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S.M.A.R.T. Heart 2013:
Nutrition Strategies
Nutrition…It’s a Science
“To protect yourself against nutrition cultism and
quackery, you should realize that what is true
about nutrition is not sensational and what is
sensational isn’t true. Nutrition is a science
and not black magic.”
Victor Herbert, MD, JD
1. Review your numbers, what they mean and
learn what changes you can make to care for
your future self
2. Explore the basics of better nutrition and
how to put out the “inflammatory fire”
3. Create a better/S.M.A.R.T. strategy based on
the latest information re: diet, exercise
recommendations and adequate sleep
Know Your Numbers
NIH recs:
Men - < 40 inches
Women - < 35 inches
WHO recs:
Men - < 37 inches
Women - < 31.5 inches
Know Your Numbers
What is Blood Cholesterol?
• Cholesterol is a waxy fat-like substance produced by
the liver and supplied by the diet through animal
• Cholesterol moves through your bloodstream to your
body’s cells in special carriers called lipoproteins
• Your body needs cholesterol to insulate nerves, form
cell membranes and make certain hormones. It makes
all it needs
Why Cholesterol Matters?
• Too much blood cholesterol contributes to fatty
build-up in the arteries – a major risk factor for
heart disease and stroke
• Too much cholesterol in the blood can be
trapped in artery walls
• Over time, this builds up and is called plaque
• Plaque can narrow vessels and make them
less flexible, a condition called atherosclerosis
or “hardening of the arteries”
What is LDL?
• Low-density lipoproteins (LDLs) or
“bad” cholesterol work like
delivery vehicles
• LDLs keep blood cholesterol circulating in your
bloodstream allowing plaque to attach to artery walls
• The higher the level of LDL cholesterol in the blood,
the greater your risk for heart disease
What is HDL?
• High-density lipoproteins (HDLs) or “good”
cholesterol can help protect your heart
• HDL acts like waste removal vehicles taking
cholesterol from blood and artery walls to the liver
where it is removed
• A low level of HDL cholesterol
increases your risk for heart
What Are Triglycerides?
• Fats also carried through the bloodstream
• If you eat excess calories from carbs, protein or fat
your body produces triglycerides and stores the extra
as body fat
• Measurements are affected by medication, hormones,
excess sugar and fat menstrual cycle, time of day and
recent exercise
• Elevated blood triglycerides can put you at risk for
Manage Your Cholesterol With
Three Key Lifestyle Steps
• Get moving
• Aim for a healthy weight
• Choose a heart smart eating program
Lower Your LDL
Through Diet
• Eat less saturated
– Women < 11-13
– Men < 16-18
Saturated Fat Violators
Premium ice cream (1 c)
Saturated fat
Cheesecake (5 oz)
Sausage (3 oz)
Ribeye (3 oz)
Hot dogs (1)
Butter (1 Tbsp)
Cheese (1 oz)
Whole milk (1 c)
Budget 11-18 grams of saturated fat per day
Ban Trans Fat
• raises LDL cholesterol similarly to
saturated fat
• lowers HDL cholesterol
• Trans fat is found mainly in foods made
with hydrogenated vegetable oils:
 Shortenings
 Snack foods
 Processed foods
 Bakery goods
 Hard margarines
Major Food Sources of Trans
Fats in the American Diet
Average daily intake of trans fats is 5.8 grams
Replace “bad” fats with
“good” fats
• Choose fats high in
