Dr. Joel Kahn

Managing Arthritis with Diet: Plants Again!

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I would wager a bet that most persons suffering from a variety of rheumatologic disorders like rheumatoid arthritis, systemic lupus erythematosus,  and Sjogren’s syndrome have never been advised by their medical team to abandon animal foods and concentrate on the health attributes of plant foods. There have been stunning success stories of complete reversal of life-threatening illness like lupus. A recent review article argues that rheumatoid arthritis (RA) can be managed with diets rich in certain plants that have anti-inflammatory properties and it is worth a careful read (1). Completely vegan diets for RA are included in the scientific analysis because of evidence for their healing effects. The foods with the highest recommendations for arthritis therapy are listed here. 


Fruits

Regular consumption of fresh fruits rich in important phytochemicals can reduce oxidative stress and inflammation. Studies have reported that repeated and high consumption of fruits provide protective effects against RA.

Spices

Ginger has been known for its therapeutic properties as an anti-inflammatory.  Turmeric, rich in curcumin, has also proved its beneficial effects. Curcumin has also presented itself as a potent anti-inflammatory component derived from the turmeric spice. Cinnamon is widely used in South-East Asian dishes and has the ability to lower inflammatory pathways.

Essential Fatty Acids

Omega-3 or omega-6 fatty acids have shown their potential as immunosuppressants and anti-inflammatory agents. A double-blind trialwas conducted on 37 patients with active RA, and they were assigned to consume borage seed oil rich in essential fatty acids. After 24 weeks of consumption, the group which received borage oil had significantly reduced tender and swollen joint scores, whereas placebo group did not show any change. Other foods that support a healthy diet high in essential fatty acids would include ground flax seed, chia seeds, hemp seeds, walnuts, and green leafy vegetables. 

Teas

Epigallocatechin-3-gallate (EGCG) is a main chemical present in green tea. In RA, a  study of EGCG treatment has successfully shown its ability to decrease pathways of inflammation.

Herbs

Plants with effective health promoting effects are known as herbs, and these have a long history of being used as medicine to cure several diseases. Boswellia serrata) is widely recommended as an anti-inflammatory herb as prescribed in Ayurveda that has anti-inflammatory properties.  Ashwagandha (Withania somnifera) is one of the plants being described in Ayurveda as a potent anti-inflammatory plant. In a double-blind placebo-controlled study, ashwagandha significantly reduced stiffness, disability to move knee and joints, and pain score.

 The data in the review article provides a path for millions suffering from inflammatory arthritis. Another randomized trial demonstrated the benefits of a whole food plant diet on degenerative arthritis also (2). Many do not realize the potential for foods to manage or even reverse their disease. Almost all of the foods with anti-inflammatory benefits are plant based. 

 

1. https://www.frontiersin.org/articles/10.3389/fnut.2017.00052/full

2. https://www.ncbi.nlm.nih.gov/pubmed/25815212

The New Hot Diet Rage for Heart Health: Eat Like a Bolivian Tsimane

Coronary Artery Calcium CT Scan showing calcified plaque in the LAD widowmaker artery

Actually, it would be premature to anticipate people copying the lifestyle of a remote tribe living in the Bolivian jungle, but the news has been abuzz with the report that the Tsimane people have an incredibly low rate of heart disease compared to Western populations. The Tsimane live in villages of about 60 to 200 people. They often live relatively long — the most common age at death is 70.

In data published in the journal Lancet and announced at the American College of Cardiology, the results of coronary artery calcium scoring (CACS) using CT imaging in 705 adults living in remote villages between 2014 and 2015 were reported. The non-invasive heart check via CACS is the best predictor of heart disease and a direct measure of atherosclerosis. These residents of primitive villages were transported to a medical center for the evaluation.

Based on their CACS, almost nine in 10 of the Tsimane people (85%) had no risk of heart disease because of a CACS of zero, 13% had low risk and only 3% had moderate or high risk. These findings also continued into old age, where almost two-thirds (65%) of those aged over 75 years old had almost no risk and only 8% had moderate or high risk. These results are the lowest reported levels of vascular aging of any population recorded to date.

By comparison, a US study of 6814 people (aged 45 to 84) found that only 14% of Americans had a CT scan that suggested no risk of heart disease and half (50%) had a moderate or high risk — a 500% higher prevalence than in the Tsimane population. In the Tsimane population, heart rate, blood pressure, cholesterol, and blood glucose were also low, potentially as a result of their lifestyle.

The Tsimane spend only 10% of their daytime inactive. They live a lifestyle including hunting, gathering, fishing and farming, where men spend an average of 6–7 hours of their day being physically active and women spend 4–6 hours. This is far less than the average 50% of time spend in sedentary activities in Western societies.

The diet of the Tsimane was composed largely of complex carbohydrates (72%) high in fiber such as rice, plantain, manioc, corn, nuts and fruits. Protein constituted only 14% of their diet largely from animal meat caught in the wilds. Their diet is very low in fat with only 14% of their calories being fat calories. This is as low as the traditional Okinawan population known for longevity as a Blue Zone and in the range of the famous heart disease prevention and reversal studies of Dean Ornish, MD and Caldwell Esselstyn, MD. The diet was also very low in saturated fat, averaging 11 grams, and had no measurable trans fats. By contrast, the typical U.S. adult diets have more fat — about 16 percent protein, 33 percent fat and 51 percent carbohydrate, according to Centers for Disease Control statistics. Smoking was rare in the population.

The graphs below show the CACS in women and then men up to age 85 in the Tsimane population in aqua compared to a range of populations in the United States in the MESA trial. It is striking how little coronary calcification was found even at advanced ages compared to the comparable age groups in Western populations.

This chart compares levels of plaque in coronary arteries in the women and men of various cultures. The Tsimane are lowest. The lines reflect the 75th percentile in each group. Source: The Lancet

While the lifestyle and health of the Tsimane people may soon change with the availability of transportation and exposure to Western conveniences, the lessons for longevity and freedom from heart disease are clear. Decisions not to smoke and to pursue an active lifestyle of exercise, walking, standing and even fidgeting have all been shown to favor heart health and are borne out by the CT findings in the Tsimane.

In an era when the role of dietary fats, “healthy fats”, and saturated fats have opposing schools and has led to public confusion, the remarkably low fat diet of the Tsimane is a pattern supported once again for youthful heart arteries. Very few people in Western societies follow a diet consisting of 14% or less of calories from fat but the relationship with the healthy heart arteries of the Tsimane argue for largely whole food, plant based diets with very little or no butter, full fat dairy, animal meats, oils, or eggs. The trend in California of blending butter and coconut oil in coffee to create a very high fat drink, known as Bulletproof Coffee, has clearly not reached the jungles of Bolivia. Their exceptional heart health speaks volumes about not following that trend or high animal food diets in general.

Processed Red Meats And Cancer One Year Later: Cutting The Risk By Half

It is the one year anniversary of the announcement by the International Agency for Research on cancer(IARC), an agency of the World Health Organization known for expertise in analyzing scientific data for health risks, that meat acts as a carcinogen (http://www.iarc.fr/en/media-centre/pr/2015/pdfs/pr240_E.pdf). The analysis placed processed red meat at a risk similar to the notorious pesticide RoundUp at best and comparable to diesel fumes and tobacco at worst. These were very strong words that shocked many and made headlines worldwide (https://www.washingtonpost.com/news/wonk/wp/2015/10/26/hot-dogs-bacon-and-other-processed-meats-cause-cancer-world-health-organization-declares/). In case you missed it, the IARC, comprised of 22 scientists from 10 countries, reviewed over 800 studies and found that:

1. Processed meats like bacon, ham, salami, sausage and beef jerky are class I carcinogens, they highest risk assigned and cause cancer with sufficient data to make a firm conclusion. The relationship was strongest with colorectal cancer (CRC) and stomach cancer.

2. The risk increases incrementally with the amount of these meats that are eaten. Each 50-gram portion of processed meat eaten daily increases the risk of colorectal cancer by 18 percent.

3. Fresh red meats like steak and roasts, but including pork and lamb, were considered as probable causes of cancer to humans (Class 2a) with links to colorectal, pancreatic and prostate cancer.

The report of the IARC followed similar prior reports like that of the World Cancer Research Fund (http://wcrf-uk.org/uk/preventing-cancer/ways-reduce-cancer-risk/red-and-processed-meat-and-cancer-prevention) that drew similar conclusions.
Now new research has applied this announcement to indicate how the recommendations of the IARC along with other lifestyle measures can reduce the risk of CRC  https://www.ncbi.nlm.nih.gov/pubmed/27752849). Six dietary and lifestyle recommendations (body weight, physical activity, energy density, plant foods, red and processed meat, and alcohol) were examined in terms of their association with CRC incidence over 7.6 years of follow-up in 66,920 adults aged 50-76 years at baseline (2000-2002) with no history of CRC.
The analysis indicated that participants meeting 1-3 recommendations enjoyed a 34-45 % lower CRC incidence, and those meeting 4-6 of the targets experienced a 58 % lower incidence of CRC. The lowest CRC risk for women related to body fatness and red and processed meat and for men it was avoiding alcohol intake and red and processed meat.
The tragic nature of CRC in the US is enormous. In 2014 about 140,000 were diagnosed in the US with CRC and nearly 50,000 died of this disease (http://www.cancer.org/research/cancerfactsstatistics/colorectal-cancer-facts-figures). African American men and women experience the highest rates of CRC, as much as 50% higher than whites. 


Similar to the current debate about the crucial role of substituting animal saturated fats with healthy options other than processed foods rich in sugar (http://www.huffingtonpost.com/joel-kahn-md/saturated-fat-remains-the_b_12094842.html), a strategy of replacing a breakfast of sausage and bacon with a plant based bean burrito or a lentil patty would be anticipated to produce a dramatic reduction in the risk of CRC (https://www.ncbi.nlm.nih.gov/pubmed/26077375). On the 1 year anniversary of the IARC, choose plants over animal products. At least one major hospital system has announced a total ban on processed red meats to be implemented in 2017. Others must follow suit.

Follow Joel Kahn, M.D. on Twitter: www.twitter.com/drjkahn

Cardiologist’s Case Study: A Patient’s Lab Results After 30 Days on a Plant-Based Diet

Adam is a well-known Detroit businessman who is legendary for his huge smile, energy, and successful restoration business. We became friends at a CrossFit gym a few years back. On social media, Adam was known for food posts that were usually centered around his love for bacon and burgers. He was about as meat-oriented as anyone I have ever met. As we all know, change has to come from within, and so we maintained our friendship despite the fact that we were polar opposites when it came to food.

In March of this year, Adam texted me to tell me he was ready for a change. He hadn’t had a health crisis yet (he is in his 40s), but he knew his diet, heavy in processed meat, could not work in the long-term. I was shocked, pleased, and, of course, supportive when he suggested going fully plant-based for 30 days. On top of this 30-day challenge, a huge departure from his normal diet, was the added challenge that he ate nearly every meal out at restaurants. So he was going to have to do some extra maneuvering.

The Bacon-Lover’s 30-Day Vegan Challenge
To document a baseline, we arranged for some advanced blood work at the Kahn Center for Cardiac Longevity at the end of March. On April 1, he jumped right in, switching out eggs and bacon for oatmeal and fruit plates. Lunches of soups and vegetables began to appear on his Facebook page. Dinners of steak house appetizers, tofu stir fries, and entrees from my plant-based restaurant GreenSpace Café got him through the first few days. He bravely and publicly posted about his diet switch on social media and received a lot of positive support. There were, of course, a few taunts and invitations to return to the dark side.

He found grocery shopping difficult at first, so I helped him through a couple shopping trips. We filled his baskets with fresh whole foods along with a few processed vegan choices. To his credit, Adam quickly decided to only eat whole-food, plant-based meals.

He stuck to the program 100 percent, and began to notice that he got better sleep and had increased energy and greater brain clarity. He was not overweight, so he didn’t need to lose weight, but he did mention his bowel movements were easier with all the added fiber from the fruits and vegetables. He made it through the 30 days successfully.

May 1 was the day we had scheduled for his repeat laboratory studies. To be honest, we were both nervous. What if there were no changes from his abnormal baseline lab results? We knew that 30 days was not a very long time, and perhaps wasn’t long enough to see significant changes. We were both overjoyed when the results returned.

Advanced Lab Results After 30 Days on a Plant-Based Diet

Adam’s first baseline blood level showed a seriously elevated C-reactive protein at 6.1 mg/L. High sensitivity C-reactive protein (hs-CRP) is a marker of inflammation that has been linked to heart attack, stroke, diabetes and cancer. Adam’s repeat level was 0.7, a dramatic and meaningful decline to normal.

Adam’s baseline microalbumin/creatinine ratio had been a very worrisome 8.5, indicating his arteries were sick from his food choices. This simple but powerful urine test reflects the health of the arteries in the kidneys and throughout the body. If elevated, it predicts increased risks of heart disease, heart attack, and stroke. Adam’s second test, just one month later, showed an undetectable level! This dramatic improvement shocked and pleased us all.

Adam’s total cholesterol fell from 224 mg/dl to 196, his LDL cholesterol fell from 142 to 115, and his LDL particle number fell from 1714 to 1474. These are significant improvements in just 30 days.

I’ve practiced medicine for over 30 years and have eaten a plant based diet for nearly 40 years. Even after all that time, I am still so impressed at how quickly the body can recover when excess salt, sugar, fat are removed and whole plant foods replace meat, dairy, and processed foods. I am proud to report that Adam is still eating a plant-based diet, encouraged by the way he feels and the results of his laboratory reports. I recommend all of my patients dive headfirst into a vegan challenge of at least 21 days in length. The patients that take the challenge feel so much better, and many continue long-term as Adam is now doing. It’s inspiring to see!

Adam’s labwork showing his improved results after 30 days. 

Adam’s labwork showing his improved results after 30 days. 

Dr. Joel K. Kahn, MD, FAAC

Citing Sources: www.forksoverknives.com

How $80 Can Save A Life

Case study: A 48 year-old man, athletic and highly successful in his career, enjoys a day of surfing. While walking back to his car, he collapses and cannot be revived. A heart attack is to blame for his sudden death. Rare? Unfortunately, this is neither rare nor hypothetical as the world lost a good man recently and my heart goes out to his young family.

How can this happen? Although I did not know this man, I imagine he saw doctors and had checkups. Perhaps he even had a stress test along the way. There is a disconnect in the identification of early heart disease that is not true of some other important ailments. For example, consider the fact that when you turn 50 you are asked to have a colonoscopy to look directly at the colon for masses. Women are asked to have a mammogram to look directly at the breast for growths. But heart artery blockages, the number 1 cause of sudden death over age 30, are still not looked at directly. The standard recommendations at a physical exam include measuring blood pressure and cholesterol and maybe performing an ECG, all of which are indirect and inadequate examinations of the status of the coronary arteries.

I know there is a better approach, the coronary artery calcium scan (CACS). It is endorsed by the Society for Heart Attack Prevention and Eradication (SHAPE), the American College of Cardiology, and hundreds of peer reviewed research studies.The American College of Cardiology has given a high endorsement (IIA) to the use of CACS in persons with known risk factors for silent coronary disease.

The “mammogram” of the heart, as the CACS is known, is low-cost ($80 in my community) and offers a direct examination of the heart arteries. There is no contrast or IV injection and the test takes about 1 minute.

Who should not have a CACS?

If someone already knows they have coronary artery disease such as a previous cardiac catheterization showing blockage, a previous heart stent, or a previous heart bypass surgery, there would be no need for a CACS. People who know that they have blockage in other parts of the body, like an artery of the brain called the carotid artery or the arteries of the leg, remain debatable candidates for the CACS.

What about risks of the CACS? 

Other than a small out of pocket cost (insurance covered in a few states like Texas), other concerns are the possibility of creating undue stress, missing soft plaque without calcium, and the dose of radiation. For decades, cardiologists have relied on exercise nuclear testing using treadmill examinations. One measure of the dose of radiation is called a milliSievert or mSv. An exercise test with Cardiolite may expose a patient to 12 to 15 mSv of radiation. By comparison, a cardiac catheterization done in an efficient manner may expose a patient to about 10 mSv of radiation. In centers with the most advanced multislice scanners, the imaging has gotten so fast that the radiation dose of a CACS is less than1 mSv and on par with a mammogram.

Furthermore, a new research study has demonstrated that a CACS over 400 adds independent prognostic information even over the most advanced nuclear stress test.

Why do a CACS?

A CACS may provide life-changing information. For example, the European Society of Cardiology said that “there is overwhelming evidence that coronary calcification represents a strong marker of risk for future cardiovascular events in asymptomatic individuals and have prognostic power above and beyond traditional risk factors.” The same position statement indicated that in asymptomatic individuals a calcium score of zero was associated with a very low risk of heart events over the next 3 to 5 years (less than 1 percent per year). Individuals with a coronary calcium score greater than 1000 have an eleven-fold increase in risk of major events even if they are without symptoms. This is a huge difference.

No one should be surprised by heart disease. A CACS at age 40 or 45 can identify if there is a burden of silent calcified atherosclerotic plaque. If silent heart disease is found, a range of measures from plant based reversal diets, exercise, stress management, supplements, and monitoring can be implemented. In my clinic, I monitor patients with abnormal CACS and work on reversing their plaque with all of these strategies. Yes, $80 can save a life (perhaps $150 in your community). Do not wait. Call your local hospitals to see if it is offered, find out the cost, get a Rx from your health care provider, and schedule a CACS today. Finding out your score can help you ride the waves knowing the true status of your heart health.

Dr. Joel K. Kahn, MD, FAAC

Credit: Huffington Post, with permission of Dr. Joel Kahn

What To Eat For Longevity (According To A Major New Harvard Study)

In this piece, renowned cardiologist Dr. Joel Kahn shares what you need to know about eating for optimal health. If you're interested in learning more, check out his mindbodygreen class, Everyday Hacks for Long-Lasting Health: How to Eat, Move & Live for Longevity.

There seem to be more opinions on optimal eating patterns than there are stars in the sky. So when a major scientific contribution to nutrition comes out, it's important to take note.

Such a report was published in a major medical journal this week: It's the largest study ever comparing animal protein sources (red meat, poultry, fish, eggs, and dairy) with plant-based protein sources (bread, cereals, pasta, nuts, beans, and legumes). It examined over 130,000 participants, spanned 32 years, and was authored by some of the world's leaders in longevity and nutrition (Dr. Walter Willett of the Harvard School of Public Health and Dr. Valter Longo of the University of Southern California). In other words: Before you express any opinion on what your breakfast, lunch, and dinner should comprise, you need to pay proper attention to this study first.

Here's what you need to know:

What did the study look at?

A group of 131,342 participants in the Nurses’ Health Study and the Physicians Health Study was followed from as early as 1980 until 2012. They completed questionnaires about their dietary intake, and the follow-up rates were an amazing 95 percent. Overall, there were 36,115 deaths with 8,851 due to cardiovascular disease (CVD), 13,159 from cancer, and 14,105 from other causes.

 

What did the researchers find?

In short, the higher the intake of animal protein sources, the higher the rate of CVD and mortality. In contrast, those who ate more plant-derived protein had lower rates of mortality and, in particular, CVD deaths.

What else should you know?

