Shireen Abdullah (0:00)

Podcasting from Dallas, Texas, I am Shireen, and this is the Yumlish podcast. Yumlish is working to empower you to take charge of your health through diet and exercise and reduce the risk of chronic conditions like type 2 diabetes and heart disease. We hope to share a unique perspective and a culturally relevant approach to managing these chronic conditions with you each week.

Shireen Abdullah (0:32)

Dr. Steven DeVries is a cardiologist, executive director of the educational nonprofit Gaples Institute, and is an adjunct professor of nutrition at the Harvard T.H. Chan School of Public Health. Welcome, Dr. Devries.

Stephen Devries (0:46)

Thank you. Great to be with you.

Shireen Abdullah (0:47)

Such a pleasure having you on. So, before we drive into the topic for the day, I wanted to start out by learning a little bit more about your background and how this intersection around nutrition and heart health really happened for you. Why this focus in your career?

Stephen Devries (1:04)

Yeah, well, I early on in my career, I was the director of an outpatient cardiology clinic at the University of Illinois and realized that despite our best efforts with pharmacologic therapy, we were seeing people kind of return back with the same kind of problems that would be, you know, fixed up in the hospital. We would see them as an outpatient and then only find out that they were readmitted with a similar problem. And we thought that, you know, there’s gotta be more that we can do to help stem this turnstile of recurring problems.

Stephen Devries (1:37)

And that led me into a bigger search for therapies beyond medication and nutrition. Although not a big part of my training at all was an area that seemed to offer a lot which hadn’t been part of the curriculum, but something that I thought needed to be explored in greater detail. So who wouldn’t have known? But that became then the focus of my entire career to follow.

Shireen Abdullah (2:02)

You know, you touched on something there that I would love for our audience to learn, which is the nutrition training that physicians get. Can you shed some light on what that looks like as a standard today?

Stephen Devries (2:15)

Today, it’s slightly better than it had been in my training, but unfortunately, not enough has changed. For instance, in my training, I received no education on nutrition in medical school that I recall. None in internal medicine, three years of training that I recall, and certainly none in cardiology. Now, it depends on the program and the school you go to. There is definitely some variability, but I would say, as a nation, still, the training in medicine is very deficient, generally, in nutrition.

Stephen Devries (2:52)

There are some really good pockets and some that, fortunately, our nonprofit has been responsible for making come alive. But still more work to be done.

Shireen Abdullah (3:03)

In that department, which takes me to the why. Right. So today, for instance, heart disease, excuse me, remains one of the leading causes of death worldwide. From your perspective, how much of cardiovascular disease is really influenced by diet and lifestyle?

Stephen Devries (3:20)

Yeah, there’s actually data that speaks to that point, and the numbers vary, but they’re generally in the 30 to 40% range of how much of cardiovascular disease is felt to be attributed to dietary issues. So it’s quite significant. And many people feel, you know, if they’ve got a strong family history of heart disease, that heart disease is kind of inevitable, that it’s going to happen. They’re fated to that.

Stephen Devries (3:46)

And while certainly genetic predispositions are real, there’s a great deal of evidence saying that you can, you can really resist the genetic tendencies in many respects because diet and lifestyle can actually help to modify not the genes themselves, but how, whether they’re turned on or not. So it can’t be applied for every genetic issue. But definitely your genes are not your fate and nutrition and lifestyle can make a huge difference regardless of your genetic profile.

Shireen Abdullah (4:21)

Over the years, have you learned of or can you share with us any misconceptions that people have about that relationship between food and heart health?

Stephen Devries (4:30)

Yeah, well, the first one really speaks to the point I just made that many people feel that if their family history is strong for heart disease, that they’re going to get it and they might as well just accept it and not try and do anything to mitigate. And that is just clearly untrue. That there’s quite a bit.

Stephen Devries (4:53)

So that’s the first misconception that nutrition lifestyle might not matter for a large group of people. And I think the other one is that many people feel like if they’re taking the right medicine, their doctors very faithfully prescribed certain medication. Could be cholesterol medicine, could be blood pressure medicine, a variety of other anti clotting medicines that as long as they take all of those medicines, they’re going to be taken care of and then the medicines kind of will take the place of what nutrition lifestyle might have offered.

