Kris: Dr. Ozner great to have you on Wellness Talk Radio today.

Dr. Ozner: Thank you.

Kris: Dr. Ozner, what is heart disease?

Dr. Ozner: Heart disease, and in particular coronary heart disease, is the Number 1 killer in the country both for me and women because we understand that when people suffer heart attacks, and we should throw in strokes as well so we put that under the heading of cardiac vascular disease, it is from a disease which we call arthrosclerosis which is a buildup of cholesterol. And we use to think that it was simply a cholesterol storage disease but kind of like we have plumbing pipes in our bodies collecting sludge and then when the sludge becomes significant it chokes off the artery and we have a heart attack; that was the old theory. We now understand that this is actually not what happens. We understand that this disease of atherosclerosis, which I liken to the atherosclerotic plaque to a pimple in the artery wall, is really an active inflammatory disease and we’ve learned that over the past decade. Now we understand the mechanism by which these little pimples or atherosclerotic plaques rupture and lead to heart attacks. And really to everybody’s surprise who hears this it’s not the 90% plaque or blockage that you really have to watch out for it’s the 1%, 5%, 10% plaque that suddenly ruptures because it’s highly inflamed and then when blood comes into contact with the plaque itself we get a sudden and often catastrophic clot that then shuts down blood supply in the artery. The average person who has a heart attack has no prior warning, just like the average person who drops dead suddenly, what we call sudden cardiac death, has no prior warning because they have a small 10%, for instance, plaque that suddenly ruptures and when it ruptures within a matter of seconds they go from 10% blockage to 100% blockage and fall down, they have a heart attack, sudden cardiac death, sudden vascular catastrophe.

Kris: So how many of these plaques do people that are looking at having heart problems, how many of these do they have normally? Is it just several or what kind of numbers are you looking at?

Dr. Ozner: Well that’s actually a very good question because what we’ve always thought that these plaques were kind of uncommon and that, you know, most people say “Well I don’t have a plaque.” As it turns out we know from many different studies that this is a disease that starts at childhood. There was a study called the Bogalusa Heart Trial which showed that even children five, six, seven years old had the earliest signs of atherosclerosis, namely fatty streaks. And then as we get into our teenage years and our 20s and beyond most Americans have the atherosclerotic plaque and it’s from living the good old American lifestyle with our toxic American diet, our lack of exercise, our smoking, our highly stressed society, all of these contribute to build up of plaque. And as a result I would say that the overwhelming majority of Americans are walking around today with varying degrees of atherosclerotic plaque within their artery. The reason why some people have a rupture of the plaque and end up dropping dead from a heart attack or having heart attacks, stroke, and other people don’t in large part has to do with how highly inflamed these plaques are.

Kris: Okay so is there hope for people like me that grew up in a very well rounded diet as a child of kind of like Fruit Loops, Twinkies, top it off with some ice cream. Is there hope for those of us that have switched over and changed their diet?

Dr. Ozner: So that’s right. I mean you’re defining the typical American diet.

Kris: I won’t say it wasn’t fun.

Dr. Ozner: Well a lot of people think the essential food groups are pizza, ice cream and hot dogs. What we understand is that, and here’s the good news, that this is reversible and the Number 1 killer in this country cardiovascular disease is in many respects a preventable disease and we know the tools how to prevent it. My book “The Great American Heart Hoax” I talk about why we’ve missed the boat and Part 2 of the book is the solution My 10 Step Approach on How You Can Write the Chef on how you can quill the fires of inflammation. How you can have these plaques reversed and largely prevent your chances of ending up with a heart attack, with a stroke, with these devastating conditions that take people often in the prime of their lives.

Kris: So Dr. Ozner I’d like to talk about the Ozner 10 Step Prevention Plan because we thought that was just brilliant, it really laid out for people things to look for and ways to improve your heart health. So would you mind talking just a little bit about your 10 Step Prevention Plan for people?

