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Medical Intel

Feb 26, 2019

One way to protect your heart is to choose the right diet. Discover why Dr. Allen J. Taylor believes the Mediterranean Diet—which relies on foods such as fruits, vegetables and white meat—is the best for preventing heart disease.



Intro: MedStar Washington Hospital Center presents Medical Intel where our healthcare team shares health and wellness insights and gives you the inside story on advances in medicine.

Host: Thanks for joining us today. We’re speaking with Dr. Allen J. Taylor, Chair of Cardiology at MedStar Heart and Vascular Institute. Welcome, Dr. Taylor.

Dr. Allen J. Taylor: Thank you.

Host: Today we’re discussing diet choices for heart health, specifically the Mediterranean Diet. With so many ideas online and from well-meaning friends and family, it can be tough to make the best food and beverage choices for on-going heart health. Dr. Taylor, patients hear the recommendation to eat a healthy diet all the time. What does that really mean?

Dr. Taylor: Yeah, everyone’s an expert on their own diet, aren’t they? We’ve long known that (quote) “healthy diets” - and those are typically defined, from a heart perspective, as diets that are low in fat, high in fruits and vegetables - tend to be seen more frequently in patients who don’t suffer from heart disease. On the converse, people that eat poor diets are more likely to have heart disease. And that is true. The question is, where is diet science going? And in 2018, what’s the best diet to prevent heart disease? And that’s where there’ve been changes.

Host: What questions do your patients often ask about how their diets relate to their heart health?

Dr. Taylor: When you talk to patients about diet, there’s usually two things. The first is controlling body weight. And then the second is about controlling specific health problems, such as their blood pressure or their diabetes or their cholesterol. And as you tailor diets to different patients, it often has to be highly customized to the health problems that they have. But overall, it’s about reducing heart risk. And, it can get very confusing to think, “Oh, I have to avoid salt and I have to avoid fat and I can’t eat sugar because of my diabetes.” And the question is, “What can I eat?” And patients get confused. And they get so confused, they can’t make good food choices and they give up. And they eat things which aren’t good for their health. So, how do you bring it all together? There’s so many diets - there’s fad diets, the keto diets, the low carb diets, Atkins diets, South Beach - it’s all over the place these days. And today...tomorrow there’ll be another one. The optimal diet from a heart perspective is one, if you were going to design it, is one that makes good metabolic sense and has been tested. Tested and proven to reduce heart disease risk. Now, when it comes to weight loss, that’s a simple thing. It’s about calorie balance. It’s calories in and calories out. One reason people gain weight as they age is because, they don’t realize it, with every decade they age their daily calorie requirements go down about a hundred kilocalories. Now, the average 20-year-old can probably eat 2,000 or 2,200 calories a day. The average 60-year-old has to eat 400 calories less a day just to stay in balance, 1,700 or 1,800 calories. If you’re eating like you did when you were 20 or 22, you’re gaining weight. So, calorie balance is the most important thing from a weight perspective. But then it’s about what goes in to those calories; what’s making up those calories - how much is fat, how much is sugar, how much is protein? It’s hard to eat like that. It’s hard to much protein am I going to eat today? How much sugar should I eat today? And, some people can do that. What I try to do with my patients is to make it as simple as possible and to use the best evidence-based diet as possible because we’re trying to reduce the risk for heart disease. And today, that diet is the Mediterranean Diet.  

Host: What about the Mediterranean Diet makes it so heart healthy and so, quote/unquote, “easy to follow?”

