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Tips for 2006
Dr. Vagnini's Health and Longevity Tips for 2006

1. Review your family history. Very frequently when I have patients in the office, usually a mother and daughter, father and son, or children with grandparents; and if I am seeing one of them with a heart problem, diabetes or weight, I'll say to the child or grandchild 'Someday you will be moving over into that chair.' Science has confirmed the fact that heart disease, diabetes, obesity, cancer, and many other degenerative diseases are genetic in origin. What is particularly significant is a family history of premature cardiac disease and how it might impact an individual as young as 50 with a heart attack or stroke. This is an extremely serious risk factor, and persons with a family history must be aggressively treated. I had a patient many years ago with a family history of cerebral aneurysm who requested an MRI. Indeed, she had diagnosed the problem herself, and it turned out that she had not one but three brain aneurysms. Fortunately, they were successfully managed. So, my first tip is to carefully review your family history, especially when it comes to cardiovascular degenerative diseases. Yes, the reverse can also be true. I have people coming in and saying, 'My grandmother and everyone in my family lived till 90.' But, be warned, you can ruin the genes by an unhealthy lifestyle. Smoking, poor diet, high cholesterol, and lack of exercise can take good genetics and cause premature degenerative disease problems. On the other hand, for those individuals with a bad family history intensive medical management, especially in the diet and exercise area, can reverse poor genetics.
   
2. Lifestyle changes. In recent years, more and more information is being reported in the orthodox medical journals about lifestyle. A lifestyle simply means diet, exercise, and nutrient management. These three elements are potent interventions for not only the management of heart disease, but for cancer and all degenerative diseases. With respect to lifestyle management, it is an individual thing. There are diets that are geared for heart disease, for diabetes, for obesity, and other diets that are anti-cancer. The family history, of course, is what we call a non-modifiable risk factor. But other risk factors are modifiable: sedentary lifestyle, obesity, and stress. Exercise is a potent treatment for cardiovascular disease and especially diabetes. I have long been a proponent of what is called force training: aerobic training with the use of treadmill, bicycle . . . any type of exercise that increases your heart rate. Add to that resistance training with the use of weights, machines or some type of cables such as the Ultraband Fitness System, which I have introduced in my Centers. I very frequently tell people that sometimes the simplest things to do, such as diet and exercise, are the hardest. These are the things not stressed by your usual family doctor: not that he doesn't believe in them, but he's too busy taking care of sick people. When it comes to stress, hostility, and anger, it is well known that these are serious risk factors for heart disease and probably other degenerative diseases as well. They must be addressed with the use of meditation, stress reduction, biofeedback, and yoga.
   
3. Nutritional supplementation: I have developed a Cardio Nutrition vitamin program that you can learn about in more detail at my lectures, in my radio broadcasts, or on my website. It consists of a diet, exercise, and nutrient program designed to prevent or treat specific cardiovascular problems, such as high blood pressure, high cholesterol, high triglycerides, obesity, diabetes, fatigue, and other degenerative diseases. It is a proven fact that nutritional supplementation is a critical factor in addressing these health problems. A recent study out of Tufts University has indicated that the simple taking of a multi-vitamin daily is a sure way to prevent health problems. Another study reported last year that if diabetics take a multi-vitamin their infection rate is markedly decreased. More and more scientific information supports the effectiveness of antioxidant vitamins. And these studies identify specific vitamins, nutrients, amino acids, functional foods, and minerals that are effective for the management of cardiovascular and related problems.
   
4. Discontinue all forms of tobacco. There are still many closet cigarette smokers, and this is one of the most devastating health problems in the country today. These millions of cigarette smokers, and pipe and cigar smokers as well, are putting their health at tremendous risk. Nicotine is a toxin that promotes arteriosclerosis (heart disease), chronic pulmonary disease, emphysema, and cancer. Any means used to discontinue tobacco would be a great health aid. There are today nicotine gums, patches, inhalers, and pills, as well as natural therapies like acupuncture and hypnosis; and even a well-known, quite successful herbal homeopathic product, Smoke Away.
   
