RSS

Role of Dietary Fat in Vascular Health

07 Mar


Saturated Fat, Trans Fat, and Dietary Cholesterol

 

Intakes of dietary saturated fatty acids, trans fatty acids, and cholesterol have been shown to increase serum total cholesterol and LDL-cholesterol levels in a dose dependent manner; therefore, recommendations specify reducing dietary saturated fat, trans fats, and cholesterol, and limiting fat to 20%-35% of energy.1 The TLC diet is low in saturated fat (<7% energy) and cholesterol. (<200 mg/d). Of all types of fatty acids, trans fatty acids have the strongest effect on raising ratios of serum total cholesterol to HDL,17 a known predictor of CHD risk.18 Trans fats account for 2.6% or 5.3 g/d of total energy intake in U.S. populations.19 The AHA’s Diet and Lifestyle Recommendations14 include limiting trans fats to ≤1 g/d, a decrease from past consumption levels.

  

Role of ω-3 Fatty Acids in CVD Prevention

 

Two ω-3 fatty acids, docosaexaenoic acid (DHA) and eicosapentanoic acid (EPA), found in cold-water fish such as mackerel, salmon, herring, trout, sardines, and tuna, have been shown to decrease the risk of sudden cardiac death in animal studies and in epidemiologic, metabolic, and small clinical trials.20 These long-chain ω-3 fatty acids from fish oil have been shown to reduce serum triglyceride levels and favorably affect platelet function.21 Alpha-linolenic acid (ALA) is a shorter chain ω-3 fatty acid found in plant sources, including flaxseed, walnuts, canola oil, and soybeans. ALA may protect against CVD by interfering with the production of pro inflammatory eicosanoids.16 ALA can be converted to EPA but only in small amounts (2%-5%) in humans; even less is converted to DHA (<1%).1 One of the 3 dietary strategies to prevent CHD recommended by Giugliano et al2 was to increase consumption of ω-3 fatty acids from fish or plant sources. The rationale for the strategy to increase ω-3 fats may be associated with reduced generation of a pro inflammatory milieu or anti-inflammatory activity.22 The Chicago Western Electric Study cohort of 1822 free-living men aged 40-55 years reported that men consuming >35 g fish per day had a significantly decreased relative risk of death from CHD.23 In studies examining how blood levels of DHA and EPA affect cardiovascular health, the Cardiovascular Health Study, which examined free-living adults >65 years old, found that a higher concentration of combined plasma DHA and EPA was associated with a lower risk of fatal ischemic heart disease.23 There is limited research evaluating the relationship between ALA and risk of CHD. According to Van Horn et al,1 information is needed about the efficacy of marine and plant-derived ω-3 fatty acids in women and in high risk populations. In addition, research to determine optimal dietary intake of ω-3 fatty acids (EPA, DHA, and ALA) and the ratio of ω-6 to ω-3 fatty acids is needed.1 An FDA-approved qualified health claim, recommending up to 3 g/d of ω-3 fatty acids to reduce the risk of CHD, stated, “Supportive but not conclusive research shows that consumption of EPA and DHA ω-3 fatty acids may reduce the risk of CHD.”24 The AHA recommends ≥2 servings (~4 oz per serving) of oily fish per week and inclusion of foods and oils rich in ALA, such as walnuts and soy or other vegetable oils.

Over the last decade, an “inclusive food strategy” has been the cornerstone of the AHA’s dietary recommendations for combating CVD and related diseases. However, there are challenges posed by integrating a growing list of heart healthy foods into the diet without increasing energy intake beyond that required to achieve a healthy body weight.58 In relation to food, the AHA’s 4 goals are to achieve a healthy overall diet, achieve a healthy body weight, promote desirable blood lipid levels, and achieve desirable blood pressure levels. To the meet these goals, additional foods, such as nuts, have been added to the list of heart-healthy foods.

Nuts and CVD Risk

 

Consumption of 3/4 to 1 oz of unsalted nuts daily (almonds or walnuts are the nuts researched) is suggested to confer cardiovascular benefits.1 In more than 86,000 women in the Nurses Health Study, the consumption of 5 oz of nuts per week resulted in significantly lower CHD risk than those who rarely ate nuts.59 Evidence has isolated the fatty acids in the nuts as the primary cardio protective ingredients. In a randomized, crossover trial of 28 men and women, the mean (SD) levels of total and LDL cholesterol were 6.0 (1.1) mmol/L and 4.1 (1.0) mmol/L, respectively. The patients had a mean body mass index (BMI) of 26.9 (3.2) kg/m2. Participants were asked to consume a low-saturated-fat diet, which included 30 g/d of nuts (nut diet) or 1 serving of a cereal containing canola oil (cereal diet) for 2 periods of 6 weeks, separated by a 4-week washout.60 The data revealed that a 30-g/d serving of nuts had similar lipid-lowering effects as a serving of the canola-based cereal, and the investigators concluded that foods with a similar fatty acid profile as nuts can produce comparable decreases in lipoprotein-mediated cardiovascular risk.60 As always, the concern about nuts is the high caloric value. A serving of almonds or walnuts is about 140 kcal. These discretionary calories can add up quickly and cause unnecessary weight gain, which can lead to obesity, a risk factor for CVD.

