Guidelines For Heart-Healthy Living

Last Editorial Review: 2/1/2005

Six Guidelines To Healthy Living

Whatever your blood cholesterol level, you can make changes to help lower it or keep it low and reduce your risk for heart disease. These are guidelines for heart-healthy living that the whole family (including children ages 2 and above) can follow:

1) Choose foods low in saturated fat

All foods that contain fat are made up of a mixture of saturated and unsaturated fats. Saturated fat raises your blood cholesterol level more than anything else you eat. The best way to reduce blood cholesterol is to choose foods lower in saturated fat. One way to help your family do this is by choosing foods such as fruits, vegetables, and whole grains--foods naturally low in total fat and high in starch and fiber.

2) Choose foods low in total fat

Since many foods high in total fat are also high in saturated fat, eating foods low in total fat will help your family eat less saturated fat. When you do eat fat, substitute unsaturated fat--either polyunsaturated or monounsaturated--for saturated fat. Fat is a rich source of calories, so eating foods low in fat will also help you eat fewer calories. Eating fewer calories can help you lose weight--and, if you are overweight, losing weight is an important part of lowering your blood cholesterol. (Consult your family doctor if you have a concern about your child's weight.)

3) Choose foods high in starch and fiber

Foods high in starch and fiber are excellent substitutes for foods high in saturated fat. These foods--breads, cereals, pasta, grains, fruits, and vegetables--are low in saturated fat and cholesterol. They are also lower in calories than foods that are high in fat. But limit fatty toppings and spreads like butter and sauces made with cream and whole milk dairy products. Foods high in starch and fiber are also good sources of vitamins and minerals.

When eaten as part of a diet low in saturated fat and cholesterol, foods with soluble fiber--like oat and barley bran and dry peas and beans--may help to lower blood cholesterol.

4) Choose foods low in cholesterol

Remember, dietary cholesterol can raise blood cholesterol, although usually not as much as saturated fat. So it's important for your family to choose foods low in dietary cholesterol. Dietary cholesterol is found only in foods that come from animals. And even if an animal food is low in saturated fat, it may be high in cholesterol; for instance, organ meats like liver and egg yolks are low in saturated fat but high in cholesterol. Egg whites and foods from plant sources do not have cholesterol.

5) Be more physically active

Being physically active helps improve blood cholesterol levels: it can raise HDL and lower LDL. Being more active also can help you lose weight, lower your blood pressure, improve the fitness of your heart and blood vessels, and reduce stress. And being active together is great for the entire family.

6) Maintain a healthy weight, and lose weight if you are overweight

People who are overweight tend to have higher blood cholesterol levels than people of a healthy weight. Overweight adults with an "apple" shape--bigger (pot) belly--tend to have a higher risk for heart disease than those with a "pear" shape--bigger hips and thighs.

Whatever your body shape, when you cut the fat in your diet, you cut down on the richest source of calories. A family eating pattern high in starch and fiber instead of fat is a good way to help control weight. Do not go on crash diets that are very low in calories since they can be harmful to your health. If you are overweight, losing even a little weight can help to lower LDL-cholesterol and raise HDL-cholesterol.

Making The Guidelines Work: Eat the Heart Healthy Way

Look at how your family eats now and begin to plan. You don't have to cut out all high saturated fat, high cholesterol foods. Just substitute one or two low saturated fat or low cholesterol foods each day, and soon you will reach your goal of heart-healthy eating for you and your family. By making the changes slowly, you are more likely to stick with your new eating plan.

Choose heart-healthy foods from different food groups--meat, poultry, fish, and shellfish; dairy foods; eggs; fruits and vegetables; breads, cereals, pasta, rice and other grains, and dry peas and beans; fats and oils; and sweets and snacks. Choose the number and size of portions to help you reach and stay at your desirable weight. Eating a variety of foods each day will help your whole family get the nutrients you need. Use these tips to choose foods low in saturated fat and cholesterol:

