Cardio-protective Diet for You - NDR-UK

Cardio-protective Diet for You
This leaflet explains the risk factors for developing heart disease and provides advice on reducing
these risks.
People living with HIV have higher rates of heart disease than the general population. This may be
caused by the virus, ARVs and general risk factors.
What can increase my chances of developing heart disease?
There are a number of risk factors for heart disease, for example:
• having a raised total cholesterol, high LDL cholesterol or a low HDL cholesterol
• smoking
• lack of exercise
• being overweight, obese or having an increased waist size
• having high blood pressure
• having diabetes
• being male
• having a family history of premature heart disease
• being of South Asian ethnicity.
Cholesterol
Cholesterol is made by the liver. It is used as the building blocks of hormones and forms important
molecules within your cells. Some foods contain cholesterol, but this normally has only a very
small effect on your cholesterol levels.
• LDL cholesterol
This is often call ‘bad cholesterol’. It leads to build-up on your artery walls causing them to
narrow. It is important to try to keep your LDL figure low to prevent blockage of your
arteries.
• HDL cholesterol
This is often call ‘good cholesterol’. It helps to prevent build-up on your arteries. It is
important to try to keep your HDL figure high.
• Total cholesterol
Total cholesterol this is the combined figure for all the different types of cholesterol in your
blood stream. You should try to keep this low.
• Total cholesterol:HDL cholesterol ratio
Sometimes your total cholesterol maybe high but your ratio is still ok. This is better than
both being high.
Triglycerides
Triglycerides are another type of fat in your blood. Increased triglyceride levels can be associated
with being overweight (especially large waist size), having a diet high in sugar and/or alcohol,
being inactive and having poorly controlled diabetes. The higher your triglyceride level, the more
‘sticky’ your blood and the greater the risk of a clot forming. It is important to try to keep your
figure low.
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Guidelines for blood fat levels
Most centres have their own guidelines for target cholesterol levels. Ask your doctor, nurse or
dietitian what these are and compare them to your own levels in the table below.
Your measurements
Measurement Local guidelines Your results
Total Cholesterol
LDL
HDL
Ratio TC: HDL
Triglycerides
Cardiovascular risk assessment
Your consultant, specialist nurse or dietitian is likely to give you an annual ‘Cardiovascular risk
assessment’. They will consider information including your age, gender, family history, lifestyle
and blood fat levels to calculate your risk of developing cardiovascular disease within the next ten
years.
Ask your healthcare team for more information if you are interested in knowing more.
Medication for cholesterol and triglycerides
If your cholesterol remains high after you have made diet and lifestyle changes, your doctor and
dietitian may suggest you take medication to help lower your cholesterol. Usually a statin will be
prescribed, but fibrates or ezetimibe may be used. If your GP decides to start you on statin
medication, it is important to ask your HIV consultant or pharmacist if this is suitable as some
statins may interact with your anti-retroviral therapy. Your doctor may also consider switching
your ARV if it is known to raise cholesterol levels.
Improving your diet can reduce your cholesterol levels and lower risks of developing heart
disease
A better diet could improve your cholesterol levels and help decrease your risks of developing
heart disease. Even small changes in your cholesterol are likely to help improve your long-term
health.
Fat
Not all fats are equal. The effect of different types of fat on your cholesterol levels are described
below.
To lower your cholesterol levels, it is important to try and reduce the overall amount of fat in your
diet – healthy fats should also only be used in small amounts.
• Saturated Fat
A reduction in total saturated fat intake can reduce your cholesterol levels. Generally
saturated fat is found in products which come from animals. Foods very high in saturated
fat include fatty cuts of red meat, the skin from poultry, full-fat dairy products like full-fat
milk or ice cream, animal-based cooking fats like butter, ghee, lard, dripping and products
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made from these including pastries, pies, samosas. There are a few plant-based foods high
in saturated fat, including coconut cream, coconut oil and palm oil (or red oil).
