Don’t wait until you get sick: What you can do to prevent heart disease.

I have been writing recently about heart disease, how it is diagnosed, and what you and your doctor can do to treat it. In order for your doctor to start treating you for heart disease risk factors such as high blood pressure, high cholesterol, or diabetes you need to be diagnosed with one of these conditions. This requires proactively seeing your physician for screening before you start experiencing the consequences of these conditions.

But most people don’t visit their doctor until they have symptoms, and many wait until a more serious event (a heart attack, for example) occurs to seek medical attention. By this time, the disease process has progressed and managing it becomes the goal. It is possible to prevent both the conditions that lead to heart disease as well as reduce the risk that you may have a heart attack or stroke.

Your risk of heart disease is largely determined by health-related attributes and behaviors called risk factors. Some of these risk factors cannot be changed, including age, sex, and family history. Other risk factors are modifiable, meaning you can change them to reduce your risk. These modifiable risk factors include smoking, high blood pressure, high cholesterol, diabetes, obesity, and physical inactivity.

While there are medications that can lower blood pressure and cholesterol and treat diabetes, these modifiable risk factors are best addressed by lifestyle changes. Adopting healthy habits has the potential to have a bigger effect on heart attack risk than medical management. There are three important health behaviors that, together and separately, have a powerful effect on reducing heart attack risk:

Stop smoking. There is no way around this one. Quit! Ask your doctor about prescription medications that can make quitting easier. Nicotine replacement therapy in the form of patches, gum, and lozenges can help manage cravings and are available over the counter. Ultimately, though, quitting smoking is a behavior change that takes motivation, willpower, and time. But it is worth it—your risk of heart attack can drop 50–70% within five years of quitting.

Be active everyday. The importance of physical inactivity as a risk factor for heart disease is often overlooked. But make no mistake, being active on a regular basis is one of the most important things you can do to improve your heart health. Whether you have other risk factors or not, physical activity can reduce your chance of having a heart attack. And if you do have a heart attack, your active lifestyle improves your chances of survival and returning to a normal lifestyle.

The benefits of exercise are well-established and impact heart disease risk in a multitude of ways. Physical activity helps with weight control, lowers blood pressure, improves blood lipids, and prevents and treats diabetes. Think of this as a great health “deal.” By modifying one risk factor—inactivity—you can also promote beneficial changes in four others—obesity, hypertension, high cholesterol, and diabetes. There is no other treatment, drugs included, that can have such a broad impact on heart disease risk!

Improve your diet. If you are like most Americans, your diet is too high in saturated fat, salt, and added sugar and lacking adequate whole grains, fruits and vegetables, and fiber. This type of diet is associated with obesity, high blood pressure, high cholesterol, and diabetes. All of these conditions are risk factors for heart disease, so you may literally be eating your way to a heart attack.

It turns out that adopting a healthier eating pattern is important in reducing your risk of heart disease. Saturated fat intake can lead to abnormal blood lipids and high salt intake is linked to high blood pressure. While eating sugar doesn’t cause diabetes, the type of diet described above is associated with weight gain and diabetes. Just like with physical activity, a healthy diet can lead to improvements in several other risk factors.

The potential impact of these three health behaviors is great. Even modest changes in diet and activity can lead to improvements in risk factors and reduced heart attack risk. More intensive lifestyle modification can produce even greater benefits. In one famous study, daily exercise, a low-fat vegetarian diet, and stress management actually caused regression of heart disease, meaning that the blockages in the coronary arteries were smaller following treatment. While you may not follow such a strict program, becoming more active, eating a healthier diet, and quitting smoking can go a long way to improving your heart health.

The attack of our toxic food environment. And how to fight back!

The term “toxic environment” was popularized by Kelly Brownell, an obesity and weight loss researcher, years ago to refer to conditions that promote the consumption of high-calorie, unhealthy food and encourage being physically inactive. This combination is thought to be a major factor that contributes to obesity and other chronic diseases, so understanding both aspects deserves our attention. Hy Health & Fitness column in the Aiken Standard this week  focuses on our toxic food environment. (Next week I will explore our toxic activity environment)


