Full Transcript Why Heart Attacks Can Seem Sudden 0:01 So now we're really cutting to the chase about can we really predict a heart attack or a stroke. 0:08 And I was on a radio show last week and the co-host was a woman who was about 50 who exercised and took good care of herself, 0:19 it ate pretty well, and she had a massive heart attack last May. 0:23 Like half of her heart. 0:25 It was really serious. 0:27 And she said, you know, this is what we often hear, like it just came from nowhere. 0:32 I said well Vicki, usually there are some underlying causes, she was like, oh yes, they did finally diagnose what it was, 0:39 I'll tell you about it in just a minute. 0:41 Something that should have been predicted ahead of time. 0:47 So, like I said, this is a silent disease. 0:49 So 90% of people with heart disease don't have any symptoms at all. 0:54 You don�t know it's happening. 0:57 Half of men and more than half of women have death from a heart attack as the very first symptom that anything was wrong. 1:06 They have a heart attack and they die. 1:07 That could have happened to Vicki. 1:09 She got some really excellent care really quickly. 1:12 So here you go from not knowing anything's wrong to you're dead with nothing in between. 1:18 And there should be things in-between. 1:19 Oop, I'm advancing my thing without... 1:24 And the other thing, it's estimated anywhere from 50% to 77% of people who get hospitalized for heart disease have a normal cholesterol. 1:34 So you can see the disconnect between cholesterol and heart diseases and why chasing cholesterol isn't going to tell you whether you're going have heart 1:43 attack or a stroke. 1:46 So I'm getting back to the picture that we had before. 1:49 So how are you going to tell if you're at risk of a heart attack or a stroke? 1:52 The first thing is to study what your arteries look like. 1:56 And your most accessible artery is your carotid artery, which is right in your neck.
Why Cholesterol Alone Misses Risk 2:01 The way it works for medical imaging is the closer the organ is, to probe that's doing the imaging, the clearer a picture you get. 2:10 So here's your carotid artery just, you know, millimeters away from your skin surface, so you'll get a nice picture of what's going on in the carotted artery. 2:20 Before I go on to showing you what the Carotide Artery scan looks like, the easiest test of endothelial dysfunction, and it can only be done by, 2:31 I would say, three people out of everybody, four people including Rob in this room, doesn't cost any money. 2:38 It won't get paid for by your insurance. 2:41 It has no risk and it doesn't require a procedure to be done. 2:48 The easiest test of endothelial dysfunction is what are your erections like? 2:53 Because if your endosthelium's not functioning well, your erections won't be as strong as they once were. 2:59 And so that's a home test, of the endoethelio dysfunction. 3:07 It's significant one, and I don't think doctors pay enough attention to it. 3:10 They'll give you Viagra instead of saying, wow, you might have some cardiovascular disease. 3:15 I mean, yeah, get a nice erection, but in the meantime, go look and see what your arteries look like. 3:23 And this says, can we role play a couple who are too tired to have sex? 3:28 She's saying to him. 3:31 So this is what the carotid intima media thickness looks like when we scan people. 3:37 And this what an ultrasound looks, like it's in black and white. 3:41 This is a longitudinal section through the vessel. 3:47 It doesn't look round because it is not that kind of cross-section. 3:50 If you're cutting it this way. 3:54 And this is the intima. 3:58 And you measure the thickness, that's your endothelium, and you can measure it. 4:03 If there's plaque, you'll see a lump. 4:07 and if it's soft plaque that is vulnerable, likely to rupture, You'll a bigger, softer plaque.
