Wednesday, June 3, 2009
The human heart is a complex organ. We'll talk with San Diego cardiologist Dr. Mimi Guarneri about how to balance all the strains on our heart, from diet to stress to the environment.
MAUREEN CAVANAUGH (Host): I'm Maureen Cavanaugh. You're listening to These Days on KPBS. It's not the trendiest disease. There are no telethons or three-day-walks or lapel ribbons for it but the simple fact is, heart disease is still the leading cause of death in the United States. The variety of coronary conditions we call heart disease kills one American every 34 seconds. The medical and pharmaceutical companies – communities, that is, are still working urgently to find better medicines and procedures to improve the health and increase the lifespan of people with heart disease. And there are those physicians who are, in addition to regular therapies, finding new ways to treat heart disease by concentrating on the patient's total health and lifestyle. One such cardiologist is my guest this morning. Dr. Mimi Guarneri, is co-founder and Medical Director of Scripps Center for Integrative Medicine, and author of "The Heart Speaks". Dr. Guarneri's work evaulates the different areas of stress on the heart from diet to the emotions to the environment. And I want to welcome you, Dr. Guarneri, to These Days.
Dr. MIMI GUARNERI (Co-founder and Medial Director, Scripps Center for Integrative Medicine): Thank you so much.
CAVANAUGH: And we want to invite our audience to call up and join the conversation. Have you suffered from heart disease? Do you want to know how stress can affect your heart? Your questions and your comments on how to keep your heart healthy, just give us a call at 1-888-895-5727, that's 1-888-895-KPBS. Well, just a moment ago I talked about the number of different conditions that fall under the term heart disease, to start out would you give us an idea of what some of those conditions are?
GUARNERI: I think we have to think about cardiovascular disease, vascular meaning blood vessels, so the entire blood vessels in your body from your brain to your heart to your kidneys to your legs, because everything we talk about when we talk about prevention relates to all of these blood vessels. And so you can have a stroke, you can have kidney failure, you can have heart attack, you can have lower extremity inability to walk from vascular problems, and all of them have the same root, meaning poor diet, diabetes, high blood pressure, stress, cholesterol and so on. So when we talk about heart disease per se, everybody just thinks, oh, the heart but it's really about the entire blood vessel system of the body.
CAVANAUGH: That's interesting. Is there usually a big distinction made between disease of the arteries as opposed to disease – the malfunction of the heart itself?
GUARNERI: Well, when we're talking about the heart, the heart, of course, has blood vessels, which are the coronary arteries. When we talk about bypass surgery and stenting, we're talking about repairing those arteries. Those arteries are similar to the arteries that supply the kidney, that supply the legs, that supply the brain, so they're subject to the same exact risk as the other areas of the body. You can also talk about the heart muscle. The heart muscle could be weakened from heart attack, from stress, from arrhythmia, so – And we could talk about the valves of the heart, which open and close, let blood flow in proper direction.
CAVANAUGH: Well, tell us, what is the conventional understanding of what causes heart disease or this whole kind of area of coronary illness you're talking about?
GUARNERI: Well, I think if you just want to look at the conventional side, most docs would say diabetes, cigarette smoking, cholesterol and carrying excess amounts of weight and so on. When we look from the perspective of the integrative medicine side like we do at the Scripps Center for Integrative Medicine, we're really looking at the whole person. Yes, I want to know what are your lipids, what's your cholesterol, what's your good cholesterol, your bad cholesterol, do you have inflammation, is your C-reactive protein high, do you have a vitamin deficiency like a vitamin D deficiency. But we also want to know where you are emotionally, mentally, are you depressed, are you anxious, are you stressed, are you hostile, how are you living your life? Because these are all the things – it's our environment that makes us well or ill. So we talk about genes but genes account for only 20%. It's our environment and our lifestyle that count for 70 to 90% of all the chronic disease we see, whether it's heart disease, diabetes, Alzheimer's, even cancer is preventable.
CAVANAUGH: Well, now I gave the statistics that heart disease kills one American every 34 seconds and that heart disease is the leading cause of death in the United States, so what is it about our environment that's killing us?
