The science behind the benefits of a plant-based fiber diet will motivate many of us to make important lifestyle changes. Cardiologist Hooman Yaghoobzadeh, MD, explains why eating less meat, less processed food, and more fiber is so good for your heart and brain.
Dr. Stieg: I'm delighted to have with me today Dr. Hooman Yaghoobzadeh. He is Clinical Associate Professor of Medicine at Weill Cornell Medicine and Associate Attending Physician at NewYork-Presbyterian Hospital. He specializes in cardiovascular disease. Also with me is a patient of Dr. Yaghoobzadeh, Mr. Jamie Streeter, who is Managing Director in Cohen's Healthcare Investment Banking Group focusing on life sciences companies. And the reason we're here today is to talk about food and the brain. So one might be wondering why if I'm talking about food in the brain, am I meeting with somebody who's a specialist in cardiovascular disease and there's a good reason for that and that the heart and the brain are extremely similar. One may try to draw the similarity that is a V12. They're both running on high energy, high octane, and given that they both have very similar demands. So Hooman, can you tell me a little bit about what are the important energies that a patient needs to feed both their heart and their brain?
Dr. Yaghoobzadeh: Blood flow is what brings oxygen, nutrients to both the brain and the heart. Muscle blood carries with it oxygen as well as nutrients and the energy needed for all the cells to work well. Healthy, reactive young, pliable blood vessels are the tree of life for both of these organs. And they're very energy dependent organs. They're highly active, they're running on full, you know, high octane all the time and there really is minimal reserve for any detriment. The minute you start to mess with their food supply, they start to complain
Dr. Stieg: The kinds of energy that the brain and the heart need are a little bit different than what the kidney and the gut needs. Can you go into that a bit?
Dr. Yaghoobzadeh: Yeah, sure. So the heart and the brain have unique abilities to use fatty acids as well as sugars. They have a reserve, backup mechanisms to, just in case they're starved of one, to switch to the other. And so that's just a redundancy built into the system to make sure that these organs can function during starvation during lack of, even lack of, well — lack of oxygen is the one thing that neither one really can tolerate at all and there's no reserve for lack of oxygen. And that's where the first hit really comes. When there's any reduction of blood flow to either of those organs, the first hit within seconds is lack of oxygen. And the second that enough blood flow, either because of a clot or a blockage forms in one of these pipelines to these organs, the lack of oxygen will lead to death of the cells.
Dr. Stieg: I was interested in, for light reading, I was going through something that you had actually passed on to me about diets of pre-hominids versus what we eat in our American diet today. And I thought it was kind of interesting what pre-hominids are what, 10,000 years ago. And the fact that our body, our bodies and our genetic codes haven't adapted yet after 10,000 years to what we're putting in our mouths. And it really, it gets into a, I wanted to get a little bit specific about the things that they talked about in terms of this glycemic load, fatty acid loads, the macronutrients, the micronutrients. How much do you, with your patients like Jamie, how much do you stress that?
Dr. Yaghoobzadeh: I'm impressed that you read what I sent you Phil, so that's a great start. *laughs* So what's interesting is, food and calories these days come in highly packed and energy dense packages, which leads to these tremendous spikes in blood sugar. And so these, the intensity or the density with foods these days are very, very different than foods that we had access to many thousands of years ago. Because at that time, most of the foods that we ate were foods that we roughage for. So there were sprouts and grasses and seeds. They were tubers and things that grew underneath the ground. Things that potentially very early man was able to grow themselves before domestication of animals. When we would go hunting, we were also hunted, so several of our brothers, sisters friends, didn't come back home. We didn't go hunting every day, all the time. We didn't have refrigerators to put animal products and we didn't have domestication of animals to have the level of eggs and dairy and so on, so forth that we have now. So the foods back then had much, much more fiber than the typical — or the diet back then had much more fiber than the diet. Now fiber slows down caloric absorption and food metabolism in the gut and fiber is the one main difference between what a modern Western diet is and what a whole foods plant based diet is.
Dr. Stieg: Well, what I'm interested in is the fact that we've gotten so far away from the non-meat roughage kind of diet that it leads to this inflammatory process that occurs not only in the gut but also in the blood vessels. Can you go into that a little bit about what, where our diets have gone wrong and how it induces that kind of injury?
