Nutrition

Know

Nutrition and your heartHow Nutrition Affects Your Heart Health

Good nutrition is essential to normal growth, development, and overall health. It’s especially important for your heart. Following a heart-healthy diet means eating foods that are high in vitamins, minerals, and fibre — and low in sodium and fat. It has been proven that even modest changes to your diet can reduce your risk of death from CVD.

The food you eat affects many of the important risk factors associated with heart disease, including:

  • Cholesterol
  • Blood pressure
  • Weight and waist circumference
  • Blood sugar

BENEFITS OF EATING A HEART-HEALTHY DIET

You can significantly improve your cardiovascular health by following a heart-healthy diet, as the following nutritional recommendations and their effects show:

  • If you consume 5 to 10 grams of fibre each day, you can reduce your total cholesterol by 3%.
  • Decreasing your intake of fats and cholesterol reduces your risk for cardiovascular disease through the lowering of LDL, or “lousy,” cholesterol.
  • Consuming omega-3 fats is associated with a reduced risk of death from coronary artery disease. Omega-3s exert a protective cardiovascular effect by reducing triglycerides, inhibiting clot formation, and reducing blood pressure.
  • Soluble fibre in your diet reduces LDL cholesterol levels beyond those achievable by a diet low in saturated and trans fats. Also, more fibre in your diet can lead to a decrease in blood pressure, insulin sensitivity, and blood clots.
  • Diets high in whole grains and fibre are associated with improved nutrition overall and a decreased risk for cardiovascular disease.
  • When you maintain a low-sodium diet  to perform and regulate certain functions of the body, such as blood pressure and muscle and nerve function} diet, you can keep hypertension at bay, or you can lower your blood pressure if you have elevated levels.
  • Each fruit or vegetable you eat is associated with a 4% reduction in the risk for a coronary event.
  • If you get more omega-3s and less saturated fat, you can increase your HDL, or “good,” cholesterol levels.
  • You can reduce your triglycerides, another form of fat in the body, by maintaining a diet low in sugar and alcohol.

Prevalence of Poor Nutrition

Health Canada considers the nutritional health of Canadians to be pretty good but not great. In fact, the food choices Canadians make contribute to a range of of nutrition-related chronic diseases, not least of which is cardiovascular disease (CVD). A poor diet and inactivity are second only to smoking among the non-genetic factors that can lead to illness and death. Your food choices represent complex nutritional decisions — shaped by the relationship between you and your environment.

Statistics

  • Inadequate consumption of fruit and vegetables by Canadians contributed to 13.7% of the nation’s heart attacks (17.8% for women and 10.3% for men) in 2007.
  • In 2007, 56.2% of Canadians older than 12 years of age reported inadequate consumption of fruit and vegetables, amounting to fewer than five servings per day.
  • Ontario has been identified as one of several provinces (along with Quebec, British Columbia, and Alberta) that has the lowest reported intake of fruits and vegetables.
  • One-fifth of Canadians consumed more than the recommended amount of calories from fat in 2004. 1

Understand

Best Practice Guidelines

BerriesEating healthily is one of the most important things you can do to prevent cardiovascular disease and improve your overall health. And when you get the proper nutrients from the range of foods your body needs, you look and feel good. Eating right, including following a heart-healthy diet, involves a highly complex array of factors that can influence your health in a big way. A heart-healthy diet is part of a comprehensive approach to nutrition.

Cardiovascular-specific guidelines focus on six dietary components, each of which has a significant impact on your heart health:

1. Saturated, Unsaturated, and Trans Fats Less than 15 g a day
2. Omega-3 Fats 2 or more servings of fish a week
3. Cholesterol 300 mg a day
4. Fibre 25 to 35 g a day
5. Sodium Less than 2,300 mg a day
6. Fruit and Vegetables 1.5 to 2 cups of fruit and 2 to 3 cups of vegetables a day

In addition to following a heart-healthy diet, you should understand basic healthy-eating strategies and know what’s contained in Canada’s Food Guide.

