The Grand-Aides Foundation™

©2011-2012

Living with

Heart Disease

Following the Diet Your Team Prescribes

Everyone with a cardiac condition will receive recommendations from their

health care team about the type of diet they can follow to manage their

condition. The three common cardiac conditions are coronary artery

disease, heart failure and hypertension. While some people may have one

condition, it is not uncommon to have a combination of conditions.

Furthermore, although being over weight is not a cardiac condition in itself,

being over weight can cause problems for people with all three of these

conditions. This section will provide information that will educate you

about how to make healthy food selections no matter what those conditions

are.

Following Dietary Guidelines

Whether you are in good health or if you are living with a cardiac condition

or obesity, there are guidelines that everyone can follow. Even people at an

acceptable weight range and do not have a diagnosis of a cardiac condition

need to eat a healthy diet to avoid developing a preventable health problem.

It is important to stay within an acceptable range of calories, sodium (salt),

fat, and cholesterol. The next sections will go over how these 4 categories

fit within standard dietary guidelines for different conditions.

The 2010 Dietary Guidelines for Americans

The 2010 Dietary Guidelines for Americans is a recent recommendation for

people living in the United States. There is a range for how many calories,

sodium (salt), fat and cholesterol a person might eat and stay healthy. These

ranges are general and are based on the person’s age and activity level.

This table gives an overview of what a regular healthy diet may look like:

2010 Dietary Guidelines

for Americans

Make it an

Easy Average

Calories 1600-2400 2000

Sodium/Salt

(mg)

1500-2300 2000

Fat (%) 20-35% 20%

Cholesterol

(mg)

Less than 300 300

The Weight Loss Diet

Your health care team may recommend a diet that allows you to lose weight.

This type of diet will have you cut back on your calories and fat. If you are

over weight you may not realize that your diet includes more calories than

your body needs. These extra calories is stored as fat in the body. A food

diary can help identify how many calories you take in.

Many of the foods and drinks have “hidden calories”, a term used to refer to

the places fats and calories are not as obvious but still add up. We may eat

or drink a food item that is low in calories but we add something to it that is

higher in fat and calories.

Condiments are a type of hidden calorie. Condiments, like mayonnaise, and

cheddar cheese, both can make a sandwich for lunch tasty, but the

mayonnaise and cheese both add a lot of extra fat and calories. Substituting

a slice of lettuce and tomato may make it just as moist and tasty with hardly

any fat and calories.

Other places to find hidden calories are what is called “empty” calories.

These are items we consume that do not add nutritional value and still have a

high amount of calories. Examples of empty calories include; sweet soda

pop; the ingredients we add to coffee and tea such as cream and sugar; and

finally condiments like sour cream, steak sauce and salad dressing. Alcohol

in drinks, including beer, wine and other spirits, fit in the category of empty

calories.

Portion size is an important consideration when following a healthy diet.

Americans prepare and buy food items that are much larger than one portion

size. If you eat one can of soup, it may equal two portion sizes. A piece of

meat the size of the palm of your hand is one portion size. One half a cup of

spaghetti noodles and one small muffin are examples of one serving. Labels

will specifically tell you how big a serving size is for packaged and canned

items. When you go to a restaurant or buy food from a deli, you can keep in

mind the palm of your hand and ½ a cup as a rule you can follow.

Whenever you buy food at a restaurant, you can watch your calories by

buying the lunch size, which is usually a smaller portion, or plan to take

some food home in a box.

The Low Sodium/Salt Diet

People living with heart failure and hypertension (high blood pressure) are

often instructed by their health care team to keep the sodium in their diet to a

minimum. While sodium can be found naturally in some foods Americans

actually have more sodium in their food than is healthy. The concern about

too much sodium in the diet for people living with cardiac conditions is that

sodium makes the body hold on to fluids. When the body keeps the fluid the

heart has to work harder to push the fluid around. Higher levels of fluid also

make the blood pressure go up. Finally, the fluid can start to settle in areas

of the body and effect symptoms like shortness of breath and swelling.

Medications are one way of getting rid of extra fluid but the diet is an

important part of the routine to include also.

Most Americans get the sodium in their diet from processed foods. Sodium

in processed foods means it was added when the foods were prepared and

the sodium is one way to keep the food fresh. Sodium ends up in our foods

another way and that is when we add salt with a salt shaker when we cook or

at the kitchen table.

