Diet and the Risk
of Heart Disease
disease -- CHD -- is our nation's number one killer. Fortunately, we know
a great deal about the factors that put people at risk for CHD, and which
of those factors are in our power to change. Much of the research into
risk factors for CHD indicates that changes in diet and lifestyle can help
reduce some people's risk for CHD -- even people who are genetically pre-disposed
to developing it. By looking at all the risk factors that apply to you,
identifying the ones in your control, and working to make positive changes,
you stand an excellent chance of reducing your risk of CHD.
If you want
to know about your risk of heart disease, the first thing you need to do
is get a blood test to check your cholesterol level. The test will measure
the amount of cholesterol in your blood, which is an extremely important
indicator of your risk for heart disease.
While it is
normal to have some cholesterol in your blood, it can be dangerous to have
too much. This can happen if you eat a diet that is too high in cholesterol
or in the saturated fats that can increase your cholesterol level.
How high is
too high? How low should you go? The answers are pretty clear-cut.
A high cholesterol
level is a huge risk factor for CHD. According to the results of the famous
Framingham study, which tracked cholesterol levels of 5,000 men and women
over 20 years, men with average blood cholesterol levels of 260 had three
times more heart attacks than men with average blood cholesterol levels
If your cholesterol
level is high, here are some ways to lower it.
HDL (Good) Cholesterol
and LDL (Bad) Cholesterol
Reduce your saturated
fat intake to less than 10 percent of the total fat in your diet.
Reduce the amount
of dietary cholesterol you eat.
Reduce your fat
intake to less than 30 percent of your total diet.
Eat more soluble
Maintain your ideal
Your total cholesterol
level includes two different types of cholesterol in your blood: HDL and
LDL cholesterol. HDL and LDL are both lipoproteins, or protein-containing
packages in which cholesterol travels through the bloodstream. The acronyms
stand for High Density Lipoprotein and Low Density Lipoprotein. HDL cholesterol
is considered beneficial, but LDL cholesterol is considered undesirable;
read on to find out why.
Think of this as
the cholesterol that is taken out of your arteries, or the detergent that
sweeps cholesterol away.
Your HDL level
is a key factor in your risk of heart attack. For example, if your HDL
level is low (below 35), you are at risk even if your total cholesterol
is only 200. But if your HDL level is up around 80, your risk is lower
-- even through your total cholesterol may be as high as 250.
A good general
rule is, the higher your HDL cholesterol, the better.
Women's HDL levels
tend to be above 45, a good protective start against heart disease.
It is not exactly
clear how to raise your HDL, but high HDL has been associated to some extent
with the following factors.
plenty of exercise
low fat consumption
low saturated fat
of trans fatty acids
This is the cholesterol
that clogs your arteries.
The lower your
level of LDL cholesterol, the better for your heart health.
In the US, more
than half of men over 35 and women over 45 have high levels of LDL.
LDLs can be small
or large; small LDLs have been linked to undesirably low levels of HDL
(good) cholesterol and to high levels of triglycerides.
One of three men
and one of six post-menopausal women have more small LDLs than large ones
and may therefore be at higher risk for CHD.
for people with heart disease
If you need
to lower your LDL, try taking these steps.
There is also evidence
to indicate that anti-oxidants may prevent clogging of the arteries by
blocking LDL from being oxidized. Vitamin E and vitamin C are showing great
promise in this area, and dietary beta-carotene also has shown some effect.
Take the steps
described earlier to lower total cholesterol and increase HDL cholesterol.
Stay as close as
possible to your ideal weight.
Keep your fat intake
are a type of fat found in the bloodsteam. Triglycerides only recently
have begun to be considered important in cardiovascular health. High levels
of triglycerides are now generally associated with a high risk of CHD.
are often attributable to excess weight or to heredity. In some cases,
however, they may be associated with the carbohydrates in a very low-fat
diet. They are not associated with all carbohydrates, however. Simple sugars
and refined flours (such as those in a diet that is high in sugar and in
low-fat products such as cookies, pretzels and pasta) tend to raise triglyceride
levels in some people. On the other hand, whole grains and fruit do not
seem to pose a large problem. Here is what you can do to lower your triglyceride
Reduce total fat
and saturated fat intake.
Eat less sugar.
Eat more fish high
in Omega-3 fatty acids.
Lp(a) is a form
of LDL cholesteral, or "bad" cholesterol. It is emerging as another risk
factor for CHD, and elevated levels of Lp (a) in your blood should be of
concern. However, it is not clear how to lower a high Lp (a) level. Some
preliminary findings point to aspirin, red wine and Omega-3 fatty acids
from fish as possibly lowering Lp (a) levels. More research is needed before
specific dietary recommendations can be made, but following a heart-healthy
diet is a good start.
