What is the cause of this new epidemic? Before taking up our discussion of ways to forestall a heart attack, it might therefore be well to understand more clearly the basic physiology involved. Let us start with a closer look at the arteries, the vessels that carry fresh blood from the heart to the billions of cells in our bodies that are in constant need of nourishment.
Upon careful examination, we find that the arteries are not the simple tubes we have pictured them to be. Viewing them in cross section, we see that their structure is more like that of a garden hose, containing three layers of tissue in the walls. The inside layer or lining of the artery, which doctors call the intima9 consists of a slippery membrane somewhat similar to the mucous membrane on the inside of your mouth. The in-between layer, known as the media, is formed of muscle fiber. This enables the blood vessel to expand and contract with the heartbeat, to facilitate the flow of blood through it. The outer layer, called the adventitia, is composed of coarse strong fiber& which provide added strength to the artery. In both the outer and the intermediate layers, there are tiny intrinsic blood vessels which nourish the artery itself.
The thickness and exact composition of the three layers vary, depending upon an artery's size and location. Of the changes that may occur in the arteries as a result of disease, there are two types which concern us here. Both kinds have traditionally been known by the general term, "arteriosclerosis," which means hardening or thickening of the arteries. Actually, however, there are two kinds of hardening of the arteries. One occurs when calcium deposits in the middle layer of the artery cause it to become brittle and hard. For this reason, it is sometimes called a "pipestem" artery. Such calcification does not necessarily obstruct the blood flow, and is usually harmless from a clinical point of view. The other type of change, on the other hand - and it is the more frequent one - has serious consequences. It consists of a thickening of the inner wall of the artery by deposits of fats: cholesterol (a fatty alcohol), fatty acids, and the like, together with calcium.
As these deposits grow, the passageways or canals of the arteries become narrower, much in the same way as the drain from your kitchen sink becomes clogged with grease deposits. The result is that less and less blood can flow through the narrowed opening to the tissues or organs that depend on it for life. Your "pipes" have become clogged. At the same time, the swelling of the lining cells and roughening of the inner surface provide sites for formation of blood clots inside the narrowed artery. If the blockage is complete in vital arteries that feed the heart muscle, a heart attack - or as we physicians call it, a coronary thrombosis - occurs. If this disaster occurs in the cerebral arteries of the brain, a "stroke," sometimes called a heart attack in the head, results. When the small arteries of the kidneys are affected, Bright's disease, formerly called "dropsy," and other diseases ensue. But whether the thickening and blocking process takes place in the heart, head, or kidneys, it is essentially the same disease. Doctors refer to it as atherosclerosis. About a century ago, during an autopsy, a German pathologist named Rudolph Virchow laid open an artery to examine its interior wall. Along the lining he observed deposits of mushy fat that he called atheromata, a Greek work meaning "porridge." It was from this word that we derived our term, atherosclerosis. Embedded among the cells of the artery wall along with the fat, Virchow observed some glistening crystals. These turned out to be cholesterol. But how did these fats get into the artery walls? This question has puzzled scientists for the past 100 years, and it is still being pursued in various fields of research. The first theory advanced by researchers was that of "imbibition," which held that fat droplets were absorbed directly from the blood stream through the lining of the artery walls. When a weakening of the "ground" substance or actual structure of the artery wall occurred, cholesterol - the main offender - and its related fats were deposited in the artery wall. This theory has been supported by the recent discovery that these fatty deposits, especially cholesterol, exist in the same proportion in the artery wall as in the bloodstream itself.
Another theory that seeks to explain the way in which the fatty deposits get into the artery walls held that they did not come from the blood stream primarily, but were manufactured within the cells of the vessel wall. It has also been claimed that fat molecules are normally absorbed by the artery wall without leaving a harmful residue of acid crystals. But some abnormal condition, such as high blood pressure, may force an excessive amount of the fat molecules into the wall. Then the artery cannot absorb the full amount, and deposits gradually build up. Other researchers have believed that the fat droplets find their way into the artery wall through the tiny vessels that supply blood to the artery itself. According to this theory, a hemorrhage or series of small hemorrhages may occur in these tiny vessels. A clot is formed, which deposits fat particles in the artery wall when the small vessels break down. My own conclusion, based upon years of animal, laboratory, and human research, plus experience with innumerable patients, is this: Atherosclerosis results from an impairment of the body's ability to utilize (or metabolize) normally not only the fats eaten in the diet, but also those that are in the body itself. This impairment is further aggravated by the body's inability to withstand stress or tension; and by deficiencies in the supply of hormones from vital glands such as the thyroid, the adrenals, and the sex glands. In addition, there are other factors that influence the individual's susceptibility to atherosclerosis, or death from a heart attack or stroke. These include such things as inherited or constitutional factors, and the coagulability of the blood. It is easy to see how complex the problem really is. The danger of oversimplification is great. However, one causative factor that stands out continuously above and beyond all others, important as they are, is fat in the diet. And it is this factor that we can control.
