American Heart Association Low-Fat, Low-Cholesterol Cookbook

Book by Grundy Scott

Many Americans are lowering their cholesterol level, quitting smoking, watching their blood pressure, and becoming more active.

To us at the American Heart Association, this is gratifying because it means that many people are reducing their risk of heart attack and stroke. It means more Americans will have healthy hearts that last a lifetime.

Do you have high blood cholesterol? Has your doctor recommended that you eat less fat? If so, you’ve come to the right place. This new AHA Low-Fat, Low-Cholesterol Cookbook has it all. The recipes on these pages are simply scrumptious. Consider the bliss of sinking your teeth into Crab Spring Rolls with Peanut Dipping Sauce, Chicken Breasts Stuffed with Ricotta and Goat Cheese, and Mango Brûlée with Pine Nuts. You’ll find they can all be part of healthful, low-fat eating.

You may want to start with our handy assessment tool designed to help you determine how much fat you’re eating now (see “First, Look at the Way You’re Eating Now,” on page 9). Then you can easily see the changes you’ll want to make so you can follow your doctor’s advice. You’ll also discover what foods to eat; how to shop for low-fat, low-cholesterol foods; and how to cook them in the heart-healthiest way. Plus, you’ll find encouragement for your weight-loss efforts. We even have information on how to eat out in all kinds of restaurants, have fun, and still choose dishes that will do your heart good.

In the appendixes, you’ll learn how your body handles cholesterol. You’ll also see why a low-saturated-fat, low-cholesterol way of eating is so important. Dr. Scott M. Grundy, one of the foremost lipid specialists in this country and one of the AHA’s most eminent science volunteers, has updated the chapter on cholesterol-lowering drugs with the latest scientific knowledge. Some of you won’t be able to reduce your cholesterol to a safe level with diet alone. For you, this section will be vital.

If you’re using this cookbook as an aid in developing a new help-your-heart eating plan, take a look at the Step I and Step II Diets on pages 12 through 14. On the other hand, if you just want to add to your repertoire of low-fat, low-cholesterol recipes, turn to page 31.

Whatever your goal, we hope this cookbook will give you many hours of delicious eating and many more years with a healthy heart.

THE LOWDOWN ON HIGH CHOLESTEROL

Chances are you bought this cookbook because your doctor said you need to lower your cholesterol level. We think that’s good advice. Why? Because research has shown clearly that too much cholesterol in your blood can lead to heart disease, America’s number-one killer. Despite all our advances in preventing and treating heart disease, it still claims more than 950,000 lives a year.

The fact is, about 13.7 million people currently living in the United States have coronary heart disease and almost 4 million have had a stroke. Millions more are at risk of heart attack and stroke and don’t even know it. According to the National Heart, Lung, and Blood Institute (NHLBI), slightly more than 77 percent of all middle-aged American men are at increased risk of dying from heart disease.

Now for the good news: You can cut your risk of heart disease dramatically by reducing your blood cholesterol level. You can do that by cutting down on saturated fat* and cholesterol in your diet. In fact, physicians and scientists say that the best ways to improve your heart health are to lower your cholesterol level and quit smoking.

In 1985, Oxford University’s Richard Peto said, “We know two things about how to prevent death in middle age: smoking and cholesterol. Each of those two things is responsible for about one third of all deaths in middle age.”

* “Saturated fat” is popular shorthand for the more accurate term “saturated fatty acids.” That’s because what we call “saturated fat” is actually made up of lots of different varieties of saturated fatty acids. In fact, this is true for all fats, including polyunsaturated and monounsaturated. For easier reading, we’ll generally use the shorthand versions of these terms.

WILL LOWERING MY CHOLESTEROL LEVEL REALLY HELP ME PREVENT HEART DISEASE?

Countless scientific studies have shown that high blood cholesterol plays a major role in heart disease. In fact, a number of large clinical trials show that high blood cholesterol is a direct cause of heart attack. For example, one NHLBI study included 3,800 men with high cholesterol. Half were given a cholesterol-lowering drug called cholestyramine, and the other half were given a placebo. The men receiving the cholestyramine had significantly lower cholesterol levels and fewer heart attacks than the men receiving placebos. These results proved that lowering blood cholesterol reduces both the risk of having a heart attack and the risk of dying from an attack. Other clinical trials using cholesterol-lowering drugs showed similar results. The results of more-recent trials show that reducing blood cholesterol can slow the formation of atherosclerosis in both men and women and can even bring about atherosclerosis regression in some people.

