Doctor’s Tip: Atherosclerosis (hardening of the arteries), part 2
Essentially everyone on the S.A.D. (standard American diet) has at least some degree of hardening of the arteries, also known as atherosclerosis or plaque. This is primarily because this diet is high in meat, dairy, eggs, refined food, salt, sugar and vegetable oil —and low in fruit, vegetables and whole grains.
Last week’s column was about the health problems caused by atherosclerosis — from erectile dysfunction to death and disability from heart attacks and strokes. Today’s column discusses how to diagnose, treat and reverse this disease.
Calcified plaque can show up on imaging studies ordered for other reasons — for example plaque seen in abdominal arteries on x-rays ordered to evaluate back pain, or plaque in the carotid arteries of the neck seen on routine dental x-rays. Heart attack prevention doctors believe it’s important to assess their patients’ arteries, and to do this they often order carotid IMTs — ultrasound studies of the carotid arteries that pick up early signs of atherosclerosis. Coronary calcium scores — CAT scans of the heart — can also be used to assess arterial health, although false negatives can occur in women under 50 and men under 40, whose plaque has not yet become calcified. IMTs can be obtained at Glenwood Medical Associates and at Compass Peak Imaging in Glenwood; coronary calcium scores are done at Compass Peak and at most hospitals.
People on a lifelong plant-based, whole (unprocessed) food diet with no salt, sugar or added oil don’t get atherosclerosis. If you aren’t on this diet and already have this disease, Dr. Dean Ornish showed over 25 years ago that a plant-based diet plus regular exercise can reverse it, and Dr. Caldwell Esselstyn proved the same thing more recently. Just eating more fruits, vegetables and whole greens and less meat, dairy, eggs, salt, sugar and oil helps, but not as much as being 100 percent compliant.
Other measures that help stabilize plaque so that it doesn’t cause problems such as heart attacks, and so that more doesn’t form, are the following:
• Don’t smoke.
• Maintain a blood pressure of less than 120/80.
• Maintain ideal body weight, and in particular get rid of your “belly” if you have one. Measure your waist at the point of biggest circumference — approximately at the level of your navel — and if you’re a woman the measurement should be less than 35 inches, and if you’re a man less than 40 inches (cutoff points are less in Asians and East Indians).
• Engage in at least 30 minutes of daily aerobic exercise such as brisk walking (at 4 miles per hour).
• Control your lipids. Guidelines are total cholesterol <200; HDL (good cholesterol) >40 in a male or postmenopausal female and >50 in a premenopausal female; triglycerides <150, LDL (bad cholesterol) <100 or if you’ve had a heart attack <70. However, heart attack-proof levels are: total cholesterol <150; LDL in the 30s or 40s, triglycerides <70.
• Diagnose pre-diabetes early, while it’s still reversible, by a 2-hour glucose tolerance test (normal is 1-hour < 125 and 2-hour < 120). Ideally reverse it thought diet and exercise, although certain medications can be helpful.
• If you have type 2 diabetes, you can reverse it through diet and exercise unless you’ve had it for a long time. If you don’t or can’t reverse it, keep you blood sugars and A1C at goal with medication.
• Diagnose and treat sleep apnea.
• Diagnose and treat inflammation.
• There is a strong mouth-vascular connection, so practice good dental hygiene and see your dentist regularly.
• Get 7-8 hours of good sleep a night.
• Avoid stress — consider mindful meditation.
For people unable or unwilling to get their lipids to goal by diet and exercise, consider a statin drug. Most people tolerate statins well. A few people don’t tolerate them, the most common side effect being muscle aching and weakness. Heart attack prevention doctors know tricks that help people avoid side effects, and there are also medication alternatives to statins.
Dr. Feinsinger, who retired from Glenwood Medical Associates after 42 years as a family physician, has a nonprofit Center For Prevention and Treatment of Disease Through Nutrition. He is available for free consultations about heart attack prevention and other medical issues. Call 970-379-5718 for an appointment. For questions about his columns, email him at firstname.lastname@example.org.
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