Learn About Your Heart...
Made Simple

By Nicolas Shammas, MD

A new, comprehensive sourcebook for
heart and vascular disease patients

Cardiovascular Health Topics

Statistics about Heart and Blood Vessel Diseases in the United States
Structure and Function of the Heart and Blood Vessels
Diseases of the Blood Vessels of the Heart
Surgical Therapies for the Cardiovascular Patient
Peripheral Vascular Disease
Diseases of the Blood Vessels of the Head and Neck
Strokes: How to Survive Them and How to Prevent Them
Valvular Heart Disease
Heart Rhythms: How to Recognize Them and Treat Them
Congestive Heart Failure
11. Understanding Cardiomyopathy, or Weak Heart Muscle
12. Children and Heart Disease
13. Diseases of the Pericardium
14. Systemic Illnesses, Infections and Drugs that Affect the Heart
15. Erectile Dysfunction: a Vascular Disease
16. Cardiovascular Disease Prevention
17. Heart Healthy Nutritional Tips
18. Cardiac Rehabilitation
19. Medications for Cardiovascular Disorders
20. Heart Tests You Need to Know
21. Learn What to Do in a Medical Emergency
22. How to Choose Your Doctor and Hospital
23. Medical Research and How You Can Get Involved
24. Taking the Next Step — A Few Community Resources to Help You Live More Healthfully
25. How Much Did You Learn from This Book: Take a Simple Test

What are Step I, Step II, and TLC diets?

The American Heart Association no longer uses the terms "Step I" and "Step II," although these terms can still be found in certain reference books.The Step I diet restricted total fat to 30% of total calories, saturated fat to no more than 10% of total calories, and cholesterol to less than 300 mg per day. The Step II diet restricted saturated fat to less than 7% of total calories and cholesterol to less than 200 mg per day.

The TLC (Therapeutic Lifestyle Changes) diet focuses on lifestyle changes to reduce the risk of developing heart disease. The TLC diet recommends that less than 7% of total calories come from saturated fat. It also recommends less than 200 mg per day cholesterol, 2 g per day of plant stanols/sterols, and 10-25 g per day of soluble fiber. Total calorie intake should be adjusted to maintain desirable body weight or to prevent weight gain. Physical activity should also be included in the TLC diet. According to the TLC diet, an individual should get enough moderate activity to expend at least 200 calories per day.

What is the Mediterranean diet?

The Mediterranean diet is based on the eating habits of people in Mediterranean countries. People in these countries have low rates of cancer, heart disease, diabetes, and other chronic diseases. They also have a longer life expectancy. There are many different countries that border the Mediterranean Sea—many with a different version of the Mediterranean diet. Although the diet may vary from country to country, the main recommendations remain the same:

  • Eat red meat occasionally, only a few times a month, and favor the lean cuts
  • Eat small amounts of fish, chicken, eggs, and sweets a few times a week
  • Eat small portions of flavorful cheese or low-fat yogurt every day
  • Let olive oil be your main source of fat—it is important to replace other fats, oils, butter, and margarine with olive oil
  • The main dish of the meal should come from plant sources, including fruits, vegetables, potatoes, breads, beans, nuts, and seeds
  • If you drink wine, limit it to 1-2 glasses per day
  • Engage in regular physical activity every day.

What are some popular weight-loss diets?

The Atkins diet

The Atkins diet is a weight-loss diet that restricts carbohydrates (necessary fuel for the body) and focuses on eating mostly protein. You may eat as much fat and proteins as you want. The carbohydrates in the diet are so low that the body starts to burn fat as fuel, which releases chemicals called ketones that often decrease appetite.

This is not a normal state for the body and may cause dehydration, dizziness, constipation, weakness, irritability, bad breath, and headaches. It can be fatal to people with diabetes and is harmful to the baby of a pregnant mother using this diet.

Weight loss occurs because people generally consume a very low calorie diet and also lose water weight. The Atkins diet is not a nutritionally well-balanced way of eating.

