Ron Krauss, MD

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More Palatable Nutrition Guidelines

• Ron Krauss, MD
• Senior Scientist, Head of Molecular Medicine
• Lawrence Berkeley National Laboratory
• University of California
• Berkeley, California

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More Palatable Guidelines
Why new approach?

• A need for clear, user-friendly guidelines
• New studies affected recommendations
• The growing epidemic of obesity

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More Palatable Guidelines
New organization

• Focus recommendations on specific targets such as
  obesity, cholesterol, and hypertension.

AHA Dietary Guidelines Revision 2000
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More Palatable Guidelines
Cholesterol general

• Limit saturated fat
• (lt10 of daily calories)
• Limit cholesterol
• (lt300 mg/day)
• Limit trans fatty acids

AHA Dietary Guidelines Revision 2000
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More Palatable Guidelines
Focused recommendations

• We have focused the diet on the needs of
• the individual. Both in terms of their health
  
• status, and their own particular food
• preferences, and in some cases cultural
• background.
• Ron Krauss, MD
• Senior Scientist, Head of Molecular Medicine
• Lawrence Berkeley National Laboratory
• University of California
• Berkeley, California

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More Palatable Guidelines
Dietary minimums

• Fruits and vegetables
• (at least 5 daily servings)
• Grain products, including whole grains
• (at least 6 daily servings)
• Fish
• (at least two weekly servings)

AHA Dietary Guidelines Revision 2000
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More Palatable Guidelines
Cholesterol individual

• Patients with cardiovascular disease or high
  cholesterol need much more aggressive management.
• Current NCEP guidelines are
• lt7 of daily calories from saturated fat
• lt200 mg/daily of cholesterol
• This is an upper limit, we should aim lower.

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More Palatable Guidelines
Fad diets

• There is little scientific literature to work
  from.
• High protein diets are mostly from animal sources
  and make it difficult to restrict saturated fat.
• No restriction of saturated fat or cholesterol is
  not a responsible dietary regimen.

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Syndrome X definition

• A pro-atherogenic metabolic trait
• characterized by insulin resistance and
• metabolic disturbances affecting blood
• lipids (elevated triglycerides, low HDL
• cholesterol, and small dense LDL).

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Syndrome X prevention

• AHA recommendation
• weight management
• physical activity
• complex carbohydrates
• Still under investigation
• monounsaturated oils (olive oil)
• polyunsaturated oils (seed oils)

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Nutritional supplements

• We don't feel as yet that there is sufficient
  data regarding any supplement to the diet that
  would justify their use in place of real foods
  which can supply the same nutrients.
• Ron Krauss, MD
• Senior Scientist, Head of Molecular Medicine
• Lawrence Berkeley National Laboratory
• University of California
• Berkeley, California

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1999 recommended doses of antioxidants
Vitamin C daily requirements can easily be
achieved by eating 5 servings a day of fruits and
vegetables Vitamin E good sources are nuts,
seeds, liver and leafy green vegetables Selenium
good sources are seafood, liver, meat, and grains
National Academy of Sciences' Institute of
Medicine
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Antioxidant supplements

• Studies have shown no benefit with vitamin E
• (300-400 or even 800 mg/day)
• Beta-carotene may have detrimental effects in
  some populations
• Folates and homocysteine still under
  investigation
• Physicians can still choose to use them at their
  discretion

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More Palatable Guidelines
Tips for the cardiologist

• Familiarize yourself with the guidelines and
  supporting materials
• Spend time with your patients
• Make messages simple and powerful
• Match intensity of diet to the individuals risk
  factors

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Hypertension

• Limit salt intake
• (lt6 g per day)
• Limit alcohol consumption
• (lt1/day for women, lt2/day for men)
• Dietary Approaches to Stop Hypertension
• (DASH) diet

Appel LJ, et al. N Engl J Med 19973361117-1124
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Availability of guidelines

• American Heart Association
• http//www.americanheart.org/dietaryguidelines
• Circulation 2000102(18)
• Stroke 200031(11)