Depression and Heart Conditions

Depression is common in heart patients. Most studies show 2 out of 3 patients will experience depression. Does depression cause heart disease or does heart disease cause depression? Probably both. We all have ups and downs, however when one finds them overwhelming and debilitating it is time to get help. According to the National Institute for Mental Health the following are the symptoms of depression:

Signs and symptoms include:

  • Persistent sad, anxious, or “empty” feelings
  • Feelings of hopelessness or pessimism
  • Feelings of guilt, worthlessness, or helplessness
  • Irritability, restlessness
  • Loss of interest in activities or hobbies once pleasurable, including sex
  • Fatigue and decreased energy
  • Difficulty concentrating, remembering details, and making decisions
  • Insomnia, early-morning wakefulness, or excessive sleeping
  • Overeating, or appetite loss
  • Thoughts of suicide, suicide attempts
  • Aches or pains, headaches, cramps, or digestive problems that do not ease even with treatment.

One of the best things a person who is suffering from depression can do is to get daily exercise. Yet it is one of the hardest things to do when depressed. I would encourage patients to at a minimum schedule themselves 10 minutes per day of exercise. I know it is a very short duration, but it is a starting point. We build from there.  If you are a significant other of someone you suspect is depressed, don’t nag them to exercise, rather help them to engage in it. Offer to go for a walk, or go to the gym together.

For many suffering from depression winter can be especially difficult. The holidays may trigger episodes, a change in healthy eating habits to the holiday party foods, a change in exercise habits due to weather changes, getting out and socializing less due to weather, loss of loved ones,  and seasonal effective disorder can all be a catalyst for symptoms to worsen. If you note this contact your healthcare practitioner, consider counseling, increasing exercise, getting sunlight every day, and/or medications. It is important because if depression isn’t treated often heart disease worsens.

Seasonal affective disorder (SAD), which is characterized by the onset of depression during the winter months, when there is less natural sunlight. The depression generally lifts during spring and summer. SAD may be effectively treated with light therapy, but nearly half of those with SAD do not get better with light therapy alone. Antidepressant medication and psychotherapy can reduce SAD symptoms, either alone or in combination with light therapy



Heart disease patients who have anxiety have twice the risk of dying from any cause compared to those without anxiety, according to new research in the Journal of the American Heart Association.

Patients with both anxiety and depression have triple the risk of dying, researchers said.

Many studies have linked depression to an increased risk of death in heart disease patients. However, anxiety hasn’t received as much attention. Studies show that depression is about three times more common in heart attack patients. The American Heart Association recommends that heart patients be screened for depression and treated if necessary.

Depressed heart disease patients often also have anxiety, suggesting it may underlie the risk previously attributed solely to depression. It’s now time for anxiety to be considered as important as depression, and for it to be examined carefully.”

In the study, 934 heart disease patients, average age 62, completed a questionnaire measuring their level of anxiety and depression immediately before or after a cardiac catheterization procedure at Duke University Medical Center. Patients had anxiety if they scored 8 or higher on a scale composed of seven common characteristics of anxiety, with each item rated from 0 to 3 (range of possible scores: 0-21). Depression was measured using a similar scale composed of seven symptoms of depression.

Researchers, after accounting for age, congestive heart failure, kidney disease and other factors that affect death risk, found that 90 of the 934 patients experienced anxiety only, 65 experienced depression only and 99 suffered anxiety and depression. Among 133 patients who died during three years of follow-up, 55 had anxiety, depression or both. The majority of deaths (93 of 133) were heart-related.

Researchers measured anxiety and depression during cardiac catheterization because levels better reflected how patients normally handle stressful situations. Anxiety and depression each influence risk of death in unique ways. Anxiety, for example, increases activity of the sympathetic (adrenaline-producing) nervous system that controls blood pressure.

People who worry a lot are more likely to have difficulty sleeping and to develop high blood pressure. The link between depression and mortality is more related to behavioral risk factors. Depression results in lack of adherence to medical advice and treatments, along with behaviors like smoking and being sedentary.

Future studies should test strategies to manage anxiety alone and with depression in heart disease patients.

