NUTRITION STRATEGIES
To Reduce Your Risk of Cardiovascular Disease

By paying close attention to what you eat, you may reduce your risk of developing atherosclerosis, the narrowing or blockage of arteries caused by plaque that can lead to a heart attack or stroke. If atherosclerosis has already developed, you may be able to slow the rate at which it progresses. With very careful lifestyle changes, you may even stop or reverse the narrowing that has already occurred. While following these nutrition strategies is important for everyone at risk of developing cardiovascular disease, it is even more important if you have had a heart attack and/or have undergone a procedure to restore blood flow to your heart or other areas of your body, such as angioplasty, bypass surgery or carotid surgery. Following these guidelines may protect against restenosis, or the re-narrowing of the arteries.

Reduce Your Risk Factors

Following these nutritional strategies can help you reduce or even eliminate some risk factors, such as reducing total and LDL-cholesterol, reduce blood pressure, lower blood sugars and triglycerides, and reduce body weight. While most dietary plans tell you what you can’t eat (usually your favorite foods!), the most powerful nutrition strategy helps you focus on what you can and should eat. In fact, research has shown that adding certain foods to your diet is just as important as cutting back on others.

Here are seven up-to-date nutritional strategies aimed at enhancing the health of your heart and blood vessels:

1. Choose Fat Calories Wisely
The total amount and type of fat you eat each day impact your blood cholesterol. Certain fats raise your cholesterol while others can help to lower it. While it is important to monitor your total fat intake (between 20 and 35% or your daily calories), be sure to consume as little of the cholesterol-raising fats (saturated and trans) as you can.

Saturated Fats
Saturated fats raise the "bad" cholesterol, low-density lipoprotein (LDL). No more than 7% of your daily calorie intake each day should come from saturated fat. Based on your calorie level, this amount will vary. Refer to the following list of high saturated fat foods to reduce this type of fat in your diet.

Saturated fats are generally solid or waxy at room temperature and are found primarily in animal products. However, some plant-derived foods also contain saturated fat. Here are some examples of foods that contain high levels of saturated fat:

• Beef, pork, lamb, veal, and the skin of poultry
• Hot dogs, bacon and high-fat luncheon meats (such as salami and bologna)
• High-fat dairy products (such as whole milk, 2% milk, 4% cottage cheese, regular cheese)
• Butter and lard
• Sauces and gravies made from animal fat
• Most fried foods and fast foods
• Bacon fat
• Tropical oils - palm, palm kernel and coconut
• Desserts and sweets made with lard, butter or tropical oils

To cut the saturated fat in your diet, make the following substitutions:

Read the Nutrition Facts Panel on food labels.
Most foods you choose should contain no more than 1 to 2 grams (g) of saturated fat per serving. Depending on your calorie level, your daily saturated fat limit will vary:

Trans Fatty Acids
Trans fatty acids raise the "bad"; cholesterol LDL, and lower the "good"; cholesterol, high-density lipoprotein (HDL). Trans fatty acids are formed when a liquid fat is converted to solid fat through process called hydrogenation. Many manufacturers use hydrogenated fats in their ingredients because it creates a product with an extended shelf life and improved consistency.

There are currently no safe levels of trans fat to consume each day, so try to keep your daily intake as low as possible.

Trans fatty acids are found primarily in these foods and food groups:

• Any food that contains partially hydrogenated oils (such as most processed foods including cookies, crackers, fried snacks and baked goods). Since the ingredients listed on a food label are provided in order of weight, foods that contain partially hydrogenated oils at the top of the ingredients list contain more trans fat that those that contain partially hydrogenated oils lower on the list.
• Margarine - stick margarine contains more hydrogenated oil (trans fat) than tub margarine does; while tub margarine contains more hydrogenated oil than liquid margarine. Look for new margarines available that state they are trans fat free*.
• Shortening
• Almost all fast foods and fried foods are currently high in trans fat. This is because the oil they fry in is partially hydrogenated. Some restaurant chains, such as Ruby Tuesday's, now use a nonhydrogenated or trans fat free oil to fry their foods. But remember that a heart-friendly diet contains very little fried food.

Choose the following substitutions to limit the trans fat in your diet. Look for foods that are labeled trans fat free or those that use liquid vegetable oils instead of hydrogenated oils in their ingredients.

* To hold the label claim "trans fat free"; a food must contain no more than 0.5 grams trans fat per serving. Margarines that claim to be trans fat free should contain water or liquid vegetable oil as the first ingredient. These margarines may still contain some hydrogenated oil, but the amount per serving is negligible. However, portion control is key — once you exceed the serving size, the product is no longer free of trans fat.

