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- [00:00]
A
I'm Shankar Vedantam, here to tell you about a great mystery. That mystery is you. As the host of a podcast called Hidden Brain, I explore big questions about what it means to be human. Questions like where do our emotions come from? Why do so many of us feel overwhelmed by modern life? How can we better understand the people around us? Discovery your hidden brain. Find us wherever you get your podcasts.
- [00:30]
B
Starting at young ages, living a healthful lifestyle, regular physical activity, no tobacco use, eating healthfully are all things that help a person have cardiovascular health through their lifetime just not equally available to all. And that's a societal issue that we must address.
- [00:48]
C
Our hearts are the engines that power every moment of our lives. But for millions of Americans, that engine is at risk. Cardiovascular disease continues to remain the leading cause of death in this country. Factors like high blood pressure, obesity, and the lack of exercise are the underlying culprits. Thankfully, new scientific breakthroughs and innovative approaches are saving more lives. That's ahead on this episode of Tomorrow's Cure, a podcast from Mayo Clinic that brings the future of medicine to the present. I'm Kathy Werzer. Thank you so much for joining us today. We have three leading voices reshaping American heart health and our understanding about obesity, which is a major heart disease risk Factor. Joining us, Dr. Andres Acosta. He's a gastroenterologist at Mayo Clinic who has done pioneering research in tailored obesity treatments. Nancy Brown is chief executive officer of the American Heart Association. That's an organization driving forward public health, nutrition, and prevention efforts. Dr. Kevin Volp is the scientific lead for the American Heart Association's Food is Medicine initiative. He's the founding director at the center for Health Incentives and Behavioral Economics at the University of Pennsylvania and the Wharton School. Dr. Acosta, Dr. Volp and Nancy, thank you so much for joining us today.
- [02:04]
B
Thank you so much for having us with you today.
- [02:06]
D
Thank you for having us join you.
- [02:08]
A
Thank you, Kathy. A pleasure to be here.
- [02:09]
C
You know, I was going through some photos, old family photos with my mom recently, and she is ticking off all of her relatives, from my paternal grandfather to her great grandfather, aunts, uncles, sisters, brothers, everybody had high blood pressure. Everybody died of heart disease or stroke. And I was just floored. It was a wake up call for me. So I'm wondering, have each of you had similar wake up calls in your lives? What's your personal experience with cardiovascular disease?
- [02:43]
B
Well, first of all, Kathy, I think it's amazing that you and your mom took the time, of course, to look at your family history and to reflect upon your relatives, but to record that history. It's one of the things we encourage people to do at the American Heart association because family history really matters. And like you, my family has deep connections to cardiovascular disease. Grandparents, great grandparents, lost at very young ages to stroke. My maternal grandfather had one of the first carotid enderectomies that was ever conducted at the University of Michigan many, many, many years ago. And my own sister had a stroke at age 56 from undiagnosed atrial fibrillation. And now in her late 60s, suffers from heart failure, congestive heart failure, heart failure with preserved ejection fraction from the atrial fibrillation and the stress on her heart over time. So it's deeply personal for me as it is for so many people.
- [03:42]
C
Dr. Acosta?
- [03:43]
A
Kathy, that's a great question. Heart diseases in my family, strong family history of type 2 diabetes as well as with obesity. And many members of my family having heart disease, including my grandmother, also having type 2 diabetes, eventually heart failure and dying from her heart failure. It comes in the family. But at the same time, I will not say I devoted my career because of that. I devoted my career to this problem because I know that solving this problem is the biggest task our generation needs to solve for longevity and for health.
- [04:14]
C
I'm excited to talk to you about your research, too. During this conversation, Dr. Volp, what's your family history with heart disease?
- [04:20]
D
Well, I have a very deep personal connection with heart disease. My father had a heart attack and a bypass operation in his mid-50s. His father died of heart disease, although at an older age, and I myself had a heart attack and a cardiac arrest four years ago. So I fully understand, embrace, and appreciate the importance of the research that aha NIH and many others have supported and the amazing work that's been done by so many researchers over the years that's kept people like me alive. I also didn't come into this work because of that per se. I've been working on trying to help people live healthier lives for the last 25 years, and this is, of course, intensified by interest in doing that because you realize that whatever your baseline risk level is based on genetics, you can lower it by having an aggressive form of thinking through how do you change people's behavior to embrace healthier lifestyles? That lowers everybody's risks. And it's particularly important, of course, for those who are at elevated risk.
