FAQs from Emory’s Heart Health Nutritionist

Q. I love coffee, but I worry about all the caffeine I take in. Is caffeine in coffee bad for your heart? - Java Fan

The medical community is by no means unanimous on the question of coffee's effect on coronary artery disease. However, there does seem to be enough evidence to suggest that heavy coffee consumption (more than 5 cups per day) may have harmful health effects. Caffeine may promote abnormal heart rhythms, and it is not advised for women who are pregnant. Experts recommend limiting coffee intake to no more than three or four cups per day. Also, remember that tea, cocoa, chocolate and many soft drinks can contain significant amounts of caffeine.

Q. Is eating sugar bad for your heart? - Ron S.

Eating too much sugar, in the form of added sugars (corn syrup, table sugar), which are put into foods during processing or added before consumption can be bad for heart health. Added sugars are found in products like sweetened beverages (regular soft drinks, specialty coffee drinks, etc.), sweet treats (cookies, cakes, candies) and cereal products (granola etc.). Unlike naturally occurring sugars found in fruit and dairy, added sugars are significantly correlated with elevated bad cholesterol and triglycerides (fat in blood) and low good cholesterol, which increases risk of heart disease. Eating too much added sugars can also result in excess body weight and added sugars contain "empty" calories and no nutritional benefit. It is best to limit your intake of sugar and sugary foods to protect your heart, limit excess calories and make room for nutrient-dense foods that contain naturally occurring sugars (fruit, low-fat dairy). The American Heart Association recommends that men limit added sugars to 9 teaspoons or 36 grams per day and women limit to 6 teaspoons or 24 grams per day. Sugar content can be found on the food nutrition label (4 grams = 1 tsp).

Q. I keep hearing that fish oil is healthy for your heart. Should I take fish oil supplements? How many servings of fish should I eat a week to help keep my heart healthy - and does it matter what kind I eat? Thanks for providing this service! - Bill B.

You are absolutely right, Bill - evidence is mounting that fish oil is good for the heart. In fact, the American Heart Association (AHA) recently acknowledged that the omega-3 fatty acids (eicosapentaenoic acid, or EPA, and docosahexaenoic acid, or DHA) that are found naturally in fish can provide numerous cardiovascular benefits, including reducing blood triglycerides, reducing blood clotting, and regulating heart rhythms.

Experts recommend 650 milligrams of EPA and DHA a day (4.5 grams weekly) for the general population. By comparison, most adults get only about 100 milligrams a day. Eating fatty fish, such as herring, salmon, mackerel and trout, at least twice a week would provide approximately 1.5 to 3.5 grams a week. By the way, plant-based foods like walnuts, flaxseed, and canola oil also provide significant amounts of fatty acids that are converted to EPA and DHA in the body.

According to the AHA, people with established heart disease could benefit from higher intakes of EPA. Those with heart disease should strive for one gram of EPA/DHA a day. People with high triglycerides should aim for two to four grams a day, making supplements necessary.

Like the oil that is found naturally in fish, only a portion of the oil in a capsule is comprised of DHA/EPA. Most supplements contain 1,000 milligrams of fish oil and provide the fatty acids in a ratio of 1.5:1.0 (EPA:DHA), similar to the ratio found in fish. Anyone who is considering supplementing with fish oil capsules should first check with their physician, however. Supplements may interfere with blood coagulation — that means people who take medications like warfarin (Coumadin), vitamin E, aspirin, garlic, and ginkgo should be especially careful.

Q. I am on a low carb weight loss diet. I am feeling great and have lost ten pounds in a month. However, my friend says if I don't eat too much protein I can hurt my kidneys and heart. Is this so? How much protein is too much? - Sally W.

You and countless other dieters - and doctors - are asking these questions, Sally. With the heightened popularity of low-carb diets, come many nutritional questions and concerns. Although for decades the medical establishment has considered such unconventional diets like the Atkins Diet gimmicky, not to mention unhealthy, there have been several recent studies that seem to indicate there may be some merit to following a lower-carbohydrate, higher-protein diet in terms of weight loss and lowering blood cholesterol.

However, more questions remain unanswered than answered and experts are far from ready to endorse such an approach. One concern is the long-term effect that a high-protein diet may have on vital organs, such as the kidneys. The kidneys are responsible for removing nitrogen from protein and excreting it into urine. The excess protein load could potentially overstress the kidneys, particularly in individuals with already impaired kidney function. The protein recommendation for the general population is 0.8g per kilogram of body weight per day. This would equate to approximately 50 grams of protein for a 130 pound person. When choosing protein-rich foods, experts encourage healthier choices like fish, poultry, low-fat dairy products and plant-based proteins like nuts and soy products, as opposed to those high in saturated fats like red meats.

Q. What is lycopene and is it good for my heart? Thanks. - Sydney S.

There may be a lot to like about lycopene, Sydney. This phytonutrient, or plant nutrient, neutralizes free radicals and protects cell membranes. It has been associated with curtailing the risks of certain types of cancers, as well as heart disease. Lycopene is abundant in such foods as tomato products (particularly cooked ones), pink grapefruit and watermelon. While there is no established recommendation for lycopene intake, it is recommended to include lycopene-rich foods, along with a variety of other fruits and vegetables, as part of an overall healthy diet.

Q. From a health standpoint, what is the best kind of fat to use when cooking? - Lynn B.

The general consensus among nutrition experts is that consumers should aim for a balance of monounsaturated fats and polyunsaturated fats. Research indicates that both types of fats have benefits, especially when eaten as part of a diet rich in fruits, vegetables, whole grains, fish and legumes and low in saturated fat. Some of the benefits include lowering blood cholesterol levels and triglycerides, as well as improving insulin sensitivity. The American Heart Association advises that 10%-15% of calories can come from monounsaturated fat, and up to 10% of calories from polyunsaturated fats. For cooking, use olive or canola oil. Look for margarine spreads that do not contain trans fatty acids.