Sodium can be found in canned food, food that is packaged or just a major

ingredient. Labels on packaging will report how much sodium can be found

in the food you buy. Natural food that is not packaged is usually not a

problem and does not add up to too much sodium.

Buying food already prepared in a restaurant or at the Deli can have too

much sodium. The solution in these cases is to purchase food that is as fresh

as possible and ask to have it prepared without any extra salt seasoning. If

you have no choice about how the food is prepared, order a small serving

and supplement the rest of your meal with fresh fruits and vegetables.

The Low Cholesterol Diet

People with myocardial infarctions, or heart attacks, will have their blood

tested for how much cholesterol is found in their blood stream. The health

care team does this because they know that high levels of cholesterol can

lead to blockages in the heart of other parts of the body. Blockages in the

heart are what can lead to the myocardial infarction. Medication can reduce

the cholesterol in the blood but the health care team will also recommend

you follow a low cholesterol diet.

Food labels have a section that informs you about how much cholesterol is

in a food product. Foods from an animal origin, such as meat, seafood,

poultry, eggs and dairy products will all have cholesterol in them. Plant

foods, such as grains, vegetables and fruits do not have cholesterol.

Nutrition guidelines recommend Americans eat less than 300 mg of

cholesterol a day.

Reading Food Labels

Nutrition facts about the food you are purchasing are available. Food labels

help consumers evaluate and compare the nutritional content of food and

beverages. A person living with a cardiac condition that needs to loose

weight, or keep their cholesterol, and sodium intake to a minimum will find

these labels helpful. You will find how the product defines what a serving

is. It might be a number of items in the package or simply give a size, like 1

cup equals one serving.

Next you will be instructed about how many calories, fat, cholesterol and

sodium is in the product. By reading the label and focusing in on what your

team recommends you watch, you can make healthy diet choices. Most

grown fruits and vegetables do not have a label but you can usually think of

this group of foods as being pretty low in all categories and can be added to

your diet without much problem. It is always a good idea to talk to your

health care team to learn more about how you can include your favorite

foods. A general rule to remember is 2000 calories, 2000 mg of sodium,

20% fat and 300 mg cholesterol.

Traffic Light Approach to Nutrition

One way to pick good foods is to follow the Traffic Light Eating Plan. The

Traffic Light Eating Plan follows the Food Guide Pyramid. Each food group

can be split into groups based on the colors of the Traffic Light. There are

GREEN foods, YELLOW foods, and RED foods.

Each food is given a color based on its calories and the amount of fat,

calories and sodium it has. Let’s look at the colors of the Traffic Light.

GREEN means GO. GREEN foods are good for you. They have little or

no fat or sugar (1 or less grams of fat a serving). They have low energy

density. They help your body stay strong and healthy. Try to have as many

of these foods as you can! Foods in the GREEN group should be your first

choice when choosing what to eat. Most fruits and vegetables are GREEN

foods.

YELLOW means SLOW DOWN. These foods are of medium energy

density. Your body needs YELLOW foods to grow strong and healthy.

YELLOW foods have a lot of calories (up to 250 mg a serving), sodium (up

to 175 mg a serving). Be careful how many of these foods you eat.

YELLOW foods should be your second choice when choosing what to eat.

RED means STOP. All candies, chips, and sweets are RED foods. But,

RED foods are also found in ALL of the food groups. RED foods have a lot

of calories (greater than 175 mg a serving), sodium (greater than 250 mg a

serving) and a lot of fat (more than 5 grams of fat a serving). They do not

help your body to stay strong or healthy. Stop and think before you eat these

foods! It is okay to eat these foods once in a while but try not to eat them

too often. Try to eat no more than 2 servings of RED foods each day. It is

better to eat GREEN and YELLOW foods.

Tips on How to Adjust to a Healthier Diet

Fresh is best. As you learned from above, fresh foods will usually have the

lowest calories, fat, cholesterol and sodium. Whenever possible, it is good

to include a lot of these food choices. Unfortunately, foods that are canned

or packaged may have a lot of sodium so look for low sodium foods.

Interestingly, frozen meals can have a lot of sodium but frozen fruits and

vegetables usually do not. Vegetables that are canned may have more

sodium than what fits into your diet recommendations. One tip is that the

sodium can be removed by rinsing the vegetables in fresh running water

before heating them. This process removes a lot of the sodium. Other tips

for healthy cooking are:

• Fresh is best. Keep it as close to natural as possible.

