A Functional Approach to Cardiovascular Wellness

Episode Transcript
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Speaker 1 (00:03):
Hello, I'm Dr McMahon and welcome to the Wellness
Connection MD podcast.
In this episode we're going toexplore a functional approach to
cardiovascular disease, thenumber one cause of death in men
and women worldwide.
The main emphasis of thepodcast is a thorough discussion
of the modifiable risk factorsof heart disease.
Unfortunately, recent studiesshow that these risk factors are
on the rise, but it doesn'thave to be that way.

(00:24):
We give you practical,evidence-based solutions from
functional, integrative andconventional medicine to help
you avoid this dreaded disease.
We also discuss additionalresources at mcmindmdcom,
including information aboutmetabolic syndrome, natural
blood pressure therapies, stressmanagement tools, cholesterol
management, sleep therapeuticoptions, smoking cessation

(00:45):
support and Dr McMinn's cardiowellness plan.
We hope you enjoy the show.

Speaker 2 (00:52):
Welcome to the Wellness Connection MD podcast
with Dr McMinn and Coach Lindsay, where we bring you the latest
up-to-date, evidence-basedinformation on a wide variety of
health and wellness topics,along with practical take-home
solutions.
Dr McMinn is an integrated andfunctional MD and Lindsay
Matthews is a registered nurseand IIN-certified health coach.

(01:13):
Together, our goal is to helpyou optimize your health and
wellness in mind, body andspirit.
To see a list of all of ourpodcasts, visit McMinnMDcom and
to stay up to date on the latesttopics, be sure to subscribe to
our podcast on your favoritepodcast player so that you'll be
notified when future episodescome out.
The discussions contained inthis podcast are for educational

(01:35):
purposes only and are notintended to diagnose or treat
any disease.
Please do not apply any of thisinformation without approval
from your personal doctor.
And now on to the show with DrMcMinn and Coach Lindsey.

Speaker 1 (01:46):
Hello and welcome to the Wellness Connection MD
Podcast with Dr McMinn and CoachLindsey the evidence-based
podcast with all things wellnesswhere we bring you honest,
commercial-free, unbiased,up-to-date and evidence-based
information, along withpractical solutions in order to
empower you to overcome yourhealthcare challenges and to
optimize your wellness in mind,body and spirit, and to become a

(02:08):
great captain of your ship whenit comes to your health and
wellness.
We thank you so much forjoining us today.
I'm Dr Jim McMinn and I'm heretoday with our co-host nurse and
certified health coach, msLindsay Matthews.
Good morning, coach.

Speaker 3 (02:20):
Good morning, dr Mack .
It's good to be back with allyou listeners.
We are excited to be recordinganother show here.
So, dr, talking aboutcardiovascular disease, every
single cell in the body needs aconstant blood supply to deliver

(02:50):
oxygen and nutrients that arenecessary for our life, and it's
really the job of thecardiovascular system to make
that happen.

Speaker 1 (02:59):
You know, coach, by now.
I hope you appreciate that weare the evidence-based
functional medicine podcast, andin the realmbased functional
medicine podcast and in therealm of functional medicine, we
always look at things from thewhy point of view.
So let's apply that samefunctional medicine thinking to
heart disease.
So, coach, why do people getheart disease?
Well, that's what we're goingto be talking about today, coach
.
We're going to look atcardiovascular disease from the

(03:23):
point of view of risk factorsfor heart disease, because
understanding these risk factorsis crucial for prevention and
for treatment and with so manythings in functional medicine,
if you identify and treat theroot cause, then you'll get
better outcomes.
So we're going to identifythose root causes, or risk
factors, as we call them, ofcardiovascular disease today and
, in most cases, give you somepractical solutions.
And, for your viewing pleasure,we put together a list of these

(03:45):
risk factors for heart disease,which you can find at
bickmanmdcom under the documentsmenu.
It's entitled the Daggers ofCardiovascular Disease and, by
the way, coach, I think it's themost thorough list of
cardiovascular risk factors thatyou'll find anywhere.

Speaker 3 (04:00):
I love this visual and I like just thinking about
like a dagger to the heart.
You know what are those things.
So it kind of falls into twobig categories when you're
looking at the actual visualitself.
And those two categories areones that are modifiable risk
factors, which means that youget control over that risk
factor, you can modify it.

(04:21):
And then there's thenon-modifiable ones, things that
you really don't have controlover.
So, for instance, you can'tchange your family history, you
can't change your personalhistory, like how old you are,
your race, your gender, yourgenetic predisposition, but
those factors, thosenon-modifiable factors, still

(04:42):
profoundly affect your risk ofheart disease.
So we want to make sure that wedon't underestimate those.
So there was a study publishedin the Journal of the American
College of Cardiology that foundthat individuals with a family
history of premature heartdisease had two times as many
heart attacks or strokes.
So you got to pick your parentswisely, I guess, is the moral

(05:06):
of that story the next time youwant to avoid heart disease.

Speaker 1 (05:09):
Yeah, coach, there are some people to use an old
phrase that are just what I callborn behind the eight ball.
Do you know what that means,coach?
Have you heard that phrasebefore I?

Speaker 3 (05:16):
have heard that phrase before.

Speaker 1 (05:18):
I used to play pool years ago, and so that's where I
got that from.
But when it comes to heart riskfactors, however, there are
many other risk factors that aremodifiable, and that's what
we're really going to focus ontoday and, as usual, coach, most
of it goes back to being a goodcaptain of your ship, like we
talk about on every single show.

Speaker 3 (05:34):
We really do, you know.
It also reminds me talkingabout the old eight ball being
in the wrong position.
It reminds me of the oldserenity prayer which says
you've got to help me accept thethings that we can't change and
then have the courage to changethe things that we can, and
then the wisdom to know thedifference between the two.

(05:54):
So I think that applies to somany things in life and in this
case we want to help youlisteners identify the things
that you can change so that youcan be empowered and encouraged
to really avoid this commondisease that can be pretty
disastrous.

Speaker 1 (06:13):
And let me be clear possessing one or more risk
factors definitely increases aperson's risk of developing
cardiovascular disease, but itdoes not mean that
cardiovascular disease isinevitable.
I've known patients in their90s who have huge cholesterol
levels and they don't have alick of heart disease and they
go on to live a long, happy life.

Speaker 3 (06:30):
Right.
So before we dive into the riskfactor discussion, let's be
sure that we're all on the samepage.
Let's just define what we meanby the term cardiovascular
disease.
So simply put, it's a group ofdisorders affecting the heart
and blood vessels, and on thispodcast you might hear Dr Mack
and I abbreviate that with CVD,which stands for cardiovascular

(06:54):
disease.

Speaker 1 (06:55):
And the reason we feel it's important to define
the term cardiovascular diseaseis that, for instance, stroke is
considered to be acardiovascular disease.
Now, before I got into medicine, I might have thought stroke
was just mainly a brain disease,right, but it's really a
vascular disease which justhappens to be in the brain, so
it really falls into thecategory of cardiovascular
disease.

Speaker 3 (07:13):
And then, when we talk about cardiovascular
disease, there's common types.
So first type, coronary arterydisease, so that's the narrowing
or blockage of arteries aroundthe heart.
And then two another type ofcardiovascular disease would be
high blood pressure.
Three, heart failure, whichreally refers to the heart's

(07:35):
inability to pump the bloodeffectively out to the body.
Four, arrhythmias, so that'swhere your heart rate or rhythm
is abnormal, like atrialfibrillation.
Afib Stroke would be numberfive, and that's caused by a
reduced or blocked blood supplyto the brain, like you mentioned
, dr McMahon.

