Diet

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.

Figure 1: What do you need to eat and how much do you need everyday?*

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

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 fats^{7–9, 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 diet^8,11:

• 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.

 

Figure 4: Benefits of whole grains¹³

 

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

Although the association between sugar consumption per se and diabetes remains inconclusive, reducing sugar in your diet is still strongly recommended. This is because sugar contains no vitamins and minerals apart from calories; over-consumption may lead to several adverse effects such as dental caries, obesity, and micronutrient deficiency. High consumption of sugar also increases your triglyceride levels and reduces your high-density lipoprotein cholesterol, thus increasing your risk of developing heart disease.¹⁸

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

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

Alcohol is another culprit for CVD; therefore, the intake of alcohol should be limited to no more than one drink per day for women and two drinks per day for men.²² One drink of alcohol can be defined as²³:

• 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 cholesterol-like substances that occur naturally in small amounts in many grains, vegetables, fruits, legumes, nuts, and seeds. They prevent the real, artery-clogging cholesterol from being absorbed into your bloodstream, thus help lowering your raised low-density lipoprotein (LDL) cholesterol and subsequently, your risk of heart disease.^24,25

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 (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