Objectives Got Heart? Nutrition for Cardiovascular Health 1. Achieve a basic understanding of the evidencebased dietary and lifestyle guidelines for reducing cardiovascular risk 2. Recognize potential cardiovascular benefits and risks of several popular diet plans Leigh Benko, RD, LDN, CDE Risk Factors for Cardiovascular Disease (CVD) Risk Factor: a condition or behavior that increases your chance of developing a disease The following are modifiable cardiovascular (CV) risk factors: Poor Diet Hypertension Hyperlipidemia Diabetes Obesity/Overweight Physical Inactivity Heavy Alcohol Use Smoking Stress Research Linking Diet to CVD Diet is strongly associated with CV risk due to its effects on several modifiable risk factors Until recently, the effects of individual foods and nutrients on blood pressure (BP) and lipids was the predominant focus Researchers have begun to concentrate more on whole dietary patterns to identify total preventative benefits and health outcomes 1
Developing Evidence-based guidelines are developed by expert workgroups who systematically review and analyze most current research Several organizations provide evidence-based nutrition and lifestyle guidelines for reducing CV risk American Heart Association (AHA) Academy of Nutrition and Dietetics (AND) Up To Date U.S. Department of Agriculture (USDA) U.S. Department of Health and Human Services (HHS) National Institutes of Health (NIH) Reduce Saturated Fat Intake High intake is strongly associated with increased LDL bad cholesterol Limit daily calories from saturated fat to <7% (e.g. an 1800 calorie diet should contain <14 grams) Avoid fatty red meats, poultry skin, lard, butter, wholemilk dairy products, and coconut and palm oils Choose foods/beverages containing 1 gram/serving Reduce Trans Fat Intake Trans fats raise LDL and lower HDL good cholesterol Limit daily calories from trans fat to <1% (< 2 grams) Found in stick margarines, shortening, fried foods, commercially-baked pastries, cakes, cookies, and pies; frozen pizza, ready-to-use frosting, and some coffee creamers Avoid products containing Partially Hydrogenated Oils FDA recently announced plans to phase manufactured trans fats out of the food supply Include Healthy Fats Replacing saturated and trans fats with unsaturated fats may: Lower LDL and triglycerides, increase HDL Inhibit atherosclerosis and thrombus formation Reduce risk of CV-related events and mortality Monounsaturated and Polyunsaturated Fats: Sources: Oils including olive, canola, peanut, flax, safflower, sunflower, corn, walnut, and soybean; avocados, nuts, seeds, and oily fish (salmon, mackerel, trout, herring) Include 5 oz. of nuts per week (peanuts and tree nuts) Try to consume at least 2 servings of oily fish weekly 2
Reduce Sodium Intake Excess sodium intake is associated with elevated BP Goal: <2,400mg per day 1,500mg restriction may be indicated for those who are especially sodium sensitive Avoid table salt, jarred sauces, canned foods, processed cheese and meats, salty snacks, fast foods, and frozen pre-packaged meals Choose foods/beverages containing 150 mg/serving Increase Fiber Soluble fiber is especially beneficial for CV health High intake may lower LDL, help control blood sugar, and satisfy hunger for weight loss/maintenance Goal: Total fiber: 25-35 grams; Soluble fiber: 5-15 grams Sources include whole grains, legumes, nuts, seeds, fruits, and vegetables Aim For Adequate Vitamins and Minerals Inadequate intake of potassium, calcium, and magnesium may be linked to increased BP Diets rich in C, E, A, D, and B vitamins appear to decrease risk of CVD Supplementation for the purpose of reducing CV risk is not recommended Meet Dietary Reference Intake (DRI) by consuming fruits, vegetables, legumes, nuts, fortified whole grains and low-fat dairy; lean meats, poultry, and fish Limit Alcohol Intake Small amounts of alcohol may lower the risk of CV-related morbidity and mortality Benefits appear to be related to the amount rather than type of alcoholic beverage consumed Red wine may provide additional antioxidant benefits Limit daily intake to 1 drink for women, 2 drinks for men 1 drink equivalent = 12 oz beer, 5 oz wine, or 1.5 oz spirits Consumption of alcohol for CV health is suggested only if already part of one s lifestyle 3
