Eight Steps to a Heart-Healthier Diet (Part 2: Steps Five to Eight)

By Janis Jibrin, M.S., R.D., and Tracy Gensler, M.S., R.D.

 

Step Five: Balance your daily fat intake ("polys," "monos" & "Sats")
Step Six: Go with lean protein.
Step Seven: Take in at least two dairy servings daily
Step Eight: Set a daily "treat" calorie limit.

 

If you think heart-healthy eating means "boring," then you didn't catch Part 1: Steps One to Four, of our eight-step plan. Research has come a long way from the depriving low-fat diets of the past—in fact, eating heart healthier can be delicious.

 

Need a nudge to change your diet for the better? By some estimates, 74 percent of heart disease cases may be caused by poor diet and lack of exercise 1. That's just one of the reasons why we've compiled this eight-step plan that will help you lose weight if you need it, and will support healthy cholesterol levels by helping to lower LDL ("bad" cholesterol). People with active heart disease should seek recommendations from their medical professionals. Don't forget that in addition to eating right, exercise is an important component of a healthy lifestyle. For more tips and information about exercise visit http://www.smartbalance.com/articles/category/fitness.

 

If you're overweight, reducing down to "normal" weight may seem nearly impossible, especially if you've been on the diet rollercoaster a few times. But keep in mind, you don't have to fit into your prom dress (or tux) to make a difference to your heart. Losing just five percent of your body weight may be enough to help reduce your risk for heart disease, and losing 15 percent may help dramatically reduce risk— up to 45 percent 2.

 

For those of you who didn't catch Part One of the plan, we suggest you go back and start there. These are the Part One goals:

If you've been following the plan and need a few more weeks to make these habits truly your own, take your time. But if you are ready for "Part Two," read on!

 

Step Five: Balance your daily fat intake ("polys," "monos" & "sats")

Why: It used to be that if you had high LDL, your doctor prescribed a low-fat diet. But now the research suggests that it's not the just total fat but the type of fat that may make a difference.
Fat 101: High-fat foods, such as vegetable oil, butter, nuts and avocados contain a combination of three types of fat: monounsaturated, polyunsaturated and saturated fat. Some foods also contain trans fat. Usually a food is particularly high in one type; for instance, olive oil is about 75 percent monounsaturated, but just 11 percent polyunsaturated and 14 percent saturated. "And these different types of fat have varying effects on your heart, so it's important to know which oils and other foods contain more of the beneficial fats," advises Janet M. de Jesus, M.S., R.D., a nutritionist with the National Heart, Lung, and Blood Institute in Rockville, MD.
Below is a quick introduction to various types of fats. More important, we've translated all this science into what really matters to you: what to put on your plate.
Total Fat: Based on research by Brandeis University 3, the Smart Balance Food Plan provides about 30 percent of total calories from fat. The total amount of fat is balanced between monounsaturated, polyunsaturated and saturated fats to optimize your HDL ('good) to LDL ('bad') cholesterol ratio.
Monounsaturated fat: Monounsaturated fat helps support healthy triglyceride levels (a fat in the blood that research shows may have an impact on heart disease risk). Research shows that monounsaturated fats may also raise levels of HDL, the "good" cholesterol that sends cholesterol out of the body, without raising levels of artery-clogging LDL 4. The Smart Balance Food Plan includes 10 percent of your total daily calories as monounsaturated fats.
Polyunsaturated fat: In general, polyunsaturated fats have a positive effect on blood cholesterol, decreasing LDL levels. Because polys can also lower HDL levels, the Smart Balance Food Plan balances polyunsaturated fat intake and limits total calories from polyunsaturated fat to 10 percent. Here are some additional poly specifics:
  • Omega-3 polys provide essential fatty acids. (Essential fatty acids are those our body cannot make by converting other fats, so, like vitamins, we need to take them in from our diets.) Omega-3s have been shown to help support healthy triglyceride levels and overall heart health. 5,6. The types of omega-3s in fish—docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA)—are more potent than the plant-based omega-3—a-linolenic acid (ALA) 5. But ALA has also been shown to be protective, so if you don't eat fish, and can't take fish oils because you're a vegetarian/vegan or are allergic, then be sure to look for plant-based sources.
  • Omega-6 polys also provide essential fatty acids.. However, some studies indicate that in excess, omega-6s may trigger inflammation, so it's important to maintain moderation 5.
Saturated fat: Saturated fats play a part in an overall healthy diet. They are needed to help balance monounsaturated and polyunsaturated fatty acids in the diet and to maintain a healthy ratio of LDL to HDL cholesterol, although excess amounts can raise LDL levels 2.The Smart Balance Food Plan limits the amount of saturated fat in your diet to 10 percent of total calories.
There are nuances, for instance, stearic acid, the main type of saturated fat in cocoa, does not raise LDL 7. And while the research is still sorting out the pros and cons of a type of saturated fat called "medium chain"—the main type in coconut oil—it appears that in moderation it may not raise LDL 8. In addition, medium chain saturated fat is much more likely to be burned by the body rather than stored as fat 8. Until the science is clearer, it's safest to limit your intake of all saturated fat.
Trans fat: Trans fat is the most risky type of fat. Studies have shown that trans fat may raise LDL, lower HDL, and contribute to inflammation and possibly deposits of visceral, or deep belly fat, which have been linked to heart disease and other health risks 2,9. You should avoid trans fat in your diet.
Cholesterol: Technically cholesterol is not a fat, but it's worth mentioning because, in excess, it can raise LDL 2. The American Heart Association recommends limiting cholesterol to no more than 300 mg daily. Cholesterol is found only in foods of animal origin; so, for example, olive oil and peanut butter do not contain it, but meat, seafood and dairy do.

