There’s No Such Thing as a ‘Mild’ Heart Attack

Boston Celtics President Dany Ainge, 60, suffered his second “mild” heart attack on May 1

This morning it was reported that Boston Celtics President Danny Ainge suffered a mild heart attack last night in Milwaukee and was treated and will return to Boston. Ainge had a similar “mild” heart attack in 2009. This comes just a few days following the news that R&B singer Peabo Bryson had a “mild” heart attack as well.

I’ve noticed reporting on heart attacks focuses on just two kinds — major and mild. Major usually means the victim didn’t survive or needed bypass surgery. Everything else seems to get the “mild” classification from the news media. I wonder if they do this because they don’t want to alarm people, or because they don’t feel the need to describe with any detail exactly what happened to the person? Either way it doesn’t help anyone, not the least of which the survivor, who may feel better that the doctors said he or she had a mild heart attack but it doesn’t change the fact that mild or not a heart attack of any kind is a signal that things are not okay with your cardiovascular system.

I think the term “mild” heart attack gives the survivor a false sense of security. Any heart attack is a major heart attack and needs to be treated as such. Popular culture plays a role in this disservice. I used to laugh at the Saturday Night Live skit where “da Bears” fans would have a heart attack and keep on eating as if it is a normal part of life.

I suspect this image isn’t that funny to Chris Farley’s family given he died at 33 from a combination of drugs and heart failure from atherosclerosis.

Peabo Bryson  is “stable” after he “suffered a mild heart attack” on Saturday morning. Yet he’s still in the hospital and is cancelling most of his scheduled May concerts. Doesn’t sound too mild to me.

What’s my point? Any heart attack is a serious medical condition that requires considerable medical attention and lifestyle changes. Myocardial infarction means you had a significant enough blockage in an artery to cause your heart to lower blood flow and perhaps even stop beating. Or it caused a clot to travel through your heart to block blood flow. Ain’t nothing mild about that.

Some suggest the amount of permanent damage to the heart helps to classify a heart attack as mild or major. But what amount of damage to the thing that keeps you alive should be considered mild? My heart is about 15 percent damaged. Did I have a mild heart attack? Hell no. I nearly died and ended up needing three stents.

I would argue that any damage is major. Which means news outlets or doctors trying to placate patients or family members by suggesting a heart attack is mild are minimizing the seriousness of the event. I suspect Danny Ainge, now having survived two heart attacks at just 60 years of age, isn’t going to take things lightly going forward. I suspect he’s going to change his diet, take new medications, increase exercise, get regular blood checks, reduce stress, and more. And that’s the right approach for anyone who has had a heart attack — mild, medium or major.

‘Deep Medicine’ Paints Collaborative Future Between Doctors, Artificial Intelligence

Depending on your perspective, Artificial Intelligence (AI) either brings thoughts of a future enhanced by technology or strikes fear in your heart that robots will take over the world. Some of the brightest minds in technology (I’m talking about you Elon Musk) have warned humanity about the dangers on the horizon, yet it’s breathtaking to envision just how much AI can improve our lives. I for one welcome our new robot overlords.

In Deep Medicine, cardiologist Eric Topol takes readers on a fantastic journey to a not-too-distant future where AI works side-by-side with the medical community to improve all aspects of health care, from individualized medicine to improved productivity and lower costs to virtual personal wellness assistants (think Amazon Alexa on steroids). Topol’s research points to numerous advances either currently underway or in development and paints a picture of a true partnership that is already shaping the health care environment.

I choose to take an optimistic view of this future, perhaps because I admire science and what it has done and can do for humanity. When I bring up the future of medicine in conversations, I often see fear come across people’s faces rather than wonder. It happened today at a luncheon when the discussion turned to the future of health care and someone at the table brought up futurist Ray Kurzweil’s belief that in the coming years, we’ll all have nanobots injected into our bloodstream designed to hunt down and kill infections. A woman at the table looked downright mortified, and her look became even more uncomfortable when I followed by describing Kurzweil’s conviction that in the next couple of decades mankind will reach a singularity where man will essentially merge with machines. For some this concept means the end of homo sapiens, but for me and other cheerleaders for AI and machine learning it simply means the beginning of our next phase of evolution. Who’s to say evolution isn’t meant to include the merging of flesh and technology?

I understand why AI might frighten some people. And I agree mankind must move forward with a set of ethical guidelines to ensure we don’t end up in some dystopian brave new world. But I think a future with AI is brighter than a future without it. For me, science and technology represent progress. Just 100 years ago, human life expectancy was around 50 years. Today, thanks in large part to science and technology our life expectancy is around 80. Many experts believe that a person born in 2100 will have an average life expectancy of 100 meaning many of us will live well beyond the century mark. I can’t help you if you don’t want to live that long, but I’d suggest your worldview may be skewed by the fact that you equate old to unhealthy. Topol’s point is that AI and machine learning will improve not just our longevity but perhaps more importantly our quality of life.

The book, however, does not fail to alert readers to the potential pitfalls of a health care system reliant on AI. Perhaps the biggest issue for Topol, and rightfully so, is the concern over privacy. If bots and databases have access to our health information – including our genetic code – doesn’t that set up a scenario whereby our private health data can be stolen or even sold to the highest bidder? Or might we end up in a place where our employer, or the government, can deny certain rights or privileges because of our health? I’m no Pollyanna. I can imagine a situation where a person could be denied employment or insurance coverage because they have a health issue. However, Topol argues that we need to set up safeguards for just these kinds of things and if we do the pros will far outweigh the cons. And not for nothing, it’s not as if the American health care system is working now. Even though America pays thousands more per capita for its citizen’s healthcare we rank at or near the bottom of most global ratings systems in terms of measures like quality and efficiency. We can only go up from here, and technology will play a key role.

