Having recently celebrated International Women’s Day my thoughts have turned to women’s health. A story that caught my eye this week appeared in The Washington Post. It was alarming and a cautionary tale so I share it here.
Last January, a woman aged 46 woke in the early hours of the morning feeling unwell. Soon after she threw up. She got back into bed intending to try to get back to sleep. She felt very cold and threw up again. She assumed that she had one of those 24 hour stomach bugs. Fortunately her husband was awake. He was concerned about how clammy she felt and said he was taking her to the hospital. She thought he was over reacting. But he persisted as he thought she might be having a heart attack.
Hang on a minute – aren’t the symptoms of a heart attack pain in the chest? That was the symptom that her father-in-law had experienced when he suffered a fatal heart attack aged 64. But she was just 46 – fit, slim, a non-smoker, a healthy eater with normal cholesterol level and no family history of heart disease.
Probably most husbands would murmur a few reassuring comments like ‘you’ll feel better in the morning’ or ‘remember how much I vomited when I had that tummy bug?’ Her husband insisted they go to the hospital and got her to the front of the queue by saying that they thought she was having a heart attack.
The initial tests at the hospital were a bit abnormal but not suggestive of a heart attack. The tests were repeated shortly afterwards and suddenly the room filled with medical staff. It turned out that she was indeed in the early stages of a heart attack. Fortunately an interventional cardiologist was on duty and he operated immediately, literally stopping a major heart attack in its tracks by removing the blood clot and inserting two stents into her right coronary artery. What the surgeon had found was that her right artery was totally blocked while her central artery, called the LAD, was 70% blocked. Blockage of this artery causes sudden death and is known as the widow maker.
What would have happened had she gone back to sleep? She may never have woken up or, if she did survive, might have had serious damage to her heart.
Most women would probably say that they are more concerned about breast cancer than cardiovascular disease. Yet more women in the UK and the USA die of heart attacks than from breast cancer.
So let us all be warned. Heart attacks can and do happen to healthy women with normal cholesterol and healthy lifestyles. Women do not always have the classic symptoms of heart attack ie pain in the chest. Women are more likely to experience nausea or vomiting, pain in the back or the jaw, and shortness of breath. Because most of us don’t like to make a fuss and are used to plodding on even if we are not feeling so well, it can be difficult to make an assessment of when to call an ambulance or hasten to the hospital. Better safe than sorry seems to be the moral of this story.
I love to eat out although it is usually not good for cholesterol lowering purposes. Sometimes I come across a dish that tastes good and inspires me to have a go at my own version at home. Recently I ate lunch at The Wallace – the restaurant in the Wallace Collection – and was delighted with a crab salad as a starter. I lost no time in making one for myself at home and, while no match for the chef at The Wallace, I enjoyed my version too.
One of the new tastes I discovered at the restaurant was cubed apples that had been soaked in cider vinegar. It was fabulous and paired so very well with the crab meat. As with all vinegar, use the best you can afford as cheap and nasty will taste just that and will ruin your dish.
If I was on a summer holiday at the seaside I would buy fresh crabs and spend a lazy afternoon winkling out the meat. However, in the city I buy fresh crab meat from a good supermarket and simply wish that I really was on that summer holiday at the seaside!
For 4 people:
4 generous tablespoons of white crab meat
A small bunch of chives
4 handfuls of soft salad leaves
1 fennel bulb – reserve the fronds for decoration
1 ripe but firm avocado
2 granny smith apples
A few teaspoons of good quality cider vinegar
Begin by chopping the chives very finely. Add to the crab meat along with some lemon juice. Taste a little to see if you have the balance to your liking. You may want to add a few more chives or a little extra lemon juice.
Peel and cube the apples and put in a small bowl. Pour over a few teaspoons of cider vinegar and toss the apple cubes gently so that they absorb the vinegar on all four sides.
Using a cheese slicer, shave the fennel into very thin slices.
Neatly cut the avocado into cubes a similar size to the apple cubes
Place a handful of salad leaves in the centre of four plates.
Using two tablespoons, shape the crab meat into a quenelle and place in the centre of the leaves.
Scatter the fennel shavings around the crab meat.
Space the apple and avocado cubes around the perimeter of the plate.