How: Avoid foods made with partially hydrogenated oil. This oil is the main source of unhealthy trans fat.. And just because the nutrition label lists "0 g trans" doesn't mean you're in the clear. A legal loophole allows companies to make that claim even if there's 0.49 g of trans fat per serving. Just four times this amount—2 g of trans fat daily—has been shown to adversely impact blood cholesterol levels. Fortunately, companies have been removing partially hydrogenated fat from food, but you'll still find it in some margarines, piecrusts, cookies, cakes, candy, fried food and frozen food. By the way, "hydrogenated oil" does not contain trans fat, but can be high in saturated fat.

 

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Step Six: Go with lean protein.

Why: Barbecuing, broiling, grilling, frying or other high temperature cooking of meats—fatty or lean—may create cancer-causing chemicals 10.
Because fatty cuts of red meat are major sources of saturated fat, you should try to limit red meat and processed meats. A National Institutes of Health (NIH) study, which followed half a million Americans for 10 years, found that men and women who ate five ounces of red meat per day were about 30 percent more likely to die (mostly from heart disease or cancer) than those who consumed just one serving or less per week 10. Processed meat, like hotdogs and salami proved to be equally risky as red meat in this study. This study shed no light on the question of whether lean red meat is less harmful than fatty cuts because they lumped all cuts of beef and pork under "red meat." Some studies indicate lean red meat may be less risky 11, but the research hasn't yet tested this out.
On the other hand, fish eaters 5,6 and vegetarians 12 may have a lower risk of dying from heart disease 2.

How: Eat more fish and vegetarian sources of protein and less red meat (beef, pork and lamb). When eating red meat, choose lean cuts and limit portion sizes. Avoid or limit processed meats such as bacon, bologna, hot dogs, pepperoni, salami and sausage.

 

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Step Seven: Take in at least two dairy servings daily

Why: Dairy products are an excellent source of protein and important vitamins and minerals such as calcium and Vitamin D. Including dairy in your diet can help to promote bone health.
New and emerging research examining links between food and heart disease find that people who consume the most dairy foods may have a 13 percent lower risk of dying, period, from any disease, and a seven percent lower risk of dying from heart disease and 11 percent lower risk of stroke compared to those eating the least 16. And the dairy in these studies is both full-fat (like whole milk and regular cheese) and low-fat or non-fat.
One reason for the possible protection: Dairy products may help lower blood pressure. Low-fat options may have an edge, according to Harvard University's Nurse's Health Study, which tracked nearly 29,000 middle-aged women for 10 years 17. Those taking in about 3 1/2 low-fat dairy servings daily had an 11 percent lower risk of developing high blood pressure than those taking in just half a serving daily. (High-fat dairy conferred only a 3 percent risk reduction.) Dairy products—and in some research, calcium from supplements—may help regulate weight, another plus for your heart 18.

