HDL cholesterol, on the other hand, is like nature's plaque vacuum cleaner-it picks up the vessel-clogging cholesterol and carries it away to the liver, where it is disposed of in the form of bile. The higher your HDL levels, the cleaner your blood vessels will be. So, you want your high high-density high high. According to the NIH, people with HDL of 60 mg/dL or higher have a lower risk of heart disease, whereas HDL below 40 mg/dL is considered too low.

Because HDL is so important to the health of blood vessels, some physicians prefer to talk about the cholesterol ratio-your total cholesterol divided by your HDL cholesterol. For example, if your total cholesterol number is 250 and your HDL is 50, your ratio is 250/50 or 5. A ratio of 3.5 is considered optimal, and people are urged to aim for a ratio of 5 or less.

Interestingly, men and women may need to pay attention to different numbers. With women, LDL cholesterol and the cholesterol ratio are equally valuable for predicting risk of atherosclerosis. With men, the ratio may be more important-having near optimal levels of LDL may still be dangerous if HDL is too low and the cholesterol ratio is too high. If any of your numbers are high (or if your HDL is low), it's important to make cholesterol control a priority.

High cholesterol can be caused by several factors, some you can change, and some you can't. Heredity can play a big part. Some people can have a perfect heart-healthy lifestyle, and still have skyrocketing cholesterol because their bodies naturally make too much of it-our bodies' production of cholesterol is independent from what we eat. Also, LDL cholesterol increases naturally with age, so even if you put up all-star numbers when you were younger, each pa.s.sing year has made you that much more likely to have problems. Men naturally have higher cholesterol than women, but the female advantage fades when the hormonal changes of menopause lead to a steep rise in women's LDL cholesterol.

And as if high LDL cholesterol wasn't dangerous enough on its own, results of a study published in a 2006 issue of the journal Hypertension Hypertension showed that people who had high LDL cholesterol or a high cholesterol ratio had an increased risk of developing high blood pressure. People with a level of bad cholesterol (non-HDL cholesterol, which includes LDL and other dangerous cholesterol forms, such as very low-density lipoprotein and intermediate-density lipoprotein) higher than 190 had about a 30 percent greater risk of developing HBP compared with people with bad cholesterol levels of less than 160. Even worse, people with a cholesterol ratio of 6 or higher had a 47 percent increased risk of HBP compared with people who had ratios of 4 or less. On the other hand, people with HDL (our hero) of 53 or higher, had a 32 percent showed that people who had high LDL cholesterol or a high cholesterol ratio had an increased risk of developing high blood pressure. People with a level of bad cholesterol (non-HDL cholesterol, which includes LDL and other dangerous cholesterol forms, such as very low-density lipoprotein and intermediate-density lipoprotein) higher than 190 had about a 30 percent greater risk of developing HBP compared with people with bad cholesterol levels of less than 160. Even worse, people with a cholesterol ratio of 6 or higher had a 47 percent increased risk of HBP compared with people who had ratios of 4 or less. On the other hand, people with HDL (our hero) of 53 or higher, had a 32 percent decreased decreased risk of developing hypertension. Really, these results make sense. High LDL cholesterol leads to atherosclerosis...which causes narrowing of the blood vessels...which means your heart has to pump that much harder to squeeze blood through them...which means increased blood pressure. You can improve your cholesterol profile by reducing body weight (if you are overweight), increasing physical activity, and following my cholesterol-busting nutrition program. risk of developing hypertension. Really, these results make sense. High LDL cholesterol leads to atherosclerosis...which causes narrowing of the blood vessels...which means your heart has to pump that much harder to squeeze blood through them...which means increased blood pressure. You can improve your cholesterol profile by reducing body weight (if you are overweight), increasing physical activity, and following my cholesterol-busting nutrition program.

FAQSThere are so many reports about cholesterol-lowering supplements, especially policosanol. How can I tell what is valuable and what isn't?

You're right-it seems that every time you open a magazine there's a story about another miracle supplement. Policosanol is a sugar cane extract that has been touted as a way to reduce cholesterol. But a rigorous 2006 study showed that even 80 milligrams of high-quality policosanol per day didn't have any effect on cholesterol. As I write, there is preliminary information that says that cinnamon and cloves (in supplement form only, not from food) may help lower cholesterol. This is potentially good news, but it is too early to recommend seeking out cinnamon supplements. You don't want to be a guinea pig, one of the first to test out some new treatment-there may be undiscovered side effects or you may waste money on a worthless treatment. On the other hand, you also don't want to miss out on a treatment that the medical community has embraced. My advice is to read everything, and if you see something interesting, make a copy and take it to your doctor. It can't hurt to ask a professional, and most doctors are happy when their patients are proactive about improving their health.

HIGH TRIGLYCERIDES.

Triglyceride is just a fancy word for is just a fancy word for fat fat-the fat in our bodies is stored in the form of triglycerides. Triglycerides are found in foods and manufactured in our bodies. As with cholesterol, eating too much of the wrong kinds of fats (more about that in the sections on saturated and trans fats below) will raise your blood triglycerides, but some people also have a genetic predisposition that causes them to manufacture way too much triglycerides on their own, no matter how carefully they eat. Triglyceride levels can shoot up after eating foods that are high in saturated fats or carbohydrates, or after drinking alcohol. That's why triglyceride tests require an overnight fast. Triglycerides can become elevated because of genetics, or in reaction to having diabetes, hypothyroidism, or kidney disease. As with most other heart-related factors, being overweight and inactive also contribute to abnormal triglycerides.

High triglyceride levels make blood thicker and stickier, which means that it is more likely to form clots. Normal triglyceride levels are defined as less than 150 mg/dL; 150 to 199 is considered borderline high; 200 to 499 is high; and 500 or higher is officially called very high. To me, anything over 150 is a red flag indicating my client needs to take immediate steps to get the situation under control.

Studies have shown that triglyceride levels are a.s.sociated with increased risks of cardiovascular disease and stroke-in both men and women-alone or in combination with other risk factors (high triglycerides combined with high LDL cholesterol can be a particularly deadly combination). For example, in one ground-breaking study, triglycerides alone increased the risk of cardiovascular disease by 14 percent in men, and by 37 percent in women. But when the test subjects also had low HDL cholesterol and other risk factors, high triglycerides increased the risk of disease by 32 percent in men and 76 percent in women. Fortunately, triglycerides are relatively easily controlled with the diet and lifestyle changes outlined in this chapter. To lower triglycerides, lose weight if you're overweight, reduce saturated fat and trans fat, avoid foods that are concentrated in sugar (even dried fruit and fruit juice), cut way back on alcohol (when triglycerides are high, sugar and alcohol will keep them high), and incorporate omega-3 fats.

