Tag Archive for: heart health

Yes, Intensity Matters

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Can you get away with less time exercising and still protect your cardiovascular system? We know from Tuesday’s Memo that more time spent on physical activity will provide more protection. Can we save some time? Or perhaps better stated, can we do something in short bursts of time that can increase the moderate to intense exercise we get?

Before I answer that, remember that physical activity means everything you do that requires movement: walking to the kitchen, gardening, cooking, and the activity involved in your job. Exercise is also a part of your overall physical activity. In the study, all activity was registered by the accelerometer the subjects wore.

Intensity Matters to Reduce CVD Risk

With that in mind, the answer is yes: exercise intensity matters when it comes to protecting yourself from cardiovascular disease (CVD). I must admit that the charts and graphs published in the study were challenging to understand. They used a percentage of calories used per day as the way to measure outcomes. For the exercise intensity analysis, they considered the percentage of calories at moderate to high intensity. They found that as the percentage of activity at moderate to high intensity increased, the rate of CVD events decreased.

Here’s an example. Let’s take a 180-pound guy who uses a low amount of energy in physical activity such as five calories per kg body weight. The total calories he uses daily would be about 400 calories, including any exercise he did. But let’s say the percentage of moderate to severe intensity exercise rises from 10% of total exercise to 20% of that total. His risk of a CVD event would be reduced from 2% lower to 20% lower. He hasn’t invested any more time, yet he gets a jump in benefit just from increased intensity.

What Does That Mean for You?

Does this mean that everyone should be doing high-intensity interval training? Not in the classic sense; what’s high intensity for you may be impossible for your elderly neighbor and a breeze for your kid’s soccer coach. You don’t have to do special workouts such as high-intensity interval training where you’re going to bust a gut for 60 seconds and then take it easy for five minutes. That is intense, but it takes less time overall and you could do that if you want; there’s more info at drchet.com if you decide to try it.

In physical activity, everything counts from housework to walking the dog to breaking into a run to catch a bus. Those would show up as mild or moderate intensity, or high-intensity exercise for the running. It doesn’t mean that all the exercise you do has to be high intensity, but investing time in higher intensity exercise may provide you with additional benefits. Working a little harder is going to reduce your risk of cardiovascular disease and, while not assessed in this study, your risk of type 2 diabetes, hypertension, and cancer would be reduced as well.

Of course, the question is what’s high intensity for you. The chart above is geared toward weightlifting, but it will give you some ways to think about how hard you’re exercising, no matter what you’re doing. If you’re running for the bus, could you run one more block? If you’re cleaning house, do you have enough juice left to go for a bike ride?

The Bottom Line

You must be fit enough and ambulatory enough to actually do moderate to high-intensity exercise. But you know something? I know of one physical therapist who encourages patients to do jumping jacks while sitting in a wheelchair. Of course they can’t do the actual jumping part of it but for 60 seconds, their arms are going up and down, up and down, up and down at a very high rate, and maybe their legs are moving, too—and that’s high intensity for them. For others of you, it may be doing a two-minute walk up a very steep hill. The intensity of the exercise stresses the heart in ways that a nice easy walk does not. And for that, you get additional benefits, no matter where you’re starting.

So check with your doctor to find out your limitations as it relates to exercise intensity, and then get after it. Not to lose a whole bunch of weight, not to win the next 5K, not every day—but often enough to make your heart stronger and fitter.

What are you prepared to do today?

        Dr. Chet

P.S. Happy Canada Day to our neighbors to the north! We’re taking next week off to enjoy the July 4th holiday and hope you do as well (even if you’re not in the U.S.) We’ll be back with new Memos the week of the 10th. Meanwhile, it’s a great time to try increasing your exercise intensity.

Reference: Eur Heart J (2022) https://doi.org/10.1093/eurheartj/ehac613

How Hard Should You Exercise?

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Exercise is my most favorite thing to talk about—not surprising for an exercise physiologist. There’s no question that diet is important to our health, but if I had to focus on just one habit that people should adopt, it would definitely be exercise first before anything else. I believe we should all eat more vegetables and fruits, take supplements for gaps in our diet, and try to reach a normal body weight. But aside from quitting smoking, the most important thing you can do for your health is to be physically active.

Let’s look at the study. The subjects in the study were a subgroup of people from the United Kingdom Biobank study. The data were collected from 88,412 middle-aged adults, with 58% women, who were specifically chosen because they had not been diagnosed with cardiovascular disease before the study.

