Physician Assistant Brad Biskup from the Lifestyle Medicine Program at UConn Health’s Pat and Jim Calhoun Cardiology Center tries to help Carolyn and Chris understand the seemingly ever-changing prevailing wisdom on cholesterol, diet, and heart health.
Chris: What’s the deal with eggs? Good for you, or a fast track to heart disease? Today on the Pulse, we bring in our resident expert on lifestyle medicine to help us keep up with the prevailing wisdom on nutrition that seems to be constantly changing.
This is the UConn Health Pulse, the podcast to help you get to know UConn Health, and its people, a little better, and hopefully leave you with some health information you’ll find useful.
With Carolyn Pennington. I’m Chris DeFrancesco.
Some worry about it more than others, but most of us probably at least want to manage our weight and reduce our risk of heart disease. Yet with all the seemingly conflicting information out there, it’s hard to keep track of what’s good and bad for us.
Carolyn: And today we have Brad Biskup with us. Brad’s a physician assistant who heads UConn Health’s lifestyle medicine program in the Pat and Jim Calhoun Cardiology Center, and he specializes in lipid management. Welcome, Brad.
Brad: Thank you for having me.
Carolyn: So why should we care so much about cholesterol?
Brad: When we break down the cholesterol, it’s not so much the total cholesterol as looking at the different components, so when we look at the good and the bad. And one way you can always kind of remember it is when we look at the LDL, that’s the lousy one, we want it low. And the lower, there’s a correlation as far as reducing your cardiovascular risk, heart attack, and stroke. When we look at the HDL, that in general is much more productive. So when we look at the HDL, we always want that high. And so the higher we can get that, the more protective it is.
Chris: What is the link between the dietary cholesterol versus the cholesterol in our blood? And then saturated fats kind of a factor in all this. And I think we’ve heard a lot of evolving wisdom on this over the years. So, what can you do to clear that up for us?
Brad: When we look at the correlation between our dietary cholesterol, especially coming from eggs, there is a correlation because the main component that makes up the cholesterol molecule is cholesterol and triglycerides. Those are the main components. So when we have very, very high animal-based, which is where we’re going to get our cholesterol, that will drive up your LDL, and that’s again the lousy ,when we’re trying to get that lower. So there is definitely a correlation, but there seems now to be a much more strong correlation with regards to the processing of the foods, because especially when you’re looking at the processed meats, those are going to be higher in the saturated fats and overall fat content, which that really drives up the LDL, and the triglyceride, which is the fatty portion.
Carolyn: But wait a minute. So should I be eating eggs or should I not be eating eggs?
Brad: Well, what we’re good at in the United States is being all or none. And if you look at the longevity centers in the world, those are some of the blue zones. Yes, they will have some eggs in their diet, but it’s not the main component. So they’re looking more at the plant based whole foods as much as possible.
Chris: Not three-egg omelets every day?
Brad: Ideally not. And that’s when you just look at the cholesterol, you’re losing sight of the overall inflammation we also get from that, which can lead to other issues.
Carolyn: But I swear, I just saw a study saying that eggs were fine and we shouldn’t worry about it.
Brad: And that’s why when we think of how much we’re having, that’s the big component. So those three egg omelets twice a day. ,that’s getting a little extreme and that will affect not only the cholesterol, but our overall risk of developing cardiovascular disease, the heart attacks, the strokes.
Carolyn: So moderation is key.
Brad: Most important.
Chris: I wanted to ask you, Brad, about the keto diet or things along those lines. I’ve become aware of more of a push in that direction of like reduced or eliminating carbohydrates, and high protein and even high fat, even high saturated fat, with the belief being that you cut the grains and sugars out of your diet, you’re ending up having a reaction in your body that helps you lose weight. And then by the weight loss, you end up making it actually better for your heart disease risk, which seems a little counterintuitive. So what can you tell us about that?
Brad: One problem we have is when we’re looking for that quick response, you know, and again, we want to lose weight. Weight is an outcome of four different things. So when we look at what you’re eating, calorically — how many calories you’re bringing in, the type of calories, when we’re looking at your activity level — how much you’re moving, the stress and mindfulness, as well as the sleep, that’s going to help us determine how long we’re going to live much more than just focusing on the weight component.
