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Food as Medicine - Cardiovascular Disease and Nutrition

DK Publishing logoDK Publishing 2/07/2014 DKBooks

Red wine can be beneficial - Red wine has been shown to increase HDL, or “good” cholesterol levels, but drink in moderation.

Low-fiber breakfast - This breakfast of sweetened, puffed-wheat cereal, coffee, and a croissant provides just 2.3g of fiber, as well as 27g fat and 105mg cholesterol.

Grinding flaxseeds - Boost your omega-3 intake by crushing flaxseeds with a pestle and mortar and sprinkling over soups and salads.

Potassium-rich acorn squash - Make a tasty vegetarian meal by baking acorn squash halves, scooping out the seeds, and filling with a mixture of spicy chickpeas, warm baby-leaf spinach, and tomato paste.

High-fiber breakfast - With whole-grain muesli and fruit, whole-grain toast, and orange juice, this version provides 12.5g fiber, 7g fat, and only 4.9mg cholesterol.

There is a strong link between diet, exercise, and the development of cardiovascular disease.

Nutrition plays an essential role in the treatment of cardiovascular disease, especially in high blood pressure and coronary artery disease, which are very common problems in North America.

Cholesterol levels

Because an excessive amount of cholesterol in the blood is a major risk factor for other cardiovascular diseases—causing narrowing of the arteries—your first priority is to lower cholesterol levels.

You should reduce your intake of saturated fats and increase your intake of polyunsaturated and monounsaturated fats, which can actually help lower your blood cholesterol levels . A diet high in monounsaturated fats lowers LDL-cholesterol and triglyceride levels in the blood without lowering beneficial HDL-cholesterol levels. See the table opposite for more information.

High blood pressure

Another contributor to other types of cardiovascular diseases is high blood pressure. As the pressure exerted on blood vessels increases, they narrow, making it more difficult for the blood to get through, thereby increasing the strain on the cardiovascular system.

Diet and exercise are critical in the effective treatment of high blood pressure; in some cases, changing your diet and increasing your activity level can eliminate the need for medication or reduce the dosage required.

Changing your diet

There is a clear link between the consumption of saturated fats, which will raise LDL levels in the blood, and cardiovascular disease. The American Heart Association recommends limiting dietary saturated fat intake to less than seven percent of total calories.

You should also reduce sodium in your diet, particularly if you have high blood pressure or suffer from heart failure, and increase your intake of potassium- and calcium-rich foods.

Changing your lifestyle

Lifestyle changes, such as giving up smoking, losing weight, and increasing your exercise level, will help ease the burden on your cardiovascular system and reduce the effects of high blood pressure and high cholesterol. If you have angina, however, check with your doctor before embarking on an exercise program.

If you suffer from heart failure, make sure you eat enough to achieve and maintain optimum weight, limit sodium intake, and maintain a tolerable activity level.

Does my food contain cholesterol?

The National Cholesterol Education Program recommends limiting your daily dietary intake of cholesterol to 200mg for a heart-healthy diet. Dietary cholesterol is present only in foods of animal origin, such as eggs, meat, poultry, fish, seafood, whole milk, and other dairy products. Cholesterol is not found in foods of plant origin, such as vegetables, fruits, grains, nuts, and seeds.

The highest amounts of dietary cholesterol come from egg yolks, caviar, liver, and other organ meats; you should limit these foods in your diet. For example, the yolk of one medium-sized egg contains about 200mg of cholesterol.

Busy accountant with metabolic syndrome

Name Harry

Age 52 years


In the past three years, Harry has gained 12lb (5.5kg) and has now been told by his doctor that he has raised blood pressure and high LDL-cholesterol and triglyceride levels. He does not take any medication or smoke. He drinks three cups (24floz/720ml) of coffee each morning and 2 pints (1 liter) of beer each evening.


Harry is an accountant and has a high level of stress at work and at home. Work commitments mean he often orders a pizza for lunch and eats at his desk. After work and his commute home, Harry is too tired to exercise. He often eats a steak for supper and snacks on ice cream and chips at night. He rarely eats fruit.


Harry has metabolic syndrome, which places him at risk for cardiovascular disease. He needs to lose weight and take some exercise. Based on blood tests, his goal is to lower total cholesterol, LDL-cholesterol, and triglycerides, and to raise his level of HDL-cholesterol. He can achieve this by following the Therapeutic Lifestyle Change Diet and reducing his total intake of calories.

