For your heart’s sake…

Watch what you eat

For much of his life, Jackson Ellisor believed he was leading a “pretty healthy” lifestyle. Though he occasionally indulged in an ill-advised food choice – a bacon cheeseburger or pork ribs slathered in barbeque sauce, for instance – he felt he was offsetting the potential harm with regular exercise, such as jogging. 

Then, a few years ago, at the age of 57, the husband and father of two began feeling short of breath while running a race. “After about a mile I had to slow down to a walk,” he says. At first, he brushed off the incident. But when the same thing happened again a few weeks later, Ellisor decided to see his doctor.

A stress test, in which a technician monitored his heart and respiration while he ran on a treadmill, suggested that blood was not flowing freely through Ellisor’s cardiovascular system. A follow-up angiogram, in which doctors viewed x-ray images of blood flowing through his heart, indicated significant blockages in several arteries. 

His cardiologist recommended that Ellisor have bypass surgery, a procedure that shuts off blocked portions of an artery and repairs the vessel with a vein taken from another part of the body. Wary of proceeding right away, Ellisor sought another opinion.

The second cardiologist he consulted suggested he do a scan called a PET cardiac stress test, which enables a clear view of blood flow while using a drug to accelerate the heart rate rather than having the patient walk or run. This time, Ellisor received better news. “You don’t need bypass surgery,” the doctor told him. “I think we can treat this with diet, exercise and medications.”

With that, Ellisor got an opportunity that evades many cardiac patients. Temporarily spared from heart surgery, he had the chance to try to address his cardiovascular problems himself. The way nutritionist Molly Kimball sees it, such a reprieve from invasive treatment is a gift. 

Kimball, a registered dietician with Ochsner Fitness Center, says it’s a good idea for cardiac patients who are not severely ill to talk with their doctor about potential alternatives to procedures such as bypass surgery or the placement of stents in arteries. “Ask if you can have a three-month window to lower your blood pressure or reduce your cholesterol on your own,” she says.

Having counseled hundreds of cardiac patients on nutrition during the past few decades, Kimball says she has seen many reap benefits from a better diet even after having a heart attack or surgery. In 2013, she founded Ochsner’s “Eat Fit” program, which develops health-conscious menu items and recipes for use in restaurants. Kimball has worked with chefs throughout New Orleans and many other regions to encourage them to put Eat Fit options on their menus for patrons who are trying to manage their weight, diabetes, blood pressure or cholesterol. “Our goal is to help people by making the healthy choice the easy choice,” she says.

While better health is the goal, Kimball says a common reason that people seek help with their diet is vanity: “The majority come in with a goal of losing weight.” But people with weight problems often have related conditions, such as diabetes, high blood pressure and high cholesterol, all of which can increase their risk of heart disease, she says.

Kimball advises anyone who wants to improve their diet not to feel overwhelmed by the challenge. “Too many people put up barriers to their success before they even give it a try,” she says. A nutritional adviser can help break the process into manageable steps, such as reducing sugar intake.

Tips to help prevent cardiovascular disease

  • The American College of Cardiology and the American Heart Association in 2019 jointly issued guidelines that include the following:
  • The most important way to prevent atherosclerotic vascular disease, heart failure and atrial fibrillation is to promote a healthy lifestyle throughout life.
  • All adults should consume a healthy diet that emphasizes the intake of vegetables, fruits, nuts, whole grains, lean vegetable or animal protein and fish, and minimizes the intake of trans fats, red meat and processed red meats, refined carbohydrates and sweetened beverages. 
  • For overweight adults, counseling and caloric restriction are recommended for achieving and maintaining weight loss.
  • Adults should engage in at least 150 minutes per week of moderate-intensity physical activity or 75 minutes per week of vigorous-intensity physical activity.
  • For adults with type 2 diabetes mellitus, lifestyle changes, such as improving dietary habits and achieving exercise recommendations, are crucial. 
  • All adults who use tobacco should be assisted and strongly advised to quit.
Source: The 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease

Though it is widely understood that consuming too many fatty foods, particularly those that are high in saturated fats, can produce long-term damage to the cardiovascular system, people tend to be less aware of the dangers in added sugars and processed foods, Kimball said. Sugars added to most soft drinks, and “white” carbohydrates typically contained in cereal bars, granolas and crackers, can be just as damaging as saturated fats. “White, refined flours are often found in foods that masquerade as nutritious,” she points out. A dietician can help steer people away from such traps. 

