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Spring 2022

FROM THE

HEART                                                                                              Newsletter from

The Secret to Health, Happiness, and Longevity
James H. O’Keefe, MD, with Kathleen C. O’Keefe

“The only ones among us who will be truly happy are those who will have sought
and found how to serve.” Albert Schweitzer

I
    ronically, the single best strategy    tend to hum along as well as we do—
    for improving your own health,         there are just so many opportunities
    happiness, and even life expec-        for the wheels to come off. Yet each
    tancy is to stop thinking about        living species is a successful experi-
yourself and start focusing on improv-     ment as a good match for their niche
ing the wellbeing of other life.           environment. If we are to realize our
   It’s truly mind-boggling to ponder      full potential as a living organism, our
the fact that each of us is a biological   environment, diet, social milieu, and
package of self-organizing chemi-          activity patterns need to be similar
cals. We take in energy (food), water,     to that in which we evolved, so as to
and oxygen from the environment;           enable all of those self-organizing
then our DNA and RNA send instruc-         processes to happen just right.
tions to the ribosomes—little protein         Of the countless species that have
factories in our cells—that churn          existed since the origin of life, almost
out a variety of very specific proteins    4 billion years ago, about 99.9% of
which spontaneously fold into just the     those species are extinct today. Even      Lady, Francis, and Kathleen
right shapes and then self-assemble        the Homo sapiens species has been
into lipid bilayer cell membranes and      on the brink of extinction at times.        ancestor (LUCA), you would discover
innumerable other components that          One scientific model estimates that         that over the last 3.7 billion years,
are used to make up cells, tissues, and    about 100,000 years ago the entire          each and every one of your direct
organs. All these chemical reactions       human population on Earth had con-          blood relatives—child to parent to
are self-orchestrated to interact and      tracted down to just 2,000 to 10,000        grandparent to great grandparent,
automatically create, maintain, and        individuals. Regardless, through it all,    etc.—endured long enough to repro-
fine-tune you. As advanced as we are       your bloodline survived, and here you       duce and successfully nurture their
in modern science, we are just scratch-    are today.                                  offspring. It’s an unimaginably long,
ing the surface of understanding how         You are not average; you never            unbroken, winning streak of survival
intelligently designed and exquisitely     have been. You come from a very             in the face of very long odds.
adaptable living organisms are.            long line of hardy survivors. If you           Toughness, creativity, and resource-
    When you think about it this way,      could trace your lineage all the way        fulness are programmed deeply into
it’s astonishing that biologically we      back to the last universal common
                                                                                                            continued on page 2

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H E AR TFE LT STO R I E S

    The Secret to Health, Happiness, and Longevity
    continued from page 1

    your genes, but you won’t manifest          Our lives should be centered around
    those virtues by following the path         fostering positive relationships, acts
    of least resistance and dwelling in         of service, and preserving our planet.
    your own comfortable and insular            The more we can focus on these
    world. Tony Robbins says, “The path         fundamental pillars of life, the happier
    of least resistance will never make you     and healthier both the world and we
    proud.” You need a cause bigger than        will be. Obviously, nobody is going
    yourself, with goals beyond your own        to solve any of these catastrophic
    hedonistic pursuits if you want to          problems on their own. It’s going to
    really blossom.                             take an all-hands-on-deck approach.
       Depending upon their environ-            Theodore Roosevelt famously said,
    ment, living organisms via epigenetic       “Do what you can, where you are, with        lives. Emotional ties protected people
    signaling will switch on or off whole       what you have.” Mostly that means            from trauma and stress, helped to
    segments of genes, which can drasti-        each of us must help make things bet-        delay age-related physical and mental
    cally alter hormones, appetite, mood,       ter in our little corner of the world.       decline, and were better predictors
    immunity, body composition, and                 Do you want to know the secret to        of long and happy lives than genes,
    ultimately physical and mental health.      a long and happy life? In his superb         education, income, or IQ. The protec-
    Through similar epigenetic signaling        book, The Courage to be Disliked, Ichiro     tive effect of relationships proved true
    mechanisms, being self-centered and         Kishimi writes, “Just like the traveler      across the board among both the
    always taking the easy way predict-         who relies on the North Star, in our         Harvard men and inner-city males
    ably leads to lethargy and weakness.        lives we need a guiding star. That star      born into impoverished families. Dr.
    When you demand less from your              is ‘contribution to others.’ As long as      Robert Waldinger, one of the directors
    mind and body, your strength and            we do not lose sight of this compass,        of the Harvard study said, “Loneliness
    mental sharpness will atrophy. In con-      and keep on moving in this direction,        kills; it’s as powerful as smoking or
    trast, when you confront meaningful         there is happiness. No matter what           alcoholism.” In contrast, the partici-
    challenges and invest your energy in        moments you are living, or if there          pants who cultivated warm relation-
    helping other life, epigenetic switches     are people who dislike you, as long as       ships enjoyed longer and happier
    are turned on, which alters your            you do not lose sight of the guiding         lives, whereas the loners often died
    genes to radically transform you            star of ‘I contribute to others,’ you will   earlier. The bonds that we forge with
    into a stronger, more resilient and         not lose your way and you will have          our family, friends, neighbors, pets,
    resourceful version of yourself.            always companions by your side.”             and plants are like lifeboats that will
                                                                                             save us when the inevitable storms
        Some people wonder, “What’s the
                                                Fostering Positive Relationships             of life ravage our worlds.
    meaning of life?” Our planet Earth is
                                                   The quality of our relationships and         This means you need to get
    a cosmic oasis in an otherwise cold,
                                                how happy and secure we are with             outside your own head and tend
    largely empty, and lifeless (except for
                                                the people we are closest to has a           to the wellbeing of other life—and
    us) universe. It’s a special privilege to
                                                profound influence on our health and         it doesn’t always have to be other
    be part of the wonderous spectacle of
                                                longevity. Put another way, relation-        humans. Adopting and caring for a
    life on Earth. So, it seems to me, one
                                                ships are our most important pos-            dog does wonders for your physical
    important “meaning of life” is to do
                                                sessions in life—by far. The Harvard         and mental wellbeing, providing de-
    what we can to help keep the spark
                                                Adult Development Study enrolled             voted companionship, unconditional
    of life alive and well here on Earth.
                                                724 Boston men as teenagers in 1938          love, and constant entertainment. For
    Could helping our neighbor help us
                                                and followed them closely ever since.        people for who have a canine house-
    to become better ourselves? Today,
                                                This landmark study found that having        mate, it’s no mystery why dogs are
    more than ever, with climate change,
                                                close long-term relationships, more          man’s (and woman’s) best friend.
    a global pandemic, and the possibility
                                                than money or fame, was the most
    of another world war threatening our                                                       Recently, dog ownership’s effect
                                                important predictor of how happy
    survival, we need to band together.                                                      on human survival was assessed in a
                                                the people were throughout their

