Janelle is a 59-year-old woman who is concerned about her risk for cardiovascular disease (CVD). Her mother died at age 61 from a heart attack, and even though Janelle is relatively healthy, her LDL cholesterol is above the acceptable range, and she wants to decrease her own risk for CVD.
The information Janelle has found online regarding dietary fat and cholesterol is conflicting. Determined to find the correct answers, she makes an appointment with Becca, a registered dietitian nutritionist (RDN), to clear the confusion and ask questions about how and what she should eat for a heart-healthy diet.
Are Low-carb, High-protein and Ketogenic Diets Heart Healthy?
For decades, evidence has supported a relationship between a diet high in saturated fat, elevated blood lipids and cardiovascular disease. Interest in this subject has gained steam by the recent popularity of low-carb, high-protein and ketogenic diets that are often high in animal products containing saturated fat. Proponents of these diets tend to minimize their health risks and cite studies that downplay the health risks of saturated fat. But despite the hype over the past few years, evidence-based guidelines have not changed.
A 2019 Scientific Statement by the American College of Cardiology (ACC) and American Heart Association (AHA) concluded that replacing saturated fats with monounsaturated and polyunsaturated fats can be beneficial to reduce risk of cardiovascular disease.1 And more bad news for low-carb and ketogenic diet fans comes from the same article: long-standing dietary patterns that focus on low intake of carbohydrates and high intake of animal fat and protein are associated with an increased cardiac and non-cardiac mortality rate. 1
What about Coconut Oil?
Coconut oil has been hyped as a “heart healthy” fat in recent years. How can that be when coconut oil is 92% saturated fat?2 Some suggest that coconut oil is heart-healthy because of the type of fatty acid chains it contains (medium chain triglycerides). Studies do suggest that coconut oil will increase HDL-cholesterol,3,4 but it has also been noted to raise LDL-cholesterol in some studies.3,4 There is no convincing evidence based on current (limited, low-quality) research that coconut oil, as opposed to unsaturated fats, reduces CVD risk.2
How About Dietary Cholesterol?
Historically, foods high in dietary cholesterol have been linked to elevated blood lipids and cardiovascular disease risk. Evidence from observational studies conducted in several countries does not indicate a significant association between dietary cholesterol and cardiovascular disease risk.5 However, the 2019 ACC/AHA Guidelines do suggest that a diet containing reduced amounts of cholesterol can be beneficial to decrease risk of CVD.1
In recent years, the focus on dietary cholesterol has decreased, mainly because foods high in cholesterol are also high in saturated fat, so an effort to decrease saturated fat in the diet will result in decreased dietary cholesterol intake.
What Should I Eat to Reduce Risk of CVD?
Current recommendations to reduce risk for CVD suggest that individuals consume an overall healthy diet as opposed to focusing on specific nutrients.1 An eating pattern such as the Mediterranean Diet or the DASH eating plan that emphasizes intake of vegetables, fruits, legumes, nuts, whole grains and fish and minimizes intake of trans fats, red meat, processed meats, refined carbohydrates, and sweetened beverages is the best way to reduce an individual’s risk for heart disease.1 This type of eating pattern is recommended for overall good health because it is naturally low in saturated fat and dietary cholesterol, and high in dietary fiber, nutrients (vitamins, minerals) and healthy fats such as omega 3 fatty acids.6
Success for Janelle!
Becca, the RDN, emphasizes to Janelle that good nutrition advice is backed up by a body of evidence over time. Janelle learns that reducing saturated fat in her diet is one key to reducing her risk for CVD, but that an overall healthy eating pattern is just as important. Janelle sets goals for incremental changes in her diet and is delighted that she can move forward knowing that she is making the best food choices. Subsequent lipid levels indicate that Janelle is on the right track to reduce her risk for CVD.
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- Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2019;140:e596-e646. Doi:10.1161/CIR.0000000000000678.
- Eyers L, Eyers MF, Chisholm A, Brown RC. Coconut oil consumption and cardiovascular risk factors in humans. Nutrition Rev. 74(4):267-280; 2016. Doi:10.1161/CIR.0000000000000678.
- Coconut Oil: Heart Healthy or Just Hype? Harvard Health Publishing web site. https://www.health.harvard.edu/heart-disease-overview/coconut-oil-heart-healthy-or-just-hype. Published November, 2017. Updated April 13, 2018. Accessed January 13, 2019.
- Teng M, Zhao YJ, Khoo AL, et al. Impact of coconut oil consumption on cardiovascular health: a systematic review and meta-analysis. Nutr Rev. 2019. Doi:1093/nutrit/nuz074. [epub ahead of print}].
- Carson JS, Lichtenstein AH, Anderson CM, et al. AHA Science Advisory: Dietary cholesterol and cardiovascular risk. Circulation.109;doi. 10.1161/CIR.0000000000000743.
- 2015-2020 Dietary Guidelines for Americans. Office of Disease Prevention and Health Promotion website. https://health.gov/dietaryguidelines/2015/. Accessed January 8, 2020.