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A Harvard Medical School Special Health Report

Healthy Eating for a Healthy Heart

In this report: Food choices to lower your heart attack risk Advice about fish and fish oil Merits of the Mediterranean diet Special Bonus Section

40 recipes from EatingWell Magazine

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healthy eating for a healthy heart

Contents

SPECIAL HEALTH REPORT

The heart of the matter. . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Medical Editors Thomas H. Lee, M.D. Professor of Medicine, Harvard Medical School Network President, Partners HealthCare System

Harvey B. Simon, M.D.

Associate Professor of Medicine, Harvard Medical School Health Science Technology Faculty, Massachusetts Institute of Technology

Kathy McManus, M.S., R.D.

Director, Department of Nutrition, Brigham and Women’s Hospital

Writer Nancy Knoblock Hunton Editor Julie Corliss Editor, Special Health Reports Kathleen Cahill Allison Art Director Heather Derocher Production Editors Mary Kenda Allen, Melissa Rico Illustrators Christopher Bing, Alex Gonzalez, Harriet Greenfield Published by Harvard Medical School Anthony L. Komaroff, M.D., Editor in Chief Edward Coburn, Publishing Director Copyright ©2009 by Harvard University. Written permission is required to reproduce, in any manner, in whole or in part, the material contained herein. Submit reprint requests in writing to:

Harvard Health Publications 10 Shattuck St., 2nd Floor, Boston, MA 02115 617-432-1485 Fax: 617-432-4719

The impact of diet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 The impact of weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Why lifestyle changes help . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Nutrition basics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Facing the fats. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Carbohydrates: Avoid refinement. . . . . . . . . . . . . . . . . . . . . . . 10 Proteins: More than “meats” the eye. . . . . . . . . . . . . . . . . . . . 13 Beverages: Drink to your health. . . . . . . . . . . . . . . . . . . . . . . . 14 Other noteworthy nutrients . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Losing weight to help your heart . . . . . . . . . . . . . . . . . . . 20 Do you need to lose weight?. . . . . . . . . . . . . . . . . . . . . . . . . . 20 Advice from successful losers . . . . . . . . . . . . . . . . . . . . . . . . 21 Weight-loss diets and your heart. . . . . . . . . . . . . . . . . . . . . . . 24

Putting theory into practice. . . . . . . . . . . . . . . . . . . . . . . . 27 Shop smart. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Choose convenience foods wisely. . . . . . . . . . . . . . . . . . . . . . Eat out the healthy way. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Appendix: Food diary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

27 28 29 30

SPECIAL BONUS SECTION: Recipes. . . . . . . . . . . . . . . . . . 31 Sample meal plan for a week. . . . . . . . . . . . . . . . . . . . . . 43 Recipe index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Resources. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47

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Dear Reader, Is the way to a man’s heart through his stomach, as the old saying goes? If you’re talking about heart health, then the answer is yes—and it applies to women as well. What you eat really does affect your heart. In fact, we know that as much as 80% of heart disease can be prevented by eating a healthy diet, maintaining a healthy weight, exercising daily, not smoking, and drinking alcohol in moderation. But like many Americans, you may be confused by the onslaught of dietary fads reported by the media. One year, high-fat diets are to blame for America’s growing girth and clogged arteries; the next, high-carbohydrate diets are the villains. The best nutritional advice seldom makes the news because it doesn’t offer a quick fix or an easy sound bite; instead, it offers a time-tested plan to stay healthy. If you’ve already been diagnosed with heart disease or have high cholesterol or high blood pressure (two factors that increase your risk for the disease), changing how you eat can help you better manage these conditions and lower your risk of heart attack. A good diet also helps you maintain a healthy weight, which, in turn, helps lower your chance of developing heart disease. In fact, losing as few as 10 pounds can help stave off heart trouble. Adopting a better diet also lowers your chance of developing type 2 diabetes, in itself a risk factor for heart disease. Two out of three people with diabetes die from heart disease or stroke (blockage of blood flow to the brain). In this report, you will find practical eating guidelines based on the best science available. You’ll read about how to achieve a healthy weight and eat well at the same time. You’ll learn about the basics of a healthful (and tasty) diet, how to plan a balanced meal at home, and what to eat when you dine out. Finally, you’ll learn about wholesome snacks and food substitutions, so that you don’t feel deprived on the road to better eating. As an added bonus, we’ve included 40 heart-healthy recipes from EatingWell Media Group, publisher of Eating­Well Magazine, healthy cookbooks, and EatingWell.com. Bon appetit!

Thomas H. Lee, M.D. Medical Editors

Harvey B. Simon, M.D.

Kathy McManus, M.S., R.D.

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The heart of the matter

W

hat’s commonly called heart disease is known medically as coronary artery disease because it involves the narrowing of the coronary arteries, blood vessels that supply blood and oxygen to the heart. Coronary artery disease results from atherosclerosis, a buildup of fatty deposits called plaque. As the arteries fill with plaque, blood flow to the heart slows, leading to chest pain (angina) and shortness of breath. Doctors once believed that heart attacks occurred because of a biological version of a plumbing problem: like a clogged drain, an artery became clogged with plaque, thereby blocking the flow of blood to the heart. But research has revealed that inflammation and blood clots are the real culprits. Inflammation in the arteries, produced by injury to the blood vessel walls, high blood pressure, or smoking, can cause plaque deposits to rupture, triggering the formation of dangerous blood clots. A heart attack occurs when one of these clots suddenly blocks the blood supply to the heart, depriving the heart muscle of oxygen-carrying blood and causing cells to die. The longer it takes to restore blood flow, the more damage the heart suffers. But you can lower your chances of facing this scenario. Research has identified six major risk factors for heart disease, and all can be treated or controlled: high blood pressure, unhealthy cholesterol levels, diabetes, exposure to tobacco, physical inactivity, and obesity. In 2003, approximately 37% of adults had two or more

of these risk factors. Four risk factors—high blood pressure, high cholesterol, diabetes, and obesity—are related to diet.

The impact of diet

The types of food you eat, and your overall dietary pattern, can affect your blood pressure, cholesterol levels, and blood sugar levels, as well as your likelihood of becoming obese. Evidence and some preliminary heart-healthy guidelines are provided below; for more specific advice about how to start eating better, see “Nutrition basics,” page 7.

Blood pressure Current blood pressure guidelines appear in Table 1. About half of adults in the United States, and 80% of those over 50, have blood pressure high enough to put them at risk for heart disease. Although you may need to take medication to control your blood pressure, diet also has a big impact and can help you reduce your need for medication. Two eating plans in particular, based on scientific studies, are designed to lower blood pressure and reduce the risk of heart attack or stroke. ■ DASH diet. The Dietary Approaches to Stop Hypertension (DASH) trials identified eating strategies that lowered blood pressure within two weeks of starting the plan. The effects of DASH were significantly greater in black participants than in whites, and

Table 1 Blood pressure guidelines for adults 18 and older Category

Systolic pressure

Normal Prehypertension Stage 1 hypertension Stage 2 hypertension

Less than 120*

Diastolic pressure

and

Less than 80

120–139

or

80–89

140–159

or

90–99

160 or higher

or

100 or higher

*Measurements are in millimeters of mercury (mm Hg). Source: Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC7), May 2003.

2

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in individuals with high blood pressure rather than those with normal pressure. The DASH diet includes, on a daily basis, eight to 10 servings of fruits and vegetables and two to three servings of fat-free or low-fat milk and dairy products. It also emphasizes whole grains, fish, poultry, and nuts, and is low in saturated fat, red meat, sodium, and sweets. (A free copy of the DASH eating plan is available at health.harvard.edu/148 or by contacting the National Heart, Lung, and Blood Institute or local chapters of the American Heart Association; see “Resources,” page 46.) ■ OmniHeart diet. The Optimal Macronutrient Intake Trial to Prevent Heart Disease (OmniHeart) study compared three healthy diets: a high-carbohydrate DASH-like diet, a high-protein diet, and a diet high in unsaturated fat. All lowered blood pressure compared with a typical American diet. But researchers found that replacing some carbohydrates with protein (half from plant sources) or unsaturated fat (mostly monounsaturated) can lower blood pressure even further.

Cholesterol Unhealthy cholesterol levels increase your risk of heart disease, which is why experts recommend that you

Table 2 Cholesterol guidelines Total cholesterol level

Category

Less than 200*

Desirable

200–239

Borderline high

240 and above

High

LDL (bad) cholesterol level

Category

Less than 100 (less than 70 for people at very high risk)

Optimal

100–129

Near optimal

130–159

Borderline high

160–189

High

190 and above

Very high

HDL (good) cholesterol level

Category

Men: less than 40 Women: less than 50

Low (representing risk)

60 and above

High (heart-protective)

Triglyceride level

Category

Less than 150

Normal

150–199

Borderline high

200–499

High

500 and above

Very high

*Units are in milligrams per deciliter (mg/dL) Source: Adapted from the 2001 Third Report of the National Cholesterol Education Program of the National Heart, Lung, and Blood Institute.

