Most of the recent blogs have addressed risk factors for coronary heart disease—things like hypertension, hypercholesterolemia, diabetes and smoking. We’ve discussed what you can do to lower those tendencies, but we unfortunately don’t have complete control over them. Even the seemingly simple decision to smoke is not so simple once a person has become addicted to nicotine. But there are a couple areas of our health where our choices have a gigantic impact: what we eat and what we do (physically). We’ll discuss here and in the next blog how to make healthy choices.
First, let’s talk about diet. We’ll start with how we look at weight. The most common way we assess it is through the BMI (body mass index), a measure of how much you should weigh, given your height. It is calculated by dividing your weight in kilograms (kg) by your height in meters squared (m2 )—weight/height2 —and is in units of kg/m2. There are multiple websites where you can plug in your height and weight (using American units of lbs and ft/in) and have your BMI calculated.
Although guidelines vary somewhat, optimal weight is usually defined as a BMI of 18.5-25. A BMI of 25-30 puts you in the overweight category, while a BMI of under 18.5 suggests you are underweight. Obesity is a BMI of 30-40 and morbid obesity is a BMI over 40. The BMI is an imperfect measure of obesity, as it doesn’t take into consideration what a person’s weight consists of—more muscle or more fat, large-boned vs small-boned, etc. But it is easy to calculate and is widely used in doctor’s offices and in medical research.
So, is obesity a “risk factor” for heart disease. Well, not in the way you would think. In fact, research has not generally found a causal association between obesity and heart disease. When studies control for other things—this is a statistical method for assuming all other things are equal—obesity doesn’t seem to be an independent risk factor. This is likely because obesity
causes problem through its effects on other processes: obesity raises the risk of diabetes, it leads to high blood pressure. And the way people become obese is by not exercising and by eating things that will raise their cholesterol, too.
Even though obesity isn’t technically a risk factor for heart disease, though, it has a large impact on the other things that are. Therefore, think very hard about what you put into your body. I am not a dietician and everybody’s tastes are different, but I’d like to provide you with a few suggestions and guidelines:
- Focus on what you eat and don’t worry as much about your weight. If you eat the right things, your weight will tend to come down. Even if it doesn’t change a lot, those healthy choices will lower your risk of heart disease.
- Avoid animal fats. Eat leaner meats, like chicken or pork loin (white meat has less fat than dark meat). Eat more fish, which has healthy omega-3 fatty acids. Try to eat 3-4 servings a week of oily fish. Olive oil is very healthy, though be careful cooking with it because it has a low smoke point. Cook with canola oil, which has a high smoke point. Other healthy cooking oils are corn, peanut, soybean, safflower, sunflower, sesame (good for East Asian cuisine), and avocado. Walnut, flaxseed and grapeseed are also healthy oils. The goal is to avoid saturated and trans fats. Look for monounsaturated and polyunsaturated fats.
- Avoid eating dairy, particularly if you are lactose intolerant. If you do want milk, drink non-fat.
- Eat more fruits and vegetables, 3-5 servings a day (a serving is about a handful). And nuts are healthy, particularly pistachios, almonds, cashews, walnuts, pecans, brazil nuts, hazelnuts, macadamia nuts, and peanuts.
- Eat a low-carbohydrate diet. Sugar is one type of carbohydrate. Processed sugar serves no nutritional purpose, so don’t add sugar to your food and don’t eat foods that have sugar as a major ingredient. Unfortunately, that means most desserts—so eat them sparingly! While fruit has sugar, it is fructose, not sucrose. And fruit comes with lots of other good things that offset the sweetness factor. So eat fruit for dessert!
- Starches are the second category of carbohydrates and another leading cause of weight gain and diabetes in the United States. We need some starch in our diets, but avoid processed starches—a good rule of thumb is “brown is better than white”: brown rice, wheat or multigrain bread, whole wheat pasta, etc. What makes these better is that they haven’t had the healthy part of the grain stripped off and they also have a lower glycemic index than the white/processed variety. A higher glycemic index means that the food is more quickly turned into sugar, rapidly raising blood sugar (glucose) levels. Whole grains, legumes, fruits, non-starchy vegetables (potatoes and rice have lots of starch) are all low glycemic index foods.
- Salt—which, from the point of view of biology, means sodium—should be limited to 2-3 gm (grams) per day. And if you have congestive heart failure or hypertension, your goal should be under 2 gm per day. Look at package inserts to see how much sodium is present.
- If you are trying to lose weight, I recommend weighing yourself daily. It keeps you accountable day to day. And, by weighing yourself first thing in the morning, it helps focus your efforts for the upcoming day.
Enjoy making healthier dietary choices!
Greg Koshkarian, MD, FACC