The heart smart diet

1. The heart smart diet Presented by Sanmaré MacRobertClinical Dietitian Vergelegen Nutrition Centre Suite 2 F Arun Place · Main Road · Somerset West 021 851 6228 vergelegen@nutritioncentre.co.za

2. Facing the facts • Coronary heart disease is the second biggest killer of South Africans after HIV/Aids • Each day • 33 South Africans die from heart attack, • 60 die from a stroke • 60% of Coronary heart disease is due to high cholesterol • 60% of CHD deaths in developing countries are due to high cholesterol BHF website

3. Unmodifiable Risk factors Heart Disease Stroke History of stroke or pre-existing cardiovascular disease Previous TIA Age: > 45 yrs Highest risk 60-80 years Family history of stroke Male Blood disorders which increase clotting Valvular disease such as mitral stenosis • Age • Male > 45 • Female > 55 • Family History • Gender • Male • Menopause Lancet 2010; 376:112-123 American Heart Association Cleveland Clinic Krause

4. Modifiable Risk Factors Heart Disease Stroke Artherosclorosis Narrowing of arteries High cholesterol levels (LDL) High blood pressure primary risk factor for Ischemic strokes High homocystiene level Drug abuse Smoking Diabetes mellitus Atrial fibrillation Excessive alcohol intake Obesity (BMI>27) Sleep apnea • Increased LDL/HDL ratios • Smoking • Diabetes • Hypertension • Abdominal obesity • Psychosocial (i.e., stress or depression) • Failure to eat fruits and vegetables daily • Failure to exercise • Failure to drink any alcohol

6. What is cholesterol • Cholesterol = a waxy substance found in the fats in your blood • Your body needs cholesterol to build healthy cells BUT • ↑ cholesterol levels • coats artery walls and making them less flexible atherosclerosis • Blood clot can form and clog narrowed artery, stopping blood flow to brain or heart causing: • Heart attack • Stroke

7. CholesterolBlood test for Cholesterol: Lipogram Cholesterol can not dissolve in water • Carriers  lipoproteins • HDL-cholesterol – “good” • LDL-cholesterol – “bad” • Triglycerides – “ugly” • Fat in the blood Total Cholesterol is the combination of the above

8. CholesterolWhere does it come from? • Genetic • Some people inherit genes that trigger too much cholesterol production • Food • 25% • Small effect on blood cholesterol in most people • The type of fat (saturated and trans fats) can increase blood cholesterol more significantly • Liver • 75% • Type of cholesterol / lipoprotein produced depends on your diet

9. Cholesterol Liver = 75% Diet = 25% Artery Food

10. Cholesterol LDL HDL Artery Food

11. Cholesterol LDL HDL Artery Food

12. Cholesterol TG Artery Food

13. Why high cholesterol matters • One of the major risk factors of: • Coronary artery disease • Heart attacks • Strokes • Also appears to boost the risk of Alzheimer’s disease • High Cholesterol levels lead to build up of plaque that narrows the arteries • Restricting blood flow to heart or brain • Leading to heart attack or stroke

14. Managing cholesterol levels • Cholesterol lowering medication • Statins • Fibrate derivatives • Bile-sequestering resins • Dietary and lifestyle modifications • Heart smart diet • Changing lifestyle behaviours • Alternative remedies • Join my talk in September 2012 to find out more about these alternative remedies…. NOT TO MISS!!!

15. Lifestyle behaviours together with healthy eating pattern and moderate alcohol consumption, are associated with a 95% decrease in heart attack risk DIET DOES MAKE A DIFFERENCE!!!

16. The Heart Smart Diet • Becoming fat SMART • Saturated fat • Trans fatty acids • Butter vs Margarine • Dietary cholesterol • Poly unsaturated fat • Omega 3 fatty acids • Nuts • Mono unsaturated fat • Cholesterol in the diet • Plant Sterols and Stanols • Soya protein • Soluble fibre • Fruits and vegetables • Alcohol

17. Protein, CHO, Fat?What to consider? No Carbohydrates? High Protein? What about fat?

18. Becoming fat smartSaturated fat • Non essential fat • Mainly found in animal products such as meat, poultry, and dairy, and certain oils • Saturated fat raise LDL (bad) cholesterol • 1% increase in daily energy from SFA, increase LDL-C by 1.8mmol/L (1/2 tsp margarine) • Saturated fat increase LDL-C more that dietary cholesterol • Decreased intake of SFA along with weight loss can reduce LDL-C by up to 16% • Foods high in SFA usually also high in dietary cholesterol = double trouble

