What really causes heart disease

[librarising]

I LOVE reading.
Explains why I read War and Peace at an early age.
Explains my addiction to googling - everyone's got to have at least one addiction, right ?

But others prefer to watch or listen.
But the many links members provide usually require some reading.
A link to Dr Dwight Lundell's article on what really causes heart disease (warning : low carb material - warning) has been posted before on this Forum.
For those who prefer to listen, he's now been interviewed on The Livin' La Vida Low-Carb Show.

This guy is a cardiovascular and thoracic surgeon, so worth a listen :


http://www.thelivinlowcarbshow.com/show ... t-disease/

Geoff

 

[ButtterflyLady]

I think I've seen this clip before. Some of what he says is probably true for some people. Beyond that, I don't think any claim of what "really" causes a condition can ever be robust. There are always a range of factors that interplay.

My personal "soapbox" is that sleep apnoea causes much cardiac disease (and a bunch of other things). I'm able to quote robustly peer reviewed scholarly research to support that view (just not right now because I'm procrastinating here and should really be somewhere else).

Anyway thank you for taking the time to post the link. Debate and awareness-raising are good things.

 

[librarising]

I don't think any claim of what "really" causes a condition can ever be robust. There are always a range of factors that interplay.

He's not saying there's only one cause of heart disease.

Many think there is - artery-clogging cholesterol.
Why ? Because it's found at the site of the 'occurrence.'
Police are often found at traffic accidents.
Doctors and nurses round the bed of a dying patient.
None of these attendees caused the event to occur.

Dr Lundell is explaining why the cholesterol is found there. He's seen it often enough during his many operations.

As it's an audio clip, you won't have 'seen' it before (the interview was only posted yesterday), but you may well have heard or read his argument.

I'm not disagreeing with sleep apnoea as a cause, but many people are advised to make dietary changes to lower cholesterol levels, since this is seen as a harbinger of doom.
I simply no longer agree.
I posted for those who prefer to listen, rather than find the article online

Geoff

 

[ButtterflyLady]

All good points, I can't disagree with them. Because my own cholesterol/lipid results are still within the normal range, I haven't invested time in learning about lipids and their management. I have enough conditions to learn about that require my attention at the moment.

I've always been skeptical of advice to make lipid-targeted dietary changes, having gleaned from somewhere that diet can only make a minimal difference to the levels. The same goes for hypertension and salt intake - I did read widely on that subject when diagnosed years ago and I happily still add salt to my food without any noticeable ill effects. What shocks and disturbs me is knowing that some sleep medicine doctors still advise some patients just to lose weight rather than use CPAP therapy. That's a crime.

Sleep apnoea can cause congestive heart failure, pulmonary hypertension, and strokes. I'm not particularly aware of its effect on coronary arteries but it probably doesn't help in the mix. As a patient, it is so much easier to use CPAP than to change diet, lose weight, or take drugs. I end up needing to do those things anyway for the conditions that were caused or contributed to by sleep apnoea. Effective CPAP therapy for sleep apnoea promotes weight loss in obese patients, along with reducing hypertension and providing other benefits.

 

[ladybird64]

Sorry for going off topic but am curious about how CPAP promotes weightloss?

 

[ButtterflyLady]

IMHO it's very on-topic. Sleep apnoea means the person spends little time if any in restorative deep sleep, which in turn causes certain hormone levels to drop, which changes the metabolic balance, so that the next day the person both craves high calorie food and the body metabolises it faster, turning it into stored fat.

It's a viscious cycle because the extra torso fat weighs down on the lungs, suppressing breathing to a degree when we sleep on our back. This is why many of us sleep on our front or side.

Sleep apnoea occurs when the throat muscles relax during sleep (normal process) but it relaxes too much and the airway collapses and obstructs. after several seconds, the breathing centre in the brain detects the drop in oxygen, and wakes you up so that you gasp for air. You then fall back asleep and the cycle starts again. With severe SA, this happens every 60-90 seconds for the whole night.

CPAP provide continuous positive airway pressure via a sealed mask over the nose and/or mouth. This holds the airway open so the person can continue to breathe when asleep. Since they're no longer being woken up before they can reach deep sleep, their sleep returns to normal, and the hormone levels follow. The next day they don't crave bad food as much, and their metabolism is more normal.

If a patient has SA and CPAP works for them (there are many types of therapy and it needs tweaking like diabetes management does) then the excess weight they have from SA usually starts to fall off. Intentionally dieting helps too.

Where SA has led to obesity then insulin resistance then T2 diabetes, CPAP can reduce the obesity and thereby make diabetes control easier. Diabetes in itself is a preventable complication of sleep apnoea in people who are affected in this way.

