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Expert Q&A: Heart-Healthy Eating

An interview with Dean Ornish, MD.

Are any fats good for you?

The truly good fats are not so much the unsaturated fats as the omega-3 fatty acids you find in fish oil and salmon and in some plant-based foods like flax. Part of the problem when you eat unsaturated fat is that much of the unsaturated fat people consume is rich in the omega-6 fatty acids, which promote inflammation and autoimmune responses. The truly good fats are not so much unsaturated fats as omega-3 fats.

And you don't need that much of it. You can take 3 or 4 grams a day of fish oil and that is really what most people need. And you can also buy the fish oil that has all the bad stuff in fish removed -- the omega-6, the PCBs, the dioxins, and the mercury. Then you get all the benefits of eating the fatty fish but without the extra toxicities that are found in most fish these days.

Why is fiber an essential component of a heart-healthy diet?

Soluble fiber, in things like oat bran, is important for lowering cholesterol levels. It has a direct effect on cholesterol metabolism in your bile and in your liver.

Insoluble fiber is important for two main reasons: First, because it helps to push food through the intestinal tract faster. Second, fiber affects your blood-sugar levels.

The difference between refined carbs and complex carbs is that the complex, fiber-containing carbs aren't just not bad for you -- they are truly good for you. When you go from white to brown rice or from white flour to whole-wheat flour, you are going from bad carbs to good carbs.

That does two good things from a weight standpoint. You fill up before you get too many calories. And you slow the absorption of foods into your bloodstream.

If you eat high-fiber carbs, your blood sugar level goes up a little and stays there -- so you're getting a good source of energy. But bad carbs get absorbed very quickly. Your blood sugar is going to zoom way up. Your pancreas pumps out insulin to bring it back down, and the insulin accelerates the conversion of sugar into fat.

This causes all these swings in energy. Your blood sugar doesn't just go back to where it started before it got too high -- it goes way down. That increases your carb craving, and you're stuck in a vicious cycle.

It is not necessary to avoid bad carbs altogether, but to limit them and use them in combination with other foods. If you're going to have dessert, have it after a high-fiber meal. Don't have it on an empty stomach.

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