Friday, April 17, 2009

Holier than thou: Islam and the religious ego

by Asghar Ali Engineer

Every religion has its own concept of the 'other', specially the 'religious other'. Generally the followers of a religious tradition looked down upon other religious traditions as inferior and less true, if not untrue though it may not be exactly the scriptural position.

All of us have our own religious ego, like personal ego. In fact our religious ego is nothing but reflection of our own personal ego. Thus all of us tend to glorify our own religious or faith tradition while devaluing that of others. If we do not find direct support for our 'communal ego' in our scriptures, we choose some verses to so interpret them as to support our own egoistic thinking. There is hardly any exception to this rule except few individuals who have more open mind.

Islam arose among Arabs, particularly among those of Mecca. Mecca, a well- developed town on the highway of international trade in the 6th century was divided into different pagan tribes worshipping their own deities though the concept of monotheism was not entirely unknown. Thus in pre-Islamic Arabia there was the 'tribal other' rather than the religious other. Though there were a few Christians but there were so far and few in between that they hardly made ay impact on the Arab society.

In Madinah of course there was a considerable presence of Jews, and for pagan Arabs of other tribes there did exist a religious other. However, despite the presence of the religious other in Madinah the real conflict was between tribes rather than between religions. Thus even in Madinah the real other was the tribal, rather than the religious other. In Mecca though there was no concept of a religious other at all. It was for this reason that there was a fierce opposition to the Prophet of Islam when he began to preach the message revealed to him. The Meccan Arabs, for the first time, became aware of a religious other in their own midst.

Islam too, did not confront any 'religious other' as far as Mecca was concerned. It was only in Madinah that Islam was pitted against Jews. But right from the beginning the Holy Prophet did not treat the Jews as the 'religious other'. He tried to integrate them in a composite political community through what is known as the Mithaq-i-Madinah (pact of Madinah). This compact was drawn between the Muslims (as newly emergent religious community on the horizon of Arabia), Jews belonging to various different tribes and pagans belonging to various tribes. Thus even in the religious category the 'tribal other' remained an important category.

The Mithaq-i-Madinah is a very important political document drawn up by the Prophet (PBUH). It shows the statesmanship of the Prophet and his catholicity towards religious other and also his most modern concept of composite political community. He described this community as Ummah wahidah i.e. one community. Though in other empires of the world religious minorities were tolerated but were given no political rights. It was the Mithaq-i-Madinah, which did. It is interesting to note that the leaders of Jami`at al-`Ulama-i-Hind quoted this political compact drawn up by the Prophet (PBUH) to oppose two nation theory of Jinnah. They maintained that when the Prophet created a composite political community in Madinah why Indian Muslims cannot.

It would be interesting to quote from this document drawn up by the Holy Prophet as it helps us to understand the status of the religious other in Islamic community. It is important to note that all scholars are unanimous on the authenticity of this document. In fact, it is a series of pacts signed by the Muslims and several tribes on different dates. Many scholars differ on the dates on which these pacts were signed but there is hardly any doubt about its contents.

Barakat Ahmed says in his book Muhammad and The Jews (Delhi, 1979,p-39) "The Sahifah signed by the Muslims and the Jews, and erroneously called 'The Constitution of Medina ', is very important document for the understanding of the status of non-Muslims in a Muslim dominated society. Scholars of all schools of thought, such as Watt, Serjeant and Hamidullah, agree that the document is 'unquestionably authentic'."

Barkat also points out that "The Sahifah is actually not the constitution of a state; it lays the guiding principle for building a multi-cultural and multi-religious ummah in which dominant group will always be Muslim." (P-46). But one cannot agree with Barkat Ahmed when he says that the dominant group will always be Muslims. It is his interpretation. In fact, a close look at the document and if the date of its signing - the first year of Hijrah according to Ibn Ishaq in his Sirah - is kept in mind it is obvious that the Muslims were an emerging community, not the dominant community in Madinah then.

The non-Muslims had, in the document, security rights equal to all the groups and also equal political and cultural rights with the Muslims. Also, complete religious freedom was guaranteed and all groups were accorded complete autonomy.

