The heart is such an important organ and affects virtually everything else in your body that it deserves a separate discussion. From heart attacks to high blood pressure, the connection with diabetes is especially important to be aware of.
According to the American Diabetes Association, having both hypertension and type 2 diabetes is particularly lethal and can significantly raise a person’s risk of heart attack or stroke as well as increase chances of developing other diabetes-related diseases, such as kidney disease, and retinopathy, which may cause blindness. Additionally, having hypertension increases risk of stroke and Alzheimer’s, and those with type 2 diabetes are even more susceptible.
The striking relevancy of heart health today means there is ample support—tests, treatments, tips on eating and drinking, and even simple exercises that can lower stress. Although you also have diabetes to contend with, the overlap in advice leaves you with a wealth of information and inspiration.
Natural Help for the Diabetic Heart
If you have type 2 diabetes, you’ve already had a heart attack—whether you’ve had one or not!
“The guidelines for physicians from the American Heart Association are to treat a person with diabetes as if that individual has already had a heart attack,” says cardiologist Seth Baum, MD, medical director of Integrative Heart Care in Boca Raton, Florida, and author of The Total Guide to a Healthy Heart.
HOW DOES DIABETES HURT YOUR HEART?
As excess sugar careens through the bloodstream, it roughs up the linings of the arteries.
Insulin resistance (the subpar performance of the hormone that moves glucose out of the bloodstream and into muscle and fat cells) raises blood pressure, damaging arteries.
Diabetes also injures tiny blood vessels called capillaries, which hurts your kidneys and nerves—damage that in turn stresses the heart.
The end result—an up to seven-fold increase in the risk of heart disease and stroke, the cardiovascular diseases (CVD) that kill four out of five people with diabetes.
But recent studies show there are several natural ways for people with diabetes to reverse the risk factors that cause heart disease.
RECENT RESEARCH
It’s never too late to exercise—and a little goes a long way. Researchers at the University of British Columbia in Vancouver, Canada, studied thirty-six older people (average age seventy-one) with type 2 diabetes, high blood pressure, and high cholesterol, dividing them into two groups.
One group walked on a treadmill or cycled on a stationary bicycle for forty minutes, three days a week. The other group didn’t.
To find out if the exercise was helping with CVD, the researchers measured the elasticity of the arteries—a fundamental indicator of arterial youth and health, with arterial stiffness increasing the risk of dying from CVD.
Results: After three months, the exercisers had a decrease in arterial stiffness of 15 to 20 percent.
“Aerobic exercise should be the first-line treatment to reduce arterial stiffness in older adults with type 2 diabetes, even if the patient has advanced cardiovascular risk factors” such as high blood pressure and high cholesterol, conclude the researchers in Diabetes Care.
WHAT TO DO
Kenneth Madden, MD, the study leader and associate professor of geriatric medicine at the University of British Columbia, says, “You can improve every risk factor for diabetes and heart disease—and you can do it in a very short period of time.”
Dr. Madden recommends that older people with diabetes and cardiovascular disease see a doctor for a checkup before starting an exercise program.
Once you get the okay from your physician, he says to purchase and use a heart monitor during exercise, so you’re sure that you’re exercising at the level used by the participants in his study—60 to 75 percent of maximum heart rate.
Example: An estimate of your maximum heart rate is 220, minus your age. If you’re sixty, that would be 220 – 60 = 160. Exercising at between 60 and 75 percent of your maximum heart rate means maintaining a heart rate of between 96 and 120 beats per minute.
Finally, Dr. Madden advises you exercise the amount proven to improve arterial elasticity—a minimum of three sessions of aerobic exercise a week of forty minutes each.
Here are some other natural ways to reduce risk:
•Maximize magnesium. Researchers in Mexico studied seventy-nine people with diabetes and high blood pressure, dividing them into two groups. One group received a daily 450-mg magnesium supplement; one didn’t.
Results: After four months, those on magnesium had an average drop of twenty points systolic (the higher number in the blood pressure reading) and nine points diastolic (the lower number). Those on the placebo had corresponding drops of five points and one point.
“Magnesium supplementation should be considered as an additional or alternative treatment for high blood pressure in people with diabetes,” says Fernando Guerrero-Romero, MD, the study leader.
What to do: “Magnesium acts as a natural vasodilator, relaxing arteries and lowering blood pressure,” says Dr. Baum. “People with diabetes should incorporate a magnesium supplement into their regimen.”
He suggests a daily supplement of 400 mg, about the level used in the study.
“People with diabetes and high blood pressure should also be encouraged to increase their dietary intake of magnesium, through eating more whole grains, leafy green vegetables, legumes, nuts, and fish,” says Dr. Guerrero-Romero.
•Eat like a Neanderthal. Researchers in Sweden tested two diets in thirteen people with type 2 diabetes—the diet recommended by the American Diabetes Association (ADA), a generally healthful diet limiting calories, fat, and refined carbohydrates; and a “Paleolithic” diet, consisting of lean meat, fish, fruits, vegetables, root vegetables, eggs, and nuts—and no dairy products, refined carbohydrates, or highly processed foods whatsoever.
In terms of lowering risk factors for heart disease, the Paleolithic diet clubbed the ADA diet.
Results: After three months, it had done a better job of decreasing:
›High LDL “bad” cholesterol
›High blood pressure
›High triglycerides (a blood fat linked to heart disease)
›Too-big waist size (excess stomach fat is linked to heart disease)
The diet was also more effective at increasing HDL “good” cholesterol.
And it was superior in decreasing glycated hemoglobin (A1C), a measure of long-term blood sugar control.
“Foods that were regularly eaten during the Paleolithic, or Old Stone Age, may be optimal for prevention and treatment of type 2 diabetes, cardiovascular disease, and insulin resistance,” concludes Tommy Jönsson, MD, in Cardiovascular Diabetology.
What to do: “Eating a Paleolithic diet is far easier than most people think,” says Robb Wolf, owner of NorCal Strength & Conditioning in Chico, California, and author of The Paleo Solution. The basic diet: eat more lean meat, fish, shellfish, fruits, vegetables, eggs, and nuts. Eat less (or eliminate) grains, dairy products, salt, refined fats, and refined sugar.
•Have a cup of hibiscus tea. Researchers in Iran studied fifty-three people with type 2 diabetes, dividing them into two groups. One group drank a cup of hibiscus tea twice a day; the other drank two cups a day of black tea. (The hibiscus tea was made from Hibiscus sabdariffa, which is also known as red sorrel, Jamaican sorrel, Indian sorrel, roselle, and Florida cranberry.)
Results: After one month, those drinking hibiscus had:
›Higher HDL “good” cholesterol
›Lower LDL “bad” cholesterol
›Lower total cholesterol
›Lower blood pressure
The black tea group didn’t have any significant changes in blood fats or blood pressure.
The findings were in the Journal of Alternative and Complementary Medicine and the Journal of Human Hypertension.
What to do: Consider drinking a cup or two of hibiscus tea a day, says Hassan Mozaffari-Khosravi, PhD, an assistant professor of nutrition, Shahid Sadoughi University of Medical Sciences, Yazd, Iran, and the study leader.
›Seth Baum, MD, medical director of Integrative Heart Care in Boca Raton, Florida, and author of The Total Guide to a Healthy Heart. VitalRemedyMD.com.
›Kenneth Madden, MD, associate professor of geriatric medicine at the University of British Columbia.
›Robb Wolf, owner of NorCal Strength & Conditioning, Chico, California, and author of The Paleo Solution.
Four Must-Have Heart Tests
Heart disease is tricky. Like other silent conditions, such as high blood pressure and kidney disease, you may not know that you have it until you’re doubled over from a heart attack.
That’s because traditional methods of assessing patients for heart disease, such as cholesterol tests and blood pressure measurements, along with questions about smoking and other lifestyle factors, don’t always tell a patient’s whole story.
Shocking finding: In a recent study, doctors followed nearly six thousand men and women (ages fifty-five to eighty-eight) who had been deemed healthy by standard heart tests for three years and then gave them basic imaging tests.
Result: Sixty percent were found to have atherosclerosis. These study participants were eight times more likely to suffer a heart attack or stroke, compared with subjects without this fatty buildup (plaque) in the arteries.
THE MUST-HAVE TESTS
Below are four simple tests that can catch arterial damage at the earliest possible stage—when it can still be reversed and before it has a chance to cause a heart attack or stroke.
My advice: Even though doctors don’t routinely order these tests, everyone over age fifty should have them at least once—and sometimes more often, depending on the findings. Smokers and people with diabetes, very high cholesterol levels (more than 300 mg/dL), and/or a family history of heart disease should have these tests before age fifty. Having these tests can literally save your life:
•Coronary calcium computed tomography (CT) scan. This imaging test checks for calcium deposits in the arteries—a telltale sign of atherosclerosis. People who have little or no calcium in the arteries (a score of zero) have less than a 5 percent risk of having a heart attack over the next three to five years. The risk is twice as high in people with a score of one to ten, and more than nine times higher in those with scores above four hundred.
While the American College of Cardiology recommends this test for people who haven’t been diagnosed with heart disease but have known risk factors, such as high blood pressure and/or a family history of heart disease, I advise everyone to have this test at about age fifty.* The test takes only ten to fifteen minutes and doesn’t require the injection of a contrast agent.
Cost: Ninety-nine dollars and up, which may be covered by insurance.
I use the calcium score as a one-time test. Unless they abandon their healthy habits, people who have a score of zero are unlikely to develop arterial calcification later in life. Those who do have deposits will know what they have to do—exercise, eat a more healthful diet, manage cholesterol and blood pressure, etc.
One drawback, however, is radiation exposure. Even though the dose is low (much less than you’d get during cardiac catheterization, for example), you should always limit your exposure.
My advice: Choose an imaging center with the fastest CT machine. A faster machine (a 256-slice CT, for example) gives less radiation exposure than, say, a 64-slice machine.
•Carotid intima-media thickness (CIMT). The intima and media are the innermost linings of blood vessels. Their combined thickness in the carotid arteries in the neck is affected by how much plaque is present. Thickening of these arteries can indicate increased risk for stroke and heart attack.