The importance of diet in maintaining overall health, and heart health in particular, has become increasingly clear in the medical community. As public health professionals have focused on common chronic health problems in the population at large, primary care physicians and cardiac specialists have also come to view dietary changes as crucial to a successful treatment outcome. 

Keith Ferdinand, a cardiologist and professor at Tulane School of Medicine, sees a rising awareness in the medical community that addressing chronic issues requires educating people about how to lower their own risks. “If you want to decrease the disease burden on society, the best way is to change the dynamics across a whole population,” he says. 

Ferdinand, who holds the Gerald S. Berenson Chair in Preventative Cardiology at Tulane, notes that many heart ailments that become evident in middle age are rooted in a person’s childhood. Some problems have genetic links, but conditions like obesity, high glucose and high cholesterol, can also arise from the diet and lifestyle of an individual’s early life. “Preventive cardiology aims to treat the disease before it becomes clinically evident,” Ferdinand says. He adds that a “bedrock” of prevention is a plant-based diet that limits red meat, avoids saturated fats and incorporates proteins from fish. “You don’t have to become a vegetarian, but studies have shown that basic dietary changes can substantially decrease a person’s risk of dying from a heart attack.”

Ferdinand emphasizes that a patient who has been diagnosed with a cardiac problem should follow a doctor’s orders regarding treatment, including prescriptions for blood pressure medicine, statins to lower cholesterol and blood thinners for atrial fibrillation or arrhythmia. “For a person who has already developed significant cardiovascular disease or had a heart attack, stroke or heart failure, it would be a mistake to think that medications are not necessary,” he says.

But evidence that changes such as limiting one’s salt intake are effective in reducing hypertension, heart failure and chronic kidney disease, among other conditions, has made dietary discussions part of Ferdinand’s routine patient care. Sometimes he also refers patients to an innovative nutrition program at Tulane for further counseling.

Heather Nace, operations director at the Goldring Center for Culinary Medicine at Tulane, has seen numerous referrals from medical professionals around the city. “We are here to primarily serve the medical students because, traditionally, students learn very little about nutrition,” Nace says. “But we also offer free, community cooking classes that involve the same things we are teaching the students.”

Founded in 2012, the program focuses on how to choose nutritious foods and prepare healthy meals at home. Nace, who is both a registered dietician and a chef trained in culinary nutrition, realizes that a lot of talk about carbohydrates, proteins, fats and minerals can be boring, so the Tulane program tries to show students and community participants what a good diet and healthy cooking actually look like. 

“It’s easier to talk about nutrition when you have experience doing it,” Nace said. “And when physicians can do this in their own lives, they are better able to share their own healthy behavior with their patients.”

In her classes, Nace teaches students how to be mindful of what they eat, read nutrition labels and look for foods that contain the least sugar, salt and fat. She shows how to plan meals in advance to incorporate crucial food groups. But she also offers tips on how to make a meal healthier on the spur of the moment, by adding a salad or a bag of frozen vegetables, for instance. “We’re all busy and we can’t make every meal from scratch,” she says. “But if we understand how to put together a simple, nutritious meal that’s also delicious, then we can improve our health.”

One person who has taken heed is Ellisor, who now is four years removed from the threat of surgery to repair his blocked arteries. Initially, along with taking a beta blocker, a blood pressure medicine and a statin prescribed by his doctor, he began revamping his diet to focus on fruits, vegetables and fish. He cut out fried foods and reduced his sugar and salt intake. And he began bicycling every day. The result: He has dropped 30 pounds, his blood pressure is under control, and the only medicine he still takes is the statin to maintain a healthy level of cholesterol. A recent scan showed that the narrowing in his arteries also has improved.

Ellisor says he feels great and that his sense of well-being is a reward for the lifestyle changes he has made. But he acknowledges that he certainly did not undertake those changes on a whim. “The prospect of having my chest split open to repair my arteries was a huge motivator for me to try something else,” he says.

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