No, you’re not dreaming, this is another book review. I’ve run out of space, so I’ve done two in one day.
Why did I feel the need to fit this review in? Well, while I was doing my nutrition series, I saw an interesting quote on Hyperlipid about a book called The Western Way of Death, by Malcolm Carruthers (affiliate links: UK
I chased the book down second-hand on Amazon but it had to be delivered from the US, so I didn’t receive it until recently. It’s a shame in some ways, as it would have been the perfect linking book between my discussions of why the lipid hypothesis of heart disease is not valid and why stress is extremely bad for your health.
Carruthers: camera shy
Why does it fit? Well, Carruthers suggests that stress, or emotional excitement, is the main cause of cardiac disease, and that the Western diet is probably too high in sugar and too low in fat.
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What does the book cover?
Well, Carruthers divides his book quite firmly into little chapters (it’s not a long book by any means):
1. Emotion as a cause of heart attacks
Carruthers explains that the idea that strong, negative emotion causes heart attacks has been around a very long time. He recalls that William Harvey, the man who first described the systemic circulatory system of the blood, once detailed the case of a man who was wronged by another and, not being able to extract revenge, fell into a strange distemper and suffered pain in the chest, dying a few years later.
Carruthers then goes on to explain why the medical profession abandoned this idea, which is the quote Peter put up on his blog at Hyperlipid.
2. The urban environment
Having explained the theoretical background to his theory and the prevailing orthodoxy, Carruthers now turns to explain briefly why our urban environment is particularly effective at making us sick with stress.
3. Driving and the heart
One of Carruthers’ chief culprits in the urban environment for making us sick was driving so now he devotes a whole chapter to it. This chapter is based on a study that Carruthers performed and published in The Lancet, called Endogenous Hyperlipidaemia induced by emotional stress of racing driving, Taggart, Carruthers, The Lancet, 1971. The abstract of the study is as follows (see The Lancet):
“Plasma-samples were taken from racing drivers at various times within a three-hour period following a race. The samples were analysed for noradrenaline, adrenaline, free fatty acids, triglycerides, and cholesterol.
Racing driving was chosen to provide an example of an extreme emotional and aggressive situation, associated with minimal physical effort, which might be expected to demonstrate magnification of certain biochemical changes that may occur in everyday life.
The total-catecholamine levels were grossly elevated, the increase being largely due to noradrenaline. The free-fatty-acid levels were also elevated one to three minutes before the start while the drivers were on the starting grid, and up to one hour after the race. The triglyceride levels were slightly elevated after the event, continued to increase, and reached a peak at one hour.
An exciting stimulus such as fast competitive driving can temporarily raise the plasma-levels of free fatty acids and triglycerides, two substances indicted in the causation of atheroma.”
4. The heart at work
In this chapter, Carruthers anticipates many of the findings that Michael Marmot discovered as part of his work on the Whitehall studies and which are described in his book, The Status Syndrome.
5. Home is where the heart is
This chapter covers a range of home-related issues that can lead to emotional stress, including, interestingly, TV. The TV part is based on a study that Carruthers performed and published in the British Medical Journal, called Vagotonicity of Violence: Biochemical and Cardiac Responses to Violent Films and Television Programmes, Carrthers, Targart, British Medical Journal, 1973. The abstract of the study is as follows (see the full text):
“In a search for a reproducible means of evoking different types of emotional stress it was found that in spite of increased adrenaline secretion slowing of the heart occurred when watching violent television programmes.
Further evidence of increased vagal tone was provided by the “sinus arrhythmi” effect, a widening of the gap between the maximum and minimum heart rates during the respiratory cycle in parts of the humour, violence, and suspense sections of the television programme.
Groups of people taken to see two particularly violent films showed similar evidence suggesting vagal overactivity, together with increases in plasma free fatty acids and decreases in triglycerides.”
6. Drink, drugs and diet
Carruthers agrees with Malcolm Kendrick in that he thinks a little alcohol is good for you (it’s relaxing) and then explains why he thinks we shouldn’t smoke (you have to remember this book is over 30 years old).
He makes it clear that when it comes to diet, it’s not a big factor but we should probably eat more protein, more fat and less sugar.
7. The fitness factor
Carruthers explains that regular exercise can help mitigate against the cardiac disease risk that we expose ourselves to in modern society.
8. The message
The overall message of the book is one that Carruthers went on to spend several years looking at, that emotion (or stress) can be a significant cause of cardiac problems.
A scientific study he published not long after he published The Western Way of Death covers much of the same ground. See Some effects of emotion on the normal and abnormal heart, Taggart, Carruthers and Somerville, in Current Problems in Cardiology, 1983. The abstract (see PubMed) says:
“Increased heart rate and catecholamine secretion are induced by certain emotions. Automobile driving in busy city traffic, racing driving, speaking before an audience, and parachute jumping are associated with sinus tachycardia 120-180 per minute, and increase in the plasma levels of adrenaline and/or noradrenaline.
Patients with clinical coronary disease, angina, and ischemic ST changes and arrhythmias may be induced by the emotional stimuli associated with car driving and public speaking.
Emotion may parallel exercise in its ability to accelerate the heart rate up to 180 per minute in healthy subjects, comparable to the maximum reached during physical exertion. Thus, there are good grounds to advise persons at risk not only against violent exercise but also against exposing themselves to intense emotion.”
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Conclusion
The Western Way of Death has an important message that has been completely ignored since it was published in 1973: stress is the most important factor in cardiac disease.
