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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.

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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.

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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.

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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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Heart Health Metabolic

Obesity and Cardiovascular Health

In my practice, I focus on obesity and cardiovascular health only when weight clinically affects heart health. Obesity, in isolation, if all else is optimized, offers only slight improvement if corrected.

Obesity has become a sociopolitical topic rather than a medical one. In my practice, I don’t focus too much on obesity unless it is a unique contributor to my client’s heart health.

Obesity in Healthcare

In western medicine, the patient is considered sick if their BMI is over 25. The patient will always have an ICD-10 code stuck somewhere in their medical chart.

It’s hard to know why conventional medicine manages patient health in such a way. Perhaps it expedites care and makes insurance billing simpler.

It is true that carrying extra weight puts most people at increased risk of insulin resistance, joint problems, sleep apnea, certain cancers, and other metabolic issues. But not everyone.

A person can be obese (BMI > 25) and relatively healthy. They manage their stress well, they are active, and their diet is optimized for their individual needs.

Vice versa, a person can have a normal BMI and not have an ideal metabolic profile. They can still have sleep apnea, hypertension, insulin resistance, and increased cancer risk.

Personal Perspective on Weight and Heart Health

I have clients who carry extra weight but live a good life. They have a diet that fits their individual needs, and they aren’t suffering in any significant way due to their weight.

For such individuals discussing obesity is clinically unnecessary. The minor percentage points of health advantages may not be worth the effort needed to change their weight.

If weight is an important topic, however, affecting their heart health, then we make that a priority. Think of sleep apnea or insulin resistance.

Obesity And Heart Health

I’ve worked with many heart health coaching clients and many of heart risk factors due to their lifestyles. Much more so than due to their body mass index.

We work together to improve their diet, stress, exercise, breathing, chemical exposures, and relationships that change their heart disease risk and improve their heart health.

If my client has the ideal diet, lifestyle, clean environment, sleep, and social support but remains overweight or obese, then we perform calculations to assess their ongoing risk.

This final risk score is how we determine if a weight reduction would add meaningful results; if it would improve this person’s heart health.

The Current Obesity Research

Look, all else equal, it’s potentially better to have a lower BMI – up to a point, of course.

However, we’re talking about an individual and not the population. The current research, just like most research, uses statistics to draw general conclusions. And it generally states a strong correlation between obesity and cardiovascular health.

General conclusions don’t define you and must be carefully applied to individuals. Otherwise, it’s easy to do a lot and not get results.

Most individuals who suffer from obesity also tend to have poor diets. They tend to be sedentary and, therefore, strongly correlate their weight and heart health.

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Diet Heart Health

Heart Rate and Alcohol Use

For most individuals, using alcohol will have a negative or neutral effect on their cardiovascular health. The popular belief that alcohol is good for the heart isn’t something we see in clinical practice. It’s not to say that you should stop drinking. Those who are at risk of heart disease should reconsider their alcohol use. Heart rate and alcohol are closely tied, and we know that alcohol decreases heart rate variability.

Heart Rate

The sympathetic and parasympathetic systems regulate the rate of the heart. The goal is to have a low resting heart rate with good heart rate variability (HRV).

For an in-depth discussion of heart-rate variability, I recommend this podcast episode by Dr. Attia. There, he discusses HRV in much more detail. But remember that just because your HRV isn’t optimal, it doesn’t mean that you will suffer ill cardiovascular health.

Back to heart rate. If you are a tech nerd, you know that your heart rate changes whenever you drink alcohol. Commonly you’ll notice that it’ll be higher than usual and you’ll have decreased variability between beats – decreased HRV, which is less favorable.

Alcohol Use

Some of my clients binge drink, and others rarely drink. In this spectrum, there are those who drink moderately and those who drink several drinks per day.

It also matters the type of alcohol you drink, how dehydrated you get when drinking, and the quality of the beverage. So much to consider, no doubt.

I remain convinced that occasional alcohol use isn’t an issue. But binging on weekends or drinking daily is more challenging for the body to handle.

Resting Heart Rate

It’s hard to ignore my patients who enjoy excellent heart health and the association with their low resting heart rate.

Alcohol and resting heart rate have been studied in detail in the literature. Consuming alcohol regularly seems to increase the resting heart rate.

