1. For MOVE SUPPORT GROUP February 5, 2013
Heart Healthy Diet
For MOVE SUPPORT GROUP
February 5, 2013

2. The heart is the center of the circulatory system, the network of blood vessels that delivers blood to every part of the body carrying oxygen and nutrients for the organs to stay healthy and work properly
The heart is divided into 2 separate pumping systems
The RIGHT side receives oxygen POOR from veins and pumps it into the lungs where carbon dioxide is removed.
The LEFT side receives oxygen RICH blood from lungs and pump it through arteries to the rest of the body
Function of the heart

3. Heart disease is the leading cause of death in America
Heart disease is the leading cause of death in America. One in three adults has some form of heart/cardiovascular disease. Many of these deaths and risk factors are preventable, and food choices have a big impact on your heart’s health, even if you have other risk factors.
Heart Health and Diet

4. Major Risk Factors for atherosclerosis
Unhealthy blood cholesterol levels; high LDL and low HDL
High blood pressure
Smoking
Insulin Resistance
Diabetes
Overweigh or obesity
Lack of physical activity
Major Risk Factors for atherosclerosis

5. Only a few risk factors, such as age, gender and family history, cannot be controlled.
Age – men > 45 and women >55
Family history of early heart disease – if father or brother before age 55 or mother or sister before age 65
Blood cholesterol begins to rise around age 20 and continues to go up until about

6. Fat is important to include in your diet for a number of reasons
Fat is important to include in your diet for a number of reasons. Your body cannot make some types of fats but still needs them.
Fat adds flavor to foods and can help you feel full longer after meals.
It also carries vitamins and minerals through the body.
What is fat used for?

7. Cholesterol is a fat-like material that provides structure for your body’s cells. The body uses cholesterol to make hormones, bile acids, vitamin D, and other substances.
Your liver makes most of the cholesterol your body needs, but you also get some from the foods you eat.
What is cholesterol?

8. Cholesterol circulates in the bloodstream but cannot travel by itself
Cholesterol circulates in the bloodstream but cannot travel by itself. Cholesterol travels in packages called lipoproteins which have fat inside and protein outside.
LDL (low-density lipoprotein) and HDL (high-density lipoprotein.

9. Often called the “good” cholesterol, HDL helps remove fat in the blood.
A low HDL increases your risk for heart disease. To increase your levels don’t smoke (or quit if you do) and exercise more.
HDL

10. Often called the “bad” cholesterol, LDL carries fat throughout the body and leaves it on blood vessel walls. This can build up over time and cause blockages in the arteries.
LDL

11. When there is too much cholesterol in the blood, some of the excess can become trapped in artery walls. Over time this builds up narrowing the blood flow resulting in a decrease in oxygen and to the nutrients to the organs and tissues. The trapped cholesterol is called plaque, making the artery wall less flexible, or “atherosclerosis”.

12. Diagram of inside view of blood vessel
PLAQUE
CHOLESTEROL
Diagram of inside view of blood vessel

13. Another type of fat in the blood that can increase the risk for heart disease. Foods high in fat, sugar and alcohol as well as poor diabetes control can increase triglycerides.
150 or higher
Triglycerides

14. You can prevent and control many risk factors of heart disease, such as high blood cholesterol, high blood pressure, excess weight and obesity, with lifestyle changes and medications.
The main goal of cholesterol lowering treatment is to lower the LDL level.
A cholesterol lowering diet
Physical activity
Weight management

15. Change
LDL-Reduction
Decrease saturated fat to less than 7% of calories
8-10%
Decrease dietary cholesterol to less than 200 mg per day
3-5%
Weight loss of 10 pounds if overweight
5-8%
Adding 5-10 grams soluble fiber/day
Adding 2 grams plant sterols/standols
5-15%

16. Monounsaturated fats are found mainly in vegetable oils such as canola, olive, and peanut oils. They are liquid at room temperature. Eating foods high in monounsaturated fats can help lower your LDL cholesterol, raise your HDL cholesterol, and decrease your risk of heart disease. They are the best fats to have in your diet.
Monounsaturated Fats

