Author Archives: lipsticklogic

About lipsticklogic

Betty Kuffel, MD FACP An honors graduate of the University of Washington School of Medicine, Internal Medicine physician and former nurse practitioner, Dr. Kuffel has broad healthcare experience. After years of directing and working in emergency departments, and directing hospitalist inpatient care, recently Dr. Kuffel retired to pursue many interests including writing this blog for women. Because of a shared desire to help women of all ages achieve healthy fulfilled lives, she joined with her sister Bev Erickson and founded Lipstick Logic ™ to bring health and lifestyle education to women. Their contributions to educating women include hosting and speaking at women’s conferences, writing a health blog on LipstickLogic.com and writing a monthly health column for Montana Woman Magazine. Dr Kuffel has been recognized for her commitment to helping others. The Lipstick Logic concept evolved over years of caring for women in crisis. Dr. Kuffel believes education is the key to living healthier and making informed choices. Heart disease is the focus their collaborative book, Your Heart: Prevent and Reverse Heart Disease. Coronary artery disease is the number one cause of death and it is preventable. See: YourHeartBook.com

Mediterranean 5/2 Eating Plan

The Five/Two Diet
Vegetable heartAs a method of weight loss and weight control, this easy solution of five/two pertains to a 7 day eating plan. Once you have reached your ideal weight, you transition to healthy baseline calorie intake every day. If you gain a pound, then you can transition back to the 5/2 plan. This is how it works:

• For 5 days a week, you eat a healthy diet based primarily on fruits, vegetables, a few nuts, a little olive oil, limiting pasta or rice to twice a week. Add limited whole grains to the mix, with low-fat meat, including salmon or other similar fish. Mirror your food selections with the Mediterranean diet like people who live along the southern Italian coast and Greek islands. Eating primarily fresh fruits, vegetables, and little saturated fat, they tend to live longer, in better health and with lower heart disease.

• For two days a week, eat very few calories, only 500-600. The two days must not be consecutive. Instead separate them such as Monday and Thursday.

Why not do the low calorie days together? Harsh calorie restriction can trigger what researchers call the starvation response. With starvation, the body revs up to store calories by lowering the metabolic rate and packing on calories when food becomes available. It is a natural process to maintain life.

Even though the two low calorie days are not true fasting, if they are consecutive such as Monday and Tuesday, your metabolic rate may be affected. Separating the days, combined with daily exercise such as walking is known to increase metabolic rate andkabob veg calorie burn. — And, with exercise, you are unlikely to stimulate a starvation response. In fact, with a marked reduction in calorie intake and consistent exercise, you will lose weight.

British physician Michael Mosley, described the 5/2 diet in his book FastDiet in 2012. In a follow up study done at the Aston University in the UK, they found intermittent fasting (very low calorie days) more effective than daily calorie restriction and calorie counting.

Favorable findings included:
• Reduced weight
• Reduced inflammation
• Reduced blood glucose
• Reduced lipids (cholesterol)
• Reduced blood pressure

True fasting (consuming no nutrition) has been shown to lower weight, prolong life, lower blood glucose and lower cholesterol levels. However, fasting also lowers metabolic rate, something you do not want, because your body becomes very efficient at storing excess calories and weight returns.

Eating two low calorie days per week is usually safe for Type 2 diabetics. Those taking medications and insulin must consult their medical provider for advice and to help manage medication dosages when reducing calorie intake. In the end, with weight loss, some Type 2 diabetics can reduce or stop some of their medications. Or, for those with borderline glucose elevations, weight loss and the drug Metformin, may help ward off the development of full-blown Type 2 diabetes. Without interventions, most people with borderline elevation of blood glucose will evolve to Type 2 diabetes within ten years.

