For people who have heart disease, have suffered a heart attack or who have an implantable heart device, resuming sexual activity can be concerning. Is sex safe, or will it increase the risk of complications or death? At a recent Sunnybrook Speaker Series event, cardiologist Dr. David Newman examined the topic and offered some sound guidance.

Erectile dysfunction and heart disease

Erectile dysfunction — the inability to keep an erection firm enough for sex – has many shared risk factors with heart disease, including diabetes, obesity, physical inactivity, hyperlipidemia (elevated fat levels in the blood), smoking and high blood pressure. There is a strong connection between heart disease and erectile dysfunction, so it’s important that men speak with their doctors before starting any new medications.

Are medications to blame?

Dr. Newman says all medications may interact or associate with erectile dysfunction. That said, men should never discontinue a medication because they think it’s impacting another area of their health. Studies have shown that 8 per cent of men treating high blood pressure stop their medication because they think it’s contributing to erectile dysfunction. Adjusting or stopping your medication can be dangerous, so talk to your doctor first to determine what’s best for you.

Are drugs for erectile dysfunction safe?

Many family doctors and cardiologists are asked by their heart patients if it’s safe to take medications designed specifically for erectile dysfunction, which fall into a class of drugs called PDE5 inhibitors. There are many different treatment options available in this category, but they work in a similar way by improving blood flow to the penis. Generally, PDE5 inhibitors should be used with caution in patients:
• taking nitrates
• with active ischemia (symptoms of impaired coronary blood flow)
• with significant congestive heart failure
• with low blood pressure
• taking multiple blood pressure lowering drugs
• with significant liver or kidney disease
• taking erythromycin

How much physical activity is safe?

The American Heart Association (AHA) has developed guidelines on the use of PDE5 agents. As a rule of thumb, if men with heart disease can walk up two flights of stairs, it should be safe to resume sexual activity.

There is a value score called Metabolic Equivalent (MET) for various physical activities. The MET score looks at exercise capacity, the exercise energy expended and the age and weight of the patient. As Dr. Newman points out, it doesn’t take a lot of capacity to have the exercise ability to safely engage in sexual activity. Here is how sexual activity rates against some other common activities:
• walking up the stairs at home: 2 METS
• sexual activity: 2-3 METS
• sexual activity with orgasm: 2-4 METS
• cycling: 6-7 METS
• brisk walking: 13 METS
• laundry: 2.07 METS
• food preparation: 2.16 METS
• grocery shopping: 2.10 METS
• dancing or fishing: 4.5 METS
• rugby: 10 METS

Dr. Newman says it’s rare to have a heart attack during intercourse, and there is only a small increased risk if you’ve already had a heart attack. At the end of the day, having sex is part of life, and so is inherently healthy. That said, each patient should discuss his specific circumstances with his doctor.

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View the post Is sex safe if I have heart disease? on Sunnybrook's Your Health Matters blog.

If you’ve never been physically active, getting started can seem like a daunting task. There is an overwhelming amount of information available, but Sunnybrook Advanced Practice Physiotherapist Suzanne Denis says focusing on the basics is the key to fitness success.

Define your fitness goal

Before you get started, ask yourself, why you are doing this? Is your goal to become stronger, to lose weight, reduce your need for medication, or to just get healthier overall? Defining the purpose will provide positive motivation for the work you put in while keeping you on track.

Love it and list it

You will have far more success in the long-term by engaging in activities you really enjoy. For extra motivation, sign on to a class or group session of a certain activity, keep a daily journal or use a fitness tracker to mark your progress.

Get the green light

Although most people living with a chronic disease or health issue can greatly benefit from activity and exercise, it’s a good idea to meet with your doctor before starting to ensure they are safe and right for you.

Ready to go? Start slow

A mistake that many people make is starting their new regimes too enthusiastically. Too much too soon can lead to pain and risk of injury, and a higher probability people will quit within the first two weeks of a new program. Your body will take some time to adjust to new movements and levels of activity, so humble beginnings are key.

Once you have had success during the first week, keep building on that (no more than a 10 per cent increase per week) and incorporate a bit more time/weight/distance onto what you did the day before. Varying the types of activities you are doing will give certain muscle groups a chance to recover. If the activity you are doing requires equipment, make sure you are using it properly to avoid injury.

Get comfortable with feeling uncomfortable

It’s normal to feel muscle groups you haven’t before after starting a new type of activity. That means you are pushing yourself out of your comfort zone, helping build new muscle groups and overall strength. But if your pain is persistent and debilitating, make sure you seek medical assistance.

The big picture

There is an expression that you can’t outrun your fork, and it’s true! Any successful fitness regime is built on the foundation of a healthy lifestyle, which includes a balanced diet. Adequate sleep, not smoking and limiting alcohol intake will all help you achieve faster positive results with your new physically active lifestyle.

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View the post Getting active: fitness tips for beginners on Sunnybrook's Your Health Matters blog.

About 4.2 million Canadians smoke, and those who do smoke an average of 13.9 cigarettes per day. While the rate in Canada has fallen in the last few years, that’s still a lot of smoking and it still has a huge impact on the health of Canadians. Around the world, about 1.1 billion people smoke.

It’s well researched and documented that smoking cigarettes can have a bad impact on your health.

Bonnie Bristow, radiation therapist and member of Sunnybrook’s Smoking Cessation team, says smoking can have much more of an affect on the body and its functions that people may realize.

“Patients and their families are sometimes surprised to hear about the ways cigarettes can affect their bodies,” she said.

Here are some of the more surprising facts:

Smoking hurts your eyes.

Smoking cigarettes doubles the risk of changes in the lens of your eye, resulting in cataracts, Bonnie says. It triples the risk of age-related macular degeneration, which is the leading cause of blindness over 65 years old. And it also increases the risk of glaucoma, another leading risk of blindness.

Smoking slows down healing.

“Oxygen is the basis for wound healing and it all begins at the cellular level,” Bonnie says. “Smoking deprives the body of the much-needed oxygen required to repair and build cells.” If you have a surgery coming up, it’s a great time to consider quitting smoking.

Smoking affects your Zzzzzzzs.

