This is a .pdf file on the computer here, but I have no idea how to or if you can post documents on these blogs, so I copied the whole thing to post! Elliot's family has a history of type 2 diabetes, and diabetes and heart disease are closely linked. So in an effort to keep both our asses alive for as long as possible, I have been reading (and reading, and reading, and reading.......) all the nutrition info I can get my hands on.
You can probably expect to see me post these every so often. As with most things in this world, there are MANY different approaches to dealing with heart disease, diabetes, and the prevention of these things, and these postings will reflect that. They are all going to get tagged "health" so as to be easy to find :) The text is going to look a little loopy compared to the original, because in order to highlight and copy, I had to save it as a .txt document, for some reason I couldn't highlight and paste directly from the .pdf to the blog.
So without further adieu, here is the piece.
Heart-Healthy Diet
WHAT ARE THE IMPORTANT COMPONENTS OF A HEART-HEALTHY DIET?
Heart-Healthy Goals. The goals of a heart-healthy diet are to eat foods that help obtain or maintain healthy levels of
cholesterol and other lipids (fatty molecules) by achieving the following:
· Reducing overall cholesterol levels and low-density lipoproteins (LDL), which are harmful to the heart.
· Increasing high-density lipoproteins (HDL), which are beneficial for the heart.
· Reducing other harmful lipids (fatty molecules), such as triglycerides and lipoprotein(a).
Any diet should also help keep blood pressure and weight under control.
General Recommendations. Although there are many major dietary approaches for protecting health, experts generally
agree on the following recommendations for heart protection:
· Choose fiber-rich food (whole grains, legumes, nuts) as the main source of carbohydrates, along with a high
intake of fresh fruits and vegetables.
· Avoid saturated fats (found mostly in animal products) and trans fatty acids (found in hydrogenated fats and
many commercial products and fast foods). Choose unsaturated fats, particularly omega-3 fatty acids (found
in vegetable and fish oils).
· In selecting proteins, choose soy protein, poultry, and fish over meat.
· Weight control, quitting smoking, and exercise are essential companions of any diet program.
After embarking on any heart healthy diet, it generally takes an average of three to six months before any noticeable
reduction in cholesterol occurs, although some people have reported better levels in as few as four weeks. An intensive
program may be necessary to achieve significant improvements in cholesterol levels and to reduce other heart risk
factors.
[For more information on heart problems see Well-Connected Report #23 Cholesterol, Other Lipids, and Lipoproteins,
Report #3 Coronary Artery Disease and Angina, Report #14 High Blood Pressure, and Report #53 Weight Control and
Diet.]
Fats and Oils
Some fat is critical in everyone's diet, but certain fats have good or harmful effects on health, depending on their
chemistry. All fats, good or bad, are high in calories compared to proteins and carbohydrates. In order to calculate daily
fat intake, multiply the number of fat grams eaten by nine (one fat gram is equal to 9 calories, whether it's oil or fat) and
divide by the number of total daily calories desired. One teaspoon of oil, butter, or other fats equals about five grams of
fat. All fats, no matter what the source, add the same calories.
People should strive to replace saturated (animal fats) and trans fatty acids (commercial fats) with unsaturated fats from
plant and fish oils. The American Heart Association and other experts now recommend that the source of most of these
unsaturated fats should come from omega-3 fatty acids, which are found in fish and plant sources.
The Chemistry of Fats and Cholesterol. Most of the cholesterol in the body does not come from food but is produced by
the liver -- stimulated by saturated fats. The dietary key to managing cholesterol, then, lies in understanding some of
the major compounds in fats and oils that are becoming important in health:
· Fatty Acids. All fats and oils found in foods are made up of chains of molecules called fatty acids. There are
three major chains: saturated fatty acid (found mostly in animal products) and two unsaturated fatty acids --
monounsaturated and polyunsaturated fatty acids (found in plant products). The oils and fats that people and
animals eat are nearly always mixtures of these three chains, but one type of fatty acid usually predominates in
specific oils or fats.
· Essential Fatty Acids. In addition, there are three chemical subgroups of polyunsaturated fatty acids called
essential fatty acids: omega-3 and omega-6 polyunsaturated fatty acids, and omega-9 monounsaturated fatty
acids.
· Trans Fatty Acids. To complicate matters, there are also trans fatty acids, which are not natural but are
manufactured by adding hydrogen atoms to polyunsaturated fatty acids (called hydrogenation).
Harmful Fats. Reducing consumption of saturated fats and trans fatty acids is the first essential step in managing
cholesterol levels through diet.
· Saturated Fats. Saturated fats are found predominantly in animal products, including meat and dairy products.
They are strongly associated with higher cholesterol levels, and they may be even more dangerous in women
than in men. Avoiding fats during the evening meal may be especially helpful. High-fat meals are associated
with sudden surges in triglyceride levels and other lipids along with impaired blood flow in the arteries to the
Heart-Healthy Diet
heart. (The so-called tropical oils, palm, coconut, and cocoa butter, are also high in saturated fats. Evidence is
lacking, however, about their effects on the heart. The countries with the highest palm-oil intake, Costa Rica
and Malaysia, also have much lower heart disease rates and cholesterol levels than Western nations.)
· Trans Fatty Acids. Trans fatty acids are manufactured fats created during a process called hydrogenation,
which is aimed at stabilizing polyunsaturated oils to prevent them from becoming rancid and to keep them
solid at room temperature. They may be particularly dangerous for the heart and may pose a risk for certain
cancers. Some experts believe that these partially hydrogenated fats are even worse than saturated fats. Studies
report that high consumption of these fats reduces HDL cholesterol levels, has harmful effects on the linings of
the arteries, and may increase the risk for type 2 diabetes. Women whose diets were high in trans fatty acids,
however, had a 53% increased risk for heart attack compared to those who consumed the least of those fats.
Hydrogenated fats are used in stick margarine and in many fast foods and baked goods, including most
commercially produced white breads. (Liquid margarine is not hydrogenated and is recommended.) The FDA
has now required that food labels include information on trans fatty acids.
Beneficial Fats and Oils. It should be noted that some fat is essential for health, and fat is essential for healthy
development in children. Public attention has mainly focused on the possible benefits or hazards of monounsaturated
(MUFA) and polyunsaturated (PUFA) fats.
· Polyunsaturated fats are found in safflower, sunflower, corn, and cottonseed oils and fish.
· Monounsaturated fats are mostly present in olive, canola, and peanut oils and in most nuts. (Canola is the least
saturated of all the fats.) Some studies have reported that replacing carbohydrates with monounsaturated fats
improves glucose control after meals and reduces triglycerides in people with type 2 diabetes. Oils are more
calorie-dense, however, and such patients should be wary of weight gain.
