Dr. John Mandrola, MD
Dr. John Mandrola, MD
You might think a cardiologist would spend his time with patients discussing technical things with complicated medical words. But in reality, I spend most of my time talking about the four legs of a table: the table of health.
I explain that their health is like a table. And just like a sturdy table, it has four equal and strong legs. If one is shorter or longer, the table wobbles, and eventually breaks.
Here are the four "legs" that keep our health steady:
My main piece of advice on food is to be mindful of it. Think. Getting heart patients to think about food is the first step. Recently, while I was examining the belly of an obese man, I asked "What is this?" I meant his huge abdomen. The wife said, "It's cheese and crackers." Okay, I thought, that's progress. We talked about reducing empty calories; we discussed comfort eating. I asked him to think about cutting back on junk food. The next visit, he had lost weight. "I shouldn't have been eating that much junk food," he said.
When you start thinking about what you're eating, healthier choices start to become normal. When you cut back on salt, for instance, it's not long before salty restaurant meals, which you once enjoyed, don't taste good to you anymore. It's the same with sweetness and portion size.
Study after study has demonstrated the benefits of regular exercise. Note that that I used the term "exercise"—not physical activity. Exercise is a sustained activity that makes you breathe hard and sweat. I've started writing EXERCISE on my whiteboard in the exam room or on a prescription pad. I tell my patients they need to consider exercise like a drug; take it every day.
As a lifelong exerciser and bike racer, I have learned some tricks about exercise. One is to choose exercise that you'll stick with. Most middle-aged or older people aren't going to sustain a Boot-camp-like regimen. Another thing I prescribe is to carve out a protected time in your day for exercise. That means exercise is not extra, say, if I have enough time, but rather, it is my time for health.
When I ask my healthy patients how they sleep, they all tell me they maintain good sleep patterns. Pattern being the key word. Good sleepers keep a schedule. They plan. They go to bed at a set time and they don't have media screens in the bedroom. Good sleepers consider sleep as a daily prescription for health. A great deal of research lately has tied sleep disorders, especially obstructive sleep apnea, to many common diseases, such as high blood pressure, depression and heart disease. More and more, before recommending cardiac procedures, I screen and refer patients for sleep disorders.
Recently, a patient with a heart rhythm problem told me during his yearly checkup that his symptoms were gone. When I asked him what he had been doing differently, he said, "I decided to change my attitude." I asked him what he meant. "I changed how I approach stress. I decided that being angry and worried was killing me. I cut back on my work; I took time for exercise and I forced myself to see more of the positive in things. It took about a month and my heart problem resolved itself." Could it be that every angry blow-out is like putting another jellybean in the jar? Eventually the jar overflows.
I don't mean to suggest achieving mental health and happiness is easy. But I am suggesting the brain-heart connection is important. We aren't just treating a physical heart; we are treating a human heart. Although drugs and devices dominate the field of cardiology, I'd put generosity, kindness, grace, and love high up on the list of heart-healthy treatments.
Notice one common thread with each of these legs of the health table: Each of them require an action plan. Humans lucky enough to live in wealthy nations have easy access to an abundance of rich food, convenient transportation, and incessant distraction. We must have a plan to overcome these luxuries. Health, like the construction of a sturdy table, requires an action plan.