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Your Heart: The Inside Story

The way you manage your day actually changes your heart. See how (and make it stronger).

Your heart handles a lot in a day. Fortunately, it has an assistant — you! When you know more about what it goes through from morning to night, you can help it stay stronger, healthier, and happier. And keep you that way, too.

Every second of every day, your heart is there for you — it purrs during a good hug, picks up its pace on a power walk, keeps a steady beat when you work, play, and sleep. Can you visualize your body's critical engine doing all that? Probably not, and that's a shame, says Nieca Goldberg, MD, medical director of NYU Langone's Joan H. Tisch Center for Women's Health in New York.

On a panel last year, Goldberg watched women fire questions at a cosmetic surgeon about wrinkles and cellulite. "I realized that if people could look in the mirror and see inside their arteries, my job would be a lot easier," she says. Instead, "out of sight, out of mind" may be a big reason heart disease remains the number one killer of women. So we're giving you the chance to spend 24 hours hanging out with your heart — "that elegant organ that's been beating your whole life," Dr. Oz says. You'll zoom in on a health-minded (but not annoyingly perfect) woman like yourself and see her ticker responding to a day. Ride along, and learn how to protect your amazing heart, tomorrow and always.

First, Meet Your Heart's Friends and Enemies

Before we head into your day, say hello to a few molecules that float around inside you, either helping your heart do its job or getting in the way. How you treat your body determines which players end up with the starring roles in your health. Will the good guys or the bad drive the plot? You have more control than you think.

LDL Cholesterol: Think of it as lousy cholesterol. Your body naturally produces this waxy fat—your cell membranes and some of your hormones need it. But eating too much of the wrong things can push production beyond what's good for you.

HDL Cholesterol: Also known as healthy cholesterol. These little spheres are the arteries' sanitation workers, picking up LDL in your blood and hauling it off to the liver for disposal. Exercise and eating the right foods help your body make more HDL.

Free Radicals: Body stressors like smoking, infections, and pollution create these rogue oxygen molecules, thought to knock into and damage LDL, making it puffy, bloated, and ready to settle down in your artery walls.

Plaque: Damaged LDL and other debris turns into gunky, foamy, inflamed plaque. If the plaque pileup ruptures, cells rush in to repair the damage and can form a blood clot, similar to a scab on a cut. When the clot grows, it may become so big that it blocks the artery right there or breaks off, travels around, and seals off another narrowed corridor. (In the brain, that causes a stroke.)

High Blood Pressure: A whole host of things can drive up blood pressure, including hormones, stress, diet, and lack of exercise. No matter what the cause, high blood pressure is like sandblasting on delicate artery walls. It leaves little scars that become inviting homes for plaque and inflammation. Plus, your heart has to put out extra effort to manage high pressure, which can weaken the organ over time.

Inflammation: Once LDL cholesterol burrows into artery walls, your immune system perks up to deal with the intruders. All sorts of inflammatory compounds rush in (their numbers boosted by a junky diet or the presence of belly fat), increasing the size of the gunky deposit. Too much inflammation can make plaque rupture.



Inside Story: Arteries say aah.

In the two hours or so before sunrise, hormones tell your nervous system to boost your heart rate (it could go from an overnight low of about 65 beats per minute to the high 70s or more by midmorning) and push up your blood pressure by about 15 points. Don't worry — that's normal.Your heart's doing you a favor by revving up your body for the day, and a wake-up stretch helps that prep. Stretching regularly increases your arteries flexibility by about 20 percent, possibly by increasing the elastin in their walls. This lets arteries move in and out more easily, depending on what you're experiencing. (See someone you love? Open sesame. Get scared? Constrict). Taking the kinks out of your muscles may also activate the soothing side of your nervous system— which, like your body's inner yoga instructor, also encourages arteries to relax. The serene result: In one study of 28 women, eight weeks of stretching reduced blood pressure by four to seven points.


Inside Story: It's an awesome artery cleanse.