Topol also raises concerns over where technology will reside within the healthcare system. By that he means if we let AI replace doctors, we may gain some efficiencies and diagnosis improvements, but we will lose the patient/doctor connection or “presence” that he and others believe is paramount to quality care. Rather, he argues that the best future sees AI working alongside medical practitioners in order to free them up to focus on patient care. Doctors today spend more time entering data into electronic health records via keyboard or recorder and less time listening to and examining patients. If AI is able to manage the routine parts of healthcare and assist doctors with diagnosis using machine learning and big data that will give doctors more time to interact with patients, something all medical professionals agree equates to better results. If you’ve ever sat in a doctor’s office while he or she typed notes into a tablet or laptop instead of looking you in the eyes you know what I’m talking about. These days it’s not unusual for a doctor to spend less than 10 minutes with a patient!

“The greatest opportunity offered by AI is not reducing errors or workloads, or even curing cancer: it is the opportunity to restore the precious and time-honored connection and trust—the human touch—between patients and doctors,” Topol writes in Deep Medicine.

That said, there are so many areas of medicine where AI can help us make giant leaps in diagnosis and treatment. AI has remarkable advancement opportunities in areas like pathology and radiology where machines can look at millions or billions of inputs to see patterns that the human eyes could never see. It can identify correlations that might never be noticed by human researchers. It can scan through billions of pages of studies and articles and identify a diagnosis in a fraction of a second, where humans could never consume or recall the vast knowledge base that medicine relies upon. It can compare billions of patient records and uncover connections that can lead to new, more effective, treatment protocols. It can compare genetic data with pharmaceutical data and recommend the exact right drug to treat an individual’s specific medical issue.

One area that I found fascinating (and really exciting) is the potential for virtual medical assistants that can work with patients in the clinic or at home to diagnose and suggest treatment. If you have a digital assistant at home (like an Amazon Alexa or Google Home) or a smart watch or smart phone you’ve already seen how this works. By 2018, more than 60 million Americans were using these AI-powered devices and that number will grow. It’s projected that by 2020, 75 percent of American homes will have at least one voice-activated personal assistant. Indeed, we have a Google Home device in every room of our home and access Google Assistant on our smartphones multiple times per day. And while medical applications for these devices today are pretty much limited to counting steps or providing information from WebMD, many people (including myself) now have a smart device that can check one’s pulse rate and some even check blood pressure. The medical applications for these devices are increasing rapidly.

“Offering a glimpse at how wearable technology may help flag potential health problems, the Apple Watch was able to detect atrial fibrillation (AFib) in a small group of people who had received an alert of an irregular heartbeat, said researchers presenting results from the Apple Heart Study.” – American College of Cardiology, 2019

The future will include glucose monitoring for diabetics, gut biome assessment, sleep improvement, stress reduction, and more. Topol lays out a host of amazing ideas, some that are already in development. He offers several potential scenarios where an individual can begin a dialogue with a home-based AI that can results in immediate diagnosis via voice input and/or device input (one even includes a scenario where the person is asked to place his phone up against his stomach where he is having pain and the device uses ultrasound or some mechanism to determine that the patient has gallstones and should see his doctor for treatment). The future is only limited by the imagination of data scientists and inventors who can design and build all kinds of input devices.

Again, Topol is in no way suggesting AI should replace doctor care. But if AI can diagnose many common and treatable issues at home the time and cost savings will be dramatic. I’ve already had a doctor diagnose an infection by looking down my throat via video conference on my mobile phone – it’s a simple step to having that same diagnosis come from a machine without the need for human interaction.

Frankly, all of this excites me and makes me hopeful for the future. And Topol didn’t even get in to other medical advancements in this book, such as precision medicine, 3D printed spare organs, or CRISPR gene editing. I admit that part of the reason for my interest in these areas is because I have a damaged heart from a heart attack I experienced in 2011. The idea that my heart can be returned to normal through new medicines, gene editing or stem cells is, well, heartwarming. This technology came too late to keep me from having the heart attack in the first place, but it’s not too late to both improve my life and perhaps extend my life. And while I’m not exactly holding out for the singularity, I wouldn’t mind living a long and healthy rest of my life.

The Time My Family Acted FAST and Saved My Life (again)

When celebrities die, the world seems to suddenly become more aware of the many maladies that kill humans. I think that’s probably a good thing, because we need the occasional reminder of our mortality to keep us centered, but also because following the death of a famous person we get a series of reminders of what we need to look out for regarding our own health. Famous deaths, in a strange way, have a secondary effect of making us healthier.

Actor Luke Perry, who died on March 4 following a stroke.

While we don’t know yet exactly what killed actor Luke Perry, we do know it was due to complications from a stroke. The buzz around his death is that most people think stroke is a disease that old people get, but unfortunately that’s just not true. There was a good article in the New York Times this week about how stroke effects younger people.

In my work I meet a lot of young stroke survivors including some in their 20s and 30s. While it’s not too common, it does happen. The article calls out undetected birth defects, blood clots, and aneurysm as reasons for stroke in young people, and there have also been some high profile drug interaction causes like in the case of the oral contraceptives Yaz, Yasmin, and Ocella which were not found to cause stroke but which were taken off the market because of side effects that may have led to stroke in some women.

