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Spring 2022
FROM THE
HEART Newsletter from
The Secret to Health, Happiness, and Longevity
James H. O’Keefe, MD, with Kathleen C. O’Keefe
“The only ones among us who will be truly happy are those who will have sought
and found how to serve.” Albert Schweitzer
I
ronically, the single best strategy tend to hum along as well as we do—
for improving your own health, there are just so many opportunities
happiness, and even life expec- for the wheels to come off. Yet each
tancy is to stop thinking about living species is a successful experi-
yourself and start focusing on improv- ment as a good match for their niche
ing the wellbeing of other life. environment. If we are to realize our
It’s truly mind-boggling to ponder full potential as a living organism, our
the fact that each of us is a biological environment, diet, social milieu, and
package of self-organizing chemi- activity patterns need to be similar
cals. We take in energy (food), water, to that in which we evolved, so as to
and oxygen from the environment; enable all of those self-organizing
then our DNA and RNA send instruc- processes to happen just right.
tions to the ribosomes—little protein Of the countless species that have
factories in our cells—that churn existed since the origin of life, almost
out a variety of very specific proteins 4 billion years ago, about 99.9% of
which spontaneously fold into just the those species are extinct today. Even Lady, Francis, and Kathleen
right shapes and then self-assemble the Homo sapiens species has been
into lipid bilayer cell membranes and on the brink of extinction at times. ancestor (LUCA), you would discover
innumerable other components that One scientific model estimates that that over the last 3.7 billion years,
are used to make up cells, tissues, and about 100,000 years ago the entire each and every one of your direct
organs. All these chemical reactions human population on Earth had con- blood relatives—child to parent to
are self-orchestrated to interact and tracted down to just 2,000 to 10,000 grandparent to great grandparent,
automatically create, maintain, and individuals. Regardless, through it all, etc.—endured long enough to repro-
fine-tune you. As advanced as we are your bloodline survived, and here you duce and successfully nurture their
in modern science, we are just scratch- are today. offspring. It’s an unimaginably long,
ing the surface of understanding how You are not average; you never unbroken, winning streak of survival
intelligently designed and exquisitely have been. You come from a very in the face of very long odds.
adaptable living organisms are. long line of hardy survivors. If you Toughness, creativity, and resource-
When you think about it this way, could trace your lineage all the way fulness are programmed deeply into
it’s astonishing that biologically we back to the last universal common
continued on page 2
saintlukeskc.org/slcc | 816-931-1883 1
H E AR TFE LT STO R I E S
The Secret to Health, Happiness, and Longevity
continued from page 1
your genes, but you won’t manifest Our lives should be centered around
those virtues by following the path fostering positive relationships, acts
of least resistance and dwelling in of service, and preserving our planet.
your own comfortable and insular The more we can focus on these
world. Tony Robbins says, “The path fundamental pillars of life, the happier
of least resistance will never make you and healthier both the world and we
proud.” You need a cause bigger than will be. Obviously, nobody is going
yourself, with goals beyond your own to solve any of these catastrophic
hedonistic pursuits if you want to problems on their own. It’s going to
really blossom. take an all-hands-on-deck approach.
Depending upon their environ- Theodore Roosevelt famously said,
ment, living organisms via epigenetic “Do what you can, where you are, with lives. Emotional ties protected people
signaling will switch on or off whole what you have.” Mostly that means from trauma and stress, helped to
segments of genes, which can drasti- each of us must help make things bet- delay age-related physical and mental
cally alter hormones, appetite, mood, ter in our little corner of the world. decline, and were better predictors
immunity, body composition, and Do you want to know the secret to of long and happy lives than genes,
ultimately physical and mental health. a long and happy life? In his superb education, income, or IQ. The protec-
Through similar epigenetic signaling book, The Courage to be Disliked, Ichiro tive effect of relationships proved true
mechanisms, being self-centered and Kishimi writes, “Just like the traveler across the board among both the
always taking the easy way predict- who relies on the North Star, in our Harvard men and inner-city males
ably leads to lethargy and weakness. lives we need a guiding star. That star born into impoverished families. Dr.
When you demand less from your is ‘contribution to others.’ As long as Robert Waldinger, one of the directors
mind and body, your strength and we do not lose sight of this compass, of the Harvard study said, “Loneliness
mental sharpness will atrophy. In con- and keep on moving in this direction, kills; it’s as powerful as smoking or
trast, when you confront meaningful there is happiness. No matter what alcoholism.” In contrast, the partici-
challenges and invest your energy in moments you are living, or if there pants who cultivated warm relation-
helping other life, epigenetic switches are people who dislike you, as long as ships enjoyed longer and happier
are turned on, which alters your you do not lose sight of the guiding lives, whereas the loners often died
genes to radically transform you star of ‘I contribute to others,’ you will earlier. The bonds that we forge with
into a stronger, more resilient and not lose your way and you will have our family, friends, neighbors, pets,
resourceful version of yourself. always companions by your side.” and plants are like lifeboats that will
save us when the inevitable storms
Some people wonder, “What’s the
Fostering Positive Relationships of life ravage our worlds.
meaning of life?” Our planet Earth is
The quality of our relationships and This means you need to get
a cosmic oasis in an otherwise cold,
how happy and secure we are with outside your own head and tend
largely empty, and lifeless (except for
the people we are closest to has a to the wellbeing of other life—and
us) universe. It’s a special privilege to
profound influence on our health and it doesn’t always have to be other
be part of the wonderous spectacle of
longevity. Put another way, relation- humans. Adopting and caring for a
life on Earth. So, it seems to me, one
ships are our most important pos- dog does wonders for your physical
important “meaning of life” is to do
sessions in life—by far. The Harvard and mental wellbeing, providing de-
what we can to help keep the spark
Adult Development Study enrolled voted companionship, unconditional
of life alive and well here on Earth.
