someone somewhere in the US will have a heart attack every minute of every single day and our goal today is to make sure that you are not one of them so we have five foods that can help prevent a heart attack let's [Music] go welcome to the exam room live brought to you by the Physicians committee hello I am the weight loss Champion Chuck Caroll thank you so very much for watching down loing in more than 150 countries around the world and making the exam room one of the most consumed nutrition podcasts anywhere on the planet today so here are the numbers 800,000 people every year in the US will have a heart attack more than 2,000 every day more than one every single minute and the thing is about a quarter of them it won't even be their first heart attack and we all know that high fat food fast food greasy Foods those are big no NOS when it comes comes to your heart but today we're flipping the script we're turning it upside down and we're going to be talking about the foods that can do the exact opposite and support your heart make it as healthy as possible so it can beat as happily and as healthfully as possible for many many years to come and the man with five of the best for you that will be raising our heart health IQs today he is one half of the dock and Chef he is also the medical director at the Barnard Medical Center a guy who has worked with some of the most elite athletes on the planet as a team physician in both the National Football League and in Major League Baseball and oh what an athlete he is himself the man has credentials for days but talk about a guy who can just do it it's 60 years old Iron Man Triathlon competitor Dr Jim Lumis is here with us once again today and if there's a question that you have for Dr Lumis drop it in the comments or in the chat we're going to get to as many as we can when we open up the doctor's mailbag in just a little bit but let's go ahead and welcome Dr Lumis back to the exam room live how you doing my friend I'm doing great Chuck how are you thanks for having me back it's great to have you here man uh Happy Holidays happy holidays to you and I wanted to talk to you about this based off an episode that you and Chef Karen Dugan did recently on the doc and Chef where you really looked at heart disease and so like let's narrow the scope here let's let's start by talking about heart attack specifically we just heard 800,000 people a year minimum in the United States are going to have heart attack that is a huge huge huge number um how many of these heart attacks can be prevented Dr Lumis well I would I would say that most of them now some of them you have to start at a young age the sooner you start to you know adapt a healthier lifestyle and you know this is especially relevant by the way Chuck uh during the holiday season uh heart attacks go up by about 25% heart attack deaths increased by 40% and in fact December is the deadliest month for heart attacks of any month out of the year so especially relevant for this holiday season okay well there's a lot that goes into the holidays we've got stress and we've got diet in your opinion which is the bigger culprit of the two well I think it's a combination of of everything you know it is a stressful month but in typical you know the holiday season our diets really really we all fall off the wagon all the holiday parties and and you know the work parties and you know the fatty foods and the the desserts and you know on and on and on so I think it's a combination of of of stress but also I I think it's an you know this kind of acute change this deterioration in our diets you know I didn't even realized this when it comes to heart attacks until this morning about 1 and5 according to the CDC are silent heart attacks the person really has no idea that they're even even having one until as the CDC says the damage is already done so how is it even impossible that somebody can be suffering a heart attack and be oblivious to it well it's especially common in diabetics actually because um you know one of the complications of diabetes is it can it can adversely affect our nervous system so it can cause numbness and tingling in our in our hands and feet so it Alters sensation well in theory you can get the same thing with with heart so when it dos are kind of pain receptors um you can have a heart a silent heart attack uh and and not know it because the the kind of normal pain and chest pain you get gets kind of short circuited the other thing is people sometimes ignore the symptoms you know they in retrospect you know they were they did have a little shortness of breath going up the hill or climbing the stairs uh you know they they were a little more fatigued but but you know because so many people are out of shape and lead a secondary lifestyle they don't perceive that as as an abnormal you know symptom if you will so let's uh let's get to the help here uh we kind of you know teased five foods that can help what are your five best when it comes to preventing a heart attack Dr Lumis give me number one so I would say legumes probably number one um you know beans lentils and there's a couple reasons why they're such a powerful tool so so one is a substitution effect uh if you're getting your your pro your protein for example from legumes from Beans you know what else are you getting you're getting fiber so fiber has been shown to lower blood pressure lower blood sugar you know lower cholesterol help control weight U you're also getting a ton of antioxidants especially the darker beans and you know one of the risk factors for for heart disease is is high cholesterol and when we develop oxidative stress which is a normal response to our bodies and and in small doses it's good but in high doses it can actually oxidize the the LDL particles making it more reactive with the blood vessel wall red dark beans red beans Pinto beans black beans very potent antioxidants and what are you not getting you're not getting sat saturated fat when so when we get our protein for example from chicken or ham or or beef or turkey um you know what else are we getting we're getting saturated fat right and what are we not getting we're not getting anti antioxidants because antioxidents only occur in Plants we're not getting any fiber because fiber only occurs in plants so so part of that benefit you know there's there's benefit from directly from the legumes themselves uh the phytonutrients that are in the legumes but also there's a pretty profound substitution effect because again when we get our when we get our our our our protein for example from from we're not getting it from meat we're not exposing ourselves to the saturated fat which we know is one of the biggest drivers of risk for heart disease what do you have number two on your list my friend I'd say whole grains um you know true whole grains not not white flour you know such as that but true whole grain so whole wheat flour um you know wheat berries Pharaoh amorth um um even things like pseudo grains like like quinoa again the key here it's the fiber so fiber again has a a lot of effects now you do have to be careful with some of the more refined grains like white flour for example uh where you've taken some of the the you know when you when you make white flour what you essentially do is so a whole grain has several components it has um what's called the endosperm which is the kind of the The Germ of this the embryo of the plant the the