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Heart Nutrition Guidelines

This Heart Healthy Nutrition section will show you how to lower your cholesterol levels and reduce risk for coronary heart disease. A diet low in saturated fat is considered the "cornerstone of cholesterol reduction." Combine healthy eating with a good exercise program, and you've got the key to a healthy heart.

General Diet Guidelines
Blood Lipid Levels
Dietary Fats
Dietary Fiber
Avoiding Excess Salt
Buying & Preparing Food
Healthy Eating Quick Reference

General Diet Guidelines

Include a variety of whole grains, fruits and vegetables, low-fat or nonfat dairy products, fish, legumes, lean poultry and meats
Match energy intake to energy needs to achieve and maintain a healthy weight
Avoid saturated fat and cholesterol
Limit salt, alcohol, refined carbohydrates and sugars

Blood Lipid Levels

Total Cholesterol
Less than 200 mg/dl - Desirable blood cholesterol
200 - 239 mg/dl - Borderline-high blood cholesterol
240 mg/dl or higher - High blood cholesterol

HDL Cholesterol - High density lipoprotein ("good cholesterol")
Greater than 40mg/dl (male) - Desirable HDL cholesterol
Greater than 50 mg/dl (female) - Desirable HDL cholesterol

LDL Cholesterol - Low density lipoprotein ("bad cholesterol")
Less than 100 mg/dl - Desirable LDL cholesterol
130 - 159 mg/dl - Borderline-high LDL cholesterol
160 mg/dl or higher - High-risk LDL cholesterol

Triglycerides
Less than 150 mg/dl - Desirable triglycerides
150 - 199 mg/dl - Borderline-high triglycerides
200 - 499 mg/dl - High triglycerides
500 mg/dl - Very high triglycerides

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Dietary Fats

Have you every wondered who needs to eat fat? The answer is simple - everyone. It would be unhealthy and difficult to consume a "fat-free" diet. Our bodies require a small amount of unsaturated fat to meet essential fatty acid needs. Unsaturated fat is found in approximately one tablespoon of vegetable oil. But remember that fat is fat, and all fats have approximately 120 calories per tablespoon.

The following terms will help you be more "fat alert" and help you select fat sources wisely.

Cholesterol - is a fat-like substance, found in all animal and human cells, that is required in the formation of hormones, cell membranes, and other essential body substances. Since the body is able to manufacture the cholesterol needed for health and well-being, it is not a dietary requirement to ingest cholesterol. You can find cholesterol in all animal products, fat and lean meats, fish, poultry, milk, milk products and egg yolks.

Saturated Fats - tend to be solid at room temperature. Sources are foods of animal and some plant origin: butter, lard, meats, poultry, whole milk and whole milk products (ice cream and cheese). Saturated fats are also found in some vegetable oils such as palm, kernel, and coconut oils and in hydrogenated vegetable oils used in processed foods (cookies and crackers). Saturated fats raise blood cholesterol levels more than any other type of fat.

Polyunsaturated Fats - tend to be liquid at room temperature and are found in vegetable oils. Look for safflower, sunflower, corn and soybean. These fats aid in lowering LDL cholesterol when substituted for saturated fats.

Monounsaturated Fats - are also liquid at room temperature and are found in vegetable oils such as canola, olive, peanut and avocado. Monounsaturated fats can help decrease high blood cholesterol levels if they are part of a low saturated fat diet. Use monounsaturated oil as your primary fat source, whenever possible.

Triglycerides - are fats found in food. They are the body's storage form of fat. Triglycerides in the blood are derived from the fats in foods and are made in the body from other energy sources, such as sugar, refined carbohydrates and alcohol.

Hydrogenation - is a process that makes a liquid oil solid at room temperature (for example, hydrogenated corn oil becomes corn margarine). The hydrogenation process extends the shelf life of fat-containing foods such as cookies and crackers. The product becomes more saturated and its cholesterol levels increase.

Trans-Fatty Acids - are formed in the hydrogenation process and they also raise cholesterol levels.

Omega-3-Fats - are marine oils found in fatty fish, such as salmon, mackerel, bluefish, sardines, halibut, herring, lake trout and tuna. Also found in flax seed, cooked soybeans, and walnut oil. These foods may prove helpful for people with elevated triglyceride and cholesterol levels. Recommended amount/week: 7 grams.

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Dietary Fiber

What is fiber?
Fiber is the portion of vegetables, fruits, grains and beans that passes through our digestive tract into the large intestine almost without being digested. There are two basic types of fiber: insoluble fiber and soluble fiber, each with somewhat different effects on body function.

