Myths on Dieting and Heart Health

Podcast Transcript

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Leslie Cho, MD:

Hi, my name is Leslie Cho. I'm the section head for Preventive Cardiology here at Cleveland Clinic. With me today is our fantastic nutritionist, Julia Zumpano, who we refer to for patients with coronary artery disease, for high cholesterol and for high blood pressure. So Julia, I've been sending you patients for the last 20 years, even though you look like you're 12.

Julia Zumpano RDN, LD:

Thank you.

Leslie Cho, MD:

When I send patients to you with high cholesterol, what is the diet that you normally put them on?

Julia Zumpano RDN, LD:

Well, the gold standard is the Mediterranean diet, but I really take a full assessment of the patient's current intake and make slight adjustments to that, keeping the foundation of the Mediterranean diet in mind. But I would adjust the diet to reduce saturated fat, reduce things like red meat, processed fats such as butter and animal fats. Then really more importantly, we encourage foods. We encourage adding more plant-based foods, extra virgin olive oil, Omega-3 fatty acids. The foundational key, though, is the Mediterranean diet.

Leslie Cho, MD:

When we say Mediterranean diet, you and I have been talking about diet for the last 20 years. We think mostly plant, then comes fish, then comes chicken and turkey, and at the very bottom comes beef and pork, veal, shrimp and lobster. But when we tell our patients about adding, patients often think like they have to have protein and they're so afraid of losing protein. What do you tell them?

Julia Zumpano RDN, LD:

I try to build in protein through plant-based sources as well. I think it's important to remember that legumes, beans and lentils, provide great protein, nuts and seeds. Eggs are no longer demonized. We still can consume eggs safely in moderation, but egg whites are loaded in protein. Then, any seafood sources are very good sources of protein as well. Vegetables are sources of protein. So I think we can still meet our protein needs just with multiple different food groups, not just focusing on meats.

Leslie Cho, MD:

For a while, we've had this craze toward the keto diet. Everybody's on a keto diet. It does make people lose weight for sure.

Julia Zumpano RDN, LD:

Absolutely.

Leslie Cho, MD:

But it's not a great diet and we as cardiologists hate the keto diet, because it's so high in fat, especially the bad kind of fat. Of course, not just for heart, but for colorectal cancer risk, breast cancer risk, having high animal protein is really not good for you. So, what do you tell them when people want to be on the keto diet?

Julia Zumpano RDN, LD:

There is a form of the diet that we provide at the Cleveland Clinic. It's called protein-sparing modified fast. It is a ketogenic diet, but it's very lean. It uses lean animal fats and lean animal proteins, and then vegetables. I may suggest that for a short period of time, medically supervised, if there is a large amount of weight to be lost, specifically for a purpose like a surgery or some certain need. But generally, I think just major dietary adjustments can produce enough of a calorie deficit to create weight loss without needing to go into more extreme diet measures.

Leslie Cho, MD:

That's good advice. Also, I often send patients to you specifically for high blood pressure, where we really want to sort of lower sodium risk and the alcohol intake, and things like that. In terms of something easy people can do for sodium, what can they do to limit their sodium use?

Julia Zumpano RDN, LD:

Well, number one, if you're adding salt, we want to limit that. But studies have shown actually that added salt is the least common offender when it comes to a high salt diet. Packaged foods, I mean, we as a society are eating a tremendous amount of processed foods. Everything from the beginning to the end of our day. So, really looking at labels and understanding what's inside your food. If it's in a box, bag or can, really pay attention to what's in it and read the label to understand how much sodium might be in there.

Leslie Cho, MD:

You know, people ask me all the time, they want to go on a cleansing diet or a detox diet. I don't even know what that means as a cardiologist. They often talk about how they want to cleanse out their system and they think that somehow doing that will cleanse out the coronary arteries, which it does not. So, break it down for our audience. What is a detox diet?

Julia Zumpano RDN, LD:

There are several out there on the internet, but usually it's a liquid form. It may be fasting altogether or liquid. So, only consuming fruit juices or vegetable juices, or very lean protein and only vegetables. There's several different forms of very extreme diets, where you're limiting your intake to nothing or very little. The goal would be to kind of allow those organs to release any toxins and get them out of the body for a short period of time.

Now, one positive part of a cleanse is that people feel good. They cut out all the junk, so they actually feel good. Anyone's going to feel good if they cut out caffeine, processed foods and sugar. I mean, their gut feels lighter, their mind feels lighter, their body feels lighter. So, of course, there's that immediate response. But food can be our own form of detoxification, because food and especially plant foods have so many phytonutrients, antioxidants and polyphenols that do that for us, do those cleanses for us. If we just eat them in abundance on a regular basis, we will constantly be cleansing our body versus having to eat a bunch of junk and then fast to be able to cleanse it.

Leslie Cho, MD:

Yeah. The other thing that drives me crazy is people take a ton of supplements, a ton of supplements. We waste so much money on these supplements, thinking that the supplements are going to somehow help us and make us live longer. Unfortunately, there has never been a supplement that has shown that it increases or protects against heart disease. It definitely does not prevent heart disease. Actually, fish oil may cause atrial fibrillation. Vitamin C doesn't help. Vitamin E we actively discourage, because it can increase your risk of heart failure and stroke. It's really important, I think. I know people want to take something extra, because they want to prevent heart disease, and I totally admire that. But the thing is, we should not be wasting our money on things that are unproven.

Julia Zumpano RDN, LD:

Right, I agree. There are lists upon lists of supplements that are being marketed as heart healthy or for weight loss support, or blood pressure, whatever the case might be. But you have to look at what we can really do day by day. We can make a choice and prevent, just three times a day or as often as we eat, because all these foods, these nutrients are found in food. Vitamin E, vitamin C, fish oil, they're found in food. So just eat the food that has them, and then you won't risk going over your daily value of what your needs are or getting toxic exposure to artificial ingredients in these supplements. And they're poorly regulated.