Carotid Scans and Endothelial Dysfunction 4:13 And if you see a bright spot that's calcium deposits, you'll know that that is a plaque that calcified. 4:19 And what did I say about calciified plaque? 4:22 You don't really have to worry about the calceified plaques. 4:25 So we have a direct measurement. 4:27 We don´t have guess around based on family history, cholesterol, whether you have high blood pressure, although that´s an important factor. 4:38 We can look directly at your blood vessel and know if you have a problem. 4:41 So that's the first step, is looking at you blood vessels. 4:46 The next thing is starting to look at things in more detail. 4:50 Say that you do have plaque, say that do you a thickened endothelium, which is the 1st step. 4:57 Then comes the plaque. 4:59 You know, then comes vulnerable plaque Advanced lipid profile, something we call a lipoprotein particle profile is not just looking at your total cholesterol number, 5:12 that's meaningless. 5:13 It's looking your particles. 5:14 And remember I said you want to have beach ball particles, you don't want a little tennis ball particle. 5:21 So this shows you some of the different Particles and this is your LDL cholesterol, your low-density cholesterol which is the one that doctors are always 5:31 worried about on you. 5:33 And you can either have nice big particles or you could have little tiny ones and you want to have the big ones. 5:39 You can predict whether your increased likelihood with that plaque and of rupturing if you have tiny particles. 5:50 So you wanna know your particle size and number. 5:54 Excuse me, but does that come with your regular test? 5:57 You have to ask for a special test, and it's called a particle profile. 6:01 It's not your regularly cholesterol. 6:04 You know, the regular cholesterol, they give you your total, your HDL, you LDL and your triglycerides. 6:10 And I think all of that, frankly, is useless except for the trigliserides Why are the triglyserides valuable? 6:19 They tell you about your carbohydrate intake, your predisposition to diabetes. 6:26 That is what is going to cause you to lay down plaque. 6:29 Blood sugar problems is one of the really big reasons. 6:33 So your triglycerides, if they're high, I'm concerned. 6:37 Not your total cholesterol, that's not so meaningful. 6:42 And if you go on a low carb diet, you will see your triglycyrides come down more than likely, unless you're one of the people with a genetic predisposition. 6:50 Then you've got another set of problems, but that is not most of us. 6:55 Yes?
Advanced Lipid and Inflammation Testing 6:57 What you want to get is a particle profile, or it's also called advanced lipid panel. 7:05 It's called a VAP, V-A-P. 7:07 So there are different names for it. 7:10 I don't know if your doctor is going to know about it or not. 7:12 Some of the doctors in the community are starting to order it for their patients. 7:16 Not that many of them, but a few. 7:20 But you can ask. 7:23 And then the other thing that we look at is a comprehensive inflammatory markers. 7:30 And there are inflammatory that will actually give us an idea if you've got vulnerable plaque. 7:36 The white blood cells, like I explained, that plaque is made up of white cells. 7:41 You can measure some of the components of those inflamed white cell in your blood stream on a blood test. 7:48 So we do a lot of inflammatory marker testing. 7:54 And this is a slide made by Cleveland Heart Lab, which is the lab where we send our inflammatory blood tests and where send are advanced lipid profile testing. 8:07 And what they've done is give you a diagrammatic idea of what happens, right? 8:10 So here's a nice, normal, healthy lining. 8:14 The endothelium's nice and thin. 8:18 Here it's gotten a little inflamed and a litle thickened and it says down here myeloperoxidase and that is a chemical that you can measure that's made 8:27 by these inflames white blood cells. 8:28 So we can measures your myelo peroxides and say, oh you've got some inflammation going on there even if you don't have significant plaque yet. 8:38 And then at each of these stages, there are inflammatory chemicals that can be measured. 8:44 So we get a good idea of, you know, do you have plaque that's really about to blow? 8:49 Do you a plaque there that needs something done about it, or are you okay? 8:54 And finally over here, it shows you acute coronary syndrome. 8:57 That's when somebody's gotten a clot. 8:59 It's ruptured, they've got a clot, and they're blocked off. 9:06 So when we look at the real causes of cardiovascular disease, it's not lack of statin medication. 9:13 That's NOT what's giving you heart attacks and strokes. 9:16 It's inflammation going on, blood sugar problems, and it low hormones. 9:22 These are the REAL causes. 9:24 And so when, we see somebody who has vulnerable plaque in their artery, in the carotid artery we need to really look at blood sugars and Vicki who I mentioned 9:36 who at 50 had a massive heart attack was an undiagnosed type 2 diabetic. 9:42 So if somebody had done her carotic scan they would have seen plaque and they have gone ahead and gotten her fasting blood sugar and if that didn't show 9:49 anything then you need a two hour glucose tolerance test because it doesn't always show on the fasting one and she would've been diagnosed as diabetic 9:57 and her heart would be avoided. 10:01 The other issue, inflammation. 10:03 Where do we get inflammation from? 10:05 Yes, we from inflammatory disorders, like I said, rheumatoid arthritis. 10:09 We get it from periodontal disease. 10:12 Undiagnosed periodontal disease. 10:14 And the scariest thing, which I learned when I took, I went to the very prestigious Bale and Donin preceptorship, Which is mentioned in my bio in here, 10:27 with the cardiovascular preseptorship. 10:30 Learned that people whose carotid arteries, remember I told you it gets 70% narrowed down, they'll rhodorotor it? 10:37 Well they looked at the particles that came off with a rodorotoring, It had bacteria in it, the same bacteria that was in their gums. 10:46 So this bacteria goes from your gungs to your carotid artery to cause inflammation.