A good breakfast sends a microscopic crew of specialists into your bloodstream and digestive system, where they combat plaque buildup and keep blood pressure down. Lots of breakfasts are heart-healthy, but this one helps on three fronts:

1. Oats are stocked with fiber — specifically, the soluble type that can actually help lower "lousy" LDL cholesterol levels.

2. Fruit keeps blood pressure healthy, thanks to its potassium and other plant compounds. Your heart likes the soluble fiber, too. Keep your fruit bowl stocked all day. Research shows that at least four servings of fruit a day cut fatal heart attack by more than 30 percent.

3. Coffee gives you a splash of potassium and adds magnesium, another blood-pressure-controlling mineral. Try sprinkling on some cinnamon: the spice helps relax arteries as well. Pouring whole, 1 percent, or 2 percent milk in your joe — surprise — doesn't hurt your heart. In fact, people who use fat-free dairy products tend to eat more calories from other things, especially refined carbs, says cardiologist and nutrition expert Dariush Mozaffarian, MD, dean of the Tufts Friedman School of Nutrition Science and Policy at Tufts University.

A Closer Look: Clean Start

Soluble fiber, found in oats and fruit, handcuffs itself to bad cholesterol in your intestines and escorts it right out of your system. Other foods high in this helpful fiber: barley, Brussels sprouts, bulgur wheat, parsnips, most fruit (especially pears and plums), and winter squash (pumpkin and acorn squash are A+ sources).


Inside Story: Your vessels tense up.

A near miss like forgetting a meeting or a carpool pickup throws everything off. Not every little stress zing will tank your health, but chronic stress can lead to over-eating, skipping exercise, too heavy drinking, and even depression. All of these are bad for your heart. At a cellular level, the scurry and panic switches on your body's ancient fight-or-flight response. Stress hormones, including cortisol, flood your bloodstream and constrict your arteries, driving pressure up. As the blood rushes through, substances in it scrape little pock marks into artery walls. These give LDL easy niches to hide in. Stress hormones also increase inflammation and make blood more apt to clot; both problems can eventually lead to heart attacks. And especially in women, stress can trigger spasms in tinier arteries, harming the heart.

But that amazing engine can recover. Taking steps to reduce stress lowered the risk of heart attack 48 percent in one 2012 study. Of course, "you can't totally avoid stress," says Suzanne Steinbaum, DO, director of women's heart health at Lenox Hill Hospital's Heart and Vascular Institute in New York. "So I tell my patients they need a tool to stimulate the calming side of their nervous system." Meditation helps, and the solutions below give your heart a break, too.

No-Stress Ways to De-Stress

1. Spending three minutes noticing everything: Use all five senses to pay attention to what's happening around you. This stops you from ruminating on the past or worrying about the future — two key ingredients in stress.

2. Think of five people who make you happy: They could be anyone from your partner to that enthusiastic lady at Zumba. A Cornell University study showed that people had healthier responses on a stress test when they thought about a favorite person.

3. Breathe it out: Deep breathing can alter nerve traffic between brain and heart, easing stress, says C. Noel Bairey Merz, MD, director of the Barbra Streisand Women's Heart Center at Cedars-Sinai Heart Institute.

4. Tell yourself that your body is working for you: It could be as simple as using the sentence "Stress is just my body helping me get out of a tight spot." In one Harvard study, people who repeated a similar phrase before a tension-inducing task had more relaxed vessels than those who weren't taught to use a calming mantra.


Inside Story: Your heart has to work harder.

Guess what the big problem is here? All those refined carbs, meaning the white-bread bun and the sugar in the shake. In fact, researchers now suggest that those blood sugar-boosting food felons may be a bigger threat to your heart and arteries than saturated fat. They can make your blood sticky and prone to forming clots, and that's not all. Simple carbs also:

1. Stock Inflammation: Extra calories, sugar, and salt can quickly increase the army of compounds that feed inflammation. At the same time, most fast-food meals are low on goodies that soothe inflammation, like fruits, veggies, and omega-3 fats.