724 Boston men as teenagers in 1938 love, and constant entertainment. For
Could helping our neighbor help us
and followed them closely ever since. people for who have a canine house-
to become better ourselves? Today,
This landmark study found that having mate, it’s no mystery why dogs are
more than ever, with climate change,
close long-term relationships, more man’s (and woman’s) best friend.
a global pandemic, and the possibility
than money or fame, was the most
of another world war threatening our Recently, dog ownership’s effect
important predictor of how happy
survival, we need to band together. on human survival was assessed in a
the people were throughout their
2 Saint Luke’s Cardiovascular Consultants | From the Heart
H E AR TFE LT STO R I E S
definitive meta-analysis of 10 studies fitness that improved their chances going strong. Even in his 90s, Carter
that included about 4 million partici- of surviving future threats in the continues fighting for human rights,
pants. People who lived with a dog real world. Importantly, playing also resolving international conflicts,
were 24% less likely to die during the helped them forge bonds with their promoting democracy, leading clean
10-year study compared to people pack, reduce stress, and boost mood. water initiatives, assisting hurricane
who didn’t have a dog companion. There’s still nothing quite as thera- victims, and personally building
Dog ownership conferred an even peutic as play. Peter Schnohr and homes with Habitat for Humanity.
greater 31% risk reduction in car- Jacob Marott, my friends/colleagues A recent Harvard study of 13,000
diovascular death. These health and from Copenhagen, Denmark, and I adults reported that people who
longevity benefits of sharing one’s recently published studies showing volunteer for even two hours/week
home with a dog were especially pro- that the exercises that best improve have a longer life expectancy, fewer
nounced for people who lived alone. life expectancy are those that involve physical impairments, and a stronger
Life, in its wisdom, channels energy physical interactive play, like tennis, sense of well-being. According to
to organisms that are contributing badminton, volleyball, golf, basketball, Dr. Eric Kim, the study’s lead author,
to the common good, whereas life softball, and soccer. Play is a collabora- “Humans are social creatures by
force tends to be shunted away from tive endeavor—everyone in the game nature. Perhaps this is why our minds
isolated organisms that are not being benefits and usually comes away with and bodies are rewarded when we
collaborative with other life around warm feelings about their playfel- give to others. Our results show that
them. Because life is intricately inter- lows. Play is also a way to engage our volunteerism among older adults
connected, to be fully participating competitiveness in a fun and harmless doesn’t just strengthen communi-
in the phenomenon of life you need manner. These days I play pickleball ties, but enriches our own lives by
to be investing much of your time at least twice a week; we laugh, hoot, strengthening our bonds to others,
and energy into the wellbeing of liv- and kiddingly harass each other for 90
ing things around you. I think of my minutes. I have come to believe that
grandmothers, Alice and Dorothy, and play is one of life’s essential ingredi-
my mother Leatrice, who dedicated ents—let’s call it vitamin P. Doctor’s
their lives to their family, friends, and orders, get your vitamin P at least
communities. They were happy, active, twice a week.
social people who lived into their 90s;
Dorothy made it to 103. How many Acts of Service
grouchy, anti-social, mean-spirited Even for the most introverted, we
hermits do you know who are healthy need to connect to other life to pros-
and living with vitality into their 90s? per. We’re like ants that way. Investing
My mother’s mantra when I was time and energy into helping our fam-
growing up was, “Go outside and play ily and/or colony survive is what we are
with your friends.” As a teenager I had genetically programmed to do. We also
a long list of phone numbers memo- have a strong inclination for altruism
rized and was constantly calling my that not only makes us feel good when
buddies to get a game together. Since we help others, it also improves our
med school I’ve always continued to health and longevity.
do a lot of exercise, but I neglected A study that closely tracked 10,000
my play time. Just in the last couple people in Wisconsin for over 40 years helping us feel a sense of purpose
of years I’ve gotten back into play- found that people who volunteered and well-being, and protecting us
ing, so I’m up to my old antics of reduced their risk of dying during the from feelings of loneliness, depression,
frequently nagging my pals to join in study by over half. and hopelessness. Regular altruistic
on a game of pickleball, badminton, activity reduces our risk of death.”
Jimmy Carter, at age 97, is the
and even pool—it makes me feel like United States’ longest-lived president. The take-home message is the same
a kid again. Mammals invented play About 42 years ago he retired from one my wife Joan has been telling me
100 million years ago, to hone physi- his work as “leader of the free world”, and the kids for decades: “It’s not all
cal skills while frolicking with their but he’s been passionately involved in about you.” The more we can keep this
littermates. Play helped them develop volunteer work ever since and is still in mind, the better our lives will be.
saintlukeskc.org/slcc | 816-931-1883 3
H E AR TFE LT STO R I E S
Pam and Scout: Who Rescued Who?
James H. O’Keefe, MD
P
am Emerson is a scheduler feels satiated with
for us in the Duboc Cardio less food and is not
Wellness Center and the so ravenous all the
Haverty Cardiometabolic time. Nothing suc-
Center. She also sits at our front desk ceeds like success—
and checks our patients in when they the more progress
arrive for their in-person office visits. she made with her
Pam is a smart, friendly, conscientious, weight, the more
and helpful person who is a key mem- motivated she was
ber of our team. She welcomes people about following her
when they come through our front new active lifestyle
door, and in so doing, makes our first and healthy eating
impression. Indeed, Pam usually has a habits.
halo effect on the patient’s perception A turning point
of our team, which is one of the many for Pam came when
reasons most everybody who knows Scout, Pam, and Tyler her daughter, Tyler,
her loves her. had her first child
Pam has only been working with us Pam join our work family, and she about 6 months ago. It was a difficult
for 15 months; before that she was in a settled right in. Pam said, “It smacked and dangerous delivery, and Tyler re-
job that didn’t showcase her strengths, me in the face. It suddenly dawned lied heavily on her mother to support
but instead made her feel unappreci- on me that I had been killing myself! her emotionally during the days fol-
ated and stressed. And she had gotten I needed to wake up and start paying lowing the birth. Scout, the new baby,
into some bad habits. Pam told me, attention to my health.” So she started is a beautiful and healthy little girl, but
“All day I used to drink nothing but drinking water instead of pop and ate like all infants she is very needy. Pam
Coke or Diet Coke, and sweets were more vegetables, fruits, berries, and and Scout formed a very close bond
my comfort food.” As her weight crept nuts instead of junk food and sweets. from the first day, and her new grand-
up and her mood slumped down, she Pam understood that as a visible and daughter is the light of Pam’s life now.
became increasingly sedentary. Exer- important member of our Cardio “Scout made me realize that my life is
cise started becoming uncomfortable, Wellness/Cardiometabolic team she not about me; it’s about making sure
so she was spending less time pursu- needed to be setting a good example. that the people in my family are safe
ing her passions, like playing with As her diet and lifestyle improved, and loved. I want to be here for my
grandchildren, hiking trails with her the fat started to melt away and her grandkids, and they need me. I want
friends and/or her dog, and garden- energy surged, which allowed her to help them grow up to be happy
ing. Instead, she was spending her free to get more active and reengage and successful, to follow their dreams,
time sitting around indoors staring physically with the world again. and to become good citizens too.”
