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Heart Health Treatment

Fixing vs Supporting a Client

I trained as a family medicine physician and obtained my MD from UCLA Medical School. There, the mentality has been to intervene to fix a specific medical problem.

However, with more years under my belt, I can do more good by supporting my clients and patients instead of offering a fix.

Looking for a Fix

Some clients seek to have their problems solved for them; they hope to be fixed. But this can diminish their autonomy and lead to downstream problems.

Feeling so frustrated and drained is expected that you want someone to take over your care and solve your health problems.

Perhaps you’ve tried all sorts of diets and pills and interventions. Now, you are ready to give up because there seems to be no viable solution available.

Supporting my Heart Health Clients on Their Health Journey

Empowering my clients means spending long sessions side by side. It requires that they and I understand the exact problem before looking for solutions.

Is the chronic swelling in the legs the problem, or is the underlying fear of heart failure that hasn’t been addressed?

When we support someone, we tell them they aren’t alone. We offer our expertise and resources to them and guide them on their journey.

Quick Fixes are Possible

A client of mine took a beta blocker medication for his hypertension which caused him major dizziness and weakness. He didn’t know this was the side effect of the medication and assumed it was the high blood pressure.

We sat down and discussed the symptoms and reviewed his medications. He felt armed enough with the knowledge to bring up the medication side effects with his PCP, who changed it to an ACE-I medication.

The symptoms disappeared. Easy fix, right?

In some ways, it was an easy fix. But if we didn’t spend the time to talk about how beta-blockers work and what common side effects they have, it’s entirely possible he would have bounced from one medication to the next, never feeling like he had some control over his medical condition.

Patient Autonomy

Western medicine can sometimes seem adversarial because physicians feel pressured to fix a clinical problem as soon as possible.

We fear a terrible outcome for our patients, so we take over the wheel. In the long run, this turns out to be an unhealthy patient-doctor relationship.

The intention is often good, but this has resulted in a healthcare system where the physician practices defensive medicine and the patient feels ignored.

Fostering patient autonomy starts with patient education. This empowers the individual and leads to better long-term relationships and health outcomes.

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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

Reversing Atherosclerosis in Arteries

Some heart health programs aim at reversing atherosclerosis in the arteries, but this may not be a necessary goal.

Preventing atherosclerosis should always be the primary goal. From what we eat to our blood pressure and activity levels, good data shows how to prevent plaque buildup.

Once plaque has built up, it’s more important to stabilize unstable plaque and prevent the progression of atherosclerosis.

If a plaque is stable and the artery is able to dilate appropriately with changing physiologic demands it’s perhaps unnecessary to reverse the size of the plaque.

Achieving Plaque Reversal with a Super Low-Fat Diet

The arteries, as opposed to the veins, are the vessels exposed to higher pressures and, therefore at risk of plaque buildup.

The goal of plaque reversal is often to put an individual on a diet that will decrease the cholesterol so much that the plaque dissolves.

However, such low-fat, low-cholesterol diets are difficult to stick to and could create certain nutritional deficiencies for some.

They can be a great tool for a short period of time to achieve a particular lipid profile. But as a long-term method of dissolving plaque, it’s not sustainable.

Reversing Atherosclerosis in the Arteries

Even if you managed to cut out avocados, nuts, olive oil, and other fat sources, the existing plaque likely won’t just break up and dissolve in the blood.

The buildup on your drain won’t break up no matter how careful you are to avoid putting fat down the drain. Fat particles don’t readily dissolve in water.

The few studies that have shown reversal have achieved this, likely partly from the plaques shrinking and improved dilation of the arteries.

Intravascular ultrasound of atherosclerotic plaque in the coronary arteries isn’t feasible for most individuals but could play a major role in researching plaque reversal.

Stabilizing Instead of Reversing Plaque

As a summary, it’s more important to prevent plaque than reverse it. What about existing atherosclerotic plaque?

For the plaque that is already there it’s important to stabilize it. We don’t want it to break loose and cause a clot which could lead to complete obstruction of the vessel.

Stabilizing means controlling inflammation and helping the plaque remodel into a less brittle structure. Achieving this requires a bit of art because there is no clearly defined path towards preventing plaque rupture.