However, it was also required that Muslims and non-Muslims will take up arms against the enemy of the ummah (which was an inclusive term) and will share the cost of war (in fact there was no state taxation system then and each tribal community had to provide arms, horses and camels for war preparations). Also, the Sahifah said that Muslims and non-Muslims were sincere friends with honourable dealings and no treachery. This is provided in the Article 37 of the document. Significantly it was also provided in the Article 45 that non-Muslims will not be obliged to take part in the religious wars of Muslims nor Muslims will be obliged to take part in the religious conflict of the non-Muslim members of the ummah.

As there were no Christians in Madinah there is no mention of them in the Sahifah. Had they been present they too, like the Jews, would have been included in the compact. It is borne out from the fact that when a Christian delegation led by Abdul Masih and Bishop Abu Haritha b. 'Alqama visited Madinah, the Messenger of Allah invited the Christians too to join him on the basis of unity of God. It is mentioned in the Qur'an as follows: "O People of the Book! Come to a word equal between us and you that we worship none but Allah, and that we associate no partner with him, and that some of us take not others for Lords beside Allah." (Al-'Imran:64)

This invitation to Christians was extended to them after they declined to accept Islam. It clearly means that the Apostle of God honoured the Christians right to freedom of religion and emphasised what was common between them i.e. the Christians and Muslims. This document, it can be said without any exaggeration, was, in fact, foundation of the concept of modern liberal state with different religious communities constituting a single political community (ummah wahidah) which was multi-religious and multi-cultural and also multi-tribal as every tribe was an autonomous entity in every respect including various traditions and cultural practices.

It is important to note that freedom of religion is cardinal to the reachings of the Qur'an. It states the doctrine of freedom of religion in different ways. About the Jews it states that "Should they (the Jews) come to thee seeking judgement in a dispute, either judge between them or leave them. If thou keepest away from them, they shall not harm thee at all. But if thou undertakes to judge, then judge between them with equity. Surely Allah loves the just." (Ma'idah, 46-47)

If one has to judge with equity one has to judge according to ones own religious beliefs and on which the Jews always insisted. Thus the Prophet judged disputes between Jews according to the Commandments of the Torah. The principle of freedom of religion has been stated directly in the words of the Qur'an often quoted La ikrah fi' al-din (i.e. there is no compulsion in religion). (2:256) It is a clear statement of the freedom of conscience which is a fundamental philosophy of the modern secular state. The religious other cannot be forced into accepting religion much less persecuted on account of ones beliefs, religious or otherwise.

In keeping with the ethos of the time, the Qur'an divides people into three religious categories: 1) believers i.e. Muslims or Mu`mins; 2) Ahl al-Kitab i.e. those who possess a revealed Book from Allah like Bible or Torah (and later some Sufis of India included even the Vedas in this category of the revealed scriptures) and 3) kafirs i.e. unbelievers i.e. those who possess neither any scripture nor believe in any Supreme God. The word kafir has been much misunderstood due to its loose usage both by Muslims and non-Muslims.

The word Kafir literally means one who hides (truth). One who accepts the truth of other religions cannot be condemned as kafir though many Muslims did use the term in that sense in history (i.e. they used the term kafir for those who were not Muslims though they did believe in Christianity or Judaism). This is not true as far as the Qur'anic usage is concerned. Also, the Holy Prophet and his companions even accepted those not mentioned in the Qur'an as the people of the Book. For example, the Prophet made a treaty with the Zoroastrians of Bahrain as people of the Book. The fourth Caliph Uthman also entered into a similar treaty with the Berbers of Africa though they possessed no scripture of any kind.

It was much later that these categories came to be applied narrowly by some rulers and their religious collaborators. It was more due to arrogance of power or for political reasons than on account of the Qur'anic teachings. The category of kafirs was initially sub-divided into harbi and ghayr-harbi kafirs i.e. war-mongering non-believers and those with whom the Muslims have a pact for peace.

