Patient & Family Guide 2015 Heart Healthy, Sodium Restricted Guidelines 1500 to 2000 mg sodium per day www.nshealth.ca
Heart Healthy, Sodium Restricted Guidelines: 1500 to 2000 mg sodium per day Heart healthy eating can help you feel good and give you energy. Eating more fibre and less fat can lower your risk of heart disease by controlling weight, cholesterol, high blood pressure, and diabetes. Eating less sodium (salt) can help manage heart failure and high blood pressure. Eat balanced meals and choose a variety of foods from each of the food groups every day. What you can do to eat heart healthy Follow Canada s Food Guide for variety and serving sizes. Eat more vegetables and fruit. They make a great low-fat snack. Choose whole grain breads and cereals more often than white or refined breads and cereals. Whole grain products have more fibre. Fibre keeps you full and helps lower cholesterol levels. Fibre also helps control blood sugar levels if you are diabetic. Choose lower fat, lower sodium dairy products. Use only small amounts of non-hydrogenated margarine, preferably salt-free. Watch for hidden fats and trans fats in bakery or grocery store 1
items such as muffins, biscuits, croissants, cookies, crackers, and ready to use meals. Use vegetable oil instead of solid fats when you can. Do not add salt, sea salt, or seasoned salt at the table. Do not use salt during cooking. Try salt-free seasoning blends, herbs and spices, fresh garlic, vinegar, or lemon juice for extra flavour. Do NOT use NoSalt, Nu-Salt, or Half Salt unless you ask your doctor or dietitian. Limit sugars, candy, and desserts. Limit caffeine and talk to your doctor about alcohol. Keep a healthy body weight with regular physical activity and healthy eating. More tips Read food labels carefully for sodium, fat, and fibre content. Be sure to look for the serving size. Compare different products and choose those with less sodium and fat, and more fibre. Cholesterol-free does not mean fat-free or low in fat. For example, cholesterol-free french fries never had any cholesterol in the first place, but they have plenty of fat. 2
Light does not always mean low in fat or calories. It may mean the food is light in colour, flavour, or texture. Read the label closely to see why it is called light. Check the ingredient list to make sure there are no hydrogenated or partially-hydrogenated fats. Less salt does not always mean something is low in salt. Look for foods labeled salt-free, no added salt/ sodium, or low sodium. Reading labels Most labels show the mg (milligrams) of sodium, and g (grams) of fat and fibre, plus a % DV (percent daily value). Tips Where possible, look for % DV for sodium of less than 5%, or less than 120 mg per serving. Choose foods with less than 5% DV total fat and saturated fat. Look for foods with more than 15% DV for fibre, or more than 3 grams per serving. Avoid foods with % DV of more than 10% for sodium, and 15% for total fat. Choose foods with 0 grams trans fats (and no hydrogenated or partially hydrogenated fats in the ingredient list). 3
Example of a high sodium food to avoid Sample label for macaroni & cheese 1. Check serving size & calories 2. Limit fats and watch out for high sodium content 3. Get enough of these nutrients 4. Footnotes Choose more of the foods from the Best choices list and less from the foods to Avoid list. Then you will be eating heart healthy! 4
Vegetables and fruit Have 7 to 10 servings a day. Limit juice to no more than ½ cup (125 ml) 100% juice/day. 1 serving = ½ cup (125 ml) cooked vegetables 1 cup (250 ml) raw leafy greens ½ cup (125 ml) cut up fruit 1 small piece fresh fruit or vegetable Best choices Fresh or frozen vegetables Vegetables canned without salt No salt added tomato sauce, paste, and canned tomatoes (Hunt s No Added Salt Tomato Sauce is one example) Low sodium V8 juice and vegetable juices without salt Fresh, frozen, or canned fruit Unsweetened fruit juice; watch the amount Dried fruit without added sodium Avoid Canned vegetables with added salt Pickles Canned or bottled pasta and pizza sauces Vegetable juices with salt (tomato, Clamato, V8 ) Dried potato mixes, such as scalloped or mashed French fries or fried potatoes Vegetables with cheese or cream sauces Vegetables seasoned with salt Canned fruit or dried fruit with added sodium Sauerkraut 5
