By day, Dr Nikki Stamp fixes broken hearts. Not by writing lengthy love letters or standing outside someone’s window with a boom-box, but in a hospital operating theatre. She is a cardiothoracic – heart and lung – surgeon who has worked in some of Australia’s busiest hospitals.
Her book, Can You Die of a Broken Heart? is part memoir, part health guide. Ripe with anecdotes from Dr Stamp’s personal life, it includes the first time she saw a beating human heart, stories of survival, and tragedy. And offers explanations stripped of medical lingo that help us understand what makes us tick.
It is clear once finishing the last page of Can You Die of a Broken Heart? that Dr Nikki Stamp has a strong desire to change the ways we think about our health. Equal parts a young surgeon’s fascination with the body’s most poetic and mystical organ, and erudite advice that can be applied on a daily basis. In fact, the book reveals that there are a number of easy, complementary, and achievable ways that we can change our lifestyles to reduce the chance of heart disease. Read more.
Words || Dr Nikki Stamp
Wine is constant proof that God loves us and loves to see us happy.
BENJAMIN FRANKLIN, SCIENTIST AND POLITICIAN
There are some incredibly sad aspects of my job. I met a man one day who had had what we call ‘palliative’ surgery for a particularly nasty form of lung-related cancer called mesothelioma. It’s cancer of the lining of the chest and is strongly linked to asbestos. What’s terrible about this type of cancer is its dreadful prognosis. My family knows this first-hand – it was the kind of cancer that my grandfather died of. This poor man had probably been exposed to asbestos when he was building his house. He had an operation to try to control some of his symptoms and enable him to live more comfortably for as long as possible.
He came to hospital because his breathing had worsened. I sat down with him in the emergency department to talk about what had been going wrong. He was upset that what little independence he had left was being destroyed by the progression of his disease. I remember feeling an intense sense of frustration that medicine had not yet been able to provide a cure for this dreadful disease. Through his tears, he told me that not even the juice had worked. What juice was that? I asked. In the hope of finding a cure, he had sought counsel from his local health food store and been assured that their special supplements and carrot juices would lengthen his life. He bawled into his hands thinking about the $300 a week the futile carrot juice was costing him, which was money he could not afford to spend. If faced with a terminal illness, I don’t think any of us can say for sure that we wouldn’t try anything available to us. This man had put his faith in the promise of healing superfoods and supplements and, as he described it, the only thing it was doing was ‘making him poor’. The disease eventually took hold and he passed away. Part of me wanted to visit that health store and berate them for taking advantage of a dying man. Part of me was sympathetic, wondering what superfoods I would try if my life was in the balance. I recently discovered that when it comes to my own health, so-called superfoods have lodged themselves in my subconscious, as they have for many people. I am unlucky enough to have a strong family history of high blood pressure and heart disease, so I had finally decided to pull my head out of the sand and get my heart checked by my doctor. As the cuff tightened, it wasn’t good news. My genes, my stress and my recent lapse in exercise had betrayed me and I had blood pressure that was much too high. It was a wake-up call, so I marched myself down to the supermarket to add lots of fresh fruit and vegetables to the pantry.
As I walked through the supermarket, I wondered where the superfoods for high blood pressure were, making a mental note to get a bottle of red wine because it’s ‘good for the heart’. What an odd thought. Why did I think superfoods and red wine would be my saviours? The idea of food as medicine is gaining momentum as we realise the impact of what we eat on fighting or feeding disease. Is a glass of red wine a day really going to make your heart healthy? Is dark chocolate as good for you as you may try to justify? Many of us are interested in the latest iterations of the red wine debate or learning what the latest superfood is. It’s hard not to buy into the promise of the newest health food saviour. The funny thing is that before I started my own search for superfoods in the supermarket aisles, I had thought the buzz around certain foods was interesting, but could not believe that they were the cure-all they were often purported to be. However, I had never gone sifting through the evidence to see what science said about them.