It is the duty of Muslims to live in peace with those unbelievers who have either a no-war or peace pact with them. War is permitted, as a last resort only with those unbelievers who commit aggression against Muslims. It is clear both in Qur'an and hadith that rights of all non-Muslim citizens whether ahl al-kitab or not i.e. even of unbelievers must be fully protected. As explained above, there cannot be any discrimination in matters of political, religious and cultural rights between Muslims and non-Muslims. The Mithaq-i-Madinah itself makes it quite clear.

The Qur'an does not make it obligatory on Muslims to convert others to Islam. Even if they do they should do it with wisdom and goodly manner (16:125). No one is permitted to apply coercion at all. Even aggressive style of d`awah (i.e. mission) is not in keeping with the spirit of the Qur'an. Also, four most fundamental values of the Qur'an are justice ('adl), benevolence (ihsan), wisdom (hikmah) and compassion (rahmah). These values are to be universally applied to entire humanity. And in keeping with the spirit of these values the rights of non-Muslims in a Muslim society must be protected.

The Qur'an says, in respect of those non-Muslims with whom there is a pact, "And if they seek help from you in the matter of religion, it is your duty to help (them) except against a people between whom and you there is a treaty. Thus even if Muslims seek help from Muslims against those with whom the Holy Prophet had entered into a treaty, such a request cannot be accepted.

Since Allah is just He will reward anyone who submits to His Will and is doing good to others. Thus we find in the Qur'an "Nay, whoever submits himself entirely to Allah and he is the doer of good (to others), he has his reward from his Lord, and there is no fear for such nor shall they grieve." (2:112). This verse was revealed in response to the assertion by the Christians and Jews that they alone will enter paradise. Here in this verse it is made clear that all those who surrender to Allah's will and do good to others will receive their reward from their Lord.

Salvation does not come merely by following this or that religion. This has also been asserted in the verse 2:62. It says: "Surely those who believe, and those who are Jews, and the Christians and the Sabians, whoever believes in Allah and the Last Day and does good, they have their reward with their Lord, and there is no fear for them, nor shall they grieve."

Yet another verse of the Qur'an (16:36) elaborates on the universal approach of the Qur'an in matters of religion. It says, "And certainly We raised in every nation a messenger, saying: Serve Allah and shun the devil. Then of them was he whom Allah guided, and of them was he who inevitably fell into grievous error. So travel in the land and see what happened to those who rejected the truth (mukazzibin)". Thus all those who follow the path of truth as preached by Allah's apostle in their community, will be rewarded and will have nothing to fear.

And even if there are disputes in matters of religion it should be left to Allah to decide. It is for us to do good and submit ourselves to the will of Allah and to do justice. Thus the Qur'an says, "I believe what Allah has revealed of the Book, and I am commanded to do justice between you. Allah is our Lord and your Lord. For us are our deeds; and for you your deeds. There is no contention between us and you. Allah will gather us together and to Him is the eventual return." (42:15)

This verse is crystal clear that there is no use disputing about religious beliefs. We should go on doing good to each other. It is for Allah to judge on the Day of Judgement for what we believe. The real message of the Qur'an is what it calls istibaq al-khayrat (i.e. excelling each other in good deeds). See verses 5:48 and 2:148. But we waste more time in disputing with each other about our beliefs, be they inter-religious or intra-religious rather than excelling each other in good deeds.

It is also important to note that Allah has created diversity (5:48) and we should accept it in all humility. Diversity is, in fact our test. Our response should be pluralism i.e. respecting diversity. Human ingenuity also flowers in situation of diversity rather than in situation of monolithic socio-cultural or socio-religious structure. Each religion is unique as Allah has sent His apostles in all communities and nations.

The Qur'an advises the believers to live in peace with those who do not harm you or do not derive you away from your hoes and hearths. And the first attempt should be to make peace even with enemies. It is quite likely that Allah will bring about friendship between you and those of them whom you hold as enemies. And Allah is Powerful and Allah is Forgiving, Merciful. (60:7)
In the above verse also it is clear that we should do everything possible to remove causes of hostility and forgive our enemies, as Allah is Forgiving and Merciful. To live in peace with others is our religious duty. The religious other should not be treated as enemy just because he/she follows another religion. The Qur'an not only teaches tolerance for others but goes a step further and makes it obligatory on Muslims to treat all prophets of Allah with equal respect and those who do not do that are not real believers.

