Some fat is essential for normal body function. Fats can have good or bad effects on health, depending on their chemistry. When it comes to reducing heart disease risk, the type of fat may be more important than the total amount of fat.
Monounsaturated fatty acids (MUFA) and polyunsaturated fatty acids (PUFA) are "good" fats that help promote heart health. MUFAs and PUFAs should be the main type of fats consumed. Olive oil is rich in MUFAs. Salmon and walnuts are good sources of PUFAs.
Saturated fats and trans fats (trans fatty acids) are "bad" fats that can contribute to heart disease and should be avoided or limited.
All fats, good or bad, are high in calories compared to proteins and carbohydrates. One fat gram provides 9 calories versus the 4 calories provided by 1 gram of protein or carbohydrate.
Dietary guidelines for heart health recommend that:
- Monounsaturated fatty acids (found in olive oil, canola oil, peanut oil, nuts, and avocados) and omega-3 polyunsaturated fatty acids (found in oily fish, canola oil, flaxseed, and walnuts) should be the first choice for fats.
- Omega-6 polyunsaturated fatty acids (corn, safflower, sunflower, and soybean oils and nuts and seeds) are the second choice for fats.
- Limit saturated fat to less than 6% of total daily calories. Saturated fats are found predominantly in animal products (meat, whole-fat dairy) as well as tropical oils (coconut, palm.) USDA dietary guidelines limit saturated fats to less than 10% total daily calories.
- Limit trans fats (found in stick margarine, commercial baked goods, snack and fried foods) to a minimum.
Try to replace saturated fats and trans fatty acids with unsaturated fats from plant and fish oils. Do not replace fats with refined carbohydrates.
Omega-3 Fatty Acids
Omega-3 fatty acids, which are found in fish and some plant sources, are a good source of unsaturated fats. Fish oils contain the omega-3 fatty acids docosahexaenoic (DHA) and eicosapentaenoic (EPA) acids, which have significant benefits for the heart. The American Heart Association recommends eating fatty fish such as salmon at least twice a week to gain a healthful amount of these omega-3 fatty acids.
Although eating fish appears to protect the heart, the effect of fish oil supplements is unclear. Some studies suggest these supplements are heart protective, but other studies indicate that omega-3 fatty acid supplements have minimal benefit.
Carbohydrates are either complex (as in starches) or simple (as in sugars). One gram of carbohydrates provides 4 calories. Try to get your carbohydrates from complex sources such as vegetables, fruits, and whole grains. Many studies report that people can protect their heart and circulation by eating plenty of fruits and vegetables.
Complex Carbohydrates (Fiber)
Complex carbohydrates found in whole grains and vegetables are much healthier than those found in starch-heavy refined carbohydrate foods, such as white-flour pastas and white potatoes. Most complex carbohydrates are high in fiber, which is important for health.
Dietary fiber is an important component of many complex carbohydrates. It is found only in plants. Fiber cannot be digested by humans but passes through the intestines, drawing water with it, and is eliminated as part of feces content.
Different fiber types may have specific benefits:
- Insoluble fiber (found in wheat bran, whole grains, seeds, nuts, beans, and fruits and vegetables) may help achieve weight loss. Consuming whole grains on a regular basis may lower the risk for heart disease and heart failure, improve factors involved with diabetes, and lower the risk for type 2 diabetes. Whole grains include brown rice, quinoa, bulgur, oatmeal, and whole-wheat bread, High consumption of nuts (such as almonds, macadamia, and walnuts) may be highly heart protective, independent of their fiber content. The American Heart Association recommends that at least half of grains consumed in one day should be whole grains.
- Soluble fiber (found in dried beans, oat bran, barley, apples, and citrus fruits) may help achieve healthy cholesterol levels and possibly reduce blood pressure as well.
- Soluble fiber supplements, such as those that contain psyllium or glucomannan, may also be beneficial. Psyllium is taken from the husk of a seed and is effective for lowering total and LDL cholesterol. It is found in laxatives (Metamucil), breakfast cereals, and other products. People who increase intake of soluble fiber should also drink more water to avoid cramps.