How many times have you clinked glasses of wine and felt virtuous because you were drinking red? Red wine often features in the media as something that you should drink for your health, particularly for your heart. In general, alcohol consumption, especially to excess, is something we are told to avoid for the sake of our bodies. Red wine and other alcohol are two very different beasts. Alcohol, in beer, white wine or spirits, doesn’t have many health benefits, especially when you have ‘too much’. Current guidelines tell us that we should have no more than two standard drinks per day and no more than four in one sitting. A standard drink is a lot smaller than we might think, so for many people, exceeding this benchmark is easier than it sounds. Studies over many years have demonstrated that while a glass of wine after work or a beer at a summer barbecue might be a great pleasure, alcohol is not great for us. It tends to cause problems in a dose-related effect: so, the more you have, the more problems it causes.
The list of diseases that arise from drinking too much alcohol is extraordinarily long, including liver disease and some cancers. Countless studies have looked at how much a person drinks and compared that to their risk of heart disease. Most of the time, what we see is that the people who drink the most, as well as those who drink nothing at all, have the highest risk of heart disease. The so-called ‘moderate’ drinkers seem to be the best protected. These studies have a couple of flaws. Firstly, asking people to report how much they drink is not always reliable. People often think that they should drink less, so they say that they drink less than they actually do. Recently, an interesting explanation was offered as to why non-drinkers fared worse than moderate drinkers. Among people who drank no alcohol whatsoever, some studies discovered that teetotallers were more likely to have previously been heavier drinkers. Which means they might have already exposed themselves to the risks associated with heavy drinking.
Giving up drinking is great, but what this illustrates is that life is more than a snapshot. Our lifestyle and health matters over longer periods, not just right now. That includes not having periods of excess in between the times when our drinking is restrained. More finessed studies, not just observational ones, have suggested that for all of us, reducing the amount of alcohol we consume is a great idea. However, there is an unexpected finding that still persists: small amounts of alcohol may actually protect our hearts. Researchers believe that alcohol may change the levels of HDL, or good cholesterol, depending on how much we drink. High blood pressure and alcohol consumption often go together.
However, at lower levels of consumption, alcohol may relax blood vessels and so lower blood pressure. It’s not entirely clear what mechanisms might be at play; this is still coming to light. One interesting possibility relates to an enzyme called alcohol dehydrogenase that is slightly different in each of us. Some of us have a small variation in this enzyme that slows down how alcohol is processed and disposed of by our bodies. It also may encourage the liver to make more HDL cholesterol, which is thought to be protective. Alcohol use is also associated with an abnormal heart rhythm called atrial fibrillation, which is the most common type of heart rhythm problem. For each drink we have per day, our risk of atrial fibrillation increases. This is probably due to the fact that alcohol depresses the pumping ability of the heart and might directly cause problems to the heart’s electrical systems.
So why is red wine different?
Here’s an even better question: is red wine any different?
Just to be clear: in excess, red wine is the same kind of bad as a few too many beers a night. It’s not the alcohol in red wine that has the benefits, it is all the other gear. The idea that red wine might be protective is sometimes called the ‘French Paradox’. In the late 1970s a researcher noted that, despite a relatively high-fat diet filled with cheese and butter, the French had one of the lowest rates of death from heart attacks. Another finding showed that in regions of France where people preferred a white with dinner to a red, there were worse survival rates from heart attacks.
This petit observation intéressant led researchers to investigate why red wine might be powerful enough to take on butter. Around the same time as the French Paradox was noted, the war on fat was gaining momentum. It seemed remarkable that red wine might be potent enough to negate all the problems caused by public enemy number one. Around 20 years later, experiments showed that even small amounts of red wine contained a substance called phenol. Phenols are a type of antioxidant and there is one that is specifically in red wine called resveratrol. Resveratrol runs around our blood vessels mopping up free radicals. Free radicals are little angry molecules of oxygen that we all produce as side effects of the normal cellular metabolic processes in our bodies. They are harmful to our tissues and so our body has free radicals scavenged by antioxidants. Some antioxidants we make, some we get in our diet.
Back to France, where using wine in cooking is common and meat is often marinated in red wine, the result is that antioxidants knock out free radicals in the meat before it is even eaten. Resveratrol is good at preventing the oxidisation of LDL, or bad cholesterol. When LDL is oxidised, an oxygen molecule is added to it. This is like arming that molecule to go out and cause carnage. An oxidised molecule of LDL is much more easily retained in the blood vessel walls, which is where plaque can form. If red wine can prevent that LDL from getting angry and activated, it may lose some of its disease-causing ability.
That’s not the only way in which red wine can be useful.
