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Matters of the Heart
Are you still struggling with abnormal cholesterol, high blood pressure, weight issues or fatigue while your doctor just reminds you to keep taking the same prescriptions day after day?
Are you tired of being told you are still in the danger zone but the medication is only helping marginally?
Are you looking for a more proactive approach with your health that goes deeper than just prescription medications but have no idea where to begin?
About 600,000 people die of heart disease in the US every year, that’s approximately 1 in 4 deaths Every year, over 700,000 experience their first heart attack with a one in three chance of reoccurrence
If you are concerned for yourself because heart disease runs in your family, then the information in this guide is vital
Throughout, I’ll share new and cutting-edge information about prevention and testing that you and your current doctor (or cardiologist) may not know about
My goal is to give you clarity on what steps to take that will make a real difference in your risk profile, and thus get you out of the danger zone. My approach can not only lower your cardiometabolic risk drastically, but it’s also complementary to the care you already receive.
I believe that while traditional care is important, it’s just the starting point. New research has clearly shown that the equation of taking meds = improved cholesterol numbers = heart-healthy, just isn’t true anymore
The equation is much more complex
The good news is that there is a methodology that gets to the root of chronic heart disease and cardiometabolic issues in general!
Together, we can help you and your loved ones eliminate needless suffering, so you can regain your energy and get back to enjoying life without constant worries It’s a more proactive approach that also gives you far more control over your own health in other areas
The purpose of this guide is to introduce you to this new approach – a more balanced and natural treatment approach paired with more scientifically advanced medical testing
Not only can we get a clearer picture as to the specifics of your heart and blood vessel health, together we can craft a personalized plan that will allow your body’s natural healing ability to take over, so you can live your best life
You can find even more information about this more complete approach to managing your heart health on my website at apollocardiology.com. And if you have any questions, please email drtwyman@apollocardiology.com.
To your heart health and wellness,
Michael Twyman, MD
Heart Health Isn’t Just About Cholesterol
When it comes to heart health, it’s not just about having “good” cholesterol numbers... it’s a much more complex equation. In fact, 77% of heart attacks happen to people with normal cholesterol levels!
While built-up plaque in arteries can cause a lot of damage and atherosclerosis, there are many other risk factors involved that also place enormous strain on your heart – including general inflammation, poor diet, lack of physical activity, increased stress, and poor sleep
Importantly, the risk of heart attack and stroke can be lowered drastically without medication by using the safest and most advanced therapies that I’ll go into more detail in this guide To keep your risk low, there are additional lifestyle changes that I help my patients adopt
There are quite a few new noninvasive screening tests, allowing me to take a deeper look inside your arteries for blockages, so we can get a more detailed picture of what is happening vs just prescribing medication based on cholesterol levels… which doesn’t treat the inflammatory issues that cause many of the issues in the first place.
That’s why hand-in-hand with patients, I also review lifestyle factors to see how your habits and diet create inflammation (and how we can tweak them to give your heart and body more healing support
Is Your Risk Much Higher than You Think?
Approximately 70% of most individuals who died from a heart attack were not aware of their risk, which is devastating for them and their families According to the American Heart Association, 50% of men and 64% of women who die suddenly of coronary vascular disease have no previous symptoms
However, in my experience, there are many warning signs that go ignored for years. Early detection and a deeper look at your lifestyle risks, plus the proper testing is the only way to determine the proper treatment approach.
Naturally, if you or a loved one has a history of prior heart attack, they are at high risk but there are so many other factors that raise your risk – leaving your vulnerable to a sudden attack.
Individuals with the following risk factors have elevated risk for heart attack, stroke or any type of vascular disease, and should ask their doctor about Carotid IMT (CIMT) screening
High Risk Checklist
High cholesterol levels used to be the #1 marker for heart health (it’s actually a very small part of the equation)
Now that we know so much about the larger factors that play a part in your risk profile, here are the most important risk factors that need to be on your radar! Go through the checklist to give you a general idea of your risk
☑ Diet High in Carbs, Sugar, and the WRONG Kinds of Fat + Being Overweight
The science around food and heart health has changed dramatically over the past ten years –and sadly, most traditionally trained doctors don’t know the up-to-date science and didn’t receive nutritional training as part of their medical training.
