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.
Oils and fats are usually a mixture of the three kinds of fatty acids: monounsaturated, polyunsaturated, and saturated. For heart healthy eating, keep these guidelines in mind:
- Choose food products with more monounsaturated and polyunsaturated fatty acids
- Reduce your use of saturated fats; refer to this chart to make healthier choices:
Dietary Fats Percentage of Saturated Fat Percentage of Mono-
unsaturated FatPercentage of Poly-
unsaturated FatCanola oil 6 62 31 Safflower oil 10 13 77 Sunflower Oil 11 20 69 Corn Oil 13 25 62 Olive Oil 14 77 9 Sesame Oil 14 40 42 Soybean Oil 15 24 61 Peanut Oil 10 49 33 Margarine, Soft 19 49 30 Chicken Fat 31 47 21 Lard 41 47 12 Palm Oil 50 40 10 Beef Fat 52 44 3 Butter 66 30 2 Margarine, Stick Form 80 14 16 Palm Kernel Oil 86 12 2 Coconut Oil 92 6 2
To help reduce the saturated fat in your diet, try replacing:
- Cream cheese with light cream cheese in a tub
- Butter with whipped margarine
- Spray margarine with sprinkles such as Butter Buds or Molly McButter
- Eggs with 2 egg whites or egg substitutes
- Chocolate with cocoa mixed with margarine
- Ground beef with lean ground turkey or soy protein crumbles
- Mayonnaise with light mayonnaise
- Shortening (1 cup) with margarine (1 cup) or canola oil (3/4 cup)
- Sour cream with non-fat yogurt or non-fat sour cream
- Cooking oil with cooking spray in a non-stick pan
- Powdered coffee creamer with non-fat dried skim milk
- DON'T wait to cut your total fat intake.
The risk of heart disease falls sharply if you reduce fat to less than 30 percent of total calories (as opposed to the 34-54 percent that is typical in the United States). When you lower fat consumption, you also reduce your saturated fat intake, cut calories and lose weight.
Exactly how much of your diet should come from fat is a matter of controversy. Too little fat may be as bad as too much, although this idea is somewhat controversial. It probably depends on your specific health profile.
If you are on a low-fat, high-carbohydrate diet, yet you also have low HDL (good) cholesterol and high triglycerides, you may need to reconsider the quality of your low-fat diet plan. Your carbohydrates should be coming from whole-grain cereals and breads, fresh fruits and vegetables. Your diet should include only a minimal amount of sugar. If you are taking advantage of fat-free "fun foods," such as low-fat sweets, pretzels and pasta, along with fat-free ice cream and desserts, you may be unintentionally raising your triglyceride level.
- DO get more anti-oxidants.
Anti-oxidants retard the development of "free radical" cells that are implicated in heart disease and cancer. Oxidized LDL (bad cholesterol) is damaging to the arterial wall. Certain vitamins and other compounds provide anti-oxidant effects.
- DON'T eat lots of cholesterol-rich food.
Your daily cholesterol intake should be 300 milligrams or less. Certain animal foods are rich in cholesterol, but no plant foods contain cholesterol. Keep these food facts in mind.
A single egg yolk has 255 milligrams of cholesterol; if you are healthy, you should eat no more than two egg yolks per week. (If you already have heart disease, you may be advised otherwise.) Egg white has no fat or cholesterol, so you might consider eating egg whites and egg substitutes frequently. Egg white is also an excellent form of protein. Organ meats and certain seafood -- shrimp, lobster and calamari -- have high levels of cholesterol.
The body makes cholesterol. In most cases, the more cholesterol a person eats, the less the body makes. However, 20-30 percent of Americans are not able to balance the cholesterol they produce and the cholesterol they ingest this well; as a result, they may have excessively high cholesterol levels. Ask your physician about treatments available for people who fit into this category.
- DO increase the soluble fiber in your diet.