Ways to Lower Your Cholesterol Through Diet
1.Cut your total
The risk of
heart disease falls sharply if you reduce fat to less than 30 percent of
total calories (as opposed to the 34-54 percent that is typical in the
United States). When you lower fat consumption, you also reduce your saturated
fat intake, cut calories and lose weight.
much of your diet should come from fat is a matter of controversy. Too
little fat may be as bad as too much, although this idea is somewhat controversial.
It probably depends on your specific health profile. Two very different
programs have proven track records:
a cardiologist, has published a number of books about his program, which
has been proven to reverse heart disease. His plan includes exercise, meditation,
support groups, an almost-vegetarian diet, and fat intake of only 10 percent.
Ideal weight is also a goal of this plan. Overweight people with high cholesterol
and Type A personalities will greatly benefit from Dr. Ornish's program.
It is rigorous, rigid and effective.
If you are on a
low-fat, high-carbohydrate diet, yet you also have low HDL (good) cholesterol
and high triglycerides, you may need to reconsider the quality of your
low-fat diet plan. Your carbohydrates should be coming from whole-grain
cereals and breads, fresh fruits and vegetables. Your diet should include
only a minimal amount of sugar. If you are taking advantage of fat-free
"fun foods," such as low-fat sweets, pretzels and pasta, along with fat-free
ice cream and desserts, you may be unintentionally raising your triglyceride
Advocates of the
Mediterranean Diet, on the other hand, promote a diet of 30 percent fat.
The recommended sources of fat, though, are largely olive oil, fish and
nuts. People on this diet eat a good deal of cheese and yogurt, but they
rarely eat red meat and pork and drink wine only in moderation. People
of the Mediterranean have a lower incidence of heart disease and stroke
2. Eat less
Your daily cholesterol
intake should be 300 milligrams or less. Certain animal foods are rich
in cholesterol, but no plant foods contain cholesterol. Keep these food
facts in mind.
The body makes
cholesterol. In most cases, the more cholesterol a person eats, the less
the body makes. However, 20-30 percent of Americans are not able to balance
the cholesterol they produce and the cholesterol they ingest this well;
as a result, they may have excessively high cholesterol levels.
A single egg yolk
has 255 milligrams of cholesterol; if you are healthy, you should eat no
more than two egg yolks per week. (If you already have heart disease, you
may be advised otherwise.)
Egg white has no
fat or cholesterol, so you might consider eating egg whites and egg substitutes
frequently. Egg white is also an excellent form of protein.
Organ meats and
certain seafoods -- shrimp, lobster and calamari -- have high levels of
3. Avoid saturated
In terms of
heart health, there is nothing good to be said for saturated fats! They
are to blame for increasing total cholesterol, LDL cholesterol and triglycerides.
4. Avoid tropical
Less than one-third
of your fat intake should come from saturated fat.
You find saturated
fat in dairy fats such as cream, butter and cheese.
Saturated fat is
also in animal fats like chicken skin, visible fat on meat, and lard.
The chemical structure
of saturated fats makes them solid at room temperature.
oils are palm, palm kernel and coconut oil. They are highly saturated.
Many prepared foods contain them, so check labels for ingredients. You
are likely to find tropical oils in these products.
5. Reduce your
intake of transfatty acids.
are compounds that occur when foods are chemically modified by partial
hydrogenation. The safety of transfatty acids has been a controversial
subject. Recent studies have helped resolve the issue; for instance, a
US Department of Agriculture study showed that transfatty acids from partially
hydrogenated vegetable oil raise cholesterol as much as saturated fats
do. Fatty acids may also reduce HDL cholesterol (good cholesterol) and
raise Lp (a).
your use of monounsaturated fats within your total allotment for fat.
fats lower blood cholesterol and will reduce your risk of heart disease.
7. Use polyunsaturated
fats are liquid at room temperature.
They are the main
fatty acids in olive oil and canola oil.
Use olive and canola
oil in your cooking and in salad dressings to promote heart health.
fats are the major fat source in vegetable oils such as safflower oil and
corn oil. They generally lower total cholesterol, although they may also
lower HDL cholesterol (good cholesterol).
The primary polyunsaturated
fatty acid is Omega-6, or linoleic acid, a fatty acid that is essential
to our growth and development. Widespread use of Omega-6, however, may
have upset the balance with Omega-3. This imbalance may be a cancer risk.
Try to use less
hydrogenated margarine; liquid and tub margarine are better than stick
Some less hydrogenated
products may contain trans fatty acids, but you can avoid them by reading
labels. The newest types of margarine are labeled "without transfats."
