Dietary Interventions

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Dietary interventions can be an important modality in the treatment of cardiovascular disease. The traditional Mediterranean diet has been shown to benefit individuals with cardiovascular disease. It is characterized by moderate energy intake, low animal fat, high fish intake, high olive oil, high cereals, high legumes, nuts and vegetables, and regular and moderate wine intake. In a recent randomized, controlled, parallel-group clinical trial, 372 subjects at high cardiovascular risk were assigned to a low-fat diet, a traditional Mediterranean diet plus virgin olive oil, or traditional Mediterranean diet plus nuts. After three months, the mean oxidized LDL levels decreased in both Mediterranean diet groups, while no changes in oxidized LDL was seen in the low-fat diet group.82 Another study examined the effect of the Mediterranean diet in individuals with a high risk of cardiovascular disease on cardiovascular inflammatory markers. The study showed that a higher consumption of fruits and cereals is associated with lower concentrations of IL-6, and the highest consumption of nuts and virgin olive oil showed the lowest concentrations of VCAM-1, ICAM-1, IL-6 and CRP.83 The Mediterranean diet has also been shown to decrease serum glucose, systolic blood pressure, and the cholesterol:HDL ratio in individuals with high cardiovascular disease risk.84 A three-month study showed a 15% reduction in cardiovascular disease risk with the Mediterranean diet,85 while other studies report a 50%-70% reduction of the risk of recurrence in CHD patients after four years of follow-up.86

Dietary whole grains have also been associated with decreased cardiovascular risk. Whole-grain foods provide complex carbohydrates, dietary fiber, minerals, vitamins, and antioxidants. Research indicated that whole grain dietary intake decreases the risk of hypertension, myocardial infarction, and heart failure.87 In one study to evaluate the role of whole grains and atherosclerosis, whole-grain intake was evaluated and carotid intimal medial thickness was measured. Whole-grain intake was shown to be inversely associated with common carotid artery intimal medial thickness and intimal medial thickness progression.88 A 12-week, randomized, controlled trial compared two whole-grain oat-based cereals with two refined grain wheat-based cereals to evaluate their effects on the need for antihypertensive medications in patients with hypertension. At the end of 12 weeks, 73% of participants in the oats group versus

42% in the wheat group were able to stop their medication or reduce their medication by half. Treatment group participants whose medication was not reduced had substantial decreases in BP. The oats group experienced a 24.2 mg=dL reduction in total cholesterol levels, a 16.2 mg=dL decrease in LDL levels, and a 15.03 mg=dL drop in plasma glucose levels compared to the control group.89

Green tea polyphenols, particularly epigallocatechin gallate (EGCG), have been studied for their antioxidant and anti-inflammatory activity. Specific to cardiovascular disease, these catechins have been shown to reduce markers of atherosclerosis and lipid peroxidation, such as oxidized LDL.90 One study found that green tea consumption was significantly higher in patients without CAD than in those with the disease, and showed an inverse relationship between the intake of green tea and the incidence of CAD.91 In one double-blind study, green tea extract high in catechins was supplemented to a group of visceral fat-type obesity patients for 12 weeks, after a 2-week run-in period. The results showed a greater decrease in systolic blood pressure in the catechin group for subjects whose initial systolic BP was 130 mmHg or higher compared with the control group. LDL cholesterol was also decreased to a greater extent in the catechin-supplemented group. In addition, a decrease in body weight, body mass index, body fat ratio, body fat mass, waist circumference, hip circumference, visceral fat area, and subcutaneous fat area were found to be greater in the catechin group than in the control group as well.92

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