Listen! An Introduction to Understanding the Heart: Free Audiobook Chapters
As a type 1 diabetic, Dr. Stephen Hussey has always known that he was at risk of developing heart disease. As a result, he has dedicated his entire adult life to understanding the heart, to prevent himself from becoming a statistic.
And then his worst nightmare came true. In early 2021, Dr. Hussey suffered a “STEMI,” a blockage in the left anterior descending artery of his heart. During his recovery, he faced a difficult decision: follow the standard of care laid out for him by the attending cardiologist, or politely decline and apply everything he’d learned about the heart to a recovery protocol that would look massively different than what the doctors were recommending.
Understanding the Heart is a culmination of all the information that guided him through the highest-stakes decision of his life. In the excerpt below, Dr. Hussey describes his experience at the hospital and explains what motivated him to make these controversial yet constructive choices.
The following excerpt is from Understanding the Heart by Dr. Stephen Hussey. It has been adapted for the web.
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Understanding the Heart: An Introduction
It happened shortly before noon on January 5, 2021. I was in my kitchen making lunch when I turned to get something out of the refrigerator, and felt a sudden pain in my chest. At first, I thought my pec muscle was tightening up after the workout I’d done forty-five minutes prior. But then the pain intensified, and soon it was so bad I couldn’t continue cooking. I turned off the stove, stood still for a moment in the kitchen, and then—feeling flushed and hot—walked outside, into the backyard, to sit for a minute and cool off.
Outside, the pain continued to intensify. I realized that whatever was happening to me wasn’t normal, and that I needed to get help immediately. I thought for a moment about driving myself to the hospital, but the mounting intensity in my chest convinced me to call 911 instead. When the EMTs arrived, I walked a few steps to the stretcher and off I went in the back of an ambulance.
Inside the ambulance, the pain ratcheted so much that I couldn’t keep a lid on it. I felt sorry for the EMT riding with me, who had to listen to my wails. When we arrived at the hospital he wheeled me into the ER and handed the doctor a printout. The doctor looked at it and instructed her team: “Possible STEMI, prep the cath lab.”
An ST-elevation myocardial infarction, or STEMI, is a heart attack in which one of the three major arteries gets blocked. When a STEMI occurs in the left anterior descending (LAD) coronary artery, as mine did, it is known as a “widowmaker” because only 12 percent of people who experience them outside of a hospital setting survive.
The medical team wheeled me into a room, cut off my shirt, took off my pants and underwear. I felt like there were a million hands on me inserting IVs and prepping for the cardiac catheterization. Nurses bombarded me with questions about my health and how long I had been feeling this pain. I remember asking them not to call my parents just yet; I didn’t want to burden them. Eventually, the nurses wheeled me out of the room and into an elevator, and up we went to the lab.
Once in the catheterization lab, there were more hands, everywhere. At first, they tried to go in through the radial artery in my wrist, before abandoning that for the femoral artery. There was a sudden cold sensation on my groin as they sterilized the site. A male voice next to my left ear told me I was doing great and that it was going to be okay, but someone put defibrillator pads on me “just in case.” I heard the welcome instruction to administer morphine and from there it got hazy, but the pain eased as people worked diligently all around me. When I started shivering, someone covered me with warm blankets.
At the end of the procedure, the interventional cardiologist stood at my side and told me that although he’d found minimal atherosclerosis, a major acute clot had formed in the LAD artery, the largest coronary artery. He performed a balloon angioplasty, placed a stent, and told me it went in beautifully. I uttered an exhausted “thank you” before the man who saved my life turned and walked away.
Living With Type 1 Diabetes
Dr. Stephen Hussey, MS, DC — Author of Understanding the Heart
I make my living as a chiropractor, so though I’m not an MD, I have enough training in anatomy, physiology, pathology, neurology, nutrition, and clinical diagnosis to understand the gravity of what I was experiencing that January afternoon, even while it was playing out.
More importantly, I’ve lived with autoimmune type 1 diabetes since the age of nine. Even as a child, I understood that being diabetic increased my risk of other health conditions, including poor eyesight, weak circulation, and damaged kidneys—and that the diet and lifestyle choices I make to control my diabetes would have a major impact on how long, and how well, I’ll live. Because I’ve never been able to take my health for granted, I’ve always kept tight control of my blood sugars through diet and exercise, and dedicated myself to learning as much as I could about my own health, in order to avoid becoming a statistic.
