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“Dr. Hyman, my father has heart disease, his father did too, and I’m obviously concerned about my own heart,” writes this week’s house call. “What can I do to prevent heart disease?” “我的父亲患有心脏病，他的父亲也是这样，显然我应该非常关注自己的心脏状况，医生，我能做些什么来预防心脏病呢？” Most importantly, please know while genetics contributes to some degree, many other factors completely within your control can contribute to or reverse heart disease. 非常重要的一点，虽然遗传学在一定程度上对于心脏病的发生发展起作用，但许多其他因素完全可以帮助或逆转心脏病！ Genetics loads the gun, but environment pulls the trigger. The way you eat, how much you exercise, how you manage stress, and your exposure to environmental toxins all contribute to things like high cholesterol, high blood pressure, high blood sugar, and of course, heart disease. “遗传基因使枪上膛，但环境扣动扳机”。你进食的方式，锻炼的程度，如何管理压力以及暴露于环境毒素的多少，都会对高胆固醇、高血压、高血糖以及心脏病等有所“贡献”。 The current way doctors treat heart disease is misguided because they treat the risk factors not the causes. To think we can treat heart disease by lowering cholesterol, lowering blood pressure and lowering blood sugar with medication is like mopping up the floor while the sink overflows. 目前医生治疗心脏病的方式存在误导，因为他们并不认为一些危险因素是生病的原因。想象一下，我们通过降脂、降压和降糖来治疗心脏病，这就如同在水槽溢出时，只将地板擦干净而已。 Instead, we need to ask what causes these risk factors like high blood pressure, high blood sugar or abnormal cholesterol in the first place. Spoiler alert: These are not medication deficiencies! We treat these problems with medication, but studies have increasingly shown that treating these risk factors has only little benefit, or none at all. Research shows changing your lifestyle can be a more powerful intervention to prevent heart disease than any medication. 相反的，我们应当先应对高血压、高血糖或胆固醇异常等危险因素，这才是首要的。透露一下：造成这些症状绝不是因为缺乏某种药物！ 我们向来用药物解决这些问题，但越来越多的研究表明，干预这些危险因素得到的效果甚微，或基本没有效果，然而，生活方式的改变却是比任何药物都更强大的心脏病干预措施。 The “EPIC” study published in the Archives of Internal Medicine studied how 23,000 people adhered to four simple behaviors: Not smoking, exercising 3.5 hours a week, eating a healthy diet and maintaining a healthy weight. Adhering to those four behaviors alone prevented 93 percent of diabetes, 81 percent of heart attacks, 50 percent of strokes, and 36 percent of all cancers. 发表在“内科学档案”上的“EPIC”研究了23000人遵循四种简单的行为：不吸烟，每周运动3.5小时，健康饮食，保持健康体重。结果表明，秉承这四种行为的个体阻止了93％的糖尿病，81％的心脏病发作，50％的中风和36％的癌症的发生。 Likewise, the INTERHEART study, published in the Lancet in 2004, followed 30,000 people in 52 countries. Researchers found changing lifestyle could prevent at least 90 percent of all heart disease. 同样地，2004年在“柳叶刀”发表的“INTERHEART”研究报告，追踪了52个国家中的3万人，研究人员发现，改变生活方式可以预防90％的心脏病的发生。 Other research shows lifestyle intervention becomes more effective than almost any other traditional medical intervention to reduce cardiovascular disease, hypertension, heart failure, stroke, cancer,diabesity and deaths from all causes. 还有其他研究表明，对于减少心血管疾病、高血压、心力衰竭、中风、癌症、肥胖和所有原因的死亡，生活方式干预比几乎任何其他传统的医疗干预更为有效。 Your environment, in turn, changes gene , subsequently modulating inflammation, oxidative stress and metabolic dysfunction. These are the reasons we get sick and develop heart disease along with other problems. 环境反过来会改变基因表达，随后调节炎症、氧化应激和代谢功能障碍，这些正是我们发生心脏病及其他问题的真正原因所在。 