Dottie’s Tragic End

My mother-in-law was a loving, positive woman.  She was short in stature, but she was long on friendliness and love for others.  Dottie had been an elementary teacher for a number of years and was active in her local Methodist church.  Her church friends were like family and each week they would all get together, taking turns hosting family pot-luck dinners and evenings of card games.  

After her husband’s death in 1992, she got back into golf.  She first took up golf as a young girl taking lessons from her father, but while teaching school, raising three children and caring for her husband, golf had taken a back seat. 

Dottie loved getting back out to the golf course and had a group of women golfers to compete with a few days each week.  Her family and friends were delighted to see her able to participate fully in life once again after caring for her husband who was bedridden for many years before his death.

One fall afternoon in 1998, at the age of 79, Dottie went for a walk to visit some friends in her neighborhood.  She began to have some scary symptoms and the friends called 911.  She was rushed to the hospital and her grown children were called.  Dottie had suffered a massive stroke, which left her totally debilitated - unable to speak or to move her arms and legs.  The only way she could now communicate was with her eyes.

She was placed in a skilled-nursing facility.  Most Sundays for the next 6 months my husband and I would drive 2 ½ hours to visit her and then turn around and drive home.  How horrible to see that once loving and vibrant woman in such depressing circumstances.  The facility was clean and the caregivers were doing the best they could, but it was full of people (mostly women) who were in terrible shape being kept alive with feeding tubes or respirators.

My brother- and sister-in-law lived in her town and bore the brunt of visiting her and making the health-care and estate decisions that had to be made.

We all say we don’t want to live like that.  We say we don’t want to be a burden on others.  We say, “If I ever get like that, please just shoot me and put me out of my misery.”

What we forget to say is “I want to find a way to prevent that from happening to me.”

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Confusion

I have studied health and nutrition for nearly 40 years.  I am not a formally trained scientist based in a research lab.  I am the wife of a dentist and I am a mother.  Many years ago when our first baby was born, I took the responsibility of that baby’s health very seriously.  I read every book I could find that was related to child development, diet and exercise.  I attended seminars and heard many of those authors in person.

All of that information was confusing.  I had my family on a new regimen with every new book I read.  We went from Pritikin to Barry Sears to Dean Ornish to John McDougall to John Robbins to Ken and Millie Cooper to Joel Furhman and even to a vitamin and supplement company called Body Wise.  The list is long and exhaustive.  

After our kids left home, I went back to work and my husband and I started eating out for lunch and most dinners.  After a few years of that routine, I was overweight for the first time in my life!  It was time to get back on the health routine, for myself, this time.

During this long period of confusion my husband handed me a book, which he said I would love.  It’s title, Younger Next Year.  The premise of the book is that through energetic exercise and “healthy living” we could remain vigorous until we were in our 80s.  I got so excited about that message; I wanted to share it with all of my friends.  I contacted Chris Crowley (one or the co-authors) and invited him to come to Tyler to speak so I could share that good news with others.  I had to get busy and figure out a way I could pay for his speaker’s fee and expenses.  A few months of planning culminated in a large luncheon for women during May of 2007, with Chris Crowley as the keynote speaker.  He was entertaining and motivating and the event created quite a stir.  I think most of us who were in attendance left with the desire to do more to improve our health and vitality.  

The next major book I read was The China Study by Dr. T. Colin Campbell.  Another powerful book that caused me to completely change my diet (once again).  My husband and I switched to a plant-based diet almost immediately.  We have continued eating that way since the summer of 2007.  I even lost those extra twenty pounds in the first few months without even thinking about it.

As you know, there is a new diet, a new study, a new finding or a new opinion about health every single day.  This definitely leads to a mish-mash of ideas, uncertainty and total confusion for most people.  When we are given too many options, we become confused and we stop making decisions.  This is when apathy can set in.  

We look around and see that some people who we thought had healthy habits get sick and die while others who seem to do everything wrong outlive them.  So we don’t know what to believe or which way to turn.

What do you do?