How: Have two dairy servings daily (two or three if you're taking in 2,000 calories or more). If you don't like—or can't tolerate—dairy foods, substitute soy milk containing at least 25 percent of the daily value for calcium and for vitamin D. While almond milk is also OK, note that it doesn't have nearly the protein in milk or soy milk, so be sure to have another source of protein at that meal.

 

A serving is 86–100 calories, and includes:

  • 1 cup nonfat or 1% milk
  • 1 cup calcium- and vitamin D-enriched soymilk
  • 3/4 cup nonfat or low-fat plain yogurt

Although a skim or 1% latte is a great way to score a dairy serving; don't fool yourself into thinking that sugary coffee drinks with through-the-roof calories count! Even vanilla yogurt, or fruit yogurts are more of a dessert than a dairy serving because of all the sugar. However, plain yogurt with fresh fruit, nuts and a little honey makes a very nutritious breakfast, and that's a great way to spend your dairy servings.

 

Although cheddar, Swiss and other cheeses are great sources of calcium, they are also high in saturated fat. If eating cheese, choose reduced-fat versions. Because these can still be high in saturated fat, eat limited amounts of these cheeses.

 

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Step Eight: Set a daily "treat" calorie limit.

Why: It's no news to you that sweets and salty snacks can pack on the pounds—a recent Harvard University study found that most potato chips and sodas were particularly fattening. 19 But it's not just an expanding waistline that makes many of these foods bad for the heart. Sugar-sweetened beverages, like soda, sugary iced teas and punch have received the most intense research scrutiny and the findings aren't good. Preliminary, but not conclusive, research has shown that these drinks may be linked to high blood pressure, high triglycerides, inflammation and heart disease 20. The Nurse's Health Study found that compared to women who drank less than one sugary drink monthly, drinking two or more daily was associated with a 35 percent increase in heart disease 21. Some studies indicate that even diet drinks may contribute to metabolic syndrome (a cluster of symptoms including high triglycerides and excess visceral fat) and diabetes—two conditions that greatly raise the likelihood of developing heart disease 22.

How: Set a daily treat limit. We recommend the following:

 

Daily calories

Daily treat calories

1,500 to 1,600

100

Above 1,600 to 1,800

150

Above 1,800 to 2,000

200

Above 2,000 to 2,500

250

A treat doesn't have to be nutritious, but to spare your arteries, avoid those made with partially hydrogenated oil. Our suggestions: flavored yogurt; hot cocoa; dark chocolate; light ice cream; a glass of red wine (unless you have a condition that precludes alcohol consumption); or a fruit and yogurt smoothie.

 

And while a soda (or just part of a soda) is fair game, given its checkered health history, we recommend limiting it to just a few times a week or cutting it out altogether. Same for diet soda; don't drink it unless it's necessary to help wean you off regular soda. And, after you've quit regular soda, try and ease off diet.

Meanwhile, set up your environment for success.

  • Get rid of all the temptations in your home, office and car.
  • Make a plan. Because sugary and salty snacks are everywhere, if you're susceptible to these foods, you must arm yourself with a strategy to avoid and resist. Decide in advance what type of treat you're going to have that day. Writing out your plan, keeping it with you, and referring to it when you're tempted to stray can be very helpful.
  • Break habits such as a 3:00 p.m. trip to the vending machine or a morning coffee and muffin—this will help tamp down cravings.
  • When cravings hit, distract yourself by taking a short walk—just around the block can do it, calling a friend, sending an email, browsing the web, picking up a book or magazine, listening to music, or something else that's completely unrelated to food.

Changing the way you eat may be one of your biggest challenges, especially if you started out with an unhealthy diet and/or weight to lose. But we hope that breaking it up into eight smaller chunks has made the challenge a little easier and that some of the habits are sticking.

 

See also: Eight Steps to a Heart-Healthier Diet (Part 1: Steps One to Four)

 

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1. Hu, F.B and Willett, W. C. Optimal diets for prevention of coronary heart disease JAMA, November 27, 2002—Vol. 288, No. 20.