And like you were saying about the keto diet, there are certain things. But unfortunately we use this nomenclature when we’re talking about carbs. Well, the absolutely best carbs, those are vegetables. That’s what we’re looking for. There’s no question that the vegetables are the key for any diet. The keto, the Atkins, looking at all those, they’re all in there.
But when you look at the fat content, especially coming from animal products, that really can not only increase your LDL and triglyceride levels, but it’s very pro-inflammatory. And if you look at the data very closely, long term, looking at these longevity centers, they’re not doing the keto diet. You know, if they are having the meats, those are very lean meats. Those are from basically pasture-raised animals, and it’s not the main focus of the diet., the healthiest diets to help us live the longest. And that’s the problem. When we look at the keto diet and we look at those animal-based fats in there, that actually looks very good for diabetics for the first six months to a year. But then that intracellular fat increases the resistance, which is the problem with type two diabetes. And that’s why we see such a strong correlation between high animal products and looking at the risk of diabetes, let alone the cholesterol numbers.
Carolyn: So just go with fish.
Brad: Fish is going to be much better as far as a comparison wise. Then you get the extreme who go plant-based whole foods only, and that’s our problem. We’re trying to make it all or none.
Carolyn: And that’s no fun. Who can sustain that?
Brad: And that’s exactly, and that’s why you look at the majority of diets, you look at the Ornish diet, you look at the Cleveland Clinic with Dr. Esselstyn, those have all been shown to regress heart disease, literally reversing it. But the problem is being able to sustain that and enjoy the food. You know? So when I’m talking to patients, it’s about how can I help them make better choices with two different choices they like, but one of them is going to be much healthier for them.
Carolyn: Give us an example.
Brad: If we look at the fat content of animal-based versus plant-based, in other words, nuts — people worry about the nuts because of the high fat, and you look at it, some of those can be 70 to 80% fat. But why are nuts one of the most important things to reduce diabetic risk and to help lower cholesterol? Because it’s the type of fat. When we have to break down that plant-based fat — because we’re animal-based, so when we have animal-based fats in our diet, it’s very easy to absorb, which is why it has such an effect on our LDL and triglyceride levels — but when we have something that’s not normal in our body, and that’s where, when we look at the fiber, when we look at those plant-based, we have to work to break it down, which is good.
So that way we’ve put all the inflammation within the GI system and we make it work instead of getting into the bloodstream and being more inflammatory there.
Carolyn: But didn’t our ancestors, the cave men, didn’t they eat mammoths and saber tooth tigers? I mean, why is it so bad for us to eat meat?
Chris: That’s paleo she’s talking about, right?
Brad: And then we bring in the paleo. But if you look at it, how often were they eating? They didn’t have a big meal of all meat every day. And that’s where they went through these more starvation modes, these fasting states. And that way our body wasn’t used to it, and so it would absorb what it needs. But they still weren’t just eating the meat. If you think of, “How are we going to survive,” we’re going to be looking for food in the earth more than anything. And then when you do have the mammoth or some other type of meat, that was more of a treat. So you look at the overall percentage, it still wasn’t that much.
Chris: And if you think about the wild availability of food now, like everywhere in our everyday life, that’s so contradictory to how we did it under the paleo approach that you just described, and that probably makes it — I know, I find it — challenging. It’s hard to go anywhere without being able to stop for something. And I feel like our culture is such where it’s like, okay, well it’s some, someone’s gone two hours out eating something, so we need to do something about that.
Carolyn: Right. But now the research too shows that like the starvation and fasting once in a while is the best way to go.
Brad: I don’t think we teach people to listen to their bodies, and that’s where some people, they get up and they’re hungry, they have a big breakfast. I have patients who don’t eat until 2 in the afternoon because they’re not hungry, and if they push it, they literally will get nauseous. And that’s why when we listen to our body, when we have good quality foods that have low glycemic load, low sugar effect, and we feel satisfied for four or five hours, that’s a good food source. But a lot of times we’re eating because we’re bored, we’re stressed. And when you think of it, the blue zones, these longevity centers, it’s a socialization as well. They sit down, they enjoy the food with other people. And that way the focus isn’t just on the food, it’s about being with family and friends.
Chris: Brad Biskup from UConn Health’s Lifestyle Medicine Program, how does it work with you and your patients? I mean, a lot of advice, a lot of potentially conflicting advice, it’s good to talk to an expert. How does the back and forth go with a patient who comes in?
