Diet
There has been a lot of talk about diet, both in this book and in the media in general, about the importance of good, healthy eating to keep your heart in good shape. The questions below will answer, I hope, all the questions that you may have about food types, a healthy diet and losing weight. When we use the word ‘diet’ we do not mean crash diets to lose weight, but adopting a healthy lifestyle with balanced nutrition, which is far more important and safer.
In the past, many doctors have doubted the importance of lowering cholesterol, and have in many ways hindered the management and prevention of coronary artery disease. We now have overwhelming evidence that a high cholesterol causes coronary disease, and that lowering it encourages heart health and prevents the consequences of coronary disease by reducing heart attacks and the need for surgery or angioplasty. Fears that lowering cholesterol simply meant that you died just as soon but from something else have been totally disproved and the evidence accumulates daily to support the view that not only do people have less heart disease but they live better lives for longer. If you stop smoking, you will reduce your chances of lung cancer and heart disease; if you reduce your cholesterol you will reduce your chances of heart disease and stroke.
Eating healthily does not mean a boring diet. As the British Heart Foundation puts it ‘Food should be fun’ and can be healthy too. It’s all about avoiding a premature death.

FOOD TYPES AND EATING HEALTHILY
Fats
Fats or lipids are discussed fully in Chapter 2 in the section Risks of high cholesterol levels. We discuss here what types of food are involved. Remember that fats are divided into saturated and unsaturated types and most foods contain a combination. The proportion varies depending on the food chosen.
Saturated fatsare mainly of animal origin. They are usually hard at room temperature. They can also be found in some vegetable fats. Too much saturated fat can be bad for the heart and it is the saturated fat that raises cholesterol. They are found in:
•    red meat;
•    butter, milk, cheese, cream;
•    suet and lard;
•    some vegetable fats, especially coconut and palm oil;
•    cakes, biscuits;
•    chocolate;and
•    most puddings.

Unsaturated fats are mainly of vegetable origin. They are liquid or soft solids at room temperature. There are two types:
•    polyunsaturated, found in sunflower oil, soft margarines labelled ‘high in polyunsaturates’; these fats can lower cholesterol;
•    monounsaturates, found in olive and rapeseed oil.

I have read that fish oil is very good for you. Can you tell me about this?

Oily fish contain a particular type of polyunsaturated fat (omega-3 fatty acid) and this has been shown to help prevent coronary disease partly by thinning the blood. Table 9.1 shows the healthiest fish to eat.
It is best to avoid potted prawns, rich fish pâtés and fish roe as these are rich in saturated fat.
Shellfish contain higher levels of cholesterol but are low in saturated fat and may therefore be eaten in moderation – once or twice a week. Examples of shellfish are:

•    cockles, mussels, whelks;
•    shrimps, prawns, lobster;
•    squid.

Fish oils can also be taken in the form of capsules. Oily fish have a particularly good effect in reducing triglycerides (see the sectionRisks of high cholesterol levelsin Chapter 2), but some capsule preparations are high in calories, so be careful to check the label. Because of this, they have been known to upset people with diabetes and reduce the success of watching your weight. It is best to get your fish oil the natural way by regularly eating fish.
Omacor, a fish oil preparation, in addition to its benefit of reducing triglycerides, may be beneficial after a heart attack if added to statin therapy. The recommended dose is 1g daily with food, and up to 4 capsules daily for raised triglycerides.

If I eat fish twice a week, will it allow me to eat what I like for the rest of the week?

No. A recent review of the scientific evidence about eating fish to protect against coronary artery disease concluded that ‘merely adding fish to a nutritionally adverse diet will not grant a population immunity from epidemic coronary heart disease.’ Translated this means that, if you are eating poorly, simply adding fish won’t do any good. Fish should be part of a low saturated fat diet – part of a healthy eating plan.

I’m not keen on fish – can I have fish oil capsules instead?

Yes. Omacor and Maxepa lower triglycerides and Omacor has been shown to reduce the chances of further heart problems when taken after a heart attack and in addition to statins. Reduced hospital admissions for heart failure have also been recorded.

What is the difference between white fish and oily fish?

White fish includes cod, haddock, halibut, plaice and monkfish; oily fish includes herrings, kippers, mackerel, salmon, sardines, anchovies, trout and tuna. White fish is low in fat and this is good for the heart. Oily fish in addition contains a lot of omega-3 fatty acids as well as vitamins A and E, all of which may be good for the heart, so they have a greater potential benefit.

I quite like fish but it can be expensive. How much is it recommended that I eat each week?

The current recommendation is 300 g (12 oz) twice a week. The average intake in the UK is currently half this.

How do I know if the fish is fresh? I would hate to get food poisoning.

Fresh fish is usually refrigerated with ice before being sold but it can be frozen, then thawed, and sold as fresh. The law says it must be labelled as thawed because refreezing thawed fish is a source of bacteria. The safest way of buying or eating fish is to consume fresh fish within 24 hours of purchase or to cook frozen fish from frozen or immediately it has been thawed for the first time.
Fresh fish are usually stiff, the eyes are bright and not sunken, and the gills are red in colour. The skin should be shiny. Fillets should smell fresh (of the sea) and have firm moist flesh; white fillets look white and almost translucent in colour. If you are not sure, do not buy it and do not be convinced by the fishmonger as to its freshness unless you know him very well. Do not buy frozen fish which is not solid or has white patches or ice crystals on the skin. Frozen fish should not be thawed in water as it loses its texture, flavour and nutrients.
Independent fishmongers tend to know more about fish than supermarket fresh fish counter assistants.

Isn’t it possible to keep fresh fish in the fridge for a week?

Most fridges in our homes are set at about 3°C and fish spoils quickly at this temperature, so eat it within 24 hours. Stored on ice (0°C) fresh fish may last a week.

What types of food have low or high levels of fat and cholesterol in them?