Introduction

Dr. Bob: And welcome to The Dr. Bob Show. Thank you so very much for taking your time to learn a little bit more about how to be healthy and how to be happy. We've got a jam- packed 30 minutes for you-lots of information. Most of the show we'll be talking about how to prevent heart attacks. You know, there are certain risk factors that you have and if we can alter those risk factors, then maybe we can keep you from having a heart attack. I have an outstanding guest, a long-time friend of mine, Dr. George Krisle. Dr. Krisle is a board-certified cardiologist and we'll be learning about how to prevent heart attacks.

Dr. Bob: Hello, I'm Dr. Bob Overholt and I'll be your host for the next 30 minutes. After we spend some time talking about preventing heart attacks, I'm going to talk to you about the ten things that might ruin your health. We'll be talking about obesity, eye exams, colon problems. We'll be talking about exercise, cigarette smoking, cholesterol-lots of things that we'll be talking about that will help improve your health. So you'll want to stay tuned and remember before we get started, are you should be doing those things that we mention every week, exercising 20 minutes, getting 8 hours sleep, starting the day off with a good breakfast and most of all, we like laughter in your life. Stay tuned we've got a lot of information.

Dr. Bob: We're talking about how to prevent heart attacks. Our guest is Dr. George Krisle. George, welcome to The Dr. Bob Show.

Dr. Krisle: Yes, thank you.

Dr. Bob: Tell me about preventing heart attacks. First, what's going on in the heart with a heart attack?

Dr. Krisle: At the time of a heart attack, the flow through one of the coronary arteries or heart arteries that supplies the heart muscle loses flow. It shuts down…gets clogged up. It's like rust in the pipe and when not enough oxygen circulation gets to the heart muscle, it dies and that's what a heart attack is. But it dies just temporarily if flow can be restored promptly.
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Dr. Bob: And that's a key issue in modern cardiology, isn't it?

Dr. Krisle: Yes sir. Yes sir. You want to always get in there quickly so you can restore flow and save heart muscle. That's called the golden hour. The quicker you get in there, the better the outcome will be.

Dr. Bob: Now, let's talk about in heart attacks or heart disease, there are certain risk factors. Let's list those. What are the risk factors that people have?

Dr. Krisle: The number one risk factor is cigarette smoking. There is something in the cigarette that causes the heart artery to clog up or constrict or spasm so cigarette smoking is our number one bad guy when it comes to getting after the heart and causing a heart attack. High blood pressure is a risk factor. Diabetes is a risk factor. High cholesterol is a risk factor, as are obesity and sedentary lifestyle.

Dr. Bob: So, those are the main risk factors. Let's go back to smoking because it's something that I've heard you talk about before. Get rid of those cigarettes! If somebody has a heart attack, what do you tell them if they continue to smoke?

Dr. Krisle: When the heart attack occurs, that's sometimes referred to as the teachable moment. Even the most stubborn of us will realize when the heart attack comes, oh, this may be the end, I better start doing things right. Just tell people if they smoke, they are going to double, even triple their risk for another heart attack. Stop smoking and we're going to have a great chance to have a great outcome for a long time.

Dr. Bob: And what about if somebody hasn't had a heart attack and they are not so teachable at that time, how do you in your practice influence people to stop smoking?

Dr. Krisle: Go with the facts and once people understand that this is something you can do to help your health, they might listen. For example, there are risk factors we can't change. We can't change the fact that we're getting older. Men can't change the fact that they are men although women are catching up to us in the heart attack field. So there are some things you can't change. Family history you cannot change but cigarette smoking you can. That's something we do to ourselves and that's something we can stop doing in order to have a healthier, longer life.

Dr. Bob: Now, we know that cigarettes are truly addicting. How do you advise patients to stop?

