The Tip of the Iceberg
Last week I was honored to present on the obesity-diabetes-and artery disease epidemic to a group of Delta employees in Atlanta. The venue was warm and inviting and very well organized. The participants were engaged and asked a large number of insightful questions. After my talk was over, I was invited to one of the working areas and I was happy to see that there were so many standing desks and a lot of opportunities for the employees to be physically active. A great workplace!
I used several PowerPoint slides for my presentation. One of those showed a picture of a gigantic iceberg where both the above-the-surface and below-the-surface parts of the iceberg were visible. The caption read: “Why am I showing you this picture?” After I let the question sink in the minds of the audience for a few seconds, I presented the next slide. There was the picture of a huge belly of a man. The face or the rest of the body were not shown; the focus was on the belly. The caption read: “Because it is so easy to see this…”. The next slide followed in quick succession and its caption picked up where the previous one left: “...but you can’t see that!”
Just like the iceberg that sunk the Titanic, what is hiding below the surface is the most dangerous. Our artery health can’t be seen from the outside, but inside, the story is much different.
You can clearly see the “deeper issue” in this up-close photo of an adult artery.
The “that” was the inside of an artery of a person with a huge belly like the one on the slide. The artery looked ugly, like a war zone. Instead of appearing like a smooth glistening tube, the inside of the artery was uneven, filled with dirty-looking red and yellow growths, like tumors. These tumors were not cancers; they were advanced-stage cholesterol plaques with bleeding and clots on their surface. Such an artery can become the cause of a heart attack, stroke or sudden death without further notice. The slide that followed showed exactly how such a thing can happen. Most of us (especially men) start developing thin fatty lines in the wall of our arteries when we are teenagers. These early fat accumulations are called “fatty streaks” and represent the only form of cholesterol accumulation in our arteries that is reversible. As the cholesterol plaques continue to develop, it usually takes them a minimum of 20 plus years to mature and, usually, cause zero symptoms during that phase. Once mature, they can, all of a sudden and without any further warning, become unstable, and within a minute they can be causing serious symptoms like chest pain, heart attack, stroke or even sudden death.
Unfortunately, in western countries like ours, by the time we are 45 years of age most of us (especially men) do have some cholesterol plaque in the walls of our arteries. As long as these plaques stay stable, they are not a health problem and usually cause no symptoms. Once unstable, the result is catastrophic. So, what do we need to do to keep any plaques stable:
No smoking (not even one or two cigarettes a day)
Keeping our blood pressure and LDL cholesterol low (our health care provider will advise us whether or not we need medications to achieve this)
Staying physically and socially active
Eating a healthy diet with an emphasis on avoiding abdominal obesity by excluding fast carbs
Avoiding alcohol abuse
Sleeping at least 7 hours per night
Avoiding excessive stress
So, take good care of your arteries in order to keep any possible cholesterol plaques at bay and enjoy a long life without heart attacks, strokes or the need for heart surgery or other heart procedures.
To your health,
Dr. Anthony
Don’t just SIT there - it could be harmful to your health!
Sitting for a long period of time can be hazardous to your health. There are healthy alternatives to sitting, even if your job is traditionally a sedentary one. Many tips are available to keep you on your feet and healthy.
A Mayo Clinic report suggests that sitting for a significant period of time is not even offset by a few hours a week at the gym. More moving is necessary to keep your body burning calories. A study shows that sitting too much can actually cut your life short. The risk of diabetes increases, HDL cholesterol production lessens and enzymes that break down fat drop by up to 90-percent. Your blood pressure can also go up by sitting.
Sitting can be bad for your heart. While sitting, muscle burns less fat and blood moves more slowly to allow-in the long run- fatty acids to clog the heart. If you are hoping for the six pack abs, don’t sit for so long. The abdominal muscles are not engaged when sitting, and can also lead to poor posture. The curvature of the back can contribute to spine problems, strained neck and sore shoulders or back. Poor circulation in your legs can present a host of issues as well, from deep vein thrombosis (blood clots) to varicose veins to swollen ankles.
People who sit to watch TV or use handheld devices are in the same boat as those who sit to work. A study compared adults who watch more than 4 hours sitting in front of a TV with those who sat for only 2. Those who sat for the longer period of time showed a significant increased risk of events associated with cardiovascular disease. These data are also applicable to sitting in front of your computer or any kind of screen.
Sitting can be bad for your brain too. Movement pushes fresh oxygen and blood to the brain, releasing chemicals to help thought and mood. A “stale” brain can also cause clots to cause a stroke. The average US adult sits for 8 hours a day; high school students, although they sit less, they are also affected. A study found high school students who stood in class instead of sitting improved their test scores by 20 percent.
So what can you do to break up all this sitting? Here are some ideas for those who sit for work. Instead of a regular chair, opt for an exercise ball. The instability of the ball will keep you on the move and make for better ab muscles and hip flexors; using the ball may also alleviate back pain. But use caution - the ball needs to be properly inflated and your posture should not injure your lower back.
Another option is the treadmill desk. One study in 2011 found that those who used a treadmill desk reduced their hip and waist size by about 2 inches. A variable-height desk, a standing desk or an indo-board (a type of balancing board) are some other alternatives.
There are many easy options to get up and get moving. Take calls while standing, hold meetings while walking, get up and do a few laps around the office. Making the most of your lunch break can be helpful: gather a few co-workers and use half the break to eat and the other half to walk. If you sit when watching TV, use the commercial breaks to get up and move; I have my TV in front of my treadmill and I exercise the entire time I watch my favorite show. There are so many good solutions to break the vicious sitting cycle. You just have to remember to do it and be creative!
To your health!
Anthony Pothoulakis, MD, FACC