2. Kones, R. Primary prevention of coronary heart disease: integration of new data, evolving views, revised goals, and role of rosuvastatin in management. A comprehensive survey. Drug Des Devel Ther. 2011; 5: 325–380.

3. BRANDEIS'S MALAYSIAN SOLDIER CLINICAL RESEARCH 1995. Sundram K, Hayes KC, Siru OH. Both dietary 18:2 and 16:0 may be required to improve the serum LDL/HDL cholesterol ratio in normocholesterolemic men. JNutr Biochem. 1995; 6:179–187.

4. Appel, L. et al. Effects of Protein, Monounsaturated Fat, and Carbohydrate Intake on Blood Pressure and Serum Lipids Results of the Omni Heart Randomized Trial. AMA, November16, 2005—Vol294, No.19, 2455-2464.

5. Simopoulos, A. Importance of the Omega-6/Omega-3 Fatty Acid Ratio in Cardiovascular Disease and other Chronic diseases. 2008, 233:674-688.Experimental Biology and Medicine

6. Mozaffarian D, Wu JH. Omega-3 fatty acids and cardiovascular disease: effects on risk factors, molecular pathways, and clinical events. J Am Coll Cardiol. 2011 Nov 8;58(20):2047-67.

7. The role of reducing intakes of saturated fat in the prevention of cardiovascular disease: where does the evidence stand in 2010?

8. St-Onge MP, Jones PJ. Physiological effects of medium-chain triglycerides: potential agents in the prevention of obesity. J Nutr. 2002 Mar;132(3):329-32.

9. Michar, R. and Mozaffarian, D. Trans Fatty Acids: Effects on Cardiometabolic Health and Implications for Policy. Prostaglandins Leukot Essent Fatty Acids. 2008 ; 79(3-5): 147–152.

10. Sinha, R. et al. Meat intake and mortality: A prospective study of over half a million people. Arch Intern Med. 2009; 169(6):562-571.

11. Hodgson, JM, et al. Increased Lean Red Meat Intake Does Not Elevate Markers of Oxidative Stress and Inflammation in Humans. J. Nutr. 137:363-367, February 2007.

12. Position of the American Dietetic Association and Dietitians of Canada: Vegetarian diets, J. Amer Diet. Assoc. June 2003 Volume 103 Number 6.

13. Norat, T, et al. Meat, fish, and colorectal cancer risk: the European Prospective Investigation into cancer and nutrition. J Natl Cancer Inst. 2005 June; 97(12): 906–916.

14. http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HealthyDietGoals/Healthy-Diet-Goals_UCM_310436_SubHomePage.jsp

15. World Cancer Research Fund/American Institute for Cancer Research. Continuous Update Project: Colorectal Cancer Report. Washington DC: AICR, 2011.

16. Elwood, P. et al. The Consumption of Milk and Dairy Foods and the Incidence of Vascular Disease and Diabetes: An Overview of the Evidence. Lipids (2010) 45:925-939.

17. Wang, L. et al. Dietary Intake of Dairy Products, Calcium, and Vitamin D and the Risk of Hypertension in Middle-Aged and Older Women. Hypertension. 2008;51:1073-1079.

18. Van Loan, M. The Role of Dairy Foods and Dietary Calcium in Weight Management. Journal of the American College of Nutrition, Vol. 28, No. 1, 120S–129S (2009).

19. Mozaffarian, D. et al. Changes in Diet and Lifestyle and Long-Term Weight Gain inWomen and Men. N Engl J Med. 2011 June 23; 364(25): 2392–2404.

20. Hu, FB. Sugar-sweetened beverages and risk of obesity and type 2 diabetes: epidemiologic evidence. Physiol Behav. 2010 Apr 26;100(1):47-54.

21. Fung, TT et al. Sweetened beverage consumption and risk of coronary heart disease in women. Am J Clin Nutr 2009;89:1037–42.

22. Nettleton, J.A. Diet Soda Intake and Risk of Incident Metabolic Syndrome and Type 2 Diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA). Diabetes Care. 2009 April; 32(4): 688–694.

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