Breaking the heart: heart disease starts early, studies show but it doesn’t have to

The bodies in the labs belonged to teenagers who had died suddenly in car accidents, had been killed, or had committed suicide. Upon examining the bodies, researchers noticed that a surprising number of the teens carried a biological time bomb set to detonate later in life: fatty deposits in blood vessel walls. Those deposits can lead to deadly heart disease, the biggest single killer of Americans. One-third of all teenagers will eventually die from heart disease, according to the American Heart Association.

Although symptoms of heart disease rarely occur until age 50 or later, the hundreds of subjects examined in the “Pathological Determinants of Atherosclerosis in Youth” (PDAY) study mentioned previously show that the buildup of fatty deposits is already happening in many young people’s cardiovascular systems. “The process begins in childhood and progresses throughout life,” says Dr. Rae-Ellen W. Kavey, a pediatric cardiologist at the National Heart, Lung, and Blood Institute in Bethesda, Md. Luckily, heart disease can be slowed and even reversed.

Clogged Pipes

A quick tour of the circulatory system is important for understanding how heart disease strikes. The heart is a muscular pump about the size of your fist. It pumps blood through an intricate network of rubbery tubes (blood vessels) that wind their way to every body part. The blood flowing through large vessels called arteries is laden with the oxygen and nutrients that body tissues need. The blood drops off this vital cargo and flows back to the heart through veins. Blood draining from tissues also carries waste products, which are filtered through other organs and removed from the body. All of the body’s blood vessels, along with the heart, make up the circulatory system.

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For the blood to circulate, the tubes that carry it need to be open. In a process called atherosclerosis, a fatty material called plaque builds up on artery walls and narrows the lumen, or empty space, of the vessels (as seen in the subjects of the PDAY study on page 28). The arteries that supply blood to the heart, called the coronary arteries, are especially crucial. They are narrow, so even a small amount of plaque buildup can dramatically constrict the channel. A clot can form, completely blocking the narrowed artery. After just a few minutes without blood flow, the affected heart muscle cells can die, producing a heart attack. The attack may kill or disable a person, depending on the extent of injury to the heart muscle.

Controlling the Risk

Almost all teenagers in the United States have fatty streaks in their arteries that signal the beginnings of atherosclerosis, the PDAY study demonstrated. But the severity of the damage to the coronary arteries depends on certain risk factors, says Dr. Henry McGill, a pathologist at the Southwest Foundation for Biomedical Research in San Antonio, Texas. The important risk factors that you can control are high blood pressure (hypertension), diabetes, obesity, high blood cholesterol, physical inactivity, and cigarette smoking.

Blood pressure is the force that blood exerts as it pushes against artery walls. Blood pressure is measured in millimeters of mercury and includes two numbers. The first is the systolic blood pressure, taken when the heart beats; the second is the diastolic pressure, the pressure when the heart relaxes between beats. Hypertension occurs when either number is higher than normal–that is, higher than 120/80 for an adult. (The cutoff is lower for teenagers because blood pressure generally rises with age.) If the blood’s force is too great, the heart has to work overly hard. Hypertension can also stimulate the development of plaque, although scientists are not yet sure how.

Hypertension, not common in teens before the 1990s, is now appearing more often in young people, primarily those who are overweight. More young teens are also developing diabetes, a disease in which levels of blood sugar are high. That can harm the heart, Kavey says; again, diabetes is often associated with excess weight. As a result of those trends, today’s teens may start having heart attacks in their 30s or 40s, a decade earlier than today’s adults usually do. “That’s terrifying to me,” Kavey told Current Health.

Besides its association with high blood pressure and diabetes, being overweight is risky for the heart for other reasons, in the PDAY study, the subjects who were obese (significantly overweight) had almost twice as much plaque in their coronary arteries as did the teens who were not overweight.

Another type of fat can be a problem for the heart: cholesterol, a soft, waxy substance found in the blood and in all body cells. The body makes its own cholesterol and gets some from animal-derived foods such as meats, eggs, and high-fat dairy products. Too much high-fat food intake can raise cholesterol levels and contribute to plaque development.

