Heart Disease, Stroke, Blood Pressure Tips

Preventing Heart Disease: Do Cardiologists Help?

January 18, 2015 by James Bogash

cardiologists and heart disease — pixdesign123/Dollar Photo Club

Don’t get me wrong. I don’t inherently have a problem with cardiologists. But, for heart disease to be almost entirely preventable and remain the #1 killer in the industrialized world, we’ve absolutely dropped the ball.

I just don’t see any excuse for a clearly preventable disease to be the #1 killer.

And I cannot accept the fact that medicine is doing better at preventing cardiac deaths (largely due to technology saving lives when the fecal matter hits the fan). We are doing absolutely awful at preventing cardiovascular disease.

This is in the face of a truly massive amount of evidence on how to prevent cardiovascular disease using lifestyle. Maybe cardiologists are really spending the time needed to educate their patients about the best lifestyles to drastically lower the risk of having a heart attack or stroke and patients just aren’t listening. Or maybe mainstream medicine is so caught up in procedures and prescriptions that they have let lifestyle advice to patients fall to the wayside.

The answer likely lies somewhere in between. I think society is just as heavily to blame because we have created an illusion where medicine actually fixes things. You do not need to exercise or change your diet because the drug you are taking has lowered your blood pressure, stopped your irregular heartbeat or lowered your cholesterol. And when that doesn’t work you can go in for a quick in-and-out Roto-rooter procedure and you’re good to go.

If society really knew just how little these approaches really help things might change. And I think that the foundation for this perceptual change needs to begin with the cardiologists. It is a profession that needs to stand up and work as hard as possible to destroy itself.

While destroying itself sounds a wee bit, well…self-destructive, this is the way our office functions when it comes to chiropractic care. I tell patients that it is our job to destroy the practice by pushing for patients to become more active, eat right, treat injuries appropriately and engage in positive musculoskeletal behaviors like yoga.

While it don’t think it will ever happen, it’s still the attitude that we maintain every day.

Cardiologists need to hop on board with this attitude and take a good hard look at what kind of information they are giving their patients. It would be hard for any professional to look at a client, customer or patient and tell them straight on that he or she has little to offer.

Certainly cardiologists have procedures they can offer to patients. And, at the end of it all, there is absolutely no doubt that cardiologists are amazing at saving lives. But they just seem to have a hard time diverting current patients from needing that end-of-the-line lifesaving procedure.

I thought all of this would be a good primer for this particular study. In it, researchers looked at cardiac outcomes during 2 large, national cardiology conferences over the course of 9 years. They then compared these same outcomes to 3 weeks before and 3 weeks after the conferences to see how rates compared.

One would think that, with hospital cardiologists being out of town during these big conferences, it would spell trouble for patients who have heart disease during these time periods.

But here’s what they found:

In teaching hospitals, risk of high risk patients dying from heart failure during the meeting times was lower (17.5% vs 24.8%).
Deaths from cardiac arrest were also lower during meeting times (59.1% vs 69.4% ).
Rates of percutaneous coronary intervention (PCI–the procedure used to put stents in blocked arteries) were, as expected, lower during meetings (20.8% vs 28.2%;). However, lower rates of PCI did not affect a high-risk heart attack patient’s chance of dying (39.2% vs 38.5%–in other words, despite not having cardiologists to do these procedures, no one was dying any faster).
On the flipside, in nonteaching hospitals, there was no difference in the risk of dying or having a procedure (both high- and low-risk patients ).
There was also no higher risk of dying in teaching hospitals for low-risk patients.

Wow.

Not sure that there’s any other way to look at this other than saying that there is a chance that teaching hospitals may be doing slightly more harm than good when it comes to the cardiovascular departments.

As an example, it is estimated that half of the non-emergency cardiac stenting procedures are unnecessary. Considering that these procedures have risks associated with them, it would not be a surprise to see less procedures leading to less deaths.

In an area that has several teaching hospitals, I can assure you that the perception of these teaching hospitals by patients is very high and many will bend over backwards trying to get into them for their problems.

