Medical Issues published by the Daily Dish

[ami]

Ask Dr. Arthur Agatston


Q: What are the best foods to eat to get more omega-3s in my diet, and how much should I eat per week?
— Mark, New York
Dr. Arthur Agatston A:

I’m glad that you’re trying to get more omega-3 fatty acids into your diet, Mark. And since you’re presenting your question to a cardiologist, I assume it’s because you hope omega-3’s will help your heart. Well, they can. According to a scientific statement published by the American Heart Association in its journal Circulation, members of the association’s nutrition committee concluded that “omega-3 fatty acids have been shown in epidemiological and clinical trials to reduce the incidence of cardiovascular disease.” And studies have shown that eating a diet rich in omega-3s can help lower triglycerides. Over the years, I have seen this in my own practice.

As you may already know, the three major types of omega-3 fatty acids found in foods are alpha-linolenic acid (ALA), eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA). Once ingested, the body converts ALA to EPA and DHA, the types that are more readily used by the body.

Unfortunately, it is estimated that the average American consumes only about 23 milligrams of omega-3 fatty acids per day. This is far lower than the National Institutes of Health (NIH) recommendation that adults get at least 650 to 950 milligrams of EPA and DHA and 2.22 grams of ALA daily. Moreover, for adults with coronary heart disease, the American Heart Association (AHA) recommends getting 1 gram daily of EPA and DHA from an omega-3 fatty acid supplement (such as fish oils). And for those with high cholesterol levels, the AHA recommends getting 2 to 4 grams daily of EPA and DHA in the form of a fish oil supplement. For healthy adults, the AHA simply recommends eating fish at least twice a week, a number that seems way too conservative to me.

Whether you're trying to prevent heart disease or simply improve your general health, you can go a long way toward bumping up your omega-3 consumption by adding just three foods to your diet: walnuts, flaxseed, and wild-caught salmon (such as chinook). A quarter cup (1 ounce) of walnuts contains about 2.3 grams of ALA; 1 tablespoon of flaxseed contains about 1.5 grams of ALA; and a 4-ounce piece of salmon contains about 1.5 grams of EPA and DHA.

Most commercial fish-oil capsules, however, only contain about 180 milligrams of EPA and 120 milligrams of DHA. (So, you’ll have to take a lot of them to meet the AHA guidelines). But there are prescription forms of fish oil available with higher amounts of these omega-3’s. Interestingly, a study published in The American Journal of Clinical Nutrition showed that omega-3 fatty acid levels in the blood rose equally whether subjects took fish oil capsules or ate fatty fish.

Besides salmon, other good marine sources of EPA and DHA include herring (both Atlantic and Pacific), anchovies, sardines, Atlantic halibut, bluefish, tuna, and Atlantic mackerel.

Besides flaxseed and walnuts, other good plant sources of ALA include flaxseed oil and dark-green vegetables such as purslane, broccoli, kale, and collards.

I cannot in good conscience answer this question without a reminder to control your intake of potentially inflammatory omega-6 fatty acids, which are found mainly in grains and grain-fed beef and poultry, and in oils such as corn, safflower, and sesame. Though a healthy diet definitely includes some omega-6’s, the typical North American diet contains about eight times too many! This is certainly one of the reasons why heart disease and so many other inflammatory disorders are prevalent in this country.
Last Updated: 05/20/2009
Arthur Agatston, MD, is a practicing cardiologist and an associate professor of medicine at the University of Miami Miller School of Medicine. He is also the creator of The South Beach Diet.
Everyday Health Network Copyright © 2009 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service and privacy policy.

[ami]

Ask Dr. Arthur Agatston
Air Pollution, Asthma, and Heart Disease

Q: I live in an area with poor air quality, and I have asthma. Should I be worried that this will affect my heart?
— Samuel, Alabama
Dr. Arthur Agatston A:

Unless you already have heart disease, Samuel, I would be more concerned about how an asthma attack is affecting your lungs rather than what it is doing to your heart.

When you have asthma, your immune system overreacts to substances in the environment, including smog, and this triggers a full-scale alarm, or an asthma attack. When this happens, immune system defenders called mast cells, located in tiny passageways in your lungs, release chemicals, including histamines. Your airways then become inflamed and constricted, causing your breathing tubes to produce extra mucous and making it even more difficult for air to get through.

