The heart smartheart smart

diet

Vergelegen Nutrition CentreSuite 2 F Arun Place · Main Road · Somerset West

021 851 6228 vergelegen@nutritioncentre.co.za

Sanmaré MacRobertClinical Dietitian

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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

Unmodifiable Risk factors

Heart Disease

• Age Male > 45 Female > 55

• Family History

• Gender Male

• Menopause

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

Lancet 2010; 376:112-123American Heart AssociationCleveland ClinicKrause

Modifiable Risk FactorsHeart Disease

• 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

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

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

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

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

Cholesterol

Food Artery

Liver = 75%Diet = 25%

Cholesterol

Food Artery

LDL

HDL

Cholesterol

Food Artery

LDL

HDL

Cholesterol

Food Artery

TG

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

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!!!

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!!!

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

Protein, CHO, Fat?What to consider?

No Carbohydrates?High Protein?

What about fat?

Becoming fat smart

Saturated 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

Becoming fat smart

Saturated 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

Becoming fat smart

Saturated fat

Saturated fat content of food:

1 large egg 2g

Ribeye steak 4g

hamburger 5g

1 TBS coconut milk 3g

1 TBS butter 7g

1 TBS olive oil 2g

30g cheese 6g

Becoming fat smart

Saturated fat

Food labels:

Becoming fat smart

Trans 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

Becoming fat smart

Trans 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

Becoming fat smart

Trans 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

Trans fatty acids: Dietary Sources

Butter vs margarine

Butter vs Margarine

THE FACTSBUTTER

• 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

Becoming fat smart

Dietary 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

Egg 210mg per egg Fast foods 246mg/100g

Egg yolk 212mg per yolk cheese 123mg/100g

Caviar 288mg/100g Processed meat 63g/100g

Liver, pate 255mg/100g Chocolate

Butter 243mg/100g

Becoming fat smart

Polyunsaturated 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

Becoming fat smart

Omega 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

Becoming fat smart

Omega 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 / hemorrhagic storke – 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

Becoming fat smart

Mono-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

• 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.

Becoming fat smart

Nuts and heart health

Becoming fat smart

Nuts 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)

Becoming fat smart

Plant 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

Becoming fat smart

Plant 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)

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

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

What is your waist line saying?

Black Ribbon = 102 cm for male

Red ribbon = 88cm for females

Know your risk today!!!!

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. Clin Epid., 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).

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

Alternative Remedies

• Red Yeast Extract

• Plant sterols and Stanols

• Artichoke

• Barley

• Garlic

• Oatbran

and many more to come in September 2012!!!

Thank you

Sanmaré MacRobert021 851 6228