HIGH h.o.m.oCYSTEINE.

h.o.m.ocysteine is an amino acid naturally produced when the body breaks down proteins that contain another amino acid, methionine. No one knows exactly what role h.o.m.ocysteine plays in heart disease. It could be that h.o.m.ocysteine directly damages blood vessels. In the laboratory, h.o.m.ocysteine causes inflammation, damages blood vessel linings, and encourages blood clots. Or, it could be that h.o.m.ocysteine is just a marker-a sign that other things are going wrong in the body to create heart disease. Many scientists agree on one point, however: People with blood levels of h.o.m.ocysteine higher than 10 micromol/L may have an increased risk of heart attack and stroke.

The research picture gets cloudy when it comes to the benefits of lowering h.o.m.ocysteine. Early studies suggested that lowering abnormally high levels of h.o.m.ocysteine reduced the risk of heart disease and heart attack, especially when there were other risk factors at work, such as smoking or hypertension. More recent studies found that when people with normal h.o.m.ocysteine levels lowered them even more, there was no heart-related benefit. So, what's a person to do? If h.o.m.ocysteine treatment required a prescription medication, making a decision could be difficult. But the best treatment isn't new, risky, or expensive; it's making sure you're getting enough of the ultimate B trio B trio of folic acid, vitamin B of folic acid, vitamin B6, and vitamin B12 in the food you eat. So although research results may be murky, my advice is simple: Eat more of these healthful foods, as described in the next section. in the food you eat. So although research results may be murky, my advice is simple: Eat more of these healthful foods, as described in the next section.

C-REACTIVE PROTEIN.

When the body is exposed to infection, allergens, or even physical damage, it reacts by releasing chemicals designed to fight off the invasion or fix the damage. While working to protect us, these substances create inflammation. One of the body's markers for inflammation is C-reactive protein (CRP).

Inflammation feeds atherosclerosis. Your immune system's response to atherosclerosis is to rush white blood cells to the site of the damage. But the plaque gobbles up the white cells and grows bigger. Once plaque matures, it becomes fragile, and inflammation can cause this brittle plaque to rupture. These shattered pieces of plaque get carried along the blood stream, and can form clots that cause heart attacks or strokes.

The value of CRP is that it tells us when inflammation is present, possibly causing cardiovascular disease. If we know that, we can take steps to reduce the inflammation and prevent blood vessel damage. The nutrition and lifestyle changes in this chapter can help reduce inflammation.

THE METABOLIC SYNDROME.

As you might imagine, having one risk factor for heart disease is bad enough, but having more than one amplifies the threat. The metabolic syndrome describes a cl.u.s.ter of risk factors that, when taken together, create a toxic environment in blood vessels. The metabolic syndrome is characterized by having at least three of the following symptoms: high blood pressure, high triglycerides, low HDL cholesterol, large waist circ.u.mference (greater than 35? for women, 40? for men), or fasting blood sugar greater than 110 mg/dL. People with the metabolic syndrome have an increased risk of heart disease, stroke, and diabetes. Fortunately, the 4-step plan in this chapter can help improve each of the risk factors, so you can solve all five five problems with one approach. problems with one approach.

HOW FOOD AFFECTS.

CARDIOVASCULAR DISEASE.

Eating well for heart health means knowing which foods to limit, and which to embrace.

FOODS TO LIMIT OR AVOID.

The top dietary recommendation for cardiovascular health is to eliminate or at least drastically limit the foods you eat that contain saturated fats, trans fats, cholesterol, refined carbohydrates, and salt.

SATURATED FATS.

Saturated fats are found in animal-based foods, including meats, b.u.t.ter, whole milk dairy products (including yogurt, cheese, and ice cream), and poultry skin. They are also found in some high-fat plant foods, such as palm oil. The Nurses' Health Study, which included more than 80,000 partic.i.p.ants, showed that saturated fats increase the risk of coronary artery disease. It was estimated that if you replace just 100 calories of saturated fat in your diet every day with unsaturated fats (found in as olive oil or nuts), you can reduce your risk of heart disease by about 40 percent. Just 100 calories! That's about the total number of calories in one homemade chocolate chip cookie, so swap that cookie for 5 macadamia nuts or 12 almonds and you're on your way to a healthier heart. By making a few simple changes, you can improve your risk profile: - Avoid b.u.t.ter, cream cheese, lard, sour cream, doughnuts, cakes, cookies, chocolate bars, chocolate chips, ice cream, fried foods, pizza, cream- or cheese-based salad dressings, cheese sauce, cream sauces, animal shortenings, high-fat meats (including hamburgers, bologna, pepperoni, sausage, bacon, salami, pastrami, spareribs, and hot dogs), high-fat cuts of beef and pork, whole-milk dairy products.

- Choose lean meats only (including skinless chicken and turkey, lean beef, lean pork), fish, reduced-fat or fat-free dairy products. Try soy foods as a subst.i.tute for meat at least some of the time. Although soy itself may not reduce risk of heart disease, it replaces hazardous animal fats with healthier proteins. Choose high-quality soy foods, such as tofu, tempeh, enriched/fortified soy milk, and edamame.

- Always remove skin from poultry.

- Prepare foods by baking, roasting, broiling, boiling, poaching, steaming, grilling, or stir-frying. No deep-fat frying.

TRANS FATS.

Trans fats were developed in a laboratory to improve the shelf life of processed foods-and they do. But calorie for calorie, trans fats are more dangerous than the saturated fats I just advised you to avoid. Most stick margarines contain trans fats, and trans fats are found in many packaged baked goods, potato chips, snack foods, fried foods, and fast food that use or create hydrogenated oils hydrogenated oils. (All food labels must now list the amount of trans fats, right after the amount of saturated fats-good news for consumers.) By subst.i.tuting olive oil or vegetable oil for trans fats in just 2 percent of your daily calories, you can reduce your risk of heart disease by 53 percent. In a 2,000-calorie-a-day diet, that's about 40 calories 40 calories. Think of it this way-an average serving of French fries contains about 5 grams of trans fats, or about 45 calories worth of evil trans fats, and a daily serving would be enough to double double your risk of heart disease. There is no safe amount of trans fats, so try to keep them as far from your plate as possible. your risk of heart disease. There is no safe amount of trans fats, so try to keep them as far from your plate as possible.

CHOLESTEROL-RICH FOODS.

