What is the most important measurement of cholesterol or lipids in the blood, when it comes to cardiovascular disease risk? LDL-C [low density lipoprotein cholesterol], is often called “bad cholesterol” because it is linked to atherosclerosis, but the landscape is always shifting. Even as cardiologists across the country get used to the new AHA/ACC guidelines, which call for changes in how physicians and patients view LDL-C, new research is focusing attention on other related markers. For example, a recent pair of studies in the New England Journal of Medicine identify gene mutations that lower both triglycerides and heart disease risk, suggesting that drugs that target that gene pathway could be beneficial. A new paper in Atherosclerosis, coauthored by Emory’s Terry Jacobson, looks at LDL-P, a different way of looking at LDL that has been proposed to be a better measure of cardiovascular disease risk. Jacobson is director of the Office of Health Promotion and Disease Prevention at Grady Health Systems. Read more
BY CHERYL WILLIAMS, RD, LD
If you’re looking for an excuse to indulge in the yummy chocolate you get this Valentine’s Day, research suggests it may not be so bad for you.
A number of studies, conducted over the last decade have associated cocoa and dark chocolate consumption with heart health benefits. These benefits come from cocoa, derived from the cacao plant, which is rich in flavonoids (cocoa flavanols to be exact). Flavonoids are antioxidants also found in berries, grapes, tea, and apples. As a whole, antioxidants prevent cellular damage and inflammation which are two major mechanisms involved in the development of heart disease.
So what does the research say?
A study published in the American Journal of Clinical Nutrition found that high-flavanol dark chocolate reduced bad cholesterol (LDL) oxidation and increased good cholesterol (HDL) levels. LDL oxidation promotes the development of plaque and hardening of the coronary arteries, thus lessening oxidation could help to prevent heart disease.
A Harvard research study found that flavanol-rich cocoa induced nitric-oxide production, which causes blood vessels to relax and expand, thus improving blood flow. Improved coronary vasodilation could potentially lower the risk of a cardiovascular event.
In a double-blind randomized Circulation study flavonoid-rich dark chocolate (containing 70% cocoa) reduced serum oxidative stress and decreased platelet activity (clumping) in heart transplant recipients. This favorable impact on vascular and platelet function is relevant because vascular dysfunction and platelet activation (adhesion upon damaged cell wall) are the basis of atherothrombosis (blood clotting) and coronary artery disease.
How can you reap chocolate’s potential benefits?
Not all cocoa products and/or chocolates are created equal. Milk chocolate, for example, is not rich in flavanols (contains only 10-20% cocoa solids) and white chocolate contains none at all. In addition, some cocoa products and chocolates are processed with alkali, which can destroy flavanols.
Follow these tips for heart healthy chocolate consumption:
- Avoid cocoa products processed with alkali (dutched) as seen in the ingredient list
- Choose dark chocolate with at least 70% cocoa
- Enjoy 100% unsweetened non-dutched cocoa (great for hot chocolate!)
Also, remember that chocolate is not a health food, as it is high in calories, fat and added sugar. Thus, make room for dark chocolate by cutting extra calories elsewhere in your diet. Additionally, stick to small amounts (e.g. 1 ounce) and do not eat in place of plant-based whole foods such as vegetables and fruits.
Cheryl Williams is a registered dietitian at the Emory Heart & Vascular Center. She provides nutrition therapy, wellness coaching, monthly nutrition seminars and healthy cooking demonstrations working with the Emory HeartWise Cardiac Risk Reduction Program.
Improvements in blood cholesterol levels are linked with eating nuts, according to this week’s Archives of Internal Medicine.
Authors writing in the journal say that dietary interventions to lower blood cholesterol concentrations and to modify blood lipoprotein levels are the cornerstone of prevention and treatment plans for coronary heart disease.
Nuts are rich in plant proteins, fats (especially unsaturated fatty acids), dietary fiber, minerals, vitamins and other compounds, such as antioxidants and phytoesterols. The contents of nuts are a focus because of the potential to reduce coronary heart disease risk and to lower blood lipid – fat and cholesterol – levels.
Emory University’s Cheryl Williams, RD, LD, clinical nutritionist, Emory Heart & Vascular Center, Emory HeartWise Cardiac Risk Reduction Program, says nuts are among the heart healthiest whole foods as they provide a variety of health promoting compounds such as dietary fiber, vitamins (vitamin E), minerals (selenium), antioxidants and phytoesterols.
While most of the calories provided from nuts come from fat, notes Williams, it is mostly unsaturated fats (mono and polyunsaturated), which have been shown to help lower elevated serum cholesterol, and to some extent triglyceride levels (via omega 3 fatty acids provided from walnuts).
Emory’s Cheryl Williams, RD, LD, clinical nutritionist for the Emory Heart & Vascular Center and Emory HeartWise Cardiac Risk Reduction Program, says you should make it a priority to know your cholesterol levels and learn how what you eat can impact cholesterol and your heart’s health.
Since diets high in saturated fat and trans fat have been linked to chronic disease, specifically, heart disease, this knowledge could save your life.
During National Cholesterol Month Williams notes in her blog for the Atlanta Journal-Constitution’s “Doctor Is In” that eating too many fatty foods – especially those high in saturated fat and trans fat – is the primary cause of high cholesterol. Thin, active people may not be aware of how much bad fat they consume, she says.
According to Williams, “Saturated fats are derived primarily from animal products and are known to raise cholesterol levels. They are found in common foods like butter, cheese, whole milk, pork and red meat. Lower-fat versions of these foods usually contain saturated fats, but typically in smaller quantities than the regular versions. Certain plant oils, like palm and coconut oils, are another source of saturated fats. You may not use these oils when you cook, but they are often added to commercially baked foods, such as cookies, cakes, doughnuts and pies.
Even more detrimental to cholesterol levels are trans fats, artificially created during food processing when liquid oils are converted into solid fats — a process called hydrogenation. Many fried restaurant foods and commercially baked goods contain trans fats, as well as vegetable shortening and stick margarine. Read labels and avoid foods that contain partially or fully hydrogenated oils.”
For more tips from Williams about managing for healthy cholesterol levels, visit ajc.com. To learn more about heart disease from Laurence Sperling MD, director of the Emory HeartWise Cardiac Risk Reduction Program, watch videos on health.com.