Q: Years ago numerous health talks highlighted cholesterol. Nowadays I don’t hear much about it. Is cholesterol still relevant?

A: Cholesterol became a household word during the 1980s and 1990s because of its association will atherosclerosis and disease of the heart, brain, and other blood vessels. Cholesterol travels through the body in the blood packaged in high-density lipoprotein (HDL) or low-density lipoprotein particles (LDL), known as “good” and “bad” cholesterol respectively. People with high cholesterol have about twice the risk of heart disease as people with lower levels; and yes, heart disease and stroke are still leading causes of death around the world. So the relevance of adopting healthful-living practices to reduce cholesterol to appropriate levels is far from over. And we also now know that cholesterol is a player in the deadly processes involving risk, progression, survival, and prognosis of cancer. 

Cholesterol is necessary for making vitamin D, estrogen, testosterone, and other steroid hormones and is vital for sperm development, immune-system defense, and the health of our nervous system. While all our cells contain cholesterol, cancer cells tend to have higher levels of cholesterol than normal, healthy cells; and alteration in the level of cholesterol in the blood is a common occurrence in a wide variety of cancers. We don’t know whether the cholesterol “causes” cancer or if the cancer “causes” the cholesterol to accumulate in the cells, but we have some clues that have come from research conducted in the past few decades. 

Cholesterol stored in cancer cells may function as a reservoir for rapid cell division and makes breakaway cells more likely to produce new colonies away from the parent tumor (i.e., metastasis). In a manner of speaking, cholesterol is “hijacked” in the malignant process for the development, 

survival, progression, and metastasis of cancerous cells. In most cases tissue from tumors shows an increase in the uptake receptors for LDL cholesterol, which may then serve as a pipeline for new cholesterol to support rapid growth in the cancer cells. So could it be that a lifestyle that promotes high levels of LDL, or “bad” cholesterol, may also be fueling the development of cancers and cancer metastasis? 

It’s now known that alteration of the way cholesterol is handled in cancer cells can hamper or facilitate the response to anti-cancer therapies. Increased cholesterol levels are associated with higher cancer incidence, and cholesterol-lowering drugs (e.g., statins) may reduce the risk of dying from certain cancers, such as breast, prostate, and colorectal. Yet some cancers aren’t affected by blood cholesterol levels, and cholesterol-lowering drugs themselves may increase cancer risk. So just looking for medication to “fix” the cholesterol may not be the answer. 

There’s robust evidence that a healthful lifestyle using a plant-based diet of whole foods, adequate exercise, rest, stress management, and trust in God makes a lot of sense in reducing the risk of cancer as well as other leading threats to our health.

Q: Is it really safe to microwave food? 

A: This question has come up from time to time, and the concerns include making food radioactive, destroying food’s nutrients, and the ovens themselves causing cancer. Perhaps some explanation about microwaves and the chemical processes involved in cooking foods may help you in your search for a definitive answer. “Radiation” is a broad term that means the emission or transmission of energy in the form of waves or particles through space or through some material. We are bathed in radiation (e.g., light, the earth itself, communication equipment, X-rays).

Some types of radiation promote health (e.g., sunlight), while others are dangerous (e.g., uranium). 

Microwaves are considered safe when used in such things as home appliances, Bluetooth devices, radios, cell phones, GPS devices, and televisions. The microwaves used for cooking fall between radio and infrared light on the electromagnetic spectrum. Only under extreme conditions way beyond what we experience in our day-to-day lives have they been shown to cause harm, such as with devices meant to emit high-power electromagnetic pulses in military and research applications.

Typically, when food is subjected to heat, the molecules in the food get agitated, and that energy changes the structure of the carbs, fats, and proteins in the food. The amount and duration of heat exposure as well as the cooking environment (water, oil, or air) determines the degree and kind of changes that occur during the cooking process. 

