Transcription of Dr. Craig Brett for the show Maine Wellness 2015 #173
Dr. Belisle: Love Maine Radio is all about loving Maine but we can’t really think about loving Maine if we don’t think about loving ourselves and really our hearts. Today we have with us Dr. Craig Brett who is the head of cardiology at Mercy Hospital and he’s also the subject of an article that I wrote the wellness issue of Maine Magazine in January. Thanks so much for coming in and talking to us today.
Dr. Brett: Thank you Lisa.
Dr. Belisle: Craig you and I have some similar backgrounds. We both went to the University of Vermont. We both have children who are roughly the same age. I think you have 4.
Dr. Brett: That’s correct.
Dr. Belisle: I have only 3.
Dr. Brett: Okay.
Dr. Belisle: You beat me on that one.
Dr. Brett: That’s many still.
Dr. Belisle: Yeah it’s still more than none. You’re busy and you’ve been living this busy life for quite a while. The thing that strikes me most about you though is that even as a busy doctor, it’s been important for you to maintain balance. Let’s talk about that. Let’s talk about how it is that moving to Maine has enabled you to create a life that is one of balance between your personal life, your professional life, your family.
Dr. Brett: It sounds like you and I both know where to be. In the north east, both in Burlington at the University of Vermont and then in Portland, Maine I think we’ve been to the nicest places in the north east. I think we’re very fortunate that here in Maine we have the ability to have balance in our lives with the recreational opportunities that are so nearby. We’re in a fantastic medical community which was a major draw for me and to have those 2 things together and be able to access those with fairly low hassle what more could you ask for?
Dr. Belisle: You’re originally from New York.
Dr. Brett: That’s correct.
Dr. Belisle: When you decided that you were going to raise your children, what was it specifically about Maine and Cape Elizabeth where you live that caused you to understand that this would be a good place for children to grow up?
Dr. Brett: My children are having a very different upbringing that what I had in much of the urban environment in New York. Although it was a great childhood, I think what my kids have here is just wonderful. They get to see their parents enjoy recreational opportunities and stay healthy as a result. I think they’ve benefited from that. I think the ability to have good schools nearby and to be around people that are motivated and want to do things with their lives so it’s just been fantastic for them.
Dr. Belisle: Why did you choose to be a cardiologist?
Dr. Brett: I knew early on I wanted to go into medicine and the cardiology interest came later and I think it was looking around and realizing that the pace of change and the pace of scientific information and knowing the best way to treat patients was just moving really quickly in cardiology compared to some other fields.
Dr. Belisle: Unlike some people perhaps who are concerned about the pace of change, you are excited by it?
Dr. Brett: Yeah, not to pick on some of my other colleagues but I just … when I look back over my, it’s now almost 20 years of practice, the advances in cardiology are just incredible. I’m not sure all of our other specialties have seen those kind of advances. They’re not all technological advances although many of them are but just basic understanding of disease processes I think we’ve done pretty well in cardiology.
Dr. Belisle: It’s also fortunate or unfortunate I guess that heart disease is the leading killer of Americans, American adults. I think that more research has gone into it. We know that this is a huge problem. It’s not only killing people but it’s also causing morbidity and long-term problems after having heart attacks and strokes and other things related to the heart. This has been of benefit to your field.
Dr. Brett: You’re right Lisa. Absolutely. Heart disease and stroke are the number 1 killer of men and women and lead the next 3 causes combined. Everyday [inaudible 00:34:49] die of heart disease so it’s clearly a major health problem, incredibly expensive health problem and one that we’ve made some strides on. The mortality rates for heart disease is declining but it’s still a major problem.
Dr. Belisle: There are various risk factors for heart disease. One of them is smoking. I assume that that has the fact that our smoking rates have declined to a certain place and now they’ve kind of leveled off but I assume that that’s had a positive impact on heart disease.
Dr. Brett: No question. The understanding of the dangers of smoking and the impact that smoking has on the health of blood vessels that’s been appreciated now for several decades, has led to some decline in the instance of heart disease. Maine is still a pretty high smoking incidence state though so there’s still work to be done but it is better than it was in years passed.
Dr. Belisle: Is it true that with smoking once you stop, you actually can reverse some of the damage that tobacco and the products that are in cigarettes and tobacco products, that they … yeah you can reverse that damage?
Dr. Brett: No question. We have patients all the time who come in who have had a cardiac event or heart attack say and may be there were smokers, may be they had other risk factors that they had some control over like they were overweight or very sedentary. When people can change those, and not everybody does, but when they can, you can really see that the course of this disease changed.