Examples of healthy eating strategies include:

  • Eating regular meals and aiming to eat every four to six hours, incorporating heart-healthy snacks as needed
  • Eating breakfast every day
  • Consuming sufficient protein
  • Drinking an adequate amount of water to prevent dehydration
  • Minimizing fats, sugars, and processed food
  • Including fruit or vegetables at each meal
  • Having at least three different food groups at each meal
  • Cooking with fresh, unprocessed foods and limiting salt intake

Six Dietary Components for Cardiovascular Health

1. Saturated, Unsaturated, and Trans Fats

There are many types of fat in the foods we eat. Some fats are more harmful to your body than others. The more dangerous fats can lead to cholesterol buildup in the blood and, ultimately, atherosclerosis, or hardening and narrowing of the arteries. Regardless of the category, all fats should be consumed in small amounts. Foods containing fat are high in calories and can make you more susceptible to weight gain. Eating foods that are low in saturated and trans fat are likely to help you maintain a normal weight and improve your cardiovascular health. There are three main types of dietary fats:

  • Saturated fats are the biggest culprits in raising LDL cholesterol levels in your blood, which indirectly increases heart disease risk.

    Saturated fats are found in animal products, including butter, cream, whole milk, egg yolks, lard, cheese, red meat, bacon, sausage, coconut butter, cocoa butter, fried foods, chips, and candy bars.

  • Unsaturated fats are often regarded as healthier than saturated fats, although, like any fat, they should be consumed in moderation. When used in place of saturated fats, unsaturated fats have the potential to lower your total blood cholesterol and LDL levels.

    Most liquid vegetable oils are unsaturated. Other foods that have unsaturated fats include fish, poultry, flax seeds, soy products, and pumpkin seeds.

  • Trans-fatty acids (trans fats) are created from hydrogenated (or hardened) vegetable oils. Trans fats raise your LDL cholesterol while lowering your healthy HDL cholesterol, negatively impacting cardiovascular health.

     

    Trans fats are found in fried foods, processed and fast foods, snack foods, margarine, cakes, pies, and commercial baked goods.

The evidence suggests that saturated and trans fats affect blood cholesterol more negatively than do unsaturated fats.

Tips
  • Limit lean meat and poultry to two to three servings a day.
  • Replace some of your meat meals with soy or legume meat substitutes, as they are high in fibre.
  • Compare food labels for the lower fat options.
  • Choose foods with little or no trans fats.
  • Replace one whole egg with two egg whites.

2. Omega-3 Fats

Omega-3 fats lower cholesterol and reduce blood pressure — and are proven to have anti-clotting and anti-inflammatory effects. There are three types of omega-3 fats:

  • ALA — alpha-linolenic acid
  • DHA — docosahexaenoic acid
  • EPA — eicosapentaenoic acid

Omega-3s are considered essential fatty acids because your body can’t make them on its own (except for DHA and EPA in limited quantities). You must get omega-3 fats from food. When you consume omega-3 fatty acids according to guidelines, you can reduce total cholesterol and LDL levels, while increasing HDL levels, which can greatly improve your cardiovascular risk profile.

Sources
  • Cold water fish (trout, mackerel, tuna, salmon, herring, arctic char)
  • Flaxseed
  • Walnuts
  • Canola and soybean oil
  • Hemp seeds
  • Soy products
Tips
  • Cook with canola or soybean oil.
  • Add flaxseed to salad dressings and dips.
  • Add walnuts to salads.
  • Replace regular eggs with omega-3 eggs.
  • Consume fish two times a week.

3. Cholesterol

Cholesterol is a type of fat, also known as a lipid, that circulates in your blood. It is naturally produced by your body and needed for cells and tissues to work properly. Cholesterol comes from two sources:

  • The foods you eat, which provide 15% to 20%
  • Your liver, which produces 80% to 85%

When your cholesterol levels are higher than normal, you’re considered to have “high cholesterol,” which is also known as “hyperlipidemia” or “hypercholesterolemia.” Cholesterol is carried in the body by particles called lipoproteins — a type of cholesterol. There are three main components of cholesterol:

LDL (low-density lipoprotein): Sometimes called “bad” or “lousy” cholesterol, LDL carries most of the cholesterol in the blood to be stored away for future use. High levels of LDL cause cholesterol to build up on artery walls, leading to plaque formation.

HDL high-density lipoprotein): Called “good” or “healthy” cholesterol, HDL carries cholesterol from the body to the liver, where it is eliminated. The more HDL you have in your blood, the better protected you are against the buildup of plaque in your arteries.

