Heart Healthy Diet

Heart Healthy Diet – The Basics

All the requirements and recommendations for nutrients and food components can make achieving a heart healthy diet seem like an impossible task. But take heart: making your diet healthier can be boiled down to just a few simple rules to keep in mind when shopping for food and making meal choices. Although changing the way you eat can be a big challenge, the stakes are high: eating an unhealthy Western-style diet increases a woman’s risk of developing heart disease by 46%.

It is generally agreed that a healthy diet should include a variety of fruits and vegetables, grains (particularly whole grains), fat-free and low-fat dairy products, fish, legumes (e.g., lentils, chickpeas, soybeans), poultry, and lean meats. This type of diet meets recommendations by the American Heart Association, the American Diabetes Association, and the 2005 Dietary Guidelines for Americans.

The above guidelines recommend dietary steps to take for general heart health. If you have major risk factors such as high blood pressure or high cholesterol, you may need to do more.

The Mediterranean Diet

What is the Mediterranean diet?

People from Mediterranean countries (e.g., Greece, Southern Italy, France, Spain) have lower rates of heart disease than Americans. This led researchers to look at the differences in diet. The Mediterranean diet is not a single diet, but rather a pattern of eating that includes the following:

  • Lots of fruits, vegetables, bread, and other cereals, beans, nuts and seeds
  • Olive oil
  • Dairy products, fish and poultry in low to moderate amounts, and little red meat
  • Wine in low to moderate amounts
  • Although potatoes and eggs are part of the traditional Mediterranean diet, they are not usually counted as heart-healthy foods because there is no evidence that they lower your risk of heart disease.

Does the Mediterranean diet lower your risk of heart disease and stroke?

Yes. A Study of 74,886 healthy women from the Nurse’s Health Study found that women who stuck to the Mediterranean diet had a 30% lower risk of heart disease and stroke over the course of 20 years, compared with women who ate a less healthy diet. The closer a woman adhered to the ideal Mediterranean diet, the lower her risk of heart disease-related death.

The Meditteranean diet also reduces your risk of dying early overall. Researchers asked more than 22,000 Greek adults aged 20 to 86 years (60% were women) to fill out food questionnaires that were then scored (0 to 9) for how closely they followed the traditional Mediterranean diet. Nearly 4 years later, the men and women who ate a Mediterranean-style diet were less likely to die from any cause (including heart disease and cancer) than those who did not eat a traditional diet. Another study of nearly 75,000 people (67% were women) older than 60 years from 9 European countries showed that they too benefited from eating a Mediterranean diet.

Does a Mediterranean diet help people with heart disease?

Yes. The Lyon Heart Study included more than 600 heart attack patients and instructed half of them to follow a Mediterranean diet. Those who ate the Mediterranean diet were 70% less likely to suffer another heart attack or die from heart disease after just over 2 years. The study was stopped early for ethical reasons so that all of the patients could learn about the benefits of a Mediterranean diet.

Another study followed more than 1,300 Greek men and women with heart disease for almost 4 years and scored their diets for how closely they followed a traditional Mediterranean diet. A higher score reduced the risk of dying by 27% and the risk of dying from heart disease specifically by 31%.

Neither of these studies could show that any single part of the diet (fruits, vegetables, fish, cereal, legumes, or moderate alcohol) was better than any other for lowering heart disease risk.

Low-Fat Diets

Are low-fat diets good or bad?

When it comes to heart disease, the amount of fat in your diet is less important than the type of fat.10 This is because the total amount of fat doesn’t increase your LDL (bad) cholesterol; however, saturated fat (found in meat and dairy products) and trans fat (found in hydrogenated/partially hydrogenated oils) do. In the past, health advice was to cut down on fat. It was thought that people would find this easier to follow than trying to figure out the different types of fat. If you cut down on fat, you invariably lower your saturated fat intake, too. However, if you eat very little fat and fill up on carbohydrates (especially refined carbs), you can end up with high levels of triglycerides—another type of blood fat that raises your risk of heart disease—and lower levels of HDL (good) cholesterol. These negative effects don’t occur if the low-fat, high-carbohydrate diet is rich in fiber, part of a lifestyle that includes vigorous physical activity, or when the fat is mostly monounsaturated.

