10 Steps to Heart Health

By: Philip A. Ades, M.D., EatingWell Editors

You can change your fate by simply eating well.


You can change your fate by simply eating well.


Learn about 4 heart-healthy foods
In the United States, heart disease affects about 9 million adults, killing one every 37 seconds. But the good news—which Dr. Philip Ades, author of the new book EatingWell for a Healthy Heart has made it his mission to spread—is that heart-disease is mostly preventable. Research shows that up to 90 percent of heart disease can be prevented by changing one’s diet, exercising more, maintaining a healthy weight and not smoking. Reduce your risk by following these 10 simple steps.

Next: Step #1: Know your numbers. 

High blood cholesterol is linked with about one-third of heart disease cases worldwide, according to data from the United Nations. Your blood cholesterol (lipid profile) is made up of several readings: high-density cholesterol (HDL), low-density cholesterol (LDL) and triglycerides (TG). LDL cholesterol and triglycerides are often referred to as “bad” cholesterol; high levels (greater than 160 mg/dL and 200 mg/dL, respectively) are considered risk factors for developing heart disease. On the other hand, “good” HDL protects against cardiovascular disease. (A healthy HDL target is 60 mg/dL or higher.) But an undesirable lipid profile doesn’t mean that developing heart disease is inevitable. Research shows that changing your diet for the better can help lower “bad” LDL and TG levels, as well as increase “good” HDL cholesterol, if they’re out of healthy ranges. Talk with your doctor about a screening. Medications are sometimes needed.

Next: Step #2: Calculate your risk. 

Having multiple factors for heart disease increases your risk exponentially. For example, if you smoke, have high blood pressure or high cholesterol, any one of these factors doubles your likelihood of developing heart disease in the next six years. But having all three increases your chance eightfold. The good news: treating any one of these risk factors effectively—say, you quit smoking or bring your cholesterol into a healthy range—halves your likelihood of developing heart disease (i.e., you’ll have four times, rather than eight times, the risk of someone who doesn’t have any of these risk factors).

Next: Step #3: Lose weight if you need to. 

Losing as little as 5 to 10 percent of your body weight—about 8 to 15 pounds if you start at 150—will result in better blood pressure, lower risk for diabetes and improved cholesterol levels, research suggests. Are you toting around too many pounds? There are two ways to find out. First, calculate your body mass index (BMI). A normal BMI is 18.5 to 24.9. A BMI of 25 to 29.9 is overweight, and 30 and above is considered obese. Some complain that, if you are muscular or “large-boned,” you may get a BMI that suggests you’re overweight when you’re really not. To double check, Phil Ades suggests you perform the “Ades-ocular” test: Strip down to your underwear and stand sideways in front of a full-length mirror. If your abdomen droops or sticks out, the high BMI is correct. If it’s flat and firm, your BMI may, indeed, be incorrect.

Step #4: Slash your intake of saturated fat.

Butter. Sour cream. Mayo. These foods—as well as fatty cuts of meats—are high in the saturated fats that elevate “bad” LDL cholesterol, leading to plaque buildup in arteries. Limit saturated fats to 5 percent or less of your total calories (divide your weight by 12 to get the daily total limit in grams). For example, try replacing butter with vegetable-based oils, particularly olive and canola oil, both of which contain good amounts of heart-healthy monounsaturated fats, and by swapping in lean poultry, fish and beans for higher-fat meats.

Step #5: Junk the junk food.

Many packaged snacks, crackers, bakery goods and some margarines contain artificial trans fats (a.k.a. hydrogenated oils), which increase “bad” LDL even more than saturated fats, according to recent research by Walter Willett, M.D., at the Harvard School of Public Health. In a 2003 interview with EatingWell, Willett blamed trans fats for millions of unnecessary premature deaths from heart disease. Read labels carefully: if a package claims “zero trans fat,” the amount per serving may be less than 0.5 g and could have been rounded down to zero. The only way to be sure you’re getting a product without trans fats is to avoid products that include “hydrogenated oil.” Better yet, stock up on nutrient-rich vegetables, fruit and nuts.

Step #6: Fill up on fiber.

Various studies link a high-fiber diet with a lower risk of heart disease. In a Harvard study of female health professionals, people who ate a high-fiber diet had a 40 percent lower risk of heart disease than those who ate a low-fiber diet. Aim to include plenty of foods that are rich in soluble fiber, which, studies show, can help lower “bad” LDL. Soluble fiber binds bile acid, a key component in fat digestion that our bodies make from cholesterol. We can’t digest fiber, so when bile acids are bound to it, they get ushered out of the body as waste. This causes the body to convert more cholesterol into bile acids, which ultimately has the effect of lowering circulating cholesterol levels. Foods high in soluble fiber include oatmeal, barley, beans, okra and eggplant, and citrus fruit, such as oranges.

Step #7: Replace refined grains with whole ones.

Eating too many refined carbohydrates (e.g., white bread, pastries, white pasta) fuels the body’s ability to make triglycerides. What’s more, processed grains are quickly converted to glucose, which raises blood glucose levels and may predispose one to developing type 2 diabetes, a risk factor for developing heart disease. Choose whole grains, such as brown rice, wheat berries and quinoa and whole-wheat pastas, which contain more fiber (which slows down the conversion of starches to glucose) and healthful fats than processed grains.

Step #8: Go fish.

Consuming two or more servings of fish per week is associated with a 30 percent lower risk of developing coronary heart disease over the long term, studies show. Fish contain omega-3 fats, which lower levels of triglycerides in the blood that may contribute to blood clotting. Omega-3s also lower blood pressure slightly and can help prevent irregular heart rhythms. (Flaxseed oil, canola oil and walnuts also contain omega-3 fats.)

Step #9: Get nuts.

Research suggests that people who eat nuts—walnuts, pecans, almonds, hazelnuts, pistachios, pine nuts and peanuts (which actually are legumes)—two to four days or more per week have a lower incidence of heart disease than people who eat them less. All nuts contain good amounts of heart-healthy monounsaturated fats and low levels of saturated fats.

Step #10: Enjoy alcohol in moderation.

Scientific literature indicates that people who drink moderately are less likely to have heart disease than those who abstain. Alcohol appears to raise “good” HDL cholesterol. Wine, in particular, “thins” the blood (making it less prone to clotting) and also contains antioxidants that prevent your arteries from taking up LDL cholesterol, a process that can lead to plaque buildup. Remember, 1 drink equals 12 ounces of beer, 5 ounces of wine or 1.5 ounces of liquor.