What do you usually eat for breakfast? How about for lunch and dinner? These questions are standard fare during a consultation with Dr. Ron Blankstein, a preventive cardiologist at Harvard-affiliated Brigham and Women's Hospital. The answers help him tailor the dietary advice he gives, which can have a profound effect on the future health of his patients' hearts.
"Most people really aren't aware of the importance of a healthy diet, or they're confused about what they should be eating," says Dr. Blankstein. About five years ago, he revamped his own diet to follow what the current evidence suggests is the best way to avoid heart disease: a whole-food, plant-based style of eating. "I find that when I tell my patients I follow this diet myself, they're far more likely to buy into it," he says. (For an idea of what he typically eats, see "A day of plant-based meals.")
A DAY OF PLANT-BASED MEALS
Here's what Harvard cardiologist Dr. Blankstein eats on a typical day.
Breakfast: Steel-cut oats topped with ground flax seeds, hemp seeds, chia seeds, berries, bananas, and walnuts, with soy milk or almond milk
Lunch: Bowl of quinoa, beans (usually black-eyed peas or garbanzo beans), tomatoes, cucumbers, peppers, and parsley, dressed with balsamic vinegar, olive oil, lemon juice, and pepper
Dinner: Bowl with roasted sweet potatoes, lentils, kale, red cabbage, broccoli, and avocado, topped with hummus or tahini (sesame seed paste)
Snacks: Apple or other seasonal fruit; almonds
Beverages: Water, green tea
Often, he starts by correcting common misconceptions about the role of diet in health. People often assume that they don't need to worry about what they eat if they exercise a lot or if they're not overweight. Not true, says Dr. Blankstein. Eating a healthy diet is important for everyone, but especially for people prone to heart disease because of a family history or other risk factors, such as having diabetes or high cholesterol.
He always asks, "Who does the shopping and cooking at home?" If it's someone other than the patient, it's ideal if that person can be there for the diet discussion. Many of the decisions about what you eat happen at the grocery store.
MORE, NOT LESS
His suggestions often focus less on what people should cut from their diets and more about what to add. Typically, that means more whole grains, nuts, legumes (beans, peas, and lentils), vegetables, and fruits. The fiber and other nutrients in these foods help people lose weight, lower their cholesterol and blood pressure, and even reverse their diabetes, says Dr. Blankstein.
A lot of people start their day with a piece of toast or a bagel, usually made with white flour. "These highly refined carbohydrates are quickly absorbed into the bloodstream, which leaves you hungry again in a few hours," he says. Instead, have a bowl of steel-cut oats or rolled oats topped with seeds, nuts, and fruit. Having a salad for lunch is a good way to eat a few servings of vegetables. But add some protein (such as garbanzo beans, lentils, or tofu) to make it more filling, he suggests.
What about people who are used to dinners centered around meat? Not everyone is willing to follow an entirely plant-based diet that excludes meat, poultry, dairy, and eggs, he acknowledges. (But see "Processed and red meat: Unpacking the recent studies.")
"It's challenging to change long-held cultural or family traditions. But even small shifts can help," he says. Once a week, try a recipe for a vegetarian chili, or a bowl filled with a mix of cooked vegetables, grains, and beans. You can gradually expand your repertoire from there.
Processed and red meat: Unpacking the recent studies
Last fall, three new studies reanalyzed a large amount of earlier data -- including over 100 studies involving more than six million people -- about the health effects of eating meat. The results confirmed what nutrition experts have been saying for decades: eating less processed and red meat is linked to a lower risk of diabetes and a lower risk of dying from cardiovascular disease or cancer.
So why did some headlines at the time hint that there's no need to trim back on meat? The Oct. 1, 2019, issue of Annals of Internal Medicine, which published the new analyses, also featured a controversial "clinical guideline" with that very advice. The authors argued that the evidence for cutting back on meat is of low quality and that the overall benefit is small. According to them, most people enjoy meat and won't change their eating habits.
However, the article was written by a self-appointed, 19-member panel that included only two nutrition scientists. Their conclusions are not official guidelines and are not endorsed by any government or health entity. Dozens of doctors and nutrition researchers called the recommendations reckless and confusing. "It's like saying to a pack-a-day smoker, well, there's not much evidence that cutting back to a half a pack per day will help you, so just keep smoking however much you want," says Dr. Ron Blankstein, associate professor of medicine at Harvard Medical School.
The Harvard T.H. Chan School of Public Health offers a detailed look at the controversy; see www.health.harvard.edu/redmeat.
REWARDS AND BENEFITS
An expert in cardiovascular imaging and prevention, Dr. Blankstein has published hundreds of articles about technologies to detect heart disease. "But one of the most rewarding aspects of my career is helping people implement diet changes and prevent heart disease," he says. "I've had multiple patients who reversed their diabetes, decreased the level of inflammation in their body, or cut their cholesterol by 50% after switching to a plant-based diet," he says. People lose weight; they also report sleeping better and feeling better over all. "It's made me a real believer in this approach."