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Welcome back to our series on diet after heart attack. In the previous post, we discussed all things sodium. In this post, we’ll be discussing added sugars and saturated and trans fats.
Quick disclaimer—although I am a registered dietitian nutritionist, your reading of this or any articles on this website does not constitute medical nutrition therapy advice nor create a practitioner-client relationship. The information I provide here on this website is for educational and informational purposes only. Please see my full disclaimer for more information.
Added Sugars
When it comes to the topic of added sugars, I’ve found that many people are under the impression that all sugar is the same, whether it comes from fruit or from a candy bar. When they are told that cutting back on sugar is a good solution for them, they will often stop drinking soda/pop, avoid all desserts, and cease eating fruit.
But there is more to the story when it comes to sugar. Based on the current evidence we have, the American Heart Association recommends decreasing added sugars to support heart health, not necessarily naturally occurring sugars such as those in fruit.1-3
So what does this mean? The first step is to define both naturally occurring sugars and added sugars.
Natural Sugars vs Added Sugars
Naturally occurring sugars are sugars that are already found in foods in their natural forms, like the sugar that is in a piece of whole fruit, or the lactose (another type of sugar) found in plain milk. These sugars are already in a food or beverage without being added in by a food manufacturer, or even you.
In contrast, added sugars are sugars that a manufacturer or even a home cook may add into a product to make it sweeter. For example, when baking cakes or cookies, you will often add granulated sugar into those recipes to ensure they taste sweet enough and turn out with an acceptable texture.
Similarly, food manufacturers often add some form of sugar into various products to give them their distinctive tastes—product examples can include jams and jellies, candies, condiments and sauces (like ketchup or BBQ sauce), cereals, juice drinks, soda/pop/Coke, flavored dairy products, cake and bread and donut products, and other similar items.
If you happen to look at the ingredients list on some of these products, you may see sugar in various forms, not just the word “sugar.” Examples of other types of added sugars include1,4:
- White table sugar
- Honey
- Maple syrup
- Agave
- Brown sugar
- High fructose corn syrup
- Molasses
- Fruit juice concentrate
- Sucrose
- Dextrose
Notice that some of our classic sweeteners, like honey and maple syrup, are included in the added sugars category.
Limiting Added Sugars
So how do you manage added sugars in your diet then? While you don’t have to completely eliminate all added sugars (which could be a very difficult task), cutting back on how much of them you have each day can be very helpful in maintaining your heart health and potentially reducing the risk for further health issues in the future.
Why Limit Added Sugars?
A reason for my statement above is that foods containing more added sugars may not be as nutritious for your health. Oftentimes these foods contain more calories, or energy, than you might need, and they may not be as full of beneficial vitamins and minerals that help to support your health.
Over time, taking in more energy than you can use can lead to weight gain, which is often associated with increased risk of chronic diseases. For someone who has had a heart attack, keeping your added sugar intake lower to help manage your weight and prevent further damage to blood vessels would be a good strategy.
How Can You Limit Added Sugars?
So what does it look like to limit added sugars? The American Heart Association offers some guidance for us.
While the American Heart Association does reference teaspoons as a way to track added sugar,2 I’ve found that talking about it in grams can be more helpful because you are more easily able to to check the gram amount on a nutrition facts label (even if you’re adding pure sugar or honey to your cereal or beverages).
If you’d like a fuller explanation on reading the entire nutrition facts label, feel free to visit my post here about that. But for this explanation we’ll focus just on the added sugars portion of the label.
Although there is more than one line on the label mentioning sugars, it’s the “added sugars” line that should be the focus. The “total sugars” line is actually the sum of the naturally occurring sugars and added sugars together in the product. Check out my post below for a more detailed explanation of total sugars versus added sugars.
What Is The Difference Between Total Sugars and Added Sugars? A Dietitian Explains
As we look at the context of a whole day, keep in mind that the American Heart Association recommends 36 grams per day of added sugar for men and 25 grams per day for women.2 Since those are not exactly large numbers, aiming to find products that have the lowest amount of added sugar per serving can be a helpful practice.
While personal preferences may vary, I would suggest prioritizing products with added sugar according to your preferences. If you commonly use certain products with added sugars but feel that you could substitute lower sugar options in their place, then certainly do that.
