<markdown>

丹妮尔・博拉多博士是心脏病专家、国际演讲家、已发表论文的研究员，同时也是 “我的健身伙伴” 的合作伙伴。

问：博拉多博士的诊所名为 “精准预防性心脏病学”，平均而言，人们对心血管系统造成的损伤中有多少是自我造成的？

博拉多博士认为，心血管疾病的发生和预防涉及多种因素。但与肿瘤学或风湿病等其他专科的同事不同，心脏病学领域很 “幸运”，因为绝大多数心血管疾病是可以预防的。当然，存在遗传性高胆固醇和遗传性心血管疾病的情况，但无论遗传因素如何，饮食和生活方式都起着重要作用。即使患者正在接受指南推荐的药物治疗，饮食和生活方式在心血管疾病的预防中也至关重要。

她认为，知道自己可以通过自身行动预防心血管疾病，这一点很有意义，因为人们在面对诸多困惑时，都希望能掌握一定的自主权和控制权。

问：很多人仍认为饮食无关紧要，甚至一些医生也这样说，博拉多博士的患者是否有过类似经历？

博拉多博士肯定了这一现象，指出其中原因可能有几个。在现有的医疗体系中，医生们常常忙于 “灭火”，尤其是初级护理医生，他们有时一小时要接诊五位患者，根本没有太多时间关注预防，这是一个很大的问题。但实际上，查看心脏病学的各项指南，无论是美国心脏病学会、美国心脏协会的高血压指南，还是冠状动脉疾病指南、胆固醇指南，几乎每部指南的第一页都是关于饮食和生活方式干预的内容。这实际上是一级干预措施，适用于所有心血管疾病患者，无论是预防疾病还是治疗疾病。

即使是已有冠心病需要服药，或有高血压需要服药的人，情况也并非绝对。对于已经在服药的患者，饮食干预可能会使他们从需要服用高剂量的三种药物，变为只需要服用低剂量的一种药物。所以，科学和心脏病学的推荐都明确表明，饮食和生活方式是一级预防（预防心脏病发作）和二级预防（针对已发生心脏事件或中风的人）的基石和基础。

问：谈到二级预防，提及自己妻子高中同学因心脏病去世的事，想知道不健康的生活方式造成的损伤能在多大程度上被修复，心脏和心血管系统在经过多年不健康饮食、吸烟、过量饮酒后，平均需要多长时间才能恢复，以及这种恢复的可能性有多大？

博拉多博士解释说，这取决于所谓的终末器官损伤程度，也就是起始状态。但幸运的是，在几乎所有阶段，都有方法可以改善患者的长期预后。过去，我们只关注一级预防（针对无冠心病或心脏病的人）和二级预防（针对已发生心血管事件的人）。现在，由于有了像钙评分和冠状动脉 CT 血管造影这样能更早发现冠心病的诊断测试，出现了一个新的类别，即亚临床动脉粥样硬化，也就是在人们发生心脏病发作、中风或其他事件之前就检测到冠状动脉疾病。一旦发生心脏病发作，并不意味着一切都无法挽回。但根据血管病变的位置和严重程度，有时会出现终末器官损伤，比如心力衰竭，这些情况更难修复，尽管现在也有针对心力衰竭的出色指南推荐疗法。

但目标是在这些事件发生之前进行干预，防止人们进展到心脏病发作或中风的阶段，当然，理想情况下是从源头预防，比如从儿童时期就强调健康饮食，高纤维饮食，低饱和脂肪，摄入瘦肉蛋白、植物蛋白等。同时，要提高成年人对早期发现心血管疾病的意识，在出现症状和无法改变的终末器官损伤之前进行干预。

所以，预防的关键在于，越早开始越好，从儿童开始关注；同时，也永远不会太晚，即使是已经发生心脏病发作或中风的患者，戒烟、开始健康饮食，注重高纤维、低饱和脂肪、低钠的健康饮食模式，都为时不晚。

问：纤维是营养圈中大家都喜爱的营养素，纤维在心血管护理中的重要性如何？

博拉多博士称纤维非常重要，自己整天都在谈论纤维。重要的是，纤维与饮食类型无关。她自己成年后一直是素食者，但她的患者并不都是素食者，有些人只是对植物性食物感兴趣。但无论饮食模式如何，摄入更多纤维都有益处，不仅能降低胆固醇、改善血压、降低糖尿病风险和糖化血红蛋白水平，还能降低结直肠癌风险和各种与性别相关的癌症风险。而且，重要的是要从食物中获取纤维，而不是从纤维补剂中。

她多年前在加入 “我的健身伙伴” 科学顾问委员会之前，就一直向患者强调了解自己纤维摄入量的重要性。因为无论是素食患者还是饮食习惯完全不同、很少吃蔬菜的患者，当让他们记录纤维摄入量时，很多人会发现自己每天实际上只摄入约 15 克纤维。所以，在诊所里，她会让患者开始记录纤维摄入量。如果不知道自己摄入多少纤维，就无法确定起点。

很多人会说自己不能忍受豆类或其他高纤维食物，但事实并非如此。研究发现，即使是患有肠易激综合征或其他肠道疾病，甚至炎症性肠病的人，如果每天缓慢增加约 3 到 5 克纤维，同时保证每天至少 64 盎司的水分摄入，肠道菌群会逐渐适应。通过让患者记录纤维摄入量，了解他们的饮食中纤维的摄入情况，然后缓慢增加，能让患者长期更愿意坚持，而不会因为一开始就摄入大量高纤维食物导致胀气和腹胀而放弃。

有研究表明，即使是注册营养师，在一周结束时回忆自己的饮食，也会高估自己的纤维摄入量，误差高达 40% 左右。所以，即使是她自己，虽然多年来一直遵循类似的植物性饮食，也会每隔几个月用 “我的健身伙伴” 检查一下自己是否达到了蛋白质目标，是否摄入了足够的纤维，看看是否需要调整。这样能让人们避免因进展太快而产生副作用，当然，也有些人可以从每天 15 克纤维一下子增加到 40 克且感觉良好，但她不希望那些开始高纤维饮食的人因此而却步，其实有更好的方法。

问：我自己切换到纯植物性饮食后，花了两周时间才摆脱胀气和腹胀，之后就恢复正常了，是否推荐每天 40 克纤维，因为不同人有不同说法？

博拉多博士表示，纤维没有摄入量上限，最大摄入量是个人能耐受且喜欢的量。她自己每天大约摄入 90 克纤维，这是因为她吃很多豆类 pasta意面，比如毛豆和绿豆 pasta，一份 340 卡的份量就含有 24 克纤维，而且蛋白质含量也高。但她认为其他人不必吃这么多，只要在自己能耐受和喜欢的范围内即可。美国营养与饮食学会建议的最低量是女性至少 25 克，男性至少 38 克。在心脏病学领域，倾向于建议每个人的目标是每天至少 40 克纤维。

对于有高血脂、高血压或血糖升高的患者，她会建议他们争取达到每天 40 到 60 克。因为有时当人们的纤维摄入量达到 40 克时，再增加到 60 克，可能会看到低密度脂蛋白进一步降低。比如，对于正在服用瑞舒伐他汀等胆固醇药物的患者，甚至同时服用非他汀类药物依折麦布的患者，仅仅将纤维摄入量从 40 克增加到 60 克，可能就会使他们从需要服用两种药物变为只需要服用一种药物。