Obesity as a Risk Factor for CVD

 

Obesity (BMI >30) is an independent risk factor for CHD based on evidence from a recent review of large population studies, such as the Framingham Heart Study, the Nurses Health Study, the Buffalo Health Study, and the Cancer Prevention Study II.61 Obesity research has shown that excess body weight influences CHD risk factors, such as serum lipid profile (serum LDL cholesterol, triglyceride, HDL cholesterol levels), hypertension, and insulin resistance.

BMI and Waist Circumference’s Correlation to CVD Risk

 

In the Health Professionals Follow-Up Study, males with a BMI >30 had 4 times greater likelihood of CVD death than those with a BMI <23.62 In other large population studies, such as the National Health and Nutrition Examination Survey II, increases in BMI levels have been associated with increased levels of serum total cholesterol, non-HDL cholesterol, LDL cholesterol, and triglycerides63—all CVD risk factors. Age and BMI appear to play a role, as BMI is consistently associated with increased risk for CHD and mortality among those younger than 65 years.63 However, in people >65 years, BMI is not significantly related to risk of CHD or CVD events.64,65 Research has also shown that abdominal adiposity or waist circumference is related to overall or CVD mortality. 62 The lower the waist circumference in men <65 years of age, the lower the mortality risk. In men, studies have shown that a waist circumference <38 inches poses less of a CVD risk than a circumference >38 inches.66 Research also reveals that CVD risk in women increases proportionately with increases in waist circumference. In a study of 44,702 women, a higher risk (3.06) was reported with waist circumferences >38 inches compared with waist circumferences <30 inches.67 Thus, the current recommendation leans toward using waist circumference or waist-to-hip ratio as a primary predictor of CHD and risk for CVD death rather than BMI, especially in those ≤65 years of age.

Heart-Healthy Diet

Avoid saturated and trans fats

Saturated fats are mainly from animals and animal products (e.g. dairy products), except coconut and palm kernel oils.

Trans fats are fats that are altered to make them more shelf-stable. They act the same as saturated fats in regard to increasing heart disease risk.

  • Found in processed, baked products (cupcakes, cookies, etc) that you would find at the grocery store (a dead giveaway is when the ingredient list states “partially hydrogenated oil”); also, many fast food places use trans fats to cook French fries and other fried foods.

Use monounsaturated oils such as canola, olive or peanut oils. Monounsaturated fats lower your bad cholesterol (LDL), but not your good cholesterol (HDL). Although good for your heart, these “good” fats have as many calories as the “bad ones;” so, to cut calories for weight loss or maintenance, use Teflon pans and/or vegetable oil cooking sprays.

Substitute light spreads with plant substances that lower cholesterol for butter or margarine. These spreads have plant sterols in them which have been shown to significantly lower cholesterol in as little as two weeks, if used everyday (about 2 tablespoons per day). Take Control also has a salad dressing with the same health benefits.

Consume soluble fiber such as oatmeal, dried beans and peas, and fruits. Soluble fiber binds with cholesterol and takes it from your body.

Reduce homocysteine (amino acid linked to heart disease) by eating foods with the B-vitamins folic acid, B6 and B12.

Raise HDL Cholesterol via exercise (aerobic) and resveratrol consumption (a substance found in grapes, grape jellies, grape juice, and in lesser amounts in peanuts, blueberries, cranberries).

To lower triglycerides (fats in the blood that can raise the risk of heart disease) limit concentrated sweets, processed carbohydrates (versus

whole grain), and alcohol; eat more foods with omega-3 fatty acids (flaxseed and canola oil; cold-water fish sardines, cod, mackerel, lake trout, herring, canned light tuna and salmon; green leafy vegetables; soybeans; and nuts).

To lose weight use a small plate at mealtime to make smaller portions look like more. Take only a small amount of food for snacking, especially if you’ll be distracted while eating (e.g. watching TV)  the more you take, the more you’ll probably eat. Volumetric is a weight-control eating plan by which you consume foods that are low in calories but high in bulk (from fiber and water content) and, thus, give you a full feeling from fewer calories. Eat more fruits and vegetables (high in fiber and water) and mix them into casseroles, soups.

NUTRITION AND HEART DISEASE

EXPLANATIONS AND DEFINITIONS

Cholesterol in food

Cholesterol in food is frequently confused with cholesterol in the blood. Foods that are high in cholesterol include fatty red meat, eggs and animal fats such as butter and cream. Consuming plenty of food with high levels of saturated fat and trans fatty acids along with foods high in cholesterol results in an increase of cholesterol in the blood, which increases the risk for a heart attack.

The prudent diet

This is the diet recommended to promote heart health, and involves having a varied eating pattern, while reducing total fat intake, particularly saturated fats from animal products. This can be attained by limiting the intake of (fatty) red meat and giving preference to fish, chicken, low-fat

dairy products and legumes as sources of protein. The prudent diet advocates consuming more unrefined carbohydrates, such as whole grain products, plus focusing on more fruits and vegetables for sufficient vitamins, minerals (such as potassium) and fiber. Low-fat dairy products are essential for sufficient calcium intake. Salt and alcohol intake should be moderate.