The lesson learned is that telling people to cut the fat doesn’t cut it. People need more specific advice about the types of fats and foods to include in their diet. The Dietary Guidelines for Americans recommend that you get at least 20% of calories from fat. If you go lower, it’s hard to get enough of some nutrients, notably vitamin E and the essential polyunsaturated fat, alpha- linoleic acid (ALA). A diet with 20% of calories from fat can contain enough vitamin E and ALA if it includes foods that are good sources of these nutrients, such as certain liquid vegetable oils (soybean oil, corn oil).

Will a low-fat diet reduce my risk of heart disease?

The Women’s Health Initiative Dietary Modification Trial took nearly 50,000 women aged 50 to 79 years and gave half extensive nutrition counseling to follow a low-fat diet (20% of calories from fat). Those who ate the low-fat diet reduced their LDL (bad) cholesterol levels as well as their blood pressure, but they did not lower their risk of heart disease, heart attack, or stroke.

The results of this study are not as surprising as they first appear when you realize that most dietary guidelines now emphasize the type of fat rather than the amount of fat. Looking at the results more closely, the women who ate a diet low in saturated or trans fat did reduce their risk of heart disease by a small but non-significant amount. Saturated fats (found in meat and dairy products) and trans fats (found in hydrogenated/partially hydrogenated oils) raise levels of LDL (bad) cholesterol. Women who included lots of fruits and vegetables also seemed to benefit.

The findings support the general consensus that your overall diet is more important than one component (the fat content or a single food). The low-fat diet in this study would not meet current recommendations for healthy eating that emphasize whole grains, fresh fruits and vegetables, and fish.

Are high-carb diets bad?

No. High-carb diets have been blamed for everything from the obesity epidemic to diabetes. As with fat, it seems that the amount of carbohydrate is less important than the type. Aim for carbohydrates that are whole grains and high in fiber. Whole grain and fiber are better for identifying good carbs than the old style of labeling them simple or complex. Another myth about high-carb diets is that they pack on the pounds. Of the 50,000 women enrolled in the Women’s Health Initiative dietary modification trial, half were told to cut down on fat. Women who ate less fat and more carbs actually lost weight even though they weren’t told to cut calories–these women were encouraged to eat whole grain foods. You may gain weight if you eat a lot of refined carbohydrates (sweet foods and drinks, white rice, white bread) even if your overall diet is not a high-carb diet. There is also no connection between the amount of carbohydrates you eat and your risk of diabetes.

Fat & Cholesterol

How much fat can I eat?

Although the total amount of fat in your diet doesn’t increase your LDL (bad) cholesterol level, it is best not to go higher than 35% of calories from fat–even if this is mostly good fats. Fat has more calories per gram than protein or carbohydrates (9 compared with about 4) making it likely that you will eat too many calories (and gain weight) if you eat a lot of fat. It is also difficult to stay within the limits for saturated fat and dietary cholesterol when you eat a high-fat diet.

How much fat do Americans eat?

The average American diet contains 33% of calories from fat. About 25% of Americans eat too much fat (more than 35% of calories) and fewer than 5% eat a low-fat diet (less than 20% of calories from fat). As a percentage of daily calories, fat intake decreased from an average of 36% in the early 1970s to 33% in 1999-2000. However, the actual amount of fat eaten per day increased from 73 grams (1989-1991) to 76 grams in the 1990s. This is because we are eating more calories now. The latest figures available show that Americans on average eat 81 grams of fat per day (67 g for women and 97 g for men).

What is saturated fat?

Saturated fat is found mostly in meats and dairy products (unless they’re nonfat) and tropical oils (coconut and palm oil). Diets with higher amounts of saturated fat increase your risk of heart disease. Among more than 80,000 women in the Nurses’ Health Study aged 34 to 59 years, those with the highest amounts of saturated fats in their diet had a 16% higher risk of heart disease than women with the lowest intakes. This is largely because saturated fats increase LDL (bad) cholesterol levels.

The various saturated fats differ in their cholesterol-raising effects; for example, stearic acid does not increase LDL cholesterol levels. However, most foods that contain saturated fats have a mix, so it’s difficult to eat one type without consuming the others.

How much saturated fat can I eat?