Fastfood One characteristic of the toxic environment is that food is available almost everywhere. Gas stations have evolved into convenience stares that happen to sell gas, tempting you as you enter to pay. Displays of candy, soda, and other snacks are present at nearly every checkout lane in nearly every store, even stores that have nothing to do with food. You can find vending machines that sell candy and soda most places you go, even hospitals and schools. Many workplaces have a common area where you can typically find a candy dish or a break room with vending machines. Even going to a meeting at work may mean sitting around a table with a plate of donuts in the center. Sure, you don’t have to buy a soda when you pay for gas or take a donut from the plate, but resisting can be difficult. The more you are around food, the more likely you are to eat it, even if you aren’t hungry. Whether your goal is to eat less food or to eat healthier food, the world we live in makes it difficult. It’s not just willpower, either. We are all susceptible to marketing, whether done by a store, restaurant, or a friend with a plate of freshly baked brownies. The power of marketing, combined with the fact that most of us don’t really understand food or nutrition, is difficult to overcome. It gets worse. It turns out that much of the food we are continually exposed to is of poor nutritional quality. Convenience foods such as candy, snacks, and drinks tend to be high in calories, mostly from added sugar and/or fat, and low in nutrients like vitamins, minerals, and fiber. Many restaurant meals, both fast food and casual dining, are similar in this way. Even prepackaged meals that you eat at home tend to be high in calories and low in healthy nutrients. So, not only are we almost always around food, much of that food is unhealthy. It also turns out that these unhealthy, calorie-dense foods come in portions that contain a shocking number of calories that can contribute to weight gain. Think about soda, for example. It used to be that you could buy a soda in a 12 oz. can or a 16 oz. bottle. Now 20 oz. bottles are common and even larger sizes are almost always an option. The same is true for candy and snacks, like chips. As portions increase, so do the calories we consume. To be fair, there isn’t necessarily anything wrong with having so many foods and drinks available to us. We don’t need to eat these foods, right? But, all too often, we do. And when the excess calories from all of this food are combined with a low level of physical activity, a “perfect storm” is created that almost always leads to weight gain. Changing our food environment is difficult, maybe even impossible. But we can change the way we interact with our environment. This includes being more mindful of what, when, and why we are eating. Being aware of internal signals like hunger and external forces like advertising and peer pressure can help us make smarter decisions within our toxic food environment.

What your doctor may do to diagnose and treat heart disease, and what YOU should do

As Heart Month draws to a close, it’s worth understanding a bit more about the tools your doctor may use to diagnose and treat heart disease or a heart attack. And, equally important, what you can (and should) do if you have a heart attack help prevent it from happening again.


Coronary_angiography_of_a_STEMI_patient,_showing_partial_occlusion_of_left_circumflex_coronary_artery


Coronary artery disease or heart disease is caused by atherosclerosis, a process which involves the accumulation of cholesterol plaques in the arteries that supply blood to the heart. These plaques can narrow the blood vessels and reduce blood and oxygen delivery to the heart, leading to symptoms like chest pain (ischemia). The plaques can also rupture and form a blood clot, blocking oxygen delivery and causing a myocardial infarction—a heart attack.

If you experience symptoms such as chest pain or have a high risk of heart disease due to family history and other risk factors, your doctor may recommend a diagnostic test. In a graded exercise test (GXT), or “stress” test, a person exercises, typically walking on a treadmill, at increasing speed and grade while heart rate, blood pressure, and heart rhythm are monitored by a doctor or exercise physiologist.

Stress_test

Changes in these variables, as well as the person’s exercise capacity, can be signs of ischemia and heart function. Often, a GXT is combined with another diagnostic technique such as nuclear imaging, which shows areas of the heart that do not receive enough blood flow, or an echocardiogram that uses ultrasound to show the heart beating and ejecting blood.

Based on the GXT results a cardiologist may recommend an angiogram, in which a catheter is inserted into an artery and threaded into the coronary arteries, dye is injected, and the coronary arteries are viewed through X-ray imaging. This allows cardiologists to actually see the extent of the narrowing in the coronary arteries.

You can been diagnosed with heart disease based on the results of an angiogram or if you had a heart attack. During the angiogram a cardiologist can perform an angioplasty in which a balloon catheter is inflated to open narrowed arteries. A mesh stent may also be placed to help keep the vessel open for longer. In other cases coronary artery bypass surgery may be indicated. Considered open heart surgery, this procedure actually bypasses narrowed sections of coronary arteries using another vessel, typically a leg vein. Both angioplasty and bypass surgery can restore adequate blood flow to the heart and treat ischemia and heart attacks.

