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18 HEALTH HEALTH Dietary management of Dyslipidaemia SATURATED FATS The deleterious effects of saturated fats on blood lipid profiles have been long established. Saturated fats increase both TC and LDL-C and sources include fatty meats, processed meats, whole dairy products, pastries, biscuits, cakes, confectionery and fast food. All vegetable oils are low in saturated fats, with the exception of palm oil & coconut oil. In fact, coconut oil contains 92% saturated fat. These days coconuts and their products are heavily promoted as healthy; however, recent reviews of evidence show that coconut oil consumption raises total blood cholesterol (both LDL and HDL). Based on current evidence, it is still preferable to use unsaturated plant oils over coconut oil. TRANS FATS CONSTANTINE DEAN MERCURIO APD Cardiac Rehabilitation Dietitian and Student Placement Co-ordinator at Fairfield Hospital in Sydney. He also convenes the Dietitians Association of Australia Cardiology Discussion Group. DIET THERAPY IS AN INTEGRAL PART OF MANAGING ALL PATIENTS WITH DYSLIPIDAEMIA. IT IS EFFECTIVE AS A STAND-ALONE TREATMENT AND ALSO AS AN ADJUNCT TO PHARMACOLOGICAL INTERVENTIONS. ALTHOUGH DYSLIPIDAEMIA IS A RISK FACTOR FOR CARDIOVASCULAR DISEASE, IT IS MODIFIABLE; HENCE THE IMPORTANCE OF DIETARY GUIDANCE. DISCUSSED ARE THE KEY COMPONENTS OF A CARDIO-PROTECTIVE DIET THAT CAN ASSIST IN OPTIMISING BLOOD LIPID PROFILES — DECREASING LOW DENSITY LIPOPROTEIN CHOLESTEROL (LDL-C), TOTAL CHOLESTEROL (TC) AND TRIGLYCERIDES (TG), AND INCREASING HIGH DENSITY LIPOPROTEIN CHOLESTEROL (HDL-C) — AND REDUCE CARDIOVASCULAR DISEASE RISK. GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 46 : FEBRUARY/MARCH 2016 Trans fats are formed by partial hydrogenation (hardening) of vegetable oils in food processing. They are also found naturally in butter, milk fat, beef and lamb. Trans fats are often found in foods also high in saturated fats, such as pies, pastries and fast food. Trans fats increase LDL-C, decrease HDL-C and increase fasting TG levels. They are associated with increased risk and incidence of Coronary Heart Disease (CHD) and Myocardial Infarction (MI). The Heart Foundation (Australia) recommends all Australians reduce their trans fats intake to <1% of total energy intake. On average this level is achieved in Australia, largely due to food manufacturers altering procedures to reduce the trans fat content of foods. UNSATURATED FATS There are two main forms of unsaturated fat found in food – Polyunsaturated (PUFA) and Monounsaturated (MUFA). PUFA and MUFA fats are considered healthy fats, and should replace saturated fat where possible. When substituted for saturated fats, PUFAs reduce TC and LDL-C, and significantly reduce heart disease risk. Sources include sunflower oil, corn oil, sesame oil, walnuts, brazil nuts and oily fish. When substituted for saturated fats, MUFAs lower TC and LDL-C, although not to the same extent as PUFA. Sources include olive oil, canola oil, olives, avocado and most nuts. Research has highlighted the cardio-protective benefit of nuts. Two small handfuls of nuts daily (67g) can reduce total cholesterol and LDL-C by five and seven per cent respectively. Epidemiologic studies have also shown a 35% reduced risk of CHD for groups with highest nut intakes. Antioxidants have many positive effects on our health including the prevention and reduction of heart and blood vessel diseases. Extra virgin olive oil (EVOO) contains predominately monounsaturated fats and is also naturally rich in antioxidants. These antioxidants are believed to be at least partially responsible for the low death rates from cardiovascular disease seen in populations lining the Mediterranean Sea that habitually use EVOO. Several varieties of high quality, antioxidant rich EVOOs are now produced in Australia. MARINE OMEGA-3 FATS Fish is a rich source of marine omega-3 PUFAs. Current evidence supports that a higher fish intake is associated with lower rates of sudden cardiac death and heart attack. The same benefits are not conferred from the consumption of marine omega-3 PUFAs through supplements; however, marine omega-3 PUFA supplements can play a beneficial role in the treatment of those with high triglyceride levels. The consumption of 1000–4000mg of combined Eicosapentanoic acid (EPA) and docosohexanoic acid (DHA) through marine omega-3 PUFA supplementation can decrease serum triglyceride levels by 25–30%. This effect is independent of statins. The Heart Foundation recommends that all Australians aim to include 2–3 servings of fish (including oily fish) per week which provides about 250–500mg of marine-sourced omega-3s. Fish with the highest levels of omega-3 include salmon, canned sardines, herring, blue mackerel, blue-eye trevalla, and some varieties of tinned tuna. PLANT STEROLS The Heart Foundation recommends people with high cholesterol include plant sterols in their diet to reduce their risk of heart disease. Eating two grams of plant sterols daily lowers TC by an average of 10% in three weeks, while not affecting HDL-C. Plant sterols have additive effects to statins and must be consumed daily to maintain their effect. Consuming more than two grams of plant sterols per day will not further lower TC, that is, two grams per day is the optimal amount. Two grams per day can be obtained from 25g of plant sterol enriched margarine spread. Other key dietary considerations that can assist in achieving optimal blood lipid control and a reduction in cardiovascular disease risk include: •• Quantity and quality of dietary carbohydrate (CHO) – Nutritious CHO containing foods with a low glycaemic index (GI) are encouraged. It is imperative to limit added sugars and foods with a high GI. •• Dietary Fibre intake – A diet rich in fibre, particularly soluble fibre, is strongly recommended. This can be achieved through daily consumption of wholegrain breads and cereals, fruits and vegetables. In a climate where there are seemingly endless avenues to attain dietary advice, patients seeking expert dietary advice should be referred to an Accredited Practising Dietitian (APD). APDs are University-trained experts who provide evidence-based dietary advice, tailored to the specific needs of each individual client. Pharmacists can be a key referral agent to APDs and are well positioned to ensure that both medications and the dietary advice are followed. GOLD CROSS PRODUCTS & SERVICES PTY LTD : ITK ISSUE 46 : FEBRUARY/MARCH 2016 19