Triglycerides: This is the most common type of fat in your body. Triglycerides have a dual function, acting to both store and transport fat in the blood. When you eat excess calories (especially sugar and alcohol), they are stored as triglycerides. Similar to LDLs, excess triglycerides increase your risk for CVD.

Sources
  • Egg yolks
  • Fatty red meat
  • Poultry
  • Fish
  • Milk
  • Cheese
  • Shrimp
  • Lobster
Tips
  • In addition to being supplied by food sources, cholesterol is produced by your body. These means you should limit your consumption as much as possible.
  • Reduce alcohol intake.
  • Consume smaller portions of lean, well-trimmed meat.
  • Consume less sugar and sweets.

4. Fibre

Fibre is found only in plant sources, which your body is unable to digest. Because fibre is undigestible, it adds bulk and therefore aids in the digestive process. This addition of bulk also allows you to feel fuller longer and contributes to blood sugar homeostasis, which may contribute to effective weight, blood pressure, and cholesterol management.

There are two types of fibre:

  • Soluble fibre is known to slow the digestion process. When combined with water, it forms a thick gel-like substance that can bind with and remove cholesterol from the body. This promotes the control of blood sugar and cholesterol (specifically LDL).
  • Insoluble fibre acts as roughage within the gastrointestinal tract to promote digestive health and bowel regularity.
Sources of Soluble Fibre
  • Barley
  • Oats
  • Legumes
  • Lentils
  • Apples
  • Beans
  • Citrus fruit
  • Psyllium (a fibrous seed)
Sources of Insoluble Fibre
  • Whole grains
  • Wheat bran
  • Vegetables and fruit with digestible seeds
Tips
  • High fibre foods can decrease your overall calorie consumption because they move slowly through your digestive system and make you feel fuller longer.
  • Although you can take fibre pills, it is best that you get fibre from your diet.
  • Fibre should be introduced to your diet gradually to avoid the possibility of abdominal bloating and cramps. Drinking plenty of water with high-fibre meals can reduce these side effects.
  • Lentils, peas, and baby lima beans are the easiest to digest. Kidney and soy beans are the most difficult.

For help with adding more fibre to your diet, click here to find out about high-fibre cereals.

5. Sodium

Sodium is a mineral found in salt. Your body requires only a small amount, about 500 mg a day. You need salt for the functioning of your muscles and nerves, to regulate blood pressure, and to maintain the fluid in your cells, among other things. Too much salt can be harmful to your body, causing problems such as shortness of breath, elevated blood pressure, and water retention, all of which can lead to CVD, stroke, and kidney disease.

On average, Canadians consume double the recommended daily amount of salt. Because salt can be found in a variety of products, particularly processed foods, beverages, and medications, it’s easy to get too much in your diet. This makes it especially important that you monitor your sodium intake.

Sources
  • Canned soups/vegetables
  • Salted nuts
  • Instant cooked cereals
  • Processed meats
  • Frozen dinners
  • Bread
  • Fast food
  • Salad dressings/sauces
  • Snack foods (cheese, pretzels, chips)
Tips
  • Cook without salt and remove the salt shaker from the table.
  • Use spice and herb substitutes to season foods.
  • Eat fresh, unprocessed food as often as possible.
  • Follow the Dash diet for overall health and to keep your sodium in check.

To learn more about reducing your dietary sodium, watch this video from the Give Your Head a Shake campaign to cut sodium (Champlain Cardiovascular Disease Prevention Network).

6. Fruit and Vegetables

Cardiovascular health guidelines recommend that you eat a lot of fruit and vegetables. They are an excellent source of vitamins, minerals, and fibre, as well as generally low in calories.

The DASH diet, a lifelong approach to healthy eating, is a great choice for people who want to get and stay heart healthy. It is easy to follow and does not require special foods. DASH stands for Dietary Approaches to Stop Hypertension. The focus of the DASH diet is portion control and foods that offer variety and high nutritional value. The eating plan places a premium on fruits and vegetables, while discouraging sodium and saturated fat. It is also high in whole grains, low-fat dairy products, and includes fish, poultry, and nuts. The DASH diet is protective of cardiovascular health, particularly as it relates to blood pressure.

You can download the Dash diet here.

Portion Size Versus Serving Size

Portion size is the total amount of food consumed for one meal or snack. When you start a weight-loss program or an eating plan to reduce or control your blood pressure, blood sugar, or cholesterol, it is important to understand how much you should eat for a given meal or snack. Portions people serve at home and in restaurants are typically three to four times larger than recommended.

