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September 1999 Issue
Diet and the Risk of Heart Disease
by Ronda L. Halpin
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For the next few months, Seasoned Cooking will be presenting a series of articles on special diets. While the subjects of each article will be specific to special diets, they will be designed to be useful for everyone -- even those who don't suffer from any diet restrictions. The format is simple. Each article will include an overview of the disease or condition that makes a special diet necessary, a more substantial section on how to adapt your diet to cater to that condition, and a series of recipes that are specially chosen for persons on a restricted diet.

With that in mind, let's take a look at our first focus: heart disease and the importance of a low fat, low cholesterol diet.

Coronary heart disease is the number one killer in the United States. Fortunately, we know a great deal about the factors that put people at risk for it, and which of those factors are in our power to change. Much of the research into risk factors for heart disease indicates that changes in diet and lifestyle can help reduce some people's risk for heart disease -- even people who are genetically pre-disposed to developing it. By looking at all the risk factors that apply to you, identifying the ones in your control, and working to make positive changes, you stand an excellent chance of reducing your risk of heart disease. In fact, recent studies have shown a marked decrease in heart disease in the last 40 years; due in large part to the increase in knowledge about the disease and how we can affect our chances of getting it.

How Does Your Cholesterol Level Affect Your Risk?

If you want to know about your risk of heart disease, the first thing you need to do is get a blood test to check your cholesterol level. The test will measure the amount of cholesterol in your blood, which is an extremely important indicator of your risk for heart disease.

While it is normal to have some cholesterol in your blood, it can be dangerous to have too much. This can happen if you eat a diet that is too high in cholesterol or in the saturated fats that can increase your cholesterol level.

How high is too high? How low should you go? The answers are pretty clear-cut.

Cholesterol Levels
High 240 mg/dl or more
Borderline-high 200-239 mg/dl
Desirable Below 200 mg/dl

A high cholesterol level is a huge risk factor for heart disease. According to the results of the famous Framingham study, which tracked cholesterol levels of 5,000 men and women over 20 years, men with average blood cholesterol levels of 260 mg/dl had three times more heart attacks than men with average blood cholesterol levels of 195 mg/dl.

If your cholesterol level is high, here are some ways to lower it.

  • Reduce your fat intake to less than 30 percent of your total caloric intake.
  • Reduce your saturated fat intake to less than 10 percent of the total fat in your diet.
  • Reduce the amount of dietary cholesterol you eat.
  • Eat more soluble fiber.
  • Maintain your ideal weight -- discuss this number with your physician.

Your total cholesterol level includes two different types of cholesterol in your blood: HDL and LDL cholesterol. HDL and LDL are both lipoproteins, or protein-containing packages in which cholesterol travels through the bloodstream. The acronyms stand for High Density Lipoprotein and Low Density Lipoprotein. HDL cholesterol is considered beneficial and LDL cholesterol is considered undesirable.

Think of HDL cholesterol as the cholesterol that is taken out of your arteries, or the detergent that sweeps cholesterol away.

Your HDL level is a key factor in your risk of heart attack. For example, if your HDL level is low (below 35 mg/dl), you are at risk even if your total cholesterol is only 195 mg/dl. But if your HDL level is up around 70 mg/dl, your risk is lower -- even through your total cholesterol may be as high as 240 mg/dl. A good general rule is, the higher your HDL cholesterol, the better. Women's HDL levels tend to be above 45 mg/dl, a good protective start against heart disease.

HDL Levels
High 60 mg/dl or more
Intermediate 35-39 mg/dl
Low Below 35 mg/dl

It is not exactly clear how to raise your HDL, but high HDL has been associated to some extent with the following factors:

  • Plenty of exercise
  • Modest alcohol intake
  • Low fat consumption
  • Low saturated fat consumption
  • Low consumption of trans fatty acids

LDL cholesterol is the cholesterol that clogs your arteries. The lower your level of LDL cholesterol, the better for your heart health. In the US, more than half of men over 35 and women over 45 have high levels of LDL.

LDL Levels
High 160 mg/dl or more
Borderline Above 130 mg/dl
Desirable Below 130 mg/dl
Desirable for people with heart disease Below 100 mg/dl

If you need to lower your LDL, try taking these steps:

  • Take the steps described earlier to lower total cholesterol and increase HDL cholesterol.
  • Stay as close as possible to your ideal weight.
  • Keep your fat intake down.
There is also evidence to indicate that anti-oxidants may prevent clogging of the arteries by blocking LDL from being oxidized. Vitamin E and vitamin C are showing great promise in this area, and dietary beta-carotene also has shown some effect.

What Are Triglycerides and Do They Matter?

Triglycerides are a type of fat found in the bloodstream. Only recently have they begun to be considered important in cardiovascular health. High levels of triglycerides are now generally associated with a high risk of heart disease.

Triglyceride Levels
Very High 1000 mg/dl or more
High 400-1000 mg/dl
Borderline 200-399 mg/dl
Normal Below 200 mg/dl

High triglycerides are often attributable to excess weight or to heredity. In some cases, however, they may be associated with the carbohydrates in a very low-fat diet. However, they are not associated with all carbohydrates. Simple sugars and refined flours (such as those in a diet that is high in sugar and in low-fat products such as cookies, pretzels and pasta) tend to raise triglyceride levels in some people. On the other hand, whole grains and fruit do not seem to pose a large problem. Here is what you can do to lower your triglyceride level:

  • Reduce total fat and saturated fat intake.
  • Eat less sugar.
  • Avoid alcohol.
  • Eat more fish high in Omega-3 fatty acids.
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