Before I was diagnosed with heart disease I would classify myself as an unhealthy thin person. I did not eat a proper diet. I am a type A personality and used that to accomplish anything I set out to do. I also set very high limits for myself. I handled stress one way: inappropriately. I saw doctors on a regular basis during my adult life, my family heart health history or my lifestyle combined with family heart history was never discussed as a concern. Not one single time before being diagnosed with heart disease did I ever consider it a possibility in my own life, even though my father had a massive coronary at age 36. If heart disease had been introduced into the equation of my physical and mental health, I believe I would not have had premature heart disease as early as I did. Family history is a known risk factor – knowledge is power and I had no knowledge or even an inkling that women were candidates for heart disease.
I was told you can fight heart disease with food labels at my cardio rehab classes. But there I felt so alone. The cardiac rehab classes were filled with mostly overweight 60+ aged men. Most were also diabetic and not at all willing to make lifestyle changes. I was given many prescriptions to take and also told about my new eating regime. Before I basically ate very little and when I did eat it was protein. Certainly nothing close to the healthy eating habits they were teaching in cardiac rehab, which entailed watching my salt intake, lots of fresh fruit and vegetables, limited protein and when I did have protein it should be lean cuts of beef, but mostly chicken and fish. I immediately tried to implement everything I learned. I read all the labels on the food I was buying. I tried not to buy anything that contained cholesterol or too much added sodium. Honestly it was mentally coping with change that was the biggest battle. There was no class on that. The statins I took got my blood cholesterol levels at an outstanding low level, which made me think it wasn’t about diet as much as taking my pills. True change did not come right away.
“Food labels can be your biggest friend or your worst enemy,” says cardiologist Mehdi Razavi, MD, a heart disease specialist at the Texas Heart Institute in Houston. There’s plenty of useful information if you know what to look for, he explains. But labels can also be confusing and even misleading if you don’t consider the whole picture. Razavi spoke with WebMD about how to use food labels to lower your risk of heart disease.
First, how helpful are food labels for choosing a heart-healthy diet? Very helpful. In fact, most of the information on the food label was chosen based on studies of heart disease and diet. So if you keep an eye on labels, you can lower your risk of heart disease.
What’s the first thing to look at? The top of the Nutrition Facts panel shows what a serving size is and how many calories a serving contains. Obviously, if you’re overweight or have trouble maintaining a healthy weight, keeping an eye on calories is important.
Excess weight is a significant risk factor for heart disease. Most women should average about 1,800 to 2,000 calories a day – and even less, about 1,700 calories, if they’re trying to lose weight. Most men should consume about 2,500 calories. Those numbers vary based on how active you are. People who are diabetic or overweight should try to limit their calorie intake even further. Make sure you know what a serving size is, since that can be confusing. If a package indicates 150 calories per serving but it contains two servings, you’ll consume 300 calories if you eat the whole package.
What about fat on the label? We’re less concerned than we once were about total fat. A healthy diet can get 30% of its calories from fat. What matters more is the type of fat, and here food labels come in handy, since they clearly indicate saturated and unsaturated fat. Most of the fat you consume should be unsaturated. Some saturated fat is fine. In fact, the body needs a little. But no more than 10% of your daily calories should come from saturated fat. If your LDL “bad” cholesterol is high, no more than 7% of your calories should come from saturated fat.
What about trans fats? Trans fats come from partially hydrogenated oils. They've been shown to be even more dangerous to the cardiovascular system than saturated fats. The less trans fat you consume, the better. Labels can be a little confusing. Products can call themselves trans fat-free if they contain less than half a gram per serving. That amount isn't a problem if you eat such foods now and then. But if you eat them frequently, you may be consuming more trans fats than is healthy. If you want to eliminate trans fats entirely, look on the ingredient label and choose foods that do not contain partially hydrogenated oils. Be sure to make sure the food is also low in saturated fat. Some companies have replaced trans fats with saturated fat, which isn't healthy either.
