Balancing a Healthy Balancing a Healthy LifestyleLifestyle

A Series of Educational Seminars for PatientsA Series of Educational Seminars for Patients

presented by the office ofpresented by the office ofAlexander F. Castellanos, M.D., Inc.Alexander F. Castellanos, M.D., Inc.

Tipping the Scales on Tipping the Scales on Vascular DiseaseVascular Disease

April 5, 2005April 5, 2005

Cholesterol - Good, BadCholesterol - Good, BadTriglyceridesTriglyceridesHbA1cHbA1cKidney Function Kidney Function Liver FunctionLiver FunctionVascular FunctionVascular Function

Gender: Men, Women, Mixed?Gender: Men, Women, Mixed?

Exercise: Running, Walking, Aikido, Yoga, PilatesExercise: Running, Walking, Aikido, Yoga, Pilates

Nutrition: Vegetarian, Low Carbs, Nutrition: Vegetarian, Low Carbs, FatFat

>160 Factor>160 FactorStress: Anger, HostilityStress: Anger, HostilityWeight: Low Weight, OverweightWeight: Low Weight, OverweightActivity: Exercise, SedentaryActivity: Exercise, SedentaryBp Bp Nutrition: Protein, Fat, CHONutrition: Protein, Fat, CHODiabetesDiabetes

Hormones: Hormones: EstrogenEstrogenTestosteroneTestosteroneProgesterone Progesterone CortisolCortisolGrowth HormoneGrowth HormoneThyroid - Para ThyroidThyroid - Para ThyroidEpinephrineEpinephrineSerotoninSerotoninDopamineDopamine

The 70,000 miles of Arteries that pump blood

through your body.

Cardiovascular Disease effects the Heart and

… • Smoking • Increasing Age• High Blood Pressure• Elevated Cholesterol• Overweight• Diabetes• Low Physical Activity• Anger/Rage• Ethnic Characteristics• Family History

Risk Factors of Vascular Disease

Vascular Disease Vascular Disease

Vascular DiseaseVascular Disease Arteries open and close in all mammals Arteries open and close in all mammals

including men and womenincluding men and women

Damage or Disease of your Circulatory Damage or Disease of your Circulatory System is called Vascular DiseaseSystem is called Vascular Disease

The Normal ArteryThe Normal Artery

A healthy artery A healthy artery can do its job of can do its job of pushing blood pushing blood through out your through out your body.body.

A normal artery is free A normal artery is free of plaque formationof plaque formation

The artery wall is very The artery wall is very thick and elasticthick and elastic

PlaquePlaquePlaque is the accumulation of fats Plaque is the accumulation of fats

including cholesterolincluding cholesterol

Mild to Moderate plaque formation and Mild to Moderate plaque formation and damage to the walls of the arterydamage to the walls of the artery

Severe plaque formation and damage to the walls of the arteries can cause Heart Attacks,

and Strokes.

PlaquePlaque

Your body is made up of 50 trillion cells. Every second your body produces 25 million new cells.

This cell represents any cell of the body a brain cell, skin cell, liver cell etc. (show cell)

All cells need to be in close proximity to normal circulation or blood flow so they can continue to function properly.

Happy Cells vs. Unhappy CellsHappy Cells vs. Unhappy Cells

““The Happy Cell”The Happy Cell”

““The Unhappy The Unhappy Cell”Cell”

When food is digested the nutrients are first processed by the liver and are then released

into the circulation or blood stream to feed the cells of our

bodies.

When circulation is blocked or partially

blocked the required nutrients can not reach

the cell. We call that cell “The Unhappy Cell”

Happy Cells vs. Unhappy CellsHappy Cells vs. Unhappy Cells

Happy Cells vs. Unhappy CellsHappy Cells vs. Unhappy Cells Unhappy cells in our brain are called: headaches,

anxiety, depression, memory loss, altimhierzs or stroke

Unhappy cells in our chest are called: chest pain, palpitations, arrhythmia, congestive heart failure, angina, heart attack

We can do this with any cell in our body and come back with a cause of poor circulation – even with cancer!

Angiograms Miss Most AtheromasAngiograms Miss Most Atheromas Conventional angiography fails to visualize Conventional angiography fails to visualize

95%-99% of atherosclerotic plaque, Dr. 95%-99% of atherosclerotic plaque, Dr. Steven Nissen said at the annual meeting Steven Nissen said at the annual meeting of the American Association of Clinical of the American Association of Clinical Endocrinologists. Endocrinologists.

Massive atheromas lurking within the Massive atheromas lurking within the vascular wall—outside the view of vascular wall—outside the view of angiography—are the lesions that account angiography—are the lesions that account for the two-thirds of myocardial infarctions for the two-thirds of myocardial infarctions that occur at sites with “hemodynamically that occur at sites with “hemodynamically insignificant stenosis.” insignificant stenosis.”

