Healthy Eating and Dieting

Fat is one of the major nutrients in food and provides essential fatty acids, which the body can't make. It is a source of fat-soluble vitamins. Fat also gives flavor to food. Some fats are actually healthy for the heart and lower disease risk. Other types contribute to heart disease and cancer. All fats have nine calories per gram, and since a heart-healthy diet is a lowfat diet, you want to limit your fat to no more than 30 percent of your caloric intake for the day.

All fats are a combination of various fatty acids, but one type usually predominates. Different fatty acids have different roles in the body. Saturated fatty acids or saturated fats raise cholesterol and triglycerides in your blood. They also raise blood pressure and make it more likely for your blood to clot. Blood clots are what cause heart attacks and strokes. The biggest sources of saturated fat in the American diet are red meat, whole dairy, chocolate, and butter.

Trans fatty acids are a type of fat made from vegetable oils that also raise cholesterol, blood pressure and increase the risk of diabetes. Some people think they may be more dangerous to our health than even saturated fat. Trans fats are found in foods that contain partially hydrogenated oil. Check ingredients in crackers, cookies, cereal, snack foods, nutrition bars, coffee creamers and margarines.

Unsaturated fats can be classified as either polyunsaturated or monounsaturated. Some types of unsaturated fats are actually beneficial for the heart. In fact, they can lower cholesterol. Omega-3 fatty acids are a type of polyunsaturated fat that also lower triglycerides and blood pressure, help with arrhythmias, decrease blood clotting, decrease inflammation and also may reduce cancer. The average American diet is low in Omega-3 fats, which may help explain why heart disease is the number on cause of death in the United States. Omega-3 fatty acids can be found in fish, nuts, beans, berries and leafy greens.

Serving Size: Fats and Oils

• 2 tsp light margarine
• 1 tsp regular margarine
• 1 tbsp low-fat mayonnaise
• 1 tsp regular mayonnaise
• 2 tbsp light salad dressing
• 1 tbsp regular salad dressing
• 1 tsp oil (canola oil is the BEST choice)

Triglycerides

All the fat in the food we eat is in the form of triglycerides. Our liver also makes triglycerides if we eat more calories than we need, if we drink too much alcohol, or eat too many refined carbohydrates. An elevated level of triglycerides in the blood is often associated with high blood pressure, low HDL, and carrying excess fat in the belly area. This leads to a condition called insulin resistance, a situation which puts a person at high risk for coronary artery disease.

The most effective strategy to lower triglycerides and prevent insulin resistance is to exercise regularly. Aerobic exercise and resistance exercise have been shown to lower triglycerides and reduce insulin resistance.

Dietary Strategies to Lower Triglycerides

• Limit saturated fat to 15 grams per day
• Increase fiber to 30 grams per day (fruits, vegetables, whole grains, beans, nuts)
• Add soy to your diet regularly
• Include food sources of omega 3 fatty acids regularly
• Limit foods with hydrogenated oils
• Limit foods made from white flour and white sugar
• Spread your food intake into small meals
• Decrease your intake of alcohol

Fiber is the indigestible portion of plant foods. Grandma used to call it roughage. Just like cholesterol is only found in animal foods, fiber is only found in plant foods. Fiber has a special role in heart disease prevention. Fiber can be classified as either soluble or insoluble, depending on its chemical properties. Most foods are a combination of both types, but often one type will predominate.

Soluble fiber is especially effective in lowering LDL cholesterol and in controlling blood glucose and insulin levels. The best sources of soluble fiber are legumes (beans and peas), oats and barley, apples, grapes, bananas, citrus fruits, carrots, potatoes, especially sweet potatoes and soybeans.

A diet high in insoluble fiber has been shown to reduce the risk of colon cancer and possibly breast cancer. The best sources of insoluble fiber are wheat and corn bran, brown rice, celery, broccoli, cauliflower, cabbage, pears, peaches, strawberries and other fruit with seeds.

Both types of fiber are important for proper bowel function and help relieve constipation and hemorrhoids. All fiber is helpful if you need to lose weight because it provides bulk without a lot of calories, which also helps you to feel full! Another important reason to include more fiber in your diet is that most high fiber foods contain antioxidants. Antioxidants prevent LDL, the bad cholesterol, from sticking to artery walls.

