Tag Archive for: heart health

HIIT Fun?

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I have a confession: I married a woman who doesn’t like to exercise. I know—it’s not what you’d expect from guy committed to a career in making people fitter and healthier, but she was and is irresistible. Since we met, I’ve been on the lookout for fun ways to exercise, especially since HIIT (high-intensity interval training) has become popular. One could argue that HIIT shouldn’t be fun, but maybe it could be more interesting?

We’ve worked out that distraction helps, so Paula usually is reading or watching TV while biking or doing other exercises. How can we work HIIT into that formula?

  • The simplest way is just to see whether she can increase the RPMs for 30 seconds by pedaling as fast as possible; maybe she only makes it 15 seconds.
  • Then pedal at an easy pace for three and a half minutes; repeat four to six times.
  • The goal is to last for 30 seconds during all the intervals.

Another approach would be to keep the same pace, but bump up the resistance for 30 seconds, followed by the same approach of easy cycling at reduced resistance.

The same logic could be used for walking, elliptical trainers, and stair climbers. What about other forms of exercise or exercise equipment? What do you do for exercise that’s fun?

One important caution: you should always check with your physician or cardiologist before you do HIIT just to be sure your heart is healthy enough to try it. That doesn’t mean you have to make an appointment; if you see your doctor regularly, you can probably call the office or send a message through the online portal and get an answer. What are you prepared to do today?

        Dr. Chet

Eggs: A Practical Solution

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Based on Tuesday’s Memo, do we have a “hard-boiled” answer to the question of whether the dietary cholesterol in egg yolks positively impacts LDL-cholesterol levels? Or total cholesterol levels? We can’t “eggsactly” get a complete answer from this study, and here’s why. (Okay, no more puns or “yolking” around.)

Study Issues

  • The LDL-cholesterol levels in the EGG phase (high cholesterol, low sat fat, two eggs per day) were 104 mg/dl. That was lower than the 108 mg/dl in the EGG-Free phase (low cholesterol, high sat fat, no eggs) and lower than the 109 mg/dl in the control group that ate the typical diet, but with only one egg per week. The standard deviation with the groups was over 20 mg/dl, which means that 66.7% of the subjects in any group could be 20 mg higher or 20 mg lower; that 104 result could actually be 84–124.
  • While an argument could be made that the standard deviations were similar, there’s also the potential measurement error. That is currently 12%, so as all measures were about 100 mg/dl, each individual measurement could be within a range of 88–112 mg/dl.

These two issues alone raise doubt whether the EGG diet clearly reduced LDL-cholesterol.

There are also a couple of dietary factors:

  • When placed on the reduced fat diet while eating two eggs per day, the fiber intake increased by eight grams per day, while the grams of protein decreased by 20–30 grams per day. Fiber can lower cholesterol.
  • Less protein would be available to be made into sugar and fat.

One comment pointed to the statement “funded by the Egg Council” to suggest that’s why the data skewed the way it did, but the last thing we want to do is discourage that kind of research. If private companies and associations do not fund research, it won’t get done; there’s no reason to believe that the NIH will fund basic science research going forward.

A Practical Approach

As I’ve maintained recently, whether talking about seed oils, maltodextrin, or eggs in this case, it’s all about the amount consumed. What the study did show is that excess saturated fat may be, and probably always has been, the cause of abnormal cholesterol levels in people without the genetic tendency toward high cholesterol. The lesson for us is to try to get saturated fat intake to less than 10% of your total caloric intake. One more thing—increase the intake of vegetables to decrease the percentage of saturated fat as well.

If you follow these two suggestions, there should be no problem with eating eggs every day if you want. Just be careful of fat bombs such as sausage and bacon that can add fat you don’t need.

What are you prepared to do today?

        Dr. Chet

Reference: AJCN. 2025. 122 :83–91. DOI: 10.1016/j.ajcnut.2025.05.001

To Egg or Not to Egg?

