February 23, 2025 • 42 mins
With February being American Heart Month Dr. Galati focuses on heart disease. He plays a conversation he had earlier in the week with Dr. Randeep Suneja at the Cardiology Center of Houston. He talks about risk factors for heart and cardiovascular disease and the symptoms. Dr Suneja also talks about those who should go for a coronary calcium scan, where the future lies with GLP-1 agents, and more.
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Speaker 1 (00:01):
Initial Life Sequencing coming to you live from Houston, Texas,
home to the world's largest medical center in the.
Speaker 2 (00:08):
Approach ras everything looking ability.
Speaker 1 (00:19):
This is your Health First. It's the most beneficial health
program on radio with doctor Joe Galotti. During the next
hour you'll learn about health, wellness and the provention of disease.
Now here's your host, doctor Joe Galotti.
Speaker 2 (00:45):
Well, good Sunday evening to everybody. Doctor Joe Glotti, thanks
for tuning into your Health First. We're here every Sunday
between seven and eight pm. And our mission year after year,
twenty two plus years that we've been doing this, it
is very simple to make you better consumers of healthcare,
raise your health IQ and give you some insight as
(01:07):
to how to take care of your body. Being a
good consumer can certainly, without a doubt, prevent a lot
of the chronic disease that we see. By now, everybody
should know our website. It is doctor Joegalotti dot com,
d R J O E G A L A t
I dot com. Go there and sounder from newsletter send
(01:29):
me a message. All of our social media posts are there,
including YouTube and Instagram and Facebook, and our website Doctor
Joegalotti dot com all right, So the month of February
is American Heart Month, and that is the time of
the year where we raise awareness, have a conversation about
(01:54):
heart disease, heart disease and men heart disease and women.
Making sure you understand your risk factors, because really, if
you know your risk factors, you can look in the
mirror and say, hey, I did not realize I am
at risk for premature heart disease or a premature heart
(02:15):
attack or stroke or heart failure, or these palpitations I'm
having may be something more serious that needs a more
formal workup. So that is the idea. And on the
program tonight, we have to we have doctor ran Deep Sunasia.
(02:36):
He is an acclaimed cardiologist here in Houston, and I
had the opportunity a little earlier in the week to
sit down and have a conversation with him. So that
is what we have tonight, a conversation with doctor ran
Deep Sunasia, a cardiologist here in Houston. Listen and take
(02:59):
in for yourself what information do I need to know?
Look at it that way?
Speaker 1 (03:06):
All right?
Speaker 2 (03:07):
Well, as I was saying earlier, it is American Heart Month,
a month of February, and if it was up to me,
it would be part month every month of the year,
but we have to deal with what we're dealt here
and no stranger to your health. First, doctor ran Deep Sunasia.
(03:27):
He is one of the finest cardiologists, not only in
Houston but in the United States. And I've known him
a very long time. And when sometimes we are lacking
compassion in the medical field to our patients, doctor Snasia
certainly excels in that area. It's great to have you
(03:47):
on tonight, and thanks for participating in our little contribution
to American Heart Month.
Speaker 3 (03:54):
Thank you, Joe, thank you for inviting and always look
forward to our yearly meetings here on and during this month.
Speaker 2 (04:02):
Yes, exactly. Now, just a little background on doctor Sunasia.
He has been here is it twenty three years now? Well,
thirty three thirty three thirty three years, over one hundred
thousand patients. That was a landmark just recently and he
has founded the Cardiology Center of Houston. He's on staff
(04:24):
at Houston Methodist Hospital West right or is that in Katie.
It's in Katie, Texas, and you've held various positions there
over the years. Board certified in five separate areas ranging
from internal medicine, cardiology, nuclear cardiology, cardiovascular ct which I
(04:46):
want to hear about, and what I think is most
important is lifestyle medicine. So I would say, there's so
much to talk about here, but let's really orient everybody
with some of the basics and risk factors for heart disease,
cardiovascular disease, and the way I look at it, for
(05:09):
everybody listening tonight, if you do not have a good
understanding of what your risk factors are, then you're really
not paying as much attention as you need to. So
knowing risk factors is very powerful. Doctors in Asia go
(05:29):
over the list of risk factors people need to know about.
Speaker 4 (05:33):
Sure.
Speaker 3 (05:33):
I think risk factors get divided into two, which is
modifiable and non modifiable. Non modifiable risk factors are where
you cannot modify them. That includes family history, age, and race.
So there are age where premature Corno disease happens before
the age of fifty five, a family history or in
women before the age of sixty five does strong family history.
(05:56):
Age as is basically is when you get older, higher
the risk and number. Some races where you have African,
American and even some Asian population, I had highly Soccardivasca
disease compared to Caucasian population. And then we have the
modifiable risk factors where we can modify the risk factors
and those are most importantly hypertension, diabetes, history of smoking, hyperlipidemia,
(06:21):
lack of sleep and in activity, and weight is a
very big factor. Now we are talking about sitting is
the new smoking risk factor we're all been setting for
our specially post COVID and during COVID, people have been
working on their desk for eight eight hours a day
and on average, people have gained between ten to twenty pounds.
(06:42):
And Joe you, I'm sure you've seen this.
Speaker 2 (06:45):
Yeah, and you know the people people in many times
they aren't able to shake it off. They gain the
weight during COVID. You know what I would share with you,
and I think from my own personal experience, and so
we when COVID hit in the pandemic, and we did,
(07:05):
or at least I did some remote work from home
seeing patients online. And I remember the very first day
and I got my Apple Watch. On my very first day,
I came up to my office, saw my eighteen twenty patients.
Then I went down for dinner. That was basically I
(07:27):
was up here for breakfast. Maybe I went down for
lunch to go to the bathroom. I don't know. I
walked only about three hundred and fifty steps the entire day.
We're normally at work, it's seven to eight thousand steps
just doing the normal work. And I'm sure you're the same.
(07:47):
And it dawned on me that the adults that have
desk jobs is a horrible, horrible situation to be in.
Speaker 3 (07:58):
Ye And you know, as you know, the percentage of
and prevalence of obesity in the US now we are
talking about on an average, forty percent the adult US
population is obese, thirty percent is overweight and painfully, but
to twenty two percent of the adolescent kids are no obese. Right, So, yeah,
(08:21):
it's an epidemic.
Speaker 2 (08:23):
Yeah, it's it's really getting out of control now, you know,
with with the risk factors. When when you see let's
say a new patient and they have hypertension and it's
gone undiagnosed for years, and they have these other either
family or lifestyle risk factors, and you alert them and
(08:44):
you educate them and teach them and enlighten them, what
do they say do they say? Gee, I had no
idea smoking caused high blood pressure. I had no idea
that no exercise caused hypertension. Where is a public on this?
Are they just in more denial than really being completely
(09:08):
ignorant on this? What do you think?
Speaker 4 (09:12):
I see?
Speaker 3 (09:13):
The question is that if the patient comes with hypertension,
when we do the echocardiogram and we measure the wal
thickness and we see that their val thickness is increase,
and they've got leftritical hypertrophy, and I show them the statistics.
You know, when you show the patient that you got
leftritical hypertrophy, your heart is working harder. It really dawns
(09:34):
on them that you know the amount of blood fruit
to the heart is fixed, and if you have leftritical
epotrophy then you're going to have someone to call it ischemia.
Speaker 4 (09:43):
Your heart is working harder.
Speaker 3 (09:45):
And when you present these facts, it makes them aware
that they must take very proactive measures. You define that
you have to control the blood pressure very well. Every
ten percent drop in systolic BP reduces the cardiovestor complications
by but to twenty two percent. Yeah, so it's critically
(10:06):
important to control the blood pressure and along with that
other dis factors and you know weight gain leads to
elevated levels of lipids, metabolic syndrome, sugar is up, the
blood pressure all go hand in hand. And if you're
addressing one factor, I think the key factor here is
managing the weight and that will improve all the parameters.
(10:30):
But you have to make an effort and it requires
a lot of effort. Proactivity, regular exercise one hundred and
fifteen minutes per week, as you know, thirty minutes five
times a day and then ah and American artizens also
emphasize that you must do weight training about two times
a week because we are being muscle as we're getting older,
(10:52):
so it's very important.
Speaker 2 (10:53):
All right, let's take a quick break on down to
Joe Glotti. We're talking with doctor Ran Deep Ssunasia, cardiologist
here in Houston, Texas. Is website to get more information
is Houston Cardiology dot com. Stay tuned, We will be
right back. Welcome back, everybody, back with doctor Ran Deepsunasia
cardiologists here in Houston, Texas, talking about American Heart Month
(11:16):
and all that you need to know about heart disease.
