You do everything right. Your LDL cholesterol is below 50. You check your LP (a) and it is very low. You eat a superior diet and your alcohol consumption is close to zero. You take your medicines as directed. The data would tell you that you are pretty much protected against having another heart attack!
But then, there you are, Shabbat afternoon in the back of an ambulance with pretty bad chest pain on the way to the emergency room. Two hours later, you are in the catheter lab getting two emergency stents. Finally, relief!Yes, that is what happened to me two weeks before the Passover holiday. Now what? Is this my destiny? What else can I possibly do in the realm of lifestyle to prevent the next one?
First off, I feel well. I think I feel better than I have felt in a very long time. I am back to moderate exercise and other than having to rebuild some endurance, I can do pretty much whatever I need to do.
The two mentalities when a healthy person falls ill
I’ve heard two diametrically opposed sentiments from people. The first one, and I think the correct one has been: “It’s a good thing you take care of yourself the way you do because this could have had a much worse outcome.” And then there is the other way of thinking, the one I totally disagree with, which is: “See, all this effort you put in – why not just eat what you like and do whatever you want? Because all this didn’t help you!”
I almost understand why people would say that, but it comes from a lack of understanding as to what happens when you have an acute heart attack or have heart disease. At the end of the day, the damage I sustained was relatively mild. There are reasons it went down that way.
I WAS pretty miffed and upset about what happened. All this work to become “heart-attack proof” and now this? It wasn’t even 24 hours after my event when I began asking questions. A well-known, veteran cardiologist saw me on rounds the day after my stents.
I asked him straight out how, with such a low LDL and low LP(a), this could happen. He said there are other factors including genes. I don’t have great genes for cardiovascular health; both my father and grandfather had heart disease and heart attacks. But research tells us that genetics is a relatively minor player compared to lifestyle.
Subsequently, I spoke to a friend and cardiologist in the United States who runs a fantastic “Food is Medicine” program for over 300 of his patients. He is very successful at helping them heal and even getting many of them off their medications. He was also very surprised. He even picked up the phone to call and asked me a lot of questions.
Then there was the professor who came around with his cardiology students. I took the opportunity to ask him also.
Of all the answers I got, perhaps his was the best. He told me that we know what we know, but we also have to know what we don’t know.
To be perfectly honest, I fell into some despondency. But they say timing is everything. A research paper was just published and presented last month at a cardiologist conference. I found it very heartening (pun intended). Maybe intellectually you understand that you aren’t wasting your time, but it is really nice to see it in the science.
IN THE study presented at the American College of Cardiology’s Annual Scientific Session, people with cardiometabolic disorders – such as obesity, diabetes and heart disease – could increase their chances of living longer by adopting a healthy plant-based diet. This is talking about people who have these diseases entrenched.
“Among populations with cardiometabolic disorders, higher adherence to a healthful plant-based diet was significantly associated with a lower risk of total, cardiovascular and cancer mortality,” said Zhangling Chen, MD, PhD, of the Department of Cardiovascular Medicine at the Second Xiangya Hospital of Central South University in Changsha, China, the study’s lead author. “More intake of healthy plant-based foods, less intake of unhealthy plant-based foods and less intake of animal-based foods are all important.”
How much of a difference does it make? I quote the paper: “Overall, closer adherence to a healthful plant-based diet was associated with a 17% to 24% lower risk of death from any cause, cardiovascular disease or cancer, while closer adherence to an unhealthful plant-based diet brought a 28% to 36% increased risk of death from any cause, cardiovascular disease or cancer.”
That is very significant. Consider that a meta-analysis published in 2022 in JAMA-Internal Medicine showed that statin drugs reduced the risk of all-cause mortality by 9% (relative risk). So here we see that proper dietary change does more than taking a statin. This doesn’t mean, particularly if you have had a cardiac event, that you shouldn’t take your statin – you should. But this is to point out the significance, even in people who already have heart disease, of maintaining a good, healthy plant-based diet.
It's easy to give up, but everything makes a difference
IT’S EASY to say that it’s all genes; it’s easy to just give up. But everything makes a difference. And in my case, it was enough of a difference so that I am alive and have quality of life. It’s true that heart disease is about 90% preventable and that most people can halt the disease in its tracks or even reverse it. But there is that other 10%...
There are many factors in heart disease. Food is the most important, but as Dr. Dean Ornish – the man who first proved you can reverse coronary artery disease and points it out in his book Undo It! – there are a lot of other modifiable factors for our health. Do we sleep enough? What about alcohol or other substance use? Are we controlling our stress? What techniques are we using for relaxation? How are we doing in the relationship sphere? It all matters, so it’s not all the genes’ fault.
For me, I will figure out how to do better; there is no rationale whatsoever to throw in the towel. I am not going back to burgers, fries, pizza, and fatty-sugary deserts I was into putting into myself 20 years ago. There will be more vegetables and fruits, whole grains, and legumes. Water, along with some green tea and even some black coffee, are still the beverages of choice.
There are many to thank, among them the paramedics, the doctors and nurses in the ER, the ward and the doctor who put in the stents. Most of all, to the One above, who came to my rescue yet again.
Just know that along with my unfavorable genes do come some favorable ones. Two close relatives of mine have heart disease. One is 96 years old, the other is 93. So I have every reason to pay very close attention to what matters to my health – and so do you to yours. I use the principles of lifestyle medicine with all of my clients, I use it on myself, and you should use it, too, so that we all can “add hours to your days, days to your years and years to your lives.”
The writer is a wellness coach and personal trainer with more than 25 years of professional experience. He is a member of the International Council of the True Health Initiative, on the board of Kosher Plant Based, and director of The Wellness Clinic. alan@alanfitness.com