February, 2002
    
 "Eating Smart for Your Heart"
 By Lisa Drayer, MA, RD 

February is American Heart Month--and with
coronary heart disease still ranking as the #1
killer among Americans, it's time that we stop
and take a look at how we can prevent this
deadly disease.  Although having a family 
history of heart disease does increase our 
risk, it's important to banish the blame and 
take a look at the other risk factors that are 
in our control:

1.  Eat Smaller Meals 

A recent study from the American Heart
Association found that eating large meals 
raises your risk of heart attack by about 
four times, up to two hours after the meal!
Portion control is key, because eating too
much in one sitting puts extra stress on the 
heart, especially because the blood flow is
directed away from the heart and towards
the stomach for digestion, and so the heart
has to work that much harder to maintain a
constant flow of blood to the rest of the body.
In addition to decreasing stress on the heart,
controlling portion sizes will help you keep 
your weight in check, which is another 
important factor for decreasing risk of 
heart disease.

Research has also suggested that eating
smaller meals, more frequently throughout 
the day, can positively affect cholesterol 
levels, thereby reducing heart disease risk.  
A recent study published in The British 
Medical Journal found that people who 
ate 6 or more small meals had lower
cholesterol levels than people who ate one 
or two large meals each day.  This supports
earlier research published in The New 
England Journal of Medicine, which found 
that “nibbling” (i.e. consuming 17 snacks 
per day) showed metabolic advantages 
as compared to “gorging” (consuming only 
3 meals/day), including lowered total and 
LDL (‘bad’) cholesterol levels.  Both “nibbling”
and “gorging” diets were equal in total calories.  

Portion control is simple.  Keep your fish and
chicken to 3 ounces-which is about the size of
the palm of your hand, or a deck of cards, and
your pasta and rice to one cup-or about the
size of your fist.  Also, invest in some measuring
spoons and cups-this will enable you to get
familiar with the portion sizes of different foods,
and you will eventually be able to eyeball
servings.  And remember--avoid seconds,
unless they’re vegetables!
  
2.  Include More Fruits, Vegetables, and 
Low-fat Dairy Foods, and Limit the Sodium 
in Your Diet 

A recent study published in The New England
Journal of Medicine known as DASH-Sodium
Dietary Approaches to Stop Hypertension)
showed that following a heart-healthy diet with
limited amounts of sodium can greatly reduce
blood pressure, a risk factor for heart disease.

The study followed two groups. One was asked
to consume a DASH diet-a diet incorporating
lots of fruits, vegetables, and low-fat dairy 
foods, and limiting red meat, sweets, 
and saturated fats. In previous research, 
this diet was shown to lower blood pressure
levels substantially. Another was given a
“typical”merican diet. Different sodium levels,
including 3,300, 2,400, and 1,500 mg were
given to the individuals every four weeks.  
The study found that the individuals 
following the DASH diet and limiting 
sodium to 1500 mg/day experienced
the greatest reduction in blood pressure-in 
fact, as compared to the “typical” diet with 
3,300 mg of sodium, the DASH diet with
1500mg of sodium led to a decrease of
11.5 points (systolic) among individuals with 
high blood pressure, and a 7.1 point decrease
among individuals without high blood pressure.
For both diets, however, the greater the
reduction in sodium, the lower the blood
pressure.

While it’s a fact that not everyone is sodium
sensitive-that is, they experience an increase 
in blood pressure with high sodium intakes 
and a decrease in blood pressure with low
sodium intakes-it still won’t hurt to cut back 
on salt.  Keep in mind that most of the sodium 
in our diet comes from processed food-such 
as canned soups and sauces, cured meats, 
and fast foods.  

3.  Avoid Foods High in Saturated Fats and
Trans Fats, and Consume More
Monounsaturated Fats and Omega-3 
Fatty Acids.

Saturated fats in the diet increase cholesterol
levels even moreso than dietary cholesterol!
Specifically, saturated fats increase LDL, or 
the "bad" cholesterol, and decrease HDL 
levels, also known as the "good" cholesterol.
Sources of saturated fats include:  butter,
lard, cream, full-fat dairy products, red meat,
palm oil, and coconut oil.  It’s best to limit 
these foods much as possible.

By increasing LDL cholesterol to the same
extent as saturated fats, trans fats (formed 
when vegetable oils undergo a process 
known as “hydrogenation”) also increase 
risk of heart disease.  Trans fats are found 
in margarine, French fries, and commercially
prepared foods such as cookies and cakes.
Right now, trans fats are not required to be
written on food labels. (That will hopefully 
change soon). So in the meantime, look for 
the words "partially hydrogenated vegetable 
oil" on food labels-if this listed as one of the 
first ingredients on a food label, and if the 
food is high in total fat, then you can count 
on the food being high in trans fats.   

