Category Archives: Exercise

Heart Disease in Children


The Bogalusa Heart Study reported obese children as young as five show artery changes seen in early heart disease. Additional studies show obese children, in particular, have the same metabolic disorders as adults leading to early heart disease.

Many factors contribute to cardiovascular diseasethe leading cause of death in adults. A lifetime of excessive eating and not enough exercise combined with smoking are three leading causes of early heart attack and death. Many people with arteries nearly closed have no symptoms. Some have multiple heart arteries with blockages above 90% and don’t know it. A key to living longer is recognizing risk factors and lowering your risks by making healthy choices and seeing a physician for a physical and laboratory studies.

Inherited Risk with High Cholesterol Genes

Some families have faulty cholesterol genes placing them at risk for early heart disease. High cholesterol levels increase the risk of early death. In my family, males had heart attacks in their 30’s and 40’s and died very young, but today, that statistic can be changed. Today, children who carry the inherited trait for high cholesterol can be diagnosed early and treated. When treated, they are living longer than their parents did.

A new National Heart, Lung and Blood Institute recommendation is to test the cholesterol level (called a lipid panel) in children between the ages of 9 to 11. Previously, lipid testing beginning at age 20 was recommended.

Note: There are experts who disagree with this recommendation but if your child has familial and other risks, discuss cholesterol with your child’s pediatrician or family doctor.

Parents don’t often think about their child’s cholesterol levels but heart disease can develop in childhood. The test involves taking a blood sample to analyze for different kinds of fats (lipids) in the blood. Cholesterol is a lipid or fat. High levels of cholesterol are known to contribute not only to heart disease, but also strokes.

Over time as cholesterol accumulates within the wall of heart arteries, blockages starve the heart muscle of oxygen and nutrients. For most people, the process occurs over a lifetime of eating the wrong food and too much of it, with inadequate exercise. But in families with faulty cholesterol genes, the problem becomes evident at a young age and shortens life.


Drugs called statins may be prescribed in adults and in some high risk children and teens to lower cholesterol levels and prolong lives. The primary treatment in all ages is proper eating and an active lifestyle. Taking statins helps, but a low fat nutritious diet with predominant fresh fruits and vegetables is most important.

Additional Obesity Health Risks in Childrenobesity

A study published this year from the University of Eastern Finland showed obese children as young as six had already developed high blood pressure, high glucose and high insulin levels showing insulin resistance like adult Type 2 diabetics. In addition, the children had high triglycerides (a fat contributing to heart disease) and low HDL-cholesterol, the good cholesterol – the one you want high. They found blood pressure, triglyceride and insulin level elevations contributed to stiffening even in young arteries. This leads to cardiovascular disease.

 High blood pressure is a silent disease in both adults and children. Treatment decreases risk for the development of cardiovascular disease. Pediatricians now recommend measuring blood pressures in children at every visit beginning at age three. High blood pressure in children is more common in obese children and must be a part of the child’s health evaluation.

Type 2 diabetes accelerates cardiovascular disease. It was formerly a disease of older adults. Now Type 2 diabetes is common in overweight teens.

 Researchers in a Washington University study found a link between teen depression and obesity. With inactivity and smoking, the study also found teens are twice as likely to die by age 55 than non-smokers. Recognizing and treating depression, stopping smoking, avoiding second hand smoke, normalizing weight and increasing exercise can lower heart disease risk for at risk children and teens.

Early diagnosis with physician monitoring and appropriate interventions along with healthy food choices beginning in childhood and an active lifestyle are the keys to better health and a longer life.

dinner-on-healthy-platechildren kids bicycling




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Yesterday, experts in cardiovascular disease prevention published new guidelines for heart and vascular health. Based on hundreds of clinical research studies, this is the latest science-based analysis on heart disease and stroke prevention. Source: American College of Cardiology and the American Heart Association.

 My father died in 1960 of coronary heart disease. He was 52 years old. His first heart attackIMG_5818 occurred at age 46. Like many people today, he had familial cholesterol elevation and smoked. Had he known what actions to take to improve his health and the opportunity to take a statin drug to lower his cholesterol, I’m sure he would have added many years to his life. With the new guidelines, we all have the Links to Living Longer.

 The information below is provided to help others take steps to improve cardiovascular health and live longer through healthy actions. I appreciate feedback and questions.

 Thank you,

Betty Kuffel, MD

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 Cardiovascular disease is the number one cause of death.