Types of fatty acids

Fatty acids are part of all fats and oils in food and in the body. Some fatty acids promote heart health if consumed in limited amounts while others have a detrimental effect by increasing blood cholesterol levels. The detrimental fatty acids are those in high concentrations in hard animal fats, such as fat in meat, butter and cream and are known as saturated fatty acids. With the discovery that saturated fats have adverse effects on blood fats, people turned to plant oils as a safe replacement for the saturated animal fats. More recently, it has also been found that harder fats (such as some brick margarine) contain trans fatty acids which are formed during the process of partial hydrogenation (hardening) of the vegetable fats. Trans fats also raise cholesterol levels and hence should be avoided. It is important to note that tub (softer) margarines are manufactured in such a way that they contain virtually no trans fatty acids. The healthier fats that tend to reduce blood cholesterol levels are found mostly in plant oils such as sunflower, canola and olive oils. These are called polyunsaturated or monounsaturated fatty acids.

The following undesirable trends have often been found in these diets:

  1. A poor intake of fruit and vegetables.
  2. A high intake of plant and animal fat, including that of high trans fatty acids.
  3. Insufficient intake of milk and other dairy products.
  4. Overall increases in the calorie/kilojoule intake, which leads to increasing overweight or obesity.
  5. A high and increasing alcohol intake.
  6. A low fiber intake because of a low intake of fruit, vegetables and legumes.
  • The daily kilocalorie (kcal) intake per person in South Africa has increased from 2600 kcal per day in 1962 to 2900 kcal per day.
  • The daily intake of vegetable oils per person nearly doubled from 25 g in 1962 to 42 g.
  • The daily intake of protein increased from 68 g in 1962 to 79 g per.
  • Fruit and vegetable intake was 185 g/day in 1962 and 220 g/day in 2001. The amount consumed in 2001 was far below the recommended amount of 400 g/day; the latter is equivalent to five portions of fruit or vegetables per day.
  • Apart from table salt and flavor enhancers, bread and cereals are the major contributors to total sodium intake from processed food in South Africans. Bread provides the greatest contribution to total dietary sodium intake.
  • Other important food sources of salt and fat include meat products (boerewors, meat pies, ham, polony, viennas, salami, biltong and other sausages) as well as soup powders and brick margarine.
  • The practice of adding flavor enhancers or soup powders to staple foods, such as maize meal, during preparation is common and adds to the high salt intake .

Healthy eating

Healthy eating decreases the risk of heart disease and is good for the entire cardiovascular system. There are three important things to remember: balance the calories you eat with physical activity, eat a variety of nutritious foods, and eat less of the unhealthy foods.

Balancing calories:

Balancing the number of calories you take in each day with the number that you burn from physical activity is an important step in working towards a healthy heart.

Healthy foods:

It is important to eat healthy foods such as fruits and vegetables, whole-grain, high-fiber foods, fat-free and low-fat dairy daily and fish twice a week. These foods contain vitamins, minerals, fiber and antioxidants and other healthy substances not contained in dietary supplements, and include unsaturated fats instead of saturated and trans fats. Learn more about these contents of unhealthy foods:

• Fiber

• Whole grains

• Unsaturated fats

Unhealthy foods:

Unhealthy foods include many fast foods, junk foods, highly processed foods, and fried foods. These foods often contain a lot of saturated fats, trans fats, cholesterol and sodium. Learn more about these contents of unhealthy foods:

  • Saturated fats
  • Trans fats
  • Dietary Cholesterol
  • Sodium
  • Added sugar

Heart disease can be caused by a variety of conditions such as genetics or a physical calamity, but an increasing number of cases are being caused by poor nutrition. Whether you are taking precautions to avoid any heart disease in your loved one’s life, or are just now changing the nutrition

habits of your loved one after a heart condition, there are important decisions that can make a significant difference. There are three issues that must be faced early on when choosing a diet that has the heart-conscious in mind. They are: Keeping as ideal a weight as possible, decreasing saturated fat intake, and reducing sodium levels. Realizing some sacrifices will have to be made is the first step to improving nutrition, all while meeting the expected goals of improved heart function and increased vitality as a result. Here are some other dietary approaches that may help you in caring for a loved one. 

Avoid processed foods that have high amounts of sodium

Foods such as peanut butter, salad dressings, and frozen dinners are high in sodium and therefore should not be used in preparing meals

All alcohol consumption should be minimal

Less than 30 % of total calories should come from fat

Cheese, nuts, and lunch meats should be kept in moderation

Potassium supplements should be implemented into the diet

An increase in fiber with in the diet can reduce fat levels

Whole grain cereals, bran, and wheat breads all have high amounts of soluble fiber

Small meals throughout the day work best, instead of only three main meals 
Cholesterol intake should be minimal, as foods such as cheese and eggs have outrageously high amounts

Fruits and vegetables should be instrumental in the daily diet, and while it is stated that the average American should have 5 servings daily, for those with a heart condition, it is advised that it be increased to 6-8 servings

Cigarettes can cause poor blood pressure and should be avoided 

Colas, coffees, and teas should be minimized to avoid the caffeine and its adverse stimulants placed on the body.