Achieve / Maintain Healthy Body Weight BMI of 18.5-24.9 kg/m 2 is associated with lowest risk Reducing body weight by 7-10% will reduce CV risk even if goal weight is not yet achieved Loss of 1-2 lbs. per week is appropriate Limit energy intake and increase energy expenditure Increase Physical Activity 3-4 sessions per week, 40 minutes per session, moderate-to-vigorous intensity physical activity Benefits: Reduce LDL, triglycerides, and BP; increase HDL, and decrease risk of diabetes, CVD, and CV-related events / mortality AHA Dietary Pattern for Reducing CV Risk Consume a dietary pattern that emphasizes: vegetables, fruits, and whole grains Includes: low-fat dairy products, poultry, fish, legumes, non-tropical vegetable oils, and nuts and limits: sweets, sugar-sweetened beverages, and red meats Reduction in calorie intake is recommended if weight loss is desired Adapt to personal and cultural food preferences and nutrition therapy for other medical conditions Diets Developed for CV Health Examples: Dietary Approaches to Stop Hypertension (DASH), Therapeutic Lifestyle Changes (TLC), USDA Food Patterns, and the AHA Diet Life-long, balanced eating plans designed specifically for CV and overall good health Meet all guidelines for reducing CV risk Provide serving recommendations for each food group based on daily calorie requirements Guidance for achieving a healthy weight is provided Physical activity is strongly encouraged DASH The AHA dietary pattern is based on DASH Specifically designed as a lifelong approach to help treat or prevent high BP DASH Diet Specifics: Incorporates reduced sodium with high intake of calcium, magnesium, and potassium Heavy in fruits, vegetables, and low-fat dairy Guidelines for both a 2,300mg and 1,500mg sodium intake are provided 4
TLC DASH and TLC Specifically designed to lower cholesterol through a combination of heart-healthy lifestyle changes TLC Diet Specifics: Limited in saturated fat, trans fat, and dietary cholesterol Up to 5 oz. of animal protein/day: lean meat, poultry, fish No more than 2 egg yolks per week High-fiber foods are recommended Plant stanols/sterols may be added (optional) Lower LDL, triglycerides, and BP Increase or maintain HDL Reduce risk of CVD and CV-related events / mortality Improve insulin sensitivity and blood glucose control Gradual weight loss (optional) Promotes permanent lifestyle change CV Risks: No evidence of risk Bottom Line: Due to the strong evidence of CV benefit, DASH and TLC are both excellent options for the prevention or management of CVD Mediterranean Diet Mediterranean Diet Pyramid Traditional diet and lifestyle of the Mediterranean region The Mediterranean Diet Specifics: Emphasizes plant-based foods Butter is replaced with olive and canola oils Herbs and spices are used instead of salt Fish is consumed at least twice a week Poultry, eggs, cheese, and yogurt included in moderation Red meat is limited to no more than a few times a month Sweets are consumed only occasionally Red wine may be consumed in moderation Enjoying meals with others and physical activity are also important components of the Mediterranean lifestyle 5
Mediterranean Diet Reduce risk of CVD and CV-related events / mortality Improve insulin sensitivity / decrease risk of diabetes Reduce BP May see a reduction in LDL and triglycerides Weight loss with calorie deficit / increased activity Healthy lifestyle behaviors are emphasized CV Risks: No evidence of risk Bottom Line: Due to its flexibility and emphasis on meal enjoyment, the Mediterranean diet is likely sustainable for preventing chronic illness including CVD Lacto-Ovo Vegetarian Diet: The Ornish Spectrum Combines nutrition, exercise, stress management, and emotional support for preventing/regressing chronic disease Ornish Diet Specifics: High-fiber, very low-fat, lacto-ovo vegetarian diet Rich in complex carbohydrates Permits limited amounts of non-fat dairy and egg whites Meat, poultry, and