1. "Red Wine and Dark Chocolate" February 6, 2014 Sharon Smalling, MPH, RD, LD Clinical Dietitian Specialist Memorial Hermann Hospital - Texas Medical Center

2. HOT HEART HEALTH: EMERGING TOPICS!

3. This paper outlines the best diet pattern for preventing and reducing cardiovascular risk Reference: Eckel, Robert, et al. 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk. Circulation. Published online November 12, 2013; accessed online November 13, 2013. http://circ.ahajournals.org/content/early/2013/11/11/01.cir.0000437740.48606.d1 Let the Guidelines Begin! The 2013 AHA/ACC Lifestyle Guidelines are Released

4. Consume the DASH dietary pattern for positive effects on cardiovascular health Lower sodium intake Aim for saturated fat <6% of total calories Avoid trans fats from processed foods Today’s topics

5. Consume the DASH dietary pattern for positive effects on cardiovascular health Lower sodium intake Aim for saturated fat <6% of total calories Avoid trans fats from processed foods Today’s topics

6. Dash to get on the DASH diet! Although the DASH and Mediterranean diets are similar, the DASH diet was voted #1 by a distinguished group of nutrition experts Szokan, Nancy. The best diets according to US News and World Report; The Washington Post; Jan 6, 2014; accessed online Jan 7, 2014. http://www.washingtonpost.com/national/health-science/the-best-diets- according-to-us-news-and-world-report/2014/01/06/4dc78d12-7262-11e3- 9389-09ef9944065e_story.html

7. Basic idea of DASH, as described by the panel of experts… “Emphasize the foods you’ve always been told to eat (fruits, veggies, whole grains, lean protein, and low-fat dairy), while shunning those we’ve grown to love (calorie- and fat- laden sweets and red meat). Top it all off by cutting back on salt, and voilà!”

8. What is the DASH Diet? The Dietary Approaches to Stop Hypertension Diet is a well balanced, nutritious eating pattern that incorporates a variety of foods for cardiovascular health Here we will look at the servings given for a 2000 calorie diet To lose weight, eat one fewer servings of grains, meat, fruit, and fat, and limit sweets/added sugars to 3 servings per week What is the DASH Eating Plan? National Heart, Lung, and Blood Institute; July 2, 2012; accessed online Jan 7, 2014. http://www.nhlbi.nih.gov/health/health-topics/topics/dash/

9. Whole Grains Choose 6-8 servings of grains, especially whole grains – Whole wheat bread, whole grain pasta, brown rice, oats, crackers, and cereal What’s a serving? – 1 slice bread – ½ cup pasta, rice, or hot cereal – 1 oz crackers or dry cereal (about ¾ cup)

10. Fruits Choose 4 servings of fruit – in any form – Fresh fruit – Unsweetened frozen, canned, or dried fruit – Fruit juice Choose whole fruit more often than juice for fewer calories and sugar, and more fiber What’s a serving? – 1 medium fruit – ½ cup cut-up fresh, canned, or frozen fruit – ¼ cup dried fruit – ½ cup fruit juice

11. Vegetables Choose 4 servings of vegetables in any form – Fresh, frozen, canned, or dried vegetables Check the label for sodium content – Vegetable juice Like fruit, choose whole vegetables more often than juice for fewer calories, sodium and sugar, and more fiber What’s a serving? – 1 cup raw leafy vegetables – ½ cup cut-up raw or cooked vegetables – ½ cup vegetable juice

12. Low Fat or Fat-Free Dairy Choose 3 servings of low fat or fat-free dairy foods – Low fat (1% or 2%) milk, skim milk, or dairy-free milk – Light or fat-free yogurt – Reduced-fat cheese, cheese made with 2% milk What’s a serving? – 1 cup milk – 1 cup yogurt – 1 ½ oz cheese

13. Meat, Poultry, and Fish Choose 6 ounces or less of lean meat, poultry, and fish – Broiled pork chop/trimmed steak – Baked skinless chicken or turkey breast – Grilled fish or tuna packed in water – Egg What’s a serving? – 3 ounces meat, poultry, or fish – 1 egg (limit yolk to 4 per week)

14. Nuts, Seeds, and Dried Beans Choose nuts, seeds, and dried beans/peas 4-5 times a week – Almonds, walnuts, pistachios, pecans, peanuts – Pumpkin seeds, sunflower seeds, chia seeds – Black beans, chickpeas, kidney beans What’s a serving? – ⅓ cup nuts – 2 Tbsp seeds – ½ cup beans/peas

15. Heart-healthy Fats & Oils Choose 2-3 servings of heart-healthy fats and oils to cook and flavor food What’s a serving? – 1 tsp vegetable oil – 1 tsp tub spread/margarine – 2 Tbsp light salad dressing

16. Enjoy SPARINGLY… What about the other stuff?

17. So…what should I eat for breakfast?

18. Breakfast 1 cup quick-cooking oatmeal – 1 tsp cinnamon – ½ tsp Splenda® brown sugar blend – ¼ cup raisins – ⅓ cup chopped walnuts 1 cup fat-free milk

