Be Well - February 2011 Issue

Heart Disease: Combining Diets to Minimize Risks

By Melissa Ohlson, RD, LD

It’s never too late to make changes in your diet to minimize your risk of cardiovascular disease. Deciphering legitimate from misleading recommendations on the Web is a challenge. The good news is, we’ve done the research for you. Here is our “no-surfing” guide to eating that will effectively lower your cholesterol.

Revisiting the Mediterranean

A landmark, decades-old trial called the Seven Countries Study observed that men from Greece, Italy and other Mediterranean countries enjoyed a longer life expectancy and a lower rate of cardiovascular disease than men from countries such as ours.

Hundreds of studies on eating patterns in the Mediterranean have since followed. Overall, they showed that adopting traditional Mediterranean dietary practices can lower rates of cardiovascular disease, diabetes, cancer and other debilitating diseases.

Many surmise that the monounsaturated, fat-rich olive oil used in the Mediterranean provides the greatest cardiovascular protection. However, eating a diet rich in fruits, vegetables, whole grains, nuts and seeds, legumes, fish, red wine and modest animal protein appears to have even greater impact.

Looking through the Portfolio diet

Other studies have looked at the influence of individual foods and eating patterns on cholesterol and heart disease. One such study involved the Portfolio diet, which incorporates a variety of heart-healthy foods (such as margarine rich in plant sterols, almonds, soy, psyllium fiber, fruits and vegetables) into a vegetarian diet.

The Portfolio diet was found to lower cholesterol an astounding 30 percent — equal to the percentage commonly seen with a starting dose of statins (common cholesterol-lowering drugs). This study clearly showed that diet could indeed lower cholesterol, and that diet can work synergistically with statins to keep heart disease risks low.

Getting the best of both worlds

Researchers in Toronto, Canada, wondered whether combining the monounsaturated fat-rich Mediterranean diet with the plant-based, lower-fat Portfolio diet would have the greatest impact of all on cholesterol.

So they took 24 patients with moderately high cholesterol and split them into two groups: the Portfolio diet group and the Portfolio diet plus higher monounsaturated fats group. In the latter group, 13 percent of “calories from carbohydrates” came from sunflower oil, a good source of monounsaturated fat. After two months, that group — with the extra monounsaturated fats —lowered their LDL (bad) cholesterol 35 percent and raised their good (HDL) cholesterol 12.5 percent.

It appears that the added monounsaturated fats were able to do what the Portfolio-only diet could not do: raise heart-protective HDL cholesterol.

The best deal from these findings: You get to eat foods that are whole or minimally processed, taste great and are easily added to your diet. Apply the lessons learned from this research, and start today — your heart will thank you.

Combined diet: 7 tips for applying study findings to your plate

No need to travel to Crete for good things to eat — just visit your local grocer.

Remember not to simply add these new foods to your diet; they must replace unhealthier foods, or weight gain will become another obstacle to heart health.

  1. Bump up fruits and vegetables. We’re talking nine or more servings a day! Add berries to your morning bowl of oats. Munch on veggies for a snack. Toss dark leafy greens into your family’s favorite marinara sauce. Enjoy fresh fruit for dessert.
  2. Add lots of legumes. Enjoy a warm bowl of hearty lentil soup. Toss garbanzo beans into cooked whole-wheat couscous. Spread hummus onto pita bread. Enjoy a black bean taco salad.
  3. Seek out soluble fiber. Start your day with a warm bowl of old-fashioned oats. Toss ground flaxseed over yogurt or cereal. Serve barley in homemade soup. Add psyllium fiber to foods or buy cereals like All-Bran Bran Buds® with psyllium.
  4. Mix almonds and other nuts into your day. Plan to add at least one-half to 1 ounce of nuts to meals or as stand-alone snacks each day. (One ounce equals 23 almonds, so keep track of the count.)
  5. Enjoy soy. Replace your weekend pork sausage patty with a meatless patty at breakfast. Stir-fry firm tofu with vegetables. Snack on cooked edamame (soybeans in their pods). Sip on a cool glass of soymilk with meals.
  6. Supplement with plant sterols. Approximately 2 grams of plant sterols, when added to a heart-healthy diet, help to lower cholesterol. Look for plant-sterol-enriched margarines, orange juice, milk, breads, muffins and cheese.
  7. Move to monounsaturated fats. Replace those unhealthy fats in your diet to eat more like those in the Mediterranean. Slice some avocado onto a sandwich. Use olive oil to sauté vegetables or in your salad dressing. Slice olives into salads. Snack on a small serving of nuts.

