Heart Disease Archives - Page 2 of 4

Body Fat Promotes Heart Disease

Dr. Joel Fuhrman/14 October 2020/ All MFN blog/

Risk factors for heart disease – elevated LDL cholesterol, hypertension, elevated triglycerides, inflammation, and blood glucose – are all exacerbated by excess body fat, and overweight/obesity itself is considered a risk factor.^1-3

Is it beneficial to be a little overweight?

However, there has been controversy about a potential “obesity paradox” in heart disease: the idea that some amount of excess weight either does not pose any risk or is even protective. Unfortunately, the studies that suggest there may be a protective effect of body fat are often the ones that get more news coverage; but this does a disservice to an already overweight and nutritionally misguided public, allowing them to believe that excess body fat won’t harm their health.

Is there really an obesity paradox? Or is it just that BMI is not a good measure of body fat?

Many of these studies have used body mass index (BMI), however BMI, which only takes into account height and weight, is not an accurate indicator of body fatness. BMI does not distinguish between fat mass and lean mass, nor does it take into account fat distribution (visceral fat vs. subcutaneous fat). Many people whose weights are within the “normal” BMI range are still carrying excess fat.

There has been no evidence providing a convincing explanation of how excess fat could possibly provide a cardiovascular advantage. Plus, there are numerous medical conditions may cause unintentional weight loss, including depression, anxiety, autoimmune diseases, cancers, and digestive disorders. In the elderly especially, a low BMI may be an indicator of muscle loss and frailty rather than an indicator of a healthy low level of body fat. In short, people who are thinner are not necessarily healthier.

Relationship between body fat and heart disease: using better measures than BMI

A new study is helping to clear this issue up,⁴ in a cohort of almost 300,000 people in the UK (age 40-69) who were followed for an average of 5 years. Their first analysis puts the optimal range of BMI for heart disease prevention at 22-23 kg/m². It was a “J-shaped” association, meaning risk rose both above and below the 22-23 range. But the researchers went further. They used multiple measures of body fatness to get a more accurate picture: waist circumference, waist-to-hip ratio, waist-to-height ratio, and percent body fat.

Ultimately, what the researchers found was that using BMI produces different results than the other indicators. BMI was the only one that showed an increase in risk at the low end (<18.5 kg/m²). When they excluded smokers and participants with pre-existing diseases, the increase in risk associated with low BMI almost disappeared. The more accurate measures of body fatness – body fat percentage, waist circumference, waist-to-hip-ratio, and waist-to-height ratio – showed a clear trend: more body fat, greater risk.⁴

More body fat, greater cardiovascular risk

The researchers concluded that the obesity paradox observation mainly occurs due to confounding effects of disease and other factors on BMI, and that the “public misconception of a potential ‘protective’ effect of fat on CVD risk should be challenged.”⁴

As discussed above, a low BMI is often an indicator of disease, rather than an indicator of a healthy weight resulting from healthful eating. The standard American diet (SAD) is fattening. If someone is eating the SAD and is not overweight, there is likely something wrong.

Lose weight permanently on a Nutritarian diet

The dramatic weight loss-promoting effect of the Nutritarian diet contributes to cardiovascular protection. A 2015 study published in the American Journal of Lifestyle Medicine analyzed and reported weight loss results provided by 75 obese patients who had switched to a Nutritiarian diet. The average weight loss was 55 pounds, and very importantly, they kept the weight off. None of these respondents had gained back the lost weight after three years.⁵

Reprinted with permission from Dr. Fuhrman.

Dr. Fuhrman is a board-certified family physician specializing in nutritional medicine. He is President of the Nutritional Research Foundation and the author of 6 NY Times bestselling books, including The End of Heart Disease. Visit him at DrFuhrman.com

References

Coelho M, Oliveira T, Fernandes R. Biochemistry of adipose tissue: an endocrine organ. Arch Med Sci 2013, 9:191-200.
Tchernof A, Despres JP. Pathophysiology of human visceral obesity: an update. Physiol Rev 2013, 93:359-404.
Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart Disease and Stroke Statistics-2017 Update: A Report From the American Heart Association. Circulation 2017, 135:e146-e603.
Iliodromiti S, Celis-Morales CA, Lyall DM, et al. The impact of confounding on the associations of different adiposity measures with the incidence of cardiovascular disease: a cohort study of 296 535 adults of white European descent. Eur Heart J 2018:ehy057-ehy057.
Fuhrman J, Singer M. Improved Cardiovascular Parameter With a Nutrient-Dense, Plant-Rich Diet-Style: A Patient Survey With Illustrative Cases. Am J Lifestyle Med 2015.

