Food Cures (20 page)

High triglyceride levels make blood thicker and stickier, which means that it is more likely to form clots. Normal triglyceride levels are defined as less than 150 mg/dL; 150 to 199 is considered borderline high; 200 to 499 is high; and 500 or higher is officially called very high. To me, anything over 150 is a red flag indicating my client needs to take immediate steps to get the situation under control.

Studies have shown that triglyceride levels are associated with increased risks of cardiovascular disease and stroke—in both men and women—alone or in combination with other risk factors (high triglycerides combined with high LDL cholesterol can be a particularly deadly combination). For example, in one ground-breaking study, triglycerides alone increased the risk of cardiovascular disease by 14 percent in men, and by 37 percent in women. But when the test subjects also had low HDL cholesterol and other risk factors, high triglycerides increased the risk of disease by 32 percent in men and 76 percent in women. Fortunately, triglycerides are relatively easily controlled with the diet and lifestyle changes outlined in this chapter. To lower triglycerides, lose weight if you’re overweight, reduce saturated fat and trans fat, avoid foods that are concentrated in sugar (even dried fruit and fruit juice), cut way back on alcohol (when triglycerides are high, sugar and alcohol will keep them high), and incorporate omega-3 fats.

HIGH HOMOCYSTEINE

Homocysteine is an amino acid naturally produced when the body breaks down proteins that contain another amino acid, methionine. No one knows exactly what role homocysteine plays in heart disease. It could be that homocysteine directly damages blood vessels. In the laboratory, homocysteine causes inflammation, damages blood vessel linings, and encourages blood clots. Or, it could be that homocysteine is just a marker—a sign that other things are going wrong in the body to create heart disease. Many scientists agree on one point, however: People with blood levels of homocysteine higher than 10 micromol/L may have an increased risk of heart attack and stroke.

The research picture gets cloudy when it comes to the benefits of lowering homocysteine. Early studies suggested that lowering abnormally high levels of homocysteine reduced the risk of heart disease and heart attack, especially when there were other risk factors at work, such as smoking or hypertension. More recent studies found that when people with normal homocysteine levels lowered them even more, there was no heart-related benefit. So, what’s a person to do? If homocysteine treatment required a prescription medication, making a decision could be difficult. But the best treatment isn’t new, risky, or expensive; it’s making sure you’re getting enough of the ultimate
B trio
of folic acid, vitamin B
₆
, and vitamin B
₁₂
in the food you eat. So although research results may be murky, my advice is simple: Eat more of these healthful foods, as described in the next section.

C-REACTIVE PROTEIN

When the body is exposed to infection, allergens, or even physical damage, it reacts by releasing chemicals designed to fight off the invasion or fix the damage. While working to protect us, these substances create inflammation. One of the body’s markers for inflammation is C-reactive protein (CRP).

Inflammation feeds atherosclerosis. Your immune system’s response to atherosclerosis is to rush white blood cells to the site of the damage. But the plaque gobbles up the white cells and grows bigger. Once plaque matures, it becomes fragile, and inflammation can cause this brittle plaque to rupture. These shattered pieces of plaque get carried along the blood stream, and can form clots that cause heart attacks or strokes.

The value of CRP is that it tells us when inflammation is present, possibly causing cardiovascular disease. If we know that, we can take steps to reduce the inflammation and prevent blood vessel damage. The nutrition and lifestyle changes in this chapter can help reduce inflammation.

THE METABOLIC SYNDROME

As you might imagine, having one risk factor for heart disease is bad enough, but having more than one amplifies the threat. The metabolic syndrome describes a cluster of risk factors that, when taken together, create a toxic environment in blood vessels. The metabolic syndrome is characterized by having at least three of the following symptoms: high blood pressure, high triglycerides, low HDL cholesterol, large waist circumference (greater than 35? for women, 40? for men), or fasting blood sugar greater than 110 mg/dL. People with the metabolic syndrome have an increased risk of heart disease, stroke, and diabetes. Fortunately, the 4-step plan in this chapter can help improve each of the risk factors, so you can solve all
five
problems with one approach.