And if there are some products with added sugars that are a very important part of your day, then you could keep them as your main sources of added sugars. Over time, if you feel you can decrease them or substitute with lower added sugar options, then feel free to do so.
While it will take time to adjust to changes like this, keep in mind your end goals, such as reducing the risk for another heart attack; keeping your weight managed to promote health, energy, and mobility; and any other similar goals you might have.
Choosing More Nutritious Sweet Foods
Now that we’ve discussed how to work on cutting back on added sugars, let’s explore a more positive side of the matter: how to choose sweeter foods that are more nutritious for you.
A first point in our discussion is that fruits and dairy products, although there may be some naturally occurring sugar in them, shouldn’t necessarily be discouraged. The key is to choose wisely from all of the options that are out there.
Fruits
In the area of fruits, here are some of my thoughts. First, if juice is currently your main source of fruit, you’ll want to make sure that it is 100% juice (this should be specified on the label or packaging somewhere).
Second, consider that although 100% juice can be a nice option for providing a serving of fruit, it can start to add up quickly in terms of calories/energy, without much (if any) fiber to help fill you up. If you’re used to having 1-2 glasses of juice during the day, consider substituting one of these for a piece of whole fruit, and see how you like it.
With the whole fruit, you’ll get a fiber boost to help you feel fuller longer. And depending on the fruit you choose, you may even end up getting a good source of viscous soluble fiber, which can help with lowering LDL cholesterol levels and potentially prevent another heart attack in the future.
Dairy
Moving on to dairy, a few thoughts may help you out in this area. While dairy is a wonderful way to get in protein and additional vitamins and minerals, there are some versions of dairy that can be higher in added sugars. A few examples might include chocolate milk, sweetened yogurt or other types of sweetened dairy beverages, and ice cream.
While these items can have a place in your eating pattern, choosing items that are lowest in added sugar to be your main sources of dairy on a daily/weekly basis is the most heart-healthy strategy. Examples might look like plain (not flavored) milk and low- or no-added-sugar yogurts.
As a quick side note, we’ll discuss the fat content of dairy products in the next main section of this post.
Other Lower Sugar Sweet Foods
Lastly, a semi-related question you might have about added sugars is whether lower sugar or sugar-free options for various condiments, sweets, candies, and other similar items are good choices. While these items can fit into an overall heart-healthy eating pattern, I would still encourage you to treat them more as items that you enjoy every so often, instead of all the time.
The reason is that even though some of these items may be lower in sugar or sugar-free, their nutritional value is not as strong as other foods like fruits, whole grains, dairy products, etc. After a heart attack, you will want to be aiming for nutritionally dense items as much as you’re able to in order to help maintain your health.
That wraps up our section on added sugars. The next main area we’ll address is that of fats to choose and avoid.
Fats
As we move on to the area of fats in a heart-healthy eating plan, I’ll give you a quick spoiler alert: the bottom line is that reducing saturated and trans fats are the most helpful decisions for your health after a heart attack.
Why? Because they are the fats that can contribute to the forming of the cholesterol that is more likely to build up in your arteries. The more of these fats we choose, the more potential there is for the build up to happen.
But this doesn’t mean that you can never eat fat again. The key is to substitute more heart healthy fats for the saturated and trans fats. You’re making some swaps in how you’re eating.
So let’s back up a bit to give you more context if you’re not too familiar with the types of fats that are in our food supply today. The main types of fats you’ll probably hear about from healthcare professionals or see listed on a food label are saturated fat, trans fat, monounsaturated fat, and polyunsaturated fat.
The first two types of fats are the ones to cut back on, and the last two are ones to substitute in their places as much as possible. In this section we’ll discuss cutting back on saturated and trans fats.
Saturated Fats
Saturated fats are generally found in animal products—for example, the skin on poultry, the rim of fat on pork chops or steaks, or marbling within steaks. Saturated fat is also found in dairy products; but based on our current knowledge, higher-fat dairy products (with the exception of butter) may not be as significant of a risk factor for further heart disease as the other sources of saturated fat mentioned before.
As we discuss saturated fats, it’s important to mention that it is still perfectly okay to enjoy chicken, fish, pork, and other red meat. They provide a wonderful amount of nutrients that can support your health.
But when you’re buying these items, aim to choose the leanest types possible to avoid extra saturated fat. For example, when choosing beef, look for loin, round, and chuck types of cuts.5 If you’re not sure, ask someone at the meat counter or take a look at how much fat appears to be on the beef you’re thinking of purchasing.