I think you have to do your research and then you have to choose your own path.  That’s what I’ve done.  

After doing the research for - and writing the book, Diet and Cancer: Is There a Connection? I unabashedly believe that plant-based eating and moderate exercise will not only keep me slim, but most importantly – healthy.  So, that’s the path I have taken and will continue to take.  I still listen to other points of view, but I look at them through the prism of the important scientific studies that I have come to believe in.  I may refine some habits, but I no longer switch back and forth with the wind. 

And, let me tell you – after years of confusion, it feels good to finally be sure of my conclusions.

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Some Statistics on the  #1 Killer of Americans - Cardiovascular Disease

Cardiovascular disease is a class of disease that involves the heart and blood vessels.  It is the leading cause of death for both men and women in the U.S.

According to the American Heart Association there are 83.6 million American adults who have 1 or more types of cardiovascular disease (CVD), which boils down to 1 in 3 adults.

Let’s try to relate those numbers to this room for now.

Look around the room.  Look down your row.  You can count off by 3s and hope you don’t get the unlucky number “3”.  Let’s say the “1s” and “2s” are those without any cardiovascular disease, but the “3s” do have one or more types of the disease.  In the U.S. adult population, out of approximately 100 “3s” (who don’t reverse their disease) one of them will die this year. 

That sounds like your odds are pretty good – unless you happen to be number 100.  

Over 787 million Americans die of a coronary event each year – or one every 40 seconds. 

According to the National Center for Health Statistics, if all forms of major CVD were eliminated, life expectancy could rise by almost 7 years.

There are six cardiovascular diseases that are included in the 83.6 million Americans with one or more of them.  The seventh category, congenital defects, is not included in these statistics.

The first CVD is something that might surprise you:

1. High Blood Pressure  (HBP)– If your blood pressure is greater than 140/90 without medication you fall into this category.  If a health care professional has told you at least twice that your blood pressure is high or if you are taking blood pressure medicine (antihypertensive medication), you also fall into this category.  33% of adults over 20 have HBP. (77.9 million) 

The next CVD is:

2. Coronary Heart Disease (CHD) – This is a narrowing of the small blood vessels that supply blood and oxygen to the heart.  It is also called Coronary Artery Disease.  Coronary artery disease (CAD) is atherosclerosis, or hardening, of the arteries that provide vital oxygen and nutrients to the heart. (15.4 million American adults have CHD)

The third CVD is:

3. Actually having a heart attack (Myocardial Infarction (MI) – (7.6 million Americans have had a heart attack.)

Next is:

4. Chest pain (Angina Pectoris or Angina (AP) – (7.8 million American adults have had some form of chest pain.)

The 5th CVD is:

5. Heart Failure (HF) also called Congestive Heart Failure (CHF) – This is a serious medical condition in which the heart cannot pump enough blood to meet the body’s needs.  The inability may result in fluid retention, which causes swelling, for example, in the legs, feet, or abdomen. (5.8 million Americans have CHF)

The 6th form of CVD is usually thought of in a different category, but it involves the blood vessels to the brain.

6. Stroke (all types) – Happens when the blood flow to the brain stops. (6.8 million American adults have had a stroke.)

The category called Congenital Cardiovascular Defects is not included in the 83.6 million who have CVD.  These are defects in the structure of the heart and great vessels that is present at birth. (1 million) It affects about eight out of every 1,000 children. Congenital heart defects may produce symptoms at birth, during childhood, and sometimes not until adulthood.  In most cases scientists don't know why they occur. Heredity may play a role, as well as exposure to the fetus during pregnancy to certain viral infections, alcohol, or drugs.

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Atrial Fibrillation - An Abnormal Heart Rhythm

What Is AF?

Atrial fibrillation (AF) is the most common heart arrhythmia in Western countries and occurs mostly in the elderly.  AF produces a rapid and irregular heartbeat, during which the atria (the upper two chambers of the heart that receive blood) quiver, or fibrillate, instead of beating normally.

