Dr. John Day, Cardiologist

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Top 10 Ways to Lower Blood Pressure Naturally

“Is your blood pressure really 150/100 my doctor asked?”

I stared at him in disbelief. It couldn’t be correct. I wasn’t even 30 years old at the time.

“I think I’m just a little stressed coming into the doctor’s office,” I replied.

Studies show that there is a 90% chance you will suffer from high blood pressure.  Common high blood pressure symptoms include fatigue and headaches.

Last week a new study reported that getting your blood pressure below 140/90 is no longer the goal. Now, if you want to protect your brain and heart, your blood pressure needs to be below 120/80.

If you talk with your doctor about lowering blood pressure naturally, they will probably just tell you to cut back on the salt. Contrary to what your doctor may tell you, in this article I will show you that salt is not the main enemy when it comes to lowering blood pressure naturally.

Anything Over 120/80 is Prematurely Aging You

High blood pressure wears out your brain causing premature memory problems, wears out your heart causing shortness of breath, and wears out your kidneys causing fluid retention.  High blood pressure is also one of the main causes of atrial fibrillation leading to blood clots and strokes.

Studies show that any blood pressure readings over 120/80 is causing you to age prematurely. Day by day this high blood pressure is silently wearing out your organs and causing your arteries to clog up.

How Did We Get 120/80 as the New Goal?

In my medical school days it was accepted that blood pressure increased with age. This was just part of “growing old.”

However, over the last couple of decades we have seen the target systolic blood pressure (top number) decrease from 160 mmHg to 140 mmHg and now to 120 mmHg based on this newest study.

On November 9th the long-awaited SPRINT Study was finally published in the most prestigious medical journal in the world. After 8 long years, 9,361 patients, and 157 million dollars our government’s sponsored blood pressure study was finally completed. What did we learn from 157 million tax payer dollars?

First of all, to get the typical American to a systolic blood pressure of 120, without making any serious efforts at lifestyle changes, required a lot of medications. In fact, in the SPRINT study it took an average of 2.8 medications to get Americans to the 120 mmHg systolic blood pressure goal.

How much did these patients benefit from a systolic blood pressure of 120 versus the previous standard of 140?

1. An 11% trend toward lower strokes

2. The heart failure risk was reduced by 38%

3. Death from heart disease was reduced by 43%

4. Death from any cause was reduced by 27%

The fact that you could dramatically prolong life with just one more blood pressure medication got most of the cardiology community very excited and inspired to more aggressively control hypertension.

Why Did it Take 3 Blood Pressure Medications to Get to 120/80?

Why did it take so many medications to get the systolic blood pressure down to 120?  Unfortunately, these medications are not as effective as one might think.

For example, the typical blood pressure medication only lowers blood pressure by about 8 points.  Thus, if your systolic blood pressure is 144 mmHg, it is likely going to take 3 medications to get you to the new goal of 120 mmHg.

What Are the Risks of 3 Blood Pressure Meds?

How risky is it to put people on 3 different blood pressure medications just to get their systolic blood pressure down to 120 mmHg?  In real dollars, this cost can be measured by increased emergency room visits.

In the SPRINT Study, emergency room visits definitely went up for the patients taking an average of 3 blood pressure medications.  I suspect that much of this increase was likely because the study protocol promoted the use of diuretics, or “water pills,” to lower blood pressure.

Diuretics are well known to be hard on the kidneys, cause electrolyte problems, and increase the risk of fainting from dehydration. Below are the risks of lowering the systolic blood pressure from 140 to the new goal of 120 with medications:

1. The risk of fainting was increased by 46%.

2. The risk of kidney injury went up by 69%.

3. The risk of too low of a blood pressure was increased by 70%.

4. The risk of an electrolyte abnormality was increased by 36%.

Are all of these increased risks worth it to reduce the risk of premature death by 27%?  Based on my discussions with colleagues, your cardiologist will probably say yes.

These risks from blood pressure medicines are real. Having once worked as an emergency room doctor on nights and weekends to help support my family during my cardiology training at Stanford University, I also saw many of these same side effects from blood pressure medications. Fortunately, I did not suffer from any side effects when I once took lisinopril or losartan to control my high blood pressure.

Cardiologists Embrace More Meds to Control Blood Pressure

The SPRINT Study has confirmed what cardiologists have long known, when it comes to blood pressure lower is better.  And a lower blood pressure keeps your organs and you much younger.

My only concern is that we have totally overlooked the side effects of “polypharmacy.”  Polypharmacy is the term we use in the medical community to describe a situation where a patient is on a lot of medications and is at risk for many medication side effects.

Is there a Better Way?

It goes without saying that if we could slow down the aging process with a naturally lower blood pressure, free of medications, that would be ideal. Unfortunately, most physicians either don’t have the time or believe that you can really lower your blood pressure that much naturally.

Having seen my own blood pressure drop from the 140/90 range, peaking at 150/100, to readings consistently around 110/65 without medications, it can certainly be done. I have also seen this same thing in hundreds of my patients.

However, to get to a healthy blood pressure without medications will require a faithful commitment to a very healthy lifestyle. Also, these lifestyle changes need to be implemented as early as possible to prevent high blood pressure from causing permanent damage and becoming a permanent condition.

How Should I Track Blood Pressure?

Everyone needs to know their blood pressure.  Even if your blood pressure is fine now, you need to watch this closely as 90% of people will ultimately develop hypertension or a blood pressure above 140/90.

Every home should have a blood pressure monitor.  Blood pressure monitors are very affordable and a good machine will only set you back about $50. You don’t need a prescription to buy one.  To find the best blood pressure monitor either speak with your pharmacist or read this Consumer Reports article.

How Do You Take an Accurate Blood Pressure?

To take an accurate blood pressure, you need to be seated in a relaxed environment for 5 minutes. Also, your arm should be at the level of your heart.

You may need to take several readings as blood pressure readings can fluctuate from measurement to measurement. If you are nervous when checking your blood pressure you may need to take several readings until the effects of stress go away.

How Often Should You Check Your Blood Pressure?

This is a question I am often asked and my answer is generally, it depends. If your doctor has just changed one of your blood pressure medications then you need to check it frequently.

“Doc, I just fainted,” is something I often hear when people on blood pressure medications make many healthy lifestyle changes all at once. Some patients have even hit their heads hard in the bathroom from these fainting episodes.

As weight loss and other healthy lifestyle changes can quickly drop your blood pressure, if you are on blood pressure medications you will need to check your blood pressure regularly and stay in close communication with your physician.  Once your blood pressure has stabilized then a weekly check may be enough.  Talk with your doctor to find out how often they would like you to check your blood pressure.

What Should You Do If Your Blood Pressure is too Low?

If you are on blood pressure medications, and are making healthy lifestyle changes, your blood pressure may start dropping really fast.  Besides notifying your doctor, what can you do if your blood pressure drops dangerously low from medications?

In general, hydration and salt reverses most cases of low blood pressure from too much medication.  Of course, your doctor will also likely need to cut back on some of your medications to keep this from happening again.

Top 10 Ways to Lower Blood Pressure Naturally

Most of my committed patients can get their blood pressure to goal with minimal to no medications.  To help you get to a systolic blood pressure of 120 mmHg without medications, here are 10 scientifically proven ways to lower blood pressure naturally.

1. Lose 20 Pounds: 10 point reduction

I can’t tell you how many patients I have seen where getting to a healthy weight dramatically dropped their blood pressure.  One review of 8 studies showed that for every 2 pounds you lose, you can drop your systolic blood pressure by 1 point.

In my case, both my weight and my systolic blood pressure dropped by more than 30.  Of course, there were many healthy lifestyle changes that I made so it is hard to know how much of this blood pressure reduction came from weight loss and how much came from the other strategies I have listed below.

2. Limit Sugar: 8 point reduction

While your physician will probably tell you to restrict the salt if you want to lower your blood pressure, reducing the other white crystal, sugar, will drop your blood pressure even more. In fact, studies show that sugar can raise your systolic blood pressure by 8 points.  Another study showed that just a 24 ounce (710 mL) drink of sugary soda pop temporarily raised the blood pressure by 15 points!

To always keep your blood pressure in the healthy zone, try limiting all added sugars to the World Health Organization’s recommended 25 grams per day.  To put this in perspective, one 12 ounce can of Coke has 39 grams of sugar.

3. Move More: 7 point reduction

Have you ever noticed how much lower your blood pressure is after you have exercised? These blood pressure lowering effects can last up to half of your waking hours.  In general, most people can expect to lower their systolic blood pressure by about 7 points from daily exercise which is the equivalent of one blood pressure medication.

4. Bulk Up on Fiber: 6.0 point reduction

High fiber foods, like fruits, vegetables, nuts, seeds, and legumes, can dramatically lower your blood pressure.  Indeed, a review of 25 studies published on the effect of fiber in the diet showed that a high fiber diet could reduce systolic blood pressure by 6 points.  While nutritional guidelines report that you should shoot for approximately 30 grams of fiber each day, most Americans fall far short at an average of just 15 grams daily.

An easy way to track your fiber intake is to use a smartphone app like Lose It or My Fitness Pal.  Personally, I use the free version of Lose It on my iPhone and consistently average approximately 70 grams of fiber each day.  To easily surpass the recommended 30 grams of fiber each day, I tell my patients to shoot for 9 servings daily of fruits and vegetables as well as a daily serving of nuts or seeds and legumes.

5. Fruits, Vegetables, and Limited Saturated Fats: 5.5 point reduction

This recommendation comes from the DASH Diet Study.  In this very well designed study, people who increased their fruit and vegetable intake, while also minimizing saturated fats from meat and dairy, were able to drop their systolic blood pressure 6 points.  If you dissect this 6 point reduction, 3 points comes from increasing fruits and vegetables whereas the other 3 points comes from limiting saturated fat from meat and dairy.

6. Nitric Oxide from Greens and Root Vegetables: 5.4 point reduction

Nitric oxide is a powerful vasodilator which means it relaxes and dilates your arteries.  This vasodilation effect can dramatically reduce blood pressure.  Nitric oxide should not be confused with nitrous oxide which is commonly referred to as “laughing gas.”

Foods highest in nitric oxide include greens, especially spinach, and root vegetables like beets.  One study showed that eating spinach soup daily for a week lowered systolic blood pressure by 3.4 points.

Another study looked at the effects of beet root juice.  In this study, beet root juice lowered the systolic blood pressure by 5.4 points.

To keep your blood pressure where it should be, make sure you get your greens or root vegetables every day.

7. More Minerals: 5.0 point reduction

Plant based sources of potassium, magnesium, and calcium can all have a dramatic blood pressure lowering effect.  Many researchers believe that it is these minerals which account for the 5 point lower blood pressure typically seen in vegetarians.

When I share the blood pressure lowering effects of minerals with my patients, most ask if they should take supplements.  Unfortunately, studies also show that mineral supplementation generally does not lower blood pressure.

In general, if you are eating 9 servings of fruits and vegetables, a serving of nuts or seeds, and a serving of legumes each day you will get plenty of the plant based sources of magnesium, potassium, and calcium.

8. Eliminate Unnecessary Stress: 5.0 point reduction

Modern life is stressful enough. We don’t need any unnecessary stress in our lives further exacerbating things. For example, people crushed by chronic stress typically run blood pressures 5 points higher.  Even stressful situations can shoot your blood pressure up.

For example, this week I appeared on our local TV station to discuss this blog article.  As part of this TV segment, I had my blood pressure checked on live TV.  To my shock, my blood pressure shot up over 50 points.  Here is the link to see this TV segment.

When this happens at the doctor’s office we call it “white coat hypertension.”  White coat hypertension refers to a situation, like a doctor’s white coat, where stressful situations elevate the blood pressure.  While once considered benign, newer studies report risks associated with white coat hypertension.

It is critically important that you find a way to reduce or eliminate unnecessary stress in your life.  For me, my ultimate stress reducer is to exercise outside.  For others yoga and meditation can be very helpful.  Perhaps this is why some studies show a 16 point blood pressure reduction with yoga and a 5 point blood pressure lowering effect from meditation.

9. Better Sleep: 4.8 point reduction

Sleep is often a much overlooked way to lower your blood pressure.  I have found that most of my cardiac patients suffer from sleep apnea.  Sleep apnea is a condition where people snore loudly and periodically stop breathing while sleeping.

Fortunately, sleep apnea can be easily treated by sleeping with a C-PAP machine.  Studies of C-PAP therapy show a blood pressure reduction of about 5 points.

While correcting sleep apnea is important, you also have to sleep long enough to keep your blood pressure down.  With regards to sleep duration, one study showed that sleeping an extra 35 minutes could decrease systolic blood pressure by up to 14 points.

10. Limit Salt: 4.8 point reduction

“I never use the salt shaker,” patients often proudly tell me when we discuss ways to lower their blood pressure. It seems that salt is still demonized as the major cause of high blood pressure.

Most of my patients are surprised when I tell them that for 99% of my patients I don’t worry about the salt shaker at all. When it comes to salt and hypertension my concern is with processed food, fast food, and restaurant food.  Indeed, according to the World Health Organization, 80% of our sodium comes from these sources.

For example, two slices of whole wheat bread has 500 mg of sodium. Many salad dressings also contain 500 mg of sodium just from two small tablespoons. Pizza may be the worst offender as just one slice could easily top 1,000 mg of sodium.

How low should you go with the sodium?  Most studies seem to put the “sweet spot” at about 2,300 mg daily which is certainly more than the currently recommended 1,500 mg from the American Heart Association.  In salt sensitive people with high blood pressure their physicians may want to shoot for the targets set by the American Heart Association.

Final Thoughts

Based on my own experience, as well as that of hundreds of my patients, high blood pressure is completely reversible if healthy lifestyle changes can be implemented before high blood pressure becomes a permanent condition.  The key is to start today on at least one of these top 10 scientifically proven ways to lower blood pressure naturally.

To help us to get the word out that people don’t have to unnecessarily suffer from high blood pressure, or the medications used to treat high blood pressure, please share this article with friends and family members.

If you suffer from high blood pressure, or take high blood pressure medications, never self treat or stop medications without your doctor’s approval.  Hypertension is one of the main causes of dementia, heart attacks, and strokes and you don’t want to put yourself at unnecessary risk.

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Are Artificial Sweeteners Dangerous?

For years I suffered from daily headaches.  I was convinced this was because of my stressful job as a cardiologist.

One day, after giving up Diet Coke for quite some time, I realized that I had not had a headache in months. Could the aspartame have been the cause of my daily headaches?

The use of artificial sweeteners in the U.S. has gone up five-fold in the last 40 years.  This is mostly in the form of diet drinks.  In this article, I will share the latest scientific data on artificial sweeteners and answer the question: Are artificial sweeteners dangerous?

Is Your Sweet Tooth Genetic?

From a historical standpoint, craving sweets probably served us well.  Sweet plants are less likely to be poisonous in the wild and the natural sweet tooth that children have helps them to get enough calories to survive to adulthood.

However, these days a sweet tooth often leads to troubling conditions.  “I have always had a sweet tooth,” Becky told me at her last cardiology clinic visit.  In addition to her cardiac issues she also suffered from obesity and diabetes.

This past week at the Obesity Society Annual Meeting in Los Angeles, researchers presented a study that hit the worldwide press.  They found that if people had the FTO variant gene (also known as the “fat gene” or in reference to this study, “the sweet tooth gene”) or the DRD2 gene (the addiction gene), their brains light up like a Christmas tree at the slightest sight of sweets as seen by real time MRI brain imaging.

While I don’t have the DRD2 addiction gene, I do have two copies of the FTO “sweet tooth” gene.  This double dose of the FTO variant gene explains my lifelong sweet tooth cravings.  As I have gotten older, and have struggled with weight gain in the past, I have looked to artificial sweeteners to satisfy my FTO variant genes without paying an apparent caloric price.

If you want to find out if you have the FTO variant gene or the DRD2 gene, you can easily do so through a simple home saliva DNA test kit from 23andMe for $199.  To find out the details on this process, please see an article I wrote on the subject called, How to Test Your Genes.

What Artificial Sweeteners Do You Need to Know About?

If you use artificial sweeteners, you need to know the four main players.  As everyone reacts differently, it is possible that one or more of these artificial sweeteners may be causing problems for you.

That was certainly the case for me with aspartame.  I discovered that it was indeed the aspartame after systematically removing and then reintroducing each of the chemicals listed on the ingredient label of Diet Coke.

1. Aspartame (NutraSweet or Equal)

This is one of the first generation of artificial sweeteners having been FDA approved in 1981.  Aspartame is a combination of aspartic acid and phenylalanine.  For people with a genetic disease, called phenylketonuria or PKU, aspartame is highly poisonous.  The main way Americans currently get aspartame is through diet drinks from the Coca-Cola company.

2. Sucralose (Splenda)

Sucralose is part of the second generation of artificial sweeteners.  Sucralose was FDA approved in 1998 and is made from adding chlorine atoms to natural sugar.  This chlorinated sugar compound cannot be broken down by your body and thus is mostly calorie free.  As you might imagine, the addition of chlorine atoms to sugar has generated a lot of possible health conspiracy theories on the Internet.

Interestingly, in 2015, Pepsi switched all of their
diet sodas from aspartame to sucralose.  Their motives for doing so are unclear.  It is certainly possible that this was done to create a market for people who do not tolerate aspartame well or it could have been done as a marketing ploy to boost sales given their lagging market line of diet drinks.

3. Sugar Alcohols (chemicals that end in “tol”)

In contrast to aspartame or sucralose, which don’t raise blood glucose levels, the sugar alcohols do raise sugar levels in the blood but not to the extent of regular sugar.  Most people get sugar alcohols from sugarless gums, sugar free candies, and even in other food products like sugar free jams and ice cream.

In addition to aspartame, I also struggle with sugar alcohols.  If I eat more than a stick or two of sugarless gum I often suffer from bloating, gas, and abdominal pain.  Other people may have diarrhea.

If you suffer from any of these symptoms, carefully check the labels of everything you put in your mouth.  If you see any chemical ending in the letters “tol,” there is a good chance that the processed food companies have slipped in sugar alcohols without you even being aware of them.

4. Stevia

While not technically an “artificial sweetener,” given that the South Americans have been chewing on stevia leaves for millennia, one could argue that modern day processing techniques of stevia render it “artificial.”

Indeed, the Coca-Cola Company now markets Truvia under the health food halo of stevia when in reality the main ingredient listed is just a sugar alcohol.  If you want to consume a more natural, non-sugar and calorie free sweetener, try to get your stevia organic and as close to the natural leaf as possible.  This may require you to visit your local health food store.

My Top 7 Artificial Sweetener Questions

Nearly everyday patients ask me about my opinion on artificial sweeteners.  Here are the top 7 artificial sweetener questions I get.

1. Do artificial sweeteners cause cancer?

Since the 1970s, reports emerged about saccharin causing bladder cancer in rats.  What scientists did not understand at that time was that this bladder cancer risk was unique to rats and not to other animals or humans.

The second big cancer scare from artificial sweeteners was in 1996 with the publication of a report suggesting that aspartame caused brain tumors.  While this study was widely circulated in the press, it has now been dismissed by modern scientists due to shoddy science.  Subsequent studies have not clearly linked aspartame to cancer.

Newer artificial sweeteners have also undergone intense scrutiny and, fortunately, none seem to cause cancer.  Of course, it is certainly possible that at some future date we might discover that one or more artificial sweeteners causes cancer.  Thus, my opinion is that studies do not currently show a clear risk of cancer from artificial sweeteners. 

2. Do artificial sweeteners cause weight gain?

While most people consume artificial sweeteners to lose weight, could these substances actually cause weight gain?  Surprisingly, when artificial sweeteners are fed to rats they will consistently gain weight.  This is even true with stevia.

In humans it is much more difficult to interpret these studies.  The primary unanswered question is: Do overweight people use artificial sweeteners or do artificial sweeteners make people overweight?  It is the classic chicken and the egg conundrum.

Theoretically, artificial sweeteners could cause weight gain by confusing the body.  This is certainly true with rats.  Once rats are fed artificial sweeteners they lose their ability to regulate how many calories they eat.  Also, animals fed artificial sweeteners don’t secrete the same hormones that tell them they are full so they continue to eat.

In humans, MRI brain studies show that the more artificial sweeteners you consume, the more your brain “lights up” at the sight of real sugar.  In other words, diet sodas may intensify your sugar addiction.

Lastly, while you don’t get any nutrition from artificial sweeteners, the wrong kind of gut bacteria thrive on artificial sweeteners.  Thus, any possible weight gain may be from changes to your gut flora.

Before you are completely convinced that artificial sweeteners cause weight gain, I should point out that in studies of overweight people when they substituted artificial sweeteners, in place of sugar, they lost weight.

Probably the best line of evidence comes from a seminal Harvard study which looked at the causes of weight gain over time.  In this study of 168,215 people, diet sodas actually caused a 0.12 pound annual weight loss.

However, after reviewing countless studies on artificial sweeteners, my take is that artificial sweeteners probably do not cause any significant weight gain or weight loss in most people.

3. Do artificial sweeteners cause diabetes?

While artificial sweeteners have been touted as a safe alternative for diabetics, some medical studies suggest that artificial sweeteners may actually cause diabetes.  For example, one large study of 6,039 people showed that artificial sweeteners actually increased your risk of diabetes by 25%.

Reports like these sounded the alarm for more research from the medial community.  This, in turn, led to studies like the Health Professionals Follow Up Study of 40,389 people from Harvard University.  Fortunately, this study did not show any increased risk of diabetes from diet drinks.

Contrary to what you might see somewhere on the Internet, four carefully performed scientific studies also showed no significant increase in the glycemic response to artificial sweeteners.  Likewise, position papers from the American Heart Association and the American Diabetes Association, which included the top scientists in the world, could find no clear link between artificial sweeteners and diabetes.

Based on my review of the science, artificial sweeteners probably do not cause diabetes.

4. Do artificial sweeteners cause heart disease?

As with a possible diabetes risk, some studies report an increased risk of heart disease from artificial sweeteners.  Indeed, one study reported up to a 50% increased risk with just 1 daily diet soda.  In this study, not only was their risk of heart disease increased but their cholesterol, waist line, and blood pressure all went up from just one diet soda each day.

Fortunately, for every study that suggests a possible cardiac risk from artificial sweeteners, there are just as many, if not more, studies showing no increased risk.  As a cardiologist, I tell my patients that, based on the most recent science, artificial sweeteners probably do not cause heart disease.

5.Is Agave Safer?

I am often asked if agave is a safe natural alternative to sugar. While agave is a low glycemic sweetener, due to its high fructose content, in contrast to all of the artificial sweeteners we have discussed thus far in this article, agave is highly caloric.

While there are not much scientific data specifically on agave, I classify agave as something akin to high fructose corn syrup.  As with high fructose corn syrup, agave is a highly processed plant extract that is very high in fructose.

6. Is Stevia Safer?

Real stevia has been used for millennia by South Americans with no apparent health consequences.  While rats gain weight on stevia, fortunately, the scientific data do not suggest any increased risk of weight gain or diabetes in humans.  In my opinion, stevia is probably the safest non-caloric sweetener.

7. Is Regular Soda Pop Safer than Diet Soda?

Whenever the subject of artificial sweeteners comes up, typically one person will say with pride, “at least I don’t drink anything diet.”

“What do you drink?” I’ll often ask.

“I only drink the regular soda,” is the reply I generally get.

Which is less bad for you?  If you had to choose, should you do the sugary Coke or the Diet Coke?

For those of you who regularly follow my blog, you already know the answer.  Neither.  However, if you look at the scientific data, artificial sweeteners may be “less bad” for you than high fructose corn syrup.  Let me explain.

Medical studies consistently show significant weight gain with sugary drinks.  These include soda pop, sports drinks, and even fruit juice.

For example, in a seminal Harvard study, just having a little more than one sugary drink a week caused people to gain 0.25 pounds a year.  In that same Harvard study, substituting a diet drink actually caused a 0.12 pound annual weight loss.

When it comes to diabetes and heart disease, the findings are the same.  Sugary drinks put you at increased risk whereas the data are not clear for diet drinks.

My personal view is that while neither sugar or diet drinks are “healthy,” sugary drinks consistently increase health risks whereas it is not so clear with diet drinks.

My Take on Artificial Sweeteners

At the beginning of this article I shared with you that I suffered from daily headaches for years, and that, remarkably, after quitting my daily Diet Coke habit, all of these headaches mysteriously disappeared.  I, like many other people, suffer from aspartame headaches.  Perhaps this is one reason why Pepsi recently switched from aspartame to sucralose.

I also suffered with abdominal issues from sugarless gums.  I share this because many people may have sensitivities to certain artificial sweeteners or other food additives.  The less of these chemicals you put in your body the better.

I realize that with all of the conflicting medical studies, navigating the waters of artificial sweeteners can be challenging.  Here are my three tips to navigating the waters of artificial sweeteners.

1. While artificial sweeteners do have many side effects, studies indicate that they may not be as dangerous as some Internet sites suggest.

2. Artificial sweeteners are best consumed as an occasional treat, if at all.

3. If you use artificial sweeteners, stevia may be a better option.

What has been your experience with artificial sweeteners?  Do you use stevia?  Please share your experiences below for our community.

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7 Things Meat Lovers Do To Prevent Cancer

Just last week, the World Health Organization (W.H.O.) put processed meats in the same category as tobacco and arsenic–known carcinogens.  Red meat wasn’t far behind as a probable cause of cancer.

Unfortunately, the media got this story completely wrong.  Meat has many key nutrients and the human race has always eaten it–what should meat lovers do?

In this article, I will not only put the latest scientific findings on meat into perspective but I will also share 7 things meat lovers do to help prevent cancer.

Where Did This Report Come From?

Processed and red meats have long been associated with heart disease, cancer, and premature death.  Given the vast amount of scientific data available, the World Health Organization (W.H.O.) brought together 22 leading scientists from 10 countries to carefully review the 800 best medical studies looking at the health effects of meat.

These 800 studies came from many different countries, different cultures, and different ways of preparing meat.  Based on this careful review of the best science available, these cancer scientists labelled processed meats as clearly carcinogenic and red meat as probably carcinogenic.

Can We Trust the Science?

Rather than just believe what the W.H.O. is telling us, I’ve begun personally reviewing many of the 800 studies included in this report. Based on my review of the scientific data, the research team did include high quality studies.  However, nutritional science is a very imperfect science.

The biggest limitation in my mind is that meat lovers are much more likely to have other unhealthy behaviors like not exercising and eating more junk food.  While researchers try to account for this in scientific studies, it is possible that they could not fully correct for this.  Thus, it may not be the meat but rather the lifestyle choices of meat lovers that causes cancer.

Meat Contains Key Nutrients

When discussing the health effects of meat, we can’t forget that meat contains many critical nutrients like vitamin B12, iron, and zinc.  When you look at the history of the human race, we probably would not have survived in ancient times if meat was not available.

In fact, before the days of synthetic vitamins, the only real source of vitamin B12 was meat.  Thus, one could argue that we were genetically designed to eat meat.

What Are Processed Meats?

As processed meats have now been put into the same camp as tobacco and arsenic when it comes to cancer, what exactly are processed meats?  The W.H.O. has defined processed meats as “meat that has been transformed through salting, curing, fermentation, smoking, or other processes to enhance flavor or improve preservation.”  Everyday examples of processed meats include ham, deli meats, bacon, sausage, hot dogs, and pepperoni.

What is Red Meat?

While the pork industry would like us to believe that pork is the “other white meat,” the W.H.O. doesn’t see things that way.  Once again, according to the W.H.O., red meat is defined as “beef, pork, veal, lamb, mutton, horse, or goat meat.”

How Does Meat Cause Cancer?

Scientists aren’t 100% sure what makes processed and red meat cancerous but they have some pretty good ideas.  Chief among these are N-nitroso-compounds (NOC), commonly labelled as nitrites, polycyclic aromatic hydrocarbons (PAH), and heterocyclic aromatic amines (HAA) which are formed from processing and cooking meats.

In the case of NOC (AKA nitrites), this toxic chemical directly damages the cells lining the gut.  As the cells in the gut are constantly dividing, if NOC alters the DNA of the cell then this DNA mutation will be passed on to new cells and tumors can develop.

Does the Dose Determine the Risk?

Alternatively, maybe the cancer risk is all related to the dose.  While not mentioned in this W.H.O. report, perhaps there is a small dose of processed or red meat that is safe to eat.

For those who like an occasional processed or red meat treat, you may be just fine.  The people in the meat cancer studies really ate a lot of meat.

For example, from these 800 studies, the average dose of red meat was 50 to 100 grams daily.  To put that in perspective, that is the equivalence of eating a quarter pounder hamburger every day for your entire life.

What is Your Risk of Cancer?

As mentioned, you really have to eat a lot of processed and red meats each day to significantly increase your cancer risk.  Specifically, when it comes to red meat, the cancer risk is increased by just 17% for every 100 grams of red meat you eat each day.  Thus, eating that 100 gram quarter pounder burger every day, for the rest of your life, will only bump your cancer risk by 17%.

In contrast, it takes much less processed meat to increase your cancer risk.  Just eating 50 grams, which works out to be two strips of bacon, one deli sandwich, one slice of ham, one sausage, one hot dog, or one slice of pepperoni pizza each day, will increase your cancer risk by 18%.  Thus, if you like bacon for breakfast, a deli sandwich for lunch, and a slice of ham for dinner every day, for the rest of your life, you have just increased your cancer risk by 54%.

The Media Got it Wrong

While the cancer risks of processed and red meat sound “big,” this is just your relative risk not your absolute risk of getting cancer.  In absolute terms, worldwide there will be 34,000 extra cancer deaths this year from processed and red meats.  These 34,000 “meat deaths” can in no way compare to the number one carcinogen, tobacco, which will cause one million people to die this year.

To look at this relative risk in a different way, the Cancer Risk UK organization estimates that for every 100 cases of cancer in the UK, just 3 of these 100 cases could have been prevented by not eating processed or red meats. As you can plainly see, while the relative risk may have seemed big in the media reports, the absolute risk of getting cancer from processed and red meats is really quite small.

What Cancers Do You Get From Meat?

The biggest cancer risk from processed and red meats is clearly colon cancer.  This is likely because what is left of the meat from the digestion process sits for a long time in your colon.

In addition to colon cancer, there also seems to be a link between processed and red meats and cancer of the pancreas, stomach, and prostate.  Thus, if any of these cancers run in your family you may want to significantly back on processed and red meats.

Are Wild and Organic Meats Safer?

The studies reviewed by the W.H.O. generally included meat raised by modern agriculture techniques which means lots of antibiotics and hormones, industrial grain feed, and unhealthy animal living conditions.

It is possible that red meat, when raised responsibly, has no increased risk of cancer.  Unfortunately, there are no good studies to prove or disprove this theory.

Do Fish and Poultry Cause Cancer?

While processed and red meat have consistently been linked to cancer, the same does not apply to other meats.  Indeed, from one of the 800 studies used in this W.H.O. report, researchers found that fish actually decreases your risk of cancer.  Other studies have shown that fish has a neutral cancer risk.

The scientific data for poultry are also not clear.  Some studies suggest a slight increased cancer risk, others neutral, and still others report that it may weakly prevent cancer.

My take on reviewing these studies is that fish is probably neutral to beneficial when it comes to cancer risk and that poultry is probably just neutral with regards to cancer risk.

How Much Protein Do You Need?

When I suggest to patients that they may want to cut back on their meat, they usually ask “how will I get my protein?”  Perhaps the first question is how much protein do you need?

General nutrition guidelines recommend 1 gram of protein for every kilogram you weigh.  To find out your weight in kilograms, just divide your weight in pounds by 2.2.

Personally, I shoot for 1.5 grams of protein per kilogram to keep my hunger in check and to make sure my body has enough protein to build muscle mass.  I personally use the free version of Lose It! on my iPhone to track my daily protein intake.

Non Meat Protein Sources?

While my patients know that dairy is also high in protein, many are not aware that there is also a lot of protein from plants.  For example, beans, lentils, peas, nuts, seeds, vegetables, and whole grains can also be high in protein.

For example, 200 calories of spinach has 27 grams of protein which is about the same amount of protein in 200 calories of a steak.  Of course, 200 calories of spinach would be so much food it would require three heaping plates.  Regardless, calorie for calorie, spinach has the same amount of protein as a steak.

One important thing to remember with plant based sources of protein is that not all of these proteins are complete proteins.  What this means is that these individual protein sources may be missing one or two key amino acids. Thus, you have to combine a legume with say nuts, seeds, or a whole grain for it to equal a complete protein.

What Can You Do to Lower Your Cancer Risk?

If you love processed and red meats is there anything you can do to neutralize your cancer risk?  When it comes to colon cancer, fiber seems to be especially helpful in preventing cancer.  In one study, those who ate the most fiber lowered their cancer risk by 27%.  The foods highest in fiber are fruits, vegetables, legumes, nuts, seeds, and whole grains.

Also, when it comes to cancer prevention you cannot forget about the protective effects of exercise and maintaining a healthy weight.  For example, 1 in 10 colon cancers are due from not getting enough exercise.  Likewise, 10% of colon cancers are due to being overweight .  These cancer risks are much larger than eating processed or red meats.

Should You Stop Eating Meat?

Based on this report, should you go vegetarian?  No.  All this report tells you is that if you are on a meat heavy diet you may want to cut back and shift more of your daily protein intake to fish, poultry, or plant based sources.

Having said that, I must admit that since this W.H.O. report came out it is now much harder for me to eat meat.  Personally, I have never really enjoyed the taste of meat other than an occasional great burger.  While I no longer eat processed or red meat, I do encourage myself to eat wild salmon once or twice a week as part of a healthy diet.

7 Things Meat Lovers Do To Prevent Cancer

I need to point out that even if you give up processed and red meats and do everything listed below you could still get cancer.  All you can do is lower your risk.  Below are 7 things meat lovers do to prevent cancer.

1. Processed Meats Should Be a Rare Treat

As the cancer link to processed meats is highest, if you love meat and are frightened by cancer, then make processed meats a very rare treat.  If you just cannot live without deli meats, ham, bacon, sausage, hot dogs, or pepperoni then look for organic varieties that are nitrite free.  While we don’t know if the organic nitrite free varieties are any safer, at least you can feel better knowing you have done everything possible to lower your cancer risk of your favorite treats.

2. Eat Organic or Wild Meats

The vast majority of the studies looking at the cancer risk of meat included “modern meats” from animals treated with lots of hormones and antibiotics, who were fed industrial grains, and were confined to crowded living conditions.  While there are no studies to prove this, it is very possible that eating red meat the way our ancestors once did, wild and naturally organic, may not increase your cancer risk at all.

3. Cook Meat Safely

As with modern livestock techniques, it is possible that the cancer risk of processed and red meats is entirely due to how the meat is prepared.  For example, cooking at high temperatures in the pan or on the grill may be the reason why the cancer risk is increased.  To minimize your red meat cancer risk, try slow cooking or boiling your meat as part of a stew.

4. Eat Meat No More than 1-2 Times Per Week

Probably the best way meat lovers can reduce their risk is to just cut back.  For example, the average red meat eater in cancer studies ate up to 100 grams daily which is the equivalent of eating a quarter pounder burger every day.  Thus, to lower your cancer risk, try eating meat just one or two times a week.

5. Eat More Fish and Poultry

As there are no clear scientific data linking fish or poultry to cancer, try switching from processed and red meats to fish or poultry.  In fact, many studies even suggest a lower cancer risk from fish.

6. Eat More Plant-Based Protein

Contrary to popular belief, legumes, vegetables, nuts, seeds, and whole grains are also excellent sources of protein.  For example, 200 calories of spinach has just as many grams of protein as 200 calories of a steak.  One thing to remember is that plant based sources of protein may not be a complete protein so you have to mix your protein sources to get all of the amino acids your body needs.

7. Fiber, Exercise, and Maintain a Healthy Weight

Of all the cancer lowering techniques listed in this article, the very best way to lower your risk of colon cancer is simply to focus on the basics.  Ensure you are eating enough fiber, exercise daily, and maintain a healthy weight.

Each of these three things individually can effectively erase any increased cancer risk from processed and red meats.  If you can do all three then your colon cancer risk will really be quite low.  Great sources of fiber include fruits, vegetables, legumes, nuts, seeds, and whole grains.

