BY LINDA EGENES
Living From Your Heart: Dr. Suzanne Steinbaum Shares Her Passion for Women’s Heart HealthI don’t know about you, but it seems to me that there is a shift in medicine taking place—not only because patients are demanding more natural, preventive approaches, but because a new generation of doctors is leading the way.No one embodies this new paradigm of medicine more than Suzanne Steinbaum in her incredibly readable book Dr. Suzanne Steinbaum’s Heart Book: Every Woman’s Guide to a Heart-Healthy Life. As an MD, a cardiologist, the Director of Women and Heart Disease at Lenox Hill Hospital in New York City, and a spokesperson for the American Heart Association’s Go Red Women campaign—Dr. Steinbaum has the credentials. And because she speaks with the authentic voice of experience about how to live a healthy life—in her book, on her website and blog, as a columnist for Huffington Post, as a featured guest on 20/20, Good Morning America, and major networks, and as the host of her TV show, Focus OnHealth—women are listening.I sincerely think all women can benefit from reading this book, not only because any woman could be at risk for heart disease, but also for the experience of having a doctor talk to you about your health in a way that lets you know she GETS it. She understands how a woman’s physiology is different from a man’s, how stress and emotions can affect us so deeply, how women are often misdiagnosed, how clinical trials don’t reflect the way women react to treatment because most trials are done on men.Dr. Steinbaum was first inspired to become a cardiologist when she was a student observing in an ER. “I was the kind of student who wrote down everything the doctor said,” she says. “A relatively young-looking women was wheeled in sweating and vomiting. The doctors diagnosed it as gastroenteritis and left her to wait in the corner. She ended up having a heart attack. I thought, ‘That’s what I am going to do, help women not get heart attacks.’”Dr. Steinbaum likes to point out that although heart disease is thought to be a men’s disease, it is actually the number one killer of women. And because the symptoms are different in women than in men, many doctors don’t recognize the early signs of heart disease—or even heart attacks—in women.

“There is an increased incidence of heart disease in women less than 55 years old,” she says. “Women need to start early to prevent it, especially if there is a family history.”

Living from Your Heart

Dr. Steinbaum calls her philosophy of preventing heart disease “living from your heart.” When she speaks, her belief in her patients’ ability to transform their lives is palpable.

“Doing what is best for you, eating what feels best for you, exercising, living with passion, living with purpose—that is what living from the heart is all about,” she says. “And ultimately that is the way to be the most heart healthy.”

She advises her patients, “Live from your heart and everything else will be fine.”

To help her patients become more aware of who they are and what they need to feel healthy, Dr. Steinbaum leads them in an exercise called “journaling their lives.”

“When people get caught in a minutia of their own existence, it’s unhealthy, so I try to get people to step outside of themselves and to understand what they are living for,” she says. “For instance, a woman might feel motivated to lose weight so she can enjoy playing with her grandchildren.”

Later on, feeling good itself is enough motivation to eat heart-healthy foods, Dr. Steinbaum explains. But in the beginning, it’s easier for people to tie their goal to something larger than themselves.

“‘I want to lose weight to look thinner’ is usually not enough motivation,” she says.

Preventing Stress from Turning Into A Heart Attack

When I ask her to name the three most important things women can do for their hearts, Dr. Steinbaum says, “I used to say ‘stop smoking’ but now most people are on that bandwagon. Now I’d say eating a really healthy diet, and exercising, which by far is the best medication. And having a way to reduce stress is essential.”

For reducing stress, Dr. Steinbaum recommends the Transcendental Meditation technique.

“I tell my patients that we have to treat this issue of overwhelming stress in their lives, and this is an evidence-based technique that has been shown to reduce blood pressure, heart attacks and strokes by 48 percent,” she says. “The American Heart Association recommends it as the most effective stress management tool for reducing hypertension.”

She says she first recommended TM because she was impressed with the research. “And then I learned it myself, and thought, ‘Oh this is huge! This is a really, really big deal, something that goes far beyond the medical benefits. One of my favorite things to say is that I never thought I could sit still that long, and now I look forward to it. I also say, ‘Trust me on this one, this is going to work.’”

As a working mother of an eight-year-old, Dr. Steinbaum herself is no stranger to the stress of modern life. “Every day I have about 25 million things to do, and before I did TM it sometimes was an overwhelming, daunting task,” she says. “Now that I do TM, it doesn’t mean I have less to do, it just means that it’s easier and calmer. There’s a lack of chaotic thought, and it’s almost like everything falls into place.”

TM offers a way out of the vicious cycle of stress, notes Dr. Steinbaum. “If you can meditate regularly and slow your breathing, slow your heart rate, dilate your arteries and decrease your blood pressure, it’s done!”

