Quick tips: ABCs of cholesterol and other meaty topics

Hi from the mailbox!DRH Letterbox

Another great Healthy Matters show this week -thanks to the listeners who are up on a Sunday morning – getting dressed, eating breakfast, going to church, drinking their coffee – and tuning in to listen to me talk about fungus and pus.   So a heartfelt THANK YOU to Healthy Matters listeners and for your terrific questions by text and phone.  

If you have not heard the show yet, you can do so a few ways:

  • Live radio broadcast:  WCCO 8-3-0 AM dial  – Sundays 7:30 a.m. Central
  • Live streaming on your computer/mobile: WCCO.COM  – Sunday 7:30 a.m. Central
  • Podcasts for listening at your convenience – podcasts available here.

The whole shebang is sponsored by my organization, Hennepin County Medical Center (HCMC) in be-yoo-tee-ful downtown Minneapolis.

This week’s post features quick answers to questions I received on the show.  These are quick and incomplete, so make sure to talk to your own doctor to learn more.

I’ll also be doing some video posts where I can answer questions by talking rather than typing . . .  look for those soon.

From the Healthy Matters mailbag

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Several questions this week about cholesterol numbers, like this one . . . 

“My doctor recommended coming back in 6 months for repeat of cholesterol numbers and tweaking my lifestyle.  Is there an alternative to statins?”

Short answer:    Dyslipidemia, which basically means your cholesterol is out of whack, is a risk factor for developing cardiovascular problems in the future.  Statins remain the medications with the most scientific evidence to prove that they work.  There are alternatives, but none with such strong proof to back them up.

Longer answer:

  • LDL = low-density lipoprotein.  LDL = bad.  You want this one low.
  • HDL = high-density lipoprotein.  HDL = good.  You want this one high.
  • Triglycerides = fats floating around your blood stream.  You want this low.
  • Total cholesterol = a combination of the above (but you can’t simply add up the 3 of them to get your total cholesterol – it is a more complicated formula).

Your body actually requires cholesterol for life since it is part of cell membranes and an important part of the normal steroid hormones that your body makes.  Most cholesterol is manufactured in your liver, with only a modest amount coming from your diet.

The trouble for many of us is that our cholesterol factories (aka your liver) don’toff switch have an “off” switch.  It simply makes too much.  Think of statin medications as the “off” switch.  Yes, they have side effects (the most common one is muscle problems) and as science progresses, we will undoubtedly learn more about these medications.  But for now, for the right people, if you have cholesterol problems statins are the best way to reduce your risk of heart disease.

Who are the right people for statins?  Here are the latest guidelines (new in 2015):

  • People who do not have known cardiovascular disease and are between 40 and 75 years old and have a 7.5 percent or higher risk for heart attack or stroke within 10 years.

      This is cool and you should do this –> to find out your 10-year risk of heart disease, click here.

  • People with a history of heart attack, stroke, stable or unstable angina, peripheral artery disease, transient ischemic attack, or coronary or other arterial revascularization.  (Basically if you have known cardiovascular disease).
  • People 21 and older who have a very high level of bad cholesterol (190 or higher).
  • People with Type 1 or Type 2 diabetes who are 40 to 75 years old.

There are a LOT of people who could be taking these medications and receiving the benefit of reduced risk of heart disease.  Click here for a nice discussion of the guidelines.

 


Read on for another related question . . . 

“I thought the higher the HDL cholesterol the better.  My HDL was 100, LDL was 128, triglycerides 27.   Doctor expressed concern that sometimes an HDL at either extreme can be a problem . . and ordered a VAP test.”

Here is an analogy that works for me.  Bear with me, I made this up . . . 

Cropped shot of rubbish that's been put out for garbage collection day

Think of LDL and triglycerides as “garbage” floating around your bloodstream and attaching itself to your blood vessel walls, like garbage accumulating on the curb.

 Too much garbage = a mess of badness.

Now think of HDL as the “garbage trucks” driving around, picking up the garbage from the curb (vessel walls), and delivering it back to your liver where it can be processed and removed.  

You want lots of garbage trucks.

So in general, you want an HDL that is high (preferably 50-60 or more).  But can it be too high, as this questions asks?  Well, yes, it is true that HDL that is not working properly is not only ineffective in its garbage truck duties, but may actually be harmful.  However, we really don’t know what to do with that information.

The VAP test is a series of advanced tests that can more accurately pinpoint your cholesterol situation.  As I mentioned on the radio, however, we still don’t know what to do with the information since  getting the test will usually not lead to any change in treatments.  After all, we don’t really have any additional proven treatments.  So you can get the VAP test if your doctor recommends it, but be prepared to hear the same advice when it is back:  eat healthy, exercise, don’t smoke, take a statin if indicated.