Pay special attention to your daily intake:
• Choose fruits over sweets for desserts.
• Exercise portion control. Avoid second helpings. Wait 30 minutes and see if you are really still hungry.
• Do your best to prepare low calorie meals such as turkey breast instead of hot wings or steak.
• Forget potatoes, pasta, gravy, cheese sauce and fattening salad dressing.
• If you are preparing meals, serve light calorie recipes and fruit for dessert.
• Take time to exercise

Note: If you are, pregnant, breast feeding or a Type 1 diabetic, following a Mediterranean-type cuisine is healthy but do not follow the very low calorie day recommendations. However, this is a heart-healthy approach for those with high blood pressure and heart disease, even those who have had bypass and stent procedures.
Betty Kuffel, MD

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Type II Diabetes Epidemic

Diabetes Increases Risk for Heart Disease

Obesity ConceptMillions of people have Type II diabetes and the number is growing with the obesity epidemic. At first, as blood sugars rise, Type II diabetes is a silent disease without recognized symptoms, but behind-the-scenes, excess sugar molecules in the blood are causing harm.

Diabetes occurs when inadequate insulin is available for sugar metabolism. Instead of being used by cells for energy, the sugar molecules increase in the blood and interfere with cell function. This leads to heart disease, high blood pressure, strokes, vision impairment and kidney damage.

Type II diabetes is a complex metabolic problem. Although the body produces enough insulin at first, it isn’t being used properly because at the cellular level, insulin resistance develops. This stimulating the pancreas to produce more and more insulin, until the cells become distressed and die off, leaving the body unable to maintain proper insulin production. The disease worsens.

Treatment for diabetes is variable. It can be very complex, requiring numerous medications, self testing and the addition of insulin injections. Some people do very well for years in a pre-diabetic state. If a fasting blood sugar is minimally elevated, just taking the oral medication metformin, may reduce progression. But if the sugar continues to rise, additional treatment must be started as soon as possible to normalize the sugar.

If someone you know is overweight, particularly if the weight is carried around the waistline, blood sugar levels should be monitored and treated if elevated. Losing weight will help, but weight loss is not easy.

Best results occur with reduced caloric intake and healthful food choices, combined Family exercisewith exercise. Even walking thirty minutes a day, helps lower blood sugar, burns calories and improves longevity.

Type I diabetes is different from Type II. Type I is usually seen in young often thin people, including infants and children. Cells in the pancreas that make insulin are destroyed and are unable to produce insulin, a hormone essential for sugar metabolism. Insulin cannot be taken orally. It must be injected or taken as a nasal spray.

obesityType II diabetes had been a disease of aging people until recent years when overweight children began developing this serious problem. Like adults, children are at risk for serious cardiovascular disease. Elevated blood glucose levels damage arteries throughout the body. Over time the vessels become so narrowed they cannot carry an adequate supply of oxygen-rich blood and nutrients to vital organs. As more children become obese, more of them develop diabetes and are at risk for early heart disease.

So, what should we do? First, understand that Type II diabetes is a serious health risk even when no symptoms are apparent. The American Diabetes Association recommends having a fasting blood sugar test performed at least annually. Blood is taken after having nothing to eat or drink for at least eight hours. A fasting blood sugar above 100 is abnormal.

Another blood test, the hemoglobin A1C, measures red blood cell glucose attachment. This test correlates directly with the blood glucose levels over preceding weeks/months. If the A1C is 8, the glucose average has been 183mg/dl. Until more information becomes available, specialists believe an A1C goal of <7% is valuable in reducing health risks.

Symptoms of High Blood Sugar:
Excess urination (Ex.-Getting up at night repeatedly.)
Excess water consumption (Ex.-Drinking water during the night.)
Increased appetite, blurred vision, low energy
Neuropathy (burning pain and numb feelings in hands and feet)

Additional information regarding diabetes, healthful eating and weight control can be found on the following websites:
www.realage.com, www.diabetes.orgDiabetes Health in your handsBetty Kuffel, MD

MENOPAUSE IMPACT ON HEART DISEASE

Heart disease, osteoporosis and dementia increase with age.
New information supports prescribing estrogen to reduce these risks.

