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Aapi geeta sikand 6-29-12-final- heart-health-talk-consumers

Aapi geeta sikand 6-29-12-final- heart-health-talk-consumers



Geeta Sikand - Women's Forum

Geeta Sikand - Women's Forum



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  • Sacks, FM et al. Soy proteins, isoflavones, and cardiovascular health: An American Heart Association science advisory for professionals from the nutrition committee. Circulation 2006; 113. Jenkins et al. Curr Opin Lipidol 2000, Weggemans and Trautwein Eur J Clin Nutr 2003, Katan et al . Mayo Clin Proc 2003. A number of dietary factors have been proven to lower total and LDL cholesterol effectively. Amongst different dietary options, adding plant sterols to the diet is a very effective dietary intervention that can reduce LDL cholesterol by around 6-15% if taken in the recommended amount of 2–3 g/day. In comparison to soy protein, plant sterols have more than double the effect in reducing cholesterol levels whereby the daily dose is much lower.
  • To reach the recommended plant sterol intake for cholesterol-lowering of 2 /day, an individual would need to consume an enormous amount of typical foods such as fruits, vegetables or bread. One to two servings of Promise ® SuperShots ® or Promise activ ® Spread provide the recommended 2 grams of plant sterols per day for individuals with elevated cholesterol levels.
  • Safety: considered GRAS. ADI is 130 mg per kg. 110 lb person can have up to 6.5 grams daily

Aapi geeta sikand 6-29-12-final- heart-health-talk-consumers Aapi geeta sikand 6-29-12-final- heart-health-talk-consumers Presentation Transcript

  • Nutrition for Heart Health: Focus on Good & Bad Fats Geeta Sikand: MA, RD, CLS,FNLA,CDEAssociate Clinical Professor of Medicine: Cardiology: UC Irvine Consultant Dietitian June 29, 2012
  • Objectives/Presentation Outline 1) Coronary heart disease risk factors in Asian Indians 2) Evidence based diet & lifestyle recommendations to lower heart disease risk in Asian Indians 3) Good and bad fats within the context of a heart healthy diet
  • South Asia at Health Crossroads World Bank Report: February 2011 Asian-Indians (India, Pakistan, Bangladesh, Sri lanka & Nepal) 3 X more likely to develop diabetes. Diabetes doubles risk of heart disease in men & quadruples risk in women. First heart attack in Asian Indians: six years younger versus rest of the world (53 vs. 59 years)www.worldbank.org/sarncdreport
  • Are Women at Risk for HeartDisease? Heart disease is ALSO the leading cause of death in women in every major developed country e.g. US and also in most emerging economies. The myth that heart disease is only a “man’s disease” has been debunked.
  • Risk Factors forHeart Disease and StrokeWhat are “risk factors” ?Behaviors or conditions that increaseyour chances of developing a disease.Example: Being inactive is arisk factor for heart diseaseand stroke.
  • Metabolic Syndrome Primary Cause of Increased CHD Risk in Asian Indians Higher prevalence of high triglycerides, low HDL-C, glucose intolerance & central obesity. MetS increases risk for heart disease at any LDL level Pre-diabetes or Insulin Resistance Syndrome Enas EA. Brit J of Diabetes and Vascular Dis 2005
  • Metabolic Syndrome: Diagnostic Criteria: 3 or more Central obesity (waist circumference) • Men > 40 inches (Asian Indians 35.4”) • Women > 35 inches (Asian Indians 31.5”) ↑ Triglycerides > 150 ↓ HDL men < 40 women < 50 ↑ Blood Pressure >130/85 Impaired fasting glucose: 100-125 Grundy SM et al Circulation. 2004