And then there is the dreaded spontaneous arterial dissection, something that I learned far more than I would have liked when in 2017 at age 50 I suffered a stroke as a result of a dissection of my carotid artery. Because you probably have no idea what a dissection is, here’s a definition:

“An arterial dissection is a tear in the lining of an artery. When a tear occurs in a major artery in the head and neck — the carotid or vertebral arteries — that transmit blood to the brain, this is called a cerebral arterial dissection.”

— University of California San Francisco

In layman’s terms, for various reasons an artery can tear without warning and as a result blood flow can be cutoff to the brain or a clot can travel to the brain causing a stroke. Fun, huh?

In my case, I was in Tucson helping my parents move on a lovely April day and unbeknownst to me I began slurring my words. When I say unbeknownst to me that’s because I honestly have no recollection of it. I continued to move items from the truck into the apartment, and apparently my niece thought I was joking around and slurring my words on purpose in an attempt to make fun of someone. Unfortunately, that wouldn’t be abnormal behavior for me. A few minutes later, back at the truck, my brother in law responded much more dramatically. He noticed that the entire left side of my face had dropped, and he yelled for my wife.

Moments later I do remember being back in the apartment and telling my wife I was fine. In fact, I insisted I was fine. But my wife was by my side six years earlier when I had a heart attack and tried to play it off so she was having none of it. She also knew about FAST.

  • Face Drooping
  • Arm Weakness
  • Speech
  • Time to Call 9-1-1

I had the F and the S covered, and she took care of the T. Within minutes, the paramedics arrived and while my symptoms had gone I got a ride to the hospital to be safe (I was a heart patient after all). Because the stroke was short-lived, doctors figured it was a Transient Ischemic Attack (TIA), often called a mini-stroke. These are fairly innocuous, but could be a warning sign of something worse to come. But tests confirmed I had a full-on stroke, and nobody could tell me why.

I don’t want to minimize my stroke, but I got lucky. Unlike Perry, my stroke was small, came and went quickly, and in the end I have had no noticeable deficits. My face and speech returned to normal, I experienced no arm or leg weakness — hell I didn’t even have a headache. In 2011 I had a nearly 100 percent blocked widow maker artery and my heart has pretty much bounced back. I had a stroke and have had no lasting effects. I am clearly a lucky dude.

Perry, however, was not so lucky. As we learn more about his stroke I suspect the reason for its size and devastation will become more clear. For my part, it took five days in the hospital, three specialist followups back home in Phoenix, and multiple invasive tests to diagnose with some certainty (not complete certainty) that my stroke was a result of a dissected carotid artery.

Honestly, we still don’t know exactly. The hospital doctors couldn’t determine why following the stroke my carotid artery was 100 percent blocked. Neither could my cardiologist. She sent me to an electrophysiologist to see if it was due to a clot from atrial fibrillation (AFib) or another heart rhythm issue. He ran some tests and those came back normal. I then went to a vascular surgeon, who said that because of the shape of the blockage in my carotid artery it was likely a dissection, but he couldn’t be sure. Oh, he also said there was no way to fix my carotid artery because it was too dangerous to try to open the blockage so I would simply have to live the rest of my life relying on the other arteries delivering enough blood to my brain. (This is cool, but apparently the body learns to compensate and even creates new arteries to get around the blockage).

Because of my heart history, the biggest worry for me was that the carotid blockage was caused by the same thing that caused my heart attack — calcium buildup from fat and cholesterol in my blood. This was infuriating to me, and really scary, because since my heart attack I had changed my lifestyle and been working hard to maintain good cholesterol. If my efforts had been fruitless I may have been fighting a losing battle all these years.

Strangely, the possibility that the stroke was due to plaque buildup put me into a major funk. I had beat the heart attack in 2011, but if I could still drop dead any second from a stroke or another heart attack despite all that I had done to negate this possibility, I was a lost cause. After my heart attack I was oddly calm. I got lucky, and I moved on. I really didn’t overthink how close I came to dying. But the stroke knocked me for a loop.

I started to dwell on death. I began researching cemeteries because I wanted all those details to be taken care of before I croaked so my wife and family wouldn’t have to worry about it all. I went as far as to research various alternatives to burial like burial at sea and natural or green burial. I found out I could be cremated and planted with a tree, or turned into a diamond (although asking one’s spouse to wear your dead ashes around their neck after your gone is a bit selfish). I even dragged my wife to visit a few cemeteries in the area, but in the end the cemeteries in Arizona were depressing as hell and I eventually changed my mind altogether and decided I wanted to be cremated and have my ashes spread at Powerhouse Park in Del Mar, Calif. (my favorite spot on earth). So I got that going for me.

The possibility of the stroke being caused by more plaque buildup led to me having an angiogram to check inside my heart and arteries. So it was back to the hospital to have a camera inserted through my groin and up into my cardiovascular system, and the good news was that my arteries were all very clear. All the work I had been doing to keep my cholesterol down had been working.

That was sweet relief, but it didn’t provide an explanation for the stroke. Next stop was a neurologist, and more scans, and then something really odd happened. The new scans, taken just a few months following my stroke, showed that my once fully blocked carotid artery was now flowing nicely. It had spontaneously cleared on it own. This phenomena all but convinced my neurologist that I did indeed suffer a dissection, since many dissections spontaneously heal on their own. The body once again outsmarted medicine.

