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

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Heart healthy eating

Heart Healthy Eating

Jamie Anderson, MD

Stonebridge Internal Medicine

February was american heart month
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

All fats are not equal
All Fats are NOT equal

  • Saturated fat

  • Trans fat

  • Monounsaturated fat

  • Polyunsaturated fat

Saturated fat
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

Trans fat aka partially hydrogenated oil
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

Monounsaturated fat
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

Polyunsaturated fat
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

Polyunsaturated fat contd
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

Dietary cholesterol
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

Heart healthy eating

  • 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

Fish and fish oil
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

Vitamin d
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

Dietary fiber
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

Dietary fiber1
Dietary Fiber

  • How much?

    • Women – 25 grams

    • Men – 30 grams

  • Increase intake slowly

  • Drink plenty of water, especially with supplements

Heart healthy eating

  • 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

Red yeast rice
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


  • Thought to lower cholesterol

  • Larger trials with different preparations vs placebo did not show any benefit

Plant sterols
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)

Plant sterols contd
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

Heart healthy eating

  • Small studies have looked at walnuts

    • Rich in polyunsaturated fats

    • Beneficial effects on lipids

  • Lipid-lowering effects also seen with:

    • Pistachios

    • Almonds

Dark chocolate
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

Mediterranean diet
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

Dash diet
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

Grocery shopping
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

Dining out
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

Aha dietary recommnedations
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

Other measures
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

American heart association life s simple 7
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

Numbers to know
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