AVOID STROKE

How to Prevent Your Stroke by David Spence, MD

This is the most technical of the heart health books I've read so far. There are diagrams and images of the circulatory system, guides to blood pressure and cholesterol lowering drugs, explanations of how strokes are caused, descriptions of symptoms of stroke and of medical tests and surgery options. And that's just in the first section: "What Your Doctor Can Do". The second section: "What You Can Do", is full of important information for people who may be susceptible to stroke and/or heart attack. Here is a summary of just some of the information in the second section:

Stroke risk factors: age, smoking, high blood pressure, thickening of heart muscle, high blood cholesterol, glucose intolerance (diabetes, pre-diabetes).

What can lead to high blood pressure? High salt intake, obesity, alcohol, decongestants, arthritis pills, stress.

Diabetes can lead to blindness, kidney failure, heart attacks and stroke. Treatment of type 2 diabetes (insulin resistance) includes weight loss and exercise (the exercise helps retrain muscles to respond to lower insulin levels.

Dr. Spence recommends moderate exercise such as half an hour of brisk walking per day (distance: 3 km in 30 minutes). To lose weight, remember that you burn 10 cal/lb just sitting. Since 3500 calories = one pound of fat, to lose one lb per week, you need to reduce your caloric consumption by 500 calories per day.

Blocked arteries (atherosclerosis) cause heart attacks and 75% of strokes. Narrowing of the carotid arteries (carotid stenosis) causes heart attacks. Symptoms of bad arteries: angina, small warning strokes, pain in calf due to walking (pain that is relieved by rest).

If you have bad arteries, you need to reduce your cholesterol intake to 125 mg/day. An egg yolk contains 275 mg.

Reduce: animal fats, butter, cheese, egg yolks, high-fat dairy, trans-fats. Increase: whole grains, fresh fruits, vegetables, soluble fiber, olive oil, canola oil. Margerines should be non-hydrogenated with zero trans-fats. Use the low glycemic index to choose foods -- www.glycemicindex.com

Drug treatments to lower cholesterol include bile acid sequestrants, niacin, fibrate drugs, statin drugs. Psyllium (e.g., Metamucil) is a concentrated form of soluble fiber that binds bile salts and helps eliminate it from the body. When that happens, the liver has to use cholesterol from the blood, thus lowering blood cholesterol levels.

The book describes interactions that are important to understand about the effects of salt and medications on your body. It is essential to reduce your salt intake to 2 or 3 grams per day - avoid canned soups & vegetables, cured meats, pickles.

Homocysteine is thought to increase blood clotting, cause artery constriction and atherosclerosis. A combination of folic acid, B6 and B12 will normalize homocysteine levels.

Grapefruit juice affects certain medicines. It increases blood levels of felodipine*, nifedipine*, nisoldipine, cyclosporine, sleeping pills (midazolan, triazolam), cisapride, warfarin, propafenone, lovastatin, simvastatin. Do not drink any grapefruit juice if you take any of these drugs!

* these drugs also happen to have headache, ankle swelling and fast heartbeat as side effects

The information above is just a sampling from How to Prevent Your Stroke. I highly recommend this book to anyone who could suffer from a stroke or heart attack.

AHA GUIDELINES

The American Heart Association has revised its guidelines for achieving optimal heart health. Here are seven things you can do to reach that goal:

1. Get Moving for Heart Health. Regular physical activity lowers blood pressure, increases HDL ("good") cholesterol levels, keeps blood sugar in check, and helps you control your weight.

2. Eat a Heart-Healthy Diet. A heart-healthy diet includes:
• At least 4½ cups of fresh fruit and vegetables per day
• At least two 3.5-oz servings of fish per week. Ideally, you should choose fish that contain omega-3 fats, like salmon, mackerel, lake trout, sardines, and herring
• At least three 1-oz servings of whole-grain products that are high in fiber (1.1 g or more of fiber per 10 g of carbohydrate)
• Less than 36 oz of sugar-sweetened beverages per week (that's less than three 12-oz cans of soda)
• No more than two servings of processed meats per week
• No more than 1,500 mg of sodium per day if middle-aged or older.

3. Control Cholesterol for Heart Health. A total blood cholesterol level of 200 mg/dL or higher puts you at risk for a heart attack or cardiovascular disease.

4. Manage Your Blood Pressure for Heart Health. High blood pressure (hypertension) is the single most significant risk factor for heart disease. It's not curable, but it is controllable. Ideally, your blood pressure should be below 120/80 mm Hg.

5. Maintain a Healthy BMI for Heart Health. Body mass index (BMI) assesses your body weight relative to your height and indicates your level of body fat. An ideal BMI is lower than 25.