Microwave ovens cook food by energizing the water molecules in the food item, causing them to produce heat, which then cooks the food. The microwaves affect only a small distance beneath the food’s surface; the heat produced there then travels inward to heat/cook the whole item. The rotating plate in the oven helps to facilitate more even heating but does not guarantee it. 

Microwaves do not change the molecular structure of the food, nor do they make the food radioactive. Some food items—such as grapes, whole eggs, processed meats, foods in plastic containers, and foods that may have metallic residue on their surfaces because of heavy metals sometimes being present in the soil (e.g., carrots, spinach, frankfurters)—have been shown to be problematic when heated by microwaves. Currently there’s no evidence that microwaving food is dangerous, but as a precaution, microwave food in only glass or ceramic containers. 

The quality of the food is probably the most important issue since this is what will determine the nutritional benefit or nutritional harm that food will impose. God made fire, and He made microwaves (not the ovens, of course!). Both may be used to hurt or to harm. Either of them used with appropriate precautions is safe.

* Amy M. Dagro, Justin W. Wilkerson, Thaddeus P. Thomas, Benjamin T. Kalinosky, and Jason A. Payne, “Computational Modeling Investigation of Pulsed High Peak Power Microwaves and the Potential for Traumatic Brain Injury,” Science Advances, Oct. 29, 2021.

Q: Can music improve my health? 

A: Without a doubt, some music helps people feel happy. Population surveys show that music is used primarily for entertainment, personal enjoyment, background “space” filler, and religious purposes. So “health,” in the commonly used sense, is not what people generally give as their motivation for listening to or playing music, even though both these activities can have amazingly profound effects on our well-being, whether we are ill or otherwise healthy. In the Bible, David used music to calm Saul; Hippocrates played music to treat patients with mental illnesses way back in 400 B.C.; and Pythagoras, the Greek philosopher, prescribed it to treat bodily and mental ailments. Modern science now finds the same benefits and even more.

Music is a special gift to humankind. It affects not only our mood but also our learning and thinking functions. Neuroscientists believe that music activates many of the brain regions and brain chemicals and can produce physical rewiring in brain structures known to modulate heart function. It affects the beat-to-beat variations in heartbeats (HRV), which has been shown to be a powerful predictor of heart-related illness and death. It can help ease pain and relieve stress by reducing the level of stress-related hormones in the body. Research shows that people with chronic bronchitis and emphysema breathe easier while listening to music and have a modest but noticeably increased endurance and tolerance of high-intensity exercise. But all music and all people are not the same. 

Some kinds of music can be stress-producing. Heart and respiratory rates are higher in response to exciting music than in the case of tranquilizing music. In 2015 Finnish researchers found that music can bolster both positive and negative emotions. Some types of music produce sadness or support anger and aggression. The rhythm and other characteristics of the music—along with the culture, age, gender, musical taste, and emotional state—can all influence how we may respond to music. In one study, music perceived as arousing, aggressive, and unpleasant disrupted performance on a memory task and led to a lower level of reported altruistic behavior in 10- to 12-year-old children. In another study, groups of people were subjected to various compositions by Mozart, Strauss, or the pop group ABBA for 25 minutes each per day for three days. Music by Mozart and Strauss lowered blood pressure and heart rate, while music by ABBA did not. The slower tempos, tranquil melodies, gradual chord progressions, and soothing rhythms of classical music reduce mild to moderate insomnia. There’s even evidence that people who listen to calming classical music for 20 minutes per day may increase the activity of genes associated with memory, along with an increase in dopamine secretion and nerve interconnections. 

During the COVID pandemic, single music sessions were shown to improve blood oxygen levels and reduce anxiety—imagine that! 

Music is an amazing contributor to total health and well-being. A happy brain is a healthy brain. Thank God for this gift! 

Peter N. Landless, a board-certified nuclear cardiologist, is director of Adventist Health Ministries at the General Conference.

Zeno L. Charles-Marcel, a board-certified internist, is an associate director of Adventist Health Ministries at the General Conference. 

Q: Is playing sports a good way to get fit?

