Salt or sodium chloride has been traditionally used mainly to preserve food. However, modern preservation methods have made it redundant, yet food manufacturers continue to supply processed foods with added salt because we have become accustomed to the taste. Excessive salt consumption causes a significant rise in blood pressure, which is a major cause of stroke and heart attacks. Government recommendations are to decrease our salt intake to 6 grams per day (just one teaspoonful). Average blood pressure has fallen in countries which have launched public awareness campaigns to decrease salt intake and where potassium chloride is used in baked and processed foods.

As well as decreasing sodium, increasing potassium seems to be important in decreasing blood pressure. Potassium is found in abundant quantities in fruits and vegetables.

We are also born with a sweet tooth and while sugar intake is not directly associated with heart disease, sweet foods can add unwanted calories to the diet and can also contain saturated fat. In a cardioprotective diet, natural sweetness is provided by sumptuous fruits of all kinds, fresh, tinned and dried, all with the added bonus of providing antioxidants, vitamins and minerals such as potassium.

Key Action Points to Reduce Salt and Sugar in the Heart Healthy Diets

• Avoid adding salt to your cooking and to your food at the table. Rather enhance the natural flavors of your dishes with aromatic vegetables, herbs and spices such as garlic, onions, pepper, lemon juice, vinegar, ginger, chilies and tomatoes.
• Steaming and microwaving vegetables are the best ways to cook vegetables to retain all their top nutrients, flavor and taste. Serve as soon as they are cooked.
• Use fresh foods wherever possible and avoid processed foods. A huge amount of our salt intake (75 per cent) is already in the food we buy.
• Check the label for the salt content of packaged foods and choose foods which contain less than 1.5g salt (0.6g sodium) per 100g. Check for GDAs or traffic light signposting and keep to foods in the green and amber colors most of the time.
• If you only know how much sodium is in a food, multiply this amount by 2.5 to calculate the salt content. For example, 1g of sodium per 100g = 2.5g salt per 100g.
• Try to keep your daily salt intake to below 6g (2.4g sodium).
• Remember: some foods that do not appear to be salty, such as bread and some cereals, can contain large quantities of salt. Check the labels.
• Rock salt and sea salt are still salt and should be avoided. You could use a salt substitute which contains less sodium, to wean yourself off the salt habit.
• Stocks and gravies can be made from salt-free, homemade ingredients, and purée vegetables such as onions, garlic, tomatoes and aubergine with a little wine to make sauces. For speed, ‘diluted’ stocks and gravies can be made by using half the usual quantities of stock cubes or gravy granules.
• Look out for vegetables, fish and beans tinned in water rather than brine or labeled ‘no added salt’ and choose lower-salt varieties of baked beans, bread, yeast extract, bouillon, tomato and soy sauce.
• Feed your sweet tooth with natural sweetness from fresh, tinned, frozen or dried fruit.
• Look out for low-sugar varieties of squash, fizzy drinks, jams and marmalades, jelly, baked beans, tomato sauces and fruit tinned in natural juices.
• Salty and sugary solutions can be removed from tinned produce by rinsing in a colander under the tap.

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The cardioprotective diet should contain moderate amounts of lean meat, fish, dairy foods and eggs. ‘Mediterrasian’ cuisine makes more use of beans, peas and pulses, either as vegetarian dishes or mixed with smaller quantities of meat or fish.

Small amounts of dairy foods are eaten in the cardioprotective diet. Continental cheeses and feta cheese are generally lower in fat, having higher water content, while skimmed-milk products such as yogurt and fromage frais are a popular accompaniment to fresh fruit.

Although eggs contain a significant amount of dietary cholesterol in the yolk, it is the saturated fat content that actually increases blood cholesterol. There are now no recommended limits on how many eggs you should eat, but remember it is a good idea to eat as varied a diet as possible.

Key Action Points

• Eat moderate amounts of protein foods, but perhaps smaller than in the UK traditional diet. Think of the meat or fish as more of a flavor accompaniment to your main meal of starchy carbohydrates and vegetables or salad.
• If half your dinner plate is filled with starchy carbohydrates and two thirds of the other half with vegetables or salad then the final third should be for the protein part of your meal, whether fish or lean meat.
• Trim all visible fat from meat and skin from poultry.
• Choose lower-fat dairy products such as skimmed or semi-skimmed milk, lower-fat cheeses, yogurt and fromage frais.

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People in countries bordering the Mediterranean basin tend to consume a wide variety of starchy carbohydrate foods from wholegrain cereals to vegetables and legumes. All types of bread, pasta, rice, oats, bulghur, tabbouleh, couscous, semolina, gnocchi, potatoes and other fiber-rich vegetables such as legumes are the staple foods in this region. Starchy carbohydrates lend bulk and satisfying power to your food, making it filling but not fattening, as they contain only 4 kcals per gram.

