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Surgery for Blocked Arteries Questioned

What should you do if your doctor tells you that you have blocked coronary arteries? A recent study shows that in people who have blocked arteries and diabetes, the chances of dying or having a major heart attack are the same whether they undergo surgical procedures (bypass or stents) or just take medication to treat cholesterol, blood pressure and diabetes. Death rate was also the same whether or not they took insulin (BARI 2D study, New England Journal of Medicine, June 10, 2009).

Patients who had bypass procedures had fewer heart attacks than those who had stents, even though both had the same chances of dying (also reported in the BARI-1 trial). I think that stents are less effective in preventing heat attacks because stents are foreign bodies placed in arteries that can increase chances of clotting, a major precipitating cause of heart attacks. That is why people with stents are given drugs to prevent clotting. Also, type 2 diabetics who were not given insulin had fewer blockages than those given insulin. I think that this is because high insulin levels constricts coronary arteries.

This is a very important study because the most common cause of a sudden heart attack is diabetes, and 80 percent of diabetics die of heart disease. More than one third of Americans will become diabetic and that number is projected to double by 2030.

If you have diabetes and blocked arteries, try to avoid surgery. If you need surgery, you may gain better protection from a bypass than from a stent. I also believe that you should try to control type II diabetes without insulin. Get a blood test called C peptide (which measures insulin production). If it is above one, try to avoid insulin. If it is below one, or you cannot get your HBA1C blood test (which measures cellular damage from diabetes) below 6.5, you may need insulin.

For everyone, I recommend: 1) A diet rich in fruits, vegetables, whole grains, beans, seeds and nuts. Restrict meat from mammals, and eat refined carbohydrates (sugar water and flour) only when exercising. 2) Exercise every day, and avoid overweight, smoking and more than two alcoholic drinks a day. 3) Keep blood levels of vitamin D3 above 75 nmol/L.

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Dear Dr. Mirkin: Is it true that only weight-bearing sports strengthen bones? Many studies have shown that weight lifting and weight bearing sports strengthen bones, but a new study from Thailand suggests that non-impact exercise such as swimming or cycling help to increase calcium absorption from the intestines (American Journal of Physiology. Endocrinology and Metabolism, April 2009). In this study, rats that swam one hour a day, five days a week for two weeks had a marked increase in calcium absorption compared to their non-swimming litter mates. The researchers conclude that any exercise helps to upregulate the calcium transporter genes.

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Dear Dr. Mirkin: Does Helicobacter pylori, the bacteria that causes stomach ulcers, also prevent diseases such as eczema?

Nobody knows. Being infected with Helicobacter is associated with decreased risk for eczema (Journal of Epidemiology & Community Health, July 2007), but it is also associated with an increased risk for asthma (Gut, May 22, 2008). Your immunity protects you from certain infections by searching out and killing foreign germs in your body. It does this by attacking surface proteins on invading bacteria and viruses. However, your immunity is not supposed to attack your own cells, so it does not attack cells that have the same surface proteins that your cells have. The Hygiene Hypothesis proposes that you need to have certain infections to have a healthy immune system. If you are not infected with various common germs, your immunity does not have the chance to practice killing germs and learning the difference between invading organisms and your own cells. For example, it may attack ragweed pollen to cause hay fever. It may attack your lungs and cause asthma instead of attacking the bacteria that causes stomach ulcers. Your immunity may get so active with Helicobacter infections that it may attack your own skin to cause eczema.

The Hygiene Hypothesis has not been proven. It is just a hotly debated theory among doctors; only time will sort out the conflict and tell us if Helicobacter stomach infections help your immunity protect you from other infections. More on Helicobacter pylori

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Recipe of the Week:

Cold Red Bell Pepper Soup
(This may sound odd but it's delicious and beautiful!)

You'll find lots of recipes and helpful tips in The Good Food Book - it's FREE

June 22nd, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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