Anxiety reducing medications combined with stress management could improve outcome for patients with just anxiety, whereas patients with anxiety and depression may need a stronger intervention involving more frequent outpatient monitoring and incentives to improve adherence.

Slowly getting there, comments from our cardiac health innovators?



Every human has them. We struggle with our inner self, listen to the brain telling you that it isn’t good for your health, or give in to the desire to satiate the craving. Is it worth jeopardizing my health? Will one slip really make any difference? I will do better tomorrow. Whether it is food, tobacco, or alcohol many find it tough not to give in to the cravings. Here is some research and popular tips which we all probably know, but need frequent reminders why not to give in, and how to overcome the cravings which set us back.

Craving Fatty Foods?

Recent research out of Canada shows a single junk food meal — composed mainly of saturated fat — is detrimental to the health of the arteries. A single meal — composed mainly of saturated fat — is detrimental to the health of the arteries, while no damage occurs after consuming a Mediterranean meal rich in good fats such as mono-and polyunsaturated fatty acids. The high saturated fat meal testing in the study consisted of a sandwich made of a sausage, an egg, and a slice of cheese, and three hash browns, for a total of 58% of total calories from fat: extremely rich in saturated fatty acids and containing no omega-3s. While no damage occurs after consuming a Mediterranean meal rich in good fats such as mono-and polyunsaturated fatty acids, according to researchers at the University of Montreal-affiliated ÉPIC Center of the Montreal Heart Institute. The Mediterranean meal may even have a positive effect on the arteries.

Dr. Nigam and his team found that after eating the junk food meal, the arteries of the study participants dilated 24% less than they did when in the fasting state. In contrast, the arteries were found to dilate normally and maintain good blood flow after the Mediterranean-type meal.

“These results will positively alter how we eat on a daily basis.  Poor endothelial function is one of the most significant precursors of atherosclerosis. It is now something to think about at every meal,” Dr. Nigam said.

Have you got a sweet tooth? 

Try out these easy tips to overcome sugar cravings & to stop this vicious cycle…

1. Combine craving foods with healthy ones: Try to compensate for extra calories through sweets by double the amount of fiber rich low calorie options. E.g. Have a small portion of sweets with a bowl of raw salads! This ensures your huger going down & stops recurrence of cravings.

2. Look out for a fruit: Choose a fruit over sweets / chocolates. Fruits, along with sugars are also loaded with fibers, vitamins & minerals. Dry fruits like dates, raisins, dried figs etc. are some more options.

3. Go for a sugar-free chewing gum: Research has shown that chewing gum can reduce sugar cravings.

4. Space your meals evenly throughout the day: Keeping long gaps between two meals may lower down blood sugar levels & forces one to crave for sweet s which naturally provide immediate energy. Eating every 2-3 hourly helps keep blood sugar levels steady & automatically prevents sugar cravings.

5. Divert your mind from food: Take a short break & go for a walk or visit the library etc. Distracting yourself from eating sweets often works well.

6. Find & treat the root cause: Many times we turn to sweets when we are stressed out, bored or depressed.  Pointing out the exact cause & treating it is of utmost importance.

Craving Tobacco?

So here are 10 ways to help you resist the urge to smoke or use tobacco when a tobacco craving strikes, no matter where you are:

  1. Delay. If you feel like you’re going to give in to your tobacco craving, tell yourself that you must first wait 10 more minutes and then do something to distract yourself for that period of time. This simple trick may be enough to derail your tobacco craving. Repeat as often as needed.
  2. Don’t have ‘just one.’ You might be tempted to have just one cigarette to satisfy a tobacco craving. But don’t fool yourself into believing that you can stop at just one. More often than not, having just one leads to another, then another — and you may wind up using tobacco again.
  3. Avoid triggers. Urges for tobacco are likely to be strongest in the situations where you smoked or chewed tobacco most often, such as at parties or bars, in the car or while watching television. Identify your trigger situations and have a plan in place so that you can avoid them entirely or get through them without using tobacco. Don’t set yourself up for a smoking relapse. If you usually smoked while you talked on the phone, for instance, keep a pen and paper nearby to occupy yourself with doodling rather than smoking.
  4. Get physical. Physical activity can help distract you from tobacco cravings and reduce the intensity of cravings. Just 30 minutes of moderate physical activity can make a tobacco craving go away. Get out for a walk or jog. If you’re stuck at home or the office, try squats, deep knee bends, push-ups, running in place, or walking up and down a set of stairs a few times. If physical activity doesn’t interest you, try prayer, needlework, woodwork or journaling. Or do chores for distraction, such as vacuuming or filing paperwork.
  5. Practice relaxation techniques. In the past, smoking may have been your way to deal with stress. Trying to resist a tobacco craving can itself be stressful. Take the edge off stress by practicing relaxation techniques. These include deep-breathing exercises, muscle relaxation, yoga, visualization, hypnosis and massage.
  6. Call reinforcements. Touch base with a family member, friend or support group member for moral support as you struggle to resist a tobacco craving. Chat on the phone, go for a walk together or simply share a few laughs — or get together to commiserate about your cravings.
  7. Remember the benefits of quitting. Write down or say out loud the reasons you want to stop smoking and resist tobacco cravings. These might include feeling better, getting healthier, sparing your loved ones from secondhand smoke or saving money. And if you’re a closet smoker, you may save hours of time since you no longer have to spend time trying to conceal your habit.
  8. Go online. Join an online stop-smoking program. Or read a quitter’s blog and post encouraging thoughts for someone else who might be struggling with tobacco cravings. Learn from how others have handled their tobacco cravings.
  9. Try nicotine replacements. Try a nicotine replacement product instead of a cigarette. Some types of nicotine replacement therapy, including patches, gums and lozenges, are available over-the-counter. Nicotine nasal spray and the nicotine inhaler are available by prescription, as are the stop-smoking medications bupropion (Zyban) and varenicline (Chantix).
  10. Chew on it. Give your mouth something to do to fight a tobacco craving. Chew on sugarless gum or hard candy. Or munch on raw carrots, celery, nuts or sunflower seeds — something crunchy and satisfying.

Remember, trying something to beat the urge is always better than doing nothing. And each time you resist a tobacco craving, you’re one step closer to being totally tobacco-free

Craving Alcohol?

Here is a brief overview of some of the methods taught to help manage drug or alcohol cravings, as recommended by the National Institute on Drug Abuse (NIDA).


Getting out of a situation of craving and distracting yourself with another activity is an excellent way to avoid succumbing to temptation.

Experts recommend that you make a list of activities that can distract you from a craving should the need arise (going bowling, taking the dog for a walk, doing the groceries etc.).

Many people attempt to manage cravings for a certain drug by using another drug, for example, a cocaine addict may use marijuana to help manage cocaine cravings. This is a very poor technique and too often leads to full relapse; and so having a list of better alternatives at the ready can help to minimize drug substitution behaviors.

Remembering Why You Don’t Use

During an intense craving, people fixate on a remembrance of the pleasures of alcohol use, forgetting temporarily the reasons why they stopped using in the first place. Reminding yourself why you chose to stop using during a period of craving can strengthen your resolve to wait it out.

Some therapists recommend that you in fact write down a list of good reasons for staying sober on an index card and keep that card on your person at all times. Then, during a tough moment of temptation, you can review your list and remember at that moment exactly why you need to stay strong.

For example

  • Worsening liver  and heart disease
  • Lose my relationships
  • Set back any healthy lifestyle changes I have made
  • I will can’t afford more health problems

Talking Through the Craving

Talking through an episode of craving as it happens can help you to manage the severity of it. Telling someone you trust about what you are going through at the moment of a craving can empower you and reduce some of the anxiety associated with struggling against temptation alone. Talking through the craving as it happens can also help you to better understand what specifically led to the feelings of temptation.

Letting Go – Feeling the Craving

Letting yourself experience a drug or alcohol craving in a very abstract and detached kind of way can greatly diminish the experienced intensity of the event.

Therapists counsel you to envision the craving as a wave that is going to wash over you, starting low, gaining in intensity, peaking and then subsiding. Instead of fighting the craving, as you normally would, when letting go you try to experience the craving as fully as possible.

