Women Do Get Cardiovascular Disease!

woman weight trains on beach

Physicians are on the verge of practicing personalized medicine. No more shotgun therapy; we will soon be able to identify and target individual-specific diseases and even discern the tendency to develop particular diseases. Yet, while we bask in our soon-to-be success, we cannot neglect the primary way to distinguish and differentiate our patients — gender.

When it comes to heart disease somehow most doctors and laypeople still believe that women are immune to this ailment. Perhaps more misleading, many expect women’s’ experience of cardiovascular disease to precisely parallel that of men. Both suppositions are blatantly wrong.

First, women have an extraordinarily high rate of cardiovascular disease (CVD); annually more women than men die from this spectrum of disorders. The illusion that women are somehow immune to heart attacks and strokes has led to under-recognition and concomitant under-treatment of not only the risk factors causing CVD, but even heart attacks and strokes as well.  Thus, women often die from heart attacks and strokes when they could have been saved. Ignorance may be bliss under some circumstances, but certainly not when it comes to our health.

woman on beachThen there are the assorted gender-based differences in the “experience” of CVD. Women have more angina than men, but they also have more atypical symptoms, shortness of breath being the most common. Women, with mild coronary plaques have a prognosis far worse than that of men with similar anatomy. Women have more diastolic heart failure than men (heart failure in the setting of a strong but stiff heart muscle). Women have many more complications than men when being treated for heart disease, bleeding being the most common. Implausible as it may seem, I could go on for some time differentiating men and women in relation to CVD. These manifold differences are so important that in 2011 the American Heart Association changed doctors’ approach to risk stratifying women for CVD, but not men. And, important organizations such as WomenHeart and the Society for Women’s Health Research were created for the sole purpose of improving women’s cardiovascular care.

The take-home message here is simple. We all know that men and women are different. It should therefore not be an intellectual leap to grasp that gender differences extend into health and disease. As CVD kills more women than any other ailment we must put ourselves on high alert for any suggestion of risks or events. All of us have women we love in our lives. Let’s do our best to keep them healthy and free of cardiovascular disease.

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Choosing an Omega-3 Fish Oil Supplement

woman on beachI believe one of the keys to enjoying a long and healthful life is a daily program that includes diet, exercise and a regimen of appropriate vitamins, supplements and doctor prescribed medications.

Today I’d like to examine the process of evaluating omega-3 fish oil supplements – products that I believe can enhance and maintain one’s health, and in particular one’s heart health, by potentially reducing the risk of coronary heart disease.

The American Heart Association recommends that individuals with heart disease consume 1000 mg of combined EPA and DHA each day. For those patients who need to lower triglycerides, the AHA recommends 2 to 4 grams of EPA and DHA daily, provided as an omega-3 fish oil supplement in capsule form, under a physician’s care.

With the growing proliferation of omega-3 fish oil products on the market it’s becoming more vital than ever to be an educated consumer. Here are 5 simple things to look for when evaluating a fish oil supplement.

Get the proper dose of EPA and DHA
Choose a fish oil supplement that provides your target dose of combined DHA and EPA (not ALA, omega-6s, or omega-9s). It’s unfortunate that many supplements claim they contain ‘1000 mg fish oils’; a broad term that often misleads consumers who presume the product contains 1000 mg of essential omega-3s, DHA and EPA.

Look for a fish oil capsule that provides the 3:1 ratio of DHA to EPA that replicates the ratio typically found in healthful fish, such as salmon.

Choose a capsule with enteric coating
Choose a capsule that features enteric coating which enhances absorption and typically eliminates any fishy burp or aftertaste. Rosemary extract and vitamin C may be added for superior antioxidant protection.

Choose a purified product
Search out a supplement that has been refined through a process like supercritical fluid technology — a process that gently extracts omega-3s to produce highly concentrated DHA and EPA while most effectively removing contaminants (PCBs, dioxins, furans, and mercury). Also, look for supplements whose manufacturer is certified by international organizations like EMAS, the European standard for environmental care, or similar organizations.

Keeping it green
Choose a fish oil product made from small, non-endangered species of wild fish, such as anchovies, sardines and mackerel, as opposed to those that may be harvesting endangered or over-harvested larger species. Smaller fish also contain fewer toxins that increase in the flesh of larger predatory fish.

