Transcription:

Prakash Chandran: As many of us know, heart disease is the leading cause of death in the United States. Though some families are more susceptible than others, there are preventative steps that we can take to improve our overall heart health and to live happier, namely through exercise and nutritious diet, which we'll learn all about today.

We're going to talk about it today with Dr. Ghassan Mohsen, a board-certified cardiologist and an internist, and Ravneet Sohal, a certified health coach and congestive heart failure support group facilitator, both at Ridgecrest Regional Hospital.

This is the Ridgecrest Regional Hospital podcast. My name is Prakash Chandran. So Dr. Mohsen and Ravneet, really great to have you here today. You know, we're talking about heart disease and heart health and how to improve it. And Ravneet, I thought I would start with you. I wanted to ask what is the underlying cause for chronic conditions and can they be prevented?

Ravneet Sohal: Yes. Thank you, Prakash. The underlying cause for most chronic diseases is basically inflammation and that's inflammation throughout the body. Some examples of diseases that would occur with inflammation are cardiovascular disease, Alzheimer's, diabetes, arthritis, autoimmune diseases, neurological diseases, pulmonary, and even cancers as well. And of course, it can be prevented. And it can be prevented just by avoiding inflammatory foods and eating more anti-inflammatory type of foods.

Prakash Chandran: So Dr. Mohsen, one of the things that Ravneet mentioned was inflammation. And when we talk about inflammation, what exactly does that mean? And how does that go about affecting your heart health?

Dr. Ghassan Mohsen, MD: Oh, yes, Prakash, great question. So inflammation underlies a lot of our chronic diseases due to the nature of its pathology. So an inflammation, there is an upregulation in a lot of the flight or flight responses, including stress hormones; cytokines, which are considered also a form of stress hormones that lead to changes at the cellular level. So in basic terms, what we want to avoid are things like, plaque buildup in the arteries, cells being stimulated to turn over too quickly due to damage or oxidation. And with both of these processes, they are linked to chronic diseases like atherosclerosis, heart disease, hardening of the arteries, vascular disease like stroke, and then things like diabetes and, finally, cancer when there's DNA damage that can't be repaired.

Prakash Chandran: Yeah, thanks for that clarification. And Ravneet, you were saying a big piece of this is staying away from inflammatory foods. Can you tell us what those are?

Ravneet Sohal: Sure. So basically, inflammatory foods are foods that are going to cause inflammation in your body. So those are foods such as processed greens or white flour, so that's white bread, white rice, white pasta, cake mixes; foods high in sugar, those are also inflammatory foods, so candies, pastries, cookies, soft drinks, you know, your apple juice, grape juice, fruit juices. But we also have fluids high in fat like butters and margarine; processed foods, fried foods, also added fat, like the ranch dressings, mayonaise, spreads. Another inflammatory food, which is quite important, are your red meats like beef, processed meat, salami, pepperoni. So all those are your inflammatory type of foods.

Prakash Chandran: Okay. So, understood. It seems like you've ruled out a lot of what I unfortunately eat often, which I understand that I need to become better at. So can you talk a little bit about what anti-inflammatory foods are and what we should be focused on eating?

Ravneet Sohal: Yes, sure. So anti-inflammatory foods are foods such as cruciferous vegetables. So those are vegetables like broccoli, cauliflower, brussels sprouts, kale, and cabbage. The science behind this, they contain this compound called sulforaphane. And what sulforaphane does is that it helps detoxify the body and it actually eliminates cancer-causing free radicals in the body, and it promotes cancer cell death, this sulforaphane compound. There was actually a study done in 2020, Australian study, and it found that cruciferous vegetables were linked to a decline in blood vessel disease, so very good for cardiovascular health.

Also another anti-inflammatory food are your dark berries, blueberries, raspberries, strawberries, cranberries, pomegranates. These are really good. They actually contain something called ellagic acid and polyphenols, which are excellent antioxidants, and they're actually anti-mutagenic. And then another group of anti-inflammatory foods are your carotenoids. So your carotenoids are basically natural compounds that are found in colorful veggies, so you know, your pigmented type of foods. Carotenoid pigments, it actually promotes antioxidation in your body. And so those foods are carrots, yams, tomatoes, apricots, watermelon. So those are the foods that kind of have that reddish hue to them, and those are your carotenoids. So we just want to make sure that we're eating more of those anti-inflammatory foods.

