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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
In the UK, 7 out of 10 people over the age of 45 have high cholesterol levels (Bupa 2007). Although there are no clear symptoms, high cholesterol levels have been associated with heart disease and stroke – two of Britain’s biggest killers. There are several factors that can cause high cholesterol; an unhealthy diet, being overweight and a lack of exercise are three of the main contenders. As a result, some of the best ways to control and reduce cholesterol levels are losing weight, eating a heart-healthy diet and taking regular exercise.
Although eating healthily may sound simple, it’s often difficult to know which foods to avoid when trying to lower cholesterol.
Fully adapted for the UK market, Low-Cholesterol Cookbook For Dummies reveals which food you should eat and helps readers make small changes to their diet to achieve big results.
Low-Cholesterol Cookbook For Dummies includes:
- The latest dietary and medical information on cholesterol and how to control it
- Over 90 delicious recipes as well as low fat cooking techniques and ways to lower cholesterol on a daily basis
- Sensible advice on finding the right foods when shopping, planning menus, and adapting recipes to suit family and friends.
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Veröffentlichungsjahr: 2011
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Low-Cholesterol Cookbook For Dummies®
Table of Contents
Low-Cholesterol Cookbook For Dummies®
by Dr Sarah Brewer, GP, and Dr Molly Siple, RD
Low-Cholesterol Cookbook For Dummies®
Published byJohn Wiley & Sons, LtdThe AtriumSouthern GateChichesterWest SussexPO19 8SQEngland
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Copyright © 2008 John Wiley & Sons, Ltd, Chichester, West Sussex, England
Published by John Wiley & Sons, Ltd, Chichester, West Sussex
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British Library Cataloguing in Publication Data: A catalogue record for this book is available from the British Library
ISBN: 978-0-470-71401-0
Printed and bound in Great Britain by Bell & Bain Ltd., Glasgow
10 9 8 7 6 5 4 3 2 1
About the Authors
Dr Sarah Brewer, GP, qualified from Cambridge University. Having worked as a GP and as a hospital doctor, she now specialises in nutritional medicine, taking an holistic approach to well-being. She is the author of 50 popular self-help books including the Natural Health Guru series, which you can find out about at www.naturalhealthguru.co.uk.
Dr Molly Siple, RD, is also the author of Healing Foods For Dummies. She writes a nutrition column that appears in Natural Health magazine and she has taught nutrition at the Southern California School of Culinary Arts in Pasadena, California. She is the coauthor, with Lissa DeAngelis, of Recipes for Change, which was a finalist nominee for the International Association of Culinary Professionals’ Julia Child Cookbook Awards in the Health and Special Diet category. Ms. Siple also founded a successful catering business in New York City.
Publisher’s Acknowledgements
We’re proud of this book; please send us your comments through our Dummies online registration form located at www.dummies.com/register/.
Some of the people who helped bring this book to market include the following:
Acquisitions, Editorial, and Media Development
Development Editor: Steve Edwards
Content Editor: Jo Theedom
Commissioning Editor: Nicole Hermitage
Copy Editor: Martin Key
Proofreader: Andy Finch
Technical Editor: Sue Baic
Recipe Tester: Emily Nolan
Nutritional Analyst: Patty Santelli
Publisher: Jason Dunne
Executive Editor: Samantha Spickernell
Executive Project Editor: Daniel Mersey
Cover Photos: © Robert Morris/ GettyImages
Cartoons: Ed McLachlan
Composition Services
Project Coordinator: Lynsey Stanford
Layout and Graphics: Christin Swinford
Proofreader: Susan Moritz
Indexer: Cheryl Duksta
Brand Reviewer: Rev Mengle
Introduction
The first place to start in controlling cholesterol and lowering your risk of heart disease is with your lifestyle – in particular, by changing and improving what you eat. Sounds hard? Don’t despair. The advice inthis bookis easy to swallow, as we’re sure you’ll find when you sample the delicious recipes!
Good nutrition is the most important foundation for good health. Nutrients in food work in amazing ways, on both the cellular and molecular level, to restore and maintain normal body function. The vitamins and minerals in the foods you read about in this book help to lower the level of ‘bad’ cholesterol in your body, while at the same time raising the good kind, and protecting your arteries from damage. And that’s just the beginning of a long list of things they do. Of course, you’ve already taken the right first step by deciding to pick up this cookbook. Getting healthier starts in the kitchen!
The dishes in this book have been specially developed for the needs of someone whose cholesterol level is elevated. You may also need medication to treat your condition, but dietary and lifestyle changes alone often can improve your health enough to avoid the need for medicine. Do discuss your own situation with your doctor, though.
About This Book
The Low-Cholesterol Cookbook For Dummies provides a good overview of effective ways to control cholesterol levels, backed up by the experience of nutritionists and the results of scientific studies. Between the covers of this book, you can find the basics about fat and cholesterol in foods and about putting together meals that give you healthy amounts of both. You also discover lots of information on the various nutrients that lower ‘bad’ LDL (low density lipoprotein) cholesterol or raise the ‘good’ cholesterol, including soluble fibre which soaks up cholesterol and escorts it out of your body. To ensure that this book is as up-to-date as possible, it also touches on some newly recognised risk factors for heart disease that tie in with managing cholesterol.
