You may not know you have Heart disease.

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I am a healthy 47 year old Physiotherapist who has been involved in Sports & Athletics most of my life.  In addition to my above average muscular build from decades of weight training,  I am also blessed with good genetics so I have never worried about my weight  one day of my life. I may be one of the last people you would suspect to have heart disease, but I do and following a series of events & tests in recent weeks lead to a confirmed diagnosis of Severe Coronary Artery Disease (CAD).

The image of the typical person with heart disease would be someone usually older in age, who is overweight, that is a smoker, and who perhaps has poor eating habits with lots of junk or fast food in their diet.   I do not fall into any of these categories but yet my coronary arteries were significantly blocked to nearly 95% on aspects of the left main artery.  How could this have happened?  We need to first explore the risk factors that place people at higher risk for CAD before we answer this question.

 

 

 

 

 

 

 

 

 

 

 

 

 

Risk Factors for Coronary Artery Disease (CAD)

1. Age – The average age for heart attacks in Canada is about 70years old but it can happen at any age and the risk increases with age for both men and women.

2. Smoking – It increases the formation of plaque in blood vessels. CAD occurs when arteries that carry blood to the heart muscles are narrowed by plaque or blocked by clots. Chemicals in cigarette smoke cause the blood to thicken and form clots inside veins and arteries.

 

3. High Blood Pressure – People with high blood pressure are more likely to develop coronary artery disease because high blood pressure puts added force against the artery walls. Over time, this extra pressure can damage the arteries, making them more vulnerable to the narrowing and plaque buildup associated with atherosclerosis (narrowing of the arterial walls).

4. Diabetes – High blood glucose from diabetes can damage your blood vessels and the nerves that control your heart and blood vessels. The longer you have diabetes, the higher the chances that you will develop CAD.

 

5. High Cholesterol – When there is too much cholesterol in the blood, it increases the plaque build-up in the arterial walls leading to narrowing and decreased or blocked blood flow to the heart.

LASTLY…

6. Family History – People with one or more close relatives who have or had early coronary artery disease (CAD) are at an increased risk for CAD. For men, early CAD is being diagnosed before age 55. For women, early CAD is being diagnosed before 65.   These people may have a genetic predisposition the above listed CAD risk factors such as high blood pressure (Hypertension), high blood sugar (Diabetes), or high cholesterol (Hyperlipidemia).

 

My Story and Insight.

So to answer the question of how I as a healthy 47 year old male was diagnosed with severe Coronary Artery Disease, it came down to one major risk factor that was out of my control, Family History.  While we can control or influence our CAD risk factors by eating well, exercising regularly and choosing not to smoke or to quit smoking, you cannot escape your genetic predisposition.  I was first diagnosed with Hyperlipidemia or High Cholesterol in my 20’s.    Although I knew that high cholesterol was a risk factor for plaque build-up in my arteries, I reassured myself that a single risk factor was not enough to lead to Heart Disease.    I studied health sciences, understood the human body fairly well and had read many published articles and studies on the promience of Heart Disease in our society.    I use to always say, ” There are no good studies on the risk of heart disease on 25 or 35 year old males with only high cholesterol and no other co-morbidities”.    And this was the case, so I used that to convince myself that I did not need to start Statin drugs (Cholesterol medication), and just continue with my healthy lifestyle choices…. and I would be OK, but I was not!

 

6 months ago…

I began to feel unwell or a sense that I was choking  or needed to stop to breath with a period of walking.  I also felt the need to burp so I assumed that it was a Gastrointestinal (GI) issue and began to self treat with medication to reduce stomach acid production.  It seemed to give me some relief, but my symptoms were still present with ups and downs week by week and day by day.

Early August…

I finally consulted with a Walk-in physician over the phone due to COVID protocols (did not have a family doctor) to get to the root of the problem.  This physician was thorough and sent me for bloodworks, H-Pylori testing, Echocardiogram and a Cardiac stress-test to determine if my issues were cardiac or gastrointestinal related.   My stress-test returned with some abnomal signs

 

 

 

 

 

 

 

 

Part 1: Brief History of Canada’s Food Guide (Toronto Dietitian)

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* Health Canada has provided a useful history of the food guides from 1942-1992 as well as the revisions made to the current 2007 guide, which I have briefly summarized here. If you are interested, I recommend reading the full articles, as they are very informative.
Canada’s Food Guide has always recognized the role nutrition has on the health of Canadians. From its inception during the war, when food rules were introduced to protect health in times of food scarcity and rations, to the modern day guidelines, where the shift has been to prevention of chronic disease due to excessive intake in our environment of food abundance. The food guide has undergone several revisions over time based on: new nutritional evidence, changes in the food supply, developments in food processing, consumer trends, and group consultations.