2   Saint Luke’s Cardiovascular Consultants | From the Heart
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H E AR TFE LT STO R I E S

definitive meta-analysis of 10 studies      fitness that improved their chances           going strong. Even in his 90s, Carter
that included about 4 million partici-      of surviving future threats in the            continues fighting for human rights,
pants. People who lived with a dog          real world. Importantly, playing also         resolving international conflicts,
were 24% less likely to die during the      helped them forge bonds with their            promoting democracy, leading clean
10-year study compared to people            pack, reduce stress, and boost mood.          water initiatives, assisting hurricane
who didn’t have a dog companion.                There’s still nothing quite as thera-     victims, and personally building
Dog ownership conferred an even             peutic as play. Peter Schnohr and             homes with Habitat for Humanity.
greater 31% risk reduction in car-          Jacob Marott, my friends/colleagues              A recent Harvard study of 13,000
diovascular death. These health and         from Copenhagen, Denmark, and I               adults reported that people who
longevity benefits of sharing one’s         recently published studies showing            volunteer for even two hours/week
home with a dog were especially pro-        that the exercises that best improve          have a longer life expectancy, fewer
nounced for people who lived alone.         life expectancy are those that involve        physical impairments, and a stronger
   Life, in its wisdom, channels energy     physical interactive play, like tennis,       sense of well-being. According to
to organisms that are contributing          badminton, volleyball, golf, basketball,      Dr. Eric Kim, the study’s lead author,
to the common good, whereas life            softball, and soccer. Play is a collabora-    “Humans are social creatures by
force tends to be shunted away from         tive endeavor—everyone in the game            nature. Perhaps this is why our minds
isolated organisms that are not being       benefits and usually comes away with          and bodies are rewarded when we
collaborative with other life around        warm feelings about their playfel-            give to others. Our results show that
them. Because life is intricately inter-    lows. Play is also a way to engage our        volunteerism among older adults
connected, to be fully participating        competitiveness in a fun and harmless         doesn’t just strengthen communi-
in the phenomenon of life you need          manner. These days I play pickleball          ties, but enriches our own lives by
to be investing much of your time           at least twice a week; we laugh, hoot,        strengthening our bonds to others,
and energy into the wellbeing of liv-       and kiddingly harass each other for 90
ing things around you. I think of my        minutes. I have come to believe that
grandmothers, Alice and Dorothy, and        play is one of life’s essential ingredi-
my mother Leatrice, who dedicated           ents—let’s call it vitamin P. Doctor’s
their lives to their family, friends, and   orders, get your vitamin P at least
communities. They were happy, active,       twice a week.
social people who lived into their 90s;
Dorothy made it to 103. How many            Acts of Service
grouchy, anti-social, mean-spirited            Even for the most introverted, we
hermits do you know who are healthy         need to connect to other life to pros-
and living with vitality into their 90s?    per. We’re like ants that way. Investing
    My mother’s mantra when I was           time and energy into helping our fam-
growing up was, “Go outside and play        ily and/or colony survive is what we are
with your friends.” As a teenager I had     genetically programmed to do. We also
a long list of phone numbers memo-          have a strong inclination for altruism
rized and was constantly calling my         that not only makes us feel good when
buddies to get a game together. Since       we help others, it also improves our
med school I’ve always continued to         health and longevity.
do a lot of exercise, but I neglected         A study that closely tracked 10,000
my play time. Just in the last couple       people in Wisconsin for over 40 years         helping us feel a sense of purpose
of years I’ve gotten back into play-        found that people who volunteered             and well-being, and protecting us
ing, so I’m up to my old antics of          reduced their risk of dying during the        from feelings of loneliness, depression,
frequently nagging my pals to join in       study by over half.                           and hopelessness. Regular altruistic
on a game of pickleball, badminton,                                                       activity reduces our risk of death.”
                                               Jimmy Carter, at age 97, is the
and even pool—it makes me feel like         United States’ longest-lived president.          The take-home message is the same
a kid again. Mammals invented play          About 42 years ago he retired from            one my wife Joan has been telling me
100 million years ago, to hone physi-       his work as “leader of the free world”,       and the kids for decades: “It’s not all
cal skills while frolicking with their      but he’s been passionately involved in        about you.” The more we can keep this
littermates. Play helped them develop       volunteer work ever since and is still        in mind, the better our lives will be.

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H E AR TFE LT STO R I E S

    Pam and Scout: Who Rescued Who?
    James H. O’Keefe, MD

    P
             am Emerson is a scheduler                                                                        feels satiated with
             for us in the Duboc Cardio                                                                       less food and is not
             Wellness Center and the                                                                          so ravenous all the
             Haverty Cardiometabolic                                                                          time. Nothing suc-
    Center. She also sits at our front desk                                                                   ceeds like success—
    and checks our patients in when they                                                                      the more progress
    arrive for their in-person office visits.                                                                 she made with her
    Pam is a smart, friendly, conscientious,                                                                  weight, the more
    and helpful person who is a key mem-                                                                      motivated she was
    ber of our team. She welcomes people                                                                      about following her
    when they come through our front                                                                          new active lifestyle
    door, and in so doing, makes our first                                                                    and healthy eating
    impression. Indeed, Pam usually has a                                                                     habits.
    halo effect on the patient’s perception                                                                       A turning point
    of our team, which is one of the many                                                                      for Pam came when
    reasons most everybody who knows            Scout, Pam, and Tyler                                          her daughter, Tyler,
    her loves her.                                                                                             had her first child
       Pam has only been working with us        Pam join our work family, and she         about 6 months ago. It was a difficult
    for 15 months; before that she was in a     settled right in. Pam said, “It smacked   and dangerous delivery, and Tyler re-
    job that didn’t showcase her strengths,     me in the face. It suddenly dawned        lied heavily on her mother to support
    but instead made her feel unappreci-        on me that I had been killing myself!     her emotionally during the days fol-
    ated and stressed. And she had gotten       I needed to wake up and start paying      lowing the birth. Scout, the new baby,
    into some bad habits. Pam told me,          attention to my health.” So she started   is a beautiful and healthy little girl, but
    “All day I used to drink nothing but        drinking water instead of pop and ate     like all infants she is very needy. Pam
    Coke or Diet Coke, and sweets were          more vegetables, fruits, berries, and     and Scout formed a very close bond
    my comfort food.” As her weight crept       nuts instead of junk food and sweets.     from the first day, and her new grand-
    up and her mood slumped down, she           Pam understood that as a visible and      daughter is the light of Pam’s life now.
    became increasingly sedentary. Exer-        important member of our Cardio            “Scout made me realize that my life is
    cise started becoming uncomfortable,        Wellness/Cardiometabolic team she         not about me; it’s about making sure
    so she was spending less time pursu-        needed to be setting a good example.      that the people in my family are safe
    ing her passions, like playing with         As her diet and lifestyle improved,       and loved. I want to be here for my
    grandchildren, hiking trails with her       the fat started to melt away and her      grandkids, and they need me. I want
    friends and/or her dog, and garden-         energy surged, which allowed her          to help them grow up to be happy
    ing. Instead, she was spending her free     to get more active and reengage           and successful, to follow their dreams,
    time sitting around indoors staring         physically with the world again.          and to become good citizens too.”
    at passive entertainment on screens.           We also started Pam on semaglu-           Ikigai is a concept that comes from
    Pam felt herself getting pulled into a      tide, a game-changing drug for her        Okinawa—a Japanese island famous
    downward spiral that was draining the       type 2 diabetes that not only reduces     for its long-lived and healthy inhabit-
    joy and vitality from her life.             hunger, blood glucose, and body           ants. One of the central features of
       About 18 months ago, when the            weight, it also lowers risk of cardiac    traditional Okinawan culture is ikigai,
    lead scheduler/front desk position          catastrophes, like heart attack and       which means “one’s reason for being.”
    opened, Pam was our first-draft pick        stroke, and cardiovascular death.         Your ikigai is your life’s purpose or
    because a few of us already knew her        Semaglutide reduced Pam’s cravings        your bliss. This is what brings you joy
    and were impressed with her work.           for sweets and other junk food. Since     and inspires you to get out of bed in
    We were grateful and elated to have         starting semaglutide, Pam eats much       the morning and make you enthused
                                                smaller serving sizes because she         to greet the day. It is generally a cause

