Eat Smart. COACH Heart Manual. Balanced Eating. Portion Size. Fruits & Vegetables. Grains. Glycemic Index. Dairy. Meats & Alternatives

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1 Eat Smart Balanced Eating Portion Size Fruits & Vegetables Grains Glycemic Index Dairy Meats & Alternatives Fats & Cholesterol Nutrition Label Reading Salt Caffeine Breakfast, Lunch, Dinner, Snack Suggestions Dining Out Grocery Shopping Tips NOTES: 67

2 Balanced Eating Balanced Eating means.. Aiming for the portion plate ½ plate vegetables, ¼ starch, ¼ protein If you are following Canada s Food Guide to Healthy Eating then 3 out of the 4 food groups = balanced meal Eating regularly you may need a snack if your meals are more than 4-6hrs apart Choosing a variety of whole foods Avoid processed foods One Portion Size. 2 handfuls of vegetables 1 fist full of carbohydrate (rice, pasta, potato) Size of palm portion of protein (chicken, beef, pork, beans, lentils, eggs) 1 cup of soy/skim/1% milk 1 small piece of fruit (for dessert if desired) Limit to 1 2 tsp of added fat per meal 1 tsp butter or oil = 5 g fat 68

3 Fruit and Vegetables Our nutritional powerhouses! Tips for Eating More Fruits and Vegetables Eat 7-10 servings of fruit and vegetables daily (e.g. 4 servings vegetables and 3 servings fruit) Get lots of COLOUR to ensure you're getting a wide variety of nutrients 'Every meal and every snack' should contain at least one fruit or vegetable Limit yourself to one small glass of juice per day. Rely on whole fruits and vegetables to make up the rest of your daily servings Eat a salad everyday (see recipe for 'vinaigrette' in the COACH recipe booklet). Try to eat a raw piece of fruit or raw vegetables at every meal. Put your veggies on your plate first as you are more likely to eat more Try This! Blueberries: add frozen blueberries to your yogurt. Try mixing fruit-flavored yogurt halfand-half with plain yogurt to cut the sugar. Strawberries: blend skim milk, frozen strawberries and sweetener for a fast, low fat 'shake'. Frozen bananas go well in this shake too and add a creamy texture. Spinach: Cut matchstick fine and add to canned lentil soup with some finely chopped carrots and onions. A squeeze of fresh lemon lends a 'fresh note' that makes the soup taste remarkably homemade! Prunes: Make your own prune paste and substitute for some (or all) of the oil in chocolatebased desserts (brownies, cakes etc.) Beets: Borscht with kidney beans (adds fibre) and yogurt cheese to top (see COACH recipe booklet for 'yogurt cheese' recipe) 69

4 Glycemic Index (GI) This is a scale that rates foods rich in carbohydrates on how much they affect blood sugar levels compared to a standard food white bread or glucose. The scale is from and foods considered high GI affect blood sugars more than low GI foods, which turn to sugar at a slower rate. There has been some research to support the link between low glycemic index foods maintaining lower blood sugar and cholesterol levels. These foods may be important in a balanced healthy diet! Low GI (55 or less) Medium GI (56-70) High GI (more than 70) 100% stone ground bread Whole wheat White bread Barley Puffed Wheat Corn Flakes Sweet Potato/Yam New Potatoes Baking potato (Russet) Steel Cut Oats Quick Oats Instant Oats Apple Raisins Ripe Banana Information adapted from How to Eat More Whole Grains Recipes* Nick's Tabbouleh Cracked Wheat Bread (for bread machine) Millet Cornmeal Cereal with Dates Mixed Grains Crockpot Cereal Corn Tortillas Hearty Buckwheat Breakfast Cooke's Granola / Granola II Red River Cereal Bread Ruth's Barley Casserole Herbed Cous Cous Moroccan Rice Pilaf Brown Rice Pudding * Recipes appear in 'COACH COOKS' recipe booklet available at Brown rice pudding Barley in homemade soup Whole-wheat Bread (whole wheat flour should be the first ingredient listed) Whole-wheat pasta Brown Rice with Vegetarian Chili (or brown rice with stir fries) Whole-wheat couscous (Tabbouleh salad) Buckwheat pancakes (made from scratch) Homemade corn tortillas (don't require any fat/oil in preparation and no salt!) Whole-wheat baguette topped with marinated artichoke hearts, black olives and fresh tomatoes Hot breakfast cereals with added flax and wheat germ Wheat germ - add 1 Tbsp wheat germ for every cup of flour in your baking recipes Granola - make your own to avoid trans fats and too much sugar. Try with fresh raspberries. 70

