Dr. Michael Ozner is somewhat of
an iconoclast in the field of cardiology. His practice in Miami, Florida,
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, to
control weight, and to 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
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
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
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
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 grains, 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 in the US, 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
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,
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
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.