Heart Healthy Diet: Hypertension & Heart Disease (cont.)

For strict vegetarians one tablespoon of flax seed oil or one tablespoon of ground flax seed daily is the best substitute. Walnuts do contain omega-3's in lower doses but also provide fiber, other nutrients, and mono-unsaturated fat. They certainly are a heart-healthy food.

Member: Do fish oil supplements provide the same benefit as fish eaten?

Katz: Fish is an excellent source of high quality protein that is important to overall health. Fish oil capsules, of course, provide only the oil and do not constitute a whole food. But with regard to omega-3 fatty acids the supplements are an even more reliable source than the fish from which they are derived. This is because the omega-3 content of fish varies with the diet of the fish. There is some evidence for example that the omega-3 content of farm raised salmon is lower than that of their wild cousin. Farm-raised salmon are fed I suppose something like Purina Salmon Chow while wild salmon eat algae that is a rich source of omega-3's. Fish oil supplements of high quality provide a reliable dose of omega-3's with the additional benefit of having been purified of heavy metals, such as mercury.

If I may end this answer with a digression, it's interesting to note omega-3 fatty acids are widely deficient in the American diet. It makes sense we need this class of nutrients, not because our ancestors ate so much fish, but because like the farm raised salmon, other domesticated animals have had omega-3's removed from them by changes in their diet. The flesh of deer and antelope is low in total fat but relatively rich in omega-3's. In contrast, domestic cattle are high in total fat and provide almost no omega-3's. The meat we eat today is nothing like the meat our ancestors ate.

Member: How do you know the fish you are eating, or fish oil capsules actually contain omega-3 if farm-raised do not have a high level of omega-3 in them?

Katz: It's almost impossible to know the exact omega-3 content of fish; however in general, salmon are an excellent source. Even though farm-raised salmon have less omega-3 at times than wild salmon, they are still among the leading whole food sources. Other fatty fish, especially mackerel, are good sources as well, as are tuna, swordfish and halibut.

With supplements it's much easier to evaluate the exact omega-3 content. Consumer Labs is a company that conducts independent audits of nutritional supplements. Their reports are on www.consumerlabs.com. Most of the omega-3 supplements on the market do pass their tests for quality assurance, but not all consistently report correct doses on the label. Check out this resource for guidance regarding locally available products with reliable dosing.

Member: Can flax seed oil replace not eating fish in the diet?

Katz: As mentioned earlier, the best source of cardio-protective omega-3's is fish oil. But for a vegan, flax seed is definitely the best alternative. So the short answer is, I think so. Note that while we have clinical trial evidence to support the benefit of fish oil, a comparable benefit from flax seed oil is at this point based largely on educated inference.

"Popular diets that use a single class of nutrients as a scapegoat for epidemic obesity are putting up a dangerous and distracting smoke screen."

Member: Would you go so far as to tell people to avoid red meat from grocery stores or eat them in moderation, such as once a week?

Katz: I think that's an excellent question. In my view the best way to answer it is to say that you are the boss. It's your life. It's your heart. And it's your diet. If you love red meat, giving it up entirely may be a hardship for you. If this is so, moderate intake of red meat in the context of an overall health promoting dietary pattern is the way to go. If, however, red meat is not that important to you, there is no health disadvantage in giving it up entirely. A well-balanced vegetarian diet is known to be very heart healthy, and such a diet modified to include fish is perhaps the most heart-healthy diet of all.

However, lifelong health benefits cannot be derived from a diet you are not comfortable staying on for a lifetime. Make choices that balance health promotion with enjoyment of food and factor in your personal priorities to make sure your diet is indeed a source of lifelong health.

Member: Is there a way that you can reverse or help with mild mitral valve prolapse?

Katz: I am not aware of definitive evidence that dietary intervention affects the integrity of the mitral valve or the mitral valve ring. However, there is interest in the ability of at least one nutrient supplement to fortify cardiac tissue and by this means it could potentially help ameliorate mild mitral valve prolapse. The nutrient in question is co-enzyme Q-10, generally recommended at a daily dose of one to two milligrams per kilogram. Other than this, regular physical activity would be prudent as this certainly helps to optimize the integrity of all cardiac tissues.

Member: Is there a complete vitamin out that is the best for the heart?

Katz: Most conventionally trained physicians feel that almost any quality-controlled multivitamin with minerals and antioxidants is good for overall health and heart health. Many naturopathic physicians, however, emphasize the benefits of organic supplements or high potency supplements taken in divided doses. Many of my colleagues in alternative medicine recommend Multi-Nutrients by Vital Nutrients. For those not averse to taking several capsules daily, this is an excellent product.

However, one should not let perfect be the enemy of good. The simplicity of a single supplement can be desirable. If inclined toward simplicity, widely available multivitamins such as Centrum are acceptable. Perhaps most important, a supplement is just that -- not a substitute for a health promoting dietary pattern. The benefits of eating well are not to be found in any pill or combination of pills.

Moderator: What is your take on carbohydrates in the diet? What choices should we be making for heart health?

Katz: An excellent question, too, especially because weight control is very important to heart health. Everyone has heard about the Atkins diet, including reports of rapid weight loss. However I must point out that cancer, cholera, tuberculosis, and AIDS also produce rapid weight loss. That does not mean they are good for you. In fact these conditions not only cause weight to plummet, they lower cholesterol as well. This serves to highlight the importance of thinking about overall health when making dietary choices for weight control.

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