There’s a lot you can do to regain control over your sleep. Minor lifestyle and environment changes, such as preparing for sleep, following a sleep schedule, and making your bedroom conducive to sleep can have a major impact. If you do shift work, there are ways to meet the unique challenges you face.

Prepare for sleep - Setting the stage for a good night’s sleep can help you get your mind and body into “sleep mode.”

• Follow a schedule. Go to bed and get up at the same time every day — even on weekends. Creating this routine can help condition your mind and body to expect sleep at a regular time.
• Make a “Sleep Pact” with your bedroom. Make a commitment to treat your bedroom as a sanctuary for rest and sleep leaving out all the things that would get in the way of rest and sleep. Learn to relax and turn your mind off to the daily thoughts of accomplishing tasks, or worrying about something, etc.
• Make your bedroom “Sleep Friendly”. Adhere to the bedroom checklist written below.
• Unwind mentally. About a half hour before going to bed, enjoy a low-key activity such as reading or listening to music.
• Once in bed, learn to stop thinking or worrying. Avoid solving your problems from your bed. Before going to bed, make a list of problems and “next steps” for the following day or just forget about them until tomorrow. If your mind won’t turn off tell yourself “This is not the time to accomplish or plan. It is the time for letting go, relaxing into the bed, clearing my mind and falling asleep. I’ll pick up where I left off tomorrow.” Remember your sleep pact.
• Relax your body. To reduce muscular tension, try techniques such as meditation, progressive relaxation or even taking a warm bath.
• No eating After 8pm. No heavy, spicy, or high-sugar foods 2-3 hours before bed.

Bedroom check - Your bedroom may not be as conducive to sleep as it could be. The following strategies can make your bedroom more sleep-friendly:

• Block out noise. Or better yet, eliminate it. Sleep in the quiet without any background noise. Turn off radios, televisions, or stereos in the bedroom (and other rooms as well). If you can’t control the noise, try earplugs.
• Reduce light. Keep the room dark. The issue isn’t merely how light affects your eyes. Light also affects the way your brain produces hormones that regulate your sleep cycle. Even a minimal amount of light can disrupt your sleep. Possible solutions: Ask your sleep partner to read in another room; wear a “sleep mask”; use heavy shades or other window treatments that keep the room very dark.
• Adjust the room temperature. If you are too warm or too cold, you are less likely to sleep soundly. Adjust the thermostat, your sleep clothes, or your bedding; open or close a window.
• Move the clock. If you can’t sleep, looking at the clock can make you anxious. Therefore, it’s best to keep it out of view.
• Have your pet sleep somewhere else. If your dog or cat sleeps in your bed, your chances for sound sleep are jeopardized. Have your pet sleep on the floor, or get your pet its own cushion and place it in another room.
• Address your partner’s sleep problems. A bed partner who snores, tosses and turns a lot, steals the covers, talks while sleeping, or gets up often can affect your own sleep. In some cases, using earplugs or adding “white noise” (from a fan or similar humming appliance) can help. If your partner gets up a lot, make sure he or she sleeps closest to the door. If your partner tosses and turns, consider a larger bed, or even separate beds.

Tips for shift workers - If you need to get a good night's sleep during the day, one of your biggest challenges may be dealing with the sunlight. Here are some suggestions:

1. If possible, work in brightly lit areas during your shift.
2. When you drive home in the morning, wear sunglasses. Limiting light to your eyes tricks the brain into thinking it’s getting close to nighttime.
3. Make sure your bedroom is absolutely dark. If any daylight is creeping in through the curtains or shades, drape a thick towel or blanket over the window. You might also consider wearing a “sleep mask.”

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Things to Avoid - Some activities can interfere with sleep — especially if you engage in them too close to bedtime:

• Exercise Avoid exercising within three hours of bedtime. Some people try to tire themselves out by exercising close to bedtime. This tactic can backfire, since exercise actually stimulates the body by speeding up the heart rate and metabolism. There’s a positive flip side: Exercising on a regular basis (during the day, ideally) may help you sleep well at night.
• Smoking Nicotine is a stimulant that can keep you awake. Avoid smoking in the six hours before your bedtime.
• Alcohol Although alcohol may seem to help you fall asleep, it can disrupt your sleep during the second half of the night and leave you feeling unrested. It’s best to avoid alcohol before bedtime.
• Caffeine Caffeine can delay your sleep and cause you to wake up during the night. Avoid caffeinated drinks and foods (coffee, tea, cola, chocolate) after noon. Another option, avoid caffeine entirely for at least 1 month and see if your sleep improves.
• Liquids Avoid drinking fluids before bedtime to decrease the chance of having the urge to go to the bathroom during the night.
• Some products that may affect sleep: Alertness medications, Analgesics, Antidepressants, Arthritis medications, Asthma medications, Blood pressure medications, Cold/allergy medications, Diet pills

Discover Patterns - To solve any problem, you have to identify it first. One reliable way to pinpoint your sleep problems is to keep track of each night’s sleep (or lack of it) for about seven days. The easy-to-use sleep diary offered here can help you find out if anything you are doing during the day, in the evening, or at bedtime might be contributing to your sleep difficulty. Like many individuals, you may have developed habits that get in the way of restful sleep. Even if you think you know the causes and nature of your sleep problems, use the sleep diary. You may be surprised by the patterns you uncover.

How to use the sleep diary - Each day’s sleep log takes only a few minutes to complete. After the seven days, you will have a detailed picture of your sleep habits. With all the facts in front of you, it will be easier for you and your doctor to detect patterns that can lead to solutions.

Older Adults and Sleep - Contrary to popular perception, older adults do not need less sleep as they age. Like younger adults, they require between seven to nine hours of sleep nightly. Older people may seem to need less sleep because they are prone to waking up more frequently during the night.

