Paradigm Shifts in Lipid Lowering - Episode 15

Dietary and Lifestyle Modifications in Lipid Management

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Role of dietary and lifestyle modifications as part of lipid management.

Keith C. Ferdinand, MD: We’re going to talk about diet because it’s important, and I know the listeners like to hear the opinion of veteran clinicians like yourself. You’ve spoken of the Mediterranean diet. Manesh, Norman, Linda, what’s your favorite diet for our patients who are at high risk related to hypercholesterolemia and vascular disease?

Linda Hemphill, MD: I have a very simple thing that I tell my patients because I don’t have time to describe. I could send them to websites for the Mediterranean diet and so forth, but I tell all my patients to look at the nutrition information. I tell them it’s not the total fat that’s bad; it’s the saturated fat.

Keith C. Ferdinand, MD: Which is even worse than the cholesterol in the food, correct?

Linda Hemphill, MD: Exactly, yes. The formula was derived in the 1960s, I think, in metabolic ward studies: saturated fat has 2 times the effect vs cholesterol. I tell them, “Look at that saturated fat. Keep it 2 g or less in the portion you’re going to eat.”

Keith C. Ferdinand, MD: Norm, Manesh, diet?

Norman Lepor, MD, FACC, FAHA, FSCAI: You know, I’m a big fan of the Mediterranean diet. I know it’s not a very sexy answer. There are people who like to do intermittent fasting and all these other varieties that get headlines. But I’m a big fan of the Mediterranean diet, which seems to win all the time.

Manesh Patel, MD: On my dietary front, I’ll say the following: It depends on goal. Over the last few years I’ve lost some weight. If your goal is weight loss vs heart healthy—they’re often linked, but weight loss has some different things you can do vs heart healthy. I absolutely agree that the Mediterranean diet—the right kinds of fats, low carbohydrates, vegetables, fishes, good meats—is good. And what I tell my patients, when they ask me what I did, is that eating between only certain hours. 

A couple of things that are really important for people to understand is that your brain can use glucose. If you give your brain glucose for energy—straight glucose, fructose, some of those things—it does start to say, “ I don’t need to save all that other energy.” From a metabolic perspective, stay active. Some of these apps and other things, what they talk about is “keystone” habits. Can you do some activity in the morning and think about your health? Can you then at least in some way think about your plate?

I show them the 12 o’clock plate and say if you’re eating between 10 and 6 o’clock, that’s where vegetables are; here’s where protein is; this is where carbohydrates are. A small portion of the plate is carbohydrates, plus good types of proteins, mostly vegetables. It can’t be too complicated. Has to be pretty simple that they can look at their plate every day. That will make a difference. Otherwise we get into really complicated scenarios.

What most people are trying to do is say, “Is that a good nut? Should I not be eating that? Is that a bad fruit? Is that a good fruit?” That gets really complicated, even though I know low glycemic index exists. I appreciate that we think about what the types of saturated fats and nonsaturated fats are.

Keith C. Ferdinand, MD: That enthusiasm of all those various meticulous complicated ways to approach eating patterns after awhile wanes, and the person is back to the drive-through.

Manesh Patel, MD: That’s right, and the drive-through is easy, that’s for sure.

Keith C. Ferdinand, MD: It’s easy, yeah. A No. 2 combo to go.

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Transcript Edited for Clarity