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Everything you need to know about a heart-healthy diet

You can do a lot to keep your heart healthy with your diet. Researchers have found that traditional eating habits in Mediterranean countries are particularly good for the heart. You will find detailed information on this in the following texts. The risk of a heart attack increases the more unhealthy our diet. And even if not everyone succeeds in reducing high cholesterol levels or high blood pressure through diet alone, many manage to get by with less medication after improving their diet. A heart-healthy diet doesn’t have to be complicated if you stick to a few basic principles. Above all, it is important that you eat a balanced diet and do not avoid any foods (for example, cholesterol-rich eggs) or consume large quantities of “good” products (for example, tomatoes because of the antioxidants). [1]

All beginnings are hard. But once they’ve lasted a while, you’ll find that a heart-healthy diet is doable and also offers whole new taste sensations.

The 3 Golden Rules for Heart Healthy Nutrition[1]

In all of this, the principle applies: The balance makes all the difference! One unhealthy food is not bad. But in the same way that eating mainly healthy foods will add up to a healthy lifestyle, many unhealthy foods are problematic for heart health. [1]

1. The right fats

Choosing the right fats is more important than an overall low-fat diet. Monounsaturated fatty acids can protect the heart in many ways. Saturated fatty acids, on the other hand, increase harmful LDL cholesterol in the blood. A list of suitable foods can be found here. Caution is also advised with too many carbohydrates. If the body cannot convert them directly into energy, it converts them into the undesirable saturated fatty acids. [2]

2. More omega-3 fatty acids

Omega-3 fatty acids dilate the vessels and can protect against cardiac arrhythmias. They also often prevent the risk of thrombosis. [1] In addition, omega-3 fatty acids have an anti-inflammatory effect. [3]

3. Eat mostly plant-based foods

Eat lots of plant-based foods, such as vegetables and salad, whole grain cereals or legumes, and consume less sugar, alcohol or white flour products. [1]

A good example: the typical Mediterranean diet [1]

The focus here is on the word “traditional”. This primarily means the type of diet that was common in the Mediterranean region in the years 1950-1960. People who eat this Mediterranean diet are less likely to be overweight, have fewer heart attacks, and are less likely to develop cancer. Main ingredients of the traditional Mediterranean diet are a wide variety of vegetables, salads, fresh fruits, bread, pasta, rice, legumes, nuts and seeds. The ingredients are mostly locally sourced and prepared according to the season, as well as seasoned with lots of fresh herbs and garlic. Everything is prepared with lots of olive oil. Cheese and yogurt and fish are eaten several times a week, meat and eggs rather rarely.

The lessons for Northern Europeans are that they should eat twice as many vegetables and fruits as before, e.g. pickled vegetables as an appetizer, combined with pasta, fish or meat. Pasta should be prepared with vegetables, with pesto or oil and fresh herbs, and sauces containing meat or cream should be on the table rather rarely. Northern Europeans should rediscover more legumes for themselves, e.g. as a side dish, pureed as a sauce, paste or spread. The fat content of the food is not so important if it is good oils such as olive or rapeseed oil. More fish that is not breaded should also be on the menu, and meat should be an addition rather than the “main” ingredient. The freshness of the ingredients is also important, and make sure that the dishes are easy and quick to prepare, so that this lifestyle can be sustained for a long time without losing motivation. [1]

The most important heart healthy nutrition tips

Although you may know that eating certain foods can increase your risk for heart disease, many people often find it difficult to change their eating habits. Once you know which foods to eat more of and which to limit, you'll be on your way to a heart-healthy diet. Our tips will help.

Control portion sizes

How much you eat is just as important as what you eat. If you overload your plate, take second helpings and eat until you feel full, you may be taking in more calories than you should. Use a small plate or bowl to control your portions. Eat more low-calorie foods that are rich in vitamins and minerals, such as vegetables and fruits. Avoid foods high in calories and sodium, such as fast foods. [4]

It is also important to keep track of the number of servings you eat. The German Federal Center for Nutrition (BZfE) recommends using your own hand as a measure for a portion size. This is because it is individual and thus takes into account the needs of large and small people. [5] Interestingly, it is also important that our eye signals to our brain that the plate is empty and we are done eating. There is less reliance on our sense of satiety. [5]

Table of Portion Sizes [6]

