Maggie McKay (Host): Do you ever really consider what you're eating and how it's affecting your heart health, let alone your entire body? Or is it just a daily routine without much thought? In the big picture, what you eat matters. Joining me today is Dr. Michael Sills, Cardiologist on the medical staff of Baylor Scott and White Heart and Vascular Hospital Dallas, to talk about new trends in preventive heart health and food, a heart healthy lifestyle.

 Welcome to Heart Speak, the podcast from Baylor Scott and White Heart and Vascular Hospital, Dallas and Fort Worth, joint ownership with physicians. I'm your host, Maggie McKay. Welcome Dr. Sills. We're so happy to have you here today. Would you please introduce yourself?

Michael Sills, MD: Thank you Maggie. It's a pleasure to be here. I'm Michael Sills. I'm a Cardiologist at as Maggie mentioned Baylor Heart and Vascular Hospital in Dallas. I have a great interest in not only what happens to people who have heart problems, but how we can try to figure out how to prevent those problems from occurring? So I try to spend a lot of time talking with people about the kind of things that they can do to figure out if they do have heart disease and what they can do to prevent it.

Host: And Dr. Sills, you have a three-part series on how we approach heart healthy eating to maintain a heart healthy lifestyle. The first in the series is New Trends in Preventive Heart Health with Dr. Michael Sills and the second podcast in the series, today's discussion is going to focus on food and why it's so important to heart health, as well as some tips from a cardiologist's perspective.

So we are looking forward to hearing that as well. And you completed a podcast for our listeners in April, 2021 on the various trends, quote unquote at that time related to various diets. But in this podcast, we're going to explore more about what is a diet and what constitutes a true lifestyle for heart health. So Doctor, tell us why you prefer lifestyle versus diet, the terms.

Michael Sills, MD: The problem with calling something a diet is that it does mean different things to different people. A diet to some people is just simply what you eat, but when people say I'm on a diet, that usually means they're trying to lose weight or they're trying to change some aspect of their health by what they eat.

So I think it's important to try to understand that there are lifestyle changes that incorporate changes in how we eat, but that to simply say it's a diet, leaves out many important aspects of how we modify our lifestyles to either one, get ourselves into better health, two maintain health, or if we're altering what we eat because of a specific medical problem.

Host: Hmm. Well, we hear about so many healthy diets as well as vegetarian, vegan, low carb. If you were to break it down to the best, what would those choices include?

Michael Sills, MD: Well, I think again, it depends on why you're going to change what you eat. So for example, there are times that if you have borderline diabetes, that you may want to eat a lower carb diet. If your being told that your blood pressure is too high, you may want to watch what your salt is. Or you may want to think about what can I do to live to be a hundred?

What are the kinds of things that I can eat or not eat that are going to most positively affect longevity and overall health. So I think the answer is to the best diet, it really depends on what you're trying to accomplish, and it also may reflect your ethical and moral thoughts. For example, I hear people say, I won't eat anything that has a face. Well, that's a moral, ethical decision, but may have absolutely nothing to do with your health.

Host: Right. And Doctor, I've been dying to ask you about this one, the keto diet, the low carb keto. I have a lot of friends who tried it. It seems like it's been around for a while now. It comes in and out of favor. What are the trends and the current studies or the research, what are they saying about keto these days? Because it was like everyone was on it for a while and now you don't hear much.

Michael Sills, MD: Well. It goes back actually a long time to Dr. Atkins, back in the eighties. And he first came up with the idea of ultra low carb diet. The idea is that when you're eating very low carbs, you force your body to create energy from fat or protein. And you may remember they also used to talk about the protein diets. And the idea is that if you don't give your body source of energy in carbohydrates, the only way you're going to be able to generate energy is either burning protein or burning fat. With the idea, if you give extra protein supplementation, that you will force your body to generate energy from fat.

That process produces something called ketones. Ketones suppress appetite. So it was thought to be kind of a win-win. Well, if you give extra protein, we don't break down muscle. We don't have carbs to burn for energy, so we will burn only fat. Problem was, that was a very unhealthy diet. There was actually some serious changes in body chemistry with that.

People actually died from heart rhythm problems. And the body's pretty smart. It doesn't just say, oh, well I don't have carbs and I've got plenty of protein. I'll break down fat. It didn't work well and people got sick. But what was interesting about it was that people's cholesterol dropped, even though they're on a more of a fat diet than you'd expect, their blood sugars got better.

