Transcript Diet and Post - Operative Care

NUTRITION AND
CARDIOVASCULAR DISEASE
Blood Lipid Levels are Related to Risk
of CVD
Blood Lipids (Lipoproteins)
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Lipids (fat) cannot mix with water
Blood is high in water
Lipids cannot travel in blood without help
Lipoproteins are formed to carry lipids
Lipoproteins combine
Lipids (triglycerides, cholesterol)
 Protein
 Phospholipids
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Low-Density Lipoproteins (LDL-C)
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Also called “bad cholesterol)
Contain relatively large amounts of fat, and less
protein
Deposits cholesterol in arteries
Thus, ↑ LDL-C is associated with ↑ CVD risk
Serum LDL-C should be < 130 mg/dL
High-Density Lipoproteins (HDL)
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Also called “good cholesterol”
Relatively high in protein, lower in lipid
Acts as scavenger, carrying cholesterol from
arteries to liver
Liver packages as bile
 Excretes
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↑ HDL-C is associated with ↓ risk of CVD
Serum HDL-C should be >60 mg/dL (optimal) or
at least >40 in men and 50 in women
Triglycerides
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The most diet-responsive blood lipid
Should be ≤150 mg/dL in fasting state
Triglycerides
Lower blood triglycerides by:
 Not overeating
 Limiting alcohol and simple sugars
 Spreading meals throughout the day
 Including fatty fish in the diet
 Controlling diabetes if present
 Performing regular physical activity
 Not smoking
Total Cholesterol
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Includes HDL-C, LDL-C, and a fraction of the
triglycerides
Total cholesterol should be ≤ 200 mg/dL
Total cholesterol does not tell whole story
Lipoprotein Summary
Evaluating Blood Lipids: LDL
<100 mg/dL
Optimal
100-129
Near optimal
130-159
Borderline high
160-189
High
≥190
Very high
Source: ATP-III Guidelines, NHLBI, accessed 2-2005
Evaluating Blood Lipids: Total
Cholesterol
<200 mg/dL
Desirable
200-239 mg/dL Borderline high
≥240 mg/dL
High
Source: ATP-III Guidelines, NHLBI, accessed 2-2005
Evaluating Blood Lipids: HDL
< 40 mg/dL
Low
≥ 60 mg/dL
High
Source: ATP-III Guidelines, NHLBI, accessed 2-2005
Risk Factors (other than LDL) for CVD
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Cigarette smoking
Hypertension (BP ≥140/90 mmHg or on antihypertensive tx
Low HDL-C* (<40 mg/dL)
Family history of premature CHD in first degree
relative (in male <55 years, in female <65
years)
Age (men ≥45 years, women ≥55 years)
*HDL-C ≥ 60 mg/dL counts as a negative risk factor
Source: ATP-III Guidelines, NHLBI, accessed 2-2005
Risk Factors (other than LDL) for CVD
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Diabetes (considered equivalent to a history of
CHD)
Obesity
Inactivity
Source: ATP-III Guidelines, NHLBI, accessed 2-2005
Screening for CVD Risk
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Everyone 20 and older should have his cholesterol
measured at least every 5 years
Lipoprotein profile: includes TC, LDL-C HDL-C, and
TG
At least should include TC and HDL-C
If TC> 200 mg/dL or HDL-C< 40 mg/dL, obtain
full lipid profile
Source: National Cholesterol Education Program, National Institutes of
Health, accessed 2-05
Total Cholesterol
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John and Marty each
have total cholesterol
levels of 200 mg/dL.
Their health risk is
different
Total Cholesterol is Not Enough
John’s Lipid Profile
 TC: 200 mg/dL
 LDL-C: 140 mg/dL
 HDL-C: 30 mg/dL
 TG: 150 mg/dL
Marty’s Lipid Profile
 TC: 200 mg/dl
 LDL-C: 95 mg/dL
 HDL-C: 75 mg/dL
 TG: 150 mg/dL
What Affects Cholesterol Levels?
