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Can your diet save your life?

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Can your diet save your life?

  1. 1. Presented by: Margie Latrella, Cardiac APN and Carolyn Strimike, Cardiac APN Heartstrong, LLC
  2. 2. •Increased Age (Menopause) •Heredity •Overweight/Obesity •Physical Inactivity •Smoking •Emotional Stress •Gum Disease •Inflammation •Sleep Apnea •High Blood Pressure (Pregnancy Induced) •High Cholesterol (HDL, Triglycerides) •Diabetes/Metabolic Syndrome •Depression (Broken Heart Syndrome) •Thyroid disease
  3. 3.  Total CholesterolTotal Cholesterol < 200< 200  LDLLDL (Bad “Lousy” Cholesterol) < 100(Bad “Lousy” Cholesterol) < 100  HDLHDL (Good “Healthy” Cholesterol)(Good “Healthy” Cholesterol) > 60 in women> 60 in women >50 in men>50 in men  TriglyceridesTriglycerides < 150< 150
  4. 4. SystolicSystolic DiastolicDiastolic NORMALNORMAL < 120< 120 < 80< 80 HIGH NORMALHIGH NORMAL 120-139120-139 81-8981-89 HYPERTENSIONHYPERTENSION >> 140140 >> 9090
  5. 5. NCEP-ATP III definitionNCEP-ATP III definition:: Waist circumference >35” inWaist circumference >35” in women, >40” in menwomen, >40” in men  HDL <50 mg/dl in women,HDL <50 mg/dl in women, <40 mg/dl in men<40 mg/dl in men  TriglyceridesTriglycerides >>150 mg/dl150 mg/dl Glucose > 100Glucose > 100 Blood pressureBlood pressure >>130/85 mmHg130/85 mmHg
  6. 6. Atkin’s Diet (Low Carb)  Eat Protein, Fats (all fats)Eat Protein, Fats (all fats)  Causes Ketosis – burns fatCauses Ketosis – burns fat  Promotes Weight LossPromotes Weight Loss, Lowers TG, Improves, Lowers TG, Improves HDL, Lowers BP (No effect LDL)HDL, Lowers BP (No effect LDL)  ? Questionable Long Term Effects/Safety ?? Questionable Long Term Effects/Safety ?  Increases Urinary Excretion Calcium =Increases Urinary Excretion Calcium = Increased RiskIncreased Risk Osteoporosis, Kidney StonesOsteoporosis, Kidney Stones
  7. 7. Single Fatty Meal Stresses the Heart Sausage McMuffin Hash Browns (42 Grams Fat) OR Cereal, Skim Milk Yogurt Orange Juice (1 Gram Fat) 2 Hours Later – Blood Pressure Higher After High Fat Meal Journal of Nutrition (137) 2007
  8. 8.  3 Hours Later – arteries unable dilate3 Hours Later – arteries unable dilate  6 Hours Later – anti-inflammatory6 Hours Later – anti-inflammatory properties HDL diminishedproperties HDL diminished “Effects of ONE Saturated Fat Meal”
  9. 9. South Beach Diet (Low Carb)  Allows “good” carbs, Low Glycemic Index,Allows “good” carbs, Low Glycemic Index, “good” fats“good” fats  Fruits, Vegetables, Whole Grains, LeanFruits, Vegetables, Whole Grains, Lean ProteinProtein  Decreased Metabolic SyndromeDecreased Metabolic Syndrome Hayes, J of Nutrition 2007
  10. 10. Ornish Diet (Vegetarian, EXTREMELY Low Fat, High Fiber)  No Meat/Fish/NutsNo Meat/Fish/Nuts  Promotes Complex Carbohydrates (70%)Promotes Complex Carbohydrates (70%)  Regular Exercise/Stress ManagementRegular Exercise/Stress Management  ? Reverses Heart Disease – Plaque Regression ?? Reverses Heart Disease – Plaque Regression ? Decreases AnginaDecreases Angina  Decreases LDLDecreases LDL, Small amount weight loss, Small amount weight loss
