Basic Dietetics

Diet in Cardiovascular Diseases

Cardiovascular Diseases
● Cardio means heart and vascular means of blood vessels, Thus, Cardiovascular diseases
include ailments of heart (CHD) and of blood vessels (atherosclerosis).
● Cardiovascular diseases include hypertension,ischemic heart disease, angina pectoris,
myocardial infarction.

Hypertension
Increased blood pressure
Ischemic Heart Disease
Lack of blood to heart muscle resulting in heart attack.
Angina Pectoris
Reduction of blood supply to heart muscle due to narrowing of artery wall.
Myocardial Infarction
Coagulation of blood in blood vessel.

Risk Factors:
● Emotional Stress
● Hypertension
● Elevated Serum Cholesterol
● Lack Of Activity Leading to Obesity
● Smoking

DIETARY MANAGEMENT

Principles Of Diet:
● Diet therapy is the most important treatment for patients with high blood cholesterol
levels.
● Low calorie
● Low fat particularly low saturated fat, low trans fat, low cholesterol.
● High in PUFA with ω-6 to ω-3 ratio 4-10 : 1
● Low Carbohydrate
● Normal protein,minerals, vitamins
● High fibre diet with increased amount of antioxidants.

Total Energy:
● 1000 to 1200 calorie diet is suitable for an obese patient in bed.
● Loss of weight by the obese leads to a considerable reduction in the work of the heart
because the basal metabolism is at a lower level.
 ● A brief period of undernutrition during the first few days is advisable as increased
cardiac output is needed with high intake of food.

Fat:
● Restriction of fats to no more than 20 percent of the total calories consumed.

Polyunsaturated Fatty Acids:(PUFA)

● α-linolenic acid, eicosapentaenoic acid, docosahexaenoic acid are the n-3
polyunsaturated fatty acids or ω-3 fatty acids
● Linoleic acid and arachidonic acid are the n-6 polyunsaturated fatty acids or ω-6 fatty
acids
● PUFA promotes esterification of cholesterol and makes it into easily utilisable form.
● PUFA (Arachiodonic acid) promotes esterification of cholesterol and makes it into an
easily utilisable form. PUFA, especially arachidonic acid are precursors of prostacyclins,
thromboxanes and leukotrienes.
● Thromboxanes are vasoconstrictors; Prostacyclins are vasodilators, hence help in
prevention of thrombus formation.
● Linoleic acid prevents accumulation of cholesterol in blood, and also plays a key role in
transport of cholesterol.
● Foods rich in ω-3 polyunsaturated fatty acids confer cardioprotective effects.
○ It also reduces
■ incidence of sudden death
■ Decrease risk of arrhythmia
■ Lowers plasma triglyceride
■ Reduce blood clotting
● ɑ-linolenic acid reduces risk of myocardial infarction and fatal ischaemic heart disease
among women.
● Daily consumption of fish 200-400g is good to escape from cardiovascular diseases
● Fish are good source of ω-3 fatty acids such as salmon
● Consumption of 100-200g of fish, two to three times a week helps to prevent heart
disease.
● Mustard oil,flax seed, canola, soybean oil, and walnuts are good sources of ω-3 fatty
acids.

Monounsaturated Fatty Acids(MUFA);

● MUFA- Oleic acid, erucic acid
● It is present in vegetable sources such as olive oil, canola, almond oil,groundnut oil.
● It lowers LDL, without lowering HDL and also do not raise triglyceride levels
● The Mediterranean diet included fruits, vegetables ,MUFA,legumes and small portions
of meat.

Saturated Fatty Acids:

● Saturated fatty acids must be avoided. It raises HDL along with LDL.
● Polyunsaturated fatty acids should be taken in limited quantities, whereas MUFA are
preferred to Protect Cardiac Health.
Cholesterol:
Cholesterol level in diet should not exceed 300 mg.

Blended Oils:
● Mustard oil, soybean oil, safflower oil and corn oil.
● They are rich in ω-3 and ω-6 fatty acids.

Carbohydrate:
● Only complex carbohydrates should be included in the diet.
● Simple sugars reduce HDL levels.
● Carbohydrate intake should be limited to 60% of total energy in patients with
metabolic syndrome
● Soluble fibres like oat products,psyllium, pectin, guargum reduce LDL particularly in
hypercholestrolmic patients.

Low Glycaemic Foods:

● Two scientists found that foods that are more slowly absorbed may have benefits in
relation to reduction of CHD .
● Low glycaemic foods lowers fatty acid concentration which is associated with increased
glucose uptake by muscle, reduces VLDL synthesis and in turn reduces LDL and
increases HDL.
● Low glycaemic food is beneficial for those with greater degree of insulin
resistance(BMI>23).

