After three-and-a-half days of presentations on nutrition research at the American Heart Association (AHA) conference, here’s EN’s takeaway on today’s big questions on heart health.
Saturated and Trans Fats: Still Targets
Despite questions raised by headlines, limiting saturated fat remains important for heart health, according to Robert Eckel, MD, director of the Lipid Clinic at University of Colorado Hospital. The average American needs to cut saturated fat in half to meet the new American Heart Association recommendation of no more than five to six percent of calories daily, which would reduce LDL (“bad”) cholesterol by up to 11 mg/dL. If you eat about 2,000 calories a day, that’s 11 to 13 grams (g) of saturated fat a day. A regular fast food cheeseburger has 5-12 g of saturated fat, for example. While this goal may be challenging for some, fortunately, it’s not all-or-nothing: any drop in saturated fat reduces risk.
Trans fat, from partially hydrogenated oils in many processed snack and convenience foods, poses the greatest heart risk. Amounts are dropping, but it still warrants checking nutrition labels to avoid trans fat as much as possible.
Evidence no longer supports foods’ cholesterol content as an important influence on blood cholesterol or heart risk, except possibly for people with diabetes or extremely high LDL levels. The biggest implication is that you may not need to limit eggs as much as advised in years past, although unlimited use won’t fit with tight recommendations on saturated fat, either.
How to Replace Saturated Fat?
What do you include in your diet in exchange for saturated fat? Here are multiple strategies.
- Polyunsaturated fat (found in nuts, seeds, and canola, soybean and other vegetable oils) brings the biggest drop in LDL cholesterol.
Action examples: Replace cheese in a salad with almonds or walnuts. Switch one meal a week from red meat to fish; you’ll get more of both omega-6 and the especially heart-healthy omega-3 fats.
- Monounsaturated fat (found in olives, olive oil, avocado, and peanuts) brings a smaller, but still strong, decrease in LDL.
Action example: Replace sour cream with sliced or mashed avocado.
- Protein consumption is another way to reduce saturated fat—if added primarily from plant sources, with smaller increases in egg whites and fish.
Action example: Modify your usual casseroles, pasta dishes and stews, replacing all or some of the meat with tofu, lentils or beans.
- Carbohydrate as a replacement for saturated fat doesn’t lower LDL quite as much as the options above, but choices high in fiber and nutrients can bring multiple benefits. High-carbohydrate foods protect heart health when they supply dietary fiber and health-protective phytochemicals and nutrients.
Action examples: Have fruit with breakfast instead of bacon. Eat nutrient- and fiber-rich fruit instead of cookies, sweet rolls, donuts and ice cream (desserts are one of the top contributors to saturated fat in the average American diet). Let whole grains and vegetables star in mixed dishes.
Total Nutritional Quality Matters Most
Effects on heart health seem most closely tied to the total nutritional quality of the diet, rather than a focus on individual nutrients, such as total fat or carbohydrate intake. The Mediterranean diet’s focus on plant foods, nuts, olive oils, and vegetable consumption is a common thread tied to a lower risk of cardiovascular disease. In contrast, the long-term use of low-carbohydrate, high-protein diets can threaten heart health, emphasized Linda Van Horn, PhD, RD, a cardiovascular nutrition expert from Northwestern University in Chicago.
Weight and Waist
Excess body fat, mainly around the waist, triggers inflammation and insulin resistance, posing serious heart disease risk. Whatever your weight, make smart food swaps and add physical activity into your everyday life to prevent unwanted weight gain. Contrary to popular opinion, after six months neither low-fat nor low-carbohydrate diets show any better weight loss or reduction in the visceral fat deep in the abdomen that poses most risk, says Frank Sacks, MD, professor of cardiovascular disease prevention at Harvard School of Public Health. Most important is creating new habits for the long-term.
According to guidelines from the AHA in collaboration with other organizations, health risks decrease with a three to five percent weight loss—10 to 20 pounds or less for most people. A lifestyle approach to losing and maintaining weight that provides support—such as counseling and support groups—for at least six months is important; short-term efforts don’t bring long-term results, emphasizes Sacks.
A Culture of Health
Major studies show that people who eat a healthy diet, don’t smoke, get regular physical activity throughout the week, and maintain a healthy weight and waist size prevent about 80 percent of heart attacks and 93 percent of type 2 diabetes, as well as substantially reducing their risk of stroke and cancer.