the heart smart diet
DESCRIPTION
The heart smart diet. Presented by. Sanmaré MacRobert Clinical Dietitian. Vergelegen Nutrition Centre Suite 2 F Arun Place · Main Road · Somerset West 021 851 6228 [email protected]. Facing the facts. - PowerPoint PPT PresentationTRANSCRIPT
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The heart smartheart smart
diet
Vergelegen Nutrition CentreSuite 2 F Arun Place · Main Road · Somerset West
021 851 6228 [email protected]
Sanmaré MacRobertClinical Dietitian
Presented by
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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
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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
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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
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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
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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
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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
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Cholesterol
Food Artery
Liver = 75%Diet = 25%
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Cholesterol
Food Artery
LDL
HDL
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Cholesterol
Food Artery
LDL
HDL
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Cholesterol
Food Artery
TG
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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
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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!!!
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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!!!
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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
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Protein, CHO, Fat?What to consider?
No Carbohydrates?High Protein?
What about fat?
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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
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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
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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
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Becoming fat smart
Saturated fat
Food labels:
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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
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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
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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
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Trans fatty acids: Dietary Sources
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Butter vs margarine
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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
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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
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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
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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
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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
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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
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• 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
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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)
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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
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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)
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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
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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
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What is your waist line saying?
Black Ribbon = 102 cm for male
Red ribbon = 88cm for females
Know your risk today!!!!
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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).
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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
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Alternative Remedies
• Red Yeast Extract
• Plant sterols and Stanols
• Artichoke
• Barley
• Garlic
• Oatbran
and many more to come in September 2012!!!
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Thank you
Sanmaré MacRobert021 851 6228