In the case of the healthy heart, diet may indeed play a role. The consensus of medical opinion is that high blood cholesterol is related to development of coronary artery disease, and that changes in diet could help reduce this risk factor.

More than 5 million Americans suffer coronary artery disease. It is responsible for more deaths in Americans over 40 than any other illness. See also Aging Hearts and Arteries. The coronary arteries supply blood to the heart muscle. When these vessels become narrowed due to atherosclerosis (hardening of the arteries), blood flow to the heart may become impeded or, in severe cases, totally blocked. Obstruction of these arteries can cause angina pectoris (chest pain) and may lead to heart attack and death. Atherosclerosis results from buildup in the walls of the blood vessels of solid material called plaque, which contains cholesterol and other substances. A high level of cholesterol in the blood contributes to this condition, although it is not the only risk factor. High blood pressure, diabetes, cigarette smoking, and overweight also increase risk.

Scientists do not know why or how plaque is formed or to what extent the consumption of fat - especially saturated fat (See Glossary) and cholesterol influences blood cholesterol levels. However, in a proposed regulation for cholesterol labeling of foods, FDA noted that most experts believe there is a correlation between the severity of the plaque deposits and the levels of cholesterol in the blood.

This growing consensus about the relationship was echoed in Nutrition and Your Health: Dietary Guidelines for Americans, issued jointly in 1980 by the U.S. Departments of Agriculture and Health and Human Services. Those guidelines called on Americans to avoid too much fat, saturated fat, and cholesterol.

The 1988 Surgeon General's Report on Nutrition and Health recommended that Americans in general reduce their consumption of fat (especially saturated fat) and cholesterol. To back its recommendation, the report cited the association of fat consumption with obesity, some types of cancer, and gall bladder disease. Also noted was the relationship between saturated fat intake, high levels of cholesterol in the blood, and the increased risk for heart disease.

Similar recommendations have been made by the American Heart Association, the American Medical Association, the federally created Inter-Society Commission for Heart Disease Resources, the World Health Organization, and other public and private health authorities.

The problem that confronts many people is how to translate recommendations for a reduced-cholesterol, reduced-fat diet into a shopping list and menu for themselves and their families. In general, this means going more often to foods relatively low in fat and cholesterol - foods such as vegetables, fruits, cereal grain products, fish, poultry, lean meats, and low-fat dairy products.

Fruits, vegetables, cereal grains, and starches are not only relatively low in saturated fat but also contain no cholesterol. Another choice to make more frequently is oil made from vegetables, such as safflower, sunflower, corn and soybean oils. These have relatively high levels of not-so-undesirable polyunsaturated fat and low levels of saturated fat.

Here are some quick tips to help pick and prepare foods lower in saturated fat and cholesterol.

• Use soft, tub margarines, which are higher in polyunsaturates than hardened margarines.
• Use skim or low-fat (2 percent) milk.
• Buy lean cuts of meat such as the beef round and pork tenderloin, and trim visible fat.

• Choose food preparation methods that add little or no fat. For example, broil, bake or roast meat, fish and poultry instead of pan frying or deep-fat frying. Basting with wine, broth, or lemon or tomato juice will help prevent drying and give good flavor.
• Season vegetables with herbs or spices instead of butter or margarine, and enjoy baked rather than french fried potatoes.
• Eat more fish, poultry (without skin), and dried peas and beans.
• Substitute low-fat sandwich meats for higher fat cold-cuts, and use low-fat hot dogs instead of regular varieties.
• Use yogurt as a substitute for sour cream in salad dressings or dips.
• Substitute sherbet, ice milk, or nonfat frozen yogurt for ice cream.
• Use only the egg whites, or discard every other yolk and substitute a teaspoon of polyunsaturated oil for each discarded yolk in recipes.
• Reduce the amount of fat in recipes by a third to a half. If you use commercial cake mixes, for example, buy those to which you add the fat or oil. Use a polyunsaturated oil and reduce the amount by a third, while increasing the water. For example, if the recipe calls for three tablespoons of oil, use only two, but add an extra tablespoon of water.
• Cut down on baked goods made with lard, coconut oil, palm kernel oil, or shortening, and those deep fried in fat, such as doughnuts.
• Instead of two-crust pies, serve single-crust (open face) pies.
• Use low-fat dried milk in coffee.
• Use herbs or herb-flavored croutons to flavor salads or soups.
• Make your own toppings with nonfat dried milk, or use a yogurt, tofu or fruit topping.
• Use low-fat cheese such as part-skim mozzarella and ricotta in place of regular varieties, but read the label for fat content.
• Make your own breading with plain bread crumbs. Coat food with crumbs after dipping in skim milk with an egg white.
• Use a non-stick pan and vegetable oil pan-coating instead of butter, margarine or oil when sauteing or frying foods.
• Instead of using oil or fat, spray popcorn lightly with a vegetable oil coating and then sprinkle with chili powder, onion powder, or cinnamon.
• Read labels for terms that reveal the presence of cholesterol or saturated fat. Look for terms such as egg and egg-yolk solids; whole-milk solids; palm, palm kernel or coconut oils; milk chocolate; shortening; hydrogenated or hardened oils; lard; butter; and suet. Limit foods that have these ingredients.