Diet & Lifestyle Recommendations

Balance Calorie Intake & Physical Activity
  • Control calorie intake so energy balance is achieved
  • ≥30 minutes of physical activity daily; at least 60 minutes if trying to lose or maintain weight loss
Consume a Diet Rich in Veg & Fruits
  • Variety recommended
  • Diets rich in fruits and vegetables shown to ↓ BP and other CVD risk factors
  • Also helps ↓ energy density of diet to control energy intake

Choose Whole Grain, High Fiber Foods
  • Diets high in WG and fiber assoc with ↓ risk of CVD
  • Insoluble fiber associated with decreased CVD risk; soluble fibers modestly ↓ LDL-C
  • At least half of grain intake should come from whole grains
Consume Fish at Least 2x/Week
  • 2 servings (~8 oz)/week of fish associated with reduced risk of CAD and sudden death
Limit Intake of Sat & Trans Fat & Cholesterol
  • <7% saturated fat
  • <1% trans fat
  • <300 mg cholesterol
Minimize Added Sugar
  • Primary reason is to lower total calorie intake
Choose & Prepare Foods w/ no or little salt  

  • ↓ sodium intake can prevent HTN, lower BP with antihypertensive meds, facilitate HTN control
  • Achievable recommendation is 2.3 g/day
Food Prepared Outside the Home
  • Make wise choices when eating food prepared outside the home
  • Follow AHA Diet & Lifestyle Recommendations

 Dietary Factors with Unclear Effects on CVD Risk

 

Conclusion

 

Soy Protein

 

  • Soy protein rich foods may ↓ risk if replace animal products containing sat fat & cholesterol

 

Folate & other B vitamins

 

  • Available evidence inadequate to recommend Folate and other B vitamins to CVD risk

 

Phytochemicals

 

  • Flavonoids & sulfur containing compounds in fruits

and vegetables may be important in reducing atherosclerosis. 

  • Diet consistent with AHA recos best way to obtain bioactive compounds, macronutrient, micronutrients

 

Other Dietary Factors Affecting CVD Risk

 

  • Lower LDL levels up to 15%
  • Maximum effects observed at intakes of ~2 g/day
  • Consume daily
  • Fish and Omega-3 Fatty Acid Intake

Population

Recommendation

Patients without documented CHD
  • Eat a variety of (preferably oily) fish at least twice a week.
  • Include oils and foods rich in a-linolenic acid.
Patients with documented CHD
  • Consume » 1 g of EPA + DHA per day, preferably from oily fish.  Consider supplements
Patients needing triglyceride lowering
  • 2 to 4 grams of EPA + DHA per day provided as capsules under a physicians care.

Therapeutic Lifestyle Changes (TLC)

Nutrient Recommended Intake
FATS Saturated/trans fat Less than 7% of total calories from sat fat; intake of trans fat should be kept low
Polyunsaturated Up to 10% of total calories
Monounsaturated Up to 20% of total calories
Total 25-35% of total calories
Carbohydrate 50-60% of total calories
Fiber 20-30 g/day (10-25 g soluble fiber)
Protein Approx. 15% of total calories
Cholesterol Less than 200 mg/day
Total Calories (energy) Balance energy intake and expenditure to maintain desirable body weight/prevent weight gain

LDL Cholesterol: Main Target of Therapy

 

CHD Outcomes in Clinical Trials of LDL- Cholesterol-Lowering Therapy

Intervention

No. of trials

No. Treated

Person-years

Mean cholesterol reduction (%)

CHD incidence (% change)

CHD mortality (% change)

Surgery

1

421

4,084

22

-43

-30

Sequestrants

3

1,992

14,491

9

-21

-32

Diet

6

1,200

6,356

11

-24

-21

Statins

12

17,405

89,123

20

-30

-29

Dietary Modifications and LDL Reductions Achievable

 

Dietary Component Dietary Change Approximate LDL Reduction
Major Diet & Lifestyle Changes

 

Saturated Fat

< 7% of calories

8-10%

Dietary Cholesterol

< 200 mg/day

3-5%

Weight Reduction

Lose 10 lbs.

5-8%

Therapeutic Options

 

Soluble Fiber 5-10 grams/day 3-5%

 

Plant Sterols &   Stanols

 

2 grams/day 6-15%
Cumulative Estimate

20-30%

 

Lipid Goals

 

LDL Cholesterol (mg/dL)

  •  < 100
  •  < 70
High Risk

Optional                          

For very high

Risk person

  •  <130
Moderately high risk or moderate risk
  •  < 160
Lower risk

 

Total Cholesterol (mg/dL)

  •  < 200
Desirable
  •  200 – 239
Borderline High
  •  ³240
High

 

 

HDL Cholesterol (mg/dL)

  •  < 40
Low
  •   ³ 60
High

Triglycerides (mg/dL)

  • < 150

Optimal

Risk Assessment

 

LDL goals are based on:

  • Presence of disease or disease equivalents
  • Number of risk factors

 

To Determine Risk Factors:

  • Assess traditional risk factors
  • Determine 10- yr CHD risk equivalent

 

Management of Metabolic Syndrome

 