Speaker 5 (11:22):
You know, the other thing just to shift to symptoms,
because again the patients that I see, they are you know,
limping around with symptoms.
Speaker 2 (11:32):
They're short of breath, they have palpitations, they're not sleeping well,
they have some swelling in their legs. And again, you know,
I asked them, what were you thinking?
Speaker 4 (11:45):
And I think people are not.
Speaker 2 (11:47):
Putting all the dots together to say, you know what,
this might be a problem with my heart. Let me
get it checked out. So what do you see from
a symptoms standpoint?
Speaker 4 (12:00):
One point?
Speaker 3 (12:00):
I think that varies from anywhere from chestice comfort, tightness,
heaviness in the chest, which are signs of precipitated by exertion,
activity or stress, indicating anginal symptoms. You can have shortness
of breath, which can be related to again, symptoms of
high blood pressure. Exertional disney can be an anginal equivalent.
Also palputations that can be related to rhythmia. As we
(12:24):
are seeing a ton of atrial fibrillation all these days,
almost an epidemic of a FIB, right, Yeah, so yeah,
I mean.
Speaker 2 (12:33):
Is it just to stop you there for a second,
would you say, twenty five years ago you saw as
much a FIB as we all see now.
Speaker 3 (12:40):
No, definitely, not definitely, not right, Yeah, And I think
that there's multi factorial aspects in that age is one
of the biggest risk factors. People are living longer, aging
longer than we have people we are treating them well
with if they have microinfunction, they'll be treating with intervention.
They may have allued dysfunction, and as they are aging,
(13:03):
then they will ultimately develop interfibrillation liter in life. So
it is and then presence. People who have been affected
with COVID also have had disease processes from that, and
we have seen a higher amounts of aphibian patients who
are bad COVID also and other rhythmias. So definitely seeing
(13:24):
a whole lot of a FHIB. And again obesity rate
is going up. That leads to sleep apnea, which is
sleep apnea is putting increases or intrifibrillation. So every patient
with a FIB, we are screening them for sleep apnia.
And then fatty liver is going hand in.
Speaker 2 (13:44):
Hand, right, Yeah, I mean data doesn't go by that.
I think you're contacting us about a fatty liver patient
and it's it's really really we we say obesities that
have been a FIB is an epidemic, Fanny livers an epidemic.
We're we're just exploding with complications. And it is so said.
(14:08):
You know one one thing you know again Uh, I
like to say, I am a cardiologist in the closet, uh,
and I leave the expertise to you and your colleagues.
But imagine if we could wake up the American public
(14:30):
to know their blood pressure. And I've even spoken on
the radio here that wouldn't it be great if every
household had a blood pressure cuff, even if you did
not have blood pressure, a blood pressure issue, high hypertension,
that and that would be great. But imagine if once
(14:54):
a quarter you just check the blood pressure everybody in
your heart okay, and just say get the kids, your
young adults, your wife, your husband, your mother, whoever, and
just say, okay, it's the first quarter of the year.
We're going to check and document everybody is okay. We'll
do it again next quarter. But create alertness to blood pressure.
(15:19):
The numbers are staggering on the amount of people that
have hypertension. What do you think regarding the value of
home monitoring. I think that's phenomenal.
Speaker 3 (15:29):
In fact, when patients come in with hypertension, you know
sometimes many times you see you know, white foot hypertension, Also,
patients blood pressure at home is okay and when they
come to the office they are elevated. So it's critically
important to get good data and we recommend Actually AHH
never endorses any products, but American Heart as Solcition has
(15:49):
stated that for us to treat hypertension, we must collect data.
So omron VP arm cuff, ARM cuff not a risk,
cut the risk, not the risk, not the risk. Aren't
cuff done in a proper way with patient preferable lying
down and this the sigam monometer right next to you,
done two three readings after taking a few minutes of rest.
(16:13):
Collecting data over period of time because if pressure is elevated,
you don't want to just start it right away because
if the BP readings are higher in the office, so
you want to collect data for at least two to
three four weeks.
Speaker 4 (16:25):
But if the patient comes in with significantly.
Speaker 3 (16:27):
Elevated blood pressure they got left final hypertrophy on their
EKG and on their eco cortagram, obviously you're going to
start treating. But when they are borderline elevated, then you
make them aware lifestyle modification, making sure their resalt intake
is reduced, their calory intake is being monitored. I mean
I talk about the Suneja equation, which I've talked and
(16:48):
created that video which almost hit thirty six thousand views
on LinkedIn that I posted on New Years about the
way production formula where you reduce thirty fi hundred where
thirty five hundred calory count negativity is leads to negative
balance leads to one pound of weight loss of fact.
Speaker 4 (17:07):
So if you have five.
Speaker 3 (17:08):
Hundred caloriy negative balance per day and multiply by seven
aver day of the week, you lose thirty five hundred carries.
And that five hundred I'm dividing into two parts, two
and fifty negative balance by eating less mostly carved everybody.
Everybody loves carves, bread, pasta, dessert, snacks, potatoes, rice, alcohol,
a little bit less consumption per day, two and fifty
(17:29):
cars less per day, and two and fifty car is
burning more per day. That's half our of brisk walking.
And third component, which is also equally very important as
long as there is no history of congest of heart failure,
drinking sixty to seventy ounces of water, right, and you
combine that and if you do it consistently, seventy is
a week lose a pound a week.
Speaker 4 (17:48):
If you do three to four days a week, you
lose a half a pound a week. So life cell
modification is critically important.
Speaker 3 (17:54):
And I think, I, you know, just for my own curiosity,
last Tuesday, I have plied a continuous glucose monitor myself CGM,
which are now available without a prescription a month ago,
and I have myself reduced my sugar. I have an
AVNCY of five point seven, which is minimally elevated. I
(18:15):
want to make it better, bring it down, so you know,
you can modify it by reducing.
Speaker 4 (18:20):
And within a week I've noticed that I have cut
down the.
Speaker 3 (18:23):
Foods and I could monitor my sugar and react the
intake so that I can bring the glucose in a
completely normal level.
Speaker 4 (18:30):
So I think awareness and education is critically important.
Speaker 2 (18:34):
Yeah, and I think that the CGM, the continuous glucose monitoring,
the deck scam is probably one of the more popular ones.
I think if if you know you're overweight, you have
pre diabetes and hypertension, lipids, and you know that doctor
Sunasia or doctor Galati is not looking at you twenty
(18:57):
four hours a day. But if you get that little
hatch you on your arm and you're contemplating a piece
of chocolate pie and you see that your glucose is
just a little too high. That may be enough to
stop you and in the end be beneficial. So as
you know, we need oversight, we need accountability, and I
(19:20):
think electronically AI in a sense is doing this.
Speaker 4 (19:24):
Absolutely.
Speaker 3 (19:25):
I think this is one of the finest examples of
how we can utilize AI and technology because this is
continuous glucouse mountor is actually AI.
Speaker 4 (19:34):
And when you're able to see your sugar.
Speaker 3 (19:36):
And then that is automatically going to have a positive
impact in eating, making you eat better because you're going.
Speaker 4 (19:42):
To see if you eat particular food, your level is
going up.
Speaker 3 (19:45):
Within the last five six days, I have myself modified
my own eating habits, even though I consider myself a
good eater. And you know, I did my fifteenth half
methon last weekend. That's great, but there is room for improvement,
right Nobody's room for improvement. And within a week I've
noticed that I'm making some very positive changes in what
(20:05):
I'm eating, eating a little bit less and watching the cobs,
and I'm noticing this reduction in my lucas is amazing
today and the entire office day I was running around.
Speaker 4 (20:17):
My peak sugar was only one twenty.
Speaker 3 (20:19):
Yeah, and I'm morty eating, you know, I eat very
healthy breaksace with white omelets and lunches salad.
Speaker 4 (20:27):
And you can make modify it, you know.
Speaker 2 (20:29):
Yeah, yeah, I think it's just a willingness to do it.
You know, it's a willingness to do it now. You know,
of course, one of the big pillars of heart disease
and prevention is cholesterol. And there's still a lot of
sort of misunderstanding of cholesterol. Patients will still come in
(20:50):
and say, well, the ratio is good, so nothing needs
to be done. Is it true that the ratio of
good lesterol to bad cholesterol? And that may not be
a good way to say it is sort of outdated.
Now we need to look at cholesterol a little differently.
Speaker 4 (21:09):
What do you say?
