Health for a Lifetime

Preventing Cardiovascular Disease

Three Angels Broadcasting Network

Program transcript

Participants: Eric Shadle, Don Mackintosh

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Series Code: HFAL

Program Code: HFAL000113


00:51 Hello and welcome to "Health for a Lifetime"
00:53 I'm your host Don Mackintosh
00:55 and today we're going to be talking about
00:56 women's health issues.
00:58 And so, if you're a lady or have friends that are ladies,
01:01 this is the time to tune in.
01:02 And today, joining us to talk about women's health issues
01:05 is Dr. Eric Shadle and we're happy that you're
01:09 with us today and we're glad that you can join us
01:12 to talk about women's health issues.
01:13 Now I understand you've been in practice for about
01:16 15-16 years. That's correct, yes.
01:19 In obstetrics and gynecology, so you see all kinds of
01:23 women's health issues.
01:25 What do people or what do women
01:27 perceive as their largest health concern
01:31 especially when they reach the age of menopause.
01:33 Well the #1 cause for concern that women have is cancer.
01:39 Actually, a study was done where they questioned menopausal
01:43 women and 40% were concerned about breast cancer,
01:48 and another 15% were concerned about other types of cancer
01:52 as the #1 cause of death in women -
01:56 at least that was their perception.
01:58 So breast cancer being the big concern?
02:01 Their biggest concern... Actually, they asked them
02:05 what do you think you will die from,
02:07 and 40% said breast cancer.
02:10 But actually, that's NOT the most important problem of
02:17 women's health, though breast cancer
02:19 is a very significant one.
02:21 Of cancers, of women's cancers, breast cancer is only
02:25 the second leading cause of death - second to lung cancer.
02:29 So smokers and lung cancer. That's right, that's right
02:32 Okay, so then what IS the leading cause of
02:36 problems in women; the leading cause of death
02:38 for people or ladies after menopause?
02:41 Well the leading cause of death is cardiovascular disease.
02:44 It's actually responsible for more deaths than
02:47 all other causes combined.
02:50 So it's the #1 killer, just like it is with men.
02:53 It's the #1 killer just like it is with men, that's right.
02:56 It's the biggest public health problem that we face
02:59 in this country is cardiovascular disease.
03:02 The incidence of heart attacks rise with age with both
03:07 men and women and 40% who have a heart attack,
03:12 the first symptom is sudden death...
03:15 so it is certainly a scary issue and problem,
03:22 but I find it very interesting that women are still more
03:26 afraid of breast cancer than they are
03:29 of cardiovascular disease.
03:31 They seem to just be able to live with that
03:32 because everybody has that problem but...
03:34 I think that's right - I think they just see that
03:37 cardiovascular disease is something that we just live with
03:40 in this society, but cancer, the word itself brings
03:46 certain emotions to bear, I think.
03:51 Back to this issue of cardiovascular disease;
03:53 however, you know, some people or ladies that I hear talking
03:57 say that they've gone on estrogen replacement therapy
04:00 so that they will decrease their risk of
04:03 cardiovascular disease or because, I guess,
04:06 their physician says... "That's changing now"
04:09 Is that something we should talk about?
04:12 Absolutely! You've brought up a very good question.
04:16 We should look at estrogen replacement therapy
04:20 and the traditional risk factors that are talked about
04:24 in the medical community.
04:28 And, let's just list those risk factors...
04:30 These are the traditional risk factors that physicians
04:33 use today to give estrogen replacement therapy,
04:37 and the first is a personal history - a history of
04:41 heart disease; and increasing age.
04:45 As we get older, we have more risk.
04:48 Estrogen deficiency.
04:50 Dyslipidemia which simply means lipid disorders,
04:54 high cholesterol - we could say.
04:57 There are additional risk factors such as:
04:59 diabetes, smoking, high blood pressure,
05:03 peripheral vascular disease - that would be like
05:06 atherosclerosis - hardening of the arteries.
05:10 Now what I find interesting about this list...
