NoIL583 Version:1 First Published:07/2017 Last Reviewed: 08/2019 Review Date: Author: Nutrition and Dietetic Service QEH

Further Information British Heart Foundation: www.bhf.org.uk

Heart UK: www.heart uk.org.uk

Drink Aware: www.drinkaware.co.uk

Gateshead Health NHS Foundation Trust Nutrition and Dietetic Service Queen Elizabeth Hospital Sheriff Hill Gateshead NE9 6SX Tel: (0191) 445 2074

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Nutrition and Dietetic Service Healthy Eating for a Healthy Heart

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Healthy Eating for a Healthy Heart

This information leaflet is to help you make informed choices regarding your heart health by providing you with up to date dietary advice.

Prevention of coronary heart disease

The following factors can help to prevent coronary heart disease:

Stopping smoking

Eating a healthy balanced diet Exercise more regularly

Become a healthy body weight Reduce alcohol consumption

It is important that you enjoy your food and that you try to have a balanced diet. Long term healthy eating is the key to this and does allow for the occasional treat!

The cardio protective diet has been shown to provide a good balance of the nutrients we require for a healthy heart. These will be discussed in this booklet.

Healthy Weight

Being a healthy body weight reduces the risk of heart disease, stroke and type 2 diabetes. You can use the chart below to check whether you are within a healthy weight range.

This height/weight chart is suitable for adult men and women. It isn't suitable for children or young people under 18. However, it may not be suitable if you have a very muscular build. This is because having lots of muscle may put you in the overweight or obese categories, even if you have little body fat. For example, professional rugby players can fall into the ‘obese’ category despite having very little body fat. However, this will not apply to most people. If you are trying to lose weight, a weight loss of 1 to 2lbs a week is healthy and a total weight loss of 10% body weight has been shown to be beneficial in reducing heart disease.

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Physical Activity

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Cholesterol

Cholesterol is a waxy substance found in the blood. It has an important role in the body including making Vitamin D, bile and hormones. It is mainly made in the liver and is found in some foods. High levels of cholesterol may increase the risk of angina, heart attack and stroke. There are two types of cholesterol:

Low Density Lipoprotein (LDL) cholesterol is known as the “bad” cho-lesterol as it can build up within the arteries and cause narrowing.

High density lipoprotein (HDL) cholesterol is known as the “good” cholesterol as it removes “bad” cholesterol from your arteries to your liver which breaks it down and removes it.

To improve heart health, our total cholesterol should ideally be 5mmol/mol or less. A reduction in LDL cholesterol would also be beneficial. You may have been given medication called Statins to help lower your cholesterol (e.g. Simvastatin, Atorvastatin, Pravastatin) and it is important that you take these as prescribed.

Triglycerides

Triglycerides are another type of fatty substance in the blood. Raised triglycerides are linked to coronary heart disease especially if cholesterol levels are also above recommended levels, LDL is high and HDL is low.

Triglyceride levels are affected by the types of foods that we eat such as dairy products, meat and cooking oils. They can also be produced in the body from sugary foods and alcohol.

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Types of Fats

Saturated fats Trans fats Unsaturated fats (Monounsaturated and Polyunsaturated) Omega 3 Fats

Saturated and Trans Fats

Food contains different types of fat and the amount and type you include in your diet can affect your risk of heart disease. Saturated fats and trans fats may increase the amount of “bad” LDL cholesterol. Trans fats are also associated with increased risk of heart disease.

Saturated fats are normally solid at room temperature and mainly found in foods from animals. Trans fats are found in processed foods. Foods that contain these foods should not be eaten regularly as they will increase the “bad” LDL cholesterol.

Saturated Fats Trans Fats

Butter, ghee, lard, suet, dripping, cheese, cream, full-fat milk, coconut oil & fat on meat and poultry.

Processed foods such as burgers, sausages, pastry, pies, cakes, biscuits and rich puddings.

Processed foods (see saturated fats).

Fast foods.

Takeaway foods.

