Transcription:

Melanie: Welcome to BayCare HealthChat. I'm Melanie Cole, and I invite you to listen in as we discuss lifestyle and heart health. Joining me is Dr. Kirksak, J Poonkasem. He's an Integrative and Palliative Medicine physician with BayCare. Doctor, I'm so glad to have you join us today.

So let's talk a little bit about lifestyle and heart health, as we start Tell us what are the biggest modifiable controllable risk factors for cardiovascular disease. As we look at this, and we hear all the statistics about heart disease, tell us what we can control.

Dr. Kirksak Poonkasem: Hi, Melanie. Thanks for having me. And yes, this is a very important topic and some of the modifiable risk factors for heart disease, you know, are a lot of it's lifestyle related, you know, smoking, high cholesterol, high blood pressure, being overweight or obese, having diabetes, stress. Not a lot of people think about stress and heart disease. Nutrition, sleep, mental health, physical inactivity. These are things that are easily, modifiable, yet if not taken care of, it's can cause a lot of, chronic diseases and heart disease.

Melanie: Let's talk about those then. What are some of those comorbid conditions that can either contribute to, or be caused by heart disease? Because sometimes they go back and forth or hand in hand.

Dr. Kirksak Poonkasem: Yeah. So, you know, a lot of the things that, contribute to heart disease, you know, number one, poor nutrition, right? A lot of people in America, are eating the wrong way. You know, there's a lot of studies out there that, you know Americans aren't following the recommended diet. But you step back a little bit and say, well, what is the recommended diet? Right? And there's so many fad diets out there that it confuses everyone. It confuses me. And, but when you really drill down to it, there's so many things out there and we all know diets don't work, diets fail for the most part. So it's not really about diets, it's about more of the lifestyle changes that we can do incrementally and build on those small changes as we move forward.

So, one of it is nutrition. The other aspect of that is physical activity or inactivity. So oftentimes, you know, we're not, you know, a lot of times we have sedentary jobs. If we have a job that's behind a desk, we're not very active most of the day, and that's another big component to chronic disease and heart disease, that we need to make sure that everyone's aware of and can modify to get better on that part.

And smoking is another big part that again, one of those tough things that we always try to reiterate, but it's hard to stop. So, you know, those are kind of the main things that contribute to premature and those three things, nutrition, lack of physical activity and smoking, comprise about 80%, of premature deaths in the United States.

Melanie: What about things like high blood pressure and diabetes, because we hear now that those contribute to each other and high blood pressure while it is modifiable can also be genetic or so can heart disease for that matter. So what about other diseases that would go hand in hand?

Dr. Kirksak Poonkasem: Yeah. So those things that you mentioned definitely contribute to heart disease. Diabetes is huge. Diabetes is one of those things that, you know, it's becoming more prevalent in the United States. You know, prediabetes, even a lot of people in the US have pre-diabetes and don't even know it yet. So, that's something that needs to be looked at a little bit more. Now, when we talk about hypertension, high cholesterol, diabetes, obesity, these things, you know, you mentioned genetics. Some of it can be genetics, but a large portion of these things can be managed with not only medications, but lifestyle.

And I think when we look at this as a whole, we tend to look at the easy way out, like the easy, quick fix, you know, is there a pill that can help me get better quickly? But if you want to do that for a long-term, we really need to get that back to the basics and look at lifestyle. And use the lifestyle as the foundation for health and wellness as we move forward.

Melanie: So, doctor let's talk about signs and symptoms, because I think one of the biggest questions people have is how would they know whether we get our blood work done or have some signs that you can tell us about briefly? How do we know, how is heart disease diagnosed?

Dr. Kirksak Poonkasem: Yeah. So, you know, oftentimes, you know, you get your blood work when you follow up your primary physicians on a yearly basis and they monitor your cholesterol, you know. The first signs really, you know, of heart disease in general, you know, you hear about hypertension as being the silent killer. So, when you follow up with your primary care physician on an annual basis, what they do is they monitor your vital signs. They monitor blood work with the cholesterol and things like that, and symptoms that you may have are different for different people. Some people may get short of breath. Some people may get like chest pains. Things of that nature, might get some dizziness. So there's a lot of different symptoms out there that can manifest as heart disease. So that's why, you know, we want to make sure that we do follow up with our, physicians on a regular basis and not neglect having those frequent follow-ups or annual followups, depending on your situation.

And the ultimate thing is don't ignore any symptoms that you might be having. I think that's one of the big things is like people say, oh, that was nothing, but eventually that could potentially be something big that you don't want to ignore per se.

Melanie: So I'd like to kind of rifle through a few, not myths as it were, but things that people want to know if it will help. So, first of all, you mentioned stress reduction. And stress as a contributor to heart disease. Tell us a little bit about breathing exercises and if there is one that we can use to help reduce our stress levels.

Dr. Kirksak Poonkasem: Yeah, stress is huge. A lot of people go throughout their day, just kind of just doing it, you know, pedal to the metal and just going through the daily grind and their stress. There's a lot of stress on them. Stress in general, is a good thing for certain things, but chronic stress is where we have the problem and breathing is one of those things.

