More than 20 years ago, Marcia enrolled in a Coronary Health Improvement Program (CHIP) sponsored by her local hospital. She signed up on her own initiative as a preventive measure since her father and three of her grandparents had died of heart attacks.

As a result of the program, she now exercises regularly and has mastered some stress management and relaxation techniques. The recommended diet, however, was very strict, advising fat intake of no more than 10 to 15 percent of daily calories. After about a month, she drifted back to her old way of eating.

Marcia thought about the CHIP diet last week when her doctor, noting her rising cholesterol and blood pressure numbers, suggested that she consider some diet and lifestyle changes. “If that means following that low-fat diet, I’m not sure I can do it again,” she thought.

The concept of a heart-healthy diet has changed somewhat over the past two decades, but the low-fat diet plan recommended first by Nathan Pritikin and then by Dean Ornish still has considerable support from medical experts.

Although the Ornish diet is not strictly vegetarian, it is strongly oriented toward fruits, vegetables and whole grains with very little meat, butter or other fat. For any extended period of time, a diet that allows only 10 to 15 percent of calories to come from fat becomes extremely Spartan. In practice, many nutritionists consider 25 percent fat to be a more reasonable low-fat goal.

Some experts today, on the other hand, believe that even the 25 percent goal is too strict and fails to take into account the health benefits of some fats. Persons parsimoniously measuring fat grams are likely to ignore fish, nuts, unsaturated fats and omega-3 fatty acids — all now considered beneficial to heart health.

Studies have shown that people who eat fish, particularly fish such as salmon, trout and mackerel, have a lower risk of heart attacks. To get adequate quantities of omega-3 fatty acids, the American Heart Association recommends that you eat fish at least twice a week.

Nuts were once avoided as high-fat foods, but they too are high in omega-3 fatty acids as well as protein, fiber, minerals, vitamins and antioxidants. One review of 25 randomized, controlled studies found that subjects assigned to eat half a cup a day of nuts registered decreases of 11 mg/dL in their total cholesterol and 10 mg/dL in LDL.

Rather than throwing out all fats, most experts today focus more specifically on eliminating the fats known to be bad for the heart — saturated fats and trans fats — and replacing them with healthy monounsaturated fats that are known to lower LDL cholesterol while raising levels of the beneficial HDL.

For incorporating these healthy fats, the Mediterranean diet — focusing on vegetables, fruits, fish protein and healthy oils — is an excellent choice. It’s even better when it includes whole grain, rather than white pastas.

Mediterraneans enjoy wine with their meals, and it’s now known that wine — and particularly red wine — contains heart-healthy flavonoids. The Ornish diet, at least in its early forms, recommends avoiding alcohol as well as nuts and fatty fish.

Another heart-healthy plan that focuses on the pleasure of eating rather than deprivation is the TLC (Therapeutic Lifestyle Changes) diet. This diet recommends six or more servings a day (adjusted for calories) of whole grain breads and cereals; three to five servings a day of vegetables, dry beans or peas; two to four servings of fruits; and two to three servings of low-fat dairy products. Whereas the Ornish plan recommends avoiding or severely limiting all meat, the TLC diet allows five or less ounces a day of lean cuts of meat.

Losing or maintaining weight is a crucial part of any heart-healthy lifestyle, and low-carbohydrate diets have been found effective at trimming excess pounds, even when such diets involve relatively high amounts of fat and protein. Dr. Ornish’s recent article in the New York Times takes an aggressive stance against such diets, and most medical experts agree, although research so far has not reached definitive conclusions.

Rather than choosing one diet or another, the best approach may be to follow some basic heart-healthy principles endorsed by the American Heart Association: 1) cut back or avoid saturated and trans fats; 2) increase your intake of healthy unsaturated fats, omega-3 fatty acids, nuts and fish; 3) focus on getting plenty of fruits, vegetables, whole grains, fiber, potassium and antioxidants.



Rupp is a certified information and referral specialist on aging for NODA Area Agency on Aging. Contact her at 237-2236.