Sources of saturated fat and how to reduce your intake
Saturated fat
How to reduce these
Visible white fat on meat. • Reduce red meat and choose lean cuts.
Poultry with its skin.
• Reduce processed meat products such as sausages,
burgers, salami, meat balls.
• Remove visible fat before cooking.
• Grill meat to allow fat to drain off.
• Remove skin from poultry.
Butter, ghee, dripping, lard,
palm kernel oil, palm oil,
coconut oil.
Mayonnaise, tartar sauce,
Marie rose sauce.
Full-fat milk
Cheese
Cream and full fat crème
fraiche
Coconut oil, coconut cream
Pastries, pasties, pies
• Dry fry mince and drain off the fat before cooking.
• Swap to a plant-based spread instead of butter or
ghee on bread, chapattis and in baking.
• Use small amounts of unsaturated oils in cooking
instead of butter or lard.
• If certain dishes require a specific oil than try to limit
these.
• Try to use alternative flavourings like lemon juice,
vinegar, natural yoghurt, fat-free dressings.
• If you must continue to use these, swap to low-fat
version and use sparingly.
• Swap to skimmed or semi-skimmed.
• Try to keep to a small portion, about 30g or the size
of a small matchbox.
• Try to only have cheese occasionally and don’t
routinely use it as an extra on top of pasta or baked
beans.
• Choose softer pasteurised cheeses like goat’s cheese
or brie instead of Cheddar or stilton.
• Avoid full-fat cream-based sauces with meat, poultry,
fish and pasta – choose vegetable and tomato
alternatives.
• Use low-fat alternatives in cooking, for example lowfat
crème fraiche instead of cream.
• Try low-fat natural yoghurt, fromage frais or crème
fraiche with desserts.
• Use light versions and sparingly.
• If eating foods that frequently use coconut such as
South Indian or Thai cuisine, try to use alternatives
without such as dishes tom yum soup.
• Choose filo pastry rather than short crust if baking at
home.
• Try making your own pastry using an unsaturated
spread (suitable for baking).
• Make pastry toppings rather than a whole pie to
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Saturated fat
How to reduce these
reduce the amount of pastry used.
• Only have these foods occasionally.
• Trans fats
Trans fat is the most harmful type of fat for your heart because it lowers HDL cholesterol
and increases LDL cholesterol.
Trans fat are mainly found in processed foods such as cakes, pastries, biscuits, crackers and
very hard margarines. Very small amounts of trans fat occurs naturally in meat and dairy
products but most comes from processed vegetable oils. Food manufacturers are trying to
change the way they process foods to eliminate these. For example, many major vegetable
oil-based spreads are now trans fat-free.
Limiting the amount of processed high-fat foods in your diet will reduce your trans fat
intake.
• Unsaturated Fat
There are two types of unsaturated fat in the diet. Both are healthier than saturated fat.
Monounsaturated fat
These are the best type of fat as they help to lower LDL cholesterol and leave HDL
cholesterol levels as they are. Typically monounsaturated fats are found in plant-based
foods such as nuts and seeds.
Polyunsaturated fat
These are also a god type of fat, though not quite as good as monounsaturates. They
help to lower LDL cholesterol but may also lower HDL cholesterol. They are found in
similar sorts of foods as monounsaturates and will often both occur in some foods.
Sources of Unsaturated fats
Monounsaturated fats
Olive oil and olive oil based spreads
Rapeseed oil (commonly found in
vegetable oil)
Peanut or ground nut oil
Almonds
Sesame oil
Cashews
Peanuts
Pistachio
Hazelnuts
Avocado
Polyunsaturated fats
Sunflower oil and sunflower spreads
Corn oil and corn oil spreads
Soybean and soybean spreads
Safflower oil
Walnuts
Pine nuts
Sesame seeds
Remember:
- All fat (unsaturated and saturated) has the same amount of calories.
- Replacing saturated fats with unsaturated fats can help to improve your cholesterol
levels.
