IntroductionIntroduction
As a registered nurse working in cardiac rehabilitation and as an educator for many people with coronary heart disease, Type II diabetes, hypertension, and obesity, I am asked important questions about how people can take care of their hearts. The most frequently asked questions are "What can I eat that tastes good and is easy to prepare?"; "What is cholesterol and what should my cholesterol level be?"; and "How much should I exercise?" I have written this book to help answer these questions and others, and to provide easy-to-follow recipes that will contribute to a heart-healthy lifestyle.
Throughout this book you will find suggestions and tips that will help you understand healthier ways to live, including some cooking hints. The two most important things that you can do to have a happy, heart-healthy life are to eat a balanced diet and to include regular exercise in your routine. These two components will help ensure that your body functions in the most healthful way possible.
As you consider making healthful choices, it is smart to know some basics. How does your heart work? What is coronary heart disease? Is there a way to determine good fat and/or bad fat? In the following sections, you'll learn a bit about several of the basics so that you can make heart-healthy choices with a good base of knowledge.
Understanding How Your Heart Works
Each time your heart beats, it pumps oxygenated blood throughout your body using your arteries. The arteries that nourish the heart muscle are called coronary arteries. There are three main arteries and several smaller arteries that lie on top of the heart and provide its nourishment. As the years pass, the lining of one or more of these arteries can start to narrow and plug up with a fatty substance called plaque. As the plaque increases in an artery, it can block the blood flow to an area of the heart. This limits your heart from receiving the oxygenated blood and nourishment that it needs to function properly, possibly causing a heart attack. Some people develop plaque in several of their arteries and may need medical intervention to prevent a heart attack. The best news about understanding plaque is this: It's important to control as much as possible the cardiac risk factors that you can, in order to help reduce the amount of plaque build-up in your coronary arteries.
Understanding Risk Factors
How many times have you thought to yourself, "I wish I could change my nose, my hair, my height, and so on?" We naturally inherit physical characteristics from our ancestors. We are each born with a unique genetic stamp. We have certain unchangeable parts of our bodies. Factors that affect the heart such as these are referred to as non-controllable. This means that you cannot lower your risk of heart disease by changing these factorssimply because they are not controllable. These risk factors are just a part of your life and there is nothing you can do to change them. Risk factors that are non-controllable include
Heredity. If your parents, aunts, uncles, grandparents, and so forth have a history of heart disease, you are more at risk for coronary heart disease than someone whose family history does not include this disease.
Age. Although we may wish we could stop the clock or drink from the fountain of youth, we are all going through the aging process. This is a non- controllable risk factor and your age can be an important indicator as the doctor evaluates the way your coronary system is working. While our bodies are young, our coronary system works at optimum performance levels, just as the rest of our muscles and organs do. As we age, the heart muscle and surrounding arteries may be adversely affected simply because we are aging.
Gender. Men and women alike are susceptible to heart disease, however men are statistically more prone to coronary heart disease than women. Gender is, as a result, a non-controllable risk factor for men. Having said that, because women in today's society are now more likely to work in stress-filled careers, eat poor diets, and live sedentary lifestyles, the non-controllable risk factor of gender is less significant than it used to be when determining possible coronary heart disease in patients.
A special note to women: It is important to understand that coronary heart disease is not just a man's disease. Heart disease is the #1 killer of women. Most women are protected with estrogen until menopause. During menopause, estrogen production declines. This greatly diminishes a protective barrier to the vessel walls, which can allow damage to occur if the risk factors are present. The best way to protect yourself is to start the routines of exercising and eating heart-healthy foods at an early age.
What about "controllable risk factors"? What preventable or treatable medical conditions act as controllable risk factors that, left unchecked, may lead to heart disease? There are several controllable risk factors and each one deserves your attention:
High cholesterol levels. In the following paragraphs you will read the specific facts about cholesterol and how it acts as a precursor to coronary heart disease. The truth is that high cholesterol is controllable and your efforts to eat and live in a heart-healthy fashion will greatly determine whether or not this controllable risk factor is an issue for you.
High blood pressure. Your blood pressure is an important indicator of how well your heart is working. In the following section you will learn about normal and high blood pressure and what you can do to control this condition. In a lifestyle lacking exercise and proper nutrition, high blood pressure can easily be labeled a controllable risk factor.
Diabetes. Type II Diabetes or "Adult-Onset Diabetes" is a form of diabetes that occurs in mid-life or later and is most often associated with obesity and a sedentary lifestyle. Diabetes may be considered both a controllable risk factor because your lifestyle choices have much to do with this disease and a non-controllable risk factor (in some cases) because the tendency toward diabetes can also be a genetic factor. Either way, in the paragraphs that follow, you will note the connection between the type of foods you eat and the way those foods work with your coronary system.
