Evidence-Based

Dietary Management for the

Prevention and Treatment of
Cardiovascular Diseases
DOH First Conference on Dietary Management for
Lifestyle Diseases

February 28-March2, 20ll

Eurotel Hotel , Manila

Perla Sorreda- Esguerra

Chief, Division of Nutrition & Dietetics
Philippine .Heart Center
Email add: psesguerra@yahoo.com
 Global Trends
6 out of 10 leading
causes of Death

LIFESTYLE
RELATED

1. Cardiovascular diseases
2. Hypertension
3. COPD
4. Cancer
5. Diabetes Mellitus
6. Nephritis
Why 21st Century does not
encourage healthy living?
“ THE greatest epidemic
of our time is the
rapidly changing
lifestyle and a pattern
to eat more & move
less “
WHO
 “DIET-has the distinction of
being the only major
determinant of health that is
completely under your control.
You have the final say over
what does and does not go into
your mouth and stomach”.
Andrew Weil, MD
Natural Medicine
 Evidenced Based Diets for CVD
management
 AHA Step I/2- 50-60% CHO-30% Fat-15-20%
Protein/200mg cholesterol
 TLC diet( Therapeutic Lifestyle Change)
 Mediterranean- 25-35% FAT (MUFA=20%)
 DASH- Dietary Approaches to Stop-Hypertension
 Ornish- Severely fat restricted Diet-
 10% TOTAL FAT-75%CHO 15% protein.
 Therapeutic Lifestyle Change (TLC) Diet
Summary of the “old” Step 1 Summary of the “old” Step 2
Diet of High Cholesterol Diet

Total fat <30% total calories <30% total calories

Saturated Fat 8-10 total calories <7% total calories
Polyunsaturated Up to 10% total calories Up to 10% total calories
fat
Monounsaturated Up to 15% total calories Up to 15% total calories
fat
Carbohydrates
>55% total calories >55% total calories
Protein
-15% total calories -15% total calories
Cholesterol 300mg/dl <200 mg/dl
Examples of food in the Examples of food in the
Step 1 Diet Step 2 Diet
Lean Meat/Fish/ <6 oz/day <5-6 oz/day
Eggs <4 yolks/wk (2 <2 yolks/wk
Low Fat Dairy whites=1yolk) (2whites=1yolk)
Fats/Oils 2-3 servings/d <1% fat 2-3 servings/d <1% fat
Breads/Grains/ <6-8 tsp/day <6 tsp/day
Rice/Pasta >6 servings >6 servings
Vegetables 3-5 servings/day 3-5 servings/day
Fruits 2-4 servings/day 2-4 servings/day
 Therapeutic Lifestyle Changes (TLC) Diet
Summary of the TLC Diet
Total fat 25%-35% total calories
Saturated Fat <7% total calories
Polyunsaturated fat Up to 10% total calories
Monounsaturated fat Up to 20% total calories
Carbohydrates 50%-60% total calories
Protein -15% total calories
Cholesterol <200 mg/dl
Plant Sterols 2g/day
Soluble Fiber such as psyllium 10g-25g
Examples of Food in the TLC Diet
Lean Meat/Fish/Alt <5 oz/day
Eggs <2 yolks/wk (whites
Low Fat Dairy unlimited)
Fats/Oils 2-3 servings/d <1% fat
Breads/Grains/Rice/Pasta <6-8 tsp/day
Vegetables >6 servings
Fruits 3-5 servings/day
2-4 servings/day
 DASH Diet Plan :
Type of Food # of Servings Servings on a
for 1600- 2000 Calorie
Calorie Diets Diet
Grains and Grain Products 6-8 7-9
(include at least 3 whole
grain foods each day)
Fruits 3-4 4-5

