From a recent document from Tempus Clinic I gleaned the following tasty tidbits. You'll find more articles and medical testing information at
the Tempus Clinic website, here.
I quote, from Dr. Mike Nichols' commentary:
Do you think President Clinton would have chosen a disabling heart attack and the trauma of triple by-pass surgery if his testing had sufficiently uncovered and alerted him to these imminent dangers --or on the other hand -- might there be something lacking in the present day conventional testing and protocols?
There is a moral to this story far beyond President Clinton's cholesterol levels, EKG, and eating habits --and it continues to complete the picture of present day disjointed conventional screening physicals and diagnostic approaches that largely miss underlying cardiovascular disease.
This is despite the fact that each of us is more likely to die of a heart attack than of any other cause. For nothing less than the simple logical reason that this disease kills the most people it only makes sense to thoroughly and comprehensively test for underlying heart disease -- both at a personal level and as sound public health care policy -- except that's not what's happening. Irrespective of any impression you may hold, medicine as a whole isn't doing a very good job of screening for this condition. The statistics do not lie.
You need look no farther than the fact that most people only become aware that they have heart disease through suffering a first heart attack. Stated again, the ill-fated surprise of a heart attack is presently the most common first indication of heart disease and worse yet it is fatal over 60% of the time -- no second chance. These statistics come directly from the Center For Disease Control and judged on the results alone, no one in medicine should be able to look you straight in the eye and claim they are doing even an acceptable job at screening for and preventing this condition within the population. Too many people are dying!
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This will be covered in more detail in but for now accept that if you truly want to know your risk of heart attack then you should test the full and complete spectrum of known causes. While this is not an exhaustive list, this includes inflammatory markers, small pattern LDLs, HDL2B, coronary and arterial calcium, EKG, echocardiograms, full visualization of carotid arteries and heart valves, ejection fraction, blood pressure response to exercise, laminar flow, stress tests, C-reactive protein, homocysteine levels, intra-abdominal fat, heart rate variability, and poor mitochondrial function as evidenced by VO2 max and anaerobic threshold to name just a few.
This global testing is necessitated by the fact that heart attack risk and cause can manifest itself in any one of these areas without showing up in the others. So if your idea of a physical and diagnostics is to tell you if you are at risk for heart attack you can't just test a few -- you must test them all.
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In the medical world, the term 'relative risk' provides the baseline and context for evaluating risk and efficacy.
For example, if data shows that a given condition means you are twice as likely to have a heart attack then you have an increased relative risk of 2. If you are two and a half times more likely then you have an increased relative risk of 2.5; or if there is only a 20% increase in risk that means a 1.2 relative risk. A rating of one means there is no increase in risk.
Yet inquiry should never be limited to just whether something increases or decreases relative risk. The appropriate and larger questions are: does it do so to a meaningful degree, what are the alternatives, which ones are the most effective and predictive, and are there negative side effects to consider.
A case in point: In 80% of the population, even the most optimistic LDL, or bad cholesterol number studies show a maximum possible increase of 1.2 in relative risk or 20%. Other data continues to suggest that cholesterol control has little or no bearing on relative risk. In other words, a flat value of 1. Whichever you believe, it is still either a very small increase in relative risk or none at all -- especially by comparison.
When looking at heart disease, you should logically be paying the most attention to markers that foretell 3, 6 and 10 times increase in relative risk over markers that have a rating of 1.2 or lower. That's 300 to 1000% increase in risk vs. a 20% increase risk. Yet inexplicably as you will find, mainstream diagnostic and treatment protocols largely focus on these low, if not completely flat markers of relative risk.
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Chronically High Insulin Levels: The Potent Fat Storage Hormone & Plague Upon Our Health
The condition of chronically high insulin is perhaps causing the most damage of all in the largest number of people -- acting as an accelerant of atherosclerosis, heart disease, and unhealthy cellular metabolism.