A: Getting “fit” may mean different things to different people, so let’s get on the same page. To be “fit” means that you have enough strength, endurance, and flexibility to do everything that your normal day requires, and that you have reserve capacity to get through a typical crisis, an emergency, or an additional desired activity (such as climbing a flight of stairs when the elevator is out of service or climbing a hill to see a spectacular view). To the athlete, getting “fit” may mean preparing for a triathlon or climbing to the summit of a challenging mountain. So who you are and what you aspire to achieve make a difference.

Whatever the situation, however, getting fit requires movement and a “load” that you work against or carry (e.g., your body weight is considered a “load”). As you regularly repeat the activity with more or faster movement and with greater load, you become more “fit.” Whoever you are, though, being fit requires more than just exercise; it also requires a healthful lifestyle that accommodates the level of activity that’s needed.

Most sports involve movement and “load,” so if practiced regularly, they will improve fitness. Aerobic sports cause the heart to beat faster. Enjoying them regularly strengthens the heart, improves circulation, and increases lung capacity. These together improve the body’s ability to deliver oxygen to all the cells. Adding load on the muscles (e.g., weights, basketball, baseball bat, water for swimming) improves total fitness, strengthening bones, tendons, and ligaments and increasing lean-muscle mass, benefiting weight management.

You don’t have to be a star athlete to engage in sports for fun and fitness. Twenty to 30 minutes of a low-intensity sport may be a healthy starting point for sedentary adults. Swimming , cycling , bowling, pickleball, rowing, and kayaking all can be done at low intensity to start and increased as you go. Table tennis and pickleball are the lowest cardio-intensity workouts of the racket sports. You can also do a search on the Internet for other examples of low-impact, no-contact, and variable-intensity sports.

Here are some suggestions when choosing a sport:

Enjoying a friendly sport safely with friends and family is a good way to get fit!

Peter N. Landless, a board-certified nuclear cardiologist, is director of Adventist Health Ministries at the General Conference. Zeno L. Charles-Marcel, a board-certified internist, is an associate director of Adventist Health Ministries at the General Conference.

Q: We started to work two-month rotating shifts during the first pandemic surge. My family has recently complained that I’m increasingly irritable, moody, and negative. My weight, blood pressure, and blood sugar levels are creeping up too, and I’m always tired. Could this be because of the shifts?

A: You’ll need a comprehensive clinical evalu­ation to assess what else might be going on. We recommend you talk to your doctor for a defin­itive answer. That said, shift work affects stress levels, sleep quality, and overall health because of disruption of biological rhythms and may indeed contribute to your situation.

Our brain, other organs, and even our cells have biological clocks that strongly influence—in a rhythmic pattern—the way our bodies function and how we behave. Internal clocks regulate our hormones, our immune system, our digestion, and much more. These clocks are encoded in our genetic material, and the rhythms they produce provide special windows of time that are best suited for the various types of activities that we engage in daily (such as mealtimes and bedtime), and even the optimal timing for medications and radiation therapy on cancer.

The predominant body rhythm cycles every 24 hours and 11 minutes, or almost a day; hence, circa (almost) dian (day). It produces predictable changes such as reduced blood pressure during night-time sleep and a rapid rise to daytime blood pressure levels starting around 6:00 a.m. It’s not coincidental that the risk of a stroke or heart attack is highest between 6:00 a.m. and noon!

Our brain’s performance also varies with the time of day, dipping, between 10:00 p.m. and 6:00 a.m. in otherwise normal people, below the levels of someone legally drunk. We are naturally more prone to accidents and errors during those hours. The cycle disrupted by sleep deprivation, rapid travel across time zones (jet lag), and shift work has consequences (see table). Consistent bedtimes, wake­up times, and mealtimes diminish bio­ rhythm disruption and facilitate realignment.