Serving size is the standard amount of a particular food recommended by Canada’s Food Guide. For example, a typical restaurant portion of pasta is a three-cup serving. According to Canada’s Food Guide, this is equivalent to six servings of grains. Understanding recommended servings is key to portion control.

Reading the Nutrition Label

All prepackaged foods have a nutrition label that provides information about the product.

If you want to know the nutritional value of the food you’re about to buy, read the nutrition label. When seeking out heart-healthy products, look for labels that indicate low levels of saturated and total fat (3 g or less), cholesterol (20 mg or less), sodium (140 mg or less), and sugar, but higher amounts of fibre and vitamins and minerals.

Step 1 – Look at the Serving Size

Nutrition facts are based on a specific quantity of food. Always compare the serving size on the package to the amount that you actually eat. The label will list the nutrients according to the serving, not the package.

Step 2 – Look at the Nutrients and the Percent of Daily Value (% DV)

The percent of daily value puts nutrients on a scale from 0% to 100%. You need a certain recommended daily level of each nutrient. This scale tells you what percentage of your daily value a nutrient provides, usually in terms of a single serving. For example, if the label shows 10% for calcium, you’re getting 10% of your daily calcium from a single serving. The percent of daily value is based on a 2,000 calorie eating plan. You can make these assumptions about the percent of daily value on labels:

  • 5% or less is a small amount
  • 15% or more is a large amount
  • Consume higher % DV of fibre, vitamin A, calcium, and iron
  • Consume smaller % DV of fat, saturated and trans fat, and sodium

Step 3 – Look at the Ingredient List

Ingredients are listed in descending order by weight. This establishes the general makeup of the product. When reading the ingredient list, be sure to choose foods with labels that put:

  • Salt or sodium and fat near the bottom
  • High-fibre ingredients and whole grains (whole wheat, oats, rye, millet, quinoa, barley) at the beginning
  • Sugar (honey, molasses, dextrin, syrup) last

Act

Prevention and Management Strategies

Healthy eating not only protects your heart health but also promotes overall health and helps to control numerous risk factors that affect a variety of chronic conditions and diseases.

10 tips for healthy eating

Download printable version

Tips for Eating More Fruit and Vegetables (Aim to fill ½ of your plate)
If all of your fruit and vegetables are the same colour Try to include fruit and vegetables that are a variety of colours: red, orange, yellow
If you’re having a hard time including fruit and vegetables Try to include fruit and vegetables at every meal — for example, berries for breakfast, veggie sticks for lunch, salad for supper
If you’re finding it too time consuming to prepare fruit and vegetables Try frozen fruit or vegetables
If you’re eating the same fruit and vegetables every day Try a new fruit or vegetable once a week

Remember! Choose brightly coloured vegetables and fruit at all meals.

Eat at least two cups of vegetables and two to four fruits every day. The brighter the colour, the better.

Choose more dark green, red, and orange fruits and vegetables daily in order to ensure adequate consumption of vitamins, minerals, and fibre, for example:

  • Tomatoes
  • Red, yellow, and green peppers
  • Sweet potatoes
  • Broccoli
  • Peas
  • Carrots
  • Red cabbage
  • Apricots
  • Oranges
  • Mangoes
  • Berries
  • Dried fruit
  • Kiwis
  • Melons
Tips for Eating Healthy Meat and Alternatives (Aim to fill ½ of your plate)
If you’re eating poultry with the skin on Remove the skin before eating
If you’re eating red meat more than once or twice a week Choose lean cuts of pork, poultry, and fish more often, or try a vegetarian meal once a week
If you’re avoiding fish Choose fresh, frozen, or canned fish two to four times/week or consider an omega-3 supplement
If you’re using deli meats for sandwiches Try cooking extra meat the night before for sandwiches or use alternatives such as tuna, salmon, or egg

Remember! Choose lean cuts of meat, poultry, and fish more often. Try a vegetarian meal once or twice a week. Limit whole eggs to two to three per week.

