This document discusses the role of diet in coronary heart disease (CHD). It identifies major modifiable risk factors for CHD like diabetes, obesity, elevated cholesterol, and homocysteinemia that can be influenced by diet. It provides dietary recommendations for individuals with CHD risk factors or existing CHD, focusing on limiting saturated fats, cholesterol and refined carbohydrates while emphasizing plant-based foods, fiber and antioxidants. The document also describes reversal diets for CHD that restrict animal products and emphasize polyunsaturated and monounsaturated fats to potentially reverse the effects of CHD.

1. DIET AND CORONARY HEART
DISEASE
DR.HARIVANSH CHOPRA
PROFESSOR & EX. HOD
COMMUNITY MEDICINE
LLRM MEDICAL
COLLEGE,MEERUT
harichop@gmail.com
8/20/2020 1

2. OBJECTIVES :
• To study the risk factors
of CHD.
• To know about the
effect of various dietary
components on CHD.
8/20/2020 2

3. OBJECTIVES :
• To find out which type
of diet is good in CHD
and in CHD with other
risk factors.
• Lastly, to know how
the effects of CHD
can be reversed.
8/20/2020 3

4. RISK FACTORS OF CORONARY
HEART DISEASE
Risk Factors:
Modifiable Non Modifiable
Major Minor
8/20/2020 4

5. Major Minor
Hypertension
Smoking
Diabetes
Obesity
Elevated Cholesterol
Physical Activity
Mental Stress
Oral Contraceptive
Trace Elements
Homocysteinemia
Modifiable Risk Factors
8/20/2020 5

6. Non Modifiable Risk Factors
Age
Sex
Family History
Genetic Factors
Personality
8/20/2020 6

7. Of these, four factors require
dietary modifications –
Diabetes
Obesity
Elevated Cholesterol
Homocysteinemia
8/20/2020 7

8. DIABETES MELLITUS:
o Symptoms of diabetes + random
blood glucose > 200mg/dl or
o Fasting blood glucose > 126mg/dl
or
o 2 hr plasma glucose > 200mg/dl
during oral glucose tolerance test.
8/20/2020 8

9. HYPERCHOLESTEROLEMIA
Desirable levels of serum cholesterol -
<150mg/dl.
When the levels are more
than 250mg/dl –
hypercholesterolemia.
(desired levels of LDL cholesterol -
<100 mg/dl.).
8/20/2020 9

10. Hypercholesterolemia
Genetic Dietary
8/20/2020 10
Endocrinal

11. Hypercholesterolemia
Genetic Dietary
Non – modifiable by
diet Alone. Need other
methods like yoga,
exercise, meditation,
statins , plasmapheresis
PCSK9 INHIBITORS
Modifiable by
diet
8/20/2020 11
Metabolic

12. OBESITY :
Defined as an abnormal
growth of the adipose
tissue due to an
enlargement of the fat
cell size or an increase in
fat cell number or a
combination of both.
8/20/2020 12

13. According to BMI :
Underweight <18.5
Normal 18.5 – 24.9
Overweight > 25.0
Preobese 25-29.9
Obese class 1 30-34.9
Obese class II 35-39.9
Obese class III > 40.0
8/20/2020 13

14. HOMOCYSTEINEMIA :
Refers to increased total
plasma concentration of
homocysteine in the
sulfhydryl and disulfide
group,free and protein
bound.
8/20/2020 14

15. FAMILY HISTORY :
Defined as the presence of the
health condition under consideration
in one’s siblings or parents or
grand – parents < 60 years old. Usually
genetically determined.
8/20/2020 15

16. ROLE OF DIET IN
HEALTH AND
CORONARY HEART DISEASE
8/20/2020 16

17. Lets see how much energy is required for
various activities !
Sleep 0.6 cal/min.
Reading 1.4 cal/min.
Eating 1.8 cal/min.
Converse 1.8 cal/min.
Writing 1.9 cal/min.
Standing 2.2 cal/min.
Casual walking 4-5 cal/min.
Running 10-12 cal/min.8/20/2020 17

18. • This energy requirement for the
different activities a person does
in a day can be provided by a
balanced diet in a normal
healthy individual.
8/20/2020 18

19. BALANCED DIET :
This is the
recommended diet
in a normal
healthy individual
without any risk
factors for
Coronary heart
disease.8/20/2020 19

20. WHAT IS IT ?
15%-20% Proteins
20%-30% Fats
Rest Carbohydrates .
8/20/2020 20

21. Dietary modifications
in CHD are required
because of the
following reasons !
8/20/2020 21

22. •The Seven Countries Study
showed a strong positive relation
between saturated fat intake
and the 10 year incidence of
CHD.
8/20/2020 22

23. •Body weight changes
are strongly related to
changes in serum total
cholesterol and blood pressure.
8/20/2020 23

24. •Population subgroups
consuming diets rich in
plant foods have lower
CHD rates than
the general population.
8/20/2020 24

25. •Diet therapy should be
the first step in the
treatment of
Hypercholesterolemia.
8/20/2020 25

26. Lets Take the Various
Components of Diet
One by One !
8/20/2020 26

27. MILK :
Whole milk has
a cholesterol
lowering effect.
Thus , a cup or
two is permitted.
8/20/2020 27

28. EGG :
White of egg has
no fat and thus does
not raise cholesterol.
So, one or two eggs
per day are safe.
8/20/2020 28

29. NUTS :
28g of walnut with
each of the three
meals without
increasing total
dietary fat
improves serum
lipid profile.
8/20/2020 29

30. MEAT :
•No significant
change in plasma
cholesterol when
diet self selected
for beef , pork,
poultry or fish.
8/20/2020 30

31. •But some studies reveal
increased plasma total cholesterol
and systolic blood pressure
with meat.
8/20/2020 31

32. •SAAOL Diet prohibits
the intake of meat
in any form.
8/20/2020 32

33. SOYABEAN :
In typeII
hypercholesterolemic
patients already on a
low lipid, low cholesterol
diet, substitution of
animal protein by
soyabean reduced
cholesterol.
8/20/2020 33

34. GARLIC AND ONIONS :
•Good effect noted with
high doses.
•Lower blood pressure,
prevent coronary
thrombosis, heart
attacks and strokes.
8/20/2020 34

35. OTHER VEGETABLES:
•Capsicum increases
fibrinolytic activity in
blood – reduced
chances of thrombo
embolism.
•Sour foods precipitate
anginal attacks.
8/20/2020 35

36. FIBRES :
Two types – soluble & insoluble.
•Filling with fewer calories.
•Add roughage to the diet.
•Aid digestion and elimination.
8/20/2020 36

37. Soluble fibers in addition-
•Lower total blood cholesterol.
•Lower LDL cholesterol.
•Regulate blood sugar.
•Favorable effect on blood
pressure.
8/20/2020 37

38. SOURCES OF SOLUBLE FIBERS :
•Oat bran
•Rolled oats
•Broccoli
•Brussels sprouts
•Grapefruit
•Apples .
8/20/2020 38

39. Plant foods :
Beneficial factors
include –
•relative energy content
•fiber content
•unsaturated fatty acids
•anti oxidant properties.
8/20/2020 39

40. BEVERAGES :
More intake of coffee leads
to –
•Raised serum cholesterol
•Irregular heart beats
Consumers of real boiled
coffee face higher risk.
8/20/2020 40

41. ALCOHOL :(controversial role)
Increases HDL cholesterol (HDL3
but not HDL2) in marathon
runners and inactive men but not
in men who run and jog.
8/20/2020 41

42. Daily consumption of one
or two pegs of whisky
or 1-2 glasses of beer
not harmful but beneficial
to heart patients. ????
8/20/2020 42

43. WATER :
•CVS mortality 10% higher
in areas with very soft water
as compared to medium
hard water.
8/20/2020 43

44. •In areas where water supply
changed in the last 30 years
favorable effect seen when
water became harder and
unfavorable when it became
softer.
8/20/2020 44

45. MINERALS :
•Silicon deficiency – atherosclerosis
•Cadmium – toxic to heart
•Low Selenium associated with CHD
8/20/2020 45

46. ROLE OF FREE RADICALS:
•By-product of oxidation.
•Damage cell membranes, disturb
chromosomes and genetic material
and destroy valuable enzymes.
8/20/2020 46

47. • Cause 50% of CHD, lung diseases
certain cancers, cataracts, rheumatoid
arthritis, Parkinson’s disease etc.
• 2 ways to reduce them –
1. Less consumption
2. Anti-oxidants.
8/20/2020 47

48. Anti-oxidants
8/20/2020 48
sulphur compounds – leeks, onions and garlic
anthocyanins – eggplant, grapes and berries
beta-carotene – pumpkin, mangoes, apricots, carrots,
spinach and parsley
catechins – red wine and tea

49. Anti-oxidants
8/20/2020 49
copper – seafood, lean meat, milk and nuts
cryptoxanthins – red capsicum, pumpkin and
mangoes
flavonoids – tea, green tea, citrus fruits, red wine,
onion and apples
indoles – cruciferous vegetables such as broccoli,
cabbage and cauliflower

50. Anti-oxidants
8/20/2020 50
isoflavonoids – soybeans, tofu, lentils, peas and
milk
lignans – sesame seeds, bran, whole grains and
vegetables
lutein – green, leafy vegetables like spinach, and
corn
lycopene – tomatoes, pink grapefruit and
watermelon

51. Anti-oxidants
8/20/2020 51
manganese – seafood, lean meat, milk and
nuts
polyphenols – thyme and oregano
selenium – seafood, offal, lean meat and
whole grains
vitamin A – liver, sweet potatoes, carrots,
milk, and egg yolks

52. Anti-oxidants
8/20/2020 52
vitamin C – oranges, blackcurrants, kiwifruit, mangoes,
broccoli, spinach, capsicum and strawberries
vitamin E – vegetable oils (such as wheatgerm oil),
avocados, nuts, seeds and whole grains
zinc – seafood, lean meat, milk and nuts
zoochemicals – red meat, offal and fish.

53. So, diets suggested when one
or more risk factors present
but no history of CHD are -
8/20/2020 53

54. Presence of Hypertension or Family History:
Fats 20-30%
Saturated fats <10%
Dietary cholesterol <300mg/1000kcal/day
Increased consumption of complex carbohydrates
Salt intake <5g/day.
8/20/2020 54

55. Presence of Hypercholesterolemia
• A two step diet is suggested.
• The goal is to reduce the total
cholesterol to less than 150mg%
and LDL cholesterol to less than
100mg%.
8/20/2020 55

56. • If after a trial period of 2-
6 months, the Step I diet
fails to lower the
cholesterol then one
should switch to the Step
II diet.
8/20/2020 56

57. Two step dietary therapy –
Step one –
Fats <30%
Saturated fats <10%
Dietary cholesterol <300mg/day.
PUFA up to 10%
MUFA 10-15%
8/20/2020 57

58. Carbohydrates 50-60%
Proteins 10-20%
Total Calories - to achieve
and maintain
desirable weight
8/20/2020 58

59. Step Two -
Fats <30%
Saturated fats <7%
PUFA upto 10%
MUFA 10-15%
Dietary cholesterol <200mg/day.
8/20/2020 59

60. Carbohydrates 50-60%
Proteins 10-20%
Total Calories to achieve
and maintain
desirable weight
8/20/2020 60

61. OBESITY:
•Proportion of energy
dense food should be
reduced,
•Fiber content to be
increased,
8/20/2020 61

62. Obesity
•Adequate levels
of essential
nutrients in the
low energy diets
•Food energy
intake should not
be greater than
energy expenditure.
8/20/2020 62

63. DIABETES MELLITUS :
Proteins 10-20%
Saturated fat <10%
PUFA <10%
Carbohydrates rest calories
+ MUFA
Fiber 20-35g/day
Sodium < 3g/day
Cholesterol intake <300mg/day8/20/2020 63

64. HOMOCYSTEINEMIA :
•Diet rich in folate
or
•Consumption of
multivitamin
supplements
recommended.
8/20/2020 64

65. DIET IN
CHD PATIENTS
8/20/2020 65

66. SAAOL DIET:
65%-70%
carbohydrates
20%-25% proteins
10% fats (invisible)
No visible fats.
8/20/2020 66

67. FOOD ITEMS TO BE AVOIDED
Milk (full cream)
and Milk products.
Skimmed milk
beyond 200ml/day.
Cheese and Butter.
8/20/2020 67

68. Butter milk (Lassi)
beyond 200 ml of milk.
All kinds of non-
vegetarian items.
Nuts and Dry Fruits.
Sweets and all types
of oil.
8/20/2020 68

69. FOOD ITEMS MODERATELY
RESTRICTED
Brown bread and
white bread.
Rice.
Vermicelli.
Bajra, Jowar,
Maize, Wheat
8/20/2020 69

70. Peas.
Potato, Sweet potato,
Arbi.
Jaggery, Sugar.
Banana, Mango.
Cold drinks.
8/20/2020 70

71. FOOD ITEMS WHICH CAN BE
CONSUMED FREELY
Cereals – puffed rice,
chiwra.
Pulses – chana, moong,
urad, soyabean,etc.
Leafy vegetables.
8/20/2020 71

72. Roots and Tubers – carrot,
onion, white radish, garlic, ginger.
Other Vegetables – beans,
brinjal, cucumber, pumpkin, lady
finger, tomato, capsicum, kakri,
mushrooms.
8/20/2020 72

73. Fruits – apple,
guava,
orange,
watermelon,
papaya, pineapple,
ripe tomato, lemon.
8/20/2020 73

74. Now lets see the type of
diet to be taken in CHD
patients with one or
more risk factors.
8/20/2020 74

75. Reversal diet :
•10% fat (mostly
polyunsaturated or
monounsaturated).
•70-75%
carbohydrates.
•15-20% proteins.
8/20/2020 75

76. •5 mg cholesterol / day.
•Allows but does not
encourage moderate
alcohol consumption.
8/20/2020 76

77. •Excludes all oils and
animal products
except non fat milk
and yogurt.
•Allows egg white.
8/20/2020 77

78. •Excludes caffeine
and other stimulants.
•Allows moderate use
of salt and sugar.
8/20/2020 78

79. CONCLUSION :
Modification of diet goes a
long way in prevention of
CHD especially in those
people having multiple risk
factors.
8/20/2020 79

80. Dietary management
will further decrease
those risk factors and
the occurrence of
CHD.
8/20/2020 80

81. In persons already suffering
from CHD, right kind of
dietary management will
By pass the need for
interventions and bypass
surgery.
8/20/2020 81

82. 82
Avoid alcohol
Be physically active
Cut down on salt and sugar
Don’t use tobacco products
Eat plenty of fruits and vegetables
Being healthy is as easy as ABCDE