Starchy carbohydrate foods and beans, peas and pulses are the main source of fiber in the diet. Fiber is classed as both insoluble and soluble. Insoluble fiber, found in the outer layer of wholegrain and vegetables, is important for good bowel health. Soluble fiber is mainly found in beans, peas and pulses, oats, rye and most fruits. It forms a gel-like mixture that slows down the digestion of foods, helping to regulate appetite and glucose levels and lower blood cholesterol levels.

Wholegrain such as wheat, corn, oats, barley, rye and rice also contain important cardioprotective nutrients including antioxidants, vitamins and trace elements, namely vitamin E, B vitamins, zinc and selenium.

Different carbohydrates affect the body in different ways and this can be gauged by their ‘glycaemic index’ (GI). Foods with a lower glycaemic index are better for heart health as they take longer to produce a rise in blood glucose, which ultimately improves the lipid profile by increasing HDL cholesterol.

Particularly Low GI Foods are:

• porridge, oats and high-fiber breakfast cereals
• bread with added seeds and grains, rye and pumpernickel
• pasta, noodles, basmati rice, new waxy potatoes, yams and sweet potatoes
• beans, peas and lentils
• traditional English ‘stoned’ fruit (apples, pears, plums, peaches)
• oranges, bananas and grapefruit

Key Action Points to Increase Wholegrain Intake in the Cardioprotective Diet :

• Breakfast cereals, including porridge oats and muesli, are a good way to start the day and can be eaten as a healthy snack at any time.
• Base your meals and snacks around starchy carbohydrate foods by covering half of your dinner plate with potatoes, rice or pasta and accompanying them with a delicious variety of breads.
• Choose from the wide varieties of available breads, especially those with seeds and grains; there is no need to add spread.
• Wholegrain varieties of bread, cereals, pasta and rice make healthy choices, taste better and are also more satisfying.
• The chapatti is bread at its simplest -just flour and water, with no added fat or salt.
• Potatoes eaten in their jackets or new potatoes in their skins are filling not fattening. Top baked potatoes with low-fat natural yogurt, fromage frais, flavored cottage cheese or lower fat spreads rather than butter.

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The World Health Organization and other health bodies have recognized the importance of a diet containing fruit and vegetables. Epidemiological studies have repeatedly shown that populations whose diets include plenty of fruits and vegetables have lower rates of heart disease and cancer than those which don’t. The UK recommendation is for at least five portions (400g) of fruit and vegetables a day where fresh, frozen, dried and tinned all count. On average, people in the UK eat only three portions a day and the National Diet and Nutrition Survey of 4-18-year-olds, published in 2000, found that one in five children ate no fruit.

What counts as a portion?

What counts as a portion?
Apple, orange or banana	1 fruit
Very large fruit, e.g. melon, pineapple	1 large slice
Small fruit, e.g. plums, kiwis, satsumas	2 fruit
Raspberries, strawberries, grapes	1 cup
Fresh fruit salad, stewed or tinned fruit	2-3 tablespoons
Dried fruit	½-1 tablespoon
Fruit juice	1 glass (150ml)
Vegetables, raw, cooked, frozen, or tinned	2 tablespoons
Salad	1 dessert bowl

* 1 portion of fruit or vegetables is roughly the size of your clenched fist.

* Although potatoes are a vegetable they count as a starchy carbohydrate and not as a portion of fruit and vegetables.

Antioxidants

Fruit and vegetables are rich in antioxidants, which work to maintain health and protect us from damage caused by free radicals, which can injure cells and tissues. The body produces free radicals in the normal course of energy production, but certain pollutants (chemicals, smoke, solar radiation) trigger the production of free radicals. LDL cholesterol is vulnerable to oxidation by free-radical attack and oxidized LDL cholesterol is much more toxic and likely to accumulate in the artery wall.

Antioxidants include vitamin E, vitamin C, beta-carotene, selenium and zinc. In addition, some non-nutrient substances have been shown to have strong antioxidant properties, and may play a protective role. These include polyphenols (found in wine, tea and olive oil), organic sulphides (in garlic) and anthocyanins, responsible for the fabulous colors in fruits and vegetables.

Antioxidant Sources

Non-Vitamin Antioxidants

Trace elements and polyphenols are powerful antioxidants and are particularly abundant in the Mediterranean diet because of the high proportion of fruit and vegetables consumed.

Selenium is of particular interest because thee main source of selenium in the UK diet is wheat and hence bread. Since joining the European Market, the UK has imported its wheat from Europe rather than the United States. The wheat from Europe has a lower selenium content than that from the US because of soil conditions and therefore it is important to seek out good sources of selenium in the diet. Three Brazil nuts a day would provide sufficient intake.

