Erin D. Michos, MD, MHS, FACC, FAHA, an associate professor of medicine and epidemiology, and associate director of preventive cardiology at Johns Hopkins School of Medicine in Baltimore, told Cardiology Advisor, “For my own family and for my patients, I am personally a champion of the Mediterranean diet because it includes a wide variety of healthy food choices that are palatable to most patients and not too restrictive, and most importantly has strong evidence for cardiovascular benefits from multiple epidemiology and interventional studies.”

Dr. Nichols adds that the evidence clearly indicates that patients should be eating whole foods rather than attempting to get vitamins and antioxidants from dietary supplements, yet “so many Americans are still wasting their money on vitamins and supplements when their money would be better spent on purchasing high-quality foods and doing activities that promote movement, such as physical activity.”

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In a study reported in the same special issue of JACC, researchers from multiple international universities investigated whether the provision of dietary advice and healthy food would improve eating patterns and CV disease risk in healthy overweight adults.5 Their findings show that the provision of foods led to a modest increase in the consumption of recommended food items, and dietary advice resulted in small benefits pertaining to heart disease risk factors.

These results underscore the difficulty often associated with facilitating shifts in patients’ eating habits and the need for additional strategies. “I think for the most part we know what patients should be doing, but the trouble for many is keeping up with lasting behavioral changes,” said Dr Michos. “We need more data about what motivates individuals for long-lasting behavioral and lifestyle changes.”

Meanwhile, she offers the following tips and additional points for clinicians to consider as they encourage healthy eating in patients.

  • I have found that many patients have difficulty with or reluctance to following a strict vegetarian or vegan diet. But even if they can’t adhere 100%, I think there is strong benefit to striving closer to that goal with a more plant-based diet most days of the week, and I am a fan of the adoption of vegetarian days such as “Meatless Monday.”
  • When I communicate with my patients, I like to break it down into the simple message of “Eat Less. Eat Smart. And Move More Daily.”
  • I recommend that patients set goals that are specific, attainable, and forgiving.
  • I highly recommend self-monitoring with food and activity trackers to help change behavior in the desired direction and produce real-time records for review.
  • I do these things myself, too, to show my patients that even a busy cardiologist who is a full-time working mom can find time to exercise and eat healthy, and that if you do this regularly, it becomes a habit.

“I think it is important for doctors to practice what they preach or they don’t hold credibility for their patients when counseling about lifestyle,” she said.

“The goal is for both patients and their healthcare providers to make good dietary habits and regular exercise a part of their everyday life so they can maintain a long-term optimal weight and cardiovascular health.”

Disclosures: Dr Freeman and co-authors list various disclosures in their paper. 


  1. Freeman AM, Morris PB, Barnard N, et al. Trending cardiovascular nutrition controversies. J Am Coll Cardiol. 2017; 69(9):1172-1187. doi:10.1016/j.jacc.2016.10.086
  2. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition. 2015. Accessed March 24, 2017.
  3. Stewart RA, Wallentin L, Benatar J, et al;STABILITY Investigators. Dietary patterns and the risk of major adverse cardiovascular events in a global study of high-risk patients with stable coronary heart disease. Eur Heart J. 2016;37(25):1993-2001. doi:10.1093/eurheartj/ehw125
  4. Crowe FLAppleby PNTravis RCKey TJ. Risk of hospitalization or death from ischemic heart disease among British vegetarians and nonvegetarians: results from the EPIC-Oxford cohort study. Am J Clin Nutr. 2013; 97(3):597-603. doi:10.3945/ajcn.112.044073
  5. Jenkins DJ, Boucher BA, Ashbury F, et al. Effect of current dietary recommendations on weight loss and cardiovascular risk factors. J Am Coll Cardiol. 2017;69(9):1103-1112. doi:10.1016/j.jacc.2016.10.089

This article originally appeared on The Cardiology Advisor