This all leaves me with no clear answer as to what caused the dissection, as I did not experience any trauma like an accident or a roller coaster snapping my neck too forcefully. And while I ended up having a good outcome (just like I did with my heart attack), it still left me a little uneasy about how delicate our bodies can be. But hey, what can you do?

These days I don’t think about the stroke much. When I meet stroke survivors who have been left with deficiencies, I feel a little guilty in the same way I feel guilty when I meet heart attack survivors who had to get cracked open for a bypass. And, as this blog post might suggest, I am always taken back to that day in April 2017 when someone famous has a stroke.

The bottom line here is that I am probably still alive thanks to luck, and the quick thinking and persistence of a smart spouse. So I suppose the lesson is to know the signs of stroke and heart attacks and be vigilant. If you suspect you are having a stroke or heart attack, get thee to a hospital post haste even if you aren’t sure. The life you save just might be your own.

And RIP Dylan McKay!

American Stroke Association

New Data Suggests Half of Americans Have Heart Disease — Here’s How to Tell if You’re One of Them

Last week new data was released that indicates about half of all Americans have some form of cardiovascular disease, representing more than 120 million of us. And while the number crept up in part because of new guidelines regarding blood pressure, it’s nevertheless a staggering number.

The Centers for Disease Control reports that about 610,000 people die of heart disease in the United States every year – that’s 1 in every 4 deaths. Heart disease is the leading cause of death for both men and women. While the media and our elected officials spend their time focused on manufactured or even downright false threats to Americans like caravans of Mexicans and Islamic terrorists, the true threat is staring us in the face and we’ve hardly noticed. For comparison’s sake, in 2016 the number of people in America who died due to terrorism was 68. Cardiovascular disease is the number one threat to the well being of all Americans regardless of political ideology.

Like many concerns, a solution begins with the admission that you have a problem. Well, Houston…and Minneapolis…and Charlotte…we have a problem.

The factors that were used to determine if you have cardiovascular disease includes both behavior and health measures. And not surprisingly, there are no surprises here. It is simple to find out if you are one of the 120 million Americans who have some form of cardiovascular disease. There’s even a handy dandy free checklist online here.

Here are the seven factors:

  1. High blood pressure. Anything 130/80 or above is bad. Seriously, it takes one minute at any drug store to find a kiosk and check your blood pressure.
  2. Cholesterol. Generally speaking, adults should have total cholesterol of less than 200. Your LDL (bad cholesterol) should be under 100 and your HDL (good cholesterol) should be 40 or higher for men and 50 or higher for women. Triglycerides should be less than 149.
  3. Blood sugar. A fasting blood sugar level less than 100 is normal.
  4. Be active. Sitting on the sofa is going to kill you. Get up and move. You don’t need to run a marathon, just move your ass at least 150 minutes per week at a moderate pace. That’s like 20 minutes a day of walking.
  5. Eat better. This one is also easier than you think. Lay off the carbs and added sugars and eat a well-balanced diet that consists of mostly vegetables, fruits, whole grains, and healthy fats. This is not rocket science people.
  6. Lose weight. If you do the above two things (eat better and be active) you don’t have to do anything more to reach this goal.
  7. Stop smoking. Vaping too. Knock it off.

So are you one of the 50 percent of Americans who have some form of cardiovascular disease? The answer is yes if you have high blood pressure, high cholesterol, high blood sugar, or if you smoke, eat like crap, don’t exercise, or carry around some extra weight. Frankly, it’s surprising to me that it’s not more than 50 percent of us.

All this is to say what I’ve said before on this blog — heart disease is 80 percent preventable so dying from heart disease is essentially optional. It’s time to pay attention to your risks and do something about them. There’s no excuse anymore for not knowing your risks. If you are a functioning adult you should be able to rattle off your blood pressure numbers, and your cholesterol and blood sugar levels. If you don’t know your numbers, see your doctor right away and find out. Your life literally depends on it.

Not All Bread is Created Equal

“Give us this day our daily bread”

Matthew 6.11

Whole grains. Refined grains. Ancient grains. We’ve come to a place in history where even something as simple as bread has become a cacophony of choices. It’s one of those things that drives some people crazy because change is hard, and while I understand the desire for wanting things to remain the same when it comes to health I prefer to listen to the science. And the science is becoming quite clear when it comes to bread. You may have grown up on white bread but eating refined grain bread like Wonder Bread is akin to downing straight sugar — and sugar is going to be the death of you.

This week I read a great article that did a nice job of making the case for whole grain bread. Whole grain means the bran, the germ, and the endosperm of the grain kernel have all been left intact, meaning the bread is rich in fiber, vitamins, and minerals. Whole grain bread can include wheat, but can also include other grains like barley, rice, oats, and others. You may see it marketed as 9 grain, or 12 grain, or even 21 grain.

Regardless of how many types of grain are in the bread, the key thing is that the grains are not processed down to flour which removes the nutrients and when digested pretty much leads to excess sugar in your bloodstream which in turn is stored in the body as fat. This is why so many doctors, nutritionists, and other health professionals say cutting out bread can help you lose weight. Refined flour can also lead to insulin resistance and eventually diabetes and heart disease.

“Bread made with whole grains = good. Highly processed bread (e.g., white bread) that adds calories and sugar but not much else = not so good.”

— Health & Fitness Cheat Sheet

Hence you’ve probably heard me say bread equals death of some variation of the bread will kill you trope. You’ve probably also heard me say I eat a low carb diet, which is true — but note that I never say I eat a “no carb” diet.

