Are "Low" Diets Good for Your Heart?

Podcast Transcript

Announcer:

Welcome to Love Your Heart, brought to you by Cleveland Clinic's, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute. These podcasts will help you learn more about your heart, thoracic and vascular systems, ways to stay healthy, and information about diseases and treatment options. Enjoy.

Julia Zumpano, RD:

Hello, my name is Julia Zumpano. I'm a registered dietician with the Department of Preventive Cardiology at the Cleveland Clinic.

Dennis Bruemmer, MD, PhD:

And hello, my name is Dennis Bruemmer. I'm a staff cardiologist and the Director of Cardio Metabolic Health at Cleveland Clinic. And today we'll be discussing diet and the heart. And we'll be discussing a recent survey that had been done by Cleveland Clinic about some barriers about eating healthy.

Julia Zumpano, RD:

The survey found that 37 percent of Americans feel that a low-fat diet is one of the most heart health diets to follow. We do know that fat is very important to restrict when it comes to managing and preventing heart disease. Dr. Bruemmer, can you provide some insight as to why fat is not something we should necessarily intake in large amounts?

Dennis Bruemmer, MD, PhD:

Yes, absolutely. When we discuss diet in general, I think it's important to consider that this is your fuel. This is what keeps us going, and this is what should provide health as long as we get all the healthy nutrients that we need. Now conversely, if the diet is not so healthy, then this is associated with a number of cardiovascular risk factors. In fact, with all cardiovascular risk factors. So an unhealthy diet is associated with weight problems, with overweight and obesity, can be associated with increase in blood pressure and can be associated with increase in cholesterol and of course with pre-diabetes and diabetes. So these are the main risk factors that may ultimately lead to cardiovascular disease.

So I think it is very important to discuss diets, and I think we've learned from the survey that there are some misconceptions. And I think in general, we try to avoid a fat enriched diet because it increases the cholesterol and the cholesterol may ultimately lead to coronary artery disease, so blockages in the heart. And that may cause a heart attack, for example. Now conversely, some patients or some subjects in the people in the survey felt, about a third felt that a low carb diet would be important. So when you see patients as a nutritionist, what would you be talking to them about the low carb, low fat diets? What should patients actually be doing?

Julia Zumpano, RD:

Sure. Well, that's a great question. So when it comes to fat, we do want to be mindful of what kind of fat we're taking in. So not all fat is bad. We know that through studies on the Mediterranean diet that use large amounts of olive oil and nuts. So we know that certain plant fats are okay to have in moderation, but the fats that we really want to restrict are saturated fats and trans fats. So saturated fats are mainly found in animal products, so fatty meats and full fat dairy products, cheeses and creamy or buttery sauces. And then of course it's also found in other vegetable oils and margarines and packaged foods and dessert foods. So we really do want to avoid and limit as much saturated fat and trans fat as possible. But the fats that we can consume, again, are more plant-based, like the extra virgin olive oil, nuts and seeds, avocados and olives.

So those are the fats we do actually encourage. The fats found in fish such as omega-3 fatty acid, those can actually be helpful to the heart and can help lower triglycerides, can help provide favorable values to your blood pressure and your good levels of cholesterol. So we don't want to leave those out. It's very important to follow a low saturated and trans fat diet, but not necessarily avoiding all fats. So I think that's an important distinction to make and a common misconception. When it comes to carbs, I do feel that there are a good majority of people who would respond to a low carb diet very well when it comes to weight loss, lowering blood triglycerides, lowering blood sugars. So I think it's important to limit those refined carbohydrates. Those are those white products. So white bread, white pasta, white rice, bakery items, bread items, crackers, snack foods, chips, pretzels, things of those sort that really have no nutritional value anyhow.

And when you are consuming, or what carbs are the best to consume would be in the form of vegetables and fruits, beans and legumes. So really we want to consume whole foods as our sources of carbohydrates. We can consume grains, of course, whole grains such as oats or quinoa, barley. Again, some of those may even need to be restricted for certain patient populations who are trying to lose weight or lower their blood sugars. So it's very important to meet with a dietician, meet with a healthcare provider to help you navigate some of these macronutrients and how much your body actually needs specifically to meet your personal health and weight goals.