The researchers broke the data into three equal groups by activity level. The average age of the subjects in the study was 62, and the average BMI was 27. They tracked the subjects for 6.8 years, and in that amount of time there were 4,068 cardiovascular disease (CVD) events: ischemic heart disease (reduced blood flow to the heart) or cerebrovascular disease (reduced blood flow to the brain).

Their findings were interesting and confirmational. Using no or differing covariates in the statistical analysis, as the amount of physical activity increased, the incidence of CVD decreased. That would confirm what we would expect: regardless of intensity, the risk of CVD decreased and it continued to decrease for every level tested.

How does exercise intensity impact all this? We’ll take a look at intensity on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Eur Heart J (2022) https://doi.org/10.1093/eurheartj/ehac613

The Best Heart-Healthy Diet

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In assessing popular diets to find out which one follows the AHA heart-healthy dietary guidelines the best, the panel did a credible job. Instead of just using their expertise, which is substantial, they developed an objective way of assessing each popular diet. They did have one diet that received a point for each of the nine categories thus achieving 100%. That was the Dietary Approach to Stop Hypertension more commonly known as the DASH diet.

The researchers then assessed the dietary patterns and organized them into four tiers based on compliance with the AHA guidelines. I’ll break it down into the tiers for you.

Tier 1

This tier includes the DASH diet, the Mediterranean diet, the pescatarian or fish as protein, and the ovo-lacto vegetarian diets. The primary reason that the DASH diet ranked so high was its ability to get protein from every source: plant proteins such as nuts and legumes, fish and seafood, low-fat or fat-free dairy, and the ability to use lean cuts of all meats. The other diets in Tier 1 either did not recommend proteins from all sources or did not emphasize reducing the amount of salt intake, a key element of the DASH diet.

Tier 2

Tier 2 included the vegan diet and other low-fat diets. Their strength, of course, is the emphasis on vegetables and fruits as well as whole grains, but they all seek to use plant-based protein. Some of the low-fat diets can be quite extreme, such as the Esselstyn Program which restricts fat to less than 10% per day and restricts protein as well.

Tier 3

This included the very low fat diets as well as the low-carbohydrate diets. The reason these two are put together is the restriction on quality protein sources as well as whether people adhere to the diet at every meal.

Tier 4

The paleo diet and very low carbohydrate diets such as the ketogenic diet received the worst scores; that means they fall into the category of not being heart healthy at all.

Other Considerations

The panel also considered three primary issues. The first was how easy it would be to facilitate patients to adapt to the particular diet. To me, the strength of the DASH diet and to some degree the Mediterranean diet is the variety of proteins that can be used. When you get into the very low fat and the very low carbohydrate diet, the restrictions can become overwhelming for most people.

They also considered the challenges for the consumers. In my experience, there are always going to be questions about what could be included in any dietary approach, whether it’s the Mediterranean diet or the ketogenic diet. In order for people to adapt the diet, they need instruction and they need to be able to ask questions; those would be significant challenges when recommending the diets that restrict foods allowed, which could either be vegan, the very low fat, or the ketogenic diet.

The final consideration is the opportunities presented to provide patients with good information about the diet. The problem as I see it is that physicians, physician assistants, and nurse practitioners are not familiar enough with nutrition to be able to do that effectively in a medical practice, especially considering the time constraints for most healthcare practitioners. The obvious choice is to refer it to a dietetics department, but that type of consultation is not very often available in most medical practices and especially under most health insurance programs. I think the challenges are going to take years to overcome.

My Thoughts

I thought the researchers did a credible job in coming up with their recommendations. They analyzed popular diets objectively and assessed them based on the AHA Dietary Guidance.

What is lost is exactly how this is going to help people. Since 1974, more fruits and vegetables and a limit on fat intake were recommended as the foundation of every diet. No matter how many diets have come and gone, no matter how many are yet to be developed, we have not achieved the simplest and yet most obvious objectives. Food manufacturers certainly have had a role to play in this with low-fat and ultra-processed convenience food, but the choice is always with us.

There are three more things that I think must be considered. First would be the individual’s genetic tendencies. We simply don’t know enough about interaction between genes and nutrition and how that impacts input. Second, protein needs change over a lifetime. At some point, proteomics must be considered in dietary recommendations; it isn’t all about your heart.

