Chapter 9

9 | Diet

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There has been a lot of talk about diet, both in this book and in the media in general, about the importance of good, healthy eating to keep your heart in good shape. The questions below will answer, I hope, all the questions that you may have about food types, a healthy diet and losing weight. When we use the word ‘diet’ we do not mean crash diets to lose weight, but adopting a healthy lifestyle with balanced nutrition, which is far more important and safer.

In the past, many doctors have doubted the importance of lowering cholesterol, and have in many ways hindered the management and prevention of coronary artery disease. We now have overwhelming evidence that a high cholesterol causes coronary disease, and that lowering it encourages heart health and prevents the consequences of coronary disease by reducing heart attacks and the need for surgery or angioplasty. Fears that lowering cholesterol simply meant that you died just as soon but from something else have been totally disproved and the evidence accumulates daily to support the view that not only do people have less heart disease but they live better lives for longer. If you stop smoking, you will reduce your chances of lung cancer and heart disease; if you reduce your cholesterol you will reduce your chances of heart disease and stroke.

Eating healthily does not mean a boring diet. As the British Heart Foundation puts it ‘Food should be fun’ and can be healthy too. It’s all about avoiding a premature death.

FOOD TYPES AND EATING HEALTHILY

Fats

Fats or lipids are discussed fully in Chapter 2 in the section Risks of high cholesterol levels. We discuss here what types of food are involved. Remember that fats are divided into saturated and unsaturated types and most foods contain a combination. The proportion varies depending on the food chosen.

Saturated fats are mainly of animal origin. They are usually hard at room temperature. They can also be found in some vegetable fats. Too much saturated fat can be bad for the heart and it is the saturated fat that raises cholesterol. They are found in:

•red meat;

•butter, milk, cheese, cream;

•suet and lard;

•some vegetable fats, especially coconut and palm oil;

•cakes, biscuits;

•chocolate; and

•most puddings.

Unsaturated fats are mainly of vegetable origin. They are liquid or soft solids at room temperature. There are two types:

•polyunsaturated, found in sunﬂower oil, soft margarines labelled ‘high in polyunsaturates’; these fats can lower cholesterol;

•monounsaturates, found in olive and rapeseed oil.

Table 9.1 Content of omega-3 polyunsaturated fatty acids in oily ﬁsh

Oily ﬁsh	Omega-3 content (g per 100 g)
Mackerel	2.2
Herring	1.7
Sardines	1.7
Pilchards	1.7
Lake trout	1.6
Salmon	1.4
Halibut	0.9
Rainbow trout	0.6
Tuna (less if tinned)	0.5

I have read that ﬁsh oil is very good for you. Can you tell me about this?

Oily ﬁsh contain a particular type of polyunsaturated fat (omega-3 fatty acid) and this has been shown to help prevent coronary disease partly by thinning the blood. Table 9.1 shows the healthiest ﬁsh to eat.

It is best to avoid potted prawns, rich ﬁsh pâtés and ﬁsh roe as these are rich in saturated fat.

Shellﬁsh contain higher levels of cholesterol but are low in saturated fat and may therefore be eaten in moderation – once or twice a week. Examples of shellﬁsh are:

•cockles, mussels, whelks;

•shrimps, prawns, lobster;

•squid.

Fish oils can also be taken in the form of capsules. Oily ﬁsh have a particularly good effect in reducing triglycerides (see the section Risks of high cholesterol levels in Chapter 2), but some capsule preparations are high in calories, so be careful to check the label. Because of this, they have been known to upset people with diabetes and reduce the success of watching your weight. It is best to get your ﬁsh oil the natural way by regularly eating ﬁsh.

Omacor, a ﬁsh oil preparation, in addition to its beneﬁt of reducing triglycerides, may be beneﬁcial after a heart attack if added to statin therapy. The recommended dose is 1 g daily with food, and up to 4 capsules daily for raised triglycerides.

If I eat ﬁsh twice a week, will it allow me to eat what I like for the rest of the week?

No. A recent review of the scientiﬁc evidence about eating ﬁsh to protect against coronary artery disease concluded that ‘merely adding ﬁsh to a nutritionally adverse diet will not grant a population immunity from epidemic coronary heart disease.’ Translated this means that, if you are eating poorly, simply adding ﬁsh won’t do any good. Fish should be part of a low saturated fat diet – part of a healthy eating plan.

I’m not keen on ﬁsh – can I have ﬁsh oil capsules instead?

Yes. Omacor and Maxepa lower triglycerides and Omacor has been shown to reduce the chances of further heart problems when taken after a heart attack and in addition to statins. Reduced hospital admissions for heart failure have also been recorded.

What is the difference between white ﬁsh and oily ﬁsh?

White ﬁsh includes cod, haddock, halibut, plaice and monkﬁsh; oily ﬁsh includes herrings, kippers, mackerel, salmon, sardines, anchovies, trout and tuna. White ﬁsh is low in fat and this is good for the heart. Oily ﬁsh in addition contains a lot of omega-3 fatty acids as well as vitamins A and E, all of which may be good for the heart, so they have a greater potential beneﬁt.

I quite like ﬁsh but it can be expensive. How much is it recommended that I eat each week?

The current recommendation is 300 g (12 oz) twice a week. The average intake in the UK is currently half this.

How do I know if the ﬁsh is fresh? I would hate to get food poisoning.

Fresh ﬁsh is usually refrigerated with ice before being sold but it can be frozen, then thawed, and sold as fresh. The law says it must be labelled as thawed because refreezing thawed ﬁsh is a source of bacteria. The safest way of buying or eating ﬁsh is to consume fresh ﬁsh within 24 hours of purchase or to cook frozen ﬁsh from frozen or immediately it has been thawed for the ﬁrst time.

Fresh ﬁsh are usually stiff, the eyes are bright and not sunken, and the gills are red in colour. The skin should be shiny. Fillets should smell fresh (of the sea) and have ﬁrm moist ﬂesh; white ﬁllets look white and almost translucent in colour. If you are not sure, do not buy it and do not be convinced by the ﬁshmonger as to its freshness unless you know him very well. Do not buy frozen ﬁsh which is not solid or has white patches or ice crystals on the skin. Frozen ﬁsh should not be thawed in water as it loses its texture, ﬂavour and nutrients.

Independent ﬁshmongers tend to know more about ﬁsh than supermarket fresh ﬁsh counter assistants.