Speaker 1 (07:56):
And then we have number six, which is peripheral
artery disease, which isnarrowing of the blood vessels
in the arms and legs.
And then number seven iscongenital heart disease, and
these are structuralabnormalities in the heart
present from birth.
Number eight is cardiomyopathy,which is a disease of the
actual heart muscle itself.
It affects its shape, size andpumping ability.
And then we have rheumaticheart disease, caused by strep

(08:19):
infections, which causes damageto the heart valves.
And then we have venousthromboembolism, which is where
a person gets blood clots in theveins which can then travel to
bad places like the lungs or thebrain and cause serious mayhem.

Speaker 3 (08:31):
Before we move further and describe the risk
factors, let's break down thefour major components of
cardiovascular disease.
So first we have, or justreally have, the cardiovascular
system.
So we've got a pump which isthe actual heart muscle.
Then we've got all the pipesright, the vessels which go all
throughout your body, to everysingle cell in your body.

Speaker 1 (08:54):
And next we have the electrical system which
innervates the heart and thevessels, and then we have the
blood vessels and then we havethe blood itself, and this is
important because some bloodproblems, such as clotting
disorders, can greatly affectcardiovascular risk.
Unfortunately, there are manythings that can go wrong in all
four of these major componentsour cardiovascular system.

Speaker 3 (09:21):
And now we're going to move into the modifiable risk
factors.
So you can, if you want to, ifyou have space and time, pull up
the daggers of cardiovasculardisease that handout we were
talking about and you can followalong.
We'll start with high bloodpressure, and also known as
hypertension.
You might've heard that term.
It's really a silent killerbecause most of the time you

(09:42):
can't even feel it, but it cansneak up on you and cause
serious problems.

Speaker 1 (09:48):
So that high blood pressure goes on to cause heart
failure, coronary artery disease, stroke, peripheral artery
disease, aortic stenosis, whichis a heart valve disease, and
cardiac rhythm problems such asatrial fibrillation, as well as
other things like kidney disease, dementia and early death.

Speaker 3 (10:06):
The Framingham Heart Study, known as one of the
largest studies of its kind,showed that individuals with
blood pressure higher than 160over 95 had about a fourfold
increase in the risk of coronaryheart disease compared to those
that had just a fourfoldincrease in the risk of coronary
heart disease compared to thosethat had just a normal blood

(10:27):
pressure.

Speaker 1 (10:28):
Non-pharmacologic, non-invasive treatments of high
blood pressure include thingslike low-sodium diet, adequate
potassium intake, routinephysical activity and attaining
a healthy body weight.
Smoking cessation and, for somepeople, reduction of alcohol
may also help, and there arealso some other non-drug
strategies that have some solidevidence to back them up.
These are too numerous to listhere, but we have a document at

(10:50):
mcmindmdcom under the documentsection that lists these for you
, so check that out.

Speaker 3 (10:56):
At the end of the day , though, you've just got to do
what you've got to do to bringyour blood pressure down to an
acceptable range.
So if your blood pressure isnot too high and it's okay with
your provider, you might like totry some lifestyle and natural
remedies that we mentioned, butif that doesn't work, then your
provider will probably want tostart you on some meds, and most

(11:16):
doctors start to think aboutmeds when the blood pressure
exceeds 140 over 90.
Really, a target goal fortherapy is to kind of get that
blood pressure down below 130over 80.

Speaker 1 (11:27):
So the bottom line when it comes to blood pressure
is to work with your providerand to get your blood pressure
under control, whatever it takes.
This is just super important,because failing to do so can
cause lots of badness.

Speaker 3 (11:39):
So let's turn over to the diet, the modern American
diet, with this excess ofsaturated fats, trans fats,
sugar, refined carbs, ultraprocessed foods, high levels of
sodium, low nutrient density,aka the SAD diet, right,
standard American diet.
It's a major risk factor forheart disease disease.

(12:07):
So, on the other hand, we'vegot the PREDIMED study which
demonstrated that theMediterranean diet which, if
you've listened to our podcastbefore, you've heard us mention
it several times, right, dr Mack, of course Supplemented with
extra virgin olive oil or nuts,so it has all those good,
wonderful fats reduce the riskof major cardiovascular events
by 30%.

Speaker 1 (12:26):
Yeah, it's really impressive.
Yeah, never underestimate thehealing power of a good diet.
There is a specific diet calledthe DASH diet, which is a
spinoff of the Mediterraneandiet, which can bring down blood
pressure.
The letters DASH stand forDietary Approach to Stopping
Hypertension.
So diet-wise, we should limitexcessive sodium,
ultra-processed carbohydrates,sugar-sweetened beverages like

(12:48):
sodas and sweet tea, alcoholicbeverages, trans fats, saturated
fats and ultra-processed meatsand we should be eating more
vegetables, fruits, legumes,nuts, whole grains, seeds and
fish.

Speaker 3 (13:02):
You know again the good old Mediterranean diet.
It's good for whatever ails you, dr Mack.

Speaker 1 (13:07):
For real.

Speaker 3 (13:07):
It was recently named the best diet for overall
health for the eighth year in arow, and one of the amazing
things I think about theMediterranean diet that I think
is highly worth mentioning whenwe talk about cardiovascular
health is olive oil, like Ibriefly mentioned earlier.
But the Mediterranean diet usesa lot of olive oil and research
indicates that olive oil hasbenefits on both inflammation

(13:29):
and cardiovascular disease.
There was a study out of Yalethat showed a 19% lower risk of
heart disease with just a half atablespoon of olive oil daily.

Speaker 1 (13:38):
Wow, that's pretty impressive.
I think it also helps withdementia and stuff like that too
.

Speaker 3 (13:42):
Yes, yes, just because of that overall
inflammatory effect you know, Iknow you know this, dr Mack, but
Tyler and I supplement oliveoil.
We take it like a supplementevery day.
I like to take it as a shotglass personally.
But, Tyler likes to get it onhis food.
And anyway, I just think thepower of good, old-fashioned
olive oil.

Speaker 1 (14:00):
Right, right, right.
It's pretty amazing.
I had a patient one time,leslie.
She was so into like eatingnon-processed food.
I told her to take some oliveoil.
She said well, doctor, isn'tthat processed?
Shouldn't I just eat olives?

Speaker 3 (14:14):
So I guess that takes it to a whole nother level.
It does take it to a wholenother level, but wow.

Speaker 1 (14:18):
I was impressed.

Speaker 3 (14:27):
Personally, I don't take it that far, coach?
I don't think I do either.
But you know, anyway, that'sinteresting to think about.
But you know, dr Mann, I thinkit can be hard for especially us
Southerners, right we'rerecording this from Alabama that
it's hard to jump from a lot ofour fried foods to a
Mediterranean diet.
You know, after all, chick-fil-ais God's chicken, right?
Oh yeah.
So I just want to encourage ourlisteners, like I always like
to, just from a health coachperspective just take some small

(14:50):
steps in the right directionand make healthy substitutions.
So it might be helpful to workwith a good nutritionist like
our friend Rachel Olson, whowe've had on the podcast before.
She's a wonderful wealth ofknowledge, she's super nice.
You can find her informationunder our guest biographies on
mcminnmdcom.
She's super intelligent,well-researched and she can get
you really where you need to be.

(15:12):
And you know, before we move onfrom diet stuff, the
Mediterranean diet can be greatfor so many people but maybe
it's not for everyone.
For instance, my hubby Tyler.
He has some specific healthissues which have responded
better to a different diet.
So it goes back to that conceptof personalized medicine where
you know there's the Dr McMinndiet, there's the Lindsay diet,
there's the Tyler diet and wegot to kind of hone in what

(15:34):
works best for your body withwhatever it is that you're
dealing with, and nutritionistslike Rachel can really help you
if you need guidance in thatarea.

Speaker 1 (15:43):
You know, coach, for instance, we're looking at this
from the lens of cardiovascularhealth.
There are other people who atcertain points in their life,
their main emphasis may not becardiovascular health, but it
might be gut health ordysautonomia or something else,
and so they have to kind of havea diet that's really focused on
their main thing at that time.
But then things might changeand someday they might find that

(16:03):
a Mediterranean diet is rightfor them, but maybe not right
now.