Finish off the dish with a squeeze of lemon juice and a grinding of black pepper.
Enjoy with a slice of rustic wholemeal bread – a pat of butter would be a wonderful addition but I leave that to your discretion regarding your cholesterol level.
I was talking to a friend about the controversy around fats that continues to confuse me and, no doubt, many other people attempting to lower their cholesterol. As if healthy eating is not itself enough of a long term challenge, the conflicting advice makes my head spin. Should we be eating saturated fats or not? Is cholesterol directly linked to cardio vascular disease or are sugar and inflammation the real culprit? Am I avoiding eating too much saturated fat for good reason or just feeling smug while believing incorrect science? Could I be eating ice cream rather than no fat yoghurt? So many questions and no way to really get to the bottom of it – at least I find it difficult.
One of the clearest and most useful articles I have read recently on the subject was published in January in The Observer. The Science of Healthy Eating was written by a science writer, Dara Mohammadi and a cardiologist, Dr Ali Khavandi.
The article began by debunking the health benefits of low fat foods pointing out that something has to replace the reduced fat content – that something is often extra sugar. I have written several times in the blog about the sugar content of low or no fat yoghurts and encourage you to have a look at the small print next time you are in the dairy section of the supermarket. It is an eye opener.
Addressing the debate about fats, the authors returned to the 1950s when saturated fats began to get bad press. Studies revealed that people eating a Mediterranean diet – high in olive oil (an unsaturated fat) had a lower risk of heart disease. When the food industry responded to these findings (around the 1970s) they replaced saturated fats (butter, for example) with trans fats. Trans fats were made from unsaturated fats that were transformed through the process of hydrogenation. This was good news for the food industry as trans fats could increase the shelf life of biscuits and cakes and processed foods. It seemed like a win-win situation – a healthier fat that could fatten the profits of the food industry.
The belief that trans fats were healthier because they were made from unsaturated fats had a rather different outcome than expected. During the 1980s and 1990s there was an escalation of cardiovascular disease. Not only were trans fats implicated in this increase but it was also found to increase risk of type 2 diabetes. You may have noticed that in the last few years supermarkets have been trumpeting the fact that they have reduced or eliminated trans fats from their products.
Now that trans fats were bad news, saturated fats have come back into fashion. Time magazine had butter on its front cover. Talk about reinventing the wheel. Weren’t we all eating saturated fats back in the 1950s before we were rerouted by food scientists and the food industry?
Well, the authors of this article don’t believe that eating as much unsaturated fat as you desire is a good idea. They suggest that unsaturated fats (not trans fats made from unsaturated fats) are the way to go. In other words – olive oil, seeds and nuts, oily fish and avocados. Well, what a relief since that is what I have been eating and writing about for the past three years.
After addressing the debate about processed meat and what they term the ‘gluten-free con’ (only 1 % of the population has coeliac disease and will benefit from a gluten free diet yet 20 % of the population now buy gluten free products) – the authors move on to consider cholesterol. They stress the importance of understanding one’s lipid profile is an oversimplification. Do be aware of this when sitting with the GP who is reaching for the prescription pad with Statins written on it. Ask for a printout of your blood test result so that you can have a good look at the ratio. Many of us have been able to increase the levels of ‘good’ cholesterol and reduce the ‘bad’ cholesterol through changing eating habits and increasing exercise levels.
The authors dismiss concern about the cholesterol content of eggs and prawns as ‘almost irrelevant’ and focus instead on what you should be adding in to your diet. I was gratified to read that this includes oats, nuts and seeds and oily fish. I would add pulses to this list. Things to avoid are excess sugar and refined carbohydrates – so keep on eating wholemeal pasta and couscous, wholemeal bread, brown rice and the like.
It is not enough to eat healthily if you want to reduce cholesterol. Exercise has a key role to play as I tell myself every time I reluctantly put on my walking shoes.
It may be cold outside but those of us trying to lower cholesterol always need a treat even if it is ice cream in the depths of winter. I found a recipe for banana ice cream in a new cookbook by Dannii Martin called Hungry Healthy Happy. I have been frustrated by banana ice cream before as its texture was unpleasant. This recipe pointed out what to do to improve the texture and it really worked. I added raspberries as I had some in the freezer and thought they would add colour, taste and extra vitamins. When I served it to the family they were surprised at just how good a no-added sugar, fat –free ice cream could taste. That’s what I call a result.