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That’s today’s question. This Memo was driven by another provocative headline from a university press release: “Groundbreaking study finds eggs don’t harm heart health” published in SciTech Daily. I think most informed healthcare professionals have known for a while that there’s little to no relationship between cardiovascular disease and dietary cholesterol from eggs and other animal sources—at least for most people.

Researchers in Australia decided to investigate how much dietary cholesterol from eggs, saturated fat, and a low-fat diet would impact a variety of blood lipid levels. While they measured at least 50 variables related to cardiovascular disease, they focused on LDL cholesterol. They recruited 61 healthy people, 48 of whom completed the 15-week study. In a random order, each subject spent five weeks on one of the following diets (note the amount of cholesterol and saturated fat in each diet):

  • The control diet had high cholesterol and high saturated fat; it mimicked the typical Australian diet, which is similar to the typical American diet. They were limited to one egg per week.
  • The EGG diet had high cholesterol but low saturated fat, plus two eggs per day.
  • The EGG-Free diet had low cholesterol and high saturated fat with no eggs.

What did they find when they compared how people did on each diet? Those on the EGG diet averaged 6 mg/dl lower LDL-cholesterol than either the EGG-free diet or the control diet. The EGG-free diet that was high in saturated fat resulted in the highest LDL cholesterol. Even with no additional eggs, the control diet still had higher LDL than the EGG diet. 

Does this give the egg a free pass when it comes to blood lipids? Can the lead author really state, “We’ve delivered hard-boiled evidence in defense of the humble egg”? I’ll let you know on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: AJCN. 2025. 122 :83–91. DOI: 10.1016/j.ajcnut.2025.05.001

From Polypharmacy to the Natural Way

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When last we left our subject, he had a stent inserted while having a heart attack and was sent to cardiac rehab. He was on six medications (the very definition of polypharmacy) for congestive heart failure, A-fib, and hypertension. He decided that he wanted to get off all the medications he could because they contributed to him feeling weak, with no energy and a foggy brain.

The wellness center he went to had a strong nutrition-education program so while he was exercising, he was learning how to eat. The diet? As much as her wanted of raw, baked, and steamed vegetables; limited amounts of grains, beans, seeds, nuts; no meat. No SOS—that stands for sugar, oil, or salt.

The results? In five months, he lost ten pounds, but that wasn’t a goal. He reduced medications from six to two and will stop another when he’s a year out from his stent. He has normal sinus rhythm, normal blood pressure, and no signs of congestive heart failure. He states that his diet compliance isn’t perfect, but since following the nutrition approach, he has no brain fog, lifts weights, and runs on a treadmill. He wakes up every day with energy.

If you want to really get off medication for cholesterol, BP, and other associated conditions, that’s the natural way. It must be done under supervision and with your physician’s guidance. This man was fortunate that he could afford to participate in the in-patient program where he continued to learn, but many people have done it without an in-patient experience. This case report says it can be done and outlines the way. The effort is up to you.

The Kids’ Top Health Issues webinar on January 26 still has openings. I’ll cover the question I get asked most often in detail: constipation. Reserve your spot today.

What are you prepared to do today?

        Dr. Chet

Reference: BMJ Case Rep 2018;11:e227059.2. Arch

Here’s a New Term: Polypharmacy

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Polypharmacy is defined as the use of multiple or unnecessary medications.  One of the questions I often get goes something like “How do I get off all these medications my doctor has me on?” Another related question is “I don’t want to take medications—I want to do things the natural way.” These are valid goals, but it may not be easy.

Because of the nature of some conditions, there may be no other way. But when it comes to heart disease, type 2 diabetes, and hypertension, there may be a lot you can do, and thereby hangs a tale.

Several years ago, an 82-year-old man had been living with several heart issues: coronary artery disease, elevated cholesterol levels, high blood pressure, and persistent atrial fibrillation. With multiple medications to control symptoms and treat the conditions, he was a poster child for polypharmacy. He was admitted to a hospital while having a heart attack. The surgeon opened the artery, more medications were added, and he was released. On his follow-up, he was not feeling well, weak, and had periods of brain fog. He was referred for cardiac rehabilitation.