Sleep Promoting Techniques Offered By Others
Not Thinking - "I have one method that never fails to put me to sleep. As long as I'm 'decently' tired, i.e., not trying to overdo it, it's bedtime, etc., I just lie down, close my eyes, and concentrate on 'not thinking'. This often becomes a competition of my strength of will, versus my instinct to think. Occasionally a pinprick of an idea strikes you, but you just have to ignore it, and it always puts me to sleep in about two minutes. It's better then just lying there. "

Backwards Counting / Mental Computer - "Even though I am only a kid, I still have problems falling asleep sometimes. Usually, all I have to do is count backwards from 1,000, taking a deep breath in between each number, as far as it takes to get to sleep." Another mental exercise to use is to mentally 'type' in your worries onto a mental computer, such as 'fear', 'stress', and 'anxiety'. Then hit the delete key until the entire "screen" is blank." I know many adults often say, 'I wish I was as carefree as a kid,' but it really isn't that easy to be a kid!

Earplugs - "How about plain old-fashioned earplugs? I finally figured out that the reason I couldn't relax into sleep was that I was being kept irritated and awake by the crickets chirping outside my window. Earplugs work! And they're inexpensive, too."

Secure Place - "A technique that I have found most useful is to envision myself in some ideal spot: a house, say, that is perfectly secure and warm while a blizzard rages outside. I picture a window next to my bed, with snow striking against it. Then I work out the layout of the house, the heating system, the surroundings; and I make them all ideal so that the idea of security and no disturbing thoughts can intrude."

Bedtime Routine - "It helps to develop a bedtime routine. Have a series of things that you always do when going to sleep. For example, before going to bed, feed the dog, fold laundry, check the locks. Humans are creatures of habit. Remember Pavlov’s dogs? He rang a bell and they knew it was dinnertime. It's the same theory. Doing this will 'program' your body to know that it's bedtime."

Hot Water Bottle - "To help you sleep after a high stress day, lie down with a hot water bottle on your stomach, close your eyes and breath deeply, so the bottle rises and falls. We carry a lot of tension there and the weighted heat releases it."

Green Cows—and Other Animals of Color - A technique I've generally had good success with is to visualize animals in the wrong colors. For example, blue cat, green cow, red elephant, and so on. After coming up with a color/animal combination I try to actually visualize it and then I move on to the next one. Coming up with the combinations and then trying to picture the animal seems to keep my mind occupied and distracted from whatever stressful thoughts were keeping me awake and it gets boring enough that I can generally fall asleep pretty quickly.

The Impact of Daily Sleep Duration on Health: A Review of the Literature
Gonzalo G. Alvarez, MD; Najib T. Ayas, MD, MPH University of British Columbia (Prog Cardiovasc Nurs. 2004;19:56–59)
"A healthy amount of sleep is paramount to leading a healthy and productive lifestyle. Although chronic sleep loss is common in today's society, many people are unaware of the potential adverse health effects of habitual sleep restriction. Under strict experimental conditions, short-term restriction of sleep results in a variety of adverse physiologic effects, including high blood pressure, activation of the sympathetic nervous system (causing stress, tension and possible anxiety) , impairment of blood sugar control, and increased inflammation. A variety of studies have also suggested an association between self-reported sleep duration and long-term health. Individuals who report both an increased (9-11 hrs/night) or reduced (<7 hrs/night) sleep duration are at modestly increased risk of all-cause mortality, cardiovascular disease, and developing symptomatic diabetes. Although the data are not definitive, these studies suggest that sleep should not be considered a luxury, but an important component of a healthful lifestyle."

• *Multi Nutrients: 3 caps once or twice daily with food (2 x a day is ideal)
• *Vitamin D3 2000: 1-2 caps daily with food (Blood Level of 40 is ideal)
• *Magnesium (glycinate/malate): 120mg/cap, 2 caps daily
• *Fish Oil Ultra Pure 800: 2 caps daily with food

I recommend that all or most of my patients take the above protocol on a daily basis with very little skipping or forgetting. *(Vital Nutrients brand)

The benefits are numerous and include decreasing the risk of major chronic diseases later in life such as diabetes, high blood pressure, heart disease, heart failure, several kinds of common cancers, colds and flu’s, bacterial and viral infections, and thinning bones.

Ideally nutritional supplements would be accompanied by eating an excellent food program which is enough clean water daily, low sugar, lots of vegetables, some fruit, lean meats and fish, nuts and seeds, whole grains, beans, and good sources of fats and oils.

​Sounds too good to be true? I have studied the medical literature for over 30 years. My experience as a Naturopathic Physician and a Registered Pharmacist has given me a keen eye to identify and evaluate the most worth while studies that show some evidence of a great health return.

​The above outlined nutritional supplement program plus eating a clean diet (refer to Healthy Food Program – Summarized handout) WILL consistently increase the chances of living longer with greater health and a higher feel good potential.

It is not me saying this, I am just conveying the published information that I have reviewed from the years of reading medical literature on what produces and maintains great health over time and reduces health risks.

Make the commitment now to consistently use this nutritional supplement protocol along with a sensible food program each and every day.

I have seen many, many, many people over my 30+ years in practice with extremely bad health suffering with some disease or another. The vast majority of them regretted not adopting and sticking with health promoting preventive practices when they were younger. The sad thing in many of these cases their health was so poor that it was difficult or impossible to restore them to good health.

I encourage you to make a good decision for yourself.

Sincerely,

Dr. Enrico Liva

by Rick Liva, ND

Doctors often find that one of the primary causes of stress is a racing mind and thinking too much. Simply put, people have a difficult time shutting off thoughts, putting them aside, clearing the mind, and relaxing the body. Constant thinking creates brain activity and releases chemicals in the nerves that are stimulating. It is hard to fall relax and reduce stress with stimulating chemicals running around the body. However, mind clearing and relaxing releases a different set of chemicals that calm, soothe and allow people to let go, relax and decrease stress.