In the Mediterranean basin, as a result of the warm climate and the prolonged exposure of crops to sunlight radiation, some plant species such as olives, grapes and dark-colored leaves are particularly abundant in polyphenolic compounds. Polyphenols have applications in folk medicine as antibiotic, anti-diarrhoeal, anti-ulcer and anti-inflammatory agents. Several other diseases, for example, hypertension, have been successfully treated with plant extracts particularly rich in polyphenols.

Researchers have identified more than 5000 flavonoids (a form of polyphenol) in plants, some in fruits, beans, roots and leaves that are eaten as a food or used to make drinks. They are found in considerable quantities in fruit, fruit juices, vegetables, grains, tea, cocoa, red wine and soya.

Chocolate

Scientists have known about the antioxidant activity of polyphenols in chocolate for over fifty years. These are responsible for the excellent keeping qualities of chocolate and for preventing the dairy fats from becoming rancid. There is a growing body of evidence that cocoa flavonoids have cardiovascular health benefits, not only due to their antioxidant effects on LDL cholesterol, but also because of their aspirin-like effects on platelet function, their ability to relax the linings of arteries, their beneficial effects on immune function and their anti-inflammatory role. The quantity of natural flavonoids in chocolate depends on the variety of cocoa bean, the growing conditions, processing and storage. Unfortunately, chocolate also comes with saturated fat, sugar and calories and therefore should be enjoyed only occasionally!

Wine

In France, the incidence of heart disease is remarkably low, despite a diet rich in saturated fat and the presence of other risk factors (such as smoking and high cholesterol levels). This apparent contradiction has been termed ‘the french paradox’ and has been attributed to the possibility that the French custom of drinking wine with meals may provide protection against heart disease.
The protective effects of moderate wine consumption are possibly due to the alcohol-induced increase in high-density lipoprotein (HDL) levels and to the effects of the small amounts of polyphenols found in wine.

Alcohol is, however, a dependency-inducing toxin and drinking above sensible limits is a danger to health. It also supplies extra calories (around 100 kcals per unit) which do not help if you have a weight problem. The Department of Health’s current ‘sensible’ daily limits suggest no more than 2-3 units (see table above) for women and 3-4 units for men. It is both the pattern of drinking and the amount that are important rather than the type of drink. Avoid binge drinking and keep to safe levels of alcohol with some alcohol-free days.

Key Action Points

• Keep to sensible drinking limits (see above) and quench thirst with water.
• Alternate alcoholic with non-alcoholic drinks.
• Drink at least 1.5 liters (6-8 glasses) of fluid each day, which can include tea, coffee, water, fruit juice, soft drinks, etc. (However, no more than six mugs of coffee are recommended because of the caffeine content.)

Olive Oil

Olive oil is the principal source of fat in the Mediterranean diet. The flavor of extra virgin olive oil complements raw vegetables which are generally dressed with olive oil and vinegar (the latter also contains antioxidants). Unlike other oils, olive oil contains phenolic compounds, which provide its unique aroma and taste and have been shown to exert potent beneficial actions. Most vegetable oils are extracted from seeds by solvents, whereas olive oil is obtained from the whole fruit by means of physical pressure, without the use of chemicals. The phenolic fraction in extra virgin olive oil significantly higher than in plain olive oil.

Antioxidant Supplements

Recent clinical trials have confirmed that there seems little benefit in taking individual nutrients such as vitamins E, C or beta-carotene in supplement form.

The advantages may occur only when the antioxidants are part of a cardioprotective diet in which the abundance of bioactive compounds provided by fruit, vegetables, wine and olive oil work together to benefit your heart.

Folic Acid

Fruit and vegetables also supply other protective nutrients such as folic acid. A diet with an adequate supply of folic acid B6 and B12 vitamins helps to reduce the levels of homocysteine in the blood. Homocysteine is produced naturally in the body when protein is metabolized. High homocysteine levels have been associated with heart disease as high levels are toxic and can damage artery walls. Since 1998, the US Food and Drug Administration (FDA) has stipulated that enriched grain products, including breakfast cereals, be fortified with folic acid, although there has been, to date, no such legislation in the UK.

Good sources of folic acid:

• liver
• yeast extract
• green leafy vegetables
• pulses
• oranges

Foods that have been fortified with folic acid, particularly breakfast cereals, are now widely available and can increase significantly total intake.

