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In medicine, we were taught that women were protected against heart attacks until they went through menopause, and then our risks caught up with men's risks. But what if we weren't really protected that well?

For many years, our research into the heart attacks has been focused on men. Even on TV and the movies, something awful happens, and a man clutches his chest and keels over. And we find if it's a police or a medical show, that he died of a heart attack. Most of us could have figured that out before the forensic pathologist told us on the TV show because we know what men's heart attacks look like.

In fact, we understood men's heart attacks and the causes, high blood pressure, smoking, eating red meat and fatty foods, and high cholesterol. Doctors really got on men's cases, and since 1960, men have decreased their smoking. And if their cholesterol or blood pressure is high, and their wives drag them into the doctor, the men were on blood pressure medications and cholesterol-lowering drugs. And meat and fatty foods, they're still Super Bowl yummies and fast food, and they're doing better.

Men's rates of heart attacks dropped dramatically. And then we noticed that postmenopausal women caught up with men in the rates of heart attacks at about 60. So we sort of got on it and started a national campaign, like the red dress for heart health, to help women understand their risks and the signs of heart attacks. But we were still thinking about women over 50, at least OB/GYNs were. And now comes a troubling study that shows that the rate of heart attacks in young people, people under 50 are increasing and are increasing more for women. This is worrisome. And it's important to look at the communities where this work was done and see what we can learn.

From 1995 to 2014, the ARIC, A-R-I-C, Community Surveillance Study gathered information on almost 29,000 heart attacks. ARIC stands for Atherosclerosis Risk in Communities. And atherosclerosis is the clogging up of the arteries in the heart that can lead to heart attacks.

The communities that were involved in this study were in four geographic areas in the U.S. -- counties in North Carolina, Maryland, Mississippi, and suburbs of Minneapolis. Some of these counties have Americans at risk for heart attacks based on increased rates of diabetes, smoking, hypertension, obesity, and poverty in African American race. Of those 29,000 heart attacks, over the 20 years, one-third in what they called young people, people 35 to 54. Over those 20 years, the annual rate of young men's heart attacks went down some. But women's rates went up to the point that young women, pre-menopausal women had the same rate of heart attacks as young men. These data are alarming, and they mirror similar data from Canada, suggesting that the incidence of heart attacks in young women is rising.

Well, what are some of the risk factors for these young women? Smoking, high blood pressure, and diabetes very substantially increase the risk in women. And black women had very significantly more heart attacks than white women. Seventy-five percent of the young women with heart attacks had high blood pressure, 36 percent had diabetes. And women who had heart attacks were more likely to have multiple risk factors than men.

Young women who had heart attacks were less likely than young men who had heart attacks to have their cholesterol treated or their blood pressure treated. Young men and young women who had heart attacks had a 10% chance of dying the following year. Young women have some extra risk factors for heart attacks compared to men. They're more likely to have demonstrated risk for diabetes by being diabetic in pregnancy. They're more likely to demonstrate risk of hypertension and vascular disease by having preeclampsia when they were pregnant. And they are more likely to suffer the psychosocial stressors of poverty than men.

This information hurts my heart. These young women were mothers of young children and teens. They were at the most productive times of their lives, and they were also at the most stressful times of their lives. So what do we do with this information as women and as physicians? The risk factors in this study are ones that we all know about, risk for heart health, such as smoking, diabetes, and hypertension. But diabetes and hypertension often don't have physical symptoms.

Unless women are getting regular checkups, getting their blood pressure measured, their cholesterol measured, and their blood sugar checked, they may not know. Women used to go to their OB/GYN or their family doctor, get a Pap smear every year, but now they don't. Many women who used to go regularly for their checkups when they were having babies, don't go anymore. All clinic visits, for one reason or another, will have a blood pressure check, but cholesterol or diabetes checks aren't done so often in young women.

Of course, the big risk of smoking cigarettes in an unbelievable 48 percent of the young women who had heart attacks were cigarette smokers, would be addressed by the clinician, if women admitted to it. See our podcast on lying to your doctor.