Researchers are most interested in the smaller fatty-acid building blocks contained in both oils, which may have more
specific effects on lipids. Three important fatty acids are the essential fatty acids omega-3, omega-6, and omega-9.
Omega-3 fatty acids are found in fish oil (docosahexaenoic and eicosapentaneoic acids) and plants (alpha-linolenic
acid).
· Docosahexaenoic (DHA) and Eicosapentaneoic (EPA) Acids. DHA and EPA are found in fish oils, and
evidence suggests that they have significant benefits for the heart, including reducing sudden death from heart
disease, dangerous heart rhythms, inflammation, blood clotting factors, blood pressure, and improving
triglyceride and HDL levels. These fatty acids may also reduce risks for other disorders, including stroke,
rheumatoid arthritis, asthma, ulcerative colitis, some cancers, and mental decline. Fish oil supplements may
increase LDL levels in certain people and impair short term control of blood sugar in people with type 2
diabetes. The significance of these findings is not yet known.[For more information, see Fish under Protein,
below.]
· Alpha-linolenic Acid. Alpha-linolenic acid is a plant precursor of DHA, which means the body can convert it
to DHA. Sources include canola oil, soybeans, flaxseed, and certain nuts and seeds (walnut, flax, chia and
sometimes pumpkin seed). Some, but not all, studies suggest that oils or foods containing these oils may also
be heart-protective. Supplements or foods containing this oils may also protest the heart. For example studies
have reported heart protection from flaxseed supplements and also from nuts, such as almonds, macadamia,
and walnuts. Nuts are high in calories, although studies in 2002 reported that replacing usual snacks with
almonds did not affect the daily diet and significantly reduced cholesterol and other heart disease risk factors.
Still, people must be aware of that nuts are not low-calorie snacks.
Omega-6 polyunsaturated fatty acids are found in corn, safflower, soybean, and sunflower oil. PUFA oils containing
omega-6 fatty acids constitute most of the oils consumed in the US. Some omega-6 fatty acids are important for
health. However, high intake of these fats was associated in one study with weight gain in the abdomen (the so-called
apple shape), a risk factor for heart disease. High consumption is also associated with a higher risk for certain cancer
and some chronic diseases.
Omega-9 monounsaturated fatty acids are contained in canola and olive oil, which have bother been associated with
health protection.
Research suggests that a healthy balance of all these fats may be important and that our current Western diet contains an
unhealthy ratio of omega-6 to omega-3 fatty acids (10 to 1). Omega-9 fatty acids may also contain chemicals that
block harmful factors found in omega-6 fatty acids. Researchers are finding then that the most benefits may be found in
mixture of all three fatty acids found in both poly- and monounsaturated oils, but in modest amounts that do not add
too many calories.
Fat Substitutes. Fat substitutes added to commercial foods or used in baking, deliver some of the desirable qualities of
fat, but do not add as many calories. Some include the following:
Plants substances known as sterols and their derivatives called stanols reduce cholesterol by impairing its
absorption in the intestinal tract. Margarines containing them (Benecol, Take Control) are available. Benecol is
derived from pine bark and Take Control from soybeans. Two servings a day of either brand as part of a
Heart-Healthy Diet
low-fat diet can lower LDL and total cholesterol. In one study, consuming a sterol-based margarine doubled
the LDL-lowering effects of a statin (a common cholesterol-lowering drug) compared to a standard
margarine. These products do not appear to have block absorption of fat-soluble nutrients or vitamins, as
olestra does [see below]. They may be hydrogenated and include some trans fatty acids, however.
· Olestra (Olean) passes through the body without leaving behind any calories from fat. Studies suggest that it
helps improve cholesterol levels and may help overweight people lose weight. Early reports of cramps and
diarrhea after eating food containing olestra have not proven to be significant. Of greater concern is the fact
that even small amounts of olestra deplete the body of certain vitamins and nutrients that may help protect
against serious diseases, including cancer. The FDA requires that the missing vitamins be added back to
olestra products, but not other nutrients.
· Beta-glucan is a soluble fiber found in oats and barley. Products using this substance (e.g., Nu-Trim) may
reduce cholesterol and have additional health benefits.
A number of other fat-replacers are also available. Although studies to date are not showing any significant adverse
health effects, their effect on weight control is uncertain, since many of the products containing them may be high in
sugar. Of interest was one study suggesting that people who consume foods that contain fat substitutes do not learn to
dislike fatty foods, while people who learn to cook using foods naturally lacking or low in fat eventually lose their taste
for high fat diets. It should be stressed that eliminating all fats from ones diet can be harmful to general health.
Note on Dietary Cholesterol
The story on cholesterol found in the diet is not entirely straightforward. Cholesterol is found only in animal
tissues, with high amounts occurring in meat, dairy products, egg yolks, and shellfish. The American Heart
Association recommends no more than 200 mg of cholesterol per day. One study estimated, however, that
reducing dietary cholesterol intake by 100 mg/day would only produce a 1% decrease in cholesterol levels. And
eggs specifically have many nutrients. Most people, then, can eat eggs occasionally without concern.
Studies now suggest that dietary cholesterol itself may not pose any significant risk for heart disease in most
individuals. Exceptions may be people with diabetes, who should still avoid eating eggs or other high-cholesterol
foods (such as shrimp) more often than once a week.
Carbohydrates
Carbohydrates are either complex (as in starches) or simple (as in fruits and sugars). One gram of carbohydrates equals
four calories. The current general recommendation is that carbohydrates should provide between 50% and 60% of the
daily caloric intake. Important studies are reporting that individuals can protect their heart and circulation and even
extend their lives just by eating plenty of fruits and vegetables.
Complex Carbohydrates. In all cases, complex carbohydrates found in whole grains and vegetables are preferred over
those found in starch-heavy foods, such as pastas, white-flour products, and potatoes. Most of these are high in fiber,
which is important for health. Whole-grains specifically are extremely important for people with diabetes or at risk for
it. [See Box Fiber-Rich Foods and Table Some Examples of Healthy Foods.]
Simple Carbohydrates (Sugar). The World Health Organization and the Food and Agriculture Organization now
recommend that no more than 10% of daily calories should come from sugar. (Currently, Americans eat nearly half a
pound of sugar a day on average, and sugar intake constitutes 25% of a day's calories.) Sugars are usually one of two
types:
· Sucrose. Source of most dietary sugar, found in sugar cane, honey, and corn syrup.