  • Metabolic syndrome enhances risk for CHD at any LDL level

 

Metabolic Syndrome    (3 Factors):

  • Abdominal obesity (waist circumference)
    • 40 inches men
    • 35 inches women
    • ­ Triglycerides
    • ¯ HDL
    • ­ Blood Pressure
    • ­ Fasting Glucose
    •  

 

Management

 

  • Weight control
  • Increased physical activity
  • Therapies directed against specific factors

 

 

Interventions to Improve Adherence

 

 

Multidisciplinary approaches are critical

 

Highlights the role of the:

  • Physician
  • Registered Dietitian
  • Nurse
  • Physician Assistant
  • Pharmacist
  • Dentist

 

  

  • Patient-focused process

Simplify

Encourage family support

Reward adherence

Involve patients

 

 

The Portfolio Diet Study

 

  • Soluble Fiber
  • Soy Protein
  • Plant Sterols
  • Nuts

LDL cholesterol reduced

28% to 35%

 

 

Plant Sterols/Stanols: Differences

         Plant Sterols

Plant Sterol Esters

Plant Stanols/Plant Stanols Esters
Description Plant sterols in their natural form Esterified mixtures of plant sterols Stanols:  hydrogenated sterols

Stanols esters: esterified mixtures of plant stanols

Amount

 Needed for

 heart health

0.8 g or more per day, (0.4 g per serving of product) 0.8 g or more per day, (0.4 g per serving of product) 0.8 g or more per day, (0.4 g per serving of product)
NCEP ATP III/ AHA Diet recommendations 2 grams of sterols/stanols per day as part of a diet low in saturated fat and cholesterol, and high in soluble fiber

FDA Allowed Language

 

  • Diets low in saturated fat and cholesterol that include two servings of such foods to provide a daily total of at least 0.8 grams of plant sterols may reduce the risk of heart disease.

 

 

LDL cholesterol can be reduced by an average of 6%

Plant Sterols: Practical Applications and Safety

  • Plant sterols compete with cholesterol in the small intestine.
  • Best effect seen when consumed 2x/day
  • Important to consume with meals as part of a low fat diet
  • Safe to consume more than 0.8 grams a day, but no additional benefits seen over 2 grams/day
  • Safe to use with statins

Soluble Fiber – Sources and Amounts

 

Sources

Soluble Fiber (g)

Total Fiber (g)

Oatmeal, cooked (1/2 c.)

1

2

Cheerios (1 cup)

1

3

Whole Wheat bread (1 slice)

0.5

2

Pear (1 medium)

2

4

Prunes (1/2 cup)

3

6

Potato with skin (1 medium)

1

3

Brussels sprouts (1/2 cup)

3

4.5

Kidney beans (1/2 cup)

3

6

 

Sodium

 

  • Lowering sodium may reduce blood pressure in some individuals
  • Other diet and lifestyle strategies are also effective
  • 2005 Dietary Guidelines and AHA recommend consuming less than 2,300 mg of sodium per day

 

 

Trans fatty acids

 

  • Must manage intake of saturated fat, trans fat, and cholesterol
  • Trans fat now listed on Nutrition Facts panel
  • 2005 Dietary Guidelines and AHA focus on reducing saturated fat, trans fat, and cholesterol in the diet.

 

Healthy Heart Nutrients

Nutrients to lower your risk of heart disease

There are many natural ingredients that can significantly lower your chances of developing heart disease, as well as help treat any heart conditions you may currently have. By incorporating these nutrients into your diet and exercise regimen, you can improve and maintain your heart health.

Lowering Cholesterol Levels

Policosanol – a powerful extract from sugar cane wax that has been widely studied. Policosanol has been shown to lower bad cholesterol (LDL) and increase good cholesterol (HDL).

 

Guggulipid – an ancient Indian herb that has been shown to reduce LDL (bad cholesterol) levels and has performed better than modern drugs in several trials.

 

Green Tea – among its many therapeutic benefits green tea has been shown to lower the amount of LDL’s in the blood stream, and aids in the prevention of blood vessel constriction.

 

Beta Sitosterol – found naturally in soybeans, wheat germ and corn oil, this plant compound has a similar structure to cholesterol and as such can help stop the absorption of cholesterol in the body.

 

Niacin (Vitamin B3) – can help reduce total cholesterol levels in higher dosages.

 

Chromium Polyniconate – this organic version of chromium can help lower LDL cholesterol and triglycerides, as well as raise HDL (good) cholesterol.

 

Fish Oil – contains Omega 3 fatty acids (DHA & EPA) which can lower LDL

cholesterol levels in the body.

 

Lowering Triglyceride Levels

Fish Oil – high in Omega 3 fatty acids that have been shown to lower triglycerides in conjunction with Vitamin C and a low carbohydrate diet.

Vitamin C – works in conjunction with fish oil to lower triglyceride levels.

 

Guggulipid – has been shown to reduce triglyceride and cholesterol levels.

 

Green Tea – can significantly lower triglyceride levels in the blood.

Lowering Homocysteine Levels

Folic Acid – also known as Vitamin B9, folic acid can help the body produce the enzymes necessary to remove homocysteine from the blood.

