The world is in shock and mourning Michael Jackson’s sudden death reportedly due to cardiac arrest. As people are posting tributes to him everywhere, he is being remembered as “The King of Pop”, “Icon”, “Legend”, but there is one thing that we all need to remember is that he was human just like all of us.

Michael’s unexpected passing away at just 50 leaves behind a good lesson for us. We need to stop and think seriously. Yes, this is a catastrophic tragedy, and all of us are perplexed thinking how could someone like Michael, who was not obese, had a thin stature, physically active as a dancer, very athletic die of cardiac arrest. It is not very uncommon for healthy looking people to have heart disease; and cardiac arrest is the first sign of heart disease.

Someone asked me a question this morning “Dr. Kapur, given that the initial explanation of the sudden death of Michael Jackson was cardiac arrest  – can you explain the relevance or relationship of that event to Cardiometabolic Syndrome?”

Cardiac arrest occurs when there is disruption of electrical signals in heart muscles, which therefore prevents the heart from pumping blood effectively, causing a heart attack. There are more chances of getting a cardiac arrest when there has been previous heart damage due to a heart attack (blockage of arteries). This does not mean that someone who has not had any previous event cannot have a cardiac arrest. It has been reported by several studies that people with high cholesterol, high blood pressure and/or with family history of heart disease or diabetes are at risk of dying of heart disease even when they appear thin and healthy. Stress, smoking and drug abuse have been shown to have an added risk. So, even when we are athletic, thin looking with no family history of heart disease, we need to be aware of our cholesterol and triglycerides at all times.

“What steps should those who might be reflecting upon their own ‘heart health’ take to insure that they are being smart about preventative steps?”

Healthy eating, active lifestyle and monitor your health regularly without waiting for your doctor to tell you what to do is the key. Check cholesterol levels and In addition to cholesterol levels, it is important to check glucose and inflammatory markers like C-reactive protein, which is emerging as an independent risk factor for heart disease. It is recommended that people care for their own health and wellness by monitoring their cardiometabolic markers like cholesterols, triglycerides, hemoglobin A1c and C-reactive protein and not wait for their doctor to suggest these tests. This is because even doctors will not suggest these tests until they see any symptoms; so why wait until any symptoms appear. Heart disease and diabetes are like an iceberg  that is hundred times larger than what is seen on top. These diseases start way before the actual symptoms appear. It is smart to be proactive and take steps to prevent such diseases.  

As we all say “Adieu” to Michael, let us learn a lesson that he leaves behind for us…

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It really depends upon how much we like soft drinks, fruit drinks, energy drinks or any other type of sweetened caloric beverages before we can make a choice between our cravings and our cardiometabolic risk. Scientific research has shown a number of times in the past how much we have to be watchful of our caloric consumption, not just from the food we consume but also from the beverages we enjoy. Nurses’ Health Study has shown about 49% increase in the risk of coronary heart disease in women due to regular soft drink consumption. Nurses’ Health Study II has also shown a direct link between sweetened drinks and increased risk of diabetes, irrespective of total body weight. Framingham study has suggested a strong association between metabolic syndrome and soft drink intake. Another recent research study reported about 44% increased chances of getting diagnosed with metabolic syndrome if someone consumed one soft drink every day as compared to those who did not drink such sweetened caloric beverages frequently.

Unfortunately, there is a rising trend in the consumption of flavored and sweetened energy drinks, fruit drinks, vitamin water especially in United States and the intake of these beverages has tripled in last few years, which is now emerging as a major cause of obesity in children and also conditions like weight gain, insulin resistance and other cardiovascular risk factors in adults.

We have definitely seen some direct or indirect effects of the sweetened caloric drinks on our overall health and wellness. Several articles have been published in this direction, both scientific and in lay press; many research studies have identified statistically significant associations between soft drink consumption and increased body weight, diabetes and heart disease. There is no doubt about adverse and unhealthy effects of most of the sugar and fizzy drinks and I think there is no need for us to wait for further evidence to prove it again. It is time to do something about correcting the mistakes we have made so far.

All along we have been saying “We are what we eat”, but now it is all about “We are what we eat…and drink”. It is not very difficult to watch what we choose to drink when we think of healthy weight loss or just when we are thirsty. I remember my grandma sharing with me benefits of drinking water, green tea, pomegranate juice for several health reasons she could outline (all appearing non-scientific at the time) as she never went to school, but now when I think of those, I feel she knew much more science than most of us scientific pundits of today.

What are we waiting for? What more proofs do we need before we do something about this problem? Why are we debating on this subject for so long? We are becoming aware of what we eat, but should we also not be concerned about what we are drinking or what we are making our children drink? Let us create a better “Healthy Tomorrow” for our generations to follow.

Let us stop and make some intelligent choices about “drinking healthy” and let us appeal to manufacturers to make healthy drinks free of any harmful effects. At the same time, let us practice and educate ourselves about picking up the right drinks in order to prevent and manage any chronic diseases like metabolic syndrome, diabetes, heart disease and other related conditions. Let us all work together.