As well as all this information, you can find chapters that each cover a category of food, such as vegetables, poultry, or fish, giving you basic tips for cooking these and identifying which ones best suit a cholesterol-lowering diet. Use these recommendations to write your shopping lists. The recipe pages are also packed with useful health advice, and the introductions to the recipes are filled with nutritional information on what you’re about to cook.
These recipes are so delicious that you’re guaranteed to want to eat them even putting their nutritional benefits aside! Each dish features nutritious, fresh, and natural foods that have beneficial effects on your cholesterol balance. Ingredients and procedures are kept as short and simple as possible, but without sacrificing their all-important flavour.
Conventions Used in This Book
The recipes in this book are complete, but may not spell out every detail of preparing and cooking the food. For example, certain steps and techniques in cooking are standard (such as removing shells from eggs), no matter what you’re preparing. Take a quick look at the following list for points that apply to all the recipes:
Organic foods aren’t required but try to buy organic when you can, because they generally contain more antioxidants and nutrients that have a beneficial effect on cholesterol balance. If you use non-organic fruit and vegetables, wash and peel them first because this helps to remove any lingering agricultural chemicals.
Fruits and vegetables should be washed under cold running water before using.
Pepper is freshly ground black pepper. Invest in a pepper mill and give it a few cranks when you want pepper bursting with flavour.
Fresh herbs are specified in many of the recipes for their bright, authentic flavour. But you can still make a recipe if you don’t plan to use these by substituting dry herbs, using one-third the amount of fresh.
Dairy products are low-fat.
Eggs are large unless otherwise indicated.
Canned goods are the low-sodium or no-added-salt versions.
Food products don’t contain any partially hydrogenated oils – check the labels.
Keep pots uncovered unless we tell you to put on the lid.
Keep the following points about the recipes in mind:
Most of the recipes are for four servings, an easy number to multiply or divide if you’re feeding a crowd or you need just two servings for you and a friend. If the recipe makes any more or any fewer servings, we tell you so at the start.
The nutrient information given at the end of each recipe is the amount of those items in a single serving. If you choose a larger serving size, you need to increase these numbers.
If you can’t find the exact ingredient that a recipe calls for in a specific amount, don’t worry. A little more or less of an item is unlikely to ruin the dish, and – who knows – if you tinker slightly with the ingredients you may invent something that you like even better.
The preparation time estimated for each recipe includes cutting veg and assembling ingredients and measuring them. Doing this before you start cooking also makes the whole process more efficient. And you don’t discover that you’re out of olive oil just at the moment you need to add some.
The temperature for all recipes is in degrees Celsius.
Here are some non-recipe conventions to be aware of when reading this book:
Italic text emphasises and highlights new words or terms that we define.
Boldfaced text indicates the action part of numbered steps.
Monofont highlights any web addresses we refer to.
T This tasty little tomato indicates a vegetarian recipe. You see it in the ‘tabs’ at the front of the recipe names in the recipe chapters.
What You’re Not to Read
You don’t have to read every single word we’ve written. We do recommend reading the regular paragraphs, however. These sections tell you the basics about controlling your cholesterol. But you don’t have to read items marked with the Technical Stuff icon, which although interesting, give you more details and facts than you may want or need.
Sidebars are also optional reading. They provide supporting material on the subject of heart disease but aren’t absolutely essential for finding out how to manage your cholesterol balance. And if you’re already a pro at cooking, certainly skip over any cooking advice that you find obvious. But don’t worry, you won’t find instructions on how to boil a kettle.
Foolish Assumptions
We designed these recipes to suit a certain kind of cook:
You’re fairly handy in the kitchen. You know how to clean mushrooms without someone showing you what to do, and stuffing a chicken is no big deal; but making a galantine of chicken (a simmered and boned, stuffed chicken glazed in aspic) is beyond your scope, which is okay, because you won’t find many elaborate cooking techniques in this book.
You know how to shop for food. At least, you know your way around a supermarket, but when you wander into a health food store, or an ethnic supermarket, you spot all sorts of ingredients you don’t even know exist. You soon will. Some recipes purposely include special ingredients, such as date sugar, Italian Prosciutto, and oil-cured olives in various recipes to lead you into a few delicatessens.
You want dishes with personality and flavours that get your attention, start you salivating, and keep your taste-buds tingling.
Fiddling with recipes is normal for you when you’re trying out a dish, and you’re comfortable doing so. You’re the only person who knows how much garlic or onion you like, for example.
You realise that spending time cooking at least one nutritious meal per day is an important part of taking care of your health and controlling your cholesterol balance. But you’re not signing on for hours of fussing in the kitchen. A recipe that lets you get in and out in an hour or less is what you’re after, or you at least prefer a dish you can throw together and cook without watching the pot.
How This Book Is Organised
We’ve organised the chapters in this book around ways of eating and types of food proven to improve cholesterol balance. Each part is divided into chapters that address specific subjects. The following sections describe the main themes in each part.
Part I: Understanding Cholesterol Basics
These five chapters tell you what to eat and why, presenting a diet that features nutritious wholefoods, cuts back on saturated fat, and balances wholegrain carbohydrates with healthy oils. These pages are also packed with information on the nutritional components of the foods in the recipes and how they affect health in terms of biochemistry – the metabolic reactions occurring inside your cells. Useful shopping lists feature the best foods to eat.
