Never Have a Heart Attack

By Dr. Clark Gerhart
Surgeon

CBN.com – Let me start right off the bat by giving you the secret to not dying of a heart attack. The trick is to die of cancer instead. That doesn’t sound so appealing? I didn’t think you’d like it, but unfortunately since heart disease and cancer are the two leading causes of death in the U.S. they’re pretty much the choices for many of us.

But if you’d like to delay finding out what your personal preference for mortality is and find out what you can do to keep your bucket-of-bolts body running as long as you can, the best way to start is by checking with the manufacturer. God designed it and He has some clear ideas on routine maintenance.

For most spiritual-types, looking to God for health tips involves asking for divine intervention. God is great and powerful so we ask Him to use some of that other worldly power to zap whatever ails us with a magic bullet so we can go merrily on our way. And that’s what the Bible says, right? “Is any one of you sick? … The prayer offered in faith will make the sick person well.” James 5:14-15 (NIV) There you go. End of story.

Or maybe it’s not the end of the whole story. Prayer certainly is the spiritual side of the solution, but God also made incredible physical systems through which He works. The heart pumps more than a thousand gallons of blood per day and runs nonstop year after year without replacement parts. Your body produces hundreds of chemicals to carry out thousands of functions—and it’s completely automated, replenishing the chemicals as needed. Its immune system identifies and eliminates pathogens to fend off disease. And it’s all powered by an energy plant that runs on commonly found organic materials—like Dr. Brown’s flux capacitor from the time machine in the movie Back to the Future. But this is not science fiction. It’s you, and it’s real, and it’s nothing short of amazing.

Our bodies are amazing flesh and blood mobile homes specially designed for living on earth, and yet the minute a few cracks show in the plaster of our fleshly haciendas, our response is always the same: Call the landlord—I want out! We experience a few sniffles or a cramp here or there and we cry out to God expecting Him to take all of the laws of medicine and nature and toss them right out the window so He can give us a supernatural healing, magically.

Is this the way God intended it? Did He really make all of the incredibly complex physical processes just to bypass them whenever we wanted? I think the fact that he rarely provides the radical paranormal responses we seek tells us the answer. God created a physical realm for us for a reason: He wants us to live in it.

Living in this world means being subject to its laws, accepting that sometimes they work against us. Step off a curb—twist your ankle—gravity takes over—fall down. That sort of thing. But we still expect God to help out, right? Of course we do.

So, the question is what do we do when illness invades our happy abodes? Well, the shortened answer is that we lean on God heavily for spiritual support, but we don’t forget about all of the natural processes He designed to work in the midst of these circumstances. If we understand the physical systems He built into our bodies, we can better prepare for and deal with illness when it comes along.

Now not all illness is the same. It’s kind of like hurricanes. Some can blow your shingles off your roof and others can blow you off the map. Illness is just as varied. It can be an inconvenience or it can kill you. Measly category one or two hurricanes are scary, but it’s the level four and five twisting terrors that can relocate your house from downtown to the suburbs, so they’re the ones to get prepared for. Since we can’t cover every illness here, we’re going to look at the class four and five’s. The ones most likely to kill you; the top two causes of death in the U.S.: heart disease and cancer.

HEART DISEASE

Genetics

One day I asked a friend and colleague of mine why he smoked cigars, drank, and was overweight though he knew the health hazards of those habits. His response was an honest one. “None of the men in my family have lived past 60, so I do what I enjoy --- until then.” Not the best prescription for health but his comment makes an excellent point: You can’t escape your genes. The single greatest risk factor for developing the illnesses that will eventually put us in our graves is our own genetic programming.

So look at your relatives to see what illnesses you will likely encounter. If your parents and grandparents tended to die from similar problems you likely have a genetic susceptibility to those problems as well. If it’s heart attacks that seem to make most of the ancestors drop off the family tree then you have got to pay particular attention to heart health.

But having a susceptibility is not the same as being condemned to getting the illness (contrary to my friend’s opinion) so don’t throw in the towel. Genes are funny things and you can’t always predict whether you’ll take after Grandpa Joe or Uncle Lenny. And don’t think that just because you have your Mom’s eyes that you also have her coronaries. Different traits ride on different genes so you might get your eye color from your Dad but your weight from you Mom. If there is any visible trait that might be linked to your health it would be your general body habitus—the way you’re built. If you and your Mom are both shaped like a pear or you and your Dad are both bean poles then you may have the same metabolism and general heart health factors. You can look ahead in time to see what you may get by looking at that parent.

