Janelle is a 59-year-old woman who’s concerned about her risk of CVD. Her mother died at age 61 from a heart attack, and, even though Janelle is relatively healthy, her LDL cholesterol is above the acceptable range, and she wants to decrease her risk. The information Janelle has found online regarding dietary fat and cholesterol is conflicting. Determined to find the correct answers, she makes an appointment with Becca, an RD, to clear the confusion and ask questions about how and what she should eat for a heart-healthy diet.
Are Low-Carb, High-Protein and Ketogenic Diets Heart-Healthy?
For decades, evidence has supported a relationship between a diet high in saturated fat, elevated blood lipids, and CVD. Interest in this subject has gained steam due to the recent popularity of low-carb, high-protein, and ketogenic diets, which often are high in animal products that contain saturated fat. Proponents of these diets tend to minimize their health risks and cite studies that downplay the hazards of saturated fat. Despite the hype surrounding these diets over the past few years, evidence-based guidelines haven’t changed. A 2019 Scientific Statement by the American College of Cardiology (ACC) and American Heart Association (AHA) concluded that replacing saturated fats with monounsaturated and polyunsaturated fats can be beneficial for reducing risk of CVD. And more bad news for low-carb and ketogenic diet fans comes from the same article: long-standing dietary patterns that focus on low intake of carbohydrates and high intake of animal fat and protein are associated with an increased cardiac and noncardiac mortality rate.
What About Coconut Oil?
Coconut oil has been hyped as a heart-healthy fat in recent years. How can that be when coconut oil is 92% saturated fat? Some suggest coconut oil is heart-healthy because of the type of fatty acid chains it contains (ie, medium-chain triglycerides). Some studies do suggest that coconut oil increases HDL cholesterol, but it’s been shown also to raise LDL cholesterol in other studies. There’s no convincing evidence based on the current limited and low-quality research that coconut oil, as opposed to unsaturated fats, reduces CVD risk.
How About Dietary Cholesterol?
Historically, foods high in dietary cholesterol have been linked to elevated blood lipids and CVD risk. Evidence from observational studies conducted in several countries doesn’t indicate a significant association between dietary cholesterol and CVD risk. However, the 2019 ACC/AHA Guidelines do suggest that a diet containing reduced amounts of cholesterol can be beneficial for reducing risk of CVD. In recent years, the focus on dietary cholesterol has decreased, mainly because foods high in cholesterol also are high in saturated fat, so an effort to decrease saturated fat in the diet will result in lower dietary cholesterol intake.
What Should Clients Eat to Reduce CVD Risk?
Current recommendations to reduce CVD risk suggest that individuals consume an overall healthful diet as opposed to focusing on specific nutrients. An eating pattern such as the Mediterranean diet or the DASH eating plan that emphasizes intake of vegetables, fruits, legumes, nuts, whole grains, and fish and minimizes intake of trans fats, red meat, processed meats, refined carbohydrates, and sugar-sweetened beverages is the best way to reduce an person’s risk of heart disease. This type of eating pattern is recommended for overall good health because it’s naturally low in saturated fat and dietary cholesterol, and high in dietary fiber, nutrients, and healthful fats such as omega-3 fatty acids.
Success for Janelle
Becca, the RD, emphasizes to Janelle that good nutrition advice is backed by a body of evidence over time. Janelle learns that reducing saturated fat in her diet is one key to reducing her CVD risk, but that an overall healthful eating pattern is just as important. Janelle sets goals for incremental changes in her diet and is delighted that she can move forward knowing that she’s making the best food choices. Subsequent lipid levels suggest Janelle is on the right track to reduce her risk of CVD.
— Becky Dorner, RDN, LD, FAND, is widely known as one of the nation’s leading experts on nutrition and long term health care. Her company, Becky Dorner & Associates, Inc, is a trusted source of valuable continuing education, nutrition resources, and creative solutions. Visit www.beckydorner.com to sign up for free news and information.