Canada’s Food Guide was first introduced during the war in July of 1942 when food rationing was the reality. Then known as “Canada’s Official Food Rules” these rules instructed Canadians on which “health-protective foods” to eat each day to promote the best possible health given the unstable times of war. Eventually times of scarcity led to a more consistent food supply and in 1961 the rules transitioned to guidelines. This change in language and food availability highlighted flexibility; Canadians were given choice in selecting foods to meet nutritional requirements rather than being told what to eat. The subsequent version included recommended number of servings for each food group building on this flexibility of choice. And, for the first time, food consumption patterns were available which were used, alongside a government report on health, to guide recommendations making the food guide more specific to the context of Canadians.

In 1982 there was shift in the messaging of the food guide resulting from an increased awareness of the association between diet and cardiovascular disease (CVD). To help Canadians make healthy choices, guiding statements were added. These statements included the importance of variety within each group, energy balance to prevent general overconsumption of calories compared to activity (leading to weight gain), and moderation to encourage limiting the consumption of sugar, salt, fat, and alcohol – foods known to increase risk of weight gain and CVD. The last update before our current food guide, completed in 1992, was informed by unprecedented research reviews, surveys, and various consultations. The result was Canada’s Food Guide to Healthy Eating. This guide introduced the visual representation of the rainbow illustrating appropriate proportions of intake from each food group (larger bands indicate to eat the most and the smaller bands to eat the least). This guide provided ranges of servings to account for differences in requirements based on age, body size, activity level, and whether the individual is male or female, pregnant or breast-feeding.

Finally, our current guide released in 2007 after 5 years of review using research, consumer trends, statistical mCanada' s Food Guide1odelling, average calorie recommendations, consultations, research regarding chronic disease prevention, and new nutritional guidelines. The 2007 guide was largely influenced by the newly released Dietary Reference Intakes (DRIs) from the Institute of Medicine completed in collaboration with Health Canada. The DRIs used the best evidencCanada' s Food Guide2e available to provide detailed information regarding the amount of each nutrient required to achieve ideal health and disease prevention amongst the statistical majority of healthy individuals. The DRIs also provide upper limits for some nutrients, to avoid the risk of harm associated with over consumption.

To ensure that Canada’s Food Guide achieved the recommendations of the DRIs food modelling was used. First, food groups were modelled to determine optimal proportions of servings within each group to achieve acceptable DRI levels. This was done in the context of total calorie goals to ensure nutrient goals were met without exceeding healthy calorie ranges. Many of the guiding statements in the food guide are the result of this modelling. For example, by recommending ½ of grain product servings to be whole grain the nutritional quality improved without going overboard on calories. Next, using eating patterns of Canadians, 500 model meals were created using the proportions of servings determined by the food group modelling. This was to ensure that the flexibility of choice afforded to Canadians within each food group would still provide the distribution of nutrients and calories recommended by the DRIs. Pretty cool eh? Lastly, this was completed for various age groups recognizing that nutritional needs differ based on life stage.

A quote from the paper describing the revision made to the 2007 guide sums the purpose of Canada’s Food Guide best, “The purpose of the Food Guide is to assist the people of Canada in making food choices that promote health and reduce the risk of nutrition-related chronic disease”. Over all Canada’s Food Guide is about flexibility, while considering the quality of intake. Think of the food you eat as the fuel for your body; you want to optimize your performance with the best quality fuel. Canada’s Food Guide was designed and tested to ensure the optimal supply of nutrients. Understanding why the food groups, and the nutrients they contain, are recommended is important for appreciating the value of this tool. My next post will discuss why the nutrients recommended by Canada’s Food Guide are important for our bodies and overall health.
Written by: Laurie Wybenga, RD (Toronto Dietitian)

(First published on www.lauriewybenganutrition.com – Feb. 19, 2015).

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* This blog post is not a substitute for medical advice. Different medical conditions require specific dietary interventions; always follow the advice of your Physician and/or Registered Dietitian.
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References:
• Health Canada. (2007). Canada’s Food Guides from 1942 to 1992. Food and Nutrition. Available from: http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/context/fg_history-histoire_ga-eng.php
• Otten, J.J., Pitzi Hellwig, J., & Meyers, L.D. (Eds.) (2006). Daily Recommended Intakes: The essential guide to nutrient requirements. Washington, DC: Institute of Medicine The National Academies Press. Available from: http://www.nap.edu/catalog/11537/dietary-reference-intakes-the-essential-guide-to-nutrient-requirements
• Katamay, S.W., Esslinger, K.A., Vigneault, M., Johnston, J.L., Junkins, B.A., Robbins L.G… Martineau, C. (2007). Eating Well with Canada’s Food Guide (2007): Development of the Food Intake Pattern. Nutrition Reviews; 65(4):155-166. Available from: http://www.hc-sc.gc.ca/fn-an/pubs/fd_int_pat-ela_mod_alim-eng.php