Get into a comfortable and secure place, sit back and let yourself feel the craving.


  • What does it feel like?
  • What do my feet feel like? My knees, my stomach,  my neck, etc…
  • How strong is the craving right now? Is it getting stronger or is it subsiding?
  • Can you describe the feeling of the craving in words?

In a paradoxical way, in concentrating on experiencing the craving fully you detach yourself from its influence. Many people find that this detached experiential method greatly reduces the intensity and even frequency of experienced cravings.

Reducing the Power of the Internal Voice

In most of us, feelings of craving unleash an internal voice that convinces us of the inevitability of use.

A craving might cause internal voice statements such as:

  • need a drink
  • I can’t fight this any longer

However, once we take an objective look at craving induced inner voice statements, we can see that they are not inherently true at all; and so we can learn to counter these statements with more accurate reflections of reality.

  • “I need a drink” becomes, “I may want a drink, but I don’t need a drink, and all feelings of craving will pass.”
  • “I can’t fight this any longer” becomes, “Cravings can be unpleasant and difficult, but they are only temporary, I will feel better in a minute, as long as I don’t drink or use.”

Sodium and fluid retention

How Sodium causes fluid retention

The job of the kidneys is to filter the excess sodium into the urine so that the body can get rid of it. Many with heart disease and diabetes kidneys cannot handle all the extra work. The kidneys become less efficient at filtering the blood stream. This causes excess sodium to enter the bloodstream. Sodium attracts water to it and effect known as being osmotic. Water follows the sodium  and is drawn into the bloodstream. Excessive salt keeps the circulatory volume higher than it should be, creating and increased pressure in the blood stream and pressing on the blood vessel walls. The stress of the pressure on the walls creates thickening and narrowing of the vessel, leaving less space for the fluid in the blood vessels and raising resistance.  The body then requires higher pressure to move blood to the organs. The heart has to pump against this high pressure system.

I equate it to trying to blow up one of those kids balloons that is turned into animal shapes. They are really tough to blow air into, your cheeks get really sore – this is the resistance of air, similar to the resistance pressure of blood in the arteries. If you stretch the balloon (relax the arteries) then there is less resistance in blowing up the balloon (filling the artery with blood). Twenty percent  of the blood pumped from the heart goes  first to the kidneys.  High blood pressure within the kidneys cause  damage to the heart and to the vascular system in the kidneys. Salt makes you thirsty so limit salty foods, especially if on a fluid restriction.

I once had a patient who lost 45 lbs simply from adhering to low sodium diet. He had a very weak heart with only 10% ejection fraction meaning very limited pumping ability. So a weak heart and sodium in the diet made him retain fluid more than most. He began to measure and count sodium with every meal for a few months and was shocked by how much sodium he consumed even though he thought he ate pretty healthy. By reading labels, doing the math every day and making changes such as eating out less, ordering special, reviewing his medication he lost the fluid and added years to his life, not to mention the improved quality of life with less shortness of breath and fatigue by easing the workload of the heart.


According to the American Heart Association, eating more than the recommended 1500 milligrams a day puts you at direct risk of high blood pressure. Yet in America we consume an average of 3400 milligrams a day; more than twice what we should. While people with hypertension, heart and kidney disease are always advised by doctors to eat less salt, the AHA wants all of us to do this, whether or not our blood pressure is currently in the normal range. So if you are cooking or know the cook for pass this info on!


When holiday meal are  upon us  remind heart patients of being acutely aware of the sodium content in foods. The holiday meal contributes to many heart patients having increased symptoms of  high blood pressure, congestive heart failure, fluid retention, shortness of breath. The holiday meals  can be the culprit. Traditional foods like the turkey are often injected with  approximately 8% solution sodium to enhance moistness and flavor. If you read the ingredients you will often note: turkey broth, salt, sodium phosphates, sugar & flavoring. Then many a cook will soak the already salt injected turkey in a brine solution or salt it well, prior to cooking. The turkey alone gets many into trouble, then you add pre-packaged stuffing, broth, or use canned mushroom soups in casseroles. Did I mention the relish tray with pickled foods?


