Heart-Healthy Diet
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Heart-Healthy Diet Overview

Written by ColleenO.

What is typically called a "heart-healthy diet" involves limiting sodium, certain types of fat, and cholesterol, while emphasizing more healthful foods, such as fruits and vegetables, whole grains, and lean meats.

This type of diet is recommended for:

  • People with any form of cardiovascular disease (eg, coronary heart disease, peripheral vascular disease, previous heart attack, previous stroke)
  • People with risk factors for cardiovascular disease, such as high blood pressure, high cholesterol, or diabetes
  • Anyone who wants to lower their risk of developing cardiovascular disease

The DASH diet is an example of a diet that follows the guidelines for a heart-healthy diet. This diet has been studied and results suggest that it helps control hypertension, reduce homocysteine levels, and reduce the rate of bone loss.2

Because of the link between diabetes and heart disease, some experts consider a low-glycemic diet to be the most heart-healthy option. Also, growing evidence suggests that rather than eating a relatively high-carbohydrate, low-fat diet, it is probably preferable to keep carbohydrate levels relatively low while replacing saturated fat with monounsaturated fats such as olive oil.1 See the article on Low-Carbohydrate Diet for more information.

How It Works

The idea behind a heart-healthy diet is that it supports overall health while also helping control certain risk factors for cardiovascular disease, such as high blood pressure and high cholesterol.

Food Choices on a Heart-Healthy Diet

Check out these lists for general recommendations for foods to eat and foods to avoid. If you're ready to take action, follow these steps:

  1. Go through these lists and circle the foods you eat often.
  2. Of the foods you circled, cross out the ones that are on the "foods to avoid" lists. Think about how you can eat less or or cut them out of your diet altogether.
  3. Make yourself a shopping list from the foods you circled on the "recommended foods" lists.
  4. Go back through the recommended foods lists and mark foods you haven't eaten in a while or would like to try. Add those to your shopping list.
  5. Review your shopping list and think of different dishes you might make from those foods. Add other ingredients you might need.
  6. If you need some recipes for guidance and inspiration, look through old cookbooks, go online, and consult with friends. Consider working with a nutritionist, dietitian or health coach.
  7. If you need extra motivation with your shopping and cooking tasks, recruit a friend or family member to join you. By working together on healthy tasks, you'll be doing each other a favor.

Grains

Whole grains and products made from them are better than refined grains and products made from refined flours. See "How to eat healthy grains" for more info and tips.

Recommended foods:

  • Breads and rolls without salted tops
  • Most dry and cooked cereals
  • Unsalted crackers and breadsticks
  • Low-sodium or homemade breadcrumbs or stuffing
  • All rice and pastas

Foods to avoid:

  • Breads, rolls, and crackers with salted tops
  • High-fat baked goods (eg, muffins, donuts, pastries)
  • Quick breads, self-rising flour, and biscuit mixes
  • Regular bread crumbs
  • Instant hot cereals
  • Commercially prepared rice, pasta, or stuffing mixes

Vegetables

Choose local and/or organic vegetables and fruits whenever you can. Know which foods are in season where you live, and choose accordingly--your food will be fresher and less expensive. See "How to eat a diet rich in fruits and vegetables" for more info and tips.

Recommended foods:

  • Most fresh, frozen, and low-sodium canned vegetables
  • Low-sodium and salt-free vegetable juices
  • Canned vegetables if unsalted or rinsed

Foods to avoid:

  • Regular canned vegetables and juices, including sauerkraut and pickled vegetables
  • Frozen vegetables with sauces
  • Commercially prepared potato and vegetable mixes

Fruits

Choose local and/or organic vegetables and fruits whenever you can. Know which foods are in season where you live, and choose accordingly--your food will be fresher and less expensive. See "How to eat a diet rich in fruits and vegetables" for more info and tips.

Recommended foods:

  • Most fresh, frozen, and canned fruits
  • All fruit juices

Foods to avoid:

  • Fruits processed with salt or sodium

Dairy

Choose hormone-free and organic dairy products if possible.