at passive entertainment on screens. We also started Pam on semaglu- Ikigai is a concept that comes from
Pam felt herself getting pulled into a tide, a game-changing drug for her Okinawa—a Japanese island famous
downward spiral that was draining the type 2 diabetes that not only reduces for its long-lived and healthy inhabit-
joy and vitality from her life. hunger, blood glucose, and body ants. One of the central features of
About 18 months ago, when the weight, it also lowers risk of cardiac traditional Okinawan culture is ikigai,
lead scheduler/front desk position catastrophes, like heart attack and which means “one’s reason for being.”
opened, Pam was our first-draft pick stroke, and cardiovascular death. Your ikigai is your life’s purpose or
because a few of us already knew her Semaglutide reduced Pam’s cravings your bliss. This is what brings you joy
and were impressed with her work. for sweets and other junk food. Since and inspires you to get out of bed in
We were grateful and elated to have starting semaglutide, Pam eats much the morning and make you enthused
smaller serving sizes because she to greet the day. It is generally a cause
4 Saint Luke’s Cardiovascular Consultants | From the Heart
that’s above and beyond one’s own Saint Luke’s Cardiovascular Consultants
self interests. The Okinawans focus Suzanne V. Arnold, MD Jason B. Lindsey, MD
on cultivating a strong sense of ikigai Bethany A. Austin, MD Anthony Magalski, MD
as an essential trait to help them lead Dmitri V. Baklanov, MD Michael L. Main, MD
Charles W. Barth, MD Susan A. Mayer, MD
long, healthy, and fulfilling lives. Timothy M. Bateman, MD Justin R. McCrary, MD
Pam’s eyes twinkle as she talks Matthew C. Bunte, MD A. Iain McGhie, MD
Kevin A. Bybee, MD Michael E. Nassif, MD
about how Scout comes and stays
Paul S. Chan, MD James H. O’Keefe, MD
with Grandma and Grandpa on Adnan Chhatriwalla, MD Nicholas M. Orme, MD
weekends. Scout is becoming busier Matthew G. Deedy, MD Shailja Parikh, MD
and more interactive by the day, yet Michelle L. Dew, MD John E. Peterson, MD
Jonathan R. Enriquez, MD Riaz R. Rabbani, MD
Grandma Pam’s newfound energy and Mark P. Everley, MD Valerie J. Rader, MD
enthusiasm have made it enjoyable Tim Fendler, MD Brian M. Ramza, MD, PhD
to care for the baby. She used to get Adam Fleddermann, MD Carlos Rivas-Gotz, MD
Michael J. Giocondo, MD Barry D. Rutherford, MD
sore when she would get down on Joseph A. Goeke, MD David M. Safley, MD
the floor to play with Scout, but now, Thomas H. Good, MD Mohammed Saghir, MD
Pam has no trouble crawling around J. Aaron Grantham, MD Adam C. Salisbury, MD
Anna Grodzinsky, MD John T. Saxon, MD
with her.
Sanjaya K. Gupta, MD Laura M. Schmidt, MD
Over the past year, Pam has lost Anthony J. Hart, MD James E. Sear, MD
60 pounds. She wears her ID badge Kenneth C. Huber, MD David G. Skolnick, MD
Chetan Huded, MD Brett W. Sperry, MD
that has a picture taken the day she Arun Iyer, MD Daniel A. Steinhaus, MD
began working with us 15 months Dany Jacob, MD Tracy L. Stevens, MD
ago. Patients and visitors are always Andrew C. Kao, MD Robert E. Tanenbaum, MD
Taiyeb M. Khumri, MD Randall C. Thompson, MD
commenting about how different Mikhail Kosiborod, MD Deepthi Vodnala, MD
she looks today. Her numbers have Steven B. Laster, MD Alan P. Wimmer, MD
dramatically improved, too. Pam’s Stephanie L. Lawhorn, MD Martin H. “Tony” Zink, III, MD
John K. Lee, MD
blood pressure, triglycerides, choles-
terol, blood glucose, A1c, and markers Emeritus: James E. Crockett, MD, Allen Gutovitz, MD, Warren Johnson, MD, David
of inflammation have all come back McConahay, MD, Daniel Scharf, MD, and David M. Steinhaus, MD. In Memoriam:
down to normal healthy levels. She Robert D. Conn, MD, Geoffrey O. Hartzler, MD, and Ben McCallister, MD.
is sleeping soundly again and is back
to hiking the state trails, planting Funds generously donated to Saint Luke’s
Foundation by grateful patients enable us to
and tending a big garden, and rais-
publish From the Heart and send it to more than
ing three dozen free-range chickens
260,000 homes and offices. All materials are created
whom she refers to as her devoted
by our physicians solely for the education of our
fan club. “They follow me everywhere patients and referring physicians and should not
I go when I am outside,” she says. She be considered a substitute for medical advice. You
brings in eggs for us from her pet should always talk to your health care provider for
chickens, which taste nutritious and diagnosis and treatment regarding your specific
delicious. In the past, Pam’s go-to food medical needs.
was generally sweets and highly pro- Dr. O’Keefe
cessed foods, but now she eats a lot of James H. O’Keefe, MD
fresh vegetables/fruit and enjoys fish, Editor-in-Chief
chicken, and beans, but makes a point saintlukeskc.org
of eating nothing that comes from an
animal with hoofs. © 2021, Saint Luke’s Cardiovascular Consultants. All rights reserved.
Pam’s health has been radically
transformed by awakening to the real- To be added or removed from this newsletter mailing list, email Lori
ity that the world needs her, and that Wilson at ljwilson@saintlukeskc.org or call 816-751-8480.
she can make a big positive difference
for the people in her life.
saintlukeskc.org/slcc | 816-931-1883 5
H E AR T H E ALTHY LI FE ST Y LE
An Avocado a Day Keeps the Doctor Away
James H. O’Keefe, MD, with Joan O’Keefe, RD
over 30 years and found that eating
half of an avocado twice per week re-
duced the risk of developing coronary
disease by 21%. These investigators
used sophisticated statistical modeling
to estimate that replacing a daily serv-
ing of margarine, butter, egg, cream,
or processed meats such as bacon,
with a similar amount of avocado was
associated with a 35 to 40% lower risk
of heart attack and stroke.