- [05:33]
C
Given the attention on heart health in this country, what's surprising to me is that heart disease is still a leading cause of death in the U.S. i think there was a stat that someone dies of cardiovascular disease every 34 seconds in this country. So, Nancy, what is going on?
- [05:49]
B
Since the founding of the American heart Association in 1924, deaths from cardiovascular disease have actually been cut in half. So there has been tremendous progress that has been made. But you're absolutely right. You know, the numbers are too startling. One in three people dying of cardiovascular disease, rising rates of the risk factors for cardiovascular disease, obesity, hypertension. You know, these are real issues that we have to address. And there's a lot of reasons why. You know, I don't think that people wake up every day saying, I think I'll live an unhealthy lifestyle so that I can die early of cardiovascular disease. That's not what's happening for most people. If they understood that health buys them the ticket to everything else they want in life. Time with family, a productive career, time in their faith organization and in their community. You know, earlier on in people's lives, they may be a bit more dedicated to living more healthful lives. But, you know, we have to face it. There's a lot of things stacked up against people who want to live a healthy life. You know, first of all, there's access to high quality health care, which does not come equally to all people. People who want to access the health care system and maybe who even have access to the healthcare system don't always get advice on prevention and weight management. That would be important to a person living a long and healthful life. There are a lot of factors related to targeting certain groups for tobacco products, unhealthful food products, sugary beverages, and these things become part of a family's lifestyle earlier in their life, and it just becomes a way of life later. And then with the economic differences in this country, you know, for some families who don't have access to healthful foods, who don't have the ability to make fresh fruits and vegetables and other healthful foods on a regular basis, buying fast foods, having sugary beverages, they seem like the easy way to support a family on not as much money as one might need to live more healthfully. And that's why we're so excited to join you, Kathy, today, because there are some amazing solutions that we're working on at the American Heart Association.
- [08:08]
C
You mentioned fast food and sugary beverages. And Dr. Volp, I'm wondering, you know, by the time they're 18, many teens will have heart disease risk factors, and that trend has got to be worrisome.
- [08:20]
D
It's very worrisome when you look at what's happened over the past several decades, it's quite striking. We had a obesity rate of 14% in the United States around 1980, and now it's basically three times that, around 40, 42%. And a lot of that, of course, is a function of what people eat. I think people don't realize that even at a very young age, you can start to form atherosclerotic plaque if you don't eat healthy food. And as Nancy was pointing out, for many people, this has become a huge affordability issue. We did a national survey ha with research American Deloitte recently, and 77% of Americans say they would like to eat healthier food. But the number one reason people gave for not being able to eat more of it was affordability. And that's where we think food is. Medicine programs could play a big role. We have a lot of people in the population who are at elevated risk from heart disease, from diabetes, from obesity. And we need to figure out how can we do better in terms of giving them greater access to healthy food. And collectively, we need to think about what kind of programs can we put in place that both work and, and are easy for patients to follow, because otherwise we won't be that successful in engaging them.
- [09:46]
C
I want to expand upon what you're, you're talking about here, but I also want to kind of take it back just a little bit. Maybe, Dr. Acosta, you can help us out here. Are there wide variations in prevalence of obesity and diabetes and high blood pressure by sex, race, ethnicity?
- [10:03]
A
Yeah, they are. Unfortunately, as Nancy was mentioning, obesity affects all of us, all humans. But there are certain populations who are at higher risk, and we see that in particularly African American communities, Latino communities, women are more prevalent and lower social economic income is also a key factor. So it's unfortunately affecting disproportionately to people who need the most amount of healthcare and healthcare prevention. But also makes you wonder maybe these other groups who are least affected by obesity and cardiovascular risk factors is because they're actually spending more and worrying more, as Dr. Volp was just mentioning, in eating healthier and taking more care of their bodies and their overall health. So the question is whether we're all affected equally and so much restraint to do more to prevent that, or these groups are just more affected at a disproportional rate.
- [10:55]
C
Nancy, does this go back to the access to the healthcare system sometimes?
- [11:00]
B
Well, I think the healthcare system plays a really important role in encouraging prevention and treating people early when their risk is developing and to take it back even earlier. As Dr. Acosta and Dr. Volp have said, you know, starting at young ages, living a healthful lifestyle, regular physical activity, no tobacco use, eating healthfully are all things that help a person have cardiovascular health through their lifetime, just not equally available to all. And that's a societal issue that we must address.
