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ABPS Diplomate Mimi Guarneri, MD: A Holistic Approach to Caring for Your Heart and Overall Health

Dr. Mimi GuarneriDespite all the great work that medical professionals do in the ICU, the cardiac catheterization lab, and in treating heart emergencies, cardiovascular disease is the leading cause of death in men and women globally. In fact, according to the World Health Organization (WHO), about 80% of premature deaths from cardiovascular disease could be prevented through a healthy diet, regular physical activity, and avoiding the use of tobacco. The upshot is that cardiovascular disease is preventable through lifestyle change, and the same is true for diabetes, high blood pressure, and many other diseases.

Obesity & Heart Disease

One of the epidemics in the United States is obesity. Other health conditions can help explain why this is the case. For instance, one in 10 adults has diabetes, which is almost 10% of the world’s adult population. People with diabetes have an increased risk of heart disease and stroke. We are now seeing a rise in non-alcoholic fatty liver disease (NALFD), which is like insulin resistance in the liver. If the current rate of obesity and diabetes continues for another 20 years, the prevalence of NALFD in the United States is expected to increase by 50%.

Blood Pressure

Blood pressure is intimately related to cardiovascular disease. What many people do not realize is that normal blood pressure for most of us is 120/80 or below, not 130 to 139/80, which is already Stage 1 hypertension.

Body Fat

Heart disease is linked to where we have fat. For example, some of us carry extra weight in the midsection, while others typically have weight in the subcutaneous tissue in the buttocks area. When it comes to body composition, it’s important to recognize patterns. For instance, having an apple-shaped body, or having extra visceral adipose tissue, can predispose one to diabetes or inflammation. This tissue can produce inflammatory cytokines that can cause heart disease and cognitive decline. What’s more, inflammation is linked to heart disease. So, just carrying extra weight can affect how we feel.  We now know through the language of science that chronic inflammation can affect the brain, causing what we call cytokine sickness, which is marked by depression and chronic fatigue.

“Good” & “Bad” Cholesterol

Cholesterol is important to the heart—more, specifically, it’s the type and makeup of your cholesterol that matters. My patients say that the “L” in LDL, which is known as the “bad” cholesterol, stands for “lousy,” and the “H” in HDL, known as the “good cholesterol,” stands for happy. It’s not as simple as that, however. People with diabetes, for example, may have LDL cholesterol with very small particles that are aggressive. Having a lot of LDL particles called LDLP and many small particles increase risk. This means that we don’t just look at the total cholesterol. Rather, we need to look at all of the lipoproteins so that we can determine the true risk. When we consider cholesterol as a risk for cardiovascular disease, we should consider particle number, whether we have too many LDL particles, or if our HDL (good cholesterol) particles are low—all of which can put us at risk. And, remember, LPA may pose a greater risk and should be checked in individuals with premature heart disease or a strong family history.

Inflammation

Cardiovascular disease is linked to the process of inflammation, which is a consequence of diabetes, obesity, and a host of other conditions. Inflammation in the mouth can cause inflammation in the whole body and place you at risk for cardiovascular disease as well as cognitive decline, arthritis, and other problems. Food sensitivities, sleep apnea, heavy metals, and the gut microbiome are all sources of inflammation.

Diet

The well-known Lyon Heart Study evaluated how the Mediterranean diet affected people with heart disease. It showed that the diet resulted in a 70% reduction in overall mortality and a 73% reduction in heart attacks. A more recent study of people with high cardiovascular risk, the Predimed study, showed that a Mediterranean diet supplemented with lots of extra virgin olive oil and nuts resulted in a 30% reduction in major cardiovascular events. Food is medicine!

Lifestyle as an Intervention.

Genetics is not our destiny. We may be predisposed to a certain disease, but in the right environment, we may never develop that disease. Ultimately, a favorable lifestyle, which includes such factors as getting enough sleep and exercise and adding more plant-based foods to our diet, is associated with a substantially lower risk of coronary events when compared to an unfavorable lifestyle.

Mimi Guarneri, MD, is a board-certified physician in cardiovascular disease, internal medicine, and integrative holistic medicine, and a founding board member of the American Board of Integrative Medicine® (ABOIM®), which is governed by the American Board of Physician Specialties® (ABPS). 