I avoid all refined-grain bread and bread products, including bagels, pizza, crackers, pretzels, etc. I will almost always pass the bread basket at a restaurant because those rolls are more than likely made from refined grain. Yes, it’s hard. That shit is addictive. If you try to cut it out cold turkey you’ll go into withdrawal. I read that heroin-addicted rats once given sugar water will choose the sugar over the heroin.

But I do eat bread on occasion. In fact, whole grain bread is an important part of a healthy diet. I may have two slices as part of a sandwich a few times a week, or eat a slice of toast with eggs for breakfast. But I eat whole grain, high fiber, low sugar bread. And no, it doesn’t taste like cardboard. In fact, I think whole grain bread has much more taste and texture than refined flour bread.

Unfortunately, the labeling and marketing of bread are confusing. Wheat bread may be whole grain or not. Multigrain may be whole grain or not. You need to look for the words “100 percent whole grain.” Here’s a good explanation.

But I’ll make it even more simple for you. Our favorite bread is Dave’s Killer Bread Powerseed. It is ridiculously delicious and loaded with fiber, protein, and whole grains. We also enjoy Ezekiel Bread, which is made from sprouted wheat. Nature’s Own is also very good.

The trick is to eat good bread, in moderation, and to avoid bread of unknown content which means most bread served in restaurants and sub shops. You can sometimes find whole grain bread at specialty restaurants, but as a rule, you’re much better off avoiding bread when eating out.

Yes, I know, it’s hard. But your health depends on it.

Climate Change is Going to Give You a Heart Attack

There has been a glut of news lately about the increasing severity of climate change, including this one reported just yesterday about the rise of sea temperatures. I have been thinking a lot about it, and while I have been concerned for decades (at least since I read Earth in the Balance back in the early 90s), this month I went to my first local chapter meeting of Citizens Climate Lobby. While we went around the room and shared our reasons for joining CCL, I was struck by how many of the people in the room mentioned the health ramifications of climate change.

If you think climate change is a hoax or isn’t going to affect you, I can’t help you. Clearly, you are “fact-challenged.” For the rest of us living in the reality-based world, the threats are real and imminent. The current administration, not exactly known for its embrace of science (or reality), published the second half of the Fourth National Climate Assessment 2017/2018 in November and while it is full of dire news, I’d like to focus on just the health aspects of climate change.

“Impacts from climate change on extreme weather and climate-related events, air quality, and the transmission of disease through insects and pests, food, and water increasingly threaten the health and well-being of the American people, particularly populations that are already vulnerable.”

Fourth National Climate Assessment 2017/2018

You can read the entire report online, and here’s a link to the health chapter, but in a nutshell climate change will expose us to extreme heat, poor air quality, reduced food and water quality, changes in infectious agents, and population displacement which in turn will create heat-related illness, cardiopulmonary illness, food/water/vector borne disease, and mental health and stress issues.

Figure 14.1 Climate Change and Health

Much of the cardiovascular health issues associated with climate change revolve around temperature changes. A recently published study from the University of Michigan suggests “climate change may lead to a significant uptick in heart attacks” because of dramatic changes in outdoor temperature. “Global warming is expected to cause extreme weather events, which may, in turn, result in large day-to-day fluctuations in temperature,” said Hedvig Andersson, MD, a cardiology researcher at the University of Michigan and the study’s lead author. 

There are other studies that suggest the same, and I suspect we’ll soon be able to tie actual cardiovascular deaths directly to the effects of climate change. This is of particular interest to me, obviously because of my cardiovascular history, but also because I live in the desert where extreme heat and temperature fluctuations are part of the norm. Maybe I should move to a more temperate location? Oh wait, there may not be any temperate locations as climate change trudges on.

There are other heart-related consequences of climate change as well, such as the fact that increased ozone formation due to higher temperatures harms pulmonary gas exchange and causes stress on the heart and this is associated with heart attacks, increased particulate matter is associated with systematic inflammation, compromised heart function, deep venous thrombosis, pulmonary embolism, and blood vessel dysfunction, and of course stress and anxiety is associated with heart attacks, sudden cardiac death, and stress-related cardiomyopathy. Extreme cold and extreme heat increase hospital admissions for heart-related disorders and disease, such as dysrhythmias and stroke.

Climate change is the single most important issue facing mankind. It has far-reaching consequences for the planet and civilization. But it occurred to me that we’re just talking about the tip of the iceberg when we talk about sea-level rise, extreme weather events, drought and even infectious disease. Dirty air alone creates havoc for those already struggling with cardiovascular disease, and when you add in stress and mass migration and all the rest, it may not matter if you have to leave your home in South Florida for higher ground because you might not survive the heat and ozone pollution.

I for one am tired of sitting on the sidelines when it comes to climate change. For too long I’ve used the excuse that I wasn’t sure how best to make an impact, and because of that I haven’t made any impact. You can lose your mind researching what we should do about climate change, but I no longer wish to be paralyzed by indecision about how to help. Rather, I’m going to do something — something tangible.

I get a shit ton of eNewsletters and news about climate change. Any given day I may receive a message from The Union of Concerned Scientists, or, or the Sierra Club. Here’s a great list of organizations fighting climate change. It’s overwhelming, but with the start of the new year, I decided to pick one and do what I can.

I joined Citizens Climate Lobby because it has a singular focus that is easy to get behind and you can make an impact no matter where you live. And while I am not 100 percent sure a carbon fee and dividend law is the best approach to solving this thing, it’s an approach, which is more than most organizations are doing.