Prakash Chandran: Ravneet, as I hear you go through this list, it's very clear to me that a lot of what you're mentioning are things that Americans eat on a day-to-day basis, right? And it's hard to change. So if you had to pick, for example, a food or one thing that people should absolutely avoid, what would that be?

Ravneet Sohal: Yes. So, you know, there are certain foods for high cholesterol, blood pressure, diabetes that should be avoided. Now, if you have high cholesterol, you really want to reduce, even avoid, the intake of trans fats as well as saturated fats. So, what are saturated fats? So those are foods such as whipped cream, red meats, like beef, processed meats, desserts, ricotta cheese, butter. And then you also want to avoid trans fats such as fried foods, like french fries, spreads like margarine, pastries, donuts, chips, crackers, and cookies.

And then also, if you have high blood pressure, you need to watch your sodium. So you really got to cut out the salts, you know, remove that salt shaker from the dining table. You should be taking in about less than 1500 milligrams of sodium, so that's like two third teaspoon of salt. And you really just want to avoid or just really be aware of foods such as commercial non-whole grain bread, like white bread, rolls, condiments like mayonaise, ketchup, those are very high in sodium. Cold cut meats, again, like bologna and ham. Foods such as pretzels, chips, snack mixes, and crackers and also canned foods. Canned foods have a lot of sodium in them. And if you are eating canned foods, you really want to make sure that you're rinsing them thoroughly.

And then also for diabetes, you want to avoid processed sugars. So basically, when you're reading the ingredients on the food label, you want to make sure that you're avoiding the foods that have words in them like sucrose, maltose, fructose, those are all different types of sugars. And then you also want to avoid processed flours, like white breads, pastas and cereals. Specifically, you know, top foods with high sugar are your fruit juices, you know, your grape juice, apple juice, sodas, candies, cupcakes, pancakes, chocolates, granola bars. Also, condiments such as barbecue sauce, that has a lot of sugar in it, as well as ketchup, honey mustard, salad dressings, and canned fruits.

Prakash Chandran: Alrighty. We've talked a lot here about the things that you should absolutely avoid. And so now, I really want to narrow in on a diet that we can realistically eat and maintain. And I guess the first group of people that I wanted to address was who you kind of opened with, like the people that actually have high cholesterol, hypertension, diabetes, you know, they are the ones that are really going to need to watch this. Let's start with them. Like, what exactly should they be eating to stay healthy?

Ravneet Sohal: So they should be eating high fiber foods. So those are foods such as legumes, as in beans, lentils, garbanzos, vegetables as well, like eggplant, okra, sweet potatoes, fruits, these fruits that are high in fiber, such as figs, pears, raspberries; whole grains, you know, brown rice and quinoa, all those are very high in fiber, also nuts like almonds walnuts, pecans, all of the unsalted. Omega-3 sources, so those are very good for you as well, like fish, flax, walnuts. You want to also increase your intake of potassium, calcium and magnesium, and those are, you know, potassium-rich type of foods, such as potatoes, sweet potatoes, fruits, like kids love bananas and peaches. Vegetables that are high in potassium are squash, broccoli, spinach; your legumes again, white beans, lentils, soy, lima beans, so those are all very high in potassium and they should be consumed more often. Calcium-rich rich foods like greens, so your collards, kale, turnip. Beans as well are high in calcium. We want to also eat magnesium-rich foods. So those are basically your nuts wanting to make sure that they're unsalted. Almonds, cashews, peanuts, beans, brown rice, avocados, all are high in magnesium. So all those foods and then also you want to make sure that we're keeping in mind our anti-inflammatory foods as well, so those cruciferous vegetables, colorful pigmented foods and berries as well.

Prakash Chandran: Yeah, I was just actually going to ask you to elaborate on the foods that will actually help people improve cardiovascular health. So I'm assuming they are the cruciferous-type foods that you were talking about, including all of the berries that you mentioned. Is there anything else that's, you know, evidence-based that will actually go to improve cardiovascular health?

