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Some people mistakenly think that only cutting down on foods that are high in cholesterol will help lower their
blood cholesterol levels where others restrict fats in their diets to such an extent that good quality and essential
fats necessary for protecting the heart are excluded.

An effective cholesterol-lowering eating plan includes a variety of foods which provide the right balance of the
three different types of fats (saturated, poly-unsaturated and mono-unsaturated), is high in fibre and includes
adequate vitamins and minerals. Remember that it may take a couple of months to lower your cholesterol levels
but don’t give up - incorporate these dietary changes on a daily basis as part of a healthy lifestyle to help you on
your path to good health.

• Choose healthier fats
                 Cut down on saturated (bad) fats and replace them with healthier monounsaturated and
                 polyunsaturated fats (see table 1)
                 Reduce the total amount of fats you eat, especially if you are overweight
                 Cut down on trans fats in processed foods (see table 1)
                 Eat oily fish regularly (as they are rich in heart healthy omega-3 fats) (see table 1)
                 If you don’t eat fish regularly or at all, speak to a health professional about taking an omega-3
                 supplement and also aim to get some omega-3 fats from plant sources (see table 1)
                 Watch your cholesterol intake from certain foods (e.g. eggs, liver, kidneys and prawns) but
                 remember that cholesterol in food does not make a great contribution to your blood cholesterol. It
                 is more important to eat foods low in saturated and trans fats (see table 1)
• Eat a high fibre diet (include both soluble and insoluble fibre). Soluble fibre especially helps to lower
   cholesterol levels (e.g. in oats, oat bran, legumes, vegetables and fruit). Increase daily dietary fibre intake by
   choosing high fibre whole grain options
• Eat more vegetables and fruit daily
• Include a wide variety of legumes (beans, peas, lentils) and soya
• Enjoy a range of nuts and seeds (if you are watching your weight don’t have too many as they are high in
• Some people may benefit from sterol-enriched foods (e.g. using 4-5 teaspoons of Flora pro-activ margarine
   daily to effectively lower cholesterol levels by 10-15%)

• Quit smoking and avoid second-hand smoke
• Keep a healthy weight for your height
• Exercise regularly as it helps increase your HDL (‘good’) cholesterol in your blood
• Cut down on salt
• If you do drink alcohol – drink it in moderation
Table 1: Choosing healthier fats

                                       Unsaturated fats
                                                                                 Saturated fats           Trans fats
              Monounsaturated                  Polyunsaturated fats
                                           Omega-6            Omega-3

Which fats     Healthy fats – eat        Healthy fats –   Healthy fats – eat    Unhealthy fats –       Unhealthy fats –
should you      in moderation                 eat in       in moderation             limit                  limit
  include?                                moderation
   How do       Help lower LDL          Help lower LDL       Prevent blood        Increase LDL        Increase LDL (bad)
 these fats   (bad) cholesterol &             (bad)         clotting & help     (bad) cholesterol         cholesterol &
    affect     do not lower HDL           cholesterol,           reduce               levels           triglyceride levels,
cholesterol    (good) cholesterol       may lower HDL     triglyceride levels                          lower HDL (good)
   levels?                                   (good)             in blood                                    cholesterol
                                         cholesterol if
                                        eaten in excess
 Which        Olive oil, canola oil,    Grapeseed oil,    Rich sources: oily    Mostly in animal       Pastries, biscuits,
  foods             avocado,             sunflower oil,       fish (e.g.          foods: butter,        crackers, cakes,
 contain         peanut butter,             corn oil,         sardines,         ghee, lard, suet,     fried foods (French
  these         nuts and seeds           soyabean oil,       butterfish,           cream, dairy         fries, fried onion
  fats?            (almonds,             sesame seed           salmon,           products, hard        rings, doughnuts,
                   cashews,                    oil.           mackerel,           cheese, fatty               crisps)
              hazelnuts, peanuts,       Many nuts and         pilchards,           meat (beef,
                  pistachios)           seeds (walnuts,    herring, snoek,       mutton, lamb,
                                           pine nuts,       galjoen, tuna,       pork) and fatty        Main sources:
                                        sesame seeds,            trout)         chicken, biscuits,         partially
                                           sunflower                                  cakes           hydrogenated fats
                                            seeds)                                                     used to prepare
                                                             Good plant            Also in some         commercially
                                                               sources:         plant/tropical oils   baked goods and
                                                         flaxseed/flaxseed      such as coconut           fast-foods
                                                             oil, walnuts,      oil, palm oil, palm
                                                           canola oil, soya     kernel oil, cocoa
                                                                 beans                  butter
               Some margarines            Margarines are predominantly           Butter contains         Some brick
                and spreads are           made from polyunsaturated fats        mainly saturated       margarines may
                  made from                                                              fats          have a high trans
               monounsaturated                                                       Many brick           fat content
                      fats                                                      margarines have
                                                                                 a high saturated
                                                                                     fat content
To lower blood cholesterol, stock a heart healthy kitchen:
             Choose products with the Heart Mark logo as they are healthier choices for your heart and meet
             stringent HSFSA nutritional standards of being:
                        ♥ LOWER in saturated fats, cholesterol, sodium and added sugars
                        ♥ HIGHER in fibre (where applicable)