Years ago, doctors used to recommend that people with heart disease avoid all high-cholesterol foods. But dietary cholesterol does not harm health as much as saturated fats and trans fats do. Research into the effects of dietary cholesterol have been mixed, which is not surprising-different people have different susceptibilities. Still, if you want to take a firm hand to reduce your risk factors, you may want to consider cutting down on all high-cholesterol foods, including egg yolks, sh.e.l.lfish, liver, and other organ meats like sweetbreads and foie gras. You'll notice whole eggs and sh.e.l.lfish on a couple of my best food lists-that's because they're high in other heart healthy nutrients-as well as cholesterol. That said, if your LDL cholesterol is high, limit your intake of egg yolks to no more than three per week (whites are unlimited), and limit sh.e.l.lfish to no more than one portion twice weekly. You may also want to speak with your cardiologist about personal limitations.

REFINED CARBOHYDRATES.

Refined carbohydrates include sugary foods, sugared soft drinks, fruit juice, sweet baked goods, anything baked with white flour (including white bread, rolls, cereal, buns), and white rice. These low-quality carbs cause a sudden rise in insulin, which may lead to a spike in triglycerides. Whenever possible, aim for high-quality instead of low-quality carbs. That means limiting sweets, and choosing whole grain foods, such as oatmeal, healthy cereals, brown and wild rice, whole wheat pasta, and bread products that include the word whole whole or or oats oats in the first ingredient. in the first ingredient.

SALT.

For decades, the science has been pretty clear: Salt increases blood pressure in people who are salt sensitive, and the more salt you eat, the greater the potential rise in blood pressure. Sodium in small doses is necessary for the body to function properly, but too much will draw excess fluid into the blood, effectively raising blood pressure. Salt is a hard habit to break-it actually dulls your sense of taste, which means that, over time, you'll be reaching for that shaker more often to get the same taste. The best thing to do is go cold turkey. Well, almost. First, take the salt shaker off the kitchen table, and try not to add salt to foods you prepare at home. If you miss the flavor, experiment with some of the salt subst.i.tutes on the market (such as Mrs. Dash and Morton salt-subst.i.tute seasonings). Second, when reading food labels, choose brands that have less sodium. Third, limit hidden sources of sodium, such as ketchup, soy sauce, teriyaki sauce, salad dressings, prepared marinades, pickles, sauerkraut, deli meats, canned vegetables, canned soups, and broth. Go out of your way to buy brands that offer lower-sodium varieties, especially when it comes to canned goods. If you buy canned beans, choose low-sodium brands whenever possible, and always rinse thoroughly before using-the liquid they are packed in can be very high in sodium.

GOOD FOODS TO CHOOSE.

FRUITS AND VEGETABLES.

I know you're probably sick of hearing advice about eating plenty of fruits and vegetables, but it really is important, especially for people fighting cardiovascular disease. The scientific data all support the same claim: People who eat five or more servings of fruits and vegetables daily have a reduced risk of heart attack and stroke compared with people who eat less than three servings daily. Specifically, heart attack risk is about 15 percent lower, and stroke risk is about 30 percent lower! On average, the risk of coronary artery disease is reduced by about 5 percent for each additional serving of fruits and vegetables you eat every day.

What's the magic in fruits and vegetables? No one really knows. Sure, they're full of vitamins, minerals, fiber, and antioxidants, but we don't know which ones are most helpful because whenever scientists try to mimic the effects of foods with supplements, their formulations simply don't produce the same protective effects as the real thing. That means that you have to eat the foods, the whole foods (and nothing but the foods) in order to reap the benefits of fruits and vegetables. Two large caveats: Two large caveats: If you're taking any cardiac medication, avoid eating grapefruit and drinking grapefruit juice (a compound in grapefruit interferes with the breakdown of many medications). Also, if you're taking a blood thinner like Coumadin, have your doctor monitor your blood and medication dosage as you increase your intake of dark leafy green vegetables. These vegetables are rich in vitamin K which plays a key role in blood clotting (see full list of Vitamin K-rich foods in the Osteoporosis chapter on Chapter 10). If you're taking any cardiac medication, avoid eating grapefruit and drinking grapefruit juice (a compound in grapefruit interferes with the breakdown of many medications). Also, if you're taking a blood thinner like Coumadin, have your doctor monitor your blood and medication dosage as you increase your intake of dark leafy green vegetables. These vegetables are rich in vitamin K which plays a key role in blood clotting (see full list of Vitamin K-rich foods in the Osteoporosis chapter on Chapter 10).

SOLUBLE FIBER.

Soluble fiber, especially the viscous type, may help reduce cholesterol by grabbing onto cholesterol and escorting it through your digestive system and out of your body. It also may reduce the intestinal absorption of cholesterol, and it can lower blood pressure. Research has shown that eating an additional 5 to 10 grams of soluble fiber a day can reduce LDL cholesterol by 3 to 5 percent. If you eat a few foods rich in soluble fiber every day, you'll get at least at least 5 grams. It is a small improvement, but every percentage point counts! 5 grams. It is a small improvement, but every percentage point counts!

BEST FOODS FOR SOLUBLE FIBER: Psyllium seeds (ground), oat and rice bran, oatmeal, barley, lentils, Brussels sprouts, peas, beans (kidney, lima, black, navy, pinto), apples, blackberries, pears, raisins, oranges, grapefruit, dates, figs, prunes, apricots, cantaloupe, strawberries, bananas, peaches, broccoli, carrots, cauliflower, cabbage, spinach, sweet potatoes, yams, white potatoes, tomatoes, avocado, raspberries, corn, almonds, flaxseed (ground), sunflower seeds Psyllium seeds (ground), oat and rice bran, oatmeal, barley, lentils, Brussels sprouts, peas, beans (kidney, lima, black, navy, pinto), apples, blackberries, pears, raisins, oranges, grapefruit, dates, figs, prunes, apricots, cantaloupe, strawberries, bananas, peaches, broccoli, carrots, cauliflower, cabbage, spinach, sweet potatoes, yams, white potatoes, tomatoes, avocado, raspberries, corn, almonds, flaxseed (ground), sunflower seeds HEALTHY FATS.

There was a time when heart researchers slapped the same label-bad-on every kind of fat. Now, we know that trans fats and saturated fats are amazingly dangerous for cardiovascular health, but omega-3 fats and monounsaturated fats are actually good for your heart.

