GUIDE TO: IDENTIFYING CARDIOVASCULAR RISK, DISCOVERING KEY HEART NUTRIENTS AND EFFECTIVE MEDICAL TESTING

QUICK GUIDE TO ASSESS YOUR CARDIOVASCULAR RISK If you are concerned about your heart health, you may have to ask your doctor to order a few tests so that you can answer some of these questions fully. If you answer yes to at least 3 or 4 of these questions,it may indicateyou are at higher risk for cardiovascular disease. The good news is that The 30-Day Heart Tune-Up will give you the tools to correct most of these risks. 1. Is your LDL cholesterol too high (more than 100 mg/dl)? Or do you take a cholesterol-lowering medication? 2. Is your healthy HDL cholesterol too low? (less than 40 mg/dl for men and less than 50 mg/dl for women)? 3. Do you have an abnormal advanced cholesterol profile with small LDL, the wrong type of HDL, or high Lp(a)?This is extra important for people with cardiovascular disease, or a strong family history of heart disease. 4. Is your blood pressure elevated without medication (more than 120/80 mm Hg)? Or do you have to take blood pressure medication? 5. Is your blood sugar level elevated? (Elevated means more than 100 mg/dl; optimal is under 90 mg/ dl). Or do you take diabetic medication? 6. Is your waistline expanding? (>35 inches for women; >40 inches for men (>37 inch pants size) 7. Are you overweight? (Body Mass Index greater than 24, especially a body fat percentage of more than 24 for men and 27 for women) 8. Is your high high-sensitivity C-Reactive Protein (hs-crp) level, an indicator of inflammation, higher than 1.0 mg/l? (A reading of 3.0 mg/l or more poses a high cardiac risk) 9. Do you use any form of tobacco products? 10. Do you exercise less than 5 days a week? More importantly, take the fitness tests discussed in Chapters 3 & 5 to clarify whether you are as fit as you should be for your age. 11. Do you eat fatty meats and dairy products more than twice a week? 12. Do you eat one or more servings of refined carbs daily? 13. Do you eat less than five cups of fruits and vegetables daily? 14. Do you have a family history of cardiovascular disease? 15. Do you eat trans-fats (hydrogenated fats) from processed food or restaurant food?

WHICH TESTS TO ORDER? HERE IS HOW I SUGGEST YOU APPROACH YOUR PHYSICIAN: 1. First, call and schedule an appointment with your doctor. Tell the receptionist you want to make a wellness appointment to confirm you are safe to start an exercise program. If your regular follow-up exam is overdue, it might be advisable to also schedule a second appointment to get caught up on all your appropriate health screening. 2. At your visit, tell your physician that you want to take charge of your health by adding regular exercise, eating healthy foods, and managing your stress. Explain that you hope your doctor can confirm that it is safe for you to start. Tell him or her that you are following my 30-Day Heart Tune-Up. I have presented lectures on this subject to tens of thousands of physicians over the last 10 years, so your doctor might already be aware of my program. If not, I suggest you provide your doctor with this book, or refer to my website, www.hearttuneup.com so he or she can see the type of program you are following. If you have uncontrolled health problems such as diabetes, high cholesterol, or hypertension, your doctor may recommend a stress test there is a ton of information you can gain from this. But please don t let anyone rush you into an invasive procedure such as a heart catheterization without getting at least a second opinion from another physician. Make sure that you have read this entire book and discussed what you have learned with your own physician. 3. The key safety issues to resolve during your physician s assessment are to clarify that your heart, lungs, and joints are safe and ready for exercise. 4. If you are not up to date on your laboratory testing, ask your doctor to order the tests I m about to suggest, plus measure your body fat, blood pressure, and resting heart rate. (If you have had these tests in the last year, you don t need to repeat them unless your physician believes otherwise): a) Fasting lipid profile. If you have several cardiac risk factors or a family history of heart disease, ask for an advanced lipid profile that includes the size of your lipid particles and particle counts. b) Fasting blood sugar. Optimal is under 90 mg/dl and normal is under 100 mg/dl; include a Hemoglobin A1C test if you have elevated blood sugar, >99. c) hs-crp. A measure of inflammation. Normal is < 1.0 mg/dl. d) TSH (thyroid-stimulating hormone). A measure of thyroid function. Normal should be < 3.0 miu/l, and optimal is 0.5 to 2. If you have symptoms of low thyroid hormone levels, such as low energy, constipation, cold intolerance, and/or weight gain, request a full thyroid panel (which includes free T3, free T4, reverse T4, and thyroid antibodies). e) Hemoglobin (or complete blood count). To check for anemia. f) Carotid IMT study to measure your plaque growth. For the most part, insurance companies are not yet covering carotid IMT testing, despite the fact that it is now considered a state-of-the art diagnostic tool. Many physicians don t offer this testing, so you may need to search on line.