 

Vitamin B6 – along with folic acid and Vitamin B12, helps reduce homocysteine levels.

 

Vitamin B12 – works with folic acid and Vitamin B6 to assist in homocysteine removal.

 

Lowering CRP Levels

Fish Oil – the essential fatty acids in fish oil have been shown to decrease inflammation and in turn CPR levels.

 

Ginger – Ginger root extract can help reduce inflammation, as it relaxes the muscles surrounding blood vessels and facilitates circulation.

 

MSM – Methyl Sulfonyl Methane, commonly known as MSM, is a naturally occurring sulfur compound that has strong anti-inflammatory properties.

Nutrients for Overall Heart Health

In addition to all of the nutrients to the left, following are other important nutrients for maintaining a healthy, strong heart:

 

Coenzyme Q10 – vitamin-like substance for overall heart strength and stability.

 

Vitamin E – powerful antioxidant that can protect against the development of heart disease.

 

Vitamin C – works in conjunction with Vitamin E to promote heart strength.

 

Fish Oil – contains Omega 3 fatty acids which can protect the heart.

 

Calcium – assists in heart function among other health benefits.

 

Magnesium – stabilizes the heart’s electrical system and helps with heart problems.

 

Selenium – promotes a healthy heart by facilitating circulation.

 

L-Carnitine – increases energy production in heart tissue.

 

Ginkgo Biloba – gingko extract increases blow flow to the heart.

 

Hawthorn Berry – hawthorn extract improves all functions of heart muscle

 

Maitake – maitake extract can help reduce blood pressure and ease blood flow.

 

A Patient’s Guide to Heart Surgery

Diet and Nutrition

 

Healthy Diet and Nutrition

Along with exercise, eating healthy will speed up your recovery and healing. If your appetite is poor, try to eat smaller but more frequent meals.

Depending on your condition, your doctor or dietician may put you on a special diet. For example, patients with heart failure must follow a 2,000 mg low-sodium diet. Diabetic patients must follow a low-sugar, low-fat diet.

Tips to healthy eating:

  • Eat a variety of healthy foods.
  • Choose foods low in fat and cholesterol.
  • Eat less salt or sodium.
  • Cut back on sugar and sweets.
  • Eat more carbohydrates (potatoes, rice, pasta, vegetables) and fiber (“roughage”).
  • Limit portion sizes.

Poor Appetite and Nausea

Many patients lose weight in the postoperative period. They complain of lack of appetite and mild nausea. Certain medications such as pain pills may cause nausea. Try eating small frequent amounts of food, and take medications on a full stomach unless otherwise directed. If you continue to experience nausea or lack of appetite, call your primary physician.

Constipation

Constipation is due to inactivity, limited fluid intake and lack of dietary fiber. It is aggravated by medications such as pain pills and iron. Eating plenty of fiber and fresh fruits, drinking 6-8 glasses of water daily and using your prescribed stool softener (Colace) as instructed can usually relieve constipation. If this does not work, Milk of Magnesia or Dulcolax may be helpful. Avoid Milk of Magnesia if you have kidney problems.

Caloric Restriction

Your total calories may be changed to increase, decrease, or maintain your weight as necessary. Being overweight increases the work of the heart. Your drug therapy may cause you to be hungry, you may eat more, and you may then gain weight. It is, therefore, very important that you pay attention to the total amount of food you take in. In addition to adding to the work of your heart, being overweight is associated with high levels of Triglycerides (fats) in the blood stream. Having a lot of fats in your blood increases the possibility of having the blood vessels of your heart become thickened. This will be described in more detail in the section on cholesterol and fats that follows.

Cholesterol and Saturated Fat Restriction

Cholesterol is a necessary fatty substance found in the body and many animal foods. Fats are concentrated sources of energy which occur in three forms: polyunsaturated, monounsaturated, and saturated. People who have large amounts of cholesterol and saturated fats in their blood are at increased risk of having thickening of their blood vessels throughout their bodies. This is because saturated fats and cholesterol in your blood will gather along the walls of your blood vessels causing them to narrow. If this narrowing becomes severe in the blood vessels of your heart, the blood supply to your heart will not get enough oxygen, and the cells of your heart will die. This is called “Coronary Artery Disease.”

In addition to your diet, your medications may also increase the level of fats in your blood. Thus, in order to prevent coronary artery disease, your overall fat intake must be restricted after surgery. Generally, your overall fat intake should not be more than 30% of your total calories each day. Increasing the proportion of monounsaturated and polyunsaturated fat in your diet and decreasing your total saturated fat intake to less than 10% of your total fat intake will actually help to lower cholesterol and saturated fat levels in your blood. The aim of this diet is to keep the levels of fats in your blood within normal limits.

Foods high in cholesterol & saturated fats

  • Animal products
Liver and organ meats, luncheon meats like liverwurst & salami, other meats, egg yolks, whole milk, butter, cream, and whole milk cheeses.
  • Vegetables high in saturated fats 
Coconut, palm, and cocoa.
  • Other 
Fried foods.
  • Note 
Instead of frying your foods, try to bake, boil, or steam when preparing foods.