5 Grain Products WHAT TO LOOK FOR BREADS: No Trans fat (i.e. bread should not contain shortening, margarine or any 'hydrogenated' or 'partially hydrogenated' oils). Whole grain flour should be the first ingredient on the label. Each slice of bread should contain at least 2 grams of fibre. CRACKERS: Non-hydrogenated (Trans fat free), lowfat crackers, crisp breads and breadsticks. Low-sodium (salt) Made with whole-grain flour. Ryvita or Wasa Rye crackers. CEREALS: High fibre (> 3 grams/serving) Low-sugar (< 5 grams/serving) Low-sodium A serving size is 30 grams. Check the label! Some manufacturers use a 60 gram serving size to make their cereals 'sound' as if it's higher in fibre & nutrients than it actually is. AIM for some at all meals! WHAT TO WATCH OUT FOR Baked goods high in fat: croissants, Danishes, most biscuits, commercially prepared muffins. Products made exclusively from white flour (even if they are low in fat) e.g. white bagels and muffins Crackers high in fat and salt; e.g. Ritz crackers, Triscuits, Wheat Thins. Each serving should contain less than 3 grams of fat. Crackers where the first ingredient is white flour (or 'unbleached' wheat flour) Cereals containing Trans fats. Highly processed sugary cereals (e.g. Fruit Loops, AlphaBits). Low-fibre cereals (e.g. Corn Flakes, Rice Krispies, Special K). Consider sprinkling 'Bran Buds' or 'All Bran' or a similar high-fibre cereal on top of your lower-fibre cereal to boost the fibre content. RICE, PASTA & WHOLE GRAINS: Brown rice, wild rice Whole-wheat pasta / Multigrain pasta Whole-wheat cous cous, bulgur, oats, barley, spelt, quinoa, kamut, wheat berries Pasta made with high-fat fillings or served with high-fat sauces (e.g. tortellini with cheese sauce, fettuccini Alfredo) White rice or refined grain Products such as pancakes, waffles, tortillas, pita bread and homemade muffins are acceptable as long as they meet the above criteria. 71

6 Dairy Products Choose Most Often Choose Less Often Limit (or use sparingly) MILK: Skim or 1% Milk Buttermilk 1% If you prefer choose soy, almond or rice milk without added sugar. YOGURT: Plain (unsweetened), lowfat or fat-free yogurt 1% or less M.F. (milk fat) Fat-free or low-fat fruit flavored mixed half & half with plain yogurt (add extra fresh fruit) COTTAGE CHEESE: Low-fat or fat-free 1% or less M.F. Note: Most cottage cheese is high in sodium (salt) do not exceed a 1/2 cup serving each day. 2% milk Whole Milk (3.5%) Creamo ('Half & Half') Cream 2% Yogurt Flavored Yogurt (low-fat) Whole milk yogurt 2% Cottage Cheese Regular (high-fat) cottage cheese CHEESE: Cheese made from skim milk 7% M.F. (milk fat) or less Quark Note: Cheese can be high in sodium. Especially processed cheese. Use sparingly. SOUR CREAM: No fat or low-fat 'Light' cheese (20% M.F. or less) This type of cheese, even though it has less fat than 'regular' cheese is still a high fat item. Use sparingly, as a garnish. Full-fat ('regular') cheese containing more than 20% M.F. 5% or less M.F. Regular Sour Cream FROZEN DESSERTS: These desserts should be a 'once in a while' treat. Not every day fare! Ice cream is high in fat and sugar Sherbets, sorbets (fruit ices), frozen yogurt in small servings (1/2 cup serving size) - Caution: Low in fat but high in sugar! 72