Now think about this: Where did you get your genes? A random combination produced when a sperm and egg collided, you say? That’s true medically, but the maker of that whole system tells us that He’s in control from our Mother’s womb (Psalm 139:13). So, He dealt you the genes, and all the issues that go along with them. Now it’s up to you to play that hand and stay faithful to Him and His principle no matter what issues those genes may give you.

Cholesterol

The single most significant risk factor for heart disease is your cholesterol level. I have heard it said that all other factors taken together have little bearing if the cholesterol levels are normal. Basically this is because the plaque that clogs up your coronary arteries is made of cholesterol, so if there’s not so much of it swishing through you blood stream then it can’t really build up on the vessel walls even if you have other issues. The opposite is also true. Any other risk factor you have is going to be that much worse at producing a clog if you already have the thick, fatty sludge flowing through your vessels.

And if you think I was just using a little poetic license when I said cholesterol was thick, fatty sludge think again. I was surprised as a medical student to draw blood on a patient and see a thick, yellow layer rise to the top of the sample. “Something must be wrong with this container,” I remember thinking. Nope, it was fat and it looked just like the crust of Crisco-like goo that sat on top of Mom’s day old turkey soup. Yuk! It’s flowing through your veins right now if your cholesterol is too high.

The take home message here: get your cholesterol down.

Every adult should know their cholesterol level. Don’t think yours is fine because you’ve never had heart problems. The goal is to get it under control before you start clutching your chest and gasping for air. Cholesterol levels are sneaky. I’ve seen young, slender otherwise healthy people walking around with 300+ cholesterols and never know it. Everything else in this section is less important so if you don’t know your cholesterol level you can put down this article and run out to you doctor to get it checked (but take the article with so you can read the other important stuff while you’re in the waiting room).

OK, so you’re back from getting tested and your cholesterol is high. That means the total cholesterol is more than 150 or the high-density lipoprotein (HDL or “good” cholesterol) is too low. Now what? You can start by lowering the fat in your diet. But I’m not just talking about skipping the french-fries with your next Double Quarter Pounder with Cheese. You’ve got to get your fat consumption down significantly. If you’re really going to treat high cholesterol with diet it requires a vegetarian or vegan type diet or a medically prescribed diet designed by Dr. Dean Ornish that contains less than 10% of daily calories as fat. These diets will not only lower the cholesterol level but have even been shown to reduce plaque that has already formed inside the arteries.

Here’s a stark reality: Not only are these diets nearly impossible for the average American to stick to, but most people who try reducing fat and losing weight as a treatment for high cholesterol are disappointed. The problem is that having high cholesterol is not so much about the cholesterol you eat as it is about how your body handles the fats once you eat them. Remember the gene issue? Yep, it’s their fault.

All of the fat you eat goes directly from your intestines to your liver where it is processed. The liver is supposed to adjust the amount of cholesterol in your blood stream. If your ancestors passed on to you a problem with metabolizing fat you’re going to need medical help. There are a variety of medications available with differing effectiveness and side effects. You’ll have to discuss these options with your doctor. Going to the next step and using medication to lower your cholesterol has been shown to reduce the incidence of heart attacks.

The bottom line here is: don’t give up if changing your eating habits or even losing weight hasn’t helped. You may have even cried out to God to help you stick to a low fat diet and are frustrated because He’s not helping. Don’t blame God. You just had a cholesterol metabolism gene problem dealt to you and you need to manage it responsibly with the help of your doctor.

Smoking

I have a lot of patients who tell me, “I’m not going to stop smoking because my grandfather smoked all his life and never got lung cancer.” What they don’t tell you is that Grandad died of a massive heart attack before he had a chance to get cancer. The fact is, smoking may give you cancer but if you smoke long enough you will get heart disease. It’s inevitable.