Dr. Ozner: Well I’d love to. I mean, you know, it starts with Step Number 1 which is probably is one of the most important steps and that’s nutrition. Years ago I became intrigued with all of the data was coming in on The Mediterranean Diet data from all over the world including America which basically has shown study after study that the Mediterranean style diet can significantly lower your risk of a heart attack, of a stroke, of having high blood pressure to lower your risk of developing diabetes that could lower your risk of Alzheimer’s disease, of Parkinson’s disease and a whole host of other disease states including cancer. Now how can that be? How can one dietary approach do all these wonderful things? It’s because a Mediterranean Diet is not highly processed. It does not contain processed foods. And a lot of the processing that we put in food supply like Trans Fats, like refined sugar, like sodium, ratchets up inflammation, ratchets up oxidative stress and this really wrecks havoc throughout our body, create millions and millions of what we call Free Radicals. Free Radicals are these unstable molecules that go around zapping DNA, increasing the risk of cancer, oxidizing our bad cholesterol leading to heart disease. And we know that the antidote to these Free Radicals are anti-oxidant they neutralize free radicals. And where do anti-oxidants come from? They come from a wide variety of fruits and vegetables of all different colors. And so it’s very clear that our best approach to prevention of not only cardiovascular disease but a wide variety of disease is to supply our body with a wealth of fruits and vegetables of all different color, as well as avoid processing that includes partially hydrogenated oil, refined sugar like high glucose corn syrups, sodium and a whole host of different other ingredients that goes into the American food supply.

Kris: Let’s talk about those fats a little bit because that I think is very confusing to people. A lot of our labels say zero Trans Fats and when indeed they actually do have Trans Fats. And I know I’ve been confused about which oil is okay to eat. Can you kind of go into that?

Dr. Ozner: I will that’s a good question. I say that our government has let us down in this regard. The country of Denmark has banned Trans Fat years ago and the food minister said “We put public interest above industry interest.” We haven’t done that in this country we’ve bowed to a lot of lobbying efforts by the food industry and, you know, as it relates to Trans Fat. Finally, about a year ago the food industry was forced to put Tran’s fat on the label but they did a side run, an end run if you will, because they allowed the food industry to put zero Trans Fat and still have up to 500 milligrams of Trans Fat per servings.

Kris: And what are the problems with Trans Fats?

Dr. Ozner: Well the problem is that it increases your bad cholesterol, it lowers your good cholesterol, it makes your platelets more sticky, it increases other atherogenic particles like lipoprotein little A which are highly atherogenic and can cause heart attacks and guess what it ratchets up inflammation. So Trans Fats are not your friend and they are toxic. I say eating a diet that is filled with Trans Fats is like taking a gasoline powered car and putting diesel fuel in it your gasoline powered car is not designed to run on diesel fuel and if you did that see how far your car would run before it conked out. That’s what we’re doing to our body. For more interviews with the world’s top health and medical experts go to Michael Senoff’s www.HardToFindSeminars.com

Kris: And are they only found in processed food or where are they?

Dr. Ozner: Yeah for the most part Trans Fats are fats that we’ve created by hydrogenating oil, vegetable oil, and creating partially hydrogenated oil. And clearly they’re in a lot of food products they’re in most cookies, they’re in margarine, they’re in cake mixes, they’re in roughly half of the food that you buy in supermarkets. And I think that the American consumer has to become a sleuth because if our government isn’t going to protect us we have to protect ourselves and our families by reading nutritional labels. And when you read the nutritional label and you see partially hydrogenated oils listed don’t buy the product.

Kris: Well I think it’s fair to mention to that some of the problem with these highly processed fat laden foods - it took me about three years to actually change my eating habits because I was drawn to those I had had a lifetime of eating very heavily fat foods.