· Fructose. Found in fruits and vegetables. Although fructose does not appear to be have any difference effects
in the body than sucrose, most of the fruits and vegetables that contain it are vital for good health.
High level of sugar consumption -- whether fructose or sucrose -- has been associated with higher triglycerides and
lower levels of HDL cholesterol, the so-called good cholesterol. And the high consumption of sugar is most likely one
of the factor in the current obesity epidemic. Soda, other sweetened beverages, and fruit juice in fact may be singled out
as major contributors to childhood obesity.
Of increasing interest to researchers in the study of possible harm from sugar are advanced glycation end-products
(called AGEs), which are end-products of the chemical reaction between sugar and protein. This reaction occurs most
intensively when cooking at high temperatures -- particularly animal fats. (Steaming or cooking food in water does not
produce these chemicals. Low, slow cooking also produces fewer AGEs.) AGEs can also be formed by chemical
reactions in the body itself. They are now believed to promote factors in the inflammatory response that cause a number
of diseases or their complications, including Alzheimer's disease, diabetes, atherosclerosis, cataracts, and osteoporosis.
Heart-Healthy Diet
Fiber-Rich Foods
Fiber is an important component of many complex carbohydrates. It is almost always found only in plants. (One
exception is chitosan, a dietary fiber made from shellfish skeletons.) Fiber cannot be digested but passes through
the intestines, drawing water with it and is eliminated as part of feces content. High-fiber diets (up to 55 grams a
day) can be very helpful. Different fiber types may have specific benefits: :
· Insoluble fiber (found in wheat bran, whole grains, seeds, nuts, legumes, and fruit and vegetable peels)
may help achieve weight loss. Consuming whole grains on a regular basis may lower the risk for heart
disease, improve factors involved with diabetes, and may even lower the risk for type 2 diabetes in the
first place.(Wheat bran taken as supplements has not been associated with any benefits. The whole grain
may be needed for good health.) Of further note, high consumption of nuts, such as almonds,
macadamia, and walnuts) may be highly heart protective, independent of their fiber content.
· Soluble fiber (found in dried beans, oat bran, barley, apples, citrus fruits, and potatoes) may help achieve
healthy cholesterol levels and possibly reduce blood pressure as well. For example, a 2001 study
indicated that eating beans four or more times a week reduced the risk for heart disease by 22%. Oat
bran has also been highly studied for its benefits on the heart.
· Soluble fiber supplements, such as those that contain psyllium or glucomannan, may be beneficial.
Psyllium is taken from the husk of a seed grown in India and is a very effective agent for lowering total
and LDL cholesterol. It is found in laxatives (e.g., Metamucil), breakfast cereals (Bran Buds, Plantaben),
and other products. Of note, some studies suggest that psyllium increases triglyceride levels in
postmenopausal women. Sodium levels may also rise. People who increase intake of soluble fiber should
also drink more water.
Protein
In general, experts recommend that proteins should provide 12% to 20% of calories. One gram of protein contains four
calories. Protein is important for strong muscles and bones and may have specific benefits on blood pressure. The best
sources of protein are fish, poultry, and soy. At this time, it is wise to restrict red meat or any meat that is not lean.
Fish. Fish is probably the best source of protein. Evidence suggests that eating moderate amounts of fish (twice a week)
may improve triglyceride and HDL levels and help lower the risks for death from heart disease, dangerous heart
rhythms, blood pressure, a tendency for blood clots, and the risk for stroke. The most healthy fish are oily fish, such as
salmon, mackerel, or sardines, which are high in omega-3 fatty acids. Three capsules of fish oil (preferably as
supplements of DHA-EPA) is about equivalent to eating one serving of fish.
It should be noted that a French study reported a higher incidence of heart attack in men who ate fish daily. Such
findings may be due to mercury toxicity, which has harmful effects on the heart. High mercury content has been
observed in swordfish and shark and, to a medium extent, in tuna, trout, pike, tilapia (tile fish) and bass.Fish oil
supplements also may have some adverse effects on LDL levels in certain people and glucose control in people with
type 2 diabetes. More research is needed to further define the risks and benefits of fish, but at this time most evidence
for eating fish two or three times a week is highly positive for most people. [See Beneficial Fats and Oils under Fats
and Oils, below.]
Soy. Soy is an excellent food. It is rich in both soluble and insoluble fiber, omega-3 fatty acids, and provides all
essential proteins. Not all studies are consistent, but the majority has shown an improvement in at least one of the
cholesterol components in people who consumed at least 25 grams of soy protein. Soy may also reduce other heart risk
factors, at least in certain populations.For example, in one 2002 study, soy was beneficial for controlling blood sugar
and lowering LDL in postmenopausal women with type 2 diabetes. In another study, soy protein was associated with
lower systolic blood pressure in men. The best sources are soy products (tofu, soy milk) or whole soy protein. Adding
soy to lean ground beef may still provide heart benefits and be more acceptable for people who object to soy's taste or
its "veggie" image. (Note: Tablets of individual isoflavones -- chemicals, such as genistein or daidzein, found in soy
-- do not appear to offer any advantages. Soy sauce is also not a good source. It contains only a trace amount of soy
and is very high in sodium.)
More research is important to determine if soy has long-term complications. Of possible concern, a high intake of soy
during pregnancy may have some adverse effect on the fetus, although only animal studies have suggested this.
Meat and Poultry. For heart protection, one 1999 study suggested that it didn't matter if you chose fish, poultry, beef, or
pork as long as the meat was lean. (Saturated fat in meat is the primary danger to the heart.) The fat content of meat
varies depending on the type and cut. It is best to eat skinless chicken or turkey. However, the leanest cuts of pork (loin
and tenderloin), veal, and beef are nearly comparable to chicken in calories and fat and their effect on LDL and HDL
levels. It should be noted, however, that even chicken and lean meat do not improve cholesterol levels, and, in terms of
cardiac health, fish is a more desirable choice.
Dairy Products. A 2002 study reported a lower incidence of factors related to type 2 diabetes and heart disease (insulin
resistance, high blood pressure, obesity, and unhealthy cholesterol) with a high intake of dairy products, including those
Heart-Healthy Diet
with a high-fat content. Some researchers suggest the calcium in dairy products may be partially responsible for these
benefits. The effects of extra calcium on blood pressure, however, are mixed with some even showing higher pressure.
Because many dairy products are high in saturated fats, which are related to heart disease, this study requires
confirmatory evidence.
Some Examples of Healthy Foods
Apples
Flavonoids Fiber May have activity against
certain cancers (lung), heart
disease, asthma, and type 2
diabetes.
