SPORTS PHYSICAL HEART PROBLEMS HIGH BLOOD PRESSURE WHAT SHOULD THE DOCTOR DO

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Some Patients Demand That They Get Passed on Their Sports Physical Even With Untreated Medical Problems

You think it's easy being a doctor? Amazingly doctors have not settled on a sports or exercise physical exam standard. That is, besides an extensive history, what kind of sports physical tests do you run? For example, most doctors do not get an EKG electrocardiogram because many argue an EKG won't detect many heart problems. On the other hand, in Italy many would be athletes get an EKG especially an exercise EKG. Doctors every day are faced with patients (or their parents) who insist, even demand that the child or adult who is getting a physical exam for sports participation or job be passed. In a related story Dr. Secretwave101 lays out the facts of one of the doc's patients.






"I recently saw a patient because he “flunked” his sports physical at school for a resting blood pressure of 164/93. He is entering his senior year of high school, and unless I clear him to play football, he won’t make the team. He plays the starting offensive and defensive tackle positions on the varsity squad. By accounts, the kid is a terror on the field. He has lightning-fast feet, instincts that can’t be taught and immense strength for his age.

Some Studies Say An Exercise EKG is Superior to a Resting EKG It Sounds Logical




"He also has hypertension (high blood pressure) and elevated cholesterol. His BMI is 32 - well past the definition of obese and heading toward morbid obesity. College scouts are taking a serious look at this kid".

You Be The Doc - Football Player with Hypertension

WHICH FOODS HAVE GOOD FATS WHICH HAVE BAD FATS AND FOODS THAT CONTAIN TRANS FATS AND SATURATED FATS THAT ARE BAD FOR THE HEART

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"Among the more healthful fat options are using vegetables oils (some are better than others) and tub margarine in place of butter and switching to nonfat or low-fat dairy products. Avocados, fish, nuts (almonds) and seeds are other good sources of better fats". Among the foods with bad fats are whole-milk dairy products and butter, and french fries, fried chicken and other deep-fat-fried foods, especially those prepared at restaurants and fast-food establishments".



I and the American Heart Association as well as doctors and nutritionists have repeatedly expounded on the importance of watching what kind of fats you eat. You need to be aware of which are good fats and which are bad fats. Why watch the fats you eat? Because some fats, the bad fats such as trans fats and saturated fats increase heart disease and chances of a heart attack while other fats protect your heart. You can't rely on restaurants and food manufacturers to use only good fats in their products (Sorry Dorothy you're not in Kansas anymore)because sometimes visions of profits "cloud" their decision making.

Omega 3 and the Heart



Although some restaurant chains are now making a real effort to get rid of "bad" fats such as trans fats. Trans fats lead to higher bad LDL cholesterol which is associated with increased chances of a heart attack. McDonald's, for example, has made it policy to eliminate trans fats. Trans fats are a kind of fat which though they can occur naturally are more often a problem because they are produced as a result of frying or cooking.



I am amazed to discover when I read food labels on certain cookies that they still contain trans fat even now after all the bad publicity about how trans fats lead to higher bad cholesterol! The Food and Drug Administration allows companies to list zero trans fat on product labels if the food contains less than 0.5 grams of trans fat per serving. If the label lists partially hydrogenated oil, then there's probably some trans fat present".




Sally Squires in her excellent column in the Washington Post writes that "Fewer than half of Americans know that consuming "better" fats can help reduce their risk of heart disease. These better fats include delicious olive oil, rich in what chemists dub mono-unsaturated fat. Soybean oil,a polyunsaturated fat, is also heart-healthy. Both earn the distinction of being "better," because they help lower blood levels of the most dangerous cholesterol, low-density lipoprotein (LDL). The higher LDL rises, the more likely your risk of suffering a heart attack, thus the more apt your doctor is to prescribe a cholesterol-lowering statin drug (in addition to having you make diet and exercise changes)".