4   Saint Luke’s Cardiovascular Consultants | From the Heart
HEART - Saint Luke's Health System
that’s above and beyond one’s own          Saint Luke’s Cardiovascular Consultants
self interests. The Okinawans focus        Suzanne V. Arnold, MD                          Jason B. Lindsey, MD
on cultivating a strong sense of ikigai    Bethany A. Austin, MD                          Anthony Magalski, MD
as an essential trait to help them lead    Dmitri V. Baklanov, MD                         Michael L. Main, MD
                                           Charles W. Barth, MD                           Susan A. Mayer, MD
long, healthy, and fulfilling lives.       Timothy M. Bateman, MD                         Justin R. McCrary, MD
   Pam’s eyes twinkle as she talks         Matthew C. Bunte, MD                           A. Iain McGhie, MD
                                           Kevin A. Bybee, MD                             Michael E. Nassif, MD
about how Scout comes and stays
                                           Paul S. Chan, MD                               James H. O’Keefe, MD
with Grandma and Grandpa on                Adnan Chhatriwalla, MD                         Nicholas M. Orme, MD
weekends. Scout is becoming busier         Matthew G. Deedy, MD                           Shailja Parikh, MD
and more interactive by the day, yet       Michelle L. Dew, MD                            John E. Peterson, MD
                                           Jonathan R. Enriquez, MD                       Riaz R. Rabbani, MD
Grandma Pam’s newfound energy and          Mark P. Everley, MD                            Valerie J. Rader, MD
enthusiasm have made it enjoyable          Tim Fendler, MD                                Brian M. Ramza, MD, PhD
to care for the baby. She used to get      Adam Fleddermann, MD                           Carlos Rivas-Gotz, MD
                                           Michael J. Giocondo, MD                        Barry D. Rutherford, MD
sore when she would get down on            Joseph A. Goeke, MD                            David M. Safley, MD
the floor to play with Scout, but now,     Thomas H. Good, MD                             Mohammed Saghir, MD
Pam has no trouble crawling around         J. Aaron Grantham, MD                          Adam C. Salisbury, MD
                                           Anna Grodzinsky, MD                            John T. Saxon, MD
with her.
                                           Sanjaya K. Gupta, MD                           Laura M. Schmidt, MD
   Over the past year, Pam has lost        Anthony J. Hart, MD                            James E. Sear, MD
60 pounds. She wears her ID badge          Kenneth C. Huber, MD                           David G. Skolnick, MD
                                           Chetan Huded, MD                               Brett W. Sperry, MD
that has a picture taken the day she       Arun Iyer, MD                                  Daniel A. Steinhaus, MD
began working with us 15 months            Dany Jacob, MD                                 Tracy L. Stevens, MD
ago. Patients and visitors are always      Andrew C. Kao, MD                              Robert E. Tanenbaum, MD
                                           Taiyeb M. Khumri, MD                           Randall C. Thompson, MD
commenting about how different             Mikhail Kosiborod, MD                          Deepthi Vodnala, MD
she looks today. Her numbers have          Steven B. Laster, MD                           Alan P. Wimmer, MD
dramatically improved, too. Pam’s          Stephanie L. Lawhorn, MD                       Martin H. “Tony” Zink, III, MD
                                           John K. Lee, MD
blood pressure, triglycerides, choles-
terol, blood glucose, A1c, and markers     Emeritus: James E. Crockett, MD, Allen Gutovitz, MD, Warren Johnson, MD, David
of inflammation have all come back         McConahay, MD, Daniel Scharf, MD, and David M. Steinhaus, MD. In Memoriam:
down to normal healthy levels. She         Robert D. Conn, MD, Geoffrey O. Hartzler, MD, and Ben McCallister, MD.
is sleeping soundly again and is back
to hiking the state trails, planting       Funds generously donated to Saint Luke’s
                                           Foundation by grateful patients enable us to
and tending a big garden, and rais-
                                           publish From the Heart and send it to more than
ing three dozen free-range chickens
                                           260,000 homes and offices. All materials are created
whom she refers to as her devoted
                                           by our physicians solely for the education of our
fan club. “They follow me everywhere       patients and referring physicians and should not
I go when I am outside,” she says. She     be considered a substitute for medical advice. You
brings in eggs for us from her pet         should always talk to your health care provider for
chickens, which taste nutritious and       diagnosis and treatment regarding your specific
delicious. In the past, Pam’s go-to food   medical needs.
was generally sweets and highly pro-                                                                         Dr. O’Keefe
cessed foods, but now she eats a lot of    James H. O’Keefe, MD
fresh vegetables/fruit and enjoys fish,    Editor-in-Chief
chicken, and beans, but makes a point      saintlukeskc.org
of eating nothing that comes from an
animal with hoofs.                         © 2021, Saint Luke’s Cardiovascular Consultants. All rights reserved.
   Pam’s health has been radically
transformed by awakening to the real-      To be added or removed from this newsletter mailing list, email Lori
ity that the world needs her, and that     Wilson at ljwilson@saintlukeskc.org or call 816-751-8480.
she can make a big positive difference
for the people in her life.

