Charlie Seltzer, MD, DABOM, CES

www.limitlesslongevity.com

Heart Healthy Nutrition

Charlie Seltzer, MD, CES

February 20, 2013

Information Overload

Where to start?

Definitions• Diet.com

– An eating plan designed to keep blood cholesterol low and prevent the risk of heart disease.

– Eating foods that are low in saturated fat, total fat, cholesterol, and sodium. Some diets help people lower their cholesterol levels.

• – Foods that decrease risk of cardiovascular and cerebrovascular

disease

–Foods that encourage fat loss or maintenance of a healthy weight (which then decreases essentially all major risk factors for heart disease)• Can be different for different people

What should we be focusing on?

• Food, lifestyle, activity?• Is one “diet” better than the others?• Will certain foods kill you?• Will certain foods let you live to be 120?• What are quantifiable goals of “heart-

healthy” nutrition– Reduce risk factors• Weight loss accomplishes total modifiable risk factor

reduction

• In the diet…– Fat?– Carbs?– Cholesterol?

• In the body…– Triglycerides– Endothelial dysfunction

• Lining of blood vessels becomes damaged, making plaque formation more likely

– Inflammation– Insulin resistance or Metabolic Syndrome

• In the …– Being a man– Family history

What causes heart attacks?i.e. What are CVD risk factors?

Risk Factors (continued)

• What are the major “modifiable” risk factors for heart disease?

–OBESITY– Insulin Resistance/diabetes• Related primarily to…

OBESITY – Inflammation• Related to…

OBESITY

Risk Factors (continued)

• Cholesterol?– What percentage of people who have heart attacks have “normal”

LDL (or bad cholesterol)?

–About 50%–Different kinds of LDL»Small and dense -> 4x risk of CVD»Large and fluffy -> no increased risk of CVD

• Triglycerides (TG)– Risk Factors for Myocardial Infarction in the Stockholm Prospective Study: A 14-Year Follow-up Focusing on the Role of Plasma

Triglycerides and Cholesterol

• Plasma triglycerides were more important as a risk factor than cholesterol

– What’s the best way to lower triglycerides?• Weight loss

– Common for patients to halve TGs with 20 pound weight loss

Risk Factors (continued)

• Insulin Resistance (Pre-diabetes/diabetes)

– Journal of Obesity Research• Insulin resistance is primary cause of cardiovascular

disease risk in children

– American Heart Association• People with metabolic syndrome are at increased risk

for the following:– Atherosclerosis – Peripheral vascular disease– Coronary heart disease and heart attack – Stroke– Type 2 diabetes

» Major risk factor for heart attack

Insulin Resistance(continued)

–What is the best way to prevent or reverse insulin resistance?• Maintain low body fat

Let’s Talk About Fat

• Limit total fat intake to less than 25–35 percent of your total calories each day– ?????????

• Limit saturated fat intake to less than 7 percent of total daily calories– ?????????

• Limit trans fat intake to less than 1 percent of total daily calories– Trans fats =

• The remaining fat: monounsaturated and polyunsaturated fats

• Limit cholesterol intake to less than 300 mg per day, for most people. If you have coronary heart disease or your LDL cholesterol level is 100 mg/dL or greater, limit your cholesterol intake to less than 200 milligrams a day.– ????????

Saturated Fat

• Inuit – Traditional diet• ~75% saturated fat• Whale blubber, seal, caribou, organ meats• Little to no fruit and vegetables

– Prevalence of cardiovascular disease– Depends…

» Traditional diet vs. “new, Western diet”» Smoking, activity, etc.

Saturated Fat (continued)

• Masai– Diets very high in animal fats– CVD essentially nonexistant– Live active lifestyle–MAINTAIN HEALTHY BODYWEIGHTS!!!

Saturated Fat (continued)

• Cochrane Collaboration– Review of 27 studies involving more than 18,000

participants– Cutting back on dietary fat may help reduce heart

disease– Diets low in saturated fats have no significant

effect on mortality, or even on deaths due to heart attacks.

What About

??