7 Meat & Alternatives Choose Most Often Choose Less Often Limit(or use sparingly) LEGUMES: Split peas Lentils Dried Beans Tofu & Soy products Natural Nut Butter (Peanut or almond) FISH: Omega-3 rich fish such as: sockeye salmon, sardines, herring, mackerel, trout Canned fish packed in water SHELLFISH: Clams, oysters, lobster, crab or scallops (prepared with minimal fat) EGGS: Egg whites POULTRY: White turkey or chicken (no skin) MEAT: Beef: lean, trimmed of fat (rump, round, sirloin) Pork: tenderloin Note: a serving of meat is about 90 grams - size of a deck of cards. Pork & Beans Canned beans (rinse with water to reduce sodium) Canned fish in added oil (drain well) Shrimp, squid, caviar Imitation crab (usually high in sodium) Born 3 eggs (or other eggs high in omega-3 fatty acids) Egg yolks (Max. 3 per week) Chicken/turkey - dark meat (no skin) Medium-fat, trimmed, lean rib roast, lean blade roast Extra-lean ground beef (still high in fat!) Peanut butter containing shortening (trans fats) Deep-fried fish Fish served in high-fat sauce Battered fish or crispy coating (unless specified 'low-fat' and 'trans fat free' on label) Shellfish prepared in batters or dipped/sautéed in butter Duck, Goose, Giblets, Fried Chicken, Poultry skin Highly-marbled meats Ribs Corned Beef Ground pork, Pork shoulder Processed meats (even if low-fat) Organ meats 73

8 Heart Healthy Tip Try to eat some type of legume (beans, split peas, lentils or soy-based fibre, and rich in anti-cancer compounds!) Tips for Eating More Legumes *Pasta Sauce - add red lentils to your red spaghetti sauce. They cook down to a 'mushy' state and you probably won't know they're there but they'll add the fibre and antioxidants that make legumes nutrition powerhouses! *Pea Soup - just before serving purée with frozen peas. Gives the soup a fresh taste and a fabulous green colour! Canned vegetarian chili makes a filling (and quick) lunch when served on a baked potato cooked in the microwave. Try adding a can of low sodium kidney beans to your canned chili to add more fibre and decrease the sodium in each serving. Refried beans - add some salsa and heat. The salsa makes the consistency better for dipping. Serve with baked tortilla chips. Add fresh tomatoes and sweet white onions to your store-bought salsa for a fresher taste. Garbanzo beans (chickpeas) taste great on salads. Add beans slowly to your diet if you're not used to eating them. Drink lots of water and consider using a product like 'Beano'. The side effects of beans do diminish over time as your body adapts! Recipes*: Red Lentil Soup with Indian Spices Hummos Quinoa Black Bean Salad Mixed Bean Casserole Calypso Beans & Rice Refried Beans Quinoa Black Bean Salad Nadene's Black Bean Soup Marinara Sauce with Lentils/Buckwheat White Bean Soup with Red Pepper Puree Mixed Bean Salad with Edamame Hearty Soup Mix *all recipes from 'COACH COOKS' recipe booklet available at 74

9 Soy Foods Soy Foods Rates of heart disease and cancer (especially breast, prostate, colon, ovarian and endometrial cancer) are much lower in Asian countries (than in the U.S. & Europe). These differences are believed to be partially due to higher intakes phytoestrogens Soybeans are a staple of the Asian diet - and have been for thousands of years. An ever-growing body of laboratory & clinical research is indicating there may be advantages in consumption of soy by Western nations with their high rates of heart disease and where cancers of the breast and prostate are very high. David Jenkins, CACRC Recipes*: Banana Soy 'Milkshake' Strawberry Tofu Smoothie Crispy Tofu with Dipping Sauce Scrambled Tofu Yam Coconut Curry Soup (with soymilk) Creamy Tomato Tofu Soup Red Lentil Soup (with soymilk) Mixed bean salad with soybeans *all recipes from 'COACH COOKS' recipe booklet available at How to Include More Soy in Your Diet Substitute ¼ of the flour called for in your recipe with soy flour Use cooked soybeans in soups, chilies, stews, burritos etc. Replace ground beef with crumbled extra firm tofu or crumbled tempeh Try roasted soybeans as a snack; also called 'soy nuts'. Go easy - they can be high in fat! Avoid buying soy nuts roasted in oil. Fresh soy beans (in pods) are in season August to September (or buy frozen). Also called 'edamame'. Steam them about 5 minutes. Cooked beans slip easily from pods and taste delicious. A great snack for kids! Easy Tip for Using Tofu Try a layer of thinly sliced 'firm' tofu in your next lasagna. Cover it with pasta sauce then continue to layer as usual. The tofu looks like unmelted mozzarella cheese. And it is quite flavorful as it absorbs the taste of the sauce. 75