Remember the oat bran craze? Well, there is nothing crazy about eating a lot of soluble fiber -- which is found in oat bran in abundance -- if you want to lower your cholesterol.
The soluble fiber in oats, called beta-gluca, has specifically been proven to reduce blood cholesterol. A high daily intake of soluble fiber, through generous servings of oat- and bean-based foods, helps to eliminate cholesterol-laden bile acids and fats from your body.
Soluble fiber is found primarily in these foods:
- Oats
- Legumes
- Apples
- Pears
- Plums
- Carrots
- Okra
- Barley
- DON'T eat excessive saturated fats.
In terms of heart health, there is nothing good to be said for saturated fats! They are to blame for increasing total cholesterol, LDL cholesterol and triglycerides.
Less than one-third of your fat intake should come from saturated fat. You find saturated fat in dairy fats such as cream, butter and cheese. Saturated fat is also in animal fats like chicken skin, visible fat on meat, and lard. The chemical structure of saturated fats makes them solid at room temperature.
- DO increase your use of monounsaturated fats within your total allotment for fat.
Monounsaturated fats lower blood cholesterol and will reduce your risk of heart disease.
Monounsaturated fats are liquid at room temperature. They are the main fatty acids in olive oil and canola oil. Use olive and canola oil in your cooking and in salad dressings to promote heart health.
- DON'T eat tropical oils.
The tropical oils are palm, palm kernel and coconut oil. They are highly saturated. Many prepared foods contain them, so check the labels for ingredients. You are likely to find tropical oils in products like these:
- Non-dairy coffee creamers
- Whipped toppings
- Baked goods
- Cookies
- Chocolate candy
- DO reduce your intake of trans fatty acids.
Trans fatty acids are compounds that occur when foods are chemically modified by partial hydrogenation. The safety of trans fatty acids has been a controversial subject. Recent studies have helped resolve the issue. For instance, a US Department of Agriculture study showed that trans fatty acids from partially hydrogenated vegetable oil raise cholesterol as much as saturated fats do. Trans fatty acids may also reduce HDL cholesterol (good cholesterol).
- DON'T be afraid to try more soy protein.
A number of studies have shown that soy protein lowers cholesterol. Soy has isoflavones, called daidzein and genistein, which are the plant estrogens that play a role in cholesterol metabolism. Soy protein is a good protein that can be substituted for animal protein in your diet. Here are some sources of soy protein:
- Tofu
- Tempeh
- Veggie burgers made with textured vegetable soy protein
- Soy milk
- DO use polyunsaturated fats.
Polyunsaturated fats are the major fat source in vegetable oils such as safflower oil and corn oil. They generally lower total cholesterol, although they may also lower HDL cholesterol (good cholesterol).
Try to use less hydrogenated margarine; liquid and tub margarine are better than stick margarine. Some less hydrogenated products may contain trans fatty acids, but you can avoid them by reading labels. The newest types of margarine are labeled "without transfats."
- DON'T think vitamins will do it all -- get your phytochemicals.
Phytochemicals are plant chemicals that may help prevent not only heart disease, but also other chronic diseases and conditions such as diabetes, cancer and hypertension.
Fruits and vegetables are chock-full of them; eating five servings a day is a good start on the road to better health.
Garlic may help reduce blood cholesterol, LDLs and triglycerides; garlic pills are being studied now, but the results so far are inconclusive. It appears that raw garlic is the active ingredient.
- DO get your Omega-3 fatty acids.
