LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

Heart Disease

OBESITY AND CANCER, REVISITED…

by

I know.  I know.  Eat your fruits and veggies.  Exercise.  While we all kind of agree that this MAY lower our risk of cancer, just how much seems to get glazed over.  After all, Grandpa Joe smoked and drank Jim Bean until he died in a brothel accident at 106.  So just how much of an impact does a good lifestyle have on cancer rates?

Something important to consider.  The weight of cancer prevention seems to be towards quitting smoking.  This is, of course, a no-brainer.  But, as this article mentions, 80% of the population are never or former smokers, this recommendation falls on the deaf ears of the bulk of the population who are already following this recommendation.

This particular study looked at adherence to an ideal body composition, physical activity, diet, and alcohol consumption on cancer rates, heart disease fatality rates and all-cause mortality (risk of dying from anything).  Those with the highest adherence had a 42% lower risk of all cause mortality, 48% lower risk of dying of heart related causes (58% for women!!!!) and a 30% lower risk of dying of cancer.

These are general lifestyle recommendations.  General.  As in very simple to accomplish.  I could expand on the specifics in a hundred ways to make them more effective.

The bottom line is that NOTHING, absolutely NOTHING, is a powerful as lifestyle changes in lowering your risk of dying from anything.  The strength of this message seems to continually be drowned out by “this for a cure” and “that for a cure” and prevention promotions sponsored by Coke (Basha’s Heart Smart T-shirts proudly promote Coke).

As a society we need to put our collective feet down and stop funding these organizations that promote a “cure” while shoving prevention with simple lifestyle changes to the fine print.  Only THEN will they wake up and realize that this is what their individual charters

ARE YOU TAKING THIS BLOOD PRESSURE MED?

by

I remember being at a child’s birthday party and speaking with an attendee.  Turns out this person was a pharmacist teaching cardiovascular drugs to pharmacy students.  One could assume that all they are teaching to new students is evidence based and devoid of dogma.

I asked her if beta blockers were still being used given their high risk of creating diabetes (about 22%) and stroke (about 12%).  The pharmacist was unaware of any such association.  Considering that the study I was referring to was in a cardiology journal and involved looking at 95,000 patients, I was sure it was a familiar one.  I was apparently wrong.  Despite the pharmacist / instructor in cardiology drugs’ lack of knowledge in this area, there is no longer any doubt that the beta blocker class of drugs used to treat hypertension creates diabetes and stroke (heck–isn’t that what we’re trying to prevent!!??).  Think of the “ol” drugs like atenolol or propranolol.

But dont’ worry if you’re still on this class of drugs.  This article finds that giving an ACE-inhbitor (think “il” like lisinoprol or captopril) almost counteracts the negative effects of the beta blockers.  What magic!  So, the bottom line is that, if you are written a prescription for a beta blocker that will increase your risk of diabetes and stroke, make sure you get your doctor to write that second prescription to counteract the side effects of the first.

Or……..you could cut out enriched wheat flour, hydrogenated oils and exercise more….

http://www.sciencedirect.com/science/article/pii/S0002914911010277

Mesa AZ Chiropractor Gives Insight on the Effects of Asprin

by

DOES ASPIRIN REALLY PROTECT OUR HEART?

Of course it does.  Right?  I mean…this has been drilled into our collective minds by Bayer and our doctors and other advertising for decades now, so it has to be true.  Wasn’t hormone replacement therapy good for us?  And dairy?  Isn’t dogma wonderful?

Unfortunately in medicine, we begin with a great concept (at least, from a “give a drug to everyone to prevent a single disease” mindset) but it may take decades before the studies catch up with the concept.  More often than not, the reality does not hold up to the promise.

Statins were all initially approved to lower risk of heart attacks.  Problem was, we didn’t actually test this.  We ASSUMED this because statins lowered cholesterol.  Turned out, years later, that they weren’t all that great at lowering heart attack rates.  Now the engine of statin use has been plugging along for so long that we’re finding it really hard to slow it down despite the evidence that they just suck at lowering first heart attack rates.

Back to aspirin.  It’s known that aspirin contributes greatly to bleeding ulcers.  To hemorrhagic stroke.  Even to pancreatic cancer (that’s a scary one we don’t hear too often!).  These negative things are glossed over when we talk about how great aspirin is.  But do they really work at protecting our hearts and brains?