The beauty of this test is that it’s performed with ultrasound. There’s no radiation, it’s fast (ten minutes), and it’s painless. I often recommend it as a follow-up to the coronary calcium test or as an alternative for people who want to avoid the radiation of the coronary calcium CT.
The good news is that you can reduce CIMT with a more healthful diet, more exercise, and the use of statin medications. Pomegranate—the whole fruit, juice, or a supplement—can reduce carotid plaque too. In addition, research has found Kyolic aged garlic (the product brand studied) and vitamin K-2 to also be effective.
Cost: $250 to $350. It may not be covered by insurance.
•Advanced lipid test. Traditional cholesterol tests are less helpful than experts once thought, particularly because more than 50 percent of heart attacks occur in patients with normal LDL “bad” cholesterol levels.
Experts have now identified a number of cholesterol subtypes that aren’t measured by standard tests. The advanced lipid test (also known as an expanded test) still measures total cholesterol and LDL but also looks at the amounts and sizes of different types of cholesterol.
Suppose that you have a normal LDL reading of 100 mg/dL. You still might have an elevated risk for a heart attack if you happen to have a high number of small, dense LDL particles (found in an advanced LDL particle test), since they can more easily enter the arterial wall.
My advice: Get the advanced lipid test at least once after age fifty. It usually costs thirty-nine dollars and up and may be covered by insurance.
If your readings look good, you can switch to a standard cholesterol test every few years. If the numbers are less than ideal, talk to your doctor about treatment options, which might include statins or niacin, along with lifestyle changes. Helpful supplements include omega-3 fatty acids, vitamin E, and plant sterols.
•High-sensitivity C-reactive protein (hs-CRP). This simple blood test has been available for years, but it’s not used as often as it should be. Elevated C-reactive protein indicates inflammation in the body, including in the blood vessels. Data from the Physicians’ Health Study found that people with elevated CRP were about three times more likely to have a heart attack than those with normal levels.
If you test low (less than 1 mg/L) or average (1 to 3 mg/L), you can repeat the test every few years. If your CRP is high (above 3 mg/L), I recommend repeating the test at least once a year. It’s a good way to measure any progress you may be making from taking medications (such as statins, which reduce inflammation), improving your diet, and getting more exercise.
Cost: About fifty dollars. It’s usually covered by insurance.
›Joel K. Kahn, MD, a clinical professor of medicine at Wayne State University School of Medicine and director of Cardiac Wellness at Michigan Healthcare Professionals, both in Detroit. He is also a founding member of the International Society of Integrative Metabolic and Functional Cardiovascular Medicine and author of The Whole Heart Solution.
Artery Inflammation: Six Simple, Lifesaving Tests
A fire could be smoldering inside your arteries, a type of fire that could erupt at any moment, triggering a heart attack or stroke. In fact, the fire could be building right this minute, and you wouldn’t even know it. That’s because the usual things doctors look at when gauging cardiovascular risk—cholesterol, blood pressure, blood sugar, weight—can all appear to be fine even when your arteries are dangerously hot.
What does work to detect hot arteries? A set of six simple, inexpensive, and readily available blood and urine tests.
Problem: Few doctors order these tests, and few patients know enough to ask for them. Without the warnings these tests provide, patients often have no way of knowing just how great their risk is for heart attack or stroke and whether or not their preventive treatments are working—until it’s too late.
THE BODY’S ARMY ON ATTACK
Hot arteries are not actually hot (as in very warm). Instead, in this case, “hot” refers to the effects of chronic inflammation. Why call them hot then? Chronic arterial inflammation can put you on the fast track to developing vascular disease by speeding up the aging of your arteries. It’s so dangerous to the arterial lining that it’s worse than having high LDL cholesterol. And if your arteries are already clogged with plaque—which acts as kindling for a heart attack or stroke—inflammation is what lights the match.
Inflammation in the body isn’t always bad, of course. In fact, it’s an important aspect of healing. When something in your body is under attack, the immune system sends in troops of white blood cells to repair and fight off the attacker, and temporary inflammation results. That’s why when you cut yourself, for example, you’ll see swelling at the site of the injury—it’s a sign that your white blood cells are at work for your benefit.
But: When an attack against your body persists (for instance, as occurs when you have an ongoing infection of the gums), your white blood cells continue to drive inflammation. When it turns chronic, inflammation becomes highly damaging to many tissues, including the arteries.
Normally, the endothelium (lining of the arteries) serves as a protective barrier between blood and the deeper layers of the arterial wall. However, when that lining is inflamed, it can’t function well, and it gets sticky, almost like flypaper, trapping white blood cells on their way through the body. The inflamed endothelium becomes leaky too, allowing LDL “bad” cholesterol to penetrate into the wall of the artery. The white blood cells then gobble up the cholesterol, forming fatty streaks that ultimately turn into plaque, a condition called atherosclerosis. Then when the plaque itself becomes inflamed, it can rupture, tearing through the endothelium into the channel of the artery where blood flows. This material triggers the formation of a blood clot—a clot that could end up blocking blood flow to the heart or brain.
THE SIX-PART FIRE PANEL
Just as firefighters have ways of determining whether a blaze is hiding within the walls of a building, certain tests can reveal whether inflammation is lurking within the walls of your arteries. I use a set of six tests that I call the “fire panel.” Each reveals different risk factors, and for several of the tests, too-high scores can have more than one cause—so it’s important to get all six tests, not just one or two.
The fire panel can identify people at risk for developing atherosclerosis, reveal whether patients who already have atherosclerosis have dangerously hot arteries that could lead to a heart attack or stroke, and evaluate patients who have survived a heart attack or stroke to see whether their current treatments are working to reduce the inflammation that threatens their lives. Your individual test results will help determine your most appropriate course of treatment.
I recommend that all adults have this panel of tests done at least every twelve months, or every three to six months for patients at high risk for heart attack or stroke. All of these tests are readily available, are inexpensive and usually covered by insurance, and can be ordered by your regular doctor. Here are the six tests:
•F2 isoprostanes. My nickname for this blood test is the “lifestyle lie detector,” because it reveals whether or not patients are practicing heart-healthy habits. The test, which measures a biomarker of oxidative stress, helps determine how fast your body’s cells are oxidizing or breaking down. According to one study, people who have the highest levels of F2 isoprostanes are nine times more likely to have blockages in their coronary arteries than people with the lowest levels.
The score you want: A normal score is less than 0.86 ng/L; an optimal score is less than 0.25 ng/L.
•Fibrinogen. An abnormally high level of this sticky, fibrous protein in your blood can contribute to the formation of clots. It’s also a marker of inflammation. One study divided people into four groups (quartiles) based on their fibrinogen levels and found that stroke risk rose by nearly 50 percent for each quartile. High fibrinogen is particularly dangerous for people who also have high blood pressure, because both conditions damage the blood vessel lining and make it easier for plaque to burrow inside.
Normal range: 440 mg/dL or lower.
•High-sensitivity C-reactive protein (hs-CRP). Your liver produces C-reactive protein, and the amount of it in your blood rises when there is inflammation in your body—so an elevated hs-CRP level generally is considered a precursor to cardiovascular disease. The large-scale Harvard Women’s Health Study cited this test as being more accurate than cholesterol in predicting risk for cardiovascular disease, while another study of women found that those with high scores were up to four times more likely to have a heart attack or stroke than women with lower scores. A high hs-CRP score is especially worrisome for a person with a large waist. Excess belly fat is often a sign of insulin resistance (in which cells don’t readily accept insulin), a condition that further magnifies heart attack and stroke risk.
The score you’re aiming for: Under 1.0 mg/L is normal; 0.5 mg/L is optimal.
•Microalbumin/creatinine urine ratio (MACR). This test looks for albumin in the urine. Albumin is a large protein molecule that circulates in the blood and shouldn’t spill from capillaries in the kidneys into the urine, so its presence suggests dysfunction of the endothelium. Though this test provides valuable information about arterial wall health, doctors rarely use it for this purpose.
Important: New evidence shows that MACR levels that have traditionally been considered normal can signal increased risk for cardiovascular events.
Optimal ratios, according to the latest research: 7.5 or lower for women and 4.0 or lower for men.
•Lipoprotein-associated phospholipase A2 (Lp-PLA2). This enzyme in the blood is attached to LDL “bad” cholesterol and rises when artery walls become inflamed. Recent research suggests that it plays a key role in the atherosclerosis disease process, contributing to the formation of plaque as well as to the plaque’s vulnerability to rupture. People with periodontal (gum) disease are especially likely to have elevated Lp-PLA2 scores—chronic inflammation can start in unhealthy gums and, from there, spread to the arteries.
Normal range: Less than 200 ng/ml.
•Myeloperoxidase (MPO). This immune system enzyme normally is found at elevated levels only at the site of an infection. When it is elevated in the bloodstream, it must be assumed that it’s due to significant inflammation in the artery walls and leaking through the endothelium. This is a very bad sign. MPO produces numerous oxidants that make all cholesterol compounds, including HDL “good” cholesterol, more inflammatory. If your blood levels of MPO are high, HDL goes rogue and joins the gang of inflammatory thugs. It also interacts with another substance in the bloodstream to produce an acid that can eat holes in blood vessel walls. Smokers are particularly prone to high MPO levels.
Normal range: Less than 420 pmol/L.
HOW TO PUT OUT THE FIRES
While the fire panel tests above may seem exotic, the solution to the hot artery problem, for most of us, is not. That’s because the best way to combat chronic inflammation is simply to maintain a healthful lifestyle. You just have to do it! Key factors include:
•Following a heart-healthy Mediterranean-style diet
•Managing stress
•Getting plenty of exercise
•Guarding against insulin resistance
•Taking good care of your teeth and gums
•Not smoking
In some cases, lifestyle changes alone are enough to quell the flames of chronic inflammation and to put your arteries on the road to recovery. In other cases, patients also need medication such as statins and/or dietary supplements such as niacin and fish oil. Either way, the good news is that once you shut the inflammation off, the body has a chance to heal whatever disease and damage has occurred, so you’re no longer on the fast track to a heart attack or stroke.
