Download Saturated fat

The
heart smart
diet
Presented by
Sanmaré MacRobert
Clinical Dietitian
Vergelegen Nutrition Centre
Suite 2 F Arun Place · Main Road · Somerset West
021 851 6228
[email protected]
Facing the facts
• Coronary heart disease is the
second biggest killer of South
Africans after HIV/Aids
• Each day
 33 South Africans die from
heart attack,
 60 die from a stroke
• 60% of Coronary heart disease is
due to high cholesterol
• 60% of CHD deaths in developing
countries are due to high
cholesterol BHF website
Unmodifiable Risk factors
Heart Disease
• Age
 Male > 45
 Female > 55
• Family History
• Gender
 Male
• Menopause
Stroke
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History of stroke or pre-existing
cardiovascular disease
Previous TIA
Age:
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> 45 yrs
Highest risk 60-80 years
Family history of stroke
Male
Blood disorders which increase
clotting
Valvular disease such as mitral
stenosis
Lancet 2010; 376:112-123
American Heart Association
Cleveland Clinic
Krause
Modifiable Risk Factors
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Heart Disease
Increased LDL/HDL
ratios
Smoking
Diabetes
Hypertension
Abdominal obesity
Psychosocial (i.e., stress or
depression)
Failure to eat fruits and
vegetables daily
Failure to exercise
Failure to drink any alcohol
Stroke
• Artherosclorosis
 Narrowing of arteries
• High cholesterol levels (LDL)
• High blood pressure
 primary risk factor for Ischemic
strokes
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High homocystiene level
Drug abuse
Smoking
Diabetes mellitus
Atrial fibrillation
Excessive alcohol intake
Obesity (BMI>27)
Sleep apnea
What is cholesterol
• Cholesterol = a waxy substance found in the
fats in your blood
• Your body needs cholesterol to build
healthy cells BUT
• ↑ cholesterol levels
• coats artery walls and making them less flexible
atherosclerosis
 Blood clot can form and clog narrowed artery,
stopping blood flow to brain or heart causing:
• Heart attack
• Stroke
Cholesterol
Blood test for Cholesterol: Lipogram
Cholesterol can not dissolve in water
 Carriers  lipoproteins
• HDL-cholesterol – “good”
• LDL-cholesterol – “bad”
• Triglycerides – “ugly”
 Fat in the blood
Total Cholesterol is the combination
of the above
• Genetic
Cholesterol
Where does it come from?
 Some people inherit genes that trigger too much
cholesterol production
• Food
 25%
 Small effect on blood cholesterol in most
people
 The type of fat (saturated and trans fats) can
increase blood cholesterol more significantly
• Liver
 75%
 Type of cholesterol / lipoprotein produced
depends on your diet
Cholesterol
Liver = 75%
Diet = 25%
Food
Artery
Cholesterol
LDL
HDL
Food
Artery
Cholesterol
LDL
HDL
Food
Artery
Cholesterol
TG
Food
Artery
Why high cholesterol matters
• One of the major risk factors of:
 Coronary artery disease
 Heart attacks
 Strokes
 Also appears to boost the risk of Alzheimer’s disease
• High Cholesterol levels lead to build up of
plaque that narrows the arteries
 Restricting blood flow to heart or brain
• Leading to heart attack or stroke
Managing cholesterol levels
• Cholesterol lowering medication
 Statins
 Fibrate derivatives
 Bile-sequestering resins
• Dietary and lifestyle modifications
 Heart smart diet
 Changing lifestyle behaviours
• Alternative remedies
• Join my talk in September 2012 to find out more about
these alternative remedies…. NOT TO MISS!!!
Lifestyle behaviours together with
healthy eating pattern and
moderate alcohol consumption,
are associated with a 95%
decrease in heart attack risk
DIET DOES MAKE A
DIFFERENCE!!!
The Heart Smart Diet
• Becoming fat SMART
 Saturated fat
 Trans fatty acids
• Butter vs Margarine
 Dietary cholesterol
 Poly unsaturated fat
• Omega 3 fatty acids
• Nuts
 Mono unsaturated fat
 Cholesterol in the diet
 Plant Sterols and Stanols
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Soya protein
Soluble fibre
Fruits and vegetables
Alcohol
Protein, CHO, Fat?
What to consider?
No Carbohydrates?
High Protein?
What about
fat?
