Participants: Don Mckintosh (Host), Tim Lawton
Series Code: HFAL
Program Code: HFAL000162
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00:50 Hello, and welcome to Health for a Lifetime
00:52 We're glad that you've joined us today. 00:53 I'm your host Don Mackintosh. 00:55 Today we're going to be talking about a very important subject, 01:00 in fact we're going to be talking about the 01:01 number one killer in Western countries and this is 01:05 cardiovascular disease. 01:07 Not just heart attacks, which we normally think of, but also 01:11 strokes, everything that has to do with the 01:14 cardiovascular system. 01:16 Joining with us to talk about this important topic is 01:19 Dr. Timothy Lawton. 01:21 He's a physician from Wichita, Kansas. 01:23 He practices what's called, "Lifestyle Medicine. " 01:27 This is the best of two worlds, medicine and also looking at 01:31 lifestyle - that is what you can do in the style of life 01:35 that you lead. 01:36 Thanks so much for joining us Dr. Lawton. 01:38 Thanks, Don. 01:39 Now you have an actual center. 01:41 Tell us a little about what you do day to day. 01:43 Well, we see a patient who's got something like heart disease. 01:48 We look at all the different factors that are 01:51 lifestyle related. 01:52 We look at lifestyle factors that impact their 01:56 blood pressure, that impact their cholesterol, if they smoke 01:59 we work with them to help them stop smoking, and we set up 02:03 specific achievable goals that they can work on at home 02:06 day by day. 02:07 The name of your lifestyle is Veté, which means life, 02:13 and you call it Veté Lifestyle Medical Center. 02:17 So it's bringing those two together. 02:19 You follow them medically, work with their physicians... 02:21 Medical plus lifestyle, all together. 02:25 I think this is certainly the wave of the future and it should 02:28 have been the wave of the past as well. 02:30 Let's talk then about cardiovascular disease. 02:34 You were careful to say to me before we began that it's number 02:38 one, it's considered still number one if you add 02:41 heart disease and stroke together. 02:43 Right. 02:44 For years simply heart disease has been the number one 02:48 killer, but within the last year cancer has overtaken 02:51 heart disease as the number one cause of death. 02:54 But still if you combine heart attack and stroke that accounts 02:57 for almost a million deaths in the U.S. per year and it 03:00 accounts for a quarter of all of our health care expenditures 03:05 which we know is up in the trillion of dollars. 03:08 So 350 billion or something dollars on cardiovascular. 03:13 Just on diseases of the heart and brain. 03:17 Another thing you mentioned to me was that many times when 03:20 we talk about cardiovascular disease we often hear about 03:24 cholesterol. 03:25 We're not really going to talk about that too much today. 03:27 You want to talk about something else. 03:30 We'll talk about the three main risk factors but they will focus 03:35 mostly on blood pressure because it is such an important 03:38 risk factor. 03:39 I would say the number one risk factor is really smoking. 03:45 You got to quit smoking. 03:47 Best tip yet is to not start. 03:49 You can't get addicted to something you have never tried. 03:52 Right. 03:54 With the cholesterol its becoming more and more 03:56 complicated issue the more we learn about it. 03:58 It's not just high cholesterol but what kind of cholesterol 04:02 do you have? 04:03 Homocysteine and all those other things. 04:06 There's a lot of other things. 04:07 But blood pressure is pretty clear. 04:10 If it's high it's going to be a problem. 04:12 In fact, Don, I think this is really astounding - your risk 04:16 for heart attack or stroke doubles with every 20 points 04:20 your blood pressure goes up. 04:22 Starting at 115 and every 20 points you double your risks. 04:32 So we have a definition of high blood pressure here: 04:41 The top number is called the systolic pressure, 04:44 that's the squeezing pressure. 04:45 The other number is called diastolic blood pressure. 04:48 That's your relaxing pressure when the heart is refilling 04:52 to squeeze the next beat. 05:13 So that Pre-hypertension is a wake-up call. 05:15 It says you've got to do something before your 05:18 blood pressure gets any higher or your going to be in trouble. 