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 350.org, 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, and even my own employer the American Heart Association, 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!

Dying From Heart Disease is Pretty Much Optional

Punk rock legend Pete Shelley died on Thursday from an apparent heart attack at age 63, and once again my reaction was anger. Every time someone famous has a heart attack, I get in a fight with my inner voice. How did he not know he was at risk? Why didn’t he take care of himself? When are people going to start paying attention?

I know this might seem a touch disingenuous given I had a surprise heart attack when I was 45, but what I’ve learned about heart disease in the past seven years is enough to make me want to scream from the rooftops — you don’t have to go out this way! Heart disease is optional!

I’m not mad at these people, rather I’m mad at the situation. Nearly 18 million people die each year from cardiovascular disease (according to the World Health Organization) and 85 percent of those deaths are from heart attacks and strokes. 

Heart attacks and strokes are 80 percent preventable!

Yes, that’s right. The vast majority of these deaths can be attributed to preventable factors like obesity, poor physical activity, heavy drinking, eating unhealthy foods and not keeping your blood pressure and cholesterol under control. The CDC also found that about six in ten preventable heart deaths occur in people younger than 65 years old.

So why do people keep dropping dead from heart attacks? Do we not know how to prevent heart disease? Do we not care about getting heart disease? Are we too busy to worry about it? WTF people.

See, I get mad. It’s my issue, I know. Every time a famous person under…say…75, has a heart attack I am reminded of my own mistakes and my own mortality. I immediately go back to stage two of the five stages of grief. I’m serious. I get angry, then I get depressed (which is stage three).

Coach Mike Ditka had another heart attack recently. Alan Thicke. Garry Shandling. Carrie Fisher. Bill Paxton. It doesn’t make a difference who it is. Each time it happens I take it personally.

I wonder why I’ve become so passionate about heart disease prevention? Plenty of people have a health issue and keep to themselves. You don’t see Mike Ditka tweeting about heart disease. I think maybe there’s something in my personality that makes me want to stand up on a milk crate on the corner and preach the gospel of heart health. Is that a personality flaw or strength? I guess it depends on how obnoxious I am about it!

So, if you’re going to get anything valuable out of this post I probably ought to tell you how to prevent a heart attack so you don’t become one of the 14.4 million people who die each year from a preventable disease.

It’s pretty simple actually. I can tell you how to NOT have a heart attack in six words: Eat healthy. Move more. Don’t smoke.

Not smoking is the most obvious one. People who smoke are two to four times more likely to get heart disease. The risk is even greater for women who smoke and also take birth control pills. Seriously, don’t smoke.

Moving more is actually pretty easy as well. My employer, the American Heart Association, recommends adults get at least 150 minutes per week of moderate-intensity aerobic activity or 75 minutes per week of vigorous aerobic activity, or a combination of both, preferably spread throughout the week. What does moderate-intensity aerobic exercise look like? 

  • brisk walking (at least 2.5 miles per hour)
  • water aerobics
  • dancing (ballroom or social)
  • gardening
  • tennis
  • biking slower than 10 miles per hour

Seriously, all you have to do is walk for 30 minutes, five days a week. Nobody is suggesting you have to run a marathon or swim 50 laps a day.

Lastly, eat healthy. Well, this one may be a little more complicated. Note that I said complicated, not difficult. The aforementioned AHA (and others like them) suggest you simply eat a diet that focuses on a variety of fruits and vegetables, whole grains, low-fat dairy, skinless poultry and fish, etc. 

There are some that argue a “Mediterranean Diet” is best. Some argue you should be fully plant-based. Others argue keto is the healthiest way to eat. Paleo? Pegan? You can spend the rest of your life trying to figure out the “best” way to eat and never figure it out. So pick one of the above because in truth, all of them are healthy enough for the average person to avoid heart disease in combination with moving more and not smoking.

I have written about this extensively, and I’m convinced from my own health and indicators that it’s working. I eat a low carb, very low sugar, high healthy fat diet. I’m also doing a little intermittent fasting and I’m doing great by any standard. 

Want to know how you’re doing? I recommend you sign up for Life’s Simple 7 and take the survey. It’s free and you can go back again and again as your numbers change. It’s not perfect, but it’s an easy way to see how you’re doing.

Yes, heart disease is voluntary. I wish I knew that prior to Oct. 11, 2011 and that someone had shared these tips with me. Then again, had I not had a heart attack maybe I wouldn’t be on the Interwebs sharing these tips with you.

Getting ‘Poked and Prodded’ is My New Normal

Tomorrow I head to my cardiologist’s office for another in a seemingly endless series of tests. I know my life changed on Oct. 15, 2011 when I had a heart attack and that things will never be the same, but I had no idea how often I’d be subjected to diagnostic tests. I feel like the proverbial guinea pig.

