Selected Podcast
Blueberries and Blockages (TM)
Dr. Charles Roberts discusses the correlation between blueberries and cardiovascular blockages.
Featured Speaker:
Charles Roberts, MD
Dr. Roberts is board certified and specializes in cardiac, vascular and thoracic surgery. His clinical expertise includes valvular heart disease, coronary artery disease, aortic conditions, and carotid and peripheral arterial disease. Dr. Roberts is Medical Director of Cardiovascular Research and Education at Baylor University Medical Center, part of Baylor Scott & White Health. After receiving a medical degree from Emory University in Atlanta, Dr. Roberts completed his internship at Barnes-Jewish Hospital in St. Louis, MO. He went on to complete a residency in surgery at the Medical University of South Carolina in Charleston and a residency in cardiothoracic surgery at the University of North Carolina in Chapel Hill. He received his fellowship training in cardiac surgery at the Royal Brompton Hospital in London. Dr. Roberts has led multiple clinical trials and published numerous articles related to his field. He regularly presents at national and international conferences. Prior to relocating to Dallas, Dr. Roberts served as Clinical Professor of Surgery at Medical University of South Carolina in Charleston. In addition, he is an active member of the American College of Surgeons, the Society of Thoracic Surgeons and the American Osler Society. Transcription:
Blueberries and Blockages (TM)
Prakash Chandran: Today we're speaking with Dr. Charles Roberts, Chair of Cardiac Surgery at Baylor University Medical Center, Dallas, Texas, about Blueberries and Blockages, an interesting title for a new manuscript he's working on This is Heart Speak with Baylor Scott and White Heart and Vascular Hospital in Dallas, Fort Worth. I'm Prakash Chandran. So first of all, Dr. Roberts, you've peaked our curiosity. How did this manuscript title come about?
Dr. Roberts: Well, for many years, the number one disease that I've treated is called atherosclerosis. That's the medical word, but most people call it blockages. When I was growing up, the term was hardening of the arteries and that term seems to have faded, but most patients would come into my office and say, I've got a blockage in my heart, or I've got a blockage in my neck, or I've got a blockage in my legs. And the disease they're speaking of is, the medical term is atherosclerosis, but it's a very difficult word to say. And so the lay public has adopted this word blockages. But the number one cause of death in the United States is heart disease from blockages in the coronary arteries of the heart. And that particular disease, you know, I've treated my whole career doing bypasses, heart bypasses.
I've also spent a good deal of time doing vascular surgery, treating blockages in the neck, which occurs when you have atherosclerosis, this disease process, in the carotid arteries that go to the brain. And as it happens, the number one operation for all of heart surgery is a coronary artery bypass operation of the heart. And that's done to treat blockages. And the number one operation in vascular surgery it's called a carotid endarterectomy. And that's done to treat blockages in the carotid arteries that go to the brain. So you've got two major medical disciplines and the number one operation in each of these subspecialties, in each of these specialties, is to treat blockages. It's to treat this disease, which in medicine we call atherosclerosis. It's a very common condition.
Host: Yes. So if I can explain it back to you, atherosclerosis really just means a blockage, and that blockage is that hardening or narrowing of the artery. And most people don't necessarily know how to pronounce that atherosclerosis or that's a complex word. So they're just used to saying, Hey, I have a blockage. Is that correct?
Dr. Roberts: That is exactly right. In other words, this disease which is so prevalent in society has a name which is very complicated atherosclerosis. In contrast, you know, people that have cancer just are able to say, I have cancer. It's simple word, easy to say, but atherosclerosis is rather complicated. And so people by default will use expressions like I have heart disease and, but that's not very specific. That's a very general term. But the disease, you know, that we treat the most of is blockages.
Host: I have to ask you know, we've talked about the blockages part of your manuscript, but what about the blueberries?
Dr. Roberts: Well, you see, that's the dichotomy here. Blueberries are one of the top foods that we can eat, and blockages is the top disease. And so it's a sort of it's a play on words really. If we adopted a diet in which we eat the top 10 foods on a regular basis and blueberries is among those top 10 foods in virtually every list, then we're less likely to get blockages. And so that's the concept here. It's trying to emphasize that blockages or atherosclerosis is a dietary disease. And so we sort of determine our fate by what we eat.
Host: That is so interesting, you know, and we've always heard this as well, you know, we are what we eat. And I'm hearing from you that atherosclerosis or these blockages are a result of that. I'm curious as to what are some of the other reasons and also what are the typical symptoms that one might experience when they have these blockages?