A similar plan works for pork—look for loin and chop cuts of meat, and avoid pork with a lot of obvious visible fat.6 Be sure to take off the fattier rim around both beef and pork before eating.
If you’re choosing ground beef or pork, look for the highest percentage of lean that you can. If leaner versions are not available, you can rinse and/or blot after cooking to reduce extra fat.7
When dealing with poultry, keep in mind that taking the skin off before eating can be a helpful plan. Also, when choosing ground poultry, check the label for the highest percentage of lean possible to avoid having some components of skin mixed in—some brands offer 98% lean.
When cooking with leaner meats you may need to experiment with different herbs and spices or juice-based marinades to help add flavor and tenderize. But don’t worry—there are plenty of recipes out there, created by the American Heart Association and registered dietitians!
Trans Fats
Moving on to our next category of fats, trans fats are a class of fats altered in a lab to allow them to become more shelf stable. Products with trans fats could avoid spoiling for a longer period of time.
The downside of trans fats is that we have research demonstrating that they are not exactly heart-friendly. Trans fats may play a role in raising LDL (“bad”) cholesterol and decreasing HDL (“good”) cholesterol. This combination is associated with a greater risk for heart disease.8
Trans fats have generally been phased out of the food supply in recent years, although there are still some products that may contain them. Some examples might include certain cookies or chocolates or similar items. You can see if an item contains trans fats by checking the ingredients list for “partially hydrogenated” oil.
This then brings us to the question of what fats are actually good for you? The short answer, which we’ll discuss in the next post in this series, is that substituting healthier fats like olive or canola oil for cooking, avocado for creamy additions to dishes, or nuts and seeds instead of certain snacks and desserts can be some ways to get started.
If you want to know more before the next post is available, check out these articles:
The Heart-Healthy Diet for Weight Loss: Why It Can Help
Heart-Healthy Weight Loss: A Dietitian’s Top 3 Tips
Healthy Habits for Weight Loss That Can Also Benefit Your Heart
Breakfast Foods to Lower Cholesterol: A Dietitian’s Picks
Foods to Avoid with High Triglycerides: Improving Your Numbers
Conclusion
As we end this section of foods to avoid after a heart attack, I’d encourage you to think about one thing you could take away from this post today. What stuck out to you? What seems most doable for your current lifestyle?
Remember, it’s the little changes you can keep up with that really count.
Thanks for reading, and look for the next article, all about foods to choose after a heart attack, soon!
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Sources
- American Heart Association Editorial Staff. How Much Sugar Is Too Much? Heart.org. Updated May 23, 2024. Accessed August 20, 2024. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/how-much-sugar-is-too-much.
- American Heart Association Editorial Staff. Added Sugars. Heart.org. Updated August 2, 2024. Accessed August 20, 2024. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/added-sugars.
- American Heart Association Editorial Staff. Tips for Cutting Down on Sugar. Heart.org. Updated July 21, 2024. Accessed August 20, 2024. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/tips-for-cutting-down-on-sugar.
- Added Sugars on the Nutrition Facts Label. FDA.gov. Updated September 27, 2023. Accessed August 20, 2024. https://www.fda.gov/food/nutrition-facts-label/added-sugars-nutrition-facts-label.
- Mayo Clinic Staff. Cuts of Beef: A Guide to the Leanest Selections. Mayoclinic.org. Updated November 21, 2023. Accessed August 20, 2024. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/cuts-of-beef/art-20043833#dialogId65241520.
- Garden-Robinson J, Newman D. Now You’re Cookin’: Lean Pork! NDSU.edu. Updated August 2021. Accessed August 20, 2024. https://www.ndsu.edu/agriculture/extension/publications/now-youre-cookin-lean-pork.
- National Cattlemen’s Beef Association. Reducing the Fat in Cooked Ground Beef. Nybeef.org. Published 1998. Accessed August 20, 2024. https://www.nybeef.org/Media/NYBeef/Docs/reducing-fat-in-cooked-ground-beef_08-26-2020-61.pdf.
- Dhaka V, Gulia N, Ahlawat KS, et al. Trans fats–sources, health risks and alternative approach: a review. J Food Sci Technol. 2011;48(5):534-541. doi:10.1007/s13197-010-0225-8.
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