Nutrition Strategies to Reduce Your Risk of Cardiovascular Disease

Reduce Your Risk Factors

Following these nutritional strategies can help you reduce or even eliminate some risk factors, such as reducing total and LDL-cholesterol; lowering blood pressure, blood sugars and triglycerides; and reducing body weight. While most dietary plans tell you what you can’t eat (usually your favorite foods!), the most powerful nutrition strategies help you focus on what you can and should eat. In fact, research has shown that adding certain foods to your diet is just as important as cutting back on others. Here are seven up-to-date nutritional strategies aimed at reducing your risk factors and enhancing your health:

1. Choose Fat Calories Wisely

Research has revealed that the total amount of fat you eat really isn’t linked to heart disease; it’s the type of fat you consume that has the greatest influence. Two unhealthy fats, including saturated and trans fats, raise blood cholesterol and increase the risk for cardiovascular disease. However, two very different types of fat — monounsaturated and polyunsaturated fats — do just the opposite. Refer to the table below to help reduce the fat in your diet.

Trans Fatty Acids

Trans fatty acids raise the "bad" cholesterol (LDL), and lower the "good" cholesterol, high-density lipoprotein (HDL). Trans fatty acids are formed when a liquid fat is converted to solid fat through a process called hydrogenation. Many manufacturers use hydrogenated fats in their ingredients because it creates a product with an extended shelf life and improved consistency.

There are currently no safe levels of trans fat to consume each day, so try to keep your daily intake as low as possible.

Although trans fatty acids have been largely eliminated from many processed foods, they are still in some foods. Here are some ways to identify trans fats.

• Any food that contains partially hydrogenated oils (such as most processed foods including cookies, crackers, fried snacks, baked goods) will contain some level of trans fat, even if the label states "trans fat-free." (See box above.) Since the ingredients listed on a food label are provided in order of weight, foods that contain partially hydrogenated oils at the top of the ingredients list contain more trans fat than those that contain partially hydrogenated oils lower on the list. Therefore, watch your portion size.
• Margarine: Stick margarine contains more hydrogenated oil (trans fat) than tub margarine does, while tub margarine contains more hydrogenated oil than liquid margarine. Look for margarine that does not contain "partially hydrogenated oil" in the ingredient list. A sample ingredient list is included below.

* For a food to be labeled "trans fat-free," it must contain no more than 0.5 grams trans fat per serving. Margarines that claim to be trans fat-free should contain water or liquid vegetable oil as the first ingredient. These margarines may still contain some hydrogenated oil, but the amount per serving is negligible. However, portion control is key – once you exceed the serving size, the product is no longer free of trans fat.

• Shortening is an example of trans fat in its purest form. Some shortenings now claim to be free of trans fat; however, this may only apply to a food’s serving size (remember, it can still have ½ gram or less of trans fat per serving.) Unfortunately, the fat now used to substitute the trans fat in shortening is high in saturated fat, so it’s still not a healthy choice.
• Almost all fast foods and fried foods are currently high in trans fat. Some restaurant chains, such as Ruby Tuesday’s, now use a non-hydrogenated or trans fat-free oil to fry their foods. But remember that a heart-friendly diet contains very little fried food.

Look for foods that are labeled trans fat-free or those that use liquid vegetable oils instead of hydrogenated oils in the ingredient list.

Unsaturated Fats

Unsaturated fats are considered the healthiest fats because they improve cholesterol, are associated with lower inflammation (a risk factor for heart disease), and are associated with overall lower risk of developing heart disease. Unsaturated fats are found primarily in plant-based foods, and are generally liquid at room temperature. There are two types of unsaturated fat: monounsaturated and polyunsaturated.

Monounsaturated Fats

Considered one of the healthiest fat sources in the diet, monounsaturated fats should make up the bulk of your daily fat intake. Monounsaturated fats are found in high concentrations in these foods:

• Olive oil
• Canola (rapeseed) oil
• Peanut oils
• Most nuts (excluding walnuts), nut oils, and nut butters (such as peanut butter)
• Olives
• Avocados

Polyunsaturated Fats

Polyunsaturated fats are found primarily in:

• Corn oil
• Soybean oil
• Safflower oil
• Flax oil and flaxseeds
• Sunflower oil
• Walnuts
• Fish

Omega-3 is one type of polyunsaturated fat that has additional protective benefits against cardiovascular disease, including lowering triglycerides, protecting against irregular heartbeats, decreasing the risk of a heart attack, and lowering blood pressure.

Good food sources of omega-3 are fish – especially cold-water fish like mackerel, salmon, herring, and sardines. Smaller amounts of this protective fat can also be found in flaxseeds, chia seeds (often sold as salvia), walnuts, soybean, and canola oils.

To reap the protective benefits of omega-3 fat, incorporate fish into at least two meals per week and add plant-based sources of omega-3, such as ground flaxseeds and walnuts, into your daily eating plans.