While it would seem like an asthma attack, with its attendant coughing and wheezing, would be hard on your heart, asthma is not a risk factor per se for heart disease. In fact, some pulmonary specialists believe that the histaminic response that your body has to such an attack can actually help protect the heart, because the histamines may counter the release of excessive amounts of the neurotransmitter noradrenaline. This is the “fight or flight” chemical that your body produces when under stress, including the stress of a heart attack.

That said, a few studies that have found a possible association between asthma and stroke, and there have been associations made between compromised lung function and coronary heart disease (mainly in women). But more research is needed in both of these areas, so I wouldn’t be too concerned.

For someone who already has heart disease, however, it is possible that certain drugs used to treat asthma could precipitate an acute coronary event. Beta-agonist drugs that are commonly used as quick-acting bronchodilators tend to have stimulatory side effects similar to those of adrenaline. Generally, these effects are slight, but occasionally, people with certain types of heart disease, such as angina or arrhythmia, are sensitive to even these minor effects.

On the flip side, certain beta-blockers, such as Inderal (propranolol), which are used to treat high blood pressure, can have particularly strong effects on the bronchial tubes, causing constriction and triggering an asthma attack.

Since I don’t know your personal situation, I suggest that you discuss any concerns you have with your own physician.
Last Updated: 05/06/2009
Arthur Agatston, MD, is a practicing cardiologist and an associate professor of medicine at the University of Miami Miller School of Medicine. He is also the creator of The South Beach Diet.
Everyday Health Network Copyright © 2009 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service and privacy policy.

[ami]

Ask Dr. Arthur Agatston
How to Help a Heart Attack Victim

Q: What should I do if I witness someone having a heart attack?
— Carlos, Iowa
Dr. Arthur Agatston A:

Calling 911 for an ambulance is the first thing to do if you witness someone having a heart attack. Don’t even consider taking the person to the emergency room yourself unless you are in the middle of nowhere and that is your only option. The modern, well-equipped ambulance is like having the emergency room brought to your doorstep, and the person will get faster care than if you were to drive to the ER yourself and have to go through admissions paperwork.

Not surprisingly, many people lose their cool when reporting an emergency to 911.Try to remain calm and be sure to tell the operator exactly where you are. Don’t hang up if you get a recording. Stay on the line and your call will be answered in order. If you hang up, your call will be delayed because you will be placed behind other callers. If you are calling from a cell phone, be sure to provide the cell phone number to the operator (in case you get cut off) and then give your exact location or the nearest landmark if you don’t know exactly where you are. With the right information, the operator will be able to transfer you to the right call center.

Once you’ve called 911, loosen the person’s clothes to make breathing easier. Continue to try to communicate calmly with the person, even though you may be nervous and upset. You don’t want to add to the victim's anxiety and cause them to produce more adrenalin, which can be harmful in this situation. If you have one on hand, give the person one 325 milligram (preferably uncoated) aspirin to chew and swallow. An aspirin can help break up the blood clot that is causing the heart attack. (Don’t give the person aspirin if you think they may be having a stroke.) Or, if you know the person has been prescribed nitroglycerin in the past for heart disease and has the medication with them, you can give a dose (don’t give the person someone else’s nitro, however).

You won’t need to do cardiac pulmonary resuscitation (CPR) unless the heart attack victim goes into cardiac arrest, which means they are unconscious and have stopped breathing. If this happens, CPR will keep the blood circulating while you wait for the ambulance or for someone to get a defibrillator. The American Heart Association now recommends hands-only CPR instead of the traditional combination of chest compressions and mouth-to-mouth breathing. (It’s worth taking an American Red Cross class to get a refresher, if you don’t know this new method.)

The bottom line: Call 911 fast. It’s this quick action that saves lives.

Visit the Heart Health Center to learn more about heart attacks and heart disease treatments.
Last Updated: 04/20/2009
Arthur Agatston, MD, is a practicing cardiologist and an associate professor of medicine at the University of Miami Miller School of Medicine. He is also the creator of The South Beach Diet.
Everyday Health Network Copyright © 2009 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service and privacy policy.

[ami]

If you’re following the South Beach Diet lifestyle, you already know the heart-health benefits of making nutritious food choices and exercising regularly. But if you have a moderate or high risk of heart disease, lifestyle changes alone may not be enough to ensure a healthy heart. While leading a healthy lifestyle is always recommended, your doctor may also suggest certain medications that will help lower your risk of heart disease. Here's a snapshot of some commonly prescribed medications and supplements that protect your heart.

