A controlled diet effectively ensures a healthy heart
IT is well known that diet influences the risk of several major chronic diseases. These include coronary heart disease (CHD), hypertension, cerebrovascular disease, obesity and diabetes.
These conditions are the common cause of premature death and disability in affluent communities and they impose major burdens in terms of morbidity and mortality on society.
In Pakistan, 12 to 15 per cent of the population has some kind of cardiovascular disorder. Of these, 11 per cent suffer from high blood pressure, affecting people at their most productive age between 30-60. This is also the cause of over 100,000 deaths, 12 per cent of all deaths annually.
However, the modifiable risks for CHD have been identified.
Three of these factors are linked to nutritional practices: obesity, high blood cholesterol and hypertension. Other strong non-nutrition factors include cigarette smoking, physical inactivity, stress, certain drugs and lack of information, education and guidance on the role of diet in the prevention and treatment of CHD. The presence of more than one risk factor increase the risk of CHD. Risk increase by 30 per cent with the presence of any one of the three major controllable risk factor (high blood pressure, high blood cholesterol and smoking). With the presence of any two of these risks factors, the risk of CHD increases three fold. With all three of these risk factors CHD risk increases seven fold.
Smoking increases the chance of developing diabetes and raises blood fat levels. Smoking more than ten cigarettes per day alone increases coronary mortality by 1.6 fold. Coronary mortality doubles when systolic blood pressure is more than 130mm Hg in smokers. Risk of myocardial infarction is estimated to increase by four fold in oral contraceptive agents’ (OCA) users. Coronary risk in OCA users increases with age and with the presence of other risk factors, cigarette smoking and hypertension in particular.
In Pakistan 1.4 to 1.9 million babies are born as low birth weight (less than 2.5kg) that leads to a 50 per cent greater risk of diabetes heart disease and cancer later in life. About 57000 babies are born with congenital heart disease in Pakistan.
According to the National Health Survey of Pakistan, chronic diseases are a burden to many Pakistanis. People are acquiring many unhealthy life style, dietary and behaviours similar to developed countries. These lefestyle includes sedentary occupations, inadequate physical activity, imbalance diet, tobacco, alcohol and drugs. About 7.3 million Pakistani adults have high blood cholesterol levels and half of all heart disease deaths in women today are caused by raised cholesterol.
Female heart attack patients, younger than 50 are more likely to die than their male counterparts. One out of seven older adults are obese or overweight. About 40 per cent urban women (45-64 years) are obese or overweight. Obesity in urban males increases from 15 per cent of those with low economic status to 40 per cent of those with high economic status. Approximately 2.7 million people have prevalence of diabetes.
In 1992, over 11,000 Pakistani died due to diabetes. Among urban women, over 45 year of age, one in four suffer from diabetes and prevalence in urban overweight men is 24 per cent. High blood pressure is a leading risk factor for heart disease and stroke, affecting 17.9 per cent of adults (15 years and above). There are 5.5 million men and 5.3 million women who have hypertension. Urban Pakistanis have higher prevalence of high blood pressure than rural dwellers (21.5 per cent vs 16.2 per cent).
Tobacco use is one of the well-established risk factors for diabetes and CHD. About 34 per cent of men and 21.5 per cent of women use some form of tobacco regularly in Pakistan. About one in every 500 people has an inherited condition for increased risk of heart disease.
Diet is included in the category of modifiable risk factors because of its effects on Primary CHD risk factors. Many studies demonstrate a relationship between diet, plasma cholesterol and CHD. The positive relationship of saturated fat intake and dietary cholesterol to CHD and mortality has been well documented.
High carbohydrate intake lowers the risk of CHD. Recent studies suggest an inverse association between the consumption of fish and CHD. Men who consumed more than 30gm of fish per day, have a risk ratio, 2.5 times lower than animal protein (meat), which is positively, and vegetable protein, negatively, correlated with CHD. High intake of fruits and vegetables (400g per day) and pulses (30g per day) are associated with low rates of CHD and deduced risk of strokes. High fiber diets may be hypotensive.
Raised cholesterol is one of the biggest risk factors for heart disease along with smoking and high blood pressure. High cholesterol also increases the risk of clots forming, which can blocked or narrowed arteries, and cause heart attack. According to the American Heart Association, the ideal adult plasma total cholesterol is 130-190mg/dl. The National Cholesterol Education Programme defines a desirable blood cholesterol level as less than 200mg/dl. Border line — high blood cholesterol is 200-240mg/dl and high blood cholesterol level is greater than 240mg/dL.
