for every 45 adults, at least five will have diabetes. Of Bermudians 65 years and over, as many as one out of five males and one out of three females develops diabetes.

What does this have to do with heart disease. Just having diabetes increases the chances of developing heart disease. The 1996 Bermuda Diabetes Association study confirms this fact.

Bermudians with diabetes were found to have many of the lifestyle problems that lead to heart disease. These include high total blood cholesterol (45% had levels 200 mg/dL or greater), high blood LDLs -- often termed the "bad'' cholesterol (46% had levels 130 mg/dL or greater), low blood HDLs, also called the "good'' cholesterol (37% had levels less than 35 mg/dL), increased blood pressure (74.5%), obesity (77%), and limited physical activity.

These factors, as well as high dietary cholesterol and saturated fat, stress, nicotine, and stimulants lead to an unhealthy heart for not only diabetics, but the population as a whole. Heart disease is the leading cause of death in industrialised countries.

Can lifestyle changes lead to a healthier heart and prevent heart disease? Dr.

Dean Ornish, highly-publicised for his programme for preventing and reversing heart disease, conducted the Lifestyle Heart Trial (The Lifestyle Heart Trial, Lancet 336:129-33, 1990).

Dramatic improvements in the condition of the arteries were found as lifestyle improved. Eighty-percent of the patients in the study showed reversal of arterial damage within a year.

What lifestyle changes affect heart health. Diet, emotional stress, exercise, nicotine and stimulants (including crack-cocaine and caffeine) affect heart health. Diet and stress together increase blockage of the arteries. Studies of monkeys found a diet high in fat and cholesterol, plus stress, had a greater affect on the arteries than stress alone.

The monkeys had 30 times more arterial blockage with emotional stress, when given a high-fat and cholesterol diet. Chronic stress also leads to lower HDLs, or "good cholesterol'', levels (Dr. Dean Ornish's Programme for Reversing Heart Disease. New York, 199O, p. 78; Kaplan JR, Arteriosclerosis 2(5):359-68, 1982).

Diet alone is an important factor in the development of heart disease. The effects on the heart of what we eat can happen very quickly. Eating just one high-fat and cholesterol meal can lead to narrowing of the arteries and faster clotting of the blood.

This causes chest pain and often doctors see more emergency room visits following holiday feasts, according to Dr. Ornish. The opposite effect can also happen. The arteries open up and blood flow can improve in only a few weeks with a very low-fat, low-cholesterol intake and healthy lifestyle choices.

The China Diet Study (1983) found Chinese people to have low rates of heart disease. A comparison of the Chinese diet to the average American diet found: bul Total calories from fat average less than 15% versus 40% for Americans; the Chinese eat three times more dietary fibre; they also eat more calories than Americans but are 25% lighter; Chinese eat a plant-based diet and one-third less fat; they also have blood cholesterol levels, averaging a healthy 127 mg/dL; only four percent of protein in the Chinese diet is from animal sources, compared to 70% for the US; Chinese who eat animal protein have the highest rates of heart disease and diabetes; the Chinese way of eating helps lower heart disease risk for this population.

Co what dietary changes can help prevent heart disease? Risk can be lowered by decreasing your intake of saturated fat and cholesterol to levels under 1 50mg/dL -- (note: If your blood cholesterol levels do not decrease on a very low-fat/cholesterol diet, other lifestyle changes including stress management, exercise, not smoking and avoiding stimulants, will still keep your risk for heart disease low.) What practical ways can one limit saturated fat and cholesterol in the diet? Most of the dietary fat comes from foods such as meats, ice cream, butter, eggs, nuts, cheese, and oils. Begin by avoiding these foods.

Decrease dietary saturated fat and cholesterol by eliminating foods such as red meat, egg yolks, and even the skin from chicken. Also avoid all fried foods.

Try eating meatless meals more often during the week and limit oil intake as much as possible. If you must, canola and olive oil are best.

Eat whole-grain cereal for breakfast rather than eggs, and replace whole milk with low-fat or skim. Also eat more foods which are high in soluble fibre, such as rolled oats, oat and rice bran, rice bran, carrots, pectin (found in fruits), guar gum (found in lentils and most beans.

Beans are great in soups, salads, dips, sandwich spreads. and tortilla fillings. They also lower LDLs and total blood cholesterol. All of the foods above are good sources of soluble fibre and help lower blood cholesterol.

For the majority of people, these moderate changes are enough to lower total blood cholesterol. Some people will need more individualised dietary guidance.

If you are one of those people, you have tried the dietary charges just discussed and your total blood cholesterol levels are still high (Note: In the winter months, cholesterol levels are often five-to-seven milligrams higher than in the summer months), consult your physician and seek guidance from a registered dietitian for a low fat, low cholesterol plan.

Natalie Bean, RD. MPH Nutrition Services Ministry of Health HEALTH & SOCIAL ISSUES HTH