Dr. Roberts: Well, it's interesting that most people that come into my office they're generally adults between 60 and, well 55 and 75, and they have very little understanding of how they got blockages. I mean, most people will say, well, I, you know, I inherited this and that's, I would say a four out of five people blame it on their parents. They inherited it, but if the truth be is that they probably ate the same foods they eat the Western diet, which, which is what we would call atherogenic. It promotes atherosclerosis, it promotes blockage. And if you were to say, well, what is the number one cause of blockage? It's probably best to think of it as the only direct risk factor is high cholesterol. In other words, you have to have a high cholesterol to get this disease. And what do I mean by high? Well, any total cholesterol over one 50 or any LDL over a hundred then you're at risk for getting atherosclerosis. Now there's a medley of what one might call indirect risk factors, obesity, diabetes mellitus, tobacco, high blood pressure, low HDL. These are what might be called indirect risk factors. You can have them and they can accelerate the atherosclerotic process, but you have to have elevated cholesterol to get the disease. It's really a dietary disease. There is an hereditary component. There are certain people that are born without the proper number of receptors in their liver, so they can't metabolize the cholesterol and they walk around with extremely high cholesterol levels. But those genetic patients are probably no more than one in 200. The rest of us, it's environmental.
Host: Yeah. It's really interesting to hear you say that. You know, my father actually had a heart incident a couple of years ago and he has always said that it was hereditary because his dad died from a heart attack at 55. But, you know, being a vegetarian for most of his life, he thought he was eating healthy, but you know, potentially over time he's has been putting in like foods that are high cholesterol, potentially lots of sugars and things like that. So I'm assuming that this is something that just built over the majority or the latter part of his life and snuck up on him and then caused this incident, wouldn't you say?
Dr. Roberts: Yeah, it's a slow, silent, progressive disease. And people are. And it generally, at least in terms of blockage in the heart, so to speak, blockage in the coronary arteries of the heart. This condition presents itself in one of three ways. You can get what we call angina. That just means pain. Angina pectoris is chest pain. You can get chest pain, and that's the best way for this to come to our attention, because there's no muscle damage. You just get pain for example, when you walk upstairs, then it stops when you stop that. That's one way the disease can present itself. Angina pectoris. The second way is a heart attack and a heart attack means muscle damage. It means the artery shut off, muscle died. And that's what a heart attack is. The medical word is myocardial infarction and MI, they say. Now the third way this blockage in the coronary arteries can present is sudden death. You know, you're eating your rice Krispies in the morning and boom, sudden death.
So there's an expression, the blessing of angina, meaning that it is a disease comes to our attention before a heart attack or sudden death. And we're able to do something about it. We can put a stent in, we can do a bypass, we can put you on a lipid lowering drugs, these kinds of things. So from the heart standpoint, those are the three main symptoms. Now, if you want to talk about the brain, your blockage in the carotid arteries, well you can get what they call TIAs, which are temporary ischemic attacks, meaning that maybe a little bit of the plaque flipped off and went North and you kind of lost movement of your right arm for an hour and then it came back. That's called a TIA. And the other main way it can present is simply a stroke. You know, blockage in the carotid arteries of the neck and cause a stroke. So those are the two main areas. I think we've talked about the heart and the brain, the brain attack or a heart attack. But you know, there's also the legs. I mean you can get blockage in the arteries going to the feet. And when you get, you know, the equivalent of angina in the legs is called claudication. It means you've got a narrowing in let's say the femoral artery and when you walk, you get pain in your muscle down there. And then when you stop, goes away, that's called claudication on the equivalent of a heart attack down in the legs is gangrene.
Host: So I'd like to move on to treatment and prevention measures. Let's start with some of the medications that might be available to those that are suffering with some of these blockages.
Dr. Roberts: I would say that all people with Atherosclerosis or hardening of the arteries or blockage, whichever term you prefer to use need to think of it's a whole body disease. It's not just in one particular area. Think of it as a diffuse. We would use the word systemic process. And so that requires systemic treatment, which means a good diet, a proper diet. And in some cases, if you're not able to bring those cholesterol levels down, then adding a statin drug which you know, has the ability in some cases to bring down the cholesterol levels as much as 50%.
Host: And when we say a good diet, what does that mean? Can you tell us like the optimal nutrition plan or what you tell your patients around what they should be eating on a day to day basis?