That just may not always be the best idea. The bottom line is that, even in prestigous teaching hospitals, your cardiovascular health may be better off where it has always been–inside you.

Prediabetes, Exercise and Cholesterol; Does it Help?

January 17, 2015 by James Bogash

exercise for cholesterol — McCarony/Dollar Photo Club

You can’t see a cholesterol lowering drug commercial without hearing some poor guy saying he tried everything, but diet and exercise just wasn’t enough.

Once I finish yelling at the TV and vomiting the remnants of my lunch in disgust, I’m reminded that this is just marketing.

The reality, however, is that exercise will not change cholesterol levels very much in the short run (pun intended). I remind patients of this frequently when we have discussions on cholesterol levels. If you want to bring your cholesterol back under control quickly, diet is the only answer.

But for many, the exercise component is much easier to adopt. Dietary changes are perceived as far more invasive. Walk around the block a few days per week? No problem. Avoid refined carbohydrates and processed foods? No way.

Exercise is the LONG term solution to cholesterol levels. This is because the vast majority of cholesterol issues are caused by being prediabetic. There are very few instances where prediabetes is NOT an issue, but it’s a pretty rare situation. Unfortunately, this little tidbit is rarely explained to patients by their doctors. Maybe it’s because most doctors don’t understand the relationship.

This does not mean that exercise is not important for short term management of cholesterol issues because it absolutely is. But all too often the benefits of exercise are not what you would expect them to be.

Patients get frustrated when they exercise and do not take off weight. I have covered the problem with this thought process in a previous blog post that can be read by clicking here.

(A quick note on my recommendations for exercise. I am a huge fan of short-burst aerobic exercise consisting of some variation of 30 second all-out bursts performed in 10 sets. I strongly do NOT feel that the standard “walk-30 minutes a few times per week” recommendations cut it. Hitting that anaerobic zone is very, very important and the straight walking for exercise protocols do not do it. This is likely why most studies on exercise do not have a short term effect on cholesterol levels. To read more about this feel free to read a prior blog article by clicking here.)

HDL (the “good”) cholesterol is not a single molecule. The reality is that there are some 100+ different forms of HDL cholesterol. But the biggest classification of HDL molecules is into types 1, 2 and 3. HDL (3) is generally considered the most protective form of HDL.

This has to do with an enzyme called paraoxonase-1 (PON1) that has very strong antioxidant properties. PON1 levels are higher in HDL (3) molecules, which likely accounts for the strength of the protection of this type of HDL molecule.

This means that even if you have a high total HDL number, it may not be as protective as you think if most of the HDL is made up of the 1 or 2 subtypes. Although more specific lab testing that includes these HDL subtypes is available, I have found a need to order these because the information from standard lipid profiles is enough for me to understand where your cardiovascular risk lies.

This particular study puts the concepts of exercise, prediabetes and HDL cholesterol subtypes into perspective. In it, researchers studied a group of 39 patients with prediabetes and put them into two groups: a control group and an exercise group who followed a 10-week walk/run training program.

Here’s what the researchers found:

Exercise did NOT affect cholesterol levels.
Exercise did, however, increase the activity of the antioxidant paraoxonase-1 (PON1).
Exercise also decreased the levels of an oxidative stress marker called malondialdehyde.
Even better, the HDL3 the exercising prediabetic patients protected the blood vessel walls from damage by the high-powered inflammatory molecule tumor necrosis factor-a (TNF-a).
Exercise also decreased the ability of damaging immune cells to stick to the blood vessel lining (markedly decreased monocyte chemotactic protein-1, vascular cell adhesion molecule-1 expression as well as TNF-alpha-induced monocyte adhesion).
Lastly, exercise also increased levels of endothelial nitric oxide synthase (leading to higher levels of nitric oxide, a molecule that relaxes the blood vessels).

These are all pretty darn potent and beneficial effects that have been shown to greatly protect against heart disease and stroke. If I had to balance the beneficial effects of these changes against a lower cholesterol level on protection from heart disease, they are not even on the same plane.

