Transcription:
I’m Overweight and Have High Cholesterol. What Can I Do to Feel Better?

Melanie: Welcome to Bryan Health podcast. I'm Melanie Cole and I invite you to listen as we discuss weight gain and your heart. Joining me is Dr. Joseph Kummer. He's a cardiologist with Bryan Health.

Dr. Kummer, it's a pleasure to have you join us again today and what a great topic this is. So first before we get into what's going on now in the country and the obesity epidemic that we're seeing in both our children and adults, what happens to your heart when you gain weight?

Dr. Kummer: Well, it's a good question. And of course, we're all kind of in the middle of our COVID-19, right? We've all put on our own little extra weight here and there too. We've known for a long time that obviously weight gain is not good for the heart. And the question always comes up, exactly what is that correlation and what is it about obesity that's so tough on the heart? We've known for a long time that people that are obese have higher risk of heart attacks and along with that strokes and so forth too.

But, unfortunately, there's not like one exact thing that says, "Oh, there's the link." You know, "That's what it is. It's this exact enzyme. It's this exact lifestyle." But really obesity is more of a syndrome. And I tell patients to look at their body like a car. There's many factors. You have your gasoline, your transmission fluid, your brakes, your wheels, and everything's got to fit together. Everything's going to work in sync if your car is going to move.

And the body is very similar. You have your blood, you have your mental function, you have your kidneys, your lungs, your heart, and everything does tie in and obesity interferes with a lot of that. Basically, obesity will put your body in a state where you're on edge and there's more inflammation. We can check inflammatory markers and with obesity, a lot of times that goes up, but everything else kind of factors in. Your cholesterol is a factor with it. Your blood pressure's a factor. A lot of times I think we tend to categorize things just a little bit more. We don't look at the entire car going down the street. We look at the body as well. What's your blood pressure doing? And what's your blood sugar doing? And what is your cholesterol doing and your different variations of it?

But really when you're overweight, when you have obesity and then everything gets affected. So your blood pressure tends to get higher, your cholesterol numbers tend to get off and your blood sugars get higher, that all factors into the measurable things, but then there's also the general sense of wellbeing and that's often affected by all of these things too. If you're overweight, you're going to feel more tired and fatigued, right? You're not going to able to walk as far, or you're going to get more tired when you do so. Well, that often factors into, "Well, I'm going to spend a lot more time kind of sitting on a couch or not be as active, because I don't feel as good when I'm doing it." Well, that's not very good for you psychologically or mentally either. You can have more depression, more anxiety. You can be more tired and sleepy, not have the desire to get up and go to work. So you have to look at the body as an entire whole. And obesity really does factor into this in many ways.

A great example, I had a patient just an hour ago who-- we saw her earlier in the year and she was having chest pain and she had a lot of trouble breathing. And we looked at her heart arteries and they were fine. Went to a lung doctor, lungs checked out good. And she was just going from one doctor to another one saying, you know, "What's wrong? Why can't I breathe or anything? And why do I feel this bad?"

When I saw her today and she's lost 35 pounds and she feels so much better. Everything about her, she's much more alert. She thinks she can think more clearly. She's doing more activities. She enjoys life. She gets along better with her family members. She was on two different blood pressure medications that she's no longer taking. Her cholesterol numbers are markedly better. We cut back on her cholesterol medications and fat and her numbers still look better. So you can see where being overweight really just puts a damper on everything. It's more just a weight on the body psychologically and physically. This whole sense of inflammation throughout the whole body that just slows things down. It's almost like the oil is thicker in the whole car and so things just don't move quite as much.

Melanie: What an excellent description. I love your analogies and your stories, dr. Kummer. As we know, and you and I are both in this field, exercise is medicine, right? It is. And as you talk about those things that were reversed by a patient losing that weight, blood pressure, cholesterol, all of these things, can the other things that may have happened as a result of the obesity, maybe plaques in the arteries, maybe there's orthopedic things that go on, but as far as our heart, can that be reversed by losing weight or by exercise? Or then do we start from the place where you are and just try and make inroads that way?

Dr. Kummer: Yeah, that's a great question. We always think about like blocked arteries in the heart, which is of course cholesterol buildup. And there's a lot of that inflammation I talked about that factors in that and cholesterol numbers and all that. But then exercise is very good for all the above. It does lower the blood pressure. It lowers your cholesterol. Obviously, you're using up more calories, so you're going to be able to lose weight.