Your situation may not permit avoidance of shift work. We recognize that there are some jobs that are needed to sustain our modern, 24/7 way of life. You may, however, be able to reduce the severity of the impact of shift work on your health and well­being. The most powerful resynchronizers include consistent, routine mealtimes, bedtimes, exercise, and, most important, sunlight exposure.

Sleeping in the dark and avoiding post-shift light, alcohol, caffeine, sedatives, and screen ­monitor light within 90 minutes of bedtime all help to realign your body functions with your biorhythms. Keeping a consistent schedule, applied even on your days off, will help your body’s adjustment, but frequent shift changes are not optimal.

Individually tailored, carefully and prayerfully crafted, wholistic lifestyle intervention will help you (and your co-workers) reduce your physical, psychological, and even your spiritual risks.

Short-term DisruptionLong-term Shift Work
Decreased:Increased Risk:
CreativityNoncommunicable diseases
Empathy/compassionDiabetes, hypertension, heart disease
Information processingObesity
Decision-making abilityDementia, anxiety, depression, “fog”
Micro-sleepsImmune function
ImpulsivityPsychological resilience

Peter N. Landless, a board-certified nuclear cardiologist, is director of Adventist Health Ministries at the General Conference.

Zeno L. Charles-Marcel, a board-certified internist, is an associate director of Adventist Health Ministries at the General Conference.

Q: My 28-year-old sister has breast cancer. Our mom died of ovarian cancer, and the doctor wants to test my sister’s genes. He mentioned that her high cholesterol needs to be controlled for best results with the cancer. I’m 33, and all four of us siblings have high cholesterol. What’s the link between cholesterol and cancer?

A: We’re sorry to hear about your sister’s diagnosis and encourage you and all your siblings—female and male—to get evaluated since your doctor suspects a hereditary cancer. Based on the history you provided, we also strongly recommend that you do some Internet-based research from trusted, accountable sources such as the Centers for Disease Control and Prevention,* and we remind you that prevention is more effective than any type of treatment available today. Early risk reduction and disease detection often produce greater survival, lower treatment complexity, and less cost.

Cholesterol biology is complicated. Our bodies naturally make as much cholesterol as is needed, but we can also get it when we eat foods of animal origin. For years correlations between high cholesterol in the blood and the likelihood of certain cancers have been reported. In some kinds of cancer—such as breast, prostate, testicular, and colorectal—lowering cholesterol levels seems to reduce the risk of getting and dying from these cancers. On the other hand, bladder and lung cancers do not appear to be associated with cho- lesterol levels, and the use of cholesterol-lowering drugs (statins) may increase the risk compared to the benefit. Specifically, increased dietary choles- terol is associated with an increased risk of breast cancer, and that’s probably what prompted the comment by your sister’s doctor. Some studies also estimate that for every 300 milligrams of cholesterol in the daily diet (about a two-egg omelet per day), the risk of pancreatic cancer increases by 24 percent, endometrial cancer by 18 percent, and throat cancer by about 25 percent.

In 2018 researchers at the University of California, Los Angeles, showed how cholesterol promotes tumor growth. In 2019 a scientific review concluded that both a high-fat, high-cholesterol diet and having elevated levels of blood cholesterol can affect cancer development because cholesterol handling is reprogrammed in cancer cells. In 2021 researchers at Duke University demonstrated the way breast cancer cells use cholesterol to fuel the mechanisms that make them impervious to the natural cell stress as they migrate (metastasize). Metastatic breast cancer is difficult to treat, so preventing the spread is preferable. Lowering cholesterol by lifestyle and, if necessary, with medications will interfere with breast cancer metas- tasis and be better for the affected person. Current cholesterol-lowering strategies include physical exercise, adequate sleep, stress reduction, and improved diets low in animal prod- ucts (saturated fat and cholesterol) and high in legumes, seeds, avocados, olives, and especially nuts such as pecans, walnuts, and almonds.

We encourage you and your siblings to find a health-care team that’s knowledgeable about lifestyle-based, wholistic risk reduction and follow their rational plan. Thank God for His evidence-based pathway to optimal health and wholeness even in our brokenness!