"To help clear up the fat confusion, the American Heart Association has just unveiled the Better Fats Sisters, part of a national public health campaign called Face the Fats. The Sisters arrive a year after the Heart Association introduced the Bad Fat Brothers -- Trans and Sat -- to urge cutting down on artery-clogging trans fat and saturated fat. Among the foods with bad fats are whole-milk dairy products and butter, and french fries, fried chicken and other deep-fat-fried foods, especially those prepared at restaurants and fast-food establishments".



"Among the more healthful fat options are using vegetables oils (some are better than others) and tub margarine in place of butter and switching to nonfat or low-fat dairy products. Avocados, fish, nuts (almonds) and seeds are other good sources of better fats". On average, American adults consume approximately 2.2 percent of total calories from trans fat(i.e bad fat) a day at least double the amount advised, according to the AHA. In processed foods, trans fat is now being replaced by coconut, palm and other saturated fats. The shift means that Americans are now sometimes swapping one bad fat for another and eating four to five times as much saturated fat per day as recommended, according to the AHA".

Click for Cholesterol the Good,the Bad and the Ugly

It's Smart to Know The Skinny About Fat

DIET GOOD FOR THE HEART LOW TRANS FAT SATURATED FAT HIGH OMEGA 3 OLIVE OIL LIKE MEDITERRANEAN DIET SEEMS BETTER FOR CORONARY HEART DISEASE

Yet Another Study of the Benefits of Mediterranean Diet for the Heart

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We know that certain types of fats and cholesterol are related to heart problems. Trans fats and saturated fats are discouraged. Trans fats lead to higher LDL, the bad cholesterol associated with coronary artery heart blockage. Doctors have noted that some people have less heart problems and coronary artery disease. People living around the shores of the Mediterranean Sea have in the past been noted to have less than expected amounts of coronary heart disease. Could it be what they eat? The latest study in the Annals of Internal Medicine suggests yes.

Click Here to learn about University of Toronto natural foods diet to lower cholesterol




The Mediterranean diet does not regard all fat as bad. In fact, the focus of the Mediterranean diet is not to limit total fat consumption, but rather to make wise choices about the type of fat in the diet. The Mediterranean diet is low in saturated fat. However, it views two types of fat, omega-3 fatty acids and monounsaturated fats as healthy and places no restrictions on their consumption.






The omega-3 fatty acids are found in fatty fish (e.g, salmon, trout, sardines, tuna) and in some plant sources (e.g, walnuts and other tree nuts, flaxseed, various vegetables). Monounsaturated fat is abundant in olive oil, nuts, and avocados. Eating plenty of fruit, vegetables and fish instead of meat, not to mention olive oil rather than saturated fats.

What can you actually eat to copy the Mediterranean Diet



The study by Dr Panagiota N Mitrou (now of University of Cambridge, UK) and colleagues from the US National Cancer Institute appeared in the December 10/24, 2007 issue of the Archives of Internal Medicine. It confirms that among nearly 400,000 retired Americans, the closer they stuck to a Mediterranean diet, the better the outcome was. They looked at people with various levels of adherence to a Mediterranean diet.



This was just the latest in a line of studies to determine if components of the so called Mediterranean Diet, a dietary pattern based on food patterns typical of many regions in Greece and southern Italy in the early 1960s could account for this observation.

For example, "The Lyon Diet Heart Study enrolled 605 patients who had survived a heart attack. After 4 years, the patients who were eating a Mediterranean diet containing increased levels of both alpha-linolenic acid (an omega-3 fatty acid) and monounsaturated fats (from olive oil and nuts) had a 55% reduction in risk of death and a 50% to 70% decreased risk of recurrent cardiac events, compared with patients who were eating a control diet . The benefits were not explained by changes in lipid parameters."



Understanding the Mediterranean Diet. Again the closer people adhered to the Mediterranean diet, the lower their levels of inflammation, which recent research shows plays a major role in development of heart disease.

Lyon Diet Heart Study

WHAT FOOD IS GOOD FOR MY HEART INCLUDING HEART ASSOCIATION LIFESTYLE RECOMMENDATIONS OLIVE OIL TRANS FATS OMEGA 3

WHAT FOOD IS GOOD FOR MY HEART INCLUDING HEART ASSOCIATION LIFESTYLE RECOMMENDATIONS....Eating and Not Eating Certain Foods Can Impact Your Heart

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Eating certain foods and avoiding others can impact your cardiovascular heart health. Does your doctor discuss with you what foods to eat and foods to avoid for heart health? Several nutrition specialists made recommendations for what to eat to help the heart and prevent cardiovascular (heart) disease.