We work to decrease their consumption for my clients who are at risk of atrial fibrillation or heart failure. And for those who cannot cut down, we develop a strategy to consume alcohol in more ideal circumstances.

Cardiovascular Health

What is heart health or cardiovascular health? Well, it’s how well your heart and blood vessels function. And it depends on how well you want them to perform. Health, after all, is a personal journey.

When I consider my client’s heart health, I think of:

  • blood pressure
  • cholesterol
  • arrhythmias such as atrial fibrillation
  • peripheral vascular disease
  • congestive heart failure
  • heart attacks
  • angina
  • atherosclerosis
  • palpitations
  • POTS
  • exercise capacity
  • HRV

Heart health and alcohol are closely linked in the heart rate is affected. Furthermore, the rhythm of the heart is closely tied to alcohol usage.

Specific individuals are far more susceptible to this, while others can drink alcohol without any changes to their cardiovascular health.

Timing Alcohol Usage

The time of day when you drink alcohol matters. Not only that, but how hydrated you are and your stomach content are important factors.

Whenever possible, I recommend drinking alcohol with a meal and heavily hydrating after alcohol consumption. This helps with the clearance of this compound from the system.

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Heart Health Treatment

Cardiovascular Biofeedback

Biofeedback is time intensive and requires you to work with an expert to understand or “feel” your body better. It’s a potent tool that can improve the functional capacity of your heart or other cardiovascular symptoms.

Biofeedback

I explain biofeedback to my patients as a method of interpreting and understanding the physiological functions of the body. It’s a method of becoming in tune with the body.

In the age of modern medicine, it’s a common false belief that only a heart rate monitor or EKG can tell us about the heart’s function. Though these are great tools, they also improve our sense of well-being regarding the cardiovascular system.

I use biofeedback in my private practice with low back pain patients. Especially for those who have an exaggerated pain sensation, musculoskeletal biofeedback can help them better overcome the pain.

Biomechanical Biofeedback

In this article, I don’t want to focus too much on the technical side of biofeedback. There are incredible tools, from virtual reality to implantable sensors. But let’s start with the basics because it’s the most achievable for most of us.

Biofeedback can be broken down into biomechanical and physiologic ones. In biomechanical feedback, I might measure how much range of motion someone achieves with their low back injury.

Sometimes biomechanical feedback utilizes technology to determine how much pelvic pressure someone can exert with their kegel exercises.

Physiological Biofeedback

Physiological feedback might require some measurement techniques. Neuromuscular feedback may require EEG measurements or gait assessment.

I measure heart rate, respiratory rate, and even cardiac perfusion when providing cardiovascular biofeedback.

Cardiovascular Biofeedback

The common conditions I treat with heart biofeedback include the following:

  • hypertension
  • palpitations
  • shortness of breath
  • exercise capacity
  • chest pain

Individuals with a history of a heart attack want to get back into an exercise routine. Often angina gets in the way. The pain creates a cycle of fear and emotional dissonance, which worsens cardiovascular capacity.

I can show my client on a heart rate monitor what their heart is doing as they increase their activity level. We review this together and dive deep into what they are feeling in their chest, arms, back, etc.

Patient Empowerment

It’s one thing to diagnose a patient using advanced technology, and it’s another to empower a person to manage their own body. Biofeedback methods can empower a person to self-regulate their physiologic processes.

The goal is to work on a particular medical condition or symptoms afflict you. A feedback expert will sit with you and help you recognize signals in the body which you can manipulate to achieve the desired outcomes.

This is powerful in that you can do this yourself moving forward. For most heart-related issues you need a heart rate monitor and an oxygen monitor.

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Heart Health Hypertension

The Basics of Hypertension

I will write a lot more on hypertension – high blood pressure – to address the basics of hypertension and beyond. But there are some excellent ways to think about this common age-related disease. It’s not that easy to diagnose and not everyone needs to have their high blood pressure treated. Are you considering starting blood pressure medications, or have you been worried about your numbers creeping up?

An overview of high blood pressure should get you on the same page as your doctor. Managing this condition is a team approach and needs to happen slowly.

Pharmacologic Treatment

If you treat your hypertension, you will manage it through lifestyle means or by taking prescription medications. You might also try herbal treatments, of which there are a few good options out there—more on that in another article.

