11:28 AM

CHD in our kids: Rethinking the heart healthy diet

It is an unfortunate fact that many of us have forgotten: Heart disease and atherosclerosis start in childhood. The MI in a patient in their 40s and 50s started decades before, when they were a child. We know this from autopsy data in children and teens. With the pediatric obesity and T2DM epidemics in full swing in America, millions of our children are well on their way to an early heart attack unless we do something. Much new light has been shed as to what actually causes heart disease. It is not what we have been told previously: dietary cholesterol and fat DO NOT “clog” your arteries leading to a heart attack. Heart disease is an active immune/inflammatory disease that involves several steps-

  1. Damage to blood vessel epithelium (Smoking, high blood pressure, stress, toxins, infections)
  2. Increased numbers of small dense (sd-LDL) cholesterol particles that get oxidized/damaged
  3. Damaged LDL gets “stuck” in the walls of the arteries and eaten by macrophages- forming plaque
  4. Ongoing inflammation in the body fuels this process
  5. Eventually a blood clot at the site of the narrowing plugs a coronary artery and causes a heart attack

Knowing the steps that lead to heart disease gives us avenues of dietary and lifestyle intervention to stop the process. Metabolic syndrome/metabolic dysfunction- evidenced by having a low/poorly functioning HDL, increased amounts of sd-LDL (which can be measured by testing ApoB), high fasting insulin and high markers of inflammation (hs-CRP) are a bigger risk than having a total LDL that is elevated. This is the hallmark of the “Western diet” full of sugar and processed foods. What type of diet will prevent damage to the blood vessels, increase HDL, decrease sd-LDL, and decrease insulin and inflammation in the body to slow or halt the process?

Eating Heart Healthy DOES NOT MEAN

  • Giving up eggs
  • Being a vegetarian or vegan (unless you choose to)
  • Eating a low-fat diet
  • Eating lots of pasta and grains
  • Following the “Food Guide Pyramid”

To Eat Heart Healthy your patients should

  • Limit sugar/fructose, especially sweetened drinks
  • Eliminate trans/hydrogenated and deep fried fats/oils
  • Limit highly processed grains and snack foods
  • Eat more whole food (fruit, vegetables, nuts, whole grains)
  • Eat LOTS of vegetables
  • Limit highly processed meats

It turns out that dietary sugar, NOT fat is driving the obesity, type 2 diabetes and heart disease epidemics. Cutting out the sweetened drinks and foods with added sugar is mandatory and will go a long way to helping the heart by lowering the sd-LDL and lowering insulin and inflammation in the body. Dietary fat is not the enemy, unless it is hydrogenated/trans fat which is deadly. Evidence suggests that eating moderate amounts of saturated fat does NOT cause heart disease. A diet containing moderate amounts of good fat can be heart healthy! The Mediterranean Diet is one of the best heart healthy eating plans out there, with multiple studies showing Heart Disease prevention. High intake of olive oil, nuts, fruits, vegetables, fish and poultry and low intake of dairy, processed meat, processed foods and sugars. The true Mediterranean diet DOES NOT include high amounts of pasta. Start shifting their diet now, when they are young.

By Thomas Flass, MD, MS, pediatric gastroentreologist at Montana Children's.

This article was originally published in MT Pediatric Updates - Provider Newsletter issue No.1 (Jan/Feb 2020).



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