Eat more omega 3 fatty acids











Studies have suggested that omega 3 fatty acids can help the heart.
For example,the Physician's Health Study found that increased fish intake reduced the risk of sudden cardiac death.

Fish Consumption and Risk of Sudden Cardiac Death. Recall that certain kinds of fish such as tuna and salmon are high in omega 3 fatty acids. For more about the benefits of omega 3 fatty acids

healty medical Blog: Fish Containing Omega 3 Fatty Acids Are on The Recommended List of the American Heart Association

A Video and Statistical Analysis of the Mediterranean Diet

Eat more plant proteins











They recommend to eat more grains,nuts,legumes.

What Are Legumes

Eat vegetables and cut down on saturated fat and trans fats which tend to be found in meat and processed foods.Trans fats are thought to increase cholesterol levels. Trans fat content of food is listed on the food labels.

AMERICAN HEART ASSOCIATION LIFESTYLE DIET RECOMMENDATIONS

UK FOOD STANDARDS AGENCY What we eat can make a big difference to the health of our hearts

What Trans Fat Labels Mean: Read Them and Get Healthy

Eat Less Salt and Sodium. High salt and sodium are related to high blood pressure. The FDA is thinking about how to rein in the massive amounts of sodium that appear in our diets in everything from processed foods to medicines.

Eat more healthy food oils such as olive oil.

FDA Allows Qualified Health Claim to Decrease Risk of Coronary Heart Disease and

Eating for Life: Protecting Your Heart What is the Mediterranean Diet and the Lyon Heart Study and Olive Oil's Heart Effect Located

Eat less trans fats and saturated fats

Increase consumption of whole grains and dietary fiber and decrease refined grains

modify alcohol intake and exercise regularly

Nutritional Assessment and Counseling for Prevention and Treatment of Cardiovascular Disease

WHAT TO DO ABOUT HIGH CHOLESTEROL NATURAL REMEDIES TRANS FATS WHAT ARE THE BAD AND GOOD CHOLESTEROL

Natural Remedies for High Cholesterol

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You hear a lot about cholesterol. Good cholesterol, bad cholesterol, triglycerides and trans fats. In general, bad cholesterol, LDL is associated with an increased chance of heart problems. HDL, "good cholesterol" is associated with less heart problems. Trans fats seem to increase the bad cholesterol, LDL.










The Lipid Profile blood test that you take at the doctor's office provides values including:

Total cholesterol

HDL good cholesterol

LDL bad cholesterol

Triglycerides

Click Here to Read Natural Ways to Lower Cholesterol









In addition other blood tests may give more data about cardiac risk including:

C reactive protein

homocysteine

The Good Cholesterol, Trans Fats and the Bad Cholesterol: HDL and LDL

Pfizer, the drug company, got a nasty shock when they discovered that a new blockbuster drug they were developing to increase HDL good cholesterol had too many bad side effects. So what is the cholesterol?













When people talk about the good cholesterol and the bad cholesterol they are referring to HDL and LDL. HDL and LDL are lipoproteins, structures created from cholesterol and protein that travel to and from the liver carrying cholesterol..Trans fats are fats that worsen bad cholesterol. I've mentioned LDL, that is tagged with the moniker "bad cholesterol" but HDLs are called the good cholesterol because high levels of HDL seem to decrease coronary heart disease risk. Routinely doctors say that the HDL acts to carry away the bad cholesterol from the artery walls, however, there is also evidence that HDLs may interfere with LDL oxidation. Oxidation of LDL refers to a chemical process that happens on the LDL and is believed to be one of the steps in the process that leads to heart attack.

Click here to READ ABOUT PROBLEMS WITH ZETIA AND VYTORIN CHOLESTEROL DRUGS

Risk Factors: More Risk Factors For Heart Disease The More You Want to Lower Your Cholesterol

You will see different numbers listed for desirable levels of cholesterol depending on where you look. What is true is that it is even more desirable to have lower levels of bad cholesterol when you have risk factors for heart disease.



