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Doctor’s column: Atherosclerosis and the problems it can cause

Dr. Greg Feinsinger
Dr. Greg Feinsinger
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ABOUT THIS COLUMN

Greg Feinsinger of Carbondale, who retired in February from Glenwood Medical Associates after 41 years as a family physician, today concludes his 10-week series on critical health issues.

Previous installments

Blood pressure

Cholesterol

Exercise

Diabetes and prediabetes

What causes heart attacks

• How to prevent heart attacks

What diet is most healthful?

Why don’t doctors advise going vegan?

• Are coconut and olive oil health foods?

Atherosclerosis is a medical term for “hardening of the arteries.” Our arteries are lined by a delicate organ system called the endothelium, which is 0.5 millimeters thick when we’re born. There are groups of people in the world, primarily those who are on a lifelong plant-based, whole (unprocessed) food, low-fat diet, whose endothelium remains at 0.5 mm thick throughout life. Their arteries remain soft, elastic and pliable as they age, their blood pressure remains low and they don’t get atherosclerosis.

Caldwell Esselstyn, M.D. (featured in the documentary “Forks Over Knives”) calls atherosclerosis a food-borne illness, caused by the Western diet. In large part because of the S.A.D. (Standard American Diet), as we age in the U.S. the endothelial lining starts to thicken and eventually, cholesterol-laden plaque forms, causing our arteries to stiffen and our systolic blood pressure (the upper number) to rise. Other contributors to this process include bad genes, bad habits such as smoking or sedentary lifestyle, and conditions such as high cholesterol. When plaque ruptures, often driven by inflammation, a blood clot forms blocking off the blood supply, resulting in a heart attack or stroke. Other complications can occur just from narrowing of the artery, without rupture.

Following are the most common problems caused by atherosclerosis:

• Erectile dysfunction is the “canary in the coal mine” for atherosclerosis. The penile arteries are thread-like, and if those arteries aren’t working properly, other arteries are probably diseased as well. So if you are a male with E.D., don’t just call requesting a prescription for Viagra, but request a carotid IMT or perhaps a coronary calcium score, looking for evidence of atherosclerosis.

• Heart attacks are the most common cause of death in the U.S., and were discussed in two previous columns. They usually occur where plaque that is not causing a blockage ruptures. Some 20 percent of the time the first symptom is the last: sudden death. Angina is chest pain caused by a partially blocked artery, so part of the heart muscle doesn’t get adequate blood flow when a person exercises.

• Strokes (“brain attacks”) are the third-most common cause of death in the U.S. (No. 2 is cancer). There are a few different kinds of strokes, but the most common kind is ischemic stroke, which is caused by plaque in an artery in the brain that ruptures, blocking off the blood supply to part of the brain. The symptoms can be transient, lasting minutes to a few hours, and this is called a TIA (transient ischemic attack). More often, the damage is permanent, causing paralysis on one side of the body, difficulty speaking or understanding, among other things. Strokes are the main cause of disability in the U.S. And multiple small strokes as we age cause dementia.

• Peripheral vascular disease is hardening of the arteries in the legs, which can lead to pain after walking a short distance, that resolves with rest, blue toes due to lack of circulation, and can lead to surgery to bypass the blocked arteries or even to amputation.

• Intestinal ischemia is “angina of the intestines.” Atherosclerosis can block an intestinal artery, resulting in pain after eating and even gangrene of the bowel.

If you want to avoid atherosclerosis and the complications noted above, the most effective thing you can do is to eat a plant-based, whole (unprocessed) food, low-fat diet, exercise regularly and don’t smoke. If you already have atherosclerosis, the most effective thing you can do is to make these same lifestyle changes. Every one of these conditions, from E.D. to angina, can be reversed this way. For example, the plant-based diet and exercise are 90 percent effective in preventing heart attacks. Some studies indicate 98 percent.

As discussed in the previous column “How To Prevent A Heart Attack,” it’s also important that you keep your blood pressure at goal, find out if you have prediabetes or diabetes and treat it if you do, treat gum and other dental problems and associated inflammation, and make sure your cholesterol is at goal.

If you want to know more about what’s available locally to support you in making lifestyle changes, or if you just want to learn more, contact Ardis Hoffman at 303-305-9664 or ardishoffman@gmail.com, or me at 970-379-5718 or gfeinsinger@comcast.net. Also consider watching the documentary “Forks Over Knives” and reading Dr. Esselstyn’s book “Prevent and Reverse Heart Disease.”

If you are unwilling to make these lifestyle changes, there are medications such as statins, but they are one-third as effective in producing results, cost money and, like all medications, often have side effects.


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