In other words, exercising led to very powerful effect on protecting your blood vessels from damage. Given that the bulk of the evidence suggests that statin drugs to lower cholesterol pretty much suck at preventing heart attacks, the review suggests that exercising, whether or not it results in lower cholesterol levels, is far, far more powerful at preventing heart attacks and stroke.

Remember this–you are not exercising to lose weight or to lower your cholesterol. You are exercising BECAUSE IT IS THE RIGHT THING TO DO.

Low T Symptoms: Should you Believe the Commercials?

January 6, 2015 by James Bogash

low T symptoms heart disease — Irina Karlova/Dollar Photo Club

Despite the complete lack of evidence about whether it has any benefit, a day does not go by that I don’t hear a commercial on the radio for male sexual dysfunction.

By the end of the commercial, you are led to believe that the only reason for male sexual dysfunction is low T. Even worse, this low testosterone level seems to come out of nowhere and there is nothing you can do about it. Except, of course, come in for an appointment for testosterone cream, pills or injections.

Regular readers of the Rantings of course know that low testosterone levels are merely a symptom of a poor quality lifestyle and not the problem itself.

To put it plainer, smoke (while not good for you to inhale) is not the problem—the house fire is. The local fire department doesn’t rush to the scene of a house fire only to suck out the smoke and leave the fire raging.

And yet this is what the “testosterone movement” has led you to believe. There really is no other way to describe it. The past few years have seen a massive increase in the prescriptions for testosterone replacement therapy given to men (and women) based purely on low testosterone levels found on bloodwork.

Personally, it is incredibly rare for me to check testosterone levels in the blood, despite knowing a substantial amount about what contributes to low testosterone levels and how to fix low T problems.

Just because I don’t check for low testosterone does not mean that I don’t feel that low T is a problem. This particular study drives this point home. In it, researchers looked at 115 male patients with type 2 diabetes and divided them up between normal (≥12.1 nmol/L) and low (≤12.1 nmol/L) testosterone levels. They then compared levels of several markers of heart disease, including hsCRP, carotid artery carotid intima-media thickness (IMT) and atherosclerotic plaque by high-resolution B-mode ultrasound as well as assessing the health of the blood vessels (endothelial function) by brachial artery flow-mediated dilation.

Here’s what they found:

Lower testosterone was linked to poorer carotid IMT.
Those with low T had a 641% higher likelihood of a carotid IMT of 0.1 cm or greater (80% vs 39%).
Low T patients had a 260% higher risk of having plaques in the arteries (68.5% vs 44.8%).
Those with low T were 577% more likely to have endothelial dysfunction (80.5% vs 42.3%).
Low T patients had higher hsCRP levels (2.74 vs 0.89 mg/L).

While some of this may be a little technical, the bottom line is that low levels of testosterone is a marker of incredibly bad health, especially as it relates to heart disease.

But this does NOT mean that supplementing with testosterone is the answer. Rather, the entire spectrum of lifestyle changes that include exercise, diet and stress management is the answer. As a matter of fact, the most recent concerns over the use of testosterone replacement therapy had to do with actually increasing the risk of heart disease. And this is on top of the well-accepted increased risk of developing prostate cancer.

This alone should YET again prove that we cannot find a single marker in the bloodstream and treat just that marker using artificial means (drugs, hormone therapy, surgery, etc…).

Have Arthritis? Then You’re Likely at Risk for This Disease

December 31, 2014 by James Bogash

arthritis and heart disease — 7activestudio/Dollar Photo Club

As a chiropractor, I deal with patients who have arthritis pretty much every day. Some want answers, some want reasons. In most cases, we can provide both of these.

Many seem to think that past trauma is a factor in developing arthritis. While this is definitely the case, it’s not the cause of most patients’ arthritis. Rather, the bigger cause of arthritis is something that most of us are not aware of but way too many of us in society today are at a high risk for.