Statin drugs: Over the past 30 years statin drugs such as Mevacor, Pravachol, Lescol, Zocor, Crestor, and Lipitor have changed the prognosis for tens of millions of people who are at risk for heart disease or who already have it. Not only can these drugs reduce levels of LDL cholesterol by 20 to 60 percent with few side effects, they can also mildly lower triglycerides and raise good HDL. Numerous clinical trials have shown that statins may help prevent heart attacks and strokes: When combined with other drugs or with prescription niacin, statins can cause the regression of soft plaque, which is the primary cause of heart disease. Statins can also reduce inflammation and improve the overall health of the blood vessels.

Aspirin: Taking a low-dose aspirin every day thins the blood slightly and makes the blood less sticky and thus less likely to form clots that typically precipitate heart attacks and strokes. Despite the fact that aspirin is sold over the counter and is inexpensive, some people forget that it can be an important part of a heart-healthy regimen. Also note that aspirin affects men and women differently. Consult with your doctor about whether aspirin therapy is right for you.

Fish-oil supplements: Just as Dr. Arthur Agatston, author of the South Beach Diet Supercharged, advises people to eat fish high in beneficial omega-3 oils (such as wild salmon and sardines) at least twice a week, he also follows the current American Heart Association (AHA) guidelines with regard to omega-3 supplements. The AHA recommends combined eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) — the two major types of omega-3 fatty acids — in a dose of approximately 1,000 mg/day in patients with coronary heart disease. For people with high triglycerides, Dr. Agatson agrees with the FDA recommendations for considerably higher doses of omega-3s in the form of four grams of prescription fish oils per day (but Dr. Agatston advises you to be certain your doctor monitors your cholesterol, since prescription fish oils can raise levels of bad LDL in some people).

Niacin: This B vitamin (B3) is available over the counter as a dietary supplement, though Dr. Agatston recommends higher doses, available by prescription only, for those at risk for heart disease. Both alone and in combination with a statin, niacin is a very effective agent for slowing or reversing atherosclerosis and preventing recurrent heart attacks and strokes. Niacin can increase HDL (the "good" cholesterol) and it also lowers LDL as well as triglycerides. While niacin is associated with flushing and itching of the skin in some people, this unpleasantness generally disappears within an hour. In some people with diabetes, niacin can raise blood sugar levels; however, this effect is generally mild, but discuss its use with your doctor.

While diet and exercise can go a long way toward improving your health, sometimes medications and/or supplements are required. Your doctor will help you determine what prevention program is right for you.

[ami]

Ask Dr. Arthur Agatston
Will Krill Oil Lower Cholesterol?

Q: I've been hearing a lot about the benefits of krill oil — what is it, and how can it help lower my cholesterol?
— Winnie, Hawaii
Dr. Arthur Agatston A:

As many of you know, I am a big proponent of omega-3 fish oil. Not only do I take an omega-3 supplement myself, but I recommend it to many, if not most, of my patients. Omega-3s have been shown to play a key role in heart health, from reducing triglycerides and blood pressure to inhibiting inflammation.

In recent years, there has been a lot of buzz about krill oil being even better than fish oil for heart health, and I have to say I am intrigued. This marine oil, which is produced from shrimplike krill harvested from Antarctic waters, not only contains significant amounts of the omega-3 fatty acids EPA and DHA, but also phospholipids (which are integral to the building of cell membranes) and potent antioxidants, including astaxanthin, a carotenoid from the nutrient family that includes beta-carotene, lutein, and lycopene.

Krill oil has become widely touted not only because it may help to lower total and “bad” LDL cholesterol, but also because it could help with arthritic joint pain and the physical and emotional symptoms of premenstrual syndrome (PMS). Apparently it is only the Antarctic krill (Euphausia superba) — not just any krill (there are 85 species identified worldwide) — that is the source of the powerful oil.

So how does krill oil work for reducing cholesterol? No one is quite sure. But in a 12-week study involving 120 men and women ages 25 to 75, Canadian researchers tested the effects of krill oil (Neptune krill oil was used in the study) vs. fish oil on elevated blood lipid levels and found that it outperformed fish oil in reducing total cholesterol, “bad” LDL cholesterol, and high triglyceride levels — while, at the same time, increasing amounts of “good” HDL cholesterol. In the study, a dose of 1 to 1.5 grams of Neptune krill oil a day was significantly more successful at lowering LDL and triglyceride levels than a dose of fish oil three times greater (3 grams). Krill oil at higher doses (3 grams) also lowered blood triglycerides, while fish oil did not. The researchers theorize that it is the unique molecular structure of krill oil that gives it its potent effects.

