Diet and Your Heart: Can What You Eat Improve Your Numbers?

Dr. Mendez: We know eating better and healthier lifestyle really m- adds up over time, but there's no age that's too late to change. You can always try to get your blood pressure down, even if you're older and develop high blood pressure. [upbeat music] 

Courtney: Welcome to Health Matters, your biweekly dose of the latest in health and wellness from NewYork-Presbyterian. I'm Courtney Allison.

Courtney: This season on Health Matters, we're covering your health from A to Z, asking our experts to break down the health topics and wellness trends we're all curious about. Today, we're at the letter D, focusing on diet, specifically how what we eat can impact our heart health. To explore the connection between diet and the heart, we spoke to Dr. Sean Mendez, a cardiologist at NewYork-Presbyterian, Brooklyn Methodist Hospital. He explains what our cholesterol and blood pressure numbers really mean and how our diet could help improve them. He also breaks down heart-healthy diets like the DASH diet and the Mediterranean diet, offering tips on how we can best eat to protect our heart. 

Courtney: Dr. Mendez, thank you so much for joining me today. 

Dr. Mendez: Thank you. It's great to be here. 

Courtney: So today we're going to talk about the relationship between diet and heart health, and how what we eat can maybe lower blood pressure and cholesterol. But before we get into these questions, I'd love to break down all these numbers we see when we get our blood work done. What do we actually mean by heart health numbers like cholesterol, blood pressure, blood sugar, and ApoB? 

Dr. Mendez: All of those mentioned, whether it's your blood pressure, your cholesterol, specifically your LDL cholesterol and, and triglycerides, are all markers of either various disease states: high cholesterol, high blood pressure, diabetes. But also, before we technically call it a disease, they're markers that you can be of in- increased risk for that. And so when we get these numbers, really what we're trying to do is get a little more data to help try to figure out the best way to either prevent or treat heart disease or any cardiovascular disease. 

Courtney: So let's start with blood pressure, which measures the force of blood against your artery walls. What is a healthy blood pressure range? 

Dr. Mendez: I think the kind of ideal blood pressure is about one twenty over seventy. Anything above one thirty over eighty starts to be in the hypertensive range. 

Courtney: So how about cholesterol? What's a safe or healthy range of cholesterol numbers for people? 

Dr. Mendez: When we think about cholesterol, primarily we're thinking about the LDL cholesterol. The LDL cholesterol is the most associated with adverse cardiovascular disease, and so in general, an ideal LDL cholesterol goal is about less than one hundred milligrams per deciliter for everybody. Also, we think about other things like your triglycerides, which are a secondary marker. It's less strongly associated, but the higher it is, the increased risk of heart disease, and then we know the higher the HDL is associated with a lower risk of heart disease. Most of your atherogenic or heart disease-causing molecules are in LDL cholesterol, but there's some that's not picked up in your standard lipid panel. All of them have this molecule, apolipoprotein B, which is a newer molecule being tested, and so the apolipoprotein B is a measurement of all atherogenic molecules. Higher ApoB is more correlating with the risk of heart disease. 

Courtney: Could we talk about what we eat and how that can really improve our heart health? 

Dr. Mendez: All of our numbers can be impacted in a negative and positive way with our lifestyle choices. On average, in the studies with dietary changes alone, blood pressure drops about five to seven points of the top number, the systolic, and about three of the diastolic. It doesn't sound dramatic, especially when people have very high blood pressure, but it certainly makes a big difference. In general, when we're thinking about what are we saying when we lower the cholesterol, and we're talking about the LDL cholesterol, and that's about three to fifteen percent, depending on the study, just with dietary changes alone. Certainly, the foods that we eat impact in very multifactorial ways, meaning that some foods can raise your blood pressure. We know some people are very salt sensitive. Some can have a salty meal, and their blood pressure is sky-high later that day or the next day. Same with cholesterol. We know some clear associations with things that affect the LDL cholesterol. There's good evidence that saturated fats elevate the LDL cholesterol. Certainly, a lot of processed foods, refined grains, sugar products, all of that can impact it as well. 

