Are We Eating Ourselves Sick?

You know, you could just peace out for a little bit and go to go to lunch off site with some of your colleagues. Um the lounge food leaves a lot to be desired. >> Yeah. Uh you know the doctor's lounge. I mean sometimes you I you see the menu like oh what do they have today? And then you get excited. You're like it's going to be good. It's never good. >> It's never good. >> It's never good.

And then for me I I get a lot of uh pharmaceutical reps that come in and bring food which can be good but >> you have to listen to a lot of different things. >> Yeah. It's dependence, right? Like when when implant reps come in, you know, they want to show you the new shoulder replacement, whatever. Look at this new plate. Um, which is nice because that's kind of how you learn about new stuff in one way other than conferences.

But, um, sometimes it's a product that, you know, you have no interest in. It's like sometimes reps will bring in stuff that it's like for a foot and ankle company and like I only do upper extremity and I'm just looking at them like >> I feel bad.

I mean, there's a lot of reps that I really like and I enjoy talking to them and we have good discussions, but then there's some stuff I know from the beginning, I'm not interested in this, you know, this is not something I I entertain them and, you know, just because they brought lunch, I'm nice. I don't want to be, you know, >> Yeah, you can't be rude, right? >> I can't be rude. Uh but, you know, um it's it's not you never have as a physician, you never just have free lunch to yourself.

Like either if either I'm talking to a rep or I'm rounding and stop stop stop stop stop stop stop stop stop stop stop stop stop stop stop stop stop stop stop stop stop stop stop stop stop stop stop stop stop stop stop stop stop stop stop stop stop stop stop stop stopping by the doctor's lounge to like get some food real quick before I head out and get back to clinic uh and eating while I'm like just standing and like rushing through it >> scarfing it down >> scarfing it down or or I'm like writing my notes while I eat there's never not like some of our friends who can just like leave for an leisurely lunch for an hour and a half during the workday.

>> Yeah.

You know, it's crazy like I mean basically like for me and you I mean we pretty much went through you know high school, college, med school, residency, fellowship and work like I never worked a corporate job but it's just like you know you watch movies watch TV I talked to my wife who's a financial analyst all our friends they're like yeah you know we went on lunch we went to here you know it's like a big social thing to go out go offsite for lunch and you know you get to try new restaurants and stuff and >> you know we're kind of stuck eating like semi fried or overfried overfried bland food, cardboard.

Uh you know, I did experience that during my MBA program where uh we would have morning classes and then we would have like a lunch break before afternoon class and a bunch of us would get together and go for lunch somewhere every day almost uh and go >> sounds great. You know, some like sometimes like on a clinic day um if we'd finish the morning on time like I have a resident with me since it's academic. So I'll I'll take the resident off site every now and then.

There's one uh it's actually this one girro place just down the street from the medical center. Um it's like our go-to if we um if we finish morning clinic on time. The guy knows me there because we go every so often and it's like such a treat just to go anywhere that's not the that's not the doctor's lounge in the hospital cuz the the not only does the food honestly kind of suck. Um it's almost always finished. Like they bring the food one time in the day at like 11:00 a.m.

which is not a lunchtime. And as soon as they bring it, you know, the people that are closer to the lounge are not as busy. They flock there, dude. And you get there and it's like, I'll eat a little bit of cabbage, I guess. That's >> cabbage. And then the cold uh turkey sandwich that's kind of >> moist turkey uh that's been for uh >> the uncrustables. Did you have that in your >> No, no, man. The the the the quality of the food that we eat in this country is just horrible.

I mean, the amount of process I mean, doctor's lounge, right? doctors all lounge should not have ultrarocessed foods. >> Uh and that's a huge deal. I mean people >> I mean majority of Americans eat processed food which is very frustrating because that's the most uh harmful kind of food you can eat. I mean you know food that's been packaged and restored and has had a bunch of chemicals added to it.

I mean, anytime you go to a grocery store and look at these processed food, there's uh it says sugar, uh, you know, wheat, beans, whatever, and then a bunch of ingredients that you don't know what they are. >> A paragraph of stuff you can't even pronounce. >> Yeah. Ethyl, acid, carbohydr, you know, I I don't know what it says, but I mean, there's just these unknown things like, what is that? What is that food? Should that should I be putting that in my body? I mean, you know, so >> yeah, totally.

I mean it's just like well you know sometimes when people ask me I it's a good question like what is processed food? This is like it's a term that's thrown around a lot, right? Like processed food, a trans fat, MSG, all this stuff, right? I mean, like you said, processed food is just it it's ultra refined or in some way the structure of it has changed to increase the shelf life, allow it to be packaged, doesn't expire as fast. People buy it, people keep it. Um, all of that stuff.

And, you know, I think it's interesting if you think about how all of this stuff came about. It's really like a lot of marketing by the food industry. A lot of it is direct to the consumer marketing for stuff that is not healthy. But the advertising is such that people people think it's fine. >> Yeah. I mean we have to differentiate between processed food and ultrarocessed food, right?

>> Because processed food can be anything like milk that has been uh heated up and uh filtrated and pasteurized is processed processed food, right? But uh chocolate milk that's been in in a carton with a bunch of different preservative added to it so it can stay on the shelf longer is processed ultrarocessed food. So there's differentiation between those. I mean you know now processed food is not necessarily bad.

I mean you know canned uh tuna or canned salmon or smoked salmon is processed because this this salmon has been smoked and packaged. it's processed, but unless it has a bunch of chemicals and preservatives added, it's not ultrarocessed.