So all women and men need access to health care. All the women and men need regular checkups at this very busy time of their lives, 35 to 54. All women and men need to have their blood pressure, high sugar, and high cholesterol managed according to national guidelines. And women need to take their medication.

How we manage the stressors of poverty, the stresses of being a minority are issues that we all need to address as a community and as a state and as a national level. So, ladies, please take care of your heart. And thanks for joining us on "The Seven Domains of Women's Health" on The Scope.

updated: September 5, 2019

originally published: February 7, 2014

Announcer: Is it bad enough to go to the emergency room or isn't it? You are listening to "ER or Not" on The Scope.

Interviewer: All right. It's time to play along. Dr. Troy Madsen is going to give us the answer to our scenario here today of whether or not you should go into the ER for this particular condition or situation. Today, dizziness. So once again, not caused by anything else, just seemingly out of nowhere, all of a sudden I feel pretty dizzy. I have to sit down, ER or not?

Dr. Madsen: So this one depends a lot on how high a risk you have for a stroke and this is what I think about with dizziness. So young person, otherwise healthy, they feel dizzy, probably not a big deal. If you're 65, you've got high blood pressure, high cholesterol, maybe you've had a previous heart attack or a previous stroke, someone like that comes in and says to me, "I just feel dizzy. I feel like the room is spinning. I can't walk in a straight line," I get really concerned about a stroke.

So there are some blood vessels that feed the brain, the back part of the brain. That's what controls your balance. So if you get a stroke there, people will often describe a feeling like the room is spinning, they say they can't walk in a straight line, they're falling to one side. So that's when I get really concerned and I say, "Well, let's get our neurologist down here right now. We may need to give you a clot busting medication to treat the stroke." So really it's a time dependent thing if you're in that category.

Interviewer: All right. And does that usually come with the other stroke symptoms, slurred speech, facial droop?

Dr. Madsen: Sometimes but sometimes not.

Interviewer: It can just come isolated?

Dr. Madsen: That's the tough part of it. I mean, typically, it will come with balance issues. That's the big thing we see, persons falling to one side or they just say they cannot walk in a straight line. But oftentimes with these types of strokes, they don't have a facial droop. They don't say, "My arm's weak." They don't say, "I'm having trouble speaking," because it's a different part of the brain. So that's why I get really concerned when I hear that, and that's why we kind of jump right on top of it in terms of getting them treatment if they're within that window where we can treat them.

Interviewer: If it's a younger healthier person that you don't believe that it's a stroke, then what do you tell them?

Dr. Madsen: So if someone comes in the ER and they say, "I feel dizzy," you know, we'll typically do some tests like an EKG to look at their heart. Certainly full physical exam, neurologic exam. Say, "Is anything else going on?" But quite often what this ends up being is what's called benign positional vertigo. So you've got like these canals in your ear that help you keep your balance and these little stones. And if one of these little stones gets out of place, it feels like the room is spinning and anyone who's been through this knows how miserable that feeling is.

You know, most cases it's going to go away after a week or so. We can give medication to kind of calm that sensation down and there are actually repositioning maneuvers you can do to try and get this little stone back in the right place. You know, it sounds kind of funny but it's . . . Yeah, it's one of the more common things we see in younger people, otherwise healthy people, who come in with this symptom.

Interviewer: And for that person, no immediate danger. Would they be able to just go to their regular physician to get some of these things that would offer them relief for that two-week period while they're recovering?

Dr. Madsen: Exactly. I think most of these cases, you know, if you're otherwise healthy you can probably wait, get in to see your doctor. One medication that can help in the short term is meclizine. It's an anti seasickness, anti motion sickness medication. It's kind of the non drowsy form of Dramamine. You'll see it right there next to Dramamine. I recommend taking it if you have that. It can help out with some of those symptoms.

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Interviewer: You go to your doctor, they say your cholesterol is too high. Why should you care and what does that mean for your health? And what can you do about it? That's next on The Scope.

