On October 5, 2016, Medscape published an interview with a leading Cardiologist from the UK, named Dr. Aseem Malhotra. The topic was how best to prevent heart attacks, stroke and vascular disease, leading causes of death and the compromised quality of life we face in modern society. Dr. Malhotra says he has spent many years reviewing the data on cardiovascular disease and notes that dietary changes can rapidly reduce cardiovascular disease risk.
On October 5, 2016, Medscape published an interview with a leading Cardiologist from the UK, named Dr. Aseem Malhotra. The topic was how best to prevent heart attacks, stroke and vascular disease, leading causes of death and the compromised quality of life we face in modern society. Dr. Malhotra says he has spent many years reviewing the data on cardiovascular disease and notes that dietary changes can rapidly reduce cardiovascular disease risk. He further states that clinical studies show that after a heart attack, prudent dietary changes are more effective than cholesterol-lowering statin drugs in preventing future death from heart attack and related vascular events. It’s not that cholesterol-lowering drugs aren’t important, it’s that they are over-prescribed, and very often, little attention is given to diet and lifestyle – and that is a huge mistake.
With respect to diet, the original work on Diet and Heart Disease was done by Dr. Ancel Keys. Dr. Keys visited Pioppi, Italy, every 6 months, for about 30 years, looking at why their residence had such extraordinary health and longevity, with a documented, very low rate of heart disease and stroke. Their average lifespan dating back to the 1950’s was around 90 years old.
Dr. Ancel Keys was the first to note that high serum cholesterol was a major risk factor for heart disease, as he published in the famous 7 Countries Study. He also noted that the original Mediterranean diet seem to afford the people from Pioppi, Italy, protection against heart disease and other degenerative diseases, including cancer. However, as Dr. Malhotra indicates, the Mediterranean diet of today is quite different from the Mediterranean diet of 50 – 70 years ago.
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So, Dr. Malhotra is a big fan of the original Mediterranean diet, which features only a small serving of pasta as meal starter, not as a main course. The foods that should comprise the bulk of the diet are green vegetables, various cruciferous vegetables (broccoli, cauliflower, cabbage, etc.) tomatoes, and other non-starchy carbohydrates that are loaded with protective nutrients.
Other features of the diet include nuts, beans, and peas, extra virgin olive oil and fatty fish. These foods not only help to keep cholesterol down, but are also proven to reduce blood vessel inflammation. He makes the point that it is inflammation in the blood vessel wall that leads to plaque rupture and platelet clumping, that are the final events triggering a heart attack, or ischemic stroke.
A major function of diet is to reduce blood vessel inflammation, and the main way to do that is to reduce intake of refined sugars and too many starchy carbohydrates, such as bread, pasta and potatoes. As Dr. Malhotra points out, right now about 40% of the U.S. population are pre-diabetics, which is largely due to overeating refined and starchy carbohydrates and too much bad fat, and lack of physical activity.
He also notes that the drugs that control blood sugar do not actually reduce risk of heart attack or stroke, or death from all causes (heart attacks are the number one cause of death in diabetics). The one exception is the possibly the drug empagliflozin, which was recently shown to lower cardiovascular mortality in type 2 diabetics. These findings need to be confirmed in future clinical trials.
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The other way to reduce inflammation is by consuming the anti-inflammatory foods mentioned above, and by not smoking. The people in Pioppi also spend more time outside walking around, so they get more physical activity and have higher vitamin D blood levels from the sunshine exposure. Both of these also factor into their impressive longevity and disease-free health statistics. Sitting is the new smoking. If you have a desk job, he recommends getting up every 45 minutes and walking around, even if you already exercise in the gym or on home exercise equipment. The idea is to try to move throughout the day.
The people of Pioppi are also living a lower stress environment. He notes that it’s very difficult to specifically measure stress, but we know it’s a big problem. People who have chronic stress from a young age, where there’s a childhood trauma, have an average life expectancy that’s 20 years less than other people. So anything that de-stresses you will likely reduce your risk of heart disease (yoga, deep breathing, exercise, meditation, etc.)
When speaking to heart disease patients, Dr. Malhotra states that he explains the benefits of the drugs, “but what’s really important is that you make the recommended lifestyle changes”
I have provided a link to the article in Medscape in the text below. I hope you’ll take this advice to heart and keep moving towards a healthier heart lifestyle program.
Eat Smart, Live Well, Look Great.
Dr. James Meschino