While most of us think of February as a month to celebrate love and romance, the month is also a reminder of a very tragic and common disease, heart disease. Heart disease in a bit of an umbrella term, meaning heart disease is not defined as one condition in particular. Coronary heart disease, heart attacks, cardiac arrest, congestive heart failure and congenital heart failure all fall under the category of heart disease. These conditions are not only the source of 40% of the deaths in the United Sates every year, but they are also the #1 killer of women. In an effort to get a better understanding of heart disease and how to possibly avoid it, I conducted a little Q&A with Dr. Eric Ding, an epidemiologist, nutrition scientist and heath technologist. Dr. Ding is also the founder and Director of the Campaign for Cancer Prevention. Here is what he had to say:
Q: Why is it that heart disease seems to affect more women than men?
A: “There are certain social differences as well as inherent biological difference. However, there is need for clarification about the gender difference in heart disease…. Although women have fewer heart attacks than men, women are more likely to die of heart attacks than men. Part of it is differences in diet and lifestyle (e.g. men eat often more red meat and saturated fat), but also that women’s heart attacks are often less obvious, such as the fewer overt chest pains at onset of heart attacks compared to men. Additionally, women also perceive lower risk of heart attacks than they actually have, which decreases their chance of seeing the doctor. Moreover, even if women knows she has heart disease and sees a doctor, research has shown that women (compared to men) are less likely to receive ECGs, less likely to get angiograms, less likely to get bypass and stent procedures, and less likely to receive cholesterol-lowering medications. Additionally, drugs like aspirin that strongly prevent heart attacks in men are less effective against heart attacks in women. And finally, women with diabetes are more likely to die of heart disease than a similar man with diabetes. Altogether, these all lead to higher heart disease mortality for women than men.”
Q: What are the most common signs of heart disease?
A: Symptoms include, “Chest pains, sudden arm numbness/stiffness/pain and shortness of breath.”
Q: What are the survival rates for heart disease?
A: “This is tricky – it depends on many factors like age, race, geography, and duration of survival (e.g. 1 year vs. 5 year survival). But as discussed above, women have lower heart disease survival than men. The gap varies between populations, though the trend exists.”
Q: What are the most important things a woman can do to decrease her chances of heart disease?
A: “Exercise regularly (a minimum of 30min a day), maintain an optimal BMI of 18.5-25 and don’t smoke. I rank sugar sweetened beverages (SSBs) as one of the worst causes of heart disease. But it’s not the sugar per se, but rather liquid sugar intake such as in soda and sweetened juices, because liquid sugar is partially ‘invisible’ to our hunger control system. Indeed, the difference between liquid sugar and solid sugar is best seen in an experiment between sugary beverages vs. jelly beans (with same number of calories). While jelly bean eaters become full and ate less food later in the day, liquid sugar drinkers were not fully satiated and become hungrier sooner and consumed more calories at the end of the day (compared to solid sugar eaters). This is why sugary beverages (but not sugar) are inherently dangerous.
Additionally, inadequate intake of fruits and vegetables is another major cause of heart disease in America. Only a small segment of the population gets 5 servings of fruits and veggies a day, and this actually includes french fries, which nutritionists don’t really consider a vegetable
Beyond SSBs and french fries, generally, high glycemic load refined starches are a cause of heart disease. Therefore look for whole grains instead of white bread, brown rice instead of white rice, and steel cut oats instead of instant oatmeal. Also avoid mashed and baked potatoes – they have incredibly high glycemic index and glycemic load – they are equivalent to almost pure table sugar in spiking one’s blood sugar (and elevating heart disease risk).
Avoid trans-fats at all cost. Many years ago, before the nutrition and medical community realized the dangers, the emphasis had been on avoiding butter and instead people were recommended to consume Margarine instead back in the 1980s and early 1990s. However, the Department of Nutrition at Harvard School of Public Health discovered that trans-fats, high in Margarine sticks, were even worse than the saturated fat in butter for increasing heart disease risk. This eventually led to trans-fat bans from restaurants in NYC, and then the rest of the country. Trans-fats are inherently bad for both their ability to increase bad LDL cholesterol, lower good HDL cholesterol, and increase inflammation – all of which increase heart disease substantially.
Avoid red and processed meats – which have been consistently shown to increase the risk of both type 2 diabetes and heart disease. Processed meats also often have nitrites which exacerbate diabetes, which in itself is a strong causal factor for heart disease as well. Also keep in mind, that pork is a red meat, regardless of what advertising may try to persuade people otherwise.
Cocoa flavonoids are good against heart disease: multiple systematic reviews of dozens of randomized trials, cocoa flavonoids are shown to lower BP, lower bad LDL, raise good HDL, improve insulin sensitivity, and improve blood flow. A recent review of multiple long term cohort studies has also shown benefits for lowering heart disease. However, interestingly, the benefits in the trials were observed with doses of around 400-500 mg/day, equivalent of 33 bars of milk chocolate or 8 bars of dark chocolate. Thus, because it is unreasonable to consume so much calories and sugar and fat to achieve these levels of cocoa flavonoids through just chocolate bars alone… supplements of cocoa flavonoids are needed to achieve the benefits discovered. The key is getting the benefits of cocoa flavonoids for heart disease while avoiding the calories, and for that, chocolate bars are not the solution instead supplement form such as CocoaWell is an excellent option.”
Q: Is heart disease hereditary?
A: “Only partly hereditary – while over 80% is preventable, as shown in several large studies at Harvard that a combination of lifestyle factors can prevent 82% of heart disease and 90% of diabetes (a major cause of heart disease mortality).”
Q: What is the best diet and exercise protocol for a woman who already suffers from heart disease?
A: “Continue exercising and maintaining healthy body weight and drink 1 glass of wine a day (but no more for a woman).”
So clean up your diet, a dash of Cocoa and a glass of wine and celebrate for your health’s sake. Your heart will thank you for it later!