Resveratrol is also able to induce the endothelium (lining of our blood vessels) to make nitric oxide. We’ve met nitric oxide before: it’s a potent vasodilator. That is, it causes blood vessels to relax. Red wine helps our bodies make nitric oxide, which means that there is a wide-open flow to our hearts and all other organs of beautiful, nutrient-rich blood.
Red wine and indeed alcohol in general may be useful at keeping the blood thin, by calming down the clotting process when it’s not needed. If you can imagine how much better it is to push thinner rather than thicker blood through a tube, you get the idea of why that can be useful. It’s all about good flow when it comes to blood supply, and some scientists believe red wine may deliver this in spades. It is believed there may be a number of other beneficial mechanisms activated in red wine. Red wine may help to keep the heart muscle supple by blocking scarring in the heart, or blocking enzymes called angiotensin-II that indirectly increase blood pressure. This is incidentally also a target of very important and commonly used medications called ACE inhibitors. ACE inhibitors are used to lower blood pressure and help people with heart failure. What’s fascinating is that the benefits of red wine are still gained when the wine has the alcohol removed. It’s mostly about the grape that is used to make red wine.
Research on the effects of red wine on heart disease is a work in progress. An exciting possibility is that the specific substances in red wine could be turned into a medication that treats or prevents heart disease. New information, however, can be at times in conflict with previous research on red wine, alcohol and heart disease. For the time being, studies show that red wine has some great potential benefits for our hearts, but only if we consume it sparingly. The same goes for alcohol. At low doses, alcohol is enjoyable and probably good for us. At higher doses, alcohol is bad news. Don’t drink to be healthy, rather drink (judiciously) because you are.
Certain to make the news and be discussed repeatedly is any scientific study that finds chocolate is good for us. Any quasiscientific whisper that chocolate might be healthy is like a free pass to go crazy on a whole block of it. The distinction between dark chocolate and the sweeter (and possibly less healthy) milk chocolate is incredibly important. It was for one of my patients. At 52 she lived a relatively normal life, working as a paralegal in a busy law firm, and was on her feet all day. Three years earlier, she had been diagnosed with diabetes after complaining to her GP that she was constantly tired. Diabetes tends to hide away for a period of time before it’s diagnosed, and in that time it can do a lot of damage. Which, in this patient’s case, it had.
The diabetes and high blood sugars had attacked blood vessels in her legs, eyes and heart. At an age that by today’s standards was not very old, she was facing open-heart surgery. I sat on her bed as she looked me square in the eyes and said, ‘This is all my fault. I don’t check my blood sugar, I eat chocolate every day and I never deny myself anything.’
I was a little shocked, because few people are so blunt when it comes to admitting the ways in which they don’t look after themselves. And she took the same blunt approach in responding to her illness by ‘pulling her head in’, a great Australian colloquialism for addressing your shortcomings and fixing the problem.
On a ward round a few days after her surgery, she proudly showed me how she had switched from her favourite sweet and milky chocolate to dark chocolate. Chocolate, for all the positive publicity it receives, probably doesn’t have the same beneficial effects on our health as fruit and vegetables.
That doesn’t mean that there is nothing beneficial there though.
A little like red wine, dark chocolate is rich in antioxidants. An antioxidant group called flavonoids are thought to be the heroes here. Flavonoids are antioxidants that are found in plants and, just like the antioxidants found in wine, they scavenge up any harmful free radicals, preventing them from doing damage to our cells. Chocolate is made from a plant. Cocoa beans produced by the cacao tree are ground, roasted and formed into a paste and added to milk and sweeteners or other flavours. These plant origins mean that chocolate contains all those lovely plant-based antioxidants. Similarly to when we drink red wine, when we eat chocolate free radicals are mopped up and the endothelium produces nitric oxide, causing blood vessels to relax and blood to flow smoothly. It probably also improves the ratio of good cholesterol to bad cholesterol in the blood and helps our bodies respond much more effectively to insulin.
In theory, chocolate has the hallmarks of a heart-health crusader. Many epidemiological or observational studies have looked at how our hearts benefit from chocolate. A large recent study showed that in men and women who ate up to 100 grams of chocolate a day, the risk of heart disease was much lower. To put that in perspective, a single square of chocolate is around 8 grams. Chocolate eaters were also less likely to die from a heart attack.
