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Heart Disease, Cholesterol,
Saturated & Trans Fat

  1. I am looking for a dietitian who works with patients who have heart disease or high cholesterol. Where can I find one in my area? Answer
  2. My husband is on blood thinners after angioplasty surgery. Is there a difference in Romaine lettuce and iceberg lettuce? Answer
  3. My husband just had a heart attack on Monday and had angioplasty surgery Tuesday morning. Answer
  4. What are the benefits of a healthy diet in particular prevention of heart disease? Answer
  5. I have been hearing a lot about how dangerous trans fat is, but with no explanation of what it is. Answer
  6. Is it good to have mushrooms when I have a cholesterol level of about 254? Answer
  7. How much cholesterol is okay to consume on a daily basis? Answer
  8. Please advise about any diet plan to gain weight without affecting the cholesterol count. Answer
  9. I'm very fond of peanut butter sandwiches. If taken two sandwiches in a week, would that affect my count? Answer

  10. I have cut down on as much fat as I can and not kill myself. What do you suggest for me to do next to help get my cholesterol down. Answer
  11. Is there any "rule of thumb" to determine the amount of saturated fat in broiling as opposed to other methods of cooking? Answer
  12. The only time my HDL has been measured it was 43. My question is.... Am I doing OK or should I be concerned? Answer
  13. Which brand of margarine is best? Answer
  14. Are eggs really bad for you because they're high in cholesterol? Answer
  15. Which margarine is lowest in cholesterol? Answer

I am looking for a dietitian who works with patients who have heart disease or high cholesterol. Where can I find one in my area?

If you are looking for a dietitian with expertise in cardiovascular (heart) disease go to Find a Sports, Cardiovascular and Wellness Nutritionist (SCAN) and click on your state on the map of the U.S. You can also find a dietitian at the Academy of Nutrition and Dietetics. Include your zip code or city / state and the type of service you want (individual consultation) with expertise in cardiovascular (heart) disease.

Thank you for getting back to me so quickly. In the discharge papers I had to look for the info that I found. Also I saw what they sent him on his hospital tray for meals. All the other information I got, I searched the Internet. It was so difficult due to the fact that everyone has various ways of helping either through vitamins or supplements. I followed what I could and he seems okay.

I made a tuna casserole that was on his tray at the hospital. It had no fat content and I didn't use any seasonings. I went to the store and read the labels on everything I bought. I can't believe the content of sodium in the products I have been using for so long.

Is there a difference in Romaine lettuce and iceberg lettuce? I wasn't sure so I bought nothing in the lettuce line.

I will tell the doctor tomorrow about the lack of assistance that the hospital gave me regarding his diet. I really do appreciate your assistance in getting me through the weekend. I did read your sections on several items including the vitamin K one. I think that also helped me. Again thank you for helping.

You're welcome. Romaine lettuce (1 cup) has 57.4 micrograms vitamin K, which is more than iceberg lettuce (1 cup) which has 13.3 micrograms - not high. So if his doctor doesn't want him to eat iceberg lettuce which is low in vitamin K, I would not recommend Romaine lettuce either because it is higher in vitamin K. Until you can talk to your husband's doctor, continue to follow his discharge instructions where all lettuce is omitted as long as your husband needs to be on blood thinners.

The foods listed in a table on my vitamin K topic are from a table produced by the USDA. I don't believe that any other data exists at this time as vitamin K is not required on food labels. You would probably only find vitamin K values on liquid meal replacements like Ensure or vitamin supplements.

While you can observe what foods your husband was served in the hospital, you don't know the recipes that were used. Hospitals prepare several variations of a recipe for low fat, low sodium or diabetic nutrition therapy orders. The tuna casserole he was served in the hospital may have been different than the one that you use at home, but it may be OK depending on whether you put cream of celery or cream of mushroom soup (2.2 micrograms vitamin K per 1 cup) in the tuna casserole. (No value available for cream of celery soup, but 1 cup of cooked celery has 56.7 micrograms vitamin K.) Until you talk to a dietitian who can talk to your doctor and read your husband's medical chart, use the table of foods containing vitamin K as a guide for ingredients to omit in recipes at home. Omit ingredients with more than his RDA of vitamin K (120 micrograms per day).