How much fiber do you need?

Thirty grams of total fiber is a reasonable amount. Try to make at least half of that soluble fiber in order to get the most benefit for your heart. The average American only eats 10-15 grams of total fiber per day because most diets are based on processed and refined foods that contain little fiber. The fiber content of foods is listed on the nutrition facts panel under carbohydrate.

Precautions

It is very important as you begin to add more fiber to your diet that you do it gradually. This will help reduce the gas that often accompanies high fiber foods. Supplements such as Beano^® are available which can help a lot with the gas. It is also important as you increase fiber to drink a lot of fluid. Fiber draws water from cells into your intestines, which is how it makes stools soft. You want to make sure you get enough fluid to replace that water and maintain your hydration. Try to drink eight to 10 cups of fluid each day, half should be water.

An excellent source of protein on a heart-healthy diet, fish is low in saturated fat and many types contain the Omega-3 fatty acids that help lower cholesterol and triglycerides.

The American Heart Association recommends all people consume a serving of fish (three to four ounces) at least twice a week. The fish highest in Omega-3s are:

• Salmon
• Mackerel
• Tuna
• Bluefish
• Trout
• Anchovies
• Herring
• Sardines
• Halibut
• Swordfish

No one food meets the Daily Reference Intake (DRI) for Folate or Folic Acid (1.3-1.7 mg) in a single serving. You need to eat several Folic Acid rich foods each day. Most Americans DO NOT consume the DRI for Folic Acid, but supplementation in high doses (over 200mg) can cause nerve damage.

Italicized foods have 50% of the DRI (400 micrograms) per usual serving. The foods below are listed from highest to lowest folate content.

• Black-eyed peas
• Brewer's yeast
• Pinto beans
• Spinach
• Navy beans
• Beef liver
• Northern beans
• Asparagus
• Orange juice
• Turnip greens
• Lima beans
• Kidney beans
• Parsley
• Spinach
• Beets
• Bean sprouts
• Sunflower seeds
• Broccoli
• Romaine
• Wheat germ
• Winter squash
• Bok choy
• Cauliflower
• Bean sprouts
• Fortified cereals

Fruits and vegetables are an important part of a heart healthy diet because they provide fiber, which helps lower cholesterol, blood pressure and blood sugar. They also are a source of antioxidants, substances that help prevent LDL from sticking to artery walls. We recommend eating seven to nine servings of fruits and vegetables each day.

What is one serving of fruit and vegetables?

One serving of fruit and vegetables is equal to:

• 1 piece of fruit
• ½ cup canned or frozen fruit
• ¾ cup juice (no fiber though)
• 1 cup salad
• ½ cup cooked vegetable or potato

Eating a Variety Fruits and Vegetables

Try to get a variety of fruits and vegetables in your diet. Each color in a fruit or vegetable represents a compound that has disease preventative properties. The more colorful your diet, the healthier you will be. Suggestions to increase your consumption of fruits and vegetables:

• Add fruit to cereal for breakfast
• Cut up fruit for a salad
• Use fruit as a naturally sweet dessert
• Grab a piece of fruit instead of a cookie
• Mix dried fruit with nuts for a healthy snack
• Always include a vegetable with your lunch
• Have a stir-fry once a week
• Go back for seconds on vegetables rather than meat
• Ask for a side of vegetables in a restaurant and take home half the main course
• Add vegetables to spaghetti, pizza, casseroles, etc.

Many people are surprised to hear that nuts can be part of a heart healthy diet because they are high in fat. That is why, for nuts, you must eat them in moderation.

• One serving of nuts is 1 ounce or about 1/4 cup to 1/3 cup.

Nuts contain healthy fats, as well as certain vitamins and minerals, which can actually lower your blood pressure, triglycerides and cholesterol, and reduce the chance of developing type 2 diabetes. Nuts are also a great source of plant protein and fiber. Nuts contain the amino acid arginine, which in the body turns into nitric acid, a substance that helps relax the blood vessels. It is good to include a variety of nuts in your diet because different nuts supply different nutrients. Eat nuts unsalted if possible.

For peanut butter, buy a reduced fat version and preferably a natural type, because it is lower in hydrogenated oils.