That’s actually good news. Addressing and fixing the root causes benefits most chronic disease. These modifications will make you feel alive and healthy without the side effects of medication. 其实这是好消息——定位和解决根本原因有利于大多数慢性病，这些变化将会使您脱离药物的副作用，健康的生活。 Occasionally, I will use medications if I feel a patient shows a strong genetic predisposition for heart disease or if significant heart disease already exists. Under those circumstances, I carefully weigh a medication’s risks and benefits. 偶然的情况下，如果我发现患者对心脏病有很强的遗传倾向，或者心脏病已经存在，我会使用药物，但一定会仔细权衡药物的风险和益处。 At the same time, most patients can achieve the benefits of most medications through lifestyle changes. 同时，大多数患者通过生活方式的改变可以达到大多数药物的好处。 Dr. David Jenkins from the University of Toronto compared treatment with statin drugs (the number one cholesterol medication) with a diet rich in viscous fiber, almonds, soy and plant sterols. Researchers in this study found that, while they created almost equal benefits, diet became more effective to lower inflammation and homocysteine (a risk marker for heart disease). 多伦多大学的David Jenkins博士比较了与他汀类药物（干预胆固醇首选药物）的治疗方案，其中含有富含粘性纤维、杏仁、大豆和植物甾醇的饮食，这项研究的人员发现，虽然它们创造了几乎相同的效益，但饮食更有效地降低了炎症和同型半胱氨酸（心脏病的风险标记）。 I’ve, likewise, had patients lower their cholesterol simply by incorporating positive dietary and lifestyle changes. 同样，我也是通过纳入积极的饮食和生活方式的改变，使患者降低胆固醇。 Simply put, preventative medicine becomes the best form of medicine. These 10 simple modifications can go a long way to preventing or reversing heart disease. 简单来说——预防成为了最好的药物。 以下10项简单的改变对于预防或逆转心脏病非常的有效。 1. Eat a healthy diet. Increase healthy, whole foods rich in nutrients and phytonutrients (plant molecules). Aim for at least 8 to 10 servings of colorful fruits and vegetables every day. These foods are loaded with disease-fighting vitamins, minerals, fiber, antioxidants and anti-inflammatory molecules. 健康饮食。 增加健康、丰富的营养成分和植物营养素（植物分子）。 目标是每天至少8-10份彩色蔬果，这些食物含有对抗疾病的维生素、矿物质、纤维、抗氧化剂和抗炎分子。 2. Steady your blood sugar. Studies show blood sugar imbalances contribute to heart disease. Stabilize your blood sugar with protein, healthy fat and healthy carbohydrates at every meal. Never eat carbohydrates alone, and avoid processed sugars with carbohydrates.. 稳定血糖。 研究表明血糖不平衡对心脏病的发作有促进作用。每一餐摄入蛋白质、健康的脂肪和健康的碳水化合物可以稳定血糖，不要单独摄入碳水化合物，并避免精加工的碳水化合物。 3. Increase your fiber. Work your way up to 50 grams of fiber per day. High-fiber foods include vegetables, nuts, seeds and lower-sugar fruits like berries. If that becomes a challenge, try a fiber supplement such as PGX (Konjac fiber or glucomannan). 增加纤维摄入。 每天至少50克，高纤维食品包括蔬菜、坚果、种子和低糖水果（如浆果）。如果有一定难度，可以尝试使用纤维补充剂，如PGX（魔芋纤维或葡甘露聚糖）。 4. Avoid processed, junk foods. That includes sodas, juices and diet drinks, which adversely impact sugar and lipid metabolism. Researchshows liquid-sugar calories become the biggest contributor to obesity, diabetes and heart disease. Don’t be fooled that 100 percent fruit juice is healthy. Juices are essentially pure, liquid sugar because processing strips away the fruit’s fiber. 避免精加工的垃圾食品。包括苏打水、果汁和饮料等，它们会对糖和脂质代谢产生不利影响。研究显示液体糖的卡路里成为肥胖、糖尿病和心脏病最重要的因素。不要认为100％的果汁就是健康的，果汁基本上是纯的液体糖，水果的纤维素已经被加工去除了。 