I am a functional cardiologist and I hate it.
Let me rephrase that. I hate the term functional cardiologist. And don’t get me started on holistic or integrative cardiologist. Those are even worse.
Why do we need a special term to say that a doctor wants to do more than put proverbial band-aids on symptoms? Why is it so unusual for a doctor to want to fix and reverse the underlying causes of disease? Why should that require a unique identifier?
And holistic? Does anyone believe that the heart exists in isolation and is not influenced by every other aspect of our health? I find it hard to believe that any doctor would admit they feel this way, yet all too often cardiologists act this way.
How Cardiologists are Viewed
The best example is the perception of cardiologists as “plumbers,” using coronary stents to open blocked arteries. If you are in the midst of having a heart attack (an acute myocardial infarction- AMI), you want a plumber.
An AMI is caused by a sudden and complete blockage of a coronary artery (one of the arteries that supplies the heart with needed blood flow), and interventional cardiologists can stop the heart attack by opening the blockage with angioplasty (balloons) and stents. For that, you want the best plumber you can get to unclog that vessel as quickly as possible.
But here is the problem. The hundreds of thousands of patients who undergo elective stenting for partial coronary blockages do not benefit in the way they think. Almost uniformly, patients believe stents reduce their risk of heart attacks. Yet, there have been at least 12 randomized trials involving over 5,000 subjects that have shown that stents do not reduce the risk of future heart attacks or the risk of dying.
Despite this, one study paradoxically showed that patients and physicians alike believe that stenting does prevent heart attacks and reduce the risk of dying. How can our perception be so counter to what the literature shows?
It actually makes sense. We show patients the dramatic before-and-after pictures of the narrowed blood vessel and the miraculous post-stent result of the vessel now looking wide open. We usually don’t show them all the other plaque building up in the other arteries.
The Most Common Cause of Heart Attacks
It turns out, most heart attacks are the result of so-called vulnerable or unstable plaque. Unstable plaques have higher levels of inflammatory components and are more likely to rupture acutely, setting off a cascade of events that completely blocks the blood vessel. The problem is that on an angiogram pre-dating the attack, these plaques are barely recognizable and certainly not of concern.
That is difficult for many to understand. It isn’t the severe arterial narrowings that cause most heart attacks. Those cause chest discomfort (angina) from temporary reduced blood flow to the heart but rarely cause life-threatening heart attacks. The life-threatening heart attacks come from the 20%, 30%, and 40% narrowings that become unstable. What makes them unstable? Inflammation, oxidation, smoking, diabetes, and more.
Paradigm shifts take time, especially when the paradigm goes from a simple one (i.e. a blocked artery is the problem, therefore open it and the problem is solved) to a complex one. Coronary artery disease is a multi-factorial problem that can only be treated with a whole-body approach focusing on inflammation, blood sugar and insulin control, nutrition, exercise, stress management, and much more.
To complicate matters even further, we now have studies questioning if stents can help relieve chest pain any better than medical and lifestyle management. And this makes sense too. There may be one narrowing worse than the others, but by the time someone develops narrowings they also have endothelial dysfunction – impaired ability for the vessels to dilate and allow more blood flow when needed. If that is severe enough and widespread enough, it too can cause chest pain/angina. Once again, treating one blockage won’t solve that problem.
How to Treat Cardiovascular Disease
Looking at the data, it becomes clear that there is only one way to treat cardiovascular disease. Treating this disease requires a holistic, functional, integrative approach that considers the whole patient, the patient’s lifestyle, and every aspect of their health.
So where does cardiology stand? Are we plumbers? Or are we doctors? I am afraid of what the answer is for most cardiologists today. But I am hopeful that the trend is moving in the right direction. I am hopeful there will be a day when all cardiologists will be
functional, integrative, holistic cardiologists.
Thanks for reading.
Bret Scher, MD FACC
30 thoughts on “What is a Functional Cardiologist?”
Great information for us non-cardiologists!
So I do find a cardiologist that’s knows my heart is part of my body
I second every word you wrote . You explained the situation with eloquence and grace . Many patients called me a holistic doc back in the 90s . I never wanted the label , I just wanted to be , and continue to strive to be , a family doctor.