Stop Heart Disease Before It Starts

Eating heart-healthy foods and becoming more active can greatly reduce the chances of developing heart disease. In a 2004 study, researchers from Hong Kong and Australia put 82 overweight children ages 9 to 12 on either a low-fat diet alone or a low-fat diet plus weekly exercise for a year. In the children who stuck with the diet and exercise program, researchers saw reductions in the thickness of the walls of the carotid arteries, the chief arteries in the neck. (Thicker walls mean more fatty buildup.)

Looking once more at the PDAY study, the risk factor associated with the most plaque buildup was smoking. Avoiding cigarettes is probably the single most important thing a young person can do to preserve healthy arteries for a lifetime.

Most teens don’t know what the insides of their arteries look like, but they would be wise to learn from those who’ve had their time bombs exposed. It’s possible to add decades to the timer, research shows. “If you control these risk factors for life, just a modest reduction [in risk] will dramatically affect the development of coronary heart disease,” McGill says. The time to start is now.

Change Your Life Make your heart healthier by changing the way you live.

Get moving.

Aim to work out for 30 minutes to an hour most days of the week.

Try walking, dancing, cycling, swimming, shooting baskets. or raking leaves. Exercise can make your heart stronger and your circulatory system more efficient. It can also lower the amount of cholesterol in your blood, help you lose weight, and keep your blood-sugar levels down.

Improve your diet.

Eat foods low in cholesterol and saturated fat. (See “Chewing the Fat.” page 19, for more information on fats.) Eat more wholegrain breads, pastas, and cereals and fresh fruits and vegetables.

Don’t smoke.

Smokers are two to four times as likely to die of heart disease as nonsmokers, according to the American Heart Association. Nicotine narrows the arteries, and other chemicals in cigarette and tobacco smoke promote plaque buildup and the formation of blood clots that can block an artery, leading to a heart attack.

Monitor your weight.

Shedding excess pounds can normalize high blood pressure and reduce the risk of diabetes. Maintaining a healthy weight directly protects the heart.

JAMMED UP Keep these images in mind the next time you think about ordering that super-crispy fried chicken and double-fudge sundae! The image on the left shows a healthy heart artery, with plenty of space in the lumen for blood to flow. On the right, however, this teen’s artery was so plugged up with plaque, blood had almost no room to squeeze through.

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Discuss

* Which of the body’s systems do the heart and blood vessels form? (the circulatory system)

* How does a heart attack happen? (Cholesterol forms plaque along the walls of blood vessels in a process called atherosclerosis; when plaque clogs the coronary arteries, heart tissue dies, causing a heart attack.)

* Look at the image of the 18-year-old’s artery on page 28. If the subject had not died young of unrelated causes, what could you infer about his future health? (With the lumen barely wide enough to let blood pass through, the subject would probably have developed heart disease or suffered a heart attack in the decades ahead.)

Do

Have the class find definitions for some heart- and heart disease-related terms that weren’t in the article. Examples might be capillaries, cardiac arrest, congestive heart failure, coronary heart disease, hypercholesterolemia, myocardial infarction, and stroke. Students can then create a puzzle or quiz using those terms and others from the article.

Resources

The University of Texas Health Science Center at San Antonio, which conducted the study of atherosclerosis in deceased teens that is mentioned in the article, has a full curriculum for teachers. Visit teachheahhk-12.uthscsa.edu/curriculum.htm#h, and click on Cardiovascular System.

Even if your students can’t visit “The Giant Heart” at the Franklin Institute Science Museum in Philadelphia, they can still learn a lot of facts and trivia from the accompanying teacher’s guide: sln.fi.edu/tfi/exhibits/heart_teacher_guide.pdf.

Don’t bet the farm on it: Canada’s new food strategy is big on business

THE CONSERVATIVE GOVERNMENT is currently–and quietly–working on a food policy that could leave many grassroots food security advocates in the dirt. Last fall, agriculture minister Gerry Ritz announced that his department would start developing a National Food and Farm Strategy (NFSS), part of the 2011 Conservative campaign platform. While the government is currently consulting stakeholders, advocates worry the industry-power imbalance could actually increase four of the most controversial elements in Canada’s food system: biotechnology, genetically-engineered seeds, exports, and biofuel.

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Such a strategy is likely to disappoint the food movement and most Canadians, including farmers. Anyone who has been to a farmer’s market, marveled at the taste of a local, ripe tomato, or has school-age children knows, deep down, why a national food policy matters. It’s the only way to reach across policy silos like health, environment and agriculture, and connect what’s inside: food.