Meat, poultry, fish, and shellfish

Buying tips:
  • Choose lean cuts of meat. Choose fish and skinless poultry more often; they are generally lower in saturated fat than meat. Eat moderate portions--no more than about 6 ounces a day (a 3-ounce portion is about the size of a deck of cards).
  • Look for meats labeled "lean" or "extra lean."
  • Limit organ meats like liver, sweetbreads, and kidneys. Organ meats are high in cholesterol, even though they are fairly low in fat.
  • Limit high fat processed meats like bacon, bologna, salami, hot dogs, and sausage.
  • Remember that some chicken and turkey hot dogs are lower in saturated fat and total fat than pork and beef hot dogs. There are also "lean" beef hot dogs that are low in fat and saturated fat. Usually, processed poultry products have more fat and cholesterol than fresh poultry. To be sure, check the nutrition label on deli products such as hot dogs and luncheon meats to find those that are lowest in fat and saturated fat.
  • Try fresh ground turkey or chicken made from white meat, like the breast.
  • Limit use of goose and duck. They are higher in saturated fat, even with the skin removed.
  • Choose shellfish occasionally. Shellfish has little saturated fat in general, but its cholesterol content varies--some (like squid, shrimp, and oysters) are fairly high while others (like scallops, mussels, and clams) are low.
  • Buy canned fish packed in water, not oil.


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Preparation tips:

  • Trim fat from meat and remove skin from poultry before eating.
  • Bake, broil, microwave, poach, or roast instead of frying. When you do fry, use a nonstick pan and nonstick cooking spray or a small amount of vegetable oil to reduce the fat.
  • When you roast, place the meat on a rack so the fat can drip away.
  • Brown ground meat and drain well before adding other ingredients.
  • Use fat free ingredients like fruit juice, wine, or defatted broth to baste meats and poultry.

Dairy foods

Buying tips:
  • Drink skim or 1 percent milk rather than 2 percent and whole milk.
  • When looking for hard cheeses, go for versions that are "fat free," "reduced fat," "low fat," "light," or "part-skim." These have less fat per ounce than the regular versions.
  • When shopping for soft cheeses, choose low fat (1 percent) or nonfat cottage cheese, farmer cheese, pot cheese, or part-skim or "light" ricotta. These cheeses have less fat per ounce than the whole milk versions.
  • Use low fat or nonfat yogurt; try it in recipes or as a topping.
  • Try low fat or nonfat sour cream or cream cheese blends for spreads, toppings, or in recipes.

Preparation tips:

  • Try low fat cheese in casseroles, or try a sharp-flavored regular cheese and use less than the recipe calls for. Save most of the cheese for the top.
  • Use skim, 1 percent, or evaporated skim milk for creamed soups or white sauces.


Buying tips:
  • Eggs are included in many processed foods and baked goods. Look at the nutrition label to check the cholesterol content.
  • Try egg substitutes.

Preparation tips:

  • Egg whites have no cholesterol, so try substituting them for whole eggs in recipes; two egg whites are equal to one whole egg. Or, use egg substitutes.

Fruits and vegetables

Buying tips:
  • Buy fruits and vegetables often--fresh, frozen, or canned. They have no cholesterol and most are low in saturated fat. Also, most fruits and vegetables, except avocados, coconut, and olives, are low in total fat.
Preparation tips:
  • Use fruits as a snack or dessert.
  • Prepare vegetables as snacks, side dishes, and salads. Season with herbs, spices, lemon juice, or fat free or low fat mayonnaise. Limit use of regular mayonnaise, salad dressings, and cream, cheese, or other fatty sauces.

Breads, cereals, pasta, rice and other grains, and dry peas and beans

Buying tips:
  • Use whole-grain breads, rolls, and cereals often.
  • Limit baked goods like these that are made with large amounts of fat, especially saturated fat:
    • Croissants
    • Biscuits
    • Doughnuts
    • Butter rolls
    • Muffins
    • Coffee cake
    • Danish pastry
    Be aware that some baked goods contain palm, palm kernel, and coconut oils. These oils are high in saturated fats, even though they are vegetable oils.
  • Choose ready-to-eat cereals often. Most are low in saturated fat, except for granola, muesli, or oat bran types made with coconut or coconut oil.
  • Buy dry peas and beans often. They are low in saturated fat and total fat and high in fiber.
Preparation tips:
  • Try pasta or rice in soups, or with low fat sauces as main dishes or casseroles.
  • Stretch meat dishes with pasta or vegetables for hearty meals. You can use less meat this way and still have the flavor.
  • Bake your own muffins and quick breads using unsaturated vegetable oils; substitute two egg whites for each egg yolk, or use egg substitutes. Experiment with substituting applesauce for oil or cut back the amount of oil in the recipe. For each two cups of flour, you only need 1/4 cup of vegetable oil.
  • Use dry peas and beans as the main ingredient in casseroles, soups, or other one-dish meals. They are excellent sources of protein and fiber.

