A Heart Healthy Diet

© Copyright 1999 Dialog Medical, Inc. All rights reserved.

Improve Your Diet - Eating a Heart Healthy Diet

A diet lower in saturated fat and cholesterol than the average American diet is a healthy way for the whole family to eat (except infants under 2 years who need more calories from fat). If you have heart disease and need to lower your blood cholesterol level more than someone who does not have heart disease, you will probably be advised by your doctor to follow a Step II diet, which is lower in saturated fat and cholesterol than the diet the rest of your family may wish to follow. Because this Step II diet may include many changes to your current eating plan, your doctor may refer you to a registered dietitian who can help you make these changes.

On the Step II diet, you should eat:

• Less than 7 percent of the day's total calories from saturated fat.
• 30 percent or less of the day's total calories from fat.
• Less than 200 milligrams of dietary cholesterol a day.
• Just enough calories to achieve and maintain a healthy weight. (Ask your doctor or registered dietitian what is a reasonable calorie level for you.)

The recommendations for saturated fat and total fat are based on a percentage of the total calories you eat; the actual amount you can eat daily will vary depending on how many total calories you eat. See the chart below to get an idea of the number of grams of saturated fat and total fat you should be eating.

Step II Recommendations for Saturated Fat and Total Fat

According to Total Calorie Level

Total Calories 1,200 1,500 1,800 2,000 2,500

Saturated fat (grams)* 8 10 12 13 17

Total fat (grams)** 40 50 60 65 780

* One gram of fat equals 9 calories. Amounts are equal to 6 percent of total calories for

Step II; your intake should be this much or less.

** Amounts are equal to 30 percent of total calories (rounded down to the nearest 5).

NOTE: On average, women consume about 1,800 calories a day and men consume about 2,500 calories a day.

Next, here are some general ways to lower blood cholesterol through your diet:

• Choose foods low in saturated fat.

  All foods that contain fat have different mixtures of saturated and unsaturated fats. Saturated fat raises your blood cholesterol level more than anything else that you
  eat. It is found in greatest amounts in foods from animals, such as fatty cuts of meat, poultry with the skin, whole-milk dairy products, and lard, and in tropical oils like coconut, palm kernel, and palm oils. Most other vegetable oils are low in saturated fats. The best way to reduce your blood cholesterol level is to choose foods low in saturated
  fat. One way to do this is by choosing foods such as fruit, vegetables, and whole grain foods, which are naturally low in fat and high in starch and fiber. You should read the
  food labels in the grocery store to help you choose foods that are low in saturated fat.

• Choose foods low in total fat.

  Since many foods high in total fat are also high in saturated fat, eating foods low in total fat will help you eat less saturated fat. Any type of fat is a rich source of calories, so eating foods low in fat should also help you eat fewer calories, which will help you lose weight. If you are overweight, losing weight is an important part of lowering your blood cholesterol. When you do eat fat, you should substitute unsaturated fat for saturated fat. Unsaturated fat can be either monounsaturated or polyunsaturated. Examples of foods high in monounsaturated fat are olive and canola oils. Those high in polyunsaturated fats are safflower, sunflower, corn, and soybean oils. The food label is your best guide to how much total fat, saturated fat, and unsaturated fat and how many
  calories are in the foods you buy.

• Choose foods low in cholesterol.

  Dietary cholesterol also can raise your blood cholesterol level, although usually not as much as saturated fat. So it is important to choose foods low in dietary cholesterol. Dietary cholesterol is found only in foods that come from animals. Many of these foods also are high in saturated fat. Foods from plant sources do not have cholesterol but
  can contain saturated fat. Use the food label when shopping to choose foods low in cholesterol.

• Choose foods high in starch and fiber.

  Foods high in starch and fiber are excellent substitutes for foods high in saturated fat. These foods--breads, cereals, pasta, grains, fruits, and vegetables--are low in saturated
  fat and cholesterol, unless fat is added in their preparation. They are also usually lower in calories than foods that are high in fat. Foods high in starch and fiber are also good sources of vitamins and minerals.

• A word about sodium.

  If you have high blood pressure as well as high blood cholesterol (and many people do), your doctor may tell you to cut down on sodium or salt. As long as you are working on getting your blood cholesterol number down, this is a good time to work on your blood pressure, too. Try to limit your sodium intake to 2,400 milligrams a day.

Practical Ways To Change Your Diet

Here are some tips on how to choose foods for the Step II diet.

To cut back on saturated fats, choose:

• Poultry, fish, and lean cuts of meat. Remove the skin from chicken and trim the fat from meat before cooking.
• Skim or 1 percent milk instead of 2 percent or whole milk.
• Cheeses with no more than 3 grams of fat per ounce (these include low-fat cottage cheese or other low-fat cheeses). Cut down on full-fat processed, natural, and hard cheeses (like American, brie, and cheddar).
• Low-fat or non-fat yogurt, sour cream, and cream cheese instead of the high-fat varieties.
• Liquid vegetable oils that are high in unsaturated fat (these include canola, corn, olive, and safflower oil).
• Margarine made with unsaturated liquid vegetable oil as the first ingredient rather than hydrogenated or partially hydrogenated oil. Choose tub or liquid margarine or vegetable oil spreads. The softer the margarine, the more unsaturated it is. If you are watching your sodium intake, try unsalted margarine. Use the food label to choose margarines with the least amount of saturated fat.
• Fewer commercially prepared and processed foods made with saturated or hydrogenated fats or oils (like cakes, cookies, and crackers).
• Foods high in starch and fiber such as whole wheat breads and cereals instead of foods high in saturated fats.

Cutting back on saturated fat helps you to control dietary cholesterol as well, because cholesterol and saturated fat are often, but not always, found together in the same foods. Two additional points to remember when cutting back on
dietary cholesterol are:

• Strictly limit organ meat (such as liver, brain, and kidney).
• Eat a total of two or fewer egg yolks a week (as whole eggs or in prepared foods). Try substituting two egg whites for each whole egg in recipes, or using an egg substitute.

To include more foods high in starch and fiber, choose:

• More vegetables and fruits. It is recommended that Americans eat five servings of fruits and vegetables every day. They are low in saturated fat and total fat and have no cholesterol. Fruits and vegetables are good sources of starch, fiber, vitamins, and minerals and are low in sodium. They are also low in calories (which helps with weight control) except for avocados and olives, which are high in both fat and calories. Many
  fruits and vegetables are also high in vitamin C, vitamin E, and beta-carotene--so-called "antioxidants." A diet high in these fruits and vegetables may also help to lower risk for heart disease. So fruits and vegetables are great substitutes for foods high in saturated fat and cholesterol.
• Whole grain breads and cereals, pasta, rice, and dry peas and beans.

You should also cook the low-fat way:

• Bake, broil, microwave, poach, or roast instead of breading and frying.
• When you roast, place the meat on a rack so the fat can drip away.

Read Food Labels

We've already mentioned that reading food labels will help you choose foods low in saturated fat, total fat, cholesterol, and calories. Food labels have two important
parts: nutrition information and an ingredients list.

Read the nutrition information.

Look for the amount of saturated fat, total fat, cholesterol, and calories in a serving of the product. Compare similar products to find the one with the least amounts. If you have high blood pressure, do the same for sodium.

Look at the ingredients.

All food labels list the product's ingredients in order by weight. The ingredient in the greatest amount is listed first. The ingredient in the least amount is listed last. So, to choose foods low in saturated fat or total fat, limit your use of products that list any fat or oil first--or that list many fat and oil ingredients. If you are watching your sodium intake, do the same for sodium or salt.

How Soon Will You See Results?

Generally your blood cholesterol level should show a drop a few weeks after you start on the Step II diet. LDL- cholesterol levels should be measured after being on the diet for 3 to 4 weeks. You should set up a schedule for followup cholesterol measurements with your doctor. This schedule will depend on your specific cholesterol level and management program. If your LDL is still too high, your doctor may want you to begin cholesterol-lowering medicine. Once you have reached your goal for LDL-cholesterol, long-term monitoring can begin.

How Much Cholesterol Reduction Can You Expect?

How effective diet is in lowering your LDL-cholesterol level depends on your dietary habits before starting the diet, how well you follow your diet, and how your body responds to your new way of eating. In general, those with higher cholesterol levels have greater reductions in LDL- cholesterol levels than those with lower starting levels.
If you are overweight and lose weight, a low-fat diet may work even better to lower your high cholesterol.

Dietary equations predict that the Step II diet can reduce total cholesterol levels in CHD patients who are consuming an average American diet by about 8 to 14 percent. Many
people with CHD and elevated cholesterol levels consume more saturated fat and cholesterol and have higher blood cholesterol levels than average and will have an even bigger reduction. Every 1 percent reduction in cholesterol levels lowers your risk for a future heart attack by about 2 percent. So an 8 to 14 percent reduction in cholesterol
levels from the Step II diet would lower the CHD risk by about 16 to 28 percent.

Lifetime Changes in Diet

Many people find that advice from a registered dietitian or other qualified nutritionist can help them to be more successful with the Step II diet. Whoever prepares the meals in your house should also participate in these sessions. Your new diet should be maintained for life. You may want to continue diet education sessions with your dietitian quarterly for the first year of long-term monitoring and twice yearly thereafter.

© Copyright 1999 Dialog Medical, Inc. All rights reserved.