It’s not just drug therapy that shows these results. A number of clinical trials have involved cholesterol-lowering diets. Several types of study have given us a large body of evidence that shows a powerful link between diet and heart disease. The evidence also proves beyond a doubt that to a large extent diet determines a person’s blood cholesterol level. One study in Oslo, Norway, revealed that changing the diet to reduce blood cholesterol can definitely reduce the risk of heart attack. Similar trials reported from Los Angeles, Minneapolis, and Helsinki, Finland, agreed.

When the experts averaged the results of all these clinical trials, they were able to estimate how much lowering blood cholesterol will reduce the risk of heart attack. As a general rule, if you reduce your total cholesterol level by 1 percent, you reduce your heart attack risk by 2 percent. This means that if you reduced your blood cholesterol from 250 to 200 milligrams per deciliter (mg/dl), for example, you’d reduce your heart attack risk by 40 percent. That’s quite a payoff. It’s also why we wrote this cookbook: to help you reduce your cholesterol level—and one of your risks for heart attack—while enjoying delectable low-fat, low-cholesterol dishes.

WHAT’S MY CHOLESTEROL LEVEL?

Your physician has probably measured your total blood cholesterol level along with your high-density lipoprotein (HDL) level. (HDLs are often called “good” cholesterol, the kind that’s not likely to be deposited in your arteries and cause atherosclerosis.) If so, these blood cholesterol levels will show how you fit into one of the classifications on the following chart. This chart helps your doctor identify your risk of heart disease. In calculating your risk, he or she will also take into account your physical and medical history, as well as the presence of other risk factors (see appendix H, page 382).

WHAT YOUR CHOLESTEROL NUMBERS MEAN

Cholesterol (mg/dl)Classification

Total less than 200Desirable

Total 200 to 239Borderline high risk

Total above 239High risk

HDL less than 35High risk

If You’re Under 200

As you can see on the chart above, if your total cholesterol level is less than 200 and your HDL level is 35 or more, high blood cholesterol is not a problem for you right now. Continue to eat a healthful diet that’s low in fat, be physically active, and have your cholesterol level checked once every five years. Of course, if you have other major risk factors, such as smoking or high blood pressure, you’re still at risk for heart disease and you’ll want to follow the advice in this book. Even if you’re totally healthy now, your best bet is to follow prudent dietary recommendations. The information in this cookbook can help you keep your cholesterol level—along with your risk of heart disease—low.

If You’re 200 to 239

If your cholesterol level is between 200 and 239, you’re in a borderline zone. You face twice the risk of heart attack as people whose levels are well below 200. Don’t feel alone: About 31 percent of American adults fall into this category. You shouldn’t ignore this borderline status, especially if you have other risk factors. Start eating to lower your blood cholesterol using the Step I Diet, and have your cholesterol level checked again in a few months.

If You’re 240 or Higher

Finally, if your cholesterol level is 240 or higher, you could be at high risk of a heart attack. This is especially true if your HDL level is less than 35 mg/dl. Talk to your doctor, because it’s likely you’ll need further tests to determine the best treatment plan.

No matter what your classification, this cookbook can help you. These appetizing recipes were created to make low-fat, low-cholesterol eating a blissful experience and, in the process, protect you against America’s number one killer, heart disease.

HOW DO I EAT WITH MY HEART IN MIND?

Most cases of high blood cholesterol are caused by eating high-saturated-fat, high-cholesterol foods. It stands to reason, therefore, that most cases can be reversed by eating foods low in saturated fat and cholesterol. Usually, this is true. However, some people can’t reduce their cholesterol level to below 200 without medication. (See “Drugs: When Diet Alone Won’t Work,” page 375, then talk with your doctor.)

If you’ve had a heart attack or have other major risk factors, lowering your cholesterol level to below 200 is extremely important. If you have heart disease, it’s also important to reduce your low-density lipoprotein (LDL) cholesterol, the type that carries harmful cholesterol into your artery walls. You want to reduce your LDL level to below 100 mg/dl. If you don’t have heart disease or risk factors, reduce it to below 130 mg/dl. (For more information about lipoproteins and how your body handles cholesterol, see page 371.)

If you have no other risk factors and haven’t had a heart attack, you should aim—at the very least—to reduce your cholesterol level to below 240 and your LDL cholesterol level to below 160. Again, the closer you can come to a cholesterol level under 200, the better.

You may be wondering how much you’ll have to change your diet to achieve these goals. That depends on a number of things. For many people, some relatively minor changes can reduce their cholesterol level significantly. Others need to make more extensive changes. The Step I and Step II Diets outlined beginning on page 9 help meet the needs of each of these groups. The Step I Diet will work for many people. It’s recommended for everyone over the age of two. If you’ve had a heart attack or you need an extra boost to reach your goals, the Step II Diet can help you get there.