Eating for a Healthy Heart

CARDIAC REHABILITATION

NEMO This is a consensus document from Dietitian/ Nutritionists from the Nutrition Education Materials Online, "NEMO” Team.

Disclaimer: http://www.health.qld.gov.au/masters/copyright.asp

Date: August 2015 Review date: August 2017

The risk factors for heart disease

The heart healthy diet The importance of fats The core food groups Strategies to reduce salt intake

Modifying Recipes

Eating Out and Takeaways

Reading Food Labels

Food Myths

Topics for Discussion

Risk factors you can change

Being overweight

High blood pressure

High blood cholesterol

Smoking

Physical Inactivity

Stress caused by depression, social isolation, lack of social support

Risk Factors for Heart Disease

Risk factors you can’t change

Age Male/Female Family History Socio-economics

Risk Factors for Heart Disease

Other Risk Factors for Heart Disease Diabetes Management:

If you have diabetes keep blood sugar levels in the normal range

Alcohol Intake: Go easy on alcohol

Healthy Weight Range

World Health Organisation (2000); National Heart Foundation (2007)

Health is at

risk

Health is at HIGH risk

Men >94cm (37in)

>102cm (40in)

Women >80cm (31½ in)

>88cm (34½ in)

Waist Circumference

Light Beer Heavy Beer Spirits

425mL 2.8% 285mL

4.8%

100mL 11.5%

60mL 21%

30mL 40%

Go easy on Alcohol

Each of these is one standard drink = 10 grams of pure alcohol

110

No more than two standard drinks on any day More than four standard drinks on a single occasion increases risk of alcohol related injury

Wine Fortified

Wine

What is dietary fat?

Dietary fat

Saturated Unsaturated

Trans Polyunsaturated Monounsaturated

n-6 PUFA n-3 PUFA

Plant n-3 Marine n-3

Dietary cholesterol

Sterols

Phytosterols

LDL (‘BAD’) Cholesterol Can block blood vessels

HDL (‘Good’) Cholesterol

Protects against heart disease

Triglycerides High levels may ↑ risk of heart disease

Dietary cholesterol can increase blood cholesterol but not as much as saturated fat

What is Cholesterol?

Saturated fat

Raise blood cholesterol Should be avoided

Fatty meats, pies, pastries Fried foods, takeaway foods Full fat dairy products, butter, cream

Types of Fats in Foods

Usually found in animal products

Types of Fats in Foods

Trans fat Acts like saturated (“bad”) fat in the body Formed during the hydrogenation process Reducing the amount of saturated fat in your diet

will reduce the amount of Trans fats as well

‘In Australia hydrogenation is no longer used,

margarines and polyunsaturated oils in the supermarket contain negligible amounts of trans fats.’

The Heart Foundation 2013

Monounsaturated Fat Neutral effect on cholesterol

Polyunsaturated Fat Helps reduce “bad” LDL cholesterol

Most of the fat you eat should be

Types of Fats in Foods Unsaturated Fats

Vegetable Oils (Olive, canola, peanut, sunflower, safflower, corn, soybean)

Polyunsaturated margarine

Nuts & Seeds

Avocado

Fish (salmon, tuna, mackerel, sardines)

Eat moderate amounts of Mono & Polyunsaturated Fats

Types of Fats in Foods Unsaturated Fats

The Heart Foundation is urging all Australians to eat two-three serves of fish, including oily fish (canned sardines, atlantic salmon, canned tuna, frozen and fresh) each week to reduce their risk of heart disease

Omega 3 (Fish)

Types of Fats in Foods

Omega 3 (Plant) • nuts and seeds , particularly walnuts, flaxseeds (linseeds) • oils or spreads made from soybeans and canola.

Types of Fats in Foods Plant Sterols (Phytosterols)

• Plant sterols are a naturally occurring part of all plants.

• Plant sterol enriched foods are foods which have had plant sterols added to them.

• Consume 2–3 g per day from margarine, breakfast cereal, reduced fat yoghurt or reduced fat milk

• In particular, choose at least one daily serve of fruit or vegetable high in beta-carotene such as:

carrots, pumpkin, broccoli, spinach, squash, apricots, mangoes and rockmelon.

Choose foods that are grilled, baked or steamed, not fried

Limit fatty meats like

sausages and delicatessen meats eg. salami

Trim the Fat

Margarine or avocado not butter

Oils for cooking

Salad dressings and mayonnaise (97% fat free)

Nuts as snacks or on breakfast cereal

Fish at least twice a week

Ways to include heart healthy fats

High in Antioxidants Dietary fibre

Moderate in good fats

Low in Saturated fat Trans fat Added sugars Salt

Healthy Heart Diet

Choose:

Multigrain or wholegrain bread High fibre breakfast cereal Rice eg. brown rice Pasta eg. whole meal and whole grain

pasta

What is a Healthy Diet?

Choose vegetables: 5 serves a day

One serve = ½ cup of cooked vegetables 1 cup salad vegetables ½ cup of cooked legumes or lentils ½ medium potato

Choose a variety of different colours everyday!

What is a Healthy Diet?