Harry’s diet is high in saturated fat and cholesterol. He should substitute monounsaturated fat and omega-3 fatty acids for saturated fat and cut back on portion sizes and increase his activity level. Eating more fruits and vegetables, whole grains, beans and legumes, low-fat or fat-free dairy products, white-meat chicken without skin, fish, or lean meats will help. If he likes eggs, he can include two in his diet per week.

For breakfast, Harry could have oatmeal with fat-free milk and an orange. For lunch, he could order a tuna or turkey-salad sandwich or have two slices of vegetable pizza. For dinner, he could order fish and chicken more often and limit red meat to less than once a week.

Harry could increase his daily intake of soluble fiber to 1oz (28g) from oats, psyllium, legumes, and fruits. Margarines containing plant stanol/sterols could replace other spreads to further lower his LDL-cholesterol. He may also benefit from reducing his salt intake.

Flaxseeds are rich in omega-3

This seed has been valued for its therapeutic properties since ancient times. This nutty-tasting seed is one of the best sources of omega-3 essential fatty acid, and is excellent for regulating blood pressure . Flaxseeds contain both soluble and insoluble fiber. Soluble fiber helps reduce cholesterol, while insoluble fiber helps eliminate toxins from the bowel.

It is easy to incorporate flaxseeds into your diet. Ground flaxseeds provide the greatest nutritional benefit since the body cannot digest whole seeds. Crushed or milled seeds can be added to breakfast cereals, yogurt, salads, soup, or smoothies. You can also add flaxseeds to muffins, meat loaf, and sauces before baking or cooking.

Flaxeed oil is also an excellent source of omega-6, but does not contain the fiber. It can be used as a salad dressing, but is unsuitable for cooking and must be refrigerated at all times because it is sensitive to light, oxygen, and heat.

Nutrients that help cardiovascular disease

In addition to limiting your intake of saturated fats, increasing omega-3 fats, and including more fiber in your diet, there are specific changes that you can make in order to help prevent and treat cardiovascular disease.

Choose soy products

Studies have shown that 1oz (28g) of soy protein per day will lower LDL-cholesterol levels by about five percent. The Food and Drug Administration has approved a health claim for soy foods that encourages eating at least 1oz (28g) of soy protein daily, as part of a diet low in saturated fat and cholesterol, to reduce the risk of cardiovascular disease.

Reduce homocysteine levels

An emerging risk factor for developing cardiovascular disease is a high level of an amino acid called homocysteine in the blood. This can be caused by a genetic defect in the enzymes that break down homocysteine, as well as by a diet low in folate. Vitamins B6 and B12 are also needed to break it down in the body, so most doctors prescribe a supplement that contains these three vitamins for anyone with elevated homocysteine levels. If you are at risk of cardiovascular disease, ask your doctor about taking a multivitamin supplement.

Eat plant oils

Plant sterols and stanols, derived from natural plant oils, have been shown to significantly lower LDL-cholesterol levels in the blood by up to 14 percent. These have been incorporated into some brands of spreads.

The National Cholesterol Education Program recommends including 2g of plant stanol/sterol (esters) daily as part of a diet low in saturated fat and cholesterol for those with elevated LDL levels. In the gastrointestinal tract, sterol/stanols compete with cholesterol for absorption, so less dietary and biliary cholesterol is absorbed by the body.

Since spreads with added sterol/stanol are the main source of these compounds, it is important to substitute these for other added fats, such as butter, margarine, oil, or cream cheese, so that your total calories will not be inccreased by adding these to your diet.

What about alcohol?

The antioxidant properties of red wine may protect your heart by increasing HDL-cholesterol levels and reducing LDL-cholesterol from being oxidized and deposited in arteries. However, if you regularly have more than two drinks a day (for men) or one drink a day (for women), you may increase your risk of developing high blood pressure, elevated triglyceride levels, enlarged heart, and stroke. So you should make sure that you drink alcohol in moderation.

Boosting your fiber intake

Since a high-fiber diet has been proven to reduce the risk of heart attack and other cardiovascular diseases, it is vital that you eat lots of fiber-rich foods.

High-fiber foods

Eating at least 10g of soluble fiber daily has been shown to reduce LDL-cholesterol by about five percent.

