0:02 If you ask 10 people what the best
0:04 hearthealthy diet is, you're going to
0:06 get 10 different answers. Somebody would
0:08 say, "You got to cut out carbohydrates
0:11 or you got to do keto or carnivore." And
0:12 another person may say, "Well, you have
0:15 to avoid meat and go vegan." And then
0:18 there's Mediterranean and Dash and
0:21 Paleo. But after more than 10 years of
0:23 practicing medicine and helping my
0:25 patients use food as medicine, what I
0:28 found was the prescribing a diet often
0:30 times is not that helpful because many
0:33 people, not everyone, but many cannot
0:35 stick to a very restrictive plan. And
0:37 none of those diets matter if you can't
0:39 stay on them. So the way I see it,
0:41 following a nutrition plan that's only
0:43 70% good, but one that we can do for the
0:46 rest of our lives is much better than
0:48 something that's 100%, but we can only
0:50 stick to it for 6 months. So the goal
0:52 isn't to chase the next perfect diet,
0:55 but to pick the most high yield foods
0:57 that keep showing up again and again
0:59 across all studies and meta analyses
1:00 that have been done on heart disease.
1:02 And make sure you incorporate them into
1:04 your routine, whatever that routine may
1:06 be. And as we go through these, I also
1:08 want to go over foods that are sold as
1:10 heart healthy, but you need to be
1:11 careful with. And at the end of the
1:13 video, I want to go over the best
1:15 exercise and a good supplement that has
1:17 really good evidence behind them to help
1:20 you reverse plaques even faster. Now,
1:22 before we go over the best foods, you
1:24 have to understand how we get plaques in
1:25 the first place. Because if you
1:27 understand that process, you'll be able
1:30 to tailor with more precision which high
1:32 yield foods you need to lean into.
1:33 because everyone's individual
1:36 circumstances and risk are different and
1:38 what works for one person may not work
1:40 for you. So arterial plaque buildup is
1:43 not a simple process. It's not just high
1:46 cholesterol and it's not high sugars or
1:48 high blood pressure or inflammation.
1:50 plaque forms with a perfect storm of
1:53 endothelial damage which is just injury
1:55 to the thin layer of cells that lines
1:57 the inner surface of blood vessels and
2:00 then LDL particles that contain apo B
2:01 slip through the vessel wall and then
2:04 inflammation oxidizes those particles
2:06 and that's what triggers your immune
2:08 system to step in and try to repair the
2:11 damage but instead it just causes the
2:13 plaque to grow even bigger and the more
2:15 oxidative stress in the environment the
2:17 more the cycle repeats itself. So the
2:18 high yield foods that you need to
2:20 incorporate into your regimen need to
2:24 target all those mechanisms. Lower Apo B
2:26 and reduce inflammation and improve your
2:28 nitric oxide which then lowers your
2:29 blood pressure and protects the
2:32 endothelium. And finally you need to
2:34 calm down that overreactive immune
2:36 response. So if you look through all the
2:38 major studies and meta analyses of diets
2:40 that help with atheroscerosis one
2:42 pattern that emerges is the foods that
2:44 are rich in lycopine. And lycopine is a
2:47 carotenoid that's mainly found in red
2:49 and pink fruits and vegetables. So you
2:52 get it in tomatoes and guava. Watermelon
2:54 has a lot of lycopine, pink grapefruit,
2:57 papayas. And lycopine helps because it's
2:59 an incredibly powerful antioxidant. And
3:01 one of the main drivers of plaque
3:03 formation is oxidative stress that leads
3:06 to cell damage. So lycopene can reverse
3:08 that by targeting harmful reactive
3:10 oxygen species. And we have studies that
3:12 show that high carotenoid levels may
3:15 slow early stages of atheroscerosis
3:16 progression. And there was an
3:18 observational study out of Finland that
3:20 suggested that lycopene or processed
3:23 tomato intake may reduce kurateed
3:25 atheroscerosis. Now another recurring
3:27 theme that I see in all of these studies
3:30 is phytosteriles which is just a natural
3:32 plant compound that's found in nuts and
3:35 seeds especially flax seed and sesame
3:36 seeds. And you can also find
3:39 phytosteriles in legumes and whole
3:41 grains and in many fruits and vegetables
3:43 like carrots and broccololis and uh you
3:46 can find them avocados and in many leafy
3:48 green vegetables. So phytosteriles look
3:50 almost identical to cholesterol and when
3:52 you eat them they compete with
3:54 cholesterol for absorption in your
3:56 intestines which means less cholesterol
3:58 can make it through and get absorbed.
