Scott Webb (Host): Keeping our hearts healthy is essential, and my guest today has a variety of recommendations for all of us and especially women. I'm joined today by Dr. Ryan Daly. He's a board-certified cardiologist, sub-specializing in cardiovascular imaging and non-invasive cardiology at Franciscan Health.

 This is the Franciscan Health Doc Pod. I'm Scott Webb.

Doctor, nice to have you here today. We're going ro talk about healthy habits that build a healthy heart, especially for women. But before we get there, I want to have you tell listeners about yourself, your training, background, approach to care, all that good stuff.

Ryan Daly, MD, FACC, FASE, FSCMR, FSCCT: Sure. Thank you for having me. Much appreciated. So I've been with Franciscan Health for about 15 years. A little over 15 years, by way of Boston. Most of my training was back in Boston. Went to Boston University for medical school, as well as residency in internal medicine.

Went out to the Cleveland Clinic where I completed my cardiovascular training and then back to Boston to Brigham Women's hospital for a additional fellowship in cardiac imaging, basically taking pictures of the heart. After I completed a number of my fellowships, I took a job here as a clinical cardiologist and started up Advanced Cardiac Imaging for Franciscan Indianapolis, including cardiac MRI and cardiac CT.

I have the pleasure to serve as the Medical Director for Advanced Cardiac Imaging, overseeing cardiac CT and cardiac MRI. I have strong interest in preventative cardiology, calcium scoring, and I also work as one of the docs that help cancer patient's that have heart disease called cardio-oncology.

I've been involved in that for a fair bit of time as well.

Host: Yeah. Well that's great. It's always great to have experts on, and you certainly are one of those experts. And you mentioned preventative there, and that's kind of what I wanted to focus on today was how can we help women to prevent these major episodes, heart episodes, that kind of thing. So what are the essential things that women can do to stay healthy and keep their hearts healthy?

Ryan Daly, MD, FACC, FASE, FSCMR, FSCCT: Let's just start at the basics. The way we live our life is really the foundation of our health. And you always hear from docs, well, you got to eat less and move more. And it's true, but that's the same way of saying to somebody that's poor, to get rich, you gotta make more money.

Host: Right. You just need more That's all, right.

Ryan Daly, MD, FACC, FASE, FSCMR, FSCCT: So, that's not terribly helpful advice, you know, eat better, move more. So, the things that really make somebody healthy from a heart perspective, makes them healthy from a variety of different things. So, number one, we'll start with diet. Because that's a big problem in a lot of different patients, is you want to eat a heart healthy diet.

So what does that mean really well? The diet that has the most data on it is something called the Mediterranean Diet. That is one that has a lot of great data and, let's say that the main things about these diets is that they minimize processed food. Processed food, I tell people is food that a caveman wouldn't be able to find if he went hunting and gathering, or God didn't put on this planet.

Okay, so they're, they're not going to have come across donuts or french fries or pizza, but they might a number of different plants, animals, and, and nuts and berries. So things that are full of vegetables, heart healthy grains, lots of color in your diet as far as fruits and vegetables, and I suggest high quality protein. And that protein can be a variety of different things. They do recommend more plant-based protein than animal-based protein. That's fine. I just want to make sure people are getting an adequate amount of protein in their diet. That's usually weight-based and age-based. So, you know, we can talk about those details a little bit later.

I advise my patient's try to avoid anything fried. Try to minimize added sugar. Try to avoid, things that are just heavily processed that have the fiber stripped from them. Most of us don't eat enough fiber. Most of us don't eat enough vegetables. Most of us don't eat enough protein. So really tracking and paying a lot of attention to what you're eating and taking some time to educate yourself about what is protein, what is fiber, what is a good carb? So what do I call good carbs? Good carbs are carbs that have fiber in them. So, these are things like vegetables and fruits, whole grains, breads and things like that, not so much. You can eat healthy with rice, some people, but you have to make sure that that is part of a diet that is satiating, makes a person full. And you want to make sure that you're not overeating your foods as well. So, you know, most people can figure out how many calories that they need a day, and that's also important as well.

