In fact, in the book A History of the Disorders of Cardiac Rhythms by German electrophysiologist Berndt Lüderitz, he mentions that Beethoven was thought to have an arrhythmia. I looked further and found that a few others had mentioned this as well.
But I wasn’t entirely clear on where the notion originally came from, even after corresponding with these individuals. I looked briefly at Beethoven’s letters written around the time of the sonata as well as the report of his autopsy, but neither provided any definite evidence of heart problems. And bear in mind that electrocardiograms — the heart tracings used to identify arrhythmias — were not introduced into practice until more than century after Beethoven’s death.
As a cardiologist and pianist I wanted to find out if Beethoven had an arrhythmia and if it influenced his work. And I wasn’t the only who wanted to know more. Joel Howell, a medical historian, and Steven Whiting, a scholar of Beethoven’s music, also wanted to explore the possibility that the composer suffered from heart rhythm problems.
Sheet music heart via Pavel L Photo and Video/Shutterstock
We reexamined Opus 81a to see why others felt that it was a direct arrhythmic transposition. Then we studied other works where “arrhythmia” may be manifest: we examined the 5th movement (Cavatina) of the String Quartet in B-flat major (Opus 130) composed in 1825 (see video below), and Piano Sonata in A-flat major (Opus 110) composed in 1821. We found that there may indeed be, in these works, a possible manifestation of an arrhythmia.
Take for example the final movement “Cavatina” in Beethoven’s String Quartet in B-flat Major, Opus 130, an emotionally-charged piece that Beethoven said always made him weep. In the middle of the quartet, the key suddenly changes to a C-flat major, involving an unbalanced rhythm that evokes dark emotion, disorientation and what has even been described as a “shortness of breath.”
The idea is that Beethoven’s heart arrhythmia made it into his music as a irregular rhythm. But we can also use heart beats to create melodies as well. The lub-dub we hear with a stethoscope is the sound that the heart valves make when the cardiac chambers contract. An arrhythmia may be fast or slow, and often the heart beats in an unpredictable, irregular fashion.
Many years ago, my colleagues at Harvard Medical School, Boston University and I, we were able to translate the cardiac interbeat interval fluctuations (those are the fluctuations of time between heart beats) in both healthy subjects and those with heart disease — into music. We used a device called a Holter monitor to record the heart rhythm for 24-48 hours. It looks like a Walkman, and it’s attached to leads connected to the chest wall and is used in medical practice to detect irregular heart rhythms. The intervals between heartbeats were translated into numerical sequences which were then mapped onto the musical scale.
The rise and fall of the melody (of which I had no control) — not the rhythm — reflects these interbeat intervals. Once the melody line was laid out, I added harmony and rhythm and played the pieces on the piano.
Zachary Goldberg, Author provided 1.74 MB (download)
The variation in healthy hearts produced a very complex, variable melody line. Patients with severe cardiac disease yielded a melody line that was more monotonous in range and dynamics (the difference between the longest and shortest beat). A “heartsong” from a healthy subject, will therefore sound slightly different than one from a patient with heart failure. This correlates well with the surprising notion that highly regular patterns — or a loss of subtle irregularity — was actually not a healthy heart.
Zachary Goldberg, Author provided 2.43 MB (download)
Our paper is entirely speculative, but may offer a new dimension by which one can attend to Beethoven, as well as other works of music. We are listening to his music with a stethoscope. Part of Beethoven’s genius, his sublimity, was to overcome adversity and transcend limitations with his art.
We invite listeners to approach these works with open minds and open ears, and formulate your own opinions. Most important is simply to listen to the music, which speaks for itself and for all of us in ways that need no translation – nor an electrocardiogram.
By Zachary Goldberger, University of Washington
This article was originally published on The Conversation.
Read the original article.
While science has moved on, nutritional advice lags behind. And in a new study published in Open Heart, a group of researchers concludes that national dietary advice on fat consumption issued to millions in the 1970s to reduce the risk of heart disease which suggested that fat should form no more than 30% of daily food intake lacked any solid trial evidence and shouldn’t have been introduced.
While more circumspect, cardiologist Rahul Bahl wrote in a linked editorial:
There is certainly a strong argument that an over-reliance in public health on saturated fat as the main dietary villain for cardiovascular disease has distracted from the risks posed by other nutrients, such as carbohydrates.
Some fats aren’t good – trans fats, for example, which are mostly man-made – while others, such as monounsaturated fats found in olive oil are seen as having beneficial qualities.
Today, government guidelines recommend that fats should compose no more than 35% of an individual’s daily calorie intake – and that saturated fat, in particular, ought to supply less than 11%.
Fat intake decreased from 36.6% to 33.7% from 1971 to 2006, while the intake of carbohydrates rose from 44.0% to 48.7%. Yet obesity levels have escalated.