Read That Label
Don’t be fooled by labels that claim “1000 mg Fish Oils” but often contain only 30% of the healthful omega-3s, DHA+EPA. The remaining 70% is unnecessary fat. Study the label’s Supplements Facts. How much DHA and EPA are in one serving? How many soft gels make one serving? You might be surprised to learn that you must take 2, 3, or 4 soft gels to get a full 1000 mg of DHA and EPA. If that’s the case, you are getting too much unwanted fat (which can even translate into unintended weight gain).

In sum, be careful about everything you consume. The old adage, “you are what you eat” is definitely true.

Related: Finding the Right Doctor for You

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Our Next Presidential Election: This One Counts

Again I am compelled to write a political blog. Romney just selected Ryan to be his running make.  Out of curiosity, I viewed the news coverage on both CNN and Fox.  As anticipated, neither station reported the news in an unbiased fashion. Instead of simply recording the news (apparently a task too mundane for the modern reporter), both networks took the opportunity to bolster their respective and diametrically opposed positions.  I guess the days of genuine unbiased reporting are gone. No longer does there seem to be a place where people like me can turn to learn the facts in order to be able to construct well-considered viewpoints.  And so our jobs have become much more difficult.  In order to be educated to the point of being able to create valid and truth-based opinions we must turn our attention to the primary sources.  We must listen to the politicians themselves.  And we must take them at their word.  And I for one liked what I heard from Romney and Ryan.

Both Romney and Ryan vocalized issues and solutions that resonated with me and many people I know – Democrats and Republicans alike. We all agree the debt is soaring out of control. We agree that American was founded on freedom and ideals – ours was an intellectually-born nation. We agree that we are on a downward spiral and we all acknowledge the emergence of unfamiliar sentiments pervading our nation – hopelessness and despair. Never before has our nation been shrouded in a sense of imminent and seemingly immutable doom. Everyone feels this. Everyone fears this — the “left” and the “right”. Yet when we should be standing together, our nation is more divided than ever. And the divisiveness is fostered by the words of our own president, the man who was elected on his promise of unity, brotherhood, hope, and his proclaimed ability to “reach across the aisle.”  It is fruitless however to point the finger of blame here. Whether or not it is his fault is irrelevant. We are here today on the brink of disaster and if we are to re-create the prosperity and hope that was once America, we must find solutions outside of rhetoric, mudslinging, allegations, and distortions of truth. We must all stop blaming others – we must address what we face today and find solutions so our children can live in a better tomorrow. So how do we do this? I believe the solution is simple.

First, Americans must take responsibility and listen to what the candidates say. We must listen closely and we must believe that the words they utter ascend from their hearts. When Obama says, “If you’ve got a business, you didn’t build it. Someone else did” we can’t make excuses and claim, “out of context!”  It certainly is “out of touch with the working man” but it is definitely not “out of context”. In his statement, Obama clearly subjugates the individual. He diminishes the efforts and strengths inherent in individuality, the very foundation of our country.  Let’s never forget that it is individuals, not nations, who win Nobel prizes, write plays, throw three-pointers, and win Olympic gold medals. Although Obama is correct that “No man is an island”, it is just one man, John Donne who penned those immortal words. Being inextricably connected to one another does not negate the power of individuality. Nations are built by individuals, not the other way around.

To be “in the know” we must also read our politicians’ bills. Daunting yes, but well worth the investment. (I read Obama’s Health care bill and was stunned by some of its edicts.) We must all be open to moving beyond our traditional party limits to vote for the candidates, principles and all, not the party in which they reside. I choose not to hide my position. I yearn for the country Romney and Ryan spoke of. I want freedom, opportunity, and hope for everyone. I disagree with Mr. Obama that in order for everyone to have opportunity the rich must pay more. My grandparents came to this nation penniless and through opportunity, hard work, perseverance, strength, and innate skills they did quite well. I am proud of their accomplishments and the achievements of many others in their generation. And none of these people depended on handouts. In fact, they would have abhorred that notion. I do believe we must help those in need – the sick and helpless should be cared for. The able-bodied however must be given the skills to earn their way up the ladder of success. They should not be carried. Such a process would serve no one.

I could go on interminably it seems, and that is not the purpose of a blog. Let me end by making a simple suggestion when deciding whom to vote for in November. Listen closely to the candidates, not their advertisements, and certainly not to the all-too-biased newscasters. Listen to their carefully selected words. Vote for whomever resonates with your view of what America should look like. We all agree America must change. The question each of us needs to answer is how.

