Category: Diet

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Blood Sugar Diet Heart Health

Stubborn Fasting Blood Sugars

You’ve lost weight, improved your activity level, changed your diet, and that stubborn fasting blood sugar won’t get below 110.

In this article, I’ll share how we approach such outcome discrepancies in our Heart Health Coaching practice. With the most important caveat that any improvement is a massive step in the right direction; and that perfection is the enemy of progress.

Elevated Fasting Blood Sugar Troubleshooting

In this case presentation, we assume that you are actively involved in improving your blood sugars whether you are a non-diabetic, prediabetic, or type 1 or 2 diabetic.

For some reason, your actions have made a huge improvement in your A1C percentage and your postprandial sugars but the morning fasting sugars remain high.

1. Data Error

The CGM (continuous glucose monitor) our client is wearing might show elevated morning sugars, but is it accurate?

Confirming any values with a handheld glucometer and serum fasting blood sugars is best. As a bonus, we also recommend our clients check their fasting insulins.

2. Body Composition Issue

Some of our clients are underweight, and others are overweight. Is there excess visceral fat in the body?

A DEXA scan will tell us if the client has too little muscle mass or too much visceral fat.

3. Stress & Sleep

If there is undiagnosed sleep apnea or elevated stress levels, the fasting blood sugar will be hard to control.

Managing sleep and stress is just as important, if not more, than diet or exercise levels.

4. Dietary Extremes

A few clients, especially those in their 70s, seem chronically undernourished. A low dietary protein content combined with androgen deficiency leads to rapid loss of muscle mass, which is necessary for proper fasting blood sugar regulation.

5. Exercise Balance

Are you doing too much cardio and not enough resistance training?

We see too much cardio and not enough resistance training. It’s only been in the last decade that science has pointed toward the importance of weight lifting.

6. Excess Fasting

What does time-restricted eating do to your blood sugar long-term, not just short-term?

Some will do great with fasting, but many will experience glucose desensitizing during the fasting state and experience massive spikes upon waking, resulting in stubborn fasting blood sugars.

Improvement May be Enough

We remind clients that improving blood sugar profiles may be more than enough. Rarely do we recommend long-term use of blood sugar measurement via handheld glucometers or CGMs.

Even with some elevated values, health improvement is exponential as long as the changes are happening in the right direction.

Instead of obsessing over the last 10 mg/dl we encourage our patients to figure out their Heart Health Risk Score and aim to minimize other health risk factors.

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Diet Heart Health Metabolic

Approaching Weight Loss

The topic of weight loss is both a medical topic and one that is emotionally charged. Many of my health coaching clients blame themselves for their weight problems and believe that more willpower will lead to better outcomes.

Being overweight or the diagnosis of obesity is a medical condition the same way pneumonia or back pain is a diagnosis. If gaining weight is done simply by eating more then eating less should result in weight loss. And this discrepancy is precisely why weight loss is more complex.

My approach to weight loss is unique as I’ll highlight below. For those whose weight negatively affects their cardiovascular health, we create an individualized plan and tackle obstacles to obtaining an ideal weight.

Reductionist Thinking

In western medicine reductionist thinking is abundant. If you have a urinary tract infection you must take an oral antibiotic. If anyone has diabetes they must be started on medications.

Reducing any concept down to one easily explainable idea is a pitfall. It prevents more insightful thinking.

I don’t reduce obesity down to a calorie issue. This makes sense on paper in a calorimeter but the human body is agnostic to our mental models.

Weight Loss Drivers

There are several factors that affect weight loss. I see this in my clinical practice when a patient unintentionally loses weight. Below are examples.

56-year-old Mary

Mary is a 56-year-old woman who always carried an extra 50 lbs, as she put it. Her kids had grown up and she got laid off which was the perfect excuse to move to a remote city in Mexico where her husband found a job with an electrical company.

The type of food she had access to was very different there. Busy with getting settled in she didn’t pay any attention to her weight until her clothes started being too big. Without pizza, pasta, ice cream, or bagels her weight was coming down rapidly.

The activity levels she always wanted to engage in like riding a bike or hiking suddenly were much easier. It was her lower weight that made it easier for her to be more active. This, in turn, made her lose even more weight.

