Dr. Steinbaum invites you to stay in touch with what's going on in her practice, media outreach, and up-to-date news and advances in the world of women's health and cardiology. She welcomes general comments below,or in the interest of your privacy, can be contacted via Ask Dr. Steinbaum
Heart to Heart
Truth Day Thursday – The New Food Pyramid: Choose My Plate
June 9th, 2011 · Comments Off
We have a new food pyramid, just released June 2nd! Except it isn’t really a pyramid, and the guidelines are a bit vague. It is about time that there be a movement towards a healthier way to eat in this country. With a 70% increase in obesity in the past decade, we need a call to action, even if one of the steps comes with changing the food pyramid into a food plate. The familiar food pyramid of decades past is now a round plate, with half of the plate divided into two sections of fruits and vegetables, equally distributed. The other half is divided into two sections, with grains being the larger portion and proteins the smaller. And there is a round cup in the upper right hand corner, representing dairy. Here are the guidelines – enjoy your food but eat less; avoid over-sized portions; make half of your plate fruits and vegetables; switch to fat free or low fat milk (1%); compare sodium in foods such as soups, breads, and frozen meals and pick the lowest; drink water over juices or sodas.
Is this plate going to truly change behavior? The truth is one of our issues is the plate. Plate sizes have grown over the years, whereby a salad plate is now the size of a dinner plate from 30 years ago, and dinner plates appear to be platters. In “all you can eat” restaurants, they allow the plate to be filled as many times as the diner wants to without restriction. It is always nice to see an awareness campaign, but I am a bit concerned that the mission will get lost in the circle. I almost wish our groundbreaking new food pyramid shape was more like a flow chart, reminding everyone that the healthiest diet is filled with vegetables, fruits, complex carbohydrates, lean meats, and fat free dairy, with a simple diagram depicting that health and weight is not just about the food you eat. In fact, it just might be time for our food pyramid to include exercise as well. Let’s all start getting healthy. Divide your plate up, and start using the guidelines. Let see what happens… you never know, it just might work!
Food plate image can be found here.
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Truth Day Thursday – What To Do Now: Niacin, and Trusting the Science
June 2nd, 2011 · Comments Off
In the world of cholesterol, this was a really challenging week. The New York Times broke the story about the role of Niacin in treating cholesterol, and its increased risk on the incidence of heart attacks and strokes. In a study of 3,500 patients over a five-year period of time, those patients with a history of cardiovascular disease, high triglycerides, and low HDL who were started on long-acting niacin had an increased risk of stroke and heart attack. The study was stopped early due to the lack of benefit of niacin in this population. I received tons of calls and emails from patients and others who are taking this medication, asking what they should do. The entire situation of fear was reminiscent of the de-randomization of the Women’s Health Initiative, when hormone replacement therapy was found to increase the incidence of heart disease, stroke, deep vein thrombosis, and breast cancer in some women.
I was finishing my fellowship training to become a cardiologist when I snuck into the back of the room the day that the women who participated in the Women’s Health Initiative trial on hormone replacement therapy were going to find out if they were receiving the actual treatment or the placebo. I sat in the back as I watched woman after woman be called in. Some returned to the room in tears, and others in shock. The doctor running the trial got up to speak in order to calm the women and explain to them that just because they took the hormones didn’t necessarily mean their lives were going to be cut short, or that they were going to get sick.
It was six months to a year later that the next level of the trial was released. It explained more, saying that women who took the hormones within the first 10 years of menopause actually did better, and had better outcomes. What I remember most about that experience was not the release of data itself, but the result of the release of that first level of data. The way that information was released was inflammatory and made women scared and upset, instead of explaining that there was more to be analyzed and more to learn, and that the findings needed to be further understood.