Canada’s Food Guide (Toronto Nutrition Counselling)

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Let’s Talk about Canada’s Food Guide

Canada' s Food Guide1

 

 

 

Welcome to my three part series on Eating Well with Canada’s Food Guide.
There has been debate questioning whether Canada’s Food Guide is out of date and out of touch with what Canadians eat, and the environment to which we live. Yet, Canada’s Food Guide remains the standard when discussing healthy eating; but do you know why? Perhaps you have heard wind of the debate and have wondered why the food guide remains so important.
To appreciate the importance of the food guide it is helpful to understand where it came from and why it was developed. Also, it is useful to know why there are 4 food groups and why each group has a role in helping us meet our nutritional needs. And lastly, to maximize the potential of the food guide, it is important to know what a serving actually is. * Here’s a hint – they aren’t as big as you think *
Over the next three posts I am going to break this topic down as follows:
1. The History of Canada’s Food Guide and its intended purpose for Canadians
2. The purpose of the 4 food groups and the key nutrients they contain
3. Clarifying the confusion about what a Canada’s Food Guide serving is
I hope you’ll join me as we discuss this important tool in promoting the nutritional health of Canadians.
Written by Laurie Wybenga, RD (Toronto)

(First published on www.lauriewybenganutrition.com – Feb. 18, 2015).  Toronto Nutrition Counselling

Meet your Health Goals for the New Year (Toronto Nutrition Counselling)

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Staying the Course on our Goals for 2015

Nutrition Goals

January is a hopeful time; the numerous obligations of December have passed and the dawn of the New Year provides time to stop, breathe, and reflect on what we want for the future. Our talk is filled with resolutions and plans for the coming year. January is a new beginning, a fresh start. 2014 is closed. 2015 awaits.

The New Year is often associated with the resolve to be healthier – to exercise more, to eat less or, to eat ‘better’. You hear stories about previously comfortable gym classes now bursting at the seams, and talk of giving up eating this or that. But now, a few weeks later, reality appears to set in. Life catches us. Classes are missed, ‘treats’ are eaten, and guilt for missteps lead to feelings of failure in our ability to achieve success. We lose sight of the goals we set for the year – goals just weeks ago we were so committed to.

Does this sound familiar? I know it does to me. This appears to be the natural ebb and flow of January. But it doesn’t have to be! It is possible to change this pattern. What it needs is a reimagining of our goals, goals that set us up for long-term success. The missing piece is sustainability.

As a Registered Dietitian I’ll focus on what I know best – nutrition. I am sure many of you have read or heard about the rise in global obesity, a trend that increases the risk of developing chronic diseases such as high blood pressure, heart disease, and diabetes amongst others(1). It is not surprising then that a common health goal for the year is to lose weight. The benefits of losing additional pounds are clear, however it may come as a surprise to learn that even modest weight loss can result in health benefits. Research indicates that, amongst adults whom are overweight or obese, weight loss of 5-10% of one’s current body weight is often associated with improvements in health markers (such as blood pressure, blood glucose, and cholesterol levels)(2). Putting this into perspective, for an individual that weighs 200 pounds, 5-10% weight loss is 10-20 pounds. Setting an initial goal to lose 10 pounds is realistic and attainable!

The next step is making change happen. Research suggests that one of the greatest challenges with weight loss is not always losing weight itself, but keeping those pounds off year after year(2). There are a lot of diets available offering quick fixes, but the truth is weight loss takes time and commitment. Making drastic changes to your diet that you cannot sustain will not be helpful in the long run. Therefore it is essential to start with small changes you can live with, changes that can be sustained. Healthy weight loss is considered to be 1-2 pounds per week; one pound, in terms of calories, means removing 500 calories from your day, 7 days a week. Going back to the previous example, losing 1-2 pounds per week means, with perseverance, one can achieve 5% weight loss in approximately 10 weeks, or 10% weight loss in about 20 weeks. This means that in 3-6 months you may start to experience positive changes to your health!

Food Plate ProportionsBut, what does 500 calories of small change look like? Well, 1 cup of apple juice has 120 calories, whereas 1 cup of apple slices has only 60 calories – could you make the switch? Reducing the amount of pasta or rice on your plate from 2 cups to 1 saves 230 and 250 calories respectively. A can of cola (355mL) carries 140 calories and a commercial chocolate chip muffin can have between 260-490 calories depending on its size(3). As a general rule, vegetables have fewer calories compared to other food groups; substituting more vegetables for less meat, pasta, or rice will also cut calories. This doesn’t mean you should remove other food groups – simply change the proportions. In practice we use “Space on your plate” dividing your plate as follows: ½ a plate for vegetables, ¼ plate grains or starch, ¼ plate for meat, legumes, or fish.