* https://www.cdc.gov/cancer/breast/young_women/bringyour- brave/hereditary_breast_cancer/index.htm

Peter N. Landless, a board-certified nuclear cardiologist, is director of Adventist Health Ministries at the General Conference. Zeno L. Charles-Marcel, a board-certified internist, is an associate director of Adventist Health Ministries at the General Conference.

Q: Should I supplement for colds, flu, and COVID with zinc?

A: It depends! Your current situation makes the determination. Zinc is an essential nutrient. It must come from food, because the body can’t make or store it. Women need about 8 milligrams per day, and men about 11 milligrams per day. This is easy to get from a balanced diet, but in the United States it’s estimated that 12 to 40 percent of the population and 70 percent of the elderly are zinc-deficient.

Even in small amounts, zinc must be present for many cellular and bodily functions—such as taste, smell, wound healing, growth, digestion, vision, sexual development and reproduction, DNA synthesis, and DNA repair—to work properly. Zinc is essential for optimal immune function and cancer surveillance. The individuals most susceptible to zinc deficiency are elderly individuals, lactating or pregnant women, and persons with bowel, kidney, or liver disorders.

Vegetarians may be at risk if their diets are high in raw, unsprouted seeds or heavily grain-based (maize, wheat, wild rice, brown rice, amaranth, and oats, and the “brans” of these) and legume based (peanuts, almonds, sesame), since compounds (phytates) found in these foods may decrease zinc absorption from the intestines.

The most recent analyses of zinc used for pre- vention and treatment of infections show mixed results. Zinc may be helpful in reducing the severity and duration of colds and flu. In one study pub- lished in February 2021, zinc supplementation had no measurable effect on COVID infection; while another study a few months later showed that zinc status may be predictive of COVID severity (lower levels correlated with greater COVID severity).

It’s known that zinc is necessary for many aspects of the immune responses to bacterial and viral infections, and numerous studies demon- strate antiviral activity of zinc in the laboratory.

So it seems plausible that making sure you have adequate intake to meet your body’s demand would be beneficial.

Of great significance is the association between zinc deficiency and chronic disease such as dia- betes and cardiovascular diseases. Low-dose, long-duration fortification of the diet with zinc has been shown to improve specific risk factors for certain noncommunicable diseases (NCDs), decrease insulin resistance, and improve good cholesterol and triglyceride levels. This approach to fortification mimics natural zinc intake from food and was superior to high-dose or short-du- ration zinc supplementation; it also has the poten- tial to decrease the comorbidities that are associated with the greatest risk of severe and fatal COVID infections.

God gave us a health-optimizing lifestyle that helps protect us from a wide variety of physical and mental diseases. Healthful practices such as adequate sleep, exercise, and hydration; healthy eating; wholesome relationships; stress manage- ment; and trust in God are fundamental to all health enhancements.

Unequivocally, we state that you should avoid zinc deficiency, which increases the risk of acute and chronic infections and a host of other problems. Zinc is inexpensive; low-dose, easily absorbable preparations have few side effects and should help avoid deficiency. But it can interact with certain medications, medical conditions, other supple- ments, and foods, so a conversation with your health-care provider is essential. Also, do not exceed 40 milligrams intake per day as a supplement.

Peter N. Landless, a board-certified nuclear cardiologist, is director of Adventist Health Ministries at the General Conference. Zeno L. Charles-Marcel, a board-certified internist, is an associate director of Adventist Health Ministries at the General Conference.

Q:I see doctors and pastors on the Internet who challenge the need for quarantine and social distancing. They say that quarantine was historically only for people who were sick, so if we don’t have COVID-19, we shouldn’t be “locked down.” Are quarantine and social isolation really necessary for our health?

A:Navigating the Internet is challenging. Separating fact from opinion is daunting. We live in a prophetic “age of confusion.” In response to your question, we present biblical and historical perspectives of quarantine.