Insoluble fiber provides roughage to help the digestive system run smoothly. Good sources of insoluble fiber include: wheat bran, whole wheat products, rye, whole grains, fruits and vegetables and whole grain cereals
Soluble fiber has been associated with lowering blood cholesterol levels and helps regulate blood sugar levels. Research has shown that 6 grams a day of soluble fiber along with a low-saturated fat diet may help reduce blood lipid levels. Good sources of soluble fiber include: oat products, fruits and vegetables, pectin, beans/legumes, psyllium guar gum

How much fiber should you eat?
It has been shown that soluble fiber can help reduce elevated cholesterol levels if incorporated into a low-saturated fat diet. Current recommendations advise healthy adults should eat between 20 grams to 30 grams of dietary fiber daily from a variety of food sources. About 25% (6 grams) should come from soluble fiber sources. The best way to reach your fiber intake goal is to eat more fresh fruits, vegetables, cereals, whole grain products and legumes. Food labels will list the dietary fiber content and differentiate the amount from insoluble and soluble sources.

Remember to drink 8 cups of non-caffeinated fluids daily with a high fiber diet to prevent constipation. Fiber ingredients on food labels include: barley, cellulose, fruit, bran, oatmeal, vegetable, carob bean gum, oats, whole wheat, carrageenan, pectin and whole grains

Last note
Gas and bloating caused by dietary fiber is produced by bacterial fermentation of the fiber in the gut. This fermentation and fatty acid production is thought to help reduce colon cancer. Be sure to slowly increase your fiber intake over several weeks or months. The gassy, bloated feeling associated with fiber consumption will decrease as your body adapts to a high fiber diet.

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Avoiding Excess Salt

Why watch salt? - Too much salt (sodium chloride) isn't good for anyone, but when you have a heart condition it's even more important to watch your sodium intake. Excessive sodium can cause water retention, high blood pressure, and shortness of breath. To avoid excessive sodium intake, eat regular meals and snacks comprised of fresh foods, and read the food label for sodium content and hidden sources of sodium.

Sodium is a naturally occurring mineral that is essential for proper regulation of body fluids and for nerve and muscle functioning. It is a mineral found naturally in many foods including table salt, convenience, snack and fast foods.

Salt = Sodium Chloride (NaCl)
1 teaspoon salt = 2300 mg sodium
Average American diet = 5000 to 8000 mg sodium per day

Guidelines for a prescribed diet:
3-4 grams sodium - No Added Salt diet: You may use up to 1/2 teaspoon of table salt per day in cooking; avoid adding salt at the table, and limit your servings of high sodium foods (foods with greater than 300 mg sodium/serving) to no more than 3 times per week.

2 gram sodium - Low Sodium diet: Recommended by the American Heart Association for individuals with heart failure. Do not use table salt in cooking or at the table; avoid high sodium foods. Avoid canned and processed foods.

1 gram sodium diet - No table salt allowed; avoid moderate (foods with 100-300 mg sodium/serving) and high sodium foods. Avoid frozen peas, lima beans, mixed vegetables and corn; avoid all canned vegetables and soups; limit bread to 3 slices per day.

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Buying & Preparing Food

Tips for Buying Frozen Foods
Many prepared and frozen foods are high in saturated fat and cholesterol. Look for frozen food packages that say, "Light, Lean, Reduced calorie, Healthy or Diet." These versions will be lower in saturated fat, cholesterol, calories and/or sodium than the regular versions.

Tips for Buying Prepared Foods
When choosing prepared foods, choose dishes made without high-fat mayonnaise and oil. Avoid high saturated fat meats, dressing and other spreads, and dishes with creams and other sauces. Fruit salad is usually available and is always a great choice.

Tips for Eating Out

Order broiled, baked, or poached foods with sauces on the side.
Ask how a dish is prepared. Knowing all the ingredients lets you control where you get your saturated fat.
Look for restaurants that have low-fat options on the menu. With the growing interest in healthy eating, restaurants from fancy French to fast food are making low-fat choices available.
Beware of the traditional restaurant "dieter's plate" (ground beef patty, cottage cheese, and a peach half). A "diet" like this will put you on a saturated fat overload.
Ask for substitutions, even if the menu says "no substitutes." Most restaurants will bring you skim milk instead of cream for coffee, unbuttered toast, salad instead of french fries, etc.
Avoid entrees with extra sauces, cheeses and gravies, and high-fat preparations such as frying.

Healthy Eating Quick Reference

Nutritional Goals

Calories - match energy (calorie intake) to energy needs to achieve and maintain a healthy weight
Fat - 25-35% of total calories from fat, less than 7% of total calories from saturated fat
Cholesterol - less than 200 mg per day
Carbohydrates - 50-60% of total calories
Fiber - 20 - 30 grams per day
Protein - approximately 15% of total calories
Sodium - less than 3,000 mg per day
Calcium - 1,200 - 1,500 mg per day

Foods to favor

Grains (at least 6 servings/day; try to make 3 servings whole grains)
Fresh foods, legumes and vegetables, especially deep green and yellow-orange colors (at least 3 - 5 servings/day)
Fruits (at least 2 - 4 servings/day)
Nonfat or 1% dairy products
Fish (2 or more servings/week)

Source: Moore, M.C. Pocket Guide. Nutrition and Diet Therapy, 2nd ed. Mosby: St. Louis 1993.; Nabisco, Nutrition Counselor, November 1989. National Cholesterol Education Program, Circulation, 89(3). March 1994
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