GUARNERI: Well, let's look at it. Heart disease is a disease of excess: too much. What do we have in the United States? We have too much obesity. The majority of the country is carrying 30 extra pounds of weight. The obesity leads to diabetes. We have an epidemic of diabetes so we have, by 2025, we'll have over 25 million diabetics in the country. Obesity leads to inflammation. Inflammation leads to heart disease, leads to Alzheimer's disease. The obesity leads to high blood pressure. It leads to lipid abnormalities, what we call metabolic syndrome. So we have the problem of obesity leading to inflammation, diabetes and so on. And then we have another problem in this country, which is a little more philosophical: how we live our lives. We're driving everywhere. Most people are not walking. In San Diego, we don't even have sidewalks. In La Jolla, I don't have sidewalks. I have to walk on the street, which is dangerous. So we're not walking, and then we have to look at stress. How are we living our lives? I would love to poll San Diego and say how many people take a 24-hour Sabbath a week where they get away from cell phones, fax machines, Blackberries, computers, and spend time with their family, walk instead of drive, and so on. So it's also how we're living our life, the stress is huge.
CAVANAUGH: I'm speaking with Dr. Mimi Guarneri. She's co-founder and Medical Director of Scripps Center for Integrative Medicine. We're talking about heart disease, and taking your calls at 1-888-895-5727. And let's take a call from John in Hillcrest. Good morning, John, and welcome to These Days.
JOHN (Caller, Hillcrest): Hi, good morning. Good morning, doctor. I'm a 28-year survivor of HIV Aids. And going along with all the medication that I take, they give me high blood pressure and high cholesterol medication. In the last year, I've had some surgery. Now in that relation to your walking, I walk everywhere. In fact, sometimes I use one tank of gas for my car, so I walk everywhere. I'm quite healthy. I'm very slim. And I had some surgery about a year ago. It didn't go right. I've been treated kind of weird by the surgeons, and the second surgery didn't go right so I've been treated weird by the second surgeon. My doctor has put me on an antidepressant and Valium and I find myself kind of like having these kind of like panic attacks and I'm just wondering, no matter how calm I try to keep myself, I go to the doctor and they say you're high – your blood pressure's really high. And I love what you're talking about, the stress, because I usually keep a stress level – I go to the gym, I keep a stress level low through exercise. And now I find myself on antidepressants and I'm wondering what's going on here in the sense of the stress with me because sometimes I can feel my heart just thumping.
CAVANAUGH: John, thank you for that so much. And, doctor, what do you have to say to John?
GUARNERI: So, John, you're making a lot of wonderful observations, and the first thing I want you to say – to remember is that you are more than any diagnosis that anyone gives you, and that you have the power within yourself to make change, just like you're walking every day and exercising every day. When we talk about stress, you have it within yourself to start doing things so that you – Stress is not a disease, stress is not a virus in the air, it's not something in the water, stress is how we respond to situations and our perception of situations. That is something that we can absolutely change. And I would love to invite you to come up to the Integrative Center up at Scripps and take a class where we can teach you how to change your response and your perception, give you tools like breathing tools, mantra repetition, meditation, perhaps, perhaps chanting or prayer, something that fits within your paradigm that you can build into your life every day and practice, practice, practice, just like you exercise every day.
CAVANAUGH: There was a research study at Temple University in Philadelphia that recently found music can reduce stress in heart patients. Does that surprise you?
GUARNERI: Not at all. Music is the use of sound frequency. Frequency can induce relaxation. Makes total sense to me that listening to music can induce a relaxation response, absolutely.
CAVANAUGH: This double whammy that John was talking about, you know, people who have heart disease get all stressed out about having heart disease. And stress, of course, is one of the factors that can cause heart disease to begin with. So the people who come to your clinic, you know, are – really have to learn to try to overcome that in some way. And all these things you're talking about, yoga and so forth, do they work?
