Happy and Healthy New Year

Before my body melts away
I’ll grab the sacred fleeting day
I’ll hold myself in loving arms
‘Till fortune’s whim rescinds its charms

Having practiced medicine for nearly thirty years I have witnessed and experienced life’s vicissitudes. On this New Year’s Eve
I would like to share a poem I wrote during one of those rare moments of clarity that sporadically bless us.
I hope it can help you appreciate and make the most of what you have. It has periodically helped me to re-focus.
These are certainly tough times, but the more in touch we are with our gifts, the happier and more fruitful we will be.

Happy New Year.

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Heart Healthful Holiday Tips

The holidays can be a wonderful and carefree time, filled with festive parties, dinners, and family celebrations. Our guards are dropped and we often succumb to the temptation to overdo, over-indulge, and over eat. Here are a few friendly reminders – dos and don’ts – that can help you thoroughly enjoy yourself without awakening on January 2nd sporting an expanded waistline, high cholesterol, high blood pressure, and elevated blood sugar.

Eat Wisely:

  • Employ portion control; enjoy small portions of a few of your favorite dishes.
  • Replace: heavy cream, chocolate chips, processed sugar & butter in baked goods and side dishes with: skim milk, low-fat cream, natural sugar substitutes like Stevia, and low-cholesterol, vegetable oil-based butter alternatives such as Smart Balance.
  • Replace high fat libations like eggnog and heavy cream in your coffee with skim or low-fat milk, and avoid excessive alcohol.
  • If you’re at a holiday cocktail party, alternate your favorite cocktail or glass of wine with a glass of water – your head, heart, liver, waistline (and probably pride) will be grateful.
  • Socialize and enjoy the camaraderie. Replace a mouthful of food or drink with lively conversation.
  • Read those food labels – choose low calorie, low-fat, low-sugar and low-salt alternatives to traditional foods – you’ll lower your caloric intakes and potentially keep your blood pressure, weight, and cholesterol levels at normal levels. Holiday drinks and mixers like cranberry juice and apple cider come in natural, low sugar versions that often taste just as good as their sugar-laden brethren.
  • Eat your greens – a fresh salad and healthful vegetables can aid your digestion and replace some of the high-calorie, high-fat foods that will surely confront you at a holiday dinner.
  • Stay off the gravy train. Slathering gravy over your entire plate of turkey and dressing will add excess fat, sodium, and calories to your meal. Keep your gravy portion to a tablespoon or two.
  • Eat a bite of dessert, or share that slice of pie with a loved one, instead stuffing yourself with large servings of your favorite sweets. Again, your body will thank you.

Stay Active:

  • Moderate exercise is a great way to burn off some of those holiday calories (and pounds). Take a brisk walk with your loved ones, sweep a little snow off the walk, or shoot a few baskets with the kids. It will work wonders on your heart and soul.

Happy holidays!

Additional source: American Heart Association

Visit vitalremedymd.com for more preventive healthcare solutions.

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Medicine – Science or Art?

Having just read the results of the CREDO-Kyoto trial published in the American Journal of Cardiology, I am once again struck by the question, “Do we practice Medicine as an art or science?” The trial explores statin use in specific patients with severe kidney disease. The findings – statins do not help these patients. Still, I know no doctor who would withhold statins from such patients, as they are arguably the single most advantageous drug of the last decade. We doctors (and I, a cholesterol specialist and cardiologist) believe statins to be beneficial even when the data are lacking under specific circumstances such as the one cited above. The reason for our almost jingoistic attitude resides in the fact that the mechanism of statins’ action simply makes sense to us. Statins act on so many levels to thwart heart disease development and progression. They lower LDL, decrease clotting, and diminish inflammation… This in concert with our tacit understanding that trials are imperfect enables us to reach beyond black and white science into the arena of scientific reasoning. This leap might be considered by some to be more akin to art than science, but I’m not so sure. Science has been pigeonholed into a tightfitting yea or nay realm. Although we think of science as true or false, real medical science builds and tests theories derived from biologic understanding. And real medical practice cannot and should not wait for every iteration of every clinical scenario to be studied. Were we to wait for that, we would never treat a single patient. After all, no one can dispute the fact that each human being is different. Through epigenetics we understand now that even identical twins are not identical! But let’s look at a similar clinical study situation with a diametrically opposed outcome.