Choose Fruit 2 pieces per day One citrus, berry or tropical fruit plus one other

One serve (150g) = 1 medium piece fruit eg apple 2 small sized fruit eg apricot 1 cup fruit salad 1 cup tinned fruit 30 grams dried fruit e.g 1 ½ tbsp sultanas ½ cup natural juice

Choose whole fruit for extra fibre!

What is a Healthy Diet?

Include salad vegetables on sandwiches or rolls

Have fresh or tinned fruit as snacks

Add fruit to breakfast cereal

Make plant based foods the main part of each meal

Try a vegetarian meal once or twice a week - eg. use chickpeas or kidney beans

How to eat more fruit and vegetables

Eat moderate amounts of: Fish Lean red meat Lean chicken Legumes Nuts Eggs

One serve = • 65-80g lean meat cooked (palm size) •100g cooked or one small can of fish •1 cup(150g) cooked legumes/beans • 30g (small handful) nuts •2 eggs

What is a healthy diet?

Daily Intake: 2-4 serves per day Low fat milk or soy milk Low fat yoghurt Reduced fat cheese

One serve = 1 cup of milk (250ml) 200g tub of yoghurt 40g of hard cheese ½ cup ricotta or cottage cheese

Try to limit cheese and ice-cream to twice a week

What is a healthy diet?

Fruit Low fat yoghurt Fruit bread Nuts Air popped corn Wholegrain crackers Vegetable pieces with hummus

Heart Healthy Snacks

Eat more fresh and unprocessed foods!

Salt

Occurs naturally

Added during cooking or at the table

Supermarket & takeaway foods

• Choose fresh foods or foods labelled ‘no added salt’, ‘low salt’ and ‘salt reduced’

• Include plenty of fruit and vegetables

• Use herbs, spices, garlic, lemon etc.

• Avoid adding salt to cooking and at the table

• Avoid highly salted foods

• Choose Heart Foundation tick products

Tips to decrease salt intake

NUTRITION INFORMATION SERVINGS PER PACKAGE: 6 SERVING SIZE: 33g (1 BAR) PER 33g

serve PER 100g

ENERGY PROTEIN

532kJ 1.9g

1592kJ 5.8g

FAT, total -saturated

A good choice has: Less than 3g saturated fat per 100g food

Less than 10g of total fat per 100 g food

For salt (sodium):

Less than 120mg sodium per 100g is best

Less than 400mg sodium per 100g as a guide for

processed foods

Label reading

Label reading – Health Star Rating

What is the Health Star Rating? A guide to assist consumers to make healthier food

choices when buying packaged foods.

What do the Stars Mean? The stars rating is from ranges from ½ to 5. The more stars, the more nutritious the food product.

How are the stars calculated? It is based on the food products components such as

energy, saturated fat, total sugars, sodium, protein, dietary fibre, fruit, vegetable, nut and legume content.

Limit takeaways to once per week

Healthier options Try to avoid Sushi or sashimi Tomato based curries (ie. Vindaloo, tandoori or madras) Thin and crispy base pizza with vegetables and lean meat BBQ chicken without skin and salad Grilled steak or chicken burger with salad Grilled fish, baked potato and salad Pasta with tomato based sauce (ie. bolognaise) and bruschetta

×Pastries and pies ×Curries made with coconut cream (ie. Korma, butter chicken) with naan bread ×Thick based pizza with cheese and processed meats (ie. ham, salami, bacon) ×Hamburgers with the lot and chips ×Deep fried chicken and chips ×Fried, battered or crumbed fish and hot chips ×Pasta in cream based sauces (ie. Carbonara) and garlic bread

Takeaway foods

¼ meat, fish,

chicken

¼ potato, rice,

pasta

½ vegetables

Heart Healthy Choice

“Coconut oil is healthy, and should be used in cooking wherever possible.”

False! Coconut oil is made up of 85-90%

saturated fat. Saturated fat increases total cholesterol and LDL (bad) cholesterol,

and thus increases the risk of heart disease.

At this point in time, the Heart Foundation does NOT recommend using coconut oil.

Myth Busters

http://www.heartfoundation.org.au/healthy-eating/Pages/default.aspx

“The dietary cholesterol found in eggs will increase my blood cholesterol.”

False! Cholesterol in food, such as eggs, has only

a small effect on LDL cholesterol. Saturated and trans fats in food causes a much greater increase in LDL cholesterol.

You can eat up to 6 eggs per week without increasing your risk of heart

disease.

Myth Busters

“Butter is healthier for me than margarine”

False! Butter is around 50% saturated fat – that’s

the unhealthy fat that raises our cholesterol levels. Margarine is a much

healthier choice because it has a maximum of only 20% saturated fat.

Myth Busters

“The Paleo diet is healthy and will help me lose weight once and for all”

False! The Paleo diet is based on vegetables, fruit, nuts, roots and meat. While these foods are healthy, the diet excludes grain foods (breads and cereals) which are an important source of

energy and fibre, and dairy foods which provide calcium, vitamins and minerals.