I’ve also understood from a young age that having type 1 diabetes heavily predisposes me to oxidative stress, insulin resistance, and an imbalanced stress response (all topics I’ll discuss in this book). These predispositions double, or even quadruple, my risk of heart disease. But I’m hardly alone in facing that terrifying prospect. The occurrence of heart disease has reached epic proportions. In 2018, there were approximately 720 thousand first-time heart attacks and 335 thousand recurrent heart attacks in the United States. By 2035, it is estimated that more than 130 million people in the United States will have some form of cardiovascular disease. The annual direct and indirect cost of heart disease and stroke in the United States is estimated at approximately $329.7 billion. The cardiovascular system is the human body’s most commonly diseased system, and despite all the latest technology, drugs, and surgeries, it’s getting sicker and sicker, in more and more people.
What Causes A Heart Attack?
The medical orthodoxy about heart disease is that saturated fat and cholesterol clog up our arteries, leading to coronary atherosclerosis and heart attacks. It is also thought that measuring cholesterol, especially low-density lipoprotein (LDL) cholesterol, is the best indicator of heart attack risk. As a young adult, when I asked my doctors why people with type 1 diabetes were at particular risk, they offered various explanations of how high blood sugars damage arteries. But I always sensed there was more to the story. Every time I heard something about cardiovascular disease, no matter how far out there it seemed, my ears perked up and I soaked in as much as I could. Through my own health journey and experimentation, my formal medical and nutrition educations, and my relentless independent research, I have tried to learn everything I could about how to prevent this disease.
What I’ve learned about the heart over the years has often surprised me and differed in many ways from what I had been taught and told. For example, the evolutionary origins of the nervous system helps explain current rampant rates of heart disease in the Western world; special characteristics of heart tissue make heart cancer one of the rarest cancer diagnoses a person can receive; a body of research suggests that the heart is not actually the main mover of blood in the body; and the research-based critiques of the widely accepted idea that saturated fat and cholesterol lead to atherosclerosis, or clogging of the arteries, are quite convincing. As a result, my own diet is actually high, not low, in saturated fat, replete with animal proteins, animal fats, and organic vegetables.
My interest in the heart is so deep, in fact, that I wrote a book about it — which I was intending to self-publish within a matter of weeks when I experienced the STEMI. Needless to say, as I lay there in the cath lab, having suffered a major heart attack at the age of thirty-four, I began to doubt that I had any knowledge or authority on the subject to share. I knew my doctors would draw a connection between the heart attack and my high-fat diet and elevated LDL. And they did. One by one, the doctors looked at my chart, saw elevated LDL, and explained that it was the cause of my heart attack. Despite the large amount of evidence presented that LDL does not cause heart attacks, as I lay there on the table, having suffered a major heart attack, with credentialed experts explaining to me the reasons why, I had to ask myself: Why should anyone listen to me?
What happened in the hospital over the next few days changed my mind. Although I was extremely grateful to the people who saved my life, doubts began to surface about my care as early as that first night in the cardiac ICU as a nurse relayed the plan for managing my diabetes during my hospital stay. It was nothing like what I do at home. When I told the nurse my typical protocols, she said she would have to run it by the doctors in the morning. For that night, I would have to take the doses and type of insulin they recommended, not the amounts and types of insulin I use at home. Despite having had nothing to eat for the past twenty-four hours, the stress and inflammation from the heart attack had significantly increased my blood sugar. (Point in fact: When I entered the cardiac ICU, my blood sugar was over 300. Normal for me is below 150. Earlier that day making the lunch I never ate, it was about 87.) The doses they gave me didn’t bring it down, and in my experience, if blood sugar doesn’t come down within a few hours with a given dose of insulin, you get more aggressive. In the hospital, no matter how high my blood sugar tested between meals, they would only administer insulin at mealtimes.
The following day I requested to speak with the doctor. When the resident cardiologist and a pharmacist came in, I told them that I had been managing type 1 diabetes for twenty-five years. They had seen how good my A1c was, so they knew that I could do this on my own. I asked if they would permit me to manage it the way I usually do. But they didn’t budge. They stuck to their plan. And I was stuck with high blood sugars.
All told, they wanted me to take eleven different medications not including my insulin, some of which I was familiar with, many of which I was not.