Blood cholesterol readings can vary by upto 10 per cent during the course of the day, depending on what you have eaten, so your doctor may do several readings before considering treatment. If you have other risk factors such as smoking or a family history it is certainly worth testing your cholesterol.
Atherosclerosis takes decades to build up but if you lower protective cholesterol; it helps convert bad cholesterol (LDL) into a product that can carry cholesterol in the artery wall and encourages clot function in the blood.
In order to reduce reduce serum cholesterol levels and other diet related risk factors associated with CHD, the following dietary recommendations and guidelines are necessary.
Eat a variety of foods. Avoid large meals. Eat small and frequent meals to lower cholesterol levels and other heart diseases risk factors. Such dietary patterns make the body healthier and longer-lived. The consumption of fats high in cholesterol (butter fat, beef fat) and saturated fatty acids (coconut oil, palm oil and palm kernel oil) should be reduced. Minimize intake of hydrogenated (vegetable ghee) and continuously heated oils. Vegetable oils such as canola, olive, corn, sunflower, sesame, soybean should be included in the diet. Cod liver oil drops blood pressure significantly and linseed oil (one teaspoon a day) is effective in lowering heart disease risk. Emphasis on plant foods (fruits, vegetables, whole cereals, pulses, potatoes) fish, poultry, lean meat, low-fat dairy products and fewer whole eggs. Intake of orange, guava, carrot, yellow maize bread and vegetable oil reduce the risk of atherosclerosis.
Low fat milk or lassi or calcium supplementation lowers blood pressure and cholesterol. A vegetarian or semi-vegetarian diet can seriously cut heart disease risks.
Red pepper prevents the stickiness of blood cells that lead to blocked vessels. Always use some turmeric (Haldi) with red pepper to prevent the ill effects on the peptic ulcers. Use regularly fresh ginger (one teaspoon) and yogurt (one cup) for improving the health of blood vessels and heart. Both are good for lowering serum cholesterol. Garlic (two cloves daily) and onion lowers blood cholesterol and triglyceride and blood pressure. It also keeps the blood vessels clean and healthy. High intake of coffee (6-9 cups per day) is associated with higher cholesterol level. However, two cups a day is probably safe for most people.
Tea drinking appears to have no association with serum cholesterol or CHD. Reduce sugar intake. Cut sodium and salt intake (less than 5gm per day). Use potassium-based salt. Highly processed salty, salt preserved and salt pickled food is consumed sparingly. Adequate nutrition to pregnant mothers can prevent the problem of low birth weight in newborn, leading to CHD later in life. Discourage snacking on high fat, high sugar and high salt foods in early childhood, because it sets a pattern that favours the development of arteriosclerosis and hypertension.
Soft drinking water can contribute to higher incidence of high blood pressure and CHD. However, hard water seems to have a more favourable impact on health. The harder the drinking water the lower the death from CHD. The American Heart Association has recommended a standard of 20mg sodium per liter to protect heart and kidney patients, whose sodium intake must be restricted. It may be suggested that the choice to install a water softener in home may be unwise especially if the family may be heart disease prone. People in hard water areas suffer fewer heart attacks; those in soft had more cardiovascular accidents related to hypertension.
While moderate alcohol consumption appears to be negatively associated with CHD, it should not be recommended to reduce CHD risk. Alcohol increases plasma triglyceride levels, affects hypertension, alcohol hepatitis, cirrhosis and certain cancers and can cause social and psychological problems.
Butter must be avaoided. So too should palm oil, coconut oil, vegetable oils of unknown origin, hydrogenated fats and oils, visible fat on meat, chicken skin, fried meats, full cream milk, evaporated or condensed milk, cream, full fat cheese, full fat yogurt, potato chips, fancy breads, cakes, pastry, puddings and biscuits made with saturated fats, deep fried snacks, ice cream, full fat malted milk drinks. Cream soup, chocolate spreads, toffees, butterscotch, chocolate, coconut bar, salad cream, mayonnaise, cream cheese dressing, egg noodles.
There is also a need to develop following policies to address diet-related diseases including CHD.
A controlled diet effectively ensures a healthy heart 