Thus it is obligatory for Muslims to treat all prophets of Allah before Muhammad (PBU) with equal respect. In the hadith literature (Sahih al-Bukhari 9:5) we find the Prophet (PBUH) saying that "do not give me prefernce over the other prophetsÉ" And the Prophet had said this after a Muslim had slapped a Jew for saying that Moses was above all human beings and refused to say that Muhammad was also above all human beings.

Thus Islamic teachings were far ahead of its times for showing not only tolerance but equal respect for others prophets and founders of religions. It was so far ahead that even Muslims could not appreciate it adequately. Though the Qur'an does not mention non-Biblical prophets but has made it clear that the list of the names of the prophets given is not exhaustive but only illustrative.

And since the Qur'an also maintains that Allah has sent His prophets to all the nations many Islamic thinkers, theologians and Sufi saints have concluded that there are Allah's prophets in non-Biblical communities also. Some Sufi Saints like Mazhar Jani Janan even maintain that the highly revered religious personalities in India like Ram and Krishna could also be the prophets of God. But even if they are not, Muslims should not show any disrespect to them according to the Qur'an verse 6:109.

As pointed out above it is Allah's will to have diversity in the world and believers have to live with the diversity in a way, which will promote peace and harmony. Our world is now becoming increasingly diverse with faster means of communication in our globalised world. Though there has always been diversity throughout history there is much more today and it is becoming a challenge for us.

Religion is an identity marker and in this increasing diversity we want to preserve our identity even with more vigour for fear of losing it. Now there are two ways of preserving ones religious identity: either in a negative way or a positive way. The negative way is to have un-respectful or even hostile attitude towards other religious identities and the positive way is to distinguish oneself through uniqueness of ones religious beliefs while maintaining a positive attitude towards others beliefs and identities. Normally most of the people follow the positive course.

But as we have discovered in democracy and in the situation of diversity, vested interests Ð more often political Ð manipulate religious identities for communal support and clash is artificially created. One has to meet this challenge continuously in day to day life. Often powerful religious symbols, which are part of these identities, are used to promote hatred and conflict. The most recent case in India is that of Ramjanambhoomi-Babri Masjid issue.

Both Ramjanambhoomi and Babri Masjid are powerful symbols and have emotional appeal. The Hindutva forces, in order to enhance their political appeal, manipulated this identity marker and brought about tremendous conflict resulting in bloodshed. We have to be wary of these religious symbols. It is to be clearly understood that it is not religion per se but its followers with powerful vested interests manipulate its emotional appeal for their own purposes.

As far as Muslims are concerned they live either in majority situation or in minority situation in this diverse world. Where they are in majority it should be their religious duty, in keeping with the Qur'anic spirit and hadith teaching to treat non-Muslim minorities in an honourable and respectful manner. It is also to be noted that in the modern democratic world there is no 'political other'. All should have equal citizens' rights. Politically it is not religion but citizenship, which is important. Citizenship should not be determined on the basis of ones religion. Thus Muslim countries should not distinguish on the basis of religion as far as citizenship is concerned.

Dhimmi, it should be noted, was a political category and was most important political category in its own time. The Holy Prophet (PBUH) took upon himself to fully protect dhimmis (i.e. the religious other) and exhorted Muslims repeatedly, as we see in the hadith literature, to treat dhimmis with great responsibility (dhimmi itself means for which Muslims were responsible).

But today this category has been replaced by the notion of citizenship. And all citizens should enjoy equal rights be they political, cultural or religious. Similarly the Muslims in minority situation (i.e. where Muslims are in minority) should enjoy equal political, religious and cultural rights. According to the Quran all children of Adam are equally honourable (17:70) irrespective of their caste, creed, race or tribe. This verse clearly establishes the doctrine of human rights and the concept of human rights is most fundamental to the philosophy of democracy.