Interviewer: All right, Dr. Tom Miller, you know every year you go get you physical. One of the numbers you're going to get back is your cholesterol numbers. There are two or three of those numbers, and my doctor my tells me, "Oh, your cholesterol doesn't look good." What's going on?

Dr. Miller: Well, we've known for many years that high cholesterol can generally imply poor outcomes in the long term. It's related to vascular disease over many, many years, and it's associated with other risk factors for vascular disease, such as high blood pressure.

Interviewer: And which all can lead to heart attack or stroke?

Dr. Miller: Exactly.

Interviewer: Yes. So that's why if you see those high numbers they're predictor score, that this person is more likely to have those outcomes.

Dr. Miller: That's exactly right. So there's several things when people talk about cholesterol. Let me break those down real quick for you. First, is total cholesterol. And generally, if your cholesterol is over 200, that's too high, but you can break it down further from there. You break it down into triglycerides, you break it down into HDL, that's the good cholesterol, and then you break it down into LDL, the bad cholesterol. The way I kind of think about, Scott, is when you have a high HDL, that's the good stuff, it reminds me of a taxi that's ferrying sort of cholesterol and bad stuff away from the arteries and takes that back to the liver where it's chewed up and metabolized, and you don't have to worry about it anymore.

Interviewer: So you want lots of that HDL to help your body dispose off that stuff.

Dr. Miller: Yes, high HDL is better. High HDL is better.

Interviewer: Okay.

Dr. Miller: And you know how you get high HDL? Exercise.

Interviewer: Oatmeal. No, exercise.

Dr. Miller: Well, not so much oatmeal but exercise and weight loss and stopping smoking actually raises HDL as well. So really, what you do when you do those three things is you increase the number of taxis that are delivering bad cholesterol away from the arteries into the liver where it's chewed up. LDL, you think about that as a taxi taking cholesterol down to the arteries and depositing it into the sides of the arteries into the lumen or the walls of the arteries. And so that's where it sits, and over long periods of time, you get these plaque build-ups, and if those plaques rupture, then you can have bad things like a heart attack or a stroke.

Interviewer: So is the total cholesterol a sum of your HDL/LDL in the triglycerides? Is that where that number comes from?

Dr. Miller: Yes, basically, there's a little equation of that, but not to trouble ourselves too much about it. But the higher the HDL, the higher the total cholesterol. The higher LDL, the higher the total cholesterol. So if you actually have a nice high HDL and a low LDL, that's okay if your total cholesterol is just a little elevated.

Interviewer: Okay.

Dr. Miller: So total tells you kind of, is a sign post about you need to look at this more closely.

Interviewer: Okay. So you get that big number. Well, if the number is not big then you're probably fine. But if it's a big number then you need to look at how does that break down; the good versus the bad. If you got more good, fine.

Dr. Miller: Well, sometimes you can look at that ratio too. So you can look at that ratio total cholesterol and HDL. And there are calculators now that are put out by the American Heart Association in conjunction with the American College Cardiology that look at not only the total cholesterol and HDL, but they mix in your blood pressure and your other risk factors, whether you smoke, whether you have diabetes, and if you're on blood pressure medication. And it gives you score, and that score kind of tells you what your 10-year risk is.

Now, no calculator is perfect, Scott, but it's a pretty good indication of, "Wow, I'm doing really well. I'm eating right. I have low blood pressure and I don't have other risk factors," or, "Warning, I've got to do some other things to improve my health." Now, one of these things might be that you need to take a medication to lower your cholesterol while you're waiting for the lifestyle things to catch up.

Interviewer: Let's go back to the original question. Your doctor is concerned about your cholesterol numbers, so odds are at the point what he's going to say is you have high LDL, which is bad.

Dr. Miller: That could be one thing he says . . .

Interviewer: Exercise. I need you to exercise more. I need you to quit smoking.

Dr. Miller: Right, and you would say those things anyway, right?

Interviewer: Okay.

