Recently, I was interviewed about risk factors for heart disease and diabetes on Health Check with Heidi Godman.
Here is a link is to Part 1 of the interview - Click to here to Listen or Read Transcript below.
10/8/2014 -- Transcript:
Here is a link is to Part 1 of the interview - Click to here to Listen or Read Transcript below.
Oil, Salt, Sugar*
10/8/2014 -- Transcript:
Heidi: Welcome to Health Check, I’m Heidi Godman. You know doctors are always telling us to eat a healthy diet and that sounds fine until you’re trying to figure out how to make your dinner taste great, too. But, we have some help for you today. Dr. Michelle Hauser is an internist who also went to culinary school and she joins us now from Stanford University.
Michelle: Hi, Heidi. How are you?
Heidi: I'm great! I'm glad you're here. I interviewed you when you were at Harvard University and we did a number of nutrition stories together when you were at the medical school. Oh wait, it was your residency, right, when you were at Harvard Medical School?
Michelle: Yes, that's right we first met when I was in residency.
Heidi: Okay, so you just going to Stanford. Tell us what you're doing.
Michelle: Okay, so now that I'm done with my internal medicine residency, and I'm feeling like a real doctor with a license and whatnot…
Heidi: Yes, congratulations.
Michelle: Thank you. I'm doing a postdoctoral research fellowship where I am basically studying the effects of healthy lifestyle change on disease prevention like diabetes and heart disease.
Heidi: Well, that's very interesting. So, what is it that you are hoping to do with the rest of your career?
Michelle: For the rest of my career, I'm hoping to have a mix of doing the sort of research that I just mentioned, seeing patients in an academic medical center where I'm able to teach med students and residents, and hopefully take what I've learned from research and help change public-policy to help make it easier to make healthy lifestyle changes.
Heidi: Fantastic, and I know you also have that policy background. Tell us about that.
Michelle: Oh, so while I was in the middle of med school, quite a few years ago now, I went to the Harvard Kennedy School of Government and got a degree which focused on public policy and public administration.
Heidi: Fantastic. You are so well-rounded and you have this wonderful approach -also made even more wonderful because you went to culinary school. In fact, you went there long before you went to medical school, right?
Michelle: Yes, definitely.
Heidi: Tell us about that. Why did you go to culinary school?
Michelle: That was about 15 years ago, now. Oh my gosh. And, I went there because I - it's a longer story than we have time for today, but the gist of it is that I grew up in a pretty poor family and no one had a lot of faith that I would really end up being a doctor. I was trying to find my second passion to focus on so I ended up going to culinary school because I thought that would be what I would do with my life. Now, I guess I'm still doing something with it. But, I decided I would try out the medicine and that’s working out okay.
Heidi: Yeah, I think you've done very, very well. Congratulations on all of your success so far. So this nutrition approach, I know gives you a really great perspective on treating all kinds of diseases - especially heart disease which is what you're focusing on now. Tell us about that perspective.
Michelle: So, that perspective really stems initially from some personal changes that I made. That is, when I was growing up I had some extra weight and was doing all the unhealthy things that we talk about. I was drinking a lot of soda, eating a lot of fried and fast foods. When I made the changes in my life, when I learned what they were and figured out ways to do them, I just feel like a totally new person. So, while I was in my premed classes, I was also teaching at a culinary school. At that time, I started researching nutrition on my own. My students at the culinary school would ask a lot of questions about what they could do to make something healthier. After awhile, their family members started telling me stories about how they didn't have to be on a blood pressure medicine or that they were off insulin - or they cut down their insulin - for their diabetes, or were off anti-depressants. I think I was really hooked for the long term at that point on. When I really realized I could make a big difference if I focus on healthy lifestyle changes.
Heidi: Incredible. Well, what about the mistakes that people have been making that you've noticed. Have you been able to help them change their diet, change what they’re eating? But what is it that they were doing that wasn't right?
Michelle: There are quite a few things, and I mean we really pay people a disservice by focusing on people not having enough "willpower.” But, it's really over the years as we've grown more obese and overweight as a nation that the food environment has really changed. The things that are easiest to eat and easiest to make are the things that tend to be the least healthy for us. They also tend to be less expensive because of the way we subsidize our food in this country. So, you know, things like sugar sweetened beverages – which are sodas and juices - fast food, fried food and basically anything that's really far away from how it started out when it grew from the ground. Things like cookies and things that come in boxes and packages in the store.
Heidi: Things that are very processed.
Michelle: Very processed, yes.
Heidi: Well, I do want to talk about some of the consequences of eating this food because we know, generally speaking, it's bad for us. But, let's get down to the nitty-gritty. So, you mentioned sugar sweetened beverages. The statistics on how much added sugar people are eating everyday are very disturbing. So, let's talk about sugar and what it can do to our bodies. Why is too much sugar not a good thing?
Michelle: So, the biggest risk of too much sugar - and I think you made a good point that the sugar were talking about is added sugar. So, I'm not telling anyone they should be cutting out fruit or sugars that are naturally occurring. That's a separate issue. Added sugars, we don't actually need any to survive and they do present an increased risk of diabetes and weight gain. And the weight gain plays into the risk of diabetes and also into heart disease and other risk factors that go along with that like high blood pressure.
