Are You Inadvertently Raising Your Heart Disease Risk?

Many people know that eating a lot/too much salt increases blood pressure and heart disease risk. I never paid much attention to this warning because I don’t over-salt my food and don’t even care for salty snacks.

I thought I was in the clear.

I was wrong.

It was while writing my new book, The Low Cholesterol Cookbook and Action Plan: 4 Weeks to Cut Cholesterol and Improve Heart Health, that I found I was inadvertently increasing my heart disease risk with salt. Millions of Americans (including me) unintentionally eat far too much salt because of prepared/processed food and restaurants. Here’s what I learned and included in my book:

“The Centers for Disease Control and Prevention (CDC) report that “More than 75 percent of sodium Americans consume comes from processed and restaurant foods—not the salt shaker.” This is vital, because too much salt leads to high blood pressure, and having both high blood pressure and high cholesterol significantly increases heart disease risk. The AHA recommends the following amounts: No more than 2,300 milligrams (mg) a day for most adults. Ideally, no more than 1,500 mg per day for most adults.”

After a lot of research, I found that almost any meal you eat out will nearly guarantee you’ll go over 2,300 mg of salt in a day.

Sheesh.

The CDC posted this infographic highlighting the highest-salt foods in restaurants (in my book I include a list of what to order/not order at popular chain restaurants). The CDC advises both cooking at home more often and asking about sodium when eating out. While the ranges on the “Top 6” of this chart vary widely, it’s a safe bet to assume salt levels for most restaurant food you’ll encounter will be at the middle or high end, so it’s important to ask about salt in the preparation.
Reducing Sodium: From Menu to Mouth. Excess sodium can lead to high blood pressure, a major contributor to heart disease and stroke. Home prepared meals have less sodium than meals prepared in fast food or sit down restaurants. What Can You Do? Ask for sodium content before ordering, or check online before eating out. Home prepared meals have less sodium per calorie than meals prepared in fast food or sit down restaurants, on average.Food from fast food restaurants contains 1,848 mg sodium per 1,000 calories, on average. Food from sit-down restaurants contains 2,090 mg sodium per 1,000 calories, on average. The U.S. Dietary Guidelines recommend limiting sodium to less than 2,300 mg/day, and about 6 in 10 adults should further limit sodium to 1,500 mg/day*. Choose wisely to stay under 2,300 mg**. Top 6 Sources of Sodium from Restaurant Foods1,2: 1. 170 to 7,260mg sodium per sandwich. 2. 393 to 4,163mg sodium per slice of pizza containing meat. 3. 200 to 2,940 mg per burger. 4. 62 to 7,358 mg sodium per chicken entrée). 5. 250 to 4,870 mg per Mexican entrée. 6. 4 to 4,530 mg sodium per salad)* *Refers to those age 51 and older, and those of any age with high blood pressure, diabetes, or chronic kidney disease. ** Averages are for 2012–2013. 1 IOM Strategies to Reduce Sodium Intake in the United States. 2 Sodium content was determined using MenuStat.org. Department of Health and Human Services, Centers for Disease Control and Prevention.

While I like to cook, sometimes (often) I don’t have the time or energy, so for me seeing pizza on this list was distressing. For years, I’ve thought my non-meat pizza, “light on the cheese” was a relatively heart-healthy choice, but both pizza dough and jarred sauces are/can be quite high in sodium.

When you are craving pizza and have the time to make it at home, try a homemade pizza. An easy, quick, delicious whole-wheat pizza is a great lower-salt option, with an extra bonus that it’s higher in cholesterol-lowering fiber than ‘regular’ pizza. Get the easy recipe and read more about how traditional pizza dough has DOUBLE the salt of whole-wheat pizza dough in my post, Whole Wheat Vegetarian Pizza.

And next time you are combing a restaurant menu for a low cholesterol (low in saturated fat) option, also check on salt levels. You may have to ask your server for lower salt options, but that’s a small price to pay for not exceeding the recommended daily salt intake in a single meal!