endosperm um I'm sorry the wheat germ is the is the is the kind of the the seed or the where the the embryo of the plant and the and the wheat The Germ has a lot of of healthy fatty omega-3 fatty acids we have the bran which is kind of a protector and covering on top which is where the fiber is and the endosperm is where all the carbohydrates live that serve as fuel for the plant so it can take to can take root and so when we when we take a whole grain and turn it into white flour for example we strip off the bran which is where all the fiber is we take out the the in The Germ because these fatty acids you know if they're not consumed rapidly they can go rancid like oil will go bad and so they'll spoil it shortens the shelf life and so all we're left with is just the sugar component right and then we grind that up and we dye it you know we bleach it white and such and we actually have to spray vitamins back on it because we threw them all the way because we've thrown out you know the most Nutri nutritious part of the plants that's not good because that you know can Spike our insulin levels there's no fiber to damp down the the sugar levels and things like that so that's not what I'm talking about you'd have to be a little bit careful because of the way that that um when when you're looking for whole grain products you know on the Shelf uh just because of the way the USDA allows food labeling laws you can still have a fair amount of enriched white flour in a whole grain product so you really want to be careful and look for something that's truly whole grain okay so before we get to number three it's not lost upon me that number one one was legumes beans number two whole grains both of which healthy amount of carbs here but there is still a large percentage of the population who equate carbs with something that's unhealthy in terms of just cardiovascular health how important is it that we have carbs in our diet right so so that's a great point chck so so you know I think this is a great example of how we practice heal nutritional reductionism right we we we we don't talk about food anymore we talk about Foods made out of right and if you think about it 30 40 years ago we were worshiping carbs and we were demonizing fat that was kind of the era of snack Wills cookies right fat free or like free food which by the way coincides with with the um you know the kind of the beginning of the epidemic obesity epidemic in in the early 80s you know today we're demonizing carbs or worshiping proteins but carbs aren't the problem right it's the package the carbs come in so you know think about a small apple you know you know what they say apple a day keeps the doctor away right so small apple has about 25 grams of carbs that's about 100 calories uh but where where are the carbs at well they're in the apple and when we eat an apple we we literally burn calories um to to digest the Apple um it's called the thermic effective food the soluble fiber in the Apple absorbs water it slows the progression to our digestive tract so we we we slowly absorb we Liberate the sugar we slowly absorb it our insulin levels don't Spike our sugar levels don't Spike that fiber serves as a is a Prebiotic food for healthy gut bacteria down down stream there's vitamins and nutrients and all is good we take that exact same apple and we squeeze out the exact same 25 grams of carbs the exact same 100 calories we put in a glass we turn it into juice and we take that that that that glass over to the to the chemistry lab and we analyze it it's the same carbs same calories but now it's not in the glass it's not in the Apple anymore and we drink it in no way shape or form are those carbohydrates handled the same because that sugar is absorbed right out of the upper part of our digestive tract our sugar level Spike um you know on and on and on there's no fiber to help damp down that that spike in sugar to lower our cholesterol to help us lose weight to help us feel full there's nothing to feed the healthy gut microbiome so it's clearly not the carbs that are the problem it is the package that the carbs come in and I I think that's probably one of the most important Concepts that if people can take one thing away from today it's one of the most important Concepts Concepts that are out there because you know when we get to the end of this list you know it should be PR fairly obvious to everything that everything on this list is plant-based and in fact it's been shown that a plant-based diet um reduces your risk for heart disease by about 25% which is about the same you see with the Statin medication right um and and um a whole food plant-based diet is is is about 75% unrefined carbohydr hydrates in our diet but that's where the fiber comes from too so so again I think you know the the the key here is to not not to think about our food through what our food's made out of but to think about the the food itself and and and again trying to eat consume Foods as close to the ground as they were grown that that's really the key here right so we're talking about the total package you know there's a pro wrestler back in the day I forget his name who went by the total package Lex Luger right Lex the total package Luger so we could you know take the Lex Luger approach here when it comes to food and when you're considering well should I eat this is it going to be healthy you always want to look at that total package that's kind of the name of the game all right so we've got legumes we've got whole grains what's number three on Dr lum's heart attack prevention Foods list green leafy vegetables and um you know green leafy vegetables have a ton of health benefits um so just for example we talk about so if you think about the risk factors for heart disease so we talk about blood pressure cholesterol um um you know type two diabetes so blood pressure is a major risk factor um one of the ways to lower blood pressure and prevent high blood pressure in general is is increasing the amount of potassium in your diet um so we in fact the ratio of potassium to sodium we actually have a docin chef episode on this um the ratio of potassium to sodium is much more important than the amount of sodium in and of itself and so and typically we need about 4,500 milligrams of potassium a day people think about bananas bananas are fine they have about 400 but that means you'd have to eat 10 or 12 bananas a day to meet your potassium needs the greens on the top of the beets the beet greens 1,300 milligrams a cup spinach you know th000 milligrams a cup almost Swiss charred thousand milligrams of cut cup so these green leafy vegetables in addition to to to having you know all the phytonutrients and fiber they're full of potassium many of these green leafy vegetables like kale and arugula also activate nitric oxide and and so nitric oxide is very important in maintaining the health of our blood vessels and the reason is um that the our blood vessels have an inner lining called the endothelium it's a single cell lining and what the indium does is it helps control uh appropriately the constriction and dilation of our blood vessels so when we exercise we want our blood vessels to dilate to get more blood uh when we stand up we want our blood vessels to constrict so s we don't pass out so so um and one of the things that happens um with high blood pressure smoking lack of physical activity is is this IND the indm can't react like it should and