A lot of women don't know that heart disease is the number one killer of women, but it kills more women than all forms of cancer combined. So it's very important just for us to be aware of that. Right. Welcome back to another episode of uplift for her. I'm your host, Doctor Mallorie Cracroft, and today we are digging into the nitty gritty of heart health and what we can really do to prevent a heart attack before it ever happens.
We are meeting with Doctor Tracy Paeschke. She is an integrative cardiologist. She feels so strongly about treating the whole person and not just waiting and treating women after they've had a heart attack, but really going backwards and being able to treat women before they ever get the heart attack to begin with. Which of course, is what all of us want.
We'd really like to prevent the crisis if we don't need to. Doctor Tracy Paeschke is a board certified cardiologist and health coach with over 26 years of experience helping people prevent and reverse heart disease. She has shifted her own practice from traditional treatment models to more of a proactive, preventative and integrative care model. She uses advanced lab testing, wearable technology, cutting edge cardiac imaging, and she is going to tell us about all of that and more.
I know there are so many questions that come up about LDL cholesterol and what tests should I have and what do I do about it? And if you know that you have high blood pressure, or you know that you have high cholesterol, you do not want to miss this conversation. And most people who have a heart attack, they don't have a severe blockage that causes a heart attack.
They have a mild blockage, a soft plaque that became inflamed and unstable and ruptured and caused their acute event like a volcano rupture.
Well, welcome on, Doctor Tracy. Thank you so much for taking the time to be with us. This is such an important conversation, and it's a little bit difficult to find experts like yourself who really have this well-rounded understanding of cardiology. So thank you so much for being here. Thank you. And it's a heart month. Oh that's right, it is.
And we're recording this. That's great. I think this will come out after that. But still we're recording it in the right spirit. So yes that's right. Yeah. Well, wonderful. Well, I want to start by just allowing our listeners to get to know you a little bit. Tell us a little bit about your journey as a cardiologist and, and ending up where you are now, which is as a functional medicine cardiologist, taking this whole person approach to heart health.
Yeah. So I've been a cardiologist for 27 years now, practicing in the usual settings. Right. So you go see the cardiologist when you're having a problem, right. Or you're having a heart attack. So after you do that for a while, taking care of people when they have their heart attacks or their heart failure, they are their arrhythmias. You realize that there's a whole period of time, 20 to 30 years before people have those events where we could have maybe intervened a little better to help them prevent those events from happening in the first place.
And so it's hard to to talk about all the things that we need to talk about to address all those things in the traditional health care setting. Right. So our health care system is really good at reactive medicine, right? Right. Responding when someone comes in with their heart attack, we rush them off to the cath lab and open their artery.
And, you know, they usually just stay in the hospital a day or two, and then they're home and taking smell medicines. And then you see the cardiologist once a year for a checkup, right? Yeah. For maybe 15 or 30 minutes, if you're lucky. That hardly gives us enough time to talk about all the pieces that are important for heart health.
So the diet, the exercise, stress management, sleep, all the stuff. Right. And so I decided to leave the traditional cardiology setting. And I have a practice where I do I don't take insurance in my practice. So it's just it's a very sort of niche practice helping people either avoid their first cardiac event or if they've already had some sort of cardiac event, or they already have high blood pressure.
How do we improve those risk factors and prevent second events? So that's what I do now. Well, I love that. I think it's great you're doing what you're doing. I think in medicine, reactive medicine, it feels good as the doctor for a certain amount of time. I mean, you do get to have someone who is struggling and you get to help them and you get to help them feel better.
But in my experience, the longer you stay in medicine, the more you kind of look backwards and say, yeah, I'm so happy that I was able to help you in this time of distress. But man, I wish you never would have had to get in distress to begin with. And so I think it's really wonderful what you're doing.
It. It takes a really thorough understanding of the whole duration of the disease to really prevent the disease, you know? So so for people like me who don't fully have an expertise in cardiology, we can still do a lot of preventative work. But I think you have this lovely, lovely skill set to really help people. So I'm I'm excited for myself and for our listeners to learn from you today.
We've talked before about heart disease being the number one killer of women and men, I think. And so it's a it's a really big deal. This is a really big deal we're talking about. And not just the killer. But if you start adding in all of the other problems that come from heart disease, high blood pressure, you think strokes, dementia, even milder symptoms, just like not feeling good, heart disease becomes a really big problem.
So what would you say? We'll just kind of start at the beginning and we won't spend too long at the beginning because we've covered this before. But what would you say are the biggest risk factors that, if women already have, should raise kind of flashing lights for them to be aware of in terms of risk factors for heart disease?
Yeah. So and that is an important point because a lot of women don't know that the heart disease is the number one killer of women, but it kills more women than all forms of cancer combined. Yeah. So it's very it's very important just for us to be aware of that. Right. Yeah. Yeah. Again, there are different levels of prevention.
Right. So if someone already has high blood pressure or diabetes, metabolic syndrome, these are risk factors for heart disease. After women go through menopause we tend to gain weight in our belly around the abdomen. And that's called visceral fat. And that fat is more inflammatory and leads to all sorts of problems with insulin resistance and blood sugar regulation.
