Writing Rules for a Cholesterol-Lowering Diet: Examining the evolution of cholesterol-lowering diets, Calculating dietary fat allowances, Listing the people for whom low dietary fat is a no-no and Finding good sources of cholesterol control dietary information.

Writing Rules for a Cholesterol-Lowering Diet

In This Chapter

� Examining the evolution of cholesterol-lowering diets

� Calculating dietary fat allowances

� Listing the people for whom low dietary fat is a no-no

� Finding good sources of cholesterol control dietary information

Okay. You’ve been to the doctor. She ran a blood test for cholesterol (check out Chapter 3), and your numbers are high. Her first recommendation is likely to be a cholesterol-lowering diet. What’s that? The answer is in this very short chapter; so short, in fact, that you may be tempted to skip past it and go right on to Chapter 5, which explains how to put the strategies listed here into action to create a meal plan of your own.

But in the words of the golden-hearted lady of the evening played by Shirley McLaine in Sweet Charity: “Hey, Big Spender, spend a little time with me.” It won’t take long. I won’t waste words. As a result, you can head into Chapter 5 armed with a better understanding of why your doctor is pushing a low-fat, high-fiber diet to control your cholesterol. What’s to lose?

Being Prudent

The first people to say, “Hey, we can prevent heart attacks by changing what people eat,” were almost certainly the guys at the New York City Department of Health who created the Diet and Coronary Heart Disease Study Project of the Bureau of Nutrition, commonly known as the Anti-Coronary Club, on February 19, 1957. Their goal was to track a group of overweight, middle- age men who’d either had a heart attack or looked like they were about to experience one.

By the way, you may notice that I said men. No women were in the club because before the days of women’s lib, nobody considered women to be at risk for a heart attack. Gee.

Anyway, the nutrition docs enlisted the Anti-Coronary Club members as volunteers in a trial of a new controlled-fat, low-cholesterol diet. Half of the participants got the experimental diet, and half were allowed to eat whatever their little, bursting hearts desired.

Within four years, it was clear that the incidence of heart attack among the men on the controlled-fat, low-cholesterol diet was much lower than incidence among men in the other group. By cutting back on fats, cholesterol, and calories, the project turned modern heart-disease prevention in a new direction. Thus the Prudent Diet — the very first cholesterol-lowering regimen — was born.

By the way, not only was the first cholesterol-lowering diet created right here in my hometown, The Big Apple, the cardiologist-in-charge was my uncle, Seymour H. Rinzler, MD, one really good reason for my continuing interest in this subject. And make a note: Although being in The Big Apple raises some people’s blood pressure, apples, the food, are great little cholesterol busters. Check it out in Chapter 5.

Doing the Diet Two-Step

By the 1980s, Americans had pretty much accepted the idea of a link between high cholesterol and an increased risk of heart disease. In addition, they were now living long enough so that medical problems of older age — think heart attack — were becoming more common, and therefore more worrisome.

To confront the heart issue, sorry, head on, in 1984, the National Heart, Lung, and Blood Institute (NHLBI), a division of the National Institutes of Health (NIH), convened a Consensus Development Conference to deal with hyper- cholesterolemia (high cholesterol to you and me).

Fourteen experts, meeting for two days, issued two important edicts (as in “do this or you’ll be really sorry”):

 Edict Number One: Henceforth, Americans will be divided into three risk groups for heart attack based on their total cholesterol levels:

• The lowest quarter of cholesterol levels (below 200 mg/dL) is “low.” People occupying the low quarter are at low risk of heart attack.

• The two middle quarters (200–239 mg/dL) are “normal.” Those folks in the middle quarters are at moderate risk for heart attack.

• The top quarter (240 mg/dL and above) is “high.” Folks sitting in the high quarter are at high risk for heart attack.

Mg stands for milligrams, and dL is the abbreviation for deciliter (1⁄10 of a liter).

 Edict Number Two: Sticking to a low-fat, controlled-cholesterol diet is a person’s best bet for reducing the risk of heart attack, so cut your total fat intake and cut back on animal foods (the source of dietary cholesterol). Or else.

The authoritative food plan was — surprise! — the Prudent Diet, which NHLBI’s brand-spanking-new National Cholesterol Education Project (NCEP) had magically transformed into something called The Step I and Step II diets.

Step I (notice the Roman numerals which somehow make this title look very important) was meant for healthy people with cholesterol readings in

the 200–239 mg/dL range. Step II was for people who’d already had a heart attack or had a cholesterol reading above 240 mg/dL. Here’s what each diet mandated:

Step I

v No more than 30 percent of your total daily calories from fat.

v No more than 10 percent of your total daily calories from saturated fat.

Chapter 5 explains saturated fats (versus unsaturated, polyunsaturated, and monounsaturated fats) in detail.

v No more than 300 milligrams of cholesterol per day, regardless of how many calories you consume.

Step II

v No more than 30 percent of your total daily calories from fat.

v No more than 7 percent of your total daily calories from saturated fat.

v No more than 200 milligrams of cholesterol per day, regardless of how many calories you consume.

No, you’re not entitled to 30 percent of your calories from fat plus 10 percent or 7 percent of your calories from saturated fat. The percent allowed for saturated fat is part of the 30 percent allowed for total fat.

Table 4-1 does the math to show how the Step I/Step II formulas apply to 1,600-calorie, 2,000-calorie, and 3,000-calorie daily diets.

