Prevention is Possible: A Cardiologist's Blueprint for a Healthy Heart with Dr Tracy Paeschke

 

Introduction

Did you know heart disease kills more women than all forms of cancer combined? Yet 80-90% of heart disease is preventable. 🫀

In this eye-opening episode, board-certified cardiologist Dr. Tracy Paeschke shares why she switched from treating heart attacks to preventing them - and how you can protect yourself from cardiovascular disease.

After 25 years in cardiology, Dr. Paeschke reveals the surprising truth about inflammation, cholesterol, and how everyday choices impact your heart health. She breaks down exactly what to eat, how to move, and why sleep might be your heart's secret weapon.

Whether you're concerned about heart health or simply want to optimize your wellbeing, this conversation could literally save your life. Join us for a deep dive into evidence-based strategies for keeping your heart healthy for decades to come.

Core Ideas:
1. Prevention vs Crisis Care: 80-90% of heart disease is preventable through lifestyle choices, yet our healthcare system focuses primarily on treating acute events rather than preventing them.

2. The Dual Threat: Heart disease isn't just about cholesterol - it's the combination of cholesterol and inflammation that creates risk. This means a comprehensive approach to prevention must address both factors through diet, exercise, sleep, and stress management.

3. Plant-Based Priority: A whole food, plant-based diet forms the foundation of heart health, with reduced animal products showing significant benefits for cardiovascular health, including lower LDL cholesterol, triglycerides, and BMI.

Connect with Dr Tracy:

Website: https://hearthealth.care/

Mentioned in the Podcast

Want to be one of the 5 women to lose 12 lbs in 90 days in a healthy and sustainable way? Email the word "healthy" to [email protected]

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Transcription of Podcast

Dr Orlena (00:01.477)
Hello, hello, hello. Welcome to Fit and Fabulous with me, Dr. Olena. I'm super excited today. We have a fabulous guest who I'm just about to introduce. But the reason I'm super excited is because we are talking about heart health, which is a huge, interesting, amazing topic, which we're gonna dive into. So Dr. Tracy Paschke, welcome, welcome.

Tracy Paeschke (00:22.439)
Thank very much. Thanks for having me.

Dr Orlena (00:25.039)
My absolute pleasure. Thank you so much for spending a bit of time with us here. Do you wanna start just by introducing yourself and telling people a little bit about you?

Tracy Paeschke (00:33.277)
Sure. I'm a board certified cardiologist and I've been a cardiologist for over 25 years now, taking care of people when they have their heart attacks and heart failure and arrhythmias. And after doing that for a long time, I decided, you realize that there's a whole period of time before people have those acute catastrophic events where we could maybe have intervened.

and helped people to avoid those events in the first place. So that's what I decided a few years ago to pivot to purely preventive cardiology. So helping people prevent heart disease and reverse heart disease if they've already had an event or a problem, how do we keep them from having another event? So that's what I focus on now.

Dr Orlena (01:30.471)
Perfect, perfect. And I was just telling you before we started recording that I did pediatric medicine. So obviously not the same kind of cardiology as you do, but in the UK, when we train, we do have to do a little bit of adult medicine. And I remember being on those adult wards and obviously heart disease was a big thing that we saw along with other lifestyle illnesses and really just looking around and sometimes thinking.

I just wish I had a time machine and I could go back and teach people how to lead a healthy life and they wouldn't be here at all. And obviously this is what we're doing for those people who in 20 years time are not gonna have their heart attacks because they've listened to this podcast. So hopefully, hopefully. So do you wanna start just by...

Tracy Paeschke (02:12.337)
That's right. Hopefully, yes.

Dr Orlena (02:19.205)
telling us a little bit about the dire statistics of heart disease and what are some of the things that really contribute to heart disease and why it's so prevalent.

Tracy Paeschke (02:30.993)
Right, so heart disease is the number one killer of men and women across the world. And a lot of women don't realize that, but heart disease kills more women than all forms of cancer combined. yeah, so the statistics are striking, and they're not getting any better, right? So, in the United States, we spend more than any other country by far on healthcare.

Dr Orlena (02:43.364)
Wow.

Tracy Paeschke (03:00.763)
but we have the highest rates of chronic diseases. Our rates of heart disease haven't budged. So it's time, I think, to take a look at why that might be, right? So we're very good, especially in the US, right? So we're very good at taking care of people's heart attacks. It's not common that people die from heart attacks anymore, right? We rush them to the cath lab and...

and open their blocked arteries and hopefully they recover and do well. But again, it's that time before the heart attack. That's where we're not doing as well, right? And helping people prevent heart disease. And the American Heart Association estimates that 80 to 90 % of heart disease is preventable through lifestyle. Yeah, so.