Grain products Have 6 to 8 servings a day, or fewer if you are trying to lose weight. Look for breads, cereals, and crackers with less than 8% DV sodium. 1 serving = 1 slice of bread, ¾ cup (30 g) cereal, ½ very small bagel, or ½ cup (125 ml) cooked rice or pasta Best choices Yeast breads, pita bread, bagels; choose whole grain products more often Homemade muffins, waffles, pancakes, and biscuits; be careful with amounts if trying to lose weight Plain unsalted crackers Dry cereals made without salt, such as Shredded Wheat, puffed wheat, Mini Wheats Cooked cereals made without salt Pasta, such as macaroni or spaghetti; try whole wheat pasta Rice - try brown or wild rice Avoid Cheese bread, egg bread Store-bought baking mixes, such as pancake and biscuit mixes Pre-seasoned pasta mixes, such as Hamburger Helper, Kraft Dinner, Knorr Sidekicks Canned spaghetti or pasta Instant hot cereals Bread stuffing mixes Pre-mixed crumb coating, such as Shake n Bake Store-bought baked products Salted crackers Pre-seasoned rice Mr. Noodles and other instant soups 6
Milk and alternatives Have 2 to 3 servings a day. Choose low-fat products more often. 1 serving = 1 cup (250 ml) low-fat milk or soy beverage ¾ cup (175 ml) yogurt 1 ounce (30 g) cheese Best choices Milk (skim, 0.5%, or 1%) Fortified low-fat soy or almond beverages Yogurt (less than 1.4% MF) Cheese, such as: Light cream cheese Light cheddar cheese, but no more than 30 g (1 oz) a day Unsalted, low fat cottage cheese Low fat bocconcini Reduced fat ricotta Evaporated skim milk Frozen yogurt Avoid Processed cheese spreads, such as Cheez Whiz Processed cheese slices Blue, feta, Romano, and parmesan cheese Chocolate milk and other flavoured milks Malted milk Buttermilk Milkshakes Cottage cheese Milk puddings Condensed milk with more than 2% MF Hot chocolate mixes Store-bought eggnog Ice cream 7
Meat and alternatives Have 2 to 3 servings a day. Try 1 or 2 non-meat meals each week. When eating meat, choose lean cuts of meat and use low-fat cooking methods such as: baking, barbecuing, broiling, or roasting. 1 serving = 2 and ½ ounces (75 g) cooked fish, poultry, or lean meat ¾ cup (175 ml) tofu or pulses (dried beans, chickpeas, and lentils) 2 eggs, 2 tbsp (30 ml) peanut butter ¼ cup (60 ml) unsalted nuts and seeds Best choices Have fish, especially salmon, mackerel, sardines, trout, or herring, 2-3 times a week White meat of chicken or turkey Lean beef, pork, and lamb Canned tuna and salmon packed in water - rinse before eating Eggs: limit to 2-3 egg yolks a week Fresh egg whites 8 Avoid All meat, fish, and poultry that has been smoked, cured, pickled, salted, or dried, such as: Bacon, bologna, corned beef, ham, kosher meats, luncheon meats, sausage, wieners, sardines, salt cod, smoked herring Canned meats Frozen dinners Frozen meat pies Frozen, breaded fish or chicken
Best choices Unsalted dry roasted nuts and seeds (almonds, peanuts, walnuts, pecans, hazelnuts, sunflower seeds) Pulses (dried beans, chickpeas, and lentils) No added salt canned chickpeas and beans Natural peanut and other nut butters (unsalted and unsweetened) Frozen entrée items with less than 10% DV sodium and less than 15% DV fat Avoid Canned beans Canned stews Salted seeds and nuts Salted peanut butter Pizza Chinese food 9
Fats Have no more than 2-3 tablespoons (30-45 ml) of added fat a day. Best choices Soft (nonhydrogenated) margarine or salt-free non-hydrogenated margarine, such as Becel Salt Free Cooking oil, such as canola oil and olive oil Salt-free salad dressing (see recipe, page 19) Mayonnaise Salt-free, low-fat homemade gravy Vegetable oil cooking sprays Avoid Lard, shortening, butter, hard margarines (these are hydrogenated), bacon fat, cocoa butter Salt pork Hydrogenated palm and coconut oils Most store-bought salad dressings Store-bought dips Canned gravy and gravy mixes Soups Best choices Unsalted soup and broth Canned soups with less than 5% DV sodium Homemade soup with no added salt Avoid Regular canned soups Dried soup mixes, Oxo, bouillon, and consommé Split pea soup made with ham bone Bean and bacon soup 10