And choose your parents carefully.


On to a new topic from the mailbox . . .

iStock_000021022726_Large“Do acid control medications cause Alzheimer’s Disease?”

Short answer.  We don’t know.

Longer answer:  This one has been in the news as of late since a group of German researchers published the results of their study which showed an association between proton-pump inhibitor use (PPI) and the development of dementia.  The study was in people over 75 who did not have dementia at the outset, but who were taking one of the common acid-suppressing agents called PPIs.  Examples (among many others) of these drugs are omeprazole (Prilosec) and lansoprazole (Prevacid).

 The study showed that more people on these medications developed dementia than those not taking them.  Why this may be the case is not known.  But it is really important to note that the association between these medications and dementia is not proof of causation.  In other words, these medical studies do not prove that doing one thing (taking the acid-suppressing medications) actually causes the other thing (getting dementia).   Here’s a link to the actual study if you are super into medical journal articles with subtitles like “A Pharmacoepidemiological Claims Data Analysis” – I’m not joking, that is the actual subtitle of this real page-turner.

Bottom line:  this is not a reason to stop taking your acid-suppressing medications if you have a strong indication to do so (you have proven acid-reflux disease, for instance).   I should add that many people take acid-suppressing medications for shakier reasons and probably don’t need them in the first place.

 


One more for the good measure . . . 

“Paryonychia on thumb. Causes?”

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Paronychia is an inflammation around the finger- or toenails.  It is sometimes chronic (long-lasting) but often acute (comes on quickly and resolves).  It is usually due to a bacteria or fungus getting in the grooves around your nails.  It shows up as a sore, red, and swollen area around the nail.  The acute kind may be due to minor daily-living types of activities (dishwashing, trimming nails, minor trauma . . . ) and may not need any specific treatment other that putting warmth or topical anti-inflammatories on it.

If there is pus oozing out of it, you may need antibiotics or drainage by your doctor.  Chronic paronychia may be due to a fungal or allergic type of dermatitis, and may require topical treatments with anti-inflammatories or anti-fungals.


The rest of the mailbox

To give you a sense of the range of topics on a typical Healthy Matters Open Lines show – I’ll show you a partial and condensed list of the topics listeners raised this week but that I did not get to cover.  I’m struck by the range of questions – and also just how legitimate they all are!  Doing the radio show really makes me aware of the shared human condition – I bet most of us can relate to something on this list . . . !

  1. Febrile seizures in infants.
  2. What is neuropathy?
  3. Clostridium difficile infections.
  4. Atrial fibrillation.
  5. Cold sores in a young adult.
  6. Epilepsy in children.
  7. Ear infections.
  8. Testing for Diabetes type 2.
  9. What is pre-diabetes?
  10. Causes of dry tongue?
  11. Carpal tunnel syndrome.
  12. High calcium in blood tests.

Keep listening, keep checking out the blog . . . and if you have a preference for what I should cover in the future please leave me a comment and I’ll do my best!

 

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Procreative success and Blue Zones: Dr. Meghan Walsh visits the studio

Procreative success and Blue Zones?  The whole thing sounds like it may not be suitable for discussion in mixed company.  But rest assured, it’s all good, nothing indelicate going on here.  This is a post about living long and living well.  Please read on . . .

On my HealthyMatters radio broadcast last Sunday, we talked a great deal about keeping your heart healthy – after all, it was Valentine’s Day and I’m not above doing a cheesy tie-in between chocolate hearts and actual cardiac health.  I’m sentimental like that.  But good thing I brought someone to keep me from milking the sappy heart analogies too much . . . Meghan studio

To help me out, I asked my super smart good friend Dr. Meghan Walsh to join me – you’ll want to click on the Listen to Podcasts link on the right to hear her advice about broken heart syndrome, aka stress cardiomyopathy, and other heart topics.  She’s a hospitalist (cares for people in the hospital) with a focus on cardiology – in other words she totally knows what is going on when you have a heart problem.  And she should know a thing or two about keeping it healthy.  Too bad she hails from “the wrong side of the tracks” (which to a Minnesotan like me means she’s from Wisconsin).

Lately, though, I’ve been thinking about living longer and living well.  I talked about “Living to 100” on TV last week , I wrote my last blog post on “Living to 100,” and I just worked a week in the hospital where I pronounced the deaths of two people and cared for several more in the last weeks of their lives.  Let’s just say longevity is on my mind.  So Meghan and I talked about not just heart health, but how to actually live longer in general.  And during the show, she brought up the concept of Blue Zones.

Say what?  Blue what?