Speaker 3 (16:06):
And I think that idea of whole, like nutrition's not
static, because our life is notstatic.
You know our needs in life arenot static.
You know we go throughdifferent seasons.
We see that just in natureitself.
So I think it makes sense thatthe diet needs to adjust to you
and the season of life you're in.

Speaker 1 (16:23):
Correct, it's not static and it's not one size
fits all for sure.
So, speaking of nutrition,coach, low vitamin D levels have
also been linked to increasedcardiovascular risk.
A meta-analysis in the AmericanJournal of Clinical Nutrition
showed that individuals with thelowest vitamin D levels had a
52% increased risk ofcardiovascular disease.
Whoa, coach, that's huge.

Speaker 3 (16:42):
Yeah, vitamin D super huge.
And there was anotherrandomized controlled trial that
looked at supplementing vitaminD and K2 together and found
that those two supplements had a70% fewer adverse
cardiovascular events for peopletaking them.
70%.

Speaker 1 (17:01):
Yeah, that's really striking Coach.
Yeah, it is.
And so, and by the way, let mesay, before you take any
supplements, check with yourprimary care doctor or your
cardiologist, because noteverybody, for instance, can
take vitamin K, and so, anyway,there are some, you know,
supplement drug interactions andthings like that that you'll
have to check with your PCP on.
So there are some otherspecific nutritional

(17:22):
deficiencies that can alsoaffect cardiovascular risk, as
supported by scientific evidence, and these include things like
B vitamin deficiencies,deficiencies in vitamin C,
vitamin E, magnesium, calcium,potassium, zinc, iron and
omega-3 fatty acids.

Speaker 3 (17:37):
So the next risk factor on our list that we're
going to discuss is obesity, andthis is a significant problem
in America and it is increasing.
And this is a significantproblem in America and it is
increasing.
It's getting worse.
Projections suggest that about60% of today's children will
develop obesity by the age of 35.
And that's sad.
Obesity carries with it asignificant increased risk for

(18:01):
developing cardiovascularconditions.

Speaker 1 (18:05):
Significant increased risk for developing
cardiovascular conditions inaddition to other diseases and
problems, and studies show thatfor every five-unit increase in
body mass index, the risk ofcoronary artery disease
increases by approximately 20 to30 percent.
This happens via numerousdifferent mechanisms, and these
include things like increasedstrain on the heart, high blood
pressure, unhealthy cholesterol,systemic inflammation,

(18:26):
increased insulin resistance andtype 2 diabetes.
Increased risk of obstructivesleep apnea, increased risk of
blood clotting, so that extraweight is not just about looking
good in your favorite dress.
It's about life and death.

Speaker 3 (18:37):
Weight loss is a whole podcast of its own.
It's a complex issue and wedon't want to oversimplify it.
There are so many factors thatgo into it, so you really need
to work with your provider andconsider working with a
nutritionist or a health coachWhatever works for you in order
to achieve your ideal bodyweight.
Your health will improve in somany ways and you'll feel so

(19:00):
much better as well.

Speaker 1 (19:02):
Yeah, Now, Coach, just a brief word about
hydration.
There are a couple of studieswhich suggest that poor
hydration can increasecardiovascular risk via several
different mechanisms that I'mgoing to go into today.
So the solution, of course, isjust adequate fluid intake.
And the next risk factor thatwe'll mention is metabolic
syndrome.
You can think of this as kindof like a pre-diabetes.
It was always amazing to me howmany patients came in with

(19:25):
clear metabolic syndrome, buttheir doctors had never even
mentioned it.
The key here is that you don'thave to wait to cross a line
into diabetes before you startgetting risk factors for badness
.
People with metabolic syndrome,even without diabetes, are two
to three times more likely todevelop cardiovascular disease
compared to those without it,even without other traditional
risk factors like smoking.

(19:46):
So if you recognize and treatthis early, then you can nip it
in the bud and prevent someserious stuff like diabetes,
heart disease and stroke.

Speaker 3 (19:54):
So how does one recognize metabolic syndrome?
According to the American HeartAssociation, there's five
different criteria and if youhave three out of five then you
are considered to have metabolicsyndrome.
So those criteria are increasedwaist circumference, high
triglycerides, low HDLcholesterol, increased systolic

(20:17):
blood pressure that's that topnumber and increased fasting
blood sugar levels.
So they do have all thosespecific cutoff numbers.
If you really would like to golook those up, you can.
They're readily availableonline and we'll in fact have a
summary posted of it on themetabolic syndrome document in
the document section atmcminnmdcom.

(20:38):
So we'll have that listed foryou to look at.

Speaker 1 (20:41):
And treatment of metabolic syndrome usually
starts with lifestyle changes.
These include diet, exercise,all that kind of stuff.
Consistent dietary changes andregular physical activity not
only help manage metabolicsyndrome, but also reduce its
long-term health risks.
Then, if lifestyle changesdon't do the job, then
medications may help.
Again, the key is earlyrecognition, and then the
earlier the interventions begin,the more profound the benefits

(21:02):
will be.

Speaker 3 (21:03):
You know, my parents recently came into town.
Dr Mack and dad was sitting atthe table talking about chopping
wood and he was talking aboutthe importance of chopping it
early after the tree fell versuswaiting, and because if you
wait longer that wood getsharder and if you chop it right
away he described dad said itchops like butter, and I just
think about that as a concepthere with so much of this

(21:25):
lifestyle medicine the longeryou wait, the harder it will be.
So today is the day, today's theday Chop it like butter versus
waiting until it gets harder andharder to do the next risk
factor that we'll mention isdiabetes, and sometimes, if you
don't nip it in the bud likewe're talking about, then
prediabetes does turn intodiabetes.

(21:47):
The InterHeart study showedthat diabetes doubled the risk
of heart attack.
Type 1 diabetes is consideredto be an autoimmune disease.
However, type 2 is more closelyrelated to all these lifestyle
factors.
So attention to things likediet, exercise, weight
management can really helpprevent and, in many cases,

(22:08):
really actually treat type 2diabetes.

Speaker 1 (22:10):
You know, another one of the core lifestyle factors
that is, a cardiovascular riskfactor that we often
underestimate is restorativesleep.
Poor sleep quality and quantitycan eventually take a toll.
A study in the European HeartJournal found that individuals
sleeping less than six hours pernight had a 48% increased risk
of developing or dying fromcoronary heart disease.
Sleep apnea, in particular, hasbeen strongly linked to

(22:32):
hypertension, arrhythmias andheart failure.

Speaker 3 (22:35):
And speaking of sleep , another sleep-related issue is
shift work.
So numerous studies have shownthat shift workers are at higher
risk of cardiovascular diseaseevents like myocardial
infarction, stroke and coronaryartery disease.
Some meta-analysis showed that15 to 20 percent there was a

(22:55):
higher risk of cardiovascularevents for shift workers
compared to regular daytime workschedules.
So, gosh, I'm so appreciativeof night shift workers,
especially in the hospital, drMack, and I know you took your
fair turn of that, but thebottom line is it's we got to
make sleep a priority and workwith your provider if you need

(23:17):
to check for sleep apnea as well.
So, if you need more expertise,there's some excellent doctors
who specialize in sleep medicineand we'll have a document for
you again on McMinnMDcom, in thedocument section called McMinn
Sleep Therapy Options.

Speaker 1 (23:30):
In our neighborhood.
I pass by a hospital frequentlyand every time I do I look up
there and I think about all thedoctors, nurses, orderlies,
pharmacists and other fine folksthat take care of us all night,
and how grateful I am.
And what would we do withoutthem?
And you know, that can be saidfor all the people who work
nights I mean to fill up ourgrocery shelves or whatever.