Omega-3 fatty acids are polyunsaturated fats from plant and marine sources. Omega-3 is an essential fatty acid, linolenic acid. The richest sources are fish that swim in cold waters, such as those listed here; try to eat them at least once a week. The numbers listed indicate the amount of Omega-3 fatty acids in a 3-ounce serving:
- Salmon, Atlantic, cooked (1.8 g)
- Anchovy, canned in oil (1.7 g)
- Mackerel, Pacific and Jack, cooked (1.6 g)
- Sablefish, cooked (1.5 g)
- Salmon, pink, canned (1.4 g)
- Sardines packed in tomato sauce (1.4 g)
- Herring, Atlantic, pickled (1.2 g)
- Rainbow trout, cooked (1.0 g)
- Tuna, canned in water (0.7 g)
The benefits of eating these sources of Omega-3 include the following:
- Significant reductions in high triglyceride levels
- Slower blood clotting
- Prevention of abnormal heart rhythms
- Enhanced immune function
- Improved eye and brain development
If you do not eat fish, be sure to include other foods rich in linolenic acid, such as these:
- Walnuts
- Walnut oil
- Flaxseed oil
- DON'T give up all shellfish.
Shrimp, although moderately high in cholesterol, is a very low-fat protein. Eaten once or twice a month it will not affect cholesterol levels. All other shellfish are also acceptable, except squid (calamari) and roe (caviar). Mollusks such as clams, mussels and scallops are all fine. Be sure shellfish are from reputable sources and are cooked well. Have your seafood baked, broiled, steamed or boiled -- but not fried. Use only oils low in saturated fat in preparing shellfish recipes which call for oil.
- DO get enough folic acid, vitamin B6 and vitamin B12.
Low levels of folic acid and other B vitamins can cause excessive homocysteine to be produced in the body, and high homocysteine levels are an independent risk factor for heart attack and stroke.
You need 400 micrograms of folic acid a day to prevent heart disease. A multivitamin will provide the recommended amount. Foods that will also do the job include the following:
- Total cereal
- Product 19
- lentils
- asparagus
- spinach
- kidney beans
- orange juice
While this article is focused on diet, it would be wrong to avoid mentioning the importance of exercising to reduce your risk of heart disease. Get a lot of exercise. It will help you lose weight, increase your HDL (good) cholesterol and lower your triglycerides.
Lose weight if you need to. Losing just 10 pounds can make a difference in your cholesterol level, especially if your body is an "apple shape" -- that is, most of your excess fat is located near your waist. Your waist measurement divided by your hip measurement should be less than 0.9 for men and less than 0.8 for women.
And, finally, if you smoke, STOP.
Heart Healthy RecipesBy using the information given in this article and following the instructions given to you by your physician, you will find yourself on the road to reducing your risk of coronary heart disease. However, since this is an ezine with a focus on cooking, it wouldn't be right to end without sharing some recipes that put the ideas in this article to work. So, pull out those pots and pans and get ready to eat heart healthy!
Strawberry-Banana Slush
- 2 cups coarsely chopped strawberries, frozen
- 2 medium bananas, frozen and broken into quarters
- 2 cups pineapple-orange-banana juice
- 1 tablespoon sugar
- 1 tablespoon lemon juice
Place all ingredients in a blender or food processor and process until smooth.
- Yields: 5 servings
- Preparation Time: 5 minutes
Spinach Squares
- 1 package (10 ounces) frozen chopped spinach, thawed
- dash nutmeg
- 1/8 teaspoon sugar
- 1 cup low-fat cottage cheese
- 2 teaspoons flour
- 2 tablespoons grated Parmesan cheese
- 1 egg yolk
- 1/8 teaspoon black pepper
- dash cayenne pepper
- 2 egg whites
Preheat the oven to 400 degrees. Line the bottom of an 8-inch square pan with wax paper or parchment paper and set aside. Drain and squeeze excess water out of the spinach. In a large bowl, combine spinach, nutmeg and sugar.
Put the cottage cheese in a food processor or blender and process 30 seconds. Add the flour, Parmesan cheese, egg yolk, black pepper and cayenne pepper. Process 30 seconds longer or until well-blended. Add to spinach mixture and mix well.
In a medium bowl, beat the egg whites until they form stiff peaks. Gently fold into the spinach mixture. Pour into baking pan. Bake, uncovered, for 20 minutes or until set and golden.
Place the pan on a wire rack and cool for 5 minutes. Invert onto cutting board and slice into 16 squares. Serve warm.