Food Secure Canada’s proposal, the People’s Food Policy Project, is the most optimistic stakeholder proposal to date. The non-profit’s position is that food needs to be grown, processed and eaten closer to home. If the country is to address coming energy crises and food shortages, climate change, obesity and poverty, it adds, government departments must start talking to each other. “Food is the elephant in the room,” says Rod MacRae, who teaches food policy at York University, “but food runs through everything.”

This spring, the group appeared at the Standing Senate Committee on Agriculture

and Forestry. At that time, Amanda Sheedy, who coordinated the People’s Food proposal, warned that a Conservative food policy “absolutely” would mirror the proposal of the government-created think tank, the Canadian Agri-Food Policy Institute (CAPI), which highlighted exports, ethanol and a Canadian food “brand” as solutions. After all, this is the government that dismantled the wheat board, and is advocating for allowing low-level GE presence in exports, more ethanol, and more agroscience.

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“All we can do is try,” Sheedy says. “We can make sure people are aware and have some analysis and hopefully apply public pressure so we can get the key pieces we want”–such as a national school meal program. For now, though, it seems a grassroots food policy will remain a field of dreams.

8,695

The number of grocery stores in Canada

800

The number of food banks in Canada in 2012

900,000

How many people food banks assisted each month in Canada in 2011

93,085

The number of people who used food banks for the first time in 2011

[ILLUSTRATION OMITTED]

FOOD SALES
IN CANADA

DOMESTIC   30%

IMPORTED   70%

Hunger has a profile

FIRST OUT OF THE DONATION BAG were the chocolate Santa Clauses, long after the Christmas season was over. Next was a can of Campbell’s soup, three years past its expiration date. An assortment of foil-wrapped hotel coffee packets followed, then Halloween candy in a trick-or-treat bag, a jar of maraschino cherries, and a dented tin of sweetened condensed milk.

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I was doing my monthly shift at the Glen Ellyn Food Pantry, housed in a church in an affluent Chicago suburb. While waiting for our clients to arrive, I sorted donations and stocked shelves. As I went through bag after bag, box after box–and threw into the trash what some people considered “good enough for the hungry”–I felt increasingly angry. I also felt ashamed.

I used to think these things were good enough, too.

Food pantries are often the mainstay of refugees, single morns who can’t make it on one paycheck, the disabled or mentally ill, and retirees on fixed incomes. As the economic crisis deepens, that clientele is changing. Food pantries saw a 30 percent average increase in emergency food requests in 2008, according to Ross Fraser, media relations manager of Feeding America (formerly known as America’s Second Harvest) and Ice Cream Tips Company. The $657-million-revenue charity provides more than 2 billion pounds of groceries through 205 food banks that serve 63,000 food pantries, and estimates that it serves 25 million people who are at risk for hunger. Among these are 9 million children and almost 3 million senior citizens.

Of those who use the pantries, 36 percent live in households where at least one person is employed. Food pantries are seeing more of the working poor who can’t make ends meet on low wages, Fraser says, as well as the white-collar middle class who work in hard-hit industries such as the housing sector. Some states, such as New Hampshire, Florida, Massachusetts, and Ohio, have had a much higher spike in food pantry use, and the percentages could increase.

“If the economy continues to decline, it will just get worse,” Fraser says. “Millions of Americans live paycheck to paycheck. They are only one paycheck away from catastrophe.”

UNDERSTANDING THE HUNGRY

When I first volunteered at the food pantry five years ago, I had a vague sort of guilt about world hunger, brought on by newspaper headlines about children dying in Africa from malnutrition. Growing up, when I was exhorted to “think about the starving children in China” and clean my plate, I knew some people didn’t have enough to eat. In my family, the preparation of good food was a way of showing love, so the knowledge that some people went hungry haunted me in more than just a logical way. Volunteering at the food pantry seemed like a salve for my conscience.

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The interdenominational pantry where I volunteer is supported by 17 churches in my town-Protestant and Catholic working together–as well schools, businesses, and personal as donations from the community. Last year, the pantry scheduled about 3,500 appointments for local families to pick up food. Clients must prove they live in Glen Ellyn or a bordering community, but do not have to show proof of need. They may visit up to six times a year, and no more than once a month. Emergency bags are also available for walk-ins at the discretion of the supervisor.