I felt the same fear, urgency, and frustration this week. Niacin, otherwise known as vitamin B3, has been a main part of lipid treatment to increase the HDL (good cholesterol) and lower the triglycerides. It does more than that, though, by changing particle sizes and reducing proteins that increase the risk of heart attack. But this other information wasn’t part of this trial. I will impatiently wait, along with my patients, for further data to be revealed. We can only go by the science, and use that information the best we can for treatment. As a doctor, I can say that sometimes trusting and understanding the science is one of the greatest challenges. For the doctor and the patient, occasionally we have to wait to find out together.
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Truth Day Thursday – Let’s Talk About… Sex
May 19th, 2011 · 1 response
I recently got a call asking me about the benefits of sex on the heart. It is easy to mention the obvious — the rewards of intimacy, stress reduction, cardiovascular conditioning, and the release of hormones to relax the arteries and promote happiness. All to say that sex is an important part of heart health. When I started digging deeper into the research out there, I found statistics showing that for men, engaging in sexual activity two times a week leads to a 45% reduction in heart disease. Recent studies have also shown that for men who do not participate in any activity or exercise, sexual intercourse can actually increase the risk of heart attacks by 2.7 times. That being said, with the ability to walk up a flight of stairs or do moderate exercise, you get the clearance to have sex. It decreases blood pressure and releases endorphins and oxytocin, which is the body’s intrinsic pain killer.
But not much research has been done on the effects of sex on the heart of women, or at least not the same way it has in men. Is the truth that women will not participate in the studies? Maybe they think it isn’t beneficial, or believe it is no one else’s business but their own? The Truth is that it is time to talk about it. We need to understand all aspects of life and how it affects a women’s heart. As the statistics for heart disease are increasing in women 35 to 54 years old, we need to really understand what makes a women’s heart tick.
Truth Day Thursday – It Might Be In My Mind
May 12th, 2011 · Comments Off
Sometimes we can’t figure out exactly how we feel. I don’t mean emotionally; I mean physically. We can’t tell if labored breathing is shortness of breath, or just trouble relaxing enough to take a deep breath in. We’re not sure if that ache is chest pain, or just indigestion. Often we don’t know if it is coming from our heads, our lungs, our muscles, or our mind, but we do know that SOMETHING is happening that doesn’t feel right. The truth is that sometimes we can’t explain how we feel, and therefore don’t know if that feeling is worth worrying about.
I am here to tell you that it doesn’t matter. If you think or believe that something is wrong, trust your intuition and get checked. The best case scenario is that you are fine, and it was all in your mind. Plus, now it has been checked and you know the truth. Never feel embarrassed to go into your doctor and express your concerns. Getting additional information is always helpful. Don’t feel that it is inappropriate to need answers to your questions. You might be wondering, “What’s my blood pressure and heart rate, and does my EKG look normal?” “Can I get my cholesterol and sugar checked, and evaluate my body mass index?” Know that family history of heart disease increases your risk. If you do have a family history, it is critical that you know your own risks.
Countless times in a week I hear my patients say, “It might be in my head.” So what? Sometimes you may be wrong, and it might be in your heart instead.
Photo by Okko Pyykkö can be found here.
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Happy Mother’s Day!
May 8th, 2011 · 1 response
I always felt like birthdays were just given to you. That every day was a birthday, so why exactly should we pick out that one day to celebrate? I want to be able to arbitrarily choose when I need a celebration, call it a birthday, and have everyone dote on me when I am feeling blue, as opposed to the day that I was actually born. Ok, you caught me… I hate my birthday. BUT, MOTHER’S DAY, now that is a whole different thing. You see, being a mother to me has always been the biggest gift. Having had my son as an “older mom” (I told you I don’t like birthdays, so please don’t ask), the fact that he was easily conceived and relatively easily delivered (again another story, for another time), I have always appreciated his life. After a year of his existence on the planet, I needed to celebrate that I DID IT! I had given birth to a child and nurtured his existence to one year of age, and to me, that was worth the biggest celebration in the world. My “baby” is now 4 ½ years old, and I am still celebrating. I celebrate my own efforts, and appreciate my own mother’s in a way I never did before. I applaud every single woman who wakes up to feed her child, or stays awake until that child gets home at night. I understand now what it feels like to have those extreme emotions when seeing your child walk for the first time, ride a bicycle, say the alphabet, say “mama”, or simply look you in the eye. Or what it feels like when they skin a knee, have their feelings hurt, want something they can’t have, or suffer from a belly ache or fever. There is nothing like the emotions that you feel when you are a mother. So, to my mother, who gets the brunt of my emotions and who is my biggest support, thank you. And, to all Mothers, with a capital “M” for the MOST MAGNIFICENT, may this day simply remind you that no matter what, it was all worth it.