Cholesterol basics Despite its bad reputation, cholesterol plays a vital role in the formation of cell membranes, a number of hormones, and vitamin D. For that reason, the body closely regulates the supply of cholesterol in the blood, called serum cholesterol or blood cholesterol. The bloodstream delivers cholesterol to cells throughout the body. But this process isn’t as simple as it sounds. Like oil and water, fats and blood don’t mix. If your liver or intestine simply dumped fats into your blood, they would congeal into unusable globs. To avoid that problem, the body packages cholesterol with proteins into capsules known as lipoproteins. Low-density lipoprotein (LDL) carries cholesterol from the liver to the cells of the body. Excess LDL cholesterol in the blood is deposited as plaque in the walls of the blood vessels, where it can cause a narrowing that can lead to a heart attack or stroke. That’s why LDL has been dubbed the “bad” cholesterol.

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High-density lipoprotein (HDL), on the other hand, helps lower your risk of heart disease, so it’s known as the “good” cholesterol. In a process known as reverse cholesterol transport, HDL scours the cholesterol from blood vessel walls and carries it back to the liver. The liver then either uses the excess cholesterol to make bile acids, which are essential to digestion, or eliminates it from the body. Research suggests that HDL also has anti-inflammatory and plaque-stabilizing properties that can counteract the effects of LDL. Triglycerides, another form of fat circulating in the bloodstream, make up most of the fat you eat and serve as valuable sources of energy. But as with cholesterol, you can have too much of a good thing: high levels of triglycerides appear to increase the chance of developing heart disease. A blood test known as a lipoprotein profile can measure your LDL and HDL. For LDL, low numbers—below 100 milligrams per deciliter (mg/dL)—are best, and for HDL, high numbers— 60 or more mg/dL—are best (see Table 2).

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rated fat and trans fat both increase LDL (bad) cholesterol and boost levels of triglycerides (another fat in the blood). Even worse, trans fat lowers your levels of HDL (good) cholesterol. (For a quick primer on the types of cholesterol, see “Cholesterol basics,” page 3.) Your diet, weight, and level of physical activity affect your cholesterol levels, as do things you can’t control such as age, sex, and heredity. Before menopause, women generally have lower total cholesterol than men. But afterward, women’s LDL levels often rise. In addition, people respond in different ways to the cholesterol in foods. For Table 3 Normal, overweight, or obese? some, cholesterol in food directly translates to increased cholesterol in the bloodstream. The body mass index (BMI) is an index of weight by height. The definitions of normal, overweight, and obese were established after researchers examined the For others, cholesterol intake appears to BMIs of millions of people and correlated them with rates of illness and death. have little bearing on blood cholesterol. These studies identified the normal BMI range as that associated with the lowest Even so, the best strategy is to eat the types rates of illness and death. of foods that will help you keep your cholesHeight Body weight in pounds terol levels in the healthy range. That means 4’10” 91–115 119–138 143–162 167–186 191+ keeping saturated fats and trans fats to a mini4’11” 94–119 124–143 148–168 173–193 198+ mum, while consuming more healthy unsaturated fats (see “Facing the fats,” page 7). 5’0” 97–123 128–148 153–174 179–199 204+

keep your cholesterol levels within the healthy range (for current guidelines, see Table 2). But don’t be fooled into thinking that foods labeled “cholesterol free” or “low cholesterol” are necessarily heart-healthy—or, for that matter, that foods containing cholesterol are heart-risky. The reality is more complicated. Foods containing high levels of saturated fat or trans fat—such as potato chips and packaged cookies— can boost cholesterol levels in your body much more than cholesterol-containing foods such as eggs. Satu-

4

5’1”

100–127

132–153

158–180

185–206

211+

5’2”

104–131

136–158

164–186

191–213

218+

5’3”

107–135

141–163

169–191

197–220

225+

5’4”

110–140

145–169

174–197

204–227

232+

5’5”

114–144

150–174

180–204

210–234

240+

5’6”

118–148

155–179

186–210

216–241

247+

5’7”

121–153

159–185

191–217

223–249

255+

5’8”

125–158

164–190

197–223

230–256

262+

5’9”

128–162

169–196

203–230

236–263

270+

5’10”

132–167

174–202

209–236

243–271

278+

5’11”

136–172

179–208

215–243

250–279

286+

6’0”

140–177

184–213

221–250

258–287

294+

6’1”

144–182

189–219

227–257

265–295

302+

6’2”

148–186

194–225

233–264

272–303

311+

6’3”

152–192

200–232

240–272

279–311

319+

6’4”

156–197

205–238

246–279

287–320

328+

BMI

19–24

25–29

30–34

35–39

40+

NORMAL

OVERWEIGHT

CLASS I OBESITY

CLASS II OBESITY

CLASS III OBESITY

Healthy Eating for a Healthy Heart

The impact of weight

The amount of food you eat, as measured by the number of calories consumed, may be just as important as the type of food you eat. In fact, your weight is a good predictor of your risk for developing heart disease. Excess weight can raise blood pressure and increase levels of LDL, triglycerides, and blood glucose (blood sugar). It can also decrease HDL. All of these factors elevate your chance of developing heart disease. If you have gained weight since high school, you’re not alone. Since the mid-1980s, the number of people who are overweight or obese has risen sharply in the United States. Data from the National Center for Health Statistics show that more than 60 million Americans ages 20 or older, or nearly a third of adults, are now obese. Another third are overweight. This is disturbing because even a seemingly moderate weight gain in adultwww.health.har vard.edu

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hood can increase your risk of heart disease. In long-term investigations, the Nurses’ Health Study and the Health Professionals Follow-up Study found that middle-aged women and men who had gained between 11 and 22 pounds after age 20 were up to three times more likely to develop heart disease than those who’d gained 5 pounds or less. Achieving a healthy body weight is key to reducing your risk of heart disease. So, how much should you weigh? One way to determine this is to use the body mass index (BMI), which takes both your weight and height into consideration. To figure out your BMI, measure your height and weight. Then look at the BMI values listed in Table 3.

lowing five characteristics has metabolic syndrome: • abdominal obesity (waist circumference greater than 35 inches in women, or 40 inches in men) • high triglycerides (150 mg/dL or more) • low HDL (less than 50 mg/dL for women and 40 mg/dL for men) • high blood pressure (130/85 mm Hg or higher)

Figure 1 Apples and pears

• If your BMI is between 19 and 24, congratulations! That’s a healthy weight. The challenge, of course, is to keep it at that number.

Waist measurement

• If your BMI is 25 or above, try not to gain any more weight, and lose some if possible.

Hip measurement

• If your BMI is below 19, you may be too thin. Some people with serious illnesses such as emphysema, cancer, or heart failure can become extremely thin. If you begin to lose weight rapidly, check with a doctor. Another measure of your heart disease risk is waist size (see “Metabolic syndrome,” below). Carrying a “spare tire” around your middle—also known as the “apple” shape—can be more dangerous than carrying fat around your hips and thighs, known as the “pear” shape (see Figure 1). In fact, numerous studies reveal that the waist-to-hip ratio, which compares the size of the abdomen to the hips, is a stronger predictor of heart disease than BMI. In general, women whose waistlines are greater than 35 inches and men whose waistlines are greater than 40 inches should make an effort to lose weight—and inches. While the tendency to be apple-shaped as opposed to pear-shaped is partly a matter of heredity, adding pounds also adds girth, so losing weight will reduce your waistline.

Metabolic syndrome Today, more and more Americans are being diagnosed with metabolic syndrome, a cluster of conditions that promote heart disease. Anyone with three of the folwww.h e a l t h . h a r v a r d . e d u

©Harriet Greenfield

The waist-to-hip ratio (WHR) is one way to estimate how much weight a person is carrying around the abdomen versus around the hips. Men and women with a higher WHR (resembling an apple shape) have a higher risk for heart attack and stroke than men and women with a lower WHR (resembling a pear shape). To determine your WHR: 1. With your abdomen relaxed, measure your waist at its narrowest (usually at the navel). 2. Measure your hips at the widest point (usually at the bony prominence). 3. Divide the waist measurement by the hip measurement to determine the WHR. A healthy WHR for women is 0.8 or less (and a waist measurement of 35 inches or less), and a healthy WHR for men is 1.0 or less (and a waist measurement of 40 inches or less). Healthy Eating for a Healthy Heart

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• high fasting blood sugar (100 mg/dL or more). An estimated 50 million Americans have metabolic syndrome, which increases the risk of both diabetes and heart disease. Most people with metabolic syndrome are insulin resistant, meaning that their bodies don’t respond well to insulin and their blood sugar levels remain high. Many also have greater artery inflammation and a tendency to have blood clots, which can lead to heart attack and stroke. Management of metabolic syndrome is the same as for general heart health: weight control, a hearthealthy diet, increased physical activity, and, for people at high risk of heart disease, medications.

