In recent years, I’ve added educator to my CV. After 20+ years of private practice, I decided to share my knowledge in a different way and have had the privilege of speaking to my colleagues about integrative heart health in a variety of venues. It’s been a pretty busy two years, but 2024 is the biggest year yet!
I started writing this blog on the plane back from San Diego where I spoke at the California Naturopathic Doctors Association’s Annual Conference about familial hypercholesterolemia and secondary causes of hypertension. Later that same week, I presented two more times for two different organizations that provide continuing education for naturopathic doctors: High Triglycerides in Men for The Confident Clinician, and Immune-Mediated Inflammatory Diseases and Cardiovascular Health for Collaborative Education.
And that’s just this spring! I have 3 more engagements in the fall on top of a regular gig facilitating small groups interested in cardiovascular health for the aforementioned Confident Clinician organization.
Being able to share this information with my colleagues has been incredibly rewarding. But really, this knowledge is meant to support you in the end! As such, I decided to temporarily skip the go-between (sort of!) and take an opportunity to summarize my “spring tour” for you. If anything below resonates with you, please reach out to your healthcare provider to go into more detail!
Topic #1: Familial Hypercholesterolemia (FH)
· this common genetic condition leads to high LDL-cholesterol, starting at a young age and persisting throughout a lifetime
o there is no specific number that defines “high” in this case, but it is more likely in those with an LDL-cholesterol of ≧ 4.9 mmol/L (or 190 mg/dL)
· this premature, significant, and lifelong elevation increases the risk of atherosclerotic heart disease (the most common type and what we usually mean when we say heart disease)
· as a genetic condition, it runs in families, so it is common to see premature heart disease show up more often
o this is typically defined as experienced a cardiac event or intervention (like bypass or stent) before the age of 55 in men, and 65 in women
· considering both concepts above, I’ll often use the simple F+H = FH equation (courtesy of the Family Heart Foundation) to flag potential cases
o F stands for family history of heart disease
o H stands for high cholesterol
o FH = familial hypercholesterolemia
· lifestyle and nutrition continue to be foundational tools, but this is a situation where medication is necessary
Topic #2: Secondary Causes of Hypertension
· these are scenarios where high blood pressure is caused by a definable and “correctable” cause
· there are several things that differentiate secondary and primary (or essential) hypertension:
o secondary causes should almost always be treated differently than primary ones but rarely are, leading to underwhelming results
o if the cause is identified and properly treated, we will usually see a significant improvement or even a cure
o secondary causes require additional testing to figure out; it’s not enough to just know your blood pressure is high
o secondary causes are frequently missed completely or take a long time to figure out (what we call a diagnostic delay)
· signs that your high blood pressure might be related to a secondary cause include:
o it came on suddenly
o you are under 30 years old
o it is very severely high (>180/>120)
o you need 3 or more medications to control it
o it comes with low blood potassium levels
Topic #3: Hypertriglyceridemia (aka high triglycerides)
· triglycerides are reported along with your cholesterol (as they travel along in the same particles in your blood stream)
· triglyceride is just another word for fat; it’s normal for levels go up after we eat!
· however, anything above 1.7 mmol/L in a fasting state is considered high
· mild-to-moderate elevations are usually defined as 1.7-5.0 mmol/L
o they are usually due to secondary causes such as certain medications, high saturated-fat and/or high sugar diet, high alcohol intake, diabetes or thyroid conditions
· severe-to-extreme elevations are defined as 5.0 mmol/L and higher
o they are usually genetic in nature
· high triglycerides can independently increase the risk of heart disease (and if very high, pancreatitis), so we want to work on this even if your cholesterol is fine
Topic #4: Inflammatory AutoImmune Conditions
· most autoimmune conditions are inflammatory to some degree
· of particular interest would be rheumatoid arthritis, lupus, inflammatory bowel diseases, and psoriatic arthritis
· these conditions increase heart disease risk over time, largely due to the long term impact of inflammation
o what logically follows is that the better controlled your condition, the less inflammation, the less risk to the heart
· we should be having early and proactive conversations about heart health with anyone with such conditions
· important fact: there is something call the lipid paradox where your cholesterol levels go down when you experience a flare up of your condition – once the inflammation resolves, the cholesterol goes back to your normal
o people are often mistakenly told their cholesterol is “perfect” in these situations which is particularly problematic since we want to be more cautious in these conditions due to the extra risk, not less!
When I was originally preparing these presentations, I thought of them as very different topics, but the more I got into it I realized something.
What’s underneath matters just as much as what we see on the surface. High cholesterol, blood pressure, and triglycerides and inflammatory autoimmune conditions of course need to be addressed regardless of the situation. But understanding their why and how actually means providing better care. Which you deserve.
I love this new aspect of my work. There aren’t that many naturopathic doctors, at least in Ontario, who focus in this area. I’m thrilled to be able to share some heart health love on bigger platforms.
p.s. Look for Part 2: the Fall Tour sharing my takeaways from my next 3 conferences!
