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  • Dr. Tania Dempsey, Armonk Integrative Medicine

Heart Attack: Symptoms, Prevention and Heart Healthy Diet Tips


Heart disease is the leading cause of death among adults in The United States. Every 40 seconds, someone in the U.S. has a heart attack. In a 2014 report, The American Heart Association estimated that 1 million people in the United States have a heart attack each year. 1 in every 4 deaths in the United States is due to heart disease. However, not many people understand the warning signs of a heart attack until it is too late.

What is a heart attack?

A heart attack is when there is a blockage of blood flow to the heart, either because of a clot and plaque buildup in one or more arteries leading to the heart or because of a spasm in a blood vessel that squeezes off blood supply to the heart.

What is the biggest mistake people make when having a heart attack?

The symptoms for some people, particularly women, are atypical and they often don't think it is their heart. They might wait hours if not days to get help and by then it could cause significant damage to the heart or worse, death. While men can also have symptoms that are sometimes confusing, women have atypical symptoms with a heart attack more often than the classic chest pain presentation. Those symptoms can include: fatigue, heartburn or indigestion, nausea, abdominal pain, back, shoulder or jaw pain, dizziness or lightheadedness, shortness of breath, pain in either or both arms, and sweating.

Why is time of the essence when having a heart attack?

The heart is a muscle that needs oxygen to work properly. During a heart attack, there is an absence of blood flow to the heart and within minutes the heart muscle starts to die. The faster you get help, the faster the heart muscle can be saved.

Why do they say you only have under 2 hours for the cardiologist to treat the heart after you have had a heart attack?

There is a procedure that can be done within the first 12 hours from the onset of symptoms called thrombolysis. It is essentially a "clot buster.” It is given intravenously to break up the blood clot and open up the clogged artery without surgery. While it can be done in the 12-hour time frame, the results are better if done within the first 2 hours.

What are the negative impacts of not calling 911 if you suspect you are having a heart attack?

People are often concerned about calling 911 either because of cost or because they are embarrassed that they might actually have nothing real going on. I always tell my patients that it is better to err on the side of caution and call 911 because wasting time will just make the problem worse.

What exactly is plaque in the arteries and how does it build up over time? Can that piece of chocolate cake impact you? What are examples of foods that are more likely to build up as plaque?

Plaque in the arteries used to be thought of as cholesterol build-up from the diet. It is really so much more. The question is why is the cholesterol sticking there in the first place? We know that the first step before plaque even begins to form is inflammation. Inflammation is driven by diet, particularly sugar and processed food, as well as lifestyle, smoking, infection, stress, and toxins in our environment. When inflammation sets in, the arteries can get damaged and become sticky and the body then responds in a few ways to try to repair it. Certain types of white blood cells are recruited to the area and release more inflammatory chemicals and also soak up fat/lipids.

The lipids are mainly derived from oxidized low-density lipoprotein (LDL cholesterol) and triglycerides that are produced in the liver and eventually the fat-filled white blood cells, also known as foam cells, start forming a plaque over the area of inflammation. With certain stresses, the plaque can crack and the body will respond by sending blood cells, particularly platelets to help deal with the site of injury. When the cells stick together, they can form a clot that is relatively unstable and can break off leading to a blocking of the artery.

It has been shown that even one decadent meal that is high in sugar, processed carbs and unhealthy fats is enough to cause an acute inflammatory reaction that can cause an increase in blood clotting that interferes with blood flow and can make the plaque more unstable and more likely to rupture and break off. Fast food tends to be high in processed carbs and fats, that when combined together, create the perfect set up for an inflammatory state.

Are there any superfoods you recommend that will clean the arteries for those following a cardiac diet?

I don't recommend relying on any one food to clean the arteries. It does turn out, though, that there is one food that might be considered the ultimate superfood for the heart. A Japanese cheese made from soybeans known as Natto, contains an enzyme, nattokinase, that acts as an enzyme to break down clots, can help thin the blood and is anti-inflammatory.

Overall, the key to keeping the arteries clean is to decrease inflammation through a diet that emphasizes fresh, whole foods, including vegetables, nuts and seeds, and animal protein, that are preferably organic, non-GMO and pasture-raised. The lower the inflammation, the less likely that plaque will have a place to set up shop.

What is the relationship between diabetes and heart health? How does sugar cause inflammation? I thought only cholesterol causes inflammation?

Diabetes is an inflammatory condition that is a major risk factor for heart disease. Sugars and refined carbohydrates need to be processed in a specific way through the action of certain hormones, such as insulin. Insulin plays an important role in transporting glucose from the bloodstream, where the sugar from food first goes into your cells where it can be used as energy. High levels of glucose over time lead to a dysregulation of insulin and the insulin can become less effective, leading to insulin resistance which can progress into Type 2 Diabetes Mellitus.

The excess glucose that cannot be metabolized can stick to proteins and cause the formation of advanced glycation end products, also known as AGE’s. One example of AGE is hemoglobin A1c, which is a blood test that we use to test blood sugar control. It is essentially a measurement of the amount of glucose sticking to the hemoglobin of red blood cells in the bloodstream. The less effective the body is in processing the sugar, the higher the hemoglobin A1c and the more likely diabetes and other adverse effects will occur. Hemoglobin A1c levels over 5.7% is an indication of pre-diabetes.

AGE’s are highly reactive and interact with our cells in a way that can lead to oxidative stress and inflammation. This inflammation can progress to the development of plaque in the arteries.

Cholesterol itself is not inflammatory, but cholesterol that is oxidized by AGE’s is very inflammatory. The key point here is that eating foods with cholesterol in itself is not the problem. But eating cholesterol rich foods combined with sugar and carbs causes that cholesterol to become stickier and eventually gets incorporated into the arterial plaque. A great example of a bad combination would be eating a nice fatty steak along with a baked potato, sour cream and a roll on the side. Eating the nice fatty steak alone will have a much different effect.