Since it has been seven years since my cardiac event, I only have to see my cardiologist a couple of times a year now. But between those exams, I am required to have a blood test regularly (keeping an eye on my cholesterol, triglycerides, blood sugars and more) and then regular stress tests and echocardiograms. Tomorrow I get the double whammy — a nuclear stress test and an echocardiogram.

A nuclear stress test is a type of stress test that uses radioactive dye and an imaging machine to create pictures showing the blood flow to your heart. This is more involved than a standard stress test in which the victim (er, patient) is simply hooked up to an electrocardiogram (ECG) and blood pressure cuff to measure your heart’s reaction to exercise. For the nuclear stress test, you are also hooked up to an IV for the dye injection.

During the same visit, I’ll be subjected to an echocardiogram which is basically an ultrasound of your heart (it’s just like the ultrasound a pregnant woman receives to check on the status of her baby except instead of finding out the sex of the baby you find out the strength of your heart). The echo is a simple test, but I’ll never get used to the cold goo.

To be more precise, an echocardiogram takes images of the size and shape of your heart and also show how well your heart’s chambers and valves are working. This is pretty critical for me since at the time of my heart attack I had permanent damage to my heart muscle and it’s important to keep track of any changes in the amount of blood my heart pumps (known as ejection fraction). A normal heart’s ejection fraction is somewhere between 50 and 70 percent, while anything below 40 means you are in heart failure. At the time of my heart attack my ejection fraction was between 30-40 depending on who you believe, but with medication, exercise and time it has bounced back to around 60 at last check. For me, my ejection fraction is how I keep score of how I’m doing and so far, I feel like I’m winning.

The stress test, on the other hand, basically tries to determine if any of the coronary arteries that supply blood to and from your heart and blocked. A typical stress test is not foolproof, but a nuclear stress test is a much better way to determine if you have any blockages. Frankly, neither test is perfect and to be sure the best way to check for blockages is to insert a camera into your arteries but that’s pretty invasive and only done if the stress test or other indicators (like actually having a heart attack) suggest you might have a blockage. Basically, if I “fail” the stress test they’re going to go in and check and if I have blockages they can blast them with a balloon (angioplasty) and/or insert coronary artery stents to prop open the narrowed pathway. I had three stents inserted at the time of my heart attack, but the angiogram showed no other significant blockages so…I have that going for me.

All this is to ensure I have not gotten any worse since my heart attack, and thankfully, so far, I have not. In fact, I’ve gotten better. Still, these tests have become part of my routine and will likely continue to be part of my routine until such time as medical science comes up with a better way to see if your heart and arteries are doing what they are supposed to do.

I know these tests are helping me live longer, but I still feel like I’m at the doctor or a testing center all the time. It’s a pain in the ass. I know I should feel fortunate that I live during a time when we have all these diagnostic tests, and on top of that I have darn good medical insurance to pay for all these tests. But it’s still a pain in the ass.

Christian Bale Reminds us That Heart Attacks Vary

I read an interesting article today about how actor Christian Bale effectively saved the life of Vice director Adam McKay. As part of the Oscar-winning actor’s preparation to play former Vice President Dick Cheney in the upcoming film Vice, Bale learned everything he could about heart attacks because the veep had more than his share. At one point during the filming of the movie, Bale explained to McKay that not all heart attacks present with pain across the chest or shooting pain down the left arm.

Not long afterward, McKay was at the gym when he felt queasy and had tingling in his arm. He initially didn’t think much about it, but then he remembered what Bale had said about heart attacks and he rushed to the hospital. He was, in fact, having a heart attack, and getting to the ER so quickly likely saved his life and certainly saved his heart from having too much damage.

Fred Sanford on TV’s Sanford and Son had a “heart attack” in nearly every episode.

This is a lesson I try to share as often as I can. Not all heart attacks present in the same way, and in fact heart attacks in women often present in very different ways. When we think of heart attacks, many of us have the image of Redd Foxx as junkyard owner Fred Sanford clutching his chest and looking to the sky declaring to his dead wife “I’m coming to meet you Elizabeth.” That’s how I envisioned it. At least, until I had one.

Heart attacks can present in many different ways. Here are just a few: Pain in the area between shoulder blades, arm, chest, jaw, left arm, or upper abdomen. Dizziness, fatigue, lightheadedness, clammy skin, cold sweat, or sweating. Heartburn, indigestion, nausea, or vomiting. Discomfort or tightness in the arm or neck. Anxiety, chest pressure, feeling of impending doom, palpitations, or shortness of breath. In women, symptoms often include jaw pain, back or shoulder pain, shortness of breath, or nausea/vomiting.