The 2006 dietary guidelines from the American Heart Association tightened the limit for saturated fat to less than 7% of daily calories. This is stricter than the target listed in the Dietary Guidelines for Americans (less than 10% of your daily calories) and was previously reserved for people who already had heart disease or high cholesterol. Most Americans get more than 10% of calories from saturated fat. On average, Americans eat 28 grams of saturated fat per day (23 g for women and 33 g for men) making up about 11% of calories. Rather than counting calories, the AHA advises that you limit saturated fat by making healthier choices.

What are trans fats?

Trans fats are a type of unsaturated fat. Most unsaturated fats lower your risk of heart disease, but trans fats are the exception. They are made through the hydrogenation of unsaturated fats, a process used to improve the shelf life and flavor of fats and oils that essentially turns healthy fats into unhealthy ones. Trans fats are found in foods containing hydrogenated/partially hydrogenated vegetable oils such as cookies, crackers, other baked goods, commercially prepared fried foods, and some margarines.

Trans fats are worse than saturated fats because in addition to raising LDL (bad) cholesterol, they also lower HDL (good) cholesterol and increase lipoprotein (a)—another type of LDL that raises your risk of heart disease. Studies show that the more trans fats in your diet, the higher your risk of heart disease. The Nurses’ Health Study included more than 80,000 women and found that those with the highest amounts of trans fats in their diet had a 27% higher risk of heart disease than women with the lowest amounts.

How much trans fats can I eat?It’s best to try and avoid commercial trans fats altogether; small amounts of trans fats are found naturally in some meat and dairy. About 80% of the trans fat in American diets comes from commercial sources. The average intake is 2.6% of total calories compared with a recommended limit of less than 1%. Since January 2006, trans fats have been listed on food nutrition labels and some city health agencies are urging restaurants to stop using them. Foods can claim to have 0 grams of trans fat if they have less than 0.5 grams per serving, so watch your portions. To see if a food is truly trans-fat-free, check ingredients labels for hydrogenated/partially hydrogentated fats and oils.

Is the amount of cholesterol in my diet important?

Yes. The more cholesterol you eat, the higher your blood levels of cholesterol. Increasing the amount of cholesterol you eat by 100 milligrams per day raises blood cholesterol, particularly your LDL (bad) cholesterol, by about 2 to 3 milligrams per deciliter of blood (mg/dL). However, people vary widely in how they respond to dietary cholesterol, and it doesn’t raise blood cholesterol as much as saturated fat and trans fat. This is why some studies fail to show a connection between higher amounts of dietary cholesterol and heart disease risk.

Is it OK to eat eggs or other foods that contain cholesterol?

Eggs account for about one third of the cholesterol in the US diet one large egg has about 213 milligrams of cholesterol.31 Other sources are animal and dairy products, meat, poultry, shellfish (particularly shrimp). Eggs do not increase your risk of heart disease because unlike most other sources of cholesterol, eggs (and shellfish) are low in saturated fat. The Nurses’ Health Study followed more than 80,000 women for 14 years and found no difference in heart disease rates for women who ate less than 1 egg per week compared with those who ate 1 or more per day. A large study in men also found no risk from eating eggs. That said, some people are more sensitive to dietary cholesterol than others. The Nurses’ study and others hinted at an increased risk of heart disease in women with diabetes who ate a lot of eggs. For most people, moderate amounts of eggs (2 per week) and shellfish can be incorporated into a heart healthy diet.

How much cholesterol can I eat?

Healthy eating guidelines set a limit of 300 milligrams of dietary cholesterol per day for most people and 200 milligrams if you have heart disease or high cholesterol. The amount of cholesterol in the US diet fell in the past 40 years, but is steadily rising. On average, American women eat 242 milligrams and men eat 341 milligrams of cholesterol per day.

What are unsaturated fats?

Unsaturated fats are healthy alternatives to saturated and trans fats. People who eat diets high in unsaturated fats have lower rates of heart disease.

There are 2 types of unsaturated fats: polyunsaturated fats and monounsaturated fats.

What are polyunsaturated fats?