所以，让患者努力达到每天 40 克的目标，同时记住没有上限，只需享受这个过程并尝试即可。在增加纤维的过程中，缓慢且稳定地增加，如果能耐受每天增加 3 克，使用像 “我的健身伙伴” 这样的应用程序进行跟踪，就能避免因进展太快而产生副作用。很多人说自己不能忍受豆类，吃了会胀气，但其实是可以吃的，只是需要慢慢来。无论人们的饮食模式如何，多吃豆类、高纤维食物、浆果等，都是有益的。

问：想了解纤维与炎症减少之间的联系，以及这如何减少心血管事件，从心血管的角度看，纤维和炎症是如何作用的？

博拉多博士认为这可能有两方面原因。首先，我们一直强调从食物中获取纤维而不是补剂，这是因为纤维本身固然重要，但纤维所在的食物也很关键。纤维存在于水果、蔬菜、豆类等食物中，这些食物含有多酚、各种宏量营养素、微量营养素、维生素和矿物质，对我们非常有益。此外，高纤维饮食会自然取代那些可能对人们不太有益、可能更具炎症性的食物，比如油炸食品、高饱和脂肪食物等。

问：可溶性纤维和不可溶性纤维在心血管健康方面，研究显示哪种更有效？

博拉多博士称可溶性纤维被认为对降低胆固醇最有益，但她告诉患者不用纠结于跟踪可溶性纤维和非可溶性纤维，只需专注于通过吃水果、蔬菜、豆类、全谷物等食物来增加总纤维摄入量。无论是患有遗传性高血脂，还是需要服药，增加总纤维摄入量都能显著降低胆固醇。

有一项很棒的研究叫西蒙饮食研究，由大卫・詹金斯进行，他们在代谢病房对受试者进行随机分组。在代谢病房里，受试者的所有饮食都被测量、计数和记录，为期两周。他们让不同组别的受试者摄入相同的蛋白质、热量、饱和脂肪、多不饱和脂肪等，唯一改变的是饮食中的纤维含量。一组是中等纤维饮食，大约 25 克；一组是中高纤维饮食，大约 50 到 60 克；还有一组是高纤维饮食，每天约 150 克，这是非常高的量。但在两周内，高纤维组的低密度脂蛋白胆固醇降低了 30%，这在临床上意义重大。

她在几乎所有关于饮食、胆固醇和心脏病的演讲幻灯片中都会提到这项研究，不是因为每个人都需要每天吃 150 克纤维，而是想说明通过增加纤维摄入量，确实有可能看到低密度脂蛋白胆固醇的相应下降。还有更多研究表明，吃高纤维食物还能降低血压，而高血压是影响大多数人的 “沉默杀手”，同时对预防糖尿病也有益处。所以，纤维在很多方面都有益处。

问：每天 150 克纤维的饮食是什么样的，想知道他们是如何达到这个量的？

博拉多博士表示这确实是很大的量，而且他们在保持热量相同的情况下做到的。她自己每天摄入 80 到 90 克纤维，她把一些饮食上的调整称为横向转换。比如在 “我的健身伙伴” 应用上，她会寻找能获取更多纤维的食物。覆盆子和黑莓每杯含有 8 克纤维，所以她会在早上的冰沙中用覆盆子和黑莓代替香蕉，这样能获取更多纤维。早上的冰沙里放一杯覆盆子、一杯黑莓、一些奇亚籽、亚麻籽，再加点菠菜之类的，可能就能获取 20 克纤维。然后她会吃毛豆 pasta，一小份就含有 24 克纤维。一个中等大小的牛油果含有 10 克纤维。她之所以知道这些，是因为在跟踪饮食时会关注哪些食物能带来更多纤维。对于刚开始增加纤维摄入量的患者，这种横向转换很有帮助。有些人会彻底改变饮食，从每天吃三次麦当劳转变为健康饮食；而有些人已经饮食健康，只是需要优化。这时，认真审视自己的饮食，了解起点和目标是很有帮助的。

问：我也很喜欢 “我的健身伙伴” 应用，觉得很方便，还提到该应用在加拿大也能使用。

博拉多博士称其是扫描条形码的鼻祖，自己用了很久，扫描一下就能了解营养信息很有益处。通过这个应用，人们能了解自己的日常饮食，比如想降低胆固醇，有两个重要方面：增加纤维和减少饱和脂肪。第三个方面是饮食中的胆固醇，但相对不那么重要，因为如果将饱和脂肪控制在热量的 7% 以下，饮食中的胆固醇自然也会降低，因为高胆固醇的食物通常也高饱和脂肪。在记录饮食时，即使是她自己，也会发现一些标有植物性的食物，扫描条形码后才知道里面含有大量饱和脂肪，因为添加了椰子油。所以，做一些饮食记录，了解自己的日常饮食以及如何优化，是很有帮助的。如今的科技让这一切变得不再是猜测，20 年前人们只能写下食物并猜测营养成分，而现在扫描一下、记录一下食谱就能轻松了解，简单又方便。

问：之前提到了牛油果和椰子油，想从心脏病专家的角度了解，对于饮食健康、至少以植物为主的普通人来说，应该如何看待添加牛油果，以及与椰子油、棕榈仁油等进行对比。

博拉多博士认为首先要记住 “剂量决定毒性”。一般来说，当患者谈论饮食变化时，她总会提醒他们，一种食物或一餐不会导致疾病。所以如果有人偶尔吃了含有椰子咖喱的食物，也不必过于自责。但总体而言，我们建议尽量限制饱和脂肪。椰子油、棕榈油、红肉等都含有大量饱和脂肪。我们建议限制高饱和脂肪食物的摄入，因为饱和脂肪与低密度脂蛋白胆固醇之间存在直接的线性关系，而低密度脂蛋白胆固醇会导致心血管疾病。用富含多不饱和脂肪、单不饱和脂肪的食物或高纤维食物替代高饱和脂肪食物，能一举两得，有助于降低低密度脂蛋白胆固醇。

例如，牛油果是很棒的食物，富含单不饱和脂肪，也有多不饱和脂肪，一个中等大小的牛油果含有 10 克纤维。至于椰子油，虽然因为饱和脂肪含量高而不被推荐，但橄榄油和菜籽油的脂肪酸比例更好。所以，总体目标是减少饱和脂肪，用多不饱和脂肪、单不饱和脂肪或高纤维食物替代，当然还要摄入足够的蛋白质。一般来说，美国人不太会蛋白质缺乏，更多的是纤维缺乏的问题。但对于一些人群，比如举重增肌的人、正在减肥的人，需要确保达到蛋白质的推荐摄入量，并从豆类蛋白等健康来源获取蛋白质，如果是杂食者，可以选择富含脂肪的鱼类或瘦肉，而不是高饱和脂肪的红肉。

问：很多人遵循的高蛋白、低纤维饮食，想知道排除这么多纤维来源后，会遗漏哪些心脏保护营养素。

博拉多博士表示，她对那些遵循极端饮食的人抱有同理心，比如肉食，因为他们往往感觉不舒服，在寻找解决办法时偶然发现了肉食方式，而且可能像所说的那样，短期内确实有效。人们在肉食上暂时取得 “成功”，本质上是因为那是一种排除性饮食，可能排除了薯片、薯条等不健康的食物。但长期来看，肉食很令人担忧。

