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Heart Health Hyperlipidemia Treatment

Should We Be Testing for Lp(a)?

No doubt those with elevated Lp(a) have a higher risk of ASCVD, but the question is whether testing for Lp(a) is beneficial if we don’t have effective therapies for lowering it.

Lipoprotein (a)

It isn’t the best nomenclature, but this word refers to a low-density lipoprotein containing a particular molecule called apolipoprotein(a) or Apo(a).

The blood levels of Lp(a) are affected by a few factors, one of which, of course, is the LPA gene that encodes this molecule. Dietary habits, age, or sex don’t seem to affect your Lp(a) values.

It’s important to check for Lp(a) in the same lab for monitoring levels, but it may not be the best way to work with this lab value. Most experts will check this one or two times in the patient’s lifetime because it’s meant to be an indicator of overall risk.

Lp(a) is made up of a liporptein plus ApoB and Apo(a). The Apo(a) portion can independently elevate the risk for clotting.

Lp(a) & Disease Association

We know from observational studies that those who walk around with higher Lp(a) levels tend to have a higher risk of ASCVD, coronary heart disease (CHD), cerebrovascular disease (CVD), and aortic stenosis.

This molecule is also an acute phase reactant, so those with inflammation will have higher values. Meaning also it shouldn’t be checked during times of inflammation.

From a UK study of half a million individuals we know that for levels above 20 nmol/L there was an increased association with ASCVD. Which translates to a 10% higher risk for each 50 nmol/L increment above this value.

Lowering Lp(a)

Unlike someone’s LDL values, we don’t have good tools to lower a patient’s Lp(a). At least, that’s the current widespread consensus. Some experts believe there are treatments (medications) in the pipeline that will lower the serum level of Lp(a) but as much as 80%.

The next question is whether lowering Lp(a) levels would change someone’s health outcome.

With HDL and homocysteine levels, we have seen that changing the value of these in the blood through directly targeted medications doesn’t have an actual cardiovascular disease outcome.

So, we’ll see if medications that lower Lp(a) will change a person’s ASCVD. Some of the upcoming clinical research should reveal that.

How To Treat Elevated Lp(a)

Some countries, such as the UK, regularly test their patients for Lp(a). But all countries are still waiting for final results to figure out which Lp(a) lowering treatments will actually lower the risk of atherosclerotic heart disease.

It’s important to recognize that statin therapy can sometimes elevate Lp(a). Again, this is the tough part of understanding the complicated interplay between the different key players in heard disease.

Fortunately, despite the rise in Lp(a) caused by statins, those at risk will still benefit from statin’s independent anti-inflammatory and LDL lower effects.

1. PCSK9 Inhibitor

Though PCSK9 inhibitors seem to lower Lp(a) values, it’s unclear whether they can lower the risk of heart attacks in those with high Lp(a) values.

2. Lipoprotein Apheresis

Similar to dialysis, though not as severe, this can be used weekly to lower Lp(a) values by 70% or more.

3. Antisense Therapies

Some antisense oligonucleotide treatments are being researched to lower patients’ Lp(a) levels.

4. Inclisiran

Leqvio is a medication for those with elevated ASCVD disease risk who may not be candidates for standard treatment alone.

This molecule works in the synthesis pathway of the PCSK9 protein.

Serum Lp(a) Values

Serum values above 165 nmol/L seem to be associated with the highest risk such as coronary heart disease death, heart attack, or needing immediate vascular intervention.

Some believe values above 125 nmol/L equate to elevated risk, and other experts set that bar at 50 nmol/L. The patient’s clinical history obviously matters a lot.

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Diet Heart Health Metabolic

Approaching Weight Loss

The topic of weight loss is both a medical topic and one that is emotionally charged. Many of my health coaching clients blame themselves for their weight problems and believe that more willpower will lead to better outcomes.

Being overweight or the diagnosis of obesity is a medical condition the same way pneumonia or back pain is a diagnosis. If gaining weight is done simply by eating more then eating less should result in weight loss. And this discrepancy is precisely why weight loss is more complex.

My approach to weight loss is unique as I’ll highlight below. For those whose weight negatively affects their cardiovascular health, we create an individualized plan and tackle obstacles to obtaining an ideal weight.

Reductionist Thinking

In western medicine reductionist thinking is abundant. If you have a urinary tract infection you must take an oral antibiotic. If anyone has diabetes they must be started on medications.

