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Updated 11 February 2014

Diet and heart disease

You cannot modify some of the risk factors associated with heart disease (your gender, your age and your genes), but some you can. Your diet is one of them.

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Step 1: Understanding the relationship between heart disease and food
Heart disease is the result of clogging of the coronary arteries due to the build-up of fatty deposits in your blood vessels. Blockage of these arteries leads to a heart attack.

You cannot modify some of the risk factors associated with heart disease (your gender, your age and your genes), but some you can. Here is a list of the most important ones you can change, and the changes will have a positive effect on your heart health:

  • Cigarette smoking
  • Overeating: Excessive energy intake – eating more than you use - causes obesity. The overall prevalence of overweight and obesity in South Africa is high, with more than 29% of men and 56% of women being classified as overweight or obese. Interestingly, it is mainly abdominal obesity rather than the fat distributed around hips and legs that carries the most risk. This means that not only is the body mass index (BMI) important, but the waist circumference as well. Waist circumference is defined as the smallest circumference between the rib cage and belly button. This should be less than 102cm in men and less than 88cm in women.
    Obesity tends to:
    • lead to raised lipid levels
    • cause insulin resistance
    • cause type 2 diabetes
  • Eating the wrong kind of foods (too fatty) or preparing it with too much oil: saturated fats and trans-unsaturated fats are far more important factors causing raised blood cholesterol levels
  • Lack of physical activity
  • Stress
  • Alcohol abuse

Step 2: Adopting new healthy habits
Lower your risk for heart disease:

  • 1. Stop smoking or never start smoking
  • 2. Lose weight if you are overweight
  • 3. Lower your fat intake.
  • 4. Exercise 30 – 45 minutes three times per week. Brisk walking, swimming, cycling, rowing or jogging can help a lot.
  • 5. Make time to relax and de-stress.
  • 6. Limit your alcohol intake to two drinks per day.
  • 7. Make sure your blood pressure is well controlled at levels not higher than 140/90mmHg.
  • 8. If you have diabetes, make sure it is well controlled.

Step 3. The dos and don’ts of eating for a healthy heart
Scientists suggest a step-wise approach to lower fat intake: first lower your fat intake to 30% of your total energy intake, then to 25% and even (with the help of a dietician) to 20%, if necessary.

The dos
Try to buy food with a fat content lower than 3g/100g.

1. Fats, oils and nuts:

  • Limit your total fat intake to 40 – 70g (three to four tablespoons) per day
  • Rather use the following fats, oils or nuts:
    • Canola, olive, avocado and soya oils
    • Soft tub margarines (look for the Heart Mark) and non-stick vegetable sprays
    • Almonds, pecans, hazelnuts and peanuts in moderation

2. Meat, fish and poultry:
Remember that meat, fish and poultry contain protein but also a lot of visible and hidden fats.

Keep the following in mind:

  • Have lean cuts only
  • Limit portion sizes to 90 to 120g a day – about the size of your palm
  • Eat chicken without the skin
  • Eat fish at least twice a week
  • Shellfish is fine, except prawns, shrimps and caviar and tinned fish should be in water or brine

3. Lentils and dry beans:

  • All types of lentils, peas and beans
  • Baked beans and other tinned beans are fine

4. Eggs:

  • Use a maximum of three egg yolks a week
  • Cut down on other foods containing cholesterol if you do eat egg yolk

5. Milk and milk products:

  • Low-fat and skim milk
  • Low-fat and fat-free yoghurt
  • Low-fat and fat-free cottage cheese
  • Low-fat buttermilk

6. Breads and cereals:

  • Low-GI or regular brown and wholewheat bread
  • Oats, oat bran and maize meal
  • High-fibre (low fat) breakfast cereals
  • Low-fat wholewheat crackers
  • Rice and pasta

7. Fruit and vegetables:

  • Eat at least five portions of fruit and vegetables each day
  • Choose fresh fruits instead of fruit juices
  • Use avocado and olives in moderation

8. Beverages:

  • Drink tea (especially rooibos) and coffee without sugar
  • Go for diet cold drinks, sugar-free squash
  • Use sweetened cold drinks in moderation
  • Use fruit juice in moderation
  • If you drink alcohol, have no more than two drinks a day (1 drink = 340ml beer or 120ml wine or 25ml spirits). Avoid alcohol if you have high blood pressure or are overweight

9. Desserts:

  • Choose fresh fruit, jelly, skim-milk custard
  • Go for fat-free or low-fat yoghurt, fruit ices, fruit yoghurt

The don’ts
Avoid the following foods

1. Fats and oils:

  • Butter
  • Hard brick margarine, brick cooking fat, lard
  • All fried foods
  • Coconut and biscuits containing coconut
  • Mayonnaise

