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Tim Russert’s death from a heart attack at age 58 is a stark reminder of our vulnerability to the ravages of cardiovascular disease even in the face of major advances in understanding its causes and how to prevent its consequences. Some 300,000 Americans die of sudden cardiac arrest outside the hospital each year. Russert was one of those who at least was aware that he was at risk.

Russert’s doctor Michael Newman said the tough-questioning but congenial host of NBC’s “Meet the Press” had been under treatment for asymptomatic coronary disease. He was carrying excess weight, Newman observed, but he got regular exercise and he performed well on an exercise stress test in April.

None of that prevented a cholesterol-laden plaque from rupturing on Friday morning. The resulting clot, an autopsy indicated, apparently caused his heart to go into ventricular fibrillation which led to cardiac arrest. The autopsy also showed he had an enlarged heart-a manifestation of coronary disease.

Wall Street Journal Health Blog
June 13, 2008

Coronary artery disease can take one or both of two forms:

1. Hard plaque - years of calcium plaque build-up in blood vessels cause artery blockage, preventing flow of blood. It is gradual and can be measured with a CT Calcium Score.
   
2. Soft plaque - non-calcified, the plaque erodes the walls of blood vessels and causes rupturing, suddenly preventing flow of blood. A stress test is completely unhelpful in detecting the risk. A CT Angiogram will detect soft plaque and allow the physician to visualize overall plaque load and its locations.

Tim Russert most likely died as a result of a ruptured aneurysm in an artery containing soft plaque build-up.

Mr. Russert’s personal physician spoke on CNN of his having completed a stress test and being on cholesterol-reducing drugs. Neither (of these traditional measures) was adequate to detect and reduce his risk.

Indeed, to quote two eminent cardiologists:

Sidney Smith … at University of North Carolina Charlotte and past president of the American Heart Association: “Russert’s death underscores a major shortcoming in cardiac prevention: protecting people at immediate risk of a heart attack.”

Prediman K. Shah, director of cardiology at Cedars-Sinai Heart Institute, Los Angeles: “It was a classic episode, the way 80% of cases of sudden cardiac arrest occur.” He wasn’t impressed with the report of Russert’s recent successful treadmill test. Even if a test is normal, “You can still have plaque and be at risk,” he tells us. It wasn’t clear whether Russert had been taking a cholesterol-lowering statin, but even if his LDL, or bad cholesterol, was under control, that wouldn’t assure protection against a heart attack. “Statins do stabilize plaque (and thus reduce chances of rupture), but they haven’t eliminated every heart attack or sudden death,” Shah says. “We have to look for other means.”

Unfortunately, what happened here is common in the medical community. The approach ostensibly is to seek “cost effective” methods in managing patients and to stay within the “standard (‘traditional’) protocol”. Unfortunately, these are inadequate.

What’s even more concerning is that his physician knew he had high cholesterol “controlled” with a drug, was overweight but “working out”, and lived a highly stressful work life … all the more reason to take extra precautions.

What should we learn from this tragic story? Inflammation is at the root of cellular damage and plaque formation in the first place. We need to do all we can to prevent inflammation.

What contributes to inflammation? Stress, lack of exercise, poor diet, inadequate sleep and infections that lead to:

• High blood sugar
  
• Inflammatory protein in the blood
  
• Presence of the enzyme lipid peroxidise that erodes vessel wall
  
• Existing plaque burden

How do you prevent or reduce inflammation and repair the damage done?

• Natural anti-inflammatories - Omega 3 fatty acids
  
• Anti-oxidant factors - CoQ10 (dosage of which must be increased when accompanied by statin drugs) and Vitamin E
  
• Repair agents - amino acids such as arginine, glutathione, carnitine

What should you have tested?

• Insulin level and insulin resistance
  
• Inflammation markers (C-reactive protein, aracidonic acid, homocysteine)
  
• Lipid peroxidase
  
• CT Calcium Scoring & CT Angiography
  
• Genetic factors affecting inflammation, elevated cholesterol, plaque formation and spontaneous clotting tendencies.
  