Dennis Bruemmer, MD, PhD:

Excellent. So when we talk to patients about how to live healthy, and how to manage their diet, and how to lose weight, we typically encourage a Mediterranean diet. I tell patients in my simplistic way that, you can have some vegetable, you have some tomato, and instead of using the cheddar cheese, you can use the mozzarella, and all of a sudden you become an Italian. So, you can switch and you have also at the same time reduced your fat content in cheese by 70 percent. So maybe what are some of the key tips that you give patients when they are encouraged to consider Mediterranean diet? Which is the only real diet that has been studied in a prospective way to support a heart healthy diet and reduce heart attack and strokes.

Julia Zumpano, RD:

Sure. So Mediterranean diet is more of a style of eating. It's a style that is associated with countries around the Mediterranean and they've shown that reduced cardiovascular risk factors are prevalent in those areas. So we looked at the foods that they eat and predominantly fresh foods. So a lot of whole foods, minimally processed foods, that's something very important to keep in mind. A lot of plant-based foods, so fruits and vegetables, grains, oils, nuts, seeds. And then the primary source of protein is fish. Now in the area that we live in, fish is not necessarily as frequently available or as fresh as maybe areas around the Mediterranean. So certain other sources of protein are also encouraged, such as skinless poultry, egg whites, low fat dairy like Greek yogurt or cottage cheese and some low fat cheeses are also included. We do encourage getting your protein from legumes or beans, so trying to incorporate those into the diet on a regular basis. So really it is a wide variety of foods that's included. It's just a matter of really minimizing the processed foods and the very fatty foods in the diet.

Dennis Bruemmer, MD, PhD:

So very fatty foods, that would include the red meat for example, which is high in saturated fat. And that would be, in the Mediterranean diet, the red meat would really be limited to once a month probably. So rare, on rare occasions. Which I think we eat a lot of meat in this country in general as a population. So this was clearly a shift in thinking.

Julia Zumpano, RD:

Agreed. And I do believe that we eat a lot of cheese. So your example was perfect, just knowing that a lot of the cheeses we eat are very high in fat and choosing more light or mild cheeses and having them be a very small portion of the meal, not necessarily the foundation of the meal. So mozzarella or feta, ricotta, goat cheeses, some of those very mild, lighter cheeses that tend to also be lower in sodium. So it's helping in two ways. It's not only helping reduce fat, but it's also helping reduce salt if blood pressure is something we are concerned with.

Dennis Bruemmer, MD, PhD:

Yes. And don't forget the olive oil and the balsamic on the mozzarella with the tomatoes.

Julia Zumpano, RD:

And the basil.

Dennis Bruemmer, MD, PhD:

And the basil. That's correct.

Julia Zumpano, RD:

So surprisingly, the survey showed that only 18 percent of Americans thought that the Mediterranean diet was the most heart healthy. And we know that it really truly is the greatest researched and the one that we know can prove positive benefits when it comes to heart health. So the Mediterranean style diet is definitely the way to go.

Dennis Bruemmer, MD, PhD:

So when you have patients, people coming into your office and they would like to say, "Well my goal is weight loss and I want to change my diet." So we're now shifting a little bit more into the caloric content of a diet and talk about portion size control. Which all of course affects other risk factors as well, like I said earlier. Particularly weight related risk factors like diabetes. So what do you convey to patients? What should they be doing if they want to lose weight?

Julia Zumpano, RD:

Great question. So I do think weight loss plans are very individualized. I do give individualized weight loss plans. But in general, it's very similar to what we're trying to encourage from a Mediterranean diet standpoint, is really minimizing processed foods. So processed foods we know can lead to excess calories, they can increase your appetite, they can increase your intake of those foods because they can tend to be very addictive and people crave them often. We really want to take an extra look at sugar because we know sugar has no nutritional value. So how much sugars are you eating in your diet? Not just like the good old white table sugar that's maybe in your cupboard, but really hidden sources of sugar that are found in almost all the foods we eat. So they're found in ketchups and salad dressings and tomato sauces and granola bars and cereals and pancake mixes and breads and biscuits and crackers and meats. Even deli meats have sugar in them.

