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Heart disease

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The impact of heart disease on our day-to-day lives and our society is enormous. But we can have a big role to play in reducing the incidence of cardiovascular disease, as many of the risk factors (except genetics) are within our control. Keeping our weight within the ideal range, not smoking, keeping active with a healthy blood pressure, and keeping our blood fats in check, will all make an enormous difference to the risk we place on our hearts and circulation.

Good & bad cholesterol

There are two types of cholesterol: ‘good’ high-density lipoprotein (HDL) and ‘bad’ low-density lipoprotein (LDL). LDL is the kind of cholesterol that can deposit in our arteries and cause problems, while HDL is the good sort, which picks up LDL and takes it back to the liver, where it’s broken down.
It’s the balance between these two types of cholesterol that (along with eliminating other risk factors like smoking, diabetes and high blood pressure) protects us against developing conditions such as heart disease and stroke. If you have already been diagnosed with heart disease or furred arteries, getting your diet in order can help to prevent any further damage. Some evidence also suggests that you could help to reduce any existing damage.
It’s important to look at your diet and lifestyle, even if your doctor puts you on medication, such as cholesterol-lowering statins. It’s been proven that the Mediterranean diet can correct the balance of good and bad cholesterol. In addition, this type of eating provides useful antioxidants, which reduce the likelihood of LDL depositing and hardening the arteries.

Q What balance of good and bad cholesterol should I have in my blood?

A The ideal balance is 3.0 mmol/l or less LDL cholesterol and 1.2 mmol/l or more HDL cholesterol. The preferred total is cholesterol level is less than 5mmol/l.

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Eating the delicious Mediterranean way
  • The Mediterranean diet is not only wonderful in terms of fantastic flavours but it is also based around lots of fresh fruits and vegetables every day (ideally aim for the 5-plus portions). Eat with your eyes so that you include a variety of colours and types to glean a good spectrum of vitamins and bioactives – beneficial substances our hearts love.
  • Fat-wise, you’re generally better off with vegetable rather than animal fats (butter, cream, cheese and fatty, poor-quality meats increase LDL). Olive oil is the classic Mediterranean choice, but try rapeseed, hempseed, and avocado and nut oils, such as walnut oil, in dressings. These contain omega fatty acids, which help to reduce your risk of heart disease even further. If you're a real butter fan, then just keep to a little. With cheese, cut the rind off soft cheeses such as Brie or Camembert as this reduces the saturated fat level; serve with something rich in fibre, such as sticks of celery, a crisp English Apple or a thin wholegrain or oat biscuit.
  • A piece of lean meat can be pretty low in calories while being extremely satisfying. Lean meat also contains some monounsaturated fats, including the beneficial long-chain omega-3 fatty acids, as well as being a very good supplier of minerals like iron and zinc. A lean meat meal once or twice a week is fine. The poorer-quality fatty cuts need to go, as they can deal you a very hefty dose of LDL-producing saturated fat.
  • Have oily fish (sardines, salmon, tuna, mackerel) a couple of times a week. They’re a very good source of omega-3 fatty acids, which, although they don’t have much of a direct impact on either LDL or HDL levels, have benefits that reduce your overall risk of heart disease.
  • For the rest of your week, go for meals based around chicken, white fish, game, lentils and beans – think of Italian dishes such as Ribollita (a hearty stew made with vegetables, beans and bread). Eat wholegrains such as porridge (which our hearts love in particular, as oats are wonderfully rich in a special type of soluble fibre). If you're not much of a porridge fan, think about Bircher muesli or homemade or shop-bought oat biscuits. Wholemeal bread is another good choice. There are so many different varieties of good bread, from the lighter loaves to the darker Pumpernickel-style breads, which I prefer.

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    Q Should I eat cholesterol-lowering spreads and drinks?

    A You could consider one of the butter-like spreads rich in plant stanols or sterols, which can reduce cholesterol levels. But I have to say I don’t like the taste much, and you do need around 2g of either stanols or sterols each day (equivalent to 3–5 slices of bread spread with one of these margarines) to lower cholesterol by about 10 per cent over time. I don’t recommend my patients use them unless they’re particular fans, as I think it’s far better to look at being more creative with the food you’re eating to achieve your healthy heart goal. 

    Be salt savvy

    Too much salt can cause high blood pressure. Official guidelines state that adults should eat less than 6g of salt a day – look at this amount on a teaspoon and you’ll see it’s shockingly small. In fact, if we reduce our salt intake by around 2.5g a day it could reduce the risk of stroke or heart attack by one quarter.
    A salty diet may also aggravate fluid retention, which is worth noting as swollen feet can be a sign of heart or other health problems. If the swelling is persistent, check in with your GP. 
    • Smoked foods (mackerel, herring, salmon, bacon and ham) are high in salt, so watch how much you eat of these. Make them a treat, not the norm.
    • Avoid processed foods, if possible, and check labels for the salt content.
    • Swap high-salt (and sugary) breakfast cereals for porridge and natural wholegrains, such as rye or wholegrain bread.
    • Use alternative seasonings, such as fresh garlic, black pepper, fresh chilli, fresh herbs and spices and lemon or lime juice.
     
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    Reducing weight

    Body fat gets deposited when we take in too many calories and don’t burn up enough in our everyday work or home life, or engage in formal exercise. Foodwise, the easiest way to reduce our body fat is to take a careful look at concentrated sources of calories, such as fat and sugar. We also need to look at portion sizes – even if we’re eating healthily, we can have too much of a good thing.
    • Try avoiding all sweet foods other than fresh fruits. Go cold turkey on them all and within 48 to 72 hours, you’ll be through the 'danger zone' and won’t need half as much willpower to resist them.
    • Some people find vanilla good for breaking the sweet craving – if you sniff a vanilla pod or bottle of essence, the urge for sweets goes.
    • Keep a food and emotions diary for couple of weeks and see if you’re eating more than you need, either through habit or emotional eating.
    • Serve yourself less and eat it slowly and you may find your body weight reduces.
     
     

    Alcohol & heart disease

    Drinking more than the recommended 14 units of alcohol per week (for both men and women) is linked to an increased risk of heart disease. Not only is alcohol incredibly high in calories but it increases our appetite and takes away our willpower to eat well, and has a tendency to make us pile on fat around the middle. Try to reduce your drinking overall and have at least two to three alcohol-free days a week.

      

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