So, if it's processed, it can still be okay and healthy, but if it's ultrarocessed, so that's why I talk to a lot of my patients, hey, you know, when you go buy uh some of these foods and go grocery shopping, maybe look at the label sometimes and see uh are you able to recognize most of the ingredients? And that sometimes tends to be a a good rule. But we know that ultrarocessed food is is cheaper, more accessible, stays good for a while. It doesn't sometimes have to be refrigerated.

Um, you know, packaged meats and sandwiched meats that are packaged and preserved and frozen can stay there for a while and those are highly processed foods and not very good for you and are seriously linked with cancer and cardiovascular disease. Uh, >> yeah. Now, that's a good distinction between processed versus the ultrarocessed. And, you know, rule of thumb, if you can't recognize what's in it, maybe you shouldn't eat it.

And if something doesn't expire for like 5 years, you probably shouldn't eat it either. >> Yeah. >> It's not real food. Yeah, definitely. I mean, you know, uh there's so much so much talk and so much chatter around nutrition. I mean, I see all these uh you know, social media gurus and bloggers and longevity experts, so-called longevity experts come in and they say doctors do not get taught about nutrition. Yeah. I mean, you know, we we I mean, we do get some basics of nutrition in med school.

Not as in depth. We're not we don't major nutritions. There's many doctors that do major in nutrition. they make it their interest. But yeah, maybe doctors do not get as much uh nutrition counseling, but good doctors go out of their way and read about nutrition, read about diet, uh educate themselves because what we do get trained on is we get trained on how to interpret studies. We get trained on how to read papers and distin have a distinction between what is research.

We we get taught how to analyze papers, how to do uh we have journal clubs where we can dissect papers and figure out what is and what is a lie and what is some company trying to propagate. Right?

So when people say that oh yeah I've done a lot of research most people when you know a lay person or you know uh most of the people that you talk to they say I've done my own research most of the time that means they've googled and tried to find articles that agree with their worldview and uh you know and then they regurgitate those facts or they listen to some kind of influencer or a longevity expert and then they go on and talk about nutrition.

Oh no, this is a keto diet or you know I need to do Atkins diet or uh do you know this is these are proin inflammatory foods and this is what you should not be eating. Oh, you should not be eating fruits because this has the fruits have so much sugar that some influencers said that and now they're >> it's difficult, right? Like, you know, I I do think I I applaud it in a way though, right?

Like that shows that that person, you know, and I think society at large is getting more and more interested in this, but that person is interested whether they're reading, you know, the so-called right source, wrong source. Nutrition is still challenging. Um, and I think that's why so many of these diets exist, you know, like you mentioned the keto diet, Atkins, I mean, there's so many, right?

people intermittent fast, the Mediterranean diet and stuff, but all of these things exist and they kind of go in phase, out of phase based on what people are doing. I mean, people want sometimes their goal is to lose weight, sometimes their goal is just maintain, sometimes their goal is to build muscle, heart health, you know, all this stuff. Um, and so I don't think necessarily there's like a right or wrong nutrition, right?

It's very dependent on the person, the person's goals, what their general health is. Um, and then what's the data?

I mean the data on nutrition some stuff has a lot of data right like we can even talk about keto I think that's an interesting thing to maybe dispel a few myths and really go into a little detail on keto because it's a very common thing that my patients ask me about you know when we talk about like muscularkeeletal health and fitness and building muscle maintaining bone mass patients ask all the time like what do you think about the keto diet what is what is keto what is ketosis like what is that like sometimes patients will just ask you um what do you think about that like from from the cardiology perspective Yeah.

Well, uh you know, keto diet is uh there's a role for it, right?

uh metabolically healthy people with no cardiovascular disease uh or people with you know trying keto diet can be dangerous because uh recently there was a study um it was called a keto CTA trial and what that showed was uh completely metabolically healthy people uh that did not have diabetes did not have obesity uh they went on a keto diet now this was a small study 100 patients uh and they what they did is they did a DT angiogram of the heart looking at the plaque uh and they put people on keto diet their LDLs and APOB levels climbed.

Now just to kind of put in perspective keto diet uh and having keto diet is mainly uh intake of uh you know mostly uh fat protein content and avoiding carbohydrates completely. Now uh taking in that amount of animal fat to kind of you know accomplish your nutritional needs leads to increase in your apo levels or your LDL levels significantly. So in the keto ketoCTA trial they follow these 100 patients they did a CT andogram and they checked their LDL and Apo B levels which rose quite a bit.

Now they did a CT at the end of the trial and the beginning of the trial and they saw that people who were metabolically healthy, no other cardiovascular, no other uh they were not obese. They were overall skinny healthy, no obesity, no diabetes, but had some plaque, the plaque propagated even more. And despite despite what was their LDL level, this was their what was their APOB levels, uh the amount of plaque u increased quite a bit on keto diet.

So it showed us uh and the the the conclusion a lot of times for most cardiologists are taking is plaque begets more plaque. You know plaque uh if someone has plaque that we don't know about and they are on a keto diet that brings upon more plaque and increases the propagation of plaque buildup in the coronary arteries. uh and plaque.

>> Was that was that um a thing in the trial that it was believed that the keto diet itself could have potentiated more plaque development or they were potentially just unrelated that if you already have plaque, the plaque itself is just going to propagate and grow and the keto diet didn't mitigate that. It didn't stop. >> It was in the presence of keto diet and and but the the amount of your apo and l LDL levels did not show correlation with the amount of plaque you got.

people who were on these uh highsaturated fat diets sometimes ended up getting more plaque uh and there could be many reasons for it, right? We know plaque could be related to inflammation as well. >> Um >> yeah, numerous factors, right, guys? You know, so one one thing I think is is probably a good idea to talk about is just, you know, I think it's interesting like the history of this stuff. How did the keto diet come about?