And that increases our risk of cardiovascular disease. But then again, you know, we want to think about what we call now primordial prevention. So how do we even prevent those things? Right. How do we not get high blood pressure. So even stabbing it back, right. How do we not get any chronic diseases? That's the goal. That sounds great.
Yeah. Right. Not just to not have a heart attack, but how do we prevent diabetes and metabolic syndrome and high blood pressure and obesity and all the things that are risk factors for heart disease? It's interesting, like if you go on the American Heart Association's website, they talk a lot about that. Control your blood pressure and make sure your cholesterol is low and control your diabetes.
But they don't talk a lot about how to not get that stuff in the first place. I try to get people to think about it from the very beginning, because not only is heart disease the number one killer of men and women, but chronic diseases in this country are astronomical. How do we not only increase our lifespan, but our health span right?
How do we stay healthy as we age and avoid chronic diseases like diabetes, high blood pressure, metabolic syndrome, and heart disease? So that's the key. I think. Well, I think that is the key. And I want to hear what you have to say about that. Maybe let's just start with high blood pressure. Because high blood pressure is it's so, so common.
And we see it all the time. And I think it's so common that it's really easy to kind of dismiss it like, oh yeah, my mom has high blood pressure or oh, my sister has high blood pressure and we don't really think of it that much further. I think when we're diagnosed with high blood pressure, sometimes it gives us a moment of pause of like, oh gosh, why is my body doing something wrong?
But what what are the top things you want your patients to know, if that's kind of their main thing? We'll just kind of narrow it down for a minute. If they come in with high blood pressure, what are the main things we can do to get that blood pressure down? We can follow a healthy diet. If you ask ten cardiologists or ten physicians what the best diet is, you'll get ten different answers.
But in general, we know that for cardiovascular disease, a plant based diet is good for the heart, right? So it lowers cardiovascular risk and risk factors. A Dash diet is very good to help lower blood pressure. This has been studied in clinical trials a mediterranean diet. So all those diets have in common lots of fruits and vegetables, whole grains, less processed foods, less packaged foods, less refined sugars.
So a more natural way of eating like maybe we did 100 years ago, right? Yeah. And less sodium in the diet. For instance, the Dash diet has low sodium and higher potassium foods. So we know that that helps lower blood pressure. Some people are salt sensitive. Not everybody, but some people if they eat too much sodium. And again, in our standard American diet, there tends to be a lot of sodium, right?
Especially in canned or processed foods. So you have to check that and be aware of how much sodium you're eating throughout the day. And try to lower that. And we know that blood pressure goes down as your weight goes down. So if you're not at your ideal body weight, losing some weight can lower your blood pressure. Exercise helps lower blood pressure.
Cutting out alcohol helps lower blood pressure, and it's good for your heart and your brain otherwise. And then sleep apnea. You know, often if people have untreated, undiagnosed, untreated sleep apnea that can make their blood pressure go up during sleep and during the day. So that's always something to think about. The other issue is I don't think people know their blood pressure as well as they should.
So I always tell people to know your numbers, just like we know our weight and our height, we need to know our blood pressure, and we need to know our BMI, and we need to know our waist circumference. Because again, that's where we tend to hold that visceral fat. And we need to know our hemoglobin A1, C and our cholesterol.
So all these things we just need to be more aware of I think. So blood pressure should not be something that you get checked once a year at your doctor's office. I mean, these days everybody can buy a pretty good blood pressure cuff at a retail store or Amazon for, you know, 50 to $100, you can buy a good one.
You know, I tell people to check their blood pressure a couple times a week, different times of the day. We want to see what your blood pressure is doing all the time. Because what I hear a lot is, oh, my blood pressure is just high because I'm in the doctor's office. Well, maybe. Or maybe it's high all the time and you don't know because you're not, you know, not.
So I think that's important to. I'm so glad you made that point, because I actually had that thought just this morning as I was driving. I don't know why, but, I was thinking, you know, medicine has changed so much. It used to be, you know, back in the prairie days, it was like the doctor on his horse that would come to see you when you were dying, you know, and that was it.
There was no preventative care. There was no maintenance of care. There was just like, do your best. And now we've evolved so far where people really can be empowered to take care of their own health. There's so much of this information that you can find out for yourself, even to the point of having labs drawn through just direct to consumer lab companies.
I'm not necessarily advocating for that because you want to know what to do with that, but there are certain things that you can know for yourself. And blood pressure is super easy. And I think that most people should make that part of their home first aid kit. Like you should have a blood pressure cuff at home at this point and be able to track that over time.
Because it is right. That's called the silent killer because it it damages our bodies so much. But you don't ever have any symptoms. Most people don't have any symptoms of it. So know your blood pressure and then you can see if it's working too. So if you say like, oh well maybe I do need to cut out alcohol or maybe I got diagnosed with sleep apnea.
Now I'm going to wear my CPAp. Is it working. You want to know that right. So you know if you need to take further steps. Yeah. So if you have a woman who comes into your office and she says, I've been diagnosed with high blood pressure and you go through lifestyle and she's exercising really quite consistently. She's eating well and she's meditating daily.