Stephen Devries (5:25)

But that also is clearly untrue. Now, nutrition lifestyle don’t take the place in many instances, most instances of medication. But what’s also true is that nutritional lifestyle can do things above and beyond what medication can do. So the best, if you need medication and many people do and need to stay on them, if they’ve been prescribed, they should never stop medicine on their own. But that even if you’re on the right medicine, it’s really vital to know that nutritional lifestyle adds additional benefits. And it’s not as if the medicine takes away the need for doing more with nutritional lifestyle. So those are some really key points that I feel are just critical for people to understand.

Shireen Abdullah (6:13)

You know, as you say, that this really resonates with my own journey, Dr. Devries, because a few years ago, a lot of our listeners know the story where I was given a very sort of blanket from my doctor’s advice of just eat healthy. And this is when I got my sort of, my diagnosis for my diet-related condition. And at the time I just, I was really frustrated with that.

Shireen Abdullah (6:36)

And that’s part of, sort of, the reason why you do what you do is because we turn to our physicians and we ask to say, like, all right, what do I do differently? What do I need to eat? How do I improve my health? And today, physicians, or at least the ones that were trained without having any of that nutritional knowledge, they just don’t have the know-how. They don’t; they’re not trained to help people in that way. But we constantly turn to them for that advice.

Shireen Abdullah (7:05)

Which, yeah, which I find interesting because like, all right, the source of who can walk you through your health, it’s only natural to feel like they understand or they can help you understand that connection to nutrition. And that’s really not the case all.

Stephen Devries (7:19)

The time, of course. And I think people have every right to believe at least that their physician will be knowledgeable about factors that are important for their health. And most individuals and surveys confirm that people for the most part very much trust their physician. And so they should, I believe.

Stephen Devries (7:39)

But in this area and still today, unfortunately, although I mentioned things are improving still for the most part, physicians have not received adequate nutrition training to address the needs. And you know, there’s a patient that comes to mind who was having slowly, steadily rising blood glucose levels, and they were approaching, you know, the pre diabetic range.

Stephen Devries (8:07)

And I remember this patient told me he was told by his primary care physician that, you know, why don’t you come back in six months and if your sugar levels rise further, then we’ll start you on medication. And I was thinking like, no, no, that’s not the right approach. So when they saw me, I said, let’s not just wait and see if things are going to progress. Let’s try to work on them. Let’s talk about what you can do with your diet, what you can do with your physical activity to change the natural course, not just wait and see what happens and then throw you on some medicine if things don’t go the right way. But it is that that really is the impetus for the work I’m doing now.

Stephen Devries (8:46)

I am the executive director of the Gaples Institute, and our nonprofit has the mission of doing just what you said, educating physicians and the public about the role of nutrition in lifestyle, in medicine. And sadly, it hasn’t been part of medical training, as we’ve discussed. But our course from the Gables Institute is Now required in 14 medical schools, and not as an elective, but as a required part of the topic for all of the students. 125 To 200 students per class.

Stephen Devries (9:19)

So we’re really hopeful that we’re starting to turn the tide and other places are doing other things. But our program is. Is fair. Been very well received, and it’s actually, you know, I’ve had a career as a cardiologist, but feel that the nutrition training that we’re delivering has made even a bigger impact to help people than my work as a cardiologist, which I’m also very proud of.

Stephen Devries (9:43)

So there’s a lot to be done, but a lot of good work already in store. So hopefully that our children and our grandchildren will see a different future when they go to their doctor. And, you know, the kind of questions that you pose to your physician hopefully will be answered more fully in the future.

Shireen Abdullah (10:02)

Indeed. Why do you think today nutrition education has historically been so underemphasized in medical training? And then how can healthcare providers like, you know, the ones you’re training, just better integrate nutrition into patient care and chronic disease prevention?

Stephen Devries (10:20)

Well, the reason why nutrition hasn’t been integrated fully into medical education, I think there’s a few reasons. Um, it actually, it’s interesting. Nutrition did play a bigger part in medical education going back to the early to mid-1900s. And at that time, vitamin deficiency states were rampant, and dietary interventions were identified as being helpful for a variety of conditions.

Stephen Devries (10:47)

Pellagra, you know, Beriberi, scurvy, these deficiency states that are very rare today. But, you know, as those deficiency states became less common and as food became fortified, and then at the same time, pharmacologic therapy was kind of coming to the fore and these new drugs were becoming available. So the emphasis on nutrition and its place in medical education and practice really started to kind of wane over time.

