Dr. John Day, Cardiologist

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Should I Eat Fish?

Do you like fish?  Based on its profound health benefits, you may decide to become a fish lover, if not one already.

If you eat at least two servings per week, studies suggest that you can extend your life by 2.2 years!  Not only will you live longer but fish will also decrease your risk of heart disease by 36%, help to prevent dementia, lower your triglycerides, and lower your blood pressure.

In this article I will discuss the health effects of eating fish and answer the question, should I eat fish?

My Fish Story

I did not always like fish.  In fact, I hated fish until this past year.  I hated the smell, texture, and taste.  Now, at the age of 47, I can say for the first time publicly that I like fish.

I am not really sure how I finally came to like the taste of fish.  It was something that happened very gradually.  As I became increasingly convinced of the health benefits of fish, I forced myself to start eating it.  Slowly, over time, I began to enjoy the taste.  Now I love my wild Alaskan salmon!

Indeed, it has been scientifically proven that people can learn to like foods they previously hated.  This was certainly the case with me.

Live 2.2 Years Longer by Eating Fish Study

Can eating oily fish really allow you to live longer?  Yes, according to a recent study by my friend, Dr. Dariush Mozaffarian, at Harvard University.  I should mention that Dariush and I did our residency training together many years ago at Stanford University in the 1990s.

In Dariush’s study of 2,692 people followed for 16 years, he found that the highest oily fish eaters not only lived 2.2 years longer but also had 40% lower risk of dying from heart disease, 47% lower risk of dying from a stroke, and a 45% lower risk of dying from an arrhythmia.

Dariush concluded in an interview that the minimum amount of oily fish needed to get these benefits seen in this study works out to be about two servings per week.  If a life long fish hater, like me, can learn to like fish at the age of 47 then this is something that we can all learn to like.

American Heart Association’s Fish Recommendations

Based on the very strong scientific data supporting fish in our diets, the American Heart Association recommends that we eat at least two servings of fish each week, preferably an oily fish high in the omega 3 fatty acids.  Despite these recommendations, less than 1 in 5 Americans follow these guidelines.  Even scarier is that about half of us really don’t eat fish at all.

Can I get all of my omega 3s from nuts and seeds?

Not all omega 3 fatty acids are created equal.  The omega 3 fatty acids in walnuts, chia seeds, hemp seeds, or flax seeds are the short chain omega 3s (ALA).  The omega 3s in fish are the long chain omega 3 fatty acids or EPA and DHA.  EPA and DHA have the best track record for long-term health benefits.

While the body can convert some of the shorter chain omega 3s from walnuts, chia seeds, hemp seeds, and flax seeds to EPA and DHA, most of us will be lacking in these critical omega 3s unless we eat fish.  For vegetarians, you can get your DHA and EPA from where the fish do, namely marine algae.

Why do so many people avoid fish?

I suspect that the media’s hyped fear of mercury, dioxins, and PCBs in fish has frightened so many people from eating this incredibly heart healthy food.  Fish is healing food for the heart and brain.

Unfortunately, these industrial pollutants have made their way into our food supply, including fish.  However, as long as you are eating the right fish in the right amounts you don’t need to worry about mercury, PCBs, or dioxins.  Let me explain.

Mercury and Fish

Unfortunately, the fish available to us today is not the same fish that was available to our ancestors.  Today, we have to worry about mercury toxicity with fish.

While the media would have us to believe that any fish will poison us with mercury that it absolutely not the case.  Many of my patients are afraid to eat fish based on all of these media reports.

Yes, it is true that some fish are high in mercury.  However, many healthy oily fish, which are high in the protective omega 3s, are also very low in mercury.  In general, the smaller the fish the lower the mercury content.  Some of the fish which are very high in omega 3s and yet very low in mercury include the following:

   -Wild Alaskan salmon

   -Atlantic mackerel

   -Sardines

   -Anchovies

   -Trout

   -Oyster

   -Herring

Selenium Prevents Mercury Toxicity

While the media has done a good job of scaring us away from fish due to mercury risks, what they don’t tell us is that selenium binds mercury and gets it out of our body.  Fortunately, many fish are also very high in selenium so any potential mercury risks in these fish is extremely low.

Previous studies showing harm from mercury in fish were done with shark or pilot whale meat which are very low in selenium. For example, just one serving of salmon, sardines, tuna, or shrimp nearly give you all of the selenium you need for the day.

As the right amount of selenium in your diet has been shown to help protect against cancer and heart disease, to make sure you are getting enough just one Brazil nut will give you all the selenium you need for the day.  Work closely with your doctor if you are taking a selenium supplement as selenium supplements have been shown to cause harm.

PCBs and Dioxins in Fish

Once again, the media would scare us from eating fish due to the risks of PCBs and dioxins.  While we should be frightened of PCBs and dioxins from industrial pollution, fish is not where we get most of these carcinogens.

For example, according to a Harvard University report, more than 90% of the PCBs and dioxins we are exposed to come primarily from animal meat, dairy, eggs, and to a much lesser degree from vegetables.  Thus, if you are really frightened of PCBs and dioxins then you should also limit your intake of animal meat, dairy, and eggs.

This Harvard University report also states that if 100,000 people ate farmed salmon, which has 16 times the amount of PCBs and dioxins as wild salmon, for 70 years that it would cause 24 deaths from cancer.  However, eating farmed salmon over this same period of time would also prevent 7,000 people from dying of heart disease!

For me, I want the best of both worlds.  I want all of the protection salmon has to offer without the risk of cancer.  This is why I choose wild Alaskan salmon which is 16 times lower in these contaminants according the the Environmental Working Group and I eat one Brazil nut each day.

Can I just take fish oil instead of eating fish?

Perhaps it is because you don’t like the taste of fish or that it just is easier to take a pill.  Unfortunately, when it comes to health it doesn’t work that way.  Many vitamins and supplements, including vitamins C and E, beta-carotene, folic acid, estrogen, and testosterone, have all been linked to heart disease or cancer.

Fish oil is no exception.  Even fish oil, with its healthy halo effect, has been linked to prostate cancer.

It is a combination of everything in healthy fish that provides us with the health benefits not just a concentrated form of the omega 3s.  Nutrition is so much more than just isolated and concentrated compounds.  If you don’t like the taste of fish it has been scientifically shown that you can retrain your brain to like healthy foods.  I know this was definitely the case with me.

Nutritional Benefits of My Favorite Fish

It was probably knowing all of the good things I was feeding my body that allowed me to start liking wild Alaskan salmon.  Here are some of the amazing health benefits you get from just one four ounce serving of this salmon according to WHFoods website.  Even better, all of these nutrients come with only 158 calories!

   -Vitamin B12: 236%

   -Vitamin D: 128%

   -Selenium: 78%

   -Vitamin B3: 56%

   -Omega 3: 55%

   -Protein: 53%

Dr. Day’s Personal Fish Rules

While my diet is primarily plant based, I do eat healthy fish at least twice weekly because of the compelling health benefits and also now because I like the taste.  It did take two years of forcing myself to eat fish every week before I finally started liking the taste.  Here are my personal guidelines to eating fish:

1. Eat fish twice a week.

2. Focus on oily fish with the omega 3s.

3. Avoid the fish high in mercury, dioxins, and PCBs.

4. Get the right amount of dietary selenium to bind mercury.

5. I avoid fish oil supplements due to the link to prostate cancer.

To get back to our original question, should I eat fish?  My answer would be yes given the many health benefits of fish.

Have you always liked fish or did you learn to like it like me?  Do you have a favorite fish? Please leave me a comment and let me know!

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Lose Belly Fat with a High Healthy Fat Diet

Could consuming a liter of olive oil weekly actually help you lose belly fat? According to the latest study, it does.

Indeed, numerous recent studies are showing that replacing simple carbs with healthy fats can help to shrink belly fat.

This goes against everything the American Heart Association and our government taught us for years about eating a low fat diet to lose weight and avoid heart disease. Even the most recent dietary recommendations from our government recommend eating up to a half pound of carbohydrate loaded grains each day.

What would happen if we replaced some of these grains with healthy fats? The key take away from this article is that eating healthy fats will not make you fat but rather could help you to lose the belly fat. It may seem counter intuitive but please read on…

My Transition to a High Healthy Fat Diet

I was no different that the typical American kid growing up in the 1980s. In the 1980s my diet was about 15% protein, 15% fat, and 70% carbohydrates. I dutifully followed the dietary guidelines at that time and drank skim milk, used low or non-fat items, and ate my recommended 6-11 servings of grain each day.

During this period of time, and into the 1990s, I was extremely active physically.  I regularly ran marathons and even started training for an ultra marathon.  Despite these extreme levels of exercise I was still gaining weight on my high simple carb diet (lots of breads, pastas, and pastries).

Things only got worse in the 2000s when high blood pressure, high cholesterol, eosinophilic esophagitis, and an autoimmune disease, among other conditions, also developed. As part of my health turn around a few years ago, I dramatically changed my diet by increasing vegetables 4x and fully embraced a diet full of healthy fats.

Today, my diet is still about 15% protein but now my carbs have dropped from 70% to 40-45%, and my fat has gone from 15% to 40-45% of my diet. The simple carbs have mostly been eliminated  and my nuts and seeds consumption have increased about 10x. Eventually, our government will be forced to acknowledge the ever growing body of scientific data that a diet higher in healthy fats can reverse heart disease, allow us to lose weight, and feel better.

A Balanced Diet

You can’t exclude one of the three macronutirents (fat, protein, carbs) from your diet and expect a healthy outcome. A healthy diet is a healthy balance among the three macronutirents.  My 40-45% fat diet is much higher than the 20-35% currently recommended by our government.

At the same time, my 40-45% fat diet is much lower than the ketogenic diet followers who often target somewhere around 70% fat intake. For me, it is important to keep everything in balance and avoid the extremes until the scientific literature, based on long-term studies, can support these approaches.

From a historical perspective, it is interesting to note that in the late 1800s/early 1900s protein was considered unhealthy. In the late 1900s it was fat that was demonized.  Now in the 2000s it is the carbs.

We absolutely need the right carbs for optimal health, nutrition, and energy. For example, from a scientific stand point, the data supporting fruits and vegetable carbs for long-term health, including cancer and heart disease prevention, are irrefutable.

The Most Recent Study on a High Healthy Fat Diet

In one of the most scientifically rigorous diet studies ever done, researchers have shown that once again people are healthier with a high healthy fat diet. In this study, researchers analyzed 5,801 people randomized to one of three diets.  The three diets evaluated in this study were as follows:

1. Mediterranean Diet with one liter of olive oil each week
2. Mediterranean Diet with one serving of nuts daily (walnuts, almonds, and hazel nuts)
3. Standard low fat diet

The Mediterranean Diet is one also high in fruits, vegetables, fish, nuts, and seeds.  There was no exercise or weight loss goals with this study.  It was purely a diet study for 5 years.

After 5 years, researchers found that those who ate the Mediterranean Diet, supplemented with either a liter of olive oil each week or a handful of nuts each day, had less belly fat and lower triglycerides.  Not only this, the people eating the high healthy fat diet were also 35% (olive oil) and 28% (nuts) more likely to reverse the deadly metabolic syndrome.

Metabolic syndrome is a dangerous condition when at least three of the following are present in a person: excessive belly fat, high blood pressure, high blood sugar, high triglycerides, or low good cholesterol (HDL).

While I do love olive oil, I am still amazed that the people randomized to the olive oil group in this study could eat a liter of olive oil each week and yet not gain weight!

Why are fats healthy?

Don’t be fooled by the fat free label you see in the grocery store! Healthy fats are part of a healthy diet.

Fats are healthy as there are essential fats that our bodies cannot make and that we must get from our diet. Healthy fats are also filling and don’t mess up our hunger hormones and metabolism like a high carbohydrate diet can. The right fats can even reverse heart disease and keep us healthy, vibrant, and strong.

Keep the Right Carbohydrates

In this article I do not want to demonize all carbs.  The simple carbs, like sugar, wheat flour, white rice, processed foods, etc. should be minimized. The complex carbs, like fruits and especially vegetables, should be encouraged at all meals.

I fully support the current 9 daily servings of fruits and vegetables recommended by the American Heart Association. Of these nine daily servings, I would recommend that at least six be vegetables.

What are the healthy fats?

You may be wondering, what are some other healthy fats other than the olive oil and nuts mentioned in this article. Seeds are also loaded with healthy fats. Coconut, avocado, and olives are other great fats. Also, be sure to include the omega 3 fatty fish like Wild Alaskan Salmon, Atlantic Mackerel, sardines, or anchovies.

Dr. Day’s Personal Fat and Carb Rules

Here are my rules as to how I approach fats and carbs in my own diet.

1. I minimize simple carbs

2. I eat at least 9 servings of fruits and vegetables daily (healthy carbs)

3. I eat at least 1 serving of beans or lentils daily (healthy carbs)

4. I eat a variety of nuts and seeds every day (healthy fats)

5. I use organic extra virgin olive oil or coconut oil (healthy fats)

6. I eat Wild Alaskan Salmon at least twice weekly (healthy omega 3 fats)

7. I eat some form of omega 3 fats every day (salmon, walnuts, flax seeds, hemp seeds, chia seeds)

8. I do all I can to avoid hydrogenated/partially hydrogenated oils, vegetable oils, and other “Franken oils” found in processed foods

Do you still find yourself afraid to eat fats, even healthy ones? Why is this? Have you found better health by liberally eating healthy fats? Tell us about it!

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Should I go gluten free to lose weight?

One in three Americans is now going “gluten free” according to a recent survey.  It is interesting that 33% of Americans are excluding gluten from their diets, while only 1% of Americans actually have celiac disease, an autoimmune disease caused from wheat gluten.

Other wheat problems include non-celiac gluten sensitivity which is estimated at 1-6% and less than 1% of the population have documented wheat allergies.

As a cardiologist I am frequently asked by my patients, “should I go gluten free?” In this article I share my experience with going gluten free and explore the reasons for and against going gluten free to lose weight.

My Gluten Free Experience

As many of you know, at the age of 44 I found myself overweight, suffering from multiple chronic medical conditions, and on five medications.  Even as a doctor I did not know where to turn next for help.

I thought that at least if I could lose some weight my health would improve.  I tried reducing what I ate each day but I was not losing any weight. The diet thing just was not working for me. I was hungry all of the time and the free donuts in the doctor’s dining lounge of my hospital kept calling to me.

At that time it was very popular among my cardiology colleagues to go gluten free. In my desperation, I  thought that going gluten free might also help me.  My “gluten free” colleagues all challenged me to give it a “30 day test” to see whether or not I felt better. I thought that since 1-6% of Americans are gluten sensitive, perhaps dropping gluten could help me to feel better as well.

I was excited about the prospect. Yet, just two days into my first attempt at going gluten free, I caved in. My donut, bagel, and pizza withdrawals were too great. I obsessed about the forbidden foods and never felt satisfied with the meals I did eat. With these overpowering cravings, I definitely did not feel any better in the short term. So, almost as soon as I began, I decided to give up.

Two months later, still feeling not very well, I decided to give the gluten free diet another try. This time, I decided to imagine that I had “gluten antibodies” and that I was destroying my body with each donut, bagel, and slice of pizza. In reality, I did not have “gluten antibodies,” but my approach worked to some degree—I lost 10 pounds after two months.

After two months I did not lose any more weight and did not feel much better.  While giving up the junk food helped initially, it wasn’t long before I found gluten free alternative junk food for everything that I craved–cookies, pizza, bagels, you name it. With the re-entry of these foods came the re-gaining of the weight.

Why are so many people having problems with gluten?

Unfortunately, the wheat we eat today is not the wheat our grandparents or great-grandparents ate.  Modern wheat is packed with gluten, far more than what our ancestors ate. Also, modern wheat is in countless processed food products. The toxicities from gluten-loaded wheat and all of the pesticides and other chemicals used in the wheat growing process are triggering many people to develop gluten sensitivities, food allergies to wheat, and full-blown celiac disease.

Celiac Disease is Four Times More Common Today

Celiac disease is increasing at an epidemic rate.  For example, from a recently published study, undiagnosed celiac disease has increased 4 times among Air Force recruits in the last 50 years.

In this study, researchers went back to 9,133 frozen blood samples from Air Force recruits saved from 1948 to 1954 and tested them for gluten antibodies.  They then tested for antibodies to gluten in a modern day similarly matched group of 12,768 people.  Based on their findings, people are now more than 4 times likely to have antibodies to gluten (celiac disease).

We still do not know why so many more people are developing celiac disease today.  Theories range from the increased amounts of gluten we are eating to C-sections to antibiotics to a changing gut flora from our modern life.

Is gluten free healthy?

Is eating a gluten free diet healthier than one with gluten? The short answer is: it depends.  If you have antibodies to gluten (celiac disease) of course you will want to avoid gluten.  For many people who may not have celiac disease, but are gluten sensitive, going gluten free will likely help with your gastrointestinal challenges.

For the rest of us, whether or not gluten free is healthy or not really depends on what you eat instead.  If your diet stays the same except that you now eat gluten free varieties of the same processed foods, then you haven’t really gained anything.  You may even be worse off.

On the other hand, if you replace wheat gluten with fruits, vegetables, nuts, seeds, legumes, or wild fish it could be incredibly healthy. The problem with the Standard American Diet is that we eat too many processed grains, including wheat flour. This processed grain overload is a significant cause of our obesity epidemic.

Even if you tolerate gluten, it may be a good idea to limit the wheat gluten you do choose to eat, considering how much more gluten is in today’s wheat.  For example, non-gluten whole grains such as quinoa could be a healthier option. Alternatively, if  you really do like wheat, like me, try choosing low glycemic sprouted  “whole grain” varieties, like Ezekiel Bread, that are not made with wheat flour. You can buy Ezekiel products at most health food stores.

Should I go gluten free to lose weight?

For most people, going gluten free does not cause them to lose weight. Now that going gluten free is so popular, you can find whatever junk food you crave in gluten free forms. These highly processed gluten free products may even be worse for you than the wheat they were meant to replace.  In fact, I have seen patients actually gain weight eating these “gluten free” junk food options.

The only way to make gluten free a good weight loss option is to replace your processed grains (flour) with real food. If you can replace your grains and processed foods with appropriate portions of real food, physical activity, restorative sleep, and stress management you will see your weight drop quickly.

My Gluten Rules

1. If you have celiac disease, religiously avoid gluten. As many people have undiagnosed celiac disease, I recommend gluten antibody testing for everyone. Talk with your doctor about getting tested.

2. If you think you might have gluten sensitivity, try going gluten free for 30 days. If you feel better off gluten then you probably have a gluten sensitivity.

3. If you have an unexplained medical condition, there is a chance you could have an undiagnosed wheat allergy. Once again, try going off gluten for 30 days to see if things improve.

4. Even if you don’t have celiac disease, gluten sensitivity, or a wheat allergy, most likely your diet and health could benefit by eating less or different grains. Try cutting back or mixing up the grains you do eat. If you love your wheat, avoid the high glycemic wheat flour which is just like sugar to the body.  Try real whole grain sprouted Ezekiel bread which does not have any flour.

5. If you decide to go gluten free for whatever reason, replace the wheat with fruit, vegetables, nuts, seeds, legumes, or wild fish not the highly processed gluten free food products.

6. If you have a question about gluten issues, please talk with your doctor.

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9 Signs You May Have Vitamin K2 Deficiency

You may have a vitamin K2 deficiency.  Sadly, few people have even heard about this vitamin.  In this article, I share the nine signs of vitamin K2 deficiency and what you can do now to reverse a vitamin K2 deficiency.

What is vitamin K1?

Most people have heard of vitamin K.  This is vitamin K1.  Vitamin K1 is important for blood clotting.  Vitamin K1 comes primarily from green leafy vegetables.

How much vitamin K1 do you need?

Many experts feel that the current recommended dose of vitamin K1 is too low to prevent disease.  The current government recommendations are for just 90 mcg of vitamin K per day.  To put this in perspective, you can easily get 10 times the amount of vitamin K the government recommends from just one cup of cooked kale or spinach.

What is vitamin K2?

Vitamin K2 is different than K1.  The main role of vitamin K2 is to put calcium where it belongs in the body, like your teeth and bones, and keep it out of your brain, heart, and other places where it can cause premature aging and an early death.

Do you need to worry about getting enough vitamin K2?

Historically, it was felt that you did not need to worry about a vitamin K2 deficiency.  The reasoning was that your body would make all the vitamin K2 it needed from vitamin K1.

New research suggests this may not be the case.  Most people eating a Western diet are deficient not only in vitamin K1 but K2 as well.

Unfortunately, there not a good test to see if your have a vitamin K2 deficiency.  There are also no government recommendations on how much vitamin K2 you need.  To help assess for a possible vitamin K2 deficiency, below are nine signs that you may have a vitamin K2 deficiency.

9 Signs You May Have Vitamin K2 Deficiency

1. You bruise or bleed easily.

Vitamin K was named “K” after the German word “Koagulation” or clotting.  If you are deficient in vitamin K1, you will bruise or bleed easily.

As much of the vitamin K2 in your body comes from the body’s conversion of vitamin K1 to K2, if you have a vitamin K1 deficiency you will also have a vitamin K2 deficiency.  To ensure enough vitamin K2 for your body, make sure you eat a large serving of green leafy vegetables every day.  Kale, spinach, or broccoli are all excellent choices.

2. You have osteoporosis or broken bones.

Many studies have linked low K vitamins to a higher risk of low bone mass, osteoporosis, or fractures.  Vitamin K2 is especially important for normal osteocalcin function. Osteocalcin is a protein critical for healthy bones.

As vitamin K2 is critical for good bone health, this could explain why the Japanese and Chinese have much lower rates of osteoporosis or fractures even though few eat calcium-rich dairy.  Indeed, the Japanese and Chinese both eat diets very high in green leafy vegetables and fermented soy, such as natto, which has the highest known levels of vitamin K2 of any food.

3. Your mouth is full of cavities.

Vitamin K2, through its effects on osteocalcin, not only strengthens your bones but your teeth as well. In our research of Chinese centenarians, one study of rural Chinese centenarians showed that centenarians eating a diet high in the K vitamins, without any processed carbohydrates, were able to keep all of their teeth at age 100 despite never brushing.

4. You have heart disease.

Vitamin K2 may be one of the most overlooked strategies to decrease your risk of heart disease.  Based on the Rotterdam Study of 4,807 people, those with the highest dietary intake of vitamin K2 had a 57% lower risk of heart disease.

5. You have diabetes or pre-diabetes.

Through complex mechanisms, vitamin K plays an important role in regulating glucose.  Indeed, getting enough of the K vitamins can cut your diabetes risk by 51%.

6. You have an autoimmune disease.

The K vitamins may also play a role in autoimmune diseases.  One study showed that vitamin K2 may not only prevent osteoporosis in people suffering from rheumatoid arthritis, but that it may also help to put rheumatoid arthritis into remission.

7. You are becoming forgetful.

A low vitamin K diet is linked to dementia and Alzheimer’s Disease.  This may be due to calcium plaque build up in the brain from a vitamin K2 deficiency.

8. You have taken a lot of antibiotics.

Antibiotics not only kill the bad bacteria but your healthy gut bacteria as well.  If you have recently been on antibiotics, probiotics and fermented foods may help you to restore the beneficial vitamin K producing gut bacteria.

9. You take Coumadin (warfarin)

While Coumadin (warfarin) is very effective at preventing blood clots, it can also cause a vitamin K2 deficiency.  This medicine works by blocking vitamin K.

If your doctor has prescribed this medication, it is still important to eat green leafy vegetables for optimal health.  In order to do so, you will have to work very closely with your healthcare provider.  If you eat the exact same amount of vitamin K in your diet each day, then your health care provider can dose your Coumadin (warfarin) appropriately.

How do you get enough vitamin K2?

The very best way to prevent a vitamin K2 deficiency, is to eat a large serving of green leafy vegetables every day.  Green leafy vegetables are sky high in vitamin K1.  Your body will then convert vitamin K1 to vitamin K2.

Fermented foods, like fermented soybeans, sauerkraut, and some cheeses, such as brie or gouda, can all be good sources of vitamin K2.  Even though yogurt and kefir are also fermented foods, the grocery store variety contains the wrong bacteria for vitamin K2.

Other good sources of vitamin K2 include liver and grass fed chicken eggs.  Of all these sources, nothing even comes close to the amount of vitamin K2 found in natto or fermented soybeans.

Indeed, one serving of natto has enough vitamin K2 for an entire week. Not only is natto loaded with vitamin K2, but this fermented food may also help your gut flora.

Natto is a delicacy in Japan.  Unfortunately, most Westerners cannot tolerate the taste.

While natto certainly isn’t my favorite food, I have learned to tolerate it.  I have eaten a spoonful of fresh natto everyday for the last few years.  You can find fresh natto at your local Asian food store.

Can you get too much vitamin K?

Fortunately, I could find no reported cases of vitamin K toxicity from eating too many green leafy vegetables.  Unlike other fat soluble vitamins, very little vitamin K is stored.  Thus, vitamin K toxicity from food isn’t known to develop.  On the other hand, it is always possible to overdose on vitamin K from supplements.

Ongoing Vitamin K2 Studies

I have recently learned of a study being done in the Netherlands to test the effect of vitamin K2 in reversing heart disease.  This study will be the first high quality study to be done on this important vitamin.

Hopefully, vitamin K2 will be shown to reverse coronary calcification or plaque build up in the arteries of the heart.  Any reversal of heart disease will be measured very accurately by CT scans.

This study is expected to be completed by the end of 2018.  Until that time, I will continue to “enjoy” my spoonful of fresh natto each morning.

Take Home Message

The key message of this article is that vitamin K1 and vitamin K2 deficiency is common in the Western world.  This is a very preventable condition.

To prevent or reverse a vitamin K2 deficiency, make sure you have a heaping serving of green leafy vegetables every day.  Also, some fermented foods and grass fed dairy may also help you to get enough vitamin K2 in your diet.

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Is Dairy Good for You?

“Should I be drinking cow milk?” a class member asked Jane last week.

“Do you like it?”

“Yes. Well then should I be drinking skim, 1%, 2% or whole milk? I am so confused. Everyone is saying different things!”

“Listen to your body. It has the capacity to tell you what it needs.”

The problem is that we receive so many mixed messages, even mandates, from so many outside sources that we stop looking inward for the answers.

For example, our government tells us we need 3 servings of low or non-fat dairy each day.

The dairy industry has convinced us that if we don’t drink our milk we will have weak bones.

Medical studies here in the U.S. and abroad show that these recommendations have no scientific basis.

In response to many of your questions via our website and in our seminars, I will address the important question of dairy and our health.

Dairy is certainly a very controversial topic and the scientific data are not yet clear if dairy is disease causing or disease preventing.

Let me share with you what we DO know and what we do NOT know about dairy, along with my recommendations, based on the scientific data available at this time.

My Dairy Story

I grew up with the typical American lifestyle. My parents encouraged me to drink milk with every meal. I thought that milk would help me grow strong bones and I drank huge quantities of it.

As I got older I began struggling with digesting my dairy.  Sometimes I would have a bowl of cereal with milk and then have my stomach become bloated and hurt for hours.  As I became more and more lactose intolerant I gradually stopped drinking milk but I still had my daily slice of pizza.

Eventually, as many of you know, by my mid-40s I found myself overweight with high blood pressure and high cholesterol.  I also had developed a severe case of eosinophilic esophagitis from a food allergy and an autoimmune disease.

The eosinophilic esophagitis was so bad, that at times the only thing I could keep from getting stuck in my throat were liquids.  This was something that developed at a young age and only seemed to get worse with time.

It was in this health crisis that I completely changed my diet.  Knowing that dairy is one of the major causes of food allergies, I cut out the dairy along with the wheat flour, sugar, and processed foods.  I also quadrupled my vegetable intake and started eating nuts, seeds, and beans or lentils every day.

I’m not exactly sure what my food allergy was,  but my 30+ year history of eosinophilic esophagitis completely went away along with being overweight, high blood pressure, high cholesterol, and autoimmune disease.

Through this experience, I was left with the question, is dairy good for you?

Will dairy strengthen my bones?

With the aggressive advertising, the dairy industry attempts to convince us that if we don’t dutifully eat our 3 servings of dairy each day we will have weak bones.

According to the Nurses Health Study involving 77,761 people, dairy did not protect against fractures.  Conversely, those who ate the most dairy were most at risk from bone fractures.

In fact, study after study has shown that the risk of a bone fracture is much LOWER in countries like Japan or China, where they rarely eat dairy, than in the US. Could dairy actually be putting us more at risk of osteoporosis and bone fractures? At a minimum, it is clear that dairy is not a requirement for healthy strong bones.

Will dairy make me gain weight and become inflamed?

We know that weight gain and inflammation are among the major causes of chronic medical conditions. Indeed, heart disease, dementia, and cancer can all be caused by being overweight and inflamed.

Does dairy contribute to this problem?

While well-known doctors, such as Dr. Mark Hyman, have argued that dairy is a big cause of inflammation and weight gain, the overall body of published medical literature do not yet support this view.

Some studies do indeed suggest that dairy increases weight gain and inflammation whereas other studies report the opposite.  Until we see a preponderance of data going one way or the other, I am going to keep an open mind about the role of dairy in obesity and inflammation.

Gut Flora and Dairy

A diet high in dairy can have a fast and significant impact on gut flora.  After just two days of meat and dairy, we can quickly switch our gut bacteria to more bile loving bacteria such as Bilophila and Bactericides.  Bilophila has been associated with inflammation and gastrointestinal problems and Bacteroides has been associated with weight gain.

The ideal gut flora that promotes maintenance of a healthy weight is one where Firmicutes dominates.  This gut flora is found with diets high in plant-based foods.

The best dairy for our guts may be yogurt with live bacterial cultures. Probiotics have been associated with healthier gut flora.

Will dairy raise my cholesterol and cause heart disease?

While it has long been known that dairy can raise cholesterol levels, does this translate into more heart attacks? While the data are not enitrely clear, at this time it does not appear that dairy increases the risk of heart disease.

Does dairy increase my risk of cancer?

This has been an area of intense research.  The strongest link appears to be with dairy and prostate cancer.  For example, in the Physicians’ Health Study of 20,885 male physicians, researchers found a 32% increased risk of prostate cancer in people who ate 2.5 or more servings of dairy each day.

For women the link between dairy and cancer is not as strong.  However, one study of 90,655 women did link high fat dairy products with breast cancer.

Should I eat full fat or low fat dairy?

Thanks to the anti-fat movements of the 1980s, full fat dairy has almost been wiped out of our grocery stores.  However, recent data suggests that ironically higher fat dairy may actually be better than low fat dairy in preventing weight gain.

Dairy Contaminants and Organic Dairy Products

Unfortunately, dairy can be a significant source of contaminants and toxins in our bodies. Too often cows are pumped full of antibiotics and hormones which can alter our own hormones, metabolism, and gut flora.  Also, PCBs and dioxins, which are known to cause cancer, are frequently found in dairy.

Many of these contaminants have prompted savvy consumers to turn to organic dairy products to avoid the hormones and antibiotics.  Unfortunately, the higher heat pasteurization process used for organic dairy products may have unintended nutritional and/or health effects.

Unexplained Medical Conditions and Dairy

Often times people have unexplained medical conditions that their doctors cannot figure out.  Despite thousands and thousands of dollars worth of medical tests, no one can seem to figure out what is going on.

In situations such as these, it is worth considering food allergies.  The two biggest causes of food allergies are wheat and dairy. I have seen many cases where unexplained medical conditions have mysteriously resolved when the offending food item was removed from the diet.

My Assessment of Dairy

To get back to our original question, is dairy good for you, dairy is certainly controversial and we do not yet have clear answers. The bottom line is that if you don’t like dairy there is no need to eat it. Conversely, if you love dairy, there is no need to stop. Dairy is a personal decision.

1. There is no clear proof that dairy will strengthen your bones.

2. There is no scientific basis to our government’s recommendations that we must eat 3 servings of low or non-fat dairy each day.

