Q & A: Diet & Nutrition

*Q: I have just had angioplasty. I’m worried about my arteries and am following the dietary recommendations in your newsletters. But what about shrimp and lobster? I thought they were high in cholesterol, but my brother says they are allowed on a low-fat diet. Who’s right?

Your brother is correct in the sense that an occasional meal of shrimp or lobster is fine on a heart- healthy diet plan. Shrimp and lobster do have moderate to high cholesterol content. However, we now know that shellfish also contain omega-3 fatty acids, the essential fatty acids that help to protect the heart by:

  • Lowering fibrinogen levels, helping to keep arteries open.
  • Breaking up sticky clumps of platelets in blood vessels, thereby preventing the formation of blood clots.
  • Lowering blood levels of cholesterol and triglycerides and lowering blood pressure.
The extreme “low-fat” or “no-fat” diets recommended by many cardiologists has a downside – it often restricts the intake of linoleic acid (LA) and alpha-linolenic acid (ALA) – two essential fatty acids that must be obtained from dietary sources.
By achieving a healthy balance of carbohydrates, healthy fats and protein in your diet (follow my modified Mediterranean diet and try to eat a ratio of 45 to 50% carbohydrates, 20 to 25% protein and 30% healthy fat at every meal or snack), you will help keep the cells that line your arteries happy, boost your good cholesterol and protect yourself from insulin resistance, the precursor to diabetes. Sugar is the real threat to developing coronary disease because of the excessive insulin response which is the most inflammatory and endothelial unfriendly agent around.

Q: I can’t seem to lose weight. Do you have your own program for weight reduction?

Many of my patients have trouble losing weight on traditional dietary recommendations because they are insulin resistant. If you are insulin resistant, you can’t lose weight successfully on a diet that is low in fat and protein and high in carbohydrates because carbos are the building blocks for fat storage.

If you have a tendency to carry weight around your middle, rather than your hips, or have low HDL (good) cholesterol with high triglycerides, you are probably insulin resistant.

Whether you are insulin resistant or not, I recommend you follow my modified Mediterranean Diet (see below) which, in addition to helping you with weight loss, lowers cholesterol and blood pressure and improves your overall health.  This is the best program I know for losing weight and keeping it off.

My Pan Asian Modified Mediterranean Diet (PAMM Diet)

Decrease your intake of:

  • Rice and processed foods containing flour such as breads, cereals (like Corn Flakes, Frosted Flakes, Puffed Wheat and sweetened granola), flour-based pastas, bagels and pastries.
  • Vegetables such as potatoes, corn and carrots. Avoid processed canned vegetables.
  • Fruits like bananas, raisins, mango and papaya. Drink less fruit juice, especially apple and orange juice. Dilute juices with water.
  • Red meat and organ meats.
  • Oils such as corn, safflower, sunflower, peanut and canola.
  • All sugars – omit colas and sodas.
Increase your intake of:
  • Oatmeal and higher fiber pasta such as spelt and Jerusalem artichoke instead of semolina flour pasta.
  • Veggies such as asparagus, broccoli, kale , spinach, cabbage, brussels sprouts and legumes (lentils and chickpeas).
  • Onions and garlic.
  • Grapefruit, cherries, peaches, plums, kiwi and rhubarb (pears, apples, cantaloupes and grapes are suitable; however, they contain more sugar).
  • Protein such as fish (including shellfish). Flavor your sauces. Prepare with small amounts of lamb, lean beef, chicken or turkey. Enjoy up to six eggs a week.
  • Olive oil.
  • Low-fat cottage cheese, feta cheese and small amounts of grated parmesan.

Reduced cholesterol and blood pressure, as well as weight loss, decreased insulin resistance and an overall improvement in your health are among the many benefits of my modified Mediterranean Diet.

*Q: My triglycerides are high and my HDL cholesterol is low. This surprises me because I don’t eat meat and follow a strict low-fat, high-carbohydrate diet. In spite of being disciplined about my diet, I’ve given up any hope of wearing a bikini again. What advice can you give me?

If you carry your excess fat around your middle, have low levels of HDL cholesterol and high triglycerides while consuming a low-fat, high-carbohydrate diet, you very likely have some degree of insulin resistance, which can set the stage for diabetes. Your present low-fat diet is high in carbohydrates and is the source of your high triglycerides.

To lower your triglycerides and lose weight, you must do the following:

  • Switch to my modified Mediterranean diet, which means eat 45-50% carbohydrates, 20-25% protein and 30% “healthy” fats at every meal or snack. Even a modest weight loss of five to eight pounds will make a difference in your triglyceride level.
  • Eat fewer high-glycemic carbohydrates (I.e. rice, pastas, potatoes, corn, carrots and peas). Avoid bread, crackers, bagels, etc. Eat more healthy fish and nuts and use olive oil as a source of healthy fat. Add more protein to your diet such as eggs, poultry and beans.
  • Increase your exercise – walk one to two miles per day.
  • Consider seeing a personal trainer for more advanced exercise.

