LifeCare Chiropractic

The Best Chiropractic Care in Mesa, Arizona

prevent heart disease

Live Longer with a Single Nutrient

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I am NOT a single nutrient for a single disease person. I leave that up to the drug companies. Instead, an overall approach to lifestyle is the answer to today’s chronic disease disaster.

But sometimes single nutrients really do make a difference.

This is not the first time that the mineral magnesium has played the role of superstar in health and disease prevention. Diabetes, migraines, seizures and Alzheimer’s dementia are all conditions that magnesium has shown to have a strong protective effect.

This would be all fine and dandy if magnesium wasn’t a nutrient that is very commonly deficient in today’s processed lifestyle. Foods high in magnesium include:

  1. Dark green leafies like spinach and kale
  2. Nuts and seeds
  3. Most fish
  4. Beans / lentils
  5. Whole grains
  6. Avocados
  7. Dark chocolate

You can see, from this list, that the typical Western diet does not contains any foods high in magnesium. Any magnesium is usually added to the foods after they are processed and the form of magnesium most commonly used (because it is cheaper) is magnesium oxide. Magnesium oxide is a poorly absorbed form, as opposed to the elemental form most commonly found naturally in foods.

In this particular study, researchers looked at 7216 aged 55-80 Mediterranean adults who were known to have a high cardiovascular risk. Overall, the participants with the highest baseline magnesium intake had a 34% lower risk of dying. Period.

From all causes.

In other words, those people whose diets contained more magnesium were very strongly protected against dying from any chronic disease. That’s powerful.

Lest you run out and stock up on magnesium supplements and cancel your life insurance policy, keep in mind that this study was NOT on supplements, but rather on the levels of magnesium in the diet.

Along with magnesium, the foods on the list above are also very high in countless other protective factors to keep you healthy and disease free. If you don’t already eat the foods regularly in the list above, it is time to start. Your life literally depends on it.

Diabetes & Heart Disease–Are They Separate? 4 Things to Know

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Diabetes and Heart disease.  Sounds like a stupid question, right?  One is the domain of a cardiologist and the other an endocrinologist.

Sure, the two are linked and having diabetes greatly increases your risk of having a heart attack.  To be a little more precise, 65% of diabetics die of heart disease or stroke.  That’s a pretty high number.  What this usually means in mainstream medicine, where specialists manage conditions and not patients, is that any person who is diabetic needs to make sure his or her blood pressure, cholesterol and triglycerides are under control.  And, by “under control,” we mean that the patient is taking his or her medication like a good little boy or girl.

The term is “comorbidities.”  This is a term used to describe two or more diseases that run alongside one another.  Like diabetes and heart disease.

But what if our view on this was entirely wrong??  What if, in reality, diabetes and heart disease are the same condition, just with different outward expressions?

Let’s boil it down to a common denominator: blood vessel health (although “vascular health” sounds much more trendy).  No one has a heart attack or stroke until he or she has a problem with the blood vessels feeding these organs.  Healthy blood vessels don’t get filled with plaque and throw off blood clots to clog smaller arteries.  And few things are more deadly for your blood vessels than the prediabetic and diabetic conditions.

This is why prediabetes is so incredibly bad for you as well–because your blood vessels are being destroyed in the process.  The links between heart disease and diabetes are already strong and undeniable, but I suggest that they are along the same continuum.  People who die of a heart attack just didn’t live long enough to get diabetes, but you can bet that almost all of them where prediabetic.

This also means that the prevention of these two conditions is the same.  I can’t think of one lifestyle change that would benefit diabetes and not heart disease and vice versa.  Which makes everything easier because you just have to focus on an anti-diabetic lifestyle and you get more bang for your buck.  Contrast this with medical therapy, where diabetes is managed with diabetic medications, but your heart disease risk is managed with blood pressure drugs, statins to lower cholesterol and aspirin or blood thinners to prevent clots from forming.  We still treat the two as separate conditions and manage them independently.

So why the long-winded discussion?  It relates to this particular study linking HbA1c levels and heart disease risk in non-diabetics with no prior history of cardiovascular events.

For those of you not familiar with HbA1c (also referred to as glycosylated hemoglobin, hemoglobin A1c or just plain A1c).  This number on your bloodwork tracks what your blood sugar levels have been doing over an average of about 3 months, using red blood cells (which live about 3 months).  Here’s how the numbers break down:

  • An ideal number is in the low 5’s.
  • Prediabetes is considered between 5.7 and 6.4%
  • Anything over 6.5% is consistent with diabetes.
  • For a medicated diabetic, under 7.0% is good–too much lower may kill you off faster.
  • However, for LIFESTYLE, there is no number too low for a diabetic.