Dr. Ozner: Well the worse part about this is that it is not essential. I’ve always said I could make an apple pie two ways. I can make an apple pie laced with Trans Fats and laced with ingredients that aren’t good for you that will definitely lead to ill health or I can make an apple pie that’s absolutely delicious that absolutely has none of these ingredients that you wouldn’t be able to distinguish the two if you sat down and ate both apple pies. So why would we want to put something in our food supply that is going to lead to premature death? It increases our risk of not only heart disease but cancer there’s no reason for it. Before the Great American Heart Hoax I got so interested in this whole arena of nutrition and how nutritional science has really come a long way. And we know that putting patients on a Mediterranean Diet I absolutely can significantly improve their health and I wrote the “Miami Mediterranean Diet” a couple of years ago and I’ve been utilizing this before I ever wrote the “Miami Mediterranean Diet”, which is basically the “The Mediterranean Diet”. The reason I call it “Miami Mediterranean Diet” is because I’m from Miami and I’ve included updates in nutritional sciences they’ve come along over the years, and the fact of the matter is that we understand today that the American public certainly takes too many medications; they’re overmedicated. It’s not uncommon to see patients with high blood pressure, diabetes and high cholesterol, dump out 20 prescription pills on the table and, you know, we clearly have a better approach. And I’m not saying medicines aren’t good clearly some patients need to take medication to control their cholesterol for instance, but remember one thing there is no such thing as any cholesterol lowering medicine including the most powerful stat is a substitute for a healthy lifestyle. I say where we have missed our way is that often we go to the doctor and we’re given very powerful stat medications and other types of medications and nobody even mentions the power of lifestyle intervention including a healthy diet. That should be first and foremost. And then if you don’t get the goal despite a healthy diet and lifestyle then fine then medications are fine, but I can guarantee you will be on fewer medications, if you in fact even have to be on medication, by following a Mediterranean Diet and lifestyle.

Kris: Right. And we have a bill in California right now that’s addressing that very topic they’re hoping doctors will give out health nutrition information to people.

Dr. Ozner: Well I think it’s essential. The Seven Country Study performed by Dr. Ancel Keys years ago showed that if you were a middle-aged man following a Mediterranean Diet living on the Island of Greek you had a 90% less likelihood of dying prematurely from a heart attack compared to your middle-aged American counterpart which prompted Dr. Keys to say “If some countries can do without heart attacks why can’t we?” And I believe that study after study the Leon Hart Trial showed a 70% reduction in mortality in those randomized to a Mediterranean Diet versus an American Diet. And I think that the data and the handwriting is on the wall. We really have, I think in many respects, mislead the American public giving them more and more medication, putting in more and more stints, doing more and more bypass operations when in fact we know that diet and lifestyle intervention along with prudent use of medication is really the appropriate way to go.

Kris: And why aren’t more doctors helping their patients with lifestyle changes rather than just prescribing?

Dr. Ozner: Let’s understand that it takes a lot less time to scribble a medication on a prescription pad or send a patient off or stint or bypass than to talk to patients about the importance of diet exercise, stress management, smoke infestation and all the things that we know really count that takes time. And unfortunately the way our healthcare delivery system is setup in America doctors are rewarded for spending time with their patients, they’re rewarded by doing procedures. I think that if I was in charge I would do a flip flop of our entire system I would reward doctors for spending time with a patient and extend teaching them how to stay healthy and keeping them out of the hospital rather than rewarding them to do procedures. You know remember what the word doctor mean. As I lecture across the country I often ask doctors who have been in practice for many years what does the word doctor mean? And often they don’t know that the word doctor means teacher and I think that we should get back to what we should be doing as doctors and that is teaching patients how to live healthy, teaching patients the importance of a prevention approach. You know the old saying “Is it’s better to buy somebody a fish or teach them how to fish.” We know that by teaching patients, whether it’s counseling patients in our office, giving them books that they can read about nutrient, about exercise and the like, is really I think where we’re going to get the biggest bang for the buck. Let’s reserve these very expensive and risky procedures like bypass surgery and stints for those who truly need it. Those are unstable individuals in throws of a heart attack or disabling severe chest pain despite everything that we can throw at them or patient clearly who for whatever reason are unstable and require them. I say for the vast majority of stable folks who happen to have a blockage in their arteries we have a better approach and that’s the approach that I’ve outlined in “The Great American Heart Hoax” and I think that approach is one that we should be instituting in this country.

Kris: Dr. Ozner how do you deal with patient resistance to things like lifestyle changes? I know I have relatives that, you know, you mention that to them and they go “Oh I tried that and I went to a different doctor because I just wanted a pill.”

