The Changing Paradigm
At one time, nothing could be done about heart disease. As someone clutched their heart and gasped, we could do nothing but look on in pain. As we learned more about the heart, we developed drugs and learned how to cut open the body and partially repair the heart. Today, the death rate for all heart-related diseases is 45 percent of what it was in 1963. Many claim that drugs and surgery are the reasons for this.
But, if this is so, why is “progress” slow-ing down? According to the Harvard
Health Letter (January 1998), there appears to be a slight rise in the incidences
of stroke and kidney disease, and a leveling of the death rate from heart disease
among U.S. adults. In other words, perhaps the well-established paradigm—drugs
and surgery is not the best answer. Perhaps it is time to review our past and see
what we can learn. Perhaps it is time to change the paradigm.
The history of the heart and its diseases, like all medical history, is a history of
ideas: an initial idea, reinforcement of the idea, challenges to the idea, rebukes
to the challenges, and, perhaps, a new idea.
One of the first ideas was put forth by Erasistratus of Alexandria, who dissected
animals and humans (probably Egyptian mummies) 2,300 years ago. He discovered
the veins, arteries, and nerves, and postulated that the heart is nothing more than
their junction and that the arteries contain not blood, but air, spirit, or soul (called pneuma).
This entered the body through the nose, throat, and lungs—in other words, through
breathing. He believed the veins do contain blood, and his rationale for why blood
comes from open arteries is that the blood from veins rushes in as the pneuma floats out.
Parts of this idea were reconfirmed, but many more were challenged and disproved.
The great physician of the Roman Empire, Galen, confirmed that veins contain blood,
but did away with the idea of pneuma. He saw that the heart is more than a “circulation
junction” and that blood flows throughout the body, but believed it ebbs and flows with
the heartbeat. Galen was such a great influence upon the medical world that his ideas
became “medicine”. They were codified, made rigid, and acknowledged as the “limit” to
The Renaissance saw the first revolt against the dogmatic rules that Galen’s ideas had
become. The Swiss physician Paracelsus rejected much of Galen’s thought and spoke
forcefully against the tendency to accept Galen’s ideas as truth:
“Who does not know that doctors make terrible mistakes, greatly to the harm of their
patients? Who does not know that this is because they cling too anxiously to the
teachings of Hippocrates, Galen …”
For daring to challenge the status quo, he was condemned to a nomadic existence,
travelling from town to town.
Andreas Vesalius, born in 1514, continued the challenge to the medical status quo.
He compiled the complete anatomy of the human body and, in doing so, discovered
and exposed more than 200 errors by Galen. In undermining much of this traditional
medical authority, he became controversial at best, and a pariah at worst. He was
attacked by many of the pro-Galen forces and retired from academic pursuits,
embittered, and disillusioned.
William Harvey, known as the grandfather of cardiology, drove a stake into the heart
of the old school of cardiology. He understood that the heart and blood are elements
within a closed system, described correctly how blood flows through the heart, and saw
that the heart is the engine that pumps blood. He saw that the heart, lungs, and blood
vessels are interdependent and that what we call heart disease may actually originate
somewhere other than the heart, especially in the arterial systems.
A common thread that runs throughout this brief history (and, as we shall see, continues
today) is that ideas become a rigid status quo (often through no fault of the ideas’ originators)
and that when they are challenged, the challenger is repudiated, discredited, and often
driven out. It is reported that even Harvey, after publishing his ideas, suffered an immediate
decline in number of patients because of his “strange theories.”
“Strange theories” …
The notion that new ideas are “strange theories” continues in modern times.
In the ’60s and ’70s, Nathan Pritkin was persecuted as a quack and incompetent
rebel when he concluded that most heart disease is reversible through a combination
of diet, exercise, and stress management. The medical profession was relentless in its
criticism, accusing him of giving patients false hope and defrauding them by selling them
his program of lifestyle changes to prevent heart disease.
The 1960s saw another alternative opinion shot down by the medical community.
Kilmer S. McCully, M.D., then a professor of pathology at Harvard University Medical
School, went against the “killer cholesterol” tide when his studies pointed to an amino
acid, homocysteine, as a major cause of heart disease.
McCully had come across research that noted that some mentally retarded children
were dying of heart disease before reaching puberty, and the reason was due to high
blood levels of homocysteine. In 1969, after studying this issue, McCully proposed that
many Americans suffer from cardiovascular disease due to high homocysteine levels, not
cholesterol. More radically, he proposed that all one has to do is take B-complex vitamins
to solve this problem.
For the next few years, McCully struggled against the cholesterol tide and, in 1978,
had to leave Harvard. In his book, The Homocysteine Revolution, he notes that he
was told he had “failed to prove his theory.”
