Dr. Jodi Nishida
Hawai‘i Herald Columnist

February is American Heart Month! It is a month dedicated to education and awareness around heart disease – the leading cause of death in the United States. If you Google “heart health,” a plethora of information shows up and a lot of it is conflicting. This month’s article is designed to help you sift through the noise, make easy improvements and focus on what matters.

With my patients, I like to use the acronym SSSSF. This stands for the five things that greatly influence heart health: Stress, Sugar, Smoking, a Sedentary lifestyle and Fat.


Stress is potent. Stress is a killer. Stress is so powerful that it changes the chemistry of your entire body. Stress can skyrocket blood pressure in just a few seconds and undo the benefits of a perfect diet. In today’s world, everyone is stressed out about something. There’s financial stress, relationship stress, parenting stress, work stress, COVID-19 stress, stress from sitting in traffic, dealing with other people, rushing around, multitasking, watching the news, working for micromanagers, not getting along with your spouse, taking care of kids or elders, cooking, cleaning, etc. etc. We joke about life being this way and call it #adulting, but this is no joke. 

While we can’t always prevent stressful situations from happening, we can improve how we respond to them. We NEED to improve how we respond to them and here’s why: Stress causes blood pressure to rise sharply, causes your blood vessels to constrict, changes the hormones and inflammatory proteins that your body secretes and over time, these responses strain your heart and cause heart disease. Some people can feel their blood pressure rising. Others report shallow breathing or holding their breath, feeling their heart racing or even experience panic attacks. Stress is that tangible and that powerful. So what can we realistically do? 

The first step is awareness. Catch yourself in a moment of stress and bring awareness to the way your body is responding. This takes practice and is so important. One of the best immediate de-stressors is to take 10 deep breaths. Inhale for 3-4 counts and exhale for 3-4 counts. Deep breathing is one of the quickest ways to reset yourself and dampen your body’s responses. 

Second, remove yourself. Get up from your desk, get out of your house, go for a walk or go for a drive. Seeking a change of scenery can quickly get your mind off things. 

Third, listen to music. Music is associated with many positive emotions (and memories), which act as a powerful de-stressor. These are three quick techniques for stress management. Effective long-term techniques include exercise, meditation, tai chi, stretching and yoga. When practiced regularly, these techniques have lasting effects.


Sugar is the second “S” in the acronym. I’m going to pound the truth about sugar until the cows come home, people. Just like stress, sugar is a killer. I remember watching a video in physiology class in pharmacy school. The video showed how plaque buildup happens. As sugar travels through your arteries, it creates small nicks and cuts in the lining resulting in injury. The body responds by sending a host of different immune cells to the area which start to build up. As cholesterol and other things are floating by, they get caught in the immune reaction and eventually turns into plaque. This was my first window into the fact that cholesterol doesn’t cause plaque buildup, it gets caught up in the process.   

Just like stress, sugar changes the chemistry of your insides. It affects the hormones that are released and increases inflammation. Sugar damages every organ, tissue and cell. Severe diabetics are a perfect example of this. After many years of sugar toxicity, their kidneys and eyes fail. Having diabetes is also one of the leading causes of heart attacks and strokes. I recently found an article that emphasized beets and beans for heart health. Beets and beans turn into sugar! These types of articles can be misleading and influence someone to believe that if they eat lots of beets and beans, they’ll prevent a heart attack or stroke, which is so far from the truth. One cup of beets turns into four packets of sugar in the human body and one cup of beans (garbanzo, kidney) turns into 9.5 packets of sugar. Aim to slowly reduce your intake of total carbohydrates (rice, noodles, bread, potatoes, beans, grains, fruit, packaged food, sugary drinks) to less than 25 grams per day and remember that 4 grams of total carbs turns into one packet of sugar.


The third “S” stands for smoking. Whether you smoke cigarettes, smoke cigars, or vape, you are reducing the amount of oxygen that your body needs to function properly while simultaneously introducing toxic chemicals. Over time, these chemicals damage the lining of your blood vessels and organs causing your immune system to go into overdrive. 

Many people smoke to relieve stress not fully realizing that it damages many parts of their body in addition to their lungs. There are other ways to deal with stress without introducing toxins. Again, deep breathing, getting a change of scenery or listening to music are helpful. Numerous smoking cessation resources exist to help you quit this habit once and for all.

A Sedentary Lifestyle

Sedentary lifestyle is the final “S” in the acronym. If there’s one thing the COVID-19 pandemic taught us, it’s to get healthy! Regular exercise is important for heart health; and here in Hawai‘i, we’re blessed with beautiful weather year-round. Exercise can be as simple as doing 5-pound hand weights while sitting in a chair. If you sit at a desk all day, place a set of stationary pedals under your desk or go for a 15-minute walk during your lunch break. This is a great start for many. What about dancing, walking or swimming in the ocean or hula? With the ease and popularity of YouTube, there are over 100,000 exercise videos available to all of us, free of charge, for every level.  

Consistency is key and once you get moving, work towards twice a week, three times a week, four times a week, etc. I suggest finding activities that you enjoy so that you look forward to them. My friends and I recently took up pickleball and love it. You can do it!


Lastly, “F” is for fat. In regards to heart health, I’m specifically talking about trans-fat. Trans-fat is super bad for you. It entered our food industry as an unintentional byproduct of vegetable oil. It was first used in margarine, then later added to snack food, packaged baked goods, and fast food to improve texture, flavor and shelf life. Trans-fats lower good cholesterol, increase bad cholesterol and triglycerides, and cause high levels of inflammation throughout the body. Trans-fats are yet another toxin. You can reduce your consumption of trans-fats by eliminating packaged food, fast food, convenient food, frozen meals, packaged snacks and baked goods from your life. Stick to real food like meat, eggs, seafood, fish, chicken and fresh vegetables.  

Remember, the more SSSSF you have, the higher your risk for cardiovascular disease. Spend 10 minutes today thinking about your life, your stressors and what you eat, and come up with a plan. Implementing baby steps and reinforcing positive change with practice and consistency will help you move in the right direction. Take care of your heart in the same way that it takes care of you.

Dr. Jodi is a Doctor of Pharmacy and accredited Metabolic Healthcare Practitioner who’s been in healthcare for over 25 years. After experiencing the ketogenic lifestyle’s effect on her own autoimmune condition, she decided to build a keto-based medical practice so others could benefit from it too. Over the last few years, she’s helped almost 1000 patients realize the benefits of clean, medically-guided keto.

With certifications in ketogenic nutrition, cardiovascular disease management, pharmacogenomics, and medication management, she works closely with each and every patient to tailor keto to their medications, medical conditions, lifestyle and socioeconomic situation. Dr. Nishida is also in training for processed food addiction recovery. To learn more, or to contact Dr. Nishida, visit her website at theketoprescription.com.

The content of this column is not meant to be medical advice. Please consult your doctor before starting any diet or lifestyle change and understand that there is no blanket approach to keto. Keto should be tailored to each individual through the guidance of a trained professional.


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