Top 10 nutrition strategies for reducing heart disease

Here's a nice summary of sensible dietary recommendations, courtesy of the CBC News website and nutritionist Andrea Holwegner.

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Nutrition plays a major role in reducing many of the risk factors for heart disease. Making healthy eating choices is not only important to keep your blood cholesterol levels and blood pressure healthy, it greatly influences your ability to manage a healthy weight and protect against diabetes.

1. Boost your intake of omega-3 fats. These fats improve heart health by making the blood less "sticky", which reduces the risk of heart attack and stroke. Omega-3 fats also lower cholesterol. The best sources of omega-3 fats are fatty fish, ground flax seeds, walnuts, and canola oil.

2. Choose healthy unsaturated fats. Unsaturated fats found in olive oil, nuts, seeds, avocados and fish are healthy fats that are good for us. Be sure to include a moderate amount of these in your diet, as they lower your "bad" or LDL-cholesterol.

3. Increase fibre-rich foods. Fibre found in whole grain breads, bran cereals, beans/legumes, and fruits/veggies help to reduce cholesterol and keep you feeling full longer. Soluble fibre, which is especially high in bran cereals containing psyllium, can help to reduce cholesterol levels when you eat it regularly.

4. Slash trans fats. Trans fats (shortening, hydrogenated vegetable oils) are found in some margarines and many packaged foods such as cookies, cakes, frozen meals, deep fried foods, and fast foods. The food label can help you determine how much trans fats are in a particular food. Aim to reduce or even eliminate trans fats from your diet since they not only increase the "bad" LDL-cholesterol but they also reduce the "good" HDL-cholesterol in our body.

5. Reduce saturated fats. Saturated fats increase the "bad" LDL-cholesterol in our body which negatively affects our heart health. To reduce your intake of saturated fats limit heavily marbled meats, remove the skin on poultry, and consume less butter, margarine and high-fat dairy foods.

6. Eat less simple sugars & refined grains. Sweets, soda drinks, desserts and many refined foods such as white bread and low-fibre grains can increase your triglycerides, and contribute to extra calories and lead to weight gain. These foods can also contribute to higher blood sugars if you have diabetes.

7. Watch alcohol consumption. While 1-2 glasses of wine per day has been found to be beneficial for your heart, you should be aware that excessive alcohol can increase your triglyceride levels, contribute to high blood pressure and also increase your overall calorie level and lead to weight gain. If you choose to drink, do so in moderation.

8. Reduce your calories (if you are overweight). Reducing your calorie intake can help you to lose weight if you are overweight. Research suggests that many people see a drop in their cholesterol levels, blood pressure and blood sugars by even losing a few pounds.

9. Cut down on salt. I don't think it is any surprise that most of us eat much more salt than required for health. Most of our salt comes from ready-to-eat, processed/packed foods, eating out, canned foods, and condiments. Limiting dietary sodium intake to 1,500-2,300 mg per day is recommended if you have high blood pressure. Remove the salt shaker from your table and be sure to read labels and choose lower sodium foods.

10. Learn about the DASH diet. The DASH (dietary approaches to stop hypertension) diet has been shown in research to lower blood pressure significantly. This eating plan emphasizes plenty of fruits, veggies, low-fat dairy foods, and reduced saturated fat. The DASH diet also includes whole grains, fish, poultry, and nuts and is low in red meat, sweets, added sugars, and sweetened beverages typical in North American diets.

Women: Exercise now for good health later!

A new study published in the Archives of Internal Medicine gives further evidence to the linkage between exercise and good health. The study, entitled "Physical Activity at Midlife in Relation to Successful Survival in Women at Age 70 Years or Older" looked at 13,500 women, who were part of the Nurses' Health Study who had survived to age 70 years or older, without any of 10 major chronic diseases, open heart surgery or cognitive or physical impairment.

The Nurses' Health Study, just to give a little background, is considered the "grandmother" of women's health studies and represents the single largest "cohort" study of women, in which the same patients were followed and monitored over many years. It has resulted in more than 265 published scientific papers. The study was established in 1976, with the initial idea of studying the relationship between oral contraceptives, cigarette smoking and the risk of major illnesses. Thanks to the dedication and commitment of the participants, the scope and range of the study has broadened over time to evaluate other lifestyle factors, as well.

Using data from this group, the Harvard-based researchers found that higher physical activity levels at midlife were significantly associated with better odds of successful survival. Regular walking also was found to have a beneficial effect, but not quite as much as more vigorous exercise. Women in the upper 40% of activity were between 1.34 and 1.99 (for the top 20%) times more likely to successfully make it to age 70 without major health issues, compared to women in the lowest 20% of activity.

Now, if we could just find a way to make exercise fun!

Mom was right: shut off that TV!

A new study released Monday in Circulation: Journal of the American Heart Association confirms what Mom always told you - too much TV watching is bad for you.

The study looked at health data among 8,800 men and women over age 25 in the Australian Diabetes, Obesity and Lifestyle Study. Researchers separated the participants into three groups: those who regularly watched less than two hours a day, those who watched two to four hours a day and those who regularly watched more than four hours of television each day.

People with a history of cardiovascular disease were excluded from the study.

People who watched more than four hours a day showed an 80 percent greater risk of death from cardiovascular disease and a 46 percent higher risk of all causes of death, compared with those who watched less than two hours a day. Researchers controlled for smoking, high blood pressure, high cholesterol, an unhealthy diet and leisure-time exercise.

Researchers found a strong connection between TV hours and risk of death from cardiovascular disease; that link was found not just among the overweight and obese but among people who had a healthy weight and exercised.

It's probably pretty similar for playing video games and surfing the web. Being a couch potato is a dangerous occupation!

New simpler rules for cholesterol testing

I had an interesting conversation with a patient this week, who strenuously asserted that the link between cholesterol levels and heart disease remains "unproven". As it happens, this month's issue of the Journal of the American Medical Association (JAMA) has a major new study reviewing the link between cholesterol, heart disease and stroke, so I was able to show him the data.

The study group came up with some new findings, and re-confirmed some older findings:

1. HDL levels (high density lipoprotein) - aka "the good cholesterol" - is clearly protective for heart disease. Higher levels are strongly correlated with a reduced rate of coronary heart disease. We knew this already.

2. Everything else (other than HDL) in the cholesterol family is "bad", with the risk of cardiac disease increasing significantly for non-HDL levels above 135 mg/ml. "Non-HDL cholesterol" is certainly simpler to remember than LDL's, VLDL's, chylomicrons and all the rest.

3. Triglyceride levels had no relation to heart disease risk in this study. Before you start celebrating, remember that excess triglyceride levels have been linked to pancreatitis.

4. Interestingly, there was no significant linkage between non-HDL (bad) cholesterol and stroke rates. That finding was unexpected.

5. Also new, Cholesterol levels did not vary significantly from the fasting and non-fasting states. Therefore, next time you go to have your cholesterol blood test, you will no longer need to skip breakfast.

Essentially, this study simplifies assessment of the lipid risk profile for cardio-vascular disease. Measure your total cholesterol and your HDL cholesterol, and don't worry too much about the other cholesterol groups. And don't worry about getting fasting lab work, unless the fasting state is needed for some other lab test, like glucose levels.