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HEART - Saint Luke's Health System
H E AR T H E ALTHY LI FE ST Y LE

    An Avocado a Day Keeps the Doctor Away
    James H. O’Keefe, MD, with Joan O’Keefe, RD

                                                                                        over 30 years and found that eating
                                                                                        half of an avocado twice per week re-
                                                                                        duced the risk of developing coronary
                                                                                        disease by 21%. These investigators
                                                                                        used sophisticated statistical modeling
                                                                                        to estimate that replacing a daily serv-
                                                                                        ing of margarine, butter, egg, cream,
                                                                                        or processed meats such as bacon,
                                                                                        with a similar amount of avocado was
                                                                                        associated with a 35 to 40% lower risk
                                                                                        of heart attack and stroke.
                                                                                          Around our household, if we run
                                                                                        out of avocados, somebody is mak-
                                                                                        ing a trip to the supermarket that day.
                                                                                        We usually buy a few that are ripe or

    B
                                                                                        nearly so, and several that will ripen
               ack in the 19th century, when   I’m not hungry for things like sweets    over the next few days.
               Johnny Appleseed was plant-     and starchy foods. Heck, at a Mexican       Avocados, besides being delectable,
               ing trees across the American   restaurant, I can almost make a meal     contain at least 20 essential vitamins
               wilderness and doctors made     out of a large order of guacamole.       and minerals. Because of its excep-
    house calls, an apple was considered a        Botanically speaking, the avocado     tional nutrient density, avocado, when
    superfood. In the 21st century, adding     is a fruit—a berry to be precise—        consumed on a regular basis, can
    avocado, instead of bacon, to your         a strange one that contains only         confer a host of health benefits, such
    daily routine is a smart and scrump-       one tiny gram of sugar and a single      as improved gut function and reduced
    tious way to boost your vitality. Joan     gigantic seed. The fruits that are best  risks of depression, heart disease, and
    and I are both huge fans of avocado,       for your health tend not to be very      cancer. Additionally, avocados are
    though when I titled this article “An      sweet, like avocados, tomatoes, and      very high in fiber—both soluble and
    Avocado a Day…” implying that a per-       berries, including blueberries (wild     insoluble. One avocado provides an
    son should eat a whole avocado each        ones are best), blackberries, strawber-  astounding 14 grams of dietary fiber,
    day, it triggered an argument that         ries, or raspberries. These nourishing   which is more than half the daily value
    nearly got me banished to the couch        fruits tend to be high in fiber, potassi-for a woman (21 to 25 grams per day)
    for a night. And Joan has a good           um, and antioxidants, yet low in sugar.  and over a third of the daily value for
    point—this is a high-fat food, with        A Harvard
    one average-sized avocado packing a        study
    whopping 320 to 350 calories. Expe-        published
    rienced registered dieticians like Joan
                                                                                   Whole
                                               in March
    say the recommended serving size is                                           Avocado   1/2 Avocado       1/3 Avocado
                                               2022 in the
    anywhere from one-third to one-half        Journal of            Calories 322              161               106
    of an avocado per day. I get away with     the Ameri-
    eating a whole avocado (or two) per                              Fat             29 g     14.5 g               10 g
                                               can Heart
    day, but I’m very active, getting about    Association           Protein           4g         2g              1.3 g
    15,000 steps per day, and I use celery     followed
    or carrot sticks rather than chips for                           Carbs           17 g       8.5 g               6g
                                               110,000
    dipping guacamole. Personally, I find      people for            Fiber           14 g         7g                5g
    that an avocado fills me up so that

6   Saint Luke’s Cardiovascular Consultants | From the Heart
HEART - Saint Luke's Health System
men (30 to 38 grams per day). Getting             Generous Support for the Haverty
lots of daily fiber is essential for keep-
ing your bowel habits regular, and the            Cardiometabolic Center of Excellence
high fiber also keeps levels of blood

                                                  M
sugar, cholesterol, and blood pressure
                                                          ichael and Marlys Haverty
in ideal ranges, all of which helps to
                                                          have recently donated
keep your heart youthful and strong.
                                                  another $1 million grant to sup-
   One whole avocado has about                    port the Michael & Marlys Haverty
20 grams of monounsaturated fat.                  Cardiometabolic Center (CMC) of
Many people are confused about                    Excellence at Saint Luke’s Mid-
how avocados can be so high in fat                America Heart Institute. About
and calories but still be good for you.           4 years ago, Michael and Marlys
Avocados are rich in monounsaturated              donated $1 million to launch the
fat, a heart-healthy fat that raises your         Haverty CMC, which is co-directed
HDL “good” cholesterol and lowers the             by Drs. Mikhail Kosiborod and
LDL “bad” cholesterol. Eating healthy             James O’Keefe. This is an entirely
fats in the form of extra-virgin olive oil,       novel care model that has now
nuts, seeds, and avocado lowers your              been demonstrated to substan-
risk of heart disease and metabolic               tially improve the quality of
syndrome (prediabetes), helps to burn             care and outcomes in high-risk
off belly fat (especially if you minimize         individuals with diabetes or pre-
the intake of sugar and starch), and              diabetes and heart disease. Using
keep you satiated longer after a meal.            a comprehensive, team-based,
   Avocado is also a great source of              and coordinated approach to               Marlys and Michael Haverty
vitamin C, which in combination with              prevention and game-changing              photo: Ingram’s Magazine
the monounsaturated fat and anti-                 therapies, the CMC model can
oxidants in this unique fruit, helps              positively impact all the key             ally. The non-for-profit organization,
to keep your skin soft, supple, and               cardiovascular risk factors (blood        called the Cardiometabolic Center
smooth. Avocado is also a superb                  glucose and cholesterol levels,           Alliance has been growing rapidly since
source of vitamins K, E, and B6, in               blood pressure, weight, insulin           its launch in 2020, and as of today, has
addition to riboflavin, niacin, folate,           resistance, and others), and most         12 participating healthcare systems
pantothenic acid, magnesium,                      importantly, help our patients feel       across the U.S. And work is ongoing to
and potassium. Half of an avocado                 better and live longer. The remark-       potentially expand this even to organi-
contains 488 mg of potassium, which               able success of the Haverty CMC           zations outside the United States.
is more than a full banana. And a high            is the model upon which the team            Patients trust us with their health
potassium diet is one of the simplest             led by Dr. Mikhail Kosiborod and          and their lives. Our ability to improve
and best strategies to lower your                 Melissa Magwire is building a na-         their future wellbeing and vitality
blood pressure without medications.               tional movement to transform the          through the Michael & Marlys Haverty
  Joan and I keep our guacamole                   quality of care in individuals with       CMC is a mission that we feel privi-
simple: mash up a few ripe avocados,              cardiometabolic disease nation-           leged to serve every day.
add fresh squeezed lemon juice and a
pinch of salt, and voila! It’s one of the
healthiest and best-tasting dips on the       other nutrients, but essentially devoid       pit removed. I squeeze a fresh lemon
planet. By the way, guacamole is like         of sodium. So even when you add a             into each of the half-sphere hollows,
many of the most nutritious foods out         dash of salt to improve taste, these          sprinkle in a pinch of sea salt, and then
there—you will eat more of it if you          naturally delicious foods are still low in    eat them with a spoon. On the other
feel free to salt to taste. Natural whole     sodium, and tend to keep your blood           hand, Joan and my kids prefer avo-
foods like nuts, vegetables, and fruits       pressure nice and low-normal.                 cado toast—another delicious way to
such as avocados and tomatoes are                One of my favorite breakfast items         enjoy this treasure from nature.
loaded with potassium and countless           is an avocado sliced in half with the

                                                                                           saintlukeskc.org/slcc |       816-931-1883   7
HEART - Saint Luke's Health System
H E AR T H E ALTHY LI FE ST Y LE