05:21 And I imagine you see a lot of patients with this. 05:24 You know, huge numbers, huge numbers. 05:27 The numbers nationally show that by the time you're 50, 05:32 44% of us have high blood pressure. 05:36 By the time you're in your 60's it's 54% and by the time you're 05:41 70 and above it's about two thirds of all Americans 05:44 have high blood pressure. 05:46 Significant problem huge problem. 05:49 And in your practice you've seen patients, what do say to them? 05:55 We have a long list of things they can do to start improving 06:01 their blood pressure. 06:02 I think the first thing that we'll talk about is weight loss. 06:08 Because loosing even 10 or 15 pounds can be the difference 06:14 between having high blood pressure and having normal 06:16 blood pressure. 06:17 It's real exciting. 06:19 People again and again we've seen them loose, not 100 pounds, 06:22 but just a moderate amount of weight can either help them get 06:26 off medications or be better controlled. 06:28 Someone told me that for every pound of extra weight you carry 06:32 that's like 200 miles of blood vessels you have to have. 06:35 Is that true or false? 06:36 I think it's more like 6 miles of blood vessels but... yes, 06:39 there's a lot - a lot more work the heart has to do. 06:41 So when you loose weight do you loose those blood vessels? 06:44 I always wondered that, I mean, I don't mean to put you on the 06:47 the spot, or is that just a way of describing what happens 06:51 with the extra weight? 06:52 As far as loosing extra weight there's something called 06:57 visceral adipose tissue. 06:59 Visceral fat means the fat that's inside your belly 07:01 not the stuff that's hanging off the arms and on the hips. 07:04 That stuff isn't as dangerous for the heart. 07:07 It's the fat that sits around your organs inside. 07:10 And that fat, when you loose those 10, 15, 20 pounds 07:13 that's some of the first fat that starts to come off. 07:16 You might not notice a whole lot of difference except maybe in 07:19 your waist size. 07:21 That's the fat that's most dangerous for the heart - is the 07:24 fat around the middle. 07:26 And why is that so dangerous - the stuff around the organs? 07:29 Well, it effects the blood pressure but it also effects 07:32 the cholesterol and it effects how our bodies 07:35 handle blood sugar. 07:36 So it puts it at a higher risk for diabetes as well. 07:39 So is there a special lifestyle or... I hate to say diet? 07:43 Because you want it to be a lifestyle that people go on. 07:47 Is there something you tell people to help them 07:50 start loosing weight in terms of their diet? 07:53 Well, the most studied diet for blood pressure has been 07:57 something called Dash Diet, D A S H, and that stands for 08:01 Dietary Approach to Stop Hypertension. 08:04 This study has been looked over 10 years, but some of the main 08:09 components are: 08:15 Just to spend a second on the whole grains - people who eat 08:19 three or more servings of whole grains a day as opposed to 08:23 less than one, reduce the risk of heart attack by almost 1/2 08:27 just by that one change alone. 08:29 So white rice - no. Brown rice - yes. 08:34 100% whole grain bread it's got to say 100% or it's not 08:37 completely whole grain. 09:10 This is the Dash Diet 09:12 This is the Dash Diet. 09:13 Dietary Approach to Stop Hypertension 09:20 What they've shown, people who are on this diet, on average, 09:25 lower their systolic blood pressure by 11 points. 09:28 That is a stronger factor than exercising, 09:33 but that's important, you can lower it a couple of points, but 09:37 this is the most important factor. 09:38 Eleven points it will lower it if you go on this diet? 09:41 So 150 down to 139 for example. 09:44 Alright. 09:46 You said that for every 20 points the blood pressure 09:53 goes up that doubles the risk of heart attack or heart disease 09:57 or cardiovascular disease. 09:58 Right. 09:59 So when you go from 115 to 135 that's doubling that risk. 10:04 By the time you go to 155 it's a four fold. 10:07 By the time you go up to a 175 you've increased your 10:09 risk by eight fold over someone with normal blood pressure. 