Avocados
Vitamin E, vitamin B6,
folate
May be heart protective
Beans
Flavonoids Folate, iron, potassium and
zinc, fiber
Some experts believe beans
are the perfect food.
Berries, All kinds of dark
colored
Ellegic Acid Vitamin C, minerals May protect the aging brain.
(In one study blueberries
were most effective.)
Broccoli (also kale, Brussels
sprouts, cauliflower)
Flavonoids, Isothiocyanates Vitamin C, folate, fiber, and
selenium
Anticancer properties.
Protective against heart
disease and stroke.
Carrots and other bright
yellow vegetables
Lutein, Beta carotene Vitamin A (converted from
carotenoids), Vitamin C,
fiber
Protects heart, eyes, lungs.
(Cooking carrots may
increase their benefits.)
Fish (particularly oily fish,
such as mackerel, salmon,
sardines)
Vitamin B3 and B12,
Essential fatty acids,
selenium
Heart and brain protective.
Garlic Allium (organosulfurs)
May be slightly protective
against heart disease.
Possible infection fighter.
Ginger
Cancer fighting properties
Grains (whole)
Lignans (phytoestrogens) Vitamin B, Selenium
(important antioxidant
mineral), fiber, folate
May help reduce the ability
of cancer cells to invade
health tissue.
Grapes and Red wine
Flavonoids, resveratrol Fights heart disease and
cancer. May have activity
against asthma, and type 2
diabetes.
Nuts (such as almonds,
macadamia, and walnuts)
Vitamin E, Vitamin B1,
Essential fatty acids, folate,
fiber
May lower cholesterol
levels, reduce sudden death
rates from heart disease, and
help prevent stroke and type
2 diabetes.
Onions
Flavonoids, allium
(organosulfurs)
May have activity against
certain cancers (lung), heart
disease, asthma, and type 2
diabetes.
Oranges and orange juice
Monoterpenes Vitamin C, folate,
potassium, fiber
Many health benefits.
Increases HDL levels and
helps maintain normal
blood pressure.
Potatoes (Sweet)
Vitamins A, C, and E Many health benefits.
Soy
Four ounces of tofu equals
about eight to 13 grams of
soy.
A soy burger contains about
18 grams of soy.
Isoflavones
(phytoestrogens),
flavonoids, phytosterol,
phytate, saponins
May have effects similar to
estrogen, including
maintaining bone and
benefiting the heart. May
also be protective against
prostate cancer and possibly
other cancers. Possible
protection against mental
decline. More studies are
needed.
Zeaxantin, Beta carotene
Spinach and other dark
green leafy vegetables
Vitamin C, folate, Vitamin
A (converted from
carotenoids)
Protects heart, lungs and
brain.
Tea (Green tea has reported
best benefits.)
Flavonoids Both black and green tea are
heart protective and may
protect against stroke.
Cancer-fighting properties,
particularly in green tea
(probably not black tea).
Tomatoes
Lycopene, Flavonoids Vitamin C, biotin, minerals Protects heart. Studies
suggest reductions in
prostate and other cancers.
Infection fighters.
Vitamins
Antioxidant Vitamins E, C, and A. Vitamins E, C, and A are most studied for their health effects because they serve as
antioxidants. Antioxidants are chemicals that act as scavengers of particles known as oxygen-free radicals (also
sometimes called oxidants). High intake of foods rich in these vitamins (as well as other food chemicals) have been
associated with many health benefits, including prevention of heart problems. Research on the effects of vitamin
supplements on heart disease and diabetes, however, has been mixed. Although some research has observed favorable
effects from vitamin E in preventing blood clots and preventing build-up of plaque on blood vessel walls, most studies
have found no heart protection from either vitamin E or C supplements. In fact, there is some evidence that high doses
of antioxidant vitamin can be harmful. [See Box Oxygen-Free Radical and Antioxidants.]
Vitamin E, however, is still of interest to researchers for possible benefits for people with diabetes. Nevertheless, the
recent negative findings on antioxidant supplements and the lack of clear evidence on benefits should caution against
supplements unless people have diets or conditions that cause deficiencies in these vitamins.
Oxygen-Free Radicals and Antioxidants
Antioxidants are chemicals that act as scavengers of particles known as oxygen-free radicals (also sometimes
called oxidants). These chemically active particles are by-products of many of the body's normal chemical
processes. Their numbers are increased by environmental assaults, such as smoking, chemicals, toxins, and stress.
In higher levels, oxidants can be very harmful:
· Oxygen-free radicals can damage cell membranes and interact with genetic material, possibly
contributing to the development of a number of disorders including diabetes, cancer, heart disease,
cataracts, and even the aging process itself.
· They can also enhance the dangerous properties of low-density lipoprotein (LDL) cholesterol, a major
player in the development of coronary artery disease.
Antioxidant vitamins (A, C, and E), beta carotene, and many phytochemicals can neutralize free radicals and have
been studies for possible benefits. It is clear that such vitamins are required to prevent deficiency diseases. In
addition, foods rich in antioxidants are important disease fighters. To date, however, there is no strong evidence
that antioxidant supplements offer any real protection.
Special Warning on High-Dose Antioxidant Supplements. Some studies are now suggesting that excessive use of
antioxidant supplements may interfere with other nutrients or convert into pro-oxidants and become harmful.
Some of the findings are as follows:
· One small study found that high doses of antioxidants, including vitamins C and E, interfered with
cholesterol-lowering drugs and blunted their effect. This study also supports other evidence that high
doses of vitamin C may speed up atherosclerosis. A 2002 randomized study of postmenopausal women,
for example, found a higher risk for heart disease in those who took vitamin E and C supplements.
· Of particular concern are studies that have found an increase in lung cancer and overall mortality rate
among smokers who took beta carotene supplements. A 2000 study further reported a higher risk for
cancer in male smokers who took multivitamins plus A, C, or E. In determining reasons for this
disturbing effect, one animal study suggested that beta carotene increased enzymes in the lungs that
actually promote cancerous changes. Even more worrisome, in people with existing cancer, high doses
of antioxidant vitamins, such as vitamin C or beta carotene, may actually protect cancer cells (just as
they do healthy cells).
B Vitamins. Deficiencies in the B vitamins folate and B12 have been associated with a higher risk for heart disease in
some (but not all) studies. Such deficiencies produce elevated blood levels of homocysteine, an amino acid that has
been associated with a higher risk for heart disease. Some experts believe, however, that high levels of homocysteine
are only indicators, not causes, of heart problems. Folate improves blood flow through the arteries, which may be as
Heart-Healthy Diet
important for the heart as its effect on homocysteine.
