Heart Disease and Nutrition

Did you know that you have the power to reduce or even reverse your risk of cardiovascular disease? Many Americans don’t. In fact, the American College of Cardiology reports that more than 90 million Americans carry a diagnosis of cardiovascular disease and it accounts for approximately 800,000 deaths in the United States each year. Even more startling is that nearly half of all Americans have at least one major risk factor for heart disease, but many don’t know it or don’t act upon warning signs.

There are risk factors for heart disease that can be controlled and ones that cannot. While age, gender, and family history do play a role in risk factors of heart disease, these cannot be changed. However, there are several risk factors that you can control, and managing these is essential to achieving overall health and well-being, while also significantly reducing your risk for cardiovascular disease.

Some major risk factors of heart disease that can be controlled include:

• Long history of cigarette smoking and/or drug abuse
• Excessive amounts of alcohol consumption over many years
• Little to no physical activity
• Obesity
• Extreme levels of stress
• High cholesterol
• High blood pressure

Getting these risk factors controlled is essential to achieving overall health and well-being. Simple lifestyle changes that can improve your heart health, include:

• Avoid or Quit Smoking: Smoking doesn’t just put you at risk for lung cancer. Cigarette smokers are at a higher risk of developing cardiovascular disease. No matter how long or frequently you’ve smoked, your risk of developing heart disease drops significantly within one year of quitting. To learn more about smoking and its effects on the heart, please visit our “Heart Disease and Smoking” page.

• Limiting alcohol intake: According to the American Heart Association, “Alcohol intake can be a component of a healthy dietary pattern if consumed in moderation and only by women who are not pregnant and adults when there is no risk to health condition, drug-alcohol interaction, or work situations. Men should have no more than 2 drinks per day, while women should have no more than 1 drink per day.
  • One drink is equivalent to 12 oz. beer, 5 oz. wine or 1.5 oz. of 80-proof distilled spirits.

To learn more about alcohol and its effects on the heart, please visit our “Heart Disease and Alcohol” page.

• Physical Activity: The American Heart Association recommends adults engage in at least 150 minutes per week of accumulated moderate-intensity physical activity or 75 minutes per week of vigorous-intensity physical activity. Don’t be afraid to start small. Daily activities, like walking, parking further back in the parking lot, or taking the stairs, can easily add up. To learn more about exercise, please visit our “Heart Disease and Exercise” page.

• Maintaining a healthy weight: Being overweight or obese increases your risk for heart disease. To determine if your weight is in a healthy range, doctors often calculate your body mass index (BMI). Counseling and caloric restriction are recommended for achieving and maintaining weight loss. Check with your doctor to learn more.

• Coping with stress: Continued stress can have a significant negative impact on your heart. To learn more about stress and its effect on the heart, please visit our “Heart Disease and Stress” page.

• Know your cholesterol level: Based on your health condition, your doctor will recommend how often to check your cholesterol. To learn more about cholesterol’s effect on the heart, please visit our “High Cholesterol” page.

• Know your blood pressure numbers: Based on your health condition, your doctor will recommend how often to check your blood pressure. To learn more about blood pressure’s effect on the heart, please visit our “High Blood Pressure” page.

• Keep blood sugar under control: If you have diabetes, chronic high blood sugar can narrow your arteries and increase your risk for heart disease. Check with your doctor to learn more about your health condition.

*Oftentimes, people tend to ignore signs that your heart is in trouble. Not all heart problems come with the traditional or stereotypical warning signs.

Warning signs not to ignore:

• Chest pain or discomfort, including pressure, squeezing, or pain in the upper chest, back, or lower abdomen – commonly mistaken for indigestion or heart burn.
• Heart arrhythmias
• Recurrent dizziness or lightheadedness.
• Confusion, impaired thinking and feelings of disorientation.
• Shortness of breath with activity, or difficulty completing regular activities.
• Nausea or vomiting.
• Swelling in the feet, ankles, legs or abdomen.
• Wheezing, or a persistent cough, due to fluid that leaks into the lungs.