There are a lot of ways to get involved with CCL, and at a minimum you can simply stay informed and share news with others. Sometime this month, CCL will reintroduce its bill, the Energy Innovation and Carbon Dividend Act, while it is a long shot to make it to law with the current administration at the helm, we may be able to get enough momentum to make it a priority early in the next administration.

In the meantime, there are other things we can all do. We can fight fracking and other methane emitting causes like factory farming, ride a bike instead of driving all the time, wash clothes in cold water, consume less, personally divest from investments in fossil fuels, and eat more meat-free meals, for example. The point is, everyone can (and should) do something. It’s no longer just your kids and grand kids lives that depend on it — your life depends on it too.

Snoring is Much More Than a Simple Nuisance

I ran across an article today with the hyperbolic headline “7 Warning Signs That You May Be at Risk of a Heart Attack.” I truly hate headlines like this because they almost always lead to nonscientific blather. This article, from Men’s Health, suggests you may want to be concerned if you are exhausted (who isn’t), have erectile dysfunction (if your blood vessels down there are damaged, there’s a good chance the ones near your heart could be damaged as well), you have leg or hip cramps (again, blood flow issues), you’re bloated (too many beers?), and a few other seemingly innocuous maladies. But one potential symptom caught my attention and should catch your attention too — snoring.

Look at this sexy guy sleeping sound with his CPAP machine!

Snoring may seem harmless, but it could mean you have sleep apnea and that could be a big problem. Sleep apnea is a sleep disorder in which breathing repeatedly stops and starts and that can have major consequences for your heart health. In fact, obstructive sleep apnea increases the risk of heart failure by 140%, the risk of stroke by 60%, and the risk of coronary heart disease by 30%.

Let’s be honest, most of us snore once in a while or even all the time. The person who shares your bed has likely let you know you’re making noise with a late-night nudge or perhaps an occasional punch in the nose if it gets bad (kidding). You probably know if you snore, especially if you’ve ever woken yourself up from it. But you probably don’t know if you have sleep apnea unless you’ve been tested for it. A sleep apnea evaluation usually involves overnight monitoring at a sleep center although these days there are even some at-home sleep tests.

A few years prior to my heart attack my wife finally insisted I talk to my doctor about my snoring. Like a lot of people, I associated snoring with obesity and figured mine was just a minor case. But it had become so prevalent that oftentimes I’d wake up in the morning to find my wife sleeping on the sofa because I was keeping her up. I agreed to see my doctor about it, for her sake, but had I been paying more attention to the research I might have taken it a lot more seriously a lot earlier on.

There is a clear connection between sleep apnea and heart disease. Here’s a quote from an article on the American Heart Association’s website:

“The evidence is very strong for the relationship between sleep apnea and hypertension and cardiovascular disease generally, so people really need to know that.”

— Donna Arnett, Ph.D., chair and professor of epidemiology at the School of Public Health at the University of Alabama at Birmingham

A Google search for “sleep apnea and heart disease” brings up tons of articles and links to studies that show a clear connection. Unfortunately for me, while I discovered my sleep apnea before I had a heart attack I didn’t know it was a potential symptom of heart disease and therefore it didn’t raise any suspicions that would have caused me to get my heart checked out in time.

When I had my sleep study it turned out I had an apnea event (literally stopped breathing) about 80 times per hour. Think about that for a minute. That is more than once per minute. Of course that is going to cause strain on the heart!

Here’s some information on sleep apnea event occurrences. Normal is fewer than 5 breathing events per hour of sleep. Mild sleep apnea: 5 to 14.9 breathing events per hour of sleep. Moderate sleep apnea: 15 to 29.9 breathing events per hour of sleep. Severe sleep apnea: 30 or more breathing events per hour of sleep.

I was diagnosed with severe sleep apnea and nobody told me it could be associated with heart disease so I didn’t immediately go get checked out by a cardiologist. That seems like malpractice, but if I’ve learned anything over the past decade it’s that we have to be our own health advocates because doctors are overworked and under-educated in terms of knowing the latest science.

I ended up with a C-PAP machine, which applies mild air pressure on a continuous basis to keep the airways continuously open while I sleep. I have adapted well to it and use it religiously, every night. I hate having to use it, but using it means I no longer stop breathing 80 times an hour. I get a better night’s sleep and frankly, I feel safer using it. It’s a pain to travel with, but someday I’ll spring for a travel-sized machine as well.

So yes, snoring can be a symptom of heart disease or an impending heart attack. Now that you know this, you have no excuse for not talking to your doctor about your snoring. Trust me, it just might save your life.

Why I’m Doubling Down on Low Carb, Intermittent Fasting in 2019

I’m not much of a New Years resolution guy, but it’s hard not to think about the year ahead as the new year approaches. When it comes to my diet plans for 2019, I feel the need to echo the late George Herbert Walker Bush during the 1988 presidential campaign — stay the course.

All of my reading and research last year led to my full adoption of a low carbohydrate lifestyle, and nothing has changed that would lead me to rethink this approach. I’m not a doctor, but I’m fully confident that my cardiovascular health improved over the course of 2018. A year-end visit to my cardiologist confirmed my own analysis. In December I had an echocardiogram, a nuclear stress test, and a blood workup and all of these diagnostics returned very positive results.

The biggest danger for a heart attack survivor like me is to have a second cardiovascular event. In the first few years following my near fatal event, my heart performance was stable and improved a bit. My blood work was better, if not perfect, and all the other tests showed incremental improvement. Most importantly, my ejection fraction (my heart’s ability to pump blood out to my body) went up each year.