Minerals
Potassium, Magnesium, and Calcium. Some experts believe that sufficient intake of minerals, particularly potassium,
magnesium, and calcium, may be more beneficial than salt restriction for reducing blood pressure.
· Potassium. Evidence now strongly indicates that a potassium-rich diet can help achieve healthy blood pressure
levels, and that potassium supplements can lower systolic blood pressure by 1.8 m Hg and diastolic blood
pressure by 1 mm Hg. In fact, there is some evidence that a potassium-rich diet can reduce the risk of stroke
by 22% to 40%. Current expert guidelines now support the use of potassium supplements or enough dietary
potassium to achieve 3,500 mg per day for people with normal or high blood pressure (who have no risk
factors for excess potassium levels). This goal is particularly important in people who have high sodium
intake. The best source of potassium is from the fruits and vegetables that contain them. Some potassium-rich
foods include bananas, oranges, pears, prunes, cantaloupes, tomatoes, dried peas and beans, nuts, potatoes, and
avocados. Some patients, such as those taking certain diuretics that do not spare potassium, may require
supplements. It should be noted, that excess potassium can cause abdominal distress, muscle weakness, and, in
rare cases, dangerous heart events. Some people should be particularly cautious about excess potassium,
including those with conditions, such as diabetes or kidney disease, that increase potassium levels or people
who are taking medications, such as ACE inhibitors or potassium-sparing diuretics, that limit the kidney's
ability to excrete potassium.
· Magnesium. Some studies reported that magnesium supplements may induce small but significant reductions
in blood pressure. The recommended daily allowance is 320 mg. Persons who live in soft water areas, who use
diuretics, or who have other risk factors for magnesium loss or ectopic beats may require more dietary
magnesium than would others. No major studies, however, have been done on long-term benefits or risks of
magnesium supplements. A major 2001 study on diet found no effect on blood pressure from magnesium
intake from foods.
· Calcium. Calcium regulates the tone of the smooth muscles lining blood vessels, and population studies have
found that people who have sufficient dietary calcium have lower blood pressure than those who do not.
Hypertension itself increases calcium loss from the body. The effects of extra calcium on blood pressure,
however, are mixed with some even showing higher pressure.
Salt Restriction
Everyone should consume less than 2,400 milligrams (about one teaspoon) of sodium each day. People with
hypertension should strive for even lower intake. Reducing sodium may also help protect against heart failure. It should
be noted, however, that experts disagree on the overall benefits of salt restriction for everyone. Still, the following
specific groups should take particular measures to restrict salt:
· People at Risk for Salt-Sensitivity. About half of people with hypertension have blood pressure that reacts
significantly to salt. Such people are known to be salt-sensitive. Among those at highest risk for salt
sensitivity are African Americans, people with diabetes, and elderly people.
· Overweight People. Overweight individuals may absorb and retain sodium differently from people with
normal weights. In fact, one 1999 study reported that high sodium intake was associated with an increased risk
of heart disease and all-cause mortality in overweight, but not in normal weight, people. Reducing sodium can
also help reduce the risk of stroke in people who are overweight.
Simply eliminating table and cooking salt can be beneficial. Salt substitutes, such as Cardia, containing mixtures of
potassium, sodium, and magnesium are available, but they are expensive. It should be noted, however, that about 75%
of the salt in the typical American diet comes from processed or commercial foods, not from food cooked at home, so
the benefits of table-salt substitutes are likely to be very modest. Some sodium is essential to protect the heart, but most
experts agree that the amount is significantly less than that found in the average American diet. If people cannot
significantly reduce the amount of salt in their diets, adding potassium-rich foods might help to restore a healthy
balance.
Water and Other Fluids
Water. Many heart risk factors, especially those associated with blood clotting, are elevated with dehydration. In an
interesting 2002 study, drinking five or more glasses of water a day was significantly associated with a lower risk for
fatal heart events than drinking two or fewer glasses a day. More research is warranted on this simple way of protecting
health. (Other fluids, including caffeinated and sugared drinks, were not protective.)
Alcohol. A number of studies have found heart protection from moderate intake alcohol (defined as one or two glasses a
day). The benefits reported have been higher HDL levels, blood clot prevention, and anti-inflammatory properties.
Although red wine is most often cited for healthful properties, any type of alcoholic beverage appears to have similar
benefit. On the negative side, an estimated 10% of hypertension cases are caused by alcohol abuse. Men with
hypertension should limit their intake to an average of no more than one or two drinks a day, and women (especially
Heart-Healthy Diet
those at risk for breast cancer) and lighter people should also drink less. Pregnant women, people who can't drink
moderately, and people with liver disease should not drink at all.
Caffeinated Beverages.
· Tea. Although it contains caffeine, tea, both black and green, is often cited for its health benefits. Green tea
especially is rich in chemicals that offer protection against damaging forms of LDL. In one study, for example,
higher intake, particularly by women, was associated with a lower risk for severe coronary artery disease.
· Coffee. Coffee, like red wine, contains phenol, which helps prevent oxidation of LDL cholesterol. Studies are
finding no association between coffee consumption and fatal or nonfatal heart disease even after 10 years. In
fact, in one study the highest rates of fatal heart disease were in non-coffee drinkers, and women who
increased their coffee intake reduced their mortality rates. On the downside, unfiltered coffee (Turkish coffee,
Scandinavian boiled or French pressed coffee, and espresso) contains an alcohol called cafestol, which may
raise cholesterol and triglyceride levels. Filtered coffee does not contain this residue. Coffee drinking is
associated with small increases in blood pressure, but the risk it poses is very small in people with normal
blood pressure. People with existing hypertension should avoid caffeine altogether.
WHAT ARE SOME SPECIFIC DIETARY APPROACHES FOR ACHIEVING A HEALTHY
HEART?
Currently, there is much controversy over the best balance of carbohydrates, fats, and protein. A number of dietary
approaches for improving the heart are available:
· Therapeutic Lifestyle Changes (TLC) from the National Cholesterol Education Program.
· The Mediterranean Diet.
· Very low-fat diets, particularly the Ornish Program.
· The Dietary Approaches to Stop Hypertension (DASH) diet. This diet has been designed specifically to help
people reduce blood pressure.
· Restricted calorie diets.
· High-protein diets (e.g., the Atkins diet).
Although all the major dietary approaches differ in important aspects, they have some recommendations in common:
· Choose fiber-rich food (whole grains, legumes, nuts) and fresh fruits and vegetables.
· Avoid saturated fats and trans fatty acids and choose unsaturated fats.