HOW FOOD AFFECTS
CARDIOVASCULAR DISEASE

Eating well for heart health means knowing which foods to limit, and which to embrace.

FOODS TO LIMIT OR AVOID

The top dietary recommendation for cardiovascular health is to eliminate or at least drastically limit the foods you eat that contain saturated fats, trans fats, cholesterol, refined carbohydrates, and salt.

SATURATED FATS

Saturated fats are found in animal-based foods, including meats, butter, whole milk dairy products (including yogurt, cheese, and ice cream), and poultry skin. They are also found in some high-fat plant foods, such as palm oil. The Nurses’ Health Study, which included more than 80,000 participants, showed that saturated fats increase the risk of coronary artery disease. It was estimated that if you replace just 100 calories of saturated fat in your diet every day with unsaturated fats (found in as olive oil or nuts), you can reduce your risk of heart disease by about 40 percent. Just 100 calories! That’s about the total number of calories in one homemade chocolate chip cookie, so swap that cookie for 5 macadamia nuts or 12 almonds and you’re on your way to a healthier heart. By making a few simple changes, you can improve your risk profile:

• Avoid butter, cream cheese, lard, sour cream, doughnuts, cakes, cookies, chocolate bars, chocolate chips, ice cream, fried foods, pizza, cream- or cheese-based salad dressings, cheese sauce, cream sauces, animal shortenings, high-fat meats (including hamburgers, bologna, pepperoni, sausage, bacon, salami, pastrami, spareribs, and hot dogs), high-fat cuts of beef and pork, whole-milk dairy products.
  
• Choose lean meats only (including skinless chicken and turkey, lean beef, lean pork), fish, reduced-fat or fat-free dairy products. Try soy foods as a substitute for meat at least some of the time. Although soy itself may not reduce risk of heart disease, it replaces hazardous animal fats with healthier proteins. Choose high-quality soy foods, such as tofu, tempeh, enriched/fortified soy milk, and edamame.
  
• Always remove skin from poultry.
  
• Prepare foods by baking, roasting, broiling, boiling, poaching, steaming, grilling, or stir-frying. No deep-fat frying.
  

TRANS FATS

Trans fats were developed in a laboratory to improve the shelf life of processed foods—and they do. But calorie for calorie, trans fats are more dangerous than the saturated fats I just advised you to avoid. Most stick margarines contain trans fats, and trans fats are found in many packaged baked goods, potato chips, snack foods, fried foods, and fast food that use or create
hydrogenated oils
. (All food labels must now list the amount of trans fats, right after the amount of saturated fats—good news for consumers.) By substituting olive oil or vegetable oil for trans fats in just 2 percent of your daily calories, you can reduce your risk of heart disease by 53 percent. In a 2,000-calorie-a-day diet, that’s about
40 calories
. Think of it this way—an average serving of French fries contains about 5 grams of trans fats, or about 45 calories worth of evil trans fats, and a daily serving would be enough to
double
your risk of heart disease. There is no safe amount of trans fats, so try to keep them as far from your plate as possible.

CHOLESTEROL-RICH FOODS

Years ago, doctors used to recommend that people with heart disease avoid all high-cholesterol foods. But dietary cholesterol does not harm health as much as saturated fats and trans fats do. Research into the effects of dietary cholesterol have been mixed, which is not surprising—different people have different susceptibilities. Still, if you want to take a firm hand to reduce your risk factors, you may want to consider cutting down on all high-cholesterol foods, including egg yolks, shellfish, liver, and other organ meats like sweetbreads and foie gras. You’ll notice whole eggs and shellfish on a couple of my best food lists—that’s because they’re high in other heart healthy nutrients—as well as cholesterol. That said, if your LDL cholesterol is high, limit your intake of egg yolks to no more than three per week (whites are unlimited), and limit shellfish to no more than one portion twice weekly. You may also want to speak with your cardiologist about personal limitations.