3. We do not know if dairy is disease causing or disease preventing.

4. The best dairy is probably yogurt with live bacterial cultures.

5. We do not know if full fat or low fat dairy is best.

6. Dairy is a significant cause of food allergies.

7. Dairy is a personal decision.

The bottom line: if you like dairy, enjoy it. If you do not like dairy, you do not need to feel compelled to consume it to maintain your health. If you have specific questions about dairy and your own personal health, please talk to your physician.

How do you feel about dairy? Do you feel better with dairy in or out of your diet?

I can find all sorts of reasons to eat. I don’t even need to be hungry!

Just this afternoon, I finished a very healthy and satisfying lunch, and it was time to go back to work. My first thought was, “I’m going to head out to the garage freezer and see if we have any chocolate out there.”

Having quite a bit of experience with this faulty thought process, I caught myself and asked, “Jane, are you really hungry?”

The answer: “No.”

“What do you really need right now?”

The answer: “I am tired but I feel I need to get back to work. I have so much to do. Instead of giving myself permission to rest for a few minutes, which is what I really need, I thought I’d try eating some chocolate and keep going.”

Aha! The truth!

I decided that I would honor my real need to rest for 20 minutes before I went back to work and assured myself that I could eat the chocolate later, if I still wanted it.

Rejuvenated, I went back to work, and made it through the rest of the day without feeling any pull from the chocolate.

This week, in our seminar, we explored the false promises of these sugary and fake foods.  They tell us that they will meet our needs, when really they just make us want more of them and less of what our minds and bodies really need.

When we look beyond the confusion of the labels and marketing of fake food products, it’s crystal clear that simply eating real food when we are hungry is the way to nourish our bodies.

So, why can’t we implement this knowledge and eat only real food only when we’re hungry?

Why are we lured in by these fake food products, often when we’re not even hungry?

The Top Ten Reasons We Eat

Here are ten of our favorite reasons to eat.  Do any of these sound familiar to you?

1. I am tired

“I am tired, so I think I’ll eat something.”

2. I am procrastinating

“I don’t want to do this, so I think I’ll eat something.”

3. I am happy

“I am happy! Let’s eat!”

4. I am sad

“I don’t want to deal with these feelings, so I think I’ll eat something”

5. I am thirsty and need water

“My body is sending me a signal that it needs something, I’d better eat.”

6. I am with people

“Here we all are with all this great food! Let’s eat!

7. I am alone

“I am alone—no one will see me eat this.”

-OR-

“I am lonely, maybe eating something will make me feel better.

8. I feel stuck

“I don’t see any other way to meet my needs right now, what can I eat to feel better?”

9. I see food

“Oh, that looks good! I wasn’t even hungry, but I think I’ll have just one.”

Our seminar participants came up with many more favorites, including: I’m bored, It’s family tradition, I’m stressed, I’m rewarding myself….

But, here’s the one real reason to eat that will actually meet our needs:

10. I am hungry

“I am looking forward to a nutritious, satisfying meal.”

Separating the Truth from the Lies

Here’s the lie in the first nine (or so) reasons to eat:

I can fix the problems in my life or make the good things better in my life by eating.

We can eat and eat and eat until we feel stuffed, but are never satisfied. Eating for these reasons can never satisfy us because we are not addressing the real issues.

Here’s the truth in the last reason, number 10–eating because we are hungry:

“My body is ready for nourishment. I am going to honor it and give it what it needs. I am going to be satisfied because I am eating for true hunger and giving it real food.”

When I eat for any reason other than hunger, more often than not, I turn to the fake and sugary foods which lie to my brain and lie to my body that they can meet my needs and that what I really need is more of these “foods.”

How to Interrupt the Cycle

The key to interrupting this cycle and developing healthier behaviors is to become aware of the cues that precede our reach for the unhealthy/unnecessary stuff, insert ourselves by asking a few questions, and provide ourselves with a different option that satisfies our true needs.

The last chapter of Charles Duhigg’s book, The Power of Habit offers a helpful formula. I highly recommend this fascinating collection of stories and case studies, which illuminates how habits develop and the enormous consequences that can result.

I also highly recommend Susan Albers’ Eating Mindfully for an in-depth exploration of the habits that trap us in emotional eating cycles and strategies to return to mindful eating.

Here are the three questions I’ve learned to ask myself when I feel the urge to grab something to eat:

1. Am I hungry–do I feel like eating real food?

If I am thinking about eating fake sugary food items, and I can’t think of something healthy and nourishing that I want to eat, the chances are high that I am looking to eat for reasons other than true hunger.

2. What do I need right now?

If I can’t think of something nourishing that I want to eat, I can ask myself what I am actually feeling and needing. More often than not, I am feeling tired or procrastinating doing something I know I need to do but don’t want to do.

3. What options can I give myself?

When I want to reach for junk food, I am usually in a situation where I feel I can’t meet my needs otherwise—usually at work. But there is always something I can do to interrupt this cycle. If I am tired, I can close my eyes and breath for a few moments and commit to giving myself time to rest or meditate when I finish a project. If I am looking for distraction, I can set a time for 5 minutes, go on a walk, listen to a podcast, call a friend, etc..

In each case, I can interrupt the cue-reward cycle with a question and an option. Then, I can invite myself to wait until I am actually hungry to eat and offer myself real food first.

Taking a minute to check in by asking myself these questions and giving myself other options dissolves the seeming desperate urge to eat foods I don’t need and enables the overall health and well-being I desire–one mindful choice at a time.

Please share with us! What have you found to be most helpful as you strive to eat mindfully?

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Does Stress Cause Weight Gain?

Do you feel tired, have difficulties sleeping, weigh more than you should, experience head aches, or have digestive problems?

If you answered yes to any of these questions, chances are that you are part of the 77% of us that feel the weight of chronic stress every day. The paradox of our modern society is that with our ever increasing “conveniences,” life is becoming more complex and stressful.

We are living lives our bodies were not designed to live and our waistlines are expanding. Increasingly, we find ourselves inside all day long, not using our bodies to work and not eating real food. Additionally, studies show that the more time we spend keeping up with news, on Facebook, and watching TV, the more stressed we become.

Whether we realize it or not, these things are putting a stress on our bodies and our minds. It creates a negative spiral. The more stressed we feel, the more we turn to these things that are actually causing our stress.

What is Causing Our Stress?

Just what is causing 77% of us to feel so much stress?  According the Stress in America 2013 Report by the American Psychological Association, the top 5 causes of our stress are in the following order:

1. Health (family or personal)

2. Money

3. Work

4. Economy

5. Family responsibilities

How Stress Recently Threw me Off Balance

I recently finished a difficult week of being on call at the hospital.  As a cardiologist this means that I am available 24/7 for a week to help our patients.

The work load is intense and I am constantly receiving calls and on the run helping patients throughout the hospital.  With these hectic days, I am lucky if I can even carve out 5 minutes to eat.

The stress of racing to keep up really threw my eating off balance.  I was craving junk, I was hungry all the time, and my energy was depleted.

In my attempt to eat I did it all wrong for several days.  I just wanted to kill the hunger pains.

Here’s how my thought process went:  “I have no time to eat, but I’ve got to get something fast so I can keep working. I’ll just get a slice of veggie whole wheat pizza and make sure I’m getting in some steps while I eat.  Also, I am so depleted physically, I think I’ll just take a few swallows (three to four to be exact) of Diet Coke from this free soda dispensers in the staff area.”

It’s a vicious cycle, and I knew it.  I eat pizza and drink Diet Coke and it just makes me want to do it all over again.  It’s not real food and it’s not giving my body what it needs.

When I am stressed, I have a raging appetite.  I think about food all of the time and it is hard to feel full.

The only thing that keeps me from putting on extra weight during periods of intense stress is that I keep a very detailed food and nutrition log each day on my iPhone. Somehow, this tool helps me to get back on track more quickly when I lose my way.

Hormonal Changes to Our Body with Stress

Just how does stress cause weight gain?  In addition to cravings and the desire to overeat, stress has many other effects on me.

Even though my phone was not ringing during the night when I was on call, I started having problems sleeping again. I also had difficulties engaging with my family in the evenings.

It turns out that all sorts of things were out of balance in my body due to stress.  Let’s take a look at what’s happening in our bodies when we are under stress.

1. High Cortisol

When we are stressed, our bodies release cortisol.  The two main effects of cortisol are to raise our blood sugar and shut down our immune system.

When our blood sugar goes up insulin levels also go up.  Insulin is the main hormone in our body that causes us to store our calories as fat on our body.

Insulin also makes us hungry. Cortisol decreases leptin so our brains never get the signal we are full.  Another hunger hormone, ghrelin, is increased.

Of course, when our immune system is suppressed we are very likely to get sick. Have you or someone you know ever taken prednisone, a Medrol Dose Pack, or another steroid before?  What happened with the surging cortisol from these steroids?

Did you or someone you know experience an increased appetite and gain weight? The same thing happens when we feel stress.

2. High Adrenalin

Adrenalin for short periods of time, i.e. during intense exercise, can feel good and strengthen the body.  However, when the adrenalin is never shut off, like with chronic stress, it wears out the body.

In particular, chronically high levels of adrenalin cause plaque build up throughout the body leading to heart attacks and strokes.  It also raises blood pressure and is associated with back and other joint pains.

3. Low Thyroid Hormone

When we are exposed to chronic stress, thyroid hormone production generally decreases. Low thyroid hormone makes us tired and causes us to gain weight by slowing our metabolism down.

4. Low Growth Hormone

When children are exposed to constant high levels of stress, they can develop a medical condition called stress dwarfism.  This condition causes their bodies to stop producing growth hormone.

Children with stress dwarfism not only stop growing but the development of their cognitive abilities slows as well. Chronic stress can also cause growth hormone deficiency in adults, causing us to lose muscle mass, gain more fat, and lose our energy.

5. High Insulin

Not only is our insulin increased from toxic cortisol levels when we are stressed, but our cells also become resistant to the effects of insulin.  This causes our pancreas to make even more insulin.

With surging levels of insulin, we are then at high risk for diabetes.  As the insulin levels go up even more with stress, our body goes into fat storage mode and we feel compelled to eat even more.

11 Ways to Stop Stress from Making Us Gain Weight

The first step to preventing weight gain from stress is to recognize your stress. Modern life is incredibly stressful.  If we don’t actively do something everyday to keep stress in check, stress may affect our health. Let me share with you my 10 very best tips:

1. Track Yourself

When I find myself under intense stress, I have to be incredibly careful, or I will reach for the pizza and Diet Coke wherever I am.

This is why, when I am feeling stressed, I track myself. Stressed or not, in general, most of us eat much more than we think we do.  For many of us, tracking what we eat is the single most effective tool to bring awareness of what we are actually eating, otherwise weight gain will likely occur.  This is only magnified when we are stressed.

Tracking tools that have brought me the greatest success include my free healthy habit tracker app or an app on your smartphone like Lose It. While I am not a fan of “counting calories” using some sort of a tracking system is the key to successfully avoiding weight gain during a stressful period of time.

2. Name 3 Things You Are Grateful for Daily

Gratitude puts everything in perspective.  One of the biggest causes of stress is that our expectations are not being met.

If we focus on the blessings we already have instead of what we lack we can help to drive chronic stress out of our lives. This is why my free healthy habit tracker app requires us to physically enter 3 things we are grateful for each day. If we focus on the blessings we already have, instead of what we lack, we can help to drive chronic stress out of our lives. 

3. Exercise and Log 10,000 Steps Each Day

Our ancestors did not have the same problems with stress that we do today.  They worked hard outside each day which caused their levels of cortisol, adrenalin, thyroid hormone, growth hormone, and insulin to return to normal levels.

It is next to impossible to get all of these hormones back to normal levels if we sit all day long. Our bodies were designed to help keep stress levels under control by daily physical activity.

This is why I encourage people to get a daily dose of exercise and to log 10,000 steps each day.  The exercise gets our hearts moving and the steps make sure we use our muscles through the day.

4. Spend At Least 20 Minutes Outside Daily

In our modern fast paced stress-filled lives we have forgotten what it is like to go outside each day.  Even our ancient ancestors did not sit in caves all day long.  

They knew the value of getting outside. Spending time outside has been shown to reduce stress and hunger hormones.  It also helps with sleep. 

5. Set a Bedtime Alarm Clock

Do you feel like there just is not enough time in the day? If so, you are not alone.

We try to catch up on things we need to get done or even just relax with the TV or the computer late at night. I have found that the number one reason why we are so sleep deprived is that we don’t have a consistent bedtime.

Rather than set the alarm clock in the morning try setting it at night. The rules are very simple.  Set the alarm clock for a time like 10 pm.  You cannot turn the alarm clock off until you are in bed with the lights out. With a goal of at least 7 hours of sleep each night it will allow us to help manage our stress.

6. Eat Real Food

When we are stressed out, we are generally driven to eat anything but Real Food.  The hormonal imbalance from stress drives us to eat sugar and processed foods.

If we can eat 9 servings of fruits and vegetables, at least 1 serving of nuts or seeds, and at least 1 serving of a legume (beans/lentils) each day it will give our bodies everything they need to counteract the dangerous effects of stress.  It can also give us the energy and clear thinking to get us out of our stressful situations. Indeed, everything seems to get better when we focus on Real Food!

7. Meditate

Let’s face it, our lives are chaotic and noisy.  We are too disconnected from the peace and calm of nature our ancestors once enjoyed.

We have to find a quiet place to help keep our stress in check. This could be meditation, prayer, or even something like yoga.  Studies have shown that meditation can restore all of the hormonal imbalances of stress.

8. Really Connect with People

For most of us, especially men, when we feel stressed we turn inward.  Under periods of stress, real connection with others is critically important.

No, Facebook and Twitter does not count as real human connection.  Seek out a close friend or family member and make sure you connect with these people each day.

9. Help Someone Daily

When we focus on ourselves our problems can look really big.  I know this is the case with me. The best way to get out of our own stress-filled head is to help someone else.

Make it intentional to reach out and be of service to someone each day.  This could be as simple as giving an old friend a call, sharing food with a neighbor, or writing a thank you note.

10. Go On a News Fast

The old saying “if it bleeds, it leads” really is true with media. Unfortunately, our brains then fixate on the fear based negative news. Negative news activates our stress hormones and reinitiates the negative spiral of stress.

I recommend going on a news fast.  Unless your job demands that you follow the headline news, it is best for our spiritual health to minimize our exposure to all of the fear and negativity from the news.

11. Manage Our Expectations

Sometimes we just cannot change the situation.  Learn to accept what it impossible to change.

One of the biggest causes of stress and unhappiness is when our expectations are not being met.  Sometimes we just have to change our expectations.

At the end of the day, there are just things that are beyond our control. We simply can’t fix everything.

To bring it all home, does stress cause weight gain?  The answer is definitely yes.  We must recognize the stress in our lives and actively do something each day to relieve stress. What have you found that works for stress relief?

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How to Survive Sedentary Work: 10 Tips

Sitting is the new smoking. Physical inactivity now kills as many people each year as smoking tobacco.

In fact, sitting more than 3 hours a day takes two years off of your life. This is particularly worrisome considering the average American sits 8-9 hours each day.

If you come home after a long day at work and then sit in front of the television to relax or watch the news, you will be interested to know that TV watchers lose up to 5 years of life or 22 minutes of life for every one hour spent watching TV!

Most of us report that we are “active” or are getting enough “exercise.” However, if you actually track people with a pedometer, you will find that only 1 in 20 Americans actually moves enough according to government standards.

Estimates from government surveys indicate that people’s sedentary time outside of work has increased by about 40% between 1965 and 2009. Thus, not only are we sitting at work we are now sitting when we go home at night. We need to move more at work and move more at home.

The New York City Walking Culture

People in New York City live an average of 4 years longer than the rest of the United States. This may seem counter-intuitive given the challenges of living in a big city, however, a main reason for New Yorkers’ longevity is the strong walking culture.

Owning a Car is Hazardous to Your Health

Many studies show that owning a car is hazardous to your health, not only due to the toxic fumes, but because of the excessive sitting.

One large medical study found that men who ride in a car more than 10 hours per week are 82% more likely to die from heart disease than those who ride less than 4 hours per week.

Working Out and an Office Job

Even more frightening are the findings of recent studies showing that even if you exercise hard at the gym every day, you cannot undo the harmful effects of sitting or sedentary work. This caught me by surprise as I had always considered exercise as a way to “undo” any bad habits like sitting too long or eating too much.

Indeed, having an office job and sitting most of the day puts you at high risk for weight gain, diabetes, cancer, and heart disease.

Our excessive sitting as a society has led to a condition called “Sedentary Death Syndrome.”  What is this sedentary death syndrome and what can we do to survive our office jobs, commutes, and the gravitational pull towards our televisions?

My Story

A big part of my job as a cardiologist is performing procedures for my patients. Because we work in an x-ray environment, we have a heavy lead suit that we wear all day long.

I was overweight at the time and had an undiagnosed autoimmune disease, Ankylosing Spondylitis.  My back used to kill me wearing a heavy lead suit all day long performing procedures. At the time, I thought it was simply my heavy lead suit that caused my back pain, and never explored other potential causes.

Hence, very early in my career I started sitting all day long while performing these complex cardiac procedures. This helped my back pain but then led to even worse neck pain, knee pain, and hip pain from poor posture from sitting and the biomechanical effects of sitting all day long.

Amazingly, all of my pain has resolved and my autoimmune disease has even gone into remission, once I attacked the root of the problem–my “Standard American Diet” (SAD).  This SAD diet caused me to be overweight, created inflammation throughout my body, and allowed my autoimmune disease to develop and progress.

Fortunately, I was able to reengineer my “day of sitting” before I developed other chronic conditions–possibly diabetes, heart disease, etc.

Our understanding that sitting is dangerous is a relatively new finding. It wasn’t that long ago that sitting was considered “healthy.”

Train Driver and Conductor Study

In the early 1950’s, there was still skepticism that being physically active could protect against developing heart disease. This skepticism began to change when Dr. Jeremy Morris and his colleagues studied London transport workers. What he found was illuminating.

They looked at two different sets of people who worked side-by-side for years. One group was physically inactive–the drivers (sedentary work), and the other group was busy walking all day long–the conductors. What they found was that even though these two groups of people working together were essentially the same, the drivers had a 42% higher incidence of heart disease.

The only difference between the drivers and the conductors was that the drivers sat all day long, whereas the conductors walked all day long collecting tickets. Since the publication of this study in 1953, we now know that moving helps to not only protect us against heart disease but many other chronic diseases as well. Again, with this knowledge, we have to ask ourselves why it is so hard for so many of us to get moving.

Sitting in China’s Longevity Village

The traditional lifestyle in China’s Longevity Village is very different than here in the U.S.. People historically did not sit. They were too busy working in the fields and gathering food all day.

In fact, the people in the Village do not even sit to use the bathroom. They squat over a pit.

In doing that, they employ major muscle groups in their legs. Indeed, based on the Bama Centenarian Study, a study of all of the centenarians living in Bama County, China, the county where the Longevity Village resides, 97% can still use a squat toilet.

This is quite amazing since most American adults I have encountered while living or travelling in China, lack the lower extremity muscle strength to do so. We are accustomed to sitting even while using the bathroom.

Ten Ways to Stay Healthy with Sedentary Work

If you’ve got a desk sentence job, you have to sit, right? Wrong! Sedentary work doesn’t have to be sedentary at all! One of the encouraging bits of news is that it doesn’t take a lot of time to combat the negative effects of sitting.

A number of studies demonstrate that short breaks during long periods of sitting can work wonders. Those studies demonstrate that simply taking a several minute break from sitting each hour can lower body mass index, triglyceride levels and improve glucose tolerance—all important measures for combating obesity and maintaining a healthy metabolism free from diabetes.

Here are my 10 tips to counteract the debilitating effects of sitting:

1. Wear a pedometer

It sounds simple but studies show that you will unconsciously walk more than one extra mile each day just by wearing a pedometer. To learn more about the pedometers I recommend, including free options, please visit my resource page.

2. Schedule standing or walking meetings

Steve Jobs was famous for having walking meetings as he felt it increased creativity. Many corporations have now taken chairs out of conference rooms. It ensures meetings end on time and employees are healthier.

3. Use a headset to take phone calls while pacing

If you need to jump on a conference call, try walking outside for the call. If it is too noisy outside or the weather doesn’t cooperate, try taking your call while pacing in an empty conference room, your office, or even the cafeteria.

4. Use a standing desk

You can burn up to 50 extra calories each hour just by using your standing desk. It doesn’t seem like much but it will help to strengthen your legs and will improve your posture.

You don’t have to have anything fancy. Even if your employer cannot help you, this it can even be done for free with a left over cardboard box.

5. Take a walk on your lunch break

Walking on your lunch break is great but even better than walking alone is to take a walk with a coworker.

6. Use a bike desk or a treadmill desk

If you have a private office, bring your old treadmill or bike from home and create a treadmill desk or bike desk. Even better, get your employer to buy you one. You can see the bike desk and treadmill desk I put together for free with some random supplies in my home.

7. Walk or bike to work

I often have very long days at the hospital and there is absolutely no time to exercise without compromising sleep or family time. In my struggle to find time to exercise on these days, I have now starting biking to work.

8. Commit to taking a break from sitting every 30-60 minutes

Studies show that you simply need to get up and walk for five minutes every hour. There is even a “stand app” now for the iPhone which will remind you to get up and move if you have been sitting too long.

9. Replace the sofa in your TV room with exercise equipment

This is a tip I have learned from many of my patients. As they have replaced their sofas with exercise equipment their health has dramatically improved and the extra weight has melted away. Commit to move with these activities for guilt-free TV relaxation.

10. Schedule a daily family walk or hike

Even kids need to get moving more. We love our walks or hikes when we can get them. It brings our family together. As we no longer have cable or satellite TV service in our home, this has become one of our favorite family activities.

If you don’t have kids at home, then going for a walk with a spouse or friend after dinner will not only improve your health but your relationship as well.

Your challenge this week is find some creative ways to build movement into your daily routine.  Please share your ideas and experiences in the comment box below!

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Dr. John Day’s Free Healthy Habit Tracker App

Do you dream of being able to maintain excellent health, lose weight, or reverse a medical condition? The key to living the life you want is to begin making small and lasting changes now.

But how?

Over the course of my career, I have worked with thousands of patients who’ve shared the struggle I once faced: reclaiming our health. Those who track their daily habits are the ones who successfully make the changes and reverse their medical conditions.

For me, tracking my behaviors remains the single most effective tool in successfully accomplishing my goals. To help you succeed in your health goals, We’ve created a free web-based app for you to begin using today:

Dr. John Day’s Free Healthy Habit Tracker App

Benefits of  Tracking

Here are three key benefits of using this app:

1.  Customized Success Plan

Do you know what changes you need to make to succeed in your health goals?

We’ve designed this app based on the proven daily habits of the China Longevity Villagers who model the lifestyle that I and many patients and colleagues have adapted to find a new level of health, including: weight loss, reversing medical conditions, dropping medications, better sleep and more energy.

2. Awareness = Power

Do you know what you are actually eating or how much you move each day? Do you know what triggers cause your current unhealthy habits?

Studies show that you likely eat more and move less than you think and that you mindlessly engage in behaviors that are detrimental to your health.   Tracking your behavior is one of the first keys to success because it brings awareness to what you are actually doing, giving you power to make changes.

3.  Rewards

Rewards reinforce good behaviors, turning them into good habits.  As you track your daily habits, you will earn medals within the program.  Enlist a friend–support and reward one another as you progress.

The overwhelming majority of my patients find that once they started tracking their behaviors, they can then begin to set and actually achieve goals.

Tracking their achievements rewards and reinforces their new behaviors. Over time, these new behaviors became new habits. These new habits translate into a new level of health, including: weight loss, reversing medical conditions, dropping medications, better sleep and more energy.

How it Works

Let me show you how to get this free healthy habit tracker app and how it works.

First sign up for this free online app here:

Dr. John Day’s Free Healthy Habit Tracker App

Once you have signed up for this program, here’s how this free healthy habit tracker app works:

1. Daily Email Reminder

You will receive an email daily reminding you to record your results for the day.  If you don’t see it in your inbox, check your spam folder.

2. Be Consistent at Filling Out the Daily Survey

Answer all 11 questions. You can earn medals based on how many days you fill this out. In general it takes 1-2 months to develop a new habit. Thus, you can earn a bronze medal for filling it out 7 days, a silver medal for 21 days, and a gold medal for 60 days.

3. Graph Your Results

There are graphs and charts where you can see your results.

4. Real Food First

To better understand the “Real Food First” questions of the daily survey, please read our article on Real Food First.

5. Get a Pedometer

To answer question 6, you will need a pedometer. To learn more about good pedometer options, including free options for your smart phone, please visit the resource page of my website.

6. Spend Time Outside

You may be curious why I want you to track whether you spend at least 20 minutes outside or not (question #7). The reason is that medical studies show the following benefits for people who spend time outside:

-Weigh less as the morning sun lowers hunger hormones

-Have higher vitamin D levels

-Sleep better from the effects of natural sunlight on the brain

-Are more physically active

-Are happier, better able to concentrate, and heal faster

7. Practice a Random Act of Kindness Daily

For question #8, people who are able to reach out and help others enjoy many health benefits which include the following:

-Live 28% longer

-40% less hypertension

-Less heart disease

-Less stress

-Happier

8. Be Grateful

For question #10, people who are grateful enjoy remarkable health. For example, grateful people experience the following:

-Less stress

-More optimism

-Better sleep

-Less heart disease

-Stronger immune system

-Less depression

-Live longer

9. Set a Bedtime Alarm Clock

The last question, #11, may appear somewhat strange at first glance. I have found that one of the biggest problems to not getting enough sleep is staying up too late for whatever reason–watching TV, working on a computer, or playing on our phones.

To get enough sleep, I recommend setting a bedtime alarm. The rules are quite simple, when the alarm goes off it is time for bed. We should all try to get at least 7 hours of sleep each night to ensure optimal health.

I hope you find our free healthy habit tracker app as valuable as I do. Please share with me your experiences using this tool and any suggestions that you have.

Here’s to a life filled with real food, real living, and real happiness!

After our class this week on adapting the principles of China’s Longevity Village to our lives and the choices we face in eating real healthy food vs. fake unhealthy food (which turns out to be what most of us Americans are eating most of the time), a mom came up to me and asked: “I have just one question. What foods can you actually feed your family?”

We all want to eat healthy, but we often don’t know how, or don’t have time or the will. I have found seven simple strategies that I share here in the hopes that they can help you eat and enjoy more real food.

I love the food I eat. Everyday I throw a few healthy ingredients together and end up with something delicious and different every time.

I rarely follow recipes because I’m usually in a hurry and already hungry. By having real foods all ready to throw in, I can successfully make real food both fast and delicious.

Cooking for others has always been one of my greatest fears. Quite frankly, I’d rather stand up in front of a large audience and give a talk than cook for a handful of people.

Because I have traditionally felt so inadequate in the culinary arena, writing this article takes some courage for me. However, I have found many things that enable me to make real food taste good quickly. I hope that what I share will spark some new ideas and make real food easy for you to prepare and delicious for you eat.

I must say that on the occasions I do prepare food for my friends, they tell me that it tastes superb and they ask for the recipes. Sometimes I wonder: “Are they just trying to make me feel good?” But in reality, I don’t think this is the case because I truly find these foods delicious myself.

Let me apologize up front—I don’t measure. I won’t be able to give you quantities. But I can give you some strategies and ideas to run with on your own.

Who knows? Maybe you’ll find that this approach can work for you even better than providing you with a basic recipe!

Seven Strategies for Making Real Healthy Food Easy to Eat

1. Wash, cut up and store veggies in easy to access containers as soon as you bring them home. This makes the veggies easy to eat as is or throw in a dish. Some may worry that the veggies could go bad more quickly. But think about it–you’ll be eating them more quickly too.

2. Always have a quick healthy protein ready. Soak, cook and store a large batch or two of beans or legumes in the fridge that can be mixed into last minute dishes. Also keep on hand tofu, nuts, seeds, wild low-mercury frozen fish (i.e. salmon), pasture-fed organic eggs, grass-fed organic meats in moderation, if desired.

3. Make a soup or a chili each week. These keep well for many days and can be used as sauces and combined with other dishes.

4. When you make a dish, make it in bulk. Save leftovers in small glass containers which can be packed easily the next day for lunches. This saves so much time and provides healthy meals at or away from home for days.

5. Pack healthy foods with you everywhere you go. As it can be so hard to find healthy foods, and so hard to resist the unhealthy ones when you’re hungry, taking your own food can be a life-saver. Nuts keep well and satisfy as a healthy protein and fat. We also love nut butters on sprouted grain (flourless) toast.Cut up fruits and veggies in a portable container work well on a daily basis.

6. Don’t hesitate to eat your stir-fries and salads for breakfast. A vegetable, healthy protein, and fruit is standard fare with our breakfast each day. On a recent trip, a close family member saw us all eating a spinach salad for breakfast and asked, “What kind of food is that for a breakfast?” It’s one that gets us off to a good start for eating real food first and feeling great! It can really help stave off the desire for the junkier kinds of foods.

7. Reach for your real foods first when hungry. Having healthy foods and healthy dishes readily available makes it just as easy to grab something healthy as it is to grab junk food.

Speaking of junk food, lest I give you the wrong impression, we are still a work in progress. We still have some of the packaged, processed foods in our home, and we still eat them. But I will tell you this: the availability of real foods now dramatically outweighs the processed foods and the real foods get eaten much more frequently than the processed foods. Onward and upward!

Healthy Ingredients I Stock in My Kitchen
(Keep it simple. Just start with your favorites.)

Dry beans and legumes (organic dried in bulk, and bpa-free canned): mung beans, garbonzos, black beans, pintos, cannellini, navy or other white beans, lentils, split peas, etc.

Nuts and seeds: almonds, walnuts, pecans, cashews, brazil nuts (high in selenium), chia seeds, hemp seeds, flax seeds, sesame seeds, sunflower seeds, etc.

Nut butters (organic): peanut, almond, cashew, walnut, pecan, macadamia, sunflower seed, etc.

Whole grains (organic in bulk): Oat groats, barley, kamut, millet, amaranth, spelt, rye, buckwheat, wheat, thick rolled oats, etc.

Vegetables (organic—wash, cut and store for quick and easy use): Onions, garlic, kale, spinach, other leafy greens, cucumbers, carrots, cauliflower, bell peppers, celery, mushrooms, sweet potatoes, etc.

Fruits (organic–priority on in season/local fruits): Berries, oranges, apples, pineapple, watermelon, red grapes, kiwi, pomegranates, bananas, tomatoes, avocados, lemons, limes, etc.

Spices: Cinnamon, cumin, cloves, garlic, curry, tumeric, etc., I especially love spices such as Chinese Five Spice, Indian Kitchen King, or Mediterranean Herbs de Provence that have the right combinations all ready to go.

Herbs (dried and fresh when possible): Basil, parsley, rosemary, dill, cilantro, etc.

Vinegars/cooking wines: White vinegar, apple cider vinegar, balsamic vinegar, white balsamic vinegar, rice vinegar, tarragon vinegar, white cooking wine, dry sherry cooking wine, etc.

Other sauces: Braggs amino acids, low sodium soy sauce, hot sauce, organic tomato sauce (I like the Whole Foods 365 All natural fat free brand), mustard, homemade hummus, vegetable broth, vegetable boullion, apple sauce, etc.

Bread/Tortillas/Pasta: Organic, sprouted grain (no flour) breads, buns, tortillas and pastas such as Ezekiel or Food for Life brands

Milks and Dairy (organic): Almond, soy, cow, coconut, plain yogurt, pasture-raised eggs, etc.

More Healthy Proteins: Frozen Wild Alaskan Salmon, canned Wild Alaskan Salmon, grass-fed organic meats, tofu, frozen organic beans, etc.

Kitchen Tools that Make It Easier to Eat Real Healthy Foods
(Use what you have and slowly add as you go)

Over the 21 years that John and I have been married, we’ve invested in a few solid, high quality kitchen tools. From my perspective, these tools completely pay for themselves, as they make it easy to create healthy dishes quickly, and avert the desire to reach for the overly-processed, less-healthy alternatives which can lead to higher costs in health in long-run.