Speaker 3 (21:10):
Absolutely so, I think the entire emphasis noise on the
Lder number. The ratio is pretty much outdated. But Lder
number in relation to risk factors and presence of corneatic disease,
and here comes as utility of the cornaty cassium score. Right,
we are utilizing I've been doing this for almost twenty four,
(21:31):
twenty five years, I have been a very big proponent
of calcium score and potentially probably are practiced at the
biggest database of cusum scores in the state of Texas.
So when you do the cornerity custum score on a
patient and then we are able to use that number
and put them into the mesa registant calculated persentile. Now,
(21:52):
if you've got a fifty year old male coms and
his custom score is one hundred and his persentile is ninety,
his LDL will.
Speaker 4 (22:00):
Need to be below fifty five.
Speaker 3 (22:02):
But if you have one hundred year old mail with
the custum score of zero and his LDL is one fourteen,
there is no data that we need to be that aggressive.
Speaker 4 (22:13):
That is life sele modification. So the castium score is
able to guide us how we need to manage the
eldeal number and if you're ELDAL.
Speaker 3 (22:23):
Now November of twenty twenty three, high the spaces American
hunt as American conture cardiology.
Speaker 4 (22:29):
Now we're talking about high risk places where they have cornea.
Speaker 3 (22:32):
Intervention, corniati bypass graft surgery, they have diabetes and other
equivalent corneaty disease reris factors.
Speaker 4 (22:40):
We are talking about bringing the ldeal below fifty five.
Speaker 2 (22:44):
All right, let's take a quick pray. Come down to
Joe Gladi your two did your health first, don't forget
go to doctor Joegalori dot com. Stay tuned, we'll be
right back. Welcome back, everybody, to your health first. Comes
out to Joe Galati. And in honor of the month
of February, it is American Heart Month, that one month,
even though it really should be twelve months out of
(23:05):
the year that we think about our heart, heart disease,
heart disease prevention and understanding our risk factors. And in
the studio tonight is doctor ran Deepsunasia, a well known
cardiologist here in Texas, trying to explain the key points
that we all need to know with regard to how
(23:26):
to take care of your heart. You've taught me a
lot about the calcium score corrintory calcium score ct score.
And with all of the patients with fatty liver that
I see, almost all of them have diabetes, hypertension, they're overweight,
high cholesterol, et cetera. I have been recommending and sending
(23:48):
a lot of these patients for calcium scores. Is that overkill?
So people that are listening tonight, and let's say they're
fifty five sixty, they're over weight or obese and have
a cholesterol problem, Okay, they're asymptomatic, yes or no? Should
they go for a carnary calcium scan?
Speaker 4 (24:12):
Absolutely? Yes, okay, absolutely yes.
Speaker 3 (24:15):
Forty year old male with one res factor, fifty year
old female with one risk factor. And if you are
risk factors, you talk about forty percent of the population
is obese, thirty percent is olverad.
Speaker 4 (24:25):
That's seventy percent of them.
Speaker 3 (24:26):
A body called one respector already mentioned hyperlipidemia, pre diabetes,
you name it. I am screening patients as young as
forty and forty five any res factors, and then we
repeat the scan in five to seven years, depending on
their scores. And the beauty is the moment you do
the calcium score and you've got premature corneoder disease.
Speaker 4 (24:49):
Both the doctor and the patient.
Speaker 3 (24:51):
You share the data with the patient, tell them, hey,
you are in the seventy fifth percent. Time, sir ma'am
you're in the eightieth percentile. They become very prove active.
They taking care of medications, whether we're going to give
them aspen, give them statin or something more, piece of.
Speaker 4 (25:07):
Skin and inhibitor. We have other tools available now.
Speaker 3 (25:11):
So we and the patient will become very, very engaged,
pro active and including the lifestyle modification.
Speaker 2 (25:18):
Right, is there in your in your generic patient here
an age that's a little too young now we're seeing
and you're seeing them, oh piece, twenty year olds with
hypertension and diabetes. Would you engage them in this type
of screening at twenty That's a tough it's a tough point.
Speaker 4 (25:42):
Well, I have done as young as thirty five year old.
I have screened with multiple res factors with hyphpertension, hypilipidemia.
I had a young.
Speaker 3 (25:49):
Patient, twenty five year old patient who had came to
me in fact in the last one month, and he
was his father had a heart attack at the age
of thirty five, okay, and uncles, so he was young
and he was just totally worried and he's almost having
these almost anxiety attacks that I got heart disease. And
I had I kind of screen him and gave him
(26:11):
a customs score and tell him I'm going to see
you in fifteen years or ten years and if go okay,
you know what I because they have people are reading
about cornerity custom scores and they are you know, the
information is out there, so you know that young typically
I don't, but there's an unusual cases.
Speaker 4 (26:29):
One may do it. But around the age of thirty
five forty, if you've got multiple.
Speaker 3 (26:32):
Distractors, and I'm picking up corneaty disease and young patients,
absolutely young WROLD the score of one hundred fifty seventy five,
they should be absolutely should have score of zero.
Speaker 4 (26:43):
So these people have premature corneatter disease.
Speaker 2 (26:47):
Right, No, exactly to get more into the social pray
make America healthy again? What is your take?
Speaker 1 (26:57):
Now?
Speaker 2 (26:57):
What I've told everybody is trying to separate the intense
political reaction people are having too RFK Junior, they love them,
they hate them. I say, just forget about that for
a second. We have to think about making America healthy again.
(27:19):
Someone like you is right on the front line every day.
What do you think of that?
Speaker 3 (27:25):
Well, I think in any way we can improve the
health of the common people and the general population. Increase awareness,
increase our I mean, our food industry has not done
a good job. As you know, there's so much is
this commercialized food products and processed foods. We need to
clean up our foods. Absolutely, education has to be improved.
(27:49):
So I think there's a lot of things that it
can be done at multiple levels, but ultimately it all
comes down to the individual. And I think increased awareness,
increase knowledge just as simple as measuring your blood pressure
you talk about at home and getting yourself a glucose monitor,
and now with the availability of getting a CGM by yourself.
(28:13):
And I'm telling you, the moment you start looking at data,
you will automatically become proactive and it has a very
tremendous impact in patient awareness. And then they start executing,
will increase walking, increase activity, and obviously you have to
have cardiologic clearance if they're having any symptoms. You don't
want to start running preparing for a marathon if you've
(28:35):
got symptoms. But obviously you can make some lifestyle modification
changes and help yourself in more ways than you realize.
Speaker 4 (28:45):
Right.
Speaker 2 (28:46):
You know, probably thirty years ago there were some initial
studies where they found that people that just weigh themselves
every day, we're losing weight. So we're just seeing that
feed back. Now, let alone you add you're weighing yourself,
you're being conscious of the food you're eating, you're taking
(29:07):
your blood pressure. It goes a long way. But as
you've said so many times, it is the engagement. We
need the engagement. Everybody listening tonight. You know, one of
my sayings is that good health doesn't come by chance.
You have to work at it.
Speaker 4 (29:26):
You have to make an effort, and you have to
be proactive.
Speaker 3 (29:29):
And you know, whether one hundred and fifty minutes of
exercise per week, making sure you give plenty of water,
as long as you know history, condut are field, and
then incorporating lifestyle modification degree including yoga, meditation. And interestingly,
in our textbook of cardiology, we call it our bible,
the Bronz Wall's textbook.
Speaker 2 (29:50):
Get asked.
Speaker 3 (29:53):
In the last edition, this is a two volume, one
thousand page each book. For the first time, we have
five six page chapter on integrative cardiology.
Speaker 2 (30:05):
Okay, so tell us tell us about that. People may
have heard of this, but it's really worthwhile to talk now.
Speaker 3 (30:13):
So you know, in the past, the textbooks of cardiology
never incorporated anything like this, and this is a paradigm shift.
If one may say, having a chapter of integrated cardiology
in our Bible of Cardiogies is the Bronz World's textbook,
and they talk about multiple things have been addressed. They
(30:34):
talk about yoga, meditation, tai chi in patience for helping
lifestyle modification. As we know, meditation techniques help in reducing
the sympathetic nomber system, increasing parasympathetic symptom, reducing the activation
of amygdala, and also improving the connection between amygdala and
(30:57):
ventromedial frontal cortex. All these techniques have been shown to
reduce stress, manage the stress, reduce the sympathetic activity. So
they have mentioned in this chapter that you can incorporate
these in managing for stress high pretension. The concept of
coqute ten also has been added into that chapter where
I am a huge believer. Where As you know, statin
(31:20):
associated muscle symptoms started to induced muscle symptoms is very
very common. In fact, in clinical practice we see much
more than its described on textbooks. But when because when
you give the statins and they inhibit the hmg coins
and retectives inhibitors. Also, it reduces the synthes of co
q ten and coqutin is a very important molecule important
(31:41):
in the respiratory life cycle in these skeletal muscles. By
exogensy supplementing coq ten minimum two in the millions a day,
we can definitely reduce the symptoms. Although data is somewhat conflicting,
but in my practice I have seen that it absolutely helps.
