Heart Healthy Eating

1. Heart Healthy Eating Jamie Anderson, MD Stonebridge Internal Medicine

2. February was American heart month • Heart disease is the number one killer of Americans • We have identified many of the risk factors • Some we cannot change • Age, sex, genes • Some can be changed • Diet • Weight • Smoking • Physical activity • Controlling hypertension, diabetes, cholesterol levels

3. What is heart disease

4. Lowering lipids with diet

6. All Fats are NOT equal • Saturated fat • Trans fat • Monounsaturated fat • Polyunsaturated fat

7. Saturated Fat • Found in: • Dairy foods – cheese, ice cream • Meat – beef, pork, chicken • Some plants – coconut and palm oil • What it does: • Raises LDL and HDL cholesterol • May promote thrombosis • Why we care: • Raises rates of heart disease • May increase risk of prostate and colon cancer • New USDA guidelines recommend less than 7% of your caloric intake come from saturated fat

8. Trans fatAKA “partially hydrogenated oil” • Found in: • Stick and full fat margarine • Commercial baked goods – cookies, crackers, donuts • Deep fried foods • What is does: • Raises LDL cholesterol and lowers HDL cholesterol • Interferes with metabolism of good fats • Why we care: • Raises risk of heart disease • USDA recommends less than 0.5% of total calories come from trans fats

9. Monounsaturated fat • Found in: • Canola and olive oil • Meat, dairy • Partially hydrogenated oils • What is does: • Lowers LDL cholesterol • Slighty raises HDL cholesterol • Why we care: • Probably lowers risk of heart disease

10. Polyunsaturated Fat • Two types • Omega-3 and Omega-6 • Omega-3 • Found in: • Canola, soybean and walnut oil • Wheat germ • Vegetables in cabbage family • Seafood – fatty fish • What it does: • May decrease thrombosis • Important for fetal development • Why we care: • May decrease rates of heart disease and prevent sudden death

11. Polyunsaturated fat contd. • Omega-6 • Found in: • Many vegetable sources – mayo, margarine, salad dressing, nuts, peanut butter • What it does: • Affects inflammation • Why we care: • Probably reduces risk of heart disease • Increased amounts may play a role in cancer

12. Dietary cholesterol • Soft, waxy substance found circulating in your bloodstream • Two sources: • Diet – animal products only • Your body makes some, too • Dietary cholesterol does raise cholesterol levels, but not as important as saturated fat • One egg per day doesn’t seem to raise cholesterol levels in healthy people • Contains about 200mg of cholesterol

13. Salt • Increased sodium intake can contribute to high blood pressure • USDA guidelines now recommend now less than 1500mg of sodium daily • This is down from the previous recommendation of 2300mg

14. Fish and fish oil • Rich in omega-3 fatty acids • Populations with diets rich in omega-3 fats have lower rates of heart disease • Reduce triglyceride levels • Triglycerides determine amount of small LDL

15. Vitamin D • Seems to have a relationship with blood pressure • More studies needed to see if there is a cause and effect relationship • Supplementation with vitamin D hasn’t been shown so far to lower blood pressure • Vitamin D is important for bone and muscle health • Institute of Medicine recommends the following: • Age 1-70 - 600 units per day • Age >70 - 800 units per day

16. Dietary fiber • A diet high in fiber decreases the risk of heart disease, stroke and type II diabetes • Found in beans, grains, vegetables, and fruit • Most fiber is not digested or absorbed • Soluble • Dissolved in water • Fruit, oats, legumes • Reduced the risk of CAD and stroke by up to 40-50% • Insoluble • Does not dissolve in water • Wheat, rye, grains

17. Dietary Fiber • How much? • Women – 25 grams • Men – 30 grams • Increase intake slowly • Drink plenty of water, especially with supplements

18. Soy • Good source of protein and isoflavones • Have an effect on cholesterol levels – though appear to be small • Isoflavones are a type of phytoestrogen • AHA says: • Isoflavones do not seem to have any positive cardiac benefits so should not be taken • Substituting animal-derived foods with soy may be beneficial • Lower saturated fat and more fiber

