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Help your patients make healthy heart choices

Chiropractors can be the heartbeat for patients' healthy heart choices.

Simple changes to diet and exercise can make a world of difference

The most effective health interventional therapy available for the prevention and treatment of coronary heart disease and its comorbidities is improving one’s dietary habits. It is common sense to recognize the massive role foods and substances we ingest play, even at the most basic cellular level.1 

Encouraging your patients to implement some of the following healthy practices can help them fight or prevent heart disease and metabolic issues.

The Mediterranean diet

The Mediterranean diet (MD), a style of eating characteristic of those cultures living in regions around the Mediterranean Sea, is a proven method of reducing cardiovascular risk and its novel risk factors, such as markers of oxidation, inflammation, and endothelial dysfunction.2 This style of eating incorporates foods high in phytonutrients primarily from the plant kingdom—vegetables, olives, herbs, spices, and fruits. In addition, beans, nuts, whole grains, fish, moderate amounts of poultry, and some types of dairy and meat are considered. The MD positively influences human health due to the main actions of its food sources: They have antioxidant, anti-carcinogenic, anti-inflammatory, anti-thrombotic, and anti-allergic properties. 

Intermittent fasting  

Energy restriction in the form of intermittent fasting has gained a lot of popularity for improving numerous risk factors associated with cardiometabolic disease, such as high blood pressure, cholesterol, high triglycerides, and serum inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate (ESR).3 Intermittent fasting is not starvation, but includes periods of time where one voluntarily either completely or partially restricts energy intake (think skipping breakfast). During the times of periodic fasting, several positive bodily changes occur, primarily lowering of insulin resistance, decreasing hepatic steatosis, enhancing glucose uptake into skeletal muscles, reducing oxidative stress, and increasing fatty acid catabolism.4 

Levels of insulin, the primary fat storage hormone, go up when one eats a meal. With chronic excess energy consumption, insulin turns on fat production in the liver. When one finishes digesting a meal, however, blood sugar begins to drop and insulin levels taper off as well. When one refrains from eating for extended periods, stored sugar is taken from the liver (up-regulated gluconeogenesis and glycongenolysis) to be used as fuel for the body. Ultimately, fat is oxidized for energy when there is not enough sugar stored in the liver. 

Here is an example of time-restricted eating for a 16-hour fasting window, followed by an eight-hour feeding window: The last meal is consumed at 7:00 p.m. and the first meal of the day is consumed at 11:00 a.m.  

Recommended Schedule for Intermittent Fasting:

Fast 7-11 a.m.

Eat 11 a.m.-7 p.m.

Fast 7-11 p.m.

Sleep 11 p.m.-7 a.m

When eating on a restricted time schedule, one essentially has a six- to eight-hour window to eat two modestly sized meals and one large meal, which is the last meal of the day. Breaking the intermittent fast with a 300- to 400-calorie, easy-to-prepare protein, healthy fat, and fruit is my recommendation. Some examples are: 

• Two whole eggs with cheese and avocado and an apple

• One serving of Greek yogurt with a cup of almonds and berries

• Nut butter and jelly on whole/sprouted grain bread.  

Remember, the two meals following the fast are used primarily to stave off hunger and supply one’s body with enough energy to nourish it and replenish liver glycogen without overtaxing one’s digestive system. The third, and final, meal is the largest and should consist of high protein and moderate amounts of fat and complex carbohydrates. A great example: 10 ounces of grilled chicken breast, tofu, salmon, or steak, with one-half to one cup of brown rice, whole grain pasta, farro, or couscous, or quinoa, and as many vegetables as one would like.

Including ample amounts of healthy fats is a must to prevent feeling hungry. Good sources include nuts, avocados, full-fat cheese, seed and nut oils, and coconut-based foods. 

Physical exercise

Physical exercise (PE) is one of the most important, cost-effective and safe, modifiable risk factors for cardiovascular disease contributing to major causes of morbidity and mortality worldwide.5 Lipid metabolism no doubt is improved by PE. The underlying mechanism is increased blood lipid oxidation and utilization (via upregulated lipoprotein lipase), yielding a decrease in lipid levels.6 Furthermore, a multitude of other enzymes are enhanced that aid in transporting lower-density cholesterol particles and triglycerides from the blood to the liver, where ultimately they are excreted from the body.  

Nutritional supplements

In the current health care environment, physicians are becoming increasingly dependent on prescribing lipid-lowering drugs to treat patients with dyslipidemias. Many supplements, however, offer natural treatment for dyslipidemias without the many side effects of prescription medications. My most commonly recommended supplements are psyllium and plant stanols/sterols. 

Psyllium (Plantago ovata) is an herb. The seed and outer covering contain both water-soluble and insoluble fibers that, when ingested, form a gel-like substance by absorbing water from the intestines. Psyllium works by altering hepatic cholesterol metabolism, resulting in an increase in fecal bile acid excretion.7 

Plant sterols are simply constituents of plants that have similar structures to cholesterol. Although most people eat foods (fruits, vegetables, seeds, nuts, and grains) that contain plant sterols, it would be extremely difficult to consume enough for an optimal amount to provide a significant cholesterol-lowering effect. Plant sterols work by competing with and partially blocking the absorption of cholesterol from the intestine. Therefore, less cholesterol is able to pass from one’s intestines into the bloodstream, resulting in lowered serum cholesterol.8 

Lifestyle changes

The causes of dyslipidemia and its comorbidities are multifactorial. Many of these factors relate to lifestyle, such as lack of physical exercise, poor diet (especially high consumption of processed foods), tobacco usage, and inadequate sleep. 

Chiropractic offices are the primary health care candidates to help patients deal with these issues, improve their lifestyle and get to the root cause of their dyslipidemia. The holistic nature and drug-free approach of our profession, paired with the special relationships we have with our patients, put us in a special category of health care providers to take the lead. 

Louis Miller, DC, MS, is the owner and operator of Advanced Chiropractic of South Florida and Healthy Weight Solutions. He graduated from New York Chiropractic College in 2000. In 2015, he completed his master of science degree in applied clinical nutrition. He is currently writing his first book about the many nutritional cases he’s been presented during practice. He can be contacted at 561-432-1399 or through


1 Braun L, Cohen, M. (2010). Herbs & natural supplements: An evidence-based guide. Sydney: Elsevier Australia.

2 Estruch R, Ros E, Salas-Salvadó J, Covas MI, Corella D, Arós F, Gómez-Gracia E, Ruiz-Gutiérrez V, Fiol M, Lapetra J, Lamuela-Raventos RM, Serra-Majem L, Pintó X, Basora J, Muñoz MA, Sorlí JV, Martínez JA, Martínez-González MA; PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet. New England Journal of Medicine. 2013; Apr 4;368(14):1279-90. doi: 10.1056/NEJMoa1200303. Epub 2013 Feb 25. Erratum in: N Engl J Med. 2014; Feb 27;370(9):886. PubMed PMID: 23432189.

3-4 Patterson RE, Laughlin GA, Sears DD, LaCroix AZ, Marinac C, Gallo LC, … Villaseñor A. (2015). “Intermittent Fasting and Human Metabolic Health.” Journal of the Academy of Nutrition and Dietetics, 115(8), 1203–1212.

5-6 Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet. 1997; May 3;349(9061):1269-76. PubMed PMID: 9142060.

7-8 Braun L, Cohen, M. (2010). Herbs & natural supplements: An evidence-based guide. Sydney: Elsevier Australia.

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