10:13 Now you know when I first meet, or many times when people first 10:17 meet a physician or something, they have this 10:19 white coat phenomenon where their blood pressure goes up. 10:22 How do you get around that in your clinic? 10:25 Do you wear a different color of coat or what do you do? 10:27 How do you make this diagnosis? 10:30 I don't think it matters what color of coat that I wear. 10:32 Just the fact, people are often a little apprehensive going to 10:38 Doctor's office, people get anxious sometimes even about 10:41 having their blood pressure checked, so we do something 10:44 called ambulatory blood pressure monitoring. 10:47 Ambulatory means at home. 10:48 People can get a blood pressure automatic unit to check their 10:53 blood pressure at home, write these numbers down and 10:55 then compare it with what we find in the office. 10:58 Ok, so that gets around the fact that you could scare them. 11:03 Anything else you want to tell us about in terms of 11:07 blood pressure? 11:08 The Dash Diet was formulated based on what foods are rich 11:12 in certain vitamins and minerals that are good for the 11:16 blood pressure. 11:17 One of the things that has been known for 30, 40 years, has been 11:23 the importance of cutting back on the salt in the diet. 11:27 When people eat a low sodium diet, and we have a graphic 11:30 on that, but we also want them to eat a diet that is high in 11:33 potassium. 11:35 The foods that are in the Dash Diet 11:37 are high potassium foods. 11:40 But low in sodium. 11:41 So the graphic on sodium we're going to look at that 11:43 and help us see what this means: 11:46 Limiting sodium originally was hoped that people could 11:51 limit their sodium to 2,400 mg per day, this is salt. 11:56 But it was found if you can limit your sodium to 1,500 mg 12:01 a day, that is as effective as taking one prescription drug 12:06 for your blood pressure. 12:08 Now I tell my patients, you really want to do it 12:11 you got to consider the sodium as a bank account. 12:14 You got 1,500 sodium bucks to spend each day, use them wisely. 12:19 If you get that chicken noodle soup it might be 12:22 900 mg of sodium - you've blown a lot of bucks on that. 12:27 The second thing on the graphic was the importance of potassium. 12:31 Even if you cut down on the salt or sodium, if you don't eat 12:34 foods that are rich in potassium you're not going to have 12:38 as beneficial effect on your blood pressure. 12:41 So it's really a combination of lowering sodium and increasing 12:44 potassium. 12:45 Now are some people more salt sensitive than others? 12:48 It's thought that certain people are more salt sensitive 12:52 but really it comes down to how much potassium you're getting. 12:56 Potassium alone can decrease the blood pressure. 12:59 Do they have like salt shakers with potassium in them? 13:02 You can do that, but the best way really to do that is 13:06 through the foods. 13:07 And people usually think about bananas, but bananas are 13:11 actually the number 20 on my list as far as 13:14 high potassium foods. 13:15 What's number one? 13:16 Sunflower seeds. 13:18 That's good from Kansas, you know you're from Wichita. 13:21 Yes. 13:22 Almonds, raisins, parsley, nuts, spinach, broccoli. 13:29 These are all excellent high potassium foods. 13:31 Keep eating your bananas. 13:33 And tomatoes. 13:34 Absolutely. 13:35 All good. 13:36 So high potassium, low sodium. 13:41 And then the other thing is to loose weight. 13:43 That's what we've learned so far. 13:45 We're talking with Dr. Timothy Lawton. 13:47 We're talking about cardiovascular disease and 13:49 we've noticed that one of the most important things 13:53 to consider is blood pressure and how to make that come 13:57 down to a normal level. 13:59 We're going to talk more about what to do with cardiovascular 14:01 disease when we come back. 14:06 Have you found yourself wishing that you could 14:08 shed a few pounds? 14:09 Have you been on a diet for most of your life? 14:12 But not found anything that will really keep the weight off? 14:15 If you've answered yes to any of these questions, then we 14:18 have a solution for you that works. 14:21 Dr. Hans Diehl and Dr. Aileen Ludington 14:23 have written a marvelous booklet called, 14:25 Reversing Obesity Naturally, and we'd like to send it to you 14:29 free of charge. 