Legumes

Legumes, such as beans, peas and pulses are good sources of the cholesterol-lowering soluble fiber and are full of cardioprotective nutrients such as arginine, vitamin E, the B vitamins, folic acid and minerals such as calcium, iron and zinc. Vegetarians have been shown to have less risk of heart disease compared to non-vegetarians and this is both because of their diet and also other healthy aspects of their lifestyles. Beans, peas and pulses are low in fat and high in protein and can be used instead of, or combined with, meat or fish. There is a great variety of beans to choose from: chickpeas, borlotti beans, lentils, black-eyed beans, peas and sweetcorn. They can be bought dried, then soaked and cooked in plenty of boiling water (usually for an hour) until soft. Lentils take a much shorter time to cook. Kidney beans release a toxic substance whilst they are being cooked, but as long as they are boiled rapidly for at least 10 minutes at the beginning of the cooking time, this substance is destroyed completely. There is also a great selection of tinned beans which are just as nutritious and available in most stores.

Soya Beans

Soya beans are worth a separate mention as there is emerging evidence that increasing the amount of soya protein in the diet has health benefits for heart disease, cancer, women’s health and osteoporosis. Studies have shown that an intake of 25g per day of soya protein can reduce LDL cholesterol by about 6 per cent. In the USA and UK a health claim has been approved for soya which states that ’25g of soya protein a day as part of a diet low in saturated fat and cholesterol may reduce the risk of heart disease’.

It may be difficult to obtain 25g of soya protein per day, but some substitution of meat and dairy products is certainly possible. The soya bean contains some fat which is mainly polyunsaturated fat containing the essential fatty acids, linoleic and alpha-linolenic acid. Soya beans are a particularly useful source of the plant form of omega-3. In addition to these nutrients, soya beans contain a wealth of phytochemicals. One potent group of phytochemicals called isoflavones is virtually unique to soya. Isoflavones are phytoestrogens with weak oestrogenic effects and Asian populations that regularly eat soya foods have a lower incidence of hormone-dependent cancers – breast, colon and prostate cancers.

Traditional soya foods include soya beans, miso, soya milk, soya oil, soya margarine, soya nuts, soya sauce, tempeh, tofu and tofu products. New-generation soya products include concentrated forms of food ingredients such as soya protein isolate, soya protein concentrate, soya flour and textured soya protein. Soya protein is typically consumed in the UK as soya milk, yogurts, desserts, tofu, mince and vegetarian sausages and in a wide variety of bread and bakery products, e.g. cereal bars.

Nuts

Nuts are an important part of the cardioprotective diet. Recent studies suggest that frequent nut consumption may be protective against heart disease because of the beneficial effects on blood lipids. In clinical studies, diets supplemented with walnuts or almonds decreased levels of LDL cholesterol and total cholesterol. Other valuable constituents include high amounts of vegetable protein, magnesium, copper, vitamin E, folic acid, fiber, potassium and alpha-linolenic acid (principally in walnuts). Although nuts are high in fat, the fat is mostly unsaturated, which has positive effects on blood lipids. Most nuts are rich in arginine, the precursor of nitric oxide, which is important for the maintenance of a healthy lining in the arteries. Coconut is the exception and contains a lot of saturated fat, particularly coconut cream, although coconut milk is lower in fat.

Seeds

Seeds are a valuable source of protein and essential fatty acids. Linseed (or flaxseed), sesame, pumpkin and sunflower seeds are rich sources of omega-3, whilst sesame and sunflower seeds also contain omega-6. All of these seeds are packed with a wealth of vitamins and minerals such as vitamins A, B, D, E and K and folic acid, as well as the minerals calcium, iron, magnesium, selenium and zinc.

Plant Sterols And Stanols

Plant sterols are natural substances, the plant equivalents of cholesterol, and are found in small amounts in vegetable oils, such as sunflower oil, rapeseed oil, soya bean oil, and in cereals, nuts and some vegetables. Stanols are largely derived from tall oil, a by-product of the pine industry. It has been known since the 1950s that sterols and stanols reduce the absorption of cholesterol in the body during digestion but only recently have satisfactory methods for extracting, concentrating and adding them to various foods, such as spreads, soft cheese, yogurt and cereal bars, been developed. Plant sterols and stanols lower cholesterol in the blood by reducing the absorption of cholesterol from the intestine. Clinical trials have shown that 2-2.5g of plant sterols or stanols, taken daily, lower LDL cholesterol by about 10 per cent.

Portfolio Eating Plan

This is a new dietary approach to lowering cholesterol, which combines foods enriched with plant sterols, nuts (almonds), foods containing soluble fiber (oats, beans, pulses and fruits) and soya.

Evidence from clinical trials shows that following this diet plan can lower LDL cholesterol by as much as 29 per cent.