These fats from our foods enter our blood stream where, like sharks cruising about, they seek out the weak or vulnerable spots in the arteries. Here they attack, enter, and deposit or nest themselves. These fatty deposits then acquire calcium, and the hardening process begins in the arteries. Each particle becomes a captain around which rally the silent "Men of Death," who wage a relentless struggle. Soon they begin to throttle our life flow. Our blood vessels then engage in a vain effort to halt the armada of killers we now harbor within our arteries. Special fat-eating cells are rushed to these spots, where the fats and cholesterol have breached the barrier or wall and entered the artery. In the life-and-death struggle that ensues, the fat-eating cells try to engulf the cholesterol and fat particles, and may succeed temporarily in the "counter-attack." Dr. Timothy Leary, the distinguished Boston pathologist, in 1933 first devised ingenious methods of lighting up, refracting, and photographing this deadly drama. It was seen that inevitably the special fat-fighting cells are themselves engulfed by the repeated tidal waves of cholesterol and fats washed into the blood and artery walls by fat-containing foods such as butter, eggs, cream, milk, meat fats, and other animal fats in our diet.
Why is the epidemic particularly strong in the U.S.A.? If you are a typical American, whether you know it or not you consume an unbalanced, obesity-producing diet. Drs. Louis Katz and J. Stamler, prominent researchers in this field, called it "a pernicious combination of overnutrition and undernutrition - excessive in calories, carbohydrates, lipids and salt; and frequently substandard in certain critically important amino acids, minerals and vitamins."
It is not surprising that this situation exists. The science of nutrition, a comparative newcomer to the medical field, has up until recently been concerned almost exclusively with undernutrition. People have been urged to "eat the right foods" and to provide plently of meat, eggs, milk, and cheese for their children. In most areas of the world, this problem of getting enough nourishing food to eat is still of primary importance. But it is not the problem in America. Our problem is somewhat the opposite: "living too high on the hog." Our diet is too rich in fat as well as calories, refined sugars, starches, and oils. At the same time, it is low in essential nutriments, minerals and other vital requirements. The exact relationship between the amount of fat you eat and the production of cholesterol in your body is still a very complex question. Investigators differ on some points. Concerning one aspect of the problem, though, we are all agreed: the cholesterol found in the blood is made largely in the liver from fats in the diet. It is also believed that cholesterol is produced in the arterial walls themselves. But the main source and the one that we can to a great extent control is fat in our food.
As these deposits grow, the passageways or canals of the arteries become narrower, much in the same way as the drain from your kitchen sink becomes clogged with grease deposits. The result is that less and less blood can flow through the narrowed opening to the tissues or organs that depend on it for life. Your "pipes" have become clogged. At the same time, the swelling of the lining cells and roughening of the inner surface provide sites for formation of blood clots inside the narrowed artery. If the blockage is complete in vital arteries that feed the heart muscle, a heart attack - or as we physicians call it, a coronary thrombosis - occurs. If this disaster occurs in the cerebral arteries of the brain, a "stroke," sometimes called a heart attack in the head, results. When the small arteries of the kidneys are affected, Bright's disease, formerly called "dropsy," and other diseases ensue. But whether the thickening and blocking process takes place in the heart, head, or kidneys, it is essentially the same disease. Doctors refer to it as atherosclerosis. About a century ago, during an autopsy, a German pathologist named Rudolph Virchow laid open an artery to examine its interior wall. Along the lining he observed deposits of mushy fat that he called atheromata, a Greek work meaning "porridge." It was from this word that we derived our term, atherosclerosis. Embedded among the cells of the artery wall along with the fat, Virchow observed some glistening crystals. These turned out to be cholesterol. But how did these fats get into the artery walls? This question has puzzled scientists for the past 100 years, and it is still being pursued in various fields of research. The first theory advanced by researchers was that of "imbibition," which held that fat droplets were absorbed directly from the blood stream through the lining of the artery walls. When a weakening of the "ground" substance or actual structure of the artery wall occurred, cholesterol - the main offender - and its related fats were deposited in the artery wall. This theory has been supported by the recent discovery that these fatty deposits, especially cholesterol, exist in the same proportion in the artery wall as in the bloodstream itself.
