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Foods for a Healthy Heart

According to recent estimates, nearly 60 million Americans have one or more forms of heart disease. Coronary artery disease, in particular, is the leading cause of death for both men and women in this country today.

If you are at risk for heart disease and you want to get serious about prevention, or if you have heart disease and want to manage it effectively, there are a number of lifestyle changes worth considering.

Exercise is an essential ingredient in the making of a healthy heart, as is proper diet.

Below, two physicians discuss a healthy diet for a healthy heart.

Some people think that in order to avoid heart disease they have to avoid fat entirely. Is this true?
NATE LEBOWITZ, MD: There are good fats. When taken in moderation, they can contribute to a healthy heart. And we've seen this from observing certain populations of the world.

Greenland Eskimos, for instance, take in 60-70% of their diet from fat, but they have very low rates of heart disease and cancer. It turns out that in cold-water fish, or the "fatty fishes", there is a substance called omega-3 fatty acid, which seems to protect the arteries. It lowers triglyceride levels. It improves glucose control in diabetics.

Do you also recommend that cardiac patients take supplements that contain these fats?
SAM BENJAMIN, MD: It depends on the patient, and what other problems they have in addition to heart disease. I would encourage people to really talk to their doctor, rather than use some single, general rule of thumb. Some people can't tolerate fish oils. Hemp oil is another rich source of omega-6 fatty acids, another helpful fat, as is flaxseed oil. These are good alternatives to fish oil.

What about the monosaturated fats that are found in olive oil and avocados. Are they good?
NATE LEBOWITZ, MD: The Mediterranean diet contains a very high amount of olive oil, and has for over 5,000 years, and yet they have relatively low rates of heart disease. It turns out that the polyunsaturated fats in general are good. Monounsaturated fat in olive oil can be fairly beneficial. It can lower and certainly stabilize LDL levels (the "bad cholesterol"), while not affecting HDL (the "good cholesterol"), and in some cases it may keep HDL stable, even raising it a little bit.

Why are trans-fats, which are found in many processed foods, detrimental to cardiac health?
NATE LEBOWITZ, MD: If the ingredients list "partially hydrogenated" oils, that's a good way to identify a trans-fat. The trans-fats don't exist in nature. They're manufactured, and they exist in a lot of processed foods-things that are in cans and things that are in boxes. They help keep things solid at room temperature.

In some observational studies, such as the Nurses' Health Study, which was a study of several hundred thousand post-menopausal women with no history of coronary heart disease, if you simply shift your energy intake by 2% or 5% away from the trans-fats in favor of another kind of fat, a polyunsaturated fat, the risk of coronary heart disease drops dramatically to upwards of 50%. So it turns out that trans-fats may well be very, very toxic chemicals.

What role does fiber play in heart health?
NATE LEBOWITZ, MD: Fiber in general is good. Essentially, if you're taking in a lot of fiber, you're not taking in a Big Mac. So from that perspective alone, it's good.

There is soluble fiber and insoluble fiber. Both reduce colon cancer rates, and both will lower cholesterol somewhat. A good example of the soluble fiber, which means it dissolves in our bloodstream, are the oat grains-oat bran, as opposed to the wheat bran, which is an insoluble fiber. The soluble fiber is beneficial because it lowers cholesterol dramatically. Flax is excellent because it has both soluble fiber and omega-3s. Oat grains, oat bran, pectins, like grapefruit pectin, fruit pectin are also soluble fibers. You can take in a lot of it very safely, and lower your cholesterol dramatically.

The problem is that, as a nation, we take in very little fiber in our diet. In one study, if we increased our amount to about 100 grams a day from the average of 10-20 grams, cholesterol levels dropped dramatically and colon health improved dramatically.

SAM BENJAMIN, MD: But soluble fibers affect absorption of medications that people might be taking. Even though these products can be gotten without a prescription, they need to remember to discuss with their physician whether or not they might in some way affect the levels of the medication in their bloodstream.

What role do soy products play in heart health?
SAM BENJAMIN, MD: Soy substantially decreases the risk of cardiovascular events. And it improves recovery afterward. Soy products can be responsible for decreasing levels of what are called apolipoproteins, which are parts of the lipids that are offensive to our body and increase our chances of heart disease.

For people concerned about cardiac health, what must they know about "good carbohydrates" vs. "bad carbohydrates"?
NATE LEBOWITZ, MD: The bad carbohydrates are the things from refined white flour, like cakes, cookies, muffins, and white bread. These things release their sugars into the body very quickly, and provide a big rise in sugar levels, which is followed soon after by a big rise in insulin. And insulin can be very damaging to the lining of the artery. Insulin lays down fat in the truncal region. And then it crashes down your sugar, so that a few hours later, you're starving and you have no energy and you have this so-called carbohydrate craving, which leads to the vicious cycle again. A lot of people who have a muffin or bagel for breakfast are starving by mid- to late morning, and they have no energy.

The good carbohydrates, like whole grains, legumes, garbanzos, kidney beans, and whole grain oatmeal, are harder to break down, and therefore release their sugars more slowly throughout the day. There's never that insulin peak, which is a good thing, because insulin peaks are bad. And they also don't cause that carbohydrate craving, and you're less hungry throughout the day, you eat less.

By: Sam Benjamin, MD and Nate Lebowitz, MD

Wishing you the best of health

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