There are 2 types of polyunsaturated fats: omega-6 and omega-3 fatty acids. The omega-6 fatty acids (e.g., linoleic acid) are found mostly in vegetable oils such as soybean oil, corn oil, and safflower oil. The omega-3 fatty acids include alpha-linoleic acid (ALA) found in flaxseeds, walnuts, canola (rapeseed) oil, soybeans and soybean oil, and the fish oils eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Oily fish such as mackerel, salmon, tuna, and trout have much higher levels of EPA and DHA than lean fish such as cod, haddock, or flounder.

Overall, polyunsaturated fats lower your risk of heart disease. Of the nearly 80,000 women enrolled in the Nurses’ Health Study, those who ate the highest amounts of polyunsaturated fatty acids cut their risk of heart disease by 25% compared with women with the lowest intakes after 20 years. Women under 65 years seemed to benefit most.

Do fish oils lower my risk of heart disease?

Studies show that eating a diet rich in fish oils can reduce the risk of a heart attack or dying from heart disease in people who have already had a heart attack. In September 2004, the Food and Drug Administration (FDA) allowed health claims on foods containing the omega-3 fatty acids found in fish (EPA and DHA) noting that they may reduce the risk of heart disease. The other omega-3 fatty acid, ALA, may also lower the risk of heart problems particularly in people who do not eat much fish.

What about mercury in fish?

All fish contain traces of mercury; some types of fish contain more mercury than others. For most people, the risk of ingesting mercury by eating fish is not a health concern. Mercury in fish poses a slight risk to women who may become pregnant, pregnant women, nursing mothers, and young children. For these groups, the FDA advises avoiding fish that are high in mercury, such as shark, swordfish, king mackerel, or tilefish. Other more common fish—including salmon, cod, canned light tuna, and flounder are safe to eat twice a week (12 ounces total). Albacore “white” tuna should only be eaten once a week (6 ounces) at most because its mercury content is slightly higher. The FDA has prepared a fact sheet with more information on mercury in fish.

Do omega-6 fatty acids lower my risk of heart disease?

It is not clear whether omega-6 fatty acids lower your risk for heart disease or if they have a neutral effect on health. It was thought that these fatty acids may counter the heart health benefits of omega-3 fatty acids, and it was advised that you eat twice as much omega-3 fatty acids as omega-6 fatty acids (a dietary ratio of omega-3 to omega-6 of 2 to 1). Research has shown, though, that omega-6 fatty acids probably have no effect on the benefits of omega-3 fatty acids. While there is no evidence that omega-6 fatty acids are harmful, researchers caution that there is little information about very high intakes (more than 10% of calories).

How much polyunsaturated fats and fish should I eat?

All polyunsaturated fats are a healthy alternative to saturated fat. When they are substituted for saturated fats, blood cholesterol levels improve. You can get up to 10% of your calories from polyunsaturates; currently, they account for about 7% of total calories in the average American diet.

You should eat at least 2 servings (about 8 ounces) of fish, preferably oily fish, a week. For most people, oily fish is preferred to fish oil supplements because most of the research supporting EPA and DHA was for fish consumption, not pills. In addition, fish is low in calories and saturated fat making it a healthy alternative source of protein and nutrients. Make sure you don’t undo the good when preparing the fish–grill, bake, or poach, and avoid cream sauces. Women who have been diagnosed with heart disease or those at high risk should aim for 1 g of EPA and DHA per day; ask your physician if you need supplements. For people with high levels of triglycerides a type of blood fat that raises your risk of heart disease a 2-4 gram daily dose of EPA and DHA as capsules is recommended.
Americans consume 2.92 ounces of fish per week, on average. Tuna is our favorite fish (22%), followed by shrimp (16%) and salmon (9%).

What are monounsaturated fats?

Monounsaturated fats are found in fats and oils (e.g., canola, olive, sunflower), nuts and nut butters, peanuts, avocado, olives, sesame seeds, and tahini. A diet that is high in monounsaturated fats and rich in fruits and vegetables (such as the Mediterranean diet) lowers your risk of heart disease. A diet high in monounsaturated fat and low in saturated fat improves cholesterol levels more than a low-fat, high-carbohydrate diet. This is because the monounsaturated fat diet lowers LDL (bad) cholesterol without lowering HDL (good) cholesterol, and it also lowers triglycerides another type of blood fat that raises your risk of heart disease. You don’t have to cut the carbs to benefit: if you replace the saturated fat in your diet with monounsaturated fat, blood levels of cholesterol and triglycerides improve and so does insulin sensitivity an important risk factor for diabetes even when you eat the same amount of carbs.