Treatments for hypertension decrease the pressure exerted on the heart and the vascular system. Some medications work by getting rid of the amount of water in the vascular system (diuretics); others decrease the tightness of the vessels (vascular dilators). Some medications also reduce the output from the heart (beta-blockers).

The downside to medications is that they have side effects and need to be monitored. There is also no way to know which medication will work off the bat for you. With each human body being unique, it’s essential to know your body before starting these medications. Few cookie-cutter treatments will be effective without considering the individual.

The other downside to managing hypertension with pharmacology alone is that we don’t focus on the underlying causes which led to hypertension in the first place. For some, it’s an aging heart. For others, it’s genetic, yet it’s an issue with vascular resistance.

Lifestyle Treatment

Lifestyle management of hypertension would include focused activity for the individual. It’ll need to be cardiovascular training; for others, it’s resistance training.

Dietary treatments, such as salt and alcohol intake, can also make a difference but not for everyone. When going down the diet, you must be okay with a trial and error factor. 

I prefer lifestyle treatment options because it puts the individual at the helm. One learns a lot about their body when one experiments with their lifestyle to see how their health is affected. 

I will add meditation and breathing and general stress and sleep management. These can be significant factors for some while minimally effective for others. 

Diseases Associated with Hypertension

We forget that continued high blood pressure can lead to various diseases, from heart failure to heart attacks and strokes. It can cause erectile dysfunction and kidney disease. And it can hasten dementia or other cognitive issues. 

It is also among the leading accuses of eye problems and circulation issues such as peripheral vascular disease. 

I mention all of these because treating a single condition such as hypertension can improve your health immensely. You get a significant return on effort investment. 

Diagnosing Hypertension

The easiest way to diagnose hypertension is to slap a cuff on your arm. The problem is that this will miss quite a few hypertensive individuals and overdiagnose some.

A 24-hour blood pressure monitor is probably the best thing to invest in. This can be done by wearing a blood pressure cuff that auto-inflates every couple of hours or by having your doctor order the proper 24-hour blood pressure monitoring device.

A person with a few elevated readings does not mean they have a hypertensive disease. And just because you happen to see regular readings when you check, it doesn’t mean your blood pressure doesn’t get unbelievably high during specific episodes in your life. Such as when you first wake up or after or during stressful events.

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Heart Health

What is Heart Health

It’s important that my clients understand the definition of heart health. This concept can allow you to live a rather comfortable and disease-free life. Or your poor cardiovascular health can get you stuck in the revolving door of healthcare. So, what is heart health? How will it affect you?

Importance of Heart Health

I first encountered the phrase heart health when consulting for a healthcare startup. They focused on managing high blood pressure, which alone was one of the leading causes of heart disease.

#hearthealth fascinates me because the heart plays a central role in overall health. With most pediatric diseases wiped out and antibiotics readily available most of us will make it well into our forties.

With heart-healthy choices, it’s quite likely to make it well into your 80s. A healthy heart can even help prevent other chronic diseases such as cancers or diabetes.

It’s in our forties that poor cardiovascular health can have major health effects. For example, high blood pressure can cause heart failure, kidney disease, or heart attacks.

If you managed to dodge hypertension, you might still face blood vessel diseases such as a heart attack from atherosclerosis or peripheral vascular disease.

Women are at risk of strokes as they age and men at risk of myocardial infarctions and erectile dysfunction.

A Healthy Heart

The heart is at the center of the cardiovascular system and therefore controls everything downstream. This includes the blood vessels and the organs it supplies.

Living with a healthy heart is mostly about prevention; preventing extra strain on the heart and preventing poor cardiac output.

Starting our 40s with a healthy heart means that we can live longer and live a better life. Which is a life with less disease, fewer medications, and fewer visits to the doctor.

Measuring Heart Health

In our modern age of data, it’s common to want to know metrics. So my clients look for a way to quantify the health of their hearts.

There are heart scores we can calculate based on your family history and current cardiovascular health. But achieving a healthy heart requires strong preventative strategies.

Prevention

Fortunately, it’s never too late to start on prevention. Regardless of where you are in your #hearthealth journey, it’s always possible for things to improve or worsen.

Our lifestyle choices strongly impact our heart performance. These choices can be modified one step at a time resulting in a cumulative positive effect on the cardiovascular system.