Archive for the ‘Heart’ Category

Benefits of Exercise

Posted on: December 1st, 2014 by Richard Malik No Comments

It is common wisdom that exercise is healthy. A few of the benefits of exercise include: reduced cardiovascular risk, reduced diabetes risk, prevention of several types of cancer, improved mood, and reduced risk of Alzheimer’s disease.

But, how much exercise at what intensity is most helpful? Simple, clear guidance on the benefits of exercise is difficult to find.

Fitness sport couple running jogging outside on trail

When assessing a patient’s cardiovascular risk, I like to use a global risk assessment calculator that factors in age, gender, cholesterol ratio, blood pressure, smoking status, and diabetes status. My favorite cardiovascular global risk assessment tool can determine the benefits of various treatments (including exercise, Mediterranean diet, or statin therapy) on cardiovascular risk. Unfortunately, in this calculator (which is better than any other I have seen) the effect of physical activity is absolute – “physical activity” reduces cardiovascular by about the same amount as statin therapy. But it can’t be this simplistic; physical activity once a week must be less effective than daily physical activity; running for an hour must have a different benefit than walking for an hour.

To help clarify the benefit of exercise on physical health, I asked my research assistant, Dakota, to summarize a recent systematic review on physical activity and mortality. He summarized the research like this:

  • People of all ages who are able to be physically active will have a reduced mortality rate of 14 to 26% by doing 150 to 300 min of moderate to vigorous physical activity a week, respectively.
  • Doing a certain amount of physical activity a week does not guarantee a longer life and does not reduce the negative affects of smoking or an unhealthy diet.
  • Studies show that the more vigorous the activity the more beneficial it is to the body.
  • Studies also show the more time spent doing physical activity per week the better as long as a healthy diet is maintained and nutrients are not depleted.
  • Physical activity is shown to reduce mortality substantially more in women than men.
  • As a strict relation of risk reduction per calories burned the results were greater than or equal to 10% risk reduction for 1500kcal/week in men and 650kcal/week in women.  Studies support the message that ‘some is good, more is better.’

So, to reduce mortality by about 26%, exercise for 300 minutes per week. Men should burn about 3,750 calories per week and women about 1,600 calories per week. My favorite way to assess calories burned is to use the Runmeter app on my iPhone – it can be used for walking, biking, hiking, or running. Just enter your weight into the app and it will calculate calories burned and help you keep track of your own benefits of exercise!




Be well,

Richard Malik, ND

Naturopathic Medicine in Connecticut, Naturopathic Medicine in Vermont, Naturopathic Oncology in Vermont, Naturopathic Oncology in Connecticut


Top 5 Recommendations for your Family Doctor

Posted on: May 31st, 2011 by doctor No Comments

According to the National Physicians Alliance, the 5 steps your family doctor can take to most likely improve the quality of care you and your family receive are:

  1. DON”T do x-ray, MRI, or CT imaging for low back pain within the first 6 weeks unless red flags exist for other serious conditions that present with low back pain.  Low back pain in the 5th most common reason for a visit to the doctor.
  2. DON’T prescribe antibiotics for most cases of sinusitis unless severe, and symptoms of colored nasal discharge, facial pain, or dental pain last 7 or more days.  Most cases of sinusitis seen in clinics are due to viral infections that will resolve on their own.  Still, antibiotics are prescribed for 80% of these patients.
  3. DON’T order electrocardiogram (also known as EKG or ECG) for patients without cardiac problems or at high risk of cardiac problems.  Without symptoms or being at high-risk, EKG testing is likely to cause more problems than it is likely to help.
  4. DON’T perform Pap tests for patients younger than 21 years (most abnormal results resolve on their own) or women with a hysterectomy without a medical history of cancer of the reproductive organs.
  5. DON’T use bone mineral density testing to screen for osteoporosis in women younger than 65 year or men younger than 70 years unless there is another medical condition that increases the risk of osteoporosis.  Bone mineral density results have surprisingly little ability to identify a patient’s risk of fractures if the patient does not have a history of fragility fracture.
Being an educated patient and discussing your concerns with your doctor is the best way to ensure you get the best quality care possible.  By avoiding unnecessary procedures and treatments you are less likely to experience adverse effects and help to keep health care costs down for everyone.
Be well,
Richard Malik, ND

Updated Framingham Cardiovascular Risk Assessment Tool

Posted on: September 2nd, 2009 by doctor No Comments

As I have mentioned previously in this blog, the best way of assessing your cardiovascular risk – and the effectiveness of treatment to lower cardiovascular risk – is through the Framingham Cardiovascular Risk Assessment Tool.

