Eat this, not that for a healthy heart

Janelle Melgeorge Anderson, MEd, RD, LD Fairview Southdale Hospital Diet Confusion

• Mediterranean diet • DASH diet (Dietary Approach to Stop Hypertension) • AHA diet (American Heart Association) • TLC diet (Therapeutic Lifestyle Changes- National Heart Lung and Blood Institute) Mediterranean diet

• Basics – 3-8 servings of fruits and vegetables – Inclusion of : • Olive oil • Whole grains • Beans and legumes • Fish and seafood • Poultry, eggs, cheese and yogurt – Limit red meat – Limit sweets

University of Minnesota Health brand represents a collaboration between University of Minnesota Physicians and University of Minnesota Medical Center. Table 1. Validated 14-item Questionnaire of Mediterranean diet adherence.

Martínez-González MA, García-Arellano A, Toledo E, Salas-Salvadó J, Buil-Cosiales P, et al. (2012) A 14-Item Mediterranean Diet Assessment Tool and Obesity Indexes among High-Risk Subjects: The PREDIMED Trial. PLOS ONE 7(8): e43134. doi:10.1371/journal.pone.0043134 http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0043134 DASH diet (Dietary Approach to Stop Hypertension) • Consists of eating vegetables, fruits, and whole grains • Includes fat-free or low-fat dairy products, fish, poultry, beans, nuts, and vegetable oils • Limits foods that are high in saturated fat, such as fatty meats, full-fat dairy products, and tropical oils such as coconut, palm kernel, and palm oils • Limits sugar-sweetened beverages and sweets DASH diet

Food Group Daily Servings Grains 6–8 Meats, poultry, and fish 6 or less Vegetables 4–5 Fruit 4–5 Low-fat or fat-free dairy products 2–3 Fats and oils 2–3 Sodium 2,300 mg Weekly Servings Nuts, seeds, dry beans, and peas 4–5 Sweets 5 or less DASH diet

• Studies show 1,500 milligrams (mg) sodium lowers blood pressure even further than 2,300 mg sodium daily. • When following the DASH eating plan, it is important to choose foods that are: – Low in saturated and trans fats – Rich in potassium, calcium, magnesium, fiber, and protein – Lower in sodium Olive oil

• PREDIMED study – 50 mL/d (3 T) and 1 liter/wk given to participants • Decreases LDL and increases HDL • Nutritional compounds – Monounsaturated fat – Oleic acid – Vitamin E – Phenolic compounds-increase nitric oxide production and reduce free radicals Nuts

• PREDIMED study – ( 1 oz. nuts = 30 grams provides 200 calories) • 15 grams walnuts • 7.5 grams almonds • 7.5 grams hazelnuts Nuts

• Benefits of nuts: – cholesterol free – Sources of • dietary fiber and protein • vitamin E (a potent antioxidant)

• folic acid, niacin, magnesium, vitamin B 6, zinc, copper and potassium. – nonessential amino acid arginine that protects the inner lining of the arterial walls, making them more pliable and less susceptible to atherogenesis – a good source of phytochemicals (biologically active plant chemicals which contain high antioxidant properties linked to prevention of coronary heart disease) Nuts

• Nut serving sizes (range from 160-200 calories per serving) • 24 almonds • 18 medium cashews • 12 hazelnuts or filberts • 8 medium Brazil nuts • 12 macadamia nuts • 35 peanuts • 15 pecan halves • 14 English walnut halves Benefits of Omega 3 Fatty Acids

Lower triglyceride levels, increase HDL Lower resting blood pressure Decrease platelet aggregation and prevent blockage of coronary artery Decrease risk of arrhythmias Reduce inflammatory markers Sources include salmon, tuna, walnuts, flaxseeds Fish

• Mediterranean diet > 3 servings per week • American Heart Associations recommends 2 servings fish per week (3 oz. portion sizes) Legumes

