Tasteful Alternatives to the Heart-Healthy Diet

Désirée Lie, MD, MSEd

Disclosures

December 29, 2008

Case Studies

Case 1

A 23-year-old Asian Indian male student receiving a physical examination for graduate school seeks advice about a healthy lifestyle, especially related to dietary intake. His body mass index (BMI) is 26, his blood pressure is 120/70, and he exercises by running and biking 4 days a week for 30 to 45 minutes each session. He drinks soda daily and 4 to 5 cans of beer socially on weekends. His lipid panel reveals a total cholesterol level of 200 mg/dL, low-density lipoprotein-cholesterol (LDL-c) of 160 mg/dL, and high-density lipoprotein-cholesterol (HDL-c) of 25 mg/dL. His father died recently of a myocardial infarction at age 48 years and both his paternal grandparents have Alzheimer's disease. He tries to limit red meat, which he eats once a week. He enjoys Italian, Chinese, and Indian food, but because cooking is a challenge for his lifestyle and accommodations, he eats out 3 to 4 times a week with friends. He enjoys tea, all types of nuts (cashews, pistachios, walnuts, almonds, and pine nuts), and sweet desserts. He is "too busy" to measure food portions or examine the food labels to make wise choices and asks for "general suggestions." He has heard of the Mediterranean diet and asks about its composition and whether this approach might suit his risk profile and lifestyle preference. What general dietary advice would be appropriate from his primary care clinician to optimize health outcomes in relation to his cardiovascular risk?

Case 2

A 53-year-old postmenopausal Italian-American teacher is the primary cook in her family of 4 and enjoys cooking nightly for them. On weekends she hosts large dinner or lunch functions for friends, relatives, and her colleagues from work. She has limited time for exercise and walks 1 to 2 blocks during the weekend. Over the past 10 to 20 years she has gained weight at the rate of 2 to 3 kg yearly and currently has a BMI of 32. Her father has diabetes and is on oral hypoglycemics. Her father is caring for her mother who has macular degeneration and early signs of cognitive decline. There is a positive family history of early dementia. The patient is diligent about her annual well-woman examination and asks her clinician about ways to improve her risk profile for metabolic syndrome and diabetes and to reduce her risk for dementia and macular degeneration. Her blood pressure is 150/90 mm Hg, her total cholesterol is 190 mg/dL, with an LDL-c of 140 mg/dL and an HDL-c of 40 mg/dL. What dietary pattern can her clinician recommend to fit with her current lifestyle?

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