Category: Prevention

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Heart Health Prevention

The Heart Health Risk Score

I don’t know of any other health coach who creates a Heart Health risk score for their clients. I came up with this because most of us understand risk and know how to work with percentages.

Perhaps the most important point is that prevention is the most powerful tool against cardiovascular disease.

The objective is to push a heart attack, heart failure, peripheral vascular disease, valvular disease, or a stroke as far down the road as possible.

Heart Health Risk Score Criteria

In a previous article, I discussed the overview of risk stratification. In this article, I want to dive deeper into the anatomy of this score.

I have broken the risk score up into the following categories. It’s a constantly evolving tool that must be revisited often.

1. Age

You might think age isn’t much of a lever, but I disagree. If you are reading this article and taking action now, you have decided to prevent heart disease earlier than your future self.

2. Family History

A parent who suffered a heart attack at 49 is a powerful risk contributor to the heart risk score. While an uncle who suffered heart disease at 79 may not tell us much about this risk.

Your mother’s health and the environment in which she carried the pregnancy portend future risk.

3. Comorbidities

Comorbidities include conditions and diseases which accelerate atherosclerosis or elevate the coagulation response in case of an unstable plaque.

Sleep apnea, hypertension, diabetes mellitus, obesity, elevated lipid profile, systemic inflammation, and certain lifestyle factors.

4. Exercise Capacity

While some variables increase the risk of heart disease, others are protective and lower the overall cardiovascular risk score.

A healthy VO2 Max and a higher than average HRV are indicators and may be protective. In fact, exercise improves these metrics and is independently protective against cardiovascular disease.

5. Mental Health

Living in an area with high pollution, loud noise, or being under constant stress negatively impacts heart health. More so in those who don’t have compensatory coping mechanisms.

Ongoing financial stress, poor sleep, childhood adversities, and relationship stress also elevate the risk score.

Categories
Heart Health Metabolic Prevention

The Body Mass Index Limits

The Body Mass Index has had its fair share of troubles because it’s open to interpretation. Those who are muscular are comfortable being in the upper limits of it, and those who exercise a lot are comfortable in the lower ranges. Let’s discuss body mass index limits to avoid any confusion.

Body Mass Index Examples

I’m around 165 lbs and 6′. This brings my BMI to 22.4. My friends consider me too skinny when they look at me. In fact, I could lose more weight around the midsection and still would be healthy.

Unaccounted for here is that I could gain 18 lbs, and my BMI would still be normal at 24.8. So I would be okay?

Unfortunately, no. The extra 18 lbs would increase my metabolic disease risk, negatively impacting my heart health.

Using the BMI

There are limits to using the body mass index to monitor your health. But I use it as an assessment of my patient’s initial health.

My BMI of 22.4 is a good start. Knowing other factors, such as my cardiovascular risk factors, activity levels, and genetic factors, is essential.

The CDC states that a BMI between 18.5 to 24.9 is a “Healthy Weight range,” which isn’t true for everyone, as seen in the example above.

Other Weight Factors

I like to know how much weight my client has gained and over what period of time.

Equally important is the location of the majority of the weight. Central weight versus more spread out makes a difference.

Blood pressure, snoring scores, energy levels, basal heart rate, and heart rate variability can also be helpful when considering someone’s BMI.

Book a Heart Health consult with me today!

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Heart Attacks Heart Health Prevention Treatment

Heart Health in Traditional Medicine

Traditional medicine, also called western medicine, is exalted for its evidence-based, scientific approach. It has proven capable of treating some of the most life-threatening and severe conditions. However, heart health in traditional medicine remains less advanced.

First Signs of Heart Disease

Most adults don’t necessarily know they have heart disease. And unfortunately, death is the first presenting symptom in a little less than half of those presenting for the first time.

That means 50% will have a fatal heart attack and not just a high cholesterol level or atherosclerosis seen on imaging.

We haven’t figured out a way to decrease that number fast enough. This means that heart health in traditional medicine can only help 50% of adults.

Traditional Medicine and Heart Disease

In traditional medicine, assuming you have good insurance, you can get excellent care to lower your cholesterol levels and blood pressure by using medications.

This requires regular visits for blood testing to make sure your liver and kidney can handle the medications. Refills cost money and time spent in the pharmacy.