Nicotine is a stimulant. That means, while many people think it calms them down, it actually temporarily increases energy, your heart rate and breathing, and your blood pressure. Cigarette smokers can easily develop insomnia (the inability to fall or stay asleep) if they smoke close to bedtime.

“Smokers often feel more restless in the morning after having difficulty falling asleep,” Bonnie says. “The nicotine changes your natural circadian rhythm and increases your risk of sleep apnea.” Sleep apnea is a disorder where your breathing pauses and starts when you are asleep.

Smoking affects your senses, your skin and more.

Smoking dulls the sense of taste and smell. It also is one of the main causes of premature aging of the face because of the biochemical changes in the body that speed the aging process. If you smoke, you may be more susceptible to seasonal flus and colds and you have an increased risk of diabetes.

Smoking harms other peoples’ bodies: your spouse, kids and friends.

Bonnie reminds us that exposure to second-hand smoke causes more frequent and serious asthma attacks, respiratory infections and ear infections in kids. Rates of tooth decay are doubled in kids exposed to second hand smoke. Adults in contact with second-hand smoke have an increased risk of heart disease, stroke and lung cancer.

If you need help to quit smoking, check out sunnybrook.ca/quitsmoking for more resources or talk to your family doctor who can point you in the right direction. Here are some tips from a Sunnybrook social worker.

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View the post Surprising ways smoking affects your body (and your family’s bodies too) on Sunnybrook's Your Health Matters blog.

How hard do you work in a day, and how do you measure that? For your heart, it comes down to two numbers: how forcefully the blood is pushed out when it pumps and when it rests. Otherwise known as your blood pressure. If you don’t know your numbers, you should. Because you won’t necessarily feel if your blood pressure is too high or low, it can be causing damage to your body without you even knowing it.

There are some well known and proven causes of high blood pressure, including excess weight, a sedentary lifestyle, older age and having African, South Asian or First Nations/Inuit or Metis heritage. But there are also some misconceptions about other causes and actually getting an accurate reading, says Sunnybrook cardiologist Dr. Martin Myers.

Getting an accurate reading

When it comes to the latter, he says we need to leave it to the machines. “The bottom line is that human beings should not be taking blood pressure. Period. Full stop.” People can skew the results by taking the measurements incorrectly, fudging the numbers that are documented or affecting the overall reading. Dr. Myers says talking is the most common culprit for a sudden spike in blood pressure. “Some people believe talking actually calms you down, but the opposite is true.” That means patients need to sit quietly – no talking or texting – before and during the measurement.

Canadian guidelines now recommend using automated blood pressure machines when testing is done at the doctor’s office. These devices take several readings and average out the results, helping buffer out the effects of nerves. Automated machines are also used if your doctor recommends at-home monitoring, or if you chose to check your blood pressure at the drug store.

“Canadian guidelines no longer recommend a stethoscope being used with a cuff on the patient’s arm and a doctor or nurse measuring the blood pressure,” says Dr. Myers. It’s still being done, but over the next few years, you’re going to see that disappear.”

High blood pressure myths

So what about other possible factors, like coffee, stress and noise pollution? Despite what many people think, Dr. Myers says regular coffee consumption is not considered to be a cause of high blood pressure. “The only time it will cause a small increase is if you don’t drink it for a day or two and then you have a large cup of coffee,” he says, noting that’s a far cry from most people’s daily habit.

He says the same goes for stress: while it may be a contributing factor, it’s not a cause of high blood pressure. Other factors, like noise pollution and hydro lines? “The properly done studies have been negative,” he says.

Getting measured

So how often do you need to have your blood pressured measured? If it’s normal – within the 120 over 80 range – and there are no other health issues at play, Dr. Myers says every one to two years is recommended. If you have high blood pressure already, measurements will need to take place more often and your doctor can advise about frequency.

The Heart and Stroke Foundation reports 1 in 6 Canadians with high blood pressure are unaware of their condition, and that’s risky. It’s can lead to stroke, dementia, coronary artery disease, kidney failure and a host of other health issues if left untreated. So the bottom line is this: know your numbers and follow your doctor’s recommendations for management and treatment. And for more information, check out the Heart and Stroke Foundation’s Blood Pressure Action Plan.

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Going back to the school and work routine after the summer holidays can be both exciting and exhausting. Dinner can easily become an afterthought during this busy transition time, but it’s important to keep your energy up! Skip the drive-thru and try these tips to speed up your weeknight dinner prep time:

#1 Take the guesswork out of dinner

Don’t wait until the last minute to think of what to make for dinner. Plan a few meals ahead of time on the weekend and stock up on the ingredients you need so that you don’t have to make an after-school or after-work grocery run. Looking for healthy recipes? Check out nutritious meal ideas from Eat Right Ontario.

#2 Wash and chop ahead of time

Save yourself some time and energy during the week by washing and cutting vegetables ahead of time so that they are ready to use for cooking. Portion out your meat or seafood and store it in the freezer in freezer-safe containers. The day before you want to cook, put the meat or seafood in the fridge to defrost overnight. You can also marinate the ingredients in its freezer-safe container, which means one less dish to wash!

#3 Buy ready-to-use ingredients

No time in advance to prepare? Pre-cut vegetables, canned legumes (e.g. kidney beans, chickpeas), and pre-cut raw meat are just a few examples of ready-to-use ingredients that can come in handy when you’re on a time crunch. Avoid the ingredients that have been pre-seasoned or pre-marinated though — you can do this at home in no time, and you’ll have more control over the amount of salt and seasoning.

#4 Stock up on the staples

Keep your fridge, pantry and freezer stocked with versatile and long-lasting ingredients. Carrots, onions, and celery can be kept in the fridge for a long time, and frozen vegetables are a good staple to keep on hand when you don’t have time to wash or chop vegetables. Canned no-salt-added tomatoes, canned beans, low-sodium broth, low-sodium pasta sauce, and whole grain or whole wheat pasta can be kept in the pantry and used for a quick soup, stew, or pasta. With some of these staple items, you can make a hearty and healthy vegetable bean soup in just 30 minutes!

#5 Double your recipe

Make extra portions when you’re cooking so that you can enjoy delicious leftovers for a few extra meals (and conserve energy by not having to cook every day).

