Transcription:
A Cardiologist's Commentary on Diets

Alyne Ellis (Host):  Welcome to Heart Speak the podcast from Baylor Scott and White Heart and Vascular Hospital. I'm your host Alyne Ellis. Today our interview is with Dr. Michael Sills, a Cardiologist on the Medical Staff of BSW Heart and Vascular Hospital, Dallas and Baylor University Medical Center. Welcome Dr. Sills. It's so nice to have you with us today.

Michael Sills, MD (Guest): Thank you for having me.

Host: So, there are many diets currently being promoted as heart-healthy. And in fact, US News and World Report recently ranked heart-healthy diets with the best being the DASH diet, the Mediterranean diet and the Ornish diet. Which ones do you recommend and why?

Michael Sills, MD (Guest): Well, let's go in reverse. Dr. Ornish was actually originally from Dallas. His dad was an Orthodontist here, so I actually knew him. He was really the first to come up with the plant-based diet. And so he really proceeded the whole vegan diet plans. Problem is, and in a number of us that were interested when he first had it, it's very difficult to do. It's a challenge to get enough protein as it is with the vegan diets. So, from my perspective, it's not a great diet, but let me digress one sec. So, I think some of the confusion happens is that when people talk about diets, they're really thinking about three separate approaches.

One is a diet to lose weight. Two is a diet for heart health. And three is a diet that is healthy, whether it's for high blood pressure, heart disease or whatever, that helps you maintain weight. And I think for me, it's easier to think about it in those terms. So, the Ornish diet, like I said, is vegan basically.

Mediterranean diet. If you look at, that's one of the very few, if only diets where there's actually been pretty good data to say that it actually improves longevity, especially when it's a fish based Mediterranean diet. The DASH diet is a good diet for health, especially for high blood pressure, but isn't as easy to lose weight on so, you have to kind of approach it with what is your goal with having the diet and then you can almost work in reverse as to what the best diet is.

Host: And which diet do you recommend and why?

Dr. Sills: I think in general, the Mediterranean diet that's fish based is the healthiest. I think for most people, it's the easiest to keep up with. Because whatever diet you do, has to be something that you're comfortable with longterm. There's lots of ways to lose weight, but it's gotta be something that you're gonna enjoy and not resent every day as most people do with aggressive diets. And I think the Mediterranean diet, it's a pretty easy one to maintain. And I think it's, like I said, there is some longevity benefit to it.

Host: So, when you recommend a diet to your patients, do you kind of go over with them their sort of tolerance for how much they're willing to change what they eat?

Dr. Sills: Absolutely. There's no question whether it's blood pressure medicine, diet, or anything else I do. If it's going to make the patients miserable and or it's impossible for them to follow the regimen, they're not going to do it and probably not come back. So, it's gotta be something that they're comfortable with and equally important, understand the reasons.

Host: So, what are the most common mistakes that you see people making when it comes to deciding on a heart-healthy diet?

Dr. Sills: Again, I think it comes back to are they simply trying to be heart-healthy or are they trying to lose weight or both? And I think it gets really complicated when you mix lots of different agendas. For example, the Atkins diet, which was among the earlier low carb diets, promulgated high-fat. So, it suggests that all the bacon and avocado you could eat, which did help people lose weight, but also made a lot of people sick. So, I think the first thing has to be, are we treating someone who's overweight to get their blood pressure down, to get their diabetes better controlled, to get their cholesterol controlled.

So, are we focused really on their weight? Are they diabetic? Do we want to go extra low carb or, are we trying to be more in general, heart-healthy which would be more of a low fat? So, really depends on what our goal is with the diet.

Host: Well, and it sounds like you may switch off like first, your patient loses weight, which is good for your heart. And then you may switch to something else that is better in the long run as a heart healthy diet.

Dr. Sills: Absolutely. There are good diets for losing weight and good diets for maintaining weight. They may be very different.

Host: So, tips, do you give your patients to help them adopt and stick to either a heart healthy diet or any diet that you suggest they go on?

Dr. Sills: Fundamentally, it's a pretty simple formula. You have to have more calories out than calories in. That's the way you lose weight. That's what makes Weight Watchers and Jenny Craig and all the rest of those diets work is they basically say you can eat what you'd like, but you're going to have small portions.

And I think for most of us, it is about portion control. I think there's been stuff that you can easily find that in the fifties, the average size dinner plate, I think was six or eight inches, by the late sixties, early seventies at dinner plate was 10 inches, and now it looks more like a platter. And so the same amount of food on a six inch dinner plate looks very lonely on a 2020 dinner plate.

I think our problem is that our portions are bigger. We tend to eat more. Food is all too readily available, fast food, especially I think the first step is getting your portions under control because it doesn't matter what you eat. If you eat too much of it, you're going to gain weight. And if you eat less of it, you'll lose weight.

Host: But now another tip that I've heard for example is breakfast should be much bigger as a meal than dinner. Do you agree with that?

