Trump's "excellent" health

[Vegan-Vegan]

he did have a calcium test and scored 133. Anything over 100 indicates heart disease.

[bbq]

Dr. Lewis Kuller, professor of public health at the University of Pittsburgh School of Medicine as a result of his decade long cardiovascular health study made the following statement: “All males who are 65 years of age and all females who are 70 years who have been exposed to the typical western diet have cardiovascular disease and should be treated as such.”

A 1999 autopsy study of young adults in the US between the ages of 17 and 34 years of who died from accidents, suicides, and homicides confirmed that coronary artery disease (CAD) is ubiquitous in this age group.

Trump’s Physical Revealed Serious Heart Concerns, Outside Experts Say
https://www.nytimes.com/2018/01/17/us/politics/trump-physical-heart-health-cholesterol.html





President Trump has common form of heart disease
http://www.cnn.com/2018/01/17/health/trump-heart-disease-gupta/index.html

His score is 133, and anything over 100 indicates plaque is present and that the patient has heart disease. According to Trump's official medical records, in 2009 his coronary calcium score was 34. In 2013, it was 98.

Jesus Christ:

Jackson has already increased the dosage of the Trump's cholesterol-lowering medication and recommended a low-carbohydrate and low-fat diet, along with an exercise regimen.

[Lyndzie]

I thought we weren't going to talk about the President anymore?

[Skip]

To those so concerned about cholesterol levels, apply what you learn here.

What we learn here is that a starch based diet with fruit and vegetables leads to a healthy outcome. What we learn here is that this diet reduces/eliminates the need for statin drugs to control a high total cholesterol level. What we learn here is that a moderate amount of exercise is healthy for us.

Trump does not exercise, has a terrible diet, is overweight/obese, with an increasing calcium score of 133 and takes statins to try to control his high cholesterol. That combination does not bode well for his current and future health.

Jim said to avoid politics on this thread but even the picture of Trump's health becomes political between doctors assessing his current/future health status.

[bbq]

That's incredible:

https://www.theatlantic.com/health/archive/2017/12/trump-eats/547355/

“Trump’s appetite seems to know no bounds when it comes to McDonald’s, with a dinner order consisting of two Big Macs, two Filet-O-Fish, and a chocolate malted.”

This 2,400-calorie meal is among the details in a forthcoming book by Trump’s former campaign manager Corey Lewandowski and aid David Bossie, as described in a preview by The Washington Post.

A dinner of that size would offer caloric energy for a full day. The 3,400 milligrams of sodium more than doubles the American Heart Association’s recommendation of 1,500 milligrams per day. The meal provides almost no fiber—and also offers more white bread than anyone would do well to eat in a week. This is all ominous for the president’s cardiovascular system.

So is the lack of variety. The book’s authors, who traveled with Trump early in his presidency, write: “On Trump Force One there were four major food groups: McDonald’s, Kentucky Fried Chicken, pizza, and Diet Coke.”

https://books.google.com/books?id=2kU7DwAAQBAJ&pg=PT73

When you flew with Trump, you flew first class times ten.

Except, that is, when it came time to eat.

The first time Dave told his wife Susan that he was going to be on Trump Force One, she asked him to take some photos of what they served him to eat on the plane. She had read somewhere that Mr. Trump had a personal chef who traveled with him. When dinner came on the flight, Dave pulled out his BlackBerry and snapped a picture of the bag of McDonald’s hamburgers and unopened package of Oreo cookies and emailed it to Susan.

On Trump Force One there were four major food groups: McDonald’s, Kentucky Fried Chicken, pizza, and Diet Coke. There were also ancillary groups, including Vienna Fingers and the ubiquitous Oreo, before the boycott (after it was Hydrox). The reason the package of Oreos was unopened was because Mr. Trump would never eat from a previously opened package. If you’ve seen the Seinfeld episode in which George double-dips his chip, you have a pretty good idea of the boss’s reasoning. Packages of cookies, along with small airliner-size bags of pretzels and potato chips, filled the plane’s cupboards. An army might march on its stomach, but Trump’s team flew on junk food. And those snacks would have to sustain us during long flights and even longer days.

https://books.google.com/books?id=2kU7DwAAQBAJ&pg=PT75

One time in Chicago, when our motorcade blew through red lights with a police escort, the boss’s dinner—two Big Macs, two Fillet-O-Fish, and a chocolate malted—sat in bumper-to-bumper traffic. In times like that, the “run” would become like a scene out of Fast and Furious: burning rubber, up on two wheels, donuts. Well, close to that.

[Risto]

Seems pretty obvious to me that Trump's reported height and weight of 6'3'' and 239 lbs are not true. That's alarming, as it throws the rest of the statement in question - in my mind, anyway. The medical doctor is a Navy officer as I understand it, and Trump is his Commander in Chief. I imagine it would not be difficult to put pressure on the doctor if he doesn't get the hint as to what to do.

As everyone has pointed out, the height and weight numbers put Trump just shy of the obese category in the conventional BMI classification, which seems exactly the sort of thing Donald Trump obsesses about.

[bbq]

I'm trying hard not to be Captain Obvious:

[vgpedlr]

I thought we weren't going to talk about the President anymore?

I am commenting on this as an example of health and risk for anyone. I don't see how his cholesterol numbers can qualify as "excellent health" despite other indicators. My understanding is that doctors try to lower cholesterol below 200. To have those numbers with medication suggests significant CVD. While it may be common, I don't see how a doctor, even with their lax standards can call that "excellent." And 200 doesn't indicate much protection either, as there are plenty of events below that threshold. Enough that the LC folk believe cholesterol doesn't matter. Also, cholesterol levels indicate risk for other diseases, such as cancer, even without a causative role. I believe this is because cholesterol is a good indicator of a lifestyle's healthfulness.

In regards to ANY president (not just Trump) I do not believe negative health information would be released to th e the public reasons. Think of Roosevelt's polio, Reagan's Alzheimer's rumor, or Obama's smoking.

The political taboo came as a result of vitriolic political argument during the election period like everywhere else. It had nothing to do with health, and ushered in a lot of truly off topic political posts. It drove away some good people.

However, on the topic of this president, I suppose the personal chef has a pretty easy job! Ordering pizza and hitting the drive through can't too demanding!

[bbq]

The change was remarkable:







Speaking of Dr. Ornish, let's see if Harper were actually walking the talk:



https://books.google.com/books?id=_5kmDwAAQBAJ&pg=PR15

I've had teams of doctors giving me diet advice and exercise plans. One of my doctors, Dean Ornish, M.D., is brilliant, and he formulated a diet plan that I followed immediately after the attack. It started out vegetarian, really watching my fat intake. Slowly, I incorporated more nonfat plain Greek yogurt and egg whites into my nutritional regimen. Then other foods followed.

I've used the information Dean Ornish and other doctors taught me, along with everything I've learned in all my years in the health-and-fitness industry, to craft the very best, well-rounded diet plan for all of you. This plan will help you lose weight and keep you healthy. It's not just for people with heart problems. The Super Carb Diet is for everyone.

[GeoffreyLevens]

The final bit of this article applies very well here~

Trump’s doctor says he has ‘incredible genes.’ Will they keep protecting his health?

...Sometimes being lucky can trump living unhealthily.

But not necessarily forever. “If you have protective genetic factors but adopt unhealthy lifestyle habits, it will weaken the genetic benefits you were born with,” Newton-Cheh said. “You can still do yourself in.”

How badly? People with a high genetic risk for atherosclerosis but a healthy lifestyle had a 5.1 percent risk of suffering a heart attack over a 10-year period, Kathiresan said. People with a low genetic risk, perhaps like Trump, and an unhealthy lifestyle had a 5.8 percent risk.

[pundit999]

The president has pretty high LDL and substantial calcium in the arteries.
He however passed a stress test and his EKG is fine.

He does have heart disease. It just has not progressed to the point where he is showing symptoms.
A lot of times, the first symptom is a heart attack which many do not survive.

I was talking to a cardiologist the other day and he said that the patient can pass the stress test in the morning and drop dead of heart attack by the evening.

Since the president does not appear to have a family history of heart attacks, he may be protected. But he should make life style changes to keep heart attacks at bay.

[f1jim]

Not to mention that heart disease is just one issue resulting from a poor diet. Chronic diseases of all kinds follow the typical Western diet and usually end up showing in one form or another. Maybe not heart disease, maybe diabetes, maybe autoimmune issues, who knows.
f1jim

[Spiral]

The last time a President of the United States had a heart attack while serving in office was when President Dwight David Eisenhower suffered a heart attack. Low-carb advocate Gary Taubes attempted to blame a "low-fat" diet in his book "Good Calories, Bad Calories." But this video sets the record straight.

[soulnurturer]

You do have to admit the man has more energy than a slim healthier vegan for his age. Heck, for most men half his age. And he's been able to enjoy his steak and ice cream every day.