Truth Day Thursday – The Wedding: The Most Perfect Diversion
May 5th, 2011 · 2 responses
Here’s the Truth. I made a big statement to everyone that I had no interest in watching the Royal Wedding. I was busy. There were “real” things going on in the world — issues to deal with, people’s hearts to take care of, and to put it simply, the Royal festivities were just not on the agenda. The night before, phone calls stopped early and emails ceased by 11pm. All so that those who needed to go to bed could wake up in time to watch William and Kate step onto the balcony, wave, and kiss. I wasn’t excited. The last wedding I couldn’t wait to watch on TV was that of Luke and Laura on General Hospital. Remember that one? But now, in the middle of the recession and all the people suffering in the world, I could not put any importance on this spectacle.
And so, that evening, enraptured by Anne Curry’s voice on Dateline, I watched and absorbed every little detail of that wedding. I couldn’t wait for their kiss, and the fact that there were TWO KISSES was bliss! I saw Pippa holding Kate’s train on that AMAZING dress and took a deep breath in as she walked down the aisle. I giggled at Harry’s menacing whispers to his brother, while William waited at the altar for his beautiful bride. And I cried as they sang the same hymn sung at the Prince’s beautiful mother’s funeral. I cried for their love; I cried for their mother who wasn’t there to see it; and I cried for the beauty of it all. I cried for our loss of innocence, and for the fact that I almost missed it all because I was too busy.
What is that old saying? “You can never go back”… well, on Friday night, like so many people fixated on the Duke and the Duchess, I went back in time to a simpler day. When some girls dreamed of being princesses, and some boys dreamed of being knights in shining armor. When we didn’t worry about the war, the economy, terrorism, tsunamis, and other natural disasters, with nearly the same fear. We all had the chance to forget, for just a little while.
Just three days later, after the memories of the wedding started to fade, we got to remember. In awe, I sat with the TV on, but this time glued to President Obama saying that the man who was responsible for changing our lives as we knew had been killed. For a moment I remembered everything, and then began to feel some relief and peace. Reality was back, with a slightly different face to it.
The wedding was truly extraordinary. It was so lovely taking time out to pause, to cry with abandonment for their joy, and to get lost in their moment. I am not ashamed to say it. I loved every minute of it. Some might say that it was the perfect stress management.
William and Kate image can be found here.
Truth Day Thursday – Yes, I Know It’s Friday
April 29th, 2011 · Comments Off
Earlier this week I joined Lou Ryan on the radio in San Diego through www.selfhelpworks.com, an amazing program that is empowering people to live healthier lives by losing weight, quitting smoking, stopping drinking, and reducing their addictive and unhealthy behaviors. Lou started his program in 1979 and has helped over 411,000 people since then. Together we discussed how best to change behaviors. We talked about how a person overcoming their ambivalence to exercise should spend the first week simply putting on their gym clothes. The second week they should drive to the gym, the third week walk in, and the fourth week actually get on the treadmill. It is the initial steps of withdrawal and denial that are the hardest, and by completely shifting perception, a person’s whole attitude can change. In fact, instead of thinking of it as “abstinence” it could be reframed as “health indulgence”, or from “exercise” to “heart vitality”. Changing behavior is not easy for any of us, which is often why making small changes is the most effective way to achieve lasting results. For example, getting rid of butter by substituting it with olive oil, or tossing the breakfast bagels and donuts for egg whites or multi-grain bread are simple ways to make big changes. Suddenly you are five pounds lighter and your cholesterol has lowered, without the pain and torture of a diet.