  11. 11. Mediterranean Diet (Low Fat)  Small portions “high quality food”Small portions “high quality food”  Fruits/VegetablesFruits/Vegetables (7-10/day),(7-10/day), Olive oil, Nuts,Olive oil, Nuts, Red wine, FishRed wine, Fish  Exercise (Lifestyle)Exercise (Lifestyle)  Decreases LDL, BP, Blood Sugar, WeightDecreases LDL, BP, Blood Sugar, Weight  Prevents re-current CV eventsPrevents re-current CV events
  12. 12. Mediterranean Diet  PREDIMED StudyPREDIMED Study (ongoing)(ongoing)  Lowers LDL better than “routine” lowLowers LDL better than “routine” low fat diet – Adds “good” fats (olive oil,fat diet – Adds “good” fats (olive oil, nuts)nuts)  LYON Heart StudyLYON Heart Study  Secondary preventionSecondary prevention  Decreased CV events 50-70%Decreased CV events 50-70% JAMA 2004 Circ (103) 2001
  13. 13. DASH Diet (Low Fat, Low Salt)  Fruits/Vegetables, Whole grain, Fish, Poultry,Fruits/Vegetables, Whole grain, Fish, Poultry, NutsNuts  Lowers BPLowers BP, Weight Loss, Decreases LDL, Weight Loss, Decreases LDL  Lower Risk CVA/MILower Risk CVA/MI (Women)(Women) Arch Intern Med (168) 2008
  14. 14. Dr Oz’s Diet  High Fiber, Small Frequent MealsHigh Fiber, Small Frequent Meals  Low Fat, Fruits/VegetablesLow Fat, Fruits/Vegetables  Exercise, LifestyleExercise, Lifestyle  Weight LossWeight Loss, Slim Waist, Slim Waist  Claims: Decrease RiskClaims: Decrease Risk Heart Disease, Diabetes ?Heart Disease, Diabetes ? Best Life Diet
  15. 15. AHA Dietary Guidelines  Low FatLow Fat  Fruits/Vegetables (4 to 9/day)Fruits/Vegetables (4 to 9/day)  Whole Grains (6 to 8/day)Whole Grains (6 to 8/day)  Fish, Poultry, Lean Meats (< 6 oz/day)Fish, Poultry, Lean Meats (< 6 oz/day)  Legumes, NutsLegumes, Nuts  Limit added salt/sugarLimit added salt/sugar
  16. 16. Lose Belly Fat with Whole Grains  Whole GrainsWhole Grains (Oatmeal, Whole wheat pasta,(Oatmeal, Whole wheat pasta, Granola)Granola)  Weight Loss (Abdominal Fat)Weight Loss (Abdominal Fat)  Decreases CRPDecreases CRP  Stabilizes Blood SugarStabilizes Blood Sugar  Decreases Risk CVADecreases Risk CVA ““Everyone Needs at least 3 servings ofEveryone Needs at least 3 servings of Whole Grains Every Day”Whole Grains Every Day” www.wholegrainscouncil.orgJAMA (284) 2000
  17. 17.  Soluble Fiber (psyllium, beans, legumes, fruits,Soluble Fiber (psyllium, beans, legumes, fruits, oats)oats)  Lowers cholesterol, Controls blood sugarLowers cholesterol, Controls blood sugar  Psyllium (5 Gm TID) + Simvastatin 10 mg = Simvastatin 20Psyllium (5 Gm TID) + Simvastatin 10 mg = Simvastatin 20 mgmg  Reduces risk CV disease, DiabetesReduces risk CV disease, Diabetes  Decrease inflammation (CRP)Decrease inflammation (CRP)  Weight managementWeight management  Women 25 to 30 grams/dayWomen 25 to 30 grams/day  Men 30 to 35 grams/dayMen 30 to 35 grams/day Circulation (95) 1997
  18. 18. “More Americans Die By the Fork than any Other Weapon.”