17. Polyunsaturated fats are found mainly in vegetable oils such as safflower, sunflower, corn, flaxseed, and canola oils. Polyunsaturated fats are also the main fats found in seafood. They are liquid or soft at room temperature. Some polyunsaturated fats are essential and are needed for cell structure and for making hormones. Essential fats must be obtained from foods we choose. Eating polyunsaturated fats in place of saturated fats decreases LDL cholesterol.
Polyunsaturated Fats

18. Saturated fats are found chiefly in animal foods such as meat and poultry, whole or 2% milk, and butter. Some vegetable oils like coconut, palm kernel oil, and palm oil are highly saturated. Saturated fats are usually solid at room temperature. Eating too many foods high in saturated fat can raise blood levels of your total and LDL (the “bad”) cholesterol. High blood levels of LDL and total cholesterol increase your risk for heart disease.
Saturated Fats

19. Trans fats are formed when vegetable oils are processed into margarine or shortening. Sources of trans fats in your diet include snack foods and baked goods made with “partially hydrogenated vegetable oil” or “vegetable shortening.” Trans fats also occur naturally in some animal foods such as dairy products. Trans fats act like saturated fats and raise LDL cholesterol levels. They can also lower HDL (the “good”) cholesterol in the blood. Trans fats increase your risk for heart disease. There is no safe level of trans fat intake.
Trans Fats

20. Trans fat is not currently labeled on all nutrition fact labels
Trans fat is not currently labeled on all nutrition fact labels. The best way to identify if a food has trans fat is to look at the ingredient list for “partially hydrogenated oils.” An example of a food ingredient list looks like this:
Ingredients: Enriched Flour, Wheat Flour, Sugar, High Fructose Corn Syrup, Partially Hydrogenated Soybean Oil, Whey, Emulsifiers, Salt
Reading a label

21. Is butter better than margarine?
Recent studies on the potential cholesterol-raising effects of TFA have raised public concern about the use of margarine and whether other options, including butter, might be a better choice. Some stick margarines contribute more TFA than unhydrogenated oils or other fats.
Because butter is rich in both saturated fat and cholesterol, it's potentially a highly atherogenic food (a food that causes the arteries to be blocked). Most margarine is made from vegetable fat and provides no dietary cholesterol. The more liquid the margarine, i.e., tub or liquid forms, the less hydrogenated it is and the less TFA it contains. American Heart Association
Is butter better than margarine?

22. What's cocoa butter and what's its health effect?
Cocoa butter is a natural, yellowish-white vegetable fat extracted from cocoa beans. Cocoa butter is solid at room temperature and very stable.  It is used to add smoothness and flavor in some foods, including chocolate.  Cocoa butter has significant amounts of saturated fats, but a main fatty acid is stearic acid which has been shown in studies not to raise blood cholesterol levels like other saturated fats.  However, foods containing cocoa butter can be high in calories as well as butterfat and sugar; therefore you should consider them as treats that you eat only once in a while.
What's cocoa butter and what's its health effect?

24. Fiber and Cholesterol Control
One way to improve cholesterol is by eating more soluble fiber. Soluble fiber is found in foods such as oats, dried beans and peas, barley and the fleshy parts of fruits and vegetables.
Soluble fiber dissolves in water and creates a thick/sticky substance that binds with cholesterol and allows it to pass out of the body.
Adding grams of soluble fiber each day can help lower LDL or 'bad' cholesterol by about 5%. To do this, eat 4 vegetable and 4 fruit servings each day, high fiber cereal at breakfast, and add beans to soups and salads.

25. Foods high in soluble fiber are eaten and go into the stomach
The liver picks up cholesterol from the blood, repackages it, and releases it into the small intestine
Cholesterol comes to the small intestine from the diet and the liver
Soluble fiber forms a gel which binds cholesterol in the small intestines and takes it out of the body

26. Oatmeal, Cheerios
Barley
Rye
Apples, oranges, grapefruit, bananas
Carrots, green beans, peas, beans, sweet potatoes

27. Food with 2-4 grams soluble fiber
½ cup kidney beans or lima beans
1 medium cooked artichoke
½ cup cooked brussels sprouts
1 serving psyllium husk (such as Metamucil®)
Food with 2-4 grams soluble fiber

28. Foods with 1-2 grams soluble fiber
½ cup chick peas, navy beans, pinto beans, black beans, lentils,
black eyed peas, soybeans
1 cup Cheerios®, Raisin Bran®, oat bran
½ cup green beans, carrots, onions, peas, broccoli
½ cup potato with skin, sweet potato, winter squash
6 baby carrots
½ cup raw jicama
1 avocado
3 prunes
3 figs
1 apple, peach, pear, orange
½ grapefruit
1 mango
Foods with 1-2 grams soluble fiber

29. Research has shown Omega-3 fatty acids may:
Improve heart health
Help prevent cancer
Lower high blood pressure
Improve blood sugar control
Maintain healthy eyes
Improve depression

30. Various benefits of Omega-3 fatty acids
Lowers triglycerides (a type of fat in the blood)
Raises HDL (good cholesterol)
Prevents blood clots
Various benefits of Omega-3 fatty acids

31. What are omega-3 fatty acids?
Omega-3 (n-3 polyunsaturated) fatty acids are essential fats that your body needs to function properly but does not make.  Humans must eat them through food, which means getting EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) from seafood, such as salmon, tuna, sardines, mackerel or shellfish, and ALA (alpha-linolenic acid) from sources such as walnuts, flaxseed, and canola and soybean oils.  Omega-3 fatty acids, particularly EPA and DHA, have been shown to benefit the heart of healthy people and those at high risk for — or who already have — cardiovascular disease.
What are omega-3 fatty acids?

32. How are these fats used in our bodies?
Omega-3 fatty acids are known as “essential” fatty acids because we can not make them on our own. Therefore, we need to eat them in our diet. The 3 types of Omega-3 fatty acids:
Eicosapentaenoic acid (EPA)
Docosahexaenoic acid (DHA)
Alpha linolenic acid (ALA)
It is easiest for our bodies to use EPA and DHA, because they exist in a form that can be used by our bodies. When we consume foods with ALA, our body must convert it to a usable form. Our bodies have an enzyme that carries out this process. Larger quantities of foods with ALA are needed to achieve the same health benefits of foods with EPA or DHA.
EPA and DHA are found in cold-water fish like tuna, salmon, and mackerel. ALA is found in dark green leafy vegetables, flaxseed oils, and vegetable oils such as canola. It is important to eat a variety of these foods to gain the many health benefits that Omega-3 fatty acids can offer.
How are these fats used in our bodies?

33. The American Heart Association recommends that people without documented coronary heart disease (CHD) eat a variety of fish, preferably oily fish (salmon, tuna, mackerel, herring and trout), at least twice a week.  People with documented CHD are advised to consume about one gram of EPA and DHA (eicosapentaenoic and docosahexaenoic acids, EPA and DHA) per day, preferably from oily fish, although EPA+DHA supplements could be considered in consultation with a physician.  People who have elevated triglycerides may need two to four grams of EPA and DHA per day provided as capsules under a physician’s care.
What are the American Heart Association recommendations for omega-3 fatty acids?

34. Eat Foods Containing Omega-3 Fatty Acids
Select oils that provide omega-3 fat, such as canola or soybean oil.
Add flaxseed oil, which is very high in omega-3 fat, to foods like salad dressings If you use flaxseed, be sure it is ground up. Your body cannot digest the beneficial fat if the seeds are left whole.
The walnut is the only common nut with alpha linolenic acid. Try walnut oil in salad dressings, too.
Eat two 4-ounce portions of fatty fish each week, like salmon, albacore tuna (in water, if canned), mackerel and sardines.
Some chickens are given feed that is high in omega-3s so their eggs will contain more as well. When buying eggs, check the package label. Remember all egg yolks contain cholesterol.
Fish oil supplements are acceptable for those with heart disease. The recommended dose is 1 gram of omega-3 fatty acids from a combination of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) per day.
Eat Foods Containing Omega-3 Fatty Acids

35. Best sources of Omega-3 fatty acids
Choose fish for the best sources of omega-3 fatty acids because they have the most usable form..
Salmon
Mackerel
Sardines
Herring
Whitefish
Albacore tuna
Best sources of Omega-3 fatty acids

36. Good sources of Omega-3 fatty acids
Flaxseed oil
Walnuts
Pumpkin seeds
Flaxseeds
Canola oil
Good sources of Omega-3 fatty acids