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With obesity rates continuing to rise to epidemic levels, the fattening of America goes hand in hand with a cluster of health problems generally referred to as “metabolic syndrome,” including high blood pressure and high levels of the blood fats, triglyceride and/or cholesterol. Insulin resistance, where the action of insulin in the body is impaired and fails to control blood sugar levels, also complicates the picture. When these things happen all at the same time, as is generally the case, their collective impact is to raise Type II diabetes and cardiovascular disease risks simultaneously. Increasingly referred to in medical circles as the “cardiometabolic syndrome,” people with even one of its components may be at increased risk for others. Knowing what to watch for can make the difference between having, or preventing, full-blown disease; so early detection of risk factors and proactive preventive measures can help individuals lead a active, healthy and happy life.

There are 10 simple lifestyle changes that I wish to outline below, which can lower the overall risk of getting a heart disease. This information is not very new to us and we talk about the importance of all these facts in our everyday lives, but the question is how many of us consider these seriously.

More than a century and billions of dollars in medical research, hundreds and thousands of clinical trials- all have come to realize how important it is to:

1. Lose weight (especially some extra pounds accumulated in our abdomen)
2. Increase physical activity to at least 30- 60 minutes a day
3. Eat a healthy diet that includes more of whole grains, fiber, fruits and vegetables, lean meats, eggs, fish, beans and nuts
4. Quit smoking
5. Reduce stress levels
6. Manage dyslipidemia; maintain normal levels of cholesterol (both LDL-C and HDL-C) and triglycerides
7. Control hypertension
8. Limit alcohol consumption
9. Check for inflammation
10. Keep your hormones in balance

We keep asking for new tools for our physicians to formulate a magic pill, but let us stop and rethink how we can help our physicians formulate optimal treatment strategies for effective management of any or all risk conditions by considering the ten simple changes listed above.

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Stress and depression, both have been linked with diabetes and heart disease. Understanding these two factors can actually help our doctor formulate a suitable treatment plan. So, it is important that we share this with our health care provider even if they forget to ask. Any kind of stress or depression can lead to more complications, if left untreated.

Stress causes release of some hormones which can further lead to elevated blood glucose levels. When the blood glucose levels increase and if there is not enough insulin being produced by the body or if the insulin is not working properly, then this results in excessive glucose in the blood, which can ultimately lead to development of diabetes.

Stress can come from many sources, including stress from one’s occupation, job strain especially in this economy as we are going through recession; many of us are losing jobs, homes, which is very sad and unfortunate. So, this stress can cause increased production of a stress hormone called cortisol, which then makes the liver produce more glucose, which means more glucose in blood and less usage of glucose by the tissues, less insulin production by our pancreas, thereby causing a condition called insulin resistance. This insulin resistance can finally lead to diabetes and/ or heart disease.

It is extremely important to maintain blood glucose levels, especially in diabetics and this can be done through stress management training. Sharing the cause of stress with the primary care doctor, family or friends is always helpful. Sometimes, social support can reduce the stress and this way it can reduce the risk of heart disease.

Similarly, depression causes several changes in our hormones thereby leading to a hormone imbalance, can decrease body’s immunity; can affect changes in bone metabolism; and can cause cardiovascular dysfunction. This can result in decreased quality of life. People living under any kind of depression are at higher risk of getting type 2 diabetes or heart disease.

What should be done to avoid becoming a victim of conditions like stress and depression?

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Unfortunately, the answer is YES; the heart grows older as well as we age. Although several people like me always say “Oh I’m never getting old….I’m young at heart and will stay young forever”…which is good and this is how we should live with a positive attitude. With this type of attitude, we can sure increase our life by minimum of 5 years and may be more too. Again, it depends upon our mental outlook and how we live, and not just the age. Science agrees with this, but at the same time, we have now come to know so many different facts about our heart health and we should realize that with increasing age, even with a positive attitude and sound mental acuity, our heart undergoes some changes, and it continues to undergo those changes even when there is no disease, even when the person is healthy and has no known risk condition or a disease. The heart muscles start to weaken and when the heart beats, these heart muscles cannot relax completely between those beats, and when this happens they become stiff; as a result they start to function less efficiently and they don’t do their job of pumping blood very well and finally give up. The loss of good function of these heart muscles gets worse when there is any heart disease.

As the heart grows older, it does not respond effectively to adrenaline and this is the reason that older heart cannot contract or cannot pump blood faster or vigorously when there is a need, especially when we exercise or do any physical activity. So, we should not be surprised if we see our capacity to walk briskly or to work out and exercise has decreased as compared to when we were young. We all know and have experienced that all that was so easy to do when we were 16 or 18 or 20, is extremely difficult as we get older. Our heart just doesn’t function that well any more. This is also the reason for changes in our blood pressure, normally high when the heart muscles are too stiff.

The decrease in the capacity of heart to work efficiently differs from person to person. It all depends on how we live our life, what other conditions have we developed? Do we have any other disease? How and what kind of decisions we made in life when it came to eating right or how much we exercised?

We have to realize the importance of healthy life-style changes as early as possible in our lives. It is never too late. All the risk factors basically affect overall quality of life and of course how long we live. Let us not wait till the last minute when our doctor has to tell us that it is too late. Let us take charge of our own health and wellness and do something about it.

Do you agree with me?

My expertise is in the field of diabetes, heart disease and hormone balance and I wish to share some of the knowledge I have gained in these areas through research and lots of reading. I would love to answer any of your questions or address any curiosities you may have about overall health and wellness. Please feel free to add your thoughts here for our fellow readers and let us all share our experiences to build a healthy community. Let us begin talking about the real wealth- our health and wellness.   Let us start learning from each other.

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