Traditional docs certainly do wonders in the acute care setting, but when it comes to prevention you need to take an integrative medicine approach and seriously upgrade your diet with the latest scientific findingings around functional nutrition
Here’s the bottom line:
Red meat, cholesterol-rich foods like eggs, and fat are really not to blame for heart disease – and you can eat them if you consume them the RIGHT WAY as I explain in a moment
Diets high in processed carbs, loads of sugar, and high-sodium and fast-foods are the real culprits. When your body can’t burn this super-high octane, calorie-dense foods that make your blood sugar swing out of control (telling your body to save them up as fat), they get stored as belly fat. They also can cause oxidized (rusting) of your lipids and this increases the risk of plaque building up in the arteries.
☑ Tobacco User
Cigarette smoking harms nearly any part of the body because cigarette smoke is a toxic mix of more than 7,000 chemicals that can damage normal processes in the body In terms of heart health, smoking is particularly bad since it can slow oxygenation of your blood that your heart desperately needs to function
Smoking can also permanently damage your heart and blood vessels, changing your blood chemistry, as well as causing a build-up of plaque in your vessels by gathering cholesterol, scar tissue, calcium, and fat to block proper blood flow from blood vessels to your heart. The numerous toxins in the cigarette damage the inner lining of the blood vessels (the endothelium).
☑ Family History of Heart Disease/Stroke
Genetic factors may play some role in elevated lipids, high blood pressure, heart disease, and other related conditions and now that we know more about genetics than ever before, thus taking a look at yours is a smart idea
But don’t feel you are destined to have a heart attack just because of genetic factors:
Lifestyle choices can overrule genetic factors, hands down I have seen many of my patients turn the tide and reverse underlying heart disease with optimizing their lifestyles The proper testing will inform your treatment plan.
Their personalized plan, based on their individual test results, provides them with a clear roadmap consisting of a nutrition prescription, exercise regimen, stress relief plan, optimal sleep recommendations, appropriate supplements and much more – but unfortunately, this type of “lifestyle medicine” is not commonly practiced… so look for a cardiologist trained in what’s called integrative or functional medicine.
☑ High Blood Pressure
High blood pressure is a risk simply for the fact that when your blood pressure is high, it places a lot of strain on your blood vessels
People erroneously believe if their blood pressure are around 130/80mm that everything is ok because it’s only “slightly” elevated over normal.
But last year, new guidelines from the American Heart Association, the American College of Cardiology, and nine other health organizations now define hypertension (high blood pressure) to start at 130/80 and higher. This means 70% of men over age 55 are now classified as having hypertension.
The reason why so many people fall into this range is through a combination of “inflammatory” diet, lack of physical activity, poor sleep, and high levels of stress with lack of coping mechanisms
☑ Rheumatoid Arthritis (RA)
Having RA doubles the risk of most heart problems, including heart attack and stroke due to atherosclerosis (the buildup of fat, cholesterol and cellular debris (plaque) on blood vessel walls).
Part of the reason why your risk is so high is because people with autoimmune illness like RA, really struggle with systemic inflammation, on a regular basis.
While people with RA may not have high blood pressure or diabetes, living in a constant state of inflammation is extremely detrimental to your heart as well as your other organs. Your arteries are the innocent bystanders being injured by this inflammatory condition
☑ Psoriasis
Psoriasis is a chronic autoimmune disease that inflames areas of skin, causing discomfort and itching and skin lesions – because of an abnormally fast turnover of skin cells
Like rheumatoid arthritis, psoriasis causes the immune system to overreact to a perceived threat and according to some studies, psoriasis can even turn into arthritis and contribute to heart arrhythmias.
☑ Metabolic Syndrome
Metabolic syndrome is a group of conditions that occur together that’s usually triggered by serious weight gain, especially around the midsection for those who naturally have an “apple” body shape It is associated with increased blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels
Metabolic syndrome increases your risk of heart disease, stroke and type 2 diabetes
One-third of U.S. adults have metabolic syndrome and the only sustainable way to balance it is through lifestyle changes and working with a practitioner who has expertise in lifestyle medicine.