Vegetables 3-4 4-5

Low Fat or Non Dairy Foods 2- 2

Lean Meats, Fish, Poultry 1.5-2 2.5

Nuts, Seeds, and Legumes 2-4 per week 4-5 per week

Fats and Sweets 2-4 3-4

 Serving sizes for DASH

 Grain/products- 1 sl whole wheat b

 1 oz dry cereal, ½ c cooked pasta
 Veg- 1 c raw leafy, ½ ckd veg
 Fruit- 1 med,1/2c dried fruit,1/2 c
 fresh, frozen
 Lowfat- 1 c yoghurt, 1 ½ oz cheese
 8oz milk
 Meats/poultry- 3 oz(85gm)cooked meat
 Nuts/beans-1/3 c nuts, ½ c cooked dry beans, 2 T seeds
(4-5/week)
 Sweets-2 tsp sugar, jelly or jam
 Fats/oils- 1 tsp oil, margarine, 1T lowfat mayo

Nutrition,Incredibly made Easy 2003

 Mediterranean
Nutrient Recommendation For a 2000 kcal
Meal Plan
Total Fat 25%-35% of Calories 55-75 grams

Saturated Fat <7% of Calories <16 grams

Polyunsaturated Up to 10% of Calories <22 grams

Fat
Monounsaturated Up to 20% of Calories <44 grams
Fat
Trans-Fat <1% of Calories <2grams

Sources: American Heart Association. “National Cholesterol

Education Program” Dietary Approaches to Stop Hypertension
Eating Plan, 2005 Dietary Guidelines for American
 Olive oil- Good for the Heart
 KINDS of OLIVE OIL
 OLIVE OIL-obtained solely fr. The
 fruit of the olive tree to the exclusion of
oils using solvents
 Virgin oil- obtained by mechanical means
under thermal conditions that do not lead
to alterations in the oil. Did not undergo
any treatment other than washing,de-
canting,centrifuging and filtration.

 Olive-pomace-treated with solvents

 Essential composition & quality Factors

Extra Virgin olive oil-with free acidity expressed

As oleic acid of not more than 1 gm/ 100gm

Virgin Olive oil-w/ free acidity expressed as oleic

Acid of not more than 2.0gms/100 gms

Refined O oil- obtained fr virgin olive oil by refining method

w/c do not lead to alterations in the initial glyceridic
structure, oleic acid expressed as not more than
.3gms/100gms
Olive oil- marketed as such, a blend of refined and virgin oil
with a free acidity of not more than 1.5gm/100gms
 Ornish Diet
Ornish Severely Fat A Vegetarian Diet containing only
Restricted 10% of Calories from Fat
75% Carbohydrates
The rest Protein
 Plant Sterols – plant based compounds that can compete with dietary
cholesterol to be absorbed by the intestines. This results in lower
blood cholesterol levels. Also known as phytosterols.

Sources of Sterols:
Food Serving Amount
Size
Almonds 1 oz 30 mgs.

Apple one 25 mgs.

Corn Oil 1 tbs. 135 mgs.

Garbanzo 1 oz 10 mgs.
Beans
Sesame Seeds 1 tbs. 100 mgs.
Dietary fiber or roughage is the indigestible
portion of plant foods having two main
components:

1. SOLUBLE FIBER – (prebiotic, viscous) fiber

that is readily fermented in the colon into
gases and active byproducts. Absorbs water to
become a gelatinous, viscous substance and is
fermented by bacteria in the digestive tract.

2. INSOLUBLE – Fiber that is metabolically

inert, absorbing water throughout the
digestive system and easing defecation. It has
bulking action and is not fermented .

Chemically, dietary fiber consists of non-

starch polysaccharides such as arabinoxylans,
cellulose and many other plant components
 Soluble Fiber is found in
varying quantities,
including:
Legumes (peas, soybeans,
and other beans)

Oats, rye and barley

Some fruits and fruit juices

(including prune juice,
plums, berries, bananas, and
the insides of apples and pears

Certain vegetables such as broccoli, carrots

Root tubers and root vegetables such as sweet Potatoes and

onions (skins of these are sources of insoluble fiber)

Psyllium seed husk (a mucilage soluble fiber)

 FIBER CONTENT OF DIFFERENT
FRUITS AND VEGETABLES
Camote – 0.7g
Gabi – 13.5g
Tubers/Potato – 7.6g
Saba – 7.6g
Singkamas/Turnips– 2.3g
Ube – 7.6g
Cashew Nuts – 4.8g
Watermelon – 0.5g
Raisins – 5.8g
Squash – 2.2g

