Heart Health Through Whole Foods Certain whole foods in a diet can ultimately provide heart-healthy benefits. The right foods consumed in the right amounts can help lower cholesterol and/or triglycerides. They may also help to reduce risk for heart disease. Even though the benefits of whole foods may be known, too often individuals turn to over-the-counter supplements instead. It is important to discuss all supplements prior to ingestion with your physician. Individuals may not realize that taking some supplements with certain medications may be harmful or that taking too much of a good thing can be bad. The purpose of this session is to educate how to obtain certain nutrients through whole foods rather then through supplements. It must be noted that some individuals may still need supplements in addition to diet. Once again this should be guided by a physician. Supplement Health Benefits Caution Dietary Alternative Omega-3 Fatty Acids: Fish oil is used for There are some safety concerns Consuming fish oil from dietary Fish Oils reduction in cholesterol about using high doses of fish oil. sources such as fatty fish (e.g., and triglycerides. It is Doses greater than 3 grams per tuna, salmon), two servings Fish oils contain used for hyperlipidemia, day can inhibit blood coagulation per week, is associated with Eicosapentaenoic hypertriglyceridemia, and potentially increase the risk a reduced risk of developing Acid (EPA) and coronary heart disease of bleeding. Doses greater than 3 cardiovascular disease Docosahexaenoic and hypertension. grams per day might also suppress (primary prevention). Acid (DHA) immune response. Patients should Fish oil from supplements only take high-dose fish oil while These benefits may also or from dietary sources can under medical supervision. be seen in patients with reduce triglyceride levels by existing cardiovascular 20 to 50 percent. disease (secondary prevention). Aim for 3.5 ounces of salmon twice a week. Omega-3 Fatty Acids: Preliminary evidence shows Krill oil supplements contain less of Krill Oil that a specific krill oil the omega-3s EPA and DHA than product (Neptune Krill Oil, fish oil supplements. But overall Krill are tiny shrimp- Neptune Technologies & there’s much better evidence that like crustaceans. Bioresources, Inc.) can lower fish oil can lower triglycerides and Promoters say that cholesterol and triglycerides. cardiovascular risk. krill oil provides similar cardiac benefits as fish Krill oil may be suggested to healthy oil, but with fewer people who want to add these capsules and no fishy omega-3s to their diet but can’t taste. Manufacturers tolerate fish oil. claim krill oil is better absorbed. Omega-3 Fatty Acids: In hypertriglyceridemia, cod Orally, cod liver oil can have a fishy Cod Liver Oil liver oil is thought to lower taste and might cause belching, triglycerides by decreasing nosebleeds and heartburn. High Cod liver oil is less secretion of very low-density doses can cause nausea and loose expensive than the fish lipoproteins (VLDLs) and stools. Some gastrointestinal side oil concentrates. through other means. effects can be minimized if cod liver oil is taken with meals and It contains relatively Cod liver oil might if doses are started low and large amounts of moderately lower gradually increased. vitamin A and vitamin blood pressure. D. On average, 20 mL There is also some concern about of cod liver oil contains vitamin A and vitamin D toxicity in 1.8 grams EPA, 2.2 people using cod liver oil long term. grams DHA, 15,000 IU Upper limit for vitamin A is 10,000 vitamin A, and 1,500 IU IU and the upper limit for vitamin D vitamin D. daily is 4,000 IU. The upper limit of intake is the highest possible intake before adverse health effects may take place. Concomitant use of herbs that might affect platelet aggregation could theoretically increase the risk of bleeding in some people. Also, combining cod liver oil with other herbs or supplements with blood pressure lowering effects might increase the risk of hypotension. Supplement Health Benefits Caution Dietary Alternative Flaxseed Diets that are low in Alpha-linolenic acid, even with long- 1 tablespoon or 1 ounce daily in Alpha-Linolenic Acid n-3 fatty acids create an term consumption, doesn’t have conjunction with 3.5 ounces of imbalance that is linked the same effect as fish oil or fatty salmon twice a week. to several conditions fish consumption on triglyceride such as coronary heart concentrations and low density Other foods higher in alpha- disease, hypertension and lipoprotein (LDL) cholesterol. linolenic acid are walnuts, inflammatory disorders. This form of fatty acid needs soybean and canola oil. Consuming flaxseed is a to be converted in the body to way to increase the n-3 EPA and DHA. Diets high in linolenic content of diet. acid or high in saturated fat reduce this