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- If your total fat intake is high or you are overweight, it may be beneficial to reduce
the overall amount of fat in your diet in addition to decreasing your cholesterol.
Tips for swapping saturated fats with unsaturated fats
- Replace butter with an olive-oil based spread.
- Use mashed avocado and lemon juice instead of mayonnaise in sandwiches.
- Use olive oil or nut oil dressings instead of mayonnaise-style dressings.
- Add seeds and nuts to dishes such as soups, salads and cereals.
- Snack on nuts and seeds in place of snacks high in saturated fat, but remember to
only eat small quantities if you are trying to lose weight as they are high in calories.
- Use olive oil or vegetable oil for cooking in place of butter, lard or ghee.
- Try to substitute butter with vegetable-based spread or oil in baking.
• Fish
Fish can be divided in two groups – white fish and oily fish. Both of these are important
foods to include in your diet in order to keep your heart healthy.
White fish are a very low-fat and low-calorie source of protein. Oily fish contain high levels
of unsaturated fats called omega-3 fats. These help to protect your heart and keep your
blood thin.
Current recommendations for the whole population are to include 2 portions of fish (1
portion = 140g) per week with at least one of these being an oily fish. If you have
previously had a heart attack, then this recommendation is increased to 2-3 large portions
of oily fish per week.
Women who are pregnant, breast feeding or likely to become pregnant are advised to limit
their oily fish intake to 2 portions per week or 4 medium-size cans of tuna per week.
Additionally they should avoid eating shark, marlin and swordfish.
Types of fish
Oily fish
White fish
Salmon Trout Cod Canned crab
Mackerel Sprats Bass Rock
Kippers Anchovies Haddock Coley/pollock
Pilchards Skippers Plaice Hake
Sardines Sild Sole Kingfish
Herring Fresh tuna Tilapia Canned tuna
Fresh crab Swordfish
(only have once
per week)
Fish oil supplements and non-fish sources omega-3 fats
If you do not eat fish or oily fish you may want to think about taking a once daily fish oil
supplement. These are available from all pharmacists and health food shops. You
should look for a supplement containing fish body oils specifically docosahexaenoic
acid (DHA) and eicosapentaenoic acid (EPA). Specific amounts of these vary between
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ands, but as a guide one capsule should contain 1000mg total omega-3 fats and you
should aim to take 1 of these per day. Discuss this with your dietitian or consultant to
get some advice on what to take. If you are taking medication to reduce the clotting of
your blood (such as warfarin) check with your doctor before taking a fish oil
supplement. If you are pregnant, check that supplements are suitable.
The body can convert the oils found in flaxseed and flaxseed oil, walnuts and rapeseed
oil into omega-3 fats. If you do not want to take marine fish oils then these foods may
be a suitable alternative, although the benefits of these foods are not fully understood.
• Fruit and vegetables
Fruit and vegetables provide lots of nutrients that help to protect your heart. Therefore, it
is very important to include these in your diet. Aim to take 5 portions of fruit, vegetables
and salad per day.
Fruit and vegetables are an excellent source of fibre (see p7). They also contain antioxidant
vitamins which can help protect arteries.
Types of fruit and vegetables that count towards your 5-a-day
Fresh fruit and vegetables Frozen fruit and vegetables Fruit and vegetables in
dishes such as soups or
stews
Canned fruit and
vegetables. Choose varieties
in natural juice or water,
with no added sugar or salt.
A smoothie containing
whole fruit and/or
vegetable may count as
more than one portion but
this depends on how it's
made. Smoothies count as
up to a maximum of two
portions per day.
Dried fruit, such as currants,
dates, sultanas and figs.
Beans and pulses. These
only count as one portion a
day, no matter how many
you eat. That's because they
contain fewer nutrients
than other fruits and
vegetables.
A glass (150ml) of
unsweetened 100% fruit or
vegetable juice. Juice counts
as a maximum of one
portion a day, regardless of
how much you drink
because juice contains less
fibre than whole fruits and
vegetables, and more sugar.
