Dated 27th Feb 2017, the ACC (American College of Cardiology) published a review article on Debunking nutritional myths.
The article supports eating plenty of fruits, vegetables, whole grains, legumes and nuts in moderation. It also mentions that very limited quantities of lean meat, fish, low-fat and nonfat dairy products and liquid vegetable oils may be consumed. It however does not recommend intake of antioxidant pills, juicing and gluten-free diets (unless allergic to gluten).
A summary is provided:
Eggs and cholesterol:
Although a U.S. government report issued in 2015 dropped specific recommendations about upper limits for cholesterol consumption, the review concludes, “it remains prudent to advise patients to significantly limit intake of dietary cholesterol in the form of eggs or any high cholesterol foods to as little as possible.”
According to the authors, coconut oil and palm oil should be discouraged due to limited data supporting routine use. The most heart-healthy oil is olive oil, though perhaps in moderation as it is still higher calorie, research suggests.
Berries and antioxidant supplementation:
Fruits and vegetables are the healthiest and most beneficial source of antioxidants to reduce heart disease risk, the review explains. There is no compelling evidence adding high-dose antioxidant dietary supplements benefits heart health.
Nuts can be part of a heart-healthy diet. But beware of consuming too many, because nuts are high in calories, said the authors.
The authors explain that while the fruits and vegetables contained in juices are heart-healthy, the process of juicing concentrates calories, which makes it is much easier to ingest too many. Eating whole fruits and vegetables is preferred, with juicing primarily reserved for situations when daily intake of vegetables and fruits is inadequate. If you do juice, avoid adding extra sugar by putting in honey, to minimize calories.
People who have celiac disease or other gluten sensitivity must avoid gluten – wheat, barley and rye. For patients who don’t have any gluten sensitivities, many of the claims for health benefits of a gluten-free diet are unsubstantiated.
Follow a healthy eating pattern that accounts for all foods and beverages within an appropriate calorie level. A healthy eating pattern includes
A variety of vegetables from all of the subgroups—dark green, red and orange, legumes (beans and peas), starchy, and other
Fruits, especially whole fruits
Grains, at least half of which are whole grains
Fat-free or low-fat dairy, including milk, yogurt, cheese, and fortified soy beverages
A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes (beans and peas), and nuts, seeds, and soy products
A healthy eating pattern limits saturated fats and trans fats, added sugars, and sodium.
Key recommendations that are quantitative are provided for several components of the diet of particular public health concern that should be limited.
Consume less than 10% of calories per day from added sugars.
Consume less than 10% of calories per day from saturated fats.
Consume less than 2300 mg/d of sodium.
If alcohol is consumed, it should be consumed in moderation—up to 1 drink per day for women and up to 2 drinks per day for men—and only by adults of legal drinking age.
The Dietary Guidelines also include a key recommendation to meet the Physical Activity Guidelines for Americans.
This Viewpoint summarizes the updated recommendations of the US Department of Health and Human Services’ recently released 2015-2020 Dietary Guidelines for Americans.
The new guidelines on cholesterol treatment advocate aggressive control of Cholesterol levels by drugs called statins for primary prevention of heart disease. They advocate high-intensity and moderate intensity statins in patients with intermediate risks of developing heart disease.
Majority of the Physicians would be following these recommendations. But, there is a great need to discuss the risks and benefits of statin therapy with individual patients.
These become more relevant when we know that statins do increase marginally the incidence of developing diabetes.
Two recent studies also throw up interesting findings:
Study 1. A study presented in April 2014 at the Society of General Internal Medicine meeting in San Diego showed that individuals prescribed statin therapy for high cholesterol consumed more calories and more fat than nonstatin users. And, not surprisingly, this increase in calories paralleled an increase in BMI in statin users.
Study 2. An analysis of a prospective cohort study of men (published in JAMA Internal Medicine) revealed that physical-activity levels were “modestly” lower among statin users compared with nonusers independent of other cardiac medications and of medical history.
Though there may be a biologic or chemical explanation for the above findings, the above studies point to Lifestyle-Statin interaction whereby there seems to be a sense of protection felt by the patients on statins. Individuals on statins (due to a sense of security due to their drug compliance) may be abandoning on Diet moderation and Physical activity. This abandoning of important lifestyle measures would reduce gains of statin therapy.
The above findings suggest that Physicians need to continuously emphasise the importance of Lifestyle measures to individual patients irrespective of their cholesterol levels or statin therapy!
American College of Cardiology (ACC)/American Heart Association (AHA) released new Guidelines on the Treatment of Blood Cholesterol last week.
The biggest change in the new guidelines is : “there is no target level of cholesterol to be achieved by the drugs.” Lower levels of cholesterol are better but no particular level is found to be protective. So, the following are no longer considered appropriate strategies: treat to target, lower is best, treat to level of cardiovascular disease risk, and based upon lifetime risk of cardiovascular disease.
Through a rigorous process, four groups of individuals were identified, who would benefit the most with anti-cholesterol drugs called Statins.
Four Statin Benefit Groups:
• 1) Individuals with clinical atherosclerotic disease: coronary artery disease, stroke, or any vascular disease.
• 2) Individuals with elevations of low-density lipoprotein cholesterol (LDL-C) ≥190 mg/dl.
• 3) Individuals 40-75 years of age with diabetes, and LDL-C > 70 mg/dl.
• 4) Individuals who have an estimated 10-year atherosclerotic cardiovascular disease (ASCVD) risk of 7.5% or higher.
Individuals in the fourth group can be identified by using the new Pooled Cohort Equations for ASCVD risk prediction, developed by the Risk Assessment Work Group. The 10 year- Cardiovascular Risk Calculator can be calculated by entering your values in the calculator which can be downloaded from the below mentioned site.