• Pharmacogenetics - effective metabolism of medications

Genetic testing is also valuable in determining appropriate use of potent prescription medications.

Unfortunately, the world has to lose an amazing talent at a young age in order to show the sharp contrast - between traditional “disease care” and true “healthcare” made possible by science that has existed for a few years already. Managing his risks in the “traditional” manner killed him. Russert’s heart attack was predictable and, quite possibly, preventable.

Elaine Chin, MD Chief Medical Officer

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Wireless is now ubiquitous - two billion cell phone users world-wide and increasing exponentially. Economic benefits are clear. Research on safety of cell phone use is not. The US Food and Drug Administration’s position is that there isn’t enough information to determine conclusively whether cell phones are unsafe.

A recent study in the Journal of the National Cancer Institute in December 2006 demonstrated no links between cell phone use and cancer. Critics point out that the average period of cell phone use was 3 years, leaving possible effects of long-term exposure unaddressed.

Other research has demonstrated up to a 58% increased risk of parotid gland tumors (a salivary gland near the ear) in heavy cell users, and a doubling of risk for acoustic neuroma and glioma (types of brain tumors) after 10 years of heavy cell phone use.

What could be occurring?

All living organisms generate electromagnetic fields - referred to as natural “bio- fields”.

A cell phone signal generates two types of radiation fields: a near-field (within 5-6 inches of the center of the phone’s antenna) and a far-field. Extent of the near field is determined by the amount of power necessary to carry the signal - the more power, the greater the range of dangerous radiation.

Electromagnetic fields generated by cell phones and other wireless signals interfere with natural bio-fields, potentially resulting in physiological and cellular alterations - disruption and leakage of cell membranes, increased oxidative stress (build up of free-radicals), interruption of intercellular communication, possible genetic damage and increase in the risk of tumors. Symptoms such as headaches, inability to sleep and general malaise are cited too.

Dangers are magnified in children, whose developing brains are more vulnerable. Experts warn that disturbed brain activity in children could lead to lack of concentration, memory loss, impaired learning and mood disorders.

Was the cancer that ended the life of celebrity lawyer Johnnie Cochrane caused by his constant use of the phone? What about Senator Ted Kennedy, and others? We still don’t know, but ….

What should you do?

Given what we know today, our recommendations regarding wireless devices are:

1. Restrict direct cell phone use to essential and short calls
2. Use a wired hands-free set whenever possible. Using a wireless headset such as Bluetooth would be a compromised solution - they draw much more far- field electromagnetic radiation.

What else can you do?

Free radicals from radiation cause cellular damage and disrepair. Ensure antioxidant levels in your body are optimized (measurable in blood). Foods rich in antioxidants are found in deep coloured fresh fruits and vegetables.

If you are frequently exposed to other types of radiation in addition to cell phone use such as cosmic radiation from commercial flights, consider the use of antioxidants - vitamin E in particular. Vitamin E is fat-soluble and is easily transported into the brain tissue from the blood protecting it from radiation effects.

Parneet Pal, MD Manager, Health Programs

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Your typical annual check-up includes a fasting test of blood glucose levels - 6 to 7 mmol/L is regarded as “pre-diabetic”. 7 or over is defined as diabetic. But, this is a “lagging indicator” - it tells you after the fact. How can you find out if you’re heading in the wrong direction?

First, let’s understand more about the disease.

Type 1 diabetes, usually diagnosed in children and adolescents, occurs when the pancreas is unable to produce insulin. Roughly 10% of diabetes cases are Type 1. Life expectancy for Type 1 diabetics may be shortened by as much as 15 years.

Type 2 diabetes occurs when the pancreas produces insufficient insulin or when the body cannot effectively use insulin (insulin resistance). Type 2 usually develops in adulthood, although increasing numbers of children in high-risk populations are being diagnosed. Life expectancy for Type 2 diabetics may be shortened by 5 to 10 years.

Most realize that diabetes requires intense care with diet and, in most cases, constant monitoring and dosing of insulin. Fewer are aware of the multitude of serious complications and other health risks brought on by the disease:

Heart disease and stroke - almost 80% of diabetics will die as a result. Death rates from these causes are 2 to 4 times higher among adult diabetics.