6

Healthy Eating for a Healthy Heart

Why lifestyle changes help

Despite major advances in drugs and medical treatments, maintaining a healthy diet, exercising, and not smoking are still the best approaches to preventing heart disease. Improving your diet can in itself help lower high cholesterol, blood pressure, and blood sugar levels as well as prevent obesity. Consider your overall eating pattern rather than focusing on individual foods. There are no “magic” foods that can make you healthy. Eating a variety of foods helps to ensure that you have a sufficient supply of nutrients and energy. The rest of this report will explore practical steps for eating your way to a healthy heart.

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Nutrition basics

T

he Food and Nutrition Board of the Institute of Medicine recommends staying within the following calorie ranges to meet daily nutritional requirements: • fat: 20% to 35% of total calories • carbohydrates: 45% to 65% of total calories • protein: 10% to 35% of total calories. But many people find such ranges to be confusing and hard to monitor on a daily basis. For basic and easy-to-follow dietary guidelines, the best advice is to consult the Healthy Eating Pyramid (see Figure 2). Built by Professor Walter C. Willett of the Harvard School of Public Health as an alternative to the old Food Guide Pyramid from the U.S. Department of Agriculture (USDA), this eating guide is based on scientific studies. The foundation of the Healthy Eating Pyramid is exercise and weight control. These are the other basic building blocks of the pyramid:

actual amount of fat (in grams) stayed about the same. Ironically, the effort to reduce fat in the American diet has led to a gradual increase in caloric consumption, which many experts believe has caused higher average weights and a significant increase in obesity. Dietary fat is not the primary cause of body fat. What matters is total calories, not so much the source of calories. Fats, proteins, and carbohydrates, when consumed in excess, can all contribute to weight gain. Researchers have also discovered that not all fats are created equal (see Table 4). Monounsaturated and polyunsaturated fats are actually good for the heart and essential to body functions. These healthy fats, which are abundant in the Mediterranean diet (see page 26), are part of the reason this diet is good for

Figure 2 Healthy eating pyramid

• whole grains (instead of refined breads and cereals, white rice, and refined pasta) • healthy unsaturated fats (instead of harmful saturated and trans fats) • plenty of vegetables and fruits (at least five servings a day)

Daily multivitamin for most

• healthy proteins, such as fish, poultry, beans, and nuts (instead of red meat).

Facing the fats

For years, all fat was vilified. The assumption was that eating fat made you fat, which was bad for the heart. Many Americans tried to follow nutritional recommendations to cut fat to about a third of their total calories. But to compensate, they began loading up on carbohydrates (which are often substituted for fat in low-fat products)—and on calories. So while the percent of calories from fat dropped somewhat, the www.h e a l t h . h a r v a r d . e d u

The latest nutritional science is represented in the Harvard Healthy Eating Pyramid. The widest part at the bottom of the pyramid indicates the most important category: daily exercise and weight control. The foods at the top are those that should be eaten sparingly. Pyramid adapted from Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating, Simon & Schuster, 2005).

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Best seafood choices These fish and shellfish are rich in omega-3 fats and low in contaminants: • Anchovies

• Sardines

• Atlantic herring

• Scallops

• Atlantic mackerel

• Trout

• Mussels

• Wild salmon (canned or fresh)

your heart. But saturated and trans fats (which are plentiful in typical Western diets) can raise cholesterol levels and clog arteries. Replacing bad fats with good fats is more effective in preventing heart disease than reducing overall fat intake. Based on data from more than 80,000 women enrolled in the Nurses’ Health Study, researchers estimated that replacing 5% of calories from saturated fat with unsaturated fats would reduce the risk of heart disease by 42%, and replacing just 2% of calories from trans fat with unsaturated fats would reduce risk by 53%.

The importance of omega-3 fats Some 35 years ago, scientists noted that Greenland Eskimos, who subsisted largely on fish, had a low rate of heart disease. This finding led to research on the benefits of fish and the discovery of omega-3 fats— polyunsaturated fats that are particularly heart-healthy. Oily, cold-water fish, such as salmon, herring, sardines, and tuna, contain forms of omega-3 fats known

as EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). Another form of omega-3 fat, ALA (alpha-linolenic acid), is found in flaxseed, canola, and soybean oils as well as in walnuts. ALA plays a vital role in the production of metabolic energy and, to a limited extent, can be converted by the body into heart-healthy EPA and DHA. (Men, however, should be aware that research shows that high ALA intake may increase the risk of aggressive prostate cancer.) Numerous studies show that omega-3 fat in fish can reduce the risk of heart attack, stroke, or sudden cardiac death (caused by electrical problems in the heart). An analysis of data from 11 studies tracking a total of 222,364 people found the risk of death from coronary artery disease fell as fish consumption increased. Eating fish a few times a month reduced risk by 11%, two to four times a week by 23%, and five or more times a week by 38%. On the basis of such findings, the American Heart Association (AHA) recommends that people eat fish, especially oily fish, at least twice a week. If you have heart disease or are at risk for developing it, consider eating fish even more often, or talk to your doctor about taking fish oil supplements (see “Who should consider fish oil capsules?” on page 9). What about contaminants such as mercury, found in certain types of fish? A study conducted by the Harvard School of Public Health determined that for all adults, the benefits of modest fish intake—one to two servings per week—exceed the potential risks from mercury or other contaminants. However, women of childbearing age are cautioned to avoid eating larger,

Table 4 Fats: Form and function State at room temperature

Effect on cholesterol

Olives and olive oil, canola oil, peanut oil; cashews, almonds, peanuts, and most other nuts; peanut butter; avocados

Liquid

Lowers LDL; raises HDL

Polyunsaturated fat Saturated fat

Corn, soybean, safflower, and cottonseed oils; fatty fish

Liquid

Lowers LDL; raises HDL

Whole milk, butter, cheese, and ice cream; red meat; chocolate; coconuts, coconut milk, and coconut oil

Solid

Raises both LDL and HDL

Trans fat

Most margarines; vegetable shortening; foods containing Solid or semi-solid partially hydrogenated vegetable oil; deep-fried chips; many fast foods; most commercial baked goods

Type of fat

Main sources

Monounsaturated fat

Raises LDL; lowers HDL

Adapted from Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating by Walter C. Willett, M.D., with P.J. Skerrett (Simon & Schuster, 2005).

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long-lived fish like swordfish, shark, golden bass, and king mackerel, which have a higher concentration of contaminants. To play it safe, it makes sense for everyone—not just pregnant women—to select varieties high in omega-3s but low in contaminants (see “Best seafood choices,” page 8).

Who should consider fish oil capsules? In 2002, the AHA recommended that people with documented heart disease get about 1 gram of EPA plus DHA per day, preferably from fatty fish. But for many people, that goal may be tough to reach. You’d have to eat 2 to 3 ounces of wild salmon or 4 ounces of white tuna (canned in water) every single day. If you don’t care for fish (or that much fish), you may want to talk to your doctor about taking fish oil capsules, which are widely available over the counter. But be aware that these supplements aren’t closely regulated by the FDA, so you don’t Fish oil capsule always know what you’re get(actual size) ting. And you’ll probably need to take several capsules per day to get the recommended amount. Another option is a prescription fish oil capsule (Lovaza), which contains nearly 1 gram of EPA plus DHA per capsule. The AHA suggests higher doses—2 to 4 grams of EPA plus DHA per day—for people who need to lower their triglycerides. High doses of omega-3s, together with a healthy diet, have been shown to lower high triglyceride levels. However, certain people with serious forms of heart disease should go easy on fish and fish oil— namely, those with hard-to-control angina, severe heart failure, or an implanted cardiac defibrillator. Omega-3 fats help the heart’s ventricles maintain a steady beat and guard against erratic rhythms. But in people with serious heart damage, this strategy may backfire, as evidenced by findings from some studies showing worse outcomes in people with those specific types of heart problems. Fish oil is free of mercury and other contaminants found in some fish. The capsules may be less expensive than eating fish, but for some, the large capsules www.h e a l t h . h a r v a r d . e d u

can be hard to swallow and may leave a fishy aftertaste or belches. Freezing the capsules can help, or try odorless or deodorized capsules. For vegetarians, V-Pure capsules contain EPA and DHA extracted from algae, which is where fish get them.