Stephen Devries (11:15)

And then, you know, there’s a very immediate effect, often with medical therapy, with drug therapy. And so, you know, within a day or two, you can sometimes see a blood pressure lowering effect. With diet, it can take place. Blood pressure lowering effect can take place as early as two weeks, but it’s still not quite with the same dramatic results. So I think over time, just the medical practice and medical education was more focused on the drug side and the procedure side.

Stephen Devries (11:47)

And nutrition, I think, was often regarded as kind of an add on, maybe something under the domain of dietitians, but not really, really something that physicians focused very much attention on. Fortunately, I think the realization of the problems with that approach have now really come, come to widespread attention. And I can give you an example in cardiovascular disease. You know, all of our technological advances has resulted in, you know, steadily declining rates of cardiovascular death over decades.

Stephen Devries (12:21)

However, over the last few years, that, that declining rate of cardiovascular deaths has started to plateau. And you might ask yourself, why would that be? With all these new drugs and procedures, we should, you know, have fewer and fewer heart disease deaths and they should continue to drop it at the steady rates they had been.

Stephen Devries (12:40)

But the problem is another, another issue came up and that is the rising prevalence of obesity and, and with it, you know, type 2 diabetes and impaired fasting glucose. So despite the best pharmacologic therapy, and we certainly have more drugs available than ever to fight different risk factors for heart disease that we can’t out medicate our way from.

Stephen Devries (13:05)

This, you know, problematic lifestyle issue related to overweight, obesity, and with it the attendant type 2 diabetes that’s become more common. So, you know, it just goes to show that not always throwing more drugs at the issue is going to solve all the problem. Again, medication can be critically important, and thank goodness we’ve got all of these great advances, which I couldn’t endorse any more highly.

Stephen Devries (13:32)

But it’s important to know that, you know, certainly the ideal would be to maximize nutritional lifestyle to the extent possible. So perhaps some of these medications may not be needed, but oftentimes they are needed. And when they are needed, you know, I couldn’t endorse them more strongly that they’re important for care. But again, as we talked about at the top of the show, even when you’re taking medicines, the real importance of nutritional lifestyle always needs to be made clear.

Stephen Devries (14:03)

And I think that isn’t always made clear in medical encounters because physicians haven’t had the background in nutrition to really recognize that fact and emphasize it. And that to me is what it’s all about. You know, we know that physicians are never going to have enough time to deliver, you know, extensive dietary counseling to patients, nor should they. There are other people who are better qualified to do that, like dietitians.

Stephen Devries (14:30)

But what physicians need to be able to do is Say that, listen, taking the right medications, you know, is critically important, but don’t think for a moment that the medications alone are going to give you the full measure of health that you’re capable of, that, that you know, perhaps could require the medications but also will require, you know, attention to nutrition, nutrition, lifestyle, and then to go from there to refer to some additional information, to maybe be able to answer some common questions with good solid evidence based responses and then to make good referrals to dietitians who can help with in greater detail and do all kinds of things that physicians aren’t able to do, don’t have the knowledge to do and don’t have the time to do.

Shireen Abdullah (15:15)

And I think there’s something of value there. If I hear a physician sort of taking interest and providing those types of things to me, I personally would feel more inclined to then go to that dietitian referral and have a more in depth conversation with a dietitian about like this is what my physician said. What else or what more can I do to build on top of, top of that? Right. Like I feel like I would be more inclined to.

Stephen Devries (15:38)

Absolutely. That comes up a lot, I think, you know, certainly I’ve seen that myself that if as a physician you not only are offering or advising medication and procedures when they’re appropriate, but I think patients really for the most part welcome a physician who isn’t only going to take out the prescription pad and write a prescription, but will also incorporate things that the patients can do. Because most patients want to take some control over their, their health. You know, taking their medicine faithfully is one way of doing it, but also things they can do, you know, more intimately in their own life that they can, they can impact their health with.

Stephen Devries (16:17)

And that’s, you know, being given some guidance or at least prioritizing the need to, to attend to dietary issues. And so I think when a physician does, you know, have a conversation with the patient that includes nutrition and lifestyle, it makes the patient more engaged and care more and trust the physician more because they know it’s not all about pills and procedures, that they have a bigger set of therapy available and most patients really welcome.