Fiber
Dietary fiber intake is inversely correlated
with several cardiovascular disease risk factors in
both sexes, which supports its protective role
against cardiovascular disease and
recommendations for its increased consumption.
-Lairon et al. 2005

 Meta analysis of clinical data has confirmed

that a higher intake of dietary fiber, particularly
water-soluble fiber, reduces the risk of coronary
heart disease in the U.S. population.
-Bazzano et al. 2003

 Insulin secretion is reduced in the presence of

fiber.
 RDA - 25-30 grams/day
 OMEGA-3 FATTY ACIDS
essential fatty acids (EFA) found in plants
and seafoods
 “OMEGA -3 Fatty acids benefit the heart of healthy
people and those at high risk of or who have CVD.

 Research to date suggests that they decrease the

risk of arrhythmias which can lead to sudden
death, decrease triglyceride levels, decrease rate
of atherosclerotic plaques and lower blood pressure
“

 Eating at least 2 servings of oily species of

fish/week will provide sufficient amount of omega
3.

American Heart Assn.

 Cardiovascular Benefits
 Greater blood flow
 Rise in arterial blood pressure
 Increase in heart rate
 Burns more fat
 Increase endurance
 Helps your heart get better
 Makes you more fit


Institute of Medicine
 FDA
 Glycemic Index of CHo
 Definition- compares the ability to
release glucose into the blood with that
of equivalent weight of pure
glucose( GI of 100)
 Effects: the more glucose in the blood,
the more insulin released to control it
 Insulin stops the body from burning fat
 Excess sugar is converted to fat
=leading to overweight /obesity
“Sugars can produce a significant rise in total
Cholesterol, Triglycerides and Bad Cholesterol
and decrease in Good Cholesterol”

Nancy Appleton, PhD

Lick the Sugar Habit, Author
 Insulin Resistance
 Def: Inability of some cells of the
body to respond to insulin
 This happens when eating hi GI CHO
consistently which lead to constant
increase in insulin levels – the body
becomes accustomed & start to
respond less effectively over time –
resulting to impaired glucose- the
first step to diabetes.
“ When looking at CVD risk, the greatest danger comes from visceral fat not
over all excess weight”
A waist measurement of 1 meter (39 inches) in men and women under age 40
indicates a significant visceral fat accumulation.
Dr. Jean Piere Despres
Glasgow,Scotland ’98

 Bulging waistlines can also

increase the risk of high
blood pressure and raised
cholesterol levels.
 Sodium
 ” Sodium reduction-alone, or
combined with weight loss can
prevent Hpn by =20” (Trials of
Hypertension Prevention)

 Recommended amt= 2400mg Na or

1 tsp salt
 A well balanced diet includes :

1. Variety of nutrients- “Color your

plate”, RAINBOW DIET
2. Appropriate portion sizes
3. Regular meals-3-6 smaller meals
4. Limit amount of processed foods
–high salt & harmful chemicals
5.

Moderation, Variety and Balance

More fish and seafoods
– contains omega 3 fatty acids
good for the heart, less cholesterol
and saturated fats. Ex Tuna,salmon.mackerel,Dilis

Choose good fats/ Avoid the Bad and the Ugly

– monounsaturated/polyunsaturated
liquid oils rather than saturated,
Ex: canola, olive,almond,avocado,sunflower,coconut

Bad & Ugly FATS :

Saturated fats from animal sources;

hydrogenated and transfat :