The threats from trans fat Scientists now recognize that trans fat, once thought to be beneficial, can be harmful. Trans fats are made through the process of hydrogenation, which involves adding hydrogen to vegetable oils. Trans fats have been valued by manufacturers because they increase the firmness and shelf life of commercial products, including many cookies, crackers, and deep-fried foods. For a time, some health practitioners recommended products like margarine, which contains trans fat, as a way to reduce consumption of butter and other foods high in saturated fat. But these views changed when researchers discovered that the benefits of trans fats are far outweighed by increased risks of heart disease and sudden cardiac death. Trans fats not only raise LDL cholesterol, as saturated fats do, but also lower HDL cholesterol. In other words, hardened fats can lead to hardened arteries. Given this potential for harm, the Dietary Guidelines Advisory Committee, appointed by the Department of Health and Human Services and the USDA, recommended that trans fat consumption be kept as low as possible, ideally below 1% of energy (or calorie) intake. In January 2006, the FDA began requiring that trans fat be listed, along with saturated fat and cholesterol, in the Nutrition Facts label on food packages. But always check the ingredients for the words “hydrogenated” or “partially hydrogenated,” which are both clues that the product contains some trans fat. If a food contains half a gram or less of partially hydrogenated vegetable oil per serving, federal guideFood fact Nuts contain healthy unsaturated fats. Two of the best types are walnuts, which contain omega-3 fat, and almonds, which are high in vitamin E and fiber. But eat just a handful a day, not a bowlful, to avoid getting too many calories.

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lines allow the manufacturer to still list “zero” trans fat on the Nutrition Facts label. This means that if you eat multiple servings, you’ll find yourself consuming trans fat in spite of what the label indicates. Based on evidence from studies, Harvard researchers have estimated that elimination of trans fats by restaurants and food manufacturers could prevent between 72,000 and 228,000 heart attacks and cardiac deaths each year in the United States. New York City and Chicago have taken the lead in proposing strict limits on the use of trans fats in restaurants. And many companies are reformulating product recipes to remove trans fats.

Carbohydrates: Avoid refinement

Like fats, carbohydrates—sugars, starches, and fiber— can be both good and bad. Good carbohydrates are found in foods such as fruits, vegetables, and whole grains. Bad carbohydrates are in products made with sugar (sweets, snacks, and soda) and refined grains (white bread, white pasta, and white rice). Sugars and other refined carbohydrates are digested rapidly and can cause surges in blood sugar and insulin as well as boost triglycerides and lower protective HDL cholesterol. These changes increase the risk of heart disease and diabetes. Here’s how this happens. The digestive process breaks down most carbohydrates into glucose—the simple sugar that’s the main source of energy for your body—which is then absorbed into the bloodstream. A rise in blood sugar triggers a rise in insulin, a hormone that acts as a key, helping glucose to enter the body’s Food fact Potatoes are full of starch, which means they are more like white pasta or white rice than sweet potatoes or carrots. Starchy vegetables contain more calories than many other vegetables and cause increases in blood sugar and insulin levels. Moreover, products that contain potatoes, such as French fries or potato chips, often have unhealthy amounts of salt and trans fats. Still, potatoes are not all bad. They provide lots of potassium, vitamin C, and fiber (in the skin). Just don’t make potatoes your sole vegetable in a meal.

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Healthy Eating for a Healthy Heart

cells. As the supply of glucose is depleted, the elevated blood sugar and insulin levels fall. Once blood sugar returns to normal, another hormone called glucagon prompts the liver to release stored glucose as needed to keep the body’s supply constant. When you eat refined or sugar-laden cereal, white bread, or other types of refined carbohydrates, you subject your body to the blood sugar version of a roller coaster. A rapid release of glucose causes a steep rise in blood sugar, resulting in an exaggerated response—a glut of insulin. This makes glucose levels plunge, causing your brain to send out hunger signals. Just as you reach for a handful of cookies, the liver releases stored glucose, setting you up for another sugar spike. You can avoid taking a ride on the blood sugar roller coaster, and help avoid weight gain, by eating more good carbohydrates in the form of vegetables and whole grains. Good carbohydrates take longer to digest, so blood sugar and insulin rise more slowly and peak at lower levels.

Glycemic index and load The glycemic index ranks different types of food according to how fast and how high the carbohydrates they contain raise blood sugar levels. Mashed potatoes, for example, score 74 compared with the standard 100 for glucose. Foods with scores above 55 provide quick energy boosts but also lead to rapid declines in blood sugar. But the glycemic index doesn’t take into account the quantity of food or amount of carbohydrate contained in a typical serving. Since people tend to eat more of some foods than others, Harvard researchers introduced the concept of glycemic load to represent a food’s impact more accurately. This number is calculated by multiplying the amount of carbohydrates in a serving by the glycemic index of the food expressed as a percentage. For example, if you had 20 grams of carbohydrate in a serving of mashed potatoes, you would multiply that figure by the glycemic index of 74% and end up with a glycemic load of 15. Research suggests that eating a high-glycemic diet contributes to heart disease and diabetes. One study found that eating foods with a high glycemic index, such as corn flakes and white bread, can hinder blood www.health.har vard.edu

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vessel functioning, which can contribute to clogged arteries and heart disease. To protect yourself, choose foods with a low or moderate glycemic index. For examples, see Table 5.

Be colorful! Phytonutrients and antioxidants One way to tell if you are eating healthy is to look at your plate: how colorful is your food? Fruits and vegetables with deep, vibrant colors, like blueberries, tomatoes, and broccoli, contain phytonutrients, powerful plant compounds that are important to good health. Hundreds (and perhaps thousands) of different phytonutrients exist, including vitamins and minerals, and they protect the body from disease. No single fruit or vegetable can provide every beneficial chemical, so eating a variety of colorful foods is key. Well-known phytonutrients include carotenoids (which make carrots and sweet potatoes orange), flavonoids (which make grapes reddish), and anthocyanins (which make blueberries blue). In addition to pigments, phytonutrients impart flavors and aromas.

Allyl sulfides, a group of flavonoids, are found in garlic, onion, and shallots. Phytonutrients are usually most beneficial when consumed in raw foods. An exception is lycopene, which is fat-soluble. That means the body is better able to absorb lycopene when it is cooked in a small amount of healthy fat—such as tomato sauce made with olive oil. One of the vital roles phytonutrients perform is to act as antioxidants, which protect the body from harmful unstable oxygen molecules, known as free radicals. While free radicals occur naturally as byproducts of body processes, such as burning fat, they also are produced in response to environmental factors like tobacco smoke, pollution, pesticides, and excessive sunlight. If allowed to roam loose in the body, free radicals can damage DNA, certain cell structures, and cell membranes. But antioxidants can capture these destructive agents by chemically combining with them and rendering them harmless. Researchers believe antioxidants can also protect against coronary artery disease by preventing LDL cholesterol from reacting

Table 5 Choosing foods with a low glycemic index Low glycemic index (best choice)

Moderate glycemic index

High glycemic index

beets, butternut squash, green peas, parsnips, plantain, pumpkin, sweet potato

corn, French fries, potato, potato chips

applesauce, banana, dried fruit, mango, papaya, pineapple, watermelon

fruit juices and drinks

peanut butter (with sugar)

breads and related products such as bagels, English muffins, and crackers made with minimally processed whole-grain flours; high-fiber breakfast cereals; other whole grains, such as brown rice, buckwheat (kasha), bulgur, millet, quinoa, and wheat berries; pasta (not canned).

breads and related products such as bagels, English muffins, and crackers made from refined or processed flour, including white flour; low-fiber breakfast cereals; canned pasta; popcorn; white rice.

Vegetables asparagus, avocado, broccoli, celery, chard, lettuce, mushrooms, okra, onion, peppers, spinach, tomatoes, zucchini

Fruits apples, berries, cantaloupe, cherries, grapefruit, grapes, kiwi, lemon, nectarines, oranges, peaches, pears, plums

Nuts almonds, cashews, peanut butter (no added sugar), peanuts, pecans, pistachios, walnuts

Grains steel-cut oats

Dairy cheese, milk, yogurt (no added sugar)

Source: Ending the Food Fight, by David Ludwig with Suzanne Rostler (Houghton Mifflin, 2008). See www.glycemicindex.com to look up more foods.