• Mediterranean diet > 3 servings per week • DASH diet 4-5 servings per week Red meat

• PREDIMED study/Mediterranean diet <1 serving per day • Red meat includes beef, pork and lamb • New research looking at red meat consumption and heart disease

Red meat TMAO consumption Gut microbes (trimethlyamine Atherosclerosis (L-carnitine) n-oxide)

Koeth, Robert A., et al. "Intestinal microbiota metabolism of L- carnitine, a nutrient in red meat, promotes atherosclerosis." Nature medicine 19.5 (2013): 576-585. Sugar

• Ongoing research on sugar consumption, inflammation and its association with cardiovascular disease • 2015-2020 Dietary Guidelines recommends <10% calories from sugar • American Heart Association recommends reducing added sugar to: – 25 grams (6 tsp)= 100 calories for women – 37 grams (9 tsp) = 150 calories for men Eggs

• Recent meta-analysis suggests daily egg intake does not appear to be associated with risk of CHD. • Eggs are inexpensive and nutrient-dense whole food that provides protein, essential fatty acids, antioxidants, choline, vitamins, and minerals • 2015-2020 Dietary Guidelines for Americans removed cholesterol recommendations

Alexander, Dominik D., et al. "Meta-analysis of Egg Consumption and Risk of Coronary Heart Disease and Stroke." Journal of the American College of Nutrition 35.8 (2016): 704-716 Summary

Focus on overall dietary patterns for reduced cardiovascular risk: • Omega 3 fatty acid sources • Olive oil • Nuts • Fruit and vegetable intake • Limit meat • Reduce sugar References

• Alexander, Dominik D., et al. "Meta-analysis of Egg Consumption and Risk of Coronary Heart Disease and Stroke." Journal of the American College of Nutrition 35.8 (2016): 704-716 • Appel, Lawrence J., et al. "Effects of comprehensive lifestyle modification on blood pressure control: main results of the PREMIER clinical trial." JAMA: Journal of the American Medical Association (2003). • Fuller, Nicholas R., et al. "The effect of a high-egg diet on cardiovascular risk factors in people with type 2 diabetes: the Diabetes and Egg (DIABEGG) study—a 3-mo randomized controlled trial." The American journal of clinical nutrition 101.4 (2015): 705-713. • Estruch, Ramon. "Anti-inflammatory effects of the Mediterranean diet: the experience of the PREDIMED study." Proceedings of the Nutrition Society 69.03 (2010): 333-340 • Estruch, Ramón, et al. "Primary prevention of cardiovascular disease with a Mediterranean diet." New England Journal of Medicine 368.14 (2013): 1279-1290. • Koeth, Robert A., et al. "Intestinal microbiota metabolism of L-carnitine, a nutrient in red meat, promotes atherosclerosis." Nature medicine 19.5 (2013): 576-585. • Kris-Etherton, Penny M., William S. Harris, and Lawrence J. Appel. "Fish consumption, fish oil, omega-3 fatty acids, and cardiovascular disease." circulation 106.21 (2002): 2747-2757. • Martínez-González, Miguel Angel, et al. "A 14-item Mediterranean diet assessment tool and obesity indexes among high-risk subjects: the PREDIMED trial." PloS one 7.8 (2012): e43134. • Martínez-González, Miguel A., et al. "Benefits of the Mediterranean diet: insights from the PREDIMED study." Progress in cardiovascular diseases 58.1 (2015): 50-60. • Ros, Emilio, et al. "Mediterranean diet and cardiovascular health: teachings of the PREDIMED study." Advances in Nutrition: An International Review Journal 5.3 (2014): 330S-336S. • Sacks, Frank M., et al. "Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet." New England journal of medicine 344.1 (2001): 3-10. • Svetkey, Laura P., et al. "The DASH diet, sodium intake and blood pressure trial (DASH-sodium): rationale and design." Journal of the American Dietetic Association 99.8 (1999): S96-S104.