Michael Ozner, MDJanuary 2006
Dr. Michael Ozner is somewhat of an iconoclast in the field of cardiology. His practice in Miami, FL, is dedicated exclusively to cardiovascular disease prevention, eschewing intervention procedures such as stents and coronary bypass surgery. His prescription for cardiac wellness and prevention is quite simple: “Eat a delicious meal of fish, whole grains, and fresh vegetables. Drink a glass of red wine. Take a nice walk, then take a nap. Relax with your family and friends. Do it all again tomorrow, and the next day, and the next, for the rest of your life.”
The lifestyle prescription Dr. Ozner describes sounds like a vacation. Yet it is indeed a lifestyle and a prescription, one that has been shown to decrease the risk of cardiac events, control weight, and make life less stressful for those who choose to follow it.
An American-Style Mediterranean Diet
In his new book, The Miami Mediterranean Diet, Dr. Ozner brings his health prescription to the masses in a palatable form—literally. The book touts the benefits of the traditional Mediterranean diet and shows how it can be adapted to the modern American lifestyle. It is packed with hundreds of patient-tested recipes and easy-to-read health information drawn from years of clinical practice. The book is available from www.cardiacoz.com.
While The Miami Mediterranean Diet has won favorable reviews from physicians and patients alike, the book aims to do more than teach people how to reduce their cardiac risk and live longer, healthier lives. It seeks to encourage dialogue among physicians, as well as between doctors and their patients, about a prevention program with substantial evidence to support its efficacy.
“We’ve known for years that a Mediterranean-type diet will protect us from cardiovascular disease and other disease states,” says Dr. Ozner, who serves as medical director of wellness and prevention at Miami Baptist Hospital’s Cardiac and Vascular Institute. “It also allows us to lose weight and keep it off. This has been shown over and over again.”
Citing the 20-year landmark Seven Countries Study conducted by Dr. Ancel Keys starting in the late 1950s, Dr. Ozner explains that a diet low in processed foods and saturated animal fats was found to produce the longest life expectancy in the world and the lowest heart disease rates in those living in the Mediterranean region. The study tracked more than 13,000 men from Italy, Greece, Yugoslavia, the Netherlands, Finland, Japan, and the US. Among its dramatic findings: Greek men were 90% less likely to die from a heart attack than American men.
“It’s rare to see someone overweight in Greece, and they don’t restrict carbohydrates there,” says Dr. Ozner. “People eat pasta, fresh vegetables, beans, whole grains, cold-water fish, nuts, olive oil, and red wine. They walk rather than drive and are active during the day. In the US, we have fad diets restricting or eliminating carbs, and we still have an obesity epidemic.”
On the Path to Prevention
The path that led Dr. Ozner to a prevention-only cardiology practice began more than 20 years ago, when he decided that intervention—namely, bypass surgery and, at the time, balloon angioplasty—was not enough to effectively reverse America’s heart disease epidemic. His patients who had undergone such procedures kept returning for a second or third intervention while living in a state of constant stress, waiting in dread for the next cardiac event to occur.
“This is when I got interested in prevention,” explains Dr. Ozner. “Heart disease is really a conglomeration of different insults to our bodies, all of which can be controlled by a three-part program of prevention and lifestyle changes: nutrition, exercise, and stress management. Along with smoking cessation, using these prevention strategies in my own practice has resulted in a significant reduction in patients developing heart attacks if they hadn’t had one, and those who had were less likely to require repeat intervention.”
Today, Dr. Ozner’s patients include both those who are at risk for cardiovascular disease and others who have had heart attacks, strokes, or peripheral vascular disease and wish to prevent future events.
Dr. Ozner, who also serves as a clinical assistant professor of medicine and cardiology at the University of Miami School of Medicine, is puzzled as to why more cardiologists do not emphasize prevention when it works so well, though he notes that physicians are becoming more accepting of prevention modalities. His lectures promoting “aggressive prevention with conservative intervention” draw plenty of positive feedback from his colleagues. His annual Cardiovascular Disease Prevention Symposium in Miami has attracted standing room-only audiences of professionals eager to learn about recent advances in prevention.
“Physicians appreciate that the data now support prevention,” he notes. “We’ve shown that proper nutrition and use of supplements that are known to be effective can reduce low-density lipoprotein (LDL) to the low levels now recommended. We can significantly reduce our reliance on intervention this way. I regularly recommend fish oil supplements for all patients who are at increased risk or have inflammatory conditions or elevated lipids, including triglycerides. Beyond that, I make further recommendations based on the individual patient’s needs.”
Dr. Ozner emphasizes that he is not opposed to intervention when appropriate, particularly with clinically unstable patients. For someone in the throes of heart attack, surgery to open an artery suddenly blocked by a fresh thrombosis is a life-saving procedure.
“However, that’s a far cry from saying all people who have blockages, including those who are stable, require surgical intervention,” he says. “Clearly, that would be inappropriate.”
The most exciting advances in cardiology today are in the area of prevention, contends Dr. Ozner. Effective new medications are being developed through genetic engineering and other technological advances. He still believes, however, that the key to beating the nation’s number-one cause of death is alerting the American public to the urgent need for health-promoting changes in lifestyle and nutrition.
Trends Fuel Heart Disease Epidemic
Dr. Ozner points to a number of societal trends that he believes contribute to the heart disease epidemic, chief among them the abysmal state of nutrition in America. The public seems hungry only for fad diets that promise much and deliver little, he says. Food manufacturers produce products stripped of nutritional value, a situation he says demands more responsible action. Pharmaceutical companies push pills as the panacea for all our woes. The unrelenting stress of modern life further erodes our health and makes matters worse.