Dr. Yaghoobzadeh: In some ways it's not a hundred percent our faults. We have evolved to seek out calorie dense, high fat, high sugar foods through thousands of years of evolution. We are driven, addicted to look for things that are sweet and look for things that are high fat. And in fact there are research studies that show in the brain when we eat simple carbohydrates, sugars and saturated fats, which are 90% found in animal products, the pathways in the brain, the neurons, the actual specific roads that electricity flows in the brain when we eat. Those foods are very similar to when we are exposed to cocaine and nicotine. And so they are truly addictive and we seek them out. And just like in other addictions, we build tolerance to them. So if you're addicted to a substance over time you need more and more to create the same kind of joy.
Dr. Yaghoobzadeh: And the same thing happens with sweetness when it comes to sugar and taste receptors in the mouth. And there are multiple other mechanisms that drive us towards these foods. And so given that they're so easy to get in today's diet, these foods lead to inflammation in one of several ways. One of the ways that's most interesting and we're starting to figure out now is through the bacteria that live in the gut, which is called the microbiome. The gut is the main place where outside comes in, into our bodies. We have other barriers like skin, but skin doesn't let outside in. In fact, it's a true barrier. The job of the gut is to let stuff in, but when you're letting stuff in, you also have to make sure that bad things don't get in and like bacteria, toxins and so on, so forth.
Dr. Yaghoobzadeh: So the way that the gut manages to do that, it appears is that there is aligning of mucin. It's this gelatinous goo that lines the gut and has some antibacterial kinds of properties and keeps the bacteria that's in the stool and the bacteria that is absolutely necessary to digest everything that is in our guts. It keeps the bacteria away from the wall of the gut. The way that the gut creates that mucin. The cells of the gut eat things called short chain fatty acids. Short chain fatty acids are the compounds that are made by the bacteria, when they feed on fiber, so to review that bacteria feed on fiber. They make short chain fatty acids. The short chain fatty acids feed the gut cells. The gut cells make the mucin. It creates a barrier. It keeps the bacteria away, and there's this healthy symbiosis in this environment, in this ecosystem. When fiber goes down in the body, the fiber eating bacteria don't have food, they start to die off. There's not a lot of short chain fatty acids made, the gut cells are starved. They don't make mucin. That barrier breaks down. Now there's interaction between the bacteria and the gut. In lay terms, some people call this leaky gut syndrome, which we're still trying to understand exactly what that means. When the bacteria start to interact with the gut, our immune system and they're the infantry, they're standing there waiting for one of these bacteria to come in. The minute there's an interaction there, the immune system starts to get activated. The soldiers send signals back, the immune system calls, you know, to arms and sets off inflammatory cascades. That inflammation. Then it affects all other parts of the body
Dr. Stieg: in addition to activating the inflammatory cells in the inflammatory system because you now have this quote, "leaky gut syndrome," you're also absorbing bad stuff into your blood vessels, which thereby as I understand it affect both the brain and the heart vessels. So you see Jamie in your office and what tests do you run to see whether he's got a good or a bad.
Dr. Yaghoobzadeh: The things that I look for to try to figure out how much room for improvement there is in the diet, no matter where somebody starts. The first thing that I do is sort of try to get a risk profile set up to figure out how worried should I be. Once I sort of get a sense — is this a truly low risk person that is not going to have heart disease? Maybe no further testing is necessary. Is this a truly high risk person who I already know has heart disease? They have to have all their numbers? Absolutely perfect. Many of us fall somewhere in the middle. It's typically been defined as have you had a stroke or have you had a heart attack? And I think that's sort of the, the chickens out of the barn or the horses out of the gate. I wasn't born in this country, so I'm not familiar with the uh, and so I would define it as is there or is there no plaque in the arteries that supplied the two most important organs?
Dr. Stieg: So how do you, how do you find that out? What tests do you run?
Dr. Yaghoobzadeh: A carotid ultrasound is a really good test and a coronary calcium score is another good test to look at the heart.
Dr. Stieg: So for the person who's sitting here listening and saying, Oh shoot, all my family lives to be a hundred years old, how much of it is genetic and how much of it is behavioral?