A little extra salt in or on your holiday foods makes a difference.

1 teaspoon salt = 2131 mg sodium                                          1/2 teaspoon salt = 1066 mg sodium

1/4 teaspoon salt = 533 mg sodium                                        1/8 teaspoon salt = 266 mg sodium

75 mg—the average sodium content of 3 ounces fresh, unsalted beef, turkey, chicken, pork

240 mg sodium in 3 ounces self-basting frozen turkey, cooked (that’s without the gravy!)

580 mg sodium in 3 ounces frozen fully cooked baked turkey

820 mg sodium in 3 ounces honey baked ham

Bread is a major sodium contributor if you eat more than a couple of pieces a day unless you buy special low sodium bread. A slice (1 ounce) of loaf bread has 150 to 200 mg sodium—not including salted butter or other spreads or toppings. Consider using a bread maker to make a low sodium recipe.

Skip the gravy! But if you must go for low or reduced sodium gravy instead of regular salted gravy which has more than 300 mg sodium for 1/4 cup.                                                                                                                                                              

Measurements and labels of sodium

  •  1/4 teaspoon salt= 600 mg sodium
  • 1/2 teaspoon salt= 1,200 mg sodium
  • 3/4 teaspoon salt=1,800 mg sodium
  • 1 teaspoon salt= 2,300 mg sodium
  • 1 teaspoon baking soda =1,000 mg sodium
  • Sodium-free: Less than 5 milligrams of sodium per serving
  • Very low-sodium: 35 milligrams or less per serving
  • Low-sodium: Less than 140 milligrams per serving
  • Reduced sodium: Sodium level reduced by 25%
  • Unsalted, no salt added, or without added salt: Made without the salt that’s normally used, but still contains the sodium that’s a natural part of the food itself.

Names for salt

  • sodium alginate
  • sodium ascorbate
  • sodium bicarbonate (baking soda)
  • sodium benzoate
  • sodium caseinate
  • sodium chloride
  • sodium citrate
  • sodium hydroxide
  • sodium saccharin
  • sodium stearoyl lactylate
  • sodium sulfite
  • disodium phosphate
  • monosodium glutamate (MSG)
  • trisodium phosphate
  • Na

Some drugs contain high amounts of sodium.

Need an antacid after that holiday meal?  Watch out there is excess sodium there too. Carefully read the labels on all over-the-counter drugs. Look at the ingredient list and warning statement to see if the product has sodium. A statement of sodium content must be on labels of antacids that have 5 mg or more per dosage unit (tablet, teaspoon, etc.). Some companies are now producing low-sodium over-the-counter products. If in doubt, ask your healthcare practitioner or pharmacist if the drug is OK for you.


Diabetics Weight Loss and Heart Health


This report is somewhat misleading. I get concerned when reading negative sounding reports involving exercise and health. I have several thoughts on this report. One is that the study is too short. Heart disease doesn’t just disappear, once it is active in aggressive disease form it can continue to be problematic for quite some time. 1-4 years is a pretty short period of time to expect change. How long does it take the development of diabetes to display physiologic changes. The inflammatory response of diabetes irritates the arteries making heart disease more prevalent. It may take a decade of maintaining these lifestyle changes before the pay off of less cardiovascular issues shows in the statistics.

To say there was no benefit discounts all the good lifestyle adherence of  nutrition and physical activity did for the patient. It initially  focused on weight loss only, I do look forward to seeing the further analysis. Benefits go well beyond the heart. Weight loss through lifestyle changes caused the hemoglobin A1c levels  to decrease, thus decreasing the likelihood of progression of diabetes such as if unchecked increases the need for insulin or other pharmacological agents. These pharmacological agents as with any drug have good and bad components to health. One could extrapolate and assume if the patients maintained this lifestyle they would have less diabetes complications, such as non healing wounds, chronic renal disease, peripheral artery disease etc., as well as less needs for medications to control the disease. Blood pressure improvement was probably noted as well.   Ah but it is stopped because of futility, the study’s data and safety monitoring board recommended the trial be stopped.

