The Heart of the Matter

It now appears that inflammation, not high cholesterol, may cause heart disease. A combination of yoga, meditation, and a diet rich in good fats and antioxidants can help prevent it.
By James Keough

Doctors and researchers may never sort out the complex causes of heart disease, but that shouldn’t stop you from taking action now to protect your heart. For some that might entail major changes, but most of us just need to add the following to our already healthy lifestyles.

Reduce Your Risk Factors
Like many of the chronic diseases that plague our collective health, heart disease develops because we make poor choices about diet, exercise, and questionable habits like smoking and excessive drinking. Most people will say they know this already, so the first step is to act on this knowledge and make changes in how we eat (see “What You Should Eat” on page 52) and cut back on the proven risk factors for heart disease. Then consider taking these less well-known steps to give your heart a fighting chance:

1. Cut your insulin levels. Doctors tell us to do this to prevent diabetes, but high insulin levels also contribute to heart disease by causing a biochemical chain reaction that leads to inflamed arteries. High insulin levels also encourage the formation of abdominal fat (the all-too-prevalent spare tire). To lower insulin levels, limit the sugar you eat—nutritionist Bowden calls it a “far more damaging and inflammatory substance than fat ever was”—and avoid high-glycemic carbohydrates like white bread, pasta, short-grain rice, potatoes, and instant oatmeal.

2. Practice good oral hygiene. Regular brushing and flossing will do more than protect your teeth and sweeten your breath—numerous studies have found a link between unhealthy gums and heart disease. The most serious form of gum disease, periodontitis, can increase the risk of cardiovascular disease by more than 30 percent.

3. Reduce your stress level. Chronic stress in our bodies causes our adrenal glands to release a steady stream of cortisol as part of our natural fight-or-flight syndrome. This and other related hormones cause arterial constriction, increase blood pressure, speed up our heart rate, and promote clotting in the blood. Studies have shown that meditation, prayer, yoga, biofeedback, and other mind/body techniques can lower stress levels and reduce heart attack risk.

Take Your Supplements
You can counteract the heart-negative inflammatory foods and free-radical-inducing environmental toxins and pollutants by adding antioxidant-rich vitamins and other anti-inflammatory supplements like these to your diet.

Vitamins C and E. These powerful antioxidants also reduce arterial stiffness and combat the formation of plaque.

CoQ10. A fat-soluble nutrient found in virtually all your cells, Coenzyme Q10 acts as a powerful free radical scavenger and helps prevent LDL oxidation.

NAC. Its official name is N-acetyl-L-cysteine. NAC is a well-researched form of cysteine, an amino acid that raises glutathione, one of the body’s most important antioxidants.

ALA. Besides being an antioxidant itself, alpha lipoic acid (ALA) helps recycle vitamins C and E and glutathione in the body. ALAs are also found in flax seeds and flax seed oil.

Omega-3s. These essential fatty acids appear to reduce inflammation, prevent blood clots, and even cut down on heart attack fatalities.

Keep Practicing Yoga
Studies at Ohio State and Georgia State universities found that yoga reduces levels of the cytokine interleukin-6 (IL-6), a marker for chronic inflammation. Numerous studies have also shown that yoga reduces blood pressure (another risk factor for heart disease) primarily by lowering cortisol and bringing the central nervous system into balance.

Of course, yoga experts believe heart disease is more than just the sum of test results; they see it as a disconnect among our physical, emotional, and spiritual bodies. And they say that in order to create a healthful environment for the heart, we must weave together all the elements of practice—asana, pranayama, meditation, and selfless service. Here are some ways to do that.

COMMIT to a consistent practice and include a variety of poses that will put your body through its full range of motion. Backbends open the rib cage to improve heart and lung function; standing poses strengthen your legs and stretch your whole body; forward bends allow you to feel safe and nurtured and help quiet your sympathetic nervous system; and twists massage your internal organs and increase circulation throughout the body.

EXAMINE your emotional and spiritual status. Obviously, your blood pressure didn’t rise by itself. More than 20 years ago, Dean Ornish, MD, and his team of researchers proved to the world that emotional stress, isolation, hostility, and low self-esteem had as much to do with heart disease as high cholesterol, oxidized LDLs, triglyceride levels, and nicotine. And then they surprised the medical profession by demonstrating that lifestyle changes which include yoga, meditation, and group support can reverse the disease.

INCORPORATE ujjayi (victorious breath) and nadi shodhanam (alternate nostril breathing) pranayamas into your daily routine to reduce anxiety and agitation. If you have high blood pressure, however, do not practice kumbhaka (breath retention).

PRACTICE restorative yoga, chanting, and mantra meditation, all of which contribute to relieving hypertension and calming your heart, both physically and emotionally. (See the sample restorative practice to the right.)

Heart-Healthy Restorative Practice
Include any of these five restorative poses in your daily practice to calm your nerves and restore equilibrium. Avoid headstand or other unsupported inversions if you have high blood pressure. If you have time for only one pose, choose shavasana (corpse pose) or viparita karani (legs-up-the-wall pose) for maximum benefit.

1. Support the head in adho mukha shvanasana (downward dog)

2. Sink into your support in balasana (child’s pose)

3. Use plenty of props for supta baddha konasana (reclining bound angle pose)

4. Elevate your sacrum in viparita karani (legs-up-the-wall pose)

Three Ways to Get Your EFAs
Vegetarians (or people just worried about mercury contamination and sustainability) can get the essential fatty acids they need from plants alone.