Imagine if you will, a person with high cholesterol. Very high cholesterol. Recommendations for the "bad" LDL cholesterol vary but generally 100 or less is satisfactory. Now imagine a person with an LDL of 500 or 1000. Finally, imagine they are just twelve years old! That's the situation that confronts people who have a genetic problem with cholesterol disposal called Familial Hypercholesterolemia. Their bodies don't have the full mechanism for dealing with cholesterol LDL and as a result they are at very increased risk of heart attacks.



FH is less severe in people with just one gene for it but people with the homozygous (double gene dose)variety of familial hypercholesterolemia can even have a heart attack in the teens or twenties if no treatment is provided. Luckily there are ways of dealing with familial hypercholesterolemia such as medication and a blood "cleansing" procedure called LDL Apharesis. Read the story of a woman who had two angioplasty procedures and a coronary artery bypass They Wash the Cholesterol Out of My Blood.

Trans Fat Acts to Increase Bad Cholesterol: What is Cholesterol and Why The Body Manufactures Cholesterol

Cholesterol is not all bad. The body enlists cholesterol to synthesize important molecules that it needs, molecules like the male and female hormones testosterone and estrogen, not to mention Vitamin D as well as constituents of the body's cell membranes. Cholesterol is also involved with the bile that is released to help digest a meal. Because cholesterol is a lipid, it is soluble in oil but not very soluble in water so it is transported in the relatively watery blood aboard a transport molecule. Cholesterol is manufactured in the liver and travels out of the liver aboard lipoprotein particles called VLDL which are then converted to LDL, short for Low Density Lipoproteins. Our body makes most of our cholesterol but we also get cholesterol from food we eat. Foods high in animal fat and foods that are high in saturated fats, cholesterol and trans fats are likely to raise LDL, the "bad cholesterol". As of January, 2006 food labels are mandated to list trans fats. See What Trans Fat Labels Mean: Read Them and Get Healthy

Meds for Cholesterol: Statins The 500 Pound Gorilla of Cholesterol Meds and Zetia the (Not So) New Kid on the Block

Right now the most "popular" class of cholesterol meds are the statins. There are six statins on the market with the newest contender being Crestor (rosuvastatin). The others include:

Lipitor (atorvastatin)

Mevacor (lovastatin)

pravastatin

fluvastatin

simvistatin






Statins reduce the quantities of LDL Cholesterol. Statins block the manufacture of cholesterol in the liver by interfering with an enzyme that orchestrates cholesterol production,HMGCoa Reductase. That's why statins are called HMGCoa Reductase Inhibitors. Enzymes are chemicals called proteins that act all over the body to speed up chemical reactions. Statins work in the liver. That's why they get a blood test to check liver function when someones starts a statin and why they monitor liver function.A rare but dangerous possible side effect of statins is rhabdomyolysis characterized by muscle pain and weakness. One statin,cervistatin, was removed from the market because of problems with this phenomenon. It's the breakdown of muscle tissue and requires immediate emergency intervention. It may be the result of drug interactions between statins and other medications which result in high concentrations of the drug.

Zetia Ezetimibe: The New (Not So) Kid on the Block

Ezetimibe is a whole different ball game when it comes to lowering cholesterol. Zetia works in the intestine to block cholesterol absorption, not in the liver like statins. So potentially it may have fewer side effects. The downside is that so far it seems to be a mild cholesterol reducer. A combo ezetimibe/statin is Vytorin.

Read PROBLEMS REPORTED WITH ZETIA AND VYTORIN

Niacin

Niacin is a B vitamin. It can lower cholesterol and triglycerides and raise HDL. The trouble with niacin is the side effects. Hot flashes are a big problem for niacin users and sometimes they are so unpleasant that people just won't use niacin.
Niacin can also interact with other drugs and it can raise blood sugar. Always talk with your doctor if you are contemplating using niacin.



