10 Heart-Healthy Diet Rules to Live By

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The American Heart Association (AHA) publishes dietary and lifestyle guidelines for general heart health.1 These guidelines are similar to the Therapeutic Lifestyle Changes (TLC) diet from the U.S. National Cholesterol Education Panel (NCEP).

These guidelines are for healthy adults and children older than age 2 as well as people who already have health problems such as coronary artery disease, diabetes, metabolic syndrome, or heart failure.

The AHA diet and lifestyle guidelines recommend that you:

• Eat a variety of fruit and vegetable servings every day. Dark green, deep orange, or yellow fruits and vegetables are especially nutritious. Examples include spinach, carrots, peaches, and berries.
  
• Eat a variety of grain products every day. Include whole-grain foods that have lots of fiber and nutrients. Examples of whole grains include oats, whole wheat bread, and brown rice.
• Eat fish at least 2 times each week. Oily fish, which contain omega-3 fatty acids, are best for your heart. These fish include tuna, salmon, mackerel, lake trout, herring, and sardines.
  
• Stay at a healthy weight by balancing the amount of calories you eat with the activity you do every day. If you want to lose weight, increase your activity level to burn more calories than you eat.

Eat foods low in saturated fat and cholesterol. Try to choose the following foods:

• Lean meats and meat alternatives like beans or tofu
• Fish, vegetables, beans, and nuts
• Nonfat and low-fat dairy products
• Polyunsaturated or monounsaturated fats, like canola and olive oils, to replace saturated fats, such as butter
• Read food labels and limit the amount of trans fat you eat. Trans fat raises the levels of LDL ("bad”) cholesterol and also lowers high-density lipoprotein (HDL, or "good") cholesterol in the blood. Trans fat is found in many processed foods made with shortening or with partially hydrogenated or hydrogenated vegetable oils. These foods include cookies, crackers, chips, and many snack foods.
• Limit sodium intake to less than 2,300 mg of sodium per day (about one teaspoon). Choose and prepare foods with little or no salt.
• Limit alcohol intake to 2 drinks per day for men and 1 drink per day for women.
• Limit drinks and foods with added sugar.
• When you are eating away from home, try to follow these heart-healthy guidelines.

Special considerations include the following:

• Older people. As you age, you do not usually need to eat as many calories. Although the general dietary guidelines remain the same, older people should be careful to choose foods rich in nutrients to meet their nutritional needs without too many calories.
  
• Children. Many more children are becoming overweight. Although more research is needed on specific dietary guidelines for children, overweight children have an increased risk for diabetes and coronary artery disease (CAD) later in life. Children over the age of 2 can follow the AHA diet and lifestyle recommendations and maintain normal growth while lowering their risk of heart disease in the future.
  
• People with kidney disease. Cardiovascular disease can develop in people who lose normal function of their kidneys. If you have kidney disease, you may need to limit some nutrients including protein and sodium. For more information, see the topic Chronic Kidney Disease.

References

Citations: American Heart Association (2006). Diet and lifestyle recommendations revision 2006. Circulation, 114(1): 82–96.

Last Updated: May 08, 2008

The Payoff of Cardiac Rehab—After a Tough Beginning

Deb Kautz, 47, of Zumbro Falls, Minn., said she felt like "a wreck" after her heart attack. She was afraid to move, afraid that any exertion could set off another attack. This fear could have left her stuck to the couch, but she took another route. Within two weeks of her attack, she started attending the cardiac rehabilitation program at the Mayo Clinic in nearby Rochester.

Kautz started slowly walking on a treadmill. With a heart monitor on her chest and an exercise physiologist looking over her shoulder, she no longer worried about overstressing her heart. She could just focus on getting better.

Certified exercise specialist Anne Wolter has been working with patients like Kautz at the Mayo Clinic for 20 years. "Most patients aren't thrilled about starting rehab," she says. But after attending two to four sessions a week for three months—the time period generally covered by insurance—their attitude changes completely. "The best thing about cardiac rehab is when patients start gaining strength and feeling better," Wolter says. "A lot of them leave saying they're in their best shape in years."

What happens in cardiac rehab?
Participants in cardiac rehab do more than just work out. They receive nutritional advice from counselors, they get screened for depression, and they can mingle with lots of other people who are in the same straits.

For all of these reasons, heart patients who attend cardiac rehabilitation tend to recover faster and more completely than people who don't, says Sharonne Hayes, MD, director of the Mayo Clinic's Women's Heart Clinic.

While cardiac rehabilitation programs are expensive, several studies suggest that they are cost-effective because they reduce future cardiac events and allow people to return to work earlier than they would without therapy. One study found that cardiac rehab saved the government $12,000 per patient.

Although cardiac rehab programs have become standard at hospitals across the country, "far too many patients miss out on the incredible opportunity," says Nieca Goldberg, MD, medical director of the NYU Women's Heart Program. "Nationwide only about 15% to 20% of patients eligible for rehab ever get a referral from their doctors. Even fewer actually attend."