Many times there’s little drama involved in a heart attack. My heart attack presented with a radiating heat across my chest, a cold sweat, indigestion, and pain down both arms. I didn’t think I was having a heart attack, though looking back I should have. And because my symptoms only lasted for about 20 minutes, I figured whatever it was had ended and I was OK. Because of that, I didn’t seek treatment for two days and ultimately that caused permanent damage to my heart that otherwise could have been avoided. I could very easily have died while I avoided going to the hospital. My E.K.G. was so bad when I did go to my doctor two days later that she called 9-1-1 and I got a ride to the ER where 30 minutes later I was in the cath lab receiving three stents for a mostly blocked left anterior descending artery (LAD).

Heart attacks are also not always caused by blocked arteries, otherwise known as atherosclerosis. Heart attacks can also be caused by a spasm of a coronary artery, arrhythmias (abnormal heart rhythm), cardiomyopathy (enlarged heart), undetected heart defects, and even electrical shock. In other words, heart attacks are not monolithic in nature.

WebMD has a nice list of common heart attack symptoms, but even if you’re having one or more of these symptoms it can be confusing to know if you should get to the hospital. It’s easy for me to say this in hindsight, but when it comes to heart attack symptoms I suggest you don’t take any chances. What’s the worst case — you spend a few hours at the ER and go home feeling silly? It beats dying!

Does a Statin a Day Keep the Grim Reaper Away?

Are Statins good or bad? It depends on who you ask.

Statin drugs, used to lower blood cholesterol, are among the most prescribed drugs in the world. In 2016, according to drug tracker QuintilesIMS Institute, the top-selling Statin in America, rosuvastatin (Crestor), brought in a whopping $4.2 billion for manufacturer AstraZeneca and atorvastatin (Lipitor), was prescribed 106 million times to top the list (it was ranked third behind only ACE Inhibitor lisinopril and thyroid drug levothyroxine). Crestor is currently among the top-selling drugs in the world, and Lipitor is the best-selling prescription drug of all time according to Forbes, raking in $148.7 billion since its approval in 1996. And while Lipitor went generic in the U.S. in 2011, manufacturer Pfizer still generated $1.76 billion in sales in 2016 with most of its sales coming from China and other overseas markets (https://www.fool.com) Any way you look at it, Statins are big business in America and around the globe.

Conventional medical wisdom suggests a direct link between high low-density lipoprotein (LDL) cholesterol and heart disease. The theory is that if you have too much bad cholesterol in your blood, it builds up in the walls of your arteries and over time causes hardening (atherosclerosis) which slows and/or blocks blood flow to and from the heart. This theory has been generally accepted for more than 100 years, culminating with the landmark Framingham Heart Study in the 1950s that among other things “proved” that factors such as smoking, high blood pressure, and high cholesterol were related to heart disease. As the science progressed, cholesterol became more understood and now cholesterol-lowering medicine is a cash cow for drug companies. This is an oversimplification, but suffice it to say there have been entire books written on the issue and we don’t really have the time or space here to delve too deeply into the research. Yet it doesn’t take a trained research scientist to type the words “does cholesterol cause heart disease” into Google and come up with hundreds of articles with conflicting conclusions. It is especially true that in the past few years the number of studies discounting the role of cholesterol in heart disease has increased substantially. Honestly, trying to understand cholesterol can give you a heart attack itself. Triglycerides. High-density lipoprotein. Low-density lipoprotein. Very-low-density lipoprotein. Apolipoprotein B.

I don’t know anymore if high cholesterol causes heart attacks. I’m not sure the medical establishment really knows. What I do know is that among the thousands of heart attack survivors in my Facebook support group, hundreds have reported that they did not have high cholesterol at the time of their heart attacks. Others used medication and lifestyle changes to lower their cholesterol and had second or third heart attacks. I had normal cholesterol and exceedingly high triglycerides prior to my heart attack, and both were under control through diet, exercise, and medications at the time of my heart attack. Had the damage already been done in my arteries? Perhaps. I don’t think I’ll ever know. I definitely have both my cholesterol and triglycerides under control now. In fact, as of this writing, my latest blood work showed my total cholesterol was 119, triglycerides 94, HDL cholesterol 41, and LDL 59. This gives me a total cholesterol to HDL ratio of 2.9. These numbers are fantastic by any measure and my primary care doctor, as well as my cardiologist, were very pleased, to say the least. How did I get my numbers to such cardiovascular-friendly levels? Well, I’ve been working on it and experimenting with various medicines, supplements, diet, and exercise. But before I tell you my secret, I must say once again that we are all individuals with different body styles, metabolisms, and, most importantly in my mind, genetic makeup. More than five years after my heart attack, I believe it was caused by years of high triglycerides. Note I used the word believe versus know. Nobody knows for sure why I had a heart attack at age 45, but given my personal history, I have come to believe that my nearly 100 percent blocked LAD was caused by a buildup of plaque due to high triglycerides in my bloodstream. Now I understand this does not account for why I only had a blockage in one artery, given that if in fact, this was the cause other coronary arteries could just as easily have been blocked. Maybe it was random. Or maybe there was something else going on, like inflammation in the LAD that gave the plaque a place to stick.