In our practice we emphasize that patients taking status must
(32:03):
take two milliums of coq ten with food. It is
a fat soluble vitamin that should be taken food so
that it reduces the chances of statin associate meddle center.
Speaker 4 (32:13):
So the concept of.
Speaker 3 (32:14):
Coq ten has come, then Ready's rice has been incorporated
in that chapter.
Speaker 2 (32:18):
Yeah, that is you know, you know, look you know
better than me. But that has been talked about for
probably twenty years. And I remember twenty twenty five years
ago patients coming in with red rice yeast and at
first you'd sort of say, well, it probably won't hurt you.
(32:38):
But now it seems like there's some pretty.
Speaker 3 (32:41):
Decent data and patients who are not receptive who taking
statins or they cannot take any statans.
Speaker 4 (32:47):
It is pretty much like a natural statin.
Speaker 3 (32:49):
And in this textbook of Cardiologia Braunold, they said, yes,
this can be considered an alternative for patients who are
not able to handle.
Speaker 4 (32:57):
It's literally and like a natural statin, and there has.
Speaker 3 (33:00):
Been some data that it may reduce you a deal,
maybe between fifteen to eighteen percent in some percent of cases.
Speaker 2 (33:05):
Well, now with that, would it ever be a case
where you take a statin or maybe a little bit
less of a statin and the red rice yeast as
a as a combo or is it one or the other?
Speaker 3 (33:21):
I try not to combine the two because it becomes
difficult to really objectively know if they're having any problem
work contributing to it.
Speaker 4 (33:29):
But typically I keep.
Speaker 3 (33:30):
Those I'm keeping for patients who are resistant or taking
statins or they would like to have a natural alternatives
and READI strize. I do offer patients who are but
I'm a very big believer in statin and they have
been shown with so much data for all these decades,
would be so useful. But if people are totally resistant,
(33:51):
then this is a reasonable alternative.
Speaker 2 (33:53):
All right, final segment of your health first coming up.
Don't forget If you want more information about autorin deep
sination is practice, it is Uston Cardiology dot Comuston Cardiology
dot com and don't forget. Go to doctor Joeglotti dot com.
Stay tuned. Final segment coming right up, the final segment
of this week's Your Health First, and don't forget. Join
(34:15):
us at doctor Joegalotti dot com and you can sounder
forraur newsletter. Send me a message as a tab there
that says contact me, and all of our social media
is there, and all of our past programs, podcasts, other
educational material is there. But you have to go to
doctor Joegalotti dot com.
Speaker 4 (34:36):
All right, so.
Speaker 2 (34:38):
Doctor Snasa has been in the office with us talking
about heart disease, heart prevention, heart symptoms, some new therapies,
how to manage your cholesterol, things that you need to
know and do. Keep in mind that the number one
killer for all of us is going to be cardiovascular disease.
So we need to raise the bar and really pay
(35:01):
attention to heart disease. If you have heart disease, pay
attention to it. If you have risk factors, really do
get it checked out.
Speaker 1 (35:10):
You know.
Speaker 2 (35:10):
One other area and the golp one agents, the oxepics
of the world. Of course, they started off in the
diabetes circle and then into obesity. But now there are
some studies on being protective for heart disease and heart failure.
What are you seeing and where do you think the
(35:33):
future lies with these GLP one agents GLP one.
Speaker 3 (35:38):
Initially I was to be very frank, I was quite
apprehensive of giving them to patients. But the more and
more I'm studying the data, we have seen that they
definitely some percentage of population of patients who are struggled
to lose weight. Right an effective, very effective class of drugs,
and they absolutely help you in reducing weight. However, you
(36:00):
know you have to be mindful of the fact that
there are some significant side effects, and I'm sure you've
seen fair share of that. But you cannot just prescribe
a GLP one and not emphasize lifestyle modification because that
is not the right way to manage your diabetes and
hypotension and overweight problems and obixity. However, the data that
(36:25):
is coming out in benefit of reduction and heart failure
and other cardivorskit benefits is all. If you lose the
question is that is it the weight loss that is
helping you reduce it or there is some question that
the drugs are And my thought process is I say
weight loss is the best medicine.
Speaker 4 (36:44):
Way, your blood.
Speaker 3 (36:45):
Pressure will get better, your liperds will get better, your
everything will get better, your exercise.
Speaker 4 (36:50):
Todance will get better, and your heart failure.
Speaker 3 (36:53):
Of course, you sleep will get better if it will
get better, and your heart failure will get better.
Speaker 4 (36:59):
There's no quest about it. So, yeah, is the best medicine.
Speaker 2 (37:03):
Yeah, no, no, no, I mean it is. And unfortunately
with all of the advertising and marketing and things on
social media, that message gets lost. They think this the medicine.
Of course, the weight loss they see it. But you know,
the gop ones, You're right, there are a whole host
(37:24):
of gastro intestinal side effects, nausea, vomiting, constipation, people are miserable.
But weight loss through lifestyle, the Sunasia formula, of course
is it might not be as fast as a golp one.
You know, you have to be patient, you know, you know,
(37:47):
fifty pounds was not gained in six months, you can't
expect to lose it in six months. But it's that
lifestyle change that it is, learning to eat better, learning
to cook, learning to exercise, and just integrating this all
in there. So we've got a couple of minutes left here,
doctor Sunasia and for those that might just be joining
(38:11):
us late this evening. Doctor ran Deepsynasia. He is a
very very well known cardiologist here in Texas Cardiology Center
of Houston. His website is Houston Cardiology dot com. A
couple of parting remarks. If you had to tell a
(38:33):
patient people listening tonight, let's say one intervention. Now, there's
many things to do, right, But if you were going
to start off with one win, one thing that you
could cross up and say I was able to start
doing that tomorrow and I stuck with it, what do
(38:54):
you think that would be?
Speaker 3 (38:56):
Just start walking fifteen minutes a day and increase with
thirteen minutes a day. I think regular exercise does wonders right.
Journey of one thousand miles begins with a single step.
Just start walking and tell patients you know, doesn't matter.
Could be ten minutes, fifteen minutes, please, best thing is
(39:16):
just start walking and you will see it will transcribe
into benefits beyond your belief. You know, you don't have
to walk ten miles or three miles, just ten minutes,
fifteen minutes, and gradually you will see then you can
increase it. And with that you need to work on
diet and reduce the card consumption, reduce the carry consumption,
(39:39):
and weight loss has to be the most primary thing.
But seventy percent of the population with fortys in thirty
percent overweight, absolutely is critical importance America healthy. Again we
miss a control of the epidemic of weight gain.
Speaker 2 (39:56):
All right, Another scenario, So most patients are being seen
by a primary care physician or internest or maybe even
there upstir g yn and somebody is sitting there tonight
and saying, look, gee, gosh, I am overweight. I've got
this touch of blood pressure. The doctor said, my glucose
(40:19):
was just a touch elevated. What is the conversation you
want to have the patient initiate with their primary care
doctor to say, please address these heart risk factors or
maybe even symptoms. How do you frame that conversation?
Speaker 4 (40:40):
What do you think?
Speaker 3 (40:42):
I think controlling getting your lipids done, collecting data on
your blood pressure, and as a doctor they can refer
for calcium. School Houston Methodist does it for one hundred
and forty dollars any of the Methodist system and then
you have the heart scan.
Speaker 4 (40:56):
Plus they can scan.
Speaker 3 (40:57):
Your carotis, aota, the legs and including the heart scan
for two hundred and five dollars. I tell them that
is the best two hundred five dollars that you'll ever spend.
And once you have the data and then based on
the results, it is going to have a very positive impact.
Once you have the data with you, share that data
with your cardiologists, let the cardiology explain to you where
(41:19):
you cat some scores, what it means, and then you
take it from there. I think these are critically important
issues that you brought up and it is so important
for us to take care of our patients and increase
education and awareness.
Speaker 2 (41:32):
Right And that's and that's my gosh. You could you
could be in front of a microphone three hundred and
sixty five days a year, doctor Sunesia, and get get
the word out there. So as always, thanks for coming
on tonight, doctor Suonisia. Don't forget you can catch up
with doctor Sunesia at Houston Cardiology dot com. Randeep. It's
(41:55):
been awesome. It's always great to have you on.