Without much fanfare, in 2009 a dogma-destroying study was published that demonstrated no benefit for the average person taking aspirin on their vascular event risk.  The benefits were higher for those above 70, but below 70 the person would have to have a much greater risk of heart disease to see a benefit.  Get that?  NO BENEFIT for the average person.  This is another dogmatic concept that will die a very, very slow death.  Maybe not even in our lifetimes.  This current article looks at 90,000 patients and finds similar outcomes–while there was a small change in the risk for a non-fatal heart attack, no differences were seen in risk of death from heart disease, stroke or all cause mortality.  Overall, not much to hang our hats on.  Heck–combine aspirin with statins and salt reduction and you still can’t lower your risk more than a walk around the block!! 

Worse, all this flies in the face of REAL recommendations like the Mediterranean diet, which has consistently shown strong reductions in diabetic and heart disease risk.  Same thing with nut consumption (again–NO added oils!).  The problem with lifestyle and dietary changes is that the side effects of death are very high.  Heck, Jack LaLane only lived until 96 and worked out for 2 hours the morning before he passed.  If it didn’t work for him, what can us normal people hope for?

http://www.sciencedirect.com/science/article/pii/S0002914911010137

HOW DO I RAISE MY HDL (“GOOD”) CHOLESTEROL?

by

Most importantly, you do not EVER, EVER, EVER (get the point…) do it with drugs.  Just ask the patients who were taking torcetrapib, a drug made by Pfizer that was designed to raise HDL levels and lower risk of heart attacks.  Wait–you can’t ask many of these patients because the risk of death was 60% HIGHER in patients taking the drug, which obviously was never brought to market.

In my dreaming, society will someday wake up and realize that modifying a single marker (called a surrogate endmarker suchas total cholesterol, HDL, LDL, HbA1c, blood pressure or uric acid) synthetically with a drug does very little to change the endpoint.  In other words, taking a drug to lower cholesterol makes your number look better, but the true impact on heart attacks and cardiac death is small.  Drugs to increase HDL will be no different.

Want to raise your HDL the better way?  Soy, exercise, niacin, red wine, dark chocolate and general healthy, anti-diabetic lifestyles will all do the trick.  Just don’t believe that a medication will do it for you safely.

http://jcem.endojournals.org/content/96/5/1246.abstract

HOW WELL ARE WE MANAGING HEART DISEASE RISK FACTORS?

by

Let’s face it.  If you are willing to make changes, managing cardiac risk factors is a piece of cake (or rather…avoiding that piece of cake…).  Lifestyle changes are not difficult, but require commitment.  Society does not easily support healthy lifestyle and requires a shift from what you’ve been doing.  But the payoffs are massive for you and your family.

I continue to contend that lifestyle changes are the ONLY way to manage chronic diseases.  Maybe if we did not live under the false pretense that, because our “numbers” look better (cholesterol, HbA1c, blood pressure, blood glucose, etc…), we’ve dodged the bullet of early death.  I cannot stress enough that this is just not true.  We live in a society dominated by surrogate end markers.  We think that because our cholesterol has magically been lowered by the coveted, mystical statin that we’ve lowered our risk for a heart attack or stroke.  Ok–so maybe you have, but only by a SMIDGEN (which, in medical terminology, is about 1%).  This is NOT prevention, it is false hope.  Lifestyle changes, on the other hand, have true global health benefits that are unquestionable.

This particular study just reinforces how pathetic “we” are when it comes to cardiac risk factors.  We can’t even do it right using drugs!  In shooting for lower LDL levels AND optimal CRP levels (a marker of inflammation) only 12% of the patients in this large study managed to achieve the desired numbers.  You will hopefully note that they were looking at LDL levels and not total cholesterol.  Hopefully, we are finally abandoning the futility of checking total cholesterol in lieu of better markers.

The authors’ suggestions?  “Smoking cessation, weight reduction, and the greater use of more potent statins at higher doses might be able to improve these outcomes.”  We just don’t get it.  It’s almost laughable how sickeningly dependent we have become on medication to “protect” our health.  Even with a society heavily dependent on meds, we still can’t get 88% of the population to target levels.

http://www.sciencedirect.com/science/article/pii/S0002914911004632

USING CT TO LOOK AT YOUR HEART VESSELS

by

Something that is not well understood by the general population (except devout readers of my rantings…) is that there is plaquing of the arteries and there is plaquing of the arteries.  None of it is good and it is a sign of poor vascular health.  But without a doubt, the soft, vulnerable plaque is far more dangerous than the hard, stable plaque.

Picture a nice, wide open blood vessel that has some plaquing in it.  The plaque takes up maybe 10% of the opening of the canal.  If it’s a stable plaque this is just fine.  Plenty of blood flow and oxygen are getting the heart.  Your treadmill stress test comes through with shining colors. 