Unfortunately, there are a lot of vitamin and herbal supplements and some may be not recommended for your husband right now. For instance, a multivitamin containing vitamin K would not be recommended and you would only learn that by reading the labels for vitamin K content. Some herbal supplements can act as blood thinners and would not be recommended (ginkgo balboa).

I would urge you to ask your husband's doctor for a referral to talk to a dietitian as your husband has multiple food restrictions. (Does he also need to restrict salt for high blood pressure?)

Did your husband ever see or talk to a dietitian when he was in the hospital? Nurses and doctors have very limited nutrition education and nutrition therapy knowledge. It is not a good use of a doctor's or nurse's time to provide nutrition therapy (diet instructions). A registered dietitian has the education and training to provide your husband with a nutrition therapy that will meet his medical needs.

My husband just had a heart attack on Monday and had angioplasty surgery Tuesday morning. I brought him home and cannot find an appropriate diet for him based on the information on his discharge papers.

It says no iceberg lettuce and no broccoli and just about everything I thought that you could eat isn't right. Could you please advise as I can't get any doctors to answer what to do until this Monday and I don't want to give him anything that will hurt him. He is 46 years old had a complete blockage of the artery in the right side of his heart. He has 2 stents in there also to hold the artery open. He has been a truck driver for 25 years and is currently on blood thinners so they said he can't have anything that adds more Vitamin K to his system. I really hope you get this quickly as I really am scared of what I can do to help him recover.

Since I do not have access to your husband's medical chart, I would recommend you only offer the foods listed on his discharge papers. Then on Monday, call his doctor and ask to talk to a registered dietitian who can help you with his nutrition therapy and meal planning.

Your husband is on blood thinners to prevent a blood clot from forming because he had surgery to repair the blood vessels that surround his heart. Your body forms blood clots in wounds or surgical incisions to encourage healing. Unfortunately, blood clots inside blood vessels are not wanted even during healing. Clots that form could break off and flow to smaller blood vessels where they could block off an artery (heart attack). The blood thinners he is on should increase the amount of time it takes for his blood to clot and therefore reduce the changes of blood clots forming.

The reason he can't have broccoli or iceberg lettuce is because these foods are high in vitamin K which aids blood clotting or shortens the amount of time it takes for blood to clot. Have you read my vitamin K topic? There is a table of foods to avoid because they are high in Vitamin K (avoid foods greater than a person's RDA for Vitamin K) and info on warfarin (blood thinner). Your husband's RDA (Recommended Dietary Allowance) is 120 micrograms vitamin K (males 19 to 70+ years of age) per day. Ask his doctor how much vitamin K he wants him to have.

For the weekend, plan regular meals that you both are used to eating at home, but omit any foods that are not allowed on his discharge papers. To further guide you, only choose foods that are listed as containing less than 10 mcg of Vitamin K from the table in my Vitamin K topic.

It would have helped for you both to see a registered dietitian in the hospital before discharge. Tell your doctor how scared you were because you didn't understand your husband's nutrition therapy. Perhaps the next patient will receive nutrition therapy instructions from a dietitian before discharge.

You husband should also be on a low saturated fat, no trans fat nutrition therapy to help prevent future narrowed arteries due to cholesterol deposits. Ask his doctor if he heeds to limit fats.

I am 14 years old and for my high school physical education class I am researching for a 15 minute presentation on health. My topic is the benefits of a healthy diet. I was wondering if you could briefly name some of the benefits. Of particular interest was prevention of heart disease. I once heard that women are more likely to die of a heart attack than men are. Is this true?

What role does diet play in a healthy heart? Your help would be greatly appreciated. Thanks!

Benefits of a healthy diet are:
  • longer life
  • higher quality of life (interpret this as more fun and less illness)
  • lower risk of heart disease
  • cancer
  • stroke
  • diabetes

Men's risk of dying from a heart attack is increased between the ages of 40 and 55. A woman's hormones, in particular estrogen, reduce this risk until menopause. A women's risk of dying from a heart attack increases for the first 10 years after the start of menopause.

