The Great Cholesterol Myth (30 page)

It’s not the stressor, per se, that killed him. Under other circumstances—or in another person—disturbing news would be, well,
disturbing
. Not fatal. Much like people who catch colds easily because their immune systems are weak, he is far more susceptible to being hit like a sledgehammer by news that would merely shake a less vulnerable person. In his weakened, vulnerable state, the disturbing news acts like the pesticide carbaryl on a stressed-out frog—it kills him.

We hope we’ve convinced you that stress isn’t just “in your head,” and that the mind and the body operate very much as an integrated unit. A trauma to the body can cause enormous amounts of psychic pain and ultimately even lead to depression or fibromyalgia. And a trauma to the psyche has significant repercussions for the body. They can’t be separated, nor should they be. Both are part of the whole person. This is why medicine that looks at the entire person, and how everything is connected, is aptly called
holistic
medicine. (Dr. Sinatra and Dr. Jonny share this orientation; Dr. Sinatra has been practicing “integrative” [holistic] medicine for decades, and Dr. Jonny’s Ph.D. is in
holistic nutrition
.)

In this next section, we’re going to talk specifically about stress and the impact it can have on your heart and your health. And we’ll make recommendations for how you can reduce stress with an easy exercise that anyone can do.

An essential part of our prescription for heart health involves monitoring and reducing stress, and that means exploring (and expressing) your thoughts and your feelings.

If you want proof that what you think about affects your heart, try this exercise: Sit quietly and peacefully until you feel your breathing calm and your heart rate steady. Concentrate on peaceful words and images. Imagine yourself in a safe, warm, engulfing place—perhaps a favorite beach or even an imaginary tropical island. Stop reading and breathe deeply for a few minutes before continuing to the next paragraph.

Now that you’re in this “state,” think about something that really disturbs you, maybe a situation at work, or at home, or with your kids or mate. Maybe some incident that caused a great deal of distress in your life, such as a mugging, or the theft of your car, or the death of a loved one. It can even be something that didn’t affect you directly—a real-life disaster such as Hurricane Katrina or the BP oil spill. Stop reading for another minute and really feel whatever comes up for you when you think of that disturbing event or situation.

Okay, what happened? Your heart rate probably went up, as did your blood pressure. You might have been able to hear your own heartbeat as it pounded in your ears. You might have felt anxiety and distress mounting in your body. Yet absolutely nothing happened physically. All that changed was your mental state, but this had a noticeable effect on a variety of physical measures.

Years ago, the great neuroscientist Antonio Damasio did a clever experiment that demonstrated how dramatically thoughts affect your body’s physiological reactions. He asked Herbert von Karajan, the legendary conductor of the Berlin Symphony, to sit quietly in a chair while hooked up to a variety of devices that monitored heart rate, blood pressure, and brain waves. After getting baseline measurements, he gave von Karajan the score to a Beethoven symphony and asked the conductor to go through it, imagining that he was conducting the orchestra through each passage, but without any significant physical movement. Damasio measured the exact same changes in brain waves, blood pressure, and heart rate that he had observed when von Karajan actually conducted that same symphony. By merely thinking about and imagining the score, von Karajan’s body had responded exactly as it did when he was actually conducting the score.

Your nervous system can be conveniently described as having two parts,
voluntary
and
involuntary
, which pretty much cover the two major classes of functions that the nervous system performs.

The voluntary nervous system refers to those bodily functions that are under conscious control (doing the tango, knitting, walking, filing your nails, filing your taxes, playing golf, or talking, for example). The involuntary nervous system—technically called the
autonomic nervous system
—is not under conscious control and includes the lion’s share of our nervous system and functions (heartbeat, digestion, hair growth, hormone secretion, biochemical release—all the things your body does automatically without your thinking about them). Many of our functions—breathing, for example—run automatically (such as when we sleep), except when we consciously take charge of them (for
example, when we “breathe deeply” or “hold our breath”). If this weren’t the case, we’d be like the proverbial centipede trying to tell each leg where to go.

Our involuntary functions—those that are for the most part automatic—are very sensitive to our emotions. When we’re startled or frightened, the diaphragm, our main breathing muscle, automatically flattens (inhales) and then stays flattened until the emergency is over, and we exhale with a “sigh of relief.” Unfortunately, this is also the case with chronic anxiety. People suffering from anxiety—along with women in labor, or even people with chronic respiratory disease—are taught how to take voluntary control of their diaphragms, inhaling, sighing, or humming to promote exhalation.

The heart is even more vulnerable to our emotions.

Our emotions affect the heart through the autonomic nervous system, which is divided into two opposite and opposing branches. These branches are the
sympathetic nervous system
and the
parasympathetic nervous system
. Ideally, they work together to create a nice state of balance called homeostasis.

The sympathetic system is what prepares us for fight or flight. It’s basically responsible for everything that happens once the “warning light” is turned on signaling an emergency. It’s the sympathetic nervous system that’s responsible for you swerving to avoid an oncoming car or quickly scaling the nearest tree when a wild boar starts charging your campsite. The sympathetic system is in charge of increasing your heart rate and blood pressure while at the same time suppressing “nonemergency” functions such as digestion. The parasympathetic system, on the other hand, is responsible for slowing down. It lowers pulse rate, lowers blood pressure, and stimulates gastrointestinal movements.