Few doctors will prescribe a hormone replacement following menopause because the Women’s Health Initiative (WHI) showed the risks of use far outweighed its benefits. According to the study, prescribing hormone replacements to block hot flashes put women at risk of breast cancer, uterine cancer, strokes and blood clots.

Hormone supplementation is complex. There are many pros and cons, but the WHI conclusion made it easy for doctors to just say no.

However, new research may reverse that practice. It might be time to once reconsider the use of hormone replacement for some woman.

Loss of ovarian hormone effects after menopause (or surgical ovarian removal) results in reduced bone density, leading to osteoporosis and broken bones. Many other symptoms such as skin wrinkling, hair changes and reduced libido are non-life threatening, but are irritating. In addition, serious health problems evolve over years and impact long term health.

Heart shapped brain♥ Heart diseasebrain skeleton
Osteoporosis
Dementia

 

 

Heart disease is the #1 cause of death in women.
There was a time when we were told estrogen had no effect on cholesterol, but a recent study showed reduced estrogen resulted in decreased function and effectiveness of HDL. HDL is High Density Lipoprotein, the good cholesterol. We want this number to be high.

♥ In a Danish study, women who took estrogen after menopause had a significant reduction in heart attack, heart failure and mortality (with no increase in cancer, clots or stroke).
♥ A Japanese study on menopausal women reported similar favorable heart findings and, in addition, showed improved bone density.

Osteoporosis results in more than 1.5 million fractures each year.
Fifty percent of all women over the age of 50 will suffer an osteoporosis-related fracture. Estrogen aids in calcium metabolism and is a key component of bone mass. Loss of estrogen with menopause contributes to weak bones and fractures in aging women. Poor diet and lack of exercise during adolescence reduce bone strength in later years. Proper exercise, vitamin D and adequate calcium intake are beneficial for bone health.

Dementia
Alzheimer’s disease is the 6th leading cause of death in the US – 2/3rds of these are women. At this time, Alzheimer’s is the only cause of death in the top ten that cannot be prevented or cured. The good news is, a recent preliminary study of the brain showed positive estrogen effects on the hippocampus (memory area) in women taking estrogen. Hormone replacement may reduce dementia in women. (See: Estrogen is back in the news. www.lipsticklogic.com)

As the population ages, dementia, osteoporosis and heart disease are becoming more prevalent. It is important to re-examine what can be done to reduce these debilitating illnesses. Estrogen replacement may once again be appropriate in some women.

Note: Why some women cannot take estrogen supplements.
There are 230,000 new cases of Breast Cancer each year and, annually, 40,000 women die from the disease.

There are many types of breast cancer. Some breast cancers result from genetic mutations, but 85% of breast cancers occur in women with no family history.

In some types of breast cancer, hormone replacement supports abnormal cell growth, helping the cancer cells grow and spread. These cancer cells have surface markers for estrogen and/or progesterone. This means hormone supplements should not be prescribed. A personal history of breast cancer or uterine/ovarian cancer also precludes the use of replacement therapy.

In the Women’s Health Initiative, the highest risk for breast cancer was associated with hormone replacement when both estrogen and progestin were prescribed. Women who have had a hysterectomy do not require progestin.

For additional information on similar topic see our other women’s health blog:www.lipsticklogic.com

CT Scan Your Heart

Did you know heart CT scans can identify narrowed coronary arteries better than a stress test?

Stress Tests
Treadmill testFor many years, the standard medical evaluation to look for heart disease has been a stress test. Walking on a treadmill, with continuous heart monitoring and periodic blood pressure checks, is still considered useful, and provides a functional heart evaluation.

The determination is based on stressing the heart with exercise and evaluating the cardiac response by electrical changes on the ECG. With patients suspected of having microvascular disease – when large coronary arteries mayEcho_heart be normal but tiny arterioles are stiff and narrowed – the stress test is done with usual monitoring, followed by an immediate heart echocardiogram to further evaluate heart function under physical stress.

Nuclear Stress Tests
nuclear stress testIn addition to the treadmill evaluation, a nuclear dye may be injected into a vein and the heart is scanned to evaluate blood flow, comparing the heart at rest with blood flow through the heart muscle with exercise. These comparisons evaluate differences in blood flow and identify possible coronary artery narrowing.