Food Portion
Large-sized vegetables and fruits, e.g. kohlrabi or apple 1 handful
Small-sized vegetables or fruit, e.g. peas or cherries 2 handfuls or a small bowl
Bread A finger-thick slice that fits on the palm of your hand
Side dishes, e.g. potatoes or pasta 2 handfuls
Meat or fish About the size of the palm of your hand
Fat Is measured in tablespoons, one serving equals 1-2 tablespoons
Sweets or Snacks 1 handful

In principle, the well-known food pyramid of the Federal Center for Nutrition [7] also applies to people who want to pay attention to their heart health:

You can drink as much water as you like. A glass of vegetable or fruit juice can replace one of the recommended servings of fruits and vegetables. [6]

I.e. 1.5 liters or 6 full glasses of water or tea a day. 3 servings of vegetables a day or better more and about 1-2 servings of fruit. 4 servings of bread, cereals or side dishes are also useful, half of which should be whole grains. Of milk and dairy products, such as yogurt or cheese, you can have 3 servings per day. Fish, meat, sausage or eggs should only account for one portion. It is best to have meat on the menu only 2-3 times a week. 2 portions of fats and oils are also part of the daily allowance, as are extras, for example sweets, snacks and alcohol. [7]

More information about the food pyramid can also be found here at the Federal Center for Nutrition.

Eat more fruits and vegetables

Many types of vegetables are good sources of vitamins and minerals and are also low in calories and high in fiber. Like other plants or plant foods, they contain phytochemicals that can help prevent cardiovascular disease. Eating more vegetables can help you cut back on higher-calorie foods like meat, cheese and snacks.

Incorporating vegetables into your diet can be simple. Keep washed and cut vegetables in the refrigerator as a healthy snack to help combat sudden hunger in between meals. Choose recipes in which vegetables are the main ingredient, such as stir-fry vegetable dishes or salads with fresh fruit. [4]

Two to three servings of vegetables a day is ideal, but the more the merrier and, if possible, buy regionally and according to the seasons. If you google “vegetable seasonal calendar PDF”, you can download a corresponding help on many sites. In winter, you can also resort to frozen vegetables. With frozen foods, however, always pay attention to the ingredient list (avoid calorie traps) and rather try to diversify your dishes with herbs and spices. [1]

Fruit often has more calories than vegetables due to the fructose. Two portions per day should nevertheless be on the daily menu.

The following table gives a small overview [4]

Better Worse
Fresh or frozen vegetables and fruits Vegetables with cream sauces
Canned low sodium vegetables Fried or breaded vegetables
Canned fruit packed in juice or water Canned fruit with syrup
Frozen fruit with added sugar

 

Choose whole grains

Whole grain products are healthier than those made from white flour. [1] Whole grain products are a good source of fiber, vitamins and other nutrients that play a role in regulating blood pressure and heart health. You can increase the amount of whole grains in a heart-healthy diet simply by replacing refined grain products. Be willing to experiment and try a new whole grain, such as quinoa or barley. [4] Oats are also good for a heart-healthy diet because they can lower cholesterol. Oats taste best in muesli or porridge.

Whole grain products are more filling and last longer. For breads, it’s best to ask the baker, because even whole grain flour can be very finely ground and whole grains don’t necessarily stand for healthy bread. However, you do not need to interpret this maxim too strictly. A balanced diet is also possible with “normal” pasta. Cakes, cookies and the like are particularly unfavorable snacks for in-between meals. Especially because they often contain a lot of sugar and fat in addition to white flour and do not fill you up, so that you are often tempted to eat too much of them. [1]

The following table provides an initial overview [4]

Better Worse
 Whole wheat flour White flour
Wholemeal bread, preferably 100% wholemeal or 100% wholemeal bread White bread
High-fiber cereals with 5 g or more of fiber in one serving Muffins, cakes, waffles, cookies, doughnuts, etc.
Whole grain products, such as brown rice, barley and buckwheat Cornbread
Whole wheat pasta Egg noodles
Rolled oats (steel cut or normal) Buttered Popcorn

 

Eat the right types of fat

Limiting the amount of saturated fat and trans fat you consume is an important step. That’s because it will help lower your cholesterol and reduce your risk of coronary heart disease. High cholesterol can lead to plaque buildup in the arteries and increase your risk for heart attack and stroke. [4]

The German Nutrition Society recommends that no more than 30% of daily energy should come from fat. [8] The Verbraucherzentrale NRW (consumer center of North Rhine-Westphalia) specifies that no more than 2 teaspoons of spreadable fat and 2-3 tablespoons of oil should be consumed per day. It should also be particularly noted that especially sausage, chips, fast food, baked goods and also lattes contain a lot of fat. [9]

Fitness apps that show how much fat you consume with certain foods can be helpful here. Carefully managed, these digital helpers can alert you to hidden “fat traps” in your diet.