Around our household, if we run
out of avocados, somebody is mak-
ing a trip to the supermarket that day.
We usually buy a few that are ripe or
B
nearly so, and several that will ripen
ack in the 19th century, when I’m not hungry for things like sweets over the next few days.
Johnny Appleseed was plant- and starchy foods. Heck, at a Mexican Avocados, besides being delectable,
ing trees across the American restaurant, I can almost make a meal contain at least 20 essential vitamins
wilderness and doctors made out of a large order of guacamole. and minerals. Because of its excep-
house calls, an apple was considered a Botanically speaking, the avocado tional nutrient density, avocado, when
superfood. In the 21st century, adding is a fruit—a berry to be precise— consumed on a regular basis, can
avocado, instead of bacon, to your a strange one that contains only confer a host of health benefits, such
daily routine is a smart and scrump- one tiny gram of sugar and a single as improved gut function and reduced
tious way to boost your vitality. Joan gigantic seed. The fruits that are best risks of depression, heart disease, and
and I are both huge fans of avocado, for your health tend not to be very cancer. Additionally, avocados are
though when I titled this article “An sweet, like avocados, tomatoes, and very high in fiber—both soluble and
Avocado a Day…” implying that a per- berries, including blueberries (wild insoluble. One avocado provides an
son should eat a whole avocado each ones are best), blackberries, strawber- astounding 14 grams of dietary fiber,
day, it triggered an argument that ries, or raspberries. These nourishing which is more than half the daily value
nearly got me banished to the couch fruits tend to be high in fiber, potassi-for a woman (21 to 25 grams per day)
for a night. And Joan has a good um, and antioxidants, yet low in sugar. and over a third of the daily value for
point—this is a high-fat food, with A Harvard
one average-sized avocado packing a study
whopping 320 to 350 calories. Expe- published
rienced registered dieticians like Joan
Whole
in March
say the recommended serving size is Avocado 1/2 Avocado 1/3 Avocado
2022 in the
anywhere from one-third to one-half Journal of Calories 322 161 106
of an avocado per day. I get away with the Ameri-
eating a whole avocado (or two) per Fat 29 g 14.5 g 10 g
can Heart
day, but I’m very active, getting about Association Protein 4g 2g 1.3 g
15,000 steps per day, and I use celery followed
or carrot sticks rather than chips for Carbs 17 g 8.5 g 6g
110,000
dipping guacamole. Personally, I find people for Fiber 14 g 7g 5g
that an avocado fills me up so that
6 Saint Luke’s Cardiovascular Consultants | From the Heart
men (30 to 38 grams per day). Getting Generous Support for the Haverty
lots of daily fiber is essential for keep-
ing your bowel habits regular, and the Cardiometabolic Center of Excellence
high fiber also keeps levels of blood
M
sugar, cholesterol, and blood pressure
ichael and Marlys Haverty
in ideal ranges, all of which helps to
have recently donated
keep your heart youthful and strong.
another $1 million grant to sup-
One whole avocado has about port the Michael & Marlys Haverty
20 grams of monounsaturated fat. Cardiometabolic Center (CMC) of
Many people are confused about Excellence at Saint Luke’s Mid-
how avocados can be so high in fat America Heart Institute. About
and calories but still be good for you. 4 years ago, Michael and Marlys
Avocados are rich in monounsaturated donated $1 million to launch the
fat, a heart-healthy fat that raises your Haverty CMC, which is co-directed
HDL “good” cholesterol and lowers the by Drs. Mikhail Kosiborod and
LDL “bad” cholesterol. Eating healthy James O’Keefe. This is an entirely
fats in the form of extra-virgin olive oil, novel care model that has now
nuts, seeds, and avocado lowers your been demonstrated to substan-
risk of heart disease and metabolic tially improve the quality of
syndrome (prediabetes), helps to burn care and outcomes in high-risk
off belly fat (especially if you minimize individuals with diabetes or pre-
the intake of sugar and starch), and diabetes and heart disease. Using
keep you satiated longer after a meal. a comprehensive, team-based,
Avocado is also a great source of and coordinated approach to Marlys and Michael Haverty
vitamin C, which in combination with prevention and game-changing photo: Ingram’s Magazine
the monounsaturated fat and anti- therapies, the CMC model can
oxidants in this unique fruit, helps positively impact all the key ally. The non-for-profit organization,
to keep your skin soft, supple, and cardiovascular risk factors (blood called the Cardiometabolic Center
smooth. Avocado is also a superb glucose and cholesterol levels, Alliance has been growing rapidly since
source of vitamins K, E, and B6, in blood pressure, weight, insulin its launch in 2020, and as of today, has
addition to riboflavin, niacin, folate, resistance, and others), and most 12 participating healthcare systems
pantothenic acid, magnesium, importantly, help our patients feel across the U.S. And work is ongoing to
and potassium. Half of an avocado better and live longer. The remark- potentially expand this even to organi-
contains 488 mg of potassium, which able success of the Haverty CMC zations outside the United States.
is more than a full banana. And a high is the model upon which the team Patients trust us with their health
potassium diet is one of the simplest led by Dr. Mikhail Kosiborod and and their lives. Our ability to improve
and best strategies to lower your Melissa Magwire is building a na- their future wellbeing and vitality
blood pressure without medications. tional movement to transform the through the Michael & Marlys Haverty
Joan and I keep our guacamole quality of care in individuals with CMC is a mission that we feel privi-
simple: mash up a few ripe avocados, cardiometabolic disease nation- leged to serve every day.
add fresh squeezed lemon juice and a
pinch of salt, and voila! It’s one of the
healthiest and best-tasting dips on the other nutrients, but essentially devoid pit removed. I squeeze a fresh lemon
planet. By the way, guacamole is like of sodium. So even when you add a into each of the half-sphere hollows,
many of the most nutritious foods out dash of salt to improve taste, these sprinkle in a pinch of sea salt, and then
there—you will eat more of it if you naturally delicious foods are still low in eat them with a spoon. On the other
feel free to salt to taste. Natural whole sodium, and tend to keep your blood hand, Joan and my kids prefer avo-
foods like nuts, vegetables, and fruits pressure nice and low-normal. cado toast—another delicious way to
such as avocados and tomatoes are One of my favorite breakfast items enjoy this treasure from nature.
loaded with potassium and countless is an avocado sliced in half with the
saintlukeskc.org/slcc | 816-931-1883 7
H E AR T H E ALTHY LI FE ST Y LE
Are You Getting Enough
Magnesium?
