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.
Enjoyed the webinar; however wasn’t able to submit a question during your presentation. Please comment on how the C-RP marker level can be reduced after having a heart attack. Is homosystine level an important indicator of hear attack risk? What are considered normal levels for these two indicators?
Thanks,
Gil Schroeder
Thanks Gil. CRP can be influenced by a number of inflammatory factors. Interestingly abdominal fat is a major trigger for CRP elevation and when my patients improve body composition by losing inches off their waistline, often CRP levels normalize. Removing processed foods, excess carbohydrates and adding lots of nutrient dense plant-based foods and healthy fats can lower CRP as can stress reduction. These are some lifestyle factors that can help. I don’t consider homocysteine an important risk factor for heart attack risk. Optimal hsCRP is less than 1.0.
It’s shocking to hear such stories. I bought the kindle edition of your book and am reading it. Though my blood sugar is normal, I did suspect that I was developing insulin resistance. As I was putting on a lot of weight. Also my BP was fluctuating on and off after my second pregnancy. So I went on the slow carb diet with the addition of healthy fats like butter, coconut oil and ghee since Jan this year. I eat fast digesting carbs (rice, wheat) and sweets only 2 days a week. So far, I have lost 8 kgs. I’ve heard a lot about the eating soaked fenugreek seeds in the morning as it helps reduce insulin resistance, BP and cholesterol. Do you think there is any truth to this? OR is there any adverse side-effects on eating fenugreek seeds for long durations? Also I noticed that my weight loss is higher when I keep eating 1 tsp of soaked fenugreek seeds in the morning.
Soaked fenugreek or what we call “methi” is a common home remedy for numerous ailments. I haven’t found sound scientific evidence that it aids weight loss, but that doesn’t mean it’s ineffective. I consider it safe and if it’s truly working, then I see no reason not to continue. Carbohydrate
tolerance does vary among individuals so for many 1-2 days a week of fast carbs can work as you’ve done, whereas others have to be more restrictive at least initially. Doing it on physically active days and especially after exercise is preferred.
Hello Dr. Sinha:
Brought your book “The South Asian Health Solution” after my doctor at PAMF recommended it. Reading through it a had some quick questions:
1. I could not find my hsCRP in my recent lipid profile or blood tests I did with PAMF? How can I determine that/
2. If a damaged/stressed ECL is the culprit, when it starts inflaming, where does the inflammation start? Since it is a continuous layer along the arteries, does the inflammation happen close to the heart and hence lead to a heart attack?
3. Do you accept new patients or how can I get a consultation appt. from you? I am living in the San Jose, CA Bay area.
Thanks again.
Venki
1. The hsCRP is a separate test that is not part of a standard lipid profile. Not everyone needs to have it done, but I find it useful when I suspect insulin resistance or see other signs of chronic inflammatory disease.
2. In the case of a heart attack, the inflammatory damage is focused on the coronary arteries that supply the heart, for a stroke that would involve the arteries of the brain, etc.
3. Your physician can refer you to me for a consult. You can call 650-330-4523 to schedule a consult with me.