Courtney: And so I wonder, how quickly can diet changes affect lab results? Just from my own personal experience, when you get a number you don't like, you're like, "I want to fix it right away!" But what's realistic if you're going to try to make changes for it to show up in your blood? 

Dr. Mendez: Yeah, I mean, I think most of the studies that we've done have kind of been in the range of one to three months for that, for- 

Courtney: Mm-hmm.

Dr. Mendez: ... we put on this diet, and let's see the change. And, you know, it's usually recommended if we either put you on a medication for cholesterol or you're making lifestyle changes to kind of check that in that same time frame. It also depends on how much you're changing. If you're kind of gradually incorporating different lifestyle changes, then it may take a little longer. The full effect, uh, might not be seen for six months, a year or so. 

Courtney: That's great. Lifestyle changes, I imagine not smoking, reducing alcohol, exercising, all that good stuff? 

Dr. Mendez: Yep, yep, all that good stuff. Um, also always forgotten, sleep and stress management are kind of two cor- cornerstones of, of cardiovascular prevention. 

Courtney: You mentioned some foods are better to lower LDL cholesterol. Do you have any specific examples of what someone should be looking for? If they're looking to lower their LDL cholesterol, what should they be grabbing at the grocery store?

Dr. Mendez: Yeah, in general, things with soluble fiber, so oats, barley, psyllium, those are fibers known to lower LDL cholesterol. Fiber basically works in the gut. Your gallbladder makes bile, which is made up of cholesterol from the liver, and that when you eat fatty foods or foods with fat in it, the bile is secreted into your gut. What fiber does is bind up with that bile and takes it out. Healthy fats are what we call, you know, the monounsaturated and polyunsaturated fats- 

Courtney: Mm-hmm.

Dr. Mendez: ... which kind of speak to their structure at a molecular level. But the monounsaturated fats are like olive oil, mixed nuts, avocados, and the polyunsaturated fats, omega-6s, things that are seen in, like, walnuts or omega-3s, which are the seafood-related.... fats. We have seen that replacing saturated fats with these, especially polyunsaturated fats, the omega-6s, omega-3s, reduces your risk of heart disease. And there's no age that's too late to really start. The younger you are, the better, because it's really like compounding interest. Eating better, healthier lifestyle really adds up over time, but there's no age that's too late to change. You can always try to get your blood pressure down, even if you're older and develop high blood pressure.

Courtney: So let's talk about the DASH diet. 

Dr. Mendez: Mm-hmm.

Courtney: How is it helpful? 

Dr. Mendez: Yeah, so the DASH diet is essentially a focused diet. It's got pretty clear rules about what you can and can't eat. Really, the emphasis is on eating more fruits and vegetables, a few servings of low-fat dairy, avoiding red meat, and also incorporated it with a low-sodium component. And so the DASH diet has been best studied in the context of high blood pressure. Multiple studies showing evidence that the DASH diet can lower your blood pressure in that range that I, I alluded to before. And so the DASH diet is a nice diet for someone who's dealing with hypertension. It is also associated with lowering cholesterol, some weight loss as well, but the focus is really on: What can I do to lower the blood pressure? And a big part of that is both sodium restriction and, and an increase in foods that contain potassium, calcium, magnesium. Higher potassium intake is associated with lowering blood pressure. There's some evidence that it may also even mitigate high salt intake, so I don't say eat a banana every time you eat a bag of chips, but higher potassium intake can lower blood pressure. 

Courtney: What about the Mediterranean diet? That's one we hear a lot about. 

Dr. Mendez: So the Mediterranean diet is really focused on high consumption of vegetables, fruits, legumes, whole grains, nuts, olive oil, with an emphasis on that, oily fish, so salmon, things rich in omega-3s, really low-fat or fat-free dairy, and f- fish, poultry, eggs in low, moderate amounts, and really low processed foods. 

Courtney: Mm-hmm.

Dr. Mendez: So the differences are the DASH diet's the best one studied for hypertension. 