South Beach diet

The South Beach diet is a 3-phase diet plan that emphasizes eating lean protein, unsaturated fats, and high-fiber fruits and vegetables. Its first 2 weeks are very similar to the Atkins diet, as the only carbohydrates allowed are low-calorie vegetables.

The diet discourages eating foods high in glycemic index. These foods are quickly digested and raise blood sugar higher than other foods. Most high-glycemic foods are low in fiber; however, some, such as carrots and sweet potatoes, are a good source of fiber as well as other valuable nutrients. Overall, the diet is low in calories, as the average intake is 1,400-1,500 calories a day.

Weight Watchers diet

This diet is the most popular worldwide with an average weight loss of 2 pounds a week. It offers a sensible way to lose weight by reducing calories using a point system. It is well balanced and does not omit any food groups.

How much fiber should I be eating?

According to the American Dietetic Association, Americans should eat 20-35 g of fiber a day (5-10 g as soluble fiber) for a healthy heart and digestive system. There are 2 types of fiber, insoluble and soluble. Insoluble fiber is the roughage we need to keep regular. It is found in whole grains, vegetables, wheat bran, nuts, and beans. Whole grains also contain phytochemicals (plant chemicals) that reduce the risk of heart disease.

Soluble fiber has been shown to reduce LDL cholesterol levels. It attaches itself to cholesterol in your gut and prevents it from being absorbed into your bloodstream. Good sources of soluble fiber are oats, barley, beans, lentils, peas, nuts, seeds, apples, the grain psyllium, as well as other fruits and vegetables. A number of studies have shown that oats may also lower blood pressure.

Foods that contain 2-4 g of soluble fiber include 1½ cups cooked oatmeal, ½ cup cooked dried beans, 1 piece of citrus fruit or pear, ½ cup brussel sprouts, and ½ cup yogurt with fiber.

When increasing the amount of fiber in your diet, add it gradually, as too much too soon can cause cramping and bloating. Also, because added fiber requires added liquids, make sure you are drinking adequate amounts of fluids.

Why should I eat soy?

Soybeans and the foods made from them are excellent sources of calcium, potassium, zinc, and vitamin B. In addition, they are low in saturated fat, have zero cholesterol, and are high in fiber and quality protein. Soybeans have more protein by weight than chicken, beef, or fish. It is this protein that lowers total and LDL cholesterol and triglycerides without affecting HDL cholesterol.

On October 26, 1999, the Food and Drug Administration approved the following health claim for soy foods: 25 g of soy protein daily, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease. To qualify for this claim, soy foods must have at least 6.25 g of soy protein per serving. Studies have shown that this level of soy protein lowers LDL cholesterol by approximately 5%.

Other components of soybeans, such as isoflavones (phytochemicals), may need to be present to lower cholesterol, make the arteries more elastic, and reduce damaged LDL cholesterol. It's easy to add soy to your diet:

  • Soy smoothie—soy milk with fresh or frozen fruit
  • Soy cheese
  • Soy burger or sausage
  • Soy cereal
  • Toasted soy nuts or cooked soybeans called edamae
  • Soy nut butter
  • Tofu (soybean curd), firm—sliced in salads, soup, or stirfrys—or soft-used in recipes.

Is flaxseed as good for you as everyone says?

Flaxseed, which comes from the same plant that is used to make linen, contains substances that have been shown to reduce the risk of heart disease as well as cancer. They are tiny golden or reddish brown seeds that have a pleasant nutty flavor similar to walnuts.

To be of greatest benefit, flaxseeds need to be ground to release alpha-linolenic acid, which is an omega-3 fatty acid. This omega-3 fatty acid lowers total and LDL cholesterol, lowers triglycerides, prevents blood clots, and reduces abnormal heart rhythms. Flaxseeds are also high in soluble fiber, which keeps the cholesterol we produce from being reabsorbed and lowers blood sugar levels.

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