I am a healthy 47 year old Physiotherapist who has been involved in Sports & Athletics most of my life.  In addition to my above average muscular build from decades of weight training,  I am also blessed with good genetics so I have never worried about my weight  one day of my life. I may be one of the last people you would suspect to have heart disease, but I do and following a series of events & tests in recent weeks lead to a confirmed diagnosis of Severe Coronary Artery Disease (CAD).

The image of the typical person with heart disease would be someone usually older in age, who is overweight, that is a smoker, and who perhaps has poor eating habits with lots of junk or fast food in their diet.   I do not fall into any of these categories but yet my coronary arteries were significantly blocked to nearly 95% on aspects of the left main artery.  How could this have happened?  We need to first explore the risk factors that place people at higher risk for CAD before we answer this question.

Risk Factors for Coronary Artery Disease (CAD)

1. Age – The average age for heart attacks in Canada is about 70years old but it can happen at any age and the risk increases with age for both men and women.

2. Smoking – It increases the formation of plaque in blood vessels. CAD occurs when arteries that carry blood to the heart muscles are narrowed by plaque or blocked by clots. Chemicals in cigarette smoke cause the blood to thicken and form clots inside veins and arteries.

3. High Blood Pressure – People with high blood pressure are more likely to develop coronary artery disease because high blood pressure puts added force against the artery walls. Over time, this extra pressure can damage the arteries, making them more vulnerable to the narrowing and plaque buildup associated with atherosclerosis (narrowing of the arterial walls).

4. Diabetes – High blood glucose from diabetes can damage your blood vessels and the nerves that control your heart and blood vessels. The longer you have diabetes, the higher the chances that you will develop CAD.

5. High Cholesterol – When there is too much cholesterol in the blood, it increases the plaque build-up in the arterial walls leading to narrowing and decreased or blocked blood flow to the heart.

LASTLY…

6. Family History – People with one or more close relatives who have or had early coronary artery disease (CAD) are at an increased risk for CAD. For men, early CAD is being diagnosed before age 55. For women, early CAD is being diagnosed before 65.   These people may have a genetic predisposition the above listed CAD risk factors such as high blood pressure (Hypertension), high blood sugar (Diabetes), or high cholesterol (Hyperlipidemia).

My Story and Insight.

So to answer the question of how I as a healthy 47 year old male was diagnosed with severe Coronary Artery Disease, it came down to one major risk factor that was out of my control, Family History.  While we can control or influence our CAD risk factors by eating well, exercising regularly and choosing not to smoke or to quit smoking, you cannot escape your genetic predisposition.  I was first diagnosed with Hyperlipidemia or High Cholesterol in my 20’s.    Although I knew that high cholesterol was a risk factor for plaque build-up in my arteries, I reassured myself that a single risk factor was not enough to lead to Heart Disease.    I studied health sciences, understood the human body fairly well and had read many published articles and studies on the promience of Heart Disease in our society.    I use to always say, ” There are no good studies on the risk of heart disease on 25 or 35 year old males with only high cholesterol and no other co-morbidities”.    And this was the case, so I used that to convince myself that I did not need to start Statin drugs (Cholesterol medication), and just continue with my healthy lifestyle choices…. and I would be OK, but I was not!

6 months ago…

I began to feel unwell or a sense that I was choking  or needed to stop to breath with a period of walking.  I also felt the need to burp so I assumed that it was a Gastrointestinal (GI) issue and began to self treat with medication to reduce stomach acid production.  It seemed to give me some relief, but my symptoms were still present with ups and downs week by week and day by day.

Early August…

I finally consulted with a Walk-in physician over the phone due to COVID protocols (did not have a family doctor) to get to the root of the problem.  This physician was thorough and sent me for bloodworks, H-Pylori testing, Echocardiogram and a Cardiac stress-test to determine if my issues were cardiac or gastrointestinal related.   My stress-test returned with some abnomal signs

* Health Canada has provided a useful history of the food guides from 1942-1992 as well as the revisions made to the current 2007 guide, which I have briefly summarized here. If you are interested, I recommend reading the full articles, as they are very informative.
Canada’s Food Guide has always recognized the role nutrition has on the health of Canadians. From its inception during the war, when food rules were introduced to protect health in times of food scarcity and rations, to the modern day guidelines, where the shift has been to prevention of chronic disease due to excessive intake in our environment of food abundance. The food guide has undergone several revisions over time based on: new nutritional evidence, changes in the food supply, developments in food processing, consumer trends, and group consultations.

