1. Eating for a Healthy Heart Sherri Kramp, RDN, CD Clinical Dietitian Nutrition Therapy Department

2. In a 2012 study, 52% of Americans (that were polled) believed doing their taxes was easier than figuring out how to eat healthy. Source: DoSomething.org

3. Healthy Diet Goals The amount of food you need per day depends on your personal calorie needs and health status. Grains: 6 to 8 servings, with at least half as whole grains. Fruits/Vegetables: 4 to 5 cups, in a variety of colors and types. Fat-Free or Low-Fat Dairy: 2 to 3 cups Meat: 3 to 6 oz. (cooked) of lean meats, poultry or seafood Fish (preferably oily fish): At least two 3.5-ounce servings a week Processed meats: No more than 2 servings a week

4. Fats/Oils: 2 to 3 servings per day. Nuts/Seeds/Legumes: 3 to 5 servings per week. Added Sugars: For most women that is about 100 calories (~6 teaspoons) For most men that is about 150 calories (~9 teaspoons) Sodium: Aim to eat less than 1,500 mg of sodium per day.

5. Polyunsaturated Fat Monounsaturated Fat Omega 3 Fatty Acid Effects on Cholesterol Levels Lowers total cholesterol Lowers LDL Lowers HDL Lowers total cholesterol Lowers LDL Raises HDL* Lowers triglycerides Lowers total cholesterol Sourcessafflower oil, corn oil, soybean oil, cottonseed oil, and sesame oil. olive oil, peanut oil, and canola oil. Salmon, albacore tuna, halibut, oysters, sardines, walnuts, and flaxseed. Also added to foods such as peanut butter, eggs, tub margarine, and juice. *Monounsaturated fats and polyunsaturated fats may only be beneficial when they replace saturated fatty acids in the diet. Simply adding them to the diet may increase overall dietary fat. How “Good” Fats Affect Cholesterol Levels

6. Saturated Fat Trans Fat Partially Hydrogenated Oil Effects on Cholesterol Levels Raises total cholesterol Raises LDL Raises total cholesterol Raises LDL Lowers HDL Raises total cholesterol Raises LDL Lowers HDL SourcesMostly from animals: fat in meat, butter, lard, cheese, whole milk, cream. Some from plants: coconut oil, palm oil, cocoa butter, hydrogenated vegetable oil. Pre- packaged and processed food items. Liquid fats converted to a solid form via an industrial process that adds hydrogen to an oil. Listed as an ingredient. How “Bad” Fats Affect Cholesterol Levels

7. Answer is B. Quiz Question Which types of food raise your total cholesterol levels? A. Foods with monounsaturated fat. B. Foods with partially hydrogenated oil, saturated, and trans fat. C. Foods with omega 3 fatty acids.

8. Sodium Found primarily in processed foods or added in cooking or at the table. Does naturally occur as well. The New Recommendations: Limit daily sodium intake to 1,500 milligrams per day (~1/4 teaspoon is 600 mg). Choose foods with <300 mg per serving size.

9. Fiber It’s not always about cutting things back when changing to a heart healthy diet. Fiber helps reduce cholesterol and may lower risk of heart disease, as well as add to your feeling of fullness and help you eat less. Need 20-30 grams per day. Fruits and vegetables Whole grains Flax, Hemp and Chia Seeds

10. Reading Food Nutrition Labels Trans Fat Should read zero on the food label. Saturated Fat Should read 2 grams or less per serving size on the food label.

11. Shopping for Fruits and Vegetables Buy plenty of fresh/frozen/canned fruits and vegetables. Stock up on raw vegetables for snacks. Choose whole fruit over fruit juice. Be aware that grapefruit, grapefruit juice, pomegranate and pomegranate juice may interact with cholesterol- lowering meds

12. Shopping for Milk, Cheese, Butter and Eggs Select fat-free (skim), 1%, or ½% milk. Use reduced fat (made with 2% milk) cheese. Limit egg yolks to 3-4 per week. Choose soft margarine with 0 grams of trans fat. Save butter, cream, and ice cream for special occasions.

13. Shopping for Meat, Poultry, Fish and Nuts Buy and prepare more fish, such as wild caught salmon, albacore tuna, and halibut. Avoid fried meats. Choose “loin” and “round” cuts of pork and red meat. Choose light meat (breasts) rather than dark meat (thighs) when purchasing poultry. Buy skinless poultry or remove the skin yourself. Use more meat substitutes, such as dried beans, peas, lentils or tofu. Pick up nuts and seeds but remember they tend to be high in calories so eat them in moderation.