5. Management of hypertension. Among the risk factors for cardiovascular disease, hypertension has the added threat that it is a 'silent killer.' Elevated blood pressure can persist for many years without an individual knowing about it. I very frequently have patients coming into my Centers with their diastolic (top number) up around 160, 170, 180, 190, and they will say, 'But doc, I never had high blood pressure.' They just never knew it because it was never measured. Sometimes there can be the matter of 'white-coat' hypertension: blood pressure goes up in the doctor's office. If I suspect this, I have the patient check his/her blood pressure at home. This year new guidelines were established for hypertension. The desired range is 135/80 or lower. It is very well documented that hypertension is an independent risk factor for heart disease. That means even if high blood pressure is the only risk factor you have for heart disease, it is very serious. Of course, when other risk factors are present, the risk for heart disease and vascular disease is much greater. The problem with hypertension is that it is progressive as it causes renal damage, arteriosclerosis, and eventual cognitive (mental) impairment. So check your blood pressure. Medications are frequently necessary. There are also many nutrients available in my Cardio Nutrition Program that can be used to control elevated blood pressure.
   
6. Check cholesterol levels. Elevated cholesterol is another 'silent killer.' Since there is no pain from elevated cholesterol, the first sign of elevated cholesterol can frequently be a heart attack or stroke. Do not forget that one-third of all individuals with heart disease find out they have it, unfortunately, by sudden death. With regards to the so-called cholesterol controversy, there is no such thing. High levels of cholesterol are definitively associated with a greater degree of heart attack and stroke, and a higher degree of arteriosclerosis. The controversy came about because there are also other factors involved in a heart attack. (I discuss these at length next.). It is a fact, and one reason for the controversy, that many people coming into the hospital with a heart attack have only a slightly elevated cholesterol -- in the 220 to 230 range. But these individuals frequently have either high triglycerides, low HDL, or other serious risk factors, such as elevated homocysteine or insulin resistance. New guidelines for cholesterol levels were established a couple of years ago. Total cholesterol should be 200 or lower. LDL cholesterol should be in the 100 range. Recently, my Centers have introduced NMR or nuclear magnetic resonance lipid analysis. This test measures the actual number and size of the LDL particles in the blood. Science has shown that small size LDL is more atherogenic or more prone to cause arteriosclerosis. This type (small particle) of LDL happens to be present in diabetics and those with insulin resistance. There are many modalities used to lower cholesterol: natural, dietary, and exercise measures. Drug therapy is very effective when necessary.
   
7. Check triglycerides. Triglycerides are frequently overlooked in the management and prevention of heart disease. Patients with high triglycerides are frequently mistakenly treated with drug therapy. In fact, an elevated triglyceride level is a sign the patient is affected with insulin resistance, a metabolic disorder and pre-diabetes condition that should be treated by dietary measures. There are no specific drugs that will lower triglycerides. An insulin-regulating diet and the dietary supplements fish oils and niacin are effective. Unfortunately, one of the problems with triglycerides is that they cause a decrease in the good or protective HDL.
   
8.

Weight gain, obesity, and diabetes. This is an epidemic today not only in the United States, but in the world. On one of my recent broadcasts, I talked about a Time magazine cover story of a 225 lb. 10-year-old child with type II diabetes. Sadly, this is often where the problem of obesity begins: in youth. The Time story goes on to tell of the multi-million dollar industry that has grown up in response to the epidemic of obesity. It is very serious for America. Part of the problem -- we are now learning -- is in our consumption of carbohydrates; as the late Dr. Robert Atkins pointed out over and over again in his diet books. Excessive intake of carbohydrates is directly related to obesity, diabetes, and insulin resistance. With weight gain comes a multitude of medical problems, including premature death, heart disease, stroke, high blood pressure, diabetes, arthritis, and even an increased risk of cancer. So all efforts to maintain a healthy weight are a top priority in your health regimen.