Speaker 3 (41:58):
Well, thank you so much for the ortunity. Look forward
to always working with you and enjoying your conversations with you,
and look forward to many more
Initial Life Sequencing coming to you live from Houston, Texas,
home to the world's largest medical center in the.
Speaker 2 (00:08):
Approach ras everything looking ability.
Speaker 1 (00:19):
This is your Health First. It's the most beneficial health
program on radio with doctor Joe Galotti. During the next
hour you'll learn about health, wellness and the provention of disease.
Now here's your host, doctor Joe Galotti.
Speaker 2 (00:45):
Well, good Sunday evening to everybody. Doctor Joe Glotti, thanks
for tuning into your Health First. We're here every Sunday
between seven and eight pm. And our mission year after year,
twenty two plus years that we've been doing this, it
is very simple to make you better consumers of healthcare,
raise your health IQ and give you some insight as
(01:07):
to how to take care of your body. Being a
good consumer can certainly, without a doubt, prevent a lot
of the chronic disease that we see. By now, everybody
should know our website. It is doctor Joegalotti dot com,
d R J O E G A L A t
I dot com. Go there and sounder from newsletter send
(01:29):
me a message. All of our social media posts are there,
including YouTube and Instagram and Facebook, and our website Doctor
Joegalotti dot com all right, So the month of February
is American Heart Month, and that is the time of
the year where we raise awareness, have a conversation about
(01:54):
heart disease, heart disease and men heart disease and women.
Making sure you understand your risk factors, because really, if
you know your risk factors, you can look in the
mirror and say, hey, I did not realize I am
at risk for premature heart disease or a premature heart
(02:15):
attack or stroke or heart failure, or these palpitations I'm
having may be something more serious that needs a more
formal workup. So that is the idea. And on the
program tonight, we have to we have doctor ran Deep Sunasia.
(02:36):
He is an acclaimed cardiologist here in Houston, and I
had the opportunity a little earlier in the week to
sit down and have a conversation with him. So that
is what we have tonight, a conversation with doctor ran
Deep Sunasia, a cardiologist here in Houston. Listen and take
(02:59):
in for yourself what information do I need to know?
Look at it that way?
Speaker 1 (03:06):
All right?
Speaker 2 (03:07):
Well, as I was saying earlier, it is American Heart Month,
a month of February, and if it was up to me,
it would be part month every month of the year,
but we have to deal with what we're dealt here
and no stranger to your health. First, doctor ran Deep Sunasia.
(03:27):
He is one of the finest cardiologists, not only in
Houston but in the United States. And I've known him
a very long time. And when sometimes we are lacking
compassion in the medical field to our patients, doctor Snasia
certainly excels in that area. It's great to have you
(03:47):
on tonight, and thanks for participating in our little contribution
to American Heart Month.
Speaker 3 (03:54):
Thank you, Joe, thank you for inviting and always look
forward to our yearly meetings here on and during this month.
Speaker 2 (04:02):
Yes, exactly. Now, just a little background on doctor Sunasia.
He has been here is it twenty three years now? Well,
thirty three thirty three thirty three years, over one hundred
thousand patients. That was a landmark just recently and he
has founded the Cardiology Center of Houston. He's on staff
(04:24):
at Houston Methodist Hospital West right or is that in Katie.
It's in Katie, Texas, and you've held various positions there
over the years. Board certified in five separate areas ranging
from internal medicine, cardiology, nuclear cardiology, cardiovascular ct which I
(04:46):
want to hear about, and what I think is most
important is lifestyle medicine. So I would say, there's so
much to talk about here, but let's really orient everybody
with some of the basics and risk factors for heart disease,
cardiovascular disease, and the way I look at it, for
(05:09):
everybody listening tonight, if you do not have a good
understanding of what your risk factors are, then you're really
not paying as much attention as you need to. So
knowing risk factors is very powerful. Doctors in Asia go
(05:29):
over the list of risk factors people need to know about.
Speaker 4 (05:33):
Sure.
Speaker 3 (05:33):
I think risk factors get divided into two, which is
modifiable and non modifiable. Non modifiable risk factors are where
you cannot modify them. That includes family history, age, and race.
So there are age where premature Corno disease happens before
the age of fifty five, a family history or in
women before the age of sixty five does strong family history.
(05:56):
Age as is basically is when you get older, higher
the risk and number. Some races where you have African,
American and even some Asian population, I had highly Soccardivasca
disease compared to Caucasian population. And then we have the
modifiable risk factors where we can modify the risk factors
and those are most importantly hypertension, diabetes, history of smoking, hyperlipidemia,
(06:21):
lack of sleep and in activity, and weight is a
very big factor. Now we are talking about sitting is
the new smoking risk factor we're all been setting for
our specially post COVID and during COVID, people have been
working on their desk for eight eight hours a day
and on average, people have gained between ten to twenty pounds.
(06:42):
And Joe you, I'm sure you've seen this.
Speaker 2 (06:45):
Yeah, and you know the people people in many times
they aren't able to shake it off. They gain the
weight during COVID. You know what I would share with you,
and I think from my own personal experience, and so
we when COVID hit in the pandemic, and we did,
(07:05):
or at least I did some remote work from home
seeing patients online. And I remember the very first day
and I got my Apple Watch. On my very first day,
I came up to my office, saw my eighteen twenty patients.
Then I went down for dinner. That was basically I
(07:27):
was up here for breakfast. Maybe I went down for
lunch to go to the bathroom. I don't know. I
walked only about three hundred and fifty steps the entire day.
We're normally at work, it's seven to eight thousand steps
just doing the normal work. And I'm sure you're the same.
(07:47):
And it dawned on me that the adults that have
desk jobs is a horrible, horrible situation to be in.
Speaker 3 (07:58):
Ye And you know, as you know, the percentage of
and prevalence of obesity in the US now we are
talking about on an average, forty percent the adult US
population is obese, thirty percent is overweight and painfully, but
to twenty two percent of the adolescent kids are no obese. Right, So, yeah,
(08:21):
it's an epidemic.
Speaker 2 (08:23):
Yeah, it's it's really getting out of control now, you know,
with with the risk factors. When when you see let's
say a new patient and they have hypertension and it's
gone undiagnosed for years, and they have these other either
family or lifestyle risk factors, and you alert them and
(08:44):
you educate them and teach them and enlighten them, what
do they say do they say? Gee, I had no
idea smoking caused high blood pressure. I had no idea
that no exercise caused hypertension. Where is a public on this?
Are they just in more denial than really being completely
(09:08):
ignorant on this? What do you think?
Speaker 4 (09:12):
I see?
Speaker 3 (09:13):
The question is that if the patient comes with hypertension,
when we do the echocardiogram and we measure the wal
thickness and we see that their val thickness is increase,
and they've got leftritical hypertrophy, and I show them the statistics.
You know, when you show the patient that you got
leftritical hypertrophy, your heart is working harder. It really dawns
(09:34):
on them that you know the amount of blood fruit
to the heart is fixed, and if you have leftritical
epotrophy then you're going to have someone to call it ischemia.
Speaker 4 (09:43):
Your heart is working harder.
Speaker 3 (09:45):
And when you present these facts, it makes them aware
that they must take very proactive measures. You define that
you have to control the blood pressure very well. Every
ten percent drop in systolic BP reduces the cardiovestor complications
by but to twenty two percent. Yeah, so it's critically
(10:06):
important to control the blood pressure and along with that
other dis factors and you know weight gain leads to
elevated levels of lipids, metabolic syndrome, sugar is up, the
blood pressure all go hand in hand. And if you're
addressing one factor, I think the key factor here is
managing the weight and that will improve all the parameters.
(10:30):
But you have to make an effort and it requires
a lot of effort. Proactivity, regular exercise one hundred and
fifteen minutes per week, as you know, thirty minutes five
times a day and then ah and American artizens also
emphasize that you must do weight training about two times
a week because we are being muscle as we're getting older,
(10:52):
so it's very important.
Speaker 2 (10:53):
All right, let's take a quick break on down to
Joe Glotti. We're talking with doctor Ran Deep Ssunasia, cardiologist
here in Houston, Texas. Is website to get more information
is Houston Cardiology dot com. Stay tuned, We will be
right back. Welcome back, everybody, back with doctor Ran Deepsunasia
cardiologists here in Houston, Texas, talking about American Heart Month
(11:16):
and all that you need to know about heart disease.
Speaker 5 (11:22):
You know, the other thing just to shift to symptoms,
because again the patients that I see, they are you know,
limping around with symptoms.