What most people don’t realize about smoking is that it injures the lining of your arteries, which results in damage that cholesterol sticks to. Then calcium comes in and makes it a hard plaque and when enough gunk builds up you get a blockage. If the artery that’s clogged is in your heart you have a heart attack. If it’s in your leg you end up with gangrene and an amputation. So maybe we should change cigarette’s nickname from cancer stick to arteriosclerosis stick (but that’s a little hard to say isn’t it?). Whatever the name, the best thing you can do for your health is to dump the cigarettes.

But that’s not so easy is it? Smoking is an addiction as strong as or even stronger than other drug addictions like heroin and needs to be dealt with in a similar way. It takes some soul searching to get down to the root issues of why you need the stimulation cigarettes provide (You can find out more about this in my book Say Goodbye to Stubborn Sin, Strang 2005) and then face some physical dependency issues with which your doctor can help.

Hypertension

Similar to the toxins in cigarette smoke, high blood pressure injures the lining of arteries allowing plaque to build up. The damage is done through mechanical stretching and tearing which causes tiny cracks that allow the cholesterol to stick. Lowering blood pressure through stress reduction, weight loss, exercise or medication is essential to preventing heart disease. While you’re getting your cholesterol measured make sure you get your blood pressure checked also.

CANCER

Genetics

While most of our cancer prevention involves hiding from cancer causing toxins, these environmental triggers are only half of the problem. Actually getting cancer requires a trigger plus an internal genetic predisposition just like heart disease. This explains why some people really can smoke their whole lives and not get cancer—they have the trigger but no genetic vulnerability—while 49,000 people a year (according to the Surgeon General) get cancer by just breathing second hand smoke. If you have a genetic weakness, you’re vulnerable.

Finding that genetic vulnerability is the hard part, so prevention is still based on avoiding the risk factors that trigger the cancer but there is growing information on the genetics of cancer. Some cancers, like breast and ovarian cancer for example, even have genes that can be identified using a simple blood test. Genetic screening using personal risk factors and family history can be used to predict your actual risk of developing other cancers. This requires an evaluation by a geneticist and should be considered for anyone who has first-order relatives (parents, siblings, or children) with multiple cancers or cancer before the age of fifty.

Smoking

The thought of having a gene for cancer is scary, but remember if you avoid the risk factors it’s just like having a loaded gun without a trigger. Nobody is going to get hurt even though the genetic bullet is in the chamber.

The best example of this is with smoking. The American Cancer Society tells us that nearly one third of all cancers could be prevented with one lifestyle change: not smoking. This translates to 170,000 people—enough to fill Yankee stadium two and a half times—being saved per year if we could somehow make cigarettes go away.

If you are in anyway concerned about your health and are still smoking, stop every other health benefit you are pursuing—throw away the low carb bars, flush the vitamins, hang your laundry back on the Stairmaster—and put all of your efforts into kicking the habit. The extreme detriments of smoking far outweigh the benefits of the other measures.

If you’ve tried to muster your own will power and failed make sure you get my book (shameless plug number 2) and talk to your doctor. There are numerous medical options to help you.

Obesity

So you thought those extra pounds were just a strain on your heart and wearing out your joints? Believe it or not the American Cancer Society estimates that another one third of cancer deaths could be prevented by improvement in nutrition, increase in activity and weight reduction.

We don’t understand exactly how obesity produces a risk of cancer but there is no doubt that it does. If your body mass index is over 40 kg/m2 (To calculate your BMI go to http://www.asbs.org/html/patients/bmi.html) you have seven times greater risk of dying of all cancers. Keep that in mind next time you start a diet and it might just help your motivation.

Your weight is a very complicated thing that goes way beyond just how much you eat. There are emotional and spiritual issues as well as numerous physical ones which all need to be addressed if you are to be successful at shedding the extra insulation.

Infections

You probably never thought of cancer being contagious—and you’re right—but recent research has shown that certain infections can be the trigger that sets off a cell to become cancerous. The major ones are: hepatitis B virus (liver cancer), human immunodeficiency virus/Aids (lymphoma, sarcoma), human papillomavirus (cervical cancer), helicobacter (stomach cancer). Prevention or treatment of these infections can prevent the development of cancer.