These treatments don’t work for everyone. However, traditional medicine views all high-lipid and hypertensive patients similarly and treats them the same. This is one of the downsides of this practice model.

But if you need a stent or need to be resuscitated, western medicine is as good as it gets. We have incredible talent that can perform heart transplants and perform bypass grafting.

Heart Health is About Prevention

I can treat the high cholesterol with statins and perform a stent in the coronary artery, followed by a coronary artery bypass graft later in life. This is treating the symptom and not the condition.

Heart Health Coaching, which is what I do, focuses on lifestyle factors. It’s more about prevention and diving deep into potential causes for not-so-great metabolic health.

Heart Health and Pills

A pill can lower your blood pressure and decrease the chance of atherosclerosis plaque progression.

But it cannot prevent a heart attack or prevent you from getting fatty liver or diabetes from the factors which lead to high cholesterol or high blood pressure, to begin with.

Perhaps somewhere around 2-3% of individuals have genetic factors causing high cholesterol and high blood pressure. All methods other than pills will likely fail these individuals. For the rest of us, pills may not be as effective.

Prevention + Treatment

In the perfect world, everyone would have a Heart Health Coach and work to overcome hurdles toward ideal heart health.

If that fails and heart disease develops, they have the excellent skills of capable cardiologists, surgeons, and intensivists who can help restore their cardiovascular health.

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Diet Heart Health Prevention

Salt Intake and Heart Disease

There is an ongoing discussion regarding salt but we also have good science to help us make good salt decisions. There is an important connection between salt intake and heart disease.

My heart health coach clients know that each person’s diet and lifestyle are individual. No single formula applies to everyone. However, salt has a particular effect on the body which most of us share in common.

Is Salt Bad for You?

Let’s start with this question first because I get it asked a lot. I don’t think salt is bad. But for my patients who have major vascular problems, I like them to limit their salt intake.

And for my average heart health client who is healthy and wants to prevent future cardiovascular events, I urge them to reset their salt taste.

Even those with heart failure and hypertension can do fine with normal daily salt intake. But none of us will do too well with the current amounts of salt found in food.

Salt in Prepared Foods

I have a hard time trusting the sodium values listed on boxed foods. Think, Trader Joe’s or Whole Foods and canned products. And even if they are accurate, the amount of salt is staggering.

I had a taboule salad today with that chickpea salad from Trader Joe’s which I haven’t had in a year. It was during a busy urgent care shift so that’s all I could grab.

For 4 hours I’ve been dry-eyed and fatigued because my body doesn’t know what to do with the salt. I can drink a lot more water in order to pee out the salt but the salt will change the elasticity of my vessels and will drive up my blood pressure.

Bread and pastry and soups are other classic culprits.

Salt and Vascular Stress

I won’t get into the details in this article but whether you are salt sensitive or not, having more than small amounts of salt in your arteries will cause them to behave differently.

Over a long enough lifespan, this effect is cumulative and decreases the ability of the arteries to function properly. It doesn’t matter whether it’s the arteries of the heart, the brain, or the kidneys.

How Much is too Much

I don’t have my heart health clients count their salt intake. Instead, we start with good food and the salt that’s needed for good food to go down.

Take a salt you made with some spinach, baby greens, nuts, olive oil, tomatoes, and arugula. By itself, it’s not that exciting.

Add in some olives in a brine solution and now it’s exciting. A little bit of vinegar and you’re in for a treat. Of course, you have to get your taste buds used to having less salt. This takes time.

So don’t panic just because you had a few too many salty dishes in your life or during the holidays. Cardiovascular health for most of us is a marathon; slowly retrain your palate to consume less salt.

Salty Taste is a Habit

I’m sure there are exceptions but most of my patients tell me that food and tastes and flavors are matters of habit. Cut out burgers and after a while, you won’t crave them. Or if you have them they’ll feel exceedingly rich.

Cut out sugar or salt and when someone takes you to PF Chang’s you’ll put down your fork. It’s simply too much when you’ve gotten accustomed to just enough salt for the flavors to come through.

Heart health shouldn’t be the only goal for a good life and healthspan. It should be something sustainable and enjoyable. Therefore, salt is fine. It’s when we use excess amounts of it that our body responds and reacts negatively.