Exercise for Atrial Fibrillation

Eric Durak/20 April 2020/ All MFN blog/

Here are some things to look for when working with a client with Atrial Fibrillation (A-fib).

FIRST…

What types of medications are they on? Calcium Channel Blockers, blood thinners (Coumadin)? These may have an effect on the intensity and type of exercise performed. You know that people who have A-fib are at increased risk for strokes, and may have hypertension and get dizzy more often. The medications – while they may help with some factors – may preclude a well-designed exercise program just because they may not tolerate some types of exercise.

What are the exercise goals? Are they wanting to tone up? Lose some weight? Get stronger? Train for a tennis match or 5K? This would help in structuring the program. The type / intensity / duration are all dependent on what the client wants. If they are just coming off surgery or a new prescription – this is important to build the foundation (which you know).

SECOND…

Does the doctor have any contraindications for exercise? Usually, it’s not to “overdo”, which means building up a program. I read a good article by Dr. Bill Sekula on a program for A-fib. It’s essentially a “step down, time up” program, where patients go from a few minutes of exercise a few times per day – to building up to an hour of exercise one time per day. However, I am going to recommend more of an ITP (interval training program) that concentrates on moderate strength programs (using the 40-50% rule similar to cancer patients), so they don’t use the Valsalva maneuver while lifting, but still use a progressive resistance approach.

THIRD…

Monitoring with a HR monitor, and having good hydration status are both important. Of course, you probably have them using the smart water bottle. Because of the heart dynamics and possible Coumadin Rx, the hydration is important. I assume you do a HR variability test with your client. This may be a very important test to do, as over time it may be instrumental in reducing A-fib occurrences.

I like the article by Dr. John Mandrola on the amount of exercise. He states that A-fib is completely controllable through specific lifestyle changes. He states that low inflammation exercise (high intensity endurance / triathlon, etc.) training needs to be modified, as do other lifestyle issues. I really like the discussion on inflammation, which may be one of the biggest issues in cardiac care of late. He talks about the “J curve” of exercise and that the more intense actually increases the odds ratio (OR) for sudden cardiac events and other abnormalities related to A-fib.

I think he is on to something, and you should look into some other lifestyle aspects such as meditation and heartbeat regulation through mindful breathing and relaxation. I know that excess stress, lack of sleep and poor diet have effects on the electrical system, including SA node and conductivity. Regular relaxation may do a LOT to improve the normal sinus rhythm and reduce resting HR to a more manageable level.

Dr. Mandrola also recommends regular monitoring of BP, keeping the use of warm exercise clothing due to peripheral circulation issues, and not overheating.

I like the issue of ITP and progression. I also am more of a fan of modified strength training for most clinical conditions. I think it would work for AF because if you think of the strength of contraction during exercise (even moderate) – it will have a strong steady beat during exercise (in most cases).

Eric Durak is President of MedHealthFit – a health care education and consulting company in Santa Barbara, CA. A 25 year veteran of the health and fitness industry, he has worked in health clubs, medical research, continuing education, and business development. Among his programs include The Cancer Fit-CARE Program, Exercise Medicine, The Insurance Reimbursement Guide, and Wellness @ Home Series for home care wellness.

References

Stress and the Psychology of Heart Health

Jay Del Vecchio/9 March 2020/ All MFN blog/

Most of us accept stress as a necessary evil that is a part of the American lifestyle. But living under stress day in and day out can lead to heart disease. According to the American Psychological Association, prolonged stress can contribute to high blood pressure and circulatory problems, and if stress makes you angry and irritable, you are more likely to have heart disease or even a heart attack.

