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Heart-Healthy Diet

Sodium, Fat, and Cholesterol Controlled Diet

by Maria Adams, MS, MPH, RD

En Español (Spanish Version)

What Is a Heart Healthy Diet? | Food Choices on a Heart Healthy Diet | Suggestions

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What Is a Heart Healthy Diet?

A heart-healthy diet is one that limits sodium, certain types of fat, and cholesterol . This type of diet is recommended for:

People with any form of cardiovascular disease, such as coronary heart disease, peripheral vascular disease, previous heart attack, or previous stroke.
People with risk factors for cardiovascular disease, such as high blood pressure, high cholesterol, or diabetes
Anyone who wants to lower their risk of developing cardiovascular disease

Sodium

Sodium is found in salt, which is added to food. In general, most people consume much more sodium than they need. Diets high in sodium can increase blood pressure and lead to water retention. On a heart-healthy diet, you should consume no more than 2,300 milligrams (mg) of sodium per day—about the amount in one teaspoon of table salt. The foods highest in sodium include table salt processed foods, convenience foods, and preserved foods. Table salt contains nearly 50% sodium.

Cholesterol

Cholesterol is a fat-like, waxy substance in your blood. Our bodies make some cholesterol. It is also found in animal products, with the highest amounts in fatty meat, egg yolks, whole milk, cheese, shellfish, and organ meats. On a heart-healthy diet, you should limit your cholesterol intake to less than 200 mg/dL per day.

It is normal and important to have some cholesterol in your bloodstream. But too much cholesterol can cause plaque to build up within your arteries, which can eventually lead to a heart attack or stroke.

The two types of cholesterol that are most commonly referred to are:

Low-density lipoprotein (LDL) cholesterol —Also known as bad cholesterol, this is the cholesterol that tends to build up along your arteries. Bad cholesterol levels are increased by eating fats that are saturated or hydrogenated. Optimal level of this cholesterol is less than 100 mg/dL. Risk for heart disease increases when it goes over 130 mg/dL.
High-density lipoprotein (HDL) cholesterol —Also known as good cholesterol, this type of cholesterol actually carries cholesterol away from your arteries and may, therefore, help lower your risk of having a heart attack. You want this level to be high. Although there is no standard goal, you want to keep this number above 60 mg/dL. Risks for heart disease increases when it drops below 40 mg/dL.. You can raise this good cholesterol by eating olive oil, canola oil, avocados, or nuts. Exercise raises this level, too.

Fat

Fats are calorie dense, therefore they pack a lot of calories into a small amount of food. Even though fats should be limited due to their high calorie content, not all fats are bad. In fact, some fats are quite healthful. Fat can be broken down into four main types.

The fats that are good for you include:
Monounsaturated fat —found in oils such as olive and canola, avocados, and nuts and natural nut butters; can decrease total cholesterol levels, while keeping levels of HDL cholesterol high
Polyunsaturated fat —found in oils such as safflower, sunflower, soybean, corn, and sesame; can decrease total cholesterol and LDL cholesterol
Omega-3 fatty acids —a subcategory of polyunsaturated fats, such as those found in fatty fish like salmon, trout, tuna, mackerel, herring, and sardines; these fats can decrease risk of arrhythmias, decrease triglyceride levels, and slightly lower blood pressure

The fats that you want to limit are:
- Saturated fat —found in animal products, many fast foods, and a few vegetables; increases total blood cholesterol, including LDL levels
  - Animal fats that are saturated include: butter, lard, whole-milk dairy products, meat fat, and poultry skin
  - Vegetable fats that are saturated include: palm oil, coconut oil, cocoa butter
- Hydrogenated or trans fat are found in margarine and vegetable shortening, most shelf-stable snack foods, and fried foods. They increase LDL and decrease HDL. This is a fat that has no healthful qualities at all and should be eliminated from your diet.

It is generally recommended that you limit your total fat for the day to less than 25%-35% of your total calories. If you follow an 1,800-calorie heart healthy diet, for example, this would mean 60 grams of fat or less per day.

Saturated fat and trans fat in your diet raises your blood cholesterol the most, much more than dietary cholesterol does. For this reason, on a heart-healthy diet, less than 7% of your calories should come from saturated fat and ideally 0% from trans fat. On an 1,800-calorie diet, this translates into less than 14 grams of saturated fat per day, leaving 46 grams of fat to come from mono- and polyunsaturated fats.