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Table 6 Good sources of fiber Food

Serving size

Fiber content (to nearest gram)

Cereals Fiber One

½ cup

14

All-Bran

½ cup

10

Shredded Wheat

1 cup

6

Oatmeal

1 cup (cooked)

4

Barley

1 cup (cooked)

9

Brown rice

1 cup (cooked)

4

1 square

4

Grains

Baked goods RyKrisp

Whole-wheat bread 1 slice

3

Bran muffin

1

2

Spinach

1 cup (cooked)

4

Broccoli

½ cup

3

Brussels sprouts

½ cup

2

Carrot

1 medium

2

Green beans

½ cup

2

Kidney beans

½ cup (cooked)

6

Lima beans

½ cup (cooked)

6

Baked beans

½ cup (canned)

5

Pear (with skin)

1 medium

6

Apple (with skin)

1 medium

4

Banana

1 medium

3

Prunes

6

12

Raisins

¼ cup

2

Peanuts

10

1

Popcorn

1 cup

1

Wheat bran (crude)

1 ounce

12

Wheat germ

1 ounce

4

Psyllium

1 teaspoon or 1 wafer

3

Methylcellulose

1 tablespoon

2

Vegetables

Legumes

Fruit

Dried fruits

Nuts and seeds

Supplements

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Healthy Eating for a Healthy Heart

with oxygen, which leads to the progressive thickening and hardening of the walls of arteries. Antioxidants include vitamin C, vitamin E, and beta carotene and other carotenoids, as well as the minerals selenium and manganese. The best way to obtain antioxidants is through foods—not only fruits and vegetables, but also whole grains and vegetable oils. But don’t expect the same benefits from a pill. Clinical trials show that taking antioxidant supplements has no benefit. There are no scientific data to support the use of supplements of vitamin C, vitamin E, or other antioxidants to prevent or treat coronary artery disease or cancer, although they may help slow the eye disease known as age-related macular degeneration. In some cases, in fact, antioxidant supplements can be harmful. Too much vitamin A can harm bones, increasing the risk of a hip fracture, for example. Taking too much vitamin E can increase the risk of bleeding, headache, fatigue, and blurred vision. And for smokers, beta carotene may increase the risk of lung cancer. When it comes to antioxidants, taking them in moderation—and getting them from food sources rather than supplements—is wise.

Fill up on fiber When your mother urged you to eat your roughage, she was right. Many of us need more roughage, or fiber, in our diets. Fiber refers to carbohydrates that cannot be digested and, therefore, provide no calories. Because fiber “fills you up, not out,” it helps you to manage your weight better. Eating more fiber means less room for high-calorie foods. There are two basic types of fiber: insoluble and soluble. Insoluble fiber is found in the skin, peels, and husks of fruits, vegetables, and whole grains. It passes through your digestive tract without breaking down and helps prevent constipation and other digestive disorders. Soluble fiber is chiefly in oats, legumes (beans and peas), and fruit pectin. This form of fiber absorbs water in the intestines, which slows the rate of glucose digestion and absorption in the bloodstream. And soluble fiber decreases the level of LDL cholesterol in the blood, reducing the risk of heart disease. In the Physicians’ Health Study, which involved more than 40,000 male health professionals, Harvard www.health.har vard.edu

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researchers found that a high fiber intake was associated with a 40% lower risk of coronary artery disease compared with low fiber intake. The Nurses’ Health Study produced similar results. Cereal fiber, the fiber found in grains, appeared to be exceptionally beneficial. The recommended daily intake of dietary fiber is 38 grams for men up to age 50, and 25 grams for women in this age group. Recommendations are lower for people over age 50: 30 grams for men, 21 grams for women. But Americans consume, on average, a paltry 15.6 grams daily (17.8 grams for men and 13.6 grams for women). This is partly because most Americans eat less than one serving (a slice of bread or half a cup of rice or pasta) of whole grains a day. One way to consume more fiber is to eat more fruits and vegetables and whole grains (see Table 6 for suggestions). An easy way to start increasing the fiber in your diet is to start the day off with a highfiber cereal.

Proteins: More than “meats” the eye

The answer to “What’s for dinner?” is usually a form of protein like chicken or beef. American meals tend to be meat-centered, even though fish, low-fat dairy, and legumes are also good sources of proteins and are actually healthier for you (see Table 7). During digestion, proteins from food are broken down into basic building blocks called amino acids, which your body uses to create its own proteins. You have at least 10,000 different proteins in your body. Present in every cell, proteins compose most of your hair, skin, and muscles. Proteins also make up enzymes, antibodies, and many hormones. Poultry, fish, dairy products, meat, and eggs are complete proteins, containing all the amino acids that your body needs to make new proteins. Vegetable proteins are often incomplete or lacking in certain amino acids, but can be partnered with complementary foods to provide the nutrients you need. Examples of complementary pairings include beans and brown rice, peanut butter and whole-grain bread, and tofu and brown rice. The best choices for protein come from fish, skinless chicken and turkey, beans, soy, and nuts rather www.h e a l t h . h a r v a r d . e d u

Food fact The American Heart Association (AHA) used to discourage consumption of eggs because of concern about the high cholesterol content in their yolks. But now that researchers recognize that cholesterol in food may not directly translate into cholesterol levels in the blood, eggs are coming back into favor. The AHA advises that it’s reasonable to eat an egg a day if you limit other dietary cholesterol. Be aware that eggs are often used in cooking and baking. So to be safe, instead of a whole egg, try using two whites, or buy a yolk-free egg substitute.

than foods laden with saturated fat, like red meat and cheese. In fact, eating red meat (including all types of beef and pork) and processed meat (including bacon, sausage, hot dogs, and cold cuts) raises the risk of dying of heart disease or cancer, according to a 2009 report in the Archives of Internal Medicine. For the study, which involved more than half a million adults ages 50 to 71, researchers divided the participants into five groups, based on their descriptions of their meat-eating habits on a diet questionnaire. The researchers estimated that men could cut their risk of death from heart disease by 11% and women by 21% if they ate only modest amounts of red and processed meats. As recommended

Table 7 Good sources of protein

The following foods are good sources of protein but contain little or no unhealthy fat. Food

Serving size

Grams of protein

Cottage cheese, 1% fat

1 cup

Chicken, white meat, roasted

3 ounces

Salmon

3 ounces

Light tuna canned (in water)

3 ounces

Lentils

1 cup

18

Black beans

1 cup

15

Yogurt, plain, low-fat

1 cup

Tofu

½ cup

10

Almonds

1 ounce (24 nuts)

6

28 28 23 22

12

Source: USDA National Nutrient Database for Standard Reference, 2008.

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by the Healthy Eating Pyramid (see Figure 2, page 7), eat red meat sparingly—no more than once a week— or, ideally, just two to three times per month. How much protein should you aim for? According to government guidelines, protein can range from 10% to 35% of daily calories. In the average American diet, about 15% of calories come from protein, and most people get more than enough.

Beverages: Drink to your health

What you drink can also affect your weight and health. The average person needs about 64 ounces of fluid daily. However, there’s not a drop of evidence to support the notion that you need to drink eight glasses of water. Fluid can come from a variety of sources including fruits, vegetables, milk, juice, and coffee or tea. But water has certain advantages—it’s cheap, has zero calories, and is filling. The amount you need depends on a number of factors: how many fruits and vegetables you eat, how hot or dry the weather is, how much you exercise, and how old you are. (As you age, you often lose the ability to judge thirst and may get dehydrated.) Drinking a glass of water when you wake up and one glass with each meal is a good way to ensure you’re

Heart medications affected by grapefruit juice Arrhythmia medications • amiodarone (Cordarone) • disopyramide (Norpace) • quinidine (Cardioquin, Quinaglute, others)

Calcium-channel blockers • felodipine (Plendil) • nicardipine (Cardene) • nifedipine (Procardia) • nimodipine (Nimotop) • nisoldipine (Sular)

Statins • atorvastatin (Lipitor) • simvastatin (Zocor)

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Healthy Eating for a Healthy Heart

getting enough fluids. Tap water in the United States is quite safe, but if your water tastes of chlorine, you might want to enhance its flavor with a slice of lemon. Or drink filtered or bottled water. And what about milk? Although milk is an excellent source of bone-building calcium, whole milk can provide unhealthy amounts of saturated fat. To limit the fat, the AHA recommends that adults and children over age 2 drink skim or 1% milk, fortified with vitamins A and D.

Beware of liquid calories Soda accounts for more than 25% of what Americans drink, and most of it is the sweetened version with lots of calories. Soda drinking, which increased by 135% between 1977 and 2001, contributes significantly to weight gain. A 12-ounce can of soda contains the equivalent of 10 teaspoons of table sugar. Diet sodas are sugar-free or low in calories, but have no redeeming nutrients. Some research shows that high-fructose corn syrup, the main sweetener in carbonated beverages in the United States, is metabolized differently than other sugars, in a way that decreases the body’s production of insulin, which metabolizes sugar, and leptin, a key appetite-regulating hormone. But whether high­fructose corn syrup contributes to overeating more than other types of sugar requires further study. Unlike soft drinks, fruit juice provides vitamins, minerals, and sometimes fiber. The more juice and the less sugar water, the better. (Look for “100% juice” on the label.) But like soda, juice can be high in calories. To cut back, try diluting your drink slightly. If you’re making orange juice from concentrate, for example, simply add more water. (Note that vegetable juices, such as carrot juice, have fewer calories than fruit juices.) One precaution: grapefruit juice (and whole grapefruit) can raise blood levels of a number of medications. It is known to interact with some medications for high cholesterol, high blood pressure, and congestive heart failure. See “Heart medications affected by grapefruit juice,” page 14, for a list of drugs that fall into this category. Finally, although drinking alcohol in moderation appears to improve heart health (see “Alcohol,” www.health.har vard.edu

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page 15), watch out for liquid calories here as well. A 5-ounce glass of wine, for example, has about 105 calories; a 12-ounce glass of beer, about 140 calories. Have two alcoholic beverages a night and you may soon find yourself packing on the pounds.

