Recently, a 30 year old meth addict named Ricky Lee Fowler was found guilty of starting what’s now known as the 2003 Old Fire in Southern California, a raging 90,000 acre blaze that resulted in the evacuation of 80,000 people and the destruction of nearly 1000 homes. Fowler was actually convicted of murder because five people died in the fire.
But here’s the thing: none of the five died because of fire.
All five died from heart attacks.
I mention this because it’s a great example of something cardiologist Stephen Sinatra and I discuss at length in our new book, “The Great Cholesterol Myth”. In that book, we talk about the four real causes of heart disease. One of those is what caused the five deaths in the Old Fire of 2003.
I’m talking about stress.
The notion that stress kills is hardly new. In the book we talk about something called “Voodo Death”, a concept that was explored in the 1920’s by the great American physiologist Walter Cannon. Voodoo death is sudden, unexplained death arising from a voodoo curse. Here’s how Esther Sternberg, MD, put it in the American Journal of Public Health.
“The dramatic suddenness of the illness following the threat, coupled with a lack of any apparent injury, exposure to toxins, or infection suggested to Cannon that merely the fear of death could, through physiological response mechanisms initiated by fear, precipitate death itself.”
Stress Kills, Cholesterol Doesn’t
The stress response is a complicated hormonal cascade of events that was designed to save your life in an emergency. But the devil is in the details. When that stress response is turned on 24/7—the way it is for a lot of us—nothing good happens. It’s like speeding down the 405 freeway in first gear. That first gear can be a lifesaver if you’re trying to get up a steep hill, but it’s death to your transmission if you’re driving 75.
Hormones are released—like cortisol and adrenaline—which cause blood pressure and heart rate to rise. Blood pounds against the artery walls, ultimately contributing to micro-injuries in the vascular system that soon become inflamed. These inflamed areas attract oxidized particles of LDL called LDL-b, not to mention inflammatory cytokines and all sorts of other metabolic riff-raff, the end result of which can be unstable plaque.
And the end result of that can be a heart attack.
In vulnerable people—such as the five people who died in the fire—the result can be pretty immediate. A cardiovascular system that’s already been weakened by a bad diet with too many trans fats and sugar, and by inflammation and oxidation in the vascular walls can easily be overwhelmed by a sudden overload of cortisol and adrenaline. This is probably why more heart attacks happen on Monday morning than on any other time or day.
Scared to Death
There’s even a developing field devoted to the effects of stress on the heart—it’s called stress cardiomyopathy, and even “healthy” people aren’t immune to it. “You have people in acute, sudden heart failure who were perfectly healthy an hour earlier”, cardiologist Ilan Wittstein, MD, told the Wall Street Journal. Many of these patients survive—but many do not.
The chairman of the neurology department at Brigham and Women’s Hospital in Boston—Martin A. Samuels, MD—has collected literally hundreds of reports detailing how people died suddenly in scary situations. The reports include stories of children who died while on amusement rides, people who were victims of muggings (even though there was no physical attack or injury), and car accident victims whose injuries were negligible. The only thing they all have in common is that their hearts literally failed, not because of high cholesterol, not even because of physical injury, but because they were unable to survive the aftermath of a massive overload of stress hormones.
So why are we chasing cholesterol and not paying attention to stress?
Glad you asked.
One reason might be money. There’s over 34 billion dollars a year made on cholesterol-lowering drugs. There’s not a whole lot of money to be made teaching people how to manage stress.
One of the biggest casualties of the war on cholesterol is that it’s caused us to take our focus off the things that really cause heart disease, things we can actually do something about cheaply, and things that don’t require prescription drugs.
Cholesterol is not your enemy.
But stress— except in small, infrequent doses—most definitely is.