Chris W. Lecos is a member of FDA's public affairs staff.

Cholesterol and Fat on Food Labels

FDA's proposed regulation on cholesterol labeling seeks to make it easier for people who are trying to limit cholesterol and fat in their diets. The regulation, printed in the Federal Register Nov. 25, 1986, would spell out the language about cholesterol that food companies could use on their packages. In addition, it should make it easier for manufacturers to put information about cholesterol and fat content on their labels.

Manufacturers would have the option of using these terms on the labels of their products:

• "Cholesterol free" - can be used if the cholesterol content is less than 2 milligrams in each serving.
• "Low cholesterol" - would describe products with less than 20 milligrams of cholesterol in each serving.
• "Cholesterol reduced" or "reduced in cholesterol" - would be permitted in products that have been reformulated so that the cholesterol content has been reduced at least 75 percent from the original product. Manufacturers would have to state what the original cholesterol content was, along with that of the cholesterol-reduced version - for example, "Cholesterol reduced from 120 milligrams to 30 milligrams per serving."

For foods that have less cholesterol, but not 75 percent less, FDA's proposed regulation would allow such language as "less cholesterol" or "lowered cholesterol" Again, the cholesterol content of both the original and reformulated products would have to be stated. Manufacturers making these claims about cholesterol would also be required to list the saturated and polyunsaturated fatty acids, as well as cholesterol content, in the nutrition information on the label.

Guidelines for Dietary Changes to Lower High Blood Cholesterol Levels

	Maximum Total Calories
Total Fat	Reduce to no more than 30%
Saturated Fat	Reduce to less than 10%
Polyunsaturated Fat	Increase, up to 10%
Monounsaturated Fat	Reduce to 10-15%
Cholesterol	Less than 300 milligrams a day
Carbohydrates	Increase to 50-60%

Also, adjust your calorie intake to achieve or maintain a desirable weight. This chart is taken from "Eating to Lower Your High Blood Cholesterol", National Institutes of Health (NIH Publication No. 87-2920).

How Much Fat Should You Eat?

Total Daily Calories	Maximum Amount of Fat (in grams)
1,500	50
2,000	67
2,500	83
3,000	100

Above is a rough guide to help show the amount of fat that will provide 30 percent of total daily calories. For example, if you eat an average of 2,500 calories a day, 83 grams (about 3 ounces) represents 30 percent of your total calories.

If you're not sure of your typical calorie intake, women 23 to 50 generally need 2,000 calories, and men need 2,700. Whether these levels are right for you depends on your age, body size, and level of activity.

A Glossary of Cholesterol Terms

Cholesterol: A fat-like substance found in all foods of animal origin (meat and dairy products), but not in foods from plants. Some cholesterol is needed by the body, but too much can build up in arteries, leading to heart disease, heart attack, or stroke.

Fat: A component of most foods or plant or animal origin. Fat is an essential part of the diet. Not only is it a major source of energy, but it also plays a key role as a carrier of the fat-soluble vitamins, A, D, E and K. Dietary fat also supplies the body with essential fatty acids, particularly linoleic acid, necessary for proper growth and healthy skin.

Fatty Acids: The basic chemical units of fat. They can be either saturated, monounsaturated, or polyunsaturated, depending on how many hydrogen atoms they hold. All dietary fats are a mixture of the three types of fatty acids, but vary in the amount of each they contain.

Saturated Fatty Acids: Tend to raise blood cholesterol levels. They are found in largest amounts in meat and dairy products, but also in some vegetable oils, including coconut and palm kernel oils.

Monounsaturated Fatty Acids: Found in varying amounts in both plant and animal fat. Olive oil, peanut oil, some margarines, and vegetable shortening tend to be high in monounsaturated fatty acids. Recent research has shown that substituting monounsaturated fat for saturated fat reduces blood cholesterol levels.

Polyunsaturated Fatty Acids: Tend to lower blood cholesterol levels. They are found mainly in the fat of foods from plants. Safflower, sunflower, corn, soybean, and cottonseed oils contain large amounts of polyunsaturated fatty acids.

FDA CONSUMER - Reprint - HHS Publication No. (FDA) 89-2220

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Food and Drug Administration
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