Canada’s Food Guide was first introduced during the war in July of 1942 when food rationing was the reality. Then known as “Canada’s Official Food Rules” these rules instructed Canadians on which “health-protective foods” to eat each day to promote the best possible health given the unstable times of war. Eventually times of scarcity led to a more consistent food supply and in 1961 the rules transitioned to guidelines. This change in language and food availability highlighted flexibility; Canadians were given choice in selecting foods to meet nutritional requirements rather than being told what to eat. The subsequent version included recommended number of servings for each food group building on this flexibility of choice. And, for the first time, food consumption patterns were available which were used, alongside a government report on health, to guide recommendations making the food guide more specific to the context of Canadians.

In 1982 there was shift in the messaging of the food guide resulting from an increased awareness of the association between diet and cardiovascular disease (CVD). To help Canadians make healthy choices, guiding statements were added. These statements included the importance of variety within each group, energy balance to prevent general overconsumption of calories compared to activity (leading to weight gain), and moderation to encourage limiting the consumption of sugar, salt, fat, and alcohol – foods known to increase risk of weight gain and CVD. The last update before our current food guide, completed in 1992, was informed by unprecedented research reviews, surveys, and various consultations. The result was Canada’s Food Guide to Healthy Eating. This guide introduced the visual representation of the rainbow illustrating appropriate proportions of intake from each food group (larger bands indicate to eat the most and the smaller bands to eat the least). This guide provided ranges of servings to account for differences in requirements based on age, body size, activity level, and whether the individual is male or female, pregnant or breast-feeding.

Finally, our current guide released in 2007 after 5 years of review using research, consumer trends, statistical modelling, average calorie recommendations, consultations, research regarding chronic disease prevention, and new nutritional guidelines. The 2007 guide was largely influenced by the newly released Dietary Reference Intakes (DRIs) from the Institute of Medicine completed in collaboration with Health Canada. The DRIs used the best evidence available to provide detailed information regarding the amount of each nutrient required to achieve ideal health and disease prevention amongst the statistical majority of healthy individuals. The DRIs also provide upper limits for some nutrients, to avoid the risk of harm associated with over consumption.

To ensure that Canada’s Food Guide achieved the recommendations of the DRIs food modelling was used. First, food groups were modelled to determine optimal proportions of servings within each group to achieve acceptable DRI levels. This was done in the context of total calorie goals to ensure nutrient goals were met without exceeding healthy calorie ranges. Many of the guiding statements in the food guide are the result of this modelling. For example, by recommending ½ of grain product servings to be whole grain the nutritional quality improved without going overboard on calories. Next, using eating patterns of Canadians, 500 model meals were created using the proportions of servings determined by the food group modelling. This was to ensure that the flexibility of choice afforded to Canadians within each food group would still provide the distribution of nutrients and calories recommended by the DRIs. Pretty cool eh? Lastly, this was completed for various age groups recognizing that nutritional needs differ based on life stage.

A quote from the paper describing the revision made to the 2007 guide sums the purpose of Canada’s Food Guide best, “The purpose of the Food Guide is to assist the people of Canada in making food choices that promote health and reduce the risk of nutrition-related chronic disease”. Over all Canada’s Food Guide is about flexibility, while considering the quality of intake. Think of the food you eat as the fuel for your body; you want to optimize your performance with the best quality fuel. Canada’s Food Guide was designed and tested to ensure the optimal supply of nutrients. Understanding why the food groups, and the nutrients they contain, are recommended is important for appreciating the value of this tool. My next post will discuss why the nutrients recommended by Canada’s Food Guide are important for our bodies and overall health.
Written by: Laurie Wybenga, RD (Toronto Dietitian)

(First published on www.lauriewybenganutrition.com – Feb. 19, 2015).

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* This blog post is not a substitute for medical advice. Different medical conditions require specific dietary interventions; always follow the advice of your Physician and/or Registered Dietitian.
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References:
• Health Canada. (2007). Canada’s Food Guides from 1942 to 1992. Food and Nutrition. Available from: http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/context/fg_history-histoire_ga-eng.php
• Otten, J.J., Pitzi Hellwig, J., & Meyers, L.D. (Eds.) (2006). Daily Recommended Intakes: The essential guide to nutrient requirements. Washington, DC: Institute of Medicine The National Academies Press. Available from: http://www.nap.edu/catalog/11537/dietary-reference-intakes-the-essential-guide-to-nutrient-requirements
• Katamay, S.W., Esslinger, K.A., Vigneault, M., Johnston, J.L., Junkins, B.A., Robbins L.G… Martineau, C. (2007). Eating Well with Canada’s Food Guide (2007): Development of the Food Intake Pattern. Nutrition Reviews; 65(4):155-166. Available from: http://www.hc-sc.gc.ca/fn-an/pubs/fd_int_pat-ela_mod_alim-eng.php