Diets And Artherosclerosis - An Interview With Molly Gee - The Diet Channel, An Award Winning Web Site

Below is an interview with Molly Gee, a highly respected Registered Dietitian, on the topic of Diets and Artherosclerosis:

Eric Enge: Can you start us with a background on yourself and how you got into the Baylor College of Medicine?

Molly Gee: I am a registered dietician, and for the past twenty-five years I've enjoyed working in the Texas Medical Center. I first started with the teaching hospital for Baylor College of Medicine, the Methodist Hospital, in their preventive medicine center. And with that, primary prevention is really the area that I've spent most of my career. And this relates to diet, managing stress, stopping smoking. And that crosses over into all of the major chronic diseases that unfortunately Americans know too well. For the past five years I have gone back to Baylor College of Medicine as a project leader, and have been doing more human trial research on topics like obesity and diabetes. And you know, it's just been just fascinating understanding some of the things that we can do to help prevent diabetes, heart disease, and obesity.

Eric Enge: Right, yes it is a very interesting topic area. Can you give us a definition of atherosclerosis for our readers?

Molly Gee: The simple one is hardening or narrowing of the arteries, so that adequate blood supply and oxygen nutrients don't get too our body. Originally we thought that this was just a disease that progressed with age, that naturally with time the cholesterol, the lipid would build up. But with research, we have really discovered it truly is a disease, and that some people, unfortunately, are more genetically disposed to atherosclerosis, but the good news is there is a lot of things we can do to prevent it. And it is a true disease, and not just a plumbing problem.

Eric Enge: Now, isn't there a distinction between the arteries beginning to harden and the actual process by which they being to get plaque build up and clot?

Molly Gee: Right, I think that sometimes people segment plaque into two different kinds. Certainly there is the type that we've traditionally thought about as a hardening of the arteries, and that build up goes with time and that's sort of in the inside of the arteries, which can result in restricting blood flows. And then the other, which is often more unstable, and as that builds it can actually rupture. And this is where you hear about plaque being released and traveling through the arteries, and that itself blocks an artery or the blood supply to the brain, and leads to a stroke. Still catastrophic, regardless of the type of plaque.

From a symptoms standpoint, when you do have the narrowing of the arteries, this is when people first get first symptoms where they have pain upon exertion, because of an inadequate flow of oxygen. So again it really demonstrates itself in a lot of different ways. And some, unfortunately, are completely asymptomatic, and by the time that they have an event, they weren't even aware they had a coronary artery disease. Unfortunately, this is happening at an earlier and earlier age.

Eric Enge: I imagine a lot of that is driven by poor diet practices. Clearly there is a component which is hereditary, and some are just more predisposed to it than others. But, a number of people are affected just because of poor diet.

Molly Gee: Absolutely. I think that when you are looking at the traditional American diet, we want things quick. We want things fast and convenient and a lot of times some of your quicker meals are higher in fat. And then, we have the other element of super sizing. I would say that one of the key things we can do for ourselves is maintain a healthful weight. And you know, the best way to approach that is taking a look at the guidelines put out by the USDA as well as the American Heart Association in achieving a healthy weight by taking a look at a variety of foods. We can focus first on fat, and trying to cut down on the amount of saturated fat or animal-based fats. You know, that's key. And a very simple way of doing that is, take a look at the amount of lean meats and protein you are taking in each day. And again, making sure that it is lean meat. A very simple thing is making sure that the meat you have is less marbled. And then, if you are having poultry, removing the skin, because that's where most of the fat lives, right on the skin and right under. And taking a look at incorporating more fish meals. There has been research that definitely shows that having fish twice a week, because of the benefits of some Omega-3 fatty acids, may actually lower your risk of a coronary artery disease. So, that's another wonderful preventive measure. Then taking a look at any product from an animal source like dairy products. You know, you need dairy products, but you can also select fat-free, low-fat dairy products, and still get the benefits from the dairy group.

Eric Enge: Right, so skimmed milk instead of whole milk.

Molly Gee: And you know, I would say, if you are trying to cut back from using whole milk exclusively, just gradually accustom your palate by trying low-fat milk or 2% milk first before you dive into say the fat-free or the skimmed milk. Again, you will be surprised at how easily you can get accustomed to that.

Eric Enge: D you have any recommendations for a range or level of fat consumption that you'd make, and the make up of Omega-3 or good fats?