So we really want to be cautious on how much sugar we're eating because that can consume a tremendous amount of extra calories that we're not accounting for. And it also increases our blood sugars and our insulin level. Once we know we have insulin levels that rise, we struggle losing weight, so that can inhibit our weight loss. So it's very important to look at what ingredients are in the actual food you're eating. I think calories are a nice stepping stone. They're a nice gauge on understanding how much your body needs, but I think where the calories are coming from is far more important than the actual caloric intake that you're taking in.

And back to what we were talking about before about fats and carbs, those are macronutrients. So our macronutrients are the three main nutrients that most of our calories and nutrition comes from, and those are carbohydrates, proteins, and fats. So we need all three of those. Some people will need a little bit more or less of certain macronutrients, and that's where it's really important to be able to get guidance from a health professional on what is the best plan for you as an individualized plan.

Dennis Bruemmer, MD, PhD:

Yes, exactly. And that is why any extreme diet, zero fat or zero carb is typically not what we would recommend. It is also interesting to note when we talk to patients about weight management strategies, the first response we not infrequently get, "Yes, I have to exercise more." And in the respondents of the survey, over 70 percent of the people were saying that exercise is the key step to losing weight. Now again, you mentioned all the nutrients that we require, and I think when we talk to patients specifically about weight loss strategy, it's not the exercise. You have to exercise a whole lot to lose weight.

So really in order to lose weight, it's portion control, it's caloric deficit, so you have to get into a caloric deficit. So patients really need to change and reduce the amounts consumed. Being very small portion size, for example. I tend to tell patients couple of berries with one little spoon of yogurt, couple of granola on top for breakfast, maybe a side salad for lunch and maybe some broccoli and half a piece of chicken per dinner and leave the snacking in between. So it is really diet that matters for weight loss. And the exercise has a more prominent role later on to maintain what weight had been lost and is of course, overall heart healthy 30 minutes most days of activity. But really to lose weight, you have to eat actually less.

Julia Zumpano, RD:

I would completely agree. I think exercise is extremely important and plays such an important role when it comes to, like you said, weight maintenance, weight loss maintenance. And as well as getting you jump started on a diet plan, getting those calories burned, I think it is also important. But really what we eat creates much more of an importance when it comes to weight loss and the amount of calories we're taking in versus what we can actually burn to create that significant deficit to get the weight to come down.

Dennis Bruemmer, MD, PhD:

So when we discuss a heart healthy diet and you talk to your patients, what is the first small step that you tell patients, this is how you start? Because often it's a lot of information. Patients come see the doctor, they may have been in the hospital, they may have this diagnosis, that diagnosis, to fill their medications. So now they come to see you as a nutritionist and they say, "Okay, I want to make a change. Write it down, give me a guideline. What is step one, what is step two that I have to do to change to a healthy lifestyle diet?"

Julia Zumpano, RD:

So I'd say definitely step number one would be eating more vegetables. There's a constant theme with all the patients that I see. Most, majority of people don't eat enough vegetables, so really you should be filling half of your plate with vegetables. So a variety of different vegetables, different colors, seasonal vegetables. So whatever you can do to really fill up on vegetables at lunch and dinner will naturally help you eat less of those carbohydrates, the fatty meats. They're very low in calories, high in fiber, give you some protein. So really, I think that would be the number one first step, is if someone can get 50 percent of their meal be vegetables at lunch and dinner. That's really the first step. The second would be looking at, as we talked about before, any unnecessary calories in the form of added sugar or added fats in processed foods.

Dennis Bruemmer, MD, PhD:

Yes, that's very consistent with what we do on the physician side. My first recommendation is keep it very simple, avoid all fast food. So that already is a huge portion. And then if you go home, prepare your meals, fruits and vegetables should be number one.

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