You need to start the day before as the bananas need to freeze overnight.
Making this recipe for 4 people involved more banana than my food processor was happy with all at once. I thought it would explode. Next time I will process it in two batches.
For 4 people:
4 -5 ripe bananas – just peel them and slice. Then pop into a freezer bag or a Tupperware and freeze.
A handful of frozen raspberries
Crème de cassis – optional
When you are ready to make the ice cream, place the frozen bananas in a food processor and let the motor run until the bananas have become creamy. In the past I have stopped too soon and landed up with an unpleasant crumbly texture. Dannii suggests stopping from time to time to scrape down the sides. After a while it really does become creamy.
I added a handful of frozen raspberries to the mix after a few scrape downs.
I served the ice cream right away. It would be lovely with a raspberry coulis that you can make by processing another handful of raspberries and pushing the pulp through a sieve to remove the pips. A shot of crème de cassis would not go astray either!
Keeping healthy can be very rewarding but also rather boring. Healthy meal after healthy meal has to be put on the table, so keeping interested in cooking is important. As I have said many times before, it is a lifestyle change not just a matter of lowering the cholesterol or losing the weight before returning to old habits.
New ideas in the kitchen are such an important part of keeping on track. I love paging through magazines and cookbooks to get my enthusiasm up for the seemingly endless number of meals. As the New Year rolls around so does a new collection of healthy cookbooks. One of these new books made its way to my door thanks to blogger friend, Dannii Martin, who tells the story of how she lost a lot of weight and has continued to maintain her healthy eating habits.
Called Hungry, Healthy, Happy, this cookbook (as well as Danii’s blog, www.hungryhealthyhappy.com) is packed with recipes that will pep up the weekly cooking. What I like most about this book is that the recipes are perfect for everyday cooking. Most of the time I have to put a meal on the table for the family dinner while also trying to eat healthily myself. I have to balance my needs with those of growing teenagers which is not always easy. Sometimes I eat too much fat or they eat too much lean.
Cooking one’s favourite dishes in a lower fat manner is the way to go when trying to maintain healthy eating habits. We all hark after the meals we love and it is too much of a deprivation to give them up forever. A tweak here and there can make all the difference. So I was pleased to find a recipe for a club sandwich (made with fat free yoghurt rather than mayonnaise), chicken tikka masala (fat free yoghurt again replacing the cream) and even mac and cheese which adds cauliflower and yoghurt rather than the full quotient of pasta and cheese.
Each recipe is labelled as vegetarian, gluten or dairy free, where appropriate. This is a useful time saver when paging through the book looking for a suitable dish. Each recipe sets out the nutritional value of the recipe which is such important information for those watching their salt, sugar, fat and calorie intake.
Whenever I look at a healthy eating cookbook I take particular note of the dessert section. This book has far more on offer than fruit platters. I was pleased to find a recipe for banana ice cream which I have previously tried, unsuccessfully. What I really appreciated was that this version of the recipe anticipates the problem the cook will encounter – the banana crumbles – and tells you exactly what to do to remedy this situation and to successfully end up with a smooth and creamy ice cream. When I served my adaptation (I added raspberries) to my family they could not actually believe that it was pure fruit with nothing added. ‘No cream?’ asked my younger son. ‘Not even sugar?’ asked the older one. They were mightily impressed and banana ice cream will now be part of my repertoire. It is a lovely example of a dish that suits the whole family – cholesterol lowering adults and growing teenagers. Wait until I try the chocolate avocado mousse – I will not be telling them the ingredients until after I have seen their faces – looks of pleasure I hope.
This salad is bursting with vitamins, healthy fats and superfoods. Just perfect for winter when we need to find appetising ways of eating salads despite the cold weather.
I like to add seeds to all manner of dishes as they are filled with minerals – zinc in pumpkin seeds. I almost always have a pomegranate in my vegetable bowl as it not only tastes wonderful and looks pretty, but is high in vitamins and antioxidants. I have yet to find a dish that is not transformed by the addition of a scattering of pomegranate seeds.