Dr. Miller: I mean, generally, those are great ideas, but we stress them more if your cholesterol and blood pressure are elevated.

Interviewer: What else would you doctor tell you to do to try to get that under control then?

Dr. Miller: So you want to follow a low cholesterol based diet, and there are ways to do that. You can Google a step one cholesterol diet and it will tell you. And basically, it's common sense. Don't eat a lot of animal products because animal foods have cholesterol, plants don't, they don't have cholesterol. So you're not going to get cholesterol from plants, so the more vegetarian based your diet is, the more leafy green vegetables you eat, the chances are you will help lower your LDL cholesterol.

And so you want to stay away from high cholesterol meats, fatty meats. You want to trim fat off of any kind of meat that you are eating chicken or steak, and some common sense things. And most of us have heard these over and over on the news and on the media but we have to pay attention to it on the cholesterol side. But at some point it might be high enough, you actually need to be treated for it.

Interviewer: You could do all the right things and still . . .

Dr. Miller: Yes, there are some folks that have a genetic predisposition to have high LDL cholesterol and they are predisposed to really heart disease. And so we do get after them with drugs and we have good drugs now to treat high cholesterol.

Interviewer: And nothing you can do if you're genetically disposition, if you do all the other stuff right.

Dr. Miller: Yes. First step in this treatment basically, and this is true for high blood pressure as well, is to get after your lifestyle improvements. So getting your body mass index down between 18.5 and 25 and exercising on a daily basis. And I'm not talking about on Schwarzenegger type weight room stuff, I'm just talking about going out and getting to walk for 30 to 60 minutes a day.

Interviewer: Elevating that heart rate.

Dr. Miller: Yes, getting your heart rate up to a moderately elevated level. We're not talking about Olympian athlete type redlining heart rates, we're just talking about getting out and doing a brisk walk or a swim or cycling.

Interviewer: Do you find that patients when you give them this information that they tend to think, "Well, really how much is that going to make a difference?" Are they skeptical?

Dr. Miller: I don't think patients are skeptical. I think we all want to do the right thing. And I think the vast majority of us believe that exercise is healthy. It makes us feel better and losing weight makes us feel better. There's a body image piece there. It's just hard to do. We don't have a pill to help you lose weight effectively.

Interviewer: And for cholesterol. . .

Dr. Miller: And we don't have a pill to make you exercise. So it's a lot of coaching. It's like you can do this, go out and do it. So you build your patient's will power up by suggestion.

Interviewer: And doing that will noticeably decrease cholesterol numbers?

Dr. Miller: Yes, it will definitely help reduce cholesterol in the vast majority of people, but not always to a level that would be necessary.

Interviewer: Got you. But it does make a difference?

Dr. Miller: It does make a difference, and it a makes difference for reasons other than just lowering cholesterol and lowering blood pressure. So there's many different reasons to stay healthy with lifestyle interventions.

updated: March 10, 2023
originally published: May 27, 2017

Interviewer: A leader in the pharmaceutical industry takes on the job of director of the program and personalized health at the University of Utah. We'll talk with him next on The Scope.

Announcer: Examining the latest research and telling you about the latest breakthroughs, the Science and Research Show is on The Scope.

Interviewer: Dr. Dere, today is your first day at work. Is that right?

Dr. Dere: That's correct.

Interviewer: Congratulations.

Dr. Dere: Well, thank you. It's nice to be here.

Interviewer: Let's start from the basics. What is personalized health?

Dr. Dere: We frequently use, whether it's hyper tension or for a cholesterol or other maladies, we use, sometimes, a one size fits all approach to treating a patient. But we now know that different patients can respond differently to any particular intervention. Patients have different genetic profiles and are impacted by different environmental circumstances and I've been in the pharmaceutical industry so I think mostly in terms of the use of medicines with the use of drugs.
First of all, one example in terms of cancer which many people know about, in terms of women with breast cancer who are HER2 positive and this subset of patients which is about 30% of the breast cancer patients will respond to Herceptin which is a HER2 antibody. When you look at breast cancer, when you look at colorectal cancer now, it is important that we genotype these patients so that we understand their genomic profiles of the tumor and provide much more individualized therapy.

