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The Importance of Healthy Eating in Cardiac Rehabilitation Patients

 

 

What is healthy eating?

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  • Healthy eating encompasses a diet that is balanced and that includes a variety of foods providing our bodies with the nutrients we need to maintain our health, feel good and have energy.

  • A good diet can improve all aspects of life, from brain function to physical performance.  In fact, food affects all your cells and organs.

  • The main nutrients are bodies need are: carbohydrates, protein, fat, vitamins, minerals and water.

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Heart disease is a major health problem, the following are a few risk factors:

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  • High cholesterol

  • High blood pressure

  • Excess weight

  • Smoking

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The Healthy Plate - A Tool For Healthy Eating

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The healthy plate is a simple yet effective tool for healthy nutrition recommendations.  The plate comprises of 3 main sections and is formed based on modern scientific knowledge that is aimed to maintain a healthy body and a healthy weight, all the while being the foundation for disease prevention.  The advantage of using this plate as a guide is that it can be used freely without being too limiting.  The plate is divided into the following 3 parts:

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  1. Fruit and Vegetables (1/2 of the plate)

 

  • This includes all types of cooked or raw fruit and vegetables excluding potatoes.  Fruit and vegetables should be consumed to ensure the full compliment of vitamins, minerals, fibre and antioxidants needed for growth and good health.

  • Ideally fresh fruit and vegetables should be consumed before canned or frozen varieties.

  • Fruit and vegetables are low in fat, salt and calories and they are also known to help reduce the risk of heart disease, stroke and some cancers.

  • The WHO recommends that everyone should consume at least 400g or more per day of fruit and vegetables - meaning 3-4 vegetables and 2-3 fruit portions a day.

  • One portion is equivalent to 80g of the edible part of fresh, frozen or tinned fruit or vegetables.  However, if dried fruit or vegetables are used, 1 portion is equivalent to 30g of fruit or vegetables.

 

 

  2. Carbohydrates (1/4 of the plate)

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  • This section includes a variety of foods including: potatoes, oats, rice, bread, pasta, quinoa, barley, wraps, breakfast cereals etc.  Other than being a source of carbohydrates, these foods also provide our bodies with: dietary fibre, B vitamins and a selection of minerals including Iron and Calcium.

  • When choosing what carbohydrates to include in your plate it is important, unless advised otherwise by a healthcare worker, to select from the wholegrain varieties whenever possible.  These are higher in fibre which we know is helpful in regulating bowel habits and also helps us feel more satisfied with smaller portions for a longer period of time.

  • One portion is equivalent to: 2 slices of bread/ toast, 1/2 a pitta bread, 1/2 a bread roll/ bagel, 4-6 crackers, 40g of breakfast cereals, 1 medium potato, 80g of uncooked rice/ pasta/ quinoa/ barely/ buckwheat/ couscous etc.

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  3. Protein (1/4 of the plate)

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  • This section includes foods like: beans, lentils, pulses, fish, eggs, nuts, seeds, chicken, beef, pork, lamb, duck and rabbit.  These foods are important because they provide us with a source of protein, Iron, Zinc, Magnesium, Omega 3 and fibre.

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  • Lean meats should be consumed since the fats in red meat (beef, pork, lamb, duck and rabbit) is of the saturated type and should be limited to once a week (180g).

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  • Use pluses as a meat alternative to add soluble fibre into your diet which will also work to lower cholesterol levels.

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  • Aim to consume fish 2-4 times a week (roughly 140g per serving) - of which 2 portions should ideally be oily.

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  • Omega 3 helps to regulate our heartbeat, reduces the stickiness of blood, keeps arteries smooth and supple and is found in oily fish (salmon, sardines, fresh tuna and mackerel).

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Fats

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Our bodies do need a certain amount of fat from food, so it is important not to exclude it from your diet. There are three main types of fat - saturated, unsaturated and trans fats.

Eating food that is high in saturated fat can raise the harmful LDL cholesterol levels in the blood, as well as causing you to gain weight. Trans fat is usually formed during food processing and extends the shelf life of food, but these fats have been strongly linked to increased risk of coronary heart disease. Therefore, intake of saturated and trans fat should be avoided as much as possible (American Heart Association, 2020).

 

What foods contain saturated fat?

 

  • Processed meat such as sausages, burgers and salami

  • Fatty cuts of meat such as pork belly, lamb and bacon

  • Processed foods and snacks such as crisps, pastries, pies, cakes, biscuits and chocolate

  • Some dairy products such as full-fat milk, butter, cream and cheese

  • Ice-cream and full-fat dairy desserts

  • Take-away foods

 

 

Which foods contain trans fat?

 

  • Pastries

  • Margarine

  • Biscuits

  • Cakes

  • Fried foods

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As part of a healthy diet, you can replace foods that are high in saturated fat with foods that contain unsaturated fat. Most foods containing high levels of unsaturated fat come from plant sources. Unsaturated fats can be divided into mono-unsaturated fats and poly-unsaturated fats. Monounsaturated fat can help in reducing LDL cholesterol and polyunsaturated fats can help in reducing LDL cholesterol and increasing HDL (good) cholesterol, which is better for heart health (American Heart Association, 2015).

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What foods contain monounsaturated fats?