Heart-healthy fish oils are especially rich in omega-3 fatty acids. In multiple studies over the past 15 years, people who ate diets high in omega-3s had 30 to 40 percent reductions in heart disease, and fewer cases of sudden death from arrhythmia. Although we don't yet know why fish oil works so well, there are several possibilities. Omega-3s seem to reduce inflammation, reduce high blood pressure, decrease triglycerides, raise HDL cholesterol, and make blood thinner and less sticky so it is less likely to clot. So omega-3s affect nearly every risk factor for heart disease. It's as close to a food prescription for heart health as it gets. I recommend eating at least three servings of one of the omega-3-rich fish every week. If you cannot manage to eat that much fish, try taking fish oil capsules, which have the same effect. (See the Supplements section, for more information.) BEST FOODS FOR OMEGA-3 FATTY ACIDS: Wild salmon (fresh, canned), herring, mackerel (not king), sardines, anchovies, rainbow trout, Pacific oysters, omega-3-fortified eggs, flaxseed (ground and oil), walnuts, b.u.t.ternuts (white walnuts), seaweed, walnut oil, canola oil, soybeans Wild salmon (fresh, canned), herring, mackerel (not king), sardines, anchovies, rainbow trout, Pacific oysters, omega-3-fortified eggs, flaxseed (ground and oil), walnuts, b.u.t.ternuts (white walnuts), seaweed, walnut oil, canola oil, soybeans Monounsaturated fats, found mainly in olive oil, are thought to protect people against heart disease by reducing blood pressure. Scientists discovered the benefits of olive oil by observing Mediterranean populations. They use olive oil more than any other form of fat and typically have low rates of coronary artery disease. Research shows it doesn't help to just add add monounsaturated fats to your diet-you need to replace some of the unhealthy fats that are already in your diet (all those saturated and trans fats mentioned earlier) with better choices. There is some evidence that subst.i.tuting olive oil for some carbohydrates in your diet (particularly those unhealthy low-quality refined carbohydrates!) can increase HDL. monounsaturated fats to your diet-you need to replace some of the unhealthy fats that are already in your diet (all those saturated and trans fats mentioned earlier) with better choices. There is some evidence that subst.i.tuting olive oil for some carbohydrates in your diet (particularly those unhealthy low-quality refined carbohydrates!) can increase HDL.

BEST FOODS FOR MONOUNSATURATED FATS: Olive oil, canola oil, avocado, macadamia nuts, hazelnuts, pecans, almonds, peanuts, cashews, Brazil nuts, pistachio nuts, pine nuts, peanut b.u.t.ter, olives Olive oil, canola oil, avocado, macadamia nuts, hazelnuts, pecans, almonds, peanuts, cashews, Brazil nuts, pistachio nuts, pine nuts, peanut b.u.t.ter, olives

FAQSI did everything right-I saw a nutritionist, I started exercising, and stopped smoking-but my LDL cholesterol is still high. My doctor put me on a statin medication. Is there anything I should do differently with my diet?

First, keep following all of your doctor's advice. Second, follow all the diet recommendations in this chapter. If your cholesterol returns to normal levels, don't stop-the change means the program is working, and it's a lifestyle change not a temporary one-time fix. Statins are valuable medications, but they are just one tool for keeping cholesterol under control. The nutrition and lifestyle changes in this chapter can help turn your risk factors around, which will mean better health in the long run. However, some people have a genetic predisposition to make cholesterol and may still require medications in addition to lifestyle changes. Finally, many health experts (including me) recommend that their clients who take one of the cholesterol-lowering statin medications also take a supplement called Coenzyme Q Coenzyme Q10. CoQ10 is an antioxidant necessary for energy production in cells. Without CoQ is an antioxidant necessary for energy production in cells. Without CoQ10, cells can't function properly. Our bodies usually make sufficient CoQ10 to keep us healthy. Statins work by inhibiting the mechanism that allows the liver to make cholesterol, but they also slow the body's production of CoQ to keep us healthy. Statins work by inhibiting the mechanism that allows the liver to make cholesterol, but they also slow the body's production of CoQ10, leading to deficiency. To counteract these effects, I recommend taking 100 milligrams of CoQ10 once a day in a soft gel formulation. Although most people can take CoQ once a day in a soft gel formulation. Although most people can take CoQ10 safely and without side effects, it is always a good idea to talk with your doctor before taking any supplement. safely and without side effects, it is always a good idea to talk with your doctor before taking any supplement.

B VITAMINS: FOLATE, B6, B12.

If this book had been written just a year earlier, this section on B vitamins would have read much differently. Folate, vitamin B6, and vitamin B12 are known to reduce levels of h.o.m.ocysteine, and high h.o.m.ocysteine often means a higher risk of coronary artery disease. So to reduce h.o.m.ocysteine, it is important to eat plenty of vitamin B-rich foods. are known to reduce levels of h.o.m.ocysteine, and high h.o.m.ocysteine often means a higher risk of coronary artery disease. So to reduce h.o.m.ocysteine, it is important to eat plenty of vitamin B-rich foods.

But then came three studies involving more than 9,000 partic.i.p.ants who had a very high risk of a coronary artery event; they had either doc.u.mented heart disease or a history of heart attack or stroke. This research showed that taking these vitamins in the form of supplements lowered h.o.m.ocysteine, but didn't actually reduce the risk of heart attacks or strokes. Those who took the vitamins had the same number of heart attacks and strokes as those who did not. While some scientists believe that this casts doubt on the value of B vitamins for heart health, other experts still consider them essential. It could be that food will work where supplements don't. Or perhaps the vitamins work best before cardiovascular disease is so advanced that it can't be reversed. I believe that it is too early to cast the B vitamins aside. There's more research underway, but in the meantime, I recommend getting your folate, vitamin B6, and vitamin B12 from food sources, which are delicious and generally good for health. If they also help keep your heart pumping, that's even better. from food sources, which are delicious and generally good for health. If they also help keep your heart pumping, that's even better.

BEST FOODS FOR FOLATE: Fortified whole grain cereals, lentils, black-eyed peas, soybeans, oatmeal, turnip greens, spinach, mustard greens, green peas, artichokes, okra, beets, parsnips, broccoli, broccoli raab, sunflower seeds, wheat germ, oranges and juice, Brussels sprouts, papaya, seaweed, berries (boysenberries, blackberries, strawberries), beans (black, pinto, kidney, garbanzo, navy), cauliflower, Chinese cabbage, corn, whole grain bread, pasta (preferably whole wheat) Fortified whole grain cereals, lentils, black-eyed peas, soybeans, oatmeal, turnip greens, spinach, mustard greens, green peas, artichokes, okra, beets, parsnips, broccoli, broccoli raab, sunflower seeds, wheat germ, oranges and juice, Brussels sprouts, papaya, seaweed, berries (boysenberries, blackberries, strawberries), beans (black, pinto, kidney, garbanzo, navy), cauliflower, Chinese cabbage, corn, whole grain bread, pasta (preferably whole wheat)

FAQSI had blood tests done recently. My LDL cholesterol is normal, my triglycerides are normal, but my HDL cholesterol is abnormally low. Is there anything I can do to improve my HDLs?

