Of all the advancements made in our understanding of heart disease and how to prevent it, perhaps the greatest is the clear, consistent
link between healthful eating habits, coupled with regular exercise, and the prevention of heart problems. By following some fairly simple guidelines about how to eat healthfully, you can substantially improve your overall heart health and reduce your risk of developing high blood pressure, high blood cholesterol, and overweight or obesity, three of the major contributors to cardiovascular disease. The bene?ts don’t stop there; very similar dietary habits also help you prevent breast, prostate, and other cancers; control type 2 diabetes; avoid osteoporosis (bone loss); and perhaps lengthen your life. For an excellent diet plan to improve your health, see the information on the DASH diet. As you start eating more healthfully, you will probably get the most satisfaction from the immediate benefits: you’ll have more energy and you’ll shed excess pounds. Today, eating better is also easier and more enjoyable because a delicious variety of fresh, good-for-you foods are more widely available for more seasons of the year than ever before.
Of course, there is also no shortage of diet advice, nutritional claims for speci?c food products, and con?icting headlines about the value—or the hazards—of certain foods. Don’t let fads or eye-catching news stories distract you from a commonsense approach to your diet.
You’ll do better if you don’t think about dieting, but about developing new ways of eating for the long term.
If you are trying to accomplish a speci?c goal, like lowering your blood pressure or your cholesterol levels, your doctor may work with you to develop an eating plan designed to help you achieve your target. But for those of you working on an overall heart-healthy eating pattern, the American Heart Association has developed a set of general guide- lines to help you change your current habits for the better and maintain a healthy pattern throughout your life; see the box above.
Fruits and Vegetables
The good news just keeps pouring in about the healthy bene?ts of fruits and vegetables in your diet, especially for your heart. Fruits and
vegetables are the best source of vitamins, minerals, and ?ber. They have few calories and no cholesterol, and are low in fat and sodium. You can ?ll up on them at meals and snack on them in between. Generally, the most colorful fruits and vegetables are the most loaded with vitamins, including antioxidant vitamins.
Antioxidant vitamins are so called because they may slow down the process of oxidation in your arteries—a chemical process that enables cells in your artery walls to more easily absorb fatty acids and LDL cholesterol. As a result, antioxidant vitamins may reduce the accumulation of plaque in the arteries that can lead to atherosclerosis and stroke. The major antioxidant vitamins are vitamin E (found in vegetable oils, wheat germ, and nuts), vitamin C (found in green and red peppers, broccoli, spinach, tomatoes, pota- toes, and citrus fruits), and carotenoids (found in yel- low, dark green, and red vegetables and fruits). It is important to know that taking vitamin supplements does not have the bene?cial effects of a balanced diet.
Any fruits and vegetables you choose are a healthy addition to your diet. Some major research shows that fruits and green, leafy vegetables (spinach, kale, collards) are especially associated with a reduced risk of developing heart disease.
Eating Plan for Healthy Americans
The American Heart Association has designed these guidelines to help you reduce your risk of cardiovascular disease. Following this plan will improve your overall condition if you already show signs of heart and blood vessel problems, or even if you are currently enjoying good health. These are general guidelines; see also the DASH diet, pages 47–50.
• Eat a variety of fruits and vegetables (nine or more servings per day).
• Eat a variety of grain products, including whole grains (six or more servings per day).
• Include fat-free and low-fat milk products, fish, legumes (dried peas or beans), skinless poultry, and lean meats.
• Choose fats and oils with 2 grams or less of saturated fat per tablespoon and no trans fats, such as liquid and tub margarines, olive oil, and canola oil.
• Balance the number of calories you eat with the number you use each day. To arrive at that number, multiply the number of pounds you weigh now by 15 calories. This represents the number of calories you burn in one day if you are moderately active. If you exercise very little, multiply your weight by 13 instead of 15.
• Exercise to stay fit and to burn the number of calories you eat. Walk or exercise actively in some other way at least 30 minutes on most days of the week; one hour a day or more is considered optimal.
• Limit your intake of snacks, soft drinks, or candy that are high in calories.
• Eliminate foods high in saturated fat or trans fat, such as full-fat milk products, fatty meats, tropical oils, and partially hydrogenated vegetable oils. Instead, sub- stitute more foods from the first four categories listed in the first column of this box.
• Trim your salt consumption.
• Drink alcohol in moderation, if at all. That’s one drink a day if you are a woman or two drinks a day if you are a man. One drink is
12 ounces of beer, 4 ounces of wine, 11?2
ounces of 80-proof spirits, or 1 ounce of
100-proof spirits.
Daily Servings of Fruits and Vegetables
Eat at least eight servings a day of fruits and vegetables—more is even better. Choose from all fruits and vegetables except coconut, which contains harm- ful tropical oils. Consider olives and avocados as fats (see page 90). Starchy vegetables such as potatoes are included in the category of grains and grain products (see page 86).
Examples of serving sizes:
• One medium piece of fruit
• 1?2 cup chopped, cooked, or canned fruit
• 3?4 cup (6 ounces) fruit juice
• 1?4 cup dried fruit
• 1?2 cup cooked or raw vegetables
• 1 cup raw leafy greens
• 3?4 cup (6 ounces) vegetable juice
Grains and Grain Products
Grains, grain products such as breads, and starchy vegetables are rich in complex carbohydrates, which provide you with energy. They also con- tain vitamins, minerals, and fiber. Contrary to what many people believe, they are also usually relatively low in fat and calories. If you are eating less fat and sugars (also a type of carbohydrate), you can health- fully ?ll up on grains. There are two important points to remember: choose whole grain products, and watch out for added fat, calories, and sodium in the preparation or processing of these foods.
