Flax, a relatively new term to most health-conscious individuals, has a much longer history than one would expect. Archaeologists date the consumption of flax back to 9,000 BC. In 650 BC, Hippocrates wrote of flax's value in the treatment of abdominal pains. And in the 8th century, the medieval King Charlemagne was so convinced of flax's importance to good health that he passed laws requiring his subjects to consume it regularly.

This blue-flowered crop has proven to be quite versatile, and aside from its textile uses, can be used as an ingredient in many healthy recipes. Flax is used to make linen and fine quality papers, as lamp oil and as an ingredient in a variety of food products and supplements. The use of flax in the diet is showing more and more promise in many health conditions like cancer, arthritis, diabetes and menopause. Even more promising is the role of flax in heart disease prevention.

Potential Benefits of Flax in Fighting Heart-Disease
Around 42% of flaxseed's calories come from total fat. This total fat is comprised of a mix of different fatty acids: 73% polyunsaturated fat, 18% monounsaturated fat and only 9% saturated fat. What makes this so beneficial to heart health is that the majority of the polyunsaturated fat contained in flax is in the form of alpha-linolenic acid (ALA). ALA is an essential fatty acid (meaning the human body cannot create this fat from others and must get it from foods) and a precursor to the heart-disease fighting long-chain omega-3 fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Flaxseed is the richest source of ALA in the North American diet and has many potential heart-disease fighting benefits:

• Reduces blood triglyceride values.
• Neutral effect on the good cholesterol, HDL.
• Reduces blood pressure.
• Reduces platelet aggregation (clot formation) within arterial lining.
• Reduces inflammatory response.
• May protect against stroke.

In addition to being the best plant source for the essential fatty acids, flaxseed is also an excellent source of soluble (viscous) and insoluble fibers, lignans (a phytoestrogen found to help protect against certain cancers), high quality protein and potassium. Because of the soluble fiber component in flaxseed, various researchers have also revealed that flax can modestly reduce both total and LDL (bad) cholesterol values.

How to Incorporate Flax into your Diet
Flaxseeds can be found at most cooperative markets, bulk-food stores, and natural health food stores or directly through a manufacturer. Below are the main forms of flax that are available in markets today.

Whole or ground flax:
Known for the nutty flavor it adds to dishes, these reddish-brown or golden-yellow seeds can be added to virtually any food. Add whole or ground flax to a homemade baked good recipe; sprinkle on yogurt, cereals, soups or salads; add to trail mixes or toss into shakes. Because the outer hull of the seed is very difficult to digest, it is generally recommended that you grind or mill the whole flaxseed to get the greatest nutritional benefit. This can be done with your coffee grinder, blender or food processor to a coffee-ground consistency, or purchased already in the ground or milled form.

When baking, ground or milled flaxseed can be substituted for fat at a ratio of 3 to 1. For example, ½ cup of butter or margarine can be replaced by 1-½ cups of flax. Be aware that baked goods containing flax brown more quickly so you may want to adjust cooking times. Just want to add a little flax but don't want to replace the fat in a recipe? Use up to 2 Tablespoons of ground or milled flaxseed without altering any other ingredients, or sprinkle a little flax on top of yeast or quick breads for added crunch.

Whole flax can be stored at room temperature for up to one year. Because flax contains a significant amount of fat, the ground form can become rancid quickly. Store ground or milled flax at refrigerator temperatures for up to 3 months or grind the flax as you need it. A benefit to buying pre-ground or milled flax is that many manufacturers treat it with antioxidants, extending the shelf life.

Flaxseed oil:
Flaxseed oil is a wonderful form of ALA however, in the oil form it lacks the additional benefit of fiber, lignans and protein. For the benefits of ALA, add small amounts (1-2 teaspoons) of flaxseed oil to a marinade, smoothie, and shake or as a salad dressing. Flaxseed oil is sometimes difficult to find but can be purchased by ordering directly from a manufacturer or in the refrigerator section of some health food stores. Flaxseed oil becomes rancid very quickly; store in a refrigerator no more than 6-8 weeks. The shelf life is even shorter if you do not refrigerate.

Other forms of flax:
Below is just a small list of some types of food products that contain flax.

• Cereals, ready-to-eat and cooked
• Breads
• Crackers
• Energy bars
• Muffin, bread, pancake and waffle mixes
• Frozen waffles
• Omega-3 enriched eggs (hens are fed the flaxmeal)
• Snack items like chips, trail mixes and muesli

Read food label packages carefully to determine if flax is an ingredient. Most products will tell you right on the front of the package but check the ingredient's list too.

Pills and supplements:
Almost as soon as a nutrient is found to have potential in fighting disease, a synthetic supplement is soon created, touting the same disease-fighting benefits. The story is no different for flax. There are currently two forms of flax sold in pill-form, one containing ground flax the other flax oil. The oil-based have the same downsides as flax oil - lacking dietary fiber, lignans and protein and having a short shelf life. The ground flax types have the same benefits as ground flax, except you need to consume several capsules (sometimes 8 or more) each day to get the same benefit that a few teaspoons of ground flax would have. That's a lot of pills!

Another downside to taking pills is that research is still in its infancy. Researchers may find years from now that there are other components in the actual flaxseed that result in health benefits. This nutrient could be lost in the processing of the pill. In addition, the Food and Drug Administration (FDA) has yet to have regulatory control over supplements, meaning there's no real oversight on their production. The prudent approach would be to wait until further research is conducted.

How Much Flax Should I Eat?
At this time there is no gold standard serving size to consume for maximal heart-protection, but as more and more research unveils the cardiovascular benefit of flax, specific dietary recommendations may be established. A prudent intake of ground or milled flaxseed is around 2-3 Tablespoons per day, added to any foods you choose. Incorporating food products containing flax is also a great way to reap its heart-healthy benefits.

Whichever form you choose, it is always best to contact your doctor and/or registered dietitian before you incorporate flax into your diet. Do not use flax as a substitute for any prescription medications you are currently taking.

Enjoy the nutty flavor and texture that flax has to offer! Let your taste buds and your heart benefit from what this versatile food has to offer.

For more information on flaxseeds, contact any of the following:

• American Dietetic Association - http://www.eatright.org*
• Flax Council of Canada - http://www.flaxcouncil.ca*
• Flax Institute of the United States - http://www.ndsu.nodak.edu/flaxinst/*

For more information on a heart-healthy diet or exercise plan, please contact the Preventive Cardiology and Rehabilitation Program at 216.444-9353 (or toll-free at 800/223-2273, extension 49353) and we can schedule a nutrition or exercise consultation - or - use our Remote Cardiac Nutrition Counseling Services.

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