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Wellness and Nutrition

One of our physicians recently attended a national cardiology symposium at which a very well known researcher was speaking about the latest findings on the molecular basis for coronary artery disease. His work was really incredible. Elegant research costing millions of dollars to try to discover what goes on in your coronary arteries on a cellular and subcellular level to cause cholesterol and fats to build up in the arterial wall was presented. At the end of his fascinating lecture he said, "If everyone would eat a low fat diet none of this would be necessary". The point of the story is this. No matter how much fancy technology we throw at coronary artery disease, we cannot do as much to prevent it as you can by eating a healthy diet and getting moderate exercise and not smoking. We see hundreds of patients every year who get their coronary artery bypass surgery and think that they now have set the clock back fifty years and they can eat their cheeseburgers and smoke their cigarettes and stay healthy. It doesn’t work that way. The average time it takes for a bypass graft (vein graft) to clog up is about 7 years. This can be much longer, but only if the patient leads a heart healthy lifestyle. Nutrition is a very important part of that lifestyle.

The point is that by simply substituting healthy choices for unhealthy ones you can do a lot to lower your fat intake and lead a longer healthier life while cutting your risk for heart attacks, strokes and many types of cancer. The fact is that we all have coronary artery disease beginning in our teenage years. Examination of young men and women in their teens and twenties who have died from accidents or during wars has shown that early coronary disease is present from a very young age. So even if you have not had symptomatic heart disease, a healthy heart diet still makes sense. This diet is especially important if you have advanced coronary disease and have had a heart attack, angina, or required medicine or a procedure to open up a clogged artery.

What if your blood cholesterol is already within the recommended guidelines? No matter how low it may be, lowering it more will improve your chances of slowing the progression of coronary disease. If in doubt, consult your physician. The short version of nutritional advice for the promotion of health is --- "Low fat, high fiber." The fact is that a low fat diet will reduce your risk of coronary artery disease, heart attack, stroke, peripheral vascular disease, cancer, and possibly a variety of degenerative diseases. Unfortunately we have all been raised in a culture which has promoted high fat foods as tasting good. In fact we all like fat and salt (e.g. pizza) or fat and sugar (e.g. doughnuts). Learning to eat a more sensible diet involves several steps.

1. GET EDUCATED. The first step is to learn more about food and nutrition. There are many resources available including books available at your local bookstore, seminars (watch your local paper), and information at the Jewish Hospital Health and Information Centers as well as activities sponsored by the other hospitals and organizations in Louisville and in other communities around the globe. As you learn more about low fat diets you will begin to make better choices about the food you eat. Since you are accessing this information on our website you can also take advantage of the enormous amount of material available on the web on low fat diets. Be careful not to believe everything you read unless you know it comes from a reliable source. The hotlink below will connect you to some excellent information on how to reduce the fat and cholesterol in your diet.

2. STAY FOCUSSED. Even if you can’t "be good" all the time, try to make healthy choices when planning or cooking meals. Keep trying even if you "splurge" occasionally.

3. MAKE DIET PART OF A BIGGER PLAN. Make a commitment to eat a low fat diet as part of an overall plan to improve your health which includes moderate exercise (see our section on exercise) and smoking cessation if you smoke (see our section on smoking cessation).Each activity will reinforce another. Recommendation for a low fat diet will vary depending upon the individual being treated. The recommendation for those without heart disease is to limit saturated fat to 8-10% of the total daily caloric intake and limit total fat (saturated and unsaturated) to 30% of total calories. Cholesterol should be limited to 300mg per day and calories limited to achieve or maintain your ideal body weight.

For those with heart disease no more than 7% of calories should come from saturated fat and no more than 200 mg of cholesterol (1 egg yolk) per day is allowed. No more than 20% of calories should come from fat. For most people this means limiting fat intake to between 40 and 60 grams per day. For those with heart disease some authorities recommend a target of less than 30 grams of fat per day or even less. This goal is difficult but not impossible to achieve. The place to start is education. Learn how to read labels. (see below). Then learn how to make substitutions to cut down on fat intake. For example:

Instead of snacking on potato chips try air popped popcorn or pretzels. Even the tasty soft pretzels can be low in fat if you don’t get them dipped in butter.

Instead of ice cream try frozen yogurt or ice milk or sherbet.

Instead of doughnuts or eggs for breakfast try egg substitutes or a low fat high fiber cereal with a bit of dried fruit like raisons or apricots mixed in.

Instead of the deluxe Southern Indianaer at your local fast food establishment go to a sandwich shop offering low fat sandwiches spiced up with fresh vegetables, pickles and peppers. (Not for those trying to reduce sodium intake. The pickles are high in salt.) Did you know that a double cheeseburger with condiments may contain 50 grams of fat?!!!

You may wonder whether these diets really work. We have a patient we’ll call Bill. He is a real patient with our group right here in Louisville. We have been his cardiologists for about 6 years. Since we have known him, Bill has had repeat bypass surgeries, several angioplasties and an atherectomy with stent. We couldn’t convince him to stop smoking and go on a low fat diet. About two years ago Bill came to the hospital with a small heart attack. We performed another cardiac catheterization (angiogram) on him. All of his arteries and all of his bypass grafts were closed with the exception of one graft to the right coronary artery and that graft had a clot partially closing it. This graft and the right coronary artery were feeding most of the rest of Bill’s heart through small blood vessels known as collaterals which had formed to take blood from the right coronary artery and bring it to the left coronary artery. In other words he was living on one graft which had a clot sitting in it. We informed Bill that he had used up all that technology could offer. None of the cardiologists or cardiac surgeons would perform any more procedures on Bill’s heart. We told him it was now up to him to stop smoking and follow the diet we had been recommending all along. Bill did just that. He is now on less medication than he was 2 years ago. He has lost 60 pounds. His energy level has increased markedly and he hasn’t had another chest pain since then. Unfortunately, Bill is the exception rather than the rule. Many patients never make the changes they need to make in their lifestyles to promote their own health. If you speak to him now Bill will tell you that the diet really isn’t that hard and actually he quite enjoys doing his own low fat cooking. Be an exception. If you want to prolong your life and feel and look better, get started.

START TODAY. Learn how to read labels to determine the fat content of foods and start looking at the labels on the foods you buy. Try to pick lower fat content foods whenever possible. Get a good cookbook with low fat recipes. Even if you can’t become a "saint" overnight, start learning more about the foods you eat. Over time, it will become easier.

References:
Step by Step Eating to Lower Your High Blood Cholesterol
American Heart Association
For a copy of this and other helpful materials call the American Heart Association at
1.800.242.8721.

Or contact the NHLBI for a catalogue of useful publications. Write to:

National Cholesterol Education Program
NHLBI Information Center
PO Box 30105
Bethesda, MD. 20824-0105

Books:

The New American Heart Association Cookbook 5th ed. By the AHA, c. 1991 Times Books, Random House 
Lean and Luscious and Meatless by Bobbie Hinman and Millie Snyder c. 1992 Prima Publishing 
The Low Fat Good Food Cookbook by Martin and Terri Katahn c. 1994 Pub. W.W. Norton 
Reversing Heart Disease by Dean Ornish MD c. 1990 Random House

Magazines:

  • Cooking Light
  • Eating Well
  • Vegetarian Times

Websites:

  • http://www.fatfree.com/ 2,391 fat free and low fat vegetarian recipes.
  • http//www.medaccess.com "Step by Step Eating to Lower Your High Blood Cholesterol" 

    This is the electronic version of the National Heart, Lung and Blood Institutes guide to low fat eating.

 

 

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