Atherosclerosis and Diet

Chapter 20

Atherosclerosis and Diet

Chapter 20

Cardiovascular Heart Disease (CHD)Cardiovascular Heart Disease (CHD)• The blood players in the atherosclerotic process:

- elevated plasma low density lipoprotein cholesterol (LDL-c or bad cholesterol)-LDL deposits fat on artery walls and this clogs arteries -such clogging reduces or stops blood flow and hence oxygen and nutrient delivery

- fat deposits on wall of artery are called plaque

- low plasma high density lipoprotein cholesterol (HDL-c or good cholesterol)- HDL cleans arteries of fat

- elevated plasma cholesterol (elevates LDL-c)

- elevated plasma cholesterol:HDL-c ratio-more cholesterol influx than efflux as most of the cholesterol is carried on the LDL

- elevated plasma triglycerides elevates small dense LDL (sd LDL is very aggressive in clogging arteries with fat)

Cardiovascular Heart Disease (CHD)Cardiovascular Heart Disease (CHD)• The blood players in the atherosclerotic process continued:

-elevated post-prandial triglycerides (chylomicron-triglycerides)

-elevated VLDL-cholesterol (contributes to cholesterol influx into the artery wall)

-hypertension-damages arterial endothelium which leads to lipid infiltration

-plaque rupture leading to platelet aggregation in turn leading to thrombus and embolus formation- decreased bleeding time involved here

-elevated lipoprotein (a) levels-contributes lipid to the artery wall and may contribute to elevated platelet aggregation

Cardiovascular Heart Disease (CHD)Cardiovascular Heart Disease (CHD)

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Heart Healthy Diet and Lifestyle—(cont.)Heart Healthy Diet and Lifestyle—(cont.)• Calories, activity, and weight

– Attaining and maintaining healthy weight to reduce the risk of CVD

– A decrease in calorie intake and an increase in physical activity are recommended to promote weight loss.

– A physically active lifestyle with minimal sedentary activities is appropriate for all people regardless of their weight status.

Heart-Healthy Diet and Lifestyle—(cont.)Heart-Healthy Diet and Lifestyle—(cont.)• Fruit and vegetables

– In short-term, randomized trials

o Diets rich in fruits and vegetables have been shown to lower blood pressure and improve other CVD risk factors.

– In long-term, observational studies

o People who have a high intake of fruits and vegetables are at lower risk of developing CVD, especially stroke.

– Preparation methods should preserve the fiber and nutrient content without adding saturated fat, trans fat, sugar, or salt.

Heart Healthy Diet and Lifestyle—(cont.)Heart Healthy Diet and Lifestyle—(cont.)

• Whole grains

– Diets high in whole-grain products are associated with decreased risk of CVD.

– Both soluble and insoluble fiber are associated with decreased risk of CVD.

• Fatty fish

– Increased intake of omega-3 fatty acids reduces risk of CVD.

– Recommendation- 2 servings (approximately 8 oz.) of fatty fish per week, prepared in ways that do not add saturated or trans fats.

Heart Healthy Diet and Lifestyle—(cont.)Heart Healthy Diet and Lifestyle—(cont.)

• Saturated fat

– Increases LDL and total cholesterol levels

– Choosing lean meats and trimming away visible fat lowers saturated fat intake.

– Portion sizes are limited to 6 oz. or less per day.

– Monounsaturated and polyunsaturated fats are inversely related to CHD.

– Recommendation- total fat provide 25% to 35% of total calories.

Heart Healthy Diet and Lifestyle—(cont.)Heart Healthy Diet and Lifestyle—(cont.)

• Trans fat

– Increases LDL and total cholesterol levels, the ratio of LDL to HDL cholesterol, and the risk of CHD

– Found in partially hydrogenated fats

– Limit trans fat intake of less than 1% of total calories.

Heart Healthy Diet and Lifestyle—(cont.)Heart Healthy Diet and Lifestyle—(cont.)• Cholesterol

– Dietary cholesterol raises LDL levels, especially in people who are lean though the contribution of dietary cholesterol to total and cholesterol levels is small.

– Found only in foods originating from animals

• Added sugars

– The purpose of limiting the intake of beverages and foods with added sugars is to lower calorie intake and help ensure nutritional adequacy. Added sugars in sufficient amounts can contribute to pro-atherosclerotic lipid and lipoprotein profile

Heart Healthy Diet and Lifestyle—(cont.)Heart Healthy Diet and Lifestyle—(cont.)

• Sodium

– As the intake of salt increases, so does blood pressure.

– High blood pressure is a major risk factor for CVD.

Heart Healthy Diet and Lifestyle—(cont.)Heart Healthy Diet and Lifestyle—(cont.)

• Alcohol

– Moderate alcohol consumption from any source—beer, wine, or distilled liquor—is associated with a reduced risk of CVD.

– Alcohol can be addictive, and high intakes are associated with high triglyceride levels, hypertension, liver damage, physical abuse, vehicular and work accidents, and increased risk of breast cancer.