With this in mind, you can understand just how bad the news from this study are.  Keep in mind that all the patients in this study had an HbA1c less than 6.5%:

  1. As HbA1c levels increased, there was an increase in the presence of heart disease and number of blood vessels involved.
  2. Those with higher HbA1c levels had a 280% higher chance of having heart disease.
  3. Those with both higher inflammation (as measured by hsCRP) and HbA1c levels closer to 6.5%, there was a 418% higher risk.
  4. The ideal cut-off value of HbA1c was below 5.6%.

That last bullet point, #4 above, pretty much means that 2/3 of the US alone is well on their way to heart disease.  It’s beyond time to get serious about this.  And getting back to my earlier point, this study basically uses a “diabetic” blood test to determine how much at risk someone is for developing heart disease.  Doesn’t get more closely associated than that.

 

The NEW Statin Guidelines: This is the Best We Got?

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I keep thinking that I’m missing something here.  Some magical number that makes these drugs to lower cholesterol worth the hype.

I’ve read all the studies and I’ve seen the numbers, but I don’t read ALL of the medical literature that gets published on statins.   So maybe I missed the one that showed that statins are worth all the hype and the new recommendations.

There has been much pushback on the newly released 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines on reducing atherosclerotic cardiovascular disease risk.  The arguments include conflict of interest (8/15 panelists had financial ties) and overzealous interpretation of the data.  Here are the scenarios when moderate to high dose statins should be used:

  • Anyone with low-density lipoprotein (LDL) cholesterol levels >190 mg/dL.
  • Anyone from 40 to 75 years or age with type 1 or 2 diabetes.
  • Anyone aged 40 to 75 years with LDL cholesterol levels between 70 and 189 mg/dL and 7.5% or higher estimated 10-year risk of atherosclerotic cardiovascular disease.
  • Moderate-dose statin treatment in anyone with an estimated 10-year risk between 5% and 7.5%.

This pretty much covers everyone.

But this  aren’t the problem.  Or rather, the problems.

First, the queen of all twisting of the data has to do with cholesterol.  If you remember how this all started years ago, it was all about total cholesterol.  Everyone needed their total cholesterol checked so that we could see whether or not they needed drugs.  The entire, laser-like focus on preventing heart disease kept total cholesterol in the crosshairs.  We did this, spending mass amounts of money on “educating” doctors and patients that total cholesterol = heart disease = statins.

It got embedded deep.  Really deep.

It was not until 10 years later that anyone asked whether lower total cholesterol with drugs was preventing heart attacks and deaths.  Turns out they didn’t work really well.  Actually, they sucked.  So much that these new guidelines do not even take total cholesterol into account.  Basically, the suggestions were that we don’t need to look at markers anymore, but we just treat for the sake of treating because the research shows that these drugs help to reduce deaths.

Which brings us to the second problem.  They suck at preventing death.

And they did not hide this in the recommendations, as you can see in this review article on the subject.  The numbers are given as “NNT,” or number needed to treat over 5 years to see a benefit.  This number helps us to understand how many patients need to be treated to benefit a single patient.  As an example, using steroids in an acute asthma attack will save 1 person from going to the hospital for every 8 treated, so a NNT of 8.  This is considered pretty darn good.  Acid blocking drugs in a bleeding stomach ulcer to prevent another episode of bleeding?  15.  Probiotics for preventing C. diff infections?  25.

You get the idea.

So what about the use of statins?  Here’s the numbers:

  1. Dying from all causes NNT 138
  2. Having a cardiac event NNT 49
  3. Dying from cardiac causes NNT 88
  4. Having a stroke NNT 155
  5. Developing diabetes NNT 98

The saddest part about all of this is that society and medicine has degenerated to the point where we are willing to accept a treatment that is so poor that we have to treat 88 people for 5 years to prevent a single death.  And the costs to prevent that single heart attack are staggering (think about the costs of 5,280 months of statin drugs).

With these recommendations, we have given up on the hope that the American public can and will make the necessary lifestyle changes to protect their hearts and have instead leaned more heavily on the use of drugs for “prevention” of heart disease.

That is the saddest part of all of these recommendations.

 

Cholesterol Lowering Drugs and HDL—Do They Work?

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It’s pretty well established that, despite drug companies mounting a massive push and “educational” effort for years, total cholesterol by itself has little to do with heart disease rates.

