In Episode #70, Dr. Jill interviews Dr. Roberta VanZant on How to Optimize Heart Health and create stress resilience to reduce risks of heart attacks and strokes.
- Carotid intimal medial thickening is an excellent way to assess early plaque in arteries
- Leading cause of death in men and women is stroke and heart attack
- We can change risk of having a heart attack by primary prevention with appropriate early diagnostic testing and treatment
Guest – Dr. Roberta VanZant
Dr. Jill Carnahan is Your Functional Medicine Expert® dually board certified in Family Medicine for ten years and in Integrative Holistic Medicine since 2015. She is the Medical Director of Flatiron Functional Medicine, a widely sought-after practice with a broad range of clinical services including functional medical protocols, nutritional consultations, chiropractic therapy, naturopathic medicine, acupuncture, and massage therapy. As a survivor of breast cancer, Crohn’s disease, and toxic mold illness she brings a unique perspective to treating patients in the midst of complex and chronic illness. Her clinic specializes in searching for the underlying triggers that contribute to illness through cutting-edge lab testing and tailoring the intervention to specific needs.
Featured in Shape Magazine, Parade, Forbes, MindBodyGreen, First for Women, Townsend Newsletter, and The Huffington Post as well as seen on NBC News and Health segments with Joan Lunden, Dr. Jill is a media must-have. Her YouTube channel and podcast features live interviews with the healthcare world’s most respected names.
A popular inspirational speaker and prolific writer, she shares her knowledge of hope, health, and healing live on stage and through newsletters, articles, books, and social media posts! People relate to Dr. Jill’s science-backed opinions delivered with authenticity, love and humor. She is known for inspiring her audience to thrive even in the midst of difficulties.
Dr. Jill 00:12
Hey everybody, thanks for joining us again. Today I am so excited to have my friend and colleague, Dr. VanZant. We'll get into our story, but just a little intro before I introduce her formally. We go way back to Illinois. It's just such a neat story. I did my medical training in Chicago, came back to Illinois, and did my residency in family medicine there. Then, I stayed on with the hospital that's now UnityPoint, but it was Methodist Medical Center [back then]. And I remember talking to the CEO and saying, “We need to get some integrative medicine in here.” Fortunately, he was insightful enough to see the need. We created an integrative medical center, and Dr. VanZant was my medical partner there. So we have actually practiced together in Illinois and I just have such great respect. It's so fun to reconnect. She has her own practice now in Illinois, and she'll tell you all about that. We'll be sure to link you up to that.
Dr. Jill 01:08
In fact, if you're listening today and you're from Illinois, say hello because I still have a lot of patients from Illinois who I used to see. Some of you still follow and watch these. So if you are out there and listening on any podcast, YouTube, or Facebook, please say hello because I feel like it's all my old friends in Illinois.
Dr. Jill 01:27
I'm so delighted to have Dr. VanZant. Before I introduce her, just a little background: You guys know you can find all of my videos on my YouTube channel. It's just under my name, Dr. Jill Carnahan. There are over 60 hours there. It's all free content. Today we're going to be doing another one, and it'll be posted there shortly. If you want anything on the website, we have free blogs and all kinds of resources at JillCarnahan.com, and my retail store is at DrJillHealth.com. So those are the places [where] you can find me.
Dr. Jill 01:56
Now, without further ado, I want to introduce my beautiful friend and colleague, Dr. Roberta VanZant. She practices functional and holistic medicine in Illinois. And as you've been around for a while, you all know what functional integrative medicine is—kind of getting to the root cause. She is a kindred spirit in many, many ways. We've had our own adventures. Then I moved to Colorado in 2010. And she, like I said, has her own practice. She is trained as an osteopathic physician. I always feel like they have bonus material that we don't get in allopathic medicine because she knows how to adjust and treat through movement and manipulation, as well as all the same training that allopathic physicians get. I always find—this may or may not be true; it's my own little take on it—my colleagues who are osteopaths are a little bit more open-minded. I really like that about their training. I think they probably get a little bit more nutrition and some of the things that allopathic physicians miss out on. But [it's] the same training.
Dr. Jill 02:54
She is a great medical doctor. And she is trained in family medicine like myself. She's board-certified in family medicine and an osteopathic family physician. She received over 300 hours of additional training in functional and integrative medicine, as well as osteopathic manipulation. She got her medical degree at the University of Texas Health Science Center and Texas College of Osteopathic Medicine and completed her residency in family medicine at the Harrisburg Family Medicine Program in Harrisburg, Pennsylvania. She is also the first graduate of the Women's Health Fellowship through the University of Illinois College of Medicine in Peoria. So I love, love, love having you here, Dr. VanZant! It's like old friends.