(23:53):
So I'm just so grateful forthem.
But it does take a toll onthose people, yeah for sure.

Speaker 3 (23:56):
Yes.

Speaker 1 (23:58):
I can attest to that, after working 20 years of night
shifts in the ER, I know youcan yeah.
But the ears of night shifts inthe ear.
I know you can, yeah, butmental health also plays a role
in heart health, Coach.
There's an old saying that goeslike this the body is a puppet
of the mind.
And I think there's a lot oftruth to that saying, Coach.
In other words, it's all linkedtogether.
If we're having troubles withour mind and that creates

(24:18):
problems throughout our body,for instance, there's solid
evidence that things likedepression, anxiety, social
isolation, instance, there'ssolid evidence that things like
depression, anxiety, socialisolation, loneliness, PTSD and
emotional and psychologicaltrauma are all linked to

Speaker 3 (24:35):
Meta-analysis published in the European
Journal of Preventive Cardiologyfound that depression was
associated with a 30% increasedrisk of coronary artery disease.
And then there was anothermeta-analysis of 46 different
studies that found that anxietywas associated with 41% higher
risk of coronary heart diseaseand cardiovascular mortality.

Speaker 1 (24:54):
Well, coach, those are huge numbers, aren't they?

Speaker 3 (24:56):
They are, they really are, yeah, yeah, it's very
significant, and I don't knowvery many people in my life that
could say they don't haveanxiety.
You know, yeah, right.

Speaker 1 (25:04):
These are anxious times we live in, aren't they?

Speaker 3 (25:06):
Coach they are yes, sir.

Speaker 1 (25:08):
Another meta-analysis published in the journal Heart
in 2016 showed that socialisolation and loneliness are
associated with a 29% increasedrisk of coronary artery disease
and a 32% increased risk ofstroke.
In fact, chronic loneliness hasbeen compared to smoking 15
cigarettes a day in terms of itsimpact on health.
Wow.

Speaker 3 (25:27):
Wow, yeah, that's quite a statement, isn't that?
something.
Moving on to stress, soextensive research has
demonstrated that both acute andchronic stress can have
detrimental effects on our hearthealth specifically.
So some studies suggest thatchronic stress may be associated

(25:48):
with 50% excess risk forcardiovascular disease may be
associated with 50% excess riskfor cardiovascular disease.
So managing that stress shouldbe considered a very important
component of cardiovasculardisease prevention and treatment
strategies.
And again at mcminnmdcom youcan find Dr Mack's stress
management toolbox and hisstress plan in the document

(26:09):
section.
So just you know, listeners,take a day sometime, peruse that
website and hit the printbutton.

Speaker 2 (26:15):
You know.

Speaker 3 (26:16):
Print some of those resources out.
They're free for you?

Speaker 1 (26:19):
Yeah, they are free.
Research has consistentlydemonstrated a strong link
between emotional andpsychological trauma as an
increased risk factor forcardiovascular disease.
These folks have a 27 to 44%higher risk of cardiovascular
disease, even after accountingfor lifestyle and medical
factors, and this increased riskapplies to both acute and
chronic trauma.
Interestingly, severe childhoodadversity in particular puts

(26:42):
people at risk with a 50% higherrisk of developing
cardiovascular disease later inlife.
You know, coach, there's aninteresting phenomenon that I
saw back in my ER days calledbroken heart syndrome.
It's also known as takotsubocardiomyopathy or stress
cardiomyopathy.
It usually affects women,typically postmenopausal women,
and these women would have asudden heart attack due to

(27:04):
severe acute stress.

Speaker 3 (27:05):
Really, literally dying of a broken heart, like
it's called broken heartsyndrome Broken heart, like it's
called, broken heart syndrome.
Last on our list of mentalhealth-related cardiovascular
risk conditions ispost-traumatic stress disorder,
or PTSD.
Individuals with PTSDunfortunately have a 49%
increased risk of coronary heartdisease and cardiovascular

(27:27):
mortality.
Cardiovascular conditionsresulting from PTSD also include
high blood pressure, AFib,heart failure, stroke, coronary
heart disease and heart attackitself.

Speaker 1 (27:39):
Now, anybody can have PTSD under the right
circumstances or I should saythe wrong circumstances but we
often see in our brave veteranswho have made so many sacrifices
for our country.
These folks should be closelymonitored for cardiovascular
risk factors and complicationsand, interestingly, women are
more at risk than men for PTSD.
An interdisciplinary approachinvolving mental health

(28:00):
professionals and a cardiologistmay be beneficial for optimal
care for these folks.

Speaker 3 (28:05):
So when we're looking at these effects of depression,
anxiety, loneliness, socialisolation, stress, emotional and
psychological trauma like PTSD,the bottom line is clear
there's a direct heart-brainconnection and we need to take
care of our mental and spiritualhealth and stay social, really

(28:26):
in order to reduce ourcardiovascular risk.

Speaker 1 (28:28):
Now let's move on to another one of our key lifestyle
factors related tocardiovascular risk, and that is
exercise.
According to the AmericanSociety of Preventive Cardiology
, physical inactivity is a majorrisk factor for cardiovascular
disease, leading directly orindirectly to 10% increase in
premature mortality.
And yet only 50% of adults getsufficient physical activity.

(28:49):
Worldwide, approximately 3.9million premature deaths could
be prevented every year just bygetting adequate physical
activity 3.9 million.

Speaker 3 (28:59):
Yeah, that's a lot of folks in it, you know.
I'd like to point out that it'snot just the classic cardio
exercise that could help, butalso strength exercise or
resistance training can have areally significant positive
impact on cardiovascular risk.
Studies show that engaging inweight training can be as
effective as aerobic exercisefor improving blood pressure and

(29:22):
your lipid profiles, andstrength training is also linked
to a lower risk ofcardiovascular events and
mortality, specifically in olderadults.
Risk of cardiovascular eventsand mortality, specifically in
older adults.
So the combination of usingresistant training with the
aerobic training may providegreater benefits for reducing
certain cardiovascular diseaserisk factors like obesity,

(29:44):
diabetes, hypercholesterolemiaversus just doing one of those
types of exercise alone, butdoing that combination
resistance and aerobic training.

Speaker 1 (29:54):
Well.
So, coach, that begs thequestion how much exercise is
enough?
Well, the answer is somewhatdebatable, but many experts
recommend that we get at least150 minutes of moderate
intensity physical activity perweek, or greater than 75 minutes
of vigorous, intensive physicalactivity per week.
However, if you can't reachthese goals, then it's worth
noting that any exercise isbetter than none.

(30:15):
Another thing, coach I thinkthat it's worth noting that if
you sit for 10 hours a day, youcan't overcome that, really,
with exercise.
I think there's this old sayingthat sitting is the new smoking
.
You've heard that, right, yes,I have heard that.
I think when you're at work, ifyou can have a standing desk or
if you can get up once an hourand move around, all that stuff
is quite helpful as well.

(30:35):
Due to the emerging data as faras strength training that you
talked about a little bitearlier, Coach, the American
Heart Association is now alsorecommending that we combine
cardio and strength exercise.

Speaker 3 (30:46):
And I want to emphasize that you don't have to
go to the gym or buy a bunch ofexpensive equipment to really
harness this benefit.
The Harvard alumni study foundthat men who just walked
regularly had a significantlylower risk of coronary heart
disease.
And there was a large theNurses' Health Study that found
that women who walk briskly forat least 30 minutes a day had a

(31:09):
30% lower risk of developingheart disease.
So no equipment needed, exceptmaybe the good pair of
old-fashioned walking shoes.
And for the strength training.
Really people can do thoseold-fashioned things like
push-ups and pull-ups, squatsand lunges.
You don't have to make it socomplicated that you end up not
doing it.
I think sometimes that's thebarrier in itself.