Because the rapid and irregular heartbeat produced by AF cannot pump blood out of the heart efficiently, blood tends to pool in the heart chambers.  This increases the risk of blood clot formation inside the heart, which can then travel from the heart into the bloodstream.  If the clot becomes lodged in an artery, it can cause a pulmonary embolism (a sudden blockage of a lung artery) or a stroke.

The mean age for AF diagnosis in men was 66.8 years versus 74.6 years for women.  Data from a California health plan suggest that compared with whites, blacks, Asians and Hispanics have significantly lower prevalences of AF. 

Risk Factors

• Diet 
• A pacemaker catheter that has been passed through the vein in the groin
• Obesity
• Bedrest
• Family history (having at least one parent with AF)
• Fractures in the pelvis or legs
• Giving birth within the last 6 months
• Recent surgery (most commonly hip, knee, or female pelvic surgery)
• Advancing age
• European ancestry
• Body size (greater height and BMI)
• Left ventricular hypertrophy
• Left atrial enlargement
• Diabetes
• Hypertension (high blood pressure) or treatment of hypertension
• Presence of CVD (cardiovascular disease)
• Hyperthyroidism
• CKD (chronic kidney disease)
• Heavy alcohol consumption
• Data has suggested that moderate-intensity exercise (such as regular walking) was associated with a lower risk of AF.  However, data from many studies suggested that vigorous-intensity exercise 5 to 7 days a week was associated with a slightly increased risk of AF.

A study of over 4600 patients diagnosed with AF showed that risk of death within the first 4 months after the AF diagnosis was high. AF is also associated with mortality in individuals with other cardiovascular conditions and procedures, including HF (heart failure), MI (heart attack), CABG (Coronary Artery Bypass Graft Surgery ), noncardiac surgery, stroke and sepsis (a life-threatening illness that can occur when the whole body reacts to an infection).

When standard stroke risk factors were accounted for, AF was associated with a 4- to 5-fold increased risk of ischemic stroke.  Individuals with AF have an adjusted 2-fold increased risk of dementia.  AF and HF (heart failure) share many risk factors and 40% of individuals with either AF or HF will develop the other condition. 

Symptoms   

Atrial fibrillation often causes no symptoms at all.  When symptoms do occur, there may be palpitations (awareness of a rapid heartbeat), fainting, dizziness, weakness, shortness of breath and angina pectoris (chest pain caused by a reduced blood supply to the heart muscle.  Some individuals with atrial fibrillation have periods of completely normal heartbeats.

Standard Treatments   

Initial treatment focuses on finding and treating the underlying cause of atrial fibrillation. The majority of cases are caused by coronary artery disease and treatment may consist of lifestyle changes, medications that treat high blood cholesterol and hypertension and/or procedures such as angioplasty and coronary artery bypass surgery. 

Atrial fibrillation due to thyrotoxicosis (an overactive thyroid gland) can be treated with medications or surgery, while fibrillation due to rheumatic heart disease may be treated by replacing damaged heart valves.

The arrhythmia (irregular heart rate) of atrial fibrillation can be treated with medications, such as diltiazem hydrochloride, digoxin or verapamil, which work to slow the heart rate. Another treatment option is electrical cardioversion, a procedure that delivers an electrical “shock” to the heart to restore normal heart rhythm. Although this procedure is effective in most cases, the rate of recurrence is high, and 50 to 75 percent of patients eventually develop atrial fibrillation again.

When medications are ineffective, catheter radiofrequency ablation or minimally invasive surgical ablation can sometimes be performed. In these procedures, an area of tissue in the atrioventricular node is destroyed to prevent the passage of excess electrical impulses from the atria to the ventricles. The result is often complete blockage of all electrical impulses. A pacemaker is then implanted to control the heart rate and rhythm.

In addition to the treatments described above, individuals with atrial fibrillation are often given medications to prevent blood clots that can lead to stroke, pulmonary embolism and other complications. Treatment usually consists of anticoagulant medications (blood thinners), such as aspirin and warfarin.