Speaker 2 (11:32):
They're short of breath, they have palpitations, they're not sleeping well,
they have some swelling in their legs. And again, you know,
I asked them, what were you thinking?
Speaker 4 (11:45):
And I think people are not.
Speaker 2 (11:47):
Putting all the dots together to say, you know what,
this might be a problem with my heart. Let me
get it checked out. So what do you see from
a symptoms standpoint?
Speaker 4 (12:00):
One point?
Speaker 3 (12:00):
I think that varies from anywhere from chestice comfort, tightness,
heaviness in the chest, which are signs of precipitated by exertion,
activity or stress, indicating anginal symptoms. You can have shortness
of breath, which can be related to again, symptoms of
high blood pressure. Exertional disney can be an anginal equivalent.
Also palputations that can be related to rhythmia. As we
(12:24):
are seeing a ton of atrial fibrillation all these days,
almost an epidemic of a FIB, right, Yeah, so yeah,
I mean.
Speaker 2 (12:33):
Is it just to stop you there for a second,
would you say, twenty five years ago you saw as
much a FIB as we all see now.
Speaker 3 (12:40):
No, definitely, not definitely, not right, Yeah, And I think
that there's multi factorial aspects in that age is one
of the biggest risk factors. People are living longer, aging
longer than we have people we are treating them well
with if they have microinfunction, they'll be treating with intervention.
They may have allued dysfunction, and as they are aging,
(13:03):
then they will ultimately develop interfibrillation liter in life. So
it is and then presence. People who have been affected
with COVID also have had disease processes from that, and
we have seen a higher amounts of aphibian patients who
are bad COVID also and other rhythmias. So definitely seeing
(13:24):
a whole lot of a FHIB. And again obesity rate
is going up. That leads to sleep apnea, which is
sleep apnea is putting increases or intrifibrillation. So every patient
with a FIB, we are screening them for sleep apnia.
And then fatty liver is going hand in.
Speaker 2 (13:44):
Hand, right, Yeah, I mean data doesn't go by that.
I think you're contacting us about a fatty liver patient
and it's it's really really we we say obesities that
have been a FIB is an epidemic, Fanny livers an epidemic.
We're we're just exploding with complications. And it is so said.
(14:08):
You know one one thing you know again Uh, I
like to say, I am a cardiologist in the closet, uh,
and I leave the expertise to you and your colleagues.
But imagine if we could wake up the American public
(14:30):
to know their blood pressure. And I've even spoken on
the radio here that wouldn't it be great if every
household had a blood pressure cuff, even if you did
not have blood pressure, a blood pressure issue, high hypertension,
that and that would be great. But imagine if once
(14:54):
a quarter you just check the blood pressure everybody in
your heart okay, and just say get the kids, your
young adults, your wife, your husband, your mother, whoever, and
just say, okay, it's the first quarter of the year.
We're going to check and document everybody is okay. We'll
do it again next quarter. But create alertness to blood pressure.
(15:19):
The numbers are staggering on the amount of people that
have hypertension. What do you think regarding the value of
home monitoring. I think that's phenomenal.
Speaker 3 (15:29):
In fact, when patients come in with hypertension, you know
sometimes many times you see you know, white foot hypertension, Also,
patients blood pressure at home is okay and when they
come to the office they are elevated. So it's critically
important to get good data and we recommend Actually AHH
never endorses any products, but American Heart as Solcition has
(15:49):
stated that for us to treat hypertension, we must collect data.
So omron VP arm cuff, ARM cuff not a risk,
cut the risk, not the risk, not the risk. Aren't
cuff done in a proper way with patient preferable lying
down and this the sigam monometer right next to you,
done two three readings after taking a few minutes of rest.
(16:13):
Collecting data over period of time because if pressure is elevated,
you don't want to just start it right away because
if the BP readings are higher in the office, so
you want to collect data for at least two to
three four weeks.
Speaker 4 (16:25):
But if the patient comes in with significantly.
Speaker 3 (16:27):
Elevated blood pressure they got left final hypertrophy on their
EKG and on their eco cortagram, obviously you're going to
start treating. But when they are borderline elevated, then you
make them aware lifestyle modification, making sure their resalt intake
is reduced, their calory intake is being monitored. I mean
I talk about the Suneja equation, which I've talked and
(16:48):
created that video which almost hit thirty six thousand views
on LinkedIn that I posted on New Years about the
way production formula where you reduce thirty fi hundred where
thirty five hundred calory count negativity is leads to negative
balance leads to one pound of weight loss of fact.
Speaker 4 (17:07):
So if you have five.
Speaker 3 (17:08):
Hundred caloriy negative balance per day and multiply by seven
aver day of the week, you lose thirty five hundred carries.
And that five hundred I'm dividing into two parts, two
and fifty negative balance by eating less mostly carved everybody.
Everybody loves carves, bread, pasta, dessert, snacks, potatoes, rice, alcohol,
a little bit less consumption per day, two and fifty
(17:29):
cars less per day, and two and fifty car is
burning more per day. That's half our of brisk walking.
And third component, which is also equally very important as
long as there is no history of congest of heart failure,
drinking sixty to seventy ounces of water, right, and you
combine that and if you do it consistently, seventy is
a week lose a pound a week.
Speaker 4 (17:48):
If you do three to four days a week, you
lose a half a pound a week. So life cell
modification is critically important.
Speaker 3 (17:54):
And I think, I, you know, just for my own curiosity,
last Tuesday, I have plied a continuous glucose monitor myself CGM,
which are now available without a prescription a month ago,
and I have myself reduced my sugar. I have an
AVNCY of five point seven, which is minimally elevated. I
(18:15):
want to make it better, bring it down, so you know,
you can modify it by reducing.
Speaker 4 (18:20):
And within a week I've noticed that I have cut
down the.
Speaker 3 (18:23):
Foods and I could monitor my sugar and react the
intake so that I can bring the glucose in a
completely normal level.
Speaker 4 (18:30):
So I think awareness and education is critically important.
Speaker 2 (18:34):
Yeah, and I think that the CGM, the continuous glucose monitoring,
the deck scam is probably one of the more popular ones.
I think if if you know you're overweight, you have
pre diabetes and hypertension, lipids, and you know that doctor
Sunasia or doctor Galati is not looking at you twenty
(18:57):
four hours a day. But if you get that little
hatch you on your arm and you're contemplating a piece
of chocolate pie and you see that your glucose is
just a little too high. That may be enough to
stop you and in the end be beneficial. So as
you know, we need oversight, we need accountability, and I
(19:20):
think electronically AI in a sense is doing this.
Speaker 4 (19:24):
Absolutely.
Speaker 3 (19:25):
I think this is one of the finest examples of
how we can utilize AI and technology because this is
continuous glucouse mountor is actually AI.
Speaker 4 (19:34):
And when you're able to see your sugar.
Speaker 3 (19:36):
And then that is automatically going to have a positive
impact in eating, making you eat better because you're going.
Speaker 4 (19:42):
To see if you eat particular food, your level is
going up.
Speaker 3 (19:45):
Within the last five six days, I have myself modified
my own eating habits, even though I consider myself a
good eater. And you know, I did my fifteenth half
methon last weekend. That's great, but there is room for improvement,
right Nobody's room for improvement. And within a week I've
noticed that I'm making some very positive changes in what
(20:05):
I'm eating, eating a little bit less and watching the cobs,
and I'm noticing this reduction in my lucas is amazing
today and the entire office day I was running around.
Speaker 4 (20:17):
My peak sugar was only one twenty.
Speaker 3 (20:19):
Yeah, and I'm morty eating, you know, I eat very
healthy breaksace with white omelets and lunches salad.
Speaker 4 (20:27):
And you can make modify it, you know.
Speaker 2 (20:29):
Yeah, yeah, I think it's just a willingness to do it.
You know, it's a willingness to do it now. You know,
of course, one of the big pillars of heart disease
and prevention is cholesterol. And there's still a lot of
sort of misunderstanding of cholesterol. Patients will still come in
(20:50):
and say, well, the ratio is good, so nothing needs
to be done. Is it true that the ratio of
good lesterol to bad cholesterol? And that may not be
a good way to say it is sort of outdated.
Now we need to look at cholesterol a little differently.
Speaker 4 (21:09):
What do you say?
Speaker 3 (21:10):
Absolutely so, I think the entire emphasis noise on the
Lder number. The ratio is pretty much outdated. But Lder
number in relation to risk factors and presence of corneatic disease,
and here comes as utility of the cornaty cassium score. Right,
we are utilizing I've been doing this for almost twenty four,
(21:31):
twenty five years, I have been a very big proponent
of calcium score and potentially probably are practiced at the
biggest database of cusum scores in the state of Texas.