I haven't gone into what SA does to the heart, lungs and brain, but another common complication is hypertension. This is why if someone has T2 diabetes, hypertension, and obesity (throw in depression too), they are very likely to have SA.

 

[Sid Bonkers]

Sleep apnoea occurs when the throat muscles relax during sleep (normal process) but it relaxes too much and the airway collapses and obstructs. after several seconds, the breathing centre in the brain detects the drop in oxygen, and wakes you up so that you gasp for air. You then fall back asleep and the cycle starts again. With severe SA, this happens every 60-90 seconds for the whole night.

Without seeming to be pedantic I always thought it was a build up of carbon monoxide in the throat that causes the gasping reflex not lack of oxygen I learned a lot of physiology to pass my advanced divers certificate and breathing or more importantly breath holding causes this reflex just as it occurs in sleep apnoea. Its the natural reflex that lets you to breath without mentally thinking about it.

Weight loss should cure sleep apnoea I was discharged from the sleep clinic after loosing weight just before a CPAP machine that had been ordered for me was ready to collect.

 

[smitha48]

Without seeming to be pedantic I always thought it was a build up of carbon monoxide in the throat that causes the gasping reflex not lack of oxygen!:

Sid surely you meant Carbon dioxide!! I to am a diving instructor. :thumbup:

tony

 

[Sid Bonkers]

Without seeming to be pedantic I always thought it was a build up of carbon monoxide in the throat that causes the gasping reflex not lack of oxygen!:

Sid surely you meant Carbon dioxide!! I to am a diving instructor. :thumbup:

tony

:lol: You are of course correct Tony, seems both CatLady and myself made an error

I always get carbon monoxide and carbon dioxide mixed up, no wonder my car runs so badly :lol:

 

[smitha48]

The difference is only a couple of letters.............and we can't breathe either of them

 

[ButtterflyLady]

Without seeming to be pedantic I always thought it was a build up of carbon monoxide in the throat that causes the gasping reflex not lack of oxygen!:

Sid surely you meant Carbon dioxide!! I to am a diving instructor. :thumbup:

tony

:lol: You are of course correct Tony, seems both CatLady and myself made an error

I always get carbon monoxide and carbon dioxide mixed up, no wonder my car runs so badly :lol:

Sid, I made no error. I don't mean to be discourteous to you, but you've made an assumption, before I had a chance to reply to your post. Your ideas about carbon dioxide in the airway itself might apply to diving, but they don't apply to sleep apnoea. Feel free to show me the published articles supporting your view, before you assume I made an error.

Weight loss does help some people with SA, but it is not the standard treatment, because CPAP is more effective and works straight away to reduce the risk of further damage to organ systems. There are plenty of non-overweight people who still have SA. I'm surprised you weren't put on CPAP at diagnosis - how long ago are we talking about? Just checking to make sure you've been given the correct info, that's all.

 

[ButtterflyLady]

Here's a link to some easy-to-read info about SA - the multimedia clip on this page explains it very well with a physiology-based approach. Cool graphics too.

http://www.resmed.com/au/patients_and_f ... c=patients

 

[Sid Bonkers]

Sid, I made no error. I don't mean to be discourteous to you, but you've made an assumption, before I had a chance to reply to your post. Your ideas about carbon dioxide in the airway itself might apply to diving, but they don't apply to sleep apnoea.

Here you are CatLady http://wiki.answers.com/Q/What_type_of_ ... us_breathe

I dont want to be drawn into an argument here but what I and smitha said is quite correct, when we breath out, carbon dioxide which has been dissolved into our blood as a waste product is carried to the lungs were it is liberated when we breath out, the tube that we breathe through that runs from our lungs to our mouths will usually contain some carbon dioxide as we never exhale all the air in our lungs, receptors monitor the level of CO2 building up and when they reach a certain level the reflex action for us to breath again is triggered.

Not only did I learn all this stuff with the BSAC when I was undertaking advanced diver training but more recently I was diagnosed with Brochiectasis, Emphysema and Asthma so I am pretty well read on all things respiratory.

As for sleep apnoea it is common in anyone with a neck size over 17" and as you rightly said is caused by the throat muscles relaxing to a point where it collapses and interrupts breathing, but the thing that starts you breathing again is the build up of CO2 as it is 'gassed off' into your lungs.

The reason I was not given a CPAP machine straight away on diagnosis was the fact that the NHS is skint/potless/bankrupt (chose your own noun) and I had to wait something like 6 months till the next financial year before the PCT bought in another batch of CPAP machines, by which time I had lost 4 stones in weight and my sleep apnoea had disappeared along with the weight so I was discharged by the sleep clinic.

 

[ButtterflyLady]

The build-up of gas is triggered in the brain from the bloodstream, not within the airway. The airway's receptors are not sufficient to do this on their own.

I've no interest in debating details with anyone, when it's more important that this killer disease is diagnosed and treated in the many people who are most at risk. The IDF has a campaign trying to get SA and diabetes diagnosed by doctors who are treating one of them and not (yet) the other. Worth reading about on their website.

Unless you had a repeat polysomnography (overnight sleep study) then how can you be sure you are apnoea-free. It could come back as you age, regardless of your weight. As a disease it's way more complex than you might think.

My national health system also treats SA patients very badly, so I paid for my machine, which cost less than hire-purchasing a TV.

Anyway, not interested in debating with someone who makes assumptions, doesn't apologise, and describes contested scientific theories as if they are fact. Good day to you.

 

[ladybird64]

Evening CatLady

I have had a look at the IDF website and to be truthful it made my head ache!

I have been looking at this http://www.idf.org/webdata/docs/IDF%20c ... _final.doc

and also this http://www.idf.org/sleep-apnoea-and-type-2-diabetes and it appears that this studies are a bit "all over the place", there seems to be dabte about how much ill effect there really is?

Is there a link you can provide (not the Resmed one) that can give more details of how this problem is a killer? How many people die as a direct result of apnoeas and is this recorded?

I haven't been able to find anything about treatment decreasing the craving for bad foods either, although obviously if one isn't tired then one will be more energetic the following day.

Any more links would be useful please.

 

[Sid Bonkers]

Unless you had a repeat polysomnography (overnight sleep study) then how can you be sure you are apnoea-free.

I did before being discharged from the sleep clinic, I cant remember the exact numbers but it may have been 20 + or something incidents on the first one at diagnosis and after the 4 stone weight loss it was down to 11 or something which I was told was just over the limit for diagnosis which I think may be 10 incidents of stopping breathing in a night.

As I say I cant remember the numbers really so dont flame me if I have got them all wrong, I just know I wasnt discharged until after the consultant who ran the sleep clinic was satisfied I was OK, he did say that should I have any further problems that I should get re referred, but touch wood I have had no further problems as yet.

 

[ButtterflyLady]

Ok, the AHI numbers are a per-hour figure. 11 is just above the cutoff for SA, but it still suggests a condition called UARS - upper airway resistance syndrome. Most consultants do not understand this syndrome at all - it's only been recognised in the last decade. They are keen to discharge anyone with a lowish AHI, to focus on those who are heading towards life-threatening illness (AHI 30+)

Also, like all diagnostic tests, it's only a snapshot at that time. I get the impression you're the kind of person who wouldn't accept a diabetes consultant's word without doing your own research (which I applaud). I trust SA doctors about as much as I trust any doctor.

It may be possible to re-test it using a cheap, simple, home test kit from a reputable supplier. In NZ this costs about the equivalent of 50-100 pounds. If you're interested in making a case to get full sleep clinic testing again, I can give you some tips or refer you to some good SA forums.

Some things that would increase your AHI from 11 from time to time might be - sleeping on your back, alcohol, tiredness, a blocked nose for any reason, medication such as painkillers or anything that sedates. You would also be at increased risk for surgery of any kind, because it compounds SA/UARS and diabetes risk factors. I know I still felt tired and sick before my AHI got down below 5, and I'm at my best when it's under 1.

If you sleep for 8 hours, that's 88 times of having micro-awakenings that prevent you from reaching deep sleep, spike your heart rate and blood pressure, and switch off growth factor hormone production. There is also usually loud snoring before each apnoea event and in between. The airway partially collapses with snoring - when it fully collapses it's an apnoea event.

It's good that your latest HbA1c is 5.4, as it shows that your sleep-disordered breathing is not necessarily making diabetes management harder than it needs to be.

If it is UARS (an unfortunate acronym, came from the US), then it's possible that some kind of ENT surgery could fix it, if you prefer not to use CPAP. I would recommend finding out more info before settling on any options.

I'm writing this stuff to help not only you but anyone lurking who may also have these symptoms. Coming to this forum has really shown me how close the links between SA/UARS and diabetes are for a portion of the population.

 

[ButtterflyLady]

Evening CatLady

I have had a look at the IDF website and to be truthful it made my head ache!

I have been looking at this http://www.idf.org/webdata/docs/IDF%20c ... _final.doc

and also this http://www.idf.org/sleep-apnoea-and-type-2-diabetes and it appears that this studies are a bit "all over the place", there seems to be dabte about how much ill effect there really is?

Is there a link you can provide (not the Resmed one) that can give more details of how this problem is a killer? How many people die as a direct result of apnoeas and is this recorded?

I haven't been able to find anything about treatment decreasing the craving for bad foods either, although obviously if one isn't tired then one will be more energetic the following day.

Any more links would be useful please.

Hi ladybird, sorry I missed seeing your post.

The IDF consensus statement is unequivocal. Remember it's aimed at doctors, so the language has to conform to what they are used to. If it said "most diabetics have SA and are at risk of severe illness" then no doctor would pay any attention to it. It has to use words like "suggests" because that's a robust scientific term they will understand/believe. Laypeople would replace with "is" or "means that".

Same with words like "significant". In everyday usage we throw this word around to mean "major", "big" or "a lot". Anyone with a university science degree wouldn't (or shouldn't) do that, because they will be laughed out of court unless they can show a certain level of statistical measure from their research. (And I don't know what that measure is, because I never studied science at varsity - only started reading it online in my spare time for fun!).

There are online SA forums like this one that are a rich source of info and support. I'd rather not post specific links as I try to keep my own online presence compartmentalised. It's easy to find them - an hour of googling and reading reputable sites should locate them and any other info you need. The US sleep medicine professional bodies are also a good source.

Resmed is not just another medical supply firm. They were the first to develop and patent the technology in Sydney Australia after researchers at the local university invented CPAP in 1985. They're also in the top 2 manufacturers globally so they have heaps of resources for developing public information. I've spent years reading about SA online and they are my favourite resource. Like the IDF, they provide references to free online journal articles for further reading.

The hormone/cravings/weight gain theory is newish and not yet as mainstream as the diabetes/hypertension/strokes findings. The place to get the best info about this is the SA forums. I also know in my heart of hearts that this is why I craved carbs and got my body completely out of control - severely obese. I remember that desperately hungry/weak feeling that I no longer get.

Like diabetes, many people are in a sort of denial about SA at first, because their doctors have never talked about it and it's all new. I hope you don't have it and I wish no one here had it. But I would risk my life savings on the bet that some people here do have it and that their doctors need a good kick in the backside.

EDITED - to add - there are numbers on deaths from SA, but they are grossly underestimated because they are usually just put down to diabetes, stroke, emphysema or heart failure. There's also figures available for car crash deaths from people with untreated SA falling asleep at the wheel - this puts the whole public at risk, which is the bigger tragedy.

 

[Sid Bonkers]

Ok, the AHI numbers are a per-hour figure. 11 is just above the cutoff for SA, but it still suggests a condition called UARS - upper airway resistance syndrome. Most consultants do not understand this syndrome at all - it's only been recognised in the last decade. They are keen to discharge anyone with a lowish AHI, to focus on those who are heading towards life-threatening illness (AHI 30+)....

An interesting and informative post CatLady, thanks for taking the time to write it :thumbup:

I was advised that surgery would not be the best option for me, at the time I was diagnosed and that it does carry a risk that could leave me with speech problems, cant remember what those risks were exactly, it was 6 or so years ago now but I was actually relieved as I had not long come out of an intensive care unit intubated due to a lung condition, it was after this that all my problems started, I was on prednisolone (corticosteroid) for three years and that caused me to put on weight which made the SA worse, not sure it caused it but it certainly accentuated it to the point where my wife would shake me awake several times a night. It was also the prednisolone that caused my T2 diabetes, it is a well documented side effect of corticosteroid treatment and it was that diagnosis that scared me into losing the weight which I did.

I also have arthritis of the spine which gives me referred pains in my right leg, like sciatica, so I often take DF118 Dihydrocodeine before bed to help dull the pain and allow me some sleep but I still wake on average every couple of hours, I did mention this to the SA doctor who pretty much said that as we get older our sleep patterns change blah blah blah and basically brushed it off, so now you have me wondering if I do still have some SA

My sleep has been like this since coming out of ICU, before that I could sleep for England, as they say.

My stay in intensive care was extremely traumatic and at first I was actually scared to sleep in case I didnt wake up again, sounds silly now but at the time I really thought I was going to die and when I was first taken off life support I was hallucinating for several days due to the Ketamine used to anaesthetise and sedate me and overheard some doctors talking about another patients chances of recovery as minimal and was convinced they were talking about me :crazy: Weird stuff Ketamine, I can never understand why anyone would want to take it recreationally :lol:

If I could change one thing in my life right now it would be my sleep pattern, leg and back pain waking me repeatedly? Or SA? :yawn: Think I might mention it to my Doc the next time I see him.

 

[ladybird64]

Thanks CatLady

My 21 yr old daughter has SA and has used CPAP for a number of years, she is also a type 2 on insulin. There are other medical problems that I won't go into here, problems that take precedence over everything else so I got quite concerned when I saw that you had written that SA is a killer disease..sure you can understand this.

She is under the care of The Royal Brompton in London, a very well known hospital for their expertise in respiratory problems (sure that Sid knows them!) so I am confident she has the best care.

A very interesting topic which I will investigate some more, thanks.