People who eat foods high in saturated fat, don't exercise and eat more calories than they need to maintain a healthy weight increase their risk of heart disease. Unfortunately, 14 year olds aren't motivated to prevent heart disease and think that it only happens when you get old. Heart disease takes a long time to develop and usually starts in teenagers or even children who are overweight for height.

However, smoking is a great or even greater factor than eating lots of saturated and trans fats. Tell your classmates not to start smoking and if they do, tell them to stop because their breath and clothes smell.

If you would like to use some visuals, fill several test tubes with melted white shortening. Put 1 teaspoon in tube #1, 2 teaspoon in tube #2, 3 teaspoon in tube #3, etc. Then go to a fast food restaurant and pick up the nutrition information for their foods. Using the nutrition info, show your classmates how much fat is in a small or large order of fries or a bacon double cheeseburger. Every 5 grams of fat equals 1 tsp of shortening, butter or oil. Perhaps that would impress your classmates when they see how much fat is in an order of fries.

Please write back and tell me how your presentation went and what you said.

I have been hearing a lot about how dangerous trans fat is, but with no explanation of what it is. Is it the same as hydrogenated fat?

Polyunsaturated oils that are hydrogenated can contain some trans fat, but it depends on the hydrogenation process that was used. Trans fat results when healthy polyunsaturated oil (soybean) is partially hydrogenated in order to make it solid like stick margarine, solid shortening or fat in packaged or convenience processed foods. The FDA requires trans fatty acid levels to be listed on food labels. You can only tell if a margarine is trans fat free if the margarine has a claim on the label that says "trans fatty acid free" and the trans fat value on the Nutrition Facts is zero.

Research has found that trans fatty acids increases the bad cholesterol and decreases the good cholesterol even though it started out as a good polyunsaturated fat before hydrogenation. Get in the habit of reading food labels and choose foods that have 0 trans fat because no amount of trans fat is good for you.

Is it good to have mushrooms when I have a cholesterol level of about 254? I would be very obliged if you could kindly advise me on that. I am on a very strict diet now. My initial cholesterol LDL was about 268 and I have been able to lower it to 254. Please advise. Thanks immensely for your time.

If you are just concerned about eating mushrooms, they will not increase your cholesterol level unless you add fat, especially saturated fat like butter. Any vegetables or fruit other than avocado are very low in fat if boiled, baked or steamed without adding fat. Avocados have monounsaturated oils which are good fats.

I just did the Healthy Body Calculator and I had just one question. It stated that I should have as low as possible cholesterol intake daily, but the problem is I have a cholesterol count of 237 (175 of which is the bad cholesterol). Given that, how much cholesterol is okay to consume on a daily basis? In case you need to know, I am a 5 foot 3 inch, 25 year old woman and I weigh 126 pounds. Please help if you can. Thank you.

You should eat less than 200 mg of cholesterol per day even for persons with elevated cholesterol. Less than 7% of your calories should be from saturated or trans fat. Just because the cholesterol in the food you eat contains 200 milligrams per day, does not mean that 200 milligrams will stay in your blood. Your liver uses cholesterol to make bile that breaks down fats, seeds and skins as well as make some hormones you need.

Not all the cholesterol in your blood comes from the cholesterol you eat. In fact, your liver knows how to make cholesterol and does so depending on your body's need for cholesterol based substances like hormones and bile. Some researchers have proven that blood cholesterol is fueled more by liver produced cholesterol than cholesterol from food.

If your LDL (low density lipoprotein) which is generally considered the "bad" cholesterol is high, then I would recommend that you exercise and substitute monounsaturated fats like olive oil and peanut oil for the fats you currently use. Your weight is appropriate for your height and you have a healthy BMI so you don't need to adjust your calorie intake, just the kind of fats you eat.

If you are unsure contact a registered dietitian. If you don't have a dietitian, please call your doctor, local hospital or medical clinic and ask for a referral.

Thanks again for the prompt reply and the very useful information. I liked your message especially because it is very encouraging. It suits my kind of age, health and situation. We sometime use olive oil too, but mostly Canola oil and some margarine (Canola oil or corn oil) only on Saturday and Sunday with bread at lunch time. So taking two peanut sandwich a week should be OK.