• One serving peanut butter is 2 tablespoons.

Seeds, such as sunflower and pumpkin share similar properties as nuts - but eat them in moderation.

• One serving seeds = 2 tablespoons

How to add nuts to your diet

• Sprinkle on salad or oatmeal
• Stir into your favorite yogurt or add to casseroles for a crunch
• Mix with cereal and dried fruit for a homemade trail mix
• Nibble on a small handful for a snack instead of chips or pretzels
• Spread peanut butter on whole grain crackers or fruit such as apples or bananas
• Have a peanut butter and jelly sandwich for lunch on whole wheat bread with a cold glass of skim milk and an apple

Sometimes when people try to reduce the fat and cholesterol in their diet they end up not getting enough protein. This usually occurs because they cut back or eliminate meat and other high fat animal products from their diet in order to reduce their fat intake. Although this is a good idea, you need to replace the protein that these foods were providing with other protein sources that are lower in fat.

When protein is lacking in the diet a number of things in the body can be affected. Protein is responsible for growth and repair of all the cells in the body. Your immune system, which helps your body fight infection and disease, becomes weak without protein. Protein is the main ingredient of your muscles. It is also needed for red blood cell and hormone production. Red blood cells transport oxygen and hemoglobin in our body so you have the energy to carry out daily activities. Hormones are substances that regulate a variety of things in the body such as appetite, blood sugar, digestion, temperature, etc.

Research shows protein is the most satisfying of all the nutrients. When you don't eat protein at a meal you may feel hungry sooner. This may be related to protein's effect on blood sugar. Many people overlook the importance of protein in their diet.

How much protein do you need?

Protein needs are based on individual body weight. The Recommended Daily Allowance (RDA) for the average person is .4 grams of protein per pound of body weight.

For example, a 120 lb. person must multiply 120 by .4 and will get 48 grams of protein per day.

• Your protein requirement calculation: Your weight x 0.4 grams of protein = ___ grams of protein per day

Protein is made up of amino acids. Animal protein (fish, chicken, beef, milk products, eggs) contains all the essential amino acids our bodies need and are considered complete proteins. Plant proteins (breads, beans, pasta, rice, vegetables) lack some amino acids, so they are considered incomplete proteins. Soy is an exception; it is a plant protein that contains all the essential amino acids that animal proteins contain. Soy-based foods are an excellent replacement for animal protein. It is recommended to eat a wide variety of plant proteins to ensure adequate protein intake.

Plant Protein

Animal food isn't the only way to get protein in your diet. Many studies have demonstrated that people who consume a vegan diet (no animal protein at all) have a healthier cholesterol level and lower blood pressure than meat-eaters. At the Women's Heart Center, we encourage our patients to consume animal protein, three to four ounces, at no more than one meal per day.

It is important however, to get enough protein in your diet, because women often don't eat enough protein. For other sources of protein you can consume:

• Beans
• Nuts
• Soyfoods
• Whole grains

Nutritionists used to believe you needed to combine vegetable protein sources at each meal in order to make complete protein. Today, nutritionists advise eating a variety of beans, nuts, grains and vegetables over a few days. That way your body will be able to make all the protein it needs.

Serving Size: Animal Protein

• 3 ounces lean meat, fish (have at least 3 servings per week of salmon, tuna, lake trout, mackerel, bluefish) or poultry without skin (deck of cards)
• 2 eggs (limit to 4 per week)

Sodium is involved in fluid balance and blood pressure regulation. We only need to consume 250 mg sodium each day for our bodies to function properly. The average American diet supplies 20-40 times that much, so most people need to reduce the sodium in their diet. Too much sodium in the diet contributes not only to high blood pressure, but also osteoporosis. The American Heart Association and other organizations recommend we eat no more than 2400 mg sodium per day.

Table salt is 40 percent sodium and 60 percent chloride. One teaspoon of salt contains 2400 mg sodium. Table salt is not the biggest source of sodium in the American diet however. The majority of sodium we eat is from processed foods. Begin to look at the Nutrition Facts Panel on the foods you eat and see how much sodium foods contain.