So when you do the cornerity custum score on a
patient and then we are able to use that number
and put them into the mesa registant calculated persentile. Now,
(21:52):
if you've got a fifty year old male coms and
his custom score is one hundred and his persentile is ninety,
his LDL will.
Speaker 4 (22:00):
Need to be below fifty five.
Speaker 3 (22:02):
But if you have one hundred year old mail with
the custum score of zero and his LDL is one fourteen,
there is no data that we need to be that aggressive.
Speaker 4 (22:13):
That is life sele modification. So the castium score is
able to guide us how we need to manage the
eldeal number and if you're ELDAL.
Speaker 3 (22:23):
Now November of twenty twenty three, high the spaces American
hunt as American conture cardiology.
Speaker 4 (22:29):
Now we're talking about high risk places where they have cornea.
Speaker 3 (22:32):
Intervention, corniati bypass graft surgery, they have diabetes and other
equivalent corneaty disease reris factors.
Speaker 4 (22:40):
We are talking about bringing the ldeal below fifty five.
Speaker 2 (22:44):
All right, let's take a quick pray. Come down to
Joe Gladi your two did your health first, don't forget
go to doctor Joegalori dot com. Stay tuned, we'll be
right back. Welcome back, everybody, to your health first. Comes
out to Joe Galati. And in honor of the month
of February, it is American Heart Month, that one month,
even though it really should be twelve months out of
(23:05):
the year that we think about our heart, heart disease,
heart disease prevention and understanding our risk factors. And in
the studio tonight is doctor ran Deepsunasia, a well known
cardiologist here in Texas, trying to explain the key points
that we all need to know with regard to how
(23:26):
to take care of your heart. You've taught me a
lot about the calcium score corrintory calcium score ct score.
And with all of the patients with fatty liver that
I see, almost all of them have diabetes, hypertension, they're overweight,
high cholesterol, et cetera. I have been recommending and sending
(23:48):
a lot of these patients for calcium scores. Is that overkill?
So people that are listening tonight, and let's say they're
fifty five sixty, they're over weight or obese and have
a cholesterol problem, Okay, they're asymptomatic, yes or no? Should
they go for a carnary calcium scan?
Speaker 4 (24:12):
Absolutely? Yes, okay, absolutely yes.
Speaker 3 (24:15):
Forty year old male with one res factor, fifty year
old female with one risk factor. And if you are
risk factors, you talk about forty percent of the population
is obese, thirty percent is olverad.
Speaker 4 (24:25):
That's seventy percent of them.
Speaker 3 (24:26):
A body called one respector already mentioned hyperlipidemia, pre diabetes,
you name it. I am screening patients as young as
forty and forty five any res factors, and then we
repeat the scan in five to seven years, depending on
their scores. And the beauty is the moment you do
the calcium score and you've got premature corneoder disease.
Speaker 4 (24:49):
Both the doctor and the patient.
Speaker 3 (24:51):
You share the data with the patient, tell them, hey,
you are in the seventy fifth percent. Time, sir ma'am
you're in the eightieth percentile. They become very prove active.
They taking care of medications, whether we're going to give
them aspen, give them statin or something more, piece of.
Speaker 4 (25:07):
Skin and inhibitor. We have other tools available now.
Speaker 3 (25:11):
So we and the patient will become very, very engaged,
pro active and including the lifestyle modification.
Speaker 2 (25:18):
Right, is there in your in your generic patient here
an age that's a little too young now we're seeing
and you're seeing them, oh piece, twenty year olds with
hypertension and diabetes. Would you engage them in this type
of screening at twenty That's a tough it's a tough point.
Speaker 4 (25:42):
Well, I have done as young as thirty five year old.
I have screened with multiple res factors with hyphpertension, hypilipidemia.
I had a young.
Speaker 3 (25:49):
Patient, twenty five year old patient who had came to
me in fact in the last one month, and he
was his father had a heart attack at the age
of thirty five, okay, and uncles, so he was young
and he was just totally worried and he's almost having
these almost anxiety attacks that I got heart disease. And
I had I kind of screen him and gave him
(26:11):
a customs score and tell him I'm going to see
you in fifteen years or ten years and if go okay,
you know what I because they have people are reading
about cornerity custom scores and they are you know, the
information is out there, so you know that young typically
I don't, but there's an unusual cases.
Speaker 4 (26:29):
One may do it. But around the age of thirty
five forty, if you've got multiple.
Speaker 3 (26:32):
Distractors, and I'm picking up corneaty disease and young patients,
absolutely young WROLD the score of one hundred fifty seventy five,
they should be absolutely should have score of zero.
Speaker 4 (26:43):
So these people have premature corneatter disease.
Speaker 2 (26:47):
Right, No, exactly to get more into the social pray
make America healthy again? What is your take?
Speaker 1 (26:57):
Now?
Speaker 2 (26:57):
What I've told everybody is trying to separate the intense
political reaction people are having too RFK Junior, they love them,
they hate them. I say, just forget about that for
a second. We have to think about making America healthy again.
(27:19):
Someone like you is right on the front line every day.
What do you think of that?
Speaker 3 (27:25):
Well, I think in any way we can improve the
health of the common people and the general population. Increase awareness,
increase our I mean, our food industry has not done
a good job. As you know, there's so much is
this commercialized food products and processed foods. We need to
clean up our foods. Absolutely, education has to be improved.
(27:49):
So I think there's a lot of things that it
can be done at multiple levels, but ultimately it all
comes down to the individual. And I think increased awareness,
increase knowledge just as simple as measuring your blood pressure
you talk about at home and getting yourself a glucose monitor,
and now with the availability of getting a CGM by yourself.
(28:13):
And I'm telling you, the moment you start looking at data,
you will automatically become proactive and it has a very
tremendous impact in patient awareness. And then they start executing,
will increase walking, increase activity, and obviously you have to
have cardiologic clearance if they're having any symptoms. You don't
want to start running preparing for a marathon if you've
(28:35):
got symptoms. But obviously you can make some lifestyle modification
changes and help yourself in more ways than you realize.
Speaker 4 (28:45):
Right.
Speaker 2 (28:46):
You know, probably thirty years ago there were some initial
studies where they found that people that just weigh themselves
every day, we're losing weight. So we're just seeing that
feed back. Now, let alone you add you're weighing yourself,
you're being conscious of the food you're eating, you're taking
(29:07):
your blood pressure. It goes a long way. But as
you've said so many times, it is the engagement. We
need the engagement. Everybody listening tonight. You know, one of
my sayings is that good health doesn't come by chance.
You have to work at it.
Speaker 4 (29:26):
You have to make an effort, and you have to
be proactive.
Speaker 3 (29:29):
And you know, whether one hundred and fifty minutes of
exercise per week, making sure you give plenty of water,
as long as you know history, condut are field, and
then incorporating lifestyle modification degree including yoga, meditation. And interestingly,
in our textbook of cardiology, we call it our bible,
the Bronz Wall's textbook.
Speaker 2 (29:50):
Get asked.
Speaker 3 (29:53):
In the last edition, this is a two volume, one
thousand page each book. For the first time, we have
five six page chapter on integrative cardiology.
Speaker 2 (30:05):
Okay, so tell us tell us about that. People may
have heard of this, but it's really worthwhile to talk now.
Speaker 3 (30:13):
So you know, in the past, the textbooks of cardiology
never incorporated anything like this, and this is a paradigm shift.
If one may say, having a chapter of integrated cardiology
in our Bible of Cardiogies is the Bronz World's textbook,
and they talk about multiple things have been addressed. They
(30:34):
talk about yoga, meditation, tai chi in patience for helping
lifestyle modification. As we know, meditation techniques help in reducing
the sympathetic nomber system, increasing parasympathetic symptom, reducing the activation
of amygdala, and also improving the connection between amygdala and
(30:57):
ventromedial frontal cortex. All these techniques have been shown to
reduce stress, manage the stress, reduce the sympathetic activity. So
they have mentioned in this chapter that you can incorporate
these in managing for stress high pretension. The concept of
coqute ten also has been added into that chapter where
I am a huge believer. Where As you know, statin
(31:20):
associated muscle symptoms started to induced muscle symptoms is very
very common. In fact, in clinical practice we see much
more than its described on textbooks. But when because when
you give the statins and they inhibit the hmg coins
and retectives inhibitors. Also, it reduces the synthes of co
q ten and coqutin is a very important molecule important
(31:41):
in the respiratory life cycle in these skeletal muscles. By
exogensy supplementing coq ten minimum two in the millions a day,
we can definitely reduce the symptoms. Although data is somewhat conflicting,
but in my practice I have seen that it absolutely helps.