REFINED CARBOHYDRATES

Refined carbohydrates include sugary foods, sugared soft drinks, fruit juice, sweet baked goods, anything baked with white flour (including white bread, rolls, cereal, buns), and white rice. These low-quality carbs cause a sudden rise in insulin, which may lead to a spike in triglycerides. Whenever possible, aim for high-quality instead of low-quality carbs. That means limiting sweets, and choosing whole grain foods, such as oatmeal, healthy cereals, brown and wild rice, whole wheat pasta, and bread products that include the word
whole
or
oats
in the first ingredient.

SALT

For decades, the science has been pretty clear: Salt increases blood pressure in people who are salt sensitive, and the more salt you eat, the greater the potential rise in blood pressure. Sodium in small doses is necessary for the body to function properly, but too much will draw excess fluid into the blood, effectively raising blood pressure. Salt is a hard habit to break—it actually dulls your sense of taste, which means that, over time, you’ll be reaching for that shaker more often to get the same taste. The best thing to do is go cold turkey. Well, almost. First, take the salt shaker off the kitchen table, and try not to add salt to foods you prepare at home. If you miss the flavor, experiment with some of the salt substitutes on the market (such as Mrs. Dash and Morton salt-substitute seasonings). Second, when reading food labels, choose brands that have less sodium. Third, limit hidden sources of sodium, such as ketchup, soy sauce, teriyaki sauce, salad dressings, prepared marinades, pickles, sauerkraut, deli meats, canned vegetables, canned soups, and broth. Go out of your way to buy brands that offer lower-sodium varieties, especially when it comes to canned goods. If you buy canned beans, choose low-sodium brands whenever possible, and always rinse thoroughly before using—the liquid they are packed in can be very high in sodium.

GOOD FOODS TO CHOOSE

FRUITS AND VEGETABLES

I know you’re probably sick of hearing advice about eating plenty of fruits and vegetables, but it really is important, especially for people fighting cardiovascular disease. The scientific data all support the same claim: People who eat five or more servings of fruits and vegetables daily have a reduced risk of heart attack and stroke compared with people who eat less than three servings daily. Specifically, heart attack risk is about 15 percent lower, and stroke risk is about 30 percent lower! On average, the risk of coronary artery disease is reduced by about 5 percent for each additional serving of fruits and vegetables you eat every day.

What’s the magic in fruits and vegetables? No one really knows. Sure, they’re full of vitamins, minerals, fiber, and antioxidants, but we don’t know which ones are most helpful because whenever scientists try to mimic the effects of foods with supplements, their formulations simply don’t produce the same protective effects as the real thing. That means that you have to eat the foods, the whole foods (and nothing but the foods) in order to reap the benefits of fruits and vegetables.
Two large caveats:
If you’re taking any cardiac medication, avoid eating grapefruit and drinking grapefruit juice (a compound in grapefruit interferes with the breakdown of many medications). Also, if you’re taking a blood thinner like Coumadin, have your doctor monitor your blood and medication dosage as you increase your intake of dark leafy green vegetables. These vegetables are rich in vitamin K which plays a key role in blood clotting (see full list of Vitamin K-rich foods in the Osteoporosis chapter on Chapter 10).

SOLUBLE FIBER

Soluble fiber, especially the viscous type, may help reduce cholesterol by grabbing onto cholesterol and escorting it through your digestive system and out of your body. It also may reduce the intestinal absorption of cholesterol, and it can lower blood pressure. Research has shown that eating an additional 5 to 10 grams of soluble fiber a day can reduce LDL cholesterol by 3 to 5 percent. If you eat a few foods rich in soluble fiber every day, you’ll get
at least
5 grams. It is a small improvement, but every percentage point counts!