But first, a quick overview on the structure of your joints. The surface of all your joints are covered with cartilage that acts as a type of shock absorber to cushion the impact of bone and bone when you move. Cartilage is made up of about 5% chondrocytes (these are the cells that make cartilage), 65-85% water, 15-25% Type II collagen and 2-10% proteoglycans (sugar-protein molecules that bind with water to form a shock-absorbing gel). Since the cartilage-making chondrocytes are sitting inside this cartilage-gel layer, it does not have its own blood supply and needs to get nutrition in and waste products out by diffusion. I describe the situation as a sponge sitting in a puddle. You can stare at it all day long and it’s not going to do any tricks. It’s not until you start stepping on and off of the sponge that you get fluid exchange into the sponge.

This is exactly why exercise is so good for your joints–it keeps the fluid pumping so the chondrocytes have new nutrients to work with. So long as you give your joints good nutrition and combine it with exercise the cartilage in your joints can turn over, although this is a very slow process. On the flip side, give your joints poor nutrition and clog up the arteries that deliver blood flow near the cartilage and it can and will break down faster.

With this understanding of how you can damage your joints, can you think of what other chronic diseases may develop with poor nutrition and a sedentary lifestyle? While the list is quite long, heart disease is way up at the top. Which brings us to this particular study.

In it, researchers looked at the relationship between osteoarthritis of the hand (which included arthritis in more than a single joint in the hand) and heart disease. Specifically, they looked at 1348 patients with an average age of 62 and asked about painful and stiff joints of the hand backed up by osteoarthritis on X-ray as well arthritis of the hand but with no pain. These patients were then evaluated for their risk of dying as well as vascular events (coronary heart disease, congestive heart failure and/or ischemic stroke). Here’s what they found:

There was no link between death and arthritis of the hand.
There was no link between arthritis on X-ray (without pain) and heart disease.
However, in those who had painful arthritis had a 226% higher risk of having heart disease (as measured by a heart attack or coronary insufficiency syndrome).

These numbers are not anything to downplay. Why there was an association only with painful arthritis of the hand may have to do with the amount of inflammation present, but for now the researchers were not able to pinpoint the reason.

It is far more likely that the lifestyle that leads to heart disease is also a lifestyle that will destroy the cartilage of your joints than the reverse. Because of this, if you are worried about developing arthritis in your future, rather than focusing on your joints, you should start with protecting your heart.

Nuts to Lower Cholesterol

December 23, 2014 by James Bogash

NUTS ABOUT GOOD HEART HEALTH??

Nuts have consistently been shown to be very protective for the heart, and this review of multiple studies just cements this further. Interestingly enough, the average positive change in lipids for 67 g of nuts / day (less than 1/2 cup) was better than that of statins. And statins don’t contain the high levels of phytonutrients that nuts do that are also good for the heart. Not much of a contest…. Two notes. Use raw or roasted /salted nuts with NO ADDED OILS. That means canned and some bulk nuts are out. Second, walnuts and pecans are known to have the highest levels of antioxidants, so make sure they’re in the mix. For a snack in between patients, I get a small handful of mixed up nuts and a small square of dark chocolate…perfect combination for heart health!

Pregnancy Weight Gain and Childhood Health

December 18, 2014 by James Bogash

BREAKING THE CYCLE OF CHRONIC DISEASE BEGINS HOW EARLY?

Based on previous posts, this shouldn’t be a trick question. The answer is before pregnancy. In this study, women who gained excess weight during pregnancy had children that, at 9 years of age, had pretty much EVERY risk factor for heart disease elevated. A literal time bomb that will explode decades before it exploded for the parents. I’ve said it before and I’ll say it again, we need to stand up for the health of our children by taking better care of ourselves during pregnancy. This goes for BOTH the dad and the mom. The decisions you make today are either helping your child grow up healthier, or you are loading a bullet in the chamber. Decide. You can’t sit on the fence.

Heavy Metals and Heart Disease: Your Hidden Exposures

December 17, 2014 by James Bogash

When I first saw this article, I was worried that my album collection from the 80’s had to go. But upon deeper reading I realized that the danger extends far beyond Tesla and Warrant.