    Are You Getting Enough
    Magnesium?
    The Heart-Healthy Mineral
    James H. O’Keefe, MD, with Joan O’Keefe, RD

    A
               re you are having issues        magnesium’s evil twin. Excess salt           make the cells of the heart more irrita-
               with sleep, mood, muscle        intake increases blood pressure and          ble, which can increase risk for cardiac
               cramps, weakness, high          swelling, and also predisposes to            rhythm disturbances like ventricular
               blood pressure, skipped         stroke and heart failure. Unfortunately,     tachycardia (VT) and even sudden
    heart beats, or constipation? You          most people eat too much sodium              cardiac arrest. In fact, for some serious
    could be low in magnesium. About           and not enough magnesium. Oral               cardiac rhythm disorders, giving 2
    50 percent of Americans don’t              magnesium acts as a natural calcium          grams of intravenous magnesium can
    consume adequate amounts of this           channel blocker, increases nitric oxide,     be a life-saving intervention.
    beneficial mineral. A diet rich in mag-    improves endothelial dysfunction,               The daily allowance for magnesium
    nesium is high in nuts, seeds, legumes     and relaxes/dilates arteries and veins.      is about 300 to 350 mg for women
    (like beans and peanuts), spinach, and     All these actions of magnesium help          and 420 to 480 mg for men. American
    other leafy green vegetables. But even     to make it an effective therapy to           women consume an average about
    among my patients who eat a very           lower blood pressure and normalize           230 mg of magnesium per day and
    healthy diet, many of them seem to         left ventricular hypertrophy (abnor-         men about 300 mg per day. For com-
    feel better when I start them on a daily   mal thickening of the heart muscle),         parison, our hunter-gatherer ancestors
    magnesium supplement.                      particularly when done in conjunction        consumed about 600 mg of magne-
       Magnesium is an essential min-          with increasing intake of potassium          sium daily. For various reasons such as
    eral and electrolyte that serves over      and reducing sodium intake. Magne-           depleted soil from corporate farming
    300 functions, including catalyzing        sium supplementation increases the           and food processing that strips mag-
    enzymatic reactions responsible for        effectiveness of blood pressure lower-       nesium out of whole foods, it can be
    everything from creating DNA and           ing meds. The dose of magnesium              difficult to rely on diet alone for get-
    generating energy in your mitochon-        required to reduce blood pressure is         ting enough of this key mineral. Many
    dria to optimizing function of nerves      500 to 1000 mg/day.                          factors contribute to magnesium
    and muscles. It also plays a central          A deficiency of magnesium can             deficiency, including a diet based on
    role in hormonal balance; for instance,    also cause dysfunction of the lining         refined and processed foods, diseases
    magnesium affects estrogen levels          of the blood vessels, predisposing to        including kidney disease, gastrointes-
    and stress hormones and is needed          spasm of the arteries and abnormal           tinal disorders, cancer, medications
    to make thyroid hormone. Moreover,         blood clotting. Magnesium is essen-          (including diuretics, birth control pills,
    having low levels of magnesium             tial for activating the ion pump that        proton pump inhibitors), excess alco-
    increases your risk of weight gain,        maintains the gradient across the cell       hol, stress, frequent use of sauna and
    insulin resistance, high blood sugar,      membrane, keeping the sodium out of          steam baths, strenuous exercise, and
    type 2 diabetes, chronic inflammation,     the cell and the potassium inside the        vitamin D deficiency.
    and heart disease.                         cell. When magnesium levels are low,            People who aren’t getting enough
                                               it allows excess sodium and calcium          magnesium in their food tend to feel
    Magnesium and Heart Health                 to seep into the cells. This is one of the   better when they take a supplement.
      Magnesium is one of the most             ways in which low magnesium levels           I often prescribe anywhere from 300
    heart-friendly minerals. Sodium is

8   Saint Luke’s Cardiovascular Consultants | From the Heart
HEART - Saint Luke's Health System
H E AR T H E ALTHY LI FE ST Y LE

to 1000 mg of magnesium daily to               You should design your diet to          with constipation, as it will produce a
reduce muscle soreness or cramps,           contain plenty of magnesium. The           gentle laxative effect by pulling water
to facilitate sleep, and treat/prevent      foods highest in magnesium—nuts,           into the intestines to make your bowel
constipation. Magnesium is also being       seeds, leafy greens, yogurt, legumes,      movements softer and easier to pass.
studied for its potential benefits in the   and dark chocolate—also tend to be            Magnesium glycinate and
treatment of mild cognitive impair-         among the healthiest foods for many        magnesium taurate are my favorite
ment, where it may improve memory           other reasons. If you are experiencing     forms of supplemental magnesium.
and overall mental functioning.             muscle cramps, increasing intake of        These forms are absorbed in the gut
   Magnesium is one of the safest           magnesium and potassium from veg-          and pass the blood-brain barrier
and most effective sleep therapies.         etables, fruits, and legumes is often      where they interact with neurotrans-
I personally take two capsules of a         effective for relieving these and other    mitters (chemicals in your brain),
magnesium supplement just before            muscle-related symptoms.                   like serotonin and GABA, to boost
bedtime on most nights and find that           I have become personally enam-          mood and induce feelings of calm.
it produces a gentle calming effect         ored with taking a warm mineral bath       Additionally, magnesium glycinate
on my mood and helps me sleep               with magnesium salts to soothe sore        and taurate can be helpful for lower-
more deeply. Magnesium comes                muscles and joints. For thousands of       ing blood sugar levels and reducing
in many forms, but the best for             years, hot springs and mineral baths       overall inflammation in the body
improving sleep are magnesium               have been a popular way to relax,          and brain. These forms of magnesium
glycinate, magnesium taurate, or            de-stress, and improve overall health.     are less likely to produce a laxative
magnesium threonate.                        The Romans built spas by natural hot       effect but are often useful for issues
   Because magnesium citrate and            springs and relied upon the mineral        like anxiety, insomnia, chronic stress,
magnesium oxide are poorly absorbed         baths for their restorative and reju-      and inflammatory conditions. Some
forms of magnesium, they are good           venating effects. Magnesium is the         supplements provide a combination
for improving bowel function in             secret behind the healing powers           of different forms of magnesium
people who deal with constipation.          of a hot mineral spa or an Epsom           to provide a range of potential
Indeed, increasing your intakes of          salts bath. The dissolved magnesium        benefits for functioning of the brain,
water, magnesium, and dietary fiber         soaks into and rejuvenates your skin,      musculoskeletal, cardiovascular, gas-
like psyllium (Metamucil), is the best      muscles, and joints, and even gets         trointestinal, and immune systems.
strategy to avoid or treat constipa-        absorbed into your bloodstream,               Bottom line: magnesium is a
tion and improve bowel regularity.          helping to boost the levels of this        very safe mineral, and many people
We generally recommend that people          health-giving mineral.                     would benefit from increasing their
take about 200 to 400 mg daily of                                                      daily intake of it. Patients with serious
                                            Options in Magnesium
magnesium, but for more severe cases                                                   kidney disease are at risk for high
                                            Supplements
of constipation, you can use higher                                                    levels of magnesium if they take it
                                               We encourage a “food first” strategy
doses of magnesium, up to 800 or                                                       as a supplement. If you’re curious
                                            but acknowledge that many of our
1000 mg daily as needed.                                                               about this mineral, ask your health
                                            patients may need additional magne-
   Magnesium is important for activat-                                                 care provider if magnesium might
                                            sium in supplement form to feel and
ing vitamin D and has a protective role                                                be right for you.
                                            function best. You have many different
against oxidative stress. Furthermore,      formulations of magnesium to choose          Disclosure: Dr. O’Keefe is the
inadequate magnesium levels can             from. One of the most common is            founder and Chief Medical Officer for
lead to depressed immune responses,         magnesium oxide, which tends               CardioTabs, a supplement company.
whereas restoring normal magnesium          to be less well absorbed, and thus is
levels can improve immunity. Consid-        effective for relieving constipation.
ering that magnesium and vitamin D          Too high a dose of magnesium oxide
are important for immune function           can cause bloating and loose
and resilience against infection, a         stools or diarrhea. Magne-
deficiency in either of these nutrients     sium citrate is another
may contribute to severe illness with       great option for people
COVID infection.