Dr. Krisle: Two ways. One way is the kind of step-down method over four to six weeks. People have tried gum and patches and things like that. Wellbutrin or Zyban is available. Those help some people and in our practice and in our experience, the best success comes from someone who says, "Today's the day. I'm going to stop. That's it." And they just stop. They go through three or four weeks of withdrawal, it's kind of heck on wheels there for a while but once they get through the four weeks, then you've got it made.

Dr. Bob: Is that one of the most important things to stop smoking as far as risk factors go?

Dr. Krisle: Yes sir. That is essential.

Dr. Bob: Now, let's talk about blood pressure. Why does high blood pressure put somebody at risk for a heart attack? We think that with high blood pressure they may stroke out but why would they have a heart attack?

Dr. Krisle: They will stroke, but it also puts an extra burden on the heart. The heart is a muscle. It's your strongest muscle. It beats a 100,000 times a day and multiply that by 70 years and the higher the blood pressure, the harder it is for the heart muscle to work. So ideally, you would like your blood pressure to be 130/80, 120/70, maybe even 110/70 because it makes it easier for the heart muscle to pump.

Dr. Bob: Now, what if somebody comes into your office and says, "Seeing a cardiologist scares me, you know. The only time I get a high blood pressure is when the doctor takes my blood pressure." What do you tell those patients?

Dr. Krisle: Right. That's called white coat hypertension. You see a funny looking guy in a white coat and your blood pressure goes up so it's a good idea to document your blood pressure at home, provided the equipment is accurate. So, bring the equipment into your physician's office and make sure it's accurate based on the readings that the equipment gets. Record it at home once or twice a week. It doesn't have to be overdone. Bring in the readings or fax them into your doctor and then you can see what your ambulatory, natural blood pressure is. Still, it's important to know that there're some studies that say if the blood pressure is elevated in the doctor's office, we still need to pay attention to that.

Dr. Bob: Tell me, is there one outpatient blood pressure cuff that you like better than others or do you just go to your drugstore and rely on the pharmacist?

Dr. Krisle: Ask them which one they recommend, which one's the best, but whatever you get, make sure it's standardized for accuracy by comparing it to the recording that the physician or nurse gets in the office.

Dr. Bob: Good medicines to help lower blood pressure?

Dr. Krisle: Yes sir. Yes sir.

Dr. Bob: There are five different families of medicines and do you find that those medicines adequately control your patient's blood pressure?

Dr. Krisle: Yes. You know, you've got to remember that 50% of people can get a good blood pressure with one medicine, 75% of people with two, and about 95% will get control with three or triple therapy. So, you may need three different classes of medicines. As long as one of them is a beta-blocker, you can almost always get to the right goal.

Dr. Bob: Now, let's get away from blood pressure and let's talk about diabetes. You mentioned that. Where does diabetes fit with prevention? Diabetes, I thought, is high blood sugar. What does that have to do with heart attacks?

Dr. Krisle: Diabetes is high blood sugar but the biggest health risk for diabetics has to do with the circulation, especially heart attacks and it's taught now in the recent studies that an individual with diabetes has ischemic heart disease, has blockage. So, diabetes is considered equivalent to blockage to the circulation even in the absence of symptoms.

Dr. Bob: Wow! So, diabetes in itself is like you may already have some heart damage or do you assume they do?

Dr. Krisle: Wouldn't necessarily have to have damage to the heart muscle but you could have blockage in the heart circulation that could ultimately cause heart damage.

Dr. Bob: So, what does a person do who has high blood sugar?

Dr. Krisle: Diabetes means great treatment, aggressive treatment, one aspirin a day. It means getting the blood pressure to 120/70 and it means a careful work-up such as a treadmill stress test with your physician to see where you stand. And do that each year to compare and see if there're changes in the heart circulation.

Dr. Bob: And the literature shows that if somebody gets their blood sugar under good control with medications, they exercise, and change their diet, that the blood vessel problems don't cause heart problems or do they?