Molly Gee: Sure, just to start off, with try to keep the amounts of fats at 30% or less of total calories. That's tried and true. And by doing that you also magically control your calorie intake as well. Also, trying to substitute more whole grains, fruits and vegetables, that's really what you are going to be striving for, is to substitute those kinds of calories for the fat calories. The goal for saturated fats is to have it at 7% or less. And then I'd be remiss, if I didn't mention just taking a look at your cholesterol level. There are two kinds of cholesterol. That is the kind that you actually find in foods and then the kind that your body naturally makes.

Now lets talk about those risk factors that you cannot control.One of these is the genetic component. Some people have a family history and just make more cholesterol, or their bodies are just unable to clear the cholesterol their body makes. But in turn, there is the cholesterol that we take in in the form of foods. And one easy thing that I try to help my clients remember is that any food item that had a mother or father contains cholesterol. So anything from an animal source does contain cholesterol. So what you are trying to do is, limit your cholesterol to under 300 mg/ day. So, that would be a goal.

Eric Enge: Right.

Molly Gee: You know, I don't want anyone to feel like they have to be a CPA or become a registered dietician just to follow these guidelines. And I think, this is where suggesting, limiting your animal protein intake to about seven cooked ounces a day, paying attention to choosing lean cuts of meat, taking the skin off poultry, that's a real easy way to achieve the more detailed guidelines of about 7% or less of saturated fat. And again, we are getting a lot of press right now about trans fats, that's all in the news. And I would say that one way you can cut back on trans fats is eat less processed foods. That is, foods that have been prepared like commercial baked goods, and traditional snack foods. This is where we are going to find more saturated fats. Eat more fresh fruits and vegetables.

Eric Enge: Right. And, a lot of whole grains.

Molly Gee: Yes, absolutely. They've even suggested having at least three servings of whole grains per day. And you I know, I think a lot of times you would say whole grains, alright. Try to enjoy things that perhaps you hadn't thought about before like, in my culture rice is sort of the mainstay and just combining brown rice with just white rice, that's a way of sort of sneaking in some whole grains. Barley is another wonderful whole grain. During this cold weather time, incorporating barley in soups and other dishes is great, and who doesn't like a good bowl of oatmeal. Those are some examples of how you can get whole grains in.

Eric Enge: Right, and there is a variety of whole grain cereals available.

Molly Gee: Absolutely! And you know, food manufacturers, kudos to them because they recognize that they want to make it easier for their customers to get whole grains in. So, they are finding ways to reformulate tried and true favorites and get those whole grains in.

Eric Enge: Yes indeed. So let's go back to some technical aspects of atherosclerosis for a moment. How is it usually diagnosed and what can be done?

Molly Gee: Well I would say that if you know that you have a family history of coronary artery disease, heart disease, or you have someone in your immediate family that has had a cardiovascular event, regardless of your age, you need to be checked. And just a general good visit with your physician, and getting a good history and a physical, and then also taking a look at whether or not your physician feels likes doing an electrocardiogram. A lot of this depends on your age and other risk factors. For example: you know if you are overweight, or if you have high blood pressure, or diabetes, which are other risk factors for heart disease, take more of a prudent route and do more tests.

Anything from a chest x-ray, to a blood test, to checking your lipid profile, all the way to a stress test. And then there are different levels of stress tests, depending on your risk factors. Checking the size of your heart through an electrocardiogram and then certainly the gold standard is where they really take pictures with a cardiac catheterization. So you know, depending on your risk factors, and if you are having any signs or symptoms, really determines the level of diagnostics that your physician or cardiologist would do.

Eric Enge: Isn't there a correlation between visible build up of plaque in your peripheral arteries and problems with your heart?

Molly Gee: Right, and again, that is a wonderful screening process, and I would really suggest that you develop a relationship with your physician, and to have this checked out. You need to have a baseline and to see what changes occur with time. Because this way, you can see if there are any trends that warrant further treatment. Once you have it, what do you do next? You know there are things you can do to reverse it, depending on the severity and the degree that you have it. Certainly, diet and exercise, and certainly some of the pharmacotherapies have made such big progress in reversing coronary artery disease.