Key Action Points

• Try to eat a wide variety of fruit and vegetables. They can be fresh, frozen or tinned. Fruit juice counts, but only for one portion a day.
• Make the most of the enormous variety of beans, peas and pulses by infusing them with the flavors of olive oil and vegetables such as onions, garlic, tomatoes, aubergines and herbs.
• Try using soya milk, soya yogurts and desserts, traditional soya protein, such as tofu or miso and textured soya protein, as low-fat, cholesterol-lowering alternatives to dairy foods and meat.
• Enjoy a plethora of nuts and seeds in your cereals, salads and main meals. These make truly nutritious snacks, especially when mixed with dried fruit; they are, however, a significant source of calories, so beware if you are watching your weight!
• Try the portfolio dietary approach – add foods enriched with plant sterols/stanols: almonds, oats, beans and pulses, and soya whenever possible to your low fat, high fiber diet.

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Fat Health Benefits

Some fat is important in the diet as it is a provider of concentrated energy, an energy store and necessary for thermal insulation. Fat is also a vehicle for the fat-soluble vitamins A, D, E, and K and the ‘essential’ fats, linoleic and alpha-linolenic acid, which cannot be made in the body. However, we eat too much fat, particularly saturated, which raises blood cholesterol and leads to heart disease. Recommended fat intakes are based on energy needs and physical activity levels. Present guidelines suggest that no more than 30-35 per cent of daily energy intake should come from fat and no more than 10 per cent from saturated fat. The energy needs for an average woman and man are 2000 and 2500 kcals per day respectively.

Three Types of Fat -  Saturated, Monounsaturated and Polyunsaturated

In addition, some fats are more beneficial than others. There are three main types of fat in food – saturated, monounsaturated and polyunsaturated. All fatty foods are made up from a mixture of the three but are classified according to the type of fat present in the largest amount. Saturated fats are found mostly in animal products and most are solid at room temperature; palm oil and coconut oil are non-animal and non-solid saturated fats. Monounsaturated fats are found in olive and rapeseed oils and in spreads made from them. Polyunsaturated fats, often liquid at room temperature, are found in vegetable oils, such as sunflower, safflower, and in spreads made from them, as well as cereals, nuts and seeds.

Saturated Fat

Foods high in saturated fat are found mainly in meat and dairy produce and are the major influence on the level of cholesterol in the blood. Cholesterol is made in the liver and the amount produced is directly related to the amount of saturated fat in the diet. The more saturated fat we eat, the higher our blood cholesterol. On the other hand, foods which contain cholesterol have very little influence on blood cholesterol, even cholesterol-rich foods such as egg yolks, liver, sweetbreads, prawns and shellfish. This is because these foods contain relatively little saturated fat, and not all of the cholesterol is absorbed anyway. This means that the most important thing to look out for is the saturated fat content.

Trans fats are found in certain foods in small amounts and behave much like saturated fats. They are found naturally in small amounts in meat and dairy products but they are also formed when vegetable oils are hydrogenated to make solid fats for processed foods such as cakes, biscuits, pastries and fast foods.

Types of Fat	Main Sources	Effect on Risk Factors
Saturated fats	Fatty meats and meat products, lard, dripping, suet, dairy products such as whole milk, cream, butter and cheese. Coconut oil, palm kernel oil and palm oil used in convenience foods, cakes, biscuits, etc.	Raise cholesterol
Trans fats	Found in small amounts in the fat of dairy products and some meats but mainly in hydrogenated vegetable oils and in prepared foods such as biscuits, etc.	Raise cholesterol

Monounsaturated Fat

When monounsaturated fat is used in place of saturated fat, blood cholesterol levels are lowered. Olive oil, a basic constituent of the Mediterranean diet, is rich in monounsaturates. In addition it is rich in antioxidants and contains a substance called squalene which has anti-inflammatory properties, slows blood clot formation and lowers cholesterol. Another good monounsaturated oil to use is rapeseed oil (canola), which is the oil used for most vegetable oils (always check the label).

Types of Fat	Main Sources	Effect on Risk Factors
Monounsaturated fats	Olive oil, rapeseed oil (canola), peanut or groundnut oil, nuts and nut spreads, avocados	Lower cholesterol when used instead of saturated fat

Monounsaturated fatty acids are particularly beneficial as their chemical nature makes them resistant to oxidative changes. Olive oil has remarkable stability and can be stored for eighteen months and more. This resistance to the development of rancidity is combined with a marvelous variety of flavors and colors, allowing for a range of culinary applications with little or no processing. A simple traditional salad dressing can be created instantly by combining olive oil and fresh lemon juice, which creates a rich source of both lipid-soluble and water-soluble vitamins.

In salads or in cooking, olive oil is usually mixed with herbs and spices, which are also important elements of the cardioprotective diet. Herbs like oregano, rosemary and thyme are rich sources of phenolic compounds with strong antioxidant activity. These herbs maintain the nutritional value of the food and enhance the shelf life of the product.