#6 Use a slow cooker

Coming home to a meal that is already cooked and ready to eat means less stress and a more enjoyable dinner time — so,  let a slow cooker do the work for you! Prepare the ingredients the night before, add them to the slow cooker in the morning before leaving home, and follow the recipe. You’ll have a nice hot meal waiting for you when you get home.

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View the post 6 weeknight dinner time-savers on Sunnybrook's Your Health Matters blog.

The start of October, crisp cool mornings, and changing fall colours mean one thing: Thanksgiving is around the corner! This fall holiday is typically marked with a delicious (and often decadent) turkey meal. Whether you’re planning to host or attend a holiday get-together, consider these tips for enjoying a heart-healthy Thanksgiving:

#1  Skip turkeys that are pre-basted with butter.

There’s plenty of fat in the turkey skin to keep it moist and juicy while it’s roasting, so there’s no need for the added saturated fat that comes with pre-basted turkeys. Instead, choose a fresh or frozen turkey (not pre-basted), and trim off extra fat and skin before roasting. Brush the top of the turkey with 1-2 tablespoons of oil before roasting and cover with aluminum foil halfway through the roasting period to keep it from drying out.

#2  If you are using the turkey drippings to make gravy, skim off all the oil first.

Use low-sodium chicken broth and omit the giblets for a heart healthier gravy.

#3  Cook the stuffing on the side instead of in the turkey.

Make a version of your favorite stuffing on the stovetop or baked in the oven to cut down on calories, fat and cooking time for the turkey.

#4  Give your favorite side dishes a healthy boost with lower fat, higher fibre ingredients.

• Salad: serve up a salad packed with dark leafy greens (e.g. kale, spinach), colourful vegetables (e.g. bell peppers, tomatoes), and a vinaigrette dressing on the side.
• Roasted vegetables: roast a large pan of colourful mixed vegetables like beets, carrots, turnips, squash, tomatoes, and bell peppers.
• Stuffing: use hearty whole grain bread or make a brown rice, wild rice, or quinoa stuffing instead.
• Mashed Potatoes: keep the skin on the potatoes and use 1% milk, light sour cream or low-fat Greek yogurt, and partly skimmed cheese.
• Sweet Potatoes: serve these roasted or mashed, and skip the marshmallow-topped sweet potato casserole that’s loaded with calories, fat, and sugar.

#5  Fill your plate half full with salad and vegetable side dishes first.

Vegetables have a filling effect and can help you enjoy a balanced meal without over-indulging. Fill the remaining half of your plate with equal amounts of protein (e.g. turkey) and starch (e.g. potato, rice).

#6  Enjoy your turkey with small amounts of gravy and cranberry sauce.

This will allow you to savor the natural sweetness of the turkey without too much added salt from the gravy or added sugar from the cranberry sauce. One quarter cup of whole berry or jellied cranberry sauce has 22 to 24 grams of sugar, the equivalent of 6 teaspoons of sugar!

#7  Silence your sweet tooth with fruit.

For a sweet finish to your meal, enjoy some fresh fruit that is full of nutrients, fibre, antioxidants!

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View the post Tips for a heart-healthy Thanksgiving on Sunnybrook's Your Health Matters blog.

“Everything in moderation.” What was once my excuse to periodically indulge in some not-so-good behaviours (read: eating dessert), is now the motto too for over-indulging in those “good-for-you” things – at least when it comes to our cholesterol.

In a recent study, researchers weigh-in on the conventional wisdom that supercharging your “good” cholesterol to very high levels can help reduce the risk of heart disease. What they found instead was that both low levels of the cholesterol – known as high-density lipoprotein (HDL) – and very high levels could lead to a higher risk of death.

“It’s been thought that raising high-density lipoprotein is the holy grail of reducing or eliminating heart disease,” says Dr. Dennis Ko, cardiologist at Sunnybrook Health Sciences Centre, senior scientist at the Institute of Clinical Evaluative Sciences, and the study’s lead investigator. “But instead of seeing a linear correlation between HDL and mortality, we’re seeing a U-shape. It tells us that beyond a certain level, HDL cholesterol isn’t necessarily all that beneficial. Beyond the average values, we don’t see a lower risk of death.”

The study, which was published today in the Journal of the American College of Cardiology, looked at 631,762 individuals without pre-existing cardiovascular conditions. Individuals whose HDL cholesterol levels were very low (less than 50 mg/dL or 1.3 mmol/L in women and 40 mg/dL or 1 mmol/L in men) and very high (more than 80-90 mg/dL or 2–2.3 mmol/L) experienced a greater risk of death compared to individuals who had HDL cholesterol levels that fell within intermediate ranges.

Cholesterol isn’t about a battle between good versus evil.

Low-density lipoprotein (LDL) is the “bad” cholesterol that accumulates on the walls of our blood vessels and causes blockages. Our HDL, the “good” cholesterol, acts as a scavenger, grabbing hold of the bad cholesterol and carrying it to our liver to break it down.

One would think the more cholesterol we have cleaning out the bad, the better. And scientists are not yet sure why this is not the case.

“We can’t abandon the concept of cholesterol being a marker of health,” explains Dr. Ko, also an associate professor at the University of Toronto. “LDL cholesterol is still bad and the more you do to lower your LDL levels, whether through medication or lifestyle changes, the better your outcomes will be.”

The discovery, he says, is that the HDL cholesterol levels are not a specific indicator of heart health, but rather an indicator of general health.

“Yes, low HDL levels are associated with a higher risk of cardiovascular death,” admits Dr. Ko, “but the data tells us that the HDL level is not the modifiable risk factor that if we change, we will improve the cardiovascular outcome.”

The study found that individuals with lower HDL cholesterol levels were more likely to have lower incomes and unhealthy lifestyles like smoking, lack of physical activity, poor diet, and hypertension.

Howard Gaskin says these findings are a bit of a relief.

With a family history of heart disease, Howard eats well, stays active and pays close attention to his cholesterol levels: not only to keep his LDL cholesterol low, but also to keep his HDL cholesterol high.

Howard Gaskin strives to maintain his heart health by exercising and eating well.

“It’s certainly a number, a measure, a metric that I’ve been focused on for years,” says Howard, who takes medication to lower his LDL cholesterol and admits he’s been frustrated with trying to raise his HDL above what’s considered average levels.