吃高饱和脂肪且不含植物的饮食，会缺少所有重要的植物营养素，不仅会极大地增加心血管疾病风险，因为高饱和脂肪且缺乏纤维的饮食会升高导致动脉粥样硬化的脂蛋白，如低密度脂蛋白，还会增加各种癌症的风险，尤其是结直肠癌。饮食中的纤维与降低结直肠癌及其他各种癌症的风险有直接关系，甚至还会增加痴呆症的风险。

过去人们认为大多数痴呆症与遗传直接相关，无法预防，但现在知道大多数痴呆症与导致心血管疾病的风险因素有关。所以，人们在这些严格排除性的肉食上获得暂时缓解，却要承担极高的长期风险，这很不幸。但她希望他们能在出现无法挽回的问题之前，找到更健康的饮食方向。

问：遵循这类极端饮食的人早期会说自己的胆固醇降低了，这令人困惑，想知道原因。

博拉多博士解释说，胆固醇的影响因素很明确，主要与饮食中的纤维以及饱和脂肪与单不饱和、多不饱和脂肪的摄入比例有关。从理论上讲，有些人在减肥时胆固醇降低，但这也不是绝对的。有些人在高饱和脂肪的肉食或生酮饮食上减肥，他们的胆固醇可能会飙升，因为减肥本身可能不会改变致动脉粥样硬化脂蛋白的水平，如果他们吃高饱和脂肪饮食，这些脂蛋白可能会升高，这在多项随机对照试验中已经得到充分证实。

如果他们暂时看到胆固醇降低，可能是因为这种饮食限制很多。比如，如果他们之前的饮食不是肉食，而是每天吃三次麦当劳，摄入 5000 或 8000 卡，而现在每天只吃 2000 卡的肉类，那么他们的总饱和脂肪摄入量可能会因为食物量的减少而降低，但总体而言，这仍然不是有益的，因为如果他们的饮食主要以饱和脂肪为主，除非他们有罕见的遗传性低载脂蛋白血症，否则低密度脂蛋白不可能达到目标水平。所以，一般来说，可能是他们之前的饮食量很大，现在减少了，但这绝不是说这种饮食对他们更健康。

问：博拉多博士厨房中的必备品有哪些，列出五种左右。

博拉多博士称豆类 pasta意面 是第一选择，无论人们是杂食者还是素食者，豆类 pasta 都非常有益。她的患者有 NBA 和 NFL 的职业运动员，也有 90 岁只想控制胆固醇的患者，他们都喜欢豆类 pasta。豆类 pasta 是极好的蛋白质来源，蛋白质和纤维含量都很高。即使是杂食者，一周中有几个晚上用豆类 pasta 代替动物蛋白，也能同时获取大量蛋白质和纤维。而且豆类 pasta 有很多不同的品牌和种类，她建议如果尝试一种不喜欢，可以换一种，比如毛豆和绿豆的不喜欢，就试试鹰嘴豆的，再不行试试小扁豆的，还有绿小扁豆、红小扁豆的，或者羽扇豆的、黑豆的等等。她认为豆类 pasta 是一种很好的高蛋白质、高纤维来源，大多数人都能从中受益。

问：是否赞成早餐吃 pasta？

博拉多博士表示当然赞成，她自己很多时候在心脏重症监护室工作到早上 7 点，就会吃毛豆和绿豆 pasta，完全没问题。当然，如果不喜欢也没关系，还有很多其他有益的食物。她还推荐在冰沙里加牛油果，牛油果是很好的纤维来源，味道不错，还能让冰沙更浓稠，一个中等大小的牛油果含有 10 克纤维。还有浆果也不能忽视，她的患者会觉得她像个复读机，因为她总是提到黑莓、覆盆子，这些浆果能提供很多纤维。奇亚籽、亚麻籽也是不错的选择。她认为每个人都能找到适合自己的高纤维植物性食物，只需专注于尝试不同的食物，拓展自己的味蕾，将更多这些食物融入饮食中。

问：一个有点突然但重要的问题，看到博拉多博士的 Ins，最近在拉斯维加斯过得很开心，想知道是更喜欢后街男孩还是超级男孩？

博拉多博士毫不犹豫地表示是后街男孩，她在拉斯维加斯的 Sphere 剧场看了后街男孩的演出，建议大家如果有机会都去看看。她觉得后街男孩非常棒，自己 10 或 11 岁时在麦迪逊广场花园看过他们的演出，现在他们依然很出色，她本来担心他们会有些老，让自己也觉得变老了，但实际上他们状态很好，活力十足，头发也都还在，让她感觉自己一点也不老，他们真的很棒。至于超级男孩，因为贾斯汀・汀布莱克不巡演，所以机会较少，如果超级男孩重组巡演，肯定也会场场爆满，但贾斯汀・汀布莱克阻碍了这一切。

This Cardiologist Eats 90 Grams of Fiber a Day—Here’s Why

</markdown>

Edit:2025.08.07<markdown>

Welcome to the Exam Room podcast brought

to you by the Physicians Committee.

Hello, I'm the weight loss champion,

Chuck Herrell. Thank you so very much

for watching and downloading 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. Very excited for a

guest today who is a first timer on the

show. Should have happened years ago,

but schedules are what schedules are.

But with that, we welcome a

cardiologist, an international speaker,

a published researcher, and now a pal,

and you could call her a fitness pal,

cuz she's here with her partnership for

My Fitness Pal. Amazing to have Dr.

Danielle Bolardo here on the exam room.

Thanks for being here.

&gt;&gt; Thanks for having me, Chuck.

&gt;&gt; I'm really thrilled that you're here. I

mean, for real, how in the world have

our paths not crossed until now?

&gt;&gt; I know. I know. I think, you know, I'm

so excited to be here. We have so much

so much dietary, you know, enjoyment in

common. We were just chatting about how

ICNM has the best diet choices of any

conference in the world. And I'm just so

thrilled we finally get to jump into it

and discuss our favorite topic, fiber

and and plants.

&gt;&gt; It's my favorite as well. And yeah, so I

know you're not going to be at this

year's conference, but I would love to

extend the invitation for 2026. I'm not

sure the exact dates, but you know, come

on in. You know, the weather's fine in

Washington DC.

&gt;&gt; Amazing.

All right. So, the name of your practice

and and we're going to talk more about

My Fitness Pal in a little bit, but the

name of your practice is Precision

Preventative Cardiology. And I love the

word preventative there because it makes

me wonder the question on average, how

much of the damage that we do to our

cardiovascular system is self-inflicted.

&gt;&gt; Well, you know what? There's a multitude

of different components that go into,

you know, cardiovascular disease, the

development of cardiovascular disease,

the prevention of cardiovascular

disease. But I I have this conversation

with my patients multiple times a day

where I say that you know compared to my

colleagues in some other specialties

like I look at my colleagues in oncology

or rheumatology. You know sometimes you

can do all the things in the world and

give all the treatments in the world and

people can sometimes still not get

better. But in cardiology we are super

spoiled. We are super lucky that the

vast majority of cardiovascular disease

is preventable. And so, you know, there

are of course genetic causes of high

cholesterol, genetic causes of

cardiovascular disease, but one

important thing that I think is very

empowering is that regardless of the

genetics, diet and lifestyle is always

playing a major role. Um, even for

patients that are on guideline directed

medical therapy, diet and lifestyle

plays a pivotal role in all of

cardiovascular disease prevention. And I

think that's really empowering in a

world where people feel like there's a

lot of confusion and you know they want

some sort of autonomy and control. I

think that knowing that there's a lot we

can do on our own to prevent

cardiovascular disease is very valuable.