The Heart-Healthy Mineral
James H. O’Keefe, MD, with Joan O’Keefe, RD
A
re you are having issues magnesium’s evil twin. Excess salt make the cells of the heart more irrita-
with sleep, mood, muscle intake increases blood pressure and ble, which can increase risk for cardiac
cramps, weakness, high swelling, and also predisposes to rhythm disturbances like ventricular
blood pressure, skipped stroke and heart failure. Unfortunately, tachycardia (VT) and even sudden
heart beats, or constipation? You most people eat too much sodium cardiac arrest. In fact, for some serious
could be low in magnesium. About and not enough magnesium. Oral cardiac rhythm disorders, giving 2
50 percent of Americans don’t magnesium acts as a natural calcium grams of intravenous magnesium can
consume adequate amounts of this channel blocker, increases nitric oxide, be a life-saving intervention.
beneficial mineral. A diet rich in mag- improves endothelial dysfunction, The daily allowance for magnesium
nesium is high in nuts, seeds, legumes and relaxes/dilates arteries and veins. is about 300 to 350 mg for women
(like beans and peanuts), spinach, and All these actions of magnesium help and 420 to 480 mg for men. American
other leafy green vegetables. But even to make it an effective therapy to women consume an average about
among my patients who eat a very lower blood pressure and normalize 230 mg of magnesium per day and
healthy diet, many of them seem to left ventricular hypertrophy (abnor- men about 300 mg per day. For com-
feel better when I start them on a daily mal thickening of the heart muscle), parison, our hunter-gatherer ancestors
magnesium supplement. particularly when done in conjunction consumed about 600 mg of magne-
Magnesium is an essential min- with increasing intake of potassium sium daily. For various reasons such as
eral and electrolyte that serves over and reducing sodium intake. Magne- depleted soil from corporate farming
300 functions, including catalyzing sium supplementation increases the and food processing that strips mag-
enzymatic reactions responsible for effectiveness of blood pressure lower- nesium out of whole foods, it can be
everything from creating DNA and ing meds. The dose of magnesium difficult to rely on diet alone for get-
generating energy in your mitochon- required to reduce blood pressure is ting enough of this key mineral. Many
dria to optimizing function of nerves 500 to 1000 mg/day. factors contribute to magnesium
and muscles. It also plays a central A deficiency of magnesium can deficiency, including a diet based on
role in hormonal balance; for instance, also cause dysfunction of the lining refined and processed foods, diseases
magnesium affects estrogen levels of the blood vessels, predisposing to including kidney disease, gastrointes-
and stress hormones and is needed spasm of the arteries and abnormal tinal disorders, cancer, medications
to make thyroid hormone. Moreover, blood clotting. Magnesium is essen- (including diuretics, birth control pills,
having low levels of magnesium tial for activating the ion pump that proton pump inhibitors), excess alco-
increases your risk of weight gain, maintains the gradient across the cell hol, stress, frequent use of sauna and
insulin resistance, high blood sugar, membrane, keeping the sodium out of steam baths, strenuous exercise, and
type 2 diabetes, chronic inflammation, the cell and the potassium inside the vitamin D deficiency.
and heart disease. cell. When magnesium levels are low, People who aren’t getting enough
it allows excess sodium and calcium magnesium in their food tend to feel
Magnesium and Heart Health to seep into the cells. This is one of the better when they take a supplement.
Magnesium is one of the most ways in which low magnesium levels I often prescribe anywhere from 300
heart-friendly minerals. Sodium is
8 Saint Luke’s Cardiovascular Consultants | From the Heart
H E AR T H E ALTHY LI FE ST Y LE
to 1000 mg of magnesium daily to You should design your diet to with constipation, as it will produce a
reduce muscle soreness or cramps, contain plenty of magnesium. The gentle laxative effect by pulling water
to facilitate sleep, and treat/prevent foods highest in magnesium—nuts, into the intestines to make your bowel
constipation. Magnesium is also being seeds, leafy greens, yogurt, legumes, movements softer and easier to pass.
studied for its potential benefits in the and dark chocolate—also tend to be Magnesium glycinate and
treatment of mild cognitive impair- among the healthiest foods for many magnesium taurate are my favorite
ment, where it may improve memory other reasons. If you are experiencing forms of supplemental magnesium.
and overall mental functioning. muscle cramps, increasing intake of These forms are absorbed in the gut
Magnesium is one of the safest magnesium and potassium from veg- and pass the blood-brain barrier
and most effective sleep therapies. etables, fruits, and legumes is often where they interact with neurotrans-
I personally take two capsules of a effective for relieving these and other mitters (chemicals in your brain),
magnesium supplement just before muscle-related symptoms. like serotonin and GABA, to boost
bedtime on most nights and find that I have become personally enam- mood and induce feelings of calm.
it produces a gentle calming effect ored with taking a warm mineral bath Additionally, magnesium glycinate
on my mood and helps me sleep with magnesium salts to soothe sore and taurate can be helpful for lower-
more deeply. Magnesium comes muscles and joints. For thousands of ing blood sugar levels and reducing
in many forms, but the best for years, hot springs and mineral baths overall inflammation in the body
improving sleep are magnesium have been a popular way to relax, and brain. These forms of magnesium
glycinate, magnesium taurate, or de-stress, and improve overall health. are less likely to produce a laxative
magnesium threonate. The Romans built spas by natural hot effect but are often useful for issues
Because magnesium citrate and springs and relied upon the mineral like anxiety, insomnia, chronic stress,
magnesium oxide are poorly absorbed baths for their restorative and reju- and inflammatory conditions. Some
forms of magnesium, they are good venating effects. Magnesium is the supplements provide a combination
for improving bowel function in secret behind the healing powers of different forms of magnesium
people who deal with constipation. of a hot mineral spa or an Epsom to provide a range of potential
Indeed, increasing your intakes of salts bath. The dissolved magnesium benefits for functioning of the brain,
water, magnesium, and dietary fiber soaks into and rejuvenates your skin, musculoskeletal, cardiovascular, gas-
like psyllium (Metamucil), is the best muscles, and joints, and even gets trointestinal, and immune systems.