Protein,Vitamins And Minerals:

● Since total fat, animal fat, organ meats, eggs and sea food are restricted, Vitamin A
deficiency may occur. Hence, supplements of Vitamin A is essential.
● Mega doses of niacin is an effective treatment of dyslipidemia
● Vitamin B6,B12 and folic acid supplementation decreases risk of cardiovascular
disease related to homocysteine risk factor.
● 200-300mg of Vitamin C reduces cholesterol.
● Selenium intake in urban South Indian is low and hence leads to CHD.
● In lactovegetarian diet , legumes namely red gram, black gram, wheat , parboiled rice
and milk provide selenium, including wheat and finger millet.
● Sodium is restricted in hypertension.Usually restriction of sodium of 1600 to 2300mg
is good among patients with CHD.
● As sodium is restricted , iodine should be prescribed.
● Intake of salt 3g/d is both safe and adequate for healthy adults.
● In countries like India ,sodium loss can occur through sweat, the requirement is not
more than 7g/d.
● Potassium, if its low, it leads to high blood pressure.
● Magnesium intake has been associated with decreased incidence of CHD and low
magnesium levels leads to high blood pressure and angina.
●
Water:
 ● Heart diseases are more common areas with soft water than where the water is hard.
● Minerals such as Ca,Mg,Cr,V in hard water appear to be protective.
● Restriction of fluid is not required as long as sodium is not restricted.

Atherosclerosis:(Narrowing of the arterial walls dui to deposits of fatty material)

● It causes resistance to blood flow.
● Making the heart to pump harder
● Thus,increasing blood pressure.
● The increase in blood pressure injures the arteries further, thus worsening
atherosclerosis.

FUNCTIONAL FOODS FOR CHD

● Foods rich in antioxidants, hypocholesterolemic agents and phytochemicals protect

from CHD.
● Vitamin C,I, and β -carotene have potential health benefits for reducing CVD.
Vitamin E
● Vitamin E reduces platelet aggregation and thrombus formation.
● Food sources of Vitamin E : Vegetable oils, dark green leaf vegetables , nuts and whole
grain cereals.
● Most concentrated antioxidant.
Carotenoids
Green leafy vegetables and yellow orange coloured vegetables are good sources of
carotenoids.
Vitamin C
● Guava, red grapes, pomegranate have the maximum antioxidant properties, whereas
pineapple , banana oil and sapota have the least.
● Green leafy and cruciferous vegetables contain nutrients and phytochemicals that
protect the heart.
● Five servings are recommended to fulfil the antioxidant requirements.
Selenium
Seafood, kidney and liver are good sources of selenium,
Soya protein
● Soya protein sources include products like isolated and textured supplements. soya
bean and its soya protein

● Recommended to consume 25g/d soya protein to reduce CVD.

Beans

● Greater consumption of legumes was linked to lower incidence of hypertension

● Pinto beans reduce total and LDL blood cholesterol
Fruits and Vegetables
 ● FLAVONOLS powerful health giving chemicals which can protect against heart disease
are found in wines,fruits and vegetables
● Small cherry tomatoes, red onions are highly loaded with flavonols.
Garlic

● One half or one clove of garlic per day is sufficient to reduce cholesterol level.
Nuts.

● Almonds are the best source of α tocopherol.

● 70% of fat in almonds is MUFA,it helps to reduce cholesterol.
Yogurt and Milk:
Synthesis of cholesterol is reduced when yogurt and milk are consumed.
Sodium restricted Diets:

● Most people daily intake of salt is 3-7g .

● 500-700mg is a severe restriction. No sodium is used in cooking. Processed foods are
avoided.
● 1000-1500mg is moderate restriction
● 2000-3000 mg is mild restriction Small measured amount of salt is used in cooking.

SOURCES OF SODIUM IN DIET:

● Most plant foods are low in sodium.

● Fruits, unsalted butter, unsalted cereals and brands, oils, sugars can be used without
restriction.
● Less than 5mg - Bitter gourd, bottle gourd, brinjal, france beans, onion stalks ,onions
ridge gourd.
● 5 -11mg - Pumpkin, ladies finger, peas , cucumber, colocasia, potato,tapioca, sweat
potato.
● 12-15mg - Cabbage, green plantain
Fruits
● Less than 6 mg- Amla, guava, orange, papaya, peaches, plum, pomegranate, tree tomato
● 7-13mg - Peas, ripe tomato
Food Preparation For Sodium Restricted Diet
● Use of spices, Sherbs, flavour extracts helps improve acceptance of salt less recipe.
● These include lemon juice, pepper, green pepper,onion, garlic which may be used in
salads, stews etc.
Dietary Guidelines:

● Patient should maintain the body wright slightly than standard weight.
● The patient should know the energy content of the food he consumes.
● Small amounts of almonds and walnuts can be high consumed, high amount of nuts and
oil seeds increase the calories.
● Coconut should be restricted in the diet.
● Egg yolk contains cholesterol. It should be restricted to 2-3 eggs/week.
● Patient should take skim milk or low fat milk.
● Olive oil contains MUFA, increase HDL
● Artificial sweeteners can be included occasionally in the diet.
● If a patient is suffering from hypertension, sodium should be restricted.