Conservative Treatments

According to many studies, the underlying cause of most cases of atrial fibrillation is closure of the small arteries to the heart muscle, due to the Western diet and lifestyle.  

There are many controversies surrounding the proper treatment of people with atrial fibrillation. Digoxin is an inexpensive, highly effective, relatively safe, time-honored, generic medication.  With the introduction of expensive beta-blockers and calcium antagonists over the past four decades, doctors were told digoxin was inferior for the treatment of atrial fibrillation. But, based on the research, digoxin is the drug of choice for this common condition.

When the heart rate is already normal or slow, there is no need for any medication to regulate the heart rate.  In most cases, when rate control is needed, digoxin is prescribed first to slow the heartbeat.  If this medication alone is inadequate, then a beta-blocker medication can be added.  Calcium channel blockers are more dangerous and are not used in this method of treatment. 

Conservative treatment does not usually recommend “cardioversion” with drugs or electric shocks to the heart because research shows this aggressive approach gives results that, at best, temporarily restore normal (sinus) rhythm, and there are significant risks and side effects from cardioversion.  The vast majority of the published research papers recommend medications to control the heart rate, rather than cardioversion.   

Because people with atrial fibrillation also have an increased risk of forming a blood clot in their heart, which can move to their brain and cause a stroke, the powerful blood thinner, Coumadin (warfarin) is prescribed.  The most important complication of this treatment is bleeding; therefore, people with atrial fibrillation who are otherwise healthy, should not routinely be given Coumadin; for many, a baby aspirin daily may be a better choice.

In addition to the judicious use of medications, a healthy low-fat plant-based diet is prescribed for someone with this condition in order to improve the overall health and reduce the risk for strokes and heart attacks. In most cases, once the rhythm of atrial fibrillation occurs it is permanent and a change in diet will not convert atrial fibrillation to normal; it will only lower the risk of further heart damage or stroke.

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Arthritis, Inflammation and Leaky Gut

If you've got arthritis, you know how painful it can be.  Approximately half of all people over 65 report having arthritis with symptoms of swelling, limitation of motion, or pain.  The regions of the body most affected are the hands, neck, lower back, hip and shoulder.

There are three types of arthritis with a known cause:

Traumatic Arthritis - Joints can be inflamed as a result of an injury, such as from tripping and spraining an ankle.

Suppurative or Septic Arthritis – Joints can be infected with bacteria from the blood stream.  This tends to occur in infants and young children.

Gouty Arthritis – Uric acid crystals can accumulate in the joints.

Other forms of arthritis are said by doctors to have “no known cause.” Arthritis of “no known cause” can be divided into two broad categories:

Degenerative (osteoarthritis) - This is the most common arthritis found in people living in Western civilizations.  It is seen in x-rays of the hands in over 70% of people who are 65 years and older.

Inflammatory - This includes juvenile rheumatoid arthritis, rheumatoid arthritis, psoriatic arthritis, lupus, and ankylosing spondylitis (AS). These aggressive diseases affect less than 5% of the people living in the United States today. 

Arthritis just means inflammation of a joint.  Arthritis is not a genetic disease, nor is it an inevitable part of growing older.  Many studies have linked the inflammation of arthritis to our Western diet.

As recently as 1957, no case of rheumatoid arthritis could be found on the continent of Africa.  These once unknown joint diseases have now become common as people have migrated to wealthier nations or moved to the big cities in their native countries.  With these changes people have abandoned their traditional diets of grains and vegetables for meat, dairy products, and highly processed foods.

Although unknown in Africa before 1960, African-Americans now lead in the incidence of lupus in the US.  The mechanisms by which an unhealthy diet causes inflammatory arthritis are complex and poorly understood, but involve our intestine and immune system.

Leaky gut syndrome has been theoretically suspected as a major factor in a wide range of food and chemical sensitivities, arthritis, asthma, headaches, digestive problems of varying seriousness and chronic fatigue.