Thus while religion is most important in giving meaning to our lives, it should be divested of its political implications. A composite and diverse political community should be treated as political ummah as the Prophet did after coming to Madinah. It is this concept of composite ummah wahidah (one political community) enjoying equal political, religious and cultural rights is most valid category in the modern world.

Thus Islam is most respectful of both the religious and political other. It does not treat either 'religious other' or 'political other' with a sense of hostility but, on the contrary, it makes it obligatory on Muslims to concede all rights to them and treat them with full respect. It believes in dialogue rather than in confrontation (see Qur'an ,29:46). And dialogue and diversity are the very basis of a democracy. And both are upheld by the Qur'an.
NYT

January 6, 2009

Personal Health

More Isn’t Always Better in Coronary Care

By JANE E. BRODY

Ira’s story is a classic example of invasive cardiology run amok.
Ira, of Hewlett, N.Y., was 53 when he had an exercise stress test as part of an insurance policy application. Though he lasted the full 12 minutes on the treadmill with no chest pain, an abnormality on the EKG led to an angiogram, which prompted the cardiologist to suggest that a coronary artery narrowed by atherosclerosis be widened by balloon angioplasty, with a wire-mesh tube called a stent inserted to keep the artery open.

The goal, he was told, was to prevent a clot from blocking the artery and causing a heart attack or sudden cardiac death.

Wanting to avoid an invasive procedure, Ira decided to pursue a less drastic course of dieting, weight loss and cholesterol-lowering medication. But three years later, the specter of a stent arose again. An abnormal reading on a presurgical EKG led to another angiogram, which indicated that the original narrowing had worsened. Cowed by the stature of the cardiologist, Ira finally agreed to have not one but three coronary arteries treated with angioplasty and drug-coated stents, making him one of about a million Americans who last year underwent angioplasties, most of whom had stents inserted.

Being Treated While HealthyFor patients in the throes of a heart attack and those with crippling chest pain from even minor exertion, angioplasty and stents can be lifesaving, says Dr. Michael Ozner, a Miami cardiologist and the author of “The Great American Heart Hoax” (Benbella Books, $24.95). But, Dr. Ozner said in an interview, such “unstable” patients represent only a minority of those undergoing these costly and sometimes risky procedures.

Most stent patients are healthy like Ira, who was experiencing no chest pain or cardiac symptoms of any sort. Yet Ira was afraid not to follow the doctor’s advice, despite the fact that no study has shown that these procedures in otherwise healthy patients can reduce the risk of heart attacks, crippling angina or sudden cardiac death. “We’ve extended the indications for surgical angioplasty and stent placement without any data to support the procedures in the vast majority of patients — stable patients with blockages in their arteries,” Dr. Ozner said.

What the studies do show, Dr. Ozner said, is that putting stents in such patients is no more protective than following a heart-healthy lifestyle and taking medication and, if necessary, nutritional supplements to reduce cardiac risk. The studies have also shown that stents sometimes make matters worse by increasing the chance that a dangerous clot will form in a coronary artery, as noted in 2006 by an advisory panel to the Food and Drug Administration.
Dr. Ozner, medical director of the Cardiovascular Prevention Institute of South Florida, is one of many prevention-oriented cardiologists vocal about the overuse of “interventional cardiology,” a specialty involving invasive coronary treatments that have become lucrative for the hospitals and doctors who perform them.

Even some interventional cardiologists have expressed concern about the many patients without symptoms who are treated surgically. “The only justification for these procedures is to prolong life or improve the quality of life,” said Dr. David L. Brown, an interventional cardiologist and chief of cardiology at Stony Brook University Medical Center, “and there are plenty of patients undergoing them who fit into neither category.”

Mistaken AssumptionsThe treatments — coronary artery bypass surgery, angioplasty and the placement of drug-coated stents — cost about $60 billion a year in the United States. Though they are not known to prevent heart attacks or coronary mortality in most patients, they are covered by insurance. Counseling patients about diet, exercise and stress management — which is relatively inexpensive and has been proved to be life-extending — is rarely reimbursed. In other words, procedure-oriented modern cardiology is pound wise and penny foolish. And in these economic times, it makes great sense to reconsider the approaches to reducing morbidity and mortality from the nation’s leading killer.