Dr. Taylor: Well, the first thing about a Mediterranean Diet, and it’s just simply a name for it, but it’s really a style of eating, it’s food choices. And, it has been rigorously studied, both in people with known heart disease and without known heart disease. Very important study, published about five years ago now, was a study called the PREDIMED study. And, it was a study of about 7,500 individuals who were either asked to eat a Mediterranean Diet or an otherwise really high-quality American diet. The American diet was things like using low fat dairy products, saying that things like pasta and rice were ok, and fruits and vegetables are encouraged, and lean fish and seafood are also okay. That sounds pretty good, doesn’t it? It’s pretty much what a lot of us eat. What was interesting is that the Mediterranean Diet is different than that. It’s a diet that’s, again, rich in fruits and vegetables but includes fish. It includes beans. White meats, such as chicken. Wine is okay with meals and that’s often a good selling point for the diet. And then it can include nuts and supplementation with olive oil - olive oil to cook or even olive oil to simply add to your food, like put it on top of salads. When those two diets - this really good quality American diet and the Mediterranean Diet - were compared, Mediterranean Diet won, hands down. There was nearly a 20 percent lower risk for heart events in people who ate the Mediterranean Diet. There was a 30 percent reduction in heart disease risk in the patients that ate the Mediterranean Diet. So, that’s a large reduction - 30 percent risk - that’s the same risk reduction seen with taking cholesterol pills, for example. So, very impactful. The thing about the Mediterranean Diet that I like in particular - while those are the things you should eat, and again, to repeat them, fresh fruits and vegetables, fish, white meat, beans, nuts are okay, wine is okay, and olive oil supplementation - it discourages certain things like soda drinks, commercial baked goods and sweets, spread fats and red meats. And what I like about it in particular is it doesn’t say you can never have those things. It’s about how frequently. For instance, most of those things should be fewer than one serving per day. And commercial baked goods, less than three servings per week. And so, when you stand in the line at your favorite coffee shop, what you’re tempted with while you’re waiting is nothing but commercial baked goods and sweets. And it’s okay to have one once in a while. Not every day, if you’re going to eat the Mediterranean Diet. And, I ask my patients, is that worth a 30 percent reduction in your risk for heart disease? And most become very interested in this type of diet because it’s about the food choices you make. And it’s not like you can never do certain things because look, eating’s supposed to be fun and eating is a part of life many times a day. It’s a social function; it’s what we enjoy. And so, the Mediterranean Diet, I think, can be compatible with a very healthy diet, a very heart healthy diet, but also one you can sustain. The problem with many of the fad diets is they’re great for a week or a month and people will often lose weight and that entices them into it, but frankly, we don’t know the safety of those diets. We don’t know if they’re heart safe. We don’t know what it does to their cholesterol and their blood pressures. In the end, that’s the most important thing. So, if you really want to follow an evidence-based diet, a diet that’s been proven to work, to reduce heart risk, it’s the Mediterranean Diet.

Host: When you give that example, what do you say to those patients who say, “Well, if it’s similar to taking a pill, I’ll just take a pill and still enjoy my cheeseburgers.”

Dr. Taylor: That’s great. Well, I say, “You know what? This was in addition to people taking pills.” So, this doesn’t replace pills and lowering cholesterol is not the goal of this diet. It’s about lowering heart risk. So, if you have a cholesterol problem, you probably will need a pill. If you have a blood pressure problem, you probably will need a pill. But this diet reduces heart risk. And it’s the types of food you’re eating and the types of foods you’re not eating that is driving it. So, it’s the diet that, from my viewpoint, we should be following for heart risk in this country. To come back to the diet that it was compared to, it was the previously recommended diet by the American Heart Association. So, those recommendations - and if you grew up through the ‘80s and the ‘90s, you were told, “avoid fat, avoid red meat, and the rest is gonna be fine.” Now, I’m summarizing, but that was what people were trying to avoid. And what do they substitute? They substituted sweets and baked goods and pasta, which are great, but small amounts. And, the Mediterranean Diet is by far a better diet from a heart risk perspective.

Host: What about those trendy diets like Atkins or like keto. What do you say when folks are wanting to try those types of diets?

Dr. Taylor: The goal of those diets is usually weight loss, and they do work in the short term. You can eat a ketogenic diet, and that’s a fancy term for a diet that is simply carbohydrate poor. So, it takes rice and breads and sweets out of the diet and focuses on vegetables and meats. And so, it’s a high protein diet. And in the short term, people will lose some water weight and they’ll lose water weight very quickly. Then it tails off. And, what the evidence is, is that, in the end, if you eat simply a calorie-restricted diet versus a ketogenic diet, the weight loss is the same. So, there’s no specific advantage of eating a ketogenic diet, when you look at 6 and 12 months out. What we’re talking about with things like the Mediterranean Diet is a diet that is more about prevention of heart disease. It’s not about weight. So, if you want to lose weight, it’s really about ins and outs - how many calories you’re taking in; how many calories you’re burning. Oftentimes patients aren’t quite aware. They’ve got a certain pattern of eating and often there’s some overeating. And, you’ve got to measure it. There’s some great health apps like MyFitnessPal. It’s a free app and you put in all your foods. It tells you exactly what you’re eating and how many calories. And there’s other ones as well. That’s important - to measure where you are and how much you’re eating. And it’ll tell you how much protein and fat and sugars you’re eating. And again, if you want to lose weight, you’ve got to measure your ins and monitor your outs. More exercise, less eating. It’s the only way to lose weight in a stable, long-term way. But from a heart risk perspective, it’s about the types of foods you’re eating. And, the best diet now is the Mediterranean Diet. That diet is better than the best American diet, 30 percent better for heart risk. It’s an easy sell.  

Host: So, when you’re thinking about all these diets - you have paleo and you have keto and you have Atkins and they have all these flashy names - well, Mediterranean Diet just sounds very fancy and complicated. How do you break that down for people so it’s something relevant to them that they can really do?