Managing With Medication
As I watched ESPN, messages kept popping up on the screen telling me I had a new medication, and a moment later, a nurse would come in to try and administer it, but the only doctor I’d spoken to about medication was the cardiologist and that was specifically about insulin. I was uncomfortable taking the other medications until I had an opportunity to speak with a doctor and understand what I was being prescribed, and why. I wasn’t necessarily opposed to taking medication—I get it: I had just had a heart attack—I just didn’t want to take medication I didn’t understand until I had an opportunity to speak with someone who did.
The attending cardiologist arrived for rounds with a handful of interns and residents mid-morning. He began by telling me I needed to take a blood thinner for a year and a baby aspirin every day for the rest of my life to prevent a clot from forming around the stent. This made some sense to me. I had never had a stent in my body. There was no telling how my body would respond to it. However, I also had some concerns about the long-term use of blood thinners and baby aspirin. I was aware that chronic aspirin use has been shown to increase the likelihood of gastrointestinal bleeds and kidney failure (which I’ll cover in chapter 17). As a type 1 diabetic, I already had increased risk of kidney failure. When I asked the doctor’s opinion about the baby aspirin, he told me there is old research suggesting a connection to kidney failure, but that it wasn’t a real concern. I agreed to disagree and moved on to the blood thinner. I told him the few doses of the blood thinner I had taken was giving me bloody noses. He replied that the hospital air is dry, and many patients experienced this.
“What about magnesium?” I asked.
“What about it?” he said. “I know that if you test it in the blood and it’s low you should take it.”
I clarified, “I mean, use it as a blood thinner?”
“Magnesium is not a blood thinner,” the attending cardiologist replied.
I knew that wasn’t true. Magnesium has been shown to decrease viscosity of the blood, especially in combination with vitamin E, and prevent clotting. Granted, I didn’t know if it would have the same effect as a medication in preventing a clot after a stent. I was hoping to discuss that. No luck. The doctor told me he was not going to comment further on magnesium because he was only familiar with allopathic treatments, an answer I could respect.
However, the doctor then promptly left the room before I had the opportunity to ask any additional questions about the other medications I was being prescribed. Of course, I’m not an MD, and certainly not a cardiologist. I’m speaking as a well-educated patient: Not having the opportunity to even ask these sorts of questions made me feel like the doctors were treating my disease, a heart attack, instead of assessing me as a patient—and a person. Trying not to be rude with my concerns was starting to become difficult, and yet I also felt it was essential for me to understand the medications I was taking and why. “Informed consent” is supposed to be the hallmark of good medicine, but I felt that I had not been informed about what I was consenting to, or why. How does one navigate this, especially as one is lying in a hospital bed, exhausted and vulnerable, having just suffered a near fatal experience?
Taking Charge of Your Journey
That evening I was well enough to move f rom the cardiac ICU to a room on the cardiology floor. Of the eleven medications that my doctors expected me to take, I had only taken the blood thinner and one of the blood pressure medications, a beta-blocker called metoprolol (aside from the insulin). Metoprolol has been shown to decrease insulin sensitivity over time, so while I don’t think it contributed to the struggles I had regulating my blood sugar that night—I had only had two doses of metoprolol by that point, and my blood sugar struggles probably had more to do with the poor management of my diabetes by the doctors than metoprolol—I later felt surprised that as a type 1 diabetic, I’d been prescribed metoprolol for long-term use, especially as opposed to other beta-blockers, which have been shown to increase insulin sensitivity.
The doctor had also recommended a second blood pressure medication, an ACE inhibitor, but since my blood pressure is normally on the lower end, I decided to take only the metoprolol. I think that was a good decision. In the middle of the night, a nurse came in to take my blood pressure. It had dropped to 98/50, which is very low, even for me. After she left, I realized I was hot. I sat up in bed—slowly—and eventually stood up to turn down the thermostat. Halfway to the thermostat, I got very lightheaded and reached for the wall so I wouldn’t fall over. I steadied myself, turned down the thermostat, and got back in bed, grateful I hadn’t agreed to the additional blood pressure medication.