Ravneet Sohal: Yes, there is. So number one I would go for would be fish, like salmon, trout, mackerel. These fish, they contain fish oils, which is rich in omega-3 fatty acids. And so they will reduce your inflammation, lower your LDL cholesterol, which is the bad cholesterol, and it'll prevent heart disease in the long run. There've been many observational studies that show that people who eat fish regularly, they have a lower risk of heart attacks, strokes, and death from heart disease. Also, a metaanalysis study was done regarding fish consumption, so omega-3 fatty acids and the risk for heart failure, and the results showed that there's a lower risk of heart failure with the intake of marine omega-3 fatty acids.

Another food item is tumeric. So tumeric has been used in India for centuries to treat a variety of ailments. It has a strong anti-inflammatory response. Curcumin is actually the active ingredient in tumeric and it is also an antioxidant. Actually, the curcumin has shown to be effective against atherosclerosis and myocardial infarctions. So, that's a wonderful evidence-based spice. Beets also is another good one. It contains high doses of nitrate, which vasodilates. So vasodilate, meaning that, you know, it opens up the arteries, allowing better blood flow. So there was actually a study done, you know, just to prove the evidence base part of it that in 2013, a British study showed that simply drinking a cup of beet juice daily significantly lowered blood pressure in hypertensive patients. So just by drinking beet juice, yeah. Another one is pumpkin seeds and walnuts. There was actually a study in 2019, AHA's Hypertension Scientific sessions found that eating pumpkin seeds may help lower blood pressure. So pumpkin seeds are high in fiber and, you know, they have that heart-healthy nutrients, magnesium in them.

Prakash Chandran: You know, one of the things that you mentioned early on was fish oil. And it reminds me that there are a lot of discussions around oils, right? Which oil is the best for a heart-healthy diet? So could you just speak to that a little bit as we start to close on the food piece of this?

Ravneet Sohal: Yes, of course. Olive oil. So olive oil has anti-inflammatory and antioxidant properties, as well as antimicrobial properties. It'll boost your HDL, which is your good cholesterol. And it also has proven to prevent diabetes and strokes. Evidence base-wise, the 2020 European study found that patients who had heart attacks had better lining repair, you know, if they took in olive oil. Another study in 2020 at University of Minnesota Medical School showed that olive oil helps people live longer. So there's another study as well, which is actually very interesting, in the frequently cited PREDIMED study, people who ate a Mediterranean style diet that included four plus tablespoons of extra virgin olive oil per day had a lower risk of developing cardiovascular disease and their combined risk for heart attack and stroke from heart disease was around 30% lower than people who ate a low-fat diet.

Prakash Chandran: So just the final question really around the food is if you could pick one food that's the most beneficial that you could ever consume, what would that be?

Ravneet Sohal: Garlic, for sure. It's an antioxidant. It's antiviral. It has something in it called allicin, which is an active ingredient that prevents blood clots. It also lowers cholesterol and there was a study done, a meta-analysis study, that showed that people who consumed garlic were associated with a blood pressure decrease of up to eight points. Eight points, so garlic, sure.

Prakash Chandran: Wow. Yeah. Okay. Very good to know. So, Dr. Mohsen, I wanted to move on to you and talk a little bit about physical activity and exercise. So besides eating healthy and eating all of the things that Ravneet comprehensively explained to us, we also know that physical activity is good for you, right? But can you explain the difference between physical activity and exercise?

Dr. Ghassan Mohsen, MD: Thank you, Prakash, for all the great questions and thank you, Ravneet, for all those great insights into nutrition. So the physical activity and exercise question, well, they're actually in the same family. So if you're doing exercise, you're doing physical activity and if you're doing any physical activity, you're exercising. The main difference is conceptually. With exercise, you're going to just make an effort every day to plan your day to dedicate a certain amount of time to getting yourself on a consistent exercise program. That doesn't mean the rest of the day that you're going to just take it easy and be sedentary, but you're going to engage in physical activity, which means, you know, trying to stand instead of sit, okay? You're going to walk to your office instead of drive your car. Those are all things that are going to be physical activity. So I wouldn't make a huge difference between the two, but think of them as just being a very proactive person to get your steps in every day.

