I’ve had the privilege of making a positive impact on the health of many patients and employees through my consult practice and employer wellness programs. I share these stories often to educate and motivate patients and physicians.  Unfortunately I’m also haunted by tragic stories where healthy changes came too late or never came at all.  I replay these often in my head, wondering what else I could have done or said to prevent such a fate from falling upon these patients and their families.  I wanted to share one of these with you not to “scare” you into making healthy lifestyle changes, but to provide a sense of reality to an epidemic that often doesn’t seem real until it strikes.  Those who have gone through it are left wondering “what if….”    The story I share below is an excerpt from my book and is a fictitious case with patient name and some details changed, but is based on a story line that is becoming too common of a theme.   Read Ravi’s story and then sign up for a free webinar on Thursday, February 13th, 2014 where I’ll be discussing how you can reduce heart disease risk. (information at the end).

Ravi, a 41-year-old accountant and father of two sons, came to me after sustaining his first heart attack at age 39.  He had a significant family history of early heart disease. (His father passed away at 47 from a fatal heart attack.) Prior to his first heart attack, Ravi was a non-smoking vegetarian with a body mass index of 25, abdominal obesity, and gout (a painful arthritis condition usually localized to pain in the big toe).  After his first heart attack, surgeons inserted stents to open up his clogged arteries. He underwent an intense post-heart attack cardiac rehabilitation program and lost 15 pounds.  He was put on the standard post-heart attack regimen of cholesterol lowering medications and blood thinners.

He saw me for a South Asian consultation two years later, accompanied by his wife. When I asked Ravi about stress, he told me he was dealing with the usual stress of work and raising young, active boys, but felt he had his overall stress levels under control.  His wife disagreed and vented that Ravi was back to being a workaholic.  He kept up with visits to the gym three to four times a week and stuck to his prescribed low-fat diet, but unfortunately he had regained 10 pounds.  His arms and legs looked fairly muscular, but he had the typical protuberant South Asian belly.

One of the main components I recall from that consultation was the sense of tension in the exam room between Ravi and his wife.  It was obvious that even though Ravi was trying to portray a relaxed attitude, he was, like so many of my other South Asian clients (especially men), internalizing a great deal of stress.  The other notable factor was that he was consuming a tremendous amount of carbohydrates in his diet, albeit in the form of whole grains.  His lab work showed normal blood pressure, medication-lowered LDL (“bad”) cholesterol levels at 60 mg/dL, elevated triglycerides at 185 mg/dL, and low HDL (healthy cholesterol) at 32 mg/dL.  His blood sugar was in the prediabetes range.  The only other abnormal lab was an elevated hs-CRP (highly sensitive C-reactive protein), a marker for inflammation.  Together we outlined a detailed lifestyle plan that included a complete overhaul of his diet with a focus on reduced carbohydrates. We also incorporated yoga and mindfulness practices to help manage his stress.  One month later I received a message from Ravi’s wife that he had died from a massive heart attack on a Sunday morning.  He leaves behind his wife, and six- and four-year old sons.

This was a completely preventable tragedy and with the right information in hand, and by implementing healthy changes earlier in his life, Ravi may have been alive today.   To understand how you can reduce your risk, join me for a Heart Disease Risk webinar on Thursday, Feb. 13, 2014, 12 – 1 p.m. Pacific Time.  We’ll talk about how inflammation is the real culprit behind heart disease and how you can accurately interpret your key risk markers like cholesterol and body size.  We’ll also discuss some key lifestyle strategies that have helped patients reverse their risk.  This is similar to the talks I give to companies throughout Silicon Valley and I am happy to finally bring it to the community.  Go here to RSVP and share your questions and concerns during this interactive seminar.  Let’s work together to reduce the epidemic of preventable heart disease.

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