The Skeptical Cardiologist Discusses Heart Healthy Diets

The skeptical cardiologist was interviewed recently by Brooke Simonsen for The Health Investment podcast.

If you’d like to hear my latest thoughts on diet and the prevention of heart disease this serves as a concise summary. Brooke asked me many excellent questions and I respond on topics including saturated fats, plant-based diets, keto diets, dairy fat, nuts and cholesterol.

The podcast is available at this link

Her introduction gives more details:

  • What’s your story? (Specifically, what led you to become a doctor in the first place and later start your blog The Skeptical Cardiologist?)
  • Speaking of your blog…I’d love to dive into many of the topics you’ve covered to debunkmisconceptions floating around out there…
    • First up: What is a plant-based diet? Should everyone be following this eating pattern?
    • What about the belief that omega-3s and fish oil can prevent cardiovascular disease?
    • Is measuring cholesterol obsolete, as some say? Should we be concerned about the amount of dietary cholesterol we consume (like from egg yolks)?
    • Can a low-carb diet help prevent heart disease (or reverse it)?
    • Can you touch on the topic of reversing heart disease naturally vs. taking a statin? 
    • Why is it important to be skeptical of “natural” treatments (like herbs)?

Let me know what you think

Pontificatingly Yours,

-ACP

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9 thoughts on “The Skeptical Cardiologist Discusses Heart Healthy Diets”

  1. Enjoyed your discussion on nutrition, I agree nutrition is a very complex subject, energy balance being the cornerstone of weight control (probably one of the most important facets of health) but the nuance of long term health repercussions based on consumption of certain foods is still very gray. Like with most subjects that involve nuance there is rarely time to dive into the complexities during a typical patient/clinician office visit. I feel like blogs and podcasts like yours and other clinicians can provide valuable resources in getting those nuanced messages out there to supplement the general guidance a patient might get during an office visit.

    A few questions I had while listening,

    Do you feel MDs could benefit with more nutritional training/curriculum during med school?

    I noticed you used good/bad cholesterol during the discussion as well as APOB. From a clinician standpoint, do you still use good/bad when explaining biomarkers or do you use APOB to explain that component of atherogenic risk?

    I thought it was interesting that you were going to go the MD/PhD route and focus on immunology. I am fascinated by this subject, do you still have a passion for that and stay on top of the research?

    Reply
    • Christian,
      Thanks for your kind words
      Do you feel MDs could benefit with more nutritional training/curriculum during med school?

      Re MDs benefiting from more nutritional training-it’s a tough question to answer because I fear that if there was more nutritional training/teaching in med school it might be teaching outdated dogma based on weak observational data. It would be better to have courses for med students on evaluating the medical literature, trial design and analysis, clinically relevant statistics so that they can adjust and evolve their understanding of different areas as the science evolves.
      I noticed you used good/bad cholesterol during the discussion as well as APOB. From a clinician standpoint, do you still use good/bad when explaining biomarkers or do you use APOB to explain that component of atherogenic risk?

      Another excellent question. I just gave a talk on lipids to the cardiology trainees at SLU and I hope to put that on my site soon. I started that off talking about the lifecycle of apo B which I now consider the fundamental trigger of the atherosclerotic process. Apo B exists as VLDL, VLDL remmant, and LDL so it is a little inaccurate to describe LDL as “the bad cholesterol”. It is a useful surrogate since 90% of its lifecylcle apo B exists as LDL.When talking to patients I have persisted in the “bad cholesterol” verbiage because it is ingrained in the public. It is hard enough to move beyond patients focusing on the total cholesterol concentration. Most patients are not interested in the nuances of atherosclerosis and just want to know a simple goal/number to shoot for and LDL provides that.

      I thought it was interesting that you were going to go the MD/PhD route and focus on immunology. I am fascinated by this subject, do you still have a passion for that and stay on top of the research?

      I have so much on my plate just trying to keep up with the areas of cardiology that I’m interested in that it is impossible for me to know immunology well at all. For example, I take Dupixent, which modulates an immune pathway felt to be important in the inflammation that patients with atopic dermatitis suffer from. I had to Google just now exactly how it works….”DUPIXENT is the first and only therapy to specifically target the IL-4Rα, thereby
      inhibiting IL-4 and IL-13 signaling and reducing type 2 inflammation1,2,7,
      Sad to say I know nothing about any of these pathways or receptors and I don’t know what type 2 inflammation is.
      Dr P

      Reply
  2. Great pod cast and great advice. I’m a 52 year old male about 10 months post 3x CABG and I’d like to ask if your dietary recommendations change at all for such patients or do you let the bio-markers that you reference dictate….

    as always, thanks in advance..

    John

    Reply
    • My recommendations are similar in terms of diet and lifestyle for those pre or post CABG.
      I have a much lower LDL goal for those post CABG in general
      Dr P

      Reply
  3. Hi Dr. Pearson,
    In your podcast for the Heart Healthy diet you talked about different supplements of which most are of no benefit. You didn’t mention flaxseed oil. I have had reaction to statins affecting my liver and tried Ezetimibe which caused problems with my gut. My LDL is 127 and HDL 38 everything else was WNL.
    So my doctor prescribed Flaxseed oil 1200 mg/day. In your opinion or are there any studies that show flaxseed helpful for lowering LDL.

    Reply
    • Pamela,
      the simple answer is no.
      I have had a similar question that I had researched on flaxseed and BP and the answer is also no.
      I believe I have a post on flaxseed if you search on the site.

      Reply
  4. Enjoying the podcast this very moment…. thx in advance. My question is going to be about egg yolks. Is the saturate fat in yolks of concern to those with hereditary high cholesterol?

    Reply

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