Table 2: Choosing healthier foods

  FOOD TYPE            GUIDELINE                    GOOD CHOICES                           POOR CHOICES

                    Red meat: max. 2-3       Skinless chicken or turkey, lean       Any fatty cuts of meat (ribs, fried
                    servings per week           meat cuts (beef, pork, lamb,        meats, poultry with skin), regular
                                             ostrich, venison), lean/extra lean         mince meat, sausages or
                      Eggs: (poached,           mince meat (beef, chicken,           boerewors, organ meats (brain,
                    boiled or scrambled)     ostrich, soya), lean biltong, egg      kidney, liver, tongue), processed
                                                whites, tofu, canned & dried           meat (salami, polony, ham,
                                              legumes (beans, peas, lentils),         bacon, canned meat), sweet
                                                            soya                     meats, fatty biltong, deep fried
                                                                                        fast foods & take-aways
                                                                                        (hamburgers, meat pies,
                                                                                       sausage rolls, samoosas)

                    At least 2-3 servings       Any fresh white or oily fish           Prawns, shrimps, calamari,
                          per week            (sardines, butterfish, salmon,          caviar, fish roe, fried seafood
    FISH &          (preferably oily fish)    mackerel, pilchards, herring,
   SEAFOOD                                   snoek, galjoen, tuna, trout), fish
                                                canned in water or tomato
                                               sauce, perlemoen, oysters,
                                                  mussels, local crayfish

                     Choose low fat/fat      Low fat/fat free: fresh, long-life &     Full cream for these: fresh,
                    free (skim) products      powdered milk, yoghurt, maas,             long-life, powdered milk,
                                             buttermilk, evaporated milk, ice-         yoghurt, maas, buttermilk,
                                               cream, cottage cheese. Soya            evaporated milk, ice cream,
                                               milk, reduced fat hard cheese          cottage cheese. Condensed
                                              (e.g. low fat mozzarella, ricotta,    milk, cream, sour cream, cream
                                                   low fat cheese spread)           substitutes, tea/coffee creamers,
                                                                                      cream cheese, high fat hard
                                                                                       cheese (cheddar, Gouda,
                                                                                        Tussers, parmesan, blue
                                                                                      cheese, brie), full fat cheese

                     At least 5 servings     Fresh, frozen or canned (without        Vegetables prepared in butter,
   FRUIT &
                           per day           added salt) vegetables, fresh or        cream sauces or mayonnaise,
                                             dried fruit, fruit canned in natural        deep fried vegetables
FOOD TYPE         GUIDELINE                   GOOD CHOICES                           POOR CHOICES