Hypertension—(cont.) The DASH eating planHypertension—(cont.) The DASH eating plan

DASH Food Groups DASH Daily Servings (except as noted)

DASH Serving Sizes

Vegetables 4-5 250 mL (1 cup) raw leafy  vegetables125 mL (½ cup)  cooked vegetables170 ml (6 oz) juice 

Fruit 4-5 1 medium piece of fruit63 mL (¼ cup) dried fruit125 mL (½ cup) fresh, frozen or canned fruit

Grains(mainly whole grains)

7-8 1 slice bread250 mL (1 cup)  ready to eat cereal125 mL (½ cup) cooked rice, pasta or cereal

Low  Fat or No-Fat Dairy Foods

2-3 250 mL (1 cup) milk250 ml (1 cup) yogurt50 g (1½ oz) cheese

Lean meats, poultry and fish 2 or less 3 ounces cooked lean meats, skinless poultry, or fish

Nuts, seeds and dry beans 4-5 per week 1/3 cup (1.5 oz.) nuts30 mL (2 tbsp) peanut butter2 tbsp (1/2 oz.) seeds1/2 cup cooked dry beans or peas

Fats and Oils 2-3 5 ml (1 tsp) soft margarine15mL (1 tbsp) low-fat mayonnaise30 mL (2 tbsp)  light salad dressing5 ml (1 tsp) vegetable oil

    

TLC dietTLC diet•Component TLC Diet

•Total fat 25-35% of total calories*

•Saturated fat <7% total calories

•Polyunsaturated fat Up to 10% of total calories

•Monounsaturated fat Up to 20% of total calories

•Trans fat Lower intake

•Carbohydrate** 50-60% of total calories

•Dietary fiber 20-30 grams per day

•Protein 15-25% of total calories

•Cholesterol <200 mg/day

•Sodium <2,300 mg/day

•Dietary options

•Plant sterols/stanols Add up to 2 grams per day

•Soluble fiber Increase 5-10 grams per day

•Fish (fatty fish) Include in weekly eating plan

•* allows an increase of total fat to 35% of total calories and a reduction of carbohydrate to 50% in persons with metabolic syndrome and/or at risk for type 2 diabetes. ** Carbohydrate should derive predominantly from foods rich in complex carbohydrates including grains (especially whole grains) and fruits and vegetables.

Mediterranean dietMediterranean diet•Key components of the Mediterranean diet

•The Mediterranean diet emphasizes:

•Eating primarily plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts

•Replacing butter with healthy fats, such as olive oil

•Using herbs and spices instead of salt to flavor foods

•Limiting red meat to no more than a few times a month

•Eating fish and poultry at least twice a week

•Drinking red wine in moderation (optional)

•The diet also recognizes the importance of being physically active, and enjoying meals with family and friends.

Mediterranean dietMediterranean diet•Key components of the Mediterranean diet

•Focus on fruits, vegetables, nuts and grains

•The Mediterranean diet traditionally includes fruits, vegetables and grains. For example, residents of Greece average six or more servings a day of antioxidant-rich fruits and vegetables.

•Grains in the Mediterranean region are typically whole grain and usually contain very few unhealthy trans fats, and bread is an important part of the diet. However, throughout the Mediterranean region, bread is eaten plain or dipped in olive oil — not eaten with butter or margarine, which contains saturated or trans fats.

•Nuts are another part of a healthy Mediterranean diet. Nuts are high in fat, but most of the fat is healthy. Because nuts are high in calories, they should not be eaten in large amounts — generally no more than a handful a day. For the best nutrition, avoid candied or honey-roasted and heavily salted nuts.

Mediterranean dietMediterranean diet• The focus of the Mediterranean diet isn't on limiting total fat consumption, but

rather on choosing healthier types of fat. The Mediterranean diet discourages saturated fats and hydrogenated oils (trans fats), both of which contribute to heart disease.

• The Mediterranean diet features olive oil as the primary source of fat. Olive oil is mainly monounsaturated fat — a type of fat that can help reduce low-density lipoprotein (LDL) cholesterol levels when used in place of saturated or trans fats. "Extra-virgin" and "virgin" olive oils (the least processed forms) also contain the highest levels of protective plant compounds that provide antioxidant effects.

• Canola oil and some nuts contain the beneficial linolenic acid (a type of omega-3 fatty acid) in addition to healthy unsaturated fat. Omega-3 fatty acids lower triglycerides, decrease blood clotting, and are associated with decreased incidence of sudden heart attacks, improve the health of your blood vessels, and help moderate blood pressure. Fatty fish — such as mackerel, lake trout, herring, sardines, albacore tuna and salmon — are rich sources of omega-3 fatty acids. Fish is eaten on a regular basis in the Mediterranean diet.

What is in these good diets that helps with reducing atherosclerosis?

What is in these good diets that helps with reducing atherosclerosis?