I invite you to explore your Heart Health with me. To find out more about my work, click the link below.

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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.

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Diet Heart Health

Too Many Heart Healthy Diet Options

I am currently reading a book about heart-healthy diets, and the week prior, I finished a book giving nearly the opposite advice. With so much research and diet experts, it’s normal to have too many heart-healthy diet options.

I don’t believe that there is one correct diet option out there. That’s the wrong way to approach this health topic.

Heart Healthy Diet Options

There is the ketogenic diet which is quite popular in 2022. Before that, it was the low-carb diet and the Paleo diet.

Low-fat was the craze during all of my medical training from the late 90s into the early 2000s.

There is the vegan diet and whole plant-based diet, and the Mediterranean diet. And oil-free versions of each of these.

Focusing on how these diets are different is counterproductive. There is more value in teasing out what they have in common.

Even more critical, which individuals benefit from which diets? An individualized approach is often superior to population-based medicine.

Individualized Approach

Even some whole grains and organic fruit might tip them over if I have a highly insulin-resistant patient.

A ketogenic diet is the right solution for these individuals, perhaps for a short period of time. Eventually, like all of us, a person has to learn to eat intuitively instead of following a diet.

Some can stick to a particular diet. But inherently, diets have little wiggle room, which leads to a high dropout rate. And their long-term results tend to drop off after the first few years.

A patient with very active Inflammatory Bowel Disease (IBD) will not do well with a high-fiber diet. And the patient with Chronic Kidney Disease (CKD) won’t help their kidneys with a high-protein diet.

Food & Heart Health

I don’t focus on just the heart in my heart health coaching practice. If I achieve optimal cardiovascular health through a heart-healthy diet option but ignore the liver or brain, I will have failed the individual.

A diet ideal for the cardiovascular system will minimize insulin resistance, offer the right amount of dietary fats, and decrease inflammation.

Controlling inflammation might be more critical depending on where you are on your heart health journey. Later in your journey, decreasing peripheral resistance may be more critical.

What The Diets Have in Common

Heart-healthy diet options often have sustainability and high nutrient content in common.

Such diets offer the right macros to the individual without exacerbating any particular disease condition.

Few of these diets will provide excess calories, and the food sources are among the highest quality. Even if you are averse to the term “organic,” the foods in these diets are often grown in a way that requires fewer antibiotics and pesticides.

These diets have hardly any processed oils, fats, sugars, or proteins. Some will recommend adding coconut oil, olive oil, or butter, but that’s generally as processed as it gets.

Categories
Heart Attacks Heart Health Metabolic

Atherosclerosis and Inflammation

If you’re interested, you can read about how a coronary plaque ends up causing a blockage of the vessel and eventual ischemia. It’s often not what most people think. In this article, I will discuss the basics of how atherosclerosis and inflammation play a role in heart health.

Atherosclerosis

Plaque is the buildup inside an artery, leading to decreased blood flow and sometimes complete lack of blood flow – obstruction.

With obstruction comes ischemia – lack of oxygen to nearby tissue; not just muscle but the vessels themselves, the nerves, and connective tissue.

You need cholesterol to build up the plaque. With a total cholesterol value below 150, achieved naturally without medications, it’s rare to see someone develop much plaque in their arteries.

Another ingredient for plaque buildup is hardened vessels and increased pressures or turbulent flow of blood through those vessels. Hypertension can cause this; lack of exercise or inflammation can also contribute.

Unstable Plaque

Let’s lay the cards flat on the table – we don’t know much about inflammation. Astute clinicians can recognize inflammation when they see it. There are specific biomarkers that are helpful as well.

Inflammation adds to the problem of atherosclerotic and negatively affects heart health because it leads to unstable plaques.

A plaque is like a scab on a wound. If it’s the right time for it to come off, it’ll fall off without any bleeding. Rip it off prematurely, and you’ll get fresh blood.

That fresh blood will clot in the artery and create unstable plaque is prone to rupturing and exposing those raw surfaces. Suddenly you go from a tiny plaque to a massive clot that halts all blood flow in that artery.

Measuring Inflammation

There are several biomarkers that can tell us there is inflammation. But it’s not biomarkers alone I use in my practice.