Shireen Abdullah (16:47)

That’s very helpful. Dr. Devries, a follow up question for you. Here at Yumlish, we talk a lot about food environments in particular and how they shape health outcomes as well. What factors in today’s food environment really make it difficult for people to maintain a heart healthy diet?

Stephen Devries (17:07)

Yeah, yeah, I can give you some examples. It is hard and it’s certainly, you know, there are Issues about, you know, people have agency over what they do, but the environment can make it so difficult and stack the deck against them. As you’re saying, you know, take, you know, people who go out to eat.

Stephen Devries (17:26)

You know, just the fact if you’re traveling, traveling a lot or, you know, your job is such that because, you know, you, you need to entertain clients or whatever, if you’re, if you’re eating at restaurants a lot, restaurant food is typically way over salted. Portion sizes are huge. So, you know, that’s one environmental factor. Just the people who go out to eat a lot for whatever reason, you know, it’s, it’s possible, but it’s really hard to get healthy meals.

Stephen Devries (17:54)

Certainly ones that are not over salted, ones that don’t have, you know, portion sizes that are too large, that are tempting when it comes with a big portion on your plate, it just really kind of makes it harder to, to turn away and make, make for a more appropriate, smaller size. So those things are hard. Also in the supermarket, you know, people are rushed, they don’t have enough time.

Stephen Devries (18:18)

Some people work in two jobs. So getting food that is convenient is, is important. We can’t, can’t overemphasize the idea that people, you know, are hassled and they need to sometimes choose foods that are convenient for them. And sadly, those convenient foods are often not healthy choices. They’re often prepared with, you know, too much salt, too much unhealthy fats, too much sugar. And so people end up making choices from convenience.

Stephen Devries (18:50)

But, but they’re not typically the healthiest ones. So you know, there are, there are strategies to, to fight that, but it is definitely fighting a lot of upstream currents that are set up by industry,.

Shireen Abdullah (19:04)

You know, trying to come at it from the public health standpoint as well. What role do you think digital education and just public health initiatives around nutrition can help in improving nutrition knowledge overall?

Stephen Devries (19:18)

Yeah, no, I think definitely that some larger initiatives, some governmental ones, like there are all kinds of discussions now about front of package labeling. You know, some discussions in some countries have adopted kind of a stoplight kind of labeling with red, yellow and green. And so those sorts of prompts I think would help people to choose healthier choices. So, you know, those have not been implemented in the United States, but perhaps those could make a difference.

Stephen Devries (19:52)

And I do think education does matter. Certainly as we talked about, education is not everything that there are some societal factors and issues of food access and affordability that are, you know, go beyond education because they go to the options that people have Regardless of what, what they know would be a better option.

Stephen Devries (20:14)

But all that being said, I do think education and actually our nonprofit, you know, focuses on education through digital means as you talked about, because it’s a really great way, you know, is this podcast, it’s a great way to scale, you know, one conversation or one set of programs to make it accessible to a wide range of people.

Stephen Devries (20:35)

And just a particular point, you know, that I think education helps, you know, people talk about, well, healthy eating is really expensive. And so, you know, how, how do healthy eating messages apply to, to people who economically are, are in a difficult place. And I would say, you know, one suggestion that education and kind of messaging would help for is just replacing sugar sweetened beverages with water.

Stephen Devries (21:03)

You know, that would be one tip that could be spread through digital education or a variety of ways that is incredibly health promoting step to replace sugar sweetened beverages with water. And also it’s economically positive too because for the most part people have access usually, often hopefully to healthy water for free. And certainly in place of sugar sweetened beverages, it would be a tremendously positive health movement and one that would be budget positive.

Stephen Devries (21:35)

So you know, there are some messages that can be transmitted. Again, there’s sometimes that there’s habits that need to be overcome to kind of wean people away from those. But knowledge is the first step. It’s not the only thing needed. But it’s one really important part of the puzzle of trying to get people to eat healthier.

Shireen Abdullah (21:55)

You mentioned the swap out of the sugar sweetened beverages for water. I’m going to put you on the hot seat here because for right this training with the Gapos Institute. But what are some of the most impactful dietary changes people can make to support their heart health?