Fruit and veg in convenience
foods, such as ready meals
and shop-bought pasta
sauces, soups and
puddings. Some are high in
salt, sugar and fat, so
only have them occasionally
or in small amounts.
What is a portion of fruit and vegetables?
A medium apple, orange, banana.
Two small fruits, for example kiwis or plums.
Half a grapefruit, a slice of papaya or melon, 2 slices of mango.
A heaped tablespoon of dried fruits.
150ml pure fruit juice or smoothie made with whole fruit.
A cereal bowl full of salad.
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Three heaped tablespoons of cooked vegetables.
Three heaped tablespoons of beans or pulses.
• Fibre
There are two different types of fibre in your diet. Both help heart health.
Insoluble fibre
This is found in pips, skins and seeds of fruits, vegetables and the husks of cereal
products. It is very good for your bowel and can help weight loss by making you feel
full.
Soluble fibre
This is found in things like porridge oats, okra, beans and pulses and fruits. It helps to
lower LDL and total cholesterol levels.
• Sources of dietary fibre
Insoluble Fibre
Found in vegetable and fruit skins, pips,
husks and seeds
Pips
Skins of fruits
Wholegrains and wholegrain products (e.g.
breads, cereals, pasta)
Bran and bran products
Stringy vegetables
Nuts
Potato skins
Soluble Fibre
Found inside fruits and vegetables and in
some grains
Oats, rye and barley
Psyllium
Root vegetables and root tubers. carrots,
celeriac, cassava, yam
Beans, pulses and legume
Flesh of apples and pears
Soft fruits and berries
Okra
• Plant stanols and sterols
Stanols and sterols are naturally occurring compounds found in plants that can block the
absorption of some cholesterol. The amount of stanols and sterols found naturally in most
fruits and vegetables are very low, so it would be difficult to eat enough through these
sources to have a significant effect on your cholesterol levels.
Many products fortified with high stanols and sterols concentrations are now available.
These include spreads, milks, yoghurt and yoghurt shots. The following table provides
details about products and doses to help you achieve a daily intake to achieve a significant
health effect.
Stanol/Sterol containing products and their recommended doses
Food item
Spreads
Flora proactive low fat spreads (light, olive oil,
extra light)
Benecol ® spreads, regular, olive oil, light)
Asda cholesterol lowering spread
Portion size
10g/2 level
teaspoons
12g/2 slightly
heaped teaspoons
2 level teaspoons
Servings needed to
meet 2g/day
3
3
3
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Yoghurts
Flora proactive
Benecol ® low fat bio yoghurt
125g pot
125g pot
Milk
Flora proactive 250mls 3
Cheese
Minocol
Benecol® light cream cheese style spread
Mini yoghurt drinks
Pro X cholesterol lowering
Asda cholesterol lowering
Flora proactive health yoghurt drink
Benecol ®yoghurt drink (light)
Tesco healthy living cholesterol lowering
65g serving /2 small
matchboxes
20g serving/ 4
teaspoons
100g/1 bottle
100g/1 bottle
100g/1 bottle
67.5g/1 mini bottle
100g/1 bottle
Mini smoothie drinks
Benecol ® fruit and dairy smoothie 65.5g/1 mini bottle 1
Mini dairy-free drinks
Benecol ® dairy free mini drink 65.5g/1 mini bottle 1
3
3
3
3
1
1
1
1
1
• Soya
There is some evidence that soya and soya products can lower your cholesterol levels and
therefore reduce your risk of heart disease. Taking 25g of soya protein every day can lead
to a small reduction in total cholesterol. The following suggestions are useful choices to
help you meet this daily intake:
1 litre of soya milk
150g tofu
try soya yoghurts
use soya mince instead of meat/poultry mince.
Weight
Being overweight can have a significant effect on your cholesterol levels especially if you carry
your weight around your waist and abdomen. In recent years it has been shown that waist
circumference is a more accurate way of telling whether someone is overweight and at higher risk
of heart disease.