›Bradley Bale, MD, medical director, Grace Clinic Heart Health Program, Lubbock, Texas, and cofounder, Heart Attack & Stroke Prevention Center, Spokane. He is coauthor, with Amy Doneen, ARNP, and Lisa Collier Cool, of Beat the Heart Attack Gene: The Revolutionary Plan to Prevent Heart Disease, Stroke and Diabetes.
Hospitalized for Heart Attack? Make Sure They Check You for Diabetes
It’s well-known among health-conscious people that heart disease and diabetes are linked, so it seems a shame to be hearing news from the American Heart Association that 10 percent of Americans who’ve had a heart attack probably have undiagnosed diabetes. What’s worse, though, is news that doctors are missing opportunities to detect and treat diabetes in people even when they are hospitalized for a heart attack.
Are so many doctors this clueless? Although it might be a great challenge for health-care professionals to identify everyone with diabetes before complications, such as heart attack, occur, a basic precaution can at least help those who do land in the hospital because of heart attack. So if you’ve had a heart attack or have cardiovascular disease—or you want to be prepared to give yourself the best odds if you ever have a heart attack in the future—here’s what you need to insist that your medical-care team does for you, especially if you land in the hospital.
A SIMPLE OVERLOOKED TEST
It comes down to getting a simple blood test. Doctors who order a hemoglobin A1C test when a patient is being treated for heart attack are making the right move to ensure that diabetes won’t be missed and the heart attack can be treated correctly, says Suzanne V. Arnold, MD, MHA, an assistant professor at the University of Missouri in Kansas City. She led a study on undiagnosed diabetes in heart attack patients that was reported at last year’s American Heart Association meeting. The hemoglobin A1C test shows average blood sugar levels for the preceding three months and is widely used to diagnose both type 1 and type 2 diabetes and monitor how well blood sugar is being controlled after diagnosis.
In her study, Dr. Arnold and her team took 2,854 patients who were hospitalized for heart attacks but had never received a diabetes diagnosis and arranged for them to have the hemoglobin A1C test. Both the hospitalized patients and the doctors treating them were kept in the dark (“blinded” in scientific speak) about the test results, and doctors were left to their business-as-usual patient care. Diabetes was considered recognized by the researchers if a patient either received diabetes education while hospitalized and/or diabetes medication when sent home.
The study results were a real eye-opener. Sure, Dr. Arnold’s team discovered that 10 percent of these patients had diabetes and didn’t know it, but the far bigger issue that patients and their families need to know about was that doctors failed to recognize diabetes in 69 percent of these previously undiagnosed patients.
That’s a major fail—especially when all it took for the treating doctors themselves to discover diabetes was to order the same simple, inexpensive A1C test that Dr. Arnold’s team had already ordered for their study.
Six months down the road, the researchers checked in on the patients they themselves knew had diabetes. They found that 71 percent of the patients whose diabetes had also been discovered by a doctor during their hospital stays were getting diabetes care. As for the patients whose diabetes had not been discovered by doctors treating them in the hospital, only 7 percent were getting diabetes care, meaning that the likelihood was strong that no one, except Dr. Arnold’s team, had yet checked these folks for diabetes. This left them at high risk for more cardiovascular complications, including additional heart attacks.
KNOWLEDGE THAT CAN ALSO GUIDE HEART ATTACK TREATMENT
Knowing that a heart attack patient has type 2 diabetes is important in the moment because it determines treatment decisions, explains Dr. Arnold. For example, patients with multivessel coronary artery disease and diabetes may do better with bypass surgery (rather than stents) and particular blood pressure medications, such as ACE inhibitors.
Dr. Arnold’s advice for people who have heart attacks and survive but don’t know whether they have diabetes is that they insist on having a hemoglobin A1C test during their hospitalization. She does not advocate routine hemoglobin A1C screening for everyone, though, calling it “impractical,” although it’s certainly something you can bring up with your doctor if you know you have heart disease. And although you may be in the know about diabetes and heart disease prevention, this seems like a good place to include a refresher for you or a loved one. You can assess your risks and the warning signs of diabetes with these checklists from the American Diabetes Association.
Your chances of diabetes increase if you:
•Have a family history of type 2 diabetes
•Don’t get much exercise and are otherwise physically inactive
•Are overweight
•Have high blood pressure
•Have low HDL “good” cholesterol and high triglycerides
•Don’t watch your diet and feast on high-calorie, fatty, sugary, and low-fiber foods
•Smoke
•For women, had diabetes during pregnancy
These are warning signs of diabetes:
•Unquenchable thirst
•Excessive urination
•Increased appetite, despite eating
•Unexpected weight loss
•Tingling, pain, and/or numbness in your hands and/or feet
•Blurred vision
•Cuts and bruises that take a long time to heal
•Extreme fatigue
It’s not very challenging for health-conscious people to avoid type 2 diabetes and heart disease, but keeping this bit of information on a simple blood test in mind can protect you or a loved one even more.
›Suzanne V. Arnold, MD, MHA, assistant professor at Saint Luke’s Mid America Heart Institute and the University of Missouri at Kansas City. Her study was presented at the 2014 annual meeting of the American Heart Association.
New Heart Attack Risk
In a recent finding, low blood sugar levels overnight may trigger prolonged slow heart rates during sleep in people with diabetes. This could lead to abnormal heart rhythms, which increase risk for heart attack.
If you have diabetes (especially if you also have cardiovascular disease): Talk to your doctor about ways to stabilize your blood sugar overnight, such as adjusting the timing, dose, and/or type of medication you take.
›Simon Heller, MD, professor of clinical diabetes, University of Sheffield, UK.
Six Secrets to Holistic Heart Care
You don’t smoke, your cholesterol levels look good, and your blood pressure is under control. This means that you’re off the hook when it comes to having a heart attack or developing heart disease, right? Maybe not.
Surprising statistic: About 20 percent of people with heart disease do not have any of the classic risk factors, such as those described above.
The missing link: While most conventional medical doctors prescribe medications and other treatments to help patients control the big risk factors for heart disease, holistic cardiologists also suggest small lifestyle changes that over time make a significant difference in heart disease risk.* My secrets for preventing heart disease:
Secret #1: Stand up! You may not think of standing as a form of exercise. However, it’s more effective than most people realize.
Think about what you’re doing when you’re not standing. Unless you’re asleep, you’re probably sitting. While sitting, your body’s metabolism slows, your insulin becomes less effective, and you’re likely to experience a gradual drop in HDL “good” cholesterol.
A study that tracked the long-term health of more than 123,000 Americans found that those who sat for six hours or more a day had an overall death rate that was higher—18 percent higher for men and 37 percent for women—than those who sat for less than three hours.
What’s so great about standing? When you’re on your feet, you move more. You pace, fidget, move your arms, and walk from room to room. This type of activity improves metabolism and can easily burn hundreds of extra calories a day. Standing also increases your insulin sensitivity to help prevent diabetes. So stand up and move around when talking on the phone, checking e-mail, and watching television.
Secret #2: Count your breaths. Slow, deep breathing is an effective way to help prevent high blood pressure—one of the leading causes of heart disease. For people who already have high blood pressure, doing this technique a few times a day has been shown to lower blood pressure by five to ten points within five minutes. And the pressure may stay lower for up to twenty-four hours.
During a breathing exercise, you want to slow your breathing down from the usual twelve to sixteen breaths a minute that most people take to about three breaths. I use the “4-7-8 sequence” whenever I feel stressed.
What to do: Inhale through your nose for four seconds, hold the breath in for seven seconds, then exhale through the mouth for eight seconds.
Also helpful: A HeartMath software package, which you can load on your computer or smart phone, includes breathing exercises to help lower your heart rate and levels of stress hormones. Cost: $129 and up, at HeartMath.com. You can also sign up for some free tools on this website.
Secret #3: Practice “loving kindness.” This is an easy form of meditation that reduces stress, thus allowing you to keep your heart rate and blood pressure at healthy levels.
Research has shown that people who meditate regularly are 48 percent less likely to have a heart attack or stroke than those who don’t meditate. Loving kindness meditation is particularly effective at promoting relaxation—it lowers levels of the stress hormones adrenaline and cortisol while raising levels of the healing hormone oxytocin.
What to do: Sit quietly, with your eyes closed. For a few minutes, focus on just your breathing. Then imagine one person in your life whom you find exceptionally easy to love. Imagine this person in front of you. Fill your heart with a warm, loving feeling, think about how you both want to be happy and avoid suffering, and imagine that a feeling of peace travels from your heart to that person’s heart in the form of white light. Dwell on the image for a few minutes. This meditation will also help you practice small acts of kindness in your daily life—for example, giving a hand to someone who needs help crossing the street.
Secret #4: Don’t neglect sex. Men who have sex at least two times a week have a 50 percent lower risk for a heart attack than those who abstain. Similar research hasn’t been done on women, but it’s likely that they get a comparable benefit.
Why does sex help keep your heart healthy? It probably has more to do with intimacy than the physical activity itself. Couples who continue to have sex tend to be the ones with more intimacy in their marriages. Happy people who bond with others have fewer heart attacks—and recover more quickly if they’ve had one—than those without close relationships.
Secret #5: Be happy! People who are happy and who feel a sense of purpose and connection with others tend to have lower blood pressure and live longer than those who are isolated. Research shows that two keys to happiness are to help others be happy—for example, by being a volunteer—and to reach out to friends and neighbors. Actually, any shared activity, such as going to church or doing group hobbies, can increase survival among heart patients by about 50 percent.
Secret #6: Try Waon (pronounced waown) therapy. With this Japanese form of “warmth therapy,” you sit in an infrared (dry) sauna for fifteen minutes then retreat to a resting area for half an hour, where you wrap yourself in towels and drink plenty of water. Studies show that vascular function improves after such therapy due to the extra release of nitric oxide, the master molecule in blood vessels that helps them relax.
Some health clubs offer Waon treatments, but the dry saunas at many gyms should offer similar benefits. I do not recommend steam rooms—moist heat places extra demands on the heart and can be dangerous for some people.