At the time of my heart attack, my ejection fraction (EF) was measured at around 30-35 percent. An EF of less than 40 percent may be evidence of heart failure or cardiomyopathy. For me, this was the scariest aspect of my event. It was also what has been driving me to make changes to my lifestyle.

Improving my EF has provided positive reinforcement for the things I’ve been doing to improve my cardiovascular health. I know that lifestyle led to my heart attack, and therefore lifestyle could keep me from having another one. This is why I’ve spent the past seven years exercising more, taking my prescribed medications, seeing my cardiologist regularly, and eating right.

Honestly, the only aspect of the above lifestyle changes that have provided any complications for me over the years since my heart attack has been eating right. I truly believe the medical establishment either doesn’t know or doesn’t want to suggest how to eat appropriately for cardiovascular health (I think they don’t want to provide advice because it is not so clear cut and if they are wrong they may be worried about liability). All the proof you need that the medical establishment doesn’t know the best way to eat is to Google diet advice — you’ll go down a rabbit hole from which you may never surface.

After my heart attack, my first cardiologist told me to avoid sodium because high blood pressure can lead to heart failure and/or cardiomyopathy. In that first year I avoided sodium like it was poison. Do you have any idea how hard it is to limit sodium intake to less than 1,500 mg a day?

But sodium didn’t cause my heart attack, so I spent a lot of time researching the latest medical advice on diet. I was really frustrated with what I found. I read about the China Study and Dr. Caldwell Esselstyn and thought perhaps meat was the cause of heart disease. I became a pescatarian, eliminating all meat except for fish. Then research started to point to the Mediterranean Diet as the best overall diet and that seemed reasonable so I went down that path. My blood work was better, but still not where I needed it to be.

I watched every movie about diet from Forks Over Knives to Fed Up to Fat, Sick and Nearly Dead and all I got was more frustrated and confused. But as time went on, I started to notice a trend — there was more and more information out there about the dangers of carbs and sugar. I really honed in on this trend, reading everything I could get my hands on. At the same time, I started working with a new primary care doctor who also believed that carbs and sugar were the real culprits of diseases like diabetes, metabolic syndrome, and heart disease.

I jumped in to the low carb movement under doctor care and with regular blood work checkups to assess how I was doing. And for me, the results have been compelling. My blood work is enviable by any standard, and my weight is in a good range. Best of all, my EF has continued to rise and last month was measured at between 60-65 percent — the best it has been since before my heart attack and within the normal range.

As of today, I have above average blood work and a normal EF. That’s all I could have asked for seven years post heart attack. I may cheat here and there (I do enjoy a beer now and again), and my sugars are not as low as I’d like them (that’s where the intermittent fasting is hopefully going to help), but basically, I am in great cardiovascular health. And I’m enjoying how I eat, which is to say I get to eat a wide range of foods including meat, eggs, and a little whole grain bread.

So here I am in January 2019 with probably the best cardiovascular health I’ve had since I was a teen. I attribute this to exercising more, taking my prescribed medications, seeing my cardiologist regularly, and eating right — that is to say, a low carb, low added sugar diet. I definitely need to exercise a bit more, but for the first time in a long time, I am confident I am eating healthy.

It’s the Sugar, Stupid

A juicy steak on the left and a 6-inch Veggie Delight from Subway on the right

Which meal is more heart healthy, the steak or the sandwich? If you believe the American government, and the media, and the vast majority of medical professionals, then it’s no contest. The veggie sandwich is a better choice for heart health because it contains no cholesterol or fat. The steak, on the other hand, has been vilified for decades because we’ve been told that eating foods that contain fat (especially saturated fat) raises the level of cholesterol in your blood and high levels of LDL cholesterol in your blood increases your risk of heart disease.

Signed. Sealed. Delivered. Yes? Not so fast.

What if I told you there has been a vast conspiracy to condemn fat in order to bury the evidence that the real enemy of heart health is sugar? Would you tell me I am crazy and to lose the tin foil hat? Are you willing to risk your life on it?

Lately some of my friends and family have been telling me I sound like Oliver Stone barking about the Kennedy assassination when it comes to sugar. They’d like me to turn down the volume a bit and stop being such a fun suck. Sugar is a vice, but it’s not the root of all dietary evil they say. Shut up and eat a cookie for crying out loud!

Okay, I admit I’ve been ranting a bit too much lately. But if you’d read what I’ve been reading you’d be disturbed as well. And if you’d had a heart attack at a young age like me and have been in a life and death struggle to figure out how to keep it from happening again you might be more open to alternative theories.

The fact is, there is mounting evidence that sugar is the root cause of heart disease. Rather than treat you to a series of quotes from various authors, doctors, and scientific studies I’ll simply list some resources for you to explore on your own at the end of this post. But suffice it to say, I’ve seen enough evidence to convince me that fat has gotten a raw deal and sugar has been artificially and immorally propped up by the sugar industry itself as a simple vice that is fine in moderation. Hell, at first it was literally endorsed as a health food.

I’ve been on a personal journey to protect my heart for nearly a decade now, and at every turn I run into more evidence that sugar (and processed carbohydrates) is the cause of heart disease. Despite the fact that the government still points the finger at fat and cholesterol. It’s frustrating to see how slow this ship is turning. But I believe it is indeed turning and that in the very near future the health powers that be will be forced to issue a gigantic mea culpa and set us all on the path to healthier hearts.