It would never be appropriate to fixate on single marker; our metabolic health is much more complex than that. Yet, if you had to pick one of the most important markers, it would probably be that of chronically high insulin levels. By itself, the condition of chronically high insulin is perhaps causing the most damage of all in the largest number of people --acting as an accelerant of atherosclerosis, heart disease, and unhealthy cellular metabolism. That makes it a good place to start.
You can begin your understanding of this by realizing that our body must process every calorie we consume. One rule in this process is that all unused calories essentially must convert to fat. Such is the major dumping ground for unused calories and the body will continue without limit to create as much fat as it needs to accomplish this end.
Unbeknownst to most, a key hormone in this process is insulin. In the caloric pecking order, insulin first attempts to deliver calories to our muscles but then insulin switches roles towards helping the body convert those unutilized calories to stored fat.
While it may be widely regarded as a glucose-regulating hormone, it is less well known that insulin acts as one of the most potent fat storage hormones. After blood sugar regulation, insulin's main metabolic action is to store unused calories, mostly carbohydrates, as fat.
This is the double-edged sword of insulin. While it's needed to regulate blood sugar, a consistent overabundance of circulating insulin promotes poor cellular health and metabolism; guarantees that most calories will be stored as fat; and it is a main ingredient in the witches brew for advancing atherosclerosis and heart disease.
In determining cardiovascular health, overall insulin levels, largely determined by your eating habits, exert one of the strongest influences on heart disease and atherosclerosis. In short, chronically high insulin levels act as a plague upon our health and that is why most of us need to be ever mindful of foods that produce a heavy glycemic load and insulin response.
There is no argument that insulin is a life essential and necessary hormone. In the right amounts at the right times insulin helps deliver fuel to our cells, aids in muscle growth, and regulates blood glucose levels.
In order not to be damaging however, insulin is a hormone you wish to come and go as quickly as possible while requiring only the smallest amounts to accomplish the job. Otherwise, excessive and prolonged insulin levels favor turning calories to fat, are toxic to the linings of the arterial walls, and become a major cause and accelerant of atherosclerosis all in a self-feeding vicious cycle.
The destructive potential of insulin is measured in both space and time. The more insulin needed to carry out the work at given times the worse the effects; the longer that insulin lingers in your blood the greater the harm. The worst of all possible worlds is to have high insulin levels most, if not all of the time. The more chronically high your insulin levels the faster and heavier its health eroding effects.
Cellular Metabolism, Body Composition and Eating Habits Determine Average Insulin Levels
Ongoing consumption of foods that spike or elevate insulin levels for extended periods play the largest role in the equation of rising and chronically high insulin levels
Three factors play mightily into the insulin equation: cellular metabolism, body composition and diet.
On the metabolic side, unhealthy cellular structure and metabolism generally requires increasingly larger amounts of insulin to keep blood glucose within acceptable levels. Unhealthy cells also become ever worse at processing calories.
As to body composition, healthy and abundant muscle mass triggers a more active metabolism that helps the body burn calories even while fast asleep on the couch. Fat is very much the opposite of this and burns few calories.
Muscle promotes minimal and healthy insulin levels; fat promotes a trend of insulin resistance requiring ever higher and lingering insulin levels, which in turn greatly limit the muscles' ability to absorb and process calories. This is yet another self-feeding negative cycle that can result in increasingly larger percentages of caloric intake converting to fat and triglycerides.
Perhaps the largest part of the insulin equation is an unhealthy diet. More specifically, this means significant ongoing consumption of foods that spike or elevate insulin levels for extended periods --also known as placing the body under a heavy glycemic load.
These slow metabolizing or insulin spiking foods typically fall into the category of starchy or sugary carbohydrates such as breads, pastas, rice, rice cakes, chips, potatoes, pancakes, soft drinks, diet soft drinks, sugary drinks, artificial sweeteners, desserts, candy bars, ice cream, and sweets of all kinds. Such foods cause either prolonged or very high insulin levels, or many times, both. Generally, neither condition by itself is healthy, the two together even worse.
