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PREVENTING AND TREATING ATHEROSCLEROSIS by Zoltan P. Rona, M.D., M.Sc. DEFINITION : Atherosclerosis is a degenerative condition in which arteries build up deposits called plaques (atheromas) which consist of lipids (mainly cholesterol), connective tissue and smooth muscle cells originating from the arterial wall. Another term used to describe atherosclerosis is "hardening of the arteries". Plaques develop quietly over a period of years and are unnoticeable until there is an interruption in the normal flow of blood. Progressively limited blood flow leads to lowered nourishment of the tissues involved (heart, brain, etc.), oxygen deprivation or thrombosis (complete blockage followed by clotting). The most frequently affected arteries include the aorta, the coronary and cerebral arteries. The areas serviced by the diseased arteries become deprived of oxygen and other vital nutrients. If this occurs in one of the arteries that supplies the heart (coronary arteries) the result may be a heart attack. If it occurs in an artery that supplies brain tissue then the result may be a stroke. THE EAR LOBE CREASE Significant symptoms of atherosclerosis only appear at the end stage of the disease process when blood flow to a particular body part has been greatly reduced. An early warning sign of atherosclerosis is a crease in the ear lobe. This is because a decrease in blood flow over a period of time results in a collapse of the vascular bed of the ear lobe. This leads to a diagonal ear lobe crease which has been recognized as a sign of atherosclerosis since 1973. Studies show that the ear lobe crease is a better predictor of heart disease than any of the other known risk factors including high blood cholesterol, smoking history, sedentary lifestyle and others. Its presence does not prove that the person having it has coronary artery disease but it strongly suggests it. This correlation, unfortunately, does not work with Orientals and American Indians, but seems to hold true for all other races. A review of the scientific literature reveals that the best treatment of atherosclerosis is a comprehensive prevention program involving diet, exercise and lifestyle modification. The major risk factors induced by the typical North American diet and lifestyle are hyperlipidemia (high blood fats), high blood pressure, obesity, stress, personality type, physical inactivity, cigarette smoking and diabetes mellitus (sugar diabetes). Even hereditary factors such as heart attacks or strokes in family members can be offset to a large degree by diet and lifestyle changes. There are many different theories about the biochemical mechanisms that bring about atherosclerosis involving the different types of cholesterol proteins (lipoproteins), platelets and other blood clotting factors but there is considerable disagreement amongst so-called experts as to the relevance of any of these in the actual disease process. In almost any book store one can find respected authors claiming that cholesterol is the most important factor in predicting the appearance of atherosclerosis. Equally respected scientific authors claim the reverse to be true. The truth is that no one knows for sure about the specific role of cholesterol or whether or not we should really be so concerned about it. DIET Population studies have shown that death due to atherosclerosis is positively correlated with red meat consumption and inversely correlated with fish consumption. One study showed that mortality due to coronary heart disease was 50% lower among those who consumed an average of 30 grams of fish per day compared with those who ate meat daily. Meat eaters in this study had a 300% increase in their risk of coronary heart disease. This is thought to be due to the beneficial effect of the types of fat found in seafoods (omega-3-EPA, linoleic, linolenic) on blood levels of cholesterol [and triglycerides as well as their role in preventing platelets from sticking or clumping together. Common sugar promotes higher blood levels of cholesterol, triglycerides and uric acid. It also increases platelet stickiness and should be limited in any preventive diet for atherosclerosis as much as possible. An increase in dietary fiber (especially psyllium seed husks, legumes and oat bran) lowers cholesterol as well as improves bowel elimination. In the past decade it became fashionable to use the Pritikin diet as not only a treatment for atherosclerosis and obesity but as a preventive as well. The Pritikin diet recommends that total fat intake comprise no more than 10% of the daily caloric intake with 10% protein and 80% carbohydrate. Although this approach yields excellent results in the short term, it lead to signs and symptoms of essential fatty acid deficiency if adhered to for extended periods of time. Side effects include eczema, dry skin, premenstrual tension and depression. A modified Pritikin approach includes the essential fatty acids found in seafoods and vegetables. It can be followed indefinitely without side effects yielding the same or better results as the Pritikin approach. A sample menu follows: Breakfast 1/2 grapefruit 1/2 cup oatmeal 3 ounces salmon steak 1 cup skim milk Lunch 1 sardine sandwich (using whole grain bread) 1 cup fat-free soup 1 apple 1/3 cup cooked lentil beans


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