The Healthy Heart Diet

By Lambeth Hochwald / Recipes by Maria Cooper

When Mary Anne Nally of Southold, New York, went for her annual physical, she feared what her doctor might say when he saw her blood-test results. “High cholesterol runs in my family, and even though I eat a relatively healthy diet, I had a sneaking suspicion mine was high too,” says the 54-year-old. “I was afraid my doctor might want to put me on a statin drug, which I really didn’t want to take.” When her doctor did, indeed, suggest a statin, Nally asked him to give her three months to get her cholesterol down on her own. He agreed, but warned her that she’d have to work hard. “He said I would need to start exercising regularly and completely overhaul my diet.”

With at least 11 million Americans taking statin drugs to keep their cholesterol levels under control, popping a pill to get your numbers down seems like a no-brainer. But the research is clear: Diet, along with a healthy dose of daily exercise, can do your body just as much good. In fact, according to a recent study conducted at the University of Toronto, eating cholesterol-lowering foods regularly, such as oats, almonds, and barley, can lower your levels just as effectively as statins—and a lot more safely.
“Diet is definitely the key to lowering cholesterol without drugs,” says Judith Stanton, MD, an internist who combines conventional internal medicine with alternative and complementary therapies in her Berkeley, California, practice. Stanton sites multiple studies on how a Mediterranean diet—which consists of mostly fruits, vegetables, grains, and olive oil—has been shown to reduce the risk of heart disease by 72 percent, while cholesterol-lowering drugs only decrease the risk of heart disease by 34 percent.

Whether you take a statin now, your doctor has threatened to prescribe one, or you want to avoid that possibility, changing your eating habits can have a lifelong impact on your heart health.

Cholesterol 101
Over the last 20 years or so, cholesterol has gotten a pretty bad rap. Fact is, literally every cell of the body needs this waxy, fat-like substance to help digest fats, strengthen cell membranes, and make hormones. Because of the essential role cholesterol plays, the body creates all it needs on its own—about 1,000 mg a day. However, we get even more from some of the foods we eat; egg yolks and meat, for example, have the most, while plant-derived foods have none at all.

In order for cholesterol to reach our cells, it must rely on special carriers called lipoproteins: low-density lipoproteins (LDL) and high-density lipoproteins (HDL) to be exact—two terms often tossed around respectively as “bad” and “good” forms of cholesterol. Why the value judgments? To answer that, it helps to know what each one does, says Robert Marshall, MD, assistant professor of medicine at Georgetown Hospital in Washington, DC.

LDL carries cholesterol through the body and deposits it in the cells. HDL transports any cholesterol the cells don’t need to the liver, where it eventually gets processed and eliminated. As long as the right balance of cholesterol exists in the body, this LDL–HDL relationship works well. However, when the body has far more cholesterol than it needs—which happens when we eat too many foods high in cholesterol—LDL deposits the excess cholesterol onto artery walls, where it forms plaque that clogs the blood vessels and can ultimately lead to heart disease or even a heart attack.

Diet changes that work
One thing holistic docs know for sure: Watching what you eat can effectively keep cholesterol levels in check. Foods high in saturated fat and cholesterol, such as fatty cuts of beef, pork, and lamb and whole dairy products like milk, cream, and full-fat cheeses, upset the body’s natural production of cholesterol. Similarly, foods that have no cholesterol, such as oatmeal, fruits, and vegetables, won’t touch the body’s ideal levels, but these fiber-rich foods can help lower LDL cholesterol in the body.

“In order to digest a food like oatmeal, the body needs to use bile acids,” says Marshall. “To replenish bile acid after digestion, the body actually draws on its own cholesterol sources—like the excess cholesterol floating around in your blood. So foods like this can actually catch that cholesterol before it oxidizes and hardens on your artery walls.”

However, while all of this is hopeful news for patients like Nally, who want to try to lower their cholesterol through diet alone, no amount of diet changes can alter our basic cholesterol metabolism. “Thanks to our genes, we all have different ways of metabolizing cholesterol,” says Robert Vogel, MD, a cardiologist and chief medical director of the Pritikin Longevity Center and Spa in Aventura, Florida. “Some of us absorb more cholesterol, some less—despite our LDL and HDL levels. That’s why one person may eat a healthy diet and still have high cholesterol while someone else cuts out red meat and whole milk and watches her cholesterol levels drop 100 points.”

But even if your family history shows that you have a predisposition for high cholesterol, savvy doctors still want to help you avoid statins; if yours doesn’t, it might be time for a second opinion. Luckily for Nally, her doctor was on board with her commitment to make the necessary changes to stave off statins.

The plan
To kick her cholesterol-lowering plan into high gear, Nally completely cut out foods that contain artery-blocking saturated fats and trans fats, including her favorite packaged foods. She also doubled her servings of fruits and vegetables, particularly those that are high in soluble fiber (think apples, pears, spinach, kale, and broccoli).

Tougher for Nally, though, was keeping her total cholesterol intake to 200 milligrams or less each day, which meant reading food labels carefully. “Fruits and veggies and the other ‘heart-healthy’ foods have no cholesterol, but things get trickier when you venture into the packaged food aisles,” says Janet Brill, PhD, RD, a nutritionist, exercise physiologist, and author of Cholesterol Down: Ten Simple Steps to Lower Your Cholesterol in Four Weeks—Without Prescription Drugs (Three Rivers Press, 2006). “For example, if you eat just one egg yolk, you’ll take in 213 mg of cholesterol, and you’re already over the top of your daily maximum,” says Brill. “Instead, opt for egg whites.”