“Gulping down processed foods in our hectic environment leaves little wonder why—despite the billions of dollars we spend on intervention—our nation is still the leader in terms of heart attack, stroke, and other diseases,” he says. “This is where ‘lifestyle’ clearly comes into play.
“We know what the root of the problem is. We as a nation have stopped exercising—we drive instead of walking, take elevators instead of stairs. We eat processed foods instead of fresh fruits and vegetables. Our lives are filled with enormous amounts of stress, all of which has led to deterioration of our health status. The trillions of dollars spent on health care are bankrupting the country. Society would be much healthier if we returned to a healthier lifestyle.”
Dr. Ozner faults the food industry for not providing Americans with healthier food choices. For example, food processing destroys whole grain, ripping out the germ and bran—major sources of nutrients, vitamins, and fiber—leaving only starch stripped of all nutritional benefit. Dr. Ozner notes that per-capita consumption of refined sugar has increased exponentially over the past few decades, leading to an obesity epidemic in children and adolescents. He decries cuts in physical education programs in schools, and is mystified by the apparent lack of concern for this age group.
“One could say, ‘So what?’” he says. “So what is that we have an epidemic today of type II diabetes in children, adolescents, and young adults, which leads to heart attacks.”
Trans fats should be banned, Dr. Ozner says, as they are in Denmark. Scientific studies have long linked hydrogenated oils to adverse medical conditions. Trans fats have contributed to thousands of premature deaths from cardiovascular disease.
According to Dr. Ozner, “We really need to wake up to the fact that we’ve been given bad information and led down the wrong path with fad diets such as the low-carb craze. We should insist that the food industry become more responsible with advertising and promoting healthy foods. Much as we’ve placed sanctions on cigarette manufacturers, we should do the same with the food industry.”
Our nation’s flawed health care delivery system is also at fault for much of what it attempts to treat, Dr. Ozner says. Physicians are rewarded for treatment procedures instead of for keeping people healthy and out of the hospital through preventive medicine. We are overly reliant on pills and under-reliant on healthy lifestyle choices, he says.
“I’ve seen people get on prescription medication just so they can abuse diet and lifestyle,” Dr. Ozner notes. “The fault here lies with the public for listening to the bombardment of pharmaceutical industry advertising hype. But the pharmaceutical industry is also responsible for pushing these pills on society. COX-2 inhibitors like Vioxx® are a perfect example. We’ve known for years that one of the best anti-inflammatory substances for arthritis is fish oil, a natural substance containing eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). It makes more sense to use products like that.”
The lack of nutrition training in medical schools also contributes to the problem, he says. Many physicians feel nutrition simply is not important, contrary to the growing body of data demonstrating that it is extremely important. It takes time and an inclination to discuss nutritional guidelines with patients, so physicians often find it easier to write prescriptions than to talk about nutrition. Additionally, physicians are wary of sending patients to registered dieticians, fearing the dieticians may tell patients something contrary to what the physician believes.
“For all those reasons, it’s easiest to give people reading material, whether it’s a book like mine or other nutritional guidelines, to educate them on healthy lifestyles and keep them off the fad diets,” Dr. Ozner says. “Have them read publications like Life Extension magazine, get people thinking about health and prevention, and they’re more likely to stay healthy.”
Dr. Ozner believes in putting responsibility for overall health squarely on the patients’ shoulders. They must be proactive, Dr. Ozner says, and not sit back and wait for cardiovascular disease, cancer, and other conditions to strike. Patients should embark on effective strategies early in life and discuss all prevention modalities with their doctors. First, they should seek out a physician they can trust. However, he notes, it is prudent to seek second opinions if there is any doubt concerning recommendations for medicine, hospitalization, or procedures.
Building trust calls for returning to the doctor-patient relationship that existed years ago, when patients frankly discussed any troubling topic with their personal doctors. More recently, managed care and other market forces have made medicine more of a business than a professional calling.
“The doctor-patient relationship has eroded because physicians must see patients every five minutes to make ends meet,” Dr. Ozner notes. “You can’t counsel patients with the details of a good preventive program in that short a time.”
If physicians do not have time to talk to patients who want to improve the relationship, what is the solution? Be creative, Dr. Ozner says, and find ways to disseminate information: “I give reading assignments, and ask them to write down any questions they have. The patient comes back motivated and educated and, I think, more likely to follow recommendations.”
For the physicians’ part, Dr. Ozner notes that the word “doctor” actually means “teacher.” He says physicians need to get back to the very derivation of what they are by instructing patients rather than quickly scribbling prescriptions.
“Doctors need to find resources to teach people how to live a healthy lifestyle,” he explains. “I think the Life Extension Foundation does a very good job in helping promote the concept of prevention and a preventive approach to health care. The Foundation is about quality of life. It really has helped educate the public on a variety of disease states and, most important, how to prevent them. I applaud any organization that tries to improve people’s health and decrease the likelihood that they will develop disease states.”
Beating the heart disease epidemic comes down to changing attitudes all around, says Dr. Ozner. For the health care system, it means redirecting billions of dollars spent on intervention into prevention modalities. For physicians, it means embracing prevention modalities, educating patients, and redeveloping trust. And for patients, it means waking up, taking responsibility for their health, and looking beyond pills.
“In America, we’re all looking for a magical pill to solve all our problems, when what will work is changing our attitudes,” he says. “You can live a long, happy life that will result in more pleasure from exercise, from eating food that’s delicious, and from reducing stress. I’m amazed to see how people who adopt this type of lifestyle honestly feel they’re not only healthier, but much happier.”
For more information, visit www.cardiacoz.com.