14:30 Here's a medically sound approach successfully used 14:33 by thousands who are able to eat more 14:36 and loose weight permanently 14:37 without feeling guilty or hungry through lifestyle medicine. 14:41 Dr. Diehl and Dr. Ludington have been featured on 3ABN 14:44 and in this booklet they present a sensible approach to eating, 14:48 nutrition, and lifestyle changes that can help you prevent 14:51 heart disease, diabetes, and even cancer. 14:54 Call or write today for your free copy: 15:07 Welcome back. 15:08 We're talking with Dr. Timothy Lawton. 15:10 We're talking about cardiovascular diseases. 15:12 Dr. Lawton has told us that cardiovascular disease is 15:17 still number one in Western countries, especially America, 15:21 when you look at heart disease and stroke and add those 15:24 together. 15:25 Many times we talk about cholesterol and smoking 15:30 and these things are important to avoid, but Dr. Lawton is 15:33 really focusing our attention today on hypertension. 15:37 Dr. Lawton, you see a lot of this in your 15:40 life style medicine center there in Wichita, Kansas. 15:44 A lot of people come in with this problem. 15:46 You've seen that really,... what was it you said? 15:49 That really hypertension is very important to look at. 15:52 It's one of the most significant risk factors when we look at 15:56 preventing heart disease and stroke. 15:59 You told us we need to loose weight, and you've given us 16:02 some ideas on how to do that. 16:03 And you've told us that our diet if we follow what you call the 16:07 DASH Diet, it can actually decrease our blood pressure by 16:11 11% is that what you said? 16:13 11 points on average. 16:16 You know the exciting thing about the DASH Diet is they have 16:20 actually gone above and beyond the DASH Diet to incorporate 16:25 some new additional recommendations. 16:27 The original DASH Diet contained a limited amount 16:31 of dairy and meat. 16:33 The new version, actually just released within the last couple 16:37 weeks, shows that if you substitute animal protein 16:42 for plant protein you have an additional reduction in your 16:45 blood pressure. 16:46 How many points? 16:47 A couple more points in addition to the 11. 16:49 What they did in this study was they cut half of the 16:53 animal protein and brought in plant protein, such as 16:57 beans, vegetables, and nuts. 16:59 Ok, and then the third thing you mentioned was limiting 17:03 the sodium, but not just limiting sodium 17:06 but putting potassium in its place. 17:08 Potassium is the antidote, the anti-salt, so to speak. 17:12 Salt makes the pressure go up and potassium makes the 17:16 pressure go down. 17:17 And these are all the foods, plant based foods. 17:21 Many of them are very high in potassium. 17:23 You think of bananas, olives, sunflower seeds, nuts, beans, 17:27 green leafy vegetables, all these things, squash, yams, 17:32 very high in the potassium. 17:34 Now you mentioned magnesium to me. 17:38 Magnesium is another important factor. 17:42 There is something to keep in mind. 17:45 Certain minerals balance each other in the body. 17:49 Salt, or sodium, is balanced with potassium. 17:52 That's why one works against the other. 17:55 Calcium and magnesium work opposite each other 18:00 as far as blood pressure. 18:02 Calcium and magnesium required for the squeezing of the muscle 18:06 cells in the body. 18:07 One is required for the squeezing and one is required 18:09 for the relaxation. 18:11 So for someone to have an abnormal level of either 18:15 calcium or magnesium will affect the heart, but also keep 18:18 in mind, each of the blood vessels is surrounded by a 18:22 structure of muscles that help us... let's say we should cut 18:27 ourselves and loose a significant amount of blood. 18:28 Well, our blood vessels would squeeze down to conserve 18:31 and increase the pressure in what we have left. 18:33 So those muscles are very important in each of our 18:36 blood vessels. 18:37 People who have high blood pressure are sometimes 18:39 prescribed a calcium channel blocker, 18:43 something to block the calcium. 