Heart healthy eating principles

Heart healthy eating principles Healthy eating patterns do not rely on one type of food or one type of nutrient to promote heart health. Heart healthy eating patterns are based on a combination of foods, chosen regularly, over time. This optimal combination can be categorised into five healthy eating principles. This style of eating is naturally low in saturated and trans fats, salt and added sugar and rich in wholegrains, fibre, antioxidants and unsaturated fats (omega-3 and omega-6). Eating this way will improve the heart health of all Australians by reducing cardiovascular disease (CVD) risk factors such as high blood pressure and blood lipids and decreasing the risk of CVD events and mortality. In addition to the quality of foods consumed, their quantity is also an important determinant of a heart healthy eating pattern, as it can lead to weight gain and in turn, heart disease. 1 Plenty of fruit, vegetables and wholegrain cereals 2 3 4 5 Variety of healthy protein sources including fish and seafood, lean meat and poultry, legumes, nuts and seeds Reduced fat dairy such as unflavoured milk and yoghurt, and cheese Healthy fat choices with nuts, seeds, avocados, olives and their oils for cooking Herbs and spices to flavour foods, instead of adding salt

1 PLENTY OF FRUIT, VEGETABLES AND WHOLEGRAIN CEREALS Eating vegetables and fruits is consistently linked to healthier hearts. Research shows that higher intakes of vegetables and fruits is associated with lower risk of heart disease. The fibre, potassium and other micronutrients contained in fruits and vegetables have shown to reduce the risk of high blood pressure and cholesterol, therefore providing a protective effect towards CVD. 1,2,3 Eating wholegrain foods is also linked to heart health. The term `grains usually refers to wheat, corn (maize), rice, barley, oats, rye, millet, quinoa, teff and similar foods. These grains can be eaten whole, processed into products like couscous (wheat) and polenta (corn), or used to make grain foods like bread, breakfast cereals, pasta, and noodles. Eating patterns high in fibre from wholegrains have been linked to reduced LDL-cholesterol levels, and reduced heart disease risk. 1 Foods high in soluble fibre are particularly beneficial to lower total cholesterol levels such as oats, barley and legumes. 1 In addition, fruits, most vegetables and wholegrains have a low glycaemic load, which assists in lowering serum triglyceride levels and consequently reduce the risk of CVD. 1 Current eating patterns are low in vegetables, fruits and wholegrains. Increasing intake of vegetables and fruits, along with increasing intake of wholegrains and concurrent reduction in refined carbohydrates will help to shift current eating patterns towards healthier eating patterns. TIPS FOR EATING MORE FRUIT, VEGETABLES & WHOLEGRAIN CEREALS: Filling half the main meal plate with vegetables, and aiming to include vegetables at other meal and snack times, assists to meet the recommended 5 serves per day. The amount of grain foods will largely depend on the activity level of the individual, and wholegrains should be the preferred option. This includes brown rice, wholemeal pasta, grained bread and oats. Two serves of fruit can be incorporated into breakfasts, as a snack or alternative to dessert. Heart Healthy Eating Principles The Heart Foundation Page 2

2 VARIETY OF HEALTHY PROTEIN SOURCES INCLUDING FISH AND SEAFOOD, LEAN MEAT AND POULTRY, LEGUMES, NUTS AND SEEDS Healthy eating patterns include a variety of protein sources. These foods are good sources of macro and micronutrients such as proteins, iron, zinc and vitamins, particularly those of the vitamin B group. Research suggests that including plant-based proteins in your daily eating plan is linked to healthier hearts. Animal-based proteins like meat and poultry are not associated with heart disease risk, and in fact regular consumption of fish promotes heart health. Red and white meat (including poultry) is a popular food in Australia, and one of the main sources of vitamin B12. Choosing lean cuts of meat and poultry and avoiding processed and deli meats like sausages and salami can help reduce the total saturated fat and sodium content in the diet. In addition to these popular foods, including a variety of other protein sources promotes a balanced eating pattern, and will help to shift Australians towards healthier eating patterns. Fish and seafood are good sources of omega-3 fatty acids, and their regular consumption is associated with a reduced risk of heart disease incidence and mortality. 4 Fresh or canned fish should be incorporated into two to three meals per week. Pregnant women and children should limit intake of swordfish and orange roughy to limit exposure to mercury. 5 Legumes, nuts and seeds are good sources of plant proteins, fibre, healthy fats and micronutrients. Their regular consumption is linked to healthier hearts. Including beans and legumes into weekly eating patterns, as an alternative to meat, will result in higher intakes of fibre, unsaturated fats and phytonutrients and lower intakes of saturated and trans fat. VARIETY OF PROTEIN SOURCES IN A HEALTHY EATING PATTERN CAN BE ACHIEVED BY: Including fish and seafood two-three times per week Legume based meals twice per week Choosing lean cuts of meat and removing skin from poultry Choose nuts and seeds as a healthy snack or add to your breakfast. Heart Healthy Eating Principles The Heart Foundation Page 3