Foods high in mono saturated and polyunsaturated fats

  • Meats and other protein foods
Lean meats, low fat dairy products, and fatty fish (salmon, tuna, trout, bluefish).
  • Vegetable fats 
Olive oil, corn oil, soybean oil, sesame oil, sunflower oil, and tub margarine.

Concentrated Carbohydrate Restrictions

You may be asked to cut down on the amount of sugar and concentrated sweets in your diet as well. Carbohydrates not only add to calories, but large amounts may contribute to an increase in the Triglycerides on the blood.

Fluid and Sodium Restriction

Salt is made up of two minerals – Sodium (Na+) and Chloride (C). It is the sodium portion of salt that we are concerned with in your diet. Sodium must be restricted in your diet because it causes your body to hold fluids.

You must also control your sodium and fluid intake since Prednisone causes your body to hold both of these. The result of holding fluid and sodium is that extra fluid builds up in your veins and arteries. To avoid this fluid and sodium build up, you should cut down on both.

To cut down on fluids, choose solid foods instead of liquids; for example, eat fruit instead of drinking juice. To cut down on salt, your doctor may prescribe a sodium-restricted diet for you. Your diet order may read: “No added Salt” or 3 to 4 gram Na+ diet. The doctor may also prescribe a water pill to help get the sodium and fluid out of your system.

Foods High in Sodium (Na+) Content

  • Meat and Other Protein Foods
Ham, Canadian bacon, bacon, luncheon meats, frankfurters, sausages, scrapple, pepperoni, dried beef, chipped beef, corned beef, canned meats, pastrami, canned fish, sardines, herring, lox, anchovies, smoked salmon, caviar, cheese, regular peanut butter, and frozen TV dinners.
  • Vegetables
Sauerkraut or other vegetables prepared in brine, olives, pickles, relish, vegetables packed with sauces or seasonings, salted mixed vegetable juice (V-8), regular tomato juice, regular spaghetti sauce, tomato sauce or tomato paste, frozen peas, and lima beans.
  • Breads & Cereals
Bread and rolls with salt toppings, corn chips, potato chips, salted pretzels, salted popcorn, and other salted snack foods.
  • Fats
Bacon fat, salt pork, olives, salted nuts, party spreads and dips.
  • Soups
Canned broth soups, commercially prepared stews, bouillon cubes, and instant or dried soups.
  • Other
Be careful of monosodium glutamate (MSG) used in Chinese food. When you order Chinese food, you can request that it be prepared without MSG.

Note
You should check with your doctor or dietician before using salt or salt substitutes.

 

Eat Healthy to Help Prevent Heart Disease

You can lower your chances of getting heart disease by eating healthy. For a healthy heart, eat:

–      Less Fat

–      Less Sodium

–      Fewer Calories

–      More Fiber

Eat less fat

Some fats are more likely to cause heart disease. These fats are usually found in foods from animals, such as meat, milk, cheese, and butter. They also are found in foods with palm and coconut oils. Eat less of these foods.

Eat less sodium

Eating less sodium can help lower some people’s blood pressure. This can help reduce the risk of heart disease. Sodium is something we need in our diets, but most of us eat too much of it. Much of the sodium we eat comes from salt we add to our food at the table or that food companies add to their foods. So, avoid adding salt to foods at the table.

Eat fewer calories

When we eat more calories than we need, we gain weight. Being overweight can cause heart disease. When we eat fewer calories than we need, we lose weight.

Eat more fiber

Eating fiber from fruits, vegetables and grains may help lower your chances of getting heart disease. To learn more visit the fiber article.

Diet Tips for a Healthy Heart

–      Eat a diet low in fat, especially animal fats and palm and coconut oils. (These foods contain saturated fat and cholesterol. Saturated fat and cholesterol can cause heart disease.)

–      Choose a diet moderate in salt and sodium.

–      Maintain or improve your weight.

–      Eat plenty of grain products, fruits and vegetables.

–      Choose milk with 1% fat or skim milk instead of whole milk.

–      Eliminate fried foods and replace them with baked, steamed, boiled, broiled, or microwaved foods.

–      Cook with oils which are low in fat and saturated fat like corn, safflower, sunflower, soybean, cottonseed, olive, canola, peanut and sesame oils. Stay away from oils and shortenings that are high in fat and saturated fat.

–      Smoked, cured, salted and canned meat, poultry and fish are high in salt. Eat unsalted fresh or frozen meat, poultry and fish.

–      Replace fatty cuts of meat with lean cuts of meat or low-fat meat alternatives.

–      In recipes requiring one whole egg try two egg whites as a lower fat alternative.

–      Replace sour cream and mayonnaise with plain low-fat yogurt, low-fat cottage cheese, or low-fat sour cream and mayonnaise.

–      Substitute hard and processed cheeses for low-fat, low-sodium cheeses.

–      Use herbs and spices as seasoning for vegetables and potatoes instead of salt and butter.

–      Replace salted crackers with unsalted or low-sodium whole-wheat crackers.

–      Substitute canned soups, bouillons and dry soup mixes which are high in salt for sodium-reduced soups and bouillons.

–      Replace white bread, white rice, and cereals made with white flour with whole-wheat bread, long-grain rice, and whole-grain cereals.