We know that high Homocysteine levels correlate with cardiovascular events – heart attacks and strokes. This understanding led to a series of outcome trials to evaluate the lowering of Homocysteine with three B vitamins. Some trials showed benefit while others did not. Of course, each trial had its own pitfalls; that is always the case. With Homocysteine however, doctors responded differently, claiming there is no need to treat this problem, no matter how compelling the scientific premise. Here, I believe we erred. Some studies cited as negative tested the same population as the CREDO trial, sick Kidney disease patients. We do know that this population is simply harder to treat. After all, they are generally much sicker individuals. But, no one has ever suggested withholding statins from everyone because of their failure in severe kidney disease. That of course would make no sense. Somehow though this is precisely what occurred after the negative Homocysteine trials appeared. And frankly it is even worse than that. These same trials often demonstrated a reduction in stroke rate with Homocysteine lowering. Yet, stroke reduction was ignored. For Homocysteine, the baby was thrown out with the bathwater. As a result, many physicians might be missing the opportunity to reduce a cardiovascular and cerebrovascular risk because of this jaded response to a handful of clinical trials. There are biases I suspect that went into the imbalanced condemnation of Homocysteine reduction.

The bottom line though is that we must try to be impartial when reviewing literature. And, we must try to be scientific. We need to acknowledge that medicine is a hybrid. It is a science practiced by diverse artists, the doctors. Each physician has his or her own palate and brushstroke. Although all doctors will use the same paints and canvas to create their image of medical management, the final drawings will vary greatly from one to the next. With this understanding we should all be a bit less critical of one another. To state with absolute conviction that one opinion is “right or wrong” should be reserved for the very rare event of certainty. And that is an event that is alarmingly uncommon.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

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The Fiscal Cliff: Lessons Gleaned from Preventive Cardiology

Cardiovascular prevention requires a team effort with the doctor at the helm but the patient a necessary, eager, and deeply involved participant. The goal of prevention is to identify risks and then diminish them before a crisis ensues. Success demands identification of potential problems followed by a collaborative effort between doctor and patient to minimize those risks. Only through both proper identification and risk reduction can heart attacks and strokes be prevented. As I reflect on what I do for a living I am struck by the similarity we are all experiencing as we walk steadily toward the fiscal cliff. And I find myself perplexed by the fact that although our elected leaders have identified the problems they have been unable to work collaboratively to correct the issues. An analogous scenario would be this. I, the physician, identify a severe cholesterol problem in a patient. I then perform a coronary CT angiogram and demonstrate multiple plaques within the patient’s arteries feeding her heart. I recommend a medication to lower her risk and show her all the copious data supporting my recommendation. She turns to me and replies, “No thank you; I think I’ll just take my chances.” I of course counter with a litany of references to literature and clinical experience. Although I understand this is the best option for her, I fail to offer “lesser” alternatives. I am intransigent. She too is adamant; refuses therapy; and six months later sustains a fatal heart attack. The heart attack could have been avoided, but to do so required the joint efforts of doctor and patient. I should have been more open to “alternative” – albeit probably less successful – possibilities, and she should have been more willing to consider my well-considered recommendation.

Now we find ourselves in an economic and political game of “chicken”. Who will flinch first? Unfortunately the stakes are unbearably high. All our futures hang in the balance. Our president, recently elected by a narrow margin in the most contentious presidential battle many of us have ever witnessed blames the Republican Congress for the standoff. The Republicans blame the President. It appears their current mode of “working together and reaching across the aisle” is at best a pipedream and at worst an impossibility. Surely the Republicans must bend. But so too should the president. He represents the entire country, even the nearly 50% who did not vote for him. He was appalled by Romney’s 47% comment yet he seems to be enacting the very principle he condemned.  And, he is our leader. The buck does stop with him. He must find the way to compromise. And if he does ultimately reach across the aisle the Republicans in turn must be willing to compromise as well. If not, we will like lemmings drop over the fiscal cliff. And we all know how that ends for the lemmings. Let’s hope Congress and our President find the way to diminish the risk that they’ve so clearly identified. Let’s hope we do not experience the unnecessary, potentially fatal, but certainly avoidable “heart attack”.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

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Are You Getting Enough Omega-3s? Take a blood test and see…

Omega-3 fatty acids are essential fatty acids in the human diet that are primarily found in oily fish like salmon, sardines, albacore tuna, herring, mackerel, etc. They are also available in fish oil soft gels. The principle omega-3 fatty acids are docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA).  Over the last 25 years, compelling evidence has accumulated from epidemiological studies and large clinical trials demonstrating their beneficial impact on joint, brain, eye, and heart function.  With regard to the cardioprotective effects of omega-3 oils, the strongest evidence to date relates to reducing risk for sudden cardiac death, the primary cause of coronary heart disease (CHD) death in the US today.