However, I still have to educate people in the community and my practice on this little tidbit.  The focus away from total cholesterol was made quietly, most likely as an effort to save face by those who had been pushing cholesterol levels as THE answer to heart disease.

The research on HDL (the “good” cholesterol), LDL (the “bad” cholesterol), VLDL (the “worst of the worst”) and triglycerides, however, is stronger.

In my opinion, the HDL:triglyceride ratio is the most valuable, but overall it’s the entire picture painted by all the lipids that give us the best picture.  This viewpoint, however, is not what drug research and use is about.  Since drugs can usually only affect one blood value at a time (i.e. statins will lower LDL but won’t have a big impact on triglycerides), researchers have to push hard to find a relationship between a value and a disease (such as total cholesterol and heart disease) and then find a drug that affects that value.

Miraculously, despite all my Rantings on cholesterol lowering drugs as well as an eBook on cholesterol lowering drugs, I still have patients come in who think that the drugs they’re on will actually protect them from heart disease and stroke.  Needless to say, I’m not a fan of cholesterol lowering medication and will not hesitate to point out the research related to cholesterol.

Which leads me into this particular study.  In it, researchers looked at two types of lipids, HDL cholesterol and apoA-1.  Most know that HDL is generally considered the “good” cholesterol and lifestyles that promote higher levels will be strongly protective against heart disease and stroke.  ApoA-1, however, is less well-known.  Apolipoprotein A-1 is one of the major proteins that makes up the HDL molecule and helps to shuttle cholesterol around the bloodstream.  Having higher levels is more protective to the heart.

This study looked at the effect that HDL and ApoA-1 levels had on heart disease.  Then, they looked at what effect statins had on these relationships.  Here’s the specifics:

  1. HDL lowered the risk of a major cardiovascular event by 17%,
  2. ApoA-I level lowered risk 21%.
  3. In those patients taking statins whose LDL cholesterol levels were lowered to at least 50 mg/dL, an increase of HDL-C did not lower heart disease risk.
  4. However, in the statin responders, a rise in apoA-I did lower the risk of heart disease by 7%.

So what does this mean?  Higher levels of HDL and ApoA-1 are good for your heart.  But when those levels are artificially raised by a cholesterol lowering drug, it either didn’t help at all or the benefit was far less than higher levels occurring naturally.

When we find, from observational studies, that some lab value protects against some disease, it is LIFESTYLE that gives the benefit.  Cheating by using drugs to lower the value, if it works and doesn’t kill you from the side effects, will never produce the same benefit.

How Much Do We Know About “Good” Cholesterol?

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When it comes tocholesterol, we’ve viewed things in black and white.  Total cholesterol is bad.  LDL is bad.  HDL is good.

When drugs to lower total cholesterol and LDL cholesterol failed miserably (yes—the statins), the drug companies tried to make a drug that raised HDL cholesterol.  Ironically enough, the money for research and development likely came from the money from sales of the near-worthless statin, atorvastatin (Lipitor).

Torcetrapib, the first drug of its time made by Pfizer, indeed did raise HDL cholesterol but ended up killing patients 60% faster in phase III clinical trials so the drug was scrapped.

So what happened?

For some reason, the drug companies still don’t get it.  They don’t seem to understand that it’s not about the NUMBER, it’s about what the number represents.  Any number on your blood work, whether it’s total cholesterol, HDL, fasting glucose, HbA1c or liver enzymes, are merely the snapshot of the entire picture.  You see water leaking from 10 different locations in your house; do you plug all the individual leaks and throw down towels?  Or do you figure out what the problem is (like maybe the roof…) and fix it??

While this seems so obvious with home repair, it seems to have escaped the realm of common sense in medicine.  We find some type of lab value and latch onto it like a toddler with a new toy (or rather, a toddler with the box from the new toy…).  Then we put all of our focus into that lab value and build an entire approach to a disease based on this single lab value.

Back to the HDL issue.  HDL is not a single molecule.  Rather, as this particular study points out, it is actually made up of at least 85 different subtypes of proteins.  85.  So which ones are the best of the best and which ones are irrelevant as far as your risk of heart disease?  Many prescription drugs are designed to target a very specific pathway.  In the example above given for Torcetrapib, it is highly likely that the drug only affected a very small number of the 85+ types of HDL molecules.  Given that we don’t even understand how each of these types of HDL molecules work in concert, messing with only one could potentially lead to disaster, which is what happened.