- [11:31]
C
72% of American adults, I understand, are not at a healthy weight. Now, for some people, it's eating the wrong foods, too much of the wrong foods. Right. But there is obesity that's involved in this. And Dr. Acosta, I know obesity is considered a chronic relapsing disease. You've studied this. Are there obesity phenotypes?
- [11:51]
A
Yeah, absolutely, Kathy. So we need to understand that obesity is a chronic, multifactorial, heterogeneous disease. What do I mean by multifactorial for our listeners? There's many reasons why we're going to gain weight. There's many reasons why we start accumulating calories in the form of fat or adipose tissue, and there's many reasons why we turn into complications of obesity that then become cardiovascular risk factors. We don't all walk through the same path. Something that, as you were saying for your grandparents, might have been the path for them to develop heart disease, most likely smoking. Without knowing just by the prevalence of smoking back then versus now, there are other things that affect. So because of that, it's important that we start to stratify or classify the population. When we have a problem that 42% of Americans have this problem, let's find out who are they and why do they have these problems. So there's many ways to stratify the population. One way to stratify population is who has already developed a comorbidity, who has insulin resistance, heart disease, we call them. Those with obesity who are metabolically unhealthy, those who have type 2 diabetes, insulin resistance and whatnot. We also look at other ways of classifying obesity. Those who deposit the abdominal fat or that excess of calories in their abdomen or on their hips. We call them the apple versus pears or abdominal obesity versus hips obesity. Right. And we know that people who accumulate the fat in the abdomen tends to have higher risk factors to develop heart disease and many other diseases. Then recently we came with a new classification that is more going to the root cause of obesity, of the biology of the disease by studying energy balance. So we came with a classification of four groups or phenotypes that have different energy balance underlying conditions. Some folks like to eat High quantities in one sitting. I call them hungry brain. They go for high quantities, seconds and thirds in one eating. There's some other people who like to eat in between meals. I call them then the hungry God. They want a snack in between meals. Most of the people know this is a problem. And the third group is people who have emotional eating. They want to eat for their cravings, they want to eat for their emotions, either positive or negative emotions. Right. They want to cope with life with food. And the last group is people who are not burning enough calories. They have a problem with their metabolism and they're not burning enough calories. We call them those low burn phenotypes. And it's interesting because we have these different classifications who tell us different things about obesity. But it's important to know where we are. And the most important thing is understanding the biology and going down to the root cause of obesity, why I'm gaining weight or why I'm difficulty losing weight.
- [14:27]
C
If you know your phenotype, might it help them with tailoring weight loss therapies?
- [14:32]
A
Absolutely. So we have done a series of studies for the last decade, many of them randomized placebo controlled trials, many of them real world studies of patients being followed in the clinic. And we have shown in our studies. I'm happy to share the links here in the podcast through our different studies that if you do a phenotype tailored intervention, we identify what's your phenotype and we put you on a lifestyle intervention that is tailored to your phenotype, we put you on medications and there's a lot a big right now discussion about all the excitement about the new medications. If we tell who is the right patient for the right medication, the right patient for the right device or the right surgery, the amount of patients who lose weight doubles compared to if we just do the standard of care. And that is extremely exciting. For example, if you have a hungry gut phenotype and you get in these medications, you're going to lose two times more weight, then you don't have the right phenotype. But the key thing which is important for our listeners is that what we are showing is that the science of understanding the biology of the disease, when it matches with the interventions that are already FDI approved, it changes the conversations. Patients understand why they need to be treated this and why they're being successful with this intervention. So we change the conversation and we stop talking about you have obesity because you don't have discipline or because you're eating unhealthy or because these and that and start blaming themselves. And now they understand what's underlying biology, what's driving them to overeat or to not burn enough calories to have emotional eating. And then based on that, they understand there's an underlying treatment and that remains at four levels, from lifestyle all the way to surgery. And then they will have better outcomes. But also understand why they're struggling with obesity, which I think is the most important question that we need to explain to 140 million Americans who are suffering from this disease that they keep trying to lose weight and keep failing. It's our responsibility as scientists to give them an answer. I think that's where we need to work in the next decade, is to really get down to the science and the biology of obesity to prevent heart disease.