She's, you know, kind of taking all of those basic steps. You might order a sleep study next. Is there anything else that you're thinking that from a test perspective that you would want to know? If she's kind of checking those boxes otherwise? Yeah, I mean, we we often check electrolytes and kidney function and just make sure there's not something going on there.
But typically, you know, it's just sometimes high blood pressure runs in families. Yeah. Sometimes people just have high blood pressure despite all the things they're doing that are otherwise healthy. Now, it's not a normal part of aging, you know? I mean, I don't want people to think that everybody gets high blood pressure. You live to be 100.
You're going to have high. That's actually not the case, right? Yeah, but a high percentage I forget that it's very high in the United States. I think it's like 80% of people will have high blood pressure by the time they reach 80. Don't quote me on that. But that statistic is high. And again, I think it just has to do with with life, you know, modern life.
Well. And so much of the the strain that our bodies are under due to culture, right, of, of processed foods for our whole lives, like right, you can eat healthy for some period of time in the body will reverse that. How long does it take? I think that right to say, well, so let's move on then. From blood pressure, you were talking about risks of heart disease and one of the risks that I had questions about is cholesterol.
I think that cholesterol has a lot of confusion around it. Now. I think there are definitely, from the conventional medical perspective, I've heard doctors say sometimes, like, we should just put statins in the water so that everyone has a statin on board because the lower cholesterol the better. And I think that's not necessarily the case. And I also think maybe it's just part of the conversation.
I also think that on other sides of the conversation, you have people saying, you know, doing carnivore diets or doing other diets and their LDL skyrockets and they say, oh, it doesn't matter, because my because I don't have any insulin resistance. So as long as my insulin resistance is fine, then it doesn't matter if my LDL is is high.
So tell us, what's the scoop on LDL cholesterol, which we call like our quote unquote bad cholesterol, right. We typically want to see it less than 100 is what we're we're looking for. When we go to the doctor and have our blood tested. But where do we go from there? The short answer, I think, is it's more nuanced than your cholesterol is high here.
Take Lipitor for the rest of your life. You know, for instance, when you get, the standard lipid panel that you get at your normal doctor once a year, maybe, or every few years contains total cholesterol, HDL, LDL, and triglycerides. Right. And that's all we've checked for years. Really. That's the only thing that insurance will pay for prevention and preventive cardiology.
That was your standard lipid panel. Well, we know now that for instance, the the LDL number that you get on that standard lipid panel, it's a calculated value, right? It's a concentration. So it's the way it's not even directly measuring your LDL particles. So we know that if we do measure LDL particles or other cholesterol particles that's called like an NMR usually a lipid profile.
Right. So that's directly measuring the particles because not all LDL is the same. We know that if you have big fluffy LDL particles, those are less likely to cause plaque and small, dense LDL particles. So you can have a high total cholesterol, and even a high LDL on that calculated value. But if they're all big fluffy particles, your risk is not the same as someone who has has more small, dense LDL.
So again, it's more nuanced. We know that apob is a more accurate measurement of the average genic bad cholesterol. In fact, some experts are saying we shouldn't even be checking LDL anymore. We should just check Appleby. There's a particle called LP little A. It's estimated that 1 in 5 people have elevated LP, little AA, LP a little AA is an independent risk factor for cardiovascular disease, meaning your cholesterol, LDL cholesterol can be beautiful, but if you're an LP little A is high, you're still at risk for heart disease, and most people have never even have that one checked.
So it's it's I think cholesterol is important. That's what makes the plaque right. You can't have plaque. Total cholesterol. That's right. Indigenous people in, the Amazon rainforest have LDL cholesterol levels in the 50s, and they don't get cardiovascular disease as kids. Toddlers have LDL of like 20 and 30. So lower is better on that. But the other piece that has been missing, I think is the inflammation piece.
So we know if we take people who've had a heart attack and we get their LDL down below 70, which is what guidelines recommend with a statin if we but if they have an elevated CRP, if they have inflammation in their body that we don't address, they have significant residual risk even with low LDL. So that's the other big piece.
And again, we've known for years that most people who have a heart attack have, quote, normal cholesterol levels. And most people who have a heart attack, they don't have a severe blockage that caused a heart attack. They have a mild blockage, a soft plaque that became inflamed and unstable and ruptured and caused their acute event like a volcano rupturing, to release all that stuff into the bloodstream, which makes the blood clot, which is what causes a sudden heart attack.
That's why that story that everybody's heard of, where somebody had a stress test and they passed their stress test and everything looked great. And then they had a big heart attack the next week. It's because a stress test looks for severe blockage that's impairing blood flow. That causes changes on an EKG or a picture. Well, that's not what caused the heart attack, but the heart attack was caused by that mild plaque that wouldn't be seen on those stress tests.
So that's that's that's the big piece. I think that that we haven't been as good about addressing. Okay. I want to come back to that because yes, that is a big question. Let me see if I summarize this correctly. You correct me if I'm wrong. I think one of the difficulties with preventing heart disease is that it? It's it is multiple pieces to a puzzle that all fit together.