  19. 19. www.nhlbi.nih.gov
  20. 20. Calorie Difference: 525 calories 1,025 calories 20 Years Ago Today 500 calories SPAGHETTI AND MEATBALLS www.nhlbi.nih.gov
  21. 21. *Based on 130-pound person If you do aerobic dance for 1 hour and 20 minutes you will burn approximately 525 calories.* Calories In = Calories Out www.nhlbi.nih.gov
  22. 22. Chocolate chip cookie 220 calories! 20 Years Ago Today 55 calories 275 calories www.nhlbi.nih.gov
  23. 23. *Based on 160-pound person If you ride a bike for 50 minutes you will burn approximately 220 calories.* Calories In = Calories Out www.nhlbi.nih.gov
  24. 24. COFFEE 20 Years Ago Coffee (with whole milk and sugar) Today Mocha Coffee (with steamed whole milk and mocha syrup) 45 calories 8 ounces 350 calories 16 ounces Calorie Difference: 305 calories www.nhlbi.nih.gov
  25. 25. If you walk 1 hour and 20 minutes, you will burn approximately 305 calories.* *Based on 130-pound person Calories In = Calories Out www.nhlbi.nih.gov
  26. 26. ¼ of Plate Grains, Starches ¼ of Plate Beans, Meat, Poultry or Fish ½ of Plate Fruits and Vegetables
  27. 27. “Salt is NOT a Food”  No Vitamins/NutrientsNo Vitamins/Nutrients Most Americans consume more salt than they need
  28. 28. Sources of Dietary Sodium (Salt) Food Processing At the Table During Cooking Inherent Food Processing 77% 6% 5% 12%
  29. 29. Adding Potassium to Your Diet can Help Lower BP Daily recommended amount PotassiumDaily recommended amount Potassium 4,700 mg/day4,700 mg/day
  30. 30. WHO Recommendations on Sugar Intake Added free sugars include:Added free sugars include:  Table, refined, processed,Table, refined, processed, added sucroseadded sucrose  Corn sugar(glucose), cornCorn sugar(glucose), corn syrup (high fructose)syrup (high fructose)  HoneyHoney  SyrupsSyrups  Sugars added to fruit juicesSugars added to fruit juices Added free sugars doAdded free sugars do NOT include:NOT include:  Fresh fruit sugars-Fresh fruit sugars- natural fructose andnatural fructose and sucrosesucrose  Milk – lactoseMilk – lactose  VegetablesVegetables Limit “added free sugars” to 48 grams or 12 tsp. per day One 12 ounce soda averages 12 teaspoons of sugar!!!
  31. 31. WHITE TEA GREEN TEA BLACK TEA (Not Supplements) Polyphenols (Antioxidant)
  32. 32. Black Tea  Decreases LDL /TriglyceridesDecreases LDL /Triglycerides  Improves endothelial functionImproves endothelial function  VasodilationVasodilation  Lowers blood pressureLowers blood pressure  Decreases risk MI/CVADecreases risk MI/CVA (1 - 3 cups/day)(1 - 3 cups/day)  Helps regulate blood sugarHelps regulate blood sugar
  33. 33. Green Tea (3 to 5 cups/day) (More Antioxidants)  Lowers Total Cholesterol/LDL/TGLowers Total Cholesterol/LDL/TG  Improves HDLImproves HDL  Lowers Blood PressureLowers Blood Pressure  Anti-inflammatoryAnti-inflammatory  Reverses Endothelial DysfunctionReverses Endothelial Dysfunction  Decreases Risk MI/CVADecreases Risk MI/CVA  Decreases MortalityDecreases Mortality  Reduces Blood Sugar LevelsReduces Blood Sugar Levels  Very Low Caffeine ConcentrationVery Low Caffeine ConcentrationInt J Card (108) 2006 J Nutr Bichem (18) 2007 JAMA (296) 2006
