1. What is my family history? Did my parents have a diagnosis of heart disease, hypertension, or high cholesterol? Did my grandparents have a cardiovascular diagnosis? What was it? The most common types of heart disease are coronary artery disease, heart failure, electrical dysrhythmias such as A-fib, valve disease and enlargement of the heart. Heart attack remains the #1 cause of death in the world.
2. What kind of workup have I had? Has my doctor done anything other than just cholesterol and an EKG? The older we get the more detailed the workup should be. Arterial imaging is typically done after age 40 but genetics can be done anytime. A typical annual visit with a primary care doctor is not a preventive cardiology visit. Preventive cardiology is proactive. The problem with a lot of heart conditions is that the patient will often have no symptoms until things have gone too far in the wrong direction. Much can be done to prevent this. How? It is typically done through blood work, genetic testing, and imaging. Imaging is important because cardiovascular health is looked at directly – taking out the guess work. Important screening imaging studies include: echocardiogram, coronary artery calcium scoring, coronary CT angiogram and ultrasound of the arteries in the neck. In my line of work we say “Why guess when you can test?”. By doing a personalized risk assessment, a targeted treatment plan can be implemented.
3. Is my blood pressure optimal? Optimal blood pressure is below 120/80. Everyone with hypertension should do a 24-hour ambulatory blood monitor to make sure that blood pressure is going down at night. This is called dipping. Blood pressure should decrease by 10% during sleep. If you are a “non-dipper,” your risk is much greater. Blood pressure is not adequately treated in this country. Normal BP is 120/80 mm Hg but risk for Cardiovascular Disease (CVD) starts at 110/70 mm Hg. Both systolic blood pressure and diastolic blood pressure are a continuum of risk starting at 110/70 mm Hg. There is no threshold of BP > 115/75 mm Hg that identifies cardiovascular risk. The risk is linear and doubles for each 20/10 mm Hg BP rise. Both systolic and diastolic pressure matter but before age 50 the DBP predicts CV risk best. After age 50 the SBP predicts CV risk best. Untreated hypertension can cause kidney disease, atherosclerosis, stroke and heart failure.
4. What is the reality of my diet and exercise habits? Most of us know that a natural foods, unprocessed, mainly plant-based diet that is low in sugar, refined starchs and salt, is the way humans should eat. The question is are you on an optimal diet for your cardiovascular genetics? Vibrant Labs has a test called CARDIAX that can identify what eating patterns are best for you. You should ask yourself if you are getting enough protein, too. Healthy protein sources (plant and animal) can lower blood pressure. Sources should all be organic, pasture raised without any added salt. Adequate protein is typically 1.3 to 2 g/kg depending on age and activity level. You should have an exercise plan for all seasons. You should avoid gaining more than 10 pounds in the “off season.” Getting out of shape in the winter and trying to get back in shape in the summer gets harder as we get older. The exercise plan associated with the biggest risk reduction is 1 hour 6 days a week, which includes a mixture of high intensity, strength, and aerobic training. This is where things should start. Walking is good, too, as it provides other benefits but walking alone is not enough.
5. What is the quality of my sleep and am I managing my stress adequately? Because we live at altitude here in Colorado, sleep apnea is much more common than in other states. Even mild sleep apnea can increase blood pressure, inflammation, and cause weight gain and fatigue. Snoring and daytime fatigue are the typical symptoms of this. Many of us have sleep challenges and do not feel energetic in the morning. To optimize the sleep-wake cycle for health, hormones and longevity, we should follow reasonable sleep hygiene. This includes following the 10/3/2/1/0 rule.
10 – No caffeine 10 hours before you want to be asleep (10pm is the ideal for bedtime)
3 – Have your last large meal about 3 hours before you want to be asleep
2 – Cease all work related activity at least 2 hours before you want to be asleep
1 – Avoid screens and artificial bright lights 1 hour before you want to be asleep
0 – Don’t press the snooze AT ALL in the morning. When you wake up, get up! (approx 6a ideal)
1 – Within 1 hour of waking, get outside in the sun – no sunglasses
*bonus* – within that 1 hour waking window, get a 3-minute cold shower.
Try to go to bed and wake up at the same time every day. Keep sources of bright light to a minimum 1 hour before bed. Consider blue light blocking glasses after dark if working on the screen. The bedroom should be 65 degrees or cooler, dark, quiet and phones should be kept out of the bedroom.
These are the questions, stay tuned for a follow up article by Dr. Steve Parcell. Take the time to really answer these questions and we’ll let you know when “Part Two” is available.
By: Dr. Steve Parcell | NatureMed Integrative Medicine
Stephen W. Parcell, ND earned his doctorate in naturopathic medicine in 2002 from Bastyr University in Seattle. This was a four-year full-time program with clinic rotations and internships. Prior to this he completed pre-med coursework at the University of Vermont. Dr. Parcell holds a Bachelor of Arts degree in Business from New England College, which he received in 1986. In his previous career he worked in bond trading and mutual fund sales.
Dr. Parcell has done additional training at the American College for the Advancement of Medicine (ACAM), the National Lipid Association (NLA), the American Academy of Environmental Medicine (AAEM) and the American Academy for Anti-aging Medicine (A4M). He is the past Vice President of the Colorado Association of Naturopathic Doctors (COAND). He is board certified in anti-aging medicine through A4M. After completing a two-year internship at the Bastyr Center for Natural Health in Seattle, Dr. Parcell completed a two-year internship in integrative medicine with Terry Grossman, MD.
NatureMed is an integrative, naturopathic medical clinic in Boulder, Colorado and the only one of its kind in the area. The clinic has four naturopathic doctors on staff. The naturopathic doctors are all graduates of CNME accredited post-doctorate naturopathic colleges. Dr. Kelly and Steve Parcell completed internships with medical doctors after graduating from Bastyr University where they met. Both Kelly and Steve Parcell have been practicing for over 20 years.