Body mass index (BMI) is a measure used to indicate how healthy your weight is. To calculate your
BMI divide your weight (kg) by your height (m) squared
BMI = weight (kg) ÷ (height (m) x height (m))
BMI is categorised into ranges that indicate how healthy your weight is for your height. Health
risks are greater for people of Asian ethnicity at a lower weight, so there are different suggested
ranges for each BMI category.
Body Mass Index and categories
Underweight Ideal weight Overweight Obese
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Morbidly obese
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Adults
(general)
Adults of Asian
ethnicity
less than
19.9
Less than
18.5
20-24.9 25-29.9 30-40 More than 40
18.5 – 22.9 23 – 26.9 More than 27
The chart below will help you to find your BMI and see how healthy your weight is.
Waist circumference and risk of heart disease
Increased risk
High risk
Male (general) More than 94cm More than 102cm
Male (Asian ethnicity)
More than 90cm
Female (general) More than 80cm More than 88cm
Female (Asian ethnicity)
More than 80cm
If your weight is higher than it should be and you feel motivated to try and reduce your weight
then you should ask for a referral to the dietitian who can make specific suggestions and give you
advice and support.
Getting started with weight loss
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• Eat small, regular meals throughout the day. People who don’t eat meals regularly tend to
overeat because their hunger is not controlled.
• Keep an eye on the size of your starch food portions. These are good food choices by
eating too much can lead to weight gain. Examples include rice, potato, pasta, yam,
plantain, cassava, maize, bread and breakfast cereal.
• Choose lean cuts of meat, fish and protein and limit portion size to 120g (3-4 oz) and try to
include some vegetarian alternatives such as beans, pulses and eggs.
• Fill space on your plate with vegetables and salad as these are low in calories. Try to cook
vegetables without adding oil or butter.
• Dairy products are in rich in calcium. This is vital for bone health. Choose low-fat varieties
such as skimmed or semi-skimmed milk, low-fat yoghurts and reduced-fat cheese. You can
also try dairy-free sources of calcium which are lower in fat such as calcium-fortified soya
milk and soya yoghurts.
• Use low-fat cooking methods such as grilling, roasting, boiling and stewing without extra
fat or oil.
• Swap high-fat and sugar snacks like chocolate, biscuits, pastries and crisps for lower-calorie
options like fruit, vegetable sticks, low-fat crackers and low-fat yoghurt.
• Watch out for high-fat sauces and dips – mayonnaise, salad cream, salad dressings, Marierose
sauce, butter sauces and peanut sauce all have a lot of fat and can double the amount
of calories in your food!
Always ask for dressing and sauces on the side so you can add only a tiny amount. Try lowfat
alternatives like citrus juice, balsamic vinegar, low-fat yoghurt and reduced-fat
dressings.
• Make sure your drinks aren’t adding lots of extra calories into your diet. A can of cola can
have more calories than three jaffa cakes, and energy and protein drinks like Nutrament,
Nourishment and Red Bull are very high in calories and sugar.
The list below shows some helpful swaps:
Instead of
Choose
Cola and other fizzy drinks
Diet or low calorie alternatives
Pure fruit juice
Sugar-free fruit squash/cordial
Latte or cappuccino
Americano
Hot chocolate or malt drinks
Low-calorie alternatives
• Move more. Losing weight is all about using up more calories than what you take in food
and drink. Exercise helps you to burn more calories.
Exercise
Exercise plays an important role in reducing the risks of developing heart disease. Standard adult
recommendations are to get at least 30 minutes of moderate intensity exercise at least 5 days a
week. Moderate intensity means something that makes you feel a little bit warm and gets your
heart-rate up. Thirty minutes does not need to all be in one go and can be split up into three, tenminute
sessions.
Many people find going to a gym helpful as they provide weights, exercise machines and classes to
offer a variety of activities. However, there are lots of other ways to exercise, for example:
• swimming
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• brisk walking to and from work
• skipping in your back garden or garage
• joining a dance class and getting in plenty of practise
• badminton with family and friends
• housework
• gardening.
