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By Dietitian, Juliette Kellow BSc RD
Gone are the days when a healthy heart diet meant filling up on tasteless, boring meals. The latest advice to help us lower the risk of heart disease actively encourages us to create meals with delicious, fresh ingredients like salmon, avocado, olive oil, oats, wholegrains and an array of fruit and vegetables.
Fortunately there are plenty of things you can do to help keep your heart healthy. And more often than not, looking at your diet – and losing weight if necessary – are the simplest changes you can make to help heart health.
The four major risk factors for heart disease are smoking, having high cholesterol, having high blood pressure and being physically inactive.
However, being overweight, diabetes, drinking too much alcohol, and having too much salt in our diet also increases the risk. A family history of heart disease is also a risk factor.
Bear in mind, our risk of heart disease depends on how many risk factors we have and how strong each individual risk factor is. Giving up smoking and taking more aerobic exercise are important first steps.
Cholesterol is a fatty material that’s made mainly in the liver. It’s an essential part of every cell and is the building block of many important steroid hormones. However, too much in the blood increases the risk of heart disease.
Cholesterol uses the body’s circulation as its transport system and travels around on vehicles made up of proteins. These combinations of cholesterol and protein are called lipoproteins and there are two main types – low density lipoproteins (LDL) and high density lipoproteins (HDL).
LDL transports cholesterol from the liver to the cells, where certain amounts are needed. However, any remaining cholesterol can be chemically changed (a process called oxidation) and taken up by the cells in the artery walls where it starts to build up – it’s this process that causes narrowing of the arteries or atherosclerosis. Consequently, high levels of LDL cholesterol increase the risk of heart disease – that’s why it’s sometimes called ‘bad’ cholesterol.
In contrast, HDL carries excess cholesterol away from the arteries to the liver, where the body gets rid of it. As a result, high levels of HDL cholesterol are thought to protect against heart disease and so, are sometimes called ‘good’ cholesterol.
Your blood cholesterol levels can be measured by a simple blood test. Your doctor will look at figures for your overall or total cholesterol level, plus figures for your LDL and HDL cholesterol. All these values are measured in units called millimols per litre of blood, usually shortened to mmol/l. Healthy levels are as follows:
Your doctor may prescribe medication. However, it’s also important to look at your diet.
According to the British Heart Foundation eating a heart healthy diet can help to lower your cholesterol levels by between 5% and 10%. In most cases, the aim is to reduce your total cholesterol, particularly by lowering levels of LDL or ‘bad’ cholesterol. But it’s also important to raise levels of HDL or ‘good’ cholesterol.
In particular, losing weight is one of the most important things you can do to lower your cholesterol if you are overweight or obese. Better still, losing those excess pounds will also help to reduce other risk factors for heart disease such as high blood pressure and diabetes.
Overall, you should cut down on the total amount of fat you eat. For a healthy heart diet Weight Loss Resources recommends that no more than 30 percent of your daily calories come from fat.
This means if you have a daily calorie intake of 1,500 calories, you should have no more than 50g of fat; if your daily calorie allowance is 2,000 calories, you should have no more than 66g of fat a day. Fortunately, WLR does the maths for you – all you need to do is look at your Nutrition Profile in Food Diary to find out the maximum amount of fat you should have each day. (You can take a free trial of WLR's tools to see how it works.)
It’s important for heart health to make sure you’re eating the right types of fat, too. There are three main types of fat in food – saturates, monounsaturates and polyunsaturates. Most foods contain a mixture of these, but they are generally classified according to the type of fat found in the largest amount.
Foods high in saturates include fatty meats, full-fat dairy products, butter, lard, cream, cheese and many processed and takeaway foods. These types of fats increase LDL or ‘bad’ cholesterol so it’s important to eat fewer of them.
Good sources of polyunsaturates include pure vegetable oils and spreads such as sunflower, corn and soya oils and margarines and some vegetables. These types of fat help to lower LDL or ‘bad’ cholesterol. But they also lower HDL or ‘good’ cholesterol.
Good sources of monounsaturates include olive oil, rapeseed oil, avocados, nuts and seeds. These types of fats lower LDL or ‘bad’ cholesterol but they help to maintain levels of HDL or ‘good’ cholesterol.
