Medical Mondays 2

 

 

Dr. Patricia Yarberry Allen is a collaborative physician. This week, she asks cardiologist Timothy C. Dutta to lay out the startling, research-backed numbers on the impact of the lifestyle choices of Americans on their risk of heart disease.

 

Dear Dr. Pat:

I have a strong family history of heart disease. Some family members have died early from heart attacks; others have lived longer but suffered from heart failure in later life, and they had a really poor quality of life.  I am 45, and have decided to do all that I can to change what seems to be my family’s fate. My husband is thin and a runner but he has promised to be supportive of any change in our daily lives that will help me be healthier.

I am a teacher in a small Midwestern university. Even at my university, almost all my colleagues are overweight. No one seems to exercise except at football games, where they walk stairs to the stadium, cheer, and jump around . . . oh, and eat high-fat, high-calorie food and drink too much. Faculty parties are all food- and drink-focused as well.

I work long hours, standing in the classroom, sitting at my desk counseling students, preparing my teaching assignments, reading students’ papers, grading exams, and—you get the picture: hours of sitting.

We are short-staffed due to cost cuts at our state-supported university, and I have had no assistant for two years. I am lucky that I have tenure and that I love what I do, but I feel stressed all the time because I seem to have more to do than I can do.

I am overweight and don’t exercise at all.  I am 5 feet 5 inches in height and weigh 150 pounds. My blood pressure and cholesterol are both over the recommended levels, and my doctor told me to lose weight and come back in six months.  If the numbers aren’t better he told me that I will need drugs to lower my blood pressure and cholesterol.

What are the real causes of heart attacks and heart failure in people with family histories like mine? How should I begin to change my life, since I am dead serious and ready to begin a new way of living?

Frances

 

Dr. Pat Responds:

Dear Frances:

Many Americans can find a description of themselves in your story. I encourage patients who care about the quality of their future health to embrace a change in their eating and living habits as a way of life. Most people can lose 10 pounds, but then most gain it back, sometimes adding more.  Since you say that your family and personal history have persuaded you to “find a new way of living,” you are an ideal patient for effective and lifelong behavior change.

Studies show that small changes in behavior are likely to be helpful, but in your case I would suggest that you find a nutritionist to help you create a diet that is low in calories, but involves your having frequent small meals. Really go for that 20-pound weight loss that will give you a BMI in a healthy range, but understand that you have to create a diet for life, not a diet for three months.

Add exercise throughout your day and evening.  Spend 10  minutes walking rapidly or climbing the stairs in your building at work.  Find time at the end of the day to go to the university gym.

Then work on managing your work stress, Frances. Take a meditation class and practice meditative breathing whenever you feel overwhelmed.  Look at your work schedule and ask for help in organizing your tasks from an older mentor in your department.  If you know what you have to do and have a schedule for completion of your tasks, then you may not be as overwhelmed. Stress hormones increase blood pressure and make it harder for patients to lose weight.

Find friends who aren’t obsessed with eating and drinking. You can become a good role model to others in your community with your determination and soon-to-be-found success.  Others will see that it is possible to achieve weight loss, find time to exercise, decrease their stress, and avoid drugs for blood pressure and cholesterol control.

I have asked Dr. Timothy Dutta, a cardiologist in private practice in New York City and a member of the Women’s Voices for Change Medical Advisory Board, to discuss the main causes of heart disease and to discuss the research that supports this. He will also suggest change that you may adopt to achieve your goals.

Dr. Pat

 

Dr. Dutta Responds:

Dear Frances:

The five most important risk factors for heart disease are high blood pressure, high cholesterol, diabetes, smoking, and family history. Four of these five are impacted by lifestyle.  Smoking is obviously a lifestyle choice, but high blood pressure, high cholesterol, and diabetes are greatly affected by diet and exercise. A poor diet and a lack of exercise impact the risk for all of these, but  how much do they increase the risk?

Risk factors for high blood pressure (hypertension) include salt intake, excessive alcohol use, obesity, and lack of exercise.   Societies whose members consume more than 2300mg of sodium per day have high rates of hypertension. Those that consume less than 1200mg of sodium per day have low rates of hypertension. Moderate alcohol intake (three drinks per week) lowers the risk of heart disease, but excess alcohol intake increases the risk of high blood pressure. Consumption of three or more drinks per day may double the risk of hypertension. Obesity is attributed to about one quarter of the cases of hypertension in the United States.  The numbers of Americans with hypertension could be reduced by more than 30 percent by increasing exercise.

Risk factors for high cholesterol are also heavily influenced by diet, exercise, alcohol consumption, and smoking. Societies whose members have a lower saturated-fat intake and more physical activity have dramatically lower cholesterol than Americans do. The average total cholesterol in rural China is 126mg/dL [4].  The average total cholesterol in the United States is 196mg/dL, and that is including the 15 percent of Americans who take statin drugs.

The risk of diabetes starts to increase above a Body Mass Index (BMI) of just 22, and is increased by more than 60-fold for women with a BMI greater than 35.  Inactivity makes the risk even higher.

The good news is that even modest improvements with diet and exercise can greatly improve health. The American Heart Association recommends 30 minutes of moderate-intensity exercise per week, or 25 minutes of vigorous activity per week.

There is a lot of controversy and confusion over what diets are good and bad.  Good-quality studies are hard to find and also hard to interpret.  A lot of understanding is lacking, but the common themes are fewer calories, lower salt, and attention to the type of fats and carbohydrates.  Plant-based diets,  as far as no dairy, easily fit this description, and palatable choices are getting easier to find. The newest data shows impressive results for a Mediterranean diet—that is, a diet rich in olive oil and nuts.

Patients frequently have an unrealistic goal for weight loss that can be a setup for failure. A 10 percent reduction in weight is more attainable and is enough to lead to health benefits.  The American Heart Association has a lot of materials to help provide more information.