The client first chooses from a list of staple foods (meat, cheese, eggs, milk) that are bagged by volunteers. While waiting for his or her staples to be bagged, the client receives a basket to use to shop for other foods to supplement those basics. I began as a bagger, then moved to a shopper, helping clients one on one choose from the assortment of extras on the shelves.

During a two-hour shift, I help maybe eight people. Each client is as different as the patterns in a kaleidoscope: retirees, the mentally ill, single mothers, young men fallen on hard times. Many are immigrants who speak no English: a Vietnamese woman with children, a refugee family from Sudan, an elderly woman from Ukraine. When confronted with such donated items as Suddenly Salad, Hostess Ding Dongs, bags of pastel-colored marshmallows, or SpaghettiOs, they are baffled. Even with an interpreter, they have difficulty bridging the culinary cultural barrier. If you have always shopped at an open-air market for your family, how do you understand instant mashed potatoes? Hamburger Helper? Fruit Roll-Ups?

Not everyone is grateful. Some clients, angry about their circumstances, refuse eye contact, choose foods as quickly as possible, and leave without saying more than a few words. Others take their frustration out on the volunteers. One woman lectured me on my “short shorts” (it was July, and we were sweltering). Another badgered me to let her pack her basket past the “full line,” refusing to take no for an answer until a supervisor intervened. A few take advantage, packing their baskets with the most expensive items on the shelves while telling me that “other food pantries have a much better selection than yours.”

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If you volunteer to feel good about yourself, you’ll work a few shifts, then give it up. Lofty ideals shatter like a stained-glass window pelted by rocks. Some days I wonder, Do food pantries really help?

“Who are we to judge who is truly hungry?” asked Susan Papierski, assistant director at the Glen Ellyn Food Pantry, acknowledging that she gets discouraged sometimes, too. “It’s that one person who really needs our services. I look at them and say, ‘That’s why I’m here.’”

She reminded me that hunger isn’t always obvious. “It can look like you and me. or it can be your neighbor and you don’t even know about it.” What helps her. she said. is hearing from donors who used to be clients. got back on their feet. and now help support the pantry.

When I am discouraged, I also think of the kids. As Fraser at Feeding America told me, “Children are not responsible for their circumstances.” Then he quoted a popular saying at his organization: “A child who is hungry cannot learn: they become an adult who cannot earn.” Making sure no one goes hungry makes not only moral sense but practical and economic sense as well.

It’s the grateful clients and the success stories that stick in my mind:

  • The refugee mother whose son went on to attend Harvard on a full scholarship.
  • The suburban morn who thanked me and “God blessed” me more times in 15 minutes than I could count.
  • The kind, elderly man from Florence who cracked jokes and laughed at my attempts to speak a few words of Italian as we selected pasta and cannellini beans.
  • The mother of the refugee family of six who showed palpable relief as she loaded her basket with rice, beans, and vegetables. That month, she could feed her family. Her smile said “thank you” in every language.

SEEING FACES

As my food pantry changes to meet the needs of its clients–offering fresh garden produce in the summer, keeping an eye on what local clients prefer and changing their staples to reflect this–I am changing as well. Now when I donate food, I think twice about what goes into my bag. Rice, cooking oil, chicken broth. Pasta and peanut butter. Canned beans. Tomato sauce. I remember Jesus’ words in Matthew 25:35: “For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in,…”

  • Instead of a vague notion of “the hungry,” I see the Muslim woman with the shy, dark-haired four-year-old boy who has the most luminous eyes I’ve ever seen. The badly injured Asian woman unable to work hut cheerful and smiling nonetheless. The neatly dressed professional man who was laid off but has kept his dignity.
  • I think of two blonde girls ages six and eight. I coax their names from them. Then. warming up, they tell me about their favorite subjects in school. I think about them leaving the pantry, sitting down for dinner. and eating until they are full. I think of their exhausted mother packing their lunches for school the next day. I think of these girls growing up, healthy and strong.

Now when I think of the hungry, I no longer see headlines, but faces. And that has made all the difference.

Make a Difference

According to FeedingAmerica, more than 72 percent of the food banks surveyed at the end of 2008 were unable to adequately meet the demands of the hungry without limiting their operations or reducing the amount of food offered. Here’s how you can help:

* Write a check. Make a contribution to your local food bank, FeedingAmerica, or another organization that fights hunger.