You also get some tips on what to order in restaurants. If you intersperse cooking with eating out, you can refer to Chapter 4 to find out about the healthy foods you can order. And in Chapter 5, we give you some tips on setting up your kitchen and getting ready to cook.
Part II: Mastering the Beneficial Breakfast
Breakfast deserves its own section because it’s usually the least nutritious meal of the day, and yet is also the most important. Oats are in the spotlight, of course, as a source of soluble fibre, but you also find information here about other healthy breakfast grains. In Chapter 7 on cooked breakfasts, we steer you in the direction of eating a little protein-rich fish before the sun is high in the sky. You also find out about the health benefits of eggs and how many are fine to eat per week. Chapter 8 tackles the issue of wanting breakfast but having no time to make it, and gives you ways to ensure that you eat something quick, yet healthy, to start your day right.
Part III: Making Your Day with Heart-Healthy Snacks and Starters
This part is especially helpful for beginner cooks, because you really can’t go far wrong making soup or salads. These foods are forgiving, and so if you want to add ingredients or experiment with changing amounts, dabble away. These dishes include lots of cholesterol-controlling foods and also provide ways of eating red meat, because a little goes a long way in soups and salads. Chapters 11 and 12 give you a chance to have fun by putting together some tasty party foods – all sorts of healthy starters and nibbles that dress up easily to impress company.
Part IV: Cooking with Poultry, Fish, and Meat
Find out how to include animal protein in your diet without over-dosing on saturated fat and pre-formed cholesterol. It’s all about knowing which cuts are the leanest and controlling portion sizes so you eat less over all. You find some good reference materials here that you can use as a guide on these matters, as well as recipes that taste rich and leave you feeling well-fed. If you like fish, with their ever-so-healthy oils, look for the preferred fish shopping list and guidelines on how frequently to eat seafood. Then you can start cooking up some delicious fishes for your dishes.
Part V: Cooking with Cholesterol-Controlling Vegetables, Beans, and Grains
This part enables you to explore many enticing ways to cook plant foods that are naturally low in saturated fat and cholesterol. Read the how-tos on buying, storing, and preparing grains, beans, and vegetables so that you become more confident about cooking these foods and start to eat them more often. You also find a shopping list of the top 10 vegetables that are good for health and cholesterol balance. Look out for the fine details on bean cookery and the useful chart giving recommended cooking times for different grains.
Part VI: Serving Up Sweet Finishes
This part gives you the chance to create some extra-special desserts. As well as great fruit puddings, you find guilt-free recipes for baking using healthy wholefood ingredients. You can even satisfy your sweet tooth with creamy concoctions based on tofu, fromage frais, and yogurt.
Part VII: The Part of Tens
This last part covers two important topics: healthy drinks to enjoy and ways to save money when you’re stocking your kitchen with all these quality foods. We present the information in each chapter as a list of ten points.
Icons Used in This Book
Throughout the book, you’ll see icons that mark the vital information in low-cholesterol cooking. Here’s a listing of what they mean:
The tips in this book offer you useful shortcuts and information for food preparation, cooking, shopping, and more.
This icon alerts you to things you should avoid eating or that need to be handled in a specific way, or possible complications that come up while you’re watching your diet or preparing certain foods.
This icon points out general suggestions about shopping, cooking, and eating that are good to keep in mind.
Text marked with a Technical Stuff icon gives you the low-down on nutrient and vitamin details and scientific studies and findings. You don’t have to read this information to use the recipes in the book, but you may find it interesting.
Where to Go from Here
The nice thing about using a For Dummies book is that you can open it at any chapter and find all you need to know about a certain topic without having to flip to other sections. You may well have picked up this book right now simply because you’re hungry and all you want to do is make yourself a salad, in which case just move to Chapter 10. After all, this is a cookbook, and people usually head for the recipes.
However, at some point, perhaps while munching through that healthy green salad, try poking your nose into the first three chapters, especially Chapter 1. This opening chapter gives you a complete overview of the main themes of the book. Also, at least skim over the recommended foods in Chapters 2 and 3. Then you don’t just fulfil the role of a reader. You become the expert!
Part I
Understanding Cholesterol Basics
In this part . . .
This part provides an overview of ways to eat that are proven to help control cholesterol balance. We explain how all sorts of delicious foods can lower a raised cholesterol level in specific ways, and why soluble fibre and other ingredients are good for your heart. We also show how you can continue to eat foods such as nuts, red meat, and even certain shellfish, which cholesterol-lowering diets often exclude. In addition, we help you figure out what to order in restaurants. Finally, this part offers advice on how to set up your kitchen to cook in healthy ways, and which basic cholesterol-lowering ingredients to shop for so you can start trying some of the recipes.
If you look at only one chapter in this part, look at Chapter 1, which includes the essence of all the major points in the book.
Chapter 1
Conquering Cholesterol Is Easier Than You Think
In This Chapter
Sorting out the different types of cholesterol
Reducing your heart disease risk factors
Developing a way of eating to control cholesterol balance
Linking cholesterol to carbohydrate intake
Having firsts but not seconds
Introducing the recipes
Your heart goes about its business, beating over 100,000 times a day, and yet you probably give it little thought, until you have your cholesterol checked and discover it’s too high. Then, suddenly, caring for this precious part of your body takes centre stage.