Dr. Yaghoobzadeh: Spectacular question. Very, very difficult answer. There are very few diseases that are a hundred percent one or the other and most diseases are a combination of both. And when we talk about what risk factors patients have, we try to come up with probabilities as opposed to, is this person going to have a heart attack or is this person not going to have a heart attack? So we say, okay, this person is going to have a 10% risk of a heart attack and we're going to try to lower that to a 3% risk.
Dr. Stieg: Then we come to Jamie, who's, as we said, a managing director in a healthcare investment firm. So I'm presuming that you have lots of common sense and you are always thinking about being an absolutely healthy individual. What light went on, "I've got to go see Hooman, and maybe change my lifestyle." Did something happen?
Jamie Streeter: Well, I think we all have good intentions, right? So I think the, if you're younger, you just sort of assume it's not a big deal. I have a history where my father—he didn't die, he had a heart attack at 39. He actually just passed away at 87, after two bypasses, a carotid and aortic aneurysm and a number of other procedures. So to say he's a product of modern medicine is an understatement. But he's also, I think an indicator of the kind of risks that I could conceivably have to deal with. And we don't go to see Dr. Yaghoobzadeh just for any reason cause you all have primary care physicians. So you're going to a cardiologist because I think you are already inclined to look a little deeper. Um, but I think that unequivocally there's a clear, at least in my mind, a predisposition to having an issue. And so I figured I—
Dr. Stieg: Both genetic and behavioral, and that, that takes me back to a question to you, Hooman, is, so many of the diseases we're talking about are developmental. You, you started getting to an age where you start. We were worried. The reality of it is people should start worrying when they're 30 you know the newest data suggests that Alzheimer's is a developmental disease that may be inflammatory. Obviously a heart disease is a developmental disease as well as genetic. What do you, what do you do to motivate your 30 year old patient?
Dr. Yaghoobzadeh: I sprinkle information in whenever I see an opportunity. So if there is a relevant issue that's going on, I talk about it. We talk about diet almost every time. I will continually bring up research that's recently been done on lifestyle modification. I have a Twitter account that I post research that's relevant to a whole foods plant based diet. So it's something that is constantly brought up. Patients know that I follow the diet or at some point patients find out that I follow the diet and that is very interesting for them. They'll ask me why and so I'm always looking for an in, you know, I don't lecture about it unless the patient needs a lecture. I, you know, will be very tact and figuring out, you know, when is the right time to use tough love, humor, so on and so forth.
Dr. Stieg: So just as an aside, how many pounds of brussel sprouts raw do I need to eat and I don't have to eat anything else and I can get all the protein, all the glucose and all the macro and micronutrients I need.
Dr. Yaghoobzadeh: The, I mean, it's interesting, I don't know the answer to that, but what's interesting is, you know, we think about protein as, Oh, it has to be eggs or chicken and so on and so forth. Or, or it has to be nuts or beans. There's research that if you eat all of your calories as broccoli now, you'd never do that. I'd never do that. We'd be sick. But if you did in a day, all of your calories from broccoli, you would get enough protein. So this, this, yeah, it is amazing.
Dr. Stieg: Given all the healthy things that, Hooman has instructed you on, do you exercise regularly?
Jamie Streeter: I always exercise. I think that's part of the whole, I think dynamic here.
Dr. Stieg: So what do you do routinely?
Jamie Streeter: Well in the summer I'm riding a bike, probably 120 to 150 miles a week.
Dr. Stieg: Do you have a daily, exercise 30 minutes a day, an hour?
Jamie Streeter: It's more like an hour at least. And it's, the bike is on the weekends cause I travel during most of the week. So it's running or I'm going to gym. What, what changed for me was I changed what I ate.
Dr. Yaghoobzadeh: I think it's very common for athletes and I have a lot of patients who come in and say, Oh, I'm at very low risk. I exercise all the time. I do all this intense exercise, but they're missing the other half. And the research may suggest that it's really 70% diet, 30% exercise as it pertains to cardiovascular disease.
Dr. Stieg: So what do you do to make it compelling for the patient? And by that I mean I have oodles of patients that come in to me and they want to live life the lifestyle that they want to live and they say, just fix it so I can go back to that lifestyle. You're in the business of getting people to change their lifestyle. How do you do that?
Dr. Yaghoobzadeh: I actually have cheerleaders with pom-poms in the back of my office. I would be interested to, to hear what you have to say about that.