How has this W.H.O. report calling out processed meat as carcinogenic and red meat as probably carcinogenic affected what you eat?  Please share your thoughts and comments below.

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The Top 10 Causes of Weight Gain

The average American gains 1 to 2 pounds a year.  That is as little as 10 extra calories a day–less than one bite of food.  This weight gain is so subtle that most people don’t even know it is happening until one day they tune in and discover that they have gained 20 to 30 pounds since high school.

The famous 5th century B.C. Chinese General, Sun Zi, said in the book The Art of War, “If you know the enemy and yourself, you need not fear…If you know neither the enemy nor yourself, you will lose every battle.”

In this article, I am going to help you better know the enemy and share with you the top 10 causes of weight gain.  It is only by knowing the enemy and yourself that you can enjoy the weight that works best for you.

My High School Weight

While not especially lean, I weighed a respectable 180 pounds in high school.  My first year away at college, rather than “The Freshman 15,” I actually added “The Freshman 25” and hit a peak weight of 205 pounds during my first nine months away from home.

Fortunately, I started exercising again after my freshman year of college, which helped prevent further weight gain. However, it did not allow me to lose all of the weight I had gained.  I carried that extra weight around for two more decades until my 40s when I was forced to change my diet and lifestyle due to other health problems.

The Best Study on Weight Gain

To better know the enemy, most of the scientific data I am going to share with you is from a seminal Harvard study published in the most prestigious medical journal, the New England Journal of Medicine.  This study involved 120,877 U.S. men and women and the lead author was my former classmate, and fellow cardiologist, Dr. Dariush Mozaffarian.

What surprised me most about this Harvard study was that it wasn’t just one thing that cause people to gain weight.  Rather, it was a cluster of bad habits and lifestyle choices that led to 1 or 2 extra pounds each year.  Unfortunately, as the weight goes up so do chronic medical problems as well as the need to take lifelong medications and make appointments with the cardiologist or other doctors.

I should also point out that these top 10 causes of weight gain have also been seen in other studies.  Also, the Harvard study did not show causation but rather correlation.  In other words, weight gain was observed to happen in people who reported doing these 10 things–whether or not this was the actual cause of their weight gain cannot be determined from this Harvard study.

The Top 10 Causes of Weight Gain

1. Can’t Find Time to Exercise: 0.44 pounds/year (0.2 kg/yr)

It should come as no surprise that not exercising was the number one cause of weight gain.  While a weight gain of just 0.44 pounds per year (0.2 kg/yr) may not sound like too much of a price to pay for not exercising, this adds up to a total weight gain of 21 pounds (9.4 kg) from high school to retirement at age 65.

While many people mistakingly feel that you can exercise off a bad diet, the research just doesn’t support this.  Exercise is for maintaining not losing weight.  Even during my marathon running years, when I was running 20 or more miles a day, I never seemed to burn off the extra weight I gained from my freshman year of college.

2. French Fries and Potato Chips: 0.42 pounds/year (0.19 kg/yr)

The number two cause of weight gain caught me by surprise.  While I knew French fries and potato chips caused people to gain weight, I would never have predicted that this effect would be stronger than sugary drinks.

Even more surprising was that the average person in this study only ate French fries or potato chips one time per week at most.  I suspect the reason why fries and chips are so dangerous to your waistline is because these processed potatoes are instantly converted to sugar in the body, they contain high amounts of unhealthy oils, and the same people who eat fries are more likely to eat other junk food as well.

As with a lack of exercise, this gradual weight gain from fries and chips, on average, adds up to a grand total of 20 extra pounds (9.1 kg) by retirement.

3. Trans Fat from Processed and Fried Foods: 0.36 pounds/year (0.16 kg/yr)

Number three in this Harvard study also came as a surprise to me.  While I was well aware of the ultra artery clogging effects of trans fat, I had no idea this toxic fat also causes people to pack on the weight.

When it comes to trans fat in the diet, most of my patients mistakingly believe this is no longer a problem as all of their packaged food labels read “zero” for trans fat.  What they don’t understand is that, based on lax reporting guidelines, processed food companies can create such unrealistically small portion sizes so that the trans fat content in a “microscopic serving” is below the required reporting level of 0.5 grams.

To keep your arteries clean and your weight in check, if you see “partially hydrogenated oil” anywhere on the ingredient list then this is something that you should never eat.  When it comes to trans fat, there is no safe amount you can eat.

In addition to processed foods, the worst trans fat offenders are fried foods, microwave popcorn, and store bought bakery items.  If you give in and eat processed or fried foods you can count on gaining an average of 17 pounds (7.7 kg) and a likely visit to a cardiologist by retirement age.

4. Sugary Drinks: 0.25 pounds/year (0.11 kg/yr)

While falling much lower on this list than I would have expected, sugary drinks are still an important cause of weight gain.  In addition to sugary drinks, other forms of sugar like desserts, refined grains, and fruit juice combined also added up to an additional 0.25 pounds/year (0.11 kg/yr).  By refined grains, I am referring to the typical grocery store breads, pastas, cereals, crackers, etc.

Thus, if you do sugary drinks, desserts, refined grains, and fruit juice you can expect to gain 0.5 pounds/yr (0.22 kg/year) from your sweet tooth–an even greater effect than not exercising.

It is interesting that fruit juice did not cause as much weight gain as sugar sweetened beverages like Gatorade or soda pop.  The lead author of the Harvard study, Dr. Dariush Mozaffarian, was also surprised and explained that the reason was likely because they found that most people seem to drink sugary beverages in much greater quantities than fruit juice.

Once again, it did not take much to increase weight.  The average person in this study only had a little more than 1 sugary drink per week and 1.3 servings of dessert and 1.2 servings of refined grains each day.

Regardless, doing all forms of sugar namely sugary drinks, desserts, refined grains, and fruit juice, even in very small amounts, can add up to a hefty 23.5 pound (10.7 kg) average weight gain by retirement.

5. Red Meat: 0.24 pounds/year (0.11 kg/yr)

For those who follow a dietary regimen that advocates meat, I’m sure the number five cause of weight gain in the Harvard study comes as a surprise.  I should point out that all meats are not raised and processed equally, and that most of the 120 thousand plus people in this study were eating the typical grocery store or prepared forms of meat which come from antibiotic and hormone treated animals.

Equally as strong as red meat for weight gain in this study were processed meats.  By processed meats I mean meats like bacon, hot dogs, sausage, and deli meats.  If you eat processed meats you can expect to gain an additional 0.23 pounds each year.  Thus, eating both red and processed meats will cause you to gain, on average, 0.47 pounds per year or 22 pounds (10 kg) by retirement.

I should point out that the people in this study did not eat much red or processed meats.  Indeed, the average person had less than one serving daily of red and processed meats combined.

If you are a meat eater, and don’t want to gain weight, then the Harvard study would suggest giving up red meats as well as processed meats and instead focus on poultry or fish.

6. Stress: 0.15 pounds/year (0.07 kg/yr)

Most of us also know that we naturally crave junk food when we are feeling stressed.  Stress causes changes to the hormones that regulate hunger.  According to the study I use to calculate the damage from stress, you can also count on gaining an average of 7 extra pounds (3.2 kg) if you are under a lot of stress.

7. Sleep Deprivation, 0.14 pounds/year (0.06 kg/yr)

Most people intuitively know that they also crave junk food when they are tired.  I know this is a weakness of mine after I have been up all night in the hospital taking care of patients.  Sleep deprivation is a well known cause of activating our hunger hormones in a way that causes weight gain.

What most people don’t understand is that when it comes to weight gain, over sleeping seems to be just as dangerous as under sleeping.  In a separate study I use to calculate the weight gain risks associated with sleep duration, it shows that sleeping under 5 hours or over 9 hours a night puts you at risk of weight gain.

Based on these definitions, if you under or over sleep you can count on gaining an average 7 extra pounds (3.5 kg) from high school to retirement.

8. Butter: 0.12 pounds/year (0.05 kg/yr)

In the 1980s and 90s a, few people would have been surprised to see butter on this list.  Yes, it is true that butter is much healthier for you than the trans fat containing products, like margarine, from the 1980s and 1990s.

While butter made the top 10 based on the data from the Harvard study, I should point out that dairy had mixed effects when it came to weight gain or loss over time.  For example, the Harvard study showed that cheese also caused weight gain but milk was neutral and yogurt even caused significant weight loss over time.

Thus, the type of dairy seems to be important in determining whether or not you gain or lose weight with dairy.  For the worst dairy offender, butter, it can cause you to gain an average of 6 pounds (2.7 kg) from high school to retirement.

9. Alcohol: 0.1 pounds/year (0.05 kg/yr)

As with dairy, the data on alcohol and weight gain are mixed.  Heavy beer drinkers seem to show the highest weight gains from alcohol.  In the Harvard study, alcohol drinkers can expect to gain an average 0.1 pounds per year or 5 pounds (2.3 kg) by retirement.

10. Electronic Devices: 0.08 pounds/year (0.04 kg/yr)

Rounding out the top 10 list are electronic devices. When this Harvard study looked at television watchers, they found that just 36 minutes a day contributes to an average four extra pounds (1.7 kg) by retirement.

Final Thoughts

So there you have it, the scientifically proven 10 best ways to gain weight as an adult.  When it comes to changing any bad habit, the first step is awareness.

As the 5th century B.C. famous Chinese general, Sun Zi taught us in The Art of War, the key to wining any battle is to know the enemy and yourself.  Now that we have identified our top 10 enemies in weight gain, it is time to become aware and create an environment that helps us to conquer these enemies.

What is your number one weight gain enemy?  What has helped you to battle this enemy?

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The Right Way to Get Vitamin D

“Did your labs come back OK?” my wife Jane asked.

“Yeah,” I replied.  “Everything was what I expected except for my low vitamin D level.”

“What do you do when your vitamin D levels are low?”  Jane asked.

In this article I am going to share with you the latest research on vitamin D, the right and wrong ways to get vitamin D, and the ways in which I am working to get my vitamin D levels up.

Why Does Vitamin D Matter?

Since the childhood bone disease, rickets, was first described in 1650, researchers have long known about a crucial element that was needed for healthy bones. However, it would not be until 1918 that vitamin D was finally discovered.

The fascinating thing is that over the last decade or two we have discovered that not only are low levels of vitamin D associated with bone disease but that it is also linked to a myriad of other problems.  For example, low vitamin D levels are also commonly seen in people who are obese, have high blood pressure, are struggling with diabetes, or have high cholesterol.

Vitamin D and Heart Disease

In addition to the role of vitamin D for healthy bones, vitamin D may prevent cardiovascular disease.  This is especially important given that 74% of Americans are deficient in vitamin D.

For decades now, we have known that heart attacks tend to occur more often in people who don’t get much access to the sun like during the winter months and in geographic areas closer to either the North or South Pole.  In addition, countless studies have shown that heart disease is much more likely to occur in people with low vitamin D levels.

The Chicken or the Egg Conundrum

What we don’t know is whether low vitamin D caused the weight gain, diabetes, high blood pressure, high cholesterol, and heart attacks or whether these medical conditions caused vitamin D levels to drop.  In other words, did vitamin D cause all of these bad things to happen or are low vitamin D levels just a marker of someone with a lot of medical problems?

What is the Ideal Vitamin D Level?

At my hospital, the “normal” range for 25-hydroxyvitamin D levels is 30-80 ng/mL.  As my vitamin D level came back at 25 ng/mL, I was clearly deficient according to these levels.  Is this something that I need to worry about?

As a cardiologist, I am naturally interested in what are the optimal vitamin D levels for health and cardiac function.  As I have reviewed the scientific literature, the best study looking at vitamin D levels, in relationship to heart disease and longevity, is the NHANES III Study.

In the Third National Health and Nutritional Examination Survey (NHANES III Study), which involved 13,331 people, researchers found that a 25-hydroxyvitamin D level below 18 ng/mL or above 50 ng/mL was associated with cardiovascular disease and premature death.  Other studies have shown a similar vitamin D “sweet spot” usually somewhere between 30 and 50 ng/mL which is slightly lower the normal range of my hospital and what has been traditionally recommended.

Atrial Fibrillation and Vitamin D

As atrial fibrillation is the most common heart rhythm abnormality, and it is one of the leading causes of stroke, our team was very interested in looking at whether vitamin D played any role in atrial fibrillation.  In our study of 132,000 patients at Intermountain Healthcare, we found that even low levels of vitamin D (less than 20 ng/mL) had no increased risk of atrial fibrillation.  In contrast, people who took supplements to get their vitamin D levels above 100 ng/mL were 2.5 times more likely to develop atrial fibrillation.  Thus, our study showed that unless you took too much vitamin D, in the form of supplements, there was little link between vitamin D and atrial fibrillation.

What is the Right Way to Get Vitamin D?

The very best way to get the right amount of this critical vitamin is the way nature intended, namely through food and time spent outside.  In fact, nature even created a way whereby we can get enough vitamin D during the warmer months to get us safely through the winter.

For example, one study showed that it takes two months for vitamin D levels to drop after you have been outside in the sun.  This is because vitamin D is a fat soluble vitamin that is stored in fat.  This is nature’s way of protecting our vitamin D levels during the winter.

Studies suggest that our vitamin D levels are, for the most part, determined by how much time we spend outdoors.  As most people rarely get outside, perhaps this could explain why 74% of Americans are vitamin D deficient.

At the time my vitamin D level was checked, like most physicians, I spent most of my time inside of hospitals treating patients.  While I am still busy in my cardiology practice, I now make it a priority to get outside whenever possible.

Do Vitamin D Supplements Prevent Osteoporosis?

Many older women take calcium and vitamin D supplements to prevent osteoporosis.  Unfortunately, two recent large studies, both published in the prestigious British Medical Journal, challenge this long-held recommendation.  Unfortunately, both studies failed to show any benefit in improving bone mineral density or preventing fractures.

Do Vitamin D Supplements Prevent Heart Disease?

As with osteoporosis, vitamin D supplements have proven disappointing when it comes to preventing heart disease.  Paradoxically, people with the lowest levels of vitamin D are at the highest risk of heart disease but yet raising vitamin D levels with supplements have not been shown to help.

Do Vitamin D Supplements Prevent Cancer?

As with bone and cardiovascular disease, the same is true with cancer.  For example, people with low levels of vitamin D are much more likely to suffer from cancer.  However, giving vitamin D supplements have not decreased their cancer risk.

What Should You Do if Your Doctor has Prescribed Vitamin D?

Even though studies have not shown any clear benefit from vitamin D supplementation, if your vitamin D levels are low there may still be a role for supplementation.  As with any doctor prescribed medication or supplement, never stop something that has been prescribed without speaking with your doctor first.

What is the Right Way to Get Vitamin D?

As you can probably tell from this article, the right way to get vitamin D is to spend more time outside.  Of course, you have to be sun smart to minimize your risk of skin cancer.

For example, just 15 minutes of summer sun at mid day can provide you with a dose of vitamin D ranging from 10,000 to 25,000 IU depending on skin color (the vitamin D dose is lower from the sun in people with darker skin), cloud cover, elevation, and whether there is a reflective surface like water.

I should point out that clothing and sunscreen will block vitamin D absorption.  Also, the more skin that is exposed the higher the dose of vitamin D you will get from the sun.

The best time for the ultraviolet B rays and vitamin D production is somewhere between 10 am and 4 pm from April to October.  In contrast, ultraviolet A rays tend to dominate earlier or later in the day.

While too much ultraviolet B rays can cause sunburns, too much ultraviolet A rays can cause skin aging and wrinkling.  Both forms of ultraviolet light can cause skin cancer.

If you live closer to the Earth’s poles, like anything north of Los Angeles in the Northern Hemisphere, you probably will not get much vitamin D from the sun during the winter months unless you do the vitamin D sun “hack” that I describe below.  For people living far from the equator, you will need more vitamin D containing foods when the weather turns cold.

The Best Food Sources of Vitamin D

The very best food source of vitamin D is salmon.  Just a 4-ounce serving of salmon (158 calories) will provide you with 128% of the vitamin D you need for the day.  Other good food sources of vitamin D include sardines, tuna, milk, eggs, and mushrooms.

Vitamin K2: The Missing Link

We can’t just focus on vitamin D.  It is important to realize that vitamin D works in concert with calcium, vitamin K2, and vitamin A to make sure everything in the body is working correctly.

Of these, perhaps the most important may be vitamin K2.  The role of vitamin K2 is to keep calcium out of your arteries, where it can cause heart disease, and instead put it back in your bones.

Natto, Japan, Osteoporosis, and Heart Disease

A diet high in vitamin K2 may explain why the Japanese have extremely low rates of bone fractures despite eating minimal dairy and calcium.  For example, natto, or fermented soy beans, is a delicacy in Japan.  No other food comes anywhere close to comparing to natto when it comes to vitamin K2 content.

While natto tastes disgusting to most Westerners, I have actually learned to tolerate natto and have a tablespoon every morning.  Natto is something you can buy at most Asian grocery stores or you can even buy it online where they ship it to you in refrigerated boxes.

The Calcium Paradox

In addition to strong bones, studies suggest that vitamin K2 may also prevent heart attacks.  Vitamin K2 may be the answer to the “Calcium Paradox” wherein many older people suffer from lack of calcium in their bones (osteoporosis) but yet have too much calcium in the arteries of their heart (coronary artery disease).

How Do You Get More Vitamin K2?

If you cannot stand the taste of natto, how else can you get vitamin K2?  First of all, eat your greens.  Green leafy vegetables are very high in vitamin K1 which can be converted to vitamin K2 by your body.  To learn more about which foods contain vitamin K2, please read my article “9 Signs You May Have Vitamin K2 Deficiency.”

Warfarin, Osteoporosis, and Coronary Artery Calcification

I should point out that the people most at risk for vitamin K2 deficiency are those people taking the blood thinner warfarin (also known as Coumadin).  Warfarin blocks vitamin K and any attempts by you to eat more vitamin K1 or vitamin K2 foods will block this blood thinner.

Studies have shown that people taking warfarin are at higher risk for low bone mineral density and vitamin D as well as at increased risk for coronary artery calcification.  Fortunately, for most people, there are now new blood thinners that are much safer than warfarin.  If you or a loved one are still taking warfarin, speak with your doctor about switching to one of the safer new blood thinners that don’t block vitamin K.

The Wrong Way to Get Vitamin D

As you have probably guessed, the wrong way to get vitamin D is to just blindly take supplements without even first knowing your vitamin D levels.  The problem with supplements is that your body cannot control for toxicity.

In other words, if you take too much vitamin D the excess is just stored in your fat cells and toxicity can occur.  From our research, vitamin D toxicity can cause a dangerous heart condition called atrial fibrillation which can lead to strokes.  Vitamin D toxicity can also lead to dangerous levels of calcium in your blood or kidney stones.

When vitamin D is taken naturally, like through the sun, the body can control levels so that toxicity does not develop.  Given that 74% of Americans are deficient in vitamin D, many people may require supplements at least during the winter months.  However, vitamin D supplements should only be taken under the direction of a physician, who can monitor vitamin D levels, and only after you have first tried natural ways to correct your vitamin D deficiency.

The 5 Right Ways to Get Vitamin D

1. Get Tested

Get tested now to see if you are one of the 74% of Americans who have low levels of vitamin D.  Surprisingly, many insurance companies will not cover this simple and cheap test unless you have osteoporosis.  If your insurance company will not cover a vitamin D test, you can either pay for one out of pocket or purchase a much cheaper home test kit on Amazon or through the Vitamin D Council for as little as $50.

2. Start Winter with Your Vitamin D Tank on Full

Fortunately, studies show that vitamin D levels don’t start to drop until about 2 months after you have spent some time outside in the sun.  Thus, if your vitamin D tank is “full” on November 1, then you can at least get through the end of the year without any deficiencies.

However, in order to keep the tank full until spring, you will need that January vacation to a sunny beach, eat a lot of vitamin D containing foods, or supplement.  Please remember to always be sun smart so that you don’t trade vitamin D deficiency for skin cancer.

3. Eat Foods High in Vitamin D in the Winter

Knowing that vitamin D levels will drop through the winter, focus on the foods which are naturally high in vitamin D like salmon, sardines, tuna, cow milk, eggs, or mushrooms.  Also, many alternative milks, and other foods, are fortified with vitamin D.

4. The Winter Vitamin D “Hack”

Contrary to conventional wisdom, it is still possible to extract some vitamin D from the sun during the winter even if you live north of Los Angeles in the Northern Hemisphere.  However, this may require you to be on the top of a mountain with your skin uncovered and snow on the ground to amplify the sunlight dose.

There are some apps that can help you calculate your vitamin D dose.  By simply entering your latitude, longitude, skin type, how much skin is exposed (not covered by clothing or sunscreen), time of the day, sky cover, altitude, and what kind of surface is below you, you can calculate how much sun you need for your daily vitamin D needs.

5. Supplement When All Else Fails

Supplements should only be “supplements” for what is needed when natural approaches fail. I like USP or GMP certified supplements to minimize your risk of contaminants.

A Contrarian View to Vitamin D

Perhaps the real problem to vitamin D deficiency and the increased risk of osteoporosis, heart disease, and cancer is that most people don’t spend enough time outside.  It could be that low vitamin D levels are really just a marker of someone that rarely gets out.  Given the myriad of health benefits that happen when people are outside, like more physical activity, less stress, and less depression, it could be that the missing link is more time in nature rather than another supplement.

What did I Do for My Low Vitamin D Level?

This is something I struggle with as I hate to put any drugs or supplements into my body unless it is absolutely critical.  My “compromise” for a documented vitamin D deficiency is to eat more wild salmon in the winter, cross country ski at high altitude in just shorts on sunny winter days, and take a low dose of a vitamin D supplement.  Hopefully this approach will help to keep my bones and heart strong.

What do you do to ensure you have enough vitamin D to get you through the winter months?  Please share your comments below for our community to read.

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Do Smartphones Cause Heart Attacks?

“What are you working on?” Jane asked.

“I’m just checking my email really quickly,” I replied.

Had I been at my office this would have been OK.  Sadly, we were out on our weekly date.

A recent study shows that 70% of people in a romantic relationship have been snubbed by their partner’s phone.  Related studies show that 60% of college students have a smartphone addiction and these students can spend up to 10 hours a day on their phones!

In this article, I share the latest scientific data on the cardiac risks of phone snubbing, or “phubbing,” as well as heavy phone use in general.

What is Phubbing?

Phone snubbing, or “phubbing,” is a new word describing a situation where someone looks at their phone rather than the person they are with.  Phubbing could range from taking a cell phone call while you are talking to another person to checking email, text messages, or Facebook posts.

The Dangers of Phubbing

To better understand the risks of phubbing in our modern society, researchers James A. Roberts and Meredith E. David from Baylor University recently published a study on the impact of phubbing on 308 adults.  As you might have suspected, given the significance of this problem, this study received worldwide media attention.

Here is what they found in this study.  Phubbers and victims of phubbing are more likely to suffer from the following:

1. Strained relationships

2. Increased anxiety

3. Decreased life satisfaction

4. Increased risk of depression

Of course, this study does not prove that phubbing causes relationship breakups, anxiety, unhappy lives, and depression.  It is equally possible that the reason why these people “phubbed” is that they were already suffering from these problems.  Regardless, common sense tells us that phubbing can’t be healthy.

Are You a Phubber?

Are you guilty of phubbing?  Here are six of the phubber criteria as established by James A. Roberts and Meredith E. David in this study.

1. During a typical mealtime that my partner and I spend together, my partner pulls out and checks his/her cell phone.

2. My partner places his or her cell phone where they can see it when we are together.

3. When my partner’s cell phone rings or beeps, he/she pulls it out even if we are in the middle of a conversation.

4. My partner glances at his/her cell phone when talking to me.

5. During leisure time that my partner and I are able to spend together, my partner uses his/her cell phone.

6. If there is a lull in our conversation, my partner will check his or her cell phone.

What Are the Dangers of Cell Phone Use?

While we all have heard about the possible cell phone brain cancer link and the dangers of texting while driving, could there be other equally dangerous risks?

While not as dangerous as a possible brain tumor or an automobile accident, heavy smartphone users now often suffer from “text neck.”  As the head can put 60 pounds of pressure on the neck when tilted down to text it is not hard to imagine why smartphones are quickly becoming one of the leading causes of chronic neck pain.  Not only does “text neck” cause chronic neck pain but it can also cause you to be permanently hunched over.

Perhaps much more serious than “text neck” is that studies show that heavy smartphone use increases stress levels.  Even more frightening is that depression may follow those people who can’t ever seem to put their phones down.

Do Smartphones Cause Heart Attacks?

As we have learned from this “phubbing” study, broken relationships, stress, and depression often follow phubbers and their victims.  According to medical studies, what are the cardiac dangers of bad relationships, anxiety, and depression?

1. Broken relationships increase the risk of heart attacks by up to 45%.

2. Stressed out people are more than twice as likely to suffer a heart attack.

3. Depressed people are up to 6 times more likely to die from heart problems.

6 Ways to Beat Your Cell Phone Addiction

As smartphones are part of modern life, what can you do to protect your heart?  Here is how I advise my patients.

1. Download the Breakfree App

Are you addicted to your smartphone?  Awareness and tracking are critical steps in identifying and breaking any harmful habit.

To help me with my own smartphone addiction, I have recently downloaded the free iPhone and Android app, Breakfree.  I like this app because it will give you your own honest smartphone addiction score.

In addition, Breakfree will tell you how many times you unlock your phone each day, how much time you spend on your phone, and it will tell you exactly how you are spending all of your phone time.  For those of you with kids, this app can monitor their phone use and determine when they can and cannot access the internet.

2. Unplug

As scary as it might seem, you need to periodically unplug from your phone for a healthy heart.  This “unplugging” helps you to connect with those things in life that really matter most.

At minimum, I recommend unplugging for the first 30 minutes after you wake up and for the last 30 minutes of your day before bed.  You just don’t need the stress that comes from checking your phone first thing in the morning or the sleep loss from checking your phone just before bed.

Some of my patients have shared with me that they actually turn their smartphone off on Sundays or when out with friends.  Personally, when I am not on call, and everyone has made it back home safely at night, I have started switching my iPhone to the airplane mode to help me resist cell phone distractions.

3. Turn Off Notifications

The constant buzzing or chirping of a smartphone will drive anyone but the most focussed to check their phones.  Knowing my own personal weaknesses, I have turned off every notification except the ringing of an incoming call.  To keep a ringing phone from driving me crazy, I have only given out my cell phone number to my closest friends, family members, and my office staff.

4. Delete Non-Critical Apps

To minimize temptations, do you really need the Facebook app on your smartphone?  Are there other apps you can delete to save you from your phone?

5. No Devices at Meals

Mealtimes are times to eat mindfully and connect with other people.  Outside of the dangers of “phubbing” someone during mealtime, screen time at mealtime can quadruple your risk of obesity.

We have had to establish rules in our home as children, as well as adults, will naturally gravitate to electronic devices during mealtime if left unchecked.  Commit now to device free mealtimes with your family and friends.

6. Vote Now to Stop Phubbing

There is now an organization dedicated to the mission of eradicating phubbing.  While this might be a bit much for some, if you are motivated to end phubbing, like me, you can visit their website and vote to stop phubbing.

Are you guilty of phubbing?  Have you been phubbed before?  Please leave your comments below for our community to read.

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Honey vs. High Fructose Corn Syrup

“Our family finally kicked the sugar addiction,” Katie proudly exclaimed to me.

I was thrilled for her.  She had been battling heart disease for years and had finally kicked the habit.

“How did you do it?” I asked.

“Oh, it was easy” she replied.  “We now only use raw honey.”

Is raw honey, or even processed honey, really healthier than other forms of sugar?  In this article, I share the latest medical science comparing how raw and processed honey stacks up against high fructose corn syrup and regular table sugar.

Should You Eat Natural or Processed Honey?

If you can remember back to 2011 there was a big report and lawsuits claiming that the honey being sold in grocery stores wasn’t really honey at all.  The basis of their argument was that most grocery store honey has no detectable pollen, therefore it couldn’t be real honey.

It is true that grocery store honey is highly processed.  They remove most or all of the pollen, from the plants the bees had visited, as well as any tiny bee parts, like bee wings, and it is pasteurized.  The end result is that the “honey” is sweeter, creamier, and less likely to crystalize.

Raw or natural honey enthusiasts claim that raw honey contains many more nutrients and has more health benefits, especially when it comes to allergy relief and infection treatment, than processed honey.  While the medical literature does not support many of these claims, most of the studies promoting possible cardiovascular benefits of honey only included natural honey in their studies.

On the other hand, processed honey, despite being processed, does have some benefits. For example, by removing most or all of the pollen, people are much less likely to have an allergic reaction to this form of “honey.”

Another benefit of processed honey is in the prevention of botulism for children less than one year of age who still have an undeveloped immune system.  Also, in some parts of the world, like the Black Sea area, raw honey includes grayanotoxins that the bees pick up from certain plants and flowers which can cause “Mad Honey Disease.”  Mad Honey Disease is a condition that can cause an intoxicated like state which also shuts down the heart’s ability to beat correctly.

Possible Benefits of Honey

Since the Stone Age times, Honey has been considered a health food.  Honey has also been used by many cultures to treat gastrointestinal, cardiovascular, inflammatory conditions, and even cancer.

For example, there are some small studies which show a role for honey when it comes to preventing heart disease.  In one such well-designed small study, natural honey was shown to reduce cholesterol, markers of inflammation (C-reactive protein blood test), and fasting blood glucose in 60 overweight people, ages 20 to 60, who were at high risk for diabetes and cardiovascular disease.  Some studies even report a slight weight loss when natural honey is used instead of other forms of sugar.

I should point out that this study, as well as most other studies which came to the same conclusion that honey was good for the heart, only used natural or unprocessed honey.

Honey vs. High Fructose Corn Syrup

Armed with a number of small studies showing that honey may have a beneficial effect when it comes to cholesterol, inflammation, diabetes, weight loss, and heart disease, the honey industry was eager to continue their wining streak by sponsoring the latest study with the United States Department of Agriculture (USDA).

In this very rigorously designed study, 60 men and women from North Dakota, ages 20 to 80, were invited to come into the USDA research center.

I should point out that the honey used in this study was Dutch Gold Honey.  Dutch Gold Honey is not a natural honey, rather it is processed.  As it states on its website, “Dutch Gold Honey generally removes most of the pollen.” Why was Dutch Gold Honey used?  Simply because it is the most commonly used honey in the U.S.

In this study, each participant was randomly fed 50 grams of processed honey, high fructose corn syrup, or table sugar, in addition to their usual diet, for 2 weeks.  All of these 60 study participants were “on their honor” not to eat any other form of sugar during this study other than what was fed to them at the USDA office in North Dakota.

After the two weeks were up, there was a 2 to 4 week “wash out period” where they did not eat any sugar at all.  Once the washout period was up, they were then randomly assigned to 50 grams of processed honey, high fructose corn syrup, or table sugar for another two weeks and the cycle was completed until everyone had rotated through each of the 3 sugar treatment strategies.

What did they find at the end of the study?  In contrast to what I presented earlier in this article, processed honey did not beat out the other forms of sugar.  In fact, there was no difference at all when it came to body weight, blood pressure, inflammation, cholesterol, blood glucose levels, or diabetes among these 3 different forms of sugar.

Plain and simple, processed honey was just as bad for you as high fructose corn syrup or table sugar.  Also, table sugar was no healthier for you than high fructose corn syrup.  Their conclusion was that sugar was sugar, regardless of its form or source.

Take Home Message

The take home message of this study is that the processed honey you buy in the grocery store is no better for you than the high fructose corn syrup in a bottle of Coca-Cola.  Store bought honey is anything but a health food.

For the raw or natural honey enthusiasts, this study doesn’t apply.  Many small studies still argue for a potential cardiovascular benefit of natural honey.  Unfortunately, the definitive study has not yet been done so we can’t say that raw honey is a health food.

What should you do?  If you have a sweet tooth, like me, then natural honey from reputable suppliers for people over the age of one is probably healthier than high fructose corn syrup or table sugar.  However, please keep in mind that even raw honey is mostly sugar and should be eaten in limited quantities for a heathy cardiovascular system.

Have you tried raw or natural honey?  What has your experience been?  Please leave your comments below for our rapidly growing community

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How To Do The One Minute Workout

“I don’t have time to exercise,” Mark told me at his last clinic visit. Mark is not alone. In fact, most of my patients and friends all feel the same way.

Could just one minute of exercise be enough for optimal heart health? In this article, we will explore the new science behind sprint interval training (SIT) as an option for busy people who don’t have time to exercise.

If you would rather not read the rest of this article, here is a short television segment I did on the “One Minute Workout.”

How Long Should We Be Exercising?

To understand just how significant the time saving benefits of sprint interval training are, we need to first review the exercise duration guidelines. Currently, our government recommends 150 minutes of moderate intensity exercise or 75 minutes of high intensity exercise each week.  For busy people trying to juggle work and family responsibilities, 2.5 hours or even 75 minutes of exercise time may simply be out of reach.

For those of you who follow my blog, you know that I have stressed that exercise actually gives you more time in the long run. For example, studies show that you can become biologically 10 years younger with regular exercise.

While exercise can make you biologically younger, it may not satisfy the day-to-day demands on your time. Of course, for those people who can carve out the time to exercise, this investment of time not only sharpens your mind but also significantly increases your productivity for the day.

The studies I review in this article take exercising to a whole new level. In fact, with sprint interval training, it may only require a total of 3-minutes of all out exercise each week to achieve the same benefits as traditional exercise.

What is Sprint Interval Training?

Sprint interval training (SIT) is something that is completely different than traditional endurance training exercises or even high intensity training (HIT). Whereas high intensity training is exercising at high intensity, sprint interval training is done at an even higher level of exercise.

Sprint interval training is all out exercising at the highest possible intensity your body is capable of. It is an all out sprint and is something that can only be maintained for about 30 seconds at most.

The One Minute Workout Study

In this study, Dr. Jenna B. Gillen from McMaster University, in Ontario, Canada and her team, enrolled 7 overweight/obese men and women to test her hypothesis that just one-minute of all out exercise for 3 days a week would be enough for good health. To simplify the study, she designed the following stationary bicycle protocol for this study:

1. Warm up for 2 minutes

2. Three “all out” pedaling sprints against resistance for 20 seconds

3. Rest for 2 minutes between each sprint

4. Three minute cool down after finishing all of the sprints

If you do the math you can see that this stationary bicycle protocol takes a total of 10 minutes to complete. Following this protocol 3 times a week adds up to a grand total exercise time of 30 minutes. Thirty minutes of exercise weekly is far less than the currently recommended 150 minutes of moderate intensity exercise or 75 minutes of high intensity exercise.

Of course, to realize the benefits of this exercise protocol, it has to be at the maximal possible intensity. For most people this means that you either hit or come close to hitting your peak heart rate.

To calculate your peak heart rate simply subtract your age, in years, from 220. For a 40 year-old person this would calculate out to be a peak heart rate of 180 (220 minus 40). While this simple peak heart rate calculation is not perfect for everyone, it is certainly a reasonable estimate of your maximal exercise intensity.

The beauty of this protocol is who doesn’t have 30 minutes in a week to spare? Even though this exercise protocol is extremely short, the bigger question is does it actually do anything good for your cardiovascular system?

To answer this question, Dr. Gillen and her colleagues did a chemical analysis of muscle biopsy specimens as well as continuous glucose monitoring, peak VO2 measurements, insulin sensitivity evaluation, and blood pressure readings of these 7 people in this study. Through all of these tests, they concluded that even this short exercise protocol seemed to achieve all of the desired effects of traditional exercise.

Can Anyone Do the One Minute Workout?

Sometimes the exercise protocols used in studies can’t be easily replicated in the “real world.” This is definitely not the case with this study.

I especially like this exercise protocol for my patients as using a stationary bicycle is a safe way for them to do an all-out sprint. If all-out resistance pedaling doesn’t sound like much fun to you, I’m sure you could have the same effect outside on a running track or even running up stairs.

I definitely wouldn’t recommend doing this exercise protocol at home on a treadmill. For starters, treadmills don’t go fast enough for a sprint. Secondly, there is a good chance that you could get thrown off your treadmill at the end of the sprint.