2. Pile on the Belly Fat: That's especially dangerous stuff, because these fat cells pump chemicals into your bloodstream that rev up inflammation, says Steinbaum. "They damage the whisper-thin linings of arteries and get into plaque, making it more likely to rupture and lead to heart attacks," she explains. Surprise: You can have belly fat even if you're not overweight thanks to poor food choices, lack of exercise, and stress. In other words, bad habits show up on the inside even if you look fine from the outside.

3. Open the Door to Diabetes: Especially as you hit menopause. Diabetes damages vessels and throws off your bad/good cholesterol ratio.

A Closer Look: Lunch Can Be Trouble

Extra calories from lunch end up as fat on your body. While the subcutaneous type might not be pretty, the deep, visceral stuff is downright nasty. It wraps around your organs, and instead of just sitting there it gets inflammation going.

Sugar and refined carbs from your "oops" lunch load blood with even more inflammatory bad guys, which sneak through nicks in the lining of artery walls and add to the plaque pileup.


Inside Story: A break for your heart? Not really.

We know you've got emails, memos, and possibly a new level of Candy Crush to conquer, but please don't plant your butt for long. When you sit for a while, muscle cells go into "sleep mode." They burn far less blood sugar and fat, which leads to increases in weight and blood pressure, and that bothers your heart more than you'd expect: Research suggests that years of sitting for at least four hours a day could double the risk for fatal heart disease.

Help your heart bounce back: A new British study found that an hour of moderate exercise a day, like a brisk walk, could erase some of sitting's health risks. And little breaks every hour or so can help reduce inflammation and keep your waistline trim, says Micah Zuhl, PhD, an assistant professor of exercise science at Central Michigan University. Try making some sit-less rules for yourself. Fill your water bottle just halfway so you'll make more trips for refills. Or stand up every time you text someone.


Inside Story: A rebalancing act for your bloodstream.

True, there's fat in that almond butter, but not the kind you need to fear. Unsaturated fats (polyunsaturated and monounsaturated) are heart-friendly. "These are great for raising healthy HDL," says Mozaffarian.

Research shows that good fats have also been found to knock down LDL, reduce triglycerides (little packets of fats in your blood that carry the fat you eat into storage), and even help lower blood pressure. Research goes back and forth over whether polyunsaturated fats (oils from fish are in this category) or monounsaturated fats (avocados, many nuts, and seeds) are better for your heart. But the fact is, many oils contain both, so it's not really an either/or decision, and there's no need to make yourself crazy splitting hairs about the ratios of polys to monos on a snack. Just stay away from trans fats, and keep saturated ones like those in cheese and butter to about 5 percent of your daily fat total. (That's about 11 grams if you eat 2,000 calories a day.)

Nuts and seeds are the ultimate good-fat snack: Four servings a week can cut heart disease risk by 22 percent. But there are plenty of other ways to get these fats into your afternoon pick-me-up (like olives, hummus with veggies, sweet potato chips, or avocado dip). Bonus: They keep your appetite in check.


Inside Story: Your engine gets more efficient.

Your body responds to aerobic exercise the way a dog reacts when he sees the leash. Yes, please! Every workout serves up at least five major heart benefits:

1. Your arteries relax.As you begin to exercise, blood pressure rises to feed more oxygen to the working muscles. But then an amazing thing happens. Your tiniest arteries get less rigid and expand between heartbeats, so more blood and oxygen can get through. That's why the stress of exercise is good for your cardiovascular system — unlike mental stress, which tightens up the same arteries. For hours afterward, arteries stay relaxed, helping to control your blood pressure, says Zuhl.

2. Your heart muscle gets buff, so it's more efficient. It's like you've traded your V-6 engine for a V-8.

3. HDL goes up. Exercise is a great way to increase this cholesterol, Zuhl says, which helps clear out that "lousy" LDL.

4. Belly fat melts. That solves a lot of problems beyond buttoning your pants. A waist measuring 35 inches or more could double your risk for a fatal heart attack, but exercise takes aim at belly fat. Even shedding 5 to 10 percent of your weight (8 to 17 pounds if you weigh 170) could help.