Dr. Ozner: Well I think that as I go around the country I’m often told by doctors that I don’t really waste my time talking about lifestyle intervention because people aren’t going to follow it anyway. My experience is that the vast majority of men and women through tout the United States want to live a healthy life, they want their children to live a healthy life, and they understand that if they can do this – a lot of people are confused they want credible information and really what I have found is that if you give somebody, for instance, a diet that is delicious it’s easy to prepare it’s inexpensive they’ll follow it. So I would often, as patients would come in as it relates to “Miami Mediterranean Diet” I would put the book down and I’d say “Here try this book, the recipes in this book for two months” and I’d joke I’d throw $1 dollar down on the book and I’d say “Well you and I are going to have a bet and you come back after two months and you tell me that what you were eating before taste better, less expensive, was easier to prepare then you win the dollar, otherwise I win the dollar”, and I haven’t lost too many dollars over the years. People love food if it’s delicious, if it’s certainly easy on the wallet, if the ingredients could be found anywhere, if it’s easy to prepare, this is what we should be doing for health. We should be teaching people how easy it is to prepare delicious food that’s healthy for you. Most people embrace this but they say “Not only am I spending less money on food but actually even my kids like it.” I’ll give you a perfect example, you know, we have a major obesity epidemic in children today and an epidemic of Type 2 Diabetes in children because of the obesity epidemic and clearly they’re eating all of this processed foods, they’re not exercising. Well I say that as an example pizza, pizza which has been around for thousands of years is one of the healthiest things you can eat, but not necessarily the pizza that you get by calling one of those pizza stores because in those pizzas, the pizza dough and the ingredients are highly processed. I say make the pizza yourself at home, use whole grain, whole wheat pita bread or a whole grain wrap, put some tomato sauce, some low fat or fat free mozzarella, some garlic, some onion, some salmon, whatever floats your boat, and you’ve got something that’s not only delicious, the whole family will eat it and it’s healthy for you. And there are many, many examples of this that I can site that I think that the bottom line is we should spend time teaching people. There is nothing such as oh don’t worry about it just abuse your lifestyle and I’ll fix you with a stint or I’ll fix you with a bypass operation or I’ll fix you with a pill, it doesn’t work that way.

Kris: And Dr. Ozner you’re having success helping people make these changes so what are you doing differently from the average doctor? It sounds like you’re giving people really specific concrete tools and information.

Dr. Ozner: I do, you know, to be honest with you I started this many years ago. Before I wrote a book I typed up about 30 or 40 pages of what I felt constituted a healthy Mediterranean style diet and I would hand it out to the patients and it was my patients that said that “Wow this is so great you got to write a book.” Which I did and this has been time tested and basically I think that the difference is that a lot of these earlier diets, a lot of them are fad diets we’ve had the low- carb craze. Well people can’t just walk around all day long eating a lot of saturated fat and just take the bun away but eat the Big Mac with the cheese. And I think that we’ve gone overboard with these diets that really have not been tested and the scientific community. Remember anything that’s recommended, whether it be medication, whether it be surgery, whether it be diet should have what we call evidence-based medicine behind it. We should have randomized controlled clinical trials to show that this particular eating pattern, well you live a long life with fewer heart attacks, fewer cancers, and right on down the line, and that’s what “The Mediterranean Diet” has done these other diets have not. And I think that in addition to that the added benefit is that it’s delicious. I mean, you know, it wouldn’t have been around for 7000 years if it didn’t taste good and I think that’s when people start eating whole grains, when they start eating nuts, which are one of the healthiest things that we can eat, almonds and walnuts, you can spice it up and put some brown cinnamon on it, cold water fish like salmon and mackerel and trout and tuna, bean. We know that low fat dairy products, extra virgin olive oil in moderation, we don’t recommend that people pour olive oil all over their food but the operative word is drizzle olive oil on their food to replace butter and margarine. This is a healthy eating pattern and if they like to have a good steak once in a while I tell patients, you know, a couple of times a month go out to your favorite steak restaurant but don’t do what the typical American does wake up in the morning and have bacon or sausage for breakfast. Well over 90% of my patients who I’ve put on the diet clearly stick with this long term and has done very well, not only in terms of weight control, but in terms of long term health.

Kris: For your other 10 Step Solutions you mentioned exercising and managing stress, how are those things related?