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Alcohol

Alcohol is high in calories and can affect your blood pressure and triglyceride levels. The Chief Medical Officer’s (CMO) guideline for both men and women states that: To keep health risks to a low level it is safest not to drink more than 14 units a week on a regular basis. If you regularly drink as much as 14 units per week spread your drinking over three or more days. For women that are pregnant or think you may become pregnant, the safest approach is not to drink alcohol at all, to keep risks to your baby to a minimum. Drinking in pregnancy can lead to long-term harm to the baby, with the more you drink the greater the risk.

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Avoiding Saturated Fats

Below is a table demonstrating ways to reduce your intake of saturated fats.

Avoid (foods high in saturated fat)

Try

Fried foods Dry roast (add no fat), boil, steam, grill, casserole and poach.

Reduce deep fried foods like samosas, chips etc.

Full cream milk Semi-skimmed, 1% fat milk

Cream, thick and creamy yoghurts, custard

Low fat/diet yoghurts or fromage frais.

Avoid creamy foods.

Butter Margarine or low fat spread high in unsaturated fats (olive/rapeseed).

Use minimal amounts on bread, sandwiches and potatoes.

Do not add extra to vegetables.

Fat/skin on meat/poultry, processed meats, e.g. sausages, burgers, tinned meats.

Remove all visible fat before cooking.

Choose leaner cuts of meat and unprocessed meats, healthier options include fish, pulses, lentils and beans.

Avoid making gravy with fat juices.

Full fat cheeses e.g. Cheddar, Stilton, Red Leicester

Reduced fat hard cheeses, cottage cheese and low fat cheese spreads.

Chocolate, biscuits, crisps, cakes

Cutting down on these foods.

Choose fruit, crumpets, plain biscuits (rich tea, fig roles, malted milk, nuts and popcorn).

Pastries, pies, pasties, sausage rolls

Potato topped meat pie and lean meat sandwiches.

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Unsaturated Fats

Unsaturated fats are a better choice of fat than saturated fats. These can help lower cholesterol when taken in moderate amounts. There are two types of unsaturated fats — mono-unsaturated and poly-unsaturated fats.

Mono-unsaturated fats decrease the “bad” LDL cholesterol and slightly increase the “good” HDL cholesterol.

Poly-unsaturated fats decrease total blood cholesterol.

Remember if you are trying to lose weight, reducing your total fat intake may be beneficial as all fats are high in calories. Changing to the “low fat” or “light options” may also be of benefit.

Mono-unsaturated Fats Poly-unsaturated Fats

Olive and rapeseed oils.

Spreads made from these oils.

Some nuts including wal-nuts, almonds and pecans.

Sunflower, corn, soya and rapeseed oils

Spreads made from these oils.

Nuts and seeds (walnuts, pine nuts, sunflower seeds, sesame seeds.

Salt

High salt intakes can increase the risk of developing high blood pressure, which can increase the risk of developing coronary disease.

Salt may be referred to as sodium on food packaging and all types of salt can affect your blood pressure including sea salt, rock salt and celery salt.

You should have no more than 6g of salt per day (one teaspoon). To reduce your intake:

Use lemon juice, herbs, spices and pepper to flavour foods instead

Avoid adding salt in cooking or at the table

Avoid salt alternatives e.g. Lo salt

Cut down on processed foods such as: -Salted, smoked or tinned meats -Processed meats, burgers, sausages -Smoked or salted fish -Tinned and packet soups -Salted crisps and nuts

Food labels may show the amount of sodium rather than salt.

To convert the figure for sodium to salt you need to multiply by 2.5 For example 2 grams of sodium = 5 grams of salt.

When looking at food labels:

Greater than 1.5g of salt (0.6g sodium) per 100g is high

Less than 0.3g salt (0.1g sodium) per 100g is low

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Nuts and Seeds

These are recommended as part of the cardio protective diet if substituted for foods high in saturated fat as they are high in mono-unsaturated and poly-unsaturated fats. A portion is 30g or a small cupped handful. You should avoid salted, dry roasted or flavoured nuts.

Sugar

Eating lots of foods which contain refined sugar can affect your triglyceride levels. Cutting down on these foods can help to reduce this:

Sweets Chocolate

Brown/white table sugar Honey

Biscuits

Cakes and pastries Full sugar drinks

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Omega – 3 Fats

These are a type of poly-unsaturated fats that are beneficial for heart health. This includes lowering levels of triglycerides in the blood, helping regulate your heart beat and makes your blood less likely to form blood clots. The best source of omega –3 fats is oily fish. Aim for two portions of fish per week (140g portion when cooked) one of which should be an oily fish. If you are pregnant you should eat no more than two portions of oily fish a week and avoid marlin, shark and swordfish.

Types of oily fish Tips on how to eat oily fish

Alternative sources of omega – 3 if you

don’t eat fish

Herring – fresh or pickled

Pickled – with salad, grilled with new potatoes and vegetables

Green leafy vegetables especially broccoli, spinach or cabbage

Rapeseed or soya oils

Walnuts, flaxseeds (linseeds) and their oils

Foods fortified with omega – 3 (eggs, milk, bread)

Omega – 3 fatty acid compounds (fish oil supplements) are not recommended due to a lack of evidence

Mackerel – fresh, canned or smoked

Flaked in to rice salads or grilled with new potatoes and vegetables

Sardines – fresh or canned in oil or water

Grilled, BBQ, or canned sardines on toast

Pilchards – canned in tomato sauce

With pasta and green salad or on toast

Trout – fresh or smoked

Poached, grilled or baked

Kippers – fresh or vacuum packed

Poached for breakfast or supper

Salmon – fresh, frozen or canned

Fish cakes and fish pie mix

Dietary Cholesterol

Found in certain foods such as eggs, offal (liver and kidney) and shellfish. Consuming these foods does not contribute greatly to your total cholesterol therefore there is no need to restrict these foods.

Plant Sterols and Stanols

These are found in a range of plant foods such as cereals, vegetable oils, seeds and nuts. They have a similar structure to cholesterol and work to reduce how much cholesterol is absorbed in the gut, so more is lost in the faeces. Research has shown that consuming sterols and stanols in combination with a healthy lifestyle can significantly lower blood cholesterol.

There are also a range of dairy products that have been fortified with sterols and stanols such as spreads, drinks and yoghurts (Benecol, Flo-ra Pro-Active, supermarket own brands). If you choose to have any of these products they need to be eaten every day, with meals and in the correct amount to get the benefits.

These products can be used but are not recommended as there may be other simpler changes that you can make, such as regular exercise and eating plenty of healthy food low in saturated fat.

Fruit and Vegetables

These provide vitamins, minerals, fibre and other plant nutrients such as antioxidants that help protect your heart. Fresh, frozen, tinned and dried varieties all count. Aim to include five or more portions each day. A portion is: Two to three tablespoons of vegetables

Two small fruits such as plums or one larger fruit like an apple, an orange, a peach or a medium banana

A small glass of 100% juice A handful (30g) of dried fruit 8

Whole Grain Starchy Food and Fibre

You should base your meals around starchy foods (bread, potatoes, cereals, rice, pasta) and aim to include more whole grain varieties of these. Whole grain starch foods include wheat and oats, rice, barley, rye, wild rice, buckwheat and quinoa.

Change white breads for wholemeal or granary breads, use brown rice and whole grain breakfast cereals such as wheat bisk or bran flakes.

There are two types of fibre; insoluble and soluble.

Insoluble fibre is found in wholegrain and wholemeal foods and in conjunction with a good fluid intake (six to eight cups / day) helps prevent constipation.

Soluble fibre is found in oats, pulses, lentils, fruit and vegetables and these can help reduce absorption of cholesterol in the gut.

Ways to increase fibre intake:

Whole grain / seeded bread, crackers and crisp bread Whole grain breakfast cereals

Wholegrain rice and pasta Aim for five portions of fruit and vegetables per day

Add pulses (baked beans, haricot beans, chickpeas, lentils, dhal, kidney beans) to soups, stews and casseroles

Try oat based breakfast cereals

If you are increasing your dietary fibre, ensure that you drink at least six to eight cups of fluid each day.

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