                                                                                      saintlukeskc.org/slcc |     816-931-1883     9
HEART - Saint Luke's Health System
H E AR T H E ALTHY LI FE ST Y LE

     The Power of Continuous Glucose Monitoring:
     When We Know Better, We Do Better
     Mitchell Fagan, 4th year medical student

     P
               eople always ask me what the                                                ated with endothelial dysfunction.
               odd-looking patch on my arm                                                 Your endothelium is the critically
               is. When I respond that it’s a                                              important lining on the inside of your
               continuous glucose monitor                                                  blood vessels. When the endothelium
     (CGM), the next statement I usu-                                                      becomes dysfunctional, it markedly
     ally hear is, “I didn’t realize you were                                              increases risks for stroke and heart
     diabetic.” I don’t have diabetes, so why                                              attack. Further, higher glucose levels
     would a healthy medical student like                                                  after eating promote atherosclerosis—
     me would want to wear a CGM? Well,                                                    inflammation and hardening of your
     there are more than a few reasons.                                                    arteries. These changes compound
        More than half of Americans have                                                   over decades and you may only
     pre-diabetes or diabetes, and many                                                    discover your HbA1c is elevated after
     more have hyperinsulinemia—defined                                                    years of hyperinsulinemia and high
     as elevated blood levels of insulin.                                                  glucose variability. Most people are
     There is a well-studied connection                                                    surprised to discover that the sugar
     between hyperinsulinemia and the                                                      they consume is also transformed into
     risk of cardiovascular disease, cancer,    Mitchell Fagan                             fat called triglycerides and stored as
     and Alzheimer’s disease. Insulin is the                                               subcutaneous fat and belly fat. This is
     hormone released from your pancreas        insulin levels. Because insulin isn’t      why a low-carb diet and/or fasting are
     that lowers your blood sugar levels.       easily measured, the next best thing to    sure-fire strategies for lowering blood
     It also induces lipogenesis, which         monitor is glucose.                        triglyceride levels.
     is a fancy word for the process of            The metric we use to define diabe-         When I first inserted my glucose
     creating and storing fat. Too much         tes is the blood glucose level. While      monitor into my arm, I found that
     insulin, whether it’s injected as a        glucose levels exist on a spectrum, a      after a high-carb meal my glucose was
     drug or made by the person’s own           fasting glucose over 126 mg/dL or a        often spiking into the 160s mg/dL and
     pancreas, causes weight gain, insulin      hemoglobin A1c (HbA1c) over 6.5%           then crashing to the 50s mg/dL. In
     resistance, and other problems with        will land you a diagnosis of diabetes      medical jargon, this is hyperglycemia
     your metabolism. In other words, if        mellitus. You’ve probably had your         followed by a hypoglycemic episode.
     we want to achieve optimal health,         HbA1c tested at your doctor’s office,      Being on this blood glucose roller-
     we need to avoid chronically elevated      which is a three-month average of          coaster causes endothelial dysfunc-
                                                your glucose levels. However, HbA1c        tion and heart disease. I found a few
                                                doesn’t necessarily tell you if you have   simple tricks to help keep my blood
                                                high insulin levels. A more precise        glucose stable and prevent large
                                                and nuanced way to evaluate your           swings. Now, most of the time, I keep
                                                metabolic status is to wear a CGM and      my glucose within 70 to 100 mg/dL
                                                utilize your glucose levels as a proxy     with my postprandial (after consum-
                                                for insulin.                               ing a meal) glucose under 140 mg/dL,
                                                   Research suggests that higher           which is ideal.
                                                glucose variability and higher peak           I quickly discovered that the order
                                                glucose levels are associated with         in which I consume various foods dur-
                                                mortality and earlier onset of chronic     ing a meal is critically important. I eat
                                                diseases. High peak glucose levels         a lot of handmade pasta and I found
                                                have also been found to be associ-
                                                                                                           continued on page 13

10   Saint Luke’s Cardiovascular Consultants | From the Heart
H E AR T H E ALTHY LI FE ST Y LE

Gratitude is the Antidote to Envy                                                James H. O’Keefe, MD

W
                  hen Tom Brady and
                  the Buccaneers were
                  beaten in the NFL play-
                  offs last winter, many
people who don’t live in Tampa Bay
rejoiced. Schadenfreude is a German
word that means “finding joy in an-
other’s misfortune or struggle.” In fact,
it’s part of the fun of sports, where
you can indulge the dark side of these
natural human emotions without
feeling guilty. For those of us in Kansas
City, it’s been especially fun to be on
the Chiefs’ bandwagon in recent years.
Face it—we humans are instinctively
tribal animals, and there’s something       tions like one global interconnected        and you have a giant-screen TV to
that feels deeply gratifying when our       being. The secret of the phenomenal         watch a vast array of entertainment.
tribe vanquishes the competitors and        success of the Homo sapiens species is      You fly safely around the U.S. and the
victory is ours.                            that we all are like one giant organ-       world at near super-sonic speeds and
   A zero-sum game is the simple            ism. When a creative genius comes up        have access to life-saving drugs and
idea that when one person gains,            with a transformative invention, we all     procedures that our ancestors could
the other person must lose—like in          benefit from it. A brilliant anonymous      have not even imagined—our life ex-
boxing, poker, or war. For sure, there      person in the region that is now east-      pectancy has doubled in the last cen-
are times when we must adopt a dog-         ern Poland/western Ukraine dreamed          tury. And then there’s that all-knowing
eat-dog mentality, say when you’re          up the wheel about 5,500 years ago.         rectangular electronic device in your
trying to win the Superbowl, get into       Their oxen-pulled wheeled carts al-         pocket. Not one of these astounding
a prestigious school, compete for           lowed them to expand across Europe          technologies for improving the quality
a mate, or do almost anything that          and displace all the hunter-gatherers       and quantity of life that we now take
involves a lawyer.                          who were living there. As a result, to-     for granted was available to even the
   And life in America in the 21st          day you get to work on wheels, rather       wealthiest person in the world 100
century seems more hypercompeti-            than by foot.                               years ago. Yet, when we look around
tive than ever. Even so, most of the           Each one of us is analogous to a         and see someone who is doing a little
time we humans do best when we              single cell in the giant complex organ-     better than we are, it tends to cause
avoid the winner-take-all attitude and      ism that is life on Earth, and now the      angst.
look for ways to make life a win-win        internet is like our collective brain.         For some strange reason, there
proposition. Candice Millard, a widely      From that perspective, it’s humbling to     is a nefarious emotion called jealousy
acclaimed author who lives and works        imagine how hard it would be for any        deeply imbedded in the Homo sapiens’
in KC, wrote, “My advice (for what it’s     one of us to survive on our own—like        brain software. Oscar Wilde said,
worth) for success and happiness:           a single cell removed from the body, a      “Anybody can sympathize with the
Compete with yourself and root for          person left to fend for themself out in     sufferings of a friend, but it requires
everybody else.”                            the wild wouldn’t last long.                a very fine nature to sympathize with
   We are the omnipotent masters of            Objectively, nearly all of us are way    a friend’s success.” Humans are funny
the world, and our technological pow-       better off today than, say, even the        that way—someone we know has
er and collective intelligence are rising   king of England was in 1500. Your           some good luck or does something
exponentially. But this is only possible    house is comfortably climate con-           great, and often this negative
because the human race now func-            trolled no matter what the weather,
                                                                                                          continued on page 14

