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5. HEART HEALTH DIET


The goals of a heart-healthy diet are to eats foods that help obtain or maintain healthy cholesterol and lipid levels -- to reduce overall levels and low-density lipoproteins (LDL) and to increase high-density lipoproteins (HDL). Reducing other lipids, such as triglycerides and lp(a) lipoproteins are also important. Any diet should also help keep blood pressure under control.


Recommended Foods:

Fat, Oils, and Dairy Products

 

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Decrease or Eliminate

Notes

Fats and Oils:

Monounsaturated fats: canola, olive oils. Polyunsaturated fats: sunflower, soybean, corn, safflower, sesame oils.

Saturated fats: butter, cream, lard, bacon fat, shortening, animal fat drippings, stick margarine, and dressings and mayonnaise made with egg yolks and cream.

Commercial products: trans-fatty-acid-free margarine, low-fat or fat-free salad dressing and mayonnaise, low- or no-fat sour cream, non-dairy creamers.

Milk and Milk Products:

Milk or yogurt products labeled skim, fat-free, no-fat, nonfat, zero-fat, low-fat or 1% fat milk. (2% fat milk products are not low fat; they have 25% less fat than whole milk and are considered reduced- or less-fat.)

Whole dried, condensed, and evaporated milk, chocolate milk, goat's milk, soy milk, cream, half-and-half, real or non-dairy whipped topping, custard style or whole milk yogurt, ice cream.

 

Cheese:

Low-, or non-fat, hard cheese (3 to 5 grams of fat or less, and reduced sodium), low-fat cottage, pot, or farmer's cheese (1% or 2% milk fat), part-skim ricotta or mozzarella, light cream cheese, parmesan, or romano (2 Tbsp. limit).

All whole milk cheeses (e.g., brie, blue, Swiss, American, feta, mozzarella, cheddar, muenster, gouda, edam, havarti, camembert, Jarlsberg, roquefort, provolone), Welsh rarebit, processed cheeses (e.g., cheese food and spreads) fondue, creamed cottage cheese.

Except for low-fat cottage-type cheeses, most natural and processed hard cheeses -- even many made from part-skim milk -- are higher in saturated fats than lean meats.

Eggs:

   

Eggs are a good source of protein, are rich in very beneficial nutrients, and low in saturated fat.


Complex Carbohydrates

 

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Decrease or Eliminate

Breads:

Any whole-grain sandwich bread, muffins, rolls, pita, tortillas (not fried) or crackers (low-fat and unsalted), especially rye or oat. Fiber content: 1 slice whole-wheat bread = 0.4 g soluble, 2.1 g insoluble fiber.

White flour products, including bread, egg bagels and breads, croissants, sweet or buttered rolls, popovers, refrigerated dough, commercially prepared stuffing, muffins, doughnuts, sweet breads (e.g., zucchini, banana, pumpkin), crackers with butter or cheese, cinnamon or chocolate graham crackers, taco shells, crackers made with coconut or palm oil or with more than 5 gm of fat per serving.

Cereals and Whole Grains:

Whole-grain side dishes, cereal, and flour products (e.g., grits, oats, barley, cornmeal, millet, cous cous, bulgar wheat, buckwheat groats, quinoa, flaxseed, meal), commercial dried cereals that are vitamin fortified, low-fat, low-sugar, low-sodium, and high in fiber; Fiber content: 1/3 cup uncooked oatmeal = 1.3 g soluble, 2.8 g insoluble fiber. 1 ounce corn flakes = 0.1 g soluble, 0.3 g insoluble fiber.

Granola or any cereals with palm or coconut oils; instant cereals with more than 240 mg of sodium per serving.

Pasta:

All types, preferably whole-grain and prepared with low-fat sauces; noodles made without egg yolks.

Egg noodles; pasta prepared with butter, cream, high-fat cheese sauce or dried, commercial pasta sauce.

Rice and Dried Beans:

All types rice (preferably converted or brown), dried beans and peas, canned and cooked beans, tofu, refried beans, textured vegetable protein (TVP), hummus. Fiber content: 1/2 cup cooked kidney or pinto beans = 2 g soluble, 6.7 g insoluble fiber.

Rice or beans with commercial, packaged sauces, baked pork and beans, canned chili con carne.


