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Proper nutrition can change course of CHD, other diseases
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BOSTON — Nutrition is a powerful source of cardioprotective intervention and physicians must be better about incorporating nutritional education into their treatment plans, according to a presentation at the Cardiometabolic Health Congress.
“I really call nutritional work interventional cardiology,” Stephen Devries, MD, FACC, executive director of the Gaples Institute for Integrative Cardiology and associate professor at Northwestern University School of Medicine, said during the presentation. “Now, I know my lead-wearing colleagues take umbrage with this idea, but when we think about interventional cardiology, we’re trying to intervene and change the course of heart disease. If we’re not changing the course of disease with nutrition, what is?”
Although emphasizing improved nutrition may seem like a simple goal, there is evidence that such strategies are not being utilized as frequently as they should be, Devries said, adding that much of the problem comes from a lack of nutritional education for physicians themselves. In a 2017 report from the American Journal of Medicine, 90% of cardiologists said they received very little, if any, nutritional education during their fellowship.
Understanding the importance of nutrition in treatment is important because of the many benefits. According to a JAMA study in 2017, 45% of cardiometabolic deaths can be attributed to a suboptimal diet, with high sodium and processed meat intake and a lack of nuts/seeds and marine omega-3 are some of the major contributing factors. In addition, a 2018 JAMA study found that poor quality diet was the No. 1 risk factor for death in the U.S.
Diet intervention has been shown to reduce these risks, with multiple studies indicating that a Mediterranean diet (more fruit, vegetables, fish, nuts, olive oil and whole grains) can drastically improve cardiometabolic health, Devries said.
Diabetes risk can also be mediated by improved nutrition, even in comparison to metformin. A 2002 study in The New England Journal of Medicine showed that 58% of people with borderline diabetes avoided full diabetes with 30 minutes of walking and 12 lb of weight loss over 3 years compared with 31% of people who took metformin.
“It might seem ... this was a very intensive exercise and diet program that would be very difficult to replicate. But take a look at what was involved,” Devries said. “I think by any stretch we would say that these are significant changes but not ones that are completely out of the question or difficult to achieve.”
Even for patients with diabetes, diet continues to be an important tool to improve CV outcomes, with the highest quality diets improving the HR for CVD mortality by nearly 25%, according to Devries.
Improvement from nutrition is thought to take an extended period, but this is not necessarily the case, Devries said, citing evidence from NEJM that showed the Dietary Approaches to Stop Hypertension (DASH) diet lowered systolic BP within 2 weeks. Additionally, the Mediterranean diet, as evidenced in the Lyon Study, leads to a higher percentage of people without CV events compared with those on a normal diet in the first year.
Determining which foods are best for cardioprotective health is an important step to utilizing nutrition-based cardiologic intervention. Devries said dark green leafy vegetables contain a multitude of beneficial substances for cardiometabolic health.
“Think about this next time you go through the store and look at green leafy vegetables,” Devries said. “This is polypharmacy that really works.”
In addition, blueberries, which Devries describes as the “natural purple pill,” and other berries lead to multiple benefits, including improved endothelial function and lower BP due to anthocyanins. Nuts are another food group that would create major benefits when incorporated into daily dietary intake, especially in relation to CVD, he said.
Devries said adding foods with proven benefits to the diet is necessary, but so is replacing some of the more harmful substances that are digested. Saturated fats and sodium are two that warrant attention. Devries cautioned against replacing saturated fats with refined carbohydrates and advised using whole grains along with monounsaturated and polyunsaturated fats, which can be found in olive oil and fish, respectively, as healthier alternatives to saturated fats.
“It’s interesting that the replacement with the greatest benefit is fat for fat, saturated fat for healthier fat,” Devries said. “The idea isn’t that we need to be on a low-fat diet. The idea is we need to be [eating] healthier [fats].”
As for sodium, Devries said he does not believe it is effective to discuss the number of grams consumed by patients, but rather to look at where the majority of sodium intake comes from. Such common foods as bread and cold cuts are some of the greatest sources. Devries also warned of the dangers of processed meats, which have been shown to increase risk for CHD, diabetes and cancer.
Perhaps the most difficult step of nutritional intervention is communicating with patients. Devries advised physicians to focus on addressing one nutritional item each time a patient visits the office. This includes discussing how many dietarily beneficial foods a patient is eating, which he said can be almost analogous to discussing their adherence to medication dosage. Physicians also need to enforce the idea that improved nutrition is foundational for good health.
One way physicians can accomplish this goal is by ensuring they incorporate better nutritional practices into their own lives. A 2010 study from the Canadian Journal of Public Health showed that medical professionals who ate more fruits and vegetables were more likely to engage in nutrition counseling with their patients.
“If you convey it’s important, coming from you as primary health care provider, that will send a message that’s very powerful,” Devries said. – by Phil Neuffer
References:
Devries S. Interventional cardiology delivered with a fork. Presented at: Cardiometabolic Health Congress; Oct. 24-27, 2018; Boston.
Appel MJ, et al. N Engl J Med. 1997;doi:10.1056/NEJM199704173361601.
de Lorgeril M, et al. Circulation. 1999;99:779-785.
Devries S, et al. Am J Med. 2017;doi:10.1016/j.amjmed.2017.04.043.
Frank E, et al. Can J Public Health. 2010;101:390-395.
Knowler WC, et al. N Engl J Med. 2002;doi:10.1056/NEJMoa012512.
Micha R, et al. JAMA. 2017;doi:10.1001/jama.2017.0947.
US Burden of Disease Collaborators. JAMA. 2018;doi:10.1001/jama.2018.0158.
Disclosure: Devries reports no relevant financial disclosures.