Most people mistakenly think of coronary artery disease as a plumbing problem. Influenced by genetics, diet, diabetes, hypertension, smoking and other factors, major arteries through which oxygen-rich blood flows to the heart gradually become narrowed by deposits of cholesterol-rich plaques until blood can no longer pass through, resulting in a heart attack. In coronary bypass surgery, a blood vessel taken from elsewhere in the body is reattached to a clogged coronary artery to bypass the narrowed part.

However, as Dr. Ozner points out in his book, “three major studies performed in the late 1970s and early 1980s clearly proved that for the majority of patients, bypass surgery is no more effective than conservative medical treatment.” The exceptions — patients whose health and lives could be saved — were those with advanced disease of the left main coronary artery and those with severe crippling, or unstable, angina.

Bypass surgery does relieve the pain of angina, though recent studies suggest this may happen because pain receptors around the heart are destroyed during surgery.
“The studies on angioplasty delivered even worse news,” Dr. Ozner wrote. “Unless the patient was in the midst of a heart attack, the opening of a blocked coronary artery with a balloon catheter resulted in a worse outcome compared to management through medication.” In fact, one trial, published in 2003 in The Journal of the American College of Cardiology, found that balloon angioplasty, which flattens plaque against arterial walls, actually raised the risk of a heart attack or death.

Stents were designed to keep the flattened plaque in place. But studies of stable patients found no greater protection against heart attacks from stents than from treatments like making lifestyle changes and taking drugs to lower cholesterol and blood pressure.

A Small CulpritA new understanding of how most heart attacks occur suggests why these procedures have not lived up to their promise. According to current evidence, most heart attacks do not occur because an artery is closed by a large plaque. Rather, a relatively small, unstable plaque ruptures and attracts inflammatory cells and coagulating agents, leading to an artery-blocking clot.

In most Americans middle age and older, small plaques are ubiquitous in coronary arteries and there is no surgical way to treat them all.

“Interventional cardiology is doing cosmetic surgery on the coronary arteries, making them look pretty, but it’s not treating the underlying biology of these arteries,” said Dr. Ozner, who received the 2008 American Heart Association Humanitarian Award. “If some of the billions spent on intervention were put into prevention, we’d have a much healthier America at a lower cost.”

Dr. Ozner advises patients who are told they need surgery to get an independent second opinion from a specialist.

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NYT

New Thinking on How to Protect the Heart

By JANE E. BRODY

Published: January 12, 2009

Many measures are probably familiar: not smoking, controlling cholesterol and blood pressure, exercising regularly and staying at a healthy weight. But some newer suggestions may surprise you.

It is not that the old advice, like eating a low-fat diet or exercising vigorously, was bad advice; it was based on the best available evidence of the time and can still be very helpful. But as researchers unravel the biochemical reasons for most heart attacks, the advice for avoiding them is changing.

And, you’ll be happy to know, the new suggestions for both diet and exercise are less rigid. The food is tasty, easy to prepare and relatively inexpensive, and you don’t have to sweat for an hour a day to reap the benefits of exercise.

The well-established risk factors for heart disease remain intact: high cholesterol, high blood pressure, smoking, diabetes, abdominal obesity and sedentary living. But behind them a relatively new factor has emerged that may be even more important as a cause of heart attacks than, say, high blood levels of artery-damaging cholesterol.

That factor is C-reactive protein, or CRP, a blood-borne marker of inflammation that, along with coagulation factors, is now increasingly recognized as the driving force behind clots that block blood flow to the heart. Yet patients are rarely tested for CRP, even if they already have heart problems.

Even in people with normal cholesterol, if CRP is elevated, the risk of heart attack is too, said Dr. Michael Ozner, medical director of the Cardiovascular Prevention Institute of South Florida. He thinks that when people have their cholesterol checked, they should also be tested for high-sensitivity CRP.

