It turns out that Dr. John Warner, President of the AHA, was unable to continue his hosting of the last American Heart Association's scientific sessions not because he had a "mild" heart attack as was previously reported. In fact, as reported now in a American Heart Association PSA - Dr. Warner DIED the second morning of the scientific session, and realistically is only alive today because he DIED in a hotel filled with physicians responsive enough and skilled in delivering near immediate life-saving CPR. The PSA makes the important point about more people taking the opportunity to learn how to do CPR. You see, only 32% of people who have an episode of what's called SUDDEN DEATH receive CPR outside the hospital. So there's lots of opportunity for improvement on that front. The sorry statistic that is left out, though, is the fact that only 8% of people survive their out of hospital episode of SUDDEN DEATH. Even if we got everyone CPR, we'd only have about 25% of folks back from the dead. So why wait until they're dead?
The said truth is that the current standard of care does a terrible job of identifying people at risk for sudden cardiac death. However, that is NOT the STATE OF THE ART care, just the standard. There are technologies available to give us a better leg up - I talked about some of those in my previous blog from December.
Do not rely on the standard of care to keep you safe - you owe it to yourself to identify your risks, your underlying conditions that remain undiscovered (and unexplored), and to take action once the information is available. While I would love if you would consider letting me assist in that discovery, I am only asking that you start the process. TAKE ACTION! The chances of surviving the "mild" heart attack just isn't very good.
You may have seen the news a couple of weeks back - the President of the American Heart Association (AHA), John Warner, MD, noted interventional cardiologist was missing his national AHA conference because he suffered a "mild" heart attack. He has referenced how his family has no "old men" - they all die early of cardiovascular disease. It's that history that prompted him to enter the field of cardiology initially, and spurred him to volunteer with the AHA.
To suffer a heart attack for Dr Warner might seem like an inevitability to most. We certainly don't know what he was doing to avoid this eventuality, but if we were to assume that he was doing everything he would profess as the President of the AHA, then can we consider ANY heart attack as "mild"? What does it say about the odds for the general population if the TOP DOC has a heart attack?
Let's consider some of the guidelines to cardiovascular prevention as suggested by the AHA. Of note, the last guideline for primary prevention of heart attack was released in 2013. The most recent updates involved discussions of diet, activity, cholesterol and risk assessment. Fundamentally, the general approach is one of risk assessment - making a "best guess" as to the likelihood of having a heart attack in the next ten years. These calculations are population based, but virtually all of the recommendations are based on "expert opinions" - in other words, the AHA physician's "best guess." With more Americans learning that they have heart disease by having a heart attack than any other way, it seems to me we are missing far too many opportunities for early identification. This would require a fundamental shift in how we approach cardiovascular disease.
Many years ago I was introduced to the Bale Doneen Method and have been using the program ever since. The basic premise of the Method is establishing whether the prerequisite condition exists - in other words, is there atherosclerosis? Without the deposition of sufficient lipid in the arterial wall, the possibility of a heart attack is nearly nill. This is not, however, the method used as the standard of care.
Let's look at an analogous situation in gastroenterology. If a patient comes into the office and they are worried about colon cancer risk. Hypothetically, we give the patient advice to adjust their lifestyle (reduce red meat, etc.), and take an aspirin a day. This advice, while carrying some risk of side effects, also lowers a patient's lifetime risk of colon cancer by more than 50%. That's a really good result, so why isn't this the standard of care?
There's a very simple answer - the same result can be achieved by one thorough evaluation of the colon by colonoscopy. One colonoscopy lowers lifetime risk of colon cancer by 50%, and affords the opportunity to remove to remove a dysplastic growth before it becomes an actual cancer. Define the disease process, identify the precursor condition and eliminate it before it's a real problem. We don't do that with cardiovascular disease.
The standard of care in "primary prevention" of cardiovascular disease is to prevent the first heart attack. But that's not preventing the disease - that's preventing the first negative event! That's like saying if we can avoid an amputation, we've done a good job with diabetes!! What about everything else that's messed up?!
The Bale Doneen Method works to identify the underlying issue - the presence of excess lipid (usually oxidized LDL) in the artery. It is this atherosclerotic process that underlies the vast majority of cardiovascular events. An array of blood tests, extensive history and targeted physical findings establish the presence of disease (atherosclerosis), not an evaluation of risk. THIS IS PRIMARY PREVENTION - preventing the process that DRIVES the first event, not simply avoiding the first event. And 90+% of heart attacks are thus avoidable.
Assuming Dr. Warner was being treated with the standard of care, his life was essentially up to chance. Standard of care (N.B.: reimbursed by insurance) does not look at lipid size, broad evaluation of inflammation, genetic factors effecting statin sensitivity/responsiveness or dietary tendencies, nor does it investigate the character of identified lipid collections (plaques). These are all components that contribute to the development of atherosclerosis, ever increasing the risk of a future event. Remove the factors influencing the development of the disease process and you reduce or remove the disease process.