Recommended foods:

  • Nonfat or low-fat (1%) milk
  • Nonfat or low-fat yogurt
  • Cottage cheese, low-fat ricotta, cheeses labeled as low-fat and low-sodium

Foods to avoid:

  • Whole milk
  • Reduced-fat (2%) milk
  • Malted and chocolate milk
  • Full fat yogurt
  • Most cheeses (unless low-fat and low salt)
  • Buttermilk (no more than 1 cup per week)

Meat and Beans

Choose natural, hormone-free, antibiotic-free, and organic meats if possible.

Recommended foods:

  • Lean cuts of fresh or frozen beef, veal, lamb, or pork (look for the word “loin”)
  • Fresh or frozen poultry without the skin
  • Fresh or frozen fish and some shellfish
  • Egg whites and egg substitutes (Limit whole eggs to three per week)
  • Tofu or tempeh
  • Nuts or seeds (unsalted, dry-roasted), low-sodium peanut butter
  • Dried peas, beans, and lentils

Foods to avoid:

  • Any smoked, cured, salted, or canned meat, fish, or poultry (including bacon, chipped beef, cold cuts, hot dogs, sausages, sardines, and anchovies)
  • Poultry skins
  • Breaded and/or fried fish or meats
  • Canned peas, beans, and lentils
  • Salted nuts

Fats and Oils

Recommended foods:

  • Olive oil and canola oil
  • Low-sodium, low-fat salad dressings and mayonnaise

Foods to avoid:

  • Butter
  • Margarine
  • Coconut and palm oils
  • Bacon fat

Snacks, Sweets, and Condiments

Recommended foods:

  • Low-sodium or unsalted versions of broths, soups, soy sauce, and condiments
  • Pepper, herbs, and spices; vinegar, lemon, or lime juice
  • Low-fat frozen desserts (yogurt, sherbet, fruit bars)
  • Sugar, cocoa powder, honey, syrup, jam, and preserves
  • Low-fat, trans-fat free cookies, cakes, and pies
  • Graham and animal crackers, fig bars, ginger snaps

Foods to avoid:

  • High-fat desserts
  • Broth, soups, gravies, and sauces, made from instant mixes or other high-sodium ingredients
  • Salted snack foods
  • Canned olives
  • Meat tenderizers, seasoning salt, and most flavored vinegars

Beverages

Keep in mind that alcohol should be consumed in moderation, and caffeine from beverages such as coffee and tea may cause or worsen an arrhythmia.

Recommended beverages:

  • Low-sodium carbonated beverages
  • Tea and coffee in moderation
  • Soy milk, rice milk, almond milk, hemp milk, etc.

Beverages to avoid:

  • Commercially softened water

General Guidelines for Eating a Heart-Healthy Diet

General recommendations for a heart-healthy diet:

  • Choose heart healthy fats such as canola, olive, and flaxseed oil, and foods high in heart-healthy fats, such as nuts, seeds, soybeans, tofu, and fish. See below for more information about fats.
  • Eat fish at least twice per week; the fish highest in omega-3 fatty acids and lowest in mercury include salmon, herring, mackerel, sardines, and canned chunk light tuna. If you eat fish less than twice per week or have high tryglycerides, talk to your doctor about taking fish oil supplements.
  • Read food labels.
    • For products low in fat and cholesterol, look for: “Fat free,” “low-fat,” “cholesterol free,” “saturated fat free,” and “trans fat free”—Also scan the Nutrition Facts Label, which lists saturated fat, trans fat, and cholesterol amounts.
    • For products low in sodium, look for: “Sodium free,” “very low sodium,” “low sodium,” “no added salt,” and “unsalted”
  • Skip the salt when cooking or at the table; if food needs more flavor, get creative and try out different herbs and spices. Garlic and onion also add substantial flavor to foods. For more information on salt, see below.
  • Trim any visible fat off meat and poultry before cooking, and drain the fat off after browning.
  • Use cooking methods that require little or no added fat, such as grilling, boiling, baking, poaching, broiling, roasting, steaming, stir-frying, and sautéing.
  • Avoid fast food and convenience food. They tend to be high in saturated and trans fat and have a lot of added salt.
  • Talk to a nutritionist, dietitian or health coach for individualized planning and advice.