• Hemp and flax seed oils contain alpha linolenic acid (ALA), which the body converts to the essential fatty acids found in fish oil. Hemp oil tastes better than flaxseed oil, and it contains the ideal ratio of omega-6 EFAs to omega-3s: 3 to 1. A further benefit: hemp seed oil also contains gamma-linolenic acid (GLA), which reduces inflammation and improves the health of the skin. Both oils break down when heated, and they turn rancid quickly, so refrigerate them after opening and consume them in one to three months.

• In addition to omega-3s, walnuts contain heart-healthy monosaturated fats and an especially heart-friendly, non-wheat version of vitamin E. The skin covering the nut also contains key phenolic acids, tannins, and flavonoids, so eat it too, even though it’s somewhat
bitter tasting.

• Three ways to get your EFAs: Micro-algae contain high levels of DHA and EPA that, along with ALA, make up the three essential fatty acids in omega-3s. The fish eat the algae and store the omega-3s in their fat. Micro-algae, now available in supplement form, have the same heart-healthy benefits as fish oil, according to a study in the British Journal of Nutrition.

WHAT YOU SHOULD EAT
Historically, people in the Mediterranean countries of Spain, Greece, and Italy, and those who live in Asia, particularly China and Japan, have had a fraction of the heart disease found in the United States and northern Europe—and they have some of the longest life expectancies, as well. The reason? Their traditional diets. They differ in details—you won’t find soy in marinara sauce or olive oil in a wok, but both diets have low levels of saturated and hydrogenated fats, high levels of healthy fats, and an emphasis on fish and vegetables. Cardiologists Stephen T. Sinatra, MD, and James C. Roberts, MD, coauthors of Reverse Heart Disease Now (John Wiley & Sons, 2007), propose combining the two in the Pan-Asian Mediterranean (PAM) diet, which contains these basic ingredients.

ANTIOXIDANT-RICH FRUITS AND VEGGIES. These compounds combat the free radicals that oxidize LDL cholesterol molecules and cause inflammation throughout the body. The trick here is to eat your colors.

What to eat: Brightly hued fruits like blueberries, blackberries, cherries, red grapes, and strawberries; rich green veggies like kale, spinach, brussels sprouts, and broccoli; and vibrant red veggies like beets and red bell peppers pack the highest concentrations of antioxidants. Onions, too, boast a specific flavonoid, quercetin, which blocks the oxidation of LDL. Looking for an antioxidant beverage? Try red wine in moderation (it contains resveratrol) or green tea, which blocks an enzyme involved in inflammation.

NUTS AND SEEDS. Rich in good essential fatty acids, protein, and fiber, these staples of our hunter-gatherer past also contain phytosterols (plant fats), which help cut back on the dietary cholesterol we absorb.

What to eat: Raw almonds, walnuts, pecans, Brazil nuts, and sunflower seeds.

LOW-GLYCEMIC GRAINS. Because these foods contain more fiber than their high-glycemic cousins, they take longer to digest and, therefore, help maintain steady blood sugar levels, reducing the need for dramatic increases in insulin. The added fiber also helps cleanse the digestive system and sops up excess cholesterol. In fact, studies report that a 10 g increase in daily fiber intake produces a 29 percent reduction in heart disease risk.

What to eat: Pumpernickel or spelt bread; bulgar; brown or wild rice; pearl barley, steel-cut oats, quinoa, millet, and buckwheat.

OMEGA-3 FATTY ACIDS. Processed food made with corn, safflower, and sunflower oils contains excessive amounts of inflammation-causing omega-6 fatty acids, and, as a result of our fondness for these products, the ratio of omega-6s to omega-3s in our bodies is way out of whack. Estimates put it at as much as 20 to 1 instead of a healthier 3 to 1. Avoid omega-6-rich polyunsaturated vegetable oils and processed foods, and ramp up your omega-3s.

What to eat: Cold-water fish (salmon, mackerel, sardines), hemp and flax seeds, soybeans, and sea vegetables. (See “Three Ways to Get Your EFAs” on page 52 for more vegetarian options.)

LITTLE, IF ANY, BEEF AND DAIRY. Despite their central roles in the standard American diet, these two foods contain too much saturated fat for daily consumption. They’re also high in methionine, a precursor to homocysteine, which promotes damage to the arteries.

What to eat: Substituting fish gives you lean protein and a dose of anti-inflammatory omega-3s, and avoiding animal foods altogether eliminates the problem.

GARLIC. Prominent in both Mediterranean and Asian cuisine, garlic has a long medicinal pedigree. Among other phytonutrients, it contains allicin, which boosts good cholesterol levels while lowering LDL. And it lowers blood pressure and reduces blood platelet stickiness.

How to use: Cut up raw garlic and let it sit for 15 minutes to release its healthy compounds. You need to eat the equivalent of about five cloves of garlic a day to gain the most benefit.

LOTS OF OLIVE OIL. The ancient Greeks thought the olive tree had great healing power, and studies suggest that the monounsaturated oil—high in omega-9 fatty acids—from its fruit can reduce heart attack risk and lower blood pressure.

What to use: Opt for extra-virgin olive oil, which is minimally processed, unrefined, and low in acidity.

SOY. In its many shapes and forms, soy helps raise HDL and lower LDL and blood pressure.

What to eat: Use whole or fermented soy, such as edamame (soybeans), tempeh, tamari (wheat-free soy sauce), soy milk, and soy-milk yogurt.

Contributing editor James Keough writes about alternative and complementary medicine from his home in Providence, Rhode Island. Visit his website at jameskeough.com.