especially it can't Dil like like it should and that increases pressure in inside the blood vessel wall which can cause it to be damaged and increasers for heart disease and things like that one of the most potent activators of endothelium to help dilate a perpus is a compound called nitric oxide and and again there many of these green leafy vegetables are very potent activators of nitr oxide and by the way you know one of the other uh important activators of nitric oxide are beets so we talked about the greens on the top of the beets which many people throw away the beets themselves are probably one of the most potent um activators of nitric oxide and in fact um there's studies that have shown for for endurance athletes in particular that loading with beets you know before you before you perform some endurance activity can increase uh performance by about 10 to 15% interestingly enough Al uh beets can serve as is almost like Nature's Viagra because we know now and again we have a doc and Chef episode specifically about this that that erectile dysfunction is the canary and the coal mine for heart disease and the reason is is that that you know when we lose the ability to dilate our blood vessels appropriately we can't you know we can't attain and maintain an erection and so beads help help help do that so um um um there's there's lots and lots of great benefits from green leafy vegetables recent study actually just showed that um one cup of of green leaf vegetables a day reduces your RIS or heart disease by about 15% man right no side effects there by and large exactly that's exactly right all right legumes whole grains green leafy vegetables we've got two more still to go what's it number four doc so fruits in general but berries in in particular right so again berries U you know fruits in general are good but berries in in particular and so berries have um are very very other than the dark beans are probably the most potent antioxidants out there anti-inflammatory antioxidants and again so we create oxidative stress that's a natural byproduct we we we use oxygen to help generate um energy for our muscles to contract and and and one of the natural byproducts that is is are called oxygen free radicals which is and that creates oxidative stress and small doses they're they're good they they serve they help signal the muscles for example when you start to exercise your oxid stress goes up that sends a signal to your muscles hey I'm getting ready to damage you so so get ready to fix me when I'm done um it also can help heal wounds and and and boost our immune system in small doses and high doses though oxidative stress is bad it can damage DNA increase risk for cancer it can damage muscle cell walls that's why people get sore and stiff after after physical activity um but the other thing it can do as I mentioned earlier is it can oxidize the LDL particles which makes them much more reactive with the with the with the blood vessel wall and our bodies have a very limited ability naturally to mitigate oxidative stress and the only way you can you can gain antioxidant capacity is through dietary antioxidants and again the only place they occur is in Plants because in general these these dietary antioxidants are the plant's natural defense mechanisms to keep them from getting you know infected by viruses and and and bacteria when they get get damaged so so and again in general the darker a food the darker the food the more potent the antioxidants so again that's why the dark beans but also blue blueberries raspberries strawberries um blackberries Etc very potent antioxidants ton of fiber again great for our hearts all right we've got a lot of questions coming in but before we open up the doctor's mailbag there's still one more on the top five what is it my friend I would say it's soy soy soy right so soy um um has has is is packed full of what are called isoflavones uh they've been shown to help lower LDL cholesterol lower blood pressure prevent heart disease uh also prevent breast cancer again we've got a whole Doc and Chef episode just on soy um and and you know some people are scared of soy um you know they're concerned it's going to cause breast cancer but in fact it's the opposite um soya actually blocks binds weekly the phytoestrogen the plant-based estrogen soy bind weekly to the to the breast cells for example and block the effect of natural estrogen but Soy uh now you also want to be careful about how you consume the soy um you don't want it to be ultra processed so so you know whole bean especially whole bean soy products like like edamame or Tempe uh but you know soy milk and and um and uh tofu are fine uh tofu is just curle soy milk you scrape the curds off pressing a block that's that's what tofu is that's good you probably don't want to go any more processed than that so some of the the fake like vegan Burgers um you know text we you see textured vegetable protein some of the the soy some of the the plant-based protein powders have ultr processed soy you do need to be a little bit careful with that there is some evidence that that may activate another receptor on breast tissue for example which may actually increase your risk for for breast cancer so but Soy is a is a is is great for our health overall um but in particular it's been shown to help prevent heart disease for there's a lot of mechanisms again mainly through partly through lowering cholesterol and such as that yeah but before anybody poo poos uh tofu like you can really do some incredible things um I know Chef Karen Dugan um your your your counterpart at the doc and Chef she does this amazing recipe where she just chops up the tofu basically makes it into cubes lets it marinate for I know 4 to 8 hours sometimes overnight in the refrigerator really lets it soak up all of the flavor and then we'll put it in the air fryer no oil anything like that and then let it roast in there for I don't know 15 20 minutes something like that and then when they come out oh my God they are the most delicious things ever I think the one that I'm thinking of in particular had kind of a peanutty flavor to it it was so dag on good Dr we made a she made a peanut dipping sauce for it right exactly so yeah yeah soy is really just a sponge right so if you taste soy you know I mean tofu just raw tofu it's it's pretty bland right kind of cardboard is but it's it it it is a sponge for flavor so it'll soak up whatever flavor you put it in and so there's tons of ways you can you can make soy I mean I I sometimes just you can bake it you can barbecue it you can you can you can put in the air fryer you can put it in a stir fryer I mean there's tons and tons of ways to use soy and uh you know it's it's you know two to four servings a day actually is is probably the optimal level for a woman to help prevent breast cancer for sure and and again like if if you're a painter if you're a creative type think about soy or tofu in particular as kind of a blank canvas and and you know paint it with whatever flavor you want when you're in the kitchen and it will take it on it's so good that's a great that's a great analogy Chuck I like that I may have to borrow that one thank you my friend it's all yours share and share alike um so here's here's the deal so those are the five best let me also ask you though about some of the the worst and I think back to and I've never told this story on the show before I was at a steakhouse one time