The Role of Inflammation in Heart Disease

Chronic inflammation is recognized as a contributor to several chronic diseases, including heart disease.  Most people believe that it is all about their cholesterol level, and target dietary cholesterol and saturated fat as the villains for increased risk of heart disease.  Unfortunately, common dietary guidance for heart disease does not match the scientific evidence.

When we visit the doctor for heart disease screening, the blood lipids that are measured include LDL and HDL cholesterol.  LDL and HDL are actually lipoproteins that transport cholesterol.  They are not necessarily harmful as they perform their normal transport functions.  In order to cause disease, they have to damage a blood vessel which triggers a series of potentially harmful inflammatory reactions in an attempt to repair the damage.

To better understand inflammation, think about a time when you cut yourself.  Your body’s normal response to repair the injury is inflammation, a surge of both red and white blood cells to the site to do their part.  This also happens in the blood vessels, and the repair creates a plaque which can grow in size to block the blood vessel or it may shear off and cause blockage in a small vessel.  The formation of plaque in the blood vessel walls also makes them less flexible, contributing to high blood pressure.

The development of heart disease, or specifically atherosclerosis, is from inflammation and oxidative damage in the wall of the blood vessel, not from blood cholesterol floating through the artery, haphazardly sticking to the vessel walls. 

Simple changes in how you eat can help counteract chronic inflammation, a root cause of many serious diseases, including heart disease.

Some foods have been shown to increase inflammatory markers and some foods have been shown to reduce them.  As a result, many health professionals are now recommending an “anti-inflammatory” diet rich in foods that reduce inflammation.

Anti-Inflammatory Diet Guidelines

The graphic that I think summarizes an anti-inflammatory diet best is Dr. Weil’s anti-inflammatory food pyramid.

 Source: http://www.drweil.com/drw/u/PAG00361/anti-inflammatory-food-pyramid.html

As shown on the pyramid, foods that help reduce inflammation include vegetables, fruits, whole grains, beans, healthy fats, fish rich in omega-3 fatty acids, whole soy foods, cooked Asian mushrooms, high quality dairy and meats, spices, and tea.  The items at the top to eat sparingly include red wine and dark chocolate.  It is important to note that the base of the pyramid is filled with real food, not highly refined packaged foods that fill the grocery shelves.  This means that you may need to re-introduce yourself to your kitchen and get back to the basics.

What about foods that promote inflammation?  In general, a Western dietary pattern promotes inflammation. This pattern includes foods high in sugar (especially desserts and soft drinks); refined grains; red and processed meats; and fried foods, particularly fried potatoes.  Specific foods to avoid include white flour and sugar foods and refined vegetable oils high in polyunsaturated fat (sunflower, safflower, corn, and cottonseed oils).   

In addition to follow an anti-inflammatory diet, reducing stress and getting regular physical activity are essential for reducing chronic inflammation. 

For additional information and tips for implementing an anti-inflammatory diet, I recommend Dr. Weil’s website.

If you need help customizing your diet to reach your health goals, call Full Life Nutrition for a free 15-minute nutrition consultation at (206) 391-5479.

Blood Pressure - Know Your Numbers!

High blood pressure, or hypertension, affects about 30% of adults and if untreated, increases risks for heart disease, stroke, kidney disease, and dementia.  Often the cause of high blood pressure is due to many factors, including a combination of lifestyle and genetic factors.

Blood pressure is the force exerted per unit area on the walls of arteries and it is measured in millimeters of mercury (mm Hg).  The measurement is expressed as two numbers:  (1) systolic pressure - the amount of pressure in arteries as the heart contracts, and (2) diastolic pressure – the amount of pressure that remains in arteries between beats with the heart is relaxed. 

Classification of Blood Pressure	Systolic/Diastolic Pressure
Normal	< 120/80 mm Hg
Prehypertension	120-139/80-89 mm Hg
Hypertension – Stage 1	140-159/90-99 mm Hg
Hypertension – Stage 2	≥ 160/100 mm Hg

It is normal for blood pressure readings to fluctuate during a 24-hour period.  Don’t eat, smoke or drink caffeine or alcohol within 30 minutes prior to a measurement.  It is also best to sit down for at least 5 minutes prior to a measurement.

Lifestyle Strategies for Reducing Blood Pressure

If your blood pressure is above the normal range, diet and lifestyle can have a significant impact in achieving optimal levels.  If lifestyle changes are recommended by your doctor as primary treatment, it is important to maintain these changes for 6 to 12 months for the best results.

Lifestyle modifications that have been shown to lower blood pressure include maintaining a healthy weight, consuming a diet rich in fruits, vegetables, and low-fat dairy products and low in sodium, participating in regular physical activity, and limiting alcohol consumption.  Stress management is also beneficial for managing blood pressure. 

The National Institutes of Health published the following summary of the impact of lifestyle changes on blood pressure.¹  The effects of implementing these modifications are dose and time dependent and could be greater for some individuals.