Some people with inflammation in their bodies may never develop unstable plaque. And some with inflammation may not have much plaque, to begin with. But that might be the exception.

If someone has atherosclerosis, my goal is to increase their exercise capacity – both cardiovascular and anaerobic. Next, I want their systemic inflammation to be as low as possible.

Examples of inflammatory biomarkers:

  • CRP
  • ferritin
  • ESR
  • homocysteine
  • uric acid
  • triglycerides
  • HDL
  • platelets
  • neutrophils or leukocytes
  • insulin

Atherosclerosis and Inflammation

In regards to heart health, atherosclerosis isn’t a death sentence. Most of us will develop it, and less than half of us will suffer heart attacks or other complications because of it.

Preventing atherosclerosis is what I do in my program – that’s my main goal. But most of those who come to me already have atherosclerosis.

Plaque and inflammation have an essential relationship in heart health which I address with this second group. I want to decrease their total body inflammation to allow newly formed plaques or old plaques to stabilize.

Other Inflammatory Markers

No need to do these blood tests. Even without serology, we can tell if someone has inflammation.

The following are inflammatory markers I use based on signs and symptoms:

  • obesity
  • acne
  • rosacea
  • seborrheic dermatitis
  • joint pain
  • fatigue
  • sleep disturbance
  • agitation
  • sound sensitivity
  • GI changes
  • heavy menses
  • concentration issues

As you can imagine, these are rather subjective. Even if you have a little bit of all of this it doesn’t mean there is inflammation.

We use these data points as a guide. With them, we change our diet and lifestyle and reevaluate. If these markers decrease, then inflammation is likely.

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Diet Heart Health

Vegan vs. Whole Plant-Based Diets

There is no one diet to prevent or treat cardiovascular disease. Each person will benefit from an individualized approach. But I am asked about vegan vs. whole plant-based diets and wanted to address it here.

A plant-based approach isn’t the only way to achieve heart health but for those who want to cut animal products out this article is relevant.

Vegan Diet

Veganism is more of a religion than a diet. It’s a way of life for many where their aim is to minimize human and animal suffering.

Vegans also eat a plant-based diet but often have a high-carb and high-fat version. Not always, but easy to overdo it with vegan cheese and fake friend meats.

Most vegan restaurants serve highly processed foods. And vegan items in the grocery store aim to mimic a western diet, so there are a lot of oily and meat-looking items for sale.

Processed food is the enemy of heart health. And so, most vegan options tend to perform poorly regarding cardiovascular health.

Whole Plant-Based Diet

A whole plant-based diet is much more heart-friendly because it focuses on nutrients. Most whole plant-based food options are nutrient-dense and, by definition, not processed.

Hummus – sesame seeds, garbanzo beans, lemon, salt – that’s a whole plant-based food. But the version you buy in the grocery store often has many more processed items. Often, it’s loaded with oil to increase the calorie content.

A white flour tortilla is vegan but not healthy. But a 100% whole wheat tortilla (ground whole wheat grains, water, salt) is relatively healthy.

But grains or gluten-containing products aren’t right for everyone. That’s why I maintain that there is no perfect diet for everyone. It’s per individual.

Olive Oil

Inevitably the discussion next goes to olive oil when we compare vegan diets to whole plant-based diets.

The latter has no place for olive oil. But vegan food is often saturated with oils. For some, this isn’t an issue. For many, the extra oil can accelerate atherosclerosis.

Olive oil has some health properties, but like any good thing, it can raise cholesterol levels. This could (not will, but could) increase the risk of plaque deposits on the lining of the arteries.

Heart Healthy Diets

In my practice, we experiment with different foods and have items we cut out right off the bat.

If the cholesterol profile responds well and the inflammatory markers go down, we continue to make small adjustments.

To achieve heart health, I wouldn’t worry about olive oil. I would first worry about a diet with processed food ingredients – many ingredients you can’t pronounce or items you don’t recognize.

Exercise, stress management, minimally processed diet, and insulin management. Those are the most important tenets of achieving good cardiovascular health.

We dive into the diet in much more detail for those who still need tweaking. For one person, there is an absolute need for fish oil. For another, they have to cut out beans because of the inflammation it causes.