So there's a lot that we can do, right? That's an empowering message that we have a lot of control in our hands.

Dr Orlena (04:05.253)
That's amazing, that's absolutely amazing. So what are some of the things that people can do? And you know, we talk about lifestyle and here's me telling people, eat healthily, exercise. What are some of the things that you advocate that really move the needle in terms of leading a heart healthy life?

Tracy Paeschke (04:07.389)
Mm-hmm.

Tracy Paeschke (04:23.003)
Yeah, so I use the Pillars of Lifestyle medicine to help guide me and the people I see. those are whole food plant based diet and regular movement, restorative sleep, avoiding risky substances, stress management and social connection.

So those are the pillars of lifestyle medicine and they're all very important in cardiovascular disease. Because one thing to remember is that heart disease is a combination, know, of course cholesterol is important. We've all mostly heard, most likely everyone's heard of that, right? That cholesterol is important contributor to plaque and heart disease. But the other important piece is inflammation. So it's both of those pieces, right? So this is...

This is how things like sleep and stress and those things contribute to heart disease through that inflammation piece, right? So we have to not only address cholesterol through diet and modifications there and sometimes medication if people need it, but also through lowering the inflammation in the body, stress reduction, seven to nine hours of restorative sleep.

exercise, all those things contribute and that's why I try to address all those things.

Dr Orlena (05:56.789)
And so what I'm hearing you say is that there's two big things really, are cholesterol and inflammation. So let's address cholesterol first. What leads to a buildup of cholesterol? And I know as well that not all cholesterol is considered bad cholesterol. So would you like to talk a little bit about what people call good cholesterol and bad cholesterol?

Tracy Paeschke (06:16.689)
Yeah, so the traditional sort of standard lipid panel looks at total cholesterol, HDL, the quote healthy cholesterol, LDL cholesterol and triglycerides. So in the U.S. anyway, that's the standard lipid panel. And that's really the only thing that most people ever get, right? Well, there are a couple of limitations to that standard lipid panel. One is it's like,

that LDLC, if you look on your report, it'll say LDLC. So that's a calculated concentration value. So it's not measuring LDL particles directly. So it's sort of an estimate actually. And then the, know, so that used to be, I mean, that's a good screening tool, but we know now that there are a lot of other

Lipa proteins that we need to be looking at so for instance European guidelines now recommend that everyone have a an Lp little a checked at least once in their lifetime so Lp little a is a more atherogenic more thrombogenic so called causes more plaque and blood clots then Than other lipa proteins, but we're missing that just if we just get the standard lipid panel

So I recommend, and it's, they think that the US guidelines are gonna update to recommend that as well. So, but again, if you don't specifically check an LP little a, you won't see it on your standard lipid panel. But it's estimated that one in five people have elevated LP little a, so it's an important marker. That's the one that's most genetically transmitted and less affected by lifestyle. And then the other,

Lipoprotein that's important to measure is APO-B. So APO-B is this little thing that's stuck to lipoproteins and it's actually a more accurate measurement of atherogenic particles. So a lot of experts recommend that that we check APO-B along with our standard lipid panel. So again, it's just giving us more more detailed information about these particles.

Dr Orlena (08:35.961)
Sorry.

Dr Orlena (08:42.373)
And so from a nutrition point of view, what can we do to make sure our cholesterol is in a healthy range?

Tracy Paeschke (08:49.713)
Well, so you know cholesterol, our body makes cholesterol, So cholesterol is important for cells, cell walls, and for hormone production. So we need cholesterol. But unfortunately most people have too much cholesterol, mainly based on our diet, right? So if you look at indigenous populations in the world that

hunter gatherer type population still around today, their LDL cholesterol are like 40 to 50. Babies have LDL cholesterol around 30. Average American has an LDL cholesterol around 120, 130.

Diet is a very important piece of this. Some of it's genetic, but again, not a lot of it. So a lot of it has to do with our diet. So the standard American diet, the SAD diet, right, contains a lot of animals and animal products, a lot of processed food, a lot of refined sugars and things that are...

contributing not only to heart disease but other things, right? Cancer risk and Alzheimer's. Because it's all related, right? So it's not like you have to follow a certain diet for your heart and then a certain diet for your brain and one to lower colon cancer risk. It's all the same. It's a good plant-based healthy diet.

Dr Orlena (10:35.65)
And I love a plant-based healthy diet and I love that you said a plant-based healthy diet. So one of the things I see is a lot of people really advocating eating meat. Can you talk a little bit about, well, do we need to cut out meat entirely? What role does meat play in terms of heart disease? And is it exclude meat entirely or are little bits of meat okay?