Stress. The word stress is very popular today. You'll hear this word used on a daily basis by almost everyonewhether a teenager or a corporate manager. Stress is a common and constant companion in our lives and its very presence can cause additional stress. It almost becomes a self-feeding cycle!
Whether you have non-controllable and/or controllable risk factors present in your life, it is extremely important to control the cardiac risk factors that you can. Your efforts to control this disease will play an important part in how much you are able to enjoy your life in a healthful way. Coronary heart disease is a family disease, so all family members should be eating a lowfat, heart-healthy diet and be involved in a daily exercise program.
Understanding Cholesterol
Cholesterol is produced by the liver and is needed for your body to function properly. There are two main types of cholesterol: LDL (low density lipoprotein), which is considered the "bad," and HDL (high density lipoprotein), known as the "good" cholesterol. The "bad" LDL cholesterol is actually important because it lines and protects the nervous system and helps all of your hormones work properly. However, a problem arises in that after the LDL has done its job, it continues to circulate in your blood. The "good" HDL cholesterol retrieves it and brings it back to the liver to be reprocessed. If we each had equal amounts of "bad" LDL cholesterol and "good" HDL cholesterol in our systems, we would be able to process the "bad" cholesterol and get rid of it. Unfortunately, your liver usually produces two or three times more of the "bad" LDL than the "good" HDL. As a result, the bad "LDL" is always present in your blood system. And, it is one of the main components that make up the plaque that plugs up your coronary arteries. Most experts today define healthy cholesterol levels to be
Total Cholesterol Levels without known coronary heart disease | = 180 or less |
Total Cholesterol Levels with known coronary heart disease | = 160 or less |
LDL "bad" Cholesterol | = 100 or less |
HDL "good" Cholesterol | = 40 or greater for men |
HDL "good" Cholesterol | = 50 or greater for women |
QUESTION: If my cholesterol is high, what can I do to reduce it?
First things firstif your doctor has prescribed a cholesterol-reducing medication, always take it. In addition, you can add the following to help reduce your cholesterol level:
Exercise aerobically for 30 minutes, 5 to 6 days a week.
This exercise needs to "feel" moderate-to-somewhat-hard and you have to be able to talk without feeling short of breath. Exercise such as this increases the amount of oxygen your heart and body need to strengthen all of your muscles, especially your heart muscle. This also stimulates your liver to produce more of the "good" HDL cholesterol, and reduces its production of the "bad" LDL cholesterol.
Eat foods that are low in saturated fats and trans fats.
Saturated and trans fats stimulate your liver to produce more of the "bad" LDL cholesterol which increases plaque.
Question: What are saturated fats, unsaturated fats, and trans fats?
Saturated fats are fats that will stimulate your liver to produce more of the "bad" LDL cholesterol and increase your cholesterol levels.
Saturated fats include
Butter
Lard
Shortening
Palm or coconut oil
Fat marbling in beef
Dark meat
Unsaturated fats are generally vegetable oils. These oils will not stimulate your liver to produce more of the "bad" LDL cholesterol. Therefore unsaturated fats won't increase your cholesterol level. There are two types of unsaturated fats: the mono-unsaturated and the polyunsaturated fats.
Monounsaturated fats include
Canola oil
Olive oil
Peanut oil
Avocados
Polyunsaturated fats include
Sesame oil
Sunflower oil
Corn oil
Soybean oil
Trans fats are produced by taking an unsaturated vegetable oil and adding hydrogen to it, creating an oil called "partially-hydrogenated oil." Trans fats add shelf life to many processed foods and many food manufacturers will use trans fats for that reason alone. Unfortunately, trans fats will stimulate the liver to produce "bad" LDL cholesterol and will increase your cholesterol levels.
Understanding Your Blood Pressure
When you have your blood pressure checked using a blood pressure machine, there are two numbers that appear. The upper number is the amount of force it takes for your heart to pump blood through the arteries in your body. The bottom number is the amount of pressure present in your arteries during the resting phase of your heart beat. The more narrowed or restricted your blood vessels are, the higher the pressure in your arteries. If it continues for a long time, damage takes place in the lining of your arteries causing plaque to build up. This may cause a stroke or a heart attack.
Question: What is a normal blood pressure level? What is hypertension or high blood pressure?