Dr. Roberts: Well, this is a very challenging situation because we live in a world where this, you know, the top 10 foods that taste good are probably nine of them are not good for us. So it's an extremely challenging situation. But I would say that the closer you can get to a plant based diet, the better. You know, there's an expression eat less. Mostly plants. I mean that's a probably a good starting point. You know, just on practical levels, I try to tell my patients, you know, instead of you know, eating meat three times a day, why don't you limit it to once one meal a day? Eat all the fruits and vegetables you want. One of my colleagues here at Baylor, Dr. McCullough always preaches, you know, avoid the three S's, sugar, starch, and saturated fat.
Host: Absolutely. You know, just as we wrap up here, I just wanted to talk about, I mean, I think the one primary thing that I've learned here is that atherosclerosis or blockage or whatever you decide to call it, is a dietary disease. And so, you know, can you talk a little bit more just as we close here around the importance of taking early steps to lower the risk, especially with diet and manage with the help of a specialist.
Dr. Roberts: Yes. I think it's probably sensible in early adulthood to get a lipid panel checked and see what your lipid levels are. And you always want your total cholesterol under 150 and your LDL cholesterol under a hundred. Now, if you can, you know, keep those two numbers in those ranges total under a hundred and excuse me, total under 150 and an LDL under a hundred. You know, you're, you're radically lowering your risk of atherosclerosis and obviously these other indirect factors like obesity, well, keep your body mass index under 25. Two thirds of Americans are either overweight or obese, but if you can keep your body mass index under 25 and keep your blood pressure under 140, over 90, these kind of other, and obviously no tobacco. Tobacco is a plant, but it's addictive and it accelerates atherosclerosis. And you know, when I do coronary bypasses in people in their forties, almost invariably they smoked tobacco.
Host: I just had a clarifying question. You know, when you get your physical, are you automatically given a lipid panel? You know, I'm 38 years old and I don't think I've ever had one before. Is this something I should be asking for?
Dr. Roberts: I would, if you're over 30 and you go get a physical, I would ask for a lipid panel because you know, you're talking about the number one cause of death in the United States and you're talking about in general, the Western diet is atherogenic. So if you, if you can't get that total under 150 or the LDL under a hundred by being a vegetarian or you can't modify your diet enough to achieve those numbers, then you might want to consider taking a step.
Host: Got it. And just as we close here, is there anything else that you would like our audience to know about lowering their risk of getting atherosclerosis?
Dr. Roberts: I would just say that just be mindful that it's a dietary disease and that we make choices every day on what sort of nutrients we put in our body. And to do your best to lean toward more plant-based, limit me to once a day. And that's probably your best bet. And avoid processed food. It's probably your best bet to lower your risk of atherosclerosis.
Host: That's Dr. Charles Roberts, chair of cardiac surgery at Baylor University Medical Center, and on the medical staff at Baylor Scott & White Heart and Vascular Hospital - Dallas. Thanks for checking out this episode of Heart Speak. To find a specialist on the medical staff at Baylor Scott and White Heart and Vascular Hospital in Dallas and Fort Worth, please visit Baylorhearthospital.com. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks, and we'll talk next time.
Blueberries and Blockages (TM)
Prakash Chandran: Today we're speaking with Dr. Charles Roberts, Chair of Cardiac Surgery at Baylor University Medical Center, Dallas, Texas, about Blueberries and Blockages, an interesting title for a new manuscript he's working on This is Heart Speak with Baylor Scott and White Heart and Vascular Hospital in Dallas, Fort Worth. I'm Prakash Chandran. So first of all, Dr. Roberts, you've peaked our curiosity. How did this manuscript title come about?
Dr. Roberts: Well, for many years, the number one disease that I've treated is called atherosclerosis. That's the medical word, but most people call it blockages. When I was growing up, the term was hardening of the arteries and that term seems to have faded, but most patients would come into my office and say, I've got a blockage in my heart, or I've got a blockage in my neck, or I've got a blockage in my legs. And the disease they're speaking of is, the medical term is atherosclerosis, but it's a very difficult word to say. And so the lay public has adopted this word blockages. But the number one cause of death in the United States is heart disease from blockages in the coronary arteries of the heart. And that particular disease, you know, I've treated my whole career doing bypasses, heart bypasses.
I've also spent a good deal of time doing vascular surgery, treating blockages in the neck, which occurs when you have atherosclerosis, this disease process, in the carotid arteries that go to the brain. And as it happens, the number one operation for all of heart surgery is a coronary artery bypass operation of the heart. And that's done to treat blockages. And the number one operation in vascular surgery it's called a carotid endarterectomy. And that's done to treat blockages in the carotid arteries that go to the brain. So you've got two major medical disciplines and the number one operation in each of these subspecialties, in each of these specialties, is to treat blockages. It's to treat this disease, which in medicine we call atherosclerosis. It's a very common condition.
