By Jack T. Saari

Diseases of the heart and circulation are the leading cause of death in this country, with an annual economic impact approaching $200 billion. The types of disease include arteriosclerosis (hardening of the arteries), high blood pressure, high cholesterol, clotting tendency, abnormal heart rhythm, and coronary heart disease. Ultimately, all of these conditions will have an impact on the ability of our hearts to deliver blood to our bodies. What can we do to prevent or reduce the impact of these diseases?

Some of the simplest things we can do for our hearts are related to nutrition, but these involve behavioral changes and changing our behavior is hard to do. So perhaps condensing the story into two simple messages will help. The two messages are to 1) balance our diet and 2) manage our calories.

The first message, to balance our diet, is generally described in the USDA food guide pyramid, which is symbolized by the logo at the head of this column. Briefly, the guide suggests that, on a daily basis, we eat fats, oils and added sugar sparingly, 2-3 servings in the dairy group, 2-3 servings in the meat, beans, eggs and nuts group, 3-5 servings in the vegetable group, 2-4 servings in the fruit group and 6-11 servings in the bread cereal, rice and pasta group. Serving sizes should be moderate. A good guide for serving size and number for a specific age, gender and activity level is found in the USDA, USDHHS document Dietary Guidelines for Americans, found on the internet at http://www.usda.gov/cnpp/DietGd.pdf. These practices will result in the appropriate balance of vitamins, minerals, protein, fat and carbohydrate.

OK. Say we have this message and are trying to follow to it. What specific changes will provide the most benefit to our hearts? Recently, large-scale surveys were reviewed and analyzed by noted nutritionist Dr. Walter Willett and colleagues at Harvard School of Public Health. This review has indicated that several dietary changes related to a balanced diet appear most beneficial to heart health.

Willett's recommended changes involve both fat and carbohydrate consumption. Remember that the food pyramid cautions us to eat fats sparingly. This is sound general information, but Willett's findings indicate that, in addition to the amount of fat in the diet, we need to worry about the type of fat that we eat. He suggests substituting unsaturated fats for saturated fats and trans-fats. This translates into using plant-based oils (which tend to be unsaturated), eating leaner meats (less saturated fat) and curbing use of artificially hydrogenated oils such as margarines and shortenings. The latter, also known as trans-fats, are widespread in our diets, particularly in the fast food industry (although the practice is changing), and insidious, because they won't be required on food labels until 2006. Willet also suggests increasing consumption of omega-3 fatty acids, a particular class of unsaturated fatty acids from fish oils and plants such as soy, flax and canola.

Suggestions regarding carbohydrate consumption are to eat a diet high in fruits and vegetables, nuts and whole grains and low in refined grains (as in white bread). This will result in a diet that is chock full of many of the vitamins and minerals that we require. It will also provide carbohydrates in a form (complex carbohydrates) that will introduce a less stressful sugar load into your body. Fruits and vegetables also provide fiber that has been shown to improve heart health. The changes suggested by Willett have been associated with specific beneficial effects such as depression of triglycerides and bad (LDL) cholesterol and as well as overall decreased risk of coronary heart disease.

The second simple message is to manage our calories. We've all heard of the hazards of too much of a good thing. It also applies to our diet. One may follow the guidelines regarding a balanced diet to the letter, but if input of calories exceeds output, we'll gain weight, the stresses of which place our hearts at risk. One-half of the approach to managing our calories is to reduce caloric intake. We won't call it 'dieting'. 'Eating less' sounds a lot less stressful. This means little more than consuming the appropriate size and number of portions noted above for a balanced diet.

The other half of managing calories is to increase their use. This means using our bodies. We won't call it 'exercising.' We need to find activities that we enjoy doing, such as walking, biking, running, swimming or skiing. To give us discipline, we may need to couple it with something that we have to do, like going to work, walking the dog, yard work or picking up the kids from school. Or social interaction may provide incentive, as in walking with a friend, golfing, softball or racquetball. Such activity does several things. One, it uses calories. Two, it keeps us from eating, as we tend to do in front of the TV and other inactivity. And three, it may suppress appetite, especially in men. Regular physical activity has other rewards. People who engage in regular physical activity begin to like it for how it makes them feel, mentally and physically. The practices of eating appropriately and using our bodies, when used together, each make the other easier.

In summary, two simple messages can help pump up heart health: 1) balance our diet, with emphasis on lean meat, fish- and plant-based fats and on fruits, vegetables and whole grains, and 2) manage our calories, by eating less and engaging in useful and enjoyable physical activities.