8. Get your
Omega-3 fatty acids.
acids are polyunsaturated fats from plant and marine sources. Omega-3 is
an essential fatty acid, linolenic acid. The richest sources are fish that
swim in cold waters, such as those listed here; try to eat them 3-4 times
The benefits of
eating these food sources of Omega-3 include the following.
If you do not eat
fish, be sure to include other foods rich in linolenic acid, such as these.
in high triglyceride levels
slower blood clotting
prevention of abnormal
improved eye and
A note of caution:
Do not use fish oil capsules without medical supervision; their concentrated
levels may interfere with other medications.
9. What about
10. Increase the
soluble fiber in your diet.
moderately high in cholesterol, is a very low-fat protein. Eaten once or
twice a month it will not affect cholesterol levels.
All other shellfish
are also acceptable, except squid (calamari) and roe (caviar).
Mollusks such as
clams, mussels and scallops are all fine.
Be sure shellfish
are from reputable sources and are cooked well.
Have your seafood
baked, broiled, steamed or boiled -- but not fried.
Use only acceptable
oils in preparing shellfish recipes which call for oil.
oat bran craze? Well, there is nothing crazy about eating a lot of soluble
fiber-which is found in oat bran, in abundance-if you want to lower your
fiber in oats, called beta-gluca, has specifically been proven to reduce
blood cholesterol. A high daily intake of soluble fiber, through generous
servings of oat- and bean-based foods, helps to eliminate cholesterol-laden
bile acids and fats from your body.
is found primarily in these foods.
Some people take
soluble fiber in the form of psyllium seed; this is most effective when
taken with your largest meal of the day. It has little effect on cholesterol
reduction when taken at bedtime.
11. Be sure
to get enough folic acid, vitamin B6 and vitamin B12.
Low levels of
folic acid and other B vitamins can cause excessive homocysteine to be
produced in the body, and high homocysteine levels are an independent risk
factor for heart attack and stroke.
You need 400
micrograms of folic acid a day to prevent heart disease. A multivitamin
will provide the recommended amount. Foods that will also do the job include
12. Try more
A number of
studies have shown that soy protein lowers cholesterol. Soy has isoflavones,
called daidzein and genistein, which are the plant estrogens that play
a role in cholesterol metabolism. Soy protein is a good protein that can
be substituted for animal protein in your diet. Here are some sources of
25-50 grams of soy protein daily, or 60 milligrams of isoflavones, to reduce
made with textured vegetable soy protein
13. Get more
retard the development of "free radical" cells that are implicated in heart
disease and cancer. Oxidized LDL (bad cholesterol) is damaging to the arterial
wall. Certain vitamins and other compounds provide anti-oxidant effects.
Vitamin E is an
anti-oxidant; doctors recommend 400-800 IU daily for heart patients.
Vitamin C is recommended
as an anti-oxidant at 350-500 mg a day.
recommended at 15 micrograms a day.
14. Go beyond
vitamins -- and get your phytochemicals.
are plant chemicals that may help prevent not only CHD, but also other
chronic diseases and conditions such as diabetes, cancer and hypertension.
15. Shape up!
Fruits and vegetables
are chock-full of them; eating five servings a day is a good start on the
road to better health.
Garlic may help
reduce blood cholesterol, LDLs and triglycerides; garlic pills are being
studied now, but the results so far are inconclusive. It appears that raw
garlic is the active ingredient.
Get a lot of exercise.
It will help you lose weight, increase your HDL (good) cholesterol and
lower your triglycerides.
Lose weight if
you need to. Losing just 10 pounds can make a difference in your cholesterol
level, especially if your body is an "apple shape."
Your waist measurement
divided by your hip measurement should be less than 0.9 for men and less
than 0.8 for women.
If you smoke, stop.
Oils and fats
are usually a mixture of the three kinds of fatty acids -- monounsaturated,
polyunsaturated, and saturated. For heart -- healthy eating, keep these
guidelines in mind.
Choose food products
with more monounsaturated and polyunsaturated fatty acids
Reduce your use
of saturated fats
Refer to this chart
to make healthier choices.
of Saturated Fat %
to Reduce the Saturated Fat in Your Diet
Try these suggestions
for replacing saturated fat in your diet with improved fat choices.
High in Saturated Fat
Saturated Fat Alternative
cream cheese in a tub
Buds or Molly McButter
egg whites or egg substitutes
ground turkey, soy protein crumbles
(1 cup) or canola oil (3/4 cup)
yogurt or non-fat sour cream
pan, Pam cooking spray
dried skim milk