John E. Lewis, Ph.D. is the founder and president of Dr Lewis Nutrition® and past full-time associate professor in the Department of Psychiatry and Behavioral Sciences and now voluntary associate professor in the Department of Family Medicine and Community Health at the University of Miami Miller School of Medicine. He is also a diplomate, faculty member, and advisor of the Medical Wellness Association. He has been the principal investigator of more than 30 different studies in his research career.AM:
The Holiday Heart Syndrome is often talked about at year’s end. What is it, and what causes it?
Dr. Lewis: Great question. Americans are already not eating well and they are not exercising. About 75-80% of Americans fall in this category. It is a hard statistic to believe, and it is sad, but true. When I say Americans are not exercising, I mean they are almost totally and completely sedentary at any time of the year, not just during the holidays. Additionally, roughly 75% of Americans fall in either the overweight or obese category. What is most important about the holidays is the indulgence people tend to take part in when it comes to eating. You start with Thanksgiving, and then it goes all the way to the new year. It is a constant indulgence of food.
Another thing that is very important in the equation is seasonal affective disorder. When the holidays roll around, perhaps you are missing your spouse, parents, grandparents, or other loved one, and you have seasonal affective disorder. We know there are very strong correlations between mood disorder, major depressive disorder, and cardiovascular disease. That is really the missing piece here. Thus, in many cases, it may not be so much about people already eating poorly. How much more bad food can you eat? They are already not exercising. How much more sedentary can you become? I feel the key to this issue is the mental health aspect and people having this type of depression is linked to a cardiovascular outcome.
AM: The situations you describe is one situation you can’t pin on COVID.
Dr. Lewis: That is right. COVID is mostly in the rearview mirror at this point. To me, this really is about mental health. You get around to the holiday season and you start reflecting on your childhood and youth and people who are no longer with you. You get despondent. That despondency translates to depression, and then you just get so down and out. As I mentioned, in the scientific literature there are very strong links between depression and heart attacks or cardiovascular disease in general. That is not my opinion; it is validated scientific research. So, to me, that is the missing link. Then you add fuel to the fire by throwing in some extra alcohol use. Unfortunately, we used to think several years ago that drinking a glass of red wine every day at dinner was a healthy thing to do. Now, there is research that shows alcohol is no different from tobacco. There is no minimally safe amount of alcohol you can drink. It is neurotoxic to the brain and central nervous system, and it is driving an increased risk of cancer.
I am unaware of much research looking at alcohol drinking in terms of predisposing or elevating your risk of sudden heart attack, but when you combine the neurotoxic effect along with elevating your risk of cancer, why would the heart also not be affected by that?
AM: Another seasonal description is called the Christmas Holiday Effect.
A trend that’s been observed, is not only in the U.S, but worldwide, most notably Canada, Norway, Sweden, and Denmark. Despite the festive spirit that surrounds the holiday season, research consistently shows that cardiovascular deaths do spike, and that’s really what you’re saying.
A 2016 study published in the Journal of American Heart Association found that cardiac events increased by 4.2% between December 25th and January 7th.
Dr. Lewis: That is an alarming statistic.
AM: It was thought that maybe colder weather had something to do with it, but researchers found the same phenomena happening in New Zealand at year’s end and that’s their summer in the Southern Hemisphere.
Dr. Lewis: Correct. Climate factors have little to nothing to do with it. I know when I used to live in Tennessee in the wintertime I did not want to get up in the morning and go out in the cold. I do not know if anybody necessarily does, but there may be a relationship between cold temperatures and constriction of the blood vessels, so that you are not getting the same amount of blood flow as you normally would. I am also wondering where vitamin D fits into this equation. Now, not getting enough vitamin D for a few weeks would not necessarily trigger some sort of a sudden-onset heart-related episode, but for people in the northern latitudes who endure cold temperatures from fall into early spring, relative to those of us living in Florida or in the Sun Belt, they are definitely not getting as much vitamin D. We now know that vitamin D is not just about your bones. It affects every single major organ in the body, including the cardiovascular system. So, imagine having little to no exposure to UV-B radiation during the cold temperature season. For those folks, it is indicated to take a vitamin D3 supplement during this time.
AM: Some people ignore the warning signs of a heart attack during the holidays because maybe it’s not convenient to get it checked. What would be the simple signs that literally call out to you to go to the hospital or see your doctor.?
Dr. Lewis: Clearly, the most significant sign would be the pain in the left side of the chest extending down into the shoulder and the arm. Other signs include when you feel like you have this caving-in or crushing-in sensation where you cannot breathe as well as dizziness, nausea, very heavy sweating, and disorientation. All of these are very significant signs of potentially some type of a heart event that I would recommend getting to the emergency room as quickly as possible.
AM: Are heart attacks more common in men or women?