Adding TLC

No, TLC doesn’t stand for Tender Loving Care. The letters are the abbreviation for Therapeutic Lifestyle Changes (TLC) diet, the food facts recommended in May 2001 when NCEP released a whole new set of guidelines for managing cholesterol. Which, come to think of it, may actually be Tender Loving Care for your heart.

The document in question is the Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, commonly known as ATP III. (For more about ATP III and its recommendations on cholesterol- lowering meds, check out Chapter 12.)

Step I (see the preceding section) was still okey-dokey, but TLC replaced Step II as the must-use diet for people with specific medical conditions and risk factors such as

v High level of LDLs

v A previous heart attack or cardiovascular disease, such as blocked arteries

v Type 1 diabetes (insulin-dependent diabetes, diabetes mellitus) or metabolic syndrome, also known as insulin resistance syndrome, a cluster of risk factors that includes Type 2 diabetes (non-insulin dependent diabetes), high blood pressure, excess weight, elevated LDLs (“bad” cholesterol), and low HDLs (“good” cholesterol)

Table 4-2 shows the daily rules for the TLC diet. As you read them, notice that this diet allows slightly more total fat than you got with the Step II diet. Why? To give people with diabetes the option to replace some calories from carbs with calories from fat. Are these guys considerate, or what?

Finding Diet Aids

Some people have no trouble adapting to a cholesterol-lowering diet. Others find it pure torture. The following resources may relieve some of the pain:

v Healthcare professionals and groups: These fine folks can show you how to adapt your menus to your diet or send you to other fine folks who can get the job done:

• GPs: Your general practitioner (your family doctor) is your first stop on the way to lower cholesterol. She can give you menu plans and tips to ease your way into low-cholesterol eating.

• HMOs and PPOs: Yes, mangled care, I mean managed care, can be annoying, frustrating, and — let’s not mince words — downright loathsome. But once in a while the system works. Many managed- care plans now include some options for alternative medicine, such as nutrition therapy and consultations with registered dieti- tians. If your plan is among the innovators, that’s good news for your pocketbook — and your cholesterol.

v The local YMCA or YWCA: Ask about diet classes. There’s bound to be a heart-healthy one on the list. Just be sure that anyone who hands out personal advice for your very own body has the proper credentials, like the letters RD (for registered dietitian) after his or her name.

v The Internet: They don’t call it the Information Age for nothin’. Try these Web sites:

• www.eatright.org: The American Dietetic Association. Follow the prompts to the feature that enables you to find a registered dietitian/personal nutritionist right in your neighborhood (or at least close to home).

• www.americanheart.org: The American Heart Association.

• www.nhlbi.nih.gov: The National Cholesterol Education Project. Reach it through the National Heart, Lung, and Blood Institute site.

When in doubt, just search www.google.com, type cholesterol diet, and surf. What? You’re reading this book on a boat drifting up the Amazon? In a balloon-tire, all-terrain vehicle on your way to the Alaska pipeline? No nutritionist in sight? No excuses, please. If The Person In Charge of Everything didn’t want you to check out your diet wherever you are, would she have

The low-fat surprise

Just when you think you’ve heard it all, some- body springs a surprise. This time I’m the surprise springer, and this is my surprise: Not everyone benefits from a low-fat diet. Who are the exceptions?

v Newborns and infants: In the early 1980s, just as cholesterol-mania was hitting its first peak, some conscientious parents decided to cut back on fat and cholesterol right from the beginning in order to give their baby a head start in preventing a heart attack later in life. It sounds reasonable — a low- cholesterol diet in infancy equals high heart protection later on — but in this case, one and one don’t add up to two.

Unlike an adult whose body is completely developed, an infant is still making new tissue and new connections in the wiring of his brain — an organ packed with cholesterol. As a result, newborns and infants require whole-fat foods.

As the low-fat infant diet spread, hospitals began to see otherwise healthy infants who didn’t thrive — a medical way of saying that they didn’t develop properly. When doctors identified the cause of the problem — these low-fat baby diets — and parents added fats back into their baby’s diet, some damage was reversed.

Today, the American College of Pediatrics recommends that a full 50 percent of an infant’s calories should come from fat. The organization also says that children absolutely shouldn’t be on a low-fat diet until they are at least past their second birthday and then only on the advice of a physician. Babies are not little adults; they’re complicated organisms complete with (invisible) handle-with-care tags!

v People with diabetes: Some experts have suggested that a diet high in carbohydrates and low in fat is less beneficial for people with diabetes than a diet high in fat and relatively low in carbohydrates. This claim hasn’t been nailed down yet to anyone’s complete satisfaction. If you have diabetes, you know better than to change your diet without talking to your doctor first.

invented GPS (global-positioning satellite) cell phones, or wireless laptops? Give me a break! Better still, give yourself a break, and check out the Real Rules for yourself.

You can also buy a really reliable cookbook, such as

v The American Heart Association Cookbook

v Low-Cholesterol Cookbook For Dummies by Molly Siple (Wiley)

v Lowfat Cooking For Dummies by Lynn Fischer and W. Virgil Brown (Wiley)

Each recipe comes with a nutrient analysis listing the amount of the following nutrients in a single serving:

v Calories

v Protein

v Carbohydrates

v Cholesterol

v Sodium

v Total fat

v Saturated fat

v Polyunsaturated fat

v Monounsaturated fat

Armed with these nutrition numbers, you can put together menus that fit the requirements of a cholesterol-lowering diet. Can’t wait for another trip to the bookstore? Check out the hearty-healthy recipes in Chapter 14.