Host: Yes. So if I can explain it back to you, atherosclerosis really just means a blockage, and that blockage is that hardening or narrowing of the artery. And most people don't necessarily know how to pronounce that atherosclerosis or that's a complex word. So they're just used to saying, Hey, I have a blockage. Is that correct?
Dr. Roberts: That is exactly right. In other words, this disease which is so prevalent in society has a name which is very complicated atherosclerosis. In contrast, you know, people that have cancer just are able to say, I have cancer. It's simple word, easy to say, but atherosclerosis is rather complicated. And so people by default will use expressions like I have heart disease and, but that's not very specific. That's a very general term. But the disease, you know, that we treat the most of is blockages.
Host: I have to ask you know, we've talked about the blockages part of your manuscript, but what about the blueberries?
Dr. Roberts: Well, you see, that's the dichotomy here. Blueberries are one of the top foods that we can eat, and blockages is the top disease. And so it's a sort of it's a play on words really. If we adopted a diet in which we eat the top 10 foods on a regular basis and blueberries is among those top 10 foods in virtually every list, then we're less likely to get blockages. And so that's the concept here. It's trying to emphasize that blockages or atherosclerosis is a dietary disease. And so we sort of determine our fate by what we eat.
Host: That is so interesting, you know, and we've always heard this as well, you know, we are what we eat. And I'm hearing from you that atherosclerosis or these blockages are a result of that. I'm curious as to what are some of the other reasons and also what are the typical symptoms that one might experience when they have these blockages?
Dr. Roberts: Well, it's interesting that most people that come into my office they're generally adults between 60 and, well 55 and 75, and they have very little understanding of how they got blockages. I mean, most people will say, well, I, you know, I inherited this and that's, I would say a four out of five people blame it on their parents. They inherited it, but if the truth be is that they probably ate the same foods they eat the Western diet, which, which is what we would call atherogenic. It promotes atherosclerosis, it promotes blockage. And if you were to say, well, what is the number one cause of blockage? It's probably best to think of it as the only direct risk factor is high cholesterol. In other words, you have to have a high cholesterol to get this disease. And what do I mean by high? Well, any total cholesterol over one 50 or any LDL over a hundred then you're at risk for getting atherosclerosis. Now there's a medley of what one might call indirect risk factors, obesity, diabetes mellitus, tobacco, high blood pressure, low HDL. These are what might be called indirect risk factors. You can have them and they can accelerate the atherosclerotic process, but you have to have elevated cholesterol to get the disease. It's really a dietary disease. There is an hereditary component. There are certain people that are born without the proper number of receptors in their liver, so they can't metabolize the cholesterol and they walk around with extremely high cholesterol levels. But those genetic patients are probably no more than one in 200. The rest of us, it's environmental.
Host: Yeah. It's really interesting to hear you say that. You know, my father actually had a heart incident a couple of years ago and he has always said that it was hereditary because his dad died from a heart attack at 55. But, you know, being a vegetarian for most of his life, he thought he was eating healthy, but you know, potentially over time he's has been putting in like foods that are high cholesterol, potentially lots of sugars and things like that. So I'm assuming that this is something that just built over the majority or the latter part of his life and snuck up on him and then caused this incident, wouldn't you say?
Dr. Roberts: Yeah, it's a slow, silent, progressive disease. And people are. And it generally, at least in terms of blockage in the heart, so to speak, blockage in the coronary arteries of the heart. This condition presents itself in one of three ways. You can get what we call angina. That just means pain. Angina pectoris is chest pain. You can get chest pain, and that's the best way for this to come to our attention, because there's no muscle damage. You just get pain for example, when you walk upstairs, then it stops when you stop that. That's one way the disease can present itself. Angina pectoris. The second way is a heart attack and a heart attack means muscle damage. It means the artery shut off, muscle died. And that's what a heart attack is. The medical word is myocardial infarction and MI, they say. Now the third way this blockage in the coronary arteries can present is sudden death. You know, you're eating your rice Krispies in the morning and boom, sudden death.