(solid state at room temperature)
found mostly in snack foods,cookies/donuts

Limit cholesterol intake

– reduce meat and dairy products

Add more soy and legumes/nuts

- at least 3x/week
 Phil. Heart Assn. Dietary
Guidelines (PHA)
1. Consumption of a variety of fruits, vegetables,
grains fish, legumes, poultry and meat
2. Modify food choices to reduce sat fats,
cholesterol, and transfats by substituting PUFA
& MUFA
3. Limit salt intake, avoid processed foods
4. Limit alcohol intake
5. Avoid Tobacco smoking & second hand smoke
6. Blood Pressure control-goal is 120/80 mmHg
7. Engage in Moderate physical activity regularly
American Heart Association (AHA)
guideline
1. Balance caloric intake and physical activity to
achieve & maintain healthy weight. A 30-90 min
exercise daily
2. Consume a variety of foods, fruits and vegetables
that are deeply colored
3. Choose whole grains, high fiber foods
4. Consume fish, especially oily fish at least 2x a week
such as salmon, mackerel, sardines rich in omega 3
fatty acids
5.Limit daily intake of saturated fats in animal products
6. Use little or no salt in foods.
7. Cut down on beverages and foods that contain
added sugars
8. if you drink, do so in moderation
 PHC ALIVE DIET

Appropriate
Daily
Promote Level of
Healthy (heart)Intake for Intake to

Condition Ensure
Vim, vigor
and vitality Tip top shape
and

Excellence
 PHC ALIVE DIET
FOOD PYRAMID
MINIMIZE
SALT, SUGAR, RED WINE, RED MEATS,
TRANS FATS, SATURATED FATS, BUTTER

EAT LESS PASTA, NOODLES, WHITE RICE, FORTIFIED 3-4 SERVINGS

CEREALS,

EAT ADEQUATELY FISH, SEAFOODS, SEAWEEDS, SKINLESS 4-6 SERVINGS

POULTRY, EGGS, NUTS, YOGHURT, OLIVE OIL,
AVOCADO, CANOLA OIL

WHOLE GRAINS, BROWN RICE, OATS, WHEAT BREAD, 6-7 SERVINGS

EAT FREQUENTLY
ROOT CROPS, DRIED BEANS, AND TOFU
Regular Exercise
at least 3x a week
for 30 mins each
session
Exercise daily. Walk
with God.
 ENERGY
CARBOHYDRATE FAT
MENU ITEM kcal /
ExchU grams / serve
Serve
Quarter Pounder with
558 3 28.1
Cheese
Mc Chicken 494 3 24.2
Fillet-O-Fish 371 3 15.7
Mc Nuggets – 6 Pcs 302 1 17.7
French Fries – Large 524 4 28.5
French Fries – Medium 407 3 22.1
Muffin – Choc Mud 507 4 27.5
Sundae – Hot Caramel 312 4 8.1
Sundae – Hot Fudge 315 3.5 10.6
Coca-Cola – Large 205 3.5 -
Coca-Cola – Small 94 1.5 -
Bacon & Egg Mc Muffin 344 2 17.1
Hashbrown 156 1 9.9
Hotcakes w/o Butter &
266 3.5 4.6
FAST FOODS CAN increase the risk of weight
gain and Obesity in regular consumers by
encouraging unintentional over eating
Medical Research Council Scientists
Obesity Reviews Nov.2003
 Exercise & Calories Burned Index
HAMBURGERS
EXERCISE Large Fish and Chicken 3 Pancakes
Hamburger Chips and Fries with butter
s & Fries and syrup
Aerobics 114 74 102 67
Active
Dancing 132 85 118 78
Energetic
Jogging 105 68 95 62
5mph
Swimming 105 68 95 62
Steadily
Walking 176 114 158 104
3mph
 Pizza & Other Fast Food
Exercise Pizza 12” Pizza 12” Regular hot
Cheese Pepperoni dog

Aerobics
Active 117 143 31

Dancing
Energetic 135 165 36

Jogging
5mph 108 132 28

Swimming
Steadily 108 132 28

Walking
3mph 180 220 48
 Fast Food Extras

Exercise Large Doughnut Muffin Hot

Fries Plain fudge
Aerobics
Active 47 21 25 32

Dancing
Energetic 54 34 29 37

Jogging
5mph 43 27 23 29

Swimming
Steadily 43 27 23 29

Walking
3mph 72 45 39 49
 Drinks
Exercise Beer 12 fl Soda Red wine, Orange
oz glass Juice
Aerobics
Active 19 12 12 11