The keto diet was before any anti-seizure medications existed, it was the only way to treat seizures. you would put patients on a ketogenic diet, meaning you'd really really restrict almost eliminate their carbs and like you mentioned, put them on a very high animal fat-based diet.

Um, because basically by having a diet like that without carbs, your body can't default to using the easy energy source from carbohydrates breaking down to glucose and then using it, it's forced to now break down the existing fat through the liver. It's called oxidation. And that's why it's called ketosis. You have these the breakdown products of fat. It breaks into ketone bodies. They float around.

Um, and that's what makes someone who is fasting or hasn't eaten in a long time, their breath has a distinct odor to it because ketones have that smell. But they float around in your body and those are now used as energy sources. And allegedly, I mean, the mechanism is still not understood, but it worked in seizures because since it's a less readily available energy source, harder to create that hyperexitability throughout the brain, which is what leads to a seizure.

And so that's one of the proposed theories why it worked for seizures. But then, you know, fast forward now seizure medications exist and that's more of the mainstay. But people then found that the ketogenic diet also can lead to pretty remarkable weight loss. It's not necessarily sustainable because when you go back to normal feeding, normal meaning the baseline diet that most people have, which is heavy in carbs, you're just going to rebound. Yeah.

>> Um and so that that's another question, right? Can the ketogenic diet, if you're purely looking to lose weight, right, purely for weight loss, does it work? Yeah, it definitely does work. Um, but it's not a maintained thing because it's very difficult to maintain that and a ketogenic diet is hard to do. Um, and it has other negative effects also like um like muscularkeeletal effects.

You know, if you're in a chronic state of acidosis because ketones or keto acids, that's what it's called, ketosis, keto acidosis. So your body's normal acid base, the relative acidity in the blood should be at a homeostasis at a level around 7.35 7.4, right? If you're a little more on the acid side of it, what happens? Something in our body has to try to buffer it, right? Try to make it back to normal. One of the ways it does that is your bone starts breaking down.

Your bone leeches out calcium and phosphorus and stuff so that it can buffer it. And the buffering works, but what does it do over long term? You lose bone mass. That doesn't happen short term. short-term acidosis environments, it doesn't happen, but long term it does and you can lose bone mineral density. So that that's another thing to consider.

>> Yeah, even from a cardiovascular disease point of view, uh you know, uh short-term weight loss and diabetes control is very beneficial and keto can be have a use can can be useful there, but long-term keto diet uh can have a lot of effect on the cardiovascular outcomes because uh you are developing more plaque buildup in your coronaries, which is what most cardiologists are very concerned about. So, I do not recommend keto diet to a lot of my patients.

They ask me about it and I tell them honestly, yes, if you want to quickly lose weight, get in better shape, maybe improve your diabetes and insulin resistance, keto diet has a role, but you have to think long term. Uh long-term maintenance- wise, what is the best type of diet out there? And there's uh resoundingly one answer for that. uh and and there's only one diet that has been shown significant cardiovascular outcome benefit and that's a Mediterranean style diet, right?

I mean they did the study called the Lion Diet Heart Study, L Y O N.

Um, and they did this study uh where they put people on the Mediterranean style diet and we'll talk about what the basic principles of the Mediterranean diet are and that showed a 50 to 70% reduction in a major cardiovascular events and that study had to be finished early because the amount of benefits and the reduction cardiovascular events showed it was astounding and uh you know >> yeah I mean that's a huge that's a huge effect 50 to 60% reduction I mean that's massive.

Yes, you know, um, you know, a Mediterranean diet with the, uh, it's a known fact that there's areas around the Mediterranean that they have noticed that people live, uh, long time. There's so-called, you know, blue zones or green zones >> uh, where people live uh, as as centinarians. You know, they live in hundreds and 90s and >> uh, and the the concern was what is the reason? Why are they living so long? And when you study the Mediterranean diet, you kind of find out the reasons.

And a big part of the Mediterranean diet is, uh, you know, omega-3s, uh, omega-3 intake through diet, not through pills, not through supplements, but through diet is a huge role. And big part of omega-3 is olive oil. You know, olive oil makes up a big portion of the Mediterranean diet. And the use of olive oil can be very beneficial based on the studies we know. >> Yeah, for sure. I mean, it's a it's a huge thing. You just to kind of clarify that a bit.

Homaya, the the Mediterranean diet, it doesn't just mean like you go to your local like Arab Mediterranean restaurant, eat a bunch of gear, right? What? >> Yeah. Falaf, you know, you eat falaf, fried falafel balls, right? No, that's not what it means. >> You know, I'm going to go to the sharmas the shuarma and get a bunch of rice. >> Yeah. No, it does not mean eat Mediterranean food. It doesn't mean eat like you know food from the Arab countries. Uh it means the Mediterranean principles of diet.

So the base of all the Mediterranean diet is um you know things like berries, fruits, vegetables. It's a very vegetable forward diet. So a large amount of your diet includes uh tomatoes, cucumbers, uh blueberries, blackberries and that makes up the base of the diet. Right? the most of your uh fiber content nutrition should come from berries or fruits or vegetables initially. Now add on to that you add on um you know um sources of >> even grains right like >> a lot of whole grains. Yeah.

