Heart Attacks Among My Fit Friends

Andrew Siegel, M.D.    Blog # 65


My good buddy V. had a heart attack a few weeks ago. He is a urologist in his mid 50’s, a non-smoker of medium build, and an avid recreational cyclist who puts in several hundred miles every week. If it wasn’t for his company and support, I would never have completed the 3 hour challenging bike ascent up Mt. Mitchell (elevation 6683 feet) in Asheville, North Carolina a few years ago.

After some intense cycling, he was taking a breather to wait for one of his cycling partners to catch up with the rest of the group when he developed extreme left shoulder pain and unrelenting sweating.  The unremitting pain was of intensity unlike any that he ever experienced, and in the ambulance in route to the hospital he gazed at his own EKG seeing the classic findings of a myocardial infarct.  He was given morphine for pain, nitroglycerin, aspirin and oxygen and after arriving in the ER was rapidly whisked to the cardiac catheterization lab.  He was found to have a complete occlusion of the right coronary artery and it wasn’t until a wire was passed through the occlusion that he felt dramatic pain relief.  After a stent was placed in the occluded artery, he was sent to the coronary care unit for monitoring.  He was discharged the following day on numerous medications and prescribed rest, time off work, and a specialized diet; he was also admonished to stop exercising until he finishes a program of cardiac rehabilitation.

When I spoke to him, he was extremely depressed about the situation, never having previously had any symptom of heart disease.  He had survived a life-threatening event, going from no medications to seven and having to severely restrict the physical activities that brought him so much pleasure.  To repeat, he was not overweight, not a tobacco user, and did not have high blood pressure, although his cholesterol ran on the high side of normal.  He did not have any family history of heart disease.  He had been a strong recreational cyclist for many years. He never paid attention to his diet because of his fast metabolism and vigorous exercise regimen, which always left him at a healthy weight.  V. is Italian and loves pasta, cheese and meat dishes and has always eaten anything and everything that he wanted.


Now for the story of A., my good friend from surgical internship:  He became a heart surgeon and practiced in the Midwest for many years, but has recently relocated to the Southeast, where he is the Chief Medical Officer of a hospital.  Like V., A. was always in tip-top shape, a non-smoker and a running enthusiast.  As interns and surgical residents, we spent countless hours running the hills of the north shore of Long Island and each ended up having sibling chocolate Labrador Retrievers as pets.

A few years ago, several hours after a vigorous workout in his home gym, he was relaxing in the living room with his wife. As he stood up, he crumpled to the floor, obviously having passed out.  His wife found him to be pulseless and not breathing. Fortunately she was a RN and managed to maintain her composure and promptly initiated CPR after calling 911.  She continued the cardio-pulmonary resuscitation until the emergency team arrived.  When hooked up to a cardiac monitor he was found to be in a very abnormal rhythm called ventricular fibrillation.   After he was shocked, his heart resumed normal rhythm and he started breathing spontaneously.  Angiography in the hospital demonstrated severe coronary artery disease, and he underwent angioplasties and several stent placements.

A. was of average weight, a non-smoker, and a compulsive exerciser; however,  he had a strong family history of cardiac disease and never paid much attention to his diet. I recall his fondness for ice cream and his not uncommon consumption of a pint of Hagen-Daz at one sitting.


The point that I wish to make is that maintaining a good weight, avoiding tobacco and pursuing regular exercise is not always enough for vitality and a healthy heart.  Particularly when there is a family history of heart disease, but also as a general health axiom, all efforts must be put in place to stem cardiovascular disease, the number one cause of death in the United States.  In addition to maintaining a good weight, avoiding tobacco and exercising, healthy eating is an indispensable and essential part of the effort—a sine qua non.

The quality and quantity of what we eat play an essential role in determining our health destiny.  The following is an excerpt from The Huffington Post written by Dr. David Katz entitled “Un-junking Ourselves.”  Although the subject of Dr. Katz’s discussion is a child, it is relevant to adults as well.

Think about a child — or former child — you love. This should be pretty easy for any parent, grandparent, aunt, uncle, or just about anybody else who has known a kid or ever been one.

Now, think about that child’s growth from year to year and ask yourself: What were they growing out of? What was the construction material? Matter can’t be constructed out of nothing — it comes from somewhere. If a child’s head is four inches higher off the floor this year than last year, then that four-inch platform of extra kid was built out of… something. What?  Food and nothing else. Food is the construction material — the only construction material — for the growing bodies of children we love.