                                       Whole wheat/brown/seeded/rye           White options in bread, rolls, roti,
STARCHES      At least 6 servings of   bread/rolls, brown/whole wheat             pita and flour. Refined &
              starches per day, of       pita, whole wheat pasta, high        sweetened cereal, muesli with
              which half should be          fibre cereals (bran flakes,        coconut, commercially baked
                   wholegrains           Weet-Bix), oats, mealie meal,        products (pastries, cakes, tarts,
                                          rice, samp, barley, mealies,        samoosas, doughnuts, biscuits),
                                           potatoes, sweet potatoes,           French fries, crisps, pizza with
                                                 oven-baked chips,               high fat toppings, buttered
                                          air-popped popcorn, baked             popcorn, high fat crackers,
                                       pretzels, whole wheat crackers,                 cheese biscuits
                                              rice cakes, brown/nutty
                                                wheat/soya/rye flour
                                         Unsaturated oils (sunflower,         Tropical oils (palm, palm kernel,
                 Use sparingly                canola, olive, avocado,              coconut), butter, ghee,
                                         grapeseed, nut oils), soft tub       hard/brick margarine, lard, suet,
FATS & OILS                               margarine, olives, avocado,           full fat mayonnaise, high fat
                                           seeds, nuts, peanut butter,        spreads, dressing & dips, cocoa
                                        cooking sprays, reduced oil/lite        butter, coconut/coconut milk

              Limit Alcohol – max:      Cold drinks, fruit juice, Rooibos        Milo, Horlicks and regular
              1 drink/day in women     tea, regular tea or coffee, lite hot   cocoa or chocolate drinks mixed
               2 drinks/day in men       chocolate with low fat/fat-free            with full cream milk
                 Limit caffeine-
              containing drinks to 4
                  cups per day

                 If overweight or
              diabetic, limit sugary
              Limit if overweight or      Sugar, honey, syrup, jam,               Fudge, chocolate, toffees,
 SUGAR &              diabetic         glucose sweets, jelly, sorbet ices      instant puddings, commercially
DESSERTS                                                                      baked products (pastries, cakes,
                                                                                   tarts, doughnuts), biscuits
                        -                Vegetable soups (including           Cream-based soups, soups with
                                       those with beans, peas, lentils,         fatty meat/bones, soups made
                                       barley), milk-based soups made              with full cream dairy, hard
                                                with skim milk                    margarine or coconut milk
                        -                              -                          Regular mayonnaise, tartar
  OTHER                                                                          sauce, cream-based sauces,
                                                                                          cheese sauce
   • Choose products that bear the Heart Mark logo
   • Favour low fat/fat-free options
   • Buy oils low in saturated fats (e.g. canola, grapeseed, sunflower or olive oil)
   • Choose high fibre options where possible (e.g. brown/whole wheat bread, flour, pasta and crackers)
   • Include good sources of soluble fibre, including: oats, oat bran, legumes (dried beans, peas and lentils),
      barley, citrus fruits, strawberries, apples, apricots, dates, raisins, carrots, broccoli, sweet potato and

   • Avoid frying foods. Rather use healthier cooking methods such as dry-frying, roasting, baking, poaching,
      boiling, steaming, grilling and microwave cooking
   • Use non-stick pans and cooking sprays for grilling or stir frying
   • For sautéing, stewing or for casseroles use little oil, otherwise a little water or vegetable stock are
      healthier alternatives and work just as well
   • Remove all visible fats from meats and the skin from chicken PRIOR to cooking
   • Avoid meats where the fat cannot be removed
   • Lean meats can be roasted or grilled on a rack so that any excess fat can drip off
   • Meat dishes can be thickened by using legumes and vegetables in combination
   • Substitute cream in recipes with low fat evaporated milk and sour cream with plain low fat yoghurt
   • Drain all visible fats while cooking and blot foods with a paper towel afterwards
   • When making sauces, avoid using butter or margarine, rather use seasoning or mustard for flavouring
   • For soups, casseroles, stews, curries and gravies - chill overnight and skim off the fat before reheating
   • To increase vegetable and fruit intake:
           o try varieties of fruit desserts
           o add vegetables into recipes where suitable (e.g. in salads, casseroles, soups and stews)
   • Replace all-purpose flour with whole grain products such as whole wheat flour or oat bran. Soy flour can
      also be used in biscuits and breads
   • To increase your soluble fibre intake:
           o add lentils to rice, mince, soups, gravies and stews – this hides them well and they act as great
           o use oat bran to bind mince when making meatballs or fricadels, mixed into yoghurt, soups, gravy
               powders (½ gravy powder, ½ oat bran) or cooked porridges
           o substitute a third to one half of the flour needed in a recipe with oat bran when baking

