Diet

There has been a lot of talk about diet, both in this book and in the media in general, about the importance of good, healthy eating to keep your heart in good shape. The questions below will answer, I hope, all the questions that you may have about food types, a healthy diet and losing weight. When we use the word 'diet' we do not mean crash diets to lose weight, but adopting a healthy lifestyle with balanced nutrition, which is far more important and safer.

In the past, many doctors have doubted the importance of lowering cholesterol, and have in many ways hindered the management and prevention of coronary artery disease. We now have overwhelming evidence that a high cholesterol causes coronary disease, and that lowering it encourages heart health and prevents the consequences of coronary disease by reducing heart attacks and the need for surgery or angioplasty. Fears that lowering cholesterol simply meant that you died just as soon but from something else have been totally disproved and the evidence accumulates daily to support the view that not only do people have less heart disease but they live better lives for longer. If you stop smoking, you will reduce your chances of lung cancer and heart disease; if you reduce your cholesterol you will reduce your chances of heart disease and stroke.

Eating healthily does not mean a boring diet. As the British Heart Foundation puts it 'Food should be fun' and can be healthy too. It's all about avoiding a premature death.

FOOD TYPES AND EATING HEALTHILY

Fats

Fats or lipids are discussed fully in Chapter 2 in the section Risks of high cholesterol levels. We discuss here what types of food are involved. Remember that fats are divided into saturated and unsaturated types and most foods contain a combination. The proportion varies depending on the food chosen.

Saturated fats are mainly of animal origin. They are usually hard at room temperature. They can also be found in some vegetable fats. Too much saturated fat can be bad for the heart and it is the saturated fat that raises cholesterol. They are found in:

• red meat;

• butter, milk, cheese, cream;

• suet and lard;

• some vegetable fats, especially coconut and palm oil;

• cakes, biscuits;

• chocolate; and

• most puddings.

Unsaturated fats are mainly of vegetable origin. They are liquid or soft solids at room temperature. There are two types:

• polyunsaturated, found in sunflower oil, soft margarines labelled 'high in polyunsaturates'; these fats can lower cholesterol;

• monounsaturates, found in olive and rapeseed oil.

Table 9.1 Content of omega-3 polyunsaturated fatty acids in oily fish

I have read that fish oil is very good for you. Can you tell me about this?

Oily fish contain a particular type of polyunsaturated fat (omega-3 fatty acid) and this has been shown to help prevent coronary disease partly by thinning the blood. Table 9.1 shows the healthiest fish to eat.

It is best to avoid potted prawns, rich fish pâtés and fish roe as these are rich in saturated fat.

Shellfish contain higher levels of cholesterol but are low in saturated fat and may therefore be eaten in moderation - once or twice a week. Examples of shellfish are:

• cockles, mussels, whelks;

• shrimps, prawns, lobster;

• squid.

Fish oils can also be taken in the form of capsules. Oily fish have a particularly good effect in reducing triglycerides (see the section Risks of high cholesterol levels in Chapter 2), but some capsule preparations are high in calories, so be careful to check the label. Because of this, they have been known to upset people with diabetes and reduce the success of watching your weight. It is best to get your fish oil the natural way by regularly eating fish.

Omacor, a fish oil preparation, in addition to its benefit of reducing triglycerides, may be beneficial after a heart attack if added to statin therapy. The recommended dose is 1 g daily with food, and up to 4 capsules daily for raised triglycerides.