So there's an expression, the blessing of angina, meaning that it is a disease comes to our attention before a heart attack or sudden death. And we're able to do something about it. We can put a stent in, we can do a bypass, we can put you on a lipid lowering drugs, these kinds of things. So from the heart standpoint, those are the three main symptoms. Now, if you want to talk about the brain, your blockage in the carotid arteries, well you can get what they call TIAs, which are temporary ischemic attacks, meaning that maybe a little bit of the plaque flipped off and went North and you kind of lost movement of your right arm for an hour and then it came back. That's called a TIA. And the other main way it can present is simply a stroke. You know, blockage in the carotid arteries of the neck and cause a stroke. So those are the two main areas. I think we've talked about the heart and the brain, the brain attack or a heart attack. But you know, there's also the legs. I mean you can get blockage in the arteries going to the feet. And when you get, you know, the equivalent of angina in the legs is called claudication. It means you've got a narrowing in let's say the femoral artery and when you walk, you get pain in your muscle down there. And then when you stop, goes away, that's called claudication on the equivalent of a heart attack down in the legs is gangrene.
Host: So I'd like to move on to treatment and prevention measures. Let's start with some of the medications that might be available to those that are suffering with some of these blockages.
Dr. Roberts: I would say that all people with Atherosclerosis or hardening of the arteries or blockage, whichever term you prefer to use need to think of it's a whole body disease. It's not just in one particular area. Think of it as a diffuse. We would use the word systemic process. And so that requires systemic treatment, which means a good diet, a proper diet. And in some cases, if you're not able to bring those cholesterol levels down, then adding a statin drug which you know, has the ability in some cases to bring down the cholesterol levels as much as 50%.
Host: And when we say a good diet, what does that mean? Can you tell us like the optimal nutrition plan or what you tell your patients around what they should be eating on a day to day basis?
Dr. Roberts: Well, this is a very challenging situation because we live in a world where this, you know, the top 10 foods that taste good are probably nine of them are not good for us. So it's an extremely challenging situation. But I would say that the closer you can get to a plant based diet, the better. You know, there's an expression eat less. Mostly plants. I mean that's a probably a good starting point. You know, just on practical levels, I try to tell my patients, you know, instead of you know, eating meat three times a day, why don't you limit it to once one meal a day? Eat all the fruits and vegetables you want. One of my colleagues here at Baylor, Dr. McCullough always preaches, you know, avoid the three S's, sugar, starch, and saturated fat.
Host: Absolutely. You know, just as we wrap up here, I just wanted to talk about, I mean, I think the one primary thing that I've learned here is that atherosclerosis or blockage or whatever you decide to call it, is a dietary disease. And so, you know, can you talk a little bit more just as we close here around the importance of taking early steps to lower the risk, especially with diet and manage with the help of a specialist.
Dr. Roberts: Yes. I think it's probably sensible in early adulthood to get a lipid panel checked and see what your lipid levels are. And you always want your total cholesterol under 150 and your LDL cholesterol under a hundred. Now, if you can, you know, keep those two numbers in those ranges total under a hundred and excuse me, total under 150 and an LDL under a hundred. You know, you're, you're radically lowering your risk of atherosclerosis and obviously these other indirect factors like obesity, well, keep your body mass index under 25. Two thirds of Americans are either overweight or obese, but if you can keep your body mass index under 25 and keep your blood pressure under 140, over 90, these kind of other, and obviously no tobacco. Tobacco is a plant, but it's addictive and it accelerates atherosclerosis. And you know, when I do coronary bypasses in people in their forties, almost invariably they smoked tobacco.
Host: I just had a clarifying question. You know, when you get your physical, are you automatically given a lipid panel? You know, I'm 38 years old and I don't think I've ever had one before. Is this something I should be asking for?
Dr. Roberts: I would, if you're over 30 and you go get a physical, I would ask for a lipid panel because you know, you're talking about the number one cause of death in the United States and you're talking about in general, the Western diet is atherogenic. So if you, if you can't get that total under 150 or the LDL under a hundred by being a vegetarian or you can't modify your diet enough to achieve those numbers, then you might want to consider taking a step.
Host: Got it. And just as we close here, is there anything else that you would like our audience to know about lowering their risk of getting atherosclerosis?
Dr. Roberts: I would just say that just be mindful that it's a dietary disease and that we make choices every day on what sort of nutrients we put in our body. And to do your best to lean toward more plant-based, limit me to once a day. And that's probably your best bet. And avoid processed food. It's probably your best bet to lower your risk of atherosclerosis.
Host: That's Dr. Charles Roberts, chair of cardiac surgery at Baylor University Medical Center, and on the medical staff at Baylor Scott & White Heart and Vascular Hospital - Dallas. Thanks for checking out this episode of Heart Speak. To find a specialist on the medical staff at Baylor Scott and White Heart and Vascular Hospital in Dallas and Fort Worth, please visit Baylorhearthospital.com. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks, and we'll talk next time.