Our intestinal lining (or gut wall) is a semi-permeable membrane, like a sieve, that allows small molecules (the products of digestion) to pass through, and blocks the larger molecules. These larger molecules then travel through our intestine and are eliminated. When functioning as intended, the gut wall prevents those larger molecules from stimulating food sensitivity and inflammatory reactions.

Infections, toxins (such as drugs, chemotherapy, anti-inflammatory medications) and an unhealthy diet (too high in fat, cholesterol, and animal protein) can compromise the barrier and allow large molecules to pass into the blood.  This condition of increased intestinal permeability is referred to as a "leaky gut." 

Patients with inflammatory arthritis have been shown to have inflammation of the intestinal tract resulting in increased permeability.

What to do about "leaky gut?"

In scientific studies, fasting has been shown to decrease intestinal permeability, thus making the gut "less leaky."  This may be one of the reasons fasting has been shown to dramatically benefit patients with rheumatoid arthritis.  When patients return after the fast to a diet with dairy products, the gut becomes more permeable and the arthritis returns.  An unhealthy diet containing dairy and other animal products causes inflammation of the intestinal surfaces and thereby increases the passage of dietary and/or bacterial antigens (foreign proteins).

Some components of the rich American diet are known to impair the function of the immune system.  Vegetable oils (both the omega-3 and the omega-6 variety) are particularly strong suppressors of the immune system.  Low-fat diets have been shown to retard the development of autoimmune diseases, similar to lupus and rheumatoid arthritis, in experimental animals. Those vegan diets that have failed to help arthritis patients have been high in vegetable oils, which are known to damage intestinal integrity.

The importance of the overall diet cannot be overemphasized.  Proper foods such as whole starches, vegetables and fruits, keep the intestinal barriers strong and the immune system in a fighting condition. In addition to being free of animal products, the diet must be low in fat of all kinds - vegetable oil (even olive oil, corn, safflower, and flaxseed oil) and animal fat.  When it comes to blaming individual foods, dairy products seem to be the most troublesome foods, causing the most common and severe reactions.  Many reports indicate grains, such as corn and wheat can also aggravate the symptoms.  The truth seems to be almost any food can cause trouble, but few people react to vegetable foods.

The immune suppressing quality of oils (for example, fish oil and primrose oil) has been used to suppress the pain and inflammation of arthritis, but like too many drug therapies the ultimate outcome may not be best for the patient.  Suppression of the immune system prevents it from doing its work of removing invading foreign proteins. 

One dangerous paradox in arthritis treatment is that the drugs most commonly used to treat arthritis are toxins to the intestinal barrier.  All commonly used nonsteroidal anti-inflammatory drugs (like Advil, Motrin, Naprosyn, etc.), apart from aspirin and nabumetone (Relafen), are associated with increased intestinal permeability in man. While reversible in the short term, it may take months to improve the barrier following prolonged use.

What won't change in either form of arthritis with a change of diet, is the permanent destruction, stiffness and deformity which has already happened through years of disease.

If you suffer from arthritis (either degenerative or inflammatory), try changing your diet for at least two  weeks.  Eat only whole starches (sweet potatoes, brown rice), vegetables (green and yellow) and fruits (except citrus).  Water is your beverage. 

After 2 weeks, you should be feeling much better.  At that point you can add in grains and citrus.  If you start to have symptoms again, eliminate those and add them back in one at a time to see if you can decide which food(s) cause the adverse reaction.

Stop taking any nonsteroidal anti-inflammatory drugs, and if necessary, replace with aspirin or nabumetone (Relafen).

If you try this "anti-arthritis" diet, write a comment and let me know how it worked for you. 

The high sensitivity CRP (hs-CRP) is a test that measures very small amounts of CRP in the blood and is ordered most frequently for seemingly healthy people to assess their potential risk for heart problems.  Inflammation (swelling) is a risk factor for heart disease, heart attack, sudden death, stroke and peripheral arterial disease.  It has also been linked to an increased risk of restenosis, or the re-closing of an artery that has been treated with balloon angioplasty.  CRP seems to be at least as predictive of cardiac risk as cholesterol levels. 