Polyunsaturated Fats – Omega-6 and Omega-3

There are two main families of polyunsaturated fatty acids: the omega-6 family, which are derived from the essential fatty acid linoleic acid, and the omega-3 family derived from the essential fatty acid, alpha-linolenic acid. Omega-6 are found mainly in seed oils and polyunsaturated spreads. Omega-3 are found in oily fish (marine sources) and in some seed oils and vegetables (plant sources).

Both omega-6 and omega-3 reduce the risk of heart attacks but have different and important biological effects. Omega-6 lower blood cholesterol levels whilst marine omega-3 reduce the risk of blood clots and inflammation and also prevent abnormal heart rhythms. Marine omega-3 may also exert a beneficial effect on blood pressure and lower blood triglyceride levels. Both omega-6 and omega-3 are important ‘good’ fats and many of us could eat more for optimal heart health. Most of us do not eat enough omega-3s, possibly because high amounts of omega-3 are found in relatively few foods. Oily fish is the richest source of the long-chain omega-3 fatty acids – eicosapentanoic acid (EPA) and docosahexanoic acid (DHA).

Types of Fat	Main Sources	Effect on Risk Factors
Omega-6	Vegetable oils such as sunflower, safflower, soya, corn oil and spreads	Lowers blood cholesterol
Omega-3 plant sources	Flaxseeds and oil (linseed), rapeseed (canola), soya oil, walnut oil and walnuts, green leafy vegetables	Lowers blood cholesterol
Omega-3 marine sources	Oily fish	Reduces thrombosis, inflammation and fatal arrhythmias. May reduce blood pressure and triglycerides

Fish

One of the most extraordinary nutrition revelations in recent years has been the role of fish in preventing heart disease. Studies have shown that eating fish can avert potentially fatal disruption of heart rhythms and reduce the thickness and stickiness of the blood, which in turn means less chance of a blood clot and the start of a heart attack. There is a lower incidence of heart attacks among people who eat fish regularly, such as the Japanese and Greenland Inuits, than among non-fish eaters. The Food Standards Agency advises eating two servings of fish per week, one of which should be oil-rich. It is recommended that people who have already suffered a heart attack eat two to three medium servings of oil-rich fish per week or take a daily fish oil supplement of 1g EPA and DHA. For vegetarians DHA produced by algae can be bought as a supplement.

Types of fat in oil-rich fish	Omega-3 (grams per average portion)
Mackerel	4.5
Kipper	3.7
Fresh tuna	3.0
Trout	2.9
Kipper (tinned)	2.7
Salmon	2.5
Herring (pickled)	2.2
Pilchards (tinned in brine or tomato sauce)	1.8
Salmon (pink or red, tinned)	1.4
Smoked salmon	1.3
Mackerel (tinned in sauce or oil)	1.3
Sardines (tinned)	1.2
Swordfish	1.1
Tuna (tinned in oil)	0.7
Crab (tinned in brine)	0.6
Cod	0.3
Tuna (tinned in brine)	0.1

The amount of omega-3 in fish varies according to the seasons, and whether fish is wild or farmed.

Plant Sources Of Omega-3

Alpha-linolenic acid, the plant source of omega-3 is found in some seed oils, for example, linseed, rapeseed and soya, and in some nuts (particularly walnuts) and green leafy vegetables. The body can synthesize longer-chain EPA and DHA from alpha-linolenic acid but the conversion rate is slow. Therefore it is important to eat both fish and plant sources of omega-3 to increase the amount of omega-3 in our diet.

Plant Sources Of Omega-3 Fatty Acids (Alpha-Linolenic Acid)

Plant sources of omega-3 fatty acids (alpha-linolenic acid)	Omega-3 (grams per average portion)
Flaxseed and flaxseed oil (linseeds and linseed oil)	1.8
Walnuts	1.5
Walnut oil	1.3
Rapeseed oil	1.0
Soya oil	0.8
Vegetable oil, blended	0.7
Soya margarine	0.2
Baked beans	0.2
Spinach and leafy green	0.2
Spinach and leafy green vegetables of all kinds	0.2
Peanuts	0.2
Corn oil	0.1
Olive oil	0.08
Bread rolls (white or wholemeal)	0.08
Almonds	0.04
Sweet potatoes	0.04
Green peppers	0.02

Less Heart Attacks and Coronary Deaths in Mediterranean Countries

In the 1960s, Dr Ancel Keys, an American epidemiologist, and his colleagues examined the relationship between diet and heart disease rates in seven countries and found that people who lived along the Mediterranean Sea suffered only a tiny fraction of the heart attacks and coronary deaths experienced by Americans and people in Western industrialized countries. The dietary fat consumed by Mediterranean people was mostly of vegetable origin in contrast to diets rich in highly saturated animal fats from meat and dairy products consumed in other countries.