Speaker 1 (31:32):
Yeah, start easy, and you know, I have begun to
realize, Coach, I think the keyis consistency.
Really Make it a lifetime habit, you know.
Just plan it into your day.
Okay, when am I going to getexercise?
Am I a morning exerciser?
Or I know my wife, Dr Cheryl.
She likes to exercise in themorning.
I'm not a morning guy, so I doit before dinner, but I do it

(31:53):
consistently almost every day,and so I think that's the key.
Next on the list is smoking,and smoking.
Tobacco significantly increasesyour chances of developing
Smoking damages and narrows thearteries through a number of
different mechanisms, but thegood news is that after quitting
smoking, health benefits suchas improved circulation usually
happen relatively quickly, coach.

Speaker 3 (32:14):
Quitting can be difficult, though, and it can be
hard to do it by yourself, sothere's many tools in the
smoking cessation toolbox, sowork with your provider to get
on a program, and the first stepis just really to make up your
mind that it's important enoughfor you to do it.

Speaker 1 (32:31):
You know, one good way to get them in to quit coach
, is to tell them that smokingis terrible for erectile
function and knowing that, rightthere, we'll get a lot of guys
to kick the habit.

Speaker 3 (32:41):
You know it's funny.
I was talking to someone lastnight who was sharing the story
that there was a man that wasdiagnosed with prostate cancer
and he decided he was going toquit smoking because of that.
And you know, I mean I'm surethere's some correlation there,
but of course the correlationwould be, a stronger cancer for
something else but that was the.
You know that was the dominothat helped him stop it.

Speaker 1 (33:03):
Well, you can tell them that smoking, tell the guys
that smoking causescardiovascular disease and it's
not going to change their mind.
But if you tell, them that itcauses erectile dysfunction,
then for sure they'll quit.
So anyway, that's motivating.
Yeah, that's right, that'sright.

Speaker 3 (33:18):
So maybe sometime we can do another podcast on that.
Dr Mack Smoking cessation.

Speaker 1 (33:23):
Yeah, yeah.

Speaker 3 (33:23):
But next on the list is socioeconomic status, and you
know we're not surprised herethat people who have a lower
socioeconomic status are at agreater risk of developing
cardiovascular disease, and thereasons for this are multiple
and complex.
Diet is generally considered tobe one of the biggest reasons.

(33:44):
People from a highersocioeconomic background usually
have greater access to morenutritionally balanced diets.
Background usually have greateraccess to more nutritionally
balanced diets.
And then, on the other hand,people with that low
socioeconomic status often livein places called food deserts
where they're not having accessto food that is more healthy for
you and then just factually, itcosts money to eat.

(34:05):
Well, organic food is moreexpensive than processed foods
and less readily available.

Speaker 1 (34:17):
Another factor is that people with lower
socioeconomic status have ahigher exposure to toxins.
We'll dive into the toxin issuein just a bit.
But think about it You'll neverfind a chemical factory or a
polluting oil refinery in anaffluent community.
They're always located incommunities of color and where
you'll find a lot of poor peoplealways located in communities
of color and where you'll find alot of poor people.

Speaker 3 (34:38):
So let's kind of also mention ethnicity.
The terms race and ethnicityare often used interchangeably,
but ethnicity really has abroader context.
Race is primarily a socialconstruct, historically based on
physical characteristics suchas skin color, facial features,
hair texture.
It has often been used toclassify people into broader
categories like Black, White,Asian, whereas ethnicity refers

(34:59):
to shared cultural factorslanguage, religion, ancestry,
traditions, cultural practices.
So it's more about the person'scultural identity than a
physical appearance.

Speaker 1 (35:11):
So, for instance, statistics suggest that people
who are of Caribbean descenthave a greater risk of
developing cardiovasculardisease, regardless of their
race.
Another example for instance, awhite person who lives in the
American South, who eats theclassic Southern diet, which is
terrible for your heart, mayhave a different cardiovascular
risk profile, say, compared to awhite person who grows up in

(35:32):
Japan, where he or she isexposed to a diet rich in
omega-3s, along with vegetables,soy, green tea, and a low
consumption of saturated fatsand processed foods.

Speaker 3 (35:49):
Menopause has long been thought of as a
non-modifiable risk factor.
However, times have changed andin these days where we have
hormone replacement therapy asan option for these women, we
can kind of start to think ofmenopause, possibly even as a
more modifiable risk factor tosome extent.

Speaker 1 (36:01):
Now I'm going to use the abbreviation HRT for hormone
replacement therapy, and formany years HRT was thought to
cause an increase incardiovascular risk.
This was mainly due to a studycalled the Women's Health
Initiative Study, which was backin the 90s, and it was very
misleading in this regard.
Women in the study who tookPrimpro had more heart problems
than women in the study who didnot.

(36:23):
A more in-depth breakdown,however, of the WHI data and
more recent studies havechallenged that notion.
The problem was in those earlystudies like the WHI, they used
the wrong hormones.
The primrin used in the Women'sHealth Initiative study is not
the same as a woman's ownnatural estrogen.
The estrogen in primrin comesfrom a pregnant horse.
It's basically horse estrogen,not human estrogen.

(36:46):
It's not the same.
They have a different chemicalcomposition and even a slight
change in chemical compositioncan create different outcomes.
Also, they gave it orally andwe know now that oral estrogens
cause more blood clots andcardiovascular risk, whereas
transdermal estrogens do not.
Likewise, the Primpro uses aprogestin called Provera, which

(37:06):
is not the same as a woman'snatural progesterone, and in
hindsight, the data suggeststhat the Provera was definitely
a culprit when it comes tocardiovascular risk.
Also, in some of these studies,the HRT regimen was started at
an older age, many years aftermenopause, which skews the
results towards cardiovascularbadness.
However, we now see, with someexcellent large studies, that a

(37:27):
well-designed HRT regimen withbioidentical hormones, used the
right way at the right time, canactually reduce cardiovascular
risk.

Speaker 3 (37:34):
For instance, the Danish osteoporosis prevention
study with over a 10-yearfollow-up found that early
initiation of HRT reducedcardiovascular mortality and did
not increase stroke orthrombolytic events.

Speaker 1 (37:51):
Another study called the E3N study, a large study out
of France with over 100,000women specifically examined
transdermal estrogen with abioidentical micronized
progesterone, and they found alower risk of cardiovascular
disease compared with other HRTtypes and also compared to
neurohormone replacement therapyat all.
These studies illustrate whatI've been saying on the podcast
for many years when it comes toHRT, it matters what you use and

(38:14):
how you use it, and when itcomes to cardiovascular disease,
it also matters when you use itTo reduce cardiovascular risk.
Hrt works best if it startedwithin 10 years of menopause.
Also, you'll want to use atransdermal estrogen along with
a bioidentical progesterone.
If you do that, then the datais crystal clear.
There is no increased risk ofclotting and HRT can

(38:34):
significantly reducecardiovascular risk.
So work with a qualifiedprovider who specializes in HRT
to get on a customized program,and this can help you in many
ways, including heart protection.

Speaker 3 (38:45):
And let's transition to also cover the issue of
infectious disease.
So certain infectious diseasesdo increase the risk of
infectious disease.
So certain infectious diseasesdo increase the risk of
So, for instance, viralinfections, hiv, influenza,
chronic hepatitis C, covid-19,and bacterial infections like

(39:06):
chlamydia, pneumonia,streptococcal infections, as
well also chronic infections ofthe gums in our mouth, those can
increase the risk ofcardiovascular disease.
Got to also mention parasiticinfections like the Chagas
disease and chronic gutinfections like H pylori are
linked to cardiovascular disease.

(39:27):
So the solution here is ofcourse to avoid or properly
treat these infections when theycome up.

