What you need to know about diagnosing and treating heart disease

Coronary artery disease or heart disease is caused by atherosclerosis, a process which involves the accumulation of cholesterol plaques in the arteries that supply blood to the heart. These plaques can narrow the blood vessels and reduce blood and oxygen delivery to the heart, leading to symptoms like chest pain (ischemia). The plaques can also rupture and form a blood clot, blocking oxygen delivery and causing a myocardial infarction—a heart attack.

Coronary_angiography_of_a_STEMI_patient,_showing_partial_occlusion_of_left_circumflex_coronary_artery


If you experience symptoms such as chest pain or have a high risk of heart disease due to family history and other risk factors, your doctor may recommend a diagnostic test. In a graded exercise test (GXT), or “stress” test, a person exercises, typically walking on a treadmill, at increasing speed and grade while heart rate, blood pressure, and heart rhythm are monitored by a doctor or exercise physiologist. Changes in these variables, as well as the person’s exercise capacity, can be signs of ischemia and impaired heart function. Often, a GXT is combined with another diagnostic technique, such as nuclear imaging, which shows areas of the heart that do not receive enough blood flow, or an echocardiogram that uses ultrasound to show the heart beating and ejecting blood.

 

Based on the GXT results, a cardiologist may recommend an angiogram, in which a catheter is inserted into an artery and threaded into the coronary arteries, dye is injected, and the coronary arteries are viewed through X-ray imaging. This allows cardiologists to see the extent of the narrowing in the coronary arteries.

 

You can be diagnosed with heart disease based on the results of an angiogram or if you had a heart attack. During the angiogram, a cardiologist can perform an angioplasty in which a balloon catheter is inflated to open narrowed arteries. A mesh stent may also be placed to help keep the vessel open for longer. In other cases, coronary artery bypass surgery may be indicated. Considered open heart surgery, this procedure actually bypasses narrowed sections of coronary arteries using another vessel, often a leg vein. Both angioplasty and bypass surgery can restore adequate blood flow to the heart and treat ischemia and heart attacks.

 

Many people consider the treatment complete after the heart attack has ended and the angioplasty or bypass surgery is complete. The truth is that the long-term outcomes are largely based on what happens next. Traditionally, heart disease patients were told to rest and not stress their hearts, a belief that many still hold today. But exercise-based cardiac rehabilitation programs are key to improving heart health and preventing future complications.

 

Most cardiac rehabilitation programs include several phases. Phase I programs start in the hospital and focus on getting out of bed and performing self-care activities and some walking. Phase II cardiac rehab involves closely-monitored exercise, usually for 12 weeks following a heart attack or surgery. Phase III involves longer exercise sessions with greater independence and transitions into Phase IV, a lifelong exercise program. Education about exercise, nutrition, weight control, stress management, proper medication use, and psychosocial wellbeing are essential in all phases of cardiac rehabilitation.

 

The benefits of cardiac rehabilitation are well-established through research and practice. In fact, many patients credit cardiac rehabilitation with saving their lives, even if they had bypass surgery. Despite this, less than a third of patients who are eligible for cardiac rehabilitation actually attend a program. If you or someone you know has had a heart attack or surgery, encourage them to ask their doctor about cardiac rehabilitation—it is likely to be the best way to improve quality of life and avoid future heart problems.

 

 

Heart health numbers to know

 

February is American Heart Month, an ideal time to assess your risk of heart disease and take steps to improve your health. When it comes to heart disease, there are several numbers, including your blood pressure, cholesterol, and glucose, you (or your doctor) may be monitoring. But there is another set of numbers that are equally important for preventing and treating heart disease: 0, 5, 10, 25, and 30.

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0 is for no smoking. Cigarette smoking more than doubles your risk of heart disease and stroke, is by far the leading cause of lung cancer and other lung diseases, and is responsible for over 400,000 deaths per year. If you smoke, quitting now is one of the most important steps you can take to improve your health. Nicotine replacement therapy in the form of gum, lozenges, and patches as well as prescription medications can help, but quitting really does require serious dedication. It’s well worth the effort and some benefits of quitting can be realized almost immediately.