&gt;&gt; All right. So let's let's talk about

that because I feel like you know a lot

of us are are still kind of going

through life with the belief that you

know what we eat really doesn't matter.

And maybe you know our own doctors have

told us that in the past. I know that a

lot of people who have come on the show

have have mentioned that to me. Um, have

your patients shared similar experiences

with other doctors that they may have

met with in the past.

&gt;&gt; No, absolutely. And I think that, you

know, there's probably a few different

components to that and one of them being

that, you know, sometimes some doctors

just like in, you know, in our general

health care system, sometimes doctors

are just trying to put fires out because

not to their own, you know, fault, it's

just that our health care system is very

busy. some, you know, especially our

primary care doctors who are doing the

Lord's work out there, you know, are

they sometimes have to see five patients

an hour and so they're trying to just,

you know, put out fires and they don't

get a lot of time focused on prevention,

which is of course a huge issue. I I

wish that healthc care would be focused

mostly on prevention. Um, and that's

just unfortunately not the way our

system is is designed. Um but yes,

people do often, you know, get told

that, you know, diet may not make as

much of a difference. But when you

actually doubleclick into every

guideline for cardiology, whether it's

our hypertenture, hypertension

guidelines from the American College of

Cardiology, the American Heart

Association, our coronary artery disease

guidelines, our cholesterol guidelines,

if you actually go the first page of

almost every single guideline we have is

diet and lifestyle intervention.

Actually, it's literally a class one

intervention, you know, diet and

exercise for every disease process we

have in cardiovascular disease. And this

is for people who are both preventing

disease and for people who are treating

it. Meaning, even if you're someone with

existing coronary disease and you need

to be on medications or you have high

blood pressure and you need to be on

medications, it's not binary. There's

actually a class one recommendation for

diet and lifestyle intervention for all

individuals across the board. And

sometimes even for patients who are

already on medication, they need to be

on guideline directed medical therapy.

Their dietary intervention can actually

be the difference between being on a

high dose of three medications to being

on a low dose of one, you know. And so

um it is very clear in the science and

even in what we recommend in cardiology

that diet and lifestyle are absolutely

the cornerstone and foundation for both

primary prevention so preventing us from

ever developing heart disease but also

secondary prevention in people who've

already had a cardiac event or a stroke.

&gt;&gt; Yeah, let's talk about that secondary

prevention. My wife recently sadly had a

friend from high school who passed away.

And you know, I'm not sure what type of

prevention, you know, what care he was

under before he had his heart attack,

but you know, I I do wonder, you know,

how much of this damage can be undone?

How long does it take for the heart and

the cardiovascular system to be able to

rebound after years of eating

unhealthily, maybe smoking, drinking in

excess? How quickly does it take the

body on average to be able to rebound?

And to what extent have you seen that to

be possible?

&gt;&gt; Yeah. So, you know, it depends. There's

there's different levels of what we call

end organ damage. And so, it depends on

where you're starting. But luckily, you

know, at pretty much all the stages, we

have ways that we can improve and uh

really improve patients outcomes long

term. Um, we now have, you know, we used

to just look at as primary prevention,

so for people without coronary artery

disease or heart disease, and secondary

prevention, so people who've already had

a cardiovascular event. And now we look

at it more because we have diagnostic

testing that catches coronary artery

disease earlier like calcium score and

CT coronary angography that we now have

this new category we call subclinical

atherosclerosis. So when we detect

coronary disease earlier in people who

have coronary artery disease before

they've had a heart attack or a stroke

or an event. Once you've had a heart

attack it doesn't mean that all is over

and that we can't fix things. But um you

know once someone has had a heart attack

depending on which lesion of the vessel

it's in and how severe it is sometimes

there is endorgan damage like heart

failure or things that lead to you know

further along that um can be harder to

fix. Although we do have phenomenal

guideline directed medical therapy for

heart failure now as well. But the goal

is to get in before those events happen

to prevent people from progressing to

that heart attack or stroke and trying

to get in of course ideally primordial

prevention. So for children, you know,

emphasizing healthy eating, high-fiber

diet, low saturated fat, getting lean

protein, plant proteins, things like

that at a younger age. And then you know

emphasizing and making awareness for

detecting cardiovascular disease earlier

in adults before they have symptoms

before there's end organ damage that we

can't you know change. So the dynamics

of prevention are essentially it's never

too early to focus on prevention

literally the second you know um

children are eating focusing on you know

eating a healthy diet that focuses on

cardiovascular health and reducing

cardiovascular risk and then there it's

never too late at the same time even for

patients who've had a heart attack or a

stroke it is never too late to quit

smoking to start eating a healthier diet

focus on eating higher fiber lower

saturated fat lower sodium and a

healthier dietary pattern. Um, and so

it's never too early or too late. And

we're really trying to emphasize getting

in early to prevent some of the things

downstream that we may not be able to

really fix as much as we wish we could.

&gt;&gt; Yeah. You know, and golly, I wish I

could go back in time and just do things

so much differently growing up. I wish I

knew then what I know now. And I wish

that, you know, my parents knew the same

thing so like we could have all been on

this healthier path. But it scared the

living daylights out of me to be in my

early to mid20s and already having chest

pains, you know, being 420 pounds, heart

disease running rampant in my family

among many other ailments. Um, you know,

standard American family, you know,

where it just seems, you know, that, you

know, that kind of stuff is passed down

through the generations. I guess my

concern is like how much of that bell

can I unring? Because I mean getting up

to 420 and only being 5'5, I mean I I

was I was pounding some calories, a lot

of calories.

&gt;&gt; You know what? There's a ton you can do.

And and that's the thing is that it's

that's the magic is that the the

combination of um dietary and lifestyle

changes, exercise, eating a healthier

diet as well as for certain individuals,

people who have coronary artery disease,

their guideline directed medical

therapy, you know, the combination of

both, you can really change the

trajectory and the course of someone's

outcomes as they as they age by getting

them on the right path. Of course, the

earlier the better, but that's why it's

never too late. And so it's really, you

know, it's it it has to be emphasized

enough. I think sometimes people also

think once they're diagnosed with heart

disease that that's it. It's just

medications and they're just relegated

to, you know, um that's it for the rest

of their life. But actually, no. We even

have clinical trials that show us this.

One great example is called the Leon

Heart Study. This is one of my favorite

studies. It was a randomized control

trial that looked at individuals who

were on a standard uh cardiovascular

prevention diet and they randomized them

to either just staying on that standard

diet versus um being put on a diet that

was a Mediterranean diet that was very

high in fiber. So when you look at the

actual food breakdown from the trial,

they increased their amount of fiber,

legumes, fruits, vegetables, um whole

wheat bread, they replaced um uh

saturated fat, a high saturated fat

butter with a um a high poly and

monounsaturated fat um plant oil.

Instead, they reduced red meat. And um

with all of these dietary changes, this

is in a secondary prevention population.

So people have already had a heart

attack and stroke for the Leon heart

study. These individuals are already on

medication for their heart disease. They

found that there was a 50 to 70%

reduction in further cardiovascular

events. The trial was supposed to be

four years and they had to end it early

because it was considered unethical to

keep it going because the results from

the dietary change alone were so robust.