Finally, they specifically did not consider the potential for weight loss or weight maintenance in every program. Regardless of diet, it was, it is, and it will always be about the calories. If someone can get to a normal body weight and maintain it, I think there might be room for just about any type of diet, providing it provides enough vegetables and fruits.

The Bottom Line

As the lead author suggested in an interview, there were four recommendations across all popular diets: eat whole foods, eat more non-starchy vegetables, eat less added sugar, and eat less refined grains. If we could start with that, I think our hearts would love us for it.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001146

How Popular Diets Impact Your Heart

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When the American Heart Association (AHA) speaks, news organizations tend to report what they say and people tend to listen. It’s doubly true when they rank all the popular diets according to how they relate to heart health. Because we seem to live in a society based on the “see food, eat food” diet, that can be meaningful. Here’s what a group of experts did to evaluate popular dietary approaches to diet and rank them according to AHA guidelines for a heart-healthy diet.

The AHA has ten dietary guidelines for eating a heart-healthy diet, such as “Eat plenty of vegetables and fruits” and “Choose healthy sources of proteins.” For the complete list, click on this link to the article; the scientific statement is open access on the AHA website.

Then the panel selected the most popular diets in the U.S. such as the Mediterranean diet, the DASH diet, several versions of a vegetarian diet, low-fat, paleo, and ketogenic diet. They gave each diet a full point for following each of the AHA guidelines or partial points depending how closely they followed the guidelines.

This was not an arbitrary assignment by a panel of experts; they used the best information available to determine the best heart-healthy diet. Who got the highest score? Mediterranean? Vegan? Ketogenic? I’ll let you know on Saturday along with my thoughts on the diets. One thing’s for certain: eat your fruits and vegetables. You may as well start with that right now.

What are you prepared to do today?

        Dr. Chet

Another Buffalo Bill’s Cardiac Arrest

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I hope that you took 60 seconds to watch the video from Tuesday’s Memo and learn CPR. As I said, it’s simpler than when I taught it, and it may just save someone’s life—someone you love or maybe a stranger.

In the close, I mentioned another Buffalo Bill who suffered a cardiac arrest several months before Damar Hamlin’s on-field experience. The owners of the Bills and Buffalo Sabres and CEO of the Buffalo professional sports teams are Kim Pegula and her husband Terry. One night last June, Terry was awakened by Kim going into cardiac arrest. One of her grown daughters happened to be staying with her parents and performed CPR until emergency services arrived. She saved her mother’s life.

In an open letter in The Players Tribune, Kim’s daughter Jessica, a top-ranked tennis player, told the story of her mom. This time, without the immediate attention from a couple dozen experts, Kim’s brain was without oxygen for longer. While she continues to improve every day, she suffers from expressive aphasia. She can probably understand almost everything, but she sometimes can’t get the correct words to communicate well. No one knows whether she’ll regain lost function, but she’s alive to make that journey because of CPR. It’s a very moving story and I urge you to read it.

Who can do CPR? Almost anyone. The American Heart Association has no minimum age for learning CPR. They say, “The ability to perform CPR is based more on body strength than age. Studies have shown that children as young as nine years old can learn and retain CPR skills.” Now—are you going to take the time to learn CPR in 60 seconds? Just click this link.

Aging with a Vengeance

After the Super Bowl Webinar on Taking Back Your Muscle last Sunday, I had inquiries about the prior Super Bowl Webinar Reclaiming Your Power. I’m happy to let you know you can purchase both replays in the Store at drchet.com. If you order one or both, make sure you use the correct email address; it’s the only way you can get the link to listen to the replay. And if you want to gift the replay to someone, you can; when you’re checking out and get to the billing details page, enter their email address instead of your own.

What are you prepared to do today?

        Dr. Chet

References:
1. https://www.heart.org/en/damar-hamlins-3-for-heart-cpr-challenge
2. https://www.theplayerstribune.com/posts/jessica-pegula-tennis

Happy Heart Health Month!

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Happy Valentine’s Day to everyone! February is American Heart Month; it also has an emphasis on women’s heart health with Go Red for Women. That’s symbolized by wearing red as often as you can during February. I can’t think of a better day to do that than today—Valentine’s Day. There’s a lot that we can do for our hearts with diet, exercise, and more, but that’s not what this memo is about. It’s about responding to a challenge.

Whether you’re a football fan or not, you’ve probably heard about Damar Hamlin, the Buffalo Bills safety who had a cardiac arrest on the field in January. He has recovered and is doing well, and he hopes to get back to playing football. But he’s alive only because the immediate training staff responded by doing CPR on the field.