So a lot of this starts with some meal planning. And the issue with this meal planning is everybody's feeling the bite of inflation nowadays. And eating healthy is expensive. Getting the fresh fruits and vegetables, getting the lean cuts of meat, things like that. So that's diet, plants, animals, nuts and berries. More plants than animals. Leaner proteins. No fried foods, minimizing added sugars.

Host: Wondering, doctor, about health by subtraction. Like what does that mean exactly and what kinds of things should we limit or avoid?

Ryan Daly, MD, FACC, FASE, FSCMR, FSCCT: Charlie Munger always says, you know, when you look at a problem, it's important to invert. If you wanted to make somebody sick, how would you do that?

Well, you'd tell them to go smoke a lot and do a lot of drugs, right? So these are things that you don't want in your diet, okay? You don't want in your lifestyle. You don't want to be smoking. Smoking is probably the absolute worst thing that you can do for your health outside of an, you know, illicit recreational drugs.

Alcohol. Alcohol. People used to say, oh, alcohol's good for the heart. And then, no, no, no alcohol, unfortunately, it's not really great for the heart. Even wine I think that that was a psyop to be completely honest. It raises your blood pressure. It doesn't make you sleep well.

Can it be part of a healthy diet? Yeah, I think so. But the issue is, is that people think that it's, that means, well, you should drink it, you know, and they should be adding it to their diet. Well, no, I wouldn't say that. I think that most people would be served by not having empty calories that cause insulin resistance.

80% of the United States population has one marker of metabolic dysfunction, means that 80% of the population is metabolically unwell, and that's the first step towards chronic disease. So that's one major thing.

Host: And Doctor I hear all the time that we're supposed to move more, right? So tell us about moving more and the value in doing that.

Ryan Daly, MD, FACC, FASE, FSCMR, FSCCT: Well, most of us are unfortunately ungodly inactive, not all of us. But compared to what we used to do, we're not doing what we need to be doing. It's been shown that the more you move, the longer you live. The higher level of exercise that you can do, something a marker that we call the VO2 max. People are at the higher VO2 max at different ages. They tend to live the longest.

That tends to be one of the strongest predictors of how long you're going to live is how cardiovascularly fit you are. And that kind of makes sense, right? So that requires us to be pretty active as far as, not just walking, but brisk walking, like you're late to church, trying to catch the bus.

The current recommendations are 150 minutes of dedicated exercise per week. Okay? So that's really not a ton. That is the bare minimum, and most people don't meet it. So let's break that down. That's five days, okay of doing 30 minutes of dedicated exercise. Now, dedicated exercise, I would say is a brisk walk, you know, at a little bit of an incline, like three and a half miles an hour, maybe 2% incline, you know, or if you want to do the elliptical or you want to go swimming, or you want to go for a jog.

So that's to get your baseline cardiovascular fitness. Okay. So when we say move more, that's what we're talking about. And then there's other parts of this that, you know, most of us, are very blessed in the United States and we have access to things like Smartphones. Not everybody does, but a lot of people do.

Or they have a pedometer or they have some way to track their steps. So have somebody help you take a look at how many steps are you doing a day. And I'd say that most people are probably doing under 5,000 steps a day. I'd say half the population is doing under 5,000 steps a day. Under 4,000 is sedentary.

So, this is a really great opportunity to have something actionable with your health, which is walk more, make sure, take a look, put it down, write it down on the calendar. Okay. Or schedule it. For me, if something doesn't get scheduled, it doesn't get done. So, you know, when I want to go work out, I have it on the calendar, when I want to do resistance training, it's on the calendar and it's scheduled like an appointment I have with a patient or you know, a lawyer or going to the post office. It's scheduled, it's on my calendar because it really is that important. You know, why work and bust your backend, all your life, not to enjoy the fruits of your labor in your old age by neglecting your health now.