Heart Disease and the Framingham Study

Abimbola Farinde, PhD/27 September 2018/ All MFN blog/

Heart disease that can consist of coronary heart disease, heart attack, congestive heart failure, and congenital heart disease is reported to be the leading cause death for men and women in the United States which is one of the reasons it is becoming recognized as a national problem. With the inclusion of high blood pressure and elevated cholesterol it is estimated that about 60 million Americans have a cardiovascular disease (CVD).

In 1948, scientists and participants set out on an ambitious project to identify the risk factors for heart disease. During this time very little was known about the general causes of heart disease and stroke but it was becoming immediately recognized that the death rates from CVD was steadily increasing and becoming an American epidemic.¹

The goal of the Framingham Heart Study was to help identify the factors and contributors to CVD by following participants (5,209 men and women between the ages of 30 and 62) from the town of Framingham, Massachusetts over an extended period of time who had not developed CVD or experienced a heart attack or stroke.²

Additional efforts were made to the study in 1971, 1994, and 2002 with new generations of participants. Throughout the years, the Framingham Study has identified the major CVD risk factors that can include:

smoking
obesity
physical inactivity
high blood pressure
high blood cholesterol

These risk factors can be modified by those who wish to minimize or reduce their risk. The identification of this major CVD risks has been recognized as the cornerstone of CVD and the strategies that are employed for prevention and treatment in clinical practice settings.²

To date, the Framingham Heart Study continues to serve as a critical element towards achieving a better understanding of CVD and assisting with the development of diagnostic tools for the condition.

While cardiovascular disease is still recognized as a national problem that is the leading cause of illness and death in the United States, the performance of the Framingham Heart Study serves as the foundation for addressing this issue.

Abimbola Farinde, PhD is a healthcare professional and professor who has gained experience in the field and practice of mental health, geriatrics, and pharmacy. She has worked with active duty soldiers with dual diagnoses of a traumatic brain injury and a psychiatric disorder providing medication therapy management and disease state management. Dr. Farinde has also worked with mentally impaired and developmentally disabled individuals at a state supported living center. Her different practice experiences have allowed her to develop and enhance her clinical and medical writing skills over the years. Dr. Farinde always strives to maintain a commitment towards achieving professional growth as she transitions from one phase of her career to the next.

References

Scutchfield & Keck, 2003
Framingham Heart Study, 2016

Personal trainer and her client with dumbbells

Metabolic Syndrome: A New Focus for Lifestyle Modification

Tammy Petersen/4 June 2018/ All MFN blog/

Personal trainers have the opportunity to do more than just help people they train become more active. We need to be prepared to also help our clients implement lifestyle behavior changes related to stress, family history of coronary heart disease, obesity, smoking, high blood pressure and high cholesterol.

A look at what is called metabolic syndrome will help you understand why, even though increasing physical activity levels is the overall best thing you can do for any client, there are additional ways to guide them to a healthier lifestyle. Sometimes you may be able to help them make the changes yourself; and, sometimes you will need to refer them to another health professional like a doctor or dietitian for guidance. Either way, knowing how to help them or when to direct them to someone who is more knowledgeable than you is important. So, first let’s become familiar with the syndrome and the clinical criteria that the doctor uses to diagnose it. Your goal is then to help your clients understand and make the necessary changes so that they don’t progress to cardiovascular disease and the almost certain heart attack heart that will be the end result.

Cardiovascular disease is still the number one cause of morbidity and mortality in the United States and much of this burden of disease can be linked to poor nutrition and a dramatic increase in sedentary lifestyles, leading to overweight and obesity. This increase in weight leads to an increase in the incidence of type 2 diabetes, and blood pressure and cholesterol problems, which are all well-established cardiovascular disease risk factors. The National Cholesterol Education Program (NCEP) Adult Treatment Panel (ATP) III has updated the recommendations for the evaluation and management of adults dealing with high cholesterol, renewing its emphasis on the importance of lifestyle modifications for improving cardiovascular risk. The NCEP has coined the term “therapeutic lifestyle changes” (TLC) to reinforce both dietary intake and physical activity as crucial components of weight control and cardiovascular risk management.

