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Heart attack on a platter

Last updated: November 2010

A few years ago on Thanksgiving Day I was called to the emergency room to see a 52-year-old high-school football coach in the throes of a heart attack. In the whirlwind of activity to stabilize him before a transfer to a nearby medical center for angioplasty and stenting, I didn't have time to sit down with his wife to take a decent history until later that evening. "You couldn't possibly believe what he ate today," she said, and went on to describe a meal that could have fed his entire starting offensive backfield. He also had a high blood cholesterol level and a family history of early coronary disease.

In years gone by skeptics wondered whether a single meal could actually trigger a heart attack. But over the past decade or two we've learned a lot more about the physiological events that take place after eating a meal packed with carbohydrates, fat, and salt. Some research has found that it can set the stage for a heart attack, as happened to our football coach. For example, a study of 1,986 heart-attack patients presented at a meeting of the American Heart Association in 2000 suggested that an unusually large meal quadrupled the chance of having a heart attack within the next two hours.

The price of a pig out

After a large meal (a Thanksgiving feast can easily exceed 4,000 calories), cardiac output of blood is increased and diverted to the intestinal circulation to aid digestion, which can take as long as 6 hours, leaving other organs, including the heart and brain, relatively deprived. The work involved in all this shunting around of blood might be the equivalent of vigorous sex or moderate exercise.

But that's not all. An increase in insulin, triggered by the carbohydrate content of the meal, can compound the situation by preventing normal relaxation of the coronary arteries.

Triglyceride elevation, from the fats and carbs, can impair the function of the inner lining of the coronary arteries and cause those vessels to become less elastic and acutely inflamed. Increases in inflammatory markers such as C-reactive protein have been noted following a large, high-fat meal. And the rise in blood pressure that usually occurs after eating such a meal can cause those inflamed patches to rupture, which in turn can lead to blockages and heart attacks.

Gobbling down a huge dinner can have other health consequences, too. The prodigious amounts of gastric acid produced during the body's effort to digest the food can cause acid reflux that often goes on for many hours. The high fat content of a typical holiday feast can precipitate a gallbladder attack in people who have gallstones. The high salt content might trigger acute heart failure in someone with a history of that condition.

Add to those possibilities the sleepiness generated not only by the meal but also by the wine one might imbibe (making the drive home an accident waiting to happen), waking up the next morning with acute gout, plus the embarrassing flatulence, and you have many good reasons to revamp your eating habits at Aunt Fannie's fabulous feast this year.

The only thing you probably don't have to worry about is rupturing your stomach. That rarely happens because it can expand to accommodate nearly four times the normal volume of food.

Be a gourmand, not a glutton

So what's a formerly fearless foodie to do when gathered 'round the family dinner table groaning with potentially deadly goodies?

Don't arrive famished. Have a snack an hour or two before.
Stay away from the finger food at the hors d'oeuvres table.
Eat the salad first.
Use a salad plate instead of a dinner plate.
Taste everything to your liking but take small portions, and resist seconds.
Eat slowly, and participate in conversation.
Skip the dessert, or at least go easy on it. Fruit is preferable.
Limit alcohol intake to one glass of wine, and drink at least one full glass of water.

This article first appeared in the November 2010 issue of Consumer Reports on Health newsletter.

Marvin Lipman, M.D.

Chief Medical Adviser and Medical Editor

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