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Recently a close high school friend delivered some pretty heavy news. Having experienced several bouts of chest pain while mountain biking, he went in to see the doctor at the urging of his wife. A series of tests revealed that his left anterior descending coronary artery (LAD) was 100% occluded (blocked). The LAD artery supplies blood to the walls of both the left and right ventricles, the heart chambers responsible for pumping blood to the body, including the lungs, brain, muscles and other organs. This phenomenon - a totally blocked main artery - is called a widow maker, since most don't live to tell about it. The reason why our friend wasn't dead was that the occlusion had developed slowly over the course of several years, which gave his body the chance to adapt. By adapt we mean develop corollary circulation, little blood vessels that grow out of a blocked artery to circumvent the blockage and maintain adequate perfusion of the heart. Our friend - we'll call him Pedro - was just over 40.

His question was, "Why me?"

Pedro had always exercised regularly, engaging in consistent cardio such as running and bike riding to supplement regular weight-training sessions. Over the years he had even competed in a handful of triathlons and obstacle races. After his diagnosis and treatment - he required a stent placement and will be on blood thinners and statins for the rest of his life - members of his immediate family, including his older siblings, went in and got tested. This is standard medical practice as heart disease runs in Pedro's family. His father had died of a heart attack when Pedro was in his early teens. One sister was a bit on the heavy side, with the classic pear-shaped body, fuller in the hips and thighs. She had never been much of a fitness enthusiast. To Pedro's (but not the doctor's) surprise, his sister's test came back negative. Despite her being overweight and out of shape, her arteries were pristinely clean.

So, back to Pedro's question: "Why?"

For one who was getting the recommended amount of exercise, we must look beyond fitness to evaluate the cause of his severe vascular disease. Surely family history is not to blame given his sisters' clean bill of health. And so we come to diet. What was Pedro's diet like? Carnivorous to say the least. Pedro likes to call himself a follower of the bodybuilder's diet, lean meats and complex carbs. But even so-called low fat animal products - skinless chicken breast and turkey burgers, which had been Pedro's staples since our days in high school - are high in cholesterol and saturated fat. Add to this the fact that with each passing child (Pedro is a father of three) came more indulgence in cheat meals, which meant lots of pizza and other treats that kids love to eat. Ironically, Pedro's weight didn't change from the 200 pounds he was as high school prom king (he stands 6'1''), but over the years I watched as his body mass altered considerably. Despite his regular workouts, by the time he reached his mid thirties he had lost the dense muscle mass he sported in his teens, with shoulders like boulders and pecs like slabs of granite. As is the case with many in middle age, Pedro had become a bit on the doughy, pouchy, paunchy side, with an increase in his waist circumference as quantifiable evidence of the fact. In other words, though his weight remained constant, his body fat percentage increased, and the increase came mostly in the form of visceral fat. Between the age of 20 and 40, Pedro had become the dreaded apple shape. Fat accumulated in the lower body (the pear shape) is subcutaneous, while fat in the abdominal area (the apple shape) is largely visceral.        

Visceral fat is located deep within the midsection. It coats the major organs - the liver, heart, lungs, and digestive tract. Visceral fat is highly metabolically active, churning out inflammatory substances called cytokines that can wreak havoc on the body's organs. These chemicals - for example, tumor necrosis factor and interleukin-6 - increase the risk of cardiovascular disease by reducing cellular sensitivity to insulin, blood pressure and blood clotting.

Scientists don't know exactly what causes people to lay down visceral fat, but most fingers point to a high-fat diet as the culprit. All the exercise in the world fails to cancel out the overwhelming effects of dietary indiscretions. And this is understandable. Consider that a slice of regular crust pizza contains nearly 300 calories, the amount you burn on a 3-mile jog. One medium chicken breast also contains 300 calories, including saturated fat and half the day's upper limit of cholesterol (150 grams). And it is precisely excess calories, particularly saturated fat and cholesterol, as well as trans fats found in hydrogenated vegetable oils, that likely give rise to this deadly form of fat.

To trim the tummy, experts recommend both diet and exercise  But while it takes at least 20-25 minutes to cover 3 miles on foot, most can shovel a slice of pie down in a tenth of the time. And so for many, especially a busy father of three like our friend P, cutting down on empty calories seems a far more effective method of keeping visceral fat at bay.

The good news is that visceral fat yields fairly easily to dietary modification, with benefits ranging from lower blood pressure to more favorable cholesterol levels. Which means far fewer pizzas for our friend.


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