Bravo my friend,
PS I think HD will agree
I like that you mentioned looking into medical and lifestyle management. This is a great way to make sure that you have a great heart. My uncle who was researching cardiologists the other day.
Yes! Lifestyle management should always be the first approach. Thanks for your comment
It's scary that most heart attacks are caused by unstable plaque and inflammatory components. I actually learned the other day that Kasin found in milk and meat can cause inflammation in the body. It sounds like I should definitely cut down on the amount of dairy and meat I eat. My father is very out of shape, and now I'm even more worried about his heart. What tips do you have for finding a great cardiologist to help him out?
Hi Taylor. I would caution against eliminating any real food based on hearing it can cause inflammation. That is something that can be measured in each individual. Meat in particular has a bad rap for causing inflammation when in reality it is frequently what is eaten along with the meat. As for finding a great cardiologist for your father, that depends on where he lives. Alternatively, you can look for an online coach who can help him through his medical journery and communicate with his doctors. I hope that helps!
This writing reinforces what I concluded in my recent journey. As a 62 year old, former smoker with mild chest pain and discomfort in my neck, I went for a physical. After referrals to pulmonologist and cardiologist, and multiple CTs, EKGs. an ECG, and a nuclear stress test I’m dismayed. Cholesterol was never tested or mentioned. CT showed significant cornary calcium around the heart. My 2nd cardiologist (the first one had no time for conversation at all) said my results were ‘atypical’, and implied inactionable. He prescribed aspirin and statin and a ” good American diet” and “let us know if it gets worse.” Needless to say I was left wanting. Currently looking for another opinion from a real Dr who gives a damn.
I’m sorry for your awful experience, most anyone with serious health issues in this country would have a similar story to tell if they had the wits to.
Hence the reason folks like our good Dr here should use his title proudly and loudly until it becomes the actual standard and therefore unnecessary; so that folks like us can know where to go for actual help.
Be thankful for the perspectives your trials have brought you, and keep taking charge of your health.
Thank you for your mention of gratitude for what we learn in trials.
Good evening. I agree with your “holistic” approach to heart disease PREVENTION/REVERSAL. I am in New York City. Could you refer a colleague here whose practice is integrative cardiology such as your. Heart fully appreciated.
Ricardo : email@example.com.
So we actually have some options for you! Unfortunately, Dr. Scher cannot offer a Medical Consultation or the Concierge Service in NY. In order to be eligible for those, you must live in one of the following states: CA, CO, UT, AZ, OH, IL, NV, TX.
That said, we highly recommend you check out our 6 Month Boundless Health Program, which has no state requirements, and is an excellent program for those seeking to prioritize their health.
The Boundless Health Membership Program is a 6-month program where Dr. Bret Scher will give you the tools you need to achieve your goals and your Best Health Ever. You will receive weekly courses that will teach you about nutrition, fitness, goal setting, how to stay focused, and so much more. Each video comes with a workbook or handout to reinforce your knowledge, not to mention some of Dr. Scher’s favorite recipes and practical health tips.
Learn more here: https://program.lowcarbcardiologist.com/sign-up/
We hope this helps!
Thank you for that information. Until that day comes when all cardiologists practice holistic, functional, integrative medicine then we will have to continue to use those terms to differentiate the ones that do from the ones that don’t. I’ve seen three cardiologists and have yet to hear one mention diet or exercise or do blood work to check for deficiencies. What I’ve learned I’ve learned from reading books by cardiologists that practice integrative medicine. Unfortunately, where we live, only conventional cardiology is practiced.
I eat as healthy as it gets, mostly vegan and mostly raw, no alcohol, no sugar, no gluten, no coffee. I walk, hike, do yoga. I take heart healthy supplements, even high C IVs AND still my BP is 150/95.
Frustrated and out of options.
We’re sorry you’ve been feeling frustrated, but you are far from being out of options! We recommend scheduling a 1-on-1 medical consultation with Dr. Scher so we can dig in and see what’s really going on.
