Coronary heart 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.
The Cholesterol
Connection
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.
Cholesterol Levels
|
High |
240 or more |
|
Borderline-high |
200-239 |
|
Desirable |
Below 200 |
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 of 195.
If your cholesterol level is high, here are
some ways to lower it.
- 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 fiber.
- Maintain your ideal weight.
HDL (Good) Cholesterol and LDL (Bad)
Cholesterol
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.
HDL Cholesterol
- 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.
HDL Levels
|
Low |
Below 35 |
|
Intermediate |
35-39 |
|
High |
60 or more |
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
- modest alcohol intake
- low fat consumption
- low saturated fat consumption
- low consumption of trans fatty acids
LDL Cholesterol
- 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.
LDL Levels
|
High |
160 or above |
|
Borderline |
Below 130 |
|
Desirable |
Below 130 |
|
Desirable for people with heart disease |
Below 100 |
If you need to lower your LDL, try taking these
steps.
- 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 down.
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.
Triglycerides
Triglycerdides 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.
Triglyceride Levels
|
Very High |
1000 |
|
High |
400-1000 |
|
Borderline |
200-399 |
|
Normal |
Below 200 |
High triglycerides 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 level.
- Reduce total fat and saturated fat intake.
- Eat less sugar.
- Avoid alcohol.
- Eat more fish high in Omega-3 fatty acids.
Lp (a)
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.
Fifteen Ways to Lower Your
Cholesterol Through Diet
1.Cut your total fat intake.
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.
Exactly how 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:
- Dr. Dean Ornish, 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.
- 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
than Americans.
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 level.
2. Eat less cholesterol-rich food.
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.
- 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 cholesterol.
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.
3. Avoid saturated fats.
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.
- 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.
4. Avoid tropical oils.
The tropical 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.
- non-dairy coffee creamers
- whipped toppings
- baked goods
- cookies
- chocolate candy
5. Reduce your intake of transfatty acids.
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).
6. Increase your use of monounsaturated fats
within your total allotment for fat.
Monounsaturated fats lower blood cholesterol
and will reduce your risk of heart disease.
- Monounsaturated 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.
7. Use polyunsaturated fats.
Polyunsaturated 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).
- Try to use less hydrogenated margarine;
liquid and tub margarine are better than stick margarine.
- 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."
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.
8. Get your Omega-3 fatty acids.
Omega-3 fatty 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 a week.
- salmon
- bluefish
- mackerel
- tuna
- herring
- sardines
The benefits of eating these food sources of
Omega-3 include the following.
- significant reductions in high triglyceride
levels
- slower blood clotting
- prevention of abnormal heart rhythms
- enhanced immune function
- improved eye and brain development
If you do not eat fish, be sure to include
other foods rich in linolenic acid, such as these.
- walnuts
- walnut oil
- flaxseed oil
A note of caution: Do not use fish oil capsules
without medical supervision; their concentrated levels may interfere
with other medications.
9. What about shellfish?
- Shrimp, although 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.
10. Increase the soluble fiber in your diet.
Remember the 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 cholesterol.
The soluble 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.
Soluble fiber is found primarily in these
foods.
- oats
- legumes
- apples
- pears
- plums
- carrots
- okra
- barley
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 the following.
- Total cereal
- Product 19
- lentils
- asparagus
- spinach
- kidney beans
- orange juice
12. Try more soy protein.
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 soy protein.
- tofu
- tempeh
- veggie burgers made with textured vegetable
soy protein
- soy milk
Experts recommend 25-50 grams of soy protein
daily, or 60 milligrams of isoflavones, to reduce cholesterol.
13. Get more anti-oxidants.
Anti-oxidants 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.
- Beta-carotene is recommended at 15
micrograms a day.
14. Go beyond vitamins -- and get your
phytochemicals.
Phytochemicals are plant chemicals that may
help prevent not only CHD, but also other chronic diseases and
conditions such as diabetes, cancer and hypertension.
- 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.
15. Shape up!
- 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.
Facts About Fats
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.
Dietary Fats
| |
Percentage of Saturated Fat % |
Percentage of Mono-
unsaturated Fat |
Percentage of Poly-
unsaturated Fat |
|
Canola oil |
6 |
62 |
31 |
|
Safflower oil |
10 |
13 |
77 |
|
Sunflower Oil |
11 |
20 |
69 |
|
Corn Oil |
13 |
25 |
62 |
|
Olive oil |
14 |
77 |
9 |
|
Sesame oil |
14 |
40 |
42 |
|
Soybean oil |
15 |
24 |
61 |
|
Peanut oil |
10 |
49 |
33 |
|
Margarine, soft |
19 |
49 |
30 |
|
Chicken fat |
31 |
47 |
21 |
|
Lard |
41 |
47 |
12 |
|
Palm oil |
50 |
40 |
10 |
|
Beef fat |
52 |
44 |
3 |
|
Butter |
66 |
30 |
2 |
|
Margarine, stick form |
80 |
14 |
16 |
|
Palm kernel oil |
86 |
12 |
2 |
|
Coconut oil |
92 |
6 |
2 |
How to Reduce the Saturated
Fat in Your Diet
Try these suggestions for replacing saturated
fat in your diet with improved fat choices.
|
Food High in Saturated Fat
|
Lower Saturated Fat Alternative
|
|
Cream Cheese
|
Light cream cheese in a tub
|
|
Butter
|
Whipped margarine
|
|
Spray margarine
|
Butter Buds or Molly McButter
|
|
Egg
|
2 egg whites or egg substitutes
|
|
Chocolate
|
Cocoa with margarine
|
|
Ground Beef
|
Lean ground turkey, soy protein crumbles
|
|
Mayonaise
|
Light mayonaise
|
|
Shortening (1 cup)
|
Margarine (1 cup) or canola oil (3/4 cup)
|
|
Sour cream
|
Non-fat yogurt or non-fat sour cream
|
|
Cooking oil
|
non-stick pan, Pam cooking spray
|
|
Powdered coffee creamer
|
Non-fat dried skim milk
|