Invasive Coronary Arteriogram – Coronary Angiogram
The gold standard for evaluating narrowed coronary arteries is the invasive coronary Coronary angioangiogram. In that procedure, a catheter is placed in an artery, threaded to the heart and dye visible under fluoroscopy X-rays is used to outline the inside of the arteries supplying the heart muscle with blood and oxygen. If an artery is dangerously narrowed, the blockage can be dilated and stented to keep it open and prevent a heart attack. So, this test can be both diagnostic and therapeutic.

CT Coronary Angiogram (CT = Computed Tomographic Angiogram of the coronary arteries of the heart)

ct-heartJohns Hopkins researchers recently published their research comparing the noninvasive cardiac CT scan with stress tests and coronary angiograms. The CT angiograms showed a 91% accuracy in detecting or ruling out an artery blockage. Stress tests measured out at 69% accuracy.

Both heart CT scans and invasive angiograms are more expensive than stress tests. Stress tests provide information, but the CT scan is better. If the CT looks good, further medical follow-up will still be required, but you avoid complications, higher radiation exposure, and higher cost of the invasive procedure.

No evaluation carries 100% accuracy. The American Heart Association and the American College of Cardiology recommend stress tests as a first line screening tool. These guidelines may change because of this study showing the increased accuracy of the CT angiogram.

For more information on heart CT scans and the calcium score check out: https://www.nlm.nih.gov/medlineplus/ency/article/007344.htm

Betty Kuffel, MD

HEART ATTACK RISKS

Understand your risk factors and take action … before you have a heart attack.

Your Heart Book Cover- Final FINALThe American College of Cardiology reported young women with heart attacks are more likely to die than men. Part of this scenario is because many women do not experience the classic symptoms of chest pressure, arm, or jaw pain. Women are also more likely to report stomach symptoms, fatigue or shortness of breath instead of chest pressure when a coronary artery is closing. Without the proper diagnosis, life-saving interventions including stents to open a closing artery are delayed or not performed.

In a study evaluating women under age 55, Yale researchers found half the women believed they were healthy prior to a heart attack. Fewer women than men in the study had not received education from their care providers regarding risks for heart disease. Many of the women had modifiable risks and only 22% of them received information about heart disease and how to reduce their risks.

Nearly half of women in a 2012 survey did not report heart disease as a leading cause of death, yet they considered themselves well-informed on female health issues. Read a quick take on statistics and how you can identify and reduce your risks.

Excerpt from Your Heart book:

Women and Heart Disease

Many women do not realize they are at high risk for heart disease and early death. Under age 50, heart attacks in women are twice as likely to be fatal as in men. Each year more than 250,000 women die of heart attacks. Six times the number of women die from heart disease than from breast cancer. Many factors weigh into these statistics including hormones.

♥ Research reported in the National Institutes of Health bulletin, The Heart Truth for Women, states that by leading a healthy lifestyle, women can lower risks by 82%. You are in charge. This means: regular exercise, healthy weight and not smoking. Also take medications to control other risk factors such as high blood pressure and high cholesterol. What you choose to do and what you eat can improve health and prolong life.

♥♥♥♥♥

Five risk factors both men and women can modify and reduce their risk for dying from a heart attack:
• High cholesterol
• Smoking, tobacco use
• Diabetes
• Obesity
• High blood pressure

What to do about these risks: See your physician for an evaluation

  • Check your cholesterol and blood pressure.
  • Treat cholesterol and blood pressure abnormalities with diet modification and medication.
  • Stop all tobacco use.
  • Keep blood glucose normal with diet and medication.
  • Eat a Mediterranean diet and control your calorie intake. Consider the 5/2 diet for weight reduction (discussed in previous blogs on this website)
  • Exercise at least 30 minutes each day.