Tracy Paeschke (11:00.539)
Yeah, you know, I get that question a lot. And I don't... If you look at the data, I was just reviewing a study before we got on here. So it was a meta-analysis published recently in the American Journal of Preventive Cardiology. So they looked at studies and people who followed a vegan and vegetarian diet had a lower risk of cardiovascular disease.

from all these different studies that they looked at. And people who followed a vegan diet had lower LDL, lower triglycerides, lower BMI, so even better results with a vegan diet. you know, I think, right, because you know, some people, there's the, I don't know, the paleo diet, where they eat all the meat.

You hear different things. So I tell people to make the foundation of their diet plants, right? Because I think people hear a lot of conflicting things and even if you ask 10 cardiologists, you'll get 10 different answers about what to eat, really. So but from what I know, I know that

If you make your diet focused on whole foods and plant-based foods, you're gonna be healthier than you are otherwise, right? So, but I think it's important to meet people where they are, right? I mean, it's hard, it's hard for everyone to become a vegan tomorrow. So I try to tell people the benefits of

eating more plants and less animals or animal products. And then I try to give them different ways where they can transition to that. So maybe they can't do it overnight, but maybe they could start with a meatless Monday, right? So instead of making their tacos with ground beef, they do black beans and brown rice, right? So they use different ingredients. They start

Tracy Paeschke (13:22.877)
cooking with different recipes. Because our diet and food, it's a cultural thing, it's what we grew up eating. So it really takes an effort for a lot of people to make changes in this area. I mean, we just go to the grocery store and we get the same thing off the shelf that we've always gotten and we make the same recipes and it's the same, because that's the easy part.

So if we're making intentional changes in our diet, it takes some work, right? And so I tell people to just do it in steps. And what most people find is that they feel better if they eat less meat, right? And less processed foods and less restaurant, know, going out to eat if they cook at home, they have a lot of more control over what they're eating.

They're getting more fiber, so their bowel movements are more regular. They're just feeling better. And then once they see, I can use my favorite recipes, but just make substitutions, then it's not so overwhelming. So that's what I tell people to do. But I think, I'm vegan, personally, for multiple reasons, but certainly.

Dr Orlena (14:44.729)
I think that's very telling. think if you're vegan, it's very telling about what you think about meat. And what I'm really hearing is that for you, eating animal products is more of a risk than you want to take.

Tracy Paeschke (15:01.371)
Right. Yes, and it's for multiple reasons. I also do it for ethical reasons. But I think there's something about when you're eating, for instance, when you're vegan, you're just more aware of everything that you're putting in your body. And I think if you can, remember the old sayings, your body's a temple and

And I think we've gotten away from that, right? We just eat whatever's handy and whatever's on the shelf and whatever's quick. But if you are intentional about what you're eating and how you're caring for your body, I think you're gonna do better, right? Because you're more aware of what you're eating and drinking. You're more aware of what you're doing, how you're interacting in the world. And I think you'll be healthier in the long run for that mindful.

mindfulness piece of it.

Dr Orlena (16:02.245)
Perfect, perfect. And so the other piece of the puzzle was really inflammation. Do you want to talk a little bit about inflammation?

Tracy Paeschke (16:09.895)
Sure, so yeah, you know, this doesn't get as much sort of press as the cholesterol piece, But we've known for a long time that inflammation is a big part of cardiovascular disease. It's sort of like that, you know, that stereotypical type A businessman who is healthy and

and he's stressed and he works all the time and he has a heart attack, right? So that's sort of where that guy's heart attack comes from. Inflammation. So we know that, and some people actually talk about calling cardiovascular disease inflammation of the vascular system, right? So we have these blood vessels that supply blood to all parts of our body.

And normally a blood vessel is a nice, think of it as like a pipe that has no obstruction to flow. It's like a nice clean hose. And things run smoothly in there and they get the blood to all parts of the body so we can live. Well, then what happens is when we have inflammation in the body,

this sort of disrupts our endothelium, so the lining of our blood vessels makes them sort of sticky, think of it. And that's what can make the cholesterol plaque stick to the blood vessels and actually infiltrate the blood vessels. So go through that endothelial layer, that thin cell layer where plaque actually develops inside the blood vessel. And then that plaque can actually become inflamed.

So think of it like sort of a disruption in the blood flow, in the blood vessel that causes the inflammatory cells in the body to go there and try to get rid of it, right? Because it's not normal. And so what happens inside this plaque is you get inflammatory cells which are trying to...

