Transcript 6. Fats, cholesterol, and cardiovascular disease

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FATS AND CHOLESTEROL
www.nutsforlife.com.au.
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1. Key Concepts and Facts
Fats are concentrated source of energy
Fats carry essential fatty acids and fatsoluble vitamins
Fats have positive and negative health
effects
Saturated fats and trans fats raise blood
cholesterol levels more than any other fat
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2. Roles of Dietary Fat
Increases the flavor and palatability of
foods
 Absorb and retain flavor
Provides sustained relief from hunger
 Stay in stomach longer
 Absorbed from small intestine more
slowly
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T
Lipids (Fats)
Component of cell
membranes
Regulate transfer of
nutrients
Cushions kidneys &
heart
Protects and
insulates organs
In 1926, Gertrude Ederle became the
first woman and sixth person to swim
across the English Channel, in 14.5
hours, beating the men's record by 2
5
hours.
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Fig. 18-3, p. 5
A Short Saturated Fatty Acid
Butyric Acid
A carboxylic group,
COOH
A chain of 3 carbons
Saturated with
hydrogen
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A Triglyceride
Glycerol
3 stearic acid
molecures
saturated fatty acids
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Common Fatty Acids
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Coconut Oil?
About half the fatty
acids in coconut oil
are lauric acid
Coconut oil is about
90% saturated fat
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Butter: 64%
Beef fat: 40%
Lard: 40%
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Essential Fatty Acids
Omega 3
Alpha Linolenic Acid
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ALA
From Fish & Flax
DHA & EPA
Omega 6
Linoleic Acid (LA)
Sunflower, safflower,
soybean & corn
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More on essential fatty acids
ALA can be converted to DPA, DHA, and EPA
5- linus pauling institute, http://lpi.oregonstate.edu
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Functions of Essential Fatty Acids
crucial role in brain function
needed for normal growth and
development
may reduce the risk of heart disease.
reduces inflammation
may lower risk of chronic diseases such
as cancer, and arthritis
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Fatty Acid Composition of Fats
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Where to Get Omega 3’s
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Fortification with Omega 3’s
Research beefing
up steaks,
hamburgers with
healthy omega-3s
By ROXANA
HEGEMAN
Oct. 9, 2015
Eggs 130 mg
EPA+DHA
200 mg EPA+DHA
per 5 oz serving
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Excellent source of Omega-3s EPA/DHA &
ALA ?
32mg EPA/DHA per serving. 400mg
ALA per serving
$10
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YOUNG WOMEN:
MERCURY GUIDELINES
Do not eat Shark, Swordfish, King
Mackerel, or Tilefish.
Eat up to 12 ounces (2-3 average meals)
a week of a variety of fish and shellfish
that are low in mercury.
Check local advisories about the safety of
fish caught in local lakes, rivers, and
coastal areas
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What is Hydrogenation of Fats?
Oleic Acid
Stearic Acid
Linoleic Acid
Stearic Acid
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Partial Hydrogenation
creates trans fats
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Why are food companies
working to remove trans
fat from foods?
Jan. 2006, trans fat
content added to labels.
2018 deadline for food
companies to eliminate
trans fat from their
products.

OK in products like meat
and cheese where they
occur naturally
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Vitamin D, and bile
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Cholesterol+Sun = Vitamin D
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Trans fats or trans fatty acids: contain fatty acids in the trans form.
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Mediterranean Diet
Groups who consume high fat diets can have average or below
average rates of heart and other chronic diseases
The traditional Mediterranean diet is based on whole grain
products, vegetables, fruits, nuts, olive oil, dried beans, wine,
fish, and poultry
35-40% of calories come from fat, mostly monounsaturated
People eating the Mediterranean diet tend to be physically
active and normal weight or lean
Despite high fat content, people with that diet and lifestyle have
low rates of heart disease and cancer, and long life expectancy
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Progress
Recent recommendations for fat intake are
a change in dietary intake guidance
Change developing for years as research
results supported new recommendations
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Fat Intake Recommendations
Do I need to watch my percentage of
calories from fat?
Willett: No. As long as you use healthy
fats, and your keep your portion sizes
modest, it doesn’t matter if your dish or
meal has 40 percent or more of its
calories from fat. The same is true for
your diet: Focus on choosing foods with
healthy fats, not the percentage fat.
