Tag Archives: Heart Disease

DR. C’S MEDICINE CABINET: “FOLIC ACID” SUPPLEMENTS

Folic acid has a secure place in my medicine cabinet, and is there for one of the best reasons. In screening for possible causes for heart disease, my doctor ordered a HOMOCYSTEINE LEVEL. The Laboratory value came back elevated.

The treatment given was folic acid. Some background is necessary. Homocysteine is a rather toxic amino acid that can cause heart disease and neurological problems, among other things. If you do not get enough folic acid in your diet with green vegetables, legumes, nuts, eggs and the like (it is hard to be deficient with a good diet), your Homocysteine may become elevated.

You need folic acid to convert Homocysteine to the essential amino acid, Methionine. 10-15% of the population, and up to 30% of older people have elevated Homocysteine levels. Stiffness, slow gait, and heart disease can be related to these elevated levels.

Since I have a good diet, I assume that I have a weak form of an enzyme called Tetrahydrofolate Reductase, which is the rate limiting enzyme in converting Homocysteine to Methionine. A weak enzyme needs more folic acid to do its job. The MDR of Folic acid is 0.4 mg./day. I started supplementing with 1 mg. Daily, without effect on the Homocysteine level. I doubled the dose to 2 mg., and my blood level was still above the upper limits of normal, 15 micromoles/L.. I doubled it again to 4 mg., 2 mg. Twice daily.

Finally my level became normal at 10, This was a decade ago. Recently, I have been doing some research on Alzheimer’s Disease, because a Friend is losing her short term memory. I talked to a neurologist to see if a medical evaluation was mandatory, and found that he has recently BEEN GIVING FOLIC ACID supplements to his AD Patients.

Folic acid deficiency is now being suspected as being a factor in AD! This story is similar to the Vitamin D conundrum. Should I take Vitamin D or not? Am I a “believer” or not. The resolution is easy. You get a Vitamin D blood level.

The lab test will report “normal” if your level is above 20 ng,/ml. I prefer 50, which I achieve with 4000 i.u. Daily supplement. The NFL likes their players to be above 50 to be in best shape. The point is, take a measurement, and then decide.

If you chose to take a Folic acid supplement, I would suggest checking both your Folic acid blood level, and Homocysteine blood level as a reference.

Also, if you take folic (B9) supplements, you should also take extra B12, and B6, since they are involved in the same metabolic pathways. Balance is necessary in metabolism.

–Dr. C

BLOOD VESSELS: HUMAN “PULMONARY CIRCULATION”

Humans have a high energy requirement. Like a sports car we need to be turbosupercharged. We need an entirely separate Pulmonary circulation to handle our great oxygen demand.

Fish can get by on a single heart and circulation. They are “cold-blooded” and have no elevation of temperature above that in the environment. The water buoys them up, and they don’t need to constantly fight gravity.

Birds, and by extension, therapod dinosaurs, need more efficiency, and have a separate pulmonary circulation, just like we do. They share with us a DOUBLE CIRCULATION, a 4-chambered heart, with 2 entirely separate circuits.

In my residency, I saw a lot of congenital heart disease. In the process of development, the very early human embryo has a single circulation, just like “early” vertebrates, like fish.

In the process of development, the Systemic and Pulmonary circulations divide the previously unitary system into 2 separate systems, by a continuous spiral of partitions, or “septae”.

Ontogeny recapitulates Phylogeny: Development recaps Evolution. If this process of separation fails to happen in a given child, Congenital Heart Disease is the result:

  • IASD. Interatrial Septal Defect is failure to separate the Atria, the upper chambers of the heart;
  • IVSD, Interventricular Septal Defect, is failure to separate the Ventricles, the lower chambers of the heart;
  • AV Communis is both of the above, plus failure of Atria and Ventricles, the upper and lower chambers, to separate, giving one big inefficient chamber.

When you listen to the hearts of these children, there are prominent murmurs, or noises, which betray the presence of turbulence and inefficiency, the very thing that evolution “tried” to prevent.

In the normal Human Heart, the blood returns from it’s systemic circuit through the capillaries, depleted of oxygen, into the vena cava. It passes to the Right Atrium, through the tricuspid valves, to the right ventricle.

With the contraction of the heart, the blood goes through the pulmonary artery, into the pulmonary capillaries, into close contact with air-containing alveoli. The oxygen passes through the alveolar membrane into the capillary blood, which becomes red. The oxygenated blood then passes into the pulmonary veins and on into the left atrium, and the systemic circulation.

It is interesting, and essential that the systemic arteries contain red, oxygenated blood, and the Pulmonary artery contains blue, oxygen-depleted blood. The “tired” blood, returning from the body must be “pepped up” by passing through the pulmonary circuit, picking up oxygen in the process.

Similarly a clot, originating in a quiet vein, perhaps a dilated, or varicose vein, is pumped into the Pulmonary circuit, where it lodges in the tiny capillaries and produces a PULMONARY EMBOLISM.