While most of us are aware that heavy metals are not good for us, for the vast majority, our understanding of exposures is limited to playing with the old mercury-based thermometers and maybe not living next to a smelting plant. Beyond that, however, the general public’s understanding of where heavy metal exposures come from is shallow.

If you’d like to stay in the dark, then stop reading right now. If, however, the last time you had a good scare was watching Poltergeist and you’re ready for more, then I’d like to direct you to this particular study. In it, researchers looked at four heavy metals (lead, cadmium, mercury and arsenic) to see how much they contributed to heart disease. While the end results varied across the different studies that the researchers looked at, here is an overview of what they found:

With lead, those with the highest levels were 252% more likely to die from any cause, 563% more likely to die of cardiovascular causes and a whopping 837% more likely to die from ischemic heart disease.
With cadmium, every 2-fold increase is linked to a 28% higher risk of death from any cause, 21% higher risk of dying of heart disease.
For mercury, there is a 69% higher risk of a heart attack, a 290% higher risk of having heart disease and a 230% higher risk of dying from any cause. The authors also note that the effects may actually be even stronger, since much of our mercury exposure comes from fish, which has a protective effect, likely blunting some of the damaging effect of the mercury.
Higher levels of arsenic are linked to a 71% higher risk of dying from coronary artery disease and a 303% higher risk of dying from a stroke. These risks were generally higher for diabetics.

While the details of these association vary (based on the study looked at, what body tissues were used to check heavy metal levels, men versus women, etc…), it is very clear that heavy metals are NOT good for our vascular system and should be avoided as much as possible.

But this is the problem, isn’t it? How can you avoid exposure if you really don’t know where those exposures are coming from? The obvious ones like not smoking (cadmium), not camping outside of a smelting plant in a third-world country (lead and cadmium) and not using a straw to suck up the silvery stuff from the broken thermometer are easy. It’s the hidden ones that will sneak up on you.

Luckily, this same study gives a great overview of common sources of exposure to these 4 heavy metals. Here’s a summary from the article:

Lead: Food, water, air, gasoline additives, food-can soldering, lead-based paints, ceramic glazes, drinking water pipe systems, folk remedies. In general, pretty much everywhere. Another common source is from environmental dust. Simply taking your shoes off at the door may lower your exposure.
Cadmium: Contaminated food (leafy vegetables, grains, organ meats, and crustaceans), drinking water, inhalation of polluted air, occupational exposure in industries, tobacco smoke. For most non-smokers, exposure to cadmium is mostly from foods raised or grown on contaminated soil. It is likely that organic products (meat as well as plants) will be lower in cadmium.
Mercury: Contaminated fish, meat and organ tissue of marine mammals or feral wildlife, dental amalgams, skin-lightening creams, antiseptic facial products, mercury-containing laxatives or diuretics, teething powders, latex paint. These exposures are easier to identify but not necessarily avoid (i.e. you got amalgam fillings 20 years ago, you LOVE high-mercury fish like yours truly…)
Arsenic: Contaminated fish, tobacco smoke, arsenic treated wood, ingestion of high-arsenic drinking water. A big problem here is that much of the water used for organic farms may be contaminated with arsenic, so that even if all organic principles are followed, arsenic levels may be higher for this reason.

So, if you just avoid all these sources of heavy metal exposure listed above, you should be fine. Cause you’ll be DEAD from not eating, drinking or breathing.

Your best bet is to minimize your exposures where ever you can on top of eating a high-quality diet loaded with lots of protective compounds that can help detoxify some of these heavy metals out of your system or at least mitigate some of the damage heavy metals cause. And with the New Year right around the corner, it always makes sense to start out the year with some type of physician-oriented detox program to do the best you can clearing out some of the accumulated garbage from the prior year.

At Risk for Heart Disease? Just Look for this in the Mirror

December 6, 2014 by James Bogash

There is a medical obsession with determining who is at risk for a disease. Cancer, heart disease, osteoporosis and stroke are examples.

Arguably, none of us sign up for chronic disease. It’s not like you fill out a form when you’re 18 and check off that you’d like to have open heart surgery at 55 because the scar from the sternotomy seems like a great way to pick up chicks.

And yet, from a bird’s eye view, it may seem like we really are making a conscious choice for chronic disease. Fast food, sedentary lifestyles, drinking out of plastic water bottles, avoiding berries and vegetables like taxes on April 15 and using artificial sweeteners are all choices that clearly increase the risk of chronic diseases.

As a society we continue to choose these behaviors. Medicine’s answer to this is to look for markers in the blood or on some type of diagnostic device (MRI, CT, EKG, etc…) to try to predict whether or not someone is going to have a chronic disease event like a fracture, heart attack, stroke or cancer diagnosis. Then, if we find these markers, we can use drugs to try to stem the likelihood of having one of these events.

It’s really pretty screwed up if you think about it.

Consider this. You KNOW you need oil in your car, but it’s just such a hassle to go to the shop, wait while you have the service done and on top of all that, you have to pay for it. Instead of changing the oil you just keep your mechanic’s phone number on speed dial. Check engine light on? Just cover it up with an ASPCA sticker. Car beginning to smoke? Just don’t run it in a closed garage. Starting to overheat? Just move to Minnesota. All of this in an attempt to put off the inevitable point at which the engine blows.

Luckily, at this point we can replace the engine and begin the process all over again. Even better, we can get your insurance company or even the government to pay for the new engine. It’s a good day.

But seriously–does this just not sound like the most stupid approach you could think of?

Somehow, though, when it comes to our health we take this exact approach. Don’t make the simple fixes early on–just cover up symptoms as they arise until the inevitable happens. Then we address the inevitable and continue back on the same approach that put us there in the first place.

So long as medicine continues to follow this model, identifying those at risk gives us the advantage of being able to tell who we should medicate. If that sounds a little cynical and simplistic, that’s because it is. Untold BILLIONS of research dollars are spent trying to decide if we should medicate Joe when his cholesterol is at 235 or wait until it climbs to 245. Billions. And it’s all because we have to decide when the side effects of a treatment are outweighed by the benfits.

For me personally, when I’m talking to patients about improving their lifestyles, all that research doesn’t mean squat. That’s because there is no downside to exercise, cleaning up the diet and stressing less. None. So it doesn’t matter if a patient starts these changes at 245, 235 or even at a cholesterol of 165. It’s a completely different philosophy.

Either way, all of this Ranting brings me to this particular article. In it, researchers looked at how much the presence of a diagonal ear crease increased the risk of heart disease prediction using the Diamond-Forrester classification.

The DF classification has been around for decades and uses age, sex and symptoms along with four diagnostic tests (stress EKG, cardiokymography, thallium scintigraphy and cardiac fluoroscopy) to predict someone’s risk of having a heart attack. Just like every other scoring system, it misses cases that are there and misdiagnoses cases that aren’t. For this reason, anything that can be done to improve the accuracy of this classification is helpful.

Enter the diagonal earlobe crease. I have written about the strange link between the presence of a diagonal earlobe crease and heart disease in a previous article that can be read by clicking here.

Researchers looked at 199 patients with chest pain and evaluated how effective the DF classifcation, the diagonal earlobe crease and the mixture of the two at determining who had greater than 50% blockage of the coronary blood vessel on CT scanning. Here’s what they found:

Those who had a diagonal earlobe crease were a striking 360% more likely to have advanced plaquing in their coronary blood vessels.
However, when they added the DF classification to the earlobe crease, this group jumped up to a 560% higher risk.

In other words, merely looking at the patient was able to much more strongly predict whether or not a patient was really at risk of having advanced heart disease.

Before you go running off to look in the mirror, consider this. Just because you have an earlobe crease does NOT mean you are doomed to a heart attack. But what it may mean is that you need to be that much more diligent with making the right choices for your lifestyle.