Angiogram vs. IVUS of ArteryAngiogram vs. IVUS of Artery

““This is a painful lesson This is a painful lesson for my colleagues in for my colleagues in interventional interventional cardiology. They don't cardiology. They don't like [to be told] they're like [to be told] they're looking at the wrong looking at the wrong end point” end point” when they when they give patients with a give patients with a normal angiogram a normal angiogram a clean bill of health, said clean bill of health, said Dr. Nissen, head of Dr. Nissen, head of clinical cardiology at clinical cardiology at the Cleveland Clinic.the Cleveland Clinic.

Factors for Increased Vascular Factors for Increased Vascular DiseaseDisease

EmotionsEmotions FearFear Stress/AnxietyStress/Anxiety AngerAnger

Treatments and Medications that Worsen Treatments and Medications that Worsen CVDCVD

Poor NutritionPoor Nutrition

Sedentary LifestyleSedentary Lifestyle

Increased WeightIncreased Weight

Fat and Vascular DiseaseFat and Vascular DiseaseNew study links fat, inflammation and heart disease - Mar 31 New study links fat, inflammation and heart disease - Mar 31

(HeartCenterOnline). (HeartCenterOnline).

Study of the subcutaneous fat in 20 post-menopausal women who had Study of the subcutaneous fat in 20 post-menopausal women who had risk factors that raise the risk of heart disease. The study was risk factors that raise the risk of heart disease. The study was published in the April issue of the published in the April issue of the American Journal of PhysiologyAmerican Journal of Physiology. . Main Findings: Main Findings:

Fat may directly contribute to inflammation by producing Fat may directly contribute to inflammation by producing inflammatory proteinsinflammatory proteins

Fat acts like a body organ capable of secreting Fat acts like a body organ capable of secreting hormones and proteins hormones and proteins

Fat suppresses anti-inflammatory proteins. Fat suppresses anti-inflammatory proteins.

Women with high levels of abdominal fat have higher levels of Women with high levels of abdominal fat have higher levels of pro-inflammatory proteins and lower levels of anti- pro-inflammatory proteins and lower levels of anti- inflammatory proteinsinflammatory proteins

Hormones and Vascular Disease Hormones and Vascular Disease Women's Health Initiative s "Anti estrogen agenda"Women's Health Initiative s "Anti estrogen agenda" The interpretation of the most recent findings of the WHI is a The interpretation of the most recent findings of the WHI is a

perfect example of this. When the first arm of the WHI study perfect example of this. When the first arm of the WHI study showed a barely significant increase in breast cancer of 8 showed a barely significant increase in breast cancer of 8 cases per 10,000 women, this finding was blasted across the cases per 10,000 women, this finding was blasted across the media.media.

When the second arm showed a decrease in breast cancer of When the second arm showed a decrease in breast cancer of 7 cases per 10,000 women, I did not see one news report, 7 cases per 10,000 women, I did not see one news report, magazine article, or editorial. If any other medication had magazine article, or editorial. If any other medication had been shown to decrease breast cancer by 23%, there would been shown to decrease breast cancer by 23%, there would have been a national education campaign to get the good have been a national education campaign to get the good news out to the public.news out to the public.

The statements by Dr. Stephen Hulley and Dr. Deborah Grady The statements by Dr. Stephen Hulley and Dr. Deborah Grady in their JAMA editorial (291[14]:1769-71, 2004) verge on in their JAMA editorial (291[14]:1769-71, 2004) verge on being hypocritical.being hypocritical.

Larry Kincheloe, M.D., Oklahoma CityLarry Kincheloe, M.D., Oklahoma City

Hormones and Vascular DiseaseHormones and Vascular Disease

Volume 350:482-492 January 29, 2004 Number 5

Risks of Testosterone-Replacement Therapy and Recommendations for

Monitoring

Ernani Luis Rhoden, M.D., and Abraham Morgentaler, M.D.  

Waist Size and DiabetesWaist Size and DiabetesThe circumference of a man’s waist is a better predictor of his risk of developing type 2 diabetes than his body mass index (BMI), which is a weight-to-height ratio, or waist-to-hip ratio alone.  This finding, published in the March 2005 issue of the American Journal of Clinical Nutrition, is based on data collected from 27,270 men tracked over 13 years who participated in the Harvard Health Professionals Follow-Up Study.