So it's not like you can get any sort of picture from looking at one anything. You can look at insulin resistance alone and say you have increased risk of heart attack, but you really don't know that person until you look and see how much insulin resistance do you have? How is your blood pressure? How many vegetables are you eating in a day?
Right? Like how many plants are you eating in a day? How is your sleep? How is your stress? And then looking at the lab values that LP little you mentioned. So to my understanding, we check it once during life or for women, once before menopause, once after menopause because it can change a little bit. But that's a risk prognosticator that that helps us understand.
If you have a normal LP, little A, then we're going to take the regular steps to make sure you're healthy. If you have a high LP, little AA, then that means you have to make up for that in tightening up all of the other elements so that your risk can go down as far as possible. So that is a really frustrating test because if it's high, it's kind of a bummer to tell patients like, hey, this test just means you're at higher risk and we can't lower that risk, but we can lower all of these other risks like insulin resistance, etc..
So we can start building this picture now, looking at you as an individual and say, what is your baseline risk? Maybe based on family based on LP little A and then start piecing together these these other parts and say overall everything looks as good as it could. Your LDL is nice and low, your HDL is nice and high, your triglycerides are nice and low.
Your LP is nice and low. Your blood pressure is great. Your energy is great. Great. Yeah, you're doing great so far. And if not, then we work to kind of get those down. And for me that just explains why functional medicine. You know, I just think it's really difficult to go to your ten minute annual exam with, you know, for women, most of them are still going to their to their ObGyn for years.
And there's no chance that most OB GYNs are going to have the type of training to have that kind of conversation, much less have the time to sit and really help you understand what your risk is. And I think that's a little bit how we and that's no shade on my profession. Right. Like that's it's not what we were trained to do.
But women aren't really pushed in to do it with anyone else. And I think even family practice doctors, it takes it takes a rare family practice doctor or internist who's if you've never had a heart attack to really sit down and go through these risk factors with you, it really takes some time to understand all of this. So anything you want to say on that part of just that, that baseline understanding?
No, I agree. And that's, you know, that's where the personalized medicine part comes in. Because for instance, when someone comes to see me in my practice, we do the advanced lipid panel. Sure. But we also check the able B and LP and the NMR panel and the inflammatory markers and homocysteine and insulin levels and heat. Right. Because yes, you're building a picture of someone's risk.
And and to build the picture you need all the pieces. Because again, if you're cholesterol looks great but you're LP a little high and you're CRP, the measure of inflammation is high. You're at increased risk. So if you only get the standard lipid panel, it's only just a small piece of the puzzle. Yes. And that's why, you know, we always see people that have a very strong family history of heart disease.
And they say, oh, well, my my doctor said my cholesterol is fine. I don't have anything to worry about. Well, that's just the tip of the iceberg, right? That means you have one less thing to worry about, right? Right. But we want to check everything. So we we know. Because you're right. We have to have the data to be able to give an opinion to someone about, you know, what to do about those risk factors.
Before we move on, you mentioned advanced lipid panel and the advanced lipid panel. Sounds super fancy, but it's actually it's not that far out of reach. It's not when people hear that I think they're like, oh, that sounds expensive. It's not much. What are you checking on that? So of course, the standard lipid panel Apob LP little like LP plaque two.
Right. LP it's like little P, big P, big L, big Ed, little 2 or 2. Two. Yeah. That's right. Milo peroxidase, oxidized LDL, even fibrinogen and ferritin. Those, have to do with inflammation. Right. So all these little markers again you can fill out your spreadsheet and and if all those things are low or maybe just one is high, that's much different than someone who has high several things.
Right. Exactly. And also if you have LDL, your bad cholesterol is like, okay, it's not terrible, not great. Maybe it's one 2130. So to put it in perspective, we want it to be less than 100 and screening less than 70 after heart attack. 190 loosely is kind of when you're thinking statin all all different details there. But that's the general ballpark.
So if your cholesterol is like 120 to 140 and you do this advanced lipid panel and your inflammatory markers are terrible, then that's really helpful information. Because if all you look at is the LDL, then your doctor is going to say, you know, you should diet and exercise, see if you can get that LDL down. And that's going to be the end of the conversation.
Literally the entire sentence is the end of the conversation. But if you know that your LDL is like sort of okay, but you've got all these other inflammatory markers, you know, maybe your LP little is is high and you've got bad insulin resistance and your CRP that inflammatory markers high and your Milo oxidase and your, you know, if you have all these other things that gives you the opportunity to then do something about it to get the inflammation down, to get the cholesterol down, even though it's just okay, you could still be at more risk than what it looks like on the surface.
So I love the full picture. I think that's awesome. The other part of the full picture that I think is important is some sort of imaging to see if you have plaque. Perfect. So let's talk about this because I think people are hearing about this more and more. This idea of coronary calcium score is one of them. And then tell us the other ways that we can really get an idea of all of those other labs, the LDL and the insulin resistance.