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Recommendations
Americans encouraged to increase
consumption of EPA and DHA by eating
fish more often (i.e., twice a week)
Most Americans consume enough
linoleic acid, but intakes of alphalinolenic acid tend to be low
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Our saturated fat intake averages 1112% of calories, and increases risk of
heart disease
Recommendation is that saturated fat
intake should be no more than 10% of
calories
Intake of trans fats should be very low
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Nutrition & Heart
Disease
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Key Concepts and Facts
Heart disease is leading cause of death
Dietary and lifestyle factors are important
Diets that provide some “healthy fats”
decrease heart disease risk more than low
fat, high carbohydrate diets
Lowering high blood cholesterol levels
reduces risk of heart disease
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Heart disease is the leading cause of
death for both men and women.
About
600,000
people die of
heart disease
in the United
States every
year–that’s 1
in every 4
deaths.
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Fig. 19-2, p. 3
Average age of first heart attack is 64.7 years for men and
72.2 years for women.
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Risk of Cardiovascular
Disease
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Fig. 19-6, p. 4
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Fig. 19-3a, p. 3
Atherosclerosis
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Fig. 19-3b, p. 3
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Fig. 19-4, p. 4
CAN THESE BE
SYMPTOMS
OF RISK OF
HEART
DISEASE?
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Xanthomas– fat deposits
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Total Cholesterol:
Not the whole story
Harvard Health News
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Fig. 19-8, p. 6
FOCUS ON BLOOD LIPIDS
HDL helps remove cholesterol from the
blood
HDL carries cholesterol to the liver for excretion
High HDL (> 50 mgm/dl for women, >40 in men)
protects against CVD
LDL cholesterol incorporated into plaque
Higher the LDL level, more likely
atherosclerosis will develop and progress to
heart disease
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Dr. Willet on Coconut Oil
In short term studies, coconut
oil raised HDL cholesterol
There are no long term
studies on coconut oil and
heart- health
Coconut oil has a wonderful
flavor and texture-- there's no
problem using coconut oil
occasionally. But most of
your oils should be healthier.
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Triglycerides and CVD Risk
High levels increase heart disease risk
Elevated triglycerides are one symptom of
metabolic syndrome
 Also low HDL cholesterol
 Elevated fasting glucose
 Abdominal obesity
 High blood pressure, low HDL
People with metabolic syndrome are at
particularly high risk for heart disease
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Other Factors:
Folate and Homocysteine
High blood levels of homocysteine, an
amino acid, increase plaque formation
Folate is required to convert the
amino acid homocysteine to
methionine, reducing homocysteine
in the blood.
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Harvard Health News
There is some evidence that B vitamins,
including folic acid, B6, and B12, may
help lower blood levels of a substance
called homocysteine
The risk of heart attack or death from
heart disease was nearly halved among
women who consumed the most folic
acid and B6 from diet and supplements
compared with those who consumed
the least.
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Folate, B6 and B12
One meta-analysis showed that
consumption of 400 mgm folic acid in
fortified foods or supplements reduced
homocysteine by 25%
When folic acid was combined with
vitamin B12, homocysteine levels sank
another 7%
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Since 1998 refined grain products like bread, crackers, pasta, and
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rice have been fortified with folic acid.
Antioxidants and Anti-inflammatories
Oxidation causes
damage to
endothelium (cells
lining arteries)
Inflammation
increases plaque
formation
Textbook correction: p. 19-7 line 20:
change to “other components of
foods that reduce oxidation…”
Table 19-1
Foods that reduce oxidation
and chronic inflammation
Fish, seafood
Nuts
Coffee, tea, wine
Most fruits and
vegetables
Whole grains, highfiber foods
Vegetable oils
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DHA and EPA
Fatty fish from cold waters are highest
sources of DHA and EPA
Omega-3 fatty acids protect against heart
disease by:
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decreasing blood clotting
decreasing blocked arteries
decreasing plaque build-up
decreasing blood pressure
decreasing blood triglyceride
levels
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Nuts
Nut consumption
decreases risk of
CVD
Nuts have good fats
that lower LDL
1 oz of nuts a day
decreases LDL
1 oz has ~200
calories
FDA approved “heart
healthy” claim for nuts
and products made
from them
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Coffee?