Compared to those in the group with the smallest waists ,29-34 inches, the other groups:34.3-35.9 inches – 2 times more likely to develop diabetes36-37.8 inches - 3 times more likely to develop diabetes37.9-39.8 inches - 5 times more likely to develop diabetes40-62 inches - 12 times more likely to develop diabetes

The currently recommended waist circumference cutoff of 40 inches for men may need to be lowered:

“Many of the men who developed type 2 diabetes had measurements lower than the cutoff (40 inches for men),” explains Wang, “and the risk associated with waist circumference increased at a much lower level.”http://www.jhsph.edu/PublicHealthNews/Press_Releases/2005/Wang_waistsize.html

An Effect of Vascular DiseaseAn Effect of Vascular Disease

A Uric Acid Crystal

A Gouty Joint

Johnson, R. J. et. al. N Engl J Med 2004;350:1071-1073

A Disease of Kings or Those who Eat Like One

The Gout, by James Gillray, 1799

Alexander the Great, King Henry VIII, and Poet Laureate Alfred Lord

Tennyson all had gout.

Low-Fat and Very Low-Low-Fat and Very Low-Fat Weight Loss DietsFat Weight Loss Diets

Anti-CHOAnti-CHO

< 20% CHO< 20% CHO

Atkins' DietAtkins' DietProtein PowerProtein Power

CHO Addict’sCHO Addict’sDietDiet

Zone DietZone DietSugar BustersSugar Busters

AHAAHAWeight WatchersWeight Watchers

Jenny CraigJenny CraigDash DietDash Diet

Pritikin DietPritikin Diet Dean OrnishDean Ornish DietDiet

<< 30% CHO 30% CHO<< 30% Fat 30% Fat

40% CHO40% CHO25-35% Fat25-35% Fat55-60% CHO55-60% CHO < 15% Fat< 15% Fat < 10% Fat< 10% Fat

Anti-FatAnti-Fat

Adapted from: Riley RE. Nutr Aspects of Exercise, 1999.Adapted from: Riley RE. Nutr Aspects of Exercise, 1999.

> 30 – 35%> 30 – 35% proteinprotein

>20% & < 30%>20% & < 30%ProteinProtein

Less than 20% ProteinLess than 20% Protein

Proliferation of Diet BooksProliferation of Diet Books Amazon.com search “weight loss” = 1428 Amazon.com search “weight loss” = 1428

matchesmatches

Top 50, best – selling diet books: Top 50, best – selling diet books: 58% were published in 1999 or 200058% were published in 1999 or 2000 88% were published since 199788% were published since 1997

"Studies show that up to 80 percent of coronary heart disease, 90 percent of diabetes and about one third of cancers can be avoided through a change in lifestyle,”

Uton Muchtar Rafei, Regional Director of the World Health Organization

Balance Balance

Control Emotions, Control StressControl Emotions, Control Stress

Exercise – Walk at least 1 hour a day 3-5 days a weekExercise – Walk at least 1 hour a day 3-5 days a week

Eat Healthy – reduce fats and animal proteins, largest Eat Healthy – reduce fats and animal proteins, largest meals should be lunch and breakfast, watch intake meals should be lunch and breakfast, watch intake after 5pm.after 5pm.

Reduce Weight – “Loose the Fat, Loose the Plaque”Reduce Weight – “Loose the Fat, Loose the Plaque”

Waist ManagmentWaist Managment

Quit Smoking Quit Smoking

Get Regular Check-upsGet Regular Check-ups

Know your Numbers – Cholesterol, Blood PressureKnow your Numbers – Cholesterol, Blood Pressure, , HGAICHGAIC

Balance Balance

Cholesterol - Good, BadCholesterol - Good, BadTriglyceridesTriglyceridesHbA1cHbA1cKidney Function Kidney Function Liver FunctionLiver FunctionVascular FunctionVascular Function

Gender: Men, Women, Mixed?Gender: Men, Women, Mixed?

Exercise: Running, Walking, Aikido, Yoga, PilatesExercise: Running, Walking, Aikido, Yoga, Pilates

Nutrition: Vegetarian, Low Carbs, Nutrition: Vegetarian, Low Carbs, FatFat

>160 Factor>160 FactorStress: Anger, HostilityStress: Anger, HostilityWeight: Low Weight, OverweightWeight: Low Weight, OverweightActivity: Exercise, SedentaryActivity: Exercise, SedentaryBp Bp Nutrition: Protein, Fat, CHONutrition: Protein, Fat, CHODiabetesDiabetes

Hormones: Hormones: EstrogenEstrogenTestosteroneTestosteroneProgesterone Progesterone CortisolCortisolGrowth HormoneGrowth HormoneThyroid - Para ThyroidThyroid - Para ThyroidEpinephrineEpinephrineSerotoninSerotoninDopamineDopamine

Balancing the ResearchBalancing the Research Check Folders for More Information Check Folders for More Information