These guidelines if practiced routinely (daily) are extremely powerful and useful to help achieve and maintain a relaxed state and most certainly will improve the quality of one’s life. Let’s face it, we live in a stressful world and most people don’t know how to effectively manage their thoughts, clear their minds, relax and let go of the stressors of life.

What to expect once you have made relaxation, meditation, and mind management a habit:

1. You have a connection between your mind and body that helps you let go physically, relax your muscles and quiet your mind.
2. You are able to let go mentally, redirect negative thoughts to pleasant or more productive thoughts and have a neutral mind (being present to your surroundings) more often.
3. You will notice your thoughts more readily and change your mind’s focus if you choose. You can manage and direct your thoughts to focus on something more productive or pleasant.
4. You are able to recognize your emotions, deal with them more effectively and let go.
5. You experience a greater amount of mental peace and relaxation moment to moment in daily

life.

GETTING STARTED:
First, give it time. Relaxing/Meditation takes practice. If you’re expecting to do it ‘perfectly’, you may actually create more stress for yourself than you relieve, and you won’t want to stick with it. You need a willing attitude, an open mind and perseverance to get good at this and make it a useful tool. With practice, it becomes easier and more effective.

Posture - Different postures affect how the energy flows through the body and how alert the mind is in relaxing meditation. Lie down to enhance the letting go of body tension and achieve complete relaxation. Keep your arms at your side and legs uncrossed. Make sure you are really comfortable before beginning.

How Long to Relax/Meditate - Usually 15-30 minutes (goal is 20 minutes) is a good amount of time, although if you are new to this, you may want to start with 5 or 10 and build up. If you relax/meditate regularly, it can be helpful to do so about the same number of minutes each day.

When to Schedule Your Relax/Meditate Time - Although you can relax/meditate at any time, the ideal times are usually in the morning as a start to your day, or in the late afternoon in order to unwind from the activity of the day and be refreshed for the evening. However, anytime is better than none.

How Often to Relax/Meditate - Once daily is recommended and can make a huge difference. Twice a day if needed. A regular routine of relaxation/meditation is invaluable. The benefit derived from meditation starts to carry over into our daily life and activity more when we relax/meditate regularly.

Focus in Relaxation/Meditation – Achieving deep relaxation is all about bringing and keeping your focus and attention on two things, the thoughts in your head and relaxing and letting go of your muscles. Once you are in the proper position and ready, bring your focus to your thoughts. Your primary job is to keep your mind’s attention on something neutral, pleasant and/or relaxing. By doing so you momentarily stop thinking about the everyday stuff of life that causes you stress, tension, and upset. As you start to practice this technique, you will observe that as you attempt to keep your mind focused on something neutral for a period of time (seconds or minutes), your mind drifts and starts thinking about everyday life. When that happens simply be aware that you are there and bring your mind back to the neutral, pleasant or relaxing focus.

Avoid beating yourself up if you frequently lose your focus and think about everyday life. REMEMBER THIS NEXT SENTENCE  Losing the focus through a relaxation/meditation session is normal. The best thing to do is bring yourself back to the neutral, pleasant or relaxing mind focus and keep it there as long as you can.

What to focus on in your mind - Anything that works for you. You can create it. The goal is to focus on something neutral, pleasant or relaxing and keep the focus as long as you can.
Some Examples:

• The Sounds of The Ocean, Soothing Music Nature Sounds, Running Water, Wind Chimes, etc.
• You can put your focus on and pay attention to your breath by keeping your mind and thoughts totally riveted on listening to your breath coming into your lungs, leaving your lungs and the pause in between.
• You can try to keep constant attention on the black in front of your closed eyes. This may sound silly but try and do it and at the same time let the muscles of your body loosen and relax physically.
• A word such as relax, down, or another of your choosing. As you say the word to yourself stretch the word out. Example; Use relaaaaaaaaaax and when you are saying the word in your head let the muscles of your body loosen and relax physically.
• Body Scan – Explained below.

Thoughts in Relaxation/Meditation - Thoughts arise spontaneously in the mind. They are a natural part of relaxing. The goal of relaxing/meditating is to become more at ease, relaxed and at peace with whatever is happening. Therefore, it is important to not resist anything that comes in, including thoughts. Simply notice that thoughts are present and let them go the way they come — effortlessly. When you find that your mind/thoughts have been caught up in an every day train of thought, easily come back to the focus of your relaxing/meditation.

Our experience of thoughts may change as we relax/meditate. As we disengage the gears of the mind, the mind has an opportunity to settle down. Sometimes you may experience a kind of dream- like state, somewhere between being asleep and awake. This also is a natural experience in relaxing/meditation. There may also be times when there is a state of “no thought”. No matter what happens just take it easy — take it as it comes!

Body Scan Meditation – Learning to Let Go of Stress and Relax Your Muscles
This is a relaxing/meditation technique where you are putting your mind’s focus on individual body parts (scanning) and you are choosing to deeply relax the muscles of that body part.

​Breathe in s-l-o-w-l-y and deeply through your nose. Feel your abdomen move upward as your diaphragm contracts and draws air into your lungs. Your chest should not rise noticeably.

While breathing slowly, direct your mind’s attention to your feet. Feel your feet. Curl your toes once to fix your awareness to it. Now relax... as if you can feel your muscles and all the tension melting into the bed and disappearing. Relax this way as you go through each part of your body.

As you breathe in through your nostrils, slowly scan your legs from feet to knee, and up through your thighs. As you breathe out, trace your leg down to your feet. Do this 3 times, then take your mind off your breath and remain with your feet. Relax... as if you can feel your muscles and all the tension melting into the bed and disappearing. If thoughts appear, that's fine. Gently come back to your breath, and shift awareness over to your legs and feet.

Now focus on your stomach and lower abdomen. Feel it r-i-s-i-n-g as you breathe in. Sinking as you exhale. Nice and slow. Your heart probably slows down. This is normal. Remain aware of your stomach/abdomen, your breath... up and down. Become aware of sensations. Relax... as if you can feel your muscles and all the tension melting into the bed and disappearing.