Simple Carbohydrates (Sugar)
Americans eat nearly half a pound (0.23 kg) of sugar a day on average, and sugar intake constitutes 25% of a day's calories. Ideally no more than 10% of daily calories should come from added sugar.
- Sucrose. Source of most dietary sugar, found in sugar cane, honey, and corn syrup. Sucrose is a disaccharide (a type of molecule formed by two simple sugars) composed of glucose and fructose.
- Fructose. Naturally occurring sugar found in fruits and vegetables. Although fructose does not appear to be have any different effects in the body than sucrose, most of the fruits and vegetables that contain it are important for good health. However, because fructose can raise triglyceride levels, people with high triglycerides should try to select fruits that are relatively lower in fructose (cantaloupe, grapefruit, strawberries, peaches, and bananas). Fructose is a monosaccharide (simple sugar).
- A third sugar, lactose, is a naturally occurring sugar found in dairy products including milk, yogurt, and cheese. Lactose is a disaccharide composed of glucose and galactose.
High levels of sugar consumption, fructose or sucrose, are associated with higher triglycerides and lower levels of HDL (good) cholesterol. The high consumption of sugar is contributing to our current obesity epidemic. Soda, other sweetened beverages, and fruit juice are major causes of childhood obesity.
The American Heart Association recommends eating nutrient-rich fruits and vegetables instead of sugar-sweetened beverages and food products with added sugars. The focus is on limiting added sugars in foods, not the naturally occurring sugars found in fruits and unsweetened dairy products. The AHA recommends no more than 100 calories (6 teaspoons) for women and 150 calories (9 teaspoons) for men of added sugar per day.
Be aware that nutrition labels on food packages do not distinguish between added sugar and naturally occurring sugar. Ingredients that indicate added sugars include:
- Corn sweetener
- Corn sugar
- Coconut sugar
- High fructose corn syrup
- Fruit juice concentrates
- Maple syrup
- Brown rice syrup
- Any sugar molecules ending in "ose" (dextrose, fructose, glucose, lactose, maltose, sucrose).
Food product labels can help you determine how much sugar is present:
- Sugar-free. Less than 0.5 grams of sugar per serving.
- Reduced sugar/Less sugar. At least 25% less sugars per serving compared to traditional standard serving.
- No added sugars or without added sugars. No sugars or sugar-containing ingredients such as juice or dry fruit is added during processing.
Protein is found in animal-based products (meat, poultry, fish, and dairy) as well as vegetable sources such as beans, soy, nuts, and whole grains. Protein is important for strong muscles and bones. The best sources of protein are fish, poultry, low-fat dairy products, beans, and soy. Restrict intake of red meat or any meat that is not lean.
Evidence suggests that eating moderate amounts of fish (twice a week) may improve triglyceride and HDL levels and help lower the risks for death from heart disease and stroke.
The healthiest fish are oily fish such as salmon, mackerel, trout, sardines, or albacore ("white") tuna, which are high in the omega-3 fatty acids DHA and EPA. Most guidelines recommend eating fish at least twice a week. On average, 3 capsules of fish oil (preferably as supplements of DHA-EPA) are about equivalent to eating one serving of fish. However, studies suggest that fish oil supplements are not as heart protective as dietary sources.
Women of childbearing age or nursing mothers should avoid fish that contains high amounts of mercury (such as shark, swordfish, and mackerel) and limit intake of tuna to 6 ounces/week. They should, however, try to eat at least 12 ounces/week of a variety of lower mercury-containing fish and shellfish (such as catfish, salmon, haddock, perch, tilapia, trout, crab, shrimp, and scallops).
Meat and Poultry
Saturated fat in meat is the primary danger to the heart. The fat content of meat varies depending on the type and cut. For heart protection, choose lean meat. It is best to eat skinless chicken or turkey. The leanest cuts of pork (loin and tenderloin), veal, and beef are nearly comparable to chicken in calories and fat as well as their effect on LDL and HDL levels. However, in terms of heart health, fish or beans are better choices.
The best dairy choices are low-fat or fat-free products. Substituting low-fat dairy products for full-fat dairy products can help to lower saturated fat intake and total calorie intake while still providing protein, vitamins, and minerals.