19. Lunch Turkey sandwich: – 2 slices 100% whole wheat bread – 3 oz low sodium turkey lunchmeat – green leaf lettuce/tomato & cucumber slices – 1 ½ oz low fat Swiss cheese – 1 Tbsp light mayonnaise 1 cup grapes

20. Snack Morning snack: – ½ cup baby carrots (approximately 5) – 16 almond crackers Afternoon snack – 5.3 oz container non-fat Greek yogurt – ½ cup unsweetened peaches

21. Dinner Spaghetti – 1 cup whole grain spaghetti noodles with ½ cup “heart healthy” spaghetti sauce – 3 oz lean ground beef (90/10) – 2 Tbsp grated Parmesan cheese, reduced-fat Tossed salad – 1 ½ cup lettuce & assorted vegetables – 2 Tbsp reduced-fat French dressing ½ cup strawberries

22. Consume the DASH dietary pattern for positive effects on cardiovascular health Lower sodium intake Aim for saturated fat <6% of total calories Avoid trans fats from processed foods Today’s topics

23. Consume no more than 2,400 mg per day For those with high blood pressure, aim for 1,500 mg per day Reducing sodium intake by 1,000 mg daily will have positive effects on blood pressure, even if intake is still above 1,500 or 2,400 mg Different Strategies, Same Goal: Lower Sodium

24. Reducing your sodium intake by 1,000 mg doesn’t have to take a lot of work, just make some easy substitutions! Reducing Sodium See if you can pick out the winner…

25. versus 1 packet of apple cinnamon flavored instant oatmeal Quick-cooking oats with raisins, walnuts, cinnamon, and brown sugar blend Round 1: Breakfast 186 mg saved

26. versus Sandwich with 2 ounces of ham Sandwich with 2 ounces pre- made tuna salad from a pouch Round 2: Lunch 347 mg saved

27. versus Cheddar cheese and 10 saltine crackers Reduced-fat cheese and 16 almond crackers Round 3: Snack 220 mg saved

28. versus Round 4: Dinner 1 Tablespoon of your own spice blend (garlic, paprika, pepper, etc.) ¼ teaspoon Creole seasoning 307 mg saved

29. Go for the and save 1000 mg! Apple cinnamon flavored instant oatmeal Ham sandwich Cheese and crackers Creole-seasoned chicken Quick-cooking oats with cinnamon, raisins, walnuts, and brown sugar blend Sandwich with tuna salad from a pouch Low fat cheese and lower sodium crackers DIY-seasoned chicken 1,060 mg saved

30. Consume the DASH dietary pattern for positive effects on cardiovascular health Lower sodium intake Aim for saturated fat <6% of total calories Avoid trans fats from processed foods Today’s topics

31. Reduce percent of calories from saturated fat to <6% Saturated Fat In a 2000 calorie diet, that’s 13 grams total We talk a lot about limiting foods like high fat meats, whole milk and cheese, and butter Where are the rest of the saturated fats we eat?

32. Here are some other sources of saturated fat to watch out for: Saturated Fat Microwave popcorn Some peanut butters/Nutella Baked goods Non-dairy creamers Ramen noodles Granola bars Chips – even bagel crisps and veggie chips

33. Here are some other sources of saturated fat to watch out for: Saturated Fat Microwave popcorn 3 c = 2.3gm Some peanut butters/Nutella 2T =3+ gm Baked goods 2.5 gm Non-dairy creamers 1T = 2 gm Ramen noodles 1 pkt = 6.6 gm Granola bars choc chip = 3.2 gm Chips – bagel crisps 6 = 1.9 gm veggie chips 1 oz =.5 gm

34. Consume the DASH dietary pattern for positive effects on cardiovascular health Lower sodium intake Aim for saturated fat <6% of total calories Avoid trans fats from processed foods Today’s topics

35. 2005 Guideline: keep trans fat consumption as low as possible 2010 Guideline: avoid consumption from processed foods; limit to <.5% of total calories consumed from natural sources; in a 2000 calorie diet this equals 1-2 gm per day AHA/ACC Lifestyle Guideline: reduce consumption of trans fat in the diet Sources: – Natural: milk, beef, goat, deer, buffalo Reducing intake of saturated fat from meat and dairy will result in lower trans fat intake – Commercial: fried and baked foods; stick margarines; foods containing partially hydrogenated vegetable oils NOTE: A nutrition label may state “0” gm trans fat as long as a serving contains <.5gm. Trans Fat

36. “More than ever it’s time to embrace the idea that eating basic healthy foods throughout the day is key to a strong immune system, long-term health, and energy to live the life you want to live.” Smart Bytes® Nutrition Blog www.karencollins.com/smartbytes Our Quote for the Night…

37. heart.memorialhermann.org/heart-healthy-diets