Melissa Ohlson, RD, LD, is a registered dietitian in the Department of Preventive Cardiology and Rehabilitation in Cleveland Clinic’s Heart & Vascular Institute.

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Your Cleveland Clinic Health Tip

For heart health, retire the remote & take a break from Facebook

Spend two or more hours per day watching TV, video gaming, surfing YouTube or viewing other online entertainment? Studies associate this with substantially increased risks of death from heart attack and stroke. Our heart specialists’ prescription: Get up and be active, and minimize passive screen time.

Be Well – February 2011 Issue

Sleep Secrets: How to Get Those Zzzz’s You Crave

Our expert also ‘busts’ myths about sleeping pills

It’s 2 a.m. and, as on so many other nights, you can’t fall asleep. You take a sleeping pill, but nothing happens. What’s wrong?

“It is better to try good sleep behavior approaches first. If you work against the natural sleep process, then sleeping pills won’t help you,” says Cleveland Clinic sleep psychiatrist Douglas Moul, MD.

The irony about insomnia is that the harder you work at it, the worse it gets. “Get out of the way,” says Dr. Moul, and let natural forces take over. In addition, keep these three tips in mind, he says:

1. Decrease mental activity at bedtime.

An active mind will keep wakefulness going, so reserve your bed for sleep and sex. If you are awake in bed, get up and do something boring elsewhere. “This tactic helps lots of people,” says Dr. Moul.

2. Say ‘no’ to naps.

Good, deep sleep requires a buildup of wakefulness. Use daytime to increase the pressure to sleep. Sneaking naps during the day will dissipate that pressure.

3. Aim for improved — not perfect — sleep.

Some wakefulness at night is normal — being asleep is not like being unconscious. If you try good sleep behaviors every night for three weeks and still have insomnia, talk with your doctor. You may need extra help: coaching from your sleep doctor or a sleep psychologist, or sleep medications.

Busting myths about sleeping pills

To derive the greatest benefit from sleeping pills, you must use them correctly —and separate myth from fact, says Dr. Moul.

Myth #1: Sleeping pills are supposed to knock you out.

Fact: Sleeping pills only help you get to sleep. A sleeping pill should be taken when you are getting a little sleepy to facilitate this process. “If it is taken before you start to wind down, you will only get angry and frustrated, and this will defeat the pill,” says Dr. Moul.

Myth #2: Sleeping pills are a long-term solution.

Fact: Sleeping pills may not work if they are taken nightly. It depends upon the person.

Myth #3: If a sleeping pill stops working, all you have to do is ‘up’ the dose.

Fact: If your sleeping pill stops working, increasing the dose may not make it work.

Myth #4: Sleeping pills are addictive.

Fact: Addiction to sleeping pills is rare unless people already have substance abuse problems.

Myth #5: Choosing the right sleeping pill is easy.

Fact: Finding the medicine you need to combat chronic insomnia may take time. “Be patient and don’t get upset if the first medication doesn’t work. You may have to try many different medications to find one that offers stable benefits without side effects,” says Dr. Moul.

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Be Well – February 2011 Issue

Your Free Guide to Atrial Fibrillation

After age 60, the risk of atrial fibrillation, an irregular heart rhythm associated with stroke, heart failure and death, increases. Learn about this common heart condition and how it is effectively treated.