>> So the next the next phase on that is using grains and things like pharaoh blue brown rice quinoa um you know and um couscous. So there's multiple types of grains that can be used. And then legumes, legumes are a big part of it. Legumes are beans, uh lentils, um you know, peas. Uh these are very beneficial. Um and then when they talk about animal uh fat or you know, they talk about more like lean proteins uh mostly from the poultry or fish uh such as salmon.

Salmon's a big part of Mediterranean diet and Mediterranean diet recommends at least two to three servings of fish a week. uh fish that are high in omega-3s. Um some of the fish that are very high in omega-3 are salmon, sardines, uh macarel, u tuna. Uh those can be very beneficial. Eating more chicken, more turkey. So that's a component of it. Now they also talk about um having a dairy component, a small dairy component and does not mean drink milk, but they mainly focus on cheeses um as well.

So that those principles and you can if you're South Asian for example, you can still uh have a Mediterranean diet. You can have a meal of raw vegetables, a salad of cucumbers and tomatoes, brown rice with some lentils and some fish and that can be uh a complete balanced Mediterranean style meat. And that can be flavored in any way you want. It doesn't have to have a sumak, you know, but uh it can be any flavoring.

If you're Asian, you can have Mediterranean components of the diet and flavor it the way you want it. But you >> Yeah. And that that's an important thing to mention that it's it's not about flavor or like a specific type of cuisine. The Mediterranean diet is not a cuisine. It's really just focusing on those types of ratios in your food. Primarily fruits, vegetables, and whole grains rather than processed grains.

And when you eat meat, animal products, it's mainly fish and then poultry and and honestly very little red meat. That's kind of the main stay of it. Um, and like you're saying, I mean, there's so many studies, so much data on the Mediterranean diet. >> Yeah. >> Like the seven country study, there's so many of them that show resoundingly across numerous countries, I mean like thousands of patients.

I I think like that's seven countries there was like 12,000 patients um across many different areas where they were living that showed similar positive effects on cardiovascular health all cause mortality. >> Yeah. No definitely um you know um I think Mediterranean diet is an easy diet to do as well. I mean it includes a bunch of variety of things. I mean you you can have bread, you can have pasta, you can have uh you know brown rice, you can have fruits.

uh and it's a very balanced diet and that's why it's shown such a such a significant reduction in cardiovascular events and for long-term it's very sustainable. You know, you don't you're not going on these long fasts. You're not eating uh uh large amounts of animal fat. You're balancing your diet. It's not a diet of subtraction. You're not eliminating things. It's not an elimination diet. It's a diet that's inclusive of all different types of food nutrients. Right?

So that's that's a big component of the Mediterranean diet and that's why easy to maintain. You can do it over a long time. You can make it a lifestyle. Uh and there's many thousands of recipes. I mean you know um the American uh Society of Preventive Cardiology came up with their newest guidelines on nutrition and that's the first time we've had true guidelines on nutrition and uh recommendation of Mediterranean diet is a huge part of those guidelines.

There's a lot of people that, you know, they kind of discard Mediterranean diet or they say that, you know, the keto diet is the only way or the Atkins diet is the only way, the low salt diet is the only way or some people say the intermittent fasting is the only way, but there's no no such thing as only way, but there's only >> Yeah, there's no there's no only way. >> There's no only way, but there's only one diet that's shown true evidence-based uh outcomes, right?

Um and that's the Mediterranean diet. So, as a physician who practices evidence-based medicine, that's the only diet as from the cardiovascular outcomes point of view, that's what I can recommend for most of my patients. >> Yeah. No, well said. For sure. I mean, you know, and like the um the Atkins that we've said the Atkins diet a couple times. It's a common thing that most people have heard of. The the Atkins diet is in a way it's kind of like the keto diet is just a little less strict.

Um, the keto diet, a true keto diet is actually done, I mean, you got to calculate it out for that patient, their body, everything. It's a very regimented and exact ratio of stuff. The Atkins diet is kind of more loose. Basically, just eat a lot less carbs and sugar. Um, not as strict as the keto diet itself, but even that, I mean, that is hard to maintain. Um, trying to really eliminate uh carbs all the time is a very difficult diet. Takes a lot of planning.

Um, and you you can be pretty low of energy. I mean, and it's not right for everybody. Um, if you're not otherwise healthy and young and you have some issues, some metabolic disease, diabetes, anything like that, it it can actually even be detrimental. I mean, some of these so-called diet fads or these transient selective restrictions of what you can eat, they can actually cause harm um in some settings. >> Yeah, restrictive diets are never uh the long-term answer, right?

For the short term, you can have the short-term gain, but long term, you need something that will give you a wide variety of nutrients. And uh instead of having to take supplements and adding vitamin C and uh you know, calcium and all these different extra supplements, omega-3s through fish oil, I mean, having a balanced diet uh that can provide all of these nutrients is very important.

And if if you simply follow the the principles of the Mediterranean diet, you'll get majority of your nutrients through that. Right? Now a big other big misconception is okay the sugar sugar is and not all sugars are the same. Right? I mean uh complex carbohydrates are different than simple processed carbohydrates. Just because a bowl of grapes has the same amount of calories or sugar as a Hershey's chocolate doesn't mean you choose the Hershey chocolate or the grapes.

Grapes are definitely better just because the amount of fiber content in them. And fiber has a huge play in reducing your uh glycemic index and your and your uh cholesterol, right? And your your APOB and LDL levels. >> Totally. Totally. And so that that's another you these are there's so many buzzwords, right? These these hot button words, a glycemic index. So like what is a glycemic index? What does that mean? Using that example, right? Like a chocolate bar and some fruit.

um let's say they both have 250 calories. Which one are you going to eat for a snack? Is one calorie one calorie? Is a calorie a calorie across the board? And that's where glycemic index comes in. It basically looks at if you eat two different things, how rapidly does it raise your blood glucose? Uh with 100 being like horrible and zero being the best thing, right?