strategy to avoid or treat constipa- absorbed into your bloodstream, Bottom line: magnesium is a
tion and improve bowel regularity. helping to boost the levels of this very safe mineral, and many people
We generally recommend that people health-giving mineral. would benefit from increasing their
take about 200 to 400 mg daily of daily intake of it. Patients with serious
Options in Magnesium
magnesium, but for more severe cases kidney disease are at risk for high
Supplements
of constipation, you can use higher levels of magnesium if they take it
We encourage a “food first” strategy
doses of magnesium, up to 800 or as a supplement. If you’re curious
but acknowledge that many of our
1000 mg daily as needed. about this mineral, ask your health
patients may need additional magne-
Magnesium is important for activat- care provider if magnesium might
sium in supplement form to feel and
ing vitamin D and has a protective role be right for you.
function best. You have many different
against oxidative stress. Furthermore, formulations of magnesium to choose Disclosure: Dr. O’Keefe is the
inadequate magnesium levels can from. One of the most common is founder and Chief Medical Officer for
lead to depressed immune responses, magnesium oxide, which tends CardioTabs, a supplement company.
whereas restoring normal magnesium to be less well absorbed, and thus is
levels can improve immunity. Consid- effective for relieving constipation.
ering that magnesium and vitamin D Too high a dose of magnesium oxide
are important for immune function can cause bloating and loose
and resilience against infection, a stools or diarrhea. Magne-
deficiency in either of these nutrients sium citrate is another
may contribute to severe illness with great option for people
COVID infection.
saintlukeskc.org/slcc | 816-931-1883 9
H E AR T H E ALTHY LI FE ST Y LE
The Power of Continuous Glucose Monitoring:
When We Know Better, We Do Better
Mitchell Fagan, 4th year medical student
P
eople always ask me what the ated with endothelial dysfunction.
odd-looking patch on my arm Your endothelium is the critically
is. When I respond that it’s a important lining on the inside of your
continuous glucose monitor blood vessels. When the endothelium
(CGM), the next statement I usu- becomes dysfunctional, it markedly
ally hear is, “I didn’t realize you were increases risks for stroke and heart
diabetic.” I don’t have diabetes, so why attack. Further, higher glucose levels
would a healthy medical student like after eating promote atherosclerosis—
me would want to wear a CGM? Well, inflammation and hardening of your
there are more than a few reasons. arteries. These changes compound
More than half of Americans have over decades and you may only
pre-diabetes or diabetes, and many discover your HbA1c is elevated after
more have hyperinsulinemia—defined years of hyperinsulinemia and high
as elevated blood levels of insulin. glucose variability. Most people are
There is a well-studied connection surprised to discover that the sugar
between hyperinsulinemia and the they consume is also transformed into
risk of cardiovascular disease, cancer, Mitchell Fagan fat called triglycerides and stored as
and Alzheimer’s disease. Insulin is the subcutaneous fat and belly fat. This is
hormone released from your pancreas insulin levels. Because insulin isn’t why a low-carb diet and/or fasting are
that lowers your blood sugar levels. easily measured, the next best thing to sure-fire strategies for lowering blood
It also induces lipogenesis, which monitor is glucose. triglyceride levels.
is a fancy word for the process of The metric we use to define diabe- When I first inserted my glucose
creating and storing fat. Too much tes is the blood glucose level. While monitor into my arm, I found that
insulin, whether it’s injected as a glucose levels exist on a spectrum, a after a high-carb meal my glucose was
drug or made by the person’s own fasting glucose over 126 mg/dL or a often spiking into the 160s mg/dL and
pancreas, causes weight gain, insulin hemoglobin A1c (HbA1c) over 6.5% then crashing to the 50s mg/dL. In
resistance, and other problems with will land you a diagnosis of diabetes medical jargon, this is hyperglycemia
your metabolism. In other words, if mellitus. You’ve probably had your followed by a hypoglycemic episode.
we want to achieve optimal health, HbA1c tested at your doctor’s office, Being on this blood glucose roller-
we need to avoid chronically elevated which is a three-month average of coaster causes endothelial dysfunc-
your glucose levels. However, HbA1c tion and heart disease. I found a few
doesn’t necessarily tell you if you have simple tricks to help keep my blood
high insulin levels. A more precise glucose stable and prevent large
and nuanced way to evaluate your swings. Now, most of the time, I keep
metabolic status is to wear a CGM and my glucose within 70 to 100 mg/dL
utilize your glucose levels as a proxy with my postprandial (after consum-
for insulin. ing a meal) glucose under 140 mg/dL,
Research suggests that higher which is ideal.
glucose variability and higher peak I quickly discovered that the order
glucose levels are associated with in which I consume various foods dur-
mortality and earlier onset of chronic ing a meal is critically important. I eat
diseases. High peak glucose levels a lot of handmade pasta and I found
have also been found to be associ-
continued on page 13
10 Saint Luke’s Cardiovascular Consultants | From the HeartH E AR T H E ALTHY LI FE ST Y LE
Gratitude is the Antidote to Envy James H. O’Keefe, MD
W
hen Tom Brady and
the Buccaneers were
beaten in the NFL play-
offs last winter, many
people who don’t live in Tampa Bay
rejoiced. Schadenfreude is a German
word that means “finding joy in an-
other’s misfortune or struggle.” In fact,
it’s part of the fun of sports, where
you can indulge the dark side of these
natural human emotions without
feeling guilty. For those of us in Kansas
City, it’s been especially fun to be on
the Chiefs’ bandwagon in recent years.
Face it—we humans are instinctively
tribal animals, and there’s something tions like one global interconnected and you have a giant-screen TV to
that feels deeply gratifying when our being. The secret of the phenomenal watch a vast array of entertainment.
tribe vanquishes the competitors and success of the Homo sapiens species is You fly safely around the U.S. and the
victory is ours. that we all are like one giant organ- world at near super-sonic speeds and
A zero-sum game is the simple ism. When a creative genius comes up have access to life-saving drugs and
idea that when one person gains, with a transformative invention, we all procedures that our ancestors could
the other person must lose—like in benefit from it. A brilliant anonymous have not even imagined—our life ex-
boxing, poker, or war. For sure, there person in the region that is now east- pectancy has doubled in the last cen-
are times when we must adopt a dog- ern Poland/western Ukraine dreamed tury. And then there’s that all-knowing
eat-dog mentality, say when you’re up the wheel about 5,500 years ago. rectangular electronic device in your
trying to win the Superbowl, get into Their oxen-pulled wheeled carts al- pocket. Not one of these astounding
a prestigious school, compete for lowed them to expand across Europe technologies for improving the quality
a mate, or do almost anything that and displace all the hunter-gatherers and quantity of life that we now take
involves a lawyer. who were living there. As a result, to- for granted was available to even the
And life in America in the 21st day you get to work on wheels, rather wealthiest person in the world 100
century seems more hypercompeti- than by foot. years ago. Yet, when we look around
tive than ever. Even so, most of the Each one of us is analogous to a and see someone who is doing a little
time we humans do best when we single cell in the giant complex organ- better than we are, it tends to cause
avoid the winner-take-all attitude and ism that is life on Earth, and now the angst.