44-Year-Old Jesus

Jesus got diagnosed with an inflammatory bowel condition which caused him severe diarrhea and bloody stools. He was about to lose his health insurance so he decided to not start on any new medications but he met with a nutritionist who suggested a diet to help prevent further flare-ups.

Jesus was petrified of the blood in his stool and was committed to never seeing that again. Though stressed about work he bought those college-style bound notebooks and kept a food journal and meal planned as instructed by this nutritionist.

He was told to eat fish, olive oil, fruits, nuts, seeds, oats, and legumes as much as he wanted. The items to avoid were bread, white rice, alcohol, pasta, desserts, and anything fried.

Jesus was never worried about his weight and felt that for his height he had a normal physique. At 5’10” and 205 lbs he described himself as stocky but not fat or skinny/scrawny, which was what kids teased him about when he was in grade school.

9 months later when he found a new job and could afford health insurance again, he saw me for the first time and was quite concerned about his weight loss. He had lost around 27 lbs and believed it was due to the inflammatory bowel disease.

Foods that Help with Weight Loss

It’s clear from the examples above that changes in what we eat impact weight loss. For some individuals certain foods are obesogenic – they cause a high spike in blood sugars which results in fat deposition and more hunger.

But there is no one diet that helps every person lose weight – human physiology is simply not the same from person to person.

I, for example, can eat a lot of fruit without gaining weight. Trying the same diet for some of my patients results in rapid weight gain. Therefore, it has to be individualized. But some generalizations can be made.

1. Slow Carbs

Slow carbs are whole grains and seeds such as 100% whole wheat or brown rice, quinoa, barley, oats, etc. These tend to not cause a sudden spike in blood sugars which helps curb hunger later in the day but also signals decreased weight retention.

Slow carbs versus higher glycemic load or glycemic index carbs seem to also help lower high blood pressure. Something Jesus also noticed from the example above.

2. Fiber

Fiber is filling and helps many maintain healthy gut flora. Though some believe that fiber is not needed many of my patients do well with it, anecdotally.

Avoiding it is generally a bad idea. But it’s easy to overdo it. Beans, generally quite high-fiber, can be well tolerated by some but someone else can only handle 1/4 cup without getting a lot of GI symptoms.

3. Healthy Fats

Certain fats are more obesogenic. Milk and fatty meats seem to not be ideal food choices for weight loss.

Olive oil, fish, avocados, nuts, and seeds are better fat/oil choices for someone trying to lose weight.

Some physicians recommend avoiding fats altogether and eating more starches. Perhaps you have the kind of physiology which would respond well to this. Experiment and find out.

4. Plant Proteins

Animal foods tend to be a bit more calorie-heavy but less nutrient dense. As in, they satisfy your macronutrient needs but may not have enough micronutrients.

Obtaining proteins from plants is a good option for many of my Heart Health coaching clients. Does this work for everyone? Absolutely not. We are all unique and our response to certain foods must be taken into consideration.

5. Nuts

Without brown rice or something oily, it’s hard for me to feel satiated. Nuts and seeds are ideal for me after a lighter meal. It’s my dessert and helps me feel full.

I could also feel full with a fatty whip cream or ice cream dessert but the weight and health consequences from that aren’t worth it.

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Diet Heart Health Hypertension

Carbs and Blood Pressure

The human gut benefits from a balanced diet. It can withstand quite a poor diet for short periods. But, in the long run, there has to be a balance; otherwise, we suffer health side effects. Carbs and blood pressure are an example of this improper balance.

Carbs and high blood pressure correlate closely. It doesn’t mean you have to cut out carbs, but it’s important to choose carbs wisely and get plenty of fiber or protein in the diet.

Blood Pressure and Diet

It’s not that you are trying to hurt yourself, but some of your diet decisions may not be ideal for your unique physiology.

Functional nutrition is a branch of medicine focusing on each person’s unique physiology and microbiome. One person does well with a lot of processed carbs, while another suffers health consequences from the same diet.

I have patients whose blood pressure isn’t affected by salt. They might suffer other issues, such as vascular stiffness, but their blood pressure doesn’t falter.

Carbohydrates – specifically processed carbs – seem to affect most of us negatively over the long term. Carb consumption has a reasonably direct relationship with our blood pressure.