Cholesterol Reduction and More

Recent research findings show that when unsaturated fats are substituted for some carbohydrate in the diet, these good fats reduced harmful LDL and increased healthy HDL cholesterol. In addition, replacing a carbohydrate-rich diet with one rich in unsaturated fat, primarily monounsaturated, lowered not only cholesterol but also blood pressure and overall heart disease risk.

Total Fat

According to the latest national cholesterol guidelines, your total daily fat intake should range from 20 to 35 percent of your total daily calories. How much fat you should eat depends upon your individual cardiovascular disease risk and lipid levels. Ask your physician or dietitian for more information.

Your total daily fat should come from these sources each day:

By choosing unsaturated fats instead of saturated fats whenever possible, you’ll be able to meet these guidelines.

2. Limit Dietary Cholesterol

Because cholesterol is made from the liver, it is only found in foods of animal origin (not in plant-based foods). For most people, the amount of cholesterol in the diet has a modest impact on their blood cholesterol levels. However, there are many people whose blood cholesterol levels fluctuate very strongly with the amount of cholesterol eaten. In addition, cholesterol in the diet greatly affects people who have diabetes.

It is important for everyone to make an effort to limit total dietary cholesterol. If you have high cholesterol, limit your daily dietary cholesterol to 200 milligrams; if you have normal cholesterol levels, limit to 300 milligrams daily.

Here are a few tips to cut cholesterol in the diet:

• Eat three or fewer egg yolks per week. Choose egg whites or egg substitutes instead.
• Remove skin from poultry before eating; trim fat from red meat before eating.
• Limit red meat and poultry portions to a 3-ounce portion (size of a deck of cards).
• Choose nonfat or low-fat cheeses. Limit total cheese intake to three meals weekly.
• Try soy-based cheese alternatives on sandwiches or in casseroles.
• Choose broth over cream-based soups.
• Limit high-fat dairy foods such as cream cheese, 4 percent cottage cheese, or whole milk yogurt; choose nonfat or low-fat varieties.

3. Get Your Daily Fiber Boost

As part of a healthy diet, fiber can reduce cholesterol. Dietary fiber is a type of carbohydrate that the body cannot digest. It’s found primarily in whole grains, fruits, vegetables, and beans. As fiber passes through the body, it affects the way the body digests foods and absorbs nutrients.

A diet rich in fiber has health benefits beyond cholesterol control: it helps control blood sugar, promote regularity, prevent gastrointestinal disease, and helps in weight management.

There are two types of dietary fiber: soluble and insoluble. Each has a unique effect on health.

• Soluble (viscous) fiber: Provides the greatest heart-health benefit because it helps to lower total and LDL-cholesterol. Good sources of soluble fiber include oats, oat bran, barley, legumes (such as dried beans, lentils, and split peas), psyllium, flaxseed, apples, pears, and citrus fruits.
• Insoluble fiber: Generally referred to as "roughage." Insoluble fiber promotes regularity, adds bulk and softness to stools, helps with weight regulation, and helps prevent many gastrointestinal disorders. Good sources of insoluble fiber include wheat bran, whole wheat and other whole grain cereals and breads, nuts, and vegetables.

Foods contain a mix of soluble and insoluble fiber. To receive the greatest health benefit, eat a wide variety of all high-fiber foods.

How to get more fiber in your diet

• Start the day off right with whole grain cereal or whole grain toast (if your cholesterol is high, choose oatmeal or oat bran cereal or toast).
• Instead of fruit juice, have a whole piece of fruit.
• For a fiber-packed lunch, toss ½ cup garbanzo beans into a leafy green salad.
• Choose whole grain buns, bagels, English muffins, crackers, and bread instead of enriched or white varieties.
• Purchase whole wheat pasta and brown rice instead of enriched varieties.
• Top yogurt or cottage cheese with fresh fruit or nuts.
• Give zest to broth soup by adding vegetables, dried beans, or barley.
• Use brown rice instead of white rice.
• Snack on fresh fruit, vegetables, or a homemade nut and dried fruit mix.

Best sources of dietary fiber

The best sources of dietary fiber are raw or cooked fruits and vegetables, whole grain products, and legumes (such as dried beans, lentils, or split peas). Refined foods such as white bread, pasta, and enriched cereals are low in dietary fiber. The refining process strips the outer coat (called the bran) from the grain, lowering the fiber content.

Fiber’s role in weight management

Substituting enriched, white pasta and rice and other refined foods with whole grain varieties is a great way to boost dietary fiber intake and help to prevent blood sugar fluctuations throughout the day. This, in turn, helps keep you feeling satisfied and can help prevent sudden cravings for sweets or other quick-sugar foods later in the day. The end result: weight control.

4. Increase Fruits, Vegetables, Legumes, and Nuts

Only three percent of Americans consume the recommended amount of fruits, vegetables, legumes, and grains recommended by health professionals. To maximize your intake of heart disease-fighting antioxidants, vitamins, minerals, protein, and dietary fiber, adopt the following three strategies.