05:13 This is the list that is published in all of our journals
05:17 It would be a list that is in our textbooks...
05:20 I find it very interesting that there are no lifestyle issues
05:25 there other than smoking.
05:27 Smoking is the only one that's a lifestyle issue
05:29 that they talk about as a risk factor.
05:31 And when you say "lifestyle issue," you mean
05:33 something they could do something about. That's right
05:36 That the patient themselves, that the person would take
05:41 primary responsibility for their own health,
05:44 and I think the reason for that is that physicians today,
05:48 we are not trained to involve the patient themselves
05:52 in their own health and yet we all have, in our own power,
06:01 well the power to control our health.
06:04 To choose what is good to eat.
06:06 To choose to make the right choices.
06:08 In terms of lifestyle - so let's then talk more about that.
06:12 What kind of lifestyle things should we be doing,
06:17 or another way to put it is -
06:19 How does this relate to estrogens?
06:21 Can we eat foods that are high in estrogens?
06:23 Well, I do want to get to that
06:29 maybe a little later in the program,
06:31 but first of all, what we eat has the most important thing
06:36 to do with heart disease and that is our cholesterol.
06:40 We know that high cholesterol is one of the basic
06:44 foundation points for heart disease,
06:48 for cardiovascular disease, for hardening of the arteries.
06:51 And if you don't have a high cholesterol level,
06:53 you're not going to get hardening of the arteries,
06:56 and then you're not going to have a heart attack.
06:59 So you don't have to replace, supposedly, your estrogen...
07:01 You're really addressing a more fundamental issue. That's right
07:04 Is that what you're talking about? That's right
07:06 It's a much more fundamental issue.
07:08 Which I think - you talk about this or we've talked about this
07:11 is primary versus secondary prevention. Yes
07:15 And what do you mean exactly by that?
07:17 Well primary prevention of heart disease is someone
07:21 who has never had any known disease;
07:23 they've never had a heart attack and never had any symptoms,
07:26 and so you want to help that person prevent
07:30 heart disease from occurring...
07:32 Whereas secondary prevention of heart disease is
07:37 a person who has already had a heart attack,
07:39 but now you're trying to help
07:41 them prevent another heart attack.
07:43 Of course the second group would probably be
07:45 more highly motivated. Absolutely!
07:47 Since they already had a heart attack. Absolutely!
07:49 And the other ones, they probably are just looking
07:51 at you like you're from the planet somewhere - you know.
07:54 They've had their heart attack;
07:55 they've had their wakeup call,
07:57 and knowing that 40% will actually die
08:01 during their first heart attack.
08:03 So they're part of that 60% obviously,
08:06 and now we're very interested in secondary prevention.
08:09 Let's go back for a minute to PRIMARY prevention though.
08:12 What role does estrogen replacement therapy
08:14 have in primary prevention?
08:16 In other words, they haven't had a heart attack yet,
08:18 and they want to avoid it.
08:19 Well let me answer that by saying that the
08:23 pharmaceutical companies, the drug companies
08:26 in this country market estrogen very heavily as a way
08:30 to prevent heart disease and they make those claims
08:33 based on retrospective studies;
08:36 that is studies that look back at a patient's history,
08:41 and they don't have good control groups...
08:44 And so they've looked at these retrospective studies
08:48 that have indicated as much as a
08:50 50% reduced risk of heart attack, primary prevention,
08:55 in women who take estrogen replacement therapy.
08:59 And so they use that data and say...
09:01 "Wow, all women need to be on
09:03 estrogen in order to prevent heart disease. "
09:08 And it gets a lot of press;
09:11 it gets in the Ladies Home Journal,
09:13 and Time Magazine and all these things,
09:16 Good Housekeeping and all those,
09:18 and then we have women coming in and saying,
09:20 "Well, I think I need to take estrogen because
09:23 there is heart disease in my family. "
09:26 But interestingly enough,
09:28 there are a couple of very good studies that are ongoing
09:32 right now and one of them is the Women's Health Initiative.
