There are several practical and easy-to follow diet and lifestyle changes that women can adapt to help significantly reduce their risk of heart disease and heart attack and that can also improve overall health and well-being.
Starting a Heart Healthy Diet
Get to Know Your Fats
One very helpful strategy for improving heart health involves educating yourself about food sources, so that over time, you are able to quickly determine which foods contain healthy fats and which ones contain unhealthy fats. This way you can limit your intake of foods associated with weight gain, increased levels of bad cholesterol and increased risk of heart disease.
Despite its current reputation, fat is a nutrient and essential for normal function of the body. But it also is a nutrient that is abused in the American diet of processed food, super-sized fast food, frozen food, fried food, hot dogs and hamburgers, and all manner of snacks and desserts. Couple this diet with low levels of physical activity and you have a lifestyle tailor-made for the development of heart disease, diabetes and obesity.
Getting a handle on the different types of major fats may seem a bit challenging at first, but all of them can be divided into three general categories:
These are found primarily in animal products such as meat, milk, cheese, butter and cream. Saturated fats have a somewhat sinister — although somewhat undeserved — reputation in the American diet. Saturated fats are the reason that foods are tender, flaky or creamy, as well as solid at room temperature. Like all fats, saturated fats help make you feel satisfied and full. Problem is, many Americans have grown accustomed to ingesting much more saturated fat than is needed for normal, healthy function of the body, and this excess intake has contributed to major increases in the number of people who are overweight and who have diabetes, high blood pressure and heart disease.
Trans Fatty Acids
Trans fatty acids are created through hydrogenation, a process food manufacturers use to harden unsaturated liquid vegetable oils into saturated- like fats. This helps increase the shelf-life of a product and helps improve texture and consistency.
Oils may be hydrogenated or partially hydrogenated (e.g., shortening or margarine). The list of foods containing partially hydrogenated oils—and therefore trans fat—is slightly longer than the U.S. Constitution, but some of the main culprits include fast foods, particularly French fries, baked goods made with partially hydrogenated vegetable oil or vegetable shortening, doughnuts, most crackers, boxed cookies, stick margarine, certain granola bars, hard taco shells and frosting mixes.
Note: Peanut butter does contain hydrogenated oils, but it contains only very small amounts of trans fat. It also is a good source of protein and it contains mono- or polyunsaturated fats, the good fats (see below).
Unsaturated Fats (the “good” fat)
These consist of monounsaturated and polyunsaturated fats, the latter of which contain heart-friendly omega-3 fatty acids. When eaten in moderation, unsaturated fats are the “good” fats; when used in place of saturated fats, they can help lower cholesterol types known to contribute to heart disease and heart attack risk. Unsaturated fats, unfortunately, pack lots of calories, so they must be enjoyed in moderation. (See the tips below for examples of foods that contain unsaturated fats.)
Lipids: What you should know
Cholesterol and triglycerides are the two main types of fat molecules — or lipids — in the body. Without them, the body could not function. For instance, cholesterol is an essential component of cell membranes and is used by the body to produce vitamin D and hormones such as estrogen. It also is used to produce substances that aid digestion. Triglycerides are a major source of energy.
The body has two main sources of cholesterol and triglycerides: the liver and your diet. Cholesterol is found only in animal products (meat, milk, cheese, butter and cream). For some people, eating excesses of cholesterol-rich foods will raise blood cholesterol levels. In normal, healthy humans, the liver produces all the cholesterol the body needs, so you really don’t need supplemental cholesterol from your diet.
Triglyceride levels can be elevated for a number of reasons: excess sugar, alcohol, fat or calories or uncontrolled diabetes. In addition, some medical conditions and medications, or your genetic makeup, can cause elevated triglyceride levels.
Cholesterol and triglycerides travel throughout the body via the bloodstream, but only with the help of lipoproteins — LDL and HDL — which ferry these fat molecules to various destinations. LDL, or low-density lipoprotein, is known as the bad cholesterol because it sneaks through artery walls and unloads cholesterol there. This is how coronary artery disease, the most common type of atherosclerosis, begins and progresses. HDL, or high-density lipoprotein, clears cholesterol from the bloodstream and ferries it back to the liver for removal from the body. HDL can also help clear the cholesterol that LDL leaves embedded behind artery walls. That’s why it’s called the good cholesterol.