Do diets high in monounsaturated fats help people with diabetes?

There is some evidence that diets high in monounsaturated fats may help people with diabetes control blood sugar levels. However, the American Diabetes Association notes that these diets have not been shown to improve fasting glucose or hemoglobinA1c (Hb A1c ) levels.

How much monounsaturated fats should I get?

Your diet can include up to 20% of calories from monounsaturated fats. Currently, about 12% to 14% of calories in the average US diet come from monounsaturated fats. Most women get 18-24 grams per day compared with 25-39 grams per day for men. Most of the monounsaturated fat in your diet should come from plant rather than animal sources because plants have no cholesterol and are low in saturated fat.

What are essential fatty acids?

Your body needs some fats and cholesterol to function properly. You don’t have to eat any saturated fat or cholesterol because your body makes all that you need. Likewise, you don’t need trans fats at all. However, some of the fatty acids you need must come from your diet because your body can’t make them. These are the essential fatty acids and they include the polyunsaturated fatty acids ALA and linoleic acid.

Signs that your diet doesn’t include enough linoleic acid are dermatitis, or rough scaly skin. Deficiencies in ALA result in poor wound healing and more severe dermatitis (with bleeding) that may affect the scalp.

What are plant sterols and stanols?

Plant sterols and plant stanols are vegetable fats. They are not found in all plants, but both are found naturally in small quantities in the following foods:

  • soybeans
  • pine-tree oils
  • sesame, corn, sunflower, and canola oils
  • sesame seeds and sunflower seeds
  • peanuts
  • rice bran
  • green peas

They have been shown to lower cholesterol levels, and some food products are enhanced with plant sterols and stanols—primarily commercial margarines. Research shows that eating margarines enriched with plants sterols or stanols (2 g to 3 g per day) can lower LDL cholesterol levels by 7% to 20% (but 2 g appears to give the most benefit). This benefit has been seen in women with heart disease, and in men and women with normal or high cholesterol levels. Plant sterols and stanols are not available as nutritional supplements.

Fruits & Vegetables

Are fruits and vegetables good for my heart?

There is a lot of research showing that people who eat more fruits and vegetables have lower rates of heart disease. In the Women’s Health Study, nearly 40,000 healthy female health professionals completed detailed food questionnaires and were followed for an average of 5 years. Those who ate the highest amounts of fruits and vegetables cut their risk of cardiovascular disease including stroke and heart attack by one third compared with women who ate the least amounts. Similarly, the Nurses’ Health Study and the male Health Professionals Follow-up Study showed a 20% reduction in heart disease risk for men and women who ate the most fruits and vegetables.

These health professionals ate far more fruits and vegetables than most Americans (more than 10 a day in one study). But research from more moderate fruit and veggie eaters also shows a benefit. A 19-year analysis of nearly 10,000 adults aged 25 to 74 found that eating 3 or more daily servings cut the risk of dying from cardiovascular disease (especially stroke) by 27% compared with eating less than 1 serving per day.

How do fruits and vegetables benefit the heart?

Most of the benefit seen for fruits and vegetables is explained by the fact that they help lower risk factors for heart disease (particularly blood pressure). None of the studies mentioned above found that any single fruit or vegetable was better than another. For heart health, potatoes are not usually counted as vegetables because they have not been shown to lower heart disease (despite the name, sweet potatoes are not related to potatoes). Fruits and vegetables have many nutrients that may benefit the heart including folate, potassium, plant sterols (shown to lower cholesterol), and antioxidants such as vitamin C and flavonoids. They are also a good source of fiber. It’s hard to pinpoint exactly how fruits and veggies work their magic because people who eat more fruits and vegetables also tend to lead a healthier lifestyle (e.g., they exercise more and are less likely to be overweight).

How much fruits and veggies should I eat?