It is preventable and treatable.

Many people do not follow lifestyle recommendations and do not take medications known to prolong life. These guidelines provide a standardized basis for the best approach to reduce risks and save lives.


Eat Healthy

Vegetable heartCalculate your calorie requirements and follow a Mediterranean or plant-based diet that includes a predominance of fresh foods with 4-5 servings of fruits and vegetables per day, high fiber and whole grain foods, fat-free or low-fat milk products, nuts, lean meat/poultry/fish, limit saturated fat and trans fat, limit sweets and added sugar.

Reduce High Blood Pressure

See your physician for a health evaluation and laboratory studies. Blood pressure monitoring and treatment may be necessary. Reducing salt/sodium intake below 2,000/ day is recommended for most adults. Monitor your own blood pressure and read food labels. Avoiding processed food and salty soups will help reduce blood pressure.

Reduce High Cholesterol

Because of common inherited disorders many people cannot reduce cholesterol to healthy levels even when eating a low fat vegetarian diet and attaining low weight. Some must take a drug to treat the abnormal lipids. (Lipid is a generic term for fat and cholesterol.)

If Necessary, Take Statins

Statins are the most effective drugs to reduce harmful LDL cholesterol. The new guidelines strongly recommend the use of statins while at the same time decreasing your intake of all types of saturated fat including full fat milk products, coconut/palm oil, and all trans fats found in “partially-hydrogenated” fat products. These include margarine and many commercial baked goods. Under new guidelines statins are indicated for people diagnosed with heart disease, Type 2 diabetics aged 40-75, and an LDL of 190 or higher, and other factors if determined to be at risk. LDL is the bad cholesterol. Remember – taking a statin does not mean you can continue to eat bacon cheeseburgers – healthy eating is imperative to reduce risks of heart disease even when taking statins.

Lose Weight

If you are overweight like most Americans, no matter what your age, you are at higher risk for arterial heart disease and vessel disease throughout your body. Children as young as five years old, who are obese, are at risk for early heart disease and diabetes.

With weight gain, fat accumulates in the body contributing to high LDL (bad) cholesterol, higher triglycerides and high blood pressure. All are known to be detrimental to health.

In addition, weight gain correlates with the development of Type 2 diabetes and blood glucose elevation making your risk of heart disease even higher. Avoid diabetes. Treat pre-diabetes (mild elevations of blood glucose).

 To calculate your ideal weight and develop a plan for better heart health, see your physician for guidance. Note: Many websites such as  provide calculators for calorie needs and BMI to determination obesity range. BMI is Body Mass Index. Knowing these guidelines will help you take appropriate action to reduce your health risks.

Be Active

Risk reduction recommendations include activities such as brisk walking for 40 minutes at least 3-4 times a week.

Factors contributing to cardiovascular health include: race, gender, age, total cholesterol, HDL cholesterol, blood pressure, diabetes and smoking.

Uncontrolled high blood pressure, cholesterol abnormalities, excessive weight, diabetes and tobacco use are high risk factors contributing to arterial narrowing, heart disease and stroke.














Even if you have been diagnosed with Type 2 diabetes, coronary artery disease, peripheral vascular disease, or have had a heart attack, stents or a stroke, there is hope for improvement.

 Major risk factors for coronary artery disease are all factors under your control:

♥ Tobacco use – stop smoking or chewing

♥ High blood pressure – meds, weight loss & exercise help lower blood pressure

♥ Cholesterol abnormalities – statin drugs & a low-fat diet help reduce cholesterol

♥ Obesity – exercise and reduced calorie intake help reduce obesityObesity Concept

 ♥ Type 2 diabetes – lower blood sugar with proper diet and insulin

♥ Low activity – take walks, join a fitness center

♥ More than one alcohol drink per day – limit all alcohol consumption

♥ Illicit drug use – get help – stop using illegal drugs

♥ High levels of calcium supplements (over 1200mg/day) – limit supplements


smoke-091Quit using tobacco of any kind, normalize blood pressure, weight and blood glucose. In addition, a medication regimen to improve lipids may be necessary. All these factors contribute to lowering risks and reducing the closure of arteries and stents.

 Stents are inserted into diseased plaqued-blocked arteries to buy time. Bypass grafts provide a route around the blockage. Both are temporary methods used to save lives.