Recipe: Pumpkin Ravioli in a Wild Mushroom-Ginger Broth

Ravioli filled with this savory mousse will delight your family and friends. The pumpkin says that fall has arrived and luckily for us, canned pumpkin puree is always available. Use a mélange of wild mushrooms in the broth. We like thinly sliced cremini, shiitakes, chanterelles and morels. Because some of these are hard to find, we buy dried and reconstitute them. You can use other winter squashes or sweet potatoes for the filling.



  • Refrigerated butter-flavored cooking spray
  • 1 shallot, minced
  • ¾ cup pumpkin puree
  • ¼ cup egg substitute
  • 2 tablespoons reduced-fat ricotta cheese
  • 2 teaspoons minced fresh sage
  • 1/8 teaspoon ground nutmeg
  • Freshly ground pepper
  • 32 won ton wrappers (3.5-inch square), defrosted if frozen
  • Kosher salt

Wild Mushroom-Ginger Broth

  • 3 cups fat-free, reduced-sodium chicken broth
  • 1 ounce dried wild mushrooms, rehydrated (see Note)
  • ½ pound assorted wild mushrooms, thinly sliced
  • 2 teaspoons grated fresh ginger
  • 1 garlic clove, crushed
  • 2 scallions, white parts and 3 inches of the green, thinly sliced
  1. Coat a nonstick skillet with cooking spray. Saute the shallot over medium heat until wilted, about 5 minutes. Remove from heat. In a bowl, combine the pumpkin puree, egg substitute, ricotta cheese, sage and nutmeg. Stir in the shallot and pepper. Set aside.
  2. Place 8 won tons on the counter and put 1 tablespoon of the pumpkin mousse in the middle of each. Wet the edges of the won ton and place another on top, pressing all around the edges to seal securely. Leave square or cut with a floured glass to make a circle, again making sure that each ravioli is sealed. Place on wax paper and cover with a clean kitchen towel. Place another 8 won tons on the counter and repeat the process. If not cooking immediately, transfer to a cookie sheet, cover and refrigerate.
  3. To make the broth, combine the chicken broth, rehydrated and fresh mushrooms, ginger and garlic in a saucepan, bring to a boil, then simmer for 10 minutes. Set aside and keep warm.
  4. To cook the ravioli, bring a large pot of lightly salted water to a boil. Reduce to a simmer. Slide in half of the ravioli one at a time and stir gently. Poach for 2 to 3 minutes, until the ravioli rise to the top of the pot. Remove with a slotted spoon and cook the remainder of the ravioli.
  5. While the ravioli are cooking, bring the ginger broth back to a simmer.
  6. To serve, place 4 ravioli in each of 4 shallow soup bowls. Ladle ¾ cup broth into each soup bowl. Top with a quarter of the mushrooms and garnish with sliced scallions. Serve immediately.

NOTE: To rehydrate dried mushrooms, soak the mushrooms in boiling water to cover for about 15 minutes, or until softened. Remove the mushrooms with a slotted spoon. Strain the soaking liquid through a coffee filter to remove sediment. Use in the recipe or reserve for another use.

DIETITIAN’S NOTE: Although this dish contains about 100 milligrams more sodium than we generally recommend at a meal, it is a good source of potassium, contains dietary fiber, and is low in total fat. Just make sure you monitor the sodium content in your other meals, and serve the ravioli with a side of fresh vegetables.

Nutrition Information

Makes 4 Servings

Per Serving:

  • 280 calories (5% calories from fat)
  • 1.5 g total fat (0 g saturated fat)
  • 13 g protein
  • 55 g carbohydrate
  • 4 g dietary fiber
  • 10 mg cholesterol
  • 700 mg sodium
  • 657 mg potassium

This heart-healthy recipe and more than 150 others are available from the nation’s #1 heart center in the Cleveland Clinic Healthy Heart Lifestyle Guide and Cookbook (© 2007 Broadway Books). The cookbook is available in bookstores or online from, or

Be Well – February 2011 Issue

Let's Move It! Free Mobile App

Let Cleveland Clinic and your mobile phone keep you motivated. More than just a pedometer, our free mobile app offers walking challenges, a calorie tracker and videos to encourage and inspire.