More than 20 years ago, Marcia enrolled in a Coronary Health Improvement Program (CHIP) sponsored by her local hospital. She signed up on her own initiative as a preventive measure since her father and three of her grandparents had died of heart attacks.
As a result of the program, she now exercises regularly and has mastered some stress management and relaxation techniques. The recommended diet, however, was very strict, advising fat intake of no more than 10 to 15 percent of daily calories. After about a month, she drifted back to her old way of eating.
Marcia thought about the CHIP diet last week when her doctor, noting her rising cholesterol and blood pressure numbers, suggested that she consider some diet and lifestyle changes. “If that means following that low-fat diet, I’m not sure I can do it again,” she thought.
The concept of a heart-healthy diet has changed somewhat over the past two decades, but the low-fat diet plan recommended first by Nathan Pritikin and then by Dean Ornish still has considerable support from medical experts.
In a recent article in the New York Times [September 22, 2012], Dr. Ornish pointed to 35 years of medical research conducted at his nonprofit Preventive Medicine Research Institute demonstrating that “patients who ate mostly plant-based meals...achieved reversal of even severe coronary artery disease.”
Although the Ornish diet is not strictly vegetarian, it is strongly oriented toward fruits, vegetables and whole grains with very little meat, butter or other fat. For a person accustomed to the typical American diet, it is notoriously difficult to follow, even for those motivated to change.
For any extended period of time, a diet that allows only 10 to 15 percent of calories to come from fat becomes extremely Spartan. In practice, many nutritionists consider 25 percent fat to be a more reasonable low-fat goal.
Some experts today, on the other hand, believe that even the 25 percent goal is too strict and fails to take into account the health benefits of some fats, such as those containing omega-3 fatty acids. It’s not the amount but the kind of fat that counts for heart health, they say.
Leave Space for Healthy Fats
Persons parsimoniously measuring fat grams are likely to ignore fish, nuts, unsaturated fats and omega-3 fatty acids–all now considered beneficial to heart health.
Observational studies have shown that people who eat fish, particularly fatty fish such as salmon, trout and mackerel have a lower risk of heart attacks. To get adequate quantities of omega-3 fatty acids, the American Heart Association recommends that you eat fish at least twice a week.
Nuts were once avoided as high-fat foods, but they too are high in omega-3 fatty acids as well as protein, fiber, minerals, vitamins and antioxidants. One review of 25 randomized, controlled studies found that subjects assigned to eat half a cup a day of nuts registered decreases of 11 mg/dL in their total cholesterol and 10 mg/dL in LDL.
Scientists believe nuts are beneficial in lowering oxidative stress and improving the function of blood vessels as they dilate and contract. And observational studies have found that persons eating more nuts are less likely to develop heart disease.
Rather than throwing out all fats, most experts today focus more specifically on eliminating the fats known to be bad for the heart–saturated fats and trans fats–and replacing them with healthy fats.
Monounsaturated fats, found in nuts and avocados as well as olive and canola oils, are known to lower LDL cholesterol while raising levels of the beneficial HDL.
Eating enough of these healthy fats may be difficult or impossible for anyone following an extremely low-fat regimen, such as the one Marcia tried. As a result, the American Heart Association now recommends that fats account for 25 to 35 percent of calories.
For incorporating these healthy fats, the Mediterranean diet–focusing on vegetables, fruits, fish protein and healthy oils–is an excellent choice. It’s even better when it includes whole grain, rather than white pastas.
Mediterraneans enjoy wine with their meals, and it’s now known that wine–and particularly red wine–contains heart-healthy flavonoids and other substances. The Ornish diet, at least in its early forms, recommends avoiding alcohol as well as nuts and fatty fish.
Another heart-healthy plan that focuses on the pleasure of eating rather than deprivation is the TLC (Therapeutic Lifestyle Changes) diet. This diet recommends six or more servings a day (adjusted for calories) of whole grain breads and cereals; three to five servings a day of vegetables, dry beans or peas; two to four servings of fruits; and two to three servings of low-fat dairy products. Whereas the Ornish plan recommends avoiding or severely limiting all meat, the TLC diet allows five or less ounces a day of lean cuts of meat.
Another approach is the DASH diet, originally developed as a “dietary approach to stop hypertension.” The DASH diet calls for five servings daily of both fruits and vegetables plus whole grains and low-fat dairy products.
Combined with sodium restriction, the DASH diet has been proven effective at lowering blood pressure–an important risk factor for elevated cholesterol and heart disease.
Losing or maintaining weight is a crucial part of any heart healthy lifestyle, and low carbohydrate diets such as the Atkins diet have been found effective at trimming excess pounds, even when such diets involve relatively high amounts of fat and protein. Dr. Ornish’s article in the New York Times takes an aggressive stance against such diets, and most medical experts agree although research so far has not reached definitive conclusions.
Rather than choosing one diet or another, the best approach may be to follow some basic heart-healthy principles endorsed by the American Heart Association:
• cut back on saturated fat (no more than seven percent of your total calories);
• avoid or limit consumption of trans fats, found in many margarines and prepared foods);
• increase your intake of healthy unsaturated fats, omega-3 fatty acids, nuts and fish;
• focus on getting plenty of fruits, vegetables, whole grains, fiber, potassium and antioxidants.
Far from being restrictive, a good heart healthy diet leads you to explore and enjoy a widening variety of flavors, textures and nutrients.
REFERENCES:
“Best heart-healthy diets,” U.S. News & World Report, 2012.
Jeanie Lerche Davis, “25 top heart healthy foods,” WebMD Feature, reviewed by Kathleen M. Zelman, MPH, RD, LD, August 25, 2009.
Gary Gerstenblith, M.D., and Simeon Margolis, M.D., Ph.D., “Coronary heart disease, 2012,” the Johns Hopkins White Papers.
Mayo Clinic Staff, “Heart-healthy diet: 8 steps to prevent heart disease,” MayoClinic.com, April 30, 2012.
National Institutes of Health, “Your guide to lowering your cholesterol with TLC,” NIH Publication No. 06-5235, December, 2005.
Dean Ornish, M.D., “Eating for health, not weight,” New York Times, September 22, 2012.
“Review: Eat More, Weigh Less,” WebMD Medical Reference, reviewed by Kathleen M. Zelman, MPH, RD, LD, February 1, 2012.
11/29/2012
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