☑ Erectile Dysfunction
Erectile dysfunction is defined by the inability to get and keep a firm erection and does have a link with heart disease When the inner lining of the blood vessels (endothelium) is damaged and the smooth muscles of the blood vessels aren’t working well there is a lack of blood flow to the penis and erectile dysfunction occurs This is an indication that blood flow isn’t flowing in a healthy way and this may also be happening in the arteries to the heart
Erectile dysfunction does not always indicate a heart problem, but it’s something that your cardiologist should explore with you.
☑ High Cholesterol
Having high cholesterol may or may not increase your cardiometabolic risk (depending on the health of your vessels and the level of systemic inflammation)
To be sure, while cholesterol is found in plaque it is not the main cause of coronary events The cholesterol generally needs to be damaged by oxidation (which is caused by rampant inflammation) before it gets trapped in the vessel walls and causes plaque formation and blockages that impede blood flow in the arteries
A traditional lipid panel with total cholesterol, triglycerides, HDL-C, and LDL-C is not sufficient to calculate risk. Cholesterol and triglycerides are transported in the bloodstream by lipid particles. There are advanced lipid panels that measure the total number of lipid particles and the size of those particles. Particles predict risk. Too many particles floating in your bloodstream is like a traffic jam occurring on highway and having an increased risk of an accident
Addressing Your Risk Factors
You may be feeling overwhelmed right now, especially if you’ve realized that you have multiple risk factors
The first step is having the knowledge that you are at risk and then getting the support from experts like the ones at Apollo Cardiology to help you craft a personalized “game” plan to reduce the risk
We will sit down with you to review your history, discuss your health goals and then send you for the appropriate testing.
After the testing is completed and reviewed with you, then it’s all about implementing my lifestyle program that will kickstart your path to optimal heart health and help you lead your healthiest, most vital life!
In the next section, I’ll touch on the various specialized heart testing that we routinely employ at Apollo Cardiology - something that unfortunately isn’t utilized enough by doctors who focus on acute care medicine “Heart attack prevention” is my area of expertise and it takes some detective work to get to the root causes.
Advanced Testing
In my practice, we use 3 noninvasive screening tests to assess for cardiovascular risk Two of the tests look for plaque and one of the tests looks at the health of the artery
The CT Coronary Calcium Scoring and Carotid IMT Test allows us to actually look inside your arteries for plaque that may lead to heart attacks down the line
The CT Coronary Calcium Score is a low radiation dose CT scan that looks for calcium in the walls of your heart arteries. Calcium is suppose to be in your bones and teeth and NOT in your arteries. The more calcium that is present due to previous damage to the arteries, then the higher the risk of having a future heart attack. This test is performed at a radiology center and does not require an IV or any significant prep.
The carotid intima-media thickness test (CIMT) measures the extent or existence of plaque build-up in the carotid artery. The test measures the thickness of the inner two layers of the carotid artery (called the intima and media) Any thickening of these layers can alert us to issues even if there’s no other risk factors present The test is administered at the office and takes under 10 minutes and does not require any special preparation or fasting before the test
Another unique test that we utilizate at our practice is the EndoPAT (endothelial function testing) This is a safe and noninvasive diagnostic tool that enables us to give a more comprehensive assessment of both large and small arteries
It allows us to evaluate the thin membrane that lines the inside of the heart and blood vessels called the endothelium It’s so important to keep this membrane healthy because it is lined with endothelial cells that control vascular relaxation and controls blood clotting, blood platelet adhesion, and immune function.
Endothelial Dysfunction is now considered one of the earliest detectable stage of cardiovascular disease. Healthy Endothelial Function means that the arteries expand properly. Abnormal
EndoPAT studies indicate that there may be damage occurring to the arteries which if not corrected could lead to hardening and plaque build-up of the artery The EndoPAT test can be performed in the office and takes just 15 minutes
Diet vs. Medication
Inflammation has been found to be associated with just about every health condition out there. I starred in an Amazon Prime documentary “Un-Inflame Me” in which I help a patient decrease their inflammation and regain their health. I can help you do the same.
Inflammation has long been known to play a key role in allergic diseases like asthma, arthritis and Crohn’s disease – and in my practice, I see a lot of inflammation of the heart and blood vessels
Researchers are investigating chronic inflammation’s effects on health and possible preventive medical and lifestyle applications, though we already have many ways to treat inflammation
In fact, eating well is one of the easiest ways you can mitigate inflammation!!