Dr. Belisle: You just mentioned another couple of risk factors for heart disease and those would be weight and sedentary lifestyle. What do we know about those? This seems to be something we’re struggling actually more with. Whereas the smoking rates have declined, the obesity rates have risen.
Dr. Brett: You’re absolutely right and for a time there was some controversy about whether obesity was actually a cardiac risk factor. That seems to be pretty much put to bed. It is and the reason it is is not just the weight that someone is carrying around, the excess weight that somebody who is obese may be carrying around but the way that that extra weight changes their metabolism. People that are obese tend to have a very characteristic profile of elevation of a certain type of lipid or a fat that’s measured in the blood stream called triglycerides. That elevation also causes risk of plaque build up in arteries that obesity … the presence of obesity also results in body’s resistance to the effect of insulin which we know can create problems in blood vessels.
There’s something about the obese state that causes these other metabolic changes that we know are directly harmful to the blood vessels.
Dr. Belisle: You’re talking about insulin resistance and that’s really related to diabetes. There’s a lot of crossover between the people who have diabetes, people who are obese, people who have heart disease. Must be an interesting thing for you to try to tease out how to manage all of these problems that are co-existing.
Dr. Brett: There are several problems that coexist as you mentioned. Being obese, having high blood cholesterol particularly these triglycerides, the insulin resistance which is the precursor of diabetes, also when the blood pressure is elevated so it’s multiple things but it really all comes back to that profile and you can correct all of those things in many cases just with getting someone’s metabolic state back to normal by significant weight loss and exercise. It still remains the best medication we have so to speak.
Dr. Belisle: You’re a big fan of exercise. You yourself are a cyclist and you enjoy skate skiing on the river in Maine in the winters. What do you talk to your patients about? Because not everybody is going to be a cyclist. Not everybody is going to enjoy going out in the snow. What do you suggest?
Dr. Brett: It’s so much easier when you just love exercise and you miss it when you don’t get it. I think for those of us that have that temperament it’s easy. Unfortunately not everybody has that temperament and for so many of my patients exercise is just … it’s work. It’s a chore. They have to drag themselves to wherever they’re going to do their exercise activity. For those people it’s a real challenge and I think these are people that may be exercise and fitness and doing these types of things has never been a big part of their life or may be it was at one point and they just lost track of it and then got to physical state that didn’t allow it anymore. For those people it is a real challenge and I don’t think there’s an easy answer. People need to find something that they like to do that burns calories hopefully in an aerobic fashion.
There are some programs locally that try to promote that, that we direct our patients to but it is a key thing to find an activity, something that will allow some fitness and hopefully weight loss for these patients.
Dr. Belisle: It really is about enjoyment. You have to find something that you’ll like to do.
Dr. Brett: I think the people that are successful at it enjoy the activity. I think people that where it’s always a chore, always a drag, they may do it for a while. It doesn’t actually become a part of their life forever and so it’s an ongoing struggle but if they can find something they like to do and do it and they get better at it and their body feels better at a certain level of that activity then it’s easy.
Dr. Belisle: We’ve been talking about things that we enjoy when it comes to physical activity. What about when it comes to eating? That’s something … you’re a lipidologist. A lipidologist is somebody who specializes in the fats that are problematic for arteries. Food is an interesting question these days isn’t it?
Dr. Brett: It is and I think everybody out there, so many of my patients out there are confused because there’s so many conflicting recommendations that come out seemingly on a weekly basis about what’s good, what’s not good. Can you eat eggs? Can you eat margarine? Is butter actually better for you? It just goes on and on and on and can drive people nuts. A lot of it comes back to just common sense and some basic, eat certain food groups in moderation. We know for certain that saturated fats and trans fats are bad. These are fats that you see in animal meats predominantly so you keep that moderate. We know that whole grains, we know vegetables, we know most fruits on the other hand are good and will lower the bad levels of the cholesterol and in some cases raise the so called good level of cholesterol.
These are not ground-breaking recommendations. These really get back to a lot of common sense and I think nit-picking about certain elements [inaudible 00:42:13] should we always use olive oil or can we sometimes use [inaudible 00:42:19], I think that’s missing the big picture. A diet moderate in saturated fats and animal fats, predominantly consuming whole grains, fruits, vegetables, keeping animal protein … you don’t have to exclude it completely but keep it moderate and try to get fish once or twice a week. These are basic recommendations that are still the cornerstone of what we tell people.
Dr. Belisle: I have in my family people who are involved in the paleo diet which I think doesn’t have to be meat. It’s definitely low carb but I know that some people interpret the paleo diet as needing to be more meat because you’re cutting out carbs and need the calories as they want the protein load. How does that impact one’s heart? Do we know?