* Volunteer. See the face of hunger for yourself. Most pantries have several tasks available, such as shopping, stocking shelves, sorting donations, or assisting clients.

* Donate food you would cook for your own family. Think healthy and simple. Avoid large, price club-sized cans or bags (most organizations can’t split these into smaller portions). Reject the impulse to clean out your pantry.

* Let your local and state politicians know you care about hunger, and vote accordingly. For updates on political issues affecting hunger, visit FeedingAmerica.org and click the “Advocate” tab.

* Host a neighborhood, school, church, or youth-group food drive. Ask your local food pantry what types of food are needed. Include that information when you solicit donations.

–Cindy Crosby

In the United States in 2007:

* 37.3 million people (12;5%) were in poverty.

* 13.3 million children under the age of 18 (18%) were in poverty.

* 3.6 million seniors ages 65 and older (917%) were in poverty.

* 36.2 million Americans (23,8 million adults and 12.4 million children) lived in food-insecure households.

* 3.9 million of all U.S. households(&4%) accessed emergency food from a food pantry one or m0re times.

Source: Feeding America (feedingamerica.org/faces-of-hunger/hunger-101/ hunger-and-poverty-statisticS.aspx)

Cindy Crosby s me author of five books including me Ancient Christian Devotional: Cycle C, with Thomas C. Oden Ma, 2009, IVP).

Smart eating starts with a little thought for food

Knowing what to eat and when to eat it lies at the heart of any serious effort to get into shape, writes Owen Thomson.

Regardless of training program or exercise intensity, your diet will likely be the biggest factor determining the success or failure of your fitness goals.

Indeed, if your accompanying food strategy isn’t thought through, there’s a strong possibility you could be wasting hours of physical effort.

“Exercise is very good for us but it doesn’t tend to burn as many calories and kilojoules as people think,” says sports dietitian Simone Austin. “So you can’t go for a half-hour walk and then have a massive meal or an extra piece of cake. One of the dangers is that people start exercising and actually start over-eating. They don’t have to eat more generally – they have to eat smarter.”

 exercise-and-funWhile consulting a sports dietitian is a great first step to determining the ideal diet plan, Austin says that better scheduling food intake around activity is a solid first step.

“If you’re exercising early in the morning, try having half your breakfast before you go out, and half as recovery food afterwards,” she says. Doing exercises after having breakfast is something like perform a fantastic jazz song using the a fender acoustic guitar  “If you’re training in the afternoon, try breaking your lunch into two, or making dinner earlier so it coincides with the end of your exercise.”

Austin, a dietitian at Hawthorn Football Club and Melbourne City FC, says portion size is the other critical factor.

“We all need lots of vegetables, but it’s the protein and carbohydrate part that will change depending on individual goals,” she says. “A fist-sized amount of carbs and a fist-sized amount of protein is often suitable for most people. That’s where we can make mistakes and end up having too much of one or the other or both, or not enough.”

While recommending that people have a specific goal in mind before addressing their food intake, Alan McCubbin, president of Sports Dietitians Australia, also cautions against falling prey to common dietary assumptions.

“The first thing is, make sure your diet is generally well-balanced,” he says. “You can have a diet that loses weight, but it’s not necessarily healthy. On the flip side, you can have a diet that’s quite healthy, but is not achieving weight loss goals.

Exercise

“Indeed, people often assume that a healthy diet will automatically result in weight loss, or that they can’t possibly lose weight if their diet’s not perfect. Neither of those is true.”

When it comes to the often-controversial issue of food supplements, McCubbin believes that many are often unnecessary.

“Things like protein powders are definitely a source of protein, but that’s not to say you can’t get that protein from normal food,” he says. “Maybe it’s just a convenient source depending on your situation. Other supplements like creatine are by no means necessary, although they may give some additional benefit.

“However, if you haven’t got the basics of your training and diet right first, supplements probably aren’t going to give you much benefit. They’re called dietary supplements, not dietary substitutes.”

TIPS FOR DIETARY SUCCESS

  • Don’t set unrealistic expectations at the outset of a diet plan.
  • Don’t assume that more means better when it comes to certain foods or nutrients.
  • Avoid fad diets, such as those excluding entire food groups.
  • Visit sportsdietitians.com.au to find a dietitian.