That's all just telling us risk, that's telling us what could be going on in the body when we image we we want to get an idea of what actually is already there. So explain to us the coronary calcium score and the other modalities EKG to or echo or, you know, whatever else you use to really identify how is the actual blood vessel and plaque situation.
Right. Because this is the key question. Do you have any plaque? Right, right. So the analogy would be like a mammogram, right. We get a mammogram to see if we have some abnormality in our breast tissue. Well, for cardiovascular screening again insurance doesn't pay for any routine cardiovascular screening beyond the standard lipid panel. So what what we do in the in the traditional health care setting, how it's been is we in the standard lipid panel.
And then we get some risk calculator and we punch your numbers in. Right. Well that's fine except those risk calculators are traditionally not tested on women. So most women that you put in that risk calculator will get a low risk. So we're missing a lot of women at risk. So again doing the more advanced lipids and inflammatory markers will help us find some people.
And then the big thing to find people who are at risk is to see if they have any plaque. So when I started in cardiology 20 some odd years ago, we didn't have really the technology to do this, but now we have several different options. So I think of them in sort of a stair step fashion, and this is how I explain it when I talk to people.
So at the at the bottom to look for plaque, we have a CMT. So a carotid ultrasound. So it's an easy test. You can usually get one for about $200 cash. They pull all jelly on your neck and take a picture of your carotid arteries with an ultrasound. No radiation exposure. It takes about ten minutes. And it looks for plaque or thickness in your carotid artery, which we know is associated with plaque in the heart arteries.
So it's like a surrogate. Now, it's not directly looking at plaque in the heart artery. So that's that's a downside. But if that's the you know, if you want something but you don't really want to go up and radiate an exposure or cause that's a good place to start, the next step up would be a calcium score. So people most people have heard of these.
You can get these in most cities, either at the hospital or some imaging center for around $100 off. And in February and October they have specials because it's heart month. And so they put you on a table and you go under the scanner and it takes a picture of your heart. And then the computer calculates a calcium score.
You don't get an ivy. It's quick. You do get some radiation exposure so it'll give you a score. Normal is zero. There shouldn't be any calcium in your arteries. So normal is zero. And we know that as your score goes up, your risk goes up. So it starts to bump up around 100. And then it really starts to bump up when your score gets around three and 400.
The downside of a calcium score is that it only looks at hard calcified plaque. So for instance, if you're someone who has an elevated LP little late, you are more likely to have soft plaque than hard plaque. So you could have a calcium score of zero and still have lots of black because it's just not picking up your soft plaque.
So the next step up is a ccta. So that's a, CTE of the coronary arteries. So it's like a noninvasive heart cath. Right? I used to do heart cats back in the day where we go up in your groin, or now they go in your wrist and they shoot dye to look for plaque. Well, this is a noninvasive way to look for plaque.
You go under the scanner, they give you an IV with this one. They give you a contrast dye to light up your coronary arteries. And then they take a picture of your heart, and they can reconstruct your heart and make this model. And they can look inside of the arteries for blockage. And, and they can tell a little bit about what kind of plaque it is.
But if you really want to know what kind of plaque it is, you do the ccta and then you send it off to clearly. So clearly is the eye analysis of the plaque. And it's clearly. Yeah. And they give you beautiful pictures of your coronary arteries. So then not only do you know if you have blockage, how what percent.
Blockage it is where it is. And then it breaks it down as to what kind of plaque it is. Hard plaque, soft plaque or inflamed plaque, which is the worst. So that's the greatest thing, right. Because then we take your all those advanced lipids and inflammatory markers and then we take your pictures and then talk about personalized assessment recommendations as to how you how you really, really know where you're at.
So let me back up a little bit. So you talked about hard plaques or soft plaques. And the soft plaques are more concerning because they're more likely to rupture. They're also kind of younger plaques. Is that right? They're less sure. One of the things that statin medications does is it it calcified it it puts kind of a it makes those plaques get a hard coating on them so they're less likely to rupture.
So that's one of the benefits that we see with statins. And that's more what you're talking about for the coronary calcium score what we see is calcified plaque. So you can kind of see where those plaques have already matured. Now no plaque is what we're going for. But if there is any calcified plaque there, that is a sign that you you have some process going on, if you can see with any of the others, is the existing calcified or soft?
Can it tell the difference. No, it's just looking for plaque. Yes. Yeah. Thickness of plaque. So yeah, after we get this view of do you have plaque. Ideally the best version is telling us soft plaque, inflamed plaque, hard plaque. But with any of these now we know. Okay I have some plaque there. Let's start with the easier scenario.
The easier scenario is I don't have any plaque there. I don't see anything. My markers are all okay or not high. The anything you want to say about those people that they don't have plaque yet, but their numbers are not perfect. Well, I still guide them to the pillars of lifestyle medicine. So wholefood plant based diet, regular exercise, restorative sleep, avoiding risky substances, social connection and stress management.
Yeah okay. Because those pillars are good for good health in general. Right. Because if you do all those things, even if you don't have any plaque in your coronary arteries, if you follow the pillars of lifestyle medicine, it's going to help your brain age. Well, your bones and muscles and your balance and decrease risk of certain cancers. So so it's going to help you in other ways as well.