There are simple ways to reduce saturated fats and trans fats:

Cut the fat from your meat or choose lean meat with less than 10% fat. Less favorable than meat is sausage, because here you often do not see the fat directly. For example, salami is half fat. Use less butter or oil when cooking and serving. Find a substitute for high-fat foods, such as a baked potato with homemade salsa or plain yogurt instead of butter. Eat more whole fruits instead of fruit porridge or fruit spread on bread.

It is important to distinguish between good and bad fats [1,4]

Better Worse
Olive oil Lard
Rapeseed oil Coconut, palm, cottonseed and palm kernel oil
Plant and nut oils Gravy
Cholesterol-lowering or trans fat-free margarine Cream sauces
Nuts, seeds Non-dairy cream products
Avocados Hydrogenated margarine and shortening
Butter Cocoa butter, contained in chocolate
Lean ham Salami
Turkey breast Breaded pork chop
Whole grain rolls Croissants
Frozen vegetables Frozen creamed vegetables
Pretzels Potato chips
Fruit cakes Cream cake

When using fats, choose monounsaturated fats, such as those found in olive oil or canola oil. Polyunsaturated fats, found in certain fish, avocados, nuts and seeds, are also good choices for a heart-healthy diet. When used in place of saturated fats, monounsaturated and polyunsaturated fats can help lower your total blood cholesterol levels. Moderation is important, however. All types of fat are very high in calories. [4]

As a general rule, use cold-pressed oil for salads and cold dishes and refined oil for baking, frying and deep-frying.

Choose low fat protein sources

Lean meats, poultry, fish, dairy products and eggs are some of the best sources of protein. Choose lower-fat options, such as skinless chicken breast instead of fried chicken patties. Fish is a good alternative to high-fat meats. Certain types of fish are rich in omega-3 fatty acids, which can lower blood fats called triglycerides. The highest amounts of omega-3 fatty acids are found in cold-water fish, such as salmon, mackerel and herring. Other sources include flaxseeds, walnuts, soybeans and canola oil.

Legumes – beans, peas and lentils – are also good, low-fat sources of protein and contain no cholesterol, making them a good substitute for meat. When you replace animal protein with plant protein – such as a hamburger with a soy or bean burger – you reduce your fat and cholesterol intake and increase your fiber intake. [4]

Better Worse
Fish, especially fatty cold water fish like salmon Fats and marbled meats
Poultry without skin Spareribs
Legumes Hot Dogs und sausages
Soybeans and soy products, such as soy burgers and tofu Bacon
Lean minced meat Fried or breaded meats
Eggs (which also contain relatively high cholesterol)

 

Reduce salt (sodium) intake

Eating too much salt can lead to high blood pressure, a risk factor for heart disease. Limiting salt (sodium) is an important part of a heart-healthy diet. [4]

5g of salt per day is recommended by the World Health Organization (WHO). This is equivalent to about one teaspoon. [10]

Although it’s also good to reduce the amount of salt you put in your food at the table or when cooking, that’s just a first step. This is because much of the salt that many people consume comes from canned or processed foods, such as soups, baked goods, and frozen meals. Eating fresh foods and making your own soups and stews can reduce the amount of salt you consume.

If you prefer the convenience of canned soups and prepared foods, look for those with no added salt or reduced sodium content. Be wary of foods that claim to contain less sodium because sea salt has been added to them instead of regular table salt – sea salt has the same value as regular salt.

Another way to reduce the amount of salt in your food is to choose your spices carefully. Many spice blends are available in reduced-sodium versions and can add flavor to your food with less sodium. [4]

Better Worse
Herbs and spices Table salt
Salt free spice blends Canned soups and ready meals, e.g. frozen meals
Canned soups or ready meals without added salt or with reduced salt content Tomato juice
Reduced-salt versions of condiments, such as reduced-salt soy sauce and reduced-salt ketchup Condiments like ketchup, mayonnaise and soy sauce

 

Plan ahead and treat yourself now and then

Many people benefit from making a plan for their food, sfor example, for one week at a time. Create daily menus and look for vegetables, fruits and whole grains when choosing foods for each meal and snack. Choose lean protein sources and healthy fats, and limit salty foods. Remember to use the right portion sizes and add variety to your menu.