Worried about how many foods you have to cut out? You needn’t be. Plenty of delicious, easy-to-eat foods can help you meet your cholesterol-lowering goals. For example, the folate and potassium in orange juice will help increase heart health and reduce cholesterol, says Brill. Experts also agree it’s a good idea to boost your intake of omega-3 fatty acids by eating fish two to three times a week. Studies show that in addition to lowering blood pressure and reducing the risk of blood clots, omega-3s also reduce inflammation, which can bring your cholesterol levels lower.

In general, shoot for a diet rich in vegetables (ideally six servings per day), fruit (four servings a day), olive oil or canola oil, fish, whole grains, oatmeal, green tea, mushrooms, sesame seeds, and flax, says Brill.

“When I thought about my new diet in terms of what I should add rather than what I had to give up, I missed the sweets and processed foods so much less,” says Nally. “It’s amazing how when you get in the habit of swapping bad stuff for good stuff—like yogurt instead of ice cream and olive oil instead of butter—you literally stop craving the unhealthy things. They even start to taste worse.”

Lambeth Hochwald is a freelance writer in New York City.

Vegetable Frittata
4 to 6 servings

1 tablespoon olive or canola oil
2 cups sliced mushrooms
1 medium, julienned red pepper (1 cup)
2 cups minced broccoli
1/4 teaspoon dry thyme
2 cups chopped spinach

Whisk and set aside:
12 egg whites
3 tablespoons skim milk
(or nondairy alternative)
1/2 teaspoon salt
1/2 teaspoon black pepper
3 tablespoons chives, chopped,
reserve 1 tablespoon for garnish
3 oz crumbled goat cheese, reserve
1 oz for garnish

1. Preheat oven to 350 degrees.
2. Heat oil in large nonstick skillet over medium-high heat. Add mushrooms in an even layer, and do not move them for
3 minutes. Stir, and continue to sauté for about 5 more minutes until they are browned.
3. Add red pepper, broccoli, and thyme and sauté
3 to 5 more minutes; add 2 to 4 tablespoons of water if vegetables begin to stick. Add spinach, and toss until wilted.
4. Spray a 9-inch pie pan with nonstick spray. Sprinkle goat cheese and chives on bottom ofpan, then add vegetables. Pour egg whites on top and bake for 25 minutes, uncovered. Cover with foil and bake 10 more minutes. Remove from oven and let rest for 5 to 10 minutes. Garnish with crumbled goat cheese and chopped chives.
nutrition info per serving (4): 216 calories; 11. 4 g fat; 5.8 g saturated fat; 22.3 mg cholesterol; 22.3 g protein; 7.5 g carbohydrates; 2.8 g fiber; 564.6 mg sodium

Dark Chocolate & Date Truffles
Makes 24 truffles

1 bag or bar of dark chocolate (12 oz)
1 2/3 cups raw cashews
8 oz dates, finely chopped
1/4 teaspoon sea salt
Zest of 1/2 of an orange

1. Melt chocolate in double boiler until just melted.
2. Meanwhile, blend 2?3 cups cashews with 2?3 cups water in blender on high for 30 seconds. Chop remaining cashews and set aside.
3. Fold together melted chocolate, cashew mixture, dates, sea salt, and orange zest.
4. Refrigerate until firm, approximately 45 minutes. Roll 3/4-inch balls in hands and then in chopped cashews. Refrigerate until ready to serve. (Note: Truffles will keep in freezer up to 1 month.)
nutrition info per truffle: 105 calories; 5 g fat; 3 g saturated fat; 1 mg cholesterol; 1 g protein; 15 g carbohydrates; 1.5 g fiber; 5 mg sodium

Oatmeal Raisin Pancakes
Makes 16 3-inch pancakes

1 1/2 cups quick oats
1/2 cup whole-wheat flour
2 tablespoons wheat germ
2 teaspoons baking powder
1 tablespoon cinnamon
3 tablespoons brown sugar
3/4 cup raisins
3 egg whites
1 1/2 cups skim milk (or nondairy alternative)
1 teaspoon vanilla
2 ripe bananas, mashed (microwave 20 seconds
if not very ripe)
1/4 cup nonfat plain yogurt
Nonstick cooking spray

1. Mix dry ingredients in large bowl and create a well in the center.
2. Whisk together wet ingredients, and pour into the well and blend.
3. Heat a large non-stick skillet to medium–high heat, and cover with non-stick spray. Pour 1/4 cup portions onto pan and cook approximately 2 to 4 minutes on each side. Serve with a sprinkle of powdered sugar.
nutrition info (per pancake): 93.4 calories; 0.7 g fat; 0.2 g saturated fat; 0.5 mg cholesterol; 3.6 g protein; 19.4 g carbohydrates; 1.9 g fiber; 163.1 mg sodium

Grilled Cod With Black Bean–Mango Salsa
Serves 4

4 1/2 pounds cod fillets
2 tablespoons extra-virgin
olive oil

Black Bean-Mango Salsa
Makes 6 cups
1 lime
1/2 orange, reserving zest
1 tablespoon red-wine vinegar
1 teaspoon honey
1 small, minced jalapeño pepper (optional)
1 15 oz can black beans, drained and rinsed
1 small mango, diced (1 cup)
1/2 cup green onion, finely sliced
1/2 cup chopped cilantro

1. Mix together all black bean–mango salsa ingredients at least 30 minutes (and up to 24 hours) prior to serving.
2. Lightly brush cod fillets on both sides with extra-virgin olive oil and grill 6 to 7 minutes on each side, until fish is opaque.
3. Mound 1½ cups of black bean mixture on a plate. Lean each piece of grilled cod against salsa.
nutrition info per serving: 339.1 calories; 2.1 g fat; 0.4 g saturated fat; 93.5 mg cholesterol; 46.1 g protein; 33.6 g carbohydrates; 7.8 g fiber; 136.7 mg sodium