And so the higher a food item's glycemic index is basically like what you were saying the more bas basic and simple sugars meaning carbs are present in that food meaning it can be more rapidly digested and absorbed and converted immediately into glucose in your body. Therefore raising your blood sugar much faster. Whereas if it's got a low glycemic index meaning it's more complex carbs it takes longer to break down. It's harder to break down.

So, it's a slower and steadier rise in your blood glucose after you eat rather than a sudden spike. And those sudden spikes are what's really detrimental. Whereas those steady sustained rises in your blood glucose as satiety sets in, the glucose level slowly goes up. It's better. It's it's more sustainable. You're going to eat less often. Um and you're going to get less of those glucose spikes. It messes with insulin a lot less. That that's what glycemic index is.

And that that's exactly why grapes are better than a chocolate bar. Yeah, exactly. I mean, you know, uh, when you have a spike in your blood sugars, I mean, you have a bolus of insulin that's produced to counteract that amount of glucose rise, right? And insulins we know builds fat uh uh insul insulin is the direct cause of adapose tissue production in the body. So people who use a lot of insulin u um tend to get you know tend to gain weight and tend to gain fat as well.

So insulin uh glucose spikes with insulin production can also lead to increase in weight and that's why you see a lot of um you know people who eat these simple carbohydrates tend to gain a lot of uh you know fat and adipose tissue as well but you cannot say generally that sugars are just bad for you. Yeah. What type of sugars?

Now, if you're drinking alcohol, uh that is also sugars and sugars are definitely bad for you then because you know the the amount of poisonous uh chemicals in a alcoholic drink along with the amount of sugar that it has. It has a much much more damaging than the amount of sugar you taking in from uh a sweet potato, right? So, not all sugars or all carbohydrates are are equal.

And some with high fiber content, low glycemic index are much more better and preferred than some of the other ones like a chocolate bar >> for sure. And I mean like you know no human would be alive today without sugar. It is the basic energy molecule in our body. So to think sugar is the enemy is not necessarily true. It's you just don't need to add excess sugar. But we get sugar from everything.

I mean everything even protein ultimately breaks down and becomes in some way um glucose which gets broken down in our cells and used for energy. That's, you know, even like and not all foods are like a grape is not always the exact same, right? Like foods change over like ripening. Um like a banana that is green, less ripe, it has a different glycemic index. It has actually real different um carbohydrate molecules in it.

>> And as it ripens, as that green banana turns yellow, it starts smelling better, tasting better, getting softer. It's actually in a way you can think about it as it's breaking down those complex sugar molecules like emalopectin all that stuff are breaking down into more of the traditional saccharides that are found in fruit. Um and so it does change it becomes even you know more simple uh more simple carbs.

It doesn't mean you should only eat green bananas but it's just it's just another way to think about it and understand that process. >> Yeah.

The other thing to think about with that exactly like you like you said now a lot of people in the past have thought that juicing is very healthy right and juicing was a health >> you talking about juicing like roids >> yeah just like what we've been doing as you can tell from our muscles >> no but juicing juicing fruits >> juicing fruits >> just couldn't help it >> there was a trend right people were getting juicers and they were just um you know making juices from different fruits and and drinking those and they would body had a Ninja blender.

>> Yeah, I'm I'm going on I'm going on a juice cleanse, but juices uh where you squeeze all the juice out of the fibrous fruit and just drink the juice, that's not as good and that's exactly what you're not supposed to do because you're taking in the the sugary aspect of the fruit and drinking that instead of and leaving out all the fibers content. That's very important.

On the other hand, smoothies are could be much more beneficial because you're leaving the fiber in and you're blending in the fiber content within that smoothie and drinking that. Now, uh eating and chewing and um chewing on food that has a component satiety where it fills you up faster. So, definitely that's much better than a smoothie where you're just intaking all that fibrous and sugar intake without having to chew it.

uh but smoothies would be uh better because of the fiber content versus juicing where juicing is just the sugars that you're you're extracting from the fruit and drinking that right. So um it depends. I mean if you're drinking celery juice I I don't know what to say about that but yeah juicing orange >> nothing to say go God bless your soul.

Yeah, like you know uh those uh green shots that you the jamba juice used to have uh uh I don't know how healthy they were but I can say that a lot of juices that are just extracted out of from the fruit and the fiber content left behind are not healthy. Uh and they do increase your sugars and your blood glucose pretty significantly are leaving out the fibrous content from the fruit is not a good idea. Totally, totally, totally.

You know, another interesting question um like jumping topics a little bit is like um like white bread versus wheat bread, right? Like that that's such a common thing. I mean, like is white bread actually worse than wheat bread or not? I mean, I remember growing up there's less information about it and like we ate white bread all the time until like my mom one day read some, you know, magazine or something that was like, "Hey, white bread's like really bad for you.

it is highly processed this and that and I mean pretty much in our household we only ate wheat bread after that and you're little kids you're like oh man this isn't as good it's like harder it's like coarse whatever I want my PB&J on white bread where's that Mrs. Beard's Bakery, you know. Um, but that that's an interesting one to talk about, too, because it's not just bread that's white and wheat.

I mean, it's like you were talking about earlier, like white rice, brown rice, different types of pastas, all this stuff. Like, how refined is it? Um, and that that's something I didn't really know either until I actually started researching it a little bit. Like, I was like, I actually don't really know much about the real difference between white and wheat bread. >> And it's hard to say, right?