… Become mainstream
Pritkin and McCully, like Vesalius and Harvey before them, were proven correct. In the
late ’80s, Surgeon General C. Everett Koop took the bold step of reversing decades of
medical thought when he declared that 75 percent of the deaths in America are caused
by lifestyle decisions on diet, smoking, and consumption of alcohol. Today, the National
Heart Association publishes a list of dietary recommendations that echo Pritkin’s earlier
McCully was also vindicated. Articles on homo-cysteine began reappearing and, in 1995,
studies in the Journal of the American Medical Association reported that homocysteine is
a major risk factor in CVD. Today, homocysteine is considered an independent risk factor-it
is not influenced by other factors, such as smoking, cholesterol, and physical activity. It is
also acknowledged that ade-quate amounts of vitamins B12 and B6 and folic acid can reduce
high homocysteine levels and lower the risk of CVD.
Today, there is more and more emphasis on lifestyle as the key to cardiovascular health.
Virtually all heart organizations acknowledge that diet and exercise are keys in preventing
heart disease and recommend a diet that is low in total fat, saturated fat, and cholesterol
and rich in fruits, vegetables, and fiber.
The paradigm changes
The paradigm underlying these new ideas is that we are responsible for our health.
If bad lifestyle decisions are responsible for 75 percent of the deaths in America; if
most heart disease is reversible through a combination of diet, exercise, and stress
management; if nutrition combats high homocysteine and cholesterol levels, it means
that we have it in our power to control our health destiny. We do not have to wait until
the crisis and then rush to the doctor or hospital; we can take steps to lower our risk of,
and prevent, CVD.
Cardiovascular diseases (CVD)–which encompass events such as heart attack, stroke,
angina pectoris, atherosclerosis and arteriosclerosis, and high blood pressure–are the
No. 1 killer in North America. In the United States, somebody dies from heart disease
every 33 seconds, and from a heart attack every minute. In Canada, in 1992, CVD
accounted for 38 percent of all deaths.
One drawback to the “cholesterol as king” theory of cardiovascular disease (CVD)
is that many people with no risk factors suffer from heart problems.
Indeed, an article in the June 26, 1996, issue of the Journal of the American Medical
Association notes that the traditional CVD risk factors (age, genetics, gender, smoking,
blood pressure, cholesterol, sedentary lifestyle, diabetes, weight, stress) only explain
about 50 percent of all CVD. The amino acid homocysteine may be the reason.
Homocysteine is formed when the body breaks down protein, especially the protein found
in meat. Meat protein contains the essential amino acid methionine, and when methionine
is digested, it produces homocysteine. According to McCully’s theory, if homocysteine levels
increase, the result is the buildup of plaque, which, of course, may lead to atherosclerosis,
heart attacks, strokes, and death.
Homocysteine builds up if we eat too much meat or do not get sufficient amounts of
vitamins B6 and B12 and folic acid. These three vitamins are integral in the process
of recycling and excreting homocysteine. If we do not have sufficient amounts of these
vitamins, homocysteine levels rise.
Reducing the risk
Practicing AIM’s Healthy Cell Concept is the first step. This concept states
that five elements–cell food, cell exercise, cell environment, cell protection, and
a healthy mental attitude–are all it takes to regain and maintain your health. You
will find that living the Healthy Cell Concept encompasses the following ways to reduce your risk.
Paying attention to all risk factors may help in combating the “unchangeable” risk factors
of age, sex, and heredity. For example, one of the reasons men are more at risk for CVD than
women may be because, on average and historically, they have smoked more and dealt more
with job-related stress. The trend is now changing. Incidences of CVD in women are rising, and
more women than men are now dying from CVD: In 1995, about 455,000 males and 505,000
females died from CVD. This may be because women are smoking more and are being subjected
to more stress after entering the job market.
Stopping smoking limits your risk of cancer,
emphysema, heart attack, and stroke (not to
mention you won’t smell like an ashtray).
Lowering your weight can raise your “good” cholesterol level and lower your
“bad” cholesterol level. It also helps prevent diabetes and strengthens the heart.
Exercising has the same benefits as losing weight and, hey, helps you lose weight!
Changing your diet is one of the biggest things you can do. Avoid foods high in
cholesterol, saturated fat, trans-fatty acids, and all fat-doing so will reduce cholesterol
levels, reduce risk of cancers, and help you lose weight. Eat more fruits, vegetables,
and fiber. This again helps maintain healthy cholesterol levels, and substances found in
fruits and vegetables known as phytochemicals work to prevent cancers. Fiber lowers
cholesterol and is linked to lower incidences of some cancers and heart disease. It can
also help you lose weight. Decreasing your sodium intake and increasing your potassium
intake can help you maintain a healthy blood pressure.
Using supplements (and foods) high in antioxidants may help prevent CVD. Folic acid
and B vitamins combat a high homocysteine level. Garlic and ginkgo both aid circulation
in general, and garlic has been shown to reduce cholesterol levels and blood pressure.
Coenzyme Q10 helps in the manufacturing of energy, improves quality of life for those
who have suffered heart problems, and may help lower high blood pressure. Fish oil
reduces triglyceride (a type of fat) levels and may help reduce the incidence of coronary
heart disease. Tocotrienols reduce cholesterol levels and may help prevent breast cancer.
Vitamin E may reduce risk for CVD.
Practice stress reduction exercises.
Doing so can result in lower blood pressure, less incidence of CVD, and a stronger immune