Dr. Benico Barzilai is one of the nations foremost cardiologists. As former head of the Cleveland Clinics cardiology department, he has watched over the past four decades as treating heart disease went from managing pain to treatments which begin as soon as the patient is brought in.

But he is dissatisfied with the way people view heart disease. A heart attack, he says, means that somewhere along the line, the patient was failed by the medical system. You dont want to be taking care of them when the illness is more extreme, he said. You want to be taking care of them much earlier.

Born to two Holocaust survivors from Thessaloniki, Greece, Dr. Barzilai is no stranger to the frum community. Last year, he was a featured panelist at the Boro Park Jewish Community Councils senior health expo.

I had a opportunity to interview Dr. Barzilai recently. Although health is not my usual interview subject, it is Dr. Barzilais sole occupation so thats what we discussed.

What is the most common misconception about heart health that you hear about? What is the one thing you want readers to take away from this interview?

I dont know whether this is the most common misconception, but most people dont think about their heart health until theyre in their 50s, or maybe their 60s. But we know that hardening of the arteries probably starts when people are in their 20s and 30s, so people need to realize that heart health is a lifelong thing. So many people I know get real and jump on the bandwagon only when they are in their late 40s or 50s. They dont realize that it has been going on for a long time.

So kids shouldnt be given candies and nosh from a young age in order to train them for when they get older?

No. With kids the problem is that they start with obesity. Childhood obesity has gone up dramatically, and with childhood obesity comes early diabetes and early high blood pressure.

Its very important for people to know, even in their 30s what is their blood pressure? What is their blood sugar? What is their cholesterol? You should probably start checking your cholesterol every five years sometime in your 30s, and if you have a family history, then maybe in your 20s.

Were talking about making sure people are cognizant of their health early on.

Take a person in his 40s who never paid attention to his heart health, and they are now reading this interview and see that Dr. Barzilai is saying, Youre late to the game. What should they do now?

Its really important to know your numbers. Are you overweight? Do you have high blood pressure? Do you have diabetes or prediabetes? A lot of people at that age have prediabetes. You need a cholesterol check in your 40s for sure. And of course, if they have a family history, they need to be cognizant of all these things. If you have a mother or father who had heart trouble starting in their 50s, you must start thinking about it in your 40s.

What would be an ideal diet for someone who wants to take care of his heart but doesnt want to give up all the comfort foods he is used to?

The Cleveland Clinic and other institutions such as the American Heart Association are now recommending the Mediterranean diet. What is that? Thats a lot of vegetables, fruits, things like beans and fish, maybe one or two servings of meat a week. Stay away from processed foods something like a hot dog or salami is processed food. Eat a lot more grains; salmon and white fish are good for you.

Stay away from concentrated carbohydrates; we have way too many carbohydrates in our diet. You know, everyone says, Oh, lets get rid of the fats. Well, thats fine, but then if you get rid of the fats dont substitute it with sugars or carbohydrates or that type of stuff.

By carbohydrates, I guess you mean bread, crackers, those things.

Oh, yes. Bread, crackers, cookies, cakes. We eat too much of that stuff. The amount of sugar we eat in the United States per capita is way too much. Those are the types of things were talking about.

Could you give me an example of a success story of a patient of yours who listened to the doctor and was able to turn it all around?

The thing that always gets me is when I see someone in the office they know theyre overweight because they quickly get on the scale before I walk in. We talk about what their ideal weight is, and lo and behold, you see them six months later and theyve lost maybe 30 or 40 pounds. Im not saying its just diet, its probably a mix of diet and exercise, sometimes medicines. Those people really pay attention.

I saw one lady last week who was 65 pounds down over a year. It was absolutely shocking how these people actually took the advice very seriously.

When it comes to diet changes, changing the foods people eat, is it common for people to be able to change how they eat from one day to the next?

Yes. There are two things that happened. One, they realize that theyre eating much too often and much too large sizes, maybe having way too many courses, the course sizes are too big, the amount of food that theyre eating is too big, and the calorie density is too great. And two, they are not getting any exercise. You cant lose weight unless you also exercise. You have to be putting on 7,000, 8,000, or 10,000 steps a day, besides cutting out a few thousand calories hopefully a day. That helps a lot.

Its important to realize that exercise is important. Just getting up and moving around is important; dont be very sedentary, be very active.

Aside from that, any other lifestyle changes you would recommend?

Reduce your salt intake. Depending on what type of diet you have it can be very high in salt, which can contribute to high blood pressure. Stay away from store-bought food, which is usually high in salt. You can avoid putting in salt when you make things from scratch.

Those are all important issues.

One oddity in health is, everybody knows someone who is overweight and doesnt seem to care much about his diet, yet he lives to his 90s in perfect health. Is that all genetics? What allows a person to lead a long and healthy life even though he doesnt follow the science books?

Theres been a long argument in the medical literature about this concept of the healthy overweight. Is there a group of people that can be healthy and overweight? Theres been a long argument about that, and I would say that probably not. When people are overweight and theyre still healthy, if you will, theyre probably doing a lot of things correctly. They dont smoke, theyre not heavy alcohol drinkers those are two things that people get into a lot of trouble with. They probably are somewhat active I will guarantee you that if theyre healthy and are overweight, theyre very active. They are walking 7,000 to 8,000 steps a day.