My weight problem is other way round as I'm underweight and have been so all my life. I want to gain weight and want to look healthier, but dieting with cholesterol fear in mind would not let me go beyond 134 pounds. I m 5 feet 8 inches , 61 years, but weigh only 134 pounds. I eat full three meals a day and still can't gain weight. Any diet plan to gain weight without affecting the cholesterol count, please advise.

No, we don't add eggs to the custard. we buy custard packets after reading the labels. I take two boiled eggs in a week, but only white part, no yolk. At present with all my precautions, my cholesterol count is 220. This is very encouraging to know that I don't have to fear much about cholesterol after 60. I have read few articles on cholesterol, but this is new to me. And I liked it immensely and told my wife immediately. :-) No I did not. With warm regards and million thanks.

Actually, underweight is an asset to longer life. Your healthy weight is 121 to 163 pounds. When you add your data to the Healthy Body Calculator, select to gain 1 pound per week. A good middle weight for you would be 142 pounds so you don't need to gain that much weight.

Since you are underweight, use mono- and polyunsaturated fats like olive oil and peanut oil in addition to limiting egg yolks. Your elevated cholesterol may be genetic. You also need to keep your fat calories between 25% and 30% of all the calories you eat. More lean poultry and fish, starches, breads, low fat or fat-free milk products, fruits and vegetables should help you gain weight. You may need larger portions or snacks between meals to gain a few pounds.

Do you exercise? A regular program of 30 minutes of exercise 5 times per week may help lower your cholesterol and raise your HDL cholesterol (high density lipoprotein) which is the good kind of fat. Also, exercise, especially weight lifting would encourage muscle gain instead of more body fat. Lastly, exercise stresses bones and helps keep them strong, dense and less likely to break.

Thank you very much for your kind and informative reply and it was quite fast too. Now encouraged by this, I have couple of more questions. I have to watch my cholesterol and it goes up if I don't pay attention. My dad died of heart attack when he was 52 years old. I'm now 61. I'm very fond of peanut butter sandwiches. If taken two sandwiches in a week, would that affect my count?

Some time my wife makes rice pudding with 1% low fat milk and sometime custard, say thrice a week, would that affect my cholesterol? Thanks again for your kind reply.

I recommend the real type peanut butter found in the refrigerated section of grocery stores. All they have is peanuts and salt, but read the label to make sure that the peanut butter you buy doesn't have added hydrogenated fats which can add trans or saturated fats to healthy peanut butter. Peanuts contain mono-unsaturated fats, which in addition to olive oil are considered the best fats to eat.

The question is how does the peanut butter sandwich affect your calorie intake which is reflected in your weight? If your weight is in a healthy range, no problem with the peanut butter sandwich. If you are overweight, then you should take a look at all the foods you eat.

Rice pudding made with 1% milk is OK, but evaporated skim would be better. When you say custard, I assume that eggs are added to the milk and sugar to make the custard. Whether you use eggs or egg substitutes depends on your cholesterol. If your blood cholesterol is below 200, then the pudding and custard is OK. If your cholesterol is above 200, then I would change both the rice pudding and custard recipes to an egg substitute.

Again, how does your eating rice pudding affect your calorie intake and body weight? Answer is the same as peanut butter sandwich above. Just remember that anything eaten to excess can be "fattening" even if it is a healthy food.

Actually, now that you are older than 60 and a male, your risk of a heart attack is lower. Generally, cholesterol levels are less important for persons 60 and older. You should still follow a healthy eating plan of sufficient calories to maintain a healthy weight and limit fat to less than 30% of calories.

Have you tried the Healthy Body Calculator to find out how many calories, grams of fat and cholesterol you should eat? You can also choose to lose 1 or 2 pounds per week to get to a healthy weight and adjust the percent fat. Don't forget to exercise.

My question was over 1 1/2 years ago my doctor put me on medication because of my high cholesterol. It was 347. The doctor put me on Mevacor. It brought my cholesterol down to 189 along with going on a low fat diet. Then the doctor changed my pills to Lescol and each time he checks my cholesterol it is steadily going back up. It is now at 305. I have cut down on as much fat as I can and not kill myself. What do you suggest for me to do next to help get this down. If you know of any books I can buy that would give you recipes and menus it would help me a lot. Thanks for your time.