Damar is part of American Heart Month with #3forHeartTM CPR Challenge. The first part, and probably most important, is to learn how to do CPR in 60 seconds; follow the link to watch the video. Even though I’ve taught CPR, it was a good refresher and, wow, it’s a lot simpler than it used to be. Take a minute today to be prepared in case your Valentine or anyone else has a problem.

There is another part to this story about another Buffalo Bill who had a cardiac arrest. I’ll tell you about her on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.heart.org/en/damar-hamlins-3-for-heart-cpr-challenge

The Secret to Prevention

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Consistency.

I thought I’d lead with the secret to disease prevention instead of making you wait. Whatever you want to accomplish in taking charge of your health, you have to be consistent. The polypill study proved it although the scientists, being conservative in their conclusions, don’t come out and say it—but I will. Here’s why.

Why the Polypill Was the Difference

The subjects taking the polypill were more consistent in taking their medications than the subjects who took the exact same medications as individual pills. They didn’t ask the subjects whether it was easier to remember to take one versus three pills; that could be a factor as the mean age of the subjects was over 75. It’s also easier to keep one medication refilled rather than three. Whatever the reason, the subjects just took their medication on a more regular basis and thus saw a decrease in recurrence of cardiovascular disease events.

While this was a study about medication, it applies to reducing or changing your foods to eat healthier, reducing the risk of cardiovascular disease and diabetes, or any other health goal: we have to be consistent. Even getting a health benefit from taking a supplement requires you to take it regularly for weeks or months to see a benefit.

Weight Loss: A Special Case

Losing weight and maintaining the weight loss is the single most difficult thing humans can do. I know. I’ve been trying for decades. I don’t weigh what I used to weigh, but I’m not where I want to be. I know many of you are in that spot as well.

It’s not the losing that’s the problem—it’s the maintaining. When you consider the simplicity of it, why is it so difficult to sustain a way of eating that keeps you at a healthy weight? Scientists and physicians have examined genetics, proteomics, hormones, and more. They have looked at every psychological issue they can think of to try to help people lose the weight and keep it off. No luck so far.

I’ll go out on a limb and predict there won’t be any one answer. It’s really up to each individual to find a way to eat that can sustain a normal body weight. It will probably be slightly different for each of us as to the types of foods and exercise we use, but our solution exists. We just have to find a way to be consistent and in the case of weight loss, it has to be for life.

The Bottom Line

We face plenty of obstacles in our path to health. We may not have the best genes. We may have had a poor lifestyle for many years that we have to compensate for. We may not have all the resources we need. But if we can pick a couple of things at a time and make them our habits for life, we can begin the process. We just have to be consistent, day in, day out. Where we end up may not be perfect, but it can be better than you are right now. That’s what aging with a vengeance is all about.

What are you prepared to do today?

        Dr. Chet

Reference: NEJM. 2022. DOI: 10.1056/NEJMoa2208275

Will the Polypill Reduce Second Heart Attacks?

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One of the issues with prevention is having people stick to a plan, even after an event as serious as a heart attack. Lifestyle changes are challenging to stick with, but so is something as simple as taking medications. Remember, this isn’t to prevent a heart attack; it’s to prevent a second one. That’s serious.

The concept of a polypill has been around for close to 15 years. The idea was to put medications together in one pill as a preventive that would reduce the risk of getting cardiovascular disease. For a long time, that idea never went anywhere, but recently researchers decided to resurrect the concept. This time, the objective was to monitor subjects with recent heart attacks. Would there be a difference in the rate of secondary events between subjects who took the polypill and those who took the same medications as individual pills? The medications used were aspirin, ace-inhibitor, and a statin. After three years of follow-up, the subjects in the polypill experienced significantly fewer secondary events, 9.5% versus 12.7%.

Can you figure out why the subjects who took the polypill did better than the subjects who took the same medications individually? I’ll tell you the secret to disease prevention on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: NEJM. 2022. DOI: 10.1056/NEJMoa2208275

Research on Health and Apple Cider Vinegar

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Watching more television than usual means I’m seeing more commercials than I’m used to seeing. It’s time to take a look at some dietary supplements that make health claims in television commercials. I’m going to focus on the science behind any claims being made on the product label or on the product’s website to see if they pass the FDA regulations. The product claims are worded as the FDA suggests; the question is whether the science is substantial enough to make the type of claims the FDA allows.