In our practice we emphasize that patients taking status must
(32:03):
take two milliums of coq ten with food. It is
a fat soluble vitamin that should be taken food so
that it reduces the chances of statin associate meddle center.
Speaker 4 (32:13):
So the concept of.
Speaker 3 (32:14):
Coq ten has come, then Ready's rice has been incorporated
in that chapter.
Speaker 2 (32:18):
Yeah, that is you know, you know, look you know
better than me. But that has been talked about for
probably twenty years. And I remember twenty twenty five years
ago patients coming in with red rice yeast and at
first you'd sort of say, well, it probably won't hurt you.
(32:38):
But now it seems like there's some pretty.
Speaker 3 (32:41):
Decent data and patients who are not receptive who taking
statins or they cannot take any statans.
Speaker 4 (32:47):
It is pretty much like a natural statin.
Speaker 3 (32:49):
And in this textbook of Cardiologia Braunold, they said, yes,
this can be considered an alternative for patients who are
not able to handle.
Speaker 4 (32:57):
It's literally and like a natural statin, and there has.
Speaker 3 (33:00):
Been some data that it may reduce you a deal,
maybe between fifteen to eighteen percent in some percent of cases.
Speaker 2 (33:05):
Well, now with that, would it ever be a case
where you take a statin or maybe a little bit
less of a statin and the red rice yeast as
a as a combo or is it one or the other?
Speaker 3 (33:21):
I try not to combine the two because it becomes
difficult to really objectively know if they're having any problem
work contributing to it.
Speaker 4 (33:29):
But typically I keep.
Speaker 3 (33:30):
Those I'm keeping for patients who are resistant or taking
statins or they would like to have a natural alternatives
and READI strize. I do offer patients who are but
I'm a very big believer in statin and they have
been shown with so much data for all these decades,
would be so useful. But if people are totally resistant,
(33:51):
then this is a reasonable alternative.
Speaker 2 (33:53):
All right, final segment of your health first coming up.
Don't forget If you want more information about autorin deep
sination is practice, it is Uston Cardiology dot Comuston Cardiology
dot com and don't forget. Go to doctor Joeglotti dot com.
Stay tuned. Final segment coming right up, the final segment
of this week's Your Health First, and don't forget. Join
(34:15):
us at doctor Joegalotti dot com and you can sounder
forraur newsletter. Send me a message as a tab there
that says contact me, and all of our social media
is there, and all of our past programs, podcasts, other
educational material is there. But you have to go to
doctor Joegalotti dot com.
Speaker 4 (34:36):
All right, so.
Speaker 2 (34:38):
Doctor Snasa has been in the office with us talking
about heart disease, heart prevention, heart symptoms, some new therapies,
how to manage your cholesterol, things that you need to
know and do. Keep in mind that the number one
killer for all of us is going to be cardiovascular disease.
So we need to raise the bar and really pay
(35:01):
attention to heart disease. If you have heart disease, pay
attention to it. If you have risk factors, really do
get it checked out.
Speaker 1 (35:10):
You know.
Speaker 2 (35:10):
One other area and the golp one agents, the oxepics
of the world. Of course, they started off in the
diabetes circle and then into obesity. But now there are
some studies on being protective for heart disease and heart failure.
What are you seeing and where do you think the
(35:33):
future lies with these GLP one agents GLP one.
Speaker 3 (35:38):
Initially I was to be very frank, I was quite
apprehensive of giving them to patients. But the more and
more I'm studying the data, we have seen that they
definitely some percentage of population of patients who are struggled
to lose weight. Right an effective, very effective class of drugs,
and they absolutely help you in reducing weight. However, you
(36:00):
know you have to be mindful of the fact that
there are some significant side effects, and I'm sure you've
seen fair share of that. But you cannot just prescribe
a GLP one and not emphasize lifestyle modification because that
is not the right way to manage your diabetes and
hypotension and overweight problems and obixity. However, the data that
(36:25):
is coming out in benefit of reduction and heart failure
and other cardivorskit benefits is all. If you lose the
question is that is it the weight loss that is
helping you reduce it or there is some question that
the drugs are And my thought process is I say
weight loss is the best medicine.
Speaker 4 (36:44):
Way, your blood.
Speaker 3 (36:45):
Pressure will get better, your liperds will get better, your
everything will get better, your exercise.
Speaker 4 (36:50):
Todance will get better, and your heart failure.
Speaker 3 (36:53):
Of course, you sleep will get better if it will
get better, and your heart failure will get better.
Speaker 4 (36:59):
There's no quest about it. So, yeah, is the best medicine.
Speaker 2 (37:03):
Yeah, no, no, no, I mean it is. And unfortunately
with all of the advertising and marketing and things on
social media, that message gets lost. They think this the medicine.
Of course, the weight loss they see it. But you know,
the gop ones, You're right, there are a whole host
(37:24):
of gastro intestinal side effects, nausea, vomiting, constipation, people are miserable.
But weight loss through lifestyle, the Sunasia formula, of course
is it might not be as fast as a golp one.
You know, you have to be patient, you know, you know,
(37:47):
fifty pounds was not gained in six months, you can't
expect to lose it in six months. But it's that
lifestyle change that it is, learning to eat better, learning
to cook, learning to exercise, and just integrating this all
in there. So we've got a couple of minutes left here,
doctor Sunasia and for those that might just be joining
(38:11):
us late this evening. Doctor ran Deepsynasia. He is a
very very well known cardiologist here in Texas Cardiology Center
of Houston. His website is Houston Cardiology dot com. A
couple of parting remarks. If you had to tell a
(38:33):
patient people listening tonight, let's say one intervention. Now, there's
many things to do, right, But if you were going
to start off with one win, one thing that you
could cross up and say I was able to start
doing that tomorrow and I stuck with it, what do
(38:54):
you think that would be?
Speaker 3 (38:56):
Just start walking fifteen minutes a day and increase with
thirteen minutes a day. I think regular exercise does wonders right.
Journey of one thousand miles begins with a single step.
Just start walking and tell patients you know, doesn't matter.
Could be ten minutes, fifteen minutes, please, best thing is
(39:16):
just start walking and you will see it will transcribe
into benefits beyond your belief. You know, you don't have
to walk ten miles or three miles, just ten minutes,
fifteen minutes, and gradually you will see then you can
increase it. And with that you need to work on
diet and reduce the card consumption, reduce the carry consumption,
(39:39):
and weight loss has to be the most primary thing.
But seventy percent of the population with fortys in thirty
percent overweight, absolutely is critical importance America healthy. Again we
miss a control of the epidemic of weight gain.
Speaker 2 (39:56):
All right, Another scenario, So most patients are being seen
by a primary care physician or internest or maybe even
there upstir g yn and somebody is sitting there tonight
and saying, look, gee, gosh, I am overweight. I've got
this touch of blood pressure. The doctor said, my glucose
(40:19):
was just a touch elevated. What is the conversation you
want to have the patient initiate with their primary care
doctor to say, please address these heart risk factors or
maybe even symptoms. How do you frame that conversation?
Speaker 4 (40:40):
What do you think?
Speaker 3 (40:42):
I think controlling getting your lipids done, collecting data on
your blood pressure, and as a doctor they can refer
for calcium. School Houston Methodist does it for one hundred
and forty dollars any of the Methodist system and then
you have the heart scan.
Speaker 4 (40:56):
Plus they can scan.
Speaker 3 (40:57):
Your carotis, aota, the legs and including the heart scan
for two hundred and five dollars. I tell them that
is the best two hundred five dollars that you'll ever spend.
And once you have the data and then based on
the results, it is going to have a very positive impact.
Once you have the data with you, share that data
with your cardiologists, let the cardiology explain to you where
(41:19):
you cat some scores, what it means, and then you
take it from there. I think these are critically important
issues that you brought up and it is so important
for us to take care of our patients and increase
education and awareness.
Speaker 2 (41:32):
Right And that's and that's my gosh. You could you
could be in front of a microphone three hundred and
sixty five days a year, doctor Sunesia, and get get
the word out there. So as always, thanks for coming
on tonight, doctor Suonisia. Don't forget you can catch up
with doctor Sunesia at Houston Cardiology dot com. Randeep. It's
(41:55):
been awesome. It's always great to have you on.
Speaker 3 (41:58):
Well, thank you so much for the ortunity. Look forward
to always working with you and enjoying your conversations with you,
and look forward to many more
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