Have the salad ready while the broccoli is steaming gently. Once it is cooked – bright green and retaining some crunch – tip it onto the salad and eat it warm. Dressed simply with a glug of good quality extra virgin olive oil and you have another healthy fat added into your meal.
For four people:
100g mixed salad leaves
1 large head broccoli, broken into florets
1 large avocado – ripe but still firm is best
½ pomegranate, seeds removed
A handful of pumpkin seeds
A glug of good quality extra-virgin olive oil
A glug of good quality Balsamic vinegar – I use my most expensive one for dressing salads
Place the salad leaves on a large platter – I think serving salads in large serving dishes makes them so much more appetising than a bowl as all the ingredients can be seen clearly.
Dry toast the pumpkin seeds in a pan on a medium heat until they begin to pop.
Steam the broccoli florets until they turn emerald green and are tender enough to eat while retaining some bite. Keep an eye while steaming as broccoli quickly overcooks, becomes a dull green and loses its vibrant taste.
In the meantime remove the seeds from the pomegranate by cutting it in half and bending the peel back to loosen the seeds. Remove any of the membrane that may cling to the seeds as you remove them.
Cut the avocado into pieces.
Add the avocado, pumpkin and pomegranate seeds to the leaves on the platter. When the broccoli is ready, add it to the salad.
A glug of extra virgin olive oil and one of balsamic vinegar is next. Finish with a grinding of black pepper.
January is behind us and with it the endless stream of articles on self- improvement, healthy lifestyle and refusing alcohol for the month. I don’t know where the fashion for ‘Dry January’ came from but I can only imagine that the pubs are fuller than ever this week with some very thirsty customers. With Valentine’s Day in February there is a lovely romantic excuse to start popping the champagne corks again. So much for the liver detox.
The problem I have with Dry January is the way an alcohol– free lifestyle is touted for a month a year and then it is back to normal for most. So much of our health improving behaviour suffers the same fate. Gym memberships bought and not used much beyond the first few months, diets begun on Mondays and abandoned by Fridays; I am guilty of these and many more discarded attempts to be healthier.
The biggest challenge I have encountered over the past three years of cholesterol lowering has been the sheer endlessness of it. Not the short number of months it took to get my cholesterol down initially – that only took 90 days. No, the problem set in when I had to maintain what I had achieved. I succeeded in my initial goal to reduce my cholesterol level through sheer willpower and refusal to be tempted off my path by foods that were off-limits. A bit like Dry January, really, except that there were many more foods and it lasted three months.
Similarly to people who try to reduce alcohol intake on a long term basis, I have to make decisions on a daily basis, hourly even, to keep my cholesterol in check. Some days I am better at it than others. Every meal there are choices to be made – do I eat steak with the family or pop yet another salmon fillet in the oven? Do I eat ice cream with the stewed apples or help myself to a bowl of yoghurt? Do I go for my brisk walk or curl up with a box of chocolates and a book? Especially when it is raining.
Some militants might be able to make the right decisions every day, year in and year out. In the early days of my campaign to keep my cholesterol in check I thought I was one such person. Three years on I know I am not. It is a struggle. It is boring. I want to rebel. I do rebel.
I enjoy reading articles that say that the food advice we have been fed over the past decades has been wrong, that fat is not the enemy. But not all fats were created equal and some fats are better than others. Olive oil, nuts, avocado, oily fish – these are all high in healthy fats. Problem is that they also make you fat if you eat too much of them. As a woman of a certain age, that extra weight seems to be settling in for good around my belly which is known to be the worst area to be carrying fat. It increases one’s risk of cardiovascular problems. Even in the past three years I have noticed how much more difficult it is becoming to keep my weight in check. Is it because I am eating too many slices of cake or could it just be that I am eating too many healthy fats? Perhaps next time I will say no to salmon and just get stuck in to a juicy piece of steak with ice cream to follow!
To celebrate the third birthday of From The Healthy Heart it feels appropriate to feast on fruit rather than on cake.
Any fruit will do of course, but I do think that choosing a colour theme looks special. For this winter fruit platter I chose clementines, papaya (my all-time favourite fruit), physalis (Cape gooseberries) for a bit of pizzazz and raspberries for extra, contrasting colour.