In general, fish oil has not been found to lower LDL cholesterol unless it is substituted for dietary saturated fat that, by itself, increases LDL. I would not recommend krill oil or other omega-3s for the purpose of lowering LDL, and you should consult your physician before considering it. But as a way of increasing your overall intake of omega-3s, with some other potential health benefits, it looks promising.

You can purchase krill oil in capsule form at most vitamin shops or online. (It is not yet available in grocery stores.) Unlike fish oil, it does not become rancid at room temperature, and causes no fishy “burps.” I suggest looking for a product that contains Neptune krill oil (NKO), since it is the krill oil that was used in the cholesterol study. A dose of 1,000 milligrams of krill oil a day could prove useful for lowering total cholesterol and improving triglycerides. A dose of 500 milligrams once a day may help you maintain good cholesterol levels once you achieve them. If you’re already taking a statin, however, don’t stop in favor of krill oil.
Last Updated: 03/12/2009
Arthur Agatston, MD, is a practicing cardiologist and an associate professor of medicine at the University of Miami Miller School of Medicine. He is also the creator of The South Beach Diet.
Everyday Health Network Copyright © 2009 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service and privacy policy.

[ami]

Today kicks off the nationwide Breast Cancer Awareness Month campaign. During the month of October you’ll most likely hear about various pink-ribbon events (you may even be participating in some!) that are meant to increase the awareness of early detection of the disease, encouraging you to take action on behalf of your health. The South Beach Diet, in addition to being heart healthy, may also be beneficial in helping to lower your risk of developing cancer. The American Cancer Society recommends a diet high in fruits, vegetables, whole grains, and lean meats — exactly what the South Beach Diet encourages. In addition, many of their other recommendations match up with South Beach Diet guidelines. Here are small lifestyle changes to make today that may help lower your risk of developing breast cancer in the future:

* Limit or avoid fried foods.
* Choose whole grains over refined-flour products.
* Cut down on sweets.
* Avoid meats high in fat.
* Eat a diet rich in omega-3 fatty acids.
* Limit consumption of alcoholic beverages to no more than one drink a day if you’re a woman or two if you’re a man.
* Quit smoking.
* Exercise regularly to maintain a healthy weight.

Keep in mind that following these guidelines may help lower your risk of developing cancer, but there is no guarantee. Some people are genetically predisposed to cancer because of family history or environmental influences. If you think you may be at high risk of developing cancer, consult your family physician.

[ami]

Ask Dr. Arthur Agatston
Cold Hands, Warm Heart

Q: Why do I get mild chest pains when I stick my hands in ice water — for instance, to get a soda out of an ice chest? My family has a history of mitral valve problems. Is this a symptom?
— Chilly, Texas
Dr. Arthur Agatston A:

Yes, mild chest pains after submerging your hands in very cold water can be a symptom of mitral valve problems — including a relatively harmless mitral valve prolapse. This occurs when the valve between your heart’s left upper chamber (left atrium) and left lower chamber (left ventricle) doesn’t close properly. Often people with mitral valve problems have what is called dysautonomia, or a hyperactive autonomic nervous system. Not only do their feet and hands get cold very easily, but sometimes putting their hands in cold water or simply touching something cold causes a coronary spasm, or tightening of the muscle. This may be another autonomic response that you appear to be experiencing.

What is suggested by your symptoms is that your blood vessels are sensitive to the cold. But don’t automatically assume you have mitral valve problems. There could be other reasons for your sensitivity, including chronically low blood pressure or Raynaud’s disease, which affects blood flow to the extremities (although Raynaud’s typically wouldn’t cause chest pain).

Given your family history and the fact that this happens every time you touch something cold, I would suggest two things:

1. Protect yourself from the cold. For example, avoid holding cold cans, don’t wash garments in cold water, and be sure to wear gloves outdoors.
2. Get tested. Make an appointment with your doctor for a stress test or echocardiogram. Interestingly, there is a type of echocardiogram, which I use occasionally in my practice, in which the patient puts one hand in ice-cold water while the ECG is being done. Ask your doctor about this cold-water test.

See all Heart Health Q&As
Last Updated: 02/09/2009
Arthur Agatston, MD, is a practicing cardiologist and an associate professor of medicine at the University of Miami Miller School of Medicine. He is also the creator of The South Beach Diet.
Everyday Health Network Copyright © 2009 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service and privacy policy.