Monounsaturated Fats
When substituted for saturated or trans fats, monounsaturated fats can lower LDL cholesterol without lowering HDL cholesterol. Considered one of the healthiest fat sources in the diet, it is still important to keep your total intake of high-monounsaturated fat foods to a minimum. Excessive fat intake of any kind can result in weight gain.

Monounsaturated fats are generally liquid at room temperature but solidify when refrigerated. Some good food sources of monounsaturated fat include canola (rapeseed) and olive oils; most nuts (excluding walnuts), nut oils and nut butters (like peanut butter); olives and avocados.

To increase monounsaturated fats in your diet:

• Try using olive oil and vinegar instead of creamy salad dressing
• Spread natural peanut butter instead of butter on your bread
• Instead of snacking on potato chips, enjoy unsalted nuts in your favorite trail mix

Polyunsaturated Fats
Polyunsaturated fats stay liquid at room and refrigerator temperatures. When substituted for saturated or trans fats, polyunsaturated fats can also lower LDL cholesterol. When eaten in excess, these fats may also lower HDL; therefore, choose monounsaturated fats more often. Good sources of polyunsaturated fats include corn, safflower, soy and sunflower oils.

One type of polyunsaturated fat - omega-3 — has additional protective benefits against cardiovascular disease, including lowering triglycerides, protecting against irregular heartbeats, decreasing your risk of a heart attack and lowering blood pressure. A good food source of omega-3 is fish — especially cold-water fish like mackerel, salmon, herring and sardines. Smaller amounts of this protective fat can also be found in flaxseeds, walnuts, soybean and canola oil. To reap the protective benefits of omega-3 fat, incorporate fish into at least two meals per week and add plant-based sources of omega-3, such as flaxseeds and walnuts, into your daily eating plans.

Total Fat
While it is important to monitor the type of fat you eat, all fat sources contain varying levels of each type of fat. For example, while olive oil contains primarily monounsaturated fat, it also contains small amounts of saturated fat. The opposite is true for butter — it is made up primarily of saturated fat, but does contain some monounsaturated fats. Watch your total dietary fat intake and monitor your portion sizes. According to the latest national cholesterol guidelines, your total daily fat intake should range from 20 to 35% of your total daily calories. How much fat you should eat depends upon your individual cardiovascular disease risk and lipid levels. See your physician or dietitian for more information.

Your total daily fat should come from these sources each day:

2. Limit Dietary Cholesterol
Because cholesterol is made from the liver, it is only found in foods of animal origin (not in plant-based foods). For some people, excess dietary cholesterol raises their blood cholesterol levels. Therefore it is important for everyone to make an effort to limit total dietary cholesterol. If you have high cholesterol, limit your daily dietary cholesterol to 200 milligrams; if you have normal cholesterol levels, limit to 300 milligrams daily.

Here are a few tips to cut cholesterol in the diet:

• Eat 3 or fewer egg yolks per week. Choose egg whites or egg substitutes instead.
• Remove skin from poultry before eating; trim fat from red meat before eating.
• Limit red meat and poultry portions to a 3-ounce size (size of a deck of cards).
• Choose nonfat or low-fat cheeses. Limit total cheese intake to three meals weekly.
• Try soy-based cheese alternatives on sandwiches or in casseroles.
• Choose broth over cream-based soups.
• Limit high fat dairy foods such as cream cheese, 4% cottage cheese or whole milk yogurt – choose nonfat or low-fat varieties.

3. Get Your Daily Fiber Boost
As part of a low-fat diet, dietary fiber can reduce cholesterol. Dietary fiber is the part of plants the body cannot digest. As it passes through your body, fiber affects the way your body digests foods and absorbs nutrients. The amount of fiber you eat affects not only your cholesterol levels but may have other health benefits, including controlling blood sugar, promoting regularity, preventing gastrointestinal disease and helping manage weight.

The recommended daily fiber guidelines include:

• 38 grams for men 50 and under
• 25 grams for women 50 and under
• 30 grams for men over 50
• 21 grams for women over 50

There are two types of dietary fiber, soluble (viscous) and insoluble. Each has a unique effect on health.

Soluble fiber provides the greatest health benefit because it helps to lower total and LDL-cholesterol. Good sources of soluble fiber include oats, oat bran, barley, legumes (e.g. dried beans, lentils and split peas), psyllium, flaxseed, apples, pears and citrus fruits. Insoluble fiber is generally referred to as "roughage.";

Insoluble fiber promotes regularity, adds bulk and softness to stools, helps with weight regulation  and helps prevent many gastrointestinal disorders. Good sources of insoluble fiber include wheat bran, whole wheat and other whole grain cereals and breads, nuts and vegetables. The amount of each type of fiber varies in foods. To receive the greatest health benefit, eat a wide variety of all high-fiber foods.