Interestingly, the findings weren’t able to show a difference between dark and other types of chocolate. That being said, this was a pretty weak finding of the study and most other science suggests that dark chocolate has the race won when it comes to heart disease. Another interesting study used human blood vessel cells, taken from umbilical cords and grown in a lab, and almost bathed them in chocolate. The lab isolated the good parts of the chocolate, specifically the antioxidant flavonoids, and incubated the blood vessel cells in them to prove that the flavonoids found in dark chocolate were great at making healthy blood vessels. That data was used to show that in people with blood vessel disease, such as peripheral arterial disease, eating dark chocolate made their blood vessels perform much better. The vessels relaxed and blood could get more easily to where it needed to be, meaning that these patients could walk again as blood made it to their hungry working muscles. People who have blockages of the blood vessels in their legs often can’t walk far; their muscles are starved of the oxygen they need. It was thought that the dark chocolate helped them recover, in a sense. It’s a similar situation in the heart. Working out ways to improve blood supply to the heart is vitally important for healthy hearts.
We’ve come across inflammation several times now. Just to recap: inflammation is the body’s attempt at fighting things it thinks aren’t good for it. When it goes a little harder than it should, inflammation can cause damage. In our hearts and blood vessels, unchecked inflammation starts cascades of processes that harm the vessels and the heart. Being able to keep inflammation in check is very important. Cocoa and the flavonoids contained in it are quite good at stopping the cells from producing inflammatory hormone-like molecules called cytokines. It’s this action that may also stop the development of irregular heart rhythms, such as atrial fibrillation, in chocolate eaters.
Dark chocolate and milk chocolate share a lot of the same compounds, such as flavonoids. Dark chocolate, though, has a few advantages over milk chocolate. Firstly, it contains higher concentrations of antioxidants. Secondly, it also has less of the stuff that might undo all the antioxidants’ good work, such as saturated fat and sugar. A little like red wine, we aren’t about to start taking out our prescription pads and prescribing dark chocolate just yet. Nor does gorging ourselves on dark chocolate mean that we get a free pass from doing all the other things we should for our hearts, like exercising and eating fruit and vegetables. If you must have chocolate, it is probably best to stick with darker chocolate of at least 70 per cent cocoa to get the health benefits along with the treat.
Coffee and tea
I have two observations to make about coffee. The first is that it smells awful to me. As someone who drinks neither coffee nor tea, I know that puts me in the minority because most coffee drinkers I know love it! The second is that everyone around me seems to drink coffee. Common sayings like ‘First, coffee’ are an ode to how people can’t get going in the morning without their habitual eye-opener. Despite this, I can’t bring myself to be a coffee drinker; it is a taste that I never became accustomed to. Very occasionally I almost regret this because a news article tells me that drinking coffee or tea is actually ‘good for you’.
In the United States around 80 per cent of people drink coffee; nearly 60 per cent of adults drink it daily. Coffee culture is a modern phenomenon in Australia, with people being very specific about what kind of coffee they drink. Even tea is having a moment, with whole stores dedicated to selling more types of tea than you ever thought possible. It becomes a habit, a taste and an experience. A little like chocolate, when a study is published about the supposed health benefits of coffee, the internet goes wild, with people viewing it as permission to indulge their favourite vice.
However, many studies over the years have been conflicting when it comes to the health benefits of coffee. Some studies have shown that people who drink a lot of coffee may have a higher risk of heart disease. This association was strongest for people under the age of 55 who drank more than four cups a day. In comparison, a number of other big studies have showed a decline in heart disease for coffee drinkers. It’s possible that studies that found coffee drinking wasn’t great for us may have been subject to confounders, such as the way people took their coffee. Compounds in coffee have a number of effects on the heart and blood vessels.
In addition to caffeine, coffee contains phenolic acids and potassium. There isn’t a consensus on how coffee may be good for us, but it’s thought to be beneficial in reducing inflammation and the body’s sensitivity to insulin. This may be very good for the heart and blood vessels as it can minimise the number of damaging substances they’re exposed to. Coffee can directly oppose the action of hormones that relax blood vessels and so can slightly increase blood pressure. It also enhances the actions of the sympathetic nervous system on the heart, causing the heart to beat faster. That’s the thumping in your chest when you have an extra coffee. Interestingly, if you have a cup of coffee (or more) every day, your body gets used to these reactions and is able to ignore these potentially troublesome effects. For example, regular coffee drinkers don’t get the same spike in blood pressure that less habitual coffee drinkers get when they have a coffee.