Reducing any concept down to one easily explainable idea is a pitfall. It prevents more insightful thinking.

I don’t reduce obesity down to a calorie issue. This makes sense on paper in a calorimeter but the human body is agnostic to our mental models.

Weight Loss Drivers

There are several factors that affect weight loss. I see this in my clinical practice when a patient unintentionally loses weight. Below are examples.

56-year-old Mary

Mary is a 56-year-old woman who always carried an extra 50 lbs, as she put it. Her kids had grown up and she got laid off which was the perfect excuse to move to a remote city in Mexico where her husband found a job with an electrical company.

The type of food she had access to was very different there. Busy with getting settled in she didn’t pay any attention to her weight until her clothes started being too big. Without pizza, pasta, ice cream, or bagels her weight was coming down rapidly.

The activity levels she always wanted to engage in like riding a bike or hiking suddenly were much easier. It was her lower weight that made it easier for her to be more active. This, in turn, made her lose even more weight.

44-Year-Old Jesus

Jesus got diagnosed with an inflammatory bowel condition which caused him severe diarrhea and bloody stools. He was about to lose his health insurance so he decided to not start on any new medications but he met with a nutritionist who suggested a diet to help prevent further flare-ups.

Jesus was petrified of the blood in his stool and was committed to never seeing that again. Though stressed about work he bought those college-style bound notebooks and kept a food journal and meal planned as instructed by this nutritionist.

He was told to eat fish, olive oil, fruits, nuts, seeds, oats, and legumes as much as he wanted. The items to avoid were bread, white rice, alcohol, pasta, desserts, and anything fried.

Jesus was never worried about his weight and felt that for his height he had a normal physique. At 5’10” and 205 lbs he described himself as stocky but not fat or skinny/scrawny, which was what kids teased him about when he was in grade school.

9 months later when he found a new job and could afford health insurance again, he saw me for the first time and was quite concerned about his weight loss. He had lost around 27 lbs and believed it was due to the inflammatory bowel disease.

Foods that Help with Weight Loss

It’s clear from the examples above that changes in what we eat impact weight loss. For some individuals certain foods are obesogenic – they cause a high spike in blood sugars which results in fat deposition and more hunger.

But there is no one diet that helps every person lose weight – human physiology is simply not the same from person to person.

I, for example, can eat a lot of fruit without gaining weight. Trying the same diet for some of my patients results in rapid weight gain. Therefore, it has to be individualized. But some generalizations can be made.

1. Slow Carbs

Slow carbs are whole grains and seeds such as 100% whole wheat or brown rice, quinoa, barley, oats, etc. These tend to not cause a sudden spike in blood sugars which helps curb hunger later in the day but also signals decreased weight retention.

Slow carbs versus higher glycemic load or glycemic index carbs seem to also help lower high blood pressure. Something Jesus also noticed from the example above.

2. Fiber

Fiber is filling and helps many maintain healthy gut flora. Though some believe that fiber is not needed many of my patients do well with it, anecdotally.

Avoiding it is generally a bad idea. But it’s easy to overdo it. Beans, generally quite high-fiber, can be well tolerated by some but someone else can only handle 1/4 cup without getting a lot of GI symptoms.

3. Healthy Fats

Certain fats are more obesogenic. Milk and fatty meats seem to not be ideal food choices for weight loss.

Olive oil, fish, avocados, nuts, and seeds are better fat/oil choices for someone trying to lose weight.

Some physicians recommend avoiding fats altogether and eating more starches. Perhaps you have the kind of physiology which would respond well to this. Experiment and find out.

4. Plant Proteins

Animal foods tend to be a bit more calorie-heavy but less nutrient dense. As in, they satisfy your macronutrient needs but may not have enough micronutrients.

Obtaining proteins from plants is a good option for many of my Heart Health coaching clients. Does this work for everyone? Absolutely not. We are all unique and our response to certain foods must be taken into consideration.

5. Nuts

Without brown rice or something oily, it’s hard for me to feel satiated. Nuts and seeds are ideal for me after a lighter meal. It’s my dessert and helps me feel full.

I could also feel full with a fatty whip cream or ice cream dessert but the weight and health consequences from that aren’t worth it.

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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Diet Heart Health Hypertension

Carbs and Blood Pressure

The human gut benefits from a balanced diet. It can withstand quite a poor diet for short periods. But, in the long run, there has to be a balance; otherwise, we suffer health side effects. Carbs and blood pressure are an example of this improper balance.