It’s about noticing your changes in ability to perform normal tasks. For example, if you usually don’t have trouble taking the stairs, but suddenly you can’t take the stairs without getting winded or without feeling that “heartburn” sensation, that’s something that should catch your attention.

Heart-Healthy Nutrition

*Please note: Always consult your doctor before beginning any type of meal plan. The general information included in this page is not intended to diagnose any medical condition or to replace your doctor. Consult with your doctor to design an appropriate meal plan for. And remember, do not alter anything within your meal plan prior to checking and getting the approval of your doctor.

Food Groups

Before you eat, think about what goes on your plate, cup, or bowl. You may be eating plenty of food, but your body may not be getting the nutrients it needs to be healthy. The American Heart Association recommends a healthy dietary pattern that includes grains; fruits and vegetables; fats and oils; sweets and sugars; nuts, seeds and legumes; fat-free or low-fat dairy products; and lean meats, poultry, and seafood.

This table shows the suggested number of servings from each food group based on a daily intake between 1,600 and 2,000 calories based upon the Dietary Guidelines for Americans 2015-2020.

Grains: In particular, whole grains are good sources of fiber and other nutrients that play a role in regulating blood pressure and heart health.

• 5 to 6 servings per day of which half should be whole grain.
• Grains to choose: barley, wholegrain pasta or bread, whole grain cereals and crackers, rolled or steel cut oats, oat bran, brown rice, quinoa, and bulgur.
• Grains to limit or avoid: refined grain products such as white bread, refined grain cereals and crackers, pasta and white rice. Limit muffins, corn bread, doughnuts, biscuits, cookies and cakes, which can be a source of added fat, sugar and sodium.

Fruits and Vegetables: Vegetables and fruits are good sources of vitamins and minerals and are also rich in dietary fiber. Vegetables and fruits, like other plants or plant-based foods, contain substances that may help prevent cardiovascular disease. Fresh and frozen fruits and vegetables are healthier options. Choosing fruits and vegetables that are in season are often cheaper and taste the best.

• 3-5 servings per day.
• Fruits to choose: berries, melons, citrus fruits, apples, bananas, mangoes and papaya. Dried fruit can be a healthy choice but when consumed in excess can be a source of extra calories.Choose 100%fruit juice without added sugars. Avoid canned fruit in heavy syrup or with added sugars.
• Vegetables to choose: Dark green leafy vegetables, red and orange vegetables, starchy veggies such as sweet potatoes, corn, green peas and other vegetables such as broccoli, cauliflower, mushrooms, onions, cabbage and zucchini.

Fats and oils: The American Heart Association recommends limiting saturated fats and replacing with monounsaturated and polyunsaturated fats.

• Saturated Fats: Saturated fats are generally solid or waxy at room temperature and are found primarily in animal products and tropical oils. Diets high in saturated fats raise the “bad” cholesterol, low-density lipoprotein (LDL) and increase the risk of developing atherosclerosis (the narrowing of arteries caused by plaque that can lead to a heart attack or stroke).
  • Sources of Saturated Fats to limit or avoid: high-fat meats such as ground beef; sausage and ribs; butter; full fat cheese; lard and cream; lamb; bacon; poultry with skin; other dairy products made from whole or reduced-fat (2%) milk.
• Unsaturated Fats: Unsaturated fats are considered the healthiest fats because they improve cholesterol, are associated with lower inflammation (a risk factor for heart disease), and are associated with overall lower risk of developing heart disease. Unsaturated fats are found primarily in plant-based foods; and are generally liquid at room temperature. There are two types of unsaturated fat: monounsaturated and polyunsaturated.
  • Monounsaturated Fats: Considered one of the healthiest fat sources in the diet. These include:
    • Olive, canola, and peanut oils, avocado oil, most nuts (excluding walnuts), and nut butters (such as peanut butter), olives and avocados.
  • Polyunsaturated Fats: Polyunsaturated fats are found primarily in:
    • Corn, soybean, sunflower, flax oils, flax seeds, walnuts. Fish is a source of omega-3 polyunsaturated fatty acids which benefit heart health.
  • Trans Fatty Acids: Trans fatty acids are formed when a liquid fat is converted to solid fat through a process called hydrogenation. Many manufacturers use hydrogenated fats in their ingredients because it creates a product with an extended shelf life and improved consistency. Trans fatty acids raise the “bad” cholesterol (LDL), and lower the “good” cholesterol, high-density lipoprotein (HDL). There are currently no safe levels of trans fat to consume each day, so try to keep your daily intake as low as possible. Look for 0 trans fats on food labels.