Hello Dr. Scher. Thank you for this. I have been a cardiac patient since 2001 when I received my first stent. I am now at number 12. I had a heart attach in my hospital room three years ago immediately following the placement of two stents that failed, but no heart damage. I recently had another stent placed. This happens for me every two and a half to three years. My LDL is good and I am on a statin. MY HDL is 32. I am 5’6″, 141 pounds and I have been on the Keto diet for almost two years. I lost 25 pounds almost immediately on the Keto diet and my HDL went up from 32 to 48, and my triglycerides down from 78 to 38. Currently while still on the Keto diet my numbers have discouragingly returned to those of my previous Keto days. I am an avid cyclist and swimmer and practice yoga. My LP(a) is 181. A discouraged patient. Any advice? Bob Petite, Chicago
We’re sorry to hear about your experience and that you’ve been discouraged. Unfortunately, Dr. Scher is unable to give medical advice on his blog. If you would like a more detail devaluation and answer to your questions, you could always consider an individualized consult.
We think it would make a huge difference! Best of luck.
Hello very excited to have discovered your website. I’m currently looking for a new cardiologist that looks beyond just the heart. I have been diagnosed with a slight atrial flutter and have refused medications. Prior to that for many years I have been diagnosed with fibromyalgia/chronic fatigue syndrome. I am finding that I have a severe flareup of extreme fatigue, actually put me in bed for a day or two, after doing cardio workouts. I do not have the best practitioners and I’m afraid to go back to see the cardiologist because I’m sure they will just insist that I take a medication. As you probably know there’s not a lot of medical help with chronic fatigue and fibromyalgia. I wonder what your opinion is on this depleted state of experience the day after cardio workouts. Is this just a part of the chronic fatigue syndrome and I need to find the right medical care for that? Or… Is that a common response to having an atrial flutter. Another part of my dilemma is that I am on A rather low fixed income And so only see medical practitioners that are covered by insurance. So any light that you can shed on this dilemma would be greatly appreciated! I have really enjoyed discovering your website and reading lots of your articles and others responses. Thank you so very much!
Thank you for your question. This is an interesting topic that deserves a detailed analysis and explanation. We don’t feel the blog is an appropriate forum to provide you with the detailed response and advice you require. If you would like a more individualized approach and answer, please feel free to sign up for a one-on-one medical consultation with Dr. Scher. We know that your insurance most likely will not cover this, and we apologize for that, but this one appointment could be worth it to give you the clarity you need, especially since you’re not receiving it from your current practitioners.
Apologies we can’t be of more help. This truly would require an individual approach and in-depth analysis. In the meantime, we’re glad you’ve been enjoying the blog and hope you continue to do so!
My husband, at 65 and in apparent physical health, ideal weight, building contractor…had the Widowmaker on 2/15/2015. After his stent his Interventional heart doctor told him he was in great shape and that the rest of his heart looked great. He had a self paid CAC test 2 years ago that showed a score over 2000. His Dr. scolded me for taking him for that test and wouldn’t even address the test results. Some have suggested that the presence of the stent may have skewed the score but the scores were high for every artery. I desperately need to find a ‘functional’ cardiologist to assess his CAC score and prescribe the best diet for him. He is on all kinds of meds plus STATINS. Still building houses at 69.
I wish more doctors, in general, had your perspective. I worked in the back office of a family practice clinic for 6 years. The owner/provider is convinced his patients don’t care about being educated on how lifestyle choices affect health and can actually reverse many conditions and only wanted a magic pill to”fix” them, so that’s how he practices medicine. He expects his patients to be noncompliant with lifestyle improvements so he doesn’t even bother trying. Add to that all the Meaningful Use, MACRA, HEDIS, etc, bullcrap that takes away from face-to-face patient care, I think a lot of medical providers have become jaded, disillusioned, and burned out and are just coasting through with the”quick fix’ — which is only a bandaid masking the symptoms instead of looking at and treating the actual root of the problem. I understand the point of your article and agree wholeheartedly. I wish there was a way for patients to distinguish between typical “conventional” medicine (which is typically behind modern research 15-20 years) providers and those that have a more functional approach. If I had the choice between a functional practitioner and a mainstream conventional practitioner, functional would win every time. Unfortunately, finding the right fit is trial and error.
(Stepping off my soapbox now. )
I’m needing a cardiologist. I have three arteries blocked 75%, 65%, and 55%. I’m taking a vassal dilator. I’m 79 years old and am very unhappy with the lack of connection with my doctor. I feel he may be starting to have mental problems. He is 64 years old.