Categories
Heart Attacks Heart Health Statins

Statins for Heart Disease Prevention

Statins are prescribed either for existing heart disease or to prevent heart disease. Preventing heart disease is referred to as a primary prevention strategy. Let’s discuss if statins for heart disease prevention are as effective as advertised and what other factors one should consider.

Statins to Prevent Heart Disease

Statins have gone through a lot of recommendation changes over the years. Some statins stand out more than others.

But there are still a lot of disagreements when it comes to using statins for the prevention of heart disease. This means using a statin for someone who is otherwise healthy but wants to prevent a heart attack.

In western medicine, it’s the standard of care to prescribe this medication to individuals with high cholesterol or diabetes, hoping it will prevent a heart attack.

The Actual Numbers

Think back to your high school class. Let’s say you had 150 people in that class. If everyone in that class took a statin to prevent a stroke, then only 1 out of 150 would benefit.

In other words, 150 people would have to be treated to prevent 1 stroke. And 100 would have to be treated to prevent 1 heart attack.

We refer to this as the NNT – the number needed to treat.

The Harm of Statins

Fortunately, statins are relatively safe medications. Yes, some people develop terrible side effects with them. Some even can develop diabetes or muscle or liver damage.

Obviously, we wouldn’t prescribe medication unless it was absolutely necessary. If only those who really needed this medication took it, the risk of statins would be far lower than its benefits.

But the actual harms of this medication – 1 in 50 would potentially develop diabetes, and 1 in 10 would develop muscle pains or damage.

Preventing Heart Disease

So what does work if not statins?

Controlling your blood pressure, eating a healthy diet, and maintaining a healthy activity level seems to decrease your risk of a heart attack.

Other factors like stress and cholesterol matter but are closely tied to your diet and activity levels.

The Individual Factor

As a physician, I don’t like talking about medication or an illness in general terms. Each person is unique, and all things matter. I learned this phrase from my functional nutrition course.

Each person is unique, so we must approach each person’s risk factors and decisions individually.

All things matter means that the patient’s individual abilities and lifestyle factors determine what intervention we choose or don’t choose.

Categories
Heart Health Hyperlipidemia Statins

Do Statins Prevent Heart Attacks?

For the right patient, a statin is a lifesaver. But do statins prevent heart attacks? They are used to lower cholesterol levels, but some will still suffer a heart attack even when taking a statin.

It’s essential to understand this concept. You can still suffer a stroke or a heart attack while taking a statin medication.

Primary & Secondary Prevention

Statins are a group of medications such as simvastatin and atorvastatin. There are others, and each has its place in managing serum lipids.

A statin is prescribed to some patients to lower their cholesterol and prevent a heart attack, stroke, or other atherosclerosis-related medical conditions.

This primary prevention strategy is used for those who haven’t yet had a heart attack or stroke. But many will have had such cardiovascular events and be put on a statin – we refer to this as secondary prevention.

Secondary prevention means trying to prevent a second or third heart attack or stroke.

Statins and Heart Attacks

Western medicine’s big gun remains the statin drug. Even with this, nearly 25% of those on a statin still can suffer a heart attack.

I fished this number from a few studies and my personal experience with my patients. Now that even more patients are on statins, this number likely is higher.

Heart disease is a complicated process. Simply lowering your cholesterol isn’t enough to entirely prevent a heart attack. It’s a big step in the right direction – for some.

Preventing a Heart Attack

A statin won’t prevent a heart attack. It will lower a person’s cholesterol. This lower serum lipid profile may slow the progression of atherosclerosis.

A heart attack can happen in those with normal cholesterol levels. This is why it’s essential to address heart health not just from the serum lipid perspective but from a broader angle.

Whether you’ve already had a heart attack or are trying to prevent one in the first place, it’s crucial to figure out what your risk factors are.

Some of us can easily change our diets, and others will have a hard time with diet but can readily improve their exercise capacity. You’ll significantly improve heart health regardless of which strings you pull on.

Categories
Heart Health Prevention

Calculating a Heart Risk Score

A heart risk score 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.

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, 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, which means her risk for heart disease 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 want to factor in other heart risk score factors as well.

  • 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, 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, then, 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.

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