Mediterranean Diet – Epitome of Cardioprotective Diet

The population of Crete has the lowest rate of death from heart disease and the longest life expectancy of all the Mediterranean countries. A Cretan diet is rich in legumes, fruits, vegetables, olive oil and red wine. The diet is also high in alpha-linolenic acid from wild plants, legumes, walnuts, figs and snails and much lower in linoleic acid than other Mediterranean diets. Interestingly, in terms of the essential fatty acid and antioxidant content, the diet of Crete is similar to the Palaeolithic diet with which humans evolved over tens of thousands of years ago.

The term ‘Mediterranean diet’ was coined in the cookbook How to Eat Well and Stay Well, the Mediterranean Way written by Ancel and Margaret Keys in the late 1950s, promoting the delicious foods that happen to protect against heart disease and several common cancers.

The Mediterranean diet has now come to epitomize the cardioprotective diet. Other cultures have evolved diets of similar nutritional composition and they also have low rates of heart disease. The cuisines of many Asian countries provide such examples and experts have coined the phrase the ‘Mediterrasian’ diet.

What are the Characteristics of A Cardioprotective Diet?

• Low in saturated fat
• High in monounsaturate (mainly olive oil)
• Rich in omega-6 and omega-3 polyunsaturates
• Plenty of fruits and vegetables; rich in cardioprotective nutrients
• High in wholegrain cereals, vegetables and legumes
• Moderate amounts of lean meat, fish, dairy foods and eggs

Energy Requirements of A Heart Healthy Diets

Energy Intake in Calories	Total Fat (in grams)	Saturated Fat (in grams)
2000	73	22
2500	92	28
2500	92	28

(Explanation of calculations: the percentage of energy derived from fat is 33 per cent of 2500, i.e. 825 kcals. There are 9 kcals in each gram of fat, so this equates to 825/9 = 92g of fat).

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Lifestyle Changes for A Healthy Heart

Healthy Eating for Your Heart is just one part of a complementary lifestyle approach towards better health – to help you get in shape, feel fitter and have more energy. You can make it easy for yourself by making changes gradually, rather than all at once. You’ll be surprised by how even the smallest of changes can make a difference.

Balanced Diet for Healthy Eating

When it comes to eating, a balanced approach is the best – there are no good or bad foods and you can still enjoy the odd indulgence from time to time, guilt-free, provided that for the majority of time you eat:

• plenty of fruit and vegetables including legumes, nuts and seeds
• plenty of bread and other cereals (like pasta, rice) and potatoes
• moderate amounts of milk and dairy foods, low-fat where possible
• moderate amounts of lean meat and fish
• small amounts of fatty and sugary foods

Not smoking and taking plenty of physical activity are also part of this lifestyle package. If you enjoy keeping active and follow the key messages above, you will manage your weight and feel all the better for being in control.

Weight Management for Healthy Lifestyles

The concept is easy, the practice harder! Energy taken ‘in’ from the food we eat each day should equal the energy we expend ‘out’ in the energy needs of our body and in our daily physical activity. If our ‘energy in’ is greater than our ‘energy out’, this will result in weight gain. Our energy balance is so fine that it only takes an extra biscuit each day to gain 2kg in a year! We also have to eat 3500 calories less to lose 0.5kg and that is why losing weight is so difficult. It is much better to lose weight slowly – 0.5 – 1 kg per week – and maintain the weight loss than to do crash dieting only to regain the weight quickly, then diet again. Following the healthy lifestyle advice in this blog will help you to make the changes necessary to control your weight for good, by eating a cardioprotective diet and taking more physical activity.

Feeding the Family – Instill Good Eating Habits in Children from Young

We all want to give our children the best possible start in life. Making the best food choices for our children helps them to form good eating habits and attitudes to food that will influence their tastes and well-being far into the future.

Key Action Points to Instill Good Eating Habits in Children from Young

• Get your children involved with choosing, planning and preparing meals and in shopping.
• Hands-on cooking with children encourages a love of food and cooking and can be fun too.
• Just cook one meal for the whole family which you can enjoy eating all together.
• Always serve vegetables, bread and water with your meal.
• Keep the fruit bowl well stocked with a variety of fresh produce to eat whenever you feel peckish.
• Try new foods with old favorites.
  