Coffee and tea Many people cannot function without their morning cup of coffee. Most coffees—as well as energy drinks, colas, and teas—contain caffeine, a stimulant that keeps you awake and alert. But the common assumption that caffeine can disrupt heart rhythms hasn’t been proved. Arrhythmias, in fact, are most often caused by atherosclerosis, high blood pressure, and valve disease. For the most part, it is safe to drink coffee—with a few caveats. Unfiltered brews, such as French press, Turkish, and espresso, can raise blood cholesterol levels because of a higher concentration of coffee oils produced by the higher temperatures used in preparation and longer contact between the coffee grounds and water. To be safe, either drink unfiltered brewed coffee in moderation, or filter coffee through a paper filter to greatly reduce the cholesterol-raising effect. If you are a tea drinker, you also have reason to take heart. Teas have long been considered to have medicinal effects. Research has provided a possible mechanism by showing that nearly all teas, including white, green, black, and oolong, contain powerful antioxidants called catechins. Tea companies claim that the dried but not fermented green and white varieties, in particular, can lower cholesterol and reduce blood pressure. But while catechins may well be good for the heart, clinical studies have so far been inconclusive. Alcohol The fact that rates of heart disease in France are relatively low, despite a diet that’s heavy in cream, butter, and cheese, has become known as the French paradox. Some researchers have attributed this phenomenon to high consumption of red wine in France. Experts suggest that flavonoids and other antioxidants in the red wine may be responsible for raising healthy HDL cholesterol and reducing clot formation that can lead to heart attacks. But is red wine more protective than beer, white www.h e a l t h . h a r v a r d . e d u

wine, and liquor? An analysis from the Health Professionals Follow-up Study involving more than 38,000 men over a 12-year period found that those who drank alcohol at least three to four times a week were more than 30% less likely to have a heart attack than those who did not, and that their choice of beverage made no difference in terms of protection. This and other research indicates that alcohol is the key ingredient, and that it exerts its heart-protective effects by increasing HDL levels. It’s important to drink only in moderation, however: one drink per day for women and two for men (see “What’s a standard drink?” below). For women, the overall benefit of alcohol is less clear. Although moderate alcohol consumption reduces risk of heart disease, several large studies showed that having two drinks a day increased a woman’s risk of developing breast cancer by 20% to 25%. Keep in mind that alcohol’s effects depend on how much you drink. Heavy drinking is associated with a long list of ills, including liver and heart damage, increased blood pressure, added weight, greater risk for some cancers, and impaired judgment. It can also contribute to depression and violence, be dangerous during pregnancy, and lead to deadly accidents. If you don’t drink, don’t start just to protect your heart. Many other lifestyle changes, such as weight

What’s a standard drink? • 1½ ounces (a shot) of 80-proof liquor

(bourbon, brandy, gin, rum, tequila, vodka, or whiskey) • 2 –3 ounces of fruit, coffee, chocolate, or other flavored

liqueurs (cordials) • 3 –4 ounces of fortified wine (sherry, port, marsala, or

Madeira) • 4 –5 ounces of table wine • 12 ounces of regular

or light beer

Spirits 1.5 oz

Brandy 1.5 oz

Cordial 2–3 oz

Fortified wine 3– 4 oz

Table wine 5 oz

Beer 12 oz

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reduction and increased exercise, are effective ways to protect your heart.

Other noteworthy nutrients

In addition to the big three—fat, carbohydrates, and protein—people who have heart disease, or are at risk of developing it, should pay attention to several other food factors. Three common elements (sodium, potassium, and calcium) can have potent effects on blood pressure. And compounds known as plant sterols and stanols, which are found in plant cell membranes (similar to cholesterol in animal cells) may be helpful in lowering cholesterol levels in some people.

Sodium Table salt, or sodium chloride, is 40% sodium by weight. Sodium is essential for good health, but your body needs a mere 200 milligrams (mg) a day. Most Americans get between 10 to 37 times that amount, by eating foods loaded with salt. In some people, too much sodium can cause or worsen high blood pressure. Healthy people should consume less then 2,300 mg of sodium per day (the amount in about a teaspoon of salt). But those at risk for high blood pressure, including African Americans, middle-aged and older adults, and people who already have the condition, should limit their sodium to just 1,500 mg per day. While obvious in snacks like potato chips, crackers, and pretzels, salt is a hidden ingredient in many

Table 8 Sodium ranges for selected foods Reading nutrition labels carefully lets you know how much sodium a given product contains. Some foods such as pizza or tomato soup may actually have more sodium per serving than so-called salty snacks such as potato chips and pretzels. FOOD

Serving size

Potato chips

1 ounce

120–180

Pretzels

1 ounce

290–560

Tomato juice

8 ounces

340–1,040

Tomato soup, reconstituted

8 ounces

700–1,260

Frozen pizza (plain cheese)

4-ounce slice

450–1,200

Source: U.S. Department of Agriculture, 2005.

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Healthy Eating for a Healthy Heart

Range (mg)

Understanding sodium label terms If a food is labeled “healthy,” it can’t contain more than 480 mg of sodium per reference amount, according to FDA and USDA regulations. “Meal type” products, such as frozen dinner entrees, can’t contain more than 600 mg of sodium per labeled serving size. Here is a key to other sodium-related label terms: • Sodium-free means less than 5 mg of sodium per

serving. • Very low sodium means 35 mg or less per serving. • Low sodium means 140 mg or less per serving. • Reduced sodium means that the usual sodium level is

reduced by 25 percent. • Unsalted, no salt added, or without added salt

means the product is made without the salt that’s normally used, but still contains the sodium that’s a natural part of the food itself.

canned and processed foods (see Tables 8 and 9). Prepared foods such as soups, cereals, cheese, and deli meats contribute 75% of the salt in a typical American’s diet. Bouillon cubes, salad dressings, soy sauce, and other sauces and condiments are also very high in salt. Even food you may think of as salt-free can have plenty of hidden sodium. Read labels and try to choose foods with the lowest sodium content (see “Understanding sodium label terms,” above). If you cut back on salt, food may taste bland at first, but your tastes will gradually adjust. Here are some hints on cutting back: • Taste food before you add salt. • Flavor foods with herbs, spices, and salt-free products like Mrs. Dash instead of salt. • Banish the saltshaker from the table. • Examine nutrition labels to find out how much sodium foods contain. • Look for low-sodium, reduced-sodium, or no-saltadded products. • Cut back on high-sodium broths and soups as well as frozen dinners and packaged mixes. • Limit frequency of eating out or buying take-out; most of these foods contain a considerable amount of sodium. www.health.har vard.edu

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• Buy fresh foods and make meals from scratch. • Don’t add salt to the cooking water for vegetables, pasta, or rice.

Potassium Unlike salt, potassium helps lower your blood pressure. And, chances are, you need to boost your potassium supply. Only 10% of men and 1% of women get the recommended 4.7 grams a day. Potassium is a mineral found in abundance in fruits and vegetables. Although bananas are famous for potassium, other foods are equally good or even better sources, including tomatoes, oranges, baked potatoes with skin, sweet potatoes, winter squash, spinach, and lima beans. Potassium can also be found in fish such as halibut and salmon and in plain yogurt. Getting plenty of potassium also helps to flush excess sodium from the body, and research suggests that changing the balance between these two minerals can help the heart and the arteries, according to a 2009 report in the Archives of Internal Medicine. For the study, begun back in the 1980s, researchers measured sodium and potassium levels in the urine of nearly 3,000 volunteers. (The amount excreted is a good stand-in for the amount consumed.) The investigators found that the higher the ratio of sodium to potassium, the greater a person’s chance of having a heart attack or stroke, needing bypass surgery or angioplasty, or dying of cardiovascular disease over 10 to 15 years of follow-up. The best way to get more potassium and less sodium is to eat more fresh fruits and vegetables, beans, fish, homemade foods, and low-salt versions of prepared foods (see Table 9 for suggestions). But before increasing your potassium intake, consult your physician. Some people—for example, those with kidney disease—need to limit both potassium and sodium. Also, unless your doctor recommends supplements, stick to food sources, which can give you potassium as well as other healthy nutrients. Calcium Some research suggests that low calcium levels may contribute to high blood pressure. One theory holds www.h e a l t h . h a r v a r d . e d u

that a lack of calcium prompts the body to retain sodium, which raises blood pressure. So getting enough calcium may be especially important for saltsensitive people with hypertension. Consuming plenty of calcium-rich foods and beverages appears to help prevent high blood pressure. Examples of foods high in calcium include low-fat or nonfat yogurt, cheese, and milk, as well as nondairy foods such as salmon, broccoli, tofu, and legumes. Experts aren’t sure if calcium supplements are as effective as food sources. Although studies have found that supplements successfully reduce a form of high blood pressure associated with pregnancy (preeclampsia), clinical trials of people with the more common form of hypertension (essential or primary hypertension) found that for the majority, calcium supplements either made no difference or reduced blood pressure only slightly, by an average of 1 to 2 millimeters of mercury (mm Hg) in systolic pressure (the top number in a reading). Although some people experienced dramatic reductions in blood pressure with the supplements, no common link, such as race or sex, could be found to explain this response. The best reason to take calcium supplements is to prevent osteoporosis, not heart disease. The National Academy of Sciences recommends 1,000 mg a day of calcium for adults younger than 50, and 1,200 mg a day

