Transcription:
Diet/Exercise/Activity for Keeping Your Heart Healthy

Scott Webb: There are many mental and physical benefits to eating healthier and exercising regularly, especially when it comes to our hearts. And joining me again. As Dr. Neel Khanna, he's the medical director of the Cardiovascular Institute at Montefiore St. Luke's Cornwall, and he's here to discuss heart healthy foods, popular diets, like the keto diet and the benefits of regular exercise.

This is Doc Talk presented by Montefiore St. Luke's Cornwall, I'm Scott Webb. Doctor, it's so great to have you back on, on our last podcast we discussed at calcium scores and how they can predict whether or not we're gonna have a heart attack at some point today, let's talk about diet exercise and what we can do to keep our hearts healthy. So why should we all consider exercising on a regular basis?

Dr. Neel Khanna: Exercise has many benefits as probably people have been told and I've seen before. I think the primary benefit of exercise is to slow the progression or prevent the start of significant diseases such as high blood pressure and diabetes. It's been shown that exercise helps improve glucose metabolism and decrease the amount of insulin that's released after a meal, and also helps to condition the heart by lowering the heart rate and reducing the amount of work that the heart has to do. As a result, people develop high blood pressure at a much slower rate and people help, prevent the onset of diabetes, at a much higher rate when they exercise regularly.

Scott Webb: Yeah, a lot of benefits. And I'm gonna ask you as we move along here about the sort of mental benefits as well, but before we get there, what are the recommendations for daily or weekly exercise? Generally speaking.

Dr. Neel Khanna: Generally speaking the more minimum or general recommended number is 150 minutes per week. The general thing is anything that gets you up and moving is beneficial. So, on average, we recommend that people do about 30 minutes a day, five times a week. For some people, this is a little more difficult, so we tell them, please make time to do as much as you can. The important things are the duration, meaning the exercise duration should really be more than 15 minutes, especially if you're doing aerobic, cardio exercise.

It's really, after the 15 minute mark, that people start to really condition their heart to increase their vagal tone and decrease their heart rate. Also, consistency is key. If you exercise once a week, that conditioning is much slower to progress. So, that's why we recommend four to five times a week to build that consistency into the routine. But generally speaking, I tell my patients 20 to 30 minutes, five times a week, it does not have to be very high intensity exercise. We can talk about some of the ways to monitor that in this day and age, but those are generally the numbers that I tell people to aim for.

Scott Webb: Generally the number that, yeah, let's do that because I, I know between, smart watches and, you know, apps on our phones, paper and pencil not really required much anymore. So maybe you can take us through that just generally speaking, because there's different types of devices and apps, but generally the value of using these sort of electronic aids in monitoring ourselves while we're exercising, keeping track of our progress and so on.

Dr. Neel Khanna: Yeah. It's really exercise prescriptions that doctors give patients are really changing in this day and age because of these electronic devices. We used to basically instruct patients to do aerobic exercise at a moderate pace and people were confused exactly what that meant. We would tell people do it until you break a sweat or do it until you're having a little bit trouble speaking, but still able to speak in full sentences. And that's generally middle side cardio exercise where you're not overexerting yourself and doing very high intensity.

In this day and age, if you're able to track your heart rate with the use of an Apple Watch or Fitbit, which are two commonly used ones, often what we tell people to do is to calculate their maximal heart rate that they can achieve, which is basically 220 minus their age. That's your maximum heart rate that in a normal rhythm, your heart should be able to get to. And then we tell people to calculate what is 60% of that and to exercise and start out at that rate. And so if they have a smart watch, like an apple watch or a Fitbit, if they're walking, they can increase their pace until their heart rate is consistently at that.

And one of the more, beneficial in reassuring things that I've seen patients have is that they'll notice that the more they do. The more it takes for them to get to that heart rate. And that's really encouraging to the patient because that is truly conditioning yourself. When you can do the same amount of pace and you're covering more distance and your heart rate is not going up as quickly, that means you're conditioning your heart to be used to exercise and to be used to stress.