›Joel K. Kahn, MD, clinical professor of medicine at Wayne State University School of Medicine in Detroit and director of Cardiac Wellness at Michigan Healthcare Professionals. He is a founding member of the International Society of Integrative Metabolic and Functional Cardiovascular Medicine and author of The Whole Heart Solution. DrJoelKahn.com.
You Can Cure Heart Disease (and Fight Diabetes)—With Plant-Based Nutrition
In the mid-1980s, seventeen people with severe heart disease had just about given up hope. They had undergone every available treatment, including drugs and surgery—all had failed. The group had experienced forty-nine cardiovascular events, including four heart attacks, three strokes, fifteen cases of increased angina, and seven bypass surgeries. Five of the patients were expected to die within a year.
Twelve years later, every one of the seventeen was alive. They had had no cardiovascular events. The progression of their heart disease had been stopped—and, in many cases, reversed. Their angina went away—for some, within three weeks. In fact, they became virtually heart-attack-proof. And there are hundreds of other patients with heart disease who have achieved the same remarkable results.
HOW THE DAMAGE IS DONE
Every year, more than half a million Americans die of coronary artery disease (CAD). Three times that number suffer heart attacks. In total, half of American men and one-third of women will have some form of heart disease during their lifetimes.
Heart disease develops in the endothelium, the lining of the arteries. There, endothelial cells manufacture a compound called nitric oxide that accomplishes four tasks crucial for healthy circulation:
•Keeps blood smoothly flowing, rather than becoming sticky and clotted.
•Allows arteries to widen when the heart needs more blood, such as when you run up a flight of stairs.
•Stops muscle cells in arteries from growing into plaque—the fatty gunk that blocks blood vessels.
•Decreases inflammation in the plaque—the process that can trigger a rupture in the cap or surface of a plaque, starting the clot-forming, artery-clogging cascade that causes a heart attack.
The type and amount of fat in the typical Western diet—from animal products, dairy foods, and concentrated oils—assaults endothelial cells, cutting their production of nitric oxide.
Study: A researcher at University of Maryland School of Medicine fed a nine-hundred-calorie fast-food breakfast containing 50 g of fat (mostly from sausages and hash browns) to a group of students and then measured their endothelial function. For six hours, the students had severely compromised endothelial function and decreased nitric oxide production. Another group of students ate a nine-hundred-calorie, no-fat breakfast—and had no significant change in endothelial function.
If a single meal can do that kind of damage, imagine the damage done by three fatty meals a day, seven days a week, fifty-two weeks a year.
PLANT-BASED NUTRITION
You can prevent, stop, or reverse heart disease with a plant-based diet. Here’s what you can’t eat—and what you can.
What you cannot eat:
•Meat, poultry, fish, or eggs. You will get plenty of protein from plant-based sources.
•Dairy products. That means no butter, cheese, cream, ice cream, yogurt, or milk—even skim milk, which, though lower in fat, still contains animal protein.
•Oil of any kind—not a drop. That includes all oils, even virgin olive oil and canola.
What you may not know: At least 14 percent of olive oil is saturated fat—every bit as aggressive in promoting heart disease as the saturated fat in roast beef. A diet that includes oils—including monounsaturated oils from olive oil and canola oil—may slow the progression of heart disease, but it will not stop or reverse the disease.
•Generally, nuts or avocados. If you are eating a plant-based diet to prevent heart disease, you can have moderate amounts of nuts and avocados as long as your total cholesterol remains below 150 mg/dL. If you have heart disease and want to stop or reverse it, you should not eat these foods.
What you can eat:
•All vegetables.
•Legumes—beans, peas, lentils.
•Whole grains and products that are made from them, such as bread and pasta—as long as they do not contain added fats. Do not eat refined grains, which have been stripped of much of their fiber and nutrients. Avoid white rice and enriched flour products, which are found in many pastas, breads, bagels, and baked goods.
•Fruits—but heart patients should limit consumption to three pieces a day and avoid drinking pure fruit juices. Too much fruit rapidly raises blood sugar, triggering a surge of insulin from the pancreas—which stimulates the liver to manufacture more cholesterol.
•Certain beverages, including water, seltzer water, oat milk, hazelnut milk, almond milk, no-fat soy milk, coffee, and tea. Alcohol is fine in moderation (no more than two servings a day for men and one for women).
SUPPLEMENTS
For maximum health, take five supplements daily:
•Multivitamin/mineral supplement.
•Vitamin B-12—1,000 mcg.
•Calcium—1,000 mg (1,200 mg if you’re over sixty).
•Vitamin D-3—1,000 IU.
•Flaxseed meal (ground flaxseed)—one tablespoon for the omega-3 fatty acids it provides. Sprinkle it on cereal.
THE CHOLESTEROL CONNECTION
If you eat the typical, high-fat Western diet, even if you also take a cholesterol-lowering statin drug, you will not protect yourself from heart disease—because the fat in the diet will damage the endothelium cells that produce nitric oxide.
In a study in the New England Journal of Medicine, patients took huge doses of statin drugs to lower total cholesterol below 150 but didn’t change their diets—and 25 percent experienced a new cardiovascular event or died within the next thirty months.
Recommended: Eat a plant-based diet, and ask your doctor if you should also take a cholesterol-lowering medication. Strive to maintain a total cholesterol of less than 150 and LDL “bad” cholesterol below 85.
MODERATION DOESN’T WORK
The most common objection physicians have to this diet is that their patients will not follow it. But many patients with heart disease who find out that they have a choice—between invasive surgery and nutritional changes that will stop and reverse the disease—willingly adopt the diet.
Why not eat a less demanding diet, such as the low-fat diet recommended by the American Heart Association or the Mediterranean diet?
Surprising: Research shows that people who maintain a so-called low-fat diet of 29 percent of calories from fat have the same rate of heart attacks and strokes as people who don’t.
Plant-based nutrition is the only diet that can effectively prevent, stop, and reverse heart disease. It also offers protection against stroke, high blood pressure, osteoporosis, diabetes, senile mental impairment, erectile dysfunction, and cancers of the breast, prostate, colon, rectum, uterus, and ovaries.
›Caldwell B. Esselstyn, Jr., MD, surgeon, clinician, and researcher at the Cleveland Clinic for more than thirty-five years. He is author of Prevent and Reverse Heart Disease: The Revolutionary, Scientifically Proven, Nutrition-Based Cure. DrEsselstyn.com.
Diabetic Eye Disease May Predict Heart Failure
Diabetic eye disease may predict heart failure, says Tien Y. Wong, MD, PhD. According to a recent study, people who have diabetic retinopathy—diabetes-related damage to blood vessels in the retina—have more than double the risk for heart failure than diabetes patients with healthy retinas.
Self-defense: Everyone who has diabetes needs a comprehensive, dilated eye exam at least once a year. People in whom retinopathy is detected should have a complete cardiac exam and regular follow-ups.
›Tien Y. Wong, MD, PhD, professor of ophthalmology, National University of Singapore, and director, Singapore National Eye Centre, and senior author of a study of 1,021 adults with type 2 diabetes, published in Journal of the American College of Cardiology.
Diabetes Doubles Your Risk for Peripheral Artery Disease
How serious is peripheral artery disease (PAD)? We all know that plaque in arteries near the heart can lead to heart attack, and plaque in the arteries of the neck and brain can lead to stroke.
With PAD, plaque is typically found in arteries that supply blood to the legs—an indication that blood flow also may be inhibited throughout the body, which increases risk for heart attack and stroke, as well as severe disability or loss of a limb.
Doctors have long been aware of PAD, but the disease has received relatively little attention, because patients either don’t have symptoms or have only mild or moderate ones that are wrongly attributed to normal signs of aging.
What’s new: The link between PAD and cardiovascular disease is now so strong that virtually all doctors agree that a diagnosis of PAD warrants a checkup and monitoring by a vascular specialist.
ARE YOU AT RISK?
PAD is surprisingly common. It affects up to ten million Americans. Because PAD is associated with the same risk factors as heart attack and stroke, the risk for PAD is higher among adults who are over age fifty and/or people who have elevated cholesterol or high blood pressure.
Having diabetes doubles the risk of developing PAD. Prediabetes also increases risk. But the greatest risk comes from smoking. At least 80 percent of people with PAD are current or former smokers. Statistically, the worst combination is smoking and having diabetes—when combined, they increase the risk of developing PAD fivefold.
SYMPTOMS CAN BE TRICKY
PAD is dangerous because it can creep up on you without causing symptoms. In fact, up to half of people with PAD do not have symptoms.
When symptoms do occur, they start out mild and may be easy to dismiss. Because blood flow is compromised, activities that involve the use of the legs—walking, for example—can become more difficult and feel more tiring.
As plaque blockages become more severe, PAD causes intermittent claudication—legs become painful or achy or cramp up while walking.
At first, a person with PAD may experience symptoms of intermittent claudication only after walking long distances or up a hill or while climbing stairs. The discomfort usually goes away after sitting down and resting for a few minutes. If the condition is left untreated, even a short stroll will trigger the pain.
What most people don’t know: In rare cases, PAD can occur in the hands and arms, leading to symptoms such as aching or cramping in the arms.
GETTING A PROPER DIAGNOSIS
Not all doctors agree on who should be screened for PAD. However, it’s wise to be tested if any of the following risk factors developed by the American College of Cardiology and the American Heart Association apply to you.
•Younger than age fifty: If you have diabetes and one additional risk factor (such as smoking or high blood pressure).
•Age fifty to sixty-nine: If you have a history of smoking or diabetes.
•Age seventy and older: Even if you have no known risk factors.
Many experts believe that screening also is warranted—regardless of your age—if you have the following:
•Leg symptoms, such as aches and cramping with exertion.
•Diagnosis of atherosclerosis, fatty buildup in the walls of the arteries, including those in the heart and neck.
•Numbness, tingling, or loss of sensation in the feet or cold feet or areas of color change (bluish or dark color, for example) on your toes—an indication of compromised blood flow.
•High blood levels of C-reactive protein (CRP), an inflammation marker.
THE TESTS YOU NEED
If you meet one of the criteria described above, ask your doctor to test you for PAD. He/she will perform a measurement called an ankle-brachial index to get a sense of whether blood pumps equally through your arms and your legs. To perform this test, your doctor will measure your blood pressure in your ankle as well as in your arm and compare the two numbers.