Whole grains are healthier than re?ned grains because they retain the germ (the nutrient-rich core of the grain) and the bran (the outer layer of the grain, containing nutrients and most of the ?ber). If you are unsure about whether a product is whole grain, check the label for the term “whole wheat” or “whole grain” as the ?rst item in the ingredients list. Choose whole grain breads, English muf?ns, bagels, and bread- sticks; whole grain pastas; and brown rice. Limit white rice, white bread, and egg noodles.
It’s easy to consume hidden or not-so-hidden calories in the way you prepare foods or the way they are processed. Of course, limit high-fat and sweetened products such as croissants, sweetened cereal, crackers, and potato chips. (Unsalted pretzels and plain popcorn are better snack substitutes.) When you are cooking at home, cut back on butter and cheese and use seasonings liberally to boost flavor. Check sodium levels carefully if you use boxed grain mixes.
The ?ber in foods comes in two forms: soluble (meaning that the ?ber is partially broken down in your intestine) or insoluble (the ?ber passes through your system without being broken down). Both types of ?ber are part of a healthy diet. Soluble ?ber is found in oat bran, oatmeal, beans, peas, citrus fruits, and apple pulp; it helps lower cholesterol. Insoluble ?ber, found in whole wheat breads and cereals, cabbage, beets, carrots, cauli?ower, and apple skin, encourages good bowel function but does not lower cholesterol.
Fat-free and Low-fat Milk Products
Dairy products provide you with protein, cal- cium, and nutrients including phosphorus, niacin, ribo?avin, and vitamins A and D. Right now, the impact of calcium on the risk of heart disease is not entirely clear, but people who do not consume much calcium tend to have higher blood pressure, so dietitians recom- mend getting plenty of calcium from foods (1,000 milligrams per day for adults below the age of 50; 1,200 milligrams per day over 50). Fat-free or low-fat (1?2 percent or 1 percent) dairy products contain slightly more nutrients than whole or 2 percent milk but are much lower in fat, saturated fat, cholesterol, sodium, and calories. If you have dif?culty giving up whole milk (31?2 or 4 percent fat), try decreasing gradually to get accus-
tomed to the difference.
For those who eat cheese, choose natural or processed cheeses with no more than 3 grams of fat per ounce and no more than 2 grams of sat- urated fats per ounce. Part-skim cheeses such as mozzarella are popular with those watching calories and fat content. If you like ice cream as a dessert, choose instead sherbet or sorbet, low-fat yogurt, low-fat ice cream, or low-fat pudding.
Meat, Poultry, and Fish
Eating relatively small portions of meat, poultry, or ?sh will still provide you with adequate amounts of protein, B vitamins, and iron. The trick is to limit your portion sizes and think of meats as a side dish or garnish rather than as the centerpiece of your meal. Try mixing small amounts of meats with pasta, rice, or vegetables for a ?lling entr?e.
When you shop for meats, look for cuts with little or no visible fat. Choose “choice” or “select” rather than “prime” cuts of beef. Lean veal, lamb (leg or loin), and pork (tenderloin or loin chop) are good choices. Lean ham is a good choice, although cured ham and Canadian bacon are higher in sodium than other meats. Most ground meats today are clearly labeled with the percentage of fat; look for lean or extra lean, with no more than 15 percent fat. Organ meats such as liver are high in cholesterol but are iron- rich. You can enjoy small portions of these meats once or twice a month. When you prepare meat, make sure that you trim off visible fat before cooking, and cook without adding fat: broil, roast, grill, or stir-fry with a little olive oil.
Poultry meats (chicken, turkey, Cornish hens) are low in fat if you take off the skin before you cook them. Ground turkey is low in fat; check the label for the per- centage of fat in ground chicken. Low-fat processed sandwich meats (low-fat chicken or turkey, turkey ham, lean boiled ham) are available now, but check sodium levels on the label.
Fish, particularly oily ?sh, is an excellent source of protein but does not contain the saturated fats found in other meats. The recommended two servings a week are a minimum—eating ?sh and shell?sh more frequently helps you lower your dietary fat and cholesterol. Choosing ?sh and seafood may be confusing at ?rst because of some precautions about the health bene?ts of certain types. Here are a few key points:
• Oily or fatty ?sh are particularly good for you because they have high levels of omega-3 fatty acids (see box on page 89). Oily ?sh include mackerel, lake trout, herring, sardines, albacore tuna, and salmon.
• Sword?sh, king mackerel, shark, and tile?sh may contain undesir- able levels of mercury, while farm-raised ?sh contain environ- mental contaminants. Exposure to mercury is a concern especially for children and for pregnant and nursing women. For the general population, however, the bene?ts of eating ?sh far outweigh the hazards. Eating a variety of ?sh reduces your risk of adverse effects caused by levels of mercury or other contaminants.
• Although some shell?sh (such as shrimp and cray?sh) are higher in cholesterol than most ?sh, they are lower in saturated fat and total fat than meats and poultry, so they are still a heart-healthy choice.
Daily Servings of Meat, Poultry, and Fish
Eat no more than two servings (6 ounces total) of cooked lean meat, poultry, or fish per day. Choose fish two or more times a week.
Examples of serving sizes (3 ounces):
• A piece of beef the size of a deck of cards
• A hamburger 3 inches across and 1?2 inch thick
• Half a chicken breast
• A chicken leg and thigh without skin
• 3?4 cup flaked fish