Well it turns out some cool people have looked all around the world and located little pockets where people actually do live a good deal longer than the rest of us.  And they do so with vigor and purpose and vitality.  This intrigued me, and having looked into it more, I’d like to share it with you.  Read on for more . . .

So what the heck is a Blue Zone?

Turns out there is a guy from Minnesota named Dan Buettner who worked with National Geographic to identify areas in the world where people actually live longer than the rest of us – and then to try to figure out how they are doing it.  I haven’t met Dan but I’d sure like to.   He called these areas Blue Zones:blue zones

 

After studying these areas, where people routinely live longer than in most other communities (even living to 100 and beyond), the researchers learned some key factors – and none of them required fad diets or going to the gym!  He wrote a book by that name and he’s given some really engaging talks about it.  They will really get you thinking:

In his work on Blue Zones, Dan Buettner learned that these 5 communities shared 9 important characteristics, grouped into 4 categories.    Note that all of this is his work, not my own – I want to give appropriate credit –  but I’m going to paraphrase them here and include how some of it makes sense in my own life.  Maybe it will in yours as well.

And you’ll just have to read to the end to learn about procreative success.

Move naturally

  1.  Moderate, regular physical activity.

Communities in which people live the longest tend to be quite active, but it is not through intentional exercise – at the gym or anywhere else.  Rather, they structure their communities and routines so that movement is a routine part of daily life, not scheduled like we do.  Gardening.  Taking the stairs.  Regular hikes for leisure.  Mix the cake batter by hand rather than use the mixer.  Stuff like that.

Right outlook

2.  Life purpose

The Okinawans of Japan have a saying  – ikigai – which basically is the reason you get up every day.  The Blue Zone researchers found that having a sense of purpose is worth 7 years of extra vigorous life expectancy.  So many of us, however, retire from our jobs somewhere in our mid-60s, then try to figure out what to do that feels meaningful after that.  But Dan found that really old people in Japan still maintained a sense of life meaning – be it fishing, holding great-great-great grandchildren, or doing martial arts.

Here in Minneapolis, this week I admitted to the hospital a woman in her 80s who broke her hip while playing volleyball. Her goal was to get well enough to get back to her active life.   The take-home point is not that she broke her hip; that was an acceptable risk to her.  The take-home point is that she was out playing volleyball.  Awesome.   (Full disclosure – I changed a couple bits of her history to protect her privacy – but the message is the same).

3.  Stress reduction

People who live longer tend to know how to chill out.  They do this in ways that are meaningful to them, something we could all learn to do.

I’m about as Type A as they come and tend to talk too quickly, move too quickly, eat too quickly.   Guilty as charged.  When walking around Lake Harriet with Julie, my wife, she often grabs my hand.  I like to think it is for romantic reasons, but as she points out, it’s to keep me at a pace that doesn’t require her to jog to keep up.  So calming down is not a strength of mine.  But I do try.  Like live classical music concerts.  For me, a heavenly evening is spending an evening at Orchestra Hall listening to the Minnesota Orchestra.  I don’t talk to many – or any – people since I usually go alone.  For my wife, and many of my colleagues who are doctors, stress reduction means a ritualized practice of meditation.  For you it may be something else.  But we need to learn to sloooooooow down.

(Quick aside – we recently did a HealthyMatters show on meditation with a cardiologist colleague of mine, Steve Goldsmith, and a Buddhist master, Marc Anderson.  Listen to the podcast here).

Eat wisely

4.   Moderate calories intake

This is one I’ve been harping on for years when giving my own presentations on living long.  Portions sizes today = obscene!  Believe me, when you go to one of those big sports bar restuarants, you know the kind with 98 big screen TVs lining the walls, there is nothing OK about the size of that plate of food.  There just isn’t.  There are enough calories on that plate for two or even three meals.  Eating less is something we can and should do – and there are tips to help.  Like reminding yourself before every meal to stop eating when you are 80% full like the Okinawa folks.  Or putting the food on the plate in the kitchen, rather than serving family style at the table where you are tempted to take more helpings.  Or just use a smaller plate.  Simple as that.

5.  Plant-based diet

I’m sorry if you are in the meat-producing business, but I have to say it.  It is pretty clear that we need to eat, as I say, “lower on the food chain.”  Plants and legumes should be the mainstay of our diets – and the more colorful, the better!  The dark green, rich red, and bright orange ones are best.  This is pretty well established advice.  If you do eat meat, make it lean and in much smaller portions than we are used to.  The meat – if present at all – should be the size of a deck of playing cards.  The veggies, whole grains, and legumes should take up most of the real estate on your plate.