The dose of statin advised is either high or moderate in order to reduce LDL cholesterol level by > 50% and 30-50% respectively
Lifestyle modification (i.e., adhering to a heart healthy diet, regular exercise habits, avoidance of tobacco products, and maintenance of a healthy weight) remains a critical component of health promotion and ASCVD risk reduction, both prior to and in concert with the use of cholesterol-lowering drug therapies.
CardioSource – 2013 ACC AHA Guideline on the Treatment of Blood Cholesterol.
Four decades of medical wisdom that cutting down on saturated fats reduces our risk of heart disease may be wrong, a top cardiologist has said. Fatty foods that have not been processed – such as butter, cheese, eggs and yoghurt – can even be good for the heart, and repeated advice that we should cut our fat intake may have actually increased risks of heart disease, said Dr Aseem Malhotra.
Writing in the British Medical Journal, he argues that saturated fats have been “demonised” since a major study in 1970 linked increased levels of heart disease with high cholesterol and high saturated fat intake.
The NHS currently recommends that the average man should eat no more than 30g of saturated fat a day and women no more than 20g. However, Dr Malhotra, a specialist at Croydon University Hospital, said that cutting sugar out of our diets should be a far greater priority.
He told The Independent: “From the analysis of the independent evidence that I have done, saturated fat from non-processed food is not harmful and probably beneficial. Butter, cheese, yoghurt and eggs are generally healthy and not detrimental. The food industry has profited from the low-fat mantra for decades because foods that are marketed as low-fat are often loaded with sugar. We are now learning that added sugar in food is driving the obesity epidemic and the rise in diabetes and cardiovascular disease.”
A recent study indicated that 75 per cent of acute heart attack patients have normal cholesterol concentrations, suggesting that cholesterol levels are not the real problem, Dr Malhotra argued.
He also pointed to figures suggesting the amount of fat consumed in the US has gone down in the past 30 years while obesity rates have risen.
Bad diet advice has also led to millions of patients being prescribed statins to control their blood pressure, he argues, when simply adopting a Mediterranean diet might be more effective.
What are the types of Fats in our body?
The human body contains different types of fats or lipids. Lipids are important chemicals present in the body and needed for various cellular functions. The fats in our body are of different types. They can simply be divided in Bad and Good fats.
Which are the Bad fats/ lipids? How do they harm us?
The Bad fats get deposited in our arteries thereby causing blocks. These blocks decrease the blood supply of the organs causing various serious illnesses like heart attacks (decrease blood supply to the brain), paralytic strokes (decrease blood supply to the brain), or gangrene of the limbs (decrease blood supply to the limbs). Thus it is important to keep our Bad cholesterol below the normal range. There are 2 types of Bad Cholesterol in our body: LDL Cholesterol and Triglycerides. Higher levels of Bad Cholesterol can be harmful in the long run.
Which are the Good fats/ lipids? Do they harm us?
The Good Cholesterol is protective and higher levels are better. The Good Cholesterol in our body is HDL Cholesterol.
How do we know our fat/lipid level?
One needs to do a Complete lipid profile (blood test) after 12 hours of fasting.
What should be your LDL (Bad) Cholesterol level?
If one suffers from any of the below mentioned illnesses, then the LDL Cholesterol needs to be below 100 mg/dl. These disorders are
Does diet and exercise help to reduce Bad Cholesterol?
Yes, they do. Brisk walking every day for 30-45 minutes can help reduce your bad cholesterol and increase your good cholesterol. Avoiding foods rich in fats like fried food, cakes, sweets can also help reduce the bad cholesterol.
Are there medicines which reduce Bad Cholesterol and prevent heart attacks?
Statins are called the wonder drugs which reduce LDL cholesterol. These drugs are extremely safe and also decrease triglyceride levels and increase the good cholesterol! They have been proven to prevent heart attacks and in some cases reduce the blocks! These drugs need to be taken on a daily basis and need to be continued lifelong.
How many individuals have their blood-pressure and cholesterol levels under control?
Less than one third!
Less than one in three patients in the US have their blood-pressure and cholesterol levels under control, according to a new analysis of the National Health and Nutrition Examination Surveys (NHANES). Researchers say there exist significant opportunities for improving hypertension and cholesterol control.
People with high blood pressure have about double the risk of coronary heart disease, but treating hypertension only reduces heart attack risk by only 25%. It is important to treat and control both high blood pressure and cholesterol.
In the study, published online July 1, 2013 in Circulation, the researchers assessed concurrent hypertension and hypercholesterolemia control in NHANES 1988 to 1994, 1999 to 2004, and 2005 to 2010.
Across the three surveys, 60.7% to 64.3% of the individuals with hypertension also had high cholesterol levels.
The control of LDL-cholesterol levels increased over time, up from 9.2% in 1988-1994 to 45.4% in 2005-2010.
In 2005-2010, approximately 54% of all hypertensive patients had good blood-pressure control, defined as <140/90 mm Hg. In total, 21.5% of all hypertensive patients were treated and uncontrolled.
For patients with high blood pressure and elevated cholesterol levels, the concomitant control of both risk factors increased approximately sixfold from 1988-1994 to 2005-2010. The control of blood pressure and LDL-cholesterol levels increased from 5.0% in 1988-1994 to 30.7% in 2005-2010.
“What we find is that while there has been a lot of progress in controlling both blood pressure and cholesterol, still about 70% of patients who have high blood pressure and high cholesterol don’t have both risk factors controlled,” said Egan, the lead author of the study.