Contrast this with lifestyle.  Lifestyle changes do not affect a single pathway.  It is likely that the right lifestyle changes geared towards lowering your risk of heart attack and moving you away from diabetes will lead to alterations in a large number of these HDL protein molecules.  Some will shift lower, some will shift higher, all moving in the direction they are supposed to go to protect you from chronic diseases.  Picture the most elaborate concert you have ever heard; each instrument orchestrating beautifully among one another to produce the perfect outcome.  THAT is what lifestyle does.

Pharmaceutical drugs, on the other hand, would be like throwing 2 or 3 toddlers with bats into the percussion section of a philharmonic orchestra.  Not pretty.

This same reason is why, despite the near universal salivation by the drug companies to create a drug that raises HDL cholesterol levels and magically lowers the risk of dying from a heart attack (while at the same time miraculously boosting profits), it will never happen.  Too many variables at play.  Stick with GMO-free soy, exercise and nuts to raise your cholesterol levels instead.

Think You’re Doing Everything to Protect Your Heart? Even THIS?

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heart disase sleep
Enough sleep needed to protect the heart

Despite societal beliefs, heart disease is NOT genetic.  It is almost entirely environmental.  Lifestyle factors to lower your risk are very well established.

Most of you can probably name off the top few easily: Exercise, not smoking, plant based diet, don’t stress, avoid animal based saturated fats, more omega-3 fatty acids, etc… But some are a little more elusive and less well known.  But usually these risk factors may play a smaller (but no less important) role, such as BPA in plastic water, dark chocolate, nuts and lycopene in tomatoes.  But what if there was a very important risk factor that had a large impact on your risk of a heart attack or dying of a heart attack that you were not aware of?

Enter this large study out of the Netherlands.  Luckily, the Dutch are a generally healthy people, so these researchers were actually able to find some healthy people to study (as opposed to the US, where researchers have to peek into dark corners and seedy vegan restaurants to find the healthy residents).  Basically, they looked at 17,887 men and women and how their health behaviors were linked to the later risk of heart attacks or cardiac deaths.

Here’s the behaviors and the amount they lowered the risk individually:

  1. Sufficient physical activity (≥3.5 h/week cycling or sports–52% of study participants) led to 26% lower risk.
  2. Healthy diet (Mediterranean Diet Score ≥5–37% of participants) led to 12% lower risk.
  3. Moderate alcohol consumption (≥1 beverage/month–91% men, 78% of women participants).
  4. Non-smoking (65% of participants) led to 43% lower risk.

Overall, when all 4 of these healthy lifestyles were done together, there was an overall 57% lower risk of heart disease and 67% lower risk of fatal heart attack.  Sadly, even in this healthier country, only 12% of the study participants adhered to all the factors studied.  And like many of the studies on heart disease, these guidelines are pretty basic and very easy to achieve.  More specific lifestyle changes would likely lead to much greater reductions.

There was one more behavior they look at:

Sufficient sleep duration of at least 7 hours per night.

Man, I better hit the hiking trail drinking red wine and eating raw nuts dipped in pure cacao.

In the study, 80% of men and 86% of women obtained sufficient sleep.  Pretty sure we wouldn’t see these numbers here in the US with salaried employees with kids (or 5 blog / week health related blog authors…).  Overall, getting sufficient sleep lowered the risk of heart disease by 22% and fatal heart attack by 46%.  These are some pretty strong numbers.

But when added to the 4 factors listed about, the protection jumped, lowering risk of heart disease by 65% and fatal heart attack by 83%.  These are some pretty serious numbers.

Overall, this really should not come as too big of a surprise because we know that sleep is incredibly important and, conversely, not sleeping well is unhealthy.  Study after study have linked poor or too little sleep to increased inflammation,  obesity and diabetes.

Lest you think that you’re ok because you load up on Ambien and Lunesta with your valium, there are some pretty scary associations between the use of these types of drugs and death (arguably something we want to avoid…).

And stress kills sleep quality and duration, which likely feeds into this entire picture of preventing heart disease and fatal heart attacks.

With that said, I’m off to bed to lower my risk of a heart attack..

Your Heart on Vacation; When Was Your Last One?

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Vacations are of critical importance and are not merely a luxury.  They are a requirement.  So when was YOUR last vacation?

I sit here writing this particular post from the airport in Puerto Vallarta, Mexico, awaiting my flight home from a week long vacation.  So why is this relevant?

Besides the blog articles and eBooks, I have a busy chiropractic office in Mesa, AZ that takes up a full day.  A typical week ranges anywhere from 50-80 hours.  As a night owl, a typical day ends around midnight or 1 AM when I finish a blog post for the following day (you can usually tell how late I was up writing based on how much I rant..).