 

As we approach the 3-week post-new-year threshold, take time to reassess your goals, think about what is feasible for you and your lifestyle. Can the changes you want to make be sustained for the long-term? Look to the past, did you resolve to address your health last year? What worked? What didn’t? We learn from the past to inform the future. Look also to the future, why is this change important to you? What motivates you to make and sustain this change?

Remember you have 365 days to work at and build upon your goals. As much as the New Year motivates us to consider change, we are not tied to the specific resolutions we make; there is nothing to stop you from frequently modifying your goal to ensure continued success. Here’s to 2015 and making this the year we achieve our goals.

Written by: Laurie Wybenga, RD ( Toronto Nutrition Counselling )

* This blog post is not a substitute for medical advice. Different medical conditions require specific dietary interventions; always follow the advice of your physician and/or Registered Dietitian.

References
1. Health Canada. (2006). Obesity – It’s your health. Available from: http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/life-vie/obes-eng.php
2. CMAJ. (2007). 2006 Clinical practice guidelines on the management and prevention of obesity in children and adults. 176(Suppl 8): Online 1-117. Available from: http://www.cmaj.ca/content/suppl/2007/09/04/176.8.S1.DC1/obesity-lau-onlineNEW.pdf
3. Nutrition information from Canadian Nutrient File (2012). Available from: http://webprod3.hc-sc.gc.ca/cnf-fce/index-eng.jsp

How to treat a Frozen Shoulder diagnosis? ( MATRIX Toronto Physiotherapy)

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As a physiotherapist in practice in Toronto for over 12 years now at MATRIX Toronto Physiotherapy, I have seen patients suffer from all types of painful injuries and conditions. Many of these conditions are most painful in the early stages of occurrence (Acute Phase), and the pain associated with it diminishes over time through the rehab process. One of the conditions that break this typical pattern is a Frozen Shoulder or Adhesive Capsulitis. The joint capsule is a thin film or tissue that surrounds the entire shoulder joint that holds the structures together giving it increased stability.

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When the joint capsule becomes inflamed, the tissue can become thickened and shoulder movements become very stiff, painful, and restricted. Pain is the key word! There are many theories as to how this inflammation starts but the consensus is that it develops from a period of self-limiting behaviour due to pain or injury to the shoulder. Over a period of weeks to months, the capsule loses its ability to stretch and the shoulder becomes STUCK and very painful to move. I put it into perspective for my patients by explaining that if I put their unaffected “Normal” shoulder in a sling for two months, they would likely develop a frozen shoulder on that side even free of injury or pain to start with.

If a patient is given proper education to maintain full shoulder ROM through a series of rehab exercises early in their injury or pain episode, they would never develop a Frozen Shoulder. Much of the literature on Frozen shoulders describe various stages of recovery and extremely long expected recovery time-frames. I strongly believe these guidelines apply to those who are not actively and persistently working on their shoulder movements with a very aggressive physiotherapist. As long as all other pathologies have been ruled out such as tears, rips or fractures, the shoulder joint needs to be mobilized with a great deal of force in order to stretch out the ceased up joint capsule at ANY STAGE OF RECOVERY. The major issue is PAIN! Everyone’s tolerance to pain is different and the manual joint mobilization sessions are extremely painful, and many of the home exercises to promote more movement are extremely painful. The patient MUST understand and accept that the high degree of pain is a part of the recovery process and that no HARM is being done despite the agonizing pain. Over the years in my practice, the patients who have allowed me to deliver the high necessary force to stretch the capsule and who actively participate in their home-based exercises have all regained near full active shoulder range of motion in 2-4 months. This is not a judgement on those who just cannot tolerate the pain because pain is a very Primitive Response designed to help protect us.

I usually do not even begin to discuss strengthening exercises with my patients until they have regained at least 75% of their active ability to move their shoulder. I want my patients to focus their time and attention on getting more movement. Strengthening weakened muscles is an easy straight-forward process as long as they perform the prescribed strengthening exercises somewhat regularly.   The shoulder will get stronger as well just from increased ability to use it for daily activities once the functional range of motion has returned.

If you suspect you have a frozen shoulder or if you have been given such a diagnosis by your doctor, do not be discouraged. You should not scare yourself by the proposed extended recovery time-frame. You should actively seek an aggressive physiotherapist to work on the shoulder with you right away rather than believing that Frozen Shoulders get better on their own in 12-18 months as commonly stated in the literature.

Written by Aubrey So ( Matrix Toronto Physiotherapy )