BEST TREATMENT OPTIONS
There is no medication that will dissolve PAD plaque, so you should work with your doctor to manage your risk factors. If you’re a smoker, stopping smoking is the most important step you can take to help control PAD.
Everyone with PAD should do the following:
•Get the right kind of exercise. Surprising as it might sound, walking is the most beneficial form of exercise for PAD sufferers. It won’t get rid of the plaque, but it can improve your stamina and make walking less painful.
What to do: Walk on flat ground every day, or try a treadmill if you prefer.
•Use your level of leg pain to determine the amount of time you walk. For example, walk until the leg pain reaches a moderate level, stop walking until the pain is relieved, then resume walking. This approach trains the muscle to be more efficient in using its blood supply. Try to work your way up to fifty minutes of walking at least five days a week.
Be sure to consult your doctor before starting a walking program, especially if you have other conditions, such as heart disease, arthritis, or spine disease. Supervised exercise, such as that offered at rehab centers, has been shown to be the most effective for PAD patients—perhaps because people are more likely to stick to a walking program in these settings.
•Monitor other risk factors. It is critically important to pay attention to all your other health-related risk factors. For example, if you have diabetes, monitor and keep glucose levels under control. If you have elevated cholesterol or high blood pressure, talk with your doctor about medication.
To reduce the risk for blood clots, which could lead to limb damage, heart attack, or stroke, your doctor may suggest a daily aspirin (81 mg) or a medication that prevents clotting, such as clopidogrel. A statin also may be prescribed. Statins not only lower cholesterol, but also lower levels of the inflammation marker CRP.
WHEN ADDITIONAL TREATMENT IS NEEDED
In about 30 percent of PAD patients, the condition causes severe pain that affects their quality of life, or the amount of blockage significantly restricts blood flow. In these cases, your doctor may recommend a more invasive measure, such as angioplasty or bypass surgery, to improve blood flow in the affected artery.
With angioplasty, a tiny balloon and, possibly, stents are inserted via a catheter into the artery to widen the artery as much as possible. Bypass surgery involves creating a blood-flow “detour” around a blockage, allowing the blood to flow more freely.
Important: Treatment for PAD is highly individualized. If you’ve been diagnosed with the condition, you should see your doctor at least once or twice each year.
For more information on PAD and vascular specialists, visit www.vascularcures.org or see the Resources section at the back of the book.
›Michael S. Conte, MD, a vascular surgeon and professor and chief of the division of vascular and endovascular surgery and codirector of the Heart and Vascular Center at the University of California, San Francisco. He is a former recipient of the Distinguished Achievement Award from the New York Weill Cornell Medical Center Alumni Council and is on the editorial boards of Vascular and Endovascular Surgery and Vascular Medicine.
Natural Treatments for Peripheral Artery Disease
You are walking or climbing up a set of stairs, and suddenly, you notice a dull, cramping pain in your leg. Before you write off the pain as simply a sign of overexertion or just a normal part of growing older, consider this: you may have intermittent claudication, the most common symptom of peripheral artery disease (PAD).
PAD, also known as peripheral vascular disease, is a condition in which arteries and veins in your limbs, usually in the legs and feet, are blocked or narrowed by fatty deposits that reduce blood flow.
Intermittent claudication, leg discomfort (typically in the calf) that occurs during exertion or exercise and is relieved by rest, is usually the first symptom of PAD. But other possible symptoms may include leg sores that won’t heal (chronic venous ulcers), varicose veins (chronic venous insufficiency), paleness (pallor) or discoloration (a blue tint) of the legs, or cold legs.
Why is “a little leg trouble” so significant? If it’s due to PAD, you have got a red flag that other arteries, including those in the heart and brain, may also be blocked. In fact, people with PAD have a two- to sixfold increased risk for heart attack or stroke.
An estimated eight to twelve million Americans—including up to one in five people age sixty or older—are believed to have PAD. While many individuals who have PAD experience the symptoms described earlier, some have no symptoms at all.
Those at greatest risk: Anyone who smokes or has elevated cholesterol, high blood pressure, or diabetes is at increased risk for PAD.
BETTER TREATMENT RESULTS
The standard treatment for PAD typically includes lifestyle changes (such as quitting smoking, getting regular exercise, and eating a healthful diet). Medical treatment may include medication, such as one of the two drugs approved by the FDA for PAD—pentoxifylline and cilostazol—and, in severe cases, surgery.
For even better results: Strong scientific evidence now indicates that several natural therapies—used in conjunction with these treatments—may help slow the progression of PAD and improve a variety of symptoms more effectively than standard treatment alone can.
Important: Before trying any of the following therapies, talk to your doctor to determine which might work best for you, what the most effective dose is for you, and what side effects and drug interactions may occur.
Do not take more than one of the following therapies at the same time—this will increase bleeding risk.
Among the most effective natural therapies for PAD are:
•Ginkgo biloba. A standardized extract from the leaf of the ginkgo tree, which is commonly taken to improve memory, is one of the top-selling herbs in the United States. But the strongest scientific evidence for Ginkgo biloba may well be in the treatment of PAD.
Scientific evidence: Numerous studies currently show that Ginkgo biloba extract can decrease leg pain that occurs with exercise or at rest. The daily doses used in the studies ranged from 80 to 320 mg.
Warning: Because it thins the blood and may increase risk for bleeding, Ginkgo biloba should be used with caution if you also take a blood thinner, such as warfarin or aspirin. In addition, Ginkgo bilobashould not be taken within two weeks of undergoing surgery.
•Grape seed extract. Grapes, including the fruit, leaves, and seeds, have been used medicinally since the time of the ancient Greeks. Grape seed extract is rich in oligomeric proanthocyanidins, antioxidants that integrative practitioners in Europe use to treat varicose veins, chronic leg ulcers, and other symptoms of PAD.
Scientific evidence: In several recent studies, grape seed extract was found to reduce the symptoms of poor circulation in leg veins, which can include nighttime cramps, swelling, heaviness, itching, tingling, burning, numbness, and nerve pain.
Caution: Don’t use this supplement if you’re allergic to grapes. It should be used with caution if you take a blood thinner.
•Hesperidin. This flavonoid is found in unripe citrus fruits, such as oranges, grapefruits, lemons, and tangerines.
Scientific evidence: Research now shows that hesperidin may strengthen veins and tiny blood vessels called capillaries, easing the symptoms of venous insufficiency. Hesperidin has also been shown to reduce leg symptoms such as pain, cramps, heaviness, and neuropathy (burning, tingling, and numbness). Some hesperidin products also contain diosmin, a prescription medication that is used to treat venous disease, vitamin C, or the herb butcher’s broom, all of which strengthen the effects of hesperidin.
Caution: Many drugs can react with hesperidin. If you take a diabetes medication, antihypertensive, blood thinner, muscle relaxant, antacid, or antinausea medication, be sure to use this supplement cautiously, and promptly alert your doctor if you experience any new symptoms after starting to use hesperidin.
•Horse chestnut seed extract. The seeds, leaves, bark, and flowers of this tree, which is native to Europe, have been used for centuries in herbal medicine.
Scientific evidence: Several studies now indicate that horse chestnut seed extract may be helpful for venous insufficiency, decreasing leg pain, fatigue, itchiness, and swelling.
Caution: Horse chestnut may lower blood sugar and interfere with diabetes medication.
•L-carnitine. Also known as acetyl-L-carnitine, this amino acid may improve circulation and help with PAD symptoms.
Recent finding: Taking L-carnitine in addition to the PAD medication cilostazol increased walking distance in people with intermittent claudication up to 46 percent more than taking cilostazol alone, reported researchers from the University of Colorado School of Medicine in a recent issue of Vascular Medicine.
•Inositol nicotinate. This is a form of niacin (vitamin B-3) that is less likely to create the typical flushing (redness and heat) that is produced by high doses of niacin.
Scientific evidence: Several studies show that it is helpful in treating PAD. It is commonly used in the UK to treat intermittent claudication.
•Policosanol. This is a natural cholesterol-lowering compound made primarily from the wax of cane sugar. Comparative studies show that policosanol treats intermittent claudication as effectively as the prescription blood thinner ticlopidine and more effectively than the cholesterol-lowering statin lovastatin.
OTHER THERAPIES
You may read or hear that acupuncture, biofeedback, chelation therapy, garlic, omega-3 fatty acids, and vitamin E can help with PAD.
However: The effectiveness of these particular therapies is uncertain at this time. For this reason, it is best to forgo these approaches until more scientific evidence becomes available.
›Catherine Ulbricht, PharmD, cofounder of the Somerville, Massachusetts–based Natural Standard Research Collaboration, which collects data on natural therapies, and senior attending pharmacist at Massachusetts General Hospital in Boston. She is also author of Natural Standard Herbal Pharmacotherapy and Natural Standard Medical Conditions Reference and editor-in-chief of the Journal of Dietary Supplements.
Take This Test Before Starting a Statin
Before starting a statin, have a coronary artery calcium (CAC) test, advises Khurram Nasir, MD, MPH. The CAC test more accurately predicts cardiovascular risk than factors such as cholesterol, blood pressure, current smoking, and diabetes. In 35 percent of people considered high risk according to those factors, a CAC test showed that risk was relatively low and could be managed by lifestyle modifications instead of medication. The test is widely available, takes about three minutes, and may be covered by insurance.
›Khurram Nasir, MD, MPH, a cardiovascular disease specialist and director of Center for Prevention and Wellness at Baptist Health South Florida, Miami Beach. He is senior author of a study published in European Heart Journal.
Make Cholesterol a Laughing Matter
Laughter is great medicine—it’s not just a platitude. Nor should this come as a surprise, since previous studies regarding laughter have noted its impact on cardiovascular risk, blood pressure, and stress. The latest finding is that it even can lower cholesterol.