Heidi: What is it about sugar when it gets into the bloodstream? I know it's making high blood sugar, and what else is it doing physiologically to us?
Michelle: So, when we eat added sugars what happens is that an organ, kind of right where you would point to your “stomach” if you said, “oh, you know, I'm really hungry,” is an organ called the pancreas which makes our natural insulin. When we have a bunch of sugar, it will spit out a bunch of insulin - usually more than you would really need to digest and use that sugar. What happens then is that after your blood sugar goes up really high, that extra insulin makes it go down really low, really fast. What that does is it makes you hungry right away, as soon as your blood sugar gets low, even though you didn't do enough work for burn off enough calories to take care of whatever it was you just ate. It's a vicious cycle.
Michelle: You don't have enough willpower to fight that. It’s a thing that’s been there as long as we've been humans. We can't really fight it.
Heidi: And sugar is also linked to inflammation and diabetes and heart disease and there was a big study that just talked about the link between added sugar and heart disease. So yeah, added sugar - you definitely want to avoid that. What about the consequences of fat? Fat, I think, it's a very confusing topic. Some fat, the unsaturated fats, are good for us in a limited amount. Of the saturated fat, the trans fat, what are the problems with those?
Michelle: Right. As you said, fats are a complicated thing. There are a lot of experts who are very well respected who will say low-fat diets, or higher fat - as long as they are good fats - are fine. So where everyone agrees, I think, is that we should be cutting out trans fat as much as possible. The government says that we should get less than 1 g per day. But, really, if you get none, that would be best. That's because trans fats cause our bad cholesterol to go up and our good cholesterol to go down. It has the worst effect of any type of fat on our cholesterol. That means, I think that one of the statistics was, 200,000 heart attacks and deaths could be avoided, at the peak of our trans fat consumption, if we cut trans fat out of our diets. It really leads to a lot of cholesterol problems. Where you get trans fat in your diet is mainly hydrogenated vegetable oils. There's a little bit naturally-occurring in beef and red meat and dairy fats. But I think the jury is out for little bit on whether or not those are quite as bad as the ones that are artificially made with the vegetable oils.
Heidi: Right, right, and what about the saturated fat? Because, because you're mentioning beef and things like that which, of course, are full of saturated fat.
Michelle: So, saturated fat. So, we know saturated fat, it's found in things like meat and dairy products, like butter and cheese, and fast foods and desserts, that puts us at increased risk of things like heart disease, bad cholesterol going up, and what not. But, it's not as bad for you as trans fat, and, I think, the studies really give a complicated picture. The way that I read through them is that it's good to cut out saturated fat - if you replace it with how the fat with fruits and vegetables. But, if you just replace the saturated fat with things like added sugars and a lot of processed food, it actually makes you less healthy. So, you really have to be careful when you cut out saturated fat, what you're putting your diet to replace it.
Heidi: Excellent point. And I think a lot of people don't think about that. They just think, “oh, I'm getting rid of this one thing and now I can fill it with all this other stuff.” So, very good to bring that up. Then we should also mention salt, sodium. So many foods have it - restaurant food and so many different things – but salt is also a risk for high blood pressure and our heart. Tell us about that.
Michelle: The thing is with salt is that we eat about 1 1/2 to 2 times twice as much as we should per day. And, that is, when we say how much we should eat, it's actually a maximum of what we should eat. So, we actually need a very, very tiny portion of what we take in to actually survive, because we need a little. I don't think there's anyone out there that has to be concerned about getting enough salt - unless you're a marathon runner or some sort of really elite athlete. The main problem with salt is that it raises blood pressure, and for some people it raises blood pressure a lot and for some people it doesn't have quite as much of an affect. The tricky part is just that testing it out on yourself you don't really know whether or not you're one of those people that it affects a lot or little. So, anyone that has high blood pressure would really benefit from trying to cut out - even if it's for a short time, as much as they can and really get the level down low to see if their blood pressure improves. If it doesn't improve that much, they should still stick to the recommended amount, but, you know, maybe they need to look elsewhere, like weight loss and exercise and what not to get at lifestyle factors that affect their blood pressure.
Heidi: Yes and weight-loss and weight control, at least, we should say has a huge impact on good health. Tell us about that.
Michelle: Yes, weight control is one the most important things we can do, because a lot of the risk factors that we talked about before really are tied to, and you can't separate them from, weight control. Because a lot of bad habits and things that we do to ourselves travel together. Many of them lead to increased weight, so if you're gaining weight, or you're quite overweight or obese, then you're a much higher risk of not only heart disease and stroke, but diabetes, cancer, worsening arthritis for sure, infertility - which a lot of people don't think about - and a lot of problems with sleep, like sleep apnea. Then, when you don't get enough sleep, or enough good sleep, it actually makes you hungrier and you eat more and that's also a vicious cycle. So, it's very important.
Heidi: Alright, well these are all excellent points, and now we want to find out what to do about it, but we need to take a quick break. So, everybody don't go away. More with Dr. Michelle Hauser from Stanford in just a minute. You're listening to Health Check with Heidi Godman on WSRQ.
*Photo credit: http://www.fstjournal.org/features/27-1/natural-ingredients