In 2008, this tool has been updated and refined to better account for blood pressure readings and whether the person is treated with anti-hypertensive medications. Unfortunately, this tool as listed in the article is not very user friendly – I have created a form for my patients that can be used with some verbal directions.

Anyway, here is the study. It finds that many docs are not using a risk assessment tool for their cardiac patients in spite of evidence indicating it is important. I suggest you talk to your doc and encourage them to use the assessment tool for you.

Be Well,

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Vitamin D and Cardiovascular Disease

Posted on: September 2nd, 2009 by doctor No Comments

I just ran across a recent study that indicates that vitamin D deficiency might increase the risk for a cardiovascular event like a heart attack or stroke.  This is interesting information from the Framingham Heart Study that needs to be confirmed with more extensive medical research.

However future research pans out, testing for vitamin D status is important for many reasons including bone health, immune function, and possibly cancer prevention.  Vitamin D is a helpful therapy for osteoporosis, hypertension, mood disorders (especially seasonal), and other medical conditions.

The article can be found here

Be Well,

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5 Simple Steps to Prevent 9 out of 10 Cases of Type 2 Diabetes

Posted on: May 25th, 2009 by doctor No Comments

Recent research in Archives of Internal Medicine shows that 5 simple lifestyle factors cause 89% of all cases of type 2 diabetes in adults.  Here they are:

  1. Regular physical activity
  2. Don’t smoke
  3. Eat a healthy diet (fruits, vegetables, whole grains)
  4. Drink a small amount of alcohol
  5. Maintain a healthy weight (body mass index at 25 or less)
Several things are striking about these results;
  • Diabetes is the third most common cause of death in the United States
  • 89% effectiveness prevention of the is very powerful
  • All of these measures that are shown to be effective for type 2 diabetes are also effective prevention for cardiovascular disease – the number one cause of death in the United States
If doing these five things seem overwhelming, consider doing just one to get started.  Increasing exercise is usually a good place to start.
For more support on making healthy change, check out my podcast entitled “Making a Change” at iTunes or in your web browser.
Be Well,
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Getting the Right Blood Tests for Inflammation and Cardiovascular Risk

Posted on: April 6th, 2009 by doctor No Comments

I have seen several patients recently that simply had the wrong tests ordered by their MDs when assessing inflammation or cardiovascular risk. To prevent these testing errors, I encourage patients to better understand these tests and make sure their doctors are ordering the right ones.

A common test for inflammation is the Eosinophil Sedimentation Rate (ESR).  It measures the tendency of red blood cells to clump together – rouleaux or stacking formation.  This test is still offered by laboratories only because doctors not familiar with newer and superior tests still request it.  ESR tests can provide inaccurate results (false positives or false negatives) for many different reasons.

C-Reactive Protein (C-RP) directly measures a liver enzyme that is an acute phase reactant.  This enzymes rises quickly when inflammation is present and falls quickly when inflammation resolves.  Therefore, it is an excellent marker of inflammation; better than the ESR which is more likely to be falsely positive or stay elevated after inflammation has resolved.  It is the best blood test to help determine if a patient’s symptoms are due to trauma, injury, infection, auto-immune reactions, or cancer.

High Sensitivity C-Reactive Protein has many acronyms (HS-CRP, CRPHS, or Cardio C-RP).  It is a test that provides an assessment of an individual’s cardiovascular risk that is independent of other measures like total cholesterol, HDL cholesterol, or homocysteine.  HS-CRP measures a person’s baseline levels of inflammation and has been found to be an independent risk factor for cardiovascular disease because the formation of arterial plaques and clots that cause myocardial infarction and ischemic strokes are encouraged by chronic states of low-grade inflammation.  While high sensitivity C-RP is a good measure of risk of heart attack or stroke, it is not a test to assess inflammation from trauma, injury, infection, or auto-immune disease.  Frequently, this test is selected for patients when the normal C-RP is the right test.  I think this happens because clinicians are assuming that the “high sensitivity” test must be better than the normal test.