                                                                                       saintlukeskc.org/slcc |    816-931-1883    11
H E AR T H E ALTHY LI FE ST Y LE

                                                 The Fountain of Youth in a Patch
                                                 of Dirt: Let Nature Nurture You
                                                 James H. O’Keefe, MD

     I
          have a confession to make. All my      mon—good social support networks,            A recent study from Holland
          life I’ve had a penchant to develop    a physically active outdoor lifestyle,    required participants to do a stress-
          long-term relationships with           and lots of whole natural foods in        inducing task that made them feel
          plants. As a young teen, I began       their diet. Yet, they also share an-      harassed. Immediately afterwards
     working summers in a nursery up in          other surprising commonality—their        they were randomly assigned to either
     Grafton, North Dakota, and would            residents traditionally have gardened     read indoors for 30 minutes, or garden
     plant trees and shrubs around town.         throughout life, often into their 80s,    outdoors for 30 minutes. The group
     As I was growing up, my trees were          90s, and beyond.                          that read reported no improvement in
     too, and I took pride in seeing them                                                  their agitated mood, while those as-
     thrive. When we moved to KC, a friend       Gardening Therapy                         signed to gardening not only reduced
     gave us a small ficus tree as a house-        A host of studies have reported that    their levels of the stress hormone
     warming gift. Every fall I drag this tree   gardening and yardwork confer both        cortisol, they also noted improvement
     in from the patio, and we pick up its       physical and mental health benefits.      in their mood.
     leaves off the floor all winter. Then in    Tending to a yard and/or garden is an        An Australian study of people in
     spring, I drag it back outside again        enjoyable hobby that will naturally get   their 60s reported that the men and
     and nurse it back to health. Now it’s       you more outdoor physical activity,       women who gardened regularly had
     35 years old, 15 feet high, and weighs      which has been linked to improved         a 36% reduced risk of developing de-
     north of 250 pounds—it’s like deliver-      wellbeing and life expectancy. There is   mentia compared to a matched group
     ing a very large baby twice a year as I     abundant scientific evidence that gar-    of people who didn’t garden. There
     pull it through the sliding glass doors.    deners on average tend to live longer     is no cure-all to prevent aging, but
     We also have two shamrock plants            and be less stressed.                     for many people, gardening seems to
     that come in and out with the ficus.           Digging in the soil and getting your   improve both the quality and quantity
     These were gifts from two different         hands dirty bolsters your microbi-        of life as the decades roll by.
     patients/friends, both of whom have         ome—the trillions of friendly mi-
     been gone for many years. When I            crobes that reside on and inside you.     May The Forest Be with You
     water these lush shamrocks—one              Sunlight stimulates the exposed skin        A feeling of being emotionally
     with pink flowers and the other             to produce vitamin D, which is a key      connected to other people is impor-
     white—I always fondly remember              nutrient for strengthening bones and      tant for wellbeing, but so too is one’s
     my beloved friends. Around the yard         immune system. Being out in bright        connection to nature. A study from
     we have innumerable hostas that I           daylight also helps to synchronize        Harvard University found that people
     transported here after splitting them       your body’s internal clock, and that      who lived in a house surrounded
     off from hostas that still grow in the      improves the quality of your sleep at     by verdant greenery had better life
     yard of my childhood home, and              night. Sunshine boosts your brain’s       expectancy and reduced risks for
     others from hostas that grew in my          levels of serotonin—a neurotransmit-
     grandparents’ yard.                         ter that brightens mood, gives you
       Gardening and yardwork is a hobby         more energy, and keeps you calm,
     that cultivates wellbeing in plants and     focused, and optimistic. Exposing
     people. Dan Buettner has studied five       skin to sunlight also reduces
     cultures across the globe where resi-       blood pressure and dilates
     dents are famous for their longevity:       arteries by increasing
     Sardinia, Okinawa, Costa Rica, Icaria,      production of nitric oxide in
     and Loma Linda. These so-called Blue        the blood vessels, which in turn
     Zones share specific factors in com-        cuts risks of heart attack and stroke.