GUARNERI: Absolutely. There's no doubt, yoga is medicine. Meditation is medicine. For me, personally, meditation is the difference between having information and transformation. To take 20 minutes a day and to sit and to clear your mind and to breathe and to be in the present moment, these are tools that are not taught to us growing up in the United States. They're more common in other societies, and we need to learn from these societies. Because we talk about stress—oh, my wife stresses me, oh, my husband stresses me, my kids stress me, I hear this all day in my practice. Stress is not a virus. Again, it's how we respond to something, it's our perception. Two people, Maureen, you and I can see the same exact thing and have totally different response to it because it's our perception and that will have an affect on our body. The first thing I teach my patients is to learn to breathe. Five seconds in, five seconds out. Calm down the autonomic nervous system, that's the first thing. People that tend to repeat scenarios in their brain, you know, over and over again, that is stressful or hurtful or harmful for them, and I tell them to pick a mantra, a saying, something, repeat that instead, it doesn't matter which spiritual tradition it comes from. And then start to practice – We have to set up a space in our homes which is what I call our sacred space where, when we go into that space—it could be a two by four area—but we recognize that that’s where we listen to a meditation tape or guided imagery tape or we practice our yoga or we just sit quietly and do our breathing but we have to build that into our lives.
CAVANAUGH: I'm speaking with cardiologist Dr. Mimi Guarneri and taking your calls at 1-888-895-5727. Terry is calling us now and in a car. Good morning, Terry. Welcome to These Days.
TERRY (Caller): Good morning. Dr. Guarneri, I was wondering if you could comment please on severe abdominal aortic calcification, what's the cause and what's the treatment, please?
GUARNERI: A great question. The calcification you have in the abdominal aorta is the same type of calcification you can have in the arteries to the brain, the carotid arteries, or the arteries to the heart, the coronary arteries. So it means that the lining of the blood vessel has had a small ruptured plaque and that plaque has filled in with calcium. If you have any sign of calcium in your blood vessels, whether it's the heart, the aorta, the coronaries, it should just ring one bell for you: What can I do for prevention of cardiovascular disease? And right there, you should be saying, okay, am I exercising every day? Am I carrying extra weight in my midline? Have I had advanced lipid testing done? Have I seen my physician to check my blood pressure? How am I handling my diet? Am I eating a vegetarian or an anti-inflammatory Mediterranean diet? What am I doing for stress and how am I living my life? And so the fact that you have calcium there, consider it a bizarre blessing as a wake-up call for you to do something different to take control of the situation. You can reverse any formation of plaque in your vessels. And that's very different from having an aneurysm, a dilatation of the aorta. That's something that has to be addressed immediately by a physician.
CAVANAUGH: Let's take another call. Ender (sp) is in Mira Mesa, and good morning. Welcome to These Days.
ENDER (Caller, Mira Mesa): Hi, good morning. Great topic. Thanks for bringing it up. Actually, I wanted to share something like, you know, I've been practicing yoga and meditation and a breathing technique from Art of Living. And it's amazing, the immune system, I can see like, you know, I don't fall sick so often. And throughout my life, like and I've been feeling amazing joy through this. So this is a great topic for sharing this, and I wanted to share this breathing technique that I learned from Art of Living, which is just amazing, so…
CAVANAUGH: And what is that breathing technique?
ENDER: It's a rhythmic breathing technique that they teach and it basically brings our natural rhythm that is there in our body, you know, and it brings the defense system, the immune system, it enhances that. It's something called Sudarshan Kriya that they teach.
CAVANAUGH: Well, I thank you for that. Thank you for sharing that, and I – that was sort of, I guess, an advanced version of what you told us, just the breathing in and out.
GUARNERI: Well, I think that's – Thank you so much for the comment and thank you for mentioning the immune system because it's very important to recognize that when we're under stress we produce cortisol and cortisol suppresses our ability to fight cancer and to fight infection, which is why people get sick when they're under stress. And the techniques of breathing such as – whether it's through a Kryia technique, through a Kundalini yoga technique, there are many, many different techniques, Pranayama and so on, these are the kinds of things we teach in yoga and meditation in classes. And, again, as I mentioned earlier, this is medicine. It's powerful medicine.
CAVANAUGH: Is it medicine that prevents heart disease or is it medicine for people with heart disease?
