Q: I’ve have been diagnosed with mild atherosclerosis, and my doctor says I have to improve my diet. Is it more important to eat a low-fat diet or a plant-based one? — Jason D., Sioux Falls, S.D.
A: We’re glad you’re interested in taking steps to reverse your developing cardiovascular disease. We can outline the pros of each approach for you to discuss with your doctor.
If you adopt a plant-based diet, that means you are getting close to nine servings of fruits and vegetables daily. Animal protein is a minor side dish. You emphasize whole grains, healthy oils like olive oil, and don’t eat highly processed foods or foods with added sugars. This diet delivers essential phytonutrients that protect your heart, immune system, brain and other organs.
As for a low-fat diets: Reducing saturated fat consumption from meats, egg yolks and dairy is important when you have — or want to avoid — cardiovascular disease. However, low-fat diets often cut intake of good-for-you fats in avocados, olive oil, fatty fish, walnuts and dark chocolate. Those healthy fats help reduce lousy LDL cholesterol, reduce inflammation and are associated with a lower risk of heart attack and stroke. One study even found that a Mediterranean diet rich in olive oil reduced the risk for diabetes by 40%.
Our recommendation is that you eliminate most saturated fats, especially from dairy and red meats, and pile your plate with tasty veggies and fruit. Studies have consistently shown that you can substantially reverse coronary artery disease with a plant-based, low-fat diet as popularized by Drs. Ornish, Pritikin and Esselstyn. Now a new study out of the University of Minnesota says that both low-fat and plant-based diets lower lousy LDL cholesterol, and a plant-based diet is needed to lower your long-term risk for heart disease. To get the plant-based, low-fat benefits, the researcher suggests you “fill 70% of your grocery bag with vegetables, fruits, whole grains, nuts, legumes, coffee and tea.” Sounds like a good plan to us.
Q: I started taking opioids when I had a knee replacement about six months ago, and I am having a hard time getting off them. Or maybe I am addicted. I have heard that there are some meds that can help. What are they, and what doctor should I see about this? — Katy F., Topeka, Kan.
A: Thank you for reaching out. You are describing a problem that affects a few people post-surgery, despite the new recommendations for less liberal prescribing of opioids and evidence that a schedule of alternating over-the-counter pain relievers can be as effective as opioids like hydrocodone in controlling pain post-op. One study found that patients receiving an opioid prescription after short-stay surgeries have a 44% increased risk of long-term opioid use.
Fortunately, there is a medication available to help with the opioid withdrawal process — and it is successful in preventing deaths from opioid overdoses. It is called buprenorphine, and while it is also an opioid, it generally triggers far less severe symptoms while you wean yourself off the medication. Typically it is used once withdrawal starts and you interact regularly with the prescribing health-care professional for subsequent, ever-lessening doses until you are free of it.
However, you may have to do some research to find a doctor in your area who is trained and licensed to provide it — and many trained buprenorphine prescribers are not actively prescribing it or are treating few patients. Legislation is under consideration in Congress to allow a wider range of health-care professionals to offer it to people in need. Start with your surgeon and primary care physician to find out who might be able provide buprenorphine; ask for a referral to a pain management specialist, and contact Substance Abuse and Mental Health Services Administration at 1-800-662-4357 or samhsa.gov or go to “Find Treatment” at FindTreatment.gov to discover who in your area can support your efforts to get off opioids. We know you can do it with determination and support.
Mehmet Oz, M.D., is host of “The Dr. Oz Show,” and Mike Roizen, M.D., is chief wellness officer and chairman of Wellness Institute at Cleveland Clinic. To live your healthiest, tune into “The Dr. Oz Show” or visit www.sharecare.com.