Dancing
Energetic 21 14 14 13

Jogging
5mph 17 11 11 11

Swimming
Steadily 17 11 11 11

Walking
3mph 31 19 19 18
 Mcdonald’s Critics
 “as a result of their high fat &
cholesterol content, Mcdo products
contribute to heart disease & certain
form of cancer. The links between
high fat and certain diseases are
established beyond any reasonable
doubt”
 Neal Bernard, President of the Physicians
Committee for Responsible Medicine, USA
Dietary Regimen after Open Heart
Surgery-4 Phases
 Progressive 1- Acute Phase
 to be given within 24-48hrs only
 TOTAL Calories- 1000
 TOTAL Volume- 1000-1200 ml

 Progressive II- Sub-acute-Full Liquid

 to be given 24-72 hrs
 Total Calories-1500 in 1500 ml (vol.)
 Progressive III- Convalescent
(mechanically soft)
 Total calories- 1500-1800 calories
 Foods Allowed:
 easily digestible, free of gastric irritants,
soft & low in roughage.
 Meat chopped, fish without bones
 Lugao or very soft rice
 well cooked vegetable w/0 stalks
 soft fruits w/o skin & seeds
 prepared with minimal amount of oil,
spices and salt
 Progressive IV-Rehabilitative
Phase-soft to regular diet
 Total calories- 1600-1800
 Foods allowed:
 More variety of food choices. Lean
meat, chix breast, more fish rich in
omega 3fatty acids
 All fruits & vegetable (if tolerated)
 Rice instead of lugao
 Use of more herbs and spices instead
of salt
 Food for Thoughts
 “ Health is not everything. But without it,
everything is nothing”.
Dr. Hans A. Diehl
 “Let food be thy medicine….”
Hippocrates
 “Healing is a matter of time, but it is sometimes
also a matter of opportunity”.
Hippocrates
 “If you think that to maintain health is costly,
Then try DISEASE “.
Nutrition Humor?
 The best way to lose
weight is by skipping:
skipping dessert; skip
snack; skip beer; skip
skippy (peanut butter).
 It’s not minute spent
at the table that put on
weight, it’s the
seconds.
 Days without exercise
makes one weak.
 Nutrition Humor?
•Whether you
want to be thick
or thin . . .
. . . is a matter of taste.
•What makes the Tower of
Pisa lean? It never eats.
•There are two things you
should never eat before
breakfast . . . lunch &
dinner.
Nutrition Humor?
•Quit smoking- it’s a
matter of life and breath.
•100 laughs a day is
equal to 10 minutes of
exercise.

•How do you know

carrots are good for the
eyes?
•Have you seen
rabbits with
eyeglasses?
 3 Bible Principles for Healthy
Eating
I. Eat the foods God created for
you and avoid everything else.
II. Don’t alter God’s design. Eat
the food before they are
changed or processed.
III. Don’t let any food or drink
become your God. Avoid
addictions. Intermittent fasting
will help.
 Quiz

1. The DASH diet is the most effective

2. Plan for lowering:
3. A. Blood pressure
4. B. Total Cholesterol
5. C. LDL/ HDL
6. The TLC diet recommends that calories from saturated fat should be: A. 10%
7. B. less than 7%
8. C. Less than 12%
9. The best and most effective diet for the prevention of CAD:
10. A. a balanced diet rich is veggies & fruits
11. B. a Balanced diet with moderate meats and fats
12. C. a Balanced diet rich in omega fatty acids and fiber
13. D. All of the above
14. Joan, 63 yr old a housewife,with no family Hx of CAD.Her LDL
15. Level is 165mg/dl; HDL 35mg/dl, Blood pressure 147/96 mm Hg.
16. How many risk factors for CAD does Joan have?
17. A. 1
18. B. 3
19. C. 4
Food Quotes:

“The 1 law of dietetics

st

seems to be : If it tastes
good, its bad for you”
Issac Asinov
 Food Quotes:
“I don't like food that's too
carefully arranged, it makes me
think that the chef is spending
too much time arranging and not
enough time cooking”
Andy Rooney
Thank you
PHILIPPINE HEART CENTER