[ami]

Having these conditions could be just as harmful to your health as a prior heart attack.
By Arthur Agatston, MD, Everyday Health heart expert
If you are an American age 40 to 70, the odds are about 40 percent that you've been diagnosed with prediabetes, diabetes, or metabolic syndrome. Shocked by this statistic? You should be! Not long ago, diabetes and prediabetes were rare. Now they are virtual epidemics in the United States, putting tens of millions of Americans at high risk for heart disease. In fact, diabetes is such a strong risk factor for heart disease that medical professionals define it as a "coronary heart disease risk equivalent." This means that a person with diabetes has the same high risk of a heart attack as someone who has already had one. Up to 70 percent of people in coronary care units have prediabetes or diabetes. Women, take note: If you have diabetes and have suffered a heart attack, you have an even greater risk of having another heart attack or heart failure than a man who has diabetes and has suffered a heart attack.

Diabetes is well known as a disease characterized by the body's inability to process sugars and starches. Less well known are the problems that people with diabetes have processing fats in their diet. There are two common types of diabetes: juvenile-onset, or what's now known as type 1 diabetes (which usually appears abruptly before age 30), and adult-onset, or type 2, diabetes. About 90 percent of all those with diabetes in the United States have type 2. Prediabetes, sometimes called metabolic syndrome, insulin resistance, or Syndrome X, will lead to full-blown type 2 diabetes if it goes unchecked. The difficulty with processing fats and the risk of heart attack and stroke begin in the prediabetes phase, which is defined as a blood sugar level of 100 to 125 mg/dL.

The problem with type 2 diabetes and prediabetes is that people who have these conditions process fats abnormally, leading to low levels of good HDL and elevated levels of triglycerides. They also have more small HDL and more small, dense LDL (see the explanation of Question 9, page 51). In addition, they often have high blood pressure and more inflammation in their arteries.

To help reduce these risks, national guidelines recommend that people with diabetes keep their blood pressure below 130/80. Giving up cigarettes is even more important for people with diabetes than it is for others, because smoking and diabetes are a deadly combination. Type 2 diabetes is also closely linked with obesity (see Chapter 5), which explains why, as the American population gets fatter, the rate of type 2 diabetes is soaring. What is even more alarming is that there are millions more "diabetics in training" in our country today. I am speaking of our children, who, as they grow fatter and less fit, are rapidly becoming prediabetic or even diabetic. Type 2 diabetes can no longer be called an "adult-onset" disease.

Luckily, type 2 diabetes is largely a "man-made" disease that we can unmake if we set our minds to it. Exercise, weight loss, and strategic dietary changes — particularly eliminating the highly processed "bad carbs" found in baked goods, breads, snack foods, and other starchy and sugary favorites — are all very effective in reversing insulin resistance.
Everyday Health Network Copyright © 2009 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service and privacy policy.

[ami]

Ask Dr. Arthur Agatston
A Pounding Heart

Q: I have an irregular heartbeat. Recently, after I missed a dose of medication (atenolol), my heart was pounding for about an hour. Could there be damage?
— Jeanne, Englewood, NJ
Dr. Arthur Agatston A:

No doubt your heart rate did go up after you missed a dose of your beta-blocker medication (beta-blockers work, in part, by slowing the heart rate). But it’s extremely unlikely that missing one dose would cause damage to your heart. That’s because there would still be plenty of atenolol in your system, assuming you’ve been taking the drug for a while. If you have a structurally normal heart, then palpitations, even if they continued for a period of time, would not cause damage.

That said, if your heart palpitations are sustained for any length of time when you are taking your medicine, or if they are associated with other symptoms such as chest pain or light-headedness, contact your doctor and then relax. Most of the time, heart palpitations are nothing to worry about.
See all Heart Health Q&As
Last Updated: 12/23/2008
Arthur Agatston, MD, is a practicing cardiologist and an associate professor of medicine at the University of Miami Miller School of Medicine. He is also the creator of The South Beach Diet.
Everyday Health Network Copyright © 2009 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service and privacy policy.