Sweets and Added Sugars: Sugars in your diet can be naturally occurring or added. Naturally occurring sugars are found naturally in foods such as fruit (fructose) and milk (lactose). Added sugars are sugars and syrups put in foods during preparation or processing, or added at the table.

• The American Heart Association recommends limiting the intake of added sugars to the equivalent of no more than 100 calories (25 grams) per day in women and 150 calories (37.5 grams) per day in men. The American Heart Association recommends that children and adolescents aged 2 to 18 years should limit their intake of added sugars to less than 100 calories per day (25 grams) or less than 2 tablespoons. For children less than 2 years of age, added sugars should not be included in the diet.

Nuts, seeds, and legumes:

• 3-5 servings per week.
• Nuts, seeds and legumes to choose: split peas; all types of legumes (e.g. lentils, garbanzo beans, edamame, lima beans, kidney beans, etc.); sunflower seeds; flax seeds; chia seeds; walnuts; Brazilian nuts; almonds; pistachios; cashews; and peanut butter or other nut butters without added salt or sugar.

Fat-free or low-fat dairy products:

• 2-3 servings per day.
• Choose: milk, yogurt, cheese and or fortified soy beverages that are labeled fat-free or low-fat (1%) dairy.
• Products to limit or avoid: Milk, yogurt or cheese labeled as full fat or made with whole milk.

Lean meats, poultry, and seafood:

• Less than 6 ounces per day.
• Choose lean meats, poultry and seafood such as: skinless chicken and skinless turkey with visible fat removed; lean ground turkey or chicken; beef and pork labeled “loin” and “round;” use “choice” or “select” grades of beef rather than “prime.” Seafood choices such as sardines; salmon; herring, mackerel, tuna and anchovies. The American Heart Association recommends 1-2 (3.5 ounce servings) of seafood meals per week.
• Products to avoid: Red meat and processed meats (e.g. hot dogs, bacon, sausage, salami, pastrami and bologna).

Understanding Food Labels

You probably know that a healthy diet is important. Eating right can help prevent a number of problems such as high cholesterol and heart disease. This process starts with shopping healthy. A major component in doing so is understanding what you are putting into your body. Learning how to read and understand food labels can help you make healthier choices. Here are some tips from the American Heart Association for making the most of the information on the Nutrition Facts label.

1. Start with the serving information at the top of the label: This will tell you the size of a single serving and the total number of servings per container (package). This means that if you were to eat the whole package, you would multiply each of the numbers shown by 8.
2. Check, total calories per serving: Pay attention to the calories per serving and how many servings you’re really consuming if you eat the whole package.
3. The American Heart Association recommends avoiding trans fats and limiting saturated fat to less than 5-6% of total calories and sodium intake to less than 2,300 mg per day or 1,500 mg for certain individuals.
4. Make sure you get enough of beneficial nutrients such as: dietary fiber. The American Heart Association recommends 28-30 grams per day.
5. Quick guide to % daily value: The % Daily Value (DV) tells you the percentage of each nutrient in a single serving, in terms of the daily recommended amount. As a guide, if you want to consume less of a nutrient (such as saturated fat or sodium), choose foods with a lower % DV — 5 percent or less. If you want to consume more of a nutrient (such as fiber), seek foods with a higher % DV — 20 percent or more.

