Chapter 10-How Does Alcohol Affect Your Health?

How and Why the Heart Heals Itself | The Low-Salt, Low-Fat Diet | General Instructions for Following a Low-Fat Diet | Foods to Avoid | Foods Permitted | One Week of Sample Menus for a Low-Salt Diet | Rest | Should You Exercise? | What Kind of Exercise Is Permissible? | Should You Smoke? | Should You Avoid Alcohol? | What about Coffee and Tea? | Care of the Bowels | Can You Continue to Have Sex Relations? | What Is the Best “Coronary Climate”? | When May You Return to Work? | Develop a Constructive, Optimistic Attitude Toward Life | Your Chances for Long Life Are Excellent

Not long ago, David S., now a patient of mine, was rushed to the hospital after he had collapsed during a meeting of his newspaper's editorial board. He had had a heart attack.

The people who work with Dave, and those who knew him well, were astonished and a little frightened.

"He's younger than I am," said the publisher apprehensively. "And a real dynamo. Best city editor I ever had. I didn't know he had heart trouble."

Dave didn't know it either.

There were some premonitory signs of trouble, it is true. But Dave ignored them or dismissed them lightly. That morning, for instance, he had come to the office a little earlier than usual to make sure his paper didn't miss any newsworthy angles in the running story of a big forest fire that was raging not far from his city.

The telephones were ringing constantly; there were instant decisions to be made in covering the day's fast-breaking news; there were several appointments with important people—a luncheon engagement with the chief of police, and an afternoon editorial meeting.

Dave was only 41. He had climbed fast in his profession because, as his publisher said, he was a dynamo. He felt that he had to keep the flow of news moving like a Niagara of copy into the presses.

During the past week he had not been feeling as well as usual. He felt a little tired, and had to keep himself going by sheer force of will. It was just that he needed a little vacation, he told himself. He was a little too tense, that was all. That's why he "bounced back" when he got a chance to relax a bit over the weekend.

Dave was late getting back to the office after his luncheon with the chief of police. The official had been detained, and that had thrown Dave's schedule off completely. So he ate rapidly and discussed his business with the chief as he forced down his food. He was not very hungry, but he ate a hearty meal on the theory that he needed the energy to keep going.

By the time he got back to the office, Dave was a little short of breath and somewhat dizzy. Also, he was annoyed by a pain in his chest that occasionally ran down into his left arm and hand. He barely had time to see the fourth edition out before hurrying into the editorial meeting.

In the meeting he relaxed a little in his chair and felt some­what better until the national advertising manager made him angry by charging that the paper was losing revenue because the editorial department would not support advertisers with local newstories.

At that point, Dave jumped up and began a heated oration on the responsibilities of the press. And just as his remarks had reached fever pitch, Dave suddenly felt a sharp, pressing pain deep inside his chest, under his breastbone. Beads of perspiration broke out on his forehead. He felt nauseated and very weak. His voice faltered and he collapsed to the floor.

In his quiet room at the hospital, after the administration of oxygen had made his breathing easier, and an injection of medicine had relieved the pain in his chest, Dave began to realize what had happened. As a reporter he had once been assigned to the city's receiving hospital, and he recognized his own symptoms. He had suffered a heart attack.

But what was going to happen now? Patients who had not died at the hospital or who had not been dead upon arrival, were always sent to other hospitals and he never had had oc­casion to follow up the story to see what happened afterward. Was he going to die? Or would he be an invalid the rest of his life, a burden to his family and an object of pity to his friends and colleagues?

A generation ago Dave's doctor probably would have given him only slight encouragement. For when coronary thrombosis first began to be accurately diagnosed in the mid-twenties, medical authorities regarded a three-year survival period as the best of good fortune. Today the average survival span, which includes the extremely bad cases as well as the good, may be about 10 years.

So when I later discussed Dave's own case with him, I could cite from my own medical experience cases of patients who are in good health as much as 30 years after the attack.

HOW AND WHY THE HEART HEALS ITSELF

To understand the real basis for hope, following a heart at« tack, let us look briefly at that vital organ that for centuries has been referred to in our common language as the source of feeling (as in such expressions as "heartbreak," "affairs of the heart," "heartless," and so on).

