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Dietary Controversies in Cardiovascular Health

By Christopher Leet, MD, FACC Emeritus

470787299The obesity epidemic in both children and adults is real. Although a problem for all Western countries, this problem is clearly worse in this country.

To assess your overall dietary health, measure your BMI, a simple body mass index relating height and weight. Higher obesity indices are associated with lower life expectancy and poorer health status generally.

However, cardiovascular risk is better assessed by carefully measuring waist circumference, which gives an indication of intra-abdominal fat, the form most likely to cause atherosclerotic (hardening of the arteries) problems. To measure, stand with a tape measure, parallel to the floor, at the level of the belly button, without sucking in the stomach. A maximum of 40 inches for men and 35 inches for women is acceptable.

All present diets to lose weight recommend reducing calorie consumption. But while it is just that simple, there are lots of glitches. Cardiovascular risk is best treated by diets that are also low in saturated fat (less than 2.5 grams per serving) and sodium (less than 2,000 milligrams per day) and high in complex carbs.

Low-carbohydrate diets (Atkins, South Beach, etc.) may be appropriate for those with high triglyceride levels (which doctors check along with cholesterol). Diabetics need stricter attention to balancing carbs, fat and protein and may need special nutritional counseling. Those with intestinal problems may need to consider gluten-free diets, although the significance of these may be overplayed.

Recent studies in cardiology and nutrition journals have emphasized that while some people following alternative diets may seem to lose weight faster than those following balanced, low-calorie diets, the weight loss tends to even out after a year. Again, it is the overall calorie reduction that determines weight loss, along with concurrent exercise, since more exercise produces more calorie loss.

A special case relates to weight reduction surgery (gastric bypass/banding), usually reserved for those with excessive obesity (a BMI of over 40) and who have failed at all other diets. This is a subject for another article, but the explosion in this reflects the severity of the problem we face.

Manassas resident Dr. Christopher Leet, now retired, practiced medicine for nearly 40 years, specializing in cardiology and internal medicine. 

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