I have never taken statins (actually tried) but had terrible muscle pain , so no!y blood pressure is normal , blood oxygen is great. I had a high calcium score and discovered the blockages. Talking to the doctor today made me think he was reading someone else’s chart. I don’t take Repatha because y cholesterol is 77 and 55.
He said I had cholesterol of 127 snd the Repatha was working great. I told him I didn’t take it and why. I’ve tried several doctors for the heart to get a baseline, but now that I need one, I have no clue how to find a traditional and functional doctor. I live in San Antonio, Tx. Can you point me in the right direction?
Hi Judith. We’re so sorry to hear about your disconnect with your doctor, that must be very frustrating.
We do have some great news, however! Dr. Scher is licensed in Texas, so we can help! You have two options to consult directly with Dr. Scher. A one-time medical consult, which is an in-depth 90 minute video consultation where Dr. Scher digs into your medical history and consults with you directly via video: Learn More Here. Or a one-year concierge program, which is a preventative cardiology solution where you work with Dr. Scher directly on demand for one year. Learn more here: Learn More Here.
Please fill the form on the program of your interest so Dr. Scher can understand your medical history in-depth, and he’ll be in touch!
We look forward to helping you achieve your best health ever.
HI Dr. Scher- My wife is 75 years old and in great physical shape except for her heart. She eats well, works out and has never smoked. However, for 40 years she has had an issue that shows up on her EKG. The radiologist interpretation is: Sinus rhythm with 2nd degree AU block with premature supraventricular complexes. Anterior infarct with possible left atrial enlargement. It has not given her any trouble however I’m worried that she is in danger with every passing year. What would you recommend to keep her healthy and feeling good?
Thanks for your advice and help! Scott
Thanks for reaching out about your wife. I’m sorry to hear about her issues with her heart, that must be very scary.
I do think this is worth looking into with Dr. Scher. Unfortunately, Dr. Scher is unable to give medical advice on his blog. If you would like a more detailed evaluation and answer to your questions, you could always consider an individualized consult, or if you’re looking for something more long-term, a one-year Concierge Preventive Cardiology Program.
I think your wife could benefit from either one.
Best of luck, I hope you can get to the bottom of it.
I will be 64 years old on December 14th. I’m in very good health except for the fact that I have bradycardia 32 BPM resting and I have atrial flutter. The atrial flutter came about recently then last year. I run 3.5 miles once or twice a week including some sprints just like when I was in my 20s. I have 3rd degree heart block at rest, at least sometimes, but have taken echocardiogram stress test and everything is normal. The doctors don’t seem to be able to explain this and this is why I am reluctant to subscribe to even their most innocuous procedures and further testing. Right now they are recommending at least a cardiovert to get rid of the atrial flutter I am asymptomatic but I am concerned about the flutter and I’m looking into cardiovert. I don’t think the ablation is something I want to do at this point without knowing further the causes of all this. I on no medication whatsoever and I eat a sugar free alcohol-free very traditional wholesome diet also no caffeine. It is somewhat encouraging that there are other cardiologists around that are more integrative and holistic. It would be good if some cardiologist would interpret ekg’s and other tests in more detail. Do you think that Dr. Scher could help me?
Happy early birthday! I’m sorry to hear about your atrial flutter. I think Dr. Scher could absolutely help you!
I highly recommend a detailed evaluation and answer to your questions via an individualized one-on-one consult with Dr. Scher.
Best of luck!
I have a cardiologist who is totally disinterested. Because of covid he never came near me on my last visit. I had a nonstemi and two stents in 2019. Have problems with all bp meds. I am currently on lisinopril 10 mg and imdur er 60mg for chest pain that I never had. Also take pravastatin 20mg 3-4x a week. Ecercise 45min a day 4x a week. My bp seems to go low 116/68 and when it does I am very tired. Sometimes I have palpitations that could be from potassium build up. Just wish I had a doctor who actually cared about something besides pushing meds.
Thank you so much for your comment, we’re sorry to hear that. It can be extremely frustrating to find a doctor that will listen to your specific needs.
If you want a long-term cardiologist that is attuned to your needs I highly recommend Dr. Bret Scher’s Concierge Program . This program gives you dedicated time with Dr. Scher long-term, so you can get the care you deserve. Check it out.
Wishing you the best of luck.