Fat is Where s it At. Not how low can you go. Discriminate rather than eliminate. Be fat-selecting, not neglecting

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2 Disclosures Under Accreditation Council for Continuing Medical Education guidelines, disclosure must be made regarding financial relationships with commercial interests within the last 12 months; I have no relevant financial relationships or affiliations with commercial interests to disclose.

3 Fat is Where s it At Not how low can you go Discriminate rather than eliminate Be fat-selecting, not neglecting 20-35% of daily calories ( gms on 2000 calorie diet)

4 Saturated fat 5-6% total calories /d LDL up to 11 mg/dl For 2000 cal/d : gm saturated fat/d Coconut oil IS a saturated fat ( 90% of the fat is saturated) Red palm oil ( 45% of the fat is saturated) Swapping 5% of calories from saturated fat FOR linoleic acid 9% risk CHD events Switching from saturated fat to linoleic acid associated with 13% CVD risk

5 PUFAS in FATS/OILS Safflower oil 78% Sunflower oil 69% Corn oil 62% Soybean oil 61% Peanut oil 34% Canola oil 29% Lard 12% Palm oil 10% Olive oil 9% Butterfat 4% Palm kernel oil 2% Coconut oil 2%

6 GET FISHY 2007 AHA study, eating fish 1-2 x/w risk of sudden cardiac death in healthy adults by 42-50% Fish eaters may have lower BMIs Choose sustainable seafood- salmon, sardines Opt for grilling, broiling, poaching, pan-fry, roasting, steaming Think in the shell, oysters/mussels high in omega-3 FAs

7 OMEGA-3s Fish Plant based sources Walnuts/walnut oil Hemp seed/hemp oil Chia Pumpkin seeds/pumpkin seed oil Omega-2 enriched eggs Omega-3 enriched soybean oil

8 Bring in the replacements For saturated fat: PUFA MUFA Plant protein Carbohydrates with high fiber and phytonutrient content

9 Which Spread for your Bread? Butter: still a saturated fat, forget the Bulletproof coffee, opt for whipped butter Margarines can still be a source of trans fat Consider nut butters Cream cheese IS a saturated fat

10 Trans fat Can LDL and HDL Found in : Snacks Some convenience foods Some stick margarines Some shortenings Some baked goods Some ice creams

11 BEING SALT SENSIBLE Dietary Guidelines/IOM: 2300 mg/d How to do this and retain taste: Play up sour/savory Roast or caramelizing foods increases perception of a salty taste Umami rich foods increase sodium sensory perception Diamond Crystal Kosher salt has larger crystals and provide 60% less sodium than regular table salt- Sea salt and table salt are equal in sodium

12 Limiting cholesterol is old news Evidence does not support the cholesterol content of food as an important influence on blood cholesterol or heart risk EXCEPT possibly for those with diabetes or extremely high LFL levels

13 Take pains with your grains Think Whole Think Soluble Fiber to lower cholesterol: barley, potatoes, beans, fruits, vegetables 9 of 10 Americans are not meeting recommendations for dietary fiber gms/d- women gms/d- men Whole grains + statins healthier cholesterol levels

14 Root for fruit Fruit may lower CVD risk- Eur Society Cardiology Congress- 451,000 participants from China with no hx of CVD- higher fruit intake, lower risk of CVD. Average fruit intake 1.5 servings or about 5.3 oz/day Red/purple fruits- high in anthocyanins, may lower LDL USDA recommendations for fruit 1.5 cups- women 2 cups- men

15 VALUABLE VEGETABLES Tomatoes- may lower CHD and CVD risk Beans- contain soluble fiber to lower cholesterol, and great source of niacin Greens, Swiss chard, spinach- high in Phylloquinone ( Vit K) may have less progression of calcification if Vit K levels are higher

16 TRADE OFFS Instead of mayo, choose avocado or hummus Instead of chips: choose small handful of nuts Instead of sour cream, use plain Greek yogurt Sweeten with a little honey or dried fruit Instead of sugar, try cinnamon and vanilla Extend meat by adding beans, and/or mushrooms

17 The Power of Potassium Helps with blood pressure control 4700 mg/d Add fruits, vegetables, beans Steam or saute potassium loaded dark green leafy vegetables so potassium does not leach out into the cooking water

18 What s in Your Pour? Quantity matters- Mayo Clinic Proceedings 2014 Light to moderate drinking linked with decreased risks for CVD, strokes, heart failure 1 drink/d- women 2 drinks/d- men Excessive drinking raises triglycerides and increases risk of CVD, stroke, HBP, atrial fibrillation, heart failure

19 WHICH ALCOHOL IS BEST? Ethanol + polyphenols provide the cardioprotective effect- red wine better option than white wine The hops in beer are sources of polyphenols

20 Secondary prevention Extra virgin olive oil Red, purple, orange, green vegetables Salmon and other seafood Lentils/beans Red wine Dark chocolate/cocoa Green tea Figs/berries Oatmeal/barley

21 ARTERIAL AMMUNITION Quercetin- in apples, onions- BP Resveratrol Dietary nitrates- may BP Spinach Celery Arugula Beets ( contain betalain which may LDL) Rhubarb

22 SWAP FOR rather than ADD IN To manage the waist and the weight CVD risk with 3-5% weight loss: ~10-20 pounds Eat beans to get lean Be stingy with the use of fats Know your portions Change eating environment to encourage a culture of right size

23 Have App-titude MyFitnessPal SparkPeople Fooducate Figwee Portion Explorer Substitutions by Gormaya

24 Getting patients to buy in Variety Focus on OK foods Add flavor with healthy fats Make vegetables delicious Add a pinch of salt, but more herbs/spices Pump up the nutrition with pureed beans, chopped vegetables

25 SUSTAINABILITY Eating pattern that is Palatable Affordable Accessible Realistic Easy to follow and implement Inclusive rather than exclusive eating pattern Incentivize foods rather than demonize nutrients

26 CONTACT INFORMATION Leslie Bonci, MPH,RD,CSSD,RDN #ActiveAdvice