We are, no doubt, all familiar with the expression “you are what you eat,” but given how most of us eat, it’s quite clear we don’t take it very seriously. And for some pretty good reasons. The human machine, and human fuel tank, are stunningly forgiving. We can throw almost anything in the tank, and run reasonably well for decades. We can’t build a machine fractionally so accommodating.

And, of course, we don’t look like what we eat. We eat donuts, and don’t sport big holes through our middles. We eat French fries, and don’t sprout French fry antennae. But you can’t judge what we are made of by what we look like, any more than you can judge a book by its cover — or a house by its paint. Our houses are, often, made mostly of wood — but look nothing like trees. Trees are cut down and, if you will, “digested” in a timber mill to produce wood that is turned into lumber. The lumber is then used to build houses that look nothing like the trees. But if that lumber is rotten, the house in question may look all right at first — but it will fare quite badly when the first big storm comes along. The quality of a house is rooted in the quality of its construction materials.

Ditto for us. The growing body of a child is built out of food. Nutrients are extracted from food, just as wood is extracted from trees. Rotten wood makes rotten houses. Rotten food makes… sick kids. The kids may look, and even feel, fine for a while. But every cell their bodies build depends on the quality of the available construction material it is offered. Every muscle fiber, every enzyme, every brain cell, every heart cell, every hormone. Maybe not right away — but eventually, rotten construction material catches up with us all.

No one I know throws any old junk into the tank of a car they hope will run well for the foreseeable future. No one I know willingly builds a home out of junk, or of rotten wood. But food is the one and only building material for the growing body of a child you love. How’s “junk” sounding now? And, by the way, every one of us adults is turning over literally hundreds of millions of cells daily. These need to be replaced, along with spent enzymes, hormones, neurotransmitters and the like. Where do WE get the construction material for this job? Think about it.  Right you are.

Bottom Line:  In the quest for fitness, vitality and health, it is necessary to maintain a healthy weight, exercise regularly and avoid tobacco. These efforts are important, but not sufficient to avoid cardiovascular disease; an essential additional factor is what we eat.  The quality of the foods that we ingest for fuel, metabolism and tissue rejuvenation are of great importance in terms of vitality and avoiding fatty plaque deposition in our arteries and cardiovascular disease.  It comes down to a largely plant-based diet with an abundance of different fruits and vegetables, whole grains, legumes, and lean protein sources.  Meat and dairy, unrefined carbohydrates, sugars, processed, junk and fast foods need to be consumed in moderation.  We literally are what we eat and the plaque lining our arteries is a reflection of our cumulative diet over our lifetime.  While genetics and luck are beyond our control, our lifestyle—including what or what not we decide to use as human building blocks—is well within our domain.  Today in my office, I skipped the Carvel ice cream cake and grabbed a Granny Smith apple instead…just not worth it!

My two friends are literally lucky to be alive as many are not so fortunate and succumb to cardiovascular disease.  A., being a cardiac surgeon and having put his event well behind him, has adapted well to his situation.  V. is currently somewhat depressed and is suffering from a form of post-traumatic stress disorder that not uncommonly follows the occurrence of a heart attack.  It behooves all of us to try to avoid potential life-threatening cardiac issues by maintaining a good BMI, eating healthy, exercising and avoiding tobacco.  We need to be especially vigilant when there is a strong family history and/or elevated cholesterol and under these circumstances, proactive cardiology care is certainly warranted.  Family history or not, it makes the utmost sense to keep in mind that “we are what we eat.”

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food


Available on Amazon Kindle

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2 Responses to “Heart Attacks Among My Fit Friends”

  1. KV Says:

    Dr. Siegel, in many of your posts you mention avoiding tobacco. My husband doesn’t use tobacco, but chews nicotine gum regularly. I have always wondered what the long term effects of nicotine gum could be. Can you provide any info on that?

    • promiscuouseating Says:

      Your husband made a wise health decision when he chose to eliminate tobacco. The nicotine gum provides the stimulation that tobacco does, without the many toxic and carcinogenic effects of the tobacco. That stated, chronic nicotine use is not healthy either. Not only is the nicotine addictive, but it can promote insulin resistance and the adrenaline release can constrict blood vessels and increase heart rate and blood pressure, thus promoting abnormal cardiac rhythms. My honest suggestion would be to try to slowly wean him off the nicotine gum. It is really not supposed to be used for the long term, just to facilitate the process of quitting smoking. For more info: http://www.livestrong.com/article/236633-the-effects-of-long-term-nicotine-gum-use/

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