Over the holidays I finally read The Case Against Sugar by Gary Taubes. You don’t have to read it to learn what he uncovered about the dastardly deeds of the sugar industry — you can Google it and read any number of reviews and interviews with Taubes like this one in the New York Times. Here’s a highlight:

Sugar is not only the root cause of today’s diabetes and obesity epidemics (had these been infectious diseases, the Centers for Disease Control and Prevention would have long ago declared an emergency), but also, according to Taubes, is probably related to heart disease, hypertension, many common cancers and Alzheimer’s.

Taubes is a journalist and a well educated one at that. He has degrees from Harvard, Stanford, and Columbia. He has won numerous awards for his work, including the Science in Society Journalism Award of the National Association of Science Writers. He is legit. But he’s not alone in this fight for dietary truth. My explorations have led me to some amazing journalists and health professionals who have all reached the same conclusions about sugar. Like Dr. Stephen Sinatra. Dr. Mark Hyman. Dr. Zoe Harcombe. And Nina Teicholz, science journalist and author of The Big Fat Surprise.

I have also been experimenting with my own body. The fewer carbs and added sugars I eat, the better my blood work turns out. I recently had a nuclear stress test and an echocardiogram as part of my cardiovascular follow-up care, and my cardiologist said my heart is pumping at full power and all the images indicate my heart is healthy. My most recent blood work reported total cholesterol at 118, triglycerides at 120 and LDL at 55. These numbers are enviable for anyone regardless of heart history.

I believe my heart attack was caused by a single blocked artery that became blocked from years of a high carb, high added sugar diet that caused my triglycerides to skyrocket. My trigs were so high at one point (north of 700) that it skewed by total cholesterol numbers to the point that they couldn’t be accurately measured. Ironically, I was not eating an unhealthy diet according to the U.S. government. In fact, I was eating the recommended diet of low fat, high carbs. Journalists like Taubes and Teicholz have uncovered how and why the U.S. dietary guidelines went so astray, but in a nutshell, the reason is sugar. Much like how the tobacco industry lied and manipulated the science and policy of cigarettes, the sugar industry did the same. The evidence is clear.

Sugar is toxic. It screws with your endocrine system, forcing your body to produce too much insulin, which in turn causes you to become insulin resistant. Insulin resistance causes increased production of fat in the bloodstream which causes both obesity and plaque in your arteries. That’s my nonscientific explanation, but if you want to understand it in more detail you can read more on your own.

So back to that question at the top of this post. Which is healthier for the heart, the steak or the sandwich? Well, the 6-inch Veggie Delight from Subway has 41 grams of carbs and the steak has none. Carbs are sugar. Sugar equals heart disease.

If you want to live a heart-healthy life, don’t listen to the government. Listen to science.

Intermittent Fasting Off to Metabolic Slow Start

Three months ago, in an effort to reduce my fasting glucose levels and hemoglobin A1c which are slightly elevated, I added 16/8 intermittent fasting (IF) into my diet routine. The idea was that by not eating during a 16-hour window each day, I’d lower my insulin resistance and bring my sugars into a more normal range.

It’s worth noting that my sugars were not too high (109), but rather near the top of the normal range (less than 100) butting up against the pre-diabetic range (100 to 125). My A1c was 5.2, within the normal range, but not too far away from the prediabetic range of 5.7 or above. With my cholesterol and triglycerides in wonderful shape thanks to my low carb high-fat diet, the sugars were the only thing threatening my overall cardiovascular health.

Yesterday I got my most recent blood test results, and while my cholesterol/triglyceride levels were flat, my friggin’ fasting glucose and A1c went up to 112 and 5.6 respectively. Needless to say, this was not the result I was looking for when I started IF in early September. In fact, while my doctor suggested I do IF five times per week I have been doing it virtually every day for three months.

Rather than panic and give up, I thought a little more about how I’ve been eating (and drinking) over the past three months and the truth is while I have generally been on a low carb high-fat diet, I have cheated a ton. It started with a 12-day vacation to London and Paris, where I ate more than my share of chocolate croissants, macarons, and muffins and drank more than my share of beer. When we got back from Europe, I continued to snack here and there on sugary cookies and muffins and continued to have a few beers every week. I went on a boys’ trip to Wyoming where in two days I drank more than I do in a typical month, went to a beer festival with my son, and then between Thanksgiving and Christmas I’ve sneaked an unhealthy amount of sugar-laden foods and drank plenty of beer. I also hurt my lower back, which still hurts by the way, and as a result, I have not exercised much at all.

Mmmm Beer.

All this is to say, I probably counteracted the good from the IF with the bad from my lack of dietary willpower. I sent my primary care doc a note to ask for her advice, and she said to continue with IF because it really takes closer to a year to see significant results on the A1c and sugar front. She suggested I try doing IF only five days per week, but to try to extend it a couple of days a week from 16 hours off to 18-20. On the diet front she told me to eat a diet that I will stick with.

Rather than freak out, I have decided to rededicate myself to eating a low carb high fat diet, get serious about cutting out the “holiday” snacking, do IF Monday through Friday, and increase my walking to 5-6 days per week or a minimum of 150 minutes per week as recommended by the American Heart Association and others. Honestly, I felt better physically when I was sticking to the low carb high-fat diet more religiously. And the more beer I drink, the worse my GI system feels. If I didn’t love beer so much I’d give it up completely, but for now, I suppose I’ll limit my intake of the nectar of the gods and only imbibe on special occasions.

The experiment continues!