Regardless, my cholesterol levels were never very high and as you can see from my most recent numbers they are still very low. I was on a Statin prior to my heart attack, but that didn’t stop me from having a heart attack. It’s my understanding that Statins don’t do much to lower triglycerides, nor do they help raise good cholesterol (HDL). So were my doctors wasting my time by putting me on a Statin in the first place? Who knows. When I was first diagnosed with very high triglycerides I was put on a drug called fenofibrate (Tricor) to lower them, and it worked to some degree although while on Tricor they were never as low as they are now.

For the record, it’s my non-scientific belief that the combination of high levels of fish oil, moderate exercise, and a diet extremely low in processed carbs and added sugar has led to my low triglycerides and generally great blood work.

But what about Statins? If lowering LDL cholesterol is so important to the medical establishment shouldn’t we all be on a Statin? There are some doctors who believe this, perhaps most notably Dr. David Agus, professor of medicine at the University of Southern California Keck School of Medicine, who wrote in his New York Times bestselling book The End of Illness that everyone over 40 should discuss Statins with their doctor, even if they haven’t had heart problems or are at increased risk for heart disease or diabetes. Unfortunately, this strategy didn’t work for his most famous patient, Steve Jobs, who died of pancreatic cancer. Nevertheless, the anti-Statin forces are loud, so much so that some doctors are warning that the anti-Statin movement could actually be killing people.


“An internet-driven cult is attacking the safety and effectiveness of cholesterol-lowering Statins, despite mounds of clinical trial data showing the drugs work and produce minimal side effects,” 

Dr. Steven Nissen, chairman of cardiovascular medicine at the Cleveland Clinic, told CBS News in 2017.

The anti-Statin crowd seems to align around a different cause of heart disease — inflammation. In fact, more and more it seems the medical community is lining up on one side or another in this debate about cholesterol vs inflammation. One popular inflammation argument, championed by Scottish doctor and author of The Great Cholesterol Con Dr. Malcolm Kendrick, goes like this:


“Chronic stress leads to dysfunction of the hypothalamic pituitary adrenal axis (HPA-axis) which leads to sympathetic overdrive plus added raised stress hormones leads to metabolic syndrome (raised BP, raised blood sugar, raised clotting factors, raised cortisol, raised all sorts of things) which causes endothelial damage plus increased blood clotting which leads to plaque formation and death from acute clot formation.”

Malcolm Kendrick

Sounds reasonable, yes?

While the great cholesterol debate continues, millions of us remain on Statins and avoid high cholesterol foods, and it may not be doing anything at all to rid us of the number one cause of death in the world.

One thing we can say about cholesterol-lowering drugs like Statins is that they do in fact lower LDL cholesterol. There are hundreds if not thousands of studies to back these claims, so if you want to lower your LDL you should probably be on a Statin. I take a small dose of Crestor every day and my LDL is well below the danger zone. Common cholesterol-lowering drugs include:

  • Statins such as atorvastatin (Lipitor), pravastatin sodium (Pravachol), and simvastatin (Zocor)
  • Bile acid resins such as cholestyramine
  • Cholesterol absorption inhibitors such as ezetimibe (Zetia)

The Statin debate might be very different though if the drugs didn’t have such high reported rates of side effects. Common side effects include muscle pain and damage, liver damage, increased blood sugar or type 2 diabetes and memory loss or confusion. Perhaps these side effects are so widely reported because so many of us take Statin drugs, but perhaps they really do cause rough side effects in many people. I can tell you that no issue is more common in my Facebook support group than Statin side effects and the Internet is awash with people in chat rooms and on message boards complaining about Statin drugs.