So even though it was not an entirely healthy way to eat, people got the idea that maybe there's something to it. And then Dr. Agatson in Florida came out with the South Beach Diet, which was basically a modified low carb diet, much, much healthier, and that became very popular for a while. But then we went through the era where people were feeling a little bit more needy in what they eat. I, kind of called it the Krispy Kreme era, where everybody was obsessed with carbs in donuts and, everybody kind of lost interest in eating low carb.

Host: Comfort food.

Michael Sills, MD: Pretty much. Yeah, that was kind of the, the late eighties, early nineties. And then, now of course, nobody eats Krispy Kreme or nobody will admit to eating Krispy Kreme.

Maggie McKay (Host): Yeah.

Host: So where are we with keto?

Michael Sills, MD: Keto, the general idea is still a good one, that if you go low carb, that you will burn more fat and it is overall healthy for you. The actual naming of keto diet is not as popular, so you'll hear it in various incarnations, paleo diet, for example. You'll hear that. And I think people have modified it to a great deal.

The Mediterranean diet to an extent is a version of that. So I think it's still there. It's just being called different things because I think keto has a little bit of a negative connotation, but the idea overall is that for the most part, we don't need as many carbs as we have in our diet, and that most people put too much unsaturated fat in their diet, that if you eat a lower carb diet, but without putting yourself into what we call ketosis, which is an unhealthy state, that you'll probably lose weight and overall be healthier.

Host: And my trainer is so into intermittent fasting. How do you feel about that?

Michael Sills, MD: So intermittent fasting is, essentially the same thought pattern as keto diets. So when you fast for periods of time, your body runs through all of the available carbs that it has. We have glucose in our bloodstream, and anybody who's climbed a flight of stairs quickly and gets out of breath realizes that you burn through all the available glucose in your bloodstream quickly.

And you don't have, your body don't have the capacity to start breaking down storage sugar called glycogen very quickly. It takes a while for that to rev up and provide you with energy. So when you intermittently fast, what happens is your body uses up all the glucose in your bloodstream. Breaks down all the locally stored glycogen, which is basically glucose in a storage form.

And after about 20, 30 minutes, you start breaking down fat. That's why we always say exercise for at least 30 minutes, so you start burning fat. When you fast intermittently, you're actually creating that mildly ketotic state that pushes your body to burn more fat. It's actually, overall quite healthy.

You know, they talk about from caveman era on, we were hunter gatherers. We weren't farmers. So what would happen is people would wake up in the morning, eat a little something, go out for the day to forage, and they'd come back at the end of the day and have an evening meal. This whole idea of eating every two hours is really not how we've evolved.

It's not really in our best interest, and it isn't really as healthy to eat as often and as much as we do. Fasting is interestingly, if you look, it decreases your insulin levels. Insulin is what you need to help bring sugar, glucose into your muscle cells from the blood and it's interesting, but it also makes you hungry.

So by fasting and decreasing your insulin level, you actually decrease your hunger. So, one of the things I think is important to say, fasting is not starvation. Starvation is the involuntary absence of food. This is voluntarily saying I'm just going to eat in a six to eight hour period during the day.

I'm not going to eat within six hours of going to sleep, which is terrible. You're basically not using any energy. So all of that breaking down of food into the kind of parts that your body can absorb and use, basically circulates, and your body goes I don't need this right now. Turn it into fat. So I think there's a lot of good evidence that we eat too much, too often and with again, exactly what you call an intermittent fast is varied, but most of the data would say you shouldn't eat for more than about a six to eight hour period during the day.

The other thing it does for you, which I think is good, is it changes your relationship with food and hunger. We all have this notion, I am so hungry, I need to eat. And yet there are days I'm sure for all of us that you can't get to lunch. I mean, you just get busy. And what you find is that if you skip lunch, maybe in an hour or two, you're not hungry anymore.

Your body is acclimated. In fact, it anticipates food and as a result, if it doesn't see food, it goes into a different mode. It starts burning fat. Ketones build up, you're not as hungry. It's like you work out your muscles, you know you're going to get in shape by training yourself that because you're hungry doesn't mean you have to eat, is actually a good thing. There's some other things about intermittent fasting that are good. Probably don't have time today, but I'm fascinated by this whole notion of gut flora. We used to ignore that, thinking that it was unimportant, but it turns out your gut is the biggest source for immunity that you have.