5 tips for a heart-healthy diet Following a heart-healthy diet doesn’t mean eating bland foods. In fact, healthy foods are full of color, texture, and flavor. Here are five basic guidelines for eating well: 1. Eat more unsaturated fats (such as olive and canola oils) and fewer saturated and trans fats (such as butter, margarine, and shortening found in many processed and commercial baked goods). 2. Eat more colorful, nutrient-loaded fruits and vegetables, and fewer potatoes. 3. Eat more fiber-filled whole grains, and fewer refined carbohydrates (white starches). 4. Eat more heart-healthy proteins such as fish, poultry, beans, and low-fat or nonfat dairy products, and less red meat. 5. Eat more potassium-rich fruits and vegetables, and less sodium-rich processed food.

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17


for those over age 50—marks many Americans don’t reach through diet alone. However, not all researchers agree. Some note that there is little evidence that just boosting your calcium intake to the high levels that are currently recommended will prevent fractures. Whenever possible, try to get a significant portion of your daily calcium requirement from nondairy food sources. High dairy intake of calcium has been linked to increased risk of prostate cancer in men and

ovarian cancer in women. And calcium supplements may increase the risk of kidney stones.

Plant sterols and stanols Your first line of defense against high LDL cholesterol is cutting back on saturated fat and trans fat in your diet. But another dietary option may help foods fortified with plant sterols or stanols. Surprisingly, these cholesterol-­lowering substances are cousins of the trou-

Table 9 Potassium and sodium in selected foods Choosing foods with a high potassium-to-sodium ratio is good for your heart. Potassium (mg)

Sodium (mg)

Potassium-tosodium ratio

1 medium

422

1

422:1

Black beans, cooked without salt

½ cup

305

1

305:1

Orange

1 medium

232

1

232:1

Orange juice

¾ cup

357

2

178:1

Grapefruit juice

¾ cup

252

2

126:1

Peanuts, dry roasted, no salt

1½ ounces

280

3

93:1

Peanuts, dry roasted, with salt

1½ ounces

280

346

0.8:1

Avocado

½ medium

487

7

69:1

Raisins

½ cup

543

8

68:1

Baked potato, plain, with skin

1 medium

926

17

54:1

Fast-food French fries

1 medium order

655

266

2.5:1

Peanut butter, without salt

2 tablespoons

208

5

42:1

Peanut butter, with salt

2 tablespoons

208

147

1.4:1

Oatmeal, regular

1 cup

164

9

18:1

Quaker’s Instant Oatmeal

1 packet

116

249

0.5:1

Cantaloupe

¼ medium

368

22

17:1

Salmon, baked

3 ounces

244

39

6:1

Salmon, canned

3½ ounces

311

399

0.8:1

V8, low-sodium

1 cup

820

140

6:1

V8, regular

1 cup

470

480

1:1

Carrots, raw

½ cup

205

44

5:1

Milk, 1%

1 cup

366

107

3:1

Cheerios

1 cup

171

186

0.9:1

Fast-food cheeseburger

1 regular

444

1176

0.4:1

Food

Amount

Banana, raw

Source: USDA National Nutrient Database for Standard Reference, 2008.

18

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blemaking cholesterol. Cholesterol itself is a kind of sterol, although it is found almost exclusively in animals. Plant sterols and stanols are naturally present in fruits, vegetables, seeds, nuts, and cereals, but not in large enough quantities to lower your blood cholesterol. Yet if chemically modified into plant sterol and stanol esters, these waxy substances can be added in greater, more effective amounts to fat-containing food products to block the absorption of cholesterol. Research shows that eating 2 grams of plant ster­ ols or stanols daily can lower your LDL cholesterol an average of 10%. (Some people may see a decrease of as much as 20%, while others may see little or no reduction.) The FDA currently allows food packages

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to carry the claim that plant sterols and stanols may reduce the risk of heart disease. Foods with this label must also meet the requirements for low saturated fat and low cholesterol. First added into margarines, such as Benecol and Take Control, sterols and stanols are now showing up in a variety of products, including chocolate, granola bars, salad dressings, yogurts, and cooking oil. If your cholesterol is slightly high, you might want to try eating plant sterols and stanols daily to control it. Be sure to use the fortified foods in place of foods already in your diet, so that you’re not adding more calories. But if your cholesterol is considerably above normal, you may need to rely on medication.

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19


Losing weight to help your heart

I

f you’re overweight (as are many people with heart disease), you know that shedding pounds will help you look and feel better. What you may not realize, however, is that losing just 5% to 10% of your weight can help reduce your risk of heart disease by dropping your cholesterol and blood pressure values. Losing weight (by the tried-and-true formula of eating less and exercising more) takes stress off your heart. Exercise also strengthens your heart, as well as the rest of your muscles, which revs up your body’s calorie-burning rate. This chapter features general weight-loss strategies as well as more specific information about various diets and how they affect heart disease risk. Even if you’re not overweight, the eating style embodied by the Mediterranean diet (see page 26) jibes well with the basic nutritional guidelines described in this report.

Healthy snacks A healthy snack will keep you energized and help you avoid junk food. It will also prevent you from feeling starved and overeating at mealtime. Eating naturally sweet fruit for snacks instead of cookies or candy is a good way to increase the fiber in your diet and cut down on extra sugar. For a more filling snack, combine a whole-grain carbohydrate with a protein or healthy fat. For example, try these: 1 apple, sliced up, and ½ ounce reduced-fat cheddar cheese ½ cup low-fat or fat-free yogurt with ½ cup fresh berries and 1 tablespoon walnuts 1 tablespoon peanut butter with 4 small whole-wheat crackers 2 tablespoons hummus and a small piece of whole-grain pita bread 1 ounce unsalted nuts (24 almonds, 28 peanuts, or 47 pistachios) 1 cup baby carrots and 2 tablespoons salsa

20

Healthy Eating for a Healthy Heart

Do you need to lose weight?

To determine whether you are currently at a healthy weight, use the BMI chart (see Table 3, page 4) to see what doctors consider a normal weight for your height. Next, determine how many calories your body needs to maintain a healthy weight. Factors such as your age, sex, activity level, and the shape you are in (amount of muscle vs. fat) influence how many calories your body needs. But you can make a rough estimate by multiplying your current weight by 11.4. This means that if you weigh 160 pounds, for instance, you will need about 1,824 calories a day to fuel your body and maintain your weight. If you want to lose weight, aim for fewer calories per day. To determine your daily calorie count, add up the number of calories per serving of all the foods that you eat throughout the day. Nutrition labels on packaged foods and beverages list calories. Calorie counts for other foods, such as fresh fruits, vegetables, and meats, are available from books, Web sites, and handheld calculators (see “Resources,” page 46). Recipes may also provide calorie counts and other nutritional information. If you are overweight or obese, most experts recommend that you try to reduce your weight by about 10% over a six-month period, then try to maintain that weight before losing more. So, if you are 5 feet, 9 inches and weigh, say, 250 pounds (a BMI of 37), your initial goal will be to lose 25 pounds over six months, or about 4 pounds a month. If you are moderately active (doing at least 30 minutes of physical activity on most days), you can lose a pound a week by cutting 500 calories a day. Analyze your food diary (see page 22) to see where you can eliminate calories (for example, by switching from regular cola to diet soda). Try to avoid rapid weight loss—more than a pound or two a week. Be sure to eat enough nutritious foods to maintain your health. Women should www.health.har vard.edu

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consume at least 1,200 calories a day and men 1,500, unless dieting under the supervision of a health professional. Rather than relying strictly on numbers, the AHA’s dietary guidelines suggest taking a common-sense approach to choosing foods. Instead of counting calories, track what you eat and how often, and choose mostly lower-calorie foods. Follow the general guideline that a serving that contains 400 calories or more is high, while one that contains 40 calories or less is low. And rather than counting calories from fat, focus on the type of fat: limit unhealthy saturated and trans fats, while consuming healthy monounsaturated and polyunsaturated fats.