Even this, though, does not establish the status of the cardiovascular system. The majority of cardiovascular events are related to lipid driven conditions. Current cardiac evaluation still does not provide a comprehensive description of the patient's overall cardiac status. Most imaging is limited to large vessel evaluation, leaving a full 75-80% of the cardiac blood supply undefined. Historically, small vessel disease has been a diagnosis of exclusion, and is increasing in it's prevalence partly as a consequence of the rising diabetic and pre-diabetic population.
I have been utilizing an advanced cardiac evaluation tool in my practice for many years. The Multifunction Cardiogram (MCG) enables evaluation of the entire cardiac system while at rest and, in under ten minutes. Utilizing LaGrangian-Euler mechanics, artificial intelligence and machine learning, a systems biology approach establishes an extraordinarily accurate assessment of the physiologic status of the heart. Once the baseline status is established, disease is identified and can be aggressively managed. The beauty of the MCG is in its ability to quickly establish the status in real-time. Since physiology is what is being evaluated, real-time changes can be demonstrated. This means that shifts over minutes, hours, days and weeks are all visible.
Use of the MCG in clinical practice affords the physician the opportunity to evaluate a patient's cardiac status, get a near immediate result and know the level of heart disease present. From there, aggressive management can be supported by repeated studies demonstrating clear shifts in the function of the heart. Being able to reinforce patient's behavior with clear, demonstrable result improvement is essential to successful progress in the avoidance of bad outcomes.
I certainly hope that Dr. Warner is recovering well and he'll continue to do his good work. I'd like to believe that this "mild" heart attack would prompt a refocusing of the cardiac prevention effort toward identification of cardiac dysfunction in its earliest forms and personalized attention to patients of all risk. After all, if 58% of Americans learn they have heart disease by having a heart attack, we are not doing a very good job of prevention.
I thought I might talk today about FOOD. We all need it. Many of us obsess about it, mostly because others tell us we should. And then there's the reality of our work days and how difficult it all seems to be.
Probably everyone knows that there are three main types of nutrients - protein, carbohydrates and fats. Probably everyone also knows that virtually no one agrees on the balance of these three, or what should make up these three, or how to consume them.... and on, and on, and on.
I'm going to ramble a bit about CARBS and let's see if maybe we can learn something.
A quick note about calories - I've said this before. Calories in, calories out... all calories are NOT the same. 13 ounces of broccoli (a full head) vs. 7 1/2 oz of Coke? Who's going to argue that they're the same thing?
OK - You want to go PALEO? (I mean like cavemen)
You are kidding yourself if you believe that's really a low carb diet. Cavemen ate what they could kill (protein and fat), or what they could gather (some protein with a fair amount of fat - mostly nuts, but mostly CARBS).
Yes - newsflash - virtually all vegetables are mostly carbohydrates. Some have good protein (beans, lentils, wild rice, steel cut oatmeal), but most of the calories come from carbs. (ASIDE - avocado is fruit) The calorie density of REAL FOOD tends to be very low. The CARBS that people are really talking about when they talk about LOW CARB diets is avoiding PROCESSED carbs - almost anything in a box. In fact, the VOLUME of food that a PALEO diet consists of is mostly CARBS.
NATURAL CARBS -
1 serving [150gm] of raw broccoli
50 calories, 10 gms carbs, 2.7 gm sugars, 4 gm protein, 3.8 gm dietary fiber.
CARBS from the BOX- (I don't have many at home)
1 small chewy granola bar
90 calories,19 gm carb, 7 sugars, 1 gm protein, 2gm fat, <1 gm fiber.
1 slice of bread
90 cal, 15 carb, 3 sugars, 4 gm protein, 1.5 g fat, 1g fiber.
1/2 cup cooked white rice
120 cal, 27 carb, 2 gm protein, 0.2g fat, 0.3 gm fiber
LOTS and LOTS of carbs, sugar and virtually no fiber. FIBER is one significant differentiator between the box and real food.
FIBER acts like a sponge in your intestine. The modern diet is depleted of fiber - primitive cultures eat around 60 gms a day, we eat around 12. Implications? Myriad.
Let's start with Butyrate. Butyrate is a metabolite of the bacteria in your gut (your microbiome - another blog) that has been shown to improve the health of your gut microbiome, which directly impacts the health of your brain!! (told you we were going to ramble) These effects range from impacting neurodegenerative conditions to effecting behavioral issues. Foods that help this? Whole grains, legumes, onions, asparagus, and surprisingly - bananas (talk about carbs!).
Butyrate is just a small part of the story. There has been substantial work done showing that increased fiber intake lowers inflammatory markers, improves gut biodiversity, aids in the detoxification of toxins and generally lowers colon cancer risk.
ALL of this stuff comes from CARBS. But not boxed - from nature. We can argue about the nutritional value of today's food supply (not very good). We can argue about GMOs and the effects they might have (that's a very long discussion with lots of complexity). What we shouldn't argue about is the value of EATING YOUR COLORS. More colors, more nutrition. The more variety, the more complete the nutritional information delivered to your body.
By combining the vitamins and minerals from your vegetables with fiber, you provide the body the opportunity to build itself up, while allowing for enhanced garbage removal. After all, have you ever redone your kitchen? Sure, it'll look great when you're done, but somebody's got to cart away all the refuse!