Speaker 1 (39:34):
There are also certain medications that may
increase the risk ofcardiovascular disease.
For some folks, these includethe chronic use of non-steroidal
anti-inflammatory drugs, whichwe also call NSAIDs, such as
Motrin and Naproxen.
Also, there's a certain classof NSAIDs called selective COX-2
inhibitors, such as Celebrex,that are particularly associated
with an elevated risk of bloodclotting, which can lead to

(39:55):
things like heart attacks andstrokes.

Speaker 3 (39:57):
Other medicines that can increase the risk of
cardiovascular disease includeoral contraceptives,
antipsychotics, chemotherapy,immunosuppressants and some
diabetes medications, and thenstimulants like amphetamines,
either prescribed orrecreational, like cocaine and
meth.

Speaker 1 (40:15):
Other medications that impact cardiovascular risk
include Phentermin, which is aweight loss drug we don't use
that much anymore, but we usedit back in my early career
Certain anabolic steroids, someantidepressants, such as
tricyclic antidepressants,corticosteroids like prednisone,
and drugs that cause what wecall QT prolongation, which
would include someantiarrhythmics, some

(40:36):
antibiotics, some antifungalsand anti-nausea drugs.
So you'll certainly want towork with your prescribing
provider if you're taking any ofthese medications in order to
mitigate your cardiovascularrisk.

Speaker 3 (40:46):
The next risk factor that we'll mention on our
daggers of cardiovasculardisease is toxins.
This significantly contributesto cardiovascular risk, and we
feel that the adverse medicalimpact of toxins really is
grossly underestimated by themedical community.
When is the last time yourcardiologist tested for, or even

(41:10):
mentioned toxins?
I'll bet the house that theanswer is never.
However, recent scientificevidence strongly supports the
link between the exposure ofenvironmental toxins,
particularly toxic metals solead, cadmium, arsenic with an
increased risk of cardiovasculardisease.
Even low-level chronic exposureto these metals can increase

(41:35):
your risk by 15 up to 85 percent.
So if you think you are notexposed, then you really are
underestimating our world today.
We live in a world full oftoxins, and it's not an
exaggeration to say that you'llfind toxins in the food that we
eat, the water that we drink andthe air that we breathe, and we

(41:55):
just kind of need to acceptthat and then make a strategy.

Speaker 1 (41:58):
Right, right, right right, and some are more
contaminated than others.
Like you know, you have theDirty Dozen and the Clean 15,
you know when it comes to foods,and so, with the Dirty Dozen,
definitely want to buy thoseorganic, don't you?
So efforts to reduce exposureto toxins, both as an individual
and as a society, could play amajor role in reducing
These include wisely choosingthe food that you eat, and, of

(42:19):
course, organic is best in thisregard, especially for the dirty
dozen foods.
Also, be careful about thelotions and the cosmetics you
put on your skin and drinkfiltered water.
However, unless you move toMars, it's hard to control the
air that you breathe.
Air pollution is not just downthe street from the factory.
They have found toxins in theair as far away as the South
Pole and even on top of theSwiss Alps.

(42:39):
The air pollution has beenproven to be a significant risk
factor for cardiovasculardisease, with both long-term and
short-term exposurecontributing to increased
morbidity and mortality.

Speaker 3 (42:50):
So we did take a deep dive into the toxin issue
before in the podcast back in2021.
So you might want to scrollback and check that out.
You know microplastics are thelatest hot topic when it comes
to toxins these days.

Speaker 1 (43:05):
Yeah, that's in the news a lot these days, coach,
and there's a landmark studyactually on that issue,
published in March of 2024 inthe Harvard Heart Letter, and
they found that microplasticswere present in the coronary
artery plaques of a significantnumber of patients, and the
presence of these microplasticsin arterial plaques is
associated with a higher risk ofserious cardiovascular events.

(43:26):
What they found was thatpatients with detectable
microplastics in their coronaryarteries had about a 4.5 times
chance of having a heart attackand stroke or of dying of any
cause during the study period.
One more thing, before we moveon from toxin issue, coaches, is
the issue of mycotoxins, whichcome from mold and they can also
contribute to cardiovasculardisease.
So work with your provider totest for mold and treat if

(43:47):
needed.
And, by the way, you may haveto go and find a functional
medicine doc or a clinic thatspecializes in mold in order to
get proper testing and treatmentfor mycotoxins.
This is just not on the radarof most regular doctors.
So check out our podcast ontoxins if you'd like to learn
more about this important topic.

Speaker 3 (44:14):
And next up on the list of cardiovascular risk
factors is immune dysregulation,which significantly impacts the
risk of cardiovascular disease.
So extensive research hasdemonstrated that chronic
activation of our immune systemsis a major contributor to the
development and progression ofnumerous cardiovascular diseases
, including heart attack, stroke, hardening of the arteries,
heart failure and atrialfibrillation.

Speaker 1 (44:32):
A couple of the immune-mediated diseases that
present cardiovascular riskinclude rheumatoid arthritis, an
autoimmune disease in whichpatients have a 48% higher risk
of cardiovascular eventscompared to the general
population, and inflammatorybowel disease, which is linked
to about a 24% higher risk ofheart attack and stroke.
So aggressively treating thesediseases, especially from the
focus on reducing inflammation,can help reduce cardiovascular

(44:54):
risk.

Speaker 3 (44:56):
And speaking of inflammation, that's another
huge cardiovascular risk factor,really kind of getting more at
the root of the situation, right, if we're finding that as a
common theme in many of thesethings.
So it plays a pivotal role inthe development of the hardening
of the arteries which we callatherosclerosis, and that's the

(45:16):
primary underlining cause ofmost cardiovascular events.
So research has shown strongand consistent relationships
between markers of inflammationand a risk of future
cardiovascular events.

Speaker 1 (45:30):
Some studies have shown that for patients with
hardening of their arteries andsystemic inflammation, there is
a 30% higher rate of majoradverse cardiovascular events
like heart attack or stroke, a24% higher rate of heart failure
hospitalizations and a 35%higher risk of death.

Speaker 3 (45:46):
A high-quality study called the CANTOS trial
demonstrated that targetinginflammation, even without
changing cholesterol levels, cansignificantly reduce the risk
of subsequent heart attacks,stroke and the need for major
cardiac interventions.

Speaker 1 (46:02):
So identifying inflammation and aggressively
treating it can definitelyimpact cardiovascular outcomes.
We did an entire podcast on thesubject back in 2023, so if
you're interested in this, youmight want to go back and check
that out.
I'll also have a document foryou at mcminnmdcom on the causes
of inflammation.

Speaker 3 (46:18):
Our next cardiovascular risk factor is
allergies, and this also has asignificant impact on your risk.
Several studies have found anassociation between allergic
disorders, high blood pressureand coronary heart disease.
This may be mediated by acouple of mechanisms that we've
already talked about, likeimmune activation and

(46:41):
inflammation.
So avoidance and treatment witha qualified allergist would be
mainstays as part of acardiovascular prevention
program.

Speaker 1 (46:50):
And similarly, sensitivities such as gluten
sensitivity are associated withincreased cardiovascular risk.
This is not a true allergy, butit's a sensitivity or
intolerance.
It's estimated that celiacdisease is associated with a 27
to 44 percent higher risk ofcardiovascular disease, after
accounting for various lifestyle, medical and other
cardiovascular risk factors.
In order to reducecardiovascular risk, a

(47:11):
gluten-free diet would need tobe initiated and maintained in
these patients.

Speaker 3 (47:15):
You know, there's a song I've heard and it's Dem
Bones and that musicallydescribes the connection between
all the bones of the body.
Sometimes my kids like to makeit like the head bones connected
to the knee bone but that youknow that doesn't work that way,
but you know the head bone andthe clavicle and the shoulders.
So, but the idea being thateverything in the body truly is

(47:36):
connected and each organ countson the other organs to keep it
healthy, it's a harmony, it's asymphony of sorts, and the heart
is no exception to this.
So, for instance, when we havea chronic kidney disease, then
there is a significant increasedrisk of cardiovascular disease,
including coronary arterydisease, heart failures,

(47:59):
arrhythmias, sudden cardiacdeath, stroke and also
peripheral artery disease.
Everything's connected.