High blood pressure - 70% of adult diabetics experience high blood pressure and require prescription medications.

Blindness - diabetic retinopathy is the leading cause of new cases of blindness in adults 20-74 years of age.

Kidney disease - diabetes is the leading cause of kidney failure, accounting for 44% of newly diagnosed cases of kidney disease. Many have to live with chronic dialysis or require a kidney transplant.

Nervous system disease - 60% to 70% of diabetics experience mild to severe forms of damage to the nervous system, resulting in loss of sensation or pain in feet or hands, slowed digestion and carpal tunnel syndrome.

Amputation - the rate for diabetics is 10 times higher and accounts for more than 60% of non-traumatic lower-limb amputations.

Sexual Dysfunction - (erectile dysfunction in men) - more than twice the incidence among diabetics.

And other complications - diabetics are more susceptible to many other illnesses and, once acquired, these illnesses typically have worse prognoses. For example, pneumonia or influenza are likely to result in higher rates of fatality.

Many are not even aware that they are diabetic until they develop one or more complications.

Science is producing new techniques for managing diabetes but, as you will conclude, it is far more desirable to avoid it altogether if you can.

How do you know if you’re at risk?

If you are 40 or over you are at risk for Type 2 diabetes and you should be tested at least once a year. If any of these additional risk factors apply you should be tested more frequently:

• Overweight (especially if you carry most of your weight around your middle)
• Belonging to a high-risk ethnic group (Aboriginal, Hispanic, Asian, South Asian or African)
• A parent, brother or sister with diabetes
• Health complications or symptoms associated with diabetes, including
  • Unusual thirst
  • Frequent urination
  • Weight change (gain or loss)
  • Extreme fatigue or lack of energy
  • Blurred vision
  • Frequent or recurring infections
  • Cuts and bruises that are slow to heal
  • Tingling or numbness in hands or feet
  • Trouble having or maintaining an erection
• Impaired glucose tolerance or impaired fasting glucose
• High blood pressure
• High cholesterol or other fats in the blood
• Women who have had gestational diabetes (during pregnancy) or given birth to a baby weighing more than 4 kg /9 lbs.

Those diagnosed with metabolic syndrome are at 25% increased risk of Type 2 diabetes, as well as heart disease and other conditions.

Metabolic Syndrome is defined by several conditions:

• Abnormal blood sugar - insulin resistance
• Clotting state (e.g. high fibrinogen or plasminogen activator inhibitor-1 in the blood)
• Inflammatory state (e.g., elevated C-reactive protein in the blood)
• High LDL (“bad”) cholesterol and triglycerides and low HDL (“good”) cholesterol
• High blood pressure (higher than140/90)
• Abdominal obesity (men >40 inches/102 cm; women >35 inches/88 cm)

What tests should you ask for?

First, are you at risk genetically? We can identify a predisposition to various conditions leading to diabetes. If you know that you have these genes, you should take extra care.

Then, let’s look at early indicators. An important new test measures early onset of insulin resistance (using a simple breath analysis to identify the body’s ability to metabolize sugar). Assessing the degree of insulin resistance is an excellent way to predict whether one will go on to develop diabetes.

It is not unusual to have a normal blood sugar level giving individuals a false sense of security when in fact they are already exhibiting a high level of insulin resistance.

A global epidemic … some troubling facts

An estimated 246 million people worldwide (4%) are diabetic. A further 7 million develop diabetes each year. In the US and Canada 7% (24 million) of the population are estimated to be diabetic, but one-third do not know and are undiagnosed! A further 54 million Americans are classified as “pre-diabetic”. 2 million adolescents (or 1 in 6 overweight adolescents) aged 12-19 are pre-diabetic. This is truly one of the most insidious and paradoxical problems of affluence and urban poverty simultaneously.

Speaking at Harvard University Commencement in 2007 former President Bill Clinton said:

“It’s now predicted that one in three children born in the United States in this decade will develop diabetes. We run the risk that we could be raising a first generation of kids to live shorter lives than their parents. Not because we’re hungry, but because we don’t eat the right things and we don’t exercise.”