Together or separately, the usual net effect of these foods is a creeping rise in average insulin levels until the insulin is no longer able to adequately control the glucose levels and full-blown diabetes ensues. In fact, the increased mass consumption of these foods are primarily responsible for the epidemic rise in both diabetes and insulin resistance syndrome now reaching even 12 year olds.
Cholesterol is a Poor and Unreliable Predictor of Cardiovascular Health or Disease
80% of those with heart disease have the same cholesterol numbers of those who will never have heart disease.
Few health topics rival the hype surrounding cholesterol. It has become so ingrained in our way of thinking that most never stop to question its true validity as a measure of cardiac health. It is just widely assumed you are heart healthy if you can bring down your cholesterol by whatever means --but does the data support this assumption?
This may shake up your health paradigm but Tempus's reading of the science finds cholesterol to be a relatively poor and unreliable predictor of cardiovascular health and disease.
That said, Tempus is for using any tool, any marker, any method that the science tells us will help uncover and battle coronary artery disease. We have no reason to downplay the cholesterol model other than our reading of many studies tells us it is of very limited value and that heart attack victims and non-victims alike tend to spread evenly across the cholesterol spectrum.
This means a person can have a low cholesterol reading and have near equal odds of suffering a heart attack --or have relatively high cholesterol with still equal odds of not suffering a heart attack. Stated another way, large numbers of people who have so-called good or low cholesterol readings suffer from major cardiovascular disease and large numbers of people with so-called bad or high cholesterol readings will never suffer a heart attack or stroke. In other words traditsterol numbers are of negligible value as a predictor or indicator of coronary heart disease.
Statins, the Most Widely Prescribed Drugs in the World, did Nothing for 997 out of a 1000 (except expose them to the side effects)
Taking fish oil capsules had a better outcome on survivability!
If I told you a drug had only 3 chances in a thousand of helping, would you think it was very effective? Put another way, what do you think about a pharmaceutical that has a long list of serious side effects; which must be used every day; and does nothing for 997 out of a 1000 people taking it?
These are the little mentioned statistics surrounding Statins --the most widely advertised and prescribed drugs in the world.
In one of the largest studies ever (involving patients already diagnosed with Coronary Artery Disease), the Heart Protection Study made claims that Statins lowered cardiac risk by 30%. The underplayed fact is that they had to ignore 989 people out of 1000 to arrive at that figure. In our opinion, the more important statistic is that Statins did nothing for 99.7% of those taking them.
Here's how the numbers unfold. For every thousand people who did not receive Statins 11 would die of a cardiac event. For an equal number that actually took statins, approximately 8 still died of a cardiac event. In rounded terms, out of every 1000 people taking this powerful drug, statins might have helped 3 out of 1000 to survive. Thus, the larger story that needs emphasizing is that taking Statins had no effect on the survival of 997 out of a thousand --or it did nothing for 99.7%. Yet each of these other 997 had to pay for and take the drug every single day --and expose themselves to the potential side effects -- all of it apparently for no benefit if defined by saving your life.
If it isn't questionable enough to daily ingest a side effect laden drug that appears to do so little for so few, consider this. Recent studies indicate that a healthy fat diet or taking fish oil capsules had a better outcome on survivability than taking statins, which by the way interfere with the protective effects of a healthy fat diet.
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While all the attention has long centered around major blockages it turns out that the small, immature growths of atherosclerosis are the primary source of heart attack.
Understanding cardiovascular and heart health begins by understanding the process of atherosclerosis and heart attack. Advances in science and technology have led to a new understanding of this, yet many, even within our health care system, cannot seem to shift their attention and methodology away from the old and disproved model.
This outdated model centers itself around the concept of stenosis -- the disproved idea of artery clogging fats that stick to the artery walls and slowly accumulate until the artery clogs and triggers a heart attack.