Lifestyle Modification	Recommendation	Approx. Systolic Blood Pressure Reduction
Weight reduction	Maintain normal weight (BMI 18.5-24.9 kg/m2).	5-10 mm Hg/22 lbs
Adopt DASH eating plan	Consume a diet rich in fruits, vegetables, and low-fat dairy with a reduced content of saturated and total fat.	8-14 mm Hg
Dietary sodium reduction	Reduce dietary sodium intake to no more than 2,400 mg/day.	2-8 mm Hg
Physical activity	Engage in moderate aerobic physical activity such as brisk walking (≥ 30 min/day most days of the week).	4-9 mm Hg
Moderation of alcohol consumption	Limit consumption to no more than 2 drinks per day for men and 1 drink per day for women.	2-4 mm Hg
	Total approximate reduction from all factors	21-45 mm Hg

While each of these separate lifestyle modifications has only a small impact on blood pressure, adopting all of them over time could make the difference between hypertension – stage 2 and normal blood pressure levels. 

Untreated high blood pressure can be very dangerous.  Over time, the increased force on the blood vessel walls may cause damage that promotes the development of atherosclerotic plaque.  As the plaque deposits increase, they narrow the space inside the blood vessel through which blood flows, increasing the risk of heart attack or stroke.

Visit your health care practitioner regularly to monitor your blood pressure or buy a blood pressure monitor to take your own readings at home.  You can find easy to use, automated blood pressure monitors at your local pharmacy or online.

Next week:  all about inflammation and its effect on heart health.  Plus, foods that will help you reduce inflammation every day.

Reference

¹ From the National Institutes of Health, National Heart, Lung, and Blood Institute National High Blood Pressure Education Program: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, NIH Publication No. 04-5230, August 2004.

Health Benefits of Sweet Cherries

I recently received an industry magazine with a full- page advertisement for cherries.  Normally I skip right past the advertisements, but I was so impressed with the information that I wanted to share it.

      Source:  Northwest Cherry Growers paid announcement.  For more information and 

      citations, please visit www.nwcherries.com.

Northwest Cherry Growers highlighted 7 reasons to include cherries as a regular part of your diet:

1. Cherries contain flavonoids and procyanidin, which may help protect brain neuron cells to reduce the risk of dementia. 
2. Cherries are rich in vitamin C, fiber, carotenoids and anthocyanins – all which may help keep cancer cells in check.
3. Potassium in cherries may help keep blood pressure in check, reducing the risk of stroke.
4. The anthocyanins in cherries may also help reduce inflammation, a risk factor for cardiovascular disease. 
5. The glycemic index for cherries is lower than plums, blueberries, peaches, grapes, and apricots, making it a good choice for managing blood sugar.
6. The phytochemicals in cherries may be a factor in reducing inflammation, which helps to reduce pain from injuries or other diseases.
7. Cherries contain melatonin, which helps regulate sleep cycles, especially after long flights.

While there is likely an equally long list of health benefits for other fruits and vegetables, it is the perfect time to highlight the goodness of fresh, sweet cherries while they are in season.  Enjoy in smoothies, jams, or eat fresh for a sweet snack.

Heart Disease: How is it Diagnosed?

There are many different methods used to diagnose heart disease from lab values, to an electrocardiogram, stress test, CT heart scan, or MRI of the heart.  If you are over 40 or have a family history of heart disease, it is important to discuss your risk for heart disease with your doctor. 

Your doctor will likely discuss key lifestyle areas that could represent risk for heart disease including diet, exercise, smoking, and stress.  A fasting blood lipid panel will also be ordered to measure the total cholesterol, low-density lipoproteins (LDL), high-density lipoproteins (HDL), and triglycerides in your blood.  Abnormalities in these values can represent a risk for heart disease.

Understanding Your Lab Values

Most people understand that a total cholesterol level under 200 mg/dl is desirable, and levels significantly over this represent increased risk for heart disease.  But how do LDL, HDL and triglycerides fit into the picture?

LDL and HDL are both complex particles called lipoproteins.  Lipoproteins transport lipids, including cholesterol, in the blood.  LDL and HDL differ in the ratio of protein to lipids and are classified based on their density.

LDL = low density lipoprotein; is highest in cholesterol esters as a % of weight

HDL = high density lipoprotein; is highest in density due to a high protein/lipid ratio

LDL transports lipids through the blood stream to various tissues throughout the body.  The LDL attaches to a cell membrane via an LDL receptor to deliver cholesterol for cell membrane synthesis.  The cell membrane requires cholesterol for normal structure and function.  However, excess cholesterol not needed by cells remains in the blood as LDL which can play a role in the development of atherosclerotic plaque in blood vessels.  Thus, high blood levels of LDL correlate with higher risk of heart disease.

HDL has an entirely different and more beneficial role in the body.  HDL functions to transport cholesterol from tissues and from other lipoproteins to the liver.  The liver can then excrete excess cholesterol as bile acids necessary for digestion of dietary fats.  Thus, high blood levels of HDL correlate with lower risk of heart disease.

A triglyceride is a glycerol molecule with three attached fatty acid chains.  Triglycerides are derived from fats in foods, but may also be metabolized from carbohydrates and sugars by your liver.  They are the storage form of fat in your body, a concentrated source of energy available when your body needs it.  If you eat more food than your body needs for energy and repair, it will be converted to triglycerides and stored for future use.  Your triglyceride level can vary greatly depending on the content and size of your meals so it is important to fast for 8-12 hours prior to your blood draw.

The classification of each of the blood lipids is shown in the table below.

Classification of LDL, Total, and HDL Cholesterol (mg/dL)

Lab Value	Classification
Total Cholesterol
<200	Desirable
200-239	Borderline high
≥240	High
LDL Cholesterol
<100	Optimal
100-129	Near optimal/above optimal
130-159	Borderline high
160-189	High
≥190	Very high
HDL Cholesterol
<40	Low
≥60	High
Triglycerides
<150	Normal
150-199	Borderline high
200-499	High
≥500	Very high
Cholesterol Ratios
Total Cholesterol:HDL	Optimal is 3.5:1 (goal <5:1)
LDL:HDL	Optimal is <3:1

Source:  Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). National Institutes of Health, National Heart, Lung, and Blood Institute.

The results of your blood lipid panel are a good starting point to understand how your diet and lifestyle are affecting your heart health.  Some cardiologists have begun to also use lipoprotein particle concentration and size measures to evaluate risk of heart disease.  Tests are also used to test for genetic components that may contribute to abnormal lipid profiles.

Unless your doctor identifies a genetic component to your abnormal lipid levels, diet and lifestyle play a major role in improving your cholesterol and triglyceride levels.  After we set the foundation with a good understanding of what heart disease is and how it is diagnosed, I will include current information about foods that will help you reduce your cholesterol and your risk of heart disease.

In the next post, I will cover the diagnosis of high blood pressure, and the connection between elevated blood pressure and the development of atherosclerosis.

Lifestyle Factors and Heart Disease

Heart disease is often referred to a ‘lifestyle’ disease, meaning that the elements in our life that we choose to experience regularly may either increase or decrease our risk of heart disease.  The 2004 INTERHEART study of heart attack incidence in 52 countries found that diet and lifestyle factors may have the potential to prevent 90% of the heart attacks in these populations.   

Unfortunately, many people wait until they have symptoms of heart disease before they pay attention to their diet and lifestyle choices – or they continue to ignore them until it is too late.

The lifestyle factors most important for heart health can be summarized into 4 key items:  

1.  Smoking - Let’s get smoking out of the way first.  Smoking is strongly linked to increased risk of heart disease.  Smoking 40 cigarettes per day increases the risk of heart disease 900 times compared to nonsmokers.  Even smoking only 1-4 cigarettes per day increases the risk by 40%.  If you smoke, find a way to quit.

2.  Stress Reduction – Chronic stress is also strongly correlated with risk of heart disease.  Chronic stress without periodic relief increases the amount of cortisol released from our adrenal glands.  It is part of our “flight or fight” response to being in danger.  These elevated cortisol levels increase both inflammation and oxidative damage in our bodies, including blood vessels.  This promotes more plaque buildup and potential blockage of a blood vessel.  Find what works for you to defuse daily stress – a walk, meditating, talking with a close friend or counselor, deep breathing, etc.  We all experience stress every day.  The key is to use what works for you daily to break the cycle.  Don’t wait until the stress is over or until the vacation you have planned two months from now.

3.  Physical Inactivity – Inactive people are 1.5 to 2.4 times more likely to develop heart disease.  Regular physical activity, defined as 30 minutes per day, helps to decrease our cortisol level, decreases our feelings of stress, and strengthens our heart and blood vessels.  The best way to increase your activity is to build it into your lifestyle.  Walk or bike to work, walk to complete your errands, take the stairs wherever you can, find an active hobby that you love.  Regular physical activity will decrease inflammation and oxidative damage.

4.  Food Choices - There are so many mixed messages about what is healthy that it is difficult to know what to believe.  How do you choose the right diet?  

     The problem with most people’s diets is that they are including too much of the harmful foods and not enough of the foods that protect the heart and blood vessels.  You can change the balance by focusing on these foods.  Limit foods high in sugar and white flour, and increase foods rich in antioxidants (fruits, vegetables, legumes), omega-3 fatty acids (cold water fish such as salmon or sardines, flax seeds, or walnuts), and soluble fiber (fruits, oatmeal).  I’ll include more detail on what to eat and why after more information about heart disease and the cause of plaque in blood vessels.

There isn’t just one magic bullet or drug that will decrease the risk of heart disease.  How much we move, how we feel about life, and what we choose to eat and drink all contribute to the health or decline of our cardiovascular system.  The key is to implement changes over time to create an overall lifestyle that fits your values and health goals.  Pick one area to focus on, find the support you need, and take action.

Next I will include information on how heart disease is diagnosed and how to better understand what your lab values mean.  Stay tuned!