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A. Introductory Comments
Heart disease and stroke continue to be leading causes
of death and disability in the United States. Obesity and associated
type 2 diabetes are on the rise. While many doctors can guide you to
appropriate medical therapy for these conditions, finding the right
diet and exercise program presents a different challenge
altogether.
Dr. V combines intelligence and wisdom from his
training and experience in medical science with common-sense and
intuition from his life-long interest in exercise and nutrition in
The HAPI Heart Diet and The HAPI Heart Cookbook. A
health-promoting lifestyle that includes daily physical activity and
eating foods that the human body was actually designed to consume is
described.
Dr. V delves into how such strategies prevent, retard
or even reverse cardiovascular disease, type 2 diabetes,
'cholesterol' (lipoprotein) disorders and
obesity.
The HAPI Heart Diet and The HAPI Heart
Cookbook have it all: in-depth scientific information
about cardiovascular (CV) disease, type 2 diabetes,
pre-diabetes, obesity and lipoprotein disorders broken
down for patients as well as physicians; detailed charts on
calorie counting, glycemic index as well as good vs bad fats in
oils, nuts, fish, white meat and red meat; over 250 pages of healthy
but yummy recipes based on the principles of classic French culinary
art (la haute cuisine); food preparation tips and wine
recommendations for healthy but yummy meals; and over 40
pages dedicated to appropriate aerobic, stretching and
strengtening exercise. The HAPI Heart Diet and The HAPI
Heart Cookbook weren't written for weenies. No gimmick, no
quick fix and no miracle pill will be found in their pages.
These books are for people who are serious about
understanding CV disease and changing their lives for the
better. These books are for people who really want to
learn how to eat less, eat smart and move more each
and every day for the rest of their lives in order to guarantee
healthier and happier
futures.
In The HAPI Heart Diet and The HAPI Heart
Cookbook, the reader will not be talked down to but instead
will be engaged face-to-face as an adult responsible for their own
health. What Dr. V believes to be the truth will not be sugar-coated
but WILL be kept as simple and straight forward as possible. Humor
and a light-hearted approach to life, health and disease will
be found throughout the books.
Regardless of whether or not other diets have worked
for you in the past, if you think positively, decrease your daily
caloric intake, increase your daily caloric expenditure, optimize
your daily metabolism and realize you are embracing a new and better
way of life rather than a new and better way to fit into some trendy
clothes for that upcoming high school reunion, you will find it
impossible not to succeed. The HAPI Heart Diet and The
HAPI Heart Cookbook will show you
how.
B. The Basics
The five main principles
of the HAPI Heart Diet are: 1) eat less; 2) eat smarter; 3) exercise
more; 4) exercise smarter; and 5) have the right
attitude.
In the HAPI Heart Diet,
total daily caloric intake must be appropriate to the individual’s
height and physical activity level. These calories should be
consumed in four to six main meals each day (balanced in terms of
fat, carbohydrate and protein content) with the largest meals during
mid-day. 25-40% of daily calories should come from fat; 40-55% from
carbohydrate; and 15-30% from protein. Less than 1% of daily
calories should come from trans fatty acids; less than 7% from
saturated fatty acids; and less than 10% from omega-6
polyunsaturated fatty acids. On the contrary, 15-30% of calories
should come from omega-9 monounsaturated fatty
acids.
Carbohydrates with a
relatively low glycemic index (GI) should be eaten throughout the
day (balanced in main meals along with fat, protein and extra
fiber), except right after exercise, when carbohydrates with a high
GI should be eaten (along with a smaller amount of protein but no
significant fat or fiber). Salt should be avoided while peppers,
herbs and spices should be liberally used.
Exercise must be
performed each day for at least 60 minutes, preferably in the
morning and/or evening (60% aerobic, 20-30% strengthening and 10-20%
stretching). Drinking at least six to eight glasses of water
(preferably right before as well as in between meals) and adding 25
to 35 grams of supplemental fiber (such as one to two Fiber Choice
sugar-free wafers or one to two tablespoons of Benefiber powder
taken with each balanced main meal) is also required. One-half
tablespoon of Benecol Light and one-half teaspoon of high-quality
liquid fish oil (such as the JR Carlson brand) should be taken with
main meals. One to two cups of green and/or white tea should be
taken with each main meal with one to two glasses of red wine (or
the equivalent) as an alternative with dinner.