In research presented at the 2009 meeting of the American Physiological Society, twenty high-risk diabetic patients who had both hypertension and high cholesterol were divided into two groups. One group received standard pharmaceutical treatments for diabetes (metformin, TZD, and glipizide), hypertension (ACE inhibitors), and high cholesterol (statin drugs), while the second group received the same medication but also were instructed to watch thirty minutes a day of humorous videos. Since different people find different things funny, participants were able to select their own.
LAUGHING ALL THE WAY TO GOOD HEALTH
By the end of the second month, the benefits were already evident. By the end of one year, the laughter group had increased their “good” cholesterol by 26 percent (compared with 3 percent for the control group) while also decreasing C-reactive protein, an inflammatory marker, by 66 percent (versus 26 percent in the control group). In addition, over the course of the yearlong study, only one patient in the laughter group suffered a heart attack—compared with three in the control group.
“The benefits we see with laughter are very similar to what we see with moderate exercise,” notes researchers Lee Berk, DrPH, of Loma Linda University and Stanley Tan, MD, PhD, of Oak Crest Research Institute. Dr. Berk has even coined a term—Laughercise—to describe the benefits of therapeutic laughter. This newest finding builds upon previous research by the same team in which laughter was found to boost blood flow to the heart. Dr. Berk says that further studies are planned to determine how long this positive effect will last.
HEALING POWER OF LAUGHTER
Dr. Berk says that “it’s clear that the repetitive use of laughter produces physiological changes that lower stress hormones, increase endorphins, and—in our studies—lower risk factors for heart disease, including inflammation and cholesterol.”
›Lee Berk, MPH, DrPH, associate professor of Allied Health and Pathology, Schools of Allied Health Professions and Medicine, Loma Linda University, Loma Linda, California.
Small Drops in Blood Pressure Can Reduce Risk of Dying by One-Fifth
Type 2 diabetes is now considered a global pandemic, which is alarming, since many people who have this disease will eventually be disabled by or even die from complications of it. That’s the bad news. The good news is that you can reduce your risk of heart attack, stroke, and kidney disease—three common complications, often fatal—by bringing your blood pressure down, even by just a little. About 73 percent of adults with diabetes have high blood pressure (defined in this case as greater than or equal to 130/80 mmHg) or use prescription medications for hypertension. Research demonstrates that treatment with blood pressure drugs can reduce the risk of dying by one-fifth, generally with few side effects.
LOWER BLOOD SUGAR = BETTER OUTCOMES
People with diabetes are extrasensitive to changes in blood pressure, explains Anne Peters, MD, director of the University of Southern California (USC) Westside Center for Diabetes in Beverly Hills. The ADVANCE (Action in Diabetes and Vascular Disease) trial, involving more than eleven thousand people with type 2 diabetes from twenty countries, clearly demonstrated that lowering blood pressure significantly improved certain outcomes. It should be noted that the trial was funded by Servier, the manufacturer of Preterax, and the National Health and Medical Research Council of Australia.
Participants were randomly given the blood pressure drug Preterax—a combination of the ACE inhibitor perindopril and the diuretic indapamide—or a placebo and were followed for more than four years. Researchers found that treatment with Preterax significantly reduced the risk of serious complications of diabetes. Specifically, those who took Preterax:
•Reduced their risk of death from cardiovascular disease by 18 percent
•Cut their risk of kidney-related events by 21 percent
•Lowered their risk of death from any cause by 14 percent
The findings were published online in the September 2, 2007, issue of The Lancet.
MORE AGGRESSIVE TREATMENT REQUIRED FOR PEOPLE WITH DIABETES
Commenting on the study, Dr. Peters says that in her view, the improvements were small and actually less than she would have expected. She says that physicians treat blood pressure more aggressively in people with diabetes, typically prescribing medications for those whose pressure is above 130/80. Participants in the ADVANCE trial had a far higher mean starting blood pressure of 145/81 and were only treated to an average of 135/75—an improvement, to be sure, but one that doesn’t go far enough to reach target levels for people with diabetes.
That said, Dr. Peters notes that the study does add to the literature that even small reductions in blood pressure are beneficial. Also, she says, ACE inhibitors and diuretics have long track records for safety and effectiveness in people with diabetes, as well as those who don’t have the disease. Generic versions of these blood pressure–lowering drugs are also available.
We asked naturopathic doctor Andrew Rubman, ND, whether these results could be achieved without pharmaceutical drugs. He believes they could and suggests beginning with dietary and lifestyle modifications. “Specifically, calcium and magnesium are important for both hypertension and adult-onset diabetes,” he says but notes that managing blood pressure to target levels for a person with diabetes is complicated and requires specialized care. “Just as you’d not take heart medications without oversight from a cardiologist, you can’t treat a medical condition with supplements without specialist oversight.”
›Anne Peters, MD, professor of clinical medicine, Keck School of Medicine of the University of Southern California in Los Angeles, and director of the USC Westside Center for Diabetes. She is author of Conquering Diabetes—A Cutting Edge, Comprehensive Program for Prevention and Treatment.
Five Foods That Fight High Blood Pressure (You Might Not Even Need Medication)
Is your blood pressure on the high side? Your doctor might write a prescription when it creeps above 140/90, but you may be able to forgo medication. Lifestyle changes still are considered the best starting treatment for mild hypertension. These include not smoking, regular exercise, and a healthy diet. In addition to eating less salt, you want to include potent pressure-lowering foods, including the following.
RAISINS
Raisins are basically dehydrated grapes, but they provide a much more concentrated dose of nutrients and fiber. They are high in potassium, with 220 mg in a small box (1.5 ounces). Potassium helps counteract the blood pressure–raising effects of salt. The more potassium we consume, the more sodium our bodies excrete. Researchers also speculate that the fiber and antioxidants in raisins change the biochemistry of blood vessels, making them more pliable—important for healthy blood pressure. Opt for dark raisins over light-colored ones, because dark raisins have more catechins, a powerful type of antioxidant that can increase blood flow.
Researchers at Louisville Metabolic and Atherosclerosis Research Center compared people who snacked on raisins with those who ate other packaged snacks. Those in the raisin group had drops in systolic pressure (the top number) ranging from 4.8 points (after four weeks) to 10.2 points (after twelve weeks). Blood pressure barely budged in the no-raisin group. Some people worry about the sugar in raisins, but it is natural sugar (not added sugar) and will not adversely affect your health (though people with diabetes need to be cautious with portion sizes).
My advice: Aim to consume a few ounces of raisins every day. Prunes are an alternative.
BEETS
Beets too are high in potassium, with about 519 mg per cup. They’re delicious, easy to cook (see the tasty recipe on page 132), and very effective for lowering blood pressure.
A study at the London Medical School found that people who drank about eight ounces of beet juice averaged a ten-point drop in blood pressure during the next twenty-four hours. The blood pressure–lowering effect was most pronounced at three to six hours past drinking but remained lower for the entire twenty-four hours.
Eating whole beets might be even better, because you will get extra fiber.
Along with fiber and potassium, beets are also high in nitrate. The nitrate is converted first to nitrite in the blood, then to nitric oxide. Nitric oxide is a gas that relaxes blood vessel walls and lowers blood pressure.
My advice: Eat beets several times a week. Look for beets that are dark red. They contain more protective phytochemicals than the gold or white beets. Cooked spinach and kale are alternatives.
DAIRY
In research involving nearly forty-five thousand people, researchers found that those who consumed low-fat “fluid” dairy foods, such as yogurt and low-fat milk, were 16 percent less likely to develop high blood pressure. Higher-fat forms of dairy, such as cheese and ice cream, had no blood pressure benefits. The study was published in Journal of Human Hypertension.
In another study, published in the New England Journal of Medicine, researchers found that people who included low-fat or fat-free dairy in a diet high in fruits and vegetables had double the blood pressure–lowering benefits of those who just ate the fruits and veggies.
Low-fat dairy is high in calcium, another blood pressure–lowering mineral that should be included in your diet. When you don’t have enough calcium in your diet, a “calcium leak” occurs in your kidneys. This means that the kidneys excrete more calcium in the urine, disturbing the balance of mineral metabolism involved in blood pressure regulation.
My advice: Aim for at least one serving of low-fat or nonfat milk or yogurt every day. If you don’t care for cow’s milk or can’t drink it, switch to fortified soy milk. It has just as much calcium and protein and also contains phytoestrogens, compounds that are good for the heart.
FLAXSEED
Flaxseed contains alpha-linolenic acid (ALA), an omega-3 fatty acid that helps prevent heart and vascular disease. Flaxseed also contains magnesium. A shortage of magnesium in our diet throws off the balance of sodium, potassium, and calcium, which causes the blood vessels to constrict.
Flaxseed is also high in flavonoids, the same antioxidants that have boosted the popularity of dark chocolate, kale, and red wine. Flavonoids are bioactive chemicals that reduce inflammation throughout the body, including in the arteries. Arterial inflammation is thought to be the trigger that leads to high blood pressure, blood clots, and heart attacks.
In a large-scale observational study linking dietary magnesium intake with better heart health and longevity, nearly fifty-nine thousand healthy Japanese people were followed for fifteen years. The scientists found that the people with the highest dietary intake of magnesium had a 50 percent reduced risk for death from heart disease (heart attack and stroke). According to the researchers, magnesium’s heart-healthy benefit is linked to its ability to improve blood pressure, suppress irregular heartbeats, and inhibit inflammation.
My advice: Add one or two tablespoons of ground flaxseed to breakfast cereals. You also can sprinkle flaxseed on yogurt or whip it into a breakfast smoothie. Or try chia seeds.
WALNUTS
Yale researchers found that people who ate two ounces of walnuts a day had improved blood flow and drops in blood pressure (a 3.5-point drop in systolic blood pressure and a 2.8-point drop in diastolic blood pressure). The mechanisms through which walnuts elicit a blood pressure–lowering response are believed to involve their high content of monounsaturated fatty acids, omega-3 ALA, magnesium, and fiber and their low levels of sodium and saturated fatty acids.
Bonus: Despite the reputation of nuts as a “fat snack,” the people who ate them didn’t gain weight.
The magnesium in walnuts is particularly important. It limits the amount of calcium that enters muscle cells inside artery walls. Ingesting the right amount of calcium (not too much and not too little) on a daily basis is essential for optimal blood pressure regulation. Magnesium regulates calcium’s movement across the membranes of the smooth muscle cells, deep within the artery walls.
