Rediscovering the kitchen for heart health
First the bad news: After decades of major progress in reducing deaths from diseases of the heart and blood vessels, the decline in cardiovascular mortality has slowed significantly, according to the latest report from the Centers for Disease Control and Prevention. The researchers called their findings “alarming,” suggesting that cardiovascular benefits from medical interventions may have reached a saturation point and that further improvements depend largely on changes in society and personal behaviour.
The new data, published in June in JAMA Cardiology, covered the years from 2000-14. From 2000-10, the annual rates of decline for all cardiovascular deaths heart diseases and stroke averaged 3.69 per cent for men and 3.98 per cent for women. But since 2011, the rates of decline dropped to a mere 0.23 per cent for men and 1.17 per cent for women.
These findings point to “near stagnation” in controlling cardiovascular diseases and deaths, Dr Stephen Sidney and colleagues wrote. And, they noted, the reasons are not difficult to discern. Based on data from the latest National Health and Nutrition Examination Survey in 2011-12, Americans did better in controlling three major risk factors smoking, high blood pressure and elevated cholesterol, often with the help of medication but many more people became obese and developed Type 2 diabetes.
According to data from the survey, the prevalence of adult obesity rose to 34.9 per cent in 2011-12 from 22.9 per cent in 1988-94, and the CDC found that the prevalence of diabetes nearly tripled, to 7.2 per cent in 2013 from 2.5 per cent in 1990.
Furthermore, the national survey showed, the percentage of adults who in 2012 were consuming an “ideal” diet that could minimise life-threatening damage to blood vessels was near zero.
It’s not that these grim data were unexpected. Four years ago, Dr Richard J. Jackson, a professor and former chairman of environmental health sciences at the University of California, Los Angeles, predicted that the current generation of young Americans (those born since 1980) may be the first to live shorter lives than their parents.
Even earlier, in 2007, Dr Earl S. Ford of the CDC and Dr Simon Capewell of the University of Liverpool wrote that unless measures were taken to “transform the abhorrent risk factor profile that currently characterises much of the U.S. population” and dangerous trends were reversed, “mortality rates among younger adults may represent the leading edge of a brewing storm.”
Now for the good news: Neither medical innovations nor genetic interventions are needed to turn the tide on cardiovascular diseases and deaths and restore their once-significant declines. And the very same changes needed to improve cardiovascular health may also help prevent many common cancers, diabetes, arthritis, cognitive decline, depression and osteoporosis.
Dr Donald M. Lloyd-Jones, a chief architect of a 2010 strategic plan to improve cardiovascular health, said: “The whole may be greater than the sum of the parts. We shouldn’t assume that chronic diseases automatically occur with aging. Living healthfully until we die is an achievable goal.”
Lloyd-Jones, a cardiologist and preventive medicine specialist at the Northwestern University Feinberg School of Medicine in Chicago, chaired an American Heart Association committee of experts that adopted the recommended changes. Instead of focusing on the negative, the plan aims to achieve “ideal cardiovascular health” through “ideal health behaviours” and “ideal health factors.”
Here’s how the committee defined “ideal:” No smoking; maintaining a body mass index below 25; being physically active; following current dietary guidelines; and maintaining an untreated total cholesterol level of less than 200 milligrams, an untreated blood pressure level of less than 120 over 80, and a fasting blood glucose level of less than 100 milligrams.
The committee had hoped that fostering these seven health behaviours and targets would, by 2020, “improve the cardiovascular health of all Americans by 20 per cent while reducing deaths from cardiovascular diseases and stroke by 20 per cent.”
But current trends project at best a 6 per cent improvement.
“Although most of us are born with the potential for ideal cardiovascular health, fewer than half of all adolescents have retained five or more of the seven behaviours and factors at ideal levels,” Lloyd-Jones wrote in 2014. “And things get progressively worse with age until ideal cardiovascular health becomes rare above age 60,” he said.
Still, he has not given up hope for a better result.
Now for the details. First and foremost, quit smoking or never start. Heart risks drop significantly within a year of quitting and eventually reach those of a nonsmoker.
Next, get regular physical exercise, at least 150 minutes a week of moderate physical activity or 75 minutes a week of vigorous activity, or a combination of the two. Keep in mind that this is the minimum amount of physical activity needed to glean health benefits. More is better.
Exercise should be part of your daily routine, like brushing your teeth. I do a combination of moderate and vigorous exercise every day. It energises me and helps me control my weight without having to watch every kilojoule.
As for diet, the committee recommended focusing on foods, not nutrients. (As Lloyd-Jones put it, “We don’t eat nutrients.”) It refrained from suggesting how many kilojoules people should eat, since caloric needs vary tremendously based on an individual’s basal metabolic rate, body size, lean body mass and physical activity.
Rather, it suggested a version of the DASH diet (for Dietary Approaches to Stop Hypertension) that was successfully tested by the National Heart, Lung and Blood Institute. It calls for 4 1/2 or more cups of fruits and vegetables a day; two or more 100 gram servings of fish each week; 85 grams of fibre-rich whole grains a day; at most 1 litre of sugar-sweetened drinks (less than 1882 kilojoules, or the equivalent in other sweets) a week; four or more weekly servings of nuts, legumes and seeds; and no more than two servings a week of processed meats.
At the same time, limit saturated fats to less than 7 per cent of total kilojoules and daily sodium to 1,500 milligrams for people with high blood pressure and no more than 2,300 milligrams (or 1 teaspoon of salt) for everyone else. Currently, Americans consume an average of 3,500 milligrams of sodium a day, most of it from processed and restaurant foods.
Which brings me to a final recommendation of my own: Rediscover your kitchen. No matter how busy you are, finding time to prepare healthy foods for yourself and your family should be a top priority.
New York Times
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