The American Medical Association has recently revised the "normal level" numbers for a resting blood pressure:
Blood Pressure without coronary heart disease: | 135/75 |
Blood Pressure with coronary heart disease or diabetes: | 125/70 |
When your blood pressure exceeds these levels, you may have hypertension or high blood pressure. Simply said, that means that your heart and arteries are working too hard and you may be damaging your coronary system.
Question: How can I control my blood pressure?
Exercise is the key to reducing blood pressure. Exercise stimulates the relaxation of the smooth muscle located around the lining of your arterial walls. As the arteries relax, the diameter of the arteries increases, which decreases the workload of the heart, and reduces your blood pressure.
Reduce the amount of your salt (sodium) intake. Salt is an irritant to the nerves located around your blood vessels, which causes the vessels to become narrower. This makes your heart have to work harder, which increases your blood pressure. You need about 300 milligrams of sodium (salt) each day for your brain to function. That isn't much when you compare that amount to the 3,000 to 5,000 milligrams of salt most Americans have each day! You should try to keep your daily salt intake to 2400mg or less. That is equivalent to one teaspoon of salt.
If you take prescribed medication to reduce your blood pressure, never stop it abruptly. If you feel tired, sluggish, or lightheaded, always call your physician.
Understanding Blood Sugar Levels
Your pancreas produces a hormone called insulin. Insulin plays a vital role in your health because it helps reduce the amount of sugar circulating in your blood system. If the insulin cannot break down the sugar, the sugar accumulates in the bloodstream, causing damage to the walls of the blood vessels. The damage allows plaque to increase, narrowing the arteries. The fat cells become resistant to insulin, allowing high levels of sugar in the blood, which damages the arteries. This not only affects the heart, but also the eyes, brain, kidneys, and legs.
When you eat carbohydrates, your body turns it into sugar. This sugar is good for you because it provides energy that your body needs. The best types of carbohydrates to consume are complex carbohydrates found in fruits and vegetables. These provide energy and important vitamins that you need. Try to avoid large amounts of simple carbohydrates such as pasta, potatoes, white bread, and white rice. These do not provide the nutrients that the complex carbohydrates do and they add many unnecessary calories.
Question: How does my blood sugar level affect the health of my heart?
High blood sugar levels affect the lining of all the arteries, including the coronary arteries. This damage can allow plaque to form, which narrows your arteries. When your cells become resistant to insulin, allowing high levels of sugar in the blood, the coronary arteries are damaged as a result.
Question: What role do Type II Diabetes and carbohydrates play in heart health?
Type II Diabetes is typically seen in overweight individuals. Most of the eating patterns that contribute to Type II Diabetes include high amounts of processed flour and refined sugars, which lead to insulin-resistant blood sugar. Your heart was created to work with a balance of blood sugars, and the over-consumption of carbohydrates converted to sugar is a precursor to damage to the arteries in your coronary system.
With a good base of knowledge about your coronary system, the risks associated with heart disease, and an introduction to cholesterol, blood sugars, and blood pressure, it is time to look again at the two factors that contribute significantly to a healthy heart: a balanced diet and regular exercise.
Understanding a Balanced Diet
Most of my patients have one common complaint and question, "What can I eat that tastes good and is healthy for me?" Recently, one of my patients told me that she went to the store to buy healthy food and came home frustrated with only two items in her grocery bagnonfat yogurt and fat-free milk. A trip to the grocery store can be a confusing and frustrating experience, particularly when you are trying to read food labels and juggle your daily meals into a balanced day of healthful eating. And then, there is the flavor! No one really wants to eat foods that taste like bad imitations of good food. You want to prepare good-tasting food for yourself and your family. The better tasting your food is, the more willing you and your family will be to change your eating lifestyle to a heart-healthy and balanced one.
This book is full of great tasting foods and recipes that bring them all together. In the following chapters you will find recipes for each mealtime, as well as snacks, packable lunches, and cooking tips for selected recipes. But, before you try these recipes, let's first look at what our bodies need on a daily basis, let's explore what it means to have a "balanced diet," and let's examine food labels to understand them better.
First, what do our bodies need to best function every day? My dietary or caloric recommendation for females is approximately 1,800 to 2,000 calories per day. My recommendation for males is 2,000 to 2,200 calories per day. As we age, the amount of calories that we need will decrease because our metabolism slows down.
Second, what is considered a "balanced diet?" Of the total calories you consume, I recommend that approximately 20% should come from fats, 25% from proteins, and 55% from carbohydrates.