As well as focusing attention on the LDL cholesterol (also called bad cholesterol) levels, the NCEP also identified metabolic syndrome as a secondary target of therapy. Metabolic syndrome (also called insulin resistance syndrome and syndrome X) is characterized by decreased tissue sensitivity to the action of insulin (pre-diabetes), resulting in a compensatory increase in insulin secretion. This metabolic disorder predisposes individuals to a cluster of abnormalities that can lead to such problems as type 2 diabetes, coronary heart disease and stroke. The prevalence of the syndrome has increased 61% in the last decade. It is crucial for medical professionals to identify patients at risk and follow these patients closely and counsel them about making lifestyle changes to lower the risk of type 2 diabetes and cardiovascular disease.

GUIDELINE: According to the NCEP, the criteria for metabolic syndrome includes at least 3 of the following 5 clinical factors

Risk factor	Defining level
Abdominal obesity Men Women	Waist circumference >40 in (>102 cm) >35 in (>88 cm)
Fasting triglyceride level	>150 mg/dL
HDL cholesterol level Men Women	<40 mg/dL <50 mg/dL
BP	>130/>85 mm Hg or taking antihypertensive medication
Fasting glucose level	>100 mg/dL or diabetes

Source: Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive Summary of the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Bethesda, Md: National Institutes of Health; 2001. NIH publication 01-3670.

Millions of Americans at risk for metabolic syndrome can sharply lower their chances of getting this disease by adopting a healthy lifestyle (stop smoking, low-fat diet, weight loss/maintenance and increased physical activity). Without diet and exercise modifications, most patients will eventually fail and progress to type 2 diabetes within a decade and experience a heart attack about 10 years later. Experts recommend a diet reduced in saturated fats (<7%), low in cholesterol (<200 mg/day), high in fiber (20-30gm/day) and reduced in simple sugars. Weight loss of only 5-7% (less than 15 pounds) can make a big difference in health markers like cholesterol and blood pressure. A program that includes daily exercise reaching 85% of heart rate for age is reported to be of benefit too. However, any exercise is better than none, and a target of 30 minutes every other day is a reasonable level for most people.

As a fitness professional reading this, hopefully you are not asking yourself “so what?” but are instead seeing an opportunity to educate and motivate your current clients and to use your knowledge to help attract future clients. The medical community is good at diagnosing this syndrome, but not necessarily equipped to provide patients with the tools to be successful with the lifestyle changes they recommend. There exists a wonderful opportunity to build a partnership with physicians in your area. Most physicians will gladly refer patients to you for help with the all-important exercise and nutrition portion of the treatment program. In many cases, you have more knowledge in this area than the physician who has been trained in tertiary, not preventative, (i.e. most MD’s know very little about diet and exercise since this is not a focus in medical school) medicine. Often times all that you will need to get a referral is for the doctor to be aware of your existence and to give them an easy way to get the patient to you. A short introduction letter outlining your qualifications and showing your desire to help people make lifestyle changes is a good start. A personal visit to your primary care doctor and others in your area is even better. But, be prepared to take up just a few minutes of their time to introduce yourself, your idea, and leave your letter and cards.

Tammy Petersen, MSE, is the Founder and Managing Partner for the American Academy of Health and Fitness (AAHF). She’s written a book on older adult fitness and designed corresponding training programs. SrFit Mature Adult Specialty Certification is used nationwide as the textbook for a college based course for personal trainers who wish to work with mature adults. SrFit is also the basis for a specialty certification home study course that qualifies for up to 22 hours of continuing education credit with the major personal trainer certification organizations.

References

Centers for Disease Control and Prevention. Early release of selected estimates based on data from the January-June 2003 National Health Interview Survey. URL: cdc.gov/nchs/about/major/nhis/released200312.htm.
Summary Health Statistics Tables for the U.S. Population: National Health Interview Survey, 2016 https://www.cdc.gov/nchs/nhis/SHS/tables.htm 16 Apr. 2018.
Centers for Disease Control and Prevention. Prevalence of health care providers asking older adults about their physical activity levels—United States, 1998. Morbidity and Mortality Weekly Report. 51(19):412-4, 2002.
Huang, Paul L. “A Comprehensive Definition for Metabolic Syndrome.” Disease Models & Mechanisms5-6 (2009): 231–237. PMC. Web. 16 Apr. 2018.