For example, if you eat grilled salmon one night, try a black bean burger the next. This will ensure you get all the nutrients your body needs. Variety makes your meals more interesting and helps you follow through with your plan. [4]

Treat yourself to a small sweet treat every now and then. A candy bar or a handful of potato chips won’t hurt your heart-healthy diet. But don’t let it become an excuse to abandon your healthy eating plan. If overindulgence is the rule rather than the exception, you’ll torpedo your own efforts. The important thing is to eat healthy most of the time. [4,11]

More helpful information

Nuts, legumes, fish...

Nuts are healthy in moderation
The tasty kernels are very high in fat, but contain plenty of polyunsaturated fatty acids. Cashew, macadamia, hazelnut and peanuts are considered good for heart health. Brazil nuts and walnuts also provide valuable omega-3 fatty acids. Unfortunately, none of this applies to coconut. On the contrary, this can increase cholesterol levels and contains mainly saturated fatty acids. [1]

Rediscover legumes
The term sounds stale to many, but legumes are real “super foods”, because they contain many vitamins, minerals and fiber, as well as high-quality protein. Time again to get grandma’s recipe for lentil or pea stew out of the cupboard. Or search for recipes under the keyword “Mediterranean food” and get inspired for appetizers, pastes and spreads. [1]

Fatty fish is good for the heart
Fish is the exception to the motto “as low-fat as possible”. Fatty fish should be eaten 1-2x per week, for example herring, mackerel, salmon and tuna. Unfortunately, this does not apply to eel – it has too many saturated fatty acids. By the way, even canned fish is highly recommended, as long as it is not pickled or in cream sauce. Unfortunately, breaded fish is also unfavorable. [1]

Flaxseed for more omega-3
An easy way to add healthy fat (and fiber) to your diet is to use ground flax seeds. Flax seeds are small brown seeds that are rich in fiber and omega-3 fatty acids. Studies have shown that flax seeds lower unhealthy cholesterol levels in some people. You can grind flaxseeds in a coffee grinder or food processor and add a teaspoon to yogurt, applesauce, or cereal. [4]

What do I do if I have elevated triglyceride levels, high blood pressure or am overweight? [1]

Elevated triglyceride levels
Lose weight if you are overweight. In principle, however, you should always lose weight slowly, since triglycerides rise sharply, especially at the beginning of a diet. Eat fewer carbohydrates, but eat something higher in fat with a high proportion of monounsaturated and polyunsaturated fatty acids. Otherwise, you rules for a heart-healthy diet apply even with elevated triglyceride levels. Eat plenty of foods with omega-3 fatty acids and avoid alcohol and sugar as much as possible.
Important with high triglyceride levels: sugar substitutes such as fructose or sorbitol are not suitable for reducing calorie intake for those affected. Sweeteners such as aspartame, acesulfame K and saccharin, on the other hand, are not a problem.

Hypertension
Even with high blood pressure, people who are overweight should lose weight first and foremost. And in general, the recommendations for a heart-healthy diet apply just as much to people with high blood pressure. That is, eat plenty of vegetables and fruit, salt sparingly, prefer to use herbs, watch out for hidden salt, e.g. in smoked, pickled or cured products, and avoid convenience foods or alcohol.

Excess weight
Diets make you slimmer, but to maintain your weight, it is necessary to change your lifestyle. If you have problems with this, you should seek professional help, such as from your doctor.

The following rules are important:

  • No fad diets, take your time
  • Eat plenty of vegetables and whole grain products
  • Prefer lean meat and good fats, avoid “hidden fats” and foods high in sugar, such as sausage, cream, chocolate, potato chips, soft drinks, white bread
  • Lose no more than one to one and a half pounds per week
  • Meaningful exercise program (walking, climbing stairs, going for a walk, bicycling

The difference between the "good" HDL and the "bad" LDL cholesterol [1]

HDL = high density lipoproteins are transported and excreted via the blood, i.e. this cholesterol can be disposed of efficiently and is therefore considered “good”.