2. Meat, fish and poultry:

  • Fatty beef, pork and mutton
  • Processed meats such as salami and polony
  • Organ meats such as offal, liver and kidneys
  • Tinned meat and pies
  • Take-aways such as fried chicken and hamburgers
  • Deep-fried foods

3. Milk and milk products:

  • Full-cream milk
  • Condensed milk
  • Cream, artificial cream, coffee and tea creamers
  • Full-fat ice cream and yoghurt
  • Full-fat cheeses

Breads and cereals:

  • White bread and rolls
  • Refined breakfast cereals
  • Salted, high-fat savoury snacks
  • Biscuits, cakes, puddings, chocolates, fudge etc
  • Crisps, corn crisps, other savoury snacks

Preparing your food:
The way you prepare meat can also decrease the fat content considerably - grilling and frying in a non-stick pan with little or no oil (use Spray and Cook to coat the pan) will save plenty of fat. You can also boil or stew meat dishes (potjie) the day before serving, let the stew cool completely and remove the layer of fat that collects on top of the liquid.

When you roast meat, use very little oil to coat the bottom of the container, cook the meat at a lower temperature and when the roast is done, drain off all the fat that has collected in the bottom of the pan and get rid of it. Keep a large bottle handy in the kitchen to collect this fat that oozes out of roasts and throw it away on a regular basis. This not only prevents the drains from getting clogged up but spares the arteries of your family from a similar fate.

Step 4: Your basic daily guide to eating correctly for a healthy heart

Food group Daily/weekly servings Serving sizes Examples/notes Significance for heart health
Fats, oils 3 per day 1 Tbsp margarine, oil. Canola, sunflower, olive oil, soy oil, soft or tub margarines with a high polyunsturated/monounsaturated fatty acids content. Avoid hard or block margarine, commercial cakes, biscuits and pies. Try to limit your total fat intake to less than 3 Tbsp per day, including all hidden fats in meat/oil used for food preparation and nuts.
Grains 6-7 per day 1 slice of bread; 1/2 C cooked rice, pasta or cereal; 1/2 C dry cereal. Whole wheat, pita bread, bagel, cereals, oatmeal. Major source of energy and fibre.
Red meat Maximum 3-4 portions per week Palm sized (90-120g) beef, venison, ostrich, pork, chicken, with all visible fat trimmed and chicken's skin removed. Buy only lean meat. Venison has a lower fat content than commercial beef and lamb. Modern day pork is one of the lowest-fat meats available, provided you cut off the fat layer. Turkey contains less fat than duck and chicken. Good source of protein, but meat contains a lot of hidden fats.
Fish 3-4 portions per week 120 - 150g Tuna, trout, salmon, mackerel and other fish. Add only a teaspoon or two of butter or saturated fat. Use herbs, lemon juice, freshly ground black pepper, dry white wine, or tomato to give fish dishes added flavour without the fat. People who eat fish at two or more meals a week, have a reduced incidence of heart disease, believed to be due to the Omega-3 fatty acids found in fish that protect the heart and blood vessels.
Vegetables 4-5 per day 1C leafy vegetables; 1/2 C cooked vegetables: 2/3 C (170ml) vegetable juice. Tomatoes, potatoes, carrots, peas, squash, broccoli, turnip, greens, spinach, artichokes, sweet potatoes, beans, cabbage. Rich sources of potassium, magnesium and fibre.
Fruits 4-5 per day 2/3 C fruit juice; 1 medium fruit; 1/4 C dried fruit; 1/2 C canned fruit. Apricots, oranges, grapefruit, mangoes, melons, peaches, pineapple, prunes, raisins, berries. Sources of potassium, magnesium and fibre.
Low fat (2%) or fat-free dairy products 2-3 per day 200ml milk, 1 C yoghurt, 1 Tbsp cheese Skimmed/fat free milk, skim/fat free buttermilk, fat free yoghurt. Eat even low fat cheeses (ricotta, mozzarella, Camembert and Brie and Weighless cheeses) in moderation. Major source of protein and calcium, but stay away from full-cream and even "low-fat" products.
Nuts, seeds and legumes 3-4 per week 1/3 C nuts, 2 Tbsp seeds, 1/2 C cooked legumes Almonds, pecan, hazelnuts, walnuts. Source of magnesium, potassium, protein and fibre. Also high fat content. Count as part of your daily fat portion.
Eggs 1 per day
1 egg Cook eggs with as little added fat as possible. Rather poach, boil, microwave, scramble with low fat milk, or fry in Spray and Cook in a non-stick pan. Source of protein and fat.

Visit our Heart Centre for up-to-date information on heart disease.

- (The Heart and Stroke Foundation SA, Health24, January 2009)

 
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