- Yields: 16 appetizer servings
- Preparation Time: 40 minutes
Spicy Salmon with Southern Salsa
- 3 medium peaches, coarsely chopped
- 1 cup red bell pepper, coarsely chopped
- 1 cup sweet onion, coarsely chopped
- 1/4 cup fresh basil, thinly sliced
- 1/4 cup white wine vinegar
- 1/2 teaspoon grated orange rind
- 2 tablespoons fresh lime juice
- 2 garlic cloves, minced
- 1/4 teaspoon ground chipotle pepper
- 4 salmon fillets, 6 oz. each
Combine all ingredients except chipotle pepper and salmon fillets in a medium sized bowl. Stir until well mixed. Set aside for 1 hour.
Sprinkle salmon fillets with ground chipotle pepper. Prepare broiler. Place fish on broiler pan coated with cooking spray and broil for 5 minutes on each side or until fish flakes easily when tested with a fork. Serve immediately with 1 cup of salsa spread over each fillet.
- Yields: 4 servings
- Preparation Time: 1 hour and 15 minutes
Lemon Dijon Pasta
- 5 ounces (2 cups) uncooked dried rotini pasta
- 2 cups frozen broccoli
- 1 tablespoon margarine
- 1 tablespoon flour
- 1/4 teaspoon salt
- 1/8 teaspoon white pepper
- 1 cup skim milk
- 2 tablespoon Dijon-style mustard
- 1 tablespoon chopped onion
- 2 teaspoon lemon juice
Cook pasta according to package directions and add broccoli during last 5 minutes of cooking. Rinse with hot water and drain.
In a 3-quart saucepan, melt margarine until sizzling; stir in flour, salt and pepper until smooth and bubbly (about 1 minute). Gradually stir in milk and mustard. Cook over medium heat, stirring constantly, until mixture comes to a full boil (about 4 to 6 minutes). Continue boiling 1 minute, then remove from heat. Add onion and lemon juice to sauce and stir. Immediately add pasta mixture; toss to coat evenly.
- Yields: 6 servings
- Preparation Time: 20 minutes
Italian Broccoli with Tomatoes
- 4 cups broccoli florets (fresh or frozen)
- 1 tablespoon water
- 1/2 teaspoon dried oregano
- 1/4 teaspoon pepper
- 1 tablespoon lemon juice
- 2 medium-ripe tomatoes, cut in wedges
- 1/2 cup shredded part skim mozzarella cheese
Wash and cut broccoli into 1/2-inch pieces, if using fresh broccoli.
Place broccoli and water in a shallow microwave dish. Cover with lid or plastic wrap. Microwave on high for 6 to 8 minutes, stirring twice. They are finished when tender.
Drain the broccoli. Stir in spices and tomato wedges. Sprinkle cheese on top. Cover. Microwave to melt cheese. Let stand for a few minutes before serving.
- Yields: 6-8 servings
- Preparation Time: 15 minutes
Apple Cobbler
- 1 tablespoon cornstarch
- 1 tablespoon sugar
- 1/8 teaspoon cinnamon
- 3/4 cup water
- 2 medium tart apples (like Macintosh or Granny Smith), peeled and sliced
- 3/4 cup reduced fat biscuit mix
- 2 tablespoons light margarine, melted
- 3 tablespoons water
Mix cornstarch, sugar and cinnamon in a saucepan. Add 3/4 cup water and mix well. Add apples. Cook over low heat, stirring occasionally, until liquid thickens and apples just begin to soften, about 6 minutes. Pour into 1-quart casserole dish. Stir biscuit mix and margarine together. Add 3 tablespoons water and mix well. Spread on top of apple mixture. Bake at 400 degrees until top is lightly browned, about 30 minutes.
- Yields: 6 servings
- Preparation Time: 1 hour
For more information about coronary heart disease and what you can do to reduce your risk of having it, consult your physician and visit any of the following web sites: