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High in Flavor, Low in Cholesterol: American Heart Association And the Mediterranean Diet

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Contrasting colors, flavors and textures of fresh vegetables combine with pasta, bread and olive oil in typical Mediterranean dishes.

Here's a case where what you don't know, can hurt you.

If you're among the 41 million American adults with a cholesterol level of 240 and above, you have twice the risk of heart attack as people whose cholesterol level is below 200.

Yet, according to a recent American Heart Association survey, 51 percent of Americans age 40 and older don't know their own cholesterol numbers. And despite the fact that health experts have been talking about cholesterol for decades, many people don't know what it is, what it does, or even how to control it.


Cholesterol is a waxy substance made by the liver and also supplied in the diet through animal products such as meats, poultry, fish and dairy products. Cholesterol is needed in the body to insulate nerves, make cell membranes and produce certain hormones. However, the body makes enough cholesterol, so any dietary cholesterol isn't needed.

Excess cholesterol and fat circulating in the bloodstream can form plaque (a thick, hard deposit) in artery walls. The build-up causes arteries to become thicker, harder and narrower, which can slow or block the flow of blood to the heart. A heart attack results when blood flow to the heart is severely impaired and a clot stops blood flow completely.


The first step to taking control of your risk for heart disease is to know your numbers. The American Heart Association recommends that all adults age 20 or older have a fasting lipoprotein profile (total cholesterol, LDL cholesterol, HDL cholesterol and triglyceride) once every five years.

Studies have shown that the buildup of plaque in the arteries that supply the heart begins in late adolescence and early adulthood. That means a cholesterol level measured at age 22 can predict the risk of a heart attack over the following 30 to 40 years. Waiting until midlife to measure and lower cholesterol reduces the benefit that can be obtained.

A desirable cholesterol level is less than 200 mg/dL. If your number is in this range, your heart attack risk is relatively low, unless you have other risk factors, such as high blood pressure, obesity, cigarette smoking or a family history of heart disease. Almost half of adults have total cholesterol levels below 200 mg/dL.

People whose cholesterol level is from 200 to 239 mg/dL are borderline high risk. If your number is in this range, your doctor may order more blood tests to determine your risk. About a third of American adults are in this group.

High cholesterol is defined as a level of 240 or more. About 20 percent of the U.S. population has high blood cholesterol levels. If you are in this group, it is important to see your physician for further testing.


Diet is an important first line of defense against high blood cholesterol but headlines about health are often more confusing than helpful, says registered dietitian Bonnie Brost of Superior.

"The latest craze is olive oil," said Brost, who works as a cardiac rehab specialist at St. Mary's Medical Center in Duluth. "However, people need to understand that olive oil is only a small piece of the benefits of the popular Mediterranean-style diet. It's important to consider all aspects of the diet - more fish, more fruits and veggies, less meat and less saturated fat."

The common Mediterranean-style diet shares many of the characteristics of the American Heart Association's diet guidelines. Both recommend high intakes of cereals, grains, fruits, vegetables and dried beans while limiting animal fats in the form of butter, cream and lard. Meat and poultry are eaten in moderation, with poultry more frequently served than red meat.

The Lyons Heart Study, published in 1999, tested the effectiveness of the Mediterranean diet, using a group of subjects who had survived a first heart attack. The results indicated that patients following the Mediterranean-style diet had a 50 to 70 percent lower risk of recurrent heart disease.

Brost also emphasizes the important of decreasing trans fat in the diet, since research is now showing that trans fat can lower levels of the beneficial HDL cholesterol. Trans fat is a type of fat that is formed when vegetable oil is hardened through a process called hydrogenation. Effective Jan. 1, 2006, the Food and Drug Administration that will require food labels to list the amount of trans fatty acids in food products.

"I don't think people realize the amount of hydrogenated fats they get in a day," said Brost. "It is probably not possible to eliminate them all together, but less would be better."

Food sources of hydrogenated fats include crackers, cereals and baked goods such as coffee cakes and muffins.

Brost offered these heart smart tips:

-Eat more fruits and vegetables. One of the most consistent findings in dietary research is that a high intake of fruits and vegetables lowers the risk of heart disease and stroke. Consume at least five servings per day of fruits and vegetables.

-Include more of the "good" fats found in nuts, seeds, canola oil and olive oil. These monounsaturated fats tend to increase levels of beneficial HDL cholesterol and decrease levels of artery-clogging LDL cholesterol. Have one or two handfuls of nuts as a snack instead of pretzels or potato chips. Saute lean meats, fish, chicken or vegetables in a small amount of canola or olive oil. Sprinkle a few sunflower seeds or walnuts on your salad.

-Have at least two fish meals per week to get the protective benefits of the Omega-3 fatty acids, which seem to help prevent blood platelets from clotting and sticking to the walls of blood vessels. Omega-3's acids are found mainly in fatty, cold-water fish, such as tuna, salmon, sardines, mackerel and lake trout. Other sources include flaxseed and flaxseed oil, canola oil, soybean oil and nuts.

-Don't forget to move. Physical activity also is essential to heart health. Like any other muscle in your body, your heart gets stronger with regular exercise. Strive for 30 to 40 minutes most days of the week.

For more information about diet and heart disease, including tips and recipes, visit the American Heart Association's Web site at or the National Heart Lung Blood Institute's Web site at



-Incorporate an abundance of food from plant sources, including fruits and vegetables, potatoes, breads, grains, beans, nuts and seeds.

-Eat minimally processed and seasonally fresh and locally grown foods.

- Use olive oil as the principal fat, replacing other fats and oils.

- Total dietary fat should range from less than 25 percent to more 35 percent of energy, with saturated fat no more than 7 to 8 percent of total calories.

-Eat low to moderate amounts of cheese and yogurt daily.

-Consume low to moderate amounts of fish and poultry weekly; and limit eggs from zero to four servings per week.

-Eat fresh fruit as a daily dessert; limit sweets with a significant amount of sugar and saturated fat.

-Only eat red meat - beef, veal, pork, sheep, lamb and goat - a few times per month.

-Incorporate regular physical activity at a level that promotes a healthy weight, fitness and well-being.

-Consume moderate amounts of wine, normally with meals; about one to two glasses per day for men and one glass per day for women.

Source: Rick Hall, MS,RD, See


(c) 2003, Duluth News Tribune (Duluth, Minn.). Distributed by Knight Ridder/Tribune News Service.

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