Food Shopping Suggestions

Making simple, smart food choices at the grocery store or when dinning out can go a long way. Some general recommendations to follow when shopping:

• Choose heart-healthy recipes: To acquire some recipes, please visit our “1,000 heart-healthy recipe cookbook.”
• Read food labels: Ingredients and nutrient content can vary a lot by brand and preparation. When there’s more than one choice, compare labels. Choose the item with the lowest amounts of sodium, saturated fat, trans fat and added sugars.
• Skip processed foods in boxes and bags: Whole foods tend to cost less than processed varieties, while sparring you the added sodium and sugar that can lead to weight gain, diabetes and heart damage.
• Choose frozen, canned or dried produce when fresh isn’t available or practical: It can be just as nutritious as fresh, and will last longer. Choose canned fruit packed in water or its own juice. With canned and frozen vegetables, choose the product with the lowest amount of sodium. Heavy syrups and sauces can add unwanted ingredients (sugar and/or sodium) to your healthy fruits and veggies.
• Be aisle-smart: Shop mostly from the outer aisles of your market. That’s where fresh fruits, vegetables, dairy, fish and meat tend to be displayed. In the middle aisles, look for heart-healthy canned tuna, salmon and sardines, frozen unprocessed fish fillets; and dried or canned beans. Look down too as often the priciest items are placed at eye level, while cheaper store brand are at lower level.
• Choose whole-grain foods: Lots of products claim to be, but there’s a simple way to know for sure. Look for the word “whole-grain” (or “whole” followed by the grain name) as the first item in the ingredients list.
• Pick what’s in season: When produce is plentiful, it tends to cost less. For example, corn is a better buy in the summer, while apples are a bargain in the fall and winter.
• Don’t shop when you are hungry: You’ll be less likely to make poor decisions.
• Look for Heart-Check mark: When it’s on the label, you know the product has been certified by the American Heart Association to meet specific science-based nutrition requirements.
• Cook more meals at home: Research shows that people who cook meals at home eat healthier and consume fewer calories than those who cook eat out.

Eating Out

However, when the time comes for a night out, don’t be afraid to ask for healthy options. You can follow these tips:

1. Avoid ordering before-the-meal “extras” like cocktails, appetizers, bread and butter because these are often sources of extra fat, sodium and calories.
2. Ask for butter, cream cheese, salad dressings, sauces and gravies to be served on the side.
3. Choose boiled, baked or grilled fish or chicken, instead of fried.
4. Steer clear of high-sodium foods – including any food that’s served pickled, in cocktail sauce, smoked, or in soy or teriyaki sauce. Avoid dishes with lots of cheese, sour cream and mayonnaise.
5. Be selective at salad bars: Choose fresh greens, raw vegetables, fresh fruits, garbanzo beans and reduced-fat, low-fat, light or fat-free dressings. Olive oil and vinegar may be better choices than bottled dressings. Avoid cheeses, marinated salads, pasta salads and fruit salads with whipped cream as they can be a source of extra calories and fat.
6. Choose desserts carefully. Fresh fruit, fruit ice, sherbet, gelatin and angel food cake are good alternatives to more traditional fat- and cream-laden desserts. Use fat-free or 1% milk in coffee instead of cream or half-and-half.
7. Don't be hesitant to ask your server how particular foods are prepared or what ingredients they contain.
8. Ask what kinds of oils foods are prepared with or cooked in. The most desirable oils are monounsaturated oils (olive oil, canola oil and peanut oil) and polyunsaturated oils (soybean oil, corn oil, safflower oil and sunflower oil).
9. Ask whether the restaurant can prepare your food to order. Ask the chef to prepare the food with very little butter or oil or none at all.
10. Ask if smaller portions are available or whether you can share entrees with a companion.
11. Ask whether healthy substitutions are possible. For example, if a dish comes with French fries or onion rings, ask whether you can get a baked potato with vegetables, and low-fat or fat-free sour cream or soft margarine on the side.

General Tips

Although you might know that eating certain foods can increase your heart disease risk, it's often tough to change your eating habits. Whether you have years of unhealthy eating under your belt or you simply want to fine-tune your diet, here are some great tips.