Simply peel and cut the fruit into similar sized pieces. I like to leave the physalis attached to their papery skins as they look so elegant. They are divine dipped in dark chocolate, by the way, but that is a story for another day.
Now all you need to do is to put on the kettle for a pot of herbal tea.
Two weeks ago I overlooked a rather significant birthday – From The Healthy Heart turned three. I was too busy celebrating a family birthday with cheesecake (several slices since you are wondering) to notice. It has naturally set me to wondering what has changed – if anything – over the past three years.
I had a good think about this while I walked yesterday. It was one of those fabulous winter days when the sky is bright blue and the sun is blazing coldly. There were patches of ice on the ground but I was warm in my coat and rather pleased to be on foot. Then it struck me that one aspect of my life that has definitely shifted in the right direction is my attitude to exercise. No, I have not yet come to love it exactly but I do now walk 3-4 times a week. Previously I rarely walked. Ever. Hard to believe now. Although I tumbled off the exercise wagon for quite a few months over last summer, I have picked it up again. I also have spent the past year attending a weekly Pilates class so hopefully my core is in better shape although you wouldn’t know it to look at me.
Over the past three years I have read countless articles and research studies about the importance of regular exercise for our general health and life expectancy. Most recently I discovered that whereas previously, people with serious illness or recovering from surgery were encouraged to rest, now the thinking is that they should exercise as much as they can manage. The reason for this is that exercise has anti-inflammatory effects on the body. That is probably also why it helps to mitigate the effects of stress which causes inflammation.
On the food front I am much more aware of what not to eat and, as importantly, what to include in the diet – oats, almonds, pulses, oily fish, good fats (avocado for example). In truth, I am far better at adding in than in taking out. So I find it easy to include the above items, some daily and others weekly. However, it is turning down the homemade cake, the scoops of ice cream, the roast potatoes, the winter puddings and the summer ones come to think of it – all this I find difficult and waver in my ability to stand firm.
Hence, my weight – which dropped rather pleasingly along with a dress size – hovers now somewhere between what I was three years ago and where I got down to at my best behaved. Not that I embarked on this programme specifically to lose weight, but getting to your normal size is all part and parcel of lowering cholesterol.
As for that actual cholesterol result – or more importantly the ratio between HDL (the good stuff) and LDL (the baddie) – that hovers too. It is coming up to that time of year called the annual test. If you have not had your cholesterol tested in the past year, please be encouraged to do so. Everyone over the age of 20 should have their cholesterol tested.
To celebrate the blog’s birthday I will not be treating myself to cake. No, I will start the year as I mean to go on with a healthy and colourful platter of fruit.
Thanks for reading From The Healthy Heart – let’s all enjoy a healthy year together.
This recipe is from a new cookbook called Spiralize! 40 nutritious recipes to transform the way you eat, written by Stephanie Jeffs and published by Pavilion Books. I don’t usually blog about other people’s recipes, but am making an exception today as I have written about the book in today’s blog post.
The dish is easy to make, gorgeous to look at and delicious to eat. So that gets it onto my ‘must repeat’ list. My kids loved it too.
If you don’t have a spiralizer, Jeffs suggests using a vegetable peeler although you will then get ribbons rather than noodles.
The recipe does not state whether or not to peel the vegetables. I did peel although no doubt I reduced the nutrient content by doing so. Next time I will try it unpeeled.
The recipe serves 1 so I used 4 times the beetroot and veg and 2 avocadoes. I did not use the coconut oil but it tasted delicious nonetheless.
For one person:
1 small beetroot
1 medium carrot
1 tsp coconut oil, warmed until liquid
1 pinch Himalayan salt – I don’t have this to hand so I used Maldon sea salt
1 ripe avocado
Preheat the oven to 170 C
Spiralise the beetroot and carrot – using blade 2 if you have a spiralizer. Spread the noodles on a baking sheet and drizzle over the coconut oil. Bake in the oven for 20 minutes, or until crispy and slightly browned. I kept mine in the oven for ½ hour.
In the meantime scoop the avocado flesh into a bowl and mash with a fork. Add a pinch of salt. Some black pepper won’t go amiss either. Nor would a squeeze of lemon, although these last two ingredients are not in the recipe.
Plate the noodles and serve along with the dip.