As you can see from the accompanying diagrams (see Figs. 3 and 4) the heart is a large muscle (about the size of your fist), which is divided into four chambers. The two smaller chambers at the top of the heart are called the auricles; the two larger ones at the bottom, ventricles.

The auricles receive that impure blood that is being returned to the heart through the veins. This blood, because its supply of oxygen is almost exhausted, appears blue. The larger chambers, or ventricles, pump the fresh blood, after it has been oxygenated by the lungs, out through the arteries again, to nourish every part of the body.

The heart muscle itself, of course, has to receive nourishment. This is accomplished by means of a pair of blood vessels, called coronary arteries, that in diameter are about the size of soda straws. They encircle the heart, supplying it with the blood it needs to keep it functioning. When the inner lining (called the intima) of these arteries is filled with fatty deposits, they may become blocked, cutting off the heart's own blood supply, and "starving" a section of that vital organ.

Fig. 3. Heart (Interior View)

In this diagram of the inside of the heart, four chambers are shown. The two upper small ones (auricles) receive the venous blood from the body. The right auricle pumps the blood through a valve into the right ventricle whence the blood is pumped into the lungs to be refreshed with oxygen. From there it flows back into the left ventricle. From the left ventricle, the fresh blood is pumped through the aorta and its arterial branches into all parts of the body.

Fig. 4. Right Side of the Heart

This diagram shows the interior of the right side of the heart. Venous blood flows from the right auricle into the right ventricle. The Aortic Arch is the bend of the Aortic Artery through which the heart then pumps the fresh blood to all parts of the body.

When this occurs, the muscle can no longer function in the affected area. Depending on the size and the location of the area involved, the result is that the heart is either crippled, until healing occurs and a scar forms, or it stops beating al­together and death ensues.

When a patient survives a heart attack, as Dave did, the heal­ing or repair of the damaged portion is as dramatic as any biological process known to science. This is the way it works:

Nature rushes defensive forces to the scene. Undamaged arteries now grow buds into the tissues where famine exists. Thus a new network of blood vessels gradually spreads through the disaster area, creating what physicians call "collateral circulation." In this way, the heart "detours" around the road blocks that have clogged the coronary artery. The normal "traffic" of blood flow may thus continue, and the heart can go on pumping. The patient survives, and a scar of healing grows across the portion of the heart muscle that was damaged.

Treatment following a heart attack will vary according to the nature of the case. Sometimes anti-coagulant medicines are used to prevent further blood clotting. These are used only under the supervision of the doctor, and after a time are usually dis­continued altogether. The diet thereafter must be watched closely, however. In my own practice, as I pointed out in another chapter, coronary patients who followed the strict diet I devised and prescribed for them lived twice as long as those who did not adhere to such a low-fat, low-cholesterol diet.

During the critical two-week period immediately following the attack, if there are no complications, the patient is often al­lowed to sit up in a chair. Usually another one to three weeks of absolute rest is required before limited physical activities are allowed. This restriction avoids serious complications that might develop if any strain is placed upon the heart while it is healing.

The electrocardiograph, a machine that records the electric pulsations made by the heart when it beats, is used in all hos­pitals to follow the patient's progress after he has survived a coronary occlusion (heart attack). By studying the tracings made by the up-and-down motion of the recording needle-pen, the physician can determine exactly which portion of the heart is damaged, and how it is responding to treatment.

After the initial rest-period stage of recovery, the doctor offers the patient guidance that, in its details, will differ according to individual needs. In general, however, the following rules of health and manner of living are followed by most physicians and patients:

Weight'. Control of weight is a vital factor, as shown in Chapter 7.

Diets Diet is also crucial, both to recovery and in adding years to the remaining lifespan after an attack. (See Chapter 6).

We present the following dietary principles for those in­dividuals who, because of high blood pressure, a heart condi­tion, or some other cause, are required by their doctors to fol­low a low-fat, low-salt (sodium) diet:

THE LOW-SALT, LOW-FAT DIET

General instructions for following a low-salt diet

You should eat only foods low in sodium content. Use no table salt (sodium chloride) in food preparation or at the table. Neo-curtasal, Diasal, Lacasal, Co-Salt (sodium free substitutes) may be used to season foods while cooking or at the table. Do not use bicarbonate of soda (baking soda) either in cooking or as an antacid. Use distilled water.