Rockridge Press has published The Low Cholesterol Cookbook & Action Plan in both traditional book and electronic formats. Click links below to link to the book on Amazon:

Paperback The Low Cholesterol Cookbook and Action Plan: 4 Weeks to Cut Cholesterol and Improve Heart Health

Kindle:  The Low Cholesterol Cookbook and Action Plan: 4 Weeks to Cut Cholesterol and Improve Heart Health

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Whole Wheat Vegetarian Pizza

Healthy, easy and delicious, 2 slices of this vegetarian whole wheat pizza delivers 13 grams of cholesterol-lowering dietary fiber, and is loaded with flavor. As long as you remember / have time to bring the pizza dough to room temperature, prep will take no more than 30 minutes. We always make 2 pizzas as it’s great left over.

My personal favorite toppings are broiled eggplant, broccolini sauteed with garlic, and sauteed mushrooms. But feel free to substitute any vegetables you like—as long as you pre-cook them a bit so they’re not raw, they should be delicious.

This recipe is flexible and adaptable: if someone wants meat, just place some sliced pepperoni atop a few of the slices or make one pie with meat and one totally vegetarian.

For those who want to make their own dough, go for it. I hear it’s easy but I’ve never tried it as that bag of Trader Joe’s whole wheat pizza is like magic to me (and there’s no food processor to clean!)

Have pizza purists in the house? Do a taste-test of whole wheat pizza dough vs ‘regular’ white pizza dough. But just so you know, the whole wheat pizza is much healthier: first of all, it delivers DOUBLE the cholesterol-lowering dietary fiber. Not only that, the plain dough has almost double the salt and 50% more total fat than the whole wheat dough!

Give this recipe a try for a great “Meatless Monday” or any day vegetarian dinner!  Bonus: it’s great with kids or picky eaters (ahem, like myself). Kids love to roll out the dough…and if you let kids or family/friends customize with their own toppings it makes for a great pizza party. Just don’t break out the wine and beer until all the slicing is complete! (Yes, I sadly speak from experience; I now have a firm rule of no alcohol until all chopping and slicing is complete.)

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Going Lo-Co Whole Wheat Vegetarian Pizza
Prep Time
30 mins
Cook Time
15 mins
Total Time
45 mins
 

Homemade Healthy Whole Wheat Pizza takes a bit of time but is easy and delicious. You can use any vegetables: my favorites are broiled eggplant, sauteed mushrooms and broccolini sauteed with garlic!  One serving = 2 slices (1 pie = 8 slices)

Servings: 4 people
Author: Karen Swanson
Ingredients
  • 1 bag Whole Wheat Pizza Dough (Trader Joe's)
  • 1/4 cup Pizza or Tomato Sauce (like Prego Pizza Sauce)
  • 3 ounces Mozzarella Slices (Trader Joe's whole or part skim)
  • 1 whole Eggplant
  • 6 oz Sliced White Mushrooms (About 1/2 container Trader Joe's)
  • 4 oz Baby Broccoli (broccolini) - heads
  • 4-6 cloves Fresh Garlic
  • 5 TBSP Extra Virgin Olive Oil
  • 1 TBSP Flour (To sprinkle under dough)
Instructions
Prepare Pizza Dough:
  1. Take out pizza dough so it comes to room temperature (I leave out for at least 1 hour).

Prepare Vegetables While Dough Comes to Room Temperature:
  1. Broil the Eggplant: Set rack to top and start broiler. Wash and slice eggplant into 1/3 inch thick slices. Set on a baking sheet lined with foil. Lightly spray or brush slices with olive oil then lightly salt. Turn the slices and lightly oil & salt the other side. Broil for 3-8 minutes per side, until golden brown. Turn and broil the other side. Set aside.

  2. Preheat oven. First, carefully move the rack(s) to the middle of the oven. Then preheat to 425 (with pizza stone if you use...I do not.) 

  3. Saute the sliced mushrooms over medium-high heat in a large saute pan in about 2 TB of olive oil until lightly browned, about 10 minutes, stirring occasionally. Remove to plate.