  • Goals for Heart Health Control the ABC’s:  A1C  Blood pressure  Cholesterol/lipids Maintain a desirable weight Stop smoking Sikand Geeta 2011 2nd edition. “Preventing Heart Disease in Asian Indians: Diet & Lifestyle Recommendations” in “AAPI’s Guide to Nutrition, Health & Diabetes”
  • Weight Loss Reduces Risk Improves blood cholesterol  Lowers total and LDL cholesterol  Lowers triglycerides  Raises HDL cholesterol Reduces blood pressure Makes your insulin work better (improves effectiveness in the body) Lowers blood glucose
  • AHA 2006 Diet & Lifestyle Recommendations Achieve a healthy weight Decrease total fat, saturated fat and trans fats. Replace with unsaturated fats and oils Increase intake of omega 3 fatty acids Increase intake of plant stanol esters Consume nuts and soy protein Increase intake of viscous fiber Lichtenstein et al Circulation 2006
  • American Heart Association 2020 Dietary Goalsrimaryruits & Vegetables: ≥ 4.5 cups/dayish: ≥ two 3.5 oz. servings/week (preferably oily fish)iber-rich whole grains (≥ 1.1 g of fiber/10 g of CHO: ≥ three 1oz. equivalent servings per day)odium: < 1500 mg/dayecondaryugar-sweetened beverages: ≤ 450 kcal (36 oz.)/week
  • The Portfolio Eating Plan to lower LDL-C• NCEP Guidelines: – Saturated fat < 7% kcal – Cholesterol < 200 mg/day• 1.0 g plant sterols/1000 kcal• 9.8 g viscous fibers/1000 kcal• 21.4 g soy protein/1000 kcal• 14 g whole almonds/1000 kcal• Jenkins DJ, JAMA. 2003
  • Effect of Portfolio Eating Plan on LDLReduction 10 g psyllium (viscous fiber) lowered LDL 6-7% 45 g soy proteins reduced LDL 12.5% 1-2 g plant sterols reduced LDL 13% 10 g almonds lowered LDL-C 1% Similar to the effect of statins Jenkins DJ, JAMA. 2003
  • Lowering Triglyceride Lose weight (belly fat) Increase physical activity Control blood sugar Limit:  Refined carbs/simple sugars  Alcohol  Total fat (if TG very high) Omega 3 fatty acids (fish oils)
  • Look AHEAD Trial: 4 yrs Follow upIntense Lifestyle Intervention versus Control Group • n=5,145 59 yrs (45-74 yrs), BMI 36 (>25) • Diet-lifestyle counseling: RDs  Wt loss −6.15% vs −0.88% (P<.001)  Improved Treadmill fitness (% METS) 12.74% vs 1.96% (P<.001)  A1c level −0.36% vs −0.09% (P<.001) Greater proportion of intervention group met A1c, BP & lipid goals versus control group  Arch Intern Med 2010 lookaheadtrial.org.
  • Is Dietitian Intervention Effective toReduce LDL ? N=74 male veterans, mean age 61 yrs 2-4 dietitian visits (8 weeks) Reduced LDL -13% ( p<0.001) 50% no longer needed lipid lowering meds Saved $904 per pt $1.00 spent on MNT = $4.60 saved in lipid medication costsLDL reduction greater with more dietitian visits 12% vs 22 % (p<0.001) with 2 vs 4 visits Sikand et al. J Am Diet Assoc 1998
  • Is Dietitian Intervention Effective?Systematic Review: Amer Diet Assoc 2 to 6 planned visits with a RD over 6-12 weeks reduced: LDL: 7-22% , TG 11-31%, saturated fat intake 2-4% & energy intake ( 232 – 710 kcal per day) & body weight. Initial Dietitian Visit 45 to 90 min F up Dietitian Visits 30 to 60 min each Grade 1 Strong McCoin, Sikand et al J Am Diet Assoc 2008
  • Metabolic Syndrome Case Study: Meet Raj  Raj-55 yrs; family hx of heart disease  5’8”, 170 lbs, total cholesterol 214 mg/dl Non-HDL-C 179 mg/dl LDL-C 138 mg/dl (<100) HDL-C 35 mg/dl (>40) Triglycerides 205 mg/dl (<150) Fasting glucose 120 mg/dl (< 100) A1c 6.5 (< 5.9) BP 132/95 (120/80) Waist circumference 38” (<35”) BMI 26
  • Raj’s Current Diet & Lifestyle • Software engineer • Inactive: works long hours • High saturated fat intake: High fat dairy products e.g. paneer • High refined carbohydrate consumption – bread, rice, sweets • Alcohol?