By following the Paleo diet, you may be missing out on

important nutrients. Even if you lose weight in the short term, diets that are too restrictive (ie. cut out whole food groups),

are often too hard to follow ongoing. For long-term sustainable weight loss, the Dietitians Association of

Australia recommends following the Australian Dietary Guidelines.

Myth Busters

“I should eat dark chocolate, and drinking red wine to reduce my risk of heart

disease, because they contain antioxidants”

False!

Whilst there is evidence to suggest antioxidants found in foods can contribute to reducing heart disease, dark chocolate

and red wine are not good sources for heart health.

Myth Busters

Antioxidant source

Good choice for heart health

Recommendation as per the Heart Foundation

Fruits and vegetables True

Eat 2 serves of fruit, and 5 serves of vegetables per day.

Tea True Black or green tea made with leaves or tea bags. (May add reduce, low or no fat milk).

Coffee True People who already drink coffee, should drink less than 5 cups per day of instant, paper-filtered, percolated, or café-style coffee in preference to boiled or plunger coffee.

Raw cocoa powder

True Use raw cocoa powder in drinks and cooking.

Dark chocolate False

Most commercial chocolate will be a poor source of antioxidants.

Red Wine False The amount of alcohol has more impact on cardiovascular health than the type of alcohol consumed. People who already drink, should consume no more than two standard drinks per day.

Antioxidant supplements False

Combination or individual antioxidant supplement are not recommended for the prevention of cardiovascular disease.

Antioxidants for the heart

Recommended 30 minutes of moderate intensity exercise on most, preferably all days of the week.

Examples: Mowing the lawn Gardening Walking or Jogging Washing windows Raking up leaves Shopping Jogging on the spot while watching TV Vacuuming Washing the car

Physical Activity

Questions?

• Dietitians Association of Australia (DAA) – www.daa.asn.au

• Heart Foundation – “My Heart, My Life”

www.heartfoundation.org.au

• NEMO Fact Sheets –

www.health.qld.gov.au/nutrition/nemo_cvd.asp

Resources

http://www.daa.asn.au/http://www.heartfoundation.org.au/http://www.health.qld.gov.au/nutrition/nemo_cvd.asp

National Heart Foundation: – The lipid position statement (2005) – Lipid management guidelines (2001) – Reducing Risk in Heart Disease – Salt and Hypertension (2007) – Position statement. Fish, fish oils, n-3 polyunsaturated fatty acids and

cardiovascular health (updated November 2008) – Summary of evidence. Dietary fats and dietary cholesterol for

cardiovascular health (2009) – Position statement. Dietary fats and dietary sterols for cardiovascular

health (2009) CSANZ Guidelines for the diagnosis and management of familial

hypercholesterolaemia (2009)

References

http://www.heartfoundation.org.au/SiteCollectionDocuments/The-lipid-position-statement.pdfhttp://www.heartfoundation.org.au/SiteCollectionDocuments/The-lipid-position-statement.pdfhttp://www.heartfoundation.org.au/SiteCollectionDocuments/Lipid-management-guidelines.pdfhttp://www.heartfoundation.org.au/SiteCollectionDocuments/Recommended-framework.pdfhttp://www.heartfoundation.org.au/SiteCollectionDocuments/Fish-position-statement.pdfhttp://www.heartfoundation.org.au/SiteCollectionDocuments/Fish-position-statement.pdfhttp://www.heartfoundation.org.au/SiteCollectionDocuments/Fish-position-statement.pdfhttp://www.heartfoundation.org.au/SiteCollectionDocuments/Fish-position-statement.pdfhttp://www.heartfoundation.org.au/SiteCollectionDocuments/Fish-position-statement.pdfhttp://www.heartfoundation.org.au/SiteCollectionDocuments/Fish-position-statement.pdfhttp://www.heartfoundation.org.au/SiteCollectionDocuments/Fish-position-statement.pdfhttp://www.csanz.edu.au/LinkClick.aspx?fileticket=EOvAvk2jApc=&tabid=148http://www.csanz.edu.au/LinkClick.aspx?fileticket=EOvAvk2jApc=&tabid=148http://www.heartfoundation.org.au/SiteCollectionDocuments/Fish-position-statement.pdfhttp://www.heartfoundation.org.au/SiteCollectionDocuments/Fish-position-statement.pdfhttp://www.heartfoundation.org.au/SiteCollectionDocuments/Fish-position-statement.pdf

Q&A Dietary fats, dietary cholesterol and heart health: http://www.heartfoundation.org.au/SiteCollectionDocuments/Dietary-Fats-

Dietary-Cholesterol-and-Heart-Health.pdf

Q&A Antioxidants in food, drinks and supplements for cardiovascular health: professionals

http://www.heartfoundation.org.au/SiteCollectionDocuments/Antioxidant-QAs.pdf

Coconut Oil: http://daa.asn.au/for-the-media/hot-topics-in-nutrition/coconut-oil/

Paleo: http://daa.asn.au/for-the-public/smart-eating-for-you/nutrition-a-z/paleo-diet/ Health Star Rating: www.uncletobys.com.au/health-nutrition/health-star-rating/

References

http://daa.asn.au/for-the-public/smart-eating-for-you/nutrition-a-z/paleo-diet/

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