In fact, you need to take care of your heart even if your cholesterol levels are normal. And that’s where this cookbook comes in – to give you a tool for controlling your cholesterol balance and keeping your heart healthy with good nutrition.
This chapter starts with a brief description of cholesterol before introducing you to a healthy way of eating, and the types of foods to include in a heart-healthy diet. We describe other risk factors for heart disease and explain how the same foods that lower cholesterol levels can help these conditions, too. Next, we warn you about portion control before moving on to discuss the recipes and the inspiration behind them.
Knowing That Cholesterol Doesn’t Grow on Trees
Cholesterol is a wax-like fat. Animal livers produce cholesterol, whether it’s your liver or the liver of a chicken or cow. Only animal products, such as eggs, meat, and dairy foods, contain cholesterol. As plants don’t have livers, they don’t contain any cholesterol, which is one reason why a cholesterol-friendly diet includes eating lots of plant-based foods.
Your liver manufactures cholesterol by joining together 15 two-carbon molecules known as acetates (or vinegars) end to end. Then, after a few other steps, a 27-carbon cholesterol molecule is formed. But here’s what’s really interesting – those two-carbon acetates can come from several sources, including fatty acids, proteins, sugars, starches, and alcohol.
Normally, your body produces less cholesterol as you consume more pre-formed cholesterol (in other words, cholesterol made by the animal you’re eating rather than made in your body from saturated fat) in your diet. However, in some people, the opposite is true, and the level of cholesterol in their blood increases as they eat more and more cholesterol in animal-based foods. Individual responses to dietary cholesterol vary widely – depending partly on the genes you inherit, so choose your parents carefully!
Excess cholesterol is potentially dangerous because it can build up inartery walls and reduce the flow of blood to your internal organs, including the heart. This blockage results in a disease called atherosclerosis, where the arteries harden and fur up, which is a major cause of heart attacks and strokes.
Cholesterol circulates in your bloodstream in the form of a package called lipoprotein, which is made up of cholesterol, protein, and fat assembled in your liver. For more details about cholesterol and the heart, take a look at Controlling Cholesterol For Dummies by Carol Ann Rinzler and Martin W. Graf (Wiley).
Lipoprotein comes in many different types, but the two you hear most about are low-density lipoprotein (LDL) and high-density lipoprotein (HDL).
LDL transports cholesterol away from your liver and it’s this cholesterol that deposits in arterial walls and starts the formation of plaques – the lumpy bits that cause arteries to narrow. Blood flow slows at these narrowings and a blood clot can form that quickly blocks the flow of blood and triggers a heart attack or stroke. That’s why people think of LDL as ‘bad’ cholesterol. In contrast, HDL carries cholesterol back to the liver where it gets converted into bile acids and excretion via your intestinal tract. HDL helps to protect against atherosclerosis, which is how it earns its nickname of the ‘good’ cholesterol.
So, the purpose of a good cholesterol-friendly diet is not just to lower your total cholesterol, but also to lower LDL and raise HDL. It’s all about obtaining the right cholesterol balance.
If you don’t know your cholesterol levels and plan to have them checked, you ideally need more than one test because cholesterol levels can fluctuate. If your total cholesterol is more than 5 mmol/L (millimoles per litre), ask your doctor when he or she can repeat the test again. If the results of the two tests are within 0.80 mmol/L of each other, average them (by adding the two figures and dividing by two). If the difference is greater than 0.80 mmol/L, take a third test and average the three (by adding the three results and dividing by three). If the result remains above 5 mmol/L, discuss it further with your doctor.
Doing the numbers
What constitutes a healthy cholesterol level is controversial, even among doctors, and the upper level accepted as normal (by the Joint British Societies – a group of UK expert societies involved in cardiovascular disease) is reducing as doctors develop more ways to reduce the risk of heart disease.The National Institute for Health and Clinical Excellence (NICE) and Department of Health offer these general guidelines to assess cholesterol levels. When you have a cholesterol test, compare the results with these figures. Doctors measure cholesterol levels in millimoles (mmol) of cholesterol per litre (L) of blood.
Category Level
Total cholesterol less than 5.0 mmol/L
LDL cholesterol less than 3.0 mmol/L
HDL cholesterol greater than 1.2 mmol/l
However, the Joint British Societies recommend lower cholesterol limits for people who have, or are at risk of, coronary heart disease, as follows:
Category Level
Total cholesterol less than 4.0 mmol/L
LDL cholesterol less than 2.0 mmol/L
HDL cholesterol greater than 1.2 mmol/l
Eating for the Right Cholesterol Balance
The goal of controlling cholesterol balance with diet is not just to keep your total cholesterol within normal range. You also want to choose foods that lower LDL cholesterol and elevate HDL, while avoiding foods that do the opposite.
Lowering your ‘bad’ LDL levels
One of the most forceful messages about lowering cholesterol that has come through loud and clear over the years is to reduce your intake of saturated fats and dietary cholesterol, because they raise cholesterol levels. However, as research has progressed, this recommendation is altering slightly. Doctors now consider dietary cholesterol to be less of a risk factor in raising cholesterol levels than saturated fat, and another factor is trans fatty acids – the new bad boys on the block.
Restricting saturated fat intake
Saturated fat has a chemical structure that contains as many hydrogen atoms as possible and is usually solid at room temperature. Major dietary sources of saturated fat include full-fat dairy products, fatty meats, and tropical oils (coconut and palm oils).
