Your Guide to What You Must Know For Your Heart

The aims of healthy eating are:

• To reduce total fat intake.
• To increase intake of wholegrains/cereals.
• To increase the intake of fruit and vegetables.
• To reduce the intake of simple sugary foods.
• To eat appropriate amounts of calories to help to maintain ideal body weight.
• To moderate salt intake.
• To moderate intake of alcohol.

Fat     Back to Top

A reduction of total fat is recommended. Including large amounts of fat in the diet will increase energy intake and contribute towards obesity. A high fat diet is indicated as a risk factor in the development of coronary heart disease (CHD). Some studies have also shown an association between certain cancers and fat intake. Therefore, the total fat intake should provide no more than 35% of energy intake, which can be derived from saturated, polyunsaturated and monounsaturated fat.

Saturated Fat     Back to Top

The intake of saturated fat, which is obtained primarily from dairy, meat products and fat spreads should be decreased to provide no more than 10% of energy intake. Saturated fat has been found to directly affect total plasma cholesterol and the proportion of low-density lipoproteins (LDL), which contribute to an increased risk of CHD. Evidence suggests that the lower the intake of saturated fat, the lower the risk of coronary heart disease.

Polyunsaturated Fat     Back to Top

These fatty acids are divided into two groups: n-6 and n-3, according to the position and distribution of the double bonds in the structure of the fat.

n-6 polyunsaturated fatty acids (PUFA) are derived from seed oils and polyunsaturated margarines. They include corn, sunflower, safflower and soya oil. These fats have been found to reduce both LDL cholesterol and HDL cholesterol. There is some evidence to suggest that higher intakes of these fats are associated with lower risk for CHD. However, it is believed these fats are related to lipid peroxidation. Lipid peroxidation is initiated by free-radicals which attack polyunsaturated acids, the major constituents of cell membranes. This process leads to a self-propagating reaction causing disturbances in membrane structure and function. Lipid peroxidation can cause an increased risk of coronary heart disease, particularly if the diet is low in antioxidants: vitamins C, E and betacarotene, which are found in fruit and vegetables. Therefore, it is recommended that these fats should not exceed 10% of total energy intake.

n-3 PUFA or Fish oils have been found to lower the amount of triglycerides in the blood and have beneficial anti-inflammatory and thrombolytic properties. Rich sources of the oils come from oily fish such as mackerel, herring, pilchards, sardines, trout and salmon. It is currently recommended that fish should be included as a meal, 2 x a week, of which oily fish should be eaten as one.

Monounsaturated Fat     Back to Top

Substitution of saturated fat by monounsaturated fat appears to reduce the total cholesterol by reducing the amount of LDL. The proportion of high-density lipoproteins (HDL), however, remains unchanged. Foods high in monounsaturated fat include olive oil, rapeseed oil, peanut/walnut oil and avocado. These are encouraged as a substitute to saturated fat.

Trans-Fatty Acids     Back to Top

These are hydrogenated fats found in margarine and products made from them, e.g., biscuits, pastry, dairy and meat dishes. They may have undesirable effects on plasma LDL and HDL cholesterol and therefore should provide no more than 2% of total energy intake.

Ways to Reduce Fat Intake     Back to Top

• Cook foods without adding fat or oil. Grill, bake, microwave, or casserole instead of frying or roasting. If frying, use a minimal amount of unsaturated fat, e.g., sunflower, olive, rapeseed and soya oil.
• Use spreads labelled "high in saturated fat" sparingly or change to a low-fat or reduced-fat spread.
• Use low-fat dairy products, e.g., semi-skimmed/skimmed milk, low-fat yoghurt and lower-fat cheeses. Dairy products should not be totally excluded from our diet as they are a valuable source of calcium. Low calcium intakes in the first four decades of life may result in an increased risk of osteoporosis in later life. Low-fat dairy alternatives contain the same amount of calcium as the full-fat equivalents. 3 servings of dairy foods per day, 1 serving = 1/3 pint milk, 1oz cheese, 1 small carton of yoghurt will meet the daily nutritional requirement for calcium.
• Avoid hidden fats in pastries, cakes, biscuits and fatty meats.
• Choose leaner cuts of meat and cut visible fat away from meat. Have chicken and fish more often than red meat.

Carbohydrates     Back to Top

The intake of carbohydrate foods should make up 50% of total energy intake. These are derived from starch, fruit, vegetables and sugar.

Starch     Back to Top

Starchy foods such as bread, potatoes, breakfast cereals, rice and pasta should form the base of all meals. They should replace the energy deficit caused by a reduction of the dietary fat.

Insoluble fibre, which is found in wholemeal bread, wholegrain breakfast cereals, brown rice and pasta has found to be of benefit in preventing bowel disorders such as constipation and diverticular disease. They do not, however, have any beneficial effect on cholesterol.

Sugar     Back to Top

A high intake of sugar can affect dental health and lead to obesity. It is therefore recommended that sugar contributes to no more than 10% of total energy intake. This can be achieved by:

• Avoidance of added sugar to drinks, cereals, desserts, etc.
• Use of artificial sweeteners.
• Use of diet drinks, low calorie, reduced sugar squash.
• Replacing puddings, yoghurts and jams with reduced sugar alternatives.