Now follow the same procedure with your arms as you did with your legs. You may clench your fists at first to really direct your awareness to your hands. Breathe... Now scan up along the length of your arms, to your chest. Then down your arms to your hands. Remain there. Breathe. Sense and scan. Relax... as if you can feel your muscles and all the tension melting into the bed and disappearing.

Come back up to your chest, shoulders and head. Continue scanning up along your neck, to your face. Gently clench your jaws and release. Feel the back and top your head. Feel the sensations in your jaws, your throat. Breathe, scan and relax. Pay special attention to your face and jaw. Focus on them and relax deeply. Your jaw may flop open if you are very relaxed, let it happen. Focus on your shoulders and back of your neck, common places for tension to store. Relax... as if you can feel your muscles and all the tension melting into the bed and disappearing.

Now detach your mind’s attention from all body parts. Breathe... Feel how everything is relaxed, resting gently. Just breathe, let any sensation come to you. Accept it as a part of you. Return to your breathing. You can end or go back and focus more and relax tense body parts.

Noise - It’s enjoyable to meditate in a quiet place, but it is not always possible. The key is to not resist noise. Don’t try to ignore the noise or to block it out. Simply let it be and continue with your meditation. Everything is a part of relaxing/meditation — the noise, your thoughts about it, the way the mind may start to resist it, the emotions that arise about it. Treat everything that arises in this practice the same way — let it be, let yourself be!

Falling Asleep - Hopefully in relaxing/meditation we enter a state of “non-resistance”. This would include not resisting sleep if it comes. The goal of relaxing/meditation to establish a state of ease. Therefore, if sleep comes, let it come.

Strong Emotions - When we enter into a state of relaxation in meditation, strong emotions can sometimes arise. This can happen for several reasons. When the mind settles down, we may become aware of an emotion that has been “under the surface” while we are busy in activity and focused on other things. It may also be that deep relaxation causes a kind of “unwinding” or purification, so that any emotion that has been held in the body is released. The relaxed state can be much like the dream state in which various issues are being processed.

If we are uncomfortable with a particular emotion, such as grief, the tendency may be to want to push it away, stuff or ignore it. Emotions are a flow of life energy, and if we resist that flow, the energy becomes “stuck”. If you notice resistance to emotions, let the resistance go. Allow the emotion to be experienced fully and the energy of the emotion can flow and resolve.

On the other hand, when a strong emotion arises, the mind may become very busy interpreting it or dramatizing it with a story about it. If anger arises, for example, the mind might pick up on something that happened in the past, or imagine something happening now as the cause of the anger. This involvement of the mind in the emotion intensifies and feeds it, and also obstructs it from moving through easily. When we become aware of being caught up in a train of thought or a story, let that go and bring the awareness easily back to the focus of the relaxing/meditation.

If the emotion or thought is so strong that you cannot easily come back to your focus (such as the focus on the breath), then simply allow yourself to feel the emotion. Let the awareness locate a physical sensation in the body that is associated with the strong emotion (or thought). Simply continue to feel that sensation in the body. With the awareness easily on the sensation, it will eventually dissolve and the mind will be free to continue with the focus of the relaxing/meditation.

Ending The Relaxing Session - It’s important to take time to come out of relaxing slowly. Remain with your eyes closed for a minute or two. Stretch, move around a bit, and gradually become more active and get up.

by Rick Liva, ND
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1. Be honest, authentic and candid by regularly sharing your thoughts, feelings, hopes, wants, desires, frustrations and upsets. Do this on your own without be asked. When you speak always be civil, respectful and compassionate. Speaking loud and angry causes the person listening to shut down and emotionally go away.
2. Some people do not easily express their thoughts and feelings. The reason they do not is almost not important. So, you must ask what is true for another and how they are. Ask questions to elicit specifics as to what they are feeling and thinking. NEVER EVER assume that you know what a person is thinking, feeling, planning or what the meaning is behind their behavior. Always ask about their intent, thoughts, and feelings and get the facts from them directly.
3. Work together with people you care about on creating better relating and help them manage themselves to relate better with you.
4. Being there for the other person means encouraging and helping them to fully express thoughts, feelings, hopes, wants, desires, frustrations and upsets. Demonstrate compassion, empathy and kindness.
5. Learn to be an excellent listener. Listen Well Means: 
   1. Being quiet and paying close attention when they are speaking and expressing  thoughts and feelings.
   2. Wait until they are finished before you ask questions, or respond to what they have said.
   3. Listen intently, write down key points if necessary so you will remember what to respond to; keep your mind and attention on what someone is saying vs. what you are going to say when the person stops speaking. Put your agenda aside while listening. Do not offer advice unless asked to do so.
   4. Understand what the other person is attempting to communicate by asking questions if necessary. Try to end any conversation only after each of you is satisfied that you have said all that needs saying. Allow for agreeing to disagree.
   5. Remove yourself when you get to the point of “extreme” anger or upset. Listening stops with extreme upset. Come back when you have calmed down and be willing to dialogue and express what you have to say in a respectful manner. If you leave explain why vs. just storming out. Example: I’m mad/upset and need to go and cool down.
6. Make requests of your spouse, significant other or appropriate people in your life. If they decline to grant your request negotiate with them to see if they agree with some close version of your request. Be prepared to have the other person make requests of you and negotiate with them if needed. Write down ALL promises made so they are available for review in the future and to avoid misunderstanding.
7. How to hold another accountable? If another person has agreed to grant a request of yours, get their permission to hold them accountable for keeping their promise. If the promise has not been kept simply point out that they are not doing what they agreed to do and have a conversation about that. Treat them with some compassion, love, and forgiveness. Give them 1 or more opportunities to do better the next time.
8. How to hold yourself accountable? If you make a promise to someone and agree to grant their request be willing to hold yourself accountable for following through and keeping your promise. Review the promises and agreements you made with others. If you find yourself falling short admit that to the other person and speak about it. Also, allow them to hold you accountable for keeping your promise.
9. When holding someone accountable for doing what they say they would do, do so with kindness, respect and some tenderness.
10. Regularly show/speak gratitude for having another in your life, occasionally include the small stuff they do.
11. Manage yourself so you can accept others as they are, communicate with them about changes you would like to see them make and make a request(s) for such changes. Help them work at and produce the items/behaviors they agree/accept are important for them to put in place. Accept that you may have to regularly work at this on an ongoing basis. 
12. With significant others  Work together on creating and accomplishing house projects, resolving money issues, creating joy, mutual and individual satisfaction.
13. Regularly have fun, go on small or large adventures and play together with people you enjoy.
14. Fulfill another’s request(s) of you to do some activities special to them but are not on the top of your list. Make sure you do your best to be present and enjoy the activity as best you can.