So, in general, optimal lipid levels are characterized by low levels of LDL and high levels of HDL.
The table below summarizes the recommended lipid targets.
|Total cholesterol (a measure of HDL, LDL and other lipoproteins)
||Less than 200 mg/dL
||Less than 150 mg/dL
|LDL (Low-density lipoprotein)
||Less than 130 mg/dL
Less than 100 mg/dL for those with heart or blood vessel disease and for those with diabetes or high total cholesterol
|HDL (High-density lipoprotein)
||Greater than 55 mg/dL (females)
Greater than 45 mg/dL (males)
Healthy Heart Tips
The list of tips below offers helpful guidance on fat intake and will help get you on the road to a heart- healthy diet and lifestyle.
1. Reduce your intake of saturated fat
Foods high in saturated fat can raise levels of low-density lipoprotein (LDL), the artery-clogging cholesterol. Saturated fat, in general, is solid at room temperature and is found in beef, pork, lamb, poultry skin, hot dogs, regular cheese, full-fat dairy foods (e.g., regular milk or yogurt), butter, lard, and tropical oils (e.g. palm, palm kernel and coconut). To cut back your intake of saturated fats, follow the table below:
The table below summarizes ways to cut back your intake of saturated fats.
||Trans-free tub or liquid margarine*
||Low-fat or nonfat cheese
|Creamer or half-and-half
||Nonfat creamer or nonfat half-and-half
|Whole or 2% milk
||1% or nonfat (skim) milk
||Low-fat or nonfat cream cheese
||Nonfat or low-fat frozen yogurt or sorbet
|2 to 4% milk fat cottage cheese
||1% or nonfat cottage cheese
||Light or nonfat mayonnaise
|Prime grades of beef
||Choice or select grades of beef
||Ground sirloin, ground round
|Chicken with skin
*All margarine contains some hydrogenated oil; in trans-free margarines, the main ingredient is water or liquid oil
2. Reduce your intake of hydrogenated and partially hydrogenated fats, which contain trans-fatty acids
Trans-fatty acids, or trans fats, are formed when a liquid fat is converted to solid fat through a process called hydrogenation. As do saturated fats, hydrogenated fats can increase levels of LDL, the bad cholesterol. They can also decrease levels of high-density lipoprotein (HDL), the good cholesterol. Finally, trans fat can make blood platelets “stickier,” which in turn can accelerate the progression of atherosclerosis and increase the risk for cardiovascular events (e.g., heart attack).
Trans fat is found in any hydrogenated or partially hydrogenated product, for instance most processed foods—cookies, crackers, fried snacks, and baked goods, and frozen breaded entrées chicken, fish); they also show up in most fast foods and fried foods.
Until 2006, food labels are not required to list trans fat levels per serving. (See sidebar on page 11: FDA Acts to Provide Better Information to Consumers on Trans Fat) So for now, the best way to gauge whether a product has high or low levels of trans fat is to read the ingredient label, which lists items according to their weight. In other words, if partially hydrogenated oil is among the first ingredients listed, this indicates a high level of trans fat in the product. If partially hydrogenated oil shows up near the end of the ingredients list, this indicates a lower level of trans fat in the product.
To cut back your intake of trans fat, follow the table below:
The table below summarizes ways to cut back your intake of trans fats.
||Trans-free tub or liquid margarine*
||Baked, grilled or broiled foods
|Crackers containing hydrogenated oils
||Baked crackers or crackers containing non-hydrogenated (e.g. liquid) oils
|Granola bars containing partially hydrogenated oils
||Granola bars containing canola oil or non-hydrogenated oils
|Chocolate or yogurt-covered pretzels
|Energy bars dipped in frosting or chocolate
||Plain, non-coated energy bars
|Powdered creamers containing hydrogenated oils
||Nonfat half-and-half, skim milk, powdered creamers containing non-hydrogenated oils
*The more “liquid-like” the margarine, the lower the levels of trans fat per serving
3. Increase your intake of monounsaturated fats
Monounsaturated fats are liquid at room temperature, solid at refrigeration temperatures. Monounsaturated fats can lower LDL cholesterol without lowering HDL cholesterol (this is a good thing). Despite what you may have heard or read, monounsaturated fats do not lower triglyceride- or raise HDL levels. Foods rich in monounsaturated fats include olive oil, olives, canola oil, avocados, most nuts and nut butters (e.g., peanut butter or almond butter).