Brad: Well, the first thing when we look at their cholesterol levels, finding out what their numbers are, then I go into their lifestyle, what’s their stress, what are they eating, their activities? And then when we start talking about their biggest risk factor, is it the LDL being high as the HDL being low, or triglycerides, and then we start talking about what they can possibly do. When we look at just fiber — think of it — you don’t change anything in your diet, but you add up to 30 grams of fiber, that can lower your LDL almost 30%
Brad: Just that one thing without really changing your diet.
Chris: 30 grams of fiber a day?
Brad: So if you have one cup of raspberries and a half cup of almonds, you’re already over 15. So that’s a good start.
Carolyn: Alright, that’s promising.
Brad: When we’re looking at having that discussion with our patients, it’s a discussion. That’s what we’re supposed to, respect their decisions, help them make educated decisions. And I think that’s one thing we’re not doing. We’re jumping right into these guidelines, which they came up with, and it doesn’t look at complete lifestyle change at all. There’s nothing in there about how much you’re exercising. If I think of the number-one thing that’s going to reduce your risk of cardiovascular disease, if you exercise, it can reduce your risk 40%. Going on a statin with primary prevention only reduces about 18 to 20%
Carolyn: And don’t statins have side effects?
Brad: Absolutely. And that’s why when you look at the risk of, it depends on which statin, the risk of diabetes, there’s some studies have shown as far as with dementia or mental status changes.
Carolyn: Exactly, and who needs any greater risk of dementia?
Brad: And that’s why when you look at, OK, if you’re increasing your risk of having any cognitive impairment with being on a statin and you can exercise, and that reduces your risk, 40% of developing Alzheimer’s, it’s like, OK, the only good thing about the exercise is all the side effects are positive. The other problem is we’re not training health care providers at all, as far as understanding the lifestyle changes that are needed for cholesterol. A majority say, “Oh, it won’t work,” because they don’t have that educational background.
And if I think of going through what I went through as far as PA school, one of the top ones, and I got zero with regards to nutrition and exercise and understanding lipids. But we always find out about the statins and the medications.
Chris: You said if I get my patients on the right omega-3, I can see improvements in their HDL. So how do they know what the right omega-3 is, or is that a, is that an individual?
Brad: Now, when we’re looking at the omega-3, the best ones are going to be very high in DHA, EPA, and those are usually the triple- or ultra-strength omega-3s. So those are going to be the ones that are going to help us the most. When you look at the prescription — sometimes we can get prescription omega-3 — those are for triglycerides greater than 500. That’s when we can use those, and that’s why when we’re looking at the dose of omega-3 for triglycerides, we have to go above 3,000 milligrams a day, up to about 6,000 to have an effect on triglycerides. But when we’re looking at that HDL, the omega-3, the better quality, we want to be 2,000 to 3,000 to have a good effect on that.
Carolyn: I have salmon like once a week. Is that enough to do? Do I have to still take fish oil?
Brad: Salmon in general, if you look at the normal serving, have between 1,500 and 1800 milligrams of omega-3. So unless you have it every day.
Carolyn: It’s not enough, OK.
Brad: It won’t be enough. But when I look at the lipids, I’m very specific. When I look at triglyceride levels, I’m going to look at their activity, their stress, their sleep, because when we have high stress hormones going, produces the sugars, which are quickly converted triglycerides. So if I’m looking at the exercise, I want to keep it low intensity. And keep it where it’s longer up to 40 to 45 minutes because then we can start utilizing triglycerides as an energy source.
Chris: Brad Biskup from the UConn Health Lifestyle Medicine Program and Brad, you’re a certified diplomat in lifestyle medicine, do I have that right?
Brad: Yes, that’s correct.
Carolyn: Very impressive.
Chris: Congratulations! Thank you for joining us. You always bring us good information, and at the end of our conversations I don’t know whether to be thankful or to be depressed.
Brad: I think the most important thing is you learn from every conversation, no matter what it is, and you try not to be guilty about it and just how you can make more educated decisions.
Chris: Well, I hope that’s true for you today for listening. That is our time for today. For Brad Biskup and Carolyn Pennington. I’m Chris DeFrancesco. Thank you for listening to the UConn Health Pulse. Be sure to subscribe, so you can catch us next time, and please share with a friend.