Cardiovascular Diet Myths

Welcome to the Mayo Clinic Cardiovascular Continuing Medical Education Podcast. Join us each week to discuss the most pressing topics in cardiology and gain valuable insights that can be directly applied to your practice. Welcome back to the Mayo Clinic Cardiovascular Podcast Series, Interviews with the Experts. I'm your host, Sharon Hayes. I'm a non-invasive cardiologist, advice chair of faculty development and academic advancement for the Department of Cardiovascular Medicine.

here in Rochester, Minnesota. Today, I'm joined by Dr. Stephen Kopetsky, who is Professor of Medicine in the Preventive Cardiology Division, where he serves as an expert in lipid management and lifestyle here at Mayo Clinic in Rochester. So today our topic is cardiovascular diet myths. Welcome, Steve. Thank you, Sharon. Great to be here. What we eat and how we live are critically important in our overall cardiovascular health. Unfortunately...

There are many misunderstanding and misinformation out there about what we should be doing and what we shouldn't be doing. Today, we'll learn more from our expert about the effects on our health related to trans fats and ultra processed foods. cholesterol, artificial sweeteners, highly processed foods, as well as the many and perhaps novel benefits related to the Mediterranean and DASH diets. So Steve, let's start with trans fats.

Since 2018, trans fats have been prohibited from being a food additive in the U.S. Are there still some trans fats still sneaking into our food? Amazingly enough, Sharon, there are. The law was written that they had to be less than 500 milligrams of trans fats per serving. And as you know, if you took 500 milligrams or 499 milligrams of aspirin, that would be a big deal.

Now, I'm not saying that 499 milligrams of trans fats are as much as they used to be, of course, but it is getting into our food and it's per serving. And many times we'll get a bag of chips and there's four servings per bag. So it really can add up. And if you're a big absorber of cholesterol and of these fats, it can really affect your LDL cholesterol. So what should we be doing instead?

Is there a way we can watch for this? There is a way. There are certain phone apps you can get that will analyze the barcode on anything you buy, any food, especially the ultra-processed foods, and that's where they usually are. is in chips and ultra processed things like dressings, salad dressings, crackers, you know, all these other things that are open and eat, ultra processed things. And we got to be careful with those and kind of educate ourselves.

So here's another question, another myth to bust. Does eating food high in cholesterol cause elevated levels of blood cholesterol or LDL cholesterol? Well, you know, some studies came out and said we've tracked the cholesterol that was eaten in food and it did not affect your cholesterol level. Well, that's because they didn't control for the other fats that you ate.

But when you do control for other fats, like not just cholesterol, but also saturated fats, especially saturated animal fats that will raise cholesterol, it has been shown. that eating cholesterol in the food will raise our serum cholesterol blood levels. Just help clarify the saturated fat aspect because, you know, for a long time, we don't eat shrimp, don't eat these high cholesterol, but those were also foods with very low saturated fat. If I just...

subsist on shrimp, is my cholesterol going to go up? Well, we don't want to have you just eat only one thing, of course. But I will guarantee if you just existed on egg yolks, yes, it would go up.

All right, let's switch to another topic, which we hear a lot about the dangers or the lack of benefit, anyway, of artificial sweeteners. Which artificial sweeteners increase cardiovascular risk? Well, you know, some amazing studies have been done. They've actually been published in Nature and that showed that erythritol, which is one of the alcohol sweeteners, can actually activate platelets so they clot easier.

Then they did a study to say, what if you took in erythritol that you got just from a couple of sweetened, artificially sweetened drinks a day, does that increase your risk for heart attack? And indeed it did. Now, the issue with erythritol is that, you know, I used to eat it. It was mixed in. I like monk fruit as a sweetener. And they started mixing erythritol in with monk fruit and certain actually sweeteners.

Some brand names we won't mention are just pure erythritol. They actually can increase your cardiovascular risk. So again, it's caveat emptor. You have to know what it is, know which foods have it. And again, I'd get a phone app. One of the phone apps I use a lot is Yucca, Y-U-K-A, which aims at the barcode and tells me exactly what's in the food I'm getting ready to purchase. And oftentimes, I'll just put it back on the shelf.

That sounds great. Do these foods, because you know about labels and you're looking for this, is it obvious on their label or do we need something like an app to help us? Well, they should say, you know, a lot of times they'll say on the front label, but they always say it on the ingredients. Erythritol, it's in the fine print, and you just have to read it and look at it and know it's there. Let's switch to a more positive view.

Can the diet we eat speed up or slow down the aging process? You know, it really can. some of the DNA methylation studies which is one way we measure our aging process that certain foods will actually speed up the aging process or slow it down. Well, what will speed it up? It is particularly like the red processed meats. So that's the sausages, the hot dogs, you know, the things that we love to eat at the county fair and on summer picnics.

But it really does increase our aging process. And they've looked at it. like with things like coronary disease, like with dementia, and it does have a correlation. Every bite that you take of those things can increase your risk. Now, what slows it down? Well, Things like Mediterranean diet you talked about in the intro, things like fruits, vegetables, legumes, whole grains are really quite good for us. They have a lot of fiber in them, which is fiber is a non-caloric carbohydrate.

So we don't absorb the calories from it, but it is very anti-inflammatory and our microbiome likes it too. What do you think is kind of the, you've mentioned some apps, you've mentioned some research. Are there any new studies on the horizon we should be looking for that will help us advise our patients? Or how can we stay most up to date? Because if we read the news, I think even we as physicians and clinicians.

we can be led astray. So tell us how we can keep up. Yeah, I really think that the one thing if you can focus on is the ultra processed food category. Why is that? Well, number one, we're all eating them. And since COVID, we're eating more of them. And the average American eats about eight servings a day. Unless you're under 35, then you're eating about 10 or 12 servings a day. And unfortunately, it is something that every bite can be tracked to increasing our cardiovascular risk.

It's something that we really need to work on, but it's ubiquitous. It's hard to get away from the ultra-processed foods. The other thing of ultra-processed foods is that it is... Acellular is very finely broken down, and so our microbiome and our bodies can actually absorb more calories. So the old myth, a calorie is a calorie is a calorie, is a myth.

With ultra-processed foods, we actually absorb more of the calories in it, and we gain more weight when we eat them. Thanks, Steve, for that cautionary advice. Because, you know, I used to say, and I still do sometimes, depending on the context, there isn't a food that will kill you and there isn't a food that will save your life, especially.

in moderation because sometimes it's just overwhelming to people to make all of the changes that we sometimes ask them to make. But staying away from these ultra-processed foods is one that is sort of blanket. And may actually go against what I said, because maybe it will kill you. You know, it really does have that potential. And for instance, 100 grams of ultra-processed food, which is about three bites for an average American, will increase your HSCRP, index of inflammation, by 4%.

Well, we can get a few bites in a day of ultra-processed food, and it's a pro-inflammatory food, and we all know the problems that causes with cardiovascular disease. I appreciate your wisdom and busting or supporting some of these myths as we've talked about. So thank you very much, Steve. Thanks for having me.

So this wraps up this week's episode of Interview with the Experts. I'd like to thank Dr. Kopetsky for joining us today and discussing this really important topic. We look forward to all of you joining us next week for another Interview with the Experts. Be well.

Thank you for joining us today. Feel free to share your thoughts and suggestions about the podcast Be sure to subscribe to the Mayo Clinic Cardiovascular CME podcast on your favorite platform and tune in each week to explore today's most pressing cardiology topics with your colleagues at Mayo Clinic. This has been a Mayo Clinic podcast.