Pam Taub, MD, FACC, FASPC: Progressive Dietary Measures for the Prevention of CVD

Among the multitude of risks associated with cardiovascular disease and diabetes, questions regarding dietary habits have always been at the forefront.

As such, the conversations regarding contemporary diets have been important in the prevention of disease and comorbidities in at-risk patients.

In an interview with HCPLive during The Metabolic Institute of America’s (TMIOA) 2021 Heart in Diabetes sessions in New York, NY , Dr. Pam Taub, MD, FACC, FASPC, Professor of Medicine, Founding Director of Step Family Cardiovascular Rehabilitation and Wellness Center, spoke of some of the ways in which dietary habits could help or hinder the progression of cardiovascular management.

When treating her patients, Taub always recommends incorporating diets that have the most evidence-based data to them. Often, diets are made with an individual patients’ needs and cardiovascular struggles in mind.

“What I advise patients to do is to stick to where we have the data, and the data is really around making sure that patients consume good amounts of vegetables and a plant based diet and using the least amount of processed foods as possible,” Taub said. “Also, staying away from red meat and limiting their alcohol intake. That's where the evidence-based diet is really the most robust, and that's what I stick to.”

In her presentation, Taub noted several differences between intermittent fasting and time restricted eating, the former of which has often received the most media coverage.

Despite studies showing some cardiometabolic benefits to intermittent fasting, it was not recommended for at-risk patients, especially those in older patient populations.

“There's lots of subtypes of intermittent fasting, there's alternate day fasting, where every other day you only consume 25% of your daily caloric intake, and that is not safe, especially our for our patients with diabetes are patients with heart failure who are on diuretics,” Taub said. “So when people tell me they're interested in fasting, I really try to curate the right regimen for them.”

Time restricted eating had been incorporated in several studies, 1 of which focused on adult patients with metabolic syndrome.

In it, patients adhered to their ordinary dietary habits, but were given a 10-hour period when they could consume food and a 14-hour fasting period.

This study resulted in a reduction in body mass in patients with metabolic syndrome.

Taub noted that she incorporates the 10-hour consumption and 14-hour fasting periods into many patients’ dietary habits, as time restricted eating allows patients to more naturally follow the body’s circadian rhythms, which positively influences cardiovascular health.

“From an evolutionary perspective, humans really were meant to eat when the sun came out and to fast when it became dark,” Taub said. “We were not meant to be consuming calories throughout the day or eating late at night. That is a period when our organs want to shut down. All of our organs have a circadian clock, and those clocks really want a period of rest and rejuvenation just like we do.”

In her presentation, Taub spoke of the state of ketosis that is activated when in a fasting state, and cited a recent publication that linked ketones to a decrease in blood pressure and body weight, as well as a potential benefit in myocardial function.

She added that sodium-glucose cotransporter-2 (SGLT2) inhibitors shared “mechanistic similarities” to fasting, and that many patients with who are at risk of cardiovascular events have incorporated these inhibitors in their regiment.

The production of ketones by SGLT2 inhibitors have been cited as 1 of the many mechanistic benefits, though Taub urged clinicians to use caution when treating patients.

“You have to be careful when a patient is on SGLT2 inhibitors,” Taub said. “You cannot recommend a ketogenetic diet for these patients, and I do not recommend long periods of fasting for patients with SGLT2 inhibitors because we just don’t have the data for the safety of concomitant SGLT2 inhibitors and aggressive fasting.”