Tracy Paeschke (18:22.609)
to fix the problem, but sometimes they cause more of a problem because if you get too many inflammatory cells, it can cause that plaque to rupture, which is what causes an acute event like a stroke or a heart attack. So this inflammation piece is very important. So again, that's things, and this explains why, because some people can have normal cholesterol or low cholesterol and have heart attacks still, right?

It's because they have this inflammatory piece that's not being addressed. So just like we check lipids and we check APOB and LP little a and these advanced lipids in my practice, we also check CRP. So that's a marker of inflammation, right? We know that people who have a CRP greater than two have increased risk of cardiovascular disease.

So it's very important to address that inflammation piece. And again, that's looking at things like stress, sleep, lack of exercise, because all those things lower inflammation in the body. And diet too plays a role there.

Dr Orlena (19:33.671)
And so people who've got a raised CRP for other reasons, like for example, they might have an autoimmune disease or something like that, some other chronic inflammatory process, is that gonna put their risk of heart disease up as well?

Tracy Paeschke (19:45.863)
Yes, we know that people with inflammatory arthritis who have those elevated CRPs have increased risk of cardiovascular disease.

Dr Orlena (19:55.439)
And so the reverse is if you have a normal CRP, you have a lower risk.

Tracy Paeschke (20:00.451)
Well, I don't know if that's been yeah, I don't know if that's been studied actually. But we knew there have been some clinical trials using. Inflammatory anti-inflammatory like the Cantos trial and there's another one even using Colchicine so to lower inflammation. Some of those.

Dr Orlena (20:02.573)
Not necessarily.

Tracy Paeschke (20:30.363)
Some of those studies show decreased cardiovascular risk, but in the general population, do people with lower CRP have lower risk? I don't know that data. Yeah.

Dr Orlena (20:41.861)
Okay, okay. And I think we can't complete our conversation about inflammation and heart disease without mentioning type 2 diabetes. I know that that is a big risk factor as well and that type 2 diabetes is obviously a lifestyle issue. Can we talk a little bit about diabetes and how that plays into heart disease?

Tracy Paeschke (21:03.099)
Yeah, so diabetes, you know, we've known this for a long time as well that diabetes is one of the strongest risk factors for developing cardiovascular disease. So having diabetes increases your risk of having a heart attack, having heart failure, so multiple increased risk of stroke, so multiple issues with this. So this goes back to

prevention, right? So there are different steps in prevention and I like to even focus on what we call primordial prevention. So because we all know that if you have diabetes, we want your blood sugar very well controlled to lower your cardiovascular risk, but really how do we help people not get diabetes in the first place, right? So that's the primordial prevention piece.

And that's through, again, through these good lifestyle means. again, a good whole food plant-based diet is gonna lower your risk of developing diabetes. It lowers your risk of metabolic syndrome. It improves your triglycerides. And again, it helps you lose weight sort of by default because you're not eating other stuff that makes people gain weight. Again, people who exercise have

lower risk of diabetes and better blood sugar control. So this primordial prevention is helping people before they even get things like diabetes and high blood pressure, right? So before they, because high blood pressure and diabetes are strong risk factors for heart disease, but again, how do we help people not even get those things, right?

Dr Orlena (22:58.597)
Perfect. And so in a nutshell, if you had to sum up your dietary recommendations briefly, what would you say?

Tracy Paeschke (23:07.535)
I would tell people to eat a whole food plant-based diet, less animals and animal products, and not just red meat, but any kind of meat, right? All meat has saturated fat, all meat disrupts your gut microbiome, and there's a huge connection between the gut and the heart and the gut and the brain.

and lots of data on how important the gut microbiome is in maintaining good health. So less animals or animal products, more fruits and vegetables, whole grains, leafy greens, beans, legumes, plants, nuts, seeds, all those should be the foundation. And I recommend

Dr. Greger's Daily Dozen. has an app. Dr. Michael Greger has an app that people can download. And it helps you keep track of all those recommended servings of all those good things every day. And trust me, if you eat 12 servings of all those things in that app, you won't be hungry. You'll feel great. You'll be healthy. And your gut will be better. Your brain will be better.

So that's what I recommend.

Dr Orlena (24:34.721)
And I don't have that book to hand, but from memory they were things like berries and like a handful of berries and I will have to get it. Yeah.

Tracy Paeschke (24:43.291)
Like three servings of beans. Yep. Yeah. Again, if you eat all that every day, in fact, it's hard for me to eat all that every day. It's just so filling, right? So, because people worry about that sometimes. I'm just going to be eating the salad if I, no, you you get your big bowl of leafy greens and you throw beans and whole grains in there and all your.

veggies and even some blueberries and you have a great meal and your stuff.