- [16:40]
D
Busy healthcare professionals this one's for you. Find Mayo Clinic talks on your favorite podcasting app or visit ce mayo.edu podcasts to learn more. Every week we share succinct, relevant and practical medical insights tailored for healthcare clinicians that you can immediately apply to your practice. Each episode covers common health issues seen in a primary care practice shared by Mayo Clinic experts. Hi, I'm Dr. Bill Maurice from Mayo Clinic Laboratories. Curious to learn more about healthcare innovation?
- [17:22]
C
I'm Dr. Bobbi Pritt, host of Answers.
- [17:25]
B
From the Lab, a podcast that explores trends and innovations in laboratory testing and clinical diagnostics.
- [17:32]
D
New episodes drop twice a month. You can subscribe on your favorite podcast app or visit mayocliniclabs.com to learn more.
- [17:38]
C
Now, Dr. Volp, your focus is on using behavioral economics to address cardiovascular disease. And a lot of this is changing patient behavior. So when it comes to the diet part of this, where are you on this spectrum? How do you suggest that a patient change their behavior in order to lose weight, become healthier, and help their heart?
- [17:59]
D
Let me tell you a little bit about what the AHA is doing with our Healthcare by Food initiative. The real goal here is building evidence in a systematic way on what's effective, what's cost effective in helping people improve their health through healthier diet. And there's a lot that's known from nutrition research about what healthy diets look like. But what clinicians, by and large and insurance companies have not known is what type of program to prescribe for whom, in terms of the duration, the intensity, the dose, what are the other components of it besides healthy food? How do you structure these programs? How do you get people engaged? How do you help people form habits? And so, in essence, what we're doing is really trying to Take a systematic approach to designing specific food is medicine programs that vary based on the clinical condition that somebody has. So, for example, a patient with heart failure who's frequently hospitalized is going to get a very different program than somebody who's struggling with obesity and diabetes. And that's all generated based on dietitian recommendations and what is known in different fields about what do healthy diets look like. A big part of this is really thinking critically about some of the access issues. So generally speaking, as already noted, there is a strong inverse correlation between socioeconomic status and healthy diets. And what we're trying to help with here is address some of the underlying inequities that lead to a lot of the disparities that are observed in cardiovascular outcomes. And we think we can do that by working closely with scientists and with insurers in terms of designing these programs, but designing them in such a way that they are going to be cost effective relative to some of the already covered therapies. And that's really where our goal is. So we do a lot of thinking about human centered design. How do you meet the lived experience of the patient who you're trying to help? Behavioral science. Really thinking about some of the challenges here in terms of consumer engagement and having people want to participate in these programs and stick with it for the long term, which of course is important.
- [20:15]
C
Nancy, can you bring this down to listeners and maybe paint a picture? What would it look like in a community?
- [20:21]
B
Yeah, well, I think our dream and our vision is tools that are reimbursable, that relate to food is medicine programs, medically tailored meals, food prescription programs, produce prescription programs that would be part of the dialogue between a healthcare provider and a patient. As Dr. Volt mentioned, you know, some patients are suffering from significant illness like congestive heart failure with frequent rehospitalizations. And we know, you know, I mentioned my sister with congestive heart failure every single day, how much fluid is she taking in and how much sodium is she consuming? And any little change in the balance of that can send her weight up six, eight pounds in a day. And so these having a program that would be reimbursed that would provide easy access to the correct healthful foods for a person like that could make a huge difference not only in the health of a person with congestive heart failure, but also on medical costs in this country.
- [21:25]
C
Dr. Acosta, what real life examples can you give listeners that might highlight the impact of personalized medicine for patients, especially as it relates to your research?
- [21:35]
A
I will add first A comment to the previous comment about food as medicine, which I love, I preach that and I am trying to understand even more. So we really, really personalize food to each individual, right? In the space of obesity that we know there's so many patients and it's so costly to our society, now we have a big win, which is the GLP1s. But that has also turned into a big challenge to all of us, particularly our payers, right, our government payer systems and our private insurance companies because of the cost of the medications. Now we can put into the equation things like what Dr. Volp was just mentioning, which is fascinating. We can now say, give me a prescription for healthy food. Five years ago that would have been inconceivable. No one will say an insurance will pay for healthy food. But now when the alternative is paying for these expensive medications, which we know have a lot of benefits, maybe the science will get us there to saying, I'll give you a prescription. Because when the average family of four is spending about $1,000 a month in food, if two of those individuals qualify for a medication, is cheaper to give them a prescription for healthy food and see if that can help them improve their overall condition. Maybe not. The research needs to get there.