Table 3: Using better fats in cooking/baking
       When your recipe requires:                          Rather use:
       1 cup butter                                        1 cup soft margarine
       1 cup hard margarine                                1 cup vegetable oil
       1 cup full cream milk                               1 cup low fat or skim milk
       1 cup light cream                                   1 cup low fat evaporated milk
       1 cup whipping cream                                2/3 cup skim milk + 1/3 cup of vegetable oil
       1 cup sour cream                                    1 cup low fat, plain yoghurt OR low fat/fat-free
                                                           cottage cheese
        1 whole egg                                        2 egg whites
        1/3 cup of cheddar cheese                          1/3 cup of mozzarella OR ricotta cheese
        *Check the labels as not all soft margarines are suitable for baking

Eating Out
    • Choose menu items that are marked with the Heart Mark logo
    • Be aware of hidden ingredients in meals which may not be mentioned on the menu
    • Ask for salads without the dressing (or to be served on the side so the amount used can be controlled)
    • Choose pastas with tomato-based instead of cream-based sauces
    • Choose grilled options preferably served with rice or a baked potato instead of chips
    • Foods known to be high in fat (pies, pastries, toasted sandwiches, biscuits, cakes and vetkoek) are poor
   •     Ask the chef to leave out certain ingredients which could affect your cholesterol levels (e.g. cheese or

Table 4: Sample Menus for lowering cholesterol

                                    Menu 1                         Menu 2                        Menu 3

       Breakfast            Whole wheat toast with         Cooked oats with skim        Bran cereal with skim milk
                         avocado and a small low fat or   milk, apple and cinnamon         and sliced banana
                               fat free yoghurt

  Morning snack*                    Banana                         Grapes                         Peach

        Lunch             Whole wheat roll with grilled   Rye sandwich with low fat      Seed loaf sandwich with
                          chicken and salad or mixed         cheese and salad            low fat humus and salad

 Afternoon snack*                Strawberries                      Orange                         Apple

        Supper                  Grilled fish              Chicken stir fry (skinless    Spaghetti bolognaise (with
                               Baked potato               chicken, carrots, broccoli,      lean mince, carrots,
                        Creamed spinach (white sauce        peppers, mushrooms,                   celery)
                              with skim milk)                      onions)                 Mixed garden salad
                                 Butternut                       Brown rice

  Evening snack*                     Apple                          Melon                     Mixed berries

   *Fruits as stated or any other fresh fruit of your choice, see below for extra snack ideas to add throughout the

Most snack options, although convenient, are very high in fat and salt. The most common downfalls are
chocolate, chips and biscuits. Rather try:
   • Homemade, unsalted popcorn (2 cups popped is one portion-size)
   • Low fat/fat-free yoghurt (1 cup) with/without fresh fruit
   • Dried fruit pieces with no added sugar
   • 2 Ryvita or 3 Provitas with low fat/fat-free cottage cheese or thinly spread peanut butter
   • One small handful of nuts
   • Raw vegetables dipped in low fat/fat-free yoghurt, low fat hummus/tzatziki

For more heart smart information and free nutritional advice call the Heart Mark Diet Line on 0860 223 222
or visit