Carbs and high blood pressure correlate closely. It doesn’t mean you have to cut out carbs, but it’s important to choose carbs wisely and get plenty of fiber or protein in the diet.

Blood Pressure and Diet

It’s not that you are trying to hurt yourself, but some of your diet decisions may not be ideal for your unique physiology.

Functional nutrition is a branch of medicine focusing on each person’s unique physiology and microbiome. One person does well with a lot of processed carbs, while another suffers health consequences from the same diet.

I have patients whose blood pressure isn’t affected by salt. They might suffer other issues, such as vascular stiffness, but their blood pressure doesn’t falter.

Carbohydrates – specifically processed carbs – seem to affect most of us negatively over the long term. Carb consumption has a reasonably direct relationship with our blood pressure.

Carbs and Blood Pressure

Fortunately, it doesn’t mean you have to adopt a ketogenic or carb-free diet.

The balance of your macronutrients could help protect against the downsides of a high-carbohydrate diet that is mostly processed.

Certain foods have carbohydrates that digest slower than other carbohydrates. You can test it out by wearing a CGM or checking your blood sugar every 30 minutes after certain meals.

Some carb-rich foods will spike your blood pressure. A continuous blood pressure monitor is helpful for this. But checking your blood pressure every 30 minutes will be as effective.

A Balanced Diet

Some nights I eat a late meal that’s heavy in processed carbs. For example, it might be a homemade burrito with white flour and white rice.

The timing of this late meal, combined with the high glycemic index, often leads me to snore heavily at night, wake up congested the next day, and raise my systolic blood pressure by at least 10 points.

But if the tortilla is a whole-wheat tortilla and I have brown rice with plenty of veggies and go easy on the salt, my body handles it much better.

Heart Healthy Diets

There is no single diet out there that works for everyone. Many argue that diets as a concept of achieving health don’t make sense.

Chances are there are many foods you can eat and remain healthy. However, a dietary adjustment may be needed to achieve Heart Health once you are dealing with a particular cardiovascular disease.

Schedule a session with me today to discuss how to experiment with your diet to figure out what foods are best avoided and which to consume more of.

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Heart Attacks Heart Health

Fearing a Heart Attack

The health anxiety surrounding a heart attack can be overwhelming. Every little pain or twinge makes you wonder if your heart is about to give out. The reality is that your heart is much more resilient than you might think. Fearing a heart attack is definitely worth discussing but often not as dangerous as you think.

Heart Attacks Aren’t Always Fatal

Having seen many patients in the urgent care and emergency room, they present with chest pains. I order an EKG and see they have a heart attack or perhaps had one recently.

Unfortunately, a little under 50% of adults might have a fatal heart attack, but symptoms are often quite telling.

They might have sudden fatigue or nausea or chest pains or shortness of breath with certain actions. But of course, there are cases where the plaque breaks off suddenly without previous underlying coronary artery stenosis.

The Fear of a Heart Attack

Fearing a heart attack – the fear itself – is often detrimental. And we fear it because we worry that if we don’t fear a heart attack, we may not do anything about it.

The hearty attacks which kill you won’t have any control over. At least not the heart attack (myocardial infarction) itself. But you can affect the chance of a heart attack by living a “heart healthy” life.

The anxiety and stress of fearing a heart attack have little value. It adds little to your decision matrix and keeps you in a negative loop.

Preventing a Heart Attack

It’s never too late to start working on your heart health. I’m not a fan of terms like a “heart-healthy” diet or lifestyle because they reduce the problem to a few individual actions.

The body and the mind are connected even if we wish they weren’t. The outlook and expectations you have feed back into your cellular health, down to the last cardiac myocyte.

To prevent a heart attack, the key factors are:

  1. stress
  2. sleep
  3. diet
  4. inflammation
  5. activity
  6. individual risks
  7. environment

Your individual risk might be the genetic factors predisposing you to your particular cardiovascular condition.

Your environment may not be conducive to your optimal heart health, etc.

When the Fear Comes

You’re sitting somewhere or coming back from the gym and feeling off. You feel something in your chest, and your heart rate goes up. You think you’re damaging your heart or having a heart attack causing you to sweat.

Everything spirals down quickly, and you fear the worst.

A deep breath at this point is the best medicine. Sit down, just be present. Feel what’s going on in the chest. Feel what’s going through your head.