· In selecting proteins, choose soy, poultry, and fish over meat.
· Weight control and exercise are essential companions of any diet program.
Timing of Meals
Eating small frequent meals (six or more instead of two or three large ones) has been associated with being
thinner and having a better cholesterol profile. Naturally, findings should not be taken as a license to snack on
high-sugar or commercial packaged snacks, soda and sugar sweetened beverages (including too much juice), and
fast foods in general. Snacking on such foods is a fast track to obesity.
Low-calorie snack packages (Lean on Me, Level Best) are being developed for people with type 2 diabetes that
contain supplements (such as psyllium, barley, fructose, green-tea extract, chromium picolinate and 5-http)
associated with claims for improving factors that affect the heart and diabetes. Although promising, these
packages have not been clinically studied, and patients should be warned that their long-term risks and benefits
are not known.
Therapeutic Lifestyle Changes (TLC) from the National Cholesterol EducationProgram
Guidelines in 2001 from the National Cholesterol Education Program include the following for preventing and
managing high cholesterol levels in adults:
· Choose five or more servings of fresh fruits and vegetables and six or more servings of whole grains, legumes.
Soluble fiber is preferred (from cereal grains, beans, peas, legumes, and many fruits and vegetables).
· Fats can be up to 35% of daily calories, but no more than 7% should be from saturated fat. (People with high
triglycerides or low HDL or both may need a higher fat intake.) Choose fats containing unsaturated fatty acids
(from vegetables, fish, legumes, and nuts). Choose margarines containing sterols or stanols (e.g., (Benecol,
Take Control). Avoid trans fatty acids found in commercial products as much as possible.
· Proteins choices should be limited in general to fat-free and low-fat milk products, fish, legumes, skinless
poultry, and lean means.
· Limit cholesterol intake to less than 200 mg per day.
· Maintain healthy body weight and a healthy level of physical fitness.
Heart-Healthy Diet
Mediterranean Diet
The Mediterranean diet is rich in heart-healthy fiber and nutrients, including omega-3 fatty acids and antioxidants. The
diet recommends the following:
· A relatively high fat intake (about 35% to 45% of daily calories), but mostly from monounsaturated and
polyunsaturated oils. The Mediterranean diet is known specifically for its use of olive oil. Extra virgin olive oil
has been associated with lower blood pressure. Other studies have reported an association between olive oil
and a lower risk for heart disease as well as possible benefits for people with type 2 diabetes.
· Daily glass or two of wine.
· Protein source is primarily fish. In fact, one 2001 study suggested that fish-consumption was the primary
heart-protective ingredient in this diet.
· Carbohydrate choices emphasize fresh fruits and vegetables, nuts, legumes, beans, and whole grains.
· Foods seasoned with garlic, onions, and herbs.
Positive Arguments. Evidence is increasingly strong on the heart-protective properties of the Mediterranean diet. In a
2002 study, it not only enhanced the benefits of a cholesterol-lowering statin drug, it also maintained levels of
antioxidant nutrients that are normally decreased with the statin. One study suggested that is significantly lowered the
risk for a second heart attack after an average of four years compared to a conservative Western diet. Some studies have
reported that it is more beneficial than the previous American Heart Association Step 1 and 2 diets, although there are
no comparison studies yet with the more recent AHA approach.
Negative Arguments. Weight gain from the high intake of fats and risk for alcohol abuse can be problems with the
Mediterranean diet. Other concerns include reduced iron levels and possible calcium loss resulting from consumption of
fewer dairy products. People who use the diet should take the following precautions:
· Cook in iron pans.
· Eat foods that contain iron or are rich in vitamin C, which aids in iron absorption.
· A calcium supplement may also be needed because of lack of dairy products.
· People should avoid wine if they have risk factors for complications from alcohol. Such people include women
who are pregnant or at risk for breast cancer and anyone prone to alcohol abuse.
The Ornish Program and Severely Fat-Restricted Diets
The Ornish program limits fats significantly. It aims at reducing saturated fats as much as possible, restricting total fat
to 10%, and increasing carbohydrates to 75% of calories. It is a very effective but demanding regimen:
· It excludes all oils and animal products except nonfat yogurt, nonfat milk, and egg whites.
· Foods stressed are whole grains, legumes, and fresh fruits and vegetables.
· People in the program exercise for 90 minutes at least three times a week.
· Stress reduction techniques are employed.
· People do not smoke or drink more than two ounces of alcohol per day.
People on low fat diets should consume a wide variety of foods and take a multivitamin if appropriate.
Positive Arguments. A 2001 systematic review of 27 studies reported that reducing dietary fat is associated with a 16%
reduction in risk and a 9% decline in mortality rates. Low-fat diets that are high in fiber, whole grains, legumes, and
fresh produce offer health advantages in addition to their effects on cholesterol.
· The Ornish program directors have reported a 91% reduction in angina after one year and a 72% reduction
after four years in spite of significant HDL cholesterol reduction. One study reported that the diet reduced
LDL levels to recommended levels without the addition of a cholesterol-lowering drug.
· A major analysis of low-fat diets reported a 9% reduction in mortality rates and 16% reduction in
cardiovascular events (such as heart attack and stroke).
· It is effective in keeping weight off.
· It protects against high blood pressure.
· It may possibly protect against certain cancers.
Negative Arguments. The American Heart Association argues that the Ornish program is so difficult to maintain that it
will not benefit many people. The comparison study showing the advantage of the Ornish over the Step 2 diet, in fact,
was very small because few participants could sustain the efforts needed to fulfill the requirements of the Ornish
program for five years.
Some experts argue that it is not clear whether fat-restriction or the other elements in the program, exercise and stress
reduction, are mainly responsible for its benefits.
Heart-Healthy Diet
· High-carbohydrate and low-fat diets can reduce HDL levels and increase blood sugar and triglyceride levels.
(In such cases, however, people may have chosen their carbohydrates primarily as simple sugars, not the
complex carbohydrates found in whole grains and fresh fruits and vegetables.)
· Very low-fat diets may also increase the risk for stroke from hemorrhage in the brain.
· Very low fat diets may reduce calcium absorption, which may be particularly harmful in women at risk for
osteoporosis.
· Many people who reduce their fat intake do not consume enough of the basic nutrients, including vitamins A
and E, folic acid, calcium, iron, and zinc. People on low fat diets should consume a wide variety of foods and
take a multivitamin if appropriate.
The DASH Diet and Other Dietary Considerations for Reducing High Blood Pressure
The DASH diet (Dietary Approaches to Stop Hypertension) is proving to help lower blood pressure after eight weeks.