But what if the plaque is unstable?  That mass taking up 10% of the lumen of a large blood vessel, but now it breaks free and works its way into a smaller vessel, taking up most of the canal, starving the heart muscles for oxygen and causing a heart attack.  The stress test on this plaqued artery prior to the mass breaking off?  Again passed with shining colors.

What??  Am I saying that you can drop dead of a massive heart attack leaving a perfectly healthy stress test?  Yup.  And it all boils down to the stability of a plaque.  So how do we know? 

First, this study looks at the ability of CT scan to identify the soft vs hard, stable plaques and finds that it does a pretty good job.  Not too shabby.  Next, we can easily check lipoprotein-associated phospholipase A2 (Lp-PLA2, or PLAC test for short) in the blood.  This test has some pretty strong correlation with being able to predict if any plaques are unstable and ready to rupture.

Even more importantly, what can we do to make sure any plaques were are sporting are the stable type?  Exercise, higher intake of healthy fats (raw nuts, seeds, wild caught fish, avacodos, flax, olive oil, etc..) and lowering our levels of inflammation (see earlier blog postings) all increase the stability of a plaque.

Of course, making sure they’re not there in the first place sounds more preferable to me.

http://www.sciencedirect.com/science/article/pii/S0002914911003912

GETTING A CARDIAC STENT? CHECK THIS FIRST…

by

 

Regardless of whether you’re on the cath table just starting to fade away from the anesthesia or are reading this from home, inflammation is a major, massive player in heart disease.  We’ve spent so much time focusing on cholesterol levels, mainly because we had a drug that could lower this value so we fit the disease risk factors to the drug that could control that risk factor.  Only recently has inflammation (usually as measured with hsCRP) been looked at as a risk factor.

Percutaneous coronary intervention (PCI) is the procedure in which a cardiologist pokes a camera into your coronary arteries to look at how healthy they appear.  If there is a problem, the common answer is to place a stent in a blocked artery to make sure that blood continues to flow through this artery to feed the heart.  The big problem with this procedure is that these stents have a tendency to plug back up again (restenosis).  Two schools of thought exist– the use of bare metal stents or the use of drug eluting stents to lower the risk of restenosis.  In this particular study, researchers determined that the inflammation levels were a major determinant in which a bare metal stent or a drug eluting one should be used.

Less simplify this.  Manage your inflammation long before you need a stent and the decision won’t be there to make.  Exercise, live an anti-diabetic lifestyle, stress less, add a multivitamin, D and mixed tocopherols (Vit E) as well as fix any silent sources of inflammation like poor oral health, poor gut health or food allergies.

http://www.sciencedirect.com/science/article/pii/S0002914911003869

CAN OUR CORONARY BLOOD VESSELS JUST BURST??

by

Pretty scary to think about, huh?  As a bit of anatomy, the coronary blood vessels are the ones that feed nutrients to the heart itself so it can do its job.  Block these suddenly and the heart muscles cannot get oxygen.  This is called a heart attack.  This can be caused by a rapid blockage from a piece breaking off from a clot in a larger blood vessels (emboli) or from the slow blockage that occurs with damaged blood vessels forming plaques over time.  This will cause chest pain when the heart’s demand for oxygen goes up, either with stress or strenous situations.

Less commonly thought of is a rupture of these blood vessels.  This would be the same as a hemorrhagic stroke ocurring in the brain.  Any way you look at it, it is NOT a problem with the heart–it is a problem with the blood vessels feeding the heart.  A vascular problem.  It is critical that we think of heart and stroke issues as being a problem with the blood vessels. 

What makes this particular article a little scary is that the authors were looking for patients that had evidence of healed ruptures of their coronary arteries.  This is NOT a good thing!  It is nice that the ruptures healed, but it is a sign of very sick blood vessels.

Here’s were the study gets worse.  The patients that suffered these ruptures did NOT have “traditional” risk factors like elevated cholesterol.  So the traditional risk factors, in this particular scenario, had little impact on vascular health.  This means one of two things.  First, there is nothing we can do to prevent these episodes from happening (not likely).  Or, (more likely) we’ve been looking in the wrong direction to protect our blood vessels. 

Protecting our blood vessels has everything to do with lowering inflammation through diet, management of pro-inflammatory situations (periodontitis, gut dysfunction, food allergies) and exercise as well as leading an anti-diabetic lifestyle.  THIS is where the massive bang for your buck occurs with avoiding heart disease and stroke.

http://www.sciencedirect.com/science/article/pii/S0002914911003870