  34. 34.  Caffeinated CoffeeCaffeinated Coffee::  1 to 3 cups decrease CV risk1 to 3 cups decrease CV risk ( in women)( in women)  S/P MI – no increased risk with espressoS/P MI – no increased risk with espresso (GISSI(GISSI – Prev Study)– Prev Study)  Increased risk HTNIncreased risk HTN  Decreased FMD/Endothelial functionDecreased FMD/Endothelial function  Decaffeinated CoffeeDecaffeinated Coffee::  Increases cholesterolIncreases cholesterol (ApoB)(ApoB)  Overweight – Increased HDLOverweight – Increased HDL Am J Clin Nut (83) 2006 Am J Clin Nut (86) 2007 Circ (107) 2007 AHA 2005 Scient Session 2005 (abstract 3852)
  35. 35.  Increases HDL, Lowers BPIncreases HDL, Lowers BP  Decreases blood clotsDecreases blood clots  Reduce risk CVA, MI, DiabetesReduce risk CVA, MI, Diabetes  Decrease mortality after MIDecrease mortality after MI  Women – one drink/dayWomen – one drink/day  Men – two drinks/dayMen – two drinks/day If You Don’t Drink, Don’t Start Adverse Effects: HTN, Alcoholic Cardiomyopathy
  36. 36. “Take 2 Hershey Kisses or BonBons to Lower Your Blood Pressure ??”
  37. 37.  Potent Antioxidant/Plant Phenols/FlavonoidsPotent Antioxidant/Plant Phenols/Flavonoids  Decreases Arterial Stiffness/Dilates VesselsDecreases Arterial Stiffness/Dilates Vessels  Lowers Blood Pressure (2 to 5 mmHg)Lowers Blood Pressure (2 to 5 mmHg) Similar BPSimilar BP med effectmed effect  Inhibits Platelet ActivationInhibits Platelet Activation  ““Hold the Milk” – Benefits lost ifHold the Milk” – Benefits lost if drink milk with chocolate ??drink milk with chocolate ?? Arch Intern Med (167) 2007
  38. 38. Lowers Total Cholesterol, LDL, Triglycerides Lowers Blood Pressure Prevents Platelet Aggregation
  39. 39.  Garlic Dose ???Garlic Dose ???  1 to 2 cloves raw garlic1 to 2 cloves raw garlic (chopped, wait 15 minutes then use, do(chopped, wait 15 minutes then use, do not cook at high temperatures)not cook at high temperatures)  300 mg freeze dried powder 2 – 3 x’s/day,300 mg freeze dried powder 2 – 3 x’s/day, must be enteric coated avoid breakdown inmust be enteric coated avoid breakdown in stomachstomach  7.2 grams aged extract7.2 grams aged extract  Side effects – bad breath, body odor, GI upset,Side effects – bad breath, body odor, GI upset, antiplatelet effect (D/C high doses beforeantiplatelet effect (D/C high doses before surgery – increases bleeding risk)surgery – increases bleeding risk)
  40. 40. Garlic Trials = Inconsistent Results  May haveMay have short-termshort-term effect on loweringeffect on lowering cholesterol ???cholesterol ???  May lower BP 3 to 5% ???May lower BP 3 to 5% ???  Mild antiplatelet effectMild antiplatelet effect Arch Intern Med. 2007;167:346-353 Amer Fam Physician. July 1, 2005 Journ Agric & Food Chemistry June 2006
  41. 41. (Contains Tilapia, Sardines, Anchovies)
  42. 42.  Decreases Risk SCD/MIDecreases Risk SCD/MI (re-infarction)(re-infarction)  Decreases TriglyceridesDecreases Triglycerides (20-40%)(20-40%)  Decreases Growth AtheroscleroticDecreases Growth Atherosclerotic Plaque (Decreases Inflammation)Plaque (Decreases Inflammation)  Lowers Blood PressureLowers Blood Pressure (2-5 mmHg)(2-5 mmHg)  Prevents Platelet AggregationPrevents Platelet Aggregation  Decreases Stroke RiskDecreases Stroke Risk AHA Scientific Statement, Circulation 2002
  43. 43.  AHA recommendsAHA recommends eatingeating omega 3 fattyomega 3 fatty acids from fish and plant sourcesacids from fish and plant sources NOT FRIED