 

5 is for eating five fruits and vegetables each day. A healthy diet is an essential aspect of good health. While there is no one single measure of a healthy diet, adequate fruit and vegetable consumption is widely considered to be essential for good health. Fruits and vegetables contain vitamins, minerals, and fiber and most are low in calories. At a minimum, you should eat five servings per day with an emphasis on fresh fruits and vegetables. Your real goal should be to include fruits and vegetables in all meals and snacks, but five servings per day is a good start.

 

10 is for 10,000 steps per day. Regular physical activity is essential for good health. Almost any activity counts, and a good goal is to be as active as possible throughout the day. You can track your physical activity using a pedometer (step counter) or an app on your phone. A target of 10,000 steps per day is a commonly cited goal, but you should try to take as many steps as possible. You can do this by minimizing the time you spend sitting, taking the stairs instead of the elevator, and walking instead of driving when possible. More steps are better, even if you don’t get to 10,000.

 

25 is for maintaining a healthy body weight, or a body mass index (BMI) of less than 25. The BMI is a measure of weight relative to height. A BMI of 18–25 is considered healthy, 25–29 is considered overweight, and 30 and higher is considered obese. The risk of health problems like diabetes, heart disease, and some cancers goes up with BMI, so maintaining a healthy body weight is good for your health. If you are overweight you should lose weight, even if you don’t make it to an ideal weight.

 

30 is for 30 minutes of exercise per day. In addition to being as active as possible throughout the day, you should dedicate a minimum of 30 minutes for exercise or other activity. Considerable research shows that that as little as 30 minutes of moderate to vigorous activity leads to improved fitness and health with greater benefits coming from longer duration or higher intensity activity. This can include exercise—a brisk walk or jog, lifting weights, or other aerobic exercise—as well as other activities like housework and yard work. Your goal should be to sit as little as possible, move as much as possible, and make time each day to be active.

 

 

 

That’s not fruit!

Making healthy food choices is never easy. It is made more challenging by the fact that some foods that appear to be a smart choice may be less healthy than you think. Often, prepackaged fruits and vegetables contain added sugar, fat, or salt, making them less healthy than eating them fresh.

Consumption these foods can also make it less likely that people—especially children—will eat fresh fruits and vegetables when they are available. Here are some examples of foods that may appear to be healthy but, upon closer examination, turn out to be less nutritious than we might think.

fruit-snacks


Fruit snacks: These gummy fruit treats are a favorite among kids. If you check the package you will probably see that they contain real fruit or fruit juice, so they must be healthy, right? While there is variation among different brands, in most cases these snacks contain little, if any, actual fruit. If you read the ingredients you will see that they do contain lots of added sugar, meaning that many of these snacks are essentially candy. In fact, if you compare some brands of fruit snacks with something that is easily recognized as candy, such as gummy bears, you will see that they have a similar sugar content.

 

Fruit drinks: Not everything that looks like fruit juice is actually juice. Take orange “juice” drinks like Sunny D and Hi-C for example. These popular orange drinks contain mostly added sugar and water—and only 5% juice. By contrast, real orange juice is 100% juice. You might think that because Sunny D and Hi-C have less sugar and fewer calories they are a healthy alternative to real orange juice. Don’t be fooled! When you look at the ingredients you will realize that these drinks are far from real juice, essentially orange soda without the bubbles!

 

There are two problems with this. First, some foods that appear to be healthy because they either claim to or actually do contain fruit are actually less healthy than we might believe. Considering that fruit snacks and fruit drinks are likely to be consumed as alternatives to real fruit juice or a piece of fruit as a snack, these foods could lead to poor nutrition. This is especially true in children.

 

Second, sweetness is one of the most important tastes we respond to. Consuming food and beverages that are flavored like fruit but are actually much sweeter may make real fruit less palatable. Again, this is especially true for children who may develop an expectation that strawberries should taste like strawberry-flavored fruit snacks or that orange juice should taste as sweet as Sunny D. These kids are likely to prefer the sugar-sweetened version over the real fruit. Since these sugar-sweetened “fruits” tend to be higher in calories, consumption of these foods is one contributor to childhood obesity.