4. Increase your intake of polyunsaturated fats, which include heart disease fighting omega-3 rich fats
Most of us don’t get enough intake of omega-3 fatty acids, which are essential to life and good health. Omega-3 rich foods offer a host of heart-health benefits, including reduction of triglycerides, increase in HDL cholesterol, reduced risk of sudden death, reduced platelet “stickiness” and reduced risk of arrhythmias. Omega-3 rich foods are found in fatty fish such as mackerel, sea bass, salmon and tuna; ground or milled flaxseeds, canola oil, soy foods (e.g., soy beans, tofu, edamame, roasted soy beans); and dark leafy greens.
Remember: Although unsaturated fats (mono- and polyunsaturated) are referred to as the “good” fats, you still have to monitor your intake of them. Excessive fat intake of any kind can result in weight gain.
5. Increase your intake of fruits and vegetables
Eating five or more servings per day of different fruits and vegetables provides an abundant variety of antioxidants, b-vitamins, dietary fiber and a host of additional plant chemicals known to help prevent disease. A simple effective daily strategy involves choosing a “rainbow” of colors from among fruits and vegetables that you enjoy. For instance, eat a variety of carrots, red and green peppers, tomatoes, celery, lettuce, strawberries, raspberries, peaches, plums, oranges, kiwis and bananas. Choosing a rainbow of colors helps ensure a diverse intake of nutrients.
6. Increase your intake of fiber
Increase your intake of fruits, vegetables and grains, and you’ll increase your intake of dietary fiber, a tactic that can promote heart health by lowering cholesterol levels. For instance, a study published in the June 2, 1999, issue of JAMA (Journal of the American Medical Association) showed that compared with women whose diets were low in dietary fiber intake, women whose diets were high in such intake had lower rates of heart disease.
Although dietary fiber cannot be digested, it actually promotes normal digestion and improves absorption of nutrients. Dietary fiber consists of insoluble and soluble fiber. Soluble fiber provides the greatest heart-health benefit because it helps lower LDL-cholesterol; it may also promote better control of blood sugar. Good sources of soluble fiber include oats, oat bran, barley, legumes (e.g., dried beans), lentils and split peas, psyllium (from plantago plants) and most fruits.
Insoluble fiber, sometimes referred to as “roughage,” promotes digestion regularity, adds bulk and softness to stools, helps with weight regulation and may prevent many gastrointestinal disorders (e.g., diverticulosis).Good sources of insoluble fiber include wheat bran, whole wheat and other whole grain cereals and breads, and vegetables.
Overall, you should aim for a total intake of 25 or more grams of dietary fiber (soluble and insoluble) each day.
How to get more fiber in your diet:
- Start the day off right with whole grain cereal or 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 1/2 cup of garbanzo beans (chickpeas) into a dark 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 or white varieties.
- Top yogurt or cottage cheese with fresh fruit or nuts.
- Give zest to broth soup by adding veggies, dried beans or barley.
- Substitute brown rice for white rice.
- Instead of cookies or chips, snack on vegetables, low-fat granola bars or trail mix.
7. Increase your intake of unrefined carbohydrates
Eliminate processed or refined carbohydrate foods (e.g., white bread, white pasta, white rice) and substitute them with unrefined carbohydrate foods (e.g., whole grain breads, brown rice, oats, barley, bulgur [a form of whole wheat], quinoa [a grain-like product], whole wheat pasta, whole grain crackers and cereals, etc.). Unrefined or whole-grain carbohydrates provide more vitamins, minerals, antioxidants and dietary fiber than refined carbohydrates.
