Eat Smart for your Heart

by Lisa Drayer, MA, RD

February is American Heart Month - and with coronary heart disease still ranking as the #1 killer among Americans, it's time that we stop and take a look at how we can prevent this deadly disease. Although having a family history of heart disease does increase our risk, it's important to banish the blame and take a look at the other risk factors that are in our control:

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1. Eat Smaller Meals
A recent study from the American Heart Association found that eating large meals raises your risk of heart attack by about four times, up to two hours after the meal! Portion control is key, because eating too much in one sitting puts extra stress on the heart, especially because the blood flow is directed away from the heart and towards the stomach for digestion, and so the heart has to work that much harder to maintain a constant flow of blood to the rest of the body. In addition to decreasing stress on the heart, controlling portion sizes will help you keep your weight in check, which is another important factor for decreasing risk of heart disease.

Research has also suggested that eating smaller meals, more frequently throughout the day, can positively affect cholesterol levels, thereby reducing heart disease risk. A recent study published in The British Medical Journal found that people who ate 6 or more small meals had lower cholesterol levels than people who ate one or two large meals each day. This supports earlier research published in The New England Journal of Medicine, which found that "nibbling" (i.e. consuming 17 snacks per day) showed metabolic advantages as compared to "gorging" (consuming only 3 meals/day), including lowered total and LDL ('bad') cholesterol levels. Both "nibbling" and "gorging" diets were equal in total calories.

Portion control is simple. Keep your fish and chicken to 3 ounces-which is about the size of the palm of your hand, or a deck of cards, and your pasta and rice to one cup-or about the size of your fist. Also, invest in some measuring spoons and cups-this will enable you to get familiar with the portion sizes of different foods, and you will eventually be able to eyeball servings. And remember--avoid seconds, unless they're vegetables!

2. Include More Fruits, Vegetables, and Low-fat Dairy Foods, and Limit the
Sodium in Your Diet
A recent study published in The New England Journal of Medicine known as DASH-Sodium (Dietary Approaches to Stop Hypertension) showed that following a heart-healthy diet with limited amounts of sodium can greatly reduce blood pressure, a risk factor for heart disease.

The study followed two groups. One was asked to consume a DASH diet-a diet incorporating lots of fruits, vegetables, and low-fat dairy foods, and limiting red meat, sweets, and saturated fats. In previous research, this diet was shown to lower blood pressure levels substantially. Another was given a "typical" American diet. Different sodium levels, including 3,300, 2,400, and 1,500 mg were given to the individuals every four weeks. The study found that the individuals following the DASH diet and limiting sodium to 1500 mg/day experienced the greatest reduction in blood pressure-in fact, as compared to the "typical" diet with 3,300 mg of sodium, the DASH diet with 1500mg of sodium led to a decrease of 11.5 points (systolic) among individuals with high blood pressure, and a 7.1 point decrease among individuals without high blood pressure. For both diets, however, the greater the reduction in sodium, the lower the blood pressure.

While it's a fact that not everyone is sodium sensitive-that is, they experience an increase in blood pressure with high sodium intakes and a decrease in blood pressure with low sodium intakes-it still won't hurt to cut back on salt. Keep in mind that most of the sodium in our diet comes from processed food-such as canned soups and sauces, cured meats, and fast foods.

3. Avoid Foods High in Saturated Fats and Trans Fats, and Consume More Monounsaturated Fats and Omega-3 Fatty Acids
Saturated fats in the diet increase cholesterol levels even moreso than dietary cholesterol! Specifically, saturated fats increase LDL, or the "bad" cholesterol, and decrease HDL levels, also known as the "good" cholesterol. Sources of saturated fats include: butter, lard, cream, full-fat dairy products, red meat, palm oil, and coconut oil. It's best to limit these foods much as possible.

By increasing LDL cholesterol to the same extent as saturated fats, trans fats (formed when vegetable oils undergo a process known as "hydrogenation") also increase risk of heart disease. Trans fats are found in margarine, French fries, and commercially prepared foods such as cookies and cakes. Right now, trans fats are not required to be written on food labels. (That will hopefully change soon). So in the meantime, look for the words "partially hydrogenated vegetable oil" on food labels-if this listed as one of the first ingredients on a food label, and if the food is high in total fat, then you can count on the food being high in trans fats.

On the other hand, monounsaturated fats lower LDL levels and keep HDL levels the same (in fact, some studies show that they increase HDL levels), and sources of these fats include almonds, walnuts, peanuts, avocados, peanut butter, olive oil and canola oil. Omega-3 fatty acids, which are a type of polyunsaturated fat, also have a protective effect on the heart by preventing blood clotting. Sources of omega-3s include fatty fish, such as salmon and mackerel, as well as vegetable oils and flax seeds.

(Note: Although shrimp is high in cholesterol, it's low in saturated fat, and is free of trans fats. Thus, it can be enjoyed even among those with high risk of heart disease!)

4. Experiment with Soy Protein
Studies have shown that soy protein, which is found in tofu, tempeh, and soy-based meat alternatives, can reduce LDL cholesterol levels. Specifically, research has shown that 25 grams of soy protein per day can lower high "LDL" or "bad" cholesterol levels by about 10%. This research is the basis of a current food claim approved by the Food and Drug Administration--the claim states that diets low in saturated fat and cholesterol that include 25 grams of soy protein each day may reduce the risk of heart disease. (According to the FDA, foods must contain at least 6.25 grams of soy protein per serving to qualify for the claim).

Researchers believe that the isoflavones in soy (which are estrogen-like compounds) play a role in soy's cholesterol-lowering effects. Since the isoflavones in soy may indeed act like estrogen, however, they have the potential to promote the growth of breast tumors. The research isn't clear, so if you have breast cancer or are at high risk for the disease, then it's best to avoid large quantities of soy.
A good way to get soy protein with its isoflavones is to try some of the soy products in the supermarkets-such as the vegetarian burgers and hot dogs, or a soymilk such as Silk. You can also try a protein powder, which can be stirred into various beverages. Although soy bars are also a good source of soy protein, many contain excess calories. Still sound unappetizing? Head over to the local bookstore, pick up a soy cookbook, and try some recipes!

5. Enjoy Chocolate in Moderation
Yes, Valentine's Day is around the corner, and if you can't get excited about a loved one, get excited about chocolate. Why? Because in addition to the fact that it tastes great, research has shown that chocolate offers us health benefits. Chocolate contains antioxidants known as catechins, and these substances may help to reduce the risk of heart disease by decreasing the harmful effects of LDL, or "bad" cholesterol. Preliminary research (funded by Mars, Inc.) suggested that the antioxidants in chocolate do help to inhibit the oxidation of LDL particles, thereby reducing the risk of heart attack and stroke.

Another recent study found that the catechin content of chocolate is four times greater than tea! According to the study, Dark chocolate had the highest total catechin content (53.5 mg per 100 g), milk chocolate contained 15.9 mg per 100 g, and black tea contained only 13.9 mg per 100 mL. In addition, a new study from Pennsylvania State University further supported the fact that flavonoid-rich chocolate, in moderation, is beneficial for cardiovascular health.

Research also suggests that unlike other saturated fats, the stearic acid in chocolate (a saturated fat) may not increase LDL cholesterol.

But don't forget, when it comes to the bottom line, fruits and vegetables are more nutritious sources of antioxidants, and chocolate offers us lots of calories...so be careful if you're watching your waistline!

And an Extra Note: Be sure to exercise! Research shows that cardiovascular exercise increases HDL cholesterol levels, which lowers the ratio of Total cholesterol/HDL, of which high levels is an indicator of heart disease risk. Aerobic exercise also helps us burn extra calories and can increase our metabolism for up to 8 hours after we stop exercising.

Check out Calorie Lab's calorie calculator to see how many calories in your favorite Valentine's candies!

First Published: February 2002
Updated: April 2007

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