1. Blendtec, Vitamix or other high quality grinder
2. Wondermill or other high quality grinder
3. Bosch or other high quality mixer
4. Nesco Dehydrator or other high quality brand
5. Nesco Pressure Cooker or other brand
6. Ceramic dutch oven
7. Lemon/lime Juicer
8. Citrus Zester

The tool we use the most is our industrial quality blender, which allows us to quickly make great soups, sauces, smoothies, batters, nut butters…you name it. It has been well worth the investment for us.

Jane’s Southwest Salad

Healthy Food Recipe: Fresh Organic Southwest Salad
(Without measurements—It’s ok! Try it!)

Here’s a delicious and satisfying organic salad that I threw together last week with the ingredients I had on hand:

Black beans
Corn
Diced celery
Diced red onion
Halved cherry tomatoes
Barley (cooked al dente—this I had cooked in bulk and stored in my fridge to add to many dishes)
Fresh cilantro
Fresh lime juice
Lime zest—lots!
White balsamic vinegar
Kosher salt
Fresh ground pepper

You get the idea. You can throw in anything you have—you can change the vegetables to cucumbers, broccoli, kale, carrots, add avocadoes…you can switch the beans/legumes to garbanzos, lentils, cannellini… you can adapt the dressing to lemon, lemon zest and garlic….you can vary the herbs to basil and parsley…whatever you have in stock.

The key is to keep healthy foods all around you, make them easy to access, prepare them in bulk, and don’t be afraid to experiment. Just grab whatever healthy ingredients you can find and create any combinations you desire.

Please help me and all those reading! Please share your real food recipes and tips with all of us in the comment box below.

Here’s to a week filled with real food, real living and real happiness! Cheers! Jane

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Ten Ways to Break Your Sugar Addiction

Oreo cookies and cupcakes are more addictive than cocaine, according to recent medical studies.  Could the findings of these studies help explain why two in three of us are overweight or obese?

Many studies have shown that when a person with a sugar addiction sees something like a cookie or a cupcake, the prefrontal cortex area of their brain lights up on a brain scan as much as a cocaine addict when they see cocaine.

In my experience as a cardiologist, nearly all of my patients that have been able given up sugar and simple carbs and replaced these foods with real food choices have been able to return to a normal weight.  It really is that simple.

Simple carbs, like breakfast cereals, pancakes, breads or pasta made with flour, white rice, fries, or potato chips are really just sugars to the body. The key to breaking a sugar addiction, avoiding hunger, and maintaining a normal weight is to minimize or avoid sugar and simple carbs.

My Story

I lived what I thought was the typical American teenager’s life.  Every day, I ate cereals such as Frosted Flakes and Rice Crispies, or Bisquick pancakes for breakfast.  For lunch and throughout the day, I enjoyed  white bread sandwiches, pastries, bagels, and soda pop.

I was always wanting the stuff, but never felt satisfied.  I thought this was normal as all of my friends and their families ate this same way. I thought we were eating healthy because all of these foods are low in fat and cholesterol.

At the age of 21 I lived in Taipei, Taiwan with a Chinese family and had no contact with any caucasians for the entire summer. There were no processed or sugary foods available to me.

Never mind adjusting to a new culture and language, the hardest part of the experience for me was living without sugar!  I could not find any of the usual sugar fixes in my Taipei neighborhood. There were no bagels, waffles, donuts, or cookies.  On a student’s budget, I could not afford to travel to, or pay for, my traditional fixes at any of the grocery stores catering to Westerners living in Taipei.

So there I was, a summer in Taiwan with no sugar.  I went through quite severe sugar withdrawals.  I was irritable, depressed, and anxious for the first week or two. And then, miraculously, the cravings for sugar and simple carbs, and the accompanying symptoms, disappeared.

The amazing thing is that I felt the best I had ever felt in my life that summer in Taiwan.

Even at the young age of 21, it occurred to me that I really did have a sugar/simple carb addiction.  I thought I was cured until I came back to college in the U.S. at the end of the summer.

Everyday, as I passed my university bookstore each morning, I smelled something delicious. At some point during the second week, I vaguely remember thinking, “What could hurt in having just one?” It was all over that day.  I picked up right where I left off and sugar became my overwhelming daily fair once again.

This daily fair continues until  a medical crisis in my mid-40s , when I finally got this sugar/simple carb addiction under control and regained my health.

Do sugar and simple carbs qualify as addictive substances?

The medical definition of an addiction is a strong and harmful need to regularly have something.  By this definition, sugar and simple carbs qualify.  We know it is harming our bodies but, when addicted, we feel compelled to eat it despite the direct links to harmful effects such as obesity, diabetes, dementia, cardiovascular disease, cancer… the list goes on.

What do sugar and simple carbs do to the brain?

Sugar and simple carbs are no different than smoking, alcohol, or cocaine on their effect to the brain.  In fact, an addiction to sugar and simple carbs may even be more difficult.

While smoking and drugs are despised in our culture, sugar and simple carbs are celebrated, starting at a young age.  Our children are showered with sugar and simple carbs at school, church, many friends’ homes, sporting activities, etc..

The Chemical Changes to Our Brains with a Sugar Addiction

1. Increase Serotonin Release

We all crave serotonin.  Serotonin makes us feel good and relieves anxiety.

Most medications used for depression and anxiety actually block the break down of serotonin.  Thus, these medications increase the serotonin in our brains.

2. Increase Dopamine

Dopamine is the “feel good” chemical in our brain.  With sugar and simple carbs we get the same dopamine rush as we would with cocaine.

3. Endorphin Release

Sugar and simple carbs cause a release of opiates within our brains.  This is the same thing as the “runners high.”  In fact, many medical studies have shown that we can block much of the addictive properties of sugar and simple carbs with a medication called naloxone.

Naloxone directly blocks the effects of opiates in the brain.  Thus, naloxone is very helpful for drug and alcohol addicts battling these addictions.

 4. Acetylcholine Release

Elevated levels of acetylcholine in the brain are seen with all addictions.  Sugar and simple carbs can have the same effect.  With elevated acetylcholine in the brain, the higher cognitive effects of the prefrontal cortex are impaired.

With impaired prefrontal cortex function, our willpower and ability to focus on high-level goals is also affected.  Thus, even though we know what sugar and simple carbs are doing to our health, we are powerless to change.

10 Steps to Break the Sugar and Simple Carb Addiction

In addition to the struggle we face with the brain chemicals that compel us to eat sugar and simple carbs, we also face another very real challenge: the people around us who are also in the throws of the junk food and want us to partake with them. It can seem nearly impossible to resist.

These scenarios can create a psychological dilemma. If we partake, we can get caught up in the addictive cycle.  On the other hand, when we make these foods “forbidden” or “evil,” it can further intensify the obsession for these foods.

What to do?  Let me give you my 10 steps to break the sugar and simple carb addiction.

 1. Real Food First

While abstinence would be best, for the 99% of us who cannot abstain, I have found that eating real food first is the best option.  This approach works best for our children as we are guiding them to make healthy food choices and navigate the plethora of sugar and simple carbs that surround them everywhere.  We call this the Real Food First Diet.

This approach is really quite simple.  At each meal, have vegetables, fruit, a healthy protein, and a healthy fat first.  If your body is telling you that you are still hungry after eating real food first, then you can eat whatever you want.

Of course, you need to wait at least 30 minutes for the “I’m full” signal from your gut to finally get to your brain before you eat more.  The goal is that if you fill up on real food first that you will reduce or lose the desire for sugar and simple carbs.

I have found that if people fill up on real food with each meal that they generally lose their desire to snack or eat junk food.  If, however, you are craving a snack, the same rules apply.  Eat real food first, wait 30 minutes from your first bite of real food and if your body is telling you that you are still hungry then you can eat whatever you want.

2. Do Something You Enjoy Everyday

Find something that you love and do it every day.  Take time for yourself.  If you get to do at least one enjoyable thing each day it raises your own natural serotonin, dopamine, and endorphins.  When these substances go up, acetylcholine returns to healthy levels within the brain.

If we can get our fix of serotonin, dopamine, and endorphins naturally we won’t feel compelled to get them from sugar and simple carbs.

3. Get 20-30 Minutes of Sunlight Each Day

Sunlight is also a powerful stimulator of serotonin, dopamine, and endorphins.  As a society we are doomed to stay inside.  Our offices are inside, the gym is inside, and at night we are inside our homes taking care of children.

Difficult as it may be, we must find a way to get outside each day.  Explore exercising outside sometimes rather than the usual gym class.  Instead of watching TV or working on the computer at night, try going for a walk with the family.

4. Get Physical Touch

Physical touch also stimulates release of these same feel good chemicals in the brain.  Physical touch, inside of a safe monogamous relationship, can have powerful beneficial effects even beyond the release of these brain chemicals.

If you don’t have anyone in your life, get a regular massage.  Indeed, medical studies show that massage can also significantly increase these feel good chemicals in the brain.

5. Yoga or Meditation

If you want to drop your serotonin, dopamine, and endorphin levels fast, just get stressed out.  I have found that yoga and meditation are very effective in reducing stress for my cardiac patients.  As our stress levels go down we can get our feel good brain chemicals up without sugar or the simple carbs.

6. Physical Activity

We have all heard of the runner’s high. This does not come immediately.  Once we make exercise a regular part of our lives we will eventually feel the high from surging serotonin, dopamine, and endorphin levels from exercise.

This was the case for me.  I remember absolutely hating to run.  Even running a mile was pure torture.  On a whim one day in medical school I committed to run the New York City Marathon with my roommates who were avid runners.

At first, every step was painful.  After about a month into my training, I found that I actually started enjoying these runs.  After two months, I was hooked and have been hooked on exercise for the last 20 years of my life.

7. Get 7 Hours of Sleep

This is probably the most overlooked part of resisting sugar and carb addictions.  If we can just get 7 hours of sleep each night we can get all of our body’s hormones in check and we will be in a better place not to crave sugar and simple carbs.

In our stress filled lives, we just want to keep working on various projects until late into the evening.  I have found that the best way to get 7 hours of sleep is to set our alarm clocks for bedtime rather than waking up time.

Let me explain.  Rather than setting our alarm clocks for 6 am, an even more effective strategy is to set our alarm clocks for 10 pm at night.

The rules are simple.  You cannot turn off the alarm clock until you are in bed with the lights out.  If we have a hard stop to the day we will find that we are much more productive with our time as there is a time limit to everything.  Also, with so much more energy the next day we will be able to accomplish even more.

8. Change Your Scenery

When you are bored, frustrated, or just avoiding a task it is so easy to start obsessing on sugar and simple carbs.  The sugar and simple carbs become a distraction allowing us to procrastinate what we really need to be doing.  I know this is the case for me.

Sometimes if you can’t plow through your task it is best to just change the scenery.  Perhaps taking a walk or getting a nice tall glass of ice water is all you need to break the sugar and simple carb thought obsessions.

9. Get Support

You are not alone in your efforts to resist the siren’s call of sugar and simple carbs.  Find an accountability partner or a friend or family member to give you support.

You may even want to consider joining a support group such as a 12-step group for people struggling with food addictions.  Having some tools and working with a group of people who are working towards the same goals can provide a powerful medium to break the sugar and simple carb addiction.

10. Go for Quality

The World Health Organization has deemed it unsafe to eat more than 25 grams or about 6 teaspoons of added sugar daily (including honey, maple syrup, juices, sports drinks, etc.). Choose wisely and enjoy what you select.

If you are limited to just 6 teaspoons of added sugar daily make them count.  For me, I choose to spend most of my 25 grams of added sugar each day on high quality dark chocolate.  As these 25 grams are priceless, I choose only the best.  Don’t waste your 25 grams of added sugar on a little more than 7 ounces of high fructose corn syrup in a Coke.  Make each gram of sugar count.

Have you been able to break free from a sugar and simple carb addiction? What has been your secret to successfully breaking free from your sugar/simple carb addiction?

“That candy bar you ate from your kid’s Halloween bag is stuck right there in your thigh! Squeeze harder! Get it out! Come on, you know you ate more than you should. We all have our favorite jeans that we want to fit into! Keep lifting!”

So we did. We all lifted our leg higher at the “counsel” of our Pilates instructor.

What was the message offered to us that day?

External appearances are more important than our internal well-being?

We’re not good enough as we are?

We can’t trust our body to tell us what it needs?

The tragedy here is that we may take in and even look for these types of external cues to tell us how we’re doing.  These external cues abound in our modern society.

Productive Movement in China’s Longevity Village vs. Our Typical Gym Experience

During our most recent trip to China’s Longevity Village, as I worked along side Mrs. Huang and her neighbor in the fields one morning, I couldn’t help but reflect on the stark contrast between my gym classes which are designed to mimic the real motions utilized in real work and real work itself.

I noticed the strong steady rhythm at which Mrs. Huang and her friend worked. With seeming ease, they carried the packs that held the substantial fruits of their efforts; their faces expressed both contentment and determination.  Side by side, they conversed about the issues in their families and community, identifying possible solutions as they went. At the end of the day, they would prepare their harvested food and partake with their families of multiple generations in one home.

There I was outside working with these women and with the earth, thinking about what a strange phenomena it is, by contrast, that I hop in my car and drive to a building so that I can stand on a machine or in a room, with others doing the same–to move.

As these women work in their fields, their focus is on harvesting the fruits of the earth.

By contrast, as my friends and I work out in the gym, our focus is on the mirror in front of us and the images that are reflected back to us.  We focus on the external appearance of ourselves and others, as instructors call out our next move, telling us what we need to be doing.

In this way, our cues come from an external voice while our focus is on an external image.

Similar to my Pilates instructor, who encouraged us to squeeze the candy bars out of our thighs, my cycle instructor admonished us as Thanksgiving approached:

“Who is planning to eat pie?  Are you going to be naughty?  Pedal faster!”

We pedaled faster then we got in our cars and drove home.

Now, don’t get me wrong, I have loved the gym since I was old enough to join one.  I still love it.  For some of us, the gym may be the only way we can work in physical activity, and is a vital component of our well-being.

However, for our ultimate well-being and enjoyment, we need to learn to identify and confront the external messages that can override the messages our body will most definitely give us to tell us what it really needs.

Making the Shift from External to Internal Cues

I used to exercise to compensate for the junk food I ate and measure my exercise status by the number of calories burned, the maximum heart rate achieved or the minutes spent on a particular machine. I exercised primarily alone with the sole focus of “getting in shape.”

Today, gratefully, I move simply because it feels good. I get outside more. I join with friends and family more. Together, we produce more.

Our family is always looking for new and creative ways to get out and enjoy nature together. One of our favorites that we just discovered is, instead of driving all the way to grandma’s and grandpa’s, parking and riding our bikes the rest of the way.

I feel so much better and can accomplish so much more than I did when I was trying so hard to do the exercise thing according to the rules I thought I was supposed to be following.

What great freedom I experience with this shift from focusing on the external to honoring the internal!

By observing with compassion, I can now identify and confront these messages that sometimes exist at the gym and elsewhere that tell me that how I look on the outside is more important than how I am taking care of myself on the inside, that I am not good enough and should do something to compensate, and that I need to look outside myself for the answers.

Challenge for the Week

Here is your physical activity challenge for the week:

1. Make it natural.

2. Make it social.

3. Make it productive.

4. Make it enjoyable.

5. Do what feels good to your body.

6. Politely dismiss any external cues that may suggest you do otherwise.

Listen, honor, and let us know what you discover by leaving a comment below!

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The Top 10 Benefits of Dark Chocolate

Did you know that chocolate could improve your cognitive function and increase your chances of winning a Nobel Prize?  Sounds strange, but these were the conclusions of a study published in the most prestigious medical journal, the New England Journal of Medicine.

As a recovering sugar addict, my new vice is dark chocolate.  I especially like it with almonds; the darker the chocolate the better.  Fortunately for me and for those of you who share this love of dark chocolate, there are literally hundreds and hundreds of medical studies supporting the idea that dark chocolate, in moderation, can be a healthy vice.

In this article I will discuss the pros and cons of dark chocolate and health.

Which dark chocolate is best? 

The higher the percentage of cacao the better.  To have any health benefits, dark chocolate needs to be at least 60% cacao (ideally 70% or higher).

Unfortunately, milk chocolate is not good for you as the cacao percentage is low and it contains mostly sugar.  Likewise, there are no health benefits from white chocolate.

Remember that chocolate is high in calories and even dark chocolate has added sugar.  Read the dark chocolate labels closely as the World Health Organization has recommended that the safe daily intake of sugar is approximately 25 grams each day.  The key is to only eat dark chocolate in moderation.

If you eat dark chocolate with carmel and other candy-like ingredients then it really just becomes candy and you are doing more harm than good.  Again, check the labels of dark chocolate with peanut butter or other fillings as they may contain transfats which can be deadly to the heart.  If you are going to eat dark chocolate, eat a pure form of it.

What quantity of dark chocolate is considered “moderate?”

One square of a bar, or about one ounce per day (definitely not the whole bar!), seems to be “moderate.”  In fact, in a study of nearly 20,000 people, there was a 39% reduction in heart attacks and strokes with dark chocolate consumption.  In this study, participants ate an average of about one square of a dark chocolate bar each day.

Naturally, the question arises: “What other factors may have been adjusted in this study population that could have contributed to this outcome?” This is always the challenge of doing clinical research.

For now, I’m hoping that the dark chocolate was a central factor.  If you want to read more about this study, click here.

If you like dark chocolate covered almonds, one ounce of dark chocolate is somewhere in the range of 8-12 pieces per day.  This is where I struggle. It is a challenge for me to stay within the framework that I need to.

The thing that keeps me honest is a food journal.  I record each chocolate almond I eat.  Otherwise, I’d be likely to eat the whole bag.

Is Dark Chocolate Healthy?

This study, which links dark chocolate consumption to heart attack and stroke reduction, adds to a growing body of evidence that dark chocolate, in moderate quantities, may indeed be heart healthy.  Below are additional benefits of dark chocolate based on medical studies.

1. Dark chocolate decreases your chance of cardiovascular disease by 39% as already discussed in this article.

2. Dark chocolate decreases your blood pressure by 1-3 mmHg.

3. Dark chocolate is high in antioxidants.

4. Dark chocolate improves arterial blood flow and may help to prevent plaque build up in the arteries.

5. Dark chocolate has a mild beneficial effect on cholesterol.

6 .Dark chocolate has a reasonable amount of protein, fiber, magnesium, iron, and zinc.

7. Dark chocolate may enhance mood, cognitive function, and memory.

8. Dark chocolate may help to keep your weight in check.

9. Dark chocolate may be anti-inflammatory.

10. Dark chocolate may increase your happiness.

Should you start eating dark chocolate for health reasons?

I would not recommend eating dark chocolate just for its health benefits.  For example, fruits and vegetables are packed with much more nutrition than dark chocolate.

However, if you have a sweet tooth or are a chocoholic, then having some dark chocolate in moderation can be a relatively guilt-free treat. Because I still experience strong sugar cravings, and am surrounded by sugary treats everywhere, eating dark chocolate is a compromise that helps me avoid giving in to less healthy alternatives.

This is a work in progress, and I’m sharing openly with you that this is where I currently am in my journey of sugar addiction recovery. I am finding the healthiest ways to make this work in my current daily environment.

My goal is to eliminate these cravings all together.  If I could give up any form of sugar, including dark chocolate, I know I could release the cravings all together.

I experienced this freedom from cravings when I lived in Asian communities such as Taiwan in the late 1980s and China’s Longevity Village in 2012 and 2013, where I did not have access to any “treats” of any kind.

What are the risks of dark chocolate?

Unfortunately, dark chocolate is not risk free.  Despite the benefits of dark chocolate, here is my list of potential health concerns with dark chocolate.

1. Dark chocolate is high in calories and contains added sugar.

2. Dark chocolate, or any form of chocolate, is highly addictive.

3. Caffeine.

For many of my patients, caffeine can trigger palpitations or other heart rhythm problems.  If caffeine triggers palpitations for you, you should avoid this. Also, the caffeine from dark chocolate can impair your sleep quality.

I have a strict rule that I never have any dark chocolate after 12 pm each day.  As long as I never have any dark chocolate after 12 pm I seem to sleep just fine at night.

It takes 4-6 hours for half of the caffeine to get out of your body.  Thus, if your bedtime is 10 pm, like mine, and you have some dark chocolate at 12 pm then about 25% of the caffeine will still be in your body when it is time to sleep (2 half lives).

4. Increased risk of kidney stones

5. Increased risk of acid reflux

If you suffer from kidney stones or acid reflux it would be best to minimize or avoid dark chocolate as well.

My Three Dark Chocolate Rules:

To help me “manage” dark chocolate, let me share with you my three rules.  Many of my patients have found these rules to be very helpful.

1. Limit the amount.

As dark chocolate is so addictive, it is absolutely critical to eat this in moderation.  Read the labels carefully.  In general, if you ensure that you never take in more than 25 grams of added sugar from any source, then your dark chocolate consumption will probably be reasonable.

2. The darker the better

Go for the real dark chocolate.  The higher the percentage of cacao the better.  My favorite is 80%.

3. Use dark chocolate to replace unhealthy sweets in your diet 

Probably the best use of dark chocolate is when it is used to replace unhealthy sweets in your diet.  Dark chocolate can be particularly effective when you are in a situation where you are surrounded by tasty sweets.  A little bit of dark chocolate can enable you to resist other foods that are more harmful to your body.

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More than half of us here in America have high blood pressure. In fact, 56% of us are above the ideal blood pressure of 120/80 mmHg, as established by the American Heart Association (AHA). High blood pressure leads to heart attacks, heart failure, atrial fibrillation, strokes, and kidney failure.

For years, we have been told to eat a low sodium diet. The American Heart Association (AHA) has recommended 1,500 mg, which is substantially less than one teaspoon per day. One teaspoon of salt has 2,300mg of sodium.

Despite these recommendations, the average American kept on eating an average of 3,400 mg of sodium each day. In fact, less than 1% of Americans could ever achieve the AHA goal.

Based on emerging new medical studies, it appears that following these AHA guidelines would not have helped us reduce our blood pressure as much as one might think. Also, new data indicates that perhaps this ultra low sodium diet is not the best for our long-term health either.

Sodium and High Blood Pressure

While medical studies do support that we can reduce our blood pressure with a low sodium diet, the results are not that impressive. The average person can drop their blood pressure only by about 5 mmHg with a low sodium diet.

As one who has suffered from high blood pressure and wanted to get off the medications, I thought the answer to lowering my blood pressure was to dramatically reduce my sodium. I reduced my sodium so much that all of my food tasted incredibly bland. In fact, it just was not pleasurable anymore.

Over time, I found that the answer to reducing my blood pressure came through significant weight loss, eating real food rather than processed food, reducing and managing my stress, and moving throughout the day. By doing these things, I was able to dramatically drop my blood pressure to 110/70 mmHg without medications.

Asian Paradox

Having been taught that a low sodium diet was critical to good cardiovascular health, I was always amazed at how many Asian cultures, such as Japan or China, could eat high salt diets, yet have much lower rates of heart disease. From my perspective, it did not add up.

Having spent time in Asia nearly every year of my adult life, I have made it a point to learn more about what they eat. On our last trip to China, my wife, Jane, spent the day with Mrs. Huang and her daughter-in-law cooking meals.

According to Mrs. Huang, the secret to making Chinese food taste great involved three simple ingredients: the right cooking oil, fresh garlic, and salt in one form or another.

Although I have preached a low sodium diet to my cardiology patients for years, I could never reconcile how the Japanese and Chinese can take in so much sodium through soy sauce and salt, in one form or another, but yet seem to avoid heart disease. I knew from medical studies that after Asians immigrate to the U.S., their rates of heart disease gradually approach those of other Americans.

Could it be possible that their diets, high in fruits, vegetables, legumes, nuts, seeds, and fish, in their native countries protect them from heart disease? Could it be possible that salt is not so harmful if it is added to real foods rather than eaten with processed foods?

I suspect that the real problem is not salt but rather processed foods. Interestingly, as more and more Asians are adopting the Western diet with processed foods, their rates of obesity, diabetes, and heart disease are now dramatically increasing.

Medical Societies Can’t Agree on Daily Sodium Intake

The salt controversy really heated up in May of 2013 when the prestigious Institute of Medicine published their daily sodium intake recommendation. They specifically stated the following:

1. There was no compelling data to recommend less than 2,300 mg daily of sodium even in higher risk patients (those patients with diabetes, high blood pressure, or heart disease).

2. They even raised the question that the AHA’s ultra low sodium recommendations may even cause harm.

The 2014 Sodium Controversy

The August 14,2014 issue of the most prestigious medical journal, the New England Journal of Medicine, there were three published articles all questioning the optimal daily sodium intake.

It is interesting to note that all three articles came to different conclusions. Amongst these data, I believe there is a middle ground when it comes to how much sodium per day is optimal. Moderation, not dramatic reduction, is the answer when it comes to daily sodium intake.

Take Home Message on Daily Sodium Intake

1. The ultra low sodium diet is out.

Most experts now recommend a more moderate approach to daily sodium intake. Even though the data seems to be mounting against the AHA’s ultra low sodium recommendations of 1,500 mg/day, the AHA holds strong to their current guidelines. I project that, in time, they will adjust their sodium guidelines, as they did with their ultra low-fat, high-carb diet recommendations.

2. The right amount of daily sodium seems to be about 2,300 mg

Approximately 2,300 mg per day seems to provide the right balance between health and good tasting food. I have carefully tracked my own daily sodium intake. As long as I steer clear of processed foods, fast foods, or most restaurant foods, I find that I can add the desired amount of salt to real food and stay at about 2,300 mg per day.

3. Minimize eating out and processed foods

For most Americans, achieving the moderate sodium recommendations will require significantly cutting back on eating out and processed foods, as 50% of what we eat is processed or restaurant-prepared. The problem is not the saltshaker itself, but rather, who is adding the salt to the food you eat.

Indeed, 80% of the sodium we consume each day is from eating out or from processed foods. Only 20% of our daily sodium intake comes from the salt shaker.

Do you know how much sodium you are getting?

Take back your control. Start today and for one week, do these two things:

1) Read food labels.

It is easy to verify the appropriate sodium percentages, as 2,300 mg is the recommended daily allowance listed on the food labels.

2) Return to real foods.

Make it a point to eat out less and prepare real food at home more. Preparing your own simple, real foods could easily drop your average daily sodium intake of 3,400 mg to 2,300 mg, improving your overall health.

What has worked for you in maintaining a healthy blood pressure? We’d love to hear from you.

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How to Prevent Weight Gain After Eating a Big Meal or Junk Food

What should you do if you just ate way too much? Most of us follow this unhealthy behavior with yet another unhealthy behavior: sitting. In our western culture, we were often taught to rest after a meal to allow the body a chance to digest the food.  Could this be the wrong advice? How can you prevent weight gain after eating a big meal or the wrong carbs?

The Chinese have a famous saying, “Take 100 steps after eating and live to 99” or 饭后百步走，活到九十九 (Fan hou bai bu zou, huo dao jiu shi jiu).  This concept of going for a walk after eating is part of Chinese culture and helps to explain why obesity rates are so much lower in Asia.

My study of the Chinese language and travel to China for cardiac conference lectures, over the last 32 years, finally led me to discover China’s Longevity Village where people are living exceptionally long, healthy lives.  In this village, we noticed that people regularly took walks after eating.  Seeing the Chinese walk after meals prompted my curiosity about the potential health benefits, and I began to research the science behind it.

The Glucose and Insulin Spikes

One of the primary hormones involved in hunger and weight gain is insulin.  When we eat the simple carbs, such as “healthy” whole wheat bread, processed foods, cereals, pasta, crackers, white rice, fruit juice, sports drinks, soda pop, pastries, sugar, etc., it causes a spike in our blood glucose.  The blood sugar spike from these simple carbs, or what I like to call the “hunger carbs,” then leads to a spike in insulin.

Simple Carbs –> High blood glucose –> High insulin –> Hunger and weight gain

When high insulin levels are coursing through our blood from overeating or eating the hunger carbs (i.e., junk food), it then causes our fat cells to grow and multiply by taking up all of the excess glucose.  Insulin is what causes our cells to pull the glucose out of the blood.  Once this happens, blood glucose levels drop, and we are hungry again.

If you ask someone you know with diabetes taking insulin they will likely tell you that they gained weight after going on insulin.  Insulin is the critical hormone for making fat (weight gain) and plays a dominant role in driving us to eat more.  The goal is to naturally keep our glucose and insulin levels as low as possible without any drugs.

Good Carbs vs. Bad Carbs

Of course, the best way to prevent this in the first place is not to overeat or eat the hunger carbs.  While “carbs” have been demonized recently in popular health books, healthy carbs such as those found in fruits, vegetables, nuts, seeds, beans, and lentils are an essential part of a healthy diet and in preventing diseases.  These healthy carbs or filling carbs don’t result in a significant sugar rise as they are slowly digested, from all of the fiber they contain, in the gut.

Also, some intact whole grains such as quinoa and brown rice can also be a good source of healthy carbs in our diet.  The primary problem with carbohydrates is flour.  Flour is nothing more than sugar to our bodies.

If you enjoy bread, as I do, try eating bread like Ezekiel, Trader Joe’s flourless bread, or Paleo Bread from Whole Foods.  Flourless or almond bread is slowly absorbed and doesn’t result in the big sugar and insulin surges.

What should I overeat or eat the hunger carbs?

If you slip up and overeat or give into junk food, which is normal, I recommend following the advice of the Chinese and go for a nice walk as soon as you finish eating.  This can help to minimize the damage.

What is the physiologic basis to walking after a meal?

After a big meal or eating junk food we get a big surge of glucose or sugar in our blood.  When this happens we can either wait for our body to bring down these toxic levels of blood sugar with insulin or we can quickly drop our blood sugar levels ourselves with exercise.

Our muscles need glucose to function.  When we exercise or go for a walk, the large muscles in our legs quickly extract the sugar from our blood stream.  When this happens, it prevents the insulin spikes and steals the sugar from going into the fat cells.

Glucose Storage in Muscle

Glucose is stored in muscle as glycogen.  As we need glucose when exercising, the body can store about 90 minutes of exercise fuel (glycogen) in the muscles.  This roughly translates to about 2,000 calories.

When our glycogen fuel tanks are full, the excess glucose has to go somewhere else.  However, if we can deplete these glycogen fuel tanks right after a meal then there is a place, other than making body fat, for any excess glucose from a meal to go.

Does Taking a Walk After Eating Really Work?

In a fascinating study, Dr. Loretta DiPietro from George Washington University showed that in a group of diabetic patients, a brisk 15-minute walk after each meal could prevent blood glucose spikes.  Moreover, these three 15-minute walks after each meal were shown to be much more impactful than a single 45-minute walk.

The principle is the same for us.  Walk after a meal to prevent blood glucose and insulin rises.  If we can keep our blood sugar and insulin as low as possible naturally, without any medications, we can prevent insulin from causing weight gain.  We can put the excess glucose from a big meal or junk food into our muscles instead of into our belly fat.

Timing of Meals and Exercise to Weight Gain

The concept of taking a walk after eating brings up another question.  Does it matter when we eat or exercise with respect to weight gain?

If you are like me, you were probably taught to never eat before working out.  While most of us have probably experienced the stomach cramps that come with exercising on a full stomach, could it be possible to moderately eat before exercising as a way to keep your weight in check?  After all, elite endurance athletes eat during all day long endurance competitions without problems.

One attractive feature to exercising after eating is that you can prevent the glucose/insulin spike.  Without the glucose/insulin spike we can help to prevent our fat cells from growing.

While there is not much data on this approach in humans, recent studies in rats suggest that exercising after eating can have a powerful weight loss effect.  Not only did the animals who exercised after eating lose weight but they also gained more muscle mass.  Could exercising after we eat grow our muscles rather than our bellies?

Practical Tips

Certainly, exercising or going for a walk after eating is not a license to eat whatever you want.  Unfortunately, it just does not work that way.  You simply cannot out train a bad diet.  In the end, for most people a bad diet will eventually wreck your health, regardless of how much you exercise, just like it did to me.

Based on these data and the teachings of the Chinese, I now try to walk or do something physical after most meals.  Could the Chinese be right after all?  Could a walk after eating be just what you need to prevent weight gain?