Table 9.2 A guide to healthy eating*

Food types	Everyday foods	Eat in moderation	Eat with caution
Cereals and breads	Flour and bread, pasta, breakfast cereals and porridge oats	Water biscuits; plain semi-sweet biscuits (e.g. rich tea, digestive) (once a week) cream crackers	Fancy bread and pastries, (e.g. croissants, brioches)
Vegetables, fruit and pulses	Most kinds (fresh, dried, canned, frozen). Tofu and other soya products	Chips and roast potatoes cooked in oil marked High in polyunsaturates oil marked High in polyunsaturates olives, lower-fat crisps (once a week)	Crisps, chips cooked in oil other than olive oil or oil marked High in polyunsaturates
Nuts	Nuts may be included in vegetarian diets to replace meats	Most nuts (use a few only)	Coconut
Fish	Sardines, tuna, salmon, mackerel, trout, white fish (including haddock, cod, plaice) – steamed, grilled or baked, not fried	Shellfish (e.g. lobster, crab, prawns)	Any fish in batter, fish roe (e.g. taramasalata)
Meat	Chicken, turkey (both without skin), veal, lean ham	Not more than 3 times a week: lean cuts of beef, pork, lamb, bacon, lean mince; liver, kidney, meat paste	Visible fat on meat, sausages, pâté, duck, salami, meat pies and pasties, pork pies
Eggs and dairy foods	Skimmed milk, cottage cheese, curd cheese, egg whites, low-fat yoghurt, low-fat fromage frais	Semi-skimmed milk; not more than 3 times a week: medium-fat cheese (such as Edam, Brie, Camembert, Parmesan); half-fat cheeses (e.g. half-fat Cheddar); 3–4 eggs a week	Full-cream milk, cream cheese, most blue cheeses (e.g. Stilton), full-fat yoghurt, condensed milk, cream, coffee creamers
Fats	All fats need to be limited	Polyunsaturated margarines and oil (e.g. corn oil, sunflower oil, olive oil, low-fat spread)	Butter, dripping, lard, ghee, margarines not labelled High in polyunsaturates, blended vegetable oils
Preserves, spreads and sweets	Artificial sweeteners	Jam, marmalade, honey, boiled sweets, fruit pastilles, sugar, peanut butter	Chocolates, toffees, fudge, mincemeat containing suet, chocolate spread
Cakes, biscuits and desserts	Home-made cakes and biscuits made using low-fat recipes; jellies, sorbets, skimmed-milk puddings	Occasional cakes, puddings and biscuits made with polyunsaturated margarine/oil (2–3 times a week), ice-cream	Ready-made cakes and biscuits, cream cakes, dairy cream, ice-cream, full-fat milk puddings
Drinks	Tea, coffee, water, fruit juice, low-calorie Tea, coffee, water, fruit juice, low-calorie	Packet soups, alcohol, low-fat drinking chocolate and malted drinks	Cream soups, full-fat milk drinks and shakes, cream-based drinks
Other miscellaneous foods	Herbs, spices, mustard, vinegar, Worcester sauce, fat-free or low-fat salad dressings	Low-calorie salad cream and mayonnaise, French dressing made with polyunsaturated or olive oil	Salad cream, mayonnaise, creamy dressings

* Information from Trim the fat from your diet, published by the British Heart Foundation

Isn’t it possible to keep fresh ﬁsh in the fridge for a week?

Most fridges in our homes are set at about 3°C and ﬁsh spoils quickly at this temperature, so eat it within 24 hours. Stored on ice (0°C) fresh ﬁsh may last a week.

What types of food have low or high levels of fat and cholesterol in them?

Here are some of the main foods in the high fat groups.

Foods high in total fat

•Fried food

•Whole milk, cream, high-fat cheeses (such as Cheddar)

•Fatty meat and meat products, e.g. sausages and pâté

Foods high in saturated fat

•Fatty meat and meat products

•Foods cooked in lard, butter or hard margarines

•Cakes and pastries made with butter and hard margarines

•Palm and coconut oil

•Fatty poultry (duck, goose); poultry with the skin on

Foods high in total and LDL (bad) cholesterol

•Egg yolks (eat only three to four eggs a week at the most)

•Liver and other organ meats (kidney, brain, heart, sweetbreads)

•Shellﬁsh (but these are lower in saturated fat than most meats and poultry so are ﬁne to eat in moderation – see the question above on ﬁsh oils)

Foods high in polyunsaturated fat

•Some nuts and seeds (e.g. chestnuts, walnuts, not coconut)

•Oily ﬁsh

•Many soft margarines and vegetable oils (check the labels)

Foods high in monounsaturated fat

•Olive oil and olives

•Rapeseed oil

•Margarines and spreads made from olive oil

What sort of foods should I eat to cut down on my fat intake?

Basically, avoid full fat dairy produce, deep-fried foods, pastry, biscuits and puddings. See Table 9.2 for a comprehensive list of the healthiest foods to eat as regards fats, and those to eat in moderation, occasionally or best left alone. Don’t panic – all the good things haven’t been removed, it is just a modiﬁcation as part of a new way of living.

For cutting down on dairy foods:

•Change whole milk dairy products to semi-skimmed or skimmed;

•Change butter or hard margarine to poly- or monounsaturated margarine;

•Change lard or hard vegetable fats to pure vegetable oils (such as corn oil or olive oil, high in polyunsaturates and monounsaturates respectively), but remember that all fats are high in calories;

•Change cream to low fat yoghurt or fromage frais;

•Change ice-cream to frozen yoghurt, sorbets or low fat frozen desserts;

•Change high fat cheeses (such as Cheddar, cream cheese) to lower fat cheeses (half fat Cheddar, Edam, Brie, Camembert, cottage cheese and lower fat soft cheese).

Eat no more than 170 g (6 oz) of cooked lean meat a day. If you do want to eat red meat:

•Eat the leaner cuts and always cut the fat off at the table;

•Avoid burgers, pork, meat pies, bacon and full fat sausages;

•Switch to chicken or turkey (but do not eat the skin);

•Switch to game meats instead of duck or goose which are fatty meats;

•Avoid processed meats (sausages, hot dogs, salami, pâté);

•Avoid high cholesterol organ meats (offal, e.g. liver, kidneys, sweetbreads).

Cut down on egg yolks (no more than three or four per week) or consider the use of egg substitutes or egg whites in cooking.

Eat ﬁsh that is low in saturated fat two or three times a week (you can include shellﬁsh in moderation – see above). Try more oily ﬁsh than white ﬁsh.

Avoid purchased baked goods like cakes (substitute bread or mufﬁns – but check the label) or meat pies.

Eat plenty of fresh fruit and vegetables, but avoid coconut, olives (not the oil) and avocados, which are high in calories and may cause weight gain).

Change from croissants to wholemeal bread.

Substitute chestnuts or walnuts for peanuts, but remember that all nuts contain a lot of calories.

