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Food and Heart Disease

A few years ago, while attending the annual meeting of the American College of Lifestyle Medicine, I heard Dr. Koushik Reddy ask a question during one of the sessions. Listening to the back and forth between he and the speaker I remember thinking that here was a doctor who really cared about his patients.

Dr. Reddy is a cardiologist with the James A. Haley Veteran’s Hospital in Tampa, FL. He believes that if he can convince his patients to change their diet it will address and improve their risk factors for heart disease and potentially avoid further cardiac events and related procedures. He says he offers them “a carrot or a stent”.

I’ve been following Dr. Reddy on Facebook and he recently shared a paper he co-wrote along with several other preventive medicine practitioners and researchers. The title of the article is “Practical, Evidence-Based Approaches to Nutritional Modifications to Reduce Atherosclerotic Cardiovascular Disease; An American Society for Preventive Cardiology Clinical Practice Statement”. The article will appear in the June 2022 issue of the American Journal of Preventive Cardiology. I thought I would take advantage of my early access to share some of its key points.

As we all know, cardiovascular disease is the #1 cause of death in the United States. According to the paper, 90% of our heart disease risk stems from factors over which we have some control. These are: cholesterol levels, smoking, high blood pressure, diabetes, abdominal obesity, stress and stress responses, low consumption of fruits and vegetables, over consumption of alcohol, and lack of regular physical activity.

Many of these factors are related to nutrition and the authors go on to present data about various eating patterns that show evidence of having some effect on heart disease and its precursors. The five eating patterns discussed include the Mediterranean Diet, the DASH (Dietary Approaches to Stop Heart Disease) Diet, Vegetarian and Plant-based Diets, Low Carbohydrate and Keto Diets, and Fasting or Intermittent Fasting diets.

The Mediterranean, DASH, and Vegetarian/Plant-based diets all have multiple studies which show them to improve risk factors for cardiovascular disease. What they all have in common is the emphasis on the consumption of whole foods including fruits, vegetables, whole grains, and lean sources of protein. In all three diets processed meats, red meat, sugar, and sodium are restricted.

Intermittent fasting and time restricted eating may show some promise for weight loss and heart health, but the authors point out that there is nothing to show that they are any more effective than typical calorie-controlled diet plans and that there is no hard evidence to date for these diets related to cardiovascular health.

As for low carb and keto, much evidence points to the role of saturated fat in raising LDL or “bad” cholesterol and for that reason the authors specifically state “…we do not suggest encouraging patients to adopt a high saturated fat, animal-based ketogenic diet pattern for primary prevention of CVD”.

This well thought out article helps to clarify the role of a healthy diet in addressing the risk factors for cardiovascular disease. It’s good advice!

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