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Medical organizations throughout North America understand that our rigorous certification standards prove that ABPS Diplomates are capable of delivering the best patient care possible.

Far too often, medicine is led by less than 5% of non-practicing physicians taking away and replacing the voice of the 95% of physicians practicing and placing patient safety and care first on the front lines every day. The American Board of Physician Specialties has raised the standards in physician board certification not only in the quality of their boards of certification, but in hearing and allowing for the voice of those active physicians caring directly for patients. Having been a part of the ABPS over the last 28 years has allowed me to grow as a woman leader in a field often wrought with challenges. It helped me and others raise the bar of the standards of care in my specialty, Emergency Medicine, through their Board Certification in Emergency Medicine (BCEM). ABPS also helped raise the standards of care for 21st century medicine through their certifications in other specialties, particularly in Integrative Medicine & Disaster Medicine. Having physician voices heard matters to medicine and is essential in the betterment of patient safety and care.

Sarah E. Gilbert, MD, FAAEP
Sarah E. Gilbert, MD, FAAEP
Emergency Medicine
On October 18, 2007, President George W. Bush released Homeland Security Presidential Directive 21 (HSPD-21), calling on our nation, among other initiatives, to “collectively support and facilitate the establishment of a discipline of disaster health”. It is a great testament to the wisdom and foresight of the American Board of Physician Specialties that it immediately set to work and created, within the short span of only one year, an educational blueprint and set of certification examinations, both written and oral, for a new subspecialty of disaster medicine—and it is why I chose to be part this vital initiative and this wonderful organization. This is but one of the many innovative programs initiated by the American Board of Physician Specialties over the years, and why I am proud to support its work on behalf of our nation’s public health.

Art Cooper, MD
Disaster Medicine
When the American Board of Physician Specialties offered to host the American Board of Integrative Medicine, ABPS became a landmark organization working to move medicine into the twenty first century. Certifying physicians who have completed rigorous academic training in Integrative Medicine ensures that the field of Integrative Medicine will continue to develop academically, clinically, and professionally. The leadership of ABPS continues to impress me - they are diligent in constantly innovating to provide certifications for physicians who want to advance their careers and their areas of expertise. I am honored to be a part of this organization.

Ann Marie Chiasson, MD
Integrative Medicine
There are many ways board certification advances a physician career. ABPS Board examination verifies your accuracy, precision, and reflects your mastery of your residency training verifying your expertise. ABPS Board certification demonstrates your level of expertise beyond your practice experience, primary education degrees, and training which are necessary for insurance reimbursement and practice privilege requirements. Attaining your ABPS Board Certification will clarify your purpose, secure your practice growth, and expand into leadership positions. Board certification can serve as an indication of a physician’s commitment to medicine, beyond the minimal standards and competency of training, their measurement to quality of care, and attaining an award for excellence.

Chris Kunis MD
Internal Medicine
When I think historically, advancement in medicine and patient safety and care has been driven by the diversity of people and scientific thought. That’s what I found at the ABPS and more. For over 60 years that is just who we are. I found a physician certifying body that provides a choice and voice to all physicians ensuring that patients are always placed first.

Jerry Allison, MD
Emergency Medicine
When I decided to pursue a full time role as a physician executive it was important to me to obtain additional professional training, education and work experience. Board certification through the ABPS in Administrative Medicine is validation of my efforts and a demonstration of dedication to professional development. We need more physicians to become full time health care executives, knowing there is a board certification option in Administrative Medicine encourages physicians to take the leap from full time clinical practice to healthcare organizational leadership.

Richard Paula, MD
Administrative Medicine
The American Board of Physician Specialties has provided me with the opportunity to demonstrate mastery of internal medicine through board certification. As a hospitalist, board certification is an expected credential, and hospitals recognize the American Board of Physician Specialties (ABPS) as one of the three standard credentialling bodies for Internal Medicine. Additionally, the ABPS has helped me develop leadership skills as a Board member and Committee Chairperson. ABPS has also helped me sharpen critical thinking skills as a test question developer and reviewer. The Allopathic (MD) and Osteopathic (DO) physicians in the ABPS are lifelong learners and frequently pursue multiple board certifications. I enjoy the camaraderie of my peers in ABPS.

Loren Jay Chassels, DO
Internal Medicine
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