Fats and oils

Buying tips:
  • Choose liquid vegetable oils high in unsaturated fat for cooking and in salad dressings. Examples are canola, corn, olive, peanut, safflower, sesame, soybean, and sunflower oils.
  • Buy light or nonfat mayonnaise instead of the regular kinds that are high in fat.
Preparation tips:
  • In cooking, limit butter, lard, fatback, and solid vegetable shortenings.
  • When using fats and oils, use only small amounts and substitute those high in unsaturated fat for those high in saturated fat.
  • For a spread, use tub or liquid margarine, or vegetable oil spread instead of butter.
  • Flavor cooked vegetables with herbs or butter-flavored seasoning.

Sweets and snacks (have only now and then)

Buying tips:
  • Choose these low fat sweets for a special treat:
    • brownies, cakes, cheesecakes, cupcakes, and pastries labeled "fat free" or "low fat." Even though they have less fat, they still may be just as high in calories. If' you are trying to lose weight, read the label to compare;
    • animal crackers, devil's food cookies, fig and other fruit bars, ginger snaps, graham crackers, and vanilla or lemon wafers;
    • frozen low fat or nonfat yogurt, fruit ices, ice milk, Popsicles, sherbet, and sorbet; and
    • gelatin desserts.
  • Try these low fat snacks:
    • bagels, bread sticks, melba toast, rice cakes, rye crisp, and soda crackers;
    • unsweetened, ready-to-eat cereals;
    • fresh fruit, fruit leather, or other dried fruit;
    • pretzels, no-oil baked tortilla chips; and
    • plain, air-popped popcorn.
Preparation tips:
  • Freeze grapes or banana slices for treats.
  • Make puddings with skim or 1 percent milk.
  • Top angel food cake with fruit puree or fresh fruit slices.
  • Cut up raw vegetables and serve with a low fat dip.
  • Make air-popped or "light" microwave popcorn.

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Read food labels  

Reading food labels can help you and your family eat the heart-healthy way. Food labels have two important parts: the nutrition label and the ingredients list. Also, some labels have claims like "low fat" or "light."

Look on the nutrition label for the amount of saturated fat, total fat, cholesterol, and total calories in a serving of the product. Use this information to compare similar products and find the ones with the smallest amounts.

If there is no nutrition label, look for the list of ingredients. Here, the ingredient in the greatest amount is shown first and the ingredient in the least amount is shown last. So, to choose foods low in saturated fat or total fat, go easy on products that list fats or oil first--or that list many fat and oil ingredients.

In addition to the nutrition information and ingredients list, some food packages have claims like "low fat," "light," or "fat free." See The Low-Down On Food Label Claims for a list of these claims and what they mean.   

Eat out the heart-healthy way

Whether your family is eating on the run or sitting down together to a full course meal, you can make choices that are low in saturated fat and cholesterol. These tips will help:

  • Choose restaurants that have low fat, low cholesterol menu items. Don't be afraid to ask for foods that follow your eating pattern: It's your right as a paying customer.
  • Select poultry, fish, or meat that is broiled, grilled, baked, steamed, or poached rather than fried. Choose lean deli meats like fresh turkey or lean roast beef instead of higher fat cuts like salami or bologna.
  • Look for vegetables seasoned with herbs or spices rather than butter, sour cream, or cheese. Ask for sauces on the side.
  • Order a low fat dessert like sherbet, fruit ice, sorbet, or low fat frozen yogurt.
  • Control serving sizes by asking for a small serving, sharing a dish, or taking some home.
  • At fast food restaurants, go for grilled chicken, and lean roast beef sandwiches or lean plain hamburgers (but remember to hold the fatty sauces), salads with low fat salad dressing, low fat milk, and low fat frozen yogurt. Pizza topped with vegetables is another good choice. Eat these less often: combination burgers, fried chicken and fish, french fries, milk shakes, and regular salad dressings.

Make Physical Activity Part of Your Routine

Regular physical activity improves cholesterol levels: It helps to lower LDL and raise HDL. It can also help you lose weight, if you are overweight. But you don't have to train like a long distance runner to benefit: Even doing any physical activity for just a few minutes each day is better than none at all. Try to build physical activity into your daily routine in ways like these:

  • Take a walk at lunch time or after dinner.
  • Use the stairs instead of the elevator.
  • Get off the bus one or two stops early and walk the rest of the way.
  • Park farther away from the store.
  • Ride a bike.
  • Work in the yard or garden.
  • Go dancing.
Try to be active as a family: Take trips that include hiking, swimming, or skiing. Use your back yard or the park for games like badminton, basketball, football, or volleyball.