  4. Prepare the broccolini and garlic. While mushrooms are sauteeing, wash broccolini, discard stems and leaves, and cut heads into bite-size pieces. Slice garlic.

  5. Saute the garlic and broccolini.  In the same pan used for mushrooms, add about 2 TB of olive oil and once warm, add garlic and cook over medium heat for 1-3 minutes until garlic is fragrant but not brown. Add broccolini heads, mix, and cook for 2-3 minutes, then add a bit of water, cover and let steam for 1-2 minutes.

Prepare and Bake Pizza:
  1. Once pizza dough has come to room temperature, roll it on a lightly floured surface to the size of your pizza pan or desired size. (Note: dough should not feel wet - if it does, add more flour to avoid sticking to pan.) If using pizza pan with holes (aka perforated pizza pan) place dough on the pan and stretch to sides.

  2. Spread the pizza sauce on top of the rolled dough. Dot with mozzarella slices. Atop the cheese, add the broiled eggplant, sauteed mushrooms and sauteed broccolini/garlic.

  3. Bake for 12-15 minutes. Lift bottom of pizza to check it's cooked long enough to reach your desired crispiness. Slice with pizza cutter into eighths.

Recipe Notes
  • One serving = 2 slices (1 pie = 8 slices)
  • Nutrition Facts from My Fitness Pal.
Nutrition Facts
Going Lo-Co Whole Wheat Vegetarian Pizza
Amount Per Serving
Calories 297 Calories from Fat 225
% Daily Value*
Total Fat 25g 38%
Saturated Fat 5g 25%
Polyunsaturated Fat 2g
Monounsaturated Fat 13g
Cholesterol 11mg 4%
Sodium 904mg 38%
Potassium 197mg 6%
Dietary Fiber 13g 52%
Sugars 9g
Protein 18g 36%
Vitamin A 6%
Vitamin C 19%
Calcium 20%
Iron 22%
* Percent Daily Values are based on a 2000 calorie diet.
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Coronary Calcium Scan Illuminates Heart Disease Risk

In our initial meeting, I told my cardiologist that nearly every adult in my family takes a statin due to a family history of high cholesterol. He then asked if anyone had done a Coronary Calcium Scan.

I’d never heard of that test, and none of my relatives have had it done.

But I did, last month.

The reason: my cholesterol results worsened slightly versus a year ago. My latest Cardio IQ blood test* revealed a high number of LDL (bad) cholesterol particles, and that these LDL particles had shifted from the ‘safe,’ fluffy Pattern A type to the more dangerous, small Pattern B type.

Probably this is due to age (women are plagued with worsening cholesterol at/post menopause) and the fact that I’ve not been able to exercise daily due to injury.

I’m relieved to report that my Coronary Calcium Scan score was zero, which is normal. The report I received states, “A low score suggests a low likelihood of coronary artery disease but does not exclude the possibility of significant coronary artery narrowing.”

So good for now (but could get bad…hence the annual Cardio IQ testing.)

That my score was zero was both a relief and confirmed our treatment plan. I’m to continue to manage my cholesterol and heart disease risk with exercise and a heart-healthy diet (read more in my new book, now available for pre-order: The Low Cholesterol Cookbook and Action Plan: 4 Weeks to Cut Cholesterol and Improve Heart Health. More on my book launch in a later post!)

Should you have a Coronary Calcium Scan? The answer is, it depends.

The test is not for everyone. Insurance often doesn’t cover the cost (mine did not; I paid $283.) And it exposes you to radiation—about the same amount you would normally be exposed to in one year.

A terrific explanation of this test was published by Harvard Health’s article, Should you consider a coronary artery calcium scan? Their opening line says it all: “If you’re on the fence about whether to take a statin, this test might make sense.”

So if you and your doctor want more insight into your current risk of heart disease risk and/or you are trying to decide if a statin is needed, consider this test. It reveals if calcium (plaque) has built up in the walls of the heart’s arteries. A score greater than zero indicates calcification is present; as that is an early sign of cardiovascular disease, it should factor into your treatment plan.

