President Lyndon B. Johnson declared February American Heart Month in 1964. He worked hard to bring heart health to the forefront of American minds after he himself suffered a heart attack. Yet, 57 years later, 1 in every 4 deaths in the US is related to heart disease. Nothing has improved, despite decades of research. In 2016, the American Heart Association (AHA) reported that 48% of American adults have some form of heart disease. Regardless of these 1 in 2 odds, an AHA survey conducted in 2019 reported that 72% of Americans don’t consider themselves at risk for heart disease. Where is the disconnect?
I believe it may start with the common advice we’re all given about how to avoid heart disease.
For example, here are the AHA’s top 6 tips for preventing heart disease:
- Don’t smoke
- Maintain a healthy weight
- Control blood sugar and cholesterol
- Treat high blood pressure
- Get at least 150 minutes of moderate-intensity physical activity a week
- Get regular checkups
Americans are well aware of these healthy living recommendations and people do try to live by them. Nobody wants heart disease. People are not stupid, lazy, or too stubborn to prioritize their own health. Very rare is the person who is unwilling to make some sacrifices, pay a lot of money, or try anything, if they think it will improve their health. Despite this effort on the part of basically everyone, there is no improvement in health outcomes.
An entire month is dedicated to raising awareness of this disease, which was necessary in 1964 (thank you LBJ) and even more critical now (thank you AHA). How about if we leverage February’s heightened awareness by reframing the AHA’s recommendations for preventing heart disease and ultimately, how we think about living heart healthy, so that we can improve these 1 in 2 odds?
Here we go…
#1 Don’t smoke
Okay, we can all agree on this one. Inhaling smoke and cancerous chemicals into your lungs really is a universally bad idea. Please don’t smoke, kids. And, if you think vaping isn’t smoking, it is. That should cover it.
#2 Maintain a healthy weight
How, though? The advice to “lose weight” or “maintain a healthy weight” is a personal pet peeve of mine. The general idea is fine, being overweight is linked to every chronic condition, including of course, heart disease. The problem with this advice is twofold: (a) It contributes to the false belief that being overweight causes these health issues, and (b) it doesn’t help anyone actually accomplish said weight loss.
The CDC itself claims that “Being overweight also increases your risk of metabolic syndrome, a cluster of heart-disease risk factors”, but that’s just plain false. Being overweight is correlated with metabolic syndrome. “Correlates with” is not the same as “increases your risk for”, and it’s a shame that even the CDC would make this mistake. This is just another way to blame the victims. Being overweight is a symptom of metabolic imbalance, not the thing that leads to it. You won’t become overweight unless you already have a metabolic issue.
When we perpetuate overweight as a cause of other health problems, combined with no practical advice on how to lose weight, it solves nothing. You need to lose weight for your health? Should you take weight loss drugs, do a juice cleanse, eat only dry lettuce for 6 months, drink laxative tea, start training for a marathon, or have surgery? The possibilities are endless, and most of them aren’t going to advance the cause of your health, even if you do manage to lose weight, which is also highly unlikely.
Weight is connected to overall health. It’s an indicator, not a cause. Weight loss doesn’t improve overall health (and won’t last) unless you lose weight by improving your overall health.
#3 and Control blood sugar and cholesterol & #4 Treat high blood pressure
I’m combining these two tips because I don’t understand the logic behind separating them. Since the advice contains no information on how to do any of these things, I’m left scratching my head why blood sugar and cholesterol are deemed controllable by lifestyle but high blood pressure apparently must be treated by medication.
All three of these things are entirely preventable and entirely reversible with lifestyle interventions. Most importantly, just like weight, all three of these are symptoms of metabolic illness (and thereby increasing risk of heart disease), not the cause of it. Treating any of them in isolation doesn’t address the heart disease that often accompanies them. Of course we should all endeavor to have healthy blood sugar control, cholesterol levels, and blood pressure. However, the idea that treating these symptoms will prevent heart disease is an incredible reach. The ineffectiveness is borne out in the statistics and the studies.