Participants who were obese and had the highest alcohol intake who also ate animal protein sources had the highest death rates. The association between eating animal protein sources and increased death was strongest for those with unhealthy lifestyles. Those with the unhealthy lifestyles and increased death rates ate more unprocessed and processed red meats, eggs, and high-fat dairy and less chicken, fish, and low-fat dairy. The association of increased death rates in those who consumed more animal protein sources was also stronger in participants with diabetes mellitus.

The researchers calculated that opting for plant protein sources in place of animal protein would greatly reduce CVD deaths. They also found that switching from eggs to plant proteins was associated with a 17 percent drop in cancer deaths.

The strengths of the study were the large sample size, repeated dietary assessments, and high follow-up rates for up to 32 years. The weaknesses included the observational nature of the data.

The bottom line: Eat plants for your protein

The study authors concluded that "high animal protein intake was positively associated with mortality and high plant protein intake was inversely associated with mortality, especially among individuals with at least one lifestyle risk factor. Substitution of plant protein for animal protein, especially that from processed red meat, was associated with lower mortality."

Of course, it's only a matter of time until counterarguments about the advantages of grass-fed and organic sources of animal meats, eggs, and dairy surface. But the data are robust, and the message is clear. Animal proteins, as found in meat, eggs, and dairy, are unaffected by the manner of animal husbandry and there are multiple pathways linking animal proteins to inflammation, disease, and death.

The time is now to limit or eliminate animal protein food sources in favor of the wide range of delicious and healthy substitutes found in every grocery store. We must replace our gluttony for eating animals with responsible and compassionate choices.

Joel Kahn, MD, FAAC

Are Green Juices & Smoothies Actually Healthy? A Cardiologist Explains

Oh, the controversy over green smoothies and juices! Are they great for you...or not so great? Of course, if you're choosing between a green juice and a doughnut, there shouldn't even be a moment's discussion. But beyond that, the web is studded with debates and arguments for and against green juices and smoothies.

As I write this, I'm drinking a cold-pressed juice of chard, kale, celery, cucumber, lemon, and spinach, without added fruit. Am I causing harm or helping my health?

Let's dive into the science. In the last few years, a new system has been identified in our bodies that supports heart health: inorganic nitrates. Leafy greens and some other vegetables, like beets, are rich in them. When we swallow these nitrate-rich vegetables, they are rapidly absorbed in our GI tracts and appear in our bloodstream. They can be converted by the way of enzymes into nitric oxide (NO).

Let's all give a big cheer for NO. This miracle gas is made in the lining of our 50,000 miles of arteries (endothelium). When our arteries produce a lot of NO, our arteries relax, our blood pressure is normal, our blood is less likely to clot, and our arteries resist making plaque. There's another reason to be grateful for NO. When we want to have sex, it's NO that causes blood vessels to dilate and engorge the parts that need to grow. In other words: When you want to say yes to sex, say NO.

So when we eat leafy greens and drink our green juices and smoothies, the dietary nitrates power our blood vessels and improve the overall quality of our lives.

Then what's the controversy? There's an argument that to get the effects of dietary nitrates, our food needs to come in contact with bacteria on our tongue that convert the nitrates to make NO in our arteries. If you quickly gulp your green juices or smoothies past your tongue, you may not permit time for the bacteria to munch on the dietary nitrates.

But there is a secret, second pathway that you should know about. When our blood level of nitrates rise after eating or drinking plant-based nitrate-rich foods, the nitrates enter our salivary gland and are concentrated in our saliva. Our saliva may have nitrate concentrations 10 times that of our blood. How convenient! The green drink we swallowed 45 minutes ago may be secreted right on to our tongue to enjoy the bacteria-nitrate interaction. So if the bacteria don't get your dietary nitrates the first time down, this "entero-salivary" recirculation makes sure they get them the second time around. Is that not amazing?

So, fear not the green juices and smoothies. In fact, enjoy them! (But leave the fruit content low or absent.)

Here's one of my favorite detoxing green smoothies that will make your arteries say Hallelujah.

Ingredients

  • 1 cup green tea, chilled (or 1 teaspoon matcha green tea in water)
  • 1 cup loosely packed cilantro
  • 1 cup loosely packed organic baby kale (or another baby green)
  • 1 cup organic cucumber
  • 1 cup pineapple
  • juice of 1 lemon
  • 1 tablespoon fresh ginger, grated
  • ½ avocado

Preparation

Place ingredients into a blender and puree until smooth.

Joel Kahn, MD, FAAC

The Unexpected Source Of Household Toxins + How To Stay Safe: A Cardiologist Explains

I don't like to be an alarmist. The world is not coming to an end tomorrow. But the fact that we've created a far dirtier planet cannot escape posing some serious concerns.

In my field of cardiovascular disease, air pollution as a trigger for heart attack and death is rarely mentioned but is highly supported by quality research. Indeed, in a rather shocking analysis, living near a freeway was equated as a health risk to passively smoking 10 cigarettes a day. And the famous Framingham Heart study recently added to the huge database of research studies by identifying a relationship between air quality and cardiovascular inflammation.

So, perhaps like you, I hold my breath as long as possible when a truck or bus burps dark black fumes on the sidewalk—and I will not visit Beijing without a gas mask!

Of more immediate concern is indoor air pollution, right in your own home. The World Health Organization recently published a document that shocked me with statistics that might just push me into alarmist mode. Some of the facts they report on air quality in our homes and health include:

  1. Around 3 billion people cook and heat their homes using open fires and simple stoves burning biomass (wood, animal dung, and crop waste) and coal.
  2. Over 4 million people die prematurely from illness attributable to the household air pollution from cooking with solid fuels.
  3. More than 50 percent of premature deaths due to pneumonia among children under age 5 are caused by the particulate matter (soot) inhaled from household air pollution.
  4. There are 3.8 million premature deaths annually from noncommunicable diseases including stroke, heart disease, chronic obstructive pulmonary disease (COPD) and lung cancer that are attributed to exposure to household air pollution.

Did you read the same words I read? Over 4 million people a year die from illnesses related to household air pollution. Of these deaths, 60 percent are due to stroke and heart disease—the conditions that I, as a cardiologist, am striving to prevent at all costs!

Two scientific studies have looked at the utility of high-quality air filters in the home to reduce indoor air pollution and heart disease measures, with different results. One demonstrated some reduction in the impact of nearby traffic air pollution in a residence using an air filter while another failed to show any benefit. A recent review on the topic favors a home air filter, with benefits for conditions from asthma to blood pressure. But clearly the jury is still out on the topic.

Until there is more information, here are five simple steps you can use to keep your indoor pollution down:

1. Keep your floors clean with door mats, regularly mop to pick up the dust, and use a vacuum with a HEPA filter.

2. Keep your home lower in humidity, as mites and mold love moisture. Fix leaky plumbing, vent the clothes dryer, don’t overwater plants, and use an exhaust fan when cooking, bathing, or running the dishwasher.

3. Make your home a no-smoking zone—that includes a wood-burning fireplace and grilling indoors. Do not have indoor fires whether for pleasure, heat, or cooking.

4. Test for radon periodically, which is linked to lung cancer and is odorless. This is true whether your home is new or old. Granite countertops have been linked to radon.

5. Avoid fragrances that use synthetic and volatile organic compounds (VOCs) that plug in, get thrown in the dryer, or are sprayed in the bathroom. Enjoy natural good smells as much as possible.

Considering all this, I've placed a powerful HEPA air filter in my bedroom. I have two rescue dogs that sleep on my bed every night after visiting every bush and flower bed all day long. Plus, the windows are open with screen doors blowing in all kinds of outside matter that I'd rather be filtered out. And I'm guilty of not taking my shoes off at the door (despite my wife’s reminders). I take comfort in knowing that the low-grade hum of a HEPA filter I hear at night is circulating and filtering the air I breathe. It may be a consideration for your home, too.

Joel Kahn, MD, FAAC