Having a drug to prevent cancer would be great wouldn’t it? Pop a pill and forget about all hardships of cancer treatment. Sounds like a medical sci-fi movie but now it is reality for some cancers. A new vaccine against human papillomavirus (the virus responsible for genital warts) could prevent 70% of the 9,700 cases of cervical cancer developed by women annually, according to the Centers for Disease Control.

The Advisory Committee on Immunization Practices (ACIP) (http://www.cdc.gov/nip/acip/) recommends this vaccine for 11-12 year-old girls or for 13-26 year-old girls/women who have not yet received or completed the vaccine series. All young women should discuss this with their doctor.

Hormones

Women who suffer from PMS can tell you that estrogen can cause problems, but did you ever think it could cause cancer? Well, causing cancer is still in question but it can definitely play a part in cancers of organs that are stimulated by estrogen namely uterus, ovaries and breast.

The most exciting development in this area is another medication that can actually prevent breast cancer. Systemic estrogen receptor modulators (SERMS), of which Tamoxifen is the most commonly prescribed, were used for many years for the treatment of breast cancer before researchers noticed that women on the drug were less likely to develop cancer in the other breast than the normal population.

These drugs reduce cancer risk by blocking estrogen receptors on breast cells and can reduce the risk of developing breast cancer by 30 – 50%.

To be eligible for using SERMS for the prevention of breast cancer a women needs to have an increased risk of developing breast cancer using a calculation based on her risk factors. One method for calculating your risk of developing breast cancer is the Gail Model which you can use to calculate your risk of by going to the National Cancer Institute website http://www.cancer.gov/bcrisktool/.

When you stop and think about how these medications attach to cell membranes and block hormone receptors to hinder the activity of mutated cancerous cells—wow. What an incredible system. And the next generation of anti-estrogen drugs, the aromatase inhibitors, appear to have the same ability to prevent breast cancer but with fewer side effects. It is no wonder after God was done creating us he stepped back and looked over what He had created and said “Wow, this is good!” (Genesis 1:25)

And it’s important to remember that He still likes His incredible design today, which is why He does not so easily discard the systems He designed into our flesh and blood opting instead for spiritual cures. Accepting that God is at work in the midst of the physical processes He built into our bodies is a great place to start when trying to understand how to unify medical and spiritual aspects of healing.

Sunlight

Even though we all like the healthy glow of sun-kissed skin, the reality is that the ultraviolet rays found in sunlight are not at all healthy. The most significant danger they pose is skin cancer. One million skin cancers a year are triggered by sunlight and could be prevented by protecting the skin with clothing or sun blocking lotions of sun protection factor (SPF) 15 or higher.

Spotting skin cancer on the body is difficult, even for the physician. Even though the medical books I studied in school gave definite characteristics that help differentiate a non-cancerous mole from a malignant skin cancer, large research studies have shown that there really is no way to tell with the naked eye. So, what do you do? You biopsy every skin lump, bump or mole that changes, itches, bleeds, or basically does anything to draw attention to itself. It involves a minor surgery but it’s the only way to know for sure.

For people who have had a skin cancer, especially the particularly deadly form melanoma, should consider a new type of monitoring called Mole Mapping. This takes the subjectivity out of you physician’s examination and avoids the puzzled confusion you feel when your doctor asks, “So, have any of your moles changed?” It involves taking a total body photograph at regular intervals so that moles can be measured and compared objectively from one examination to another. Any that change in size have just called attention to themselves and you know what that means—biopsy.

Screening

Whole textbooks are written on appropriate screening for cancer and it can get pretty complex since it changes with gender and age. So, we can’t cover it all here except to say that screening saves lives by diagnosing cancer at the earliest possible time when it is still curable. If you take the macho approach (and I’m talking mostly to the guys) saying, “I don’t feel sick so I don’t need a doctor,” you’re going to potentially miss an early cancer.

Breast cancer can be identified early through screening which includes annual breast exam and mammogram beginning at age 40. Magnetic resonance imaging (MRI) is more sensitive than mammogram and can be used in addition to the mammogram in women with dense breasts or those at high risk. Breast self-exam is often promoted as screening but it has not been shown to identify new cancers consistently. Pap smears annually beginning in the child bearing years can help identify cervical cancer. Annual digital rectal exam and stool testing for blood along with an initial colonoscopy should be done in everyone beginning at age 50 to help diagnose colon and rectal cancer. The same annual rectal exam along with blood testing for prostate specific antigen (PSA) will help identify prostate cancer in men.