But uh the the principle is that white bread or white pasta or white rice tends to be it tends to be more simple carbohydrates tend to have more a higher glycemic index compared to brown rice. Now until we do randomized control trials and head-to-head comparisons and see which one's better than the other. But in general which one's better, we can't really give the answer truly what it is.

But in general, something that's a little bit more complex, e harder to break down into uh you know, um sugar uh within your body or glucose within your body tends to be better for you. And that's why I think people lean more towards the wheat bread. Wheat bread tends to be uh considered healthier compared to white bread.

But in my opinion, if you're if you're making white bread uh from flour at home where you're putting in, you know, um the flour, the egg, you know, and everything, you know, that's going into the ingredient, making white bread at home compared to buying a processed uh white bread from the grocery store, uh the one you made at home with knowing what ingredients are going in there is much better than the one you bought from the grocery store. >> Yeah, no doubt about it.

I mean, it really just depends on what's in the flour, right? Like that. So, I I found this out recently that, you know, there's wheat bread and white bread. Um, and it's all wheat. White bread is also wheat because all bread just comes from the wheat uh plant, all the different types of wheat.

But if it's whole wheat, that that's really what is healthier because whole wheat, as the name implies, you take the whole the whole piece of wheat, you know, the kernel, the the germ, um the whole thing, and you use that, you grind that, you moralize it, whatever, and you you use that to create the flour rather than discarding the germ and the bran and then just having uh the flour part of it, which is what white bread is. So you discard the coarser, harder stuff, the healthier stuff.

Um when you make white bread and then obviously you it's bleached. That's how it becomes white. It doesn't just become white. Um but that keeping like the germ and the brand portion of it in whole wheat is really what adds the health benefits to it. That's what adds the different texture to it. It's almost more of like um like a nuttier taste rather than kind of a smooth airy taste which you have in white bread. Um because it's just denser.

Um, and that's why white bread is so soft because without the we the germ portion and the brand portion, it's all fluffy and smooth. It actually captures more CO2 during like the rising process. That's why it's so like squishy when the bread leaves. So that that's like the main difference. And that's the same thing we were talking about with like in the Mediterranean diet, not processed foods, these whole grains. That that's what makes the Mediterranean diet healthy.

And even if you're not following that, even if you're just having a random PBJ sitting at home, >> buy whole wheat rather than white bread. It's just healthier. >> Yeah. I don't think uh I even remember the taste of white bread anymore, you know, but recently recently Mariam made some white bread at home. She baked it from scratch and that was delicious. Uh so we ate that. But uh you know, we don't have or buy white bread and sometimes I go over somewhere and I see white bread.

This is this is different. I mean, I sometimes I've I've stopped enjoying white bread now because I've gotten so used to uh bread, >> but I tend to eat more wheat bread. we tend, you know, try I try to follow for the most part now, you know, the principles of the Mediterranean diet, uh, which is I've found it to be not be very hard from my point of view, you know.

>> Um, but I think the the key is and and the the other important thing is which is hard for a lot of people to do is um trying to cook your food as much as possible, right? Uh, we now it's become so easy in our daily lives. We're busy, we come home, we're tired, and then uh just ordering out. Really? >> Just hit up Door Dash or something. Yeah. >> Yeah. Just hitting up Door Dash and uh you know, getting the food delivered to your door, opening the package, eating it, no groceries, no no mess.

Uh but, you know, the there's a few benefits of cooking. There's tons of benefits from >> Oh my gosh, so many. Yeah. >> You know, first is knowing knowing what ingredients you're putting in your food and what what kind of things you're adding and the spices you're putting. um you know uh it's more rewarding because when you when you when you make it yourself when you eat it with as a family it just gives you a better reward and a better relationship with food.

And then when your kids see you uh cutting vegetables, fruits, uh you know making salads, uh they build those habits and they they learn that you know food is a very important part of our life. I mean human beings pretty much do everything for food. We work because we need food. Food is a source of energy you know and having a good uh healthy relationship with food is very important and cooking at home plays a huge role in that.

I mean teaching your kids from early age uh you know these are vegetables and these these you know help you uh you know increase your you know improve your like we we we sometimes joke with as long hey this will help you do poo poo better because you know this is going to be you know it's going to help with the with increase the fiber content or you you can talk about okay this is this is protein this is you know muscle you build muscle with that or we talk about oh let's eat this rice or pasta this is energy you know so we kind of describe those things with him and he knows that it's like oh I want energy and I want muscle and you know he he tells us that so it kind of is good to use food in terms of what the purp the what purpose is providing as well in your daily life >> right >> totally yeah I mean it's it's a big motivator for kids um for sure um yeah I mean it can be a fun process too I I honestly personally really don't cook that often um I uh I mean I I cook eggs, you know, like I'll make breakfast for Rayon in the morning sometimes, like on the weekends or make eggs for myself, like just scrambled eggs and stuff, but I really don't make like meals.

Um, >> my my culinary repertoire is personally very subpar. >> Yeah. Well, I think I think I think it's a good habit and I I I want to it's a hobby of mine as well and I enjoy cooking. I just don't get enough time to do it. Um, but I do want uh, you know, to raise my kids having a good relationship with food and being able to cook it and uh, knowing what they're eating.