Leslie Cho, MD:

Yeah, they're totally unregulated, not poorly regulated. It's unregulated. Things like red yeast rice, which is a lovastatin – it's actually a statin – is unregulated. People who are on that think it's totally safe, but they're not. And so, they really should be telling their doctors and getting their liver function test checked. Unfortunately, because they're not regulated, people think they're safe and they're really not very safe.

The other thing that I think is sort of a misconception, or there's a lot of rumor out there, is whether we should be restricting the time of eating. I do think that time eating does work. When you restrict the number of hours that you're allowed to eat, you're going to eat less calories, so of course you're going to lose weight. I don't think there is magic to the time eating, as much as there is the magic of limiting your calories, because you're limiting just the hours you can possibly eat in a day.

Julia Zumpano RDN, LD:

Right.

Leslie Cho, MD:

What do you think?

Julia Zumpano RDN, LD:

You got to think about it, where time restricted eating generally starts after you eat dinner, you stop eating and you eat maybe a little later for breakfast. Most snacking that occurs in the evening is not nutrient dense. It's a lot of junk food that's providing you excess amounts of sodium, fat, sugar, etcetera. So you're actually eliminating unnecessary snacking in that sense. You're just putting your window of eating within the daylight hours, which matches your circadian rhythm, which actually works really well from a metabolic standpoint as well. I don't like to look at it as skipping meals. I look to look at it as eating within a window and then not eating, giving your body rest from food for those non-eating windows, that fasting window. But skipping meals on the flip side can really lead to overeating.

Leslie Cho, MD:

That's right.

Julia Zumpano RDN, LD:

If you're skipping a meal and you find yourself hungry a couple of hours later, and grabbing whatever you can grab, you're going to grab something that's unhealthy, has packed in calories and fat, and it's going to actually inhibit your weight loss goals. Or you may over-consume in that next meal, because you're so hungry and mentally like, "Well, I didn't eat today. I can have as much as I want."

Leslie Cho, MD:

I mean, for me, I overeat when I don't get enough sleep. It turns out, it's this fascinating research that the same place in your brain that gets turned on when you're sleep-deprived is the same place that gets turned on when you're hungry. When people are sleep-deprived, they get hungry and they eat terribly. When I have worked very, very long hours or I'm up at night doing procedures, I notice the next day I am so hungry, I'm ravenous for food. Before we end, let's end by telling our audience, what do you eat? Because people ask me all the time what I eat. So, what do you eat?

Julia Zumpano RDN, LD:

So I do follow more of a Mediterranean style diet. I do like to eat within about an eight to 10 hour eating window. I like to eat a little bit of a later breakfast. 11 a.m. to 7:00 p.m. is my perfect window, if I can manage it day by day. It changes. I do like to include a mix between plant protein and animal protein. Mostly my lunch is plant-based, a lot of greens, a lot of green vegetables in there. Then, my evening includes a protein, alternating proteins, always including a fish at least once or twice a week. Some poultry, some red meat, a lot of vegetables, a lot of extra virgin olive oil, and a lot of nuts and healthy fats. Avocados. I find nuts and fats very filling, so I really try to incorporate a lot of healthy fats into my diet. But a good variety of foods, fruits mixed into there as well. I do try to focus on whole foods as much as possible.

Leslie Cho, MD:

That's good. I eat mostly plants. I don't eat red meat. I eat a lot of fish, because I'm Korean. I tend to be Mediterranean, Asian, with a lot of fish. I eat a lot of vegetables, and because I learned from you, I eat a lot of nuts and sort of things that make me feel full, but are also very high in fiber. That also makes you feel full. So a lot of vegetables, a lot of fruits. I don't drink alcohol. I hope I never have a day where I skip caffeine, but I tend to have a fair amount of caffeine. But what I don't have is, I don't have a lot of sugar. I know you don't have a lot of sugar either.

Julia Zumpano RDN, LD:

No, I do avoid sugar and caffeine, because of your guidelines. I no longer drink coffee. I do a green tea here and there, but I've noticed as I improve my sleep quality, I really don't need it. There are some days I just kind of like the flavor and the warmth of it, or may need a little pick me up. But I really do try to limit caffeine. I do avoid sugar, added sugar as much as possible. Natural sugars are great in fruit, and a little sugar here and there is okay, but not on a regular basis.

Leslie Cho, MD:

Do you eat bread?

Julia Zumpano RDN, LD:

I don't eat bread, but I do try to do things like potatoes and other grains. That's only because I limit some of the wheat products for personal reasons, digestive issues. But bread is fine, as long as it's whole grain. It's a phenomenal source of fiber. Grains are great sources of fiber. They have protein, they have a lot of phenomenal vitamins. I'm in the thought of don't restrict anything unless it's really necessary and your body's telling you you can't handle it.

Leslie Cho, MD:

I totally agree. I think the whole brainwashing about bread being evil has really gone overboard. I think that everything in moderation is okay, whole grain, as you taught us, in moderation. You have 50% of your plate is vegetables, 25% is protein, 25% is starch or carbohydrates. I think that's a very good sort of ratio to think about how we eat, and simple ways for us to keep in mind that ratio.

Julia Zumpano RDN, LD:

I absolutely agree. Yeah. Every food can fit. You can include some more than others, but we don't want to demonize any foods by any means.

Leslie Cho, MD:

Fantastic.

Julia Zumpano RDN, LD:

For more information on heart care, please visit clevelandclinic.org/heart. Again, that's clevelandclinic.org/heart. Thank you for listening to the Love Your Heart podcast.

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