And really - that tire around the middle is mostly stuff that everyone wants to get carted away, but can't figure out how to get that done. FIBER is a great start, in combination with good vegetables and overall nutrition.
If you need more help with that, or any other medical / health condition, I think you'll find my process is a bit different than most. Let's talk - it might be something simple, or at least we could get you started in the right direction.
I'm always available by phone (646-801-7541), or by email.
Remember - we ALL have genius inside - we need to identify it, grow it and then share it as broadly as we can!
So, here we go again. Years ago, James Gandolfini died and everyone said - look at him, he was so heavy, he didn't take care of himself. And there was Michael Clarke Duncan (The Green Mile) - he wasn't in good shape, he was so big! Except he had given up meat two years earlier. Two guys with, one assumes, pretty good medical care, or at least access to pretty good medical care.
And now Alan Thicke, at 69, gone. Certainly that's not old enough. You look at him and say - hey, he's in pretty good shape, even playing hockey with his 19 year old son. Oh, that's what killed him - he shouldn't be playing hockey at his age! REALLY?? At what age does one crawl up into a ball and watch the world go by?
We think that medical care in this country has us covered. It doesn't. The standard tests yield not much better than a coin-flip when it comes to prediction. Did you know that a Nuclear Treadmill Stress Test, essentially what everyone banks on when it comes to knowing if you're going to have a heart attack, can only detect 14% of those going on to have one. And after all, you wouldn't mind if your mechanic got the source of your car's problem wrong 6 out of 7 times, right?
I have available a groundbreaking technology that saves lives - I've done it multiple times. It's not a new test, just one that flies in the face of the medical establishment in this country. Instead of identifying 1 in 7 people, I can identify at least 19 out of 20 - and you don't get sweaty, in fact it takes 7 1/2 minutes of lying still, without getting undressed. But insurance doesn't cover it, despite showing results comparable to the best invasive tests available.
I have not saved enough lives, despite my best efforts. 90+% of heart attacks are preventable - the program I employ (even without the above referenced test) has demonstrated this over several thousand people and 15 years. Even a recent article in the NY Times speaks to the opportunity people have by simply doing some of the right things.
But I'm guessing Alan Thicke was doing lots of the right things. And yet he's dead. So, besides kissing your spouse and kids, and telling them that you love them, what else can you do?
Do your research. Find a medical program that tells you the truth - about their capabilities, about your responsibilities, and do everything you can to learn what's going on in your body. That requires more than the usual medical approach. The standard approach defines risk, not disease. Know if you have the underlying conditions that lead to a heart attack and go on the offensive!
And if not, that's ok. Only 1 in 20 will have a heart attack this year, so the odds are in your favor.
I really liked that show....
Below is an extraordinary bit of news.
Hey - everyone knew mushrooms are good for you....
December 05, 2016
Psilocybin May Provide Swift Relief From Depression, Anxiety in Cancer Patient
Researchers found that the hallucinogenic drug relieves depression and anxiety quickly, and that the effect can last for months.
HealthDay News --
A single dose of psilocybin can quickly lifts the spirits of cancer patients, and the effect can last as long as 6 months, according to 2 studies published online Dec. 1 in the Journal of Psychopharmacology.
In one study, researchers led by Roland Griffiths, PhD, of the Johns Hopkins School of Medicine in Baltimore, treated 51 adults with life-threatening cancer with a low dose of psilocybin followed 5 weeks later with a higher dose of the drug. Most patients experienced relief from their anxiety and depression that lasted up to 6 months, the researchers found.
In the second study, a team led by Stephen Ross, MD, of the NYU Langone Medical Center in New York City, randomly assigned 29 patients with advanced cancer to either a single dose of psilocybin or the vitamin niacin. Among 80% of the patients, psilocybin rapidly brought relief from distress. Moreover, the effect lasted for more than 6 months, based on test scores for anxiety and depression, the researchers found.
"Our results represent the strongest evidence to date of a clinical benefit from psilocybin therapy, with the potential to transform care for patients with cancer-related psychological distress," Ross said in a Langone news release. "If larger clinical trials prove successful, then we could ultimately have available a safe, effective, and inexpensive medication dispensed under strict control to alleviate the distress that increases suicide rates among cancer patients."
1. Griffiths RR, Johnson MW, Carducci MA, et al. Psilocybin produces substantial and sustained decreases in depression and anxietey in patients with life-threatening cancer: A randomized double-blind trial. J Psychopharmacol. 2016;30(12):1181-1197. doi:10.1177/0269881116675513.
2. Ross S, Bossis A, Guss J, et al. Rapid and sustained symptom reduction follwoing psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. J Psychopharmacol. 2016;30(12):1165-1180. doi:10.1177/0269881116675512.
3. Nutt D. Psilocybin for anxiety and depression in cancer care? Lessons from the past and prospects for the future. J Psychopharmacol. 2016;30(12):1163-1164. doi:10.1177/0269881116675754.
Bruce L. Feldman, MD
Dr Bruce is an advocate for health. You need to be your own health advocate. His blog offers his opinions and insights on numerous topics he believes might be of interest. Hope you agree!