  44. 44. DART Trial (Diet & Reinfarction Trial)  Secondary Prevention TrialSecondary Prevention Trial  People ate 2 servings fatty fish/weekPeople ate 2 servings fatty fish/week  Decreased 2 year totalDecreased 2 year total && CV mortality 30%CV mortality 30% BMJ 1998
  45. 45.  1 ounce nuts 5 X’s/week decreases risk CV1 ounce nuts 5 X’s/week decreases risk CV disease 25-39%disease 25-39%  Lower LDL cholesterolLower LDL cholesterol  Omega 3 fatty acidsOmega 3 fatty acids (Protect against arrhythmias)(Protect against arrhythmias)  Precursor nitric acidPrecursor nitric acid (vasodilator)(vasodilator)  High in fiberHigh in fiber  Handful = 150 caloriesHandful = 150 calories Am J Clin Nutrition (70)1999 Nutr Metab CV Dis (11) 2001
  46. 46. Omega 3 Intake Recommendations:  No CHDNo CHD:: Fish twice/week and oils/foodsFish twice/week and oils/foods rich alpha-linolenic acidrich alpha-linolenic acid (flaxseed, walnuts)(flaxseed, walnuts)  Patients with CHDPatients with CHD:: 1 Gm EPA+DHA1 Gm EPA+DHA per dayper day (preferably from fish: 2- 4 ounces salmon, 4-(preferably from fish: 2- 4 ounces salmon, 4- 12 ounces canned tuna, 7 ounces flounder/sole)12 ounces canned tuna, 7 ounces flounder/sole)  Patients with High TriglyceridesPatients with High Triglycerides:: 2 to 42 to 4 Gm EPA+DHA per dayGm EPA+DHA per day (High Doses May Cause(High Doses May Cause Bleeding)Bleeding) AHA Scientific Statement, Circulation 2002
  47. 47.  High Fiber ContentHigh Fiber Content (2 tablespoons 4.5 Gm Fiber, 3 Gm Omega(2 tablespoons 4.5 Gm Fiber, 3 Gm Omega 3)3)  Ligans (phytoestrogen)Ligans (phytoestrogen) (Menopausal symtpoms)(Menopausal symtpoms)  Omega 3 fatty acidsOmega 3 fatty acids
  48. 48.  Lowers CholesterolLowers Cholesterol  9% drop Total Cholesterol, 18% drop LDL (Seeds NOT Oil)9% drop Total Cholesterol, 18% drop LDL (Seeds NOT Oil)  Reduces Platelet AggregationReduces Platelet Aggregation  Reduces Inflammatory MarkersReduces Inflammatory Markers  Improves Glucose ToleranceImproves Glucose Tolerance J Clin Endo & Metab, 90 2005
  49. 49. Acts like HMG-CoA (Statin - Lovastatin), Contains Sterols/Isoflavones • Reduces Total Cholesterol 15-20%, LDL 20-30%, Triglycerides 20-30%, Increases HDL 15 to 20% •Dose 600 mg BID = 10mg HMG-CoA reductase inhibitor daily •Contraindications – same as Statins, DO NOT TAKE WITH STATIN, •Can cause myopathies
  50. 50. (2 Grams/Day Lower LDL 9 to 20%) Competes with Cholesterol for Absorption in Intestines
  51. 51.  Vitamin E, C, Beta CaroteneVitamin E, C, Beta Carotene  Negative Primary Prevention StudiesNegative Primary Prevention Studies:: ATBC, Health Professionals F/U Study, NursesATBC, Health Professionals F/U Study, Nurses Health Study, Iowa Women’s Health Study,Health Study, Iowa Women’s Health Study, PPP, CARET, HPSPPP, CARET, HPS  Negative Secondary Prevention StudiesNegative Secondary Prevention Studies:: HOPE, GISSI-Prevension Trial, VEAPS,HOPE, GISSI-Prevension Trial, VEAPS, WACS, WAVE, HATSWACS, WAVE, HATS (?May Increase Mortality?)(?May Increase Mortality?) JAMA. 2005;293:1338- 1347 JAMA 2007; 297:842-857 JACC 2005;46(1):184