When it comes to drinking coffee for health, the truth probably lies in a grey area. When all these studies are considered, the overall trend is that drinking some coffee is not bad for your heart. It’s probably even a little beneficial for your heart. But not as healthy as exercise or a balanced diet. The other important thing to keep in mind is how you have your coffee: adding sugar is not good. When looking at coffee drinkers who have had heart attacks, these people tended to add a lot of sugar to their diet in general, as well as to their coffee. So, for health, coffee is probably fine, and may even be good for your heart. However, skip the sugar and get your caffeine hit au naturel.
I am perpetually overwhelmed by reports detailing the latest superfood. With headlines like ‘Five superfoods that Jesus ate’, it’s a battle not to click on the link and get drawn into the news of some unaffordable exotic berry or unpronounceable grain. With promises of longevity and health, superfoods seem to be the cure to our growing personal and societal epidemic of ill health. I try to look at these claims with a healthy dose of scepticism and scientific curiosity, but as I admitted earlier, I reflexively found myself thinking of superfoods as a way to deal with my own hypertension. ‘Superfood’ is more of a marketing term than a scientific one. Generally, the label is given to foods that have a high nutritional benefit. In fact, when a food is labelled as a superfood in the media, sales of that food spike significantly. Consumption of these superfoods is disproportionately higher in people with higher incomes. This is hardly surprising given that these foods are often relatively expensive.
Foods that are often called superfoods include easily attainable staples like broccoli and blueberries as well as the slightly more exotic goji berries, spelt grains, quinoa and kale. They are generally foods that are high in vitamins, minerals and antioxidants, just like red wine and dark chocolate. And, just like red wine, these plant-based foods produce antioxidants called phenols, of which resveratrol is one, and basically keep our blood vessels healthy by mopping up free radicals and producing nitric oxide. In a number of superfoods, the active ingredients that form the basis of their super-status are actually found more abundantly elsewhere. Kale is constantly labelled a superfood, but Brussels sprouts and other green leafy vegetables are just as healthy. Rocket has more nitrates, which lower blood pressure, than beetroot. Salmon has nearly double the good omega-3 fatty acids, which are important for maintenance of a healthy fat profile in blood, than chia seeds. All are much cheaper and easier to come by.
In theory, so-called superfoods are good for us. They tend to be fruits and vegetables or grains that are low in sugar and fat and high in micronutrients. Here’s the question though: are superfoods any better for us than boring old vegetables that are cheaper and much easier to get our hands on? The crux of the matter is this: no single food, super or otherwise, can make up for an otherwise ordinary diet. In fact, European legislation says that no food can be called, marketed or claimed as a superfood unless you can prove its health benefits. The ban has been in place since 2007, which was incredibly forward thinking.
The testing of superfoods isn’t carried out in a way that is necessarily applicable to daily life. Compounds in superfoods that are good for us are often isolated in a lab and then given to cells to see how they respond. Those results are then extrapolated to the population. That is, we see a good thing in a test tube so we think that it might be good in real life, too. But we don’t know for sure. Unlike general fruit and vegetable consumption or even red wine and chocolate consumption, there aren’t enough people eating these superfoods to enable us to study how healthy they are or how many heart attacks they have had, and how this might relate to their superfood diet. So, we can’t say that a superfood is a true panacea. When it comes to superfoods, the science isn’t there. Superfoods cannot compensate for obesity, inactivity or simply having an unlucky combination of genes. Are they harmful? Probably not. Should you pay more for them? If you like them and are willing to spend more on your grocery bill, go for it. I love quinoa for its flavour as well as its benefits as a whole grain, not because it is a superfood.
The science behind superfoods may change over time and if there is a food that is going to help us lose weight, reduce heart attacks or live longer then that is excellent. For now, however, you do not have to consume superfoods to be truly healthy. Healthy foods are available everywhere and are generally much cheaper. Foods like salmon, everyday fruit and vegetables and standard whole grains are backed by science as helping improve the health of your heart by lowering blood pressure, reducing bad cholesterol, cultivating a healthy gut microbiome and keeping a healthy weight.
(original extract has been modified for digital formatting)