The lifestyle modifications arm of this study showed improved Hemoglobin A1c levels. If the study looks at  keeping the HgbA1c lower rather than simply weight loss, over a period of 10-20 years I bet one would note a decrease in the incidence of heart attack, stroke, angina, re hospitalizations for cardiovascular issues.  Mentally the patients were happier, if you work in healthcare….that means alot!!!

I would still push hard for any and all with diabetes to adopt a healthy lifestyle of good nutrition and exercise, and not just for those who need weight loss. I hope the final research will address these issues and not just focus on a negative. I can just hear patients thinking well I don’t need to worry about weight loss through activity as that won’t help my heart, lets just see what medication I can take to improve my glucose control.   Nutrition and exercise are crucial and should be the front line of treatment for heart disease and not just limited to weight loss.

Weight Loss No Help for Diabetic Heart

By Chris Kaiser, Cardiology Editor, MedPage Today

Published: October 19, 2012

Losing weight — an average of 5% of total body weight — `and keeping it off for 4 years didn’t reduce the number of heart attacks or strokes in persons with diabetes.

That result prompted the National Heart, Lung, and Blood Institute to pull the plug on its massive Look AHEAD (Action for Health in Diabetes) study.

The study enrolled 5,145 people with type 2 diabetes and a BMI greater than 25, randomizing half to a lifestyle intervention and half to a general program of diabetes support and education.

Although those in the intervention group kept off 5% of their initial body weight at 4 years, there was no difference between them and the standard care group in the rate of myocardial infarction, stroke, hospitalizations for angina, and cardiovascular death — the primary outcome.

Essentially, there was no harm from the intervention, but there was no benefit either, according to a statement from the NIH.

Because of the finding of futility, the study’s data and safety monitoring board recommended the trial be stopped.

Mary Evans, MD, director of special projects in nutrition, obesity, and digestive diseases at the National Institute of Diabetes and Digestive and Kidney Diseases, told MedPage Today that people who “volunteer for a weight-loss intervention study involving reductions in calorie intake and increased physical activity may be healthier than the general population with type 2 diabetes.”

She said that participants had to pass a treadmill test to assure it was safe for them to exercise. They also received annual feedback about their risk factors, including HbA1c, blood pressure, and cholesterol levels.

After the first year, Look AHEAD participants in the lifestyle intervention arm had lost 10% of their initial body weight, but as time went on, they gained some of it back. The standard care group lost about 1% of its initial body weight at both 1 and 4 years.

Despite no reduction in cardiovascular events in those in the intense intervention arm, they did experience other health benefits. Patients in this group saw improvements in sleep apnea and mobility, as well as quality of life. In addition, their diabetes medications were reduced.

In addition, at 1 and 4 years, both diabetes control (glucose, HbA1c) and most cardiovascular disease risk factors (blood pressure, HDL cholesterol, triglycerides) were more favorable in the lifestyle intervention than in the control group with the exception of LDL cholesterol, which was not different between groups at year 1, Evans shared.

At year 4, those in the intensive lifestyle intervention group continued to have more favorable diabetes control and CVD risk factor reduction, with the exception of LDL-C in which there were slightly greater reductions in the standard care group. Participants in the lifestyle intervention group maintained greater improvements in fitness at both years 1 and 4, Evans said.

To be enrolled, patients had to have their blood pressure under at least moderate control (160/100 mmHg), HbA1c levels ≤11%, and fasting triglycerides concentration less than 600 mg/dL. The trial included those with and without a history of cardiovascular disease.

“Cardiovascular event rates in diabetic individuals with heart disease are expected to be approximately twice those of diabetic individuals without a history of heart disease,” according to the study protocol.

The ages of participants ranged from 45 to 76, and 60% were women.

“Data from the end of the study are currently being analyzed to better understand the relationship between changes in fitness, weight, diabetes control, cardiovascular disease risk factor control, and outcomes in the Look AHEAD study,” Evans said.

Researchers also are exploring differences in subgroups, such as minorities (about 37% of the total population) and those with a history of cardiovascular disease.