“monos” and “polys’
which can lower LDL
and may increase HDL:
Olive oil
Nuts/nut butters
Fatty fish
Corn oil
Safflower oil
Sunflower oil
Add Omega-3 Fatty Acids
• Found mostly in seafood, especially higher fat
Albacore tuna
Rainbow trout
Omega-3 Benefits
Studies have shown beneficial trends with Omega-3 in:
Blood pressure
Resting heart rate
Risk of arrhythmia
Sudden death
Dry eyes
Autoimmune diseases
LDL/HDL cholesterol
All-cause mortality
Metabolic syndrome
Fetal growth/development
Physicians’ Health Study
Relative Risk of Sudden Cardiac Death
and Blood Omega-3 Levels
Continue On The Road To A
Healthy Heart
Plant stanols/sterols
Soluble fiber
Weight loss
Manage your blood
Incorporate Plant Stanols
and Sterols
• Plant compounds that block the
absorption of cholesterol form the
• National Cholesterol Education Program
guidelines: 2g/day can lower LDL
cholesterol by 5-15% within weeks
• Fortified products available
Soluble Fiber
• Oats: 3 grams per day*
1.5 cups cooked oatmeal/day or 3
plain packets instant
¼ cup dry oat bran
• Psyllium: 7 grams per day*
Metamucil (1Tbsp. Sugar-free/day)
Konsyl (2 heaping tsp./day)
• Beans, fruits, vegetables
* Supported by research to lower LDL 3-
Soluble Fiber Sources
3 packets plain instant
3 gms fiber
300 calories
¾ cup dry oatmeal
3 gms
¼ cup dry oat bran
3 gms
3 cups Cheerios
3 gms
2¼ cups Kashi Heart
to Heart
3 gms
5 Metamucil psyllium
7 gms
½ cup beans
2-3 gms
1 cup cooked
2-3 gms
2 medium fruits
2-3 gms
High Blood Pressure
• Cutting sodium by 2,000 mg a day could lead to 23%
fewer strokes and 17% less heart disease.
• The average American consumes 4,000 mg/day.
BMJ 339: B4567, 2009
Salt Shockers!
• Average 1 cup canned soup
1,000 – 1,200 mg
Try lower sodium options like:
Tabatchnick Low Sodium (frozen),
Health Valley No Salt, Campbell’s Ready
to Serve Low Sodium
Campbell’s Healthy Request, Healthy
Salt Shockers!
• Pretzels and other
salty snacks average
• 2 oz bag = 1280 mg
Try unsalted pretzels, baked
chips, original SunChips
Manage Your Sugars
• We now consume 22-30 tsp sugar/day =
350-475 extra, empty calories
• Recommendations (AHA, 2010):
– Women – 100 calories/day/added sugar
– Men – 150 calories/day/added sugar
Beverages = Liquid Candy
Big Gulp
Cal: 364
Sugar: 23.5 tsp
Super Big Gulp
Cal: 512
Sugar: 32 tsp
Lemonade (8 oz)
Cal: 140
Sugar: 7 tsp
Lemonade (20 oz)
Cal: 260
Sugar: 16.5 tsp
The 10-Percent Solution
• Studies show that a weight loss of just
5 to 10 percent of body weight can significantly
lower your blood pressure, improve blood cholesterol
and improve ability to control diabetes
Prescription: Exercise
• Exercise:
– Improves blood lipid levels
– Increases energy
– Helps lose weight and keep it off
– Improves blood pressure
– Increases confidence and decreases stress
– Lessens sadness and depression
Get Moving
• If inactive, ease into an exercise program 30
minutes of daily activity
• Exercise aerobically (briskly) 30-60 minutes 56 days per week
Stand Up!
• The latest research suggests that in addition to
exercise, limiting the amount of time we are
inactive i.e. sitting improves heart health,
reduces insulin resistance and likely lowers
cancer risk
• Interspersing light bouts of movement through
out the day helps with fat metabolism and
waist size
Am J Epidemiol. 2000;152(12):1171-1178.
Diabetes Care. 2012;35(5):976-983.