Dr. Ozner: Well they’re related in a big way. I think that 90% of Americans are sedentary, they’re unfit. We know they wake up in the morning, they eat a big breakfast, they drive to work, they work in a sedentary job, and they come home, eat a big dinner and plop down in front of the TV set with a bag of potato chips and a Coca Cola. Well that’s not healthy for you, you know, we were designed as hunter gathers to be moving to be exercising. I once put on an entire conference for physicians on the cardiovascular benefit of exercise. One of the things that I could tell you that exercise does it helps the lining of the artery walls, which we call the endothelium produce a substance called nitric oxide which is a very, very important substance that helps keep our arteries dilated and open along with many other benefits that raises our good cholesterol it makes our cardiovascular system more efficient. I think the bottom line is that what we need to do in America is we see it as rising obesity epidemic and rising heart disease epidemic is we really need to get people moving. Now the confusion is people think that they have to be jogging down the street or join a gym or do extreme forms of exercise they don’t have to do that. Simply walking 30 to 45 minutes a day, walking at your own pace, is going to get people from the unfit category to the mildly fit category and that’s where we’re going to achieve the majority of benefit in this country, not to make people super athletes so they can run in the Boston marathon. And I think that the people understand how easy it is to get that 30 minutes a day. In fact I often tell people “Look I want you to watch at least 30 minutes of television every day, watch the nightly news, watch your favorite sitcom, but as you’re watching that 30 minutes of TV I want you off the couch and I want you walking in place on the carpet swing your arms. It’s free you don’t even need a pair of walking shoes, it doesn’t matter if it’s snowing outside or if it’s 100 degrees outside, anybody can do that. We have data to show that that will significantly extend your life that will significantly reduce your risk of heart disease, of osteoporosis, of cancer and whole host of other disease states. We need to get America moving. You know for those that are interested you could also get a pedometer and flip it to your belt and make sure you get in the 10,000 steps a day. Whatever it is, if you enjoy bike riding, swimming, you know, it’s the old commercial Just Do It we need to get America moving. As far as stress management is concerned stress is the forgotten risk factor. You know I could tell you how many times I’ve gone to cardiovascular meetings and they talk about all of these risk factors, such as cholesterol, such as healthy Little A’s, such as literally hypertension, diabetes, but very few times will you ever see stress listed. I think that’s a mistake. I think it’s one of the most important risk factors and we understand the mechanism by which stress leads to heart disease. And we understand that people that are under chronic stress, and remember stress can be people that are anxious, people that are depressed, people that are hostile, that are angry, people who unfortunately have social isolation, they’re living alone, there’s a lot different stressful stimuli that really turns on our sympathetic nervous system and we get an outpouring of adrenaline what we call catecholamine. Well this excessive amount of adrenaline raises your blood pressure, causes your arteries to constrict, makes your platelets more sticky and more likely to clot, and does a whole host of things that are deleterious to your vascular health. In addition it stimulates your hypothalamic pituitary adrenal axis leading to an outpouring of glucocorticoid the steroid which can raise your blood sugar, lead to what we term atherogenic dyslipidemia, again, increase platelet number making you more likely to clot and the two of those things led to a significant uptick in your risk of heart attacks, stroke and cardiovascular events. Now how do you correct stress? I talk about it in my book “The Great American Heart Hoax” the easy way to counteract stress from yoga to meditation to self-hypnosis to prayer to what Dr. Herb Benson talked about in Boston years ago the Relaxation Response. These are simple easy things that people can institute in their lives to lower stress, to lower cardiovascular events. We know it’s very interesting about a year ago there was an article in one of our prestigious medical journals that look for people that take a brief mid- day nap everyday, which is done routinely in the Mediterranean regions of the world the old siesta. We’re talking about 20 minutes, 30 minutes naps, even 15 minutes will do where people will relax in the middle part of the day and it was shown that people that do that on a regular basis lower their risk of death from heart disease by 37%. Wow! That’s better than we get with our most powerful stint and yet nobody’s talking about that. I think stress is truly one of the important cardiovascular risk factors. Then I talk in “The Great American Heart Hoax” as far as the step wide approach another step is how to lower your cholesterol. We don’t need to bombard our bodies with five different medications to lower cholesterol unless we got a rare genetic cause of cholesterol elevation. I think for the vast majority of people there is a natural way to lower your cholesterol with diet