Foods that are high in soluble fiber include oatmeal, whole oats, and legumes, as well as fruits, which are rich in the soluble fiber pectin. They will help decrease harmful LDL-cholesterol levels and reduce your risk of cardiovascular disease.

One meal that is easy to transform into a fiber-rich one is breakfast . By making simple changes, such as substituting whole-grain cereals and breads for refined varieties and adding fruit, you can increase the amount of soluble fiber that you eat every day.

Dietary advice for high blood pressure

By making some simple changes to your diet you can can help reduce high blood pressure. In addition to the changes outlined here it is also important that you reduce the amount of salt in your diet . Always talk to your doctor before implementing changes.

Potassium and calcium

The DASH diet recommends increasing your dietary intake of potassium and calcium . Potassium can be found in all the food groups—fruit and vegetable sources include oranges, pears, acorn squash, spinach, and artichokes. Dairy products are excellent sources, too, as are protein foods, such as red meat, poultry, and lima beans. Dairy products are of course rich in calcium (be sure to opt for low-fat versions), as are green leafy vegetables, such as kale and broccoli.


People who drink large amounts of alcohol are more likely to develop high blood pressure, whereas small amounts of alcohol raise HDL-cholesterol levels and are beneficial for cardiovascular health. Larger amounts of alcohol cause blood vessels to constrict or narrow, forcing the heart to pump harder. Alcohol can thus raise your blood pressure and make your high blood pressure more difficult to manage.

Benefits of this diet

Research shows that people on the DASH diet were able to reduce their diastolic blood pressure (the lower measurement of blood pressure, taken between heartbeats when the heart is relaxed) by up to 5mmHg, regardless of their age, gender, ethnicity, or initial blood pressure levels. For those with high blood pressure that ranged from 140/90 to 159/99mmHg, the DASH diet’s effectiveness was similar to that of medication for high blood pressure.

Dietary advice for heart failure

Many people with heart failure tend to lose weight and become undernourished because they follow restrictive diets and may not get enough calories. They need to work with their doctor to find a way of reducing their sodium intake and limiting their fluid intake. They should also try to maintain or increase body weight with high-calorie, nutrient-dense foods and food supplements.

Maintain a healthy weight

It is important to maintain an adequate calorie intake to prevent weight loss. If you have already lost weight due to loss of appetite, you may need to take in more calories. Having small, frequent nutrient-dense and high-calorie meals may help you meet your caloric needs. See High-calorie meals to counteract weight loss in COPD for suggestions for nutrient-dense snacks and meals.

Reduce sodium intake

People with heart failure retain sodium and fluid, so restricting sodium (salt) in the diet is usually necessary. The level of sodium restriction varies depending on the severity of the condition. Those with long-term heart failure with symptoms such as shortness of breath should reduce their dietary intake of sodium to less than 2000mg per day.

If you suffer from heart failure you must do more than just “stay away from salt.” You must check food labels for sodium content, select only foods with less than 400mg per serving, and use herbs and other nonsalt seasonings when cooking. These dietary changes will help you feel better and maintain your health longer .

Limit fluid intake

People with heart failure may be advised by their doctor to limit fluid intake to six to eight glasses per day, which is about 3–4 pints (1.5–2 liters). Fluids may be restricted slightly more than this for patients in hospital.

Take food supplements

High-protein, high-calorie supplements can help increase calorie intake in a relatively small volume, and are especially useful for those with a poor appetite. These supplements are available in both liquid and dessert forms and in a variety of flavors.

Reducing salt intake

People who suffer from heart failure and those with high blood pressure should follow a low-salt diet. Reducing sodium is proven to be one of the best ways of lowering high blood pressure.

Tips for cutting down sodium

Convenience foods, canned foods, and eating out frequently all contribute to the higher sodium intake among North Americans today, so if you are following a low-sodium diet read labels carefully.

Use fresh herbs, seasonings, and spices, such as basil, cinnamon, or cumin, to flavor vegetables.

Avoid using a salt shaker.

Use soy sauce sparingly: 1 tsp contains about 1,200mg of sodium.

Buy either fresh, plain frozen, or canned “no salt added” vegetables.

Rinse canned foods, such as tuna, to remove sodium.

Choose ready-to eat breakfast cereals that are lower in sodium.

Buy low- or reduced-sodium or no-salt-added versions of foods.

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