Carbs and Blood Pressure

Fortunately, it doesn’t mean you have to adopt a ketogenic or carb-free diet.

The balance of your macronutrients could help protect against the downsides of a high-carbohydrate diet that is mostly processed.

Certain foods have carbohydrates that digest slower than other carbohydrates. You can test it out by wearing a CGM or checking your blood sugar every 30 minutes after certain meals.

Some carb-rich foods will spike your blood pressure. A continuous blood pressure monitor is helpful for this. But checking your blood pressure every 30 minutes will be as effective.

A Balanced Diet

Some nights I eat a late meal that’s heavy in processed carbs. For example, it might be a homemade burrito with white flour and white rice.

The timing of this late meal, combined with the high glycemic index, often leads me to snore heavily at night, wake up congested the next day, and raise my systolic blood pressure by at least 10 points.

But if the tortilla is a whole-wheat tortilla and I have brown rice with plenty of veggies and go easy on the salt, my body handles it much better.

Heart Healthy Diets

There is no single diet out there that works for everyone. Many argue that diets as a concept of achieving health don’t make sense.

Chances are there are many foods you can eat and remain healthy. However, a dietary adjustment may be needed to achieve Heart Health once you are dealing with a particular cardiovascular disease.

Schedule a session with me today to discuss how to experiment with your diet to figure out what foods are best avoided and which to consume more of.

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Diet Heart Health

Overcoming Food Cravings

I haven’t succeeded personally or with my patients in overcoming food cravings. I have found that embracing it and accepting it goes a long way.

If you get the strong urge to binge or eat something unhealthy, allow yourself the space to accept the urge. It doesn’t mean that you should binge or eat the unhealthy thing, though that is also precisely what might happen.

Food Cravings and Their Origin

Not to get too philosophical, but the craving for food either comes from genuine hunger or from some emotional state.

Genuine hunger is rarely something you have to battle. It’s there, and it’s uncomfortable, but it’s manageable. You feel it but can cope.

An emotional food craving is what I get when I have a stressful day ahead of me or spend a few days or hours stressed out.

Stress, anxiety, fear, the unknown, insomnia, or chronic pain are all factors that can spark a food craving.

I often don’t know I’m stressed or worried until I chase down a restaurant on my food delivery app. But what I do with this emotional food state is what’s the most important.

Accepting the Food Craving

It’s never helped me to be hard on myself because I am craving to binge. It hasn’t helped when I’ve restricted after a binge. Nor has it been effective when I’ve chewed myself out in my head for being weak or not sticking to the plan.

Allowing the food craving however has been a miracle. It has allowed me to overcome the food craving because it’s no longer something bad. It’s nothing that I have to fight and I just embrace it lovingly and await what’s next.

The Result of Acceptance

When I’ve accepted my weaknesses or shortcoming or whatever they are called I’ve found myself in a more peaceful state.

Overcoming food cravings only happens when I embrace the feeling and accept what is happening. No judgment and no resistance.

Oftentimes I end up eating unhealthy food or binging or whatever else. But the long-term consequence has been that overall I make solid food choice which are in line with my health goals.

Accepting the Bad

Imagine if we could all be okay with being inadequate, incompetent, lazy, or whatever other derogatory adjective we’ve created in our modern society.

Doesn’t it feel great to not to have to judge yourself and not have to spend energy and negative feelings judging others?

Food cravings that stem from health anxiety or body dysmorphia are tough to battle. But they are very easy to embrace. It’s in the embracing that the cycle disappears.

Unhealthy Food and Health

As I’ve mentioned before, it’s more important that you eat the rightt foods and less important if you sneak in something bad as well.

I care more that my patients get a nutrient-dense diet in their body and I’m less worried about the few chips or sugary foods. Get the right diet in and we can work on shifting the bad calories to better calories in the future.

One single unhealthy meal won’t ruin your health. Even decades of bad eating likely won’t affect you as long as you can turn things around.

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Diet Heart Health Prevention

Salt Intake and Heart Disease

There is an ongoing discussion regarding salt but we also have good science to help us make good salt decisions. There is an important connection between salt intake and heart disease.

My heart health coach clients know that each person’s diet and lifestyle are individual. No single formula applies to everyone. However, salt has a particular effect on the body which most of us share in common.

Is Salt Bad for You?