The first product is Goli, an apple cider vinegar (ACV) gummy supplement. The website makes claims about weight loss, appetite control, blood sugar control, energy, immune function, detox, gut health, skin, and heart health. I chose to examine heart health.

The company used three studies to support the claim. The first examined the use of 750 and 1,500 mg of ACV in a drink. The results showed no clear pattern of benefit although triglycerides went down. The second study compared a group using ACV plus calorie reduction with a control group that had no intervention; in this case, the restricted calories could explain any benefits. Finally, they used data from the Nurses Health Study that reported better heart outcomes in women who used oil-and-vinegar salad dressing. The focus of that research was on the type of oil, not the type of vinegar.

Based on the FDA Guidelines, claims cannot be made from research that uses an ingredient in food as the substantiation for a benefit from a dietary supplement. I checked the research on several of the other claims they made and the research they used, and I came to the same conclusion. They may be very tasty gummies, but the research does not appear to support the claims they make. But if you want to take a gummy or two to reduce your appetite, our grandson Riley recommends sour gummy worms. Just FYI.

What are you prepared to do today?

        Dr. Chet

References:
1. Guidance for Industry: Substantiation for Dietary Supplement Claims Made Under Section 403(r) (6) of the Federal Food, Drug, and Cosmetic Act. https://bit.ly/2QLDRa2
2. Biosci, Biotechnol, Biochem. 2009; 73(8):1837-1843.
3. https://doi.org/10.1016/j.jff.2018.02.003.
4. Journal of the American College of Nutrition, 2001; 20:1(5-19).

Treating a Woman’s Heart Disease

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The paper I’ve been using as a primary source for this week’s Memos is titled “Sex Differences in Ischemic Heart Disease. Advances, Obstacles, and Next Steps”; the purpose of this paper is to provide the current state of the science to clinicians when it comes to preventing and treating heart disease in women. A team of experts combed the medical literature to let their colleagues know where we stand in treatment and where future research should go, and you could look at it as a roadmap for improving prevention and treatment. You could also look at this as an indictment for less-than-quality care for women with heart disease.

There were seven categories of treatment options for various phases of heart disease, from diagnosing heart disease to mortality. I’m going to talk about just two but understand that even though the mortality from heart disease has decreased over the past 30 years, there are still gaps in treatment between men and women.

The first was a 30-minute delay in restoring the flow of blood to the heart in women who were having a heart attack with ST- segment elevation, a distinct change in the EKG. The time from the onset of symptoms and arrival at the hospital as well as time from arrival at the hospital to needle insertion for a percutaneous coronary intervention was 30 minutes or longer compared to men. That means women don’t get to the hospital early enough, so that’s on them. Ladies, you need to make that 911 call a little quicker. But it also means that once they’re there, it takes longer to get the arteries open again. That creates the possibility of more damage.

One of the problems is getting the correct diagnosis. There are 11 other conditions that can cause ST-segment elevation including takotsubo syndrome also known as broken heart syndrome. Still, 30 minutes seems way too long and needs to be improved.

The second is the one that really stunned me: fewer women are given recommendations for cardiac rehabilitation after a heart attack. Not only that but fewer women register to take part in cardiac rehab. They also attend fewer sessions than men do. When I read that, I was almost apoplectic. The heart is a muscle that can be damaged by a heart attack. When it’s time to rehabilitate that muscle, it’s not like restoring range of motion after knee surgery. If this muscle isn’t rehabbed and then trained for the rest of a women’s life, the death rate increases for those women.

That has to change today. If you have any type of coronary event, from atrial fibrillation to a full blown heart attack, the first question you ask is “When can I begin cardiac rehab?” I understand that every insurance plan may be different but you need to understand any limitations, how to exercise after a heart attack, and how to progress. That’s important, not just for the muscle, but also for the nervous system, the lungs, increasing the number of blood vessels, and even to reduce the depression that occurs after a heart attack.

And then you’re going to do it until you get every session you qualify for and get a plan to take home with you to keep improving. When that’s done, you’re going to get a plan from your physician as to how to progress from that point. These are non-negotiable. This has to change and it has to change today. The quality of your life depends on it.

Next Tuesday I’ll finish American Heart Month with a question I get a lot: does taking my calcium supplements increase calcification in my coronary arteries? I’ll let you know on Tuesday.

What are you prepared to do today?

Dr. Chet

 

Reference: Circ Cardiovasc Qual Outcomes. 2018;11:e004437.