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Black Bean Burgers

1/2 cup rolled oats
1 15.5-oz can black beans, rinsed and drained
1 large egg
1 tsp. ground cuminSAM_0229
Kosher salt
½ cup shredded pepper Jack cheese
1 medium shallot
3 Tbsp. chopped fresh cilantro
1 Tbsp. olive oil
4 whole-wheat hamburger buns

Put the oats in a small food processor and pulse four times to roughly chop. Add half the beans and pulse into a course paste, about 6 pulses. Add the egg, cumin, and ½ tsp. salt and process to mix well, about one minute. Transfer the bean mixture to a large bowl. Stir in the remaining beans, the cheese, shallot, and cilantro.

With wet hands, form the bean mixture into four patties and transfer to a lightly oiled plate. Refrigerate briefly to let the burgers set.

Heat a large heavy skillet on high heat; add the oil and swirl the pan to coat the bottom. Cook the burgers until brown with a good crust, about 3 minutes on each side. Serve the burgers on buns, topped with sliced tomato and avocado, or your favorite garnish.

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It is estimated that over 200 million Americans, more than 2/3 of the US population, do not get enough magnesium. This is important because magnesium is a mineral that plays a critical role in the human body. Magnesium helps maintain normal muscle and nerve function; studies point to magnesium’s efficacy for treating muscle and nerve pain as well as its ability to reduce cramping. Magnesium also keeps the heart rhythm steady and supports a healthy immune system. Magnesium also helps regulate blood sugar levels, promotes normal blood pressure, and is known to be involved in energy metabolism and protein synthesis. Recent study has focused on the role of magnesium in preventing and managing disorders such as hypertension, cardiovascular disease, and diabetes.

Bone health is supported by many factors, most notably calcium and vitamin D. However, some evidence suggests that magnesium deficiency may be an additional risk factor for postmenopausal osteoporosis. This may be due to the fact that magnesium deficiency alters calcium metabolism and the hormones that regulate calcium. Several human studies have suggested that magnesium supplementation may improve bone mineral density.

Even with an optimal diet, magnesium and other nutrient deficiencies can occur for several reasons. If the soil in which foods are grown has been depleted of nutrients, including magnesium, so are the foods that are grown in it. Add to that the fact that processed foods and refined grains are generally low in magnesium (another good reason to avoid white bread and opt for whole grain, since magnesium is concentrated in the germ and the bran of grains and refining flour removes them). If we could get adequate magnesium in our diet, absorption would still pose a problem for many of us. Our ability to absorb magnesium is affected by conditions such as diabetes and liver disease. Using nicotine, alcohol, caffeine, and excess sugar depletes magnesium; so do drugs such as antacids, diuretics, birth control pills, albuterol, insulin, corticosteroids and some antibiotics.

What to do? The recommended daily allowance for magnesium is 400 mg/day. Consider taking a quality multivitamin that provides 100% of the Recommended Daily Value for magnesium and the other essential vitamins and minerals as a good foundation for a healthful diet. Most dietary magnesium comes from vegetables, such as dark green, leafy vegetables. Other foods that are good sources of magnesium include, fruits (bananas, dried apricots, and avocados); nuts (almonds and cashews); peas, beans (legumes), and seeds; soy products (soy flour and tofu); and, whole grains (brown rice and bran cereal).

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Finding the “Right Doctor” for You

Dr. Seth J. BaumAs patients, we often agonize over our choice of doctors. We read so much on the internet – much of which is conflicting information – and doctors often have too little time to help us separate the wheat from the chaff. So when facing serious – or even minor- medical decisions, we might find ourselves alone and in a quandary. To whom do we listen? Do we take the medications prescribed? Do we get second or even third opinions? Our decisions are vital to us; yet, they appear at times to be trivial to those who are caring for us.

First, let me debunk a damaging myth. Most physicians are not the careless, heartless people many paint them to be. Most physicians I’ve met (and as a frequent lecturer, I’ve met plenty) do care greatly about their patients. Also, like their patients, they feel mired in abundant and contradictory data. And they, too, feel frustrated by the insufficient time they have to spend with their patients. Despite these issues, it is paramount for patients to believe in their physicians because the doctor-patient relationship must be solid for optimal health to result. Therefore, when it comes to making decisions about your health, be sure you are in the right hands. To do so, follow this rule taught to me by one of my own patients: “Find a doctor you trust, and trust him”. At times it may be quite difficult to do, but it is most definitely achievable.

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