The Dr. Hyman Show - Exclusive Dr. Hyman+ Ask A Cardiologist: Hypothyroidism, Atrial Fibrillation, And More

Episode Date: November 1, 2022

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Hey podcast community, Dr. Mark here. I'm so excited to offer you a seven-day free trial of my revolutionary new platform called Dr. Hyman Plus. For seven days you get special access to all the private content included in Dr. Hyman Plus entirely free. It's so easy to sign up. Just go to Apple Podcast on your phone and click try free button on the Doctors Pharmacy podcast. You'll get exclusive access to ad-free Doctors Pharmacy podcast episodes and functional medicine deep dives where a practitioner dives into topics like heart health, muscle health, insulin resistance, and more to help you understand the root cause of specific ailments and walk you through the steps to improve your health today. You'll also get access to all my Ask Mark Anything Q&As where

I answer the community's biggest health and wellness questions. Because I'm so sure you're going to love this platform, I am offering you free access to all of this content for seven days and a teaser of my brand new episode. Head on over to the Doctors Pharmacy Podcast on Apple Podcast and sign up for your free trial. Okay, here we go. Hi, everyone. Welcome to an episode of Ask a Cardiologist. I'm Herschel Perth, the Dr. Hyman Plus Community Manager, and joining me is Dr. Neil Patel, a cardiologists. I'm Harshal Perth, the Dr. Hyman Plus community manager, and joining me is Dr. Neil Patel, a cardiologist. You may recognize Dr. Patel from his Dr. Hyman Plus deep dive on understanding cholesterol and heart health. Hello, Dr. Patel. Thanks for joining us. Hi, thanks for having me on.

Awesome. So we've picked out the questions from our community, and we're excited to hear Dr. Patel's answers on them. Just a reminder that Dr. Patel can't give out specific medical advice. All the information that he's going to be talking to you today about is just general information. And if you're looking for specific advice on your situation, it's really important for you to talk to your practitioner or your cardiologist. So let's go ahead and get started. So our first question, Dr. Patel, is from our community. And the person says,

what are the cardiac implications of not treating subclinical hypothyroidism, if there are any? I think this is a great question. I think that to kind of step back and make sure that everyone's on the same page, let's just talk about the purpose of the thyroid. The thyroid gland sits right around here in everyone's neck and it controls metabolic functions. It releases hormones that help regulate our metabolism, healthy metabolism, and it also helps us to regulate organ function. So when we define hypothyroidism, the term hypo means low functioning.

So the thyroid itself is not able to put out enough hormone to help regulate the other organs from doing their jobs. So when we talk about subclinical hypothyroidism, I want to take that term apart so it makes it very clear clinical hypothyroidism can show up in the following ways you may have dry skin you may be more sensitive to constipation you may be more sensitive to heat you might have fragile hair and that's one extreme all the way on the other extreme is hyperthyroidism where the thyroid function is overactive and so in those situations you might find yourself having in a regular heart rhythm which we'll talk about later high blood pressure and in some extreme cases, you can have heart failure. So when we talk about subclinical hypothyroidism, it's actually not clinically detected, meaning you are not having symptoms from what we are seeing on your blood work.

So to define subclinical hypothyroidism, for those of you who are interested in that, your TSH, which is one marker for thyroid function and thyroid health, that number is generally around 10 or higher. But your free T4, which is the active form of thyroid, is in the normal range. So we as cardiologists generally say when someone has subclinical hypothyroidism, that isn't something that we directly recommend treatment for as the actual functionality of the thyroid hormone is intact. So I think to summarize is that on blood work, you might appear to have hypothyroidism, but if there aren't direct symptoms related to that functionality of the thyroid,

then the effects on your other organs should be minimal and thus don't need direct therapy. Okay, great. That makes a lot of sense. Thanks for that answer. So our second question is someone who says, what would be the reason for my total cholesterol number would be so high when all of my other cholesterol panel numbers are excellent? My nurse practitioner suggested that it might be because my good cholesterol number was so great. Is this true? So this is a very common question that I get not only in the clinic, but even from my own family. And I think to answer that question, let me summarize and let me show you guys what exactly goes into total cholesterol when it's measured in the laboratory.

So here's the actual formula that is used to calculate your total cholesterol. These letters here, VLDL, IDL, LDL, which many of you are familiar with, lipoprotein little a, and HDL, which you are probably familiar with. These are all the different forms of lipoproteins that constitute our cholesterol. But what can happen is your total cholesterol, as you can see, can be very high depending on if one of these individual markers are elevated more than the others, because it's a weighted kind of look at your total cholesterol. So what I generally recommend for individuals is yeah, your HDL might be high, but I'd be interested to see exactly how high are we talking? Because if we're talking that your total cholesterol is above 200, I mean, that means that your HDL has to be greater than almost 100, which I think might be genetic variations, but I'd be interested to see what these other

characteristics look like. One place of discussion that I've been having with my patients is, well, there's a lot more to this panel here than what a total cholesterol or regular lipid panel shows. So I generally recommend an NMR. Here's's an example you guys may be familiar with this it's a specialized lipid test where it breaks down each individual component of the lipoproteins again lipoproteins are components of our total cholesterol so here in NMR, this is an example, you get an HDL, you get the number of small LDL particles, you also get the LDL size. What I want you to realize is that the larger the size of the LDL, the higher the number could be. However, when we're talking about risk of these cholesterol particles, the smaller the LDL, the more damaging they can be.