What one habit will you change to help you get moving more after you eat? Write it down. Try it for one week and document how you feel.  Together, we can lift one another in our quest to navigate the challenges of this society and take back our power to live well.

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Do you have any of these 12 magnesium deficiency symptoms?

You probably have no idea that you are currently suffering from magnesium deficiency. Indeed, studies show that up to 89% of Americans are magnesium deficient.  Read on to see if you have any of these 12 magnesium deficiency symptoms.

Jill’s Experience

Jill was a 45-year-old woman suffering from a heart condition known as atrial fibrillation. It made no sense why someone so young should develop this heart condition as she didn’t have any of the usual atrial fibrillation risk factors.

The only tip-off as to the cause of her atrial fibrillation was that she was taking Prilosec for acid reflux, Lasix occasionally for leg swelling, and she was eating the “Standard American Diet.” Even though her magnesium levels came back normal on her blood test, I suspected a magnesium deficiency as the cause of her heart problem.

Interestingly, once I convinced her to replace all added sugars and processed foods with real foods which included a massive salad every day, she immediately lost 20 pounds without even trying. In no time at all her acid reflux was gone and she was off the Prilosec. Also, with no added sugars or processed foods, her legs no longer swelled so there was no further need of diuretics.

Best of all, she felt better than she had ever felt and her atrial fibrillation went away. As she made many lifestyle changes, it was impossible to know what exactly drove her atrial fibrillation into remission.

However, in my mind, I’m sure replacing her magnesium stores played a role. Continue reading to figure out how she boosted her magnesium stores.

Can you test for magnesium deficiency?

While you can test for magnesium deficiency, you probably don’t want the test your doctor orders. The reason for this is because the standard magnesium test only measures the magnesium in your blood.

As 99% of your magnesium is not freely floating around in your blood but rather is inside of your cells and bones, you need a better test for magnesium deficiency. Of the various ways to test for magnesium deficiency, probably the best is the RBC magnesium test. The RBC magnesium test measures the amount of magnesium inside of your red blood cells.

Who is at risk for magnesium deficiency?

Many things contribute to magnesium deficiency. For example, if you are under a lot of stress, you likely are not absorbing much magnesium from your food.  Those who love drinking filtered or bottled water also aren’t getting much magnesium. And processed foods are notorious for being completely absent of magnesium.

Other conditions contributing to magnesium deficiency include being overweight, diabetic, or over age 60. Likewise, many prescription medications like diuretics or acid-blocking medications are also keeping your magnesium levels dangerously low.

Do you have any of these 12 magnesium deficiency symptoms?

1. Weight Gain/Diabetes

When you don’t get enough magnesium in your food and water, it can cause glucose and insulin levels to rise.  When insulin levels are high, you may suffer from food cravings.  Unfortunately, these food cravings are generally for sugar or processed carbohydrates which lead to further weight gain.

2. Fatigue and Muscle Weakness

Magnesium is a critical component of energy production in the body.  In fact, the body’s energy molecule, ATP, is created through magnesium dependent chemical reactions.

If you are tired all the time, you are probably magnesium deficient.  Likewise, if your muscles are weak, you may also not be getting enough magnesium.

3. Anxiety

People under high levels of mental or physical stress, poorly absorb magnesium from the gastrointestinal tract. Contributing to a downward spiral, magnesium deficiency is a significant cause of anxiety.  Fortunately, studies show that restoring the magnesium may help in the treatment of anxiety.

4. Insomnia

Having enough magnesium balances out your stress hormones.  Magnesium also helps the body maintain sufficient melatonin and other sleep hormones.  Indeed, magnesium supplementation has been shown to help with sleep.

5. Depression

Magnesium deficiency and depression go hand in hand.  Low magnesium stores lead to depression and people suffering from depression are more likely to eat a diet low in magnesium.

6. Dental Cavities or Osteoporosis

Dental cavities and osteoporosis are two more signs of magnesium deficiency.  Magnesium affects vitamin D metabolism and osteocalcin which play a vital role in bone turnover and formation.

Ironically, if you are taking calcium supplements for osteoporosis, you may be making matters worse. Calcium supplementation can throw off your calcium/magnesium balance.

7. Constipation

If you suffer from constipation you probably are magnesium deficient.  Magnesium in any form is an excellent laxative.

8. Muscle Cramps or Migraine Headaches

Do you suffer from leg cramps, eye twitches, or muscle spasms?  Do you get frequent headaches? These may all be magnesium deficiency symptoms.

9. Inflammation, Arthritis, or Autoimmune Diseases

If you suffer from chronic inflammatory conditions, such as arthritis or autoimmune diseases, you may be magnesium deficient.  Studies have linked magnesium deficiency to arthritis and elevated C-reactive protein (CRP) blood tests.

10. Palpitations, Heart Attacks, Heart Failure, or Cardiac Arrest

Most forms of heart disease are linked to magnesium deficiency.  This mineral is critical to optimal cardiac function.

11. Thyroid Problems

Thyroid problems are widespread in the U.S.  Research suggests that many thyroid issues may be due to magnesium deficiency.

12. Cancer

Cancer may be a wake-up call that magnesium levels are low. Magnesium is a critical nutrient for many DNA repair mechanisms.   As new cancer cells are created every day in your body, you need your DNA repair mechanism functioning optimally.

Magnesium in Our Water

Our ancestors used to get large amounts of magnesium just from their drinking water.  Mountain spring water is naturally high in magnesium.  Unfortunately, many municipalities remove magnesium as part of their water treatment process.

If you want to see how much magnesium is in your drinking water, click here.  In general, the “harder” your water, the more magnesium you are getting.

Interestingly, drinking hard water may lower your risk of heart disease.  If you happen to live in a city with naturally hard water, you can get up to 30% of the magnesium you need each day from water.

Unfortunately, water softeners, water filters, reverse osmosis devices, and bottled water are generally all depleted of magnesium.  If you drink any of these magnesium depleted water types, you have to get 100% of your magnesium from food.

Magnesium in Our Food

Once upon a time, our soil contained much more magnesium.  Unfortunately, modern agriculture has stripped this essential mineral from the ground.  Processed foods are even worse when it comes to magnesium content.

Fortunately, organically grown produce has been shown to have up to 29% more magnesium.  To get enough magnesium in your diet, make sure you eat plenty of green leafy vegetables, especially spinach, nuts, seeds, and legumes every day.  To see a breakdown of which foods contain the most magnesium click here.

Can you get too much magnesium?

In general, it is very tough to get too much magnesium from your food and water unless you have kidney disease.  Certainly, it is possible to get too much magnesium if you are taking supplements.

How much magnesium do you need each day?

The recommended daily amount of magnesium varies depending on your gender and age. Assuming there are no problems with magnesium absorption, you need about 400 mg of magnesium each day. If you can get at least 400 mg of magnesium daily from your water and food, you can start to enjoy the health benefits of magnesium.

Magnesium in China’s Longevity Village

As you know, we have been studying the residents of China’s Longevity Village for many years.  We have found that these people do not suffer from magnesium deficiency symptoms.

The mountain spring water they drink is extremely hard and packed full of essential minerals.  Researchers suggest that these people get up to 50% of their magnesium just from the water.

Also, modern agriculture has yet to put a stake in the ground in this rural area of China.  Thus, the soil is extremely high in magnesium and other minerals.

Their diet, which is very high in vegetables, nuts, seeds, and beans, only further augments the magnesium they are getting every day.  We suspect that the magnesium in their food and water may be a major reason why heart disease is very uncommon, and people live to old ages free of chronic medical conditions.

To learn more about why China’s Longevity Village has the highest known concentration of centenarians in the world, please be sure to pick up a copy of our new book, The Longevity Plan.

How can you correct magnesium deficiency?

Let me give you five simple steps to correct magnesium deficiency.

1. Drink hard or mineral water.

2. Eat a heaping salad with spinach, nuts, seeds, and legumes daily. 

3. Embrace the stress in your life.

4. Talk with your doctor about magnesium supplements.

5. Talk with your doctor about medications that may be contributing to your magnesium deficiency like diuretics, acid reducing medications, or calcium supplements.

Practical Tips

As 89% of Americans are magnesium deficient, there is a high likelihood that you may be one of them. Fortunately, magnesium deficiency is easy to correct.

I know I used to be one of these people. Before my health transformation, I required Prilosec daily for acid reflux, ate the Standard American Diet, and was always stressed. These three things alone probably put me also into a state of magnesium deficiency.

Now, in addition to eating a diet very high in magnesium, I have found that taking a magnesium supplement before bed helps me to sleep. Indeed, medical studies show that magnesium supplementation is an effective treatment for insomnia.

If you suspect you may have a magnesium deficiency as well, correct anything that can be fixed to boost your magnesium stores. Also, speak with your physician about whether a magnesium supplement might be right for you.

If you enjoyed this article, please be sure to subscribe to our free weekly newsletter and podcast. Also, to learn the secret to fantastic health at any age, please be sure to read our new book, The Longevity Plan.

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My typical reaction upon entering my children’s rooms has often been, “This place is such a mess! You guys have got to clean this up! Now!” And so many times, with such a sense of urgency, I meant now. I would quickly work with them to get some layer of clutter cleared before I could commence with whatever it was that I had come in there for in the first place.

It was the same around the house where people kept leaving their dirty socks, games, dishes, etc. around. I felt like I was constantly after them: “Guys! Remember, dirty socks belong in the laundry bin, not the floor…..Please put each game away after you play, so they aren’t all out at the same time with mixed up pieces….and….It saves you time to do your dishes before you leave the kitchen because no one has to call you back….”

We are still working on this, but something has changed.

A Shift in Focus, A New Outcome

It occurred to me that while there were areas of the house where I had less control over other’s actions, at the same time, there existed areas that I could control, and that by changing these, I could positively influence my dilemma of clutter in the house. I decided to start with my bathroom drawer, figuring that this would give me an immediate and achievable win. I couldn’t wait to get started.

As soon as the kids were in bed, I headed straight for that drawer and got to work. I cleared out bottles of stuff–some of which had been in there more than a decade.  (I am one who tends to hang onto things, thinking, “What if I need this someday?”) The image of that clean drawer gave me a lift each time I thought about it. The next night, I tackled the bathroom cupboard.This starting-projects-late-at-night habit is something else I’m working on, but that’s another topic for another day.

What happened when I shifted my focus to areas under my control? My need to fix other people’s clutter lessened, and the clutter itself lessened. I had taken back my power, and with it, came a greater sense of peace.

I found myself walking into my kids’ room, being unaffected by the clutter and being able to focus on the person with whom I came to interact, instead of the mess. And when I did ask my children to clean their rooms, the request came free of the sense of desperation that previously accompanied such “requests.”

My children sensed this shift and their resistance seemed to melt away to the same place my anxiety vanished. They now found the mental and physical space to move forward on their own, and the results were astounding.  They actually took initiative to clean their own desks one night instead of going to bed.  (I know what you’re thinking.  They’re following my bad example of staying up late to start a project.  We’ll have to tackle that issue separately.  I promise I’ll work on this and let you know how it goes!)

Giving Away My Power and Taking it Back

The point I want to make here is that in blaming an external factor, I gave my power away, when all along I had the power within to change my situation.

It sounded something like this:

Giving Away My Power: “I just can’t keep on top of all the clutter in the house because my kids leave their stuff everywhere.”

Taking Back My Power: “I can organize my own areas, which is changing the clutter situation in my home as well as my reaction to it.” Despite the existence of factors beyond my control, when I put the focus back on me, and the things that are within my control, I can change my situation.

Confront Your Excuses and Reclaim Your Power

Where are you giving away power that is actually yours to use?  Here are a couple of common excuses that you may have heard from others or even, possibly, yourself.

Giving Away Your Power in health: “I have diabetes, high blood pressure, high cholesterol, or this ______________(fill in the blank) condition, because it runs in my family.

Taking Back Your Power in health: “My lifestyle choices have an even greater impact than my genes do on whether or not I develop conditions, even genetic ones. I can make some small lifestyle changes, knowing that most conditions are reversible or preventable and that I can turn genes on or off  through my lifestyle choices.”

Giving Away Your Power in exercise: “I’m so busy with work and family that I don’t have time to exercise.”

Taking Back Your Power in exercise: “By making exercise a priority, I gain back time during my day, and over my lifespan. Studies show that exercise promotes energy, alertness, and concentration, increasing the productivity and quality of the remainder of my hours in the day.”

Seven Steps to Take Back Your Power

Here’s my challenge for you this week.  Follow these seven steps to take back your power:

1. Get Curious: As you go through the week, observe yourself with curiosity: What situations do you wish could be different?  Where are you blaming factors or people outside of yourself for this situation? Write it down.

2. Focus: Pick one, only one, situation for now. Write it down.

3. Identify: Get creative and pinpoint one thing within your control, not dependent upon outside factors or people, that you can do differently in this one situation. Write it down.

4. Experiment: Do that one new thing.

5. Assess: How does this one new approach change your situation and your feelings about your situation? Write it down.

6. Repeat. Introduce one more change in the same situation, or identify one new situation in which you can make one new change.

It’s time to confront your excuses and reclaim your power.  By doing so, what new reality can you make possible in your life? Let us know how it goes! You can leave a comment by clicking here.

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Can You Gain Weight from a Fecal Transplant?

Did you catch the news headlines about the woman who experienced massive weight gain following a fecal transplant from her daughter this past week?  Can this even be true?

Just what is the science behind a fecal transplant and why on earth would anyone ever want to have this procedure done?  In this article I will discuss the answers to these questions.

A Medical Mystery?

An unnamed woman, I’ll call her “UW,” was innocently prescribed a course of antibiotics by her physician to treat an infection she was struggling with.  While the antibiotic cleared up her initial infection the antibiotic caused a new infection, Clostridium difficile colitis.

Clostridium difficile, or “C. diff” for short, is an infection of the colon that can arise after someone has been treated with antibiotics.  As antibiotics can quickly wipe out your good gut bacteria, this then allows very dangerous bacteria, like C. diff, to quickly fill the void and cause a life-threatening infection inside of your colon.

For anyone who has ever experienced C. diff colitis, this can be an especially difficult infection to treat.  Even more antibiotics are given.  Unfortunately, even our most powerful antibiotics often cannot touch this deadly C. diff.

It is in just these most difficult cases when doctors may consider a fecal transplant.

U.W. was just one such patient.  She was in severe pain and her life was in jeopardy from the C. diff infection.  UW opted to get her fecal transplant from her 16 year old daughter.  It just so happened that her daughter was gaining weight at this exact period of time that she needed a fecal transplant.

As this is still a new medical procedure and doctors did not know all of the potential complications, they thought UW’s daughter would make a great fecal donor.  Her physicians then took some of her daughter’s stool and placed it in her own gut.

Her daughter’s stool bacteria were able to fight off her C. diff infection and she was soon cured of this disease.  Unfortunately, over the next 16 months her appetite was uncontrollable and every calorie she took in just seemed to stick.

UW had never had to deal with weight issues before in her life.  Now, regardless of what she did or how she ate she just kept gaining weight.  UW told her gastroenterologist, “from the moment I had the fecal transplant, I felt like a switch flipped in my body.”  The switch was indeed “flipped” and a woman who had never dealt with weight issues before suddenly gained 34 pounds!

Fecal Transplants for C. diff Infections

Fecal transplants for C. diff infections have now gone “main stream.”  For example, the venerable Mayo Clinic even advertises a 90% cure rate for C. diff, with a fecal transplantation.  Based on UW’s experience, doctors now know not to perform fecal transplants from overweight individuals to avoid long-term weight gain.

Could a fecal transplant be used for weight loss?

If a fecal transplant from UW’s overweight daughter made her suddenly become obese, could the opposite also be true?  This is something researchers are looking into right now.  Could transplanting fecal material from the gut of a thin person to an overweight person help them to lose weight?

Gut Bacteria

As there are 10 times more bacterial cells in your gut than the rest of your entire body, could these bacteria play a role in preventing weight gain and even coronary heart disease? Exactly what are these bacteria doing in your gut?

Studies indicate that up to 1,000 different strains of bacteria live in your gut.  These bacteria eat your food, help you digest your food, absorb key nutrients, neutralize toxins, and keep nasty bacterial invaders, like C. diff, away.

Having the right gut bacteria or gut flora can help to protect you against cancer.  When you have gas it may just be a by-product of these bacteria helping you to break down foods like beans.

Depending on your gut flora, you could absorb all or just part of the calories from what you eat.  In other words, with the wrong gut bacteria in place, like in the case of UW, you could absorb more calories from the foods you eat.

Likewise, if you have the right set of bacteria in your gut, you won’t absorb as many calories from food allowing you to eat even more without gaining weight.  Your gut flora can even control your glucose absorption rate, thus influencing your odds of developing diabetes.

Fecal Transplant for Weight Loss

In one the most prestigious scientific journals, Science, Dr. Jeffrey Gordon and colleagues from Washington University published groundbreaking research showing that gut bacteria from a fecal transplant can determine whether mice are lean or obese.

In this study, researchers first created mice with no bacteria in their gut.  At the same time they identified genetically identical human twins of which one twin was thin and the other twin was overweight.  Researchers then injected fecal material from either the thin or the obese human twin into these mice that they had created who lacked any bacteria in their gut.

Dr. Gordon and colleagues found that with the same diet and exercise patterns, the mice who received a fecal transplant from the overweight twin became overweight, like UW, and that the mice who received a fecal transplant from the thin twin twin became lean.

Oral Version of the Fecal Transplant

Mice share a nasty habit of eating each other’s droppings, also known as coprophagia.  Thus, to further test their theory, researchers then put a thin mouse in a cage with overweight mice and an overweight mouse in a cage with thin mice.

Given the innate habit of coprophagia, they could then test the theory of fecal sharing through the oral route.  As you might guess, the thin mouse eating obese mice droppings became obese.  Likewise, the overweight mouse eating lean mice droppings became thin. This change in mouse body weight was completely independent of their diet and exercise patterns.

Our Diet Determines Our Gut Bacteria

There is more to this study than just measuring the effects of swapping fecal material.  Dr. Gordon and his team also found that mice eating a healthy diet (a diet high in fruit and vegetables while low in saturated fats) could prevent them from becoming overweight if they were exposed to fecal gut bacteria from an obese mouse.

In previous studies, Dr. Gordon and his team showed that within our guts there literally is a “food fight” to see whether the Bacteroides or Firmicutes bacterial strain will dominate.  Thin people tend to have more of the Bacteroides strain and overweight people tend to have more of the Firmicutes strain.

While it may seem like a fecal transplant could be a quick obesity cure, it would still require long-term effort.  For example, to maintain the weight loss after a fecal transplant a person would have to continue to eat a very healthy diet otherwise it would just be a matter of time before the Firmicutes strain took over again and the person gained all of their weight back.

Indeed, Dr. Gordon and colleagues have also shown that within just 24 hours of eating a Western Diet (high sugar and high saturated fat), the bacteria in the gut could be shifted back to Firmicutes despite a fecal transplant.  Thus, if you did not want to change your eating habits you would need a daily fecal transplant to stay thin.

I suspect few people would sign up for a daily fecal transplant procedure.  However, if you could put fecal material from a thin person into a supplement then perhaps this is something you could take every day…

Could antibiotics really be a “fat drug?”

Along the same subject of gut bacteria and weight gain, animal breeders have known for years that if animals are given just a small amount of antibiotics every day that they will gain weight regardless of their diet or exercise patterns.  The data suggest that the healthy gut bacteria killed off by antibiotics allows the bad bacteria to take hold and cause the animal to extract more calories and accumulate more fat from the same diet.

While most of the antibiotics given to animals to fatten them up don’t survive the cooking process, some people feel it is possible that some could survive to your dinner plate.  This small dose in non-organic meat and dairy could be just enough to cause you to gain weight.

Even more plausible is that the course of antibiotics you took last winter may have caused you to gain an extra five pounds that you just can’t seem to get off.  Could our love of antibiotics for livestock and for every cough we humans get be yet another potential cause of the obesity epidemic in the U.S.?

Probiotics and Health

Probiotics have become progressively more popular.  Yogurt and other fermented foods may just give the necessary boost to the healthy bacteria struggling to keep the bad guys out of your gut.

There are also many probiotic supplements now on the market.  Lactobacillus and Bifidobacterium are the most popular as these are the best studied.  Many tout the benefits of ingesting live healthy gut bacteria.

A number of small studies have supported the use of probiotics for various gut, allergy, high cholesterol, depressive, and other conditions.  Currently, however, the strongest data supporting the use of probiotics is to prevent antibiotic-associated diarrhea.  This is an area of science that is still in its infancy and thus, there are still no FDA approved health claims for probiotics.

Personally, I believe we are just at the beginning of our understanding of the role of probiotics.  It certainly makes sense that if we can grow the right bacteria in our gut we just may be able to control many inflammatory and immune related diseases, obesity, and diabetes just to name a few.  Stay tuned, as this will be an exciting area of medical research for many years to come.

Gut Health in China’s Longevity Village

Remarkably, during our stays in China’s Longevity Village we could not find anyone, including the elderly, suffering from constipation, diarrhea, irritable bowel syndrome, or any other gut malady.  They rarely take medications, including antibiotics, and don’t pump their livestock up with antibiotics either.

They eat an extremely high fiber diet.  Almost everything they eat is high in fiber.  How can you not have a healthy gut with so much fiber?

They also love fermented foods like fermented tofu.  Sugar and other simple carbs like bread as well as red meat, and dairy were traditionally absent from their diet.

While they did not intentionally practice intermittent fasting for health reasons, most of the older generations experienced periods of time where they were hungry when food was limited.  These periods of famine may have promoted the healthy gut bacteria which conferred upon them health and longevity.

9 Lessons for Maintaining a Healthy Weight and a Healthy Gut

1. Feed your gut bacteria fiber.

A high fiber diet, consisting of plenty of fruits and vegetables is just what you need to help colonize your gut with the good, disease and obesity fighting bacteria.  High fiber foods are also called “prebiotics” as they create the perfect environment for healthy gut bacteria to thrive. With the right gut bacteria, you can eat more food and be less likely to gain weight or become diabetic.

2. Only take antibiotics when it is absolutely necessary.

Everyone knows that antibiotics are over-prescribed. Not only are we harming our gut health but we may also be gaining weight and creating superbugs from excess antibiotics.  We are just beginning to learn about the potential life-long detrimental effects of just a single course of antibiotics on our gut health.

3. Only eat organic meat and dairy.

Eating non-organic meat and dairy, pumped full of antibiotics, may just be yet another source of unnecessary antibiotics in our diets.

4. Consider probiotics.

Early data are promising for probiotics.  Before considering supplements, I always recommend first getting probiotics naturally from foods such as yogurt or fermented foods.

5. Manage stress.

Studies have shown that when we are under stress it causes the beneficial gut bacteria to die off.  Make it a point to do something for stress each day.  Stress reduction could come in the form of yoga, exercise, being in nature, prayer, mediation, or even just spending time with friends and family.

6. Minimize unhealthy fats.

As shown in the mouse experiment, unhealthy fats in your diet promote the unhealthy gut bacteria, which then could lead to obesity and diabetes.

7. Minimize acid reducing and anti-inflammatory drugs.

These drugs also disrupt healthy bacteria in the gut.  It is important to keep the right acidity in the stomach to promote the right kind of bacteria in our guts.  Likewise, anti-inflammatory drugs, like ibuprofen, can damage the walls of your gut which can also affect good gut bacteria.

8. Minimize the “hunger” carbs.

If possible stay away from sugar or anything else that is like sugar including even “whole wheat” bread, cereals, most pastas, pastries, crackers, processed foods, etc.  These simple carbs, which I like to call the hunger carbs, just make you hungry as soon as you finish eating them.

The disease causing gut bacteria also love these unhealthy carbs as much as we do.  If you love your bread, like me, making your own bread.  You can even try my wife’s “real” bread recipe.

Another option is to try Ezekiel Bread, which is also slowly absorbed and does not result in that sugar surge you get with even traditional whole wheat bread.  Ezekiel Bread can be found in the frozen section of most health food stores.

9. Intermittent fasting.

There are even data supporting the role of intermittent fasting and optimal gut health.  If you already fast for religious reasons, this may be one additional benefit.  Even going without food for just 12 hours seems to increase the balance of Bacteroides to Firmicutes which decreases your likelihood of obesity or diabetes.

Remember, this is early research, but it is fascinating to consider the possibilities.

What do you think about the idea of fecal transplant to control weight gain?  What have you found to help your own gut health?  Do you take probiotics?

Disclaimer

Please do not try anything discussed in this article without first speaking with your physician.  There can be risks with anything, even just changing your diet.

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In the cereal aisle, I overheard a mother telling her child, “You can have this cereal, or this one, or this one.” The child countered, “Can I have this one?”

“No,” The mother replied, “but you can have this one.”

I looked up to see her pointing to a box of sugary chocolate puffed cereal.

I paused, intrigued. By what criteria was this mom making her selections?

Pretending to be busily evaluating the cereal boxes myself, I continued to listen as the tension increased between the mom and the boy of about 10 years in age.

Finally, her food rule was revealed. “Look, we’re going gluten-free, so you’re going to have to pick one of these gluten-free cereals.”

Why was I so intrigued by this scenario?

Because I saw myself in it. Over my lifetime, I have placed a lot of “food rules” on myself. At one time, my “rule” was “fat-free” or “reduced-fat.” As long as a food met this criterion, I could happily consume it.

Do you remember SnackWells fat-free cookies in the green box? I was in heaven when those appeared on the shelves.

Never-mind that they were loaded with sugar and other mysterious ingredients; they were “fat-free,” and thus permissible.

Were you as excited as I was when fat-free Olestra made its debut? This ingredient in fat-free Pringles and other chips was marketed as the answer to eating our chips without all the fat.

It wasn’t long before I, and others, discovered that something about this ingredient didn’t agree with our bodies. It was removed from the market almost as quickly as it came on.

During this era of “if it’s fat-free, it’s ok,” John’s brother, Mike, said one day, “Even fat-free foods have calories and it’s the calories that count, not the fat.”

By my rules at the time, I disagreed. Some time later, I switched my food rules from “fat-free” to “sugar-free.” At this point, anything sugar-free was the way to go.

It didn’t matter what chemical was being used to replace the sugar or what it might ultimately do to my body.

I’ll never forget the day my sisters-in-law and I discovered sugar-free jellybeans.  We were in London and attended a play that night.  We brought our newfound treasure with us and freely partook.

It wasn’t long before whatever it was that replaced the sugar began wrecking havoc in our digestive systems.  Bloated, cramping, and gassy, we kept jumping up from our seats and heading for the bathroom.

Upon our return to the hotel room, our attempts to sleep continued to be interrupted by the same symptoms.

We had a great time teasing each other about our great fortune that turned into misfortune.

I find it fascinating that I have put so many irrational food rules on myself, these being just two of many examples, all in the name of being “healthy.”

These rules kept me stuck in a lot of processed foods with a lot of labels making the promises I wanted to hear.

Don’t most “diets” have rules that, when we really think about it, don’t actually make sense for our health?

Do you remember the one that lets you eat as many cheeseburgers as you want as long as you don’t eat the bun?

Or how about the rule that John followed for a while which allows you to consume any quantity of breads, pastas or pastries you desire, as long as they are gluten-free?

John’s not gluten-intolerant and, like many on any diet attempting to control food intake and weight, he ended up actually gaining weight from this particular diet attempt.

Today, I am trying a new approach.  The new “rule” is simply Real Food First. What is real food?

As a society, we have drifted so far from this basic concept of real food that we can be left asking ourselves whether the Mac and Cheese box declaring its ingredients to contain whole grains with 2 extra grams of fiber is now real food?

So much of our packaged foods today are devoid of so much of the nutrition we need.  Instead, they contain nutrient-deficient ingredients that can cause us to crave more of these same nutrient-deficient ingredients.

As Americans, we tend to have so much guilt around food and often don’t enjoy our food.

The abundant temptations and our resultant obsession with food rules to control our intake in the name of health, may contribute to what is making us sick from food.

In China’s Longevity Village, I reflected on our dilemma as I witnessed friends and family working together to grow, harvest, prepare and partake of their food.

Food rules, guilt, and obsession over resisting food are non-existant, as are obesity and eating disorders.  The people are simply grateful to have the real food that they’ve worked to produce.

In the U.S., 50% of our meals are prepared or eaten out.

It is easy to become distanced from the knowledge of what is actually in our prepared food.

When we get curious and begin asking questions, we often find it is comprised of ingredients that do not promote our health or even create cravings to eat more processed foods.

For me, when I find that I am in the grip of the junk food, it takes some work to escape its hold.

The junk food can override the natural cues my body tries to send me to eat healthy, and instead, make me think I just want more junk.  But as I refuse to succumb to this lie, and eat more real food, I am better able to listen to my body’s cues and actually come to crave the real food more than the junk food.

I currently strive to first eat the vegetables, fruits, legumes, nuts and seeds that give me the nutrition my body needs and satisfy my hunger in a real way.

I am finding that this reduces my intake of the less nourishing foods and sometimes eliminates the desire for these foods all together.

Another benefit to this approach, for me, is that nothing is “forbidden.”

In my experience, when I forbid myself a certain food, I often end up eating that food in excess.

The freedom that Real Food First offers, in contrast to the irrational food rules and the accompanying cravings, tastes so much sweeter than any sugar-free cookie or fat-free potato chip I could ever consume.

We’d love to hear your stories about your own attempts to escape the grasp of junk food.

Have you ever tried restricting certain foods or ingredients?  How have these attempts have worked for you?  What is working for you now? You can leave a comment by clicking here.

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Real Food First: A Simple Guide to Losing Weight, Getting Kids to Eat Healthy, and Feeling More Energy

When we returned home from our first visit to China’s Longevity Village, we asked ourselves, “With all the junk food our kids encounter at school, church, playdates, scouts, sports, and practically everywhere in our society, how can we help our kids not only eat healthy, but develop a desire to eat healthy?”

The pay off of good habits developed early was apparent in the village. We were so impressed how a group of people in this village were able to feel so good, have so much energy, and escape the chronic medical conditions that we see everywhere in the U.S. None of them were taking any medications and they were still growing their own naturally organic food well into their 80s, 90s, and 100s.

The traditional diet of China’s Longevity Village is a diet consisting of vegetables, fruit, beans, nuts, seeds, and fish.  They eat vegetables with every meal, including breakfast.  There was no added sugar, limited grains except for unrefined brown rice, and limited animal meat.  Dairy was not part of their diet as they are lactose deficient.

The Junk Food Life

It is so difficult to eat healthy as a kid in our society.  School lunches are horrible.  Little league coaches, scout leaders, and church leaders often enjoy offering “treats” to our kids. But how rewarding are these “treats” when kids in the U.S. are becoming overweight at an alarming rate and developing chronic conditions earlier and earlier in life?

Eating junk food has become the norm.  How do we help our kids break away from the path of least resistance and take initiative to make healthier behaviors? We can’t always be with them.  Somehow, we have to help them develop the desire and the tools to make their own healthy choices.

Like most parents, we are trying to empower our kids with knowledge about what their bodies need and why. We teach them to read labels.  We teach them how food grows. We try to help them practice balance–maximizing the good and minimizing the bad.  All these things are good, but left to their own devices, our kids still tend to prefer the not-so-healthy choices and go for the less healthy ones.

Recently, we’ve been trying a new approach: Eat Real Food First.

Let me explain.  With each meal we offer and encourage our children to eat vegetables, a fruit, a healthy fat, and a healthy protein.  If their bodies tell them that they are still hungry after their fruit, vegetables, healthy fat, and healthy protein, then they can choose to eat additional foods, including not-so-healthy items, if desired. We are finding that by filling up on real food first, our desire for and the amount of junk food we actually eat decreases.

Tips for Getting Kids to Enjoy Vegetables

Getting kids to eat vegetables can be challenging.  Vegetables are something that we know few others will offer to our kids so we make sure to at least offer some form of a vegetable to our kids with each meal.

When given the choice, our kids will always opt for the carrot sticks.  While carrots are extremely healthy, we try to make sure that by the end of the day they have had a rainbow of vegetable colors (orange, green, red, etc.).  Of the rainbow of colors, we try to make at least one of them a cruciferous vegetable (broccoli, kale, cauliflower, etc.)