Eating the right way also balances many of the other risk factors for your heart while protecting you from a long list of other chronic illnesses.
Unfortunately modern medicine has placed most of its focus on acute and emergency care (much needed) and medicating symptoms with allopathic drugs.
This is why conventional medicine rarely addresses the root cause of an illness and just focuses on creating a fast “diagnosis” that almost always calls for some prescription drugs
While some prescription medications can save lives, taking meds for something that can be fixed with lifestyle changes just doesn’t make sense!!
Sadly, many of the medications on the market have serious side effects, do not heal the underlying root cause, and only cover up symptoms in a body that’s already super unbalanced
It’s like the “Check Engine Light” is coming on in your car, and willfully ignoring it – rather than finding out where the trouble lies
Foods That Cause Inflammation
What researchers believe is that an overactive immune system results in the body being flooded with defense cells and hormones that damage tissues.
Dietary and environmental toxins may build up in the body, turning the immune system on and keeping it highly reactive.
Foods that can promote inflammation are:
● Corn and soybean oils and other GMO foods
● Gluten
● Dairy made from corn-fed animals and treated with antibiotics
● Refined “white” carbohydrates
● Conventionally raised meat (animals fed on corn vs grass)
● Sugars
● Trans fats
That’s why a more natural healing approach aims to reduce systemic inflammation through a diet that (a) reduces or eliminates these inflammatory foods while (b) loading up on cardio-protective, anti-inflammatory foods.
New Ways of Eating for Heart Health
Your body is an amazing natural healing machine It has the capacity to reverse many chronic conditions with the proper care and fuel
We know through current science-based studies that what you eat and drink plays a critical role in your overall health
Yet, most Americans are overweight and deficient in key nutrients While no one diet works for each person, some general guidelines are to eat a seasonal diet and to limit your feeding window to 12 hours or less
By now you’re probably realizing that USDA food guidelines are off
If you tally the calories and content of the example pyramid, you get around 3500 calories with 300 grams of carbs a day (most people’s limit should be around 80-ish).
The food pyramid provides zero discussion of healthy fats and the need for organic foods while overemphasizing carbohydrates, grains, meat and dairy typically raised with high levels of toxins and hormones.
Little attention is placed on the dangers of refined carbohydrates and many “health experts” out there still believe the “high cholesterol foods = high blood serum cholesterol” equation
This may be due to the conflict inherent in the USDA’s mission, which is to set national health nutrition policy while helping to market and promote specific agricultural products to Americans
In this next section I want to open your eyes to a new way of eating to create the best healing environment for your heart, lower your inflammation, and help you put your worries for heart attack risk at rest
Vegetables and Seasonal Eating
Getting plenty of fresh veggies into your diet (around 4-6 cups a day) is the best way to detox your body, get more standard nutrition in the form of minerals and vitamins, and give you special fibers and nutrients that can feed your gut bugs (who safe-guard you against inflammation)
The easiest way to build your plate? Start with filling it with vegetables and sprinkle nuts and seeds and healthy flavorings on top Add proteins with guidance from your practitioner – for example, we give our patients specific guidance on their fat and protein requirements based on their health goals and lab work results.
Seasonal eating is important too – depending on where you live in the world and the power of the sunlight that time of year (High sun = high carb, low sun = low carb). If the fruit/vegetable does not grow that time of year in your location then you should pick something else to eat if you want to eat optimally. WHY? Your mitochondria (the little powerplants in your cells) sense their environment They are the engines that make you energy Sunlight grows most of the food that helps supply the building blocks for the mitochondria to turn into energy The
mitochondria get mixed messages if they receive food that is out of season Your GI tract would think it is summer and your skin would think it is winter
Fats
Contrary to the commonly-held beliefs about fat, a higher fat diet is not necessarily bad if you pick the right kinds of fat
Saturated fats used to be demonized but what we are finding now is that they are generally neutral as long as they don’t come in the form of trans-fats or come from corn-raised beef or poor-quality dairy sources that also contain a lot of extra hormones
Avoid fried fats as this oxidizes the fat, damaging it – think of it the way too much exposure from weather can damage or rust your car Your body will not be able to utilize this fat effectively and will contribute to inflammation in the system
Moreover, it’s beneficial to know your Apo E genotype (a simple lab test) to help guide how much good healthy fat to include in your diet. Certain genotypes do not do as well with a higher fat diet.
