Question

What aspects of the standard American diet and lifestyle lead to the development of heart disease? (The foods we eat are typically high in what?) Alternatively, what components of the Mediterranean dietand lifestyle contribute to heart health? (The recommended foods: what are they high in and what are they low in?)

Answer 1

There is much controversy surrounding the optimal diet for cardiovascular (CV) health. Data relating diet to cardiovascular diseases (CVDs) has predominantly been generated from high-income countries (HIC), but over 80% of CVD deaths occur in low- and middle-income countries (LMIC). Relatively sparse data on diet and CVD exist from these countries though new data sources are rapidly emerging ). Non-communicable diseases (NCDs) are forecasted to increase substantially in LMIC because of lifestyle transitions associated with increasing urbanization, economic development and globalization. The Global Burden of Disease study cites diet as a major factor behind the rise in hypertension, diabetes, obesity, and other CVD components (3). There are an estimated over 500 million obese and close to 2 billion overweight or obese individuals worldwide . Furthermore, unhealthy dietary patterns have negative environmental impacts, notably on climate change.

Poor quality diets are high in refined grains and added sugars, salt, unhealthy fats and animal-source foods; and low in whole grains, fruits, vegetables, legumes, fish and nuts. They are often high in processed food products – typically packaged and often ready to consume – and light on whole foods and freshly-prepared dishes. These unhealthy diets are facilitated by modern food environments, a problem that is likely to become more widespread as food environments in LMIC shift to resemble those of HIC .

In this paper, we summarize the evidence relating food to CVD, and the powerful forces that underpin the creation of modern food environments -- what we call the global food system -- to emphasize the importance of identifying systemic solutions to diet-related health outcomes. We do this in the context of increasing global attention to the importance of improving food systems by the international development and nutrition community . While the “food system” may feel remote to a clinician sitting in an office seeing a patient, its impacts on the individuals they are trying to treat are very real. The paper is based on a World Heart Federation international workshop to review the state of knowledge on this topic. This review of diet, dietary patterns and CVD is not based on new systematic reviews or meta-analyses but represents a careful review of many published meta-analyses, seminal primary studies, and recent research by the scholars who participated in the Conse.

The way people eat has changed greatly across the globe; moreover the pace of change in LMIC’s is quickening. Snacking and snack foods have grown in frequency and number ); eating frequency has increased; away-from-home-eating in restaurants, in fast food outlets, and from take-out meals is increasing dramatically in LMIC; both at home and away-from-home-eating increasingly involve fried and processed food ; and the overall proportion of highly processed food in diets has grown .

These changes in the global food system coupled with these food behavior shifts have enabled some critical changes to the global food supply, all with dietary implications. First is the shift to refined carbohydrates – refined grains and added sugars. Rapidly increasing production of starchy staples combined with processing technologies mean that refined flour is increasingly dominant in diets. White bread, for example, once rarely consumed in Latin America, became widespread after the introduction of high-yield wheat varieties. In Asia, white rice became dominant as a staple over legumes and coarse grains, with a more recent trend being rapidly rising consumption of instant noodles as a staple . Since 1964, average total carbohydrate intake in the US has increased from about 375 g/d to 500 g/d (from 2 to 6 kg/year of ready-to-eat cereals), but the percent of carbohydrate that is fiber has not substantially changed over this time, reflecting increased refined carbohydrates and sugar sweetened beverages (SSBs) is high in HIC . In the 1985 to 2005 period extensive added sugar intake occurred across HIC ) but more recently large increases have occurred in LMIC, particularly in consumption of sugar-sweetened beverages and processed foods . Today in the US packaged and processed food supply over 75% of foods have some form of added sugar . With urbanization there is some evidence to show that refined carbohydrate consumption is increasing, whereas consumption of traditional grains (i.e. millet, maize) is decreasing in LMIC

.The Mediterranean diet incorporates the basics of healthy eating — plus a splash of flavorful olive oil and perhaps a glass of red wine — among other components characterizing the traditional cooking style of countries bordering the Mediterranean Sea.

Most healthy diets include fruits, vegetables, fish and whole grains, and limit unhealthy fats. While these parts of a healthy diet are tried-and-true, subtle variations or differences in proportions of certain foods may make a difference in your risk of heart disease.

The Mediterranean diet emphasizes:

• Eating primarily plant-based foods, such as fruits and vegetables, whole grains, legumes and nuts
• Replacing butter with healthy fats such as olive oil and canola oil
• Using herbs and spices instead of salt to flavor foods
• Limiting red meat to no more than a few times a month
• Eating fish and poultry at least twice a week
• Enjoying meals with family and friends
• Drinking red wine in moderation (optional)
• Getting plenty of exercise