And that any changes in your gut flora can actually have a profound effect on immunity and your overall health. And it turns out, when you've got constant food, carb things for the bacteria in your gut to deal with, you tend to get some overgrowth of unhealthy gut flora so that not having food in your gut at all times actually promotes some of the growth of some of the more healthy aspects, and they call it the microbiome.

So there's pretty good evidence that that also can help with your immune system. And lastly there's something called the metabolic syndrome, which is a situation where your body develops insulin resistance. All of a sudden, instead of being effective at pulling glucose, sugar out of your blood, your muscles become relatively resistant to it.

That's typically manifested by type two diabetes where you, no matter what your insulin is, you can't get that sugar out of your bloodstream and you end up with a high blood sugar. It turns out that intermittent fasting seems to help with insulin resistance. So there's a whole host of benefits to your health and that also doesn't necessarily just exclude the whole notion that by eating less periods during the day, you probably will consume less calories and also hopefully be able to stabilize or lose weight.

Host: Going back just for a minute, how many hours do you think it's good to stop eating before you go to sleep?

Michael Sills, MD: Really depends on how big a meal you have. The old phrase is eat breakfast like a king, lunch like a queen, and dinner like a pauper.

Host: Hmm.

Michael Sills, MD: And I think the problem is most people reverse that. They skip breakfast, grab whatever they can for lunch and then chow down on dinner, and that's probably the least healthy way to eat.

You really shouldn't be eating a lot late in the day. Especially when it's in proximity to bed. That big bowl of ice cream you have before you go to sleep is going to sit there and all those calories are just going to get turned into fat. So I think we typically tell people, you shouldn't really have much to eat within three hours of bedtime.

Now, I recognize, for most of us, we get home six, seven o'clock at night by the time you get dinner and then you look up and it's time to go to bed. But the whole idea is just try to eat light for dinner.

Host: Okay. Good to know.

Michael Sills, MD: Eat like a pauper.

Host: You mentioned sugar, the enemy. My husband says sugar is the devil. Oh my gosh. If I hear that one more time, so we're seeing more types of artificial sweeteners coming to the grocery store shelves, and in our foods. Should we be concerned about artificial sweeteners?

Michael Sills, MD: The irony is artificial sweetener is the true devil.

Host: Oh

Michael Sills, MD: I remember years ago I saw a study that baffled me, that looked at people who drank regular soda versus diet soda and the people who drank diet soda were way more likely to develop long-term diabetes.

Host: Wow.

Michael Sills, MD: There's been some research to look at that, and it turns out that the artificial sweeteners can be up to five to 10,000 times sweeter than sugar. And for people who consume lots of artificial sweetener, their brain gets exposed to very high levels of sweetness and it becomes an addiction. You crave sugar more and more. So it turns out that the people who consume large amounts of artificial sweeteners are much more likely to develop what we call visceral, central body fat.

And actually, it turns out central body fat, also referred to as brown fat is actually really unhealthy. It leads to more insulin resistance. It leads to actually more heart failure. And there's been some other studies one called the Northern Manhattan Study where they looked at people who consumed at least one diet soda a day, and noted that they had a 40 plus percent increase in the risk for what we call major adverse cardiovascular events.

So, heart attack, stroke, and or vascular death. So, it's very interesting that sugar of course is not good in excess, but artificial sweeteners are actually worse for you. Also the function of the sodium content, they're more likely to increase hypertension risk. And then once again, we go back to the gut flora issue, but they clearly influence gut flora in an adverse way, which again, can create the metabolic syndrome, insulin resistance, immunity. And like I said, it predisposes people to weight gain. So your husband's almost right. You know, but it's artificial sugar is the devil.

Host: Okay. That's good to know. So, just a little aside, should we be ta, should we be taking probiotics or prebiotics or one that has both? What's the story on that?

Michael Sills, MD: That's a good question. I think it really depends on what your diet is. If you have a good, healthy diet including fermented dairy, for example, yogurt, some cheeses, you're probably doing pretty well in terms of your gut flora.

Host: Mm-hmm.

Michael Sills, MD: The challenge is also knowing what kind of probiotics and prebiotics to take. There's a lot out there. Unfortunately, it's not terribly regulated, so you don't really know what you're getting. Now when you get activity of yogurt, for example, which is basically probiotics, you can feel pretty comfortable that they're not going to put something out that isn't safe, but you always have to be careful putting foreign bacteria into your gut without knowing what you're getting into.

So I think the answer is in a natural sense, like I said, with yogurts you're probably going to be very safe, but you just have to be careful getting stuff that you don't know where it's coming from.