Dr Orlena (25:17.625)
Perfect, fabulous. so tick for nutrition. You mentioned exercise. Now I am somebody who loves exercise and I always say people should be doing exercise that lights them up. That's something that you enjoy, that really gives you energy. But also there are so many health benefits, including reducing heart disease. So what kind of exercise? Does it matter what kind of exercise we do? And how does it impact our risk of heart disease?

Tracy Paeschke (25:42.449)
Well, the American Heart Association recommends 150 minutes of moderate intensity aerobic exercise every week. So, you know, a nice brisk walk, a 30 minute walk most days of the week will get you there. And then of course women, you know, we need some resistance exercises for our bones and our muscles. So, right, again, with this, try to meet people where they're at, right? Because some people,

don't want to go to the gym or they don't like to go to the gym or the weather where they live doesn't allow them to get outside and go for a walk. So again, you have to kind of think about your situation and how you can work this in. The other thing to remember is that places like the Blue Zones, and I know you follow the Blue Zones and talk about that.

You know, they don't do regular scheduled exercise, but they do more everyday movement, right? So they're just active in their everyday life. Whereas we in modern society tend to sit at our computer for several hours a day. They're gardening, they're sweeping the floor, they're actually sitting on the floor and getting up from the floor, right? So it's just this more everyday movement. So I think it's all important.

But again, and and sometimes I think people think it's too cumbersome, right? I don't I don't want to go to the gym every day and you know, it's a pain to get there and I don't have I can't afford that and so start where you are and figure out what you can do in your life that works works with your lifestyle To be more again be more intentional about your movement

And sometimes, you know, I recommend people use some wearables because it helps you realize how much you're not moving, right? Sometimes, sometimes we think we're doing more than we are. They've studied this actually. People who keep a journal of their exercise are actually moving less than a wearable says. So it just helps you kind of see your baseline where you are and then how you can make some improvements in that.

Dr Orlena (27:46.319)
Yeah, definitely.

Tracy Paeschke (28:06.279)
So maybe it's a standing desk with a treadmill underneath, or maybe you take a break every hour and you do jumping jacks or some other form of calisthenics, or you vacuum your floor every day. Something to get you going, get you moving, is important.

Dr Orlena (28:26.821)
Perfect, perfect. And why does exercise have such a positive impact on our health?

Tracy Paeschke (28:35.685)
Well, multiple reasons, but for the heart, know, exercise lowers resting blood pressure. So when we're exercising, our blood pressure goes up a little bit, but then post exercise, it comes down to even lower than it was before we exercised.

Dr Orlena (28:52.293)
It's not the same for stress because I get so frustrated when I see people on Instagram going, you shouldn't do exercise because it stresses you. And I'm like, well, it stresses you for a little bit, but then overall.

Tracy Paeschke (29:00.153)
no.

Right, right. But again, know, just evolutionarily, right? If you think back, I mean, we were always moving. Thousands of years ago, we were constantly moving. So not moving is the stressful part. Because again, things like heart rate, you know, the more exercise we do, it lowers our resting heart rate over time, right? So your heart rate goes up.

of exercise, that's a normal response, but then it comes down post-exercise, and if we exercise over time and become more fit, cardiovascular fitness goes up, our resting heart rate goes down, and we know that that's healthier. Again, exercise helps our body use glucose, right? So it helps us avoid metabolic syndrome, which increases inflammation.

Avoid diabetes, which increases inflammation. So again, know, everything is connected, right?

Dr Orlena (30:09.893)
Yeah, absolutely. And for me, would say, I hear so many people say to me, I can't exercise because I'm too tired to exercise. And I get that when you get home from work and you're not in the habit of exercising, that's not when you want to be starting. But once you have exercise in your life, I think exercise really gives you energy. And I am somebody who always loves to exercise first thing in the morning. And if I don't exercise first thing in the morning, I feel myself drained and just...

I just don't have as much energy as I do when I have a consistent, good exercise routine and I do different, you know, I swim a lot, I cycle, I might do weights. But for me, starting the day with exercise, I just know I'm more productive, I feel so much better in myself and so many other people say the same to me, but there's this general idea that, I'm too tired to exercise. And I think...

that people have it the wrong way around, that actually exercises where you get your energy from.

Tracy Paeschke (31:09.211)
Right. Well, and right, like you said, it might be if you don't exercise in the morning, then you can find a thousand excuses not to do it later. Right. So again, I think this goes back to sort of sort of assessing your lifestyle. Right. And assessing your life. I mean, if you're if if. I think this goes back to the core of the issue is that people.

In our modern society, we don't take good care of ourselves, right? We don't take care of our physical and mental health, right? So, I mean, we put work first and family first and kids first and everything first, and then we're on the bottom of the list, right? And so it's hard to get to the bottom of the list in a day because we're busy doing those other things, work and school and family.