Sit with it without trying to change it. They call this mindset a mindful approach to anxiety or stress, or any feeling. It works because you don’t try to take full control of the situation.

If your gut tells you that you should call 911, then that’s what you’ll do. If you feel it could be benign, you can decide to wait.

It feels good to have faith in your instincts and your body.

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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

Overcoming Food Cravings

I haven’t succeeded personally or with my patients in overcoming food cravings. I have found that embracing it and accepting it goes a long way.

If you get the strong urge to binge or eat something unhealthy, allow yourself the space to accept the urge. It doesn’t mean that you should binge or eat the unhealthy thing, though that is also precisely what might happen.

Food Cravings and Their Origin

Not to get too philosophical, but the craving for food either comes from genuine hunger or from some emotional state.

Genuine hunger is rarely something you have to battle. It’s there, and it’s uncomfortable, but it’s manageable. You feel it but can cope.

An emotional food craving is what I get when I have a stressful day ahead of me or spend a few days or hours stressed out.

Stress, anxiety, fear, the unknown, insomnia, or chronic pain are all factors that can spark a food craving.

I often don’t know I’m stressed or worried until I chase down a restaurant on my food delivery app. But what I do with this emotional food state is what’s the most important.

Accepting the Food Craving

It’s never helped me to be hard on myself because I am craving to binge. It hasn’t helped when I’ve restricted after a binge. Nor has it been effective when I’ve chewed myself out in my head for being weak or not sticking to the plan.

Allowing the food craving however has been a miracle. It has allowed me to overcome the food craving because it’s no longer something bad. It’s nothing that I have to fight and I just embrace it lovingly and await what’s next.

The Result of Acceptance

When I’ve accepted my weaknesses or shortcoming or whatever they are called I’ve found myself in a more peaceful state.

Overcoming food cravings only happens when I embrace the feeling and accept what is happening. No judgment and no resistance.

Oftentimes I end up eating unhealthy food or binging or whatever else. But the long-term consequence has been that overall I make solid food choice which are in line with my health goals.

Accepting the Bad

Imagine if we could all be okay with being inadequate, incompetent, lazy, or whatever other derogatory adjective we’ve created in our modern society.

Doesn’t it feel great to not to have to judge yourself and not have to spend energy and negative feelings judging others?

Food cravings that stem from health anxiety or body dysmorphia are tough to battle. But they are very easy to embrace. It’s in the embracing that the cycle disappears.

Unhealthy Food and Health

As I’ve mentioned before, it’s more important that you eat the rightt foods and less important if you sneak in something bad as well.

I care more that my patients get a nutrient-dense diet in their body and I’m less worried about the few chips or sugary foods. Get the right diet in and we can work on shifting the bad calories to better calories in the future.

One single unhealthy meal won’t ruin your health. Even decades of bad eating likely won’t affect you as long as you can turn things around.

Categories
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
Heart Health Heart Health Clinic

Slow Medicine for Healing

Modern medicine relies heavily on chemicals and surgeries for quick treatments. However, healing and cures take time. It’s what many refer to as slow medicine.

The healing is facilitated by health experts, and the curing is mainly done by nature – it’s the body’s work.

Slowing Down Western Medicine

I’m a big fan of more extended visits with my heart health clients. I often need an extra hour to make it through the most essential points.

I need time to get to know them as individuals and then learn about how they view healing and what health means.

In my clinical practice I spend on average 7 minutes with a patient. There is just enough time for pleasantries, followed by a prescription or a canned response to a classic clinical presentation.

Slowing down western medicine is unlikely to achieve the results we are looking for.

Slow Medicine and Heart Health

Slower medicine means allowing my heart health clients to come along for the ride. They need time to digest my perspective on heart health and share theirs.

The cardiovascular system doesn’t respond as quickly as the skin or the musculoskeletal system. It needs time and fine-tuning.

This style of care is as much about building a relationship with my client as it is about giving time for the vessels and neurovascular structures to adapt to the adjustments.

More Time with You

Sometimes I spend 2 hours talking to a client. Slow, indeed. But we’re not talking about blood pressure the entire time.

I don’t take socialization for granted when it comes to healing. Avoiding a rush in care allows for tangents and deeper conversations.

I learn from my clients as much as they learn from me. I need the time afforded by slow medicine to have a chance to help with healing.

Categories
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.