The Sweet Spot

by Walter Pierce

Could carbs - read sugar - be among the biggest culprits in heart disease?

Could carbs - read sugar - be among the biggest culprits in heart disease? By Kari Walker, RN, BSN

Tuesday, Feb. 4, 2014

[Editor's Note: A study released this week (after this story went to press) in JAMA Internal Medicine indicates that excess sugar can double your risk of heart disease, even in people who are not obese. Read more here and here.]

The inflammatory response is a life-saving feature our bodies are equipped with to help fight intruders, like bacteria, by releasing cells designed to target attacks on body systems. Redness and swelling are signs we would notice after sustaining a cut to the hand, a reassurance our body is functioning to heal itself. In time, these symptoms disappear, leaving behind scar tissue as a reminder of the incident.

Now take this inflammatory response and put it into the cardiovascular system and you have turned something life-saving into something possibly life-threatening. Ongoing research now suggests inflammation could be as big a threat to developing heart disease as two other commonly known culprits: high cholesterol and high blood pressure.

The past 15 years of research on the topic is helping cardiologists like Dr. Stephen Simpson of Cardiology Specialists of Acadiana better treat inflammation.

Dr. Stephen Simpson

"When a blood vessel wall is damaged over years, the body attacks it like a cut on your skin and inflammation develops. Your skin reforms skin, but with blood vessels, the result is similar to a scar but other cells are also working together and the deposit becomes a fatty streak that builds into a blockage," explains Simpson. The leading cause of this "fatty streak" is inflammation. "Eventually the deposit becomes enough to cause cardiac blockage or rupture," he says. This is when heart attacks and strokes can occur.

So what causes this inflammation process and how do we stay heart healthy? Simpson and the American Heart Association agree risk factors like cigarette smoking, high blood pressure and oxidized LDL cholesterol can compromise normal cardiovascular system functions and lead to atherosclerosis, the build-up of fat in the arteries leading to slowed flow of blood and in turn blockage. But for those non-smokers with normal blood pressure and OK cholesterol levels, you are not in the clear: You could still run the risk of cardiac damage due to inflammation because of diet.

In years past, doctors were quick to suggest a low-fat, high-carbohydrate diet as a key to health, but now research is suggesting years of promoting higher carbohydrate foods may have caused surges in blood sugar levels among patients, possibly causing inflammation.

In other words, that seemingly harmless low-fat ranch salad dressing is secretly loaded with sugar and other processed ingredients setting the stage for elevated blood sugar levels and inflammation.

Dr. Wade May, a cardiologist with Cardiovascular Institute of the South, stresses the starting point is to move the numbers on the scale toward a healthy weight and focus on eating a lower carbohydrate diet free of processed foods.

"Eliminating sugary drinks, like soda, and replacing with water or tea, increasing fruits and vegetables in the diet and lean meats like fish are good. Following what's basically considered a Mediterranean diet will help," May says. Meals should start from a foundation of vegetables and lean proteins over starchy carbohydrates the body will convert into sugar. "Reconfigure what the plate is supposed to look like in your mind. It shouldn't start with a heap of white rice," May stresses. Processed foods are of concern as many of the additives to extend shelf life are high in Omega-6 fatty acids, shown in studies to be associated with inflammation. As far as fad diets are concerned, these so-called quick fixes are not sustainable long-term - everything in moderation is key. Even the occasional scoop of ice cream.

In addition to diet, exercise is another lifestyle factor that can reduce potentially harmful inflammation. "Exercise improves blood pressure and blood sugar, which reduces inflammation and reduces free radicals," adds Simpson, who notes that doctors see lower rates of damaging inflammation in patients who exercise. It's key to lowering the risk of developing co-morbidities like diabetes, hypertension and high cholesterol - all three are disease processes that will increase a person's risk of developing heart disease.

Dr. Wade May

Even with proper diet and exercise, individuals deeming themselves "in good health" should be aware of family health history to paint a bigger picture - this is crucial for a physician to develop a plan of care on how to aid in prevention of damaging effects of heart disease. Preventive anti-inflammatory regimens like aspirin and Statin drug therapies are proving beneficial for those with family histories of heart disease related to high cholesterol.

"Patients with a strong family history or other risk factors, like premature family history, is a red flag that there may be something else going on with the patient," Simpson says.

Tips for prevention of heart disease and inflammation

Maintain a healthy weight

Find an exercise routine you enjoy and make it part  of daily life

Adopt a lower carbohydrate diet heavy with green vegetables, fruits and lean proteins rich in Omega-3 fatty acids

Substitute snacks for things like trail mix, hummus, carrots, celery and water in place of processed junk food

Swap cooking with butter for extra virgin olive oil

Start screening of blood pressure, lipid profile and blood sugar levels at age 30 every five years then annually at age 40 (for low-risk individuals)

Get advanced testing for cardiac inflammation such as C-reactive protein (CRP) or a coronary calcium scan if indicated by a physician

Take advantage of free corporate wellness screenings and community health fairs to save time and money or basic testing for heart disease