Diet
The dietary requirements for cardiac health remain complex and there are multiple diets advertised throughout the world. It is important to distinguish what one is trying to achieve with the diet. For example, a diabetic diet will be very different to a weight reducing diet which will be very different to a cardiac diet. For example, a healthy cardiac diet maybe high in calories and may lead to weight gain rather than weight loss.
With regards to cardiac risk, I would promote a pure weight reducing diet until the weight is normalized.
Having normalized weight, which itself has probably got the biggest impact in reducing cardiac risk, I would then focus on a healthy cardiac diet. Personally, I do not think this needs to be a complex issue requiring a dietician input. Whilst it is important to avoid certain foods, a healthy heart diet is more about what you add to your diet than omit. Put very simply, we should be reducing our saturated fat intake and dairy products, we should aim to continue eating meat but make it lean meat, and of particular importance we should be increasing our fruit, vegetables, fibre, legumes and of course fish. Arguably it is the increase in fibre, vegetables and fish that has the most benefit. The so called ‘Mediterranean’ Diet.
Weight Loss and Obesity
Unfortunately for multiple reasons we are becoming an obese society, in particular with increased abdominal girth. It is now recognized that over and above BMI (body mass index) central obesity with increased abdominal girth remains one of the strongest risk factors for cardiovascular disease. This is partly related to the relationship of abdominal girth to high blood pressure, Insulin resistance and adverse cholesterol profiles, the so called Metabolic Syndrome. It is this group of patients that I believe have the greatest benefit from life style changes and I am very confident that with normalization of body weight and abdominal girth nearly all the metabolic abnormalities, including the blood pressure, will normalize and will enable patient to reduce and possibly come off their medications. Excess Adipose tissue (fat cells), particularly around the stomach and abdomen with increased abdominal girth, should be regarded in the same manner as a malignant cancer. Fortunately, unlike most malignant cancers, this one is entirely Curable.
It is particularly in these patients that I say to “… if you give me your body for six months I can almost guarantee to reduce your cardiac risk profile and get you off many of your cardiac medications”.
Is this achievable?
Most people find it hard and would say ‘No’. However, one of the oldest laws of Physics, is the law of conservation of energy, such that if you put in more calories to your body than are burnt off, you will gain weight, and if you burn off more calories than are put in you will loose weight. Unfortunately, there are two caveats to this:
The fact is that the body is a very efficient piece of equipment, and if you reduce your calorie intake your metabolic rate will reduce in parallel with this until you get down to approximately 900 calories intake per day, which is the minimum the body can operate at. (Does it surprise you that many over the counter weight reduction schemes talk about 900 calories a day!) Therefore, it is important to keep the metabolic rate high and this can only be achieved by regular exercise. Although during exercise itself you actually burn up quite a small amount of calories, with appropriate exercise you can maintain a higher metabolic rate for the next 24 hours, till you next exercise.
The second very important point relates to Insulin resistance. Insulin resistance leads to Fat deposition and Weight Gain, and excess Fat (particularly around the abdomen/stomach) leads to Insulin resistance- an unfortunate vicious circle! With Insulin Resistance almost all diets will fail, as Insulin inhibits Lipolysis (burning up fat).
As such, Calorie reducing diets often fail unless we find a way of Getting your Insulin Sensitivity back. Fortunately this is entirely possible through a fairly simple Life Style approach:
Intermittent fasting, or more correctly, daily fasting of 18 hours with a 6 hour eating window. This is often regarded as impossible, but simply involves missing breakfast, and eating lunch and dinner.
Avoiding Carbohydrates.
Daily exercise, the more the better, done in the morning during fasting on and empty stomach.
During the fast you run out of the immediate energy source in the blood, then run out of energy sources in the Liver and muscle, but you have an enormous source of energy in fat cells, which are now accessible as your Insulin Sensitivity is back.
Now, here’s an important point. You do not need to ruin your life by dieting and miss out on quality of life. Once you have reached your target weight, the by CONTINUING to EXERCISE, you may be able to be more relaxed with your diet. The 6 to 12 months of strict dieting is a small investment for the future.