A reminder of the Heart Disease Risk Factors: as detailed by the National Heart, Blood, and Lung Institute:

“Risk factors are conditions or habits that make a person more likely to develop a disease. They can also increase the chances that an existing disease will get worse. Important risk factors for heart disease that you can do something about are:

High blood pressure
High blood cholesterol
Diabetes and prediabetes
Smoking
Being overweight or obese
Being physically inactive
Having a family history of early heart disease
Having a history of preeclampsia during pregnancy
Unhealthy diet
Age (55 or older for women)”

Statin medications do lower cholesterol and have been proven effective when other risks of heart disease (see list above) are present. But when high cholesterol is your only risk factor, it just might make sense to discuss a Coronary Calcium Scan with your doctor.

* A Cardio IQ  is a more detailed test than a ‘regular’ cholesterol blood test; in addition to the regular cholesterol figures, it measures LDL Particle number and size, apo-B and Lipoprotein (a). You can read more in my posts, ApoB and Cardiovascular Risk, and Cholesterol Tests Your Doctor Hasn’t Told You About.

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Roasted Butternut Squash and Mushroom Curry

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My interest was piqued by David Tanis’ New York Times article, A Warming Curry for Fall— because this accomplished chef mentioned that he’d adapted a Madhur Jaffrey recipe. I find her recipes can be challenging, so I was thrilled at a Mr. Tanis modification.

This recipe was both heavenly and easy—one of the most delicious recipes I’ve made. Plus, it truly took only about 30 minutes (not including roasting time – and you can make it without roasting the butternut squash if you have 30 minutes max).

Not only that, but the resulting dinner is a great vegetarian option—not always my forte but one I am trying to tackle—and it was filling. And as I served with brown jasmine rice, it was even a decent source of cholesterol-lowering fiber.

I read through the many comments online and decided to modify Mr. Tanis’ recipe right off the bat to add more flavor. (See the NYT article link above for the original recipe.) I’ve included mine with adaptions below.  It’s very flavorful but not at all spicy—the only tricky part will be procuring fresh curry leaves (available at Indian markets and online: see amazon link below).  While Mr. Tanis says curry leaves are optional, to me, they really make the dish.

My modifications were to add ground cumin, garam masala and also Maharajah Style Curry Powder By Penzeys Spices. Yes, I know that ‘curry’ is a catch-all and that many of the ingredients are listed both separately and in this curry powder.  But the recipe was delicious with these additions and I love Penzey’s curry.

As for rice, I served it with Trader Joes Brown Jasmine Rice for a fiber boost.

The picture above I took while it was cooking, and my version of the recipe follows. Don’t be daunted by the number of ingredients—nearly all are just spices!  And I didn’t even bother with wild mushrooms: I used sliced Baby Bellas and Shitakes … and didn’t measure them, just used 2 packs from Trader Joe’s.

It’s simple, I promise! If you like curry you will want to give this recipe a try.

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Roasted Butternut Squash and Mushroom Curry - Going Lo-Co adaption of David Tanis recipe
Prep Time
10 mins
Cook Time
20 mins
Total Time
1 hr
 

Delicious, easy vegetarian curry published by David Tanis in the New York Times. Mr. Tanis adapted his recipe from a Madhur Jaffrey, and I've slightly modified further, for more flavor and cholesterol-lowering fiber. It's easy - but the fresh curry leaves are a must. If you are not familiar, they are sold in Indian markets, or see below for a link to fresh curry leaves on Amazon!