12   Saint Luke’s Cardiovascular Consultants | From the Heart
developing respiratory illnesses              The Power of Continuous Glucose Monitoring
and cancer.
   Doctors in Shetland, Scotland,             continued from page 10
routinely prescribe physical activity         that when I consume pasta before my         sense that fasting would be a simple
out in nature to reduce blood pressure        protein, vegetables (fiber), and fat, my    yet effective strategy to accomplish
and anxiety and improve wellbeing             glucose could go as high as 160 mg/         this. I also complete a 3-to-5-day
for people with conditions such as            dL. Yet, when I consume high-quality        water-only fast every few months and
diabetes, mental illness, stress, heart       protein like fish with a salad and then     my glucose usually stabilizes at 75 mg/
disease, and high blood pressure.             have pasta, my glucose will rarely go       dL and stays there consistently until I
Planting a garden and trees, even on          over 130 mg/dL (a massive improve-          break my fast.
a small yard in an urban setting, is an       ment!). While data suggests that a             Using the simple tactics described
easy and enjoyable way to integrate           pesco-Mediterranean diet is gener-          above, I have been able to lower my
some outdoor nature time into your            ally healthy, there is considerable         average glucose, glucose variability,
daily life.                                   variability in what the perfect diet is     postprandial glucose, and lipid levels.
   The practice of consuming an abun-         for an individual. Using a CGM is the       There is no substitute for high-quality
dance of fresh vegetables, ideally from       best option we have to offer for diet       data that can lead to data-driven
local gardens and markets, is central         personalization. Moreover, everyone         behavior change. Because there is no
to longevity. Even so, vegetables and         has a different carbohydrate tolerance,     one-size-fits-all diet plan, a CGM will
fruit that you grow yourself will make        and monitoring glucose will help you        help personalize your diet to your
you healthier even if the produce             titrate your carb intake for optimal        body. Although a CGM requires a phy-
never makes it to your own table. The         health. I have found the CGM to be the      sician’s prescription, it is simple and
famously therapeutic Mediterranean            best behavior modification tool ever        easy to attain. Using a GoodRx coupon
diet—the traditional eating style of          for customizing one’s diet and improv-      helps lower the price as well, to about
peasants from the shores of the Medi-         ing well-being.                             $70/month out-of-pocket cost (insur-
terranean Sea—is rich in home-grown              Exercise also plays an important role    ance generally won’t pay for CGM
vegetables, fruits, nuts, olives, and         in glucose stability. Your muscles are      unless you have diabetes). Although
grapes, from which they make olive oil        the main engine that burns sugar in         many feel that the diagnosis of their
and red wine.                                 your body. Therefore, the more muscle       chronic disease occurred
   If you are outside for more than 15        mass you have, the more glucose can         suddenly
or 20 minutes apply sunscreen to your         be burned for energy within those
exposed skin. However, modest doses           muscles. I found that prioritizing
of ultraviolet light from the sun may         strength training has helped me lower
improve some skin conditions like             my postprandial glucose. Walking
eczema and psoriasis. I personally take       before or after a meal also
advantage of the mood-brightening             helps prevent a glucose
effects of fresh air and sunshine             spike after eating. Another
by getting outside for at least two           strategy I rely upon to
walks daily.                                  keep my glucose and insulin
   A balanced life, like a chair, is stabi-   levels low is fasting. I follow
lized by four legs: social connection,        a time-restricted eating program,
wholesome diet, physical activity,            commonly referred to intermittent
and mental engagement. A person               fasting, which allows me to eat
needs to invest energy into all four of       between 4 to 6 hours each day, and          and without warning, the factors that
these fundamental factors to stay in          fast for the other 18 to 20 hours. This     predispose to these diseases manifest
optimal balance with their health and         strategy keeps my glucose and insulin       over many decades. Therefore, moni-
wellbeing. Gardening is a simple and          levels low for most of the day and          toring your glucose now may play a
enjoyable habit to cultivate that can         night. Since the goal is to keep insulin    critical role in preventing disease years
contribute to all four of these pillars       as low as possible, it intuitively makes    down the line.
of health.

                                                                                         saintlukeskc.org/slcc |    816-931-1883      13
Physician Leaders of                       Gratitude Is the Antidote to Envy
     Saint Luke’s                               continued from page 11

     Cardiovascular                             emotion called envy wells up, which         yourself of the positive aspects of
     Surgical Program                           is a disguised form of hostility based
                                                on one’s own insecurity. We each
                                                                                            your life, and it turns out to be a
                                                                                            very effective strategy to neutralize
                                                have only a few dozen people with           envy. Practicing gratitude has been
                            Dr. J.              whom we are personally connected.           shown to increase one’s sense of
                            Russell Davis       When something good happens to              wellbeing and improve heart health.
                            is a board-cer-     someone in our little circle of family/     Laura Redwine at the University of
                            tified general      friends/coworkers, it should be a           California, San Diego did a simple but
                            and thoracic        reason to celebrate their victory.          remarkable randomized-controlled
                            surgeon who            When I see someone accomplish-           trial (our gold-standard way to test
                            specializes in      ing their dreams, I remind myself to        a therapy) involving 70 individuals
                            cardiothoracic      be genuinely happy for them and             who had early-stage heart disease.
     and heart transplant surgery. He is        pass along hearty congratulations.          Half of them were asked to keep a
     the Chief of Cardiothoracic Surgery        My wife Joan says that when she sees        daily gratitude journal, whereas the
     at Saint Luke’s Hospital of Kansas         a person who is succeeding wildly,          control group were treated as usual.
     City. Dr. Davis is especially interested   she tells herself, “Don’t be envious,       The gratitude journal group were
     in developing blood conservation           be inspired.” Joseph Epstein said,          told, “For the next eight weeks you
     techniques and minimally invasive          “Of the seven deadly sins, only envy        will be asked to record 3 to 5 things
     valve procedures. Dr. Davis is proud       is no fun at all.” To refresh your mem-     for which you are grateful on a daily
     of the work of SLCC and the service        ory, during the 14th century Dante          basis. Think back over your day and
     they provide to the community. “We         Alighieri wrote a poem called Inferno,      include anything, however small or
     have a highly functioning group of         in which he listed the seven deadly         great, that was a source of gratitude
     surgeons that offer a large scope of       sins as lust, gluttony, sloth, greed,
     cardiac work,” he says. “Patients have     wrath, pride, and envy. Harboring
     no reason to leave Kansas City for         jealously is like holding a grudge.
     cardiothoracic surgery or care.”           Buddy Hackett joked, “I don’t carry a
                                                grudge. While you carry the grudge,
                            Dr. Karthik         the other guy is out dancing.”
                            Vamanan is a           Your brain and heart are linked by
                            board-certified     a high-bandwidth nerve connection
                            vascular            that instantaneously transmits your
                            surgeon who         emotions to your heart. Feelings of
                            specializes in      grief, anger, fear, and envy are toxic
                            treating a wide     to your heart. Of the cardiotoxic
                            range of vascu-     emotions, jealousy ought to be the
     lar disease processes. Dr. Vamanan         easiest to avoid. There is no personal
                                                                                            that day. Make the list personal, and
     serves as Surgical Director of the         upside to feelings of envy. In con-
                                                                                            try to think of different things each
     Saint Luke’s Vascular Program. Dr.         trast, when thankfulness, joy, or love
                                                                                            day.” Impressively, the gratitude
     Vamanan wanted to be a surgeon at          registers in your heart, these feelings
                                                                                            journaling lowered levels of harmful
     a very young age. After trying various     tend to lower blood pressure and im-
                                                                                            inflammation and improved heart
     fields, he found he loved vascular         prove your cardiac health. For many
                                                                                            rate variability—a measure of cardiac
     surgery and the patients he treated.       people, social media can stoke feel-
                                                                                            health and resilience.
     “Every time I see a patient in clinic,     ings of envy. If that’s the case for you,
     especially the ones that have been         it may be best to limit the time you          An old English proverb says, “Envy
     seeing me for 15 years or more and         spend on Facebook, Instagram, etc.          shoots at others and wounds itself.”
     whose lives we have significantly                                                      On the other hand, a grateful heart
                                                  Another great way to neutralize
     improved, I feel very fortunate and                                                    tends to attract blessings and culti-
                                                envy is to think grateful thoughts.
     privileged to do what I do.”                                                           vate wellbeing. You choose.
                                                Gratitude arises when you remind

14   Saint Luke’s Cardiovascular Consultants | From the Heart
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