stay-at-home cousins. Those who have settled in California, where fat in-take is even higher, suffer more heart attacks still.
The evidence mounts daily that most people, even those with an inherited tendency to heart disease, can substantially reduce their risk of heart disease by following a low-cholesterol diet. Some studies even show that cholesterol reduction helps reverse cholesterol deposits that have already formed. But cholesterol is not the whole story.
Fats—Saturated, Polyunsaturated, and Monounsaturated Perhaps equal in importance to the actual amount of cholesterol in the diet may be the amount of saturated fats that are consumed. They tend to raise the cholesterol level in your blood no matter how little cholesterol you ingest.
Saturated fats are the fats that become hard at room temperature. They're found primarily in animal products such as meats, cheese, butter, cream, whole milk, and egg yolks. They're also found in some vegetable products such as coconut oil, palm oil, and cocoa butter.
But now the fat story brightens. Two types of fat may actually be beneficial for cholesterol control. Polyunsaturated fats, such as safflower, corn, and sesame oils, and monounsaturated fats such as olive oil and peanut oil, may help to lower blood cholesterol levels. Of course our bodies need some fat to maintain health, but you shouldn't eat too much of these beneficial fats either, since all fats may pose a cancer risk.
Fish Oil Rapidly mounting evidence shows that eating certain ocean fish at least twice a week, in place of meat or eggs and butter fats, may diminish your risk of coronary heart disease. This new research from the University of Leiden in the Netherlands, the Oregon Health Sciences University, and Harvard Medical School* has shown that fatty fish, with their high levels of omega-3 fatty acids, may be even more useful than polyunsaturated vegetable oils when it comes to lowering blood cholesterol levels. In fact, fish oils may also affect another aspect of body chemistry beneficially: by reducing the stickiness of certain cells important in blood clotting, they may help prevent blood clots from forming and blocking your arteries, thereby reducing your risk of heart attack and stroke.
The discovery of the beneficial value of fish oils grew out of observations by Danish researchers in the 1970s that had long seemed contradictory to cardiologists. Why did Eskimos, who eat huge amounts of animal fats, have such a low rate of coronary heart disease? Similarly, in coastal regions of Japan where despite rampant high blood pressure caused by high salt intake, heart attacks are not a frequent cause of death. One logical explanation put forward was that Eskimos are genetically resistant to heart attacks. But it turned out that it was not their genes that protect them, because the few who move to Denmark and switch to the local diet are just as prone to heart disease as Danes.
The studies applied only to salt-water fish. It is unknown whether freshwater fish would produce the same results. Fish richest in these protective oils are those that live in deep, cold waters. Examples include salmon, tuna, and Atlantic mackerel. Shellfish, such as shrimp and lobster, though higher in cholesterol than fish, also have this protective fish oil and are now considered desirable alternatives to red meat once or twice a week.
Fats, Fiber, and Cancer
Eating too much fat (both saturated and unsaturated) not only increases the risk of heart disease but may also lead to cancer of the colon, breast, prostate, and lining of the uterus. Consider colon cancer, prominent in nearly all the countries where heart disease is a major killer. The scientific evidence suggests that a diet low in fat and high in fiber (especially from whole grains, fruits, and vegetables) can help prevent this cancer. In Japan, for example, with its traditionally low-fat, high-fiber diet, colon cancer is rare. But when Japanese migrate to the United States and ultimately adopt a largely Western diet, their rates of the disease approach the high U.S. rate.
Of course there are other risk factors that play a role in heart disease, high blood pressure, and cancer, such as heredity, overweight, inactivity, and smoking. With regard to heredity, there is some evidence to support the theory that though your genes may place you at high risk, it may be possible through changes in diet to minimize the consequences of genetic factors. Insofar as weight is concerned, cutting back on fats and meats in the diet reduces calories considerably, so weight control becomes much easier.
What Medical Experts Tell Us to Do
According to the American Medical Association dietary guidelines, your cholesterol intake should be kept to less than 100 milligrams per 1,000 calories and never more than 300 milligrams per day. Saturated fat should comprise less than 10% of calories, and total fat intake should account for less than 30% of total caloric intake. They also recommend that you reduce your sodium intake to about 1 gram per 1,000 calories, not to exceed 3 grams per day. For the average person eating about 2,000 calories a day, these guidelines mean a daily intake of no more than 200 milligrams of cholesterol and 2,000 milligrams of sodium.
The Heart Association also advises you to keep total calories low enough just to maintain your ideal body weight and to get your carbohydrates primarily from grains, fruits, and vegetables. The following is a summary of the dietary guidelines issued by the American Heart Association:
Saturated fat intake should be less than 10% of calories.
Total fat intake should be less than 30% of calories.
Cholesterol intake should be less than 100 mg per 1,000 calories, not to exceed 300 mg per day.
Sodium intake should be reduced to approximately 1 gram per 1,000 calories, not to exceed 3 grams per day.
Other specific dietary guidelines issued at,the same time by the American Heart Association were:
Protein intake should be approximately 15% of calories.
Carbohydrate intake should make up 50-55% or more of calories with emphasis on increasing sources of complex carbohydrates.
If alcoholic beverages are consumed, the limit should be 15% of total calories, not to exceed 50 cc of ethanol per day.
Total calories should be sufficient to maintain the individual's best weight.
A wide variety of foods should be consumed.
An example for an average person consuming 2,000 calories per day:
200 milligrams of cholesterol
2,000 milligrams of sodium
22 grams of saturated fat
66 grams of total fat (1 gram of fat yields 9 calories.)
Therefore:
(2,000 x 10%) ÷ by 9 = 22.
(2,000 x 30%) ÷ by 9 = 66.
To reduce the risk of cancer, the National Academy of Sciences in its report Diet, Nutrition and Cancer, recommends that fat comprise no more than 30% of your total calories and preferably less. The Academy also urges the consumption of more vegetables, fruits, and whole grains, and less salt-cured, smoked, and charcoal-broiled food (these are carcinogenic). It further recommends that you moderate your consumption of alcoholic beverages, get some exercise on a regular basis and stop smoking.
How to Apply These Recommendations to Everyday Life
Developing a healthy diet means following two basic rules: moderation and variety. In other words, cut down on the things that put you at risk and eat a wide range of
