Posted on Jun 08, 2019, 4 p.m.
Original article can be found on medium.com:
Written by: Dr. Joel Khan
Professor of Cardiology, Summa cum Laude grad, Kahn Center for Longevity and GreenSpace Cafe.
In early 2017 many followed media reports of the unexpected heart attack of Biggest Loser fitness trainer Bob Harper and his fortunate recovery. His return to fitness and a plant diet was a journey that taught many readers about life after a heart attack.
This past week a poignant report in the New York Times by MSNBC reporter Trymaine Lee described his heart attack at age 38 and the fear of the future that such a traumatic event creates at a young age. After treating patients suffering heart attacks of all ages for over 30 years, the psychological burden of dealing with mortality is one I can relate to and have discussed with many in my clinic. I wish Mr. Lee, Bob Harper, and all others experiencing this journey the best of health, healing, and long life.
My career passion has been the prevention of heart attacks and in that spirit I will contribute some recommendations that may not have been previously considered by readers who are recovering from a heart attack.
1) Intensive Cardiac Rehabilitation
After recovery from a stent placement or cardiac bypass surgery, all patients should be offered enrollment in a cardiac rehabilitation (rehab) program, usually located in a hospital facility. This program is covered by insurance providers due to data accumulated over decades that improved outcomes and lower medical expenses are realized by participants. Since 2010, Medicare and other providers have also paid for a “juiced up” version of rehab called Intensive Cardiac Rehabilitation (ICR).
Traditional cardiac rehab typically allows for 36 sessions and focuses on exercise with some instruction on non-exercise factors, such as diet and stress management. ICR includes up to 72 sessions (as many as six sessions per day), and incorporates exercise and in-depth education about nutrition, stress management, meditation, and the relationship between lifestyle and heart health. The Centers for Medicare and Medicaid approved coverage for two ICR programs: the Pritikin ICR program and the Ornish Program for Reversing Heart Disease. To be approved for reimbursement by Medicare, ICR programs had to show in peer-reviewed published research that they actually reverse the progression of heart disease; reduce the need for coronary bypass surgery; or reduce the need for coronary angioplasty and stents. The ICR programs also had to show that the program dramatically improved the participants’ cholesterol, blood pressure, need for medication, and body weight. Typically for three to four hours a day, twice a week, for nine weeks, ICR patients exercise and learn how to live a healthy lifestyle. They learn how to cook heart healthy meals, shop for healthy foods, and order wisely in restaurants. The comprehensive plan also helps patients quit smoking, manage stress, meditate, maintain positive personal and professional relationships, and adopt a positive mindset. At the end of nine weeks, patients are encouraged to attend regular support groups, which follow a similar format as the supervised sessions. Although hospitals are reimbursed more for ICR than traditional rehab, there are still limited access to ICR programs. In Michigan where I practice there is only one program, Pritikin ICR, in Ann Arbor. Soon after discharge home from a heart attack I would recommend searching if there is a Pritkin or Ornish ICR in your area and ask for a referral.
After standard or ICR, I suggest seeking out a support group for heart patients. One group that has chapters around the country is Mended Hearts. In Detroit I co-founded the Plant Based Nutrition Support Group with Paul Chatlin in 2014 after his heart scare. That grass roots movement has grown to over 6,000 members providing education and a peer group to many with heart disease.
2) Transcendental Meditation
Much of the research on the medical benefits of meditation for heart patients, particularly transcendental meditation (TM), has come from Dr. Robert Schneider and his team at the Institute for Natural Medicine and Prevention. The TM method involves using a sound or mantra repeated effortlessly over and over for 20 minutes twice a day. Students are taught in formal sessions for 90 minutes for 4 consecutive days. TM is taught by certified teachers and a fee is charged. It is a non-religious practice for relaxation, personal growth, and stress reduction.
Dr. Schneider and researchers completed a study on 201 people with heart disease and prior heart attack. The group was taught either to practice TM 20 minutes twice a day or received instructions to spend at least 20 minutes learning about health. During a follow-up just over five years, the group that meditated saw a 48% reduction in the combined occurrence of death, heart attack and stroke! One would be hard put to find a pharmaceutical agent with the same ability to reduce cardiac events. Learn to meditate, whether it is TM, proven after a heart attack, or other forms of meditation.