Let’s start with this question first because I get it asked a lot. I don’t think salt is bad. But for my patients who have major vascular problems, I like them to limit their salt intake.

And for my average heart health client who is healthy and wants to prevent future cardiovascular events, I urge them to reset their salt taste.

Even those with heart failure and hypertension can do fine with normal daily salt intake. But none of us will do too well with the current amounts of salt found in food.

Salt in Prepared Foods

I have a hard time trusting the sodium values listed on boxed foods. Think, Trader Joe’s or Whole Foods and canned products. And even if they are accurate, the amount of salt is staggering.

I had a taboule salad today with that chickpea salad from Trader Joe’s which I haven’t had in a year. It was during a busy urgent care shift so that’s all I could grab.

For 4 hours I’ve been dry-eyed and fatigued because my body doesn’t know what to do with the salt. I can drink a lot more water in order to pee out the salt but the salt will change the elasticity of my vessels and will drive up my blood pressure.

Bread and pastry and soups are other classic culprits.

Salt and Vascular Stress

I won’t get into the details in this article but whether you are salt sensitive or not, having more than small amounts of salt in your arteries will cause them to behave differently.

Over a long enough lifespan, this effect is cumulative and decreases the ability of the arteries to function properly. It doesn’t matter whether it’s the arteries of the heart, the brain, or the kidneys.

How Much is too Much

I don’t have my heart health clients count their salt intake. Instead, we start with good food and the salt that’s needed for good food to go down.

Take a salt you made with some spinach, baby greens, nuts, olive oil, tomatoes, and arugula. By itself, it’s not that exciting.

Add in some olives in a brine solution and now it’s exciting. A little bit of vinegar and you’re in for a treat. Of course, you have to get your taste buds used to having less salt. This takes time.

So don’t panic just because you had a few too many salty dishes in your life or during the holidays. Cardiovascular health for most of us is a marathon; slowly retrain your palate to consume less salt.

Salty Taste is a Habit

I’m sure there are exceptions but most of my patients tell me that food and tastes and flavors are matters of habit. Cut out burgers and after a while, you won’t crave them. Or if you have them they’ll feel exceedingly rich.

Cut out sugar or salt and when someone takes you to PF Chang’s you’ll put down your fork. It’s simply too much when you’ve gotten accustomed to just enough salt for the flavors to come through.

Heart health shouldn’t be the only goal for a good life and healthspan. It should be something sustainable and enjoyable. Therefore, salt is fine. It’s when we use excess amounts of it that our body responds and reacts negatively.

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Diet Heart Health Hyperlipidemia Prevention Statins Treatment

How the Body Regulates Cholesterol

In this article, I wanted to provide a basic overview of cholesterol regulation in the body. I share such articles with my heart health coaching clients whenever necessary. How the body regulates cholesterol is relevant to choose the right method of controlling cholesterol levels.

Cholesterol Regulation

Cholesterol is quite essential. The following key players regulate cholesterol in the body:

  • cells lining the intestine
  • liver
  • pancreas
  • intestinal bacteria

The food we eat has some form of cholesterol which becomes absorbable after manipulation by intestinal bacteria and pancreatic enzymes.

Cholesterol can enter the bloodstream also through the bile system. Whether you still have a gallbladder or not, your liver will produce cholesterol pumped into the intestines.

Cholesterol Absorption Varies

Some individuals are hypoabsorbers of cholesterol. No matter how much high cholesterol foods they consume, their intestinal cells don’t take up much of it.

Others are hyperabsorbers of cholesterol; even the lightest meals can have every bit of its cholesterol extracted and pumped into the bloodstream.

Cholesterol Regulation and Treatment Options

For my hypoabsorber clients, I am less concerned about their dietary cholesterol intake. Their cholesterol production in the liver would be a more important factor.

The hyperabsorbers will benefit a lot from a particular dietary change. Sometimes it helps to cut back on saturated fats, but eating times and gut bacteria are also important criteria.

Dietary change? Statin therapy? Ezetimibe? Evolocumab?

To answer that, I need more information about the person. A generic cholesterol test won’t always tell us the whole story.

The Liver’s Cholesterol Production

How cholesterol is regulated in the body has a lot to do with the liver. This fleshy organ on the right upper quadrant of the abdomen produces LDL, HDL, and VLDL particles.