Restricting sodium improves results. The diet appears to have antioxidant effects and may even prove to be a good diet
for lowering LDL cholesterol levels -- although the beneficial HDL levels also decline.
This diet is not only rich in important nutrients and fiber but also includes foods that contain far more electrolytes,
potassium, calcium, and magnesium, than are found in the average American diet. The dietary recommendations are as
follows:
· Avoid saturated fat (although include calcium-rich dairy products that are no- or low-fat).
· When choosing fats, select monounsaturated oils, such as olive or canola oils. (One study reported a reduced
need for anti-hypertension medication in people with a high intake of virgin olive oil, but not sunflower oil, a
polyunsaturated fat.)
· Choose whole grains over white flour or pasta products.
· Choose fresh fruits and vegetables every day. In one 2002 study people who increased their intake of fruits and
vegetables experienced a drop in blood pressure after six months. Many of these foods are rich in potassium,
fiber, or both which may help lower blood pressure. [For a list of foods containing potassium, see Potassium,
below.]
· Include nuts, seeds, or legumes (dried beans or peas) daily.
· Choose modest amounts of protein (preferably fish, poultry, or soy products). Soy in combination with
fiber-rich foods or supplements may have specific benefits. Oily fish may also be particularly beneficial. They
contain omega-3 fatty acids, which have been associated with heart and nerve protection .
[For more information see Well-Connected Report #14 High Blood Pressure.]
Calorie Restriction
Calorie restriction has been the cornerstone of weight-loss programs. Restricting calories in such cases also appears to
have beneficial effects on cholesterol levels, including reducing LDL and triglycerides and increasing HDL levels. In
fact, in a study of an African community, inhabitants had very-low calorie diets and favorable cholesterol levels in
spite of a relatively high intake of saturated fats. [Also see Box Guidelines for Weight Loss.]
The standard dietary recommendations for losing weight are the following:
· As a rough rule of thumb, one pound of fat equals about 3,500 calories, so one could lose a pound a week by
reducing daily caloric intake by about 500 calories a day. Naturally, the more severe the daily calorie
restriction, the faster the weight loss.
· To determine the daily calories requirements for specific individuals, multiply the number of pounds of ideal
weight by 12 to 15 calories. The number of calories per pound depends on gender, age, and activity levels. For
instance a 50-year old woman who wants to maintain a weight of 135 pounds and is mildly active might
require only 12 calories per pound (1,620 calories a day). A 25-year-old female athlete who wants to maintain
the same weight might require 25 calories per pound 2,025 (calories a day).
· Fat intake should be no more than 30% of total calories. Most fats should be in the form of monounsaturated
fats (such as olive oil) and saturated fats (found in animal products) should be avoided.
Guidelines for Weight Loss
Life-long changes in eating habits, physical activity, and attitudes about food and weight are essential to weight
management. Unfortunately, although many people can lose weight initially, it is very difficult to maintain weight
loss. People with type 2 diabetes may have a particularly difficult time. The following offer some general
suggestions that may be helpful:
· Start with realistic goals. It is important to realize that when overweight people achieve even modest
weight loss they reduce risk factors in the heart. Ideally, however, overweight patients should strive for
15% weight loss or better, particularly people with type 2 diabetes.
Heart-Healthy Diet
· A regular exercise program is essential for maintaining weight loss. If there are no health prohibitions,
choose one that is enjoyable. Check with a physician about any health consideration. [For more
information, see Well-Connected Report #29 Exercise.]
· Hunger pangs should not be taken as cues to eat. A stomach that has been stretched by large meals will
continue to signal hunger for large amounts of food until its size reduces over time with smaller meals.
· Be honest about how much you eat, and track calories carefully. Studies on weight control that depend
on self-reporting of food intake frequently reveal that subjects badly misjudge how much they eat
(typically underestimating high-calories foods and over-estimating low-calorie foods). In one study,
even dietitians underreported their calorie intake by 10%! People who do not carefully note everything
they eat tend to take in excessive calories when they believe they are dieting.
· For patients who cannot lose weight with diet along, effect weight-loss medications are now available,
which include sibutramine (Meridia) and orlistat (Xenical). Orlistat may have particularly benefits for
patients with type 2 diabetes. This drug may delay or even prevent the onset or progression of diabetes.
It may also improve cholesterol levels, regardless of weight loss. Sibutramine is also helpful in weight
loss but should not be used by patients with high blood pressure or kidney or liver problems.
· Once a person has lost weight, maintenance is required. To maintain a healthy weight in our culture,
everyone must make daily, even hourly, decisions about what is consumed and what is expended
through activity. Such thinking, in many cases, can become automatic and not painful.
· Procedures known as bariatric surgeries have been very helpful in producing rapid weight loss and even
improving insulin and glucose levels in people with diabetes.
Even repeated weight loss failure is no reason to give up. Most studies indicate that yo-yo dieting or weight
cycling has no adverse psychological or physical effects. (Of some concern was a 2000 study reporting lower
HDL levels, the so-called good cholesterol, in women whose weight cycled from frequent dieting. No other heart
risks were evident, however.) Repeated dieting also does not impair the body's ability to burn calories efficiently.
or symptoms and by the adoption of healthy lifestyle habits, not by just the number of pounds lost. [For more
detailed information, see Well-Connected Report #53 Weight Control and Diet.]
High-Protein Diets
High-protein, low-carbohydrate diets have become popular again. They include the Zone, Dr. Atkins, Protein Power,
Sugar Busters, and Dr. Stillman. As an example, the Atkins diet has a four-phase program:
· For the first two weeks individuals consume no more than 20 grams of carbohydrates a day (no fruit, bread,
grains, starchy vegetables, or dairy products other than cheese, cream or butter.) They eat pure protein and fats.
(This phase is not suitable for children, pregnant women, or anyone with kidney disease.)
· After the first phase, individuals continue to lose weight while they increase carbohydrate levels by five grams
each week.
· When individuals get close to their weight goal, they add another 10 grams of carbohydrates per week as long
as they do not begin to gain weight. Weight loss is very slow at this time, but the individual is now getting
used to maintenance.
· Lifetime maintenance is usually between 40 and 100 grams of carbohydrates a week.
Anyone who chooses this diet should prefer fish or soy products to meat as protein sources. Fish, in fact, may reduce
leptin, a hormone associated with fat storage and heart diseases, and so be the best protein source. People on this diet
should also select monounsaturated fats (as in olive oil) over other fat sources.) Patients often need supplements, at least
a multivitamin and possibly calcium, chromium, omega-3 fatty acids (found in fish oil), and other supplements.