• Fresh fruits and vegetables are ideal. Preservation methods such as canning

make foods high in sodium and sugar.

– Low-sodium varieties

– Foods packed in water instead of oil

GRANDGRAND--AIDES FOOD LABELSAIDES FOOD LABELS

PER SERVINGPER SERVING

All the rest! Sodium > 175 mg Sodium 125-175 mg

Calories > 250 Calories 150-250

– Frozen fruits and vegetables

• Prepared seasonings are typically loaded with sodium: These are not loaded

– Salt-free seasonings

– Fresh herbs & spices

– Citrus zest

– Lemon juice

Many people find processed foods or foods that are already prepared to be

very convenient. Frequently when we purchase these foods we are trading

convenience for the healthiest choices. It is possible to make good choices

at restaurants when you follow these tips:

– Order a garden salad with the dressing on the side.

– Be specific about what you want for your main course – meat or fish that is

grilled or broiled without added sauces that contain fat.

– Ask for tomato rather than cream sauce on your pasta.

– Ask for a baked potato instead of french fries. (Remember to go easy on the

butter and sour cream.)

– Keep desserts light and simple, such as fresh fruit, sorbet or frozen yogurt.

– If the serving is large, eat half and ask to take the rest home.

Tips for choosing Low Salt (Sodium) Foods

When eating in a restaurant, choose restaurants that serve fresh foods

Visit the salad bar – order salad dressings on the side, and dip your

fork into the dressing, skip the croutons, olives, bacon bits

Choose foods without breading – breading contains salt

Choose foods without sauces or ask for sauces on the side

Limit the use of condiments – ketchup, steak sauces

Be cautious when ordering for that are “good for your heart”, they

often contain high amounts of salt instead of fat

Hidden Sources of Salt (Sodium)

Some antibiotics contain sodium – ask your doctor and pharmacist

about your medicines

Some over the counter medicines – check the labels carefully

Look for the word “soda” on food and beverage labels. Some

common names for salt or sodium are:

Sodium Chloride –NACL

Sodium Bicarbonate

Sodium Carbonate

Sodium Alginate

Sodium Sulfate

Sodium Caseinate

Sodium Benzoate

Baking Soda

SODIUM GUIDELINES: FOODS TO CHOOSE

Protein - choose 2-3 servings per day

2-3 ounces of fresh or frozen fish, shellfish, meat (beef, veal, lamb,

pork) or poultry

1/2 cup cooked dried beans or peas

1/2 cup low-sodium canned fish (such as salmon or tuna)

1 low-sodium frozen dinner (less than 600mg sodium per meal) -

Limit to one per day

1 egg (no more than 3 whole eggs per week)

Dairy products - choose 2 or more servings/day

1-1/2 ounces of low-sodium cheese

1 cup milk (non-fat or 1% recommended)

1/2 cup low-sodium cottage cheese

1 cup soy milk

Vegetables and fruits - choose 5 or more servings/day

1/2 cup fresh whole, chopped, cooked, frozen or canned fruit

1/2 cup chopped, cooked, frozen or no-salt added canned vegetables

1/2 cup low-sodium tomato juice or V-8 juice

1/2 cup low-sodium tomato sauce

1 cup raw leafy vegetables

Bread and grains - choose 6 or more servings/day

Low-sodium breads, rolls, bagels and cereals (1 serving = 1 slice

bread, 1 small roll, 1/2 bagel, 1/2 English muffin or a 4-inch pita

1/2 cup pasta (noodles, spaghetti, macaroni)

1/2 cup rice

Low-sodium crackers (read label for serving size)

Sweets and snacks (include sparingly)

1 ounce unsalted nuts

1/2 cup low-sodium pretzels or chips

3 cups popped low-sodium popcorn

3 fig bars or gingersnaps

1 slice angel food cake

1 tbsp. jelly or honey

1 cup sherbet, sorbet or Italian ice; 1 popsicle

8-10 jelly beans; 3 pieces hard candy

Fats, oils and condiments (use sparingly)

Olive and canola oils

Low-sodium butter and margarine

Low-sodium soups

Low-sodium salad dressing

Homemade gravy without salt

Low-sodium broth or bouillon

Low-sodium catsup

Low-sodium mustard

Low-sodium sauce mixes

Other seasonings (can use freely)

