What’s the Best Medicine for Heart Health?
By Lynn Kennedy
Key takeaways from the American Heart Association’s March 2017 conference in Portland, OR
The link between diabetes and heart disease usually comes across as a depressing message, but findings presented at a recent American Heart Association conference in Portland, OR, offer hope: there are things people with diabetes and their healthcare providers can do to positively influence heart health. Read on to learn more about what you and your doctor or nurse could decide together!
Fellow diaTribe team member Ben Pallant and I were very inspired hearing about the latest research and seeing the hundreds of researchers and healthcare providers from around the world who gathered to learn about the leading science on keeping the heart in good condition.
Dr. Steinberger, an expert on children’s heart health from the University of Minnesota, explained how most babies are born with ideal heart health, and keeping this up as we age is both the challenge and the key. Many factors help with heart “maintenance” – avoiding smoking is the most straightforward one. Physical activity and eating patterns (the what, when, and how much is eaten) also play a prominent role in helping maintain health, although these are notably more complex – there is still so much research to be done to even determine what “healthy eating” truly looks like (see below for more on this).
Recent studies have excitingly demonstrated the “cardioprotective” effect of a trio of diabetes drugs (Victoza, Jardiance, semaglutide) – in other words, they help maintain heart health and reduce the risk of heart disease and stroke (and in some cases, they even reduce the risk of death). Even better than these emerging drug options (as exciting as they are), and in addition to existing drugs that also help the heart (like statins), researchers at the conference repeatedly underscored how the two best medications for heart health are regular exercise and “healthy eating.”
When it comes to mealtime, what do the experts suggest? Many presented findings that compared the heart health of groups of people with different eating habits to see if any trends emerged. Research on eating and heart health tended to point in one direction: eating fewer carbohydrates and less sugar is associated with decreased risk of developing diabetes and/or of developing heart disease.
Researchers presented studies that looked at eating patterns like the Mediterranean diet, the “Southern” US diet, the paleo diet, the DASH diet, and the diet recommended by the ADA. Dr. Ma, who works for the NIH, showed that the Mediterranean diet, characterized by high intake of fish and plant proteins and fewer sweets, can have a positive effect for people with diabetes and/or a heart condition. In contrast, Dr. Shikany, from the University of Alabama, found that the “Southern” diet, which is characterized by heightened intake of fried foods, sugar-sweetened beverages, and processed meats, was associated with greater risk of heart disease. And after comparing a number of diets, Kristin Hirahatake, a PhD student at the University of California, Irvine, discussed how foods like vegetables, fruits, nuts and seeds, and a high ratio of unsaturated to saturated fats seem to be associated with good heart health. As a result, she wants to study the specific effects of low-carb, high-fat eating next.
Members of the diaTribe team, along with so many of our readers, have commented for years that, in their personal experience, eating fewer carbohydrates than a “typical” North American diet seems to lead to better blood sugars and diabetes management. It is important to specify that “lower-carb” doesn’t mean severely restricting carbohydrates below 100 grams per day. diaTribe’s own Adam Brown has written extensively on his game-changing experience reducing his carbohydrate intake, something that helps his diabetes management day-to-day while also contributing to a positive long-term health outlook (better cholesterol, lower weight, and beyond). Read more on his experience here and here, and sign up for more in his upcoming book, Bright Spots & Landmines. [Please note diaTribe does not offer medical advice. Always speak with a healthcare provider before making significant changes to your diet or diabetes management.]
Experts at the conference were also loud and clear that saying “goodbye” to sugar-sweetened beverages, and especially to soda, is likely a good measure to prevent heart problems. Not surprisingly, eliminating sugar-sweetened beverages is also recommended for helping keep blood glucose in-range. Dr. Steinberger said that drinking less than 36 ounces of sugar-sweetened beverages per week (3 cans) should be everyone’s goal, although she further stressed (along with too many other presenters to count) that the ideal amount of sugar-sweetened beverages is as little as possible. These expert opinions are in line with an AHA recommendation released last fall that urged parents to limit childrens’ sugar-sweetened beverage consumption to no more than 8 ounces per week.
For those looking to replace soda, try sparkling water with a fresh lemon or lime. There are a number of “naturally flavored” carbonated beverages available now too; just make sure to look for zero grams of sugar on the nutrition facts label.
diaTribe is also working on more articles related to food since so many people with diabetes have emphasized just how much food impacts daily life with diabetes. See a recent article with breakfast food inspiration – The Morning Meal – for some great options from professional food writer Catherine Newman. What else about food and diabetes would you like to know? Let us know!
Dr. Vanhees, an expert in heart health and exercise from the University of Leuven, in Belgium, put it simply: “Exercise is medicine.” He detailed his main conclusions from his impressive career studying exercise and heart health: it is important to focus on increasing the frequency of exercise (days per week) and the intensity of exercise. Time spent exercising can also be a good measure, but less so than how often and how intense – for example, he found that greater walking pace had nearly twice the positive impact on heart health than increasing just the amount walked. He also mentioned studies that found interval training (i.e., repeated bursts of greater intensity) had a greater impact on heart health than continuous activity did. Readily noting that safe and enjoyable exercise tends to work the best, and since ability and options can vary greatly by age and location, Dr. Vanhees encouraged people to find what’s best for them, working with a healthcare provider where necessary.
Dr. Vanhees’ tips on exercise add helpful specificity to the American Diabetes Association’s exercise recommendations for people with all types of diabetes. As diaTribe previously covered, the ADA recommends exercising on at least three days per week, for a total of at least 2.5 hours of moderate-to-vigorous physical activity each week. Another key tip is the 3-for-30 rule: doing at least three minutes of light activity (e.g., leg extensions or walking) for each half hour spent sitting still.
For more on exercise and diabetes, check out Adam Brown’s article on regular walking for better blood sugars and on Diabetes & Exercise Solutions; Bright Spots & Landmines has a whole chapter on exercise too. Write to us here if you’d like more information after it’s published!
Over time, high blood glucose levels can damage blood vessels and the nerves that control the heart, meaning a good way to protect the heart is to keep blood sugar levels in check (for example, an A1c below 7%).
Dr. Jaako Tuomilehto, a leading heart disease prevention expert from the University of Helsinki and Dasman Diabetes Center in Kuwait, and an advisor to the diaTribe Foundation, detailed how positive and deliberate food and exercise choices today can have lasting heart health benefits a decade from now. The “legacy effect,” as it’s called, of deliberate food and exercise interventions aimed at lowering blood glucose levels have been shown to reduce the risk of developing heart disease years down the road, even if blood glucose is not as tightly managed over time. This bodes particularly well for people with prediabetes or type 2 diabetes who are able to participate in the Diabetes Prevention Program (or other programs like it), as well as for those with diabetes that work strong food and exercise habits into their day-to-day life.
As more therapies become available to manage blood glucose levels, and as researchers continue to uncover the ins and outs of “healthy eating,” diaTribe is hopeful that heart health – not heart disease – can be a reality for more and more people with diabetes.
Want to learn more about diabetes and heart health?
For diabetes-specific tips on diet and exercise that really make a difference, check out Adam’s Corner here, where diaTribe’s own Adam Brown discusses regular walking for better blood sugars, eating fewer carbohydrates, and more! Also be sure to check out the other diaTribe articles on heart health below, and let us know if you have any other questions!