In an era marked by remarkable advances in medical science, the prevalence of cardiometabolic diseases continues to surge, presenting a significant global health challenge. We have mentioned in the first part of this article (The Silent Killer, July 23, 2023) how cardiometabolic diseases (CMD) have long been treated primarily with pills such as statins.
But the fact is that CMD is not merely a result of chance or genetics, but rather a lifestyle disease shaped by the choices we make. Consequently, the key to preventing or even reversing this modern epidemic lies in embracing the transformative power of right diet and lifestyle modifications.
A paradigm shift is necessary, with a holistic understanding of the relationship between lifestyle and health, and the potential of lifestyle changes to effect lasting changes in cardiometabolic well-being.
Choices of diet, physical activity, stress management, sleep patterns and other lifestyle factors exert a profound influence on development and progression of CMDs. By taking a proactive and holistic approach, individuals can not only thwart the onset of these conditions but also chart a course towards reversal and remission, mitigating the need for excessive reliance on pharmaceuticals.
CARDIOMETABOLIC FOOD PLAN
The Cardiometabolic Food Plan is designed for the following individuals:
Those with risk factors for cardiovascular disease (CVD);
Those with risk factors for conditions such as metabolic syndrome, type 2 diabetes (T2D), or both’
Those with cardiovascular disease, or CVD (e.g., high blood pressure, high cholesterol, and elevated blood fats)
Those with metabolic syndrome (e.g., high blood sugar, increased belly fat)
Those with T2D
Fortunately, diet and lifestyle interventions are effective in preventing and treating all of these conditions. Some people may question why the same food plan is suggested to treat both cardiovascular and metabolic diseases. While they may seem to be different types of conditions, cardiovascular and metabolic dysfunctions share similar causes, including inflammation, insulin resistance, and stress. This food plan is called “cardiometabolic” as it addresses both disease states. It allows people to use food medicinally to treat the common underlying causes.
The Cardiometabolic Food Plan is a modified version of the Mediterranean Diet (see box Features & Benefits of the Cardiometabolic Plan). The traditional Mediterranean Diet first attracted interest when it became apparent that people living on the Greek island of Crete had a greatly reduced risk of CVD. Since then, it has become the most well-known, well-studied diet for CVD, metabolic syndrome, and type 2 diabetes.
The diet consists of whole, unprocessed foods such as fruits, vegetables, wholegrains, nuts, legumes, dairy, extra virgin olive oil, spices, modest amounts of poultry, fish and red meat, and red wine (see box Therapeutic Foods in the Cardiometabolic Food Plan). It is the combination of all these foods together that is responsible for the cardiovascular and metabolic benefits of this way of eating.
More important than the starting plan itself, I find that modifying the nutritional approaches based on a patient’s clinical work-up and genetic, metabolomic and microbiome evaluations is key to success. This allows for a dynamic approach that is far superior to the ‘one-size-fits-all’ cardiology guideline recommendations.
A review of 50 studies on the Mediterranean diet (The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals by Christina-Maria Kastorini, Haralampos J Milionis, et al) reported that this way of eating favourably changes parameters of metabolic syndrome such as waist circumference, presence of high-density lipoprotein cholesterol, triglycerides, systolic and diastolic blood pressure, and blood glucose.
HIDDEN HUNGER
'Hidden hunger’ refers to the deficiency of vitamins and minerals when habitual diets lack adequate levels of these micronutrients. Some deficiencies also serve as underlying causes of chronic diseases. A functional medicine approach prioritises nutrient-dense diets rich in antioxidants and anti-inflammatory agents to support heart function and overall wellness.
By incorporating a variety of plant-based foods and considering targeted supplementation when necessary, individuals can optimise their cardiovascular health and mitigate the risk of metabolic dysfunction (see box Important Micronutrients to Consider in Cardiometabolic Disease)
CICARDIAN FASTING
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As part of cultural or religious traditions, humans have practised periodic fasting for thousands of years. Only in the past century has much of the population had easy access to excess calories every day. This relatively recent eating pattern correlates with the onset of many chronic illnesses, including CVD. Intermittent fasting strategies, including time-restricted eating interventions, have a range of health benefits, including being helpful in checking precursors to CVD such as obesity, hypertension, dyslipidaemia, and diabetes.
Studies suggest that intermittent fasting treatments may improve health through multiple pathways, potentially reducing oxidative stress, enhancing mitochondrial health and DNA repair, and triggering autophagy, a cellular recycling system with a possible therapeutic role in some inflammatory diseases.
And specific timing patterns of eating and fasting windows may lead to greater improvement of cardiometabolic markers.
Time-restricted eating is a form of circadian fasting — a dietary pattern that optimises circadian elements such as daily rhythms for insulin peaks and glucose tolerance by consuming food and beverages within a shortened window of time during the day, extending a person’s nightly fast to 12 hours or more.
Intermittent fasting can be undertaken in many ways, with different durations. With longer fasting times (likely over 24 hours), autophagy may be improved. During autophagy, the body performs a “housecleaning” of sorts, removing damaged cells and pathogens, among other actions. This could be a beneficial process for improving immune function and helping patients with chronic inflammatory diseases.