And that's why we really try to

emphasize that all levels through the,

you know, the lifespan that it's never

too late to make those dietary changes

and get those benefits.

&gt;&gt; All right, let's talk about one of the

greatest places a person can turn to get

those benefits and that is everybody's

favorite nutrient in our nerdy nutrition

circle,

&gt;&gt; fiber.

&gt;&gt; That's right. Fiber. Uh, how key is that

when terms of cardiovascular care?

&gt;&gt; You know, it's so important. I probably

I'm like a broken record because all I

do is talk about fiber all day every

day. And what's really important too is

that mentioning that fiber is dietary

agnostic. I happen to be vegan for my

entire adult life. Um but you know, of

course, not all my patients are vegan.

Um some people are just plant curious.

But regardless of your dietary pattern,

eating more fiber is beneficial not just

for lowering your cholesterol, improving

your blood pressure, improving your risk

for diabetes and your A1C, but also to

reduce colurectal cancer risk to reduce

various different kinds of sex related

cancer risks. And so eating a higher

fiber diet, and what's important is that

we mentioned fiber from foods, not from

fiber supplements, is incredibly

beneficial. One of the reasons why I'm

like a broken record with using My

Fitness Pal is because for years before

I joined their scientific advisory

council, I was constantly reiterating um

to patients the importance of knowing

how much fiber they're eating. And the

reason why is because often if you talk

to people and I have patients that some

patients that are vegan and I have some

patients that are absolutely on the

opposite end of the spectrum and they

haven't eaten a lot of vegetables in

their life but across the board I have

vegan patients who when I get them to

track how much fiber they're eating

they're like wait a second I'm actually

only eating about 15 grams of fiber a

day. Um and I see that across the board

whether they're vegan or whether they're

omnivores. And so what I started to do

in my practice is since we know fiber is

directly related to reducing your

cholesterol, eating high-fiber foods

helps with weight management, eating

high fiber foods helps to reduce blood

pressure, helps to improve your uh blood

sugar. Um what I start to do is have

patients start to track it. They don't

if you don't know how much fiber you're

eating, you don't even know where you

you start. One of the things you may

hear being a fiber advocate yourself is

people say, “Well, I can't tolerate

beans or I can't tolerate X, Y, or Z

sort of foods.” And this is where I say

that I can't have any conversation

without talking about dietary tracking

like using My Fitness Pal for my

patients because you need to know what

your baseline fiber intake is because

even if you're vegan, even if many of

your listeners who are vegan, they may

still be getting only 15 or 16 or even

10 grams of fiber a day. And if they add

something that's high in fiber and they

go from 15 grams of fiber a day right to

30 grams of fiber a day, they may say to

you, “Well, if I add a can of black

beans, I feel gas. I feel bloating.”

It's not that people who start to

believe like, well, I can't tolerate

beans or I can't tolerate high fiber

foods, but that's actually not the case.

We actually find that even people with

IBS or um different kinds of bowel

disease, even inflammatory bowel

diseases, that they find that if you

increase fiber slowly by about 3 to five

grams per day. The gut microbiome takes

some time, but it really gets used to

increasing your fiber while you're

simultaneously getting hydration, at

least 64 fluid ounces of fluid a day.

And so I find that by getting my

patients to track their fiber intake,

first of all, doing an intake of what

their diet is like with regards to how

much fiber are they getting, regardless

of if they're plant-based or omnivore,

any dietary paradigm, and then

increasing their fiber slowly. I get

patients that have so much more buyin

long term because they don't just start

following a plant-based recipe that's

high in fiber and then they get gas and

bloating and then they give up. It's a

gradual increase by tracking that they

can actually integrate more fiber into

their diet, not get abdominal

discomfort, not get any GI distress or

bloating, and then they stick with it

long term. And you know, I was just

mentioning in a conversation before,

there's even research studies to show us

that we're bad at knowing how much fiber

we eat. They did a study where they

looked at uh registered dietitians whose

job and registered dietitians, I have

dietitians that work for me in my

practice. They are the unsung heroes of,

you know, medicine. They are worth their

weight and gold. And registered

dietitians job is to know how much we're

eating of of how many different things.

They do this day in day out. And they

looked at registered dietitians and they

had them track their diet on a you know

writing it down dayto day versus doing a

dietary recall at the end of the week.

They found that they under they

overestimated the amount of fiber they

were eating by it was somewhere upwards

of 40% at the end of the week versus

tracking it. And so I actually even

myself do my own dietary inventory even

though I've been eating a very similar

plant-based diet for years. I still do a

check-in with myself with my own My

Fitness Pal every couple months to see

am I meeting my protein target? Am I

getting enough fiber? Just seeing if

there's anything I need to shift because

even us who talk about this day in day

out, we may not even realize that we're

maybe slacking in some areas rather than

others. And I find that it helps getting

the buy in when people don't get the

side effects of going too much too soon.

Although there will always be those

people who can go from eating 15 grams

of fiber a day to 40 and they feel fine.

But I also don't want those who start a

high-fiber diet to feel deterred when

there's a better way.

&gt;&gt; Yeah. I I remember it took me a good two

weeks after I switched over to an

exclusively plant-based diet for um you

know the gas and the bloating to to kind

of go away, but then it was just like I

woke up one morning and it was perfectly

normal and and no problem since. So, uh

is 40 grams per day your recommendation?

I've heard some people say 30, some

people say a little bit lower, some

people say, “Well, I want at least 60.”

Is 40 the sweet spot for you?

&gt;&gt; My favorite question. So the the thing

about fiber is there's no upper limit of

fiber intake. There's no upper limit of

fiber intake. The max amount of fiber

you should eat is the maximum amount you

tolerate and enjoy. I happen to eat

about 90 grams of fiber a day. I tell my

patients, you don't have to eat 90 grams

of fiber a day, but that's how much I

eat because I eat a lot of legume pasta.

My edetamame and mung bean pasta has

like 24 grams of fiber for 340 calorie

servings and it's high protein, high

fiber. It's amazing. Um, but I eat a lot

of fiber. But I always say you don't

have to eat that much. there. But there

is no upper limit. The upper limit is

the max amount you tolerate and enjoy.

But the RDA, the uh the lowest amount

that even the American Academy of

Nutrition uh and um sciences recommends

is at least 25 grams for women and 38

grams for men. In cardiology, we heer on

the side of, you know, having everyone

target at least 40 grams of fiber a day.

That being said, I give my patients a 40

to 60 gram target to reach if they have

hyper lipidmia or hypertension or

elevated blood glucose. Keeping in mind

that oftentimes as people get up to that

40 gram uh per day, sometimes they get

to 60 and they see their LDL lower even

more. Sometimes if I have a patient just

on for example a cholesterol medication

like rubastatin and they may have been

on ruaaten plus a non-statin medication

called a zettoide sometimes even just

going up from 40 to 60 grams of fiber a

day can be the difference between being

on one medication and two and so even

though that doesn't seem like a huge

difference to someone listening for

someone that doesn't maybe necessarily

want to be on multiple medications

that's a huge win right and so I think

that getting patients to try to hit that

40 grams a day target but keeping

keeping in mind there is no upper limit

and that they should just enjoy the

process and experiment. Find different

foods that they enjoy. But I do think

that while they're increasing their

fiber, going slow and steady if you

tolerate an increase of three grams per

day and tracking using like an app like

My Fitness Pal can be so beneficial to

not getting those side effects that

people can get sometimes if they go too

much too soon. And I've heard it

countless times, people saying, “I

cannot tolerate beans. I can't eat those

foods. They give me gas.” And I always

say, “That's not true. You can eat them.

