Getting to the Heart of the Matter With Dr. Ding

QUESTION: Why is it that heart disease seems to affect more women than men?

Dr. Eric Ding

DR. DING: There are certain social differences as well as inherent biological differences. However, there is need for clarification about the gender difference in heart disease…. Although women have fewer heart attacks than men, women are more likely to die of heart attacks than men. Part of it is differences in diet and lifestyle (e.g., men eat often more red meat and saturated fat), but also that women’s heart attacks are often less obvious, such as the fewer overt chest pains at onset of heart attacks compared to men. Additionally, women also perceive a lower risk of heart attacks than they actually have, which decreases their chance of seeing the doctor. Moreover, even if a  woman knows she has heart disease and sees a doctor, research has shown that women (compared to men) are less likely to receive ECGs, less likely to get angiograms, less likely to get bypass and stent procedures, and less likely to receive cholesterol-lowering medications. Moreover, biologically, drugs like aspirin that strongly prevent heart attacks in men, are less effective against heart attacks in women. And finally, a woman with diabetes is more likely to die of heart disease than a similar man with diabetes. Altogether, these all lead to higher heart disease mortality for women than men.

QUESTION: What are the most important things a woman can do to decrease her chances of heart disease?

DR. DING: Exercise regularly (30 minutes a day), maintain an optimal BMI of 18.5-25 and don’t smoke.

I rank sugar sweetened beverages (SSBs) as one of the worst causes of heart disease. It’s not the sugar per se, but rather liquid sugar intake such as in soda and sweetened juices, because liquid sugar is partially “invisible“ to our hunger control system. Indeed, the difference between liquid sugar and solid sugar is best seen in an experiment between sugary beverages vs. jelly beans (with same number of calories). While jelly bean eaters become full and ate less food later in the day, liquid sugar drinkers were not fully satiated and become hungrier sooner and consumed more calories at the end of the day (compared to solid sugar eaters).

This is why sugary beverages (but not sugar) are inherently dangerous (read my recent piece for more info: For the same reason, parents should not give too much SSB to their children.

Inadequate intake of fruits and vegetables is another major cause of heart disease in America. Only a small segment of the population gets 5 servings of fruits and veggies a day — and this actually includes French fries, which nutritionists don’t really consider a vegetable [But how did the starch French fries get classified as vegetable by the USDA? It’s not hard to imagine what industry group had successfully lobbied the USDA for the ‘French fry’ vegetable classification!].

Cocoa flavonoids are good against heart disease: from multiple systematic reviews of dozens of randomized trials, cocoa flavonoids are shown to lower BP, lower bad LDL, raise good HDL, improve insulin sensitivity, and improve blood flow. Recent reviews of multiple long-term cohort studies have also shown benefits of cocoa for lowering heart disease. However, interestingly, the benefits in the trials were observed with doses of around 400-500 mg/day, equivalent to 33 bars of milk chocolate or 8 bars of dark chocolate. Thus, because it is unreasonable to consume all the calories, sugar and fat to achieve these levels of cocoa flavonoids through just chocolate bars alone… supplements with concentrated cocoa flavonoids are helpful for garnering the benefits discovered (supplements available commercially, e.g. CocoaWell supplements in 400 mg.  dosage). The key is getting the benefits of cocoa flavonoids for heart disease while avoiding the calories, and for that, chocolate bars are not the solution – supplements are a better option.

Additionally, beyond SSBs and French fries, generally, high glycemic load refined starches are a cause of heart disease. Therefore look for whole grains instead of white bread, brown rice instead of white rice, and steel cut oats instead of instant oatmeal. And avoid mashed and baked potatoes, which have an incredibly high glycemic index and glycemic load, equivalent to almost pure table sugar in spiking one’s blood sugar (and elevating heart disease risk).

Avoid trans-fats at all cost. Many years ago, before the nutrition and medical community realized the dangers, the emphasis had been on avoiding butter — and instead people were recommended to consume margarine instead. However, the Department of Nutrition at Harvard School of Public Health discovered that trans-fats, high in margarine sticks, were even worse than the saturated fat in butter for increasing heart disease risk. This eventually led to trans-fat bans from restaurants in NYC, and then the rest of the country. Trans-fats are inherently bad for both their ability to increase bad LDL cholesterol, lower good HDL cholesterol, and increase inflammation – all of which increase heart disease substantially.

QUESTION: Is heart disease hereditary?

DR. DING: Only partly hereditary – while over 80% is preventable.  As shown in several large studies at Harvard, a combination of lifestyle factors can prevent 82% of heart disease and 90% of diabetes (a major cause of heart disease mortality).

QUESTION: Can you offer any health studies on natural products/dietary supplements and their proven benefits for Heart/Cardiovascular health?

DR. DING: Emerging studies and systematic reviews suggest that:

–Vitamin D may hold promise not only for cancers but also for prevention of coronary heart disease. As well as potentially diabetes.

–As noted earlier, cocoa flavonoids, from multiple systematic reviews of dozens of randomized trials, are showing great heart health results.  See information above re supplements like CocoaWell.

–Niacin lowers bad LDL, but it causes flushing.

–Potassium supplements strongly lower BP, but be careful of overdosing.

–Folic acid among LOW folate individuals may lower stroke risk, but folate is not beneficial in most people, since the US now has folate fortification in most grain products.

–Magnesium may modestly improve glucose and lower CVD risk.

–Algal oil supplement was shown in a recent meta analysis to lower triglycerides and raise HDL, but it slightly increased LDL.

–Grapefruit enhances the effects of Cholesterol lowering statin medications, effectively requiring less meds to achieve same effects at lower drug dose. But one should inquire with your doctor. And don’t ever drink alcohol with grapefruit.

QUESTION: What research are you currently working on? What kinds of research projects would you most like to do?

DR. DING: I believe in the importance of evidence-based translational medicine…there is so much fluff and false claims in the nutrition world that I want to make sure all claims are justified with a strong body of consistently supported scientific evidence. That is why I enjoy conducting large systematic reviews and meta-analysis (which I have taught at Harvard for the last 6 years). I’m an epidemiologist and nutritionist – so I like to focus on evidence based medicine in the realm of disease prevention… because an ounce of prevention is worth a pound of cure.

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