On this date three years ago, my husband's heart stopped beating. He was in his 50s, seemingly healthy and robust, and most people were genuinely shocked at his death. I didn't wake up that March morning believing that my husband would die that day, but in a general sense I was less shocked than many others seemed to be. That was partly due to life experiences (my mother died when I was young, so I grew up understanding the unpredictability of death) and partly due to understanding some of his risk factors.
I'm going to mark this anniversary by writing about heart disease and talking about some lesser known causes. At some point I'm going to talk about a risk factor or two that I wish Dan would have taken more seriously. I imagine that last sentence put some of you on edge. Believe me, I spent a lot of time debating whether or not to write this post, but I decided to do so for multiple reasons, including that I'd like to think that Dan would want me to.
Heart disease is the leading cause of death in the United States. The Centers for Disease Control notes that it causes one out of every four American deaths. Risk factors listed by the CDC include high blood pressure, high cholesterol, smoking, diabetes, excess weight, poor diet, physical inactivity, and excessive alcohol use. I believe these are fairly well known by the general population. There are many other risk factors, however, that are less understood.
This is by no means an exhaustive list, but some of the lesser known contributors to heart disease include the following:
Air pollution - Air pollution is a broad term, but in general, fine particulates in the air, such as from industrial and traffic fumes, are associated with higher rates of heart disease. The American Heart Association reports research showing increases in death and hospitalizations when there are higher rates of smog. ABC News reports on a study finding that being stuck in traffic more than triples the risk of having a heart attack.
Non-stick chemicals - As I've noted many times, chemicals in our consumer products are generally not tested for safety, so the health effects often remain unknown. Some, however, have been linked to heart disease, including a family of chemicals used in products such as non-stick pans and stain resistant coatings. A 2012 study found that people who had the highest rates of the chemical PFOA in their blood were twice as likely to experience heart disease, heart attack, or stroke as those with the lowest levels. Because of the bad press, PFOA is being replaced by other similar chemicals, but many health experts warn that there is no reason to believe that the newer versions are any less problematic.
Chemicals found in food and beverage containers - A 2014 study in the International Journal of Environmental Research and Public Health concluded that the chemical BPA, found in many places, including plastic bottles and in the lining of food cans, was associated with heart disease in both acute and chronic low-dose exposure situations. As with PFOA, the bad press about BPA has led to some changes, but a 2016 study found it present in 67% of cans tested.
Heavy metals - University Health News reports that researchers have implicated at least four heavy metals associated with clogging arteries: lead, mercury, cadmium, and arsenic.
Mold and other toxins found in water damaged buildings - Water damaged buildings, or those with high indoor humidity levels, tend to be breeding grounds for a multitude of organisms, including a wide variety of fungi and bacteria. Exposure can lead to chronic inflammation, which can contribute to heart disease. A study in the Internet Journal of Toxicology found an association between exposure to molds in damp buildings and high cholesterol levels.
Sleep apnea - The American Heart Association notes that sleep apnea is associated with high blood pressure, arrhythmia, stroke, and heart failure. I'm almost certain that Dan had sleep apnea, and I wish I had been successful at convincing him to get tested.
Sugar consumption - This is the big one that I worried about for years. Dr. Mark Hyman's summary of the research notes that people with the highest sugar consumption have a 400% higher risk of experiencing a heart attack than those who consume the least. Sugar (in all its various forms) is not just a problem because of its "empty calories," adding to weight without contributing nutrition, but because it is inflammatory and dangerous in and of itself.
Americans eat a lot of sugar, and the amount continues to climb. A Huffington Post article reports that the American Heart Association recommends that women cap their consumption at six teaspoons a day and men at nine, but that the average American consumes 30 teaspoons daily. There are a number of reasons for this. One is simply that American food manufacturers sweeten almost everything. I remember returning to the United States after living overseas and being astonished to find sugar in canned kidney beans. Dr. Hyman notes, "Most of us don’t know that a serving of tomato sauce has more sugar than a serving of Oreo cookies, or that fruit yogurt has more sugar than a Coke, or that most breakfast cereals — even those made with whole grain — are 75% sugar. That’s not breakfast, it’s dessert!"