3) Cardiac Nutrition
The long held concept that after a heart attack heart arteries always get more diseased with time was shown to be incorrect in 1990 by Dean Ornish, M.D. He prescribed a plant-based diet without added fats to patients with proven heart blockages. He also recommended walking, social support and stress management to help their hearts. He demonstrated that the patients who adhered to his “lifestyle program” felt better and showed reductions in the amount of narrowing in their arteries. Dr. Ornish followed his patients for longer periods of time and with further testing and showed even more improvements, avoidance of hospitalizations, and reduced costs.
Because the research done by Dr. Ornish, and the original Pritikin Center were in California, it could be argued that the plant diet reversal of heart disease was only a West coast thing. Fortunately, a similar research program at the Cleveland Clinic Foundation led by Dr. Caldwell Esselstyn monitoring patients with advanced heart disease who converted to totally plant based diets without added oils identified the same types of clinical improvements with documented shrinking and reversal of heart blockages. I would encourage anyone recovering from a heart attack to read books and watch videos by Drs. Ornish and Esselstyn.
4) Advanced Labs
After a heart attack the question of why this serious event happened should be considered. It may seem obvious in some cases where smoking or known diabetes mellitus is present. In others it is truly a mystery to be solved. Therefore I suggest that advanced lab tests be requested at a medical visit after a heart attack. You can order most of these labs direct from Wellness FX and Life Extension.
Advanced lipid profile: Rather than giving you a calculated LDL cholesterol level, advanced panels measure LDL particle number and size, which are more predictive of future heart and stroke events. Two people with the same cholesterol levels can have widely different particle and size measurements, making for very different risks. If the LDL particle number is elevated, then further changes in diet, fitness, and Rx medications can be considered.
hs-CRP: The high sensitivity C-reactive protein is a blood test patented by Harvard Medical School to measure inflammation or the “flame” that results from an irritated immune system. The higher the hs-CRP the greater the risk of events due to atherosclerosis such as a heart attack, stroke and other conditions like cancer and dementia.
Lipoprotein (a): This is a genetic form of cholesterol that’s elevated in about 20% of those tested. It is also known as lp(a) or the sticky cholesterol and was identified as a cause of Bob Harper’s heart attack. It is rarely drawn even though research studies indicate that if the lp(a) level is high, the risk of recurrent heart attack and stroke skyrocket. It runs high in many families that have been impacted by heart disease.
Homocysteine: This amino acid is produced by a process called methylation. It can injure arteries when elevated. It may be due to a genetic defect in the MTHFR gene, which is easily measured, and can also develop due to meat heavy diets. It can be treated with methylated B-complex vitamins and diet changes.
TMAO: TMAO is a newly described marker of heart and kidney health that’s elevated after eating meat- and egg-heavy diets with an altered gut microbiome. It is a blood test that is available and my clinic has performed more than just about any other clinic in the world. It has been shown to cause heart and kidney damage, and is associated with worsened prognosis.
5) Carotid Intimal Medial Thickness (CIMT)
A CIMT is a 20-minute ultrasound of the neck that uses advanced software measurements to examine carotid arteries for both and soft and hard plaque. The CIMT also measures the thickness of arteries, another sign of aging. I recently published some examples from my clinic of reversal of plaque detected by serial CIMT, safe to do using ultrasound. A baseline CIMT, if you can find an advanced prevention clinic that offers it, can be used to provide a yearly analysis of arterial health and response to treatment measures.
A number of supplements have been studied in humans in terms of their impact on whether atherosclerosis may progress or decrease over time. I have summarized these findings recently. Some of these could be considered after a heart attack. Of more direct interest is the antioxidant known as Coenzyme Q10 or CoQ10. Many studies in animal models have suggested that this supplement is of benefit after an experimental heart attack, likely due to depletion of coQ10 in cells. This occurs both from the heart attack itself and from statin cholesterol lowering medication. A recent study in humans reported better recovery of measures of heart function in patients recovering from a heart attack. As the safety of coQ10 is very high and it is widely available, it may be a consideration for most patients before or at discharge.
A heart attack at any age is a major health concern and it is particularly frightening in younger patients like Mr. Lee and Bob Harper. Working with an experienced medical team to monitor standard parameters of recovery, such as the necessity of medication and return to work, is crucial. In addition, the 6 approaches that are discussed here can empower patients to make positive steps toward healing the mind and the body during recovery from this serious and common condition.