Let's put this into grams:
Females:
Fats: 40 to 45 grams, of these fats only 14 to 16 grams from saturated fats
Protein: 113 grams
Carbohydrates: 248 grams
Males:
Fats: 50 to 55 grams, of these fats only 16 to 20 grams from saturated
Protein: 113 grams
Carbohydrates: 248 grams
It is important to understand that you receive 9 calories for every 1 gram of fat that you eat. You receive 4 calories for every gram of carbohydrate that you eat and 4 calories for every gram of protein.
Now, how do you go to the grocery store and actually use this information? In this book you will find that each recipe has nutritional information. This information tells you how many grams of fat, protein, carbohydrates, and other nutrients that will be in each serving. It is important to remember that this information is "per serving," and is not meant for the entire recipe. By determining which recipes you will cook and following the list of ingredients as described, you can be fairly certain of the amounts of grams that you will be eating. The other way to determine the grams of nutrients that you eat is by reading the nutritional food labels on the food containers at the grocery store.
Third, let's examine a typical food label. Many of my patients are confused by how to read a food label so I have developed the following easy guideline:
As you look at the U.S. Department of Agriculture food label (see the illustration below) you will note the product information.
Look at the serving size.
Check the calories per serving.
Look at the two columns that define the product. One column is in grams and the other column is in percentages. Rememberthese grams and percentages are per serving. Using the information in the previous paragraph, you can now calculate how many grams of fat you eat per day. (Although many people calculate this using percentages, I have found that it is easier for me to work with the gram counts.)
As you prepare recipes during the day, add these grams together, along with the nutritional information from the recipes. Stay within the previously suggested amounts. Do this on a daily basis and you will have a good, balanced diet and one that is heart-healthy, too!
Understanding Exercise: The Key to Life
What does exercise have to do with a heart-healthy diet?
Controls your weight
Reduces your "bad" LDL cholesterol
Is the only thing that will increase your "good" HDL cholesterol
Keeps blood sugars under control
Helps control blood pressure
Produces endorphins, our "feel-good" hormones, which help reduce stress
Did you know that aerobic exercise produces all of these healthy results for your body? Aerobic exercise gets the oxygen pumping to the heart muscle as well as to of the other muscles in your body. Exercise is a number #1 health benefit that you can do for yourself. Exercise includes walking, riding a bike, walking on a treadmill, swimming...any movement that gets your heart pumping. While you are doing an aerobic exercise such as these, you want to be able to talk comfortably, and the exercise should feel moderate to somewhat difficult. Your exercise needs to last 30 to 45 minutes in duration, with a 5-minute warm-up and a 5-minute cool-down. I recommend doing aerobic exercise five days a week.
Because your heart and body will work hard during aerobics, have a small, healthy snack and a 6 to 8-ounce glass of water an hour before you begin exercising. Next, gently stretch your muscles so that they are warmed and flexible. Now, start your aerobics with the 5-minute warm-up. After exercising for the 30 to 45 minute duration, finish with your 5-minute cool-down and gently stretch again. Have another 6 to 8-ounce glass of water. The water will prevent you from becoming dehydrated. Dehydration can make your heart beat faster and cause your blood pressure to fall. Talk to your doctor before starting any new exercise routine.
If you find you are craving a food that is not heart-healthy, this is the perfect time to take a walk or ride a bike or start walking on your treadmill. It is an excellent way to change your focus and it also helps you feel better for two reasonsyou now have feel-good endorphins in your body and you will have gotten beyond the "need" for the food. Even at work, if you are craving an unhealthy snack, take a walk around the building or walk up and down the stairs. This cookbook will provide great, tasteful, and easy-to-prepare recipes that will help your family eat in a heart-healthy fashion. Get the whole family involved, teaching them the importance of eating well. Enjoy!!
Recipe Layout
As is the case with all cookbooks, each recipe is composed of a list of ingredients and instructions that show you how to make a particular dish. However, each recipe also includes some valuable additions to make your cooking experience particularly worthwhile:
Nutritional Information
Each recipe featured in Delicious Heart-Healthy Meals In No Time is followed by a detailed listing of nutritional information per serving of calories, total fat, saturated fat, carbohydrates, protein, cholesterol, sodium, and percentage of calories from fat. Look for the icon.
Note from Nurse Charlene
When an ingredient substitution or special preparation step can make a recipe even healthier for you, you'll find this icon.
Packable
Many of the recipes you'll find in this book make perfect meal selections to pack for eating on the go. Whether packing a picnic for the park or just a meal to eat at your desk, you'll love these take along dishes. Look for the icon.
Fast Facts
Fast Facts notes will detail on-the-run substitutions you can make to make recipes faster and easier to fix: every cook's dream.
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