4:01 But that's not where the magic happens.
4:02 Because when it comes to cholesterol in
4:05 our blood, most of it does not come from
4:06 cholesterol that we eat. It's the
4:08 cholesterol that's produced internally
4:10 by our liver. So how this whole process
4:12 works is the liver senses a drop in
4:14 absorb cholesterol. And because your
4:16 liver tries to maintain its own
4:19 cholesterol balance and homeostasis, it
4:21 starts pulling more LDL particles out of
4:23 the bloodstream. So over time, you
4:27 basically get less LDLs that carry apo B
4:29 moving through your arteries. And that's
4:32 important because LDL and more precisely
4:34 Apo B has been shown to cause heart
4:36 disease. If you look at meta analyses
4:38 and if you look at the mandelian
4:40 randomization studies, it is one of the
4:42 main drivers of aththeroscerosis. It's
4:44 not the only factor, but it's key in
4:46 developing plaques. And we have several
4:48 meta analyses that show that eating more
4:51 phytosteriles can significantly reduce
4:53 your LDL with an average reduction of
4:56 about 14 mg per deciliter. Okay, another
4:58 food that is essential for plaque
5:00 reversal are flavonoids, which are just
5:02 natural compounds that are found in
5:05 fruits like berries and apples and
5:07 oranges. You can also find them in
5:09 onions and leafy greens. And there's a
5:12 lot of flavonoids in dark chocolate. So,
5:14 this is how they work. When plaque
5:15 builds up in your blood vessels, it
5:18 starts with LDL particles getting
5:20 trapped and damaged in the inner lining
5:22 of your blood vessels. And this LDL
5:24 particle starts getting oxidized which
5:26 makes the whole area very sticky. So
5:29 white blood cells called macrofasages
5:31 are drawn to that area and they cause
5:33 inflammation. And this whole process is
5:35 what makes the plaque grow. So this is
5:37 where flavonoids come in. They lower
5:39 that adhesion molecule expression.
5:41 Basically they make arterial walls less
5:44 sticky so fewer cells can attach and
5:47 that in turn lowers inflammation and it
5:49 helps macrofasages work in a calmer way.
5:52 so they don't turn LDL into its damaged
5:54 and oxidized form. And one subset of
5:56 flavonoids that is especially important
5:59 is kakans which you can find in green
6:01 and black teas. And there was a meta
6:03 analysis that looked at nine prospective
6:05 studies that showed that drinking three
6:07 or more cups of green or black tea is
6:10 associated with a 21% reduced risk of
6:12 stroke compared to the consumption of
6:14 less than one cup per day. Now another
6:17 important and very powerful nutrient is
6:19 extra virgin olive oil. Now this pops up
6:22 across many studies and high intake is
6:24 associated with a significant reduction
6:26 in major cardiovascular events like
6:29 heart attacks. Olive oil is very high in
6:32 polyphenols and monossaturated fats
6:33 which have antioxidant and
6:35 anti-inflammatory properties. So they
6:38 help smooth out the damaged endthelium
6:41 or arterial inner lining. And on top of
6:43 that olive oil may also help with
6:45 insulin sensitivity and reduce
6:46 inflammation. So mechanistically you
6:49 target multiple steps that lead to
6:50 atheroscerosis. Now another food that
6:53 will help is fatty fish like salmon and
6:56 mackerel or sardines. These fish are
6:59 rich in omega-3 fatty acids, especially
7:01 EPA and DHA that are incredibly
7:03 important in keeping your heart and
7:05 blood vessels healthy. There's clinical
7:06 studies that show that people eating
7:09 fatty fish one to three times per week
7:11 had a lower risk of heart disease and
7:13 strokes. And then we have the multithnic
7:15 study of aththeroscerosis which is one
7:17 of the largest and longerunning studies
7:19 on heart disease that found that higher
7:22 DHA levels was associated with a 12%
7:24 lower risk of corateed plaque
7:26 progression. So this is the plaque that
7:28 can lead to strokes. These omega-3 fatty
7:31 acids calm down the immune response that
7:34 aggravates plaques and they can also
7:36 increase your nitric oxide production
7:37 which then stabilizes the plaque and
7:40 makes it less likely to rupture and
7:42 cause clots and problems downstream.
7:44 Now, when it comes to atheroscerosis,
7:46 it's not enough to eat the right foods,
7:48 but it's also just as important to try
7:50 to limit certain foods, especially foods
7:52 that are very inflammatory. So, no
7:54 surprise here, but we especially want to
7:56 be careful with processed carbohydrates
7:59 like pastries and cereals and any foods
8:02 that are full of sugar or fructose. So,
8:04 some of the most common offenders that I
8:06 see, so we're talking about foods that
8:08 are promoted as hardhealthy, but they're
8:11 actually harming you, flavored yogurts.
8:13 Many of them are packed with added
8:15 sugar. So, it's much better to buy plain
8:18 full fat yogurts and just add your own
8:20 sweetener of choice for taste. Now, at
8:22 this point, most people know that most
8:25 breakfast cereals are basically dessert
8:27 and just processed sugars, but there's
8:29 alternatives that masquerade themselves
8:31 as healthy, but are not really that much
8:32 better. So, I'm talking about many
8:34 breakfast bars or granola bars. Make
8:36 sure you look at the ingredient labels,
8:39 as many of those are still packed with
8:40 sugar, but just with healthier
8:43 packaging. And another sneaky food that
8:45 I always bring up is, well, it's not a
8:47 food, but it's a drink and it's juices.
8:49 If you drink apple juice or orange
8:51 juice, any type of juice, you're
8:53 probably getting a lot of added sugars.
8:55 But even if the label on the bottle says
8:57 there's no added sugars or this product
9:00 only has natural sugars, well, these
9:02 sugars may be natural, but they're still
9:04 absorbed in a highly concentrated form.
9:06 And another problem is these juices
9:08 don't come with a protective fiber that
9:10 we would normally get if we're getting
9:11 it from a fresh fruit. So, as I
9:13 mentioned before, fresh fruits are
9:16 wonderful and they're heart healthy, but
9:18 it's very easy to overconume sugars and
9:20 fructose in a fruit if you're getting it
9:22 in liquid form. Now, as a bonus, here's
9:25 some non-food related things that will
9:26 also help you expedite reversing your
9:29 atheroscerosis. First, no surprise here,
9:31 but exercise is extremely important for
9:33 your heart health. But there's one type
9:35 of exercise where we actually have
9:37 evidence in showing that it can reverse
9:38 arterial plaques. So there was a
9:40 randomized control study published in
9:42 the European Journal of Preventive
9:44 Cardiology that showed that just 6
9:46 months of supervised highintensity
9:48 interval training or HIT showed a
9:50 significant reduction in plaque volume.
9:52 And what was especially amazing, the
9:54 plaque volume regression after 6 months
9:56 of this exercise was slightly larger
9:58 than what they observe with statin
10:00 intervention. Now because
10:02 aththeroscerosis is a disease that
10:04 develops over many years and decades, we
10:06 don't know how that translates to actual
10:08 clinical outcomes. But the initial
10:10 results from the study are pretty
10:12 remarkable. Now beyond exercise, there
10:13 is one supplement that I want to
10:15 highlight that actually has decent
10:17 evidence in slowing the progression of
10:19 coronary atheroscerosis and that is aged
10:22 garlic extract. So there was a double
10:23 blind randomized control trial that
10:25 showed that aged garlic extract can
10:27 stabilize vulnerable plaques. And there
10:29 was another randomized control trial
10:30 that showed that the group that was
10:32 randomized to take an age garlic extract
10:35 for one year had a lower progression of
10:37 coronary artery calcification and
10:39 improve blood pressure. Now, one more
10:41 bonus tactic that I recommend to my
10:43 patients that may help improve
10:45 cardiovascular health and that is sauna
10:46 therapy. Now, this is not something
10:49 where we have direct evidence that shows
10:51 plaque stabilization or regression with
10:53 sauna, but there's plenty of indirect
10:55 associations. So there's studies that
10:58 show a link between sauna bathing and
11:00 improvement in endothelial function. And
11:02 there's meta analyses like this one that
11:04 show that sauna can help with blood
11:06 pressure. Now most of the evidence is
11:08 based on observational and mechanistic
11:10 data, but there is enough indirect data
11:12 that supports its health benefits. Not
11:14 just when it comes to heart disease, but
11:17 there's also linked to significantly
11:19 lower risk of all cause mortality. So,
11:22 based on the current imperfect evidence,
11:23 I still think it's a worthwhile
11:25 intervention to try if you have access
11:27 to saunas. All right, I hope this was helpful.