Many people consider the treatment complete after the heart attack has ended and the angioplasty or bypass surgery is complete. The truth is that the long-term outcomes are largely based on what happens next. Traditionally, heart disease patients were told to rest and not stress their hearts, a belief that many still hold today. But exercise-based cardiac rehabilitation programs are key to improving heart health and preventing future complications.

Most cardiac rehabilitation programs include several phases. Phase I programs start in the hospital and focus on getting out of bed and performing self-care activities and some walking. Phase II cardiac rehab involves closely-monitored exercise, usually for 12 weeks following a heart attack or surgery. Phase III involves longer exercise sessions with greater independence and transitions into Phase IV, a lifelong exercise program. Education about exercise, nutrition, weight control, stress management, proper medication use, and psychosocial wellbeing are essential in all phases of cardiac rehabilitation.

The benefits of cardiac rehabilitation are well-established through research and practice. In fact, many patients credit cardiac rehabilitation with saving their lives, even if they had bypass surgery. Despite this, less than a third of patients who are eligible for cardiac rehabilitation actually attend a program.

If you or someone you know has had a heart attack or surgery, encourage them to ask their doctor about cardiac rehabilitation—it is likely to be the best way to improve quality of life and avoid future heart problems.

Much ado about nothing: Supplement-free dietary supplements

Dietary supplements, including vitamins, minerals, and herbs, are used by millions of people every day. In fact, over 50% of Americans regularly take dietary supplements. Maybe you are one of them. If so, you should be aware of some recent news that once again raises concerns about supplement use.

This is the topic of my Health & Fitness column in the Aiken Standard this week.


 

Miracle cure pill bottle

The most common reason people report taking dietary supplements is to improve or maintain their health in general, but many take them for specific reasons such as bone health or weight loss. Anecdotal evidence suggests that people who take supplements are healthier than people who don’t. However, supplement users are more likely to eat better, exercise, and not smoke, all of which contribute to good health. [more details here.]

Given the claims made by supplement manufacturers, you may be surprised to learn that there is very little evidence to suggest that taking dietary supplements can improve your health. In fact, no scientific organization recommends the routine use of dietary supplements. Among the few exceptions is folic acid supplementation for women who are or who may become pregnant to prevent neural tube defects in the developing fetus. There aren’t many others.

While there is support for using vitamin or mineral supplements to address individual deficiencies, there is no reason to believe that taking supplements will do much to make a healthy person healthier. The fact that all supplements contain the statement, “This product is not intended to diagnose, treat, cure, or prevent any disease,” should tell you something. At best, taking dietary supplements will cause few, if any, benefits; at worst, they may do harm.

There have long been concerns about the safety and efficacy of dietary supplements. Ironically, this is by design. According to the 1994 Dietary Supplement Health and Education Act (DSHEA) manufacturers do not need to prove that their products are effective, only that they are safe. That said, there are instances in which the safety of dietary supplements has been questioned. [you can find tips for using dietary supplements safely here] Some can interfere with the way that other prescription and over-the-counter drugs work. Others may make certain health problems, like high blood pressure or diabetes, worse. And there is a concern that people might use dietary supplements to treat a condition rather than seeking medical help.

You may have seen in the news recently that the New York Attorney General is taking action against four major chain retailers for selling fraudulent and contaminated dietary supplements. DNA analysis showed that many of the supplements examined were completely lacking the active ingredient and contained other ingredients not listed on the label. In one case, a sample of St. John’s Wort contained no actual St. John’s Wort extract, but did contain the extract of a common house plant!

Some supplements undergo quality testing by independent labs, including U.S. Pharmacopeia and NSF International, and have labels which suggest that you are purchasing the actual substance. Keep in mind that this does not guarantee that the supplement will be safe or effective, just that it has been tested for purity.

Despite these questions about supplement purity, safety, and health benefits, there is nothing necessarily wrong with taking dietary supplements. If you choose to take supplements be aware of potential health risks, know that you may not be getting what you pay for, and don’t expect any miracles. And always make sure you tell your doctor which supplements you take to avoid any adverse reactions with other medications.

Finally, remember that no amount of dietary supplements can match the health benefits of good nutrition and regular physical activity.

Numbers you need to know to prevent and treat heart disease.

February is American Heart Month, an ideal time to assess your risk of heart disease and take steps to improve your health. When it comes to heart disease, there are several numbers, including your blood pressure, cholesterol, and glucose, you (or your doctor) may be monitoring. But there is another set of numbers that are equally important for preventing and treating heart disease that you may not be familiar with: 0, 5, 10, 25, and 30.