Foods to Avoid

Foods Permitted

One week of sample menus for a low-salt diet

Please note: all vegetables are either fresh or dietetic salt free.... no fat added. Salt-free bread or toast is used ... salt-free crackers Distil­led water used in cooking.... Skim milk or low sodium milk may be used wherever needed.... Jello or fruit may be taken between meals ....

* The recommended amounts of meat, fish, poultry and white of eggs should not be exceeded, because the sodium content of these foods is not sufficiently low to permit their unlimited use.

REST

Sleep and rest are important. With a return of normal health, the heart patient may be inclined to do more than he should. Avoidance of fatigue from work or social activity, however, is the wisest course.

Most patients should get from eight to nine hours of sleep in these hectic times. Some people, it is true, seem to get by with only five or six hours of sleep. But they are exceptional people. Patients must also be guided by their own reaction to work and daily activities. If they find themselves feeling tired or "run down" during the day, they should take a little time out for a nap. A good time for such cat-naps is the middle of the day and just before the evening meal.

I often advise businessmen patients of mine to take a half-hour to rest, either in their offices or clubs, once or twice during the day, while their secretaries or business associates "cover" for them. They find that being "out" a half hour once or twice a day causes no great inconvenience, occasions no comment from their clients and is most refreshing.

Social activities must be pleasant, non-taxing, and of the kind that induce a cheerful and relaxed mood. The coronary patient has always to bear in mind that he is better off away from scenes of anxiety, tension, or conflict—at play as well as at work.

The value of relaxation to the coronary case and development of keen interest and enjoyment in activities outside work is especially appreciated by the physician. Several years ago in Los Angeles, a number of my colleagues formed a "Coronary Club." To be eligible, you had to be a physician and you had to have suffered a coronary thrombosis. Club members have de­veloped the highest skills in their hobbies. Some of the most widely enjoyed of these hobbies are oil paintings, chess, sculpt­ing, and water-color painting. Several of the doctors have already won recognition and prizes during the annual "shows" that local and national medical societies give for painting and sculpture. Indeed, one of my colleagues finds that he can hardly wait to get away from his office in order to work on an oil painting of his daughter!

SHOULD YOU EXERCISE?

The kind and amount of exercise you take assumes a more important role in your life following a heart attack. Some people are almost fanatical in their belief that physical exercise is the only way to maintain good health. They are the persons who insist upon the efficacy of such gadgets as treadmill machines, Indian clubs, bar bells, and a variety of exercising machines. They will assure you that your heart trouble was caused in the first place by lack of exercise. The only way to regain your health now is to "restore the vitality and muscle tone that can come only from exercise."

Some years ago I treated Dr. B., a brilliant and well-known biochemist and bachelor. After he recovered from his coronary attack he tried to live the exemplary, perfect life, living at home alone with his mother. After one year of excellent physical health, a new symptom developed: severe and persistent head­ache.

The following conversation took place in my office:

"Doctor Morrison, this headache of mine is just about killing me. I feel as though a vise were squeezing and crushing my head."

"Well, Dr. B., you know your heart and blood pressure as well as the rest of your 'physical exam' are now perfectly nor­mal".

"But, Dr. Morrison, why do I suffer from this infernal head­ache? I lead an ideal life. I watch my diet, I don't smoke, don't drink, retire every night at 10 p.m., never keep late hours, am home every night with mother, never go out, don't even bother with women. What can it be?"

Looking him straight in the eye and with a grin, I said: "It's simple, Ben, your halo is just too tight".

There was a startled minute of surprise and silence. Then Dr. B. himself grinned and saw through this joke into his own overstriving for perfection, having forgotten that the body needs more than physical tending to—it needs diversion, recreation, mental relaxation. I prescribed a holiday, a large dose of fun, a deep draught of gaiety and diversion, to be followed by regular, frequent doses of the same "medicine." His headache, obviously from tension and accumulated anxiety, vanished quickly!

Actually, the extent of your physical exertion in any activity is a matter that must be decided by your physician. He knows that patients vary widely in their capacity for exercise and their body's tolerance to physical exertion. He knows also that exercise is nothing more than a means of stimulating the body's metabolism, of changing the body's chemistry through its effect on both circulation and on improved elimination.

At least one half of all patients who experience a coronary thrombosis make a complete recovery and are able to resume normal physical activities. Of the other 50 per cent of patients, about one quarter find they are definitely limited as to their physical exertion or work. The remaining 25 per cent are either retired from work and normal activities entirely, or assume a disabled status.

President Eisenhower is a good example of those who recover completely. Despite the complication of ileitis added to his initial trouble, he made a satisfactory comeback following a coronary thrombosis. Although he was placed on a prolonged program of anti-coagulants (drugs that prevent clotting in the blood), he continued to play golf occasionally; he exercised with care and moderation, and returned to his customary Presidential duties.

WHAT KIND OF EXERCISE IS PERMISSIBLE?

Among muscular activities that are suitable to patients who have recovered from heart attacks are swimming, walking, square dancing, fishing, gardening, bowling, and horseback riding. They may also resume normal sexual relations and otherwise live normally. More violent forms of exercise, such as tennis or squash, how­ever, are definitely dangerous.

Moderate physical activity is recommended for coronary pa­tients because during mild exercise, there occurs a nutrient with­drawal from the blood to meet increased metabolic needs. This withdrawal, in turn, results in a lower serum concentration of fats and consequently of cholesterol.

SHOULD YOU SMOKE?

One of the first questions a smoker will ask his physician following a heart attack is, "Doctor, do I have to give up smoking?" In most instances, the doctor will have to say "yes."

In general, smoking is not good for the circulation. In fact, it is often quite injurious to circulation in the legs, if the patient is sensitive to nicotine, as many are. In some persons, smoking produces a tightening or further narrowing of the blood vessels, an action that physicians call vaso-constriction. In cases of coronary artery disease, the added squeezing down of the ar­teries as a result of smoking can be quite dangerous.

Available evidence from research is not sufficient to show that smoking causes heart attack, but physicians know that some patients with angina pectoris (a form of coronary artery dis­ease) may easily aggravate their condition by heavy smoking.

Many of my patients have found it extremely difficult to give up the tobacco habit.  For them, I usually recommend filtered pipes instead of cigarettes or cigars. For others, denicotinized tobacco, or a substantial reduction in smoking is effective. A discussion of the role of smoking and its effects on your health may be found in Chapter 8.

SHOULD YOU AVOID ALCOHOL?

The use of alcohol in modera­tion is permitted and is, in fact, often beneficial. Refer to Chapter 9 for the full story on alcohol and health. Just a few reminders will be touched on here.

Temperate use of distilled liquors and wines is usually health­ful, for they tend to dilate or open up the arteries, and thus to improve circulation. As a rule, I do not recommend the use of beer, because it is a gas-former. When beer is taken with a heavy meal, the resulting gas in the stomach may embarrass the heart or restrict its free function.

My experiments, as reported in Chapter 9, showed that severe gas-pressure could damage the heart or even arrest its action and thus affect the coronary arteries adversely. Many deaths that have been attributed to "acute indigestion" occurred in this way—gaseous ballooning of the stomach that actually squeezed life out of the heart. An additional disadvantage of beer, other than its gas-forming properties, is its salt content, which may be harmful to certain patients.

For most coronary patients, moderate amounts of Scotch, brandy and wines, however, are recommended.

WHAT ABOUT COFFEE AND TEA?

Coffee and tea are also stimu­lants which, if used in moderation, may be helpful, since they too tend to dilate the blood vessels, permitting an increased flow of blood.

But, as in the case of other stimulants, they can be harmful if they are used to excess.

CARE OF THE BOWELS

Proper care of the bowels is essential. Constipation, which often results in straining at the stool, is harmful and may even be dangerous. Not infrequently I have known patients to precipitate heart attacks by straining to force a bowel movement.

Because the importance of easy elimination in treatment of coronary patients is not generally known to the lay public, there was a good deal of surprise and amusement throughout the country when Dr. Paul Dudley White, the President's cardi­ologist, issued his now famous medical bulletin on the second day after the Chief Executive's coronary attack. At that time he stated that the President's condition was encouraging and that he had had a good bowel movement! This celebrated event is said to have been reported around the world. And the re­joicing was reflected in an upward swing in the stock market!

On the matter of regulating the bowels your doctor is, of course, the best advisor. Most individuals require a well- bal­anced diet, containing fruits and vegetables, together with an adequate intake of water. They also need to take sufficient time for a relaxed bowel habit.

Many of my patients have found that a glass of prune juice on arising in the morning, or one or two glasses of hot water with lemon juice or tea, are beneficial. Others have found that strained vegetable juices (cabbage juice, for example) or fruit juices taken upon arising stimulate natural bowel function. Still others have to resort to the natural, bulk-producing mild vegetable laxatives such as plantago (called Metamucil), psyllum seeds, "Saraka," "Serutan" and so on.

CAN YOU CONTINUE TO HAVE SEX RELATIONS?

Mr. L., 43, had just recovered from his first coronary attack and was about to leave the hospital. His attractive young wife, who was his con­stant bedside companion, stepped out of the room to pay the hospital bill, leaving us al<me for the first time without either his wife or his nurse in the room.

The first question he asked: "Doctor, when will it be safe for me to have sexual relations with my wife?" This is one of the most pressing questions in the mind of most male patients under 60 (and even in some who are older!). This spoken or unspoken fear is so intimately linked with the patient's fear that he has "lost his manhood" or his virility, or that he is to be an invalid or semi-invalid from then on, that it is a deep psychological concern to men. It is a fear profoundly linked to the male personality, so shaken by a threat to existence as brought on by a coronary attack.

Some men are like my patient, Mr. A., aged 63, who, when­ever he attempted the sex act following his coronary attack, developed severe anginal pains. Even administration of nitro­glycerine for pain prevention was to no avail. Mr. A. finally had to resign himself to the inevitable and seek gratification from other things in his life. This he did with resourcefulness. He developed the hobby of water-color painting and derived keenest pleasure and pride from this art.

To most men and women who have made a good recovery from their "coronary," however, the sex act is an expression of love and devotion and is generally a relaxing, healthful ex­perience. However, this is always so when carried out in modera­tion, never to the point of strain, or when fatigued or during unfavorable circumstances, since the heart actually does signi­ficantly increase its action during the sex act, as shown by recent published medical research.

One businessman, a 44-year old European patient of mine, Mr. H., is an example of a well-recovered "coronary" case with a relaxed, philosophical attitude toward life. A devoted hus­band, deeply in love with his attractive, loving wife, he finds great satisfaction from frequent sexual relations. Mr. H. assures me this is the best "sedative" he knows, and that it banishes the daily tensions of his work. Love-making both refreshes and soothes him and is as necessary to "nourish" his love-life, as his daily food is necessary to nourish his body.

WHAT IS THE BEST "CORONARY CLIMATE"?

The ideal climate, as far as the coronary patient is concerned, is a temperate one. Extremes of heat and cold should be avoided. High altitudes, especially those above 5000 feet, are also a strain on the heart.

Newspaper readers are well aware that during heat waves or hot spells, hospitals and emergency treatment rooms are kept busy treating patients who have collapsed from both heat strokes and heart strain. Similarly, patients who suffer from angina— a heart or coronary disease—experience their worst pains when they walk about in cold or freezing weather.

Sections of the United States that are favorable to the coronary patient are the central and southern areas of California, the southern portions of New Mexico, Arizona, and Florida. There are other temperate localities in the country where the coronary patient will experience no discomfort from the weather. Your physician can advise you which locality would be best for you.

To demonstrate how some men with initiative lick a climatic problem, there is a 59-year old former patient of mine who came to see me 10 years ago from a northern part of the state of Washington. Mr. 0. had had a coronary but, on exertion, suffered from anginal chest pains only during cold weather, in the winter season.

I persuaded him to leave his wheat farm after harvest time to the care of his son-in-law, who farmed with him, and to drive down and live in a trailer during the winter months in a charm­ing spot between Los Angeles and San Diego, by the ocean and the desert. He now spends practically half the year working on his Washington farm and half the year living with his wife in their trailer in Southern California.

For 10 years now he has had no anginal pain, but here is the "pay-off": After his first winter spent in Southern California, he returned to Washington so tanned, healthy, and happy that his friends (and even people he did not know but who had heard of him) formed a "Coronary" Club, and established a trailer settlement in this Southern California spot. Here a size­able settlement from North Washington was formed, and the amount of fishing, bathing, card playing, and general fun and relaxation for members of this "Coronary" Club are a delight not only to those who have had a coronary attack, but to those men and women who are desirous of avoiding one and who wish to enjoy life and good health in their older years.

WHEN MAY YOU RETURN TO WORK?

When the coronary patient's heart has healed and its function has returned to normal (as determined by his doctor), he is usually allowed to return to his customary activities as soon as is practical. Of course, it is wise to do this gradually, rather than to plunge into a job where he left off. Even if it means only part-time activity at first, most people derive a great satisfaction and a lift to their morale when they can return to some useful routine of life.

If the patient was engaged in very strenuous physical labor or factory work which he really did not enjoy, but which he was forced to do to earn a living, he is usually better off to find a lighter kind of work, provided it does not involve the frustrations of a long apprenticeship. There are many ways of reevaluating the kind of work a man or woman has been doing. Many of my patients were engaged in occupations that were a continued source of irritation, causing a state of alarm. Their coronary at­tack may even have been partly due to the unbearable and pro­longed tension. For such patients I always recommend a different occupation or way of life. Then the question arises, "How can I find the right work for myself?" The American Heart Associa­tion has developed splendid programs in most of the large cities, aimed at rehabilitation of heart patients. An important part of these programs is helping the patients find the right kind of job. Some centers have also created 'heart kitchens," where housewives who have suffered heart attacks are taught many labor saving devices. Here women learn for the first time that housekeeping need not be a drudgery.

The Association also sponsors vocational rehabilitation serv­ices which analyze each patient's skill, educational background, physical condition, and so on, to produce a profile of his job qualifications. Often it turns out that the average person possess­es hidden talent or unsuspected skills that may open up entirely new vistas that might have remained closed to him all of his life, if he had not suffered a heart attack.

DEVELOP A CONSTRUCTIVE, OPTIMISTIC ATTITUDE TOWARD LIFE

The case of W. K., a brilliant and successful lawyer, is a perfect example of the vital necessity for the right attitude and philosophy of life.

W., who was 52, certainly had a frightening family history. He was the only one of four brothers still alive. His three brothers had all died of heart attacks. Clearly, W. was a familial or hereditary candidate for coronary thrombosis, particularly since his blood cholesterol level was abnormally high. But Bill was a cynic, a disappointed father, and an unhappy man.

By nature a pessimist, he believed that it was his fate to die of a coronary thrombosis. He proceeded to help fate along—as had the rest of his former family. No amount of pleading by a devoted and concerned wife* no amount of urging by his doctor, could induce W. to change his philosophy and his living habits.Bill insisted on eating everything, the richer and fatter the better. He drank to excess, smoked heavily and took as little rest as possible. In short order the ax fell.Bill had his coronary throm­bosis and joined the rest of his family—48 hours after his attack.

On the other hand, Charles, an optimist and, of all things, an airplane pilot, was confronted with the same problem. He also had lost 3 brothers from coronaries, but Charles believed in helping to direct his own fate in a positive way. At the age of 37, he had the most vital of reasons, other than himself, for re­maining in good health. The lives of thousands of passengers were in his hands. Characteristically enough, Charles also had an abnormally high blood cholesterol level. But being of a practical turn of mind, he set to work immediately in following a strict low-fat diet with dietary and vitamin supplements out­lined in Chapter 5. His blood tests rapidly became absolutely perfect in every way. He felt and looked marvelous. Today, 10 years after the original examination, he is the perfect physical specimen.

What a sharp contrast in attitude and philosophy of living between Bill and Charles. What a striking contrast that meant perfect health in one case and death in the other!

An equally dramatic instance of the importance of a constructive and optimistic attitude toward life and health is the case of John, a railroad engineer, 55 years of age. John piloted a crack transcontinental express for many years. He had become a little overweight and first suffered from mild anginal chest pains. He feared to bring this to the attention of the railroad doctors, for he was certain that he would lose his job. On examin­ing him, I found that he already had coronary artery disease, was overweight, and had a high blood cholesterol level.

Our engineer was also a man of constructive action. He put himself on a rigorous low-fat diet, he reduced his weight to the ideal one, and in two months became completely free of all pains. And in his own words, *'he never felt better in his life."

He said his own engine had become tired of hauling "excess freight on the line" and "since disconnecting" (to quote his own terrible puns) "the fat in his freight had given him a fright."

Now, after eight years of continual work, he has still a sense of well-being. He is in excellent health. His blood tests, his electrocardiograms, and his physical examinations are all per­fectly normal for a man of his age.

This then is an inspiring example of how a man can help direct his own fate and those of the countless others entrusted to his care.

YOUR CHANCES FOR LONG LIFE ARE EXCELLENT

If you have had a coronary thrombosis, a key point to remember is this: your chances are excellent for many years of useful, productive living, provided you follow your doctor's advice.

If you will reduce your weight to a normal figure and stay on the low-fat diet and nutritional health program described in this book, you can live just as long as the average overweight man or woman who does not follow the rules of good health given in these pages!

The age at which you have an attack is not the important factor in your recovery. One patient of mine, for example, a business man in whom I am particularly interested, had his first heart attack at the age of 63. It was a severe coronary thrombosis.

Neither his family nor, to speak frankly, his former physicians expected him to live very long after the attack. But I recom­mended the diet and the health rules that I have included here. He took them seriously, and followed them faithfully.

He is now 82 years of age, and so active in the conduct of his business that his 44-year old son, who is physically able and in good health, cannot keep up with his father's drive and vitality. A widower, he married a woman many years his junior, and they lead a normal, active, happy life together. They are constantly off on business trips, attend dances (he learned to dance when he was past 70), and take trips abroad.

But it is important to bear in mind that this patient has wisely kept his weight to normal; he remains on a low-fat diet, avoids fatigue, naps often during the day, does not smoke or drink, worships regularly, and fallows the Golden Rule in both his business and private life. His outlook on life is vibrant, positive, constructive.

No doubt many physicians in America could relate similar cases in their own practice.

In short, you can be victorious over modern man's most deadly opponent if you play the game according to the rules. Here, in summary, are the 10 most important:

1.  Hit that waistline hard!  Keep your weight normal. Fol­low Chapter 6 on "Calling all Calories." Your belt in the front should not make you deserve a 'belt in the back'!

2.  Follow religiously the low-fat diet and nutritional way of living. In this way you will "add years to your life and life to your years."

3.  Consult your doctor for advice and check-ups regularly (just as you would your dentist) at least once a year. Certainly do so more often whenever there are specific questions or problems, "An ounce of prevention"

4.  Be sure to get your complete quota of sleep and rest. The average adult needs eight to nine hours a night. The night owl is often a scarecrow in the morning. Whenever you can, steal a cat-nap or rest as often as possible through the day. You recharge your 'battery' this way.

5.  Find out from your doctor how much exercise and physical exertion is safe for you. Then abide faithfully by his in­ structions. Perhaps your heart has completely recovered and you can do anything within reason. Perhaps you have to be moderate in physical activities. Your physician is the best judge of this.

6.  You are best off to stop smoking cigarettes. Ideally you are better off not to smoke at all! If you can't give up the weed, try a pipe, or at least cut down to a few cigarettes.

7.  As for alcoholic beverages, follow the Greek advice, "all things in moderation."  Moderate and controlled drinking is a good relaxant.   Remember, "what's one man's meat, may be another's poison."  Some people don't tolerate al­ cohol well. To some it may have serious effects, especially when taken in excess.

8.  Be sure that your "plumbing" system is working in the famous American way: your bowels must function nor­mally. Avoid constipation, as directed.

9.  Try to avoid extreme altitudes or extremes of temperature. If you have a choice, try to live in a temperate or equable climate.

10. Whenever possible, try to arrange your work and living so that they may give you a maximum of gratification and a minimum of grief. If you can, try to enjoy a hobby that will give you relaxation and mental refreshment. Develop a wholesome, cheerful outlook and philosophy of life.

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