Becoming fat smart
Saturated fat
• Non essential fat
• Mainly found in animal products such as meat,
poultry, and dairy, and certain oils
• Saturated fat raise LDL (bad) cholesterol
 1% increase in daily energy from SFA, increase LDL-C by
1.8mmol/L (1/2 tsp margarine)
 Saturated fat increase LDL-C more that dietary cholesterol
• Decreased intake of SFA along with weight loss can
reduce LDL-C by up to 16%
• Foods high in SFA usually also high in dietary
cholesterol = double trouble
Becoming fat smart
Saturated fat
• Sources:
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Full cream dairy
Fatty meals and marinades
Sauces
Butter
Potato chips
Cakes
• Check food labels for SFA
 AHA is < 7% of total energy
• < 16 g per day
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Chips Chocolate
Pies
Rusks
Toffees
Coconut, palm and
palm kernel oil
Becoming fat smart
Saturated fat
Saturated fat content of food:
1 large egg
Ribeye steak
hamburger
1 TBS coconut milk
1 TBS butter
1 TBS olive oil
30g cheese
2g
4g
5g
3g
7g
2g
6g
Becoming fat smart
Saturated fat
Food labels:
Becoming fat smart
Trans fatty acids
• During food processing, fats may undergo a chemical
process – hydrogenation
 Found in margarines and spreads, shortening, cooking oils
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Raises LDL (bad) cholesterol
Lowers HDL (good) cholesterol
Raises Triglyceride levels
2% increase in dietary TFA
Leading to
arteriosclerosis
 heart attack &
stroke
 Raise LDL:HDL ratio by 0.1
 Increases the incidence of CHD by 23%
• Trans fats may damage the cells lining the blood vessels,
leading to inflammation
• Cause insulin resistance  Diabetes (tim noakes)
Becoming fat smart
Trans fatty acids
• Trans fats are made by adding hydrogen to
vegetable oil - keeping food fresher for longer
• Also formed as oil ages or is re-used
• Also occur in nature as the result of fermentation
in grazing animals
• Trans fats more difficult to digest, and your
body recognizes it as saturated fat
Becoming fat smart
Trans fatty acids
• How to reduce trans fat intake:
• READ FOOD LABELS
• Trans fats
• Partially hydrogenated vegetable oil
• Fully or completely hydrogenated oil doesn’t contain
trans fats
• Use margarine as a substitute for butter, and choose soft
margarines over harder, stick forms
• French fries, doughnuts, cookies and crackers are high in
trans fatty acids
• According to the AHA - < 2g TFA per day
Trans fatty acids: Dietary Sources
Butter vs margarine
Butter vs Margarine
THE FACTS
BUTTER
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727kcal/100g
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48g of saturated fat/100g
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219mg of cholesterol/100g
MARGARINE
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731kcal/100g
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16 or 10g of saturated fat/100g of standard or lite marg
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No cholesterol
Becoming fat smart
Dietary Cholesterol
• Only 25% of cholesterol come from dietary sources
• Diet high in Cholesterol can raise cholesterol levels and
contribute to atherosclerosis
• The AHA recommends to limit dietary cholesterol intake to <
300mg/d
• Sources
Egg
210mg per egg
Fast foods
246mg/100g
Egg yolk
212mg per yolk
cheese
123mg/100g
Caviar
288mg/100g
Processed meat 63g/100g
Liver, pate
255mg/100g
Chocolate
Butter
243mg/100g
Becoming fat smart
Polyunsaturated fat
• Liquid form at room temperature and when
chilled
• ↓ LDL-c & ↓ HDL-c
• Sources:
 soybean oil, corn oil and safflower oil (ω - 6)
 fatty fish such as salmon, mackerel, herring and
trout (ω - 3)
 walnuts
 sunflower seeds
Becoming fat smart
Omega 3 fatty acids
• ↓ cardiovascular events by 19-45%
• Triglycerides
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Lowers triglycerides in a dose-dependent manner.