So again, I still make that the foundation for good health. Great. Okay. Now let's take the more complicated scenario, which is you have someone with abnormal markers and then you have imaging that shows plaque. So we can't get rid of plaque that we know of currently to my understanding. Is that correct? A little so soft plaque you can actually regress soft plaque.
Doctor Dean Ornish, the cardiologist, did those original studies back 30 years ago where he did angiograms before and after he put people on a plant based diet, stress management and exercise, and he saw a plaque regression. So we can see some plaque progression, soft plaque. And then, like you mentioned, converting it to hard plaque again because that's a more stable kind of plaque.
Yeah. Let me back up a little bit then. So you have that scenario labs abnormal plaques present. What walk us through kind of your approach in that way. We've spoken about lifestyle. So I think that's obviously going to be the same lifestyle stuff you. But you're going to turn the volume up, right. Like your diet. You really want to narrow in in your movement and your sleep and evaluating for sleep apnea.
Yeah. What else are you going to be doing as part of that evaluation to make sure that this person now at pretty high risk for heart attack can decrease their risk? A couple things I always try to get people to do is some form of wearable. I think wearable data is great because it helps them, you know, again, they've looked at this.
People overestimate how much they're exercising. They underestimate how much they're eating. Right. So, and wearables are great at tracking sleep. So to me, this is one of those falls under the know your numbers things. Right. So some sort of wearable to track things and make sure you're getting things on target as much as you think you are.
I try to get people to do a two week continuous glucose monitor to see how different foods affect their blood sugar. I talk about supplements with people red yeast, rice and a good multivitamin and B vitamins and vitamin D and omega threes. Anti-inflammatory foods. But sometimes people need prescription medicines. Again, though, it's not just the old your cholesterol is high.
Here. Take Lipitor for the rest of your life because a lot of people that's I mean I don't I wouldn't do that as a, as a patient myself, you know. Right. So but if I can show someone there clearly picture that has their artery laid out before them with significant plaque inside there, it really helps you see what's going on.
And then if it's time to talk about prescription lipid lowering drugs, then you can see why I might be recommending that. Because you have this plaque and it's 30% and your lad and it's soft plaque and it's a dangerous kind of plaque. And your LDL is or even more specifically, your Apple B is 120 well, I want your Apple B to be less than 55.
I actually go by European guidelines even more stringent lower the better. And so again, when you're looking at your own personalized data, it's easier for you to make health decisions. So then I talk to you about different lipid lowering prescription therapies stands. Everybody knows about those. There are injectable medications, Pcsk9 inhibitors that get cholesterol really low. There's Bambino like I said, there's area there's some new ones, you know, even coming out targeted directly to LP delay.
So there's a lot of options. And sometimes we know that if we combine medications sort of like sometimes we combine blood pressure medications to get a synergistic effect. If we combine a mid dose statin and zalia, often it works better to get LDL down with less side effects. Right? Because you're not doing high dose statin therapy. So there are a lot of options.
Again, it's hard in the traditional system for your cardiologist. Go over all those options because it takes time and it takes just sort of this back and forth. And so it's a lot easier to say here, take your Lipitor. But there are options. Yeah I want to go down that road just a little bit more I because I'm not a cardiologist, when I have someone who is at high risk for a heart attack, then I, I feel obligated to send them to a cardiologist while we're continuing to work on the lifestyle aspect of things.
And I found some cardiologists have a lot of resistance to really anything other than a statin, you know? So we might say we might do advanced lipid testing and see that they they should respond well to that. Yeah. And, I think one of the frustrations is a lot of these patients will find that now that's not going to work.
You know, that they're kind of just dismissed. And I think that this goes back to what you were saying is the more a patient can know their own numbers, they can say, well, but but this came down like this work. Right? So I think that's really empowering to how many patients don't I don't want patients to think they're in this alone.
And I really dislike it when we as a medical community make it feel like the patients are against the conventional medical system. There are lots of doctors doing really wonderful things, so I don't want people to go in feeling like they're going to have to fight for good care. But at the same time, I want to empower people to know.
The more you know your numbers, the more you can advocate for yourself and say, look, I don't want to take a statin. What else can I do? But going back to what you were saying, with all of the risk stratification is if you already have a ton of plaque there and your numbers are bad, you may not want to skip the statin.
I think sometimes from a patient perspective, we have this feeling kind of like you and I both said, like, I don't want to take that if I don't have to take it. And and so I get that. I think that's where all of us want to be is I want to and we both get patients coming in this way.
Right. Like, I want to heal myself naturally. I want to be as healthy as I can without medications. And I think that's a really good goal. But the bigger goal is to not have a heart attack. The bigger goal is to not die of a heart attack. And so for for people to to recognize where you're at, if you don't have any plaque and your numbers are like, okay, by all means, let's dig in to lifestyle, let's use natural methods to make you as healthy as possible.