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Diet
Weight
Physical activity
Age and gender
Heredity
You control the first three!
Lowering LDLs
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See your doctor to assess for other conditions
Reduce dietary saturated fat, trans fatty acids, and
cholesterol
Increase MUFA and PUFA
Increase dietary fiber (soluble)
Lowering Blood TG
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Is the most diet-responsive blood lipid
Avoid overeating
Limit alcohol
Limit simple sugars
Small frequent meals
Include fish in the diet
Raise the HDL
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Physical activity
At least 45 min./day, 4 days a week
Avoid smoking
Eat regularly
Eat less total fat
Moderate intake of alcohol increases HDL
Therapeutic Lifestyle Changes (TLC)
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TLC Diet
Physical activity (30 minutes on most, if not all,
days)
Weight management: will help manage
triglycerides, increase HDL,
Diet Strategies for Reducing the Risk
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Eat less saturated fat & trans fats
Replace with MUFA and essential fatty acids
Eat fish 2x a week
Eat plenty of fruits and vegetables
Eat more whole grains and less refined CHO
Eat at least 3 meals regularly
TLC Diet
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Low in saturated fat (<7% of calories) and
cholesterol (<200 mg/day)
Enough calories to maintain a desirable weight
High in soluble fiber
Plant stanols or sterols, if needed
Other Recommendations
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Fat intake can be higher as long as saturated and
trans fatty acid are minimal
Eat diet with plenty of fruits and vegetables
Cut down on red meats
Cut down on simple sugars and refined CHO
TLC: Healthy Cooking
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Bake, steam, roast, broil, stew or boil instead of
frying
Use a nonstick pan with cooking oil spray or
small amount of liquid vegetable oil instead of
lard, butter, shortening, other solid fats
Chill meat and poultry broth until fat becomes
solid, remove
TLC: Dining Out
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Choose restaurants that have lowfat options
available
Ask that sauces, gravies, and salad dressings be
served on the side
Control portions by asking for an appetizer serving
or sharing with a friend
TLC: Dining Out
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At fast food restaurants, go for salads, grilled (not
fried or breaded) skinless chicken sandwiches
Avoid regular salad dressings and fatty sauces. Limit
jumbo or deluxe burgers, sandwiches, french fries,
and other foods.
Eating food with anticoagulant properties is a good way
to supplement your medication for stroke patients.
What are Anticoagulants?
Anticoagulants are agents or substances used to prevent or
reduce the formation of or ability of blood to clot.
Fruits are good sources of anticoagulants.
Drinking fruit juices is a convenient way to meet this
daily requirement as these are concentrated
GRAPES, APPLES, PINEAPPLES, & SPICES:
GREAT ANTICOAGULANTS
Grapes contain phytonutrients called flavonoids that
reduce platelet clumping and harmful blood clots.
Grapes also have a flavonoid-type compound called
resveratrol, which is more common in grape wine.
Apples also contain phytonutrients like those found
in grapes
Pineapples are well-known as great sources of fiber,
which acts like a broom in removing toxins in the blood
and bad cholesterol.
This is often the reason why it is recommended to people
with high blood pressure.
Besides being a great fiber resource, pineapples also
have enzymes called bromelain, which is a natural
anticoagulant.
Bromelain works by breaking down fibrin, the protein
substance in blood that causes clotting.
Besides fruits and vegetables, nature has other
anticoagulants in the form of herbs and spices. Ginger,
for one, helps make blood platelets less sticky.
If you don't like eating meals with ginger, your other
options are curry powder, cayenne powder, paprika,
thyme, cinnamon, dill, oregano, turmeric, licorice, and
peppermint.
There are many reasons why you need to incorporate
fruits and vegetables into your diet.
Enjoying natural anticoagulants together with your
medication to avoid another stroke is one of them
Wish you all
Good Health..!