Dr. Brett: The low carbohydrate diets definitely have their place for the right people. People that need to lose weight, that have pre-diabetes, that have triglycerides elevation, they do need to be on a low carbohydrate diet and you do replace those calories typically with protein and not animal protein. It’s interesting most people when they do that diet, if you look at their lipid profiles, they improve. Their triglycerides come down. The bad cholesterol levels don’t change too much. They might change a little bit but not too much. There are some people though that have certain genetic predisposition relating to how their liver metabolizes cholesterol that when they go on one of these low-carbohydrate high-protein diets, their bad cholesterol goes crazy and it goes real high.
I think you can do these low-carbohydrate diets can be useful but they probably should be done under some supervision and making sure at some point a lipid profile, a cholesterol profile is checked if you’re going to do that.
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Dr. Belisle: There are people in Maine and this is something that you and I talk about in the article for Maine Magazine that are genetically predisposed to having high cholesterol levels and in fact we had Dr. [inaudible 00:45:42] who’s doing a study out of Lewiston and founded a small enclave of people who have particularly high cholesterol levels. Genetics are something that we can’t really avoid if we’re going to metabolize things differently, probably more poorly that is the way that it is.
Dr. Brett: It’s true. We live in a corner of the United States that has a real spike in the incidence of this genetic abnormality that goes by the abbreviation FH, for familial hypercholesterolemia and it’s often seen in a French-Canadian population and it’s a genetic abnormality where the liver doesn’t properly clear the bad cholesterol levels. This is an incredibly frustrating condition for people because I see people that look like you live fit, in the proper way, they eat right and yet their bad cholesterol level is 300. They are so frustrated that they can’t change that with diet and exercise because they’re already eating a prudent diet and exercising and it’s terrible for them. These are people that there’s just no other option besides medication unfortunately but it is treatable. We see a fair number of these people up here.
As a lipidologist practicing in Northern England is especially interesting. When I go to my meetings I think my colleagues are all jealous that I see all these FH patients that they don’t to the same incidence.
Dr. Belisle: We’ve talked about weight and we’ve talked about not smoking, we talked about diet, sedentary lifestyle. One thing we haven’t talked about is blood pressure and pulse which is as much of a risk factor. I want to talk about stress and the relationship between stress and blood pressure and pulse and just overall cardiac health and what we know about it now because I think that this shifting and it’s a special interest of yours.
Dr. Brett: I have been fascinated with the association between stress and heart disease for sometime and there are so many anecdotes but the clinical evidence is indisputable that people that are chronically stressed have a higher incidence of cardiac events than people who don’t record chronic stressors when you evaluate them. It’s not entirely clear if chronic stress actually causes atherosclerosis which is the name of the plaque buildup in the arteries that leads to heart attack or whether chronic stress just serves as a trigger in people who already have that problem. Just to review briefly the stress response, we humans benefit greatly from the ability to generate a stress response.
When you’re faced with a stressor, you have a very immediate activation of your autonomic nervous system. Your heart rate goes up, your blood pressure goes up, your blood sugar goes up ready for fast energy, your ability to clot increases so that if you get injured in a fight or flight of state, your can heal quicker. Your body shunts blood away from more elective functions like digestion and shunts blood over to the muscles, really activates the body for action and humans have evolved this has clearly been a beneficial response and in today’s society having that ability is helpful for certain situations.
The problem is when those systems are activated chronically like people who are just stressed out of their mind and those systems are just constantly activated, then we see people with problems of hypertension or high blood pressure, diabetes from the high blood sugar. The propensity to clot makes one more susceptible to having heart attack or stoke. We’re all familiar with the symptoms people can have when they’re chronically stressed. You know they’re jittery and they have some stomach upset, poor digestion, they’re little forgetful. They may be depressed. They’re just not, they’re not functioning like they should when these systems are chronically activated.
We see the end result of this as an increased incidence of cardiovascular events like heart attack and stroke. We joke at Mercy Cardiology where I am that we know which [inaudible 00:50:08] suffering the most stress because we’ll see clusters of employees coming from certain places and during certain times and say “Things must be really bad over there” but the association is really … it’s very clear between these chronic stressors and events. There does seem to be certain stressors that may be particularly bad. Marital discord is a terrible stressor. Chronic marital discord, it’s one that’s actually been studied where this activated system really can be shown and [inaudible 00:0:41] higher caretaker stress where you’re caring for somebody who may be ill or disabled, typically a loved one at home. That generates a tremendous chronic stress response that’s quite harmful or can be quite harmful.
Workplace stress has been studied as I mentioned and particularly folks who are high-demand low-control type situation at work, you can measure real profound activation of the chronic stress systems.