But if you flip it, right, if you put yourself at the top of the list and you figure out, do, take some time and do some introspection and figure out what you need to be healthy. Because again, that saying, you can't fill from an empty cup, right? So if you're not in good physical and mental health, you're not gonna be able to help your aging parents or your

young adult children, you're not going to be able to have top performance at work or you know your stress level be under control. So we have to figure out how to put ourselves at the top of the list, take good care of ourselves through all these things we're talking about. Well I feel better when I eat better but it's hard for me to eat better in my busy day. All right well then

you know, let's brainstorm some ways to help that, right? So maybe on Sunday you meal prep, you think about, plan your meals out for the whole week, or you just make a big pot of quinoa and roast a bunch of veggies and buy your tofu and then you can do all sorts of things through the week, right? You can have a salad one day or a bowl next week.

Tracy Paeschke (33:34.813)
day or a wrap the next day. Again, it takes some forethought and it takes some planning, but you have to figure out how to do it or maybe exercise. Maybe you realize, well, if I don't exercise in the morning, I'm not gonna do it. That's just what happens in my life. So then you figure out how to make it happen in the morning, right? How do you adjust the rest of your day to make it happen in the morning? And same thing with

Sleep, right? Sleep is huge. Sleep is one of the best ways to keep our brains healthy as we age. So it's good restorative sleep. It's sleeping seven to nine hours, go to bed at the same time every evening, wake up at the same time every morning. You start to wind down an hour or so before you wanna be asleep, so that's no screens, no movies, no drama, right? So we're trying to.

like when we teach our kids to how to sleep, right? We don't just throw them in the crib and see in the morning, right? We do a routine with them, a wind down, we read to them, we relax, we turn down the lights, we make the room cool and dark. So again, how do we work those things into our life where that becomes just normal, right?

Dr Orlena (36:16.576)
Can you hear me?

Tracy Paeschke (36:21.661)
I don't know what happened.

Tracy Paeschke (36:27.655)
Can you hear me now? I can't hear you.

Tracy Paeschke (36:53.159)
you

Tracy Paeschke (37:01.213)
You there?

Dr Orlena (37:08.059)
Can you hear me now?

Tracy Paeschke (37:08.701)
Yeah.

Dr Orlena (37:15.439)
If I turn this microphone in, we get a lot of feedback.

Dr Orlena (37:38.856)
Now, okay, I don't quite know what happened and I did realize that...

Tracy Paeschke (37:40.21)
Yeah.

Dr Orlena (37:51.348)
Somehow in here, I can hear you very faintly, but I think I can't turn it down anymore.

Dr Orlena (38:14.826)
Alright.

Dr Orlena (38:18.26)
So I think we should just carry on and I'm hoping that it won't pick it up on the recording or that the recording will be able to just take it out. But you stopped at a very good time.

Can you hear me now?

Tracy Paeschke (38:32.754)
So, I can. Can you hear me?

Dr Orlena (38:35.71)
Yeah. Let me just see if I can turn that down.

Tracy Paeschke (38:37.639)
So I didn't catch what you said after I did that spiel about taking better care of ourselves.

Dr Orlena (38:44.776)
Okay.

Dr Orlena (38:49.01)
I said, okay, so we've talked about nutrition and we've talked about sleep and we've talked about exercise. Is there anything else that you think is important for us to be doing so that we are confident we're leading a heart healthy lifestyle?

Tracy Paeschke (39:05.341)
Yeah, so the other piece that's important is avoiding risky substances, right? So that's things like no smoking. Most people know that by now that smoking is bad for your health in general, but especially heart health. Vaping is not any safer, so no vaping. Alcohol is a toxin to the heart. So, you know, there was this old advice that we used to hear that a glass or two of

wine is good for your heart. They reanalyze that data last year and actually that data is not very good. And we know that if people drink a lot of alcohol, it can actually weaken the heart muscle. So that's how much of a toxin it can be to the heart. Alcohol increases blood pressure, increases triglycerides. It's horrible for brain health. It's bad for the liver, obviously.

increases risk of certain cancers. So again, if we're talking about overall good health, I recommend that people don't drink any alcohol. Pardon.

Dr Orlena (40:14.021)
wow, yeah.

I said, yeah, no, absolutely. And in fact, I saw an article today which was talking about the alleged J-curve. So, you know, there was a little bit, if you drink in moderation, it's healthy for you. And they were like, no, there's no J-curve. It's just a straight line. The more you drink, the worse it is.