Fruits and Vegetables

 

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Decrease or Eliminate

Notes

Vegetables:

Vegetables (three or more daily servings): One serving = 1/2 cup cooked or 1 cup raw.
Note: some examples of fiber content are given below for one serving.
All fresh, frozen, canned (low sodium) vegetables, particularly dark green, yellow, or cruciferous vegetables (e.g., broccoli, cabbage, cauliflower, Brussels sprouts); rinsed, canned vegetables, salsa, low sodium vegetable juice, tomato paste, canned, low-sodium homemade soups, sun-dried tomatoes without added sodium, boiled and baked potatoes. Fiber examples: 1/2 cup cooked spinach = 0.5g soluble, 2.1 g insoluble fiber.

Deep fat-fried vegetables; canned vegetable juices and soups with sodium; commercially prepared soups made with cream or chunky meats; pickled vegetables, including sauerkraut and dill pickles; fried or instant mashed potatoes; vegetables cooked with cream and butter.

Some veggie-burgers and veggie hot dogs are excellent and have no or are low in fat. Others, however, are quite high in fat, usually from soy or other vegetable oils, although it is rarely saturated fat. Labels should be read carefully. Unlike veggie burgers, veggie hot dogs provide almost no fiber.
Cooking note: Season vegetables with herbs, spices, lemon juice, or vinegar instead of cream sauces, salt, or butter. Low-fat yogurt blended with 3 to 4 tsp. cornstarch can substitute for heavy or sour cream.

Fruits:

All fresh and frozen fruits and juices with very low or no added sugar, canned fruit in water or its own juice, dried fruit, rhubarb, avocado (1/8 of a fruit). Fiber example: 1 medium-sized apple = 1.2 g soluble, 3.6 g insoluble fiber.

Coconut, fruits canned in syrup, maraschino cherries, dried fruits with sodium preservatives.

Grapefruit is a good source of fiber and two servings a day may even reduce cholesterol. It can interact with many medications, however, including increasing concentration of some cholesterol-lowering drugs and other drugs used for heart disease.


Protein

 

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Decrease or Eliminate

Notes

Fish:

Fresh or frozen fish, canned fish in water with reduced sodium, clams, scallops, lobster.

Fried, smoked, or salted fish, oil-packed canned fish, canned sardines, squid, caviar, roe, imitation seafood (surimi), anchovies, oysters, crab.

Note on shellfish: Clams, oysters, mussels, and scallops are very high in fat and dietary cholesterol. Shrimp, lobster, and crab are low in fat, but high in cholesterol. In one study, shrimp did not raise cholesterol levels, although it did increase both LDL and HDL levels. Some studies indicate that shellfish are as protective as other fish for the heart.
Note on cooking: Cooking fish on the stove appears to breakdown beneficial omega-3 fatty acids; microwaving does not.

Poultry:

Chicken, turkey, rock Cornish hen, pheasant. Select breast meat over dark meat. Remove skin and trim fat. Baste with juice or wine instead of fat, drippings, or butter. Reduced-fat and sodium turkey and chicken cold cuts and frankfurters.

Goose, duck, squab, capon, giblets, organ meat, canned chicken.

A burger made from ground, skinless, turkey breast meat has less than 1 gram of fat and virtually no saturated fat. However, some packaged ground chicken or turkey may contain more fat than ground beef. Check labels or have the butcher grind the meat.

Meat
(Except Poultry):

Lean and Extra Lean Beef: eye of round, top round Pork: Lean and Extra Lean tenderloin, sirloin, top loin.Veal: shoulder, ground veal, cutlets, sirloin
Lamb: leg shank.

Decrease: all good and choice cuts of beef, pork, ground beef (85% to 90% fat free), veal, lamb, venison, and rabbit products (no more than 1 to 2 times/ wk).
Eliminate: prime cuts, ground beef (less than 80% fat-free), fried meats, organ meat (organ meats are very high in cholesterol; brains have 2000 mg of chol. per 3.5 oz.), all processed meat, including beef cold cuts, most frankfurters, luncheon meats, sausages, canned meats, and corned beef.

When cooking ground meat for sauces and stews, rinse the meat with warm or hot water after browning. This removes fat, but does not affect the taste.
Lean = less than 10 grams of fat and 4 grams of saturated fat per 3-oz serving. Extra lean = less than 5 grams of fat and 2 grams of saturated fat per 3-oz serving. Extra lean pork, for example, has a fat content equivalent to that of chicken.
Reduced-fat beef hot dogs are now available, some with no measurable fat. Check labels carefully, however. Some are actually still quite high in fat.


Miscellaneous

 

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Decrease or Eliminate

Notes

Beverages (Other Than Fruit Juice):

Soda water, club soda, flavored seltzers, sugar-free instant cocoa, mineral water, tea, or filtered coffee.