uh before you know losing all the weight and the waitress was actually someone who I went to high school with and after I placed my order she said well you know more people have a heart attack after eating steak and potatoes than any other meal now I was equal parts offended and motivated to take up that challenge to prove that I could kill this Porter House without killing yourself killing myself exactly um so I'm just curious have have you heard that is there anything to that notion or was this person just kind of needling me for I don't know whatever reason that day well I mean we know that a high fat meal is not good and again part of it has to do with disregulation of the endothelium's ability so if you've already got heart blockage there and all of a sudden you dump all this saturated fat and now a sudden your in thelium can't work and and you know you go outside side and you climb up a hill or climb some stairs and your blood vessels can't dilate next thing you know you're having chest pain you're going to have a heart attack right um there there's a so so again if you if you go down the list of the bad foods it's it's h probably the worst is processed meat um you know baloney bacon um and there's a lot of reasons there's there's a lot of reasons that that that that can occur there's some so red meat in general processed meat is even worse red meat in general though um and again it's the saturated fat also we know that heem iron is a very potent we talked about antioxidants heem iron is a very potent prooxidant so those are those are those are um foods that make whatever oxidative stress we have even worse right and so um heem Iron is the type of iron that we see in in in red me and people think well you know I gotta eat red meat because I or I'm going to get iron deficient um and and again that's a that's a fallacy because um you know it is true that that heem iron is very easy for our bodies to absorb but too much heem iron again marketly increases your risk for heart disease um and heart attack um there is iron in plants but it's not bound to hemoglobin it's non-em iron and so um it is a little more difficult for our bodies to absorb the non-em iron that you find in Plants however if you co-ingested with a source of vitamin C um you'll see Iron absorption rates um um just as good as that is he iron without the the heart attack risk um saturated fat in general you know so so um you know many of the seed oils especially things like corn oil um you know are very um are bad for our hearts you know we perceive that boneless skinless chicken breast and salmon is you know are good they still have a fairly significant amount of of um of saturated fat now it is true that omega-3 fatty acids can help protect us from heart disease and it's true that some of the fatty fishes do have more Omega-3s but again there's all that also comes with ass serving of saturated fat and when we talk about fatty fishes you know most of them are contaminated by Mercury and and and and you know um microplastics and all kinds of forever chemicals um and and it's also true that one of the other risk factors for for heart disease and inflammation is the overc consumption of omega-6 fatty acids and so um the primary source of those are are are meat and dairy and so Dair is another thing very high on the list just under the meat um and so we need about a dietary ratio about three to one somewhere in there Omega 6 to omega-3 you know standard Western diet 50 to one even an unhealthy kind of a vegan diet where you're eating a lot of vegan junk food you can see 20 to 30 to one um because we also find Omega-3s Omega sixes in many of the seed oils um corn o again being the worst so 80 83 to1 ratio around somewhere in there of Omega 6 omega3 and cornal they often add cornal to cattle feet to fatten them up quicker but even things like olive oil is still 13 to2 and so you'd have to be a little bit careful with with with with using oil in general uh but particularly the the oils like the tropical oils like coconut oil and palm oil that's all saturated fat all you know there's no Omega-3s in there as well so the the ways you increase your omega-3 intake um you can take um omega-3 supplements but you want to be sure they're from Al algae algo based um but also things like um you know chia seeds and hemp seeds and and and and walnuts um flax seed even green leafy vegetables have some Omega-3s so so again um it's really avoiding the oils the dairy the meat and particularly the red meat and the the um and the um um process me those are the big ones yeah let's stick with oil for a second Emanuel sent in a question a little bit earlier asking whether there were any oils that were in fact heart healthy and of course that brings olive oil into the conversation that one is always much talked about um but then you also hear people trumpeting things like avocado oil and even some of the nut oils and and and sesame oil and things like that the ones that really are getting shunned right now are the vegetable oils so I mean is it possible to even rank them and say well these are at least a little bit less heart unhealthy there there is some evidence that that you know the Mediterranean diet which can you know which includes olive oil you know there's a heart healthy aspect to that but actually um Dr Barnard and pcrm did a study where they looked at Mediterranean diet versus a kind of a low low very lowfat Whole Food plant-based diet and did see additional reduction in things like cholesterol and some of the risk factors I think part of the problem is a lot of the studies that have been done with olive oil um you know are comparing them to a diet that's really unhealthy right so so in other words if if if the primary source of oil is olive oil versus butter and and you know beef fat and lard uh yeah of course you're going to see a significant reduction and in in heart disease risk so there's very little research around other than this one study that I know of that that pcrm published a couple years ago a year or so ago uh looking at olive oil versus a true lowfat no oil Whole Food plant-based diet that research just isn't out there um so you know I mean again is a little bit of olive oil every now then going to kill you um no probably not um do you need to put olive oil on stuff to make it healthier definitely not um um now the the argument around the other problem with oils are is that um we talked about saturated fat right from meat and dairy mainly but there's another kind of fat which is even a worse risk factor for heart disease and that's trans fats and so trans fats were used for a long time in in Ultra processed foods to help stabilize shelf life and things like that most of those have been removed now it's you can't put trans fats in in processed foods and packaged Foods anymore however um oils have what's called a smoke point and when you cook it when you heat an oil above its smoke point it actually chemically changes some of the fats in the oil and turns them into trans fats and for example olive oil has a very a relatively low um smoke point avocado oil on the other hand has a a very high smoke point um and so some of the the discussions around oils or around around you know how you're using them what temperature you're cooking them in how you can make them more healthy by using say avocado oil if you're going to fry foods but again um you know that's kind of which one is less bad for you