How to get more fiber in your diet:

• Start the day off right with whole grain cereal or whole grain toast (if your cholesterol is high, choose oatmeal or oat bran cereal or toast).
• Instead of fruit juice, have a whole piece of fruit.
• For a fiber-packed lunch, toss ½ cup garbanzo beans into a dark leafy green salad.
• Choose whole grain buns, bagels, English muffins, crackers and bread instead of enriched or white varieties.
• Purchase whole-wheat pasta and brown rice instead of enriched or white varieties.
• Top yogurt or cottage cheese with fresh fruit or nuts.
• Give zest to broth soup by adding vegetables, dried beans or barley.
• Snack on fresh fruit, vegetables, a granola bar or trail mix.

The best sources of dietary fiber are raw or cooked fruits and vegetables, whole-grain products, and legumes (such as dried beans, lentils, split peas). Refined foods such as soda, fruit juice, white bread and pasta and enriched cereals are low in dietary fiber. The refining process strips the outer coat (called the bran) from the grain, lowering the fiber content.

Using whole grains is a great way to boost dietary fiber intake and helps prevent blood sugar fluctuations throughout the day. This, in turn, helps keep you feeling satisfied and can help prevent sudden cravings for sweets or other sugary foods. The end result: weight control.

4. Increase Fruits, Vegetables, Legumes and Nuts
Only 3 percent of Americans consume the recommended amount of fruits, vegetables, legumes and grains recommended by health professionals. To maximize your intake of antioxidants, vitamins, minerals, protein and dietary fiber, adopt the following three strategies:

1. Choose 5-A-Day. Aim for a combined 5 servings of fruits and vegetables (at minimum) each day. One serving of fruit is 1 medium-sized piece of fruit, ½ medium banana, ½ grapefruit, 2 Tbsp dried fruit, ½ cup canned fruit, ½-¾ cup most juices. One serving of vegetables is ½ cup cooked vegetables or 1 cup raw or leafy vegetables.
2. Aim for ½ cup of legumes at least 4 times weekly. Add dried beans to salads, have split pea soup or toss lentils into a rice dish. Legumes are a powerhouse of protective nutrients - including potassium, fiber, protein, iron and the B-vitamins.
3. Enjoy 5 ounces of nuts each week. Researchers have linked regular nut intake to a lower incidence of cardiovascular disease. Moderate consumption (no more than 1 ounce) of nuts per day provides you with many protective nutrients like vitamin E, zinc, iron, protein, monounsaturated fats and dietary fiber. Choose fresh or dry roasted, unsalted nuts and natural peanut butter for maximum protection. Avoid sugared, salted or oil roasted varieties. Purchase nuts in the bulk-food section of the grocery store or near the baking isle.

More tips:

• Bag some raw vegetables or fruit and take to work for a quick snack.
• Toss nuts into salads, in stir-fries, trail mixes, or eat them plain.
• Spread peanut butter on crackers, celery, toast or even stir into your morning oatmeal.
• Have a vegetable-based soup with your usual sandwich at lunch.
• Instead of a cookie, enjoy a fresh, crisp apple for dessert.
• Keep fresh fruit on your desk or workspace.
• Buy pre-cut vegetables if time is an issue.
• Keep dried fruit, nuts or canned fruit with you if you predict you'll be missing a meal.

5. Eat a Variety of Lean Protein Foods
Increase plant sources of protein and start reducing your intake of animal protein. Steaks, ground meat, pork, chicken and poultry quickly add up your cholesterol and saturated fat intake and pack a lot of calories in a small portion. Substituting non-meat sources of protein for meat significantly reduces saturated fat and cholesterol and boosts fiber, vitamins, minerals and antioxidants.

• Choose 2-3 vegetable protein meals weekly: split pea soup, garbanzo bean salad, soy or black-bean burgers, tofu stir-fry or textured vegetable protein.
• Limit red meat intake to no more than one meal weekly (this includes beef, pork and veal).
• Choose 2 skinless poultry meals weekly.
• Aim for a minimum of 6 ounces of omega-3-rich fish (or 2 meals) weekly.

6. Distribute Meals and Snacks
Skipping meals is not recommended. Small, frequent meals and snacks appear to promote weight loss and maintenance and give you an opportunity to consume important nutrients throughout the day. Skipping meals only lowers metabolism and deprives you of key nutrients. Researchers have also found that people who balance their calories into 4-6 small meals each day have lower cholesterol levels.

• Divide calories into 4-6 smaller meals.
• Eat the bulk of the day's calories during daylight hours for maximum energy.

Sample Small, Frequent Meal Plan

7. Practice Portion Control
When you are trying to follow an eating plan that's good for you, it may help to know how much of a certain kind of food is considered a "serving."; The following table offers some examples .