Betty Kuffel, MD

Sleep Apnea Affects Memory and Heart Health

Are you sleepy during the daytime? Is snoring a problem? Both are symptoms of a serious health problem. Apnea means without breath. Sleep apnea occurs when air movement in and out of the lungs is reduced during sleep, making blood oxygen plummet. Brain sensors identify the low oxygenSunset level and high carbon dioxide shift. This, in turn, triggers partial awakening to correct the problem. Deeper breathing is stimulated, often accompanied by loud snoring as increased effort overcomes the obstruction.

Once the airway is opened again, oxygen rises and carbon dioxide drops. The extra breathing stimulus isn’t needed…and sleep resumes. This cycle repeats many times each night. During most episodes, full awakening doesn’t occur. Other times, the person suddenly awakens gasping and choking. Individuals with sleep apnea may not experience overt symptoms, may be unaware of snoring episodes, and don’t realize their memory lapses and frequent naps are related to a problem that also increases their risk for serious heart problems.

Obesity contributes to this problem, but many thin people are affected, too. Alcohol, narcotics and sedatives relax throat muscles resulting in breathing problems. A narrow airway or large tonsils, even in children, can cause sleep apnea.

There are two primary types of sleep apnea. Obstructive sleep apnea occurs when the airway is blocked by oral tissue when throat muscles relax during sleep. Central sleep apnea is related to reduction of the respiration mechanism in the brain. Both types negatively affect health.

To diagnose the problem, a sleep study to continuously monitor oxygen, heart rate rhythm, and wakening is needed. The primary treatment for sleep apnea is “continuous positive airway pressure,” known as CPAP. This means wearing a carefully fitted mask attached to a small machine. The pressure and fit are individualized for each person to produce enough air pressure to keep their airway open during the normal relaxation of muscle tone during sleep. The adjustment to wearing such an apparatus may be inconvenient and a bit awkward at first, but can be life-saving.

After a good night’s sleep most people with sleep apnea experience a significant improvement in health and wellbeing. Small travel units are available.

What are the symptoms of sleep apnea?
• Restless sleep and fatigue
• Frequent awakening
• Daytime sleepiness, irritability
• Reduced memory
• Morning headaches and confusion
• Chest discomfort
• Children and teens may be poor students
• Behavioral problems in children

Health and heart risks associated with sleep apnea:
• Car accidents due to daytime sleepiness
• Atrial fibrillation, irregular heart beat
• Heart attacks and strokes
• High blood pressure
• Sudden death
• Dementia

Consult a physician and inquire about a sleep study if you are concerned about this health problem.

www.mayoclinic.org/diseases-conditions/sleepapnea
Betty & Bev

NEW BLOOD PRESSURE GUIDELINES

September 11, 2015

High blood pressure increases risk for:
heart attacks, heart failure, strokes, and kidney failure.

Blood pressure.2Until today, physicians did not have an optimal goal for patients with high blood pressure. New information released from the Sprint study was reported by officials from the National Heart, Lung and Blood Institute. A paper with all the data will be published in a few months.

The Sprint study examined nearly 10,000 men and women, ages 50 and older, who were at risk for heart and kidney disease. Twenty-eight percent of the participants were over the age of 75.

Officials from the National Heart, Lung and Blood Institute announced they ended the study a year before the planned conclusion because of the potentially lifesaving results. This is extremely important information because high blood pressure is so prevalent. One in three people (79 million adults in the US), have high blood pressure and half of those being treated have systolic pressures over 140.

About two years ago, a panel of experts at the National Heart, Lung and Blood Institute panel recommended a systolic goal of 140 because there was no convincing data to show lower was better, now we have that data.

There have been improvements over the past few years with healthier lifestyles, more exercise and lowering abnormal lipid levels, but cardiovascular disease remains the leading cause of death. Uncontrolled high blood pressure contributes to heart disease in addition to the other disorders noted above. It is important to monitor your blood pressure and take control of your health. If your blood pressure is consistently above 120 systolic (the upper reading), see your healthcare provider for assistance in lowering your blood pressure to 120 or below.

Betty Kuffel, MD