• Nutrition and Weight Management
• Heart Healthy Diet and High Fiber Foods
• Be aware of plant stanols
• Consider adding soy products
• Monitor Your Dietary Fat
• Choose unsaturated fats most often
• Consider Sources of Trans Fats
• Consume foods rich in Omega 3 Fatty Acids
• Eat Fewer High Cholesterol Foods
• Modify Your Sodium Intake
• Moderate Your Alcohol Intake

Introduction
Basic to any heart healthy way of living is a heart healthy way of eating. The purpose of this section is to help you begin a new way of eating that will improve your health and well-being.

During a CHAMPS appointment, a dietitian will evaluate your nutritional health status, give specific diet recommendations, and help you set nutrition-related goals. Weekly nutrition classes are a forum for group discussion, a place to share and learn ideas from other CHAMPS participants, and an opportunity to stay current on nutrition issues. Dietitians provide information to help put heart healthy nutrition guidelines into useful, easy-to-understand terms. The classes are offered Monday afternoons and Wednesday mornings.

Nutrition and Weight Management
Attaining a reasonable weight is important because excess weight can increase your risk of heart disease, hypertension, diabetes and other chronic diseases. The CHAMPS team will measure your height and weight to determine a healthy weight and, if necessary, set a reasonable goal weight.

A healthful weight management method is one that balances nutrition and exercise. The following suggestions are designed moderate food intake and promote and weight management.

• Keep a food diary. Record foods and beverages in specific amounts. Note times and situations.
• Do nothing else while eating. It's easy to overeat when distracted.
• Put down your eating utensil between bites.
• When 3/4 of the meal is eaten, stop for five minutes. If in 5 minutes you are still hungry, continue eating. If no longer hungry, stop!
• Divide your portions in half before eating so you can have a second meal.
• Use smaller plates so portions look large.
• Shop for food on a full stomach and with a list.
• Keep healthy snacks handy. Keep high calorie snacks out of sight.
• Don't serve family style. By not having bowls of food on the table, you are less likely to reach for second helpings.
• Avoid nibbling on leftover food.

If weight loss or a low body weight are a problem:

• Eat six small meals per day.
• Eat nutrient and calorie-dense foods
• Ask the dietitian about nutritional supplements

A safe and successful weight management plan focuses on positive lifestyle changes. Set yourself up for success by making small changes. You will feel good about your immediate success and be motivated to make more changes. Stay positive and reward yourself for each accomplished goal.

Heart Healthy Diet
A heart healthy diet is made up of a variety of whole grains, vegetables, fruits, low-and non-fat dairy products, lean meats and mostly unsaturated fats. It contains few sweets and limits high sodium foods. The following sections address these topics.

Eat whole grains, legumes, vegetables and fruits.

High fiber foods
Studies indicate health benefits associated with consuming up to 35g. fiber daily. Of this, 10-25g should be soluble fiber. Good sources of soluble fiber are: oats, citrus fruits, pears, apples, berries, prunes, apricots, brussel sprouts, cabbage, sweet potatoes, carrots, legumes. Regular consumption of high fiber foods is associated with decreased cholesterol and blood glucose levels.

Look for color to find antioxidants/phytochemicals/flavonoids
Considerable evidence shows that oxidants are involved in the development and expression of coronary heart disease and antioxidants may contribute to disease resistance. Examples of antioxidants and phytochemicals are Vit.C, Vitamin E and beta-carotene. High antioxidant intake has been associated with lower disease risk. Study on antioxidant supplementation is in process.

The American Heart Association doesn't recommend using antioxidant vitamin supplements until more complete data are available. Examples of food sources of antioxidants are as follows.