Both drugs are effective at reducing blood cholesterol levels and work similarly. Mevacor and Lescol slow the production of cholesterol by your liver.

Current recommendations are for blood cholesterol levels to be below 200 in the U.S. Food intake of cholesterol is usually set at the same level, less than 200 milligrams per day. Exercise and weight loss seem to help reduce blood cholesterol levels. You didn't say if you are eating a low fat eating plan (25% to 30% calories from fat with less than 7% of calories from saturated fat or 8 grams per 1,000 calories) as this is the recommended meal plan to reduce cholesterol.

There are many low fat cookbooks out there and the American Heart Association Low Fat Low Cholesterol Cookbook is a good one. Look for one that gives you the calories, grams of fat and saturated fat per serving and is written by a person with professional cooking education or experience. Otherwise, you are taking a gamble as to whether the recipes taste good or not. Some food companies like General Mills also have low fat cookbooks too.

I don't know of any sources that provide menus. But you could use nutritional analysis software to track your food intake, analyze your recipes and create menus with foods you like to control your cholesterol intake.

Because of high cholesterol and high triglycerides I am trying to stick to a diet that is low in saturated fat. The other night I cooked 1/2 chicken breast. The nutrition book that I have show that breast to have 250 calories and 3.86 grams of saturated fat. Unfortunately, the book does not tell if that is with or without skin. Of course, I removed the skin prior to cooking. The book also did not specify if that was raw, fried, roasted or broiled. I broiled it. Is there any "rule of thumb" to determine the amount of saturated fat in broiling as opposed to other methods of cooking?

Secondly, is there any place that you know of on the Internet where I can obtain information on how many grams of saturated fat there are in various foods? Any information would be appreciated. Thank you.

There is no rule of thumb for calculating saturated fat from the amount of fat in a food. The food source, cooking method and serving size determines saturated fat content. Saturated fat is found mostly in animal foods like meat, cheese, butter and milk, but it is also found in tropical oils like palm and coconut oil. The fat content of your eating plan should be between 25% and 30% of your total calories.

The USDA lists a 3 ounce roasted chicken breast without skin as having 142 calories with 0.9 grams saturated fat and a 98 gram chicken breast with skin has 193 calories with 2.1 grams saturated fat. There is no data for broiled chicken breasts. Interestingly, chicken breast has almost as much cholesterol whether you eat the skin (82 milligrams) or not (73 milligrams)!

If you are overweight, you should lose weight. Saturated fat, trans fat, total fat and weight need to be reduced to lower your cholesterol. As to your high triglycerides, you should eliminate alcohol and simple sugars to get your triglycerides down.

As to sources of saturated fat information on the Internet, here is a list from the USDA of the saturated fat content in foods. Otherwise you can look up one food at a time by searching the USDA National Nutrient Database. Otherwise look for nutrition analysis software that will track your calories, saturated fat, percent fat and alcohol in the foods you eat.

My total cholesterol has been measured a large number of times (as a benefit of being a regular blood donor). It varies from a low of 109 to a high of 150.

The only time my HDL has been measured it was 43. My question is.... Am I doing OK or should I be concerned?

Blood cholesterol level norms are less than 200 milligrams per deciliter. Norms for HDL (high density lipoprotein) which are good cholesterol are more than 40 milligrams per deciliter. Exercise helps increase HDL. Norms for LDL (low density lipoprotein) are less than 100 milligrams per deciliter, more than 130 is considered elevated and greater than 160 high risk. LDL is the bad cholesterol that sticks to arterial walls and narrows the artery (like a clogged drainpipe).

At 43, your HDL is normal, but exercise would get them higher.

Which brand of margarine is best?

I cannot recommend a specific brand to you. However, look for a margarine with a liquid oil as the first ingredient on the food label. Oils that are high in polyunsaturated fat are safflower, sunflower, soybean, corn and cottonseed. Polyunsaturated fats help lower blood cholesterol levels. The margarine will also contain partially hydrogenated vegetable oil (usually soybean) to harden the margarine and keep it in a stick form. Look at the ingredients of the margarine you are using.

