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The Nutritional Ways to Lessen the Risk of a Heart Attack or Stroke (Cardiovascular Disease)

Cardiovascular disease (CVD) is a term that describes a disease of the heart or blood vessels.  What this means to most of us in layman’s terms is usually a heart attack or a stroke.

We know that people with diabetes have a higher chance of being debilitated or dying from having a heart attack or a stroke than the person sitting next to them that doesn’t have diabetes. This fact always scared me enough to try to make the best choice for my heart health at least 90% of the time.

When I was diagnosed with diabetes over 30 years ago, many “rules” were different than they are today.

Now, before the FDA approves new diabetes medications, they require pharmaceutical companies to conduct studies to make sure that they are not harmful to your heart and blood vessels before they can be brought to the market.  These are called CVOTs, which stand for cardiovascular outcome trials. Interestingly as a result of this 2008 requirement, some of the newer diabetes medications have been found to be protective of the blood vessel and have shown a significant reduction of major adverse cardiovascular events.  This is positive news for people with a family history of heart disease or risk factors such as high lipids (cholesterol and triglycerides), high blood pressure, and high blood sugar.  The FDA, which stands for Food and Drug Administration, also regulates about 80% of the US food supply with the exception of meat, poultry and eggs which are under the USDA – United States Department of Agriculture.  Their roles are to keep the food supply safe and properly labeled. They do not require studies before food and supplements are brought to the market.

Nutrition labels are helpful, if not a bit overwhelming to decide what to look at, but they don’t tell you if a product will increase your risk for cardiovascular disease or not. Most of us learn how to eat from the family we grew up with.  We may, or more likely may not, have had any nutrition education in school.  Once we are adults, it is often hard to change years of our eating habits.  Sometimes being diagnosed with a health concern is a type of “wake-up call” that may lead us to examine our eating habits.  You may have grown up in a household where healthy eating was the norm.  My mother hated vegetables and she was forced to eat them as a child so she didn’t force her 6 kids to eat them.  So I never had vegetables besides corn and iceberg lettuce until I was 18.

You cannot turn on the TV, open a magazine, or your computer without seeing something about the latest and greatest “diet“ around.  As you know, there are many and some have come and gone and come back again.  Some of the recent ones are the keto diet, vegan diet, vegetarian diet, and intermittent fasting diet. Others have some familiar names as well, such as the Atkins diet, the Ornish diet, DASH diet, a low-fat diet, the cabbage soup diet, the Pritikin diet, the Zone diet and the Weight Watchers diet – to name a few. Many of these have formalized programs that you attend in person and some are available in a book form.

Diet is a word that can be used as a noun describing the kinds of food that a person habitually eats – such as “I eat a heart-healthy diet.”  It can also be used as a verb meaning to restrict oneself to smaller amounts of special kinds of food in order to lose weight – such as “It is difficult to diet”. When nutritionists speak about food, we usually use the word diet to mean the types of food someone eats – such as what type of fruits do you include in your diet?

Drugs are rigorously studied before being approved because there is a financial gain or beneficial reason to conduct expensive human research.  Diets are not typically studied in the same way because these studies require funding.  Recently several diets were studied in a meta-analysis, which is the examination of data from a number of independent studies of the same subject in order to determine overall trends. Giorgio Karam and colleagues, from the University of Manitoba, systematically looked at data from 40 randomized controlled trials of more than 35,000 individuals using 7 dietary programs (low fat, Mediterranean, very low fat, modified fat, combined low fat and low sodium, Ornish, and Pritikin) to determine the effect of the diet on the prevention of death from any cause or death from a cardiovascular event, stroke, non-fatal heart attack and unplanned cardiovascular intervention in individuals with an elevated cardiovascular risk. They compared the diet results to a minimal intervention, which was providing a healthy diet brochure.

Based on their review of the studies lasting more than 9 months, the Mediterranean diet and low-fat diet (reduced fat intake to 20-30% of calories with <10% saturated) were superior to the other diet plans and the minimal intervention group.  The effects were more pronounced for those at highest risk.  The highest risk was determined by two or more factors such as hypertension, high cholesterol, obesity, diabetes or previous heart attack, stroke, coronary artery or peripheral artery disease. The Mediterranean and low-fat diets showed a reduction in all-cause mortality and non-fatal myocardial infarction (heart attacks).  In addition, the Mediterranean diet evidence showed a reduced risk of stroke while the low-fat diet showed little to no benefit for stroke reduction.

So, what does this mean for someone with or without diabetes who would like to reduce their cardiovascular risk?

The Mediterranean diet was developed based upon the eating habits of long-living adults in the Mediterranean. In addition to food choices, it encourages communal eating and an active lifestyle.  I refer to it as a moderation diet, which is what I teach because it is usually sustainable.

Mediterranean diet pyramidMediterranean diet meals are based on a variety of the following:

  • colored vegetables and fruits
  • legumes
  • beans
  • whole grains
  • nuts
  • olive oil as the primary source of fat (replace butter or margarine).
  • fish or seafood (consume at least 2 times per week).

The largest difference from the USDA food guide pyramid is that protein foods such as poultry, dairy, red meat, as well as sweets and red wine (with meals) are only recommended once daily to weekly.  A typical Western diet may include animal proteins 2-3 times per day instead of per week.

If you are a visual learner, there are Mediterranean Diet Pyramids available online for downloading and printing.  As with any eating plan, I prefer to teach that you can have all foods to avoid feeling deprived but some of them are in small portions and less frequent.

Here’s to your heart health!

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