Most authorities cite the Bible as the most ancient documentation of restricted social interaction to limit the spread of disease. Leviticus contains divine instructions for evaluating and physically (socially) distancing individuals thought to be harboring potentially serious contagious diseases. Such people were barred from associating with others for seven days, and if their situation remained unresolved over that time, a second seven-day separation was enforced.

Coincidentally, in those days 14-day physical distancing was not a novel, human concept but rather a biblical prescription. Should an individual be diagnosed or confirmed to be acutely infected, they would be disallowed free access to society and required to broadcast aloud that they were “unclean” whenever in a public space (see Lev. 13:1-46). Furthermore, ceremonially unclean individuals could not congregate or be involved in communal worship activity.

Despite claims to the contrary, the most reliable evidence is that COVID-19 is a serious contagious disease. For a while, how it was spread was largely unknown, testing for infection was inadequate or unavailable, and the infectiousness and number of asymptomatic carriers was merely speculative; everyone became a potential case! So, to interrupt the spread, it was prudent to apply social distancing and various forms of preventive hygiene, as the Bible also describes and prescribes (see Lev. 15).

In today’s language, persons in biblical times who were suspected of disease were “quarantined,” and confirmed cases were placed in “medical isolation.” Both involved physical (social) distancing and meticulous hygiene. Moreover, quarantined or medically isolated individuals were disallowed from the Hebrew equivalent of going to church.

The Bible describes the concept and practice of quarantine, but doesn’t give it a name. The word “quarantine” (from quarantina, or“40 days”) was coined in Venice in 1448. Before that time, ships were held offshore for 30 days (trentena) to curtail the spread of the bubonic plague (Black Death). The “trentena” was not completely effective since the plague’s time course from infection to death averaged 37 days; thus, we have “quarantina.” As people learned more and “knew better,” they “did better.” Today, we can ignore history or learn from and prudently build on it. For example, we now can be physically distanced but still socially connected—a win-win.

God cares for us; we care for others; we don’t put them at unnecessary risk. While protecting others, we protect ourselves. It’s inconvenient and costly, very costly, sacrificially costly. Yet Christ’s followers are motivated by love and compassion for all, especially the most vulnerable (see Matt. 25:31-46). After all, aren’t we our brother’s and sister’s keeper?

Peter N. Landless, a board-certified nuclear cardiologist, is director of the General Conference Health Ministries Department. Zeno L. Charles-Marcel, a board-certified internist, is an associate director of Adventist Health Ministries at the General Conference.

Q:We recently moved close to my husband’s elderly aunt, whom he hadn’t seen since he was a teenager. Her house was filled with moldy newspapers and just “stuff.” There was literally no place to sit. This couldn’t be healthy, could it?

A: You describe a well-developed case of hoarding—and, no, it’s not healthy, on several levels.

Hoarding is a subtype of obsessive-compulsive disorder, in which affected individuals stockpile and have emotional attachments to items—regardless of the objects’ real value—that others view as worthless. Hoarders have a compulsive need to constantly acquire “stuff” and have difficulty in getting rid of possessions. The thought and process of discarding brings significant stress and distress, often because of fear of losing something valuable, important, or useful. This appears to be the driving force of the disorder. Hoarding is estimated to affect between 2 and 5 percent of the U.S. population, is more common in Western countries, and, unfortunately, is a growing problem.

As in the case you described, accumulated possessions grow to the point of blocking off living spaces (bathroom, kitchen, utility and clothes closets) and appliances (stove, refrigerator), thus affecting the ease of doing everyday household tasks, such as cleaning and cooking. As a result, sanitation and hygiene become challenging, and personal safety becomes compromised.

Interestingly, the situation is often not perceived by the affected individual as a “problem.” Clutter inhibits free passage, thereby increasing falls and injuries. It poses a fire hazard and impedes access by emergency personnel. Clutter invites and shelters pests, mold, and structural damage, increasing the risk of respiratory, allergic, and infectious conditions.