3 REDUCED FAT DAIRY SUCH AS UNFLAVOURED MILK AND YOGHURT, AND CHEESE Within a healthy eating pattern; milk, yoghurt and cheese will be important sources of calcium, protein and other vitamins and minerals. Reduced fat dairy foods with no added sugar are good sources of protein and calcium, and as part of healthy eating patterns, their consumption has been linked to a reduced risk of high blood pressure and heart disease. 3 Similar to other saturated fats, dairy saturated fat appears neither protective nor harmful when compared with total carbohydrate on heart disease risk, while saturated fat compared to unsaturated fat increases heart disease risk. Reduced fat, no-added sugar dairy is preferred to assist with healthy weight, healthy blood pressure and cholesterol, as key risk factors for heart disease. TIP: HEALTHY FAT CHOICES WITH NUTS, SEEDS, AVOCADOS, OLIVES AND THEIR OILS FOR COOKING TIPS: 4 Cook with oils like olive, canola, avocado, peanut and sunflower. Add a sprinkle of nuts and seeds to your breakfast Choose reduced fat unflavoured yoghurt and cheese as snacks and desserts Unsalted nuts, seeds such as linseed, chia or tahini, avocados, and cooking oils made from plants or seeds like olive, canola, peanut, sunflower, soybean, rice bran, sesame and safflower will contribute unsaturated fats (omega-3 [ALA] and omega-6). These types of fats have been associated with reductions in LDL cholesterol and increases in HDL cholesterol, reducing the risk of heart disease. 12 Evidence suggests healthier fats or oils are those which promote healthier lipid profiles, and other cardiovascular risk factors, or feature prominently in traditional or healthy eating patterns. These oils tend to have significant amounts of monounsaturated or polyunsaturated fatty acids compared to saturated/trans fatty acids, and include plant based oils (often referred to as vegetable or seed oils) including olive 6, canola, soybean, safflower, sunflower, avocado, macadamia, rice bran 7 and peanut 8. On the other hand, fats and oils which have considerable amounts of saturated or trans fatty acids compared to unsaturated fatty acids have not demonstrated these same health benefits and include butter, lard, copha, dripping, palm oil, coconut oil. 9-12 Margarines based on olive, canola, peanut and sunflower oil are a preferred choice to butter as their consumption will be associated with lower intakes of saturated and trans fat. Fifty percent of the fat content in butter is saturated fat and 4% is trans fat. 9 Margarines in Australia have low levels of trans fat. Nut butters, avocado, hummus and tahini are also preferred options to butter. Heart Healthy Eating Principles The Heart Foundation Page 4

5 HERBS AND SPICES TO FLAVOUR FOODS, INSTEAD OF ADDING SALT Most Australian studies suggest people are consuming around 9 grams of salt per day from the foods they choose every day. 13 Diets high in salt are linked to increased risk of hypertension and heart disease. 14 A healthy eating pattern, based on the previous 4 principles, will be naturally lower in sodium, and will help to lower population salt intakes. Australians should aim to reduce their salt intake to less than 6 grams per day by following the above healthy eating principles and not adding salt to food or during cooking. TIP: Herbs and spices should be used to flavour foods, in preference to salt. Water is always the preferred beverage of choice. Following the Heart Foundation Heart Healthy eating principles means that discretionary foods are naturally excluded and are not part of a heart healthy eating pattern. This eating pattern will also contribute to a reduced risk of CVD events and mortality, as well as improvements to CVD risk factors such as high blood pressure and blood lipids. Heart Healthy Eating Principles The Heart Foundation Page 5