But just like exercise or changing your diet, you have to do it regularly to create the change in the physiology. “We know that the change is persistent if you make a regular, routine practice of it,” she says.

Dr. Steinbaum has clearly poured her heart into her mission of educating women and preventing heart disease, and it’s her biggest reward when she sees a patient living from her heart and feeling better.

“I feel lucky to be a part of that transformation,” she says. “It’s amazing. Simply amazing.”

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Linda Egenes writes about green and healthy living and is the author of six books, including Super Healthy Kids: A Parent’s Guide to Maharishi Ayurveda, co-authored with Kumuda Reddy, M.D.

(I originally wrote this post for Transcendental Meditation for Women Blog, April 30, 2015. Reprinted with permission.)

Five Top Heart Health Strategies According to Recent Research An Interview with Robert D. Brook, M.D.

BY LINDA EGENES

Robert Brook MDRobert D. Brook, M.D., is a cardiovascular medicine specialist and professor of medicine at the University of Michigan’s Division of Cardiovascular Medicine. He has authored over 150 peer-reviewed publications in the areas of vascular biology, atherosclerosis, cardiovascular imaging, hypertension, prevention, and hyperlipidemia. A pioneering researcher in the field of environmental cardiology, his research focuses on how air pollutants cause heart disease and trigger cardiovascular events.

Dr. Brook recently served as chair of “Beyond Medications and Diet—Alternative Approaches to Lowering Blood Pressure: A Scientific Statement From the American Heart Association (AHA),” which critically reviewed the evidence supporting the efficacy of alternative mechanisms to lower blood pressure.

The AHA report concluded that the Transcendental Meditation (TM®) technique lowers blood pressure and recommends that TM may be considered in clinical practice for the prevention and treatment of hypertension.

Here Dr. Brook discusses the TM technique and other ways to prevent heart disease.

Linda Egenes: Looking at the latest research, what are the five most important things we can do to protect our hearts?

Dr. Brook: First and foremost, start with a healthy diet and lifestyle. A number of research studies have been conducted on the Mediterranean diet, so it has the most scientific evidence as being protective to the heart.

Second, incorporate aerobic activity into your lifestyle. The usual recommendation is 150 minutes of moderate to intense aerobic activity a week. Both the Mediterranean diet and regular aerobic activity have been shown in numerous studies to be effective in both primary prevention (those without heart disease) and secondary prevention (those with established heart disease).

Third, control your cholesterol. While many people do this through diet and exercise, there is an overwhelming amount of evidence that statins are extremely effective in the prevention of heart attacks, and they also reduce the risk of stroke. So I don’t want to downplay how important statins are—they are a central aspect of cardiovascular prevention.

Fourth, control your blood pressure with lifestyle approaches and/or medications. Unfortunately, there are close to 80 million people in the United States with hypertension, and with 40% of the global population suffering from high blood pressure, it is the leading cause of mortality in the world.

Fifth, never start smoking and quit smoking if you do. The interesting fact is that within six months to two years after a person stops smoking, we see a dramatic reduction in the risk of heart attacks, even in people who had a prior heart attack. Avoid exposure to secondhand smoke as well.

Linda Egenes: What about air pollution?

Dr. Brook: In North America we are lucky to live with relatively low levels of air pollution. While it’s still a public health issue, there is good evidence that as air pollution levels have fallen following the Clean Air Act of the 1970s, there has been the expected reduction in the risk of cardiovascular disease. Nevertheless, air pollution still poses a risk to cardiovascular health even at today’s lower levels.

Unfortunately, in much of the rest of the world, things have gotten worse. Developing nations such as China, India, and the Middle East have now inherited our problem of coal power plants. On top of that, they are burning biomass (wood and crop residues) for cooking and heating inside their homes, so their pollution levels are ten times the levels of North America and Western Europe.

Particulates from biomass-burning indoors is not just the cause of asthma, cancer, and chronic lung disease, but it’s a serious problem for the heart as well. With hypertension number one, the number two killer of people in the world is smoking, and number three is indoor air pollution, which includes secondhand smoke. Outdoor air pollution is the ninth leading cause of death globally.

Linda Egenes: How did you become involved in the AHA committee?

Dr. Brook: A number of academic physicians and scientists from the United States were invited to an AHA conference in Beijing to discuss the epidemic of hypertension in developing nations. At that meeting there was great interest in nonpharmacologic ways to control blood pressure, due to the expense of pharmaceuticals, the cost to society, and the lack of availability in some countries. So the question emerged: are there research studies to support the use of nonpharmacologic methods to reduce hypertension—beyond the well-known and well-proven successes of diet changes, weight loss, and salt reduction?

I happened to be in the right place at the right time, and volunteered to take a leadership role. Nonpharmacologic approaches to hypertension are also of great personal interest since every day in my clinical practice someone asks, “Is there a way I can control my blood pressure without medication?”