Then more broadly, as you look at personalized health, one could potentially expand our thinking around this towards preventive interventions and by preventive interventions they don't just mean cancer screening or other types of screenings like blood pressure, glucose screenings. But it could mean on different nutritional approaches, on different approaches towards how one looks at weight bearing exercise or the broad arena of what people would put under the generally the wellness category of types of interventions.

Interviewer: And does it always come back to genomics or genetics or can there be other ways to figure out what personalized care someone needs?

Dr. Dere: The short answer to your question is, I think there are different ways. There has been such an explosion of information about the entire human genome and, you know, the expression of different proteins that our bodies form from the human genome, that genetics becomes certainly the center piece of a personalized health approach. So, I think there are different ways ranging from family history and the likes but genetics plays a critical role, In Utah, in that regard, one of the tremendous attractions for returning to Salt Lake City is that the researchers here have really been pioneers in unlocking some secrets of the human genomes through their family studies in cardio vascular disease on the neural sciences.

Interviewer: Yeah, well, that brings me to my next question. You have spent, I think, 25 years in the pharmaceutical industry, the last 11 years at Amgen as senior vice president and you also spent time at Eli Lilly and now you're coming to academia. Why the switch?

Dr. Dere: Some might say maybe it's a midlife crisis, I guess. I think the leadership here is dynamic and visionary. I think the desire to transform the health care delivery system to gradually improve the care that patients receive and that being first and foremost was an important role in the decision making, along with the spirit of trying to translate research findings, whether they're in the genetics arena whether they're in the molecular medicine arena, to something that's tangible that benefits patient. So this link between basic research, findings and impacting patients and ultimately improving the value of our health care system or our health care delivery to patients, kind of that entire package there I found very, very appealing.

Interviewer: And when you talk about moving, say basic research to patient care, do you see this program as bringing basic research to a point where you can then hand it off to pharmaceutical industry or how do you see that playing out?

Dr. Dere: You know that's a great question because I think we're entering into a very dynamic field. We have, I think, not done a particularly job in industry in terms of developing innovated new medicines over the past 20 years. Hopefully, it's not coincident with my time in industry but it has been that time if you look at the data and what does the data show us? When I joined the industry, it took about $250 million for every new drug that was approved by the FDA and right now, when you look at the numbers of new drugs approvals and the cost of the research and development, it's in the $2 billion range. So fundamentally, we're becoming less efficient and less effective in bringing new medicines to the market place.
So, I hope that there is a more blurring, a greater collaboration, a public private partnership in all areas, whether it's for target identification, one of the things you alluded to, yes, I hope that our insights into genetics can help to identify new targets that could potentially interdict receptors enzymes in the like and cure human disease. So I hope for that and also hope for a greater partnership in later phases of development that heretofore have been in the domain of industry but where we, in terms of good clinical researchers in academia, can also play a role.

In a period of time where there is an absolute revolution in terms of biology, absolute revolution in terms of biology and our understanding in deeper understanding of the link between genetics and molecular medicine and the like, but this biologic revolution, this is an extraordinarily exciting time to be still active and still be responsible for, hopefully, doing good things for patients which is our ultimate goal.

Announcer: Interesting, informative and all in the name of better health. This is The Scope Health Sciences Radio.

For a long time I've been listening to women tell me about whether they feel well or not. And in fact, they have taught me that their sense of wellness doesn't come from their blood pressure, or their Pap smear, or their mammogram, or their cholesterol, things that we talk a lot about in our visits. Their sense of wellness comes partly from these things, but in fact it comes from many other domains of their life. And, of course, the most famous line is a woman saying, "You're only as happy as your least happy child."

Many people have been looking about what it means to be well and realize there are probably a number of domains, kinds of things that contribute to wellness, and at the University Of Utah Center Of Excellence in Women's Health we've defined the seven domains of health mostly from listening to our patients.