The embolus clogs the pulmonary circuit, increasing resistance, raises the normally-low pulmonary artery pressure and produces PULMONARY HYPERTENSION, placing more load and strain on the Right Ventricle.

Pulmonary Hypertension is also caused by a variety of Lung, heart, inherited and kidney diseases, as well as by certain drugs, high altitude, and Obstructive Sleep Apnea.

Please check the Mayo Clinic discussion that follows.

–Dr. C

Pulmonary Hypertension Article

STUDY: “FRAGMENTED SLEEP” INCREASES INFLAMMATION & HARDENING OF THE ARTERIES

From UC Berkeley (June 4, 2020):

UC Berkeley Logo

“We’ve discovered that fragmented sleep is associated with a unique pathway — chronic circulating inflammation throughout the blood stream — which, in turn, is linked to higher amounts of plaques in coronary arteries,” said study senior author Matthew Walker, a UC Berkeley professor of psychology and neuroscience.

Disrupted nightly sleep and clogged arteries tend to sneak up on us as we age. And while both disorders may seem unrelated, a new UC Berkeley study helps explain why they are, in fact, pathologically intertwined.

Some tips to improve sleep quality

  • Maintain a regular sleep routine, going to bed and waking up at the same time each day.
  • As part of a nightly wind-down routine, avoid viewing computer, smartphone and TV screens in the last hour before bedtime, and keep phones and other digital devices out of the bedroom.
  • Engage in some form of physical exercise during the day.
  • Get exposure to natural daylight, especially in the first half of the day.
  • Avoid stimulants, like caffeine, and sedatives, like alcohol, later in the day.

UC Berkeley sleep scientists have begun to reveal what it is about fragmented nightly sleep that leads to the fatty arterial plaque buildup known as atherosclerosis that can result in fatal heart disease.

Read full article

COMMENTARY

“How much sleep do we need”, and “Sleep Hygine” were past topics on this site, and my own sleep fragmentation was mentioned. This study correlates sleep fragmentation in the elderly with increased blood vessel disease compared to elderly people who have no interruptions in their sleep.

The elderly have several obstacles to a good, full night’s sleep, although a fair number of my friends claim the blessings of sleeping soundly. As we get older, we lose the deepest sleep we enjoyed as children, and there is some loss of REM sleep as well. The elderly sleep more lightly.

Diseases begin to accumulate as we get older, and These DISORDERS and their TREATMENT can disrupt sleep. I mentioned My BPH with it’s blockage of flow, leading to incomplete emptying of my bladder. This led to FREQUENT URINATION and frequent arousal at night.

With aging, the tissues in the throat become more flabby, and if you SLEEP on your BACK, your inhalation may be blocked. This may result in OBSTRUCTIVE SLEEP APNEA, where your breathing  and sleep are interrupted repeatedly. The associated SNORING may interrupt the sleep of your partner, or even the sleep of those in the next room.

GERD, where you choke on regurgitated stomach contents, is more common in the elderly.

Chronic Heart, lung and Kidney disease can interfere with sleep.
SLEEP DEPRIVATION leads to a variety of problems, such as the inflammation and Arterial blockage highlighted in the above article.

Sleep is intimately connected with DIET and EXERCISE. As one of the PILLARS of HEALTH,  It s well worth discussing with your Doctor and following her instructions.

—Dr. C.

TELEHEALTH: “Smartphones Used to Monitor Heart Patients with Pacemakers”

In a first of its kind study, Cleveland Clinic researchers found Bluetooth-enabled pacemakers successfully transferred information to doctors 95% of the time through an app on the patient’s smartphone or tablet. In comparison, traditional bedside consoles were successful 77% of the time.

Read more

OPINION: HEART AND BRAIN HEALTH ARE LINKED FOR LIFE

Your heart and your brain are your two most vital organs, and if you enjoy life, they should be a top priority. These amazing structures are tethered to life-giving support by your arteries, just as the new you was tethered by your ubilical cord.

Life is fragile, hanging by a thread, or an artery. over the span of your life, These arteries can become plugged by fatty deposits called plaques. A healthy life style-SLEEP, DIET and EXERCISE– could slow down or prevent this atherosclerosis.

But everybody should know about the symptoms of HEART ATTACK and STROKE (1) and how to respond if the arteries sustaining your heart or brain become blocked.

You should be familiar with the hospitals in your area. How close are they? What are their capabilities? Are they Class 1 for heart attacks and stroke? Do they have a CATH LAB?

SPEED is important. Within minutes of the BLOCKAGE of an ARTERY to your heart or brain, vital cells start to die. The goal is to remove the blockage as soon as possible. CALL 911 as soon as you have heart attack or stroke symptoms. Don’t be afraid of the ER because of Covid, since almost all now use TELEMEDICINE SCREENING to keep infected patients segregated.

Alas, for many people, such PREVENTATIVE MEDICINE requires too much SELF DISCIPLINE AND CONVICTION. America has an epidemic of OBESITY and an avalanche of tasty FAST FOODS provided by a CONSUMER SOCIETY that is ever-attentive to the latest fads and trends.

DR. C