Be well,


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Vitamin D & Cancer Prevention

Posted on: March 3rd, 2009 by doctor No Comments

I just ran across an interesting study that, through statistical analysis, comes to the conclusion that the incidence of several types of cancers are lower when people have higher vitamin D blood levels.  Their recommendation is for people to maintain vitamin D levels between 55ng/ml and 90ng/ml.  These levels are between the standard mainstream medicine reference ranges of above 32ng/ml being optimal and above 100ng/ml being toxic.

These researchers are recommending vitamin D intakes between 2,000 and 10,000 IU per day.  Current recommendations are 400-600 IU per day.

Vitamin D levels are accurately assessed with a test called 25-OH Vitamin D.  If taking high doses of vitamin D, please have your vitamin D levels checked by your physician after 3 months of supplementation to ensure your safety.

Vitamin D3 5,000 IU

Vitamin D3 5,000 IU

If you are deficient in vitamin D, supplementation will likely improve bone health, blood pressure, and possibly mood and immune function.

Here is the highest qualtiy and most affordable Vitamin D supplement I have found; tested for identity, potency, purity, and label claim to expiration date.  Taking one capsule every third day ensures a daily dose below the Institute of Medicine’s conservative upper intake limit of 2,000 IU per day.  At this dose, one bottle lasts about 9 months!

Be Well,


Natural Supplement Companies & Shady Research

Posted on: March 2nd, 2009 by doctor No Comments

In my last post, I discussed how pharmaceutical companies can skew medical research and statistics.  They aren’t the only ones trying to profit from science studies.

A supplement manufacturer recently sent me an email about a study that shows that their meal powder is helpful for lowering cardiovascular risk through positive effects on cholesterol that exceed benefits that can be seen with simply adopting a mediterranean diet.  Great News!  Right?  Maybe not.  

The study lasted 12 weeks and has two parts.  In one, people are eating a “Mediterranean” (quotation marks to be explained in a moment) diet, while the other group eats a “Phytochemical Enriched Diet” (PED).  The results of the study show that “Mediterranean” diet participants reduced their cardiovascular risk by 2.9% while the PED dieters reduced their risk by 5.6.  The “Mediterranean” dieters did very good, but the PED dieters did much better.

Actually reading the study brought up some concerns about the validity of the research results:

  1. the “Mediterranean” dieters consumed only 12 grams of fiber per day (a very low amount that is equivalent to the fiber found in only 1/3 cup of chickpeas or garbanzo beans)  
  2. Mediterranean diets are known for improving cholesterol values
  3. Mediterranean diets are known for being fiber-rich
  4. According to According to the Institute of Medicine (the same organization that establishes Daily Recommended Allowances for micronutrients), the daily recommended allowance of fiber is 25 grams per day for women and 38 grams per day for men
  5. One of the health benefits of fiber is it’s ability to improve cholesterol values
  6. The PED group in the study consumed 21 grams of fiber per day – 75% more fiber than the “Mediterranean” diet group

Based upon these observations, the study reveals the importance of fiber for improving cholesterol values and cardiovascular risk.  Based upon their own statistical analysis, the researchers show that the fiber intake is the most likely cause for the improved results in the PED group.  However, the study is written as though the “Phytochemical Enriched Diet” in their proprietary “medical food” is the factor for the improved cardiovascular risk.  BALONEY!

The Bottom Line:

When natural medicine or supplement companies spend plenty of their own money on research, they are more likely to bias their results, just like pharmaceutical companies.  In either case, the result is harm to people’s health at worst or harm to their bank accounts at best.

Eating more fiber by consuming more vegetables, fruits and whole grains is a great first step for lowering the risk of cardiovascular disease, diabetes, and cancer!

To learn how to empower yourself to understand and improve your cardiovascular risk go to the Heartsection of the World of Wellness.

Be Well,

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