Start With Breakfast
Have a low-cholesterol breakfast. Every morning Goldberg and her husband eat breakfast together. “I have a bowl of high-fiber, low-sugar cereal, like Kashi GoLean, with low-fat milk and antioxidant-rich blueberries,” she says. Fiber is filling, and the soluble form―found in oatmeal, beans, fruits, vegetables, and this cereal―can lower cholesterol. Aim for 25 grams of fiber a day.
Take a supplement, if necessary. “A healthy diet is still the best way to get your nutrients,” says Goldberg. “A bag of chips washed down with a vitamin isn’t a good solution.” However, she does suggest taking an omega-3 fatty-acid supplement daily if you don’t eat fish regularly. Choose one with the two forms of the acids that aid the heart: eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Or twice a week set a goal for having two to three servings of natural omega-3 sources, like a small handful of walnuts or a 3 1/2-ounce portion of salmon. (For those with high triglyceride levels, she recommends prescription-strength omega-3s.)
Be honest with your doctors. Goldberg implores patients to see her as a nonjudgmental confidante. “I’ve had people on cholesterol-lowering drugs neglect to take them and not tell me. So I then check their blood and consider increasing their dosage unnecessarily,” she says. “No one should ever be embarrassed when it comes to their health. Your doctors can give you the best help only when they really know all the information.”
Take baby aspirin, if needed. For those people who are at high risk for heart disease, who have it, or who are over the age of 65, Goldberg often suggests taking a daily baby aspirin (81 milligrams). “I tell many of my patients to take one,” she says. “This is a cheap and effective prevention strategy.”
Cut Back Where Needed
Drink caffeine conservatively. The doctor enjoys a mug of coffee but tells anyone prone to heart palpitations to keep their caffeine intake to less than 300 milligrams a day, which is the equivalent of two to three cups. Or consider an alternative, like green tea, which has less caffeine but is rich in antioxidants that can improve the flexibility of your arteries, which may help prevent plaque from building up in them.
Eat sweets sparingly. A 2008 study found that women with elevated blood-sugar levels had a risk of developing coronary heart disease similar to that of women with full-blown diabetes. “If you want dessert, make it one that has heart benefits, like dark chocolate,” Goldberg says. “Have a small piece made with 70 percent cocoa so it’s high in antioxidants.”
Tweak family recipes. Instead of frying foods, the doctor bakes or grills, and she uses whole-grain pasta and brown rice in lieu of basic white. She makes healthier versions of the things she grew up eating and incorporates fresh vegetables into them whenever possible: “When I make my mom’s chicken soup, I toss in a bag of baby carrots or use a mandoline to quickly slice and add antioxidant-rich onions or scallions.”
Make small changes. (They work.) Goldberg had a patient who smoked, didn’t exercise, and had a family history of heart disease. She prescribed statins to help reduce the patient’s cholesterol while the patient slowly cut down on smoking and started exercising more and eating better. Within a few months, Goldberg was able to lower the patient’s medication, since the patient’s modest efforts had made a huge impact. “Your health is not pass/fail. Just having risk factors does not mean you’re doomed,” Goldberg says.
Watch Your Diet
Stick with fresh foods. “Almost nothing in my meals comes from a package,” Goldberg says. “I snack on fresh fruits, especially clementines and peaches, and vegetables. I also like dried fruit, like unsweetened apricot slices, because it’s easy to pack and eat on the go.” In addition, Goldberg has at least one vegetable-laden salad a day. The base is dark greens, such as spinach, which she tops with lean grilled chicken or egg whites. She throws in lycopene-rich tomatoes and orange and red peppers for their antioxidants. “At a salad bar, I avoid anything glistening or creamy looking,” she says. “Two clues that they’ve got a lot of artery-clogging fat.”
Snack smartly. “I have a handful of almonds or walnuts when I get home or while cooking dinner,” says Goldberg. “This prevents me from overeating at night.” The walnuts have omega-3 fatty acids, and almonds contain arginine, which helps keep arteries strong.
Try a Mediterranean diet. Studies have shown that people who follow a Mediterranean diet have a 50 to 70 percent lower risk of recurrent heart disease, and those who get at least five servings of vegetables a day have about a 25 percent lower risk of a heart attack. So Goldberg consumes plenty of fish, grains, vegetables, fruits, and olive oil. “I think this is a great nonfad diet. Most people who start it usually stay with it,” she says. “It’s tasty and easy to live with.” Indeed, her copy of The Mediterranean Diet Cookbook is well-worn.
Do a Little More (or Less)
Go with red wine. “I’m actually allergic to alcohol, so I don’t drink. But if you like to, opt for wine, and limit it to one glass a day,” Goldberg says. Red, in particular, has a high concentration of the antioxidant resveratrol, which can help maintain blood vessels’ health. “But grape juice has the same benefits―something wine lovers don’t always want to hear,” she adds.
Throw salt overboard. Since excess salt can increase blood pressure, Goldberg tells her patients to keep their sodium intake to less than 2,300 milligrams a day, which many people hit from processed foods alone. “Simply remove the salt shaker from the table,” she says. “One of the best substitutes is chopped chives. Sprinkle a few teaspoons on soups, salads, or pasta for a salty kick.”
Do better than butter. Goldberg occasionally uses a spread, like Benecol or Smart Balance, on bread. Both have plant-derived stanol esters, which can help lower bad cholesterol. “The labels tout this, but don’t think of these products as medicine,” she says. “You certainly don’t want to ingest the amount it would take to make them work that way. They’re just better choices than butter or margarine.”
Stick to a Routine
Make exercise nonnegotiable. Goldberg works out five times a week, alternating between personal-training sessions, Spinning classes, and a little Pilates. “I wouldn’t miss an appointment with a patient, and I don’t cancel my appointment to exercise, either,” she says. “It makes me feel so good afterward, and it keeps my cholesterol and blood pressure under control.”
Take stress seriously. Constant stress can lead to elevated levels of adrenaline and the hormone cortisol, which makes arteries more vulnerable to plaque. “For me, reducing stress is all about saying no and planning alone time,” Goldberg says. To unwind, she watches the Food Network, schedules a manicure, and recently instituted “no e-mail” weekends.
Sack out early. Studies show that people who get less than seven hours of shut-eye a night can have higher blood pressure. Lack of sleep also leads to higher levels of cortisol and even weight gain. “I go to bed around 10:30 each night and wake up most mornings at 6:20,” says Goldberg.
Meet the Author
Twenty years ago, when Nieca Goldberg was in medical school, heart disease was known as a “man’s disease”―something most apt to befall a 55-year-old businessman. Today the disease is the number one killer of U.S. women, claiming nearly 500,000 lives annually. Goldberg, now 50, devotes her career to helping fellow females protect their hearts at Total Heart Care, her practice in New York City. She also teaches the science of heart health as a clinical associate professor of medicine at New York University. But the doctor doesn’t have to look to research for evidence that diet, exercise, and stress management can prevent future problems. Even though she has a family history of heart disease, her habits have kept her health in check. “Making consistent, small, smart choices can have a huge effect,” says Goldberg.