Soy foods are made from soybeans, a legume. Soy is rich in both soluble and insoluble fiber, omega-3 fatty acids (omega-3 fatty acid ALA, not the DHA/EPA found in fatty fish), and provides a high protein, low carbohydrate content. The best sources of soy protein are soy products (soybeans, tempeh, tofu, soy flour, and soy milk). Soy sauce is not a good source of soy protein. It contains only a trace amount of soy and is very high in sodium.
For many years, soy was promoted as a food that could help lower cholesterol and improve heart disease risk factors. However, it appears that soy protein and isoflavone supplement pills do not have a major effect on cholesterol or heart disease prevention. The American Heart Association still encourages people to include soy foods as part of an overall heart healthy diet but does not recommend using isoflavone supplements. It recommends replacing foods high in animal fats with those containing soy protein.
Antioxidants are chemicals that act as scavengers of particles known as oxygen-free radicals (also sometimes called oxidants). Vitamins E and C have been studied for their health effects because they serve as antioxidants. High intake of foods rich in these vitamins (as well as other food chemicals) are associated with many health benefits, including prevention of heart problems.
However, despite much research, there is little evidence that regular use of multivitamin supplements reduces the risk for heart disease. Supplements of vitamin E, vitamin C, and beta-carotene are not recommended as part of a heart-healthy diet. Food rich in these nutrients is recommended.
A multivitamin may be recommended in certain specific circumstances for individuals with increased nutritional needs such as people who have had weight loss surgeries or women who are trying to get pregnant.
B Vitamins (Folic Acid)
Deficiencies in the B vitamins folate (known also as folic acid or vitamin B9), B6, and B12 have been associated with a higher risk for heart disease in some studies. Such deficiencies produce higher blood levels of homocysteine, an amino acid that has been associated with a higher risk for heart disease, stroke, and heart failure.
While major studies have indicated that B vitamin supplements help lower homocysteine levels, they do not protect against heart disease, stroke, or dementia (memory loss). Homocysteine may be a marker for heart disease rather than a cause of it.
Vitamin D, in addition to promoting bone health, may also be important for heart health. In studies, people who were vitamin D deficient appeared to have an increased risk for heart-related deaths. Other studies have suggested that children and adolescents who have low blood levels of vitamin D may be at increased risk of developing heart disease and diabetes. More research is needed.
Dietary sources of vitamin D include fatty fish (such as salmon, mackerel, and tuna), egg yolks, liver, and vitamin D-fortified milk, orange juice, or cereals. Sunlight is also an important source of vitamin D. However, many Americans do not get enough vitamin D solely from diet or exposure to sunlight and may require supplements.
At this time, there is no standard recommendation for whether people should take vitamin D supplements for heart health, or at what dosages. Many health care providers recommend that for bone and overall health, people should receive the following daily amounts of vitamin D, according to their age:
- 0 to 12 months: 400 IU per day.
- 1 to 70 years: 600 IU per day.
- 70 years and older: 800 IU per day.
A potassium-rich diet can provide a small reduction in blood pressure. Potassium-rich foods include:
- Dried peas and beans
- Nuts and seeds
- Potatoes with skin
- Soy milk
- Swiss chard and spinach
Potassium supplements should not be taken without first checking with your provider. For people who take potassium-sparing diuretics (such as spironolactone), or have chronic kidney problems, potassium supplements may be very dangerous.
Some studies suggest that magnesium supplements may cause small but significant reductions in blood pressure. The recommended daily allowance of magnesium is 320 mg. People who live in soft water areas, who use diuretics, or who have other risk factors for magnesium loss may require more dietary magnesium than others.
Calcium regulates the tone of the smooth muscles lining blood vessels. Studies have found that people who consume enough adequate dietary calcium on a daily basis have lower blood pressure than those who do not. Consuming too much dietary calcium may, however, have a negative effect. Dairy products are the main dietary source of calcium. Other foods that are rich in calcium include collard greens, sardines canned with bones, and fortified almond, rice, or soy milks.