[GeoffreyLevens]

Trump's CVD Prevention Strategy and Risk

Trump's CVD Prevention Strategy and Risk
Cardiologists, nutrition specialists discuss his risk level and best management

by Roger Sergel, Executive Producer, MedPage Today
January 18, 2018

Presidential physicals often offer opportunities for discussions of important public health issues. President Trump's physical is no exception. His borderline obesity and high cholesterol led his doctors to recommend a program of weight reduction and exercise. But Trump's doctors face the the same challenges as many physicians in trying to get their patients to exercise and lose weight in order to move the needle on their cardiovascular risk. We invited specialists in cardiology and diet and nutrition to comment on three questions surrounding the Presidents physical. Several, without being asked, also offered comments on Trump's individual cardiovascular risk that we also share below.

What do you say to borderline obese patients who seem amenable to lifestyle change but reject exercise?

Martha Gulati, MD, Chief of Cardiology, University of Arizona College of Medicine-Phoenix, and Editor-in-Chief, CardioSmart for the American College of Cardiology:

"For all patients, but particularly obese patients, all lifestyle changes are important.

I would say that diet for weight loss matters most. So if the goal is for President Trump to get his weight down, eating less and eating better is key.

I still would advocate for him to exercise for the cardiovascular benefits, independent of weight loss. He needs to move more and sit less. Perhaps what might be easiest for him is to count steps and have more walking meetings. Perhaps that won't feel like exercise to him. But then aim for 10,000 steps a day. But he needs exercise to raise his heart rate and work that muscle. Golf isn't bad exercise -- if he walked the course!

The impact that lifestyle changes can have on health is highly underrated. We need this advice for most patients, and this includes the president. Wouldn't it be great if he showed the rest of the country he can do it and be the example that they might follow.

Paul D. Thompson, MD, Chief of Cardiology, Hartford Hospital:

Even small amounts of weight loss can have quite beneficial effects on such cardiovascular risk factors as blood pressure, triglycerides, and blood sugar. The bad or LDL cholesterol level also decreases during weight loss and when the caloric balance is negative, but the unfortunate fact is that it often rebounds to the baseline level once the person reaches a new stable weight. The other great benefit of weight loss is that it decreases stress on the joints in the hips and legs so probably prevents the arthritis that occurs in many folks with aging.

Something else that is often overlooked is that small amounts of exercise can produce remarkable benefits in cardiovascular risk. Actually, the biggest improvement with exercise, as shown by epidemiologic studies, is when one goes from having no to even a little bit of exercise. Indeed, the CDC recommends 150 minutes per week, or approximately 22 minutes a day of moderate exercise such as walking. Most folks can do that and probably would accrue considerable lifetime benefit.

William T. Abraham, MD, Director, Division of Cardiovascular Medicine,The Ohio State University:

President Trump may be onto something here. The totality of data on weight loss, including systematic reviews of many studies, indicates that diet is more effective than exercise in promoting weight loss. Think about this and it makes sense. It is far easier to avoid the 1,000 to 1,200 calories in the typical fast-food deluxe cheeseburger and large fries, than it is to exercise it away. It would take approximately 2 hours of moderate to high intensity exercise on the treadmill to negate this caloric intake. Of course, the combination of diet and exercise may be more effective than either weight loss strategy alone, and regular exercise has health benefits that far exceed its effects on weight loss.

Robert H. Eckel, MD, Professor of Medicine,University of Colorado Denver Anschutz Medical Campus, past president American Heart Association:

Reducing weight by eating less is my first recommendation. Let's focus on getting weight off first and then becoming more active to help keep it off.

Jim Januzzi, MD, Director, Dennis and Marilyn Barry Fellowship in Cardiology Research, Massachusetts General Hospital:

It turns out while exercise, stress reduction, and getting sleep are all important to foster weight loss, the single most important aspect involved in weight loss is reduction of caloric intake. Without reducing what one eats -- and what one eats -- it is impossible to substantially lose weight. Thus, the optimal strategy is a combined approach of exercise, stress reduction, improved sleep hygiene, and a nutritional approach reducing simple carbohydrates, saturated fats and total calories.

What success rate do you expect for patients with goal of 5% loss of body weight in one year?

Meir Stampfer, MD, DrPH, Professor of Epidemiology and Nutrition, Harvard T.H. Chan School of Public Health:

It is much harder to lose weight without some increased physical activity in addition to the diet. A 5% loss is certainly feasible, if he sticks with it. I do not know dietary advice he got -- a Mediterranean diet with some attention to restraint could lead to 5% loss, but many diets do not work long term.