Now, one thing I kind of wanted to talk about, you mentioned eggs a little bit and that's a big uh, topic of discussion that comes through where >> Dude, I love eggs. So many eggs, right? I love eggs. Eggs do have a lot of dietary cholesterol. Now, a lot of people ask you like, is dietary cholesterol bad?

uh you know can are you able to uh you know can you know shrimp has a lot of dietary cholesterol should you know or nuts cashews have a lot of cholesterol >> red meat I mean yeah >> what does that mean and and and a lot of times we found out that dietary cholesterol uh is not necessarily bad for you a lot of the the the foods that you eat that have high amounts of cholesterol a lot of times the cholesterol itself does not get ingested or absorbed in the gut because the cholesterol particle itself is larger uh So only a small amount of cholesterol gets ingested through your gut.

So eating eggs is completely fine. It's okay unless you're eating 20 eggs a day or 10 eggs a day that can increase the amount of cholesterol you're intaking. But two to three eggs, you know, uh not horrible. Eating shrimp is not that bad for you. Actually, pretty healthy. Um you know, eating nuts and cashews unsalted is pretty healthy even though it tends to have cholesterol in them per se.

But >> yeah, which you know that that's a really interesting thing because like you know there's a lot of data on that what you're saying like that dietary the correlation of dietary cholesterol with actually your serum cholesterol it's not at all a direct relationship it's a very marginal effect and it's crazy that you would think the opposite right like you would think okay if I eat foods with a lot of cholesterol gosh my cholesterol is going to go up but it's not necessarily true cholesterol really like is a marker of your overall health like your circulation your health all the inflammatory stuff that's going on your glucose relationship.

I mean, there's so much overlay with all the other things going on in your body and your metabolism. It's not just eating things with cholesterol. The benefit of eggs, I mean, it's awesome. It's a very >> It's a huge misconception, right? I mean, that, oh, yeah, people look at the thing, they oh, that thing has a lot of cholesterol. I'm not going to eat that. >> No, I mean, that's not true.

But yeah, people uh need to pay a little bit more attention to saturated fats because saturated fats itself is a huge um you know has a direct causation with increasing your uh lipoproteins LDLs in the body. Uh trans trans fats saturated fats are not very good for you and that's why even in the Mediterranean diet things that are high in saturated fats are suggested that you should only consume them rarely maybe once every two weeks or twice a month uh and a very small amounts of them.

So things like beef that has tons of marbling or fat um which is full of saturated fat is not necessarily very good for you. >> But it's but it's delicious, bro. >> That's that's that's the tough part, right? I mean a good burger or steak can can be amazing. But you know, I think in moderation like if you tell someone never eat steak again, right? You they're gonna be like, "What is this guy talking? I'm gonna eat a steak." But if you tell them, "Hey, you can have a steak.

maybe have it once every two weeks or once, you know, once every two weeks or, you know, twice a month. Then people are like, "Okay, well, I can enjoy my steak a little bit." Uh, you know, we we've done steak nights. We love our steak, you know, with extra butter on top. >> If you're eating the steak, just get it as delicious as possible. >> Yeah. No, I mean, yeah, but you got to do everything in moderation. And that's why I think people need to be very careful about saturated fats.

Then you know I think there's uh as the cardiologist I'm always worried about cardiovascular disease and there's nothing else to worry about I think in life card heart in my opinion organ you know there is >> remember guys the the heart exists to give blood to the bones. >> Yeah. Yeah. Well if if the heart doesn't exist then the bones die off. So you know to each their own.

But what is uh what are your some of these uh you know what what are some kind of dietary uh advice that you give to your patients for the most part you know mainly my patients are not asking me about cardiovascular health or their blood glucose and stuff right like you know we're talking on this podcast about a bunch of stuff and I have a lot of interest in this stuff independently like you know researching it for my own life and just because I think it's interesting but you know when I'm giving professional advice to a patient in my clinic, it's very much orthopedic surgery related.

Uh patients are asking about their bone health. I mean, there's a lot of elderly patients that I see who have osteoporosis, especially ones that have had a fracture, like an osteoporotic fragility fracture, who have fallen and broken their hip from just like falling out of a chair. If you think about that, you're sitting 2 and 1/2 ft, 3 ft above the ground, and you fall and you break the hardest bone in your body, your femur. Uh that's ridiculous.

I mean, that is a sign that your skeleton is on the cusp of failure. Um, same thing with like in the wrist the distal radius that's a very common fracture that people with osteoporosis have. Same with proximity. So there's a lot of stuff like that. So I I a lot of my advice regarding diet, nutrition, supplementation, things like that are really geared towards bone health and muscle mass maintenance because osteopenia and osteoporosis is the loss of bone mass which can be very detrimental.

I mean the mortality rates after that are super high and same thing with patients that have lost muscle mass. sarcopenia mortality rates are tremendously high. So I'm really focusing a lot on adequate protein intake for these patients, calcium and vitamin D supplementation, having them see an endocrinologist um to do more than just that do real like bisphosphinate therapy, teraritide, things like that to build back their bone and then resistance training all these kind of things.

I've started talking to patients more and more about creatine and just because the reality is, you know, a lot of these people that come in and see you, they're like 60, 65, 70 years old. They're not going to be able to enact an adequate regimen nutritionally to get the relevant protein that they need in their diet. They're just not. It's just it's very difficult to start that at that age, especially if you have not had a lifestyle to do that.

Um, so, you know, from my perspective in my clinic with my patients is very much focused on that. I really don't talk a lot and maybe I should, I don't know.