“I think I will obviously focus a lot less on HDL as a measure of the success of what I’m doing,” he says.

Bottom line: It’s just a number.

Dr. Ko’s take-home message is simple: our HDL level is just a number that doesn’t necessarily warrant the attention we’ve been giving it. While low levels indicate poor health, super high levels do not necessarily mean you’re healthy. Instead, we need to maintain our cardiovascular health the way we’re told over and over again: no smoking, exercise regularly, reduce your stress, and eat your fruits and vegetables.

“It’s what you do – your exercise, your diet – that’s more important. That’s what we think is making the impact,” says Dr. Ko.

So for health-conscious Howard, little has changed. “I exercise because I enjoy it, I run because I have a good time doing that. So, I’ll still continue to focus on those strategies, but with different metrics in mind,” he says.

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Have you ever looked at the nutrition labels on a food product and wondered how to make sense of the information? If so, you’re not alone! Food labels contain a lot of information, and it can be confusing to consumers. In a 2012 survey conducted by researchers at the University of Waterloo, more than half of the 687 Canadians surveyed were not able to correctly identify and understand calorie and serving size information.

What is the Nutrition Facts table?

The Nutrition Facts table is a nutrition label that is mandated by Health Canada and the Canadian Food Inspection Agency to be on most packaged food products, and can be used to help determine the nutritional value of the product. It’s typically found on the back or side of the product, and contains information on serving size, calories, and 13 core nutrients. Reading the Nutrition Facts Table can help you compare nutrition information of foods and make healthier food choices. Here’s how you can make sense of the facts:

Serving Size

The Serving Size is the amount of food used to calculate the nutrient information listed on the table. It is not the recommended serving size.  When you are looking at the serving size listed on a product, consider the amount that you will actually be consuming. You can also compare different food products with similar serving sizes listed to determine which product is the healthier choice.

Calories

The Calories number tells you the amount of calories based on the serving size that is listed. If you eat more than the serving size listed, you will also be consuming more calories than the amount listed on the table.

Core Nutrients

The amounts of 13 core nutrients are listed on the table: fat, saturated fat, trans fat, cholesterol, sodium, carbohydrate, fibre, sugar, protein, vitamin A, vitamin C, calcium, iron. Choose a product that has the following:

• No trans fat (0g)
• Less fat, saturated fat, and sugar
• Less sodium (<200mg per serving)
• More fibre (>2 g per serving)
• More calcium and iron

% Daily Value

The % Daily Value tells you whether a product has a little (5% or less) or a lot (15% or more) of a nutrient. It’s important to note that 100% daily value is based on a 2000 calorie diet – this might not be the recommended calorie intake for everyone. When comparing different products, the % Daily Value can help you identify which product has more or less of a vitamin or mineral (e.g. vitamin A, vitamin C, calcium, iron). For all other nutrients (e.g. fat, sodium, fibre, sugar, etc.), focus on the actual amount that a product contains instead of using the % Daily Value.

So the next time you’re on a grocery run, take a few minutes to scan the Nutrition Facts table and compare food products. It’ll make you more aware of the nutrition content of the foods that you’re buying, and can help you make more informed and healthier food choices!

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Although the cause of Carrie Fisher’s death was reportedly a massive heart attack, one could say that she actually died of bipolar disorder. It is well known that heart disease is society’s leading killer. In contrast, it is largely unrecognized that people with bipolar disorder are at particularly high risk of heart disease. Shining a light on the heart-bipolar connection serves a number of important parallel purposes, including the promotion of assertive approaches to optimizing heart health, reducing the ongoing stigma toward bipolar disorder and other forms of mental illness, and encouraging further research efforts on this topic.

Carrie Fisher was not only a luminary artist, she was also a luminary advocate for mental health, focusing especially on bipolar disorder, a condition from which she suffered. Because of Ms. Fisher’s profession and talents, hers is an epic and singular story that has and will continue to touch the world for many years. But hers is also a typical story, albeit tragically so, of a young woman who experienced the onset of bipolar disorder early in life, who survived decades of the effects of bipolar disorder on her mind and brain, and who, it could be said, was ultimately felled by the impact of bipolar disorder on her heart.

Based on the most recent data from the United States general population, not only are people with bipolar disorder more likely to have heart disease, they also experience heart disease up to 17 years earlier, on average, than people who do not suffer from mood disorders. A sixty year-old woman with bipolar disorder may have the heart of a mentally healthy woman in her late seventies. The extent to which bipolar disorder increases and accelerates the risk of heart disease exceeds what can be explained by smoking, drug and alcohol use, sedentary lifestyle, nutrition, physical side effects of psychiatric medications, and even traditional heart disease risk factors such as high blood pressure and obesity. All of these factors are particularly common among people with bipolar disorder, but they are only part of the story.

Almost certainly, the distress caused by the symptoms of bipolar disorder, alongside the stress caused by the impact of those symptoms on people’s lives, contributes in part to elevated heart disease risk. There are a number of biological processes that could form the heart-bipolar bridge, including elevated levels of inflammatory markers, which have been shown to coincide with the episodes of mania and depression that define bipolar disorder and which increase the risk of heart disease.

Studies have also found evidence of poor blood vessel health among people with bipolar disorder, in the brain as well as the body. The scientific literature on this topic is so compelling, and yet so under-recognized, that a recent scientific statement from the American Heart Association positioned bipolar disorder (as well as major depressive disorder) among youth as a risk factor for early heart disease.

It is worth noting that among teenagers, bipolar disorder is twice as common among girls than boys. It is also worth noting that the extent of increased risk of heart disease attributable to bipolar disorder is even greater for females than it is for males. In losing Carrie Fisher, the world has lost a warrior princess who gifted us with valiant efforts both on and off the screen. As we each consider the ways in which we will honor her memory, let us consider all of the young warrior princesses (and princes) with bipolar disorder for whom the prospects of a long and healthy life rest on early and assertive approaches to heart health.

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View the post The princess at the heart of bipolar disorder on Sunnybrook's Your Health Matters blog.

Heart disease remains the number 1 killer of both men and women worldwide. In 2016, actor Carrie Fisher died of a heart attack along with approximately 17.5 million other people around the world. Heart disease has edged out cancer as the leading killer worldwide for the past few years.

Here’s the good news: there are some things we can do to help prevent heart disease and, if heart disease or attack is recognized and treated early, there are some great outcomes for patients.

I spoke with Dr. Mina Madan, cardiologist at Sunnybrook, to answer some FAQs about the heart and how we can keep ours healthy.

Q. A real easy one, to get us started: What is the heart? (Because it’s been awhile since we’ve sat in a Science Class)

The heart is a muscle pump in the left part of the chest that pumps blood carrying oxygen to the rest of the body. It has its own blood supply that delivers oxygen and nutrients to the heart.

Q. What is coronary artery disease?

The heart’s blood supply is kind of like a plumbing system. Coronary artery disease is build up in those pipes. When there’s a blockage – made up of cholesterol plaque – oxygen and nutrients can’t get to the heart, and so it starts starving. The build-up can happen over time or abruptly.

After about 30-40 minutes of a complete (100%) blockage, you may start to feel some or all of the classic symptoms of a heart attack.

Q. What are the symptoms of a heart attack – or what doctors would call a myocardial infarction?

The classic symptoms are: central heaviness in the chest, burning in the chest that radiates up the neck and into the jaw, pain in the back, difficulty breathing, sweating, pain in your left arm, nausea or vomiting. If you experience these symptoms, call 911.

Q. What are some of the not-so-typical symptoms?

There are other atypical symptoms that both men and women may have. Those might be just jaw pain, just back pain, or burning in the stomach area (kind of like acid reflux). This explains why sometimes the diagnosis of heart attack can be missed.

Q. I’ve heard women experience heart attack differently than men and many don’t realize they are having a heart attack at all?

It’s true. Many women have other atypical symptoms or report just feeling breathless, or really fatigued in the days leading up to a heart attack; some women experience the so-called classic symptoms, but less intense. These symptoms could be a sign of trouble in your heart. You should talk to your doctor.

It’s not really known why these differences exist – just differences in how men and women are wired.

Heart attacks are more common in men. Post-menopausal women have heart attacks more often than pre-menopausal women due to the reduced levels of estrogen associated with menopause (estrogen has a protective effect on the heart).

Q. What are heart disease risk factors?

It’s important that people know the risk factors. Diabetes, high blood pressure, high cholesterol, smoking and a family history of heart disease are all risk factors. As you approach middle age it’s important you are aware of your family history. Talk to your doctor about your risk factors and take measures to keep your heart healthy.

Q. What can we all do to stay on the heart-healthy track?

If you smoke, consider quitting.

Get your blood pressure checked – you can actually do it yourself at most pharmacies.

Have an annual appointment with your family doctor.

Maintain a healthy body weight through a healthy diet and by staying active. You should exercise three to five times per week. Obesity itself is not a risk factor – but being overweight often goes hand in hand with high blood pressure, high cholesterol and diabetes.

If you have risk factors, feel out of breath more than usual or have any of the other lead-up symptoms mentioned above, talk to your doctor about taking a stress test. If heart disease is diagnosed, there are treatments and the outcomes are usually very good.

This column was also published in the Town Crier Group of Newspapers in Toronto, Ont.

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View the post Heart Attack 101: what men and women should know on Sunnybrook's Your Health Matters blog.

The ingredients list on a food label is required by Health Canada and the Canadian Food Inspection Agency to be listed on most packaged Canadian food products that contain more than one ingredient. Understanding the ingredients list can help you look for specific ingredients that you want or don’t want because of allergy or intolerance, compare products, and make healthier food choices.

Ingredients are listed by order of weight.

This means that the first ingredient weighs the most (i.e. there is more of it in the food product) and the last ingredient weighs the least (i.e. there is less of it in the product).

Choose products that have fewer ingredients.

Products with longer ingredient lists are more processed, especially if many of the ingredients listed are preservatives or words that you don’t recognize. Look for products that list fewer ingredients, and ones you would normally cook with at home or eat on their own.

Identify the different names for unhealthy ingredients.

Sometimes reading the ingredients list is like reading a foreign language. Knowing how to identify different names for ingredients will help you make healthier food choices. Here are some common (and sometimes tricky) ingredients to avoid:

Trans fat

Trans fats raise your bad cholesterol (LDL) and decrease your good cholesterol (HDL). Sources of trans fat include hydrogenated and partially hydrogenated oils and shortening. Avoid products that have sources of trans fats listed anywhere on the ingredients list.

Sodium

Sodium can increase your blood pressure. Look out for the words “sodium” or “salt” – even if they’re combined with other words, like in monosodium glutamate (MSG), disodium, garlic salt. Other sources of sodium are brine and soy sauce. Avoid products that list sodium within the first five ingredients.

Sugar

Words that end in “ose” are all forms of sugar (glucose, fructose, sucrose, dextrose, etc.). Other sources of added sugar include corn syrup, molasses and honey. Under new food labelling requirements starting soon, sugars-based ingredients will be grouped together in brackets after the name “sugars”, which will make it much easier for you to identify all of the sources of sugars added to food. Sugar can increase your risk of heart disease, so avoid products that have any added sugars listed within the first five ingredients.

Use the ingredients list as a partner to the Nutrition Facts Table.

The ingredients list is typically listed close to the Nutrition Facts Table on the food product. This makes it easier to compare the ingredients list and nutritional content of different products. If you see two products with identical or very similar ingredients lists, make sure to compare the Nutrition Facts Table to help you make a healthier choice.

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Every year for Heart Month, Sunnybrook assembles a panel of leading experts to discuss the newest treatment options and prevention strategies. This year’s lecture — Ticker Talk: Heart News That’s Good For You — is now available to view on webcast. Here are some of the intriguing audience questions the panel responded to during the discussion:

Can the heart be physically damaged by a psychological loss or trauma?
The impact of extreme and sudden stress — such as that brought on by a personal loss or tragedy — has become increasingly recognized as a factor affecting heart health. Dr. Bradley Strauss, Chief of the Schulich Heart Centre, says there is definitely a link between sudden tragedy and acute heart muscle dysfunction. “Usually, people recover, but in a small number of cases, people die or are left with severe heart muscle dysfunction,” he says. “The relationship between emotional distress and the heart is real in ways we still don’t properly understand.”

For your heart health, is it better to sleep on your right side or left side?
If you sleep on your left side, you may be more aware of your heartbeat, which could be unpleasant for some. However, experts say there is no medical reason to choose one side over the other. It really comes down to personal preference.

Is there a specific type of exercise that is better for your heart?
It’s generally recommended that people get 150 minutes of moderate physical activity a week — which breaks down to about 30 minutes five times per week. Cardiologist Dr. Mark Hansen says the important thing is choosing an activity you enjoy so you continue doing it.

For patients undergoing cardiac rehabilitation, walking is often recommended as the baseline exercise because it’s easy and readily accessible. If you are currently living with a heart condition, it’s always a good idea to check with your doctor before starting any new exercise program to ensure it’s safe and appropriate.

Are sleep apnea and atrial fibrillation (abnormal heart rhythm) related?
Sleep apnea causes pauses in your breathing or shallow breaths during sleep, and has been linked to an increased risk of high blood pressure, heart attack and stroke. But Dr. Eugene Crystal, director of Arrhythmia Services, says there is also likely a connection between sleep apnea and atrial fibrillation. Both of these conditions share risk factors, including older age and being overweight. And many people are found to have atrial fibrillation for the first time when they undergo a sleep test. Despite these links, he says it’s not clear if you can cure atrial fibrillation by treating sleep apnea. It’s important to get proper guidance on managing each condition from your doctor.

Is there a link between varicose veins and heart disease?
Varicose veins are very common, but really have no relevance to the development or severity of heart disease.

» To learn more about the discussion, watch the full webcast.

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View the post Experts answer 5 intriguing heart health questions on Sunnybrook's Your Health Matters blog.

QUESTION: A close friend has been troubled by manic depression for many years.  She’s now in her 40s and recently found out that she already has signs of heart disease. Is there anything that actually links depression to heart problems?

ANSWER: Numerous studies have found that patients who suffer from either depression or bipolar disorder face elevated chances of getting heart disease at an early age.

“It is quite clear there is an increased risk of coronary artery disease, which ultimately causes heart attacks,” says Dr. Benjamin Goldstein, director of the Centre For Youth Bipolar Disorder at Sunnybrook Health Sciences Centre.

Of course, many people who struggle with major depression or bipolar disorder – also known as manic depression – adopt habits that can contribute to the development of heart disease.

For instance, their psychiatric disorders increase the likelihood that they will smoke, not exercise regularly, and fail to stick to a healthy diet. What’s more, some of the medications used to treat these conditions can cause weight gain, as well as alter cholesterol and blood-sugar levels in ways that can be bad for the heart.

But even in studies that control for the effects of lifestyle and medications, these patients are still more prone to get heart disease early compared with the general population.

“Their rate of heart disease goes well beyond what we would expect to see with traditional cardiovascular risk factors,” says Dr. Goldstein. “Smoking, a sedentary lifestyle and poor nutrition just doesn’t explain the whole story. So, there is something else going on.”

People with bipolar disorder develop heart disease an average of 17 years sooner than those without a psychiatric condition.  This means that when they’re in their mid-40s, they already resemble individuals in their late 50s or early 60s in terms of the condition of their blood vessels.

Similar trends, although not as extreme, are seen in people who suffer from major depression. This group show signs of heart disease an average of six years sooner than would ordinarily be the case.

“It’s like premature aging – and people are literally dying early because of this,” says Dr. Goldstein.

So how does depression set the stage for heart problems?  Dr. Goldstein notes that mood disorders are linked to a wide range of biological changes that seem to speed up vascular deterioration.

In particular, people with bipolar disorder and depression tend to have increased levels of inflammation – and inflammation, in turn, is known to boost the risk of cardiovascular disease.

During a manic episode or a bout of depression, inflammatory markers – such as C-reactive protein – proliferate in the blood stream.  Once the mania and depression subside, the inflammatory markers return to normal levels.

“Inflammation is your body’s immediate response to any threat, such as an injury, an infection or even stress,” explains Dr. Goldstein.  “At the right time, and in the right amount, inflammation is super important for maintaining health.”

However, prolonged inflammation can be harmful. The cascade of proteins released by the inflammatory process can damage the inside lining of blood vessels.  This can result in a build-up of plaque and other deposits, narrowing the arteries, and ultimately leading to heart disease.

Those who suffer from bipolar disorder are particularly vulnerable to the effects of inflammation because they can experience repeated bouts of manic behavior and depressive episodes over many years.

“If you have a few weeks of depression in your whole life, the magnitude of increased risk is pretty modest,” says Dr. Goldstein.  “But if you’re 50 years old and have spent half the past decade depressed, then the risk is probably substantially elevated.”

Aside from inflammation, mood disorders can cause other changes in the body that fuel the advance of heart disease. Studies show that depression is linked to an increase in the stickiness of platelets, which cause blood to clot. As well, there is evidence suggesting depression affects the autonomic nervous system that regulates the heartbeat.

“There are many different mechanisms and we don’t fully understand them all,” says Dr. Brian Baker, a psychiatrist and Associate Professor at the University of Toronto.

Some researchers even speculate that certain genetic traits may predispose some individuals to both mood disorders and heart disease.

Dr. Goldstein believes physicians should pay more attention to the onset of heart disease in young people with mood disorders. Unfortunately, it’s often overlooked because health-care providers are primarily focused on treating the depression and the mania. And the relatively young age of the patients make them less obvious candidates for cardiovascular-disease prevention.

“When you look at the data, you realize that we need to start addressing this issue early on,” says Dr. Goldstein. “There is a lot to be gained by increased recognition and knowledge about the higher heart-disease risk faced by this group of patients.”

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View the post How depression can lead to heart disease on Sunnybrook's Your Health Matters blog.

You’ve probably noticed nutrition claims on packaged foods when you’ve gone grocery shopping. Boxes, cartons, cans and bags filled with some of our favourite foods all seem to be screaming “fat free,” “low sodium,” or “light.” These are Nutrient Content Claims: they describe the level of a nutrient or energy in food, and are regulated (for products sold in Canada) by Health Canada and the Canadian Food Inspection Agency. Unlike the Nutrition Facts table and the ingredients list, using these claims on packaged foods is optional. Some may even be deceiving. Here are some common nutrient content claims and what they actually mean:

“Light”

The “Light” claim doesn’t necessarily mean the food is healthy. “Light” may simply mean that the product is light in colour, taste, or flavour. But, more often than not, this nutrient content claim means the product has 25 per cent fewer calories or 25 per cent less fat than a similar product per serving. While this reasoning does imply the product is healthier for you, if the original or previous product is super high in calories or fat, it doesn’t mean this version is a healthy option.

“Trans Fat Free” or “Zero Trans Fat”

These products contain 0.2 grams of trans fat or less per serving, which means it may still contain a trace amount of trans fat. It’s important for your heart health to avoid trans fat completely, so look at the Nutrition Facts table to see if the product actually has zero grams of trans fat. You’ll also want to check the ingredients list to make sure the product doesn’t contain any ingredients that are sources of trans fat, like shortening or partially hydrogenated oil.

“Low Fat”

“Low Fat” products have less than 3 grams of fat per serving, which is great! But, buyers beware: some low fat products actually have higher amounts of sodium and/or sugar than the regular product to compensate for taste. Use the Nutrition Facts table to help you choose a product that is low in fat, sodium, and sugar.

“Source of Fibre”

To claim a product is a “Source of Fibre,” the product must have 2 grams of fibre or less per serving, which isn’t much. To help you increase your fibre intake, choose a product that has the claim “High in Fibre,” meaning that it has 4 grams of fibre or more per serving.

“Low Sodium”

“Low Sodium” products have 140 milligrams of sodium or less per serving. Choose products that claim “No Sodium” (which actually means less than 5 milligrams of sodium per serving) or “No Added Salt” if you really want to reduce your sodium intake.

“Sugar Free” or “No Sugar”

These products have less than 0.5 grams of sugar per serving. But some low sugar products may in fact have higher amounts of fat to compensate for taste. To help you reduce your sugar intake as much as possible, choose a product that has the claim “No Added Sugar,” which means that it doesn’t contain any added sugars or any sugars that functionally substitute for added sugars like molasses, fruit juice, honey, and maple syrup.

Bottom Line: Don’t just look at the nutrition claims

Instead of relying solely on the nutrient content claims, use them in conjunction with the Nutrition Facts table and the ingredients list to help you make informed and healthy food choices.

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View the post The truth about nutrition claims on Sunnybrook's Your Health Matters blog.

Making healthy food choices and establishing healthy eating habits is key to keeping your heart pumping well and lowering your risk for heart disease. Limiting your total fat intake can help improve your blood cholesterol level and help you maintain a healthy weight. But are all fats bad? While you should avoid some fats completely, others are good for you to eat (in moderation).

Unhealthy fats: Limit your intake.

Saturated fats

Saturated fats can raise your blood cholesterol and triglycerides, a type of blood fat in your body. Elevated levels of both of these in your blood can increase your risk for heart disease. Saturated fat is found in meat and dairy products, as well as tropical oils like palm oil and coconut oil.

Tips to limit your saturated fats:

• Choose lean cuts of meat, skinless poultry, and trim visible fat off the meat before cooking.
• Choose lower fat products such as skim or 1% milk, partly skimmed cheese, and fat-free yogurt.
• Use less butter, palm oil, and coconut oil.

Trans fats

Trans fats are even worse for your body than saturated fat because they raise LDL (“lousy”) cholesterol and lower HDL (“healthy”) cholesterol, increasing your risk for heart disease. They are formed during a process called hydrogenation when a liquid oil is “transformed” into a solid fat. Foods that contain trans fats include hard margarine, shortening, fast foods, and products made with partially hydrogenated vegetable oil.

Tips to eliminate trans fats:

• Food products that claim “Trans Fat Free” or “Zero Trans Fat,” actually contain 0.2 grams of trans fat or less per serving, which means it may still contain a trace amount of trans fat. Use the Nutrition Facts Table and Ingredients List to help you pick products that don’t have any trans fat.
• Choose non-hydrogenated margarine and avoid using hard margarine and shortening.
• Avoid eating fast food, but if you find yourself needing the quick fix, choose healthier options such as salad (go easy on the dressing) or grilled instead of deep-fried items.

Healthy fats: Eat in moderation.

Unsaturated fats

Unsaturated fats help lower LDL cholesterol and raise HDL cholesterol. They are mainly found in plant foods and are liquid at room temperature. Unsaturated  fats include monounsaturated fats that are found in canola oil, olive oil, nuts, nut oils, and avocado; and polyunsaturated fats that include omega-3 fats (more on that below).

Eating too much fat (even if it’s the healthy kind) can still lead to weight gain, so it’s important to use these fats in moderation. Use up to 2-3 tablespoons of added fats – like cooking oil or vinaigrette dressings – per day.

Tips to manage your unsaturated fats:

• Make heart-healthy dishes with a small amount of plant-based cooking oil and heart healthy cooking methods such as grilling, stir-frying, baking, and roasting. Keep in mind that the amount of cooking oil you use is more important than the type of oil.
• No matter how healthy your cooking oil, avoid deep-frying and pan-frying.
• Enjoy salads with oil-based vinaigrette instead of creamy dressings.
• Eat unsalted nuts and nut butters.

Omega-3 fats

Omega-3 fats are essential fats that our bodies need but don’t naturally make, so we must get it from food. Eating foods that are rich in omega-3 help lower your risk of heart disease by lowering triglycerides and raising HDL cholesterol. These foods include fatty fish such as salmon, trout, sardines; ground flax seed, walnuts, canola oil, and wheat germ.

Before starting omega-3 supplements, such as fish oil or flax oil capsules, talk to your doctor, pharmacist or dietitian to make sure it’s safe to do so. There may be drug-nutrient interactions with medications you are taking.

Tips to get your omega-3 requirements, without supplements:

• Eat fatty fish 2-3 times a week instead of meat.
• Sprinkle ground flax seed on your cereal or yogurt.
• Choose flax products and other foods high in omega-3 more often, such as flax bread and omega-3 eggs.