Honesty - Telling the truth, admitting wrongdoing. Being trustworthy and acting with integrity.
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Authentic - genuine, real, veritable share the sense of actuality and lack of falsehood or misrepresentation.

Candid - Characterized by openness and sincerity of expression; unreservedly straightforward. frank; outspoken; open and sincere; free from reservation, disguise, or subterfuge, straightforward.

Civil/Civility - courtesy; politeness, polite action or expression

by Rick Liva

Cardiovascular disease remains the number one killer of Americans today, and we all associate cholesterol with heart disease. However, if your cholesterol levels are in the normal range do not become complacent. Half of all patients who have heart attacks have normal levels of cholesterol. It seems that other risk factors may be even more important than cholesterol.

In the October 19, 2000 issue of The New England Journal of Medicine, three articles were published showing that the presence of blood indicators of inflammation are strong predictive factors for determining who will develop coronary artery disease and suffer cardiac-related death.

The advanced risk factors that contribute to coronary artery disease are emerging as powerful prognostic indicators to determine risk. One or a combination of these risk factors can cause blood to thicken, become sticky and clot. They also cause inflammation of blood vessels and buildup of plaque. These risk factors are:

LAB TESTS THAT SHOW RISK OF HEART DISEASE

• Advanced Lipid Panel – Cholesterol, Triglycerides, HDL (good cholesterol), LDL (bad cholesterol), Lipoprotein Subfractions, Apolipoprotein B; Lipoprotein (a), HDL and LDL Particle Size
• hsCRP – a marker of inflammation in the wall of the artery. The higher the number the greater the risk of heart disease.
• Insulin Level - The higher the number the greater the risk of heart disease. Ideal is 6-8
• Homocysteine - The higher the number the greater the risk of heart disease. Ideal is 6
• Myeloperoxidase - The higher the level the greater the risk of heart disease. Ideal less than 470
• Fibrinogen – High levels of Fibrinogen contribute to hardening of the arteries. Ideal is 300
• Testosterone Level - Testosterone is a muscle-building hormone, and there are many
• testosterone-receptor sites in the heart. Weakening of the heart muscle can sometimes be attributed to testosterone deficiency. Testosterone is not only responsible for maintaining heart muscle protein synthesis, but it is also a promoter of coronary artery dilation and helps to maintain healthy cholesterol levels.

Most doctors and even many cardiologists do not commonly check for all of these risk factors because they may not be aware of their importance. This is unfortunate because there are simple methods to reduce these risk factors.

C-REACTIVE PROTEIN (CRP)
CRP has been shown to be twice as effective as a standard cholesterol test in predicting heart attacks and strokes. CRP is a blood protein that is a marker of inflammation occurring in the body. When coronary blood vessels are damaged, the resulting inflammation causes the liver to begin producing this protein. A normal CRP level should be negative to very low, so any elevated reading may mean trouble in the coronary arteries. In a recent study of postmenopausal women, those with the highest levels of CRP were 4.4 times more likely to have a heart attack as compared to those with the lowest levels.

Inflammation is a major player in the development of coronary artery disease because it damages the endothelium (the inner lining) of the blood vessels. The body then tries to repair this damage by forming deposits of plaque in the damaged area, which can lead to blockages. Inflammation can be due to chronic gum disease, bacterial infections such as chlamydia or helicobacter pylori, and possibly even viruses like herpes simplex and others. CRP may be elevated years before heart disease sets in.

Aspirin is an anti-inflammatory and can lower CRP. However, it makes more sense to find out what may be causing the inflammation and to eliminate the source. Also, there are more natural methods that can be used to reduce inflammation instead of, or in addition to, aspirin (see lowering fibrinogen risk).

HOMOCYSTEINE
Homocysteine is an amino acid derived from protein metabolism. It is naturally found in the body. When levels are too high, it can cause irritation to the endothelium of the coronary blood vessels. Homocysteine often causes the initial lesions on arterial walls that enable LDL cholesterol and fibrinogen to accumulate and eventually obstruct blood flow. Homocysteine damages artery wall cell directly.

Even when cholesterol and triglyceride levels are not significantly elevated, homocysteine alone has been demonstrated to promote atherosclerosis (hardening of the arteries) and thrombosis (blood clots). Levels above 9 are a problem. An excess of homocysteine is like having a silent killer lurking in your bloodstream.

Recent research shows that women who have both elevated homocysteine and high blood pressure have 25 times the incidence of stroke or heart attack. Some simple nutritional supplementation can neutralize homocysteine.

FIBRINOGEN
Fibrinogen is an inflammatory component of blood coagulation, which if elevated can cause heart attack or stroke by several mechanisms, including increased platelet aggregation, hyper-coagulation, and excessive blood thickening. Studies reported in The New England Journal of Medicine show that those with elevated fibrinogen were twice as likely to die of a heart attack. An acceptable range for fibrinogen is less than 300 mg/dl; anything over 360 is undesirable. If your level is elevated, here is what you can do:

Lowering Fibrinogen Risk
Although blood levels of fibrinogen are influenced by genetics, the most important contributor is smoking. In fact, half of all cardiovascular risk can be attributed to smoking! If you smoke and have other risk factors for heart disease such as elevated fibrinogen, you are on the path to an early grave. Smoking cessation can dramatically reduce your risk of heart attack!