right it's not which one is good for you because because I would argue that really there's no oil that's ABS that absolutely is good for you um there's probably somes that are less bad and if you if you if you choose to cook food at a high temperature and you know you want to fry it then you should probably use an avocado oil but a better choice is to use an air fryer and again we have a whole we have a whole Doc and Chef episode specifically on air frying and and this this whole whole discussion around around um around fats so let me ask you this you go to a fast food restaurant it's not uncommon to take a look at the grill take a look at the uh french fryer and to see smoke Rising off of the top I'm not talking about steam I'm talking about actual smoke so that then is a real that should be a big signal to us like hey this is really not something that's going to make your heart happy right right well that that's that's a true statement there's probably nothing in McDonald's going to make your heart Happy maybe than the wiy tomato the wilty uh lettuce and tomato that's on top of the burger that that's really about it because even even the condiments right uh even the ketchup is chalk full of of of sugar and on and on and on so so there's really probably nothing um good for you at McDonald's maybe the salad without the dressing great great point though because Annie is wondering whether refined sugars like those that are in the ketchup in condiments are those actually un uh unhealthy for the heart they are and and again so when we talk about heart disease so heart people don't just wake up with heart disease one day right so there are multiple risk factors for heart disease and so again I think this is a good another example we talked about nutritional reductionism a minute ago you know we we we practice Health reductionism as well right we treat you know so so think about the risk factors for heart disease so it's high blood pressure it's high cholesterol it's insulin resistance type two diabetes es it's obesity it's it's secondary lifestyle um you know there is a genetic component you know smoking things like that but in general as a physician you know I learn to treat all those things separately so I treat I would I learn to treat people's blood pressure different than their type two diabetes different than their cholesterol you know there's a pill for this and another pill for that but if you flip this all upside down um you know at the fundamental level all of those things are food born illnesses driven by the food that or lifestyle related in particular but driven mainly by the food we eat but also by how much we move and how much we stress and how much we sleep and you know whether or not we smoke and how much alcohol we drink and so so so we know that refined sugar you know again part of it's a substitution effect when we're getting we're eating white flour sugar what are we not getting we're not getting fiber right we know that fiber across the board reduces all those risk factors and we know refined sugar um increases our risk for insulin resistance it's also the fat I mean there's a lot of misconceptions around insulin resistance and type two diabetes type two diabetes isn't doesn't come from carbohydrates and sugar although it it plays a role it mly comes from fat um you know insulin's a key that unlocks the door to let the sugar into our muscle liver cells so we can store for future energy and when we get fat deposited in the muscle and liver cells it jams up the lock from the inside so insulin can't unlock the door so the sugar starts to rise in our bloodstream we have to make more insulin and then when we eat these Ultra refined Foods like the white flour and the sugar and these these heavily sugared condiments um that even in and of itself even we need even more insulin and so that puts a a tremendous strain on our pancreas and over time our pancreas keep can't keep up that's what we call type two diabetes but even people with pre-diabetes even early in resistance have a have a significantly increased risk for heart disease so again I don't think we can isolate you know one of these risk factors they're really all the same thing right and look here's the thing risk factors heart disease heart attack certainly not limited to just the US I mean this is a global issue and that's why I'm really excited that we have so many people tuning in from around the world right now igue is watching in Nigeria we have uh Caro who's watching in Kenya Elaine who's in Scotland Aaron is in New York Maddie in Melbourne uh Lynn in rockchester New York tofu Tuesday checking in from Sunny Phoenix which I'm jealous because it was just sleeing outside my window here south of DC uh Camila is in Norway uh but going back to Scotland you know just kind of a question for Elaine I can't imagine that haggus I believe which is one of the famed Meats of Scotland is going to do your heart any favors either it's not a it's not a it's not a meat Chuck it is the um it's groundup uh typ classically sheep lung and sheep you know it's kind of the parts of the sheep historically that that no one wanted to eat so they ground it up mixed it with some spices stuffed it into a sheep's stomach and uh and cooked it and that's what hogus is yes Believe it or I have actually back in the day way a long time ago I actually had some hogus in in Edinburgh um yeah you're a brave soul I just I mean that sounds worse than baloney to me and God only knows what they put in balone um my goodness so that's it's you're right I mean it's kind of like sheet baloney is what yeah yeah oh man all right uh question from Pete wondering whether white meat causes as many heart attacks as red meat we all have that perception or a lot of us do that white meat is the healthier choice well again we're this is more of a question is it healthier or less bad right um um and we know that that white meat consumption significantly increase risk for heart disease maybe not as much as red meat but but it's not it's it's not a negative risk factor because because again if you look at at the you know things that increase your risk or things that decrease your risk yes white meat increases risk for heart disease right I mean there's no doubt about it um so it may not be as much as as red meat but it's not a negative risk factor like the foods I went through are the five foods I mentioned earlier all of which are clearly negative risk factors right they clearly reduce your risk for heart disease so depending on how badly you don't want to have a heart attack right I mean you know um I think Dr Gregory uses the analogy I mean you know if if you wake up every morning and you bang your shin with a hammer um you know is the answer to you know take some Tylenol and just hit your shin twice a week instead of every day right how about we stop banging our Shin with a hammer because every time we eat white meat we eat red meat we eat a piece of cheese we you know drink a glass of milk uh we are literally taking a hammer to the Indo linting of our heart right and so you know again is hitting your is it hitting it 10 times a day uh worse than hitting it five times a day yeah it is is is is not hitting at all better than hitting it five of course it is right so so again I I think that um um I think sometimes we think about this the wrong way right so you know what we haven't talked about yet uh Dr Lumis is eggs and I think back to