Michael Sills, MD (Guest): What's interesting about this literature is if you decide you want to believe something, you can find someone who's written persuasively about it somewhere. Because there's also a school of thought now that talks about intermittent fasting and really what intermittent fasting is eating for certain periods during the day. And most of those diets leave out breakfast. They'll tell you to do is you could eat for like six to eight hours a day.

So, from before lunch to an early dinner. So, again it depends on individual preference. Like I said, intermittent fasting has its fans. So no, I think that most people are best off eating three meals a day of small portions that are balanced. I don't think there's any one that's better than another in that regard.

Host: And not a lot of snacking, particularly after dinner, I would assume.

Dr. Sills: No. Especially you ascribe to a little bit of the intermittent fasting theory, then you really should confine the number of hours you eat. It goes back a little bit too we are fundamentally hunter gatherers, which meant that our caveman days, we would basically eat a little bit in the mornings, go out and spend the day foraging and then come back at the end of the day, eat a little bit more. But what we were never meant to do was eat a lot of grains because we were itinerant or eat constantly because that's not what's in our genetic makeup.

Host: So, I think we're sort of dancing around something in a way, and I totally understand what you're saying about losing weight and everything and controlling diabetes, but what is a heart healthy diet? What is that?

Dr. Sills: What it comes down to is more of a what are we going to achieve with the diet? So, again the best diets tend to be low fat and low carb. Because those are the diets that are going to help reduce blood pressure, blood sugars, and cholesterol. Whether you want to do it in a Mediterranean fish based diet, which I personally think is the most healthy.

That means trying to avoid saturated fats, fried food, processed meat in general, most red meat, substituting fish, fruits and lots of vegetables. That ultimately is going to be the most heart-healthy diet. There is a school of thought that would say that unprocessed red meat and whole dairy actually tends to raise your good cholesterol.

Not everybody agrees, but most people feel like fermented dairy, cheese and yogurt is actually fine for you. So, heart-healthy is really balanced. It's controlling your calories, controlling your fat, controlling your carbs, trying to supplement it with things like olive oil. And when you have to have fats.

Host: Yeah. Do you have a favorite food that's part of your favorite heart healthy diet?

Dr. Sills: Oh, gosh. Well I went to cooking school a thousand years ago and it was French. And so unfortunately my favorite food tends to be butter. They'll joke is the three secrets to French cooking are butter, butter, and more butter. But I do think that butter and eggs are not necessarily bad for you. I think it's the saturated fats, it's fried stuff. To me, yogurt and fish is kind of the basis of what I eat. I eat yogurt for breakfast. I tend to have something fish or perhaps Turkey based for lunch and fish for dinner, and then supplement it with lots of fruits and vegetables.

Host: Now if somebody already has heart disease, will a heart healthy diet help him or her improve the health of their heart.

Dr. Sills: There's never been any evidence that any medication or for that matter, diet will reverse coronary disease. Many, many years ago, there was a man named Nathan Pritikin who created the Pritikin diet. And at the time of his death, he insisted on an autopsy that was published in the New England Journal that showed he had reversed a lot of his coronary disease. Problem was he also had leukemia is probably from malnutrition from that that made a difference. But we've never been able to prove that you can reduce the incidence of coronary disease or potentially the outcome. Some medications like aspirin and statins seems to reduce the adverse outcomes. But unfortunately, it's not a lot of direct evidence that diet will change that unless you can make your diabetes go away, completely normalized your cholesterol and blood pressure. A little bit of evidence that that may help.

Host: But at the same time, a heart healthy diet could keep things from getting worse.

Dr. Sills: And that's the most important point. And you can correlate that with the fact that people who have these kinds of diets tend to live longer.

Host: Well, thank you so very much. Is there anything else you'd like to add?

Dr. Sills: The one thing I would say is everybody comes in and asks two questions. One, is there a pill I can take that makes me lose weight? Answer, no. There's no quick and easy way to do it. Unfortunately, a good diet you'll lose one, maybe two pounds a week. So, whatever you do, you're going to have to enjoy that diet and two, they all want to know what's the right diet. The answer is the right diet is what works for them. There's a ton of information. And the easiest thing is to talk to their provider because we have lots and lots of stuff that's available to help people. But there's no magic pill, unfortunately.

Host: Well, thank you very much for the information. I still think it's very encouraging and thank you so much for being here.

Dr. Sills: My pleasure.

Host: That's Dr. Michael Sills, a Cardiologist on the Medical Staff of Baylor Scott and White Heart and Vascular Hospital, Dallas and Baylor University Medical Center. To find a cardiologist, please call 1-844-BSW-DOCS. That's 1-(844) 279-3627. Or visit bswhealth.com/heartdfw.

Thanks for listening to Heart Speak the podcast from Baylor Scott and White Heart and Vascular Hospital in Dallas and Fort Worth. I'm Alyne Ellis. If you found this podcast helpful, please share it on your social channels and be sure to check out our entire podcast library for topics of interest to you.

Baylor Scott and White Heart and Vascular Hospital, Dallas Fort Worth joint ownership with physicians.