2. FATS AND CHOLESTEROL

3. 1. Key Concepts and Facts Fats are concentrated source of energy
Fats carry essential fatty acids and fat-soluble vitamins
Fats have positive and negative health effects
Saturated fats and trans fats raise blood cholesterol levels more than any other fat

4. 2. Roles of Dietary Fat Increases the flavor and palatability of foods
Absorb and retain flavor
Provides sustained relief from hunger
Stay in stomach longer
Absorbed from small intestine more slowly T

5. Lipids (Fats) Component of cell membranes
Regulate transfer of nutrients
Cushions kidneys & heart
Protects and insulates organs
Illustration Although their body fat stores don’t fit the image of the super-athlete, cold-water swimmers need the fat to help stay warm. Pictured here is the English swimmer Mike Read, who had swum the English Channel 20 times by age 39.
In 1926, Gertrude Ederle became the first woman and sixth person to swim across the English Channel, in 14.5 hours, beating the men's record by 2 hours.

6. Illustration 18.3 A triglyceride.
Fig. 18-3, p. 5

7. A Short Saturated Fatty Acid
Butyric Acid
A carboxylic group, COOH
A chain of 3 carbons
Saturated with hydrogen

8. A Triglyceride
Glycerol
3 stearic acid molecures
saturated fatty acids

9. Illustration 18.4 A look at the difference between a saturated and an unsaturated fatty acid.

10. Common Fatty Acids

11. Coconut Oil? About half the fatty acids in coconut oil are lauric acid
Coconut oil is about 90% saturated fat
Butter: 64%
Beef fat: 40%
Lard: 40%

12. Essential Fatty Acids Omega 3 Alpha Linolenic Acid From Fish & Flax
ALA
From Fish & Flax
DHA & EPA
Omega 6
Linoleic Acid (LA)
Sunflower, safflower, soybean & corn

13. More on essential fatty acids
ALA can be converted to DPA, DHA, and EPA
5- linus pauling institute,

14. Functions of Essential Fatty Acids
crucial role in brain function
needed for normal growth and development
may reduce the risk of heart disease.
reduces inflammation
may lower risk of chronic diseases such as cancer, and arthritis

15. Illustration 18.5 Fat profiles of selected foods.

16. Fatty Acid Composition of Fats

17. Where to Get Omega 3’s

18. Fortification with Omega 3’s
Research beefing up steaks, hamburgers with healthy omega-3s By ROXANA HEGEMAN Oct. 9, 2015
Eggs 130 mg EPA+DHA
200 mg EPA+DHA per 5 oz serving

19. Excellent source of Omega-3s EPA/DHA & ALA. 32mg EPA/DHA per serving
Excellent source of Omega-3s EPA/DHA & ALA ? mg EPA/DHA per serving. 400mg ALA per serving
Illustration Products that feature “no trans fats” and “trans fat–free” labels.
$10

20. YOUNG WOMEN: MERCURY GUIDELINES
Do not eat Shark, Swordfish, King Mackerel, or Tilefish.
Eat up to 12 ounces (2-3 average meals) a week of a variety of fish and shellfish that are low in mercury.
Check local advisories about the safety of fish caught in local lakes, rivers, and coastal areas

21. What is Hydrogenation of Fats?
Oleic Acid
Stearic Acid
Linoleic Acid

22. Partial Hydrogenation creates trans fats

24. Why are food companies working to remove trans fat from foods?
Jan. 2006, trans fat content added to labels.
2018 deadline for food companies to eliminate trans fat from their products.
OK in products like meat and cheese where they occur naturally
Illustration Trans fat: the newest addition to Nutrition Facts panels.

25. Vitamin D, and bile

26. Cholesterol+Sun = Vitamin D

27. Trans fats or trans fatty acids: contain fatty acids in the trans form.

29. Illustration 18.9 A look at the cuisine of the Mediterranean diet.

31. Mediterranean Diet
Groups who consume high fat diets can have average or below average rates of heart and other chronic diseases
The traditional Mediterranean diet is based on whole grain products, vegetables, fruits, nuts, olive oil, dried beans, wine, fish, and poultry
35-40% of calories come from fat, mostly monounsaturated
People eating the Mediterranean diet tend to be physically active and normal weight or lean
Despite high fat content, people with that diet and lifestyle have low rates of heart disease and cancer, and long life expectancy

32. Progress
Recent recommendations for fat intake are a change in dietary intake guidance
Change developing for years as research results supported new recommendations

33. Fat Intake Recommendations
Do I need to watch my percentage of calories from fat?
Willett: No. As long as you use healthy fats, and your keep your portion sizes modest, it doesn’t matter if your dish or meal has 40 percent or more of its calories from fat. The same is true for your diet: Focus on choosing foods with healthy fats, not the percentage fat.