REFERENCES AND KEY PAPERS 1. Sacks FM, Lichtenstein AH, Wu JHY, Appel LJ, Creager MA et al. Dietary Fats and Cardiovascular Disease: A Presidential Advisory Forum from the American Heart Association. Circulation. 2017; 135(25). 2. World Health Organisation. Increasing fruit and vegetable consumption to reduce the risk of noncommunicable diseases. E-library of Evidence for Nutrition Actions (elena). 2014. 3. Collins C, Burrows T, Rollo M. Dietary patterns and cardiovascular disease outcomes. University of Newcastle (for the National Heart Foundation of Australia). 2017. 4. National Heart Foundation of Australia. Position statement Fish and seafood. 2015. 5. Food Standards Australia New Zealand. Mercury in Fish: Food Standards Australia and New Zealand. Canbera: FSANZ, 2015. Available at www.foodstandards.gov.au/consumer/chemicals/mercury/pages/default.aspx. 6. Hohmann CD, Cramer H, Michalsen A, Kessler C, Steckhan N, Choi K, Dobos G. Effects of high phenolic olive oil on cardiovascular risk factors: A systematic review and meta-analysis. Phytomedicine. 2015 Jun 1;22(6):631-40. 7. Jolfaie NR, Rouhani MH, Surkan PJ, Siassi F, Azadbakht L. Rice Bran Oil Decreases Total and LDL Cholesterol in Humans: A Systematic Review and Meta-Analysis of Randomized Controlled Clinical Trials. Hormone and Metabolic Research. 2016 Jul;48(07):417-26. 8. Huth PJ, Fulgoni VL, Larson BT. A systematic review of high-oleic vegetable oil substitutions for other fats and oils on cardiovascular disease risk factors: Implications for novel high-oleic soybean oils. Advances in Nutrition: An International Review Journal. 2015 Nov 1;6(6):674-93. 9. Pimpin L, Wu JH, Haskelberg H, Del Gobbo L, Mozaffarian D. Is butter back? A systematic review and metaanalysis of butter consumption and risk of cardiovascular disease, diabetes, and total mortality. PLoS One. 2016 Jun 29;11(6):e0158118. 10. Fattore E, Bosetti C, Brighenti F, Agostoni C, Fattore G. Palm oil and blood lipid related markers of cardiovascular disease: a systematic review and meta-analysis of dietary intervention trials. The American journal of clinical nutrition. 2014 Jun 1:ajcn-081190. 11. National Heart Foundation of New Zealand. Coconut Oil and the Heart, 2014. 12. Clifton P and Keogh J. Dietary fats and cardiovascular disease: an evidence check rapid review brokered by the Sax Institute for the National Heart Foundation of Australia. 2017. 13. Jeffery P, Riddell L, Land M-A, Shaw J, Webster J, Chalmers J, Smith W, Flood V, Neal B. Quantifying salt and potassium intake in Victoria adults. Journal of Hypertension. 2012; 30:1118. 14. Institute for Health Metrics and Evaluation. Global Burden of Disease Study Data Visualizations: GBD Compare (Australia). 2015. Accessed from: http://vizhub.healthdata.org/gbd-compare/ For heart health information, please contact us 13 11 12 then our website www.heartfoundation.org.au 2017 National Heart Foundation of Australia ABN 98 008 419 761 Terms of use: This material has been developed for general information and educational purposes only. It does not constitute medical advice. Please consult your healthcare provider if you have, or suspect you have, a health problem. The health information provided has been developed by the Heart Foundation and is based on independent research and the available scientific evidence at the time of writing. The information is obtained and developed from a variety of sources including, but not limited to, collaborations with third parties and information provided by third parties under licence. It is not an endorsement of any organisation, product or service. While care has been taken in preparing the content of this material, the National Heart Foundation of Australia, its employees and related parties cannot accept any liability, including for any loss or damage, resulting from the reliance on the content, or for its accuracy, currency and completeness. This material may be found in third parties programs or materials (including, but not limited to, show bags or advertising kits). This does not imply an endorsement or recommendation by the National Heart Foundation of Australia for such third parties organisations, products or services, including their materials or information. Any use of National Heart Foundation of Australia materials or information by another person or organisation is at the user s own risk. The entire contents of this material are subject to copyright protection. Enquiries concerning permissions should be directed to copyright@heartfoundation. org.au PRO-183-0817 August 2017 Heart Healthy Eating Principles The Heart Foundation Page 6