Today I called a patient to tell him the results of one of his tests, and before we hung up he made a comment about my Truth Day Thursday blog postings. I started laughing as I explained how difficult I find everything technology-oriented, and how I have been lucky enough to find a wonderful person to help me figure it all out! I explained that it is challenging to need that help, and so I have to schedule writing the blog in order for it to be complete by the deadline. This week was overbooked and filled with emergencies, and the time passed for me to have my Truth Day blog ready for my helper to post it, which is why it is now reaching you on Friday.
Behavioral change isn’t easy, whether it’s an exercise plan, dietary switches, or working on getting your blog in on time. At the end of the day, torturing yourself about your failures isn’t the most productive way to handle it. Tomorrow is always a new day. Hence the Truth Day Thursday blog on a Friday. Now, what change are you going to make for yourself today? Together let’s make a decision to change one behavior about ourselves that needs improving. What is yours and how are you going to do it? Me? My weekly blog will now be written on Sunday night before the hectic week begins… Let’s see how it goes!
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Truth Day Thursday – The Truth About Sugar
April 21st, 2011 · Comments Off
As the American Heart Association released their latest Scientific Statement on Triglycerides, I had to pause and start counting. These guidelines give recommendations on how to reduce triglycerides 20-50% by making lifestyle changes. The dietary recommendations include substituting saturated and trans fats for healthy fats, as well as reducing the amount of sugar in the diet to less than 5-10% per day (or about 100 calories for women and 150 calories for men). It states that fructose, whether it is from processed or naturally occurring in food, should be between 50 and 100 grams per day. Saturated fats should be less than 7% of the total cholesterol. And there should be no more than 36 ounces of sugar sweetened beverages per week in the diet. As I grabbed the 42 page document to review over breakfast, I was putting a bit of jelly on my multi-grain bread, and flipped over the label only to see that there are 13 grams of sugar in one tablespoon. I grabbed a teaspoon, and read while eating. I then cut up a honeydew melon, only to discover in the document that the fruits lower in fructose are cantaloupe, grapefruit, strawberries , peaches and bananas. I had some coffee and put agave in it. It occurred to me that this was also going to be a problem, and it was only 7:30 a.m. In the agave there is 16 grams of sugar in one tablespoon. And I am a HEALTHY eater! By noon, I started realizing that we are surrounded by sugar, and even the healthiest of us need to really pay attention. Before I even realized what I was doing, I was sucking on a lozenge from the health food store, also filled with sugar! By the time I was done with the document, my understanding of my “healthy” diet completely changed.
So, here’s the Truth, and trust me, I am right there with you. I am going to start to count every day, for at least the next three days, how much sugar I am eating per day. Let’s do this together. The goal is less than 100 grams per day, or about 100 calories, for women. Today I realized that when we don’t pay attention, sometimes we just don’t realize exactly what we are doing. It is simple — I will have almond butter on my bread and soy milk in my coffee. It is just a matter of knowing. Now, for the exercise…
Photo by Uwe Hermann can be found on Flickr here.
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Truth Day Thursday – A Lesson from Skiing: The National Disabled Veterans
April 14th, 2011 · 2 responses
For this Truth Day, I want to share with you an extraordinary experience. Grabbing the last moments of snow before Spring, I ventured out to Snowmass, Colorado to ski. This outdoor activity has been a part of my life since I was small, and enjoy it for my mind, body and spirit. I learned a lot about Spirit during this trip, as I met many of the veterans who were there as part of the National Disabled Veterans Winter Sports Clinic. The week was devoted to the men and women in the military who have lost their limbs, have suffered brain damage, or had neurologic trauma. Vice President Joe Biden spoke to the over 1,000 disabled veterans and volunteers, and spoke of the sacrifices that have been made by U.S. military veterans. Quoting the classic Steinbeck novel East of Eden, Biden said, “I suggest that you are, in Steinbeck’s words, the most tested, the most tested of all Americans.” He proceeded to talk about the families at home stating, “So many of your husbands and wives, and sons and daughters, mothers and fathers, stood and waited, and as a consequence served with you”.