Dr. Krisle: They do but do later. A tight control or optimal control really, really good control of diabetes will forestall or prevent the complications from occurring early but they may occur down the road.

Dr. Bob: Now, how about cholesterol. Is cholesterol a risk factor?

Dr. Krisle: Cholesterol is a key risk factor.

Dr. Bob: Good because that's what we're going to be talking about in a minute. We'll be talking about where cholesterol plays a part. But first, let's look at a patient who had risk factors themselves and see what they did.

Ned: Michigan State University.

Dr. Bob: Michigan State. Is that big orange?

Ned: Big green!!!

Dr. Bob: Big green!

Ned: Green and white (laughter).

Dr. Bob: Did you play sports at Michigan State?

Ned: I sure did. I was a collegiate swimmer there.

Dr. Bob: So, you swam how far every day?

Ned: Oh, approximately seven to ten thousand yards, approximately five miles a day.

Dr. Bob: Five miles a day, every day. When you got out of college and you quit swimming four to five miles every day, what happened to your weight?

Ned: My weight ballooned, so to speak because I quit exercising and I didn't do any exercise on my own immediately following my career.

Dr. Bob: What was your weight when you swam?

Ned: When I swam, my weight was anywhere from 190 to 195.

Dr. Bob: And what did you get up to?

Ned: 255.

Dr. Bob: Two hundred and fifty-five pounds?

Ned: Two hundred and fifty-five pounds.

Dr. Bob: And how much weight did you lose?

Ned: At that time I lost about 60 lbs.

Dr. Bob: So, you lost 60 lbs. Have you ever been concerned about having a heart attack at your age?

Ned: I never was really concerned about it. I know that when I was so heavy, my resting heart rate was 120 which was not good.

Dr. Bob: And what was it when you were swimming?

Ned: When I was swimming, it was probably about 60. I doubled it.

Dr. Bob: OK, and now that you have been exercising regularly, what's your resting rate?

Ned: Steady about 72.

Dr. Bob: Isn't that wonderful?

Dr. Bob: Working on those risk factors can definitely improve your health. Now, let's summarize. We're talking to Dr. George Krisle, board-certified cardiologist. We've talked about risk factors. The first that we talked about is smoking-gotta stop. High blood pressure-gotta get it under control. Diabetes-if you've got diabetes, you're assumed to already have ischemic heart disease. Get that blood sugar under control and be sure that you're working out a program with your doctor. Now, let's go to cholesterol. We mentioned that last. Tell me about cholesterol and risk factors.

Dr. Krisle: Right. Hypercholesterol or cholesterol that's too high is a critical risk factor because it can be corrected and fixed and when it's fixed, you can live a longer life. And remember the numbers. There're three numbers to remember: one's the total cholesterol, and you want that under 200; the second is the LDL cholesterol, and you want that under 100.

Dr. Bob: Now, do you call the LDL the "lousy cholesterol?"

Dr. Krisle: Right. The LDL is the bad cholesterol. You can remember it because L and lousy start with L and HDL is the happy good cholesterol. You want that as high as it can be and the recent guideline recommendations used to say 35 and now that's been changed to 40 and in reality, you want it to be as high as it can be because it protects the heart circulation.

Dr. Bob: How does it protect the heart?

Dr. Krisle: It's a reverse cholesterol transport and you have to know a lot of metabolic pathways to understand how it does this, but it's sort of like an anti-rust or protector for keeping all the LDL, bad cholesterol, from getting plugged up in the artery.

Dr. Bob: Now, I've heard that the HDL can actually reverse some of the damage that's been done to blood vessels. If they've got a lot of cholesterol deposition, it can pull it out. Is that right?