Prakash Chandran: Yeah. And just expanding on that a little bit. My uncle actually recently sent me this video on the benefits of just walking, right? Like walking for 10 to 15 minutes a day, every single day over time can have amazing benefits for you. Is that something that you can speak to?

Dr. Ghassan Mohsen, MD: Yes. Great, great question. Walking just 10 minutes a day has had extreme amount of benefits in many studies. And we just know from anecdotal experience, patients reporting they're feeling better. And on more of the physiological side, what we see happening is people are improving their circulation. And with that comes better blood pressure, better blood sugar, better cholesterol levels. All these markers are going to be beneficial for your risk for heart disease. In addition, it improves your overall metabolism, which means you're going to be burning calories for the rest of the day. So just walking 10 minutes, you're giving yourself the foundation to improve your overall health and lead a healthier life.

Prakash Chandran: You know, you made a good distinction between physical activity and exercise and the importance of just, you know, getting your steps in. How much physical activity should someone be doing?

Dr. Ghassan Mohsen, MD: Yeah. Sometimes you know, given you're seeing different numbers, you know, given by health providers or American Heart Association. So we try to simplify it to people as try to get about 30 minutes in a day if you're beginning. So if you haven't exercised in some time, and you're trying to get active, you know, starting with 30 minutes of moderate exercise daily will get you to around 150 minutes a week.

On the flip side, if you don't like doing light exercise and, you know, you're busy and you're trying to get, you know, your exercise in throughout the week, you can shoot for more vigorous activity and that might be jogging and that might be doing things like some sprints and that'll be about 75 minutes.

One thing I tell patients who ask, you know, "How do I know if I'm doing a moderate or vigorous activity?" You can, you know, do some simple tests. If you're doing moderate activity, you should be able to hold a conversation, but you won't be able to talk more than, you know, five to 10 seconds, so you have to take a break and catch your breath. Another way is to look at your heart rates. So if you're exercising in the moderate range, you're going to be reaching 50 to 70% of your target heart rate. And a lot of patients wonder, "Well, how do I measure my target heart rate?" You simply take your age, which is if you're 50 years old, and you subtract that from 220. So if you are a 50 years old, your maximum heart rate will be 170 beats per minute. And then you'll take that time, 70 percentile, if you're in the 50 age range, will come out to be about 140 beats per minute for your maximum heart rate. So, using, you know, the target heart rate to help you see where you're at, will kind of help you go along to see how much effort you're putting in with your exercise, then making sure you're getting in enough.

Prakash Chandran: Yeah. You know what? I hadn't heard of that target heart rate and the 220 minus your age, but I'm definitely going to take that with me. You know, just in regards to everything that you just cited, are there studies or is there any evidence that shows that physical activity in the way that you describe actually works?

Dr. Ghassan Mohsen, MD: Oh, absolutely. You know, studies have repeatedly showed that if you replace sedentary lifestyle with activity, you can decrease your risk of heart attack or stroke-related deaths by nearly 50%. So, you know, doing these exercises daily is very critical to try to improve your overall longevity. On the flip side, we know if you are inactive, it certainly can be very detrimental to your overall health and lead to premature aging, as well as cardiovascular illness. So, you know, shooting for that 150 minutes of moderate exercise or 75 minutes of vigorous exercise a week will go a long way to keep you from getting any of these chronic heart or chronic age-related conditions.

In addition, my interest in cardiology and I think one thing that we noted in terms of improvement in someone's health is just looking at the heart itself. With exercise, the heart can reverse a lot of damage. We know if someone has a heart attack and they participate in rehab over the following months, there's a significant improvement in both the pumping and the relaxation phase of the heart. And we've seen significant improvements in many patient's ability to exercise up to their target heart rate. With that being said, if you have started exercise, you can always increase the intensity of it. And you will also benefit in terms of having more efficiency and ability to pump the blood with less heart effort. So you will notice things like your heart rate will be slower at rest and will be slower to rise during exercise. So these are things that you can actually gauge yourself by noting your exercises working.

