1. More Palatable Nutrition Guidelines Ron Krauss, MD Senior Scientist, Head of Molecular Medicine Lawrence Berkeley National Laboratory University of California Berkeley, California

2. Why new approach? More Palatable Guidelines A need for clear, user-friendly guidelines New studies affected recommendations The growing epidemic of obesity

3. New organization More Palatable Guidelines Focus recommendations on specific targets such as obesity, cholesterol, and hypertension. AHA Dietary Guidelines: Revision 2000

4. Cholesterol: general More Palatable Guidelines Limit saturated fat (<10% of daily calories) Limit cholesterol (<300 mg/day) Limit trans fatty acids AHA Dietary Guidelines: Revision 2000

5. Focused recommendations More Palatable Guidelines “[We have focused] the diet on the needs of the individual. Both in terms of their health status, and their own particular food preferences, and in some cases cultural background.” Ron Krauss, MD Senior Scientist, Head of Molecular Medicine Lawrence Berkeley National Laboratory University of California Berkeley, California

6. Dietary minimums More Palatable Guidelines Fruits and vegetables (at least 5 daily servings) Grain products, including whole grains (at least 6 daily servings) Fish (at least two weekly servings) AHA Dietary Guidelines: Revision 2000

7. Cholesterol: individual More Palatable Guidelines Patients with cardiovascular disease or high cholesterol need much more aggressive management. Current NCEP guidelines are: <7% of daily calories from saturated fat <200 mg/daily of cholesterol This is an upper limit, we should aim lower.

8. Fad diets More Palatable Guidelines There is little scientific literature to work from. High protein diets are mostly from animal sources and make it difficult to restrict saturated fat. No restriction of saturated fat or cholesterol is not a responsible dietary regimen.

9. Syndrome X: definition More Palatable Guidelines A pro-atherogenic metabolic trait characterized by insulin resistance and metabolic disturbances affecting blood lipids (elevated triglycerides, low HDL cholesterol, and small dense LDL).

10. Syndrome X: prevention More Palatable Guidelines AHA recommendation: weight management physical activity complex carbohydrates Still under investigation: monounsaturated oils (olive oil) polyunsaturated oils (seed oils)

11. Nutritional supplements More Palatable Guidelines “We don't feel as yet that there is sufficient data regarding any supplement to the diet that would justify their use in place of real foods which can supply the same nutrients.” Ron Krauss, MD Senior Scientist, Head of Molecular Medicine Lawrence Berkeley National Laboratory University of California Berkeley, California

12. 1999 recommended doses of antioxidants Vitamin C (mg/d) Vitamin E (mg/d) Seleniu m (g/d) Women 75*1555 Men 90*1555 Recommended maximum 20001000400 *Smokers should add 35 mg/d Vitamin C: daily requirements can easily be achieved by eating 5 servings a day of fruits and vegetables Vitamin E: good sources are nuts, seeds, liver and leafy green vegetables Selenium: good sources are seafood, liver, meat, and grains National Academy of Sciences' Institute of Medicine

13. Antioxidant supplements More Palatable Guidelines Studies have shown no benefit with vitamin E (300-400 or even 800 mg/day) Beta-carotene may have detrimental effects in some populations Folates and homocysteine still under investigation Physicians can still choose to use them at their discretion

14. Tips for the cardiologist More Palatable Guidelines 1.Familiarize yourself with the guidelines and supporting materials 2.Spend time with your patients 3.Make messages simple and powerful 4.Match intensity of diet to the individual’s risk factors

15. Hypertension More Palatable Guidelines Limit salt intake (<6 g per day) Limit alcohol consumption (<1/day for women, <2/day for men) Dietary Approaches to Stop Hypertension (DASH) diet Appel LJ, et al. N Engl J Med 1997;336:1117-1124

16. Availability of guidelines More Palatable Guidelines American Heart Association http://www.americanheart.org/dietaryguidelines Circulation 2000;102(18) Stroke 2000;31(11)