So, let's be more physically fit. The other thing that we're supposed to do is we're supposed to do strength training or what we call resistance training. Now, that doesn't mean that you have to go be Jay Cutler and start doing bodybuilding, but sarcopenia. That's the medical term for you don't have enough muscle, is rampant. The American College of Cardiology recommends doing some type of resistance training. That means lifting weights and that weight can be your body weight, twice per week. Okay? And usually 30 minute sessions. So this is the prescription for physical activity, and this is considered the floor. Now a lot of people that are hearing this, they're probably not ready to go do 150 minutes per week of exercise. They can probably walk that far, but this is something they should really discuss with their family doctor or some type of a clinical advisor to make sure that, that they can get there safely. It's a process, but it's very, very important.

Host: So let's talk about belly size and the downsides, doctor, of having a bigger belly. Like what does it mean, what does it indicate, and so on?

Ryan Daly, MD, FACC, FASE, FSCMR, FSCCT: You know, look at yourself, in the mirror and measure how big your belly is at the belly button, and then compare that to what it should be on the internet.

Your waist size is an unbelievably powerful predictor of chronic disease and including heart health, because that is a surrogate or proxy for how much bad fat you have. Okay? There's two different types of fat. There's the fat that's underneath your skin. We call that subcutaneous fat. That's pretty harmless.

It's not very pretty, not very cosmetic, but it's actually protective. There's a deeper fat that we call visceral fat that is around your organs. And that stuff's like kryptonite. That increases a risk of diabetes, high blood pressure, heart disease, cancer, even. It's awful, awful stuff. So, the first surrogate marker of that is how big is your belly?

We can get more granular on this, and you can get different types of imaging tests to see how much you have. One of them is called the Dexa scan. I don't want people running out getting that, but, if you have a normal waist size, it may be worthwhile doing that occasionally, okay to see where is your visceral fat content. Again, we're talking about optimizing health. Most people, we don't need to do all of this fancy testing. We can look at, you know, how are your triglycerides? How's your blood pressure? How is your weight? How is your waist? These things we want to optimize first. That's to get you from the C minus to the B plus.

You know, these other testings are usually to get you from that B plus to the A plus. So, you know, don't smoke, don't drink. Don't do drugs.

Host: So doctor, I want to talk about prevention a little bit and maybe some of the things that we can do. A heart check, maybe the calcium score or anything else that folks can do, but especially women that they should be prepared to do and think about doing, speak with their primaries about maybe every couple of years, every decade, something like that.

Ryan Daly, MD, FACC, FASE, FSCMR, FSCCT: One of the tools that we have is something called a calcium score. So, Franciscan calls it a heart scan. So what this is, is it's a very low radiation CAT scan that quantifies the amount of hard plaque that a person has in their heart. The more plaque you have, the higher the risk likely, that you could have a bad heart event.

And this might help guide, how we treat you as far as how aggressive to be regarding your cholesterol levels, your blood pressure levels, or either whether you should be on an aspirin or not. The scan isn't for everybody. You should discuss with your family doctor, whether the scan is right for you.

Typically it's for people who are older than the age of 40. Usually 45, that have some risk factors for heart disease such as smoking, high blood pressure, diabetes, strong family history, mom or dad had a heart attack or a brother had a heart attack, high cholesterol or inflammatory disease such as rheumatoid arthritis, something like that. Every woman and every man should get a certain blood test called an LPa. It's for lack of a better explanation, it's a genetic form of cholesterol that can identify people who are at higher risk of developing plaque in their lifetime.

So this is something that everybody should get checked at least once.

Host: Yeah. And oftentimes the calcium scores are like 49 bucks and whether insurance pays or not, it's a pretty good investment, you know, for less than 50 bucks. Doctor, I appreciate your time today. It's always good to get a sense for men and women, the things, as you say, like family history, genetics, we can't really outrun that stuff, but there's lots of stuff that we all do to ourselves, whether it's smoking, drinking, living a sedentary lifestyle, all that stuff.

So a real good sense of what we men, women, everybody can do to help themselves. And obviously get that calcium score, a relatively inexpensive way to have a sense of what's going on. So appreciate your time. Thanks so much.

Ryan Daly, MD, FACC, FASE, FSCMR, FSCCT: Thank you very much.

Host: To learn more, visit Franciscan Health.org/HerHear and if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.