Yet up until this time there had never been a critical review or statement by the AHA of nonpharmacologic, non-dietary ways to improve blood pressure. At the same time, there’s a lot of misinformation out there. So I knew this review would not only address the worldwide public health issues discussed at our meeting in China, but would also be a helpful resource for clinicians, healthcare providers, and patients in the US as well.

Linda Egenes: I understand it took about two years for the committee to analyze over 1000 studies and come up with recommendations?

Dr. Brook: Yes. All this information was available before, and we sifted through the large number of studies and publications across many disciplines. We also critically analyzed each alternative approach to fit the algorithm, the grading criteria, that the AHA has developed to give global recommendations based upon research.

This is a formal process in the AHA and other societies, forming a writing committee that analyzes the research, writes the paper, and takes it through multiple stages of approval, including independent peer review and a final endorsement by the AHA. It took two years from start to finish, which is pretty standard for a writing committee of this kind.

Linda Egenes: Can you talk about the research on the TM technique and how it stood up under review?

Dr. Brook: We chose several broad categories of nonpharmacologic, alternative approaches to hypertension, including exercise, device-guided approaches such as slow breathing and biofeedback, and stress reduction approaches such as meditation.

In the stress reduction category, we focused on the more recent studies of TM and other types of meditation such as mindfulness, contemplative meditation, and focused attention. Separate meta-analyses and our review of the research on TM showed a fairly clear overall reduction in blood pressure, about 4 or 5 mmHg systolic. Using the AHA’s metrics, we graded TM rather high based on the evidence.

TM stood alone amongst all of the meditation techniques because of the great deal of research and corroborative evidence. There were far more studies in relation to blood pressure and hypertension on TM as compared to other meditation techniques. There also were three meta-analyses (a collection of many studies) that corroborated that TM was effective for lowering blood pressure.

And in some of the more recent studies done by scientists such as Robert Schneider, M.D., at Maharishi University of Management and collaborators at the Medical College of Wisconsin, and other universities, it was shown that TM not only lowered blood pressure but also reduced cardiovascular disease itself.

Linda Egenes: TM was the only meditation technique recommended in this report by the AHA, correct?

Dr. Brook: Right. I would say there is a lack of compelling evidence that other types of meditation and stress reduction techniques, including yoga, are as effective in reducing blood pressure.

This doesn’t mean that they don’t reduce blood pressure. It’s just that there is a lack of compelling or good evidence that they do. In comparison, there is good evidence that TM is effective in modestly lowering blood pressure. That is why it stood out and was selected amongst the meditation techniques. I say this with the caveat that as better trials are done, it may well be that some of the other techniques will be found to be effective as well.

There were very few, if any, head-to-head studies that would compare the effectiveness of one type of meditation technique vs. another. In the future we’d like to be able to compare TM to other techniques to see if there is really something unique about TM as compared to other meditation approaches or general stress reduction or slow breathing. And, could this be done on a larger scale for a longer term?

Linda Egenes: I’m curious. Are you a practitioner of the TM technique?

Dr. Brook: No. I am not an advocate; I am not an activist. I’m not coming from the inside at all. This is an external review by somebody who is somewhat of a skeptic. The studies show what they show and the publications are what they are. I didn’t come in knowing anything about the TM technique.

Linda Egenes: Sometimes studies on the TM technique are criticized when the people who are doing the studies are TM meditators.

Dr. Brook: That is a generic criticism. Anybody doing the research is, of course, an insider in that area. No area of research is not subject to that same potential bias, so I reject that criticism as long as the researchers are ethical, and we assume that they are. I know that Dr. Robert Schneider and his collaborators have displayed the highest scientific integrity in their research at Maharishi University of Management, the University of Iowa College of Medicine, the Medical College of Georgia in Augusta, the Medical College of Wisconsin, and other research institutions.

Linda Egenes: Since doing this research, do you recommend TM to your patients?

Dr. Brook: Absolutely. A population-level reduction of 5 mmHg systolic is a profound 10-15% reduction in heart attacks, strokes, and cardiovascular disease. At the same time, I don’t want to overstate the effect of TM on blood pressure, which is modest but still helpful. It’s a good adjunct for people who have mild hypertension or upper-normal levels, what we call pre-hypertension. Or it can be helpful as a supplement for people who have intolerances to blood pressure medications, or who aren’t at goal on one or two medications and don’t want to add a third pill.

And I always tell Dr. Robert Schneider, “You can do TM for many other reasons, and if as an ancillary benefit it also helps to lower blood pressure, that’s a wonderful side effect.”

(I originally wrote this interview for Enlightenment Magazine, Issue number 20. Reprinted with permission.)