Americans also eat a lot of sugar because we're addicted to it. I don't use that term lightly. Sugar affects the same reward centers of the brain that other drugs do, and produces tolerance in the same manner. People find themselves needing more and more of it to satisfy their sweet tooth and may experience withdrawal symptoms when they don't consume it at regular intervals. To quote Dr. Hyman again, " Recent and mounting scientific evidence clearly proves that sugar — and flour, which raises blood sugar even more than table sugar — is biologically addictive. In fact, it’s as much as eight times more addictive than cocaine." A 2007 rodent study reported that 94% of the animals chose sugar (or an artificial sweetener) over cocaine when given the choice.
Drug abuse is a serious and growing personal and societal problem that I don't want to trivialize in any way. An Associated Press article reports that almost 13,000 people died of a heroin overdose in 2015 and prescription painkillers killed over 17,500 people. A 2015 LA Times story reports another serious statistic: sugary drinks are linked to 25,000 deaths in the United States each year.
It seems likely that many, if not most Americans are addicted to sugar to some degree. I believe I was, until my health forced me to radically change my diet. I believe Dan was. We talked about it some through the years, and he never quite denied it, but he never quite addressed it, either. About a year before he died, he developed a persistent itchy rash that doctors had trouble diagnosing. At some point I sent him an article which suggested giving up sugar for two weeks in the case of mystery skin ailments. Not long afterwards, he remarked to me that he had decided that he wouldn't cut sugar out completely, but that maybe he would try to cut down.
I remember that conversation clearly. Dan was itchy and miserable, but not fully willing, for a a brief two weeks, to trade sugar for the possibility of relief. The basic definition of addiction is continuing to engage in a behavior despite negative consequences, and I remember feeling a wave of deep sadness and thinking, "This is a strong addiction. It could kill him." I thought there was a good possibility that his heart would cause him major problems some day, but I didn't know how soon the day would come. I think my vague thought of what might happen was that he might have a heart attack in his 60s, and that, if we were lucky, he would live through it and then maybe get serious about changing his diet.
Obviously, I don't know that sugar consumption had anything to do with Dan's sudden death. He had plenty of other risk factors, including genetic ones, and had a period of high work stress in the time period before he died, which could well have been the final straw. I'm also certainly not unaware that my own health limitations added a significant degree of stress to Dan's life. (On the flip side, I think my need to live a low-toxicity life was protective for him in some ways, as well.) I can't point to sugar and say that I know it killed my husband, but the research is clear that it is, in fact, a killer.
I'm very sensitive to "blame the victim" messages and absolutely don't want this to come across that way. This isn't blaming, but warning. It's remembering the events of this day three years ago and deeply and sincerely wanting to spare other people a similar experience. Sometimes people take things more seriously when they know people who have been affected, which is my sole motivation for sharing personal stories.
As I was debating whether or not to write this post, I ran across Leviticus 5:1, which says "If you are called to testify about something you have seen or that you know about, it is sinful to refuse to testify." Yes, it's Old Testament and no, it wasn't written about blog posts, but it convinced me. What I can offer the world these days is limited, but I can testify about things I have seen and know about.
I imagine I've made a lot of people mad by this point. To those who are mad because they loved Dan and are angry that I wrote some negative things about him, I'll simply say that I loved him, too, and miss him greatly. I've cried every day this month so far. I'll also remind you that I wrote a very different sort of post about him three years ago.
To those who are mad because in addition to harping about chemicals, I'm now harping about a very prevalent food choice which is a source of comfort and pleasure, I'll simply say that I get it. Those of us who became addicted to sugar were simply eating the standard American diet or found ourselves eating more sugar because we were avoiding fat and dietary cholesterol like the experts recommended. The sugar industry manipulated studies and public policy just like the chemical industry does today. It's easy to understand how we ended up in this place, but now that we're here, it's time to accept that there are real consequences.
I write because I care about you. Whether I know you personally or not, you matter to me simply because you've taken the time to read this post. I know other people care about you, too, and we all want your heart to keep beating for a very long time.