Endurance Versus Sprint Interval Training

I grew up under the old mindset that endurance training was needed if you wanted to burn fat.   The teaching at the time was that to get rid of body fat you had to put in long grueling hours of exercise to see any benefit.

Intuitively this makes sense. A sprint is so intense and it is not aerobic exercise at all. It is far too short of a period of time to reasonably burn any fat.

Despite what makes sense intuitively, there have now been many medical studies showing that sprint interval training not only results in fat loss but also may be even better than endurance training at burning fat. Indeed, some studies suggest that sprint interval training may burn off belly and hip fat better than traditional endurance exercise.

Since reviewing the medical literature on sprint interval training, I have now incorporated this into my weekly exercises. I have found that this is a much more efficient way to get in my daily work out on the days when I spend long hours in the hospital.

Calories Burned with the One Minute Workout?

My philosophy on exercise is that it should be something that you enjoy and even look forward to. The beneficial mental and stress reducing effects of exercise are every bit as important as the cardiovascular benefits. The problem is that if you are focused on how many calories you are burning then you probably are not enjoying your exercise.

However, for those of you who would like to know how many calories you are actually burning with sprint interval training, one study estimated a calorie burn rate of up to 100 calories for every minute of sprinting. Of course, the actual calorie burn rate varies from person to person depending on exercise intensity, how big you are, etc.

Risks of Sprint Interval Training

As you might expect, there are some risks associated with sprint interval training. For example, even just 20 seconds of an all-out sprint could cause a heart attack or even death in someone with a serious heart blockage. Also, doing sprint interval training on an outdoor running track, or running up stairs, could result in significant orthopedic injuries.

The safest way to incorporate sprint interval training would be to check with your physician first before starting this kind of an exercise protocol. Also, to minimize the risk of orthopedic injuries, all out sprints would probably be safest on a stationary bicycle.

Final Thoughts

Based on the compelling medical studies discussed in this article, the excuse of “I don’t have time to exercise” just does not hold water. One minute of all out exercise for three days a week is something that most people can safely do. At a burn rate of up to 100 calories per minute, you can’t do much better than that.

For me, sprint interval training seems to work best on my long hospital days when I wouldn’t be otherwise able to exercise. On days when I have more time, I still prefer endurance exercises like running, skiing, mountain biking, or mountain climbing. I find that these outside endurance exercises not only make me much happier but also give me the mental clarity to solve the various challenges I may be facing in my life.

If your physician feels that sprint interval training is safe for you, give it a try and let me know how it goes for you.   Please leave your comments below for our community to see.

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How to Lose 10 Pounds with Water Preloading

“I just can’t seem to lose any weight,” Holly said at her last cardiology clinic visit.

“Are you drinking enough water?” I asked.

“I’m lucky if I can drink a glass or two of water through the day,” she replied.

Could water preloading be the secret for Holly to overcome her weight loss challenge?  In this article I share the new science behind water preloading and how it can help you to maintain a healthy weight for your heart.

What is Water Preloading?

Water preloading is really just the process of hydrating prior to every meal. Water preloading may help with weight loss because it stretches the stomach.  This mechanical stretching of the stomach shuts down ghrelin release.  With the hunger hormone ghrelin suppressed you will be less likely to overeat with your meal.

What is the Science Behind Water Preloading?

While many people have intuitively known that hydrating before a meal helps them to control their appetite, until recently there were no solid scientific data supporting this practice.  Fortunately, the study has now been done.  In this well-designed scientific study, Dr. Helen Parretti and colleagues from University of Birmingham showed effortless and significant weight loss with the simple act of water preloading.

To come to this conclusion, researchers enrolled 84 obese people and then randomly divided them into two groups.  The water preloading group was told to drink 500 mL, or 2 cups of water, within 30 minutes prior to eating each meal.  In contrast, the control group was told to imagine that their stomach was full prior to eating.  Interestingly, these study participants had no idea why they were doing what they were told to do.

Without even trying to lose weight, the water preloading group had lost an average of 5.3 pounds (2.4 kg) whereas the imagine your stomach is full group lost a mere 2.6 pounds (1.2 kg).  The results are even more impressive if you just look at the results of the people who actually did what they were supposed to do in this study.  Specifically, those who were 100% faithful in water preloading before each meal lost 9.5 pounds (4.3 kg)!  Equally impressive was that 27% of the water preloading group were able to lose enough weight to get down to their target body weight from water preloading alone.

Thin People Drink More Water

A separate line of evidence in support of water preloading is that there have now been many studies which have shown that fit people tend to drink more water.  Indeed, one study showed that water drinkers, on average, consumed 194 less calories each day.

It is unclear as to why fit people drink more water.  It is possible that by drinking water they are not drinking sugary or diet drinks.  Alternatively, drinking water may be allowing them to control their appetites.  Equally possible is that fit people drink water for cultural reasons as that is what healthy people tend to do.

Should You Try Water Preloading?

Given than about half of all Americans drink less than 4 cups of water each day, the simple answer would be “yes,” for most people.  Interestingly, in this report from the CDC, the same people who don’t drink enough water are also the same people who choose unhealthy foods.

The water preloading protocol of this study resulted in just 6 cups of water in a day.  This is still less than the 8 cups of water recommended by many healthcare providers.

For 99% of the population, there is little downside in drinking 2 cups of water before each meal.  Even if you don’t lose weight, if you are like most water deprived Americans, then drinking more water will probably result in other health benefits.

Will water preloading work for everyone?  Probably not.  However, if the results of this small study are true, then water preloading could result in a quick 10 pound weight loss over the next 3 months for you.

I must confess that since reviewing this study I have been very diligent in water preloading before each meal.  Whether it is a placebo effect or not, I have noticed that I don’t need to eat as much food to feel full.  Placebo effect or not, it is nice not feeling as hungry through certain parts of the day.

Who Shouldn’t Do Water Preloading?

If you are considering water preloading, and you do not feel well or are being treated for any medical condition, you should speak with your physician first.  For example, 500 mL of water prior to each meal is enough fluid to cause someone with heart failure to quickly become short of breath from fluid retention.

What has been your experience with water preloading?  Please leave your comments below for our community.

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Is Your Heart Age Older Than You Are?

“You are only as old as your heart,” said a world famous cardiologist during a lecture to my medical school class at Johns Hopkins 24 years ago.  At the time I did not understand what he meant, now I do.  The amount of years you have left can be predicted by your heart age.

According to a CDC study this past week, the average American adult has a heart age that is nearly 7 years older than they are.  In Utah we have the youngest hearts in the country.  However, even in Utah our average heart age is still 4.3 years older than our actual ages.

How old is your heart?  In this article I will not only show you how you can calculate your heart age but also how you can reverse your heart age.  If you would rather not read this article, here is the link to a TV interview I did on this blog article.

Calculate Your Heart Age

How old is your heart? Here is a link to an online heart age calculator.  Take this one-minute test now before reading on.

If you chose not to calculate your heart age at this time, your heart age is calculated by your gender, age, systolic blood pressure, smoking status, diabetes status, and your body mass index (BMI).  As you might have suspected, to be young at heart it is best if you are a woman, have a low systolic blood pressure, don’t smoke, don’t have diabetes, and have a very lean body weight.

This online heart age calculator is based on data from the legendary Framingham Heart Study.  These are the same data the CDC used to report that our hearts are aging much faster than we are.

How Does Your Heart Age?

Just how does the heart age and how does this affect your lifespan?  In general, there are three ways your heart ages.

1. Plaque Build-Up (Atherosclerosis)

The first way the heart ages is through plaque build up in your arteries which is also called atherosclerosis. This plaque build up is composed of cholesterol, calcium deposits, and other debris.  As plaque builds up it can block blood flow and can even cause heart attacks and strokes.

This plaque build up can start at a very young age if you choose an unhealthy lifestyle.  For example, in an autopsy study of U.S. service men who died during the Korean War, researchers discovered that at an average age of just 22, 77% of the service men already had atherosclerosis.

2. Scarring of the Heart Muscle

If you are not careful with your lifestyle, your heart progressively accumulates micro scars over time.  These scars can cause the heart to dilate and develop arrhythmias.  For example, this micro scarring is one of the main causes of atrial fibrillation.

While some degree of micro scarring occurs with the natural aging process, you can dramatically increase the scarring with poor lifestyle choices.  Perhaps this is the reason why I am seeing younger and younger patients in my cardiology practice with atrial fibrillation.

3. The Heart Muscle Becomes Stiff

In some ways the heart is like trying to blow up a balloon.  In order for the heart to pump properly, the ventricles need to fill up with blood.  Once they fill they can then pump blood to the rest of the body.

However, if the ventricles become too stiff they cannot fill.  If the ventricles don’t fill properly, like that stiff balloon you try to blow up for your child’s birthday party, then there is no blood inside of the ventricles to pump.  This can cause heart failure even though the heart squeezes normally.  Once again aging and lifestyle factors determine whether or not the heart becomes stiff.

Four Ways to Reverse Your Heart Age

If you are like most Americans, your heart age is much older than you are.  How can you reverse this so that your heart, brain, and other organs don’t age prematurely and leave you suffering from chronic medical conditions?

1. Keep Your Blood Pressure in Check

When it comes to the heart and cardiovascular system, in general, the lower the blood pressure the better.  There is nothing magical about a blood pressure of 120/80 mmHg.  In fact, according to the online heart age calculator, the best systolic blood pressure for heart age is 90 mmHg.  While a systolic blood pressure of 90 mmHg is best to slow heart aging, for 80 million Americans that number is 140 mmHg or higher.

Contrary to popular belief, blood pressure is something that is under our control.  If caught early, most of my patients can get their blood pressure into the normal range naturally with lifestyle changes.  Others may require medications to reduce blood pressure to a safe level.

I once had a systolic blood pressure of 140 mmHg or higher.  Once I cleaned up my diet, increased my movement throughout the day, managed stress, and lost 30 pounds my systolic blood pressure dropped to 110 mmHg without any medications.  I have even had patients who have dropped their systolic blood pressure up to 50 points with aggressive lifestyle changes including significant weight loss.  To learn more about how to reduce your blood pressure naturally, please read this article I wrote.

2. Lose the Refined Carbohydrates

Smoking, diabetes, and obesity are the three major causes of premature aging.  Diabetes dramatically ages all of the organs, including the heart and brain.  Indeed, studies show that up to 10 years of life can be lost due to poorly controlled diabetes and obesity.

Fortunately, studies also show that 90% of adult onset diabetes can be prevented through a healthy lifestyle.  First and foremost to preventing, reversing, or controlling diabetes is to eliminate all refined carbohydrates from your diet. Many researchers believe that our current diabetes epidemic is really just a manifestation of excessive refined carbohydrates.  In other words, too much sugar in your diet.

Basically, refined carbohydrates mean sugar and everything else that behaves like sugar in your body.  These include 99% of the breads and breakfast cereals sold in the U.S., fruit juice, soda pop, sports drinks, crackers, french fries, chips, pizza, pastries, pancakes, waffles, and most processed foods.

Because I am genetically at very high risk for developing diabetes, and also enjoy eating bread, I generally only eat Ezekiel Bread.  Ezekiel Bread, as well as other flourless breads, can be purchased at health food stores or grocery stores that cater to health conscientious consumers.  If breakfast cereal is a must for you, there is even very low glycemic Ezekiel breakfast cereals.  For options on healthy drinks, other than water, please read the article I wrote, My Top 10 Healthiest Drinks.

3. Log At Least 10,000 Steps Daily

When it comes to heart age and longevity, maintaining a healthy weight is critical.  In addition to eliminating all refined carbohydrates from your diet, staying physically active is critical to maintaining a healthy weight.

Probably the easiest way to do this is to just log your steps. Studies show that walking 10,000 steps daily, for as little as 6 months, can take 3 cm off of your waistline alone.  Without regular physical activity, studies show that you will probably gain 1-2 extra pounds each year.  In just 10 years that could add up to a significant obesity problem.

Logging 10,000 steps a day is not hard.  I have patients in their 90s who faithfully log at least 10,000 steps daily.  I know because they proudly show me their pedometer data when they come to see me for clinic visits.

While the body mass index (BMI) used in this online heart age calculator is not perfect, it provides an estimation of whether or not you are at a healthy weight.  The goal BMI is 18.5 to 24.9.  To learn what your BMI is, here is a BMI calculator.

4. Breathe Clean Air

It goes without saying that smoking is probably the worst thing you can do to prematurely age your body.  Indeed, studies show that every cigarette smoked takes 11 minutes off of your life. Not only do smokers lose out on 10 years of life but they are also 23 times more likely to suffer from cancer.

Final Thoughts

Is this online heart age calculator completely accurate?  Of course not.  However, it can give you a rough idea of how fast your heart is aging.

If you heart is prematurely aging then you can bet that the rest of your body is premature aging as well.  Studies show that if we can take care of our hearts then most people can reach age 90 in great health.

What are you doing to keep your heart young?  Please leave your comments below for our community to read.

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Should I Take Fish Oil?

“I hate fish,” Sarah shared with me at her last clinic visit.  “Can’t I just take fish oil instead to get my omega 3s?”

Sarah is not alone.  According to the New York Times, at least 10% of all Americans still take fish oil.  Even I used to gulp down these big pills that gave me “fish breath.”

Many of my patients would much rather take a pill than eat real food.  Can fish oil replace all of the benefits of eating wild fish?

In this article I answer the question, should I take fish oil?  If you would rather watch the highlights of this article, here is a two-minute interview I did on our local TV station about this article.

Eskimos, Fish Oil, and Heart Disease

Before I answer this fish oil question, I would like to back up and discuss how fish oil ever became considered as a possible heart disease treatment option.  In the 1970s, Danish researchers captivated the world’s attention by supposedly finding extremely low rates of heart disease among the Inuit Eskimos of Greenland.

These Danish researchers concluded that it was the large amount of omega 3s, from fish oil and other marine life, in their diet which prevented heart disease.  These findings seemed very counter intuitive at the time because the Eskimo Diet was largely devoid of fruits and vegetables.

While many popular internet sites still promote the “Eskimo Diet” to prevent heart disease, modern researchers have found that Eskimos have the same rates of heart disease as non-Eskimo populations.  Not only has the “Eskimo Diet” been debunked as a way to prevent heart disease, recent large studies have sadly reported that fish oil may not prevent cardiac disease.

What Are the Possible Cardiac Benefits of Fish Oil?

In general, I have found that most of my patients who take fish oil fall into one of two categories.  The first takes fish oil hoping to prevent heart or brain disease.  In contrast, the second group takes fish oil as part of a healthy diet that includes plenty of omega 3 fatty acids.

Despite the lack of strong data to support fish oil, what are the theoretical heart benefits of fish oil that still have so many people taking these supplements?

1. Fish Oil is a Blood Thinner

Like aspirin, fish oil thins the blood.  This blood thinning effect could help to prevent blood clots, heart attacks, and strokes.

2. Fish Oil Reduces Inflammation

Fish oil has a powerful anti-inflammatory effect.  As inflammation is at the “heart” of cardiovascular disease, the fact that fish oil reduces inflammation should theoretically prevent heart disease.

3. Fish Oil Reduces Triglycerides

Elevated triglycerides, or fat in the blood, is a major cause of heart disease.  As fish oil reduces triglycerides it is no surprise that the FDA has approved certain pharmaceutical grades of fish oil, like Lovaza and Vascepa, for this purpose.

Does Fish Oil Prevent Heart Disease?

Despite early enthusiasm for fish oil based on studies of the Inuits living in Greenland, recently a growing number of studies are concluding that fish oil does not prevent cardiac disease.  While my cardiologist colleagues once recommended fish oil to most of their cardiac patients, it is now just a small minority of them who still recommend this treatment.

Does Fish Oil Prevent Alzheimer’s Disease?

Like with the heart, early research suggested that fish oil may prevent Alzheimer’s Disease.  Unfortunately, more recent research suggests that this is likely not the case.  Indeed, a large study published this past week confirmed the findings of other studies, namely that fish oil does not improve cognitive function or prevent memory loss.

Does Fish Oil Cause Cancer?

While the media misreported a 2013 study by proclaiming that fish oil causes cancer, if you examine this study closely it does not even report if they actually took fish oil.  As a follow up to this study, a 2015 study showed that fish oil just might be slightly protective against cancer.  Based on my interpretation of the medical literature, fish oil is likely neutral when it comes to cancer risk.

Can Fish Prevent Heart and Alzheimer’s Disease?

While the data for fish oil in the prevention of heart disease is unconvincing, stronger data do exist supporting oily fish for the prevention of heart disease.  Indeed, in a large study done by my former colleague, Dr. Dariush Mozafarrian, he showed that this risk of death from heart disease could be reduced by 36% by eating oily fish 1-2 times per week.  Another big study showed that regular fish consumption decreases the risk of dementia by 19%.

Can I Get Omega 3s From Plants?

For those who don’t like fish, wouldn’t it be nice to get all of your omega 3 fatty acids from plants?  I know I used to feel that way until I forced myself to start liking fish.

Unfortunately, most of the research showing a beneficial effect of omega 3s come from studying the fish forms of omega 3s, namely EPA and DHA.  However, I should point out that the body can convert some of the plant form of omega 3s, ALA, into EPA and DHA.

If you don’t like the marine forms of omega 3s don’t despair as I suspect future research will show that plant omega 3s also protect against heart disease and dementia.  If you are looking to increase your plant based omega 3s, some great options include walnuts, flax seeds, chia seeds, vegetables, and legumes.

How Should I Get My Omega 3s?

While your body can make most of the fats it needs for health, the same is not true for the omega 3 fatty acids.  These fatty acids are called essential because they must be obtained from food. Here is how I advise my patients to get omega 3s for their heart and brain health.

1. Skip the Fish Oil

While I once recommended this to my patients, and even took it myself for a period of time, recent studies don’t show any clear benefit.  Thus, unless your triglycerides are high, it may be best to skip fish oil.  If fish oil helps you then you can be reassured that the medical studies also do not show any clear harm from taking this supplement.

Of course, if your doctor has recommended fish oil, do not stop this medication.  Rather, please discuss the recent medical studies with your physician to see if you might be a candidate for real food sources of omega 3s.

2. Eat Wild Oily Fish Twice Weekly

The best way to get omega 3s is from wild oily fish.  My favorite is wild Alaskan salmon which we can get very cheaply at Costco.  Wild oily fish is high in EPA and DHA while also very low in mercury and other contaminants.

3. Eat Plant Omega 3s on Your Non-Fish Days

On the days you don’t eat fish, make sure you eat plant based omega 3s.  For example, just 1/4 cup of walnuts (14 halves), provides you with 113% of the daily recommended amount of omega 3s.

Since the scientific data no longer enthusiastically recommend fish oil, here is a list of how you can easily get all of the omega 3s your body needs each day from real food sources.  How do you get your daily dose of omega 3s?

Addendum

Since writing this article, I have received many, many questions from my patients regarding fish oil.  The question of should you take fish oil is very difficult to answer in a blog article.

We know that fish oil reduces triglycerides.  We also know that high triglyceride levels cause plaque build up or atherosclerosis in the arteries of the heart and elsewhere throughout the body.  The missing link is that the scientific data are not yet clear as to whether or not fish oil prevents heart attacks.

Even in the cardiology community this subject is highly controversial.

The bottom line is that if you are a heart patient you need to have an open conversation with your cardiologist as to whether fish oil is right for you.  In my mind, as long as your fish oil is fresh (has not gone rancid) and is from a reputable source (pharmaceutical grade, USP certified, or GMP supplements) the downside risks seem to be minimal.  Whether or not there is an upside benefit is what is highly debated.

Hope this helps!

John

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How to Prevent the Health Effects of Overworking

“Am I going to have a heart attack or stroke?” John asked me at his clinic visit yesterday.

“Based on the medical study that just came out, it does look like your risk is increased,” I responded.

“Yeah, it’s in the newspapers and on TV and it’s got me worried.  I certainly don’t want to die from too much work,” John said with fear in his voice.

Deep down, it has me worried as well.  As a recovering workaholic this recent study was a reminder to me that none of us are superhuman.

In this article I will share the health risks of overworking and will give you specific strategies on how to prevent the health effects of overworking.  If you would rather get the “Reader’s Digest” version of this blog article, here is the link to a 2-minute TV segment I did on this blog article.

Heart Attack Risk from Too Much Work

The study that has the world talking right now was published this week in the prestigious medical journal, The Lancet.  Fully 603,838 people from the U.S., Europe, and Australia were included in this study.

After following all of these people for an average of 8.5 years, researchers concluded that the risk of a heart attack was increased by 13% in those people who work more than 55 hours a week.  While this risk may sound quite frightening, this number is much smaller than previous studies which indicated an increased heart attack risk of up to 80% in people working more than 40 hours per week.

Stroke Risk from Overworking

While the risk of a heart attack was only modestly elevated in this study, the risk of a stroke from overworking was very impressive.  Indeed, this study showed that in people working more than 55 hours a week, the stroke risk was increased by 33%. Even those who work just a little more than 40 hours a week were at increased risk of a stroke.  Is excessive work really worth the cost of potentially spending the rest of your life in a nursing home?

How Do Long Working Hours Cause Heart Attacks and Strokes?

Just why do people who put in long hours at the office, or work multiple jobs, have more heart attacks and strokes?  Deep down, I think we all know the inherent risks of overworking from our own experiences.

However, for the skeptics out there, let me share possible reasons for this increased risk based on the best medical data available.

1. Long Working Hours Increase Our Perceived Stress

I have come to learn that when I have put in long hours at the hospital I tend to feel more “stress.”  Studies show that this stress alone may increase our risk of a heart attack or stroke by up to 40%.

2. Excessive Work Raises Our Blood Pressure

Whether it is job stress related, or just due to the fact that we don’t have enough time to live a healthy lifestyle, excessive work raises our blood pressure.  Regardless, your risk of high blood pressure is at least twice as high if you work long hours.

3. Overworking Causes Overeating and Under Exercising

It comes as no surprise that the more hours we log in at work the more food we eat, especially the donuts and other treats our coworkers bring in, and the less time we will have to exercise.  Indeed, medical studies verify that people who work long hours tend not to have a clean diet and are more likely not to exercise.

4. Workaholics Are More Likely To Become Diabetic

As a direct result of poor food choices at work, as well as being stuck in a chair, workaholics are much more likely to become diabetic.  Diabetes is one of the strongest risk factors not only for heart attacks and strokes but also dementia as well.

5. Long Working Hours Cause Depression

While some people thrive on long working hours, for the rest of us, we tend not to be as happy when work dominates our lives.  Is it any wonder then that studies have shown that the more hours you put in at work the higher your chances are of depression?  Depression, in turn, is a powerful risk factor for cardiovascular disease.

Can You Die from Overworking?

It should come as no surprise that overworking can cause an early death.  Indeed, the Japanese even have a word for this, karoshi.  Probably due to the long working hours in Japan, the Japanese have long recognized that even young executives can kill themselves from working too many hours.  Are you at risk of a karoshi-death?

How to Prevent the Health Effects of Overworking

What should you do if you routinely put in more than 40 hours per week?  With “always on” smartphones, more and more of us never seem to get away from work.  What can we do to prevent a karoshi early death (death from overworking)?

1. Look at the Big Picture

Perhaps the most important thing is to evaluate your priorities and what your goals are in life.  Are you running yourself ragged, and destroying your health, just so that you can live in that bigger house, go on those nice vacations, and drive that fancier car?  Perhaps the real solution is to simplify and start enjoying your life now.

2. Love Your Work

In my experience as a cardiologist, most of my patients who develop cardiovascular disease from overworking do so because they do not enjoy working.  For these patients, work is something they dread.  They live for the weekend and dread Monday mornings.  Is it any wonder then that the highest risk of a heart attack is on Monday morning when people are just preparing to go to work?

The number one way to avoid the risks of overworking is to find a job or calling in life that doesn’t require “work.”  Try to find a way to get paid for playing or doing something that you love so much you would do it for free.  As has often been said, “Choose a job you love, and you will never have to work a day in your life.”

3. Manage or Prevent Perceived Stress

Of all the risks of overworking, perceived stress seems to be the strongest risk factor for heart attacks and strokes.  If you must work long hours, find a way to minimize or eliminate unnecessary perceived stress.

For example, if you are in a stressful work environment, perhaps it is time to change jobs.  If you love where you are at, but it causes you too much stress, perhaps meditation, yoga, or daily exercise might help you to unwind each day.

4. Use All Your Vacation Time

Working long hours and not using all of your vacation time is a double hit.  Surprisingly, 41% of Americans don’t use all of their vacation time.  I used to be one of these people. At least if you are going to work hard then you should play hard as well.  Even if you are not working long hours never let a vacation day go unused.

5. Get At Least 7 Hours of Sleep

To work more than 40 hours a week, most people steal time from sleep.  I know this was one way I used to find extra hours in a day.

In previous articles, I have discussed the heart attack, dementia, and cancer risks associated with sleep deprivation.  To safely work long hours you must make sleep a major priority in your life.

6. Eat the Right Foods at the Right Time

Too often, those who are burning the candle at both ends, tend to eat junk at work and then have a big meal when they come home late at night.  If you want optimal performance at work, eat a healthy breakfast before you leave in the morning and be sure to pack a healthy lunch and snacks, if needed, throughout the day.  Dinners, ideally, should be light and relatively early with nothing to eat right before bed.

Commit now not to eat the sugar your coworkers will inevitably bring in.  Also, the packed healthy lunch you prepare each day will help you to resist fast food, or other garbage, for lunch.  Just like you would never knowingly put bad gas in your car, you should never put bad food in your body and expect optimal work performance.

7. Find Time To Move

To safely navigate working long hours you must also find time to move throughout the day.  Getting a workout in each day can’t protect you from the dangers of an office job.

For example, one study showed that even if you exercise every day, you are 47% more likely to die young if you sit for more than 7 hours a day.  Considering that the average American sits 9.3 hours a day, this is probably you.  If you work in an office, even if just part-time, consider a treadmill desk, bike desk, standing desk, or even just getting up every 30 minutes to prevent the health risks of sitting.

Take Home Message

The big picture is that this study confirms the findings of many previous studies.  Specifically, working long hours significantly increases your risk of a heart attack or stroke.

The key to eliminating this risk is to either simplify your financial needs or find something that does not “feel like work.”  If work is play then, in my experience,  you can avoid the cardiovascular risks of working long hours.

If you feel compelled to work long hours, or have no other choice, you must take special care of your body.  Just like you would never neglect taking care of your car on a long road trip, the same must be true for your body.  If you are going to work it hard, you must prevent or manage perceived stress, get restorative sleep, eat the right foods at the right times, and ensure that you are moving through the day.  And, of course, please at least promise me that you will use all of your vacation days.

Do you work long hours?  What have you found that helps you to maintain excellent health despite long working hours?

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Is Testosterone Safe for the Heart?

“Should I do it, doc?” Bob asked me during a recent clinic visit.  Bob was 54 years old and was hoping that testosterone supplements would be his miracle drug to increase energy levels, put on more muscle, and to help with erectile dysfunction (ED).

“This may put you at increased risk for a heart attack or a stroke,” I replied.

“I know and it worries me,” Bob responded.

While American men spend almost 2 billion dollars a year for testosterone supplements to feel young again, the FDA recently announced that testosterone increases the risk of heart attacks and strokes.  Does testosterone actually work and what are the cardiovascular risks?  In this article, I will share the results of two prominent studies that were just published to help answer Bob’s question, is testosterone safe for the heart?

Safe But Useless Unless Levels Are Very Low – TEAAM Study

The first of the two studies, the TEAAM Study, was just published in the prestigious Journal of the American Medical Association.  The TEAAM Study was a small but very well designed study from Harvard University.

Basically, Harvard researchers enrolled 308 men, age 60 or older, and then randomized them to either testosterone gel or a placebo gel daily for 3 years.  All of these men had low or low-normal testosterone levels.  The goal was to look at the effects of testosterone on general health, sexual function, and overall risk to the cardiovascular system.

After 3 years of using testosterone or a placebo, researchers unfortunately found that testosterone did not improve general health or sexual function.   However, this was not all bad news.  Fortunately, they did find that even after using testosterone supplements for 3 years there was no increase in atherosclerosis or coronary artery calcium deposition in the heart.

The take home message from this study is that while testosterone may be safe for the heart, it really doesn’t do any good unless your testosterone levels are really low (less than 100 ng/dL).

Testosterone Decreases Heart Attacks and Prolongs Life – VA Study

The second big testosterone study to come out was just published in the European Heart Journal.  This VA study was based on a retrospective review of 83,010 veterans from VA hospitals.  As this was a retrospective study, or basically just a medical “chart review,” the findings are no where near as reliable as the randomized TEAAM Study where the doctors and patients had no idea if they were using real testosterone or a placebo.

Thus, it is possible that the veterans taking testosterone in this study may have had a “placebo effect.”  In other words, if they believed the testosterone was helping them then it was possible that the benefit was entirely due to the power of the mind to heal them.  This is something that I have discussed in a previous blog article, 5 Ways to Heal Yourself With The Power of Your Mind (#62).  As a result, the findings of this study should be taken with the proverbial “grain of salt.”

Despite the limitations of this VA Study, researchers showed that in patients with documented low testosterone levels that testosterone supplements decreased the risk of a heart attack by 24%, decreased the risk of stroke by 36%, and decreased the risk of premature death by 56%.  The take home message of this study is that if your testosterone levels are low then testosterone supplements may not be as dangerous as other studies have indicated.

Should You Take Testosterone Supplements?

At the end of the day, these two recent testosterone studies just further “muddy the water” regarding testosterone supplements.  While I can’t recommend testosterone supplements, as this is something you should discuss carefully with your physician after weighing the risks and benefits, here is what I told Bob and my other patients who are considering testosterone supplementation.

1. Don’t even consider testosterone unless your levels are extremely low.

Regardless of your symptoms, testosterone is not worth the risk unless your levels are clearly low and you are having significant symptoms.  Like any other supplement, testosterone is no magical pill to feel young again or ward off disease.

2. Your cardiovascular risks are unclear.

While the two studies discussed in this article showed that testosterone is safe, and possibly even beneficial for heart health, other studies have shown the exact opposite prompting an FDA warning that testosterone may cause heart attacks or strokes.  For patients with active heart disease, I generally counsel against testosterone supplements unless levels are extremely low and the symptoms absolutely unbearable.

However, in patients with a well controlled heart condition, testosterone supplements may be safe.  Fortunately, the two recent studies are very reassuring when it comes to the cardiac risks of testosterone.

3. Boost your testosterone levels naturally

In my opinion, the very best way to boost your testosterone levels is to do so naturally with a healthy lifestyle.  For example, medical studies have shown that getting enough sleep, maintaining a healthy weight, getting regular exercise, managing stress, and eliminating unnecessary medications may all raise your testosterone levels.  Better yet, raising testosterone levels naturally will help all aspects of your life and will help to prevent other health problems.

Do you or a loved one have low testosterone levels?  What has worked for you?  Please leave your comments below for our community.

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10 Reasons Why Spicy Foods Are Good For Your Heart

“Have some more,” Mr. Wang said as he eagerly put more food on my plate.

“No thank you,” I tried to respond in Chinese, but no words came out.  My mouth was on fire and my eyes watering.  I really wanted to be a grateful guest but the red hot chili peppers in this Sichuan Chinese dish was far spicier than I had ever experienced before in my life.

Surely, I thought, this much must put me at increased risk for ulcers and it couldn’t be healthy.  Now, 29 years later, there is compelling scientific data that we should eat spicier food.  In fact, these spices may be a key factor to great health and longevity.

In this article, I share 10 scientifically proven reasons why spicy foods are good for your heart.  If you are looking for a very quick summary of this article, here is a TV appearance I did to discuss this blog.

Do Spicy Foods Cause Ulcers?

Growing up, conventional wisdom held that spicy foods caused acid reflux and stomach ulcers.  In fact, many medical experts of the day even recommended that we eat blander foods.

No doubt, some foods like pizza, sausage, and deli meats can aggravate “ulcer-like” symptoms.  However, the active component of chili peppers, capsaicin, has been shown in many studies to prevent or reverse ulcers. Indeed, cultures or groups of people who eat the most chili peppers rarely get ulcers.

Why is the Media Now Discussing Spicy Foods?

Unless you have been on a “news fast” this past week, you have undoubtably heard many reports of the recent Harvard study on eating spicy foods.  In fact, this study was discussed in nearly every major U.S. newspaper and media outlet this past week.

There is a good reason why this study deserved all of the attention it received.  This was a mega-study.  A study so large that it included 487,375 healthy Chinese people, ages 30-79, who were followed for an average of 7.2 years.

These Harvard researchers did a good job of controlling for 20 different lifestyle factors which could have influenced the results of this study, like smoking status, vegetable intake, exercise frequency, etc. so that they really were only looking at the mortality effects of eating chili peppers.

Over the course of this 7.2 year study, 20,224 of the study participants died.  Researchers then analyzed the cause of all deaths and compared these findings to their self-reported intake of chili peppers.

10 Reasons Why Spicy Foods Are Good For Your Heart

Based on the results of this Harvard study, as well as other published studies, here are 10 compelling, and scientifically proven reasons, why spicy foods are good for your heart.

1. Lose Weight

As I have discussed in a previous blog (#60), many studies have shown that chili peppers decrease appetite and increase metabolism.  This double combination can definitely kick start any healthy weight loss effort.

2. Healthy Gut Flora

Capsaicin, the active component in chili peppers, possesses powerful antibacterial properties.  By keeping these bad bacteria away, some data suggests that capsaicin may promote a healthy gut flora. From other studies we are now learning that a healthy gut is a key factor in preventing heart disease.

3. Less Diabetes

While diabetes prevention likely goes hand-in-hand with weight loss and a healthy gut flora, studies show that chili pepper eaters have less diabetes.  While this Harvard study did not convincingly show this, the study did show a trend toward less diabetes in people eating chili peppers at least three times a week.

4. Antioxidant and Anti-inflammatory Effects

Countless studies have confirmed that capsaicin has very potent antioxidant and anti-inflammatory effects.  These effects assist the immune system in the balance between inflammation and infection control.

5. Better Immune System

As discussed above, capsaicin optimizes our immune system function.  Is it any wonder then that in this Harvard study, chili pepper eaters were 26% less likely to die from infections if they ate chili peppers at least three times a week.  This benefit was even greater in women where a 45% decreased risk of death from infections was seen.

6. Lower Blood Pressure

Capsaicin, through activation of the TRPV1 receptor, has significant blood pressure lowering effects.  Ideal blood pressure control, in turn, has been shown to prevent atrial fibrillation, heart attacks, kidney failure, strokes, and dementia.

7. Less Cancer

Many studies confirm the anticancer properties of capsaicin.  Indeed, in this Harvard study, researchers showed a modest 8% reduction in cancers in those people eating chili peppers on most days.  Other studies have shown that cultures who eat a lot of spices, like India, have a much lower incidence of cancer.

8. Better Lung Function

A surprising finding of this Harvard study was that even just eating chili peppers once a week decreased your risk of dying from respiratory diseases by 33%.  While researchers are still not sure of this connection, I suspect it likely has something to do with less respiratory infections.

9. Less Heart Disease

As you might expect, this Harvard study also showed much less heart disease deaths.  Indeed, eating chili peppers at least once weekly decreased your chances of dying from a heart attack by 18%.

10. Live Longer

While most people don’t eat chili peppers to live longer, this spice is clearly linked to a longer lifespan.  In this Harvard study, your risk of premature death was reduced by 14% if you ate chili peppers three times a week.  Even those who ate chili peppers once weekly saw a 10% decreased risk of premature death.

Does It Matter How Often You Eat Chili Peppers?

Do you have to eat chili peppers every day to get all of the benefits we have discussed in this article?  The simple answer is “no.”  Most of the benefit appears to be from going from no chili pepper in your diet to eating some at least once weekly.

Fresh, Dried, or Processed?

While eating dried or processed chili pepper is easiest, from this Harvard study it appears that the greatest health benefits are seen with fresh chili peppers.  For example, fresh chili peppers contain more potassium and vitamins C, A, K and B6.