Course: Main Course
Cuisine: Indian
Servings: 4 people
Calories: 482 kcal
Author: David Tanis, adapted by Karen Swanson
Ingredients
  • 3 tablespoons vegetable oil or canola oil
  • 10 ounces butternut or other winter squash peeled and diced in 1/2-inch cubes
  • Salt and freshly ground black pepper
  • 1 or 2 small whole green chiles such as jalapeño or serrano
  • 3 medium shallots or 1 small onion finely diced. I use already-diced fresh onions and diced more finely
  • ½ teaspoon black or yellow mustard seeds
  • ½ teaspoon cumin seeds
  • Handful of fresh or frozen curry leaves
  • 4 garlic cloves minced
  • 1 teaspoon ground coriander
  • Pinch of cayenne
  • ½ teaspoon turmeric
  • 1/2 teaspoon ground cumin
  • 1/2 teaspoon garam masala
  • 1/2 teaspoon curry powder
  • 1 pound mushrooms preferably a mix of cultivated and wild, trimmed and sliced 1/8-inch thick
  • ¾ cup coconut milk preferably reduced fat
  • 2 tablespoons lime juice freshly squeezed
  • fresh cilantro diced and sprigs for garnish
  • 2 cup brown jasmine rice
  • 1 cup baby spinach leaves optional
Instructions
Prep before cooking
  1. Cook about 2 cups of brown rice or brown jasmine rice so it will done when curry is done.

  2. Roast the diced squash (directions in 'prep' and 'cooking' below) either earlier in the day, or 1 hour before you want to serve.

  3. Prep ingredients to facilitate quick steps in this recipe: a) Chop cilantro and squeeze lime; set aside. b) Dice squash into relatively uniform 1/2" cubes and set aside. c) Cut a lengthwise slit in each chile to open it, but leave whole and set aside. (This allows the heat and flavor of the chile to release into the sauce without making it too spicy.) d) Measure spices into 2 small bowls (one with mustard and cumin seeds, one with all other spices) and set aside. e) Mince garlic. f) Bring curry leaves to room temperature, if frozen.

Cooking
  1. Roast the squash: Preheat oven to 425. Slick squash cubes with olive oil, salt and pepper and roast them for 20-30 minutes (set them aside to  add to pan after the mushrooms.) The original recipe sautes squash on cooktop but roasting is easier and boosts flavor depth - you just have to time it so they are roasted before you start cooking.

  2. In a wide skillet, heat oil over medium-high heat. Add shallots or diced onion to skillet, salt lightly and cook, stirring, 1 minute. Add mustard seeds, cumin seeds and curry leaves and let sizzle for about 1 minute.  
  3. To skillet, add the minced garlic, coriander, cayenne, turmeric, chiles, cumin, garam masala and curry and the slit-but-still-whole jalapeno (or serrano) chili peppers. Stir well and cook for 1 minute more.

  4. Add mushrooms to pan, season with salt and toss to coat. Continue to cook, stirring, until mushrooms begin to soften, about 5 minutes.
  5. Add squash cubes to pan, stir in coconut milk (shake can well first!) and bring to a simmer. Lower heat to medium and simmer for another 5 minutes. (If adding baby spinach for nutrition and color boost, add it after about 2-3 minutes so it wilts by time the 5 minutes of cooking squash is done.)  If mixture looks dry, thin with a little water. Taste and season with salt. 

  6. If you are serving for a dinner party, you can keep curry warm in a (pre-warmed) crock pot set to warm.

  7. Just before serving, stir in lime juice. 

  8. Serve atop high-fiber brown rice. Top with diced cilantro (unless you/guests are averse to taste) as it adds a lot of flavor.  If desired, garnish with cilantro leaves.

Recipe Notes

Nutritional Data calculated using My Fitness Pal.

Nutrition Facts
Roasted Butternut Squash and Mushroom Curry - Going Lo-Co adaption of David Tanis recipe
Amount Per Serving
Calories 482 Calories from Fat 108
% Daily Value*
Total Fat 12g 18%
Saturated Fat 2g 10%
Polyunsaturated Fat 7g
Monounsaturated Fat 2g
Sodium 18mg 1%
Potassium 105mg 3%
Total Carbohydrates 87g 29%
Dietary Fiber 6g 24%
Sugars 5g
Protein 9g 18%
Vitamin A 23%
Vitamin C 22%
Calcium 11%
Iron 12%
* Percent Daily Values are based on a 2000 calorie diet.
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Heart-Healthy Delicious Snack – Roasted Chickpeas

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Two major events caused me to evaluate how well I’m doing with my lo-co lifestyle: my upcoming annual cardiologist visit, and 3 solid weeks writing the first draft of The Low Cholesterol Cookbook and Action Plan (to be published in January 2018).