Another problem with the stenosis model is that recent pathology has now clearly revealed that major blockages and choke points are seldom the cause of a heart attack. Stated again, we now know that major blockages and choke points are seldom the cause of a heart attack. In fact, research using Intra Vascular Ultra Sound has revealed that most heart attacks come from atheromata that demonstrate less than a 20% incursion within the arteries of the heart. Yet a 20% incursion or blockage won't even show up on the radar screen of conventional diagnostic and surgical approaches.
It's an odd phenomenon that while all the attention, grave concerns, and resources have centered around major blockages it turns out that the small, immature growths of atherosclerosis are the primary source of heart attack.
This may help explain why, according to some, half a million bypass grafts and 650,000 angioplasties a year have seemed to have little impact on overall survivability and relative risk. As you follow along you will see the reason for this, but you have to begin this journey by weaning yourself from the old and disproved stenosis model.
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Atherosclerosis is Really a Disease of the Entire Arterial System, Not Just the Heart
Fighting atherosclerosis is far more important to your health and life than just avoiding heart attack.
The role of atherosclerosis in heart attack tends to so dominate the scene it's easy to lose sight of the larger picture that atherosclerosis is really a disease of the entire arterial system. Your vascular tree of arteries are like the veins of a leaf that branch out ever smaller and smaller and do not end until they finally reach into and feed every cell in your body. The vitality, health, and very life of each cell depends on the healthy flow of oxygen rich blood just as much as your heart depends on it at the larger level. And just as atherosclerosis is affecting the health of your heart arteries it is likewise affecting the health of every artery feeding every cell. From whatever level you examine atherosclerosis --be it microscopic arteries to large arteries --the same phenomenon is occurring in varying degrees: Growing formations of atheromata or rupturing atheroma are simply having the effect of choking off a healthy blood supply to whatever cell or region it may be serving. The more distant the artery the more prone it is to this effect which is why diabetics first lose circulation in their feet.
If you can visualize its cascading effect down to the cellular level, you will begin to understand why fighting atherosclerosis is far more important to your health and life than just avoiding heart attack. It is truly one of the great unifying principles of health and aging.
From the hair you lose on your toes and legs; to unhealthy nails and hair, to a change in erections and sexual function; to hands and feet that often feel cold; to losing your keys and the date of your mother's birthday, to forgetfulness and full blown dementia; to diabetic feet and un-healing cuts and bruises; from peripheral vascular disease to pulmonary embolism; from angina to shortness of breath; from aneurism to fatal arrhythmia; from heart attack to stroke; from a very long list of small changes and disfunctionalities to many of the gravest health crises -- most of these are simple expressions of atherosclerosis in the vascular tree.
If you can't find your motivation to fight atherosclerosis in the big things perhaps you will find it in all the little things that aren't quite the same as they used to be effecting your everyday life and functionality. Because more than anything else, vascular disease is what trims away our vitality and youth one slow nearly imperceptible clip at a time. Clutching your chest as you realize you are having a heart attack is often only the endpoint of the disease.
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When applied correctly, nothing comes close to the methodology of Tempus's targeted exercise and targeted nutrition in fighting atherosclerosis and a whole host of other diseases and conditions
This would be a pointless discussion if the means did not exist to halt and reverse atherosclerosis. We know there is yet no drug, or surgery that will do so --nor any combination or amount of supplements --but Tempus doesn't believe that scientific inquiry and medical practice should end at the door of drugs and surgery. In fact, that would not be very scientific or Doctor like at all.
The good news is that we have positively found that targeted vigorous exercise, nutrition, and diet are the most effective and probably only means of reversing atherosclerosis and fighting many diseases. However, it is only very specific types of exercises in the right amounts, at the right intensity, and proper frequencies --and a very specific diet of the right foods in the right amounts. This targeted exercise, and targeted diet and nutrition as we call it, are far different than the unending, over hyped generalizations regarding diet, supplements, and exercise.