 

This isn’t just the case with fruit. Adding salt and sauces to vegetables makes them more flavorful, to the point that many of us don’t eat plain vegetables very often. The majority of potatoes are consumed in the form of French fries, loaded with both fat and salt. This has changed how we expect potatoes to taste so that now we typically eat baked potatoes “loaded” with butter, sour cream, cheese or bacon. When was the last time you ate a plain baked potato?

 

But there are some simple steps you can take to get back to eating real fruit and vegetables. Look for 100% fruit juice or, better yet, a piece of fruit instead of fruit-flavored drinks. Instead of sugar-sweetened fruit snacks, try dehydrated fruit. Cut back on the salt, butter, and other toppings you add to vegetables or purchase frozen vegetables without added sauces.


Nutrition, exercise, and health information can be confusing. 
But it doesn't have to be that way.
What can I help you with?
 drparrsays@gmail.com | @drparrsays

Lose big by not winning your weight loss competition.

There are numerous community and workplace weight loss competitions and fitness challenges underway in our area right now. These programs are a popular way to start making health improvements with friends or coworkers. Many people find the competition aspect of these programs to be motivating. Even those who are reluctant to start a diet or exercise program are more likely to give it a try. But this raises the question, are “biggest loser” type weight loss programs effective at promoting lasting weight loss? Does winning the competition make maintaining a healthy body weight any easier?

weight-loss-pants


The short answer is probably not. Remember, the goal of any diet should be for you to lose weight and keep it off. The majority of people who lose weight will eventually gain it back, plus some extra. This is more of a problem for programs that emphasize rapid weight loss. As a general rule, the quicker someone loses weight, the quicker they are likely to gain it back. So, an eight-week weight loss competition is likely to promote rapid weight loss followed by weight gain when the program ends.

 

There is a practical reason why this happens. In order to lose weight and keep it off, people need to learn a whole new lifestyle involving what, when, why, and how to eat and exercise. These lifestyle changes are difficult to make and can take months or years to fully adopt. It is unlikely that trying to win a weight loss competition, which emphasizes quickly losing weight over learning new skills and behaviors, would support that outcome. In addition, some contestants may follow inappropriate diets or participate in exercise that is too intense. This could lead to injury, illness, or, at the very least, a failed weight loss attempt.

 

That’s not to say that these weight loss competitions don’t have benefits. There are certainly participants who would not otherwise consider losing weight at that time. Many programs organize participants into teams and the benefits of group support in promoting weight loss are well established. Some programs provide incentives for participating like access to exercise facilities or personal training sessions, which may encourage people to be more active. Others provide monitoring and education to promote success beyond the program. For example, the 12-week YMCA Team Lean program includes weekly education sessions and weigh-ins, a strong group dynamic, and monitoring to prevent rapid, unhealthy weight loss. Other programs, however, are shorter in duration and provide little in the way of education or support for making long-term lifestyle changes.

 

And don’t think that you are likely to achieve similar results to the contestants on the reality TV shows. The environment on those shows is so different from real life—constant supervision, guidance by experts, and the ever-present cameras, which make the contestants accountable to millions of viewers. The fact is that many “biggest losers” regain all the weight they lost after the show ends. Despite the intensive education and intervention, many contestants are not prepared to make the type of lifestyle changes needed to maintain weight loss in the real world.

 

There is a simple solution if your goal is to lose weight and keep it off: participate in the competition, take advantage of the resources, but don’t focus only on winning. Instead, use the program to develop healthy eating and exercise habits.  You will find that concentrating on modifying your behaviors is the key to success. Whether you win or not, know that the end of the program is just the beginning of your weight loss journey.

 


Nutrition, exercise, and health information can be confusing. 
But it doesn't have to be that way.
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 drparrsays@gmail.com | @drparrsays

 

Worried about your health insurance? Try this DIY health care plan.

Health care is in the news again, this time because the Affordable Care Act seems likely to be repealed. Health care has long been an important and contentious topic in both political and social circles. Given the importance that accessing quality health care has for everyone, it is unfortunate that promoting good health has turned into a political debate.

While the Affordable Care Act wasn’t perfect, it did expand access to health care, especially for people with pre-existing conditions. Ideally, a replacement health care plan will also make it easier for people to get preventive care. This is important since preventable chronic diseases such as diabetes, heart disease, and cancer are among the leading causes of disability and death.  They also contribute to high health care costs, including prescription medications.

