Drug Addiction is Like Heart Disease

I was just asked, “How is drug addiction is similar to heart disease”, on a Foundations of Addiction’s homework assignment and was surprised at how similar they are.  Here are my thoughts:

Both drug addiction and heart disease start with behaviors that ultimately lead to the development of the condition. With drug addiction this is the use of drugs in an experimental or social pattern. With heart disease this is the unconscious eating of food, refraining from regular exercise, and other behaviors such as smoking cigarettes.

In neither case does the person believe that their actions could lead to a problem, and even if they have some forethought, there is a tendency for them to minimize the possible consequences in their mind.  A friend, who is studying the effect of time on decision making at Wharton School of Business, reminds me that the further off the possible consequence the less value the consequence has.  With drug use, most early users do not even entertain the possibility of becoming addicted, while with people making poor diet and lifestyle choices the consequences are so far in the future they also seem like an improbability.

Both diseases have a genetic component as well. Addiction and heart disease tend to run in families. This predisposition means that the same type and level of use in the future addict or cardiac patient may not result in the development of disease in others when they use at that level. This reality, coupled with the time delay in the progression of the illnesses, contributes to the ability of a person to deny that their behaviors are creating problems.

In addition, both diseases are multifaceted. Heart disease results from a combination of factors including behavioral, genetic, environmental, and social.  In addition, since food addiction and cigarette addiction are risk factors for heart disease, the same psychological issues that lead to any addiction can contribute to heart disease.

We also know now that some addictions lead to hard to reverse changes in how the brain works, much like the damage of a heart attack tends to be permanent. The organs affected may be different, but the seriousness of the illnesses are the same.  Although, I would be remiss not to mention that some addictions lead to cardiovascular issues such as heart failure and stroke.

Indeed, it appears that the two diseases in terms of fundamental etiology, are more similar than they are different.

Cholesterol and Coconut Oil

High cholesterol, high blood pressure and cardiovascular disease run in my family.  Both my mother and father have had coronary artery bypass operations as did my paternal grandfather.  Being interested in health and knowing my predisposition, I have followed my cardiovascular risk markers with interest.  I believe that improper diet and inadequate exercise play a significant part in the development of heart disease as well as in cancer, type 2 diabetes and many other diseases.

This year, my fiftieth year on the planet, I checked in with blood pressure 110/70, an unremarkable echocardiogram, and total cholesterol at 201 (just a point above the desirable range).  However, a closer look at the cholesterol readings showed that my HDL, the cholesterol that has the beneficial role of acting like a scavenger in the body, was off the chart at 75.  The standard range for HDL is 40 to 59 mg/dl. It was my elevated HDL level that actually put my total cholesterol slightly over range.

My first question was – what does it mean to have HDL way above normal?  Naturally, I did a Google search.  What I found was when HDL is higher than normal it is actually considered protective.  My risk for cardiovascular disease was actually lowered!  (Trumpets sound here!)  All the energy I devote to living a simple, healthy lifestyle paying off.

I then began to wonder – what caused my increase in HDL?  When searching on that question I bumped right into the answer:  Coconut Oil.  Researchers have found that coconut oil consumption is associated with higher levels of total cholesterol and HDL.  (2011)

Every morning for breakfast I have a cup of germinated brown rice with some type of legume dish, typically chili or lentil soup. For years, I adorned the rice with Spike (a salt seasoning blend) and about 1 to 2 teaspoons of flaxseed, hempseed, or other oil high in essential fatty acids.  Then I discovered coconut oil.  It has such a lovely flavor that I started using it on my rice.

Now one of the things about me, the thing that makes my experiment with right diet for a healthy heart so daring, is that I don’t buy into the mainstream ideas.  For instance, when they said eggs were bad for my heart, since they were high in cholesterol, I defied the mainstream ideas and had two or three a day.  When people were switching over to margarine, I was still eating salted butter (I like it plain…).  They think salt raises blood pressure?  Great, I eat as much of it as I can.

Now “they” were saying coconut oil was good for my heart because it increased HDL.  My reaction?  I immediately cut back and started eating more flaxseed oil again.

Yes, I understand that HDL is associated with lower cardiovascular risk, but that is HDL that is naturally high.  My HDL was being artificially elevated by increased intake of coconut oil.  This doesn’t mean that it is beneficial.  It also doesn’t mean it is not beneficial.

This is the mistake people made with eggs.  They thought “eggs have cholesterol,”  then, “Cholesterol is bad” and finally decided “eggs are bad”.  I knew coconut oil raised HDL and I suspected that it has a place in my healthy diet, but I wanted to see some direct evidence about whether it was really beneficial.

To achieve my objective I had to move away from the mainstream news and information websites and into PubMed for primary literature.  I wanted to read, first hand, what scientists had found.

The first thing I discovered was that a 2009 research study reporting on the effects of dietary coconut oil consumption in women with belly fat was being misrepresented by some major health information websites.  The study showed after 12 weeks women that added coconut oil (vs soybean oil) to their diet had a significant reduction in waist circumference.

The first misquote I found said the reduction was after only one week. However, the biggest issue I have was that the reduction was not “real world” significant.  The women using soybean oil (2 Tablespoons (30ml) a day) had a drop of 0.6 centimeter (about a quarter inch) while the women using coconut oil dropped 1.4 cm (just over half an inch).  We are talking about a 1/4 inch difference (technically it would be 5/16ths of an inch) between the two groups. Anybody out their measure their waist lately?  I would say the error in measurements would be greater than a quarter inch!

Next study I looked at was from 2012.  Nice research that investigated what happens to atherosclerotic plaques when people living in Kerala, India switch from the coconut oil they’ve used all their lives to sunflower oil because they have cardiovascular disease.  Well designed study –  but the fact they found 71 people that had used coconut oil all their lives and were undergoing coronary artery bypasses suggests that coconut oil is not a miracle cure nor a miracle prevention for heart disease.

Their results?  The switch to sunflower oil for at least a year didn’t change the composition of the plaques at all.  Here we have a situation where the details of the study are more interesting than the results.  It is interesting to me that the researcher found a population of long term coconut oil users with heart disease. In addition, many of the participants had diabetes and hypertension as well as coronary artery disease.

The last study I looked at was perhaps the most negative regarding coconut oils benefits.  Completed in 2006, it revealed that six hours after a meal (carrot cake and a milkshake made with about two ounces of oil) HDL from people ingesting coconut oil made the cells that line blood vessels more inflammatory than the HDL from safflower eating people.

There were some limitations to the study design and other researcher have published comments suggesting that the differences observed were due to safflower oil having a greater concentration of Vitamin E rather than the fact it is a polyunsaturated oil.  Christopher Masterjohn says,

Compared to coconut oil.. safflower oil contains 77 times the alpha-tocopherol, more than 100 times the gammatocopherol, and 73 times the total tocopherol.

This suggests if you normalize for vitamin E there may have been no difference between coconut oil and safflower oil.  In other words:  their results are inconclusive.

All this said, I’m still looking for evidence regarding the benefits of coconut oil in cardiovascular disease.  In the meantime, it is remains a tasty addition to my morning rice on occasion.

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