And just in case some of you more spiritually minded Christians might be tempted to think that keeping up with screening or any other routine healthcare shows a lack of faith, don’t be. Just after my wife and I had our first child it was time to get her vaccinated and we heard some Christians suggest that it showed a lack of faith to vaccinate your children and that we should simply trust God to keep them free of disease. While discussing it with my parents my mother gave a response that has shaped my thinking to this day. She said when she was a little girl every family knew someone who had polio and every parent feared for their child’s safety and cried out to God to protect their babies. When the vaccine for polio was invented they saw this as God’s answer to their prayers. They had no way to save their children from the crippling disease, but God provided a way.

Needless to say we vaccinated our daughter with hearts full of thanksgiving for God’s provision. Is it faithless to trust in a physical vaccine (or surgery, chemotherapy, blood transfusions or any other medical treatment)? Perhaps. But it is not faithless to trust in the God who provides us these blessings. So use medical wisdom knowing that “Every good and perfect gift is from above, coming down from the Father.”
James 1:17 (NIV)

The take home message: Do the right thing and see your doctor and thank God for His blessings. And guys, an annual check-up won’t kill you—in fact it might save your life!

One Last Thought on Medical Treatment

We’ve talked about preventing illness, but what if you get sick? When using physical means to prevent illness doesn’t work you might be tempted to scrap the idea of using good healthcare and run to God for a supernatural cure. Isn’t asking God for a miracle cure the best answer?

If you’re still tempted to think this way I have to tell you that it is not only unspiritual but may be completely offensive to God. Shocked? Well what if I asked you for a container to hold some flowers and you gave me a beautiful porcelain vase. Instead of gratitude I smashed the vase and demanded a crystal vase instead. Would you be offended? I’ll bet you would. Would you rush out and get a crystal vase? I know I wouldn’t.

Don’t we do just that to God? Consider a person I knew that had kidney cancer, a disease that is cured by surgery in its early stages. She refused any medical treatment and prayed instead for healing saying she was trusting God for a miracle. Sounds pretty spiritual doesn’t it? Faith like that should move God to act and provide healing shouldn’t it?

Well it did. God provided a way for a cure through surgery but she rejected it. In essence saying, “God I don’t like the gift of healing the way you’ve provided it, I want it another way.” Do you think God scampered out to get the crystal cure? Not this time. She died holding onto her “faith”.

So does this mean we never look for a miracle cure? Of course it doesn’t mean that. Both biblical and modern history are full of stories of how God has superseded physical law to accomplish His will in His children’s lives. We hear that message all the time. To maintain balance you have to understand and manage the physical process God designed for us to experience healthy living.

Healthy living—at least in a physical sense—is a failing endeavor right from the start. Our physical bodies will all eventually fail us. There is still only one way to beat heart disease, cancer and every other illness and live forever—and that’s to trust in Christ and get into heaven!

Reprinted with permission. Copyright © 2006 Faith & Fitness Magazine and Lifestyle Media Group. Faith & Fitness Magazine is a lifestyle resource to build physical and spiritual strength. It helps readers make connections between the Christian faith and the fitness lifestyle. To contact the publisher of Faith & Fitness Magazine, Brad Bloom, for reprint permission, e-mail brad@faithandfitness.net.

Dr. Clark Gerhart Clark D. Gerhart, MD, FCAS is a board certified general surgeon and fellow of the American College of surgeons. In practice since 1995, Dr. Gerhart specializes in minimally invasive surgery, which he has used to treat various gastrointestinal disorders and other maladies.

Dr. Gerhart is also a Christian speaker and author whose main focus is exploring concepts of "the flesh," combining medical and spiritual insights to explore the origins of our sin nature—and how to deal with it—along with helping Christians understand general medical issues as well as medical ethics and other topics. He conveys complex medical and spiritual issues in a down-to-earth, light-hearted manner that audiences enjoy. His greatest joy is having listeners and readers reach that “Aha moment” when a new revelation sheds light on an old struggle and they respond, “So that’s why that happens!”. You can contact him by e-mail at clarkgerhart@epix.net