Other measures to lower clotting risk from elevated fibrinogen are low dose aspirin and other more natural alternatives that can be used to make your blood less likely to clot. Blood-thinning alternatives to aspirin include Omega-3 fatty acids (found in salmon or fish oil capsules), garlic, ginger, bromelain, gingko biloba, vitamin E, vitamin C and Curcumin Extract. Consult with your doctor if you have been advised to take aspirin or other prescription blood thinners such as Coumadin, before taking any of these natural alternatives.

Lp(a)
Another toxic blood component is Lp(a) or lipoprotein (a), a strong predictor of early heart disease. It was reported in a recent issue of the medical journal Circulation that those with high levels of Lp(a) are 70 percent more likely to have a heart attack then those with lower concentrations.

Lp(a) is a "sticky" small cholesterol particle that causes inflammation and clogging of blood vessels, and is mostly genetically determined. Modifying Lp(a) is not easy, but can be done. High dosages of nutrients like Coenzyme Q10, vitamin C, L-carnitine, and niacin or niacinamide can be useful.

INSULIN
Excess insulin causes diabetes, heart disease and premature aging. Insulin is a storage hormone produced by the body to lower blood sugar by sending it into the cells. Over time, excess blood sugar and insulin stresses the system and the cells become less responsive. This condition is known as insulin resistance.

Excess insulin promotes smooth-muscle growth in blood vessel walls, which contributes to the formation of plaques. Artery walls become thickened and stiff, causing blood pressure to rise. Insulin resistance may contribute to as much as 60 percent of heart disease we find in women and 25 percent in men.

Signs of insulin resistance How do you know if you are insulin resistant? Ideally, fasting levels of insulin should be below 10. However, other telltale signs of insulin resistance include weight gain, (especially around the abdomen), elevated triglyceride and low HDL levels.

Insulin levels can be lowered by medication, but diet changes are preferred along with exercise and weight loss. We may recommend a diet that consists of 40% low glycemic carbohydrates, 30% lean protein, and 30% healthy fats. Insulin resistance is a major problem and lowering insulin levels is a goal for improved health and anti-aging.

MYELOPEROXIDASE
Myeloperoxidase (MPO) is a inflammatory enzyme that may play a direct role in the pathogenesis of cardiovascular disease (CVD). It is involved in 1) lipid peroxidation, converting LDL to an atherogenic form and HDL to a dysfunctional form; 2) destabilization and rupture of atherosclerotic plaques; and 3) vasoconstriction and endothelial dysfunction. Thus, MPO has been studied as a biomarker of CVD.

Elevated plasma levels of MPO have been linked to increased risk for

1. Heart disease in low-risk populations;
2. Major adverse cardiovascular events in patients with angiographically confirmed heart disease MPO measurements can provide prognostic insight in both primary prevention and secondary prevention of heart disease.

Higher plasma MPO concentrations are associated with poorer outcomes than are lower concentrations.

OTHER DIAGNOSTIC TESTS OF VALUE TO PREDICT RISK
Ultra Sound of Carotid Arteries – This shows if there is any plaque in the artery wall. Plaque buildup can decrease blood flow or cause a stroke if the plaque breaks off and clogs an artery. If you find plaque in the carotid arteries it may be a good bet that there is some plaque buildup in the heart arteries as well.
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Calcium Score Test – Ultrafast CAT Scan of heart arteries that shows calcium buildup. The higher the amount of calcium buildup in the artery wall the greater the risk for heart attack.

Stress Echocardiogram – Treadmill test that looks at functions (valves opening and closing and heart muscle movement) of heart after a stressful exercise period.

Thallium Stress Test – Treadmill test where they inject a radioactive substance to tell how much blood is getting into the blood vessels that feed the heart muscle.

by Rick Liva, ND

Think Ahead, Plan, Shop, Prepare & Cook Meals at least 4x/week, eat your leftovers for lunch. This is a must for consistently good diet.

Attempt to drink a minimum of 8 ounces of pure water, either distilled or spring, five (5) to six (6) times per day. No more than 8oz. with a meal as more may dilute digestive juices.

Consume two (2) to three (3) cups of fresh or frozen vegetables daily. Consume a medium to large sized raw salad daily (no iceberg lettuce) or at least every other day. Eat 1⁄2 to 1 cup of raw food each day such as red peppers, carrots, celery, cucumber, snow peas, kale leaves (not the stem), arugula, watercress.

EAT CABBAGE FAMILY FOODS OFTEN - Broccoli, cauliflower, Brussels sprouts, green or red cabbage, arugula, bok choy, Swiss chard, collards, kale, kohlrabi, mustard greens, rutabaga, turnips, turnip greens and watercress. Have 1-2 cups of any of these 3-4 x a week. Use a variety not the same ones all the time. Best to steam OR sauté and not boil.

Consume one (1) to two (2) pieces of fresh, whole fruit per day. No fruit juice or limit to 4oz/day.

Make every effort to consume 1 1/2 to 2 cups of cooked whole grains (brown rice, barley, oats, NON-GMO cornmeal etc) 2-4x/week. Additionally, consume whole grain or whole grain sprouted bread, 1-2 slices 3-4 times per week. Pasta should be limited to one (1) small serving per week and complimented with two servings of vegetables and a salad to ensure adequate intake of fiber.

Consume 1-2 cups of cooked beans (red beans, white beans, black beans, black-eyed peas, etc.) 3 times per week. It is OK to use canned beans, just rinse before use to remove the salt.

Consume 1-2 small handfuls of unroasted, unsalted nuts daily. Walnuts, almonds, filberts, pecans, sunflower and pumpkin seeds. Little or No peanuts.