another one of the episodes that you did on the dock and Chef where we really looked at eggs and and whipped up an incredible like homemade just egg substitute where she actually grounded up the mung beans and made just egg the same kind of thing that you would get in the stores but made it in uh the in the shop there at the center for plant-based living in St Louis uh eggs and heart attacks some people say eggs are super healthy some people say they are to be avoided what does the science say to you sir so so there is a lot of controversy around around around egg consumption so we so particularly around the effect it has on dietary cholesterol so it it is clear that that dietary cholesterol can raise our cholesterol levels a little bit what's not clear what's less clear is does that increase in dietary increase in cholesterol from dietary cholesterol significantly increase our risk for for for heart attacks and there's some evidence suggest it does there's some evidence that suggest it doesn't um however um you know I think again I I personally think we should think about our food as we think about the way we think about money right so if you have a 100 calories to invest in your health in the moment and and what you're looking for the investment you're looking for is not having a heart attack and not having a stroke and not getting diabetes and not having cancer you know that's that's our long-term that's that's what we're looking for over the long term um and we can invest that 100 calories and because you know when we invest money we're looking at a positive return on investment so nutrition or nutrition nutrition returnal investment is exactly that it's reducing our risk for these these chronic diseases so if you have 100 calories to spend right this minute you can spend it on olive oil we already kind of talked about that you could spend it on an egg you could spend it on boneless skinless chicken breast we kind of talked about that or you could spend it on on you know beans and lentils right what does your nutritional return on investment look like for each of those those you know for each of those so 100 calories of olive oil is a little less than a tablespoon right and what do you get back from that nutritionally besides fat well nothing right there's no fiber there's no protein there's no cancer fighting F there's a few antioxidants but not very many um and and you know there's 125 calories per tablespoon of oil um so in fact oils in general are probably one of the worst return on investments you can make and I don't care what kind of oil it is right so what about an egg you know 100 calories of egg has some protein has a little cholesterol but what else does it have nothing right there's no fiber there's no cancer fighting phytonutrients there's no antioxidants and in fact people don't realize half a stock of broccoli has more protein than an egg right um you know there's eight grams of protein and a half stock of broccoli there's six grams in an egg and what else are you getting you know what are you not getting when you eat the eggs you're not getting the fiber and the cancer fting phytonutrients so again not a great return on investment what what about 100 calories of chicken breast you know what are you getting you're getting protein you're getting some fat what are you not getting you know there's no there's no fiber there's no cancer fighting phytonutrients and in fact whether we're talking about an egg or boneless skinless chicken breast you know the animals have just served as the middleman for the nutrition right so they've already used all the good stuff they've already used all the fiber and cancer fighting phytonutrient ant antioxid run their own Machinery they concentrate what's left into protein and fat primarily which we then consume now you know 6 8 10,000 years ago our ancestors probably had a survival advantage to have access to this kind of pre-digested preconcentrated animal fat and protein because our ancestors needed to get big and strong and and get away from leopards and find a mate and pass on their DNA before they died to some infectious disease when they were 30 so they never had to worry about it if I over consume the fat and the protein that comes from animals I'm not going to have a heart attack or stroke or get diabetes because they are already dead and we've unmasked all of that since as we've extending the life expectancy and and and because most of us are no longer star for calories we have the luxury of skipping the middleman right we can go straight to the plants because all the protein in an egg or a chicken breast or a piece of steak where did it come from it came from the plants that those animals ate primarily right so and by the way you know 100 calories of of chicken breast is about an ounce so think about how much space that's going to take up in your stomach think about how much space that oil is going to take up in your stomach or that egg's going to take up what about 100 calories of beans lentils broccoli you know we're talking 8 to 12 ounces right that's a lot of beans and broccoli you're going to be full what else are you getting besides the protein you're getting fiber cancer fighting fyon nutrients on and on and on so that is why these plant-based foods are such a such a amazing investment that we can make in in our future I mean think about it CH we're coming into football bowl season and Super Bowls coming up in a couple months you know you turn on a ball game and you open a bag of Doritos how hard would it be the 1,000 calories of Doritos for that games over that's just the first half bro that's just the first half exactly come on think about how you know how long would it take you to eat a thousand calories of blueberries or broccoli take you a week right it's like 10 pounds right so again it it's you know these plant-based Foods become calorically self-limiting right so so you can't overindulge in blueberries for the most part right you can't over overindulge in broccoli so so again you know that's why I think if we if we really really dig down and and think about the package that our food comes in you know that's really the key here the total package all right let's grab a couple of more here before we uh take things home uh let's start with Marsha and I think that this is a really pertinent question to what it is that we've been talking about all day today Mara at 12:37 says I've tried to discuss a plant-based diet with my cardiologist but she's more interested in statins how do I find a cardiologist who will support a focus on diet rather than just on drugs yeah so unfortunately um you know that that's a big issue and Kim Williams the past president of the of the American college Cardiology has said there's two types of cardiologists there's there's ones that are plant-based and there's ones that have not read the science Soh so so you're you're spot on there Marg that that it is important um there are a couple of good databases um that you know there's some find plant-based doctor databases pcrm has one um the plantrician project um um has one and so if you just Google plant-based doctor directly you can put in your ZIP code you can put in your um um you know the specialty you're looking for and it'll help identify you know plant-based doctors in the neighborhood and I can tell you you know here in Washington DC um there's two that I know of there's one down in Fredericksburg which