Skip these 5 Foods for Better Heart Health

Ashley Koff, RD/21 September 2017/ All MFN blog/

There’s no shortage of marketing messages about what’s best for heart health and some of it is well, just plain wrong. Here’s my top 5 offenders – don’t believe their hype, choose my real deals instead.

1) The”Oat” cereals

AKA the Sugar & chem lab project bombs – cereals like Honey nut cheerios & Honey bunches of oats or getting “fully loaded” oatmeal with added sugar & dried fruit – my heart just skipped a beat – not in a good way. AKA better: choose organic oats and add spices, nut butter and / or hemp seeds. We are loving Natures Path’s new plain Qi’a oatmeal

2) Fat-free dairy

Mooooove away from this stuff – research shows full-fat dairy is associated with lower risk of obesity (which means lower heart disease risk too) and likely due to the hormone profile change when the fat is removed, as well as the fact that without the fat it’s harder to feel full which means you fill up on other calories. AKA better: choose organic whole milk or skip the dairy and choose full fat coconut or cashew etc.

3) Pieces, Parts and Puffs

While potatoes pack in heart healthy potassium and rice provides vitamins, minerals and antioxidants – when we over process them and then add salt and other chemistry lab projects we end up with a heartbreak. AKA better: whole bean or potato chips with added spices not loads of salt.

4) Soy sauce or soy protein isolate in bars or protein powders

We hear soy and think heart health but the truth is these are heart failures. Highly processed parts of soy contain none of the good stuff – fiber, omegas, antioxidants that we find in whole organic soybeans. AKA better: whole organic soybeans or organic tofu or organic tempeh – and “protein” powders and bars that contain them or other whole quality plant sources like hemp and quinoa.

5) Heart shaped candies

They look so love-ly and even have such sweet quotes on them. But they aren’t the sweet friend for heart health that you think – artificial dyes and chemistry lab corn syrup are not the basis of a lasting love affair. AKA better: choose a little heart-healthy organic dark chocolate (that’s >65%) and if you do want candy try authentic sweets – organic, free of artificial dyes etc – like those from our friends at TruSweets.

Originally printed on ashleykoffapproved.com. Reprinted with permission.

Ashley Koff RD is your better health enabler. For decades, Koff has helped thousands get and keep better health by learning to make their better not perfect nutrition choices more often. A go-to nutrition expert for the country’s leading doctors, media, companies and non-profit organizations, Koff regularly shares her Better Nutrition message with millions on national and local television, magazines and newspapers. Visit her website at ashleykoffapproved.com.

Key to the Heart

Genome Magazine/7 April 2017/ All MFN blog/

Unlocking the genetics of heart disease may be complicated but not impossible.

Why do Yoga if you have Heart Disease or have had a Stroke?

Kristy Manuel, MS, Yoga Therapist/23 February 2017/ All MFN blog, Conditions/

Psychological stress has been shown to increase activation of the sympathetic nervous system and the hypothalamic pituitary adrenal axis. This increased activation releases adrenaline, noradrenaline, and cortisol, which lead to faster heart rate, increased cardiac output, and narrower arteries. These changes, in turn, create increased blood pressure. Activation of these systems also accelerates the progress of atherosclerosis and can lead to acute plaque rupture, which results in ischemia of the heart (angina) and coronary heart disease and stroke.

The Role Anger Plays in Heart Attack Prevention

Jesse Silkoff/21 February 2017/ All MFN blog/

Everybody knows that if you want to prevent heart disease, you should exercise and eat a healthy diet, right? Well, that may not be true in every single case. While aerobic exercise can certainly lower blood pressure, reduce bad cholesterol in the body, and control weight gain, research shows that working out while angry or upset may increase your risk of heart attack.