A Contrarian View of This Study

Is capsaicin the “secret sauce” for good health or is there something else at play in this Harvard study?  For the contrarians out there, let me offer several other explanations for the health benefits observed with chili peppers.

First, perhaps the benefit may simply be due to a selection bias.  For example, people suffering from chronic medical conditions tend to prefer blander foods.

Second, healthier people are more likely to have the energy to cook at home with spices.  Thus, once again, it may not be the chili peppers but rather the fact that healthier people are drawn to this spice.

Third, Chinese people cooking with chili peppers are also much more likely to include other spices, like garlic, ginger, and curry, which also have similar health benefits.

Closing Thoughts

With all of the compelling scientific data I have presented in this article, you would think that I was a regular chili pepper eater.  Truth be told, I rarely eat it unless I am eating Chinese food at a friends’ house or at a restaurant.

My challenge for all of us is to try and include more spices in our cooking at home.  Not only will our food taste much better but our health may also significantly improve!

Do you regularly cook with spices?  What spices do you like to use the most?  Please leave a comment below so that our community can benefit from your experience.

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6 Ways Clutter Damages Your Heart

“Has anyone seen my $20 bill?” my son cried out this morning.

As expected, no one had seen it.  All morning he searched frantically to find his birthday money.  He was sure someone had stolen the cash.  In the end, he found his money once he cleaned his room.

How many times have you tried to sort through your clutter as well?  In this article I discuss 6 ways clutter damages your heart and offer 8 tips on reclaiming your sanity.

Is Clutter a Problem?

All of this “clutter” is not benign when it comes to our health.  As reported in Psychology Today, clutter causes stress.  Even in the UCLA “clutter” study I mentioned above, trying to manage all of the clutter in the home caused mothers in this study to have high stress hormone levels.

Stress contributes to heart attacks, heart failure, and arrhythmias.  One of the best ways to lower our risk of cardiovascular disease is to create both physical and mental space in our lives through decluttering.

We Are Committed to the Decluttered Life

Jane and I have committed to take some significant steps in our journey to declutter our lives.  It is time to reclaim our space- physical, digital and mental–and here is our strategy:

1. Two-second Rule

If we see something that we can effectively get rid of in 2 seconds, we do it immediately.  Usually, this means putting it in the trash.

2. Create a Place for Everything

Long ago I created a special basket for my keys and wallet.  I now do the same for my iPhone, Macbook, and just about everything else I own.  If all of our stuff has a “home,” then you never have to look for anything.

3. Lock Down Bin

We have younger children.  As anyone with children will tell you, if left unchecked, kids will leave their stuff everywhere and I mean everywhere.

To help solve this problem, we have a lock down bin.  Here is how it works.  If we ever see a child’s item where it shouldn’t be, we simply put the item in the lock down bin.

To get the cherished possession back, our children either need to do a job or pay a dollar.  If lost items are not purchased back within a certain period of time, we donate everything left unwanted in the lock down bin.

4. Space for Something New

We are now instituting a rule that for every one thing that is added, one or more things must be removed.  This works for new clothing as well as new commitments for our calendar.  If I can’t donate a shirt I don’t buy a new one.  Likewise, if I can’t take something off of my schedule I don’t add anything new.

5. Empty Space

Empty space is the most beautiful thing in our home.  It doesn’t matter where it is — an empty shelf, an empty desk.

6. Make Everything Electronic

Several years ago I made the rule to never file or save anything “physical” again.  I can’t tell you how liberating this has become for me.  I now store all receipts on Evernote.  All of my children’s important school work is photographed and digitally filed.

7. Autopilot

Trying to remember to pay our bills on time was costing us time and money.  Now we’ve automated every bill possible and set up electronic tracking systems. I love getting the electronic “FYI” that everything has been automatically taken care of for me.

8. Three Item To-Do List

I used to have never ending to-do lists.  What didn’t get done on one day was passed on to the next day.

It was a no win battle.  Now I have electronically created  system whereby I can only put in a maximum of 3 items on my to-do list for any given day.  If something goes on then something must go off.

9. Readily Available Donate Box

To help us regularly donate old or unused items, we have a readily accessible donate box in our garage.  As soon as the box is full it is donated.

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5 Ways Your Smartphone Can Tell If You’re Depressed

One in 14 Americans will suffer from depression this year.  Your friends are worried you might be the one.  Can your smartphone diagnose you with depression?

In this article, I share 5 scientifically proven ways your smartphone can tell if you’re depressed.  I also share specific things you can do now to minimize your risk of every suffering from this devastating condition.

Depression Causes Heart Attacks

While most people are aware of the link between depression and suicide, few people are aware that depression causes heart attacks.  For example, in a recently published study of 34,726 American adults from Columbia University Medical School in New York City, the combination of stress plus depression increased the risk of premature death or a heart attack by 48%.

How Can Your Smartphone Tell If You Are Depressed?

You may be wondering how exactly your smartphone can tell if you are depressed.  Rather than creating yet another app that asks you questions to see if you are depressed based on your answers, researchers at Northwestern School of Medicine in Chicago sought to answer this question with more objective data generated by smartphone sensors and GPS data.

In this study, researchers enrolled 40 adults.  With an app to collect smartphone data, Northwestern University researchers were able to diagnose depression with 87% accuracy.

This objective smartphone diagnosis of depression, based on sensors and GPS tracking data, was then compared to the traditional way of diagnosing depression.  Based on the results of this study, here are the 5 ways your smartphone can tell if you’re depressed.

5 Ways Your Smartphone Can Tell If You’re Depressed

1. Your Circadian Rhythm Is Off

Your circadian rhythm is your body’s internal 24 hour clock which is set based on the sun.  Even plants and animals have this same 24 hour internal clock.

In people without a stable circadian rhythm, the risk of cancer and heart attacks are both significantly increased.  Our bodies need to be in rhythm with the sun for optimal health.

In depression, people tend to live lives out of sync with the natural circadian rhythm.  In other words, as people are entering into a bout of depression they may go to sleep much earlier or later than previously or they may have days when they go into work late.

In my case, my iPhone knows I like to go to bed at 10 pm and arise at 5 am.  I leave for the hospital somewhere between 6:30 and 7:30 am and that we keep our bedroom very dark at night and I try to keep my daytime light exposure as high as possible.  My iPhone could also tell you that I get on my treadmill desk or bike desk first thing in the morning and, whenever possible, I try to carve out time to exercise hard outside later in the day.

Through motion detectors, your smartphone can tell if your circadian rhythm is off.  To keep yourself as mentally healthy as possible, try to go to bed and arise each morning at the same time, keep it dark at night and light during the day, and have a set time to eat, work, and exercise.

2. You Stop Going to Your Favorite Places

Through GPS technology, your smartphone can quickly learn where your favorite places are.  For me, my smartphone could learn very quickly that I tend to be happiest when I regularly visit the ski resorts near my home to either ski in the winter or mountain bike in the summer.

People suffering from depression tend to lose interest in their favorite activities.  They tend to stop going to their favorite places.

Where are your favorite places?  Do you have a favorite movie theater, restaurant, or workout location?  Make sure you never withdraw from your favorite places or activities.

3. You Suddenly Start Spending More Time at Home

Your smartphone can also tell if you suddenly start spending more time at home.  People suffering from depression tend to stop going out and isolate themselves at home.

Sure, there could be a change in your life like an injury or a new baby.  However, significant events like these, can also be a risk factor for depression.

In my situation, my smartphone knows that if I am at home I am rarely sitting.  I am either on my treadmill desk or engaged in some sort of activity with my family.

Once again, to stay mentally healthy, don’t suddenly start spending all of your time locked within the walls of your home.  Make sure you are connecting with other people and with nature whenever possible.

4. You Spend More Time on Your Phone

Studies have shown that depressed people tend to spend more time on social media or their smartphones.  Not surprisingly, your smartphone can track how much time you are on it each day.

For example, in this study, depressed people spent an average of 68 minutes playing on their phones while non-depressed people spent a mere 17 minutes on their phones.  Could it be that the smartphone is a distraction from the world for depressed people?

To be honest, I am guilty of spending too much time on my smartphone.  I’m not sure if I am at the 68 minute mark or not but I am certainly spending more than 17 minutes on my iPhone each day.  I have made it a personal goal to only check social media and emails once or twice, at most, each day.

Many of my patients have shared with me that the simple act of unplugging from technology on Sundays helps them to avoid feeling depressed and keep their hearts beating right.  If you are spending too much time on your smartphone you are missing out on your life.

5. You Frequently Reach for Your Phone

As with number 4 above, depressed people in this study were much more likely to reach for their smartphones.  Perhaps these people were worried they might miss the latest Facebook post, that critical text message, or an important work email.

I am guilty of this as well.  Once again, for your health, don’t reach for your phone unless it is absolutely critical.

Can I Get the App?

I would love to have an app, like the one used in this study, running on my iPhone in the background. Then, if my behaviors suddenly start to change, it could ask me if I was OK and whether or not I needed help.

Even though all of the data used in this study is already available from your smartphone, an app like this to gather and analyze these data does not currently exist in the iTunes store.  The only apps currently available rely on self-reported data from quizes or questionnaires to assist in determining if you are depressed or not based on your answers.

An app that actually tracks your behaviors could be very helpful as it provides objective observational data that could prompt you to make an appointment with your healthcare provider to prevent a major bout of depression.  Perhaps if you know a software developer you could encourage them to create such an app.

Final Thoughts

Depression is a serious condition.  Depression can ruin your health, your family, and your life.  If you suffer from any of the symptoms discussed in this article, let your physician know so that you can receive the help you need.

Remember, this was a small study.  The findings of this study cannot be used to diagnose true depression until they are validated in a large group of patients.  Regardless, I found the findings of this study very fascinating and it may open the door to new apps to identify people who need help.

Next Steps

Please leave your comments for our community below.  Also, if it is hard to find the time to read my blog, you can subscribe to listen to my podcast by clicking on these iTunes or Stitcher Radio links.  Now you can get all of this valuable information while you are working out, driving, or doing just about anything.

Lastly, if you are not yet subscribed to our newsletter please do that now by clicking here.  In this weekly newsletter I share life changing information that you can’t find anywhere else on our website or on the podcast.

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Which Pain Medications Are Safe For the Heart?

“What is there left for me to take for my back pain?” My patient Mary asked after the recent FDA warning that common pain medications, like ibuprofen and Aleve, increase the risk of heart attacks and strokes.

Fully, 100 million Americans suffer from chronic pain.  Are you one of them?

In this article I discuss the life-threatening cardiac risks of traditional pain medications.  I also share 9 heart healthy pain treatment strategies based on the latest scientific studies.

NSAIDs Like Ibuprofen and Aleve

The non-steroidal anti-inflammator medications (NSAIDs), like ibuprofen and Aleve, are the classic “go to” medications for people suffering from pain.  The problem is that ever since the Vioxx experience, in which an estimated 140,000 people suffered a heart attack from this medication, we have known that you put your heart and brain at risk each time you take one of these medications.

Even the safer NSAIDs, like ibuprofen and Aleve (naproxen), may increase the risk of a heart attack and stroke.  Indeed, taking ibuprofen increases the risk of a heart attack by 14% and strokes by 11%.  NSAIDs also increase the risk of a dangerous heart rhythm, called atrial fibrillation, by 33%.

In addition to these cardiovascular risks, NSAIDs also raise your blood pressure and increase your risk of bleeding, heart failure, kidney failure, and ulcers.

Aspirin

While aspirin is considered a NSAID, it stands out as possibly the only pain medication that appears to be safe for the heart.  Aspirin was once felt to prevent heart attacks and strokes, however, more recent research is challenging this long held belief.  This new research has led the FDA to announce in 2014 that aspirin was no longer recommended for the general public to take in order to prevent heart attacks and strokes.

While aspirin has long been felt to be “safe,” it can also cause serious side effects like bleeding and ulcers. For example, in one large study, there was a 1 in a 100 risk of major bleeding each year in people taking an aspirin daily.  This risk of bleeding, from any of the NSAIDs, is of particular concern for people who may be on other blood thinners.

Acetaminophen

Like aspirin, acetaminophen was once felt to be a safe medication.  However, even this medication is linked to an increased risk of heart attacks and strokes.

This risk appears to be similar to that of NSAIDs.  In addition to the increased heart attack and stroke risk, this medicine can also raise your blood pressure and cause liver damage.

Opiate Medications

According to the CDC, there are 259 million prescriptions written each year for narcotics in the U.S.  If you break this down, that is nearly one bottle of narcotic pain pills for every person in the United States.

These narcotics cause countless cardiac arrests through prolongation of what is called the “QT” interval on the ECG.  It is for this reason that many opiates, such as Demerol and Darvocet, have been taken off the market.

What Can I Take For Pain?

At this point you are probably wondering, what can I take for pain?  Unfortunately, there is no “free ride” when it comes to managing pain with traditional medications.  As with everything, you and your physician have to carefully weigh the risks versus benefits of everything that you take.

For example, I love to exercise hard.  However, at age 48, occasionally I will have pain from a pulled muscle or from a fall while skiing.   When this happens, I take 220 mg of naproxen (Aleve).

As a cardiologist, I am very aware of my increased risk of a heart attack, stroke, atrial fibrillation, or heart failure on the days when I take this medication.  However, I also have to balance these risks with the potential benefit of exercise.  To keep these risks at a minimum, I only take a very low dose (220 mg of Aleve) on the days that I experience significant pain.

Heart Healthy Pain Treatment Strategies

For those who suffer from chronic pain, you may want to explore alternative pain therapy to decrease your cardiovascular risks associated with the traditional pain medications.  Below are some possible alternative pain treatments to discuss with your physician.

1. Maintain a Healthy Body Weight

As with everything, “an ounce of prevention is worth a pound of cure.”  For most people, getting down to a healthy body weight would resolve a large portion of the pain they experience.  I know that this was critical for me to resolve my chronic back and knee pain.

2. Turmeric (Curcumin)

If you enjoy Indian or Asian foods then you have undoubtably eaten this spice before.  It is also found in curry.  Turmeric or curcumin has very potent anti-inflammatory properties.

Indeed, in one large study turmeric (curcumin) was shown to be just as effective in reducing pain, with a lot less side effects, when compared to ibuprofen for people suffering from arthritis.  In my own experience, I have not found turmeric (curcumin) to be as effective as low-dose Aleve but it does seem to help with relatively minor aches.

An additional benefit of turmeric (curcumin) is that it may also help to prevent cardiovascular and Alzheimer’s Disease.  Perhaps this explains why the risk of dementia is 4.4 times lower in India when compared to the U.S.

3. Capsaicin

Capsaicin is the active component of chili peppers.  While eating peppers may help with pain, the most potent effects seem to be from using capsaicin topically.  Indeed, many studies have confirmed the potent pain relieving effects of topical capsaicin for the use of arthritis or nerve pain.

Even though capsaicin is a completely natural product, side effects can occur.  For example, some people may experience severe skin reactions.

If you like to eat red peppers or chill peppers, capsaicin has also been shown to increase metabolism and help to burn fat.  Thus, not only may your pain decrease but you may also lose weight.

4. Omega 3 Fatty Acids

While oily fish is not generally considered a “pain medication,” studies do support pain relieving effects with omega 3 fatty acids.  I suspect that this is due to the anti-inflammatory effects of omega 3s.  Even if wild Alaskan salmon does not help your pain, studies show that you have markedly reduced your overall cardiovascular risks.

5. Glucosamine and Chondroitin

Glucosamine and chondroitin have now gone “mainstream,” especially for the treatment of knee arthritis.  Both of these substances help to build or repair cartilage, especially in the knee.  Indeed, studies have shown that these can be just as effective as NSAIDs for pain and swelling with minimal side effects for most people.

6. Ginger

While also not commonly thought of as a “pain medication,” studies indicate that ginger may be another pain treatment option with minimal side effects.  Ginger is known to have anti-inflammatory effects which may help to prevent heart disease in some studies.

7. Yoga or Meditation

Studies have shown that yoga and meditation can be very effective “pain medications.”  As anxiety and depression amplify pain, I suspect that the primary effect of yoga and meditation is on our pain perception.  Regardless, both yoga and meditation have also been shown to help reverse or prevent heart disease.

8. Acupuncture

Acupuncture has been used for millennia in China to treat chronic pain and other health problems.  Modern studies have supported the pain relieving effects of acupuncture.  Fortunately, when done correctly, the cardiovascular risks appear to be very low.

9. Massage Therapy

Massage therapy can be very effective for musculoskeletal pain.  Another benefit is that it is also appears to be heart healthy.

Take Home Message

Unfortunately, all of the traditional pain medications can have life-threatening side effects.  When taking pain medications it is critically important to discuss the risks, benefits, and alternatives to these medications with your physician.

While some pain is unavoidable, many people can prevent or treat chronic pain through a healthy lifestyle which also includes anti-inflammatory foods, herbs, and spices as well as stress management.

Have you tried any of the 9 alternative pain treatment options discussed in this article?  If so, what was your experience?  Please leave your comments below to share with our community.

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10 Things That Great Sleepers Do

“Its 4 am and I can’t sleep!”

Fully, 70 million Americans can’t even get at least 6 hours of sleep each night.  Are you one of these 70 million people?

Sleep is critical for optimal heart and brain health.  As a cardiologist who has struggled with sleep for a significant part of my life, I have made it a focus to study the habits of people who enjoy great sleep.  Based on my research, in this article I will share the 10 things that great sleepers do each night.

How Much Sleep Do You Get

If you are like the typical American, you cut your sleep short by 42 minutes each night during the weekday.  This weekday sleep deprivation is generally caused by setting an alarm clock in the morning.  Studies show that “catch up” sleep on the weekend cannot undo the inflammation and decreased cognitive function that happens from sleep deprivation.

What Happens When We Don’t Get Enough Sleep?

We all know that we don’t feel very well after a bad night of sleep.  The problem is that this is just the tip of the proverbial iceberg.  Indeed, studies show that just one week of poor sleep, defined as sleeping an average of 5.7 hours a night, results in 711 changes to our genes.  These genetic changes may even increase our susceptibility to cancer.  Another study showed that just one night of bad sleep caused brain damage.

Sleep and the Heart

Our hearts need adequate sleep to function properly.  Even just losing one hour of sleep, like what happens each year when we go on Daylight Savings Time, results in an increased risk of a heart attack for one week.  Sleep deprivation also doubles the risk of atrial fibrillation.

Interestingly, studies show that both short and long sleepers have up to a 30% increased risk of premature death. This increased risk of premature death seems to be driven primarily by the cardiac effects of sleep deprivation.

Sleep and Dementia

Sleep deprivation results in “shrinking” or atrophy of the brain, especially in the memory center.  It also impairs cognitive function.  Is it any wonder then that chronic sleep deprivation can cause dementia?

10 Things Great Sleepers Do

My study of the habits of the 37% of Americans who report that their sleep needs are being met was very helpful for me when I struggled with insomnia.  I have always been fascinated by deconstructing what works for certain groups of people who are able to avoid chronic medical conditions.  Below are the 10 things that great sleepers do.

1. Exercise Each Day

In my experience, daily exercise is one of the most critical components to great sleep at night.  I have found that on days where I am unable to exercise I am often unable to sleep at night.

Based on the results of 1,000 people participating in the 2013 Sleep in America Poll, exercisers are 48% more likely to enjoy a great night of sleep.  Interestingly, non-exercisers are also approximately 3 times more likely to report fatigue, taking sleeping pills, or snoring at night.

2. Have a Set Bedtime

Studies show that the number one reason why people report that their sleep needs are not being met is due to staying up late for evening activities.  Just having a set bedtime resulted in an average of 1 additional hour of sleep each night.

For many people it is hard to go to bed on time as often this is the only chance you get to have a minute to yourself.  Based on what I have seen with my patients, setting an alarm clock at night to signal that it is time to go to bed is much healthier than setting the morning alarm clock to wake you up too early.

3. Don’t Hit the Snooze Button

Contrary to popular belief, getting a few “extra minutes” of sleep by hitting the snooze button does not help.  In fact, abruptly wakening from an alarm clock can actually make you more tired in the morning due to a condition known as sleep inertia.

If you need an alarm clock in the morning then you likely are sleep deprived.  Our bodies function best when we are able to awake naturally, on our own, without the need of an alarm clock.

4. Avoid Blue Light at Night

Blue light, like that which is emitted from televisions and electronic devices, at night activates our brains and suppresses natural melatonin production.  As a result, watching TV or using your phone or computer at night often makes it difficult to fall asleep.

According to the 2014 Sleep in America Poll of 1,103 adults, having an electronic device in the bedroom doubles your chances of a bad night of sleep.  In addition, having an electronic device in the bedroom results in 1 less hour of sleep.

5. Don’t Sit During the Day

Great sleepers don’t sit very long during the day.  On average, those who sleep well at night, sit 1 hour and 10 minutes less than those who struggle with sleep.  They also watch TV 1 hour and 7 minutes less than poor sleepers.

As I track my steps each day, I have found that if I take less than 10,000 steps it is difficult to sleep at night.  For me, I tend to sleep best on the days when I get 20,000 or more steps.

6. Have Caffeine and Alcohol Rules

Caffeine and alcohol are two major sleep disrupters.  Great sleepers tend to have personal rules in place as to how much and what time of the day they take in their caffeine or alcohol.

For example, according to the 2014 Sleep in America Poll, having a caffeine curfew, or time of the day when they don’t eat or drink anything with caffeine, resulted in an average of 42 extra minutes of sleep at night.  For most people, the half-life, or time it takes for half of the caffeine to be metabolized by your body, is 4-6 hours.  Thus, to rid your body of 75% of your morning coffee will require 8-10 hours (2 half-lives).

Some people, like me, are genetically programmed to be slow caffeine metabolizers.  You can learn if you are also a caffeine slow metabolizer by the 23andMe DNA test for $99.  As a result, I can only eat dark chocolate in the morning hours or I won’t be able to sleep at night.

7. Manage Stress

According to a 2009 Canadian study of 464 adults, stress or anxiety was one of the primary causes of insomnia.  It is nearly impossible to sleep at night when your mind is active and adrenalin levels are still high.

I have found that the simple act of just writing down your anxieties prior to going to bed can work magic for your sleep.  Somehow, the act of putting your concerns down on paper frees up your mind to relax.  Others have found that listening to meditation programs or music helps to quiet their minds at night.

8. Work Reasonable Hours

In a study of 22,389 adults, long work hours were shown to be a major cause of insomnia.  Work, for many people, can be very stressful.  Our bodies and minds need a chance to relax and disengage from work.

If you are working too many hours you may find it difficult to sleep at night.  I know that when I have a long day in the operating room it can be hard to sleep at night unless I unwind with exercise and time with my family.

9. Have the Right Bedroom Environment

Your bedroom is arguably the most important room in your house for optimal health.  Great sleepers have purposefully created an ideal sleeping environment.

Based on the 2012 Sleep in America Poll of 1,087 adults, the following were reported as key aspects to great sleep at night:

– Cool room temperature (79%)

– Fresh air, free of allergens (75%)

– Dark room (73%)

– Quiet room (72%)

– Clean bedroom (66%)

If you are struggling with sleep, perhaps now is the time to make sure that your bedroom has these important features.

10. Reverse or Treat Sleep Apnea

Sleep apnea is a condition where people stop breathing at night.  Typically, the sleeping partner can easily make this diagnosis as people suffering from sleep apnea tend to snore like a train, stop breathing, and then gasp for air.

During these periods when people stop breathing at night their oxygen levels drop dangerously low causing  high blood pressure, atrial fibrillation, coronary artery disease, heart failure, and even sudden cardiac arrest.  For most people, sleep apnea can be reversed by weight loss or by treating it with a CPAP machine at night.

You Can Learn to Enjoy Great Sleep

Chronic insomnia, like most medical problems, is something that can be overcome with a healthy sleep lifestyle.  Based on the research of thousands of people who enjoy great sleep, the more of these 10 habits you can achieve the greater your likelihood of great sleep.

Have you found these 10 sleep habits helpful?  Please share with our community what has helped you to sleep better at night.

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9 Ways to Protect Your Heart from Overeating

“How much weight have you gained?” My mother asked me over the Christmas break after my first semester of college.

“I’m not sure,” I responded.  Really I knew.  You have probably heard of the “freshman 15” before.  For me, it was the freshman 25.

It wasn’t healthy I know.  Plaque build up in the heart can even start as a child.

Food is hard.  Free food and buffets are even harder.  Is there a way to eat mindfully while protecting your heart?

In this article, I will share with you the science behind 9 mindful eating approaches to protect your heart from overeating without feeling deprived.

The Chinese Food Buffet Study

Believe it or not, there was actually a study published on how thin people and overweight people approached an all-you-can-eat Chinese food buffet.  In this study, researchers analyzed 213 people from 11 different all-you-can-eat Chinese buffets across the U.S. What they noticed is that thin people and overweight people behaved quite differently at a buffet.

While this study was done at a Chinese restaurant, the lessons can be applied to any eating location, including your own home.  Most of the 9 mindful eating strategies discussed in this article were learned from this Chinese Food Buffet Study.

Mindful Eating

Unfortunately, with ever increasing portion sizes, we have no idea what a healthy serving size is anymore.  Moreover, we have lost our internal cues telling us we are full.  As a result, most people eat too much with each meal.  Even if you only eat healthy foods, you can still gain weight if your portion sizes are too big.

Mindful eating strategies have been closely associated with an increased ability to maintain a healthy weight.  This study is just one of many published studies showing that mindful eating can help you to control portion sizes and your weight.  Below are 9 ways to protect your heart from overeating.

9 Ways to Protect Your Heart from Overeating

1. Use a Smaller Plate

Multiple plate sizes were available at these Chinese restaurants in the Chinese Food Buffet Study. As I have discussed in a previous article, regardless of your plate size, most people have been trained to eat everything on their plate.

In this study, thin people selected smaller plates. This strategy can be especially helpful if you are the type to eat everything on your plate.  Indeed, studies show that switching out your 12-inch plates for 10-inch plates results in eating 22% less without feeling hungry.

2. Increase the Distance

In this study, thin people were more likely to sit further away from the buffet line than overweight people. The more distance you can put between you and the food, the less you will eat. This works for any temptation, it is what I like to call the “hassle factor.”

If it takes more energy to get food, you will be less likely to do it. It is just human nature. Instead of serving meals from the table, try serving meals from the counter.  It may prevent second or third helpings.

3. Use Chopsticks

Interestingly, thin people in the Chinese Food Buffet Study were much more likely to use chopsticks than a fork. You simply cannot shovel food in your mouth as fast with chopsticks compared to a big fork or a big spoon.  Each bite is slow and deliberate with chopsticks.

This is something that we have regularly done in our home.  Our kids love chopsticks.  Even if you are serving Western style foods, eating with chopsticks can provide an added level of excitement.

4. Take Time to Select Your Food

While at the Chinese buffet, thin people were more inclined to carefully evaluate all of their food options before putting food on their plates. In contrast, overweight people immediately started loading up their plates at the beginning of the buffet line.

Don’t just eat what is convenient. Rather, carefully take your time to decided exactly what you want to eat.

5. Use Good Manners

At the Chinese buffet, thin people were more likely to put a napkin on their lap. While this may sound trivial, focussing on proper table manners helps to slow down the eating process.

It takes 20-30 minutes for the brain to register that you are full.  As most people eat until they are full, slowing down the process can allow you to feel full with smaller portions.

6. Don’t Finish Your Plate

While 92% of Americans clean off their plate, interestingly, thin people in the Chinese Food Buffet Study were more likely to leave food on their plates. Just because food is left on your plate doesn’t mean you have to finish it off.

I am a “finisher.”  I eat everything on my plate.  Unless I move physically my plate away from me, I will continue to nibble until my plate is completely clean.

7. Chew Your Food

Your mother always told you to chew your food well. In this study, thin people chewed 15 times per bite of food compared to just 12 times per bite of food in overweight people.

I have always struggled with chewing my food well.  I tend to inhale my food.  Based on the results of this study, I am striving to chew my food at least 15 times for every bite.

8. Vegetables First

Studies show that what goes on the plate first is eaten in greatest quantities.  The key to heart healthy eating is to eat vegetables whenever possible.

If vegetables go on the plate first, your meal will likely be mostly vegetables.  Studies have consistently shown that vegetable eaters are much more likely to be thin and heart healthy.

9. Fruit for Desert

Some of us, like me, seem to have been born with a sweet tooth.  Fortunately, studies show that we can channel our sweet tooth into a love for fruits.

While fortune cookies are generally served at American Chinese food buffets, fortune cookies are not found in China.  Rather, fruit is eaten for desert in China.  The same can be true in Western countries.

Take Home Message

The key message to this study is that you don’t have to diet or starve yourself to maintain a healthy weight and protect your heart. By following the 9 mindful eating strategies discussed in this article, you can significantly increase your chances of staying thin and controlling your portion sizes.

Have you tried any of these 9 mindful eating approaches? Please share your experience below.

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The 7 Most Dangerous Foods for Your Heart

“Margarine is healthier,” I was told in the 1980s.  I still remember moving out of my parents house and buying groceries for the first time in 1985. Like everyone else, I cringe to think that I used to buy that tub of trans fat laden margarine because I thought it was safer for my heart than butter.

The sad thing is that most Americans still unknowingly eat this unhealthy fat each day!  Fortunately, the FDA has finally intervened and announced this week that “food manufactures” must eliminate added trans fat from our food supply within 3 years.  As with lead poisoning, there is no safe level of this toxic fat.

Despite this good news from the FDA, there is a catch.  Food manufacturers can petition the FDA to keep putting trans fat into their fake food products.

Even if the food label says zero trans fat, you are still at risk due to legal loopholes in trans fat reporting requirements.  As long as there is less than a half of a gram, food manufacturers do not need to report this.  For people who eat a lot of processed foods or eat out a lot, this can really add up.  A large percentage of fast food establishments, restaurants, and bakeries still use this fat.

In this article I will share with you how to protect yourself from the 7 most dangerous foods for your heart. These 7 foods are those highest in trans fat.

Why Should We Worry About Trans Fat?

Trans fat causes inflammation to our arteries. It also dramatically raises our bad cholesterol (LDL) and lowers our good cholesterol (HDL).  The end result is rapid plaque build up within our heart.  The CDC estimates that trans fat causes up to 20,000 heart attacks and 7,000 unnecessary heart deaths each year in the U.S.

Why Does the Food Industry Like Trans Fat?

Why do food manufacturers still insist on putting this fat into their products?  The answer is because it gives fake food products a shelf life that just may be longer than your own life.

In addition to a long shelf life, some claim that trans fat makes things “taste better.” Lastly, when frying with trans fat, you can re-use the oil over and over.

Trans Fat in Meat and Dairy

It might surprise you to learn that trans fat is also found in meat and dairy.  Grass fed animals may even have more trans fat than grain fed animals.

I should note that the chemical structure of naturally occurring trans fat is different from that of the man-made variety we have discussed thus far in this article.  Fortunately, the natural forms of trans fat don’t seem to present the same cardiovascular risks.  To stay on the safe side, it may be wise to eat leaner cuts of animal meat.

Why Are Cholesterol Levels Falling?

Something strange is happening in the U.S.  Despite the fact that we are gaining more and more weight, our cholesterol numbers keep dropping.  The pharmaceutical industry would like us to believe that this is due to the cholesterol lowering, “statin” drug, prescriptions being written.

Personally, I believe it is because we have been gradually phasing trans fat out of our diet.  As mentioned, trans fat raises our bad cholesterol (LDL) and lowers our good cholesterol (HDL).

Since the FDA loosely required food manufacturers to report trans fat in 2003, we have reduced our consumption of this fat by 78%.  Interestingly, over this same period of time, the number of people with high cholesterol in the U.S. has dropped by 27%.

Heart Stent and Bypass Surgeries Are Falling

Not only have our cholesterol levels dropped but the number of heart stent procedures has declined by 28% and cardiac bypass surgeries have gone down by 46% during this same period of time.  I suspect that much of this decrease has occurred due to the gradual elimination of trans fat from our diets.

The 7 Most Dangerous Foods for Your Heart

1. Pastries

As if the sugar and refined grains were not dangerous for your heart, the trans fat in many commercially prepared pastries delivers the triple hit to your heart.  Never eat cookies, cakes, donuts, or pies without first checking the label to see if there are partially hydrogenated oils.

Commercially prepared frosting and refrigerated dough can also be high in trans fat.  Even breads or crackers may contain trans fat.

If you want to have a pastry, try making a healthier version at home without all of the sugar, refined grains, or trans fat.  For suggestions on healthier options, please review the many recipes my wife has posted on our website.

2. Margarine and Shortening

Margarine was the poster child for trans fat a generation ago.  Shortening is another common source of trans fat.  Fortunately, Crisco has recently eliminated trans fat.

If you want to use a healthier oil, try using olive oil or coconut oil.  There are many healthier options than margarine or shortening.

3. French Fries and Fried Foods

French fries and fried foods are often fried in trans fat.  If you love French fries, try baking your own at home with a little bit of olive oil and sea salt.  Homemade sweet potato fries can be especially healthy.

4. Chips

Potato chips and other chips often contain trans fat. If you like the taste of chips, consider switching to kale chips.  Better yet, make your own kale chips at home with some olive oil and sea salt.

5. Candy

Candy can be another source of trans fat.  If you love your sweets, like me, consider switching to dark chocolate instead.  With regards to health, the darker the chocolate the better.  Dark chocolate has much less added sugar than milk chocolate.

6. Frozen Pizzas

Frozen pizzas are yet another source of hidden trans fat and other heart unfriendly ingredients.  Consider making your own pizza.  It is surprisingly easier than you think.  You can even include almond flour and coconut flour into your homemade pizza dough recipe.

7. Popcorn

Microwave popcorn often contains trans fat.  Movie theater popcorn is no better.  If you love popcorn you can still eat it–just try the air pop variety at home.

Bringing It Home

The key message is that trans fat is still in our food supply and there is no safe amount you can eat.  If you buy processed or prepared foods, you must ensure that partially hydrogenated oil or shortening is not listed anywhere on the ingredient list.

If you like to eat out, ask the manager, or your server, what types of oils are used.

Was it hard for you to eliminate trans fat from your diet?

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5 Reasons Why You Shouldn’t Count Calories

The Chinese don’t calories.  Could counting calories actually cause weight gain?

Recent medical studies have shown that a calorie is not a calorie.  In this article I review the science on calories and share with you 5 reasons why you shouldn’t count calories.  I will also teach you how to “hack” unwanted body fat without feeling hungry.

I Grew Up Counting Calories

Calories were counted in my home growing up. I quickly learned what a calorie was and how to read labels.

I was excited to learn that one serving of Fruit Loops had just 110 calories.  Like most people, I had no idea how little a one cup serving size really was.  Because there were so few calories in one serving, I thought I was OK eating half the box.

Strangely, even after so many calories at breakfast, I could never seem to make it to lunch time until I was famished again.  On the other hand, I made the observation that if I just had a few tablespoons of peanut butter (each tablespoon has 100 calories) for breakfast that I could easily make it to lunch without getting hungry.

Calorie Didn’t Exist in Chinese

At the age of 19 I lived among the Chinese immigrant community in New York City as part of a volunteer church missionary assignment.  When I tried to discuss “calories” with recent immigrants, they just gave me a blank stare.

Let me explain, the word for calorie in Chinese, kaluli, is a loan word.  In other words, the sounds were borrowed from English as the word didn’t previously exist in Chinese.

Thus, not only do the Chinese not count calories, they didn’t even have a way to discuss calories before English loan words invaded their culture.  Could there be wisdom in not counting or discussing calories?

The Science of Calories

The definition of a calorie is the amount of energy required to raise one gram of water by one degree celsius.  While this works in a test tube, it simply does not work that way in our body.

Food is information for our genes.  Food affects our hormones.  Food either turns up or down our metabolism.

It is the “effective” calories that matter.  The problem is that everyone’s effective calories from food is different.  Thus, the calorie label on food is not reliable.  A calorie is not a calorie.

Real Fruit vs. Energy Bars

The conventional wisdom is that a “calorie is a calorie.” If conventional wisdom is correct then it shouldn’t matter how you get your calories, right?

In a fascinating study, researchers in Brazil gave overweight women one of three different food supplements in their diet.  Study participants were told to eat this food supplement three times a day.  These food supplements consistent of an apple, pear, or an oat “energy bar.”  Each food supplement had the same number of calories.

To better understand the effects of these food supplements, under the direction of a nutritionist each participant’s diet was the same–15% protein, 30% fat, and 55% carbohydrates.

If a calorie really is a calorie then you would expect that everyone’s weight should be the same at the end of the study, correct?  At the end of the 3 month study, participants assigned to fruit for their food supplement lost approximately 3 pounds whereas the participants assigned to the oat energy bars did not any weight loss.

Good vs. Bad Foods

Most people believe that weight loss is simply a function of calories in minus calories out.  Surprisingly, that is exactly what researchers did not see in this landmark study published in the most prestigious medical journal, the New England Journal of Medicine.

In this study, led by my former Stanford University classmate, Dr. Dariush Mozaffarian, they followed 120,877 well educated health professionals for 20 years.  These people were healthy and were not obese at the beginning of the study.

Overall, most people gained 20 pounds, or one pound per year, over the course of the study.  However, there were medical outliers.

For example, people whose diets consisted of fruits, vegetables, nuts, whole grains, or yogurt either lost or maintained their weight over 20 years.  In contrast, people whose diets consisted of refined grains, sugary drinks, fruit juice, fried foods, processed meats, red meat, deserts, potato chips, or butter all gained weight over 20 years.  Interestingly, milk and cheese did not seem to have a significant impact on long-term weight gain.

If a calorie is really a calorie then how do you explain why certain foods caused weight gain and other foods caused weight loss?  Clearly, what happens in a test tube and what happens in real life are really two completely different things.

Foods Determine Metabolism

To further drive home the point that a calorie is not a calorie, in this interesting study researchers demonstrated that what you eat can determine your body’s metabolic set point.  In this study, Harvard researchers enrolled young overweight adults and tried them on three different diets.  These three diets included a low fat diet, low glycemic diet, and a low carb diet.

On each diet they burned the same amount of calories and ate the same amount of calories.  Interestingly, metabolism was highest for the low carb and low glycemic diets and lowest for the low fat diet.  Not surprisingly, the hunger hormones were the lowest for the low carb and low glycemic diet and highest for the low fat diet.

The low carb diet did come at a cost.  The low carb diet had the highest levels of inflammation and stress hormones.  Given these findings, the low glycemic diet might be the best.

Food is information for your DNA.  What you eat turns on or off different genes and hormones.  Your metabolism is also turned up or down based on what you eat.

5 Reasons Why You Shouldn’t Count Calories

Now that I have hopefully convinced you that a calorie is not a calorie, let me give you 5 reasons why you shouldn’t count calories.

1. You May Eat More

You would think that people who count their calories would eat less.  The problem is that we either make mistakes or are not honest with ourselves.  For example, in a classic study, people underestimated their daily calories by 47%!

It is true that for some people counting calories can bring mindfulness of what you are actually eating.  For these people, I would recommend tracking your nutrition with a handheld device rather than count calories.  If you do want to count calories, from personal experience, I would recommend either lowering your daily caloric intake target or overestimating your calories to prevent weight gain with this approach.

I know that for me, tracking nutrition was especially helpful in teaching me to eat more mindfully and to maintain my weight loss.  Like so many people, I often don’t get the internal cues that I am full.  As a result, if I don’t track my nutrition with the LoseIt app, I will probably overeat.

2. Gut Flora Determines Calories Absorbed

Even though you may be diligently counting your calories, studies show that the bacteria in your gut may have the final say on whether you absorb all or just part of your calories.  Perhaps the key to weight loss is not restricting calories but rather promoting the gut flora that will cause you to loose weight like fermented foods and fiber.

3. Processing and Cooking Unlock Calories

In general, the more prepared food is the more calories you will store as fat.  If you want to gain weight then eat a lot of processed foods and cook everything you eat well.

For example, studies show that cooking food unlocks more calories than raw foods.  The same thing is true when it comes to grains.  Studies show that refined grains cause weight gain whereas whole grains cause weight loss.

Perhaps this explains why people lose weight with nuts.  Studies show that nuts have much less “effective calories” than what you would predict because they require so much effort to digest.

4. Metabolism Trumps Calories

While one cup of fruit loops and one tablespoon of peanut butter have the same number of calories, the fruit loops will slow your metabolism and the peanut butter will speed things up.  Thus, the effective calories of a cup of fruit loops is far more than a tablespoon of peanut butter.

In general, refined grains and sugar slow metabolism.  Protein speeds up metabolism.  Fiber not only promotes the weight loss bacteria in your gut but also speeds up metabolism.  Even capsaicin may rev up your metabolism.

The time of the day you eat also affects metabolism.  Erratic eating patterns slow metabolism whereas regularly timed meals speed up metabolism.

There are also many other factors in metabolism.  For example, muscle mass and exercise speed up metabolism.  Consuming a lot of water also speeds up metabolism.

Even things like altitude and air temperature affect metabolism.  Studies show that high altitudes increase metabolism.  Metabolism is also increased when it is cold or hot.  Room temperature seems to slow metabolism.

5. Hunger Hormones Determine Intake

While you might like to think that you can control your food intake by counting calories, at the end of the day your hunger hormones decide when and how much you eat.  What you eat and your lifestyle can determine whether these hunger hormones are working for you or against you.

For example, as discussed from the study above, low fat diets activate hunger hormones whereas low glycemic and low carb diets turn hunger hormones off.  High stress levels and sleep deprivation also dramatically turn on hunger hormones as I discussed in a previous article.

Are You Still Counting Calories?

A calorie is simply not a calorie.  Weight loss is not a function of calories in versus calories out.  It is far more complex.  Calorie counters often undercount and end up eating more.

Food is information for our DNA.  What we eat determines if our gut bacteria even allow us to absorb the calories or not. Processed and prepared foods favor calorie absorption and raw foods make it hard to absorb calories.  Metabolism sets your burn rate and hunger hormones dictate how much you eat.

If your goal is weight loss you have to learn how to “hack your weight.”  When did you stop counting calories?

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5 Reasons To Get Off Acid Reducing Meds

Worldwide headlines reported that the popular acid reducing medications, such as Prevacid (iansoprazole), Prilosec (omeprazole), and Nexium double your risk of dying from a heart condition.  What should you do if you are part of the 60% of Americans who has heart burn, or acid reflux symptoms, each year?

What is worse, acid reflux or a heart attack?

In this article, I will share 5 reasons to get off acid reducing meds.  I will also give you 5 natural strategies to prevent acid reflux in the first place so that you will never miss these medications.

Acid Reducing Medications and Heart Attacks

As a cardiologist, I see a lot of patients on acid reducing medications.  In my experience, most of the patients I see with chest pain have chest pain due to acid reflux.

The study which got the world talking about the dangers of proton pump inhibitors (Prevacid (iansoprazole), Prilosec (omeprazole), and Nexium) came from Stanford University.  In this study, researchers reviewed the records of 2.9 million Americans taking these medications.

Dr. Nigam H. Shah and colleagues found that people taking these acid reducing medications were twice as likely to die from heart related conditions.  Interestingly, if people took the older acid reducing medications, such as Tagamet (cimetidine), Zantac (ranitidine), Pepcid (famotidine), or Axid (nizatidine) they did not see this risk.

There are many possible reasons why proton pump inhibitors may cause heart attacks. For example, these medications are known to alter gut bacteria.  These medications also block the absorption of key nutrients like, magnesium and vitamin B12, which are critically important for heart health.  In addition, these medications may increase the risk of blood clots.

If you are on a proton pump inhibitor, don’t panic.  This study was not confirmatory and there are certainly many limitations of this study.  For example, the people included in this study tended to have more chronic medical conditions.

Also, this was an observational study.  Just because proton pump inhibitors are associated with dying from heart disease does not mean that the proton pump inhibitors caused their deaths.

I Was Once Dependent on Prilosec (Omeprazole)

Yes, it is true.  I used to buy the large Costco pack of Prilosec (omeprazole).  I could not survive without this medication.  Sometimes my chest would hurt so much I had to take Aleve with my Prilosec.

Interestingly, after I completely changed my lifestyle several years ago, my acid reflux seemed to have mysteriously gone away.  In fact, I can’t remember the last time I had acid reflux.

I’m not sure the exact reason why my acid reflux resolved.  It probably had something to do with eliminating dairy (I have a dairy food allergy), losing weight, and eliminating most processed foods from my diet.

Acid Reflux Is Rarely Seen In The Developing World

In 2010, Americans spent 14 billion dollars on medications like Prevacid (iansoprazole), Prilosec (omeprazole), and Nexium.  Each year more and more Americans are getting heart burn symptoms.

Historically, heart burn symptoms were rarely seen in the developing world.  For example, in a review of 36 published studies, the risk of having acid reflux symptoms in China was less than 5% in any given week.  The risk of acid reflux is also extremely low in Africa.

The fact that acid reflux is rarely seen in the developing world is reason for hope.  It suggests that there is something about the American lifestyle which contributes to this condition.  Based on these studies, if we can change our lifestyles then most people can avoid acid reflux.

5 Reasons To Get Off Acid Reducing Meds

Proton pump inhibitors, or PPIs, such as Prevacid (iansoprazole), Prilosec (omeprazole), and Nexium) were never meant to be taken long term.  The problem, is that so many people become “addicted” to PPIs.  While these medications are effective in reducing symptoms from acid reflux, the long term consequences of these medications may far outweigh any potential short term benefits.

PPIs can be very helpful for short term episodes of severe acid reflux.  Indeed, the 5 reasons I list to get off acid reducing medications all tend to occur with long-term use.

Please note that I am not recommending that you stop these medications on your own.  This is a shared decision you have to make with your physician after carefully weighing the risks and benefits of these medications.  This shared decision should also take into account that most people can control heart burn symptoms with simple lifestyle changes.  Also, these risks may not apply to the older acid reducing medications such as Tagamet (cimetidine), Zantac (ranitidine), Pepcid (famotidine), or Axid (nizatidine).

1. To Prevent Heart Disease

As discussed above, proton pump inhibitors (PPIs) such as Prevacid (iansoprazole), Prilosec (omeprazole), and Nexium may double your risk of dying from a heart condition.

2. To Prevent Dementia

Proton pump inhibitors (PPIs) block the absorption of vitamin B12 in the gut.  Vitamin B12 is critical to keep homocysteine levels low.  When homocysteine levels are high, dementia, strokes, and heart attacks are much more common.

3. To Prevent Fractures

In addition to blocking the absorption of vitamin B12, PPIs may also block calcium absorption.  Thus, people taking these acid reducing medications long-term are at a 78% higher risk of breaking their hips.

4. To Prevent Anemia

PPIs are well known to block iron absorption.  If your iron levels are too low you may become anemic.  This is especially dangerous for menstruating women as they already tend to be low in iron.

5. To Prevent Magnesium Deficiency

Fully 60% of Americans are deficient in magnesium.  This problem is magnified in people taking PPIs.  Magnesium is critical for proper heart function and to prevent DNA mutations which could cause cancer.  To learn more about the symptoms of magnesium deficiency, please read this article I wrote.

Do PPIs Prevent Esophageal Cancer?

One reason why your physician may put you on a PPI is to prevent the potential risk of acid reflux causing cancer of the esophagus.  While Prevacid (iansoprazole), Prilosec (omeprazole), and Nexium certainly block acid production in the stomach, it is unclear how much benefit there may actually may be when it comes to preventing esophageal cancer.

It is interesting to note that even though 119 million prescriptions are written every year in the U.S. for PPIs, esophageal adenocarcinoma has increased more than 350% since the mid-1970s!  Once again, do not stop PPIs on your own as your physician may be using this medication to prevent cancer of the esophagus for you.

6 Ways to Prevent Acid Reflux Without Meds

1. Avoid Your Food Triggers

Food allergies can be a big cause of acid reflux.  I know that was the case with me.  Eliminating dairy helped me tremendously with symptoms of acid reflux.  Another common cause of acid reflux is gluten sensitivity.

Outside of food allergies, the main triggers of acid reflux are pizza, soda pop, alcohol, chocolate, fried foods, fatty meats, citrus fruits, tomatoes, or spicy foods.  The key is to figure out your own triggers.  While I listed the most common culprits, your triggers may be different.

2. Keep Your BMI Below 25

Our Western Diet and our expanding waist lines are the primary reason why the U.S. is the acid reflux capital of the world.  Interestingly, we don’t even know when we are overweight anymore.  For example, in a recent study, 78% of parents of obese children thought their child was at a normal weight.

I see this in my cardiology practice as well.  Many of my patients have no idea what their ideal weight is.  Here is a BMI calculator to see if you are overweight.  The goal is to keep your BMI below 25 to help with acid reflux.

3. Eat Early and Light Dinners

The bigger your meal the more likely you will have heart burn.  Also, eating before bed is a recipe for acid reflux.  As soon as you lie down, and gravity no longer keeps your stomach acid in your stomach, you may start to feel the heart burn.

In fact, I routinely tell my patients to stop eating after 7 pm for a variety of reasons.  According to studies, eating late at night may also cause weight gain, strokes, and heart attacks.

4. Review Your Medications with Your Doctor

Many medications can cause acid reflux.  The most common medications to cause heart burn include the following: calcium channel blockers, antibiotics, anti-inflammatory medications, bisphosphonates, pain medications, and sedatives.  It is critical to always review your medication list with your doctor as you may be taking a medication you may no longer need.

5. Don’t Constrict Your Stomach

Wearing tight clothes can be a mechanical cause of acid reflux.  If you suffer from frequent heart burn, see if loose fitting clothing helps.

6. Consider an Older Acid Reducing Medication

If you absolutely must take an acid reducing medication long-term, you could talk with your doctor about whether one of the older medications, such as Tagamet (cimetidine), Zantac (ranitidine), Pepcid (famotidine), or Axid (nizatidine), might be safer for you.

Do you take acid reducing medications?  Is there anything you have found which helps to prevent acid reflux?

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Do you even want to live to 90?

Most people think that living to 90 means living in a nursing home.  Would you want to live to 90 if you were in great health and could do everything you wanted to do?  In this article, I’m going to share the seven things you must do for great health at 90 and beyond.

Will you live to age 90?

Odds are that you will be medically disabled by age 69 according to data from the World Health Organization.  As the current life expectancy is now 79 in the U.S., this means that you will likely spend the last 10 years of your life with chronic medical conditions, on lots of medications, and with many doctor visits.  Is this really how you want to spend your “golden years?”

Research shows that if you can do all 7 things discussed in this article, you can escape this fate.  Don’t leave 21 high quality years “on the table.”  Read on to understand the science of how our bodies were genetically designed to function well until age 90.

Our Distorted Concept of Aging

Many people are afraid of a long life.  Some even have the mistaken idea that the reason why they make poor lifestyle choices is because they don’t want to live very long.  What they don’t realize is that these poor lifestyle choices are much more likely to cause premature medical disabilities rather than a premature death.

Sadly, I often hear the following from patients.  “If I had known I was going to live this long I would have taken better care of myself.”

The key message of this article is that you don’t have to “grow old” in the traditional sense of the word.  You can continue to do everything you now enjoy doing and enjoy great health at 90.  For most people, your genes allow you to enjoy great health at 90 if you are committed to maintaining a healthy lifestyle.

Men vs. Women and Longevity

In general, men get sick and die much younger than women.  This is why almost every centenarian population on this planet is mostly made up of women.  So why are men cursed to die early?

This is a question that has baffled scientists for years.   Of the many theories out there, the most likely are that women tend to be more health conscientious and are more connected socially.

Is there any hope for men to live longer?  The one exception to the female centenarian rule seems to be the “Sardinian men.”

Surprisingly, on the island of Sardinia in the Mediterranean, most of the centenarians are men.  The healthy, low-stress, agrarian lifestyle allows the Sardinian mean to easily make it to 100.

But what about in the U.S.?  Do men stand a chance of great health at 90?

Despite the grim odds for men, there is one group that does remarkably well in the U.S.  This one group of men that seem to thrive are male physicians.  What can we learn from these long lived male physicians that can help all of us enjoy great health at 90?

Of course, if you are a woman then your chances of great health at 90 are even better if you follow the same playbook I am going to share…

The Physician’s Study

The Physician’s Health Study was launched in 1982 at Harvard University to test the role of aspirin and beta-carotene in preventing cardiovascular disease and cancer.  Now, 36 years later, we have learned far more than the health effects of aspirin and beta-carotene.

Surprisingly, many of these male physicians have lived healthy lives, doing everything they have always enjoyed, until their 90th birthday and beyond.  Indeed, researchers found that if these physicians did all seven things described in this article, most of them had great health at 90.

I should point out that if a male physician even missed just one of the following things, then they probably wouldn’t make it to 90.  Below are the 7 things you must do for great health at 90.

7 Things You Must Do For Great Health at 90

1. Don’t Smoke

Every cigarette smoked takes 11 minutes off your life.   This adds up to dying 10 years too early.  It also causes rapid aging and premature medical disability.  Indeed, for physicians to make it to age 90 with excellent health meant absolutely no smoking.

If you smoke it is never too late to change.  The sooner you can quit the sooner you can gain back these lost years of quality life.

If breathing tobacco air isn’t a problem for you, then make sure air pollution levels are as low as possible.  While it is often impossible to do much to impact the air in your city, you can at least get a HEPA filter to help with your indoor air.  This is what we have done in our home.

2. Prevent or Reverse Diabetes

Diabetes is a tragic disease causing premature medical disability and death.  In one study, diabetes took away up to 9 years of life and caused people to become medically disabled 20 years earlier.

According to a study performed by my former classmate, Harvard researcher Dr. Dariush Mozaffarian, 90% of diabetes is completely preventable.  Even if it is genetically impossible to reverse your diabetes, do everything possible to keep your hemoglobin A1C in the normal range or at least as close to the normal range as possible.

The best thing I have seen in my practice to normalize hemoglobin A1C levels it to keep your weight in the normal range and eliminate all sugar and flour of any kind from your diet.

3. Keep Your Blood Pressure in Check

High blood pressure not only wears out your heart but also your arteries and other organs.  The goal blood pressure for longevity is 110/70 mmHg.  Anything above 110/70 is prematurely aging the body.  Indeed, studies show that people with high blood pressure lose 5 years of high quality life to heart attacks and other heart problems.

As with diabetes, I have seen hundreds of my patients reverse their high blood pressure and get off of medications with an unwavering commitment to a healthy lifestyle.  To learn more about how to reverse high blood pressure without medications, please read this article I wrote.

4. Physically Active

Studies show that every hour spent sitting watching TV takes 22 minutes off your life.  This could be any form of sitting.

The physicians with great health at 90 were definitely physically active.  Exercise was a daily habit for them. At the cellular level, studies show that if we spend too much time sitting then we give up 10 years of life.

A recently published study showed that being very physically fit can decrease your risk of dementia by 88%!  This study highlights the importance of physical fitness for great health at 90.

5. Maintain a Lean Body Weight

These physicians with great health at 90 were not overweight.  They were a lean group.  The average body mass index (BMI) of these physicians was 24.

A BMI of 25 or higher is considered overweight.  To determine your own BMI, click on this link.

Studies show that carrying around extra weight will rob you of up to 9 years of life.  Like diabetes, it can cause you to become medically disabled 20 years before your time.

6. College Education

When reviewing the findings of the Physician’s Health Study, it is important to note that this was a very homogenous group.  They were all physicians.  Thus, we also have to understand what makes a physician a physician.

To begin with, to become a physician means you have to go to school for a long time.  Countless studies have shown that the more education you achieve the more likely you are to avoid medical disabilities and live a long life.

According to this 2011 report from the Centers for Disease Control (CDC), people did not finish high school gave up 9 years of life.  Even those who may have attended college, but did not finish their degree, lost out on 5 years of life.

If you did not go to college, or did not finish your degree, it is never too late.  Most colleges offer night courses or online courses to help you get your degree.  Spending the time now to get your degree may also help you to avoid Alzheimer’s Disease later in life.

7. Calling in Life

Most physicians I know feel that being a physician is their calling in life.  There is no separation between work and personal life.  It is all one life.

As a physician, you are driven by your desire to help other people.  This calling in life, or sense of purpose, has been shown to improve health and longevity.

Based on my calculations of studies done, those without a strong sense of purpose give up 4 years of life.  People without a perceived calling in life are also at increased risk of developing Alzheimer’s Disease at a young age.

If you don’t yet have a purpose or mission driving your life, now is the time for you to explore why you are on this Earth.  What legacy do you want to leave?  What gets you out of bed each morning?

Surprising Factors Not Associated with Longevity in this Study

Interestingly, there were certain factors not associated with health and longevity in physicians.  The following were not shown to improve the health and longevity of physicians in the Physician’s Health Study:

1. Social connection

2. Wine consumption

3. Cholesterol numbers

Social Connectivity and Longevity

Of these, the most surprising to me was that social connection was not a predictor of health and longevity in physicians.  This finding goes against other studies.

My guess is that physicians really are socially connected and that these researchers just didn’t ask the right questions.  For example, every time I go to church or a social event, at least several neighbors come up to me asking for medical advice.  As neighbors reach out to me in this way I feel much more socially connected as a naturally introverted person.

If you aren’t a physician all is not lost.  Reach out to others.  Don’t worry if you feel shy or awkward as the rest of the world also feels shy and awkward.  Others will be grateful that you have reached out.

Cholesterol, Alcohol, and Longevity

Also of interest in this study was that as you get older cholesterol numbers don’t seem to matter as much.  While this may seem odd, many other studies have also come to the same conclusion.

Lastly, alcohol and longevity is a question that comes up all the time when I give lectures on our book, The Longevity Plan.  While earlier studies reported that alcohol may help to prevent heart disease and promote longevity, more recent studies report that these earlier studies may have been flawed.

The reason for this is that early studies of alcohol and longevity failed to account for the abstainer bias.  In other words, people who refrain from alcohol may have other health conditions that don’t allow them to drink.  When you account for the abstainer bias then any protective effect from alcohol goes away.

It Isn’t Just Physicians Who Make It To 90

You don’t have to be a physician to enjoy great health at 90.  With strict adherence to a healthy lifestyle, studies show that most Seventh Day Adventists, Mormons, and Okinawans also enjoy great health at 90.

Making It Work For You

The key message of the Physician’s Health Study is that aging does not need to mean medical disabilities, lots of medications, and frequent visits to the doctor.  You can continue to enjoy excellent health to age 90 and possibly beyond.

Your genes are programmed to allow for great health at 90.  Unless bad luck strikes, healthy decisions now means great health at 90.

Are unhealthy lifestyle choices worth becoming medically disabled 20 years younger?

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What Kind of Healthy Eater Are You?

“Eating healthy is hard,” Julie said at her last clinic visit.

“I know,” I replied.  With junk food around us all the time it can be incredibly difficult to navigate healthy food choices.

In the famous Chinese book, The Art of War  from the 6th century B.C., Sunzi states the following:

“If you know yourself and your enemies, you can win 100 battles without a single loss.”

知彼知己，百戰不殆

Zhi bu zhi ji, bai zhan bu dai

How true this is when it comes to healthy eating.  You must know your strengths if you want any chance of winning this battle.

To help you know your healthy eating type, take the quiz in this article.

Focus on Your Strengths

Fully 108 million Americans are on a diet!  Of these 108 million dieting Americans, studies show that up to 106 million of them will fail!  Why do 98% of all diets fail?

One reason why diets don’t work is because diets force people to focus on their weaknesses, namely limit calories.  If people better understand their healthy eating type, then they can focus on their strengths.

According to the Gallup organization, if we focus on our strengths we are six times more likely to succeed.  The same is true with healthy eating.  We must focus on our strengths to be successful.

In working with my patients, I have identified three main areas of healthy eating strengths.  To help you find your “healthy eating strengths,” take the quiz below.

Are You A Restrictor?

1. I like having a list of the foods I can and cannot eat. Yes/No

2. I can resist restricted foods. Yes/No

3. I do best when food temptations are out of sight. Yes/No

4. I don’t feel deprived of unhealthy foods. Yes/No

Are You A Moderator?

1. Moderation in all things is healthy. Yes/No

2. I can make a box of cookies or a bag of chips last for weeks, even months.  Yes/No

3. I don’t obsess over food.  Yes/No

4. I don’t have any food addictions. Yes/No

Are You A Replacer?

1. I love healthy versions of my favorite foods.  Yes/No

2. Knowing that there are healthy ingredients makes food taste better.  Yes/No

3. I like foods that look like what I have always eaten.  Yes/No

4. I like to modify recipes at home or the menu at restaurants. Yes/No

What is Your Healthy Eating Strength?

To determine your healthy eating type, add up the number of times you responded “Yes” in each category.  If you reported “yes” at least two or more times then this is a healthy eating strength for you.  You may find that you have more than one healthy eating strength.

Strength: Restrictor

Congratulations if you are a restrictor.  You draw strength from a list of foods to eat and avoid.  To you there are good foods and bad foods.  You make a decision once and then you never have to decide again.

Restrictors may be motivated by a strong sense of purpose when it comes to healthy eating.  They may even have suffered from a previous health crisis.  Many have a strong family history of cancer, heart disease or dementia and they want to do everything possible to maintain their health for their families.

For example, a restrictor who is trying to eat healthy will either completely cut pizza out of their diet or decide that the only pizza they can eat is a healthy homemade pizza.  To stay strong, restrictors may not even go anywhere near where the traditional American pizza is served.

Successful restrictors like to keep temptations out of sight.  They pack a healthy lunch from home so that they are not tempted to go out for lunch.  They also always have healthy snacks on hand to avoid the temptation of a vending machine.  At home, successful restrictors have completely purged their homes of any junk food.  This way they are never tempted.

When invited to a friend’s house, where healthy food options may be limited, restrictors may eat something before they leave to help them resist unhealthy food temptations.  Many restrictors I know can actually visualize what unhealthy foods are physically doing to their bodies.  To them, every bite counts.  Every bite they take is a step closer or away from health and wellness.

Successful restrictors find enough strength through their purpose or healthy eating to help them avoid feelings of deprivation. They may even choose to log their daily nutrition in a hand-held app.

Strength: Moderator

Congratulations if you are a moderator.  You never have to feel deprived.  If you occasionally have a desert with friends you are fine with just a few bites.  Moderators are the best adjusted to the American way of life and thrive in food settings with all types of people.

For example, successful moderators tend to eat very healthy at home, however, when they are out with friends it is fine for them to have a slice or two of pizza.  They also don’t feel guilty about the slice of pizza with friends.

Moderators don’t need to record their nutritional intake on a hand-held app.  They tend to listen to their bodies which means they generally eat very healthy and stop when their bodies are full.  They don’t overeat and they don’t binge.  Successful moderators practice mindful eating habits.

Strength: Replacer

Congratulations if you are a replacer.  I have found that most people trying to eat healthy can be classified as “replacers.”  Replacers look for healthier options of everything.

For example, a replacer would never give up pizza.  Rather, they would make their own healthy homemade pizza with almond or coconut flour, fresh tomatoes, olive oil, garlic, and plenty of veggies on top.  Because it is healthy they feel free to eat as much as they need.

Replacers are always looking at how to “hack” any recipe into a healthy version.  They like to experiment in the kitchen or shop at health food stores.  They also enjoy food conversations with other replacers as they creatively come up with healthier versions of the foods they love.

Successful replacers can always find something healthy at any restaurant.  The salad dressing is always on the side and it is generally olive oil and balsamic vinegar.  They generally ask for raw vegetables instead of the pre-meal bread and steamed veggies instead of the fries.  They may also choose a lettuce rap for their sandwich instead of the white bread bun.

A replacer prefers kale chips to potato chips and dark chocolate covered almonds over chocolate cake.  They may even try to use ripe bananas instead of sugar in a recipe.

The Challenges of Restrictors and Replacers

While moderators thrive in all food situations, restrictors and replacers face unique challenges when not surrounded by other health conscientious people.  Surprisingly, I have found that food is far more divisive than even politics or religion.

Many people, if they are honest, have underlying food addictions.  As a result, there is a chance that they may become quite defensive if others are trying to make healthier food choices.  For this reason, when restrictors and replacers eat with people on the Standard American Diet (SAD), they need to be exceedingly careful not to appear judgmental.

As a standard practice, it is best for restrictors and replacers to not discuss food with family or friends unless asked.  Lead by example. People, unfortunately, are very sensitive when it comes to food.

My Healthy Eating Strength

I am both a restrictor and a replacer depending on the situation.  I am driven to eat as healthy as possible because of my previous health challenges and to suppress the many serious disease causing genes that I have.

I also cannot moderate.  For me it is the whole bag of cookies or no cookies.  For this reason, when it comes to cookies, I am a restrictor.

In other situations I am a replacer.  For example, if I want a slice of bread with my nut butter, the only bread I generally eat is Ezekiel bread.  Ezekiel bread has no flour and is very low glycemic.  While I could easily down a whole loaf of bread at a restaurant, it is impossible for me to overeat on Ezekiel bread.  There just is no sugar rush or addictive qualities in Ezekiel bread.

My wife, Jane, has found herself with tendencies in each of these categories at various times in her life.  Currently, she has tendencies toward both a moderator and a replacer.  While she prefers not to buy or make a traditional cake, she can go to a kid’s birthday party and be satisfied with one or two bites of cake.

Jane also loves experimenting with healthier versions of her favorite foods.  For example, on our website you will find chocolate chip cookies made with white beans, and mac-n-cheese made with cauliflower.  You may also see other healthy versions of the foods you have always loved.

Making it Work for You

Let’s face it, eating healthy is hard.  I know it is a struggle for me every day.  They key is to focus on your strengths rather than your food weaknesses.  Understand your healthy eating type and then structure your environment to help you capitalize on your strengths.

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The 9 Best Ways Saunas Help Your Heart

Diet and exercise can be a hard road for many people trying to protect their hearts.  Based on new science, saunas may be the easiest heart-healthy habit anyone can adopt.  In this article, I’ll review the science and share the nine best ways saunas help your heart that you probably didn’t know about.

My Sauna History

I was not a big fan of saunas.  I always preferred the steam shower or the hot tub to the sauna.

In my youth, I tried the sauna a few times at the local gym.  At that time, it seemed like the sauna was always dominated by older men, wrapped in towels, who read the newspaper in silence.  There definitely was an awkward silence in the sauna at the gym.

As a result, I haven’t been back to a sauna in more than 30 years.  With an ever-increasing number of medical studies advocating the health benefits, I’m starting to wonder if we should put one in our home.

The Sauna Culture in Finland

In contrast, saunas are everywhere in Finland.  Saunas get them through the long and cold winters.  Not only do saunas get them through the winter but saunas may also be one reason why the life expectancy in Finland, without any natural vitamin D for most of the year, has a much longer life-expectancy than what we have in the U.S.

The sauna culture in Finland is also much different than that of a typical U.S. gym.  It is a social event.  Many homes have a sauna.  Families, friends, and neighbors take saunas together.  Rather than the silent sauna experience, these saunas are often lively and fun.

The Finnish Sauna Study

In this study, researchers followed 2,315 middle-age Finnish men (age 42-60) for an average of 20.7 years to see if regular sauna use prevented heart disease and extended life.  Even after controlling for the other cardiac risk factors, the risk of sudden cardiac death was  52% lower in the near-daily sauna users when compared to those who rarely used the sauna.  Also, total mortality was also reduced by 17% in the frequent sauna users.

I should point out that these Finnish saunas are not for the faint of heart.  It is an intense dry heat at temperatures much higher than what we use for saunas in the U.S.  Thus, the results of this study may not apply to the typical U.S. sauna, steam rooms, or hot tubs.

The 9 Best Ways Saunas Help Your Heart

There are many possible ways that saunas help your heart.  Here are nine of them:

1. Stress Reduction

It is hard to take your stress into the sauna.  Saunas offer a great way for both physical and mental relaxation.  As we have discussed in many previous articles, stress is one of the biggest factors in heart disease.

2. Social Connection

Connecting socially with friends and families may be the secret to a long and healthy life.  Indeed, studies have shown that social connection may be the most important factor in cardiac health and longevity.

3. Saunas Mimic Exercise

Daily exercise is one of the most important things you can do for your heart.  Saunas have to be the simplest way to “exercise.”

Both exercise and saunas result in “heat training” to the body.  Indeed, with sauna therapy, you can often see a marked heart rate response.  A heart rate of 150 beats per minute is not unusual for many sauna users in Finland.

4. Saunas Lower Blood Pressure

The sauna’s heat dilates and relaxes blood vessels.  This results in significant blood pressure lowering.

Of all the ways you can protect your heart, blood pressure lowering is one of the best.  And this blood pressure lowering effect from the sauna can up to two hours.

5. Improved Exercise Tolerance

Saunas may benefit skeletal as well as cardiac muscle.  Indeed, studies have shown that heat training improves exercise tolerance and speeds muscle recovery after injury.

6. Better Glucose Control/Less Diabetes

Through the effect on skeletal muscles, saunas improve insulin sensitivity.  As your insulin sensitivity improves, glucose metabolism normalizes, and the risk of diabetes becomes a non-issue.

7. Improved Cognitive Function Through BDNF

Sauna use has also been shown to increase brain-derived neurotrophic factor (BDNF).  BDNF is like fertilizer for our brains.  Indeed, increased BDNF can improve cognitive function and memory.  To learn more about BDNF, please read my article on BDNF.

8. Improved Lung Function

For hundreds of years, Finnish doctors have recommended sauna use for patients suffering from lung conditions.  Indeed, some studies even suggest improved respiratory function with regular sauna use.

9. Longevity

As was seen with the Finnish sauna study discussed in this article, saunas and a longer lifespan go hand in hand.  This is likely due to increased expression of heat shock proteins and FOXO3 through heat training.

Heat shock proteins are specialized proteins that repair damaged proteins and waste protein accumulation in our bodies.  Chronic diseases, like cardiovascular disease and Alzheimer’s Disease, result in progressive protein degradation or accumulation.

Heat training, through exercise, also increases expression of heat shock proteins.  Also, centenarians tend to have increased expression of heat shock proteins as well.  We have found that the long-lived people in China’s Longevity Village also have increased expression of heat shock proteins.  Heat shock proteins are repair proteins that are required for a healthy and long life.

In addition to heat shock proteins, heat training and exercise also increases expression of the FOXO3 gene.  FOXO3 gene expression enhances DNA repair.  Once again, people with the highest levels of FOXO3 expression are the people most likely to live a long and healthy life to 100+.

The Risks of Saunas

Saunas are certainly not without risk.  A heart rate of 150 bpm in someone with a preexisting heart condition could trigger a heart attack.  Also, severe dehydration, combined with electrolyte depletion, could trigger a cardiac arrest.

If you want to enjoy the possible health benefits of saunas, it needs to be done wisely.  To begin with, it is always best to consult with your physician first.  Also, make sure you are well hydrated and that your electrolytes are tanked up prior to entering the sauna.  When first using the sauna make sure you limit your time in the sauna.

You also need to be very careful if you are on blood pressure medications.  The blood pressure lowering effect of saunas, in combination with blood pressure medications, could cause you to pass out.

Alcohol consumption has no place in the sauna. Indeed, based on a Swedish study, 71% of all sauna deaths involved alcohol.  It also may not be a bad idea to use the “buddy system” in the sauna as well.

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The Hidden Costs Of Being Busy

On December 14-16, 1970 at Princeton University researchers performed one of the most insightful studies on human behavior.  Researchers wanted to know if, in our busy lives, whether or not we would be the Good Samaritan to an unknown stranger who was dying.

To study this question, researchers recruited 67 seminary students.  They selected seminary students as these were university students studying to be pastors or priests, possibly the most caring people in society.

Students were told that they would be giving a 3-5 minute impromptu speech on the Parable of the Good Samaritan from the Bible.  Half of the students were told to take their time walking to the other end of the campus to give their speech (unhurried study group) and the other half were told that they were already late and had to hurry (“busy” study group).

Unknown to the students, a “dying” victim was placed in the alley they had to walk through on their way to give a talk on the Parable of the Good Samaritan.  What do you think happened?  Did these caring young seminary students stop to help the “dying” person laying in the alley?

Interestingly, only 10% of the busy seminary students stopped to help the “dying” victim.  Let me phrase this a different way, 90% of the “busy” seminary students, on their way to give a talk on the Parable of the Good Samaritan, were so busy that they consciously walked past a dying man laying in an alley.  Can being busy so distort our sense of humanity that we completely stop caring for others?

Fortunately, the unhurried students were more than six times more likely to stop and help the “dying” victim.  Do you ever feel like you have too many things to do each day?  Are you always hurrying?  What really are the hidden costs of being busy?

What Do Busy People Miss?

I used to wear the “I’m busy” badge of honor.  It seemed like a status symbol.  I felt important.

Unfortunately, I have found that when I am the busiest, I miss out on the most important things in life.  When I am busy I am not connecting with my family, I am not connecting with myself, and I am definitely not connecting with the spiritual aspect of my life.

Is there a health cost of being busy?

Time Urgency and Heart Attack Risk

Harvard researcher, Dr. Stephen R. Cole, sought to answer whether busyness, or a sense of time urgency, translated into any cardiac effects.  To answer this question, he studied 680 men living in the Boston area.

In this study, Dr. Cole found that regardless of people’s diets, exercise patterns, family history, or smoking status, the “busiest people,” or those with the strongest sense of time urgency, were more than four times more likely to have a heart attack than those who felt the least sense of time urgency.

The Most Important Thing In Life

As a cardiologist, I have taken care of many patients as they were dying from heart failure in the intensive care unit (ICU).  I have always found these “end of life discussions” are the most difficult and meaningful conversations to have with patients and their grieving families.

In my 20 years since graduating from Johns Hopkins Medical School in 1995, I have yet to meet a dying patient who shared with me that they wished they could have been busier in their lives.  Rather, deathbed patients have either felt joy on a life well-lived in the company many caring family members or have died alone in the ICU having lived a life of regret by not connecting with others.

In the end, how we measure our lives is really a function of how well we have connected with others.   Being too busy prevents us from connecting with others.  It prevents us from experiencing the true joys in life.  Busyness harms our health.  These are the hidden costs of being busy.

Four Ways to Stop Being So Busy

Are we trying to do too much?  Is our busyness preventing us from connecting with others and finding meaning in this life?  Let me share with you four strategies I have found helpful in treating the busyness disease.

1. Define What Is Most Important To You

Treating busyness does not mean we have to slow down.  Rather, it just means we must focus our efforts on that which is truly most important or essential.

This may mean redefining what success looks like in this life.  You may have to eliminate many important but not essential things in your life.

For the dying patients I have cared for in the ICU, a successful life looks a lot different than most of the busy people I know.  For dying patients, success is all about relationships and leaving a legacy not to-do lists.

A lack of time is a lack of priorities.  There is plenty of time, even for the seemingly most busy people, if they put first things first.

I have recently read two great books that have helped to put this in perspective for me.  These books are Essentialism by Greg McKeown and How Will You Measure Your Life by Clayton Christensen.

2. Manage Your To-Do List

I used to have a long to-do list everyday.  A list that I hopelessly never fully checked off.  This left me busy and stressed out each day until bedtime.

I have found that I do best when I limit myself to just 3 items on my to-do list each day.  In other words, in addition to seeing patients at the hospital each day, I can have no more than 3 items on my to-do list.  One of these 3 items is to connect with each person in my family, one on one, for at least 20 minutes each day.

While I am not always perfect, this strategy allows me to be both a minimalist and essentialist at the same time.  If my to-do list includes more than 3 items, I quickly find that I am too busy and disconnected from what really matters.  If spending 60 minutes of your precious time each day on Facebook or watching TV is not on your to-do list then stop doing them.

3. Always Arrive 15 Minutes Early

The busy person is always racing the clock and always loses.  Just like the caring seminary students in the Princeton Good Samaritan Study, the hidden cost can be lost relationships or a lost life.

To help me not be so busy, I make it a goal of always arriving 15 minutes early.  When I am not rushed I am happier and more in tune with life.  While I may not always arrive 15 minutes early, having this as a goal helps me to be less hurried and more in tune with others.

4. Stop Saying You Are Busy

Strangely, there is an unusual culture in the field of medicine.  Doctors often address each other by asking the question, “Are you busy?”  The implication is that a doctor with too many patients is a successful doctor.

How often do you tell friends and coworkers how busy you are?  Let me challenge you to never say you are busy again.  When asked, like I am often asked at the hospital, always respond “I am trying to be effective not busy.”

Take Home Message

The real cost of busyness is missing out happiness and health.  In other words, missing out on life.  Busyness is a disease that has to be treated.  It is not a badge of honor or the sign of an important person.

What are you doing to end busyness?

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The 6 Best Ways to Reverse Your Biological Age

I think you would agree with me that no one wants to have their body age prematurely.  By just making a few simple lifestyle changes you can instantly turn the aging clock back 10 years or more.  In this article I’m going to teach you the six very best ways to reverse your biological age.

My Premature Aging Experience

The day after my 40th birthday I lost grip strength in my right hand.  As a cardiologist who performs surgery, that was not good.  Not only was the grip strength in my right hand shot, but I also couldn’t turn my neck without excruciating pain.

Rather than see a doctor, I decided to order my own neck x-ray.  Minutes after getting the neck x-ray done, my radiologist colleague called me.

“John, I can’t believe this is your x-ray.  You have severe degenerative disk disease.  It looks like you have the neck of a 60 or 70 year old,” he said.

A follow up MRI of my neck wasn’t any better.  After reviewing the MRI with an orthopedic colleague he said, “you will definitely need your neck operated on in the next five years.”

I was aging way too fast.  Aren’t we all aging too fast?  While we can’t control our chronologic age, is there anything we can do to reverse our biologic age?  In this article, I will share with you six ways to reverse your biological age.

Chronological vs. Biological Age

Our chronological age is how many years we have lived on this Earth.  In contrast, our biological age is how fast our body is aging.  How fast we age, for the most part, is completely up to us.

When taken to the extreme, we have all seen the 40 year old smoker who looks like she is in her mid-50s.  Indeed, studies show that on a cellular level, smoking two packs per day for 30 years prematurely age you by more than 10 years!

This “premature aging” is not just on the outside.  It is inside as well.  I see this everyday when I am doing surgeries.  Even though a patient may be 82 years old (chronological age), when you look inside at the time of surgery, their biological age may only be 72.

It is not just smoking that prematurely ages us.  A poor diet, lack of exercise, sleep deprivation, stress, and loneliness all age us prematurely as well.

How To Determine Your Biological Age

As I am writing this article, I decided to take the Real Age Test to get an idea of what my biological age is.  After answering the 170+ questions, my biological age came back at 39, or 9 years younger than my chronologic age of 48.

Whether or not my biological age is really 9 years younger than my chronological age is up for debate.  I must admit that I do feel much younger now than I did at the age of 40 when I was having neck problems.  The complete lifestyle transformation I made in my mid-40s has definitely made me feel much younger.

Of course, whether or not you believe this test, that over 27 million people have already taken, is a completely different issue.  It can be a very insightful exercise into what is prematurely aging you.

If you do choose to take the Real Age Test, you may want to opt out of everything otherwise they will sell your information to pharmaceutical and other health related companies for targeted advertising.  Their only recommendation for me to be biologically even younger, was to take an aspirin daily.  However, based on recent medical studies, there really is no scientifically proven reason for me to start taking an aspirin.

Telomeres: Our Biological Clock

Telomeres are the caps on the ends of our chromosomes or DNA strands.  They are like the tips of shoelaces.  Without these plastic tips on the ends of our shoelaces, the shoelaces quickly start unravelling.  The same is true of our DNA.

As we age our telomeres gradually get shorter and shorter.  This is like the sand in the hourglass ticking away the years of our lives.  When our telomeres get too short our DNA is no longer protected.  Thus, when cells divide, errors will be made causing cancer and other chronic medical conditions.  Eventually, our telomeres get too short to maintain life.

Fortunately, there are things we can do now to lengthen our telomeres and reverse aging at the cellular level.  By making these changes now, we can reverse our biological age and dramatically slow the overall aging process.   We can start growing younger today!

Telomere Length in China’s Longevity Village

Centenarian In China’s Longevity Village

As you know, my wife and I have led a research team investigating the health and longevity miracle of China’s Longevity Village.  Our experiences and the lessons learned were all described in our 2017 best selling book, The Longevity Plan.

As telomeres represent our own internal biologic clock, we were very interested in the telomere length of the people living in China’s Longevity Village.  As might be expected, many studies have shown that these people, with their exceptionally healthy lifestyles, have a very slow loss of telomere length.  Perhaps this explains the unusual longevity and lack of cardiovascular disease, cancer, and other conditions seen in the Village.

6 Ways to Reverse Your Biological Age

1. Manage Stress to Shave 10 Years Off Your Telomeres

In a very interesting study, Dr. Elissa S. Epel from the University of California at San Francisco and colleagues determined that those who perceived they were under the most stress for the longest periods of time, prematurely aged their telomeres by about 10 years.  Fortunately, in a separate study, she showed that mindfulness and meditation could reverse this premature aging effect to telomeres.  While we cannot avoid stress, we can change how we perceive stress and we can block the effects of stress on our telomeres through mindfulness, meditation, etc.

2. Exercise To Take 10 Years of Your Telomeres

In a similar study, Dr. Lynn F. Cherkas from King’s College in London showed that in 2,401 twins that regular exercising slowed telomere aging by about 10 years when compared to their non-exercising twin.  The message here is clear, exercise can reverse or slow the aging process.

3. Eat a Healthy Diet To Reverse Telomere Aging By 5 Years

Many studies have shown that a healthy diet can reverse or slow telomere aging.  In particular, diets high in vegetables, fruits, fish, nuts, seeds, and legumes can protect our telomeres from shortening.  Sugar, processed foods, and processed meats have the opposite effect to our telomeres.  Eat right to stay young!

4. Maintain an Ideal Weight To Lengthen Telomeres By 9 Years

Being overweight is another cause of premature aging.  Carrying excessive weight causes oxidative stress, or “rusting,” to our cells resulting in telomere shortening and premature aging.  Studies show that maintaining an ideal body weight can lengthen our telomeres by 9 years.

5. Sleep At Least 7 Hours To Reverse Telomere Old Age

Sleep is when our bodies go into repair mode.  We need this repair process functioning optimally if we want to reverse our biologic age and “grow younger.”

In a fascinating study, researchers found that older people sleeping at least 7 hours had the telomeres of middle aged people. In other words, at the cellular level, you can completely reverse telomere “old age” with at least seven hours of restorative sleep each night.

6. Avoid Loneliness for Optimal Telomere Health

Social isolation, or feeling lonely, is not only a powerful predictor of heart disease but telomere shortening as well.  In this study, social connection was shown to be an additional way to keep our telomeres long.  Thus, if you want to slow the aging process, stay connected to your friends and family every day.

Bringing It Home

It has now been nearly 11 years since my neck x-ray and MRI.  I have 100% of my grip strength and my neck feels great.  I have no pain.  I never did need the spine surgery my orthopedic colleague promised me that I would require.

The take home message of this article is that the simple lifestyle decisions we make every day determine whether or not our bodies age fast or slow.  For those with “high mileage” bodies, you can quickly shave ten or more years off your biological age.  For those wishing to stay “forever young,” the six steps outlined in this article is your road map.

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How To Get Off Medications Safely

Fully 70% of all Americans take prescription medications according to the Mayo Clinic.  Nearly twice as many Americans are now taking prescription medications compared to 15 years ago.  Are we opting for medications instead of treating the real underlying problem?

Do you struggle with fatigue?  Are you having troubles sleeping at night?  Do you not feel like yourself anymore?  If you answered “yes” to any of these questions then chances are that you may be suffering from  a medication side effect.

If you want to learn how to get off your medications safely by replacing them with healthy new habits, then this article is just for you.  Even if you are not on any medications at this time, in this article I will show you how to develop healthy habits so that you may never have to take a medication in your life.

Mark’s Experience

No sooner had Mark turned 40 than his doctor told him his cholesterol was too high.  Although Mark exercised regularly, he was a busy executive and it was hard for him to make healthy food choices while traveling.

“I know I can beat this with a healthy diet,” Mark told himself.

He started eating more vegetables, dramatically reduced bread and pasta, eliminated sugar, and replaced red meat with fish.  He was making real progress and his cholesterol numbers were coming down.  He even lost 20 pounds.

Given his family history of heart disease, his doctor wanted his cholesterol numbers even lower.  After 6 months of trying, the numbers were simply not low enough.  His doctor wanted him to take a “statin” medication to further lower his cholesterol.

At first nothing changed.  Mark continued to make healthy food choices and faithfully take his statin.  Three months later, his cholesterol numbers were now perfect.

“I’ve dodged the bullet that killed my father,” Mark thought.  With perfect cholesterol numbers, little by little, Mark started bringing back his “comfort foods.”  He quickly gained back the 20 pounds he lost plus an extra 10.

Previously, Mark felt obligated to go to the gym each morning before work.  However, with things busier at work and with his perfect cholesterol numbers, he no longer felt compelled to go to the gym each day.  A year later, his blood pressure and cholesterol were up and he was diabetic.

Mark’s physician then prescribed metformin for his diabetes, lisinopril for his high blood pressure, and increased his dose of simvastatin.  What went wrong?

Do Prescription Medications Change Behavior?

Conventional wisdom would tell you that patients who faithfully take their medications must be healthier. Could “fixing” his cholesterol problem actually be the cause of Mark’s new health challenges?

Eating Behaviors Change With Medications

Mark, like many patients I have cared for, subconsciously felt like his heart was “protected” on a statin.  Even though he knew he still needed to “eat right,” the motivation was just no longer there with perfect cholesterol numbers.

Is there any scientific evidence to back up this observation that statins change eating behaviors?  In a recent study of 27,886 Americans followed for 20 years, UCLA researchers discovered a most unusual finding.  Once Americans go on statins, they start eating 10% more calories, 14% more unhealthy fats, and gain an extra 10+ pounds in the process.

Statins are not known to make people hungrier or crave junk food.  Rather, researchers concluded that once a statin was “on board,” people no longer felt compelled to religiously watch their diets.

Indeed, these are changes that are not just seen with statins.  I have seen the same thing with diabetes and high blood pressure medications as well.  Too often, once people start on these medications they start making poor food choices again.  They feel a false sense of security on the medications.

Exercise Behaviors Change on Medications

It is not just our food choices that change with statins.  We tend to stop moving as well.

In a recently published study of 5,994 older men, once they were prescribed a statin their exercise efforts plummeted and their sitting time skyrocketed.  Despite controlling for other factors, these researchers concluded that statins changed exercise behavior.  In other words, once people went on a statin they somehow felt that exercise was no longer as critical.

The Medication Snowball Effect

In Mark’s case, one simple statin soon led to two more medications.  Indeed, this happens far too often.  Is it any wonder that 20% of all Americans take five or more medications?

In the medical field we call this “polypharmacy.”  The more medications you take the more symptoms you have.  Soon you are taking medications to counter the symptoms of the other medications.  It is hard to safely break free of this cycle.

What Will It Take?

If you are committed to getting off medications safely, it will definitely require major behavioral changes.  For each person the pathway may be different.  For example, to get off of pain medications may require dramatic weight loss to unweight your back, knees, or hips.

For other conditions, such as anxiety, it may require religiously exercising, meditating, yoga, and volunteering to get to a point where you could safely come off medications.   Getting off of sleeping pills may require you to aggressively manage stress and anxiety, stop caffeine after 10 am, exercise outside every day, and religiously go to bed at the same time every night.

In my cardiology practice, most of my patients want to get off of blood thinners.  These blood thinners are critical in preventing strokes.  For some of these patients, the only pathway off of blood thinners may require them to completely reverse their diabetes or high blood pressure.

Sometimes It Is Not Possible To Get Off Medications

Unfortunately, there are some conditions that may require life-long medications.  For example, this could be due to a genetic abnormality or damage that has already been done.

In these cases, don’t despair.  Rather, work with your physician to get to as few medications as possible by adopting healthy behaviors.

How To Get Off Medications Safely

Whenever a physician wants to prescribe a medication, the real question you should ask your doctor is, what things have to change for me to safely get off this medication.  Avoid the doctor that gives you no hope of ever getting better.  Anything is possible with dramatic lifestyle changes.

In general, a healthy lifestyle, which includes healthy food choices every day, daily exercise, rejuvenating sleep each night, daily stress management, and really connecting with others each day will help you to get off of most medications.  To help you partner with your physician in getting off your medications, let me share with you these eight strategies.

1. Know Your Medications

Probably the most challenging thing for a physician is a patient who does not even know what medications they are on.  If your goal is to go “drug free,” then step 1 has to be to know your medications.  Also, know your dose and know the common side effects with each of your medications.

2. Find Out What It’s Going To Take

Sit down with your physician and ask what specifically is it going to take to get off of your medications.  Encourage your physician to imagine the impossible.  Too often, physicians either don’t feel patients can really change their lifestyle or that medical conditions are reversible.

Don’t let your doctor’s pessimism or lack of faith in you deter your efforts.  Review each medication one by one at each doctor’s visit.  For example, you could ask your doctor how low does your blood pressure, cholesterol, or hemoglobin A1C have to go before you can safely get off these medications.

2. Connect With Your “Y”

For any behavior change, you have to connect with your “Y” (why).  You have to have a reason or change is far too difficult.  If feeling energetic and alive again is not enough for you, then just read the package insert for each of your medications for inspiration.  For many conditions, the side effects of the medications may actually be more dangerous than the underlying medical condition you are treating.

3. Change Your Environment

Once you have your “Y,” (why) the next step is to change your environment.  I have found that if you have the right environment then behavioral change is incredibly easy.

For example, if your family is willing to support you in having a junk food free home, then you will always eat perfectly at home.  Likewise, if you can make friends with fitness junkies then you can’t help but to exercise effortlessly each day.

4. Take the First Step

Once you have a reason (the “Y”) and the proper environment in place, then it is time to start taking steps.  If your “Y” is strong and your environment supportive, you can take big steps.  In contrast, if your “Y” is relatively weak, like wanting your jeans to not fit so tight, and your spouse has a house full of junk food, then you must make baby steps or you will fail miserably.

5. Be Specific

You need to clearly define each step for your new habits.  For me, one of my biggest challenges was to eat healthy at the hospital.  I had to stop eating the junk in my hospital’s cafeteria.  I also had to stop eating the junk many nurses and other hospital employees were bringing in each day.

The solution was easy.  I had to bring in healthy options from home so that I would not be tempted by my hospital’s cafeteria or the free food at the nurse stations.

6. Create a Trigger

You need a “trigger” for the new good habits to kick in.  For me, I had to link packing healthy food to a habit I already had.

After family dinner, our habit is for our family to clean the kitchen together.  For me, this became the new trigger.

Here is how simple it was.  When we are cleaning up after dinner, I will pack food for the hospital.  It worked.  It also made logical sense.  Instead of just putting the left overs into the fridge, I packed them into individual Pyrex containers to take to the hospital in the morning.

The same can be true for you.  Just take any habit you have and make a small tweak for the better.  When ___ (fill in the blank), I will do ___ (fill in the blank).

7. Accountability

We must be accountable to others and/or ourselves for new behaviors to stick.  Friends may not be the best accountability partner as they often let you off too easy.

I have found that for many of my patients, a physical trainer at the gym can be very effective.  Most trainers will give you grief if you eat junk or miss a few days at the gym.

For me, I prefer iPhone apps.  I have apps that track everything.  These apps hold me 100% accountable.

8. Reward

We need to reward our successes.  It has to be fun.  Have a celebration if your doctor is willing to safely take you off a medication or even lower the dose of a medication.

Even though I am now off of all medications, I still need rewards.  For me, in addition to feeling great, the reward is seeing my progress on the app.  I love reaching higher levels and checking things off.

Bringing It All Home

The real goal in how to get off medications safely is to change how we view medications in the first place.  Anytime your doctor wants to prescribe a new medication, get him or her to clearly spell out what needs to happen in order for you to safely get off of this medication.  View any medication as just a temporary “crutch,” until you can reverse your underlying medical condition.

Of course, you must never stop a medication on your own.  Stopping a medicine or reducing a medication on your own could have life-threatening consequences.  Rather, work closely with your physician in helping you to live a healthy enough lifestyle so that medications will no longer be necessary.

If your physician does not believe you can completely turn your life around or that chronic medical conditions can’t be reversed with dramatic lifestyle changes, then look for another physician.

What has your experience been?  Have you been able to safely get off your medications?

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Why Do More Women Die From Atrial Fibrillation Than Men?

In this podcast, I interview Dr. Jared Bunch about the recent article he wrote for Everyday Health on this subject.  Given that 1 in 4 adults in the U.S. will experience atrial fibrillation at some point in their lives, this is an especially important topic.

How Do I Listen To This Podcast?

To listen to this podcast you can click on the sound icon above.  Alternatively, you can subscribe to my podcast on iTunes or Stitcher Radio so that you never miss an episode.

What is Atrial Fibrillation?

Atrial fibrillation is the most common heart rhythm abnormality.  In atrial fibrillation, the two upper chambers of the heart are in complete electrical chaos.  This typically results in a very fast and irregular pulse.  Patients often experience palpitations, shortness of breath, chest discomfort, and fatigue.  Surprisingly, in the inactive and elderly, people may not have any symptoms at all.

Is Atrial Fibrillation Dangerous?

Even if you have no symptoms at all, atrial fibrillation is still a very dangerous heart condition.  Patients suffering from atrial fibrillation are much more likely to have a stroke, develop dementia, or experience heart failure or a heart attack.

What is the #1 Risk for Women?

Contrary to conventional wisdom, the number one cause of death for women is not breast cancer.  In fact, it’s not even all of the cancers combined.  Rather, the number one cause of death for women is still heart disease.

Why Do Women Die More From Atrial Fibrillation Than Men?

Many studies have shown that women are more at risk from dying from atrial fibrillation than men.  We still don’t know exactly why women are more at risk than men.  There are many possible theories.

1. Women tend to be 4 years older at the time of being diagnosed with atrial fibrillation.

2. Women are less likely to be prescribed blood thinners with atrial fibrillation.

3. Women may respond differently to blood thinners than men.

4. Women with atrial fibrillation have a higher heart attack risk than men.

Two Types of Heart Attacks

In general, there are two different kinds of heart attacks.  The first is the classic form of a heart attack where a plaque in one of the arteries of the heart ruptures and blocks off blood flow in that artery.  All of the heart muscle downstream of that clot is at risk of dying.  Physicians call this kind of a heart attack a “ST elevation” myocardial infarction (STEMI) because the ST segment of the ECG is elevated.

The other form of a heart attack is where the demands of the heart exceed blood flow available.  This would be the same concept as “red lining” your car’s engine.  If you run your heart too hard for too long this can also cause heart muscle to die or a heart attack.  Physicians call this kind of a heart attack a “Non ST elevation” myocardial infarction (NSTEMI) because the ST segment of the ECG is not elevated.

Why Do Women Have More Heart Attacks With Atrial Fibrillation?

In a recently published medical study of 14,462 people that were followed for 21.6 years, researchers observed 1,374 heart attacks.  Overall, people suffering from atrial fibrillation were 63% more likely to suffer a heart attack.

These atrial fibrillation induced heart attacks appeared to be primarily the NSTEMI form where heart demands exceed blood flow to the heart rather than the classic blood clot.  Even more surprising is that most of these atrial fibrillation heart attacks occurred in women.

Just to clarify, atrial fibrillation is an electrical problem with the heart whereas a heart attack is a plumbing problem with the heart.  However, if the electrical problem (atrial fibrillation) drives the heart rate too fast for too long it can trigger a heart attack or a plumbing problem with the heart.

While a 63% increased risk of a heart attack from atrial fibrillation sounds frightening, the numbers were even more frightening if you break them down by gender.  For example, men were just 21% more likely to suffer a heart attack from their atrial fibrillation whereas women were 172% more likely to suffer a heart attack from atrial fibrillation.  Approximately 10% of people suffering from this type of a heart attack never make it out of the hospital alive.

The question then naturally arises, why were women so much more likely to suffer heart attacks from their atrial fibrillation?  Researchers were unsure exactly why women were so much more at risk.  Some theories include poor control of atrial fibrillation, untreated other medical problems, or lack of blood thinners.

What Can Women Do?

1. If you have atrial fibrillation get it treated so that you can avoid a heart attack.

2. Breathe clean air. This means no smoking or exposure to second hand smoking.

3. Reverse or control the other risk factors.  The common cardiac risk factors include high blood pressure, cholesterol, and diabetes.

4. Maintain a healthy weight.

5. Exercise every day.

6. Eat a healthy diet.

7. Manage stress, stay socially connected, and get restorative sleep at night.

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8 Nutrients to Prevent Cancer and Slow Aging

In 1744 all of England was busy discussing George Anson’s tragic sea voyage around the world. Anson had set sail in 1740 with a crew of 1,854 only to return four years later with just a crew of 188 people.  What went wrong?  How did 1,666 people die from this around the world sea voyage?

Intuition would tell you that most of the people probably died from pirates, enemy ships, or even a shipwreck.  Interestingly, what killed most of the people on this ship was scurvy.  Indeed, the number one cause of death on the sea, prior to 1753, was not from pirates or war but rather malnutrition from a lack of vitamin C.

Malnutrition is something that only occurs in impoverished third world countries, right?  Wrong.  Despite our overabundance of calories and the obesity epidemic in the U.S., most Americans suffer from malnutrition.

If you suffer from a deficiency in any of the 8 nutrients I am going to discuss in this article, you could be putting your DNA at risk for developing cancer cells or other chronic diseases leading to a premature death.

How Do You Know if You Have a Nutrient Deficiency?

Certainly, you could be tested for many different essential nutrients to see if you have enough for optimal health.  The problem is that many of the commercially available tests may not be accurate.  For example, the standard magnesium blood test does not adequately reflect the body’s store of this important nutrient.

Certainly, if you get sick easy or heal slowly then you probably have a nutrient deficiency.  Likewise, if you have always had troubles losing weight, or you are hungry all the time, then there is also a good chance you are deficient in a key nutrient as well.  Indeed, hunger may be our body’s signal that it is lacking an essential nutrient to carry out its necessary life functions.

The Triage Theory of Cancer and Aging

Nearly 20 years ago during my cardiology training at Stanford University our student loans were coming due.  As Jane and I had just finished our graduate studies, we were deep in debt from the costs of these private universities.  To survive financially, I had to “moonlight” by working as an emergency room physician at nights and on the weekends during my cardiology training.

In the emergency room the most important thing to learn is how to properly triage patients.  In other words, the emergency room team needs to quickly determine who needs emergent treatment and who can wait.–Who gets admitted to the hospital and who is sent home to follow up with their regular physician.  Lives depend on properly triaging the life-threatening from the minor medical problems.

The same is true with our bodies.  Our body is a complex structure that must perform a nutritional “triage” every day.  One such example of the triage theory of cancer and aging is vitamin K.  This theory is championed by the legendary scientist, Dr. Bruce Ames of U.C. Berkley.

Vitamin K is required for blood to clot properly.  The body will do everything it can to ensure that we have enough vitamin K to prevent us from life-threatening bleeding.  If our dietary intake of vitamin K is compromised then everything available will be used to prevent bleeding rather than converting vitamin K1 to vitamin K2 which may prevent heart disease and osteoporosis.

This “triage” allows us to escape life-threatening bleeding now while sacrificing future health problems from heart disease and osteoporosis.  The same may be true of the other essential nutrients.  To keep us alive now, our bodies may put us at risk for cancer and premature aging later if we suffer from nutritional deficiencies.  Clearly, if we want to prevent cancer and slow the aging process we must ensure we have all the essential nutrients our bodies need.

8 Nutrients to Prevent Cancer and Slow Aging

According to the Triage Theory of cancer and aging, if we are deficient in any nutrients the body will favor survival over preventing future damage to our DNA which could lead to cancer cells and premature aging.  Our bodies are constantly turning over.  For example, every 2-3 days we grow new cells that line our intestines and every 2-3 weeks we have completely new skin.

As part of this turn-over process, cells are constantly dividing.  As part of each cell division, our DNA, which is our genetic blue print, must be copied perfectly.  Any mistakes could lead to cancer or premature aging.  This process requires the right amount of micronutrients for the body to both make a perfect DNA copy and to correct any damage to our DNA that occurs during life.

In the remainder of this article, I will discuss 8 must have nutrients to minimize the risk of DNA damage during our lifetimes.  Unless you have chronic gut issues, all of these nutrients should be easily obtained from a healthy diet.  Much of the information I will share is based on the lifetime of scientific discoveries by Dr. Bruce Ames.

1. Folate Deficiency

We all know how important it is for a pregnant woman to ensure she has enough folate in her diet in order to have a healthy baby.    Folate not only prevents neural tube defects with pregnancy but also has been extensively studied as a way to keep our DNA healthy.

While folate deficiency is relatively uncommon in the U.S., studies suggest that approximately 10% of Americans may not have enough folate to protect their DNA.  Up to half of low income children and the elderly may be folate deficient.  Even minor deficiencies in folate may put us at risk for cancer.

Fortunately, it is easy to get enough folate in our diets.  For example, just one serving of beans, lentils, asparagus, or spinach nearly provides all of the folate we need for the day.  Thus, for most people eating a diet high in legumes or vegetables, folate is not something you need to worry about.

2. Magnesium Deficiency

Studies show that approximately 60% of all Americans are deficient in magnesium.  This is something that I see everyday in my cardiology practice as magnesium deficiency is associated with many heart conditions.  In a previous article (blog #27), I discussed 10 common symptoms associated with magnesium deficiency.

Not only will getting enough magnesium help to prevent heart disease but it will also keep our DNA healthy.  Indeed, in a study of 4,035 people, those with the highest levels of magnesium were 40% less likely to develop heart disease and 50% less likely to suffer from cancer.

Keeping our magnesium levels up is far more challenging that folate.  For example, if you are under a lot of stress you will quickly become magnesium depleted.  Also, if you are taking acid reducing medications, these medications can block magnesium absorption in the gut.

To make sure you are getting enough magnesium in your diet, focus on nuts, seeds, and greens.  Indeed, if you eat nuts, seeds, and greens each day then you will probably get enough magnesium in your diet.  Of the greens, spinach is best as one serving of spinach provides 39% of the magnesium we need for the day.

3. Vitamin B6 Deficiency

Studies show that up to a quarter of all Americans have vitamin B6 deficiency.  This is surprising because, unless you eat a lot of empty calories from processed foods, vitamin B6 is plentiful in both meat and plant-based foods.

Great plant-based sources of B6 include potatoes, sunflower seeds, bananas, and spinach.  Many studies have linked low levels of vitamin B6 with cancer.

4. Vitamin B12 Deficiency

Surprisingly, given our meat heavy diet in the U.S., 14% of the elderly still suffer from vitamin B12 deficiency.  Along with folate and vitamin B6, the B vitamins play an important role in keeping our DNA strands healthy and free from genetic blueprint errors.  My favorite way to get enough vitamin B12 is with wild salmon.  For example, even a small, 158 calorie, 4-ounce serving of salmon has 236% of the vitamin B12 we need for the day.

5. Vitamin C Deficiency

Fully 23% of Americans are deficient in vitamin C.  Contrary to popular belief that you need a glass of orange juice to get enough vitamin C, the three very best sources of vitamin C are not orange juice but rather papaya, peppers, and broccoli.  Indeed, just one serving of broccoli will provide you with 135% of the vitamin C you need for the day.  In a study of 56,423 people, the minimal number of servings of fruits and vegetables each day to minimize your heart disease and cancer risk, as well as to prolong life, was five.

6. Vitamin E Deficiency

Vitamin E is yet another important nutrient we need to protect our DNA.  Fortunately, it is extremely easy to get enough of this nutrient.  For example, just one serving of sunflower seeds will give you 82% of the vitamin E you need for the day.  If sunflower seeds are not your thing, then most nuts and vegetables are also packed with vitamin E.

7. Zinc Deficiency

Zinc is critical for many DNA processes.  Once again, given our meat heavy diets in the U.S., it is surprising that 12% of Americans are deficient in this nutrient.  For vegetarians, excellent sources of zinc include nuts, seeds, and legumes.

8. Biotin

Biotin is a B-complex vitamin that researchers are just beginning to understand.  In addition to helping to balance blood sugar levels, biotin has been shown to protect DNA from degradation.  Convincing data are not yet available that it prevents cancer in humans.

Biotin is also another nutrient that we are often lacking.  For example, 40% of pregnant women are deficient in this nutrient.

Biotin is extremely easy to get from the diet.  For example, a single serving of peanuts or peanut butter provides 88% of this nutrient.  Almonds are also very high in biotin.

Other Nutrients

While I have specifically discussed 8 nutrients that are important in protecting our DNA, there are also many other nutrients to be aware of to keep our DNA intact.  These other nutrients include the following: iron, selenium, calcium, copper, niacin, choline, riboflavin, and others.

Every day we are exposed to DNA strand breaks that could lead to cancer or a premature death.  If we give our bodies everything that it needs, it will go a long way in keeping everything working properly.

Can I Take Supplements to Get All My Nutrients?

You may be thinking, this is too hard so I’ll just take supplements.  Unfortunately, supplements have not been shown to prevent cancer.  If anything, studies show that supplements may increase the risk of cancer.

Cancer cells also require the same nutrients to grow, spread, and metastasize.  The problem is that supplements are often massive doses of just isolated compounds whereas the nutrients we get from food are balanced with thousands of other nutrients and cofactors to make sure we get the right amount.

One of many examples of this from the medical literature involves a large and well designed study from Norway.  In this study, people taking folic acid and vitamin B12 supplements had a much higher risk of cancer than those who did not take these supplements.  Similar findings have been seen with many other supplement studies.

The key to successful aging and cancer prevention is to have the right balance of nutrients.  For most people, this is best done by eating nutrient dense foods and then letting our body use what it needs to keep everything in balance.  As long as you don’t have any chronic gut issues, all of these nutrients can be readily available in the diet–without the need for supplements.

If you have a specific nutritional deficiency then supplements may be indicated.  However, this should be done under the direction of your healthcare provider.  If you have the nutrients your body needs then it won’t have to “triage” and can instead focus on keeping your DNA healthy for a long and cancer free life.

A Simple Approach to Ensuring Adequate Nutrition

If you want to make sure your body has enough nutrients to keep everything working properly, here is a simple rule of thumb that will work for the vast majority of people.

1. Shoot for a goal of 9 servings of fruits and vegetables each day.  To get to “9” daily will likely require you to include vegetables with your breakfast.

2. Eat nuts and seeds everyday.

3. Eat a serving of legumes each day.

4. Eat oily fish at least twice weekly.

5. Minimize empty calories.  These include processed foods, especially processed grains, sugar and other items.

What works for you?  How do you make sure you get all the nutrients your body needs?

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How a Baker Now Lives a Healthy Lifestyle

In this podcast, I interview LuAnn Lukenbach who is the owner of LuAnn’s Cupcakes in Park City, Utah.  Everyday she is in her bakery surrounded by countless temptations.  Despite these challenges, she has defied the odds and has been able to lose 50 pounds and maintain a healthy lifestyle!

In this podcast, LuAnn shares the following:

1. How she lost 50 pounds.

2. How she has converted her living room into a real “living room.”

3. How she has maintained a daily habit of taking 10,000 steps.

4. How she has overcome the temptation of all of the “BLT’s” (bites, licks, and tastes) in her bakery.

5. How intermittent fasting has helped her in maintaining a healthy weight.

6. How a diet high in fruits and vegetables has allowed her to feel her best.

7. How she has created healthy treats in her bakery.

How to Listen

To listen to this podcast you can click on the “sound” icon above.  Alternatively, you can subscribe to this podcast on iTunes or Stitcher Radio so that you never miss an episode.

What things have helped you in your healthy lifestyle?

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Do These 3 Things to Protect Your Brain

Cindy could not remember where she put her keys.  The night before she forgot the name of someone she knew.  When she shared these experiences with her friends over lunch they all laughed it off as “senior moments.”

Was it really a senior moment?  Cindy is just 55.  Could her forgetfulness be a sign of early dementia?

What is normal brain aging and what is early dementia?  How can you tell?

In this article, I will share with you the recent three recommendations from the Institute of Medicine on how to protect your brain from aging.  When it comes to brain health and preventing dementia, it is never too late to start.  Even if you are still in your 20s or 30s, now is the time to protect your brain!

Why Does Brain Health Matter?

The key factor determining your ability to live an independent, meaningful life is your cognitive function.  Is it any wonder that in the 2015 survey of retired people, the top concern of 93% of people was staying mentally sharp.

The problem is how do you protect your brain?  When further asked in this survey, most retired people felt that brain games (crossword puzzles, sudoku, etc.) were the key to healthy brain function.  Few had any idea that physical activity played a role in brain health.

Brain Puzzles Don’t Protect Your Brain

Contrary to conventional wisdom, crossword puzzles or sudoku generally do not protect your brain.  Yes, it is true your brain is stimulated when you first start doing crossword puzzles or sudoku but this is quickly lost once you have developed some degree of proficiency.

In other words, crosswords and sudoku only make you better at doing crosswords and sudoku.  To stimulate the brain, you need a lifetime of always learning new things.

In a fascinating study, Dr. Richard Haier wanted to study the effects of brain puzzles on cognitive function.  To test this concept, he selected study subjects who had no interest in video games.  Specifically, he wanted to know what would be the effect of learning Tetris on brain function.

Sure enough, as people first started playing this new game Dr. Hairer and researchers witnessed tremendous brain stimulation.  For example, by scanning these study participants’  brains with a functional MRI scanner, they saw areas of the brain light up like a Christmas tree as these people struggled to learn how to play Tetris.  New brain connections were being formed and the brain was alive and stimulated.

However, just as they were starting to get good at Tetris something totally unexpected happened.  The brain started shutting down.  In other words, brain stimulation only occurred while they were learning something new.

To keep new brain connections forming, we must continually find new things to learn.  Doing crosswords or sudoku day after day will only numb the brain like Tetris did in this study.  You may be a crossword or sudoko pro but yet still forget someone’s name or items you needed to purchase at the grocery store.

Do These 3 Things to Protect Your Brain

If crosswords and sudoku won’t protect your brain, what should you do to keep your brain functioning at peak performance?  According to the report from the Institute of Medicine, these are the three most important things to do to protect your brain.  If you want to access this information yourself, here is the link to get your own free 373 page eBook report on Cognitive Aging from the Institute of Medicine.

1. Physical Activity

Since the 1970s it has been recognized that people who regularly exercise have better cognitive function that those who choose not to.  Indeed, a recently published study, looking at the combined results of 47 previous studies on this topic, showed that people, age 40 and older, who exercise have 35% better brain function with aging.  In other words, if you are 40 or older, you are at high risk of losing your brain function and memory if you are not physically active.  Not only can you protect what you have but these same studies show that you can actually get “smarter” and remember things even better with daily physical activity.

While researchers still are not completely sure how exercise makes you “smarter” and improves your memory, there are a number of different theories.  The most exciting right now is the role of Brain Derived Neurotrophic Factor (BDNF) which I discussed in a previous article.  Other theories include increased blood flow to the brain, less depression, improved neurotransmitter release, etc. from exercise.

Current guidelines from the American Heart Association are to get at least 150 minutes of moderate intensity exercise or at least 75 minutes of high intensity exercise each week.  Regardless of how exercise benefits the brain, if you want to always stay mentally sharp, put away the crosswords and sudoko and get moving!

2. Improve Your Cardiovascular Health

It has often been said that you are only as old as your arteries.  The same things that protect your heart and arteries are the same things that will protect your brain.  Below are the goals of the American Heart Association (AHA) when it comes to optimal cardiovascular health.

1. Keep your blood pressure below 120/80 mmHg.

Constantly exposing your heart and brain to high blood pressure over time causes premature aging of these organs.  Work with your physician to keep you blood pressure in the ideal range.

When getting blood pressure under control, I have found that lifestyle factors have more of an effect on blood pressure than medications.  However, in some cases, medications may still be required even if you are doing everything right.  To learn more about how to control blood pressure naturally, here is an article I have written on this subject (blog #12).

2. Stay physically active

As discussed above, the AHA defines physical activity as a minimum of 150 minutes of moderate intensity or 75 minutes of high intensity exercise each week.  I would take this a step further.  In addition to these minimums, I recommend at least 10,000 steps each day for my patients as well.

3. Keep your total cholesterol below 170 mg/dL.

As with high blood pressure, high cholesterol can also be lowered naturally.  For example, rural Chinese and other people eating a traditional plant-based diet, typically have a total cholesterol below 130 mg/dL without any medications.  If your cholesterol is high and you want to lower it naturally, here is an article I have written on the subject (blog #9).

4. Eat a healthy diet.

It goes without saying that if you want a healthy heart and brain you must eat a healthy diet.  A healthy diet is defined by the AHA as eating 9 servings of fruits and vegetables each day, nuts and legumes on most days, and oily fish at least twice weekly.  Salt, unhealthy fats, sugars as well as other simple carbohydrates and red meat should be minimized.

5. Maintain a healthy weight.

Strangely, a large percentage of my patients have no idea what a healthy weight is for them.  Most are in shock when I tell them how much they should weigh to be at a healthy weight.  It seems like most people just compare themselves to everyone around them.  As long as their bodies look similar to everyone else they must be “OK.”

To not be considered overweight or obese you need to have a body mass index (BMI) of 25 or less.  While this system is not perfect, countless studies have shown that it works when predicting cardiovascular risk.  To see if your BMI is less than 25, click on this link.

6. Never Smoke

Nothing more needs to be said here.  To maintain optimal health we need to breathe clean air.

7. Keep fasting blood glucose below 100 mg/dL.

Measuring your blood glucose is something that can easily be done with any standard blood test.  While the AHA has focussed on fasting blood glucose, I feel that the hemoglobin A1C is a better marker for diabetes or pre-diabetes.  The hemoglobin A1C test measures the amount of sugar attached to your red blood cells and gives you a running 3-month average of your blood glucose.  A normal hemoglobin A1C is below 5.7%.

3. Avoid Mind Robbing Medical Conditions and Medications

With regards to recommendation number 3, the Institute of Medicine (IOM) recommends that you work with your physician to treat any underlying medical conditions or medications that may cause dementia.

Specifically, the IOM has called out diabetes and sleep apnea as two treatable causes of dementia. Fortunately, for most people, weight loss will cure both of these conditions.  However, until you can reverse your diabetes and sleep apnea, work with your physician to make sure both are under excellent control.  For diabetes, this means a goal hemoglobin A1C of less than 5.7% and for sleep apnea this means ensuring that you are using CPAP or whatever your physician has prescribed to treat this condition.

Other medical conditions which can caused dementia, such as thyroid disease, stroke, high blood pressure, high cholesterol, obesity, kidney disease, etc. were also called out by the IOM.  If you have any of these conditions, work closely with your physician to get these conditions under control.

Medications are another common cause of dementia.  In particular, the IOM has targeted sleeping pills, including sedating antihistamines like Benadryl or Tylenol PM, some antidepressants and anti-anxiety medications, narcotics, muscle relaxants, and even medications for urinary incontinence.  If you are on any of these medications do not stop them abruptly.  Rather, work with your physician to see if there are any less toxic treatment options which don’t put your brain at risk of dementia.

Concluding Thoughts

When I read this report from the Institute of Medicine I became quite alarmed myself as I regularly took Benadryl (diphenhydramine) for about 20 years to help me sleep at night.  This is the same medicine that is in Tylenol PM.

Had I known of the long-term risks of this medication, I would never have taken it.  Unfortunately, what we have done in the past cannot be changed.  We also cannot waste our time worrying about how we used to live.  The important thing is to live as healthy as we can now.

What things are your doing to protect your brain?

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The Best 4 Nuts to Prevent Heart Disease

In this podcast, Drs John Day and Jared Bunch discuss the best four nuts to prevent heart disease.  Below you will find the topics Drs Day and Bunch discuss.  Here is a link to the original article in Everyday Health which was written by Dr. Bunch.

How to Listen to this Podcast

To listen to this podcast you can click on the “play icon” below the photo above or you can listen to it through iTunes or Stitcher Radio.  Even better would be to subscribe to this podcast on iTunes or Stitcher Radio so that you never miss an episode.

Introduction

In countless studies, most nuts appear to be very heart healthy.  Nuts are also an important component of the Mediterranean Diet which has been shown to decrease the risk of heart disease by 30%.

Which Nuts Should You Choose?

Based on the available research, there does not seem to be a significant health difference as to whether you like your nuts raw, in a nut butter, or roasted.  However, if you do suffer from high blood pressure or have water retention issues, you may want to select a non-salted form.  Below are the 4 nuts discussed in this podcast.

1. Almonds

Almonds seem to be at the top of everyone’s heart healthy nut list.  Like other nuts, almonds have been shown to lower LDL (bad cholesterol), help in the treatment of diabetes, reduce inflammation, and may also help with weight loss.  Almonds, when eaten in moderation, are always an excellent heart healthy nut choice.

2. Pistachios

Similar to almonds, pistachios also help to lower LDL cholesterol and help with the treatment of diabetes.  Pistachios seems to have a unique benefit in lowering stress induced high blood pressure.  If you are under a lot of stress or are suffering from high blood pressure, pistachios could be an excellent nut option for you.

3. Walnuts

Walnuts are uniquely positioned to help reverse heart disease or plaque build up within the arteries of the heart.  Walnuts also have ALA, which is a plant-based form of the omega 3 fatty acids.  If you have had a blockage within the arteries of your heart, a prior heart attack, or stent placement, walnuts might be the right nut for you.

4. Peanuts

While technically not a nut, but rather a legume, peanuts have not enjoyed the same heart healthy halo effect as almonds.  Despite the poor public image of peanuts, studies show that peanuts can be just as healthy for the heart as other nuts.

Besides the risk of food allergies with any nuts, peanuts have an additional risk of aflatoxin.  This mold can cause liver disease or even cancer.  This risk seems to be very manageable provided you are eating a moderate amount of peanuts from a reputable source.

Are These Really the 4 Best Nuts to Prevent Heart Disease?

The simple answer is “no.”  Nuts, in general, are all very effective at helping to prevent heart disease.  So if you are a pecan, macadamia, or Brazil nut lover don’t despair.  You can continue to enjoy the nuts you love most!

Are nuts a part of your heart healthy diet?  Which nuts are your favorites and why?

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Is the Paleo Diet Good for Your Heart?

By the time Bob turned 40 he was overweight, had high blood pressure, high cholesterol, and had developed adult-onset diabetes.  He felt horrible. His doctor had a “heart-to-heart” talk with him and told him and told him he had to go on medications for high blood pressure, high cholesterol, and his diabetes.

Bob went online and studied the Paleo Diet.  At the age of 40 he said to himself, “I am too young to take all of these medications.”

Heart disease ran in his family and he did not want to travel the same health path his father had.  He decided to try “Paleo” first before going on all of the medications his doctor prescribed.

Bob faithfully followed the Paleo Diet.  It became a new way of life for him.  He started exercising every day without fail.  He gave up all sugar, grains, dairy, legumes, and processed foods.  He only ate wild meats, vegetables, fruit, nuts, and seeds.

Within 4 months he lost 60 pounds. His high blood pressure, high cholesterol, and diabetes were gone.  He was sure his doctor would be mad at him for not taking the pills he had prescribed.

Roaming the Savanna eating only wild meats, vegetables, and fruit has to be good for the heart, right?  After all, heart disease is just a recent phenomenon from our diets high in sugar, processed grains, and a sedentary lifestyle, correct?

The Paleo community tells us that this diet will solve most of our modern health problems.  On the other hand, U.S. News and World Reports ranks the Paleo Diet dead last each year in their annual review of popular diets.  Where is the truth?

In this article, we will answer the question, is the Paleo Diet good for your heart.  We will also look closely at whether heart disease existed among our paleo ancestors and what we can learn about this way of life and the risk of heart disease.

Heart Disease is Common Even in the Young

On the Standard American Diet, atherosclerosis or plaque build up in the arteries of the heart is very common and starts in childhood.  For example, even in physically active U.S. soldiers serving in the Korean War, autopsy studies of these young U.S. soldiers showed that 77% already had evidence of heart disease!

This study completely challenged our concept of “heart disease” from being something that only “old people” get.  Perhaps our diet improved between the Korean and Vietnam Wars as the same study of Vietnam War soldiers who died showed that only 45% of these young soldiers had heart disease at autopsy.

The take home message of these autospy studies is that, even in young soldiers who were physically fit, heart disease can start in childhood from a poor diet.  Would our hunter gatherer ancestors on a “pure diet” also have such high rates of heart disease?

Heart Disease in Our Hunter Gatherer Ancestors

In 2013, Dr. Randall C. Thompson from Saint Luke’s Hospital of Kansas City published the very provocative medical study, “Atherosclerosis across 4000 years of human history: the Horus study of four ancient populations” in the prestigious Lancet medical journal.  In this study, Dr. Thompson and colleagues performed CT scans of the hearts and arteries of 137 mummies from four different ancient hunter gatherer cultures.

The four ancient hunter gatherer cultures studied were as follows:

1. Ancient Egyptians

2. Ancient Peruvians

3. Ancestral Puebloans (Southwest U.S.)

4. Unangan hunter gatherers (Inuit Eskimos of modern day Alaska)

All four ancient cultures were physically active outside every day.  Also, with the exception of the Unangans (Inuit Eskimos), all four ancient cultures primarily ate wild animal meat, vegetables, and fruits.  In contrast, the Unangans ate primarily an all meat diet with little or no plant based foods.

It should be pointed out that these four ancient hunter-gatherer cultures did not eat grains or much dairy with the exception of eggs in the Unangan diet.  Everything was organic and there certainly were no processed or GMO foods.

This sounds like the perfect lifestyle, right?  Heart disease should never occur, correct?

Even though many of these mummies were young at the time of their deaths, atherosclerosis or plaque build up in the arteries of the heart was seen in 34% of these mummies with the “perfect” Paleo lifestyle.  Among the Unangans, who ate an almost all meat diet, heart disease was seen in 60% of the mummies.

Is Heart Disease Inevitable?

How can our ancient ancestors who lived a “perfect lifestyle” still get heart disease?  Is heart disease inevitable?

While our ancestors thrived on a Paleo Diet, they did not escape heart disease.  Indeed, humans have thrived on all diets except the Standard American Diet (SAD).

There are, in fact, ancient cultures who have thrived without heart disease.  Three classic examples are the Kitavans from the tropical islands of Papua New Guinea, the Tarahumara Native Americans of Mexico, and rural Africans.

All three of these cultures (Kitavans, Tarahumara, and rural Africans) had a similar diet.  While it was also a hunter-gatherer type lifestyle, all three were low in meat.  These three diets were very high in plant based foods, including legumes and real whole grains, which are both shunned by modern-day Paleo followers.  Sugar and processed foods also did not exist in these three primitive cultures.

Benefits of the Paleo Diet

There are certainly tremendous health benefits of the Paleo Diet and lifestyle.  Unfortunately, these are largely ignored by US News and World Reports.  For example, eliminating all added sugars and processed foods can immediately reverse many chronic medical conditions, similar to Bob’s experience at the beginning of this article.

In addition, the Paleo community encourages daily physical activity similar to what our paleo ancestors would have done.  Physical activity, in combination with a diet free of any added sugars or processed foods, can be a very healthy lifestyle.

Weaknesses of the Paleo Diet

While many people thrive on the paleo lifestyle, it is by no means a perfect diet.  As we have covered in this article, ancient cultures living the paleo lifestyle still experienced heart disease.

From these studies, it is not clear if the heart disease came from campfire smoke inhalation, chronic inflammation from infectious diseases, or a meat heavy diet.  Certainly, the easiest way to create plaque build-up in the heart, or heart disease, is to feed animals a diet extremely high in meat.

From my perspective, arbitrarily shunning any foods created within the last 10,000 years, just because it doesn’t meet the definition of “paleo,”doesn’t make a whole lot of sense.  For example, among many different cultures legumes have been shown to be the most important dietary factor in longevity.

Legumes are avoided in the Paleo Diet because they are felt to contain two anti-nutrients, lectin and phytic acid.  Most lectins in beans are deactivated with cooking.  Additionally, many medical studies suggest that phytic acid may actually prevent cancer.

Even real whole grains are shunned in the Paleo Diet.  While processed grains have been one of the major drivers of our current health crisis in the U.S., study after study has shown that real whole grains can prevent heart disease and prolong life.  For example, a recent Harvard University study of more than 100,000 people showed that whole grains decreased heart disease by 20% and prolonged survival by 15%.

The key here is to avoid processing and to eat grains in moderation.  For most Americans, moderation means dramatically reducing how much grain you are currently eating.  Turning wheat into flour is really turning just turning wheat into sugar.  If you enjoy wheat, and do not have any gluten sensitivities, try buying bread without flour like Ezekiel Bread.

Lastly, if you tolerate dairy, dairy can be another healthy food.  For example, yogurt with no added sugar and live bacterial cultures can be part of any healthy diet.

The Modified Paleo Diet

If you want to eat more like our ancestors, may I suggest the “Modified Paleo Diet?”  This diet is similar to a diet eaten by Kitavans, Tarahumara, and rural Africans.

With the “Modified Paleo Diet,” added sugar and processed foods are still avoided.  Vegetables, fruits, nuts and seeds are still encouraged.  However, wild animal meat is eaten sparingly (wild fish is OK) and legumes as well as real whole grains are included in the diet.  Dairy is optional depending on how well you tolerate this food group.

Have you tried the Paleo Diet?  What was your experience?

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6 Ways to Stop Feeling Hungry All the Time

The holidays are the worst time of the year for Josie.  Josie is just 16 and all she can think about is food.  She is obsessed with food and is hungry all of the time.  Regardless of how much she eats, she is always hungry.

According to her mother, “Ever ingredient is meticulously measured and the calories counted.  When she was younger, screaming tantrums would begin if the clock ticked past the allotted serving time.”

To save her from overeating, her mother shares,  “We pile up the meal on a small dish so it looks fuller. We cut food in half and tell her it’s twice as much. We keep empty raisin boxes and fill them with half the number they’d normally contain so she can have an extra box.  We always keep back a bit of her meal so that if there’s a dropped spoon disaster, and three peas go on the floor, then three peas get replaced.”

Josie has a rare genetic condition, called Prader-Willi Syndrome, which causes her hunger hormone, ghrelin, to be extremely high.  Unless people suffering from this condition are physically restrained from eating, they will literally eat themselves to death.  If left unchecked, Prayer-Willi patients typically die young from obesity related complications.

Can the same thing happen to us?  Can our hunger hormones also get so far out of the normal range that we also feel hungry all the time?  In this article I will share with you 6 ways to stop feeling hungry all the time.

The Hunger Hormones

Before we discuss how to stop feeling hungry all the time, let me first introduce the “hunger hormones” and discuss the reasons why we feel hungry.  Below are the main hunger hormone players:

1. Ghrelin

Ghrelin, also called the “Ghrelin Gremlin,” is the one to fear the most.  Another easy way to remember the roles of ghrelin and leptin is that ghrelin “grows” your appetite whereas leptin “lowers” your appetite.  Ghrelin levels are extremely high with the Prader-Willi Syndrome.

When there is nothing in our stomachs, the hormone ghrelin is released.  On the other hand, when our stomachs are full then ghrelin secretion stops.  Once released, ghrelin acts on receptors in the brain to make us feel hungry.

The frustrating thing is that ghrelin not only makes us feel hungry but also activates the “reward center” of our brains.  Activating the reward center of our brains makes us crave the addictive or “comfort foods” like pizza or chocolate chip cookies.

Now that we understanding how ghrelin works, one obvious way to suppress ghrelin production is to fill our stomachs with water, fiber, or other low calorically dense foods at meal times.  If we can “stretch” our stomachs with a big salad and a tall glass of water then perhaps we can quickly shut down the body’s production of ghrelin.

2. Leptin

Leptin is another hunger hormone.  Leptin is released from the fat cells when they are “full” to signal to the brain to stop eating.

Leptin has the opposite effect of ghrelin.  Thus, for most people, letpin is a good thing if the goal is to stop feeling hungry all the time.  To help remember the effects of leptin just remember “lucky leptin.”

A young boy’s medical case, we’ll refer to him as “T,” was recently described in the most prestigious medical journal, The New England Journal of Medicine.  “T” is two years old and lives in the country of Turkey.  As with Josie, “T” is also hungry all of the time.  He ravenously devours any food he can get.  He never feels full.

“T” has a rare genetic condition where his brain cannot detect leptin.  While “T’s” height is just a litter bit taller than average, at the young age of just 2 he weighs 67 pounds!  Unlike Josie, T’s parents have not restrained him from eating.

“T’s” condition is something that has been well described in adults.  This condition is called “Leptin Resistance.”  With leptin resistance, even though leptin levels are high the brain cannot detect leptin.

The purpose of leptin is to prevent us from gaining weight.  The problem is that even though leptin levels are high in obese people, the brain never “registers” the leptin.  While leptin resistance in adults is not as severe as with “T,” leptin resistance may play a significant role in the worldwide obesity crisis.

Researchers are just starting to learn why obese people’s brains do not register the leptin signaling that they are “full.”  New research suggests that we can block the effects of leptin from eating a diet high in sugar and simple carbohydrates.  These simple carbs raise our triglyceride levels which has been shown to block leptin signaling to the brain.

Of course, the obvious way to help our brains to sense leptin and stop feeling hungry all the time is to minimize sugar and simple carbohydrates in our diets.

3. Insulin

Insulin is a hormone released by the pancreas.  Insulin is released when blood sugar levels rise.  The main effect of insulin is to cause us to store fat.

A diabetic patient recently told me, “as soon as I went on insulin I gained 10 pounds!”  This is not unusual.  If you talk with many people with diabetes they will often tell you the same thing.

A high sugar meal, like bread, pasta, or breakfast cereals, will cause a high spike in your blood sugar levels.  When this happens, the pancreas releases insulin causing the extra sugar to be stored as body fat.  Once the blood sugar drops you are hungry and the cycle begins all over again.

A simple way to prevent hypoglycemia from making you hungry is to eat foods that don’t spike your blood sugar.  Minimizing or avoiding sugar and simple carbohydrates will keep your blood sugar levels stabilized.

4. Cortisol

Have you or a loved one ever taken a short course of prednisone or another steroid?  Were you always hungry?  Did you gain 5 to 10 pounds from just a week of taking prednisone or another steroid?

Cortisol is the body’s steroid hormone.  Cortisol is released from our adrenal glands.  When we are sleep deprived or chronically stressed, cortisol levels are high.  As long as cortisol levels remain high our appetite will remain high as well.

5. Neuropeptide Y

Neuropeptide Y is a brain neurotransmitter and is also considered by many to also be a “hunger hormone.”  Neuropeptide Y is a powerful brain chemical that compels us to eat.

In a classic study, researchers in 1985 injected male rats with neuropeptide Y.  Within just minutes of the injection, male rats became obsessed with food and lost all interest in sex.  Even though a willing sexual mate was readily available, these male rats, under the influence of neuropeptide Y, craved rat chow more than sex.

Studies show that neuropeptide Y is released in response to stress as well as a high sugar, high fat diet.  Interestingly, intermittent fasting has been shown to lower neuropeptide Y levels.

Clearly, if we want to stop feeling hungry all the time, we also need to keep neuropeptide Y levels down.  The best way to do this is to minimize or avoid unhealthy fats and sugar, manage stress, and, under the direction of your physician, consider intermittent fasting.

I Have a “Double Dose” of the Fat Gene

I have had my genome analyzed and I have two copies of a variant of the FTO gene which is also known as the “Fat Gene.” Having two copies of the “Fat Gene” (one from my mother and one from my father) means that my ghrelin levels are genetically programmed to be high.

This means, that for those of us with two copies of this gene, we don’t feel full when we eat.  Studies show that most people in the U.S. with a “double dose” of the Fat Gene are obese.

While eating the Standard American Diet (SAD), I was overweight and yet was always hungry.  Since changing my lifestyle, my weight has dropped 30 pounds and I have maintained this weight loss now for more than 3 years.  While a healthy lifestyle has helped me to control my hunger and ghrelin levels, if I am not careful I can quickly become very hungry very fast.

Despite having genetically high levels of ghrelin, at least I can feel fortunate that I don’t have the same constant hunger pains that someone suffering from the Prader-Willi Syndrome might have.

6 Ways to Stop Feeling Hungry All the Time

Now that we understand the brain chemistry of hunger, we can now “hack” our hunger to keep ghrelin, cortisol, insulin, and neuropeptide Y levels low and allow our brains to shut down the hunger signals by being able to sense leptin.  Here are my 6 very best ways to stop feeling hungry all the time.

Ghrelin Release from the Stomach

1. Fill Your Stomach to Stop Ghrelin Release

If you want to keep the “ghrelin gremlins” at bay, stretch your stomach with low caloric density food.  In other words, drinking water with your meals, eating high fiber foods, or just filling your stomach with lots of vegetables can fill your stomach to suppress ghrelin and keep you at a healthy weight.

In contrast, very caloric dense food, like a piece of cake or a piece of candy, doesn’t fill your stomach.  Because the stomach is not stretched from these calorically dense foods, ghrelin levels remain high.  As long as ghrelin levels remain high, your brain will drive you to eat more.

When you feel hunger coming on, and it is not yet time to eat, reach for a bowl or bag of fresh vegetables and a glass of water to drive the “ghrelin gremlins” away.

2. Minimize Sugar and Simple Carbs

“Lucky leptin” is the signal that comes from our fat cells and tells our brains we have had enough food.  This is the hormone that is supposed to keep us at a healthy weight.

The problem is that most obese people are “leptin resistant.”  Unfortunately, studies show that sugar and simple carbs block the effect of leptin on our brains.  In addition, sugar and simple carbs increase insulin and neuropeptide Y release.

In order to prevent leptin resistance and keep insulin and neuropeptide Y levels down, minimize sugars and simple carbs.  I have found that for most of my patients, if they can just minimize or eliminate sugar and simple carbs, their weight quickly normalizes.

3. Get At Least 7 Hours of Restorative Sleep

Sleep is probably the most under appreciated weight loss strategy.  Besides the obvious that we are not eating when we are sleeping, getting enough sleep at night keeps ghrelin levels low and leptin levels high.  This is exactly the right combination which will help us to stop feeling hungry all the time.

In contrast, sleep deprivation increases cortisol and neuropeptide Y levels as well.  With all of these hunger hormones working against us, sleep deprivation makes it exceedingly difficult to maintain a healthy weight.

Don’t worry about going to bed hungry as sleep quickly raises leptin levels to prevent hunger from awakening you at night.  If hunger is waking you up at night then there is a good chance you are “leptin resistant.”

4. Practice Stress Management Each Day

Along with sleep, another under appreciated way to stop feeling hungry all the time is to manage stress.  When we are feeling stressed out, studies show that ghrelin, cortisol, and neuropeptide Y levels go up while leptin levels fall.  Once again, this is the perfect storm for feeling hungry all the time and gaining weight.

As chronic stress and weight gain go hand-in-hand, is it any wonder that yoga and meditation have both been shown to be possible weight loss options?  The key point here is to find what helps you to “de-stress” and do that each day.

5. Minimize or Avoid Unhealthy Fats

As a diet high in the unhealthy fats has been shown to induce neuropeptide Y, the goal is to minimize or avoid the unhealthy fats.  The main source of unhealthy fats in our diet is from processed foods, fast foods, and most restaurant foods.

6. Intermittent Fasting

It seems counter intuitive to fast in order to help control hunger.  However, if you are healthy, intermittent fasting for periods as short as 12 hours, has been shown to have beneficial effects.  For example, intermittent fasting may help with leptin resistance as it lowers triglyceride levels.  In addition, fasting lowers neuropeptide Y levels.  If you are interested in intermittent fasting, please discuss this with your physician first.

Are you always hungry?  What has helped you to stop feeling hungry all the time?

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9 Ways to Stop Being a Night Owl

Jeff struggled with weight issues his entire life.  He was a computer programmer and told me, “I do my best work between 8 pm and midnight.”  Does this also sound like you?

The trouble was that he was always hungry late at night, had troubles getting up in the morning, and was now was seeing me for heart problems.  Could his night owl ways be contributing to his heart condition?

One third of all adults are night owls.  Are you one of them?

In this article we will explore what makes people night owls, the health risks of night owls, and 9 ways to stop being a night owl.

Is There a Genetic Basis to Night Owls?

Some night owls have told me that they are genetically “hard-wired” to stay up late at night.  Could this be true?

Interestingly, researchers have now identified the “Night Owl Gene” or the “CLOCK gene” as it is known in the medical literature.  In the medical studies, night owls are often referred to as the “evening chronotype.”

People with the CLOCK gene have a genetic predisposition to an altered circadian rhythm.  The circadian rhythm is your built in 24 hour clock.  This genetic tendency toward an altered circadian rhythm keeps them up at night unless they are careful to control their environment.

Mice with the CLOCK Gene

Mice possessing the CLOCK gene have been studied extensively.  In these mice, not only is their circadian rhythm out of sync with the sun causing sleep disorders, but they also frequently suffer from mood changes, difficulties with pregnancy, and with obesity.

In humans, studies show that people with the CLOCK gene also frequently suffer from attention deficit disorder (ADD or ADHD).  From these studies, the genes controlling for circadian rhythm are also tightly linked to mood, weight gain, and concentration.

Environment vs. Genes for the Night Owl Syndrome

Even if you have the CLOCK gene, are you destined to be a night owl for the rest of your life?

Many researchers have said that the equation for obesity is really quite simple.  Obesity equals the wrong genes plus a modern lifestyle.  The same could be true of night owls.  The night owl syndrome also equals the wrong genes plus our modern lifestyle.  Let me explain.

In a classic study, researchers at the University of Colorado, Boulder studied this question.  Their study group of people consisted of both “night owls” and “morning larks.”

For the first week of the study, they extensively studied these people in their natural “modern lifestyle” sleeping state.  For the second week of the study, they took these people high up in the Rocky Mountains.

There, they camped in a location far away from any light pollution.  Also, as part of the study, all electronic devices or artificial light, including flashlights, were completely banned.  Study participants did have access to campfire light at night.

Interestingly, at the end of the week there were no night owls.  Everyone’s circadian rhythm, or their own internal 24 hour clock, was in sync with sun.  In addition, researchers also found the following:

1. People fell asleep and awoke 2 hours earlier in a natural environment.

2. People were exposed to 4-times more light during the day in a natural environment.

3. Natural melatonin production began at sunset.

4. Natural melatonin production turned off with sunrise.

5. No one suffered from insomnia.

Are There Night Owls in China’s Longevity Village?

An interesting question is whether or not there are any night owls in more natural or ancestral environments.  The answer is generally, “no.”  Based on our study of China’s Longevity Village, until recently there were no night owls.

Electric lighting is a recent phenomenon to this Village.  Prior to electric lights, night owls didn’t exist when all you had were fires or candles.  Modern studies have shown that the wavelength of light from fires and candles is such that it does not activate the brain the same way blue light does from electric lights and electronic devices.

Lessons Learned

What lessons can we learn from the Rocky Mountain Sleep Study and from China’s Longevity Village?  The take home message is that if people are exposed to natural light during the day and have no access to artificial light at night then their circadian rhythm will naturally be in sync with the sun.

The converse is also true.  Locking ourselves up in dark homes or offices during the day and then living by electric light and electronic devices at night will bring out the night owl tendencies in anyone.  This gets back to the equation of a night owl.  A night owl equals genetic tendencies plus a modern lifestyle.  If you take away one component of this equation then the night owls go away.

Health Risks of Night Owls

Does it really matter if you are a night owl or not?  Can this just be a “benign” lifestyle choice?  Are there any dangers of having an altered circadian rhythm?

The most extreme example of night owls are shift workers.  People who work graveyard shifts are the most extreme examples of night owls.  Their nights and days are completely reversed.  What are the health risks of shift workers?

In one of the largest studies ever done, researchers found a 23% increased risk of heart attacks in shift workers in this study of 2,011,935 people.  Not only do shift workers suffer more heart attacks, they also are much more likely to get cancer.

It is not just shift workers who are at risk.  Studies of people who travel and suffer from frequent jet lag have the same risks as shift workers.  For those who just prefer going to bed later, here are the health risks according to published medical studies.  I have hyperlinked each health risk with the medical study supporting this finding.

1. Obesity

2. Cancer

3. Depression

4. Muscle loss or weakness

5. Sleep apnea

6. High stress hormones

7. Cholesterol problems

8. Type 2 diabetes

9. High blood pressure

10. Heart disease

9 Ways to Stop Being a Night Owl

As you can see, the medical studies of night owls don’t look good.  If you suffer from the night owl syndrome, let me give you 9 ways to stop being a night owl and start enjoying better health now.  The old adage, “don’t fight the sun” really is true.

1. Get Morning Sun

If there is one time of the day that is most important to get bright light, it is the first thing in the morning.  This bright and natural morning light will reset your own internal circadian rhythm and get you back in sync with the sun.

The morning sun is also critical to maintaining a healthy weight.  Indeed, studies show that morning light accounts for 34% of our body mass index or BMI.  Thus, if you have been struggling with weight issues your entire life, perhaps the solution is as simple as going outside first thing in the morning for 30 minutes to get some natural morning light from the sun.

Even if you are not a shift worker or suffer from jet lag, just prolonged exposure to artificial light at night may increase the risk of breast cancer.

2. Eliminate Blue Light After Dinner

With work deadlines, kid homework, etc. it can be impossible in our modern lives to eliminate all artificial light at night.  This artificial light, or blue light, throws our circadian rhythm off.

Studies show that even brief exposure to blue light at night can delay sleep by 30 minutes.  Additional research shows that artificial light exposure at night not only delays natural melatonin release but that it also shortens it throughout the night making it more likely that you will wake up through the night.

So how can we survive in this modern world without artificial light at night?  The answer may be as simple as wearing orange glasses after dinner to filter out the blue light.

Yes, this photo shows me sporting my new orange glasses.  Studies support that blue light shielding glasses have been shown to improve sleep. This is what we have started doing at our home.  It does seem to help.

3. Eliminate Electronic Devices After Dinner

While blue light filtering glasses may help, electronic devices are one of the biggest causes of the night owl syndrome.  Indeed, electronic devices may account for 50% of all sleep disorders according to the 2014 National Sleep Foundation Poll.

To stop the evening stress and cortisol stimulation, as well as the blue light stimulation, turn off all electronic devices after dinner.  This includes TVs, computers, phones, iPads, etc.

If you absolutely must use an electronic device at night, then either use blue light filtering glasses or download blue light shielding apps for your computer, iPad, or smart phones.  Here is a blog article to learn more about blue light filtering apps.  I am not aware of any filtering devices yet for TVs.

4. Dim the Lights After Dinner

If walking around your house with orange glasses or goggles on at night to filter out blue light doesn’t sound like something you want to do, a simpler approach is to just dim the lights in your house at night.  Dimming the lights at night can somewhat approximate “sunset” to your body and start to get the natural melatonin production from the pineal gland started.

5. Physical Activity During the Day

Countless studies have shown that maintaining physical activity during the day helps with sleep at night.  Even better would be to exercise outside each day.  This natural light exposure helps with keeping our circadian rhythms in sync with the sun.

6. Natural Light or Bright Office Lights During the Day

To keep our body’s circadian rhythm in sync with the sun, getting as much bright light during the day is critical.  Don’t despair, even if you work in a dark office there are still things you can do.

For example, try taking a walk outside on your lunch break.  Exposure to the midday sun will help to keep your body in rhythm.  Other options include purchasing a blue light device for your office during the day.

7. Maintain a Strict Bedtime Schedule

Because of their genetic tendency, night owls have to be very strict in maintaining a consistent bedtime schedule.  It is so easy to get involved in a task and then discover it is suddenly 1 am!

For most of my patients, they would be much better off to set a bedtime alarm clock instead of a morning alarm clock.  Indeed, for many of these patients, the real reason why they are seeing me in my cardiology practice is because they are chronically sleep deprived.

8. Maintain Adequate Vitamin D Levels

Studies report that night owls tend to have lower levels of vitamin D.  As you know, low vitamin D has been linked with just about every medical condition imaginable.  The cause is probably because they are fighting the sun and are not getting outside enough.