09:35 "WHI" Study that has actually changed the recommendations
09:40 for estrogen in association with primary prevention,
09:45 and as a result of that study,
09:47 the American Heart Association does not recommend
09:50 HRT which is hormone replacement therapy
09:53 or ERT - that is estrogen replacement therapy,
09:56 just estrogen by itself - for the prevention of
10:00 coronary heart disease or heart attacks.
10:03 So that's completely different than what they're saying...
10:05 That's exactly right!
10:07 So they're not recommending...
10:08 they don't think it really has any primary role in
10:11 preventing.
10:12 Absolutely... The American Heart Association does not,
10:15 and that's because this was a large prospective
10:18 placebo-controlled study designed to impact
10:24 on women's use of both unopposed estrogen,
10:27 and that is estrogen where you take it by itself,
10:30 as well as hormone replacement therapy which would be
10:33 estrogen plus progesterone.
10:36 Okay, so in other words, when you say - double-blind
10:38 and all controlled placebo and all that,
10:40 that means - they've looked at everything,
10:43 and now they're really getting real data instead of just
10:45 looking back and anecdotally maybe saying...
10:49 "Well, we THINK we see this," as a marketing tool
10:52 the drug companies were using that but now there are real
10:54 studies saying - "No, there is not really a role in
10:58 preventing cardiovascular disease. "
10:59 Not only is there not a role, but they actually
11:03 found that there is a small increase in the number of
11:06 cardiovascular events in those women taking
11:09 hormone replacement therapy.
11:11 Now it's not enough to stop the study,
11:12 the study is still ongoing, it's not due to be
11:15 completed until the year 2005.
11:18 But, you have to be concerned about those kind of findings.
11:23 Okay, so in other words, instead of finding that it prevents it,
11:25 it could even potentiate it or make it worse,
11:29 but it's not to the level where they had to stop
11:31 a study because it's really a dangerous thing. That's right
11:34 Okay - Wow, so that's completely different.
11:36 So again, everything you see on TV,
11:40 and, of course, we're on TV right now -
11:42 it kind of shoots us in the foot but everything you see on TV
11:45 or everything you hear on the radio,
11:46 or everything you read in whatever magazine or journal,
11:48 it doesn't necessarily match with the facts
11:53 if you're trying to avoid the #1 killer of women
11:55 which is heart disease. That's right
11:57 There is the Nurses' Health Study
12:01 which is another prospective study with over 70,000
12:06 postmenopausal women.
12:07 That study did show a small decrease in the
12:11 risk of coronary events; however, it wasn't enough
12:16 that the American Heart Association is convinced,
12:20 and that study is ongoing as well and we're going to see
12:24 what that has to say about some of these risks.
12:27 It looks like that the women that actually have a decreased
12:32 risk in coronary events in the Nurses' Health Study
12:36 are those who are also seeking medical care
12:41 and have better lifestyle as well,
12:43 and so there may be some confounding factors that
12:48 are making it difficult to tell whether estrogen
12:53 is having that much of an effect on cardiovascular disease or not
12:56 So the one study says - Absolutely no effect.
12:59 This next study says - Well there may be some
13:01 kind of increase or decrease but it's probably
13:03 related to some other kind of factor.
13:05 That's what they're saying. Yes, that's right
13:08 So the bottom line then and there is no
13:11 bottom line yet, is what you're saying... Yes
13:13 You can't give a bottom line yet,
13:14 but it appears to be that this is not really
13:19 estrogen replacement therapy in preventing heart disease
13:23 is not really the right tree to be barking up.
13:26 Yes and really, you think about it,
13:29 it doesn't make that much sense to be looking
13:33 at that anyway because there are so many other
13:36 lifestyle factors that we probably should be
13:39 talking about at some point,
13:41 but estrogen, I'm not sure is really one of those
13:45 lifestyle factors that we need to be looking at
13:48 certainly for cardiovascular disease.
13:50 So nobody, watching the program, needs to go out
13:52 and buy those pills and start taking them to prevent it.
13:54 Not to prevent heart disease, that's right.
13:56 Now what about secondary?
