VIDEO
The Best Diet for Preventing Heart Disease
Diet
There has been a lot of talk about diet 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.
Fats
Fats or lipids and 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 labeled ‘high in polyunsaturates’; these fats can lower cholesterol;
• Monounsaturates, found in olive and rapeseed oil.
Content of omega-3 polyunsaturated fatty acids in oily fish
Oily fish -Omega-3 content (g per 100g)
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. 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, 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 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
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.
A guide to healthy eating
Food types – Everyday foods
Cereals and breads – Flour and bread, pasta, breakfast cereals and porridge oats
Vegetables, fruit and pulses – Most kinds (fresh, dried, canned, frozen).
Tofu and other soya products – Nuts Nuts may be included in vegetarian diets to replace meats
Fish – Sardines, tuna, salmon, mackerel, trout, white fish (including haddock, cod, plaice) – steamed, grilled or baked, not fried
Meat – Chicken, turkey (both without skin), veal, lean ham
Eggs and dairy foods – Skimmed milk, cottage cheese, curd cheese, egg whites, low-fat yoghurt, low-fat fromage frais
Fats – All fats need to be limited
Preserves, spreads and sweets artificial sweeteners
Cakes, biscuits and desserts – Home-made cakes and biscuits made using low-fat recipes; jellies, sorbets, skimmed-milk puddings
Drinks – Tea, coffee, water, fruit juice, low-calorie soft drinks, clear soups
Other miscellaneous foods – Herbs, spices, mustard, vinegar, Worcester sauce, fat-free or low-fat salad dressings
* Information from Trim the fat from your diet, published by the British Heart Foundation
Eat in moderation – Eat with caution
Water biscuits; plain semi-sweet biscuits (e.g. rich tea, digestive) (once a week) cream crackers – Fancy bread and pastries, (e.g. croissants, brioches)
Chips and roast potatoes cooked oil marked High in polyunsaturates or olive oil (once a fortnight); avocados olives, lower-fat crisps (once a week) – Crisps, chips cooked in oil other than olive oil or oil marked High in polyunsaturates
Most nuts (use a few only) – Coconut
Shellfish (e.g. lobster, crab, prawns) – Any fish in batter, fish roe (e.g. taramasalata)
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
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
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
Jam, marmalade, honey, boiled sweets, fruit pastilles, sugar, peanut butter – Chocolates, toffees, fudge, mincemeat containing suet, chocolate spread
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 ice-cream
Packet soups, alcohol, low-fat drinking chocolate and malted drinks – Cream soups, full-fat milk drinks and shakes, cream-based drinks
Low-calorie salad cream and mayonnaise, French dressing made with polyunsaturated or olive oil – Salad cream, mayonnaise, creamy dressings
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 cholesterolin 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.
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. 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 (6oz) 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, and pâté);
• Avoid high cholesterol organ meats (offal, e.g. liver, kidneys, and 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). 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 margarine 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. 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
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 2g, taken daily at night.
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 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, barbecue – ing, 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.