If your body doesn’t have enough magnesium, too much calcium will enter the smooth muscle cells, which causes the arterial muscles to tighten, putting a squeeze on the arteries and raising blood pressure. Magnesium works like the popular calcium channel blockers, drugs that block entry of calcium into arterial walls, lowering blood pressure.
My advice: Eat two ounces of walnuts every day. Or choose other nuts such as almonds and pecans.
›Janet Bond Brill, PhD, RDN, FAND, is a registered dietitian/nutritionist, a fellow of the Academy of Nutrition and Dietetics, and a nationally recognized nutrition, health, and fitness expert who specializes in cardiovascular disease prevention. Based in Hellertown, Pennsylvania, Dr. Brill is author of Blood Pressure Down: The 10-Step Plan to Lower Your Blood Pressure in 4 Weeks—Without Prescription Drugs, Prevent a Second Heart Attack: 8 Foods, 8 Weeks to Reverse Heart Disease, and Cholesterol Down: 10 Simple Steps to Lower Your Cholesterol in 4 Weeks—Without Prescription Drugs. DrJanet.com.
Lower Blood Pressure with This Vitamin
Many of us swallow a daily multivitamin and assume that we’re getting all the vitamin C that we need.
After all, most multivitamins provide 100 percent of the USDA’s recommended Dietary Reference Intake (DRI) per day for vitamin C—75 to 90 mg.
So we’re all set, right?
Well, a recent analysis from Johns Hopkins University in Baltimore shows that getting even more than the DRI each day might go a long way in terms of reducing blood pressure or maintaining healthy blood pressure.
But how much is enough?
“C” IS FOR CONTROLLING PRESSURE
Scouring forty-five years of medical literature, lead investigator Stephen Juraschek, MD, and his colleagues looked at twenty-nine clinical trials comparing blood pressure measurements among participants taking vitamin C supplements with those taking placebos. The range of supplementation taken was 60 to 4,000 mg per day—the median amount was 500 mg per day—so most subjects were taking far more than the USDA’s recommended amount. Subjects took the supplements for, on average, eight weeks. Some had high blood pressure, and some didn’t.
Results: Participants with normal blood pressure who took vitamin C had 3.8 points lower systolic blood pressure (the top number of the reading), on average, than the placebo group and 1.5 points lower diastolic blood pressure (the bottom number of the reading), on average, and those with high blood pressure who took vitamin C had 4.9 points lower systolic, on average, and 1.7 points lower diastolic, on average.
These reductions may not be as significant as the results you might get from blood pressure medications, but if your blood pressure is only slightly high, the vitamin might help keep your pressure in a healthy range or help you take less or no medication.
Juraschek says that the dips in blood pressure are thought to result from vitamin C’s action as a diuretic—it prompts the kidneys to excrete more salt and water from the body, which can relax blood vessels.
MAY HELP, WON’T HARM
Again, this research was a meta-analysis of many studies, and each study was conducted slightly differently, so Juraschek can’t tell us exactly how much vitamin C is the ideal amount to take.
But since the people in the study were taking more than the USDA’s recommended amount of vitamin C and their blood pressure was lowered, then should we all be taking more than 75 to 90 mg per day?
There’s mixed advice from experts on the topic.
Juraschek takes a very cautious approach, saying that more research is needed before people increase how much vitamin C they take. He warns that doses larger than the USDA’s recommendation could lead to diarrhea or kidney stones in some people, such as those prone to those problems.
But we’re talking about vitamin C here! A vitamin that’s good for you that is naturally in many healthy foods. Is so much caution necessary, given that vitamin C is, generally speaking, quite benign?
Excess vitamin C is excreted in urine, so how dangerous could it really be for most people? We spoke to naturopathic doctor Andrew Rubman, ND, medical director of the Southbury Clinic for Traditional Medicines in Southbury, Connecticut, to find out the answers.
Dr. Rubman says that people who are prone to diarrhea or kidney stones might have problems consuming extra vitamin C, so those people, in particular, may want to be cautious. “But that’s not most of us,” he says. “Chances are that most people—especially those who are prehypertensive (blood pressure between 120/80 and 139/89) or hypertensive (blood pressure of 140/90 or higher)—would benefit from taking more than 75 to 90 mg per day.”
If you’re interested in taking more vitamin C than you already do as a way of controlling blood pressure, discuss it with your doctor, especially if you have diabetes or another chronic condition.
›Stephen Juraschek, MD, lead investigator, department of epidemiology, Johns Hopkins University, Baltimore. Juraschek et al., “Effects of Vitamin C Supplementation on Blood Pressure: A Meta-Analysis of Randomized Controlled Trials,” The American Journal of Clinical Nutrition (April 4, 2012).
›Andrew Rubman, ND, medical director, Southbury Clinic for Traditional Medicines, Southbury, Connecticut.
Stress Busters That Help Beat High Blood Pressure
We don’t mean to cause undue alarm—especially since the point of this article is to reduce stress, not add to it—but a disturbing set of facts needs to be brought to light. It’s the reality that high blood pressure is becoming an increasingly significant problem for women.
A recent study in the journal Circulation found this alarming trend—that rates of uncontrolled hypertension are increasing among women even as rates among men are decreasing.
The Centers for Disease Control and Prevention report that more than one-third of women age forty-five to fifty-four now have high blood pressure, while among women age seventy-five and older, 80 percent do!
A more recent report from the National Center for Health Statistics states that, in the past decade, there has been a 62 percent increase in the number of visits to the doctor due to high blood pressure.
How much the lousy economy might be contributing to the problem (though studies have shown that worries about job stability increase a person’s risk for high blood pressure) is up for debate. Other research has shown that chronic stress is a significant contributor to hypertension. As C. Tissa Kappagoda, MBBS, PhD, a professor in the preventive cardiology program at the University of California, Davis, explained, “Chronic stress raises blood pressure by increasing levels of adrenaline and cortisol, hormones that promote artery spasm and salt retention. It also increases vascular resistance, the resistance to flow that must be overcome to move blood through the blood vessels, which is a primary cause of hypertension.” Stress also can impede basic self-care, such as eating healthfully and exercising—which probably explains why stress is such a “massive multiplier of the effects of conventional risk factors,” Dr. Kappagoda added.
Though high blood pressure doesn’t cause pain or other obvious symptoms, it does damage arteries—increasing the risk for heart attack, diabetes, stroke, and kidney problems. How high is too high? Hypertension is diagnosed when blood pressure hits 140/90 mmHg or higher, but doctors now realize that prehypertension (blood pressure between 120/80 and 139/89) is also risky.
Of course, it’s important to follow your doctor’s advice regarding blood pressure–lowering lifestyle changes, such as limiting salt and alcohol and losing excess weight. But stress reduction should be a priority too, Dr. Kappagoda said—and may reduce the need for hypertension medication. That’s good, because these drugs can have side effects, such as dizziness, chronic cough, and muscle cramps, and often are taken for the rest of a person’s life.
Research shows that the following stress-lowering techniques help reduce blood pressure. If you have hypertension or prehypertension, consider:
•Breathing control. When you’re relaxed, your breathing naturally slows, and if you slow down your breathing, your body naturally relaxes. This encourages constricted blood vessels to dilate, improving blood flow.
Target: Practice slow breathing for fifteen minutes twice daily, aiming to take six breaths per minute.
If you find it difficult (or even stressful!) to count and time your breaths, consider using a biofeedback device instead. One example designed for home use is RESPeRATE, which looks like a portable CD player with headphones and uses musical tones to guide you to an optimal breathing pattern. Typically, it’s used for fifteen minutes three or four times per week, and results are seen within several weeks. In studies, users experienced significant reductions in systolic pressure (the top number of a blood pressure reading) and diastolic pressure (bottom number). There are many similar and effective devices, said Dr. Kappagoda, so ask your doctor about the options. Biofeedback devices are safe and have no side effects.
•Meditation. A recent analysis of nine clinical trials, published in American Journal of Hypertension, found that regular practice of transcendental meditation reduced blood pressure, on average, by 4.7 mmHg systolic and 3.2 mmHg diastolic. Though these results are for transcendental meditation specifically, many experts believe that any type of meditation works.
Goal: Meditate for twenty minutes daily.
•Exercise. Regular physical activity reduces blood pressure not only by alleviating stress, but also by promoting weight loss and improving heart and blood vessel health. Research shows that becoming more active can reduce systolic pressure by 5 to 10 mmHg, on average. An excellent all-around exercise is walking, Dr. Kappagoda said, so with your doctor’s OK, take a thirty-minute walk at least three times weekly.
Caution: Weight training can trigger a temporary increase in blood pressure during the exercise, especially when heavy weights are used. To minimize this blood pressure spike, use lighter weights to do more repetitions, and don’t hold your breath during the exertion.
›The late C. Tissa Kappagoda, MBBS, PhD, professor of medicine in the Preventive Cardiology Program at the University of California, Davis. Dr. Kappagoda published more than two hundred medical journal articles on matters relating to cardiology and cardiovascular health.
Reduce High Blood Pressure by Tapping Your Toes
There’s a killer running rampant among us—and its name is high blood pressure.
Overly dramatic? Not really.
High blood pressure increases your risk not only for heart attack, heart failure, and stroke, but also for grave maladies that you may never have considered, such as kidney failure, dementia, aneurysm, blindness, and osteoporosis.
Yes, medications help reduce blood pressure, but their nasty side effects can include joint pain, headache, weakness, dizziness, heart palpitations, coughing, asthma, constipation, diarrhea, insomnia, depression, and erectile dysfunction!
But there’s a promising alternative therapy that’s completely risk-free—and costs nothing.
We’re talking about tapping, which is based on the principles of Chinese medicine.
SOMETHING OLD, SOMETHING NEW
The tapping method was described by Ann Marie Chiasson, MD, of the Arizona Center for Integrative Medicine. For her own patients with high blood pressure, Dr. Chiasson has adapted a tapping technique that is part of the ancient Chinese practice called qigong.