Limit consumption of flesh foods (beef, pork, chicken, fish, lamb) to a 4oz serving three (3) to four (4) times per week OR a 4-6 oz serving once daily . Limit eggs to two (2) to six (6) per week.

Learn to eat a wide variety of all types of foods. Avoid eating the same few foods over and over.

Oils: Use olive, canola or sesame oils in cooking as needed. Olive oil is much preferred, use it liberally. Avoid the use of sunflower, safflower, corn or peanut oil.

​Dairy Products: Butter, Cheese, Cheese Substitutes, Milk, Milk Substitutes, use all of these in very small quantity. Yogurt (full fat plain is preferred) may be used more liberally. 1+ cup per day is OK.

Foods to avoid: Caffeine, Soda, ALL Fried Food, Hydrogenated Oils, Preservatives, Colors & Additives, Processed lunch meats, Dried Sulphured Fruits, Roasted or Salted Nuts , White Rice and/or White Flour Products, “Accent”, or MSG, aspartame. Best to avoid alcohol or use in small amounts. READ LABELS.

Foods to eat very sparingly: Coffee, Sugar treats of any sort, eat 1-2 small sugar treats/week at most.

Other Suggestions: Eat slowly and chew each mouthful 15-20 times. Eat only when hungry. Eat to 80- 90% full, avoid overeating, under eat at each meal/snack. LEARN TO LIVE WITH SOME LEVEL OF HUNGER IN BETWEEN MEALS. Avoid eating when upset, bored, angry, stressed, etc. No food 2-3 hours before bedtime.

SOME REASONS TO WALK:

• A team of British researchers analyzed data from the best exercise studies to see if walking has any kind of effect on mild to moderate depression. The findings reveal that walking does improve mild to moderate depression. People walked 20 to 50 minutes three times a week to daily.
• Walking is the key to maintaining weight loss for 5 years or longer. Forty-nine out of 50 people in the National Weight Control Registry database who lost at least 30 pounds walk daily.
• Women who walk briskly at least 3 hours a week reduce their risk of heart disease by up to 40%. These brisk walks have the same effect as 15-20 minutes of vigorous daily exercise.
• Older people who strt taking hour-long walks 3 times a week have better memory and judgement ability.
• A 12-year study of 60-80 year olds demonstrates that daily, moderate-intensity, 2-mile walks cuts the death rate by half.
• Three 10-minute walks increase fitness and decrease body fat just as well as one 30-minute walk.

WALKING SCHEDULE – When walking walk briskly and maintain the pace throughout the time you walk. Maintain a brisk pace that is comfortable for you. You can work up to longer distance and shorter time. Dress appropriately for the temperature.​

• Week 1-4: Walk 1 mile three to four times a week. (Time target 22-25 minutes) Week 5-8: Walk 1.5 miles three to four times a week. (Time target 30-35 minutes)
• Week 9-12: Walk 2 miles three to four times a week. (Walk as briskly as you can tolerate and be comfortable)
• Week 12 and beyond: Walk 2 miles four to five times a week. (Walk as briskly as you can tolerate and be comfortable)
• Cooldown: Walk at a slower pace for the last 3 minutes and ideally do 2-3 minutes of stretching.
• Increasing intensity: To shorten a 30 minute walk to 20 minutes, step up the intensity of your workout by climbing steps or hills or interspersing a brisk walk with a light jog. Do this by walking fast or jogging for 2 minutes, returning to your normal pace for 1 minute and repeating that cycle for 20 minutes (6-7 times). For further information see Walking Magazine or visit their web site at www.walkingmag.com.

As part of a healthy food program it is best to make every effort to consume 1 1/2 to 2 cups of cooked brown rice 2-4x/week.
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• 2 parts water with 1 part of brown rice
• Put water in pot and bring to a hard boil
• Add the brown rice and bring water back to boil for 30-60 seconds
• Then turn down heat to low level and put lid on pot
• Let cook for 40 minutes (DO NOT remove lid until 35-40 minutes has elapsed)
• Check after 35-40 min

Any leftover cooked brown rice can be kept in the refrigerator and use the next day for breakfast, lunch or dinner.

A breakfast suggestion: Use leftover brown rice, place in a small pot, add 2-3 ounces of soy milk, rice milk, almond milk to the pot or liquid of your choice.

Heat until warm then remove from stove. Add a little butter or coconut oil if you like, dice up some fruit or mash 1⁄2 to 1 banana, top with several sprinkles of cinnamon powder. Can add some nuts (walnuts, almonds, filberts, pecans) or seeds (sunflower, pumpkin seeds, or ground chia or flax seeds).

Enjoy!

Read this at least 3 times on different occasions. Make notes and choose where you want to place your efforts as you use this information to improve your mental and physical health, wellbeing and contentment. 

1. What Do You Want?

What specifically do you want? In what area of your life?

• Work or Career
• Financial
• Significant other relationship
• Family and friend relationships
• Personal – psychological (self esteem, self love, confidence, attitude, etc.)
• Personal – physical fitness, body image, overall health, etc., Other??

Write your wants, desires or goals. Written wants that are clearly defined have a much greater possibility of being accomplished than vague thoughts swimming around in your head. Be specific and always frame them from the positive vs. the negative. Example: I don’t want to be fat vs. I want to weigh 150lbs and here is what I have to do to get there. Your subconscious mind works to achieve positively framed items but not negatives.

How are you going to get what you want?

• What do you have to do?
• What do you have to learn?
• What specifically needs to change?
• What do you have to do less of? More of?
• With whom must you speak to gain knowledge to help you attain your goal?
• If you want “X”, are you always choosing to work on actions that will get you closer to having “X”?
• Can you accept that achieving a goal may take the form of accomplishing many small successful steps over a fairly long period of time?

How will you deal with getting off track, or being stalled? How will you deal with set backs, minor or major failures?