Statin drugs decrease the production of cholesterol molecules in the liver.

The liver also has LDL receptors and absorbs cholesterol.

From fatty liver to elevation of liver enzymes to problems with the gallbladder, it’s important to consider the health of this organ when assessing my clients.

The Role of Gut Flora and How Cholesterol is Regulated

Some bacteria in the gut convert free cholesterol molecules into a stanol chemical that intestinal cells cannot absorb.

We could call these beneficial bacteria. They can help slow down the absorption of cholesterol for certain individuals.

Ezetimibe is a medication that works similarly, blocking the absorption of free cholesterol molecules.

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Diet Heart Health

Too Many Heart Healthy Diet Options

I am currently reading a book about heart-healthy diets, and the week prior, I finished a book giving nearly the opposite advice. With so much research and diet experts, it’s normal to have too many heart-healthy diet options.

I don’t believe that there is one correct diet option out there. That’s the wrong way to approach this health topic.

Heart Healthy Diet Options

There is the ketogenic diet which is quite popular in 2022. Before that, it was the low-carb diet and the Paleo diet.

Low-fat was the craze during all of my medical training from the late 90s into the early 2000s.

There is the vegan diet and whole plant-based diet, and the Mediterranean diet. And oil-free versions of each of these.

Focusing on how these diets are different is counterproductive. There is more value in teasing out what they have in common.

Even more critical, which individuals benefit from which diets? An individualized approach is often superior to population-based medicine.

Individualized Approach

Even some whole grains and organic fruit might tip them over if I have a highly insulin-resistant patient.

A ketogenic diet is the right solution for these individuals, perhaps for a short period of time. Eventually, like all of us, a person has to learn to eat intuitively instead of following a diet.

Some can stick to a particular diet. But inherently, diets have little wiggle room, which leads to a high dropout rate. And their long-term results tend to drop off after the first few years.

A patient with very active Inflammatory Bowel Disease (IBD) will not do well with a high-fiber diet. And the patient with Chronic Kidney Disease (CKD) won’t help their kidneys with a high-protein diet.

Food & Heart Health

I don’t focus on just the heart in my heart health coaching practice. If I achieve optimal cardiovascular health through a heart-healthy diet option but ignore the liver or brain, I will have failed the individual.

A diet ideal for the cardiovascular system will minimize insulin resistance, offer the right amount of dietary fats, and decrease inflammation.

Controlling inflammation might be more critical depending on where you are on your heart health journey. Later in your journey, decreasing peripheral resistance may be more critical.

What The Diets Have in Common

Heart-healthy diet options often have sustainability and high nutrient content in common.

Such diets offer the right macros to the individual without exacerbating any particular disease condition.

Few of these diets will provide excess calories, and the food sources are among the highest quality. Even if you are averse to the term “organic,” the foods in these diets are often grown in a way that requires fewer antibiotics and pesticides.

These diets have hardly any processed oils, fats, sugars, or proteins. Some will recommend adding coconut oil, olive oil, or butter, but that’s generally as processed as it gets.

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Diet Heart Health

Vegan vs. Whole Plant-Based Diets

There is no one diet to prevent or treat cardiovascular disease. Each person will benefit from an individualized approach. But I am asked about vegan vs. whole plant-based diets and wanted to address it here.

A plant-based approach isn’t the only way to achieve heart health but for those who want to cut animal products out this article is relevant.

Vegan Diet

Veganism is more of a religion than a diet. It’s a way of life for many where their aim is to minimize human and animal suffering.

Vegans also eat a plant-based diet but often have a high-carb and high-fat version. Not always, but easy to overdo it with vegan cheese and fake friend meats.

Most vegan restaurants serve highly processed foods. And vegan items in the grocery store aim to mimic a western diet, so there are a lot of oily and meat-looking items for sale.

Processed food is the enemy of heart health. And so, most vegan options tend to perform poorly regarding cardiovascular health.

Whole Plant-Based Diet

A whole plant-based diet is much more heart-friendly because it focuses on nutrients. Most whole plant-based food options are nutrient-dense and, by definition, not processed.

Hummus – sesame seeds, garbanzo beans, lemon, salt – that’s a whole plant-based food. But the version you buy in the grocery store often has many more processed items. Often, it’s loaded with oil to increase the calorie content.