14. Shopping for Bread and Baked Goods Choose whole grains such as whole wheat, oats, whole rye, corn and buckwheat (first ingredient should be a whole grain). Remember that store-baked goods are made with egg yolks, saturated fats and trans fats. Make your own baked goods with polyunsaturated or monounsaturated oils, skim milk and egg whites or look for goods baked with the above. Choose whole grain breads over high fat breakfast breads such as apple fritter bread.

15. Shopping for Oils, Dressings and Shortenings Choose canola oil, corn oil, olive oil, safflower oil, sesame oil, soybean oil and sunflower oil as they are lowest in saturated and trans fats. Avoid palm oil, palm kernel oil, coconut oil and cocoa butter as they are high in saturated fats despite being vegetable oils. Use non-stick pans or cooking sprays. Choose reduced-fat, low-fat or fat-free salad dressings for use as marinades or dips or to use with salads.

16. Heart-Check Mark The American Heart Association's heart check mark can allow you to quickly and easily spot heart-healthy foods in the supermarket. This mark signifies that the food meets the American Heart Association's criteria for saturated fat for healthy people over age two.

17. Dining Out Try to avoid restaurants that offer all-you-can-eat buffets or specials. If you're familiar with a restaurant’s menu, decide what you're going to order before you go. If the nutrition information is available online use it to choose before going. Look for symbols for heart healthy, low fat or low sodium.

18. Deciphering the Menu Words that signify higher in fat Fried Au gratin Crispy Scalloped Pan-fried Sautéed Creamed Stuffed Breaded Cheese Alfredo Words that signify lower in fat Steamed Poached Broiled Baked Grilled Roasted Blackened

19. Talking with Your Server How is the food prepared or what ingredients does it contain? What kinds of oils are the foods prepared with? (Look for olive, canola, peanut, corn, and sunflower oils) Can the items be prepared to your needs? (Toasted vs Grilled) Are smaller portions available? Ask for half of the entrée to be put in a go-to box right away. Can I substitute the French fries for applesauce?

20. Avoid before-the-meal “extras”. Ask for butter, cream cheese, dressings, sauces and gravies to be served on the side. Avoid high-sodium foods. Key words are pickled, cocktail sauce, smoked, broth, au jus, soy, and teriyaki. Avoid dishes with cheese, sour cream and mayonnaise. At salad bars, choose fresh greens and vegetables, fruits, beans and low-fat or fat-free dressings. Avoid cheeses, creamy salads, and fruit salads with whipped cream. Order just water to drink. Ordering Your Meal

21. Eating Fast Food Pass on “value-size” or “super-size" items. Choose a side that is not deep-fried. Avoid ordering sandwiches with double meat. Avoid adding bacon, mayo or “special” sauces. Top with your choice of vegetables and low-fat condiments. Try asking for a wheat or whole-grain bun if available. Order “no added salt” items. Drink water, diet soda or skim milk.

22. Answer is C Final Quiz Question Choose foods with _____ mg mg of sodium per serving size. A. <500 B. <400 C. <300

23. Recommended Resources Book Recommendations: American Dietetic Association Complete Food and Nutrition Guide by Roberta Larson Duyff "The Heart-Brain Diet: Essential Nutrition for Healthy Longevity" by the editors of the Tufts Health and Nutrition Letter. “The Biggest Loser Complete Calorie Counter” by Cheryl Forberg, RD Cookbooks: Healthy Recipes Kids Love by the American Heart Association The New American Heart Association Cookbook, Seventh Edition by the American Heart Association Quick and Healthy Low Fat-Carb Conscious Cooking by Brenda J. Ponichtera, RD Websites: www.iuhealth.org/goshen/nutrition www.heart.org www.calorieking.com Free Recipes: http://www.choosemyplate.gov/healthy-eating-tips/sample-menus-recipes.html http://www.fnsusda.gov/fncs-recipe-box

24. Academy of Nutrition and Dietetics’ Nutrition Care Manual, 2014 Academy of Nutrition and Dietetics Association Evidence Analysis Library American Heart Association NHLBI Health Information Center Tufts University Health & Nutrition Letter Sources

25. Sherri Kramp, RDN, CD Clinical Dietitian Nutrition Therapy Department 574-364-2679