Getting to the root of heart disease

What really causes heart disease? Despite sophisticated medical technology, a medicine cabinet loaded with advanced pharmaceutical weaponry and a huge amount of nous, heart disease remains globally our number-one killer. How is it possible that a disease that we appear to know so much about with our heart-healthy diets and our cholesterol-lowering strategies is still our principal nemesis?

It all begins with what you put in your mouth. After ditching meat and fats to embrace then discard carbohydrates, reverting back to animal protein with the paleo-frenzied peloton to finally adopting the Mediterranean dietrich in fruits, vegetables, seafood, beans and nuts, with a hold on all those grains, we’ve ultimately arrived at a gambit that’s endorsed by the nutritional mavens. It would have been good for our hearts had we stuck with this pattern of eating, but the problem is it doesn’t really satisfy our most basic culinary desires.

For most of us regularly chowing down on grilled fish, kale, broccoli and tomato isn’t going to transport us to food heaven. We might have abandoned steak and cigarettes only to replace these with another poison in the form of sugar and our craving for anything that is sweet. In fact the unique combination of sugar and fat hits the sweet spot in our brains that makes us consume with unbridled abandon so perfectly, a phenomenon keenly appreciated by consumer technologists, that we’ve managed to give birth to an industry that satisfies our most primal gustatory fantasies — as a result of which we’ve unleashed an epidemic of obesity that has fuelled heart disease in an unprecedented fashion.

The problem is, half of humanity don’t think they have a problem. Men don’t spend much time beating themselves up in front of an unforgiving mirror. It’s totally different if you’re a female with a similar dilemma. The cultural weight on your burgeoning girth and tormented ego is immense and it only gets harder to shed those unwanted kilos as you get older.

What we haven’t been told is that being overweight is now also the number-one cause of blocked arteries and our dismal failure to prevent heart disease. You only have to look at the number of overweight doctors to realise that our health educators are similarly ensnared by an industry that wants us to engage in a hedonistic orgy without concern for its lethal repercussions.

Aside from our obsession with cholesterol, which has spawned a whole industry of newer industrial-strength medications designed to sterilise that villain, there are a number of other malicious fats that are lining up to clog up our blood vessels. One of these is triglycerides, also quantified when cholesterol is assessed, and it goes up when the fat that is barrelling up on our outsides as a result of our profligate lifestyles also assembles around our liver cells, making it more difficult for them to eliminate the seditious sludge that is fomenting our metabolic downfall.

Unlike the ongoing pharmaceutical campaign to neutralise cholesterol, there are no drugs which corral triglycerides. The solution is patently simpler than that. We just have to turn our backs on what we’re doing every day of our lives — eating foods that are predominantly laced with sugar and fat — and get back on that treadmill. Once we jettison fat we also liberate our liver cells from all their fatty constraints and, hey presto, they process and eliminate triglycerides just as nature intended. Obviously, for most of the Western world to radically alter their eating habits isn’t going to be easy. We just need to eat lots more fish or take fish oil supplements, the natural way to lower triglycerides, except environmentalists are telling us that this is rapidly dispossessing the oceans of their natural inhabitants. Why should dead fish be responsible for looking after our hearts?

There are additional largely unacknowledged co-conspirators. Lipoprotein(a) is another potentially blood-vessel-blocking fat that can be measured and lowered with red wine, unfiltered coffee and supplements of L-carnitine and coenzyme Q10. Homocysteine, a protein found in all of us, is similarly quantifiable and subdued with B vitamins.

The final kindling that causes your engorged and overheated blood vessels to become a raging wildfire is a process called inflammation, essentially your immune cells locked in overheating malfunction. From there you’re only one small incendiary step away from a fatal heart attack. The main trigger for inflammation is obesity, and there are a number of other lifestyle-generated instigators including disturbed sleep, noise, air pollution and unremitting stress that cause inflammation to go into overdrive. Inflammation has become so potent and extensive that scientists have even devised high-powered anti-inflammatory medications to quell this process. Unfortunately, these drugs are so overarching that they also shut down the immune system.

Heart disease is largely man-made. Now that we understand it better, will we have the collective will to change our behaviours to defuse this metabolic time bomb?