Ultimately, as well as eating fewer fatty foods in your diet, it’s important to swap foods high in saturates for foods rich in unsaturates. It might sound complicated but in practice it’s simple – for example, if you really must fry, use a small amount of olive oil rather than butter!
A few foods such as liver, kidney, prawns and eggs do contain more dietary cholesterol than many other foods. However, thanks to research, we now know the cholesterol in food has little effect on our blood cholesterol levels – it’s saturated fat that has the biggest impact. Consequently, there’s no need to limit the amount of these foods you eat, unless your GP or a dietitian has specifically advised you to do this.
Trans fats have increasingly been in the news in the past few years. They tend to be found in foods that contain hydrogenated fats or hydrogenated vegetable oils and are thought to be as harmful to heart health as saturates. This means it’s a good idea to eat fewer foods that contain them.
Ironically, it’s the processing of pure vegetable oils – a good source of heart-friendly unsaturates – that creates harmful trans fats! During manufacturing, these liquid oils have hydrogen bubbled through them in a process called hydrogenation to improve their texture, flavour and shelf life. The resulting product is a more solid fat called hydrogenated fat or hydrogenated vegetable oil, which goes on to be used as an ingredient in many processed foods.
Currently, there are no legal requirements for food manufacturers to label trans fats on their products and few choose to do so. This means for now, you need to scour ingredients’ lists for hydrogenated fats or hydrogenated vegetable oils. If a product contains either, it will almost certainly contain trans fats, too – and the higher up the list the ingredient appears, the more trans fats the product will contain.
The good news is, eating fewer foods that contain trans fats not only helps to keep your heart healthy, but also helps shift those pounds. The reason: trans fats tend to be found in cakes, biscuits, margarines, takeaways, pastry, pies and fried foods – all foods that are also loaded with calories!
Despite recent reports to the contrary, most health experts still believe omega 3 fats have an important part to play in a healthy heart diet.
Our bodies can make omega 3 fats from foods like rapeseed oil, walnut oil and soya. However, oily fish such as salmon, sardines, mackerel, trout, fresh tuna, pilchards, kippers and herring are also packed with omega 3 fats. In fact, omega 3 fats are thought to be so important for our health that the Food Standards Agency recommends we should all eat at least one serving of oily fish each week.
Triglycerides are another type of blood fat or blood lipid. Like high cholesterol, raised triglyceride levels in the blood can increase the risk of heart disease and stroke.
Being overweight or obese, having a high fat diet, drinking too much alcohol and not taking enough exercise can all contribute to high triglyceride levels. Usually, blood tests to measure cholesterol also measure triglyceride levels. Anything above 2mmol/l is considered high.
Most fibre-rich foods are low in fat, which makes them a great choice for a healthy heart. But they’re also packed with vitamins, minerals and naturally occurring plant chemicals called phytochemicals.
When it comes to heart disease prevention – and other conditions such as cancer – it appears to be this whole package of fibre and nutrients that’s important. Indeed, there’s good evidence that eating a high fibre diet with more wholegrain foods such as wholemeal bread, brown rice and wholegrain breakfast cereals can help to prevent heart disease – one large study found that women who ate around three servings of wholegrain foods a day were 30 percent less likely to suffer from heart disease.
Furthermore, a particular type of fibre called soluble fibre may also help to lower blood cholesterol levels.
This type of fibre is found in some fruits, vegetables, oats, barley and pulses such as beans, lentils and peas – all low-fat foods that are also a great choice if you’re also trying to lose weight.
In particular, soluble fibre is thought to bind with cholesterol and prevent it from being reabsorbed into the bloodstream. This lowers the amount of cholesterol in the blood, therefore reducing the risk of heart disease.
Soluble fibre also forms a gel in the intestine, which is thought to slow down the digestion and absorption of carbohydrates. This helps to keep blood sugar levels steady, preventing carb cravings that leave many of us reaching for sugary snacks that are also often combined with fat – we’re talking biscuits, chocolate, toast and jam, muffins, doughnuts!
Most fruit and vegetables are low in fat and high in fibre – both of which are important for a healthy heart diet. But fruit and veg are also packed with antioxidants, which help to protect against heart disease.