According to the TV ads, some margarines seems to be a good way of lowering cholesterol – do they really work?

Research has shown that Benecol, which contains special plant extracts, lowers cholesterol by 10–14%. Similar results are reported with Flora Pro-activ. Although these products lower cholesterol, there is no evidence that they reduce heart risk in the same way that statin drugs do (see Treatment in the section Risks of high cholesterol levels in Chapter 2). They are helpful when you have a borderline raised cholesterol, because you may be able to avoid drugs; but, if you have heart disease already, these products should be used with drugs – you will then beneﬁt from the drugs, but the doses might be lowered. I do recommend them as part of healthy living, but price may be a problem for some people, and you will get beneﬁts from supermarket spreads that are high in either poly- or monounsaturated fats, if the costs worry you.

A liquid yoghurt drink a day maximises the beneﬁt of Flora Pro-activ or Benecol.

My friend in America is taking nicotinic acid (niacin) for her cholesterol – is it available here?

Nicotinic acid is available, but not often used because of its side effects, especially ﬂushing. It can also affect the liver and make any stomach ulcers worse. It can react with alcohol and upset control in people with diabetes, so doctors have to monitor anyone on this drug very carefully. Occasionally, it can make angina pain worse.

A new formulation (Niaspan) has been launched. Nicotinic acid raises the good cholesterol (HDL) by up to 24%. Doctors will probably try it on those who have a low HDL in spite of being on statins, and therefore it is given in combination with these. Treatment will be introduced carefully and the dose gradually increased. Niaspan claims to cause less ﬂushing than other types. Typical doses are 375, 500, 750 and 1000 mg, to a maximum of 2 g, taken daily at night. Flushing may be reduced by taking soluble aspirin 30 minutes beforehand and taking Niaspan with food.

Someone told me that nuts were good for reducing coronary disease – should I eat them regularly?

Nuts (though not coconut), eaten about four times a week, have been linked to a reduction in heart attacks. Walnuts and almonds lower cholesterol. Therefore, nuts as part of a healthy lifestyle may reduce the risk of heart disease. Eat them with cereals, as a snack, or with a salad. Beware of added salt and remember that they have a high calorie content. If you use nuts in cooking, remember some visitors may be allergic to them.

Are there better ways of cooking I could try?

Yes; instead of frying or roasting you could try grilling, barbecueing, braising, poaching, steaming, stir-frying or sautéing with minimal fat; baking, casseroling or microwaving also reduce the use of fats.

•Grill on a rack so that the fat drips away. Special fat-reducing portable grills are a healthy choice.

•If you have a roast, don’t cook the meat in its own juice or make gravy from the juices. Cook the joint on a roasting rack and baste the meat with vegetable oil, lemon juice or a little olive oil.

•If you use a polyunsaturated margarine or oil for cooking, use as little as possible. Oil sprays are a way of avoiding excess in cooking.

Fibre

The doctor often recommends that I should eat more ﬁbre. Is ﬁbre important in my diet?

Fibre also means roughage; and yes, it is important. Most people associate roughage with bran but there are many foods which serve the same purpose (see Table 9.3). Starchy foods have the advantage that they are ﬁlling without providing a lot of calories. Fibre passes through the bowel without being absorbed into your body and lowers cholesterol by reducing fatty foods in your diet. This type of ﬁbre, known as soluble ﬁbre (see question below), is effective in lowering cholesterol, if enough is eaten. It binds with bile salts from the liver, which are full of cholesterol, and prevents them from being absorbed. At the same time, by absorbing water like a sponge, it gives a full-up feeling.

Table 9.3 Foods and ﬁbre content

High fibre foods	Low fibre foods
Wholegrain cereals (branflakes, muesli, porridge, wheat biscuits)	Plain and frosted rice cereals, cornflakes, Special K
Breads (wholewheat, granary, rye, wholewheat pitta)	White bread and rolls
Brown rice, pearl barley, bulgur wheat	White rice
Pasta (wholewheat)	Pasta (white)
Wholewheat crispbread, crisprolls	White biscuits and crackers (water biscuits)
Popcorn, Twiglets, wholewheat breadsticks	Cheese Puffs, Hula Hoops, pretzels, Quavers
Wholewheat and oatmeal biscuits (especially with dried fruit)	Rich tea biscuits, shortbread, wafers
Wholemeal scones, fruited teabreads	Pastries, cakes

Soluble ﬁbre-rich foods include:

•pulse vegetables, e.g. peas, beans and lentils;

•fruit, e.g. bananas, apples, berries and citrus fruits; and

•oat cereals (not wheat).

The average person eats 15–20 g of ﬁbre a day and this needs to be increased to over 25 g. As ﬁbre is increased in the diet, it becomes important to drink plenty of ﬂuids so that the swelling action can be achieved. Increase the ﬁbre content gradually to give your digestive system a chance to adjust.

What is the difference between soluble and insoluble ﬁbre? Should I eat both?

Insoluble ﬁbre is important for digestion and taking it with ﬂuid helps to prevent constipation and other bowel problems. Soluble ﬁbre helps to lower cholesterol. Insoluble ﬁbre is found in wholegrain and wholemeal foods (wholemeal bread, granary bread, brown rice, wholemeal or wholegrain ﬂour and wholewheat breakfast cereals). A mixed diet of both types of ﬁbre will keep you regular and lower your cholesterol.

When I am in the supermarket, I get confused as to which foods are best for ﬁbre content. Can you tell me more about which contain more ﬁbre?

To increase ﬁbre is not difﬁcult. Aim to eat two items from this list each mealtime:

•wholemeal bread or wholemeal chapattis or pitta bread;

•wholegrain cereal (bran, Weetabix, Shredded Wheat, porridge);

•baked potatoes (and eat the skins) instead of fried;

•wholegrain pasta and brown rice;

•fruit (particularly apples, pears, bananas): fruit is also low in calories and rich in vitamins and antioxidants (see the section Risks of high cholesterol levels in Chapter 2);

•dried fruit, e.g. raisins;

•vegetables (particularly root vegetables, e.g. carrots, turnips, parsnips; and green vegetables, e.g. sprouts, cabbage, broccoli): vegetables are also low in calories and rich in vitamins and antioxidants (see the section Risks of high cholesterol levels in Chapter 2);

•pulses: peas, beans, lentils, sweetcorn, baked beans, chickpeas;

•nuts: walnuts, chestnuts (but be careful, all nuts have a high calorie content).

Try to use wholemeal ﬂour rather than white when you are baking, or a mixture. Table 9.3 gives a list of high versus low ﬁbre foods.

I know that vegetables are good for me because they contain ﬁbre and vitamins. I have heard that boiling vegetables loses the vitamins. How should I prepare fruit and vegetables to get the maximum beneﬁts from them?

Many vitamins are lost in storage and on exposure to oxygen in the air. Buy (or pick) little and often and prepare just before you eat them. Leave the skin on where possible. Eat vegetables raw, or by steaming, stir-frying or microwaving. If you boil your vegetables, boil quickly in the minimum of water in a tightly covered pan and serve immediately. Use the cooking water for stock or gravy. Frozen vegetables are just as good as fresh and can be quick to prepare, convenient and economical.

Sugar

I have rather a sweet tooth. Is sugar really that bad for you?

Yes. Sugar is just calories without any good bits added (like vitamins, protein, ﬁbre) and you get the calories that you need with the good bits by eating healthily. We really don’t need sugar on its own as this can cause tooth decay. Sugary foods also tend to be high in calories, so eating too much can make you put on weight.

Chemical names for sugar are glucose, sucrose, fructose, dextrose and maltose. None is any better than another nor is brown or cane sugar any better than white.

I’ve read that poor dental health can cause coronary heart disease – is this true?

Poor dental health is not good for you whichever way you look at the problem. It causes bad breath and can lead to infections. There is a link between poor dental health and coronary heart disease but this may reﬂect other factors such as poor nutrition, cigarette smoking and generally poor conditions in a person’s lifestyle. A recent publication has suggested that even allowing for these other factors, poor dental health can harm the heart. The message is clear – look after your teeth and gums!

Have you any tips for cutting down on sugar?

Cutting down on sugar is the easiest way to begin losing weight whereas cutting down on your fat intake is the most effective (see the section Losing weight below).

•Begin by cutting out sugar in tea and coffee. It may be tough at ﬁrst but after four or ﬁve days you will wonder why you ever added sugar. Try to do without artiﬁcial sweeteners if you can, or use them only sparingly; some contain sodium (salt) which can upset your blood pressure control or treatment of heart failure.

•Drink low-calorie drinks, e.g. Diet Coke or caffeine-free diet coke, Diet 7-Up, diet tonic. Remember plain water is the most refreshing calorie-free drink there is.

•Choose tinned fruit in natural juice rather than syrup.

•Beware of sugar-coated breakfast cereals. A good breakfast could consist of low-fat, low-calorie yoghurt poured on unsweetened muesli, bran-type cereals with some fresh fruit, or porridge made with skimmed or semi-skimmed milk.

•Chocolate, cakes, biscuits and puddings can be replaced by fresh fruit, e.g. apples, bananas and pears, or low-fat yoghurts, fromage frais, low-fat mousses and frozen desserts.

Salt

I have raised blood pressure and my doctor tells me that I must cut down on my salt. Why is this?

Excess salt can raise the blood pressure (see Chapter 2). Salt (sodium chloride is the chemical name) in excess causes your body to retain water, upsetting the hormone balance, and the blood pressure goes up.

It is best to avoid extra salt at the table and any salty foods, e.g. crisps and salted nuts. Table 9.4 gives a guide to salty foods.

So how much salt do we actually need in our diet?

Your body needs 500 mg of sodium a day, the same as one-third of a teaspoon of salt. We eat on average one to three teaspoons of salt a day, equivalent to 6–18 g salt. In the UK, men eat just over 3 g sodium a day, equivalent to six to seven times more than they need.

Table 9.4 Levels of sodium in various foods

Foods	Typical portion size (g)	Sodium (mg)
Processed foods
Bacon (grilled)	45	900
Baked beans	200	1060
Bread (2 slices)	75	390
Butter (salted, spread on large slice of bread)	7		61
Cereals
All-Bran + milk	25+115	468
Cornﬂakes + milk	30+115	340
Cheddar cheese	30	183
Corned beef (2 slices)	60	570
Cream cracker
+ processed cheese	21+20	392
Ice-cream	75	54
Mars Bar	65	98
Pork pie (medium)	140	1104
Sausages (2 grilled)	90	900
Sausage roll		332
Scone	50	385
Spaghetti hoops	125	525
Tomato sauce (1 tbsp)	17	58
Tomato soup (canned)	240	1108
Unprocessed foods
Apples (1 medium dessert, peeled)	120	2
Bananas (1 medium peeled)	100	1
Beef (roast topside, 3 slices)	90	43
Cabbage (boiled, white)	100	4
Carrots (boiled, old)	70	35
(tinned)	65	240
Chicken (meat only)	100	81
Cod in batter (fried)	85	85
Unprocessed foods (cont’d)
Eggs (2, scrambled with milk/butter/salt)	140	1442
Potatoes (boiled, old) (mashed with butter)	150 170	5 83
Drinks
Beer (1 pint draught bitter)	568 ml	68
Bovril (heaped tsp)	5	240
Coffee (instant)	195	1
Horlicks + semi-skimmed milk	20+195	199
Marmite (heaped tsp)	5	225
Milk (2 tbsp)	30	15
Tea (1 cup)	195	Trace

I know that I eat too much salt and my blood pressure is on the high side. What foods should I try to limit?

When you read a food label, look at the sodium level not just the phrase ‘low in salt’ (see the questions on food labelling below). See the difference in processed foods which are high in sodium because salt is added during their manufacture (see Table 9.4). Salt gives us sodium – 1 g table salt contains 390 mg sodium. Now compare these with unprocessed foods which are low in sodium but high in potassium. Potassium is helpful in lowering blood pressure. Restriction of both sodium and potassium intake may be advised if you have kidney disease but healthy people usually get rid of any excess. However, if you eat a lot of sodium, this can lead to high blood pressure and ﬂuid retention, which puts a strain on your heart.

Remember, there may be unexpected sources of salt – monosodium glutamate is often overlooked. Try herbs and spices rather than salt with your cooking. Watch out for salt in:

•snacks, especially salted nuts or crisps;

•frozen or canned ﬁsh (even tuna in brine);

•meat, especially ham or bacon, sausages, corned beef;

•canned foods and packet soups;

•commercial pies;

•some cheeses;

•salad dressings.

I have heard that bananas are very good for you. Why is this?

It is true to say that most people are not deﬁcient in either sodium or potassium and a good healthy diet contains more potassium than most of us need. However, potassium-rich foods can help to lower blood pressure and may reduce the need for tablets in some people with high blood pressure. Many fruits like apples, pineapple, grapefruit and raw tomatoes contain potassium; dried raisins and bananas are particularly good sources. Leaf vegetables (spinach, broccoli, brussels sprouts, cabbage, celery and lettuce) are also good sources as are potatoes, parsnips, broad and baked beans. A high intake of potassium is not usually harmful because your kidneys get rid of any excess but, if you have kidney disease or are taking potassium-containing tablets, potassium levels can build up and cause irregular heartbeats. Check with your doctor if you are unsure.

How do I read food labels and what do the ﬁgures mean for me?

It is important to know about salt, fat and calories. Most of the salt that you eat is that added in food manufacturing, so simply watching the salt you add is not enough. Some food labels may specify the sodium content, but it would be impracticable (and difﬁcult) for you to have to add up the sodium content of all manufactured foods that you buy. As a general guide, cut down on salt added in cooking, avoid it at the table and avoid the very salty foods listed above.

Try to keep your daily cholesterol below 300 mg and sodium below 3000 mg (3 g). This is a higher sodium intake than we need but the body copes with this and it is a more practical approach to food. Sodium in grams × 2.5 equals salt in grams; so, 3 g of sodium = 7.5 g of salt and 2.4 g of sodium = 6 g salt. We need 500 mg of sodium a day (500 mg = 0.5 g) and that equals 1.25 g salt or one-third of a teaspoon.

As a reminder, your fat intake varies with calorie advice but for a typical female, who needs 2000 kcal a day, this will be about 70 g of fat, and for a male needing 2500 kcal a day, 95 g of fat. Of these ﬁgures, saturated fat should be no more than a third. Table 9.5 is adapted from the American Heart Association Guidelines.

Here are some guidelines for reading labels.

•Compare ﬁgures per 100 g and per serving if you eat the whole pack. You can usually compare product to product per 100 g.

•For each 100 g portion, a simple guide to content is shown in Table 9.6.

•Energy is measured in calories (kilocalories shortened to kcal) and joules (kilojoules shortened to kJ): 1 kcal equals 4.2 kJ.

Table 9.5 Guidelines for food intake for average-sized men and women per day

Intake	Men	Women
Energy	2500kca	2000kcal
Total fat*	95g	70g
Saturated fat†	30g	20g
Fibre	20g	16g>
Salt‡	6.0g	5.5g

‡ 6.0 g salt equals 2 level teaspoons and 2.4 g sodium.
If you take in more calories than you burn up, you will gain weight. See above for your daily needs.

•Proteins are important for your body’s building bricks. We all have more than we need except vegetarians, who need to pay more attention to increasing the protein content of their diet to adequate levels.

•Sugar content should be no more than 70 g daily for men and 50 g for women.

An example of a good food label, giving us all the essential information, is given in Table 9.7. Look at the fat, ﬁbre, sugar and sodium content and compare with Table 9.6.

Garlic

I have read that garlic is very good for high blood pressure. Is this true?

There is unfortunately no evidence that garlic reduces cholesterol but it may slightly reduce blood pressure – more research is needed.

The best advice is to make garlic part of your diet, providing, of course, that you like it and it doesn’t limit your social life!

Drinks

I drink quite a few cups of coffee a day. Is coffee bad for the heart?

High caffeine levels can cause palpitations (see Chapter 6). Boiled coffee (percolators) can raise cholesterol but instant, ﬁlter or expresso do not. There is no real evidence of any harmful effect of coffee on the coronary arteries. So you can drink and enjoy coffee without worrying about it causing a heart attack. Try to avoid percolated coffee because of the cholesterol effect and cut down on all coffee if you have palpitations.

Table 9.6 Guide to food-type content in 100 g-portions

Food type	A lot (g)	A little (g)
Sugar	10	2
Fat	20	3
Saturated fats	5	1
Fibre	3	0.5
Sodium	0.5	0.1

I like to have a drink now and again. How does alcohol affect my heart?

Alcohol in moderation helps the heart, but in excess it can cause
strokes, high blood pressure and cirrhosis of the liver. Alcohol therefore can be consumed without undue worry but it needs to be controlled. Alcohol is, unfortunately, high in calories, so it is not helpful if you are trying to lose weight. Binge drinking is very bad for blood pressure – the following day your blood pressure may be very high and this is when strokes occur.

We measure alcohol in terms of units and it is recommended that men have no more than 28 and women 21 units in a week. Ideally men should not drink more than 4 units a day and women 3 units a day. The British Heart Foundation recommends a weekly limit of 21 units for men and 14 for women. When pouring drinks at home no one ever pours a single shot of spirits unless they use an actual measure – it is always a double or even a treble!

To calculate a unit, multiply the strength of the drink by its volume and divide by 1000. So 250 cc of wine, as often served in wine bars, of 10% strength, is 2.5 units (250 × 10 ÷ 1000).

One unit of alcohol is equal to:

•one 100 cc glass of wine (red or white): a typical 125 ml measure represents 1.6 units per glass (a bottle of wine at 12.5% volume contains six 125 ml glasses);

•a single measure of sherry;

•half a pint of normal strength beer;

•quarter of a pint of strong beer;

•a single measure of a spirit.

Table 9.7 An example of a good food label for a breakfast cereal

Ingredients: Wheat, malt extract, sugar, salt, niacin, iron, thiamin (B1), riboﬂavin (B2), folic acid
	Nutrition information Typical values 100 g (3.5 oz)	Typical values per per 37.5 g serving with 150 ml semi-skimmed milk
Energy	339 kcal	191 kcal
	1439 kJ	811 kJ
Protein	11.5 g	9.1 g
Carbohydrates	67.3 g	31.7 g
of which Sugars	4.7 g	9.2 g
Starch	62.6 g	22.5 g
Fat 2.7 g	3.4 g
of which Saturates	0.7 g	1.8 g
Mono-unsaturates	0.3 g	0.9 g
Polyunsaturates	1.7 g	0.6 g
Fibre	10.9 g	3.9 g
Sodium	0.3 g	0.2 g
Thiamin (B1)	1.2 mg (85% RDA)	0.5 mg (35% RDA)
Riboﬂavin (B2)	1.4 mg (85% RDA)	0.8 mg (47% RDA)
Niacin	15.3 mg (85% RDA)	5.7 mg 31% RDA)
Folic acid	170 µg (85% RDA)	70.0 µg (35% RDA)
Iron	11.9 mg (85% RDA)	4.4 mg (31% RDA)

RDA means Recommended Daily Allowance

Per 37.5 g serving with 150 ml semi-skimmed milk = 191 calories and 3.4 g fat

Any form of alcohol beneﬁts the heart (not just red wine) but it must be at a regular acceptable intake – you can’t save all your units up for Saturday night! See also the question below on calories in alcohol. Some alcohol now has the units on the can or bottle – this is very helpful and more labels should carry this information.

Always make sure alcohol does not interfere with any medication you might be taking. For example, it increases the effect of warfarin and it interacts with sleeping tablets (increasing their effects) and some painkillers (e.g. co-codamol) and some antibiotics (such as metronidazole). Alcohol can also increase the drowsiness some people experience with antihistamines (such as Piriton).

I have heard a lot about the beneﬁts of wine. Is wine better than beer or spirits?

Unfortunately, this has become confusing with reports contradicting each other. All alcohol is beneﬁcial in moderation. Wine has some advantages over beer. However, alcohol is not a medicine and should only be taken if enjoyed.

Snacks

Besides fruit can you suggest some healthy snacks?

Here are some ideas to try.

For nibbles

•raw vegetables (cucumber, celery, mangetout, baby corn, broccoli or cherry tomatoes)

•dried fruits (apricots, banana, raisins, sultanas)

•yoghurt (low-fat types)

•popcorn (no added salt or sugar)

For more substantial snacks

•fresh vegetable soups (not cream)

•beans on toast

•baked potatoes (ﬁll with cottage cheese, baked beans or salad)

•wholemeal or soft grain white bread sandwiches with healthy ﬁllings, e.g. tuna and sweetcorn, turkey and salad, a little Brie cheese and fruit

Drink water, slimline tonic or tea with lemon or lime.

All these suggestions are not only good for a healthy diet, but also a good way towards losing weight (see section below).

LOSING WEIGHT

It is easy to start cutting down on calories but keeping to your resolutions is tough. Most people with high blood pressure tend to be overweight. Losing weight should be a gradual process as part of a lifestyle change – avoid dramatic slimming fads.

I know I have to lose some weight. Have you any general tips?

Most people know what is fattening and what isn’t so you can avoid obvious foods (see Table 9.2) but here are a few tips.

•Losing weight is much easier if at the same time you increase your physical exercise. Taking exercise beneﬁts the heart in general (see Chapter 10). To lose weight you need to take a brisk walk, or an equivalent form of exercise, for 60–90 minutes daily.

•Avoid snacking. If you nibble a lot, drink plenty of water, and use fruit or starchy foods (such as a roll with low fat spread) as your ﬁller rather than peanuts or crisps. See the list above for healthy snacks.

•Plan your meals and plan how to avoid temptation. If you are visiting friends for a meal let them know what you are trying to achieve and why. Good friends will be pleased that you conﬁded in them – they will probably be constructive and helpful. If you go to a restaurant, look for those which have courses that ﬁt in with your healthy eating plan.

•If you develop a craving (a choc attack!), reach for that apple and go for a walk. Remind yourself what you are doing and why.

•If you slip, don’t give up, regroup and get back on course.

•Avoid too much alcohol – instead of a gin and tonic have a slimline tonic. Have one glass of wine, not two. (See the question below on alcohol.)

•Eat slowly and take your time over the meal.

•Have a salad (with a low-calorie dressing) with the meal.

•Always eat breakfast. Porridge is a good low-calorie ﬁller. Use semi-skimmed milk. Cereals vary a lot as regards calorie content – read the label carefully rather than the marketing message.

•Don’t miss meals or have one big meal a day.

•Don’t shop when you are hungry and always take a shopping list with you rather than go for impulse buying.

•Use a smaller plate when serving.

•Stick a photograph of how you want to be on the fridge. It will help you to avoid temptation as you visualise the new slimmer you!

•Slim with a friend or join a reputable slimming club – group support can be very motivating.

•Eat healthy foods (as discussed in the section Food types and eating healthily above).

•Always cut the fat off food and do not cook in fat. Avoid fried foods. (See the advice above on the best ways to cook food.)

•If you do use fat for cooking, use a healthier oil (such as olive oil) which is high in unsaturated fats (see Chapter 2). Shallow-fry in the minimum of oil to get the maximum beneﬁt. Use a non-stick frying pan and do not overheat. If you deep fry, use a ‘good’ oil and replace the oil after ﬁve uses.

•Keep away from cakes, milk chocolate, biscuits and any pastries or pies (dark chocolate in moderation may be beneﬁcial).

•Choose plainer biscuits, e.g. rich tea or marie types.

•Have a fresh fruit salad, fruit tinned in natural juices, fromage frais, low-fat mousse or frozen yoghurt for dessert.

How quickly should I lose weight?

Aim for no more than 1 kg (2 lb) a week – a gradual change is more likely to be sustained and it is healthier.

My friend has taken so-called diet tablets. Do these work?

Eating healthily and weight loss are about making lifestyle changes, so drugs should be avoided if at all possible. Some drugs are addictive and others may damage the heart valves. Many that are sold for high prices are capsules of nonsense. Xenical (orlistat), however, has research behind it. It may help obese people as part of a lifestyle change. It goes with a properly controlled low-fat diet and works by inhibiting the absorption of 30% of the fat eaten. Side effects include bowel disturbances. Xenical is part of a carefully controlled diet, supervised by a dietitian, and is a course of tablets, not a long-term treatment. It is not a magic slimming bullet, but it does have an important role for a small number of obese people.

Rimonabant acts on the brain to reduce the craving for food and has been an effective weight-reducing drug when used in combination with taking dietary advice. It can lead to depression, causing its marketing to be halted. Not everyone beneﬁts from drug therapy but drugs can help a signiﬁcant number of people.

I have been on a slimming diet and managed to lose some weight. How can I keep the weight off now?

First of all remember why you lost it – you have lowered your blood pressure and reduced the strain on your heart. So praise yourself. You will feel better and that alone will give you the incentive you need to keep slim and ﬁt.

Here are some more tips.

•Maintain regular exercise, walking briskly, cycling, swimming (see Chapter 10).

•Keep eating sensibly: plan your meals and follow the plan carefully.

•Eat more starchy foods (such as an extra slice or two of bread a day) to prevent you losing more weight if you have reached your target. Do not be tempted to turn to biscuits and cakes again!

•At parties or business lunches, if there is a buffet, choose carefully and don’t overeat just because its free and the size of the spread is tempting (see question below on eating out).

•If hunger strikes, drink a glass of water and eat fruit – don’t open the fridge door.

If you start gaining weight, look carefully at what you are eating and how much you exercise – what have you changed? If you lose weight below your target, gradually increase your calorie intake ﬁrst of all by 200 kcal a day (an apple is 60 kcal, a slice of bread 80 kcal: there are many ‘calorie counting’ booklets on the market, listing various foods both raw and packaged); after a week, check it again and keep exercising.

I have seen two different charts for an ideal weight. What should my target weight be?

Your ideal weight must take into account your height (see Figure 9.1). Doctors work to your Body Mass Index or BMI. This is your weight in kilograms divided by the square of your height in metres:

images

A normal BMI is 20–25. It works well for people over 1.6 m (5 ft 3 in) up to 1.87 m (6 ft 2 in) but not so well for short or tall people. Ask your doctor or practice nurse to help you work out your BMI and set your own target BMI. Now check it against your bathroom scales which are not as accurate but which will still show any changes. You can work out what you weigh in kilograms which is equally a guide to your BMI. For example, say that your BMI is 27 and that you want to get to 25, work out your kg at each BMI point and then, using your bathroom scales, all you need to do is set your kg target, as you know what BMI it represents. If you are not sure what to do or how to do it, ask the practice nurse to help you. Here is an example to help you:

A 1.87 m (6 ft 2 in) man weighs 95 kg. His calculated BMI is:

images

He would like to be healthier with a BMI of 24–25 so the calculation is:

images

He now knows what to aim for on his scales.

Check your weight once a week only and aim to lose 1 kg (2.2 lb) in the ﬁrst week and then 0.5 kg a week thereafter. If you use bathroom scales, do not put them on a carpet, and check them against a known weight (such as bags of ﬂour) from time to time. Compare them with your doctor’s scales or a large one in a chemist’s shop.

images

Figure 9.1 What you should weigh. Take a straight line up from
your height (without shoes) and across your weight (without clothes),
and put a mark where the lines meet. How did you do?

I ﬁnd the whole business of BMI confusing – can it be made simpler?

Of course. Simply follow the height and weight chart. Another simple formula is:

•Height in cm minus 110 = optimal weight in kg for men

•Height in cm minus 100 = optimal weight in kg for women.

So, if you are male measuring 5 ft 10 in, convert your height to centimetres (177.8 cm), take away 110 and you reach 67.8 kg. This is your ideal weight.

I have heard the nurse talk about a waist/hip ratio. What is this? Does it apply to my husband as well as me?

If your tummy is fat, the risk of heart problems increases and you can calculate the risk by comparing the waist measurement with that at the hip. You divide your waist measurement by your hip measurement. So, if your waist measures 26 in and hip 34 in, then you would have a ratio of 0.76 (26 divided by 34); you would not be at risk because the safe ratio for women should be no more than 0.8; this means that your waist should not be more than 80% of your hip measurement. Put another way, being apple-shaped is bad but pear-shaped is positively good!

The ratio for your husband, say with a 40 in waist and a 34 in hip, is calculated by dividing 40 by 34 which equals 1.18. He would be at risk because the safe ratio for men should be no more than 1.0. So his waist should not be greater than his hip measurement or the ratio would be over 1.0. Having a belly that’s bigger than your hips increases your risks of getting coronary artery disease.

Waist circumference is used more as a sign of obesity and predisposition to diabetes. It is measured breathing out, 2 cm (1 in) above the umbilicus (navel). For men, if your waist is 94–102 cm (37–40 in) you are overweight; over 102 cm (40 in) and you are fat (politely known as obese). In women, if the waist is 80–88 cm (32–35 in) you are overweight, and over 88 cm (35 in) you are fat.

Doctors tend to focus more on abdominal obesity which increases the risk of heart disease.

I’ve tried all sorts of slimming diets and nothing seems to work – what can I do now?

Trying a slimming diet is not the right way of tackling weight reduction – it is a lifestyle change that is needed. If you cannot do it on your own, don’t give up. Join one of the groups such as WeightWatchers and attend regularly. Remember why you need to lose weight: your blood pressure will beneﬁt and you will reduce your chances of a stroke or heart attack.

Is it safe for heart patients to try the Atkins diet?

The Atkins diet is high fat, high protein and low carbohydrate. The theory is that when we eat carbohydrates and sugar the body responds by making insulin to burn them off. Too much intake equals too much insulin and then too much fat is stored and therefore we gain weight. In the short term it works for many people but there is a tendency towards constipation and bad breath. Heart patients with high cholesterol levels are usually protected by statins but control can be lost. My view is that if there is signiﬁcant weight loss, this is good in the short term – say 2–3 months – but for long-term protection a switch should be made to the Mediterranean Diet, which is proven to cut the risks of a heart attack and is the programme described in this chapter.

We have a local WeightWatchers group in our area. Are slimming groups any good?

Any group like this can be helpful because of the supportive role
and the sensible advice they offer. They reinforce the following basic rules.

•Eat less fat and sugar.

•Avoid nibbles.

•Do not miss meals.

•Eat more fruit and vegetables.

•Fill up on low-fat high ﬁbre foods.

•Take regular dynamic exercise, e.g. walking, cycling, swimming – any strong movement exercise.

You have mentioned before that Asians have a higher incidence of coronary disease and diabetes – what dietary changes can they make?

It is true that Asians in particular are vulnerable to coronary disease and diabetes, and have a tendency to abdominal obesity. Try the following tips.

•Fried foods should be avoided.

•Eat low-fat yoghurt, semi-skimmed or skimmed milk and reduced fat cheeses instead of full-fat versions.

•Try casseroling, boiling, grilling, steaming, poaching or microwave cooking instead of adding fat or oil. Some vegetables, such as fenugreek (methi), aubergines and karelas, soak up more oil in during cooking.

•Try to make minced meat dishes and dhals without fat and avoid using oil in the cooking.

•Remove visible fat from meats.

•Do not spread fat on chapattis and do not add oil or ghee to the chapatti dough.

•Reduce deep fried snacks, e.g. chevdon, sev, samosas, puris, pakoras and chips.

•Switch from creamy salad dressing to low-fat yoghurt based dressing.

There is an excellent information sheet on this website: www.heartuk.org.uk (number 03).

We have a full social life and I am often out during the week at business lunches. How can I avoid fatty foods when I am out?

If you are going to family or friends, tell your host that you have been told to lose weight and what you need to do about it. They will understand and because they will now know that you don’t eat fatty foods or sweet desserts, any embarrassment will be avoided.

The following tips apply to eating in restaurants.

•Avoid the cocktails (tomato juice and mineral water are just as fashionable these days).

•Avoid fried appetisers or cream soups – select minestrone or gazpacho soups.

•Choose a fresh fruit starter such as melon.

•Look for the grilled ﬁsh or poultry and ask for any sauces to be left off.

•Grilled Dover sole and a salad are a good standby.

•Remove the skin from poultry and don’t eat fatty meat.

•Take a salad with vinegar and oil instead of mayonnaise.

•At a salad bar, avoid cream dressings, cheese, olives, bacon bits and croûtons.

•Have fresh vegetables such as spinach or carrots. Ask for sauces or butter to be left off vegetables or put ‘on the side’.

•Order baked or boiled new potatoes in their skins.

•At Oriental restaurants, have a stir-fry of chicken or ﬁsh and vegetables. Steamed rice is better than fried. Resist sweet ’n sour dishes and banana or apple fritters.

•In Italian restaurants, avoid creamy sauces.

•In Indian restaurants, have plain tandoori or tikka with a salad and steamed or boiled rice, rather than those dishes which come in thick sauces. Indian cooking involves a lot of fat and sometimes coconut so, in general, menu options should be very carefully selected. Ask if you are not sure how certain dishes are cooked.

•Dessert can be fresh fruit or sorbet – try to avoid cream.

•Enjoy a glass of wine and perhaps ﬁnish with black coffee (decaffeinated if you are prone to palpitations – see Chapter 6).

Some restaurants now have items marked as being low in fat. Airlines also often offer this when meal options are presented.

If you are the host, you can choose the restaurant. If you are a regular at a particular restaurant, tell the owner about your preferences so that you will be able to eat without drawing attention to any question mark over your health.

There are times when I really fancy a steak. Should I never eat this?

An occasional treat is ﬁne. Make sure it is a grilled ﬁllet with the fat
removed. If you are not sure what to eat, always go for the healthy option but, if after a while you feel you ‘could murder a steak’, enjoy one, but don’t overdo it. Remember, a 170–225 g (6–8 oz) ﬁllet steak is the best weight to go for.

What should my intake of fats be?

Your saturated fat intake should represent no more than 10% of your total calories; polyunsaturated fats should make up 10% and monounsaturated fats 10–15%. As 1 g of fat equals 9 kcal:

•if your daily calorie intake is 1500 kcal, you need only 50 g of fat at most;

•if it is 2000 kcal you need 65–70 g of fat, and

•if it is 2500 kcal, you need 85–90 g of fat.

Can you give some simple guidelines regarding calories?
How many should I need on a daily basis?

To calculate the number of calories to maintain your weight now, multiply the number of pounds you weigh by 13 kcal if you don’t take much exercise, and by 15 if you do. The equivalent ﬁgures if you calculate in kilograms are 29 and 33 respectively.

To lose 1 lb you need to burn up 3500 kcal (7700 kcal for 1 kg) and this means reducing your daily intake by 500 kcal to lose 1 lb in one week (550 kcal for 0.5 kg). You can cut down 500 kcal by, for example, cutting out a can of coke, a chocolate bar or 4 teaspoons of sugar.

Weigh yourself once a week and adjust your intake accordingly. Always combine weight loss with a healthy increase in physical activity. For example, if you walk briskly at 4 miles per hour for 2 miles, you will use up 300 kcal.

If you fall below your target weight, increase your calorie intake by 200 kcal a day (around a couple of slices of bread and a thin slice of lean ham) but keep up the exercise programme.

I know I should eat more vegetables and fruit in my diet to lose weight. Which ones have the least calories?

Nearly all vegetables and fruits in general are low in calories and high in nutrients and vitamins. However, dried fruits are high in calories. Vegetables are encouraged because they are very nutritious and low in calories, so you can really go to town with them! Some, especially beans and legumes, are packed with protein and great for using instead of meat dishes (as in lentil lasagne) or to pad out meat-based meals (as in chilli con carne). You do not really need to count the calories but, as a guide, an average portion of the following vegetables is equal to about 20 kcal:

Asparagus	Mushrooms
Aubergine	Onions
Green beans	Parsnips
Broccoli	Peas
Brussels sprouts	Peppers
Cabbage	Radishes
Carrots	Spinach
Cauliﬂower	Tomatoes
Celery	Turnips
Cucumber/courgette	Vegetable juices
Lettuce

The following fruits are each equal to 60 kcal:

1 apple	1 nectarine
4 apricots	1 orange
1 banana	1 peach
12 cherries	3 dates
2 plums	2 ﬁgs
3 prunes	½ grapefruit
2 tangerines	15 grapes
2 tablespoons of raisins	½ mango
1 portion blackberries/melon/ pineapple/strawberries/raspberries

If you buy tinned fruit, make sure that they are in natural juices, not syrup.

What exactly is a ‘portion’?

A portion is one large fruit (such as an apple, orange or banana);
two small fruits (such as plums or satsumas); 1 cup of raspberries, strawberries or grapes; 1 glass (150 ml) of fruit juice; 1 tbsp of dried fruit; 2 tbsp of raw, cooked or frozen vegetables or 1 dessert bowl of salad.

I know there is a good deal of ﬁbre in breads and cereals.
What about their calorie value?

The following are equal to 80 kcal:

•1 slice of bread;

•1 portion of bran cereal (such as All-Bran, one Shredded Wheat) without milk;

•1 portion of pasta or rice.

Remember that high ﬁbre starchy foods are valuable parts of a healthy lifestyle as we have already discussed.

How many calories are there in alcohol?

A glass of wine is 100 kcal, a pint of beer 400 and a single measure
of spirit 100, whereas slimline tonic is at most 1 calorie and water contains nil. Unsweetened fresh fruit juice and sparkling water are very good alternatives to alcohol when you are trying to watch your weight.

I want to be healthy and not overweight – can you summarise for me the most important ways of achieving this?

It is important to think of any change as a healthy change to your lifestyle. Losing weight must be a part of a change to healthy food and a regular exercise programme. It is really a healthy way of living rather than just losing weight. To achieve this, follow these basic rules.

•Eat lots of fruit and vegetables every day.

•Eat high ﬁbre foods which are ﬁlling, healthy and low in fat.

•Try to avoid fatty foods, e.g. bacon, sausages and pies.

•When you have poultry, do not eat the skin.

•Avoid cakes and crisps, which contain a lot of fat.

•Use low-fat yoghurt or fromage frais instead of cream.

•When you cook, steam, grill, bake or microwave food instead of frying.

•When you have canned ﬁsh, drain off the oil (your cat would like it) or use those that come in brine.

•When you have pasta, use tomato-based vegetable sauce rather than creamy sauces.

•When you use fats, even polyunsaturated or olive oil, use it sparingly.

•Try not to nibble nuts.

•Eat slowly.

•Use a smaller plate.

•Cut down on alcohol; drink plenty of water.

•Don’t replace meals by snacks – always eat breakfast.

•Don’t shop when you are hungry.

•Don’t be depressed if you slip up – regroup and start again the next day.

•Try to take dynamic exercise three times a week for at least 30 minutes.

If I miss a meal because I am travelling or I am on business, what can you suggest as an alternative?

Cereal bars, ﬁg rolls, nuts, oat biscuits and rice cakes provide low-fat energy. Fruit is always a good standby – an apple a day may well keep the doctor away after all!