- [22:49]
B
What you described is exactly what we seek to do, especially, you know, when we think about the entire ecosystem. You know, an individual, for example, taking a glp, that should be, you know, part of a comprehensive program that includes selecting appropriate foods. And for person, you know, who are obese or who have significant disease like congestive heart failure, pregnant mothers, you know, there's certain groups of people where eating healthful foods is exactly the important thing to risk in future years. We have to think of this as a basket of approaches, a comprehensive approach. And I can tell you, you know, we work very closely with large employers across the country, especially through our CEO roundtable. And you know, the CEOs of large corporations want to do the right thing by their employ employees. They want to help their employees have the best shot at health and well being in the long term. And we have to design programs that are affordable. And so the thought of putting every person, you know, who is overweight or obese on a GLP is not likely an affordable solution for employers in America and for our public programs like Medicare and Medicaid. Yet, you know, for populations of persons who are, you know, significantly obese and have these major health issues like congestive heart failure as an example, it's a real winning combination. And the work that Dr. Volp is leading is really intending to create the definitive evidence to illustrate that food is medicine programs can both improve health and maintain or reduce costs.
- [24:30]
D
Yeah, I think it would be helpful to give you a couple of numeric examples. So if we think about heart failure, heart failure is the leading cause of readmissions among Americans over age 65. Readmissions are very expensive. If we can lower readmissions by 20%, the health system will both save money and people will be better off because they won't be struggling to breathe and have to be hospitalized. That is well within reach, we think. There have been some small scale trials that have shown reductions in readmissions of 40 to 60%. But what we need is more studies that really map this out and map out different doses of medically tailored meals and map out dietitian schedules and things like that. But that is in essence what we're striving for. Because when you think about the challenge of the US being first in healthcare spending internationally and 46th in life expectancy, we have to figure out how do we do things differently? How do we help those who are most in need do better, both from a health and economic standpoint?
- [25:37]
C
Listening to you, I think it's fascinating to think about getting a prescription for healthy food. Right. I wonder though, can someone, even at an advanced age, 65 plus, with heart disease, if you start making changes, can you stave off some of the damage or improve your health? And how fast does that happen?
- [25:57]
D
Yeah, well, here's another very concrete example. There's a study that was recently done on heart failure patients who were hospitalized that showed that 45% of them had moderate malnutrition and 30% had severe malnutrition. And in essence, what the adherent patient struggles with, as Nancy alluded to with her sister, is they are very conscious of trying to keep their weight at a constant level. Because when weight goes up, it means there's more fluid on board and that fluid floods their lungs and then they can't breathe. So what happens is that in their efforts to try to keep their weight down, a lot of patients become progressively more malnourished unless they have really been coached in having nutrient dense diets. And that's where some of these programs, I think, are showing significant short term benefits. Even as short as one month, two month interventions. We're seeing this significant reduction in hospital readmissions because a lot of these patients, it is restoring some of their strength by just helping them come back from the brink by giving them even a short term nutritional intervention for Patients that's sick can be really helpful.
- [27:13]
C
Dr. Acosta, does this ring true to you in your practice?
- [27:16]
A
Absolutely. Gaining health, it can happen at any time. For all of us, it doesn't matter the age. We know there's a series of studies that tell us that even for patients who are waiting for a major surgery, they becoming a little bit more active before surgery gives them better outcomes. And what do we mean by that doesn't matter your age. Even folks who are older than 65, getting healthier also should be a part of our lives. Eating healthier and then we just need to tailor to where we are in our life. So for someone who is going into their sixth decade of life or later, preserving muscle mass is one of the most key predictors for long term survival. So yes, we want to lose weight, but we also want to make sure that we're gaining muscle mass because that's also associated with frailty and longevity. So it's important that once more time we go back to our recommendations, not only with food, but also all these health recommendations, health prescriptions of how to get healthy that are appropriate for each one of our stages of life as well as that are tailored to again, going back to our phenotypes, our biology, to what we really need, that it matches us. This one size fits all is never going to work. And that's why we need to take the state of the art of medicine, take the understanding that we have learned from all these different things to understand our own biology and have more guided recommendations. Because sometimes recommending less is more. When they really hit, when they really create that notch that change your behavior. You may need one little advice. Is the example you asked me before about patient who have heart disease. This patient walks to the emergency room having his first heart attack in the mid-50s, has never thought about losing weight, but then suddenly said you have a heart, you just had a heart attack. And then the doctor says you need to lose weight. Having this body mass index is not normal. So he understood that he came with phenotype and we put him on the right medication for him. And then he understood that he needed to change his life and he knew how. So those examples is what we need to be proactive, but we need to do it before they have the heart attack. They need to happen at your annual primary care visits, they need to happen at your screening visits, they need to happen at your employee renewal of benefits visits. Then is where we talk about, hey, let's bring health back and we know how to help you and we understand the science and we have tools to help you with.