  • What are Raj’s Goals? Does he want to see a RD? Lifestyle intervention program? telephone app? What diet changes should Raj consider? Is Raj motivated to lose weight? Weight loss 10 lbs: improve BP, LDL-C, TG, HDL-C, A1c, fasting glucose
  • Recommendations to Lower Raj’s LDL-C: TLC Diet Decrease saturated and trans fats, dietary cholesterol Lose weight Increase  Total Fiber (20-30 grams a day)  Soluble Fiber (~10 grams a day)  Plant stanol/sterol (2 grams a day)  Activity (30 minutes most days/week) Sikand G 2011 “Nutrition, Health & Diabetes” AAPI 2nd edition. Preventing Heart Disease in Asian Indians: Diet & Lifestyle Recommendations
  • Lifestyle Changes for Raj to considerDiet : Keep a food log Exercise Limit/choose lean meat, Keep a physical activity poultry (5 - 6oz. day) log 2 or 3 servings of non-fat or low fat dairy products  Begin a walking program Include fish 2x/week and gradually increase to 35 minutes per day Increase fruits & vegetables  Use a pedometer and set Small serving of nuts a goal to increase 250 Focus on portion control steps/day up to 10,000 steps
  • TLC Diet Options for RajIncrease intake of viscous (soluble) fiber:10-25g per day Sources of soluble fiber include:  Oats  Dried beans  Fruits/vegetables (eg.strawberries, bhindi, baingan)2 tbsp plant sterol/stanol esters Sources include:  Benecol, Promise activReducing sodium and alcohol intake
  • TLC Diet Could Reduce Raj’s LDL by 20-30% (WIIFM) Dietary Dietary LDL chol component change reduction Plant sterols 2–3 g/day 6-15% Saturated fat < 7% calories 5–10% Dietary cholesterol < 200 mg/day 5% Soluble fiber 5–10 g/day 5% Body weight Lose ~10 lb 5% Total estimated 20-30% LDL reductionSacks FM et al. Circulation 2006;113. Jenkins et al, Curr Opin Lipidol 2000; Weggemans and Trautwein, Eur J ClinNutr 2003; Katan et al, May Clin Proc 2003.
  • Food Components to Reduce Fat Saturated fatty acids—less than 10% of calories • Less than 7% reduces risk of CVD further • Replace with poly- and monounsaturated fatty acids (not with sugar or refined grain) Trans fats—as low as possible Cholesterol—less than 300 mg per day • Effect small compared to saturated and trans fats new • Egg yolks—up to 1 per day new
  • Aim for 25 – 35 gm Dietary Fiber per day  Starchy beans/lentils: Aim for ½ cup cooked beans in 3 - 5 meals per week  Oatmeal, oat bran, barley, brown rice, Quinoa  Vegetables and fruits (eat edible skin) Aim for 2 ½ c. veggies and 2 c. fruits a day  Whole grain breads, crackers and cereals with at least 5 gm of Dietary Fiber per serving  Psyllium seeds (Metamucil)
  • Foods Containing Viscous or SolubleFiber: 10 – 25 gm/day Oats Barley Lentils (daals) Legumes (rajma, channa, black eyed beans) Prunes, Apples Rye bread, pumpernickel bread Supplemental fiber: Metamucil® and Citrucel®. (Not all fiber laxatives lower cholesterol)
  • Limit Saturated Fats: “Bad” Fats Raise LDL Solid at room temperature Whole milk & whole milk dairy products: butter, paneer, cheese, cream, ice-cream, whole milk yogurt, desserts made with whole milk e.g. khoa, kulfi, kheer Fatty cuts of lamb, pork, beef, poultry with skin, lard, bacon, sausage, hotdogs Palm oil, palm kernel oil and coconut oils
  • Trans-fats: “Bad” Fats Raise LDL & Lower HDL Processing changes vegetable oils into semi- solid fats e.g. partially hydrogenated fats Re-use of oil in cooking/frying e.g. commercially prepared snacks e.g. samosas, bhajias, chevda, bhel etc French fries, fried chicken, onion rings Stick margarine, shortening, vanaspati Baked goods: cakes, donuts, cookies
  • Monounsaturated Fats : Good Fats Lower LDL May help raise HDL (good) cholesterol. Olive oil, canola oil, peanut oil Avocados Nuts: almonds, peanuts, pecans, pistachios, hazelnuts Is EVOO good for cooking?