Another theory that seeks to explain the way in which the fatty deposits get into the artery walls held that they did not come from the blood stream primarily, but were manufactured within the cells of the vessel wall. It has also been claimed that fat molecules are normally absorbed by the artery wall without leaving a harmful residue of acid crystals. But some abnormal condition, such as high blood pressure, may force an excessive amount of the fat molecules into the wall. Then the artery cannot absorb the full amount, and deposits gradually build up. Other researchers have believed that the fat droplets find their way into the artery wall through the tiny vessels that supply blood to the artery itself. According to this theory, a hemorrhage or series of small hemorrhages may occur in these tiny vessels. A clot is formed, which deposits fat particles in the artery wall when the small vessels break down. My own conclusion, based upon years of animal, laboratory, and human research, plus experience with innumerable patients, is this: Atherosclerosis results from an impairment of the body's ability to utilize (or metabolize) normally not only the fats eaten in the diet, but also those that are in the body itself. This impairment is further aggravated by the body's inability to withstand stress or tension; and by deficiencies in the supply of hormones from vital glands such as the thyroid, the adrenals, and the sex glands. In addition, there are other factors that influence the individual's susceptibility to atherosclerosis, or death from a heart attack or stroke. These include such things as inherited or constitutional factors, and the coagulability of the blood. It is easy to see how complex the problem really is. The danger of oversimplification is great. However, one causative factor that stands out continuously above and beyond all others, important as they are, is fat in the diet. And it is this factor that we can control.
These fats from our foods enter our blood stream where, like sharks cruising about, they seek out the weak or vulnerable spots in the arteries. Here they attack, enter, and deposit or nest themselves. These fatty deposits then acquire calcium, and the hardening process begins in the arteries. Each particle becomes a captain around which rally the silent "Men of Death," who wage a relentless struggle. Soon they begin to throttle our life flow. Our blood vessels then engage in a vain effort to halt the armada of killers we now harbor within our arteries. Special fat-eating cells are rushed to these spots, where the fats and cholesterol have breached the barrier or wall and entered the artery. In the life-and-death struggle that ensues, the fat-eating cells try to engulf the cholesterol and fat particles, and may succeed temporarily in the "counter-attack." Dr. Timothy Leary, the distinguished Boston pathologist, in 1933 first devised ingenious methods of lighting up, refracting, and photographing this deadly drama. It was seen that inevitably the special fat-fighting cells are themselves engulfed by the repeated tidal waves of cholesterol and fats washed into the blood and artery walls by fat-containing foods such as butter, eggs, cream, milk, meat fats, and other animal fats in our diet.
Why is the epidemic particularly strong in the U.S.A.? If you are a typical American, whether you know it or not you consume an unbalanced, obesity-producing diet. Drs. Louis Katz and J. Stamler, prominent researchers in this field, called it "a pernicious combination of overnutrition and undernutrition - excessive in calories, carbohydrates, lipids and salt; and frequently substandard in certain critically important amino acids, minerals and vitamins."
It is not surprising that this situation exists. The science of nutrition, a comparative newcomer to the medical field, has up until recently been concerned almost exclusively with undernutrition. People have been urged to "eat the right foods" and to provide plently of meat, eggs, milk, and cheese for their children. In most areas of the world, this problem of getting enough nourishing food to eat is still of primary importance. But it is not the problem in America. Our problem is somewhat the opposite: "living too high on the hog." Our diet is too rich in fat as well as calories, refined sugars, starches, and oils. At the same time, it is low in essential nutriments, minerals and other vital requirements. The exact relationship between the amount of fat you eat and the production of cholesterol in your body is still a very complex question. Investigators differ on some points. Concerning one aspect of the problem, though, we are all agreed: the cholesterol found in the blood is made largely in the liver from fats in the diet. It is also believed that cholesterol is produced in the arterial walls themselves. But the main source and the one that we can to a great extent control is fat in our food.
