- Healthy living
Your risk of developing cardiovascular disease (CVD), including coronary heart disease and stroke, is influenced by many factors. Some factors (eg, family history, ethnicity, age) are non-modifiable, but some factors (eg, high blood pressure, high cholesterol, diabetes, obesity, physical inactivity, unhealthy diet, and smoking) are modifiable. Making changes to the modifiable risk factors can help in preventing CVD.1
Unhealthy diets (eg, diets that are high in saturated fat and trans fat) are found to result in abnormal blood lipid levels, ie, high total cholesterol, high levels of triglycerides, high levels of low-density lipoprotein cholesterol or low levels of high-density lipoprotein cholesterol. This in turn, increases your risk of heart disease and stroke. Eating a healthy, balanced diet is one of the key strategies that can help to modify your blood lipid profile and subsequently, reduce your risk of developing CVD.1,2
This article will provide you an overview on healthy eating—which includes consuming an adequate amount of fibre from wholegrains, fruits and vegetables, as well as limiting the intake of saturated fatty acids, trans fat, sugar, salt and alcohol—as a crucial step in managing your cardiovascular health.
What is a healthy, balanced diet?
Different types of foods can give you different combinations of energy and nutrients. To maintain or improve general wellness and obtain an adequate amount of energy for your daily functions, it is important to achieve your daily nutritional requirements by eating a varied, well-balanced diet—a diet which combines cereals, fruits and vegetables, meat, fish, poultry, legumes and dairy products—that eventually translates into sources of protein, carbohydrate, fat, vitamins and minerals for your body (Figure 1).3,4
Figure 1: What do you need to eat and how much do you need everyday?*
*The number of servings calculated is based on 60% of total calories from carbohydrates (50% complex carbohydrates + 10% refined sugar), 15% from proteins and 25% from fats, for people who need a total of 1,500 kcal per day, 2,000 kcal per day or 2,500 kcal per day.3
Figure 2 shows how you can make a well-balanced diet on a plate.
Figure 2: Healthy plate portion4
Another key to a healthy, balanced diet is to eat in moderation. This includes:
1. Eating according to your daily energy requirement: The amount of energy you need in a day is dependent on your gender, age, height, weight, body size, physical activity level and your basal metabolic rate.4 Find out your daily energy requirement based on which of the following category you fall into3,4:
2. Taking the right number of servings: You should also control your portion sizes by taking the right number of servings to avoid overeating.4 Table 1 describes the suggested number of servings for each food group based on your daily energy requirement, whereas Table 2 presents some examples of one-serving size for various types of foods. You can also find out more about the calorie content of some common delicacies in Malaysia from Table 3.
Table 1: Recommended number of servings for each food group4
Table 2: Examples of one-serving size for various foods4
Table 3: Calorie content in various Malaysian delicacies4,5
A cup, plate, bowl, tablespoon and teaspoon are common household measures used to estimate the amount of food you consume daily. Alternatively, you can also use the visual guide below as measurement standards (Figure 3).6
Figure 3: Visual guide for estimation of food portion,6
Smart fat choices
You may think that all fats are harmful to you and you should try to eliminate them as much as you can from your diet. This is in fact not true. Your body needs some fat to support a number of body functions.7,8
Fats are either saturated or unsaturated. Saturated fat is solid at room temperature and harmful because it can raise your cholesterol. In contrast, unsaturated fat—the healthier choice of fat—is liquid at room temperature and can help to improve your cholesterol levels. Monounsaturated fat and polyunsaturated fat (eg, omega-3 and omega-6 fatty acids) are types of unsaturated fat.7–9
Trans fat is another type of harmful dietary fat that has been changed by a process known as dehydrogenation. This process increases the shelf life of fat and makes the fat harder at room temperature.9
Knowing which fats raise your low-density lipoprotein (LDL) cholesterol and which ones don't is the first step in lowering your risk of heart disease and stroke (Table 4).10
Table 4: Getting to know the different types of fats7–9, 11
Avoiding harmful dietary fats is essential to lower your risk of CVD. Here are some tips to help you avoid these fats in your diet8,11:
- Choose products labelled ‘Trans fat-free’ or ‘No trans fat’. Choose products labelled ‘Trans fat-free’ or ‘No trans fat’.
- Limit products that contain partially hydrogenated oil, which is equivalent to trans fat. Examples include food with margarine, pastries or cookies, fast food (fries, fried chicken, burgers), frozen food (eg, frozen pizza, frozen nugget, refrigerated dough products such as pau).
- Read food labels and choose products that are low in saturated fat and cholesterol (the lower the better).
- Use monounsaturated fat (olive oil, canola oil) or polyunsaturated fat (sunflower oil, corn oil) instead of solid fat (eg, butter) in cooking or baking.