Tree nuts (especially
almonds, hazelnuts, macadamia nuts and pecans), olive oil, macadamia
nut oil, canola oil and avocadoes should be the main vegetable
sources of fat (rather than walnuts, pine nuts, margarine or the
other vegetable oils).
Fish and shellfish should be the main animal sources of fat
(rather than high-fat dairy products, eggs or the various
legged-animal meats). Less than 300 mg of dietary cholesterol (from
animal products) should be consumed every
day.
Leafy green vegetables
(especially broccoli), apples, avocadoes, beans, berries,
cauliflower, garlic, kale/romaine (but not iceberg) lettuce,
mushrooms, onions, pears, peppers, sweet potatoes, tree nuts (as
above) and tomatoes (basically the entire fresh produce section of
your local supermarket) along with brown/wild rice, whole grain
breads, cereals and pastas should be the main vegetable sources of
carbohydrate. Carrots, corn and peas are fine but, since they do
contain a lot of natural sugar, should be taken mixed with other
vegetables. Low-fat/non-fat dairy products such as skim milk and
yogurt should be the main animal sources of carbohydrate. These
‘healthy’ carbohydrates should either be taken with your main meals
(that also contain protein and fat) along with a fiber supplement or
within 30 minutes of exercise. Processed, 'refined' foodstuffs
(white flour, white bread, cakes, candies, cookies, white noodles,
white pastas, pies, white potatoes, white rice and other ‘sweets’)
should be avoided.
The main animal sources
of protein should be low-fat/non-fat dairy products (cottage cheese,
skim milk and yogurt) as well as small servings (4-6 oz – about the
size of the four main fingers held together) of fish and/or
shellfish (rather than eggs or legged-animal meat). The main
vegetable sources of protein should be whole grains, legumes, nuts
and seeds.
As you can see, the
foundation of the HAPI Heart Diet is pursuing a natural lifestyle:
being physically active each day and consuming foods at every meal
that our bodies were actually designed to
consume.
The
HAPI Heart Diet is a variant of ‘The Mediterranean Diet’ evaluated
in the Lyon Heart Study. This study
involved patients with known coronary heart disease
(CHD):
a) eating more fresh fruits and vegetables; b) eating more bread and
less other starch; c) drinking a modest amount of alcohol; d) eating
more fish and less other meat; e) using only olive and canola oil;
and f) using no margarine or butter (de Longeril M et al. Circulation. 2001:103; 1823-1825).
These dietary changes lead to a striking ±25% absolute risk
reduction (way, way, WAY better than any drug EVER
studied for such purposes) in recurrent CV
events
C. Why
I Wrote 'Another' Diet Book
Q: How much training in
diet, exercise and nutrition does the typical physician have in
medical school and/or in internship/residency/fellowship following
medical school?
A. None
Patients come to doctors
for solutions to their problems. One of the biggest (no pun
intended) problems occurring in our modern society is obesity and
the associated disease states of type 2 diabetes mellitus and
atherosclerotic cardiovascular disease. In such circumstances, the
physician will typically advise the patient to: “Exercise and follow
a sensible diet.” But the conversation usually ends at that point.
This book is my attempt to continue the discussion.
We
live in an era where information about almost every topic imaginable
is almost instantly accessible. The problem with all this
information is separating the good information from the
MIS-information. I believe (at least in terms of health and
disease) this is one of the most important current roles being
played by medical doctors (the latter word literally meaning
‘teachers’). Many physicians and laypersons out there may believe
that much of the information presented in this book is ‘above the
head’ of the average patient. I believe otherwise – I believe the
truth ‘shall set you free’ and that people can understand much more
than others give credit.
As
an example of this, let’s consider the story of Galileo and his
discovery that the cosmos did not rotate around the earth (the
center of the Creator’s universe as per scientific dogma of the
time) but rather, in fact, the earth rotated around the sun.
When
Galileo presented his findings to the scientific authorities of the
time (high-ranking officials of the Catholic Church), he was first
applauded for his scientific wit and acumen but then abruptly
dismissed, informed that these findings were not ‘news,’ since the
Church had known of such things for over 1000 years.
Galileo
then asked (obviously), “If the Church has known of such things for
more than 1000 years, why haven’t the masses been
informed?”