Jamie Streeter: You know, I think in all candor, this really does come down to a certain amount of self motivation. As a function of my job, I travel a tremendous amount and I actually ascribe a lot of the, the creep in weight and bad stuff too. It's just harder to manage when you're on the road constantly. And so I just sort of said to myself, "Can I make an experiment?" Which is what he suggested. Can I just change this for awhile and see what happens? And I think the, you know, the most dramatic thing is you start the process, you're in the process, things you used to do, you stopped doing and you find that you don't even miss them. And then it became very much just like everyday process.
Dr. Stieg: I feel that I, I mentally tried to change my attitude towards food and I just tried to make it less relevant in my life other than the fact that I needed to eat something that I enjoyed that was healthy and then get on with it.
Dr. Stieg: Running down in quick form, a healthy, good breakfast, a healthy good lunch and a healthy good dinner.
Dr. Yaghoobzadeh: Sure. So options for breakfast a would be a shake with blueberries, peanut butter, spinach, chia seeds, hemp seeds, flax seeds, or a really good bread like Ezekiel bread with avocado smash. Steel cut oatmeal with—.
Dr. Stieg: What is Ezekiel bread?
Dr. Yaghoobzadeh: Ezekiel, so it's a, it's a brand of bread, you know, healthier breads that are whole grain and have a low carb to fiber ratio. Most supermarkets now will have Ezekiel bread and it's in the frozen food section because if you find bread that's not in the frozen food section, not in a bakery where it was baked that day, the bread is being preserved and the preservatives are sugar most often. And so this bread is in the frozen food section because it doesn't have preservatives like sugar. Lunch would be a salad. My salads are sort of hearty grain salads, you know with nuts and seeds and lentils, mushrooms, it would be like a burrito bowl with brown rice and black beans and guac and lettuce and tomato and salsa and things like that.
Dr. Yaghoobzadeh: Dinner would be any of the peasant stews, Moroccan carrot and lentil stew, three bean chili, pea soup, lots of roasted vegetables, what we call Buddha bowls. So a whole grain, a bunch of fresh vegetables, roasted vegetables. I have fish. I believe fish is part of a healthy whole food plant based type diet. I think that fish have, especially for the brain, there's a lot of uh, healthy nutrients like Omega three fatty acids that we need and we require and are tough to find in other foods, although you can find them in chia and flax and hemp.
Dr. Stieg: One of the things I was just thinking about while you're talking about that is how do you, how do you handle high bean diet and the aroma that follows you as you walk down the hallway? Or does your body adapt to that and then it's less of a problem.
Dr. Yaghoobzadeh: Yeah. Your body does adapt to it. Fiber is responsible for gut motility when there's a lot of fiber throughout the diet for days and days and days, everything is moving through the gut very quickly. Um, whereas when there's not a lot of fiber, especially the animal protein sit in your gut and tend to go rancid it the same way that animal proteins go, rancid on your kitchen counter top. Think about that.
Dr. Stieg: Jamie, after you saw the light and decided to reform your lifestyle, what changes did you see in the laboratory tests that that Hooman was running?
Jamie Streeter: Not being that familiar with the data? I'll, I'll let him chime in as well, but obviously when you're given the test results from your doctor there, there's the LDL results, HDL results, total cholesterol and triglycerides. I think it was fair to say it was pretty dramatic, the change. The, the LDL went from around 130 to the low 50s. The HDLC essentially the same, which is obviously part of the goal. The total cholesterol went from two 13 to one 32 and triglycerides went from 207 to 67. I also have to say, I guess we increased the Lipitor dose by 10 mgs. The weight was pretty visible and pretty dramatic. So I went from sort of fluctuating between 205 and 210 down to about 175. And, uh, I, since I ride my bike a lot, I can tell you quite categorically that when you take 30 pounds off and you get back on a bike, you feel a lot better when you're riding the bike.
Dr. Stieg: Dr. Hooman Yaghoobzadeh and Mr. Jamie Streeter, I want to take this opportunity to thank you so much for spending time with us to talk about, most importantly, the diet, but you know, how it affects our gut and then eventually affects the two major organs. I will remind you that we can transplant your heart, but we can't transplant your brain.
Dr. Yaghoobzadeh: Yes.
Dr. Stieg: Thank you so much for being with me.