Regardless of the cause, talk to your physician about getting your vitamin D levels tested.  If they are low, get them back into the normal range through natural sunlight in a sun-smart way or through high vitamin D containing foods, like salmon, or through supplements under the direction of your physician.

9. Consider Melatonin Supplements

The data for melatonin supplements as a sleep aid are strongest for people suffering from jet lag.  In these studies, melatonin supplements seem to help them regain their natural circadian rhythm.  While melatonin has not been formally tested in people suffering from the night owl syndrome, anecdotally it seems to help some of my patients.  If you are considering melatonin supplements, please discuss this with your physician first.

Do you suffer from the night owl syndrome?  What have you found that helps you to get your circadian rhythm back in sync with the sun?

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How to Diagnose Palpitations

A reader recently shared with me, “Last July I was laying on the couch and out of nowhere I had a weird series of beats. Thump thump thump thump….just hard, slightly faster, off rhythm beats. I sat up and my heart beat returned to normal.

For whatever reason, I had a totally random thought that this was an indicator of some serious underlying heart issue and I panicked. I basically had a full on panic attack that night.

Since that time, I have been hyper-focused on my heart. So, over the next several months, I would have odd beats and would freak out and have a panic attack. This led me to several Urgent Care visits. ECGs always came back totally normal. ”

Sadly, thousands of patients have shared similar experiences with me.  Their palpitations are so severe that they struggle to exercise, sleep, or even go to work.

What Are Palpitations?

Palpitations are the perceived sensation of abnormal heart beats.  They are often described as “hard beats,” “skipped beats,” or some patients will even tell me “my heart stopped.”

These palpitations are often associated with anxiety, stress, sleep deprivation, poor diet, or stimulants.  For many patients, in addition to the palpitations, they also get chest discomfort, shortness of breath, fatigue, dizziness, or lightheadedness.

Are Palpitations Dangerous?

For many patients, palpitations make them feel like they are having a heart attack.  The more concerned they are about their heart, the worse the palpitations.

Fortunately, 99% of the time, palpitations are totally benign.  Everyone’s heart skips from time-to-time.  For the vast majority of people, they never feel these premature beats unless they are taking their pulse.  For many patients who feel premature beats, once they learn their palpitations are benign their symptoms often go away without treatment.

How, then do you know if your palpitations are part of the 1% that are worrisome?

How to Diagnose Palpitations

By the time patients have made it to the cardiologist, they have already had blood work to look for electrolyte abnormalities, thyroid problems, etc.  Thus, in my cardiology practice, we generally focus on two additional tests:

1. Stress echocardiogram to rule out other heart problems.

An echocardiogram or “echo” uses ultrasound technology to evaluate the heart.  We can see if the heart is enlarged, if there are valve problems, or other cardiac abnormalities.

The “stress” portion of the examination consists of a treadmill.  Often, exercise can reproduce the palpitations.  The addition of an exercise component to the examination can also help to rule out any serious heart blockages.

2. ECG documentation of the palpitations when they are happening

Mysteriously, palpitations rarely, if ever, happen in the doctor’s office.  If you are that rare patient that has palpitations in the doctor’s office, then a simple ECG there can cinch the diagnosis.

For those who do not have palpitations at the doctor’s office, some form of a heart monitor to go home with is what is needed to make the diagnosis.  This usually consists of a Holter monitor, event monitor, or one of the new smart phone ECG apps.

What is a Holter Monitor?

If the palpitations occur every day, I generally order a Holter monitor.  At our hospital, Holter monitors can be for 24 or 48 hours and they look like the photo to the right.

One of our ECG technicians attaches the Holter monitor system to the chest.  Patients are instructed not to swim or shower until the test is completed.  Each time they experience their typical symptoms they are instructed to push the button and then record their symptoms.

Every heart beat is recorded with the Holter monitor.  It becomes very easy to quickly see what the heart is doing while they are having symptoms.

The advantage of the Holter monitor is that it is generally a much quicker and cheaper test.  While it is cumbersome to wear, as long as the symptoms occur while the monitor is on it is a great test.

What Is An Event Monitor?

Event monitors are monitors that patients can put on and take off each day.   This allows patients to shower each day.

At our hospital we use monitors that have three ECG leads, as shown in this photo.  Typically, we will check out these monitors to patients for a month.

Most event monitors now utilize cell phone technology to transmit ECGs in near real time.  With up to a month to make the diagnosis, it is usually very easy to identify the cause of the palpitations.  As with the Holter monitor, when patients have symptoms they push the button and record their symptoms.

What are the New Smart Phone ECG Apps?

In recent years, ECG technology has moved to the cell phone.  While insurance companies generally don’t cover this technology, the out-of-pocket costs are often much cheaper than the copay with a Holter or event monitor.

An additional advantage is that there are no electrodes stuck to the chest so that skin rashes can be avoided.  Also, as people own this device and usually have their phone with them, this can be an ongoing monitoring device for many years.

The two main options at this time are Alivecor and ECG Check.  For around $75 you can have your own high quality ECG app.  I know that if I suffered from palpitations I would definitely purchase one of these devices.

While most of my patients have opted for Alivecor, I have found that both devices deliver a high quality ECG.  My patients love this technology.

Once you have these ECGs on your smart phone you can then fax, email, or text them to your physician.  Other physicians may prefer that you bring your phone with you to your next doctor visit and then review the ECGs as part of your clinic visit.

What Do You Usually Find on ECG with Palpitations?

1. Nothing

For reasons that I still cannot explain, at least half of the time that patients report palpitations, the ECG only shows normal rhythm.  These patients are not “crazy,” — they are feeling something in their chest, it just is not their heart.

2. PACs and PVCs

The next most common finding are premature beats.  These can be premature atrial contractions (PACs) or premature ventricular contractions (PVCs).

Most of the time these are isolated beats.  Sometimes, you can have 3, 4, or more consecutive premature beats.  People suffering from long runs of these consecutive premature beats are also at risk for more serious rhythms like #3 or #4 as described below.

Except for rare cases, premature beats are benign.  For people suffering from premature beats, please read this article I wrote on how to make them stop.

3. Atrial Fibrillation or Flutter

In my experience, a very distant but third most common cause of palpitations are atrial fibrillation and atrial flutter.  These two rhythms can be dangerous as they can cause strokes, heart failure, dementia, or premature death.

4. Other Rhythms

Lastly, there can be other rhythms that can cause palpitations such as supraventricular tachycardia (SVT) or ventricular tachycardia (VT).  Of these two rhythms, VT can trigger a cardiac arrest.

How to Diagnose Palpitations

In closing, the most important two things to remember when trying to diagnose palpitations is to rule out other conditions and to capture an ECG while the palpitations are occurring.  Fortunately, 99% of the time these palpitations are completely benign.

Do you suffer from palpitations?  How were your palpitations diagnosed?  What has helped you to control the symptoms?

Disclaimer

Do not self diagnose or treat based on anything you have read in this article.  If you suffer from palpitations, please work closely with your physician to both make the diagnosis and to design the right treatment approach for you.

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Do Mormons Live Longer?

Mormons don’t drink, they don’t smoke, and they even have detailed health guidelines in their scriptures.  They also tend to have a tight knit spiritual community.  Does this translate into better health and a longer life expectancy?

In 2008, UCLA researchers published the “Mormon Longevity Study” in the journal Preventive Medicine.  In this article I will share the results of the Mormon Longevity Study, evaluate the role of spirituality on lifespan, and compare the results of this study with longevity studies of other religious groups.

Please read on to learn more about the health lessons we can learn from these religious communities which may benefit your own health and lifespan as well.

The Mormon Health Code

Mormons have an additional set of scriptures based on modern day revelations called the Doctrine and Covenants.  It should be noted that this health code originated in 1833 which was long before processed foods, GMOs, and our modern forms of “wheat” and sugar were available.  In section 89 of the Doctrine and Covenants, Mormons have the following health code guidelines:

1. Do not drink alcohol

2. Do not use tobacco

3. Avoid “hot drinks” (this has been interpreted by church leaders to mean coffee and non-herbal teas)

4. Plant based foods are encouraged (fruits, herbs, vegetables, etc.)

5. Animal meat should be eaten sparingly (fish is not mentioned)

6. Grains are the “staff of life” (this recommendation came before commercial grain processing was available)

Monthly Fasting

In addition to the health code discussed above, Mormons are also instructed to fast monthly for personal spirituality and to help the poor.  This fast is defined as going without food or water for 24 hours.  The cash equivalent of what was saved by not eating or drinking for 24 hours should then be given as a donation to help the poor.

There are many health benefits from this practice.  For example, this monthly fast alone could prolong life through developing individual spirituality, the “Volunteer Effect,” and the activation of longevity genes as well as the prevention of heart disease.

1. Individual Spirituality

Cultivating individual spirituality has been shown in medical studies to be a powerful predictor of longevity among the centenarian community.  In addition to a monthly fast, Mormons are encouraged to pray, meditate, and perform acts of selfless service each day.

2. The “Volunteer Effect”

In addition to developing personal spirituality, there is also the “Volunteer Effect” of the monthly fast.  Study after study has shown that volunteers are happier, healthier, and even live 22% longer than those who choose not to give of themselves.  Outside of the monthly fast, every Mormon is encouraged to accept a volunteer service position within the church.

3. Intermittent Fasting Activates Longevity Genes and Prevents Heart Disease

Lastly, intermittent fasting has been shown to activate the genes that promote longevity.  Indeed, my colleague, Dr. Ben Horne, has shown that the practice of intermittent fasting prevents obesity, diabetes, and heart disease.  As heart disease remains the number one killer in the U.S., intermittent fasting could have a significant impact on lifespan.

Tight Knit Community

Perhaps the health benefits of the Mormon faith have nothing to do with their health code, spirituality, or other aspects of their faith.  Based on the work of Dr. Juliane Holt-Lunstad, which was covered in a previous article that I wrote, studies show that the single most important factor in health and longevity is the social support structure you have in place.

In other words, the closer you are to your family, your neighbors, and the more friends you have appear to be the most important aspect for a long and healthy life.  Attending church regularly provides instant access to this social support system.  This social support system can be lifesaving as you go through difficult challenges in your life.

The lesson here is that even if you are not religious, regularly meeting with other people in a supportive and nurturing environment can have significant health benefits.  Perhaps you could achieve the same health benefits by regularly participating in a supportive book group, joining with others in a shared hobby, or even social bonding through volunteer or humanitarian opportunities.

The Mormon Longevity Study

In 2008, UCLA researchers James E. Enstrom and Lester Breslow asked the question of whether the “Mormon Lifestyle” reduced mortality among active Mormons living in California.  This study included the health status of 25,647 people and followed them for 24 years.  This study later became known as the “Mormon Longevity Study” or the “UCLA High Priest Study.”

Before I share the results of this study, it should be pointed out that the Mormon Church had no influence on this study.  This study was supported entirely through grant money from the American Cancer Society, National Cancer Institute, Wallace Genetic Foundation, and the Block Foundation.

As you might have guessed, the Mormon lifestyle among Californians translated into a significant survival advantage.  Indeed, this lifestyle translated in up to an extra 9.8 years of life!

In this study, researchers defined the most faithful Mormons as “High Priests.”  They selected high Priests as their study sample group as men who have achieved this priesthood calling typically have lived a life faithful to Mormon teachings.

In this study, researchers found that the more positive health characteristics Mormons had the longer lives they lived.  Specifically, here are the 7 positive health characteristics that contributed to an extra 10 years of life in Mormons:

1. Married

2. Never smoked

3. Attend church weekly

4. At least 12 years of education

5. Moderate body mass index (BMI)

6. Regular physical activity

7. Proper sleep

Do You Have to Be a Mormon to Live 10 Extra Years?

No, you don’t have to convert to the Mormon faith to gain an extra 10 years of life.  For example, the Seventh Day Adventists, who are a religious group based primarily in California, also have a strong health code.  Interestingly, their health code is very similar to the Mormon health code.

Indeed, among a study of 34,192 faithful Seventh Day Adventists, researchers found that this way of life also conferred an extra 10 years of life.  This finding led researchers to title their study, “10 Years of Life: Is It a Matter of Choice?”

Studies of other religious denominations have also shown survival advantages.  Even in China where religious believers have suffered persecution by the Chinese communist government in the past, have shown remarkable survival advantages.

Is Spirituality or Religion Necessary for a Long Life?

As I have reviewed hundreds of studies on spirituality, religion, and longevity, the key factor in my research is the powerful effect of having a strong social network on survival.  As discussed, having a close family as well as lots of friends appears to be the primary factor in longevity.

Religious organizations provide a strong social support structure and purpose to life.  They are also very effective in reducing emotional stress and suffering during challenging life struggles.

Putting It All Together

Individual spirituality and strong social connections are both powerful predictors of health, happiness, and longevity.  Whether or not you participate in an organized religion, cultivating personal spirituality and close relationships with family members and friends may also give you an extra 10 years of life!

Have you found organized religion or individual spirituality to help you with our own health?

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Avocados Lower Cholesterol Naturally

In this podcast Dr. Day interviews Dr. Jared Bunch about a recent article he wrote for Everyday Health on avocados lower cholesterol naturally.

This podcast discusses the following topics:

1. Nutritional benefits of avocados.

2. Avocados or statins to lower cholesterol.

3. The recently published study showing that avocados can significantly lower cholesterol.

Subscribe to the Podcast

If you liked this podcast, please be sure and subscribe to the Dr. John Day Show in iTunes or Stitcher Radio.  The transcript for this podcast is posted below.

Avocados Lower Cholesterol Naturally Podcast Transcript

John: Hi. This is Doctor John Day. Welcome to the Doctor John Day show. I am so thrilled. I got Doctor Jared Bunch on the show again. So, I guess we didn’t scare you off last time.

Jared: I’m here to stay.

John:  I really like this article that you just wrote at Everyday Health, and it’s called, “This High Fat Food Can Lower Your Cholesterol.” I’m looking at your stats for this article with 5,000 shares on Facebook!  That’s amazing. So I guess you hit on something that really resonated with a lot of people in this article.

Jared: Yeah, we were really excited about the general flow and the sharing of the article. It really took off and was featured on the everydayhealth.com main website for about one week.

John: So I heard that you even came in ahead of Sanjay Gupta’s article.

Jared: Well, we never quite know where we are, but when it stays on the main page, that usually is a good sign that a lot of people are interested in it.

John: There is definitely an interest with 5,000 shares on Facebook and counting.  Let’s dive into this article and try to learn more about avocados. I like how you started your article with the confession that if you had just one meal left in your life, that you would look for Mexican food and avocados.

Jared: Absolutely. I think we all have had that thought at one time – what would be our last meal? We had that discussion one night as residents at the Mayo Clinic. We were all sleep deprived. It was about 2:00 AM, so we were all thinking this may be our last meal anyway and mine came down to Mexican food. I have a passion for that.

John: Now does that include guacamole?

Jared: I do like fresh guacamole, and I do like peppers as well, so yes.

John: What sort of nutrient benefits are we getting from avocados?

Jared: Avocados really are on a short list of most people for a superfood. They’re filled with lutein. Lutein is a powerful antioxidant. It’s actually quite interesting. It’s been a nutrient that’s been used for eye protection. It concentrates in the eye and may protect the eye from ultraviolet light. There’s fiber in it. It’s a rich source of potassium. Most people when they think of potassium, think of potato skins, bananas, and oranges.

Few people think of avocados, but avocados, pound for pound, beat out bananas and most other food sources for potassium. They’re loaded in vitamins, including C, D, E, and K. They’re low in sodium. An avocado may only contain 2.6 miligrams of sodium and they have about 0.7 grams of protein in them. And finally, they’re also one of the food sources that contains a fair amount of zinc and so it also may help you ward off colds and some of the other things that zinc shows a protective benefit for.

John: They are also high in fiber.  Considering that our daily fiber goal is 30 grams, and the average American only eats 15 grams of fiber, just one avocado almost gets you to the US daily average.

Jared: Yeah, absolutely. One normal sized avocado will almost get you there.  That’s why it’s one of the superfoods that we tend to advocate.

John: Now, avocados, is similar to our last podcast together with coconuts.  For years, avocados and coconuts were shunned, but now there’s a renaissance where avocados and coconuts are all the rage. What suddenly redeemed these two foods?

Jared: Well, there’s clearly a change in thought about eating and diets. And approximately 20 years ago, everything was centered around reducing fat. We found out that they may actually be a more harmful than diets that do contain healthy fats. And as they are a food source that is rich in healthy fat, avocados are one that we can consider. Just like coconuts.

John: For those in our audience who’ve been following the medical literature or even in the lay press lately, statins have really taken a beating. First, several weeks ago, there was a study that came out that the diabetes effect with statins may be much greater than we had previously anticipated. It actually reported that statins result in a 47% increase in diabetes. And then a couple of weeks ago at the American College of Cardiology meetings, there was a study from the Cleveland Clinic showing that statins may increase coronary calcifications. Based on your article, would you consider avocados an alternative to statins?

Jared: I wouldn’t call it an alternative.

John: Okay, so you’re not willing to go that far then?

Jared: Not quite yet. Lots of people can’t take statins.  One of the biggest concerns with statins is an inflammatory muscle disorder called myositis and this can lead to significant muscle injury.  Fortunately this is super rare.

About 10-15% of statin users will develop joint pain and muscle pain so they end up stopping these agents. In fact, in clinic today, I saw two people that, over the past two weeks, stopped their statins, because the pain was too significant to continue and they just couldn’t do what they wanted. So, lots of people are looking for alternatives. They have high cholesterol. Their doctor said, “Let’s lower your cholesterol,” and they can’t use statins – the most common drug. So they have another drug called zetia, but unfortunately that does not have the same benefits of statins. It can be used in combination with statins to some benefit, but does not have the same strength or heart protective benefits.

And so a lot of the medical community is waiting for a new class of drugs called a PCSK9 inhibitor, and those were mentioned at the recent American College of Cardiology meetings.  The pharmaceutical industry has tremendous interest in finding a statin alternative. But many people have asked, “But what can I do for myself?” They exercise, they try to lose weight, they increase the fiber in their diet, and their cholesterol is still high. That’s where I wanted to introduce the avocado as a potential option.

John: At least with my patients, most would rather take an avocado than a statin drug. How effective are avocados at lowering cholesterol?

Jared: Again, that gets back to that fats. Some fats are good for you and some are bad. Polyunsaturated fats from animal products can be harmful. Monounsaturated fats from plant-based foods can be healthful. In fact, we talked previously about coconut oils and things like that which can actually lower cholesterol. We’ve had that knowledge for some time, but not necessarily studied it in a very scientific way.

That’s what was interesting about a recent study in the Journal of the American Heart Association. This is a open-access journal supported by the American Heart Association and it often has trials that focus on some of these different therapies that maybe of interest. And this was a study that looked specifically at the potential benefit of avocados in people that have high cholesterol. Whenever we look at the beneficial effects of foods it’s good to go to reputable journals where we can trust the science and trust the outcomes, in trying to understand if they would give us benefit. And so this was a study of 45 people that were either overweight or obese, and had high cholesterol.

John: How high was their cholesterol in this study?

Jared: These were all people that in general had cholesterol levels over about 200.

John: And that’s total cholesterol above 200. So 45 people overweight to obese people all with a total cholesterol above 200.

Jared: Yes, and so they were randomized to take part in three diets. They actually studied these people after every diet. They would be on these diets for, I believe, five weeks. One diet was what we were talking about before, a low-fat diet.

John: So, going back to the diet of the 1980s, and 1990s.

Jared: Exactly. Kind of when I was growing up with my family, my mom wanted everything without fats.

John: Did you have those SnackWells fat-free cookies?

Jared: Oh yes [laughter]. There’s nothing snack well about them.

John: And the skim milk that looked like water in your cereal bowl?

Jared: Exactly. [laughter] I remember. I’m a product of the 1980s.

John: What were the other 2 diets in this study?

Jared: The other was on a moderate fat diet of healthy fats.  In addition, they had one medium sized avocado a day.

John: And what about group three?

The third group was also on a moderate fat diet. Now we know that avocados have monounsaturated fats that may lower cholesterol, so the author said, “Well we need to substitute something that has some monounsaturated fat, so we can truly understand if the avocado is unique.” And so in this one, they had additional foods, such as olives, that they introduced that would provide that healthy fat content. Every single participant was on all of these diets at one point in time. After they completed one diet, they had a two-week washout period before they had to start the next diet.

John: Each person tried all three diets, then?

Jared: Yes, and the order in which they participated was random, so you wouldn’t assume that the third diet took advantage of the two diets before it.

John: So, the only difference between the second and third diet was that the second diet got an avocado a day and in the third diet they got a different type of healthy fat.  What did they find?

Jared: That’s what I thought was quite interesting. The diet that contained the avocado had the greatest reduction in bad cholesterol or LDL cholesterol. In fact, the LDL cholesterol in just five weeks decreased on the average of 13.5 milligrams per deciliter.

John: Just for reference, if you start one of your patients on a statin, how much LDL reduction do you typically see?

Jared: I continue to raise the statin dose until I receive the desired level. You’ll often see reduction of about 20 mg/dL.

John: So if a patient, say, did still require statin, maybe they only require half the dose as long as they’re getting their avocado a day?

Jared: Yeah, that’s definitely a possibility. And we do know that symptoms with statins are often dose-dependent. And so one of the options physicians turn to is trying a different statin or lowering the dose and hoping that it reaches a level where the patient could tolerate it.

John: What happened with the other moderate fat diet in this study?

Jared: The other moderate-fat diet also reduce LDL cholesterol. In the moderate fat diet without avocados they were able to reduce it by on average of 8.3 mg/dL in five weeks. The low-fat diet really didn’t do a lot. In fact, we didn’t see much change in cholesterol at all. And so consuming these healthy fats actually helps lower our the bad fats in our body.

John: What does avocado do to LDL particle size and does size matter?

Jared: Size definitely matters in many things in life. The smaller and more dense your LDL particles, the worse. When I was in training, there was a lot of interest in saying, “Are all LDL particles alike? Are all good cholesterol HDL particles alike?” And so what they started to do was study them, and break them up by size and density, and that’s when a lot of insight came into fat, and how fat circulates and how it invades the vessels and inflames the vessels and causes disease. And they found these very small, dense LDL particles were the ones that could enter the vessel, enter the plaques, cause inflammation and tended to be those that were the most hazardous.

John: So when it comes to bad cholesterol, bigger is better.  Is that what you’re saying?

Jared: Yes–

John: And avocados will help you to grow bigger LDL particles?

Well, not as much as– they help the bigger LDL particle. The one diet out of all of them that changed the ratio of small dense particles was the avocado diet. And compared to the other moderate diets, the avocado itself had a unique property in lowering these dense particles. And so not only lowering bad cholesterol, you’re lowering preferentially the worst part of the bad cholesterol. I think that’s tremendous insight that requires a lot of additional study.

John: You bring up a good point.  When we look at the cholesterol-lowering-effect of avocados, it’s modest, not quite to the level of a statin, but perhaps there’s even more bang for your avocado in that it’s not just reduction, but it also changes the nature of LDL.

Jared: Absolutely. It has a unique benefit in the treatment of cholesterol.  While this is a small study it was well designed and performed.

John: Certainly in the medical world, it seems like – and many of our listeners will tell you is, one day we hear something’s bad for you, then the next day we hear that the same thing is good for you, and so we like to try to look at this as far as a trend in the right direction. In your research, has there been other work done on avocados and its effect on cholesterol and heart health?

Jared: There have been smaller studies that also show some benefit with avocados in lowering cholesterol.  I hope that these smaller studies on avocados lead to a much bigger trial. You know, five weeks isn’t a long trial of any drug and we had this significant improvement in five weeks. Well, what if they continued for six months or a year? Would we see the cholesterol drop further and the dense LDL cholesterol drop further?

John: While this can’t be accepted as gospel yet, it is a great first step. I think it really gets back to what Hippocrates said, “Let food be your medicine,” and clearly there seems to be a great benefit here with avocados.

Now, at the end of your article, you mention that before we get too enthusiastic about an avocado a day, we can’t forget about the the caloric load of an avocado as well as some food allergies. Can you expand on this?

Jared: Yes. Unfortunately, a lot of the things that make avocados a superfood also make it a little bit dense in calories. An average avocado will contain about 250 calories, and so that’s not a small amount if you’re watching your weight. So you may not want to eat a lot of them even though there is some benefit, because it can cause weight gain, and weight gain can sometimes negate some of the benefits.

I went running today for five miles.  When I finished my calorie counter said I’d burned 500 calories, so eating two avocados would have completely offset everything I ran off.

John: That’s a lot of exercising just to work off two avocados [laughter].

Jared: That was good guacamole.

John: Ah, so that’s how you like your avocados. Then it’s with the guac, huh?

For me it’s guacamole, yes. I need some peppers in it as well. The other interesting thing with avocados that I didn’t know is there has been some reports that in people with latex allergies, they can have similar allergic symptoms if they eat avocados. So, if you’re somebody that’s been exposed to latex and have had a severe allergic reaction it would be best to consult your doctor and maybe talk to an allergist before eating one.  Obviously, if you have a latex allergy, and you’re doing fine eating avocados, continue to do so.

John: I must confess I’m not a big guac fan.  I’m learning to enjoy avocados in some of our homemade salad dressings.

Jared: They are awesome in salads. They are also awesome on sandwiches.

John: Fantastic. Now this has been great, and if people want to learn more about this article or about some of the articles that you are writing, how can people find you in the Internet?

Jared: Absolutely. I’d love them to read my articles and comment, good or bad, and engage other viewers in conversation. It’s at everydayhealth.com under columns. My column is known as “Rhythm of Life.” I’m the one cardiologist there. You can also follow me on Twitter@TJaredBunch. As soon as these articles come out, I’ll send links to them so you can immediately read them through Twitter.

John: As always, Jared, it’s great to do this with you. We’ve been partners now in our cardiology practice for many years and now we’re doing these podcasts together. Thank you so much for coming on the show and sharing with us everything we always wanted to know about avocados.

Jared: My pleasure. Thanks for inviting me.

John: Thank you so much and thank you for tuning in.

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How to Prevent Alzheimer’s Disease

My dear friend just learned this week that her father was diagnosed with Alzheimer’s Disease.  The tragedy is that he is only 50 years old.

Does Alzheimer’s run in the family?  Is there anything you can do now to prevent you from suffering the same fate?  In this article I discuss the 10 things you need to do now to minimize your risk of ever suffering from this devastating condition.

Do You Have the Alzheimer’s Gene?

If you have a family history of Alzheimer’s Disease then there is a high chance that you have the “Alzheimer’s gene.”  Specifically, half of all people with Alzheimer’s Disease have the ApoE4 gene.  While this is the most important gene for Alzheimer’s Disease, there are also other “lesser” genes which may also be involved.

The ApoE gene controls cholesterol and lipid metabolism.  There are 3 main forms of this gene, ApoE2, ApoE3, and ApoE4.

If you have the “ApoE2” form then you are protected against developing Alzheimer’s Disease. ApoE3 is the “normal” form of this gene and has no increased or decreased risk of Alzheimer’s Disease.  Unfortunately, about 25% of Americans have at least one copy of the ApoE4 form which puts them at significant risk of high bad cholesterol (LDL) as well as heart disease and Alzheimer’s Disease.

We each have two copies of the ApoE gene.  One from our mother and one from our father.  If you have just one copy of the ApoE4 gene then your risk of Alzheimer’s Disease is increased 2-3 fold.  Tragically, if you have 2 copies of the ApoE4 gene your risk of Alzheimer’s Disease is increased 20-30 fold.  Not only does the ApoE4 gene put you at high risk of Alzheimer’s Disease, it also causes the disease to develop as early as age 30.

How Do You Know if You Have the ApoE4 Gene?

You can now know if you have the Alzheimer’s gene for a little over $100.  You don’t even need your doctor to help you with this test.  This is something you can order for yourself online.

Not only will you learn your Alzheimer’s gene status, you will also learn about thousands of other genes for cancer, obesity, autoimmune diseases, etc.  Other than filling out a few online forms all it requires of you is some of your saliva in a test tube.  To learn more, I describe the details of how to test your genes in a previous blog post.

Are Your Genes Your Destiny?

Do our genes determine whether or not we will develop certain diseases?  Absolutely not!  Our DNA is not our destiny.

Our genes just represent the seed.  For a seed to grow it requires the right nutrients in the soil, water, and sunlight.  The same is true for our genes.

If we can live a perfectly healthy lifestyle we can turn the ApoE4 gene off.  This is done through a process known as epigenetics.  In fact, only 25% of our health future is determined by our genes.  The other 75% is completely up to us based on the decisions we make every day.

How Do You Silence the ApoE4 Gene?

Fortunately, even if you have the ApoE4 gene it doesn’t need to cause high cholesterol, heart disease, and Alzheimer’s Disease.  While this often happens with our Western lifestyle, we have scientific evidence from 3 groups of people living an ancestral lifestyle who do not suffer any bad effects from the ApoE4 gene.

1. Pima People Living in Mexico

The Pima people reside in Arizona and Mexico.  They were once known for their lean bodies, great athleticism, and health.

Unfortunately, after being driven from their native lands and way of life, the Arizona Pima people were given government rations of white flour, sugar, canned goods, and industrial oils to keep them from starving.  A few generations later they now have one of the highest rates of obesity, diabetes, and Alzheimer’s Disease anywhere in the world.

In 1999, researchers studied a group of Pima people still following the traditional Pima diet and lifestyle in Western Mexico.  Even among those Pima people with the ApoE4 gene, they saw no evidence of high cholesterol, heart disease, or Alzheimer’s Disease.  The researchers concluded that this ancestral lifestyle protected the Pima people from the ravages of the ApoE4 gene.

2. Yoruba People Living in Nigeria

Later, in 2004, researchers evaluated two groups of people of African descent with regards to the ApoE4 gene and Alzheimer’s Disease.  Of the two groups in this study, one group lived in Indianapolis, Indiana and the other Ibadan, Nigeria.

As expected, the ApoE4 gene increased the risk of Alzheimer’s Disease in African Americans living in Indianapolis.  However, quite unexpectedly, the ApoE4 gene had absolutely no effect on the risk of Alzheimer’s Disease among the Yoruba people living in Ibadan, Nigeria.

Once again, the researchers concluded that the traditional diet and lifestyle of the Yoruba people living in Nigeria silenced the ApoE4 gene and protected them from developing Alzheimer’s Disease.

3. Sub-Sahara Africans

In 2014, researchers reviewed data published in 522 studies on the risk of dementia in Africa.  As with the previous two studies, this study came to the same conclusion.  In Sub-Sahara Africa, Africans who have the ApoE4 gene but yet still eat the traditional diet and follow the traditional lifestyle completely silenced the ApoE4 gene.

Are ApoE4 People the Canary in the Coal Mine?

In the past, canaries were used in coal mines to warn miners of impending danger.  The build up of toxic gases in the mine, like carbon monoxide or methane, would kill the canaries long before the miners were affected.

In our modern Western way of life, people with a copy of the ApoE4 gene represent the canary in the coal mine.  In other words, the Standard American Diet (SAD) and physical inactivity harms people with the ApoE4 gene long before people with the other forms of the ApoE gene.

For people with the ApoE4 gene, to escape the fate of the canary in the coal mine, they must give up the Standard American Diet (SAD) and embrace a physically active lifestyle.  Indeed, studies have shown that for people with just one copy of the ApoE4 gene, a poor diet and lifestyle increases the risk of Alzheimer’s Disease by 11-fold!

How to Prevent Alzheimer’s Disease: 11 Strategies

If you have a family history of Alzheimer’s Disease then odds are that you also have the ApoE4 gene.  If you have this gene or a family history of Alzheimer’s Disease, let me share with you 11 ways to prevent this tragic fate.

1. Exercise Faithfully

For people with the ApoE4 gene or a family history of Alzheimer’s, exercise is the single most important thing they can do to decrease this risk.  While exercise is good for everyone, the benefits seem to be most pronounced in people with the ApoE4 gene.

It doesn’t matter what form of exercise you do as long as you do something physical every day for the rest of your life.  In addition to exercise, make sure you minimize any sitting throughout the day.

2. Maintain a Perfect Weight

Following exercise, maintaining an ideal weight is absolutely critical for people with the ApoE4 gene or a family history of Alzheimer’s Disease.  Unfortunately, I have found that most people have no idea what their ideal weight is.  If you weigh more than your ideal weight this extra weight can turn the ApoE4 gene on.

People with the ApoE4 gene or a family history of Alzheimer’s need to have a body mass index (BMI) at least lower than 25 which is the bare minimum to no longer be considered overweight.  To learn your own BMI, here is an excellent online BMI calculator.

3. Keep Your Mind Active

Countless studies have shown that stimulating your mind over a lifetime can help to prevent Alzheimer’s Disease.  The same is true for people with the ApoE4 gene or a family history of Alzheimer’s.

4. Eat a Low Cholesterol Diet

New dietary guidelines in the U.S. will now stop recommending that people avoid cholesterol in the diet.  While dietary cholesterol does not affect blood cholesterol levels in most people, this is not true for the 25% of Americans who possess at least one cope of the ApoE4 gene.  For people with the ApoE4 gene, minimizing dietary cholesterol still matters!

5. Avoid Trans Fats and Minimize Saturated Fats from Animals

As with dietary cholesterol, saturated fats may no longer be dangerous to cardiac health as was once thought.  Once again, this is true for most Americans, not those with the ApoE4 Alzheimer’s gene.  For these people, minimizing saturated fats from animal products (meat and dairy) are critical to preventing dementia.

Trans fats are still rampant in processed foods, fast foods, bakery items, and restaurant foods.  Anything processed or prepared could be loaded with trans fats.   Even if the label says no trans fat this may not be the case due to loopholes in U.S. labelling laws.  You have to read the ingredient list carefully.  Trans fat for people with the ApoE4 gene are particularly dangerous.

6. Make 9 Servings of Fruits and Vegetables the Goal

The American Heart Association now recommends 9 servings of fruits and vegetables each day.  While fruits and veggies are good for everyone, people with the ApoE4 gene or a family history of Alzheimer’s seem to benefit the most.  Indeed, studies have shown that fruits and vegetables can decrease the risk of Alzheimer’s Disease by 76% in people with the ApoE4 gene.

7. Minimize Sugar

It goes without saying, if you want to protect your brain you need to minimize any added sugars or even foods that behave like sugar in the body.  This includes fruit juice and 99% of breads, pastas, crackers, pastries, breakfast cereals, white rice, french fries, etc. If you enjoy these foods, you can be part of the 1% to eat the healthier options I have discussed in other blog articles.

Many researchers now feel that any elevation in blood sugar levels can be toxic to the neurons in our brains.  Do your brain a favor and stick to lower glycemic foods to help maintain a healthy blood sugar level.

8. Use Supplements Wisely: B12, Fish Oil, Turmeric, and Vitamin D

Having the right amount of B12, turmeric/curcumin, and vitamin D can be protective of Alzheimer’s Disease in people with the ApoE4 gene or a family history of Alzheimer’s.  However, people with the ApoE4 gene need to be very cautious with fish oil.  Higher doses of fish oil in people with the ApoE4 gene can actually increase the risk of Alzheimer’s Disease.

I should point out here that eating fish has been shown to be very helpful in preventing dementia in many studies.  However, for people with the ApoE4 gene there may not be as much of a benefit.

 9. Avoid Smoking and Alcohol

Both smoking and alcohol activate the ApoE4 gene.  Thus, for people with the ApoE4 gene, abstaining from smoking and alcohol are important in minimizing the risk of dementia.

10. Minimize Stress

We all know that stress is dangerous to the brain.  Once again, this is most pronounced in people with the ApoE4 gene.  In these studies, perceived stress directly reduced memory.

11. Avoid too Much Iron and Copper

Iron and copper are critical micronutrients for health.  However, when levels of copper or iron get too high in the body this can trigger dementia.

Final Thoughts

Does Alzheimer’s run in the family?  Do you have the ApoE4 gene?  What have you found that has been helpful in maintaining a healthy brain?

Disclaimer

Do not self diagnose or treat based on anything you have read in this article.  I am not recommending genetic testing or any supplements in this article.  If you have a family history of Alzheimer’s Disease, please discuss with your physician which lifestyle changes would be most important to decrease your risk of Alzheimer’s.