Dr. Krisle: Right. That's called regression. If you think of the plaque as narrowing, let's say 90% of the artery, then if you can be a vegetarian, and an exercise guru, and take a statin to get your cholesterol really low, the plaque may get smaller so that the blockage is 80% or 50% or 30%. And that's called regression. And the other thing to remember about the statin medications in terms of cholesterol reduction is that not only will it make your cholesterol numbers better but there are some exciting studies that suggest it may help stabilize the inner lining of the artery. And that's called the endothelium and statins may make the endothelium kind of a happy camper and so if there is any plaque there, it may not rupture and cause a heart attack.

Dr. Bob: Now, the numbers that you mentioned, are those the newest guidelines?

Dr. Krisle: The current guidelines are less than 200 for total, less than 100 for the LDL (lousy cholesterol), greater than 40+ or higher for HDL. Really, really what we're going to be looking at pretty soon is trying to get the total cholesterol under 160.

Dr. Bob: Are most cardiologist taking statin drugs?

Dr. Krisle: That's asked in the meetings and ten years ago you'd go to the meeting and just a few hands would go up and now over half the hands in the room go up. So, yes, the answer is yes, we are.

Dr. Bob: Is there some literature that shows that if you have a normal cholesterol, normal HDL, and normal LDL that taking statins still might help that person?

Dr. Krisle: If that person had a heart attack, you can put forth the theory that no matter how good the numbers look on paper, the artery is not happy with those numbers so we need to treat the patient and not just the numbers. So, yes, you can offer statin therapy to people who have had a heart attack if the cholesterol is normal and you can still make it better.

Dr. Bob: So have you found any patients that statins didn't bring down the cholesterol?

Dr. Krisle: It always makes the numbers better. You do have to check your liver test about every six months and if you get any severe muscle aches, you have to report in to your doctor right away but the balance is way toward the good.

Dr. Bob: Next risk factor. Let's go away from cholesterol and let's walk into sedentary lifestyle. What about somebody that's a couch potato?

Dr. Krisle: Right. Exercise is a great, great benefit for the heart and there is some information now when you're out there doing your 25-30 minute walk, you're not only feeling better because you're walking, you're helping with weight control. But certainly the endothelium, the inner lining of the artery, is happy with exercise. It may release something called nitric oxide, NO, nitric oxide, and it makes the artery smoother and happier and less likely to spasm or constrict so there's a lot to be said for exercise, especially since it's something we control. We can do it to ourselves.

Dr. Bob: When you use the word aerobic and anaerobic exercise…is that what helps make this endothelial layer happier-when you push your heart rate up? or just any kind of exercise? or are they not sure yet?

Dr. Krisle: Traditionally, aerobic exercise has been favored, which means in motion-walking, swimming, jogging, bicycle riding. The old-timey, grunt and groan, 500 pound barbell exercises are not as good for the heart.

Dr. Bob: And any type of exercise that you recommend? Swimming, walking, bicycle riding…?

Dr. Krisle: Walking is great as long as it's done 365 days a year except leap year and then we need 366 days.

Dr. Bob: So, you're a firm believer in everyday activity and…

Dr. Krisle: Yes sir.

Dr. Bob: How long?

Dr. Krisle: 25-30 minutes minimum. If you've got 45 minutes, you can probably cover three miles and that would be great.

Dr. Bob: Working on those risk factors can definitely improve your health. Now, let's summarize. We're talking to Dr. George Krisle, board-certified cardiologist. We've talked about risk factors. The first that we talked about is smoking-gotta stop. High blood pressure-gotta get it under control. Diabetes-if you've got diabetes, you're assumed to already have ischemic heart disease. Get that blood sugar under control and be sure that you're working out a program with your doctor. Now, let's go to cholesterol. We mentioned that last. Tell me about cholesterol and risk factors.

Dr. Krisle: Right. Hypercholesterol or cholesterol that's too high is a critical risk factor because it can be corrected and fixed and when it's fixed, you can live a longer life. And remember the numbers. There're three numbers to remember: one's the total cholesterol, and you want that under 200; the second is the LDL cholesterol, and you want that under 100.

