Take A Walk on the Well Side

By David Brand

With its shop-lined main street, baseball field and grassy square, Wellsburg, W. Va., is in many ways a typical American town. Perhaps too typical. A survey last spring found that almost 70% of the Wellsburg area's 11,000 residents were at risk for heart disease. "I was just shocked that my cholesterol was that high," says Kitty Weidner, 75, whose reading was 241 milligrams per deciliter (mg/dl) of blood. Admits store owner Tom Zurbuch, 46, a former junk- food junkie whose cholesterol level was about 265: "Apparently, we haven't been eating right."

But Wellsburg had a change of heart last May, when Bayer, the pharmaceutical company, launched a $4 million, two-year experiment aimed at improving the townspeople's coronary fitness by teaching them the rudiments of healthy living. The basic rules: throw away the cigarettes, control blood pressure and, perhaps most important, bring down blood-cholesterol levels through diet and exercise programs. Among the first results late this summer: an average 8.3% decline in cholesterol levels.

What's good for the residents of Wellsburg is good for other Americans, who are increasingly getting the message that poor eating and living habits are major contributors to heart disease. Scientists are convinced that well- designed prevention programs can cut the incidence of heart disease in the U.S. by two-thirds, perhaps even more. "Twenty years from now," says Dr. Scott Grundy, a nutrition researcher at the University of Texas Southwestern Medical Center at Dallas, "I expect to see a dramatic reduction in heart attacks."

The food industry is slowly adapting to the recommended changes in diet. Some hotels and restaurants now offer low-fat, low-cholesterol menus. Sunshine Biscuits, maker of Hydrox cookies, is no longer using coconut oil in its products and soon plans to eliminate palm oil, both of which are cholesterol- boosting saturated fats. By next summer an American Heart Association seal of approval may be carried on foods that meet its heart-healthy guidelines.

Although the overall objective is to decrease the amount of total cholesterol in the bloodstream, best results are achieved by lowering levels of LDL, the "bad" cholesterol, while maintaining or increasing levels of HDL, the "good" cholesterol. The basic approach: cut down on cholesterol and saturated fats in the diet, both of which raise LDL levels, and get regular aerobic exercise, which tends to raise HDL counts. Here's how:

Cholesterol. The National Heart, Lung and Blood Institute suggests that Americans limit themselves to 300 mg ( 1/100 oz.) of cholesterol a day. Cholesterol is found only in animal products, sometimes to a high degree: one egg yolk has 272 mg, and 3 oz. of beef liver has 331 mg. Saltwater fish, on the other hand, are extremely low in cholesterol and also contain omega-3 fatty acids, which may lower LDL levels. Not all seafood is as highly recommended: shrimp and crab, for example, have twice as much cholesterol as fish. Grundy's major candidates for removal from the diet are eggs and organ meats, such as liver.

Saturated Fats. Simply stated, these are fats that are solid at room temperature. They are found in meat and dairy foods, as well as in some plant products, most notably palm and coconut oils. Saturated fats, which are not essential in the human diet, stimulate the liver's production of LDL cholesterol. A decade or so ago, it was believed that only polyunsaturated fats, found in corn, safflower and soybean oils, would lower cholesterol. But the polyunsaturates have been shown in animal experiments to suppress the immune system. Now the advice is to turn more to monounsaturates like peanut and olive oils, which also reduce total cholesterol.

Americans consume an average 37% of their calories in the form of fats, nearly half of them saturated. Grundy and other nutrition experts recommend that fat intake be reduced to 30% of total calories in the diet and be evenly divided among saturated, polyunsaturated and monounsaturated. In 1983 the American Heart Association called for the same 30% limit for children over the age of two. Evidence that heart disease begins in childhood, says Louisiana State University cardiologist Gerald Berenson, "is overwhelming and ominous."

Exercise. Most specialists agree that while vigorous exercise only slightly lowers LDL levels, it can drive up the HDL count and reduce triglycerides - (fatty acids that clinical studies have linked to heart disease). Stanford University medical professor Peter Wood maintains that an increase in physical activity, when accompanied by weight loss, can cause a steady rise in HDL. He advises 30 to 40 minutes of continuous exercise three to five times a week, in which the heart rate is elevated to 70% to 80% of maximum.