LDL = lipoproteins with low density. If too many of these are in the blood, they can be deposited in the walls of the arteries, increasing the risk of heart attack or stroke. This is why they are considered “bad”.

Heart healthy foods [1,12]

Food Heart healthy nutrients Found in
Fish High content of omega-3 fatty acids Salmon, tuna, mackerel, herring and trout
Berries Phytonutrients and soluble fiber Blueberries, strawberries, blackberries or raspberries
Seeds Omega-3 fatty acids, fiber and protein Flaxseed, chia seed
Legumes Rich in fiber, B vitamins, minerals Dried beans and lentils, such as chickpeas, kidney beans or black beans
Red, yellow, and orange vegetables Many carotenoids, fiber and vitamins Carrots, sweet potatoes, red peppers, tomatoes and pumpkin
Green veggies Vitamin C and E, potassium, folic acid, calcium and fiber Kale, chard, pak choi, lettuce, broccoli and asparagus
Fruits Rich in beta-carotene, potassium, magnesium and fiber Oranges, melons, and papayas
Dark chocolate The fiber and protein increase with higher cocoa content and the sugar decreases 70% cocoa content and up- The higher the cocoa content, the better!
Nuts Monounsaturated fatty acids Cashews, macadamia, hazel, and peanuts

 

Foods that can harm the heart [1]

Sausage products: too fatty
Sweets and candy: too much sugar

Ingredients that are important for a heart-healthy diet [1]

Antioxidants, e.g. vitamins E and C as well as beta-carotene and lycopene

  • intercept so-called free radicals in the body and render them harmless. Free radicals can trigger diseases.

Dietary fiber

  • good for a regulated intestinal function
  • saturate well
  • prevent strong fluctuations of blood sugar
  • important for a healthy microbiome

Fatty acids

  • Saturated fatty acids: increase blood lipids, especially the harmful LDL cholesterol
  • Monounsaturated fatty acids: lower LDL cholesterol, which can lead to deposits in artery walls
  • Polyunsaturated fatty acids are divided into omega-3 and omega-6 fatty acids
    • Omega-6 fatty acids: lower LDL cholesterol, but not its storage in the body, and are pro-inflammatory, therefore better are
    • Omega-3 fatty acids: lower triglycerides in the blood, have an anti-inflammatory effect, are good for blood clotting, reduce the risk of thrombosis, dilate blood vessels, stabilize heart rhythm
  • Trans fatty acids: increase LDL cholesterol in the blood

Secondary plant compounds, e.g. carotenoids and polyphenols

  • stimulate the immune system
  • regulate the metabolism
  • have antioxidant and antimicrobial effects

Interesting studies

A Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events in individuals at high cardiovascular risk. [13] A similar study even showed that this diet was superior to a low-fat diet under similar conditions. [14]

Adherence to recommended dietary patterns is a process. Affected individuals should preferentially select foods that are familiar favorites. Any dietary change should be individualized to one’s needs. [15]

A heart-healthy diet can also provide benefits for diabetics. A diet rich in whole grains, fruits, vegetables, legumes, and nuts; moderate alcohol consumption; and lower in refined grains, red/processed meats, and sugar-sweetened beverages has been shown to reduce risk of diabetes and improve glycemic control and blood lipids in patients with diabetes. [16]

The American Diabetes Association and the American Heart Association recommend the Mediterranean diet to improve glycemic control and cardiovascular risk factors in type 2 diabetes. A Mediterranean diet may help with type 2 diabetes and against atherosclerosis. [17]

The results of a pooled analysis of 4 cohort studies suggest that a minimum fish intake of 175 g (approximately 2 servings) per week is associated with a lower risk of major cardiovascular disease and mortality in patients with prior cardiovascular disease. However, this is not true for the general population. [18]

Our expert

Dr. oec.troph. Reinhild Quade has a degree in ecotrophology and has been working as a freelance nutrition therapist and nutritionist since 2002.

Her consulting focuses on food allergies and intolerances, neurodermatitis, pregnancy and lactation, child nutrition and allergy prevention.

She is a member of the German Allergy and Asthma Association (DAAB) and the German Society of Qualified Nutrition Therapists and Nutritionists (QUETHEB e.V.) as well as the German Nutrition Society (DGE e.V.).

Dr. oec.troph. Reinhild Quade

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