Dr. Bob: Now, do you call the LDL the "lousy cholesterol?"

Dr. Krisle: Right. The LDL is the bad cholesterol. You can remember it because L and lousy start with L and HDL is the happy good cholesterol. You want that as high as it can be and the recent guideline recommendations used to say 35 and now that's been changed to 40 and in reality, you want it to be as high as it can be because it protects the heart circulation.

Dr. Bob: How does it protect the heart?

Dr. Krisle: It's a reverse cholesterol transport and you have to know a lot of metabolic pathways to understand how it does this, but it's sort of like an anti-rust or protector for keeping all the LDL, bad cholesterol, from getting plugged up in the artery.

Dr. Bob: Now, I've heard that the HDL can actually reverse some of the damage that's been done to blood vessels. If they've got a lot of cholesterol deposition, it can pull it out. Is that right?

Dr. Krisle: Right. That's called regression. If you think of the plaque as narrowing, let's say 90% of the artery, then if you can be a vegetarian, and an exercise guru, and take a statin to get your cholesterol really low, the plaque may get smaller so that the blockage is 80% or 50% or 30%. And that's called regression. And the other thing to remember about the statin medications in terms of cholesterol reduction is that not only will it make your cholesterol numbers better but there are some exciting studies that suggest it may help stabilize the inner lining of the artery. And that's called the endothelium and statins may make the endothelium kind of a happy camper and so if there is any plaque there, it may not rupture and cause a heart attack.

Dr. Bob: Now, the numbers that you mentioned, are those the newest guidelines?

Dr. Krisle: The current guidelines are less than 200 for total, less than 100 for the LDL (lousy cholesterol), greater than 40+ or higher for HDL. Really, really what we're going to be looking at pretty soon is trying to get the total cholesterol under 160.

Dr. Bob: Are most cardiologist taking statin drugs?

Dr. Krisle: That's asked in the meetings and ten years ago you'd go to the meeting and just a few hands would go up and now over half the hands in the room go up. So, yes, the answer is yes, we are.

Dr. Bob: Is there some literature that shows that if you have a normal cholesterol, normal HDL, and normal LDL that taking statins still might help that person?

Dr. Krisle: If that person had a heart attack, you can put forth the theory that no matter how good the numbers look on paper, the artery is not happy with those numbers so we need to treat the patient and not just the numbers. So, yes, you can offer statin therapy to people who have had a heart attack if the cholesterol is normal and you can still make it better.

Dr. Bob: So have you found any patients that statins didn't bring down the cholesterol?

Dr. Krisle: It always makes the numbers better. You do have to check your liver test about every six months and if you get any severe muscle aches, you have to report in to your doctor right away but the balance is way toward the good.

Dr. Bob: Next risk factor. Let's go away from cholesterol and let's walk into sedentary lifestyle. What about somebody that's a couch potato?

Dr. Krisle: Right. Exercise is a great, great benefit for the heart and there is some information now when you're out there doing your 25-30 minute walk, you're not only feeling better because you're walking, you're helping with weight control. But certainly the endothelium, the inner lining of the artery, is happy with exercise. It may release something called nitric oxide, NO, nitric oxide, and it makes the artery smoother and happier and less likely to spasm or constrict so there's a lot to be said for exercise, especially since it's something we control. We can do it to ourselves.

Dr. Bob: When you use the word aerobic and anaerobic exercise…is that what helps make this endothelial layer happier-when you push your heart rate up? or just any kind of exercise? or are they not sure yet?

Dr. Krisle: Traditionally, aerobic exercise has been favored, which means in motion-walking, swimming, jogging, bicycle riding. The old-timey, grunt and groan, 500 pound barbell exercises are not as good for the heart.

Dr. Bob: And any type of exercise that you recommend? Swimming, walking, bicycle riding…?

Dr. Krisle: Walking is great as long as it's done 365 days a year except leap year and then we need 366 days.