- [29:40]
D
I completely agree with what Dr. Acosta was saying. One of our challenges is our system is pretty good at reacting to disease once it's diagnosed and somebody needs high technology intensive treatments. We're not so good at getting further upstream and being proactive. And that's really where we need to go. Really thinking about how a lot of people struggle with having ingesting a lot of empty calories, not having nutrient dense diets, muscle mass, preserving lean muscle mass, absolutely critical. And we need to figure out how do we make it easier for patients so they're not swimming upstream. That's, in a sense the challenge that's in front of us and it's not easy. We've seen from this rise in obesity rates from 14% to 42% in the last four decades that there is this tide that is not in a favorable direction. Busy healthcare professionals, this one's for you. Find Mayo Clinic talks on your favorite podcasting app or visit ce mayo.edu podcasts to learn more. Every week we share succinct, relevant and practical medical insights tailored for healthcare clinicians that you can immediately apply to your practice. Each episode covers common health issues seen in a primary care practice shared by Mayo Clinic experts. Are you trying to become a better human? Well, the Human Optimization Project is an exciting new podcast offering from Mayo Clinic which aims to help you do exactly that. We're all struggling to balance the need to perform and do more while simultaneously maintaining our wellness. In the Human Optimization Project, we're focusing on 10 key domains of human performance to help people achieve more, improve well being, and become the best humans they can be. If that sounds like what you're looking for, search for the Mayo Clinic Human Optimization Project on your favorite podcasting app.
- [32:01]
C
So, Nancy, I'm curious. You're leading the American Heart association and you know darn well messaging is really important. And it seems to me that you're maybe pushing the rock up the hill here when it comes to messaging. There's all this noise that's out there. You're told to supersize that drink. I mean, you go down grocery aisles and you have highly processed foods to choose from, right? So how do you break through that buzz?
- [32:25]
B
You're absolutely right. You know, every day the American Heart Association's goal is to take the science that we create and to bring it to life through communication and marketing strategies and in our local communities, in science initiatives like the programs Dr. Volp has spoken about and through our advocacy work. And as it relates to reaching people. You know, there are a number of ways to go about doing that. You know, one is through social media influencers, which we are very active in using. Others is through campaigns like Go Red for Women. Today I have my red dress pin on. Go Red for Women is a campaign that urges women to understand that heart disease is their greatest health threat. And we engage millions of women in being advocates for their own health and that for the other, the health of the other women in their lives, we provide them fun and easy ways to get involved. And as I said earlier, when you feel better and you eat better, it really buys you the ticket to everything else that matters to you in your life.
- [33:33]
C
Say, I want to leave some takeaways for listeners. So I'm going to go down the line here. And I'm curious what each of you will say about this. Nancy, is there one big thing that a listener could do or something to do on the systemic level here, but that gives you some hope that we'll be able to reduce some of these numbers in the next decade or so?
- [33:55]
B
I would say two things. Number one is to really focus on our own health as our cherished resource, the thing that we can control, that buys us the ticket to everything else that matters in life. And I'm going to add on to that. Kathy, where you started knowing your family history really matters. I think right here on this call when you asked us, we each had something about people who had heart disease earlier in life. And that should be a warning sign for people that this too can happen to me if someone early in their life had something happen and I need to pay attention.
- [34:33]
C
Dr. Acosta, you're doing active research at Mayo Clinic, and I'm curious what excites you looking into the future when it comes to making inroads with heart disease?
- [34:41]
A
The excitement is how we were trying to bring this whole field new of diagnostics into the space of obesity and cardiovascular disease. Because I would love to be able to contribute to programs like the American Heart and Dr. Volp are doing with Food as Medicine by giving them that diagnostic test that tells a patient which foods they should be eating. And I'm not talking about the people who already have heart disease who are going to go to the hospital because, you know, they're, they're spending problems already with advanced heart disease. I'm talking with the majority of us who are struggling with obesity, who want to either prevent weight gain or we want to lose weight to not have type 2 diabetes and then heart disease. I would love in the future to have that diagnostic test that I can go to my doctor. And my doctor said, you need to eat this diet and you need to eat these things here because these are the things that will help the most to you as an individual. Really personalize precision medicine as we have precision oncology, precision obesity, precision health for food, for medications, for weight loss, as well as for devices and surgery. If we can bring that in the next decade, there'll be no more trial and error, no more prescriptions that we tried this and failed. Right? So that, to me, is where we need to meet 21st century science and all the advances we're doing in our labs, at Mayo, at Penn, in all these different institutions, supported many of them by American heart, and bring it to mainstream, bring it to that patient level. I'm doing this diet because that's what my doctor recommended, and that's why now I have a healthy weight, and that's why I'm healthy. So I hope that's what we can achieve in the next five to 10 years and we will really be able to fight this epidemic and prevent heart disease and the 280 other diseases that are associated with obesity and discomorbitities. Right, including many cancers.
- [36:29]
C
How far away are we from your vision?
- [36:32]
A
The NIH has done a significant investment on precision for nutrition health and really trying to find out personalized health. So I'm very excited about the progress we're doing here. We're bringing all these omics, right? Genetics, microbiome, metabolomics, proteomics, exposomics. Now with the advances on artificial intelligence, we're going to accelerate this whole process. So we already have things on the market, and hopefully in the next five years, we'll have a lot more for our patients and clinicians to use evidence, guidance therapy at a precision level.
- [37:06]
C
That's exciting. Dr. Volp, what future innovations get you excited when you think about cardiovascular health?
- [37:12]
D
There's a lot, so I will try to limit myself to a small number. First, I will say we have 23 trials that are in the field currently, as well as about a dozen other studies, so about 35 studies where we are learning a lot, and we'll continue to learn a lot as a foundation for future work. We are also working with a number of state Medicaid programs and private insurers on evaluating programs, helping them design better programs. So I feel like there's enormous opportunity in this space to learn a lot in a relatively short period of time in ways that really help Americans. I think there are also some simple things that we can do. We know that 90% or more of Americans don't eat enough fruit and vegetables, eat too much sodium, too much sugar, about 60 pounds of sugar per year. As a 20 year plus primary care doctor, I would say that that is one piece of advice I would often give patients. If there's one thing you want to do for your health, a simple thing is to just drink less sugary beverages and that that in itself can be very helpful because those are empty calories and are not not helpful to your cardiometabolic risk. So I think the research is moving forward at a good rate. I think that will continue to accelerate as we learn more and people see the potential for Food is Medicine as a compliment to the terrific work Dr. Acosta and others are doing to really move forward on a lot of different fronts here in ways that help us lower cardiometabolic risk, say Nancy, Best sources.
- [38:50]
C
Of information for folks listening right now who want to learn a little bit.
- [38:53]
B
More, we would encourage people to come to our website@heart.org we're delighted to welcome you to our content. And also I would say that we are creating a registry of individuals who are interested in contributing data around weight gain, weight loss at various stages of life, healthy living beyond weight. And so we will encourage people to become part of that registry as well.
- [39:19]
C
We of course outline some of these big issues dealing with heart disease, but also some of the breakthroughs happening that will keep our hearts healthier longer. Thank you so much for joining us.
- [39:29]
B
Thank you, Kathy. It's been a great discussion.
- [39:31]
D
Yeah. Wonderful talking to you, Kathy.
- [39:34]
A
Thank you, Kathy. I'm delighted to be part of this panel and good to see you all.
- [39:37]
C
Nancy Brown and Dr. Kevin Volp of the American Heart Association. Dr. Andres Acosta, Mayo Clinic. Good conversation. Thank you so much. Tomorrow Tomorrow's Cure is a production of Mayo Clinic with production help from the podglomerate. Be sure to follow Tomorrow's CURE wherever you get your podcasts. I'm Kathy Werzer. Thank you so much for listening.