The
reply came, “Oh, Galileo, the masses would NEVER understand
such things.” Fast forward to the current era – many four-year-old
children can easily recite, “Mercury, Venus, Earth, Mars, Jupiter…”
The masses CAN understand such things. The TRUTH
usually makes sense (although I still haven’t figured out why I
voted for Perot in ’92) – what’s difficult to understand is a
half-truth.
Thus,
in both of these books, I start things off (in Chapter 1) by
describing what I believe to be the truth – lipoprotein
(‘cholesterol’) disorders serve as the foundation for cardiovascular
disease, type 2 diabetes, pre-diabetes and obesity. Anyone who wants
and/or needs to understand these important disorders (patient as
well as physician) must therefore understand the ‘How’ and ‘Why’ of
them.
Now,
you may wonder ‘how and why’ I have such deep interest in such
disease states. Q: Is it because my father (still alive and kicking)
and paternal grandmother were type 2 diabetics. A: probably, but I
think the real answer concerns how I decided to present myself as an
Internal Medicine physician (probably best described as a
‘pediatrician for adults’) in the first place. I could be the
typical ‘Burps and Farts, Aches and Pains, Sprains and Strains,
Coughs and Colds, Moans and Groans, S***s and Giggles’ internist
OR I could do something that ‘really mattered.’ I think most
adults would agree that preventing cancer and/or cardiovascular
disease (together causing the VAST majority of premature
death and overall human suffering out there) would be considered
things that really matter. Now, what could I do about cancer? I
could promote a healthy lifestyle and screen for certain cancers
(breast, colon, pelvic, prostate and skin) but then refer to a
‘specialist’ if any such cancers were actually detected. Not too
exciting. How about cardiovascular disease? I could do a lot –
promote a healthy lifestyle and screen for certain related disease
states (hypertension, diabetes and dyslipoproteinemia [the latter
term meaning ‘screwed up lipoproteins’]) but then I could
ALSO actually treat such things. Imagine that? And I feel, if
you’re going to do something important, you might as well do it
right or don’t even bother doing it at all. Don’t do anything
important half-a***d is my motto (because if it doesn’t work out you
only have yourself to blame). I believe that if I do my job right
AND if the patient does their job right, together we can put
the vast majority of interventional cardiologists and cardiovascular
surgeons OUT OF BUSINESS (sorry guys, nothing
personal).
Now
let’s talk about how I view the proper patient-physician
relationship. Like most American boys born and raised in the
Midwest, I learned to love football
at an early age. I
think of myself (the physician) as quarterback and the patient as
wide receiver. Together we call the play in the huddle – a pass. I
will do my part to throw the ball right where it needs to go and
right into the receiver’s hands. But they need to do their part –
they must run the right route, catch the ball and avoid the
defenders. They get to score, do their favorite end-zone celebratory
dance and receive all the applause of the crowd (and rightfully so).
But, they also get to hear the booing of the crowd if they drop the
ball, get smacked by the defender, fumble the ball and/or fail to
get the crucial first down or score. What if they run the wrong
route? Then we both just look silly. That’s why good communication
between doctor and patient is crucial – we MUST be on the
same page. Think about it – miscommunication serves as the root
cause of almost all conflict between people – fistfights, lawsuits,
divorces, wars, etc… MAKE SURE you and your doctor are on the
same page.
Enough
of such philosophy (sorry, I just can’t help myself, being of Greek
descent and all). Since the ‘truth’
usually resides between the two extremes of ‘ignorance’ and
‘neurosis,’ we will then (in Chapters 2 through 7 of The HAPI
Heart Diet) elucidate on various nutritional-, dietary- and
exercise-related concepts to find some common sense recommendations
for happy and heart-healthy living. The five central principles of
the HAPI Heart Diet will be described: 1) eating less; 2) eating
smarter; 3) exercising more; 4) exercising smarter; and 5) having
the right attitude.
Regardless of whether or
not other diets have worked for you in the past, if you think
positively (‘have the right attitude’), decrease your daily caloric
intake (‘eat less’), increase your daily caloric expenditure
(‘exercise more’), optimize your daily metabolism (‘eat smarter’ and
‘exercise smarter’) and realize you are embracing a new and better
way of life rather than a new and better way to fit into some trendy
clothes for your upcoming high school reunion, you will find it
impossible not to succeed with this
approach.