If you're recovering from a heart attack or bypass surgery, ask your doctor about the local cardiac rehab program. You might have to be persistent. That same attitude will serve you well as you rehab your way to recovery.

Lead writer: Chris Woolston
Last Updated: April 12, 2008

Why Supplements May Do Your Heart More Harm Than Good

If you're having trouble eating a healthy amount of fruits, vegetables, grains, and healthy fats, you may be hoping to fill those holes in your diet with a pill.

Problem is, pills don't really work. "I get asked a whole lot about supplements and vitamins," says Laurence Sperling, director of preventive cardiology at the Emory University School of Medicine, in Atlanta. "And what we have to say right now is that we do believe that a heart-healthy diet, a balanced diet is beneficial. We recommend only a multivitamin. And no high doses of supplements."

In multitudes of studies, one supplement after another has failed to benefit the heart in any measurable way. That includes antioxidants as well as B vitamins such as folic acid, which does not seem to prevent heart disease.

A 2004 review of previous studies found that vitamin E supplements were no help for treating or preventing heart disease

A 1994 study of smokers found that beta-carotene supplements didn't protect the heart, but they did raise the risk of lung cancer.

"While fruits, vegetables, and other whole foods clearly protect the heart, it's evidently impossible to capture that power in a pill," says Melissa Ohlson, RD, coordinator of the Cleveland Clinic's preventive cardiology and rehabilitation nutrition program.

Fish oil is the exception
People with heart disease may want to take fish oil capsules after talking with their doctors. The omega-3 fatty acids in fish oil can help prevent arrhythmias, decrease triglycerides (a type of fat in the blood), slow down the buildup of plaques in the arteries, and slightly lower blood pressure.

Lead writer: Chris Woolston
Last Updated: April 09, 2008

How Cardiac Rehabilitation Can Save Your Life

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What is cardiac rehabilitation?
Cardiac rehabilitation (rehab) teaches you how to be more active and make lifestyle changes that can lead to a stronger heart and better health. Cardiac rehab can help you feel better and reduce your risk of future heart problems.

In cardiac rehab, you work with a team of health professionals. Often the team includes a doctor, a nurse specialist, a dietitian, an exercise therapist, and a physical therapist. The team designs a program just for you, based on your health and goals. Then they give you support to help you succeed.

If you have had a heart attack, you may be afraid to exercise. Or if you have never exercised, you may not know how to get started. Your cardiac rehab team will help you start slowly and work up to a level that is good for your heart.

Many hospitals and rehab centers offer cardiac rehab programs. You may be part of a cardiac rehab group, but each person will follow his or her own plan.

Who should take part in cardiac rehab?

Doctors often prescribe cardiac rehab for people who have had a heart attackor bypass surgery. But people with many types of heart or blood vessel disease can benefit from cardiac rehab. Rehab might help you if you have:

• Heart failure.
  
• Peripheral artery disease (PAD).
• Had or plan to have a heart transplant.
• Had angioplasty to open a coronary artery.
  
• Had another type of heart surgery, such as valve replacement.

Often people are not given the chance to try cardiac rehab. Or they may start a program but drop out. This is especially true of women and older adults. And that’s not good news, because they can get the same benefits as younger people. If your doctor suggests cardiac rehab, stay with it so you can get the best results.

Medicare will pay for cardiac rehab for people with certain heart problems. Many insurance companies also provide coverage. Check with your insurance company or your hospital to see if you will be covered.

What happens in cardiac rehab?In cardiac rehab, you will learn how to:

• Manage your heart disease and problems such as high blood pressure and high cholesterol.
  
• Exercise safely.
• Eat a heart-healthy diet.
• Break bad habits, like smoking.
• Reduce stress and depression.
  

Get back to work sooner and safely.

Exercise is a big part of cardiac rehab. So before you get started, you will have a full checkup, which may include tests such as an electrocardiogram (EKG or ECG) and a “stress test” (exercise electrocardiogram). These tests show how well your heart is working. They will help your team design an exercise program that is safe for you.

At first your rehab team will keep a close watch on how exercise affects your heart. As you get stronger, you will learn how to check your own heart rate when you exercise. By the end of rehab, you will be ready to continue an exercise program on your own.

What are the benefits of cardiac rehab?
Starting cardiac rehab after a heart attack can lower your chance of dying from a heart attack and can help you stay out of the hospital. It may reduce your need for medicine.

Cardiac rehab may also help you to:

• Have better overall health.
  
• Lose weight or keep weight off.
• Feel less depressed and more hopeful.
  
• Have more energy and feel better about yourself.

Changing old habits is hard. But in cardiac rehab, you get the support of experts who can help you make new healthy habits. And meeting other people who are in cardiac rehab can help you know that you're not alone.

Last Updated: April 08, 2008