What these numbers mean and why they are so important is the topic of my Health & Fitness column in the Aiken Standard this week.


 

Blood test results

0 is for no smoking. Cigarette smoking more than doubles your risk of heart disease and stroke, is by far the leading cause of lung cancer and other lung diseases, and is responsible for over 400,000 deaths per year. If you smoke, quitting now is one of the most important things you can do to improve your health. Nicotine replacement therapy in the form of gum, lozenges, and patches as well as prescription medications can help, but quitting really does require serious dedication. It’s well worth the effort and some benefits of quitting can be realized almost immediately.

5 is for eating five fruits and vegetables each day. A healthy diet is one important aspect of good health. While there is no one single measure of a healthy diet, adequate fruit and vegetable consumption is widely considered to be essential for good health. Fruits and vegetables contain vitamins, minerals, and fiber and most are low in calories. At a minimum, you should eat five servings per day with an emphasis of fresh fruits and vegetables. Your real goal should be to include fruits and vegetables in all meals and snacks, but five servings per day is a good start.

10 is for 10,000 steps per day. Regular physical activity is essential for good health. Almost any activity counts, and a good goal is to be as active as possible throughout the day. You can track your physical activity using a pedometer (step counter) or an app on your phone. A target of 10,000 steps per day is a commonly cited goal, but you should try to take as many steps as possible. You can do this by minimizing the time you spend sitting, taking the stairs instead of the elevator, and walking instead of driving when possible. More steps are better, even if you don’t get to 10,000.

25 is for maintaining a healthy body weight, or a body mass index (BMI) of less than 25. The BMI is a measure of weight relative to height. A BMI of 18–25 is considered healthy, 25–29 is considered overweight, and 30 and higher is considered obese. The risk of health problems like diabetes, heart disease, and some cancers goes up with BMI, so maintaining a healthy body weight is good for your health. If you are overweight you should lose weight, even if you don’t achieve a BMI of less than 25.

30 is for 30 minutes of exercise per day. In addition to being as active as possible throughout the day, you should dedicate a minimum of 30 minutes for exercise or other activity. Considerable research shows that as little as 30 minutes of moderate to vigorous activity leads to improved fitness and health with greater benefits coming from longer duration or higher intensity activity. This can include exercise—a brisk walk or jog, lifting weights, or other aerobic exercise—as well as other activities like housework and yard work. Your goal should be to sit as little as possible, move as much as possible, and make time each day to be active.

What you need to know about heart disease

February is American Heart Month, a time to raise awareness about heart disease, the leading cause of death among adults in the United States. Heart disease, sometimes called coronary heart disease or coronary artery disease, is responsible for nearly 375,000 deaths each year, mostly from heart attacks. Over 13 million adults have been diagnosed with heart disease and, if other cardiovascular diseases like high blood pressure, heart failure, and stroke are included, that number jumps to 80 million. (more statistics are available from the American Heart Association)

The process that leads to heart disease is called atherosclerosis and is characterized by the accumulation of cholesterol-containing plaques in the coronary arteries, the vessels that supply blood to the heart. These plaques narrow the vessels and reduce the amount blood delivered to the heart. The heart requires a constant supply of oxygen to beat and any narrowing in the vessels reduces blood flow and interferes with normal heart function. A decrease in oxygen delivery can cause chest pain (angina pectoris), especially during activity or exertion. It is usually relieved with rest, but can limit normal activities. A complete blockage in blood flow causes a heart attack, also called a myocardial infarction or MI, in which the heart muscle is damaged, sometimes permanently. Many MIs lead to death because dangerous arrhythmias—abnormal heart rhythms—develop that lead to cardiac arrest.

The traditional view of heart disease holds that the cholesterol plaques progressively narrow the arteries until they close completely, a process similar to a blockage in a pipe in your house. It turns out that the process of atherosclerosis is more complex. In fact, most heart attacks occur because of vessels that are around 50% blocked.

Current evidence shows that inflammation plays an important role in the accumulation of plaque in the vessel walls. Additionally, inflammation plays a role in making the plaques unstable and prone to rupture, resulting in a blood clot in the artery which completely blocks the flow of blood leading to a heart attack. This makes more sense if you think of the inside of a blood vessel like your skin. A cut on your finger results in inflammation and the formation of a blood clot which stops blood flow. A similar process occurs inside the coronary arteries to lead to an MI.