Vigorous activities like brisk walking, running, swimming, or jumping rope are called "aerobic." They are especially good for the health of your heart and can burn off extra calories. Aerobic activities can condition your heart if you do them for at least 30 minutes, three to four times a week. But even if you don't have 30 minutes, three to four times a week, try to find two 15-minute periods or even three 10-minute periods.

Most people do not need to see a doctor before they start being active, especially if they start off slowly and work up gradually to a sensible plan. But you should get advice from your doctor beforehand if any of these conditions apply to you: if you have a medical condition; if you have pains or pressure in the chest or shoulder area; if you tend to feel dizzy or faint; if you get very breathless after a mild workout; and if you are middle-aged or older, have not been physically active, and plan a fairly strenuous exercise program.

Lose Weight Sensibly 

If you are overweight, losing even 5 to 10 pounds can improve your blood cholesterol levels. But don't go on a crash diet: The healthiest and longest-lasting weight loss happens when you take it slowly, losing 1/2 to 1 pound a week. If you cut 500 calories a day by eating less and being more active, you should lose 1 pound (which amounts to about 3,500 calories) in a week. (Overweight children and adolescents should not be put on strict weight loss diets; consult your family doctor if this is a concern.)


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A heart-healthy eating plan can help you lose weight because cutting down on fat is a good way to cut down on calories. And, if you are overweight, you should take care to eat foods high in starch and fiber (like vegetables, fruits, and breads and cereals) instead of high fat foods. Choose low fat and low calorie items from each food group. Finally, you'll need to limit the amount--or serving sizes--as well.

But there's more to losing weight than just eating less. The most successful weight-loss programs are those that combine diet and increased physical activity. A low fat, low calorie way of eating combined with increased physical activity can help you lose more weight and keep it off longer than either way can achieve alone.

The Low-Down on Food Label Claims

Here are the main label claims used on food packages--and what they mean:

Saturated Fat--

*Saturated fat free: Less than 1/2 gram saturated fat in a serving; levels of trans fatty acids must be not more than 1 percent of total fat.

**Low saturated fat: 1 gram saturated fat or less in a serving and 15 percent or less of calories from saturated fat. For a meal or main dish (like a frozen dinner): 1 gram saturated fat or less in 100 grams of food and less than 10 percent of calories from saturated fat.


*Cholesterol free: Less than 2 milligrams (mg) cholesterol in a serving; saturated fat content must be 2 grams or less in a serving.

**Low cholesterol: 20 mg cholesterol or less in a serving; saturated fat content must be 2 grams or less in a serving. For a meal or main dish: 20 mg cholesterol or less in 100 grams of food, with saturated fat content less than 2 grams in 100 grams of food.


*Fat free: Less than 1/2 gram fat in a serving.

**Low fat: 3 grams total fat or less in a serving. For a meal or main dish: 3 grams total fat or less in 100 grams of food and not more than 30 percent calories from fat.

Percent fat free--A food with this claim must also meet the low fat claim.


*Calorie free: Less than 5 calories in a serving.

**Low calorie: 40 calories or less in a serving.


*Sodium free: Less than 5 mg sodium in a serving.

**Low sodium: 140 mg sodium or less in a serving. For a meal or main dish: 140 mg sodium or less in 100 grams of food.

Very low sodium: 35 mg sodium or less in a serving.

*Words that mean the same thing as free: "no," "zero," "without," "trivial source of," "negligible source of," and "dietary insignificant source of."

**Words that mean the same thing as low: "contains a small amount of" and "low source of."

Light--A product has been changed to have half the fat or one-third fewer calories than the regular product; or the sodium in a low calorie, low fat food has been cut by 50 percent; or a meal or main dish is low fat or low calorie.

"Light" also may be used to describe things like the color or texture of a food, as long as the label explains this: for example, "light brown sugar" or "light and fluffy."

Reduced/Less/Lower/Fewer--A food (like a lower-fat hot dog or a lower-sodium cracker) has at least 25 percent less of something like calories, fat, saturated fat, cholesterol, or sodium than the regular food or a similar food to which it is compared.

Lean and Extra Lean--Two terms--"lean" and "extra lean"--are used to describe the fat content of meat, poultry, fish, and shellfish.

Lean--Less than 10 grams fat, 4.5 grams or less of saturated fat, and less than 95 mg cholesterol in a serving.

Extra lean--Less than 5 grams fat, less than 2 grams saturated fat, and less than 95 mg cholesterol in a serving.

(Source: prepared by the National Heart, Lung, and Blood Institute-National Institutes Of Health)

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