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Heart attacks are the most common cause of death. Do you worry a lot about all the vast amounts of heart information on a daily basis? The one that constantly reminds you of how bad different foods and different activities are for your health?

Well, I do, and I am a doctor. Take heart attacks, for example.

We were first told that eating fat would cause fatty streaks and blockages to build up in our arteries, and so to avoid a heart attack we should eat “low-fat” foods. This kind of made sense and for years I would confidently start my day with sugary cereals that had the promise of a low-fat label on the box. Then more recently it was explained that eating sugary carbohydrates will inflame our arteries and cause a heart attack.

With so much information overload, no wonder our hearts are distressed

And of course, we all know that smoking, stress, inactivity, and possibly even over-activity could lead us down the path to our most common cause of death – a heart attack. I could just worry myself silly until I disappeared into a vortex of distress. I am quite sure that these studies are, for the most part, sincere in their intent. However, they can’t all be equally correct. For example, on nutrients alone, if I cut out all the fats and stop eating the carbohydrates, I might only have protein left to eat. Apparently, that could give me cancer of the colon!

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So, if we want to get to the bottom of this rabbit-warren information overload and find out what are the most important rules for health then let’s look at things a little differently.

To avoid a heart attack, let’s look at what makes for a perfect heart attack

Similarly, if we want to avoid getting a heart attack, it might be most useful for us to look at things from the other side. Let’s look at what makes the perfect heart attack. If we could master that, then we would have a good handle on what best to do to avoid a heart attack.

The starting point

The primary aim of creating a heart attack is to block an artery that feeds the heart. If we can stop the blood and nutrients getting to the heart, then that part of the heart will die and we will have achieved our goal. To do that we need two ingredients. An inflamed artery, plus some inflamed cholesterol. What is important here is the inflamed part.

We need sticky (or inflamed) cholesterol to attach to a sticky (or inflamed) artery wall. If we fail to inflame either one of these items, then our attempt at a heart attack flops. Of these two, the most important component is the sticky arterial wall. It is one thing to have inflamed cholesterol but to get it to stick to an artery wall and create a blockage, we need to inflame the arteries around our heart.

How do we inflame the heart?

Our biggest hurdle in creating a heart attack is to inflame arteries. As it turns out, there are three reliable ways we do this:

  1. Eat sugary carbohydrates over many years. When we eat sugar, sweets, fizzy drinks, starchy foods (bread, potatoes), and sweet fruit (bananas, grapes, dried fruit), then we are forced to release the hormone insulin to remove all this sweet glucose out of the blood and store it in fat cells. If we can eat sugary foods on a daily basis then we should successfully over-rev our sugar-insulin system and inflame our arteries[1] [2].Heart Disease
  2. If we really want to get the artery walls inflamed, then constant worry is an excellent way to achieve this. We have all heard from someone who dropped dead from a heart attack after receiving really bad news. The emotional shock will tighten up the arteries and cut off any blood vessel that is already half blocked. However, it is the daily stress and worries that we put ourselves under that successfully inflames arteries and allow blockages to start forming[3].
  3. Smoking – if all else fails, then a sure-fire way to inflame arteries is to smoke. This doesn’t even take much effort: if you can only manage 1 cigarette a day, this will inflame your arteries and give you a 50% better chance of a heart attack[4].

Add some cholesterol to make the perfect heart attack

olive oil | Longevity LIVE

So now that we have inflamed our arteries, we just need the cream on the cake – some cholesterol. Preferably inflamed. It turns out that we can’t eat any old fat and expect it to clog up an artery – we need to be quite specific about which one we choose:

  • Fish and fish oils, for example, tend to reduce inflammation in arteries and make our arteries irritatingly healthier.
  • Olives, avocados, nuts, and seeds all contain healthy fats that move us further away from our goal of a heart attack.
  • We used to think that eating cholesterol-laden foods like meat, eggs, and dairy would successfully block off arteries with the cholesterol that we had consumed.

    Eating these saturated fats certainly increases our LDL cholesterol levels in the blood, but it turns out that they don’t worsen the really bad LDL cholesterol levels.

The final nail in the coffin for us considering meat to be the bad boy of nutrition was a huge 2017 study that did not focus on blood cholesterol levels, but rather focused on whether those people who ate butter and eggs died from a heart attack or not. What they showed was that eating meat, eggs, and butter did not result in heart attacks. However, eating starchy carbohydrates did cause heart attacks[5].

Your heart is not the same as mine

It is important to appreciate that no two humans are alike and genetics means that about 1 in 500 people will be excellent at over-absorbing cholesterol into the bloodstream. For this select group, eating steak and eggs may raise bad cholesterol levels[6].

  • Thankfully for the rest of us, there are two groups of fats that won’t disappoint when it comes to successful heart attacks:

–    trans fats, like margarine, are vegetable oils that have been damaged chemically to make them thicker.

–    seed oils like sunflower or canola oil are quickly damaged when heated and used in deep-fry foods.

What is so special about these oils is that they have already been damaged and inflamed either with chemicals or in the frying pan, so that both arrive in the body as pre-oxidized fats. Once we have inflamed arteries, these fats are one of our best tools to block that artery[7].

