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Dr. Eduardo de Marchena, associate dean for International Medicine Institute and professor of medicine and surgery and interventional cardiologist at University of Miami Health System, enjoys a healthy lunch outside his office at the University of Miami Schoninger Research Quadrangle, Friday, Feb. 12, 2021. He had developed hypertension and lost nearly 40 pounds, enabling him to get off his blood pressure medication.

Special for the Miami Herald

Dr. Eduardo de Marchena is a cardiology professor at the University of Miami Miller School of Medicine, an associate dean for international medicine and an expert in structural heart disease and coronary artery disease.

Yet, this acclaimed cardiologist found he was facing the kind of weight challenges that can plague many heart patients.

“It’s easy to preach and difficult to follow your own advice,” said de Marchena. “I’ve known about the proper way to diet for many, many years. But throughout my life, I’ve always had a little problem with weight.”

The weight became more of an issue when de Marchena reached his mid-60s. “I was exercising less and eating more. I developed high blood pressure for the first time in my life and had to take medication.”

He then tried all types of diets — the Atkins diet, the Zone diet, Mediterranean diet, Paleo, even fasting.

“They all worked but for a very short period of time,” said de Marchena. “After awhile, I lost interest, getting bored or sluggish from the diet.”

He decided to see nutritional expert Dr. Michelle Pearlman, also at the Miller School of Medicine.

“I didn’t put him on a diet,” said Pearlman, who is board-certified in gastroenterology, internal medicine and obesity medicine. Instead, she helped him to change his eating habits, not eliminating food groups but making better choices.

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A view of the healthy lunch of Dr. Eduardo de Marchena, associate dean for International Medicine Institute at University of Miami Health System, had outside his office at the University of Miami Schoninger Research Quadrangle, Friday, Feb. 12, 2021. SAM NAVARRO Special for the Miami Herald

As a result, de Marchena has lost close to 40 pounds since the summer, going from 195 pounds to 156. He has been able to go off his blood pressure medicine.

“He’s an inspiration to his patients,” said Pearlman. “They ask him ‘What in the world did you do?’ ‘’

How this doctor got off blood pressure medication

What de Marchena did was decrease his portion sizes, focus on foods with more fiber and decrease the sugar in his diet. He switched to healthier snacks like hummus or guacamole with carrots or almonds. He eats more chicken or fish instead of red meat and reduces two glasses of wine at night to one four-ounce glass. And he gets some type of physical exercise for 30 minutes a day.

These types of changes are meant to promote health for the long term, said de Marchena.

“I’ve been able to keep off the weight and I’m wearing clothes I haven’t worn in 20 years,” he said.

Too often people try different diets and then go back to their old habits, and that’s not a good thing, said Lillian Craggs-Dino, a registered dietitian with Cleveland Clinic Florida in Weston. “Yo-yo dieting is harmful to your health.”

“Diet is a four-letter word,” she added. “It can be very confusing. One size doesn’t fit all.”

Diets all have pros and cons, said Dr. Jonathan Fialkow, deputy director of the Miami Cardiac and Vascular Institute and chief of cardiology at Baptist Hospital.

“Why do most diets fail? Because people get hungry,” said Fialkow. “By eating less of the wrong kinds of food, they can get hungrier and more tired and that’s why people fail.”

Added sugar and heart disease

Physicians and dietitians share a common concern: Too much added sugar can raise blood pressure and increase chronic inflammation, and these can lead to heart disease.

While factors like family history, age, stress and lifestyle choices like smoking are risk factors, weight gain, especially belly fat, and obesity can play a big role.

“Just being overweight impacts your cardiologic status,” said Fialkow.

The pandemic hasn’t helped people keep down their weight.

“With people home because of COVID, they have more time so they often feel like eating due to boredom,” said Pearlman. “We go to the refrigerator to see what’s there.”

There are now dozens of diets available — there’s even a taco cleanse (eating vegan tacos for every meal).

“So much about heart health is stress related,” said Tiffany Smith, registered dietitian nutritionist at Broward Health in Coral Springs. “ If your diet is causing you additional stress, that’s not doing you any good. Pay attention to how your diet makes you feel.”

Here’s a look at a few diets getting a lot of buzz and what you need to know, but keep in mind the experts urge you to see a dietitian or physician before making a big change.

Mediterranean Diet

This diet is considered one of the most healthy choices, said Cleveland Clinic’s Craggs-Dino.