is a you know couple hour train ride away and then there's one in the suburbs of DC but even here in DC you know there's only two doctors that I know of that that really truly advocate for a whole food plant-based diet but again there I think that's changing I think more and more doctors are starting to come around and understand the fundamental importance of a plant-based diet and especially in heart health and so I I would just suggest you you you you go online and you Google plant-based doctor directories and whether you're looking for a Obin doctor pediatrician you know primary care doctor um those are great resources all right uh Weiss 1233 avocados are they healthy I used to eat a lot of olive oil with avocados nuts fish fruits my LDL went to 102 I was expecting a lot lower number right now I eat mostly plant greens and egg whites so that's a great question so avocados you know can can be part of a healthy diet nuts as well right but the problem is with with both nuts and avocados um they they do have a lot of fat and so what usually recommend for patients who who have are trying to really get their their cholesterol in control so so when we talk about LDL cholesterol you know optimally it should be less than 100 ideally if you really want to minimize your risk for heart disease it should be down in the midle less than 7075 somewhere in there so people that struggle with high cholesterol there is a genetic component to this there is there is a genetic about 10 15% of the of our cholesterol risk comes from from family uh from DNA um but you do have to be careful about and especially people who have insulin resistance so type two diabetes metabolic syndrome fatty liver pre-diabetes you have to be careful not so it's not only the type of fat you consume but the quantity of fat and so I usually recommend trying to keep your total fat intake whether it be from nuts and seeds or avocados which are which are healthy fats to no more than about 30 35 grams a day uh and then you want your fiber intake to be 40 to 45 grams a day are higher than that right so oftentimes what I'll do is um is I'll have patients spot check their diet I use there's a lot of apps you can do it I I like chronometer it's called it's c o n o m t e r it's very tedious uh but but but but keeping a 24 or 48 hour food diary I like chronometer because you can save recipes you can just cut and paste recipes it'll calculate all the nutritional values and just see where you're at and I can tell you you know I live and breathe this stuff and about once a quarter I do do chronometer just to reenter myself and I am almost always amazingly disappointed at the disconnect between what I think I'm doing and I'm actually doing and the thing that gets me in trouble is exact it's nuts and nut Butters right so say I want to have a snack in the afternoon and brown Trader Joe's has these little brown rice cakes which are perfectly fine fiberous little peanut butter you want to be sure you get the one that doesn't have it's just peanuts you don't want one with palm oil which is I added oftentimes as an emulsifier because we mentioned earlier tropical OES are not good for you you know little peanut butter um you know maybe some apple cut up maybe a little cinnamon perfectly healthy snack right well I get the peanut butter out right a big spoonful for me a spoonful for the cracker another Spoonful for me well that's two-thirds of my fat just like that right without even thinking about it just the other day u a couple I have two sons that live here in town and we were GNA have a taco party and I and I made a h um I I wanted to make a a Chipotle cashew Crema right to drizzle on the tacos um and you know the amount of fat in that from the cashews is for a little drizzle you know minimal so I get my Vitamix out and I get the cashews out handful for me handful for the blender handful for me again two-thirds of my fat intake so so again you know avocado is the same thing you know if it was up to me I could take I could eat a whole huge bowl of of guacamole I could just take a whole avocado and fill it full of hot sauce and eat with a spoon probably don't want to do that especially if you if you if you ttin toward higher um uh toward higher cholesterol or especially if you've got you know insulin resistance you know you you want to treat avocado like you would a condiment right so so you know a couple slices on a on a on a bowl or in a salad or on a burrito perfectly fine but again it needs to be in the context of limiting your overall fat intake to probably no more than about 30 35 grams a day somewhere in there yeah I hear you say you probably don't want to do that but then there's also that part of you that says yeah I I I really do I really do they're they're so dag on tasty uh last question I want to give this one to a first-timer who's able to join us live Anette at 12:15 thanks for Patiently Waiting uh wondering about their own heart health wondering whether it's better to first get a calcium score test or a stress test not sure why they would be looking to get these but by and large is it possible to wait which is more important sure sure so um so so for those you don't know a stress test there's different kinds but the typical stress test is an exercise stress test where you put someone on a treadmill you hook them up to an EKG and you have them exercised so you can't exercise anymore and you monitor the the for changes and in in in the EKG normal heart muscle conducts electricity in a certain way and when when if you were to have some blockage and all of a sudden you're not getting enough blood supply to the muscle it changes the way that that the electricity is conducted you can see that on an EKG the problem is you have to have about 60 to 80% blockage um uh to fail a stress test right um so so you could have 75% blockage and be in pretty good shape and and still pass a stress test now the good news is if you pass a stress test the likelihood you're going to have as significant heart as it at the end of the next couple years is is is is is is reasonably low um but there are some patients who have a strong family history um and and you know or they've got a lot of risk factors and where we're really want to be very careful about you know getting their cholesterol down you know pretty low and sometimes it's just not possible to do with with diet and exercise you know I'm I'm not anti- Statin but I I mean but everyone you know I mean I do use lifestyle lifestyle um primarily but there are some patients who who actually might benefit from from from statins and so um a coronary calcium score what we're talking about here is um when when we start to develop plaque or blockage in our in our arteries um you can think of it as almost like a scar bar that's forming in the in the in the in the subendothelium just below the endothelium and and as that progresses or matures um that scar if you will that plaque will start to calcify and it turns out you can actually measure the amount of of calcium um that's present in the coronary arteries and so that's what so that's a coronary Ary calcium calcium scores the test is what we're talking about here and it's it's done with a with a modified Cat Skin limited Cat Skin now it doesn't tell you how much blockage you have so it doesn't say oh you've got 50% blockage in you know your left anterior descending artery but but it it measures What's called the the plaque burden