Most often, they like the vegetables raw with a salad dressing for dipping.  However, more and more, they are enjoying stir-fry dishes with different sauces.  Our 9- and 11-year-old sons now declare that curry is their favorite, our 6-year old daughter likes hoisin sauce.

We invite the kids to cut and cook the vegetables with us.  Somehow, working with the food itself helps them to enjoy eating it more.  They each have developed their favorites to chop–one particularly likes to chop onions, another zucchini, and another carrots. Whatever works!

If there are certain vegetables they traditionally resist, we find that when we cut them up small and mix them with a variety of other colorful vegetables, we have more success.  A vegetable they’ve always “hated,” often gets eaten without comment or fuss.

Our next step is to grow some of these foods ourselves.

We’d love to hear your suggestions, questions, and successes helping your family to enjoy vegetables. Please share your comments at the end of this blog.

What fruits do we encourage?

Fruits are not so difficult. We can’t think of a fruit our kids won’t eat.  We always try to have a wide variety of fruits peeled and cut up ready to eat with each meal.  It could be something as simple as a few organic strawberries, half of an orange, or a small bunch of organic red grapes.  One small serving of a fruit with each meal is enough and can address the desire for something sweet.

“Hunger Carbs” vs. “Filling Carbs”

Vegetables, legumes (beans and lentils), and to a lesser extent fruit, are what we call the “filling” or “healthy” carbs.  These carbs, which are slowly digested, do not result in big sugar or insulin spikes, and heal us.  These carbs fill our bellies and allow us to feel full.

These “filling” or “healthy” carbs stand in stark contrast to the “hunger” or “disease” carbs.  The hunger carbs result in rapid sugar and insulin spikes.  They cause us to become hungrier and cause our bodies to break down and become sick.

Have you ever wondered why you can have bowl after bowl of Fruit Loops and never feel full?  The hunger carbs are bread, including whole wheat bread, pasta, sports drinks, soda pop, pastries, crackers, and most processed foods.

If you eat the “hunger carbs” you will just be hungry again in a very short period of time.  The “hunger carbs” are one of the biggest reasons why we are gaining unneeded weight.

What healthy fats do we encourage?

For their healthy fats we encourage things like nuts or nut butter of any kind, seeds or seed butter of any kind, hummus, or even Wild Alaskan Salmon.

For the longest time, none of our kids would eat fish.  But after offering it over and over and over, all three of them have now learned to enjoy Salmon.  They even ask for it when we are planning meals! We like the Wild Alaskan Salmon because it offers the best fish health benefits with minimal mercury, dioxin, or PCBs.

If they are asking for “milk,” healthy fats choices could also include organic unsweetened almond milk, coconut milk, or soymilk.  We realize that soy can be a controversial food item for some people.  This is likely because of how we eat soy in the U.S.  Our soy here is genetically modified (GMO) and processed, not using the whole bean. The organic soymilk we buy does use the whole organic soybean, not merely isolated components or added chemicals. We just make sure we read the labels carefully.

Countless medical studies from Asia have demonstrated the health benefits of soy.  This is likely because they eat the whole bean and the beans they traditionally used were non-GMO.  If you choose to drink soymilk only buy the organic unsweetened whole bean varieties.

If they are asking for a dessert or something sweet, assuming they have not already had candy offered to them from someone else, we may offer dark chocolate.  Our kids have learned to love even 80% cacao dark chocolate.  The darker the healthier.  Dark chocolate includes many healthy fats. We have recently begun mixing nut butters with almond milk, cocoa and stevia. This concoction is a step up in nutritional value from traditional sweets and satisfies our sweet tooth. And, somehow, a smaller amount seems to satisfy, rather than producing an unquenchable desire to eat more and more, as the others sweets usually do.

What healthy proteins do we offer?

For a healthy protein with each meal, we offer our children the same foods listed above that provide the healthy fats–nuts or nut butter of any kind, seeds or a seed butter of any kind, legumes (lentils or beans of any kind), hummus, or Wild Alaskan Salmon.

As most of our suggested healthy fats and proteins are on the same list, depending on what our kids want to eat, one serving of something high in the healthy fats and proteins could suffice for both.

We understand that some of our recommended healthy proteins are not complete proteins with all of the necessary amino acids (i.e. lentils, beans, nuts, and seeds).  This is not a concern to us as our kids will also get other protein sources during the day which will round out their amino acid profile.  For example, at some point during the day, our kids will want a sandwich or a bowl of a healthier cereal.

Ideally, the sandwich or cereal comes after eating the real food first. Otherwise, it’s easy to fill up on the less-nutrient-rich foods and not want the more nutritious foods afterwards.  The protein from the whole grains in these items will make a complete protein when combined with lentils, beans, nuts, or seeds.

We try to offer the healthiest possible versions of the snack foods they ask for at home—i.e. chips, crackers, treats, and we encourage them to be eaten with meals, No foods are forbidden or restricted, as we’ve seen that this can create unintended problems in itself. We know that they will certainly find the junk food at school, a friend’s house, or at church, etc. Our intent is to be relaxed about these realities in our society.

The important thing is that we have at least given them three opportunities each day to provide them with real food first to help keep them healthy.

Day by day, our kids are relaxing into the idea of eating real food first with every meal we have together.  Sometimes they even take their own initiative to get the healthy stuff first.  Sometimes.  We hope this is a work in progress, and will continue to build over time. We’re not there yet, but we are finding that this approach is helping us to guide our children to eat healthy.

Real Food First is the adaptation of China’s Longevity Village Diet to an American lifestyle, which helps us to more successfully navigate the realities of our society and live better.

How to Start Eating Healthy as the Best Way to Lose Weight

As a cardiologist, 80% of the health problems that I see every day could have been avoided with healthy lifestyle choices.  The benefits of eating healthy, reducing stress and moving more are truly life changing.

The question among my patients is always: “how do I start eating healthy and what is the best way to lose weight?” Carrying extra weight is one of the biggest factors causing so many of the health issues I see today.

Unfortunately, less than 5% of diets work long-term.  Eating less does not work because your body’s metabolism just slows down and you are hungry all of the time.  This just makes you tired and irritable.

Exercising alone to lose weight doesn’t work either.  Vigorous exercise can just work up an appetite and, if left unchecked, will cause you to negate any calories you may have burned off with one sports drink, a treat, or a big meal.

By eating real food first, we can give our body all the nutrition it needs for optimal health and eat the foods that will fill us.  Eating real food speeds up your metabolism, so that you burn more calories through the day. Filling up with real food first, in combination with exercise and moving throughout the day, really is the best way to lose weight.

Step 1: Real Food First

Step 1 of the Real Food First Diet is really quite simple.  At each meal, before you eat anything else, have a fruit, two vegetables, a healthy fat, and a healthy protein.  The list of suggested items above for our kids is exactly what you could use as you are starting as well.

You have to be religious about starting every meal, including breakfast, with real food first.  Vegetables are not typically part of a traditional American breakfast.  Let’s change that.

For breakfast, steam up some broccoli as a side with your oatmeal sprinkled with your favorite nuts and almond milk.  Make a delicious salad. If you love your eggs, mix in tomatoes, onions, garlic, broccoli, zucchini—whatever you have.  For eggs, I recommend organic, pasture raised, local eggs.  Never go a meal, especially breakfast, without eating Real Food First.

Step 2: Nothing is Forbidden After Eating Real Food First

After you have finished eating Real Food First, if your body tells you that you are still hungry, decide what you need.  Remember it takes at least 20-30 minutes before your brain gets the message you are full so eat slowly and wait a while after eating real food first. No foods are forbidden or restricted with the Real Food First Diet. There is no counting the calories.

Of course, this is not license to binge or disregard the signals your body is sending you! Listen to your body. If you decipher that you are physically full, but still “hungry” for something else, stop eating, figure out what you really need, move on to another activity, and reassure yourself that you can eat again when you are hungry.

Ideally, you will fill up on the real food first so that you body’s natural weight regulation system will kick in and regulate your weight to the ideal weight.  The problem comes when we eat the “hunger carbs.”  These are the carbs that our body immediately turns into sugar like bread (even whole wheat), pizza, pasta, crackers, processed foods, desserts, etc.

The more “hunger carbs” we eat, the hungrier we will be.  This results in high insulin levels that completely override all of our body’s natural weight regulation system.

If you love bread, like me, try switching to Ezekiel bread, which has no flour and is very high in protein and fiber.  As this bread is not rapidly converted to sugar, like traditional whole wheat or multi grain breads, it is considered a “filling carb.” Even our kids like Ezekiel bread.  It makes great French toast and sandwiches (especially when toasted).  We also enjoy Ezekiel buns, cereals, and pastas.

Step 3: Real Food First with Snacks

If you are hungry between meals then the Real Food First Diet allows you to snack as long as you snack on real food first. We find that if you are eating real foods first, most people do not get hungry between meals.  If you do, have a vegetable, healthy fat, or healthy protein first.

Like with mealtime, if your body tells you that you are still hungry after a vegetable, healthy fat, or healthy protein, then you can eat what you need.  Once again, give your brain 20-30 minutes to get the message you are full.  No foods are restricted or forbidden once you have had real food first.

Immediate Weight Loss

Depending on your previous diet and how overweight you are, you could lose anywhere from 5-20 pounds in your first 10 days by eating real food first.  While this is primarily water weight from the simple carbs or “hunger carbs” (bread, pasta, sports drinks, sodas, pastries, crackers, processed foods, etc.), it is still exciting to see the weight drop so fast at first.

After this initial weight loss, most of my patients see a gradual one to two pound weight loss each week when they eat real food first in conjunction with regular daily exercise (30 minutes if moderate intensity/15 minutes if high intensity) and 10,000 steps daily.

With most diets, people quickly gain back all of the weight, and then some, with eating real food first this is not the case.  This is a lifestyle change.  There is no specific “diet” or meal plan.  Just eat real food first and if your body tells you that you are still hungry after the real food then you can eat what you need.  There is no hunger.  There is no deprivation.

Reclaim Your Energy

In addition to the rapid weight loss in week number one, the biggest thing my patients notice is how much better they feel.  Suddenly, it was as if some one gave them all of their energy back.

Rather than just sitting and feeling tired they suddenly wanted to get up and start doing something.  Many of my patients have told me that they have not felt this good and energetic in years.

Yes, real foods give us energy.  If we can get rid of the energy draining “hunger carbs” or the “disease carbs” and replace them with the “filling” or “healthy” carbs, we can have as much energy as we had when we were kids.

Make Real Food First a Habit!

We have found that with every new habit, tracking our progress is one of the most important things for success.  To help you put Real Food First and reclaim your health and energy now, please sign up for Dr. Day’s free Healthy Habit Tracker App on the resource page of our website.

By signing up for this program, you will get a daily email reminding you to record your progress for the day.  You can even earn “medals” for the number of days you consistently fill out the form.  It is never too late to change!

How about you?  How do you put real foods first?  Have you found success in reaching and maintaining your ideal weight with real foods? Please help others by sharing your questions and experiences here. You can leave a comment by clicking here.

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There was a time when I could not imagine a day without a chocolate chip cookie or a donut. Who doesn’t love a fresh warm chocolate chip cookie?

As a cardiologist, I would generally go to the hospital cafeteria during off hours, when I knew not many people would be there, to buy my cheeseburger, fries and cookie.

I hated it when people would look at my white lab coat stating “cardiologist” and then the tray of food and sarcastically jab, “that’s a healthy meal for a cardiologist.” It’s like they somehow expected me to be able to resist because I was a doctor, but I’m no different than anyone else.

The scary thing is that the only person I thought I was hurting with my “sweet tooth” addiction was me.  At the time, I had no idea that behaviors are contagious or that my poor food choices could cause my children to inherit a gene for, say, diabetes or obesity.

Even though it has been more than three years since I have had a cheeseburger, fries, cookie or donut, I still crave these items. What has helped me to stay strong? Not only does what I eat make me feel better, but studies now show that what I eat can change my genes and can also affect the health of the generations that follow me.  This gives me the purpose and resolve to shift my habits to healthier ones for myself and for my posterity.

The Obesity Numbers

How has the obesity rate gone from approximately 10% in 1970 to 36% in 2010?  That is nearly a four-fold increase!  Now, more than 2 in 3 Americans is overweight or obese (69% of the U.S. population).   For men it is even worse, as 3 in 4 adult men in the U.S. are overweight or obese.

What is Driving Everyone to Gain So Much Weight?

Why are we eating 500 more calories each day now than what we ate in 1970?  Traditional wisdom, based on Darwinian evolution theories, tells us it is impossible for our genes to have changed that much in the last 40 years.  Thus, it must be our lack of willpower that is driving most of us to gain the weight.

Behaviors Are Contagious

Could gaining weight be as contagious as catching the common cold?  Indeed, this is the argument set forth in a landmark study published in the most prestigious medical journal in 2007.

In this study, researchers from Harvard and U.C. San Diego evaluated 12,067 people from 1971 to 2003 living in Framingham, Massachusetts as part of the Framingham Heart Study.

These researchers found the following:

1. If your friend gains weight, you are 57% more likely to gain weight too

2. If your sibling gains weight, you are 40% more likely to gain weight too

3. If your spouse gains weight, you are 37% more likely to gain weight too

How can this be?  The argument is that we tend to follow the behaviors we see around us.  The good news is that these same researchers found that if a friend or family member “gets healthy” you will probably “get healthy” as well.

One easy solution to take advantage of these scientific findings?  Identify and start hanging out with people who strive to live healthy lifestyles.    It just might be what finally enables you to more effortlessly lose weight, enjoy exercising more regularly, and feel better.  Experiment and see if you find that it is possible to catch this contagious “healthy bug.”

Genetic Predestination?

Just this past week I had several patients tell me that they were “destined” to be overweight, diabetic, and have heart disease because that is what happens to everyone in their family.  One patient even went on to tell me, “we all get the same gene and there is nothing we can do about it.”

When I heard this I was so saddened.  He felt he was a victim and with this thought process he too had become overweight, diabetic, and had a heart condition.

Could it be that this was a learned behavior and had nothing to do with his genes at all?  Or could it be possible that even if it was “genetics,” we can change our genes through our lifestyle choices?

According to the exciting new science of epigenetics, the encouraging news is that, yes, we can change our genes.

Epigentics

“Epi” means outside or on top of.  Thus, epigenetics refers to the science of how “tags” are put on the outer portion of our genes.  What we eat and how we live determines which of our genes are turned on or off based on these “tags” or our epigenome.

Healthy Lifestyles Change Our Own Genes

It is not just us that will benefit from us modifying our own genes but our posterity will benefit as well.  In the groundbreaking research of Dr. Dean Ornish of men with early prostate cancer, he found that a healthy lifestyle consisting of the following resulted in over 500 positive gene changes.

1. Plant-based diet

2. Daily exercise

3. Daily stress reducing activities

4. Weekly support groups

Depending on how you look at it, epigenetics could be really exciting or really scary.  If we eat real foods and live a healthy lifestyle, this can put tags on our genes which turn off bad genes and turn on good genes.  This can benefit us now and reverse chronic medical conditions.

In some cases, these new genetic tags, can be passed on to our children and grandchildren.  Thus, your healthy lifestyle can give you and your children and grandchildren a genetic advantage for generations to come.  Alternatively, your bad habits can genetically handicap you, your children and grandchildren.

So, getting back to the question, why then has there been nearly a four-fold rise in diabetes and obesity in the last 40 years?  Could learned behavior and epigenetics explain this rapid rise?

Can Foods Change the Genes We Pass to Our Children?

Not only are our kids and grandchildren “destined” by the behaviors they see in us but it is also possible that we are passing on new genes that can predestine them to being overweight and diabetic.

Parent Diets and Children/Grandchildren Health

There was a fascinating study showing this phenomenon in action.  The northern most point of Sweden, Norrbotten, is a very isolated cold corner of the world.  During winters when food was scarce, people were very lean.  Conversely, during years of plenty, people ate much more food than was needed.

Surprisingly, researchers found that children born during famine years, when their parents did not overeat, were not only healthier but also lived 32 years longer.  Not only did these famine year children enjoy remarkable health but their grandchildren did as well.  Conversely, children born during “plenty years,” when people overate, had more health problems and died much younger.

Dr. Randy Jirtle from Duke University pioneered this groundbreaking research.  From his research, he found that what types of foods mice mothers were fed prior to conception could genetically play a large role as to whether her babies would have diabetes or obesity.  He followed up this research in humans by showing that if a man was overweight at the time of conception it was likely that his child would genetically have the “obesity gene” turned on.

The science of epigenetics completely overturns the concept of Darwinian Evolution.  In other words, species slowly evolve over time.  Rather, with epigenetics, species can change rapidly when exposed to certain environmental factors.

Parental Guilt

Naturally, one downside of epigenetics could be more parental guilt.  I know this is the case for me.

I was overweight and ate my fair share of processed, chemical-laden, sugary foods when each of my three children was born and I suffered myself with many unnecessary medical conditions.

Jane and I are now doing our best to model healthier food behaviors while our kids are still young.  I now live free of several medical conditions and medications that previously held me back. With the right supportive environment, perhaps any epigenetic tags that I may have passed on to our children could be reversed.

We are emphasizing real food first in our home.  In other words, we encourage our children to eat real food first at every meal (vegetables, fruit, healthy fat, and a healthy protein) before they eat anything else.  The goal here is that they will be satisfied after eating the real foods and desire fewer “hunger carbs” like sweets. I am seeing this approach work wonders for my patients and colleagues. Time will tell, and we’ll let you know how it goes with our kids!

What do you think?  Are healthy or unhealthy behaviors contagious?  Through our lifestyle choices, can we impact the helpful or harmful genes we pass on to our children and grandchildren? You can leave a comment by clicking here.

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Is there such a thing as healthy cooking oil?  Perhaps like you, as a child who loved to cook with butter or margarine, this was something I never thought about.

I remember fondly my early days of cooking in my parent’s kitchen. I must have been about 8 or 9 years old when I learned to cook my favorite foods.  I used to love putting heaps of margarine on the bread of my grilled cheese sandwiches to get them to grill up nicely and taste great.

I also had no qualms about putting the half of cup of vegetable oil in the cake batter recipe.

Although I can still taste that creamy butter or margarine melting in my mouth, for me, the health risk is just too high to ever go back there again.

In fact, I no longer use any oil with cooking.  For my daily vegetable stir-fry dishes, I now use water or vegetable broth and stir the food continuously. I flavor my dishes with herbs and spices.  If I bake a fish, I like to use naturally oily fish, like Wild Alaskan Salmon, so that no additional oil is ever needed.  I prefer to get my healthy fats with nuts and seeds each day.

My patients often ask, which oils are the healthiest?  If you enjoy cooking with oil, you’ve no doubt also wondered which oils may be healthier than others. Here’s what the data shows.

Is There a Healthy Oil?

If you are confused on this one you are not alone.  It seems that the recommendations from the “experts” for the healthiest cooking oil keep changing, creating a moving target.

On one hand, oil is a processed food which is extremely high in calories and does not have much in the way of nutrients.  Vegetable oils and hydrogenated oils have now been shown to be a significant risk to cardiovascular health.

On the other hand, some people promote the health benefits of organic extra virgin olive oil as part of the Mediterranean diet.  They claim the monounsaturated fats and polyunsaturated fats, including omega 3s, are a critical component to our health.

Healthy Populations that Eat Oils

To try and sort out what is the healthiest cooking oil, some have looked at populations of people who do or do not consume a lot of oil.  While this is not direct evidence, it can be somewhat reassuring that at least in these populations of people their oil consumption does not appear to affect their health in a negative way.

1. Mediterranean Cultures with High Olive Oil Consumption

The Mediterranean Diet, commonly eaten in Greece, Southern Italy, and Spain is rich in olive oil and is now held up by the medical community as the ideal diet that all Americans should eat.  Most physicians feel that olive oil is the best cooking oil.  In addition to the olive oil, these people also eat a lot of vegetables, fish, fruit, and legumes and a moderate amount of cheese, yogurt, and wine with much less animal meat.  Unlike in the U.S., sugar and processed foods are generally absent from this diet.

Eating this way has been shown to decrease your risk of heart disease and cancer.  Is the benefit from the olive oil or something else they are eating such as all of the vegetables and fish?  Also, is the benefit really because olive oil is a just a healthy substitution to the other oils they could be eating like butter or hydrogenated vegetable oils?

2. Polynesian Cultures with High Coconut Oil Consumption

In recent years, coconut oil has become one of the most popular “healthy oils”.  In fact, if you do an internet search many sites now claim that coconut oil is the best cooking oil.  We have also started cooking with coconut oil.

Historically, coconut oil was held in contempt due to the high content of saturated fats.  Now, more recent data is exonerating coconut oil.  In fact, newer data has shown that not all saturated fats are bad and that the saturated fats that come from coconuts and nuts, for example, may be good for us.

Fascinatingly, there have been several studies looking at remote Polynesian Islands where a large percentage of their calories come from coconut oil.  Despite such a high content of oil in their diets, their risk of cardiovascular disease appears to be quite low.  If you want to read more, here is a study of the Kitava Island and the Pukapuka and Tokelau islands.

3. Bama, China with Historically Minimal Oil Consumption

In contrast to the Mediterranean Diet, there are rural Chinese villages where people historically eat minimal oil and enjoy remarkable health, longevity, and freedom from cardiovascular disease.   Our research team has been studying one such area in China where they did not historically eat oil. Because this rural mountainous area of Southwest China was so poor, the only cooking oil they could use is what little they could press themselves from hemp seeds.  This sparing use of oil could be one of the numerous factors in the longevity and wellness of the peoples of this region in China.

Organic Extra Virgin Olive Oil

With olive oil, I recommend organic extra virgin olive oil.  We buy the Kirkland organic extra virgin olive oil for a very reasonable price at Costco.  Store your olive oil in a cool dry place to keep it fresh as long as possible.  This is particularly important if you purchase the typical large Costco sized container.  If the oil is old throw it out.

I would not recommend using this oil for high heat cooking as at high heats the oil smokes, may be converted to transfats, and loses any potential health benefits.

Although organic extra virgin olive oil has a halo effect, I would not recommend eating large quantities of even this healthy oil.  Even organic extra virgin olive oil is extremely high in calories.  To help keep your weight in check, use the least amount of this oil you need to flavor your food.

Other “Healthy Oils”

What other oils are potentially “healthy”?  Right now, aside from olive and coconut oils, avocado oil is also very popular.  Other potential “healthy oils” could include almond, walnut, or macademia nut oils.

Sesame seed oil is popular in Asian dishes and is accepted as one of the healthier oils as well. Once again, try getting by with less oil if possible.

Questionable Oils

Organic canola oil was felt to be a healthy oil in the past but as of recently seems to be falling out of favor.  If you choose this oil, I would only recommend the organic cold pressed variety.

Two other questionable oils are peanut oil and palm oil.  Peanut oil is enjoyed in Asian countries and can be used with higher temperature cooking.

Palm oil has now become the darling of the processed food industry now that trans fats have to be labeled.  The issue with palm oil is that it may have a detrimental effect on your cholesterol levels and the environmental concerns with generating this oil.

Oils to Avoid

I would definitely avoid anything that lists hydrogenated or partially hydrogenated oil.  I would also definitely avoid vegetable oil or margarine.  I also would recommend staying away from corn oil, cottonseed oil, sunflower oil, safflower oil, shortening, and any fake butter products.

The problem is that a huge percentage of processed foods all have these bad oils and trans fats.  These oils can cause weight gain and inflammation and should be avoided.  The scary thing is that these oils were once considered healthy.  Now we know they can accelerate chronic diseases and they will damage your arteries and cardiovascular system.

The scary thing is that even though the label says no trans fat, this is very deceiving.  As long as there is less than 0.5 grams of trans fats per serving it does not have to be revealed.  Any amount of trans fat is dangerous.  If you eat processed foods, it is very difficult to avoid dangerous oils!

Do You Really Need the Oil?

As oil is packed with calories and minimal nutrients, one question to ask is do you really need the oil?  For example, in my daily stir-fry dishes I do not use any oil at all.  Without oil, I have to continuously stir my food.  For flavor, I do not miss the oil at all.  I use many different sauces to make my stir-fry food taste fabulous.

In baking recipes that call for oil or butter you could substitute avocado puree, mashed bananas, nut butters, or unsweetened applesauce instead.

My 8 Tips on Oil

1. Keep portion sizes in check.

Oil is incredibly high in calories. Don’t eat oil for the sake of eating oil.  Only use what you need and no more.  With oil, less is more.

2. Make sure your oil is fresh.

Old or rancid oil has breakdown products that can be toxic.  Keep oil in a cool, dark place with the lid on to keep it fresh as long as possible.  If it does not smell fresh don’t use it!

3. For Asian stir-fry dishes, sesame oil may enhance the taste.

It has a great taste and is a safer oil when cooking at high temperatures.

4. For dips, sauces, hummus, and dressings, use organic extra virgin olive oil.

5. For other high temperature cooking, consider cooking with coconut oil (organic extra virgin coconut oil), or organic avocado and almond oils.

6. For low temperature cooking, consider organic extra virgin olive oil.

7. Avoid the unhealthy oils and any oil in processed foods.

8. Do you really need the oil?

Are you willing to experiment with a healthy non-oil substitute for baking? Get creative!  There are lots of resources on the internet to inspire you.

What do you think?  What do you feel is the best cooking oil? Do you like the coconut oil benefits? Have you tried cooking with coconut oil?  What non-oil substitutes have you discovered? Drop me a line and let me know your experience. You can leave a comment by clicking here.

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Could a recent study that hit worldwide news, provide enough evidence to overturn the long-held belief that a little alcohol is good for the heart?

According to the Center for Disease Control (CDC), one in ten deaths of working age adults in the U.S. results from alcohol consumption. Despite this fact, many in the medical community have been telling us for years that a little bit of alcohol is good for us as it prevents coronary heart disease (plaque build up in the arteries of the heart).

What are the effects of alcohol on the heart? Is there a link between alcohol and heart disease?

This recommendation to drink a little bit of alcohol did not come from high quality studies. This recommendation came from observational studies based on how much alcohol people said they drank. So many of us wanted to believe that this vice could actually be healthy for us, so few questioned if this was even true or not. This groundbreaking and scientifically rigorous study of 261,991 people hit worldwide news demonstrating that any alcohol may be hazardous to your heart health.

My Previous Alcohol Recommendations to Patients

For years I have struggled with this alcohol conundrum in counseling cardiac patients. On one hand, alcohol, especially red wine, appeared to be very effective in preventing plaque build up in the heart. This was the “heart” of the so-called “French Paradox” where supposedly their red wine protects their hearts from their high saturated fat diet.

On the other hand, I have personally seen, and the tragic data shows, that alcohol destroys many families, and causes liver failure and cancer. While alcohol was believed to prevent coronary heart disease, it is a known cause of heart failure and the most common cardiac arrhythmia, atrial fibrillation. I struggled as to how I could best counsel my patients on the subject of alcohol.

With regards to alcohol and heart disease, my conclusion at the time was to advise limiting alcohol to one drink daily, if they drank, preferably a red wine. This way we could potentially minimize any negative bad effects of alcohol on the heart.

If they did not drink, I never encouraged drinking to prevent coronary heart disease.  Lastly, if they suffered from heart failure or atrial fibrillation I recommended that they stop drinking.

I advised such based on the available data—it was all we had. I now advise differently, as the latest study provides new findings.

Any Alcohol is Dangerous to the Heart Study

This study is very important in that it is much more scientifically rigorous than previous studies. The data behind the alcohol recommendation to prevent coronary heart disease was based on observational studies. Observational studies have to be taken with a grain of salt because there are so many confounding factors which researchers cannot control.

Could observational study bias explain the alcohol protective dogma that the medical community has believed for so long? Do we need to worry about alcohol and heart disease?

In this study, first author Dr. Michael V. Holmes from the Perelman School of Medicine in Philadelphia, Pennsylvania and colleagues took a different approach. Rather than just doing yet another observation study based on the subjective recall of how much alcohol everyone drank, they looked at whether or not people had the ADH1B gene.

The ADH1B gene codes for the alcohol dehydrogenase 1B enzyme which breaks down alcohol in the body. People with this enzyme rapidly metabolize alcohol which results in nausea, facial flushing, and not feeling well when they drink alcohol. As a result, most people with the ADH1B gene drink very little alcohol or they abstain altogether.

In this study, Dr. Holmes and his colleagues had the brilliant idea to look at the clinical outcomes of 261,991 people in this international study to see if this gene could predict clinical outcomes.

Interestingly, people who genetically cannot tolerate alcohol were less likely to:

• Be overweight
• Have high blood pressure
• Have significant levels of inflammation
• Have a heart attack
• Have a stroke

Overnight, this study has challenged the long-held dogma that alcohol might somehow be good for the heart. We now have a pretty good idea about the effects of alcohol on the heart.

Our Experience in China’s Longevity Village

This study supports our findings during our stay among the residents of China’s Longevity Village. Based on our research in China’s Longevity Village, which is a rural mountain village in Southwest China near the Vietnam border, most of these long-lived people completely abstain from alcohol. These people were historically water drinkers.

This abstinence is largely based on their extreme poverty and geographic isolation from China and the rest of the world. In fact, based on studies of these long-lived people, 64% of the people completely abstain from alcohol. Could this be one factor, among many, that contributed to their long lives and freedom from the chronic medical conditions from which so many of us here in the U.S. suffer? We delve into our findings in China’s Longevity Village, and their implications for our own lives here in the U.S., in our book scheduled for publication next year.

My New Alcohol Recommendations to My Patients

The results of the more than 260,000 people in this study demonstrate that alcohol does not have any protective effect to the heart. In my opinion, given the many tragic outcomes of alcohol consumption, the less alcohol we drink the better. For my patients who have developed any form of heart disease, I now encourage them to avoid or minimize alcohol consumption.

Not only is it this study, another mega study just came out in the July 22, 2014 issue of Journal of the American College of Cardiology showing that any alcohol can be a significant cause of a dangerous heart rhythm abnormality called atrial fibrillation.

What do you think? Is this study strong enough to overturn the long held belief that alcohol is somehow protective for the heart? You can leave a comment by clicking here.

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Prevent Cancer with Cruciferous Vegetables

Let’s face it, cancer scares all of us.  Who would ever want to spend all of their time at the doctor’s office or in the hospital undergoing surgery, chemotherapy, or radiation treatment only to feel horrible, potentially lose your hair, and know that in the end you might not even make it.  Even though the number one health risk women face is heart disease, studies show that what they fear the most is breast cancer.

Is there a way to help prevent cancer with food?  

Yes, welcome to the cruciferous vegetables.  The cruciferous vegetables are one of the best cancer prevention medicines we have.  Not only are these some of the healthiest veggies by nutritional content, but many studies have shown that they can also prevent cancer.  The time to start preventing cancer with food is now.

Which are the cruciferous vegetables?  

Before we go any further, you may be wondering what exactly are the cruciferous vegetables?  These are broccoli, cauliflower, brussels sprouts, kale, bok choy, and cabbage.

What makes cruciferous vegetables so effective in preventing cancer?  

While fruits and veggies in general are very potent anti-cancer agents, the cruciferous vegetables seem to be even stronger than the standard fruit or vegetable in preventing cancer.  These cruciferous veggies have very potent sulfur-containing phytochemicals which can knock out carcinogens before they even start to turn cells cancerous.

The time to start eating the cruciferous vegetables is before you get diagnosed with cancer.  Thus, if you are worried about all of the toxins in our environment and the potential risk of cancer, make sure you get enough cruciferous vegetables to allow your liver a chance to detoxify them.

While the cruciferous vegetables seem to contain special “cancer prevention” properties, I do not want to minimize the cancer prevention effects of all of the other fruits and vegetables.  Fruits and vegetables are critically important to maintaining health and energy.  Eat them with every meal.

The American Heart Association now recommends nine servings of fruits and vegetables each day. If you do the math that works out to be 3 servings with each meal.  Of these nine daily servings of fruits and vegetables, I recommend to my patients that at least six of the nine are vegetables.

What cancers do cruciferous vegetables prevent? 

