Keep It Simple: Advice For a Heart Healthy 2024

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!

Vikas Sunder, MD:

Thank you for tuning in. I'm Vikas Sunder, a cardiologist at Cleveland Clinic with an interest in preventive cardiology and joining me in this episode is my colleague Dr. Van Iterson, our director of Cardiac Rehab at Cleveland Clinic main campus. 2024 has arrived and in addition to sporting that new outfit and maybe even a new haircut, you're coming up with your new year's resolutions that you can stick to this year.

Heart disease remains the leading cause of death for women and men in the United States and worldwide. Why not make 2024 your most heart-healthy year yet? This may be the year you can be proactive and adopt an evidence-supported, heart-healthy dietary pattern as well as an exercise regimen and those topics will take center stage in this episode.

So even in the scientifically designed studies, there's tremendous variation in the specific foods and quantities consumed, so in this portion of the segment, we're going to emphasize commonalities and core principles, heart-healthy dietary patterns. It may be the pattern that's the most important. We also have to acknowledge that food insecurity and food access concerns exist in our world today with the high cost of groceries so we'll do our best to focus on principles and offers and suggestions, some of which may even save you some money.

In preventive cardiology in our practice at Cleveland Clinic, we like to talk about a Mediterranean dietary pattern, based on food patterns typical of Crete, Greece and southern Italy in the early 1960s. Meta-analysis have shown that Mediterranean pattern diets can help reduce cardiovascular risk factors including diabetes, high cholesterol, high blood pressure, and obesity.

So, one study took patients hospitalized with their first heart attack and put these patients on a Mediterranean pattern diet and at 44 months, it showed a 65 percent reduction in cardiac death and heart attack. So, core components of this Mediterranean pattern diet include a high amount of unsaturated fat like olive oil as the primary fat source as compared to saturated fat like butter, and a high intake of plant-based foods and including an abundance of fresh fruit and vegetables. You want to include whole grain foods and complex carbohydrates with high dietary fiber. More protein sources should be from legumes, for example, beans and peas, as well as nuts. Those simple carbohydrates including refined grains such as those ready-to-eat cereals, white bread, sugar-sweetened beverages should be avoided.

Another dietary pattern we often talk about in preventive cardiology is the DASH dietary pattern which again incorporates an abundance of fruits and vegetables, some low-fat and non-fat dairy and limited intake of sugar-sweetened beverages, foods and red meat. DASH diet also includes foods rich in potassium and magnesium. This diet reduced blood pressure in those with a higher range of normal blood pressure in the studies. So, as you can see, there are significant overlap in the core principles of these two heart-healthy dietary patterns.

Regarding fat consumption, for patients at higher cardiovascular risk, the American Heart Association actually recommends making saturated fat less than 6 percent of your total daily caloric intake. It sounds difficult, but you really want to limit your intake of cheeses, meats, butter, all of which contain saturated fat. And the AHA also recommends sodium reduction to less than 2,300 milligrams per day to control blood pressure. Regarding that sodium, processed meat, which can include meat that's smoked, cured, or salted or chemically preserved can be a significant contributor to your daily sodium intake.

So, the Mediterranean dietary pattern does include poultry, eggs, and fish, as well as seafood and yogurt, all consumed in moderate amounts and a low amount of red meat, which really should be consumed sparingly. I'll add that there is research done including by our own Dr. Stanley Hazen at Cleveland Clinic showing that a diet rich in red meat increases production of this compound called TMAO. When the gut bacteria digest the red meat, it generates this compound. And TMAO has actually been linked to the development of cardiovascular disease.

A short word on alcohol as well. If you do not drink alcohol, I would not start drinking alcohol. For men, you really want to limit your intake to one to two daily drinks or less, and for women, one daily drink or less and that is if you do drink.

Regarding a vegan diet, which is another commonly spoken about diet in preventive cardiology, there was an interesting study done that was published in the Journal of American Medical Association just at the end of November, that's November 2023, and they randomized 22 pairs of identical twins to either a vegan diet or an omnivorous diet which included meat. After eight weeks, those 22 participants who were randomized to the vegan diet experienced significant decreases in their LDL or the bad cholesterol levels, decreases in body weight as well as decreases in fasting insulin levels.

So, whenever we consume protein, we have to consider and be mindful of the vehicle which is being delivered to our bodies in. Animal-based proteins, even some of those vegan substitutes come in a vehicle containing varying amounts of saturated fat and other sources of added calories, which impact cardio metabolic health. So, plant-based sources in their unprocessed form, that is nuts, seeds and legumes should really be a mainstay for your protein intake.

