A Walk on the Beach

Florida beach sunrise

Whenever feasible my wife and I enjoy a walk on the beach. This weekend was spectacular in southeast Florida, perfect for a peaceful, health-promoting amble upon a welcoming bed of sand. The ocean was obliging. The air carried a salt water scent and the breeze kept us comfortable as we strolled during the sun’s rise. Then it happened. The pungent odor of cigarette smoke invaded our space, instantly driving away our much-needed bliss. We looked at each other wondering who could possibly smoke at the beach. After all, the beach is meant for physical and mental salubrity. It is nature’s place; it is the embodiment of our reconnection to our roots, the birthplace of humanity in fact. How could someone mar this place and what would that someone look like?

Sitting by the shore, two young parents – accompanied by their three castle-building children – puffed continuously on their cigarettes. Walking thirty-plus feet from them, my wife and I could barely tolerate the smoke they emitted. Imagine then how much smoke their kids were inhaling! We know from countless studies that second hand smoke is deadly. In fact, every year approximately 40,000 Americans die as a consequence of second hand smoke. And, in view of our focus on healthcare dollars, we cannot ignore the extraordinary financial toll tobacco takes on our economy. Money is one thing. Offending my wife’s and my sensibilities and putting us at risk is another. Even more consequential though is the fact that these parents were unwittingly (I hope) putting their own children in harm’s way. Is this child abuse? I would argue it is. The data are irrefutable. Tobacco in any form – smoked, chewed, sniffed, or even involuntarily inhaled – can kill us. And, death aside, the immense cascade of hostile chemicals caused by tobacco and nicotine are terrifying. That being so, how is it not child abuse to subject one’s offspring to an ongoing and deadly threat? So while healthcare reform stares us unblinkingly in the eyes, let’s not neglect some of the most obvious and profound changes we can legislate. Let’s honestly and fervently take on the tobacco issue. Make smoking in public illegal. Make smoking in the presence of children illegal. In this situation let’s not get sidetracked by issues of civil liberties for the tobacco abusers. If they want to smoke in private, that’s okay. But, they are killing the rest of us. That is simply unacceptable.

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When Passions Collide – Omega-3s Are Essential So Why Would We Remove Them From Our Diets?

Last week the Cleveland HeartLab held its fourth annual Clinical Symposium. Excellent speakers addressed the group of some four hundred physicians and nurse practitioners from across the country. One in particular spoke with passion and unswerving conviction about his brand of a “no heart disease” diet. Dr. Caldwell Esselstyn vociferously and vehemently admonished the audience not to include any oils in their diets. “No oils” he repeatedly shouted pounding his fists in the air. No one can deny he walks his talk; he is extraordinarily svelte, clearly carrying no superfluous fat on his own body. My talk was about the essential role omega-3 and omega-6 fatty acids play in health and disease. And I too have my convictions and passions. And so we collided.

I steadfastly adhere to a worldview incorporating moderation, scientifically rigorous reflection on every aspect of human beings (from our evolutionary roots to the most reductionist biologic understanding), and acknowledgement that we do not and likely will never know everything. My position does not make room for Dr. Esselstyn’s view. His is simply too extreme. It also fails to consider the fact that human beings cannot adequately produce some vital fats such as EPA and DHA; those afforded us by our friends, the fish. EPA and DHA are indisputably essential contributors to the entire gamut of health considerations. From skin to eyes to brains and hearts, our organs need these fats to thrive. In fact, every cell in the human body requires DHA for optimal function. And even more compelling is the fact that we cannot adequately manufacture this fat. We need to eat it. So why eschew it? That is the problem with his thesis. Even if his handful of subjects adhering to this diet fails to develop cardiovascular events, it does not prove that the lack of fat plays any role. There are just too many other variables left unconsidered. Additionally, what diseases might be borne of such an unnaturally restricted diet? Too many questions remain for us to make a global experiment of Dr. Esselystyn’s hypothesis. We’ve done this before with dietary advice and hormone replacement recommendations and sadly we’ve been wrong every time.

In sum, I genuinely applaud Dr. Esselstyn for his dedication to extinguishing heart disease. His passion is real and his motivation pure. Still, that does not mean I must agree with him.

Get more information on the world’s most potent omega-3 fish oil supplement at vitalremedymd.com

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Familial Hypercholesterolemia: The Difficult to Manage Patient – a case challenge

I recently had my case challenge, “Familial Hypercholesterolemia: The Difficult to Manage Patient” published on the Cardiometabolic Disease Clinical Community website. The case: A 60-year-old asymptomatic, diabetic, overweight woman with Familial Hypercholesterolemia (FH) has been under my care for one year. The case study outlines many of the patient’s past medical conditions, medications, physical examines and lab results. You can participate in the challenge by answering the related questions on the Clinical Community on Cardiometabolic Disease website.

More about the Clinical Community on Cardiometabolic Disease
Learn about the important connection between Cardiometabolic Conditions and Cardiovascular Disease with the American College of Cardiology’s new Clinical Community on Cardiometabolic Disease, a new CardioSource website.

The new resource is under the direction of Dr. Nathan Wong from the University of California, Irvine and Dr. Michael Blaha of the Johns Hopkins Ciccarone Center – this new clinical community will disseminate information about the important connections between diabetes and other cardiometabolic conditions such as hypertension and dyslipidemia and cardiovascular disease. With six of the top ten causes of death globally being cardiometabolic risk factors, we need to do a better job in addressing these issues in order to have a chance at achieving our 2020 goals for reducing cardiovascular disease by 20%.

The site includes a wide array of new features provided on the community website, which you can access by clicking here. Features include: Case Challenges, videos, Articles of the Month, Hot Topics and more.

related: more articles on cholesterol and Familial Hypercholesterolemi from FPIM.org

Please read more about preventive cardiology at www.preventivecardiologyinc.com.

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“Find a Doctor You Trust And Trust Him”

woman runner stretching
A patient recently shared advice given him by his close friend (who also happens to be a physician). When my patient questioned his friend about the best way to make medical decisions in the context of today’s information-overload (which can be not only misleading but downright wrong and dangerous) he counseled him to “Find a doctor you trust and trust him.”

This philosophy may appear simplistic, superficial, or even tautological. It is not. Actually, it is brilliant in its simplicity. After all, how is anyone, doctor or layperson, to understand everything about medicine? Advances and discoveries abound. I’ve said this before – but it is certainly worth repeating, – every day hundreds if not thousands of articles are published in the medical space. It is impossible for even the most studious physician to appropriately assimilate such exhaustive data. A judicious doctor will however rigorously read the most pertinent trials and merge them into his well-established and highly-refined approach to health and illness. This approach is founded upon oftentimes decades of combined arduous education as well as invaluable clinical experience. Recognizing everything that goes into a fine physician’s decision-making process how is it remotely possible for even the most voracious reader of internet tomes to come close to the well-considered recommendations of such doctors? It is just not possible. This realty does not imply that patients shouldn’t educate themselves to become their own best advocates. They should; and in fact they must. Knowing more will help patients find those doctors they trust. But at that point patients ought to let their guard down just enough to accept the well-considered advice of their trusted physician. Without doing so, patients leave themselves wide open for not just doubt and concomitant angst, but inferior care as well.

Please read more about preventive cardiology at www.preventivecardiologyinc.com.

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