Categories
Diet Heart Health Hyperlipidemia Prevention Statins Treatment

How the Body Regulates Cholesterol

In this article, I wanted to provide a basic overview of cholesterol regulation in the body. I share such articles with my heart health coaching clients whenever necessary. How the body regulates cholesterol is relevant to choose the right method of controlling cholesterol levels.

Cholesterol Regulation

Cholesterol is quite essential. The following key players regulate cholesterol in the body:

  • cells lining the intestine
  • liver
  • pancreas
  • intestinal bacteria

The food we eat has some form of cholesterol which becomes absorbable after manipulation by intestinal bacteria and pancreatic enzymes.

Cholesterol can enter the bloodstream also through the bile system. Whether you still have a gallbladder or not, your liver will produce cholesterol pumped into the intestines.

Cholesterol Absorption Varies

Some individuals are hypoabsorbers of cholesterol. No matter how much high cholesterol foods they consume, their intestinal cells don’t take up much of it.

Others are hyperabsorbers of cholesterol; even the lightest meals can have every bit of its cholesterol extracted and pumped into the bloodstream.

Cholesterol Regulation and Treatment Options

For my hypoabsorber clients, I am less concerned about their dietary cholesterol intake. Their cholesterol production in the liver would be a more important factor.

The hyperabsorbers will benefit a lot from a particular dietary change. Sometimes it helps to cut back on saturated fats, but eating times and gut bacteria are also important criteria.

Dietary change? Statin therapy? Ezetimibe? Evolocumab?

To answer that, I need more information about the person. A generic cholesterol test won’t always tell us the whole story.

The Liver’s Cholesterol Production

How cholesterol is regulated in the body has a lot to do with the liver. This fleshy organ on the right upper quadrant of the abdomen produces LDL, HDL, and VLDL particles.

Statin drugs decrease the production of cholesterol molecules in the liver.

The liver also has LDL receptors and absorbs cholesterol.

From fatty liver to elevation of liver enzymes to problems with the gallbladder, it’s important to consider the health of this organ when assessing my clients.

The Role of Gut Flora and How Cholesterol is Regulated

Some bacteria in the gut convert free cholesterol molecules into a stanol chemical that intestinal cells cannot absorb.

We could call these beneficial bacteria. They can help slow down the absorption of cholesterol for certain individuals.

Ezetimibe is a medication that works similarly, blocking the absorption of free cholesterol molecules.

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Heart Health Prevention

Heart Healthy Aging

I believe in an individual approach when it comes to health. But some basic tenets are worth paying attention to regarding heart healthy aging.

A heart healthy approach to aging makes sense because it’s no longer war, famine, and infectious diseases responsible for most deaths.

For those of you reading this, you are likely more susceptible to cardiovascular risk factors and disease:

  • atherosclerosis
  • high blood pressure
  • nerve damage from ischemia
  • kidney damage from hypertension
  • dementia from poor cerebral blood flow
  • heart attacks
  • ischemic amputations

How to Design a Heart Healthy Aging Model

Perfection is the enemy of progress when it comes to health. Every step you take in the right direction will improve your health.

Much like investing, multiple such behavioral changes will have compounding effects. Let’s keep that in mind before reading the list below.

Thank you to Dr. Weil for the inspiration for this list.

1. Maintain a Healthy Activity Level

Staying active has, time and time again, proven protective. From how our muscles metabolize nutrients to healthy bones to how our heart responds to stress, being active is protective and healing in many ways.

Our lives are ever more sedentary, but that doesn’t mean we can’t get up from time to time. We can perform stretches and go for a walk.

The term exercise doesn’t capture things quite as well. People who are marathon runners aren’t necessarily “healthier” than those who remain active by going for walks or performing active house chores.

How active do you need to be?

It depends on your risk factors and what you’re capable of doing based on where you are on your heart health journey.

2. Minimize Your Body’s Inflammation

Inflammation is something our bodies are great at managing and repairing the damage from it. But there is a limit to how much our bodies can cope with.

Recognizing the signs of inflammation is perhaps the toughest challenge. This takes an astute clinician and practice on your part to recognize the signs.

And it’s often our diets that can help decrease the effects of inflammation on our cardiovascular and metabolic systems.

What’s a good diet?

Each person will need an individualized approach to their diet. But almost all sides agree that a minimally processed diet with high nutrient content and a low pesticide content will get you there 90% of the way.