Carl "Chip" J Lavie, MD, Medical Director, Cardiac Rehabilitation and Preventive Cardiology, John Ochsner Heart and Vascular Institute:

There is very low success with 5% weight loss, but much better with 2%-3% , and we have published in Obesity last year that 3%-4.9% is still clinically meaningful with exercise training ... [H]e is not likely to adapt meaningful increases in physical activity and exercise. Unless he has significant dyslipidemia, glucose abnormalities, hypertension, or high inflammation, his prognosis at this weight should be quite good. If he had a test for fitness ( I suspect he probably has done a fitness stress test) and was found to be relatively fit, which is what I would suspect, then his prognosis would be excellent as my colleagues and I explained in a paper in JAMA.

Connie Diekman, MEd, RD, Director of University Nutrition, Washington University in St. Louis:

Weight loss is easy to accomplish, what is most important is establishing healthy behaviors that allow for maintenance of that loss. A 5% weight loss is not a large amount of weight – for someone who is 200 pounds this would be 10 pounds in one year.

Losing 5% of body weight – hopefully fat mass, not muscle mass – can be accomplished in a year if an individual develops better eating habits – boost intake of plant foods like beans, nuts, vegetables, whole grains and limit animal fat intake and added sugars while learning proper portions – and if they get regular physical activity.

Pamela Douglas, MD, Professor of Medicine, Duke University School of Medicine, Past President of the American College of Cardiology:

For patients in their 70s who do not also choose to exercise, significant and durable weight loss is highly unlikely. However, it also depends on the current diet and what can be changed. The president is in an unusual situation in that he has access to full time chefs and other professionals who can custom tailor a diet.

Dean Ornish, MD, Founder & President, Preventive Medicine Research Institute:

Medicare and many insurance companies are covering my program for reversing heart disease in a new benefit category (as of 2011), "intensive cardiac rehabilitation."

In our earlier randomized, controlled trial, in JAMA ... patients lost 10.9% of their body weight during the first year (from 91.4 kg to 80.74 kg).

So, a 5% loss of body weight in one year is achievable for many people. Our intensive cardiac rehabilitation program is 9 weeks long. After one year, we are achieving 85%-90% adherence in all sites.

How much of an impact does 5% weight loss have on cardiovascular risk?

Howard S. Weintraub, MD, Cardiologist, New York City:

The expectations of benefit from a 5% weight loss would not be profound. Many people would look for a weight loss of at least 8%-10% before there was likelihood of major metabolic change.

What is the president's cardiovascular risk?

Martha Gulati:

Let me also comment on his risk. I know the physician who examined him says he was in excellent health. But he is NOT low risk. I calculated his ASCVD risk score using the numbers released on his lipids and blood pressure (I found they reported total cholesterol 223 HDL 67 LDL 143 systolic BP 122 for age 71 white male). His 10-year ASCVD risk of a cardiovascular event even while on his statin is very high. It is 16.7%. So I agree with the physician increasing his statin dose (I presume from a low or moderate dose to a high-intensity dose) but this will probably only lower his 10-year risk to about 13% based on our prediction model. It appears his LDL has climbed significantly despite being on a statin and this is affected by his diet and sedentary lifestyle. So if he can improve his diet, lose weight, and follow a DASH diet, his health will likely improve. Even his blood pressure (based on our new guidelines) is in the elevated range, and a better diet/DASH diet and weight loss will help that too. He needs to remove fast food from his diet and introduce more vegetables and fruit into his diet. Certainly not getting two servings of ice cream would help. Cutting out dessert most days would help further. He is lucky. He has a chef who can prepare healthy, tasty nutritious foods that are low in salt and consistent with the DASH diet.

Howard Weintraub:

The commander-in-chief has an elevated 10-year risk based upon the MESA calculations and upon the Pooled Cohort Equation. Based on the MESA data his coronary calcium score places him at approximately the 50th percentile for men of his age. Hence, he has at least a 50% chance of dying from cardiovascular disease. Based on everything we know now I think there is reason to question how good his genetics are. His diet is not good, and it is reflected in a rising coronary calcium score. He is certainly not immune to the cardiovascular effects of hyperlipidemia and a rising BMI. It would appear that even though his HDL is high it does not appear to be protecting him from coronary atherosclerosis. Along with greater emphasis on lifestyle modification his dose of statin should probably be increased significantly, based on the recommendations from the Pooled Cohort Equation.

Jim Januzzi:

Independent risk factors for major adverse cardiovascular events have been well established, and are unfortunately quite evidently present in our president. These include stress, anger, poor nutrition, and obesity. It's worth pointing out his form of obesity, namely abdominal in location, is particularly linked to adverse cardiovascular events.

Chris Cannon, MD, Senior Physician, Brigham and Women's Hospital:

An area of interest for me is his target LDL. Given that his calcium score is 139, he has non-obstructive ASCVD, so having an LDL <70 mg/dL would be ideal. Thus, a higher dose of rosuvastatin, and maybe adding ezetimibe if needed.