At some point, he decided that he wanted to reduce his medications. Together with a wellness center and under the supervision of his physicians, he changed his diet; on Saturday, I’ll tell you what happened over the next six months.

The Kids Top Health Issues webinar on January 26 still has openings. Every day, more scary headlines cast doubt on science and health practices. For example, will fluoride really impact a child’s IQ? Those questions and more will be covered in this webinar. Reserve your spot today.

What are you prepared to do today?

        Dr. Chet

Reference: BMJ Case Rep 2018;11:e227059.2. Arch

A Little Good News

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On January 2, 2023, the Buffalo Bills were playing the Cincinnati Bengals on Monday night football. A Bengal caught a pass, was tackled and fell into one of the Bills, Damar Hamlin, hitting him in the chest as he fell. Both players got up, and then Hamlin fell down again. What we didn’t know for a while was that he had a cardiac arrest and was clinically dead. Through the efforts of the training staff, they got his heart started and they headed to the hospital. He recovered, but the story didn’t stop there.

Hamlin began a mission to work with the American Heart Association to educate the nation about how to do CPR. If you don’t remember, check out this Memo. There’s no question that because of his misfortune, hundreds of thousands of people know how to save someone’s life with CPR.

Hamlin has come full circle as well. He was cleared to play football and began the long trip back. The good news is that he’s not only back but he’s a starter for the Bills this season; he got his first interception ever in a game a week or so ago. Just a little good news to begin the month.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.heart.org/en/damar-hamlins-3-for-heart-cpr-challenge

Yes, Intensity Matters

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Can you get away with less time exercising and still protect your cardiovascular system? We know from Tuesday’s Memo that more time spent on physical activity will provide more protection. Can we save some time? Or perhaps better stated, can we do something in short bursts of time that can increase the moderate to intense exercise we get?

Before I answer that, remember that physical activity means everything you do that requires movement: walking to the kitchen, gardening, cooking, and the activity involved in your job. Exercise is also a part of your overall physical activity. In the study, all activity was registered by the accelerometer the subjects wore.

Intensity Matters to Reduce CVD Risk

With that in mind, the answer is yes: exercise intensity matters when it comes to protecting yourself from cardiovascular disease (CVD). I must admit that the charts and graphs published in the study were challenging to understand. They used a percentage of calories used per day as the way to measure outcomes. For the exercise intensity analysis, they considered the percentage of calories at moderate to high intensity. They found that as the percentage of activity at moderate to high intensity increased, the rate of CVD events decreased.

Here’s an example. Let’s take a 180-pound guy who uses a low amount of energy in physical activity such as five calories per kg body weight. The total calories he uses daily would be about 400 calories, including any exercise he did. But let’s say the percentage of moderate to severe intensity exercise rises from 10% of total exercise to 20% of that total. His risk of a CVD event would be reduced from 2% lower to 20% lower. He hasn’t invested any more time, yet he gets a jump in benefit just from increased intensity.

What Does That Mean for You?

Does this mean that everyone should be doing high-intensity interval training? Not in the classic sense; what’s high intensity for you may be impossible for your elderly neighbor and a breeze for your kid’s soccer coach. You don’t have to do special workouts such as high-intensity interval training where you’re going to bust a gut for 60 seconds and then take it easy for five minutes. That is intense, but it takes less time overall and you could do that if you want; there’s more info at drchet.com if you decide to try it.

In physical activity, everything counts from housework to walking the dog to breaking into a run to catch a bus. Those would show up as mild or moderate intensity, or high-intensity exercise for the running. It doesn’t mean that all the exercise you do has to be high intensity, but investing time in higher intensity exercise may provide you with additional benefits. Working a little harder is going to reduce your risk of cardiovascular disease and, while not assessed in this study, your risk of type 2 diabetes, hypertension, and cancer would be reduced as well.

Of course, the question is what’s high intensity for you. The chart above is geared toward weightlifting, but it will give you some ways to think about how hard you’re exercising, no matter what you’re doing. If you’re running for the bus, could you run one more block? If you’re cleaning house, do you have enough juice left to go for a bike ride?