• Vitamin C: fruits (especially citrus) and vegetables, including green and red peppers, tomatoes, potatoes, and green leafy varieties (like spinach and collard greens).
• Vitamin E: vegetable oils (like soybean, corn, and safflower) and vegetable oil products (like margarine), whole grains, wheat germ, nuts and seeds, and green, leafy vegetables
• Beta-Carotene: yellow-orange fruits (like cantaloupe) and vegetables (like carrots) and green, leafy vegetables.
• Lycopene: tomatoes, tomato products, watermelon, pink grapefruit
• Allicin: garlic, onion, chives, leeks
• Lignans: flaxseed, berries, whole grains
• Resveratrol: grapes, berries, peanuts, red wine
• Ellagic Acid: raspberries, strawberries, blueberries, walnuts, pomegranates
• Catechins: black and green tea, wine, apples
• Isothiocyanates: broccoli, cauliflower, brussel sprouts
• Phytic Acid: wheat bran
• Isoflavones: tofu, soybeans, soymilk, tempeh, textured soy protein
• Lutein: kale, greens, spinach, Swiss chard, red pepper, Romaine lettuce
• Limonin: citrus fruits

Be aware of plant stanols
Studies suggest consuming plant stanols can help lower LDL. The National Cholesterol Education Program suggests 2,000mg plant stanols/day. Plant stanols are added to margarines, such as Benecol and Take Control, as well as Minute Maid's Health Wise orange juice. Natural food sources are: nuts, legumes, seeds and cooking oils. Most people get 200-300mg/day from oils. Following is a brief summary of foods and amounts of plant stanols:

• 3 Tbsp Benecol margarine = 2,000mg
• 2 Tbsp Take Control margarine = 2,000 mg
• 16oz. Health Wise Orange Juice = 2,000mg
• 1/2c. legumes = 248mg
• 1/4c. peanuts = 85mg
• 1 Tbsp. corn oil = 134mg
• 1 oz. seeds = 142-200 mg

Consider adding soy products
Studies indicate soyfoods may help reduce heart disease. The FDA recommends 25g soy protein daily as part of a heart healthy diet. The following is a list of soyfoods and their protein content.

• 1/4c. firm tofu — 10g soy protein
• 1/2c. silken tofu — 9g
• 2 soy breakfast links — 12g
• 1 soy-based burger — 10-12g
• 8oz. soymilk — 7g
• 1 soy protein bar — 14g
• 1/2c cooked soybeans — 14g
• 1/2c tempeh(fermented tofu) — 16g
• 1/4c roasted soy nuts — 17g

Monitor Your Dietary Fat
Our body needs fat. Fat serves as the storage substance for the body's extra calories. It fills the fat cells, or adipose tissue, that help insulate the body. Fats also are an important energy source.

Healthy skin and hair are maintained by fat. Fat helps in the absorption, and transport through the bloodstream of the fat-soluble vitamins A, D, E, and K.

Diets high in saturated and trans fats increase risk for heart disease. Diets that contain some mono- and polyunsaturated fats promote heart health. Moderation of all fat is important.

Whatever your lifestyle preference, a dietitian can help you establish a plan to adjust fat intake to recommended levels. The American Heart Association recommends a diet with less than 30% of calories from fat, less than 10% saturated fat. It suggests 5-8 total fat servings per day and encourages choosing foods low in saturated and trans fats, as well as cholesterol.

The National Cholesterol Education Program recommends a diet with 25-35% of calories from fat. It suggests up to 20% of calories as monounsaturated, up to 10% polyunsaturated and less than 7% saturated.

Choose unsaturated fats most often
As noted above, it is not only the amount of fat in the diet, but also the type of fat, that is important. Saturated fats tend to increase blood cholesterol levels. Polyunsaturated and monounsaturated fats tend to decrease blood cholesterol levels when substituted for saturated fats. Choose polyunsaturated and monounsaturated over saturated fats. Sources of these fats are listed below.

Consider Sources of Trans Fats
Trans fats are another type of fat that may increase total cholesterol and LDL cholesterol levels. Trans fats also may decrease HDL cholesterol levels. Trans fats result from vegetable oil processing. Trans fats are found in margarine, shortening and products made from these. Major dietary sources are: cakes, cookies, crackers, pies breads, animal products and margarine. The American Heart Association recommends choosing margarine with no more than 2g saturated fat per serving and with liquid vegetable oil as the first ingredient. On food labels, look for grams of trans fats listed under saturated fats. This is a sample label from the FDA, showing how a food label will look with a trans fat listing.