Dr. Lewis: That has been an interesting topic. Historically, the research has shown that men have been more predisposed to heart attacks than women, although I have seen a couple of studies that contradict that. What is interesting is if you get past your middle 50s, then the risk decreases. In other words, the risk peaks in mid-life, which makes sense. That is because people in their mid-to-late 40s through their 50s are really trying to be somebody. That is when people are really trying to make their mark in the world. We have all of this pressure and are driving hard. So, it makes sense that once you get over those peak years, you are on the downside of your career and your stress and inflammation come down. Historically, men have been more at risk of heart attack, although a couple of studies show not so much agreement with that.
AM: No matter how you look at it, age is a factor.
Dr. Lewis: No question about it. When you are in midlife working hard, and you are pressing and pushing yourself, you are often neglecting what you are eating, bypassing exercising, and not getting enough sleep. You are also neglecting to manage your stress. All of these things are definitely building yourself up to be a prime candidate for a heart attack. This goes back to the root that you and I believe in, “let food be thy medicine.” If you are not taking care of yourself every single day with your food and your physical activity habits how do you expect your body to take care of you? It is going to fail you. It is just a matter of time.
Some people will be unlucky, and it will happen earlier in life. Again, in that middle-age era when you are driving so hard, you are ignoring everything else, and all you are thinking about is your career, making money, and climbing that so-called ladder, just think what is all of that worth if your health is in the toilet?
AM: We’re talking about heart attacks, but you also have to consider strokes, AFib, and congestive heart failure. There’s other heart-related conditions that are more prevalent at this time of year.
Dr. Lewis: That is right. You lump all of those things into the same basket. They are all cardiovascular-type events that can be fatal for many people. There may not be a second chance to change behaviors. We want to prevent these things from happening. We do not want to have an event happen where you die from it or even become disabled to some degree where you are no longer the person you used to be because you simply did not take care of yourself. Of course, lots of people die instantly from heart attack and stroke. That is an unfortunate reality of these occurrences.
AM: You kind of hit on this earlier, but many people love to eat and drink more at any time of the year. Is there a way that people can enjoy great food and good times during this time of the year and still be healthy?
Dr. Lewis: That is a great question. I am the exception, definitely not the rule. I am the person who does not care if it is December, May, or whatever time of year it is. I am traveling down the road the same way, and I do not deviate too much from my diet. But, for most people, I think it is better to look at life as gray, not so black and white. They should not be so rigid that they become miserable and moody. So, you go to your neighbor’s, your family’s, or a work-related event and have a big meal. Maybe you have a few drinks of alcohol. However, after that I like to encourage people to think about it as it is okay if you fall off the wagon one time. But, the very next day, jump right back on the wagon. Do not allow indulgence to become a habit. Do not give that any inertia and let it build up. Immediately recognize it for what it was. You had a good time and a lot of fun with your family and friends, but the very next day, get right back to your regular health behaviors.
AM: Are there secrets to getting over the hump to avoid all these negative health calamities?
Dr. Lewis: It is another great question. Psychologists like to refer to something called the “teachable moment.” That is when somebody has a negative experience, whether it is a heart attack or a stroke, or has lost a family member. Something happens, and then the light bulb goes off and the persons says, “Wait a minute. Now I understand I need to do something.” If we can get to that point of starting to say we have some concept of what it means to be healthy, then that is where people can change. Unfortunately, as a society, our train has completely jumped off the tracks, and I think for most people what I would say is just change one thing. If there is one thing that you could change today, then do that, for example coming home from work, putting on your sneakers, and going for a 30-minute walk. Maybe that is easier said than done for many people but just change one thing. We all want the magic bullet. That is the nature of our society. We have been conditioned to think of that one thing to do, the one magic bullet, that will be the difference maker. I do not believe in that concept, but I do believe in taking small steps. Eventually, it will lead to the bigger goal and outcome, which is improved health. So, rather than trying to take on diet, exercise, and other behaviors all at one time, just change one thing. Take that daily walk, Increase your overall hydration. Or have an apple a day. Do one thing that you can easily change. Then hold onto that change. Psychologists say it usually takes about 15 tries or 15 attempts to do something, and then it becomes a habit. Do it every single day for 15 days, and then at that point, your brain gets wired, and it becomes normal.
AM: Will an apple a day still keep the doctor away?
Dr. Lewis: Absolutely. I try to eat an apple as often as I can. It is one of the most nutritious foods. Just make sure it is organic otherwise it has pesticides and herbicide sprayed all over it.
AM: In regard to diet, front-loading each day with protein and fiber for breakfast is often recommended. That can steady blood sugar, curb cravings later, and may help to boost satiety, making it easier, possibly for some people, to pass up high caloric and sugar dessert or treats. Would you agree with that?
