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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.

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Diet Heart Health Prevention

Salt Intake and Heart Disease

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

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

Is Salt Bad for You?

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

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

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

Salt in Prepared Foods

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

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

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

Bread and pastry and soups are other classic culprits.

Salt and Vascular Stress

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

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

How Much is too Much

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

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

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

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

Salty Taste is a Habit

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

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

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

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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.

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Heart Health Treatment

Supporting a Health 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, and less emphasis was placed on supporting the patient.

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.

Patient support always results in better long-term outcomes than offering someone a quick medication or procedure.

Supporting my Heart Health Clients

Empowering my clients means spending long sessions side by side. They and I must 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 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 suppose we didn’t spend the time to talk about how beta-blockers work and what common side effects they have. In that case, 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.

Heart Health Coaching
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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.

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