How would someone even know if they have a heart issue?

Heart issues are often silent until it is too late. There are some tests that cardiologists might choose to do if you have a lot of risk factors that suggest heart disease might be ensuing.

Is there any annual coronary testing you recommend that could prevent a heart attack from occurring?

There are 2 blood tests that I think are critical and every adult should have these screened yearly. One is the hemoglobinA1c (Hgba1c) and the other is the High Sensitivity C-reactive protein (hsCRP). The Hgba1c is a marker for blood sugar control and can indicate whether you are at risk for developing diabetes. If you show levels of 5.7% or greater, this can indicate pre-diabetes or even diabetes depending on the level. 70% of diabetics die from some form of heart disease so this is a critical piece of information to have. The hsCRP is a marker for inflammation and this can indicate inflammation in the blood vessels that is the impetus for the development of plaque formation.

Why do people with low cholesterol get heart attacks?

The research suggests that the total amount of cholesterol is not important but rather the types of cholesterol present. The smaller, stickier types of LDL cholesterol, whether the level is high or not, will be more likely to contribute to the formation of plaque. Oxidized cholesterol from stressors including too much glucose seems to be equally important.

How is it that perfectly healthy people even under 40 get heart attacks?

Some forms of heart attacks are not even due to blocked arteries from plaque. Rather, they could have an acute spasm of the artery that blocks off the blood supply and oxygen but the end result is the same- a heart attack.

What sort of diet and lifestyle changes do you recommend for someone who has suffered from a heart attack? Is there a cardiac diet you recommend?

The diet I recommend consists of organic, whole foods rich in vegetables and good sources of animal protein and healthy fats. I usually recommend a gluten free, grain free diet as well because of the research indicating that grains are highly inflammatory and can spike the blood sugar. Of course, no smoking, reducing stress, and participating in a monitored exercise program is also very important.

What are some things you wish people knew that could prevent them from having heart issues?

Sugar is deadly- stay away from it. Look at your family history to see if there are increased risk factors that you will need to monitor more closely. Sugar, not fat, is at the root cause of obesity, heart disease and cancer. Sugar, particularly the processed kind, causes insulin to be released from the pancreas in an effort to get the sugar into the cells to be used as energy. Too much sugar will cause a large release of insulin and over time the cells become resistant to the insulin, leading to higher levels of sugar remaining in the bloodstream and increased amount of fat production. This will eventually turn into diabetes and cause significant inflammation and damage to many organs, including the kidneys, heart and blood vessels, eyes, and the nervous system, to name a few.

In addition, certain foods contain fructose, a type of sugar found in high fructose corn syrup as well as fruit, and fructose is processed differently. It is metabolized in the liver where the excess sugar is converted into fat. The liver will store some of the fat causing the condition known as fatty liver. Sugar is a poison and until we reduce the intake in this country and in the world, we will continue to see rising rates of many chronic diseases.

How does the American diet impact cardiovascular health today?

We are the fast food society relying on processed foods that are quick and cheap. Unfortunately, the unhealthy oils, chemicals and refined carbohydrates that usually go into these foods cannot be processed by our bodies and just leads down a road to poor health.

What oils are unhealthy?

Unhealthy oils are ones that are detrimental to our cells and body as a whole. Canola oil, for example, is one of the worst oils out there. Canola oil is made from genetically modified crops, is refined, partially hydrogenated and contains trans fatty acids. Much of the canola oil on the market is also manufactured using hexane, a component of gasoline. Other unhealthy oils include corn, soy and peanut.

I will group healthy oils into two groups- the first are healthy oils that can be used for cooking and the second are oils that should be used raw and never heated. Cooking oils that are more saturated are best such as coconut oil, butter or ghee, or animal fat such as tallow. Healthy oils that should be used raw on food are olive (organic, extra virgin), flaxseed oil, safflower or sunflower oil, avocado oil and macadamia nut oil.

Are you seeing more patients having heart issues in your practice due to poor diet at a younger age?

Yes, there is no question that young people are being afflicted by heart disease. We know that children eating the standard western diet already show signs of changes in their arteries that over time will lead to heart disease at a young age.

What is the role between heart health and other diseases/issues in the body such as lyme disease or other issues you may treat? Is there any connection?

This is a great question. Mast cell activation syndrome (MCAS), which is an inappropriate release of mediators from a white blood cell, called the mast cell, can cause a heart condition known as Kounis syndrome, named after Dr. Kounis who described it. Kounis syndrome is defined as the coexistence of acute coronary syndromes including coronary spasm and acute myocardial infarction with conditions associated with mast cell activation from an allergic, hypersensitivity or anaphylactic/anaphylactoid reaction. It requires immediate treatment addressing both the heart and the mast cell reaction, but this can often be difficult since many medications used to treat the heart actually make mast cell activation worse and vice versa.

The other condition that I treat that is also linked to the heart and overall vascular health is Bartonella. Bartonella is a bacterial infection that can be transmitted from ticks, lice, flees, biting flies, spiders and cats and dogs. Bartonella, once it enters the body can hide just about anywhere, but it has a predilection for the lining of blood vessels where it can cause inflammation and damage and can even attach to heart valves causing endocarditis or infection of the heart valve.

If you could tell people one thing about heart health that you wish they knew, what would it be?

Dental health can predict heart health. Taking care of your teeth, getting regular dental exams, and using good dental hygiene with brushing and flossing can reduce the risk of heart disease because it reduces the number of bacteria in the mouth. We now understand this bacteria can not only cause inflammation in the mouth but it can also travel to the blood vessels near the heart and add to the inflammation that might be found there already setting up the perfect storm.

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