Speaker 1 (48:06):
In fact, studies have shown that patients with
chronic kidney disease havenearly double the risk of
coronary artery disease comparedto those without chronic kidney
disease, and cardiovascularmortality accounts for about 40
to 50 percent of all deaths inpatients with advanced kidney
disease, compared to 26 percentin those with normal kidney
function.

Speaker 3 (48:24):
Also, liver disease significantly affects
cardiovascular risk.
For instance, people withnon-alcoholic fatty liver
disease have nearly double therisk of coronary artery disease
compared to those that don'thave liver disease at all.
And liver disease is actuallymuch more common than you might
think.
Many people don't even knowthey have it until it really

(48:46):
gets severe.
Yet it affects the heart in itsearly stages.
So the solution to the problemis early detection and then
appropriate management of liverdisease, as well as just a
multidisciplinary approachinvolving a liver specialist and
a cardiologist.
Those kind of big pictureoutlooks can be really helpful
when you're thinking about this.

Speaker 1 (49:07):
There are some other organs Coach which affect heart
health, and these include thebrain, the lungs, the pancreas,
the thyroid and the adrenalglands, the gut, the muscles,
the fat tissue, endocrine systemand bone marrow.
Disorders affecting blood cellproduction can indirectly impact
cardiovascular health, but inthe interest of time we won't go
into this in detail.

Speaker 3 (49:24):
And our next cardiovascular risk factor is
sarcopenia, and that's the lossof muscle mass.
So multiple studies havedemonstrated a significant
association between sarcopeniaand higher cardiovascular
disease risk.
It's associated with a fasterprogression of cardiovascular
disease and a higher risk ofmortality.
So screening for sarcopenia inproper intervention may be

(49:49):
crucial in preventing ordelaying the progression of

Speaker 1 (49:54):
Now, if you've been listening to our podcast for any
length of time, then you'llknow that we are bullish on the
microbiome.

Speaker 3 (49:59):
That's right.

Speaker 1 (50:00):
And when it comes to the gut microbiome, studies show
that alterations in the gutmicrobiome can significantly
increase heart attacks, strokes,peripheral artery disease,
hospitalizations and death.

Speaker 3 (50:10):
Interestingly, we see the oral microbiome also
playing a role here.
Several studies have identifiedspecific oral bacteria
associated with increasedcardiovascular disease, like a
longitudinal study that was over18.8 years.
Have identified specific oralbacteria associated with
increased cardiovascular disease, like a longitudinal study that
was over 18.8 years.
Found that good oral hygiene,like brushing and flossing, was

(50:30):
associated with a 51% reductionin cardiovascular disease
mortality.
Get out the floss, folks.

Speaker 1 (50:39):
Well, isn't that fascinating.
I think most folks are prettyclueless to that fact.

Speaker 3 (50:44):
Yes, yeah, I know I was Teeth bones connected to
your heart muscle.

Speaker 1 (50:49):
There we go there we go, and some studies actually
have linked frequent mouthwashused to increase cardiovascular
risk, especially with theantibacterial mouthwashes
containing something calledchlorhexidine.
There are several mouthwashbrands out there that are not
antibacterial and you can do aweb search on those.
I use one called Tom's of MaineI like quite a bit and my wife,

(51:09):
Dr Cheryl, says my breath isnot terribly bad, just
moderately bad.
So the bottom line is that goodoral hygiene is in order and
aggressive treatment ofperiodontal disease and
targeting oral dysbiosis may behelpful to reduce cardiovascular
disease.

Speaker 3 (51:24):
Next let's take a look at clotting disorders.
So there's a whole host ofclotting disorders, often caused
by genetic alterations orautoimmune issues.
But these disorders canincrease cardiovascular risk
through different mechanisms,primarily by promoting clotting,
increasing inflammation andinfluencing atherosclerosis

(51:46):
development, which again, that'sthe hardening of the arteries.
So a tailored approach forthese patients can certainly
reduce their risk of adversecardiovascular events, and a
team approach with ahematologist and cardiologist
would be your best bet if youhave a clotting disorder like
this.

Speaker 1 (52:04):
And then we move on to excessive alcohol consumption
.
It's another cardiovascularrisk factor.
It significantly affectscardiovascular health by
increasing the risk of highblood pressure arrhythmias,
heart attack, stroke, heartfailure and enlargement of the
heart muscle itself.

Speaker 3 (52:19):
Unfortunately, we do see a lot of sexism in our world
today that we live in, and wefind that alcohol picks more on
women than men.
So women who consume eight ormore alcoholic beverages per
week, calculating that out, justone a day, right.

Speaker 1 (52:33):
Yeah, just about one a day coach.

Speaker 3 (52:35):
For us ladies, that gives us a 45% higher risk of
heart disease compared to thosewith a low intake, which is
really significant.
Dr, Mack can't ignore that.

Speaker 1 (52:45):
Well, coach, I have a confession to make.
I went to my excellent newprimary care doctor I won't
mention her name, but anywayabout a year ago and it's my
first visit to her, and sheasked me if I drink alcohol.
I told her that I did.
She asked how much and I smuglytold her well, just one drink
per night and thinking I wouldget a real gold star for being a
good boy.
But no, I was busted coach.
She told me that I needed tocut back.

(53:08):
I was shocked, quite frankly.
But you know what?
She was right.
She's up on the latestliterature and the recent
studies are suggesting that noamount of alcohol is really good
for you.
All that stuff about red winebeing healthy is really kind of
now down the drain.
So I have a cutback coach and,by the way, I found a pretty
good non-alcoholic beer that'sreally not all that bad.
It's a brand called Athletic.
This is not a commercial I haveno financial relationship, but

(53:32):
just giving you all some tipsand it also happens to be gluten
free.
I think it's only like 45calories, but it's not bad.
So I made a simple substitutionand now everyone's happy, my
primary care doctor's happy andI'm happy because it's still
good to have my beer at night.

Speaker 3 (53:44):
There you go.
So let's take a look at somelab work and labs that signal an
increased cardiovascular risk.
So let's start withhomocysteine levels.
So elevated homocysteine levelsmay be connected to the MTHFR
genetic mutation or otherfactors like nutritional

(54:05):
deficiencies, kidney dysfunctionor other lifestyle factors in
general.
However, in all honesty, thecardiovascular benefits of
lowering your homocysteinelevels are still being debated,
and also exactly how low thathomocysteine should be is a
controversial topic.
So many experts tend to startwith a heavy emphasis on
lifestyle changes first.

Speaker 1 (54:26):
Another lab coaches uric acid.
These are also associated withincreased cardiovascular risk.
Uric acid is thought to be agout-related lab, but there are
also strong associations withcardiovascular disease.
However, there's an ongoingdebate about whether uric acid
is actually a causal factor orsimply a marker of other
metabolic abnormalities.
To lower uric acid levels,start with a low-purine diet,

(54:47):
drink plenty of water, maintainyour ideal body weight, and even
drinking a bit of coffee may behelpful.
There's an excellent book onthis subject by Dr David
Perlmutter called Drop Acid,which we highly recommend, and
along with any of his otherbooks they're all quite

(55:08):
excellent.

Speaker 3 (55:08):
C-reactive protein is the next lab up that we'll
mention, so the CRP isconsidered to be a great marker
for systemic inflammation, whichwe have discussed in this
podcast.
Studies have consistently foundthat higher CRP levels are a
strong and independent predictorfor an increased risk of heart
attack, stroke andcardiovascular death, and those
studies are also showing thatlowering CRP, especially in

(55:30):
higher risk individuals, isassociated with improved
cardiovascular outcomes.
A comprehensive strategycombining lifestyle medications
and risk factor management isyour best bet for maximizing
cardiovascular health withgetting your CRP down.