Tips to Reduce Sodium in Your Diet

• Not adding salt in cooking
• Limit salt at the table, or use a salt substitute
• Look for low sodium versions of canned foods
• Prepare more foods from scratch rather than using boxed and frozen items
• Limit restaurant meals, especially fast foods
• Go easy on condiments such as catsup, mustard, pickles and olives

The proper amount of vitamins and minerals is important for a healthy body and a healthy heart. The government has set guidelines for Americans called Dietary Reference Intakes, which give levels of minimum and maximum amounts for most vitamins and minerals. You can find them at Food & Nutrition Information Center. We recommend everyone take a one-a-day type vitamin and mineral supplement that contains no more than 300% of the DRI for any nutrient. People over 50 should choose a supplement that is low in iron, unless they have been told otherwise.

Some vitamins and minerals that are important for the heart are often lacking in the typical American diet. Examples are B-6, folic acid, calcium, magnesium and chromium. B vitamins may help lower a new emerging risk factor for heart disease called homocysteine. Calcium and magnesium are important for blood pressure regulation. Calcium is also involved in cholesterol metabolism and may play a role in weight management.

B Vitamins And Your Heart

A deficiency of vitamins B-6, B-12, and folic acid can increase your risk of heart disease. These vitamins are involved in the breakdown of a substance called homocysteine. Homocysteine seems to make blood clot easier, a dangerous situation if there is plaque in your arteries. To keep homocysteine down:

Make sure you get enough B-6, B-12 and folic acid or folate in your diet.

One thing interesting about B-6 is the requirement is linked to the animal protein in your diet. The more animal protein you eat, the more B-6 you need.

B-6 is a vitamin that is often low in the diets of most Americans. However, mega doses of B-6 can cause irreversible nerve damage. So, if you take a supplement, check with your doctor or dietitian. The DRI is 1.3 - 1.7 mg. Up to 100 mg seems to be safe. To lower homocysteine, 2 mg is recommended.

Mega doses of folic acid are often recommended to lower homocysteine. The DRI is 400 mcg. Most multi-vitamins contain that much. To lower homocysteine, you can take up to 1 mg. or 1000 mcg. safely. Flour is now fortified with folic acid.

Vitamin B-12 is found exclusively in animal products so vegans need to supplement unless they are using B-12 fortified foods. Absorption of B-12 decreases as you get older, so all people over the age of 50 should take a synthetic supplement containing 2.4 mcg of B-12. Most multivitamins contain at least that much. Up to 6.0 mcg is recommended to lower homocysteine.

Getting Enough B Vitamins in Your Diet

• Eat a variety of fresh fruits and vegetables.
• Choose dark green leafy type vegetables rather than pale green ones. Eat them daily.
• Use whole grains, six to 11 servings everyday.
• Everyday eat some beans.

There are many different types of grains that are popular throughout the world. In some nations, grains are the staple of the diet, the staff of life so to speak. Most grains have an outer layer called the bran, which wraps around an inner section that has some type of seed or kernel at the center.

Whole grains are breads, cereals, rice, pasta, etc. that are made from all parts of the grain. This is in contrast to refined grains, which do not include the outer bran or inner seed. Whole grains are high in fiber, while refined grains are low in fiber. Whole grains are a good source of vitamin E, an antioxidant which protects against disease. They are also a good source of B vitamins, which protect against heart disease. Whole grains provide magnesium, which is important for blood pressure regulation.

Grains have gotten a bad rap lately due to the popularity of low carbohydrate diets, but all grains are not created equal, and whole grains are an essential component of a diet to lower heart disease risk as well as cancer risk. Try to consume six to eight grain servings each day. Half should be whole grains.

When you are looking at the Nutrition Facts Panel on a food, look for the word "WHOLE" as the first ingredient. Look at the fiber content of the food. Whole grains generally include 3 grams of fiber or more per serving.

Serving Size: Bread, Cereal, Rice, and Pasta (Preferably Whole Grain)

• 1 slice bread
• ½ - ¾ cup of cooked rice or pasta
• ½ cup of cooked cereal
• 1 ounce ready-to-eat cereal
• 4 - 6 low-fat crackers
• 6" tortilla or pita
• 1 ounce pretzels
• ½ bagel or English muffin
• 3 rice cakes
• 1 small muffin (low-fat or fat-free)
• 1½ cups popcorn