look for ways to make life a win-win internet is like our collective brain. For some strange reason, there
proposition. Candice Millard, a widely From that perspective, it’s humbling to is a nefarious emotion called jealousy
acclaimed author who lives and works imagine how hard it would be for any deeply imbedded in the Homo sapiens’
in KC, wrote, “My advice (for what it’s one of us to survive on our own—like brain software. Oscar Wilde said,
worth) for success and happiness: a single cell removed from the body, a “Anybody can sympathize with the
Compete with yourself and root for person left to fend for themself out in sufferings of a friend, but it requires
everybody else.” the wild wouldn’t last long. a very fine nature to sympathize with
We are the omnipotent masters of Objectively, nearly all of us are way a friend’s success.” Humans are funny
the world, and our technological pow- better off today than, say, even the that way—someone we know has
er and collective intelligence are rising king of England was in 1500. Your some good luck or does something
exponentially. But this is only possible house is comfortably climate con- great, and often this negative
because the human race now func- trolled no matter what the weather,
continued on page 14
saintlukeskc.org/slcc | 816-931-1883 11H E AR T H E ALTHY LI FE ST Y LE
The Fountain of Youth in a Patch
of Dirt: Let Nature Nurture You
James H. O’Keefe, MD
I
have a confession to make. All my mon—good social support networks, A recent study from Holland
life I’ve had a penchant to develop a physically active outdoor lifestyle, required participants to do a stress-
long-term relationships with and lots of whole natural foods in inducing task that made them feel
plants. As a young teen, I began their diet. Yet, they also share an- harassed. Immediately afterwards
working summers in a nursery up in other surprising commonality—their they were randomly assigned to either
Grafton, North Dakota, and would residents traditionally have gardened read indoors for 30 minutes, or garden
plant trees and shrubs around town. throughout life, often into their 80s, outdoors for 30 minutes. The group
As I was growing up, my trees were 90s, and beyond. that read reported no improvement in
too, and I took pride in seeing them their agitated mood, while those as-
thrive. When we moved to KC, a friend Gardening Therapy signed to gardening not only reduced
gave us a small ficus tree as a house- A host of studies have reported that their levels of the stress hormone
warming gift. Every fall I drag this tree gardening and yardwork confer both cortisol, they also noted improvement
in from the patio, and we pick up its physical and mental health benefits. in their mood.
leaves off the floor all winter. Then in Tending to a yard and/or garden is an An Australian study of people in
spring, I drag it back outside again enjoyable hobby that will naturally get their 60s reported that the men and
and nurse it back to health. Now it’s you more outdoor physical activity, women who gardened regularly had
35 years old, 15 feet high, and weighs which has been linked to improved a 36% reduced risk of developing de-
north of 250 pounds—it’s like deliver- wellbeing and life expectancy. There is mentia compared to a matched group
ing a very large baby twice a year as I abundant scientific evidence that gar- of people who didn’t garden. There
pull it through the sliding glass doors. deners on average tend to live longer is no cure-all to prevent aging, but
We also have two shamrock plants and be less stressed. for many people, gardening seems to
that come in and out with the ficus. Digging in the soil and getting your improve both the quality and quantity
These were gifts from two different hands dirty bolsters your microbi- of life as the decades roll by.
patients/friends, both of whom have ome—the trillions of friendly mi-
been gone for many years. When I crobes that reside on and inside you. May The Forest Be with You
water these lush shamrocks—one Sunlight stimulates the exposed skin A feeling of being emotionally
with pink flowers and the other to produce vitamin D, which is a key connected to other people is impor-
white—I always fondly remember nutrient for strengthening bones and tant for wellbeing, but so too is one’s
my beloved friends. Around the yard immune system. Being out in bright connection to nature. A study from
we have innumerable hostas that I daylight also helps to synchronize Harvard University found that people
transported here after splitting them your body’s internal clock, and that who lived in a house surrounded
off from hostas that still grow in the improves the quality of your sleep at by verdant greenery had better life
yard of my childhood home, and night. Sunshine boosts your brain’s expectancy and reduced risks for
others from hostas that grew in my levels of serotonin—a neurotransmit-
grandparents’ yard. ter that brightens mood, gives you
Gardening and yardwork is a hobby more energy, and keeps you calm,
that cultivates wellbeing in plants and focused, and optimistic. Exposing
people. Dan Buettner has studied five skin to sunlight also reduces
cultures across the globe where resi- blood pressure and dilates
dents are famous for their longevity: arteries by increasing
Sardinia, Okinawa, Costa Rica, Icaria, production of nitric oxide in
and Loma Linda. These so-called Blue the blood vessels, which in turn
Zones share specific factors in com- cuts risks of heart attack and stroke.
12 Saint Luke’s Cardiovascular Consultants | From the Heartdeveloping respiratory illnesses The Power of Continuous Glucose Monitoring
and cancer.
Doctors in Shetland, Scotland, continued from page 10
routinely prescribe physical activity that when I consume pasta before my sense that fasting would be a simple
out in nature to reduce blood pressure protein, vegetables (fiber), and fat, my yet effective strategy to accomplish
and anxiety and improve wellbeing glucose could go as high as 160 mg/ this. I also complete a 3-to-5-day
for people with conditions such as dL. Yet, when I consume high-quality water-only fast every few months and
diabetes, mental illness, stress, heart protein like fish with a salad and then my glucose usually stabilizes at 75 mg/
disease, and high blood pressure. have pasta, my glucose will rarely go dL and stays there consistently until I
Planting a garden and trees, even on over 130 mg/dL (a massive improve- break my fast.
a small yard in an urban setting, is an ment!). While data suggests that a Using the simple tactics described
easy and enjoyable way to integrate pesco-Mediterranean diet is gener- above, I have been able to lower my
some outdoor nature time into your ally healthy, there is considerable average glucose, glucose variability,
daily life. variability in what the perfect diet is postprandial glucose, and lipid levels.