19. Red yeast rice • Fermented rice product used in Chinese cuisine • Varying amounts of “monacolin” • Monacolin works like some cholesterol medications • Lowers total and LDL cholesterol • Not all strains are alike • Monacolin content ranged from 0 to 0.58% • No long-term safety studies • Natural products lack standardization

20. Garlic • Thought to lower cholesterol • Larger trials with different preparations vs placebo did not show any benefit

21. Plant sterols • Margarines – benecol and promise activ • Available in forms enriched with plant sterols • Reduces total and LDL cholesterol • No adverse effects found in short-term studies • No studies done looking at effects on heart disease • Plant stanols added to orange juice rice milk (Heart Wise beverages) • Plant sterols found in yogurt drink (promise activ super shots)

22. Plant sterols contd. • AHA recommends: • Not to be used in the general population • Can be used by those with a known need to lower cholesterol levels • Recommended doses by manufacturer • Promise activ – 2 tbs per day • Benecol – 3 servings per day • Minute Maid Heart Wise OJ – 2 8-oz servings per day • Promise active Super Shots - one 3-fl oz serving per day

23. Nuts • Small studies have looked at walnuts • Rich in polyunsaturated fats • Beneficial effects on lipids • Lipid-lowering effects also seen with: • Pistachios • Almonds

24. Dark chocolate • Moderate amounts of 70% dark chocolate has been found to reduce heart failure • Watch for saturated fat! • One serving of Hershey’s Special Dark has 7 grams of saturated fat • A 2,000 calorie diet should have no more than 16 grams of saturated fat

25. Mediterranean diet • High in fruits, vegetables, whole grains, beans, nuts, seeds, and olive oil • Moderate fish, poultry and dairy • Limited red meat • Less heart disease found in studies

26. DASH diet • Dietary Approach to Stop Hypertension • Rich in fruits, vegetables • Moderate in low-fat dairy • Low in animal protein • Many plant sources of protein • Legumes, nuts • Reduces blood pressure and LDL-c • May decrease risk of stroke and heart disease

27. Grocery Shopping • Fruits and vegetables – • Fresh and frozen are good choices • The more color the better! • Choose produce canned in water • Stock up on raw vegetables you can snack on • Buy fresh or dried fruits for dessert • Fruit juice doesn’t have the same benefits as whole fruit • Grapefruit and pomegranate juices may interact with some medications

28. Dining out • Avoid: • Fried, creamed, au gratin, crispy, sautéed, • Buttered, stuffed • Look for: • Steamed, broiled, baked, grilled, poached or roasted • Looked for items marked “healthy” • Ask for dressings on the side • Ask for light or no butter • You can usually modify you order

29. AHA dietary recommnedations • Fruits and vegetables – at least 4.5 cups per day • Fish (oily preferably) – at least two 3.5oz servings per week • Fiber-rich whole grains – at least three 1oz servings per day • Sodium – less than 1500mg per day • Sugar-sweetened beverages – no more than 450 calories (36oz) per week

30. Other measures • Nuts, legumes, seeds – at least 4 servings per week • Processed meats - no more than 2 servings per week • Saturated fat – less then 7% of calories per day

31. American Heart Association“Life’s Simple 7” • Don’t smoke • Maintain a healthy weight • Engage in regular physical activity • Eat a healthy diet • Manage blood pressure • Take charge of cholesterol • Keep blood sugar at healthy levels

32. Numbers to know • 120/80 – an ideal blood pressure • 1500 – mg of sodium to not exceed in a day • 40 – or less is the max inches in a man’s waistline • 150 – or less is an ideal triglyceride level • 50 – or more is how high a woman’s HDL should be • 30 – minutes at least 5 days per week of activity • 0 – tobacco products used • 5 – or more servings of fruits and vegetables per day