Dr. Roberta VanZant 03:32
It is, yes.
Dr. Jill 03:33
It's so great.
Dr. Roberta VanZant 03:35
Yes, thank you so much! It's wonderful to be able to talk with you. I'm really impressed with everything that you're able to share. You do such a great job. We do go so far back. I think when I first started as a fellow, you were in your third year of residency and then you went out and started doing functional medicine right from the get-go. I was so blessed to be able to come on board and work with you at the Center for Integrative Medicine years back. And really, that's where I got my start—working alongside you. And you taught me so much when we worked together. It's just been a joy to be able to continue to do functional medicine full-time. It really is amazing to me as I look back. I've been doing it for 16 years now, and it's hard to believe. But I started out working side by side with you and you taught me so much.
Dr. Jill 04:26
Aw, thank you. I feel like it's the same way. You taught me just as much. And it was so neat because, honestly, did we really even know what we were doing?
Dr. Roberta VanZant 04:37
No. Sometimes I still question that, but it's okay. Yes, I know. You learn along the way and you just grow. I think that God just puts before you the things you're supposed to learn in certain seasons. And I still think that every day there's so much more that I could know and need to know, so we just never stop learning.
Dr. Jill 04:59
Thank goodness, right? I'm the same way. It's interesting too. I'm sure you have this perspective but I have patients who've been to a lot of different places and different practitioners and are still looking for answers: I'm always surprised at how many times they tell me the doctors said, “I'm sorry, I can't help you anymore.” My heart drops and I'm shocked because I don't have all the answers but I'll never stop trying. And I know you have the same philosophy. And it's always like you said. The way that I feel like I get my greatest education is through my patients because they'll come in with something new or something slightly different than what I've seen before. And I have to help them, be a team with them, and figure it out. And I get excited. But that's where I learn. We wouldn't learn without the people who come in and bring these—
Dr. Roberta VanZant 05:41
Absolutely. The amount of information that is especially available to us now that we are able to search the vast internet is vast—more than we could ever stick in our brains and try and spit back out. So I'm usually appreciative when people bring new ideas to me. And whether or not I continue exploring those ideas, it's always an option. But I think it's a good thing when we're exposed to new things, new ideas, and new thought processes because no two functional medicine physicians practice the same or think the same. And that's a good thing because, as we were just talking about before we got on the air, everybody has a passion based on their experience. And how the experiences that you have in your life impact you really drive what you do and how you can then help your patients and interact with them.
Dr. Jill 06:36
So well said. And that's a great segue because what I love to start with is your journey from osteopathic medicine manipulation into functional medicine. And obviously, family practice is in there too, just like myself. Tell us a little bit about how you got interested in functional medicine and then some of your own challenges with patients, family, friends, or people that have driven you where you're at today.
Dr. Roberta VanZant 06:59
Well, I actually did not come out of my undergraduate [program] thinking I was going to go right into medical school. I went into my undergraduate [program] thinking I was going to go to medical school and then I discovered there were other things out there that I wanted to do. So after I graduated from college, I actually went and worked in research for a while. Then I was a medical editor for a neurosurgeon for a while. It was while I was working with him that something happened and I realized I wanted to go to medical school.
Dr. Roberta VanZant 07:27
But more than that, I had some minor health challenges. I had a friend at the time who had been raised without any antibiotics and just very non-traditionally. So that introduced me to using herbs and things like that. So that was my first taste of non-traditional medicine. And it was that, combined with a spiritual journey that I was on, that really made me think that I wanted to become a physician who treated the whole person—you know, that “holistic approach.”
Dr. Roberta VanZant 07:57
And after knowing that, I started looking at where I wanted to go to medical school and ended up at the osteopathic school that you mentioned. And not every person who goes to an osteopathic school has a really widened or more thoughtful approach. But I do feel like there are certain people who choose that and it's because the philosophy is that the body has the capacity to heal itself. That's the very essence of the osteopathic philosophy. So I loved that and I wanted to treat people from birth to death and be able to just sit down with them and talk. So I ended up going to an osteopathic medical school and learned a couple of other tricks along the way doing osteopathic manipulation, which has been wonderful. But I really loved the approach to it.
Dr. Roberta VanZant 08:47
Then I went into residency up in Harrisburg, as you had said, and did family practice residency. Honestly, it was pretty traditional. And that's okay because I always think that my traditional training gives me a sense that I can keep my feet in both worlds to some degree. So with a foot in the traditional world, I understand how that works; I've treated patients that way. But in the integrative or functional medicine world, I can see the bigger picture and the bigger toolbox.