Carbs are bad…

• From everydaypaleo.com– “Grains are good for birds, not us.”– “We lack the digestive abilities to eat grains without major

problems.”• Kent Rieske (Bible Life Ministries)

– Carbs (including fruit and whole grains) promote insulin release, causing…• Cancer• Heart disease• Stroke

• 2013 Study from Johns Hopkins– Low carb diets reduce inflammation better than low fat diets

Carbs are bad…(Continued)

• A Paleolithic diet improves glucose tolerance more than a Mediterranean-like diet in individuals with ischemic heart disease.– Diabetologia, 2007– 14 patients advised to consume an ‘ancient’ diet for three months

• Lean meat, fish, fruit, vegetables, root vegetables and nuts• NO grains, dairy foods and salt

– 15 patients who were recommended to follow a Mediterranean-like prudent diet • Whole-grain cereals• Low-fat dairy products• Fruit and vegetables • Refined fats generally considered healthy.

– Mediterranean diet group• increased blood sugar after carbohydrate intake and most of them had overt

diabetes type 2• In addition, all had been diagnosed with coronary heart disease

Carbs are good…

• Obesity is inversely related to whole grain intake…

• But intervention studies with whole grains have not produced weight loss

• Visceral fat, however, may be affected favorably.

Current Atherosclerosis Reports November 2010, Volume 12, Issue 6, pp 368-376

Carbs are good…(continued)

• Study: Whole-Grain, Cereal Fiber, Bran, and Germ Intake and the Risks of All-Cause and Cardiovascular Disease–Specific Mortality Among Women With Type 2 Diabetes Mellitus

• Whole-grain and bran intakes were associated with reduced all-cause and CVD-specific mortality in women with diabetes mellitus.

Circulation. 2010 May 25;121(20):2162-8

What About

??

Dietary Cholesterol from Eggs Increases Plasma HDL Cholesterol in Overweight Men Consuming a Carbohydrate-

Restricted Diet

• Carbohydrate-restricted diets (CRD) significantly decrease body weight and independently improve plasma triglycerides and HDL cholesterol.

• Including eggs in a CRD results in increased HDL-C while decreasing the risk factors associated with Metabolic Syndrome.

© 2008 American Society for Nutrition

The Consumption of Milk and Dairy Foods and the Incidence of Vascular Disease and Diabetes: An Overview of the Evidence

• Reduction in risk in subjects with the highest dairy consumption relative to those with the lowest intake for:– All-cause deaths– Ischemic heart disease– Stroke – Diabetes

• “In conclusion, there appears to be an enormous mismatch between the evidence from long-term prospective studies and perceptions of harm from the consumption of dairy food items.”

Lipids October 2010, Volume 45, Issue 10, pp 925-939, Open Access

• Diets high in saturated fat may or may not increase risk of heart disease.

• Low fat diets may reduce risk of heart disease• Omega-3 fatty acids (fish oils) may reduce risk of

heart disease.• High intake of fruit and vegetables may reduce risk

of heart disease.• Whole grain consumption is either great or horrible

for your health, depending on who you listen to.

Is anything clear?

YES!!!!!!!!!!!!!

Extra body fat significantly increases a person’s risk of heart disease and death.

So what is heart healthy nutrition?

• A MAINTAINABLE, PRACTICAL nutrition plan that enables you to achieve and maintain low body fat levels with optimum muscle mass!!

So what is heart healthy nutrition?(continued)

• Ideally (all other things being equal), one that includes:– Cage free eggs– Grass fed meat– Organic dairy– Fruit and vegetables–Whole grains– Things you like in moderation

Choose the healthier option…

• Glazed donut + apple + scoop of protein powder– 180 calories– 60 calories – 100 calories– Total: 340 calories with 27 grams of protein

• Large bowl of oatmeal with banana and almonds– 300 calories– 120 calories– 160 calories– Total: 580 calories with 16 grams of protein

Examples of Healthy Breakfasts

• Uncured, organic ham, low fat cheese and a cage free egg on a spelt English muffin

• Almond milk, low fat Greek yogurt, blueberry and natural peanut butter smoothie

• “Pancakes” made with a touch of vanilla extract and equal parts low fat cottage cheese, oatmeal and egg whites and topped with microwaved strawberries and Stevia

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Examples of Healthy Snacks

• Garden salad with grilled chicken and low fat dressing

• Salmon and low fat mayonnaise wrap with lettuce and tomato

• Chicken and broccoli stir fry with light soy sauce

Examples of Healthy Lunches

• Chicken with asparagus

• Shrimp and pineapple skewers

• Turkey Chili

Examples of Healthy Dinners