TOP FIVE HEART FRIENDLY NUTRIENTS: FIBER is essential for good health. If you only change one aspect of your diet, adding fiber would be my top priority. Signs of deficiency: Constipation, high blood sugar, abnormal cholesterol profiles, rapid aging Recommended dose: 30-50 grams daily Foods Rich in Fiber: Apple, medium, 3.3 grams Carrots, 1 cup, 3.6 grams Raspberries, ½ cup frozen, 5.5 grams Quinoa, 1 cup cooked, 5 grams Avocado, 1/2, medium, 6.5 grams Pear, medium, 5.1 grams Beans, 1 cup, cooked, 13-19 grams FISH OIL contains long chain omega-3 oils which are reported to reduce the risk for heart attacks. They reduce inflammation and are being studied in pregnancy to optimize fetal brain formation. Recommended dose: 1000 mg EPA&DHA daily Foods Rich in Omega-3 Fat (3.5 oz serving): Anchovies, 1.75 grams Mussels, 0.7 grams Salmon, Pacific, Silver, Wild, 2.4 grams Trout, Rainbow, Wild or Farmed, 1.2 grams Herring, 2.1 grams Oysters, 0.6 grams Sardines, canned in water, 1.9 grams MAGNESIUM is involved in hundreds of anti-aging reactions. Signs of deficiency: Constipation, Irregular heartbeat, Migraines, Insomnia, Muscle cramps. Recommended dose: 400-600 mg daily as Mg-glycinate, -malate chelate, or -citrate (avoid Mg oxide) Foods Rich in Magnesium: Pumpkin/Squash seed kernels, 151 mg/oz Bran Cereal (100%), 103 mg/oz Spinach (cooked), 81 mg/0.5 cup Black Beans (cooked), 60 mg/0.5 cup Brazil Nuts, 107 mg/oz Quinoa (dry), 89 mg/2 oz Almonds, 78 mg/oz; VITAMIN D supports healthy and strong bones. Vitamin D deficiency is associated with: bone pain; increased risk for cancer, autoimmune disease, cognitive decline, depression, and cardiovascular disease. Recommended dose: 1000-3000 IU vitamin D3 daily. (A vitamin D 25 Hydroxy blood level of 40 ng/ml is optimal) Foods Rich in Vitamin D: Milk (fortified OJ or soy milk): 100 IU/ 8 oz Egg: 25 IU/yolk Cold water fish, 100-350 IU/3.5 oz (fattier fish has more vitamin D) VITAMIN K is essential for bone and artery health. Without vitamin K, bones lose calcium and arteries become stiff as they accumulate calcium. Recommended dose: 250-1000 mcg Vitamin K daily Foods Rich in Vitamin K: Kale, cooked, 1062 mcg/cup Onion, raw, 207mcg/cup Beets, cooked, 697 mcg/cup Collards, cooked, 1059 mcg/cup Spinach, cooked, 889 mcg/cup Broccoli, cooked, 220 mcg/cup

The Multi-Vitamin Snap-Shot Summary Ingredient Dosing Range Comments Iron 0 mg or 20 mg 20 mg for menstruating women Vitamin A (as retinol or retinyl) 3,000-5,000 iu Vitamin A (as mixed carotenoids) 3,000-15,000 iu Mixed beta carotene, lycopene, lutein, zeaxanthin, alpha carotene, cryptoxanthin Thiamin (B1) 15-30 mg Riboflavin (B2) 10-30 mg Niacin (B3) 50-100 mg Mixture of niacin and niacinamide Pantothenic acid (B5) Pyridoxine (B6) 50-100 mg 10-25 mg Cobalamin (B12) 100-1,000 mcg Stomach acid blocking meds decrease absorption. Young, healthy adults only need 10-50 mcg daily Biotin 300-1,200 mcg Higher dosages needed with blood sugar regulation problems Folate Look for mixed forms of Folate, not only Folic Acid 400-600 mcg Higher dosages may be needed for planned pregnancy Vitamin C (calcium ascorbate) 250-1,000 mg Vitamin D 1,000-3,000 iu Higher dosages needed with advancing age, autoimmune disease, and with bone density loss Vitamin E (With mixed d-alpha, gamma, and delta tocopherol) 50-150 iu Dosages >150 IU are warranted for various indications Vitamin K 75-150 mcg 75-150 from a multi, but total Vit K intake Calcium (protein bound minerals are much better absorbed and tolerated) Magnesium (protein bound minerals are much better absorbed and tolerated) Iodine (from kelp) should be 250-1000 mcg daily 0-100 mg Can be dosed separately from a multivitamin (Total needs vary from 800-1,500 mg daily) 0-100 mg Can be dosed separately from a multivitamin (Total needs vary from 300-800 mg daily) 75-150 mcg Chromium (nicotinate) 150-200 mcg 400-800 mcg daily for blood sugar control Manganese Molybdenum INGREDIENTS TO LOOK FOR IN A MULTIVITAMIN 5-10 mg 100-150 mcg Selenium 100-200 mcg Caution: Dosages > 400 mcg daily are toxic Zinc (glycinate or amino acid chelate) 15-25 mg Taking more than 40-50 mg daily long-term can cause gastro-intestinal irritation Copper 1 mg Zinc and copper should be in a 20:1 to 15:1 ratio Boron 1-2 mg Co-Q10 is a chemical compound that has a dual function in energy production. You should take this supplement when taking a statin med. because lowering cholesterol production typically lowers Co-Q-10 levels by 20%. Good quality is essential and you should buy a product that has a 4-8% absorption rate. Discuss dosing with your medical provider.