In
Chapter 4 of The HAPI Heart Cookbook, we’ll
start things off with how best to stock your kitchen with all those
various and sundry items needed to make your meals both healthy as
well as yummy. Then we’ll go over various healthy cooking
techniques. We’ll get into the basic types of meals – snacks,
pre-workout meals, post-workout meals, soups, salads, grains,
seafood, non-seafood meats and desserts (each getting its own
section). We’ll discuss how best to design your meals – main ones
(breakfast, lunch and dinner) as well as smaller meals in between
those main ones. Instead of just throwing a bunch of pre-arranged
recipes at you, I’ve decided to make things a bit more interesting
by giving you the knowledge, freedom and versatility to create your
own healthy and yummy meals. Believe it or not, all this will be
based on the fundamental principles of classic French
cooking/culinary art (‘la haute cuisine’). That’s right…
HEALTHY classical French cooking – can you believe it? We’re
talking Béchamel, Beef Bourguignon, confit, Coq au Vin, coulis,
Demi-Glace, Duxelles, Espagnole, Jus Lié,
Matignon,
Mirepoix, Velouté… As you will see, we don’t mess around in ‘The
HAPI Heart Diet.’ For example, in the non-seafood meats section, I
review the fat breakdown of different cuts of beef then recommend
various healthy cooking techniques and healthy but yummy spice rubs,
pastes, marinades and sauces that go great with beef, pairing all
these options with various wine suggestions to make some
REALLY yummy (but healthy) meals (beef or otherwise). In
Chapter 9, I give an example from my own life showing a sample day
on the diet and lifestyle.
The
HAPI Heart Diet and The HAPI Heart
Cookbook aren't for the guy who’s just come from the
doctor’s office, a little shell-shocked at having received the news
that his total cholesterol is in the 250+ range nor for the
health-conscious couple that simply wants to acquire a new
repertoire of recipes and restock their fridge. These books are
for people who are serious about understanding cardiovascular
disease as well as changing their lives for the better. These
books are not light and fluffy, like so many other diet,
exercise and ‘healthy living’ books. The
HAPI Heart Diet and The HAPI Heart Cookbook
aren’t for weenies. These aren't
‘dance your way to better health, pour a glass of wine and let’s
talk about cutting out butter’ books. No gimmick, no quick fix and
no miracle pill are found in their
pages.
The
underlying theme of The
HAPI Heart Diet and The HAPI Heart
Cookbook is more
like: ‘I’m talking to you
as an adult responsible for your own health; I will not sugar coat
what I believe to be the truth; I will not talk down to you; I will
not make it easy but I WILL keep it as simple and
straight-forward as possible.’ Please be appreciative, rather
than alarmed or offended, by my level of frankness. eaders
will have to roll up their sleeves and pay attention, but they will
learn everything they need to know about lipoprotein subclasses,
physiologic versus pathologic conditions, ‘good’ versus ‘bad’ fats
and will walk away with all kinds of diet and exercise advice,
eclectic health- and nutrition-related tips and a whole bunch of
healthy and yummy recipes.
I have
included specialized information (including the whole of Chapter 10
of The HAPI Heart Diet at the end) meant primarily for
physicians because I want the doctor and patient to be on equal
footing and the ‘same page’ when it comes to health, disease,
exercise and proper nutrition. Be prepared for statistics, graphs
and in-depth medical terminology to be presented from the outset.
These aren't ‘Diet Books for Dummies.’ But don’t worry –
you WILL understand the ‘big picture’ nature of any technical
scientific lingo. To assist in your comprehension of the material,
at the end of each chapter I have included a list of learning
objectives for that particular chapter. I throw a wide net in The
HAPI Heart Diet and The HAPI Heart
Cookbook and
hope to ensnare you, reel you in and share with you (whether
prospective patient or clinician) a thing or two about happy,
heart-healthy living.
In my opinion, life is a
blessing and gift from the Creator whose purpose is the continuous
improvement of our self and of others around us. We are challenged
with many choices throughout our life in this journey of
self-improvement. It is the choices we make that help determine our
future. We are motivated in these choices either by love or by fear.
These books are my attempt to help patients and doctors make better
choices for healthier and happier futures based on love for life
rather than fear of sickness or death. My intent was to present my
thoughts for the reader’s education, inspiration and
enjoyment. My
deepest hope is that you get something worthwhile from these
books.
Call (239)
261-HAPI today for an appointment at the Heart Attack
Prevention Institute (HAPI) with Dr. V.
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