Other foods Best choices Mineral water Diet pop Sherbet Postum, Ovaltine Coffee, tea Ground flax seed Low sugar jams and jellies such as Triple Fruit or Double Fruit Herbs Spices without salt No salt added seasonings, such as Mrs. Dash Vinegar Tabasco sauce Unsalted air-popped popcorn Cream of tartar Cocoa Baking powder and soda in small amounts Avoid Pickles Softened water Sports drinks, such as Gatorade Regular pop Sugar, honey, corn syrup, maple syrup, molasses, regular jams and jellies Salt, seasoning salt, sea salt, Accent Celery salt Garlic salt Onion salt Olives Soy sauce, light soy sauce Hoisin, teriyaki, and oyster sauces Salsa, picante, and taco sauces Poultry and meat coatings 11
Best choices No more than 1 tsp (5 ml) a day (total) with less than 5% DV sodium of: Worcestershire sauce Ketchup Relish Mustard Avoid Potato and nacho chips Cheezies and pretzels Salted microwave popcorn Party snacks Fluid Limiting how much fluid you drink in a day is also important if you have heart failure. Your doctor will let you know how much fluid you should have each day. Keep track of the amount of beverages you drink, including water, milk, juice, pop, coffee, tea, and alcohol. You also need to keep track of certain foods that would be liquid at room temperature, like ice cubes, popsicles, ice cream, sherbet, soups, Jell-O, or puddings. 12
Portion size matters Eat lots of vegetables and fruit. These are low in calories and fat and high in fibre. Half of your plate should be filled with vegetables, one quarter with grains and the rest with fish, poultry, or meat. Vegetables (at least 2 kinds) Grains & starches Meat & alternatives (potatoes, rice, corn, pasta) (fish, lean meat, chicken, beans, lentils) Fruit Milk 13
Extra help There are many cookbooks to help you add variety. Any cookbook by the Heart and Stroke Foundation, The Canadian Diabetes Association, or Dietitians of Canada has very good information. They can be found in most libraries and bookstores. You can make your own recipes heart healthy with a few changes: Do not use salt in your baking or in your soup, sauce, gravy, or casserole recipes. Cut back on the amount of salt in yeast bread recipes. Use non-hydrogenated margarine instead of butter, shortening, or lard. If a recipe calls for 3/4 of a cup of fat, use only half a cup or 1/3 of a cup of fat. Fruit juice, puréed fruit, or low-fat yogurt can be used for half of the fat in muffins needing more than half a cup of oil. Refrigerate juices from roast meats and poultry until the fat rises to the top, and skim it off before making gravy. Sauté with water, juice, low sodium broth, or wine instead of fats, or use vegetable oil cooking sprays. Use less meat, eggs, or cheese than suggested in a recipe. 14
What about omega-3 fatty acids? Omega-3 fatty acids are fats that our bodies need to stay healthy. They can help lower the risk of heart disease. The best way to get them is from eating fish. You should have 1 gram of omega-3 fatty acids from food daily. To do this, have 5 to 6 ounces of fish at least twice a week, preferably salmon, mackerel, sardines, herring, or trout (not deep fried, smoked, or salted). Supplements of omega-3 fatty acids are available, but should only be taken after talking to your doctor. Too much omega-3 fatty acids can cause increased bleeding and lead to poor sugar control in people with diabetes. If you are taking anticoagulant medications, you should not take omega-3 supplements. If your doctor agrees, take no more than 1 gram daily of omega-3 fatty acids from supplements. Your doctor may prescribe more (3 to 6 grams per day) if your triglyceride levels are high. Do not take this much without your doctor telling you to. Do not use cod liver oil in place of omega-3 supplements. Do not take omega 3-6-9. Our diets are naturally high in omega-6, and omega-9 is not needed. 15
There are 3 kinds of omega-3 fatty acids that you may see listed on labels. EPA (Eicosapentenoic Acid) and DHA (Docosahexenoic Acid) are in fish, especially coldwater fish and seafood. Look for supplements with higher amounts of EPA and DHA. ALA (Alpha-linolenic acid) is in plant sources, such as flax seed, soy foods, soybean and canola oils, and some nuts. What about flax seed? Flax is very high in fibre and is a source of ALA omega-3 fatty acids. Flax seeds need to be ground up to make the omega-3 fatty acids useful to your body. Your body cannot use them as whole seeds. Ways to use flax Sprinkle ground flax on hot or cold cereal, yogurt, or applesauce. Add ground flax seed to hamburger, soups, or casseroles. Replace 1 tablespoon of fat in a recipe with 3 tablespoons of ground flax seed. Replace 1 egg with a mixture of 1 tablespoon of ground flax seed plus 3 tablespoons of water. Add ground flax seed to muffin, bread, or loaf recipes. Flax oil cannot be used in cooking, but can be used in salad dressings or added to drinks. 16
Storing flax Whole flax can be stored at room temperature in a clean, dry place for up to 1 year. Flax seed should be ground as needed and stored in an airtight container that you cannot see through. Keep it in the fridge or freezer for up to 30 days. Keep flax oil in the fridge. Eating out Restaurant foods are often very high in fat and salt. Choose wisely when eating out and limit how often you eat out. Choose a restaurant that cooks food in many ways, not just fried. Ask how foods are cooked. Crispy often means deep-fried. Pan-fried or sautéed means cooked in fat. Ask for sauces on the side and just use a little, or leave them out altogether. Sauces such as béchamel, béarnaise, and hollandaise have a lot of fat. Ask if foods can be prepared without added salt. Avoid meals that contain high fat and high salt ingredients, such as bacon, sausage, and cheese. Pickled, cured, or smoked meals will be high in salt. 17
Watch out for salads. Caesar salad and salad items at a salad bar (chicken salad, potato salad, pasta salad, etc.) are high in fat and salt. If adding chicken or seafood to a salad, make sure it is grilled instead of deep-fried. Ask for light salad dressing on the side and use small amounts. Trim the fat off meats and remove the skin from chicken. For sandwiches or subs, choose plain sliced chicken, turkey, or beef and add lots of vegetables. Skip the cheese and ask for a small amount of light dressing. Ask for whole wheat bread or buns, and go for the smallest size, not the foot-long. More information For more helpful tips on how to follow a low sodium, low fat, high fibre diet, visit the Healthy Canada website: www.healthycanadians.gc.ca/eatingnutrition/index-eng.php Or the Heart and Stroke Foundation website: www.heartandstroke.com/site/c. ikiqlcmwjte/b.3483951/k.38bc/healthy_ living Healthy_Eating.htm There are dietitians in some grocery stores. They offer a wide variety of services, including supermarket tours. Check your local supermarket for help from a registered dietitian. 18
Recipes Balsamic vinaigrette 1 small onion, chopped 3 garlic cloves, minced ¼ tsp (1 ml) pepper ¾ cup (190 ml) balsamic vinegar ½ cup (125 ml) olive oil 2 tbsp (30 ml) honey 2 tsp (10 ml) dry mustard Per 2 tbsp serving: Calories: 110 Total Fat: 10 g Saturated Fat: 1 g Sodium: 60 mg Carbohydrates: 6 g Protein: 0 g Salt-free seasoning blend 2 tbsp (30 ml) onion powder 2 tsp (10 ml) garlic powder 2 tsp (10 ml) paprika 2 tsp (10 ml) dry mustard 1 tsp (5 ml) thyme, crushed ½ tsp (2 ml) pepper ¼ tsp (1 ml) dried parsley 19
Speedy barbecue sauce 1 cup (250 ml) cider vinegar ¾ cup (175 ml) canned crushed tomatoes 3 tbsp (45 ml) packed brown sugar 1 tbsp (15 ml) Worcestershire sauce 2 tsp (10 ml) hot pepper sauce 2 tbsp (30 ml) chopped garlic Combine all the ingredients in a medium saucepan and bring to a boil over medium heat. Lower heat and simmer for 20 minutes, stirring often. Remove from heat and cool slightly before using. Makes 1½ cups. Per 2 tbsp serving: Calories: 20 Total fat: 0 g Saturated fat: 0 g Sodium: 40 mg Carbohydrates: 6 g Protein: 0 g Dietitian: Phone: If you have any questions, please ask. We are here to help you. 20
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Looking for more health information? Contact your local public library for books, videos, magazines, and other resources. For more information go to http://library.novascotia.ca Nova Scotia Health Authority promotes a smoke-free, vape-free, and scent-free environment. Please do not use perfumed products. Thank you! Nova Scotia Health Authority www.nshealth.ca Prepared by: Food and Nutrition Services Illustrations by: LifeART Health Care 1 Images, Copyright 1994, TechPool Studios Corp. USA Designed by: Nova Scotia Health Authority, Central Zone Patient Education Team Printed by: Dalhousie University Print Centre The information in this brochure is for informational and educational purposes only. The information is not intended to be and does not constitute healthcare are or medical advice. If you have any questions, please ask your healthcare provider. r. LC85-1166 Revised July 2015 The information in this pamphlet is to be updated every 3 years or as needed.