  • Omega-6 Polyunsaturated fats: Good Fats Lower LDL Lower LDL (bad) cholesterol when used in place of saturated fat. Corn oil, safflower oil, sunflower oil Sunflower seeds
  • Plant Stanols/Sterols lower LDL-C 10% Adjunct therapy to diet and medication eg. Bennecol spread, Smart balance Heart Right spread, Promise activ spread, fortified in orange juice & in health bars e.g. Kardea bars Naturally found in vegetable oils, nuts, legumes, whole grains, fruits, vegetables; yet in small amounts, making it difficult to get recommended amounts
  • 2 Grams of Plant Sterols 150 small apples 83 oranges 210 medium carrot 425 tomatoes 11 cups of peanuts 70 slices of whole grain bread OR 2 Tbsp Smart Balance® Heart Right Buttery Spread 2 Tbsp Promise activ® Buttery Spread
  • Phytosterols Added to FoodsSupplemented Foods amount calories1 Tbsp Benecol® 0.85 g 50-701 Benecol® smart chew 0.85 g 201 oz Lifetime® LF cheese 0.65 g 30-551 c Minute Maid® Heart Wise OJ 1.0 g 1101.5 slices Oroweat® Whole Grain & Oat Bread 0.4 g 901 c Rice Dream® Heart Wise Rice Milk (original or vanilla) 0.65 g 1401 c Silk Heart Health Vanilla Soymilk 0.65 g 801 Tbsp Smart Balance® Heart Right Buttery Spread 1.7 g 45-801 Tbsp Promise activTM spread 1.0 g 45-70VitaMuffin VitaTopsTM Muffin or VitaTopsTM Brownie 0.4 g 100
  • Omega-3 Fats: Good Fats Lower Risk of Heart Disease & TG Two servings (3.5 oz each) of fatty fish per week are associated with a 30-40% reduced risk of death from heart attack or stroke Lower triglycerides Associated with ↓ sudden death (ACS) Salmon, mackarel, sardines, rainbow trout, herring, halibut & albacore tuna
  • Fish Oil Supplementation Recommendations  3-4 oz fatty fish/day or  1-3 g omega 3 fatty acids per day (for heart health and TG lowering)  FDA: 3 g omega 3 fatty acids a day (with no more than 2 g per day from a dietary supplement) Look for 1g fish oil capsules contain  180 mg of EPA and 120 mg DHA
  • Plant Sources of Omega-3 Fat2-3 gm/day of ALA Decreases Risk Canola oil 1TBS = 0.94 g/serving Ground flax seeds 1 TBS=1.6 g/serving Flaxseed oil 1 TBS=7.3 g/serving English walnuts 1 TBS (7 halves) = 2.6 g/serving Soybean oil 1 TBS =0.94 g/serving Chia seeds (sabza) 1 tsp =1.7 gm/serving
  • Raising HDL (Good) Cholesterol Be physically active Lose weight if overweight Decrease refined carbs Moderate fat intake Increase monounsaturated fats Do not smoke
  • Food Sources Potassium  Vegetables (potatoes, tomatoes, spinach, broccoli, acorn squash, collard & mustard greens)  Fruits (grapefruit, orange, banana, watermelon, strawberries)  Caution for use in those with kidney disease Magnesium  Vegetables (spinach, broccoli, green beans, tomato juice; navy and pinto beans)  Whole grains (100% whole wheat bread, crackers)  Other (tofu, halibut)
  • Decrease Sodium/ IncreasePotassium Limit sodium from ALL foods to 2,300 mg (~1 tsp. salt) per day or 1500 mg/day (at risk, older, HTN) Consume potassium rich foods: low fat milk, milk fruits and vegetables
  • Strategies to Lower Salt Intakeo Become aware of salt content in food eg ketchup, soy sauce, pickles, chutneys. Read labels. Cook with little or no salt. Refrain from adding salt at the table Avoid processed salty foods eg snack mixes bhel, chevda, nuts Use spices & lemon instead of salt Rinse canned foods e.g. beans Use no-salt-added food products – read labels
  • 2010 US Dietary Guidelines:Summary Enjoy your food, but eat less. Reduce calories from solid fats and added sugars (SoFAS) Choose foods high in potassium, dietary fiber, calcium & vitamin D. Make half your plate fruits & vegetables. Maintain a healthy weight. Perform regular physical activity. Switch to fat free or low fat milk (1%). Reduce salt by comparing sodium in foods e.g. soup, bread & frozen meals & choose foods with lower numbers. Drink water instead of sweetened beverages.   www.dietaryguidelines.gov
  • Resources Preventing Heart Disease in Asian Indians: Diet & Lifestyle Recommendations” By Geeta Sikand,MA,RD,CLS,FNLA,CDE,FADA In “Indian Foods; AAPI’s Guide to Nutrition Health & Diabetes” 2011 2nd edition www.aapiusa.org www.aha.org
  • Thank you for your attention gsikand@gmail.com