I have many patients on salary who put in similar hours and any self-employed person is putting in these hours or more.  And then there are the “40 hourers” who work incredibly hard during the hours they are at work.

The stress level of living a life at this pace is legendary.

This is definitely not the first time I have written about stress and how much it destroys your digestion and your health.  Tools like exercise and meditation are critical to mitigating the havoc that stress wreaks in your life.

Besides these everyday tools, never, ever forget the power of a vacation.  I know full well how important it is for me to disconnect (well—almost disconnect…) from technology and give my mind and body a break.

For me, this week break on the beach (not to mention some high speed ziplining and fantastic fresh Mexican seafood) has done some serious recharging and I’m ready for the office again on Monday.  That is, of course, if the rest of my team didn’t blow it up in my absence.

I try to vacation 3-4 times per year (I could take more, but my boss refuses to pay me for my time off despite how much I complain, gripe and threaten) with a few short weekend trips thrown in for good measure.  But it’s truly the technology poor vacations that suit me the best.

So why does any of this matter?  To get to the point, this particular study looked at the relationship between taking vacations and the risk of both heart disease and death in a large group of middle aged men.  Here’s what they found:

  • Those who took more annual vacations were 17% less likely to die from any cause.
  • Specifically, the risk of dying from a heart attack was 29% lower.
  • There was a hefty 32% lower risk of being diagnosed with heart disease or suffering from a heart attack.

These are some serious numbers.  And let’s face it, taking a vacation is an intervention most people WANT to do, seemingly unlike a healthy diet and exercise.  Of course, money is an issue for many.

I would contend that money is not an issue.  Rather, it is an issue of spending priorities.  Cancel cable and drop Starbucks and you just bought a family vacation.  Smoker?  Quit and go on a cruise for two weeks.

So when was YOUR last vacation?

How to Prevent Diabetes, Avoid Heart Disease with a Simple Plan

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Chronic disease is taking too many too soon. On top are 2 particular diseases. A simple approach can show you how to prevent diabetes and avoid heart disease.

Everyone wants to live as long as they can with the greatest health they can.  Longevity is the goal, but without health it may not seem worth it.  Technology has a good way of keeping you alive long after it was your time to go.  That’s not exactly on my wish list for my lifestyle as I age.

So how can we age gracefully and do our best to avoid chronic disease?  The research has consistently pointed to calorie restriction without nutrient restriction to maintain an ideal body weight and stave off disease.  This usually means that your 1200 calories per day comes from broccoli and not from a Big Mac Value Meal.

But not everyone wants to live life in a restricted calorie fashion.  Actually, to be honest, few do.  And society certainly does not support this lifestyle with the near elimination of the “small” size in the fast food industry (really–does it make us feel better to order the “medium” sized value meal?  Do we somehow feel cheated if we were to only buy a “small” value meal??).

Luckily, there has been research looking at how effective modifications to the calorie restricted lifestyle are.  One of the ones that seems to rise to the top is alternate day calorie restriction.  The name describes it well, but basically you would restricted your calories to about 50% of normal every other day.  During the non-restricted days there are no calorie restrictions, although the quality of the foods you eat should remain high.

This particular study looked at two different variations of alternate day calorie restriction and compared the outcomes.  Both variations used an alternate day calorie restriction (as mentioned, this is typically 50% of your normal caloric intake), but on the off days, one variation used a high fat diet (45% of calories) while the other used a low fat diet (25% of calories).  The diet lasted for 2 months and had some pretty surprising results:

  1. Weight dropped 4.8% in the high fat diet and 4.2% in the low fat group.
  2. Fat mass decreased almost 12 lbs in the high fat and just over 9 lbs in the low fat group.
  3. LDL cholesterol and triglyceride dropped 18% and 13.7% (high fat) and 24.8% and 14.3% (low fat).
  4. Here’s the real info: fat free mass remained unchanged-basically all weight lost was fat (Tweet this).

Overall, in a mere 2 months, 12 pounds of pure fat was lost and LDL cholesterol tanked almost 25% in the low fat group.  The results from both groups were strong, but the low fat group seemed to have better results when it came to lowering the heart disease markers.  These are powerful results for such a simple intervention.

Of all the diets that have come and gone, this is one approach that has never really been publicized, and yet the results are strong and the ability to continue the diet as a permanent lifestyle is very realistic.

Based on this study, would you be willing to cut your calories every other day for 2 momths to lose 12 pounds of fat?