Studies show that a healthy diet, including regularly eating cruciferous vegetables, can decrease your risk of breast, prostate, and colon cancer by 60-70%!  And it is not just these cancers.  Most cancers seem to be reduced with cruciferous veggies.  In fact, even in smokers who have very high cancer risks, cruciferous vegetables can help to prevent a lot of these cancers as well.

How often should I eat cruciferous vegetables? 

I recommend that my patients have at least one to servings of these veggies each day to help detoxify your body and to help prevent cancer.  Fortunately for me, broccoli is one of my most favorite foods.  I just find that my day is incomplete if I cannot find at least one to two servings of my favorite vegetable.

My nurses and colleagues at the hospital, as well as my friends, all tease me about broccoli.  They always make sure there is some broccoli at every event they invite me to, including a child’s birthday party.

Broccoli is also very high in vitamin C which can help you not to come down with the common cold.  I am learning to branch out and try other cruciferous vegetables as well.  For example, I now eat cauliflower several times a week. When I am traveling in Asia I routinely eat bok choy.

At a dinner with other physicians this past weekend, one of the doctors said “the person who eats kale regularly does not need to see the physician”.  While I would never take this statement literally as it is important to always stay in contact with your physician, these real foods do have the power to heal our bodies and our minds.

How should I eat my cruciferous vegetables?  

To get the most out of these veggies, it is best to eat them as fresh as possible.  Studies show that you start to lose some of the nutrients after three days of picking.

The “farm to plate” time is very important for all fruits and vegetables.  If it is “out of season” or the “farm to plate” time is much longer than three days, consider buying the “flash frozen” organic frozen vegetables for maximum nutrition.

Also, eat them raw or lightly cooked.  If you cook these veggies until they are soggy you will lose much of the nutritional and anti-cancer benefits and they just won’t taste very good this way.  For me, I absolutely love dipping raw broccoli into hummus for an afternoon or morning snack.  Also, broccoli for me is an absolute must in any stir-fry.

Should I buy organic?

Our family made the switch to organic several years ago.  For us, organic food just tastes so much better knowing that there is no pesticide residue.  Fortunately, the organic cruciferous vegetables are not that much more expensive than the non-organic variety.

It seems a shame that we have to worry about pesticide residue on our produce.  This is something our ancestors never had to worry about 100 years ago.

Studies show that pesticides may cause Parkinson’s Disease or Autism. Personally, getting Parkinson’s Disease scares me just about as much as getting cancer.  Newer studies are even showing that organics may be more nutritious as well.

Do cruciferous vegetables cause thyroid goiters? 

For those of you who may not know what a thyroid goiter is, it is simply an enlargement of the thyroid. If you look on the internet, there is a lot of misinformation about this. This is really a shame because these are such incredibly healthy vegetables.

Yes, it is true that if you isolate certain cruciferous vegetable molecules and give them to animals in mega doses you can interfere with their thyroid function.  Based on my review of the published medical data, I could not find any studies linking cruciferous vegetables, as part of a healthy diet which includes getting enough iodine, in causing thyroid problems. Personally, I have never seen a goiter in my patients that was felt due to cruciferous vegetables. If this is something that worries you or you have a history of thyroid disease, get enough iodine in your diet, cook your cruciferous vegetables, and discuss this with your doctor.

One last point. If you have cancer or think you may have cancer always work very closely with your physician.

What do you think?  Do you get your one to two servings of cruciferous vegetables each day?  Do you feel organic produce is worth the price?  How do you like to prepare your cruciferous vegetables? You can leave a comment by clicking here.

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We all recently saw the headlines, too much sitting increases our risk of cancer by up to 66%! Sitting really is the new smoking. If you figure that sitting to watch TV for one hour shortens your life by 22 minutes and smoking one cigarette takes 11 minutes off your life then sitting down to watch that one hour TV show tonight is the equivalence of smoking 2 cigarettes.

We all know we need to get moving more. Not only do we need to exercise each day but we also need to keep moving all day long. Sitting on our butts the entire day after a grueling one hour work out in the gym will undo any benefit we may have achieved in the gym. Our bodies were designed to move!

We all need to get moving. Based on objective pedometer data, less than 1 in 20 American adults actually moves enough during the day.

Every day I encourage my patients to get moving. Often when I make these suggestions, they have excuses. Let’s face it, we all have excuses why we would rather not move.

I thought that in this article I would compile the top 10 excuses I hear every day why people can’t get active. I know most of them not just because I’ve heard them from my patients, but because I used them myself. Here are some of the top excuses my patients offer when I encourage them to be physically active on a daily basis:

Excuse #1: “I don’t have time to exercise”

Fact: Physical activity creates time.

Being physically active will not only add years to your life, but will make the years you have vastly more productive. Exercise promotes energy, alertness, and concentration, increasing the productivity and quality of the time you spend at work and with your loved ones. A recent study in a prestigious medical journal found that if people could be physically active for as little as 15 minutes per day, that would improve their longevity by 3 years. That works out to be an extra 19 hours of life for every hour of physical activity.

Even if you are not concerned with extra time later, how can you squeeze it in now? I get it. I am a busy cardiologist, serve as in coming president of a large international medical society, have church and community responsibilities, a family with three small children, and I am writing a book with my wife, Jane.

I can only find time to exercise on my off days. What about the other days? As I have analyzed my time, I find that I spend two to three hours each day on a computer. With my treadmill desks and my bike desk I can now convert this “computer time” to “exercise time”.

At my home we have an old treadmill that we purchased shortly after Jane and I were married 20+ years ago. It was a treadmill that was gathering dust and the incline button did not even work. With some old furniture we were not using, an old nightstand on top of an end table, we now had a perfect treadmill desk. The cost? Free. I have included a photo of my “poor man’s” treadmill desk at the end of this article.

At the hospital it was a bit more challenging. I made a strong case and even offered to pay for a treadmill desk. Fortunately my employer, Intermountain Heathcare, agreed to buy the entire treadmill desk for me. If your employer is not in a position to help you with a treadmill desk, could you use a “box” marked for the recycle bin as your new standing desk? That is what I did prior to my treadmill desk. Studies show that even just standing while working can burn an extra 50 calories an hour and strengthen your leg muscles over the course of the day!

To help mix things up at home, I took an old mountain bike that I was no longer using and with a bike trainer and some bricks, wood, and barrels we had in our basement was able to build a bike desk. Cost? Free. I have included a photo of my “poor man’s” bicycle desk as well at the end of this article.

What if you don’t spend part of your day on the computer? Two of my patients, took their Lazy boy chairs out of their front room and replaced them with a treadmill and stationary bike. Now, when they “sit down” to watch TV or a movie at night they now exercise together instead. Is it any wonder why together they were able to lose close to 100 pounds and put their heart disease into remission?

Excuse #2: “My knees or my (fill in the blank) hurt too much”

Fact: The right physical activity is physical therapy.

If your body is injured, it will hurt more if you don’t use those muscles, tendons and joints. There is something every one of us can do to stay active throughout the day. Be creative! If your knees hurt, try swimming, water aerobics, riding a bike or cross country skiing. The right physical activity will strengthen whatever ails you and help you heal faster.

This is exactly what I was doing before I made drastic changes in my own life. Little by little I was withdrawing from all physical activity because it hurt. Somehow I thought that if I just rested my (fill in the blank) that I would start feeling better.

I sat all day for my surgeries. This only made things worse for me. Paradoxically, by standing to do my surgeries all day long, along with other changes, allowed my joints and back to heal.

Find something you can do, cross train, do physical therapy, something until your injury resolves. Many of my patients with severe joint problems and obesity have found swimming, water aerobics or even walking in a pool against the current to be very therapeutic. Do something. Your life depends on it!

Excuse #3: “I can’t afford to exercise”

Fact: Physical activity can be free or even save you money.

You do not have to pay for a gym membership or buy any equipment to begin being physically active. There are many things you can do for free. It does not cost anything to go for a nice walk. It may even be healthier to be physically active outside. All you need is a good pair of shoes to start today.

Be creative. You may even be able to save money by exercising. Can you bike to work? Many of my patients bike to work from April through October. Depending on your gas mileage, most of my patients save over $2,000 a year. What if you could eliminate one car in your household? Better yet, biking to work could give you 60 minutes of exercise time while only “costing” you 20 more minutes than what you would have spent driving your car. Imagine that, a 60-minute work out with only a 20 minute time investment!

Excuse #4: “I don’t have a babysitter”

Fact: Physical activity is vital for children too.

We have three young kids so we understand it can be a challenge to find any/enough time for yourself. Try taking turns with someone else, watching the kids while the other engages in physical activity. Better yet, try getting your kids involved. It will help them build healthy habits and it can be fun. If they are really young, push them in a jogger stroller or pull them behind your bike. Just last night we biked as a family to Grandma’s House. Go for a walk or a hike together as a family. I ski with my kids every week during the winter and spring. Plan physically active family vacations.

Excuse #5: “I am too tired to exercise”

Fact: Physical activity will give you more energy.

Do you feel too tired after a long day at work to be physically active? Do you just want to relax? It can be difficult to get off the couch when you are feeling drained, but within a short time, you will feel more energized and alive physically, emotionally, and mentally. Studies show that the best energy “pill” we have is to be physically active all day long.

Put your work out clothes and exercise gear out ahead of time. Schedule a time to exercise with a friend. Not wanting to have to put your clothes or exercise gear away for nothing or let your friend down, you will be energized in the end.

Excuse #6: “I am not losing any weight”

Fact: Physical activity will tip the scale in your favor.

Regular physical activity will increase your metabolism so you will burn more calories even while at rest. Most people naturally start to make healthier food choices once they begin exercising.

Unfortunately, others, like me in the past, believe they can eat anything they crave as long as they burn off the calories. The trouble is that exercise rarely works alone. Unfortunately, exercise increases your appetite. An energy drink and a big unhealthy meal following your workout will completely undo any benefit you may have achieved. You also cannot look at exercising as “punishment” for unhealthy eating. You have to eat right and move your body. The two work together.

While physical activity decreases most people’s desire to eat junk, in some people physical activity can trigger the desire to eat the junk. Perhaps this was due to years of conditioning from playing little league sports where we routinely reward our children with donuts and fruit juice following their workouts. Remember, that sports drink and what ever other junk you go for after your work out will undo any benefit you may have achieved. Physical activity is not a free ticket to eat junk.

Staying active may be enough to maintain a healthy weight when you are younger, but as you grow older, you may find it increasingly difficult to lose weight. It may take more time for all the benefits of your new routine to develop. Be patient and think of physical activity as a lifelong plan.

Excuse #7: “I don’t want anyone to see me”

Fact: Physical activity will enhance your self-esteem.

Do you feel intimidated to go to a gym or exercise in your neighborhood? If you worry about not having the “right” clothes or the “right” body to fit into the gym culture or be out in your neighborhood, please consider that this is the time to honor and take care of yourself, rather than being held back by fears of what others may or may not think. Also, you don’t need to box yourself into going to a gym if it doesn’t work for you.

There are plenty of activities you can choose in lots of different locations. Be creative and be willing to experiment. You deserve to feel great and exercising is one of the best ways to feel more comfortable and confident about your body.

Excuse #8: “I just can’t do what I used to do”

Fact: You can be physically fit at any age.

If you have never been active, you now have a chance to get in the best shape of your life. You may not be as fast or as flexible as you once were. It is natural for our bodies to change over time. You simply need to redefine what it means to be physically fit at each stage of your life and go for it!

My patient, Mary, could barely even walk without becoming short of breath. She did not let this stop her. With encouragement and tracking her daily results, she was able to build up to seven miles a day within 3 months! It is never too late to change!

Excuse #9: “Exercise is Too Boring”

Fact: There has to be something you enjoy doing.

I think the problem here is that most people equate exercise to going to the gym. I get it. If exercise meant that I had to go to the gym I would hate it as well. I hate the gym and have not been to a gym in years. For me, I have to be outside or in the mountains for physical activity to be fun.

When my patients ask me what type of exercise should they do I always answer, do something you enjoy. If you enjoy it you will stick to it. There has to be something you enjoy. Do something every day.

Do you like dancing? Go dancing.

Do you like golf? Then golf and carry your own clubs. Stay away from the cart at all costs.

Do you like gardening? Then please garden as this is an incredibly beneficial activity with many health benefits.

Excuse #10: “I am afraid to exercise”

Fact: Except in rare cases, being physically active is one of the best things you can do for your body.

When I encourage patients to be more physically active, I often hear the excuse that they are afraid they might hurt their heart or even die. I am saddened by these fears they share with me nearly every day that I am in the clinic.

If you have experienced any of the following symptoms, please talk to your physician before becoming physically active again: extended period without physical activity, pre-existing cardiac condition, shortness of breath or chest discomfort. Except in very rare cases, being physically active is one of the very best things you can do for your heart.

Amazingly, study after study shows that for patients surviving a heart attack or even living with heart failure, one of the best things they can do to improve their health, wellness, and longevity is to be very physically active. Just days after a heart attack, we get our patients into an exercise program. Try to be honest with yourself: your excuses may be unnecessarily limiting your life.

These excuses are common. Odds are you’ll see yourself somewhere in this list. Even my wife, Jane, and I have used some of these excuses from time to time. The bottom line is that despite whatever limitations you may be facing, there’s always something you can do. Be creative and remain open. Studies show that every effort you make will increase rather than decrease your capabilities over time.

What do you think? What do you do to stay active? Please let me know.  You can leave a comment by clicking here.

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Did you know that losing even one hour of sleep can cause a heart attack? Did you know that occasionally taking a sleeping pill, something even as mild as an antihistamine, increases your risk of dying five-fold? Even more frightening is that both lack of sleep and taking sleeping pills increases your risk of dementia!

My Insomnia Struggles

I am a recovering insomniac. Since my college days I have struggled with falling asleep. It was especially bad before a major test.

I remember the night before I had to take the MCAT (Medical College Admission Test). My whole life I had wanted to become a doctor. I knew my chances all hung on getting a good MCAT score.

It was 2 am, I had been laying in my bed for four hours and still could not sleep. I gave in and took a Benadryl (antihistamine). An hour later I still was not asleep and took a second Benadryl. I finally feel asleep.

It seemed like just a split second and my alarm went off at 6 am. My head was in a fog. I thought I would have to look for a new career as there was no way I would ever do well on this test. Somehow, I did well enough on the MCAT to get into Johns Hopkins Medical School.

Medical school was no better. As a Chinese major coming out of college I was no match for all of my classmates in medical school with Ph.D’s in the sciences. I was a stress case and I could not sleep. I started taking an antihistamine every night to sleep.

Things got worse in my residency and fellowship training. Being paged all night long with erratic sleeping schedules never let me get into any kind of rhythm.

I was hooked. The Benadryl/antihistamine and melatonin habit would continue for the next 20 years.

To counter the effects of grogginess in the morning, I would start the day with a Diet Coke. Is it any wonder why I was tired all of the time? It never even occurred to me at the time that I could be causing my own lack of energy!

By my 40s I not only had trouble falling asleep but also struggled with staying asleep. It seemed that if I was not careful I had to get up in the middle of the night to pee. Once this happened I had no chance of going back to sleep.

At age 44 with my health in shambles, many chronic medical problems, and on 5 medications I decided it was time to turn my life around. I really thought I would never sleep again without medications.

How Critical is Missing Even 1 Hour of Sleep?

I recently was invited to speak at the Annual Scientific Sessions of the American College of Cardiology in Washington DC. While there, a study looking at the impact of even losing one hour of sleep from Daylight Savings Time caught my attention. In this study analyzing 42,000 recent heart attacks in Michigan they found two very interesting findings.

Your heart attack risk is increased 24% on the Monday following losing an hour of sleep due to Daylight Savings Time. In stark contrast, your heart attack risk is decreased 21% on the Monday after gaining an extra hour of sleep when we go off of Daylight Savings Time in the fall.

If just one hour can have such an impact, is it any wonder that jet lag and night shift workers have been shown to be at risk for many medical problems?

The Importance of Sleep

While we are sleeping our body is busy working to repair and prepare our bodies for the next day. In the brain, memories processed and new brain connections made. For the cardiovascular system it is when repairs need to be made to prevent heart attacks. Sleep also ensures that we have the proper balance of the hunger/full hormones so we don’t overeat the next day. Indeed, sleep deprivation can increase your risk of being overweight by 40%!

How much sleep do we need?

Adults need at least 7 hours of sleep for optimal health. Based on a study which averaged the results of 17 studies involving more than 1 million people, they found that short sleepers (less than 7 hours) are 38% more likely to die young Long sleepers are also at risk. From this same study, long sleepers (more than 9 hours) were 23% more likely to die too soon.

Is it OK to take sleeping pills to make sure I get enough sleep?

This is a dangerous trap to fall into which can lead to dependency and an early grave. For 20 years I had horrible insomnia. I became dependent, both mentally and physically, on 2 Benadryl tablets (50 mg) and a melatonin each night or I could not sleep.

Of course, there were many reasons why I had insomnia. My diet was awful, I was constantly awakened at night while being on call as a physician, my stress levels were sky high, and I was drinking Coke/Diet Coke through the day. Fortunately, I have been off any sleeping aids now for several years after completely changing my life.

Just how dangerous are sleeping pills?

In this study of over 10,000 people taking sleeping pills were 5 times more likely to die prematurely! Even taking a Benadryl or other antihistamine in this study less than 18 times a year tripled your risk of dying before your time.

In another study of approximately 34,000 people, taking a sleeping pill doubled your risk of dementia. Clearly, these are things that should best be avoided!

Is sleep apnea a problem?

For sleep to be effective it has to be rejuvenating. Too many people suffer from sleep apnea in this country. Sleep apnea is where people snore loudly at night and will stop breathing. This is primarily due to being overweight. People with sleep apnea might think they are sleeping at night but in reality they are not getting rest because they are subconsciously waking up all night long when they stop breathing.

Sleep apnea increases your risk of high blood pressure, heart failure, heart attacks, cardiac arrests, and dying too early.

How do I know if I have sleep apnea?

If you think you have sleep apnea, just ask your spouse as they can usually make the diagnosis. They will tell you that you snore way too loud and will stop breathing in the middle of the night. For the average person, if you are just 20 pounds overweight (BMI of 28) there is a 41% chance you have sleep apnea. If you have sleep apnea you need to get tested and treated until you can get the weight off. Fortunately, sleep apnea is something that is reversible. If you would like to be tested please speak with your doctor and they can order this test for you.

10 Ways to Cure Insomnia without Medications

Fortunately, things are much better now. Except for rare cases when traveling, I no longer need anything to help me sleep. I find that as long as I can follow my 10 rules below, my sleep is generally very good and I can get my recommended 7 hours of sleep.

1. Have a Strict Routine

Go to bed and get up at the same time every day. I realize this can be hard, especially when traveling, but this is probably the most important step. It can also be very hard if your spouse or sleeping partner have different sleeping schedules. For me, I try to go to bed at 10 pm and get up at 5 am. Start winding down about an hour before your bedtime. Dim the lights and stay away from TVs and electronic devices.

2. Avoid All Stimulants After 12 pm

It takes 4-6 hours for half of the caffeine to get out of your body. Thus, if you have caffeine at say 12 pm then at 10 pm there is still 25% of the caffeine that is still active and keeping you awake (2 half-lives). It is not just caffeine but any stimulant, including nicotine, after 12 pm could set you up for a sleepless night.

3. Don’t Eat or Drink 4 Hours Before Bed

If you go to bed with a full stomach then not only could you be kept awake from acid reflux or the grumblings of your digestive system but you will also pack on the weight. The only thing your body knows what to do with late night calories is to store them as fat. Also, if you drink before bed then odds are you will be up in the night having to use the bathroom.

4. Have a Cool, Dark, and Quiet Room

This seems intuitive but so often we neglect this one. We keep our cell phones by our beds. Flashing electronic lights will keep us up and interrupt our sleep. Trust me on this one. Keep it cool, eliminate all traces of light, and make it quiet and you will sleep much better.

5. Be Physically Active Outside During the Day

Physical activity allows us to work out our stress hormones so they don’t keep us up at night. Just be careful not to exercise right before bed as that could keep you up all night. By exposing your body to natural sunlight it helps it to regulate your sleep/wake hormones. If you work in an office, try to find as much natural light as possible. Our bodies were designed to work outside during the day and sleep at night. Don’t fight nature!

6. Be Smart With Naps

If you need a power nap during the afternoon that is fine. Just keep it short. Five to 20 minutes is enough. A long nap in the afternoon will keep you up at night.

7. Make the Bedroom Just for Sex and Sleep

Don’t bring your work into the bedroom. Also, don’t watch TV in your bedroom. Train yourself that the bedroom is only for the “S” activities. If you condition your mind it will make it so much easier for sleep.

8. Music and Meditation Techniques

For me, I can go to sleep so much faster with music. I set my iPhone to turn my music off in 25 minutes. I generally never even make it to the second song and I am out. Relaxation CDs/mp3s can also be helpful. For some people listening to the ocean puts them to sleep.

9. Manage Your Stress

Laying awake at night thinking about everything can keep you up. I find that writing down everything on my mind that I need to do helps to clear the stress. For others, deep breathing techniques may help to put them to sleep. Find what works for you and do it consistently.

10. Review Your Medications

It is possible that side effects from medications are keeping you up at night. Perhaps taking your medications in the morning or switching to a different medication may allow you to sleep better. If you think this could be a problem for you, please discuss this with your physician.

Do you suffer from insomnia? What has worked for you? Please share your tips to great sleep with me! You can leave a comment by clicking here.

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Do you have a plan for your life?  Why are you committed to reclaiming or maintaining your health?

Finding your purpose or your “why” power is what gets us out of bed each morning.  If we don’t have a reason for living, the entire day becomes a chore and we lose site of our goal.  Over time, we can fall into a trap of a negative downward spiral. We stop investing in ourselves.  We stop investing in the relationships with family members or others within our social networks.  We may stop eating the foods that give us health and energy.  We may even stop exercising or moving altogether.

I have found that my patients who have successfully reversed their medical conditions have a very strong answer to “Why are you committed to regaining your health?”  They also have an answer to the follow up question, “What will happen if you cannot regain your health?”

We have to visualize our goal.  We also need to visualize what will happen if we cannot stick to our goal.  Every day I review my life’s goals and purpose.  It gives me much greater focus and clarity with all of the distractions and temptations in our modern life.

My Experience

In my mid 40s I had lost my health and lost my “Why”.  I was working long and crazy hours at the hospital.  I had lost my connection to my family, myself, and even my spirituality.

I would not take vacation time. Each day I would start working at 5 or 6 am and often would not come home from the hospital until 8 pm or later at night.  I definitely was not happy at that time either.

I had this crazy idea that if I just worked hard enough and we saved our money that we could retire early and start enjoying life.  I fell victim to the trap of once this happens (fill in the blank), I will be happy.  You cannot put off your happiness. The key is to be happy in the moment, happy in whatever stage of life you are in.

In the end, my body just gave out.  It hurt to move or do anything.  I wound up on 5 different medications and had developed an autoimmune disease, severe esophagitis, degenerative disk disease, high blood pressure, high cholesterol, horrible insomnia, and chronic fatigue.

I always felt tired and would try to compensate by eating plenty of donuts, bagels, pizza, and Diet Coke each day.  Finally, I realized how far off course my life had become.  I also realized that my answer to the second question, “what will happen if you cannot regain your health” was that I would become a decrepit, arthritic, and sickly overweight man and would likely wind up in one of those Jazzy scooters before age 60!

The first step for me to regain my health was to develop a strong life’s purpose.  My purpose required me to have excellent health so that I could fulfill my role in this life.  The purpose also had to be strong enough to resist all of the temptations of modern life.

The Power of Purpose and Risk of Heart Disease

Does having a sense of purpose matter with regards to health?  The answer is a resounding yes!  I learned this first hand.

One of the largest studies looking at the role of a life purpose and survival was done in Japan.  In this study, they had a total of 43,391 people that they followed for 7 years.  They found that those who did not have a sense of purpose for their lives were 50% more likely to die during the 7 years of the study.

Interestingly, in this same study the risk of dying from a heart related cause was 60% higher if you lacked a sense of purpose in your life.

The researchers offered several explanations for their findings.  They cited other studies which have shown that people without purpose or hope are more likely to develop blood clots, have increased levels of inflammation, and are more likely to have the dangerous forms of cholesterol.

Having a Purpose Can Protect Against Alzheimer Disease

An equally fascinating study was recently published on 246 individuals from Rush University Medical Center in Chicago.  In this study, they found that having a life mission or purpose could help to prevent cognitive decline and Alzheimer’s Disease.  It makes sense to me, if you have a purpose you have passion.  If you have a passion for life you will live in a way that promotes health and wellbeing.  To read this study click here.

Lack of Purpose and Poor Health

This is something that I have seen many times in my career.  The most dangerous day in the life of a man is the day he retires.  For many men, their sense of purpose seems to come from their job or career.  So often, when men retire their health quickly crashes over the next 1 to 2 years.

Does this mean we can never retire?  Of course, not.  However, instead of turning retirement into lounging on the chair, it could be an opportunity to move from a “for profit” to a “non-profit” career.

Volunteering can be so incredibly therapeutic and health promoting.  Many studies have shown that those who volunteer gain remarkable health benefits.  We all need to feel needed and valued for optimal health.

How to Develop Your Life’s Purpose

How can we develop our own life purpose as this is the first step to reclaiming our health?  This is something that is very personal and will vary from person to person.  You must be sure that your purpose and goals are your own rather than “should’s” that may be placed on us externally.

For me, what seemed to give me the greatest clarity of my life’s purpose was to imagine what I would want people to say of me at my funeral.  What do I want my life to stand for and what legacy do I want to leave?  What mark will I leave on the world so that my posterity will know that I once lived here.  I hope that I can live my life so that on my gravestone my family will have carved my life’s purpose which is “He served God, loved his family, and healed the sick”.

To fulfill my life’s purpose I must have good health.  I now know that I can never take this for granted again!  This strong sense of purpose keeps me motivated and helps me each day to live in a way that promotes health.  It gets me out of bed, it motivates me to move each day, and it inspires me to resist foods that will take me away from this purpose.

What is your “Why”?  Does a strong sense of purpose give you the power to resist the temptations of modern life? You can leave a comment by clicking here.

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Eliminate Stress in Seven Steps

I recently performed an ablation for a patient who was suffering from atrial fibrillation following the recent death of her husband of 50 years.  She and her husband did everything together.  It was the kind of marriage that everyone dreams about.

Unfortunately, last summer her husband died suddenly.  She was left heart broken.  She was so devastated she could not leave her home for months until she became too short of breath to even walk inside her home.

Her daughters brought her to the emergency room where she was diagnosed with Takotsubo cardiomyopathy or congestive heart failure from the Broken Heart Syndrome.   After she was treated with the appropriate medications, her heart failure improved. However, it was not until she was no longer grieving her husband that her heart failure completely resolved.  Unfortunately, she was left with atrial fibrillation…

Takotsubo Cardiomyopathy or the Broken Heart Syndrome in My Practice

This is something that I have seen many times in my career.  While it is often from the death of a loved one, I have also seen it from other forms of stress such as family conflict, natural disaster, a lawsuit, losing a job, losing a house, etc. Fortunately, most cases resolve once people are able to manage their stressful experience.

Stress and Our Health

Stress is everywhere!  In fact, 83% of Americans are stressed out at work according to Everest College’s 2012 study. Another study showed that chronic stress has a similar damaging effect on the body as smoking 5 cigarettes a day  Even just thinking you are “stressed” is enough to increase your risk of a heart attack by 27%.

Stress shortens our lives and leads to premature aging.  The stress we are feeling now predicts our health 10 years down the road.  Stress is part of the human experience.  We cannot avoid it.  The key is how do we process and manage stress?

What are the effects of stress on the cardiovascular system?  

For years, I have seen how people with high anxiety levels seem to be very prone to a dangerous heart rhythm abnormality called atrial fibrillation or Afib.  It always seems that when these people are most stressed they have an episode of Afib.  In addition to Afib, stress can trigger may other cardiovascular problems.  If you want to read more just click on each condition.

1. Stress can trigger arrhythmias

2. Stress can cause strokes

3. Just one episode of mental stress can cause heart cells to die. (here is a more layperson’s report of this study)

4. When we are stressed out we eat heart damaging foods.

What can we do?

Unfortunately, studies have shown that we can even inherit stress from our parents.  But, like everything else we have learned, our DNA is not our destiny.  We can change our lives and change the lives of those who will follow us.

7 Ways to Manage Stress and Avoid the Broken Heart Syndrome

1. Keep a Gratitude Journal

Be grateful for whatever you have.  Studies show that if we have an “attitude of gratitude” stress becomes much more manageable.

2. Get Enough Sleep

When it gets dark at night it is time to start winding down our day.  If we are sleep deprived we cannot manage anything very well.  Get your sleep and your stress will be much easier to manage.

3. Keep Physically Active

Physical activity allows us to diffuse the toxic stress hormones, cortisol and adrenalin.  If you are stressed, go on a long strenuous walk.  Exercise really does reduce stress!

4. Eat Right

If we eat the right foods, especially fruits and vegetables  it gives our bodies the right nutrients to keep everything working properly.

5. Meditate

Meditation can quiet the mind and reduce stress.  Meditation can come in many different forms.  For some it can be prayer for others it could mean yoga.

6. Connect With Others

Too often, when we are stressed, we turn inward.  This is especially true for men.  When we are stressed out is when we need to reach out to others the most.  We need to find ways to help others when we are stressed the most.  It seems counter intuitive but when we focus on others rather than ourselves our stress will magically resolve.

7. Accept What You Cannot Change

At the end of the day, there are just things that are beyond our control. We simply can’t fix everything.

What do you think?  Is stress affecting your health? You can leave a comment by clicking here.

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If aggressive lifestyle changes are made soon enough, the A-fib may completely go away.  I have seen many patients “beat” A-fib just by making significant lifestyle changes.  For others, the A-fib attacks may significantly decrease.  Sometimes, lifestyle changes alone may not be enough.  If this is the case, all is not lost.  These lifestyle changes will double your chances of successfully beating A-fib with a minimally invasive procedure called an A-fib ablation.

If we are going to beat A-fib, we need to know everything that may be contributing to this condition.  If we can aggressively attack each of these 10 items early enough there is an excellent chance that you can get rid of A-fib once and for all!

1. Get Rid of High Blood Pressure

High blood pressure is one of the main causes of A-fib.  It puts a big strain on the heart which can cause the lower chambers of the heart to thicken and the upper chambers of the heart to enlarge.

If you have high blood pressure you are not alone.  Studies show that half of all Americans have a blood pressure above the goal of 120/80 mmHg as established by the American Heart Association.  As with A-fib, if significant lifestyle changes are made early enough, high blood pressure is completely reversible.

I have seen this with many of my patients.  In fact, after just a few weeks of making major lifestyle changes, under the direction of their physicians they can start getting off of their high blood pressure medications.  I personally dropped my blood pressure which could go as high as 150/90 mmHg down to 110/70 mmHg without medications.

For more information on how to reverse high blood pressure, please read my article “How to Get Off Your Blood Pressure Medications: Lower Your Blood Pressure with These Eight Steps.”

Until you can reverse your high blood pressure with lifestyle modification, you may need to work with your physician on getting this under control.  For my patients with A-fib, I tend to be aggressive on getting the blood pressure under control.  I usually shoot for a target of less than 135/85 mmHg.

2. Reverse Your Biologic Age

Unfortunately, getting older is a big risk factor for developing A-fib.  Even though you are getting older year-by-year (your chronological age), you can reverse your biologic age now!  Your biologic age can be 10-20 years younger than how “old” you are.  You can regain your youth, feel great, and reverse the effects of aging on your heart.

How do you reverse your biologic age?  Please read my recent article “We Can Reverse the Aging Process“.

3. Keep Stress in Check

It seems like we are all stressed out.  According to a study from Everest College, 83% of Americans are stressed out at work.  One study showed that our chronic stress is the equivalent of smoking 5 cigarettes a day!  Even if you just think you are stressed is enough to increase your risk of a heart attack by 27%!