S.M.A.R.T. Goals
Specific, Measurable, Actionable, Realistic, Time Bound
• Behavior modification
– Positive, matter-of-fact attitude
• Become aware of behaviors
– Keep record
• Change behaviors
– Practice
– Set small, specific goals
Unrealistic vs. Realistic Goals
• I will walk 3 miles everyday
 I will walk 30 minutes 3x /week
• I will never eat dessert again
 I will limit my desserts to 150 calories 3x/week
• I will lose 60 pounds in 5 months
 I will lose ½ -2 pounds /week
• Decrease negative cues:
– Replace the candy dish
on your desk with sugar free
candies or a fruit bowl
• Increase positive cues:
– Keep extra workout
clothes handy at home,
work, and in the car
Mindless Eating
Why we eat more than we think:
Brian Wansink, PhD. Cornell University
Lessons From Mindless Eating
Water within arms reach, no soda in the house
Healthy options at eye level
“Challenge” foods out of sight
Pre-portioned items/bags for better
• Intentional monotony
• Planned 150-200 calorie snack (carb + protein)
Greek yogurt
½ turkey sandwich
Broth-based soup
Dry roasted edamame
Higher protein cereal + skim milk
Trail mix
Hummus and whole grain pita crisps/carrots
Turkey jerky (try Krave – lower sodium/no nitrate)
Babybel cheese and Special K cracker chips
Snacks, Snacks
Peanut butter crackers
Apple slices and 1 T almond butter
Popcorn and pumpkin seeds
Flavored rice cake or mini bagel with low fat cream
• Sommersault crackers (sunflower seed base)
• Healthy nachos (baked tortilla chips, fat-free refried
beans, low fat cheese sprinkle, salsa)
Snacks, Snacks and More Snacks
Orgain or Mix 1 shake
Kind bar, Clif Builder bar, NuGo bar, Luna bar
Drinkable yogurt/kefir
Shirataki noodles and Laughing Cow cheese
PB2 crackers
Meridan’s protein muffin
Hard boiled egg and piece of fruit
Eggcellent Choice?
• Harvard/China metaanalysis of 8 studies
(263,000 cases CVD
and 210,000 stroke)
• Found NO evidence of
an association between
egg consumption and
heart health risk
– BMJ, December 2012
Reducing the Risk
• The research is clear
– Reduction of body fat is a primary target for
reducing CVD, prediabetes, diabetes and cancer
– Even modest composition change is linked to
significant improvements in health metrics (blood
sugar, BP, TG, HDL chol., inflammation)
• Today’s Dietitian, March 2013
Why Should We Learn More
About Inflammation?
• Some researchers believe that low-grade
inflammation is associated with everything
from heart disease and diabetes to Alzheimer’s
and arthritis, and may even be the cause of
most chronic diseases
• Test for inflammation = C-reactive protein
(CRP). Elevated levels of CRP often signal an
increased risk of heart attack and stroke
Put Out the Fire
• The same steps that help prevent heart disease
may reduce chronic inflammation:
– Talk to MD about low-dose aspirin to help prevent heart
attack and stroke
– Control your blood pressure with diet, exercise, and
medication (if needed)
– If you are overweight, lose some weight (even 5-7%).
Obese people tend to have high CRP
– Eat a healthy diet with a moderate amount of fish (high in
omega-3 DHA and EPA fats)
The Anti-inflammatory Lifestyle
Varied high quality foods; Few low nutrient foods
Total calories awareness to promote optimal weight
Emphasizes healthful, high fiber carbohydrates
Focuses on plant proteins with less animal protein
Healthful fats and omega 3 fatty acids
Generous use of spices: garlic, ginger, tumeric, etc.
Increased tea consumption
Green Tea
• Green tea is rich in catechins
• Claims: anti-inflammatory;
metabolism-boosting action
• Science: preliminary evidence
suggests green tea can boost
metabolism (Dose: 270 mg
EGCG per day)
• Advice: Drink green tea and
experience a reduction of 50100 calories
Anti-inflammatory Diet =
Mediterranean Diet
• The Mediterranean diet, supplemented
with extra-virgin olive oil or tree nuts
reduced the risk of suffering a
cardiovascular death, a myocardial
infarction or a stroke by 30%!
• The research is part of the project PREDIMED, a
multicenter trial carried out between 2003 and 2011 to study
the effects of the Mediterranean diet on the primary
prevention of cardiovascular diseases.
“Primary Prevention of Cardiovascular Disease with a Meditteranean Diet.” New England
Journal of Medicine, 25th February 2013.
How Much Is Going In?
• Write it down to identify
your problem
areas/opportunities for
Try these “apps”:
• Lose It (iPhone app)
• Sparkpeople
• Slim Down Shopping List (iPhone app)
Recharge your battery
• Get a good night’s sleep
(7-8 hours)!
– Less than seven hours
increases the risk of obesity
approximately 30% and
– Appetite increases by 22%
– Inadequate sleep increases
the stress hormone cortisol