The process that occurs in coronary arteries also takes place in other vessels. A blood clot that forms in a vessel in the brain can cause a stroke, sometimes called a “brain attack” because the process is similar to a heart attack. Narrowed vessels that reduce blood flow to the brain can cause a reversible condition called a transient ischemic attack (TIA) or mini-stroke. Narrowed arteries in the legs can cause muscle pain during exercise or activity.

Atherosclerosis is a process that starts when we are young and progresses as we age. It generally doesn’t cause symptoms like chest pain until the arteries are at least 70% narrowed, so most people are unaware that it is happening. The process is accelerated by conditions like obesity, diabetes, high cholesterol, and high blood pressure as well as risk factors like a high fat diet, lack of exercise, and smoking.

Genetics play a role, too, but since you can’t change your genes, the emphasis is placed on factors that you can control. It turns out that making lifestyle changes can greatly reduce your risk of heart attack, and may even reverse the process that causes heart disease.

I will continue to celebrate Heart Month with more information about how to assess your risk for heart disease and what you can do to prevent and treat heart disease.

 

Is chocolate healthy? The depends on what you mean by chocolate. And what you mean by healthy.

With Valentine’s Day quickly approaching, you may be planning to get something sweet for someone special. Traditionally, this typically includes a box of chocolates. While candy isn’t really a healthy option, eating certain types of chocolate has been linked to some health benefits.

The idea that chocolate may be healthy is no doubt welcome news for chocoholics. But it may leave you wondering if eating chocolate really is healthy. The answer depends on what you mean by chocolate and what you mean by healthy.

ChocolateA

First, it is worth understanding what it is about chocolate that may promote health. The health benefits of chocolate have to do with the fact that it comes from a plant, the cacao tree. Like many plant-based foods including fruits and vegetables, chocolate contains phytochemicals, plant-derived compounds that have health benefits. Indeed, chocolate does contain antioxidant flavonoids that have been shown to affect a variety of physiological systems. These flavonoids are also found in a wide variety of fruits and vegetables as well as coffee, tea, and wine. The beneficial effects include dilation of blood vessels, improved blood clotting, and reduced inflammation, all of which can reduce the risk of cardiovascular diseases including heart attack and stroke. Additionally, these flavonoids may lower blood pressure, regulate insulin levels, and reduce stress.

The chocolate that we eat contains two main components from the cacao plant, cocoa and cocoa butter, in addition to added sugar and other ingredients. Cocoa is the non-fat component of the cocoa bean and cocoa butter is mostly fat. The flavonoids are found in the cocoa, so chocolate that is richer in cocoa, like dark chocolate, contains more of these beneficial compounds. For example, dark chocolate may contain 70% cocoa, compared to 25% cocoa in milk chocolate. These flavonoids also give dark (sometimes called semi-sweet) chocolate more of a bitter flavor than milk or white chocolate. This is also because dark chocolate may contain less sugar than milk chocolate, but this isn’t always true.

Milk chocolate contains more of the cacao butter along with other additives, usually milk. White chocolate is made exclusively from the cocoa butter and contains no cocoa, so none of the beneficial phytochemicals. Even though the fat in cocoa butter is mostly healthier monounsaturated and saturated fats, it still contains calories. Sugar, milk, and other ingredients also add calories, so chocolate is certainly something to enjoy in moderation.

One thing to keep in mind is that some of the research into the health benefits of chocolate was conducted in animals, not humans. And some of the research in humans used isolated extracts from the cacao plant, not chocolate. And when subjects were given chocolate it was dark chocolate that is high in cacao. The point is that the evidence for chocolate being healthy was not based on eating more Hershey’s bars!

But given the potential benefits, eating dark chocolate instead of other sweets such as cakes, cookies, and other candy is probably a good idea. Simply eating more chocolate in addition to other sweets will not make you any healthier, and the extra calories could lead to weight gain. Look for chocolate that contains at least 70% cocoa (sometimes listed on the label as cacao or cocoa solids) and remember that a small amount is enough.

Also keep in mind that many fruits contain the same antioxidants as chocolate, so a serving of berries, for example, is a better choice. And finally, achieving good health requires more than simply changing one aspect of what you eat, so include dark chocolate as a part of a diet that includes real food balanced by daily physical activity.