Speaker 1 (55:46):
High fibrinogen is considered an independent
predictor of cardiovascularevents, including coronary
artery disease, peripheralartery disease and ischemic
stroke, due to its role in clotformation, inflammation and
atherosclerosis.
Lowering fibrinogen canpotentially reduce
cardiovascular risk.
Again, your first-linetreatment is going to be diet,
along with exercise andmaintaining a healthy weight.
If that doesn't do it, then avisit to your good hematologist

(56:10):
may be in order to get on somemeds.
A high ferritin level may alsosuggest increased cardiovascular
risk.
High ferritin is associatedwith an iron storage disease
which adversely affects theheart.

Speaker 3 (56:21):
And that brings us to the elephant in the room, which
is the issue of cholesterols,also known as lipids, and
certainly lipids are related tocardiovascular risk.
We're not going to deny that.
But this subject is supercomplex and somewhat
controversial too.
So it seems like a lot of ourcardiologist friends would like
to err on the side of puttingstatins in the water supply, but

(56:43):
we kind of are thinking not sofast on that.

Speaker 1 (56:47):
And if we're really to do justice to the lipid issue
on today's show, we'd have tolengthen the podcast by like
half hour or so.
So it's just too much to getinto here today.
But I'm going to promise to doa separate special podcast on
the topic of lipid management inrelation to cardiovascular risk
in the near future.

Speaker 3 (57:04):
Of course, you should work with your provider on this
lipid issue, and let me clearlystate that there are many
people who do need to be onstatins.
These drugs save lives, nodoubt.
However, we feel that there's alot of people on statins who
have dealt with a lot of theside effects and really won't
receive a lot of clinicalbenefit or no clinical benefit,

(57:28):
and so there are others who arenot on statins who really also
need to be on it.
So we kind of see both sides ofthe fence here.

Speaker 1 (57:37):
Yeah, coach, there's an interesting statistical
concept in medicine called NNT,which means number needed to
treat, and when it comes tostatins, for the general
population the NNT is over 400.
So what this means is that youwould have to treat over 400
people, who get no benefit andhave to put up with the costs
and the side effects of statins,in order to prevent a heart
attack in one person for thenext five, 10 years, and so

(58:00):
that's pretty good return oninvestment for the drug
companies.
But in all fairness, it's alsoimportant to realize that as
you're dealing with sickerpatients, then the NNT goes down
and, as we said, it's acomplicated issue and it's worth
noting that for people withmild to moderate elevation,
there are some other optionsbesides statins to bring down
cholesterols.
We've posted on the website foryou at mcminnmdcom, under the

(58:22):
documents menu, a summary calledNatural Ways to Balance Lipids.
The document startsappropriately with lifestyle
recommendations and alsomentions some non-drug
alternatives which may beconsidered.
But at the end of the day, it'sbetween you and your provider
to get on the right program foryou.

Speaker 3 (58:38):
I remember an herbal cocktail that we'll mention here
called Heart Savior, and we'veused this on hundreds of
patients with measured lipidsbefore and after taking this
supplement and have found it tobe quite effective in bringing
down cholesterol levels in manypatients, and also don't really
recall a single patient with anyadverse side effects, which is

(59:00):
kind of nice.
So you can find that on Amazonand, by the way, we don't have
any financial connections tothis company at all.

Speaker 1 (59:08):
So, wrapping things up, coach, there are a few other
supplements that we've notmentioned so far which have some
supportive evidence ofbeneficial effect for
cardiovascular disease, andthese include the olive oil we
talked about, garlic, magnesium,zinc, l-arginine and
L-citrulline, cocutin, thecatechins, like ECGC, which is
found in green tea, and D-ribosefor congestive heart failure.

(59:29):
Some of the latest studiessuggest that fish oil only helps
people really with existingheart disease, although there
may be some other benefits offish oil beyond the heart, like
the brain, for instance.
Otherwise, Coach, that aboutdoes it for a discussion of the
modifiable risk factors forcardiovascular disease?
And let me summarize from afunctional and integrative
medicine point of view, the bestway to approach cardiovascular

(59:49):
disease, especially from apreventive point of view, is to
look at modifiable risk factors,which is the root cause of the
problem.
We recommend close monitoringand advanced and personalized
prevention in order to minimizethe risk of poor health or death
due to the number one killer ofmen and women, and I have a
document at mcminnemdcom calledMcMinn Cardio Wellness Plan to

(01:00:11):
summarize my suggestions for you.

Speaker 3 (01:00:13):
As we wind down today , I'd like to ask you to please
take a moment to rate us oniTunes.
I'd like to ask you to pleasetake a moment to rate us on
iTunes.
The reviews make a differencefor us.
And also, if you'd like, if youenjoy this podcast, then please
do share out with a friend.
Tell them about it.
So thanks so much for helpingus spread the word.
You won't find a moreevidence-based, unbiased podcast

(01:00:35):
on wellness anywhere out thereon the web, and we do our
homework on these importanttopics and we want to shoot
straight to you, so we're nottrying to sell you things.

Speaker 1 (01:00:45):
If you'd like to reach out to us and comment on
the show or make recommendationsfor future topics, you can do
so at drmcminn at yahoocom.
Well, coach, can you leave uswith another one of your
brilliant Coach, lindsay pearlsof wisdom.

Speaker 3 (01:00:58):
Oh, thanks, dr Mack.
You know this podcast has mademe really think about one of my
favorite health topics, the goodold blue zones.
And, listeners, if you're notfamiliar, there have been
identified regions around theglobe that are known for their
exceptionally high lifeexpectancy in the populations,

(01:01:19):
and so there's five main regionsthat have been identified, in
that One's Okinawa, japan,sardinia, italy, there's one in
Costa Rica and Greece and thenLoma Linda, california.
So these are places where,again, the populations are the
healthiest and they live thelongest, or you have the most
centenarians, people over 100years old, and wouldn't you know
it, dr Mack, they also havesignificantly lower rates of

(01:01:41):
cardiovascular disease in thoseareas, which makes sense.
So, for example, let me justtell you some of these stats In
Okinawa, there's an 80% lowerrisk of cardiovascular rates
than in the US 80% that'ssignificant.
In Greece, we see that 20% ofthe individuals who are 80 to 90

(01:02:02):
plus years old have zeroclinical signs of cardiovascular
disease.
And then in the NequiaPeninsula, there's 25% lower
risk of dying from heart diseasecompared to non-blue zone
regions in the world.
So certainly there's things inthese regions that people are
doing right, and I think itlines up when you've, if you're
familiar with the blue zones,then you've heard a lot of the
themes which we've mentioned inour podcast today.

(01:02:24):
So much of that lifestylemedicine, like just
incorporating physical activityin your everyday life and just
walking, gardening, those typesof things, eating that
Mediterranean diet I mean, herewe're talking about Greece,
right so those things ringfamiliar and I think lifestyle
medicine is just never to beunderestimated.

Speaker 1 (01:02:47):
You know, coach, we've talked about a lot today
and I think on first glance itcould be overwhelming.
However, I think, just thinkabout what might apply to you.
And again, the first step isalways lifestyle medicine and
work with your provider to maybedo a thorough workup and
identify some of the riskfactors that might apply to you.
And on one of our handouts Imentioned, I actually have some

(01:03:08):
advanced testing that can bedone and I talk about that as
well.
So, anyway, don't freak outabout this.
It's not too much, but it'ssuper important.
Again, the number one killer ofmen and women.
So we all need to sort of justlook at those risk factors and

(01:03:29):
do what we can to mitigate those, but anyway thank you so much
for listening.

Speaker 3 (01:03:33):
This is Dr McMinn and this is Coach Lindsay.
Take care and be well.

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