Dr. Roberta VanZant 09:14
So I had a pretty traditional training program and then moved here to do a women's health fellowship, where I live now in Peoria, Illinois, never thinking I would be here 16 years later because I'm not from this area. But the way things happened, I did get a job. I met my husband, who was from this area, and ended up staying here. And the first job I had really was what challenged me. I was lucky enough to be able to spend about 30 minutes with a patient. I said at that point that I did primary care for women's health. So I was spending about 30 minutes with patients and I loved that because I could spend that time. I knew I never wanted to be a physician who just ran in and out and saw 30 to 40 patients a day. That was never going to be a good fit for me.
Dr. Roberta VanZant 09:57
But it was while I was working on women's health that I started to learn about bioidentical hormone therapy. And you would think in a women's health fellowship I would know all about that but it was pretty traditional. And I knew some but it was going to a conference on bioidentical hormone therapy, adrenal/thyroid testing, etc. I walked away and thought: “Why did I not learn this in medical school? Why did I not learn this in residency? This just makes so much sense.” And it was then that I started really doing what I'd call functional medicine right after I got out of my fellowship because it was looking behind the cover, trying to figure out why, asking the question why. “You feel this way but why?”
Dr. Roberta VanZant 10:38
So I started really doing just more hormones, thyroid, etc. I worked as a faculty member for a while at a residency program here in Peoria in a family practice. I really enjoyed that. But when I had my second child, I knew I didn't want to work full-time and you had just opened up the Center for Integrative Medicine there. So I remember I approached you and I said: “I just want to work part-time, and I know that I want to do all functional medicine. I don't want to do traditional medicine; I never will.” That's when I embarked upon doing all functional medicine and have never looked back. You know, add in all the other things.
Dr. Roberta VanZant 11:12
And then it's through your own experiences in life. And you name it in functional medicine, we've had it—either I've had it or my family member or somebody I know—autoimmune, thyroid, adrenal, hormones, infections, Lyme disease, tick-borne disease, etc. So all of this has just layered on my experience. But the cardiovascular stuff that we do at my office as well is my own personal experience. That's the thing that I would say has driven me to lean into that area specifically in a special way because of my family history and my own personal history.
Dr. Jill 11:55
Yes, I'm so excited! Like you said, we haven't talked much about heart health. I believe the statistic [shows] it's the fourth leading cause of mortality. Often, we talk about men, we think about men, and we study men. But hey, women! We're just as prone to this and actually underserved, I think, with the statistics, the research, and even [inaudible].
Dr. Roberta VanZant 12:12
Dr. Jill 12:15
And again, I love how you frame that. I feel the same thing. We've had this wonderful conventional training, and I embrace it and love all the important things we've learned. But now we've got a bigger toolbox and more things to do. Instead of just going to drugs and surgery, we can actually go to the root cause and say, “How and why did this happen?” and try to reverse it. So, I want to talk about that. And I just want to acknowledge our journeys here.
Dr. Jill 12:38
One thing that came to mind as you were talking—I probably said this before—I remember back in medical school, I was like the oddball because I was interested in integrative medicine. There was an integrative club that I started at Loyola. I remember my colleagues like, “Yes, whatever, Jill does her thing.” But what's happened over the years—and I'm sure you've had this too—is that as they or their family members come across their own illness or something where conventional medicine doesn't have a great answer, I get calls all the time now. They're like, “Jill, we remember back in the day when you were the weird one.” And now, “Is there anything you could do to help us?” I think things are shifting. There are more and more doctors frustrated with the limited time with patients and the limited answers. Really, there's some great stuff with trauma, heart attacks, and car accidents—but then there's more! “But wait, there's more.”
Dr. Jill 13:27
So, cardiovascular disease—let's dive in. Give us just the state of affairs. Are you seeing a lot [of it] in women? Are you seeing younger [women with issues]? How does this first present? What kind of symptoms or family history would people be concerned about? Then we can talk about what you do for diagnosis and treatment.
Dr. Roberta VanZant 13:45
Well, I really think there are probably two categories of people when it comes to cardiovascular disease: People either know that they had a family member with cardiovascular disease [through a] parent, grandparent, etc.—Alzheimer's is in there as well; you wrap that up as a cardiovascular issue or some type of dementia—and they either accept it very frankly, like “This is just something I'm going to have,” or they're scared of it and want to just ignore that they might have that. But either way, they know it's part of their family history. And then there are the patients who may not have it as part of their family history, or they're already doing something to be very proactive and think: “I'm healthy; I'm taking care of myself.”
Dr. Roberta VanZant 14:25
Obviously, lifestyle is a huge deterrent to all kinds of illnesses, [including] cancer and cardiovascular disease. But the unfortunate truth is that cardiovascular illness is the number one cause of death in the United States for both men and women. One in two people will die of something related to a cardiovascular event. For example, breast cancer for women: One in six women will develop breast cancer, which is different. They don't actually die from it, but one in six will develop breast cancer. But we have so much technology and advancements that we can actually do many things to prevent progression, treat it, etc., whereas cardiovascular disease gets swept under the rug for women. We have Go Red for Women Month in February. I think more women are aware of that, but it's still on the back burner in medicine. We don't talk about it enough. And certainly, I think most women are surprised to hear that their number one chance of dying is going to be from some type of cardiovascular-related event.
Dr. Jill 15:29
So tell me, when you're seeing patients in the clinic, they might be coming for hormones or [things like] that—and I'm sure you're looking at all the risk factors because you're doing a big, wide swath of testing—what percentage is a new thing when you bring this up, “You're at risk here; we need to address this”? Would you say it's 50/50, people who know versus [those to whom] you have to actually bring it to their attention?
Dr. Roberta VanZant 15:51
I think it's probably more age-related, honestly. The older a person gets, the more they think about their mortality. So women who are probably 50—or at least 60 or older—are thinking about that risk for themselves, in my experience, more or less. They may have been told they have high blood pressure or high cholesterol by that time in their lives, as opposed to younger individuals who may not have any clue about that. But my biggest concern is really for those women who are 30… I shouldn't say just women; men as well. But you asked me about women. So my biggest concern is for those individuals between 30 and 50. We know that, statistically, plaque happens between the ages of 40 and 50 for the most part. That's when most plaque starts to occur. And I really think that those are the people that we have to educate.
Dr. Roberta VanZant 16:43
And this is a different brand for me—trying to share with patients in functional medicine. I'm sure you know this: You don't have to really try and advertise functional medicine, because when people know about functional medicine, they find you. They know that it's different, that you can offer something that other physicians aren't [offering], and that you're going to look at the root cause. They're not feeling well. Something's not right for them.
Dr. Roberta VanZant 17:08
Cardiovascular prevention is a completely different thing. What I would hope is that it's true prevention. That's education. You have to educate people about understanding why they need to really look at that risk because they can obviate that risk very early in their lives. And we can actually identify their risks much earlier than they would think.
Dr. Roberta VanZant 17:31
In traditional medicine, there's this paradigm of either you've never had any issues with this—you've never had a heart attack or stroke, you've never had a stent—or you have. It's black and white. You've either not had anything, maybe you have some risk factors, or you have it. And probably the one exception to that is diabetes. Diabetes is called the cardiac equivalent. We know that high blood sugars are hard on the blood vessels. So that's one thing that in conventional medicine we try to be a little bit more aggressive about, even if a person hasn't had symptoms.
Dr. Roberta VanZant 18:04
But really, the amazing thing is that there's plenty of tools out there—relatively simple, outpatient tools—labs and testing that you can do to figure out if you fall into what I'd call that middle category, which is not that you haven't had symptoms, but that you actually have disease or inflammation of the blood vessels but you haven't had an event.
Dr. Roberta VanZant 18:26
So really, [there are] three different categories, right? You either have no disease… This is more of an arterial disease. And I totally give credit to Dr. Bale and Dr. Doneen of the BaleDoneen method for bringing this idea and this understanding so eloquently to the forefront, which is that we really have three different categories. It's an arterial disease that we need to be looking at—not just have you had an issue or have you not, but rather, is there a problem with your blood vessel or not? And you either have had problems with your blood vessel or you haven't. But if you have, you're going to be in that “yes, we know that” category. If you haven't, we can actually divide that out and look at: “Well, do you have issues ongoing right now? Do you have plaque? Do you have inflammation in your blood vessels?” And if you don't, that's true active prevention to keep it that way.
Dr. Roberta VanZant 19:15
But if we can find [out] if you have plaque or if you have endothelial inflammation in your blood vessels and you haven't had an event, we can actually impact that too. You're not just a sitting duck. So that's the paradigm shift that we're trying to affect, which is that you can truly be preventative; you don't have to just be a sitting duck. But more than that, you can know about what's going on inside your blood vessels, and we can figure out what's causing the problem too.
Dr. Roberta VanZant 19:45
There's enough data and evidence out there that it's not just, “Do you have high cholesterol? Do you smoke? Are you overweight? Do you have high blood pressure?” Those are important, absolutely. Those are the obvious risk factors. But there are other things, like if you have PCOS. Do you have endometriosis? Sleep apnea is a huge one that goes grossly undiagnosed. Chronic inflammation, autoimmune disease, infections—patients do have ongoing infections—all of these things. Genetics play a huge part. I know you spoke with my friend Sharon Hausman-Cohen a few weeks ago, whom I love. The genetic component of it really is so important to talk about with all illnesses, but for sure cardiovascular illness. There are some genetic predispositions that we can actually manipulate with an epigenetic impact and help offset. So I think that there's so much that can be done! It's all about educating people about that.
Dr. Roberta VanZant 20:47
Coming back around to what you were asking me a minute ago, educating patients to know what they don't know or don't think is important right now—that's different than what I would say more patients come to me for in functional medicine, which is: “I have this probem. I don't feel good.” This, this, this, “and I need help.” So it's a nice segue for the most part to be able to look at people's risk factors and talk about, “Hey, we have this program” or “we have some ways to figure out if you're at risk now.” I know we're talking about all these other things. But I know you know this: in functional medicine, my goal is to always get people better and out the door. I don't want them to be lifetime patients of mine. I want them to feel good and to eventually move on. But while they're there, I'm hoping that we can talk about their cardiovascular risks too and make that long-term impact on them.
Dr. Jill 21:38
Gosh, I love it. What a great overview. And when they're coming in, are you assessing everybody who comes in for heart health? How do you get them into the heart program and what does that look like?
Dr. Roberta VanZant 21:51
Well, I think that it's always in the back of my mind but with any person, you're going to address the things that are most important to them first. And sometimes that's a discussion at the first and sometimes it's not. But if they have risk factors, it will be something that we try to get into the discussion [about] at some point because my goal is to take care of all of them and help them to get truly healthy from whatever they're suffering from, but also for the long term. Then we also have patients who come just for the cardiovascular program that we do. I call it the Healthy Heart Program. And they come specifically because they know that they have a risk, they're concerned because of family risk, or they've had a family member [with cardiovascular issues]. Now the word is getting out. We have more people who come because the wives dragged their husbands in. Or there are some younger people who are educated enough about cardiovascular risks that they know they still need to figure out what's going on.
Dr. Jill 22:52
Obviously, you deal with some genetics and advanced lipid profiles—kind of the basics. But what else? I'm assuming you're checking the gut. You're checking inflammation markers. What kind of workup, in general, are you doing with these patients?
Dr. Roberta VanZant 23:03
Well, I'd have to say that the very first thing that I do is look at their blood vessels. And that's through that simple test of CIMT, carotid intima-media thickness. Do you do that? Or do you have any options to do that in your area?
Dr. Jill 23:14
I don't, but we have a referral in the area.
Dr. Roberta VanZant 23:18
Yes. CIMT testing really changed the game for me. I had known about it a long time ago. I tried to get one of the local hospitals to do it, and it was kind of blown off, like, “We don't do that; it's a very specific measurement,” blah, blah, blah. So, it wasn't until probably about five or six years ago that I discovered the BaleDoneen method, which I really credit with helping me to understand more about my own health, which is, of course, how I wanted to implement it for my patients. But CIMT for me is foundational because it visualizes the arteries of the neck of the carotid, and it tells us both about plaque and about inflammation in the blood vessels in the intima-media. Of course, that's the lining right underneath the endothelium, and that is what can actually change in size. It's representative of inflammation. And many different things can impact that and all of those things we think about. Gut dysbiosis, sleep apnea, high cholesterol, genetics, insulin resistance, high blood pressure, infections, inflammation—all of the things that we've discussed a minute ago impact the thickness of the blood vessel lining. And we can actually measure that and determine if it's thicker than it should be for a person's age.
Dr. Roberta VanZant 24:39
And if there is more than a five-year discrepancy from their age, then there is something going on to accelerate their vascular aging. And if the intima-media is thickened, then that actually creates a sticking point for that LDL. So we hear a lot about whether LDL is good or bad, but it's really only bad if it's sticking in the blood vessel wall. So CIMT testing tells us that. We can tell if you have a thickened blood vessel lining and we can tell if you have plaque. And then we can determine if the plaque is risky by how thick it is by the circumference of it and if the type is stable or unstable. So that's where the rubber meets the road for heart attacks and stroke—if you have unstable plaque. You have to have plaque. You can't have a heart attack or stroke without some type of plaque for the most part. And if you have plaque, if it's unstable, you're at risk of having an event—a heart attack or a stroke—and suffering some kind of illness from that. So, CIMT testing is usually where I recommend everybody start because I can get a really clear picture of how immediate their risk is. Obviously, if they don't have plaque, there's some time. If they do have plaque, then we may want to be more aggressive.
