by Paul Goldfinger, MD, FACC
(Special to the Ocean Grove Record.com)

Has your doctor ever uttered the words “monounsaturated fat” to you? Has he ever told you which type of oil is best on your salad? Has your doctor mumbled “diet and exercise” to you and then handed you a prescription for a statin drug? Have you ever been baffled by the huge array of options that come under the heading of “heart healthy” eating? For example, just look at the choices among “healthy” margarines that you find at the supermarket. In this column we will explore some of these issues.

If you go to the web site of the American Heart Association (www.americanheart.org), you will find enough information on “heart healthy” diets that your head will spin around like a scene from The Exorcist. But, curiously, the entire complicated presentation is about food, and nowhere can you find any specific clinical documentation that “healthy eating” will prevent heart attacks or sudden death from heart disease. The AHA makes general statements like, “A healthy diet and lifestyle are your best weapons to fight cardiovascular disease”. They make reference to “long term benefits”, but those “benefits” are not defined.

The reason for the vague terminology is that diet alone will not usually result in sufficient reductions in blood cholesterol numbers, nor is there evidence that diet alone will be sufficient to protect against specific end points such as heart attack and cardiac death. That is why doctors are aggressive in ordering statin drugs (which do reduce the risk of heart attacks and deaths) and why nutrition is just one component of a comprehensive risk reduction process. Nevertheless, even though the AHA won’t be so explicit, the sum total of research in this field does suggest that diet plus lifestyle changes will reduce your risk. As a cardiologist, I have been interested in prevention for many years and I can assure you that AHA style prevention programs do work and that diet is important.

The AHA and the National Institutes of Health have done an amazing job in arriving at specific recommendations based on over 50 years of research. The AHA prevention approach (called TLC-total lifestyle change) stresses not only diets, but lifestyle changes which include weight and blood pressure control, stopping smoking, and regular exercise. (Note that Americans have succeeded in becoming one of the world’s most successful countries as far as stopping smoking, but, unfortunately, we are second in the world in obesity). Doctors need to do more in learning about prevention and making sure that their patients are following the guidelines.

It is important to note that heart healthy diets are about much more than just “low fat.” The issues include fiber, sugar, calories, oils, fish, fruits and vegetables, and these items are covered in the recommendations. The guidelines are lacking in some details which are of interest regarding chocolate, red wine, fish oil capsules, cheese, beans, vitamins, plant stanol esters, grape juice, nuts, garlic, soy, tea, and coffee.

The subject of good and bad oils is fascinating, especially the olive oil story which begins with epidemiologic studies from the Mediterranean region. People who live along the Mediterranean, in places like Crete and Sicily, have reduced rates of coronary artery disease, and this is thought to be related, in part, to their diets. Of course, there are over 20 countries that border the Mediterranean, and there are considerable variations in their diets. Some groups eat more meat than others, some use butter or lard, and some eat a lot of cheese. But, in general, the diets there are characterized by fresh fruits and vegetables, fish, poultry, olive oil, garlic, nuts, breads, cereals, potatoes, legumes and red wine.

The olive oil part has interested me. Olive oil contains monounsaturated fat, which seems to provide protection against arterial damage. This idea has taken hold in the public mind, and thus many people have increased their consumption of olive oil, but what about other vegetable oils?

In the south of France, northeast of the Bordeaux region, is the city of Lyon. A group of scientists there wanted to study the benefits of a Mediterranean style diet on the rate of coronary events in a group of heart patients. I was interested in this trial for a number of reasons, but especially because of the type of oil used in the study. The researchers were afraid that the butter eaters would not like olive oil, so they used canola oil instead. Like olive oil, canola oil is a monounsaturate, but it also contains omega-3 fatty acids (“fish oil”).

The data showed such a powerful benefit of the diet that after 4 years, there was a 50%-70% drop in cardiac complications in the diet group, and the study was terminated early. As with so many of the dietary research trials, there were problems with the methodology, but, by any standard, it was a fascinating and compelling study, even if you don’t believe that anything definite was established. The study strongly suggested that canola oil is fine in a prevention diet, and you will see that the NIH names canola oil in a list of good monounsaturated oils that includes olive, sunflower and peanut oils, but they also reference polyunsaturated oils like corn, safflower, cottonseed and soybean.

It is my duty to point out that fats of all kinds are high in calories and thus will promote weight gain. A tablespoon of olive oil has the same 12 grams of fat (110 calories) as a tablespoon of butter, so even though olive oil is healthier than butter, it is no less fattening. I do believe, however, that a heart healthy diet should contain “good oils” even though some advocates of strict low fat diets would restrict all oils. If you want this doctor’s advice, buy extra virgin olive oil and put that on your salad. Colavita’s extra virgin olive oil costs $4,921.00 per barrel, but you can get a 5 oz bottle for about 5 bucks.

So I think we have been chewing the fat long enough. I do want you to know that there is a place on the internet where you can find a detailed discussion of the diet recommendations of the National Heart, Lung and Blood Institute (TLC: Total Lifestyle Change Diet) and you can read about the Lyon Heart Trial there as well. (www.nhlbi.nih.gov/health/public/heart/index.htm). You can also go to the AHA web site to see a link to the July 4, 2006 issue of Circulation where the prevention guidelines for physicians can be found.