A new controversy for margarine brands is trans fatty acids which are formed when liquid oils are hydrogenated to make stick margarine and shortening. The shape of the fat molecules gets twisted into a trans shape. Research has found that trans fatty acids increase LDL (bad cholesterol) and decrease HDL (good cholesterol). If you quit using stick margarine and solid shortening, the effect of the trans fatty acids on cholesterol will lessen after 6 months according to Dr. Kritchevsky. By the way, the new food label does list saturated fats and trans fatty acid content as it is required on the current food label.

Polyunsaturated margarine, if left at room temperature, will usually melt in the summer. Polyunsaturated fats are usually liquid at room temperature. Whereas, cholesterol and saturated fat are usually solid at room temperature.

You should be able to find several good low cholesterol, low saturated, low trans fat margarines in your grocery store. Take a look at the ingredients in your store's brand. You don't have to buy nationally advertised brands to find one low in cholesterol, trans and saturated fat.

Are eggs really bad for you because they're high in cholesterol? I wanted to try that egg diet, but was afraid of how many eggs it tells you to eat.

Eggs are not bad for you, but egg yolks are high in cholesterol. The latest nutritional analysis by the USDA shows that a large egg has about 212 milligrams of cholesterol with 210 milligrams in one large egg yolk. These values are much lower than the previous value of 274 milligrams in USDA's Agriculture Handbook 8-1 from 1976. This is interesting since we used to advise people to keep their blood cholesterol under 250. Now we recommend that persons keep their blood cholesterol under 200. The American Heart Association recommends low cholesterol, low saturated fat eating plans to prevent heart disease.

Low cholesterol meal plans recommend egg whites and limit egg yolks. However, just limiting egg yolks does not prevent heart attacks or cause weight loss.

You should be more afraid of any diet that tells you to eat one food for the diet to succeed in weight loss. There is no one magic food that causes weight loss or burns fat more efficiently. There have been cabbage soup diets, grapefruit diets, vinegar and lecithin diets, fruit diets and egg diets. The list goes on and on. Any meal plan will achieve weight loss if it is lower in calories than how much you currently eat. However, the weight loss eating plan that succeeds in the long term is the plan that teaches you to permanently change your eating habits by eating less and exercising more.

Which margarine is lowest in cholesterol? My father died of a heart attack and my family has a lot of heart problems. I'm only 36 years old and I really like butter. Is it that important I use margarine because I don't use much butter at all on my food.

Since I cannot recommend specific brands to you, I will tell you which margarine to look for in the grocery store. The cholesterol is lowest in margarine made with liquid oil from safflower, sunflower, cottonseed, soybean or corn. Read the label and look for one of these oils listed as the first ingredient.

If the label says hydrogenated or partially hydrogenated, it contains some saturated fat. Margarine is hydrogenated for convenience to make it stay in a convenient stick form. This process of hydrogenation makes the margarine higher in saturated fat and trans fat. People who eat foods high in saturated fats and cholesterol tend to have higher blood cholesterol levels and an increased chance of having a heart attack.

To answer your second question, yes it is important for you to use low cholesterol margarine especially considering your family history. You should also drink only skim or fat-free milk, cut all fat off your meat, limit meat to 6 ounces per day and limit egg yolks to two per week. Because some people's eating plans are high in animal fats, they need margarine, oils and salad dressings made with polyunsaturated oils to help offset the negative effects of saturated fats found in foods from animal sources like meat and dairy. But all fat from all sources should be limited to less than 6 teaspoons per day. Try limiting added fats and dressings to 2 teaspoons per meal at each of 3 meals per day.

Even though you don't think you use much butter, most people do not count how many sticks of butter they use per week. Divide the number of sticks you use per week by how many people ate that week. This might surprise you especially if you do a lot of cooking or baking with butter. Butter contains saturated fat. Also, you haven't considered the invisible cholesterol (marbling in meats, egg yolks, liver, ice cream, lunchmeats and sausages) that contribute a significant amount of cholesterol. You would do better to eliminate the visible cholesterol in butter and limit your intake of the invisible cholesterol found in fatty meats, whole, 2 percent and 1 percent milk.

A heart attack doesn't just happen one day because of what you ate. It is the result of your life long eating habits, weight control, exercise and genes. It's not too late for you to work to prevent a heart attack. Start today because you didn't get to choose parents who had a low risk of heart disease.

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