Dr. Lewis: I have seen so many back-and-forth discussions and conversations about that. Certainly, if you eat some amount of fat combined with an amount of protein, then theoretically, depending on what your basal metabolic rate is, obviously that approach should be more filling than if you just ate a bunch of cake, cookies, candy, and foods that little if any good nutrition. Some combination of protein, polyunsaturated fat, and fiber is needed. That meal should get most people through at least several hours. There is lots of debate right now about intermittent fasting, and what your window of eating should be. It is not controversial as it certainly makes sense on some level. But the science, in my opinion, is lagging behind much of the marketing we hear. I think the work of Dr. Valter Longo and his colleagues at the University of Southern California have done around this topic is interesting.
AM: Digestive enzymes, probiotics, and stress-regulating adaptogens, for a total digestive reset can help support the body.
Dr. Lewis: Absolutely, and do not forget the polysaccharides from aloe vera and rice bran that we have studied in our research that can be so efficacious. Those are very important nutrients as well and you do not get them from foods, but from dietary supplements.
AM: Let’s get back to early warning signs. You touched on that, but are there some, even before we get to the holidays that we should be looking for?
Dr. Lewis: Shortness of breath is one. If you feel like you can no longer walk from your house to your car or your office to your car without feeling tired, that can be an issue. A little dizziness or disorientation along with shortness of breath can also be telling. These are warning signs that you are potentially not getting good cardiac output, so I would pay attention to any symptoms like those, especially if they have not been typical for the majority of your life. If one day you think you are really out of breath or you really feel like you are struggling to climb up a couple flights of stairs, then do not wait to get evaluated. Normal routine activities that all of a sudden feel like impossible tasks are a tremendous warning sign.
AM: Exercise and eating properly are two key things that are going to help protect the heart.
Dr. Lewis: No question about it. In my view of the world, I look at nutrition and diet as number one and then exercise as number two. I used to think the opposite of that until I got pretty into in my research career. I saw how powerful the effects of the polysaccharides are that we studied in our lab at the University of Miami, and it changed my mind. To me, nutrition, including the use of dietary supplements, by far and away, is the most important modifiable behavior for overall health, including the health of the heart.
AM: Making sure we get regular checkups is very important and not just at this time of the year.
Dr. Lewis: That is absolutely correct to protect against potential heart failure.
AM: People knowing their numbers, like blood pressure, cholesterol, and blood sugar are extremely important as well.
Dr. Lewis: No doubt about it. Hypertension is the silent killer. If you are living and never checking your blood pressure, you can be making a fatal mistake. One thing people should be aware of is the white coat phenomenon. When you go for a checkup with your nurse and primary care physician, you may not necessarily get an accurate resting blood pressure due to getting nervous or anxious. That will elevate your blood pressure and give you a false reading. I check my blood pressure, unless I just had a nightmare and my mind is racing, right when I wake up from a night’s sleep in a calm state. That is your true resting blood pressure.
AM: Wearables for checking your blood pressure are trendy these days.
Dr. Lewis: That is true. A lot of very good devices are on the market today that are quite accurate. I have tested several myself and they are very valid. So, just check your blood pressure when you wake up in the morning before you roll out of bed. The night before, put your equipment next to the bed on your nightstand and then take it the next morning. That will be your most accurate blood pressure reading. In any event, keep yourself checked out and monitored. There is no reason not to do some of the basics.
AM: Any other heart health recommendations?
Dr. Lewis: I mentioned that many years ago it used to be the common thought that if you drank a glass of red wine every day that was heart protective. The reality though is that many fruits and vegetables have resveratrol just as wine does.
Was that recommendation an outright lie sold to us by the alcohol industry to the unsuspecting consumer population that just drinking a glass of red wine every night is the best way to get your resveratrol? I do not know, but it is another example of why you need to do your homework. Lots of fruits and vegetables contain resveratrol. So, just drinking a glass of red wine every night is not the best way to get your resveratrol intake.
Again, as we go through the holidays, and maybe you are not feeling up to par, possibly missing loved ones who are no longer with you, turning to exercise is so good for you. Exercise has been shown time and time again to be as if not more effective than antidepressants for alleviating depressive symptoms. So, if you are feeling down in the dumps or have the blues, move your body. Do not think the first thing you need to do is go see a psychiatrist and start taking an anti-depressant. Move your body first. It is sad for me to see people load themselves up on more and more medications, which by the way, some of those drugs actually cause people to become suicidal. Pursue the natural methods first because natural approaches are the standard. We have it totally backward in this country. We think medication is the standard, but it is not. Medication should be the alternative. Nutrition and exercise are the standards and the foundations for health. Medication should only be used in, in my opinion, for emergencies or in really difficult to treat situations where seemingly everything else has failed. I tend to not believe nutrition and exercise fail. I just do not look at life that way. Nonetheless, if you are feeling bad and down in the dumps, start moving your body and eating well. Those are the keys to health at any stage of life at any time of the year.