What’s the latest thinking on the healthiest types of unsaturated fat? Unsaturated fats include vegetable and nut oils, such as olive oil, corn oil, safflower oil, and canola oil. These are liquid at room temperature. Saturated fats, in contrast, which are solid at room temperature, are known to raise blood cholesterol levels and the risk of heart disease. Unsaturated fats are divided into monounsaturated and polyunsaturated. Some studies suggest that polyunsaturated fats are the healthiest. I don’t think you need to worry too much about polys versus monos. In fact, most vegetable and nut oils contain a mix of the two.
Is it important to look at levels of dietary cholesterol in food?If you have elevated LDL cholesterol or a family risk of heart disease, you should keep an eye on how much dietary cholesterol you consume. The Therapeutic Lifestyle Changes diet, known as TLC, has been shown in studies sponsored by the National Heart Lung and Blood Institute to significantly reduce heart disease in people at risk. The TLC diet calls for no more than 200 milligrams of dietary cholesterol a day for people with high cholesterol. Reading labels is important, of course. But more important is limiting the amount of foods that contain high levels of cholesterol, many of which don’t carry labels, such as eggs and organ meats.
What about sodium? Too much sodium increases the risk of high blood pressure, or hypertension. High blood pressure, in turn, increases the risk of developing heart disease. Some people don’t seem to be as sensitive to salt as others. If you have high blood pressure, you should definitely limit sodium intake. The most recent evidence shows that the less sodium you consume, the lower your risk of hypertension. The DASH diet, which stands for Dietary Approaches to Stop Hypertension, originally set the limit at no more than 2,300 milligrams of sodium daily. New evidence shows that lowering your intake to 1,500 milligrams further lowers your risk of high blood pressure. Since three-quarters or more of the salt we consume comes in packaged foods, labels are particularly helpful here.
Labels also show potassium levels. What should we look for? Too much sodium and too little potassium both play a role in high blood pressure. Low potassium levels can also affect the electrical impulses that activate the heart, causing heart beat irregularities. The Institute of Medicine recommends 4,700 milligrams of potassium a day. But rather than worry about numbers on the label, I’d suggest eating more foods with potassium, which include fruits and vegetables, especially orange juice, broccoli, garlic, bananas, tomatoes, and beans — all of which are healthy for you in many ways.
A lot of people are cutting back on carbohydrates. What help can food labels offer? The total amount of carbohydrates is less important than the type. The healthiest forms are unrefined carbohydrates, which are found in whole grains, beans, seeds, nuts, and other whole, unprocessed foods. (Limit less healthy carbs such as sugar, white rice, and regular breads and pastas.) It’s wise to look at a label to make sure it contains whole grains and plenty of fiber. Several studies have shown that people who eat plenty of whole grains have a lower risk of heart disease.
What about protein? We know protein is important. The body needs it for many functions. Protein in a meal helps make it satisfying. That can help people maintain a healthy weight. But labels aren’t particularly useful, since most of the protein people consume is in foods that aren’t required to have nutrition panels, such as fish, meat, and poultry. Here you need to use some commonsense guidelines. The best sources of protein are unprocessed foods with the least saturated fat. That includes plant-based sources, such as nuts and beans, and fish and lean meat. A healthy diet should contain 60 to 120 grams of good quality protein a day.
Finally, food labels typically list levels of various vitamins. What should people look for? The evidence linking certain vitamins to lower risk of heart disease isn’t very strong. We used to be excited about vitamin E and beta-carotene, for instance, which appeared to significantly lower heart disease risk. But more recent research hasn’t shown a strong link. Rather than worry about how much vitamin E or vitamin B a packaged food contains, I suggest eating an overall healthier diet, especially one that puts fruits, vegetables, nuts, and other plant-based foods in the middle of the plate. The strongest evidence for the role of diet and heart disease prevention, after all, comes from studies that look at the overall diet. And the healthiest diets are those that contain abundant fruits, vegetables, and other plant-based foods, along with lean meats and fish.
Lois Trader's book is available here: SURVIVING