Food for Life: How the New Four Food Groups Can Save Your Life (8 page)

It is sad to think of children of ten or eleven trying to make sense of breast development and the onset of periods, when nature almost certainly did not intend reproductive maturity so far in advance of psychological maturity. Think how different the adjustment to sexual maturity would be if children had four or five more years to anticipate it.

The effects of diet do not start at puberty. Food choices exert noticeable effects much earlier, even in the toddler years. Vegetarian children may, in some cases, grow up a bit more gradually. At first, researchers worried that these children might be growing too slowly. But it turned out that they reach essentially the same height as other children do, but slightly later. A vegetarian diet in effect extends each phase of life. Children grow up more gradually, reach puberty later, are much less likely to die of heart disease or cancer in mid-life, and overall live years longer than people raised on typical Western diets. The standard American diet has an effect reminiscent of anabolic steroids. Athletes who inject steroids have overly rapid growth and an early onset of atherosclerotic heart disease (“hardening of the arteries”).

But if we live years longer, what will we die of? Personally, I plan to die at age 120, while racing in the Monte Carlo Grand Prix. People who maintain healthful life-styles do not just add years to their lives. They also often avoid disease and the protracted decline of function that accompany cancer, stroke, diabetes, or obesity. Chances are, they aren’t just trading their “golden years” for “Medicare years,” or wasting their time shuttling between the doctor’s office and the prescription counter.

If you thought living longer means a longer period of illness or disability in old age, think again. Dr. Robert Kohn, of Case Western Reserve University, examined the cause of death of people who died at a very old age, eighty-five and later. He found that many had no identifiable cause of death. So far as anyone could tell, they had no illness, no particular infirmity. They just eventually died “of old age.”
⁷⁵
So adding years to life need not mean
years of infirmity. And when the end of life finally comes, it can be without the protracted misery that marks the last chapter of so many people’s lives.

There is little doubt that the best diet is based on grains, vegetables, fruits, and beans. “Now some people scoff at vegetarians,” says Dr. William Castelli, director of the Framingham Heart Study, “but they have a fraction of our heart attack rate and they have only 40 percent of our cancer rate. They outlive us. On the average they outlive other men by about six years now. And they outlive other women by about three years. The average age of death of a vegetarian woman is already up in the eighties, well ahead of where other women die.”

Most people are not aware that they have any control over the effects of time on their bodies. But the best scientific evidence shows that you don’t necessarily have to develop wrinkles at the corners of your eyes and across your forehead—or at least not so soon. You can keep strong bones and maybe keep your hairline a while longer, too. And as we will see in the next few chapters, you can also have a trim waistline, a teenager’s cholesterol level, and much more control over your own health, once you know how to go about it. Time will play some of its dirty tricks on us no matter what we do. But the new way of eating you are about to begin has tremendous power to shield you from damage that would otherwise age your body prematurely.

Fort Mason is a group of buildings next to San Francisco’s Golden Gate Bridge. I entered Building F at the appointed time, and was offered a seat in a circle of chairs. The other participants were heart patients, and they were palpably excited. The chest pain that had meted out increasing punishment to them over the years had given them a reprieve. Like prisoners freed from captivity, they were now doing all sorts of things they had thought they could never do again. These patients had all suffered from significant heart disease. And they got better, not with surgery but with an effective program of life-style changes.

In the not-so-distant past, doctors felt that little could be done to slow the progression of heart disease. That idea has been exploded by new scientific research. Not only do we have powerful new approaches to preventing heart disease, we also have ways to reverse it—to make even advanced disease go away without drugs or surgery, as Dr. Dean Ornish’s patients made very clear.

Cholesterol is as important a factor as we ever thought, but we know that there is a cholesterol threshold below which heart disease is very rare, and it is not the 200 value that is frequently quoted. Emerging research also shows that iron, long thought to be a purely healthful nutrient, can act as a co-conspirator with cholesterol in the poisoning of the heart.

On the other hand, we have better defenses than ever. New heart protectors—natural constituents of vegetables and fruits—can add a layer of defense. And oat bran is not the only game in town; many foods provide soluble fiber that can drive cholesterol levels down.

This chapter covers all these areas, including the dramatically effective new program used for its reversal. And in terms of prevention, the prescription
in this book is much stronger than that offered by federal guidelines or most other cholesterol-lowering programs. The reason is simple: If you want to reduce your risk of a heart attack, and especially if your goal is to reverse existing heart disease, those programs are simply too weak. As we see in this chapter, there are stronger approaches with scientifically proven effectiveness.

But first, what exactly is heart disease?

Common heart disease, or
atherosclerosis
, is a disease of arteries. The coronary arteries are perhaps the most important arteries in the body because they carry blood to the heart muscle itself. The name
coronary
comes from the fact that they ring the heart like a crown.

When a person experiences the chest pain of heart disease, the heart muscle is not getting enough oxygen. Something in the coronary arteries is stopping the flow of blood to the heart. If you could look into the artery, you would see a raised bump, called a
plaque
. It impedes the flow through the artery, just as a wad of gum stuck on the inside of a pipe would slow the flow of water.