The American Heart Association reports that 1 in 3 Americans have high blood pressure. 75% of them are on medication to lower it. Shouldn’t the medication be improving the rates of both high blood pressure and heart disease, if treating high blood pressure improves your risk of heart disease? It isn’t improving anything. Here’s one study that had to be terminated after three years, because the participants who received more intense treatment for their high blood pressure were doing so much worse than the control group. High blood pressure isn’t healthy, but like weight loss, manually lowering it doesn’t improve health. High blood pressure is a symptom, not a cause. If you have high blood pressure, it’s because you need high blood pressure to make sure the blood is circulating in your body at the proper rate.
Lifestyle interventions can lower all three of these symptoms naturally and at the same time, because they’re all symptoms of the same imbalances leading us toward metabolic disease. We so often try to do it the other way around, targeting each measurement with its own medication. Indeed the AHA is recommending that we take this approach. As we can see in the studies, and all around us, that doesn’t improve health or heart disease.
#5 Get at least 150 minutes of moderate-intensity physical activity per week
Compared to the previous 3 tips, this one is refreshingly straightforward. We know how to exercise for 2.5 hours per week. Put one foot in front of the other and you’ll get there. The heart is a muscle and exercise improves muscle strength. Exercising undeniably improves the heart’s ability to pump blood efficiently, which is a good thing, of course. Exercise is good for the heart. However, I would argue that the reason it’s on this list of heart health tips is wrong. The intention here is clearly to promote exercise as a weight loss method.
Small problem, exercising has never been proven to aid in weight loss if dietary changes are not also involved. Weight loss on its own does not improve heart disease outcomes either. There might be an echo in here, but if you didn’t read #2 (above), that point bears repeating!
Here’s the crux of the thing: Improved health leads to higher energy levels, more exercise, weight loss, and improved heart health outcomes. Not the other way around. They all go together as signs that health is deteriorating or improving.
#6 Get regular checkups
Where do I even start with this one? First, it’s basically redundant. What happens when you get a checkup? They measure your weight, blood pressure, cholesterol, and blood sugar levels. If you’re overweight, they tell you to lose weight. They don’t help you do so. If any of your stats aren’t in the “normal” range, you get a medication that addresses that specific symptom. As we now know, none of these steps improve overall health or heart disease outcomes. We already discussed the lack of any improvement from blood pressure medication. Cholesterol medications do tend to lower cholesterol levels, but that’s not necessarily a good thing because cholesterol is one of the body’s most important healing mechanisms. Lowering it manually makes it more difficult for your body to repair damaged cells and lower inflammation. As a 2016 review found, the older you are, the less connection there is between cholesterol levels and health. In fact the older people were, the higher their cholesterol, the longer they continued to live.
Please don’t stop going to the doctor and getting checkups. You can’t tell if you’re making progress in the right direction if you never get assessed. Just don’t expect the visits to the doctor to keep you from getting heart disease. Modern medicine is not focused on prevention, nor is it effective in helping to prevent anything. We have to take our long-term health into our own hands.
Nowhere in these tips does the AHA mention healthy eating as a means of preventing heart disease. This seems to me like a criminal oversight, but not a surprising one in this situation. Unfortunately, when you start to get specific about good and bad foods for health, people get offended and companies take away funding. That’s why the general advice is always “lose weight” instead of any helpful advice about how to improve your overall health with nutrition. This kind of half-hearted advocacy is the main reason so many people are still sick after so long.
The AHA’s first suggestion is to stop putting cigarette smoke and chemicals into your body. That’s good, but they go on to ignore the fact that many things we call food also contain chemicals and other substances that can harm our bodies just as much as cigarettes.
At Reframe Wellness, we take a different approach to health. We believe you build your own health future by what you put into your body. The content of your diet is the most important factor in long-term health. You cannot build a healthy body without healthy fuel. All calories are not created equal when it comes to what your body can do with them.
Nobody wants to get heart disease, and most people do understand that it is preventable. The majority of Americans do try to live by the simple heart health rules and look for those little Heart Healthy stickers on food at the grocery store, yet heart disease rates are continually increasing, and heart disease remains the number one cause of death in the United States. We can’t improve if we’re not being given the right advice. We say eat more fat, less whole grains, and sweet potatoes instead of regular. These are things that will actually help you prevent heart disease. Maybe it’s time to stop letting the establishment accuse us of being lazy and reframe the idea of a healthy lifestyle.
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