The body accepts the stent and forms a smooth covering over the interior like the natural vessel. If lifestyle changes and medications are not made to keep the stent open, the stent will close just like the diseased artery. Bypass grafts also develop cholesterol plaques. New plumbing buys you time and allows you to take control and improve your health.

 Taking a statin to lower your cholesterol is not a ticket to eating fried foods, bacon cheeseburgers or eggs.

Taking a glucose-lowering medication or insulin, is not a ticket to eating sweets and carbohydrates

 Stents and grafts are not tickets to continue your past eating and lifestyle habits


In addition to cholesterol narrowing in large arteries, microvascular disease  makes small coronary arteries stiff. More common in women, this disorder can also affect men. The cause is not known but is more commonly seen in conjunction with Type 2 diabetes and inflammatory disorders related to autoimmune diseases such as: rheumatoid arthritis, MS and lupus. In addition, anemia, polycystic ovary disease and hormones can contribute to microvascular dysfunction.

Microvascular disease is treated with medication, lifestyle changes, and normalizing all risk factors. Exercise and healthy food choices are key.Family exercise


Diabetes Health in your handsType 2 diabetes is preventable, treatable and partially reversible in many people. If you have prediabetes or borderline blood glucose without aggressive treatment including weight loss, you will likely progress to full blown diabetes within ten years. With proper medical care, exercise and healthful food choices, you can take control and improve your health.

 Until the epidemic of obesity around the world occurred, Type 2 diabetes was a disease of older people, not teenagers. We are now seeing overweight adolescents with Type 2 diabetes. Of grave concern is evidence of heart disease present in overweight 5-year-olds.obesity

Bad food choices and lack of exercise contribute to Type 2 diabetes & heart disease.

Even if heart disease runs in your family you have the ability to reduce hereditary risks and live longer. Interventions need to begin in childhood and continued throughout life, but it’s never too late to start. The American Heart Association recommends children should have a blood lipid panel before age twenty to help determine risks and begin treatment when appropriate. Do you know your lipid numbers?

You can offset “bad cholesterol genes” by making healthy choices.

 When vessels become narrowed with inflammatory cholesterol plaques, symptoms can be intense with crushing chest pain radiating into the neck and down the arms, weakness, sweating and collapse. However, that is not always the case. In fact, arteries may be more than 90% closed and generate no symptoms. Just because you have no chest pain, it doesn’t mean you don’t have cardiovascular disease.

 Major risk factors for coronary artery disease include: tobacco use, uncontrolled high blood pressure, cholesterol abnormalities, obesity, diabetes, low activity, alcohol and other drugs, high levels of calcium supplements (over 1200mg/day) and hereditary factors. In addition, microvascular dysfunction, a form of coronary artery disease in small vessels is common in women. This is because women more often develop autoimmune disorders such as rheumatoid arthritis, MS and lupus. In addition, anemia, polycystic ovary disease, hormone changes and Type 2 diabetes all contribute to the metabolic mix.

Even if you have been diagnosed with Type 2 diabetes, coronary artery disease, peripheralMed.Food vascular disease, or have had a heart attack, stents or a stroke, there is hope for improvement. Exercise and normalizing weight, blood pressure and blood glucose, in addition to a medication regimen to improve lipids — all contribute to lowering risks and reducing the closure of arteries and stents. Taking a statin to lower your cholesterol is not a ticket to eating fried foods, bacon cheeseburgers or eggs. Good dietary practices are essential to long term health.

Weight Training Reduces Heart Disease Risks

Man-Lifting-WeightsExercise correlates with long life, better health, less depression and better memory. Another medical study published recently also found that even if you have a favorable lipid panel (your cholesterol numbers), exercise is more important than having an ideal weight. That is good news for overweight people struggling to lose the excess body fat.

Just because your “cholesterol numbers” are right-on, it doesn’t mean you can stop taking walks and eating a low fat diet. This study shows strength training is also beneficial.

HDL is high density lipoprotein, the favorable form of cholesterol that acts as a transport molecule removing the LDL (bad cholesterol) from narrowed arteries. HDL has other functions including reducing inflammation, a strong component of coronary artery disease which is the number one cause of death in adults.

We want the HDL high and the LDL low. The levels can be improved through exercise, medication and proper eating but the new information is —even if the HDL is in a favorable range, strength exercise training improves its ability to transport LDL and reduce inflammation.