13:58 We were talking about primary prevention,
13:59 what about secondary prevention?
14:02 Should we be taking some hormones then or...
14:05 You know, you would think that secondary prevention,
14:08 if estrogen is going to decrease the risk for heart disease,
14:12 it would decrease it for secondary prevention
14:16 more certainly than primary...
14:18 Because, if you look at these lifestyle live-in programs
14:23 that affect how we eat and they teach us... exercise, cooking,
14:32 decreased fat intake and that kind of thing,
14:35 what you want to find are the sickest people.
14:38 The people that have the heart attacks,
14:40 the people that have the most weight,
14:42 the people that have the worst cholesterol and diabetes
14:46 and all that - and you see dramatic change.
14:49 So you would expect to see the same thing with estrogen.
14:52 You want to find the sickest people to see the biggest change
14:56 if there is something that's going to affect it.
14:59 And so with estrogen, we certainly expected to
15:03 see that in secondary prevention studies,
15:06 and there is something called... "The HERS Study"
15:11 with a little over 2700 postmenopausal women
15:17 under the age of 80 who already had coronary heart disease,
15:23 and what we found with this study - was that they actually
15:30 had an increased risk for coronary events if they were
15:34 taking hormone replacement therapy during that first year.
15:37 So the women who were taking hormone replacement therapy
15:41 in the HERS Study, they've already had a heart attack,
15:45 you put them on hormone replacement,
15:47 that's estrogen and progesterone,
15:49 and you find that there is an increase in the number of
15:53 heart attacks in that first year!
15:55 Wow! So in other words, what does that mean?
15:58 It could mean, if playing off of what we said about
16:01 primary prevention, it could mean that
16:03 these are the type of people that think -
16:05 "Hey, I'm just going to take a pill - instead of changing
16:08 my lifestyle" That's right, that's right.
16:11 Is that the conclusion you're drawing? YES
16:13 We'd much rather take a pill
16:15 than have to change our lifestyle
16:17 because sometimes that seems too difficult to do.
16:22 And so, physicians shy away from talking about
16:25 those kind of things and certainly people -
16:27 if they can just take a pill, and still be having
16:29 whatever they want to eat, they're going to do that.
16:32 I think so... Physicians don't talk
16:34 about it much because - first of all most physicians
16:38 need to change their lifestyle, to be honest with you...
16:41 And so it's kind of hard to tell your patient to change
16:45 a lifestyle factor when you're not living that way yourself.
16:51 That's right, yes.
16:52 So it becomes very difficult.
16:55 So then what role does diet play in the prevention
16:59 of cardiovascular disease? What have you seen?
17:02 Well to me, diet is really the lifestyle factor that we
17:08 need to be talking about with cardiovascular disease,
17:11 and it affects so many parts of our lives,
17:15 and obviously it affects so many different diseases
17:20 that we might have.
17:22 We really need a cholesterol of under 160,
17:25 maybe even under 150 to reduce plaque that is
17:30 already in our arteries and to prevent cardiovascular disease,
17:36 and yet in this country, what we find is that
17:42 we actually have levels of 190 or 200 that is
17:49 considered normal in this country.
17:51 But we have multiple studies that definitely demonstrate
17:55 a link between diet and cardiovascular disease.
18:00 So you really then focus in on that...
18:04 You know, you can take drugs now, like your statins,
18:08 and all these different things;
18:09 statin medications that they make your cholesterol just
18:13 go down - that's another pill and it's not estrogen,
18:16 but it's another pill and are there any hazards
18:20 to just saying - "Hey, I took care of the problem that way"
18:22 Well, taking these statin medications which do lower
18:28 our cholesterol, does appear to decrease one's
18:32 cardiovascular risk.
18:33 You would expect it to if you can get your
18:36 cholesterol down.
18:39 The concern that I have, first of all,
18:43 it doesn't make much sense to be taking a medication
18:46 to lower cholesterol - when we're eating
18:49 a lot of cholesterol and when we're eating a lot of
18:51 saturated fats and animal proteins,
18:55 it is going to raise our cholesterol.
18:57 It seems to me much wiser to lower our
19:02 cholesterol by making a few simple changes in our diet.
19:08 We're talking with Dr. Eric Shadle
19:11 We've been talking about women's health issues.
19:13 We've been talking about cardiovascular disease;
19:15 talking about estrogen replacement therapy,
19:18 and the doctor has just said,
19:20 "Look, we need to take a closer look at lifestyle issues"
19:22 And when we come back, we're going to look at some
19:25 practical things about what you can do to decrease
19:28 your risk of the #1 killer of women, #2 killer of women,
19:31 all those are related together, so join us when we come back.
19:40 Have you found yourself wishing
19:42 that you could shed a a few pounds?
19:43 Have you been on a diet for most of your life,
19:45 but not found anything that will really keep the weight off?
19:49 If you've answered "yes" to any of these questions,
19:52 then we have a solution for you that works.
19:54 Dr. Hans Diehl and Dr. Aileen Ludington
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20:02 and we'd like to send it to you free of charge.
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20:10 permanently without feeling guilty or hungry
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20:18 and in this booklet, they present a sensible approach
20:21 to eating, nutrition and lifestyle changes that can
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20:46 Welcome back, we've been talking with Dr. Eric Shadle,
20:49 and we've been talking about women's health issues.
20:51 We've been talking about heart disease;
20:52 we've been talking about how
20:54 estrogen replacement therapy relates to that...
20:56 And you kind of shocked me but what you suggested,
21:00 and you've had the studies and whatnot is that
21:02 although the bottom line is not yet known,
21:05 it appears that it's not as helpful as we've been led
21:07 to believe over the last couple of years. That's right
21:09 And so we need to look at more than just taking a pill
21:12 because there maybe are some problems with pills.
21:16 Are there problems with pills?
21:17 I mean, one of the things you do a lot as a physician,
21:19 is help people access what's behind that nice little
21:23 counter at the pharmacy. That's right
21:25 Are there any problems with that?
21:26 And part of it is that patients have an expectation for that...
21:29 So they come in - they're not expecting me to tell them
21:32 "well maybe you could eat more fruits and vegetables"
21:36 They're wanting me to take out
21:37 my prescription pad and write them...
21:39 And help you get behind that counter!
21:40 And then all their problems will be solved,
21:43 but the problem with medications is that every single medication
21:47 has side effects and the statins,
21:51 the medication that you were talking about earlier
21:54 that lower our cholesterol certainly have problems
21:57 with our liver and perhaps the kidneys,
22:01 and they really should be taken as the very last resort.
22:05 I've got to tell you that I had many of the same views
22:10 about 5 years ago as most of my medical colleagues
22:13 do in town and that is that you give every
22:19 menopausal woman estrogen and you'll help her
22:22 with heart disease and all this
22:24 until Dr. Diehl came to Rockford, Illinois
22:27 and put on the CHIP Program;
22:29 the "Coronary Health Improvement Project"
22:31 and I can just give a personal testimony that it absolutely
22:35 changed my life and as I have looked at research
22:40 looked at these studies, I just am absolutely convinced
22:45 that what we need to be doing is changing our lifestyles
22:49 particularly in the area of our diet,
22:53 and we need to be eating less fat, less animal protein.
22:57 We need to eat the grains and the vegetables,
23:02 and the fruits, nuts - those types of things
23:09 And we're going to get everything that we need,
23:12 and it's going to impact so many different levels.
23:16 Here today, we're talking about cardiovascular disease,
23:18 and it definitely impacts that, but it also impacts
23:24 so many other areas of our health as well.
23:26 So instead of just taking the pill...
23:28 I mean what we've talked about so far is women
23:32 #1 think that the thing that's going to get them is
23:35 breast cancer. That's right
23:36 But if you take these plant foods and whatnot,
23:39 that has been shown to have protective things
23:41 even against cancer.
23:42 Even against breast cancer, absolutely!