  52. 52. “Get antioxidants from food, not supplements” At this time, there is little reason to adviseAt this time, there is little reason to advise that individuals take antioxidantthat individuals take antioxidant supplements to reduce their risk ofsupplements to reduce their risk of cardiovascular disease.cardiovascular disease. AHA Scientific Advisory 08/02/2004
  53. 53. So far,So far, no study has shown that folic acidno study has shown that folic acid supplements reduce the risk of CADsupplements reduce the risk of CAD or that takingor that taking these vitamins affects the development orthese vitamins affects the development or recurrence of cardiovascular disease.recurrence of cardiovascular disease. Food SourcesFood Sources:: Fortified cereals, Dark Leafy Green VegetablesFortified cereals, Dark Leafy Green Vegetables
  54. 54.  Lowers Homocysteine Levels But May NotLowers Homocysteine Levels But May Not Decrease Risk CV Disease ??Decrease Risk CV Disease ?? HOPE – 2 Trial Shows NO HOPE for High Dose B Complex Vitamins in Decreasing Heart Disease Risk •Over 5,000 High Risk Patients •No Benefit NORVIT Trial Demonstrated Possible Harm •Over 3,700 Post MI Patients •Decreased Homocysteine Levels BUT Increased Adverse CV Events N Engl J Med 2006
  55. 55.  Framingham Heart StudyFramingham Heart Study  62% Higher Risk Heart Disease events62% Higher Risk Heart Disease events (especially in people with HTN)(especially in people with HTN)  Recommended Daily DoseRecommended Daily Dose 800 and 1,000 IU of800 and 1,000 IU of Vitamin D3 (cholecalciferol)Vitamin D3 (cholecalciferol)  AHA recommends getting Vitamin D from foodAHA recommends getting Vitamin D from food sources (milk, salmon, mackerel, sardines, fortifiedsources (milk, salmon, mackerel, sardines, fortified cereals)cereals) Science Daily March 2008 Am J HTN (20) 2007
  56. 56. (Generates ATP, Free Radical Scavenger) • Produced naturally in body ubiquinone • Food Sources: Organ Meats, Beef, Sardines, Mackerel, Nuts
  57. 57.  Improves QOL, Decreases Heart FailureImproves QOL, Decreases Heart Failure HospitalizationsHospitalizations (CHF patients may have lower(CHF patients may have lower CoQ10 levels?)CoQ10 levels?)  Improves myopathic pain in StatinImproves myopathic pain in Statin Treated PatientsTreated Patients (Statins may decrease CoQ10(Statins may decrease CoQ10 production?)production?)
  58. 58.  Take supplements with fatty meal (toTake supplements with fatty meal (to improve absorption)improve absorption)  Recommended dose 50 to 200 mg/dayRecommended dose 50 to 200 mg/day  Possible interaction with CoumadinPossible interaction with Coumadin
  59. 59.  Improves CholesterolImproves Cholesterol  Lowers T.C. (9%) LDL (3%)Lowers T.C. (9%) LDL (3%) Triglycerides (10%)Triglycerides (10%)  Increases HDL (2.5%)Increases HDL (2.5%)  INCONCLUSIVE STUDIESINCONCLUSIVE STUDIES Circulation Feb 2006
  60. 60. Eating foods that contain soy protein instead of food high in animal fats may be beneficial ??
  61. 61. Medication & Herbal/Supplement Interactions
  62. 62. “Healthy living is the most powerful medicine of all. It requires no prescription, and all of the side effects are beneficial.” Dr Katz, director Prev. Research Ctr, Yale
  63. 63. Heart Health Blog http://heartstrong.wordpress.com/ www.heart-strong.com

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