| More than 61 million
Americans suffer from cardiovascular disease, primarily high blood
pressure, coronary heart disease, stroke and congestive heart failure,
according to the Centers for Disease Control and Prevention. Each
day, more than 2,600 Americans die from heart disease, making it
the leading cause
of death in the United States.
The public and medical community, however, have
the opportunity to end this epidemic through improved nutrition,
exercise and smoking cessation, according
to renowned cardiovascular disease expert
Jeremiah Stamler, M.D., former chair of the Department of Preventive
Medicine at Northwestern University Feinberg School of Medicine in
Chicago, where he is now professor emeritus.
In this interview with Life Extension
magazine, Dr. Stamler discusses conventional medicine’s approach
to reducing heart attack risk. While the preventive strategies
advocated by Dr. Stamler have scientific merit, they pale in comparison
to the aggressive approaches Life Extension members take to guard
against cardiovascular disease.
Dr. Stamler recently spoke with Life Extension magazine about how
to prevent heart disease.
Life Extension: When you mention that we can end heart disease,
is this a radical idea or does the medical community tend to agree?
Jeremiah Stamler: When I talk about the end of heart disease, I
talk about coronary heart disease and cardiovascular disease as an
epidemic problem—as a mass onslaught in the population. It
would be incredulous to say there will be no more heart attacks,
stroke, etc. The epidemic was first confronted as rising coronary
death rates after World War II, peaking in the mid-1960s, then declining
thanks to the first preventive efforts and improved medical care.
These achievements set the stage for ending the epidemic.
The coronary death rate is down more than 50% since its 1960s peak,
and the stroke death rate is down even more. But since the early
1990s, the declines have slowed or stopped, creating an urgent challenge.
What I’m talking about is how to get back fully on track.
The National Heart, Lung and Blood Institute, the Office of the
Surgeon General and health goals of the nation have acknowledged
the concept that there can be progressive decreases in the incidence
of and mortality from heart disease. So the concept of ending the
heart disease epidemic is a generally accepted one.
LE: What factors help to decrease heart disease incidence and mortality?
JS: First and foremost, primary prevention of the major risk factors
producing the epidemic—high blood pressure, high blood cholesterol,
adverse eating patterns and smoking—is key to accomplishing
this. Most major risk factors are amenable to influence by dietary
means. We have known this for decades about blood cholesterol. What
is new is that recent research has proved this to be true also for
high blood pressure. So we can now move toward the end of the epidemic.
There needs to be major emphasis on a strategy of giving high priority
to the application of this knowledge to ensure that the declines
continue. It’s a matter primarily of improving lifestyles.
LE: How many people have favorable levels of all the major risk
factors for heart disease?
JS: If we all had favorable risk factors, the epidemic would cease.
Overall, less than 10% of the general population has favorable levels
of all major risk factors. When their blood pressure, cholesterol
and smoking rates are jointly addressed, most middle- aged men and
women have one or more unfavorable risk factors. A majority has two
or three of these major risk factors, making them highly prone to
heart attack. Adverse eating patterns plus sedentary habits are big
in producing this.
LE: Recent guidelines from the NHLBI state that people
with systolic blood pressure of 120-139 mm Hg or a diastolic
blood pressure of 80-89 mm Hg should be considered as prehypertensive.
A reading of 124/84, which previously was considered “normal,” may
not be favorable for preventing heart disease. What do you make of
this statement?
JS: The word “normal” is assessed in epidemiological
circles as belonging in the museums of history. Normal has all too
often been equated with what is common in the population. Blood pressure
levels that are common in the general population—as well as
cholesterol levels, saturated fat and cholesterol intakes, and smoking
rates—are not normal. Common is what prevails in a society
at a given point in time. Common is often a measure of high-risk
status of the whole population. In the 1960s, serum cholesterol of
245 was common. Today we know a favorable cholesterol level is less
than 200 and an optimal level is under 180. The focus needs to be
on favorable and optimal and making that common in the population.
LE: What should people do to help end the heart disease epidemic?
JS: We need first and foremost to improve nutrition. Nutrition is
key for preventing rise of blood cholesterol and blood pressure to
adverse levels—the common pattern from youth through middle
age at present. Eating right, along with exercise, can prevent obesity
and along with not smoking can help to prevent heart disease.
LE: How does eating right help?
JS: Eating right can serve to maintain favorable levels of blood
total cholesterol, LDL-cholesterol (which is harmful for the arteries),
blood sugar, blood pressure and weight. Also, eating right may raise “protective” high-density
lipo-protein (HDL), have anti-clotting effects and overall have positive
effects on the heart. We have moved somewhat in that direction. Total
fat intake is down. It was 40-45% of calories in the 1950s, and is
now 32-33%. It needs to be lower—20-27% as in the DASH [Dietary
Approaches to Stop Hypertension] diet, which is about as good a diet
recommendation as we can make. Sixteen to 17% of calorie intake in
the 1950s consisted of saturated fat; it’s now 12% and needs
to be below 10%. Cholesterol intake used to average 700 milligrams
per day, and now is about 300-350 milligrams, but needs to be 250
milligrams or less.
LE: What foods are in the DASH diet that makes it heart healthy?
JS: The DASH combination diet includes high intake of fruits, vegetables,
whole grains, beans, low-fat and fat-free dairy products, lean poultry,
fish and very little red meat so that it is lower in total fats,
saturated fats and cholesterol. It is also reduced in sweets (sugars)
and salt. It markedly lowers adverse blood pressure levels. Generally,
protective nutrients come from vegetables, fruits, whole grains and
beans. Fiber may be protective in a variety of ways, but the whole
story is not in yet. There’s a possible benefit from long-chain
polyunsaturated fats such as the omega-3 found in fish. Omega-3 may
have beneficial effects on blood pressure and risk of heart arrhythmia.
LE: Despite the importance of nutrition for heart health, the United
States is experiencing an obesity epidemic, and obesity contributes
to high cholesterol, high blood pressure, diabetes and other cardiovascular
problems. How should the medical community handle this?
JS: Unfortunately, even though nutrition should be a high priority,
obesity is waxing not waning. Less privileged and lower-income population
groups of all ethnicities seem to be at even higher risk than the
upper strata. The problem reflects cultural and socioeconomic issues.
Advertising, television and radio don’t push good nutrition
and often contribute to a sedentary lifestyle.
It’s ironic that while total fat intake has gone down over
the years, reflecting public response to repeated recommendations,
the epidemic of obesity has increased during those years. There’s
too much high-calorie food out there. Everywhere we turn—on
the street there are sellers of goodies, from bakeshops to fast-food
institutions to vending machines. At the ball game, we are used to
eating. When we sit in front of television, we eat. When we go over
to a friend’s house, we eat.
My advice to people is to get on the scale every morning, and with
the first one or two pounds of weight gain, get it under control
and keep it under control. Let us condition ourselves to enjoy the
pleasure of eating foods of low caloric density—few calories
per fork or spoonful—so we can enjoy lots of good and nutrient-rich
food without caloric excess.
LE: Much attention has been given to the problem of carbohydrates
contributing to weight gain. How do you view carbohydrates and heart
health?
JS: The fact is, the food industry has often had the approach of,
if you can’t beat ’em, join ’em. As scientific
evidence increasingly showed that foods high in saturated fats and
cholesterol weren’t healthy, the food industry altered its
marketing tactics. They made substitute foods like fat-free cake
and cookies that contain concentrated calories from carbohydrates
or sugars. So the public was substituting one type of calorie-dense
food for another and making it hard to achieve a total decrease in
calorie intake.
As you cut fat, calories still need to come from somewhere. You
can increase your protein intake from 15% to 25% without fat increase,
using beans, fat-free dairy products, egg whites, seafood, lean poultry
and lean red meat. You can also replace fat calories with carbohydrates
from fruits, vegetables and whole-grain products. But refined and
concentrated carbohydrates do not supply a lot of nutrients and are
calorie-dense, causing ready weight gain.
Soft drinks and alcohol are another problem. Many people consume
soft drinks with a lot of calories from sugar, or lots of alcohol,
which is also caloric. Heavy drinking of alcoholic beverages can
cause high blood pressure and many other problems. Drinking should
be done in moderation if one wishes to consume alcoholic beverages.
LE: Do you recommend that people diet to achieve heart
health goals?
JS: I don’t emphasize going on a diet. Diets are all too often
seen as punishment for sin and by definition are pejorative. Going
off a diet is seen as returning to the pleasures of eating. All of
that is a disaster.
Instead, we need to improve the pleasure of eating and eat in a
wiser way, picking up the best from cultures around the world, while
throwing out the worst. For example, we need to eat foods low in
fat as in East Asian cultures, but avoid the high salt intake.
LE: How important is exercise? What sort of recommendations should
people follow?
JS: Exercise is very important. I recommend 30 minutes of moderate
non-weight bearing activity daily. This includes vigorous calisthenics,
walking, biking and swimming. I don’t emphasize jogging, because
of potential problems over the years with damage to feet, ankles,
knee and hip joints. Human beings exercised at work up until the
Industrial Revolution. Since then, physical activity at work has
steadily declined and we’ve developed recreational activities
that are sedentary. We became a sedentary species. If you take in
only 50 calories a day in excess, that’s 350 calories a week,
3,500 calories in 10 weeks, which equals a pound of fat. Moderate
exercise every day can create a 50-calorie deficit, helping to control
and correct weight gain.
LE: How likely is it that Americans will respond to the need for
dietary changes and increasing exercise?
JS: It’s not like putting fluoride in the water, where the
government takes care of it and our teeth are okay. Now we’re
talking about how we all behave. Health care professionals need to
communicate with people and give them practical details. Also, the
public needs to receive a continuous, steady and effective public
education message.
Once people are motivated and motivation is reinforced by sustained,
frequent effective messages and the “how-to” details
are made known, they tend to adhere to nutrition recom-mendations.
For example, much progress has been made in the area of fat and cholesterol
intake due to public education. The American public is interested
in health.
However, people still need to learn a lot of details, such as how
to read labels when they go shopping, how to find and use proper
recipes and how to know what to order when they eat out in restaurants.
Salt is ubiquitous in the food supply. Sixty-five to 85 percent of
salt we get is from salt added to foods in the process of bringing
them to market. Cooperation from the food industry is needed to end
that big problem.
We need a simple public education plan that can impact not only
what we do at home but also in the supermarkets and restaurants.
The American people will respond. I’m hopeful we will make
continued progress. |