8. Increase your intake of plant protein sources
Increase your intake of plant sources of protein and cut back on the intake of animal protein. A steady diet of steaks, ground meat, pork, chicken and poultry with skin means a steady intake of cholesterol and saturated fat, both of which contribute to weight gain and increased risk of heart disease. So try to minimize the intake of meat and poultry. There are plenty of palatable nonmeat substitutes that provide good sources of protein but that also provide heart-friendly ingredients such as fiber, vitamins, minerals and antioxidants.
- Eat two to three vegetable protein meals weekly: split pea soup, garbanzo bean salad, bean- based meatless burgers, tofu stir-fry or textured vegetable protein.
- Red meat should be eaten at no more than one meal per week.
- Eat two skinless poultry meals each week.
- Eat a minimum of six ounces of omega-3-rich fish weekly.
9. Choose nonfat dairy food sources (especially important for bone and blood pressure health)
Such sources are skim milk or 1% milk, 1% or nonfat yogurt or cottage cheese, and reduced fat cheeses.
10. Decrease the number of desserts and sweets you eat to a few times per month.
You don’t have to eliminate them from the menu altogether to derive benefit—just don’t make them part of your everyday diet.
11. Moderate alcohol intake
Research is being conducted on the benefits of alcohol. Women who regularly consume alcohol (and have no history of alcohol abuse) should ingest no more than one alcoholic drink per day: 4 oz wine, 1.5 oz spirits, 12 oz beer. Women whose triglyceride levels are elevated (>150 mg/dL) should consider avoiding alcohol altogether.
12. Maintain or achieve a healthy body weight
A body mass index, or BMI, of 18 to 24.9 is considered ideal. Speak with your physician or registered dietitian to learn how you can maintain or achieve a healthier body mass index. Even a loss of 5 to 10% of your body weight can have a significant impact on your overall heart health. For instance, a 200 lb. female would have to lose only 10 to 20 pounds; a 280 lb. male would have to lose only 14 to 28 pounds.
13. Get moving—and do it regularly!
Engaging in aerobic exercise—even brisk walking—for at least 20 minutes most days of the week, in addition to maintaining an active lifestyle, can have considerable heart-health benefits. Regardless of the exercise regimen you choose, check with your physician before starting one.
14. Get your cholesterol checked regularly
If the levels are abnormal, follow the steps outlined above to help get things stabilized. If you have high levels of LDL or “bad” cholesterol:
- Increase your intake of soluble dietary fiber (e.g., oats, legumes, flax, psyllium, fruits, vegetables, barley).
- Reduce your intake of saturated and trans fat.
- Increase soy consumption (25 grams soy protein daily).
- Use cholesterol-lowering margarine (2 tablespoons daily of Benecol or Take Control).
- Try to achieve optimal body weight.
If you have high levels of triglycerides:
- Limit your intake of simple sugars (table or granulated sugar; most candy, cookies, cakes) and refined starches (white bread, rice and pasta).
- Increase your intake of omega-3 fatty acids.
- Eliminate your intake of “liquid calories” (e.g., fruit juices, fruit drinks, soda pop, sugar- sweetened lemonade and iced tea, alcohol).
- Try to achieve optimal body weight.
If you have low levels of HDL—the good cholesterol—try to begin an exercise program. If you are overweight, try to get on a weight-reduction program.
FDA acts to provide better information to consumers on trans fat
“On July 9, 2003, the Food and Drug Administration (FDA) issued a regulation requiring manufacturers to list trans fatty acids, or trans fat, on the Nutrition Facts panel of foods and some dietary supplements. With this rule, consumers have more information to make healthier food choices that could lower their consumption of trans fat as part of a heart-healthy diet. Scientific reports have confirmed the relationship between trans fat and an increased risk of coronary heart disease."
“Food manufacturers have until Jan. 1, 2006, to list trans fat on the nutrition label. FDA estimates that by three years after that date, trans fat labeling will have prevented from 600 to 1,200 cases of coronary heart disease and 250 to 500 deaths each year.”
For more information about these issues, visit the Food and Drug Administration website at www.fda.gov.
*Source: Food and Drug Administration Web site
Need Diet and Lifestyle Guidance?
For more information on preventive cardiology, or to schedule an appointment with a preventive cardiology physician or nutritionist, call the main campus of The Cleveland Clinic at 216.444.9353. To learn about services at the Family Health Centers, see our Family Health Center website.