Qigong involves simple movements, including tapping on the body’s meridians or “highways” of energy movement. These meridians are the same as those used during acupuncture and acupressure treatments. According to a review of nine studies published in the Journal of Alternative and Complementary Medicine, qigong reduced systolic blood pressure (the top number) by an average of seventeen points and diastolic blood pressure (the bottom number) by an average of ten points. Those are big reductions! In fact, they are comparable to the reductions achieved with drugs—but the qigong had no unwanted side effects.
Though Dr. Chiasson has not conducted a clinical trial on her tapping protocol, she has observed reductions in blood pressure among her patients who practice tapping. The technique she recommends could also conceivably benefit people who do not have high blood pressure if it reduces stress and thus helps lower the risk of developing high blood pressure.
TAP AWAY
Some tapping routines are complicated, involving tapping the top of the head, around the eyes, side of the hand, and under the nose, chin, and/or arms. But Dr. Chiasson’s technique is a simpler toe-and-torso method that is quite easy to learn. It is safe and can be done in the privacy of your own home, so if it might help you, why not give it a try?
First, you may want to get a blood pressure reading so you can do a comparison later on. If the tapping technique is helpful, you eventually may be able to reduce or even discontinue your high blood pressure drugs (of course, for safety’s sake, you should not stop taking any drugs without first talking to your doctor about it).
Dr. Chiasson’s plan: Each day, do five minutes of toe tapping (instructions below), five minutes of belly tapping, and five minutes of chest tapping. You may experience tingling or a sensation of warmth in the part of the body being tapped and/or in your hands, which is normal. You can listen to rhythmic music during your tapping if you like. As you tap, try to think as little as possible, Dr. Chiasson says—just focus on your body, tapping, and breath.
Rate: For each tapping location, aim for a rate of about one to two taps per second.
•Toe tapping. Lie flat on your back on the bed or floor. Keeping your whole body relaxed, quickly rotate your legs inward and outward from the hips (like windshield wipers), tapping the sides of your big toes together with each inward rotation. Tap as softly or as vigorously as you like.
•Belly tapping. Stand with your feet a little wider than shoulder-width apart. Staying relaxed, gently bounce up and down by slightly bending your knees. At the same time, tap softly with gently closed fists on the area below your belly button and above your pubic bone. Try to synchronize your movements to give one tap per knee bend.
•Chest tapping. Sit or stand comfortably. Using your fingertips, open hands, or gently closed fists, tap all over your chest area, including the armpits. Tap as softly or as vigorously as you like without pushing past your comfort level.
Cautions: If you are recovering from hip or knee surgery, skip the toe tapping (which might strain your joint) and do only the belly tapping and chest tapping. If you are pregnant, stick with just the chest tapping—lying on your back during toe tapping could reduce blood flow to the fetus, and tapping on your belly may not feel comfortable and could stimulate the acupressure points used to induce labor, Dr. Chiasson says.
Follow-up: Continue your tapping routine for eight weeks, then get another blood pressure reading to see whether your numbers have improved. If they have—or if you simply enjoy the relaxing effects of the tapping—you might want to continue indefinitely.
›Ann Marie Chiasson, MD, family practitioner and clinical assistant professor of medicine, Arizona Center for Integrative Medicine, University of Tucson. She is author of Energy Healing: The Essentials of Self-Care. Her video Energy Healing for Beginners: Ten Essential Practices for Self-Care, which includes a tapping demo, can be downloaded from www.AnnMarieChiassonMD.com/Publications.html.
Alpha-Lipoic Acid Helps Reduce Diabetes and Heart Disease Risk
Alpha-lipoic acid, which is found in foods such as red meat and liver, works as an antioxidant, so it fights disease all over the body. It also regenerates other antioxidants, such as vitamins A and E, and improves insulin sensitivity, so it reduces your risk for cardiovascular disease and diabetes, and it may help reduce blood sugar levels. Dr. Horowitz typically prescribes 300 to 600 mg per day in pill form, while those patients with diabetes and/or cardiovascular risk factors will often be prescribed up to 1,200 mg per day.
›Richard Horowitz, MD, Hudson Valley Healing Arts Center, Hyde Park, New York.
Stroke: You Can Do Much More to Protect Yourself
No one likes to think about having a stroke. But maybe you should. The grim reality: stroke strikes about eight hundred thousand Americans each year and is the leading cause of disability. And having diabetes increases your stroke risk.
Now for the remarkable part: About 80 percent of strokes can be prevented. You may think that you’ve heard it all when it comes to preventing strokes—it’s about controlling your blood pressure, eating a good diet, and getting some exercise, right? Actually, that’s only part of what you can be doing to protect yourself. Read the surprising recent findings on stroke—and the latest advice on how to avoid it:
•Even “low” high blood pressure is a red flag. High blood pressure—a reading of 140/90 mmHg or higher—is widely known to increase one’s odds of having a stroke. But even slight elevations in blood pressure may also be a problem.
An important recent study that looked at data from more than half a million patients found that those with blood pressure readings that were just slightly higher than a normal reading of 120/80 mmHg were more likely to have a stroke.
Any increase in blood pressure is worrisome. In fact, the risk for a stroke or heart attack doubles for each twenty-point rise in systolic (the top number) pressure above 115/75 mmHg, and for each ten-point rise in diastolic (the bottom number) pressure.
My advice: Don’t wait for your doctor to recommend treatment if your blood pressure is even a few points higher than normal. Tell him/her that you are concerned. Lifestyle changes—such as getting adequate exercise, avoiding excess alcohol, and maintaining a healthful diet—often reverse slightly elevated blood pressure. Blood pressure consistently above 140/90 mmHg generally requires medication.
•Sleep can be dangerous. People who are sleep deprived—generally defined as getting less than six hours of sleep per night—are at increased risk for stroke.
What most people don’t realize is that getting too much sleep is also a problem. When researchers at the University of Cambridge tracked the sleep habits of nearly ten thousand people over a ten-year period, they found that those who slept more than eight hours a night were 46 percent more likely to have a stroke than those who slept six to eight hours.
It is possible that people who spend less/more time sleeping have other, unrecognized conditions that affect both sleep and stroke risk.
Example: Sleep apnea, a breathing disorder that interferes with sleep, causes an increase in blood pressure that can lead to stroke. Meanwhile, sleeping too much can be a symptom of depression—another stroke risk factor.
My advice: See a doctor if you tend to wake up unrefreshed, are a loud snorer, or often snort or thrash while you sleep. You may have sleep apnea. (For more on this condition, see page 321.) If you sleep too much, also talk to your doctor to see if you are suffering from depression or some other condition that may increase your stroke risk.
What’s the sweet spot for nightly shut-eye? When it comes to stroke risk, it’s six to eight hours per night.
•What you drink matters too. A Mediterranean-style diet—plenty of whole grains, legumes, nuts, fish, produce, and olive oil—is perhaps the best diet going when it comes to minimizing stroke risk. A recent study concluded that about 30 percent of strokes could be prevented if people simply switched to this diet.
But there’s more you can do. Research has found that people who drank six cups of green or black tea a day were 42 percent less likely to have strokes than people who did not drink tea. With three daily cups, risk dropped by 21 percent. The antioxidant epigallocatechin gallate or the amino acid L-theanine may be responsible.
•Emotional stress shouldn’t be pooh-poohed. If you’re prone to angry outbursts, don’t assume it’s no big deal. Emotional stress triggers the release of cortisol, adrenaline, and other so-called stress hormones that can increase blood pressure and heart rate, leading to stroke.
In one study, about 30 percent of stroke patients had heightened negative emotions (such as anger) in the two hours preceding the stroke.
My advice: Don’t ignore your mental health—especially anger (it’s often a sign of depression, a potent stroke risk factor). If you’re suffering from negative emotions, exercise regularly, try relaxation strategies (such as meditation), and don’t hesitate to get professional help.
•Be alert for subtle signs of stroke. The acronym FAST helps people identify signs of stroke. F stands for facial drooping—does one side of the face droop, or is it numb? Is the person’s smile uneven? Astands for arm weakness—ask the person to raise both arms. Does one arm drift downward? S stands for speech difficulty—is speech slurred? Is the person unable to speak or hard to understand? Can he/she repeat a simple sentence such as, “The sky is blue” correctly? T stands for time—if a person shows any of these symptoms (even if they go away), call 911 immediately. Note the time so that you know when symptoms first appeared.
But stroke can also cause one symptom that isn’t widely known—a loss of touch sensation. This can occur if a stroke causes injury to the parts of the brain that detect touch. If you suddenly can’t feel your fingers or toes—or have trouble with simple tasks such as buttoning a shirt—you could be having a stroke. You might notice that you can’t feel temperatures or that you can’t feel it when your feet touch the floor.
It’s never normal to lose your sense of touch for an unknown reason—or to have unexpected difficulty seeing, hearing, and/or speaking. Get to an emergency room!
Also important: If you think you’re having a stroke, don’t waste time calling your regular doctor. Call an ambulance, and ask to be taken to the nearest hospital with a primary stroke center. You’ll get much better care than you would at a regular hospital emergency room.
A meta-analysis found that there were 21 percent fewer deaths among patients treated at stroke centers, and the surviving patients had faster recoveries and fewer stroke-related complications.
My advice: If you have any stroke risk factors, including high blood pressure, diabetes, or elevated cholesterol, find out now which hospitals in your area have stroke centers. To find one near you, go to heart.org/myhealthcare.
›Ralph L. Sacco, MD, chairman of neurology, the Olemberg Family Chair in Neurological Disorders, and the Miller Professor of Neurology, Epidemiology, and Public Health, Human Genetics and Neurosurgery at the Miller School of Medicine at the University of Miami, where he is the executive director of the Evelyn McKnight Brain Institute. He is also the chief of the Neurology Service at Jackson Memorial Hospital and the 2014 recipient of the American Heart Association’s Cor Vitae Stroke Award.
*People already diagnosed with heart disease and/or who have had a stent or bypass surgery do not need the coronary calcium CT.
*To find a holistic cardiologist, go to the website of the American Board of Integrative Holistic Medicine, www.abihm.org, and search the database of certified integrative physicians.