- Do not reuse cooking oils.
- Choose low-fat dairy foods.
- Eat more fruits, vegetables and whole grains.
- Choose lean meat and skinless poultry. Cut the visible fat off meat and remove the skin from poultry.
- Replace meat with fish, such as salmon and mackerel, at least twice a week to get healthy omega-3 fatty acids.
- Occasionally, go vegetarian by replacing animal proteins with plant-based protein foods such as beans, lentils, nuts and seeds, as well as their products including tofu and tempeh.
You can also learn to prepare healthy meals on your own using the following healthy cooking methods4:
- Steaming: Maintains nutrients and flavours.
- Stir frying: Cooks small pieces of food quickly with minimal oil in non-stick pan.
- Grilling and roasting in high heat: Allows fat to drip away from meats.
- Baking/microwaving: Maintains flavours and aromas with minimal oil.
- Braising: Helps soften tough meats without oil.
- Stewing: An easy and fast way to cook different types of food using a slow cooker.
Whole grains are awesome!
Whole grains are rich in dietary fibre, vitamin E, trace minerals and phytochemicals, and should make up 50% of your total grain intake.13 Figure 4 shows how you can benefit from whole grains.
Figure 4: Benefits of whole grains13
Fibre is important
Do you know that fibre, found in cereals, fruits and vegetables, has a vast range of benefits for your health too? There are two types of fibre—soluble and insoluble—both of which can help you stay at a healthy weight and promote healthy bowel movements.13 Soluble fibre, however, is associated with additional benefits—it helps to lower blood sugar and reduce blood cholesterol13 (by lowering total and low-density lipoprotein cholesterol).
Find out about the amount of fibre you should be taking daily and the sources of soluble and insoluble fibre from Figure 5.
Figure 5: Fibre, both soluble and insoluble, is good for you
You can increase your fibre intake by following the tips below16:
- Start the day with a high-fibre breakfast by incorporating whole grains and their products such as whole-wheat biscuits, muesli, oat porridge and whole-grain cereals.12,16
- Opt for whole grains and their products over refined grains.12,16
- Keep potatoes unpeeled when making baked potatoes, stews, curries and soups (but be sure that you clean them thoroughly).
- Add pulses such as beans, lentils or chickpeas to stews, curries and salads. Consider replacing foods from animal protein with foods from plant-based protein such as nuts, beans, tofu and tempeh in mix dishes.
- Make room for fruits and vegetables. Fill up half of your plate with various types of fruits and vegetables.4
Eat a variety of vegetables and fruits everyday
Get sugar out of your diet
If you want to keep yourself healthy, you should start reducing your daily sugar intake by following the simple suggestions in Figure 6.18
Figure 6: How can I cut down on my sugar?4,18
Curb the salt
Excessive intake of dietary salt has been found to induce high blood pressure and increase the risk of heart disease and stroke. Hence, it is important for you to cut down on your dietary salt intake.21
Sounds easy, but not sure how you can do this? Let’s find out from Figure 7.
Figure 7: How can I cut down on daily salt intake?4,21
Limit alcohol intake
- 218 mL of standard 4.5% cider;
- 76 mL of standard 13% wine;
- 25 mL of standard 40% whiskey;
- 250 mL of standard 4% beer; or
- 250 mL of standard 4% alcopop
However, you are advised not to start drinking for any reason if you are not a drinker.22
Plant sterols are powerful cholesterol-lowering agents too
Eating 1.5–2.4 g of plant sterols daily for 3 weeks has been shown to reduce LDL cholesterol levels by up to 10%.24
Plant sterols can also be found in some foods such as margarine spreads, orange juice, cereals, granola bars, some cooking oils, salad dressings, milk, and yogurt.25
Prebiotics help to maintain a healthy digestive system
Prebiotics (eg, inulin, oligofructose) are food for probiotics—beneficial bacteria (eg, Bifidobacteria) that help keep your digestive system healthy. Prebiotics are carbohydrates that cannot be digested by the human body and can be found in foods such as asparagus, bananas, legumes, garlic, onions, wheat, and soybeans.26,27
Prebiotics are also added into many foods, including yogurts, cereals, breads, cookies, ice cream, spreads, drinks, and supplements as a subcategory of functional food ingredients.27
Additional tips for healthy eating
- World Heart Federation. Cardiovascular disease risk factors. Available at http://www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease-risk-factors/. Accessed 19 September, 2019.
- World Heart Federation. Diet and cardiovascular disease. Available at http://www.world-heart-federation.org/cardiovascular-health/cardiovascular-disease-risk-factors/diet/. Accessed 19 September, 2019.
- Ministry of Health Malaysia. Malaysian dietary guidelines key message 1–eat a variety of foods within your recommended intake; 2010.