High-protein diets can be very effective in producing short-term weight loss, but their long-term effects on health or
on weight maintenance are in question. Centers that promote this approach argue that heart problems from obesity are
due to insulin disturbances from sugar imbalances.
In fact, a well publicized 2002 study reported that people on the Atkins experienced lower levels of triglycerides
(unhealthy fat molecules) and higher HDL (so-called cholesterol), while those on the American Heart Association diet
experienced the reverse effects -- which are risk factors for heart disease. It should be noted that in the study, people
on the Atkins diet -- and not those on the AHA diet -- were given supplements of omega-3 fatty acids, which are
known to be heart-healthy. In assessing the study, some experts suggest that its major contribution to information on
diet is the possible limitation of the AHA diet -- not necessarily the healthy implications of the Atkins diet. Long term
effects on health are still unknown.
For example, the Atkins diet restricts healthful complex carbohydrates in vegetables and particularly in fruits that are
known to protect against serious diseases -- not only heart problems but also cancer. The Atkins diet also causes
excessive calcium excretion in urine, which increases the risk for kidney stones and osteoporosis. One byproduct of this
diet is the release of substances called ketones, which can cause nausea, lightheadedness, and bad breath. A 2002 study
suggested that such diets during pregnancy may increase the risk for high blood pressure in the offspring.
At this point, restricting calories on a low-fat diet is still the best proven method for maintaining weight loss and
preventing serious conditions -- notably diabetes.
Heart-Healthy Diet
WHAT OTHER LIFESTYLE CHANGES SHOULD ACCOMPANY A HEART-HEALTHY
DIET?
Exercise
Inactivity is one of the four major risk factors for coronary artery disease, on par with smoking, unhealthy cholesterol,
and high blood pressure. In fact, studies suggest that people who change their diet in order to control cholesterol are
successful in actually lowering their risk for heart disease only when they also follow a regular aerobic exercise
program.
The following are some observations on the effects of exercise on coronary artery disease:
· People who maintain an active lifestyle have a 45% lower risk of developing heart disease than do sedentary
people. Even moderate exercise reduces the risk of heart attack.
· People who lose weight and exercise regularly have significantly better chance of maintaining that weight loss
compared to those who do not exercise.
· Some studies suggest that for the greatest heart protection, it is not the duration of the exercise that counts but
the total daily amount of energy expended. Therefore, the best way to exercise may be in multiple short bouts
of intense exercise.
· Burning at least 250 calories a day (the equivalent of about 45 minutes of brisk walking or 25 minutes of
jogging) seems to confer the greatest protection against coronary artery disease, particularly by raising HDL
(the so-called good cholesterol) levels. (It may take up to a year of sustained exercise for HDL levels to show
significant improvement, but in terms of raising HDL levels, more is better.)
· Aerobic exercise also appears to open up the blood vessels and, in combination with a healthy diet, may
improve blood-clotting factors.
· Resistance (weight) training offers a complementary benefit by reducing LDL (the so-called bad cholesterol)
levels.
· Exercises that train and strengthen the chest muscles may prove to be very important for patients with angina.
[For complete information, see Well-Connected Report #29 Exercise.]
Stress Reduction
Stress is always highly associated with negative effects on the heart and other parts of the body. A number of
techniques are available to help people relax and reduce tension. [See Well-Connected Report #31 Stress.]
Key Components of a Lifestyle Change Program
Lifestyle Reduce rate of eating.
Keep food records.
Eliminate environmental triggers to eating.
Identify high-risk situations for overeating.
Uncouple eating from other activities.
Exercise Confront psychological barriers to exercise.
Understand mechanisms linking exercise to weight control.
Establish reasonable exercise goals.
Develop a plan for regular activity.
Integrate increased activity into daily lifestyle.
Attitudes Develop reasonable weight-loss goals.
Avoid "all or none" thinking.
Focus attention away from the scale and toward behavior.
Uncouple weight from self-esteem.
Recover from lapses with constructive action (relapse prevention).
Relationships Understand the key role of social support to health.
Heart-Healthy Diet
Identify supportive others.
Match personal style to support-seeking activities.
Be specific in making support requests.
Be assertive but reinforcing in drawing help from others.
Nutrition Resist the lure of popular fad diets.
Develop pro-health rather than restriction mentality about eating.
Eat with moderation in mind.
Maximize fiber.
Develop a tailored plan.
From Brownell KD. The LEARN Program for Weight Control. 7th ed. Dallas, Tex: American Health Publishing
Company; 1998.
WHERE ELSE CAN INFORMATION ABOUT HEART-HEALTHY DIETS BE
OBTAINED?
National Heart, Lung, and Blood Institute (www.nhlbi.nih.gov). Call (301-251-1222). Provides excellent free
information, including Step by Step, Eating to Lower Your High Blood Cholesterol.
American Dietetic Association (www.eatright.org). Call (800-366-1655). This site offers good, recent information on
nutrition and has an excellent searchable database for dietitians within a particular locality in a desired specialty,
including eating disorders and weight control.
American Heart Association (www.americanheart.org). Call (800-242-8721). This is the primary source of
information about heart problems. They will send free pamphlets and reading material, including useful diet
information and locations of local representatives.
The Ornish Program ( www.ornish.com).
Iowa State University nutrition information (www.extension.iastate.edu/pubs/fo1.htm).
International Food Information Council (ific.org).
Nutrition Analysis Tool (spectre.ag.uiuc.edu/~food-lab/nat).
Good list of fiber-rich foods (www.slrhc.org/healthinfo/dietaryfiber).
International Society for the Study of Fatty Acids and Lipids (www.issfal.org.uk).
For more information on soy, visit (www.soyfoods.com) or call (1-800-TALKSOY).
DASH Diet (www.mckinley.uiuc.edu/health-info/dis-cond/bloodpr/dash-1500.html).
This site offers a useful heart risk evaluation test (www.heartriskevaluations.com/).
This site provides a good list of fiber-rich foods (www.slrhc.org/healthinfo/dietaryfiber).
FIND A HEART SPECIALIST: www.ama-assn.org/aps/amahg.htm.
FIND A DIETICIAN: www.eatright.org.
Review Date: 3/31/2002
Reviewed By: Harvey Simon, MD, Editor-in-Chief, Well-Connected reports; Associate Professor of Medicine,
Harvard Medical School; Physician, Massachusetts General Hospital
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of
any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical
conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not
constitute endorsements of those other sites. Copyright 2003 A.D.A.M., Inc. Any duplication or distribution of the
Heart-Healthy Diet
information contained herein is strictly prohibited.
