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Correction to This Article
This article incorrectly said that avocados are high in LDL, or "bad" cholesterol. Avocados contain no LDL but are rich in monounsaturated fat, which is considered more healthful than saturated fat.
Doc, I've Seen the Light
Health Scare Sparked Change of Heart -- and Diet

By David Hagedorn
Special to The Washington Post
Wednesday, June 13, 2007

As I was having a heart attack on March 30, my past flashed before me. I saw a freezer filled with hollandaise sauce, the leftovers of research for a February article in the Food section in which I wrote:

"I can see the e-mails already. The fat! The eggs! But the fact is, hollandaise is worthy of an occasional guilt-free indulgence." To that I can now add: Unless a doctor has just told you that one of your arteries is so blocked you need an emergency procedure.

The countdown to this "episode" had started a few days earlier, when I stepped on the scale at my March 27 checkup.

"Whoa!" exclaimed Theo Hodge, my doctor. "183!" he announced, visibly aghast. Not a good sign.

"Muscle weighs more than fat," I offered feebly.

"Not in this case," he countered. "You're 5 foot 7, 48 years old, and your total cholesterol is 284. You need to go on Lipitor." Then he delivered what was, for someone who eats and cooks for a living, the coup de grace: "And you have to drastically change your diet."

According to the National Cholesterol Education Program guidelines, total cholesterol should be below 200; LDL (the "bad" cholesterol) below 100; HDL (the "good" cholesterol) above 40; and triglycerides below 150. The numbers Hodge rattled off to me were largely not good (284, 168, 55 and 300, respectively), but what they represented was not exactly sinking in. My cholesterol had always been under control, so I considered myself immune to danger. I spouted the virtues of moderation over deprivation and pooh-poohed martinets who ranted against fat.

When I left the doctor's office, my thoughts turned to the steak-and-cheese taste test I had just conducted purely for my own edification. Perhaps I had been overdoing things a tad. Still, I managed to summon sufficient denial skills to rationalize a trip to Deli City for a Reuben.

And I smoked a cigarette on the way.

The next day, I showed up in the emergency room of George Washington University Hospital complaining of indigestion and pain down my left arm. Soon I was in the good hands of the chairman of GW's Division of Cardiology, Richard Katz, who also serves on the board of the Larry King Cardiac Foundation. He looked at my chart and concluded, "We'll just skip the stress test we scheduled for tomorrow and go right to the catheterization."

Blood tests and EKGs had revealed elevated levels of the enzymes that act as chemical markers for heart muscle damage.

Jonathan Reiner performed the procedure. Using ultrasound from inside the artery, he discovered a 95 percent narrowing in the mid-vessel of the LAD (lower anterior descending artery). During a 45-minute procedure, he removed the occlusion and installed a drug-coated stent to prop the artery open. "You were very lucky you came in when you did," he said. "Consider it a wake-up call."

Although I attempted to minimize the gravity of the situation by referring to it as an "episode," Katz quickly corrected me.

"It was a heart attack," he stated unequivocally. He glanced at the "heart-healthy" breakfast of yogurt and granola that the nurses had brought me and that I had left untouched. "This doesn't mean you'll never eat steak again. Just make it a good one and cut the portion. You need some fat in your diet, just don't waste it on bad food." He had a point; I had certainly been guilty of that. "But," he added while handing me prescriptions for Toprol (a beta blocker), Crestor (a cholesterol-lowering statin), Plavix (an anticoagulant) and aspirin, "you'll also be taking these every day for the rest of your life."

Reiner explained that because my genetics cannot be changed, "the cholesterol medicines help level the playing field; they change the way the body handles LDL and keep the bad cholesterol low. But you also have to eat smarter. Lots of fish, white meats, turkey, chicken without skin; no fried foods, butter, eggs or whole milk."

I tested the advice at brunch that afternoon at Hank's Oyster Bar. The menu consisted mostly of what I had just been warned against. While my friends plotzed over a poached egg with crab cake and -- yes -- hollandaise sauce, I ordered the very thing I had shunned at the hospital: yogurt and granola with fresh berries. Drastic changes to my diet, and my way of looking at menus, had begun.

Because eating in restaurants was a professional necessity, changing the way I cooked at home was vital. I started eating breakfast regularly. I cut out alcohol, except for the occasional martini or glass of wine. No more starches as meal mainstays. Light olive oil instead of butter. Avocados, high in LDL, now figure prominently in my diet. I eat very little red meat, a great deal more fish, and lots of vegetables.

And bye-bye, mayonnaise. In a ranch dressing, for example, avocado replaces the mayo and turns out to be better than the original. On a shopping outing to Alexandria, a friend enjoyed fish and chips at Eamonn's: A Dublin Chipper; I went to Chipotle and ordered a gargantuan chicken fajita with guacamole, salsa and lettuce -- only. Weeks before, I would have eaten all of it in one sitting; that day I saved half of it for a late-afternoon snack. The Chipotle version was good, but my own would be better. I made a mental note for my new repertoire: steak-and-cheese, out; chicken fajitas, in.

Being very careful throughout the day allows me to ease up when dining out at night. For a dinner at Palena, I tasted the bread and then asked for it to be taken away. I relished every (skinless) morsel of a perfectly roasted chicken served with greens, but tasted my companion's pork dish. For dessert? A sorbet tower and one bite of the buttery shortbread that surrounded it. I could not resist an Ann Amernick caramel, but hey, I'm only human.

Larry King arrived at the same formula, and he certainly has experience with heart problems. "He's a routine kinda guy," Linda Roth Conte, the publicist for his heart foundation, wrote in an e-mail. "For breakfast -- Cheerios, blueberries, not-fat milk, scooped-out bagel with non-fat cream cheese. For lunch it's a salad with mustard vinaigrette dressing and sometimes soup; dinner is fish or chicken with green beans or an occasional steak." It must be working for him. "He's a solid 159 pounds and never waivers from that," according to Conte.

That regimen works for me, too. As of last week, I was down to 167, a loss of 16 pounds in two months. Total cholesterol: from 284 to 186; LDL from 168 to 83; HDL from 55 to 60; triglycerides from 303 to 215. Hodge congratulated me on my progress. "You've really taken the diet seriously, but you still have a ways to go," he warned. "I want to get the LDL below 70 and the triglycerides below 150, so we'll double up on the Crestor."

That brought home Katz's insistence that I take the meds ad infinitum; it would take more than an apple a day to keep the heart doctors away.

All of which leaves only one thing left to say. That hollandaise piece I wrote was titled "Last-Minute Sauce, With No Mea Culpa." Well, two months later, mea culpa.

David Hagedorn, a chef and former restaurateur, writes the Food section's Chef on Call column. He can be reached atfood@washpost.com.

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