Now, it's been hard to demonstrate that there has been a true significant regression of, say, plaque buildup. If somebody has an 80% blockage in an artery in their heart, if they exercise, we haven't demonstrated that it can reliably make that-- it almost never will make the plaque or cholesterol buildup go away entirely. Now, maybe it'll make it go down a little bit. Maybe it will be a little bit. We don't know that entirely for sure. But what we do know is that a heart attack is when a plaque in the heart artery ruptures, and then a blood clot forms all of a sudden, then it completely blocks the artery.

We do know that exercise and treating cholesterol and treating blood pressure help to stabilize what's there. So it may not be able to get rid of what's there, but it does make it more stable. So it won't be as likely to rupture. It won't be as likely to form a blood clot and cause heart attack. So that by itself is going to help a tremendous amount as far as keeping them from having a heart attack. But if the artery gets worse and tighter, then you're going to have more symptoms of decreased blood supply, like pain in the chest. And keeping all those other things under control also keep it from progressing.

So even if it doesn't get rid of what's there, it stabilizes what's there and it keeps it from getting worse. And that by itself is very good. I mean, that will make enough of a difference. Do we have to get rid of what's there? Well, not really, to be honest with you, unless you're having some trouble with it. The most important thing is going forward. Exercise is an excellent way of really trying to help every single one of those different risk factors that we talked about.

Melanie: Well, then if you had to choose, and you're a cardiologist, Dr. Kummer, and I imagine quite an excellent one, if your patients come to you and say, "Okay, I don't know that I can concentrate on both exercise and diet." If you had to choose, and you wanted someone to really concentrate on something to help them with their obesity or help them even to lose 20 or 30 pounds, which one would you choose? How would you tell them to get started? If it's both, how can they do that? Or if you had to choose, which one?

Dr Kummer: Yeah, that's a tough call, because I think it has to be a little bit individualized. But I'll be a good politician here and not give an answer, but give a lot of words. So basically, it depends upon the individual. If they weigh 500 pounds, I'm going to work on trying to get them to lose weight. If somebody is a pretty good normal weight, then I would say, "Let's focus on exercise."

Unfortunately, it's difficult because we can't really quantitate which one is more important. They're both very important. But I really think that each individual would have something that they would need to work on a little bit more. And you look at their diet too. You have to factor in are they eating healthy and talk to them about that. But as far as what's truly more important for just the average person, that's kind of hard to say, but I would almost think that losing weight if you're overweight is probably one of the better things you could do.

But we have a lot of data to support value of exercise by itself, but the good thing to think about is that they go hand in hand. And if you exercise more, your body's much more conditioned. It's just in better shape and your blood sugars are better too. And so you don't have quite the craving and your body just is in a better milieu, a better state where you're not going to have as much of a craving to go out and eat.

And when you're burning calories and you have your appetite under better control, your body's in normal healthy cycle, plus you're not at home walking back and forth to refrigerator. So you tend to be in a situation where often people will lose weight even if they're not overly intentionally doing it by exercise, just because the body's happier, because it's more content, because you're burning more calories. So if you exercise, you're often going to lose weight that you should be losing anyway. So I would say for most people, exercise is very important, but if you are significantly overweight, probably going to get a lot more bang for your buck by really just focusing on the weight itself.

Melanie: Well, let's do that for just a minute here, Dr. Kummer, as we focus on the weight itself. When you look at diet and when your patients ask you, you know, know how to cook kale or any of these things I hear about that are supposed to be anti-inflammatory and help us to really lose weight and fill ourselves up, what's your best diet advice? What do you tell people? Especially sometimes people say, "Well, making a salad is a pain" or, you know, "I'm not satisfied with that." What do you tell them? Your best advice about eating healthy so that they can hopefully get the weight off and then exercise follows and if they work hand in hand as you said,

Dr. Kummer: We recommend the Mediterranean diet. You probably heard a fair amount about that, but the Mediterranean diet is not a weight loss diet, but it's a healthy eating diet. And it involves a lot of fish and lot of chicken and the nuts, fruits, vegetables. One of the biggest benefits of it is it's a very palatable diet. People like the Mediterranean diet. It actually can taste good. So usually when you think about a diet like, "Oh my goodness. I have to go and suffer, because I can't have this or I can't have that." But the Mediterranean diet, you can make a lot of good healthy things that taste good. And to be honest with you, that's one of the reasons why it does tend to be fairly effective is that people can stick with it.