5. Increase omega-3 fatty acids. Eat anti-inflammatory foods like cold-water fish including salmon, sardines and herring, as well as flaxseeds and even seaweed. Healthy fat actually benefits your heart by improving your overall cholesterol profile. It also lowers the small, dangerous LDL particles that contribute to heart disease by converting them into light, fluffy, safe LDL particles. 增加摄入ω-3脂肪酸。吃抗炎食物，比如冷水鱼（包括鲑鱼、沙丁鱼和鲱鱼），以及亚麻籽甚至海藻。 健康的脂肪通过改善您的整体胆固醇状况有益于心脏，还通过将它们变成轻质、蓬松、安全的低密度脂蛋白颗粒来降低可以导致心脏病的小而危险的低密度脂蛋白颗粒。 6. Eliminate ALL hydrogenated fat. Hydrogenated fat lurks in margarine, shortening, processed oils and many baked goods and processed foods like cookies and crackers. Even when the label states “no trans fats,” the word “hydrogenated” indicates that the product contains trans fat in one or more of the ingredients. Use healthy oils instead like coconut oil (rich in medium-chain triglycerides or MCTs), extra-virgin, organic, cold-pressed, olive oil, organic sesame oil, and other nut oils. 消除所有氢化脂肪。 氢化脂肪潜伏在人造黄油、起酥油、加工油和许多烘焙食品和加工食品中（如曲奇和威化）。 即使标签显示“无反式脂肪”，“氢化”一词表示产品在一种或多种成分中含有反式脂肪。建议您使用健康油代替椰子油（富含中链甘油三酸酯或MCT），特级、有机、冷压橄榄油，有机芝麻油或其他坚果油。 7. Avoid or reduce alcohol intake. Alcohol can raise triglycerides, contribute to fatty liver and create sugar imbalances. Reducing or eliminating alcohol intake lowers inflammation, which contributes to heart disease and nearly every other chronic disease. 避免或减少酒精摄入量。 酒精可以提高甘油三酯，有助于形成脂肪肝，并造成糖分失衡。避免或减少酒精摄入可以降低炎症，炎症可以引发心脏病和几乎所有其他慢性疾病。 8. Take quality supplements. Combined with a healthy diet and exercise program, supplements can dramatically improve cardiovascular health. Take a good multi-vitamin/mineral along with a purified fish oil supplement that contains 1000 to 2000 milligrams a day of EPA/DHA. (You might need higher doses if you have low HDL and high triglycerides.) I also recommend a fiber supplement such as PGX (Konjac fiber or gluccomanan) to lower cholesterol and balance blood sugar levels. 使用优质补充剂。 结合健康的饮食和运动计划，补充剂可以显著改善心血管健康。服用多种维生素、矿物质以及每天含有1000至2000毫克EPA / DHA的纯化鱼油补充剂，如果HDL和甘油三酯高，可能需要更高的剂量。我还建议使用纤维补充剂，如PGX（魔芋纤维或葡萄糖聚糖）来降低胆固醇并平衡血糖水平。 9. Get out and move! Research shows 30 to 45 minutes of cardiovascularexercise at least five times a week can benefit your heart. After all, your heart is a muscle, and muscles need exercise. If you feel stronger and more capable, high-intensity interval training (also called burst training) and strength training help build muscle, reduce body fat composition and maintain strong bones. 加强运动。研究显示，每周至少5次，每次35-45分钟的运动，可以使心脏功能受益。 毕竟，你的心脏是肌肉组成的，肌肉需要运动。如果你感觉强壮了，能力加强了，可以进行高强度间歇训练（也称爆发训练）和力量训练，有助于建立肌肉，减少身体脂肪组成并保持强壮的骨骼。 10. Manage stress levels. Stress alone can cause a heart attack. Sadly, chronic stress often triggers a cascade of events that cause that final, fatal heart attack. Among its problems, stress increases inflammation, raises your cholesterol and blood sugar, increases blood pressure and even makes your blood more likely to clot. Find your pause button to manage stress and relax. Yoga, Tai Chi, meditation, breathing techniques and guided imagery can lower stress. 压力管理。 单独压力就可导致心脏病发作。可悲的是，慢性压力通常会在引发一系列事件之后，导致最后致命的心脏病发作。其中，压力会增加炎症，增加胆固醇和血糖，增加血压，甚至使血液凝血。找到您自己身体的“暂停键”来管理压力并放松。瑜伽、太极、冥想、呼吸技巧和引导影像都可以降低压力。 本文转自“功能医学医生”微信公众号
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