- Nutrition Month Malaysia. Eat right, move more, fight obesity. Available at https://www.nutritionmonthmalaysia.org.my/wp-content/uploads/2019/01/nmm2014-press-article-thestar-20140316.pdf. Accessed 8 October, 2019.
- Bahagian Pemakanan Kementerian Kesihatan Malaysia. Panduan nilai kalori 200 jenis makanan.
- WebMD. Portion control and size guide. Available at http://www.webmd.com/diet/printable/wallet-portion-control-size-guide. Accessed 19 September, 2019.
- NHS choices. Fat: The facts. Available at http://www.nhs.uk/livewell/goodfood/pages/fat.aspx. Accessed 19 September, 2019.
- Mayo Clinic. Dietary fats: Know which types to choose. Available at http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/fat/art-20045550. Accessed 19 September, 2019.
- WebMD. Types of fats–topic overview. Available at http://www.webmd.com/diet/guide/types-of-fats-topic-overview?page=1. Accessed 19 September, 2019.
- American Heart Association. Know your fats. Available at http://www.heart.org/heartorg/conditions/cholesterol/preventiontreatmentofhighcholesterol/ know-your-fats_ucm_305628_article.jsp#.vx1qlvl9601. Accessed 19 September, 2019.
- Ministry of Health Malaysia. Malaysian dietary guidelines key message 8–limit intake of foods high in fats and minimise fats and oils in food preparation; 2010.
- Nutrition Society of Malaysia. Wonders of whole grains; 2012.
- WebMD. Soluble and insoluble fibre: What’s the difference? Available at http://www.webmd.com/diet/insoluble-soluble-fiber. Accessed 19 September, 2019.
- Ministry of Health Malaysia. Malaysian dietary guidelines key message 4–eat adequate amount of rice, other cereal products (Preferably whole grain) and tubers;2010.
- Malaysian Dietitians’ Association. Soluble fibre–top 10 foods to lower your cholesterol. Avaialable at http://www.dietitians.org.my/health-info/soluble-fibre-%e2%80%93-top-10-foods-to-lower-your-cholesterol. Accessed 19 September, 2019.
- NHS choices. How to get more fibre into your diet. Available at http://www.nhs.uk/livewell/goodfood/pages/how-to-get-more-fibre-into-your-diet.aspx. Accessed 19 September, 2019.
- Ministry of Health Malaysia. Malaysian dietary guidelines key message 5–eat plenty of fruits and vegetables everyday; 2010.
- Ministry of Health Malaysia. Malaysian dietary guidelines key message 10–consume foods and beverages low in sugar; 2010.
- World Health Organization. WHO calls on countries to reduce sugars intake among adults and children. Available at https://www.who.int/mediacentre/news/releases/2015/sugar-guideline/en/. Accessed 19 September, 2019.
- American Diabetes Association. What can I drink? Available at https://www.diabetes.org/blog/what-can-i-eat?referrer=https%3A//www.google.com/. Accessed 8 October, 2019.
- Ministry of Health Malaysia. Malaysian dietary guidelines key message 9–choose and prepare foods with less salt and sauces; 2010.
- Centers for Disease Control and Prevention. Alcohol and public health: Frequently asked questions. Available at Available at https://www.cdc.gov/alcohol/faqs.htm. Accessed 8 October, 2019.
- Drinkaware. What is an alcohol unit? Available at https://www.drinkaware.co.uk/alcohol-facts/alcoholic-drinks-units/what-is-an-alcohol-unit/. Accessed 19 September, 2019.
- Heart UK. Plant sterols and stanols (Phytosterols). Available at https://heartuk.org.uk/cholesterol-and-diet/healthy-eating/plant-sterols-and-stanols. Accessed 19 September, 2019.
- WebMD. The new low-cholesterol diet: Plant sterols and stanols. Available at https://www.webmd.com/cholesterol-management/features/low-cholesterol-diet-plant-sterols-stanols. Accessed 19 September, 2019.
- WebMD. Probiotics and prebiotics: Ask the nutritionist. Available at http://www.webmd.com/vitamins-and-supplements/nutrition-vitamins-11/probiotics?page=1. Accessed 19 September, 2019.
- Brownawell AM, et al. J Nutr 2012;142:962–974.
- Nestle Malaysia. The Malaysian diet. Available at http://www.nestle.com.my/nutrition_health_wellness/how_am_i/health_and_nutrition_for_everyone/nutrition_for_families/the_malaysian_diet. Accessed 19 September, 2019.
- Heart Foundation. Eat some: Healthy oils, nuts & seeds. Available at https://foodwatch.com.au/blog/fats-and-oils/item/7-healthy-alternatives-to-spread-on-your-daily-bread.html. Accessed 8 October, 2019.