Humbled, I watched these men regain a sense of themselves by learning to ski, some in chairs, some with amputated limbs, and some blind, all with volunteers guiding them to the moment when they felt a sense of the physical accomplishment that has been taken from them. The human spirit is so remarkable, and when truly tested can flourish in the fight to live. The lessons learned because of them are endless. Appreciate each day, keep the Spirit alive, and choose to Live each day with vigor and vitality.
I decided this year to get a helmet. The truth is, I never had one before. But I found the most perfect one… covered in hearts. As these brave men and women reminded me, do everything you can to cherish your life. Take steps to protect you and your family whenever you can, because if you have the choice to, empower yourself to have the ability to choose. Choose Health. Choose Life. Just Do Something!
Truth Day Thursday – The Million Women’s Heart Project
April 8th, 2011 · 2 responses
In the dim lighting of Donna Karan’s amazing Zen-like space in New York City, Urban Zen, we could hear on the speakers the beating of a heart and a clock ticking. The Million Women’s Heart Summit, lead by the non-for-profit, Events of the Heart, was center stage, hosting this amazing event. Events of the Heart started in 2007 and had a vision of educating Women about their hearts through performance. This concept of storytelling is one that, throughout the ages, has been used to educate, empower, and bring a community-at-large closer together. Women and men from all disciplines, races, denominations, ages and belief systems came together to talk about how to prevent the number one killer of all women, heart disease. We talked about prevention, under-diagnosis, mis-diagnosis, and the difficulties behind even trying to diagnose it at all. We put our minds, spirits, passions and hearts together to see if we could figure out the best call of action. As Donna Karan spoke of the collective consciousness and Tovah Feldshuh talked of her mother, who she had almost lost to heart disease, we all felt like we were in this performance together, in this one arena of hope to make a difference.
As Deborah Roberts from ABC moderated, Pat Mitchell told us that less than 17% of the world’s news is about women, and Dr. Charlotte Yeh from AARP explained to us that women are 47% less likely to use medical care for themselves. Diane Salvatore, editor-in-chief of Prevention Magazine, explained the need for women to understand their health risks by telling us about the 18 pages devoted to the issue in the February edition, while Joni Evans of www.wowOwow.com quoted Leslie Stahl to remind us of a woman’s essential need to collaborate, to discuss, to engage with one another.
Here’s the Truth:
- The incidence of heart disease has been increasing in women ages 35 to 55.
- Working overtime and long hours increases the risk of heart attack and stroke.
- 60% of Americans do no physical activity whatsoever.
- There has been a 70% increase in the incidence of obesity in the last decade.
- One-third of our children are obese.
Ten years ago, the American Heart Association started Go Red for Women when we just began to talk about educating women about their hearts, and whose red dresses have symbolized our mission. Yet, here we are today, telling the same story.
The Truth is we need a Call to Action. We need all people to understand. On this Truth Day, know that we all are part of the collective problem, and we need to talk about it to make a change, to make a difference, and to change the outcome of not only women’s lives, but the VITALITY of ALL lives. Even today, 50% of women are not aware of the signs and symptoms of heart disease, or do they even know what risk factors lead to heart disease.
The bottom line TRUTH…You Can Do Something. Tell 5 friends, AND help the mission by spreading the word. Text “HEART” to 48510 and you can help support us, by donating testing of one woman for heart disease. By doing that, you might have just help to save a life. Simply, tell those women you love that getting their blood pressure, sugar, and cholesterol checked may be the first steps in taking care of their heart. Then, tell them to tell 5 friends. Soon enough, every woman will know THE TRUTH.