Dr. Roberta VanZant 25:52
And then I layer in the advanced lipid testing, as you referred to it too. And again, it's a simple blood test that tells us what's going on backstage. It tells us what's going on as far as inflammation in the endothelial lining, if the blood vessel is able to make enough of its own nitric oxide, and if the blood vessels are cracked and allowing protein through. It tells us if the plaque that's present is inflamed or not. So, I really feel like there's so much that we can tell from a simple blood draw and the CIMT to effectively give a person [information about]: Do they need to do something now? Or if they are looking pretty good, what can they do to keep it that way?
Dr. Jill 26:39
I love this because some of the stuff that you and I do is cash only and it sounds like the basic blood work and probably the carotid inter-media thickening—some of that would be covered by insurance. Is that true? Or can they get reimbursed?
Dr. Roberta VanZant 26:52
Well, the labs usually are. Not all of the labs. There are a few genetic tests that aren't; they're cash pay. But most of the labs go through insurance, especially with appropriate diagnoses, either if a person has a diagnosis of hyperlipidemia or a family history, etc. The CIMT is usually not covered. Medicare will reimburse for it if it's done through a traditional office, but not much. So usually, that is a cash pay, out of pocket. But different places offer different prices. But usually, it's not going to break the bank. You're not talking thousands of dollars. [For] a couple of hundred dollars, you can get a look at your blood vessels and the carotids are just representative—honestly, I don't think I said that—of what's going on in the heart and the brain. They're easy to access. You don't have to disrobe. It's easy to get to.
Dr. Jill 27:45
Say [with] a 55-year-old woman or man [that] you find some issues and you're starting to address them. Are you typically checking that again every year?
Dr. Roberta VanZant 27:55
Yes, usually no more than annually. You can check the blood work. The blood work is usually helpful. I always tell patients: We can tell, if the chemicals are off, what's going on in your blood vessels. We can modify that and that's our roadmap. But we'll repeat the cardiovascular CIMT in a year. And I remember the first patient. He had tried many things and he was dedicated to lifestyle change. He was not overweight. He was trying lots of supplements. When we got a CIMT, I was just floored because he had a decent amount of plaque and unstable plaque. We got his labs and his plaques were unstable and it really scared me for him, honestly, because we know that with certain labs, if they're off, the risk for an event could be tomorrow—i.e., a heart attack or something—or five years.
Dr. Roberta VanZant 28:56
After being able to have that conversation with him, we made appropriate changes. A year later, some of his plaques had reversed; some of them had stabilized. He was in a much safer place. And I knew that he was going to be okay. Of course, as a doctor, you want to do the best you can for your patients. But if I had known that this gentleman, despite everything, had still had a heart attack or stroke, it would have just sickened me, going, “What else could I have done?” Well, I really feel like now I know. Now I know how to help people know what's going on with them and give them the information so they can make some choices.
Dr. Jill 29:34
Yes, gosh, I love it. And if you're listening, you probably know this, but what is so classical is the lipids and some of those genetic factors, like ApoE4. But what Dr. VanZant and I also look at is what she mentioned: Infections and inflammation. And endothelial dysfunction is so common with viruses, bacteria, and toxic exposures in our environment. So even with the patients I see in my clinic, which are mold and Lyme, you still, even at a young age, could have a very high cardiovascular risk just because of infections and inflammation on top of genetics. So it's very relevant to even populations that may not think they have a high risk.
Dr. Roberta VanZant 30:16
Dr. Jill 30:18
So this is great. And I want to talk about the other part of our title, [which] is on optimal stress resilience. And if you're listening, you may wonder—obviously, stress and heart do go together, but I think this could be maybe one of the most important things we talk about. I always find that for me, patients, or anyone else, it's easy to give a pill, whether it's a drug or a supplement. It's a lot harder to make lifestyle changes and to get people motivated to do that, yet they're the most important things. What are you looking at for the program as far as stressors and sleep? And what kinds of things are you looking at, in what categories? And what are some practical ways people can look at those areas of their lives?
Dr. Roberta VanZant 30:58
Absolutely. You mentioned sleep. One of the things that I usually check in patients if I have even a whiff that they may have a sleep disorder is checking for sleep apnea. And there are so many different, neat ways now to treat sleep apnea. And thankfully, we can do most sleep tests at home so it's easy to have home sleep tests looked at. Sleep apnea is something that I can't treat. A patient is going to have to do something, whether it be weight loss, an oral device, or potentially even a CPAP if it's significant enough.
Dr. Roberta VanZant 31:34
Sleep apnea is probably one of the most undiagnosed things I see. And it always makes me a little bit sad and angry when a patient comes to me and they've had chronic blood pressure elevation or, unfortunately, chronic fatigue, and nobody's evaluated them for that in the traditional world because to me, that's like bread and butter. So I would say that evaluating sleep is huge. And there are so many things that can disrupt sleep. But making sure that… Am I okay here? I'm getting a little bit of feedback.