Root Causes: Blood Sugar, Inflammation, and Hormones 10:58 and blood sugar problems are the cause of the vast majority of cardiovascular disease. 11:04 And the big push in the last 50 years, and it's gotten us somewhere, is lowering blood pressure to reduce cardiovascular diseases, 11:14 exercise, treating diabetes, But we've probably reached our limit in those things and these other approaches are what need to be taken in order to start 11:29 looking at helping everybody else who hasn't been helped with blood pressure lowering and treating their diabetes, the rest of us. 11:38 So the real solution is in doing the right testing. 11:40 Like I mentioned, the carotid scan has a 97% correlation with plaque. 11:47 We do the inflammatory test to look for, we look at eight different inflammatory markers. 11:54 Blood sugar test. 11:57 The advanced lipid profile or particle profile. 12:01 And hormone testing, this is what will give you a plan for avoiding a heart attack and stroke. 12:10 And then some of the solutions are things a lot lifestyle. 12:16 If you find that you have a blood sugar problem, you need to just about eliminate carbohydrates from your diet. 12:21 Is it easy? 12:22 No. 12:23 As a species, we're hardwired to like carbs. 12:27 They give us energy. 12:28 Our bodies know that and our brains know, but it's not the best thing for your cardiovascular system if you've got a problem. 12:38 There are a number of supplements and I'll tell you about some of the supplements that we have. 12:42 Hormones, like I said, are, in spite of what you've read, they're protective. 12:48 Flossing is really important. 12:50 You want to avoid periodontal disease. 12:53 So I want talk to you a couple of things and they are inside your folders underneath the slideshow. 13:01 I want to tell you a little bit about our heart health program because it really addresses all of the things that I just talked about. 13:09 And then after I go through this, I'll be happy to answer questions. 13:15 So we want identify, treat, and monitor actual disease. 13:19 We don't want a dance in a circle around your cardiovascular disease by treating your cholesterol. 13:24 The first thing we do is our carotid intima media thickness, and it's done with an ultrasound, a portable ultrasound. 13:32 We do it here. 13:33 You can either be sitting up or lying down. 13:35 It takes about five to seven minutes to do. 13:38 Um, we have a really great tech named Linda Carrera, does the scanning and then it gets sent electronically to a lab that has a huge database so they compare 13:51 you to people your age because in this situation in measuring the thickness you do want an age relative to your same age comparison and they issue a report
Heart Health Program and Treatment Options 14:02 card and you either get an A, B, C, D or E based on the sickness of the intima the amount of plaque and whether there's any narrowing. 14:14 And then we decide what to do based on what your inflammation tests show and what you're blood sugar tests shows. 14:23 In my experience, it narrows down to either you may not be diabetic but you've got enough of a blood-sugar problem that's laying down plaque or you have 14:33 periodontal disease that has not been detected and it's festering and causing inflammation in your blood vessel. 14:41 and people who have problems like rheumatoid arthritis really need to work aggressively on lowering inflammation. 14:50 So, and the treatment and aggressiveness of treatment is based on how much plaque is there. 14:56 Is it soft plaque, which we worry about having a volcanic explosion. 15:02 Some people, we use nutritional supplements to regulate things like blood sugar and lower inflammation. 15:09 Other people who have a lot of serious plaque. 15:12 I do use pharmaceutical medications for blood-sugar lowering quickly. 15:19 Nutritional deficiencies, low levels of vitamin D are definitely a risk factor for cardiovascular disease, heart attacks and strokes. 15:30 And the advanced cholesterol testing I mentioned as well, where we measure the type of particles and the likelihood of getting deposited. 15:40 And then we set goals, so it really depends on everything has to be individualized. 15:47 If you find out you have plaque, and we find the underlying cause, You have options for what you want to do. 15:56 Do you wanna take the natural approach? 15:57 Do want medications? 16:00 Huge amount of it is lifestyle, so we do a lot of lifestyle guidance here. 16:04 What are alternatives to eating carbohydrates? 16:09 What does eating paleo mean? 16:11 How do you adjust what your done your whole life to change on behalf of your own health? 16:17 how much exercise is good? 16:18 what kind of exercise? 16:20 All of those things are addressed. 16:23 And we have a program called the Heart Health Quick Start Program that's an evaluation program where you get your carotid scan, 16:30 you've got your inflammatory blood markers, your blood sugar markers and your lipoprotein particle profile. 16:38 and we go over the results and, you know, and then make recommendations. 16:43 Some people continue care here, especially if they have bad plaque. 16:47 They want to stay working with me and doing testing every three months to monitor the progress of their inflammation and blood sugar. 16:56 Other people are, they're doing pretty good and they are just going to continue on their own exercise and dietary program because it's working well.
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