The financial burden is enormous - for uninsured individuals and for North American society. The impact on quality of life is fundamental.

Peter Cooper President & CEO
Elaine Chin, MD Chief Medical Officer

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So many believe diet soda is a better choice over regular sodas - no sugar, no weight gain. If you do, please read on.

A recent study published in the journal Circulation (January 2008) reported diet soda to be directly associated with the risk of developing metabolic syndrome, despite “zero calories and zero sugar”. While the study could not explain the reasons, theories for this include:

• A chemical in diet soda that promotes insulin resistance - an indicator of metabolic syndrome, or
• The fact that since diet soda is considered to have “zero calories”, individuals feel “less guilt” when consuming an extra cookie or other sweet snack.

Others believe that the insulin secretion response to sugar substitutes is similar to that of real sugar. Given the very significant direct associations between diet soda intake and increased incidence of metabolic syndrome, researchers believe the correlation merits further study.

The next time you reach for a diet soda you may want to consider its potentially harmful effect on your metabolism! We suggest you reach for water instead!

Shelley Burns, ND

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What we’ve known for some time about Vitamin D
It plays a key role in bone and muscular health:

• Essential for promoting calcium absorption in the gut and maintaining adequate serum calcium and phosphate concentrations to enable normal mineralization of bone.
• Required for bone growth and bone remodeling. Without sufficient vitamin D bones can become thin, brittle, or malformed.
• Prevents rickets in children and osteomalacia (weak bones) in adults. Together with calcium and magnesium, vitamin D helps protect older adults from osteoporosis (bone thinning).
• Important in modulation of neuromuscular and immune functions and reduction of inflammation.

Important additional benefits from emerging research

Cancer protection: against tumors of the colon, prostate and breast.

Heart health: A June 2008 study in the Archives of Internal Medicine reported a two-fold increase in risk of heart attacks in men with lower vitamin D levels than those with normal levels. Vitamin D is thought to reduce buildup of plaque in arteries.

This study may explain why the incidence of heart attack appears to have a seasonal pattern - higher during winter months and more common in northerly countries, regardless of whether people have other proven risk factors. This is consistent with seasonal fluctuations in levels of vitamin D in the body - declining during fall and winter when sunlight is too feeble to make any of it in the skin.

Protection from Type 1 Diabetes: A study in the Archives of Disease in Childhood earlier this year reported that giving children vitamin D supplements in infancy was associated with a 29% reduced risk of developing Type 1 diabetes later in life.

Possible protection against other diseases? Insufficient levels of Vitamin D have also been associated with autoimmune disorders such as rheumatoid arthritis and multiple sclerosis.

Where do you get Vitamin D?

Sun - best known natural source. Ultraviolet B rays penetrate the skin, converting a precursor to vitamin D. Approximately 20 minutes of direct exposure every day is recommended. However, we estimate about 20% of the population to carry a gene that prevents the body from absorbing D from sun.

Foods - Fish (such as salmon, tuna, mackerel) and fish oils, egg yolks, milk, dairy products and other foods with natural and fortified vitamin D.

Scienta Health’s analysis of Vitamin D levels in their clients confirm that even with a healthy, D-rich diet, intake is seriously inadequate for at least 9 months of the year, due both to inadequate sun exposure and to depletion of the nutrient in foods.

Other factors exacerbate the need for supplementary sources of D:

• Kidney disease - inability to convert storage form Vitamin D into its active form
• Malabsorption due to food allergies to dairy
• Strict vegetarianism

Supplements - Vitamin D in the form of D3 - cholecalciferol - is an essential additional source in northern climates and for individuals who have the “defective” D Receptor gene.

Supplementation - how much?

Most official guidelines recommend 200-400 IU (international units) per day. More recently nutrition researchers have been recommending up to 2000 IU per day.

We at Scienta Health recommend a better solution: get your vitamin D levels tested! This will allow for detection of deficiencies and more precise ways to rectify them through monitored supplementation and dietary changes.

Shelley Burns, ND

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