5. You're less on edge. Activity boosts levels of feel-good brain chemicals and may reduce stress-related cortisol.

A Closer Look: An Inner Tune-Up

Don't forget that your heart is a muscle, and exercising turns it into a stronger pump that moves more blood and oxygen around with less effort. Meanwhile, physical activity helps arteries do some housekeeping. It's one of the few ways to raise helpful HDL levels. These molecules grab "lousy" LDL and escort it to the liver, so your body can get rid of it. The result: less LDL floating around in your system, loading up artery walls.


Inside Story: A soothing blanket for a stressed-out heart.

What's just as nourishing as a plate that follows the classic heart-healthy formula? Sitting down at the table with people you love. Close connections keep blood pressure from spiking when you're tense. (On the flip side, people who feel isolated tend to have higher blood pressure and a nearly 30 percent increased risk of heart disease.)

If you're dining alone, try to call, Skype, or FaceTime a friend before, during, or after dinner. It's even better if you virtually check in on someone who's been having a rough time: One Johns Hopkins study found that giving support had bigger heart benefits than receiving it. "The heart is the most poetic organ for a reason," says Dr. Oz. "It reminds us how influenced we are by each other. Sure, to protect it, you have to love yourself, but studies highlight that loving others is an even better tactic to keep it beating."


Inside Story: A sigh of relief for your whole system.

Lights-out at a reasonable time guarantees you at least seven hours of rest. "Your heart rate and blood pressure dip by 10 to 20 points overnight, giving your cardiovascular system a much-needed break," says Steinbaum. Try not to go below six hours, though. Less than that on a regular basis doubles heart attack risk, possibly because sleep loss can make you gain belly fat.

To get all the heart downtime you need, you have to stop believing you can cheat on sleep. "It's like fuel for your body," says Steinbaum. What helps her turn in on time, despite her over-loaded schedule? "I think of sleep as what I need to do to be great the next day," she says.

Each evening, spend a few minutes priming your body for rest. You know you should avoid caffeine, exercise, screens, and other stimulators right before bed. But it's equally important to do something that signals to your mind and body "It's time to go to bed now." Just as, say, a shower and coffee gets your cylinders firing in the morning, it's good to have a ritual that cures up your "rest and recover" system so you can doze off. Jotting down a few things you're grateful for can deliver that cue. So could a good guided meditation podcast, or turning in with a good book — doing an every-night prompt helps your whole body slow down.

No day is going to be perfect; the point is to shoot for mostly good choices. Your heart does so much to keep up with you — it only makes sense to show some love in return. Now you know how.

Paging Dr. Oz

The good doc tackles some of your nagging heart questions.

Q: How bad is salt, really?

Oz Says: Most people don't have to track every single milligram of sodium. If you fill up on produce, whole grains, and good fats, you'll naturally keep it in control, because more than 75 percent of the salt in the American diet comes from processed foods like deli meats and breads. If you already have high blood pressure, you could be among the one in four who are salt sensitive. To find out, check your pressure, dramatically cut back on sodium for a couple of weeks, then recheck. If it's lower, keep closer tabs on your salt intake.

Q: If sugar is bad for your heart, why is chocolate good?

Oz Says: Because there's so much healthy stuff in it, despite the sweetener. Dark chocolate with a high cacao content (aim for more than 70 percent) delivers plant com- pounds that keep arteries relaxed and discourage plaque buildup. The benefits outweigh the sugar if you stick to an ounce a day — about a 1-square-inch piece.

Q: You say people should "know their numbers." Why?

Oz Says: Being aware of your cholesterol, blood pressure, triglyceride, and blood sugar scores helps you "own" your heart health. You'll be more motivated to make heart-smart choices. If you're trying to lower high numbers, keeping track lets you see whether your efforts are working, and if you're A-OK, it can help you spot early trends. More than half of Americans with high blood pressure don't know it, and 71 percent aren't aware of their LDL number, either. Let's get educated, together.


This story originally appeared in the November 2016 issue of Dr. Oz The Good Life.

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