Lots of people enjoy yoga and Pilates. These are good for toning and improving you core stability
but are not cardiovascular exercise as they don’t get your heart rate up.
If you are trying to lose weight it is especially important to try to be more active in all aspects of
your daily routine. It’s all the little things that add up.
Tips for increasing daily activity
• Use the stairs not the lift.
• Go for a walk in your lunch break.
• Get off the bus or train a stop early to get in a walk.
• Do local errands on foot.
• Cycle to work.
• Make time at the weekend for exercise – going for a walk in the park, a country cycle ride,
a swim in the local pool.
Salt
Salt can increase blood pressure, especially if it is already high. If you have high blood pressure,
you are three times more likely to develop heart disease or have a stroke than people with healthy
blood pressure. Therefore, it is important to limit the amount of salt in your diet.
Current recommendations are to limit your daily intake of salt to 6g (a teaspoon) or 2.4g sodium.
Most of the salt we eat is already in food – especially processed foods, so even without adding salt
to your food, you can still have too much. Some foods are obviously very high salt, for example
salted nuts, salted savoury snacks or instant soups. Other foods like cereal or bread may only have
moderate amounts of salt, but if you eat them a lot, your daily amount of salt may be high. The
table below provides examples of high-salt foods that you should try and cut down and foods
where it will be useful to compare brands as they may have a high-salt to compare brands.
High salt foods
Foods High in Salt (to cut down on)
brands)
Bacon Cheese Bread and bread
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Food that may be high in salt (to compare
Tomato ketchup,
mayonnaise
products
Ham Soya sauce Breakfast cereal Sausages
Salami Gravy granules Pizza Soups
Anchovies Stock cubes Ready meals Sandwiches
Smoked meat and fish
Kippers
Salted and dry roasted
nuts
Pickles
Chicken nuggets and
breaded products
Ready made sauces
Crisps
11

Salt fish
Olives
Yeast extract
Salted snacks
Reading nutrition labels is a good way of identifying foods that are lower in salt, a rough guide is:
High More than 1.5 g salt (or 0.6g sodium)
Low 0.3g salt (or 0.1g sodium) or less
Alcohol
Drinking too much can increase your risks of cardiovascular disease and has been linked diabetes,
high blood pressure, raised cholesterol and increased waist circumference.
There is some evidence to show that small quantities of alcohol may have a beneficial effect on
your HDL cholesterol – this is at around 1 unit per day.
Alcoholic drinks can be very high in calories and so may contribute to weight gain.
Alcohol consumption should be limited to:
• 3-4 units per day for men
• 2-3 units per day for women
• 2 days per week should be alcohol-free
• binge-drinking should be avoided (consuming 8 or more units in a session).
What is a unit?
The table below provides some examples of the amount of alcohol units. However, brands vary,
so check the label for product-specific information.
Units in alcoholic drinks
Drink
Units
125ml glass of 12% wine 1.5
175ml glass of 12% wine 2.1
250ml glass of 12% wine 3
1 pint (568ml) of low strength (3.6%) lager/ale/cider 2
1 pint (568ml) of high strength (5.2%) lager/ale/cider 3
1 can (440ml) of medium strength (5.0%) lager/ale/cider 2
1 small single shot (25ml) of spirit (40%) – gin, vodka, whisky 1
1 standard single shot (35ml) of spirit (40%) – gin, vodka, whisky 1.4
Tips for reducing alcohol intake
• Check the measurements on your wine glass – 3 large glasses of wine are equivalent to a
bottle.
• Watch out for cocktails which may contain 3 or more shots of spirits.
• If you’re watching your weight, choose a single shot of spirit with a low-calorie mixer.
• Try diluting drinks, for example beer with lemonade (shandy) or white wine with lemonade
or fizzy water to make a spritzer.
• Have a soft drink between each alcoholic drink.
• Visit www.drinkaware.co.uk for more information.
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My goals
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