All the traditional diets for reducing heart disease give high priority to restricting your intake of saturated fat. However, for people of normal weight, with no significant family history of high blood cholesterol levels, and with a good intake of dietary antioxidants from fruit and vegetables, the amount of saturated fat you eat is probably less important than previously thought. Over a third of the saturated fat in milk, butter, and meats doesn’t raise cholesterol levels. This is backed by the Framingham Heart Study, which shows no link between high blood cholesterol levels and saturated fat intake. The study showed that, although saturated fat intake increased as a proportion of energy from 16 per cent in 1966 to 17 per cent in 1988, the study population enjoyed significant decreases in total and LDL cholesterol levels.
Hold your horses, though – this result doesn’t mean that a high saturated fat intake isn’t harmful. Like all fats, saturated fat has a high calorie content and an excess is linked with obesity. If you have a family history of atherosclerosis, coronary heart disease, or high blood cholesterol levels, you’ve probably inherited genes that mean you process saturated fat less effectively than other people, and you need to follow a diet that is low in saturated fat.
The next question to ask is whether to replace that saturated fat with carbohydrates or other more healthy kinds of fat such as olive oil. We cover this topic in the section ‘Controlling your Cholesterol Balance through Diet’, later in the chapter.
Watching dietary cholesterol
By dietary cholesterol,we mean foods that are high in ready-made cholesterol, such as pig’s liver (700 milligrams/100 grams), lamb’s kidney (610 milligrams/100 grams), and caviar (588 milligrams/100 grams). Doctors don’t consider dietary cholesterol to be as harmful as they previously thought. Research shows that some cholesterol-rich foods, such as egg yolks and shellfish, are also relatively low in saturated fat and have minimal effect on LDL cholesterol levels.
Researchers at Harvard School of Public Health and Brigham and Women’s Hospital in Boston examined the association between egg consumption and incidence of cardiovascular disease in a study published in the Journal of the American Medical Association in 1999. Data came from a population of over 100,000 male and female health professionals. The study results show that eating up to one egg a day has no significant association with the risk of coronary heart disease or stroke. This is true even for individuals with elevated cholesterol.
The Food Standards Agency and other UK organisations don’t recommend a limit on how many eggs you can eat, even though an egg contains about 213 milligrams of cholesterol. They are a good choice for an excellent source of protein and vitamins as part of a healthy, varied, and balanced diet.
When deciding whether to consume a food that contains cholesterol, consider what else you’re eating that day so that you keep your intake within sensible limits.
Avoiding trans fatty acids
When certain oils are partially hydrogenated to solidify them in the production of cooking fats and margarines, some are converted into an artificial type of fat not normally found in nature known as trans fats. Trans fats lurk in breakfast cereals, salad dressings, all sorts of baked goodies such as muffins, pastries, breads, cakes, and biscuits, instant hot chocolate, frozen dinners, and many more foodstuffs. Any time you eat deep-fried foods such as chips or fried chicken, at home or out, you’re taking in some trans fats that form in the hot oil.
Research shows a strong link between trans fats and coronary heart disease. People with the highest intake of trans fats are 50 per cent more likely to have a heart attack than those with the lowest intake. A link is also appearing between trans fats and an increased risk of developing type 2 diabetes. (If this affects you, Diabetes For Dummies by Alan L. Rubin and Sarah Jarvis (Wiley) gives information and advice to help you live with the condition. Diabetes Cookbook For Dummies by Alan L Rubin, Sarah Brewer, Alison Acerra, and Denise Sharf (Wiley) is another good source of information.) Doctors think that this is because trans fats increase the activity of an enzyme CETP (cholesteryl ester transfer protein), which raises levels of LDL cholesterol and lowers levels of beneficial HDL cholesterol. Trans fats also raise triglycerides, another type of blood fat associated with increased risk of heart disease. (Chapter 3 gives you an even longer list of the harmful effects of trans fats.)
Check food labels and select products that say they are ‘free from trans fats’ or which don’t list hydrogenated vegetable oil, partially hydrogenated vegetable oil, vegetable shortening, or margarine.
The most effective way to avoid trans fatty acids is to select natural ingredients such as fresh fruits and vegetables rather than processed foods when you’re out shopping. Cooking your own meals using unrefined oils also helps keep trans fats off your plate. The recipes in this book let you bake your own muffins, dressings, sauces, and all sorts of main courses free of trans fats.
Choosing ingredients that lower LDL
As you plan your meals and experiment with recipes, include foods that are known to lower LDL cholesterol. Many common ingredients contain components that significantly lower your risk for heart disease. The following information helps you select foods that are good for you:
Some polyunsaturated fats lower LDL cholesterol levels. Sunflower and corn oils contain these fats, but these oils are highly processed, so try to avoid them. A better choice is safflower oil, which you can buy unrefined. (See Chapter 3 for more about why processed oils are less healthy than unrefined oils.)
Omega-3 fatty acids, a type of polyunsaturated fat found in oily fish, lower LDL levels and benefit the heart in other ways too, such as reducing the tendency to form unwanted blood clots.
Monounsaturated fats, when substituted for saturated fats, can lower LDL cholesterol and stabilise and may even raise HDL cholesterol levels. Almonds are a good source, and macadamia oil, for example, is 81 per cent monounsaturated fat – more than rapeseed oil (60 per cent), avocado oil (62 per cent), and olive oil (73 per cent). In addition, monounsaturated fats don’t raise triglyceride levels.
Soluble fibre, to a lesser extent, also lowers cholesterol because it helps to eliminate it from the body. Chapter 2 gives you a list of foods that contain soluble fibre.
Soya beans also have a beneficial effect when substituted for animal protein and may be particularly useful for individuals at high risk of coronary heart disease.
Aiming for more antioxidants
If LDL cholesterol oxidises (which is a chemical change occurring when it gets ‘attacked’ by oxygen), it’s more likely to deposit in your arteries and contribute to the formation of plaque. Fortunately, nature provides a wealth of nutrients that can reverse this process – substances found in fruit and vegetables known as antioxidants. The recipes in this book are full of these nutrients and, because foods high in antioxidants are also the most colourful, the dishes look great, too!
Antioxidants mop up and neutralise free radicals. Free radicals are molecules that contain an unpaired electron that’s missing a mate. This makes it unstable and it therefore darts here and there trying to steal one from another molecule to restore its stability. When a free radical comes in contact with LDL cholesterol, it steals an electron from it, thereby ‘oxidising’ the cholesterol and changing it. The cholesterol is then more likely to contribute to hardening and furring up of your arteries, a condition known as atherosclerosis. Antioxidants help to reduce atherosclerosis by intercepting and neutralising free radicals, to prevent cholesterol oxidation.
The best known dietary antioxidants are betacarotene, vitamin E, and vitamin C. Several minerals, including selenium, also play a role in preventing oxidation. Numerous plant substances, known as phytochemicals, function as antioxidants, too. These compounds, such as lycopene – the red pigment in tomatoes – are in the plant to protect it from sun damage, but when you eat the plant, you reap the benefit!
You can best take in antioxidants in their natural form from food. Diet always comes first. An analysis of data from the Health Professionals Follow-up Study and the Nurses’ Health Study shows that eating eight or more servings per day of fruits and vegetables rich in the antioxidant, vitamin C, reduces the risk of coronary heart disease by 20 per cent compared with eating less than three servings of these foods a day. An apple a day can keep the doctor away!
Consuming several antioxidants together, as you find them in fruits and vegetables, provides you with a bonus of antioxidant power because antioxidants work together, bolstering each other’s activities.
Raising your ‘good’ HDL levels
Although lowering LDL levels is the main goal in preventing heart disease, raising HDL levels is also an important preventative action. About 30 per cent of people with coronary heart disease have low HDL cholesterol levels while their LDL cholesterol level is normal. In fact, according to some experts on heart attack prevention, increasing HDL is as important as lowering LDL.
Quitting smoking, exercising more, and losing weight all have a beneficial effect on cholesterol balance by raising HDL cholesterol levels. Certain dietary changes can also produce worthwhile results:
Replacing saturated fat with monounsaturated fat increases HDL levels. But substituting saturated fat with carbohydrates can lower HDL levels.
Eating foods with a lower glycaemic index (see the sidebar later in this chapter), an indicator of a food’s ability to raise blood sugar levels, is associated with higher levels of HDL. Low glycaemic index foods also reduce triglycerides.
If you drink alcohol at all, consume a moderate amount (no more than one or two units per day). This can also raise your HDL level. All types are beneficial, but red wine is a good choice because of the purple antioxidant pigments it contains. (See Chapter 24 for more on healthy beverages.)
Please don’t start drinking alcohol just because red wine is beneficial for your health. Excess alcohol increases blood pressure, can damage your heart and nervous system, as well as your liver, and also makes you gain weight. Always drink alcohol sensibly and in moderation.
Calculating your total cholesterol to HDL ratio
One way to assess your risk of heart disease is to work out the ratio of your total cholesterol to your HDL cholesterol. The Total:HDL ratio is consistently reliable in predicting the risk of future heart disease.
Your doctor calculates your Total:HDL ratio from the results of your cholesterol test, and divides your total cholesterol by the amount of HDL present. In round numbers, doctors consider that a ratio of 5:1 or higher is risky and a ratio below 3.5:1 is ideal.
Say that your total cholesterol is 6 mmol/L and your HDL cholesterol is 1.5 mmol/L. Your doctor divides 6 by 1.5 to obtain 4, and so the ratio between total cholesterol and HDL cholesterol is 4:1 – less than the risky level of greater than 5:1, but not as low as the ideal ratio of 3.5:1.
To help tip the ratio in your favour, here’s how to eat:
Eat enough of the right kinds of fat, meaning monounsaturated oils and foods that contain omega-3 fatty acids, such as avocados, almonds, macadamias, and fish. Low-fat diets tend to lower HDL levels more than LDL levels, making the ratio between the two even worse.
Add lots of garlic to your recipes, because garlic can raise HDL levels and lower LDL levels. Take one to three cloves of garlic per day in any form – raw, cooked, or as an extract in supplement form. The latter has the advantages of containing a known amount of the garlic active ingredient, allicin, and of coming in odour-reduced forms. Raw onion also raises HDL levels.
Beans are beneficial because of their low glycaemic index and their fibre content, increasing HDL levels slowly over time while reducing LDL levels more quickly. (See Chapter 19 for recipes and more information about beans.)
Avoid trans fatty acids because they increase the ratio of LDL to HDL.
Curb foods with a high glycaemic index and avoid simple, refined sugars.
Losing any excess weight is also helpful as is brisk exercise. You don’t have to train up to Olympic standard, but exercising for at least 30 minutes per day – ideally more – is a good amount to aim for.
Replacing saturated fat with carbohydrates lowers total cholesterol and LDL cholesterol but also decreases beneficial HDL cholesterol.
Keeping an Eye on Your Risk Factors
Preventing high cholesterol is important for warding off heart disease, but the development of heart disease involves many other risk factors that you also need to pay attention to. The more risk factors a person has, the greater the chance of developing coronary heart disease such as atherosclerosis.
High blood pressure and carrying excess weight raises risk and we address both problems in this cookbook. Chapter 3 gives you some tips on lowering high blood pressure with a diet that contains plenty of fruits and vegetables and wholegrains. And the way of eating that the recipes offer can help you reach a healthy weight. The dishes are made with nutritious ingredients that satisfy hunger so you don’t need extra food to feel well-fed.
Being overweight (10 per cent above ideal body weight) or obese (20 per cent above ideal body weight) increases your risk of heart disease. One way of measuring weight is to use the body mass index (BMI), a figure that takes into account your weight and height. As BMI rises, LDL cholesterol levels and blood pressure also tend to increase. In addition, HDL cholesterol levels decline. To find out your BMI, go to the NHS Direct website at www.nhsdirect.nhs.uk/magazine/interactive/bmi/index.aspx.
Two other indicators of the risk of heart disease are also good to know about, namely homocysteineand C-reactive protein (CRP). Homocysteine and CRP are probably new to you, but as time goes by you’ll hear more about them from your doctor. (You can bring up these topics first, of course.) The medical world, taking a fresh look at the research, is now starting to take both these substances more seriously.
Having your homocysteine or CRP levels measured in the UK isn’t easy, because they aren’t routinely available on the NHS from your GP. The tests are available privately, however, if you’re willing to pay for them, and some specialist NHS consultants may request them.
Having elevated cholesterol and/or a raised homocysteine level and/or a high CRP level increases your risk of having a heart attack several-fold.
Having a peek at homocysteine
Homocysteine is a potentially harmful amino acid, a protein building block, associated with an increased risk of coronary heart disease. Elevated homocysteine appears to have a similar damaging effect on artery linings to high levels of the ‘bad’ LDL cholesterol. Homocysteine promotes the growth of smooth muscle cells in the arteries, making them narrower, as well as inhibiting the growth of cells that protect against atherosclerosis. Doctors think that the body responds to these changes by depositing cholesterol to mend the damage to the arteries.
Damping down inflammation
Doctors now recognise atherosclerosis as an inflammatory disease like arthritis, because the arterial walls become inflamed. This inflammation isn’t like the kind when you cut your finger and it swells and turns red. This is chronic inflammation and produces no obvious symptoms. The main test for inflammation measures the amount of a molecule called C-reactive protein (CRP), which makes your blood more sticky. People with high CRP levels tend to go on to develop coronary heart disease and have a heart attack. A study published in the journal Circulation in 2003 also concluded that CRP may directly contribute to the formation of unwanted blood clots that can cause heart attacks.
Gaining extra benefits from cholesterol-friendly foods
All these various risk factors, just like elevated cholesterol, are partly controllable by diet and often with the very same foods! These multi-tasking ingredients show up in many recipes in this book.
Take a look at Chapter 2 for lists of foods we recommend. You can find a section on what to eat to help reduce homocysteine. The entire range of homocysteine-lowering vitamins is present in green leafy vegetables, citrus fruits, fish, and dairy products.
Another section in Chapter 2 tells you about all the flavoursome foods, such as onions, garlic, ginger, and the spice turmeric, which dampen inflammation.
Lowering Cholesterol for Very High Risk People
Anyone can ask their GP for a blood cholesterol level test, but this is especially important for people at high risk. UK guidelines recommend that doctors screen people if they:
Are aged 40 years or over.
Have a close family history (for example, in parents or siblings) of raised cholesterol levels.
Are overweight or obese.
Have high blood pressure.
Have diabetes or another medical condition that can increase cholesterol levels, such as kidney or thyroid problems.
As well as offering lifestyle advice to help you with diet, exercise, and stopping smoking, doctors start treatment with a drug known as a statin,which reduces production of cholesterol in your liver. The current national targets use LDL cholesterol as the goal and by using statins doctors aim to lower LDL cholesterol to less than 3.0 mmol/L, or to reduce it by 30 per cent from your initial level, whichever figure is the lowest. An alternative approach is to reduce total cholesterol to less than 5.0 mmol/L or by 30 per cent from your initial level (whichever result is lowest). Doctors review the effect of the treatment after 4 to 12 weeks (typically at 8 weeks) to see if you need to increase the dose of statin that you’re taking, or add in an additional treatment. A blood test at the same time checks that you’re not experiencing liver or muscle side effects from the statin medication.
Statin drugs block formation of a substance called co-enzyme Q10 (CoQ10) and reduce the amount of cholesterol that your liver makes. Taking a CoQ10 supplement (which you can buy over the counter from high street shops) can help overcome the muscle side effects some people experience as a result of taking a statin drug.
