Tasteful Alternatives to the Heart-Healthy Diet

Désirée Lie, MD, MSEd


December 29, 2008

Case Responses

Case 1

This young patient has a family history of coronary artery disease with a moderate risk from his lipid profile, and he would benefit from primary cardiovascular prevention measures. Because he already exercises and is close to having a healthy BMI, the main intervention that a clinician might advise would be related to diet composition. His lifestyle precludes careful monitoring of caloric intake and weighing of food portions. He is a suitable candidate for the Mediterranean diet for which a simple handout and diet composition advice can be offered during a brief encounter. In this case, the only advice he might need would be to be to reduce consumption of soda and beer, sweet deserts, red meat, and non-low-fat dairy products, maintain nut consumption at appropriate calorie levels, and add fish and olive-oil-based foods to his diet. He might consider substituting sweet deserts with dark chocolate at modest doses[36,37,38] because there is evidence of health benefits for blood pressure and cardiovascular protection. Follow-up would include repeat lipid panel in 3 to 4 months and assessment of adherence to the recommended dietary guidelines. Failure to adhere to these guidelines might prompt referral to a dietician for more details on applying the Mediterranean diet guidelines.

Case 2

This Italian-American woman is already enamored of the key elements of the Mediterranean diet. This diet has been comparable to high-carbohydrate and low-fat diets in weight reduction and improvement of cardiovascular risk factors. She may have or may be at risk for the metabolic syndrome, which would justify a more aggressive approach to dietary management before pharmacotherapy, such as metformin, is considered. Measurement of her waist circumference and waist-hip ratio and fasting glucose and triglyceride levels is warranted. Because of her multiple cardiovascular risk factors, referral to a dietician would be appropriate to design a weight loss program and lifestyle changes that include increased physical activity and would fit with her current cooking pattern and her family's lifestyle and eating habits.

Clinical Pearls

  • Key components of the Mediterranean diet, which originated in Crete, Italy, and other European countries, are a high intake of vegetable and fruit, fish as protein, use of olive oil (that retains the lipophilic components of the olive fruit and phenolic compounds with antioxidant and anti-inflammatory properties), tree nuts, legumes, moderate wine intake, and a low intake of animal fats and dairy products.

  • Proposed mechanisms for the protective effects of a Mediterranean diet include a beneficial effect on lipoprotein metabolism, including LDL-c lowering, and beneficial effects on vascular endothelial function and platelet adhesiveness in part because of a reliance on calories from plant rather than animal sources of fat.

  • When used for weight loss, the Mediterranean diet performs as well as the low-carbohydrate and the low-fat diet.

  • Nuts eligible for a qualified US Food and Drug Administration claim for cardiovascular benefit include almonds, hazelnuts, peanuts, pecans, pistachio nuts, walnuts, and some pine nuts. The current evidence does not appear to support intake of one particular nut over another for cardiovascular benefits.


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