Dr. Jill 32:10
I'm sorry; I'm trying to get this echo off here. One sec here. There we go. We're good.
Dr. Roberta VanZant 32:17
Okay. All right. So evaluating sleep apnea is a big thing because poor sleep is going to lead to poor stress resilience. Your cortisol curve is going to be significantly altered. Women who have hormone imbalances often experience sleep difficulties, so addressing hormones [is] obviously [important]. And then [there are] just the stressors of life. We've had a really hard year across the board. I think everybody has felt the impact from COVID in one way, shape, or form. And it's brought with both obvious stress and then that subliminal stress. So giving patients that area to talk, I think, is important—talking about their concerns—and using the resources around you. I really encourage patients that if they need to see counselors, it's important to do so. Getting involved in activities and trying to have people engage in some type of exercise or activity that they like is so important.
Dr. Roberta VanZant 33:29
And the older I get, the more I understand that. There has to be joy in what you do. You can't just slog yourself to the gym every day if you absolutely hate it because there is that opposite down effect of a lack of gratitude. We know that gratitude and hope create so many wonderful chemicals in our bodies and so many chemicals that help us relax that if you're doing something you hate, it's not worth it. So I try to engage with patients and get them to think a little bit outside the box and talk about [how] being active in something that they enjoy is important.
Dr. Roberta VanZant 34:04
And I think that diet is going to always be part of the picture. This is where I hope that, although I'm not a dietitian or a nutritionist, the functional approach [allows me] to try and understand what is going on for them. And there are so many layers to that. The longer that I do this, the more I know that not even one functional medicine diet is appropriate for everybody—paleo, low histamine, or whatever. [It's] really [about] trying to help people figure out what makes their bodies hum. And that's the functional medicine approach to it so that their body likes what it's getting. And when it likes what it's getting, [there are] lower neurochemicals and lower stress hormones.
Dr. Roberta VanZant 34:47
And then the genetics are huge. I have to tell you, I used to shy away from genetics because everybody wanted MTHFR and I felt: “I don't know if it helps either here or there.” “Give you B12, folate—how do we know?” But it was really the cardiovascular genetics that got me back involved in looking at that again. And now, of course, I do Intellxx[DNA] through Dr. Hausman-Cohen's company. And that has really opened my eyes. There's a mental health wellness panel looking at how people are set up genetically to be triggered to have more stress chemicals. So I think sometimes that if patients do get that information, being able to share some of that with them [is important] so that they beat themselves up less.
Dr. Roberta VanZant 35:55
I think, of course, that you and I still grew up in the world of giving a medicine or feeling like you can just gut yourself through it. The whole attitude towards mental health and mental wellness—usually nobody wants to talk about it. But knowing that you may be predisposed to having more adrenaline because you have a COMT issue [is important], and that some of these things we can then treat through breathing exercises, humming, singing, [and other] things that stimulate your parasympathetic nervous system. All these tools, I think, are important to talk to patients about. It usually doesn't happen in one visit, but along the way [it's about] talking about reducing stress levels by looking at all of those things: Body, mind, and spirit.
Dr. Jill 36:22
I love that because it is so critical with the cortisol, HPA axis, the heart, and long-term outcomes on really every level in all of our patients. We were just talking before we went live about how this next level of healing is really going to take mind, body, and spirit [into account]. And it's so critical for us to address—not just supplements, medications, or anything like that. So stress resilience [is] absolutely critical.
Dr. Jill 36:47
I know that in my own journey—I've said this before as well but it's interesting—I used to get up at 5:30, go do a run, or go do high-intensity interval training. And about three or four years ago, I realized that wasn't serving me because I have a COMT2 issue and I was just raising my cortisol. What I found is that as I sat in the mornings and meditated and was much slower—and now my exercise is quite minimal; I hike and I walk and then I do a little bit of free weights but it's so much less than I used to do six days a week—I'm in better shape than I've ever been. [I have] less body fat and better muscle. And it was a shock to me after going through medical school and medical training. We should know the stuff—”Well, of course!”—that for me was raising my cortisol and sabotaging [my body] metabolically.
Dr. Jill 37:31
I always joke: I stopped exercising and I got in the best shape of my life. Now, I didn't stop exercising. But I do stuff in nature that's natural and that's not [part of] a fitness program. And for me, it really, really worked. I think a lot of women are overtraining. So it's funny to find that balance. Some of us need to move more and some less. I needed to pull it back. And it was a profound change that I found in that. And then the mental chatter we have—all these things can drive cortisol. And I think that's probably one of the bigger risk factors that is unacknowledged with heart disease. So I love this.