1. Choose 7-A-Day: Aim for a combined 7 servings of fruits and vegetables (at minimum) each day. One serving of fruit includes:
   
   • 1 medium-sized piece of fresh fruit
   • ½ medium banana
   • ½ grapefruit
   • 2 Tbsp dried fruit
   • ½ cup canned fruit
   • ½ to ¾ cup most juices
   • One serving of vegetables includes:
   • ½ cup cooked vegetables
   • 1 cup raw or leafy vegetables
2. Aim for ½ cup of legumes at least 4 times weekly. Add beans to salads, have split pea soup, or toss lentils into a rice dish. Legumes are a powerhouse of protective nutrients - including potassium, fiber, protein, iron, and the B vitamins.
3. Enjoy 5 ounces of nuts each week. Researchers have linked regular intake of nuts to a lower incidence of heart disease. Moderate consumption (no more than 1 ounce) of nuts per day provides you with many protective nutrients like vitamin E, zinc, iron, protein, monounsaturated fats, and dietary fiber. Choose fresh or dry roasted, unsalted nuts and natural peanut butter for maximum heart protection. Avoid sugared, salted, or oil-roasted varieties. Purchase nuts in the bulk-food section of the grocery store or near the baking aisle.

More tips to increase fruits, vegetables, and legumes:

• Bag some raw vegetables or fruit and take to work for a quick snack. Buy pre-cut vegetables to save time.
• Toss nuts into salads, in stir-fries or trail mixes, or eat them plain.
• Spread peanut butter on crackers, celery, toast, or even stir into your morning oatmeal.
• Have a vegetable-based soup with your usual sandwich at lunch.
• Instead of a cookie, enjoy a fresh, crisp apple for dessert.
• Keep fresh fruit on your desk or workspace.
• Keep dried fruit, nuts, or canned fruit with you if you predict you’ll be missing a meal.

5. Substitute Plant Protein for Animal Protein

Increase plant sources of protein and start reducing your intake of animal protein. Research shows this can have positive overall impact on heart health. Substituting non-meat sources of protein for meat significantly reduces saturated fat and cholesterol and boosts heart disease-fighting fiber, vitamins, minerals, and antioxidants.

• Choose 2 to 3 vegetable protein meals weekly, such as split pea soup, garbanzo bean salad, soy or black bean burgers, tofu stir-fry, or textured vegetable protein.
• Limit red meat intake to no more than one meal weekly (this includes beef, pork, and veal).
• Choose 2 skinless poultry meals weekly.
• Aim for a minimum of 6 ounces of omega-3-rich fish (two meals) weekly.

6. Distribute Meals and Snacks

Skipping meals is not recommended. Small, frequent meals and snacks appear to promote weight loss and maintenance and give you an opportunity to consume important nutrients throughout the day. Skipping meals only lowers metabolism and deprives you of key nutrients. Researchers have found that people who balance their calories into four to six small meals each day have lower cholesterol levels.

Here’s how to distribute meals and snacks in a heart-friendly style:

• Divide calories into 4 to 6 smaller meals.
• Eat the bulk of the day’s calories during daylight hours for maximum energy.
• See sample menu below.

Sample Small, Frequent Meal Plan

• 7:00 am: 1 cup cooked oatmeal with 2 Tbsp raisins, 6 almonds, 8 ounces skim milk
• 9:30 am: ½ cup 1% fat, calcium-fortified cottage cheese mixed with ½ cup canned mandarin oranges (in extra light syrup), 8 ounces of water
• 12:15 pm: 2 cups salad (spinach, Romaine, celery, cherry tomatoes, cucumber, carrots, onion, garlic) topped with ½ cup garbanzo beans and mixture of 1 tsp olive oil, 2 Tbsp red wine vinegar; medium apple; 5 whole-wheat crackers and 16 ounces water
• 3:00 pm: 1 ½ cups raw vegetable mix (green peppers, cauliflower, cherry tomatoes, carrots) dipped in ¼ cup hummus, 8 ounces of water
• 6:00 pm: 4 ounces grilled salmon served with 1 cup brown rice, 1½ cups steamed broccoli, 1 small rye roll with 1 tsp trans fat-free margarine and 16 ounces water
• 8:00 pm: (optional) ½ cup nonfat chocolate pudding topped with ½ banana, 8 ounces water

Nutrient Analysis: 1,850 calories, 24% total fat (52 grams), 4% saturated fat (8 grams), 11% monounsaturated fat (19 grams), 5% polyunsaturated fat (10 grams), 95 milligrams cholesterol, 41 grams total fiber, 2,200 milligrams sodium.

7. Practice Portion Control

When you are trying to follow an eating plan that’s good for you, it may help to know how much of a certain kind of food is considered a "serving." The table below offers some examples.

© Copyright 1995-2009 The Cleveland Clinic Foundation. All rights reserved.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 7/3/2009...#8961