Eric Enge: Right, this is one of the questions that I wanted to ask about, was the process of attempting to reverse it. As I understand it, what you want to do is you want to work on getting a bad cholesterol number which is not only below the danger signal range (Editor: i.e. below 110 ????), but actually more like the seventy to eighty range or something like that. Am I understanding that correctly?

Molly Gee: That's correct. As you look over time, as more research is being done, you've seen the standards for target total cholesterol, bad cholesterol, orLDL, and good cholesterol, or HDL, change. The LDL range has gotten lowered because they have seen that you can perhaps prevent atherosclerosis.

In addition, people should maintain a good weight, and be more physically active. You know, my plea is if they won't do it for themselves, think about the next generation. You know, our children are watching everything we do. And consequently, if we are not taking care of our bodies, and we are not nourishing it properly, keeping it at a good weight and being physically active, what does that tell our children? And this is what's really alarming, is that people are dying of heart disease at earlier and earlier ages.

So that's why I say, don't wait until you have some kind of chest pain or angina, don't wait until maybe you're having a little shortness of breath. I mean find out what shape you're in now, where do you stand, what's your score, what are your numbers? People need to know their numbers.

Eric Enge: Can we talk about heart disease and women for a moment?

Molly Gee: We used to, very much, think that heart disease was a man's disease. But for women heart diseases is the number one killer. I think breast cancer is the most feared, but heart disease is the number one killer. The American Heart Association, with their Red Dress Campaign this month, is really trying to educate people more about this.

Eric Enge: So, when we tried to get back to the diet world and now we are in the situation where we know we have artherosclerosis and we are trying to do things to reverse it. There are certainly drugs that might be prescribed like Statins, but aren't there also certain kinds of foods that are thought to have beneficial effects like garlic, or pomegranate, or grape seeds?

Molly Gee: Well, there are a number of foods that have antioxidant and anti-aging effects. Research is showing that things like blueberries, pomegranate, and garlic do help. Those are wonderful foods, and I think embracing those and getting more berries on your cereal is good. But at the same time, we need to know that there are no magic foods.

Eric Enge: Right.

Molly Gee: I think that finding a good healthy weight that you can maintain is probably first and foremost, finding regular physical activity, if you can get in at least thirty minutes of physical activity, most days of the week, then you are doing such a great thing for your body. Crowding out the fats as much as possible. One way to do that is reduce the amount of fried foods you eat. Incorporating more fruits and vegetables, and then also paying attention to whole grains and higher fiber foods, these are all ways that you can reduce cholesterol in your diet, reduce the fat content of your diet, and that's probably the most important thing. And then, if you are going to be choosing fruits and you love blueberries, blackberries, if you enjoy pomegranate, that's great too. There is research being done that shows that they do have antioxidant properties, that they can reduce our aging.

Eric Enge: Excellent! So, do you have any other dietary recommendations that you would make at this point?

Molly Gee: In addition to what we have talked about above, I would say getting into more fresh foods versus processed foods, taking the salt shaker off the table, that way you can control the amount of salt-sodium in your diet, and then if you use alcohol, do it in moderation, no more than two servings of alcohol per day. And when you are eating out, watch those portion sizes.

Eric Enge: Can you add a few words about the research that you are working on?

Molly Gee: One of the wonderful things that they are doing here at Baylor is primary research on how we can reduce the bad cholesterol, the LDL cholesterol, and then how we can increase the good cholesterol, the HDL cholesterol. And so there are lots of studies that are going on both in taking a look at the different pharmacotherapy solution, the statin therapy that may be able to reduce coronary artery disease. We are also taking a look at some other items like niacin, and its role in trying to increase HDL cholesterol.

Eric Enge: I really want to thank you for taking the time to talk to us.

Molly Gee: Well listen, it's been great!

Molly Gee, RD, M.Ed, is a registered dietitian and communications consultant with more than 25 years experience in health/nutrition communications and the clinical management of obesity. She currently is a project leader for the Behavioral Medicine Research Center, department of medicine at Baylor College of Medicine (BCM) in Houston. From 1992 to 2001, Molly reported on nutrition and health on KTRK-TV, the ABC network affiliate in Houston. Prior to health reporting, she was the nutrition expert on "Good Morning Houston." In recognition of her dedication and contributions to dietetics, Molly received the ADA's Medallion award in 2004 and is co-founder and past chair of the ADA's new Weight Management Dietetics Practice Group.

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