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  • Nuts and seeds (try avoiding roasted and salted varieties)

  • Extra virgin olive oil

  • Avocado

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What foods contain polyunsaturated fats?

 

  • Oily fish: salmon, mackerel, sardines and fresh tuna

  • Sunflower, canola, soybean oil and oil spreads

  • Soybeans and soy milk

  • Chia, flax and sunflower seeds

  • Omega-3 enriched foods

 

 

Another type of ‘healthy’ fat are Omega-3 fats, which are beneficial for heart health. Research has shown that omega-3 fatty acids can reduce your risk of heart disease and stroke. It is best to get them from a concentrated source, particularly oily fish.  Current guidelines suggest eating at least two portions of fish a week, one of which should be oily  (American Heart Association, 2017).

 

 

Examples of fish high in Omega-3 fats are:

 

  • Mackerel

  • Swordfish

  • Salmon (fresh, frozen, or tinned)

  • Tuna (fresh or frozen)

  • Sardines

 

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Oils in cooking

 

 

  • Polyunsaturated oils can become unstable and breakdown when heated, forming unhealthy saturated or trans fats. Polyunsaturated oils are best used in dressings or in lower temperature cooking: eg: extra virgin olive oil, flaxseed/linseed and walnut oil.
     

  • Oils high in monounsaturated fats are a better choice for high-temperature cooking as they can reach ‘higher smoking points’: eg: canola, avocado, peanut and light olive oils.
     

  • Avoid re-using oils as this can destroy nutrients and make oils breakdown into unhealthy saturated and trans fats.

 

 

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Fibre

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There is strong evidence that eating plenty of fibre is associated with lower risk of heart disease, stroke, type 2 diabetes and bowel cancer. Fibre is divided into either soluble or insoluble fibre. Soluble fibre can help to lower LDL cholesterol in the blood and insoluble fibre helps to keep a healthy digestive system and prevent constipation. High-fibre foods are also more filling than low-fibre foods and this helps to maintain a health weight (British Heart Foundation, 2020).

 

What foods contain soluble fibre?

 

  • Oats

  • Lentils

  • Chickpeas

  • Beans

  • Citrus fruits

  • Barley

  • Seeded bread

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What foods contain insoluble fibre?

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  • Wholegrain pasta, rice, couscous

  • Wholegrain bread

  • Potatoes

  • Carrots

  • Beans

  • Pulses

  • Lentils

  • Nuts

  • Seeds

 

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Salt

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A diet high in salt can cause problems of high blood pressure, which increases the risk of a heart attack, stroke or heart failure. Most of the salt we eat is present in our everyday foods like bread and cereals. Salt is made up of sodium and chloride, and salt can be labelled as either salt or sodium on packaged foods. Salt and sodium are not one and the same (British Heart Foundation, 2020). Therefore, to know how much salt there is in a packaged food product, you need to keep in mind this calculation:

 

Sodium x 2.5 = Salt

For example: 2g of sodium x 2.5 = 5g of salt

 

6g of salt is about a teaspoonful - and this should be the maximum amount of salt intake per day.

 

 

Foods rich in salt

 

  • Bacon and processed meat e.g: ham, sausages, pate

  • Crisps and salted nuts or crackers

  • Cheese

  • Cooking sauces in jars/packets/tins

  • Ready-packaged meals e.g: lasagne/chicken kiev/curries

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How can I cut down on salt?

 

  • Cook without adding salt (this includes rock salt, garlic salt, pink salt and sea salt)

  • Choose fresh foods or foods labelled ‘no added salt’, ‘low salt’, and ‘salt reduced’

  • Use herbs and spices, garlic and lemon to flavour your food

  • Eat more fresh foods and less processed packaged foods

  • Learn how to read food labels

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Reading Food labels

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Reading food labels is an easy way to know how much sugar, salt, fat, saturated fat and salt/sodium are present in the product. The table below can serve as a guide when comparing food products, to identify what food products contain high, medium, or low amounts of sugar, total fat, saturated fat and salt/sodium (British Heart Foundation, 2020).

 

 

 

High (per 100g)

Medium (per 100g)

Low (per 100g)

Sugars (total)

Over 10g

Between 5g-10g

5g and below

Fat (total)

Over 20g

Between 3g-20g

3g and below

Saturated Fats

Over 5g

Between 1.5g-5g

1.5g and below

Salt

Over 1.5g

Between 0.3-1.5g

0.3g and below

Sodium

Over 0.5g

Between 0.1-0.5g

0.1 and below

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Some tips for healthier eating:

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  • Choose cooking methods such as steaming, baking or poaching meat, poultry and fish.

  • Choose raw or roasted unsalted nuts and seeds instead of fried salted varieties.

  • Aim for 2-4 portions of fish a week (2 of which should be oily).

  • Choose Omega-3 enriched products

  • Snack on nuts and seeds throughout the day

  • Add chia or flax seeds to breakfast cereals or smoothies

  • Choose hear healthy oils for cooking

  • Choose higher fibre food alternatives

 

 

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References:

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  • Carson, T., Hidalgo, B., Ard, J., & Affuso, O. (2014). Dietary Interventions and Quality of Life: A Systematic Review of the Literature. Journal Of Nutrition Education And Behavior, 46(2), 90-101. doi: 10.1016/j.jneb.2013.09.005

 

 

 

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