Blogfinger

Artery model showing fatty atherosclerotic plaques, with one straddling a bifurcation and causing partial obstruction. Paul Goldfinger, M.D. photo.

Grilled octapus with extra virgin olive oil, and orzo with olive oil and lemon: the perfect delicious heart healthy dinner–it was Eileen’s at Niko’s Greek Grill in Long Branch.  (now closed 2023)   Blogfinger photo

By Paul Goldfinger, MD, FACC

During the early evolution of the new specialty called “preventive cardiology,” the concept of  good nutrition as a tool in the quest to halt atherosclerosis began to take shape as far back as the 1950’s.

Years later, in the 1970’s, families began to adopt the notion that they should reduce fats in their diets, particularly the saturated fat, high cholesterol kind found in red meats and dairy products.  McDonald’s and other fast- food places introduced salads, and trans-fats were abolished from commercial products and restaurants.

It is now widely accepted that low fat diets will help prevent heart disease and some cancers. Unfortunately, as of 2011, there have been no large scale diet trials that conclusively prove the point.

Several years ago, some new clinical trials suggested that reducing total dietary fat may not be the most important goal in prevention.  In our book, “Prevention Does Work: A Guide to a Healthy Heart” dated 2011, we made the following observations: “…the type of dietary fat may be more important than the amount of total fat.” Also, “Most low fat diets generally lower cholesterol levels by only modest amounts.”  Such statements are based on recent science regarding the value of low fat/low cholesterol diets in cardiovascular disease prevention.

Recent  studies have shown benefits from purposefully using  “good fats” of vegetable origin such as monounsaturated olive and canola oils;  and polyunsaturated fats such as corn oil, to help reduce risk— rather than reducing all dietary fats.  Fish oils have also been found to be specifically beneficial.

From this  new start, we have come to believe that  Mediterranean diets might be the best choice in prevention, even though no large scale trials have proven this to be the case.  In one small French study,  (the 1999 Lyon Heart Study)  of Mediterranean diets, the use of canola oil enriched with omega-3 fatty acids helped prevent heart disease even without any change in blood cholesterol levels.

In 2006, a report from a $415 million federal study of 49,000 postmenopausal women, carried out over 8 years, concluded that low fat diets do not prevent heart disease or cancer. But that trial, as amazing as it was, looked at low fat diets which were not rigorous enough and it did not look at cholesterol lowering drugs. It also did not get enough compliance in the area of eating more fruits, vegetables and other nutrients. Finally, it did not distinguish between the various kinds of fats— the good, the bad and the ugly.   For those who hoped  that saturated fats would someday be found to be healthy (as Woody Allen predicted in the movie “Sleeper”), the trial did not conclude that low saturated fat diets could be discarded.

The bottom line, as far as I am concerned, is that the best nutrition for prevention is still a Mediterranean style diet with significant reductions in animal fats and with the use of “good oils” without restriction. This plan includes an emphasis on vegetarian food sources, fiber, seafood, portion control to combat obesity, and other diet components such as nuts, red wine, chocolate, green tea, plant stanols and other nutrients which may help reduce risk.  Protein can be obtained from fish, turkey, chicken, and small amounts of lean meats such as buffalo, ostrich,venison,  or lean beef. Portion size for meats should be 4 ounces. Cholesterol levels must be brought down to “target” numbers that your doctor should be acquainted with, and this usually must be accomplished with statin drugs.

I am sorry to say that most doctors know little about nutrition and prevention, and their patients do not know enough about how to prevent heart trouble through eating and cooking properly.  That is why Eileen and I wrote our book over 15 years ago and we believe that it can save lives.  Young families as well as heart patients need this information.   This is our fourth and best edition. We will donate all profits to the American Heart Association.  It is available at Amazon.com and the Comfort Zone in Ocean Grove, NJ.