34. Recommendations
Americans encouraged to increase consumption of EPA and DHA by eating fish more often (i.e., twice a week)
Most Americans consume enough linoleic acid, but intakes of alpha-linolenic acid tend to be low

35. Our saturated fat intake averages 11-12% of calories, and increases risk of heart disease
Recommendation is that saturated fat intake should be no more than 10% of calories
Intake of trans fats should be very low

36. Nutrition & Heart Disease

37. Key Concepts and Facts Heart disease is leading cause of death
Dietary and lifestyle factors are important
Diets that provide some “healthy fats” decrease heart disease risk more than low fat, high carbohydrate diets
Lowering high blood cholesterol levels reduces risk of heart disease

38. Heart disease is the leading cause of death for both men and women.
About 600,000 people die of heart disease in the United States every year–that’s 1 in every 4 deaths.
Illustration The impact of heart disease. If deaths from stroke and other diseases related to atherosclerosis are included, the annual death toll reaches 863,298. Source: National Center for Health Statistics, 2003.
Fig. 19-2, p. 3

39. Average age of first heart attack is 64.7 years for men and
72.2 years for women.

40. Risk of Cardiovascular Disease

41. Illustration The relationship between blood cholesterol level and death from heart disease. Source: Grundy SM. Cholesterol and coronary heart disease: a new era. JAMA 1986;256:2849–58. Copyright 1986, American Medical Association.
Fig. 19-6, p. 4

42. Illustration 19. 3 The progression of atherosclerosis
Illustration The progression of atherosclerosis. As plaque builds up, arteries narrow, reducing or stopping the supply of blood to the heart, brain, muscle, or other affected parts of the body.
Fig. 19-3a, p. 3

43. Atherosclerosis

44. Illustration 19. 3 The progression of atherosclerosis
Illustration The progression of atherosclerosis. As plaque builds up, arteries narrow, reducing or stopping the supply of blood to the heart, brain, muscle, or other affected parts of the body.
Fig. 19-3b, p. 3

46. Illustration 19. 4 The heart after a heart attack
Illustration The heart after a heart attack. The dark portion at the base of the heart is affected by the blockage in blood flow.
Fig. 19-4, p. 4

47. SYMPTOMS OF RISK OF HEART
CAN THESE BE
SYMPTOMS OF RISK OF HEART
DISEASE?

49. Xanthomas– fat deposits

50. Total Cholesterol: Not the whole story
Illustration The relationship between blood cholesterol level and death from heart disease. Source: Grundy SM. Cholesterol and coronary heart disease: a new era. JAMA 1986;256:2849–58. Copyright 1986, American Medical Association.
Harvard Health News

51. Illustration 19.8 The “bad” cholesterol (LDL) and the “good” cholesterol HDL) found in blood.
Fig. 19-8, p. 6

52. FOCUS ON BLOOD LIPIDS HDL helps remove cholesterol from the blood
HDL carries cholesterol to the liver for excretion
High HDL (> 50 mgm/dl for women, >40 in men)
protects against CVD
LDL cholesterol incorporated into plaque
Higher the LDL level, more likely atherosclerosis will develop and progress to heart disease

53. Dr. Willet on Coconut Oil
In short term studies, coconut oil raised HDL cholesterol
There are no long term studies on coconut oil and heart- health
Coconut oil has a wonderful flavor and texture-- there's no problem using coconut oil occasionally. But most of your oils should be healthier.

54. Triglycerides and CVD Risk
High levels increase heart disease risk
Elevated triglycerides are one symptom of
metabolic syndrome
Also low HDL cholesterol
Elevated fasting glucose
Abdominal obesity
High blood pressure, low HDL
People with metabolic syndrome are at particularly high risk for heart disease

55. Other Factors: Folate and Homocysteine
High blood levels of homocysteine, an amino acid, increase plaque formation
Folate is required to convert the amino acid homocysteine to methionine, reducing homocysteine in the blood.

56. Harvard Health News
There is some evidence that B vitamins, including folic acid, B6, and B12, may help lower blood levels of a substance called homocysteine
The risk of heart attack or death from heart disease was nearly halved among women who consumed the most folic acid and B6 from diet and supplements compared with those who consumed the least.

57. Folate, B6 and B12
One meta-analysis showed that consumption of 400 mgm folic acid in fortified foods or supplements reduced homocysteine by 25%
When folic acid was combined with vitamin B12, homocysteine levels sank another 7%

58. Since 1998 refined grain products like bread, crackers, pasta, and
Heart healthy food choices are basic, unprocessed, and low in saturated fats.
Since 1998 refined grain products like bread, crackers, pasta, and
rice have been fortified with folic acid.