Eggnog, flavored or unfiltered coffee, baking cocoa.

Diet sodas often contain high levels of sodium or other harmful substances and should be avoided.

Seasonings and Sauces:

Herbs, peppers, garlic, vinegar, salt substitutes made from natural ingredients (unless on a potassium-restricted diet), mustard, chili powder and chilies, reduced-sodium and fat barbecue sauce, cocktail sauce, Tabasco sauce, salsa, tomato paste or puree, and ketchup (limit 2 Tbsp.).

Seasonings containing salt and MSG, including garlic and onion salts, soy sauce (reduced sodium and regular), Worcestershire sauce, canned cranberry sauce, curry sauce, dill sauce, gravy, hollandaise sauce, honey butter, creamy horseradish sauce, white and cream sauces, tartar sauce, peanut butter, guacamole, bacon bits, sweet pickle relish.

 

Snacks:

Air-popped popcorn without salt or fat, unsalted pretzels, baked tortilla chips.

All products that list "hydrogenated" or "partially hydrogenated" oils on their labels. All fried chips, oil-popped or buttered popcorn, packaged chip dips, olives, salted nuts and seeds.

Note on nuts and seeds: Unsalted nuts and seeds may actually be beneficial for cholesterol levels. Nuts are very high in calories, however. Nuts low in saturated fats are chestnuts (the lowest), walnuts, peanuts, filberts, almonds, pecans, sunflower seeds, and pistachios.

 

Sweets:

Jellies, jams, marmalade, syrup, molasses, honey, hard candies, angel food cake, frozen fruit bars, low-fat frozen desserts (e.g. yogurt), low- or non-fat muffins, cookies, and cakes (2 gm fat per serving or less).

Ice cream, commercially prepared cookies, mixes, pies, fruit crisps and cobblers; all deserts containing cheese, coconut, cream, or tropical oils; frappes, milkshakes, floats, eggnog, caramels, candy bars and chocolate candy.

Sugar itself does not raise cholesterol, but sweets should be limited because they can lead to weight gain, another heart disease risk.

Eating Out:

Asian and Indian restaurants usually have food available that is broiled or stir-fried and low in saturated fat. Be sure to ask. Many Asian restaurants will also prepare food without monosodium glutamate upon request. In Italian restaurants, choose pastas with marinara sauce or those made from fresh vegetables.

Avoid fast food burgers, tacos, and fried sandwiches (many fast food restaurants now offer salads and grilled chicken sandwiches); in all restaurants avoid egg dishes and menu items with the words buttery, deep-fried, breaded, with cream sauce, hollandaise, with gravy, au gratin, scalloped, bearnaise, or cheese sauce in them. Avoid frozen dinners of all kinds.

 


What Other Lifestyle Changes Should Accompany a Heart-Healthy Diet?

Obesity and Weight Gain
Obesity is associated with elevated total cholesterol and triglyceride levels and lower HDL levels. Even gradual increases in body fat may produce unhealthy cholesterol levels. One study found that an average increase of one pound of fat a year, as people aged, caused total cholesterol to rise and HDL levels to drop. The goals for a cholesterol-lowering diet then must also include attaining or maintaining a healthy weight.

Exercise
A recent study reported that dietary changes improve cholesterol levels only when an aerobic exercise program is also included. In addition to having a beneficial effect on cholesterol, exercise is critical to maintaining a healthy heart; it helps keep weight off and lowers the heart rate and blood pressure. People who maintain an active lifestyle have a 45% lower risk of developing coronary heart disease than do sedentary people.

Regular aerobic exercises -- brisk walking, jogging, swimming, biking, aerobic dance, and racquet sports -- are the best forms of exercise for lowering LDL and raising HDL levels. It may take up to a year of sustained exercise for HDL levels to show significant improvement. Experts recommend that people aim for a routine of 30-minute brisk walks most days of the week; an excellent goal is 20 to 25 miles a week, but in terms of raising HDL levels, more is better.

Resistance (weight) training offers a complementary benefit by reducing LDL levels. After a high-fat meal, triglycerides can be lowered either with a single, prolonged (about 90 minutes) aerobic session or by several shorter sessions during the day. One study indicated, however, that short-bursts of exercise actually increases LDL oxidation -- the process that makes LDL dangerous to the heart, so individuals should always aim for a consistent, regular program.

Before engaging in any strenuous exercise, it is advisable to consult a physician. Children should especially be encouraged to exercise every day.

 

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