37. Should I take a fish oil supplement?
Fish intake has been associated with a lower risk of heart disease.  The American Heart Association recommends that consumers without documented coronary heart disease (CHD) eat a variety of fish, preferably oily fish (salmon, tuna, mackerel, herring and trout), at least twice a week.  Consuming fish oil supplements should only be considered by people with heart disease or high levels of triglycerides who consult with their physicians.  People with documented CHD are advised to consume about 1 gram per day of the fish oils EPA and DHA (eicosapentaenoic and docosahexaenoic acids), preferably from oily fish, although EPA+DHA supplements could be considered in consultation with their physicians.  People who have elevated triglycerides may need two to four grams of EPA and DHA per day provided as capsules under a physician’s care.  Very high intake (greater than three grams of EPA+DHA per day) could theoretically cause excessive bleeding in some people.
Should I take a fish oil supplement?

38. Some farmed fish can have higher levels of omega-3 fatty acid than wild fish, and vice versa.  The omega-3 fatty acid content of wild fish can vary by the temperature of their environment (i.e., higher during the summer than winter), while the omega-3 fatty acid content of farmed fish can vary based on what they are fed.  The American Heart Association recommends eating fish at least twice a week, especially species high in omega-3 fatty acid such as salmon, mackerel, herring and trout, regardless of whether they are wild or farmed.
Are there differences in omega-3 fatty acid content between wild fish and farm-raised fish?

39. Limit Fat, Especially Saturated and Trans Fat
Select lean cuts of beef and pork, especially cuts with “loin” or “round” in their name.
Remove all visible fat from meat before cooking. Take the skin off chicken or turkey before eating it.
Cut back on processed meats high in saturated fat, such as hot dogs, salami and bacon.
Bake, broil, roast, stew or stir-fry lean meats, fish or poultry.
Drain the fat off of cooked, ground meat.
Limit Fat, Especially Saturated and Trans Fat

40. When you make a stew, soup or gravy, refrigerate leftovers and skim off the fat with a spoon before reheating and serving.
Eat fish regularly. Try different ways of cooking like baking, broiling, grilling and poaching to add variety.
Eat plant foods as sources of protein, including soybeans, pinto beans, lentils and nuts.

41. Replace higher-fat cheeses with lower-fat options like reduced-fat feta and part-skim mozzarella.
Thicken sauces with evaporated non-fat milk instead of whole milk.
Move toward using lower-fat milk and yogurt. Start with 2 percent products, then move to 1 percent and finally to fat- free to adjust to the new taste.
Use liquid vegetables oils and soft margarine instead of stick margarine or shortening.

42. Limit consumption of cakes, cookies, crackers, pastries, pies, muffins, doughnuts and french fries. These foods tend to be the biggest sources of trans fats. Many food manufacturers have removed trans fats from their foods. Check ingredient lists on food packages and avoid products containing partially hydrogenated oils.
Use non-stick spray or a nonstick pan for cooking. Try broth as a substitute for oil when sautéing foods.
Use oils such as canola, olive and soybean in recipes and for sautéing.
Make salad dressings with olive, walnut or pecan oil.

43. Regulating your intake of trans fatty acids
The American Heart Association's Nutrition Committee strongly advises that healthy Americans over age 2 limit their intake of trans fat to less than 1 percent of total calories.
Based on current data, the American Heart Association recommends that consumers follow these tips:
Choose a diet rich in fruits, vegetables, whole-grain, high-fiber foods, and fat-free and low-fat dairy most often.
Keep total fat intake between 25 and 35 percent of calories, with most fats coming from sources of monounsaturated and polyunsaturated fats such as fish, nuts, seeds and vegetable oils most often.
Use naturally occurring, unhydrogenated vegetable oils such as canola, safflower, sunflower or olive oil most often.
Look for processed foods made with unhydrogenated oil rather than partially hydrogenated or hydrogenated vegetable oils or saturated fat.
Use soft margarine as a substitute for butter, and choose soft margarines (liquid or tub varieties) over harder stick forms. Look for ”0 g trans fat” on the Nutrition Facts label.
French fries, doughnuts, cookies, crackers, muffins, pies and cakes are examples of foods that are high in trans fat. Don't eat them often. 
Limit the saturated fat in your diet. If you don't eat a lot of saturated fat, you won't be consuming a lot of trans fat.
Limit commercially fried foods and baked goods made with shortening or partially hydrogenated vegetable oils. Not only are these foods very high in fat, but that fat is also likely to be very hydrogenated, meaning a lot of trans fat.
Limited fried fast food. Commercial shortening and deep-frying fats will continue to be made by hydrogenation and will contain saturated fat and trans fat.
Regulating your intake of trans fatty acids