59. Antioxidants and Anti-inflammatories
Table 19-1 Foods that reduce oxidation and chronic inflammation
Fish, seafood
Nuts
Coffee, tea, wine
Most fruits and vegetables
Whole grains, high-fiber foods
Vegetable oils
Oxidation causes damage to endothelium (cells lining arteries)
Inflammation increases plaque formation
Textbook correction: p line 20: change to “other components of
foods that reduce oxidation…”

60. DHA and EPA
Fatty fish from cold waters are highest sources of DHA and EPA
Omega-3 fatty acids protect against heart disease by:
decreasing blood clotting
decreasing blocked arteries
decreasing plaque build-up
decreasing blood pressure
decreasing blood triglyceride
levels

61. Nuts Nut consumption decreases risk of CVD
Nuts have good fats that lower LDL
1 oz of nuts a day decreases LDL
1 oz has ~200 calories
FDA approved “heart healthy” claim for nuts and products made from them
Nuts

62. Coffee? High in antioxidants
Role in the prevention of degenerative illnesses like cancer, high blood pressure and cardiovascular disease
Lower risk of Type 2
Diabetes

63. Analysis of 84 of the best studies looking at the alcohol and heart connection included more than two million men and women followed for an average of 11 years. Compared to people who didn’t drink alcohol, those who were moderate drinkers had a
29% lower risk of being diagnosed with coronary artery disease
25% lower risk of dying from a heart attack
25% lower risk of dying from any heart or blood vessel disease
13% lower risk of dying from any cause (this included cancer deaths, too)

64. Spicy Food Linked to a Longer Life, 2015 study
Capsaicin
main ingredient in chili peppers, had been found in other studies to have antioxidant and anti-inflammatory effects
Compared to eating hot food, mainly chili peppers, less than once a week, having it once or twice a week resulted in a 10 percent reduced overall risk for death.

65. Fruits, Veggies, Whole Grains….Fiber !
High intake of dietary fiber has been linked to a lower risk of heart disease in a number of large studies that followed people for many years. (Harvard Studies)
Study of over 40,000 male health professionals, a high total dietary fiber intake was linked to a 40 percent lower risk of coronary heart disease.
A related Harvard study of female nurses produced similar findings.

66. When Blood Lipids Are High
Total cholesterol is sum of the levels of LDL-, HDL-, and VLDL-cholesterol
Dietary recommendations:
specific types of fat and foods that lower levels of LDL and triglycerides, and raise levels of HDL
adequate intake of folate, and vitamins B6 and B12 are recommended to decrease elevated homocysteine levels

67. Special Spreads
Spreads with plant stanols lower blood cholesterol levels by blocking cholesterol absorption
Daily consumption of two tbsp of spread with plant stanols or sterols causes 10% drop in cholesterol level and 14% decline in LDL concentration
Blood triglycerides also lowered
Blood levels of HDL are not affected
Spreads are one more tool for lowering high blood cholesterol levels

68. Illustration 19.9 Examples of spreads containing LDL-cholesterol-lowering plant stanols and sterols.
$10

69. Reduce LDL Exclude processed foods that contain trans fats
Limit saturated fat intake to less than 7% of total calories
Exclude processed foods that contain trans fats
Increase monounsaturated fats, not polyunsaturated fats
Increase whole grain products, fiber, vegetables, fruits, soy protein foods, and plant stanols that lower LDL without decreasing HDL levels

70. Increase HDL Levels with
vigorous exercise
eliminate trans fats
weight loss
soy and nuts in the diet
moderate alcohol
Harvard Health

71. If Blood Lipids are still too high
Cholesterol-lowering drugs if blood lipid changes achieved by diet and lifestyle improvements are insufficient

72. Statins
Statins (Lipitor, Zocor, and Mevacor) markedly reduce cholesterol production in the liver
Use related to a 30% drop in LDL levels and a 30-40% reduction in heart attack and stroke in both women and men
Statins improve blood lipids levels more when combined with dietary and lifestyle changes than when used alone

73. Statins Side effects such as Muscle pain and weakness Liver disease
Kidney failure
Memory loss
Increased risk of Type 2 diabetes

74. Statins
Expense
Cost and side effects have prompted alternatives like extreme cholesterol-lowering diets
Therapeutic diets can lower LDL and keep statin dose as low as possible

75. Diet, Lifestyle & CVD Many factors in heart disease
Prevention & Treatment need to be broad
Include
heart-healthy diet or therapeutic diet
reduction of high blood pressure
body weight
drugs
smoking cessation
Goals: improved overall health and blood lipid profiles

76. USDA Diet vs Healthy Harvard?
Men who scored highest on USDA’s original Healthy Eating Index reduced risk of heart disease or other chronic disease by 11 percent over 8-12 years of follow-up compared to those who scored lowest.
Men whose diets most closely followed the Healthy Eating Pyramid lowered their risk of cardiovascular disease by almost 40 percent over 8-12 years of follow-up compared to those who scored lowest.

77. USDA Diet vs Healthy Harvard?
Women who most closely followed the government’s recommendations were only 3 percent less likely to have developed a chronic disease
Women with high scores lowered their risk by almost 30 percent.

78. Illustration 19.10 How to have a heart attack.
Fig , p. 10

79. The Future
Prevention and treatment of heart disease has changed in recent years and will continue to evolve
Concerns about the cost of cholesterol lowering drugs and side effects, and availability of low-cost preventive and treatment will affect these changes
Diet and lifestyle modification, changes in food supply, & increased consumer involvement in risk reduction may lead to decline in heart disease
An end to obesity and physical inactivity would also serve our hearts well