A healthy diet should include 5 or more servings of a variety of fruits and vegetables—the majority of fruit should be whole fruit rather than juice. Potatoes don’t usually count for heart health; they are considered more of a starch. Although no single fruit or veggie is clearly better than any other, the American Heart Association recommends deep-colored produce (e.g., spinach, carrots, peaches, berries) over plainer varieties (e.g., corn) because they tend to have more vitamins and minerals. In 2003, only 27% of women and 18% of men ate 5 or more servings of fruit and vegetables daily (not counting fried potatoes).

A typical serving of fruit is 6 ounces of 100% fruit juice, 1 medium fruit, a quarter cup of dried fruit, or half a cup of fresh, frozen, or canned fruit. For vegetables, a serving is 1 cup of raw leafy vegetables or half a cup of cooked vegetables.

Fiber & Grains

What is fiber and does it help my heart?

Fiber is a type of carbohydrate that our bodies cannot digest it passes through us without adding any calories to our diet. In a combined analysis of 10 studies including more than 330,000 people (73% were women), each 10-gram increase in daily fiber cut the risk of dying from heart disease by 27%. There was a hint that soluble fiber (found in oatmeal and barley) was more heart healthy than insoluble fiber. Soluble fiber, so-called because it is water soluble, has been shown to lower LDL (bad) cholesterol levels.

What is the difference between whole grains and refined grains?

Refined grains have been milled, a process that removes the bran and germ (where most of the nutrients are stored). Milling gives grains a finer texture and improves their shelf life, but it also removes dietary fiber, iron, and many B vitamins. Examples of refined grain products include white bread and white rice. Whole grain products (e.g., brown rice, oatmeal) contain much more cereal fiber than refined grain. Most refined grains are enriched that is, the B vitamins (folic acid, thiamin, riboflavin, niacin) and iron are added back after processing; however, other lost nutrients (including vitamin E, magnesium, selenium) are not replaced.

What are the heart health benefits of whole grains?

The Iowa Women’s Health Study included more than 11,000 postmenopausal women and found that those who ate more whole grain than refined fiber cut their risk of dying early by 17% compared with women who got most of their fiber from refined grains.

Eating more whole grains seems to cut the risk of developing diabetes by 20% to 30%. There is also some evidence that whole grains may help people with diabetes keep their blood sugar under control.
People who eat a lot of whole grains tend to weigh less and gain less weight over the years than people who don’t, probably because fiber fills you up.

How much fiber and whole grains should I get?

You should aim for 6 or more daily servings of grains; half of these should be whole grains. According to the Dietary Guidelines for Americans, at least 3 daily servings of whole grains may lower your risk of diabetes, heart disease, and keep you at a healthy weight. The goal for fiber is about 25 grams per day or around 14 grams per 1,000 calories eaten. Fiber supplements are not recommended because there is no evidence that they provide the same heart health benefits as fiber from foods. The major sources of fiber are fruits, vegetables (especially legumes such as lentils, chickpeas, soybeans), and grains. Most grain eaten by Americans is highly refined. In 2003, the average American ate 10 servings of grain per day, but only one of these was whole grains. Nearly 40% of Americans do not eat any whole grains.
For grains, a serving is 1 slice of bread, 1 ounce of dry cereal, or half a cup of cooked rice, pasta, or cereal.

What foods are whole grains?

Examples of Whole Grains

Whole Grains

Refined Grains

Brown rice White rice
Buckwheat White flour
Bulgar (cracked wheat) Couscous
Whole rye Corn meal/corn flour
Millet Regular pasta
Oatmeal Grits
Popcorn Pretzels
Quinoa White bread
Whole-wheat bread, pasta, crackers, or couscous (if 100% whole wheat) Corn flakes
Wild rice

Foods labeled with the words “multi-grain,” “stone-ground,” “100% wheat,” “cracked wheat,” “seven-grain,” or “bran” are usually not whole-grain products. Color is not an indication of a whole grain. Bread can be brown because of molasses or other added ingredients. Read the ingredient list to see if it is a whole grain.

Choose foods that name one of the following whole-grain ingredients first on the label’s ingredient list:

  • “brown rice”
  • “bulgur”
  • “graham flour”
  • “oatmeal”
  • “whole-grain corn”
  • “whole oats”
  • “whole rye”
  • “whole wheat”
  • “wild rice”

The FDA is revising the rules for the labeling of whole grain foods. Under the proposed changes, foods such as bagels, breads, and pizzas could only be labeled “whole grain” if they are made entirely from whole grain flours.