Grapefruit juice interacts with a number of prescribed drugs, including statins. This effect is surprisingly large. For example, taking one particular statin drug (lovastatin) with a glass of grapefruit juice produces the same blood levels of the drug as taking 12 tablets with water! If you take medications, check the drug information sheet provided for grapefruit interactions.
Controlling Your Cholesterol Balance through Diet
The easiest way to change how you eat to control cholesterol is to use the same principles used in the recipes in this book. Cook with wholefoods – natural ingredients as nature made them and not refined or processed. Rely on ingredients that provide healthy fats, including monounsaturated fats and polyunsaturated omega-3 fatty acids, as well as soluble fibre, garlic, and other nutrients that maintain heart health. Incorporate plenty of vegetables, fruits, nuts, beans, wholegrains, fish, and poultry in your menus. Remember that lean meats, reduced-fat dairy foods, and eggs are also permissible in a low-cholesterol diet, but in smaller quantities.
The recipes in this book feature carbohydrates that have only a moderate effect on blood sugar levels, such as pearl barley and brown rice. For more on this subject, take a look at The GL Diet For Dummies by Nigel Denby and Sue Baic (Wiley). Saturated fat is present only in small amounts, and pre-formed cholesterol content is limited. You can adapt many of your recipes to follow these same heart-healthy cooking guidelines.
The ingredients in this cookbook feature in the traditional diets of Italy, Greece, and other countries bordering the Mediterranean. Heart disease rates are low in this region, and researchers conclude that this way of eating, the now widely publicised Mediterranean Diet, is the prime reason.
A growing body of research supports this dietary approach. Walter C. Willett, MD, and the Harvard School of Public Health co-developed a way of eating based on the results of three very large studies. These are the Nurses’ Health Study, with 121,700 participants; the Health Professionals Follow-Up Study, which included 52,000 men; and the Nurses’ Health Study II, a survey of 116,000 younger women. In total, researchers tracked the food intake and health of over 250,000 men and women.
Here’s what the data reveal:
Replacing saturated fat with carbohydrates does not significantly lower the risk of coronary heart disease.
Substituting polyunsaturated or monounsaturated fat for saturated fat is associated with a large reduction in risk of coronary heart disease.
Substituting carbohydrates for either monounsaturated or polyunsaturated fats increases the risk of coronary heart disease.
The risk of coronary heart disease increases for individuals who are overweight and sedentary.
Having a high trans fat and low polyunsaturated fat intake triples the risk of heart disease as compared with low trans fat and high polyunsaturated fat intake.
Total fat consumption is not associated with a risk of coronary heart disease.
Higher nut consumption is associated with a lower risk of coronary heart disease.
Switching fats versus lowering fats
The benefits of a diet rich in healthy fats rather than one that is low in fat is clearly shown in the Lyon Diet Heart Study, which began in 1988 and involved more than five years of follow-up. The final results were published in 1999. Researchers assigned 600 people who had experienced a first heart attack to a Mediterranean-style diet or a Western-type diet low in total fat. Those on the Mediterranean diet ate more olive oil, fish, vegetables, and fruit than those on the low fat diet. They also took omega-3 fatty acid supplements to help prevent heart disease and manage cholesterol levels.
Results from the Lyon study show that the Mediterranean-style diet is much more effective at preventing additional heart problems than a low fat diet. Of those consuming the Mediterranean diet, only 14 individuals had a second heart attack or fatal heart problems compared with 44 patients on the low fat diet. In fact, the benefits of the Mediterranean diet were so pronounced that after two and a half years, the trial was stopped early so that those on the low fat plan could benefit from switching to the more healthy Mediterranean way of eating.
The study researchers admit that a diet must be ‘gastronomically acceptable’ to be truly effective, or people don’t stick to it. No problem there! The Mediterranean diet includes the delights of Greek, Italian, and French Provençal cooking. For a sample, try the recipe for Garlicky Butter Beans in Chapter 19, the Grilled Scallops and Herby Vegetables in Chapter 14, and Roast Chicken with Marinated Olives, Rosemary, and Oranges in Chapter 13.
Working out what’s best for you
The healthy fats approach to diet offers some leeway, permitting varying amounts of healthy fats. The percentage of fat isn’t strictly fixed, and consequently, neither is the percentage of protein or carbohydrates. However, a reasonable division of calories to aim for is 30 to 35 per cent of calories from fat, 50 to 55 per cent of calories from wholegrain carbohydrates, and 15 per cent of calories from protein. You can experiment with more or less protein to see how you feel, while monitoring your weight and checking your cholesterol.
Glycaemic Index
The Glycaemic Index (GI) of a food shows the likely effect it has on blood sugar levels, because the GI rating depends upon how quickly a food is digested and absorbed. Low GI foods (in other words, those that don’t have a major impact on blood glucose levels) receive a rating of 55 or less. Intermediate foods are in the range of 56 to 69. And high GI foods are 70 and above. For example, white bread and corn flakes are a high GI food, whereas wholegrain barley and most fruits are low GI foods. The recipes in this cookbook mainly feature ingredients with a low GI rating.
To know the GI of a food before you buy it, a good source of information to check out is www.glycemicindex.com. The GL Diet For Dummies by Nigel Denby and Sue Baic (Wiley) can help, too.