It turns out that adopting some simple lifestyle modifications can go a long way toward making you and your family healthier, and may save money in the long run. Since most health care plans really focus on “sick care,” it is largely up to us to improve and maintain our health. In my Health & Fitness column this week in the Aiken Standard I describe a do-it-yourself health care plan you can implement today.

health-insurance


Move more

Significant health benefits, including weight loss and improved fitness, can be achieved with as little as 30 minutes of activity per day, but more is better. The activity doesn’t have to be “exercise.” It can include walking the dog, yard work, or house work. Research shows that sitting too much is just as unhealthy as not exercising. Spending less time sitting at work, home, or in the car is another easy way to improve health. And getting up and moving for even a few minutes is better than staying seated for long periods of time. Every little bit of activity really does count.

Eat smart

Making dietary changes can be difficult, but a few simple changes can lead to big benefits. While there is much debate about which diet is the healthiest, almost everyone agrees that eating more real food, especially fruits and vegetables, and less added sugar is a good place to start. Fresh fruits and vegetables are rich in vitamins, minerals, and fiber and most are low in calories. Eating less added sugar in sweets and processed foods can help you cut down on calories and lead you toward healthier food choices. Controlling portion sizes plays as big of a role in weight maintenance as the types of food you eat, so pay attention to how much you eat. Chances are, it is more than you think!

Chill out.

Reducing and managing stress is essential for good health. Uncontrolled stress can lead to high blood pressure, poor immune function, and weight gain. Daily exercise will help, as will using stress management techniques like progressive relaxation. When you can, avoiding stressful situations is wise. Taking time to do something you enjoy each day is a good idea, too. Getting enough sleep (most adults require 7–9 hours) is also important for good physical and mental health.

Don’t smoke

Smoking cigarettes more than doubles your risk of heart disease and stroke, and is by far the leading cause of lung cancer and other lung diseases. If you smoke, quitting now is one of the most important things you can do to improve your health. Nicotine replacement therapy and prescription medications can help, but quitting really does require serious dedication. It’s well worth the effort and the benefits of quitting can be realized almost immediately.

While these steps don’t replace traditional medical care, they can prevent, or at least delay, many common health conditions. Best of all, this DIY plan works with any health insurance, is basically free to implement, and can lead to both health and financial savings now and in the future.


Nutrition, exercise, and health information can be confusing. 
But it doesn't have to be that way.
What can I help you with?
 drparrsays@gmail.com | @drparrsays

Good news for weekend warriors.

Do you need to exercise every day? Or could you exercise on just a couple of days instead? According to a recent study, Saving your exercise for the weekend can give you the same health benefits as spreading your exercise out over multiple days. However, becoming a “weekend warrior” might not be the best approach for you.

hiking


Current physical activity recommendations call for us to accumulate 150 min/week of moderate-intensity activity or 75 min/week of vigorous activity. Typically, this would be done on multiple days per week (walking 30 min per day on 5 days, or jogging 25 min on 3 days). This study answers an important question about physical activity and health—can you get away with only exercising a couple of days per week instead of the recommended 3-5 days? It also included people who do some, but not enough, activity throughout the week.

This study looked at how physical activity pattern was linked to the risk of death from all causes, cardiovascular disease (CVD), and cancer, a common way of examining the effect of physical activity on health in large populations. The study compared the risk of death among four physical activity pattern groups: inactive, insufficiently active (some activity, but not enough), regularly active (meeting PA recommendations throughout the week), and weekend warriors (meeting recommendations in just 1-2 days per week).

The results show that, compared to the inactive group, the risk of death was lower in the insufficiently active, regularly active, and weekend warrior groups. This was true for deaths overall as well as deaths from CVD and cancer. Furthermore, the reduced risk was similar for the three activity patterns, but lowest in the regularly active participants.