The most important fat is docosahexaenoic acid (DHA, a type of omega-3 fatty acid) that’s needed for brain health and transferring energy to your cells. Good sources of DHA-containing fats include fatty fish, grass-fed meat, and pasture raised eggs
High quality grass-fed red meat is higher in omega-3 and is generally a healthy option Avoid conventionally raised beef as it contains a higher amount of inflammatory fats (too much omega-6s and loads of hormones)
Conventionally raised beef is fed grain to fatten up the animals faster Since their digestive systems can’t handle grain (they are meant to eat grass), this makes them very ill prompting cattle producers to use antibiotics Sadly, meat treated with antibiotics means you get unwanted doses of antibiotics in your body
Grass-fed meats are pricier because they take longer to raise but the meat is much leaner, contains omega-3s and has a beefier flavor. To save on grass-fed options, place a larger order and share with a neighbor or stock your freezer. Many grass-fed ranchers give a bulk discount and will ship right to your home.
Alcohol
“Two glasses of wine a day are heart-healthy ”
Time to bust another health myth: Alcohol destroys REM sleep (when you dream and when your mitochondria repair themselves) and just one 4-ounce glass is enough to disrupt your sleep
In addition, regular alcohol consumption not only puts a lot of stress on your liver (your major detox organ) but can also cause swings in blood sugar that blocks weight loss
“What about the antioxidants?” you say? The main antioxidant in red wine, resveratrol, is incredibly hard for your body to absorb – so aim to get your antioxidants instead from fruits and vegetables. That said, having a celebratory drink from time to time is fine.
Other Lifestyle Factors to Consider
1. Your Environment
The environment of your day-to-day life has a profound effect on your health Your environment includes locations, like where you live and work, your gym and your home Be aware of any toxins or allergens in your environment and how they might impact you Many musty or damp locations can contain black mold or other very toxic substances that can compromise your health long-term.
Just as there may be toxins and allergens in your home or workplace, you might also be maintaining toxic relationships with certain individuals in your life that affect your mental and emotional health – which can have a stark impact on your body’s ability to heal itself.
Stress hormones like cortisol, when consistently at high levels, can impact your heart health. We need some cortisol release (like when we wake up in the morning to get us moving) but when it gets released too often from regular mental or emotional stress, it can seriously disrupt your hormone and sleep balance This affects your heart health
2. Your Activity Level
It’s no surprise that exercise is important to for your overall health But what kinds of exercise promote the body’s natural ability to heal?
Certain aerobic and resistance exercises can improve (or prevent) various medical conditions and we
recommend an exercise program based on what we see with your testing
We’re just beginning to understand how certain activities can alleviate and suppress many chronic ailments, but regular movement at least three times a week is great for heart endurance and your mental state
- Walking is an activity that should be done daily, but does not count as exercise because it does not stress the body enough to make an adaptive change
- Resistance training 2-3 times per week. Muscle is your metabolic currency. The more muscle, the better your metabolism.
- Interval training is more physiologic than steady state cardio
- Check Heart Rate Variability (HRV) for evidence of cardiac conditioning and to ensure not over training.
3. Your Sleeping Habits
The healing properties of sleep are critical for longevity
So many of my new patients are seriously sleep-deprived and then wonder why they have aches and pains, brain fog, and heart flutters
Medical science has only recently started to unravel the myriad health effects of sound sleep
As with many health habits, the more regular you are, the better – and sleep is no exception!