I just my practice is not really like that where I talk a lot about general nutrition with patients um and you know what kind of foods to take and not to take >> you know in heart disease I think diet as you know plays a huge role and you know dietary counseling is a big part of all cardiology practice or it should be I mean there's a lot of cardiologist should be right >> it should be a lot of people are not doing that because if you're seeing 40 patients a day you're walking in and you're saying that oh your cholesterol is high you need a heart cat stress as you're not talking about their diet.

But I think uh taking time on one of the following follow-up visits to talk about diet is very important and you have to guarantee to the patient for example uh you know if someone has heart failure we we need to talk about uh the amount of sodium they're intaking right I mean uh high amounts of sodium intake salt intake can lead to heart failure exacerbations uh amount of water intake they're doing so water intake for the most part is good but if someone has congestive heart failure they do need to watch their water intake because they can get fluid overloaded pretty easily.

Uh patients who have hypertension or high blood pressure, you know, uh having diets that are pro-inflammatory or diets that have high amounts of sodium can increase their uh blood pressure and and not hydrating enough also increases the blood pressure because the kidneys are not getting the amount of uh you know uh hydration that they need and they end up causing vasoc constriction that causes high blood pressure. So adequate hydration is very important.

The amount of sodium intake is very important. But then you also want to talk about the the different principles of Mediterranean diet and patients have tons of questions. I mean what is a legume? You know you can come in and say like eat eat eat protein eat legume like how much protein do I need to a eat? So that those are the kind of things that do need to be discussed and a lot of patients are not able to even quantify.

I mean what is 2,300 you know uh milligrams of protein or whatever like you know how are we how do we even quantify that? So those are the kind of discussions that need to happen in in physician offices and primary care offices and cardiology offices and even in orthopedic offices. I mean, you know, a patient goes into a a family practice office.

If they're not getting that counseling, they hopefully get it from the cardiologist, but if they have a bone fracture and muscle loss, they hopefully are discussing that with the orthopedic surgeon. Unfortunately, in medicine, we've come to a point where we've been so disease focused that we forget to talk about prevention. And prevention starts with diet and exercise. >> You know, it's um it really is something that's just kind of like not really touched on a lot, I think.

And there's a lot of data showing that you know surveys of patients and of providers like how much do you spend on like preventive stuff nutrition all that it's really not not a lot not really not at all as much as it should be. You know in orthopedics there was this initiative that started quite a couple decades ago called own the bone where you know patient comes into you with a fracture.

Your job as their orthopedic surgeon is not just bone broke me fix you know okay here it is now their bone is fixed even though that's what we would like to do right the carpentry is the fun part um but it's owning the bone means why did this patient have a fracture what led to this was it some balance issue do they need some balance training gate training all of that kind of stuff which is real stuff u that they need real physical therapy and guidance and coaching was it because they're old and frail and don't have muscular endurance muscular strength coordination Is it because they just have very low bone mass and hence the like what I mentioned earlier bisphosphinates all this stuff getting a proper DEXA scan and monitoring them and seeing because those medications have to be really titrated uh and watch because they have a lot of side effects if you don't watch them.

So like this initiative was started it was initially adopted but like really I would say the average orthopedic surgeon has not owned the bone. It's still very much a bone broke me fix mentality. Okay, now go see your primary care and figure out the rest of your osteoporosis or go see your endocrinologist and figure it out. And I I think sadly because you know the compensation models are so incentivized in volume, see a patient, see the next patient, see the next patient.

And the compensation in general for preventive stuff and having discussions like that with your patients in clinic really are not there. And it's unfortunate because that can prevent a huge second hit. You like we've talked about on this podcast, primary prevention regarding heart disease and cardiac events and then secondary prevention in a patient who's already had a cardiac event. That same stuff is real and it exists regarding osteoprotic fractures.

Primary prevention is stopping a patient who is older like especially post-menopausal women from ever having an osteoprotic fracture because the mortality rate at one year is like 20%. I mean that is a high mortality rate. Yeah. >> And then there's secondary prevention. someone who's already had an osteoprotic fragility fracture then having another one.

I mean those patients have an approaching like 50% mortality rate uh which is insane >> and and the people who have these people who have these osteoporotic fracture they they sometimes do not die from the fracture itself they die from cardiovascular disease. >> Yeah. They almost never die from the fractures. Just their whole body health is so poor from allowing their skeleton to get that fragile. Everything has gotten that fragile. They have no reserves left to manage anything.

They almost all, like you're saying, Homayo, they almost all succumb, unfortunately, to some cardiovascular event while they're in the hospital or post hospital, like inatient uh rehab center or skilled nursing facility afterwards. Yeah. >> So, it it's very important. I wish it was more emphasized, but it's not. >> Yeah. And that just proves that that heart is the most important organ. >> Well said. I like that. I I saw you smirk right before you said it. I knew you were up to something. >> Yeah.

But uh you know we we can keep talking about this. I mean you know but in the end I think the the conclusion is that having a balanced diet is very important. I think following the science and uh large scale human studies that show benefit in cardiovascular outcomes and longevity is very important.

I think one key that I want to keep emphasizing is do not fall for a lot of these longevity experts so-called that try to sell you their supplements and their uh peptides uh for longevity because in the end longevity is diet balance balanced diet exercise and treating uh uh the metabolic disease that's ongoing rather than taking some supplement that may or may not help you.

Um but uh you know following a Mediterranean diet, following uh you know eating a lot of fish, a lot of seafood, taking high amounts of omega-3 and olive oil almost always helps with cardiovascular disease. And that's the thing that I preach to a lot of my patients. >> There you go, man. And every now and then, enjoy that tomahawk steak. >> Enjoy the tomahawk steak. Definitely. >> All right, guys. We'll see you next time at two docs one mic.