conversion. Claims of flaxseed reducing triglycerides are inconclusive To prevent intestinal blockage, at as it may actually increase least 5 ounces of fluid is required for triglycerides in those with every 10 grams of whole flaxseed hypertriglyceridemia. At this intake. Doses greater then 45 grams 1 tablespoon or 1 ounce will time there is insufficient flaxseed powder are associated provide ~7 grams of Alpha- research to support with laxative effects. Since it is bulk- linolenic acid. the claim that flaxseed forming, avoid use with individuals reduces risk of stroke or with bowel obstruction, esophageal Food and Nutrition Board of heart attack. Flaxseed stricture or acute intestinal the Institute of Medicine have appears to increase EPA inflammation. set guidelines for intake of concentrations at times but 1.6 grams daily for men and has not consistently lowered Theoretically flaxseed may increase 1.1 grams daily for women. serum LDL cholesterol and bleeding/clotting time when taken triglycerides. with other blood-thinning drugs or supplements; use should be monitored by physician. Fiber Soluble fibers can help May experience intestinal gas and/or Institute of Medicine has Soluble and Insoluble lower LDL cholesterol bloating with dramatically increased recommended an Adequate by interfering with the intakes. Increasing fiber gradually Intake of Fiber of 20 – 40 absorption of dietary will allow your body to adapt. grams per day based on age cholesterol. Because some fibers absorb water, and gender. In order to meet in you should also drink more water as diet, consume 5 cups of fruits Insoluble fibers are you increase fiber. and vegetables per day and 3 considered as gut-healthy servings of whole grain. fiber because they have a Excessive fiber can interfere laxative effect and add bulk with certain vitamin and to the diet, helping prevent mineral absorption. constipation. Soy Proteins There is some evidence Women with breast cancer Consume whole foods that that soy protein can reduce should avoid using soy protein contain whole soy such as cholesterol in individuals supplements as there are concerns soybeans, edamame nuts, with hypercholesterolemia, that these supplements possess soy milk, miso and tofu. however the results are weak estrogenic activity that may minimal. There is little effect stimulate cancer proliferation in on cholesterol reduction women with breast cancer. in those with normal cholesterol. Thus soy is not Soy can interfere with some an effective supplement medications such as medications for for prevention of heart thyroid and estrogen replacement disease but rather soy foods therapy. Talk with your physician should be considered as a about soy. cardioprotective because they are low in fat and saturated fat and high in fiber and minerals. Supplement Health Benefits Caution Dietary Alternative Garlic Some evidence does show Garlic when taken as a food or Most studies have used the garlic can reduce LDL supplement may increase bleeding equivalent of ~1 garlic clove cholesterol, triglycerides and time when taken with other blood- per day. To optimize the blood pressure; however, thinning drugs or supplements. therapeutic effects, some the evidence for garlic and Garlic supplementation can also research suggests crushing cardiovascular disease risk interfere with some medications raw garlic and then allowing reduction is not strong. so use should be monitored by it to sit for 10 minutes to physician. help retain properties that are normally destroyed by heat. Coconut Oil Medium chain fatty acid High in calories and saturated fat Not enough information is that is more likely to be that may lead to weight gain and available on the quantity absorbed rather then elevated cholesterol. recommended or the population stored and is often used who should use it. for weight loss. References Academy of Nutrition and Dietetics. Evidence Analysis Library. Disorders of Lipid Metabolism. Food and Nutrition Board, Institute of Medicine, National Academies. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fatty Acids, Cholesterol, Protein, and Amino Acids. 2002/2005. Fragakis, Allison. Thomson, Cynthia. The Health Professional’s Guide to Popular Dietary Supplements, 3rd Edition. American Dietetic Association. 2007. Natural Medicines Comprehensive Database. DHA (Docosahexaenoic Acid), EPA (Eicosapentaenoic Acid), fish oil, and cod liver oil. To schedule an appointment with a University Hospitals dietitian, please call 216-844-1499. A physician referral is required to make an appointment. Our schedulers can assist in obtaining the appropriate referral. Presented by: Heather Butscher, MS, RD, LD Outpatient Clinical Dietitian, Nutrition Services University Hospitals Chagrin Highlands Health Center 3909 Orange Place, Suite 4100 Orange Village, OH 44122 © 2014 University Hospitals CAR 00467.