We don't use haphazard oversimplifications. These are carefully researched, specific techniques pulled from scientific and medical literature shown to be the most effective by the supporting data. The tests and results we see in our own patients further verify these protocols.
For instance, specific training techniques for improving heart rate variability has been a core principal at Tempus since its beta program began in 1995 -- long before 2005 publication of the study confirming the major significance of heart rate variability in the New England Journal of Medicine.
When applied correctly, nothing comes close to the methodology of targeted exercise and targeted nutrition in fighting atherosclerosis and a whole host of other diseases and conditions. As I said, all of this exists in the medical literature, but these techniques and concepts are something you will never obtain from your celebrity gym rats, exercise gurus, neighbors, nutrition counselors, authors, family Doctors, or cardiologists.
As far as we know Tempus is the only facility in the world that is applying the combined science of these advanced techniques together in a medically scientific, comprehensive, single source manner where the results are verifiable and measurable. That is the other side of the Tempus program.
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Nothing Equals the Nutrient Complexity of Whole Foods
Only the complexity found in whole foods is capable of delivering and matching up so well with the infinitely complex nature and nutritional requirements of healthy human biology. Man cannot synthesize anything close to the extensive cross spectrum of complex nutrients available in whole foods. For instance, much has been made of taking just one caratenoid called beta-carotene. At last count, science has now discovered over 600 different healthy caratenoids found in whole foods. Imagine the impossible and impractical nature of synthesizing and taking over 600 caratenoids much less the millions of other beneficial micronutrients provided by nature in ideal combinations and ratios. This is not to mention the virtual impossibility of duplicating the complex synergistic infrastructure and ideal beneficial nutrient ratios, combinations, storage, and delivery mechanisms found in whole foods. Humbling though it may be, humankind cannot match millions of years of co-evolution.
Be Sure To Eat Across the Entire Spectrum of Nutrient Dense, Whole Foods
We have all heard the maxim to eat our vegetables and they are good examples of a nutrient dense, whole food. Yet many of us take that to mean any vegetable as long as we eat a vegetable --so we tend to center our eating habits around just a few. The default seems to be broccoli.
Yes, you should eat broccoli but the idea is to rotate and eat your way across the vegetable continuum through all the varieties and colors. It is only this way that you can gain the benefit of the full spectrum of the many important vegetable micronutrients and the accompanying nutritional, restorative and healing powers often unique to each. Yet there is no way you can obtain all the micronutrients you require by just eating vegetables.
You also need to eat across the protein continuum --rotating grass fed beef, poultry, pork, wild fish, dairy, nuts and seeds. Each of these contain other important micronutrients and essential fats, individually having uniquely important nutritional subtleties not contained in the others.
Finally, the most nutritionally empty foods are starchy and sugary carbohydrates. Such carbohydrates also tend to spike and maintain high insulin levels, which is not only toxic to the lining of arteries it is a formula that tends to turn most of those carbohydrates to fat (and deadly tri-glycerides).
That's not to say that carbohydrates are always villainous. Mostly limited to a minority of individuals that have the rarer condition of chronically low insulin levels, ingesting certain carbohydrates around workout times may be necessary towards achieving desirable muscle growth. You'll have a pretty good idea if you are one of those folks if you are rail (very) thin and find it near impossible to add weight and muscle mass. Of course, it's best to find out for sure through our advanced screening physical.
Fat Does Not Cause Fat and it is Absolutely Essential to Health
Without doubt, transfats are harmful fats, but otherwise as a society, we have turned unjustifiably fat phobic. We are blaming fats on ills for which they are not responsible and worse yet, by removing them, we are depriving ourselves of vital nutritional dimensions to health. Fats are essential to health, fat does not stick to our arteries, and fat does not cause fat.
Truth is high insulin levels combined with poor metabolism and consumption of starchy carbohydrates cause more atherosclerosis and create more fat than fat could ever hope to create. Furthermore, the liver manufactures 80% of our cholesterol all on its own -completely independent of dietary consumption of cholesterol. The message that needs to come through to the fat phobic and fat avoiding is this. Consumption of fat is not triggering the deadly subcomponent lipid production. In fact, a healthy fats diet is an essential component of cardiovascular health.
We are not advocating that you eat as much fat as you want; we are telling you that fat is essential to health -- ideally in the right quantities and ratios. We are also urging that you stay away from low fat, fat removed products. Not only is it a useless endeavor, it is a negative and misleading one.
When you remove the fats from foods like milk, and cheese, and yogurt you strip away necessary whole food complexity and essential micro nutrients. As to foods like dressings, chips and otherwise unhealthy and nutritionally empty endeavors, the low fat label simply creates a misleading, false illusion of healthiness. The lack of fat in a chip, triscuit, or rice cake cannot change the fact that it is near nutritionally worthless or the more ironic fact that almost all those calories will end up metabolized into fat for most people.
Grass & Green Fed Animals Contain the Most Health Promoting Fats & Nutrients
Fats are essential to human health. We can't live without them and ironically our hearts would cease to function without fats. To the largest extent possible, you want to consume healthy fats in the right ratios. These healthy fats can be found only in wild fish and grass fed animals --in other words, in animals that eat green.
It may surprise you to learn that 100% grass fed beef contains as much or more fish oil than fish; plus grass fed beef contains certain essential healthy fat molecules that fish does not contain. At the same time, fish has certain beneficial fat molecules that beef doesn't have. This is why it is good nutritional strategy to include and rotate through the protein spectrum of beef, fish, poultry, pork, dairy products, lamb, nuts and seeds. Each often contains unique beneficial elements that the others do not.
This doesn't mean you should eat Texas size portions and as much as you want but it does mean you should daily consume (appropriate) common sense amounts of these varying proteins on a rotating basis. It is also best to consume milk, cheese, eggs and other products derived from grass fed animals --and whatever you do, don't get the low or no fat versions because they have been stripped of the very essential fats and whole food complexity that your body needs.
When we farm raise fish and feed grains to livestock we essentially break Mother Nature's food chain and remove the needed upward migration of essential and important nutritional elements. It's not very healthy for cows either because they must be fed massive amounts of sodium bicarbonate to help relieve the intense gastrointestinal distress and liver abscesses they experience as a direct result of the very unnatural diet of grain feeding. In fact, cows consume over half of the national production of sodium bicarbonate.
All Engines Don't Get the Same Gas Mileage; Neither Do Humans -- The Misguided Notion of Calorie Counting
No one has to search very far to know that calorie counting is highly questionable concept. We all know people who can near starve and exercise themselves to death and still gain weight; and others who can eat all they want and never gain a pound. This dichotomy alone should tell you something else is at work.
In observing this phenomenon you'll often hear some passing, almost subconscious remark about metabolism --yet few people realize just how right they are.
Good cellular metabolism is why you can still burn significant calories lounging and sleeping. In fact, the measure of how many calories you are burning while lying on the couch is much more important then any concern about what you are burning at the gym. Hours a day on the treadmill can never make up for poor metabolism. Neither can major caloric restriction or starvation diets because the body's adaptive mechanism tends to respond by slowing down your metabolism even further, resulting in a worsening vicious cycle. That is but one reason why starving yourself is no path to health or permanent weight loss.
On whole, calorie counting in both consumption and exercise is a poor and inaccurate focus of anyone's efforts. It often gets you nowhere and frequently leads only to disappointment, heartbreak, discouragement, and giving up. It is both cruel and self defeating to approach weight management so blindly and ineffectively.
Health wise, at Tempus we are much more concerned with muscle and metabolism than we are with body weight. Our primary goal is health and from there positive results tend to follow. That said, a number of our patients have finally been able to get their weight problems under control after years of disappointments and of failed efforts.
You'll also find more articles and medical testing information at the Tempus Clinic website, here.