Adapting Traditional Family Recipes to Health Diets

• Reduce the amount of fat used.
• Change the type of fat by using a monounsaturated or polyunsaturated variety.
• Cut out the salt.
• Reduce the amount of meat and add more legumes.
• Replace pastry in pies with mashed potatoes, e.g. shepherd’s pie.
• Reduce the amount of sugar used; sweeten instead with dried fruit or fruit juice.
• Use yogurt or fromage frais instead of cream.
• Use half-fat cheese or smaller quantities of stronger cheeses, e.g. Parmesan.
• Grating cheese makes it go further.
• Instead of high-fat roux-based sauces, make sauces with cornflour and skimmed milk; flavor with mustard and black pepper.

Remember that forming good eating habits is just part of a lifestyle package and encouraging children to be more active and not to smoke is equally important. Living together in a pro-active environment and teaching by example is an invaluable lesson.

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Physical Activity Reduces Heart Risk Factors

Many people take no physical activity during a typical week. Physical inactivity roughly doubles the risk of heart disease and is a major risk factor for stroke. Accumulating evidence suggests that regular activity such as brisk walking, cycling, dancing or gardening are useful for the prevention and treatment of heart disease, stroke, diabetes, obesity and osteoporosis. Recent research also suggests that even everyday movement results in other benefits including cushioning the effects of stress, alleviating and preventing depression, reducing levels of anxiety and improving self-esteem.

How Continual Stress is Bad for Your Heart?

Continual stress is bad for your heart as it increases the level of epinephrine in the blood. This in turn makes the blood thicker and stickier and can eventually cause the arteries to narrow and thicken. Continual stress may also cause high blood pressure. Therefore it is very important that you find time each day to relax and unwind.

What is the Recommended Exercise Program for A Healthy Heart?

It is recommended that you should walk, cycle or swim for 30 minutes on at least five days of the week and if you don’t have 30 minutes to spare, try to do 15 minutes twice or 10 minutes three times a day. Such activities should leave you feeling warm and slightly out of breath.

Take it slowly at first, there is no need to exhaust yourself. Walking is a great exercise to start with as it provides all the exercise your heart needs and you can build it up gradually, increasing the distance and pace little by little. Remember to take things gradually at first if you are not used to physical activity and consult a doctor if you have health concerns before starting an exercise program.

Pairing Physical Exercise and Health Diets for Optimum Heart Health

The results will be optimum if physical activity goes parallel with health diets. However, understanding how to eat well is now a major concern for many people. Hence Healthy Easy Food Recipes website offers a wide selection of delicious and nutritious recipes designed for optimum health benefits. Check these healthy recipes collection out!

Twice Heart Risk Factors for Smokers

Smoking is a major cause of heart disease. People who smoke cigarettes have twice the risk of developing heart disease than non-smokers since it contributes to the building up of fatty deposits in the arteries. Smoking causes around a 25,000 deaths from cardiovascular disease each year. It has been calculated that each cigarette smoked reduces your life by 11 minutes.

The good news is that stopping smoking carries an almost immediate benefit and the risks of smoking reduce progressively after stopping. If you smoke, you should get help to quit! Even passive smoking increases the risk of heart disease by 25 per cent. Smoking also increases the risk of cancer and lung disease.

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Obesity and Heart Disease

Obesity rates have trebled in the past twenty years, and if current trends continue, 9 out of 10 adults and two-thirds of children will be overweight or obese by 2050. Obesity is related to other risk factors for heart disease – higher blood pressure, higher blood cholesterol levels and increased risk of Type 2 diabetes. The good news is that even modest weight loss (5-10 per cent of initial weight) is linked to significant health benefits.

Links Between Body Shape and Heart Disease. Are You Apple-Shaped or Pear-Shaped?

It is not just being overweight that is the problem, but where the weight is deposited. There is an association between body shape and heart disease, such that people who are ‘pear-shaped’, with fat deposited over their hips and thighs, seem to be at much lower risk than those who are ‘apple-shaped’ with fat carried around the front, like a ‘pot’ or ‘beer’ belly. Fat cells deposited over the abdomen make the body more insulin resistant, resulting in a classic clustering of risk factors, called the insulin-resistance syndrome. More insulin is produced, which increases the tendency to diabetes, increases blood pressure, cholesterol and triglycerides, lowers HDL cholesterol and increases the tendency for the blood to form clots. Health professionals are increasingly using waist measurement rather than weight to identify people at risk of heart disease. Check your own shape by measuring your waist with a tape measure (midway between the lowest ribs and top of the hip-bone – for many people this will be around the naval or tummy button).

Ideal Waist Measurement for A Healthy Person

Ideal Waist Measurement for		Increased risk – your health could suffer. Don’t put on more weight.	Substantial risk – your health is at risk. Seek advice on losing weight.
Women	Less than 80cm	More than 80cm	More than 88cm
Men	Less than 94cm	More than 94cm	More than 102cm
Asian men	Less than 90cm	More than 90cm

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