When we are stressed our bodies release cortisol and adrenalin into the blood stream.  These substances are toxic to the heart if it continues long enough.

What can we do to get our stress under control?  Make it a priority to do something every day to get your stress levels under control.  We will never be able to completely avoid stress.  It is part of the human experience.

Even something as simple as yoga to calm your nerves has been shown to decrease your risk of A-fib by 50%!  The key is to recognize your stress and do something actively every day to bring your stress levels down.  For some people this could be exercising, spending time in nature, reading a good book, getting a good night of sleep, or just hanging out with your friends.

For more information on this, please read my article “Seven Ways to Manage Stress”. https://drjohnday.com/?p=779

4. Reduce Inflammation

Inflammation is like stress, it can be helpful to the body for short periods of time. However, when inflammation never turns off it can damage the heart and the rest of the body as well as result in premature aging.

It has been recognized for quite some time that inflammation is an important cause of A-fib.  The good news is that if we can turn off the inflammation for our heart it will help the rest of our body to recover as well.

Did you know there is a simple blood test your doctor can order for you to check your inflammation level?  This test is called C Reactive Protein or CRP for short.  The goal is to have a CRP of less than 1 mg/L.  If you can get your CRP to less than one you can dramatically reduce your risk of A-fib, heart attacks, cancer, and even Alzheimer’s Disease.

How can we reduce inflammation?  Please read the article I wrote on this subject entitled “Six Strategies to Reduce Inflammation and Chronic Pain“.

5. Get Your Weight in Line

Did you know that being overweight is one of the biggest causes of A-fib today?  A recent study published in the Journal of the American Medical Association by my good friend, Dr. Prash Sanders, showed how important weight loss is with reversing A-fib.  In this study, if overweight people could lose just 32 pounds, they could reduce their A-fib attacks nearly three-fold.

This is something I have seen time and time again in my practice.  Overweight people with A-fib who can lose the weight can often make their A-fib go away.

6. Eat the Right Foods

Did you know the rates of A-fib are several times higher in North America than anywhere else in the world?  The Standard American Diet (SAD) is like pouring gasoline on the A-fib fire.  The right foods can reverse most of the factors, discussed in this article, driving A-fib.

For my patients with A-fib I recommend the following:

-Nine servings of fruits or vegetables daily

-At least one serving of nuts or seeds daily

-At least one serving of legumes daily

-Two servings of a low mercury oily fish, like salmon, weekly

For many of my patients, they need to learn how to eat vegetables.  Vegetables can be the most wonderful tasting food if prepared right.  These foods can heal our hearts and our bodies.

To go along with these must eat healing foods, I recommend that my A-fib patients minimize or avoid the following three foods.

-Processed or prepared foods

-Animal meat, especially processed meats (hot dogs, sausage, bacon, deli meats) and red meat

-Sugar, including foods that are immediately turned to sugar like wheat flour, white rice, or potatoes

The goal is to eat real food.  To get back to cooking and sharing meals with friends and families!

7. Rejuvenating Sleep

I cannot stress enough how important it is to get rejuvenating sleep if we are to beat A-fib.  For most people this means at least seven hours of sleep.  It also means sleep free from sleep apnea.

What is sleep apnea?  That is where people stop breathing while sleeping.  These big drops in oxygen levels when people are not breathing can lead not only to A-fib but also to heart attacks, sudden death, heart failure, or high blood pressure.

How do I know if I have sleep apnea?  Generally I find that the spouse or sleeping partner can easily make this diagnosis.  People with sleep apnea usually snore like a train and then will stop breathing for 20 or 30 seconds.

Fortunately, for most people, sleep apnea is totally reversible. It is a complication of being overweight.  With weight loss the sleep apnea usually goes away.

Until the weight can be lost, I recommend that my patients with sleep apnea get treated.  Studies show that you can cut the numbers of A-fib episodes by about 50% with getting the sleep apnea treated.

8. Get Moving

Did you know that people with the least amount of physical activity are at high risk of developing A-fib?  The key is to get moving!  The first thing I recommend for my patients is to get a pedometer.

Studies show that just the mere act of tracking your steps will increase the number of steps you take each day by 2,500.  That is the equivalent of walking more than one extra mile each day just by tracking your steps!

The pedometer is so helpful because people overestimate their activity.  In fact, based on pedometer data, less than 5% of Americans get enough physical activity.

I have found that in my practice, most of my A-fib patients only get 2,000 to 3,000 steps each day.  The average American gets 5,000 steps each day.  The average European, where A-fib is much less common, often gets about 10,000 steps each day.  The goal is to get at least 10,000 steps a day.

While this may seem hard to achieve, most of my patients can easily get to this goal.  You just have to be creative. Can you walk somewhere instead of driving? Can you add an evening walk to your day?  The possibilities are endless.

In addition to 10,000 steps daily, I recommend at least 30 minutes of moderate intensity exercise each day.  I am often asked, what exercises should I do.  My answer is simple, do what you enjoy.  Anything counts.  Gardening, dancing, skiing, hiking, etc. are all great.  The most important thing is that you are consistent and do something each day.

I do recommend varying your daily exercise to keep it fun, work different muscle groups, and to prevent overuse injuries.  Depending on what you choose to do, you may also need to incorporate a couple days of strength training into your routine.

9. Get Rid of the Vices

Tobacco, alcohol, and any stimulants, including caffeine, can be a trigger for A-fib.  Did you know there is even a condition called Holiday Heart?  This is when someone drinks a lot of alcohol and then goes into A-fib.

For many of my patients, just getting rid of these vices can eliminate A-fib episodes.  Other stimulant medications, including Sudafed, Ritalin, or other attention deficit hyperactivity disorder (ADHD) medications can also trigger A-fib.

To learn more about the effect of caffeine to heart arrhythmias, please read this article I wrote.

10. When All Else Fails Get it Ablated

For most of my patients, aggressive lifestyle modification can drive A-fib into remission.  Unfortunately, there will always be some cases that just don’t seem to resolved with lifestyle modification.  What should be done in these cases?

For these patients, blood thinners, medications to slow the heart, and rhythm controlling medications are often prescribed.  Unfortunately, for most patients, rhythm drugs only work for a few years at most.

When medications are no longer effective in controlling the symptoms of atrial fibrillation, an ablation is the next step. This is also an excellent option for patients who have side effects from the medications or just do not want to be on life-long medications.

Fortunately, the lifestyle changes we have discussed in this article can double the chances of a successful procedure if an ablation is ultimately required to control the symptoms.

With an ablation, we go into the heart through an IV in the leg, map where the A-fib is coming from in the heart, and then ablate those areas.  The entire procedure takes about three hours and patients will typically spend the night in the hospital following the procedure.  The following day patients will go home with just a band aid.

I have personally done nearly 4,000 of these A-fib ablation procedures.  In experienced hands, most patients can ultimately be free of atrial fibrillation.  There are certainly risks associated with this procedure but these can largely be avoided by physicians with the most experience in performing these procedures.  Please discuss the risks, benefits, and alternatives of A-fib ablations with your physician.

Here is a link to see more that I have written about atrial fibrillation.  Also, be sure to sign up for my free weekly newsletter or subscribe to my podcast.

Feel free to leave your questions and comments below.

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Did you know that half of all American adults have a blood pressure above what the American Heart Association recommends?  Of the 70% of Americans on prescription medications, a large percentage of these take medications for high blood pressure.

High blood pressure is a leading cause of atrial fibrillation, stroke, and coronary heart disease.  If we are going to reverse or prevent those conditions, we need to get our blood pressure under control.

For many of my patients, these medications often leave them feeling tired, groggy, or lightheaded.  Some even report weight gain with these medications.  Do so many Americans really need to take all of these high blood pressure medications?  Is there another way?

Welcome to the foods that lower blood pressure.  These are the natural ways to lower blood pressure.

My Experience with High Blood Pressure

The first time I saw a high blood pressure reading was at about age 30.  I had a routine check up at the doctor’s office and they told me my blood pressure was 150/100 mmHg.  At the time I thought I was just “stressed” and did not pay it much attention.

For years, even as a physician I just pushed it to the back of my mind.  I was young and healthy.  Why should I worry about my blood pressure?  I couldn’t possibly have high blood pressure.

Of course, as a physician, I knew all of the long-term complications of high blood pressure.  I knew that high blood pressure can lead to heart failure, heart attacks, arrhythmias, strokes, kidney failure, blindness, and other problems.  Somehow, this all seemed “academic” or something that did not apply to me.

By age 40 my blood pressure consistently ranged anywhere from 135-150/85-90 mmHg.  Once I hit my 40s I knew I could no longer ignore it.  I decided to try a medication.

As I had Cozaar samples (losartan) at my medical practice, I decided to give this a try.  I put myself on 50 mg a day of Cozaar and it brought my blood pressure down by about 10 mmHg.

Fortunately, I did not have too many noticeable side effects.  I was a bit fatigued from the medication.  The hardest part was remembering to take it every day.

At the time, it never crossed my mind if there was another way.  Like most of my patients at the time, I also took my daily medications.

By my mid-40s, my health had hit rock bottom.  I was on 5 medications and felt horrible.  Not only did I have high blood pressure but I also was overweight, had high cholesterol, chronic fatigue, chronic pain, esophageal problems, and an autoimmune disease.

After learning of a small remote mountainous village in Southwest China where people live very long lives free of medical problems, medications, and surgeries, I knew this was a place we had to visit.  We had to learn their secrets to optimal health.  We spent several years studying the villagers and learning from them.

After completely changing my diet and lifestyle, the weight naturally dropped off and my blood pressure came way down.  Today, my blood pressure averages 110/70 mmHg.  I am also off of all medications.  I feel better now than I have ever felt.

Most of my patients who follow this same lifestyle can also drop their blood pressure 20-40 mmHg and get off of their high blood pressure medications.  This is far more than what most doctors think is even possible from making lifestyle changes.  It is not easy, but you will feel so much better if you can faithfully follow the 8 steps below and get off your medications!

A word of caution.  These eight steps will drop your blood pressure very fast and very significantly.  Please work very closely with your physician in lifestyle changes to treat high blood pressure and never stop any prescribed medications without first discussing it with your physician.

Eight Natural Ways to Lower Blood Pressure

1. Eat Less Sodium

When physicians talk to patients about lifestyle changes to reduce blood pressure, this is probably the number one piece of advice we give.  Unfortunately, this is often the only advice patients receive about how to lower their blood pressure naturally.

There is some controversy, even with physician organizations, on how low we should go.  The most aggressive recommendations are from the American Heart Association who recommend keeping sodium (salt) below 1,500 mg per day.  Some studies indicate potential harm with this ultra low sodium diet.

I now recommend eating approximately 2,300 mg of sodium each day for my patients.  Considering that the average American consumes 3,400 mg of sodium each day, this will require some significant sodium reduction.

When I discuss this with my patients they generally tell me, “I never salt my food”.  While that may be true, that is not where we are getting our salt overload.  For the typical American, 80% of their daily salt intake comes from processed foods.

If you are going to get to 2,300 mg/day of sodium you have no choice but to minimize processed foods and be very careful when eating out.  You have to eat real food to reach this goal.

2. Stay Physically Active

Did you know that exercising daily can lower your blood pressure?  Just as important as exercising daily is to keep moving throughout the day.  For my patients, I recommend 30 minutes daily of at least moderate intensity exercise AND 10,000 steps per day as recorded by a pedometer.

Studies show that even if we faithfully go to the gym each day, if we sit the rest of the day we negate the beneficial effects.  We need to find ways to keep moving throughout the day.

Too often we are confined to “desk sentences”.  This is not real living.  Our bodies were genetically designed to move. The old adage is true.  Use it or lose it.

3. Get Plenty of Potassium and Magnesium in Your Diet

A diet high in potassium and magnesium has been shown to also lower blood pressure.  You don’t typically find these important electrolytes in processed foods or sports drinks.  Rather, these electrolytes are found in certain fruits, vegetables, nuts, seeds, and legumes.  These are the foods that lower blood pressure. Once again, to lower your blood pressure you need to eat real food!

4. Eat Animal Meat Sparingly

While I am not advocating a vegetarian diet, I am suggesting that animal meats, especially processed and red meats, may raise our blood pressure.  The processed meats, like hot dogs, bacon, sausage, and deli meats, can be especially detrimental to our health and blood pressure.

For my patients, I recommend that animal meat should be a special treat eaten one or two times a week rather than something that is eaten several times a day.  For those who do enjoy animal meats, I recommend lean and organic cuts.

Fish, on the other hand, may lower blood pressure and has many other beneficial effects.  The key to selecting fish is to find a fish low in mercury and other contaminants.  My favorite fish for nutrition is Wild Alaskan Salmon.  While this can be quite pricy, places like Costco offer very affordable Wild Alaskan Salmon.  I personally eat Wild Alaskan Salmon twice a week.

5. Minimize Stress

When we are stressed out our bodies release chemicals, such as cortisol and adrenalin, which both raise blood pressure.  Not only will stress raise our blood pressure but stress is also an important cause of coronary heart disease. With our fast paced, hectic lives, we need to do something each day specifically to release our stress.

For me, I find that exercising in the mountains has a powerful effect on lowering my stress levels.  Regardless of what I may be feeling at the time, just spending some time exercising in the mountains seems to make it all go away.

For others, it could be meditation, yoga, spending time with friends, or reading that help with stress.  Find what works for you and do something each day to reduce your stress.

6. Minimize Processed Foods and Sugar

This recommendation goes without saying.  Our processed food and high sugar diet in the U.S. is a big cause of high blood pressure.  It also raises our blood pressure through weight gain.   These simple or hunger causing carbs also cause us to retain fluids which only further raise our blood pressure.  We have to return to real foods.

With regards to added sugar, the World Health Organization (WHO) now recommends keeping added sugars to 25 grams/day or lower.  As there are 4 grams of sugar in a teaspoon, that works out to be a little more than 6 teaspoons a day.  That really is not much if you consider that a 12 oz can of Coke has 39 grams of sugar!

7. Eat Primarily a Plant Based Diet

Eating primarily unprocessed real foods, like fruits, vegetables, nuts, seeds, and legumes with fish, is the key to a healthy diet.  These are the foods that lower blood pressure.  It is always better to first try natural ways to lower blood pressure.  These foods heal us.  These foods not only lower our blood pressure but can also reverse many other medical conditions.

8. Keep Your Weight in Check

High blood pressure and being overweight generally go hand-in-hand.  Being overweight is also an important cause of atrial fibrillation, coronary heart disease, and heart failure.

I saved this for number 8, as if you are doing numbers 1-7 then weight loss will occur naturally.  Most of my patients report dramatic weight loss without feeling hungry by following numbers 1-7.

One of the biggest challenges I have had in working with my patients is in teaching them how to prepare healthy foods. It seems that as a society we have forgotten how to cook.  Instead we have outsourced food preparation to the processed food and fast food corporations who often do not care about the long-term health of their customers.

If we can focus on eating real foods and real living then the weight will come off naturally.  We won’t need to count the calories.  We can live the way we were genetically designed to live!

One point to remember.  When lowering your blood pressure naturally it is important to work with your physician very closely.  Your blood pressure can drop very fast when you make healthy lifestyle changes.  Never stop medications on your own.

How is your blood pressure? What have you found that helps to keep your blood pressure in check? You can leave a comment by clicking here.

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I am an emotional eater.  When I have something I need to do but don’t feel like doing, I suddenly feel hungry and will reach for food.  Over the years, I have given myself permission to procrastinate if I “need to eat” first.

I also use food to “reward” myself.  If I have just finished a killer work out or spent hours grueling with a difficult surgery, as soon as I finish I want to “reward” myself with something my body does not need.

Interestingly, I had no idea I was even an emotional eater.  I really had no idea I was subconsciously “eating” to procrastinate or “rewarding” myself for accomplishing something difficult.

It was not until I kept a food journal that I actually realized I did this.  With the food journal it reminded me of how much I had already eaten and when so I knew I wasn’t really hungry.  Interestingly, prior to the food journal experiment, I would forget what I had just eaten and was convinced I was hungry again.

As cumbersome as it can be to keep a food journal, it did finally give me insight on something I had been doing my entire life.  I came to realize that I wasn’t really hungry at these times.  I just did not want to do what needed to be done.

Food was, and still is if I am not careful, an emotional distraction for me.  Like so many people, I got “hunger” confused with other emotions I was feeling.

Emotional eating can come in many different forms.  These experiences and associations with food were often learned in childhood.

Emotional Eating: What Medical Studies Tell Us

Certain foods, especially the high sugar or unhealthy fatty foods, have provided us with emotional comfort over the course of our lives.  Indeed, studies show that these are the foods emotional eaters primarily turn to for comfort.

Emotional eating is a major reason for eating more than what our bodies really need.  Studies also show that unless emotional eating is addressed, long-term weight loss for emotional eaters is extremely difficult.

Six Strategies to Overcome Emotional Eating

The key for success and long-term health is to identify these emotions, determine if you really are hungry, and then redirect the action once these emotions arise.  Here are my 6 tips:

1. Recognize Your Emotions

Are you sad, bored, lonely, stressed out, or angry?  Most likely you are not really hungry at all.  Most of the time I wasn’t really hungry at all.

It could be that what you really need is to connect with a supportive friend or family member, some physical activity, or to do something that you really enjoy like reading a great book, listening to some wonderful music, etc.

Often, if we do one of the above activities, the sensation of “hunger” will pass.  You could even create a new rule for yourself such as “when I feel __, I will go for a walk first”.

2. Eat Three Healthy Options First

If you really feel that you need some food when you are feeling this way, try eating three healthy food options (i.e. celery, apple, handful of nuts, etc.) before you give yourself permission to turn to your old comfort foods.  Generally, by the time you have had 3 healthy options you will lose the urge to return to the old comfort foods.

3. Have a Plan

If you are in a situation where you are feeling very overpowered by your emotions, it often helps to have a plan. Write down what you will eat for the day the night before.  Prepare all of your foods ahead of time so you are ready to go the next day.

This is something that has been very helpful for me.  If I don’t bring a lunch and snacks with me in the morning, I will reach for the pizza and Diet Coke as a “reward” after a long or difficult surgery.

This takes away the decision making process as you have already decided ahead of time what you will eat for the day.  Write down everything you eat as part of this plan.  Sometimes, just writing down everything that we eat makes us responsible to ourselves.

4. Get Enough Sleep and Physical Activity

Often I find that when people are not getting enough sleep or physical activity it is a normal thing to turn to these comfort foods.  Our bodies are hard-wired to seek out high sugar/unhealthy high fat foods when we are sleep deprived, stressed out, etc.

5. Keep a Food Journal

This has been my best tool for fighting emotional eating.  Too often, I forget what I have just eaten and think I am “hungry” again if I don’t want to do something or am very tired after a long surgery.  The food journal reminds me that it is not hunger but a different emotion I am struggling with.

While food journals are a big hassle, this hassle has been another key to my success.  When I walk past the nurses station and see chips, cookies, or candies just the fact that I will have to record what I eat prevents me from unconsciously taking “just a little”.  The journal has taught me how to eat mindfully.

6. Learn From Bad Days

It is human to have bad days and “fall off the wagon”.  When this happens, don’t beat yourself up.  Rather, analyze the day and try to identify the triggers that led you to “fall off the wagon”.  Learn from these experiences so that you will do better next time.  A bad day can teach you how to improve going forward.

You can leave a comment by clicking here.

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Did you know that taking regular vacations can help you to prevent a heart attack? While it seems strange, most Americans do not take their full vacation time. I was the same way once. It really makes no sense at all.

Is stress crushing you?

According to the 2013 Work Stress Survey, 83% of Americans reported being stress out at work. Where are you right now in your life? Are you buried at work? Is stress crushing you?

Do you need a vacation?

The problem is that as Americans we just do not take many vacations. While Europeans get up to 30 days of paid vacation each year, we just get 14 days. Even with these 14 days of vacation, the average American only takes 10 days off.

I get this. I used to be the same way. I would never take any time off. I would let my vacation time go unused so that I could work more. Seems strange doesn’t it?

I’m really not sure what was going on in my head at the time. I think I was trying to work hard and not spend any money in hopes for an earlier retirement. That is if I still had my health by the time I hit retirement age…

It was not until I hit my own health crisis a few years ago that I started taking vacations. Now I know that vacations are absolutely critical to our health, happiness, and longevity!

Let me give you 6 Reasons Why You Need a Vacation Now!

1. Less Stress

We just do not do a good job of dealing with stress in our modern lives. 70% of all doctor visits are due to stress or illnesses brought on or made worse by stress. I see this every day in my medical practice. In fact In a study of 1500 women in Wisconsin, those who rarely took vacations were 90% more stressed out than those who regularly took vacations.

2. More Happiness

While we have always been taught money cannot buy you happiness, that is not always the case. Studies have shown that spending money on life experiences, such as vacations, actually improve happiness.

Interestingly, in a study of 1,530 Dutch people, vacations seem to boost their pre-trip happiness the most. Somehow, just thinking about your upcoming vacation makes you happier. I know this is the case for our family. For the last 20+ years our annual family vacation has been on my parent’s houseboat at Lake Powell. If we even bring up Lake Powell our kids instantly become joyous! Now that I am thinking about this vacation, I can already feel my spirits lifting!

3. More Energy

Yes, vacations can give you more energy! Perhaps it is because they give you a new perspective on life or a chance just to de-stress. Regardless, from the Wisconsin study cited above, women who rarely took vacations were 67% more tired and fatigued than those who regularly took vacations.

4. Better Marriage Satisfaction

Can you really improve your marriage just by taking a vacation? Yes, according to the results of this Wisconsin study. In this study, women who regularly took vacations reported 55% more satisfaction with their marriage. Vacations give us a chance to reconnect with those that are most important in our lives free from all of the stressors of everyday life.

5. Protect Your Heart

Yes, a vacation will help to save you from ever developing heart disease! In fact, from over 12,000 men followed for 9 years in the MRFIT Trial, those who regularly took vacations were 29% less likely to die from a heart attack. Studies of women have shown the same heart protective effects of vacation. Vacationing is indeed good for your heart!

6. Live Longer

If all of the above benefits were not enough, those who regularly take vacations live longer than those who do not. Based on the MRFIT Study above, regular vacationers were 17% less likely to die over the 9 years of the study.

What if I can’t afford a vacation?

You may be thinking, yeah that all sounds great Dr. Day but my wife and I just cannot afford a vacation right now. Vacations do not have to be expensive. In fact, you could even do a “stay’cation”.

Stay’cations, if done right, can yield the exact same health benefits. Of course, a stay’cation does not mean stay home and do chores around the house. It means to get out and explore the area around where you live!

What can I do today?

My challenge to each of you is to take some time and plan a vacation with your family or friends today. There is no better time than the present. It just might make you happier!

How have vacations helped you in your life? What was your best vacation? You can leave a comment by clicking here.

Can Weight Loss Cure A-Fib, Diabetes, High Blood Pressure, High Cholesterol, and Heart Disease?

Did you see the recent media reports about this study?  Not only did weight loss alone cure atrial fibrillation (A-Fib) but it also cure diabetes, high blood, pressure, high cholesterol, and reversed previous heart damage!

In my opinion, this was the biggest study to emerge from the largest cardiac medical conference in the world, the annual scientific sessions of the American College of Cardiology.  All of my colleagues at the meeting were actively discussing the implications of this study.

The Obesity and A-Fib Epidemic

The United States is at the epicenter of both the obesity and the atrial fibrillation (A-Fib) epidemic.  Carrying extra weight puts a significant stress on the heart which makes it very common for overweight patients to go into A-Fib.  Perhaps this is why A-Fib is 10 times more common in the U.S. than in Asia.

The LEGACY Study

In the LEGACY Study, my friend Dr. Prash Sanders from Royal Adelaide Hospital in Australia, enrolled 355 overweight A-Fib patients in this weight loss study.  To get into the study, you had to have a body mass index of 27 or higher (25 or higher is considered overweight).

To put this BMI number into practical terms, the average weight of the patients participation in this study was approximately 220 pounds.  They divided these patients into 3 groups depending on how successful they were at losing and maintaining the weight loss.  Specifically, I would like to focus on what happened to the 38% of the patients who successfully lost an average of 36 pounds and kept that weight off for one to two years.

Weight Loss Cures Half of Overweight A-Fib Patients

The biggest message of the LEGACY Study is that half of A-Fib patients can be cured by weight loss alone.  Indeed, with just a 36 pound weight loss, 46% of A-Fib patients had their arrhythmias go into remission without medications or procedures.  Even in those who were not able to drive their A-Fib into remission, those who could lose an average of 36 pounds had a 6-fold decrease in their A-Fib burden.

7 Other Benefits of Losing 36 Pounds

In addition to a 50/50 chance of putting their A-Fib in remission, those who lost an average of 36 pounds in this study also had the following 7 additional benefits.  These benefits may even be more beneficial for their health and longevity than just putting A-Fib into remission.

1. 18 Point Reduction in Blood Pressure

Considering that the average blood pressure medication only lowers your blood pressure by 5 t0 10 points (mmHg), dropping your blood pressure by 18 points with simply losing 36 pounds is amazing.  What is even better is that patients dramatically lowered their blood pressure without the nasty side effects that often come from medications!

2. Inflammation Reduced by 76%

C-reactive protein (hsCRP) is a blood test that measures inflammation in the body.  Inflammation is a major cause of heart disease, dementia, and aging.  With a 36 pound weight loss, these patients were able to drop their average dangerous CRP level of 5.1 mg/L to a much safer value of 1.2 mg/L.

The goal CRP level for everyone is less than 1 mg/L.  While these patients did not quite hit this target, their average CRP came very close.  To help put things in perspective, someone with a CRP of 3.0 mg/L or higher has 3 times the risk of a heart attack than someone with a CRP of less than 1 mg/L.

3. 88% Cured of Diabetes

Diabetes is one of the most disabling conditions.  It causes blindness, amputations, kidney failure, heart attacks, dementia, and takes about 8 years off your life.  The good news is that, according to the LEGACY Study, 88% of the time people can be cured of diabetes with just losing 36 pounds!

4. Significant Cholesterol Reduction

The primary treatment for people with high cholesterol is to take a statin drug.  Considering that this recent study showed that statin users are 46% more likely to develop diabetes, this is enough to make anyone reconsider.

An even better way to achieve all of the benefits of statins, without any of the side effects, is to simply lose 36 pounds if you are overweight.  From the LEGACY Study, losing 36 pounds resulted in a 16% reduction in LDL (bad cholesterol) and a 31% reduction in triglycerides.

5. Cure an Enlarged Heart

An enlarged heart can be very dangerous.  An enlarged left atrium can lead to A-Fib.  An enlarged left ventricle can lead to heart failure and cardiac arrest.  Losing 36 pounds resulted in the left atrium shrinking by 18% and the left ventricle coming down 8% in size.

Once again, this is very good news.  It shows that it is never too late to reverse heart damage!

6. Reverse a Thickened Heart Muscle

We like big muscles everywhere in the body except for the heart.  If the heart muscle becomes to big the heart thickens and may have difficulties pumping.  In this study, patients were able to decrease the thickness of their hearts by 14%.

7. Better Quality of Life

At the end of the day the real goal in treating A-Fib is to prevent strokes and improve quality of life.  In this study, losing 36 pounds not only cured half of the patients from A-Fib but also resulted in a 200% improvement in their quality of life!

Can Weight Loss Cure A-Fib?

To get back to our original question, can weight loss cure A-Fib, I hope the answer by now is a resounding “yes.”  This well designed clinical study published in the Journal of the American College of Cardiology showed that there is indeed hope for A-Fib patients!

Not only will half of overweight A-Fib patients be cured with just a 36 pound weight loss but most will also be cured from high blood pressure, diabetes, high cholesterol, and other forms of heart disease.

Does the LEGACY Study inspire you to get down to an ideal weight?

Disclaimer

Please work with your physician to determine if you should lose weight and what your target weight should be.  Also, while weight loss may cure you of many chronic medical conditions, the results do not happen overnight.  It took 1-2 years for the patients in the LEGACY Study to experience these benefits.  Thus, continued medications may be required until your target weight is achieved.  Please do not self diagnose or treat based on anything you have read in this article.

A New Blood Thinner Alternative is FDA Approved! The Watchman Device

I recently saw a new patient, Lisa, who was stuck in a very difficult situation.  Last year while at dinner with her daughter she suddenly lost her ability to speak.  She told me that she knew what she wanted to say but the words just came out all garbled.

Fortunately, her daughter immediately recognized the signs of a stroke and dialed 911 from the restaurant.  Even though Lisa protested, the call was made.  She was rushed to the hospital, a clot busting medication was immediately given, and Lisa had a complete recovery from her atrial fibrillation (A-Fib) stroke.

She was then put on warfarin and did well until last month when she was hospitalized again.  This time it was a massive gastrointestinal bleed requiring 4 blood transfusions.  She now was in my office wondering what she should do.

She definitely did not want another stroke nor did she want any more life-threatening bleeding episodes.  At the time of this visit, my options were limited.  Now, hope is available!

The Watchman device was finally FDA approved after the FDA struggled with this decision for 6 long years.  Now that the Watchman device is finally available for A-Fib patients in the U.S., what is it and is it right for you?

The Left Atrial Appendage

Before we can discuss the Watchman device, we need to back up and talk about the left atrial appendage.  The left atrial appendage is a pouch in the left atrium of the heart.  Every heart has a left atrial appendage.

In atrial fibrillation (A-Fib),  the upper chambers of the heart (right and left atrium) just “quiver” and don’t pump any blood.  When this happens, the stagnant blood in this dead-end pouch can clot.  If one of these blood clots breaks free from the left atrial appendage and travels through the bloodstream to the brain it is called a stroke.

The purpose of blood thinners in atrial fibrillation is to thin the blood enough so that this stagnant blood in the left atrial appendage won’t clot.  The problem is that these blood thinners not only thin the blood in the appendage but they also thin the blood throughout the rest of the body as well.  For this reason, many blood thinner patients suffer from bleeding problems.

Surgical Removal of the Left Atrial Appendage

For decades now, cardiac surgeons have been surgically removing the left atrial appendage in A-Fib patients who require cardiac surgery.  The difference is that the Watchman device can accomplish the same thing without surgery. The Watchman device is a small umbrella that is used to plug up the left atrial appendage.  If the appendage is plugged, then blood cannot get in and blood clots generally don’t form in the heart.

This X-ray image shows us inserting the Watchman device in the left atrial appendage with a catheter.  This small device is inserted through a vein in the leg.

The entire procedure takes about an hour to perform and patients usually go home from the hospital the next day.  The goal of the Watchman device is to plug up the left atrial appendage so patients don’t have to take blood thinners and can still be protected from A-Fib strokes.

Why Did the FDA Struggle with Watchman?

You may be wondering why the FDA struggled for 6 years in approving the Watchman device.  Let me quickly recount the history.

In the first major study to evaluate Watchman, the Watchman device was shown to be as effective as warfarin in preventing strokes in A-Fib patients.  Where Watchman really shined was in the very low risk of bleeding.  This is likely due to the 3% annual risk of a life-threatening bleed with warfarin.

Sounds like an easy decision for the FDA, right?  Where the FDA struggled is that when cardiologists first started to implant Watchman in this study, there was a high risk of cardiac tamponade or bleeding around the heart.  Fortunately, later studies showed that most of this risk could be eliminated with experience.

As the FDA was not convinced with the first study, they asked for another study.  In this second study, not only was the risk of bleeding again low but the risk of cardiac tamponade was also low.  The concern with this second study was that after the study was published, there were a number of strokes in the Watchman group which tipped the balance of stroke prevention toward warfarin.

This left the FDA with a difficult decision.  Here is a new device that is difficult to learn.  Also, while it is much safer than warfarin, when it comes to bleeding, it may not be as good as warfarin when it comes to stroke prevention.

If you want to read more about this 6 year journey through the FDA, here is an excellent article from the Wall Street Journal.

The New Blood Thinners versus Watchman

At the time the Watchman was first submitted to the FDA, our only blood thinner for A-Fib was warfarin.  While the late night TV lawyers would have us believe that the new blood thinners (dabigatran/Pradaxa, rivaroxaban/Xarelto, apixaban/Eliquis, and endoxaban/Savaysa) are the most dangerous medications ever created, the truth is that they are much safer than warfarin.