You just have to go slow.” And um it's a

win-win for everyone, especially once we

get people eating more legumes, more

fiber, more berries, um regardless of

their dietary pattern.

&gt;&gt; Let's talk about the connection between

fiber and a reduction in inflammation,

which then in turn leads to fewer

cardiovascular events. How do fiber and

inflammation work from a cardiovascular

standpoint?

&gt;&gt; Yeah. So, I think that it's probably

twofold. I think that a lot of the foods

that and the reason why we always

emphasize that it's fiber from foods,

not from supplements that matters,

right? Um I was actually the lead author

of the American Society of Preventive

Cardiology clinical practice statement

on nutrition and cardiovascular disease

prevention in 2022. And it was our first

cardiology, you know, statement that I

wanted to include a section on

supplements because of this confusion

about supplements. And we essentially

just wrote there is no, you know,

supplement for cardiovascular disease

prevention outside of, you know,

deficiency, someone who has a diagnosed

deficiency of something that is

beneficial. And that includes fiber

because one of the reasons why fiber

helps with overall health, things like

inflammation, cholesterol, is because

it's not just the fiber itself, it's the

food it's packaged with. So fiber comes

in foods um like fruits, vegetables,

legumes that have polyphenols, various

different macronutrients, micronutrients

that vitamins, minerals that are

incredibly beneficial for us.

Additionally, it's also the food that

it's naturally going to displace. When

you're eating a higher fiber diet,

you're getting lots of fruits,

vegetables, legumes, whole grains, it's

naturally going to displace other foods

that may be less beneficial for us that

may be more inflammatory as well, like

fried foods, foods that are high in

saturated fat and the like.

&gt;&gt; All right. And let's talk about the

different kinds of fiber, uh, soluble

and insoluble. Uh, what did the studies

show in terms of which one is more

effective for cardiovascular health? uh

if there is such a study out there.

&gt;&gt; So, you know what? So, viscous fibers

are the ones that are most tagged with

being most beneficial for lowering your

cholesterol. But I actually tell

patients to keep it simple. Don't worry

about tracking viscous versus um

non-iscous fibers. Just focus on getting

your total fiber count up um through

eating fruits, vegetables, legumes,

whole grains, and things like that. um

because your cholesterol will come down

significantly

with regardless of even if you have a

genetic hyper lipidmia and even if you

require medication, it will still make

an impact on your cholesterol. Um just

focusing on the total fiber intake.

There's a great study called the Simeon

diet study that was done by David

Jenkins and they essentially randomized

individuals in a metabolic ward. So when

you're in a metabolic ward, you live in

this unit where everything you eat is

measured, counted, taken accounted for

um for two weeks. And um what they did

was they randomized them to they kept

protein, calories, saturated fat,

polyunsaturated fat, every single thing

the same. The only thing they changed in

the diet was fiber content. And they

were randomized to a moderate fiber

diet. I believe it was like about 25

grams. Don't quote me on the exact

numbers, but then the there was a medium

sort of fiber diet that was about 50 to

60 grams, I think. And then they had a

high fiber diet arm, which was about 150

grams of fiber a day, which is very

high. But in two weeks, in 14 days, the

people on that high high fiber arm

lowered their LDL cholesterol by 30% in

14 days. Um, and it's quite clinically

significant. And I usually keep that

study in almost every slide of every

presentation I give on diet and

cholesterol and heart disease. Not

because everyone needs to eat 150 grams

of fiber a day, but because by

increasing your fiber, it is possible to

see that subsequent drop in in LDL

cholesterol. There's also been more

research that's come out that has shown

that eating high fiber foods also lowers

blood pressure and hypertension is, you

know, the silent killer that affects the

vast majority of our population. And so,

it's beneficial in in diabetes

prevention as well. And so there's

really no no box that it doesn't check

for for benefits.

&gt;&gt; I would love to know what that diet of

150 grams of fiber per day looks like. I

mean, that's a lot of fiber, doc. That's

a lot of fiber. How did How in the world

did they get up to a buck 50?

&gt;&gt; I know. I know. I know. It was certainly

a lot. And they kept calories the same.

you know, with my like 80 to 90 grams

fiber a day, people think that's high,

but it's almost like I'll tell you when

you when you start tracking, you see

what I call lateral switches. So, like

when I log on to my app, my My Fitness

Pal, and you'll see like, okay, um not

to say that I don't eat fruits or

vegetables that aren't high in fiber

because I eat a varied diet. But when I

started to go higher in fiber, I'd see

like, okay, where do I get more bang for

my buck? So for patients who are

starting to increase their fiber, I

would search in my Fitness Health app

and I would be like, “Okay, so I can get

eight grams of fiber per cup for

raspberries and blackberries.” So maybe

I'd swap out my banana for my in my

smoothie that morning for raspberries

and blackberries and get more fiber that

way. Then I found, okay, so if I do a

smoothie in the morning with a cup of

raspberries, a cup of blackberries, some

chia seed, flax seed, I may be getting

20 grams of fiber there with some

spinach, things like that. And then I

will do edamame pasta that's got 24

grams of fiber for one small serving. A

medium avocado has 10 grams of fiber.

And the only reason why I know this is

because when I'm tracking I'm like,

“Okay, this is where I'm going to get

more bang for my buck.” And that's why I

call it even lateral switches because

you have some people that are going to

make dietary changes that include

they're going from eating McDonald's

three times a day and they're switching

their full diet overhaul. And then you

have some people who say, “I'm already

eating a healthy diet, but I need to

optimize it.” Um, and that's where just

really sitting down and focusing and

doing and like doing a dietary inventory

with your own diet and seeing where are

you starting from and where do you want

to go is very helpful.

&gt;&gt; Yeah. And uh I tell you, you know, I I

actually like My Fitness Pal a lot, too.

It's super easy. I mean, you can even

scan, you know, the side of the box of

pasta and it'll pull up the nutrition

info right there automatically for you.

You can build your own recipes in there.

Like, they really have made it

effective. And one of the things also

that I like about it is um the exam room

is super popular in Canada. Like easily

a top five usually nutrition podcast in

Canada. It's available in Canada too. So

for all of our Canadian listeners, you

know, go have fun, you know. Pretty

cool.

&gt;&gt; Amazing.

&gt;&gt; Yeah.

&gt;&gt; Amazing. Yeah, they're the OG barcode

scanner. Um I've been using it forever

and it's so it's so beneficial to be

able to just scan, have an idea. also

like the learning that goes on where I

mentioned like even with my dietitians

like my dietitians can guide patients

but that dayto-day learning even for

myself of like when we try to get

someone to lower their cholesterol

there's two big levers to pull one is

going to be increasing fiber and the

second one's going to be reducing

saturated fat. The third lever is

dietary cholesterol, but that's less

important because if you get saturated

fat to less than 7% of calories, dietary

cholesterol is naturally going to follow

it because foods that are high in

dietary cholesterol are high in

saturated fat. And when you're doing

this like dietary inventory and you're

putting things in, even for myself, I've

been like, “Wow, this may be a

plant-based X, Y, or Z.” And then I scan

the barcode and I'm like, “Wow, I didn't

realize that that had so much saturated

fat in it.” It's because they snuck

coconut oil in it. And if you want to

keep your LDL low, you want to be less

than 7% of calories and saturated fat.