[ami]

Ask Dr. Arthur Agatston
Misleading Readings

Q: What is a good heart rate? I was on a treadmill, and it told me that my heartbeat was too high — what does this mean?
— Carol, Florida
Dr. Arthur Agatston A:

First, I’d be interested to learn how your heartbeat was taken while you were exercising. That’s because there can be false readings on treadmills. I’ve had patients call me in a panic, saying that the treadmill or elliptical machine they were on registered a heart rate of 300. My first question to them is always, “Well, how did you feel when your heart rate was 300?” And they invariably say, “Fine.” Believe me, if you really had a heart rate of 300, you wouldn’t be feeling fine, so I know that the reading was an aberration.

One way to figure out whether you’re exercising at a brisk enough pace to improve your cardiovascular system is to see if you’re reaching your target heart rate for aerobic fitness, which is about 60 percent of your maximum heart rate (MHR). The formula differs slightly for women and men:

For women: To calculate your MHR, subtract your age from 226. If you are 43, for example, your MHR is 226 minus 43, or 183. If you are 58, it is 168. Multiply this resulting number by 0.60 and you will find your target heart rate, the recommended number of heartbeats per minute for improving your cardiovascular health. So if you’re 43 and your MHR is 183, your target heart rate is 183 times 0.60, or 110. If you’re 58 and your MHR is 168, it’s 101.

For men: To calculate your MHR, subtract your age from 220. If you are 43, for example, your MHR is 220 minus 43, or 177. If you are 58, it is 162. Multiply this resulting number by 0.60 and you will find your target heart rate, the recommended number of heartbeats per minute for improving your cardiovascular health. So, if you are 43 and your MHR is 177, your target heart rate is 177 times 0.60, which equals 106. If you are 58 and your MHR is 162, it’s 97.

A better indication of fitness, in my opinion, is how fast your heart can recover after you have completed your cardiovascular workout. People’s heart rates will go up or down depending on their age, fitness level, and other factors. If you’re unfit and work out, your heart rate will go up rapidly and come down very slowly. As you get fitter, your heart rate will go up more slowly and come down more rapidly. That said, some older people are simply physiologically young and can reach higher heart rates than the age formula might indicate. On the other hand, some young people may never reach the heart rate suggested for their age due to what is known as chronotropic incompetence (a reduced heart rate response to exercise).

Remember, if you have symptoms such as chest pain, palpitations, or shortness of breath when exercising, you should call your doctor, who will likely give you a stress test to see how your heart responds.
See all Heart Health Q&As
Last Updated: 12/23/2008
Arthur Agatston, MD, is a practicing cardiologist and an associate professor of medicine at the University of Miami Miller School of Medicine. He is also the creator of The South Beach Diet.
Everyday Health Network Copyright © 2009 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service and privacy policy.

[ami]

6 Tips to Help Lower Your Cholesterol

To help you meet your weight-loss goals, the South Beach Diet encourages you to eat nutrient-dense, fiber-rich foods and to exercise regularly. By following the South Beach Diet lifestyle, you’re also on the right track to lowering your cholesterol and thereby reducing your risk of heart disease.

Here are 6 ways to help improve your cholesterol levels:

1. Limit saturated fat. Saturated fat (often referred to as animal fat) — from foods such as poultry skin, full-fat dairy products, and fatty cuts of beef, lamb, and pork — can stimulate cholesterol production in the body and cause your total cholesterol and LDL ("bad") cholesterol to rise. By adopting our diet, which is low in saturated fat, you've taken a good first step toward improving your cholesterol levels.


2. Avoid trans fats. Trans fats, or partially hydrogenated oils (check the list of ingredients on nutrition labels), may be even more damaging to cholesterol levels than saturated fats because they can raise your LDL cholesterol while lowering HDL ("good") cholesterol. Studies have shown that trans fats may also increase the risk of cancer. The South Beach Diet excludes foods like stick margarine, baked goods, and crackers, chips, and other processed snacks, which often contain trans fats; instead these unhealthy choices are replaced by products made with good monounsaturated and polyunsaturated fats found in olive, peanut, and canola oils.


3. Maintain a healthy weight. Being overweight can also cause an increase in LDL cholesterol. For most people, losing weight decreases your LDL; in addition, for every two pounds you lose, your HDL (“good” cholesterol) level may increase by 0.35mg/dL.


4. Exercise smart and often. A mere 20 minutes of aerobic exercise that incorporates interval training every other day can also help lower LDL levels and raise HDL levels. Combing a healthy eating plan and exercise can help further your weight loss, which will likely lower cholesterol levels even more. The important thing is to be consistent: Find aerobic activities you enjoy. Walking, swimming, and biking are all good choices.