Dr. Belisle: In our conversation you mentioned how important you thought it was for us to work with our children in helping them to understand what stress was, what it did to them physically and how they could mitigate the impact of stress because some of the things that we’re asking them to do are probably more stressful than we realize and you used the example of kids sports. You said this is something that we’re supposed to have as a stress reliever and if you’re an adult may be running is a stress reliever but there’s so much pressure on kids in addition to doing their school work and their school play, and playing the piano, you add sports on top of it. You are actually layering stress onto this generation that’s coming up behind us.
Dr. Brett: I totally agree. I have teenagers, you have teenagers. Their world can be so stressful and I’m always amazed at how my kids have to face that and they’ve been okay doing that so far but I do worry about that and it is very ironic as you point out that sometimes it is sports which if done right are an incredibly experience for kids but unfortunately are not done right on many occasions and can be a tremendous stressor. The kids often times will need to do something completely not sports related to find their relaxation which is little ironic, kind of opposite from what their parents may have to do.
It gets back to them finding where they can center themselves, where they can get to place where they’re not surrounded by that stress and I think for every kid that’s different but there’s no question the world that they are in right now is not what we had and I worry about how those stressors starting at this age may accumulate into adulthood when they start becoming more at risk for the vascular problems that we see later in life.
Dr. Belisle: Knowing that we as parents need to find out own way of dealing with stress. May be if we’re doing yoga or meditation, or tai chi, or xi gong or something that kind of slows everything down for us, may be our children coming up behind us can see how that would be important to integrate into their owns lives.
Dr. Brett: I think that kind of modeling is really important and I’m not so good at advising people what they should do to find that type of state of relaxation because it’s so different for different people. I know some of my friends like to get on a motorcycle and go for a ride and other people will find it enormously stressful. Some people find yoga, other activities to be [inaudible 00:54:04] I think you just have to find it yourself. You have to find what centers you and what distracts you from all those external stressors that we know can be so detrimental when they’re chronic.
Dr. Belisle: Any final thoughts as we head into 2015 about staying healthy. I love the fact that you’re a preventive cardiologist rather than an interventional cardiologist. You’re trying to keep people in a good place before anything bad happens to their hearts. What are some suggestions that you have for people?
Dr. Brett: It’s amazing. I see people everyday over at Mercy who are otherwise like totally in control of their professional life and they feel like they are all together and yet they don’t know some of the basic numbers in terms of what their own risks may be for developing heart disease. I think if I could get one word of advice out there is know your numbers. Everybody as an adult should know what their lipid profile looks like whether they have this genetic abnormality that puts them at risk for vascular disease. You should know what your blood pressure is, know what your family history is, know if you have a profile that could really benefit from very aggressive preventive measures so that my interventional colleagues don’t need to ever see them.
That continually surprises me and then I think the other thing is as we’ve been talking about, I think people need to really understand what the effect of chronic stress is on their body. I think that’s a little under appreciated. Everybody knows stress is bad but I think the actual effects of that chronic activation and how that promotes clotting and how that may promote atherosclerosis I think if people know what that’s doing to their body then they may be a little bit more proactive and trying to manage that as best they can.
Dr. Belisle: Dr. Brett I really appreciate your coming in and talking to me today. Obviously there’s someone who cares for Maine hearts. It’s important that you’re out there doing the work that you do and Maine’s hearts healthy because we are Love Maine Radio so we need to have healthy hearts so that we can keep on loving our state. We’ve been speaking with Dr. Craig Brett who is a cardiologist, the head cardiologist at Mercy Hospital. Thanks so much for coming in and being a part of our show.
Dr. Brett: Thank you Lisa. Anytime.
Dr. Belisle: You’ve been listening to Love Maine Radio, show number 173, Maine Wellness 2015. Our guests have included Dr. Lisa Ryan and Dr. Craig Brett. For more information on our guests and extended interviews visit LoveMaineRadio.com or read about them in the January issue of Maine Magazine. Love Maine Radio is downloadable for free on iTunes. For a preview of each week’s show sign up for our e-newsletter and like our Love Maine Radio Facebook page. Follow me on Twitter as Dr. Lisa and see my running travel food and wellness photos as Bountiful One on Instagram. We love to hear from you so please let us know what you think of Love Maine Radio. We welcome your suggestions for future shows.
Also, let our sponsors know that you’ve heard about them here. We are privileged that they enable us to bring Love Maine Radio to you each week. This is Dr. Lisa Belisle. I hope that you have enjoyed our Maine Wellness 2015 show. Thank you for allowing me to be a part of your day. May you have a bountiful life.