Number one, physical health. Well, of course, physical wellness is important. Our ability to maintain a healthy quality of life and get through our daily activities without undue fatigue or physical stress, our ability to fight off diseases, these are important to us. And the behaviors such as diet and exercise and screening that involve those things are important. So physical health certainly is important in our sense of wellness.

Number two, social health. This gets back to that "You're only as happy as your least happy child," but our social health is the ability to relate to and connect with other people in our world and maintain healthy and positive relationships with family and friends and co-workers, this all adds to our social health.

Number three is emotional health. Now although emotional health can be a function of our social health, emotional health is the ability to understand ourselves internally and cope with the challenges life can bring. The ability to acknowledge and share feelings of anger, or fear, or sadness, or stress, and hope, and love, and joy, all these abilities to recognize our own emotional state and respond to it in a healthy way is part of what contributes to emotional health.

Four, environmental health is our ability to recognize and be responsive to our environment and the challenges the environment might provide for us. Clearly people in developing countries have difficulty with clean water and that may be the number one issue in their environmental health. For us here in Utah it may be our clean air or it may be that your own home isn't a healthy place because of mold or because of other aspects in your home that aren't healthy. So the environmental health is based on the ability to recognize our quality of our air and the water and the land that surrounds us and in our homes and our communities.

Number five is intellectual health and that's the ability to feel like we really have the intellectual capacity to deal with an increasingly complex and fast world. Do we have the intellectual tools? Do we have the capacity to be informed? Do we have the ability to seek new challenges to stretch our minds? Are we worried about our cognitive ability as we get older? Is this distressing as we think we might be losing our ability to remember or process new things? How about that new iPhone? You figure that you can figure that one out?

Number six is financial health. Now this is kind of tied in with occupational health, but it's the ability to get personal fulfillment in our jobs and in our chosen career fields and have enough finances to meet the basic needs of ourselves and our family without undue stress and worry about money.

Number seven, and probably the most important, is our spiritual health. We know that people in the face of substantial emotional stress, social stress, even physical health stress, maintain a sense of wellness and connectedness and peace if their spiritual health is strong. How do we establish peace and harmony in our lives and develop a sense of congruency between our values and actions and realize common purpose that binds us together with our community, our world, maybe even our universe. So, finding meaning in life is part of our spiritual wellness and that may be even paramount, particularly in people for whom those other domains of their health are troubled. We find many people with significant physical challenges who overcome the sense of defeat by having a very strong sense of their spiritual health.

So there they are, all seven, physical health, social health, emotional health, occupational and financial health, environmental health, intellectual health, and spiritual health. So these seven domains or dimensions of our health are important as an integration of our sense of wellness. If you want to hear more, you may want to Google the Center of Excellence in Women's Health, check on the seven domains of health, and you can see a presentation in all of these domains by experts in this field. In future podcasts on The Scope, we're going to take the seven domains of health and give you some resources that will both help you strengthen each domain, but even assess your wellness in each domain. So stay tuned and we'll do it in the future on The Scope.

updated: January 4, 2023
originally published: August 7, 2014

Interviewer: You've been diagnosed with liver disease. How is that going to affect your diet? We'll talk about that next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: After you've been diagnosed with liver disease, dietary changes can make a difference. We're going to find out what you should be eating and what you should be avoiding right now, with Doctor Juan Gallegos. He's a liver expert at the University of Utah hospital. Tell us about diet and the importance of diet with liver disease.

Dr. Juan Gallegos: Thank you, Scot. It is very important because the liver receives most of the nutrition that you get through your mouth. It actually makes it into the blood from the small bowel and, then, that blood has to go and get through the liver. The liver cells, basically, detoxify your blood, and are very important in making proteins, making cholesterol, and it's basically like a chemical factory.

Interviewer: So, very important diet.