The American Heart Association reports that CHD is the number one killer of American men and women, accounting for more than one of every five deaths in the United States, usually as sudden death from cardiac arrest.  Recognizing the cardioprotective effects of omega-3s, the American Heart Association (AHA) recommends that patients with documented CHD should consume about 1,000 mg of omega-3s (specifically, combined DHA+EPA) per day; those without documented CHD should eat a variety of fish, preferably oily, at least twice a week, to provide about 500 mg of EPA+DHA per day.  It is very difficult, however, to reliably estimate omega-3 consumption based upon fatty fish intake because DHA and EPA vary greatly with species, season, maturity, fish’s diet, post-catch processing, and cooking methods.  A high-quality, highly purified fish oil supplement can deliver a more precise amount of omega-3s.  Even then, individual differences in absorption, metabolism, and distribution can lead to variable responses to a given intake.

So how do you know if you are getting enough omega-3s?

Now there is a blood test —the HS-Omega-3 Index™— that can measure your levels of the cardioprotective omega-3 fatty acids, DHA and EPA. Researchers have discovered that one of the best risk indicators for sudden cardiac death is the level of omega-3 fatty acids (EPA and DHA) found in red blood cell membranes. The HS-Omega-3 Index test measures levels of DHA + EPA in the phospholipids of red blood cell membranes and is expressed as a percent of total fatty acids in the membrane.  The result is a simple modifiable marker for the risk of death from coronary heart disease.

The target HS-Omega-3 Index is 8% and above, a level that current research indicates is associated with the lowest risk for death from CHD. On the other hand, an Index of 4% or less (which is common in the US) indicates the highest risk.  Low levels are easily corrected through dietary changes or supplements and can quickly improve test results. Of course, this is just one of a number of risk factors that plays a role in CHD.  Risks associated with other factors such as cholesterol, blood pressure, diabetes, family history of CHD, smoking, or other cardiac conditions are completely independent of and not influenced by omega-3 fatty acids. Any and all modifiable risk factors – including the HS-Omega-3 Index—should be addressed as part of any global risk reduction strategy.

Visit vitalremedymd.com for more preventive healthcare solutions.

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Wintertime Chili

1 Tbsp olive oil
2 small yellow onions, diced
2 cloves garlic minced
1 butternut squash, peeled and cut into 1-inch cubes
4 stalks celery, thinly sliced
2 cans (14.5 oz) diced tomatoes
1 can (16 oz) black beans, drained and rinsed
1 small can whole kernel corn
1 1/2 cups chicken broth
2 tsp ground cumin
1 tsp chili powder
1 tsp salt
1/4 tsp cayenne pepper
Shredded parmesan cheese for garnish (optional)

Warm olive oil in large pot over medium heat.  Add onion, garlic, squash, and celery; cook 8 minutes, stirring frequently.  Add remaining ingredients, except cheese.  Increase heat to high; bring to a boil.  Reduce heat and simmer, covered 45 minutes.  Sprinkle each serving with cheese.

Learn more about preventive cardiology at www.preventivecardiologyinc.com.

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Audrey’s Almond Clusters

1 1/2 cups sliced almonds
3/4 cup chopped walnuts
1/2 cup coconut chips
2 egg whites
1/4 cup sugar

Use a fork to beat the egg whites with the sugar in a large mixing bowl. Add sliced almonds, walnuts, and coconut and mix by hand until thoroughly coated. Make into clumps or mounds on a large cookie sheet lined with parchment paper.

Bake at 275 for 18 minutes. Then continue baking at 325 for about 8 minutes until golden. Rotate the cookie sheet half way through and watch closely to avoid overcooking as oven temperatures can vary.

Yields 18-20 clusters.

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