Throughout the "low fat" and "cut the fat" craze of the 90's Americans got fatter than ever and researchers now say it's more important to watch what kind of fat you eat and to put more fish, fruits, vegetables, and whole grains on your plate if you want to reduce your risk of heart disease and live a longer, healthier life.

A review of studies linking diet and heart health in the Nov. 27 issue of The Journal of the American Medical Association shows a combination of those dietary strategies is best way to protect yourself against heart disease.

"There has been lots of confusion on the role of nutrition in heart disease, with some promoting a high-fat diet and some promoting a low-fat diet. So we took a careful look at the science," says study author Frank Hu, MD, PhD, associate professor of nutrition at the Harvard School of Public Health.

Researchers examined nearly 150 studies on the role of several dietary factors in preventing heart disease and found three major approaches emerged as the most effective:

1. Replacing saturated and trans fats with unsaturated fats (especially polyunsaturated fat).
2. Increasing consumption of omega-3 fatty acids found in fish oil or plant sources such as soybeans or canola oil.
3. Eating a diet high in a variety of fruits, vegetables, nuts, and whole grains and low in refined grains.

Hu says no single diet is ideal for everyone, but the study suggests a combination of these approaches can have a dramatic impact on reducing heart disease.

"Stringent criteria for total fat resulted in a low-fat campaign, and this actually backfired," says Hu. "The public began eating more refined carbohydrates and sugars, and it may have something to do with the current increases in obesity and diabetes we're seeing."

Alice H. Lichtenstein, DSc, associate chairwoman of the American Heart Association's (AHA) nutrition committee, says the tide began to turn on fat limits in 2000, and most major health organizations, including the AHA, have since removed such limitations.

Saturated fats are found in animal products such as meat and dairy goods, and trans fats are found in processed snack foods and hardened fats such as margarine.

Hu and Lichtenstein say there are several easy ways to get more "good" (unsaturated) fats in your diet while cutting out the "bad" (saturated and trans fats). Some of their tips include:

• Dip your bread in olive oil (a good source of unsaturated fat) rather than butter or margarine.
• Use plant-based oils such as soy, canola, or corn oils, in cooking and baking rather than shortening, butter, or margarine.
• Switch from standard, stick margarine to softer ones that come in tubs, which contain less trans fats -- if you must use margarine.
• Eat red meat in moderation and avoid highly processed meat products such as bacon and sausage that are higher in fat. Trim the fat and skins from all types of meat, pork, and poultry.

"You can have a healthy, higher-fat diet with good fats and also have a healthy, relatively low-fat diet if most of the carbohydrates are whole rather than refined," says Hu.

Whole grains carbohydrate sources, such as whole wheat bread, oatmeal, and popcorn, are less processed and contain more fiber and nutrients than their refined counterparts such as white bread, bakery products, and most pastas.

Lichtenstein says the findings of this study are consistent with the AHA's dietary guidelines, which were also revised in 2001 to include at least two servings of fish per week. Studies have shown that people who consumed two or more servings of fish per week had a 30% lower risk of heart disease.

SOURCES: The Journal of the American Medical Association, Nov. 27, 2002 • Frank Hu, MD, PhD, associate professor of nutrition, Harvard School of Public Health • Alice H. Lichtenstein, DSc, professor of nutrition, Tufts University, and associate chairwoman, American Heart Association's Nutrition Committee • American Heart Association Dietary Recommendations • U.S. Dietary Guidelines.

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