Fat contains more than twice the calories (9kcal) per gramme than carbohydrates (4kcal). So if you eat a high-fat meal it is more calorific than a high-carb one, but there is evidence to also show that carbohydrates can lead to feelings of increased hunger. A recent study in The American Journal of Clinical Nutrition found that eating carbohydrate foods with a high glycemic index (bread, rice, pasta) caused effects on the brain that led to feelings of increased hunger, which could in turn lead to eating more.
Another study in 2013 found high-carb meals could leave you feeling hungrier hours later compared to a low-carb meal with more fibre, protein and fat. The team behind the research attributed this to the plummeting levels of blood sugar that regularly follows high-carb meals.
At the University of Hull we’ve been also looking at the effects of saturated fats on triglyceride levels – a type of fat (lipid) found in the blood. Using coconut oil because of its high (90%) saturated fat content, we found that when coupled with exercise, it significantly reduced triglyceride levels. A recent Brazilian rat study also found that coconut oil and exercise could lower blood pressure.
So where does our unshakable idea that fat leads to heart disease come from? The diet-heart hypothesis, that low density lipoproteins (LDL) cholesterol is raised in the blood by eating saturated fat, which then leads to clogged arteries and eventual heart disease, is not a credible claim.
This theory linking saturated fat and heart disease has been around since 1955 when Ansel Keys introduced his lipid hypothesis. Despite it being the foundation of dietary recommendations, it has never been proven and we have been advised to avoid certain foods including meat, dairy products and coconuts. And these myths are so deeply embedded in our minds, that recent science advocates have seen how hard it is to challenge established thinking.
When we talk about high-density lipoprotein (HDL) or LDL – often referred to as good and bad cholesterol – we aren’t actually referring to cholesterol itself. These lipoproteins actually carry cholesterol, fat and fat soluble vitamins in the bloodstream. It appears that elevated levels of cholesterol (or more accurately, cholesterol which is transported around the blood by lipioproteins) is correlated with an increase in the risk of heart disease.
However, correlation does not mean causation. Very low cholesterol is linked with an increased risk of death (though not from heart disease). And in the very old, research suggests cholesterol can be protective. So it’s fair to say the relationship between cardiovascular disease and total cholesterol is complex.
Type of cholesterol is important. The “good” (HDL) cholesterol is strongly linked with a reduced risk of heart disease. However, LDL, the “bad” cholesterol, is associated with an increased risk of heart disease. But it turns out that there are in fact subtypes of LDL which make this black and white picture more complicated. The actual size of the LDL particle is significant. Individuals are at a heightened risk of heart disease if they have most small, dense LDL particles, that may more easily lodge in the arteries, as opposed to those who have large LDL particles.
Your blood lipid profile is frequently used as a medical screening tool for abnormalities in lipids (including triglycerides and cholesterol). These blood lipid profile tests can identify approximate risks for cardiovascular disease and specific genetic diseases. Studies have also shown that saturated fats do not harm your blood lipid profile – and can actually improve it. Saturated fats could lower the risk of heart disease by shifting LDL cholesterol from dense small LDL to large LDL.
Numerous short-term feeding trials have shown that an increase in saturated fat consumption leads to a rise in overall LDL. Nevertheless, the result is inconsistent and weak. The methods used in a number of these research studies have been criticised – and plenty of studies support the contrary, that no association exists between total LDL and saturated fat consumption.
If it was true that saturated fat did cause heart disease, then it follows that people who consume more would be at higher risk. But observational studies – again only illustrative of correlation not cause – haven’t shown this. One study looked at a population of 347,747 subjects from a total of 21 studies and concluded that there was “no significant evidence for concluding that dietary saturated fat is associated with an increased risk of coronary heart or cardiovascular disease”. This has also been the conclusion of other reviews.
So what about randomised controlled trials? One such study divided 12,866 male subjects at a high risk of heart disease into a low-fat or Western diet group. After six years, no difference was found between them. The Women’s Health Imitative, the biggest randomised controlled trial in diet history, comprised of 48,835 postmenopausal women who were also divided into two similar groups and came up with similar findings.
If you don’t care for the science, then take an everyday example. Look at the large populations of the Masai in Africa who consume large amounts of saturated fat but have low levels of coronary heart disease. Or the Tokelauans of New Zealand who consume a massive amount of saturated fat through coconuts: more than 60% of their daily calories come from coconuts. These populations have no history of heart disease. And the health benefits of coconut oil are now becoming known more widely.
We’re learning so much more about fats and that there is no evidence that saturated fat causes heart disease. Leading nutrition experts have been calling for an amendment to dietary recommendations for more than ten years. But despite these calls and the high-quality evidence assembled throughout the past decade, doctors, governments – and by extension the public – still take extraordinarily little notice. But a decade of research to the contrary would suggest it’s time we moved away from entrenched thinking, towards a more enlightened attitude to saturated fat.
By Craig Scott, University of Hull
This article was originally published on The Conversation.
Read the original article.