Diet Revisited
The new dietary advice is actually based on a rather old finding that predates the mantra to eat a low-fat diet. In the Seven Countries Study started in 1958 and first published in 1970, Dr. Ancel Keys of the University of Minnesota and co-authors found that heart disease was rare in the Mediterranean and Asian regions where vegetables, grains, fruits, beans and fish were the dietary mainstays. But in countries like Finland and the United States where plates were typically filled with red meat, cheese and other foods rich in saturated fats, heart disease and cardiac deaths were epidemic.

The finding resulted in the well-known advice to reduce dietary fat and especially saturated fats (those that are firm at room temperature), and to replace these harmful fats with unsaturated ones like vegetable oils. What was missed at the time and has now become increasingly apparent is that the heart-healthy Mediterranean diet is not really low in fat, but its main sources of fat — olive oil and oily fish as well as nuts, seeds and certain vegetables — help to prevent heart disease by improving cholesterol ratios and reducing inflammation.

Virtues Confirmed
It was not until 1999 that the value of a traditional Mediterranean diet was confirmed, when the Lyon Diet Heart Study compared the effects of a Mediterranean-style diet with one that the American Heart Association recommended for patients who had survived a first heart attack.
The study found that within four years, the Mediterranean approach reduced the rates of heart disease recurrence and cardiac death by 50 to 70 percent when compared with the heart association diet.

Several subsequent studies have confirmed the virtues of the Mediterranean approach. For example, a study among more than 3,000 men and women in Greece, published in 2004 by Dr. Christina Chrysohoou of the University of Athens, found that adhering to a Mediterranean diet improved six markers of inflammation and coagulation, including CRP, white blood cell count and fibrinogen.

The same year Kim T. B. Knoops, a nutritionist at Wageningen University in the Netherlands, and co-authors published a study showing that among men and women ages 70 to 90, those who followed a Mediterranean diet and other healthful practices, like not smoking, had a 50 percent lower rate of deaths from heart disease and all causes.

“The Mediterranean diet is one people can stick to,” said Dr. Ozner, author of “The Miami Mediterranean Diet” and “The Great American Heart Hoax” (BenBella, 2008). “The food is delicious, and the ingredients can be found in any grocery store.

“You should make most of the food yourself,” Dr. Ozner added. “When the diet is stripped of lots of processed foods, you ratchet down inflammation. Among my patients, the compliance rate — those who adopt the diet and stick with it — is greater than 90 percent.”
Among foods that help to reduce the inflammatory marker CRP are cold-water fish like salmon, tuna and mackerel; flax seed; walnuts; and canola oil and margarine based on canola oil. Fish oil capsules are also effective. Dr. Ozner recommends cooking with canola oil and using more expensive and aromatic olive oil for salads.

Other aspects of the Mediterranean diet — vegetables, fruits and red wine (or purple grape juice) — are helpful as well. Their antioxidant properties help prevent the formation of artery-damaging LDL cholesterol.

Other Steps
Several recent studies have linked periodontal disease to an increased risk of heart disease, most likely because gum disease causes low-grade chronic inflammation. So good dental hygiene, with regular periodontal cleanings, can help protect your heart as well as your teeth.
Reducing chronic stress is another important factor. The Interheart study, which examined the effects of stress in more than 27,000 people, found that stress more than doubled the risk of heart attacks.

Dr. Joel Okner, a cardiologist in Chicago, and Jeremy Clorfene, a cardiac psychologist, the authors of “The No Bull Book on Heart Disease” (Sterling, 2009), note that getting enough sleep improves the ability to manage stress.

Practicing the relaxation response once or twice a day by breathing deeply and rhythmically in a quiet place with eyes closed and muscles relaxed can help cool the hottest blood. Other techniques Dr. Ozner recommends include meditation, prayer, yoga, self-hypnosis, laughter, taking a midday nap, getting a dog or cat, taking up a hobby and exercising regularly.
He noted that in a 1996 study, just 15 minutes of exercise five days a week decreased the risk of cardiac death by 46 percent.

Even very brief bouts of exercise can be helpful. A British study published in the current American Journal of Clinical Nutrition found that accumulating short bouts — just three minutes each — of brisk walking for a total of 30 minutes a day improved several measures of cardiac risk as effectively as one continuous 30-minute session.

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