The breathing exercises are one of the simple, cheap things that we can do to really affect our health and wellness overall. When, when we do conscious breathing, it actually affects the nervous system. Okay. There's two parts. There's a part of the nervous system called the autonomic nervous system. Okay. Those are the things that we really can't control. You have, the sympathetic nervous system and the parasympathetic nervous system. So when we do conscious breathing, that really affects the parasympathetic nervous system. That's where your resting and digestion comes in. There's a breathing technique called the four seven, eight breathing technique that I learned during my integrative medicine fellowship. And that's a really quick, simple technique that can be very helpful in stress reduction. And I can teach it to you real quick if you'd like.

Melanie: Definitely do that for us.

Dr. Kirksak Poonkasem: Okay. So, when we start this breathing technique or exercise, we want to place the tip of your tongue at the roof of your mouth, right behind the front teeth. And we want to keep it there throughout the breathing exercise. So when we start, we want to exhale completely through your mouth. Okay. The four part of the breathing technique is inhaling through your nose for a count of four. The seven is holding your breath for a count of seven. Eight is exhaling through your mouth for a count of eight, and that you want to make sure you keep your tip of your tongue up at the roof of the mouth.

It might be difficult or cumbersome at first, but with practice, it will become easier and easier. So that four, seven, eight is considered one breath. So you want to repeat that, you know, three or four times, you want to do it at least twice a day or when you feel stressed. So let's say you have a big interview coming up or a big test or something like that coming up, do a quick set of breathing. It takes less than a minute to do this. So, it's very effective. The key to breathing, and if you have your own breathing technique that you do on a daily basis, continue doing that. The key to breathing or conscious breathing is to be consistent on a daily basis with whatever technique works for you.

Melanie: And now just quickly answer these sort of myths as it were, aspirin. Can that help reduce our risk of heart disease? Is red wine good for your heart? And then what about things like cholesterol? If you could just kind of briefly go over those and how they contribute or help heart disease risk.

Dr. Kirksak Poonkasem: So aspirin, you want to talk to your physician about that? You know, there are some pros and cons to it, depending on your specific situation, but definitely talk to your primary doctor about that, or your cardiologist about that specifically for you. You mentioned red wine. There's a lot of myths out there, okay about red wine and that's the challenge is there’s you know, American Heart Association came out and they, there's not a lot of studies that actually say, you know, it's going to reduce your risk of heart disease. Okay. So, you know, if you do already drink alcohol, you want to do in moderation with red wine, because with red wine, there's different flavonoids and anti-oxidants that can potentially reduce heart disease risk.

But these antioxidants and flavonoids can be found in other foods like blueberries, red grapes, dark chocolate, green tea and things like that. So there's other things out there that we can use or eat to help reduce our risk of heart disease. There's no research that has been proven a cause and effect link between alcohol and better heart health. So, to all those red wine drinkers, sorry to say that, but there are some better things out there, but if you do it on moderation, t's fine. A recommendation currently for women is a one, one alcoholic beverage per day for men, it's two per day.

Melanie: So when you mentioned nutrition and that there is no one diet, is there a heart healthy diet and where does salt fit into that picture?

Dr. Kirksak Poonkasem: Yeah. So a lot of Americans consume too much sodium. So when you look at nutrition and diet, you want to consume whole foods as much as you can. And what does that mean? Is that the process foods we consume a lot of? Okay. And if you eat a lot of whole foods and less canned foods and processed TV dinners and things of that nature, that's where a lot of the hidden sodium is at. So when we focus more on whole foods, more plants and vegetables and things like that, that's going to be your go-to. Okay. So you have a lot of different diets out there that you might've heard of, you know, a Mediterranean, Atkins, a whole food plant-based, you know, DASH diets. There's a lot of different diets out there, but ultimately the research is showing and pointing us into direction of if we increase the consumption of fruits and vegetables, whole grains, legumes and more whole food type products, less of the red meats and things of that nature, it’s going to reduce your risk of cardiovascular disease, morbidity and mortality in general.

Melanie: And that certainly is the main message and what we're talking about today. As we wrap up, what would you like listeners to know about all the things we've discussed today? Whether it's a heart healthy diet or managing blood pressure and diabetes, exercise, all of these things, because especially for women, doctor, we cannot take care of our loved ones unless we take care of ourselves or put our own mask on as it were in these days before we can put the masks on of our loved ones. So wrap it up for us with your best advice as an integrative physician, what you want us to know about preventing heart disease and the things that we can do to help ourselves.

Dr. Kirksak Poonkasem: Yeah, I think the key is to invest in your health. You know, we invest monetarily for retirement, but we need to invest in our own health for retirement as well. And doing all these things that we talked about as far as lifestyle modification, it's just going to give us the best chance possible to live the longest and healthiest life possible with the quality of life.

Melanie: Well it's certainly is. And thank you so much, doctor for joining us today. And that concludes this episode of BayCare HealthChat. Please visit our This email address is being protected from spambots. You need JavaScript enabled to view it. for more information, and to get connected with one of our providers. Please also remember to subscribe, rate and review this podcast and all the other BayCare podcasts. Until next time, I'm Melanie Cole.