Oatmeal and heart health

A new scientific review of WHOLE GRAIN OATMEAL showed the positive benefits of eating oatmeal on both metabolic and heart health. A serving of oatmeal at breakfast not only lowered cholesterol, but it also reduced appetite and cravings for the rest of the day. The fullness was thought to be due to beta-glucan which increases the thickness of the oatmeal as well as the oats themselves.

I like to recommend mixing low sugar instant oatmeal, like Quaker Oats with a scoop of low sugar protein powder. Just add a little instant hot water (or microwave) and you can have a highly nutritious breakfast in 2 minutes. Please note that this study did not mention breakfast cereals like Cheerios. Also, for those people sensitive to gluten, even though oats are usually OK, because of cross contamination with wheat products in the factory, they may cause digestive symptoms.

Triglycerides, HDL and Heart disease

Lancet 2014;384:626-635

We have known for years that both LDL (bad) and HDL (good) cholesterol are important in the development of heart disease. Statins work best to lower both the total and LDL cholesterol levels and are very important in preventing cardiovascular diseases. For years, we had no idea what role triglycerides played, but recent studies have shown an association between high triglycerides and heart disease. We also thought that the higher the HDL, the less chance one has of getting heart disease. A lot has changed in the way we think about lipids over the past few years. We know that medications taken specifically to reduce triglycerides or elevate HDL has NO cardiovascular benefits! This is why we no longer recommend NIACIN products, or even FISH OIL anymore. Another drug, called FENOFIBRATES have questionable benefits and we only use them when patients cannot tolerate STATINS.

What elevated triglycerides can do is increase the risk of getting pancreatitis, a very painful condition that will land you in the hospital.

According the researchers (and I agree): Lifestyle modification (to lower triglycerides and raise HDL) is the most important therapy and often includes weight loss and reducing alcohol intake.

Remember that NIACIN and FISH OIL can lower triglycerides to help reduce pancreatitis, but there is absolutely NO PROOF that they will reduce heart disease, even when added to a statin.

There are new medications currently being evaluated to lower triglycerides but there are no indications at this time that they will be heart healthy.



New cholesterol drug coming soon?

One of the problems with lipid lowering drugs is that they either don’t work (prescription and OTC) or have side effects (Statins). There is a new class of a cholesterol lowering drug called ALIROCUMAB that is currently being tested in clinical trials. There have been 9 trials where this drug has been tested against placebos and statins and not only did it show lipid lowering capabilities, it also showed lower cardiovascular events! Yes, this will probably be very expensive when it becomes available and yes, your insurance company will probably refuse to pay for it-but at least we now may have an alternative for those people who cannot tolerate statins.

What’s a heart healthy diet?

How to Eat a Heart-Healthy Diet

Reprinted with permission from THE PRESCRIBER’S LETTER

Eating a heart-healthy diet can lower your risk of problems like heart attacks, strokes, and diabetes. Use the following tips as a guide for a heart-healthy diet. Remember not to get discouraged if you indulge in a favorite once in a while.

DO eat:

  • Fruits and veggies
  • Whole grains such as brown rice and oatmeal
  • Low-fat dairy such as cheese, milk, or yogurt
  • Poultry such as chicken and turkey
  • Fish
  • Beans and peas
  • Vegetable oils like canola or olive
  • Nuts

LIMIT your intake of:

  • Sweets like candy, ice cream, or baked goods
  • Sugar-sweetened beverages such as soda, sweet tea, or coffee drinks
  • Red meats such as beef and pork
  • Saturated fats such as that found in processed meats, animal fat, palm oil, coconut oil, etc.

Some heart-healthy diets include DASH, Mediterranean, American Heart Association (AHA), and USDA Choose My Plate. Pick one you can stay with long-term.

Reducing the sodium (salt) you eat can help keep your heart healthy by lowering your blood pressure. In fact, if you have high blood pressure, reducing your salt by about one-half teaspoon per day can drop your blood pressure by about two points.

Aim for no more than about 2400 mg of sodium, or one teaspoon of table salt, per day. A teaspoon of sea salt has a little less sodium, and a teaspoon of kosher salt has about half as much. Surprisingly, most salt in your diet doesn’t come from the shaker. Use these tips to cut back on sodium:

  • Buy fresh, plain frozen, or canned “no salt added” food. Avoid canned or processed food.
  • Use herbs, spices, and salt-free seasoning in cooking and at the table.
  • Cook rice, pasta, and hot cereal without salt. Cut back on instant or flavored mixes.
  • Cut back on frozen dinners, pizza, canned soups or broths, and salad dressings.
  • Rinse canned foods to remove some salt.
  • Choose ready-to-eat breakfast cereals low in sodium.
  • Taste food before reaching for the salt shaker.
  • Keep in mind the amount of food that has about 1000 mg of sodium: a large fast food burger or hot dog, one large slice or two regular slices of pizza, or one can of soup.

There are “apps” for your smartphone that track what you eat. Here are some examples:

More strategies to keep your heart healthy include:

  • Exercising for around 30 minutes most days
  • Stopping smoking
  • Staying at a healthy weight

Making these changes can be tough. Try tackling one at a time for the best success.

New thoughts about daily aspirin

Annals of Oncology

For years we had been asking our patients to take aspirin to help prevent heart disease. But studies then showed that daily aspirin may not be appropriate if the risks of gastrointestinal bleeding outweighed the risks of preventing heart attacks. This study shows that taking aspirin can reduce the risks of some types of cancer. They claim that taking aspirin is the first thing we should do to reduce cancer after quitting smoking and losing weight.