Consume foods rich in Omega 3 Fatty Acids
Omega 3 Fatty Acids (fish oils) are a type of polyunsaturated fatty acid found in the oils of fish and shellfish, flaxseed, tofu, walnuts, canola oil and soybean oil. Omega three fatty acids are found in greatest amounts in fatty fish such as salmon, mackerel, herring, sardines, and whitefish. Research has shown that fish oils may be beneficial in decreasing triglycerides. Their effect on cholesterol is undetermined. The AHA suggests incorporating fish into 2-3 meals per week. Those with high triglycerides may benefit from supplementation of 2-4gm eicosapentaenoic acid and docosahexaenoic acid per day, but talk with a physician first. High intake can cause excessive bleeding.

Eat Fewer High Cholesterol Foods
Cholesterol is a fat-like waxy substance that is used by your body to produce hormones and other vital substances. The body manufactures cholesterol, about 600 mg per day, for its needs. However, cholesterol also is present in foods of animal origin. Dietary cholesterol tends to increase blood cholesterol levels. The AHA and NCEP recommend an intake of 200 to 300 mg of cholesterol per day. Americans typically consume 450-500 mg of cholesterol each day. Compare the following foods to find those high in cholesterol.

Modify Your Sodium Intake
Sodium is a mineral which helps your body maintain water balance. Too much sodium in the diet may cause fluid retention, which makes the heart work harder to pump blood. This can increase your blood pressure. Your body needs 500 mg of sodium per day. The average American intake is 3 to 7 gm (3,000 to 7,000 mg) per day. The AHA recommends a sodium intake of < 3000 mg for healthy Americans. To lower your intake:

• Avoid salting your food at the table.
• Opt for salt free cooking.
• Eat fewer commercially prepared foods.
• Be conscious of selections when eating out.

High Sodium Foods

• Canned Soup*
• Canned Vegetables*
• Canned Tomato Products*
• Canned fish, meat
• Processed meats, such as ham, hot dogs, bacon, sausage, lunch-meat
• Pickled items, such as olives, pickles, and sauerkraut
• Boxed items, such as macaroni and cheese, potato and rice side dishes
• Seasonings such as garlic salt, onion salt, celery salt, some lemon peppers
• Sauces, such as soy, Worcestershire, barbeque*
• Individually frozen chicken breasts
• Marinated meat products
• Cheese and cheese spreads*
• Bouillons*

Tip: Learn to use herbs and spices in cooking. Starting guideline: use about 1/4 tsp. of dried or 3/4 tsp. of fresh spice per pound of meat.

Moderate Your Alcohol Intake
Despite the recent publicity about the benefits of alcohol for heart disease, overindulgence can cause many problems. Outweighing the possible positive effect on heart disease are the real risks of excess alcohol ingestion. Excess alcohol intake can increase triglycerides and blood pressure, cause liver damage, and impair coordination, which may lead to falls and accidents. Alcohol contains a lot of calories with no nutritional value. Therefore, alcohol in moderation is an acceptable part of your diet plan. For men, "moderate drinking" is no more than 2 drinks per day. For women, no more than 1 drink per day is recommended.

Count as one Drink

• 12 oz beer
• 5 oz wine
• 1.5 oz hard liquor (80 proof)

Caffeine

• Caffeine has many metabolic effects. For example,
• Caffeine stimulates the central nervous system.
• Caffeine releases free fatty acids from adipose (fatty) tissue.
• Caffeine affects the kidneys, increasing urination, which can lead to dehydration.

Caffeine is in coffee, tea, soft drinks, chocolate and some nuts. Whether high caffeine intake increases the risk of coronary heart disease is still under study. Moderate caffeine intake, such as 1-2 cups coffee per day, doesn't seem to be harmful.

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