  • Always choose lean cuts of meat and trim away all visible fat
  • Avoid deep-fried batter-coated fish
  • A few times a week, include meatless meals, such as vegetarian chili, burritos with beans, split pea or lentil soup, hummus, meatless curries, baked beans, tofu, soy burgers, and vegetarian meat alternatives
  • Choose omega-3 eggs more often than regular eggs
  • Healthy cooking methods include baking, broiling, stir frying, steaming, roasting, poaching, grilling, and barbecuing
  • Choose rarely: salami, sausage, bacon, hot dogs, pepperoni, or deli meats, such as bologna
Tips for Eating Healthy Dairy Products
If you’re choosing homogenized or 2% milk Choose skim or 1% milk instead
If you’re eating regular yogourt Choose yogourt with 1% M.F. (milk fat) or less
If you’re eating ice cream Choose frozen yogourt or ice milk.
If you’re eating regular cheese Try low-fat cheese with 15% M.F (milk fat) or less

Remember! Choose low-fat dairy products more often.

  • Choose rarely: regular milk products, such as whole milk, butter, cheese, sour cream, or cream cheese
Tips for Using Healthy Fats and Oils
If you’re deep-frying or pan-frying foods Try baking, broiling, steaming, stir-frying, or grilling instead
If you’re using hard fats, such as butter or lard, for cooking Instead try using liquid fats, such as the following oils: olive, canola, safflower, sesame, and corn oil
if you’re using mayonnaise, salad dressings, or sour cream Try the low-fat version, and make your own salad dressings with oil and vinegar
If you eat nuts as a snack Limit your portion size to 2 tbsp (a handful)
If you use butter Try non-hydrogenated margarine instead

Remember! Choose unsaturated fats more often. Limit your intake of saturated and trans fats.

  • Choose from among the following oils: olive, canola, safflower, sunflower, corn, sesame, walnut, and peanut
  • Choose natural nut butters, such as: peanut, almond, and hazelnut
  • Enjoy nuts and seeds as an accent to food, for example, one tbsp on top of salads or stir-fries
  • Choose rarely: any deep-fried foods, including snack foods made with hydrogenated vegetable oils
  • Read the nutrition labels to compare and choose foods with fewer saturated and trans fats
  • Choose oils such as canola and olive and non-hydrogenated margarines instead of animal, hydrogenated, and trans fats. Reduce portions of meat, and choose lower-fat milk products
Tips for Consuming Less Salt
If you buy packaged frozen meals Read the Nutrition Facts table and choose the product with the lowest % Daily Value for sodium (try for less than 10%)
If you’re thinking of going out for dinner for the third time this week Make a simple dinner at home and try scrambled eggs with vegetables and toast instead
If you’re using canned peas or beans Rinse and drain them first
If you’re using deli meat for sandwiches Use meat alternatives, such as egg or tuna for filling
If you add salt when you cook Try using herbs and spices or garlic when cooking instead

Remember! Read the food label and choose foods that have less than 200 mg or 10% DV per serving.

  • Use fresh or dried herbs, unsalted spices, lemon juice, and flavoured vinegars to boost flavour during food preparation
  • Try Mrs. Dash or McCormick No Salt Added seasoning blends
  • Reduce or limit salt in cooking and avoid adding salt at the table
  • Prepare meals using fresh, unprocessed ingredients
  • Choose rarely: processed foods, such as deli meats, canned/packaged soups, pickles, soy sauce, salted snack foods, commercial coatings for meats, frozen dinners, vegetable juices, canned vegetables, or fast foods
  • Read the nutrition labels, compare similar items, and choose foods with less sodium
Alcohol

Limit alcohol to a maximum of two servings a day for men and one serving a day for women. The recommended single-serving measures for alcohol are:

  • Liquor 45 ml (1.5 oz)
  • Wine 125 ml (4 oz)
  • Beer 355 ml (12 oz)

Resources

Workshops

University of Ottawa Heart Institute

Heart Delicious Nutrition Workshops — FREE

A dietitian offers an interactive workshop series that covers topics such as:

  • Developing the skills for heart-healthy eating
  • Getting the facts on fat, cholesterol, fibre, and salt
  • Learning how to read and understand food labels
  • Planning healthy meals\managing your diabetes
  • Setting realistic goals for healthy weight management

The workshops are appropriate for patients, families, and members of the public who are interested in learning about heart-healthy eating. To view the workshop schedule, and for more information, visit our website: http://www.ottawaheart.ca/patients_family/cardiac-rehabilitation.htm

Online tools:

Websites

REFERENCES

1.Public Health Agency of Canada (2009). Tracking Heart Disease and Stroke in Canada.