Some people have a genetic tendency to low HDL, even when all their other cardiovascular risk factors are normal. Although this might seem harmless, it can throw off your cholesterol ratio, and may indicate a future risk of heart problems. I recommend you incorporate a daily exercise regimen (exercise has been shown to boost HDL levels) and follow the diet and lifestyle recommendations in this chapter-these steps will help a.s.sure that your blood vessels stay as healthy as possible.In addition, I recommend taking low dosages of omega-3 fatty acids (see Supplements section, Chapter 7, for more information), and extended release formulations of niacin (such as Niaspan, which is only available by prescription). Extended-release niacin has been shown to raise HDL cholesterol by about 14 percent in men, and by about 20 percent in women. In addition, niacin can help lower triglycerides and LDL cholesterol.It is important to talk with your doctor before beginning niacin treatment. Although niacin is a powerful treatment for boosting HDL cholesterol, it can be dangerous for people with diabetes, gallbladder disease, gout, glaucoma, peptic ulcer, or impaired liver function, or who are pregnant or have had a recent heart attack. In addition, niacin can interact with other medications, and it may cause some uncomfortable side effects, including flu-like symptoms, rash, and flushing so intense that it can temporarily leave you looking sunburned and feeling like you're having a hot flash.Ask your doctor for a specific recommendation for the type of niacin to choose-it comes in extended-release, controlled-release, sustained-release, or regular formulations, so it isn't as easy as picking just any supplement off the shelf.

BEST FOODS FOR VITAMIN B6: Fortified whole grain cereals, chickpeas (garbanzo beans), wild salmon (fresh, canned), lean beef, pork tenderloin, chicken breast, white potatoes (with skin), oatmeal, bananas, pistachio nuts, lentils, tomato paste, barley, rice (brown, wild), peppers, sweet potatoes, winter squash (acorn), broccoli, broccoli raab, carrots, Brussels sprouts, peanut b.u.t.ter, eggs, shrimp, tofu, apricots, watermelon, avocado, strawberries, whole grain bread Fortified whole grain cereals, chickpeas (garbanzo beans), wild salmon (fresh, canned), lean beef, pork tenderloin, chicken breast, white potatoes (with skin), oatmeal, bananas, pistachio nuts, lentils, tomato paste, barley, rice (brown, wild), peppers, sweet potatoes, winter squash (acorn), broccoli, broccoli raab, carrots, Brussels sprouts, peanut b.u.t.ter, eggs, shrimp, tofu, apricots, watermelon, avocado, strawberries, whole grain bread BEST FOODS FOR VITAMIN B12: Sh.e.l.lfish (clams, oysters, crab), wild salmon (fresh, canned), fortified whole grain cereal, enriched/fortified soy milk, trout (rainbow, wild), tuna (canned light), lean beef, veggie burgers, cottage cheese (fat-free, 1% reduced-fat), yogurt (fat-free, low-fat), milk (fat-free, 1% reduced-fat), eggs, cheese (fat-free, reduced-fat) Sh.e.l.lfish (clams, oysters, crab), wild salmon (fresh, canned), fortified whole grain cereal, enriched/fortified soy milk, trout (rainbow, wild), tuna (canned light), lean beef, veggie burgers, cottage cheese (fat-free, 1% reduced-fat), yogurt (fat-free, low-fat), milk (fat-free, 1% reduced-fat), eggs, cheese (fat-free, reduced-fat) CALCIUM AND VITAMIN D.

Calcium and vitamin D work as a team-vitamin D helps the body absorb and use calcium. These two nutrients have been shown to help reduce blood pressure by 3 to 10 percent. Although this doesn't sound like much, it could add up to about 15 percent reduction in risk for cardiovascular disease. Some research suggests that milk proteins may act similarly to antihypertensive (blood pressure-lowering) medications called ACE inhibitors ACE inhibitors.

BEST FOODS FOR CALCIUM: Yogurt (fat-free, low-fat), milk (fat-free, 1% reduced-fat), enriched/fortified soy milk, calcium-fortified fruit juice, cheese (fat-free, reduced-fat), tofu with calcium, sardines (with bones), wild salmon (with bones), soybeans, frozen yogurt, low-fat ice cream, calcium-fortified whole grain waffles, bok choy, kale, white beans, broccoli, almonds Yogurt (fat-free, low-fat), milk (fat-free, 1% reduced-fat), enriched/fortified soy milk, calcium-fortified fruit juice, cheese (fat-free, reduced-fat), tofu with calcium, sardines (with bones), wild salmon (with bones), soybeans, frozen yogurt, low-fat ice cream, calcium-fortified whole grain waffles, bok choy, kale, white beans, broccoli, almonds BEST FOODS FOR VITAMIN D: Wild salmon (with bones), mackerel (not king), sardines (with bones), herring, fortified milk (fat-free, 1% reduced-fat), enriched/fortified soy milk, egg yolks, mushrooms (especially shiitake), vitamin D-fortified margarine (soft tub, trans fat-free), fortified whole grain cereal Wild salmon (with bones), mackerel (not king), sardines (with bones), herring, fortified milk (fat-free, 1% reduced-fat), enriched/fortified soy milk, egg yolks, mushrooms (especially shiitake), vitamin D-fortified margarine (soft tub, trans fat-free), fortified whole grain cereal MAGNESIUM.

Although more research is needed, magnesium may turn out to be a potent ally for reducing the risk of cardiovascular disease. In lab animals, magnesium reduces inflammation and alters the way fats are metabolized. Human studies suggest that eating lots of magnesium-rich foods may reduce triglycerides, lower blood pressure, and increase HDL cholesterol. In a long-term, 15-year study, eating plenty of magnesium-rich foods reduced the risk of developing the metabolic syndrome by about 30 percent.

BEST FOODS FOR MAGNESIUM: Pumpkin seeds, spinach, Swiss chard, amaranth, sunflower seeds, cashews, almonds, quinoa, tempeh, sweet potatoes, white potatoes, soybeans, millet, beans (black, white, navy, lima, pinto, kidney), artichoke hearts, peanuts, peanut b.u.t.ter, chickpeas (garbanzo beans), brown rice, whole grain bread, sesame seeds, wheat germ, flaxseed Pumpkin seeds, spinach, Swiss chard, amaranth, sunflower seeds, cashews, almonds, quinoa, tempeh, sweet potatoes, white potatoes, soybeans, millet, beans (black, white, navy, lima, pinto, kidney), artichoke hearts, peanuts, peanut b.u.t.ter, chickpeas (garbanzo beans), brown rice, whole grain bread, sesame seeds, wheat germ, flaxseed POTa.s.sIUM.

Your blood levels of pota.s.sium and sodium are inextricably linked. When pota.s.sium is low, the body retains sodium (and, as discussed above, too much sodium raises blood pressure). When pota.s.sium is high, the body gets rid of sodium. Eating pota.s.sium-rich foods is important for maintaining a healthy balance of both minerals, and, by extension, for keeping blood pressure low. Important note: Important note: Do Do not not take pota.s.sium supplements unless specifically prescribed by your doctor. Too much pota.s.sium will upset the balance, and could have serious, even life-threatening consequences. take pota.s.sium supplements unless specifically prescribed by your doctor. Too much pota.s.sium will upset the balance, and could have serious, even life-threatening consequences.

BEST FOODS FOR POTa.s.sIUM: White potatoes, yams, fat-free and low-fat yogurt, soybeans, Swiss chard, snapper, sweet potatoes, avocado, cantaloupe, artichokes, bananas, spinach, lettuce (especially romaine), radicchio, arugula, endive, black cod (sablefish), honeydew melon, pumpkin, milk (fat-free, 1% reduced-fat), carrots, beans (white, black, navy, kidney, pinto), lentils, lima beans, apricots, papaya, split peas, pistachio nuts, winter squash (acorn, b.u.t.ternut), enriched/fortified soy milk, watermelon, beets, tomatoes (including sauce, juice), kale, mushrooms, raisins, peanuts, plums, almonds, sunflower seeds, prunes (and juice), chickpeas (garbanzo beans), oranges (and juice), broccoli White potatoes, yams, fat-free and low-fat yogurt, soybeans, Swiss chard, snapper, sweet potatoes, avocado, cantaloupe, artichokes, bananas, spinach, lettuce (especially romaine), radicchio, arugula, endive, black cod (sablefish), honeydew melon, pumpkin, milk (fat-free, 1% reduced-fat), carrots, beans (white, black, navy, kidney, pinto), lentils, lima beans, apricots, papaya, split peas, pistachio nuts, winter squash (acorn, b.u.t.ternut), enriched/fortified soy milk, watermelon, beets, tomatoes (including sauce, juice), kale, mushrooms, raisins, peanuts, plums, almonds, sunflower seeds, prunes (and juice), chickpeas (garbanzo beans), oranges (and juice), broccoli GARLIC.

The naturally occurring compound called allicin allicin is the active part of garlic that seems to help lower cholesterol. It acts as a powerful antioxidant, and may also affect the way LDL cholesterol is used in the body and reduce triglycerides. There is some evidence that garlic may also lower h.o.m.ocysteine and reduce blood pressure. Although most studies of garlic use garlic supplements, some have shown similar good results for raw garlic. Unfortunately a great many of my clients don't like or can't tolerate raw garlic. Either they don't like the taste or it upsets their stomachs. Still, I recommend adding garlic to your cooking-as much as you like, as often as your family and friends can stand. Gently saute the garlic separately from other foods to avoid burning it, or bake it and enjoy it as a rich, nutty-flavored paste. Garlic can act as a blood thinner, so if you are already taking aspirin or warfarin, please make your doctor aware that you've added garlic to your diet. (See the Supplements section, Chapter 7, for more information about garlic supplements.) is the active part of garlic that seems to help lower cholesterol. It acts as a powerful antioxidant, and may also affect the way LDL cholesterol is used in the body and reduce triglycerides. There is some evidence that garlic may also lower h.o.m.ocysteine and reduce blood pressure. Although most studies of garlic use garlic supplements, some have shown similar good results for raw garlic. Unfortunately a great many of my clients don't like or can't tolerate raw garlic. Either they don't like the taste or it upsets their stomachs. Still, I recommend adding garlic to your cooking-as much as you like, as often as your family and friends can stand. Gently saute the garlic separately from other foods to avoid burning it, or bake it and enjoy it as a rich, nutty-flavored paste. Garlic can act as a blood thinner, so if you are already taking aspirin or warfarin, please make your doctor aware that you've added garlic to your diet. (See the Supplements section, Chapter 7, for more information about garlic supplements.) PLANT STEROLS OR STANOLS.

Sterols and stanols are natural substances found in small amounts in the cell membrane of plants, including fruits, vegetables, legumes, nuts, and seeds. Sterols are found in relatively high amounts in pistachio nuts, sunflower seeds, sesame seeds, and wheat germ. In terms of their effects on the human body, plant sterols and stanols are virtually the same.

Sterols and stanols have a structure similar to cholesterol, and they compete with cholesterol for access to receptors in the small intestines. (Imagine 15 people all hoping to get a ride in their friend's Volkswagen Beetle-not everyone is going to be riding in the car.) Sterols/stanols compete with cholesterol, effectively blocking its access. Research has shown that sterols and stanols have been shown to cut the amount of cholesterol absorbed by the small intestines by about 50 percent, and to reduce LDL cholesterol levels by between 5 and 14 percent.

You can reap these cardiovascular benefits with just 2 grams of sterol/stanol per day, though you can't get that much eating fruits and vegetables alone. Sterols and stanols have been added to certain heart-healthy spreads that taste and cook just like margarine, including Take Control and Benecol spreads. These spreads have been found to be safe, with very few side effects (although some people complained of upset stomach). That said, they're only for those with cholesterol problems, who should consume no more than the amounts recommended: 2 to 3 tablespoons per day (each tablespoon provides 1 gram of sterol/stanol). You can use it on whole grain bread, melt it on heart-healthy vegetables, or use it in cooking. I recommend trying the light light versions of these spreads to save yourself 30 calories per tablespoon. If you're not a bread eater, please don't start just to have a vehicle for these spreads! Instead, consider the plant stanol/sterol supplements. (See the Supplements section, Chapter 7, for more information about nonfood sources of plant sterol/stanols.) versions of these spreads to save yourself 30 calories per tablespoon. If you're not a bread eater, please don't start just to have a vehicle for these spreads! Instead, consider the plant stanol/sterol supplements. (See the Supplements section, Chapter 7, for more information about nonfood sources of plant sterol/stanols.) ALCOHOL.

The benefits of alcohol depend, in part, on exactly what your cardiovascular risk factors are. If your problem is high triglycerides, alcohol should be considered a rare treat, if you indulge at all. Even small amounts of alcohol can increase triglyceride levels dramatically.

For other risk factors, research suggests that one or two servings of alcohol per day may be good for your heart-that's no more than one serving per day for women, and no more than two servings per day for men. Studies have shown that drinking moderate amounts of alcohol reduces the risk of coronary artery disease by about 25 percent, and reduces the risk of death from heart disease by about 12 percent. Alcohol seems to increase the good HDL cholesterol and prevent clots.

There are right ways and wrong ways to use alcohol for heart health. The right ways are to drink moderately, and with a meal. The optimal amount of alcohol is one or two drinks per day (one serving is 12 ounces of beer; 5 ounces of wine; or one shot of hard alcohol). Although all alcohol has heart-healthy benefits, red wine also contains antioxidants called flavonoids flavonoids and and resveratrol resveratrol-an extra boost of nutrition. Studies show that people who drink these moderate amounts of alcohol have a lower risk of disease than abstainers...although I can't recommend starting to drink if you're a teetotaler.

FAQSI can't tell you how happy I was when I read that chocolate may help improve blood pressure...is it true?

Yes, but with limitations. Scientists have discovered that the antioxidant flavonoids in chocolate can lower blood pressure, reduce inflammation, improve the elasticity of blood vessels, increase HDL, and limit the negative effects of LDL cholesterol. Dark chocolate contains more than double the amount of flavonoids as milk chocolate, and-another strike against it-the milk may stop the intestines from absorbing the flavonoids. So if you're going to eat chocolate, choose a variety that is at least 60 percent dark chocolate. Of course, chocolate is also rich with calories and fat that will lead to weight gain if you overdo it, so make sure that you eat chocolate only in 1-ounce snack-sized portions...and remember to account for the extra 150 calories in your daily calorie allotment.

The wrong way to use alcohol is to drink heavily. People who regularly drink five or more servings of alcohol per day have a higher risk of disease than people who drink moderately or who abstain completely. Even three or more drinks per day raises blood pressure and increases triglycerides. The worst risks are for binge drinkers-people who occasionally consume large amounts of alcohol. Women who have five or more drinks and men who have nine or more drinks in a single drinking episode put themselves at risk of what scientists call major coronary events major coronary events-heart attacks, strokes, and death. No one wants to see a big celebration-a Super Bowl or bachelorette party-end that way. If your team makes it to the Super Bowl and loses, it's a b.u.mmer, but it doesn't have to be fatal.

If you are currently taking medication for lowering blood pressure or cholesterol, or if you have diabetes, always always talk with your doctor about whether drinking alcohol makes sense for you. There are some questions about whether alcohol might interact with medications, or complicate potential liver problems. talk with your doctor about whether drinking alcohol makes sense for you. There are some questions about whether alcohol might interact with medications, or complicate potential liver problems.

MULTIPLE CHANGES, MEGA BENEFITS.

I saved my client story for this point in the chapter because I'm guessing you're probably feeling a little overwhelmed right now. Take heart...as Sean did.

Sean was 36 years old, and about 35 pounds overweight. He had high blood pressure, LDL cholesterol of 170, HDL cholesterol of 48, and triglycerides of about 300. His internist was also a cardiologist, and wanted to put Sean on medication before he developed serious heart disease. Sean couldn't stand the thought of going on medication, so he made a deal with his doctor-if he didn't get his numbers down within two months, he would fill his prescription.

When Sean came to see me, his diet was a mess. He ate and partied like he was still in college. Weekends were orgies of buffalo wings, beer, pizza, and ice cream, all things he was loathe to give up...but he did. We made a game of his deal with the doctor-Beat the Medication. Sean did everything in this program. He stopped smoking. He started walking every evening with his wife and baby. He took fish oil capsules and plant stanol supplements. And he started eating only heart-healthy foods, including those with plenty of calcium and magnesium. He cut out salt and fruit juice and even stopped drinking beer. That was the hardest part, and it was a real struggle for Sean, but he was playing for keeps.

FAQSI'm confused about coffee. Is it OK for me to have a cup in the morning, or will it increase my risk of cardiovascular disease?

I understand the confusion. It seems as though there is always something new being written about the benefits or risks of coffee. I can show you research that says that coffee might be dangerous, and I can show you research that says the exact opposite. Most important is to follow whatever your doctor tells you. If your doctor says no coffee, then that's your final answer. There might be something special about your medical history that requires limiting caffeine. No doubt the debate will continue as study results come in. In 2006, for example, researchers released the results of a large-scale study conducted at Harvard that followed more than 44,000 men and 84,000 women for nearly 20 years. They discovered that coffee didn't make any difference in the risk for heart attack or heart disease, regardless of whether the partic.i.p.ants drank less than one cup of coffee per month or more than five cups per day. The one cautionary note: Drink only filtered coffee-unfiltered preparations such as percolated or French press coffee (including espresso and cappuccino) may cause an increase in h.o.m.ocysteine and LDL cholesterol.

After two months, Sean had lost 17 pounds. His LDL cholesterol dropped 30 points to 140, his HDLs stayed the same, and his triglycerides-slashed by more than half-were down to 120. His doctor was thrilled and gave him another two months to get his LDLs closer to 100.

For the next two months, Sean continued the program and dropped another 16 pounds. At the end of four months, he got all his risk factors under control. His blood pressure was normal, his HDL was the same, his LDL was down to 124, and his triglycerides fell to 105. He did it! He beat the medication. Even better, he felt fabulous, energetic, and empowered. Ultimately, his doctor and I would love to see his LDL cholesterol come down even more, and I am optimistic it will happen.

Want to be like Sean? It is never too late to make these healthy changes. Study after study has shown that the more heart-healthy living you do, the greater the benefits. With cardiovascular disease, you don't want to wait. don't forget we're talking about stroke, heart attack, and the possibility of sudden death. Be like Sean. Do it all. You may be able to heal yourself. But even if you need to take medications, that doesn't diminish the good that you're doing for yourself. Some people need medication, even if they do everything right, and that group includes two of my own relatives! Even then, this program is important.

BONUS POINTS.

- Know all your numbers. Don't rely on your doctor to keep track of your blood pressure, triglycerides, and cholesterol levels-they don't do much good sitting in a medical file drawer. Every time you have your blood tested, write down your numbers, and track your progress. Most doctors recommend follow-up blood work every year or every six months, depending on your individual health concerns. There's nothing more motivating than results-in this case seeing your numbers drop steadily lower and lower. Work with your doctor to set goals for each of the following tests: Blood pressure, LDL cholesterol, HDL cholesterol, cholesterol ratio (total cholesterol divided by HDL cholesterol), triglycerides, h.o.m.ocysteine, and C-reactive protein. Don't rely on your doctor to keep track of your blood pressure, triglycerides, and cholesterol levels-they don't do much good sitting in a medical file drawer. Every time you have your blood tested, write down your numbers, and track your progress. Most doctors recommend follow-up blood work every year or every six months, depending on your individual health concerns. There's nothing more motivating than results-in this case seeing your numbers drop steadily lower and lower. Work with your doctor to set goals for each of the following tests: Blood pressure, LDL cholesterol, HDL cholesterol, cholesterol ratio (total cholesterol divided by HDL cholesterol), triglycerides, h.o.m.ocysteine, and C-reactive protein.

- Ask about iron and thyroid. Heart disease risk can be affected by elevated ferritin (a measure of iron), and high cholesterol can be a side effect of low levels of thyroid hormones. Talk with your doctor about whether you need to have these additional tests. Heart disease risk can be affected by elevated ferritin (a measure of iron), and high cholesterol can be a side effect of low levels of thyroid hormones. Talk with your doctor about whether you need to have these additional tests.

- If you smoke, quit. Smoking causes inflammation, not just in your lungs, but throughout your body. Inflammation can contribute to atherosclerosis, blood clots, and risk of heart attack. Smoking makes all heart health indicators worse. If you have high cholesterol, high triglycerides, or high blood pressure, smoking magnifies the danger. Smoking causes inflammation, not just in your lungs, but throughout your body. Inflammation can contribute to atherosclerosis, blood clots, and risk of heart attack. Smoking makes all heart health indicators worse. If you have high cholesterol, high triglycerides, or high blood pressure, smoking magnifies the danger.

- If you are overweight, focus on losing weight. Body fat produces and secretes hormones and other types of biochemicals, including inflammatory chemicals. People who are overweight have higher levels of C-reactive protein, a marker for inflammation. And as already discussed, inflammation contributes to atherosclerosis and heart attacks. In addition, being overweight increases blood pressure and decreases HDL cholesterol. In 2006, researchers found that the more overweight you are, the greater your risk of death...not just from heart disease, but from all causes. Even if you have normal blood pressure, normal cholesterol and don't smoke, being overweight increases the risk of death from heart disease by more than 40 percent. You don't have to return to your high school weight to see a benefit-every little bit helps. Research has shown that losing just 10 pounds can reduce LDL cholesterol by 5 to 8 percent. (See Weight Loss on Chapter 3 for more information on how to lose weight while following this heart-healthy program.) Body fat produces and secretes hormones and other types of biochemicals, including inflammatory chemicals. People who are overweight have higher levels of C-reactive protein, a marker for inflammation. And as already discussed, inflammation contributes to atherosclerosis and heart attacks. In addition, being overweight increases blood pressure and decreases HDL cholesterol. In 2006, researchers found that the more overweight you are, the greater your risk of death...not just from heart disease, but from all causes. Even if you have normal blood pressure, normal cholesterol and don't smoke, being overweight increases the risk of death from heart disease by more than 40 percent. You don't have to return to your high school weight to see a benefit-every little bit helps. Research has shown that losing just 10 pounds can reduce LDL cholesterol by 5 to 8 percent. (See Weight Loss on Chapter 3 for more information on how to lose weight while following this heart-healthy program.) - Become more physically active. Even moderate exercise can help improve cholesterol, triglycerides, and blood pressure. Aerobic exercise seems to be able to stop the sharp rise of triglycerides after eating, perhaps because of a decrease in the amount of triglyceride released by the liver, or because active muscle clears triglycerides out of the blood stream more quickly than inactive muscle. If you haven't exercised regularly (or at all) for years, I recommend starting slowly, by walking at an easy pace for 15 minutes a day, five days a week. Then, as you feel comfortable, increase the amount of time by five minutes each day. Strive to work up to 45 minutes each day. (Always get clearance from your doctor before beginning an exercise program.) If you are relatively healthy and are cleared for exercise, research shows that you might get optimal heart benefit from moderate-intensity exercise that burns about 500 calories or more. This means brisk walking for about 90 minutes, three to five times per week. I know it sounds like a lot, but your life may depend on it. Even moderate exercise can help improve cholesterol, triglycerides, and blood pressure. Aerobic exercise seems to be able to stop the sharp rise of triglycerides after eating, perhaps because of a decrease in the amount of triglyceride released by the liver, or because active muscle clears triglycerides out of the blood stream more quickly than inactive muscle. If you haven't exercised regularly (or at all) for years, I recommend starting slowly, by walking at an easy pace for 15 minutes a day, five days a week. Then, as you feel comfortable, increase the amount of time by five minutes each day. Strive to work up to 45 minutes each day. (Always get clearance from your doctor before beginning an exercise program.) If you are relatively healthy and are cleared for exercise, research shows that you might get optimal heart benefit from moderate-intensity exercise that burns about 500 calories or more. This means brisk walking for about 90 minutes, three to five times per week. I know it sounds like a lot, but your life may depend on it.

- If you also have diabetes, control your blood sugar. Uncontrolled blood sugar can increase your risk of coronary artery disease, heart attack, and stroke. Part of your heart care is diabetes care. (For more information about nutritional advice for diabetes, see Type 2 Diabetes on Chapter 9.) Uncontrolled blood sugar can increase your risk of coronary artery disease, heart attack, and stroke. Part of your heart care is diabetes care. (For more information about nutritional advice for diabetes, see Type 2 Diabetes on Chapter 9.) - Manage stress. High blood pressure has been linked to emotional stress and anxiety. It is so common that the phrase High blood pressure has been linked to emotional stress and anxiety. It is so common that the phrase white-coat hypertension white-coat hypertension has been used to describe the spike in blood pressure some people experience in the stressful setting of the doctor's office. The best stress reducers are meditation (especially Transcendental Meditation), going to church or temple, biofeedback, guided relaxation, and cognitive-behavioral therapy. Taking time to play with or pet a dog or cat also seems to help. (In case you're wondering, watching TV does not work as a stress reliever-scientists actually checked.) Research has shown that reducing stress can reduce blood pressure by as much as 10 percent. It may not seem like much, but it's not bad for a few minutes of meditation or quiet relaxation every day. has been used to describe the spike in blood pressure some people experience in the stressful setting of the doctor's office. The best stress reducers are meditation (especially Transcendental Meditation), going to church or temple, biofeedback, guided relaxation, and cognitive-behavioral therapy. Taking time to play with or pet a dog or cat also seems to help. (In case you're wondering, watching TV does not work as a stress reliever-scientists actually checked.) Research has shown that reducing stress can reduce blood pressure by as much as 10 percent. It may not seem like much, but it's not bad for a few minutes of meditation or quiet relaxation every day.

- If you have hypertension, avoid hot tubs. Well, not just hot tubs, but also saunas, steam rooms, hot baths, and other activities that relax your body with heat. They can raise your heart rate and cause dizziness, while raising blood pressure even higher. Well, not just hot tubs, but also saunas, steam rooms, hot baths, and other activities that relax your body with heat. They can raise your heart rate and cause dizziness, while raising blood pressure even higher.