Scott Webb: Yeah, it's very cool. As you say that between apple watches and Fitbits and all these different apps, it makes it so much easier for us to see how we're doing in real time and track our progress. Very cool. I mentioned earlier about the mental benefits. Maybe you can talk just a little bit, obviously there are many physical benefits to exercise, but I'm sure there are some mental benefits as well, just in terms of our sort of outlook on life maybe.

Dr. Neel Khanna: Listen, there has been many studies done that have touted the benefits of exercise from regular. As I discussed known health conditions, such as diabetes, high blood pressure, high cholesterol, but also with decreasing the rate of depression, anxiety often people, when they see a mental health professional, they often are encouraged to engage in regular exercise. For one, it takes your mind off of some of the things that you are anxious about.

But in addition, just some people have partially that they improved blood flow to the brain. Increased cardiac output actually helps symptoms of depression. And often I tell people regular yoga meditation, coupled with regular exercise can really help people clear their minds, think more clearly, and actually improve some depressive symptoms that people have.

Scott Webb: Yeah, just so many benefits. You're so right. I think that one of the fears, maybe some folks have that maybe holds them back a little bit is they're like, oh, you know, I used to exercise, but I haven't done it in so long. And there may be some risks to just starting up, when I've been sort of sedentary for so long, should folks, if they've been off for a long time or they have some risk factors, should they consult with their primaries first?

Dr. Neel Khanna: Yeah, it depends. What kind of exercise regimen they're thinking about starting? What I tell people is that if they're definitely training for some type of an event, or if they wanna start engaging in higher intensity exercise, things that are increasing their maximal heart rate to 85%. Like I explained before about calculating. If they're getting heart rates up, it's often a good idea to consult with their primary care doctor. And if their primary care doctor has concerns, they may ask them to seek the opinion of a cardiologist.

The general rule that I tell patients, especially if they have a cardiac history is to ease into any routine that they're going to start. Don't start zero to 60, right away, start at 30 miles per hour. Get your heart rate up to the, like I said, your 60% of what your maximum heart rate should be. See how you feel there. If you're feeling symptoms that you're uncomfortable with really having trouble catching your breath after you're done exercising or during exercising. Or getting leg pain or of course getting chest pain.

Those are red alert signs that, you should stop what you're doing. Go speak to your physician about that, and see exactly what's going on. Now, if you start at that rate, you're going at 60% of your maximum heart rate, you're breaking out in a very light sweat, you feel good. It is okay week by week to increase your rate a little bit and see how your symptoms are. That's basically what we do in physical therapy is we slowly ramp people up. And when you do it slowly and you do it responsibly and you monitor yourself, it's safer.

Scott Webb: Really good stuff. And let's switch to diet. I walk through the aisles of the grocery store and I generally try to stay on the outside of the grocery store. It seems like the better stuff is around the outside, but what sorts of, hard, healthy foods do you recommend?

Dr. Neel Khanna: general. Cool message is that processed foods are often high in sodium. They're often high in trans fats. And so we ask people to try to keep their diet as natural as possible, as much home cooked food, as you can, as many greens as you can. The general idea in the modern era, and the recommendations that we give to patients is that you should be consuming food that is easily burned. So that's often lean meats. It's vegetables.

Greens lettuce broccoli, things like this, and also fruits. These are natural foods that don't require a lot of processing that don't have additives to them and are easily burned. The general rule is that the more easily burned of food is the less it'll stick around your stomach area and the faster you will burn it. And the better you'll feel afterwards.

Scott Webb: Wanted to ask you about some of the diets we hear so much about again in the media and social media things like the keto diet. There's a lot of diets out there and I'm not sure that they're really heart healthy diets. Maybe they're more weight based, maybe it's just become all the rage and gone viral if you will. What are your thoughts generally about these sort of diets of the moment?