• The road to a goal is not a straight line.
• What will you do to deal with the psychological and emotional impact of setbacks or failures?
• Any amount of failure can be a learning tool to figuring out what needs to be done to move forward. Use failure to your advantage vs. getting paralyzed by it. Accept failure(s) as a normal part of any accomplishment process and learn how to turn lemons (failures) into lemonade (successes).

How do you get back on track when you have a set back or failure?

• Forgive yourself (if you need to) and resolve to move forward.
• It is always your choice to either chase your tail or move forward.
• Remember that achieving a goal may take the form of accomplishing many small successful steps over a fairly long period of time.
• Most problems have solutions. It is your job to find the solutions.
• Are you unstoppable? If a roadblock gets put in the way of your path or goal can you figure out a way to go under it, over it, around it, move in another direction to still end up where you wanted? Declare yourself unstoppable. Declare to yourself to persistent in turning problems into solutions.
• If you find yourself stuck, realize it is your choice to stay stuck or start finding solutions to achieve your wants and desires. Remember, a new choice can always be made in an instant.

2. MIND & THOUGHT MANAGEMENT 
Most people never learn to manage their self talk and thoughts. In fact, they let their self talk run undirected from moment to moment all day long every day. This can produce stress, tension, worry and physical problems. Learning and using the following steps will help you relax, decrease worry, stress and tension by changing your mind, letting go and redirecting negative thoughts. This is a skill. The more you practice it, the better you will get at it and the easier it will be. Have fun with it. Be light and not too serious. It’ will come to you in time.

Step #1. When a negative or unpleasant thought enters your mind notice it and catch yourself being there. Unless you learn to do this part, you can’t move to the next level.

Step #2. Once you notice you are thinking negative or unpleasant thoughts, ask yourself if you want to continue to let your mind go there. In other words, choose where to put your mind’s thoughts. Your choice is whether to continue to think negative/unpleasant thoughts or redirect your mind to other beneficial thoughts or neutral ground. If necessary, ask yourself a series of questions that may illustrate the futility of continuing with a negative/unpleasant thought pattern.

• Is this benefiting me to continue this line of thinking?
• What does it cost me to continue with such thoughts?
• Do these thoughts create emotions or feelings that are supportive and beneficial or are they emotionally disturbing and stress provoking?
• If my thoughts are disturbing and stress provoking, am I willing to commit to stopping them and learn how to change or redirect my thoughts, so that I am more relaxed and content?

Step #3. You can redirect your mind’s thoughts to many areas. It all starts with noticing first, then letting go of the negative/unpleasant thought, followed by placing your mind in another place (also called redirecting). The following are a few examples of redirecting your mind’s thoughts:

• Think of something positive or peaceful.
• Be solution oriented. Direct your mind to figure out how to turn any bitter or sour situation in your life into something sweet.
• Notice your immediate surroundings and be relaxed in the moment.
• Notice tense parts of your body and relax them.
• Accept your best effort in any situation and let that be ok with you. Let go of the thought that you could have or should have done more. Learn from your errors and shortcomings and apply the lesson in the future. Relax and let go. Do this over again and again.
• Be confident that you can handle or learn to handle any turn of events that life gives you.
• Imagine the worst that could happen in any situation. Learn to accept it emotionally. Be solution oriented. Direct your mind to figure out how to turn any bitter or sour situation in your life into something sweet.
• As your mind goes back to the negative, let go of it and redirect to one of the above.

Step #4. This whole process is supported greatly by learning how to meditate and practicing meditation on a daily basis for 20 minutes.

3. Commit To Change and Let Go 

Altering what you think is not easy, but possible. The information written below is a life tool. Like any other tool, it won’t produce any result unless it is picked up and used. The more you use a tool, the more productive you are, and the easier it is. Use this tool with the goal of producing tranquility, peace of mind and a relaxed mental and physical state.

The first step starts with choosing to commit and then maintaining an unwavering commitment to alter something. Without a diehard commitment to alter something and produce an outcome, it will not come to pass.

You must decide. Resolve. Be determined. Choose. Make up your mind. Elect. or Opt to do the following. Commit to change, forgive. let go of, or transform a thought pattern. The thought pattern may have resulted from life events, how you’ve learned to think about yourself, or other people or a particular situation.

The second step is to constantly be aware and alert, to notice, observe, and note your thoughts through out the day. There is a big difference in noticing yourself in a thought pattern vs. automatically having the thought pattern run and you’re stuck in it.

The third step is to choose to redirect the thought pattern once you have developed your heightened awareness of it running. Usually people want to alter thought patterns because they are suffering. You have a choice to change, forgive. let go, or transform a thought pattern. The choice is simple. You may continue suffering at the hand of the established pattern, or you may alter the pattern by mastering the process I am outlining. Mastery is not simple. The option of choosing which way to proceed is.

The fourth step is to constantly (several or more times a day) remind yourself of the choice and commitment you have made. You will challenge your own choice and commitment daily, if not several times a day. When you notice that happening, do your best to relax and remind yourself that you plan to stay the course and alter what you have set out to do (follow Mind and Thought Management Handout suggestions). Redirect your mind to another place more suitable.

This technique works. It takes a lot of practice for it to produce results. It is no different than learning a musical instrument. To play an instrument well, a good deal of daily practice is required.

I suggest you read this and think about it for a day or two. Then read it again and think about it for a day or two and do the same for a third time. Begin to practice it. If you have difficulty, thoughts you need to discuss or questions, please make an appointment to see me so we can review them in detail.
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Dr. Gary Gruber, ND, interviews Dr. Rick Liva, RPh, ND, President of the Connecticut Naturopathic Physicians Association (CPNA), about state legislature updates for 2015.

​The CNPA is a nonprofit professional membership association representing Connecticut naturopathic doctors (NDs). We provide the most up-to-date listings and info about Naturopathic Doctors in Connecticut, continuing education opportunities, and advocate for natural health issues locally and nationally.