So, when we think about weight management for heart health, our dietary pattern is important in determining our daily calorie consumption, but we have to be proactive about energy expenditure as well and take the time to develop exercise goals. So again, joining me is Dr. Van Iterson, our director of Cardiac Rehab here at Cleveland Clinic. Dr. Van Iterson. How should we approach developing exercise goals for the new year?

Erik Van Iterson, PhD, MS:

First off, thank you Dr. Sunder for sharing your in-depth expert views on what we should be keying in on when it comes to pragmatically preparing for success and putting into action our heart-healthy diet nutrition plan for 2024. Thanks for asking me to close the loop on this discussion by having me talk to our listeners about the all-important but often frustrating to stick with topic of heart-healthy exercise.

I always like to highlight at the beginning of the discussion on exercise training with any patient several fundamental core features to stick by and to make sure that individuals remember as they start to think about what do they want to accomplish with exercise? What do I do with exercise? And where can I get a plan that I can just follow? And so, in no order of particular importance, since the following key points are all interdependent on one another, I like to make sure that I emphasize to patients that I'm a strong advocate for "keep it simple" because exercise does not need to be complicated to be effective.

And that from first starting out doing more in a fixed period of time doesn't typically translate to better and faster results, and that the body is very slow to adapt to training. And that forcing the issue with exercise, doing it hard and fast when first beginning typically won't lead to faster results nor those results that will typically last.

Next, I typically like to identify for individuals or ask the individuals to identify for me is: why do you want to start exercising? And have them be able to verbally or write down that reason since this is important for pragmatic goal setting for the present person and not the version of that person who may have played four sports in high school and/or college and had been highly competitive for many years, but that if the individual is exercising for heart health in particular, we always want to make sure that it isn't sports-specific training per se, but that individuals identified that something just as basic as your cardio aerobic exercise on a treadmill, stationary cycle, elliptical, one of those types of modalities are what they want to be focusing on. That isn't to say that strength or weight training aren't good for you, but that they just aren't as strongly correlated with benefiting heart health when you compare it with cardio, aerobic-based exercise training.

I also like to emphasize for our individuals that the body is very quick to lose any type of training adaptation, whether it was a year ago or 10 years ago, that a large proportion of training adaptations are actually lost within a matter of several months, once any previously rigorous routine of exercise training has stopped to be consistent. And so when individuals are able to remember their goals and identify the goals, then they also have to take into account their ability to execute in the real world, busy life when they're at work, working long hours, always rushing around, running errands, that this is always going to be present and that we still have to make space and time for exercise since those other factors aren't going to change.

And then finally, I'd like to highlight for individuals is that we should aim for consistency above all else when it comes to that exercise training. And that I like to emphasize this word "consistency" because this usually serves as a guide to shape decisions we can control about how the exercise itself is executed so that the approach minimizes the chances of causing major bodily injuries and perhaps equally important, it doesn't have to be an individual experience so individuals can feel confident and physically well enough to participate in exercise training today, tomorrow, the next day, and so on.

Vikas Sunder, MD:

Great. Thank you Dr. Van Iterson for your insight and input. We spend all this time devising this exercise regimen that works for us and you mentioned this real-world busy life. You and I both know the gym's always most crowded in January and then as time goes on, it tends to empty out a little bit. What are some tips that we can utilize to stick with our exercise plans?

Erik Van Iterson, PhD, MS:

Well, excellent question. I would like to highlight that. I think the most important honestly is making sure that individuals' remember the goal of why you started exercising at this point in time, even having tried this thing called exercise many times in the past, and that it's important to remember that goal because this should always shape and drive how the exercise looks, how you execute it and how you feel about it, and ultimately how it benefits your heart health. And so, if individuals are able to remember that goal, then they're able to shape what that plan or program looks like. That also helps individuals identify what are the things about exercise that they're able to control to make the experience a more positive one, something they can stick with and something they identify as being successful and prevent some of those unwanted things that they might experience where it might just serve as a turn off and something that they put on the back burner like they may have done numerous times before.

And so, what we don't want to do is have today's exercise negatively impact tomorrow's exercise and the next day and the next day, because unfortunately, that inconsistent type of pattern doesn't help us achieve our heart-healthy goals.

Announcer:

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