Cardiac Rehab and NutritionSession 1

Janice Holley MSc, RDJulie Snider MAN, RDCardiac Rehab DietitiansSt. Mary’s General Hospital

Overview of Nutrition at Cardiac Rehab

Nutrition education sessions (4) Individual appointment

45 minute assessment bring 3 day food records

spouse/partner/grocery shopper/cook

Possible follow-up

Ways to reduce risk Behaviour change in:

daily eating habits daily physical activity tobacco use managing stress….. will help you to……

Reach target levels for blood fats: LDL, HDL, TG, Ratio

Lower body weight (lower % body fat, WC) Control high blood pressure (less sodium) Control blood sugar to target levels

5 F’s to Heart Healthy Eating

FAT* FIBER FISH* FRUIT FRESH*

Today’s Session

Types of cholesterol in blood Types of fat in foods

where to find and how to limit Healthy body weight/body

composition

What are the different types of fats in blood?

Low density lipoprotein (LDL) High density lipoprotein (HDL) Triglycerides

(**Found in blood, not in foods)

What is Low-Density Lipoprotein (LDL)?

Contributes to blockages in the arteries

What is High Density Lipoprotein (HDL)?

Helps prevent blockages in the arteries

Desirable Blood Fat Profile

LDL less than 2.0 HDL more than 1.1 Triglycerides less than 1.7 Cholesterol/HDL ratio less than

4.0

Types of fats in foods

Monounsaturated fat Polyunsaturated fat Omega-3 fat Saturated fat Trans fat

Monounsaturated Fats Helps to lower LDL and keep

HDL from decreasing Sources include:

Olive and canola oil, Non-hydrogenated

margarines made from olive and canola

oil, Avocados, Nuts: almonds, filberts and cashews

Polyunsaturated Fats Helps to lower LDL;

no effect on HDLSources include: Sunflower, safflower,

corn, soybean and sesame seed oils

Nuts: walnut, pine nut,

brazil nuts, sesame and sunflower seeds

6 sources include:Sunflower,

safflower, corn, soybean and sesame seed oils; nuts: walnut, pine nut, brazil nuts; sesame & sunflower seeds

Omega 3 Fat Helps to lower LDL, keep blood thin,

reduces inflammation and irregular heart beats

EPA and DHA found in fish Highest amounts in salmon, trout, mackerel,

sardines, tuna (bluefin, albacore) ALA found in ground flaxseed, nuts,

canola oil, soy Much more on omega 3’s in next

session!

Saturated and Trans Fat

Solid fats at room temperature Mostly hidden in foods (meats,

dairy, processed foods, hard stick margarines)

Raise LDL and lower HDL cholesterol

Trans Fats – Processed Fats

Avoid: Hard margarines Hydrogenated fats Vegetable oil

shortening Fried fast foods Snack foods, cookies,

crackers that contain Trans Fat (< 2 g/day)

How much fat should you eat? Limit total fat to 60 g per day

5 g = 1 tsp

15 g = 1 tbsp

60 g = 4 tbsp

So how much saturated fat?

Limit the saturated fat to 10-15 grams maximum per day by choosing lower fat foods.

Remember 1 teaspoon has 5 grams fat.

Added Fat vs. Hidden Fat

Keep added fats to 30 g or 2 Tbsp/day

Other half (30 g or 2 Tbsp) is hidden fat

How to limit added fat

Choose lower fat cooking methods what are examples?

Less spreading! Less pouring! And Measure!

Add less non-hydrogenated margarine, less oil

Use lower fat salad dressings/mayo, fat-free sour cream

How to limit hidden fat

#1 way is to limit portion sizes Choose fish, chicken/turkey, lean pork

and plant protein more often than red meat

skinless poultry butterfly pork chops or pork tenderloin lean red meat low fat soy foods lower fat dairy products.

Choose lower fat dairy products

Skim or 1% milk Yogurt less than 0.5%

M.F. Cottage Cheese less

than 1% M.F Lower fat cheeses

Less than 20% M.F. if 1-2 times/week

4-7% M.F. if use more often

Summary:How can we lower LDL?

Limit total fat Limit saturated and trans fat Use soy products Eat more fiber (sessions 2 & 3)

Summary: How do we increase HDL?

Aerobic exercise Healthy fats e.g

canola & olive oils, almonds

Alcohol (more in sessions 2 & 4)

Lose abdominal fat

Aim for a healthy body weight

Body composition analyses : weight, fat, muscle, water

Waist circumference: Men – less than 40”

Women – less than 35”

If you are overweight -

…are you an apple or a pear?

Energy in – energy out

Next Session

Omega 3 Fat Label-reading Mediterranean diet