18:45 Well, I just said calcium and magnesium work opposite of 18:49 each other and so instead of blocking the calcium, you can 18:51 increase the magnesium in your diet or through supplements, 18:56 preferably through diet, and that can make a difference 19:01 with bringing down the blood pressure. 19:03 So what are some foods that are high in magnesium? 19:06 What are the things that I should go out and buy? 19:09 Number one on the list is wheat germ. 19:13 Wheat germ, my mom used to always put it on 19:15 top of my cereal. 19:16 Well, there you go, good for a lot of different things. 19:19 But when we eat the white bread, the refined white flour, 19:22 which makes up the majority of the wheat we consume, 19:26 it's got the germ taken away. 19:29 So we loose that magnesium that was in there. 19:31 Other sources? 19:33 Nuts, like almonds and cashews, are especially high in 19:36 magnesium. 19:37 Buckwheat, Brazil nuts, peanuts, walnuts, and rye are also good 19:44 sources. 19:45 So really what you're saying when we're thinking about 19:48 hypertension, instead of having to remember all these lists, 19:51 which are great lists, would be to just eat foods as grown 19:54 in liberal, unadulterated, unprocessed type, quantities. 20:01 That makes a big difference, yes. 20:04 Ok, what's next on our list? 20:07 The next thing on the list is to quit smoking because that's 20:13 a very important factor. 20:15 And after that - consuming healthy fats. 20:19 A brief talk about the kinds of fats is very important. 20:24 There's a certain family of fats that are called omega 3 fats. 20:28 These are found in things like: flax oil or flax seeds, 20:34 canola oil, walnuts, as well as fish and fish oil. 20:37 These actually help to bring down blood pressure. 20:40 They also help to thin the blood and reduce the risk 20:43 of blood clots. 20:45 So have the healthy fats and then a graphic that said avoid 20:49 trans fats. 20:50 What are trans fats? 20:51 If you see the word partially hydrogenated on the label, 20:55 that's another word for trans fat. 20:58 Partial hydrogenation is a process of taking a liquid fat 21:03 and making it a solid at room temperature. 21:05 Things like margarine? 21:07 Margarine, French fries, shortening, and foods in most 21:12 of the commercial baked goods - the pies, the crackers, 21:17 the cookies - these are made with trans fat or 21:20 hydrogenated fat. 21:22 So trans fats, how do they increase the blood pressure? 21:25 They impact the cell membranes. 21:33 The membranes of every cell in our body is made up of fat 21:38 and these actually get into our cell membranes, an unnatural 21:44 kind of fat that get incorporated into our bodies. 21:46 So they impact the calcium, the magnesium, and these minerals 21:53 interact with the cells. 21:54 I understand they stay in the body a long time 21:57 these trans fats. 21:58 Well, they are incorporated into every cell in our body until 22:01 those cells die and turned over; they are there. 22:04 And I see they are trying to respond to the research that 22:08 you're presenting in the stores. 22:10 I see a lot of things now that say, "No trans fats," 22:14 and those are the things to look at. 22:15 Is that what you're suggesting? 22:16 You know that's an interesting factor. 22:19 The Institute of Medicine says there is no safe level 22:23 of trans fat. 22:24 They would recommend zero. 22:26 They say, "Well, let's be practical, now, maybe you should 22:29 keep it under 2 grams a day. " 22:31 Well, the trans fat, there's a little bit of labeling confusion 22:37 that's going on. 22:38 Right now you might pick up a box of crackers and it might 22:42 say zero grams of trans fat. 22:44 But you look under the ingredients it will say, 22:46 "bleached wheat flour, partially hydrogenated soybean oil, or 22:50 some kind of oil. " 22:51 But how can they claim zero grams if it's got something 22:55 partially hydrogenated? 22:57 The labeling rule says it has to be under. 5 grams 23:03 and they can write zero. 23:04 So if it's. 49 grams you can still write zero on the label. 23:07 Interesting. 23:08 So you got to look very close at the label. 23:10 So you got to read the ingredients. 23:11 What about exercise? 23:12 That can make quite a few points improvement in one's 23:17 blood pressure. 23:18 The amount of exercise has been shown is a moderate amount 23:22 of activity like a brisk walk: 23:29 If you can do more that's better. 