Tracy Paeschke (40:33.051)
Right, right. And then the latest is marijuana, right? Because in the US, I don't know in Europe, but in the US a lot of states have legalized marijuana for medical reasons or even recreational. But the data coming out on marijuana is probably not good for your heart, right? It increases arrhythmias, blood pressure.

And some studies have shown that it increases risk of heart attacks and strokes. So again, if we're trying to be as healthy as we can be until we know more, I do not recommend marijuana.

Dr Orlena (41:15.818)
Okay, and obviously trying to reduce our stress as much as possible. And then for females, there comes a question when we come to menopause about HRT being protective. Is that something that's true?

Tracy Paeschke (41:28.221)
This is a tough one, isn't it? So, you know, everybody probably is aware of the women's health study, I don't know, 20 years ago now, or more even, that showed women on hormone replacement therapy had increased risk of heart attacks and blood clots. So everybody stopped taking hormones. You know, they've re-looked at that as well and,

It may have to do more with timing of it and types of hormones.

So the data on this is again, I follow the American College of Cardiology and the Women's Menopause Society. I would actually edit that out. This one's a tough one. And someone told me recently that they changed the Menopause Society, changed the recommendations, but I haven't looked at that data.

Dr Orlena (42:39.242)
Well, in lifestyle, so what I've been seeing in lifestyle groups is people have been recommending HRT now and saying that actually it's so protective that like basically all females should go on it.

Tracy Paeschke (42:39.421)
Tracy Paeschke (42:51.153)
Well, right.

Again, that's not the American College of Cardiology. That's still not what they're saying. Here, we can look it up real quick. And the National Menopause Society. Let me look that.

Tracy Paeschke (43:20.497)
You know, and then there's this whole question of bioidentical hormones.

Dr Orlena (43:32.522)
And I thought the risk as well was, the risk was that it increased your risk of blood, of breast cancer, but actually breast cancer was, I mean, we can just cut this out if you want, because I talked to somebody about this. This is what this lady was saying. She was saying that the risk was for breast cancer, but actually women have a higher risk of heart disease and HRT is protective. So it was a bit counterproductive really to take people off the HRT.

Tracy Paeschke (43:58.813)
Yeah, but again, it had to do with timing of it. here's what the, the benefit, this is from the National American Menopause Society. And they're a pretty good reference. Benefit ratio is generally favorable for women under 60 or within 10 years of menopause onset. For women over 60 or more,

Dr Orlena (44:22.78)
Okay.

Tracy Paeschke (44:26.469)
or more than 10 years past menopause, the risk of coronary heart disease, stroke and other conditions may be greater. So again, I think it's a sort of a changing thing.

Tracy Paeschke (44:42.651)
See, here's a study from September 4th from the Menopause Society.

The Menopause Society 2022 Hormone Position Statement says women aged older than 65 can continue HRT with appropriate counseling and risk assessment. A new retrospective analysis demonstrates it's not unusual for women as old as age 80 to benefit from HRT. But benefit, you know, again, that's not specifically addressing the heart issue, right?

Dr Orlena (45:23.284)
Well, I tell you what, I'll just leave that first bit. I mean, I can either cut it out entirely or I can just leave that bit that you just, the first bit that you read. People under 60.

Tracy Paeschke (45:31.905)
Tracy Paeschke (45:36.579)
Yeah. So, yeah, I would just cut it out. I think we could say something more general because people do ask about this.

Dr Orlena (45:37.802)
Do you want me to just cut it out?

Dr Orlena (45:49.95)
Don't worry, let's cut it out because I'm talking to somebody else about HRT entirely and so...

Tracy Paeschke (45:56.111)
Yeah, it's just, but just FYI for your, so the American College of Cardiology, I listened to a webinar probably six months ago and their position still is don't, you know, we don't recommend it for cardiovascular protection.

But I think it is an evolving area that we just kind of have to stay up to date on.

Dr Orlena (46:25.394)
Okay, okay, okay, okay. So we've really covered how to live a healthy lifestyle, eat lots of plants, do some exercise, sleep well, try and reduce your stress and don't partake of toxic substances. Anything else that you want to add to this conversation?

Tracy Paeschke (46:47.377)
The other piece that's very important is the importance of social connection, right? And again, the Blue Zones are great example of this. So social connection, again, this is something that in our modern society we've gotten more away from, right? mean, families live all over and they're disconnected. A lot of people work from home. so even though they're engaging with people,

over video maybe, it's not the same as real life connection. So I think this is something that has to be again purposely done, cultivated to make sure that we are engaged with other humans. Humans are meant to be with other humans, so I think it's important that we make this an important part of our life.