It’s probably also worth mentioning that recently the American Food and Drug Administration approved a new type of cholesterol-lowering drug called evolocumab (Repatha) which has been hailed as a “breakthrough” to reduce LDL cholesterol without the side effects of Statins. No doubt, any advancement in cholesterol reduction is going to be big business and Repatha maker Amgen is counting on a huge windfall once the drug is more readily available. By the way, as for the side effect debate, even Amgen warns that Reptha’s side effects include: a runny nose, sore throat, symptoms of the common cold, flu or flu-like symptoms, back pain, high blood sugar levels (diabetes), and redness, pain, or bruising at the injection site.

Many of the survivors I speak to say their goal is to change their lifestyle so that they eventually can stop taking so many drugs. I have a slightly different attitude — I’m grateful for the science that led to these life-saving drugs. Yes, there are side effects and as science progresses we will likely find new therapies and maybe even debunk some current therapies. And while I agree that lifestyle changes are critical to post-heart attack health and well being, I’m fine chugging down a plethora of pills every day.

The bottom line for me is that I’m not so sure high cholesterol causes heart disease. And I definitely don’t think dietary cholesterol raises one’s cholesterol (I think sugar and carbs are the culprit). I’m all in on including healthy fat in my diet, and I have no problem eating eggs and other high cholesterol foods. That said, I don’t have any side effects from my Statin so unless the medical establishment publishes new clear-cut proof I don’t need it I’m going to keep taking it. Yep, hedging that bet a bit.

So You Think Keto is Extreme? Hold My Beer!

Two weeks ago I went to my first appointment with a new primary care physician and she said that while my bloodwork looked pretty darn good, she thought my sugars were still a little higher than she’d like to see. For crying out loud, I’ve been eating like a champ and my other numbers are, frankly, enviable. Total cholesterol 108. LDLs 59. HDLs 41. Triglycerides 94.

But my glucose was at 106, a touch higher than the recommended 99. And then there’s my LP-IR Score of 56. Any doctors out there agree that glucose of 106 and LP-IR of 56 is a concern?

Then my new doctor said something that surprised me. “You should consider intermittent fasting,” she exclaimed.

Wait, what? Don’t eat? But…but…but.

She explained to me that there was a lot of research out there that intermittent fasting (IF) was the best way to lower insulin resistance and that many people found it easy to integrate into their diets. She suggested I try IF 4–5 days per week and after a while, we could recheck my insulin numbers. She also jotted down the name of a Canadian doctor who has written a few books about the subject, Dr. Jason Fung, and sent me on my way.

I’ll be honest, I’m a connoisseur of popular diets and eating styles but I’d never heard of IF. So I went home and searched the interwebs for details, and before long I was fully down the rabbit hole. Holy moly there is a whole subculture of people who don’t eat for long periods of time in the name of good health.

I watched a few interviews with Dr. Fung and I was really struck by the science. I downloaded one of his books, The Complete Guide to Fasting: Heal Your Body Through Intermittent, Alternate-Day, and Extended, and read it over the course of a few days. I went from thinking the idea was crazy, to deciding to try it out.

Fasting has been around for thousands of years, and for our ancestor’s fasting was simply a matter of the difficulty of sourcing food. Our paleo brethren often went long periods without eating and I suspect there weren’t too many cavemen with type 2 diabetes. Fasting has long been used in religious worship across multiple belief systems. Hell, when you think about it we all fast daily — we don’t eat while we sleep. Intermittent fasting is just increasing the time you already don’t eat. I decided to use the 16/8 method of fasting, where you don’t eat after dinner and then skip breakfast before breaking the fast at lunch. What that looks like for me is that I don’t eat from 7 p.m. to 11 a.m. (water, tea, and coffee are fine).

Without going into too much scientific detail, IF is about insulin. When you eat, your insulin increases. When you don’t eat, it doesn’t. If your insulin is always elevated because you eat all day, and/or eat too much sugar and carbs, your insulin remains elevated and your body reacts by pumping sugar into your bloodstream. When you are fasting your metabolism increases. The bottom line is your body burns off sugar to provide energy, and when it runs out of sugar it burns stored fat.

There’s a nice explanation of the benefits of IF at Healthline. There’s tons of information all over the web so if you want to learn more just Google it.

I’ve been doing IF for almost three weeks now. Truthfully, it’s not difficult. I just don’t eat after dinner and then skip breakfast. I start eating again around 11 a.m. and between lunch and dinner, I try not to snack too much. Of course, when I do eat I eat a low carb, low added sugar diet. I call it a modified Mediterranean Diet or Pegan (which I’ve written about before).

I won’t know if IF has lowered my insulin levels until I get them checked again in a few months, but I can tell you I have lost weight. Belly weight. My midsection is definitely tighter and my pants are looser. I mean, it’s not rocket science. I’ve been eating less. Is that a crazy idea? I don’t think it is.