Lemon juice

Vinegar

Herbs and spices without salt

SAMPLE MENU

Breakfast

Fresh fruit

Low sodium cereal (hot or cold)

Milk

Low sodium wheat bread

Reduced sodium margarine or peanut butter

Lunch

Lean roast turkey on whole wheat bread with low sodium mustard

Raw carrot sticks

Applesauce

Unsalted pretzels

Dinner

Grilled Chicken

Boiled potatoes

Steamed fresh vegetables

Tossed salad and low sodium dressing

Low sodium roll with low sodium margarine

Fresh melon

Angel food cake

Snack

Fresh fruit

Note: For a diet in which you consume 2,000 mg of sodium per

day, a sample plan might involve eating 500 mg at breakfast,

150 mg for snacks twice daily, 600 mg for lunch, and 600 mg

for dinner.

SEASONING RECIPES

Directions: Combine all ingredients in a small bowl and blend well. Spoon

into shaker and store in a cool, dark place.

Spicy blend

2 tbsp. dried savory, crumbled

1/4 tsp. freshly ground white pepper

1 tbsp. dry mustard

1/4 tsp. ground cumin

2-1/2 tsp. onion powder

1/2 tsp. garlic powder

1/4 tsp. curry powder

Salt less surprise

2 tsp. garlic powder

1 tsp. basil

1 tsp. oregano

1 tsp. powdered lemon rind or dehydrated lemon juice

Spicy seasoning

1 tsp. cloves

1 tsp. pepper

2 tsp. paprika

1 tsp. coriander seed (crushed)

1 tbsp. rosemary

Herb seasoning

2 tbsp. dried dill weed or basil leaves, crumbled

1 tsp. celery seed

2 tbsp. onion powder

1/4 tsp. (pinch) dried oregano leaves, crumbled freshly ground pepper

The benefits of a low-sodium diet include decreasing the symptoms of

cardiac disease and weight loss. A secondary (but just as important) benefit

is that these foods tend to be healthier, and can help lower cholesterol and

eat fewer carbohydrates overall.

Planning daily menus before grocery shopping can help you adhere to a low

salt (sodium) diet. Take the shopping list with you to the grocery store and

only buy the items on the list. For four or five days, keep a daily log of

which foods and beverages you eat and drink, and how much salt (sodium)

is in the foods and beverages. This will help you know how much sodium

you are consuming on a daily basis. You can use the Daily Food and Salt

Log found in your Daily Health Journal. If you do not know how much salt

is in a food or beverage, write it down anyway. Your Grand-Aide can help

you determine the salt content.

Add up the amount of salt consumed each day and see if you are meeting the

goals of your treatment plan, or if you need to trim more salt from your diet.

If you do, look at the foods you ate, how much salt was in each food or

beverage, and then determine other choices that would be lower in salt

content.

Liquids in Your Diet

Your treatment plan may include limiting the amount of liquids you drink in

a day. Too much fluid in your body can make it harder for your already

weakened heart to pump. Your doctor may prescribe a diuretic to help get

rid of excess fluid. Your doctor may also suggest that you limit liquids so

that your body can get rid of the extra water and salt.

If your doctor has limited the amount of fluid you can drink per day, monitor

your fluid intake daily, by recording fluids on the Fluid Intake Record. Your

Grand-Aide will help you complete this form. Much like the low salt diet,

for some people reducing the amount of liquids a day can reduce

complications and hospitalizations.

All foods that melt (such as ice cream, gelatin, and frozen ice treats) and

foods that contain a lot of liquid (such as soup) are considered liquids. Be

sure to count these in your daily intake.

Space your liquids throughout the day. Then you won't be tempted to drink

more than the amount you are allowed.

To relieve thirst without taking in extra water, try chewing gum, sucking on

hard candy (sugarless if you are diabetic), or rinsing your mouth with water

and spitting it out.

Alcoholic Beverages and Cardiac Disease

Alcohol can damage the cells of the heart and make it harder for your heart

to pump blood. With heart failure your heart, your heart is already pumping

less effectively. So, it is recommended that you not drink alcohol at all or if

you do, to drink sparingly.

To drink sparingly means to drink less than 2-3 standard drinks per week.

One standard drink is:

One can of beer – 12 ounces

One glass of wine – 4 ounces

One shot glass of spirits -1.5 ounces