Women's Heart Advisor Ask The Doctors: October 2017
Q: My cardiologist wants me to lose at least 40 pounds, with the hopes my diabetes and high blood pressure will resolve. I’ve tried every diet there is, but I just can’t keep weight off. Is it my imagination, or is it getting harder to lose even a couple of pounds?
A: You’ve discovered that gain-and-loss weight cycling—commonly called yo-yo dieting—makes it increasingly more difficult to lose weight. It appears the pattern of losing a few pounds, then gaining them back through unhealthy eating habits, changes your metabolism. Each time you stop dieting, you tend to gain back not only what you lost, but also a few pounds more.
For patients with coronary artery disease, gain-and-loss weight cycling is a destructive pattern. A recent article in the New England Journal of Medicine concluded that the practice is strongly and independently associated with an increased risk of cardiovascular events and death. That doesn’t mean it causes fatal and nonfatal heart attacks, but that when all other risk factors are removed, this one still increases risk a great deal.
The authors also found that the wider the swing in weight, the greater the risk. Patients whose weight varied as little as 8.5 pounds had a 117 percent higher risk of heart attack, 136 percent higher risk of stroke and 124 percent higher risk of death than those whose weight fluctuated 2 pounds or less.
So what can you do to lose those 40 pounds and keep them off? First, stop dieting. A diet is a temporary eating pattern that you plan to maintain only until you lose weight. Instead, see a dietitian. A dietitian will take into consideration your lifestyle, activity level and favorite foods and create a healthy eating plan you can stick with for life. The result should be weight loss, followed by weight stabilization and a reduced cardiovascular disesase risk profile.
Q: How much vitamin D do I need for heart health?
A: Vitamin D, the “sunshine vitamin,” helps our bones absorb calcium. We know it also plays a role in the health of other organs and body systems, since studies have found low levels of vitamin D in some patients with heart disease, as well as Parkinson’s disease and certain types of cancer.
What we have not been able to show, however, is that taking vitamin D supplements can prevent heart or cardiovascular disease. In one study, 5,000 adults with and without vitamin D deficiency were given high doses of vitamin D once a month for more than three years. At the end of the study, exactly 12 percent of both groups—those who took the supplement and those who did not—had developed some form of cardiovascular disease.
Previous studies using smaller doses of the vitamin also showed no cardiovascular benefit.
So what’s the take-home message? The proven benefits of vitamin D are found in bone health. Don’t take vitamin D supplements expecting they will help you avoid heart disease.
Q: What’s your opinion about eating eggs?
A: Eggs are nutritious and high in protein, but they are also high in cholesterol. Cholesterol is a major risk factor for cardiovascular disease, since the body deposits extra cholesterol in artery walls. Your liver makes cholesterol, but you still have some control over the amount of cholesterol in your blood by watching the foods you eat.
The more cholesterol you consume, the higher your blood cholesterol level will rise. In a meta-analysis of 17 clinical trials that evaluated different amounts of dietary cholesterol from eggs, adding 100 mg/day of cholesterol from foods was predicted to increase total cholesterol levels by 2.17 mg/dL and harmful LDL cholesterol by 1.93 mg/dL. How big a difference this would make depends on an individual’s existing cholesterol levels, normal diet and intrinsic ability to absorb cholesterol.
The bottom line is that we still advise everyone to significantly limit their intake of high-cholesterol foods, and that includes eggs. If you love to eat eggs or cook or bake with eggs, we suggest you use egg whites instead of whole eggs.