GUARNERI: It's both because if you think about it, Maureen, if you are under stress, that raises your blood pressure, raises your cholesterol, puts weight on your midline, lowers your immune system's ability to fight infection, the list is endless. So if you can interfere with that process, you're going to prevent heart disease and if you've already had an event, you really want to prevent a second event.
CAVANAUGH: Absolutely. I'm speaking with Dr. Mimi Guarneri. She is a cardiologist and Medical Director of Scripps Center for Integrative Medicine. Let's take another call from Linde in San Diego. Good morning, Linde, and welcome to These Days.
LINDE (Caller, San Diego): Good morning. Thanks for having me. My question is, I wanted to ask the doctor if she can give any type of statistics for the number of people that actually – who die of heart disease who have high cholesterol versus those who may die of heart disease who don't have high cholesterol. And I'd just like to know how important that factor is as a risk for heart disease.
GUARNERI: Okay, that's a great question. I want you to remember one thing: Cholesterol is just one piece of the puzzle. An easy way to answer this question is we have about 500,000 women, for example, dying of heart disease annually. If we were to give people cholesterol lowering medicine, we'd decrease morbidity, having an event, and mortality, dying, by only about 28%. So the bottom line is, if it was all about cholesterol, we would have this licked because we have these really powerful medicines, which is a whole other issue to discuss. We have these really powerful medicines to lower cholesterol. So, again, it's a piece of the puzzle. I want to quickly mention that there are different types of cholesterol. HDL, the good cholesterol, you want to have that really high. LDL, the bad cholesterol, has seven different types. You can have very large particles, which are not very bad for you. They're actually okay. They don't get into the lining of the vessels. And you can have very small particles that get into the lining of the vessels and are very aggressive. For women, we want to think about inflammation, checking your high sensitivity C-reactive protein. We want to look at your triglycerides, the type of fat that comes from cookies and cakes and sugar and carbohydrates. And then, of course, we want to look at all the other things like diabetes and blood pressure and so on, so cholesterol is just a piece of the puzzle.
CAVANAUGH: Let's take another call. Kara in North Park. Good morning, Kara, and welcome to These Days.
KARA (Caller, North Park): Hi. My question was relating to these disparity in our country as with regards to wealth and stress and environment and how that plays, in effect, onto heart disease because, actually, I remember about a year ago I was watching a program on stress and I believe they were talking about how it really affected lower income communities greater than the people who probably visit your Scripps Institute.
CAVANAUGH: Well, thank you for that, and also, so many factors dealing with poverty, diet, and access to healthcare and stress, as Kara was pointing out. Is there a difference between people who are well-to-do and people who are poor in rates of heart disease?
GUARNERI: Absolutely. We have to remember and never forget that poverty is a risk factor for illness, that people that live in the United States of America in the lowest socio-economic class, on average, live twenty years less than those people who are in the richest socio-economic classes for many of the reasons you mentioned. For example, the food stamp or WIC program that I grew up with in New York City seeing people use, never paid for anything that was healthy. It paid for things like white bread and perhaps white rice and fruit juice, which is just full of sugar and calories. So even trying to help people, we weren't giving people the right things, access to healthcare. Most people, if you have no healthcare and you have no money, you put off that physical exam, you put off taking care of yourself. So these are very important issues and, of course, if you're struggling to feed your family, to feed and clothe your children, to pay your rent and mortgage, to live where you're living, you can imagine that that's producing an enormous amount of stress. There's no doubt about it, and that's going to affect your physical body. And one of the things I would just like to say is if we can get to a point where we recognize that we have abundance in other ways from a spiritual perspective, but sometimes that helps us to deal with the stress that's around us every day.
CAVANAUGH: You know, Dr. Guaneri, I know that this is – you're not here to be political in any way but you're in the trenches every single day dealing with people who are sick coming to the Scripps Institute for Integrative Medicine and I'm wondering, as you watch what's going on with people debating healthcare reform, how important do you think healthcare reform is for the United States?