6. Stop Smoking for Heart Health. Smoking by itself increases the risk of coronary heart disease. When it acts with the other factors, it greatly increases your risk from those factors, too.

7. Reduce Blood Glucose for Heart Health. Adults with diabetes are two to four times more likely to have heart disease or a stroke than adults without diabetes. If your fasting blood glucose level falls in the category of "prediabetes" -- a level between 100 mg/dL and 125 mg/dL -- weight loss can help get your blood glucose down.

HEART-HEALTH BOOK

Reverse Heart Disease Now by Stephen Sinatra M.D., James Roberts M.D.

The cardiologists write about heart-related diagnostic tests, risk factors, medication, supplements, anti-inflammatory diet, exercise, stress reduction, and the "new cardiology unclog program". I'm seeing a pattern in heart-health books here ;-)

There is so much fascinating info in this book that if I created a summary here, I'd probably be accused of some kind of copyright infringement. I love to learn "why" certain nutrients are important and how they work. Such details are more convincing to me than reading a list of nutritious foods I should eat. If you enjoy details like that, read Reverse Heart Disease Now.

The doctors explain details about how the cardiovascular system works and why it needs particular proteins, lipids, etc. They mention food sources for nutrients. In particular, they recommend that people use a combination of antioxident supplements -- vitamins C, D, E, bioflavonoids, alpha-lipoic acid, beta-carotene, lycopene, CoQ10, selenium -- to improve their cardiovascular systems. Miscellaneous topics from the many they write about: triglycerides, sticky blood, cell membrane permeability, arterial inflammation, fish oil, magnesium, niacin, L-arginine, glycemic index.

I found lots of ideas here for my own "self health improvement" plan that I can discuss with my doctor. That's an essential review since some of the supplements are powerful and might not be advisable for everyone.

CARBOHYDRATES

The Carbohydrate Addict's Healthy Heart Program by Dr. Richard F. Heller & Dr. Rachael F. Heller

There is no doubt that I'm a carbohydrate addict. I'm on the DASH diet now and I'm very gradually losing weight -- will I keep it off? -- only if I stay on this diet. The DASH diet is not strict with regard to carbohydrates like the CAHHP is.

The purpose of CAHHP is to lower insulin resistance by eating carbohydrates at only one meal per day. Snacks and other meals come from low carbo foods such as lean meat/fowl/fish, dairy and a very limited list of vegetables. No breads, grains, cereals, fruit and juices, legumes, seeds, nut butters, pasta, rice, carrots, peas, or tomatoes except at one meal per day. This diet may suit some people but I believe that if I didn't get some fructose from apples, oranges and bananas throughout the day, I wouldn't be able to maintain the low cholesterol DASH diet.

The doctors share some informative details about foods and how they affect the human body. Most of it is about insulin but since my main concern at the moment is cholesterol, I'll share some cholesterol-related things I learned.

LDL, low-density lipoprotein, is not cholesterol at all. It is a carrier that transports cholesterol between blood and the liver. LDL picks up cholesterol from the liver and carries it in the blood. It is a sign that the liver is in a fat-making mode, producing cholesterol.

The "good" HDL, high-density lipoprotein, transports cholesterol in the blood to the liver. High levels of HDL mean that the liver is in a fat-burning mode.

Consumable fats

Trans fatty acids appear to be the most health-damaging of all fats. They may be listed as hydrogenated or partially hydrogenated fats. I am avoiding them as much as possible. Sources: vegetable shortening, hydrogenated fats, margarine.

Sources high in saturated fats: butterfat, beef fat, lard, milk fat, coconut oil, chicken fat, palm oil, cocoa butter (uh oh!)

Sources high in polyunsaturated fats (a better kind of fat): safflower oil, soybean oil, corn oil, sesame oil, cottonseed oil, omega-3 oils.

Sources of monounsaturated fats (best for heart health): olive oil, canola oil, peanut oil. I have purchased virgin olive oil for making oil & vinegar dressings for my salads.

I should mention that the program is not just about diet. It includes exercise, nutrition supplements, and stress-reducing changes.