So yes, I think there are some people who are overweight and kind of healthy, but I guarantee you theyd be healthier still if they lost 20 or 30 pounds. And Ive had that experience people you tell that they need to lose weight because theyve had their first heart attack or something like that, and they just cant believe how much better they feel when they lose some of that excess weight.

You were in Boro Park last year for the Boro Park Jewish Community Council seminar. What was your impression of Boro Parks seniors?

I was impressed by the amount of energy in that place. The level of energy and enthusiasm was really high. You have to understand, I grew up in Chicago, I spent a lot of time in St. Louis and Cleveland, and Ive never really experienced that type of incredible energy.

We had a question-and-answer session, and I couldnt get off the stage because there were so many questions. Furthermore, the best questions came from the women. I thought that was kind of interesting. It was fun, but I will tell you, there was this incredible intensity and interest and energy about the whole issue.

Your name is Barzilai. It sounds biblical.

Yes.

Where do you come from?

My parents survived World War II. My father was a prisoner of war, but theyre both from northern Greece, Salonika Thessaloniki now. Barzilai is a pretty common name in Sephardic circles.

What made you decide to go into cardiology?

Growing up in Chicago, I originally wanted to do engineering so I went to engineering school in Cleveland, at Case Western University. About halfway through, I decided I wanted to go to medical school, so I went to the University of Illinois.

I did something that is kind of unusual these days I actually worked through medical school. I had a job once a week working in a blood bank. You cant do that nowadays because the finances arent there. But then I was able to make enough money to pay my tuition, believe it or not. Now tuition is $50,000 or $60,000 a year; theres no way youre going to make that type of money.

I lived at home while I was in medical school, and then I went to St. Louis at Washington University for my training in internal medicine and cardiology. I became a full-time staff member there in 1984, spent 25 years there, and then I was recruited to the Cleveland Clinic in 2009 to head up the section of clinical cardiology. I did that for 10 years, and I stepped down in 2019. Now I remain a staff member.

So Ive been a cardiologist since 1984. This is quite a long time, actually.

Wow. Cleveland Clinic is one of the top medical centers in the country.

Yes. One of the things you always have to feel good about is if your family members are sick or youre sick or your friends are sick, do you feel good about the quality of care that you can offer your friends and family? Particularly in cardiology, we can offer tremendous care to people.

The tremendous experience of the institution, and the number of cases we do, give us a lot of experience. The commitment toward excellence and we measure our outcome, so we know, quarter by quarter, how were doing, whether we are meeting our benchmarks. Theres a real passion to give people the best care in the most efficient and safest way possible.

When Damar Hamlin of the Buffalo Bills collapsed on the field earlier this year, he went into cardiac arrest. I think he was taken to the Cleveland Clinic

No, he was down in Cincinnati.

It was a very interesting case. We all talked about it.

Hes doing fine now. What are the odds of surviving a cardiac arrest without any side effects?

I think people misunderstand the importance of having good resuscitation equipment. That guy had the ideal resuscitation. Someone watched it, someone recognized it, he had a team on the field within minutes, and hes young so even though his brain probably was deprived of oxygen for a few minutes it was a very few minutes they got his heart back in rhythm when he was on the floor of the stadium. This is all ideal. How often does this happen? Not often enough, thats for sure. We wish it would happen more often.

What about a heart attack? Years ago it used to be pretty fatal. What are the odds today of leading a regular life?

Its interesting. When I started in 1984, the treatment for a heart attack was we put you in intensive care, we made sure you didnt have any fatal arrhythmia or funny heart rhythms, and that was about it. We didnt have any medicine. We didnt send people to do heart catheterizations during a heart attack. We didnt have stents. We had open heart surgery, but we would never do open heart surgery in the immediate period.

A large heart attack in the front of the heart probably had a mortality back then of close to 30 percent. And that person would have a large portion of his heart damaged, so his life would be limited.

Now, that same type of person would be admitted quickly, go to the heart catheterization laboratory, they would find the blockage, put a stent in right away, and get the blood flow restored. Things are much better. Someone can have a heart attack and live for 20 or 30 years after that. We have many examples of that.

But I guess the best thing is not to get there by doing what the doctor said.

You say doing what the doctor said. How about seeing the doctor? You cant know your blood pressure, your cholesterol, and all those things if youve never had them checked. Its half the battle just getting people to go to the doctor and get checked out.

Are you talking about a regular doctor or a cardiologist?

You start with a regular doctor. If they find something, then you go see a cardiologist.

How often should a healthy adult see a doctor?

I would say once a year at least.

What is important to tell your doctor when you go there?

Family history is very important. Pay attention to your family history, particularly if you have early cardiac disease in your family. There are other diseases we didnt talk about, but many of those run in families, so you should recognize those diseases and make sure you get checked out for them.

Its important to be checked early in the course of the disease. I do a lot of work on valvular heart disease, which is abnormal heart failure, and I cant tell you how many people say, You know, I never knew I have that problem, and you know theyve had that problem for 30 years. So somewhere along the line, the medical system or someone has failed that person, because you dont want to be taking care of them when the illness is more extreme; you want to be taking care of them much earlier.

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