The Bottom Line

You must be fit enough and ambulatory enough to actually do moderate to high-intensity exercise. But you know something? I know of one physical therapist who encourages patients to do jumping jacks while sitting in a wheelchair. Of course they can’t do the actual jumping part of it but for 60 seconds, their arms are going up and down, up and down, up and down at a very high rate, and maybe their legs are moving, too—and that’s high intensity for them. For others of you, it may be doing a two-minute walk up a very steep hill. The intensity of the exercise stresses the heart in ways that a nice easy walk does not. And for that, you get additional benefits, no matter where you’re starting.

So check with your doctor to find out your limitations as it relates to exercise intensity, and then get after it. Not to lose a whole bunch of weight, not to win the next 5K, not every day—but often enough to make your heart stronger and fitter.

What are you prepared to do today?

        Dr. Chet

P.S. Happy Canada Day to our neighbors to the north! We’re taking next week off to enjoy the July 4th holiday and hope you do as well (even if you’re not in the U.S.) We’ll be back with new Memos the week of the 10th. Meanwhile, it’s a great time to try increasing your exercise intensity.

Reference: Eur Heart J (2022) https://doi.org/10.1093/eurheartj/ehac613

How Hard Should You Exercise?

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Exercise is my most favorite thing to talk about—not surprising for an exercise physiologist. There’s no question that diet is important to our health, but if I had to focus on just one habit that people should adopt, it would definitely be exercise first before anything else. I believe we should all eat more vegetables and fruits, take supplements for gaps in our diet, and try to reach a normal body weight. But aside from quitting smoking, the most important thing you can do for your health is to be physically active.

Let’s look at the study. The subjects in the study were a subgroup of people from the United Kingdom Biobank study. The data were collected from 88,412 middle-aged adults, with 58% women, who were specifically chosen because they had not been diagnosed with cardiovascular disease before the study.

The researchers broke the data into three equal groups by activity level. The average age of the subjects in the study was 62, and the average BMI was 27. They tracked the subjects for 6.8 years, and in that amount of time there were 4,068 cardiovascular disease (CVD) events: ischemic heart disease (reduced blood flow to the heart) or cerebrovascular disease (reduced blood flow to the brain).

Their findings were interesting and confirmational. Using no or differing covariates in the statistical analysis, as the amount of physical activity increased, the incidence of CVD decreased. That would confirm what we would expect: regardless of intensity, the risk of CVD decreased and it continued to decrease for every level tested.

How does exercise intensity impact all this? We’ll take a look at intensity on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Eur Heart J (2022) https://doi.org/10.1093/eurheartj/ehac613

The Best Heart-Healthy Diet

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In assessing popular diets to find out which one follows the AHA heart-healthy dietary guidelines the best, the panel did a credible job. Instead of just using their expertise, which is substantial, they developed an objective way of assessing each popular diet. They did have one diet that received a point for each of the nine categories thus achieving 100%. That was the Dietary Approach to Stop Hypertension more commonly known as the DASH diet.

The researchers then assessed the dietary patterns and organized them into four tiers based on compliance with the AHA guidelines. I’ll break it down into the tiers for you.

Tier 1

This tier includes the DASH diet, the Mediterranean diet, the pescatarian or fish as protein, and the ovo-lacto vegetarian diets. The primary reason that the DASH diet ranked so high was its ability to get protein from every source: plant proteins such as nuts and legumes, fish and seafood, low-fat or fat-free dairy, and the ability to use lean cuts of all meats. The other diets in Tier 1 either did not recommend proteins from all sources or did not emphasize reducing the amount of salt intake, a key element of the DASH diet.

Tier 2

Tier 2 included the vegan diet and other low-fat diets. Their strength, of course, is the emphasis on vegetables and fruits as well as whole grains, but they all seek to use plant-based protein. Some of the low-fat diets can be quite extreme, such as the Esselstyn Program which restricts fat to less than 10% per day and restricts protein as well.

Tier 3

This included the very low fat diets as well as the low-carbohydrate diets. The reason these two are put together is the restriction on quality protein sources as well as whether people adhere to the diet at every meal.

Tier 4

The paleo diet and very low carbohydrate diets such as the ketogenic diet received the worst scores; that means they fall into the category of not being heart healthy at all.

Other Considerations

The panel also considered three primary issues. The first was how easy it would be to facilitate patients to adapt to the particular diet. To me, the strength of the DASH diet and to some degree the Mediterranean diet is the variety of proteins that can be used. When you get into the very low fat and the very low carbohydrate diet, the restrictions can become overwhelming for most people.

They also considered the challenges for the consumers. In my experience, there are always going to be questions about what could be included in any dietary approach, whether it’s the Mediterranean diet or the ketogenic diet. In order for people to adapt the diet, they need instruction and they need to be able to ask questions; those would be significant challenges when recommending the diets that restrict foods allowed, which could either be vegan, the very low fat, or the ketogenic diet.

The final consideration is the opportunities presented to provide patients with good information about the diet. The problem as I see it is that physicians, physician assistants, and nurse practitioners are not familiar enough with nutrition to be able to do that effectively in a medical practice, especially considering the time constraints for most healthcare practitioners. The obvious choice is to refer it to a dietetics department, but that type of consultation is not very often available in most medical practices and especially under most health insurance programs. I think the challenges are going to take years to overcome.

My Thoughts

I thought the researchers did a credible job in coming up with their recommendations. They analyzed popular diets objectively and assessed them based on the AHA Dietary Guidance.

What is lost is exactly how this is going to help people. Since 1974, more fruits and vegetables and a limit on fat intake were recommended as the foundation of every diet. No matter how many diets have come and gone, no matter how many are yet to be developed, we have not achieved the simplest and yet most obvious objectives. Food manufacturers certainly have had a role to play in this with low-fat and ultra-processed convenience food, but the choice is always with us.

There are three more things that I think must be considered. First would be the individual’s genetic tendencies. We simply don’t know enough about interaction between genes and nutrition and how that impacts input. Second, protein needs change over a lifetime. At some point, proteomics must be considered in dietary recommendations; it isn’t all about your heart.

Finally, they specifically did not consider the potential for weight loss or weight maintenance in every program. Regardless of diet, it was, it is, and it will always be about the calories. If someone can get to a normal body weight and maintain it, I think there might be room for just about any type of diet, providing it provides enough vegetables and fruits.

The Bottom Line

As the lead author suggested in an interview, there were four recommendations across all popular diets: eat whole foods, eat more non-starchy vegetables, eat less added sugar, and eat less refined grains. If we could start with that, I think our hearts would love us for it.

What are you prepared to do today?

        Dr. Chet

Reference: https://www.ahajournals.org/doi/10.1161/CIR.0000000000001146

How Popular Diets Impact Your Heart

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When the American Heart Association (AHA) speaks, news organizations tend to report what they say and people tend to listen. It’s doubly true when they rank all the popular diets according to how they relate to heart health. Because we seem to live in a society based on the “see food, eat food” diet, that can be meaningful. Here’s what a group of experts did to evaluate popular dietary approaches to diet and rank them according to AHA guidelines for a heart-healthy diet.

The AHA has ten dietary guidelines for eating a heart-healthy diet, such as “Eat plenty of vegetables and fruits” and “Choose healthy sources of proteins.” For the complete list, click on this link to the article; the scientific statement is open access on the AHA website.

Then the panel selected the most popular diets in the U.S. such as the Mediterranean diet, the DASH diet, several versions of a vegetarian diet, low-fat, paleo, and ketogenic diet. They gave each diet a full point for following each of the AHA guidelines or partial points depending how closely they followed the guidelines.

This was not an arbitrary assignment by a panel of experts; they used the best information available to determine the best heart-healthy diet. Who got the highest score? Mediterranean? Vegan? Ketogenic? I’ll let you know on Saturday along with my thoughts on the diets. One thing’s for certain: eat your fruits and vegetables. You may as well start with that right now.

What are you prepared to do today?

        Dr. Chet