  • Lastly, an often-forgotten way of increasing our bad cholesterol in the blood is to damage the very organ that makes our blood cholesterol – the liver. What we need is a fatty liver and apart from drinking excessive alcohol, consuming regular amounts of sugar and starchy foods is a great way to achieve this. Once we have a fatty liver, it will not only cause bad cholesterol, but will also contribute to inflaming the arteries[8].

How to inflame cholesterol to make the perfect heart attack

So now that we have successfully made our bad cholesterols, we must not forget to inflame them to make sure that they can stick to the arteries. We have two easy choices here. We can either smoke cigarettes, or if we can’t stomach that, then going for regular runs along a busy highway should do the trick. Inhaling thick car fumes is an excellent method of inflaming cholesterol[9].

It always used to confuse me as to why after every London marathon one or two seemingly healthy middle-aged athletes would drop down dead of a heart attack. After all, isn’t exercise meant to be good for us? However, if you consider that if runners pack in pasta, potatoes, and other carbo-loading favorites, plus they train in a city heaving with diesel car fumes, then one starts to see how they are following a recipe for inflamed arteries and inflamed cholesterol.

What then becomes surprising is that there are no more heart attacks among long-distance athletes. This starts to suggest just how much exercise protects us from bad eating habits and a toxic environment[10].

heart | Longevity Live

It is clear that a heart attack is a massive problem of inflammation. Everything from making an artery sticky to a cholesterol plaque depends on inflammation. To prevent a heart attack from forming, our first goal must be to cut out sugary carbohydrates, remove continuous stress and avoid cigarettes as the three best things to protect our arteries from inflammation.

Next, we need to avoid trans fats like margarine and avoid using seed oils like sunflowers to fry our foods. These fats are pre-oxidized and can quickly turn our cholesterol rancid. Only if we are genetically predisposed would eating saturated fats like eggs and butter be problematic, but for most of us, these foods are back on the menu.

Here are a few supplements that have been shown to protect us:


Lastly, we need to try to avoid the bad air in inner cities. Breathing this air, particularly during exercise, is the other main way of oxidizing our blood cholesterol.

Lastly, if you have a very high risk of a heart attack and the above activities have not reduced your heart attack risk, then your doctor might prescribe you a statin tablet-like Crestor. Although these tablets do lower cholesterol levels, their main action is to reduce arterial inflammation and reduce oxidized cholesterol – the two weaknesses that we now know cause a heart attack[11].

Why don’t we all get these tablets – because they can come with some nasty side effects. All that most of us need to do is follow the lifestyle advice shown above.

About the author

Dr. Duncan Carmichael is a medical doctor with 25 years of experience, the founder of the Institute of Healthy Aging (IHASA) in Cape Town, and the author of the acclaimed book Younger for Longer: How You Can Slow the Ageing Process and Stay Healthy for Life.

Article reference:

[1] Giacco F et al. Oxidative stress and diabetic complications. Circ Res. 2010. 107: 1058-1070.

[2] Bornfeldt KE et al. Insulin resistance, hyperglycaemia and atherosclerosis. Cell Metabolism. 2011: 14: 575-85.

[3] Fioranelli M et al. Stress and inflammation in coronary artery disease: a review ,pyschoneuroendocrineimmunology-based. Front Immunol. 2018: 9: 2031.

[4] Hackshaw A et al. Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports. BMJ. 2018: 360: j5855.

[5] Dehghan D et al. Associations of fats and carbohydrate intake with cardiovascular disease and mortality in 18 countries and from five continents (PURE): a prospective cohort study. Lancet. 2017: 390: 2050-2062.

[6] Diet and health: Implications for reducing chronic disease risk. Nat Res Council (US) Comm on Diet and Health. 1989.

[7] Ascherio A et al. Health effects of trans fatty acids. Am J Clin Nutrit. 1997: 1006S-1010S.

[8] Misra V J et al. Non-alcoholic fatty liver disease and cardiovascular risk. Curr Gastro Rep. 2009: 11: 50-55.

[9] Jacobs L et al. Traffic air pollution and oxidized LDL. PLOS/ONE. 2011:

[10] Nystoriak MA et al. Cardiovascular effects and benefits of exercise. Front Cardiovasc Med. 2018: 5: 135.

[11] De Rao A. To JUPITER and beyond: Statins, inflammation and primary prevention. Critical Care. 2010: 14: 310.

Dr. Duncan Carmichael

Dr. Duncan Carmichael

Dr. Duncan Carmichael is a medical doctor with 25 years of experience, the founder of the Institute of Healthy Aging (IHASA) in Cape Town, and the author of the acclaimed book Younger for Longer: How You Can Slow the Ageing Process and Stay Healthy for Life.

Duncan is a regular speaker and lecturer at conferences on aesthetic and anti-aging medicine in South Africa and abroad. He qualified as a doctor in South Africa and then trained further in Europe where he studied nutrition, hormone balancing and aesthetic medicine.

Younger for Longer (‘Revelatory and accessible’ – The Sunday Post) was published in 2018 through Jonathan Ball, and is available from your favourite bookstores and through and on Amazon.


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