But HDL was barely raised in another study, headed by cardiologist Paul Thompson of Brown University. The trial involved eight previously sedentary men whose weight was kept constant through controlled diets and who were put on a regimen of rigorous exercise. After 48 weeks, Thompson reported, HDL levels had gone up an average of only 5 mg/dl. The most striking result of the study was a 16% drop in triglycerides experienced by the participants. Apart from its effect on HDL, exercise clearly improves cardiovascular health by lowering blood pressure and improving glucose metabolism.

How can the dietary recommendations be put to work? Specialists are increasingly looking to the traditional Mediterranean diet, which is rich in fish, grains, fruits, vegetables and olive oil. This diet is regarded as a healthy alternative to such high-cholesterol foods as red meat, eggs and whole-milk dairy products. Much of the fat in this regional fare comes from the monounsaturates in olive oil, which may explain why southern Italians, for example, boast one of the lowest heart-disease rates in the Western world -- even though they have HDL levels significantly below the Western average. They appear to be protected by their low LDL counts, which they owe to a diet relatively low in cholesterol and saturated fat.

Some experts feel that lean red meat and chocolate, two items that were previously taboo in low-cholesterol diets, need not be given up entirely. One recent study showed that stearic acid, which is found in both the fat of red meat and cocoa butter, does not raise LDL cholesterol. But researchers urge moderation, since these foods also contain palmitic acid, a well-documented cholesterol raiser. In place of fatty meat, nutritionists suggest lean red meat, chicken and turkey -- provided the skin of the poultry has been removed and only the white meat is eaten. (Holiday feasters, take heed.)

In general, nutritionists think Americans eat too much animal protein. "If you're eating a diet high in animal protein, you're also eating a diet high in fat," says Linda Van Horn of Northwestern University medical school. In 1985 Americans consumed an average of 71 g of animal protein a day, including high- fat products like cheese and ice cream. Grundy recommends eating only half that much, roughly the amount found in 5 or 6 oz. of lean meat or two cups of low-fat cottage cheese.

The dieter's best bet might be to replace fats with complex carbohydrates. Fat has 9 calories a gram, but carbohydrates have only 4 calories. That means that foods like spaghetti, beans, peas, potatoes and whole-grain bread are much less fattening than equivalent amounts of spare ribs or cream cheese. Most foods containing complex carbohydrates are also excellent sources of fiber.

Soluble fibers like oat and rice bran can help remove cholesterol from the body. They apparently do this by binding with cholesterol and bile acids. Insoluble fibers, such as those found in wheat or corn bran, do not affect blood cholesterol. But by increasing the speed at which food passes through the digestive tract, they may help prevent intestinal and colon cancers.

Studies by Dr. James Anderson, a professor of medicine at the University of Kentucky, showed that a throat-clogging diet that includes 3 oz. of oat bran a day (equal to six cups of cooked oatmeal or about six oat-bran muffins) can lower LDL cholesterol as much as 23%. Another long-term study has shown that 1 1/2 oz. of dry oat bran a day, if taken as part of a cholesterol-lowering diet, raises HDL levels by 10%. Such findings have helped launch a nationwide rush for oat bran and oatmeal.

Inundated with all this information, many consumers can understandably stumble on the road to good nutrition. "They go to McDonald's and order a fish sandwich," says Northwestern's Van Horn, "but how is the fish prepared? It's deep-fat fried, and it's breaded. So the total amount of fat is worse than that in a small hamburger." Others buy margarine that is described as being cholesterol free, not bothering to read the label, which may show that it contains large amounts of saturated fats in the form of palm oil.

Intelligent eating requires careful reading of food labels, says Dallas dietitian and food writer Leni Reed, who takes shoppers around Texas supermarkets teaching them how to do just that. Her most important piece of advice: disregard the label's measuring of fat by weight. Instead, she recommends working out the percentage of total calories that comes from fat. * For example, a 1-oz. serving of a cheese with a label that proclaims "reduced fat" may indeed be only one-quarter fat by weight. But in terms of calories, it may be 80% fat. "Interpret the fine print," says Reed, "so you won't be fooled by the bold print."

FOOTNOTE: *The calculation: number of grams of fat per serving multiplied by 9, divided by total calories per serving, times 100.

CHART: NOT AVAILABLE

CREDIT: TIME Chart by Joe Lertola

CAPTION: FACTS ON FAT

With reporting by Barbara Dolan/Wellsburg