The Non-Medicated Life:
Eating Out Heart Healthy

by Dr. Paul E. Lemanski

Editor's Note: This is the 12th in a series on optimal diet and lifestyle to help prevent and treat heart disease. Any planned change in diet, exercise or treatment should be discussed with and approved by your personal physician before implementation. The help of a registered dietitian in the implementation of dietary changes is strongly recommended.

Medicines are a mainstay of American life and the healthcare system, not only because they are perceived to work by the individual taking them, but also because their benefit may be shown by the objective assessment of scientific study. Clinical research trials have shown that some of the medicines of Western science may reduce the risk of heart attacks, strokes, and cardiovascular death.

In the first eleven installments of The Non-Medicated Life, informed diet and lifestyle has been shown to accomplish naturally for the majority of individuals, many, if not most of the benefits of medications. Yet, while one may know what to do at home in one’s kitchen to successfully lead a Non-Medicated Life, eating out may present a challenge. As the average American dines out about three times a week, this month’s health column will address what one may do to ensure heart health when eating out.

Epidemiologic or populations studies as well as clinical trials have shown that heart health in most cases is inversely proportional to LDL or the “bad” cholesterol. Most of the LDL in one’s blood is produced by the liver in response to the consumption of saturated fat or trans-fat. At home it is fairly straightforward to restrict saturated fat, as the FDA requires nutrition labels to contain this information. For most individuals, it is prudent to consume no more than 10-15 grams of saturated fat per day. Trans-fat may be calculated by adding the grams of saturated, polyunsaturated and monounsaturated fat and subtracting that sum from the total fat provided.

At a restaurant, however, the amount of saturated fat is rarely, if ever, provided. Nor is the amount of trans-fat, another type of fat which may raise LDL, provided. While restaurants may claim to use vegetable oil, some continue to use significant amounts of butter especially in sauces. At best, one can get some idea of saturated fat and trans-fat by noting the total fat content of a meal. Many of the restaurant chains in the Hudson Valley, Capital region, Saratoga, and North Country will list the grams of total fat in select dishes. For example, Applebee’s has teamed up with Weight Watchers to carry appetizers, entrees and desserts which list the total calories, fat and fiber of a dish. For those following a Weight Watchers Points diet, the points of a dish are also provided. TGIFriday has several guiltless items with 10 grams of fat, but devotes more attention to net carbohydrates as part of collaboration with Atkins. Although a dish may be low in carbohydrates, it may still be very high in saturated fat. Unfortunately, when the carbohydrates are taken out fat is usually put in its stead.

In addition to the type of fat, the total calories are also important to heart health to the degree they contribute to obesity. Most people are familiar with the super sizing phenomenon which has taken hold of the restaurant industry in the last 20 years. When eating out, most folks feel cheated to receive a portion of meat limited to 4 ounces or a cup of cooked pasta. Quantity has taken precedence over quality. Even the plates in American restaurants have grown from the 8 inch plates of the 1960’s to 14 and 15 inch plates commonly seen today. Over-consumption of calories leads to obesity, high triglycerides, metabolic syndrome (see the Non-Medicated Life- April 2004) and diabetes. Metabolic syndrome doubles the risk for heart attack, doubles the risk for stroke and triples the risk for diabetes.

To address some of these drawbacks to eating out, the Center for Preventive Medicine and Cardiovascular Health of Prime Care Physicians, P.L.L.C. has teamed up with select area restaurants to develop dishes which taste great and have both a restricted content of saturated and trans-fat and a fatty acid composition high in monounsaturated fats and omega-3 fatty acids. It is called the Heart Healthy Restaurant Program. The program promotes a dietary composition which is seen in traditional Mediterranean and Asian cuisine. For example, the people of Crete and Okinawa have some of the lowest rates of heart disease in the world. Moreover, a clinical trial of a high Omega-3 Mediterranean diet based on the diet from Crete has been shown to decrease the risk of death and non-fatal heart attack by 70%. Blood fatty acid analysis of Okinawans also shows virtually the same composition supporting the belief that this unique fatty acid composition together with the use of minimally processed grains and a multitude of vegetables may allow higher total daily fat consumption with actually lower rates of heart disease.

Restaurants such as Antipasto’s in Clifton Park, Bellini’s Italian Eatery in Slingerlands and Clifton Park, BFS is Albany, Café Capriccio in Albany, Chianti Il Ristorante in Saratoga, the Hidden Café in Delmar, and Lanci’s Ristorante in Saratoga are among the first in our area to offer dishes with a composition which promotes the highest standard of heart health. Dishes which are particularly heart healthy will have the program’s logo heart next to them. Menus may be downloaded from the web site for the Heart Healthy Restaurant Program to encourage planning ahead. While the portion size will not be appreciably altered, the web site will have information on portion size and tips on controlling total calories. Patrons will also be encouraged to take home their uneaten portion in containers imprinted with the web site for the Heart Healthy Restaurant Program, thereby promoting access to the site and strategies for planned portion control.

In summary, area restaurants in the Hudson Valley, Capital area, Saratoga and North Country currently provide some heart healthy alternatives which identify grams of total fat. For the most part, however, fatty acid composition is not explicitly stated and this makes informed choices more difficult. The Center for Preventive Medicine and Cardiovascular Health of Prime Care Physicians, P.L.L.C. has teamed up with area restaurants to provide choices which promote an increased consumption of vegetables, minimally processed grains and monounsaturated and omega-3 fatty acids, along with a decrease in saturated fat. As such, eating out in an informed way may help lower cardiovascular risk and avoid the proverbial bottle of pills to manage an individual’s cardiovascular health.

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Center for Preventive Medicine & Cardiovascular Health

at Mid-Valley Cardiology 111 Mary's Ave. Suite 3 Kingston, NY 845-339-3663

Main Office 400 Patroon Creek Blvd. Albany, NY 518-618-1100

at Glens Falls Associates in Cardiology 747 Upper Glen St. Queensbury, NY 518-793-1083