Heart Healthy

Category: Wellness
Published: July 2007

Learn how Dr. Paul Lemanski helps his patients at the Center for Preventative Medicine and Cardiovascular health find long term solutions for heart health, instead of quick fixes.

Success Magazine: Dr. Lemanski, what is unique about the Center for Preventive Medicine & Cardiovascular Health?

Paul E. Lemanski, MD, FACP: We are attempting to offer our patients comprehensive care that is very different than any other practice in the region. Most cardiovascular practices are using the standard methods of treating coronary heart disease with bypass surgery, stents and medication. We are attempting to also offer supervised diet, exercise and lifestyle changes to augment and improve upon the more standard approach.

SM: Why is such an approach needed? How does it improve upon the standard approach?

PL: The primary focus of the standard approach targets symptoms. The purpose of a Coronary Artery Bypass Graft or the placement of a stent is to re-establish normal blood flow in an artery narrowed by cholesterol deposit. Unfortunately, while these procedures may re-establish blood flow and resolve symptoms, they do not cure the disease process. The disease process is atherosclerosis, the relentless daily deposition of cholesterol into the artery wall. While the standard approach has addressed this shortcoming with drugs, these drugs typically only lower the LDL or bad cholesterol with much less affect on the good cholesterol called HDL or Triglycerides. Our approach is to use diet, exercise and lifestyle change to further lower LDL, but also improve upon HDL and Triglycerides. Our goal is to normalize all measurable cholesterol parameters as well as blood sugar, blood pressure and body weight.

SM: So instead of the cut and drug program which most doctors offer your approach is to try to develop a curative program that will be long lasting with your patients?

PL: I'm not sure I would characterize the standard approach as cut and drug. Part of the standard approach is also to open up and stent an artery during a heart attack and when used in this way it may be lifesaving. I would also add that certain drugs have been shown in controlled clinical trials to reduce the risk of subsequent heart attack and stroke. To suggest that such procedures or drugs are not needed or not helpful would be inaccurate. What we can say is the standard approach is simply not enough. Moreover, to subject oneself to drugs in high doses because one doesn't want to change lifestyle and diet seems shortsighted. Indeed, for some folks even high dose drugs are not enough to normalize all cholesterol parameters. We use sophisticated blood tests and then specific recommendations of select supplements, select vitamins, diet, exercise, weight loss (when appropriate) and traditional drugs to achieve optimal results.

SM: My father had open heart surgery with a double bypass at age 51, and one of his bypass grafts closed down within one year. There was no program established for him to change lifestyle, alter his diet or exercise, nothing beyond stopping smoking and limiting alcohol intake. Would your program have been very different and helped to lengthen his time?

PL: Perhaps, but prognosticating on individual cases is not generally advisable. One can say that bypass surgery and stenting for most patients, apart from use in the setting of an acute heart attack, probably do not significantly affect longevity. Such procedures are on done on high grade obstructions, the 70 to 95% narrowing, rather than on smaller deposits. We know, however, that it is the smaller deposits that cause the majority of heart attacks. These deposits can be stabilized and heart attacks reduced with the type of improvements in blood cholesterol, blood pressure and blood sugar that our program works to achieve. We approach a chronic disease process with chronic daily intervention which addresses the underlying process of the disease.

SM: What are the distinguishing characteristics of your program?

PL: Well, first we try to define the problem as clearly as we can. This would include a full history and physical exam including dietary and exercise history, and detailed family history. We obtain blood tests which tell us more than the standard cholesterol tests about your HDL and LDL particles and we use a special blood test to measure the degree of inflammation produced by cholesterol deposits in the walls of arteries. Folks with more inflammation tend to have a greater risk of a cholesterol deposit causing a heart attack. We also may measure blood flow in your legs, and depending on the initial assessment would consider a stress echocardiogram, a nuclear stress test, or a coronary artery calcium score or CAC. The CAC is particularly exciting, because it shows evidence of the actual cholesterol deposits in the walls of arteries. When cholesterol deposits narrow the blood flow by 50% or more they typically become calcified. While not currently covered by health insurance, the test is offered to our patients for $200 which is an exceptional value given the information the test provides.

Once we define the problem, we then offer solutions with an emphasis on diet, lifestyle and exercise to augment usual care. Sometimes, we will recommend the addition of the vitamin niacin to the regiment, sometimes fish oil supplements. We help patients to lose weight and then transition folks to a high omega-3 Mediterranean diet for maintenance. We support these lifestyle changes in the community with our Healthy Restaurants Program. Brindisi's in Saratoga and Bellini's in Clifton Park are two of our heart healthy restaurants.

SM: What exercise is required to stay healthy?

PL: Well, we like walking to start. It requires very little equipment and if your feet, knees and hips are not giving you a problem, a graded walking program is what we would recommend. Ultimately, we would like our folks walking about 1 -1.5 hours per day and covering 4-5 miles. We also recommend graded resistance training and flexibility training. Once folks have reached a level of fitness with walking, we would graduate them to more challenging exercise with an emphasis on cross training to avoid injury. SM: What about your Mediterranean diet recommendations?

PL: The diet we recommend is based on the Lyon Diet Heart Study. This was a study of a Mediterranean diet high in omega-3 compared to a control, which was a prudent western diet. The risk of fatal and nonfatal heart attack was reduced by 70% in those on the diet as compared to control. This is the maintenance diet in our programs and also what we use as the standard in our Heart Healthy Restaurant Program. We also use this as the model for our Mediterranean Cooking classes. Folks may learn more about our programs on our web site www.CenterForPreventiveMedicine.com.

SM: What makes the western world's way of life a problem for cardiovascular health?

PL: I would say too much of the wrong things and not enough of the right things. Of the wrong things we get too many calories, too much meat and saturated fat, too many processed foods, too much salt, and too much sugar and white flour. We don't get enough vegetables, legumes, fruits and unrefined foods. The human machine was constructed to run on unrefined foods and works best on them. Finally, we don't get enough exercise. We need 1-1.5 hours every day.

SM: What foods do you recommend in your Mediterranean diet?

PL: The Mediterranean diet does not exclude any food, as long as it is unrefined, but does adjust the frequency with which it is eaten. The Mediterranean diet focuses on an increased frequency of eating the right things and a decreased frequency of eating the wrong things. The diet historically consists of low consumption of red meat, as there are fewer cattle in Mediterranean countries than in our wide open ranges. They eat smaller animals, lamb, chickens, that are primarily range fed, and seafood, fresh from the sea. They have an alternate supply of fat through olive oil, rather than saturated, Trans and polyunsaturated fats. The Mediterranean diet has an increased vegetable intake. Less meat and more vegetables is critical to good health.

SM: What about fruit?

PL: Fruit is essential in out diet, but to a lesser extent than vegetables. Vegetables have been the staple of many societies for thousands of years and our bodies have adapted to them. Vegetables are more accessible than fruit especially in the northern hemispheres. Fruit should be eaten at the end of a meal with a preference for lower glycemic index fruits over higher glycemic index fruits.

SM: What other characteristics define the Mediterranean diet?

PL: The high omega-3 Mediterranean diet based on a Cretan diet is the most heart healthy of all Mediterranean diets. The high amount of omega-3 provides particular benefit to the cardiovascular system. A high omega-3 diet may be plant based with flax seeds, soy beans, and purslane for salad fixings. Fish provide another source of omega-3 fats.

If the approach outlined above has wetted your interest in diet, nutrition and preventing disease, you will be pleased to learn of a new column in Success Magazine, Preventative Medicine. Dr. Lemanski will answer your questions on nutrition, diet, lifestyle and prevention in the coming months.