In a small town in North Carolina called Spring Hope lived a high school principal. He was evidently a great principal and the whole town loved him (granted the whole town wasn't really all that big). But he was big, weighing in at well over 200 pounds, a college football star long before anyone had ever heard of faceguards. He was smart, too. In his spare time, he read the dictionary - in Latin. This man was the only member of a farming family of seven children who went to college. On the farm, they knew how to raise strong younguns back then. He ate a lot of the time, mostly feeding off the farm's output: a hog, a few cattle, a variety of vegetables (with the exception of really weird ones like broccoli). He could afford to eat all the time, though, since he was so physically active. Legend has it that he single-handedly right-sided a car after it overturned during his honeymoon. His duties as principal weren't so physically strenuous, though, and his weight grew on him as continued to eat sausage with red-eye gravy every morning for breakfast. At about age 75, he was at least 40 pounds overweight, still gardening and reading Latin, but his body began to fail. His legs began to swell, he got out of breath easily, he had no energy. He died at age 80 - a victim of old age, most said. But he really died of heart disease, which is statistically the number one killer in the United States. This man was not just a statistic to me, though - he was my grandfather.

Heart disease or heart attacks, which in most cases are due to vascular disease, are a curoius thing. French people have less heart disease than we do. French people, however, eat everything in butter and they smoke all the time. Since high fat diets and smoking dramatically increase the risk of heart attacks and because French people die of heart attacks less frequently than we do, American scientists have termed this phenomenon the "French Paradox". There are several putative reasons for the French Paradox: the French eat less and drink more red wine, exercise more as a way of life, work less hard, worry about less, and possess different genes than we do. There is perhaps a lesson for us here, namely, eat less, drink more wine, work less, worry about less, exercise more often as a way of life, and breed with French people.

Odds are, though, that you will die of heart disease. Odds are that if you don't die of heart disease, then you will die of cancer, and that if you don't die of cancer, you'll die of stroke. But stroke, like heart attacks, is really just vascular disease. In other words, if your vessels are clogged pipes, then blood can't get through them and organs like your heart and brain die. Interestingly, the same behaviors that help prevent heart disease also help prevent cancer and strokes. A diet high in fiber, for instance, will likely reduce cholesterol levels, drop your weight, and thereby reduce your chances of heart disease, certain cancers, and stroke. The same could be said of exercise. This is particularly true of quitting smoking, which reduces your risk of lung cancer over 100 times, and drops your risk of clogged vessels considerably. But don't just take my word for it, ask your doctor.

In the late 1980s and early 1990s, the United States realized that it was paying too much to take care of sick people, which was due in part to too many specialists running around treating disease and not enough primary care docs preventing disease. So, there was a huge push towards preventative care. Now more than ever, doctors are in the position of trying to change their patients' behaviors to prevent disease. One way to improve your relationship with your doctor is to make her life easier. Read on to find out how to be proactive in keeping yourself healthy.

Lose weight, start exercising, eat less fat and cholesterol, and stop smoking. You can even take Vitamin E and C if you want to. The most frequent objection that I heard to such lifestyle changes is, "I don't have the time to do all those things." But really none of us have the time. When is the last time that anyone had any time? It's all a matter of priorities. So that's not a good excuse. Another common excuse is, "I just can't lose weight." But losing weight is simple: reduce the number of calories in and increase the number of calories burned. One solution is to cook your own meals (with low-fat, low-cholesterol foods), prepare less than you think you need, buy fewer processed foods, and stop eating when you are not hungry. Add half an hour of exercise daily, and you'll lose weight. Not only will you drop your blood levels of fat and cholesterol and thereby reduce the probability of clogging a vessel, but you will also reduce the number of vessels in your body since fat cells require huge amounts of vessels to keep them living, a phenomenon that puts considerable strain on the heart. As far as smoking goes, once you have really decided to quit, quitting becomes easier. And see your doctor, too, because she may be able to help.

A couple of other conditions deserve note here. Hypertension, discussed in the drug examples chapter, stretches and damages vessels, causing them to clog faster. The problem with hypertension is that people don't know that they have it. Even when they do know that they have it, there are no symptoms, so it is difficult to convince patients that they need to take medicine for it. The best thing that you can do if you have high blood pressure is learn how to take your own blood pressures, record your pressures and track them religiously, and do everything that you can (reduce salt intake, start exercising, take your meds) to drop your pressures to within normal limits. This will keep your vessels healthier. The same could be said about diabetes, a condition where sugar levels in your blood are too high. Elevated sugar levels in your blood vessels causes them to clog faster. Keeping your sugars down if you have diabetes is not only critical for cardiovascular reasons, but also for kidney reasons and infection reasons and vision reasons as well. And the best way to keep your sugars down is to keep track of where they are. Your doctor wants you to help her do this.

THE SILENT KILLER

High blood pressure, or hypertension, is known as the silent killer. Most hypertensive patients don't even know that they have the disease because there are no symptoms. But high blood pressures stretch and damage your vessels, which increases the likelihood that they will become clogged up. This, in turn, leads to heart attacks, strokes, and other vascular diseases. If you have hypertension, take your meds and track your own pressures.

TRANSIENT ATTACKS

The above patient is measuring her own carotid pulse. Some patients have clogged carotid arteries, which send blood to the brain when they are not clogged up. Every once in a while, when blood flow to the brain slows a bit due to congestion in the carotids or elsewhere, a mini-stroke occurs. This is called a Transient Ischemic Attack and often signals the need for improved diet, smoking cessation, or even surgery to clean out the carotids. Full-blown strokes result when blood flow to a certain part of the brain slows rapidly to a trickle, often resulting in paralysis, speech deficits, or unconsciousness.

Many, many Americans suffer from clogged vessels, which cause the number one killer, heart attacks, and the number three killer, strokes. We have clogged vessels because we are too fat, eat too much cholesterol, smoke too much, and don't exercise enough. Heart disease is a problem that every primary practice doctor faces. Most general medicine docs now spend a lot of their time, and rightly so, encouraging patients to act in a way that deters heart disease. This is especially true with patients who have high blood pressure or diabetes. Lending your doctor a hand in this endeavor will allow her to concentrate on other important aspects of your health.

Experiences, Comments, or Tips of your Own?