The Bottom Line

Know which fats are in the food you eat, and choose foods with healthier fats more often (but still in moderate amounts) to help keep your heart healthy.

For a quick-reference look at the content in this post, check out the infographic below.

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View the post Nutrition 101: Fat on Sunnybrook's Your Health Matters blog.

Fibre has so many health benefits other than simply keeping our bowels regular. It slows digestion and keeps us feeling full for longer, helps with portion control and weight management, and keeps our blood sugar under control. For heart health, fibre specifically helps with controlling our blood pressure and lowering our cholesterol and triglyceride levels.

But, what is fibre?

Fibre is a carbohydrate that’s only found in plant-based foods – fruits, vegetables, legumes, grains, and nuts. But unlike other carbohydrates like sugars that get absorbed into our bloodstream, fibre simply passes through our digestive tracts. Even though our bodies don’t digest fibre, we still get something out of it!

What’s the difference between soluble and insoluble fibre?

Fibre is broken down into two different types: soluble and insoluble. Each of them plays an important role in helping to prevent disease and promote good health.

Soluble fibre

Soluble fibre absorbs water and turns into a gel-like substance as it goes through our digestive systems. This helps slow digestion and softens your stool so it goes through your gastrointestinal tract more easily. But that’s not all: Soluble fibre helps to lower LDL cholesterol, triglycerides, and total cholesterol. It also helps to control your blood pressure and blood sugar levels.

Foods that are rich in soluble fibre include legumes (beans and peas), oat bran, barley, quinoa; vegetables such as artichoke, squash, broccoli, carrots; and fruits that are rich in pectin, like apples, pears, berries, and bananas. It’s also found in psyllium, a common fibre supplement.

Insoluble fibre

Insoluble fibre doesn’t absorb water or dissolve. Instead, it passes through the body in almost the original form it goes in! This added bulk (or “roughage”) helps to keep our bowels regular and prevent or relieve constipation. Insoluble fibre is found in whole-grain foods, brown rice, nuts, seeds, and colourful fruits and veggies (ones that are yellow, orange and red; or have dark leafy greens).

How much fibre do we need?

In Canada, women need 25 grams of fibre per day and men need 38 grams of fibre per day, but most Canadians only get half of that amount. To meet your fibre needs, Canada’s Food Guide recommends eating 6-8 servings of grain products and 7-10 serving of fruits and vegetables. Foods that contain 4 grams or more of fibre per serving are good sources of fibre.

Remember, serving sizes vary based on the foods you eat, so check out the Nutrition Facts table and review the chart below to see how your favourite foods measure up in fibre content.

Source: Canadian Nutrient File Database

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In Canada, women need 25 grams of fibre per day and men need 38 grams of fibre per day, but most Canadians only get half of that amount. To meet our fibre needs, Canada’s Food Guide recommends eating 6-8 servings of grain products and 7-10 servings of fruits and vegetables. Here are eight tips to help you get more fibre into your day:

1. Go slowly.

Adding too much fibre too quickly into your diet can cause gas, bloating, cramping and diarrhea. Increase your fibre intake gradually by spreading out high-fibre foods throughout the day. Because fibre absorbs fluid as it passes through our digestive tract, make sure to drink plenty of fluids as you increase your fibre intake, too.

2. Start your day out right.

Start your day with a nutritious and high-fibre breakfast. Give high-fibre cereal or low-fat yogurt an extra boost by adding fresh fruit, ground flax seed or chopped nuts.

3. Choose whole-grain.

Instead of plain white flour products, choose multigrain or whole grain breads, pasta, and crackers. You’ll get more fibre bang for your buck without having to increase the amount of grain products you eat.

4. Balance your plate.

Half of your lunch or dinner plate should be filled with a variety of vegetables. Enjoying a mix of colourful yellow, orange, red and green vegetables is a great way to add fibre, and will also help you get all the different vitamins and minerals that you need.

5. Chew instead of drink.

Eat whole fruits and vegetables instead of drinking juice. If you enjoy juicing, make sure that your juicer retains the pulp in the juice so that you don’t miss out on the fibre.

6. Snack often and wisely.

Munching on high-fibre snacks between meals can help you feel satiated throughout the day, and can also help with portion control at mealtimes. Try some fresh veggies and hummus, roasted chickpeas, or apple slices with some natural almond butter as a dip.

7. Go meatless once or twice a week.

Substituting meat with legumes (beans, chickpeas, lentils) can help increase your fibre intake. Instead of ground meat, use beans, lentils and a variety of mixed vegetables in your chili or pasta sauce. You can also use legumes in soups and salads for some added fibre and protein.

8. Check the label.

Read the Nutrition Facts table and choose products that have 4 grams or more of fibre per serving (or labeled as “high source of fibre”).

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View the post How to get more fibre into your daily diet on Sunnybrook's Your Health Matters blog.

Find out more.

Read the full study.

Bladder Cancer Canada.

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View the post Are you on blood thinners? on Sunnybrook's Your Health Matters blog.

Should you just gloss over your smoking status when visiting your family doctor or specialist? No! Be honest. Tell your care team if you smoke and how many cigarettes you smoke per day.

Here’s some reasons why you should be up front about whether or not you smoke – even if it’s just a cigarette here or there:

1. Smoking puts you at risk for certain illness, blood pressure issues and more. Knowing you smoke, your physician can keep a closer eye on those things and catch any problems early. Hiding your smoking status from your care team means they may not know you are at higher risk for certain illnesses. Learn more about how smoking affects your body.
2. Smoking can affect your healing time when it comes to surgery. If you have surgery coming up, your doctor may provide specific instructions to you if you smoke. Smoking can slow down the healing process because of the reduced amount of oxygen getting to the surgery site. (Read more on the benefits of quitting smoking before surgery.)
3. Your doctor can connect you with quitting resources when you are ready. There are medications and nicotine replacement products available that can make quitting easier. Your doctor, if they know you smoke and you are looking to quit, can point you in the right direction.

It’s never too late to quit. You can find more resources from Sunnybrook’s Smoking Cessation team at sunnybrook.ca/quitsmoking

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View the post Why you should tell your doctor if you smoke on Sunnybrook's Your Health Matters blog.