Courtney: Mm-hmm.

Dr. Mendez: Um, and the biggest trials for the Mediterranean diet, they show that it reduced overall cardiovascular risk in people at either at elevated or high risk for cardiovascular disease. So the DASH diet lowers your blood pressure, but the Mediterranean diet in general has been shown much more to lower your risk of cardiovascular disease. 

Courtney: Right. The Mediterranean diet has always seemed more like a way of life and a bit more flexible. 

Dr. Mendez: Yeah, it can be flexible in a good way or a bad way, right? If you're like, "I'm going to eat pastries all the time," you know- [laughs] ... certainly, you're probably not getting the benefits of that, uh- 

Courtney: Right. Right. Are cannolis part of the Mediterranean diet? [laughs] 

Dr. Mendez: Yeah. Yeah, yeah, exactly. 

Courtney: [laughs]

Dr. Mendez: So I think that for someone trying to figure out, like, "I gotta get my blood pressure under control," often the DASH diet, it's a little easier because it's straightforward to follow, especially like incorporating-- there's diet plans or cookbooks out there which you can really just follow. 

Courtney: What tips do you tell people who want to start changing their eating habits or adopt these diets? If they're in your office, and they're like, "Okay, I want to try to make some changes here," where do you start? 

Dr. Mendez: I think first defining what I mean by diet. What kind of foods are you eating? "Oh, I eat some vegetables," but it's a couple pieces of broccoli next to, you know, mostly a fried piece of meat. I think trying to define that is good, and I think often having patients, like, write down what they ate for a week, and often that's enough to just look back and say, "Oh, when I wrote it down, that kind of puts out what I actually ate, um, versus what I think I eat," like. 

Courtney: Yeah, it's probably enlightening, I imagine. 

Dr. Mendez: Yeah, I think it's like that for anything, whether you're watching your blood pressure at home or, you know, trying to figure out your diet or how much you exercise. I think keeping a log of things for at least a short time period and reflecting on it often can put some insights and see what it is. And I think the second thing to think about is what we kind of talked about before: What are your risk factors? Are we doing this purely to prevent development? Are we doing this to treat something? So trying to figure out, what are you actually eating? And, and second, what are your underlying issues, and, and what are your goals for the diet? And to try to figure out the best approach. 

Courtney: Are there any easy food swaps you recommend that can make a difference? 

Dr. Mendez: Often, snacking can be the biggest one. People can often eat well for their meals, but the snacks in between can cause a problem, so trying to figure that out and taking it step by step. Maybe you have an afternoon snack, and you replace that with something a little more heart healthy, less processed, can be the first steps for that. And, and another big thing is, are you drinking sugary beverages? Can you replace that with water or some tea, something else with a little less negative impact? 

Courtney: Is there anything you find misunderstood about eating for heart health? 

Dr. Mendez: Yeah, I think it's two [exhales] things, one of which is that it's for everybody, right? Everybody should be focused on trying to incorporate a heart-healthy diet, not only if you have a medical problem, but you want to prevent one from coming on in the future. The second thing is food, exercise, sleep, stress, all of that is important, no matter what medications you're on. If even if your blood pressure's perfect because we have you on medication, all of these factors still matter and are still associated with decreasing your overall risk. 

Courtney: Dr. Mendez, thank you so much for joining us today and giving us all these actionable tips for people looking to take care of their heart health. 

Dr. Mendez: Thanks. It's been a pleasure. I really appreciate you having me. [upbeat music] 

Courtney: Our many thanks to Dr. Sean Mendez. I'm Courtney Allison. Health Matters is a production of NewYork-Presbyterian. The views shared on this podcast solely reflect the expertise and experience of our guests. To learn more about Dr. Mendez's work with patients, check out the show notes. Join us next time when we discuss what to know about endocrine disruptors and the role of hormones in our body. That's in two weeks, right here on Health Matters. So you don't miss it, be sure to follow and subscribe on Apple Podcasts, Spotify, or wherever you get podcasts. [upbeat music]