Eating well is one of the joys of life. Because you want foods that both taste good and promote good health, this cookbook offers you lots of excellent choices ranging from appetizers to desserts, all high in flavor but low in saturated fat, trans fat, and cholesterol. These three substances—especially saturated fat—are the dietary villains that cause your blood levels of harmful low-density lipoprotein cholesterol (LDL, the “bad” cholesterol) to rise. That’s a serious concern because high cholesterol is a major risk factor for heart disease. The more LDL cholesterol circulating in your blood, the greater your risk.
You can take three important steps to help manage your risk of heart disease. First, assess your personal situation and identify all your risk factors. Second, start reducing your LDL cholesterol level—and other risk factors—by making smart decisions about your diet and lifestyle. Third, commit to making good choices for the long term to live a longer, healthier life.
The first step is to assess your individual risk for heart disease. Risk factors are the behaviors and conditions that increase your chance of developing a disease. Some risk factors—aging and the medical history of your family—can’t be changed. Fortunately, most risk factors can be changed. Lifestyle choices such as smoking and physical inactivity, as well as conditions such as high blood cholesterol, high blood pressure, overweight and obesity, and diabetes, are all factors that you can do something about. In fact, heart disease is largely preventable.
Before you can make changes, though, you need to identify the risk factors you can personally control. For example, your levels of total cholesterol, LDL cholesterol, and high-density lipoprotein cholesterol (HDL, the “good” cholesterol)—determined with a simple blood test—help identify your risk of heart disease. (Refer to Appendix D for a detailed explanation of how cholesterol affects your heart health.) If you don’t know your numbers for blood cholesterol, blood pressure, and blood glucose, visit your healthcare provider and find out what they are.
When your numbers are available, go through this Risk Assessment checklist. The more factors you check, the higher your risk of heart disease. (For more information, see Appendix E.) For a complete personalized risk assessment, talk with your healthcare provider.
Risk factors you cannot change:
□ Age, if you’re a man over 45 years or if you’re a woman over 55 years
□ Family history of premature heart disease
Risk factors you can change:
□ Weight if you are overweight or obese (see the BMI chart on this page)
□ Waist measurement of 35 inches or more for a woman or 40 inches or more for a man
□ Total cholesterol of 240 mg/dL or more (see the chart on this page)
□ LDL (“bad”) cholesterol of 100 mg/dL or more
□ HDL (“good”) cholesterol less than 40 mg/dL for a man or less than 50 mg/dL for a woman
□ Blood pressure of 130/85 mm Hg or more
□ Triglyceride level of 150 mg/dL or more
□ Blood glucose level of 100 mg/dL or more
□ Less than 30 minutes of physical activity on most days
□ Smoking or exposure to secondhand smoke
*mg/dL indicates milligrams per deciliter; mm Hg, milliliters of mercury
The cholesterol measured in your blood, or serum cholesterol, is produced by your liver to meet your body’s needs. The cholesterol in foods, or dietary cholesterol, comes from animal sources—meats, poultry, seafood, and fat-containing dairy products such as ice cream, whole milk, and 2%-fat milk. (Plant foods do not contain cholesterol.) Consistently eating foods high in saturated fat, trans fat, and dietary cholesterol can cause your liver to produce extra cholesterol, raising your blood cholesterol level. That’s why it’s important to know what you’re eating and what to cut back on to keep your blood cholesterol low. Once you know your cholesterol numbers, you’ll have a better idea of your level of risk.
Desirable: less than 200 mg/dL
Borderline-high risk: 200 to 239 mg/dL
High risk: 240 mg/dL and above
LDL Cholesterol
Optimal (ideal): less than 100 mg/dL*
Near optimal/above optimal: 100 to 129 mg/dL
Borderline-high risk: 130 to 159 mg/dL
High risk: 160 to 189 mg/dL
Very high risk: 190 mg/dL and above
HDL Cholesterol
Major risk factor for heart disease: less than 40 mg/dL for a man and less than 50 mg/dL for a woman
Some protection against heart disease: 60 mg/dL and above
*Your other risk factors help determine what your LDL level should be. A healthy level for you may not be healthy for your friend or neighbor. If you have metabolic syndrome in addition to heart disease, your healthcare provider will assess your risk factors and decide whether an LDL goal of less than 70 is right for you, especially if your triglyceride level is 200 or higher and your HDL is less than 40.
The main goal in treating high total cholesterol is to lower your LDL level. Reducing your LDL can slow, stop, or even reverse the buildup of plaque in your arteries that can lead to a heart attack (see Appendix D for more information). Many variables affect the amount of cholesterol your body produces and how much of it is in the form of LDL cholesterol, HDL cholesterol, or triglycerides (other fats present in your blood). By changing some of these variables, especially your dietary habits and lifestyle choices, you can help reduce your level of blood cholesterol.
As a general rule, if you reduce your total cholesterol level by 1 percent, you reduce your heart attack risk by 2 percent. This means that if, for example, you reduce your blood cholesterol from 250 to 200 mg/dL (a 20 percent decrease), you could reduce your heart attack risk by 40 percent.
Be sure to schedule regular visits with your healthcare provider to monitor your individual situation. Depending on your cholesterol levels and your other risk factors, decide together on target goals and the best approach to reach them. How much you have to modify your diet and lifestyle depends on several things, including your other risk factors and how your body responds to changes in your diet. For many people, relatively minor changes can reduce their risk significantly. Others need to make more extensive lifestyle changes.
The second step toward managing your risk of heart disease and stroke is to make smart decisions about your diet and lifestyle. Eating well and being physically active are the best ways to start managing your LDL cholesterol and other modifiable risk factors. If your healthcare provider also prescribes cholesterol-lowering drugs, you still should modify your diet and lifestyle. These changes not only lower cholesterol but also help control many of the other risk factors for heart disease, including high blood pressure, overweight and obesity, and diabetes.
The main components of a lifestyle approach to lowering cholesterol are:
• A heart-healthy eating plan
• Physical activity
• Weight management
The more research we do, the more we understand how the foods you eat affect the levels of cholesterol in your blood. If you replace the foods in your diet that are high in saturated fat, trans fat, and cholesterol with nutritious foods that are not, you will naturally reduce your blood cholesterol levels. The recommendations here and in “Healthy Food, Healthy Heart” are designed to help you do just that.
Reduce saturated fat to 7 percent and trans fat to 1 percent of your daily calories. Saturated fat, which is found in animal products and some plant products, raises blood cholesterol more than anything else in your diet. Trans fat, found primarily in commercial products made with or fried in partially hydrogenated oils, also increases cholesterol. However, the typical American diet includes far more saturated fat than trans fat. In fact, most people currently take in an average of about 11 percent of their calories from saturated fat compared with about 2.5 percent from trans fat. When you choose foods in restaurants or for meals you prepare at home, try to limit both of these fats. See “Fats and Oils,”, for suggestions on how to replace harmful saturated and trans fats with helpful unsaturated oils.
Keep total fat to between 25 and 35 percent of your daily calories. It’s the type of fat more than how much fat you consume that most affects your blood cholesterol level. On the other hand, all fats are high in calories (about 9 calories in each gram of fat, regardless of type, as opposed to 4 calories in proteins and carbohydrates), and eating too much of any fat can lead to adding too many calories, which causes weight gain. The range in the recommended percentage of total fat allows you to decide how much is right for you.
Reduce dietary cholesterol to less than 200 mg a day. The cholesterol in the foods you eat adds to the amount of cholesterol in your blood, but not as significantly as saturated fat. Dietary cholesterol comes exclusively from animal products, such as meats (especially organ meats), poultry, seafood, egg yolks, and dairy products containing fat, including cheeses and butter. These foods are usually high in saturated fat as well as cholesterol, so by limiting one you can help reduce the other.
See the chart on this page for a list of common ingredients that contain cholesterol and saturated fat. this page–this page, “Make Healthy Food Choices,” offer practical tips on how you can choose wisely to eat less cholesterol.
Gradually increase your daily intake of soluble fiber to 10 to 25 grams. Fiber is the part of food that we cannot digest, but it plays an important role in good health. Of the two types, soluble and insoluble, only soluble fiber helps reduce LDL cholesterol. Studies show that when combined with a diet low in saturated fat and cholesterol, eating between 5 and 10 grams of soluble fiber each day may help reduce LDL cholesterol by up to 5 percent. Eating fiber-rich foods can also help you eat less by making you feel fuller. Increase your fiber intake gradually to avoid abdominal cramps or bloating.
• Whole grains, such as oatmeal and barley, are fantastic sources of fiber. Include hot or cold cereals in your routine to easily increase your daily intake.
• Eat whole fruits or vegetables instead of drinking juices. One medium orange has three times the fiber of 6 ounces of juice.
• Fiber-containing foods include apples, bananas, pears, oranges, grapefruit, strawberries, raspberries, nuts, broccoli, carrots, brussels sprouts, and legumes, such as black beans, kidney beans, lima beans, chickpeas, and lentils.
Include 2 grams of plant stanols and sterols in your diet if needed to further lower cholesterol. Studies have shown that including about 2 grams of stanols and/or sterols in your diet may help further reduce levels of LDL cholesterol. Stanols and sterols, which occur naturally in many plants, have been added to some margarines and other foods to make them readily available. (For use in commercial foods, the stanols and sterols are isolated from soybean oil and oil from tall pine trees.) Remember that foods containing stanols and/or sterols are not calorie-free. If you use these products, you may need to offset the calories by cutting back elsewhere.
If you think you might benefit from adding stanols or sterols to your diet, ask your healthcare provider whether this option should be part of your eating plan and which foods would be the best choices for you.
Several other dietary factors have important effects on your heart health even though they do not directly relate to your cholesterol level.
Limit sodium intake. People with high cholesterol often also have high blood pressure. Eating a healthy diet, being physically active, and limiting your sodium intake to less than 2,300 milligrams per day are the first steps to managing your blood pressure. For the most benefit, your goal should be even lower. Reducing the amount of sodium in your diet helps lower your blood pressure or even prevents it from rising.
Certain people—African Americans, middle-aged and older adults, and people with high blood pressure—should aim for less than 1,500 milligrams of sodium each day.
Increase intake of omega-3 fatty acids. Research suggests that increased intake of omega-3 fatty acids—which are found in fish such as salmon, halibut, mackerel, and tuna—reduces the risk for heart attack and death from heart disease. We recommend that you eat at least two servings of fish rich in omega-3 fatty acids every week. If you already have heart disease or high blood triglyceride levels, your healthcare professional may recommend fish oil supplements to help increase your intake of omega-3 fatty acids.
Although nearly all fish and shellfish may contain mercury and other contaminants, the health risks from mercury exposure depend on the amount of seafood eaten and the levels of mercury in the fish itself. Eating a variety of fish will help minimize the possible adverse effects caused by pollutants in the environment. Women who are pregnant, planning to become pregnant, or nursing—and young children—should avoid eating potentially contaminated fish. For most people, however, the benefits of eating fish far outweigh the risks.
Use alcohol in moderation. Studies have shown that moderate intake of alcohol may reduce risk for heart disease. High alcohol intake, however, can have dangerous consequences. Alcohol also adds calories to your diet without adding nutrients. If you do drink alcohol, do so in moderation. If you don’t drink, don’t start.
Drinking in moderation means no more than one drink per day for women or two drinks per day for men. One drink is equal to 12 ounces of beer, 4 ounces of wine, or 1½ ounces of 80-proof distilled spirits.
We know that regular physical activity protects against heart disease. It increases levels of helpful HDL cholesterol and in some people reduces LDL cholesterol. It also helps you manage your weight and reduce your blood pressure. We recommend that you aim for at least 30 minutes of moderate-intensity physical activity on five days of each week or 20 minutes of vigorous activity on three days. You can break your activity into sessions of 10 minutes or more and include moderate-intensity activities you might not consider “exercise,” such as gardening and housework, that add up during the day. In addition to the health benefits you’ll gain from being active, you’ll probably find you feel better, have more energy, and can make other lifestyle changes more easily.
Use the following chart to estimate how many calories you can burn in various activities at different intensities. Your current weight and gender affect the number of calories you use, and the more muscular you are, the more calories you burn. The numbers given are for a person of about 150 pounds. If you weigh more, you will burn more, and if you weigh less, you will burn fewer calories.
It’s a good idea to talk with your healthcare provider before starting an exercise program if you haven’t exercised for a long time. Likewise, if you have had a heart attack or have a medical condition (such as high blood pressure, high cholesterol, diabetes, or obesity), take prescription medication, are a smoker, are over 65, or are at risk for heart disease because of family history, it’s important to discuss your situation with your healthcare professional.
Adapted from Your Guide to Physical Activity and Your Heart, U.S. Department of Health and Human Services, NIH Publication No. 06-5714.
It’s one thing to read about what you “should” do to stay healthy, but it’s another to decide to make those recommendations a real part of your life. Recognizing the habits that keep you from effectively managing your weight will help you adopt the behaviors that lead to a longer, stronger life.
Determine how many total calories you need each day. Each of us needs an ideal number of calories to maintain a healthy weight. You can estimate how many daily calories you need based on your age, gender, and level of physical activity. (The footnotes in the chart on this page will give you an idea of which level is most accurate for you.) Remember that as you age, you’ll need fewer calories to maintain your weight even if you stay at the same level of activity.
Maintain your calorie balance. To avoid weight gain, you should burn at least as many calories as you eat every day. Calories in should equal calories out. If you consistently take in more calories than you need for your age and level of physical activity, you will gradually gain weight. Everyone is different, but the chart on this page should give you an idea of what you need to maintain your individual calorie balance. For example, if you are a 35-year-old woman who is moderately active, you will usually burn about 2,000 calories a day. To maintain your calorie balance—and your current weight—you should eat no more than about 2,000 calories a day.
Sedentary means you have a lifestyle that includes only the light physical activity associated with typical day-to-day life.
Moderately active means you have a lifestyle that includes physical activity equivalent to walking about 1.5 to 3 miles per day at 3 to 4 miles per hour, in addition to the light physical activity associated with typical day-to-day life.
Active means you have a lifestyle that includes physical activity equivalent to walking more than 3 miles per day at 3 to 4 miles per hour, in addition to the light physical activity associated with typical day-to-day life.
Know when to lose weight. Being overweight or obese increases your likelihood of developing heart disease and stroke even if you have no other risk factors. Excess weight reduces levels of helpful HDL cholesterol and may raise levels of harmful LDL cholesterol. Your risk is significantly greater if you’re a man with a waist measuring more than 40 inches or a woman with a waist more than 35 inches. Losing weight—even as little as 10 pounds—can help reduce your LDL cholesterol levels.
You can use the body mass index (BMI) to see whether you are overweight. This standard method classifies body weight based on your weight and height. If you fall in the overweight or obese category, think about beginning a weight-loss plan. Aim to reestablish your calorie balance to maintain a healthy weight. To find your BMI, weigh yourself without clothes or shoes. Measure your height without shoes. Find your height in the left-hand column of the chart on this page and see which range your weight falls into.
To calculate your exact BMI, multiply your weight in pounds by 705. Divide the product by your height in inches; divide again by your height in inches. If you have a BMI of 30 or above, you should discuss a weight-loss plan with your healthcare provider.
A BMI from 18.5 to 24.9 is considered healthy. A BMI from 25.0 to 29.9 is considered overweight and indicates a moderate risk of heart and blood vessel disease. A BMI of 25 translates to about 10 percent over ideal body weight. A BMI over 30 indicates a high risk of heart and blood vessel disease.
Understand serving sizes and use portion control. Research shows that portions have increased dramatically in the last 20 years. Americans eat more at each meal than ever before. It isn’t necessary, however, to count calories and measure out exact amounts every day to keep portions in line with calorie needs. Instead, learn to visualize reasonable servings of different foods.
Think in terms of the size of common objects:
• 3 ounces of cooked meat, poultry, or fish is the size of a deck of cards.
• 1½ ounces of cheese is the size of a 1½-inch cube.
• 1 medium baked potato is the size of an average fist.
• 1-cup servings are the size of a baseball.
You can use these visualizations to serve the appropriate portions at home, and when you go to a restaurant, eat only that size portion and take home the rest.
Finally, the third step in managing risk is to commit to a lifestyle that promotes a longer, healthier life. Remember that heart disease is largely preventable. If you eat wisely, stay physically active, and follow the recommendations of your healthcare provider, chances are you will:
• Reduce your likelihood of developing high blood cholesterol if you don’t have it.
• Reduce your cholesterol levels if they are high.
• Reduce your risk of developing heart disease and having a stroke.
By consistently making healthy choices throughout your life, you and your family will reap long-lasting benefits for many years to come.