And again, sometimes we have to be very intentional about it, right? Because it's easy. You're tired at the end of the day. It's easy to come home and sit on the couch and read your book. before you know it, you've gone several days without some connection. And not just connection, you know, the other part of it is connection with things we enjoy. So this is a good way to connect play because we know play is very important too. And as adults, we don't

play enough, right? Play is good for our brain. It lights up different parts of the brain. So maybe join a group that takes some art lessons or a book club in person. So something that combines not only social connection, so meeting new people, people of different ages, different backgrounds. That's important for us, but also maybe incorporating some of the play aspects.

meeting new people and learning something new, learning a new skill or a new way to take a yoga class with some new people. So those social connections are very important for our long health, a healthy lifespan, healthy health span, right?

Dr Orlena (49:04.564)
Perfect, perfect. Before we were recording, we were talking about how I think both of us have this message that we want to give people, which is it's kind of easy to lead a healthy lifestyle, but I think the opposite is kind of true as well in that...

It's very easy to just carry on and not really realize what a negative impact your life is having that we have these habits that seem kind of harmless one by one, like, you know, I might eat a little bit too much of my dessert or I might sit down and watch television after dinner because I'm busy and all of these things just feel, well, that's just my busy life. But when you add them all up,

actually you don't realize that you're putting yourself at a lot of risk. And that's a really dangerous place to be because people just don't realize that actually if I make these small changes, they may take a little bit of time to really, what I say, change from an acorn habit to an oak tree habit. But how do people know where they are in this?

this field and how do we help people really just understand that actually their health is in their hands and they have so much say in what's gonna happen down the line.

Tracy Paeschke (50:24.485)
Right. think one helpful way that people can start sort of getting a clear picture of this, because I agree. I think that's what happens, right? So we just do our normal stuff and our normal day and our normal life. And then you look up and it's 10 years later and the things that you were doing that you didn't think too much of 10 years ago. Well, now you have diabetes, right? So, so

I think a helpful way to think about it and to look at these habits is to keep a diary for a week, right, or two. Start with a week. Sort of like, you know, when you're spending too much money and you're trying to figure out where your money's going, how you keep a diary of everything you spend for a week, and then you owe $5 here, $3 there, $20 there, right, it adds up. So it's the same thing with our health. So that's a good analogy, right?

So get a notebook and just keep track of everything you do during the day, right? So how do you spend your time? What happens when you wake up? When you wake up in the morning, do you get on your phone and start scrolling social media? Or do you journal? Or do you get on the treadmill? Or do you meditate, right? So start keeping a journal, a diary of what you're doing every day. Keep a food log for a week. That's very...

eye-opening what you're actually eating during the day and then after you have that data for a week Sort of like your finances After you have a week's worth of data, you can start making tweaks in the data, right? So again, if you're gonna overhaul it, it's too much for the brain to do it all at once probably right so pick one thing so

So you keep your journal, your diary, and you see what your normal days look like. All right, well, now I've got my data. So this week I'm going to focus on my diet. What am I eating? So according to my journal, I'm eating meat at least once a day, most days twice a day. And I'm drinking two glasses of wine most every night.

Tracy Paeschke (52:44.743)
All right, I'm gonna tackle those two this week, right? So again, you do it in small bits. And then at the end of six months even, it doesn't matter. I mean, if you don't do anything, you're gonna be the same in six months anyway. So it doesn't matter how long it takes you, just start making these tiny changes and these tiny changes add up. So the acorn becomes an oak tree, right? So you make these changes in your life. So you tackle the diet piece.

the exercise piece, the stress management piece, cutting down on the risky behaviors and the social connection piece. And a year from now, if you do all those things and you tackle those things over the next year, you'll be much healthier in a year than you are today. I can guarantee it.

Dr Orlena (53:36.116)
Perfect, perfect. It's not about perfection, it's about progress. Perfect, perfect. Well, thank you so much for spending some time with us. It's been absolutely fabulous having you here. Would you like to tell people about your services and how you can help people?

Tracy Paeschke (53:52.701)
Sure, so I have a preventive cardiology practice in Colorado and I'm also licensed in seven other states. People can reach me at Dr. Tracy, so D-R-T-R-A-C-Y at hearthealth.care and then they can go to my website, www.hearthealth.care.

I have lot of downloads and resources on there. People can get some good information about preventing heart disease. Those are the best ways to reach me.

Dr Orlena (54:32.916)
Perfect, and I will leave those links in the show notes as well. So thank you, thank you so much. And any last words of wisdom?

Tracy Paeschke (54:40.655)
No, would just say, you know, good health is not unachievable and we should all try to pay more attention to our health so we can take good care of ourselves and live a long life in good health.

Dr Orlena (54:57.528)
Perfect.