Systemic analysis indicate for every 1g increase in omega-3 = 0.2mmol/L drop in triglycerides
For every 4g/day omega-3 = 25-30% reduction in triglycerides
• LDL-C
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5-10% increase
Some studies report the effect to be because of increase in LDL-C particle size
• HDL-C
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1-3% increase
Modest effect – evidence that alter HDL subfractions towards more favourable cardioprotective profile
• Reduce overall mortality in survivors of a first Myocardial infarction by 20
– 29%
• Reduce blood pressure
• Slows build up of arteriosclerotic plaque
• Prevent blood clotting
Becoming fat smart
• Dietary Sources
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Omega 3 fatty acids
Oily fish: Mackerel, sardines, pilchards, herring, trout, fresh tuna
Flaxseeds and flax oil; Ultimate seedmix: 1 TBS per day
Canola products i.e. margarine, oil & eggs
Omega 3 enriched foods:
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Bread
Yoghurt
Milk
• Dosage
 1g EPA and DHA per day for people with known CVD
 3 – 4 g EPA and DHA in patients with hypertriglyceridaemia
 To meet requirement with diet or supplements or a combination
• Supplementation
 Safety:
• Safe supplementation intake 3g per day
• No guarantee of strength purity or safety
• Fish allergy
 Side effects:
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Increased risk of bleeding / hemorrhagic storke – high doses
Decrease platelet aggregation, prolonged bleeding time, increased fibronolsys
GI upset, diarhoea, abdominal pain, bloating, indigestion
May cause vitamin E deficiency if taken for many months
Becoming fat smart
Mono-unsaturated fat
• Protective effect on CVD
 Small ↓ in LDL-c
 ↑HDL-c
 Studies on diets high in MUFA showed a 50-60% risk reduction
and re occurance in CVD
• Dietary sources:
 Nuts and avocados
 Oils (Olive, Canola, Grapeseed, Avocado oil, Macadamia nut,
Ground nut, Peanut, Sesame and Corn oil) (but high in omega)
 Peanut butter
 Popcorn
 Oatmeal
Becoming fat smart
Nuts and heart health
• If taken as part of a healthy diet they can
 ↓ LDL-C
 Reduce risk of developing blood clots that can
cause a fatal heart attack
 Improve the health of the lining of your arteries
 Contains omega 3 fatty acids e.g. walnuts
Evidence “suggests” but not prove that nuts
reduces heart disease risk.
Becoming fat smart
Nuts and heart health
• Contains unsaturated fat, omega 3 fatty acids,
fiber, vitamin E and plant sterols
• Sources:
 Almonds, brazil nuts, cashews, hazelnuts, macadamia
nuts, peanuts, pistachios, walnuts
 Nut oils – but does not contain fibre
• Limitation:
 Nuts contain a lot of energy and if not consumed with
a healthy diet, can lead to weight gain, increasing
CVD risk
 Avoid salted nuts
 Avoid sugar, chocolate or yoghurt coated nuts (↑ E)
Becoming fat smart
Plant Sterols and Stanols
• Plant stanols and strerols are essential
• Looks like cholesterol
• Sterols and stanols presents naturally in small
quantities:
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Fruits
Vegetables
Nuts
Seeds
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Cereals
Legumes
Vegetable oils and
Other plant sources
• Function:
 Lower LDL-C by blocking its absorption
 Compete with cholesterol in GI to reduce
absorption
Becoming fat smart
Plant Sterols and Stanols
• 2g per day lowers LDL-C by 10%.
• For maximal effectiveness, foods
containing plant sterols and stanols
(spreads, juices, yogurts) should be
eaten with other foods
25g a day is needed to provide the
optimal intake of plant sterols, (22.5 g)
• To prevent weight gain,
isocalorically substitute stanol- and
sterol-enriched foods for other
foods.
Plant stanol esters (2.0g per
100g)
Lifestyle changes to improve
heart health
• Establish a healthy body weight
 BMI < 25
• Maintain waist circumference under normal
ranges
 < 88cm females
 < 102 cm males
• Physical exercise
 30 minutes x 5 per week
• Stop smoking
• Drink alcohol in moderation
Also need to consider
abdominal obesity… visceral fat
• Apple shape
• Waist circumference
• <102cm (94)
• <88cm (80)
• Waist circumference > cut
offs
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↑LDL Cholesterol
↓HDL Cholesterol
↑TG
↑Ratio
What is your waist line
saying?
Black Ribbon = 102 cm for male
Red ribbon = 88cm for females
Know your risk
today!!!!
Importance of keeping an eye
on the waist circumference
• Abdominal obesity predicts CHD risk
independent of BMI, smoking, cholesterol and
hypertension.
(Kannel et al., J. Clin Epid., 44, 183-190, 1991).
• Abdominal obesity predicts CHD risk
independent of total body fatness.
(Larsson et al. ,Appetite, 13, 37-44, 1989).
• Abdominal obesity statistically accounts for
difference in CHD rates between men and
women.
(Larsson et al., Am. J. Epi., 135: 266-273, 1992).
Abdominal Obesity
• Therefore you can not just eat healthily
 YOU NEED TO KEEP AN EYE ON YOUR
WAIST CIRCUMFERENCE
A dietitian can help you to decrease your waist
circumference to the normal range
 Along with helping you eating all fats in the
correct amounts
 Decreasing your risks
Alternative Remedies
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Red Yeast Extract
Plant sterols and Stanols
Artichoke
Barley
Garlic
Oatbran
and many more to come in September 2012!!!
Thank you
Sanmaré MacRobert
021 851 6228