This information reaffirms the importance of exercise for heart health and longer life, but researchers specifically looked at how well the HDL functioned in fit vs. unfit young men. They examined 90 men of varied weights and exercise patterns. Measurements included: body size, fat composition, muscle strength, carotid artery thickness (increased in heart disease). Laboratory studies included: blood fats, insulin, inflammatory markers and sex hormones.

 Regular weight training appears to improve HDL function and reduce the risk of heart disease even in overweight men. Additional studies have shown the importance of many forms of exercise in heart health.

 Important basics of heart health:

  • Quit tobacco use
  • Normalize blood pressure
  • Treat abnormal cholesterol levels
  • Low fat diet and weight management
  • Exercise

Betty Kuffel, MD

Source: American Physiological Society (APS) (2013, October 9). When it comes to the good cholesterol, fitness trumps weight. ScienceDaily. Retrieved October 12, 2013, from­



One year ago Michael Mosley, MD, published his book The Fast Diet  with the 5/2 concept of intermittent fasting. Benefits of calorie restriction have been known for many years. There are many variations on this theme.

True fasting – eating nothing – can trigger a reduction in the body’s metabolic rate. This slowdown stimulates efficient calorie storage and weight gain when eating resumes. Known as a starvation response, it is part of our genetic makeup.

Ancestors who survived long droughts and periods of starvation carried the surviving genes of longer life.  With these favorable genes came the body’s natural ability to pack on weight easily during good times in preparation for periods when food was scarce. In the past, this was life-saving. Today, those same genes carry some of the responsibility for obesity, but not all.

 With food easily available and daily exercise reduced, one-third of our society has become obese. People are eating more calories than they need. The excess calories are stored in tissues as fat. Over time, the natural process of fat storage as energy reserve produced the obesity epidemic.

With the dramatic increase in obesity in the US and around the world in developed countries, we see an upsurge in related diseases. With excess weight, there is an associated increase in heart disease, Type 2 diabetes, sleep apnea, arthritic joints, high blood pressure and strokes. Many forms of cancer are also associated with obesity.

 Overweight people try many gimmick diets to lose weight and fail. If the dietary recommendations are non-sustainable over a lifetime, the excess weight returns. Learning and practicing healthy eating is the key to success.

 I am proposing  a variation on Dr. Mosleys concept. A 5/2 eating plan combined with the Mediterranean cuisine. Even if you are busy and eating in restaurants daily, this is effective, easy and can be followed over a lifetime.   I will explain more below.

First, a little background and recommended reading: The China Study, a book published in 2005, and the Mediterranean and plant-based food choices.

The China Study

A twenty year study began in 1983 with T. Colin Campbell, an American biochemist and nutritional expert at Cornell University and his physician son Thomas M. Campbell, in association with the Chinese Academy of Preventive Medicine, Cornell University and the University of Oxford. Using dietary surveys and blood work, these men examined the effect of diet on 48 forms of cancer and chronic disease on 6,500 people in 65 counties in China.

 Many complex analyses were made on the data, but in the final judgment, consuming animal-based protein increased blood cholesterol, heart disease, diabetes, autoimmune diseases and many forms of cancer. These diseases common in Western countries were extremely low in the Chinese population. This led to their recommendation of the vegan (animal product-free) plant-based diet.

Following President Bill Clinton’s diagnosis of coronary artery disease and bypass surgery, Clinton began eating vegan. His health improved. He lost weight and became a supporter. Sanjay Gupta, MD, CNNs chief medical correspondent is an advocate of plant based eating. Long time advocate of whole food eating and minimal animal product consumption, Dean Ornish, MD, combined this eating pattern with exercise and yoga. His patients with advanced heart disease showed evidence of reduction in arterial blockages.

 In 1970, a University of Minnesota physiologist, Dr. Ancel Keys published a report on cardiovascular disease related to diet. The initial research involved 12,000 men in Finland, Greece, Italy, Japan, Holland the United States and Yugoslavia. The highest incidence of heart disease was found in the US and Finland. These two countries also had the highest intake of saturated fat and cholesterol. Mediterranean and Japanese inhabitants with low saturated fat intake had very low incidence of heart disease and lived longer.

The Mediterranean diet, as it was later named, consists primarily of fresh fruits, vegetables, nuts, olive oil and olives, wine, whole grains, fish, limiting red and fatty meat.

 Mediterranean and Plant-based Cuisine Combined with a 5/2 Eating Plan

The Greek island of Crete had 57% fewer cardiac deaths than Finland. Their intake was also the highest in olives and olive oil, monounsaturated fats. Vegetarian or plant-based eating typically kabob vegavoids meat, but may include eggs, cheese and milk products. Omit meat and all animal products, and you are vegan.