Food Choices on a Heart Healthy Diet

Food Category	Foods Recommended	Foods to Avoid
Grains	Breads and rolls without salted tops Most dry and cooked cereals Unsalted crackers and breadsticks Low-sodium or homemade breadcrumbs or stuffing All rice and pastas Make 1/2 of your daily grains whole grains	Breads, rolls, and crackers with salted tops High-fat baked goods like muffins, donuts, and pastries Quick breads, self-rising flour, and biscuit mixes Regular bread crumbs Instant hot cereals Commercially prepared rice, pasta, or stuffing mixes
Vegetables	Most fresh, frozen, and low-sodium canned vegetables Low-sodium and salt-free vegetable juices Canned vegetables if unsalted or rinsed	Regular canned vegetables and juices, including sauerkraut and pickled vegetables Frozen vegetables with sauces Commercially prepared potato and vegetable mixes
Fruits	Most fresh, frozen, and canned fruits All fruit juices	Fruits processed with salt or sodium
Milk	Nonfat or low-fat (1%) milk Nonfat or low-fat yogurt Cottage cheese, low-fat ricotta, cheeses labeled as low-fat and low-sodium	Whole milk Reduced-fat (2%) milk Malted and chocolate milk Full fat yogurt Most cheeses, unless low-fat and low salt Buttermilk (no more than 1 cup per week)
Meats and Beans	Lean cuts of fresh or frozen beef, veal, lamb, or pork (look for the word loin) Fresh or frozen poultry without the skin Fresh or frozen fish and some shellfish Egg whites and egg substitutes (Limit whole eggs to three per week) Tofu Nuts or seeds (unsalted, dry-roasted), low-sodium peanut butter Dried peas, beans, and lentils	Any smoked, cured, salted, or canned meat, fish, or poultry, including bacon, chipped beef, cold cuts, hot dogs, sausages, sardines, and anchovies Poultry skins Breaded and/or fried fish or meats Canned peas, beans, and lentils Salted nuts
Fats and Oils	Olive oil and canola oil Low-sodium, low-fat salad dressings and mayonnaise	Butter, margarine, coconut and palm oils, bacon fat
Snacks, Sweets, and Condiments	Low-sodium or unsalted versions of broths, soups, soy sauce, and condiments Pepper, herbs, and spices; vinegar, lemon, or lime juice Low-fat frozen desserts (yogurt, sherbet, fruit bars) Sugar, cocoa powder, honey, syrup, jam, and preserves Low-fat, trans-fat free cookies, cakes, and pies Graham and animal crackers, fig bars, ginger snaps	High-fat desserts Broth, soups, gravies, and sauces, made from instant mixes or other high-sodium ingredients Salted snack foods Canned olives Meat tenderizers, seasoning salt, and most flavored vinegars
Beverages	Low-sodium carbonated beverages Tea and coffee in moderation Soy milk	Commercially softened water

Suggestions

Make whole grains, fruits, and vegetables the base of your diet.
Choose heart-healthy fats such as canola, olive, and flaxseed oil, and foods high in heart-healthy fats, such as nuts, seeds, soybeans, tofu, and fish.
Eat fish at least twice per week; the fish highest in omega-3 fatty acids and lowest in mercury include salmon, herring, mackerel, sardines, and canned chunk light tuna. If you eat fish less than twice per week or have high triglycerides, talk to your doctor about taking fish oil supplements.
Read food labels.
- For products low in fat and cholesterol, look for fat free, low-fat, cholesterol free, saturated fat free, and trans fat free—Also scan the Nutrition Facts Label, which lists saturated fat, trans fat, and cholesterol amounts.
- For products low in sodium, look for sodium free, very low sodium, low sodium, no added salt, and unsalted
Skip the salt when cooking or at the table; if food needs more flavor, get creative and try out different herbs and spices. Garlic and onion also add substantial flavor to foods.
Trim any visible fat off meat and poultry before cooking, and drain the fat off after browning.
Use cooking methods that require little or no added fat, such as grilling, boiling, baking, poaching, broiling, roasting, steaming, stir-frying, and sautéing.
Avoid fast food and convenience food. They tend to be high in saturated and trans fat and have a lot of added salt.
Talk to a registered dietitian for individualized diet advice.

Academy of Nutrition and Dietetics

http://www.eatright.org

American Heart Association

http://www.heart.org

Dietitians of Canada

http://www.dietitians.ca

Heart and Stroke Foundation of Canada

http://ww2.heartandstroke.ca

American Heart Association Nutrition Committee, Lichtenstein AH, Appel LJ, et al. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation. 2006;114(1):82-96.

Dietary guidelines for Americans 2010. US Department of Agriculture and US Department of Health and Human Services. Available at: http://www.health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf. Accessed February 15, 2013.

Dietary recommendations for cardiovascular disease prevention. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/what. Updated February 14. 2013. Accessed February 15, 2013.

What your cholesterol levels mean. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/What-Your-Cholesterol-Levels-Mean_UCM_305562_Article.jsp. Updated February 8, 2013. Accessed Febrary 15, 2013.

Last reviewed February 2013 by Dianne Scheinberg Rishikof MS, RD, LDN

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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