10 Fats & Cholesterol Definitions - Fats & Cholesterol Found in Blood LDL 'low density lipoprotein' also known as 'bad cholesterol' s major cholesterol-carrying molecule in blood s delivers cholesterol to the arterial walls s levels increase with diets high in saturated fat and trans fats s goal: level < 2.0 mmol/l or 50% decrease from baseline blood work HDL 'high density lipoprotein' also known as 'good cholesterol' s picks up cholesterol from arterial wall and delivers it to the liver for excretion s may pick up oxidized portions of LDL particles s levels increase with exercise s monounsaturated fats (in foods like olive oil and avocados) may increase HDL s goal: level > 1.0 mmol/l for men, level > 1.3 mmol/l for women TRIGLYCERIDES s likely contribute to blocked arteries s levels increase with obesity, diabetes and diets high in alcohol, sugar and processed foods. s goal: level < 1.7 mmol/l (< 1.5 mmol/l for diabetes) Adapted from da Silva, L Dietary fat and antioxidant vitamins & their potential influence on ASHD Beneficial Fats s s s Research shows some fats are not only beneficial they are essential for good health. Foods high in omega-3 fats and monounsaturated fats are associated with reduced cholesterol levels and a decreased risk of heart disease. Although the fats listed below are beneficial they must still be eaten in small quantities - or weight gain will result! These fats should replace harmful fats in your diet. 76

11 FAT & CHOLESTEROL Both the AMOUNT and the TYPE of fat you eat matters when keeping your cholesterol under good control Not all fats are created equal. Refer to the table on the back to decide which ones you should limit All fats are energy (calorie) dense. Large amounts of ANY fat can lead to weight gain Try following the steps below to optimize your own cholesterol levels. FOODS STEPS BEST CHOICES STEP 1 Ø Skim or 1% milk Ø 1% M.F. yoghurt Choose lower fat milk products Ø 20% M.F. cheese Ø 1% cottage cheese Ø Low fat sour cream STEP 2 Choose lower fat meat & alternatives STEP 3 Include sources of Omega 3 fats STEP 4 Limit the amount of fat you add to food to 3-6 servings per day (1-2 servings per meal) Ø Fish & Shellfish Ø Dried beans Ø Soy products Ø Skinless poultry Ø Lean meats -Trim visible fat - Least amount of marbling Ø Eggs (limit yolks to 3/week) Ø Limit portion sizes to 3-4 oz Ø Salmon, mackerel, herring or trout 2-3 x week or Ø 1 tsp flax oil (not heated) or 1 Tbsp ground flax per day Ø Fish or flax supplements One Serving = 1 tsp margarine, butter or oil 1 tsp regular mayonnaise 1 Tbsp light mayonnaise 1 Tbsp vinaigrette 2 tsp creamy salad dressing 2 olives ¼ small avocado Bake, broil, poach, steam, roast & barbeque more often. 77

12 UNHEALTHY FATS to Limit or Avoid (less than 20 grams per day): LDL = bad cholesterol ; HDL = good cholesterol ; Triglycerides = blood fat Type of Fat Sources Effect on Blood Cholesterol Level All animal fats Saturated Fat High fat dairy products Butter, lard LDL -LIMIT- Cocoa butter, Chocolate Palm/palm kernel oil Coconut oil Usually solid at room Many processed & store bought temperature baked goods Trans Fatty Acids -AVOID- Made when liquid oils are turned into solid fats Found on labels as: Vegetable Oil Shortening Hydrogenated Oil Trans Fatty Acids All margarines (unless labeled as 100% non-hydrogenated) Many processed & store bought foods such as crackers and cookies Fries and other deep-fried foods LDL HDL Triglycerides HEALTHY FATS to choose more often: Type of Fat Sources Effect on Blood Monounsaturated Fat Liquid at room temperature Polyunsaturated Fat Liquid at room temperature Omega 3 Fats Healthy choice Liquid at room temperature Canola oil Olive oil Peanut oil/ Peanuts Nuts and seeds Avocado Soybean oil Corn oil Walnut oil Grape seed oil Sesame seed oil Sunflower seed oil Fish Seafood Ground flaxseed Flaxseed oil (do not use in cooking) Fish oil supplements Walnuts LDL HDL LDL LDL HDL There are no known health benefits associated with saturated fats or 'trans fats' Cholesterol Level Triglycerides 78