When you look at any diet across the board, some diets work a lot better for the first month, after six months, but after about a year, the vast majority of them all come together as far as amount of weight loss, but what really makes a difference with any individual diet is just simply that the person stick with it, whether it be a low carbohydrate, low protein. It doesn't make a difference if they didn't do it a year later, they're not going to keep the weight off. If they did stick with it, then they will keep the weight off regardless of which one they did.

But the Mediterranean diet, it's healthy. It does have the antioxidants. It has not a whole lot of extra fat. It's a good variety because you have your vegetables, your fruits, your meats, your proteins, your minerals, pretty much everything that you need. It's not what I call a no diet. It's not no carbs, no protein. We're all supposed to eat a variety of things and we need, you know, some protein and we need some carbohydrates, we need some fat, and this has a little bit of each of those, and it's a good balance amongst all of them. So it does take some work. I mean, we live about as far away from body of water here in Nebraska, as you can. So there's no Mediterranean Sea next to us. We don't eat a lot of fish, it's not what we're used to. And it's not what your mom and dad may have taught you to cook. But it's available. You have to look for it. But if you go to any store, you can get plenty of fish and you can get a lot of healthy fruits, grains, nuts, etc.

So a lot of it just comes down to a mental commitment and that's what's pretty tough. And you may have to pay more money. You may have to learn a new way to cook something, but anybody can do it. There's really no excuse why you can't learn how to make a salad. It's just is a mental battle and it takes commitment to it.

It's like the same thing with any weight loss diet. If you're doing it a year later, you'll keep the weight off. If you commit to the healthy diet, really focusing on fish and, you know, the Mediterranean diet, you can do it. There's no real particular reason not to. It's just human nature. It's just tough to change. Old habits are always tough to break, but the good thing is if you do it, then this is true for both exercise and eating a healthy diet, that the toughest thing is just getting started.

Going back to the car, if the car has been sitting out in the winter forever and you go and start it, it takes long time for everything to crank up and get moving. Once you get on the highway, once everything is flowing, once you get in the routine, you can stick with it. Well, the same thing with exercise, really, if you haven't exercised in five years, it's really not fun to go out and try to run a mile. But if you do that and then you commit to doing it again a few days later and a few days later, after a couple of weeks after about a month, you're going to enjoy doing it. It's not going hurt nearly as much. You're going to feel better after you did it so. You're going to know that you're doing yourself a lot of good. And that's the same thing with healthy eating.

There's a lot of foods that just make you feel blah, a whole bunch of sugary stuff that tastes great. But then you come off this carbohydrate high once all that sugar wears off an hour later, and then you just feel tired, fatigued, and it's like a carbohydrate withdrawal or carbohydrate hangover. But if you can break that cycle, break the habits, eat things that are healthier, you're not going to have that big blah feeling. You're not going to feel that carbohydrate addiction, so to speak, as I call it. And suddenly you realize, "Hey, that stuff that I maybe didn't think was going to taste so good doesn't taste so bad anymore. And I feel better and I feel healthier and I have more energy. I'm more alert." And once you realize that it's like, "Actually, this is something not only that it's healthy for me, but I feel better. I like doing it." And then it gets obviously a whole lot easier to commit to that.

Melanie: I couldn't agree with you more. It definitely builds on itself. And that motivation helps to keep you motivated. And you're right, you retrain your taste buds and it does definitely change how you think about food and your weight and heart. And thank you so much, Dr. Kummer, you are just a great guest with so much great information. So thank you again for joining us.

And that concludes this episode of Bryan Health podcast. Please visit our website at BryanHealth.org for more information and to get connected with one of our providers. Please also remember to subscribe, rate and review this podcast and all the other Bryan Health podcasts. And please share this show with your friends and family, because we are learning from the experts at Bryan Health together. And we can all learn about exercise and diet to help our weight and our heart. I'm Melanie Cole.