Host: All right. And Dr. Sills, can you explain what Nova Groups are for our listeners?

Michael Sills, MD: Yeah. Nova is Collective research group that has tried to help us better understand how to think about food, ranging from basically unprocessed kind of natural food all the way up to ultra processed food, with the idea being that the more processing that occurs, probably the healthier food is.

And then when you get up to stuff that's ultra processed, when you go through what they define as ultra processed, if you're not a little bit disturbed by what constitutes an ultra processed food, you should be, because you shouldn't be consuming that.

Host: What would be an example of ultra processed?

Michael Sills, MD: So Nova defines ultra processed as basically it's an industrial formulation with five or more ingredients that are not natural, including preservatives and chemicals, which should disturb most of us.

That's

Host: a lot of what we eat.

Michael Sills, MD: Yeah. Well, and it also uses a lot of non-natural products casein and lactose, whey gluten, and again, most people are not as gluten sensitive as they think, but excess gluten is probably not good for you. There's things like hydrogenated oils, hydrolyzed proteins, all of the things that actually increase our risk for diabetes and obesity. There's other things that are put in such as high fructose corn syrup, which is very sweet, but also is basically pure sugar, the true devil and is really not good for you.

It's also food that's designed to increase your appetite. There was a famous, I believe it was the Atlantic did an article on the Cheesecake Factory which is, love that food, but they go out of their way to come up with the saltiest, most sugary, high calorie food on the planet. And they do research.

And what they've discovered is that the more sugar and salt you put in something, especially if you fry it; the better it tastes to us. And this is exactly what the NOVA 4 is. And what this group gets off on some social issues, but they also are concerned that with ultra processed food, that it's very often creatively packaged and it's aggressively marketed to kids and young adults. I walked by the grocery in the grocery store the other day with my son, and they had Peeps cereal.

Host: Oh no, for Easter.

Michael Sills, MD: For Easter. And their point is that they're getting young vulnerable eaters very much indoctrinated into high salt, high sugar, brightly colored food, which is really bad for them. We really need to think about again, that we were fundamentally hunter gatherers, that we need to eat in, in a more natural, healthy way.

And that's when I get back to thinking about lifestyles, about, where can we get back to a healthier way of eating that we can clearly show from a cardiovascular perspective and a longevity perspective, is beneficial for us.

Host: Right. Well, this has been so educational and informational. I love it. I can't wait till the third episode. Do you have anything else you'd like to share in closing Dr. Sills?

Michael Sills, MD: Well, I think people will also ask about the Mediterranean diet. And what I try to explain to them that it's not a diet. It's a lifestyle. It's not just a way of eating, but it's how you approach your whole way of getting calories in you. For example, they really focus on olive oil. There's been some recent stuff looking at Mediterranean diet and olive oil, and it appears to lower your risk of Alzheimer's.

Host: Wow.

Michael Sills, MD: We go back and forth about alcohol. Mediterranean diet is very low alcohol. There is an article that came out recently, once again, the pendulum is swing that no alcohol is good for you.

That, maybe some studies have said maybe a glass or two of wine a day may not hurt you. But I think clearly that as it's not part of a diet, but unfortunately, wine has about 25 calories an ounce, which is actually even just as bad as a soda. So we'd never sit there and drink a can of Coke without feeling guilty cause sugar's the devil. But we're perfectly happy. Yeah, well yeah. No, but you wouldn't feel as guilty drinking a glass or two of wine cause well, there's no visible sugar, there's no stigma to that. But in fact, alcohol has a ton of sugar in it.

Host: Right, but they always say like, the grapes are healthy for you.

Michael Sills, MD: Yeah. Yeah.

Host: The red wine. Yeah, yeah, yeah.

Michael Sills, MD: Soon as you ferment it all that, all the yeast basically turns all of that into sugar and alcohol. So, one of the things we need to think about is, is the hidden sources of calories in our diets and why the Mediterranean diet is actually a lifestyle about how we can not only improve cardiovascular health, but really addresses your longevity, risk of Alzheimer's, immunity. So, think we need to think not just about are we consuming too much sugar, but how can we change our whole dietary lifestyle to make us overall healthier and live longer?

Host: Well, we have covered a lot of useful information in this second in the series of three podcasts on our Heart Healthy Lifestyles. Dr. Sills, thank you so much and we look forward to the next one covering the true why behind exercise and heart health.

Michael Sills, MD: Thank you, Maggie. I appreciate your time.

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 Maggie McKay. 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.