View full size
David Badders, The Oregonian
Guide to heart health: Oregon cardiologists dish about diet, supplements, surgery
We’ve heard too many loud claims about heart healthy super foods, miracle diets and medical “breakthroughs.” If there’s evidence to back them up, it’s often overstated. And the next week, we’re given contradictory advice. Eating eggs clog your arteries. Eating eggs is just fine. Anti-oxidant vitamins fight inflammation. Anti-oxidants might shorten your life. We talked to cardiologists and preventive health experts to cut through the noise about preventing and treating heart disease, still the leading cause of death in the U.S.
Our experts:
Dr. Miles Hassell, medical director for integrative medicine, Providence Health Services
Dr. Sandeep Garg, cardiologist with Pacific Heart Associates practicing at Legacy Meridian Park Medical Center
Dr. Michael D. Shapiro, director of preventive cardiology, assistant professor of medicine and radiology, Oregon Health Science University
Q: Every food maker seems to claim their products are heart healthy. What should you really eat to prevent or minimize heart disease?
Dr. Miles Hassell: If we go by evidence, studies where we see an actual measure of outcomes — fewer heart attacks, fewer strokes, lower mortality — you are forced to conclude that the foods that are healthy are vegetables, nuts, fish, probably whole grains and beans, all used in the least-processed form.
It really looks like extra virgin olive oil is probably the best oil. We encourage that; we don’t tell people not to use butter. Milk, eggs, butter, meats — all the traditional foods people like can be part of a healthy diet. People who drink a small amount of alcohol are less likely to die of heart disease. It’s not hard to adopt a heart-healthy diet, but it forces people to cook and it does require avoiding things that are highly processed.
It’s under-appreciated that there is strong evidence to show that refined carbohydrates — sugary drinks, white flour and white rice — contribute to heart disease more than saturated fat. Diet drinks appear to be just as bad as sugary soft drinks in their association with heart disease and diabetes.
Dr. Sandeep Garg: Be suspicious of any food that comes in a convenient package. Be suspicious of any foods advertised on TV. I firmly believe that best way to prevent heart disease is a plant-based diet. Minimize animal fats and focus on eating more fruits, vegetables, legumes and whole grain foods, and nothing that is packaged or processed. Remember that there is no shortcut to a healthy lifestyle. Adopt these habits, turn your back on processed foods and never look back, never go back there again. For me it is not a diet, but a lifestyle choice.
Q: Are there any supplements worth taking to protect your heart?
Garg: I don’t think any supplement is going to make any difference for the general population. If you eat fruits and vegetables and healthy foods to begin with, you don’t need tablets. In specific populations, patients with high triglycerides for example, fish oil may be appropriate. For secondary prevention in people who’ve had a heart attack or diabetes, history of stroke, peripheral vascular disease, the evidence for a baby aspirin a day is excellent. For those who are at very high risk of having a first heart attack, there is some role for a baby aspirin a day.
Hassell: The supplements that are probably worth doing are fish oil and vitamin D. If you don’t eat a lot of oily fish, it may have a benefit. It may reduce blood pressure a tiny bit. Most studies seem to show a reduction in total mortality. In people who are at low risk of heart disease, fish oil still seems to be protective.
For many other supplements, evidence is accumulating that they are going to do more harm than good. Vitamin E may increase mortality rates. Other anti-oxidant supplements appear to be harmful. Even folic acid appears to have problems.
Almost everybody who’s had a heart attack deserves to be on aspirin; there is very solid evidence for secondary prevention. For primary prevention the evidence is really dubious. Daily aspirin increases the risk of internal bleeding to a degree that raises questions about any net benefit.
Q: How safe is it to do aerobics and strength training if you have heart disease or heart failure?
Dr. Michael D. Shapiro: In our cardiac rehabilitation programs, we find it to be incredibly safe. All of the science data support that. People with heart disease who do not exercise are taking a greater risk. Even outside of cardiac rehab, exercising is incredibly safe.
The benefits that patients glean from performing exercise are more than just effective for the heart. Exercise improves quality of life, improves mood, gives you more energy. Studies show that the reductions in morbidity and mortality from exercise are as good or maybe even better than medical therapy alone. It’s impressive.
That said, if you are having active chest pain, if you become really winded when you exert yourself, if you are having heart rhythm problems, that could indicate a problem. You should not exercise in those situations; you should consult with your doctor.
Hassell: The evidence for benefit is huge. In a German study published in 2004, a group of patients all had single-vessel coronary artery disease and chest pain when they exercised. Half got a stent and the other half got sent home with a stationary bicycle to exercise on every day. After one year, the exercisers experienced 60 percent fewer cardiac events.
And it’s not just heart disease. Stroke, cancer, disabling joint disease, osteoporosis — all are strikingly diminished when people exercise regularly. Exercise elevates mood and energy. It’s kind of unbelievable how much good exercise can do. We tell people it should be one of their highest priorities every day, above their work and right below God and family.
But if you’ve got a heart problem, start in a rehab program to build up your confidence. If you are feeling frail, start in tiny doses. You can do just 5 minutes and do it many times a day.
Q: Is bypass surgery obsolete now that stents work so well?
Garg: A lot of patients who were getting bypass surgery in the past are getting stents, but I don’t think surgery will ever become obsolete. There are some blockages where we can’t put in stents. And in some patients who have stents, arteries become blocked again and they need to have bypass surgery. Surgery is evolving and becoming less invasive. Minimally invasive techniques allow surgeons to operate on a beating heart. Hybrid approaches involve stenting one artery and minimally invasive bypass on another artery. For the patient needing to choose a treatment, it comes down to individual factors. Some patients may not be strong enough to undergo surgery. For others, you really don’t want to put in stents because of anatomical issues.
Shapiro: There are pros and cons to either approach. When you’re having a heart attack, generally speaking, stenting is the way to go. You want to get the arteries open as soon as possible and stenting is faster than surgery. It’s also safer when somebody is having a heart attack.
But in some other situations, you are better off having bypass surgery. This is particularly true if you have a blockage in your left main artery. If you have triple vessel blockages, especially if there is heart damage or diabetes, bypass could be better. Surgery will be a more complete procedure then stenting.
We know that with people who get stents the procedure is a much easier process. You go to the hospital, get a stent, leave the next day with really no serious disability. You are back to your normal self in a few days. But over the long term, people who get stents are likely going to need repeat procedures.
With surgery there is the upfront risk, and a much more difficult recovery. They crack your chest open and it’s painful. It takes patients months to really be back to their baseline. But the good news is, if all goes well with surgery, once you’ve recovered, you are not as likely to need repeat procedures. It’s a more complete therapy.
– Joe Rojas-Burke
Diet and Weight loss with Bill & Sheila
_____________________________________________________________________
If you require a high quality printout of this article, just click on the printer symbol next to ’Share and enjoy’, and we will do the rest. This site is hosted by (click on the graphic for more information)
Return from heart to Home Page
If you want to increase your site popularity and gain thousands of visitors – check out these sites THEY ARE FREE. Spanishchef more than doubled its ‘New Visitors’ last month simply by signing up to these sites:
Follow spanishchef.net on TWITTER