Indeed, studies have shown that the risk of life-threateining bleeding with the new blood thinners is about 50% lower than warfarin.  The sad thing is that thousands of Americans have likely already suffered an A-Fib stroke because the lawyers scared them away from these potentially life-saving medications.

The reason why I bring up the new blood thinners versus Watchman issue is because the primary benefit of Watchman is a lower bleeding risk when compared to warfarin.  As the new blood thinners have a much lower risk of bleeding than warfarin as well, this bleeding reduction benefit with Watchman may not be as clear with the new blood thinners.

Our Experience with Watchman

At our center we have been implanting the Watchman device for most of the last decade as part of clinical studies.  We have implanted this device in hundreds of patients with minimal complications.  We have found Watchman to be extremely effective in preventing strokes and are excited to again offer this as an alternative to blood thinners for our high risk A-Fib patients.

What Should Lisa Do?

Lisa is the perfect Watchman candidate.  She has already had an A-Fib stroke and has had a life-threatening bleed from blood thinners.  For her, the decision is quite simple.

Is Watchman Right for You?

At the end of the day, is Watchman something you should consider?  First of all, I would only consider the Watchman device for patients at high risk of an A-Fib stroke.  To learn if you are at high risk of an A-Fib stroke, please read this article I wrote.

In addition to being at high risk of an A-Fib stroke, patients should also meet one of the following situations:

1. Unable to take blood thinners due to a previous life-threatening bleed.

2. Patients at high risk of a life-threatening bleed with blood thinners.

3. Patients with high risk occupations or lifestyles which would make blood thinners dangerous for them.

Are you considering the Watchman Device?

Disclosure

If you feel like you might be a good candidate for Watchman, please discuss this with your cardiologist.  Together, the two of you can decide if the potential benefits of Watchman outweigh the risks of this procedure.  Also, you can have an in-depth discussion about Watchman versus blood thinners.  Please, do not self diagnose or treat based on anything that you have read in this article.

When Should I Consider an Ablation for A-Fib?

John had been struggling with atrial fibrillation (A-Fib) for years.  He had tried the medications but they all made him feel tired.  He just did not like the way he felt when his heart was out of rhythm.  Should he consider a catheter ablation procedure to manage his A-Fib?

In this article we will discuss when an ablation procedure should be considered for the treatment of A-Fib.

What is a catheter ablation procedure?

A catheter ablation procedure is a minimally invasive procedure where a cardiologist inserts thin catheters through your veins and advances them to the heart.  Once these catheters are in your heart, a 3D map is often created to see where these abnormal heart rhythms are originating from.  Once the rogue spots that are causing A-Fib are identified, these areas are then cauterized or frozen to keep the heart beating normally.

Patients may go home the same day or they may be observed overnight.  Typically just a band-aid is used for the puncture sites as stitches are not even required for this procedure.  To see video footage of an ablation you can watch this TV segment.

Do I have to take a medicine first?

Many patients who come to see me are disheartened to learn that I generally encourage them to try an antiarrhythmic medication first.  The reason is that this is the approach recommended by the A-Fib Treatment Guidelines and the fact that many insurance companies will not pay for the procedure unless an antiarrhythmic has been tried first.

On average, I find these anti-arrhythmic medications generally only work for a year or two.  For some patients they do not work at all.  For other patients I have found that they may effectively control A-Fib for more than 20 years!

One potential advantage to trying a medication first is that our technology for catheter ablation procedures just gets better with time.  Thus, if you can control your A-Fib for 3-5 years, we may have an even better treatment option for A-Fib at that time.

One thing to remember is that antiarrhythmics are not without risk.  Most of the antiarrhythmics studied have been shown to increase the risk of premature death.

Should I wait to have my ablation procedure?

Patients often ask me, “can I wait to have my ablation?”  My answer generally is that as long as you can maintain normal rhythm it is a reasonable option to wait for an ablation procedure.

There is a common saying that “A-Fib begets A-Fib.”  The reason is that episodes of A-Fib may lead to scarring of the heart.  This heart scarring then leads to even more episodes of A-Fib.

For patients who have been continuously out of rhythm for more than 1 year, the chances of a successful ablation procedure decrease significantly.  Indeed, we have published a study which showed that the longer an ablation is delayed the lower the chances of success.

What are the benefits of a catheter ablation?

In countless studies, the two clearly proven benefits of catheter ablation for A-Fib include the following:

1. To control A-Fib symptoms

2. To increase your chances of holding normal rhythm

While no one questions the role of a catheter ablation to control symptoms and increase your chances of holding normal rhythm, the question many have sought to know is will it prolong life, prevent strokes, and prevent dementia.

In our study of 37,908 patients at Intermountain Healthcare we asked this very question.  Our study showed that those patients who elected to have a catheter ablation procedure lived much longer and were much less likely to suffer from a stroke or dementia.

It should be pointed out that our study did not randomize patients to the two different treatments strategies, namely ablation versus drugs.  As it was not a randomized study, catheter ablation cannot yet be considered as a proven way to prevent premature death, strokes, and dementia.

To fully answer this question, there is an ongoing large multi-center study, called the CABANA Study, which will answer this question.  This study is funded, in part, by the National Institutes of Health.

Who is the ideal ablation candidate?

Another question I am frequently asked is “am I a good candidate for an ablation?”  After personally performing more than 4,000 catheter ablation procedures for A-Fib, these are the patients that I have found who are most likely to be “cured” from A-Fib.

1. They have paroxysmal A-Fib (A-Fib stops on its own)

2. Their left atrium is normal in size

3. They don’t have any other cardiac or medical problems

4. They have an ideal body weight

5. They are young

What are the risks of a catheter ablation procedure?

Unfortunately, catheter ablation procedures are not risk free.  Many complications can occur.  For example, patients could suffer the following complications: bleeding, infection, heart attack, stroke, tear in the heart, damage to the pulmonary veins, esophageal perforation, nerve damage, emergent open-heart cardiac surgery, or even death.

When it comes to the risk of a complication, experience does matter.  Like everything in life, the more you do something the better you get at doing it.

When it comes to catheter ablation, studies show that if your procedure is done by an inexperienced physician or hospital, you have a 1 in 200 chance of never leaving the hospital alive.  In this study, an inexperienced physician was defined as a cardiologist (an electrophysiologist or cardiologist specializing in heart rhythm disorders) who did less than 25 of these procedures each year.  An inexperienced hospital was defined as a hospital that did less than 50 of these procedures each year.

If your electrophysiologist has recommended a catheter ablation procedure for A-Fib, find out how experienced they are, how experienced the hospital is, and ask them to show you their complication rate data.  If they cannot show you these numbers you may want to consider looking elsewhere for a procedure which could have significant complications.

Should I have a radiofrequency or cryoballoon ablation procedure?

There are two general ablation approaches for atrial fibrillation, radiofrequency (heat energy) or cryo (cold energy).  Either approach can effectively eliminate the areas of the heart which are misfiring.  As there are no data showing which approach is best, the best approach for you is the technique your electrophysiologist is most comfortable with.

Is a surgical ablation procedure better?

In addition to the catheter approaches, there is also a surgical approach to treating atrial fibrillation.  If you need open-heart surgery bypass surgery or valve surgery, your surgeon could easily perform a MAZE surgery for atrial fibrillation while your chest is open.

Surgeons have now started doing less invasive surgeries for atrial fibrillation which involve much smaller incisions in your chest.  For many patients, these “Mini-MAZE” surgeries can be very effective in controlling A-Fib.

Certainly, the more invasive the procedure is the higher the risks.  Studies have not shown whether the surgical approach is more effective than catheter approaches in treating A-Fib.

The surgical approach for A-Fib could be a good option if you live in a region where you have an experienced surgeon and your electrophysiologist is inexperienced in performing catheter ablation procedures.

Should John consider an ablation procedure?

In John’s case, his atrial fibrillation has caused him significant symptoms.  When he is out of rhythm he feels very tired and short of breath with any activity.

John had also tried an antiarrhythmic medication to control his A-Fib.  Initially he tried flecainide.  When flecainide was no longer effective he tried sotalol.  Both of these medicines not only failed to control his symptoms but also caused him to feel very tired.  To be honest, John also did not like having to take medications for the rest of his life.

As he had symptoms from A-Fib and medications were ineffective, he clearly met the established criteria for a catheter ablation procedure.  Fortunately, his procedure went well and he is now drug-free and doesn’t have any more A-Fib.

Should I consider an ablation procedure?

At the end of the day, should you consider a catheter ablation procedure?  Regardless of whether you are an ideal candidate or not, the following are the people who should at least consider this procedure:

1. Your A-Fib causes you symptoms

2. Antiarrhythmics either don’t work or cause significant side effects

3. You have been in normal rhythm within the last year

Has your doctor recommended a catheter ablation procedure?

10 Ways to Cure A-Fib without Drugs or Procedures

Atrial fibrillation (A-Fib) is up to 10 times more common in North America than in Asia according to a recent medical study published by my good friend, Dr. Sumeet S. Chugh, at Ceaders-Sinai based on a grant from the Bill and Melinda Gates Foundation.

Interestingly, according to research by Dr. Gregory M. Marcus from the University of California at San Francisco, when Asians immigrate to the U.S., they lose their protected status against A-Fib and soon develop rates of A-Fib similar to other Americans.

How can we explain the fact that A-Fib is 10 times more common in North America?  Is A-Fib under reported in Asia or is there something different about our lifestyles?

Is A-Fib Under Reported in Asia?

When most physicians hear Dr. Chugh’s work that A-Fib is up to 10 times more common in North America, they naturally assume that this condition is under reported in Asia.  While it is possible that there is a component of under reporting going on, other studies suggest that this may not be the case.

The easiest study to answer this question is to just do an EKG on everyone in a specified population and count up the cases of A-Fib.  If you don’t miss anyone with a screening EKG, then there will be no underreporting of the disease.  As A-Fib is more common as people age, why not just do an EKG on everyone over age 100 as these people will represent the highest rates of A-Fib in a population?

A-Fib in Centenarian Studies

When researchers did just this, an EKG on everyone over age 100, they came up with the following results.

1. A-Fib in U.S. centenarians: 27%

2. A-Fib in Danish centenarians: 17%

3. A-Fib in Chinese centenarians (Bama County): 4%

Clearly, even when there is no underreporting of A-Fib, the rates of A-Fib are still much higher in the U.S. than in Asian or Europe, consistent with the findings of Dr. Chugh’s study.  As the U.S. is a “melting pot” country where people come from around the world to live, why is it that their A-Fib risk goes up dramatically once they move here?

Based on these studies that I have presented thus far, this naturally begs the question, is 80-90% A-Fib preventable?  From my experience as a cardiologist treating thousands and thousands of A-Fib patients, the answer is a resounding “Yes!”  Even for people who have already been diagnosed with A-Fib, if A-Fib is diagnosed early enough and if aggressive lifestyle changes are made fast enough, it has been my experience that many cases of A-Fib will simply go into remission.

10 Ways to Cure A-Fib without Drugs or Procedures

As I have spent a lot of time researching the question of is 80-90% of A-Fib preventable, I would like to share with you 10 ways to cure A-Fib without drugs or procedures.  These approaches work as I have seen the results first hand in my cardiology practice.

Not only will these 10 strategies help your A-Fib but it will also help to prevent or reverse many other chronic medical conditions that afflict so many of us in the United States.  Even my 80 and 90 year old patients have taught me that it is never too late to change!

1. Change Your Genes

Genes certainly play a role in A-Fib, like most other medical conditions.  Studies do show that Caucasians have a slightly higher risk of A-Fib when compared to people of other ethnicities.

Despite what your “genes may say,” recent studies have shown that your lifestyle can determine which genes get turned on or off based on epigenetic markers.  Thus, even if you did inherit the “A-Fib gene,” this gene can be silenced through a molecular “tag” that comes from a healthy lifestyle which can attach to the outside of the gene.

As I have long had an interest in treating A-Fib, I wanted to know if I inherited any A-Fib genes.  Thus, for $99 I had my genome tested by 23 and Me at home by simply spitting into a test tube and mailing it back to the company.  Then, for an additional $5, I had my raw genetic data from 23 and Me interpreted by a different company called Promethease.  Interestingly, 23 and Me used to give you a detailed interpretation of your genetic results until the FDA became concerned that Americans would not be smart enough to know what to do with this genetic information.

Fortunately, I learned that I have the Gs273 gene which means I have the lowest risk of A-Fib among Caucasians.  Whew, at least my chances of A-Fib are reduced by 18% because I have this gene which protects me against A-Fib.

Even if I did test positive for the A-Fib genes, I know that I could turn these genes off by closely adhering to the next 9 lifestyle strategies that I discuss below.

2. Don’t Smoke

If you have ever smoked or are currently smoking then you are at a significantly increased risk of A-Fib.  Indeed, studies have shown that if you are currently smoking you are 2.1 times more likely to develop A-Fib.  If you are no longer smoking then your risk of developing A-Fib is 1.3 times higher.

Smoking likely causes A-Fib through a process known as oxidative stress, also known as “rusting of the body,” in which free radicals damage our heart cells and DNA.  The message though is very clear, if you can stop smoking now then you can decrease your risk of A-Fib by 36%!

3. Lower Your Blood Pressure

High blood pressure has long been known to raise the risk of A-Fib.  As the heart has to pump against a higher load it causes stretching and thickening of the heart, ultimately leading to scarring and enlargement of the left atrium.  As a result of heart scarring and enlargement, the electrical pathways are disrupted thereby causing A-Fib.

Studies have shown that having a history of high blood pressure can increase the risk of A-Fib by 56%!  Unfortunately, new treatment guidelines for high blood pressure have now become very lax, especially in older individuals.

Thus, even if you have high blood pressure, your doctor may now decide not to treat it.  The concern is that if blood pressure is not aggressively managed in A-Fib patients then their arrhythmias may become even more difficult to treat in the future.

Fortunately, if caught early, I have found that most cases of high blood pressure can be treated without medications.  I know this was the case with me.  To learn more about how to lower your blood pressure naturally, please read my article How to Lower Your Blood Pressure with These 8 Steps.

4. Don’t Drink Alcohol

I realize that you have probably heard that a little alcohol is good for the heart.  While newer studies challenge whether alcohol is healthy or not for the heart, certainly when it comes to A-Fib any alcohol can be dangerous.

In a large study of 79,019 people with no prior history of A-Fib, researchers found that over the following 10 years, even just 1 alcoholic drink a day increased their risk of A-Fib by 8%.  This risk then went up to 39% for those people having 3 or more alcoholic drinks each day.

This large study showed for the first time that there is no safe level of alcohol that you can drink when it comes to A-Fib.  The more you drink the higher your risk of A-Fib.

5. Minimize Stimulants

Any drug which stimulates the body also stimulates the heart and may increase the risk of A-Fib.  As a cardiologist treating patients with A-Fib, I am seeing more and more cases of A-Fib from energy drinks, like Red Bull, especially in young men.

It is not clear yet if this increased risk of A-Fib from energy drinks is from the caffeine, sugar, taurine, or other chemicals in these drinks.  Ongoing studies will hopefully answer these questions.

While there are no reliable studies yet on the subject, I am also seeing many cases of A-Fib from patients taking Attention Deficit Hyperactivity Disorder (ADHD) medications.  The amphetamine compounds in ADHD medications are causing a wide array of arrhythmias in my patients.

When it comes to caffeine and A-Fib, the data are not so clear.  Some studies suggest there is an increased risk of A-Fib with coffee while others do not.  At the end of the day, you need to find out for yourself whether or not caffeine is triggering your A-Fib. If you find that you go into A-Fib on the days you have caffeine then it just may be a trigger for you.

6. Get Restorative Sleep

Sleep is critical when it comes to preventing or reversing A-Fib.  Unfortunately, as a society we are sleeping less and less.  For example, we now sleep 2 hours less than in the 1960s.  Studies show that not getting enough sleep can increase your risk of A-Fib by 3.4 fold!

One of the biggest problems for A-Fib patients struggling with getting enough sleep is sleep apnea.  Unfortunately, many patients with A-Fib are also overweight which then leads to sleep apnea.

In sleep apnea, the extra fat in the neck and in the back of the tongue can obstruct your airway while sleeping.  Usually, the spouse or sleeping partner can make the diagnosis as these patients tend to snore and occasionally stop breathing while sleeping.

If you think you might be suffering from sleep apnea then get tested.  Depending on what study you look at, your risk of A-Fib is about 4 times higher with sleep apnea.  In my practice we offer sleep apnea screening for most patients with A-Fib.

As of the time I am writing this article, there are no studies yet showing that getting treated for sleep apnea with a CPAP machine will reduce or reverse A-Fib. However, in patients who have had an A-Fib ablation, one study has shown that CPAP therapy can double their chances of a successful ablation.

7. Reverse Your Diabetes

Diabetes is another epidemic striking the U.S.  Indeed, studies show that diabetes has increased by 75% over the last 20 years in the U.S.!

Diabetes is another important A-Fib risk factor.  As with high blood pressure, if aggressive lifestyle changes are made early enough, most cases of diabetes can be reversed.

In one of the most insightful studies on the role of diabetes in A-Fib, researchers reported that diabetes increases your risk of A-Fib by 40%.  Even more interesting was the finding that the higher your average blood sugar and the more years you are diabetic, the higher your risk of A-Fib.

Like with smoking, the reason why diabetes increases A-Fib is likely due to oxidative stress, or “rusting” of the body.  If you now suffer from diabetes, there are likely lifestyle changes that you can make to either put your diabetes in remission or significantly reduce the amount of medications you need for this condition.  Your heart will definitely thank you for these lifestyle changes!

8. Lower Your Stress Levels with Yoga

Probably one of the main questions patients ask me on their first clinic visit for A-Fib is “did stress cause my A-Fib?”  If you have asked this same question of your doctor they likely downplayed this link between stress and A-Fib.

The truth is that the heart and the brain are intimately connected.  Any stress you may be feeling will be felt by your heart as well.

In an interesting study, Swedish researchers randomly selected 7,494 men and asked them if they had a “stressful job.”  They defined a “stressful job” as a job in which there were high demands and low autonomy.  To me, this sounds like most jobs including my own job.

Researchers then followed these 7,494 Swedish men for the next 7 years.  At the end of the 7 years they found that those who reported having a stressful job were 32% more likely to develop A-Fib.

It is not just a stressful job that can cause A-Fib but any negative emotions as well.  In a fascinating study by my friend, Dr. Rachel Lampert at Yale University, she found that feeling sad, angry, stressed, impatient, or anxious increased your risk of going into A-Fib on that day by 3 to nearly 6 fold!  Even more interesting was that at least when it comes to feeling angry or stressed, this increased risk of A-Fib is carried over to the next day.

Perhaps this explains why my good friend, Dr. Dhanunjaya Lakkireddy, showed in a well designed clinical study that yoga can reduce your A-Fib burden by 24%.  It is for this reason that I now recommend yoga for my A-Fib patients.

9. Exercise Moderately for Life

It has long been known that exercise is good for the heart.  The same, when done in moderation, is also true when it comes to A-Fib treatment.

In an interesting study, Australian researchers were able to show that when they could get men to go from “couch potatoes” to at least some limited form of exercise that they could reduce their A-Fib burden by 50%.  When it comes to exercise, even just a little bit can have a huge benefit when it comes to the heart.

However, those people who carry exercise to the extremes like in the case with competitive long distance cross country ski racers, marathon runners, or Ironman triathletes, the risk of A-Fib can increase significantly in these people.  Indeed, studies show that the faster your times in these endurance events and the more you of them you do, the higher your risk of A-Fib.

The cause of A-Fib is endurance athletes is likely due to fibrosis (scarring of the heart) due to pushing their hearts beyond what they were designed to do.  For many of these endurance athletes, if they would simply back off on their training or stop competing competitively, their A-Fib would go away.  However, this is something most of these patients cannot do as they have become “addicted” to extreme levels exercise.

These endurance athletes also cannot take medications for A-Fib as they are unable to compete effectively on cardiac drugs.  Thus, I have found that for most of my competitive endurance athletes with A-Fib, we have had to move toward an A-Fib ablation procedure so that they can continue to compete.

10. Lose the Extra Weight

Since the landmark Framingham A-Fib study in 2004, it is well known that obesity is a powerful risk factor for A-Fib.  In this study, people who were overweight had up to a 52% increased risk of A-Fib.  Researchers identified that the increased risk of A-Fib in overweight people is likely due to enlargement of the left atrium.  Today, from the same ongoing Framingham Heart Study, we also know that extra fat accumulation around the heart and scarring of the heart from obesity are also to blame for the increased risk of A-Fib.

Recent studies have shown that if people can get off the extra weight they can reverse their A-Fib.  For example, my friend Dr. Yong-Mei Cha at the Mayo Clinic, showed that gastric bypass surgery can prevent A-Fib.  Another friend, Dr. Prashanthan Sanders from the University of Adelaide, showed that by simply losing 32 pounds in an overweight person they could dramatically reduce their A-Fib burden.

This is something I have also seen in my own A-Fib practice.  Weight loss seems to be the most effective way to reverse A-Fib without drugs or procedures in my overweight patients with A-Fib.  It doesn’t take much weight loss to see a clinical benefit.  Even just losing 5 to 10 pounds can have a significant benefit.

I recently gave a presentation to an A-Fib audience on this exact blog article. Here is a link to this presentation.

Disclaimer

If you have A-Fib and want to drive it into remission without drugs or procedures, please work under the close supervision of your physician to achieve this goal.  This goal is certainly possible as I have seen it for many of my patients.

With this article I am not providing any medical advice.  All information shared is general information based on published medical studies and information that has been shared at medical conferences.  In addition, do not self diagnose or treat based on anything that you have read in this article.

Do I Have to Take a Blood Thinner for A-Fib?

If there is one thing I have learned as a cardiologist specializing in atrial fibrillation (A-Fib) it is that patients do not want to take a blood thinner.  While strokes are a feared complication of A-Fib, many of my patients would rather take their chances than gulp down a blood thinner each day for the rest of their lives.  Are there any other options?

The A-Fib Guidelines Have Changed

Until the most recent A-Fib guidelines came out in 2014, a large percentage of my patients could be safely treated with just a baby aspirin each day to prevent a stroke.  Unfortunately,”expert opinion” has swung too far in the other direction and now almost everyone is indicated to take a blood thinner for the rest of their lives.  This has huge implications, especially for women, as I will describe in this article.

Lisa’s Dilema

Lisa is a very healthy and active 65 year old woman.  She skis vigorously in the winter and competes in mountain bike races in the spring, summer, and fall.  Her passion for life are her skis and her mountain bike.  Lisa also has a history of A-Fib.

Lisa’s A-Fib interfered with her ability to compete in sports.  She had tried flecainide to control her rhythm but that only made things worse.  Frustrated, and with no other good options, she opted for a catheter ablation procedure to rid her of her A-Fib.

Fortunately, her ablation procedure went very well and she has had no further episodes of A-Fib.  She is now back to skiing and and mountain biking.  She is loving life again but she is still on a blood thinner despite her high risk of trauma from skiing or mountain biking.

As dangerous as skiing is, my orthopedic colleagues tell me that they see far more fractures and other serious injuries from mountain biking.  As a mountain biker myself I can readily attest to this.  For example, last summer I went over my front handle bars three times while mountain biking the legendary trails of the Wasatch Mountains in Utah.  Fortunately, I do not take blood thinners.

According to the latest A-Fib guidelines, because Lisa is a woman and she is 65 years old, the guidelines would call for her to be on a blood thinner for the rest of her life.  These guidelines stipulate that a blood thinner is recommended regardless of the fact that she has had a successful ablation procedure with no further recurrences of her A-Fib.

What should she do?  Can the guidelines really be right in her case?

Who should be on a blood thinner for life?

Before we get back to Lisa’s case, we need to back up and review the latest A-Fib guidelines.  Whether or not you should be on a blood thinner for life is determined by your CHADS-VASc score.  It does not matter if your A-Fib comes and goes (paroxysmal), present all of the time (persistent), or whether you have had an ablation.

In the CHADS-VASc scoring system, people can have a score of 0-9.  Lower is better with this scoring system.  Based on your score, here are the recommendations:

CHADS-VASc of 0: No blood thinners of any kind are needed

CHADS-VASc of 1: Blood thinners, aspirin, or nothing could be prescribed

CHADS-VASc of 2-9: Blood thinners for life

How do I know what my CHADS-VASc score is?

If you want to know your CHADS-VASc score there is a simple way to calculate your score.  Here is the scoring system:

C: Congestive heart failure, 1 point

H: High blood pressure, 1 point

A: Age 65, 1 point

D: Diabetes, 1 point

S: Stroke or Mini-Stroke, 2 points

V: Vascular disease (prior heart attack or blockages elsewhere in the body), 1 point

A: Age 75, 1 point (you can have up to 2 points based on age)

S: Sex or female gender, 1 point

As you can see from this scoring system, if you are a woman then a blood thinner for life could be indicated.  Is this really a fair scoring system?

What are my odds of a stroke based on my CHADS-VASc score?

In order to make an educated decision regarding whether or not you should take a blood thinner for the rest of your life, you need to know what the odds of a stroke are.  According to the A-Fib guidelines, here is your annual risk of a stroke based on your CHADS-VASc score.

CHADS-VASc of 0: 0% annual stroke risk

CHADS-VASc of 1: 1% annual stroke risk

CHADS-VASc of 2: 2% annual stroke risk

CHADS-VASc of 3: 3% annual stroke risk

CHADS-VASc of 4: 4% annual stroke risk

CHADS-VASc of 5-9: 7-15% annual stroke risk

What are my odds of a life-threatening bleed on blood thinners?

To weigh the risks versus benefits you need to now know the risk of a life-threatening bleed based on taking a blood thinner.  To simplify this process, the blood thinner with the highest risk of bleeding is warfarin (Coumadin) and the blood thinner with the lowest risk of bleeding is apixaban (Eliquis).

The other FDA approved blood thinners in the U.S., dabigatran (Pradaxa), rivaroxaban (Xarelto), and endoxaban (Lixiana) all have an annual bleeding risk somewhere between warfarin (Coumadin) and apixaban (Eliquis).

In the best study to evaluate the real risk of bleeding with these medications, the ARISTOTLE Trial, the annual risk of life-threatening bleeding in 18,140 patients was 2.13% with apixaban (Eliquis) and 3.09% with warfarin (Coumadin).  To put these numbers in perspective, this means that each year 2 in every 100 patients taking apixaban (Eliquis) and 3 in every 100 patients taking warfarin (Coumadin) may die or be seriously harmed by a bleeding complication.

Can’t I just take aspirin instead of a blood thinner?

With the unavoidable risk of life-threatening bleeding with blood thinners I am frequently asked this question.  Unfortunately, aspirin has not shown any consistent benefit in stroke prevention in medical studies.  Some studies showed it was beneficial while others have not shown any benefit.

While a baby aspirin may seem like a very safe medication, there is still about a 1 in 200 risk each year of a life-threatening bleed from aspirin.  It is for this reason that the role of aspirin was significantly downgraded in the most recent A-Fib guidelines.

Will an ablation decrease my risk of a stroke?

Intuitively it just makes sense that if you can eliminate A-Fib then the risk of a stroke should go way down.  Indeed, this is what we have seen based on our experience at Intermountain Medical Center.

In our landmark study of 37,908 patients, we showed that an A-Fib ablation procedure can dramatically reduce the long-term risk of a stroke!  Regardless of how we analyzed the data, as seen in this subsequent medical study, ablation decreased the long-term risk of a stroke.

While other experienced centers have shown similar findings, as these results have not yet been verified in a multi-center randomized study, they are not yet accepted as fact within the medical community.  It is for this reason that the 2014 A-Fib Guidelines still do not recognize that in the right hands at experienced hospitals, an A-Fib ablation can decrease the long-term risk of stroke.  Thus, with the guidelines as they are currently written, we can’t offer ablation as an alternative to life-long blood thinners.

Are there any other options to avoid life-long blood thinners?

Yes, other options are available.  As 90% of the strokes from A-Fib arise from a pouch in the left atrium (left atrial appendage), this left atrial appendage can be removed or plugged to decrease the risk of a stroke.

Watchman Device

The best studied way to close off the left atrial appendage is the Watchman device.  We have implanted this device in hundreds of patients as part of medical studies at our hospital with excellent results.

It is an overnight procedure and patients go home the next day with no cutting and no stitches.  Also, the Watchman device has been available for years in Europe.  However, at the time of this writing it is still not FDA approved in the U.S.

Lariat Procedure

Another option is the Lariat Procedure.  Once again, this is another overnight procedure with no stitches that closes off the left atrial appendage.  We have also had excellent results with this device at our hospital.

While the FDA mysteriously approved this device, there are no convincing data from multi center trials yet that it actually works as promised.  As data are still lacking, many insurance companies are refusing to pay for this procedure.

The ironic thing is that the Watchman device has been extensively studied in thousands of patients and still is not FDA approved whereas the Lariat procedure was FDA approved with no significant data that it even worked.  Go figure.

Surgical Left Atrial Appendage Excision

For patients who require cardiac surgery for other reasons, surgical left atrial appendage excision can be another viable option.  Interestingly, while surgeons have been cutting off the left atrial appendage in A-Fib patients for decades, this surgical procedure has never been studied in a rigorous manner to see if it even works.

The tricky part with the surgical approach is that, even in the best of hands, surgeons will leave a “stump” of the left atrial appendage in about 1 in 3 patients.  Often this “stump” can be a cause of stroke in A-Fib patients.

Thus, in my patients who have undergone surgical removal of their left atrial appendage, I like to perform a transesophageal echocardiogram to confirm there is no remnant “stump” before stopping their blood thinners.

Do natural blood thinners work?

While many of my patients swear by natural blood thinners, such as nattokinase, fish oil, garlic, or vitamin E, to date there are no data that show that any of these natural products can decrease the risk of A-Fib strokes.  Thus, given the lack of data, I cannot recommend these natural products as a substitute for traditional blood thinners.

However, where patients can get into trouble is when they combine these natural blood thinners with pharmaceutical grade blood thinners such as warfarin (Coumadin), apixaban (Eliquis), etc.  If you take any supplements please make sure your doctors are aware of what you are taking.

Should Lisa take a blood thinner for the rest of her life?

Getting back to Lisa, should she take a blood thinner for the rest of her life?  Her CHADS-VASc score is 2 for female gender and because she is 65 years old.

With a CHADS-VASc score of 2 her annual stroke risk is 2%.  However, her annual life-threatening bleeding risk on apixaban (Eliquis) is also 2% per year.  Seems like a wash, right?

To further complicate the analysis, she did have her A-Fib ablation procedure done at our hospital and we know from our study of nearly 40,000 patients that her long-term stroke risk is now low but definitely not zero.  Is she more at risk from bleeding out while skiing or mountain biking or from an A-Fib stroke?

As she is also concerned about her bleeding risk, on her own she decreased her apixaban (Eliquis) from twice a day to just once daily.  Once again I cannot recommend this approach as it has never been studied and it is an off label use of this medication.

At the end of the day, Lisa is a very intelligent patient who fully understands the blood thinner dilemma that she is in.  I cannot say whether what she has decided to do is right or not because it has never been studied.  Also, patients like Lisa who engage in high risk sporting activities have not been adequately studied in these big clinical trials.

What should I do?

By this point in the article you are probably confused as to whether you should take a blood thinner for your A-Fib or not.  This is why you need to have a very candid discussion with your physician to see if a blood thinner is right for you or not.

The new A-Fib Guidelines recommend that nearly everyone take a blood thinner, especially women.  The key is to clearly know your annual stroke risk, based on your CHADS-VASc score, as well as your annual bleeding risk depending on which blood thinner you are on.  Like almost everything else in medicine, it is a decision you and your physician need to make together in weighing the risks versus benefits.

Disclaimer

The decision whether or not to take a blood thinner for life is a huge decision with significant consequences either way.  This is something that you must discuss openly and honestly with your physician.

Please remember that everything I shared in this article is general information.  I never share medical advice.  Moreover, reading  this article does not create a doctor patient relationship.  Also, do not self diagnose or treat based on anything that you have read in this article.