This confirms what we already knew from numerous other studies: regular physical activity promotes longevity. The study also suggests that being active throughout the week, but not enough to meet those recommendations, is also associated with some reduction in risk. We knew that, too. What this study adds is that meeting the recommendations by doing the activity on 1-2 days, the “weekend warrior” pattern, is beneficial, too. In fact, this activity pattern seems to be about as good as being active most days of the week. This is good news for people who aren’t active on a daily basis!

That said, this study only examined mortality, meaning the number of people who died during the follow-up period. It doesn’t tell us much about how these activity patterns affect health the way most of us would consider it: controlling blood pressure, diabetes, blood lipids, or depression. It also doesn’t say anything about weight control or improving strength, endurance, or flexibility, which are important reasons many people are active. In both cases, exercising regularly is the key to realizing the benefits!

Additionally, the typical “weekend warrior” tends to engage in exercise that is more intense and/or longer duration than what they might do if they exercised regularly. Indeed, the study indicates that almost all (94%) of the weekend warriors played sports and relatively few (31%) walked for exercise. While this is fine for most people, participating in vigorous, prolonged exercise can lead to a greater risk of injury, especially in people who aren’t in good shape to begin with.

So, people who are weekend warriors should select activities they will enjoy, and focus on duration over intensity. A long walk, hike, bike ride, or kayak trip on the weekend is something most people can do without too much risk. But the best approach is to be active throughout the week as much as possible and use weekends for more ambitious exercise sessions.


Nutrition, exercise, and health information can be confusing. 
But it doesn't have to be that way.
What can I help you with?
 drparrsays@gmail.com | @drparrsays

Resolutions to make your family happier and healthier in 2017

 

By this time, you are probably well into your New Year’s resolutions. Hopefully, you are still on track to meet your goals. Whether they are health-related or not, it is likely that your goals focus on you. But what about the rest of your family? Fortunately, there are a few resolutions that your whole family can make that will help you all move, eat, and sleep better. Here are a few ways your family can make 2017 a happy and healthy year.

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Make sure everyone in the family is active every day.

Physical activity is critical for good health for everyone. Beyond that, being active can help you perform better at work and school and make it easier to do things you enjoy in your leisure time. Adults should be active for a minimum of 30 minutes per day. Everything from taking the dog for a walk to a fitness class at the gym counts. For children, the goal is 60 minutes per day through PE class, sports, and play. As a bonus, you can do at least some of the activity together to make activity a family event!

 

Make healthy eating a family project.

There is a lot of confusion about what makes a healthy diet, but there are a few guidelines almost everyone agrees on. First, eat more fruits and vegetables. At a minimum, eat at least 5 servings each day, but try for twice that. Second, limit added sugars and salt. This is tricky since salt, sugar, and other sweeteners are added to most processed foods. Eating too much sugar is known to contribute to obesity, heart disease, and some cancers, so this is among the smartest nutrition moves you can make. Salt, by itself, isn’t necessarily harmful, but less salt almost always means less processed food and more “real” food. Finally, be mindful of portion sizes. Super-sized servings and second (and third) helpings are the primary reason why people gain weight over time.

 

Plan to eat at least one meal together each day.

Most experts agree that family dinners are important for promoting good communication and healthy eating habits. Given that our days are busy with work, school, and other activities, eating dinner together every night is unrealistic for many families. So, start with planning at least one family dinner at home each week. This is also a good opportunity to teach children about food and cooking, so it is even better if you prepare the meal together.

Make getting enough sleep a priority.

Many American adults and children don’t get enough sleep. Many American adults and children don’t get enough sleep. Lack of sleep can affect children’s growth, development, and learning. It can also have an impact on an adult’s productivity at work. The effect of chronic stress on health is well-known and we should recognize a lack of sleep as a form of stress. A good goal for adults is 7–9 hours of sleep each night. School-aged children need 8–12 hours, with younger kids requiring more sleep. As difficult as it may be, earlier bedtimes can benefit everyone in the family. Limiting screen time (TV, computer, tablet) before bed can help improve sleep, too.

Obviously, these ideas are easier read than done, especially for busy families. But moving more, eating better, and getting more sleep—especially if it is done together—can help your family enjoy a happier and healthier year.


Nutrition, exercise, and health information can be confusing. 
But it doesn't have to be that way.
What can I help you with?
 drparrsays@gmail.com | @drparrsays