Um, and so, you know, it it is helpful

to do some kind of intake and realize,

okay, on my day-to-day, what am I eating

and and how much of it and how do I

optimize things? I think that's the

magic too now of, you know, of

technology is that it doesn't have to be

so much guesswork. I feel like, you

know, 20 years ago, you'd just kind of

be like writing things down and

guessing. And now it's as easy as

scanning something, adding in your diet,

knowing what your recipe was, and and

kind of just going with your day. It's

just much more simplified and

convenient.

&gt;&gt; I know. I almost feel spoiled because I

do remember like filling out uh you

know, 20 years ago those little diet

sheets and you know, tracking it all

down and you had a little notebook and

it was it was a tedious process.

&gt;&gt; Totally. and you're like trying to like

figure out well like how many calories

could this have and then you go to a

restaurant and there's nothing. I mean

now like the barcodes are available for

everything

&gt;&gt; for sure. Hey uh a couple more before uh

we wrap things up here. Um you mentioned

you know avocado. You you just mentioned

uh uh I believe it was coconut oil

something like that. From a cardiologist

perspective you know how concerned

should the average person be who's

eating a healthier diet, plant

predominant diet at the very least? How

concerned should they be about adding

something like an avocado and then you

know compare contrast that with coconut

palm kernel oil that kind of stuff?

&gt;&gt; Great question. So first of all I always

say the dose makes the poison. So you

know in general whenever patients are

talking about a dietary change I always

want to remind them that no one food or

meal in one dose is going to be the

cause of disease. So I don't want anyone

to feel you know terrible if they enjoy

something with a coconut curry or

something like that once in a while. Um

but overall we do recommend trying to

limit saturated fat. And so coconut oil

is one of those things. Um palm oil,

these are things um red meat, these are

things that are very high in saturated

fat. And so we try to recommend limiting

things that are high in saturated fat

because there's actually a direct and

linear relationship between saturated

fat and LDL cholesterol, which is the

type of cholesterol that causes

cardiovascular disease. And by focusing

on um swapping out foods that are high

in saturated fat for those that are

higher in poly and monounsaturated fat

or foods that are high in fiber, you

kill two birds with one stone and you

really can help to lower your LDL

cholesterol. So avocado, for example, is

a great food because it's high in

monounsaturated fat. It's got poly um

unsaturated fat as well and it's got 10

grams of fiber for a medium avocado. Um,

when it comes to coconut oil, although

we recommend to avoid because it's high

in saturated fat, we have things like

olive oil and canola oil which have a

better fatty acid ratio. And so in, you

know, in general, focusing on reducing

saturated fat, replacing that with poly

and monounsaturated fat or high fiber

foods and things like that is the goal.

And then of course getting enough

protein. So everyone making their RDA of

protein, which generally I think you

would agree, you know, we don't have

much of a protein deficiency in the US.

It's probably more of a fiber deficiency

that's the issue. Um, but there are many

populations that do want to make sure

they're getting the RDA of of protein.

people who are lifting muscle, building

um trying to build lean mass, people

that are on a weight loss journey,

getting their adequate amount of protein

and focusing on getting those healthy

protein sources from legumes, from bean

proteins, um if they are an omnivore,

things like fatty fish or, you know, a

lean protein and rather than those

highsaturated fat sources like red meat.

&gt;&gt; Yeah. And let me ask you about these

really high protein, low fiber diets

that a lot of people are following here.

And obviously it's easy to say yes,

people do have weight loss success on

these, but I often wonder, you know,

what kind of heart protective nutrients

are being left off of the plate by

eliminating so many um sources of fiber.

You know, it's so it's it's it's it's

really I I have empathy for, you know,

the people who I often find that when

people follow this extreme diet,

something like the carnivore diet or

something. I have empathy for these

individuals because oftent times they

are un feeling unwell and they are

looking for solutions and um they

stumble upon this as a solution and and

maybe like you said it does work

temporarily and you know essentially the

reason why people may have quote unquote

success temporarily on a carnivore diet

is because is essentially an elimination

diet. So maybe they're eliminating chips

and fries and and other foods that are

not beneficial. But um long term the

concerns really uh it's very concerning

to me um eating a high saturated fat

diet without any plants that has very

you know missing out on all those

important phytonutrients not only is the

risk for cardiovascular disease vast

because we know that eating a very high

saturated fat diet devoid of fiber is

going to raise your aogenic lipoproteins

like LDL and these ones that directly

cause atherosclerosis but also raising

your risk for various types of cancers

especially colorectile cancer.

um you know there's a direct

relationship with eating fiber in the

diet and reducing colorectal cancer risk

and all sorts of cancers and so um you

know and even dementia risk you know now

we find that back in the day you know we

used to think that the vast majority of

dementia was directly related to

genetics and there was nothing you can

do and now we know that actually the

vast majority of dementia is related to

the same risk factors that lead to

cardiovascular disease and so what

worries me about people getting

temporary relief on these really strict

elimination carnivore diets is that

they're trading very very high long-term

risks. Um, and and that's what's

unfortunate. But I do have empathy for

people who are on that journey. I just

hope that they find their way back to,

you know, a healthier direction before

something does happen that that ends up

being, you know, not fixable.

&gt;&gt; Yeah. The interesting thing is the

people who do this at least early on

they'll also say well look you know I'm

seeing a reduction even in my

cholesterol here and that that to me is

puzzling. I'm not exactly sure why the

body would respond that way. I don't

necessarily doubt the validity of that

claim for whatever reason but what what

do we know about why there might be that

shortterm reduction?

&gt;&gt; Yeah. So um so cholesterol is actually

quite simple. We're very lucky because

we have tons of data on cholesterol and

um bio the lipids are serum lipids and

kind of what dietary things impact uh

what and it's really affected by two

variables. It's really affected by

dietary fiber and saturated fat compared

to mono and polyunsaturated fat intake.