In addition to your aerobic activity, we also recommend using strength training and resistance exercises to improve your overall cardiac fitness. You can do weightlifting, body resistance exercises like pushups, squats, or just sports activities with your teammates to just increase your heart rate and get a good muscle and fitness workout. Also, you can try flexibility training using stretching to help improve your muscle agility and prevent injuries. We recommend strength training with your overall plan to make sure you get the most out of your cardiovascular routine.

Prakash Chandran: Yeah. And what about the physical inactivity that you mentioned? You know, I think that, broadly, we understand that if we don't do anything, it's not good for us. But what does the evidence say around inactivity or physical inactivity?

Dr. Ghassan Mohsen, MD: Oh, yes. There's been quite a number of studies showing that physical inactivity is linked to premature aging and death. And it is up in the list like smoking of premature death that's including from heart attack and strokes. So, to be specific, one study in Australia looked at a group of patients and found just an additional hour of watching TV translated to about 11% increase in all-cause death. So this just shows that if we maintain our activity level, we can certainly avoid a lot of the early-onset diseases that lead to premature death.

Prakash Chandran: So just as we close here, I wanted to ask a question of both of you. And Dr. Mohsen, I guess we'll start with you because we're talking about physical activity. You know, we've covered a lot here today, a lot of things that you can do, but if someone is listening to this and they haven't been physically active, what is the best way that you recommend that they get started?

Dr. Ghassan Mohsen, MD: Yeah. So first of all, you know, my advice is just be confident in your ability to start being an active person. And if you've had in the past poor experiences with exercise because of being discouraged or are not being consistent, try not to let it hinder you. So in a day, just take opportunities to do things like walk, go to your, you know, local park, make a 10 to 15-minute walk if you can, and try to get in at least a good 30 minutes a day. Then, you know, use things like walk to your grocery store instead of driving, carry your groceries back home. And the big thing is find support. So reach out to members of your family, your community, your doctor, and tell them about your interest in being active. And you'll find that other people will probably want to join you and be part of that endeavor. And it's a lifelong commitment. It's not something that we're going to try and then forget. It's not a gym membership. It's something that you're going to incorporate into your daily routine.

Prakash Chandran: Yeah. You know, there's two things that you said that resonated with me. One is that, you know, it kind of happens in the mind first, like you just have to believe that you can start being physically active and start being fit. And everyone always says that you kind of visualize it before you manifest it, so definitely agree with that. And then yeah, making the decision to take the stairs, right? Like even go back home in my apartment complex, I look at the stairs, I look at the elevator and, it doesn't happen all the time, but I try to take the stairs more often. So, thank you for that. Ravneet, I did not forget about you. Don't think that after all of those restrictive food things that you shared with us, I wasn't going to ask you how can someone that listened to everything that you shared, how can someone think about getting started on the road to a nutritious heart-healthy diet?

Ravneet Sohal: So basically, overall, if you slowly make changes to your diet, start small, specific, realistic, and actually doable, you will reap the rewards and you will reap the benefits in the long-term. Just make yourself a goal. Write down the type of food you will eat ,the amount you eat and how often, like for example, one cup broccoli with dinner twice a week. But have fun cooking, be creative, find healthy recipes and cook with your family and friends. Share healthy recipes. Have a cooking competition with friends. Who can make the healthiest yet most delicious meal? Eating healthy can be easy if you have fun doing it.

Prakash Chandran: Yeah, I think that makes so much sense. I think that, especially when it comes to diet, so many people think it's like an all or nothing, and they don't give themselves the grace to have and celebrate these small wins, even if it is that handful of almonds, as you mentioned. So, I definitely agree with that.

So, Dr. Mohsen and Rodney, I really appreciate your time today. Thank you so much.

That was Dr. Ghassan Mohsen, a board-certified cardiologist and internist, and Ravneet Sohal, a certified health coach and congestive heart failure support group facilitator, both at Ridgecrest Regional Hospital. Thanks for checking out this episode of the Ridgecrest Regional Hospital podcast. To learn more, you can visit rrh.org.

If you found this podcast to be 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 again for listening. My name is Prakash Chandran, and we'll talk next time.