So there's a lot more nuance to why someone's total cholesterol could be elevated. I would just point you in the direction of potentially getting one of these if you haven't, because it can likely clarify where the little pieces, why is it that your total cholesterol is elevated? Thank you. That's super helpful for that answer and so helpful to see the NMR test on your screen. So our next question is, could you talk about any foods or supplements

that can be used to help break down and eliminate calcified plaque? A great question, common question, and it's very forward thinking. I think just to define a couple terms. So plaque is any form of cholesterol and other material that gets embedded within the blood vessel wall. Calcified plaque by definition means that there's a hard covering over that plaque. So truth is that currently we don't have any clinically proven herbs or supplements that have significantly reduced plaque burden. From a clinical standpoint, I see a significant improvement if the narrowing in the artery that is caused by the plaque can be reduced by 25 to 30 percent. Because what we're looking for is improving blood flow to the heart. So unfortunately, currently, there isn't anything

that has been clinically proven what i tell my patients is that until data is available i would generally recommend a low inflammatory diet high in omega-3 fatty acids low in sugar low in trans fat and processed seed oils just as a comment why do we always say low sugar, low trans fat processed seed oils? They're actually damaging the blood vessel walls. And over the years, with enough damage, cholesterol can get in. There's a lot of other things that can happen that can harden the arteries or can cause plaque buildup and thus narrowing of heart arteries. The other important piece is a consistent lifestyle. Now, what I mean by consistent is in making sure that you get enough exercise, sleep, stress reduction, and appropriate nutrition. And what we're looking for with this kind of prescription, so to speak, is if you have plaque, we're looking to kind of stabilize it so that it doesn't get worse. You know, I generally tell all my patients, we got to focus on what we can

control. And currently, we just don't have anything that has proven to completely reduce plaque burden. I do want to make a comment on one vitamin, and that's specifically vitamin K2. Many of you have maybe read about this and say, hey, you know, what is its role in coronary artery disease or plaque buildup in the heart arteries? Vitamin K2 specifically has been shown to be anti-inflammatory, and it directs calcium that you've ingested to the bones preferentially. There's some thought that without enough K2, vitamin K2, calcium and other inflammatory agents can get directed and have kind of free range and they can damage our blood vessels, allowing calcium and cholesterol and other things to kind of get embedded

into the blood vessel wall. So there's more research that needs to be done on that, but definitely pay attention to that because I think that there's going to be a role in the future. We just have to kind of clarify it with proper studies. That's super helpful. So where can we find K2 naturally? Yeah, great question um a lot of the great sources that we know exist are pasture-raised eggs kefir sauerkraut so so those two foods if you if you found the commonality they're fermented um organ meats and cheese so we'll definitely be looking out for more research on k2. Thanks for that. All right. So this next question, I think is something that you probably hear quite a bit and it's

what causes AFib and how should it be treated? Yeah. So AFib or atrial fibrillation, um, is a very common electrical disturbance, uh, in the heart. If you, I'm going to show you a picture of a heart right here. So there's two top chambers and then there's two bottom chambers. Electricity governs the heartbeat and thus how fast or how slow your heart beats. What can happen though is you can have many different variations of the electrical flow within the heart. Atrial fibrillation is a top chamber issue. What happens is instead of the heart beating from one spot consistently, just like you

would with a normal heartbeat, it starts to beat from all over the place. And that's where you can get the irregularity that some patients report if they have a fib so with that some of the most common causes of why people develop atrial fibrillation or a fib one of them is actually aging as we age our tissues just like our skin our hair just about like how our organs function they all can change over time and for some individuals the electrical system can take a different path so to speak so aging high blood pressure and and the reason why is high blood pressure puts pressure back on the heart and And as that happens over years,

it can actually start to stretch out these top chambers, nothing that you would feel, but that stretching is enough to kind of trigger some more irritation on the electrical system leading to an irregularity. Alcohol use is a very, very common cause of atrial fibrillation. You also have coronary artery disease can relate to it.

Genetics plays a role. I do think that a lot of it's lifestyle driven from what I've seen patients, but I've had a few patients have a family history of it. And then lastly, something that goes kind of undetected for a lot of patients is sleep apnea. Sleep apnea is a condition where we stop breathing at night. We are unaware of that, but it actually releases more adrenaline at nighttime. And that high loads of adrenaline can lead to electrical disturbances in the heart and trigger an irregularity in the heartbeat called AFib. So a common question is, how should AFib be treated?

One thing that we've seen over the last decades is that you can live with AFib. And the real question is, does it affect your quality of life? And if it does, there's medications to help with it. But from a lifestyle perspective, looking into alcohol consumption, people will tell me that they drink one or two drinks a week. And I'll have to tell them, look, we got to listen to what your body's telling us. And we do know that alcohol is a direct player in causing AFib and or making the symptoms worse. So I generally tell people, if you're drinking any amount of alcohol, change it to rare occasions. How's your sleep? Are you

getting enough sleep? And that one I think is overlooked more than not. And part of it could be because we are creatures of habit and we end up getting less sleep and we assume that that's okay. But remember, sleep, then the purpose of sleep for our bodies is to lower our adrenaline levels and it is to increase and rejuvenate. If we're shortening that timeframe, there's a whole host of things that can occur

due to the excess stress on the body, due to the extra stress on the body due to due to the extra adrenaline in the body so make sure you're getting enough sleep make sure you look at alcohol consumption and then also nutrition always eating um a more low inflammatory diet one that is high in magnesium, can also help with the symptoms of AFib. Well, I hope you enjoyed that teaser of exclusive content that you get every single month with Dr. Hyman Plus. If you want to listen to the full episode and get access to ad-free podcast episodes, plus Ask Mark Anything episodes, plus monthly functional deep dive episodes, I guess that's why we call it Dr. Hyman Plus, then head on over to the doctor's pharmacy on Apple podcast and sign up for your

seven day free trial. Hi, everyone. Just a reminder that this podcast is for educational purposes only. This podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who's trained, who's a licensed healthcare practitioner,

and can help you make changes, especially when it comes to your health.