6.   Moderate alcohol intake, mostly wine

A glass or two of wine daily is probably reasonably good for you, at least if you look at the communities where people are living a long time.  Many of us doctors have been saying this for years, and there is some evidence to back it up.  After all, people in Provence seem to do OK with it.  I always qualify this recommendation, however, because it just isn’t for everybody.  For instance, if you have alcohol dependence or addiction to alcohol or other substances, certainly this is a really, really bad idea for you.  And as a doctor, I see people all the time who drink 7 drinks on a Saturday night, thus averaging out to one per day for that week.  Sorry, doesn’t work that way.

Right tribe

7.   Engagement in spirituality or religion

This is a common theme in the Blue Zone communities.  People who live to 100 typically are part of a spiritual community of some sort.  And they aren’t hit-or-miss about it – they show up several times per month for some sort of spiritual connection.

I was in Jerusalem on Yom Kippur last year.  Talk about honoring the holy days – the entire city shut down in what seemed to me a collective nod to the spiritual.  And my Muslim friends pray faithfully many times a day.  And Christians like the Adventists of Loma Linda reverently keep the Sabbath.  Just examples – your faith traditions may be vastly different and that is OK, but the idea of regular spiritual engagement as a factor in how long you live – well that intrigues me.

8.  Engagement in family life

Communities in which people live to 100 tend to be very family-centric.  They take care of both their children and their aging parents.  Old people are honored in the family.  It turns out that taking care of your family makes you live longer.  A good read about this is Atul Gawande’s Being Mortal.  I recommend it.

9.   Engagement in social life

Isolation isn’t good for you.  That seems to be clear.  This makes sense to me – particularly in our culture where our “friends” may well be people we barely know on our social media accounts.  Watch the TedTalk that I referenced earlier in this post and learn of the close-knit group of people in Okinawa who are life-long companions throughout the life journey of the group.  Through good and bad.  Wow.

When I was in medical residency we had a group of friends that hung out regularly to de-stress, commiserate, laugh.  We called ourselves the “Plexus” a name whose origin is a long and probably boring story.  Meghan Walsh was part of the Plexus.  But the group sort of scattered after our residency at Hennepin County Medical Center though some of us have stayed in touch.  Our friends come and go sometimes.  Not a good thing, perhaps.

Meghan and me studio

Here’s Meghan and me at the studio – the remnants of the Plexus.  (And now if I could just lose that gut . . . !)

OK, as promised . . .  what is procreative success?  Sounds like something good, eh?

According to Dan Buettner, this is the genetic goal, if you will.  It means that we are programmed to see our children and our children’s children and if we do, that’s considered success, at least evolution-wise.  So all this longevity talk – well, evolution and our genes have little to say about that.

So look to the Blue Zones for help.

 

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Quick tips: angina, bronchitis, and acid reflux

Regular listeners to Healthy Matters know that I often can’t get to all the questions that come from listeners via phone or text message, or I can’t answer the questions as thoroughly as I’d like whlogo_healthy-mattersen doing live radio.  So every so often I’m going to use this blog to post a few “quick tips” in response to listener questions.  Nothing in-depth, just a few tips I think are interesting.

And you can always listen to old shows by clicking the “Listen to podcasts” link in upper right of this blog.

Remember, these are just quick tips and are not complete medical advice.  Be sure to click the link in each section for more information!

These are from the Sunday, February 7 show.

Angina pectoris

One texter this morning asked about angina – what is it, does it mean there is heart disease, and what to do about it.

Angina pectoris is a mix of Greek (“strangling”) and Latin (“chest”) and is the term we use to describe pain in your chest which is due to coronary heart disease.  This is the blockage of your coronary arteries by plaque that some of us know as “hardening” of the arteries.  Coronary ecg-long-hiheart disease also leads to heart attacks – an unstable, emergency situation, but angina is the stable condition that comes when your heart isn’t getting enough blood to meet the demands being asked of it.  In other words, the heart is doing fine when at rest, but doesn’t have the reserve required for exertion or stress.

  • Angina occurs with exertion, stress, and hot or cold temperatures and is relieved with rest or nitroglycerin.
  • It usually feels like a pressure or squeezing in the chest (hence the name which means “strangling”).
  • There are lots of variations in symptoms, particularly in women, and may also feel like nausea, indigestion, or include arm, neck, and jaw pain.
  • Angina usually lasts just a few minutes.
  • Symptoms are usually predictable – not coming out of the blue at unexpected times.  Onset with exertion/stress, relief with rest/medications.

If you think you may be having angina, then you should be seen by your doctor for tests.  There are good medications and other treatments for angina.  Importantly, if the symptoms are becoming more frequent or severe, or occur at rest, then you may have unstable angina which requires urgent attention.  Like right now attention, not tomorrow or next week.

For more, check out the reliable American Heart Association site.

Continue reading “Quick tips: angina, bronchitis, and acid reflux”

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