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The Plate Debate: Reducing the Risk of Heart Disease


In the past few months, there has been a lot of controversy over what Americans should be eating in order to protect themselves against cardiovascular disease (CVD), cancer and obesity. From the October 2015 World Health Organization (WHO) report that sent bacon-lovers into a tailspin and the latest US Department of Agriculture (USDA) Dietary Recommendations that put a cap on daily sugar and sodium intake to the even more recent Penn Medicine study that examined the warning labels most likely to deter consumers from purchasing sugar-sweetened beverages, there’s a lot of news buzzing about what we should – rather, shouldn’t – be eating.

But with all the questions and criticisms around these new, albeit not surprising, guidelines, one has to think about the benefits of such recommendations. As February marks American Heart Month, it seems only fitting to take a look at some of these suggestions through the lens of heart health.

“Overall, the new USDA dietary guidelines recommend a healthy eating pattern that limits saturated and trans fat, added sugars and sodium,” said Daniel J. Rader, MD, chair of the department of Genetics and chief of the division of Translational Medicine and Human Genetics. “These recommendations, much like the WHO report, don’t necessarily exclude foods entirely, but rather propose consumption in moderation – scaling back your intake of these more ‘harmful’ foods.”

Though, according to Rader, processed meats and poultry are generally high in saturated fat and sodium, and have the potential to affect lipids and blood pressure, which he says, increases the risk for cardiovascular disease.

Sounds like a pretty good reason to cut back if you ask me.

But if you’re still not convinced that consumption in moderation, a Mediterranean style diet, or the US Department of Health and Human Services’ recommended DASH diet, is the best approach for staving off heart disease, perhaps some hard-hitting statistics will curb these overindulgences.

According to the Center for Disease Control and Prevention (CDC), heart disease is the leading cause of death in the United States, claiming the lives of more than 610,000 Americans annually. CVD is responsible for one in every four adult deaths, and about 47 percent of all American adults have at least one of the three major risk factors for CVD – high blood pressure, high cholesterol, and smoking. While there are some out-of-our-control factors that predispose individuals to be at a higher risk for heart disease – such as family history, ethnicity, and age – there are a variety of therapeutic lifestyle changes that can be made, relatively simply, to help reduce this risk.

“Much of cardiovascular disease is preventable,” said Mariell Jessup, MD, a professor of Cardiovascular Medicine. “Improving dietary intake has been shown to reduce cardiovascular risk within four years of the improved diet, and has also been shown to have benefits even 20 years later.”

With such a benefit associated with a healthier diet and regular exercise, Jessup notes she would encourage patients to consume more fruits and vegetables, but also reduce their intake of sugar, something she emphasizes is equally important for reducing risk.

In addition to putting a cap on daily intake of certain things – less than 2,300 mg of sodium and less than 10 percent of calories from added sugars – the newest USDA guidelines also focus significantly on eating patterns. Described as “the combination of foods and beverages that constitute an individual’s complete dietary intake over time,” recommendations on eating behaviors are aimed at prompting consumers to look more broadly at their eating habits and trends, rather than targeting their intake of specific foods, as Rader suggests.

Fran Burke, MS, RD, a clinical dietitian in Penn’s Preventive Cardiovascular Program, said “one of the most common mistakes people make when implementing new eating habits is that they cut out certain foods or food groups entirely, and replace them with other not-so-healthy choices.”

While the guidelines look at curbing these poor eating patterns, what concerns most healthcare professionals when evaluating CVD risk is the intake of saturated and trans fats – the “bad” fats. “These fats raise the bad cholesterol levels – LDL cholesterol – in our bloodstream, which is absolutely a risk factor for heart disease," Rader stressed.

In fact, he added, in a situation where people are told to avoid certain fatty foods, they often reach for processed foods, namely carbohydrates like bread and pasta, which have more sugar and more calories. This may reduce fat intake, but these alternatives can lead to obesity and diabetes, which are among the leading risk factors for cardiovascular disease.

Burke added, “ultimately, we should be practicing moderation and curbing unhealthy eating behaviors – starting with choosing fish and lean meats and eating more vegetables, fruits, and whole grains above all else.”

To Burke’s point, the USDA recommendations do suggest eating more fish, ideally twice per week, and states that there should be more variety in the proteins consumed, which can include lean meats and poultry, eggs, beans and peas, soy products, and unsalted nuts and seeds.

However with so many things to consider – what to eat, what not to eat, what to eat more or less of – some other, equally as important factors for reducing CVD risk can get lost in the shuffle.

In addition to diet and exercise, Jessup stressed the importance of the numbers. “Be conscious of blood pressure, cholesterol, and blood sugar, and if these numbers are not good, get regular advice about how to control them. Making sure blood pressure is under good control and that weight is kept to an ideal level are hard targets in the beginning, but they can have tremendous benefit.”

Overall the consensus for reducing CVD risk seems to be consistent across the board: consume a balanced diet, avoid fast and processed foods whenever possible, and exercise regularly.

And most importantly, Jessup adds, “patients should feel good about their ability to control their risk for cardiovascular disease, and should know that it is possible with some relatively simple changes.”

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