Overall, I’d give myself a B: my exercise is surprisingly solid, as I’m managing daily 45-minute brisk walks, but my heart-healthy cooking could use some tweaks.

A quick victory was needed and I found it, quite by accident, in chickpeas.

It was while I was searching for a quick, delicious ways to boost daily fiber that I discovered how easy it is to roast chickpeas. And this is great because a mere 1/2 cup of chickpeas delivers 6.3 grams of dietary fiber—that’s nearly 25% of the daily dietary fiber needed to reduce cholesterol, in one easy snack.

To find the best way to easily get a crunchy fiber-rich snack, I consulted Melissa Clark’s Crunchy Roasted Za’atar Chickpeas New York Times article, but it was Emma Christensen’s How To Make Crispy Roasted Chickpeas in the Oven post on The Kitchn I found most helpful. Here are her key tips:

“First, dry the chickpeas as much as possible. I like to gently roll them between two clean dishtowels. Also, don’t skimp on the olive oil. You can use less, but your chickpeas will be less crispy. Lastly, wait to toss the chickpeas with any spices or seasonings until you pull them out of the oven, otherwise the spices have a tendency to burn and become bitter.”

I experimented to come up with a cooking plan I liked best. For me, convection baking at 400 degrees worked better / delivered crispier chickpeas than regular roasting. And I dispensed with the parchment paper, after reading comments. You can use my version of the recipe below as a starting point, then add either fresh herbs like Emma Christensen suggests, or my favorite—Penzey’s Balti Seasoning for an easy Indian flavor (click picture for Amazon link *)—or sprinkle liberally with your favorite herbs and spices.

Make a batch of Roasted Chickpea Recipe to keep on hand for a few days as a delicious, high-fiber snack—or swap them for high-fat croutons in salads, grain bowls or even soups.

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Crispy Oven Roasted Chickpeas with Balti Seasoning
Course: Snack
Servings: 4
Author: Karen Swanson
Ingredients
  • 2 15-ounce cans chickpeas
  • 2 tablespoons olive oil
  • 1/2 to 3/4 teaspoon salt
  • 1-2 teaspoons Penzey's Balti Seasoning
Instructions
  1. Heat the oven to Convection Bake 400°F (or Bake at 425°F)

  2. Rinse and drain the chickpeas: Open the cans of chickpeas and pour the chickpeas into a strainer in the sink. Rinse thoroughly under running water.

  3. Dry the chickpeas: Pat the chickpeas very dry with a clean dishtowel or paper towels. Ideally, leave them to air-dry for a few hours. Or rub dry thoroughly, removing any chickpea skins that come off.

  4. Toss the chickpeas with olive oil and salt: Spread the chickpeas out in an even layer on the baking sheet. Drizzle with olive oil and sprinkle with salt. Stir with your hands or a spatula to make sure the chickpeas are evenly coated.

  5. Roast the chickpeas in the oven for 30-45 minutes, shaking the pan every 10 minutes. The chickpeas are done when golden and slightly darkened, dry and crispy on the outside, and soft in the middle.

  6. Remove chickpeas to a bowl. Sprinkle the Balti Seasoning over the chickpeas and stir to coat evenly. Taste and add more seasoning if desired.

  7. Serve while the chickpeas are still warm and crispy. They will gradually lose their crispiness as they cool but keep for a few days in an airtight container, becoming chewy rather than crispy but still delicious.

Recipe Notes

If you have time, the easiest way to get the rinsed chickpeas totally dry (key to crispy results) is time. Rinse the chickpeas and leave them to air dry for a few hours on dish- or paper towels.  

 

I hope you give these a try for a great, fiber-rich salad add-in or snack. In my experience, they’re delicious with wine or beer!

* Disclosure: This post contains an affiliate link that earns me a small commission, at no additional cost to you. That said, I only recommend products I personally use and love.

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