–      Substitute snacks high in salt and fat with low-fat, low salt snacks. Cut-up vegetables and fruits are a quick healthy snack.

Read the Food Label

The food label can help you eat less fat and sodium, fewer calories and more fiber.

Look for certain words on food labels. The words can help you spot foods that may help reduce your chances of getting heart disease.

Words to Look For:

  • Fat-free Saturated fat-free
  • Low-fat
  • Low saturated fat
  • Reduced or less fat
  • Reduced or less saturated fat
  • Cholesterol-free
  • Low-cholesterol
  • Reduced or less cholesterol
  • Lean
  • Extra lean
  • Healthy
  • Sodium-free
  • Low-sodium
  • Light in sodium
  • Lightly salted
  • Reduced or less sodium
  • Salt-free
  • Unsalted
  • Light
  • Calorie-free
  • Low-calorie
  • Reduced or fewer calories
  • High-fiber
  • More or added fiber

Read the Food Label

Look at the side or back of the package. Here, you will find “Nutrition Facts.” Look for these words:

  • Total fat
  • Saturated fat
  • Cholesterol
  • Sodium

Look at the %Daily Value listed next to each term. If it is 5% or less for fat, saturated fat, cholesterol, and sodium, the food is low in these nutrients. That’s good. It means the food fits in with a diet that is heart healthy and may help reduce your chance of developing heart disease.

Heart Disease Eat Right

A heart healthy diet is one of the most important steps for a person with heart disease. Proper nutrition is essential to managing symptoms of heart disease and preventing further complications. Not only can proper diet help slow the artery-clogging process, but when combined with careful lifestyle modification, it may even stop or reverse the narrowing of arteries.

For caregivers and their loved ones with heart disease, adopting a heart-healthy diet can help reduce total and LDL cholesterol, lower blood pressure, lower blood sugar, and reduce body weight. While most dietary plans detail what CAN’T be eaten, the most powerful nutrition strategy helps people with heart disease focus on what they CAN eat. In fact, heart disease research has shown that adding heart-saving foods is just as important as cutting back on others. As a caregiver, here are some strategies to help you plan meals for someone with heart disease:

–      Serve more vegetables, fruits, whole grains, and legumes. These foods may be one of the most powerful strategies in fighting heart disease.

–      Choose fat calories wisely. Keep these goals in mind: Limit total fat grams.

–      Serve a bare minimum of saturated fats and trans-fatty fats (for example, fats found in butter, salad dressing, sweets and desserts).

–      When you use added fat, use fats high in monounsaturated fat (for example, fats found in olive and peanut oil) or polyunsaturated fat (such as fats found in soybean, corn, and sunflower oil).

–      Serve a variety — and just the right amount — of protein foods. Commonly eaten protein foods (meat, dairy products) are among the main causes of heart disease. Reduce this nutritional risk factor by balancing lean animal, fish. and vegetable sources of protein.

–      Limit cholesterol consumption. Dietary cholesterol can raise blood cholesterol levels, especially in high-risk people. Limiting dietary cholesterol has an added bonus: You’ll also cut out saturated fat, as cholesterol and saturated fat are usually found in the same foods. Give your loved one energy by serving complex carbohydrates (such as whole wheat pasta, sweet potatoes, whole-grain breads) and limit simple carbohydrates (such as regular soft drinks, sugar, sweets).

–      Feed your loved one regularly. Skipping meals often leads to overeating. By serving five to six mini-meals you can help someone with heart disease control blood sugars, burn fat calories more efficiently, and regulate cholesterol levels.

Other Heart Disease and Diet Tips

–      De-emphasize salt. This will help your loved one control his or her blood pressure.

–      Encourage exercise. The human body was meant to be active. Exercise strengthens the heart muscle, improves blood flow, reduces high blood pressure, raises HDL cholesterol (“good” cholesterol), and helps control blood sugars and body weight.

–      Encourage hydration. Water is vital to life. Staying hydrated makes you feel energetic and eat less. Encourage your loved one to drink 32 to 64 ounces (about one to two liters) of water daily (unless he or she is fluid restricted).

An excellent motto to follow is: dietary enhancement, not deprivation. When people enjoy what they eat, they feel more positive about life, which helps them feel better.

How Much Is In a Serving?

When trying to coordinate an eating plan that’s good for the heart, it may help to know how much of a certain kind of food is considered a “serving.” The following table offers some examples.

SERVING SIZES

Food/amount Serving/exchange The size of
1 cup cooked rice or pasta 2 starch tennis ball
1 slice bread 1 starch compact disc case
1 cup raw vegetables or fruit 1 fruit or vegetable baseball
1/2 cup cooked vegetables or fruit 1 fruit or vegetable cupcake wrapper full or size of ice cream scoop
1 ounce cheese 1 high-fat protein pair of dice
1 teaspoon olive oil 1 fat** half dollar
3 ounces cooked meat 1 protein deck of cards
3 ounces tofu 1 protein deck of cards
** Remember to count fat servings that may be added to food while cooking (oil for sautéing, butter, or shortening for baking)


 
Leave a comment

Posted by on March 7, 2012 in Nutrition info

 

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

 
%d bloggers like this: