In the February 2008 issue of the Journal of the American Dietetic Association, Dr. Jeremiah Stamler, professor emeritus of the Department of Preventive Medicine at Northwestern University, provides an engaging commentary to Dr. Linda Van Horn's exhaustive review of "The Evidence for Dietary Prevention and Treatment of Cardiovascular Disease". He gives an historic perspective to "the nutritional war on heart disease" and explains how we came to discover that eating white flour, white rice, sugar, salt-preserved food, high fat meat and dairy foods brought us the "diseases of modern civilization", specifically, heart disease, obesity, hypertension, and diabetes.
It was fascinating to me to learn how as far back as the 19th century we were piecing together the evidence of how what we eat can either make us sick, or keep us healthy.
- Missionary physicians like Dr. Albert Schweitzer and Dr. Samuel Hutton who traveled to West Africa and Labrador were surprised to find that these isolated native people were free from atherosclerosis, malignant growths, asthma, hemorrhoids, and appendicitis. The missionaries attributed this to a diet consisting overwhelmingly of unprocessed grains and vegetables, or fish, in the case of the Eskimos. When the Native people adopted the Western diet, they fell victim to the same "diseases of civilization".
- In 1908 a team of Russian researchers were surprised to see that they could produce atherosclerosis in rabbits when they fed them meats, milk and eggs.
- In 1904 French doctors discovered how high blood pressure could be controlled with lower salt in the diet.
- After World War I, during the famine years, German autopsy studies showed decreases in atherosclerotic lesions.
- During the Nazi occupation of Norway in World War II, when milk, eggs and meat were in short supply, cardiovascular disease and coronary heart disease dropped significantly.
- In Japan, when saturated fat was 3% of the average diet, and dietary cholesterol was around 250 mg/day, the average total serum cholesterol levels in young adults was 140-150 mg/dL. At middle-age, the level went up to only 150-160 mg/dL. These are levels that are nearly impossible to achieve in the US without serious diet or statin interventions.
- In Minnesota, when saturated fat was 17% of the average diet, and dietary cholesterol was around 750 mg/day, the average total serum cholesterol levels in young adults was 170-180 mg/dL. At middle-age, the level went up to 240-245 mg/dL.
While the American Dietetic Association presents a well-researched list of dietary interventions to prevent and treat coronary artery/cardiovascular disease, Dr. Stamler gives a little different spin with his version of the "Optimal Eating Plan". His guidelines are lower in sodium, with more specific recommendations for limits to cholesterol and daily fat intake. See which version works best for you.
- Emphasize vegetables, legumes, whole grains, fruits, nuts/seeds, fish/shellfish, lean poultry, fat-free and low-fat dairy products
- Emphasize low salt intake
- Emphasize use in modest amounts of vegetable/seed oils high in Omega 3 and Omega 6 poly-unsaturated fatty acids
- Emphasize moderate and low portion sizes (depending on how caloric a food is)
- Emphasize low amounts of saturated fats and cholesterol, and stay free of trans fat
- Emphasize (for those who wish to drink) alcohol quantity moderation
- De-emphasize red meats and processed meats, especially high-fat red meats and processed meats
- De-emphasize fat-containing dairy products and baked goods and promote minimal use of solid table spreads, shortenings, and sweets
- An optimal eating plan is high in essential nutrients (ie, minerals, vitamins, water-soluble and total fiber, vegetable protein, total protein, and in Omega 3 and Omega 6 polyunsaturated fats) [total of these fats limited to 9% of the total calories]
- An optimal eating plan is moderate in total fat [about 20-25% of the total calories]; moderate in starch, mono-saturated fats, and alcohol (if desired)
- An optimal eating plan is low in salt [no more than 1,150 mg of sodium per day], low in saturated fats [no more than 7% of the total calories], low in cholesterol [no more than 100 mg/1000 calories eaten per day], and low in sugars
- An optimal eating plan should have zero trans fats
- The optimal eating plan should be low-calorie, but with a high ratio of nutrients per calorie-fully compatible with healthy enjoyment of the pleasures of eating!
From my own experience, if you make it a goal to eat 7-9 fruits and vegetables a day, limit yourself to whole grains, eat sweets and refined carbs only occasionally, add soy and beans to your diet, limit protein to low fat fish, poultry and dairy products, and limit added fats to small amounts of olive/canola/grapeseed oil, you really won't have to pay much attention to calories. There isn't much room for anything else if you eat on the "unprocessed side". However, there is only one way to really see if you are keeping your saturated fat, cholesterol, and sodium counts low, and that's by tracking what you eat for a month or two on a tracker like MYFOODDIARY.com I thought I was eating a great diet until I tracked it. Sodium, calories & saturated fat were high! It was time-consuming to do, but it was well worth it!