They proposed that if everyone between ages 50-65 started taking aspirin daily for 10 years, that there would be a 9% reduction in cancer, strokes and heart attacks in men (7% in women).

So, maybe it’s time again for all adults to start an aspirin regimen again. Of course this does not apply to anyone who is allergic to aspirin and anyone who has stomach problems should consult their physician first. Also, this study did not look at those people who take both aspirin and Advil/Aleve but we know that combining them will cancel the cardioprotective benefits of aspirin.



Chocolate and cardiovascular disease

J Am Heart Ass 2014


Studies have shown that people who consume chocolates, which contain FLAVANOLS, can improve vascular function and even lower blood pressure. It is thought that flavanols modulate nitric oxide which dilates blood vessels (just like Viagra!) There was a study in Italy which showed that people who ate dark chocolate were able to walk 15% more than they normally did. Milk chocolate had no such benefits. Also, there is much more sugar in milk chocolate which can increase the risk of getting diabetes and becoming obese.

Risks of heart attacks in older patients using testosterone

There has been a lot of controversy over the use of testosterone in older males because of recent studies showing a 25% higher risk of getting heart attacks. What’s interesting is that most studies prior to last year actually showed a decrease in heart disease. Yes, there are side effects to using testosterone-the latest being thrombophlebitis (blood clots in the legs-no know reason at this time) Here is a retrospective study from the University of Texas which looked at 6355 men over 65 who got at least one testosterone injection between 1997 and 2005 and compared them to 19,000 men who have never used any testosterone products. Not only did they not see an increase in heart attacks, but actually saw fewer! The researchers did not study topical testosterone products and there are no testosterone pills available. Research is not a perfect science and many bad outcomes in the past and have been changed.

(Anyone remember how dangerous coffee was and the subsequent cancer scare in the 1980’s? Now it’s considered to be very healthy-especially in women who drink 3-4 cups daily!))

Low testosterone is very common and may have serious adverse effects on quality of life issues. Once again, we always weigh the benefits vs risks, but hopefully this study and more like these will help both physician and patient make better decisions about their medical care.

Coronary artery calcium screening for heart disease

There is a growing discordance between the ability of current risk  tools used to estimate heart disease and actual outcomes.

Recent imaging advances have made it possible to detect subclinical coronary atherosclerosis. The coronary artery calcium score (CACS) is a marker of vascular injury that correlates closely with the overall atherosclerotic burden. Individual data derived from this and other imaging tests may provide useful prognostic information for patient management and can complement current risk prediction models.

Although most insurance companies do not pay for this test, this is an ultrafast CT scan of the heart that only costs $50 and takes minutes to complete. (It wasn’t that long ago that a test like this cost almost $500!)

• In low-risk patients, all modalities were considered “usually not appropriate”, but the panel did comment that CACS may be useful in low-risk patients who have a strong family history of coronary risk.

• In intermediate-risk patients, CACS was determined to be “usually appropriate“, as it can be used to stratify and reclassify patient risk more accurately than traditional methods.

• In high-risk patients, it was determined that more invasive studies like angiograms and stress-and-rest studies using MRI, single-photon emission CT, MPI, and ultrasound “may be appropriate.”

In other words, CACS is most useful for low to intermediate risk patients.


EXTRA EXTRA READ ALL ABOUT IT!! Within 1 year obesity will overtake smoking…..


According to the Canadian Medical Association, in 1 year obesity will lead to more heart disease than smoking cigarettes. These studies factored in smoking, hypertension and cholesterol along with obesity and predict that, even though less Canadians are smoking and blood pressures and cholesterol levels are better controlled, obesity, and its partner in crime diabetes will offset these gains.

Why obesity?

Belly fat is a metabolically active organ in the body. When elevated, it leads to generalized inflammation in the body, which not only increases the risks of cardiovascular disease but also other degenerative diseases like cancer and arthritis. A male’s waistline (measured at the navel) should be less than 40 inches and a female’s: 35 inches.

For more information, you can do a Google search on “metabolic syndrome”

If interested in any of our weight loss and fitness programs under my guidance, call the office at 941-747-2090


Do Testosterone Medications Cause Heart Disease?

In the recent past, the answer was yes, testosterone did reduce the risks of cardiovascular disease. Then, earlier this year, reports in the medical literature showed that not only did testosterone not protect against heart disease, but actually increased its risk by 25%.

According to results presented at a meeting at the American Association of Clinical Endocrinologists in Las Vegas, contrary to recent findings, a new retrospective study of data from 40 specialized clinics around the United States had found that testosterone therapy in men was not associated with an increased risk for myocardial infarction (MI) or stroke and may even be cardioprotective. In one study, 40,000 patients were followed from 2009-2014 and only 7 had heart attacks. In another study, 19,968 hypogonadal men who received testosterone therapy during a 5-year period (2009–2014) at Low T Centers nationwide (www.lowtcenter.com), the risk for MI (heart attack) was 7-fold lower and the risk for stroke 9 times lower compared with samples from the general population. Further, there was no evidence of worsening of preexisting MI or stroke in patients treated with testosterone.

Once again medical studies can be confusing and certainly data and trials can be flawed.

Our recommendation: Only use testosterone supplements if improved quality of life benefits outweigh potential side effects. Please be aware that on a physician can evaluate and treat since testosterone is a controlled medication. Please be aware that many “male enhancement supplements” may contain testosterone illegally.


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