The practice of consuming an abun- for an individual. Using a CGM is the There is no substitute for high-quality
dance of fresh vegetables, ideally from best option we have to offer for diet data that can lead to data-driven
local gardens and markets, is central personalization. Moreover, everyone behavior change. Because there is no
to longevity. Even so, vegetables and has a different carbohydrate tolerance, one-size-fits-all diet plan, a CGM will
fruit that you grow yourself will make and monitoring glucose will help you help personalize your diet to your
you healthier even if the produce titrate your carb intake for optimal body. Although a CGM requires a phy-
never makes it to your own table. The health. I have found the CGM to be the sician’s prescription, it is simple and
famously therapeutic Mediterranean best behavior modification tool ever easy to attain. Using a GoodRx coupon
diet—the traditional eating style of for customizing one’s diet and improv- helps lower the price as well, to about
peasants from the shores of the Medi- ing well-being. $70/month out-of-pocket cost (insur-
terranean Sea—is rich in home-grown Exercise also plays an important role ance generally won’t pay for CGM
vegetables, fruits, nuts, olives, and in glucose stability. Your muscles are unless you have diabetes). Although
grapes, from which they make olive oil the main engine that burns sugar in many feel that the diagnosis of their
and red wine. your body. Therefore, the more muscle chronic disease occurred
If you are outside for more than 15 mass you have, the more glucose can suddenly
or 20 minutes apply sunscreen to your be burned for energy within those
exposed skin. However, modest doses muscles. I found that prioritizing
of ultraviolet light from the sun may strength training has helped me lower
improve some skin conditions like my postprandial glucose. Walking
eczema and psoriasis. I personally take before or after a meal also
advantage of the mood-brightening helps prevent a glucose
effects of fresh air and sunshine spike after eating. Another
by getting outside for at least two strategy I rely upon to
walks daily. keep my glucose and insulin
A balanced life, like a chair, is stabi- levels low is fasting. I follow
lized by four legs: social connection, a time-restricted eating program,
wholesome diet, physical activity, commonly referred to intermittent
and mental engagement. A person fasting, which allows me to eat
needs to invest energy into all four of between 4 to 6 hours each day, and and without warning, the factors that
these fundamental factors to stay in fast for the other 18 to 20 hours. This predispose to these diseases manifest
optimal balance with their health and strategy keeps my glucose and insulin over many decades. Therefore, moni-
wellbeing. Gardening is a simple and levels low for most of the day and toring your glucose now may play a
enjoyable habit to cultivate that can night. Since the goal is to keep insulin critical role in preventing disease years
contribute to all four of these pillars as low as possible, it intuitively makes down the line.
of health.
saintlukeskc.org/slcc | 816-931-1883 13Physician Leaders of Gratitude Is the Antidote to Envy
Saint Luke’s continued from page 11
Cardiovascular emotion called envy wells up, which yourself of the positive aspects of
Surgical Program is a disguised form of hostility based
on one’s own insecurity. We each
your life, and it turns out to be a
very effective strategy to neutralize
have only a few dozen people with envy. Practicing gratitude has been
Dr. J. whom we are personally connected. shown to increase one’s sense of
Russell Davis When something good happens to wellbeing and improve heart health.
is a board-cer- someone in our little circle of family/ Laura Redwine at the University of
tified general friends/coworkers, it should be a California, San Diego did a simple but
and thoracic reason to celebrate their victory. remarkable randomized-controlled
surgeon who When I see someone accomplish- trial (our gold-standard way to test
specializes in ing their dreams, I remind myself to a therapy) involving 70 individuals
cardiothoracic be genuinely happy for them and who had early-stage heart disease.
and heart transplant surgery. He is pass along hearty congratulations. Half of them were asked to keep a
the Chief of Cardiothoracic Surgery My wife Joan says that when she sees daily gratitude journal, whereas the
at Saint Luke’s Hospital of Kansas a person who is succeeding wildly, control group were treated as usual.
City. Dr. Davis is especially interested she tells herself, “Don’t be envious, The gratitude journal group were
in developing blood conservation be inspired.” Joseph Epstein said, told, “For the next eight weeks you
techniques and minimally invasive “Of the seven deadly sins, only envy will be asked to record 3 to 5 things
valve procedures. Dr. Davis is proud is no fun at all.” To refresh your mem- for which you are grateful on a daily
of the work of SLCC and the service ory, during the 14th century Dante basis. Think back over your day and
they provide to the community. “We Alighieri wrote a poem called Inferno, include anything, however small or
have a highly functioning group of in which he listed the seven deadly great, that was a source of gratitude
surgeons that offer a large scope of sins as lust, gluttony, sloth, greed,
cardiac work,” he says. “Patients have wrath, pride, and envy. Harboring
no reason to leave Kansas City for jealously is like holding a grudge.
cardiothoracic surgery or care.” Buddy Hackett joked, “I don’t carry a
grudge. While you carry the grudge,
Dr. Karthik the other guy is out dancing.”
Vamanan is a Your brain and heart are linked by
board-certified a high-bandwidth nerve connection
vascular that instantaneously transmits your
surgeon who emotions to your heart. Feelings of
specializes in grief, anger, fear, and envy are toxic
treating a wide to your heart. Of the cardiotoxic
range of vascu- emotions, jealousy ought to be the
lar disease processes. Dr. Vamanan easiest to avoid. There is no personal
that day. Make the list personal, and
serves as Surgical Director of the upside to feelings of envy. In con-
try to think of different things each
Saint Luke’s Vascular Program. Dr. trast, when thankfulness, joy, or love
day.” Impressively, the gratitude
Vamanan wanted to be a surgeon at registers in your heart, these feelings
journaling lowered levels of harmful
a very young age. After trying various tend to lower blood pressure and im-
inflammation and improved heart
fields, he found he loved vascular prove your cardiac health. For many
rate variability—a measure of cardiac
surgery and the patients he treated. people, social media can stoke feel-
health and resilience.
“Every time I see a patient in clinic, ings of envy. If that’s the case for you,
especially the ones that have been it may be best to limit the time you An old English proverb says, “Envy
seeing me for 15 years or more and spend on Facebook, Instagram, etc. shoots at others and wounds itself.”
whose lives we have significantly On the other hand, a grateful heart
Another great way to neutralize
improved, I feel very fortunate and tends to attract blessings and culti-
envy is to think grateful thoughts.
privileged to do what I do.” vate wellbeing. You choose.
Gratitude arises when you remind
14 Saint Luke’s Cardiovascular Consultants | From the HeartYou can also read