HEALTH TIPS #2

High Blood Pressure - What You Need to Know, 1999 (from Johns Hopkins Health) provides some very useful information about blood pressure and cholesterol.
FACTS
Cholesterol comes from (1) our liver (2) foods. The more saturated fats you eat, the more cholesterol the liver produces.
Fruits and vegetables have no cholesterol
In this table, F = fibre, lowers cholesterol ... P = potassium rich

apple	F		banana		P
blueberry			date		P
fig	F		grape
nectarine			orange		P
peach	F	P	pear	F
pineapple			prune	F	P
raisin		P	raspberry	F
asparagus		P	brocolli		P
bean, green		P	bean, kidney		P
bean, lima	F		carrot		P
corn			lettuce
pepper			potato		P
spinach			squash
sweet potato		P	tomato		P
mackerel			salmon
oatmeal	F		spaghetti	F

Cholesterol -- compare amounts in various foods (milligrams per serving):
[ -- not mentioned in book]

bagel	0		butter 2 tsp	21
bran muffin	40		egg	211
cheddar cheese 1 oz	30		milk skim 8 oz	4
cream 1 oz	30		milk whole 8 oz	35
chicken dark 3 oz	--		turkey dark 3 oz	72
chicken light 3 oz	73		turkey light 3 oz	39
round steak (lower in fat than other beef) 3 oz	68		pork loin (lower in fat than other pork) 3 oz	--

Look for calcium in low fat cheese, sardines and yogurt.
Caffeine raises blood pressure temporarily.
Caffeine, milligrams per serving:
Coffee 6 oz ... 100
Cocoa 6 oz ... 5
Dark chocolate 1 oz ... 25
Cola 12 oz ... 50
Tea 6 oz ... 40

HEALTH TIPS #1

The local library, like the Internet, is a treasure trove of information as well as repository of delightful fiction. While browsing the other day, I came across shelves of health books. I picked up one about blood pressure and one about Alzheimer's. It turns out that many tips were the same for reducing blood pressure and avoiding/delaying Alzheimer's. The following are just 10 of the ideas suggested by Jean Carper in 100 Simple Things You Can Do to Prevent Alzheimer's.

• Do aerobic exercise for 30 minutes for 5 times /week or an hour a day for 3 days /week [1] [2]
• Reduce saturated animal fats and trans fats in your diet [3]
• Replace bad fats with good types: omega-3 fish oil, virgin olive oil, canola oil, low-fat or fat-free dairy products [4]
• Use DASH diet - Dietary Approaches to Stop Hypertension [5] [6]
• Eat berries: blueberries, strawberries, raspberries, blackberries or cranberries (1 cup/day) [7]
• Eat apples, drink apple juice every day [8]
• Take a multivitamin/day but try to avoid copper and iron [9]
• Cocoa or dark chocolate is okay! [10]
• Do new types of things [11]
• Reduce the brain toxin proteins called beta-amyloid and tau [12]

[1] Exercise raises levels of protein BDNF (brain-derived neurotropic factor) in the hippocampus. BDNF prevents or reverses cell degeneration.
[2] Exercise also reduces cortisol levels (depression and stress increase cortisol levels) and fights diabetes, high blood pressure, obesity, clogged blood vessels, insulin resistance.
[3] The more saturated fats you consume, the more likely you are to have a stroke and the more likely you are to develop brain and memory dysfunction.
[4] Olive oil is rich in monounsaturated fats, most notably oleic acid. Virgin and extra virgin olive oil refers to the amount of processing the oil goes through; the less processing, the better since these oils have more monounsaturated fatty acids than the more processd oils.
[5] Clinical trials showed that this diet lowers blood pressure AND reduces cognitive decline.
[6] DASH: 7-8 servings of grains, 4-5 of fruits, 4-5 of vegetables, 2-3 of low fat dairy, 2 or fewer of meat {plus 5 servings of nuts, legumes or seeds/week).
[7] Eat other antioxident foods too: golden raisins, artichokes, prunes, currants, plums, dates, cherries, raw figs, red cabbages, tomatoes, etc.
[8] Apples stimulate production of the neurotransmitter acetylcholine which is essential for learning and forming memories.
[9] Look for vitamins that provide antioxidants such as C, E and alpha lipoic acid. Also get B12, folic acid, and B6 every day. Beware -- increased copper is related to lowered cognitive ability. People with excess iron are prone to atherosclerosis and neurodegeneration.
[10] This is my favourite finding - cocoa has antioxidents called flavanols which can reduce blood pressure. Check the percentage of cocoa solids to get an idea of the flavanol content of chocolate milk powder and dark chocolate.
[11] Do things that are a bit difficult. If you are already great at scrabble, try a different game or acivity that requires abilities you haven't used often. Novelty stimulates dendritic growth in nerve cells.
[12] Brains produce beta-amyloid and tau and they can accumulate too much. They directly affect the brain's structure and cause neurons to die. Get enough sleep, control blood sugar, lose weight. DHA fish oil, cinnamon, berries, currants, plums, and grapes can reduce beta-amyloid in animal brains.

For me, the hard part comes next: putting this knowledge into action! Exercise, stop eating fast foods, and eat good things.

Sources:
Jean Carper, 100 Simple Things You can Do to Prevent Alzheimer's, 2010
Johns Hopkins Health, High Blood Pressure - What You Need to Know, 1999