5. Quit smoking. In addition to being a major risk factor for heart disease and cancer, cigarette smoking can also contribute to low HDL levels. If you smoke, quitting can raise HDL levels by 10 percent.


6. Seek medical help. If none of the above tactics helps lower your cholesterol, or if you have a family history of high cholesterol or heart disease, it may be necessary to seek medical help in the form of a cholesterol-lowering drug. Consult your physician to find the best course of action.

[ami]

Q: How low can a person's blood pressure drop before it's cause for concern?
— May, Missouri
Dr. Arthur Agatston A:

Low blood pressure, or hypotension, is rarely cause for concern — unless it's extremely low and related to shock. Hypotension is commonly defined as a blood pressure less than 100/60 (pressure between 100/60 and 120/80 is considered optimal). For most people, living with low blood pressure is not an issue. In fact, studies show that the lower your blood pressure, the lower your risk of cardiovascular disease. That said, there are a couple of conditions regarding low blood pressure that I'd like to explain.

The first is postural hypotension, medically known as orthostatic hypotension. This is a type of low blood pressure that develops momentarily when someone rises too quickly from a sitting or lying down position and there is inadequate blood flow to the brain. Individuals can sometimes pass out from postural hypotension, although lightheadedness or dizziness that goes away on its own in a few seconds or a minute or two is more typical.

Postural hypotension is more common in the elderly: Roughly 15 percent of those over age 65 experience it, but it seldom needs to be treated. Once a person is aware of the condition, learning to get up slowly usually resolves the problem. Occasionally, this form of hypotension is severe enough to require treatment — and sometimes it is a sign of another ailment, such as a virus. In addition, dehydration, extended bed rest, lack of exercise, and certain medications can all be factors associated with increased episodes of postural hypotension. If you are susceptible to frequent incidents, your condition should be evaluated by a physician.

More serious is extremely low blood pressure, which can lead to shock. The body goes into shock when the blood flow to critical organs is so minimal that they don't get enough oxygen and other nutrients. This can result in widespread organ damage and sometimes death. Shock is always a life-threatening condition that needs emergency treatment.

There are different types of shock, depending on the underlying cause of the low blood pressure — for example, heart attack or heart failure (cardiogenic shock); low blood volume from bleeding or dehydration (hypovolemic shock); allergic reaction (anaphylactic shock); and widespread infection (septic shock).

Extremely low blood pressure can develop in seconds (as with bleeding from trauma), in minutes (as with a peanut allergy), or over the course of hours (as with a worsening infection, such as toxic shock syndrome).

As a final note, if you frequently have such symptoms as dizziness, weakness, fatigue, and/or palpitations, talk with your doctor. While these symptoms can be associated with chronic low blood pressure, they can have other causes as well.

Learn how to eat to improve your health.
Last Updated: 08/25/2008
Arthur Agatston, MD, is a practicing cardiologist and an associate professor of medicine at the University of Miami Miller School of Medicine. He is also the creator of The South Beach Diet.
Everyday Health Network Copyright © 2009 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service and privacy policy.

[ami]

Why Perfectly Healthy People Get Heart Attacks

Noninvasive tests may help identify who's really at risk for a heart attack.
By Arthur Agatston, MD, Everyday Health heart expert
About 25 years ago, when I was co-director of the Noninvasive Cardiology Laboratory at Mount Sinai Medical Center in Miami Beach, performing heart ultrasounds and exercise stress tests, I got a call from an internist who told me that one of his patients had just suffered a heart attack. He was puzzled because this patient had recently passed an exercise stress test…administered by me! I was very upset by this news and rechecked the test results to see if I had made any mistakes.

After careful review, I couldn't find any errors in my analysis. The stress test was normal, and the patient had shown excellent exercise capacity. I remember feeling very frustrated. We were working with the best technology available, yet it wasn't good enough to detect a heart attack that was only weeks away.

Today, we do have other noninvasive tests that are much better at predicting the likelihood of a future heart attack. A normal stress test does not mean there aren't any potentially lethal soft plaques growing inside the lining of your coronary arteries that could rupture and cause a heart attack at any time. All it means is that the blood flow to your heart was fine on the day you took the test. Unfortunately, that doesn't mean that the blood flow will still be fine tomorrow.