Dr. Bob: So, you're a firm believer in everyday activity and…

Dr. Krisle: Yes sir.

Dr. Bob: How long?

Dr. Krisle: 25-30 minutes minimum. If you've got 45 minutes, you can probably cover three miles and that would be great.

Dr. Bob: And what happens with the last risk factor or one of the last ones, obesity. Where does that play a part?

Dr. Krisle: Right, right. Eating and obesity are very important to your heart. If we could all be vegetarians or close to it, and eat fresh fruits, fresh vegetables, whole grain cereals, some fish, we'd be in great shape. It's hard to do that. It's not how we are raised in our kind of bacon, grits and eggs society, but if we'd eat the proper foods, we'd be better off. If we're going to eat all other kinds of other foods, we should at least learn to count calories so we can keep our weight normal.

Dr. Bob: As far as risk factors go, how does the patient get the doctor to evaluate those risk factors?

Dr. Krisle: When you go to your physician, you can say, I am concerned about my health. I know the number one killer of Americans is a heart attack and I want you to check me out from head to toe and check every single risk factor that I have and tell me where I stand and what to do.

Dr. Bob: George Krisle. Thank you very much. You're an amazing teacher and I always love to have you on the show because I learn to much.

Dr. Krisle: Thank you.

Dr. Bob: Are your risk factors being controlled? Do you have risk factors? Have you seen your doctor? Have you talked with him about those risk factors? You write them down: cigarette smoking, high blood pressure, diabetes, cholesterol, sedentary lifestyle, and obesity. If you've got any of those, you have your doctor help you correct them. And now, you'll want to stay tuned because later on we're going to be talking about ten reasons why you are harming your health and what we can do about that.

Closing

Dr. Bob: That's all the time we have for this show. I want you to be exercising. I want you to be exercising 30 minutes. The last doctor on my show said it needed to be 60 minutes to really get the benefits of weight loss. Do that five, six, seven days a week. Start that day off with eight hours sleep. You'll feel so much better. A good breakfast of fruit and fiber and most of all, we like laughter in your life. I hope you've enjoyed this show as much as I have.

If you have a question for Dr. Bob, write to The Dr. Bob Show - 6700 Baum Drive, Suite 1, Knoxville, TN 37919 or send your e-mail to letters at letters@drbobshow.com

Missy Kane: You know, heart disease is still our number one killer in America and what is so disturbing about that fact is that many times heart attacks and death from heart attacks could be prevented. One of the best ways is to exercise. Cardiologists all over the country will tell their patients, "You need to have moderate exercise a part of your every week." That means three to four times a week you need to be walking or join an aerobics class, low impact, or a swimming work-out. Anything that pumps blood faster and works on your heart muscle is really going to help you prevent heart disease. Think of it this way, if you start lifting a weight, you know that lifting weights will help your bicep muscle increase in size and be more powerful. Well, the same thing is true with your heart. People who exercise regularly have a larger heart and also a more powerful heart. Everytime that heart beats, it's getting all the blood throughout your body without having to over-extend itself. But if you're out of shape, that heart has to beat too fast. So, that's just one tip for you. Think about your heart as a muscle that needs to be exercised. Most of the time if you talk to the doctor, nine out of ten cases they will say that it's never too late to start exercising and also never too late to prevent a heart attack from occurring. For The Dr. Bob Show, I'm Missy Kane.

Dr. Bob: I want to thank Dr. George Krisle. Wonderful discussion on risk factors to prevent heart attacks and heart disease. We'll have to get Dr. Krisle back again.

And now what I thought would be fun to do is talk about ten things that I think are ways that you can ruin your health and let's talk about how we can change those. So, let's go through those.