23:31 But this is the minimum that's needed to 23:34 bring blood pressure... 23:35 That brings it down another couple points. 23:37 All these things - 11 here, 5 there, you know a couple here 23:40 will make the difference. 23:41 Alcohol? 23:43 Alcohol is not recommended for blood pressure. 23:47 It seems... I'll tell you a story about that. 23:50 I had a patient who was only in his 20's and he had 23:54 high blood pressure. 23:55 He was already taking, I think, two medications 23:59 for his blood pressure. 24:00 So I just asked him about some of his habits. 24:02 He was over weight, but he drank five drinks or so a night, 24:06 just to kind of settle down. 24:07 That was his habit in the evening. 24:09 In a couple weeks we were able to cut out the alcohol. 24:14 And you know alcohol is basically an empty 24:17 calorie source. 24:18 So by cutting out the alcohol he lost about 10 pounds 24:21 almost immediately. 24:22 His blood pressure went from 160 down to 140 24:25 in a matter of weeks. 24:27 Just by cutting out the alcohol? 24:28 And loosing a couple of pounds. 24:30 But I think the alcohol directly raises the blood pressure so 24:33 cutting that out can make a big difference. 24:35 Stress management - what did you do for this guy? 24:39 He usually used to reduce his stress through drinking alcohol. 24:42 Well, what did you recommend to him? 24:45 What do you recommend or is there any association between 24:48 stress and blood pressure? 24:51 Huge, huge research going on right there. 24:54 They kind of call that the mind body factor. 24:58 There's a study out of Harvard with men with hypertension. 25:02 And they found that using stress reduction techniques, 25:07 things like prayer, meditation, people were able to... 80% were 25:14 able to reduce their need for medication simply on 25:17 stress management. 25:20 80% that's very high! 25:21 Yes, yes, very impressive! 25:23 And so finding something within your religious tradition, 25:29 looking to God, sometimes people in their religious tradition 25:33 that increases stress for them, but finding what reduces it. 25:37 I like to talk with patients not just the concept of relaxation, 25:41 but the concept of enjoyment. 25:43 Even a smile or a laugh can boost the immune system and 25:48 help to reduce blood pressure. 25:50 You wanted to say something when we talked about 25:52 healthy vs. non-healthy fats about nuts. 25:56 We had said earlier, at the beginning of the program, 26:00 that people who consume three servings a week of whole grains 26:04 cut their risk of heart attack by almost half. 26:07 Well, the same is true for people who consume five servings 26:10 a week of nuts. 26:12 They cut their risk of heart attack almost by half. 26:15 Add that to a brisk walk, 30 minutes, three times a week 26:21 you cut your risk of heart attack almost in half. 26:24 So, just doing those three things - nuts, whole grains, 26:28 and a little bit more physical activity. 26:30 How do nuts do that? 26:33 How do they decrease your risk? 26:35 Well, we just looked, they are very high in magnesium and 26:38 very high in potassium and they are high, at least some of them, 26:42 in good fats. 26:43 In fact, there's two kinds of good fats. 26:45 We mentioned the Omega 3's but there's another family 26:47 called mono unsaturated fats. 26:50 Nuts are very high in these as is olive oil. 26:53 So let's just review: we say loose weight if you need to, 26:58 go on the DASH Diet, DASH minus the meat and minus the other 27:03 things it's even better, even better if you substitute 27:08 plant protein, limit sodium but replace it with potassium, 27:13 adequate magnesium, moderate exercise which means 30-45 27:19 minutes at least 3-4 days a week, limit alcohol or 27:25 cut it out, stress management - relax, quit smoking, then have 27:34 the healthy fats, avoid trans fats. 27:37 Thank you so much for joining us, taking time from your 27:40 busy schedule there in Wichita at Veté. 27:43 Thank you, Don. 27:45 And thank you for joining us today on Health for a Lifetime. 27:48 We hope that today's program helps you avoid hypertension 27:52 and all the problems that go with it and that as a result 27:55 you have health that lasts for a lifetime. |
Revised 2014-12-17