   
9.

Insulin resistance. Insulin resistance is associated with the new term in medicine: the Metabolic Syndrome, or what nutrition oriented doctors have for many years called 'Syndrome X.' It is an inherited metabolic disorder characterized by the following:

central obesity
hypertension
glucose intolerance
elevated cholesterol, especially high triglycerides

Related conditions are elevated uric acid, low HDL, small size LDL particles, and low testosterone levels. The metabolic syndrome can be addressed by diet, exercise, nutritional and pharmacological therapy. Critical because it is the precursor of diabetes.

   
10. Management of the so-called novel risk factors: homocysteine, lipoprotein(a), and fibrinogen. They are important to consider because they are factors that may contribute to a heart attack when cholesterol levels are low or within a safe range. * Homocysteine is an amino acid-like substance. When elevated, it is associated with heart attack, strokes, and neurodegenerative diseases. It can be lowered by administering vitamins B6, B12, and folic acid. Homocysteine levels should be a part of every blood chemistry done by physicians. Homocysteine levels below 10 are desirable. * Fibrinogen is a clotting substance that when elevated is a risk factor for heart disease. It is very commonly elevated in smokers and those with insulin resistance syndrome. Eliminating smoking and diet are ways to reduce it. * LP(a) or lipoprotein(a) is a risk factor that is poorly understood and is difficult to lower. It can sometimes be lowered with niacin and should be managed by lowering LDL cholesterol.
   
11. Reduce inflammation in the body. A new study entitled High Sensitivity C-Reactive Protein (CRP) has called our attention to the risk factor of CRP. The study indicates that inflammation appears to be a part of cardiovascular disease as evidenced by elevated levels of C-reactive protein, an inflammatory marker. We now know that certain viruses, infections, and even periodontal disease are associated with heart disease. So part of a routine blood chemistry, I believe, should be a measure of high sensitivity C-reactive protein. Where found, it can be managed by taking aspirin. This is an important benefit of aspirin in addition to aspirin's anti-platelet activity. I recommend low-dose aspirin therapy for all individuals over 40, knowing that its effect may also be that of an anti-inflammatory treatment. Fish oils are also very effective and, as always, an holistic lifestyle with a proper diet, exercise, and antioxidant protection are an important defense against inflammation problems.
   
12. Evaluate toxic heavy metals. It has recently been found that lead is associated with hypertension. Moreover, I believe there is an epidemic of mercury toxicity in this country because of the fish supply. And I have been finding high levels of arsenic in some individuals, which has been reported to be present in water and food supply. Dental amalgams and other heavy metals, such as cadmium, have been associated with arteriosclerosis. This is probably one of the reasons chelation therapy has been successful for those physicians using it. Because of these considerations, every routine blood chemistry should include measurement of lead, mercury, and other heavy metals.
   
13. Check your hormone levels. In men especially, testosterone is extremely important. In addition, human growth hormone lately has been found to be an anti-aging marker. See the articles I have written on HGH and its replacement that are available through my Centers.
   
14. Be sure to get an annual physical. It must be an extensive one. I believe in the findings of studies which establish the importance and efficacy of each of these preventive tests: Depending on circumstances, (age,gender and certain risk factors) you will decide which of these tests should be included in your overall annual physical. For women I recommend bone density, GYN exam, and mammograms. For both men and women, I advise colonoscopy and, if you have been a smoker, a chest x-ray. Men should get prostate evaluations, and every man and woman at risk should get a coronary CAT scan.
   
15. Don't forget the 'Man upstairs.' Prayer and meditation belong among the resources of anyone's health maintenance program. They are a means of reducing stresses and they as well give a context to your efforts, since they remind you of your health responsibilities to yourself and to others.

This is only part of my good health advice for 2004; there will be more to follow.

Frederic J. Vagnini MD, FACS
January 2004

 
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