19. Becoming fat smartSaturated fat • Sources: • Full cream dairy • Fatty meals and marinades • Sauces • Butter • Potato chips • Cakes • Check food labels for SFA • AHA is < 7% of total energy • < 16 g per day • Chips Chocolate • Pies • Rusks • Toffees • Coconut, palm and palm kernel oil

21. Becoming fat smartSaturated fat Saturated fat content of food:

22. Becoming fat smartSaturated fat Food labels:

23. Becoming fat smartTrans fatty acids • During food processing, fats may undergo a chemical process – hydrogenation • Found in margarines and spreads, shortening, cooking oils • Raises LDL (bad) cholesterol • Lowers HDL (good) cholesterol • Raises Triglyceride levels • 2% increase in dietary TFA • Raise LDL:HDL ratio by 0.1 • Increases the incidence of CHD by 23% • Trans fats may damage the cells lining the blood vessels, leading to inflammation • Cause insulin resistance  Diabetes (tim noakes) Leading to arteriosclerosis  heart attack & stroke

24. Becoming fat smartTrans fatty acids • Trans fats are made by adding hydrogen to vegetable oil - keeping food fresher for longer • Also formed as oil ages or is re-used • Also occur in nature as the result of fermentation in grazing animals • Trans fats more difficult to digest, and your body recognizes it as saturated fat

25. Becoming fat smartTrans fatty acids • How to reduce trans fat intake: • READ FOOD LABELS • Trans fats • Partially hydrogenated vegetable oil • Fully or completely hydrogenated oil doesn’t contain trans fats • Use margarine as a substitute for butter, and choose soft margarines over harder, stick forms • French fries, doughnuts, cookies and crackers are high in trans fatty acids • According to the AHA - < 2g TFA per day

26. Trans fatty acids: Dietary Sources

27. Butter vs margarine

28. Butter vs MargarineTHE FACTS BUTTER • 727kcal/100g • 48g of saturated fat/100g • 219mg of cholesterol/100g MARGARINE • 731kcal/100g • 16 or 10g of saturated fat/100g of standard or lite marg • No cholesterol

29. Becoming fat smartDietary Cholesterol • Only 25% of cholesterol come from dietary sources • Diet high in Cholesterol can raise cholesterol levels and contribute to atherosclerosis • The AHA recommends to limit dietary cholesterol intake to < 300mg/d • Sources

30. Becoming fat smartPolyunsaturated fat • Liquid form at room temperature and when chilled • ↓ LDL-c & ↓ HDL-c • Sources: • soybean oil, corn oil and safflower oil (ω - 6) • fatty fish such as salmon, mackerel, herring and trout (ω - 3) • walnuts • sunflower seeds

31. Becoming fat smartOmega 3 fatty acids • ↓ cardiovascular events by 19-45% • Triglycerides • Lowers triglycerides in a dose-dependent manner. • Systemic analysis indicate for every 1g increase in omega-3 = 0.2mmol/L drop in triglycerides • For every 4g/day omega-3 = 25-30% reduction in triglycerides • LDL-C • 5-10% increase • Some studies report the effect to be because of increase in LDL-C particle size • HDL-C • 1-3% increase • Modest effect – evidence that alter HDL subfractions towards more favourable cardio-protective profile • Reduce overall mortality in survivors of a first Myocardial infarction by 20 – 29% • Reduce blood pressure • Slows build up of arteriosclerotic plaque • Prevent blood clotting

32. Becoming fat smartOmega 3 fatty acids • Dietary Sources • Oily fish: Mackerel, sardines, pilchards, herring, trout, fresh tuna • Flaxseeds and flax oil; Ultimate seedmix: 1 TBS per day • Canola products i.e. margarine, oil & eggs • Omega 3 enriched foods: • Bread • Yoghurt • Milk • Dosage • 1g EPA and DHA per day for people with known CVD • 3 – 4 g EPA and DHA in patients with hypertriglyceridaemia • To meet requirement with diet or supplements or a combination • Supplementation • Safety: • Safe supplementation intake 3g per day • No guarantee of strength purity or safety • Fish allergy • Side effects: • Increased risk of bleeding / hemorrhagicstorke – high doses • Decrease platelet aggregation, prolonged bleeding time, increased fibronolsys • GI upset, diarhoea, abdominal pain, bloating, indigestion • May cause vitamin E deficiency if taken for many months