CRP is a protein found in the blood and what we call a "marker" for inflammation, meaning its presence indicates a heightened state of inflammation in the body. Inflammation is a normal response to many physical states including fever, injury and infection. Inflammation plays a role in the initiation and progression of cardiovascular disease.

How Can I Be Tested?

A simple blood test can be done at the same time as a cholesterol screening. The high-sensitivity C-reactive protein (HS-CRP) test, helps determine heart disease risk and is widely available.

This test may be measured any time of the day without fasting.

The American Heart Association recommends HS-CRP as part of routine screening for those who are at intermediate risk for heart disease.

Results

Less 1.0 mg/L = Low Risk for CVD

1.0 – 2.9 mg/L = Intermediate Risk for CVD

Greater than 3.0 mg/L High Risk for CVD

Readings of 50 and above are possible, but we generally attribute a level higher than 10 to inflammation due to other conditions, such as an infection, illness, or a serious flare-up of arthritis, can raise CRP levels.

Therefore, testing should not occur while ill or injured. The HS-CRP should be ordered to evaluate CVD risk in apparently healthy individuals who have not had recent infection or other serious illness. Those who have levels of higher than 10 should be evaluated for other sources of inflammation.

It is well established that systemic inflammatory diseases contribute to the potential for plaque rupture/erosions which create thrombotic events resulting in plaque growth patterns, microvascular thrombus activity that manifests itself with end stage diseases such as vascular dementia and peripheral vascular disease or major symptomatic events such as heart attacks and strokes.

We, Bale/Doneen/Nabors, believe that a strong association of periodontal disease and vascular disease exists with the trend for reduced systemic inflammation and improved endothelial health when effective periodontal therapy is achieved.  We also recommend that the evaluation and treatment of periodontal disease along with appropriate medical care be included in any strategy for the prevention of cardiovascular disease.  Both the medical and dental communities should realize that there are positive health benefits when both fields of medicine work in harmony for the prevention of atherosclerotic vascular disease. In light of the above we, Bale/Doneen/Nabors, believe any healthcare program designed to maintain CV wellness should assess individuals for PD and when present, it should be therapeutically managed as both an oral disease of significance as well as a possible strategy to reduce CV risk.

Other common inflammatory diseases of the arteries include:

• macular degeneration
• hearing loss
• strokes
• heart attacks
• aneurysms
• kidney failure
• bowel infarction
• degenerative disks
• claudication (legs)
• gangrene
• impotence

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You're Not Taking Any Medication - Really?

Yesterday I had cataract surgery and the anesthesiologist was quite surprised that I was not taking any medications.  I asked him why he was so surprised and he answered that nearly everyone he saw was on at least one medication - for high blood pressure or high cholesterol or something else - and many of them were on a number of medications.  

He then asked me if I worked on my health or if I was just lucky.  Since he was putting me to sleep at the time, I don’t think he was really expecting a long answer, so I just said, “Lucky, I guess.”

However, that brief conversation got me to thinking.  Of course, I work on my health.  That’s not to say there is not some luck thrown in to the mix, but I think we can all work on our health and get to the point of not having to rely on the pharmaceutical companies to do that work for us.  It is probably easier to take a pill each morning than to think about “working on our health,” but many of those pills come with side effects and they don’t always translate into “good health.”

According to the web site, Healthy Is A Habit, there are measurable ways to check on our health – and most importantly – there are actually lifestyle changes we can make to get those excellent results in our own lives.

The site lists four markers for excellent health consisting of your BMI, your blood pressure, your total cholesterol, and your triglyceride level.  Since most of us aspire to excellent health, these measurements should be important to us.  In fact, we can actually – with a little bit of “work” reach them.  That “work” mainly involves choices about what we eat and choices we make about exercise.

Check out the site to find out how close you are to “excellent health.”  If you are not there, why not start with a daily walk and a copy of Coco’s Healthy Eating?  Go ahead and get started by beginning to "work" on your health rather than relying totally on “luck.”

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