Um I would say hypothetically the reason

why and weight can see a reduction in

cholesterol but also it's not

guaranteed. You can have people lose

weight on a very high saturated fat,

carnivore or keto diet and their

cholesterol skyrockets, right? Because

the weight loss itself may not change

their they may go up in aoggenic

lipoproteins if they're eating a very

high saturated fat diet. And so um and

this has been very well established in

multiple randomized control trials done,

you know, over time. And so I would say

that if temporarily they saw a

reduction, they may have the since it's

such a limited diet. So, say if their

previous diet was eating, they weren't

carnivore, but they were eating, you

know, McDonald's three times a day and

they were eating say 5,000 calories or

8,000 calories a day. And then say if

now they're eating 2,000 calories a day

of just meat, their overall saturated

fat intake may be reduced um just

because the quantity of food they're

eating is reduced. Um but overall,

that's still not going to be beneficial,

right? because if they still have the

quantity of their diets focused

predominantly on saturated fat will

still eventually, you know, be a problem

with regards to you're not going to have

an LDL at goal um on a diet that is just

all animal products. It just is

impossible unless you have some genetic

um um hypo apo lipoproteinia where you

don't make apo which is very rare. Um,

and so, you know, generally it would

just be that their previous diet maybe

just they're going down on quantity. Um,

but it's not that it's healthier for

them by any means, but the the weight

loss that people see when they do one of

these kind of, you know, either um a

highsaturated fat keto diet or a

carnivore diet is just basic caloric

restriction. And so, there's no magic to

it. Um, there's no reason why eating

that kind of diet is is uh leading

people to lose more weight. It's just

the caloric restriction. And some of

that's just from it being such a

restricted diet that they can't eat x y

or z other foods that they were

previously eating and that just

naturally limits it. But you know the

concerns long term are are very you know

robust. We have so much research showing

us the opposite. That by eating more of

these high-fiber foods, by reducing

saturated fat, we can reduce

cardiovascular disease risk, risk for

hypertension, risk for diabetes, risk

for certain cancers that um you know,

taking that shortterm weight loss is is

to me is is a huge risk outweighed by

the many many many long-term risks. And

also keep in mind that when you look at

different dietary patterns um there

generally there is no one magical diet

that leads to the most weight loss. Um

they've compared head-to-head various

different kinds of diets and they often

have a similar a little bit a little bit

of a regression to the mean. And so the

focus should be most on a diet that's

sustainable, that is overall healthy

rather than, you know, one that is going

to be one like the carnivore diet that

could put you at long-term risk for

various different kinds of cancers and

cardiovascular disease.

&gt;&gt; All right, two more fun ones. Uh, first,

what's the musthaves in Dr. Danielle's

pantry? Like if if you're going to list

like five or so, what are the musthaves?

&gt;&gt; Oh, number one through five, legume

pasta. I tell everyone, and it doesn't

matter if you are an omnivore or if you

are a vegan, legume pasta is the biggest

winner. I think that everyone can

benefit from. I have patients who are

professional athletes in the NBA and the

NFL, spanning from patients who are 90

years old, just trying to keep their

cholesterol in check, that all enjoy

these. Um, and legume based pastas are

phenomenal. There's a zillion different

brands and a zillion different kinds,

but everyone, no matter what the dietary

par paradigm, can benefit from them

because they're a phenomenal protein

source. They're super high in protein

and they're super high in fiber. And so,

even for someone who's an omnivore, they

can replace their animal uh protein for

a meal, several nights a week with a

legume pasta, and they can get tons of

protein and tons of fiber at the same

time. And the benefit is that there's so

many different types. So, I recommend if

you try one, because I've had patients

who are like, “Oh, I've tried bean pasta

before and I do not like it.” And I

always say try a different kind.

Meaning, if you try the edamame and mung

bean one and you don't like it, then try

chickpea pasta. If you don't like that,

try lentil pasta. There's green lentil.

There's red lentil. If you try that and

you don't like it, try um, you know, a

lupini bean pasta. There's uh black lent

there's black bean pasta. There's all

different kinds. And I think they're a

great almost cheat code of a great high

protein, high-fiber, amazing source that

I think most people would benefit from

having in their diet. Um, regardless of

their dietary paradigm,

&gt;&gt; pasta for breakfast, yay or nay, where

do you fall?

&gt;&gt; Oh, sure. I mean, I mean, I many nights

that I would leave the cardiac ICU after

work and at 7 a.m. eat a bowl of edamame

and mung bean pasta. I had no problem

with it. But, you know, if it's not your

your thing, no worries. Um, there's, of

course, a zillion different things that

are, you know, beneficial. I think I

think another thing that I recommend

that people sometimes look past is

putting avocado in smoothies. I think

it's a great fiber source. It's it's a a

great tasting. It helps to bulk up your

smoothies. Got 10 grams of fiber for a

medium avocado. Um, and that's um and

you you can't discount berries, too. My

patients will say I'm a broken record

because I talk about blackberries,

raspberries. You get so much fiber. um

chia seed, flax seed, you know, it's

kind of really there's something for

everyone and I think that people should

just focus on experimenting, trying

different foods, expanding their pallet,

and you know, incorporating more of

these high-fiber, plant-based foods into

their diet.

&gt;&gt; All right, final question is a bit of a

curveball, but an important one. Uh

thumbming through your Instagram, I saw

you were recently living your best life

out in Las Vegas. So, Backstreet Boys or

InSync? Come on, who's it going to be?

&gt;&gt; What kind of question is that?

Backstreet Boys. Of course, Backstreet

Boys are incredible. I saw Backstre Boys

at the Sphere in Vegas. Anyone that can

go, you should go.

&gt;&gt; Look at this. Look at this. I got it. I

got it queued up and ready to go. You

were living your best life out there.

&gt;&gt; Millennial dreams come true. They were

just as good as they were. I saw them

when I was 10 or 11 years old at Madison

Square Garden and they were just as

good. I was worried that they were going

to be a little cickety and it was going

to make me feel old, but I'll tell you,

their joints were working. Everyone was

like, they were on it. They felt

They were, you know, they all have all

their hair. I mean, I felt like they

were really powering through. I didn't

feel old at all. And they were amazing.

In sync, you know, Justin Timberlake has

ruined it because he will not tour. And

you should see the sphere was completely

booked through. Everyone was there. If

Incin went back on tour, they would have

they would be, you know, filled to the

nines. But Justin Timberlake's holding

them back.

&gt;&gt; Hold on. Hold on. Well, look, this is

this is my favorite one. Like, you're

all into it. Like look at the soul come

out of you as you're singing along here.

&gt;&gt; You remember TRL? Like

&gt;&gt; Oh yeah.

&gt;&gt; 1999 before social media we had TRL. You

you you'd come home from like middle

school, you'd have a snack, you'd be

able to watch TRL. I mean, these were

the days.

&gt;&gt; Yeah. Yeah. Good. I And that that was

the ticket, right? TRL was a big deal

back in the day. It was a huge deal.

&gt;&gt; You weren't you weren't anybody Britney

Battle on Forever.

&gt;&gt; Yeah. Yeah. Yeah. Yeah. Yeah. But check

this out. Hold on. So, there you guys

are taking a break in the sphere. Maybe

this was pre-show. I don't know. Maybe

it's just like a whole lot of dancing.

But like, look at this. Y'all made it

like a true girls weekend. Y'all got the

glam squad out there to get you going.

&gt;&gt; We went all out. We went all out. I

still got my 90 grams of fiber that day,

too.

&gt;&gt; I'm proud of But look at this. Now, as a

guy that appreciates fashion, like this

is a 10 out of 10 right here.

&gt;&gt; Oh, thank you.

&gt;&gt; Yeah, we went all out. We were like,

we're going to do Vegas tacky glam.

We're going to go all in.

&gt;&gt; So, we went all in. We're living our

millennial 90s dreams.

&gt;&gt; Do it. Do it. Do it. I love it. Hey,

look, you are welcome back anytime.

&gt;&gt; Thank you so much.

&gt;&gt; This has been a blast. Uh thank you for

everything that you're doing and uh

yeah, we put a link down below. You guys

can uh get My Fitness Pal right there.

It's an app. Goes right on your phone.

Could not be any easier. So easy.

&gt;&gt; That's the key to getting your fiber up,

your protein right. It has been

revolutionary for my own health and all

my patients.

&gt;&gt; Right on. Well, you've been

revolutionary today. You got my energy

up. So, thank you very much.

&gt;&gt; Well, thanks for having me.

</markdown>

Edit:2025.08.07

<markdown> </markdown>

讨论列表 AKP讨论 查看原帖及回帖