Getting Heart Healthy in the New Year

Podcast Transcript

Announcer:

Welcome to Love Your Heart, brought to you by Cleveland Clinic's Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute. These podcasts will help you learn more about your heart, thoracic and vascular systems, ways to stay healthy, and information about diseases and treatment options. Enjoy.

Natalie Salvatore:

Hello, my name is Natalie Salvatore. I'm a registered nurse within the Heart, Vascular and Thoracic Institute in Cleveland Clinic. And I'm joined here.

Dennis Bruemmer, MD:

Yes. Hello. Good afternoon. My name is Dennis Bruemmer. I'm a staff cardiologist in the Department of Cardiology in the Heart, Vascular and Thoracic Institute at Cleveland Clinic.

Natalie Salvatore:

Thank you so much for joining me today. So, we wanted to talk a little bit today about starting your New Year's goals. So, it's now the new year and a fresh start. What advice would you have for our patients for setting some great goals for the year?

Dennis Bruemmer, MD:

Yes, thank you, Natalie. So, I think that's a great question. Obviously, we always have the famous New Year's resolution. We, of course, encourage lifestyle and behavior change and nutrition and activity throughout the year, so not just on January 1. So, I think it's important for us to make a conscientious effort to realize that someone wants to make change. And I think that is a really critical step, and obviously New Year's is a good opportunity to do that.

Now, I would categorize this in two parts. One are, people who actually have, for example, weight related problems like having elevated blood pressure, having high blood sugars or diabetes, or having high cholesterol, versus people who don't have those risk factors, because they need to be handled a little bit separately.

Patients who have the associated risk factors obviously need to talk to their physicians to get those three risk factors appropriately taken care of, in addition to making important lifestyle modifications. Whereas those people who don't have any of those risk factors can sort of start by themselves and start to make some important change. But I think it's important to be screened for these risk factors because they're so common.

Patients with weight related problems, or just sedentary lifestyle, have much more commonly elevated blood pressure, cholesterol problems, or an elevated blood sugar. This is very common. Diabetes is a complication from weight related problems. It's very common in the United States. We currently have about 50 percent, so half of the US population, has diabetes or pre-diabetes, so it's important to be screened. We have one out of five teenagers now with a diagnosis of pre-diabetes. So, making these changes, I think, is really important and being screened for these associated risk factors that may ultimately then translate to future heart problems. So that's why this is so important.

So, what do we recommend? I think it's very reasonable to accept that our overall lifestyle in our country leaves room for much improvement. We have currently about 60 to 70 percent of our diet is processed or ultra-processed food. So that means we can't even recognize the strawberry anymore in the food that we're actually eating, if we have strawberries in anything, be it in yogurt, be whatever. So, I think moving toward more healthy dietary choices, fruits and vegetable, lean protein, plant-based nutrition, fiber-rich meals, and less of the sugary meals, the donuts, the muffins, the cookies, and the pastas and the pizzas and the burgers and the fries, just to name a few. There's nothing green in there, so those are not typically healthy nutrition, and we recommend five servings of fruits and vegetable per day. Those are the recommendations for vast majority of people, which is... that's a lot. But when you start doing that, you actually starting to replace some of those other unhealthy choices. So, I think making a real conscientious effort to include some of those changes: Fruits, vegetables, lean protein, nuts, grains, whole grains and fiber-rich meals.

And if you think about this, what I have just mentioned, you won't get much of that in the typical fast-food chains that are out there. So, shifting a little bit more over to home cooking, to preparing meals yourself. If you go out to restaurants, typically portion sizes are much larger, you can share a meal as a couple, for example, and say, okay, I want some more vegetable in that. Maybe some chicken, lean protein, fish, less red meat, and then share a portion, because the portion sizes are typically huge, almost expected to take something home.

So those are some of the nutritional recommendations. Of course, then we encourage physical activity, which is, well, the more the better. But I think to a minimum we like people to engage in 30 minutes of, we call it moderate intensity activities. So that means more like a brisk walk or... It's okay to be out of breath, okay, that's the goal. It's okay to get a little sweat on your forehead, and you should do that ideally at least five times a week. That's a lot. But those are the physical activity recommendations, okay. Do you need to go, when you start working out and when you just have not been doing much activity and you move, say, "Okay, I want to make some change." Do you need to go to the gym and really start 120 minutes on the treadmill? No, I think just setting an initial goal to be more active is quite appropriate. So, I think the nutrition and the activity are important, but also, it's very important to be screened for the cardiovascular risk factors, which are so common out there.

Natalie Salvatore:

Starting a healthier eating plan and an exercise plan sounds like it could be pretty daunting if that has not been on your radar before. What would your advice be to a patient who is looking to get healthier on how to start? So, you mentioned screening. What other tips about diving into the healthy eating and the exercise?

Dennis Bruemmer, MD:

As I said, the most important step is the first step, okay. Well, how do I get going? What do I need to do? I think start walking, for example, its good exercise, it's cheap. Going to the neighborhood, going to the park, start walking. And replace some of those not so healthy food choices with some healthier choices. I think when we look deep into ourselves, we kind of all know where we cheat. Okay. So, think about that. Be it the late-night snacks or the frequent meals in between, or the craving for carbohydrates. I think we kind of know, everyone sort of knows, well, this is something I could do better. And then really make an effort to do that and replace unhealthy choices with healthier choices. If you're hungry in between, it's okay to snack on carrots or even a small granola bar, some fiber-rich meals, but then avoid the really unhealthy things a little bit more.

So, we tend to encourage patients, get started, make it a habit and make it a routine, and then keep going. And it's okay to obviously go on the scale and say, okay, I want to lose weight. I'm going to weigh myself every day, going to have a little piece of paper next to the scale. I'm going to record my weight. Having the idea of actually being accountable, okay. So, I'm in charge, this is my health, this is my weight, and I want to make a change. And then try to lose. Start by trying to lose one pound per week, for example. Say, okay, I'm going to... This week is my good week. I'm going to make a start and I will replace all those bad things and I will start being active, and you won't see you're going to lose the weight, one pound of weight. And if you do that over three months, it'll add up, but you don't need to have a dramatic weight loss in the first week. I mean, it helps for the personal success feeling to have a more rapid weight loss initially, but the overall goal should be 5 percent of body weight, total body weight, to lose. That yields significant improvement in most of the cardiovascular risk factors.

Natalie Salvatore:

And if our patients do have some of these cardiovascular risk factors and are interested in getting started, do we have any resources here where they could find guidance and help?

Dennis Bruemmer, MD:

I think certainly if patients have cardiovascular risk factors, those typically include an elevated blood pressure, elevated cholesterol, pre-diabetes, diabetes, or even weight related problems, we have a cardiometabolic center that we run and where we look at those risk factors and where we treat those risk factors. We do this in collaboration with our colleagues in primary care and family medicine as well as in endocrinology. We have joint programs with endocrinology to work together.

And of course, we see a large number also of patients with more complicated problems that are like heart related disease, like coronary artery disease, heart failure, and manage those risk factors leading to those as well. So, starting early and getting those risk factors under control is very important and ultimately may protect from heart problems.

Natalie Salvatore:

Excellent. Well, thank you so much for taking the time to discuss with us and our listeners about starting fresh in the new year and how to set some good goals for a healthy 2023.

Dennis Bruemmer, MD:

Of course, Natalie. Thank you for having me. Appreciate it.

Announcer:

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