Dr. Jill 38:08
Our last few minutes. Now, the gut is my thing and I talk about that a lot. And I know that there's a relation with LPS and the gut and the heart. What piece does gut play? And do you do that just for some people who have symptoms? Do you always check the gut for heart patients? Or how does that connect in your Healthy Heart Program with the gut?
Dr. Roberta VanZant 38:26
Yes, I think that's one of the pieces that we always talk about and look at. Anybody who's symptomatic needs to have some type of evaluation. And symptoms—sometimes you have to pull [them] out of people because they may just think they're normal. “Yes, I'm fine!” Of course, everybody laughs because the discussions about digestive habits are much deeper than people like to usually share, but it's so important to know what a person considers normal versus what's optimal. So yes, I think that digestively, it's something we look at individually. If the person is complaining of symptoms, then it's going to need to be evaluated.
Dr. Roberta VanZant 38:26
There are some really good gene relationships between cardiovascular risk and gluten, obviously. There's the haptoglobin gene. If you have the haptoglobin gene 2-2, it increases your risk of making zonulin. You're talking about leaky gut, etc. And the things that trigger zonulin and the bacterial dysbiosis and LPS [are] all important parts of the immune system overreaction. So I would say that it's part of our evaluation of every patient to first look at what their symptoms are.
Dr. Roberta VanZant 39:56
I'm not going to go trying to turn over stones that don't need to be turned over, but we certainly have a good history there with evaluating what's going on and addressing it as appropriate. Because there are so many things that you could address, you have to go with what's going to impact the patient the most. If they're not having an issue with something and you make it an issue, in my opinion, it may not be the best approach for them. You want to ask them what's important to them. And then, if you find things that need to be important to them, it's an educational tool.
Dr. Roberta VanZant 40:29
I feel like gut health is an interesting background relationship for cardiovascular wellness. And that's why I really love the approach that we have because it really is a functional medicine approach. Honestly, I just think it's a good medicine approach. I honestly hate to even label myself as a holistic, functional medicine, integrative doctor because, to me, I'm just practicing good medicine. That's what I say all the time. To me, this is how I think all medicine should be practiced. What is odd or different about this? This is just good medicine. I listen to you, I take a good history, I do a good exam, I'm looking at all the pieces of the puzzle, and we're going to figure it out together. That's why I love the cardiovascular program that we do because it looks at everything, including those things that may not seem to make sense initially, such as gut health. It's going to be important.
Dr. Jill 41:23
Well, this is so great. Where can people find you, get more information about you, and schedule an appointment? Where can you be found?
Dr. Roberta VanZant 41:31
Oh, yes, thanks. Well, VanZantMedicalGroup.com is our website. And if anybody wants more information, they can send an email to VanZantMedicalGroup@gmail.com. We have a new patient tab on our website. If anybody is interested in getting testing [done] for cardiovascular issues in particular, you just have to call. We schedule you for CIMT testing first and then do a follow-up after that to review those results and look at your risks. I'm also on Facebook and Instagram: VanZant Medical Group.
Dr. Jill 42:02
Awesome! I will be sure to put links wherever you're watching this. And if you're in Illinois—again, we've got a lot of connection from there—I highly recommend Dr. VanZant. She's always the one—if you call me and ask me about a doctor in Illinois—who I recommend.
Dr. Roberta VanZant 42:17
I appreciate that; I do. Thank you so much. I highly admire you. I'm so proud of everything that you've accomplished. And I know you're an amazing blessing to many, many patients. And just doing things like this provides people with a lot more information that they can trust. That's important.
Dr. Jill 42:37
Thank you for what you're doing. Thank you for being in Illinois while I'm out frolicking in the mountains.
Dr. Roberta VanZant 42:43
Oh yes. Say that again. “Thank you for… ” I live in Illinois.
Dr. Jill 42:47
Sorry about the [inaudible].
Dr. Roberta VanZant 42:49
Thanks. You had to rub that in.
Dr. Jill 42:51
Oh gosh, well, it's been so fun.
Dr. Roberta VanZant 42:53
Just kidding. I love all my people in Illinois.
Dr. Jill 42:57
Oh gosh. I'll come visit you. You can come visit me. Anyway, best of luck to you, and thank you so much for the great information today!
Dr. Roberta VanZant 43:06
Thank you. Thank you again for having me on your program. I really appreciate it. It was fun!
* These statements have not been evaluated by the Food and Drug Administration. The product mentioned in this article are not intended to diagnose, treat, cure, or prevent any disease. The information in this article is not intended to replace any recommendations or relationship with your physician. Please review references sited at end of article for scientific support of any claims made.