Control your portion size:

• Use a small plate or bowl to help control your portions.
• Eat larger portions of low-calorie, nutrient-rich foods, such as fruits and vegetables.
• Keep track of the number of servings you eat.

Reduce your sodium intake: Eating a lot of sodium can contribute to high blood pressure, a risk factor for cardiovascular disease. Reducing sodium is an important part of a heart-healthy diet. The American Heart Association recommends that:

• Healthy adults have no more than 2,300 milligrams (mg) of sodium a day (about a teaspoon of salt). Most adults ideally have no more than 1,500 mg of sodium a day.

Although reducing the amount of salt you add to food at the table or while cooking is a good first step, much of the salt you eat comes from canned or processed foods, such as soups, baked goods and frozen dinners. Eating fresh foods and making your own soups and stews can reduce the amount of salt you eat.

Another way to reduce the amount of salt you eat is to choose your condiments carefully. Many condiments are available in reduced-sodium versions, and salt substitutes can add flavor to your food with less sodium. Use fresh or dried herbs to season food (i.e. basil, oregano, thyme, cumin, garlic powder, onion powder, etc.).

Track your food: The USDA and the U.S. Department of Health teamed up to create an easy way to build a healthy diet for yourself. If you would like to learn more about ways to track your food, please discuss with your healthcare provider.

Maintain your cholesterol: Because cholesterol is made from the liver, it is only found in foods of animal origin (not in plant-based foods).

• Dietary guidance to achieve cardiovascular health should remain focused on adopting a healthy dietary pattern (i.e. DASH diet or Mediterranean Diet). These diets are inherently lower in cholesterol as they emphasize fruits, vegetables, whole grains, low fat or fat-free dairy products, lean protein sources, nuts, seeds and liquid vegetable oils.

Fiber: As part of a healthy diet, fiber can reduce cholesterol. Dietary fiber is a type of carbohydrate that the body cannot digest. It’s found primarily in whole grains, fruits, vegetables and beans. A diet rich in fiber has health benefits beyond cholesterol control: it helps control blood sugar, promote regularity, prevent gastrointestinal disease and helps in weight management. There are two types of dietary fiber: soluble and insoluble.

• Soluble fiber: Provides the greatest heart-health benefit because it helps to lower total and LDL-cholesterol. Good sources of soluble fiber include oats, oat bran, barley, legumes (such as dried beans, lentils and split peas), psyllium, flaxseed, apples, pears and citrus fruits.
• Insoluble fiber: Generally referred to as “roughage.” Insoluble fiber promotes regularity, adds bulk and softness to stools, helps with weight regulation and helps prevent many gastrointestinal disorders. Good sources of insoluble fiber include wheat bran, whole wheat and other whole grain cereals and breads, nuts and vegetables.

Various Diets Used to Lower Risk of Cardiovascular Disease

DASH diet

The Dietary Approaches to Stop Hypertension (DASH) is a diet rich in fruits, vegetables, low fat or nonfat dairy. It also includes mostly whole grains; lean meats, fish and poultry; nuts and beans. It is high fiber and low to moderate in fat. It is rich in potassium, magnesium, calcium, and fiber. It is a plan that follows US guidelines for sodium content, along with vitamins and minerals. In addition to lowering blood pressure, the DASH eating plan lowers cholesterol, improves insulin sensitivity and makes it easy to lose weight.

Mediterranean diet

There's no one "Mediterranean" diet. At least 16 countries border the Mediterranean Sea. But the common Mediterranean dietary pattern has these characteristics: high consumption of fruits (particularly fresh), vegetables (emphasizing root and green varieties), whole grains (cereals, breads, rice or pasta), beans, nuts and seeds (walnuts, almonds or hazelnuts); olive or canola oil; lower-fat or fat-free dairy products, fish (rich in omega 3 fatty acids) and little red meat is eaten; eggs are consumed zero to four times a week; red wine is consumed in low to moderate amounts. The diet encourages taking the time to eat with family and friends.