Stephen Devries (22:10)

Yeah, I think a couple of things. One does involve sugar sweetened beverages. You know, there’s a lot of talk about ultra processed foods and how harmful they are and all of the adverse health consequences from excessive consumption, which is commonplace in the United States and even more commonplace than it is for adults, it is for children. So that especially vulnerable and unfortunate situation.

Stephen Devries (22:37)

So a couple of things. Of all of the ultra processed food items, there are two that have been single out to be the most closely associated with adverse outcomes. And one of them is sugar sweetened beverages. So one piece of advice would be, you know, examine your intake and to the extent you possibly can cut back or ideally cut out sugar sweetened beverages. So that’s number one.

Stephen Devries (23:03)

The second is processed meats. Processed meats like bacon, sausage and similar, they are actually some of the worst offenders for being linked to adverse outcomes. So that in terms of, you know, advice of simple things would be something to do, you know, get rid of or minimize to the greatest extent the processed meats and then on the, on the side of what to eat more of.

Stephen Devries (23:29)

We know that nuts are very, very healthy. And although there’s, it’s a subject of some debate, so I’m sure some listeners will question this. But I would say that the great preponderance of evidence suggests that seeds and nuts for the most part are healthy and should be consumed in greater quantity. And then vegetables and fruit, of course. And the idea is, you know, some people first of all to think about fruit as a snack instead of candy or bakery goods.

Stephen Devries (24:05)

So what do you have for dessert after dinner? Well, instead of, you know, a few cookies, it could be a piece of fruit, could be some berries. And interesting. People wonder about the sugar in fruit and they say, well, isn’t there sugar in fruit isn’t a that of problem too.

Stephen Devries (24:19)

But fortunately fruit also has fiber that slows the absorption of that sugar. And also fruit has a variety of other positive nutrients that promote health. So definitely fruit in place of sugary desserts would be helpful. So those are some tips that I think would be really great for your listeners.

Stephen Devries (24:40)

And if you only do one or two of them, that would be a great start. You don’t have to, I think, you know, turn your whole diet upside down. But if you just get rid of sugar, sweetened beverages or really cut down or eliminate processed meats, even if you just do that, you’ve gone a long way to promote heart health.

Shireen Abdullah (25:00)

Well, on that note, Dr. Devry, thank you so much for your time here today. We are toward the end of the episode. Can you tell our listeners how they can connect with you and then just stay informed about your work?

Stephen Devries (25:11)

Absolutely. We do offer for the public all of our interactive resources are completely free. We’ve got resources for children in a graphic novel format that is now required in many schools. And we also have nutrition learning for adults. It’s interactive, it’s got lots of graphics that are engaging and people have found it to be extremely helpful. Not even an email required and completely free. All of our material for the public and for health professionals.

Stephen Devries (25:45)

Our nutrition course I mentioned is something that is required in more and more centers. You can get all of that by going to our nonprofits website which is gaplesinstitute.org G A P like Paul lesinstitute.org.

Shireen Abdullah (26:01)

Thank you so much to our listeners. We’ll link all this up in our show notes. Thank you again Dr. Devries, for your time. To our listeners. Thank you for listening to another episode of the Yumlish podcast. Head over to our social media and answer this quick question, which is what changes would make it easier for you or your community to eat in a way that supports heart health? Again, head over to Yumlish on Facebook or on Instagram. Find this podcast post and comment below to tell us again what changes would make it easier for you or your community to eat in a way that supports heart health. We’ll continue the conversation there with that.

Shireen Abdullah (26:36)

Dr. Devries, thank you again.

Stephen Devries (26:38)

Thank you.

Shireen Abdullah (26:40)

Thank you for listening to the Yumlish podcast. Make sure to follow us on social media @Yumlish_ on Instagram and Twitter and @Yumlish on Facebook and LinkedIn for tips about managing your diabetes and other chronic conditions and to chat and connect with us about your journey and perspective. 

Shireen Abdullah (27:00)

You can also visit our website, yumlish.com, for more recipes, advice, and to get involved with all of the exciting opportunities Yumlish has to offer. If you like this week’s show, make sure to subscribe so you can hear more from us every time we post. Thank you again, and we’ll see you next time. Remember, your health always comes first. Stay well.

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Website URL: https://www.gaplesinstitute.org/

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LinkedIn URL: https://www.linkedin.com/in/dr-stephen-devries/