Also check out Heart Attack Counterattack: Fighting Back

David Letterman Atherosclerosis and How Unstable Plaque May Lead to Heart Attack

The popular entertainer, David Letterman, who has had coronary artery bypass was apparently aware of high cholesterol levels. See the story Heart Scare for Letterman. High levels of the "bad cholesterol" LDL in the coronary arteries increase the chances of atherosclerosis. Atherosclerosis refers to a process that occurs in the inner lining, the endothelium, of the arteries where complexes of cells and cholesterol called plaques develop within the artery walls. Arteries are the blood vessels that carry the oxygenated blood away from the heart to the body. The heart muscle has it's own arteries, coronary arteries, that feed it a steady flow of oxygen rich blood. Doctors often say that high cholesterol can "clog an artery" but the reality is probably more complex. Cells have receptors on their surfaces that trap LDL in the bloodstream and then internalize them for cellular use. LDL particles are major actors in an intricate process where LDL particles accumulating within the inner walls of the coronary arteries are possibly the linchpin of an intricate dance that can lead to a heart attack. The story of the relationship between cholesterol, atherosclerosis and heart disease has been built over the decades..See Cholesterol A Century of Research

Coca Cola Launches Minute Maid Heart Wise Juice: Foods to Lower Cholesterol: Margarine and Salad Dressing Too!

David A. Jenkins, of the University of Toronto and colleagues tested a vegetarian diet to lower cholesterol. See Diet May Cut Cholesterol As Much As Drugs Do.

Plant sterols are molecules found in plants that resemble cholesterol and compete in the intestine with cholesterol for absorption. They have been demonstrated to lower cholesterol.Coca Cola has Minute Maid Heart Wise Juice containing Cargill Corowise phytosterols.

Cargill Corowise Phytosterols Information A number of other foods having plant sterols are on the market with names like

Benecol and

Take Control. The Australian Medical Journal published

Cholesterol-lowering with plant sterols

See also the

(not so) New USDA Study Shows Plant Sterols Lower Cholesterol and

Sterol-Containing Margarines and Lower Cholesterol Levels

Does Garlic Lower Cholesterol and What Impact Do Oats Have?

It's not hard to figure out how garlic prevents infection. You eat it and nobody will come within 10 feet but what about reports that garlic can lower cholesterol? According to an analysis reported here Garlic and Cholesterol there was a mild cholesterol lowering effect attributed to garlic but apparently it's not very dramatic. Read FDA Allows Whole Oat Foods to make Health Claim On Reducing Risk of Heart Disease

Plaque in Coronary Artery Wall Seems to be Linchpin of Coronary Artery Disease: Inflammation

In the classic explanation of the dangers of high cholesterol, high cholesterol leads to the narrowing of the coronary arteries and a plaque may break off and block or occlude the artery. The result is little or no blood flow to the part of the heart being supplied by that artery and a heart attack. As Dr. Peter Libby points outsometimes a plaque grows so large that it virtually halts the blood flow in an artery and generates a heart attack or stroke. (he means a stroke caused by a blockage, a thrombotic stroke, but there's also another kind called a hemorrhagic stroke which is due to bleeding) Yet only 15% of heart attacks happen in this way. By carefully examining vessel walls of people who died from heart attacks, pathologists have demonstarted that most attacks occur after a plaque's fibrous cap breaks open"
attracting a blood clot that leads to the blockage of the artery.
See the fascinating and instructive article by Dr. Libby Atherosclerosis The New View.



Dr. Libby, a professor at Harvard Medical School, has pointed out that the cholesterol lowering drugs seem to decrease the number of coronary events such as heart attacks even though angiograms don't necessarily show a decrease in the stenosis or narrowing of the artery. See the more technical article Molecular Bases of the Acute Coronary Syndromes

Cholesterol Was Molecule of the Month in 1997

Tired of centerfolds? Check out the vital statistics of this sexy molecule from when

Cholesterol was Molecule of the Month and if you need even more details look at

a more recent exposition of cholesterol from Kimball's Online and

from the Howard Hughes Medical Institute Cholesterol Up Close and

Cholesterol Subclasses.




Risk factors for heart disease include:

cigarette smoking

high blood pressure

family history of heart disease

high cholesterol

overweight

diabetes