44. What does the label mean?
Cholesterol free: Less than 2 milligrams of cholesterol and 2 grams (or less) of saturated fat
Low cholesterol: 20 or fewer milligrams of cholesterol and 2 grams or less of saturated fat
Reduced cholesterol: At least 25 percent less cholesterol than the regular product and 2 grams or less of saturated fat
What does the label mean?

45. What does the label mean?
Fat free: Less than 0.5 grams of fat
Low fat: 3 grams of fat or less
Reduced fat or less fat: At least 25 percent less fat than the regular product
Low in saturated fat: 1 gram of saturated fat or less, with not more than 15 percent of the calories coming from saturated fat
What does the label mean?

46. Lean: Less than 10 grams of fat, 4
Lean: Less than 10 grams of fat, 4.5 grams of saturated fat and 95 milligrams of cholesterol
Extra lean: Less than 5 grams of fat, 2 grams of saturated fat and 95 milligrams of cholesterol
Light (lite): At least one-third fewer calories or no more than half the fat of the regular product, or no more than half the sodium of the regular product

47. Calorie free: less than 5 calories per serving
Low calorie: 40 calories or less per serving
Reduced or less calories: At least 25% fewer calories per serving than the regular version
Light or lite: Half the fat or a third of the calories of the regular version

48. Adopt appropriate standardized portion sizes to meet calorie goals.
VHA HEALTHY DIET FOOD MODEL
Calories:
per day or
per meal
Adjusted appropriately based on average age and sex of population served.
Adopt appropriate standardized portion sizes to meet calorie goals.

49. Fat:
25-35 percent of calories
55-95 grams per day or
20-32 grams per meal
10-15 percent mono-unsaturated fats.
No or minimal trans fats and hydrogenated fats.
No margarines with hydrogenated fats.
6 teaspoons mono-unsaturated fats per day.
Serve nonfat or low fat (1 or 2 percent) milk.
No or minimal deep fat fried foods.
Select and serve lower fat cuts of meat, fish and poultry at all meals.

50. Cholesterol:
milligrams per day
Limit egg yolks to 3 to 4 times per week.
Limit organ meats

51. Sodium:
per day or
per meal
Limit pre-packaged high sodium foods.
Reduce salt in recipes, substitute herbs and spices.
Incorporate Dietary Approaches to Stop Hypertension (DASH) Diet principles.

52. Carbohydrate and Fiber:
25-30 grams fiber per day
5-10 grams fiber per meal
Incorporate whole grains, vegetables and fruits daily to meet the fiber goals.
Include fresh seasonal fruit and vegetables daily.
Include beans, lentils and nuts in recipes.
Offer nuts for snacks.

53. Protein:
grams per day
20-40 grams per meal
5 to 6 ounces meat, fish, poultry per day plus.
Two 8 ounce servings of nonfat or low fat milk per day.
Limit red meats (beef and pork) to 4 to 6 meals per week.
Include fish 2 times per week.
Include plant based vegetarian entrees.

54. Discretionary Calories:
calories per day
Limit sweetened desserts to once a day.

55. 20 years ago and today 20 years ago 8 ounce coffee
45 calories with whole milk and sugar
Today 16 ounce mocha coffee
100 or 350 calories with steamed
whole milk and mocha syrup

56. 20 years ago and today 20 years ago
2.4-ounce french fries, 210 calories
Today
6.9-ounce french fries,
610 or 650 calories

57. 20 years ago and today 20 years ago 2 medium pizza slices 500 calories
2 large pizza slices
850 or 1000 calories

58. Lifestyle Changes than can be made
A healthy lifestyle–following a healthy diet, maintaining a healthy weight, regular physical activity, quitting smoking and managing stress— can lower your risk for heart disease and may prevent current heart disease from worsening.
Lifestyle Changes than can be made