Pulses, Fruit and Vegetables     Back to Top

5 servings of fruit, vegetables and pulses are encouraged each day as they have a number of beneficial effects. Firstly, these foods are rich in soluble fibre, which has been found to reduce plasma and LDL cholesterol. The fruit and vegetables contain antioxidants: Vitamins C, E and betacarotene, which are believed to be important in reducing the susceptibility to atherosclerosis and some types of cancers. An increase in dietary potassium, which is found in fruit and vegetables has been associated with a lowering of blood pressure.

Both types of fibre, soluble and insoluble, have the advantage of being bulking and promoting satiety. As fibre is often associated with low energy foods they can assist in weight (body-fat) loss. It is recommended that 30g of dietary fibre (18g non-starch polysaccharide) should be consumed daily. With this, a fluid intake of 8 - 10 cups (1 - 1½ litres) daily is required.

Salt     Back to Top

There is evidence for a direct link between the intake of salt and level of blood pressure and rise in blood pressure with age. An average reduction of 9 - 6g salt/day has been found to reduce systolic blood pressure. It is recommended that small quantities of salt only are used in cooking and not added at the table. Intake of processed foods such as salty snacks, crisps and peanuts should also be reduced.

Alcohol     Back to Top

Alcohol, if consumed, should be taken in moderation. Alcohol is high in calories, so if large amounts of alcohol are consumed the total energy intake may exceed energy output, resulting in weight (body-fat) gain.

Alcohol, in excess, causes many physical health hazards: it affects liver pathology, the nervous system, the endocrine system, respiratory circulation, and the reproductive system.

The recommended safe limits for alcohol intake are as follows:

• Men - 21 units per week
• Women - 14 units per week

1 unit = 1/2 pint beer, lager, single measure of spirit or one glass of wine, sherry, etc.

Mediterranean Diet     Back to Top

Lower rates of coronary heart disease exist in Mediterranean countries. However, some of these countries, e.g., Greece and South Italy, have relatively high intakes of monounsaturated fat, but the Mediterranean diet is characterised more by low levels of saturated fat and low total-fat intake as well as high intake of fruit and vegetables and wine. Although the recommendations from our Government mimic the Mediterranean diet in terms of low saturated fat and high intake of fruit and vegetables, there is insufficient evidence to suggest that increased intake of monounsaturated fats are of benefit in preventing heart disease. With regard to alcohol consumption, it is believed that red wine may have a protective effect on the prevention of coronary heart disease due to its antioxidant properties.

The Balance of Good Health     Back to Top

The National Food Guide, "The Balance of Good Health" has been designed to give a consistent and practical message about healthy eating. It aims to make healthy eating easier to understand by showing types and proportions of foods and put the above recommendations into a practical context.

The Balance of Good Health is based on 5 commonly accepted food groups:

• Bread, other cereals and potatoes
• Fruit and vegetables
• Milk and dairy foods
• Meat, fish and alternatives
• Fatty and sugary foods

The starchy foods, fruit and vegetables make up the bulk of the diet, demonstrating that a high-energy intake from carbohydrates and fruit and vegetables is desirable. The contribution from meat, fish and alternatives plus milk and dairy foods play a smaller role in the diet. Finally, the guide purports the intake of fatty and sugary foods being taken only occasionally and in small amounts.

The guide is intended to help educate people to reduce their fat intake by having smaller servings of meat, eating alternatives and choosing lean or low-fat products, when possible.

Takeaway Foods     Back to Top

Takeaways and fast foods tend to be high in fat and therefore high in calories; the fat generally being saturated in origin. If taken as an occasional treat, the fat intake from these foods will have a small negative effect on the overall diet. If eaten frequently, healthier choices will include grilled fish instead of fried fish in batter, vegetarian pizza instead of meat-topped pizza and a thin, crispy base is lower in fat than a deep-pan base. Moreover, choosing stir-fry dishes with a large helping of noodles or boiled rice instead of egg-fried rice. Similarly, having tandoori chicken or chicken tikka with plain boiled rice or chapattis instead of cream sauces with pilau rice or nan bread. Finally, choose a bean burger or a plain burger without a mayonnaise dressing instead of a cheese-burger.

Common Misconceptions     Back to Top

• Margarines high in polyunsaturates contain fewer calories than butter: Not True. Margarine contains the same number of calories and the same proportion of fat as butter. It is the type of fat that is different.
• Red meat should be avoided on a diet to reduce cholesterol: Not True. The colour of meat does not influence blood cholesterol; it is the fat content. If the visible fat is removed, then they are acceptable as part of a cholesterol-lowering diet.
• Bread and potatoes are fattening: Not True. 1 slice of bread or 2 boiled potatoes has 70 kcals compared to 1oz of cheese, which contains 100 kcals. It is the way starchy foods are cooked or what is added to them that can cause them to be high in calories.
• Brown sugar is better than white sugar: Not True. Brown sugar is not high in fibre. It has the same nutritional and calorie content as white sugar.
• Bananas are fattening: Not True. 1 banana contains approximately 65 kcals. It contains slightly more calories than an apple but less than a large biscuit or a slice of bread.
• Brown bread is high in fibre: Not True. Brown bread has the same fibre content as white bread. The colour of the bread is due to an additive such as caramel or treacle.
• Olive oil is good for you: Olive oil is high in monounsaturated fat, which has been found to lower LDL cholesterol without affecting HDL cholesterol. There is, however, insufficient evidence to suggest that olive oil will help to prevent coronary heart disease. It is a suitable alternative to saturated fat, but should still be used sparingly.

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