Impact of circadian disruption on glucose metabolism: implications for type 2 diabetes by Ivy C, Mason, Jingyi Qian, et al, suggests that evening fasting (skipping dinner) may be more effective than morning fasting (skipping breakfast), and that eating fewer meals during the day may reduce disease incidence.
Meal timing affects circadian rhythms, and late night eating may contribute to obesity more than food consumed at other times of the day. This may in part be due to the diurnal rhythm of glucose tolerance, which peaks in the mornings; some evidence shows that peak is lowered by early-phase time-restricted feeding.
Intermittent fasting has also been deemed safe with no serious adverse effects reported. However, it is important to note that fasting may not suit everyone. So, it is always recommended to consult a healthcare professional before making any significant changes to diet or exercise routines.
MOVEMENT A MUST FOR A FIT HEART
Exercise can lower the risk factors for patients with CMD. The benefits are manifold (see box Benefits of Regular Exercise). Recommendations for enhancing cardiorespiratory fitness include moderate and vigorous aerobic activity, resistance training, increasing daily movement while decreasing sedentary behaviour, and adding intensity to physical activity.
Various exercise routines have shown positive effects on heart health. Aerobic and resistance training programs have both been found to be beneficial for cardiovascular fitness. High-intensity interval training (HIIT) has been shown to be more effective than moderate-intensity continuous training (MICT) in improving cardiorespiratory fitness in hypertensive patients. Activities like dancing, walking, running, Pilates, tai chi, and yoga have also been associated with improved cardiovascular function and reduced blood pressure.
OFFSET SEDENTARY LIFESTYLE WITH MICROBREAKS:
Approximately 60-85 per cent of people in the world lead sedentary lifestyles without sufficient physical activity incorporated into their day. In fact, sedentary behaviours are on the rise with the popularisation of Internet-based services and working hours mostly spent in the seated position.
Data suggests that the average individual engages in sedentary behaviours for eight to nine hours per day. The number of hours spent sitting has been positively correlated with risk of diabetes, cardiovascular disease, poor mental health, and even premature mortality.
Patients might consider incorporating mindful movement into everyday routines, such as wall squats, seated leg extensions, static lunges, and standing bicep curls, just to name a few. Small physical activity sessions of about 5-20 reps, or holds and stretches for one to two minutes, can be integrated into the workday in hourly increments.
Strengthening programs using dumbbells, elastic bands, kettlebells, and anti-gravity exercises can be broken into microbreak activities lasting about two minutes. Many smartphone and desktop applications available on the market allow patients to set reminders to move during the day; some of these include StretchClock, DeskActive, Break Pal, and OfficeFit.
SLEEP QUALITY & DURATION
In 2017, sleep scientist Matthew Walker, author of the book Why We Sleep, made the assertion that humans are the only species who deliberately deprive themselves of sleep for no apparent [biological] gain.
Adequate sleep duration and quality are important factors in preventing cardiovascular diseases. Research has shown associations between sleep deprivation and hypertension, coronary heart disease, and diabetes mellitus. Short sleep duration, poor sleep quality, and later bedtimes are all associated with increased food intake, poor diet quality, and excess body weight. In addition, lack of sleep has been shown to increase snacking, the number of meals consumed per day, and the preference for energy-rich foods.
Sleep disorders like obstructive sleep apnoea (OSA) is also associated with the development of a range of cardiovascular diseases. OSA is highly prevalent among those with cardiovascular dysfunction. This may be related to the obesity epidemic as well as an aging population.
A 2018 meta-analysis found that OSA was associated with a significantly increased risk of major adverse cardiovascular events, including all-cause or cardiovascular death, myocardial infarction, stroke, repeat revascularisation, and heart failure. Metabolic dysregulation is considered by some researchers as an underlying mechanism of OSA, which often leads to CVD.
STRESS REDUCTION
Chronic stress has been associated with increased cardiovascular events. To minimize continual stress, set priorities for what is most important to you and aim for a life-work balance. Make time for friends, family and laughter. Ease stress and improve mood through physical activity.
Regular exercise helps to lower blood pressure and combat other cardiovascular disease risk factors. Mindful meditation and deep breathing can help manage stress. Consider yoga, which combines movement, controlled breathing and relaxation.
Sleep and stress are interconnected. Stress can affect sleep, and lack of sleep can, in turn, lead to more stress. Seven to eight hours of sleep per night is ideal. Better sleep hygiene is critical in management of stress and promotion of heart health.
CONCLUSION
As we conclude this topic we embrace the truth that we hold the power to change the course of our health. Armed with the wisdom of nutrition and lifestyle intervention, we pave the way towards a future where cardiovascular disease is but a shadow of the past. Let us take this knowledge, this newfound enlightenment, and paint the vibrant canvas of wellness. Together, we create a world where hearts beat strong, and life flourishes in the embrace of a heart-healthy existence.
Puja Karnani Agarwal is a functional medicine practitioner, certified human performance nutritionist, and a REPS-certified Level-4 trainer. She consults at Reverra Aesthetics, 15C Hazra Road, Calcutta 700026. She is also on Instagram@pujakarnaniagarwalofficial and her website is pujakarnaniagarwal.com