fish are omitted Is possible to meet DRI for vitamins and minerals with dairy Includes plant sources of omega-3 fatty acids Reduced sodium is encouraged Physical Activity: Both aerobic and resistance exercise are a large part of the Ornish plan Lacto-Ovo Vegetarian Diet Pyramid Lacto-Ovo Vegetarian Diet: The Ornish Spectrum Slow or regress coronary atherosclerosis Improve lipids and BP Decease risk of CVD and CV-related events / mortality Reduce risk obesity and diabetes Gradual weight loss (optional) Promotes permanent lifestyle change CV Risks: No evidence of risk Bottom Line: May be an option for those interested in a vegetarian diet for potentially regressing CVD or simply promoting overall good health 6
Meal Replacement Weight Loss Diets Examples: Jenny Craig, Nutrisystem, and Slim Fast Promote gradual weight loss through portion control Typically followed until desired weight loss is achieved Guidance or support may be offered May require membership fees Meal Replacement Weight Loss Diet Specifics: Low-calorie diet, providing 1,200 calories Prepackaged meals, bars, or shakes replace normal meals DRI for fiber, vitamins, and minerals met through fortification Some grocery items may supplement meal replacements Physical Activity: is encouraged with most plans Meal Replacement Weight Loss Diets Gradual weight loss is likely while on the plan May see improvement in BP, lipids, and glucose CV Risks: May not provide Nutrition Facts for monitoring nutrient intake Expense and lack of fresh foods may decrease adherence Life-long healthy eating habits are not necessarily learned Bottom Line: Best to opt for a diet that teaches life-long healthy eating habits in order to maintain long-term health benefits Low Carbohydrate Diets Examples: Atkins, Dukan, South Beach Popular due to rapid weight loss results The extreme restriction of carbohydrate forces the body to burn fat stores for energy Low Carbohydrate Diet Specifics: Carbohydrate-rich foods (fruits, starchy vegetables, legumes, milk, and grains) are limited or omitted Animal proteins are emphasized: meat, poultry, fish, eggs May include saturated fat and sodium-rich foods such as bacon, cheese, sour cream, butter, and bouillon Physical Activity: may or may not be emphasized Low Carbohydrate Diets Weight loss is likely Reduction in carbohydrate intake may reduce triglycerides May see a reduction in blood pressure and lipids (will likely depend on the type of protein and fat consumed) CV Risks: High intake of saturated fat is linked to increased CV risk Insufficient in many nutrients that promote CV health Does not promote life-long, heart-healthy lifestyle change Bottom Line: Not generally recommended due to excess saturated fat and sodium, omission of heart-healthy nutrients, and lack of permanent lifestyle change 7
Very Low Calorie Fad Diets Examples: Cabbage Soup Diet, Grapefruit Diet, and Lemonade Diet Claim to be a Quick Fix for achieving weight loss within a short period of time Very Low Calorie Fad Diet Specifics: Provides <1,200 calories per day Emphasizes a single food while limiting / omitting most others May restrict all solid foods, permitting only liquids (e.g. the Lemonade Diet) Physical Activity: is not typically encouraged Very Low Calorie Fad Diets Cardiovascular Benefits: None Cardiovascular Risks: Permanent lifestyle change is not promoted Grossly inadequate in cardio-protective nutrients Any decrease in weight is mostly due to fluid loss Potential for dangerous fluid / electrolyte imbalances, hypotension, and cardiac arrhythmia Repeat or extended use may lead to protein energy malnutrition, myocardial atrophy, and risk of cardiac arrest Bottom Line: Not recommended due to extreme nutrient restriction, lack of sustainable weight loss, and potentially dangerous CV risks Choosing the Best Diet for Your Heart Questions? Check with your doctor before starting a new diet or weight loss plan Avoid extreme fad diets Let the AHA dietary pattern be your guide Aim for gradual weight loss Choose a diet that is flexible, includes foods that you enjoy, and encourages permanent lifestyle change 8