More about sodium

Sodium is a mineral found in many foods. In general, most people consume much more sodium than they need. Diets high in sodium can increase blood pressure and lead to edema (water retention). On a heart-healthy diet you should consume no more than 2,300 mg (milligrams) of sodium per day—about the amount in one teaspoon of table salt. The foods highest in sodium include table salt (about 50% sodium), processed foods, convenience foods, and preserved foods.

More about cholesterol

Cholesterol is a fat-like, waxy substance in your blood. Our bodies make some cholesterol. It is also found in animal products, with the highest amounts in fatty meat, egg yolks, whole milk, cheese, shellfish, and organ meats. On a heart-healthy diet, you should limit your cholesterol intake to less than 200 mg per day.

It is normal and important to have some cholesterol in your bloodstream. But too much cholesterol can cause plaque to build up within your arteries, which can eventually lead to a heart attack or stroke.

The two types of cholesterol that are most commonly referred to are:

  • Low-density lipoprotein (LDL) cholesterol —Also known as “bad” cholesterol, this is the cholesterol that tends to build up along your arteries. Bad cholesterol levels are increased by eating fats that are saturated or hydrogenated. Optimal level of this cholesterol is less than 100. Over 130 starts to get risky for heart disease.
  • High-density lipoprotein (HDL) cholesterol —Also known as “good” cholesterol, this type of cholesterol actually carries cholesterol away from your arteries and may, therefore, help lower your risk of having a heart attack. You want this level to be high (ideally greater than 60). It is a risk to have a level less than 40. You can raise this good cholesterol by eating olive oil, canola oil, avocados, or nuts. Exercise raises this level, too.

More about fat

Fat is calorie dense and packs a lot of calories into a small amount of food. Even though fats should be limited due to their high calorie content, not all fats are bad. In fact, some fats are quite healthful. Fat can be broken down into four main types.

The “good-for-you” fats are:

  • Monounsaturated fat —found in oils such as olive and canola, avocados, and nuts and natural nut butters; can decrease cholesterol levels, while keeping levels of HDL cholesterol high
  • Polyunsaturated fat —found in oils such as safflower, sunflower, soybean, corn, and sesame; can decrease total cholesterol and LDL cholesterol
  • Omega-3 fatty acids —particularly those found in fatty fish (such as salmon, trout, tuna, mackerel, herring, and sardines); can decrease risk of arrhythmias, decrease triglyceride levels, and slightly lower blood pressure

The fats that you want to limit are:

  • Saturated fat —found in animal products, many fast foods, and a few vegetables; increases total blood cholesterol, including LDL levels
    • Animal fats that are saturated include: butter, lard, whole-milk dairy products, meat fat, and poultry skin
    • Vegetable fats that are saturated include: hydrogenated shortening, palm oil, coconut oil, cocoa butter
  • Hydrogenated or “trans” fat —found in margarine and vegetable shortening, most shelf stable snack foods, and fried foods; increases LDL and decreases HDL

It is generally recommended that you limit your total fat for the day to less than 30% of your total calories. If you follow an 1800-calorie heart healthy diet, for example, this would mean 60 grams of fat or less per day.

Saturated fat and trans fat in your diet raises your blood cholesterol the most, much more than dietary cholesterol does. For this reason, on a heart-healthy diet, less than 7% of your calories should come from saturated fat and ideally 0% from trans fat. On an 1800-calorie diet, this translates into less than 14 grams of saturated fat per day, leaving 46 grams of fat to come from mono- and polyunsaturated fats.

References

  1. Shah M, Adams-Huet B, Garg A. Effect of high-carbohydrate or high-cis-monounsaturated fat diets on blood pressure: a meta-analysis of intervention trials. Am J Clin Nutr. 2007;85:1251-1256.
  1. Rakel, David. (2007). Integrative Medicine. 2nd Ed. Chapter 89: The DASH Diet. Philadelphia, PA: Saunders Elsevier.

American Dietetic Association. Nutrition Care Manual. American Dietetic Association website. Available at: http://nutritioncaremanual.org . Accessed December 8, 2009.

American Heart Association website. Available at: http://www.americanheart.org . Accessed January 12, 2006.

Shield J, Mullen MC. Patient education materials. Supplement to the Manual of Clinical Dietetics . 3rd ed. Chicago, IL: American Dietetic Association; 2001.

 
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