GUARNERI: It is absolutely imperative. We have 50 million Americans that have no health insurance, that's number one. We have people who don't even have access to a primary care physician where the ultimate start of prevention is supposed to begin. We need to incentivise this country to focus on prevention. We need to stop dealing with healthcare after people get sick. We need to take a look at the food supply. We need to get kids and people exercising again. We need to have physical fitness in schools. We need to have nutrition courses in schools, and so on. So we have got to shift the paradigm from one of deal with the disease after it occurs to one of let's prevent it in the first place. We have the wherewithal, we have the knowledge, we have everything we need to prevent heart disease, to prevent obesity, to prevent diabetes, high blood pressure. We have this information through diet and exercise and yet – and stress management, and yet we're not putting those tools in the hands of the American people and we need to do that.
CAVANAUGH: I'm wondering, you're talking about a whole holistic, really, approach to treating people with heart disease. I wonder how that, Dr. Guarneri, is accepted these days. I know that there are some people, some doctors, some areas of the medical community, that are still resistant to looking at, as you say, yoga as medicine. How is this changing?
GUARNERI: It's changing every day because I think when you really talk to physicians and you say the word 'holistic,' the first thing, their eyebrow goes up because they're not quite sure what that means. And then when you say holistic means treating the whole person, body, mind, emotions and spirit like we do at the Scripps Integrated Center, looking at the whole person, the life they lead, what they're eating, and so on, most doctors say, yeah, that sounds right. And then when you talk about nutrition and exercise and stress – and dealing with stress, most docs, hands down, say yes, this is important, I see this every day in my practice. And look at the number of pharmaceuticals we're writing, like the gentleman who called in and said, I'm depressed, I'm getting Valium, I'm getting antidepressants. North America uses 47% of all pharmaceuticals made for the world, 47%. And so we're dispensing things like Valium and Xanax and all sorts of antidepressants when we have it within us—I'm not against medicine, there's a time and place for medicine—but we have it within us to say I'm going to do something different. I'm going to put a different program in my life and take charge of my health.
CAVANAUGH: We have time for one more call. Annalise is in San Diego. Good morning, Annalise, and welcome to These Days.
ANNALISE (Caller, San Diego): Good morning, and thank you for taking my call. I actually work in San Diego as a cardiac nurse practitioner and part of what I do is to help patients upon discharge who have suffered from acute MIs, whether it be a steny or a non-steny with some of their rehab and medications. Is there a resource that I could recommend to patients who are somewhat unfunded or who can't afford, let's say, the yoga class at ten or twelve dollars an hour, a community-based program or a good site that would be something I could share with my patients.
CAVANAUGH: Thank you for that.
GUARNERI: Well, one of the places, if your patients have no resources, there's a free clinic that is run by Dr. Ellen Beck over at UCSD that has some options for patients there. The YMCA has very reasonable yoga and tai chi classes. For people that can afford fifteen dollars for a class, they can come right up to us at the Scripps Center for Integrative Medicine and they can take classes with us. And also there's opportunities for some people to even apply for scholarship program, if it's necessary or warranted. For people that have access to cardiac rehab, for example, they can come right up to Scripps Integrative Medicine for their cardiac rehab and that should be, hopefully, covered by insurance since the research shows that people who participate in cardiac rehab have a six-fold less chance of coming back to the hospital with a heart attack or a cardiac event.
CAVANAUGH: I have to ask you because you've been so passionate about this whole topic, as one would imagine, very briefly, are you involved politically in trying to do something for healthcare reform?
GUARNERI: I have spent some time at the Institute of Medicine, which is in Washington, D.C. We held a whole summit there on talking about unhealthy America and what integrative medicine can bring to the table for prevention of the things that we're seeing like diabetes and obesity and really focusing the country back in the prevention direction. I would love to be more involved but that's been my involvement to this point.
CAVANAUGH: I have to thank you so much for all the information and for your passion. Thank you so much, Dr. Guarneri.
GUARNERI: Thank you, Maureen.
CAVANAUGH: I've been speaking with Dr. Mimi Guarneri. She is co-founder and Medical Director of Scripps Center for Integrative Medicine, and author of the book, "The Heart Speaks". You've been listening to These Days on KPBS. Stay with us for hour two, coming up in just a few minutes.