You: Staying Young: Make Your RealAge Younger and Live Up to 35% Longer. Michael Roizen F.

that we do to our hearts – whether through genetics, lifestyle choices or both – is caused not solely by genes or fried food, but also by a double-whammy Major Ager of mitochondria-induced oxidation and inflammation that happens within your arteries.

      Inflame Shame: Your Heart and Arteries

      You may have about as much tolerance for blood as you do for drivers who don’t indicate, but to understand how to protect your heart, you have to get a wee bit sanguine. If you were to sneak a peek inside a chest (c’mon, a little closer now), here’s what you’d see: a twisting muscle that looks like the coiled back of a boa constrictor. That’s your heart. Not only does its twisting motion keep you alive, but it’s also the mechanism through which your body gets the nutrients it needs.

       FACTOID

      The anti-inflammatory effect of cholesterol-lowering statin drugs can be inhibited by taking more than 200 milligrams of vitamin C or more than 100 IU of vitamin E a day in supplement form, so you need to be careful what you take with a statin.

      Here’s how the process works: the heart muscle is stimulated by pacemaker cells to eject blood through the aortic valve. It doesn’t push out blood like a balloon emptying air, but like a towel being wrung out of water. That blood pulsates into the aorta – the body’s largest artery – which delivers oxygen-rich blood to the rest of the body, as well as to the coronary arteries surrounding the heart.

       Your Own Meth Lab

      A process in your body called methylation may sound like it’s illegal, but it’s one that your body depends on. The process – changing a molecule by adding a methyl group – helps detox your body, repair DNA and form new cells. As you age, the reduced ability to methylate is associated with heart disease as well as Alzheimer’s and diabetes. What can you do? Make sure you’re getting cofactors for methyl transfer like those found in fish and whole grains. Also, taking B₁₂ and folic acid (see chart for doses) seems to help methylation by reducing levels of homocysteine.

      Much of heart disease happens in your arteries – the tunnels that feed both nutrients and toxins to all your organs – rather than in your heart itself. Made of three layers (a cellophane-like exterior shell, a muscular middle and a thin, smooth inside layer that allows blood to slide through), your arteries serve as the site of the inflammatory process that’s responsible for many kinds of heart disease (see Figure 2.1).

      How? Well, it all starts with cholesterol, which as you know comes in healthy (HDL, or high-density lipoproteins) and lousy (LDL, or low-density lipoproteins) forms. The smooth inside layer of your arteries is pummelled by a variety of things: high blood pressure, cigarettes, excess sugar. When that happens, your body sends lousy LDL cholesterol (remember it by its first initial) to those damaged areas in an attempt to heal the wounds. Your immune cells in the damaged area swallow up the LDL cholesterol and burrow into the inner layer of your arteries.

      Your body then reacts to the wounds and the cholesterol with a low-grade inflammation. Makes sense: Inflammation is how your immune system deals with many problems, like splinters, unwanted bacteria, insect venom or other foreign invaders. Meanwhile, as part of your security team, your healthy HDL cholesterol works to clear that LDL cholesterol out of the area. Think of your LDL as a bus carrying loads of hooligans and dropping them off in your arteries to do damage to them, while your HDL serves as a high-speed police van that zips through your arteries to get the rogue elements off the streets. HDL is mostly made in intestines and looks like a plastic bag that wraps cholesterol so that it can be more easily excreted.

      Like TVs, toy trucks and lingerie, cholesterol comes in different sizes. But the most dangerous kind is the smaller kind. The smaller the particle, the more likely it is to nestle itself into the arterial wall, cause damage and trigger the inflammatory process (see Figure 2.2). To clear the arteries, we need to increase the function as well as the size of the healthy HDL cholesterol. Help can come in the form of niacin, omega-3 fatty acids and vitamin B₅, as well as some new-generation fibrate and statin drugs.

Figure 2.1 Tunnel Vision The arteries have three layers: a cellophane-thick shell for an exterior, a muscular middle and a smooth inside layer that allows blood to slide through freely.

       FACTOID

      Supplements that seem to reduce inflammation include: nettle leaf extract (900 milligrams), bromelain (2,000 milligrams), ginger (900 milligrams) and curcumin (1,200 milligrams). There’s not a lot of human data on this point, but there is enough science to suggest that they can be helpful.

      Meanwhile, the low-grade inflammation occurring in response to LDL cholesterol (which, combined with inefficient mitochondria, causes the Major Ager of oxidation) sounds the alarm that summons your body’s reinforcement immune cells called macrophages. These macrophages eat the LDL cholesterol, becoming engorged with fat and blowing up like marshmallows, then attach to the arterial walls. Pathologists call them foam cells, as they clog the artery walls. An arterial plaque is born.

       FACTOID

      Men with short telomeres may have a higher risk of developing coronary heart disease. While we know that stress can shorten telomeres, we don’t know if the shorter strips of DNA are a marker for a problem or play a role in disease development. In any case, it does seem that men with shorter telomeres respond very well to statin drugs. So if you get your telomeres measured and they are shorter than you’d like, consider a statin.

      As the plaque grows, it reduces the nutrient-rich blood supply through the arteries. And when the marshmallow cracks – that is, when the plaque runs out of blood supply – there’s a big-time supersonic explosion as a clot fills up the plaque like a bloated tick. The sudden clot formation, like a scab on any cut, closes off the artery. Think of a six-lane bridge going into a city: if one of the lanes is shut down, traffic can still get through, albeit a little slower. But if an explosion on the bridge takes out all the lanes, no traffic can get through. That’s why arterial plaques are so dangerous. No test can tell whether you have just one lane closed or a potential tanker that’s waiting to explode.

      When talking about heart disease, you often hear the word calcification. That has little to do with dietary calcium and the amount of chocolate ice cream you’ve snorted down in your life. Calcification in arteries is the body’s attempt to heal those inflammatory plaques in your body. The calcium stabilizes the plaque like cement reinforcement of a plaster wall. About 90 percent of men with atherosclerosis have calcified arteries, as opposed to women, who calcify their plaques only 30 percent of the time. This means that women respond to heart disease reversal programmes even better than men, since their arteries are not lined in a cast of calcium, but it also might mean that their plaques are more precarious and prone to rupture and sudden clot formation. The big point in all of this: you can’t become healthy by testing yourself; you have to live healthily to prevent the sudden explosions that cause heart attacks and strokes.

Figure 2.2 Shutoff Arteries respond to cholesterol with an inflammatory reaction, so your body calls in immune cells called macrophages. They eat the cholesterol that forms the plaque and bloat up like marshmallows. The resulting foam cells hinder the blood supply to the plaque and increase inflammation, so it cracks – and results in an arterial explosion.

      A Valve Check

      While most cardio talk is about clots and clogs that tie up traffic in your heart and arteries, there are also toll booths involved – the valves that accept blood coming into and leaving your heart. About 30 percent of people have significant valve disease by the age