and there is solid evidence that that the plaque the the level of your calcium score directly correlates to your risk of having a heart event in the in the next you know five years um and so um I typically use calcium scoring to restoratif patients risk and I'll usually do that first if they're not having symptoms I will usually do a calcium score first because if your calcium score is zero then you don't need to get a stress test or if it's very low if it's if the calcium score is very high then we might move you know send someone to see a cardiologist they might need a stress test at that point if you know if you're calcium scores four or 500 um so that's how I use it so because I think some patients are are under so if you there's risk scores you can do you can you can enter in you know age and gender and cholesterol numbers and whether you smoke and what your per is it'll calculate what your heart risk is and that's how we've traditionally determined if someone needs to be on a stat or not I think there are some patients who you know for example you follow a plant-based diet you've got a little bit of a family history but you exercise and you're not obese and you don't smoke but you put your numbers in you know your cholesterol's but despite all that your cholesterol is still running a little high maybe there's an element of familial hyper cholesterolemia the numbers might say go on a Statin but I'm I'm thinking you know I don't think that may that might not be necessary so I'll do it a calcium score to to see if they've been over if their risk has been overestimated and then there's other patients who who um whose risk might be underestimated you know everyone in their family died of a heart attack when they were 40 and they've got say insulin resistance and all that where we might want their lipids to be down in the 60s and we can't get it below 110 which might be okay for some people um oftentimes I'll use a calcium score to to be sure they're not being under the risk isn't being underestimated that's how I personally use um the calcium score I think you know any test I order I I like to think through what am I going to do with the results and if if the answer is I'm not going to do anything with results and I typically won't order the test but but again if if I use it as in the decision tree to start whether or not to to start statins typically um um there there are other uses of it um that people use but that's how I use it in my practice you know in in a from a preventive kind of standpoint all right now here's the deal uh you can an appointment to visit with Dr Lumis at the Barnard Medical Center do it in person in Washington DC tele medicine visits also available in select States log on to Barnard medical.org I know that your patient calendar is ultra full uh but you sir are definitely worth the wait so Barnard medical.org to schedule your appointment today and then uh coming up December 14th in St Louis at the center for plant-based living you going to be putting on your doc and chef hat with Karen dug going to be having the healthiest ug sweater Christmas party ever uh and and so I just I brought this I actually got this sweater the last time I was out your way uh over the holidays and I just wanted to hold it up because I just want confirmation that this may be the ugliest Christmas sweater that you have ever seen you know what Chuck you might win the prize thank you you're not even gonna be there you might win the prize that is a pretty ugly sweater I have to admit I mean I'm not going to lie to you though this guy kind of looks like the old me with the Santa hat on good that's a good point yeah so it's just a reminder how far we've come in life that's all that's exactly right and I and I promise you you know in addition to being amazing food you know it'll probably be the most educational dinner party you've ever been to as well and not only is it a lot of fun and the food is absolutely amazing um you know and you and you don't have to cook you don't have to clean up and you might learn something right so absolutely matter of fact let me go ahead and pull up the um the menu for the Christmas party there it is right there this is what uh Chef Karen Dugan is going to be whipping up there look at this I mean this is just off the charts right there there's a link by the way to sign up uh right now in the episode notes you get a bargain for the price you get the education plus you get the dinner and oh by the way uh you know everybody's wearing an ugly sweater I mean I might send this one out there your way I don't know if you would wear that that night but uh yeah yeah yeah yeah I feel like that that poor sumo wrestler needs a name but anyway I mean just a fantastic menu and I see like chick chicken parm is on there uh with pasta and it just it never you know ceases to amaze me how fun eating a plant-based diet can be and how creative you can get in the kitchen to replicate all of your old favorites so you know we talked about taking a lot of stuff off of the plate today but it doesn't mean that you have to sacrifice the flavor that you've grown up with at all yeah you're right and you know you can also learn more if you come over to the dockin chef.com you know Karen and I started the dockin chef um earlier this year um and and it was really you know we were getting the same questions over and over like you know where do I get your protein she's getting from a nutrition standpoint I'm getting from a health standpoint where do to get your protein is soy good or bad what about gluten so we you know one day we we were at a conference U speaking and and Lio why don't we start a YouTube channel so we did and these are short 105 minute videos where we marry the nutrition signs to your plate of food and and your you Chuck here is our is our producer editor Man In Charge the boss man we call him um and each each episode I write a scientific blog post that has all the evidence and all the re the research um links to it so it's really um um we've gotten some great feedback from patients and and people in the community um about how it's almost people call it um edutainment right so um Karen and I have kind of a unique um um um um we get along well together and and and um with a lot of chemistry and and so I think you'll enjoy it and and uh new episode every couple weeks and um um so stop come over to the to the docking chef and and for some fun edutainment edutainment my friend there's a link to that also in the show description and in the episode notes right there uh Dr Lumis man thank you for your time this has been a lot of fun and just recapping for those of uh you who joined us a little bit late today the five foods the five biggies for lowering that risk of a heart attack legumes whole grains green leafy vegetables fruits especially berries and then soy right stop shaming soy bring soy into your life you will be just fine my friend Dr Lumis you are more than fine you are tops my friend appreciate your time right thank you happy holidays to you Chuck happy holidays to you my friend and to the crew behind the scenes thank you guys so very much for making the magic happen and to you exam roomies thank you for all of the wonderful questions and raising your health IQ right alongside of us and for everyone at the Physicians committee I am the weight loss Champion Chuck Carroll we will talk to you again very soon but until then keep it plant-based
