By Alyssa Trautman, MS, RD, LD
People often tell me that a cardiovascular diet is the most confusing diet to follow. “So can I eat eggs?” “Should I use a salt substitute?” “Am I supposed to follow a low-fat or low-carb diet?” These questions (and more!) are asked because there are so many different components to the diet, and because current research is changing what we know about the link between diet and stroke prevention. Here's more information about how your diet may be putting you at risk.
Fats
Cholesterol
In the past, when a person was identified at risk of a stroke, they would be prescribed a “low cholesterol diet.” This is because cholesterol, a fatty waxy substance, can block arteries, interrupting blood flow and leading to stroke. However, current studies show that simply eating cholesterol may not raise our cholesterol levels like we once thought. There are a number of factors and foods that raise cholesterol MORE than cholesterol-containing foods do. The American Heart Association has now relaxed their previous 300-milligram limit on cholesterol and asks that Americans focus on limiting other fats that are more detrimental to our health.
Trans-Fats
One of these “bad fats” is trans-fat, or trans-fatty acids. Argued as the worst fat we can consume, it is abundant in the American diet. Snack cakes, cookies, crackers, biscuits, microwave popcorn and fried foods all contain trans-fat. Food manufacturers prefer trans-fat because it is very shelf stable, and if food doesn’t spoil, manufacturers save money. The other tricky thing is, if a food has less than 0.5 grams of trans-fat per serving, the food manufacturer can legally list “0 grams trans-fat” on the nutrition label. Look for the phrase “partially hydrogenated vegetable oil” to tell you if the product does in fact contain trans-fat. Why the bad reputation? Trans-fat raises our LDL (the bad cholesterol), lowers our HDL (the good cholesterol) and raises triglyceride levels, all increasing our stroke risk.
Saturated Fats
Saturated fats are also known to raise our bad LDL cholesterol, leading to heart disease -- including stroke. Saturated fat tends to be solid at room temperature. To easily identify saturated fats, remember S=S: saturated equals solid. Think butter, Crisco, coconut oil, the fat on steak, bacon and poultry skin.
Triglycerides
Not as well-known as cholesterol, triglycerides are another form of fat found in our body. Known as the “storage" form of fat, triglycerides are created when we eat too many calories -- especially calories from carbohydrates and alcohol. High triglycerides are an independent risk factor of stroke, meaning that even if your cholesterol levels are good, having high triglycerides could still put you at risk for having a stroke – up to 30% increased risk according to one study! A simple blood test can show your triglyceride level. Optimal triglyceride levels are <150 mg/dL.
Sodium
Excessive sodium, or salt, consumption (more than 4,000 milligrams a day) is a common problem in the American diet. Not only can excessive sodium lead to high blood pressure, which is a leading cause of stroke, but interestingly, a high sodium diet has also been linked to increased strokes, even in those who do not have high blood pressure. Most people say to me, “Oh I’m good, I don’t add any salt to my food.” The problem is that food manufacturers do! Around 80% of our sodium consumption is from sodium already in foods -- that’s without consumers adding a single grain of salt. Some surprising sources of sodium in the American diet: bread, cake and pudding mixes, Gatorade, chicken (it’s typically injected with sodium broth) and salsa. The recommended goal is <2,300 milligrams sodium a day, and only 1,500 milligrams for those diagnosed with a heart condition.
Sugar
Did you know that people with diabetes are two to four times more likely to suffer from a stroke, and tend to have strokes at earlier ages than those without diabetes? But if you think only people with diabetes have to watch sugar intake, think again. Excess sugar consumption can lead to high triglyceride levels and excessive weight, both of which increase your risk of having a stroke. Try to limit refined carbohydrates and avoid foods with added sugar.
So to answer our questions…..
“Can I eat eggs?”
Yes! Once banned due to their cholesterol content, eggs are now accepted again. And for good reason, as they are high in vitamin D, vitamin A, vitamin B2, vitamin B12, lutein, choline, selenium and protein and are not shown to raise cholesterol levels!
“Should I use a salt substitute?”
Depends -- some salt substitutes are completely sodium free, such as the brands NoSalt™ and Mrs. Dash™. But others advertised as “Lite” salt still contain some sodium. Sea salt and kosher salt have the same amount of sodium as regular table salt, so should not be considered salt replacements. Individuals with kidney issues are advised to ask their doctor before using salt substitutes.
“Should I follow a low-fat or low-carb diet?”
While a “low” carbohydrate diet may not be necessary, everyone should limit intake of added sugars and consume a healthy amount of calories overall. In addition, do not think of “low-fat,” but rather, eating “the RIGHT fats.” Limit trans and saturated fats, while consuming more mono- and polyunsaturated fats. See the table below for more facts on fats.