High in antioxidants
Role in the
prevention of
degenerative
illnesses like cancer,
high blood pressure
and cardiovascular
disease
Lower risk of Type 2
Diabetes
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Analysis of 84 of the best studies looking at the alcohol and heart connection
included more than two million men and women followed for an average of 11
years. Compared to people who didn’t drink alcohol, those who were moderate
drinkers had a
29% lower risk of being diagnosed with coronary artery disease
25% lower risk of dying from a heart attack
25% lower risk of dying from any heart or blood vessel disease
13% lower risk of dying from any cause (this included cancer deaths, too)
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Spicy Food Linked to a
Longer Life, 2015 study
Capsaicin
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main ingredient in chili
peppers, had been
found in other studies to
have antioxidant and
anti-inflammatory
effects
www.hsph.harvard.edu/
nutritionsource
Compared to eating
hot food, mainly chili
peppers, less than
once a week, having
it once or twice a
week resulted in a
10 percent reduced
overall risk for
death.
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Fruits, Veggies, Whole
Grains….Fiber !
High intake of dietary fiber
has been linked to a lower
risk of heart disease in a
number of large studies that
followed people for many
years. (Harvard Studies)
Study of over 40,000 male
health professionals, a
high total dietary fiber
intake was linked to a 40
percent lower risk of
coronary heart disease.
A related Harvard study of
female nurses produced
similar findings.
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When Blood Lipids Are High
Total cholesterol is sum of the levels of LDL-,
HDL-, and VLDL-cholesterol
Dietary recommendations:
specific types of fat and foods that lower
levels of LDL and triglycerides, and raise
levels of HDL
adequate intake of folate, and vitamins B6
and B12 are recommended to decrease
elevated homocysteine levels
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Special Spreads
Spreads with plant stanols lower blood
cholesterol levels by blocking cholesterol
absorption
Daily consumption of two tbsp of spread with
plant stanols or sterols causes 10% drop in
cholesterol level and 14% decline in LDL
concentration
Blood triglycerides also lowered
Blood levels of HDL are not affected
Spreads are one more tool for lowering high
blood cholesterol levels
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$10
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Reduce LDL
Limit saturated fat intake to less
than 7% of total calories
Exclude processed foods that
contain trans fats
Increase monounsaturated fats, not
polyunsaturated fats
Increase whole grain products, fiber,
vegetables, fruits, soy protein foods,
and plant stanols that lower LDL without
decreasing HDL levels
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Increase HDL Levels with
vigorous exercise
eliminate trans
fats
weight loss
soy and nuts in
the diet
moderate alcohol
Harvard Health
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If Blood Lipids are still too high
Cholesterol-lowering drugs if
blood lipid changes achieved
by diet and lifestyle
improvements are
insufficient
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Statins
Statins (Lipitor, Zocor, and Mevacor)
markedly reduce cholesterol production
in the liver
Use related to a 30% drop in LDL levels
and a 30-40% reduction in heart attack
and stroke in both women and men
Statins improve blood lipids levels more
when combined with dietary and
lifestyle changes than when used alone
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Statins
Side effects such as
Muscle pain and weakness
Liver disease
Kidney failure
Memory loss
Increased risk of Type 2 diabetes
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Statins
Expense
Cost and side
effects have
prompted
alternatives like
extreme cholesterollowering diets
Therapeutic diets
can lower LDL and
keep statin dose as
low as possible
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Diet, Lifestyle & CVD
Many factors in heart disease
Prevention & Treatment need to be broad
Include
heart-healthy diet or therapeutic diet
 reduction of high blood pressure
 body weight
 drugs
 smoking cessation
Goals: improved overall health and blood lipid
profiles
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USDA Diet vs Healthy Harvard?
Men who scored
highest on USDA’s
original Healthy Eating
Index reduced risk of
heart disease or other
chronic disease by 11
percent over 8-12
years of follow-up
compared to those who
scored lowest.
Men whose diets
most closely followed
the Healthy Eating
Pyramid lowered their
risk of cardiovascular
disease by almost 40
percent over 8-12
years of follow-up
compared to those
who scored lowest.
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USDA Diet vs Healthy Harvard?
Women who most
closely followed the
government’s
recommendations
were only 3 percent
less likely to have
developed a chronic
disease
Women with high
scores lowered their
risk by almost 30
percent.
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Fig. 19-10, p. 10
The Future
Prevention and treatment of heart disease has
changed in recent years and will continue to evolve
Concerns about the cost of cholesterol lowering
drugs and side effects, and availability of low-cost
preventive and treatment will affect these changes
Diet and lifestyle modification, changes in food
supply, & increased consumer involvement in risk
reduction may lead to decline in heart disease
An end to obesity and physical inactivity would also
serve our hearts well
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