Antioxidant vitamins such as beta-carotene and vitamins C and E work their magic by ‘mopping up’ harmful free radicals, which can cause oxidation of LDL cholesterol – a problem that potentially speed up the process of the narrowing of arteries.
In addition, many fruit and vegetables are also good sources of naturally occurring plant chemicals such as flavonoids, which act as powerful antioxidants. No doubt you’ve heard it before, but health experts recommend eating five servings of different fruit and veg every day – and the more colours you go for, the greater the variety of nutrients you’ll get!
Eating more soya – a good source of both soluble fibre and isoflavones (from the flavonoid family) – may help to protect against heart disease.
Studies show that including 25g of soya protein each day as part of a diet low in saturates can help lower both total cholesterol and LDL or ‘bad’ cholesterol. You can get this amount of soya protein by drinking around three glasses of soya milk a day, but make sure you choose unsweetened varieties. There are also many soya desserts, yogurt alternatives and creams available but always check the nutrition information first as they may be higher in calories than you’d expect.
There’s evidence that products containing plant sterols and stanols reduce the absorption of cholesterol from the gut and so lower blood cholesterol levels as a result. However, it’s worth bearing in mind that these products are often expensive.
They’re also not a substitute for a healthy diet - even if you choose to have margarines, milks, yogurts or drinks that are enriched with plant sterols, you still need to eat a healthy diet to reduce your risk of heart disease. And if you’re trying to lose weight, it’s also worth checking out the calories before filling your shopping trolley with them.
High blood pressure is a risk factor for heart disease so it’s important to keep it under control. In fact, research shows that people with high blood pressure are three times more likely to develop heart disease or have a stroke than people with normal blood pressure.
As well as losing weight, one of the most important things you can do is eat fewer salty foods and avoid adding salt to dishes when cooking or eating them. This is because salt contains sodium – and it’s high intakes of this that raise blood pressure.
Most people in the UK eat too much salt. As a guideline, the Food Standards Agency recommends we should each have less than 6g of salt a day.
To meet this target most of us need to cut down on salty foods, which include ketchup, pickles, crisps, ready meals, takeaways, processed meats such as ham, bacon and burgers, pastry products, pizza, canned soups, ready-made cooking sauces and canned fish in brine. The good news is, these are often low in essential nutrients but high in calories and so won’t help you shift those pounds. Foods like bread, breakfast cereals and cheese can also be packed with salt although they usually contain good amounts of vitamins and minerals, too.
According to the British Heart Foundation, drinking no more than one or two units of alcohol a day is thought to help protect against heart disease – but only in men over the age of 40 and postmenopausal women! Meanwhile, alcohol also helps to raise HDL or ‘good’ cholesterol and may reduce the stickiness of the blood.
However, people who persistently exceed sensible drinking limits – that’s a maximum of three units a day for women and four units a day for men – are more likely to suffer from risk factors associated with heart disease such as high blood pressure. Binge drinking can also cause abnormal heart rhythms and regular heavy drinking may lead to an enlargement of the heart.
While some research has suggested red wine is the most beneficial alcoholic tipple for heart health, this is still not conclusive. Indeed, it’s now thought that small amounts of any alcohol are associated with a lower risk of heart disease.
However, it’s worth bearing in mind that most experts agree that eating a healthy diet, stopping smoking and being more active are likely to have a far greater benefit to heart health than drinking small amounts of alcohol.
Meanwhile, it’s worth remembering that alcohol contains calories but little else in the way of nutrients. Therefore, drinking large amounts won’t help your waistline!
It's easy to follow a heart healthy diet with WLR. You can keep an online food diary to monitor your fat, fibre, fruit & veg and calories. Try it free for 24 hours.
The British Heart Foundation has comprehensive info and advice, see All Your Heart Health Questions Answered.
The US FDA have a colourful PDF showing the elements of a healthy heart diet.
www.florahearts.co.uk Flora pro.activ is hosting roadshows across the UK, offering free heart health checks.
H.E.A.R.T. - The Cholesterol Charity HEART UK supports all those at risk of inherited high cholesterol and cardiovascular disease.
Enter your details to calculate your ideal weight range, and discover how soon you could reach it!