Dr. Juan Gallegos: Yes. Most of the time when I see patients in my clinic who have chronic liver disease, my main recommendation for them is, first, abstain from alcohol because we know alcohol has a direct toxic effect on the liver. So, if somebody already has liver disease, we strongly recommend that they abstain from alcohol so as not to damage the liver even further. In regards to any particular change in their diet, I do recommend that they try to eat healthy. Meaning, have adequate portions of fruits and vegetables, trying to limit their simple sugars, like a lot of flour, and bread, things of that nature. The other main thing, especially in patients that have very advanced liver disease, something we call cirrhosis, is to limit their salt intake because increased salt intake can lead to complications of liver disease or worsening of those complications, such as fluid build up in the abdomen, which we call ascites, or swelling of the legs and arms.

Interviewer: And why does that happen?

Dr. Juan Gallegos: Well, it happens because the liver is important in maintaining the amount of protein in our blood and, also, in maintaining the adequate amount of salt in our blood. So, when the liver isn't working well, there is an imbalance in those things that lead to people having low levels of protein in their blood, and that makes it easier for the water part of our blood to filter out, or go out of, the blood vessels and stay in the tissues and that causes ascites and swelling.

Interviewer: Is it the same thing with sugar, as well?

Dr. Juan Gallegos: It's a little bit different, but yes, the liver is very involved in sugar and metabolism. So people that have advanced liver disease can have sugar problems similar to diabetics.

Interviewer: So it sounds to me, essentially, the liver is just not doing its job the way it should be and you just have to be really careful because a normal functioning liver might be able to take the overload.

Dr. Juan Gallegos: Correct, that is true. It's just that the liver is so noble that it takes a lot of injury before it actually manifests itself as having problems. So, normally, people, when they get diagnosed, it tends to be later on in their disease course and that's where nutrition is so important.

Interviewer: All right. So we hear these things a lot. We hear nutrition is important. We hear that you should stop drinking because it can affect your liver. How important is it? It's like we hear it so often that I think a lot of people ignore it, so give us some context.

Dr. Juan Gallegos: Well, it is very important because we are what we eat, basically, and when you have a liver that's already damaged, or faulty, then, you don't want to increase the damage to that liver or make things worse and some of the symptoms that have to do with liver disease. The other important part is the alcohol issue. Even patients that have liver disease not related to alcohol, we know that the liver will be damaged by the alcohol intake, so that's why we recommend, in those cases, not to drink alcohol.
But, in those patients that have had injury to their liver because of significant alcohol intake, or now have what we call liver cirrhosis from alcohol, it is extremely important for them to stop their behavior and stop drinking alcohol because what is going to happen, if they continue to drink alcohol, is that their liver is going to get worse and their going to reach a point where their liver fails them and there's no way we can treat them anymore.

Interviewer: But one drink a day, that's not that big of a deal is it?

Dr. Juan Gallegos: Well, that's not big of a deal for a healthy person, that is true. In general, the recommendations are, for men, not to drink more than three or four drinks per day, and in women, as they are more sensitive to the effects of alcohol, the recommendation is not more than two drinks per day, but that's only for healthy people. In patients that have already liver disease, our recommendation is that there's really no minimal safe amount of alcohol and, hence, we tend to be more strict and say "No alcohol for you."

Interviewer: So when it comes to diet and alcohol, when you have liver disease, it makes a huge difference?

Dr. Juan Gallegos: It does. It makes a big difference. Of course, the other important part of it is making sure that you are being taken care of by the adequate medical provider and that you follow the recommendations, not only from a diet standpoint, but also if you're already on medications, to make sure that you follow those as well.

Interviewer: Like the difference of living and dying, living a great life and living a mediocre life; I mean how important are these things that we're talking about.

Dr. Juan Gallegos: It can be, especially in those patients with alcoholic liver disease. Continued use of alcohol will definitely result in, not only a very bad life quality, but, also, a shortened life and those people look forward to, basically, being in the hospital and dying in a very short period of time. And patients that have their types of liver disease, it might not be as dramatic, but, certainly, anything we can do to prolong their life and improve their quality of life, I think, is very important.

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