33. Becoming fat smartMono-unsaturated fat • Protective effect on CVD • Small ↓ in LDL-c • ↑HDL-c • Studies on diets high in MUFA showed a 50-60% risk reduction and re occurance in CVD • Dietary sources: • Nuts and avocados • Oils (Olive, Canola, Grapeseed, Avocado oil, Macadamia nut, Ground nut, Peanut, Sesame and Corn oil) (but high in omega) • Peanut butter • Popcorn • Oatmeal

34. Becoming fat smartNuts and heart health • If taken as part of a healthy diet they can • ↓ LDL-C • Reduce risk of developing blood clots that can cause a fatal heart attack • Improve the health of the lining of your arteries • Contains omega 3 fatty acids e.g. walnuts • Evidence “suggests” but not prove that nuts reduces heart disease risk.

35. Becoming fat smartNuts and heart health • Contains unsaturated fat, omega 3 fatty acids, fiber, vitamin E and plant sterols • Sources: • Almonds, brazil nuts, cashews, hazelnuts, macadamia nuts, peanuts, pistachios, walnuts • Nut oils – but does not contain fibre • Limitation: • Nuts contain a lot of energy and if not consumed with a healthy diet, can lead to weight gain, increasing CVD risk • Avoid salted nuts • Avoid sugar, chocolate or yoghurt coated nuts (↑ E)

36. Becoming fat smartPlant Sterols and Stanols • Plant stanols and strerols are essential • Looks like cholesterol • Sterols and stanols presents naturally in small quantities: • Fruits • Vegetables • Nuts • Seeds • Function: • Lower LDL-C by blocking its absorption • Compete with cholesterol in GI to reduce absorption • Cereals • Legumes • Vegetable oils and • Other plant sources

37. Becoming fat smartPlant Sterols and Stanols • 2g per day lowers LDL-C by 10%. • For maximal effectiveness, foods containing plant sterols and stanols (spreads, juices, yogurts) should be eaten with other foods • To prevent weight gain, isocalorically substitute stanol- and sterol-enriched foods for other foods. 25g a day is needed to provide the optimal intake of plant sterols, (2-2.5 g) Plant stanol esters (2.0g per 100g)

38. Lifestyle changes to improve heart health • Establish a healthy body weight • BMI < 25 • Maintain waist circumference under normal ranges • < 88cm females • < 102 cm males • Physical exercise • 30 minutes x 5 per week • Stop smoking • Drink alcohol in moderation

39. Also need to consider abdominal obesity… visceral fat • Apple shape • Waist circumference • <102cm (94) • <88cm (80) • Waist circumference > cut offs • ↑LDL Cholesterol • ↓HDL Cholesterol • ↑TG • ↑Ratio

40. What is your waist line saying? Black Ribbon = 102 cm for male Red ribbon = 88cm for females Know your risk today!!!!

41. Importance of keeping an eye on the waist circumference • Abdominal obesity predicts CHD risk independent of BMI, smoking, cholesterol and hypertension.(Kannel et al., J. ClinEpid., 44, 183-190, 1991). • Abdominal obesity predicts CHD risk independent of total body fatness.(Larsson et al. ,Appetite, 13, 37-44, 1989). • Abdominal obesity statistically accounts for difference in CHD rates between men and women. (Larsson et al., Am. J. Epi., 135: 266-273, 1992).

42. Abdominal Obesity • Therefore you can not just eat healthily • YOU NEED TO KEEP AN EYE ON YOUR WAIST CIRCUMFERENCE A dietitian can help you to decrease your waist circumference to the normal range • Along with helping you eating all fats in the correct amounts • Decreasing your risks

43. Alternative Remedies • Red Yeast Extract • Plant sterols and Stanols • Artichoke • Barley • Garlic • Oatbran and many more to come in September 2012!!!

44. Thank youSanmaré MacRobert021 851 6228