Dr. Neel Khanna: Yeah. What I would say is that it's sort of a studying process. It started with the Atkins and then South Beach diet and keto diet. My view on it is different than some physicians. Often, what we see is the health benefits from diets really directly relate to the amount of weight that's lost, especially if someone is in the obese category. So, you know, whereas we expected initially when people were eating high fat foods and. Their diet consisted, mostly of meats, we expected the risk of, high cholesterol and high blood pressure to actually increase. And what we conversely saw is that for a lot of people, it did drop.

And the reason for that is because those are easily burned foods. And as a result, their weight drops and with lower weight and reduced abdominal obesity and the amount of fat around your midriff. People's chronic conditions, such as high blood pressure, diabetes and cholesterol actually get better. That's incredibly important. The bottom line is what I would say is if you're gonna start a diet like that, and you're having. Great results where you're actually losing weight. You should consult with your doctor and have a lipid panel. Have your cholesterol checked a month to two months after you've started the diet.

There are some people that we've seen who've started these Corvo diets or, , very high, fat, high meat diets that their cholesterol has jumped. And as a result, it's not a good diet for them. Whereas, there are a good number of people who there actually their numbers drop their cholesterol drops despite eating high fat foods. One of the theories behind this is that people who focus on a very specialized diet, such as meats and vegetables only, they actually eat and consume a lot less calories than an average person.

And one thing we've learned over time is that as long as it's in a safe amount, the less calories you consume. The faster, the weight loss and the better, the health benefits from it. It may all be, or maybe partly that the benefits of these keto diets are basically that, because it's so specialized and because people become fuller faster, because they're higher in protein and fat that, you know, as a result, they're eating less and if they're eating less, they burn weight.

And the bottom line that I tell patients are if it causes you to lose, and you feel otherwise well and refreshed, it's probably beneficial for you. And so, our idea of what nutrition is, is continuing to change. Whereas previously where we had the food pyramid, where carbohydrates took up a large part of the pyramid, it is changing now where we have realized that consuming less carbohydrates. More greens and even more protein is beneficial for people. And it's just finding the right balance for each individual patient.

Scott Webb: I think that's such perfect advice. It's like the right balance for the person. Doctor, as we wrap up, what are your final thoughts about the value of heart healthy diets, exercise, maybe even revisiting the calcium scores, in terms of keeping our hearts healthy and making sure, or at least doing everything we can, our due diligence to prevent, major cardiac events at some point?

Dr. Neel Khanna: Think we're in an exciting time for healthcare and I really think it's a time when people can take advantage of evidence that's available to everybody over the internet and use it in a positive way. And especially these devices that now allow people to monitor themselves much closely than before that people should take advantage of some of the tools that are available. Knowing your cardiac risk with a calcium score if you qualify. Downloading an app on their phone so that they can accurately track the amount of calories that they eat on foods is a great tool that people should take advantage of, especially if they're in the overweight to obese category.

And also , these devices like Fitbits, Apple watches, other things that accurately track people's heart rate can really help them know how much exercise is appropriate for them. Are they exercising to the right intensity? It's an exciting time. The bottom line is if people use these tools and are responsible and keep their body weight low and keep a general overlook over their heart health and otherwise health, people can really do much better than they did even 10 years ago. We should use the technology and the tools that we have this day and age to really help our health and, help ourselves going forward.

Scott Webb: Well, that's awesome. You are, a dream guest doctor. I've had you on twice and you have all the answers and you do it in such a way that we can all understand, lay speak, if you will. So thank you you again, for your time, you stay well

Dr. Neel Khanna: Thank you so much.

Scott Webb: And visit Montefioreslc.org. For more information about the Cardiovascular Institute. And if you found this podcast to be helpful, please be sure to share it on your social channels and be sure to check out all the other Doc Talk episodes. This has been Doc Talk, the podcast from Montefiore St. Luke's Cornwall Hospital. I'm Scott Webb. Stay well.