Genetics, brain functioning, and stressful life events are all being scientifically evaluated as contributors to this derangement. Although elderly people exhibit more extreme examples, most can trace telltale behaviors as far back as childhood or adolescence. Despite being more prevalent than anxiety, hoarding hasn’t received much attention. The main treatment, cognitive behavioral therapy, is highly successful but requires time, often six to 12 months. The goal is to help hoarders think through and “see” the situation; stop the acquisition; acquire new, effective, organizational skills; and begin the act of discarding the accumulated items. Hoarders often know that they can’t find things and realize they prize things that are of dubious potential usefulness, are spending unnecessarily, and are placing themselves at risk; but they have an inner script that overrides corrective action.

In a way, many of us have some tendency toward accumulating “stuff,” even knowing that our value isn’t based on our possessions and that discarding what isn’t useful may not necessarily be wasteful. But even our spiritual understanding may not fix this psychological problem, which is best attended to professionally and with Christlike compassion.

Peter N. Landless, a board-certified nuclear cardiologist, is director of the General Conference Health Ministries Department. Zeno L. Charles-Marcel, a board-certified internist, is an associate director of Adventist Health Ministries at the General Conference.

Q:I have pain in my calves when I walk a short distance or up a few stairs. My practitioner says it’s artery clogging, which needs medications or surgery. Are there any natural treatments?

A:It seems as though your practitioner is talking about peripheral artery disease, or peripheral vascular disease (PVD), which is often treatable and sometimes reversible. It affects more than 8 million people in the United States, especially those over the age 60 and those who smoke, have diabetes, have high blood pressure, and are sedentary. Establishing a firm diagnosis will likely include some combination of laboratory tests, functional tests, and imaging.

If PVD is confirmed, you should know that your risk of stroke and heart attack will also be high, since it develops through the same process. Depending upon the severity of your condition, you may be able to use lifestyle approaches to relieve symptoms and reverse or slow the progress of the hardening of the inner lining of your arteries and the development of “scarring” of the arterial walls (plaque). But while lifestyle improvement is absolutely essential, it may be insufficient.

When the lining cells function properly, they produce nitric oxide (NO). NO is very potent in widening the capacity of arteries and improving circulation. Systemic inflammation, psychological stress, weight gain, high bad cholesterol, high blood pressure, diabetes, and smoking all promote malfunction of this normal process. Consequently, stress management, weight loss, smoking cessation, and active physical exercise may all contribute to your improvement or even help you avoid surgery. Please follow the recommendation for your treating physician. But get a second opinion, as treatment may necessitate surgical or balloon interventions to reestablish healthy circulation and avoid unnecessary loss of a limb.

Once diagnosed, stop smoking or using any tobacco product that you may now be using. If you have diabetes, high blood pressure, high cholesterol, or high triglycerides, get it (or them) under control by becoming actively involved in your own care. Take special care of your feet, which are at risk of gangrene. If you have diabetes, get your HbA1C, an indicator of blood sugar control, to the recommended level, since levels greater than 8.0 are associated with blood vessel complications in the eyes, heart, brain, and kidneys, as well as the legs.

Get active. A progressively more intense, daily walking schedule may reduce calf pains and increase the distance you can walk without pain. Consult your doctor about your heart disease risk, and get a recommendation for a safe starting point. If you smoke, stop! If you’re overweight, try to get lean and maintain a healthy weight. Check your blood pressure regularly and, if high, get it to safe levels. Eat more healthfully, and choose foods that help normalize nitric oxide levels and response in cells lining the arteries. Foods high in flavonoids, such as cocoa, walnuts, berries, and grapes, have been shown to help to some degree.

Prayerfully consider your situation and all options, and by God’s grace, do your best.

Peter N. Landless, a board-certified nuclear cardiologist, is director of the General Conference Health Ministries Department. Zeno L. Charles-Marcel, a board-certified internist, is an associate director of Adventist Health Ministries at the General Conference.