Some sodium (salt) is necessary for health, but the amount is vastly lower than that found in the average American diet. High salt intake is associated with high blood pressure (hypertension). Limiting sodium can help lower blood pressure and may also help protect against heart failure and heart disease. The American Heart Association recommends reduction of sodium intake to <2300 mg/day (to be consistent with the USDA Dietary Guidelines for Americans) or further reduction to 1500 mg/day as needed for enhanced BP lowering.
Some people (especially African-Americans, older adults, people with diabetes, and people with a family history of hypertension) are "salt sensitive," which means their blood pressure increases in response to sodium more than other people's. People with salt sensitivity have a higher than average risks of developing high blood pressure as well as other heart problems. Sodium restriction is particularly important for people with salt sensitivity, as well as those with diagnosed hypertension.
Simply eliminating the use of salt at the table eating can help. But it is also important to reduce or avoid processed and prepared foods that are high in sodium. Spices can be used in place of salt to enhance flavor.
Salt substitutes, such as Nu-Salt and Mrs. Dash (which contain mixtures of potassium, sodium, and magnesium), are available, but they can be risky for people with kidney disease or those who take blood pressure medication that causes potassium retention. For people without risks for potassium excess, adding potassium-rich foods to a diet can help.
Here are some tips to lower your sodium (salt) intake:
- Look for foods that are labeled "low-sodium," "sodium-free," "no salt added," or "unsalted." Check the total sodium content on food labels. Be especially careful of canned, packaged, and frozen foods. A Registered Dietician-Nutritionist can teach you how to understand these labels.
- Frozen and fresh vegetables are preferable to canned as they are usually lower in sodium (unless they are seasoned or served in a sauce most frozen vegetables have no added sodium and are comparable to fresh).
- Do not cook with salt and do not add salt to your food. Try pepper, garlic, lemon, or other spices for flavor instead. Be careful of packaged spice blends as these often contain salt or salt products (like monosodium glutamate, or MSG).
- Avoid processed meats (particularly cured meats, bacon, hot dogs, sausage, bologna, ham, and salami). Processed meats have been associated with increased risk for heart disease, type 2 diabetes, and certain types of cancer.
- Avoid foods that are naturally high in sodium, like anchovies, nuts, olives, pickles, sauerkraut, soy and Worcestershire sauces, tomato and other vegetable juices, and cheese.
- Take care when eating out. Stick to steamed, grilled, baked, boiled, and broiled foods with no added salt, sauce, or cheese.
- Use oil and vinegar, rather than bottled dressings, on salads.
- Eat fresh fruit or sorbet when having dessert.
People with certain medical conditions, (such as heart failure) that cause fluid retention may need to restrict their intake of water and other fluids.
A number of studies have found heart protection from moderate alcohol intake (one or two glasses a day). Although red wine is most often cited for healthful properties, any type of alcoholic beverage appears to have similar benefit.
However, alcohol abuse can increase the risk of high blood pressure and many other serious problems. To avoid alcohol use disorders, men should limit their intake to no more than 2 drinks a day, and women should have no more than 1 drink a day. People with certain risk factors (such as breast cancer) should have stricter limits or consider not consuming any alcohol. A standard drink contains around 14 grams of pure alcohol and is equivalent to a 12-ounce (350 milliliter) bottle of regular beer (5% alcohol), a 5-ounce (150 milliliter) glass of table wine (12% alcohol), or a 1.5-ounce (44 milliliter) shot of hard liquor (40% alcohol).
Overuse of alcohol can lead to many heart problems. People with high triglyceride levels should drink sparingly if at all because even small amounts of alcohol can significantly increase blood triglycerides. Pregnant women, people who can't drink moderately, and people with liver disease should not drink at all. People who are watching their weight should be aware that alcoholic beverages are high in calories.
Coffee and Tea
Coffee drinking is associated with small increases in blood pressure, but the risk it poses is very small in people with normal blood pressure. Moderate coffee consumption (3 to 5 cups a day, or the equivalent of 400 mg of caffeine per day) poses no heart risks and long-term coffee consumption does not appear to increase the risk for heart disease in most people.
Although both black and green tea contain caffeine, they are safe for the heart. Tea contains chemicals called flavonoids that may be heart protective.