23:44 And then the second one, we talked about
23:46 cardiovascular disease as it relates to
23:48 estrogen replacement therapy and you're saying...
23:51 "Hey, the things are not behind the counter,
23:54 they are down the aisle and they're all different colors"
23:56 That's right! That's right!
23:58 And so Dr. Hans Diehl - tell me a little bit more
24:01 about this - the "Coronary Health Improvement Project"
24:05 or they sometimes call it "CHIP"
24:08 And this has been really now effective in helping patients
24:12 in your practice. That's right
24:14 Actually, our church - we are currently doing our third
24:18 CHIP Program and I'm involved in it because I like
24:22 to refer my patients to the CHIP Program.
24:25 I have patients that have concerns about heart disease;
24:29 they have menopausal symptoms;
24:30 they have all these issues; they're overweight;
24:34 they might have high blood pressure...
24:36 And instead of just giving them a pill,
24:39 I can sit down and talk to them about -
24:41 There might be some changes that they could do
24:44 to simplify their lives...
24:45 And I can send them to the CHIP Program
24:49 which is a program that we do over the course of 30 days -
24:54 that changes peoples lives in ways that I've never
24:58 seen before in my medical career.
25:01 So it's addressing - you mentioned these things...
25:03 You mentioned hypertension, high blood pressure,
25:06 you mentioned overweight, you mentioned diabetes,
25:09 you've mentioned all those different things
25:10 which I guess the reason you're mentioning those
25:12 is because this program we've been saying...
25:14 Hey, estrogens are supposed to protect us from this,
25:16 and they don't really protect us from heart disease,
25:19 and these other things, but if you really want to
25:22 get a handle on what to do about that,
25:24 these are the things to do and the CHIP Program
25:25 sort of covers that. That's right
25:27 That's right and in our particular program,
25:30 we find 20% decrease in cholesterol levels
25:34 in just 4 weeks.
25:35 So here we are having people come in to the program
25:40 and in 4 weeks, by making a few simple lifestyle changes
25:45 including cutting out the meats and the high fats, the dairy,
25:50 and some of that that we so readily consume,
25:53 their cholesterol goes down, their weight comes down,
25:59 they find the pounds coming off,
26:01 and they all have so much more energy,
26:03 and it's just a tremendous program.
26:05 That's really quite a testimony and really it puts
26:08 the individual in the driver's seat when you address
26:10 these major components of heart disease
26:13 like a CHIP Program or other programs mentioned here on 3ABN.
26:17 They can really be involved! That's right
26:19 That should reduce their stress
26:21 which is one thing I want to ask you about...
26:23 What's the role of stress in
26:24 cardiovascular disease and how can we reduce it?
26:26 Well, that's an interesting question because a study at
26:30 Duke University which involved patients who had heart disease
26:34 found that negative emotions such as tension,
26:38 sadness, frustration actually could triple
26:42 the risk of significant decreases in blood supply
26:45 to the heart muscle and thus cause more heart attacks.
26:50 Whereas positive emotions could actually improve
26:53 blood supply to the heart muscle...
26:55 And so, I think the spiritual life - here's another
26:59 example of where one's spiritual life
27:01 getting in connection with God,
27:03 can actually have a positive physiologic effect
27:06 on our beings and actually make us healthier.
27:13 I think what you've shared with us today,
27:15 in terms of women's health, has HOPEFULLY REDUCED
27:18 the STRESS of a lot of people watching
27:20 because, really, what you're saying is...
27:22 We so often want to take pills and potions and lotions
27:26 and this and that, but really, God has provided
27:28 all kinds of things for us to help us -
27:30 that are not behind a counter in some sort of
27:33 most holy place, but they are out there
27:36 in the supermarket where you can be involved
27:38 and as you come to know Him and His plan for your life
27:42 both in diet and in stress reduction,
27:45 and all these different things,
27:48 you can live longer and healthier as a result.
27:51 Thank you so much for being with us,
27:53 and thank you for being with us at home.
27:55 We hope you join us on the
27:56 next episode of "Health for a Lifetime"


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Revised 2014-12-17