Most of my patients feel the optimal effects when they get regular amounts of deep and REM sleep. The number one tip to optimize sleep is to go to bed around the same time each evening and waked up at the same time 7 days a week
Sleep is incredibly therapeutic for your brain, as it is literally essential for you to detox any unwanted toxins in your brain tissues
When you get better sleep, your brain releases more BDNF (short for brain-derived neurotrophic factor) BDNF is a key protein implicated in the stress response, long-term memory, Alzheimer’s disease, and psychiatric disorders such as bipolar disorder, depression, and schizophrenia That’s why when you produce enough BDNF, you are sharper mentally and age more gracefully
Controlling your circadian rhythm is key to optimal sleep Minimize artificial light after sunset
Consider blue blocking lenses if exposed to artificial light at night or using devices with screens
4. Your Ability to Manage Stress
Excessive stress is one of the most salient contributors to poor health today, and is unquestionably associated with increased rates of cardiovascular disease, cancer, autoimmune disease, diabetes, and death.
Changing your diet can also greatly alleviate stress because it can literally help calm your mind by giving your brain nutrients it is lacking.
One of the major benefits of exercise is it’s well known ability to help you “burn off stress”. The runner’s high is real
Meditation, mindfulness, yoga, and deep breathing are all options to help decrease your sympathetic tone and improve your parasympathetic tone (the rest and relaxation part of your nervous system)
Now that you understand why lifestyle medicine is the best way to restore health and manage core body functions, read on to find out how you personally can begin to reap its benefits with the help of Apollo Cardiology.
Your Next Steps
With the right tools and information, the truth is that we can identify your REAL risks for cardiac events before you suffer a devastating outcome
My mission is to educate people and teach them that there is a very effective and comprehensive way to getting your heart health back on track and leading your healthiest, most energized life!
I’ve been honored to help so many patients change their lives and the lives of their families, showing them that through advanced testing and lifestyle changes, they can live a happy, heart-healthy life. Together we create a comprehensive personal roadmap that is all about you, how to rid yourself of your major risk factors and how to heal your heart and your body.
Schedule a free, no-obligation strategy session phone with me to learn exactly what we can do to address your concerns and explain how my program works.
SCHEDULE YOUR STRATEGY SESSION ONLINE OR CALL 314-635-9028
We look forward to helping you, Michael Twyman, MD Apollo Cardiology
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About Michael Twyman, MD
Dr Michael Twyman has a BIG goal, and it's personal: To live longer than his great grandmother Ola, who died at age 106 in the year 2000 And that's great news for all of us
Dr. Twyman is board certified in cardiovascular diseases and centers the care he provides on finding the root cause of disease with an array of effective techniques from preventive and functional medicine as well as from the world of “biohacking”. He utilizes an integrative and comprehensive approach to treatment and combines the latest state-of-the-art technology with scientifically proven alternative therapies
Biohacking is the art and science of changing the environment around you and inside you, so you have more control over your own biology according to Dave Asprey who coined the term
Pills and procedures may have their place in an emergency, but he's focusing on helping patients reconnect with nature so that they never need those in the first place. He's fascinated by optimizing human longevity, so he's diving deep into light, water, and magnetism and using these fundamentals of “biohacking” with his patients.
Dr Twyman will help you maximize your health with improving broken circadian rhythms, optimizing sleep, suggesting seasonal eating and optimal timing of meals, how to optimally recovery from exercise and discuss what types of exercise are best, and suggest many stress relieving techniques
Dr Twyman has extensive experience interpreting coronary calcium scoring tests and advanced lipid profiles Carotid Intima media thickness testing to assess for soft plaque and “vascular age” was added to the practice in 2019 The EndoPAT device is a novel noninvasive tool that measures the health of your arteries by measuring the endothelial function of one of your arms. If your endothelium is healthy you are less likely to be developing plaque in the arteries and are less at risk of a heart attack.
Dr Twyman was born in St Louis and graduated from Rockhurst University in Kansas City in 1998 He received his medical degree and completed his internal residency at the Saint Louis University School of Medicine
During his four years of active-duty service as a lieutenant commander in the U.S. Navy, Dr. Twyman was a staff physician at the Naval hospitals in Charleston and Beaufort, South Carolina.
Dr Twyman received his master’s degree in business administration from Webster University in Missouri before returning to St Louis for further medical training, completing his cardiology fellowship at the Saint Louis University of School of Medicine in 2012
Dr Twyman practices at Apollo Cardiology in St Louis, Missouri Telemedicine visits are available with patients who are unable to come to the office or who live out of town
Dr Twyman looks forward to helping his patients reduce their risks of having a heart attack so that they can focus on having optimal health and live their lives on their own terms