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“[Doctors] all say that lifestyle is the foundation of health, but our practice doesn't always support that emphasis; that is where a lot of attention needs to be paid,
 and where there is tremendous opportunity….The decreasing amounts of fruits and vegetables in our diet, along with tobacco use and physical [inactivity],
 are 3 of the key lifestyle aspects that raise the risk for cardiovascular disease.”

Heart-Healthy Diets Deciphered, with Dr. Stephen Devries. Medscape, July 14, 2014

Heart-Healthy Eating

Integrative Cardiologists Stress Lifestyle

Nutrition is probably the number one risk factor—certainly the lowest-hanging fruit—for heart disease. That was the view expressed by Stephen Devries, MD, and Robert A. Harrington, MD, in a dialogue transcribed on Medscape.com (July 14, 2014). Dr. Devries is the Founder and Director of the Gaples Institute for Integrative Cardiology. He is also an Associate Professor of Medicine at Northwestern University in Chicago. Dr. Harrington is a Professor of Medicine at Stanford University and host of the Bob Harrington Show at Medscape Cardiology.

“I would enjoy the day when…the focus on lifestyle is equal to, if not eclipsing, the focus on…medications,” Devries said. What you would expect from an integrative cardiologist, which he defined as “nutrition and lifestyle combined with the best in conventional medicine.” In case you’re wondering, he doesn’t use unproven supplements or strategies. “The evidence base has to be there for whatever we do,” he emphasized, “but there is a wide range of evidence to support the emphasis on lifestyle and nutrition that isn’t applied as strongly as it could be, and that is the goal of integrative cardiology.”

Dr. Devries noted a study which compared a group of individuals who were prescribed statins with a similar group who had not been given statins. In a 10-year follow up it was found that the group who took statins consumed 10% more calories than the non-statin users. “Although it wasn't proof,” he observed, “it raised the suspicion that many people feel that when statins are prescribed, there might be a subtle implication that there is a green light to be more liberal with the diet, and it doesn't matter as much now that you are on medication.”

Dr. Harrington added that he has seen the same behavior in the prescribers. “More than once, I have been to dinner with colleagues who, as they order their dinner, say, Well, I'm not worried; I'm on my statin. It's a bit tongue-in-cheek, but I don't think that is an unusual sentiment.”

While acknowledging the “incredible” importance of statins, especially for high-risk individuals, Devries and Harrington urged a greater attention to diet. In support, Dr. Devries cited a study reported last year (2013) in the Journal of the American Medical Association that showed nutrition to be number 1 among 17 risk factors for death and disability. “[Nutrition] looms even above all of the other terrible things that we need to work on, such as smoking, physical inactivity, and so forth,” he said. “Nutrition…is the low-hanging fruit that we really need to focus on,” he added.

Diet of Choice

Asked by Dr. Harrington to describe his diet of choice, Devries responded succinctly: “An executive summary would be a Mediterranean-style diet…heavy on vegetables and fruit, and…whole grains instead of refined and more fish and less red meat. In addition, the cooking oils should be predominantly olive oil and canola-based oil. That is it in a nutshell.”

Rather than focus on individual nutrients, such as saturated fat or unsaturated fat, Devries says it’s more helpful to focus on the entire diet.

The beauty of the Mediterranean-style diet is that it looks at whole food and food groups that have been shown to be beneficial, Devries explained.

“The idea is that we don't consume saturated fat; we consume pizza, desserts, cookies, and cakes,” he explained. “The problem may be in part that these foods are high in saturated fats, but there are other things that come with the pizza: the high salt content, the high [sugar] content, and so forth.”

In keeping with Dr. Devries’ thumbnail description, the key is to stick with foods that come the way Mother Nature made them—unprocessed, with little or nothing removed or added. Plain food is best because it comes without sugar or fat added. Mediterranean-style eating is a pleasure, varied, filling and satisfying.

Dr. Devries offered two studies to provide the evidence base for his diet choice: the Lyon Mediterranean diet study (1999) and the PREDIMED study (2013). The final report of the Lyon Diet Heart Study, which involved subjects with preexisting cardiovascular disease, showed a whopping 72% event reduction in the Mediterranean-style diet group compared with the control group who just watched their fat intake. The other study dealt with healthy subjects and showed a 30% decrease in vascular events. “We have, I think, really strong data to support a whole-diet approach, and I think that if we focus on that arena versus this nutrient or that nutrient, we will be in far better shape,” he said.

Dr. Harrington also asked Devries’ opinion on the Atkins and Paleo diets. “They get a lot of press, and there are many people who say, look, the only way I can really lose weight is if I focus on taking all carbs out of my diet and replacing them with protein,” Harrington offered.

“As clinicians, we are all interested in patients living longer and better; those are the endpoints that we really care about and that have not been shown for those diets,” Dr. Devries responded. In short, he didn’t recommend either of those diets on a long term basis. They are probably not optimal, in his view.

Finally, the discussion turned to advice for doctors.

Heal Thy Self

Dr. Devries offered the perhaps surprising suggestion that doctors help themselves first. “There are some fascinating data showing that healthcare providers who change their own personal lifestyle are much more likely to counsel patients with regard to lifestyle,” he said. We might add that patients are more likely to listen to lifestyle advice from a physician who takes care of him- or herself.

Most of all, Devries urged his colleagues to “impart to the patient the idea that nutrition is really the foundation of health, and that even though patients are getting the medicine [they need]…the nutrition part is still a priority that goes hand in hand with the medication.”

Unfortunately, busy cardiologists may have only a few minutes during a clinic visit to discuss nutrition. Devries believes strongly that a few quality minutes can make a “huge difference.” He suggested that doctors focus on a single topic germane to the particular patient. “It may be the case that the patient…drinks a lot of soda, so maybe those 1 or 2 minutes are devoted to the importance of eliminating sugar-filled beverages.”

Summing up, Dr. Harrington encouraged his colleagues once again to think of “good nutrition as foundational for health.”

Hopefully, more doctors will come to appreciate the importance of helping their patients help themselves—before turning to medicine or other procedures. That may come as a surprise to many on both ends on the stethoscope.

*  *  *

To listen to or read the entire dialogue go to Medscape.com: http://www.medscape.com/viewarticle/828023?src=wnl_edit_tpal&uac=210572PK

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