Risk factors

Nutrition guidelines for healthy eating

Eat for a Healthy Heart. A well-balanced diet and exercise can help you to lower your total cholesterol and lose weight, which can slow or even stop the progression of artery-clogging atherosclerosis. In some cases, a low fat and cholesterol diet may even work to reverse fatty buildup in the artery walls.

Frequently asked questions (FAQs)

What are the different types of fat?
Saturated fats are solid at room temperature and raise blood cholesterol. Most are naturally found in animal products, butter, lard, meats, poultry skin, cheese and other dairy products made from whole or 2 percent reduced fat milk, and tropical oils (like palm, palm kernel, and coconut oils).

Trans fats can raise LDL (bad) cholesterol and lower HDL (good) cholesterol so they should be kept to a minimum in your diet. While they occur naturally in some animal fats, the majority comes from partially hydrogenated oils. Trans fats are found in many commercial baked goods, fried foods, snacks and other foods made with partially hydrogenated vegetable oils, vegetable shortening and stick margarine. The Nutrition Facts label now lists the amount of trans fats in food.

Unsaturated fats can help reduce LDL cholesterol levels when they replace saturated fats in the diet. If they are simply added to the diet instead of used to replace saturated fat, they will just make the diet higher in fat. The main types include:

• Polyunsaturated fats can decrease total and bad cholesterol levels when they replace saturated fats in the diet. They are found in vegetable oils such as safflower, sunflower, corn, soybean, sesame and cottonseed.
• Omega 3 Fatty Acids are a type of polyunsaturated fat and are found in some fatty fish, such as salmon, tuna, and mackerel, and in some plant sources, such as nuts, soy, canola and flaxseed oil. They may help prevent blood clots from forming and prevent hardening of the artery walls. Current guidelines recommend two fish meals per week. Pregnant and nursing women should avoid eating fish high in mercury. Visit What You Need to Know About Mercury in Fish and Shellfish.
• Monounsaturated fats are found in olives, olive oil, avocados, canola oil, peanut oil, and most nuts. These types of fat also decrease total and bad cholesterol levels. They may also increase good cholesterol when they take the place of saturated fats.

What are my daily fat gram goals?
The National Cholesterol Education Program (NCEP) recommends limiting total fat to 25-35 percent of your total calories and saturated fat to 7 percent of total calories. What does that mean when it comes to your specific needs?

Daily fat limits based on calorie needs

How much cholesterol should be in my diet?
Cholesterol is a waxy substance produced by our body. It is also found in many foods we eat, but only in animal products. Major sources include egg yolks, organ meats, meat, shellfish, poultry and dairy products. The American Heart Association recommends no more than 300 milligrams of dietary cholesterol per day (200 milligrams per day for those with coronary artery disease) to help control serum cholesterol levels.

What about sodium?
The Dietary Guidelines for Americans recommends limiting daily sodium intake to 2,300 milligrams, which is equal to a single teaspoon! Sodium helps your body maintain water balance. Too much sodium can cause fluid buildup or elevated blood pressure. This puts extra strain on the heart and can make medications less effective. Consider replacing table salt with herbs and spices. Use fresh foods instead of processed, canned, prepackaged and convenience foods to limit the amount of salt in your diet.

What are triglycerides?
The body stores fat as triglycerides. Triglyceride levels in the blood may be raised by extra body weight. In some people, triglyceride levels may be raised by eating too much fat, too many sweets or drinking alcohol.

Cholesterol: What the numbers mean
The National Cholesterol Education Program of the National Heart, Lung and Blood Institute recommends every adult have a total blood cholesterol screening. Total blood cholesterol is the most common cholesterol measurement. It is measured in milligrams per deciliter of blood (mg/dL). Knowing your total blood cholesterol is among the first steps in determining your risk for heart disease.

Your total blood cholesterol is made up of different components: LDL, low density lipoprotein or "bad" cholesterol, and HDL, high density lipoprotein or "good" cholesterol. Below are the goals from the National Institute of Health’s Therapeutic Lifestyle Changes (TLC) program.

Total blood cholesterol is classified by levels:

• Desirable: under 200 mg/dL
• Borderline: 200-239 mg/dL
• High risk: 240 mg/dL and above

LDL Cholesterol:
• Optimal (ideal): Less than 100 mg/dL
• Near optimal/above optimal: 100-129 mg/dL
• Borderline high: 130-159 mg/dL
• High: 160-189 mg/dL
• Very high: 190 mg/dL and above

HDL Cholesterol:

• Major heart disease risk factor: less than 40 mg/dL
• Protection against heart disease: 60 mg/dL and above

Other Dietary Factors that Promote Heart Health
Plant Stanols and Sterols help block the absorption of cholesterol from the digestive tract. Studies show that a daily intake of about two grams of either stanols or sterols reduces cholesterol by about 5–15 percent. Stanols and sterols are added to certain margarines, salad dressing and some orange juices.

Soluble Fiber also helps to lower cholesterol. It dissolves into a gel-like substance in the intestines which helps to block the absorption of cholesterol and fats. Aim for 10-25 grams per day. Foods high in soluble fiber include: whole grain cereals (oatmeal, barley, oat bran, psyllium seeds), fruits (apples, bananas, blackberries, oranges, grapefruits, prunes, pears, plums, nectarines and peaches), vegetables (broccoli, Brussels sprouts, carrots), and legumes (beans, lentils and chickpeas).

To put these guidelines into practice:

• Obtain a healthy weight.
• Eat more fiber, especially soluble fiber.
• Bake, broil, roast or grill rather than fry.
• Eat more fruits and vegetables.
• Use fresh herbs and seasonings in place of salt.
• Limit your use of pre-packaged and convenience foods.
• Use nonstick cooking sprays rather than oils, stick margarine or butter.
• Choose fat-free (skim) or one percent low fat dairy products.
• Try liquid, nonfat or low-fat soft tub margarines. One of the first words on the ingredient list should be unsaturated liquid vegetable oil, not hydrogenated or partially hydrogenated oil.
• Limit red meat (beef, veal, pork and lamb) to three times per week or less in 3 oz. portions. Choose leaner cuts like sirloin tip, round steak, and extra lean ground meat.
• Trim fat from meat and remove skin from poultry.
• While whole eggs can be included in a balanced diet, a good rule of thumb it to limit the yolks to 2-3 per week.
• If you drink alcohol, do so in moderation. While small amounts of alcohol (one drink a day for woman and 2 for men) may help some people, alcohol is a significant source of calories. It can also damage the heart and liver and contribute to high blood pressure and elevated triglycerides.

For more information, visit the following web sites.
The National Institute of Health, Your Guide to Lowering Blood Cholesterol with Therapeutic Lifestyle Change (TLC)
The American Heart Association
Dietary Guidelines for Americans
USDA Food & Nutrition Information Center

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Last revised: June 11, 2007 (dh)

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