Dr. Taylor: Yeah, it can sound exotic and it isn’t and that shouldn’t scare anybody away. It’s actually just a diet that changes the quantities of things you eat to one, things that are healthier and away from things we’re probably eating too much of. And nothing in this diet is not freely available to people on a daily basis. So, it’s about the quantities. And the thing I love about this diet is that it’ don’t have to go to the Mediterranean to eat it. And you don’t have to eat foods you don’t like. It’s about the choices you make. So it’s about eating lean meats, fruits and vegetables. It’s about eliminating sodas and baked goods and sweets. And the occasional red meat is okay. And people that like red meat will find that really comforting and think that they can really sustain this.

Host: What questions should patients ask their doctor if they’re considering trying one of these newer, trendier diets or going on to the Mediterranean Diet?

Dr. Taylor: I think it’s important to talk about the goals of the diet and what the risks are or unknown risks are. If the goal of the diet is weight loss, the answer is simple. You’ve really just got to do it a calorie restriction and more activity. It’s hard work. It’s slow going. The fad diets - you’ll lose a little more weight quickly, but it’s a fake-out—it’s usually water. If the goals are other things like you want to improve your blood pressure, well, there are blood pressure improvement diets, such as the DASH diet. It restricts sodium, it supplements potassium, magnesium. It’ll lower your blood pressure. So, if you’re worried about your blood pressure, you’d like to avoid meds, there’s a diet out there for you. Similarly, for cholesterol. You can lower your cholesterol with a diet - somewhat. Restrict fats, eat lean meats. But by and large, cholesterol is pretty unresponsive to diet. And so, we usually use medicines for cholesterol. So as you talk about what diet to eat and fad diets, define your goals. Is it weight loss? Then the answer is ins and outs. And, if it’s a specific health problem, that is a little bit more of an in-depth discussion because there are some diets that are proven to work - the DASH diet is the best example. But I choose, typically, to focus on the global risk for heart disease because, no doubt, the most effective diet is this Mediterranean Diet. We’ll treat the blood pressure and cholesterol with other ways, but reducing heart risk is so important and the Mediterranean Diet is very effective.

Host: Could you share a success story from your practice about changing their eating habits and reducing their heart attack risk?

Dr. Taylor: Yeah, I can share a few. One is simply weight loss and have had many patients and I’ll describe one that, you know, everyone walks in with their smart phone and they think they’re all app’ed up. And, many patients have turned on to these apps like MyFitnessPal. And I’ve had patients come in and they’ve shown me exactly what they’ve eaten and how they’ve changed what they eat. They found foods that they thought they liked but really are quite unhealthy for them - they have a lot of sodium or a lot of calories. And, have changed their diet and have lost weight. And that’s really gratifying. And they’ve done that simply by more monitoring - and these apps, these health aids can really help. The Mediterranean Diet is a different story. And, a week doesn’t go by where I’m in the hospital talking to some patient, and it’s usually the wife that’s asking the diet question, about how to change a diet to reduce the risk of a future heart event. And, I try to be very optimistic in talking about the Mediterranean Diet - that it is a lifestyle diet. There’s nothing you can’t do, but it’s about food selections and these days, you know, we’re fortunate that the access to fresh foods and to healthy foods can be made without a lot of sacrifice. And so, it’s about shifting the types of foods you eat and usually the wine’s a big seller. People don’t mind a glass of wine with dinner, and that’s in this diet as well. So, people want to know what they can do that’s active to improve their health and eating is such an important part of life. You want to know that you’re eating a diet that’s not just you enjoy but that is healthy for you. So, I think the Mediterranean Diet is really worth a look. You can find simple information online. And even, you know, you can find the study I referenced - the PREDIMED studies - free online. You can go and look that up. And, it’s got the diet simply laid out. So, you can really start to look at the foods you’re eating and choose the right ones. I think diet is an important discussion to have with your doctor, and it’s not a quick discussion. You’ve really got to define the goals and then make a commitment toward changing diet that you can sustain. And, if you can outline a way forward. And I’ll even give patients a copy of the study and a page that summarizes the diet so they can ... somebody can look and say, “I can do that. I like that food. Ah, I’ll just have that once a week. I’ll skip it three times a week.” They sound like they can be successful, and they are. And it’s nice to see that people can make sustainable changes that you know reduce their heart risk.

Host: Thanks for joining us today, Dr. Taylor.

Dr. Taylor: Thank you very much.

Conclusion: Thanks for listening to Medical Intel with MedStar Washington Hospital Center. Find more podcasts from our healthcare team by visiting or subscribing in iTunes or iHeartRadio.