And at some point along the evolution of the disease, sometimes we get to use medications to help that process a little bit more. And I think it I want to be clear about that nuance, because I think it can feel, really discouraging to patients if they have to be put on a medication, like they somehow failed or did something wrong.
And the fact is, there's lots of factors that go into this, and we are very lucky to have great medications and really great lifestyle measures, and hopefully risk stratification and starting early enough that we don't develop this disease like we get all of these tools. But I don't want people to feel like failures or like they should reject the medications because medications are inherently bad.
Right? Right. I think, you know, as usual, the answer's probably somewhere in the middle, right? I mean, there are people that don't want to change their lifestyle at all and just want a pill, right? So there's that end of the spectrum. And then people who don't want any prescription medications at all. And I understand really all across the spectrum, anyone who's been a physician for any amount of time has seen seeing all that.
But again, I think if you're working with someone who has time to get to know you, how you feel about these things, what your health goals are, that's where the the beauty comes in, right? Yeah, exactly. And see you in follow up. I think that's the hardest part is if you can say like, can we retest my labs in three months, I'm really going to nail this down.
I'm really going to do it. I think unless you are on the verge of having a heart attack, you know, these images are terrible. Most of the time doctors are going to say, okay, yeah, don't give it a shot. That's right. We'll reach out to see where you're at. So I yeah, but it takes time. It takes time to then do the follow up and do the repeat labs.
So but I think that's a key point though because sometimes when you're in the system someone will see a cardiologist or their primary care, even a nurse practitioner, and they'll make some slight change, but then not recheck things for like a year. Somebody needs to stay on top of that. And and sure, we can start this medication or this supplement or you, you eat a more plant based diet and recheck in a couple months, not 12 months, right?
Yeah. Because time just goes by quickly. Yeah. And the good thing is that insurance is pretty good at paying for the basic cardiology labs. I also think, like the other the functional markers that we do, the advanced lipid ones are by far some of the least expensive, at least for me. I have pretty good pricing, but the LP little A and B, they're not expensive tests.
They're not they're they're quite simple. Yeah. So the other thing you were talking about, direct to consumer labs. Yeah. I think this is great, actually. Yeah. Because I see people all the time who say, I went to my primary care doctor, I heard somebody talking about LP lately, and I asked them to check that, and they said no, I said no, but that's the old gatekeeping, paternalistic physician model, right?
I think back to what you were saying about being empowered about your health. When you go to function health and get that lab panel, or you go to quest and order some labs that you heard about on this podcast. Again, I get calls every week from somebody who had labs drawn on function health and their LP, Little Eyes sky high, and they had no idea.
And maybe their primary care doctor doesn't know what to do with that information, or they they're scared to even tell their primary care doctor because they went outside them to get labs. Right. It's just kind of a weird it's a weird system. I totally agree with you. And being on the doctor side of it, I, I have seen these conversations among doctors who are like, mad that their patients got labs drawn somewhere else and now their labs are abnormal.
And what's funny is a lot of the doctors will say, why did you draw it in the first place? You never would have known it was abnormal if you hadn't run it. And to me, I'm like, well, who cares why they drew it? The good news is, you know, it's wrong. So it's a really funny mentality. And in some I don't again, I don't want to.
There's lots and lots of good doctors out there. But that mentality has never made sense to me of like, what do I do with this abnormal lab finding and the response is, you never should have checked it. Like, well, we did, and it's abnormal. So how do I help this person? So there is unfortunately a lot of weird pushback from doctors.
And I think they're fine. The doctor who's willing to think outside the box and willing to go the extra mile. I think a lot of the reason why a lot of doctors say no is they'll just automatically say, like, insurance not going to cover it. Yeah. And even if a patient says, then I'll pay for it out of pocket.
The doctor doesn't want to be caught up in that loop. They don't want to get complain to when the cost is high and they don't want they don't know necessarily what to do with it. So I mean, the ideal I think, is finding a doctor who can order it and interpret it for you and help you just kind of put the whole situation together for your for you.
But short of that, it does leave patients in kind of a weird spot where they can order the labs, but then who interprets it for them? So more just empathy for anyone listening who's experienced this, because it's kind of annoying. I think it will. Yeah, I think it'll stop. I think more and more there will be doctors who who can kind of do this for you, but it's it's a weird it's a weird zone.
Right now. I'm happy to do what I do, that I can just order the tests and not make patients feel bad about it and. Right. Yeah. Right. Okay. Well, maybe as we're starting to wrap up here, tell us about the the nature of just aging. You know what if what if I already have this disease state? What if I've already had a heart attack versus, you know, I'm 20, I'm getting ready to have a baby, and, you know, just found out my cholesterol was just barely above normal, and I have a little bit of insulin resistance.
What do you have to say about this? That their duration of the disease and kind of how we approach this throughout our lives? Yeah, right. I would say for people to remember that it's never too early and it's never too late to think about our health. Right. And we know there's that, you know, they've studied people who quit smoking when they're 80 and their health improves, even if they stop when they're 80.
Right. And on the flip side, we know that children, especially now, you know, kids are getting type two diabetes that we never used to see in kids. Their blood pressures are high. I mean, there's no telling where that's going to end up. Not good. Obviously, but it's never too early to follow these pillars of lifestyle medicine for good health.