The next day I persuaded one of the resident physicians to show me the images of my echocardiogram and explain to me what they were trying to accomplish with each of the eleven recommended medications. Many doctors and nurses had already told me that, based on my echocardiogram, the ejection fraction of my heart had dropped to about 35–40 percent. (The ejection fraction is the amount of blood that leaves the left ventricle with each contraction.) A normal ejection fraction is 50–70 percent. The damage done to my heart was in the septum, the heart muscle tissue between the two ventricles. The resident explained that the purpose of the two blood pressure medications was to decrease the workload on the heart by decreasing the signals that tell it to increase pressure or beat faster. This would prevent what is called cardiac remodeling, which is where weakened areas of the heart can change shape, while my heart tissue healed. If my heart did remodel, it could lead to the development of chronic heart failure. I agreed with him that this was important, but expressed my concern with dropping my blood pressure. He said that my body would get used to the medications and that would stop happening.
However, I also know that his recommendations—and the standard of care for cardiac events—are based on the conventional wisdom that the heart is the main mover of the blood in the body. In fact—and I realize this may be hard to accept—there is a good body of evidence that the heart is not actually the main mover of blood in the body. There is also a body of evidence suggesting there are other methods besides blood pressure medications to upregulate the flow of blood, thereby preventing cardiac remodeling, including a fascinating medicine called ouabain and the use of infrared sauna.
After talking with the resident physician, of the eleven I had been prescribed, I concluded that there were only four medications worth consideration. He thought I should definitely be on the aspirin and blood thinner, as well as the two blood pressure medications.
Later in the day, the cardiac rehab nurse came in. She was very sweet and gave me lots of good information. She said the approach to recovering as much of my heart function as possible was time, rest, and medications. Later in the day a different nurse, the heart failure nurse, came in to educate me on how best to prevent the development of heart failure, which is common after a heart attack. She explained that since my ejection fraction was low, there was a risk of blood getting backed up and that fluid could start to pool in my lungs and other areas of my body. She echoed what the cardiac rehab nurse told me: Time, rest, and medications were the best prevention.
What she said next shocked me. She outlined the recommended diet to prevent heart failure. She told me, first off, that I needed to drastically restrict my salt intake because too much would cause fluid retention. (I will debunk that idea, and other nutrition fallacies, in chapters 10 and 11 and show how it might even be harmful to restrict sodium.) Then we moved on to diet. While the vegetables, f ruits, and lean meats on the list were acceptable because they are whole foods, my jaw dropped at the other foods recommended as “heart healthy.” They included canned fruit, fruit juices, instant breakfast, margarine, mayonnaise, tofu, breads and cereals, cornstarch, sherbet, sugar, jellies and jams, graham and animal crackers, and cookies and fig bars. I could not believe she was recommending a diet so high in processed foods, especially the processed grains, sugars, and vegetable oils. I knew, right then and there, that I would not be following the recommended diet. It looked, to me, like a one-way ticket right back into the hospital, and to chronic poor health.
From Hospital to Home: Critiquing the Care
That evening, my nurse told me I might be discharged in the morning. I was relieved. I couldn’t wait to get home and start my own carefully planned heart-healing routine. In the morning, I spoke again with one of the resident physicians and we had a good conversation about my situation. She still thought I should do everything they were telling me to do, like take all the medications, but she also acknowledged that it was obvious I was putting a lot of thought into my decisions.
Then I met a different attending physician for the first time. I told him I had been feeling better every day, and doing very well under the circumstances. He said that was great. Then he said he was not going to have a discussion with me about medication. He’d heard that I’d made up my mind, and he didn’t want to discuss it. I was discharged from the hospital later that morning.
A few days later I was reviewing my medical records, which I had requested be sent to me from the hospital. Aside from it being more information on my care than I had received from anyone in the hospital, one thing struck me as odd. My first night in the cardiac ICU, I had some chest pain, which I was told was normal after the heart attack and stent procedure. One of the nurses called in the resident physician who tried to troubleshoot it. She asked me a lot of questions, and I remember answering one with a lengthy explanation of the stress I had been under. Her response was to prescribe me a Xanax. Nowhere in the medical records did anyone report that conversation. Perhaps they didn’t think my stress was clinically relevant? In fact, there is a massive amount of evidence that chronic imbalance in our autonomic nervous system—essentially, our stress response—is a main contributor to heart disease and heart attacks, and that in many ways the diseases of modern society—including heart disease—are a direct result of the massive lifestyle changes humans have undergone in an evolutionarily short amount of time.