Dr. Bob: Number l-let's take obesity. Why don't you just gain five pounds this year? It's not going to hurt anything if you gain five pounds. Well, that's wrong because if you gain five pounds every year, think what happens five years from now. You're 25 pounds heavier. What if we were to lose five pounds this year and do that every year for the next five years and lose 25 pounds? Wonder what that would do for our health? Well, what can we do? Well, we can become a vegetarian like Dr. Krisle said and have more vegetables, more fruits and occasionally some fish-that would be good for the heart. Anyway, we need to watch what we eat, cut down those foods that are not necessary. I remember one doctor telling me a candy bar is a luxury to which I do not allow myself. So, cut down on those breads and those fatty foods and see if you can't lose that five pounds this year and do the same thing next year. We'll see how skinny you are five years from now.

Number 2 would be your eyes. How often we say, "My eyes are fine, they're not burning, they're not stinging, I don't have any eye pain and my eyesight is good." Well, routine eye exams (like my wife had) could show that the pressure on your eye is elevated. Now, when the pressure on the inside of the eye is elevated, what happens is the eye doesn't burst but the pressure goes back against the eye nerve, the optic nerve, and that's what glaucoma does. It's a leading cause of blindness, second only probably to diabetes and so, be sure and get a routine eye check. Check your vision, you may need some glasses but you may be developing glaucoma, and there's excellent treatment for that.

Third would be colon exam. You know, frequently we just don't like the thought of having to have a colonoscopy. Too many people avoid that procedure and I can understand why. It's not the most pleasant thing to think about but at age 50, everybody should have a colonoscopy. Why is that? Well, cancer of the colon is almost a totally preventable disease. Cancer of the colon comes from little polyps that are inside the colon and they usually take five, six, eight, ten years before they become malignant so if you find a polyp early, have the polyp removed, then you have an excellent chance of not getting cancer of the colon. So, be sure that at age 50, you just set that time. On your birthday you call and make your appointment. You don't have to have the colonoscopy on your birthday but it should be in the year of your 50th birthday. There are circumstances where you should have it sooner when you have a family history of colon cancer, things like that, or a change in bowel habits, bleeding from the stool, tarry stools, other things that naturally you would go see your doctor about.

Number 4-thyroid disease. Too often people are just tired all the time and it's a slow gradual thing. They say, well, I'm getting a little older. Maybe it's the stress in my life. Maybe it's all the children. Maybe it's the bills. I'm just so tired I can't do anything. Well, that could be sub-clinical low thyroid, hypothyroidism. Very common in women, very common after the age of 40, just a little bit worse every year. There's a test called TSH, thyroid stimulating hormone, and that test may be the thing that results in keeping you from being so tired.

Number 5 would be heartburn. Now, if you've got persistent heartburn, several things could be going on. First, it could be stomach ulcers or duodenal ulcers due to a bacteria, helicobactor pylori, treatable with antibiotics. Persistent heartburn? Just don't take Tums for the tummy, but see your doctor. Find out what the problem is. If it's reflux disease causing dyspepsia, heartburn in this area right here in the chest, if that goes untreated, then it could change the lining of the esophagus, make it precancerous. We call that Barrett's esophagitis.

The next thing that you could do is say well, I don't want to exercise (we're down to Number 6 and I'm not going to get to ten but we will go as far as we can). Exercise is one of the most important things that you can do. It will lower your blood pressure. It will help us lose weight. It does decrease stress. And so, be sure that you get adequate exercise and do it 366 days a year on leap year, 365 on other times.

Now, I was going to talk a little bit about cholesterol. We've already talked about that. We've already talked about blood pressure and the last thing that we were going to talk about is if you want to ruin your health, stay grumpy. You know, laughter in your life does make people happier. It makes them healthier. It makes them live longer. They fight off infections better. Their immune system works better. So find that person in your life that you can laugh with, that you can be happy with. Find the things that are making sadness in your life and discuss them. Make laughter a part of your life.

Dr. Bob: I want to thank you so much for watching this show. I hope it's been helpful to you and your health and we look forward to seeing you again on The Dr. Bob Show.