The Mediterranean diet focuses on fruits and vegetables, olive oil, whole grains, nuts, beans, fish and other foods high in healthy, Omega 3 fats, with less red meat and some red wine.

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The Mediterranean Diet features healthy options, such as fish, olives, nuts and herbs. snyferok Getty Images/iStockphoto

Pros: It’s a balanced, flavorful diet promoting healthier foods high in fiber and protein. “You’re avoiding foods with a lot of sugar and processed foods, avoiding saturated fats,” said Baptist’s Fialkow.

Cons: There aren’t specific guidelines so you have to determine how to shape your menu. “It uses a lot of olive oil so we don’t want to go overboard,” said Smith of Broward Health.

Vegan Diet

A vegan diet is totally plant-based, focusing on vegetables, fruit, whole grains, legumes, nuts and seeds. It excludes meat, fish, dairy and eggs. Vegans, in general, avoid eating anything that comes from an animal.

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A vegan diet is very good for your heart, but you may need to take B-12 supplements. Mel Melcon TNS

Pros: It’s rich in high-fiber foods, has health and environmental benefits and leads to more mindful eating. “It’s extremely good for your heart and overall health but you have to eat very methodically to get all the nutritional components you need,” said cardiologist de Marchena. “I know people who have been vegan all their lives and they’re healthy. You have to be committed.”

Cons: It’s a restrictive diet so it takes more diligence to ensure you’re eating a healthy diet, which includes calcium and iron-rich foods and enough protein. People may need Vitamin B-12 supplements.

Plant-based diet

Often called a whole foods, plant-based diet, this plan emphasizes fruits and vegetables, whole grains and legumes, said UM’s Pearlman.

Pros: It’s not as strict as a vegan diet because it doesn’t require eliminating meat or dairy. Vegetarians eat a plant-based diet that can include eggs, milk, cheese, butter, yogurt and honey but no meat. It promotes eating fruits and vegetables, minimizing red meat.

Cons: The plan is “more of an approach” than a defined diet, said Smith. While it should be healthy, that’s not always the case. “People throw the term around,” said Pearlman. “If you have cauliflower and throw a ton of oil on top of it and fry it, that’s not healthy.“

Intermittent Fasting

With this plan, you fast for a certain limited time, usually anywhere from 12 to 16 hours. During intermittent fasting, the periods when you are not eating give the body time to lower insulin levels, which reverses the fat-storing process.

Pros: “It can encourage more mindful eating,” said Pearlman. “We’re constantly eating and we may not remember what we ate at the end of the day. Over the span of a week you’re eating during a smaller window.”

Cons: It can be restrictive and may trigger hypoglycemic symptoms like headaches and fatigue. People can end up binging during the times they’re not fasting. It’s discouraged for children and teens and people who have conditions like diabetes or eating disorders.

Keto diet

The ketogenic diet — better known as the Keto diet— is a very low-carb, high-fat diet. With this plan, 5 percent of calories come from carbohydrates, including low-carb, non-starchy vegetables.

The keto diet excludes carb-rich foods like grains, beans, fruits and starchy vegetables. Twenty percent of calories are from protein, such as meat, eggs and cheese. Seventy-five percent of calories come from fat.

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Researchers at Yale University have discovered that, beyond a week, the benefits of the ketogenic diet begin to cease. Dzmitry Skazau TNS

This reduction in carbs puts your body into a metabolic state called ketosis. When this happens, your body becomes efficient at burning fat for energy, the reason the diet has become so popular, said proponents.

Pros: People report losing weight on the diet in the short-term. A ketogenic diet has been used for almost 100 years to treat drug-resistant epilepsy, especially in children.

Cons: It’s considered a short-term way to lose weight, not a lifestyle. “It’s an extremely restrictive diet,” said Pearlman. “Dietary fiber is important for gut health. There’s not a lot of fruit and vegetables. They’re eating saturated fat.” Dieters are advised to get guidance from their physicians or dietitians.

Key is a balanced, long-term approach

Cardiologists and dietitians encourage the public to look beyond the dozens of diets on the market.

“What is the proper diet?” asks Fialkow of Baptist Hospital. “To eat foods in their most natural form, to avoid processed food and shop the periphery of the store where you find the most natural fruits and vegetables. We don’t want to eat food in boxes. That’s not what our bodies are made for.”

Back to basics, the experts still extol a varied diet with foods of all colors to get the most nutrients.

“An ideal diet is a moderate, balanced diet,” said Smith of Broward Health. “A little bit of everything, but not too much.”

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