I’m not criticizing my care because I’m angry. I understand the strengths and weaknesses of modern medicine—I think most of us do—and I remain incredibly grateful to the people and the medical advances that saved my life. I describe all this to illustrate the dilemma we all must grapple with: that modern medicine has two very different faces. In my case, the production of synthetic insulin and the development of a stent procedure are modern medical miracles that saved my life. I will be forever in debt to those who made those discoveries and perfected those advancements, as well as to those who used them with such skill and care. The flip side is that modern medicine is incredibly lacking. It’s shockingly unenlightened about what actually fosters good health in humans, as well as about managing care following events such as the one I had in a way that will put a patient on the true road to recovery and back in the land of good health.
During my first night in the ICU, I had all but decided there was no way I could release this book. I was filled with self-doubt. But by the time I returned home, I had come to understand that many people have faced—or will face—the sorts of decisions and dilemmas I faced in the hospital. I believe the information in this book is critical for them, and no less relevant or correct because I had a heart attack. It is my hope that the information found in this book can ignite the open conversation about heart disease that is needed to inspire progress and change in our care and understanding of the heart. And while it’s true that I don’t have an MD and I’m not a cardiologist, and I’m cognizant that in our credential-driven world some will write me off entirely on that basis, my credentials are different—and I believe stronger. Aside from having a medical background, I’m a patient. And this is my health. There is not a person in the world for whom the stakes are higher than the patient. It’s not a person’s career on the line. It’s a person’s life on the line.
What It Takes to Understand Your Heart
That said, my goal in writing and publishing this book is not to be right, or to prove anyone else wrong, so much as it is to seek the truth, wherever it may lie. I know we can’t do that without open-minded, honest, and unbiased discourse. I was deeply disturbed in the hospital by the shutdown of conversation about alternative ideas and therapies. As soon as I started to question my doctors’ recommendations and approaches, I felt immediately branded as noncompliant and cast out of conversation—about my own care. All I really wanted was to have a discussion about my treatment options. I was taking the recommendations and my recovery seriously. I valued the doctors’ expertise and opinions and wanted as much information as possible. What in the world is going on with medical care that that’s so threatening? How did we get so far off course?
As soon as I was discharged f rom the hospital, I began a routine to restore the health of my heart. The rationale behind my approach is laid out in the pages of this book. I was told that if I didn’t restrict salt, eat the recommended diet, or take the aspirin, ACE inhibitor, beta-blocker, and statin, my heart would not fully recover. I did not follow these recommendations.
Instead, I sought the advice of a cardiologist who treats the whole person and who helped me decide what medications to take on a short-term basis, and what ones to avoid altogether. I started by taking two medications, the blood thinner and the ACE inhibitor, for a month, then just the blood thinner for the next six months. After six months, I stopped taking any prescription medications. I’ve also relied on a nutrient-dense diet and supplements like magnesium, taurine, L-arginine, and carnitine, and I have procured an infrared sauna and use it often. I make it a top priority to manage stress and expose my body to environments that help it be more resilient in the face of stress. This proved difficult at first because a new stress emerged following my heart attack: My confidence in my health was shaken. At times during my recovery, it felt almost as if my relationship with my heart was strained, like my heart had lost my trust and vice versa. As I healed, recovered, and slowly returned to normal activity, my emotional relationship with my heart recovered as well.
How’s it working out for me? So far so good. At my three-month follow-up, my echocardiogram report indicated that my interventricular septum (the middle part of the heart muscle that was damaged) had gone from “severely akinetic” to only “mildly hypokinetic.” This indicates that the signal conduction of that area of heart tissue was just shy of being normal. My left ventricular ejection fraction had improved from the 35–40 percent to 50–55 percent, the lower end of normal. There was no sign of anything suggesting heart failure.
All this said, I want to be clear. If you have heart disease or any symptoms of heart disease, you should be under the care of your physician or cardiologist. I hope that your doctor’s goal is to find the underlying causes of your disease and get you to the healthiest state possible as well as keep you off of medications, if practical. If this is not their goal, it may be time to find a new doctor. Many of the ideas presented in this book are very different from what you will find within the medical practice of cardiology, a field of medicine that is proving unsuccessful at preventing heart disease and fostering good heart health. Instead, this book presents information about the heart, what it is, why it is there, the ways it can malfunction, and how we can keep it healthy. It is my hope that being under the care of the correct doctor and being armed with the information in this book will empower people to take back control of their health, to prevent—and even reverse—heart disease.
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