And then as we go through life, you know, things change, right? So we know that women with high blood pressure or gestational diabetes or pre-eclampsia, those increased cardiovascular risk down the road. So just something to be aware of. We know that we age sort of in in two big spurts, right around 44 and around 60. So those are great times to sort of reassess and and look at what we're doing, you know, get your wearable and see how things that you're doing are making a difference, positive or negative and just sort of rethink, rethink your health.
I think it's always good to reassess, sort of like you reassess your financial right. So once a year sit down and then reassess your health. Do I need to what should I work on this year. Right. Yeah. So always be thinking about it. Not not where it's like a draft. Oh I gotta exercise. And, you know, more of an empowering message, right?
It's estimated that 80 to 90% of heart disease is avoidable through lifestyle modification. So that's a huge percentage right. That's a lot that we have under our control. So that's an empowering message right. Not that you're destined to get have a heart attack because your mom did or a heart disease runs in your family or you have diabetes.
Nope. We can improve those things, lower your risk, and you can live to be 100 in good health. Yeah, that's the goal. I love that, and I just want to advocate for health coaching actually. And I think you offer this at your clinic as well, or some sort of coaching program you can tell us about, but just, you know, a lot of people think they can't get started with this until they first see their doctor, right?
They have to they have to first find the functional medicine doctor and get all the tests and all of the things on the internet that say test, don't guess right, like, yeah, but also like find yourself a health coach and focus on those lifestyle pillars. Right? So sleep movement, social connectedness, stress. What am I missing? Gut health. And by avoiding risky sounds.
Yeah, yeah. Like those are not. Those are not medicine. Now, I and you as functional medicine doctors are so happy to help you talk through that. But you don't need a doctor for that. You need just a health coach. You need a well educated health program that can help you get those things in place. Because you know what?
After you have those lab tests, guess what? We're going to tell you to do that. We're still going to say like, go get this health, these health pillars under control. And so I love that idea of setting an alarm in your phone maybe once a year on your birthday or something like that, where you kind of sit down and do a little inventory of how is my sleep, how is my movement, how is my food?
Not from a guilt standpoint, but like, do you know what I could I could increase my vegetables, I could walk a little more. I could, you know, eat a little more protein or eat a little more, eat more plants. So I think giving you just like you just set that opportunity to, to step up your game and know that it will make a difference, like a big difference.
Not I mean, you can still see a functional medicine doctor and we can kind of find these root causes, these other big things that kind of get stuck that we've got to get out of the way. But so much more than that is just the pillars. And just working with someone who can help you get those lifestyles under control.
And having a coach for accountability to to just help you make those, steps because they're hard to do on your own anyway. So tangent, but I'm just a big fan. Yeah, I agree, is there anything, as we're, closing that you'd like to say to just the women listening about cardiology and about heart health and heart disease prevention?
Is there any final message that you either want to reiterate or that we've left out? Again, just awareness that that is the number one killer of women, right. And women tend to make health care decisions and they tend to do the cooking and the purchasing. So buy healthy things, get rid of toxic chemicals when you can. I always tell you about the Ukca app.
Yeah. Use the UK app. Yeah, yeah I love that. Right. Scan everything and make sure things you bring in the house are healthy. You know, they're they found microplastics in carotid plaque. I'm sure you saw that. And brain. So that's a huge problem. So there's a lot in modern life right there. A lot of things kind of push in against us.
But again, if we keep health top of mind and we think about it and we do small things over time, it it adds up to big changes. It can be overwhelming if you think about, oh, I've got to eat better, exercise, blah, blah blah. Don't think about it like that, right? What's one thing I can do this week?
Yep. Right. So just start small. Make small changes leads to big, big changes and then lastly I would say on my website I offer a free health consultation. So like if someone doesn't really know how I can help them, and they just want to run something by me, you can go on my website and schedule that.
I'd be happy to talk to you. Oh that's wonderful. Then that's my next question is, how do people find you? Where where are you located, your website name, etc.? Yeah, that's the best place. Probably my website. It's www.hearthealth.care. Oh, nice. Yep. Yeah. So there are some free resources on there and that link to for the health consultation.
And do you have a wellness program or you have something on there that that kind of gets me started. I have a I call it heart Health Foundations. So again, it's foundations for good health and that's for people only in Colorado or who have no, that's, that's health coaching with me. So anybody can do that. Yeah. That's awesome.
And I'm licensed for medical staff. I'm licensed in seven states so I can help people, in various ways. So I just tell people to reach out to me and, and we can figure out how I can help them. And are you thinking, you see people who have been diagnosed with high cholesterol or high blood pressure, or who have had a heart attack or anywhere along the way?
Yep. Anywhere along the way from people who maybe have a family history, or they just want to get a test and I can help them navigate that to people who've had a heart attack when they were 50 and don't want another one. Yeah, yeah, yeah. Well, thank you for so much for being here. You are a vast resource of information.
So we are really grateful for this. This is really helpful. Thank you for having me.