Plaques are composed of cholesterol, fat, debris, and accumulating cells growing from the muscle layer that sheathes the artery. As plaques gradually grow, the passageway for blood becomes more narrow. When the heart is taxed by exercise or excitement, chest pain (
angina
) occurs. When the blood supply is completely blocked, part of the heart muscle dies. This is called a heart attack or, in technical terms, a
myocardial infarction
. Doctors often must treat blocked arteries surgically, with plaque-crunching angioplasty or a coronary bypass, in which arteries or veins from another part of the body are transplanted onto the heart.

We do not have just one plaque forming in our arteries. Starting in childhood, this sequence of events takes place in major arteries throughout the body. This is not a normal part of life, however. Postmortem examinations of American soldiers in the Korean and Vietnam wars showed that, while atherosclerosis had already started in these young men, their Asian counterparts did not have atherosclerosis.

Researchers set about to learn how to prevent plaques from forming and, more recently, how to make them go away. Before long, it became clear that certain characteristics help doctors predict who is going to have a heart attack and who is not. High cholesterol levels, smoking, high blood pressure, and a sedentary life-style are the best-known risk factors. In addition, your risk of heart disease is increased by diabetes, obesity, a family history of heart disease, stress, and the “Type A” personality (a need to excel, bossiness, and impatience). In addition, if your body contains too much stored iron, or your diet is low in vitamin-rich vegetables and fruits, you run an increased risk because of the free-radical damage they encourage.

If you had a bit of cholesterol on the end of your finger, it would look like wax. Cholesterol is not the same as fat. It is a specialized substance made in the livers of all animals, including the human animal, for use as a biological raw material. It is used to make cell membranes and hormones, among other functions.

Cholesterol is a dangerous substance. It contributes to the deaths of half the people in America and Europe. In a sense, cholesterol is like petroleum. Petroleum is a raw material that can be used for many purposes, but a tanker full of spilled petroleum, combined with a lit match, can be deadly. So petroleum must be very carefully contained and transported.

The body has its own oil industry, as it were. The liver manufactures cholesterol and sends it out to be used in the manufacture of hormones and cell membranes and other important parts of the body. When cholesterol is transported in the bloodstream, it is packed into special containers called
low-density lipoproteins
(LDL) and
very low density lipoproteins
(VLDL). LDL is sometimes called the “bad cholesterol” because, although it is necessary in limited quantities, a high LDL cholesterol level can dramatically increase your risk of a heart attack.

LDL delivers cholesterol to various parts of the body. When cholesterol is released from dead cells, it is picked up for disposal in another kind of package called
high-density lipoprotein
(HDL), the “good cholesterol.” The more HDL you have, the lower your risk of a heart attack. Cholesterol levels are usually measured in milligrams of cholesterol per deciliter (mg/dl) of blood serum.

If there were suddenly a huge influx of oil trucks coming from Canada or Mexico, statisticians could calculate how the risk of a deadly accident increases. The more oil trucks there are on the turnpike, the more likely a spill is to occur. The same is true of cholesterol. The more you have in your blood, the more likely you are to have a heart attack.

For four decades, the Framingham Heart Study has studied who gets heart attacks and who does not. Framingham is a small town outside Boston, which is like any other New England town except that it is a short drive from the Boston area universities. So its population has been studied by researchers for most of this century. If you had set up shop with these researchers, you would have seen something remarkable. For an entire year of the study, no one with a total cholesterol level below 150 mg/dl had a heart attack. The same thing happened the next year: not a single person whose cholesterol level was below 150 had a heart attack. And this continued the next year and the next. No one thought much about it at first. But after thirty-five years went by and no one whose cholesterol stayed below the 150 threshold ever had a heart attack, it began to seem pretty remarkable.

In many studies, researchers have found that higher levels of cholesterol are linked to higher risk. In fact, for every 1 percent increase in the amount of cholesterol in your blood, your risk of a heart attack rises by about 2 percent. That means that if your cholesterol were to go up 20 percent—say, from 200 mg/dl to 240 mg/dl—your risk of a heart attack would rise by 40 percent.
^1
,
2

Happily, it’s a two-way street. If you lower your cholesterol, you get a two-for-one
improvement
in your risk. So if you lower your cholesterol level by 20 percent—say, from 200 down to 160—your risk goes down by 40 percent.

As your cholesterol level approaches 150, there is no statistical benefit to going lower. “We think there is a threshold in cholesterol, and that it’s 150,” says Dr. William Castelli, director of the Framingham Heart Study. “We’ve never had a heart attack in Framingham in thirty-five years in anyone who had a cholesterol under 150.” The ideal level, then, is below 150 mg/dl. At that point, heart attack is not impossible, but is very unlikely.

You might be asking, if 150 is the threshold, why do we hear that 200 is a desirable cholesterol level? The National Cholesterol Education Program
set 200 as an arbitrary goal: levels below 200 mg/dl are called “desirable.” For higher levels, increasing degrees of medical scrutiny are indicated, and people with lower levels receive a measure of reassurance. Unfortunately, a lot of people whose cholesterol levels are 190 or 200 go on to have heart attacks. A level of 180 is better, and 170 better still, and so on until you reach about 150.

We know that 200 is not an ideal cholesterol level. In fact, it is quite close to the national average cholesterol level of 205. In a country where half the people die of heart disease, being near the average is not such a great thing. So why was 200 used as a goal? Because it was easy to reach. For most people, it is not difficult to lower the cholesterol level to 200. Unfortunately, setting the “desirable” level at 200 falsely suggested to people with cholesterol levels of 190 or 180 that there was nothing to worry about.