A white flour tortilla is vegan but not healthy. But a 100% whole wheat tortilla (ground whole wheat grains, water, salt) is relatively healthy.

But grains or gluten-containing products aren’t right for everyone. That’s why I maintain that there is no perfect diet for everyone. It’s per individual.

Olive Oil

Inevitably the discussion next goes to olive oil when we compare vegan diets to whole plant-based diets.

The latter has no place for olive oil. But vegan food is often saturated with oils. For some, this isn’t an issue. For many, the extra oil can accelerate atherosclerosis.

Olive oil has some health properties, but like any good thing, it can raise cholesterol levels. This could (not will, but could) increase the risk of plaque deposits on the lining of the arteries.

Heart Healthy Diets

In my practice, we experiment with different foods and have items we cut out right off the bat.

If the cholesterol profile responds well and the inflammatory markers go down, we continue to make small adjustments.

To achieve heart health, I wouldn’t worry about olive oil. I would first worry about a diet with processed food ingredients – many ingredients you can’t pronounce or items you don’t recognize.

Exercise, stress management, minimally processed diet, and insulin management. Those are the most important tenets of achieving good cardiovascular health.

We dive into the diet in much more detail for those who still need tweaking. For one person, there is an absolute need for fish oil. For another, they have to cut out beans because of the inflammation it causes.

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Diet Heart Health

Heart Rate and Alcohol Use

the resting heart rate and heart rate variability are affected by alcohol consumption

For most individuals, using alcohol will have a negative or neutral effect on their cardiovascular health. The popular belief that alcohol is good for the heart isn’t something we see in clinical practice. It’s not to say that you should stop drinking. Those who are at risk of heart disease should reconsider their alcohol use. Heart rate and alcohol are closely tied, and we know that alcohol decreases heart rate variability.

Heart Rate

The sympathetic and parasympathetic systems regulate the rate of the heart. The goal is to have a low resting heart rate with good heart rate variability (HRV).

For an in-depth discussion of heart-rate variability, I recommend this podcast episode by Dr. Attia. There, he discusses HRV in much more detail. But remember that just because your HRV isn’t optimal, it doesn’t mean that you will suffer ill cardiovascular health.

Back to heart rate. If you are a tech nerd, you know that your heart rate changes whenever you drink alcohol. Commonly you’ll notice that it’ll be higher than usual and you’ll have decreased variability between beats – decreased HRV, which is less favorable.

Alcohol Use

Some of my clients binge drink, and others rarely drink. In this spectrum, there are those who drink moderately and those who drink several drinks per day.

It also matters the type of alcohol you drink, how dehydrated you get when drinking, and the quality of the beverage. So much to consider, no doubt.

I remain convinced that occasional alcohol use isn’t an issue. But binging on weekends or drinking daily is more challenging for the body to handle.

Resting Heart Rate

It’s hard to ignore my patients who enjoy excellent heart health and the association with their low resting heart rate.

Alcohol and resting heart rate have been studied in detail in the literature. Consuming alcohol regularly seems to increase the resting heart rate.

We work to decrease their consumption for my clients who are at risk of atrial fibrillation or heart failure. And for those who cannot cut down, we develop a strategy to consume alcohol in more ideal circumstances.

Cardiovascular Health

What is heart health or cardiovascular health? Well, it’s how well your heart and blood vessels function. And it depends on how well you want them to perform. Health, after all, is a personal journey.

When I consider my client’s heart health, I think of:

  • blood pressure
  • cholesterol
  • arrhythmias such as atrial fibrillation
  • peripheral vascular disease
  • congestive heart failure
  • heart attacks
  • angina
  • atherosclerosis
  • palpitations
  • POTS
  • exercise capacity
  • HRV

Heart health and alcohol are closely linked in the heart rate is affected. Furthermore, the rhythm of the heart is closely tied to alcohol usage.

Specific individuals are far more susceptible to this, while others can drink alcohol without any changes to their cardiovascular health.

Timing Alcohol Usage

The time of day when you drink alcohol matters. Not only that, but how hydrated you are and your stomach content are important factors.

Whenever possible, I recommend drinking alcohol with a meal and heavily hydrating after alcohol consumption. This helps with the clearance of this compound from the system.