Recently, I was at a dinner party when another guest, upon hearing that I was a cardiologist, turned to me and said, "My friend just passed his annual physical with f lying colors. Two days later, he had a heart attack. How could this happen?" I'm sorry to say that I hear stories like this almost as often today as I did 25 years ago. The fact is, back then, we had an excuse. We didn't know any better. Today, we do. We know that someone can look great on paper — pass a standard exercise stress test with f lying colors, have good cholesterol scores, and never have had a sick day in his or her life — but still have arteries that are a diseased and potentially lethal mess. Today we have access to cutting-edge diagnostic tests that can identify these high-risk people early enough to prevent them from having heart attacks in the first place.

The problem is that many patients destined for heart problems don't get the benefit of our most accurate tests (including presidents of the United States). Many seemingly perfectly healthy people are "suddenly" getting heart attacks because their arteries are not perfectly healthy and they don't know it. With the proper noninvasive tests, these diseased arteries would have been identified, and the heart attacks wouldn't have happened.

Everyday Health Network Copyright © 2009 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service and privacy policy.

[ami]

A proactive approach can reduce the odds of having a second heart attack.
By Arthur Agatston, MD, Everyday Health heart expert
Here's the bad news: If you have had a heart attack, you have a one in five chance of dying within the next 10 years. Now for the good news: You can improve the odds by taking positive steps to protect your heart. My practice is filled with people who came to me after suffering a heart attack and have not gone on to have another. In fact, by following my preventive approach, they improve their heart health over time.

If you have a history of heart disease, getting advanced diagnostic blood testing is not optional, it's a necessity. It's the only way you will be able to find out whether you have the kind of cholesterol-carrying particles in your blood that are good, bad, or really terrible. (The really terrible kind accelerates the accumulation of cholesterol under the protective lining of your artery walls, leading to the buildup of the soft plaque.) Advanced blood testing is also the only way that you will be able to find out whether you have dangerous amounts of other substances in your blood, such as C-reactive protein, a marker for inflammation that can damage the lining of your arteries.

Depending on what type of offending substances advanced testing detects in your blood, your doctor will determine the type of treatment that will be most effective for healing your artery walls and preventing plaque buildup, plaque rupture, and blood clotting — in other words, for preventing future heart attacks. Typically, treatment includes lifestyle changes and medications. If you have a history of heart disease, you must be especially conscientious about making these changes if you want to save your heart and your life. Unfortunately, cardiac care units are filled with people who did not follow a prevention strategy.

Everyday Health Network Copyright © 2009 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service and privacy policy.

[ami]

Ask Dr. Arthur Agatston
How Long to Improve Cholesterol Levels?

Q: How long does it usually take to improve very bad cholesterol levels? Is a month an unreasonable amount of time?
— Joanne, Delaware
Dr. Arthur Agatston - High Cholesterol Center A:

It depends on which part of your lipid profile is elevated and how you're going about lowering your cholesterol. Ultimately, the results will be different for every person.

Elevated triglycerides (fats present in the blood plasma) tend to come down the fastest, usually in a few months or even less. This will often result in a corresponding drop in your total cholesterol. Total cholesterol is a combination of HDL (good cholesterol) and LDL (bad cholesterol); therefore, a sudden drop or increase can be potentially misleading. You'll need to pay close attention to your levels of HDL and LDL to determine if you've really decreased bad cholesterol and increased good cholesterol. If triglycerides are not elevated, it may take longer to see a decrease in your total cholesterol.

The speed with which your cholesterol levels improve also has to do with the method you've employed. Changing your lifestyle through diet and exercise is great for overall health, but it may take some time for cholesterol levels to improve. If, in addition to a healthy lifestyle, you're taking cholesterol-lowering drugs per doctor's orders, you could see improvement in as little as one month. Consult with your doctor to see if you're on the right track.

Learn more in the Everyday Health High Cholesterol Center.

Learn how to eat to improve your health.
Last Updated: 06/26/2008
Heart health expert Arthur Agatston, M.D., answers your frequently asked questions about heart health and high cholesterol, including questions on high cholesterol treatment, medications, management, and resources. Dr. Agatston is a preventive cardiologist and an associate professor of medicine at the University of Miami Miller School of Medicine. Dr. Agatston is well known as the bestselling author of The South Beach Diet. He maintains a cardiology practice and research foundation in Miami Beach.
Everyday Health Network Copyright © 2009 Waterfront Media, Inc.
The material on this web site is provided for educational purposes only, and is not to be used for medical advice, diagnosis or treatment. See additional information. Use of this site is subject to our terms of service and privacy policy.