Q. I've read that blueberries contain something that is particularly good for you. Can you give me more information? Are there some fruits that are better for the heart than others? Thanks for this wonderful service, by the way! - Cynthia W.

Thank you, Cynthia. I'm glad you are enjoying my nutrition column. Blueberries offer plenty of nutrition that's good for your heart and your overall health — as do many fruits and vegetables.

In addition to being high in vitamin C and a good source of fiber, blueberries are particularly high in anthocyanins, powerful antioxidants that may help reduce the risk of heart disease by inhibiting blood clot formation. Other blue or purplish-colored fruits (including grapes, grape juice, prunes, cranberries, blackberries, strawberries, and red apples) also contain anthocyanins, though in less concentrated amounts.

In general, richly colored fruits and vegetables contain many helpful compounds called "phytonutrients," or plant nutrients. Anthycyanins, and numerous other types of phytonutrients, have been shown to be protective for heart disease, certain forms of cancer, macular degeneration, and other diseases associated with aging.

Q. My doctor always reminds me to drink plenty of water, especially in hot weather. I'm a runner and I drink when I'm thirsty. But I'm not sure how much water is enough. Is it eight glasses a day or more? - Anton V.

Though there has been recent controversy surrounding the amount of water needed for good health, it's safe to say that water is a vital component to our diet. The most common recommendation is to drink at least eight eight-ounce glasses of water a day. Though some researchers question this recommendation saying it isn't necessary to drink that much, the greater question is what harm could be done? Eight glasses a day is a reasonable amount of water to drink.

Remember that your fluid needs can vary depending on such factors as climate, activity level, and altitude. Running and other forms of strenuous exercise may cause you to lose excessive amounts of fluid in perspiration, making it difficult for to consume enough fluid to offset sweat losses.

To determine if you have a fluid shortfall, measure your body weight before and after exercise. For each pound of weight you lose during exercise, your fluid shortfall is about 16 ounces. This means that if you lose two pounds during an exercise period, you have sweated away 2 lbs x 16 oz = 32 ounces more of fluid than you have consumed. To be safe, hydrate yourself well before beginning exercise and be sure to drink plenty during exercise and when you are finished. It may take some time to get used to drinking so much, but try taking in small amounts at a time to minimize stomach discomfort.

Q. I have high cholesterol and my doctor wants me to start adding more fiber to my diet. I'm confused. How can fiber in your diet have anything to do with your heart health? I hate those yucky fiber supplements you mix in water. What are some high fiber foods I could eat instead? Thank you. - Kate S.

Fiber is essential for good health, especially heart health. The National Academy of Sciences recommends daily fiber intakes of 25 grams a day for women and 38 grams a day for men under the age of 50. For those over 50, the recommended intakes are 30 grams a day for men and 21 for women.

Why all of this fiber, you ask? Research shows that a diet high in both types of fiber, soluble and insoluble, reduces the risk of heart disease. Soluble fiber, in particular, helps lower cholesterol levels by binding with cholesterol in the body so that it can be excreted. Good sources of soluble fiber include oats, oat bran, fruits (such as apples, pears, citrus fruits, and berries), vegetables, (like carrots, cabbage and sweet potatoes), and legumes. Insoluble fiber is abundant in grain products like whole-grain breads, cereals, and pastas.

Look for the words "whole wheat" or "whole grain" at the top of the ingredient list when choosing foods. By eating a diet rich in these kinds of foods, a fiber supplement should not be necessary.

Q. My mother-in-law is not overweight although she has had some heart problems. Her doctor has put her on the DASH diet. Can you explain what this is? - Fran

While your mother may not be overweight, it is likely that she could benefit from following the DASH diet plan her physician has prescribed, especially if she has high blood pressure. The DASH diet plan was developed as part of an investigational study that tested the effects of nutrients in food on blood pressure. "DASH" stands for "Dietary Approaches to Stop Hypertension." The DASH diet is low in total fat, saturated fat and cholesterol, rich in fruits, vegetables, low-fat dairy foods, whole grains, poultry, fish and nuts. Sodium levels on the DASH plan ranged from 1,500 to 3,300 milligrams per day, however, the lowest sodium level lowered blood pressure the most. Other benefits of this type of diet plan may include moderate weight loss, decreased serum cholesterol levels, increased fiber and antioxidant intake.

Q. I recently read that the Mediterranean diet might prevent heart disease. Can you tell me what the diet involves and whether it is really healthy? - Dave

It is well documented that regions bordering the Mediterranean Sea have the lowest incidence of heart disease in the world. Many experts attribute this, at least in part, to the Mediterranean diet and lifestyle. This type of lifestyle includes whole grains (like whole wheat bread and pasta), fruits, vegetables, legumes and cheese and yogurt as part of your daily intake. It also emphasizes heart-healthy fats like olive oil in place of more saturated fats like butter. Instead of red meat, the diet recommends leaner protein sources like fish and chicken, with fish being particularly favored due to their high omega-3 fat content. Exercise, of course, is fundamental to good health and represents the base of the Mediterranean food pyramid.

While moderate consumption of wine is included in the Mediterranean diet, it is worth noting that it is best not to drink solely for the purpose of heart health because of the numerous health risks alcohol consumption poses (alcoholism, birth defects, etc.). However, if you already enjoy drinking wine with your meals, you can likely continue to do so in moderation, which means no more than one glass a day for women and no more than two glasses a day for men.