and with exercise and the things that I’m talking about. If somebody who is not able to achieve cholesterol control despite that then, yeah, then medication would be appropriate but clearly I feel that we underutilize lifestyle changes and nutrition because that really is very successful. I’ve lowered cholesterol by 30%, 40% with diet and we’re not counseling patients on how best to do that. I talk about that. I give concrete examples of the types of food that can really rocket your cholesterol down and also with blood pressure. We know that there are natural ways of lowering blood pressure and I talk about the foods that will do that. It’s fascinating simply by changing the type of salt that we use. I talk about taking out sodium and putting other ingredients in the salt shaker that taste even better than table salt and will lower your blood pressure instead of sodium which raises blood pressure. I talk about things like pomegranate juice that has a natural ace inhibitor, this is a medicine that is often prescribed for blood pressure lowering and, you know, there’s a whole host of things that we could do to lower blood pressure. And then I get into the diabetes epidemic and what we call Metabolic Syndrome. Then I talk about easy ways to reduce your risk of developing diabetes. And I must throw this in because an article about one year ago came out in the British Medical Journal out of Spain that took 14,000 Spaniards and randomized them either to diet as usual or Mediterranean Diet. Those that followed “The Mediterranean Diet” had an 83% reduction in their risk of developing Type 2 Diabetes and I think that’s amazing. And we also know that with related to metabolic syndrome people with a big belly and with impaired fast and glucose at the study out of Italy showed that a Mediterranean diet will reverse metabolic syndrome, literally, reverse it in the first year in over half the people who have metabolic syndrome. So we talk about that. And then we talk about inflammation and how can you lower inflammation? Well first and foremost a lot of it has to do with nutrition all the things I’ve been talking about. Cold water fish is an example, brings Omega 3 Fat to the table and Omega 3 Fat lowers inflammation. Other sources of Omega 3 such as walnuts, flaxy, canola oil lowers inflammation. But we also know that there are many other things that lower inflammation and that we should be doing on a regular basis. A perfect example is taking good care of our oral hygiene our teeth. We know that the average American brushes their teeth once or twice a day but they should be flossing their teeth a couple of times a day, that significantly cuts down on plaque buildup, it significantly cuts down on the risk of developing periodontal disease. And chronic low grade periodontal disease leads to a state of chronic low grad inflammation that increases a person’s risk of heart attack, of stroke, all kinds of diseases. So flossing and seeing your dentist on a regular basis for a routine cleaning becomes very important. I talk about these issues and then I talk about the blood test that can save your live. I find it to be amazing that we will do just routine blood test, total cholesterol the good, the bad triglycerides, but I talk about three additional tests that can save your life. We can measure vascular inflammation, we can measure these other tests very inexpensively and you need to know what your numbers are and the doctor needs to have the correct numbers to be able to act on. And I think that these are the ways that we should be moving in America not just proceeding in a blinded fashion of just putting in more and more stints, doing more and more bypass operations, thinking that this is going to be the fix for people with cardiovascular disease and atherosclerosis our Number 1 killer, it’s not the fix. And in unstable patients who unfortunately in the throw of a heart attack who need a stint or whatever they too should be counseled that to prevent future episodes clearly they need to follow this lifestyle approach. And I think that whether people have risk factors for heart disease and want to prevent it or people who already have had cardiovascular events and want to prevent future episodes this is what we should be doing in the United States.

Kris: So if you want to save your life pick up a copy of Dr. Michael Ozner’s “The Great American Heart Hoax” an amazing book that has very reader friendly information on how to avoid heart disease and create a healthy lifestyle. Dr. Ozner I know people are going to want more information. Where can they go to find more information about “The Mediterranean Diet” and your work?

Dr. Ozner: Yes I’ve created a Web site and its www.DrOzner.com. On that Web site is a lot of information that it’s perfectly free, you can download a lot of these articles that I’ve written, you can watch videos that I’ve made that discuss heart disease prevention, and you can also signup for a free newsletter where I talk about heart disease prevention and things that are of current interest and clearly delighted to offer this to the American public, again for free, and it’s www.DrOzner.com. I also put on seminars around the country for physicians as well as for the lay public and I hope that this helps to get the word out that we have a new way and a better way of preventing heart disease and a lot other disease states so we can live long, happy and heart healthy lives.

Kris: Thank you Dr. Ozner.