3. Manage Your Stress

I don’t know how to avoid stress and wouldn’t advise my patients to search for the holy grail of a stress-free life.

Coping with stress or managing stress is more valuable when aiming to age in a heart healthy manner.

How much stress is too much?

There are some serum markers for inflammation, but it’s not advisable nor feasible to monitor inflammation in such a way.

If you are feeling stressed or suffering consequences from your lifestyle, it’s fair to say that uncompensated or unmanaged stress is present.

4. Allow Your Body & Mind to Recuperate

The human body and the mind need to recover from damage, infection, hard work, and other day-to-day microtraumas.

Restful nightly sleep is quite important. Trying to catch up after many sleepless nights is as inefficient as working out only on the weekends.

Sleep & rest are important aspects of allowing our bodies to recover and recuperate. That’s why this is #4 on the list for heart healthy aging.

5. Know Your Heart Health Risks

My father had a heart attack in his 70s and needed multiple stents. Family history is an important risk factor.

I also went through medical school and had a highly processed diet when I was younger. Our past medical history is also important when assessing our overall risk.

Screening tests such as cholesterol levels, blood pressure, coronary calcium scores, body mass index, heart rate variability, and your resting heart rate are important heart health risk factors as well.

What’s your risk?

Your heart health coach can sit down with you to calculate your heart health risk score and help you design a program to help you mitigate such risks.

6. Build a Social Network and Form Meaningful Connections

I have a good support system in my life. There are people whom I can reach out to and who care about me. I enjoy physical touch from loved ones and don’t feel alone.

For most of us a human network is necessary for this. For others they can get this same social connection from animals, trees, and life all around us.

To age with a healthy heart it’s important to feel supported and cater to some of the evolutionary chemicals in our body which are released from interacting with others.

7. Work With Your Body Instead of Resisting it

Aging, as many say, isn’t for the faint of heart. Certain human characteristics are honed by aging, and certain senses become dull.

I can’t do certain exercises nor expend the same energy as when I was 25. But I have the patience of someone in the mid-40s, which is a huge plus.

Aging is normal, and the weakening of certain organs is also normal. But disease is not normal. Learning to enjoy the dance of old age is better than resisting the aging process.

Categories
Heart Health Prevention

Calculating Heart Disease Risk

Calculating heart disease risk is an important result I share with my Heart Health coaching clients. It’s not something I calculate on the first visit. Instead, it’s something we aggregate over time.

This intake process is perhaps one of the most tedious aspects of our visits. But it doesn’t go down bitterly; I make it entertaining enough. With a healthy dose of humor, we get through it and can decide which actions to focus on next.

The current heart risk scores don’t apply to all patients and certainly don’t account for all known heart disease factors.

A risk score should be something actionable and empowering. Not a data point that induces fear or paralyzes the individual.

Heart Risk Score

A sedentary, obese 17-year-old videogame player who eats a processed diet will have a low score, mostly because her age is highly protective. Her risk score is low, meaning her heart disease risk is low.

There hasn’t been enough time for inflammation or atherosclerosis to take effect.

The risk score has several factors I take into consideration but each risk factor carries a different weight.

A thin, active smoker who eats a healthy diet will have a very low heart risk score because the other factors are quite protective. More protective than the negative effects of the smoking habit.

Heart Disease Risk Factors

Most of my health coaching clients already know the most common risk factors:

  • age
  • high blood pressure
  • diabetes
  • high cholesterol
  • obesity
  • family history
  • nicotine
  • sedentary

But that doesn’t tell the whole story. To dive in deeper, I also want to factor in other heart risk score factors.

  • high-stress
  • low heart rate variability
  • central adiposity
  • insomnia
  • autoimmune disease
  • air pollution
  • diet
  • muscle mass
  • hydration level
  • medication use
  • noise pollution
  • substance use
  • alcohol use
  • coping strategies
  • sleep apnea

Using the Score

What’s the use of a score if it just makes you fearful? The purpose of the score is to create awareness and empowerment, and spark action.

If obesity is the biggest factor, then we might address that first. But if it’s the hardest factor for the client to change, we’ll focus on other high-risk factors instead.

There is no one-size-fits-all. Each one of us is unique. Everything we do matters, and our health is perpetually evolving.