This is the weekly menu for the 5/2 Mediterranean Plan for Weight Control and Lifelong Healthful Eating:

         5 days of a healthful eating following Mediterranean or plant-based food consumption and avoiding all fried foods

         2 non-consecutive days of eating 500-600 calories/day, such as Monday and Thursday

(Note: A low calorie intake like this done on consecutive days is more likely to induce the starvation response and reduce your metabolic rate. It is important to separate the days and add exercise to counteract this effect.)

         One hour of exercise each day, such as walking

 Utilizing the information above, you have the tools for eating healthy. If you are overweight, following the 5/2 calorie reduction plan is healthful. If you are taking medications for heart, blood pressure or Type 2 diabetes, discuss the 5/2 plan with your physician before using this. (This is not a plan for Type 1 diabetics or women who are pregnant.)

Weight Control Math

To review: One pound = 3500 calories. If your normal intake is 2500 calories/day and you eat 500 calories two days/week, your calorie reduction each week could be 4,000 calories or more than one pound in weight loss. This is approximately 4-5 pounds per month and 48-60 pounds in a year. In addition, if you choose lower calorie foods, (more vegetables, less fat and sugar), you may lose more. Most people find this plan easy to follow for long periods.

To be effective and long-lasting, the manner of eating must be sustainable. It must become a way of life something you can do for the rest of your life. If you have a lot of weight to lose, this would be a life-changing method of controlling your eating and reducing weight. Once you reach your ideal weight, omit the 2 light calorie days and continue eating a Mediterranean or plant-based cuisine daily.

 Animal and human studies examining the effects of fasting, show a heart benefit, along with reduced blood pressure and lower cholesterol levels. Intermittent fasting also decreases diabetes development in lab animals. Eating fewer calories two days a week is not true fasting but produces health benefits.

Because Dr. Mosleys unique concept of marked calorie reduction for two out of five days lacked scientific evidence to support the process in reduction of heart disease and diabetes in humans, I was hesitant to include it in my evidence-based book, Your Heart. However, as I was writing that portion of the book a very exciting scientific review in the British Journal of Diabetes and Vascular Disease was published!

 An Aston University team in the UK, led by Dr. James E.P. Brown evaluated various approaches to intermittent fasting, looking for any evidence of advantage for its use in treating Type 2 diabetes. In their review, they found intermittent fasting was just as effective, possibly even more effective, than daily calorie restriction and calorie counting. Other favorable findings: even markedly low calorie days (not true fasting) can reduce inflammation, reduce both glucose and lipids, and reduce blood pressure.

 In Your Heart Prevent and Reverse Heart Disease, there is a significant amount of information on the Mediterranean cuisine and plant-based eating and more information on the 5/2 eating plan with sample menus.

With the right knowledge and actions, the number one cause of death in women and men is preventable. If you already have heart disease, vascular disease or Type 2 diabetes you can take control and improve your health.

 Let me know how it works for you.

Betty Kuffel, MD


Living LongerA couple senior asian talking and exercising at a park

In health and disease, taking a positive approach is important, especially in heart disease. A recent medical article published in Circulation: Cardiovascular Quality and Outcomes, reported information gathered on mental outlook and mood in people following a heart attack. The people who lived longer and exercised more were those with positive attitudes.

 When the heart arteries narrow silently over years, the person may not realize they have a progressive disease. Suddenly a heart attack strikes and the disease makes itself known. At that point, when the shock and realization a life-changing event has occurred, it affects people differently. Disbelief and depression are part of the process.

 Most hospitals have cardiac rehabilitation programs and it is within these programs that many individuals develop the attitudes and confidence to take control of their health and do everything they can to live healthier and longer.

Four keys to improved health following a heart attack are:

  • Stop all tobacco use.
  • Eat a healthy diet such as plant-based or Mediterranean with minimal fat.
  • Control lipid abnormalities – the LDL goal is 70mg/dl in most. – This is the range that can show reversal of the size of cholesterol plaques within arteries and improve blood flow.
  • Exercise daily under the guidance of your physician.

In the Circulation study done in Denmark, the patients with the most positive outlook exercised more and had a 42% lower chance of dying during the five year follow-up period than those with a poor outlook and negative mood.  However, they found even those with less optimism lived longer if they exercised.