Like our ancient ancestors did, we rely on the sympathetic nervous system for extra energy in situations of physical and emotional stress, including combat and athletic events. But such high arousal without an outlet for expression can be damaging. Emotional and psychological arousal (such as fear, dread, worry, and anger) can generate cardiac arrhythmias and coronary artery spasms. They can (and do!) increase blood pressure. And they can even provoke heart attacks and sudden cardiac death.

How does this happen? What life-and-death communications travel between the nervous system and the heart? How can they produce such physiological and pathological responses to both real—and imagined—events?

Well, just as two ordinarily happy partners can have some knock-down, drag-out arguments, in a very real sense the brain and heart can also have some “lethal conversations.” Obviously we don’t mean that the two organs sit down and have a nice chat over a latte at Starbucks—the communication takes place through the nervous system by way of chemical messengers (hormones!) that literally serve as harbingers of death. Yes, we can even overdose on our own adrenaline in situations that involve fear, horror, excessive arousal, or deep despair and depression. The body can commit suicide by overstimulating the heart. And the heart running wildly in panic mode terminates with ventricular fibrillation.

So the brain and the heart are in constant communication. There’s definitely a heart–brain “hotline.” Identifying people at risk for sudden death depends on identifying not only the traditional risk factors for heart disease but also psychological and emotional elements.

Thoughts, unconscious and conscious, appear to be critical factors that link our “personalities” with the centers of the brain that control the functions of the heart. These are the hidden emotional risk factors for heart disease. And they’re far more important than cholesterol is!

Some people truly don’t feel the pain of their symptoms because, frankly, they’re living in denial, which, for our purposes, we’ll define as a state of being cut off from the awareness of what is happening to your body. Living in denial—out of touch with your body and its feelings—often leads to disaster. You fail to admit that a problem exists. Or you believe your symptoms are “nothing,” or something very “minor.” (Steve has seen this situation time and time again in many coronary-prone patients who told him they were experiencing indigestion when in fact they were having a heart attack.)

Take, for example, the case of Jim.

Jim was a banker, opening up a checking account for a new client, as he had done many times in the past. The client had a bunch of questions, all of which Jim answered patiently. But the client persisted with more questions and concerns. Jim had another client waiting and began to feel trapped.

He probably should have told his client that he had someone else waiting and that they’d have to continue another time. But instead—as is typical in many type-A men—he withheld his emotions and frustrations. He was feeling so much stress that he had to wipe the sweat off his brow.

Jim totally denied this bodily sensation, as well as all the other obvious messages his body was sending him. His hands began to sweat. He had difficulty breathing. He became dizzy, and he experienced chest pains.

Thinking the pain was just indigestion, Jim didn’t let anyone around him know how he was feeling. Fifteen minutes later, Jim was brought to the emergency room after suffering a heart attack.

Thus, a seemingly everyday occurrence ended in tragedy. But why? Why does a man put so much strain on his body that he ends up in total collapse?

The answer is simple. Jim was living in denial.

Living with awareness about your body is really the key to preventing ill health. Jim denied all the signals his body was sending him. (Although we can’t know for sure, it’s a safe bet to say that Jim’s lifelong habit of repressing his feelings was a strong contributing factor to his heart attack.) Instead, he pushed beyond his normal expectations and almost died in the process. Jim was really out of touch with his body. He really didn’t listen to any of the “conversations” that went on between his brain and his heart. The mind saying one thing while the body is saying another is at the root of what cardiologists call
silent myocardial ischemia
(a lack of blood flow to the heart, which often
results in damage to the heart muscle). The EKG tells us the heart is in trouble, even though the patient has no sensation. But the body is telling the truth, as the heart reveals its distress.

No one questions that there are strong behavioral and psychological factors that frequently precipitate cardiac arrest. It’s no coincidence that sudden psychological or emotional stress frequently occurs just prior to a heart attack. It’s well documented that Monday morning, the day most people go back to work after a weekend away, is the most common time for sudden cardiac death. Approximately 36 percent of all sudden deaths occur on Monday! And interestingly, the second most common time is Saturday. Why? Could it be the result of psychologically and emotionally gearing up (Monday) or gearing down (Saturday)? Is the office a safe place? Or is it a place of combat and stress (especially for the heart)? Look, some people may loathe going to work, but others may loathe going home. Whatever the stress is, the heart will reveal it. And the heart will tell the truth about it.

Your doc may tell you to fast before certain blood tests, but we’ll bet that no doc ever told you to meditate before taking a cholesterol test. Now granted, we don’t think cholesterol test results are important (
unless
you get the particle size test we recommended
earlier). But your doctor undoubtedly
does
. And he or she would probably be surprised to learn that stress can actually influence those cholesterol test results. After all, how could stress—which clearly originates in the brain—influence something like cholesterol in the bloodstream?