What is glycemic index and glycemic load?

Glycemic index (GI) measures how quickly a carbohydrate food will boost blood sugar compared with white bread or sugar. High GI foods produce a higher peak in blood sugar shortly after you eat them than low GI foods. Glycemic load is a food’s GI multiplied by the number of grams of carbohydrates in a serving. Because it takes the serving size into account, glycemic load is more accurate than GI. Among more than 75,000 women in the Nurses’ Health Study, the risk of heart disease was twice as high in women who consumed foods with the highest glycemic loads.

Despite the popularity of GI diets, most health agencies do not recommend using GI or glycemic load. This is because there are no standard tests for measuring GI – figures vary widely depending on where the test was done, how the food was cooked, or where it was grown. In addition, the same food may produce a very different blood sugar response from one person to the next. Your blood sugar response will also be affected by other foods you eat before or with the carbohydrate food.

Salt & Potassium

Does salt raise blood pressure?

Salt is sodium chloride. It is the sodium part that affects your blood pressure: the more sodium you eat, the higher your blood pressure. In one study of more than 400 people (57% were women), those who followed a low sodium DASH diet—one rich in fruits, vegetables, and low-fat dairy products—lowered their blood pressure. The fall in blood pressure is steeper when your sodium intake is less than 2,300 milligrams per day. In the DASH study, the greatest benefits were seen in people with high blood pressure, African Americans, women, and people 45 years or older. Compared with an average American diet high in sodium, the low sodium DASH diet reduced systolic blood pressure (the top number) by 10.5 points in women compared with 6.8 points in men. There is a wide variation in how people respond to sodium it may raise blood pressure far more in one person than in the next. Cutting down on sodium can lower your blood pressure even if you are already on blood pressure medication.

Does cutting sodium prevent high blood pressure and heart disease?

A low sodium diet can prevent high blood pressure. A study of more than 2,000 overweight men and women showed that those who cut sodium, lost weight, or did both cut their risk of developing high blood pressure by around 20%.

There seems to be a link between a diet high in sodium and the risk of developing heart disease. The National Health and Nutrition Examination Study followed more than 2,600 overweight people (65% were women) for 19 years and found that increasing the amount of sodium by 2,300 milligrams per day increased the risk of dying from heart disease by 44%. However, there have been no studies to show if the reverse is true and it’s not known whether cutting salt will lower your risk of dying from heart disease.

How much sodium should I get?

Dietary guidelines recommend no more than 6 grams of salt per day (a heaping teaspoon) or 2,300 milligrams of sodium. You should go even lower if you are trying to reduce your blood pressure: 1,500 milligrams of sodium or 3.8 grams of salt per day. On average, Americans consume 3,375 milligrams of sodium per day. One quarter of adult men get more than 5,200 mg per day and one quarter of adult women consume more than 3,500 mg per day. Most of the sodium in our diet (about 75%) comes from processed foods; discretionary salt makes up 11% (5% from cooking and 6% added at the table). Cutting down on sodium can lower your taste preference for salty food within 8 to 12 weeks.

Does potassium lower blood pressure?

Yes. Potassium is a kind of anti-sodium; the more you eat the lower your blood pressure. In addition, potassium blunts the blood pressure-raising effects of a high sodium diet. The DASH diet is high in potassium (4.7 grams per day) largely from fruits and vegetables, and it has been shown to lower blood pressure in men and women. The blood pressure-lowering effects of potassium vary from person to person and appear to be greater in people with high blood pressure and in black men and women.

How much potassium should I get?

You should aim for 4.7 grams of potassium per day from foods such as fruits and vegetables rather than supplements. It is estimated that 10% of men and less than 1% of women get this amount of potassium. Most men get 2.9 to 3.2 grams and most women get 2.1 to 2.3 grams per day. Blood pressure medications including ACE inhibitors, angiotensin receptor blockers, and potassium sparing diuretics can impair your body’s ability to get rid of excess potassium (in urine). If you are taking these medications, you should include no more than 4.7 grams of potassium in your daily diet.

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