A high triglyceride level appears to be more dangerous for women than for men. The danger is that if you are a diabetic, overweight woman who also has high triglycerides, your risk of developing heart disease is 200 times greater than for people without these factors.

*Q: My lifestyle is a lot better than it used to be. I quit smoking, walk every day, watch my diet and cut out alcohol last year. But I drink coffee all day long. Is coffee bad for my heart?

I’m afraid it is. Coffee contains copious amounts of caffeine, and because it is a drug, like nicotine and alcohol, I advise taking care in the amount you drink.

I have seen scores of patients with problems related to caffeine intake, ranging from skipped heartbeats to caffeine-induced arrhythmias. One extreme case involved a young man suffering from a history of psychiatric disorders who was referred to me because of a very high heart rate (frequently greater than 120) and blood pressure as high as 220/120. He was drinking 10 cups of coffee per day in addition to cola beverages. His condition, known as caffeinism, increases heart rate and blood pressure as well as irritability and hyperactivity.

Caffeinated beverages, especially coffee, enhance gastric secretion and inflame ulcers. There is also a direct link between caffeine consumption and sugar cravings. For example, when you eat sugar you receive an energy boost that is followed by a sharp decline. This same pattern of stimulation followed by an energy drain is set in motion with your numerous cups of coffee. You may find yourself in a cycle of eating sugar (or carbohydrates) and/or drinking coffee every two hours – and unhealthy pattern that will make it increasingly difficult to maintain your weight.

If you do not have heart disease, limited amounts of caffeine (one to two cups of coffee in the morning) may be acceptable. If you are accustomed to a hot stimulating drink several times a day, I recommend you switch to ginger tea, a heart-healthy drink that can give you an elevated sense of alertness naturally. I use ginger tea as my afternoon hot beverage.

*Q: I have been following the low-fat diet for years and trying very hard to stick to a diet of 10% fat. You stress that “healthy fats” should be a much bigger percentage of my diet and this confuses me. Why is your opinion so different?

The problem with a very low-fat diet is that as you decrease your fats, your carbohydrate consumption generally increases. This is because people tend to cut back on their meat intake replacing it with pasta, bread, rice and potatoes. And after witnessing firsthand the counterproductive results of low-fat regiments, I am convinced that a diet low in fats and high in carbohydrates leads to the development of insulin resistance, a dangerous condition that results in substantial weight gain (particularly around the middle) and a predisposition to diabetes.

About 50 million people in the United States are caught up in this dietary chain reaction known as insulin resistance. The cycle goes something like this:

Increased carbohydrates – lead to carbo cravings – which lead to higher blood sugar – which triggers higher insulin levels in the bloodstream – leading to more fat storage – returning full circle to more carbo cravings.

And this unhealthy merry-go-round often produces further problems such as high cholesterol and blood pressure; thickened, less elastic arterial walls; and fluid and sodium retention in the kidneys.

My second objection to such a restricted fat intake is that you are not getting adequate amounts of essential fatty acid compounds such as omega-3 oils that are vital for your heart and overall health. For example, fish or squid oil or flax seeds (rich in omega-3 fatty acids) lower blood levels of cholesterol, triglycerides and blood pressure. Fish and flax also helps to prevent the formation of sticky clumps of platelets in blood vessels by lowering fibrinogen levels, which keep the blood “slippery” enough to prevent clots from forming.

*Q: I am a diabetic and want to minimize my risk for heart disease. You say carotenoids are important, but I recently read that diabetics cannot absorb beta carotene because it is a form of vitamin A. Is this correct?

Your information on beta carotene is partially correct. People who have uncontrolled diabetes or hypothyroidism have difficulty metabolizing beta carotene. But, if your diabetes is well controlled, whether by diet or medication and diet, you can certainly take up to 10,000 IU a day.

So while it’s true that diabetics often end up with heart disease, it doesn’t have to be that way. You can minimize your risk for heart disease if you have diabetes and reduce your risk of developing diabetic complications. I recommend you:

  • Eat five to nine daily servings of fresh vegetables daily; ½ of them raw.
  • Select food rich in lutein, a carotenoid essential in combating macular degeneration, one of the most feared complications of diabetes and a leading cause of blindness in the United States. Lutein can be found in spinach and /or kale, which you should eat two to three times a week.
  • Try my Top Healing Foods

Do you have a question about diet / nutrition that you’d like answered on our site? E-mail us at info@heartmdinstitute.com and we’ll do our best to post an answer through this or another HMDI article.

*Indicates that Q&A has been reprinted or adapted from Candid Advice About Your Heart, a Heart, Health & Nutrition supplement, with permission from Healthy Directions, LLC.

**Indicates that Q&A has been posted in response to emails or comments submitted to Heart MD Institute. © 2012 Heart MD Institute. All rights reserved.

Please note that Dr. Sinatra does not provide medical advice through Heart MD Institute; any and all information found on this site is intended solely as an informational tool, and it should never replace a visit to your physician, nor be considered medical advice upon which you rely when making health-related decisions.

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