13 Omega - 3 Fats 7 Ways to Eat More Omega-3's servings fish each week 2. Flax seeds (must be ground whole or in oil form for us to obtain the fat from these seeds otherwise they go through us i.e. undigested) 3. *Born 3 eggs 4. *Walnuts and other nuts & seeds (5 servings per week) 5. *Canola oil margarine (non-hydrogenated) 6. *Tofu and soy milk 7. *Dark green leafy vegetables If you do not eat fish try to have 1 tsp flax oil (not heated) or 1 TBSP ground flax seeds every day. Do not eat more than 1 TBSP flax oil or 3 Tbsp of ground flax seed meal daily, as this may provide too much omega 3 s. See recipe section for instructions on how to make ground flaxseeds. * Omega 3 from fish is better utilized by the body than Omega 3 from plant sources i.e. flax. What about Coconut Oil? Coconut oil is a plant-based saturated fat. Although it is considered cholesterol free the jury is still out and currently no strong research supports its use in replace of other healthy vegetables oils. That s not to say it may be used instead of butter or Trans fats. It is still important to use in moderation and ensure the coconut oil is non-hydrogenated. 79

14 Added Fats & Oils The following list represents 1 serving of fats/oils (1 serving = 5 g fat). Choose 3-6 servings per day (In addition to your low-fat meals & snacks) Examples of 1 serving of fat: Oils: Olive oil 1 tsp Other oils 1 tsp Canola oil 1 tsp Coconut oil 1 tsp Butter/Margarine: Margarine (non-hydrogenated) Butter mixed 50:50 with olive oil 1½ tsp 1½ tsp Avocado: ¼ small Olives: Black or Green, large 2 Nut Butters: Peanut butter (natural) Cashew butter Almond butter 2 tsp 2 tsp 2 tsp Nuts/seeds: Chopped nuts or seeds 1 Tbsp Whole nuts 10 grams (1/3 oz) Eg. Almonds 10 medium size nuts Peanuts 17 peanuts Salad Dressing: Regular Vinaigrette Regular Creamy 1 Tbsp Low fat or Light Versions (Read the label to find out serving size = 5 g fat) 2 tsp 1 serving = 5 grams of fat= 1 tsp oil Most of your fat choices should be 'healthful fats' (e.g. olives, avocados, nut/seeds). Limit butter & margarine. Be sure the rest of your diet is low in fat. For example, in addition to limiting fat intake to 3-6 servings per day, choose lower fat food products whenever possible. This will result in approximately 30% calories from fat. 80

15 What does "a fat intake of less than 30% of total calories" mean? If you are a man consuming 1800 calories per day: Total fat for the day = 60 grams with up to 14 grams (approximately 3 teaspoons) from saturated (e.g., animal) fat If you are a woman consuming 1500 calories per day: Total fat for the day = 50 grams with up to 11 grams (approximately 2.5 teaspoons) from saturated (e.g., animal) fat What Actions Can You Take To Improve your Diet? Consider making one or two changes to start. Begin slowly and gradually add other changes over time. Include at least 3 meals a day. Start with breakfast. Never skip meals. Eat regularly during the day. A guide to follow is to eat every 4 to 5 hours. This can help to prevent hunger from building. Include more plant-based foods. Have a fruit and/or vegetable, every time you eat a meal or snack. Cook with legumes or beans more often. Choose whole grain breads and cereals, i.e. whole wheat pasta, whole grain bread, high fibre cereals. Have fish instead of red meat more often. Limit foods high in sugar, i.e. juice, regular pop, cookies, pies and other baked good items. Speak to a registered dietitian for further guidance. Speak to your CV prevention & rehab team to help develop your action plan. 81