On the other hand, monounsaturated fats 
lower LDL levels and keep HDL levels the 
same (in fact, some studies show that they
increase HDL levels), and sources of these 
fats include almonds, walnuts, peanuts,
avocados, peanut butter, olive oil and canola 
oil.  Omega-3 fatty acids, which are a type of
polyunsaturated fat, also have a protective 
effect on the heart by preventing blood 
clotting.  Sources of omega-3’s include fatty 
fish, such as salmon and mackerel, as well
as vegetable oils and flax seeds.  

(Note: Although shrimp is high in cholesterol,
it's low in saturated fat, and is free of trans 
fats.  Thus, it can be enjoyed even among
those with high risk of heart disease!)

4. Experiment with Soy Protein

Studies have shown that soy protein, which 
is found in tofu, tempeh, and soy-based 
meat alternatives, can reduce LDL
cholesterol levels.  Specifically, research
has shown that 25 grams of soy protein per 
day can lower high “LDL” or “bad” cholesterol
levels by about 10%.  This research is the 
basis of a current food claim approved by 
the Food and Drug Administration--the 
claim states that diets low in saturated fat 
and cholesterol that include 25 grams of 
soy protein each day may reduce the risk 
of heart disease.  (According to the FDA, 
foods must contain at least 6.25 grams of 
soy protein per serving to qualify for the 
claim).  

Researchers believe that the isoflavones 
in soy (which are estrogen-like compounds) 
play a role in soy’s cholesterol-lowering 
effects.  Since the isoflavones in soy may 
indeed act like estrogen, however, they 
have the potential to promote the growth 
of breast tumors.  The research isn’t clear, 
so if you have breast cancer or are at high 
risk for the disease, then it’s best to avoid 
large quantities of soy.

A good way to get soy protein with its
isoflavones is to try some of the soy products 
in the supermarkets-such as the vegetarian
burgers and hot dogs, or a soymilk such as
Silk.  You can also try a protein powder, 
which can be stirred into various beverages.
Although soy bars are also a good source
of soy protein, many contain excess calories.
Still sound unappetizing?  Head over to the
local bookstore, pick up a soy cookbook,
and try some recipes! 

5.  Enjoy Chocolate in Moderation

Yes, Valentine's Day is around the corner, 
and if you can't get excited about a loved
one, get excited about chocolate.  Why?
Because in addition to the fact that it tastes
great, research has shown that chocolate 
offers us health benefits.  Chocolate 
contains antioxidants known as catechins, 
and these substances may help to reduce 
the risk of heart disease by decreasing the
harmful effects of LDL, or “bad” cholesterol.
Preliminary research (funded by Mars, Inc.)
suggested that the antioxidants in chocolate
do help to inhibit the oxidation of LDL 
particles, thereby reducing the risk of heart
attack and stroke.
  
Another recent study found that the catechin
content of chocolate is four times greater than
tea!   According to the study, Dark chocolate
had the highest total catechin content (53.5 mg
per 100 g), milk chocolate contained 15.9 mg
per 100 g, and black tea contained only 13.9
mg per 100 mL.  In addition, a new study from
Pennsylvania State University further supported
the fact that flavonoid-rich chocolate, in
moderation, is beneficial for cardiovascular
health.

Research also suggests that unlike other
saturated fats, the stearic acid in chocolate 
(a saturated fat) may not increase LDL
cholesterol.

But don't forget, when it comes to the bottom
line, fruits and vegetables are more nutritious
sources of antioxidants, and chocolate offers
us lots of calories...so be careful if you're
watching your waistline!

And an Extra Note:  Be sure to exercise!
Research shows that cardiovascular exercise
increases HDL cholesterol levels, which lowers
the ratio of Total cholesterol/HDL, of which high
levels is an indicator of heart disease risk.
Aerobic exercise also helps us burn extra
calories and can increase our metabolism
for up to 8 hours after we stop exercising.

Check out DietWatch’s candy counter
 to see how much exercise you’ll need to do to
burn off the calories in your favorite 
Valentine’s candies!
   
   
   
   
Lisa Drayer is the eCounseling Program
Director for DietWatch.com, Inc. A member of
the American Dietetic Association, Ms. Drayer
has appeared frequently on television and radio
as an expert in nutrition. She also moderates
chat discussions and answers questions on diet,
nutrition, and weight management for
DietWatch.com and Cyberdiet.com.