Advice from successful losers

Each of the following practices is a proven strategy for losing weight.

Keep a food diary Recording what you eat and drink in a food diary will allow you to analyze your current eating pattern. Jot down each item right away, so you don’t forget. Report these facts to discern eating “triggers” that you may want to avoid to lose weight: • When you eat. Note the day and time. • Where you eat. Are you at home, at a restaurant, or on the go? • What you eat. Include all foods and beverages, even samples and sips. Tell how foods were prepared (for example, baked or fried). • How much you eat. Determine portions using meas­ uring cups, measuring spoons, and a food scale until you become accustomed to “eyeballing” serving sizes.

• Why you eat. What prompted you to eat or drink— hunger, stress, or boredom? In the same diary, you may also want to keep track of how much you exercise. Record the type of physical activity, the intensity (easy, moderate, or hard), and the length of time you exercised. See “Sample food diary,” page 22; for a blank version to fill out yourself, see the Appendix (page 30).

Control portions These days, a “small” ice cream cone is often two scoops. Other foods like muffins, bagels, and even chicken breasts have also ballooned in size. According to the Centers for Disease Control and Prevention, Americans are eating more calories than they did in the 1970s. Between 1971 and 2000, the average man added 168 calories to his daily fare, while the average woman added 335 calories a day. Much of this increase is due to the size of food portions—how much you eat at one time. Today’s larger portions promote increased eating. Restaurants view larger sizes as a way to add “value” to a meal at little expense. One study found that compared with 15 or 25 years ago, restaurants use larger dinner plates, pizzerias use larger pans, and fast-food outlets use larger containers for drinks and French fries. And cookies are now seven times the size set by USDA standard portions. It boils down to this: if you supersize your food, you may end up supersizing your body. Smaller portions mean fewer calories. So exercise portion control (see “Quick tips for portion control,” below), emphasize quality over quantity, and savor what you eat. Eat breakfast Many people skip breakfast, or gobble a quick piece of toast or a muffin with a cup of coffee or tea. But hav-

Quick tips for portion control 1 thumb tip = 1 teaspoon of peanut butter, butter, or sugar thumb tip

thumb tip

finger

fist

thumb tip

finger

finger

thumb tip

fist

fist

1 finger = 1 oz of cheese

thumb tip

finger 2 handfuls

2 handfuls

fist palm

handful

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2 handfuls

finger

1 fist = 1 cup cereal, pasta, vegetables

1 palm = 3 oz of meat, fish, or poultry thumb tip 2 handfuls

palm

1 handful = 1 oz of nuts palm

palm

handful

fist

finger

fist

handful

2 handfuls = 2 oz of pretzels

2 handfuls

palm

handful

handful

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palm

handful

21


22

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Alone Colleagues

Alone Husband

Car

Work

Kitchen

Kitchen

11:00–11:05 am

1:30–2:00 pm

6:00– 6:10 pm

6:30–7:05 pm

Alone

Alone

Car

10:00–10:10

Bed

Alone

Kitchen

8:30–8:45 am

9:30–9:45 pm

(alone, or with family, friends, colleagues)

(kitchen, living room, bedroom, car, desk at work)

(record start and end time of meal or snack)

With whom

Place

Time

Sample food diary

Watching TV

Talking

Cooking

Talking

Driving

Driving

Watching TV

(reading, watching TV, talking, cooking)

Activity

Tired

Tired

Tired

Happy

Rushed

Happy

Rushed

(neutral, happy, tense, depressed, angry, bored, rushed, tired)

Mood

2

4

5

5

2

3

4

(1–5, with 0=no hunger, 5=starving)

Hunger

100

Low-fat string cheese

Broccoli White wine

1 cup 2 glasses

Frozen yogurt

Brown rice

1 cup

1 cup

Baked chicken

6 oz

Total:

3

X

X

50

X

X

X

2

1

3

2

240

?

?

Chocolate chip cookie 1 large 2 pieces

? Cheese Pizza

140

2 large slices

1

2

X

30

Kashi Chewy Granola Bar

Sugar

2 teaspoons

X

100

X

(X=yes)

Filled out just before or after eating

X

2

(after eating: 1=still hungry 2=quite satisfied 3=uncomfortable)

Fullness

90

200

80

Banana

1 medium

Calories

(if unknown, leave blank)

Apple

Skim milk

1 cup

1 medium

Shredded wheat cereal

Food

1¼ cups

Amount


ing a healthy morning meal makes for smaller rises in blood sugar and insulin throughout the day, according a host of small studies. That, in turn, can help lower levels of harmful LDL cholesterol and triglycerides. Studies show that people who eat breakfast tend to eat less throughout the day than those who skip it, and they also are more likely to have better quality diets. Finally, several large studies show that eating breakfast, especially one that includes whole-grain foods, reduces the chances of having a heart attack or stroke. For some healthy breakfast suggestions, see “Get a hearty start,” right.

Balance your plate Here’s an easy way to see if you’re eating a well-balanced meal. As you prepare or serve your food, think of a three-section plate. In the big section (half of the plate), serve yourself two or three different vegetables or two vegetables and a fruit. In one of the two smaller sections (a quarter of the plate), put a serving of fish, poultry, beans (like black, pinto, or kidney beans), or another healthy protein. Fill the remaining section with a whole grain, such as brown rice or a whole-wheat roll, or another healthy carbohydrate. As you divide your plate, keep in mind that vegetables are not all the same. Starchy vegetables—sweet potatoes, peas, corn, and winter squash—have about triple the amount of calories and carbohydrates as nonstarchy vegetables. So reserve the vegetable section for the likes of broccoli, leafy greens, tomatoes, carrots, and green beans. And put starchy (but nutrient-­filled) vegetables in the carbohydrate quarter. A balanced plate helps you reduce your total calories, reduce the saturated fat and carbohydrates in your diet, and increase heart-healthy nutrients like antioxidants, B vitamins, and fiber. If a shift from meat and potatoes to a plate half full of vegetables is too difficult, divide your vegetables, protein, and starch sections into equal thirds. Any reduction in the amount of meat and starch you eat will improve your health.

Move your body In addition to aiding weight loss, regular exercise www.h e a l t h . h a r v a r d . e d u

reduces your risk for heart disease, in part by lowering your odds of developing two major cardiac risk factors: hypertension and diabetes. And if you already have heart disease, exercise reduces your risk of dying from it. What’s more, moderate to vigorous exercise can help you reduce stress, have more energy, sleep better, control your weight, increase your bone density, brighten your mood, sharpen your mental functioning, and improve your sex life. Research shows that “couch potatoes” who adopt a more active lifestyle experience the biggest health gain. Current federal guidelines call for moderateintensity exercise for at least 30 minutes on most, and preferably all, days of the week. To qualify as moderate exertion, activities must make your breathing and heartbeat more rapid. In addition to walking, activities may include biking, golfing (while walking the course), canoeing, downhill skiing, swimming, dancing, gardening, and housework.

Get a hearty start Breakfast can be as simple as a few handfuls of trail mix or as elaborate as a multicourse meal. Here are some suggestions for keeping it as healthful as possible: • a bowl of steel-cut oatmeal topped with fruit and

walnuts (make a batch on Saturday and eat it all week long) • a bowl of high-fiber, whole-grain cereal such as

Fiber One, Shredded Wheat, or Cheerios (anything with a whole-grain product as the first ingredient and few added sugars) with milk and sliced banana, straw­berries, blueberries, or other fruit • 6 or 8 ounces of 1% yogurt with blueberries and

sunflower seeds • a whole-grain English muffin with peanut butter • an omelet made with one egg and one egg white,

or egg substitute, served with whole-grain toast and orange slices—or, even better, a veggie omelet • a whole-wheat tortilla with a smear of peanut butter

wrapped around a banana • a smoothie made with milk, yogurt, orange or pineapple

juice, fresh or frozen strawberries or blueberries, and a few slices of banana, perhaps with oat bran, ground flax seeds, or wheat germ for extra fiber and healthful oils.

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Every little bit counts Any physical activity can offset the calories you eat and increase your level of fitness. To get started, think of ways to add movement to your daily routine. For example, at the grocery store or your office, park far away from the door and walk. Take the stairs instead of the elevator. Try pacing while you talk on the phone. Or, if possible, walk or ride a bike instead of driving. Coupling this kind of activity with regular, structured exercise will help further condition the muscles in your body, including the heart.

But for some people, it’s a good idea to aim even higher when it comes to exercise. For example, if you want to guard against the gradual weight gain that often occurs in adulthood, it’s best to aim for roughly 60 minutes of moderate to vigorous activity on most days of the week. And if you are trying to lose weight or maintain a healthy weight (if you were once overweight or obese), aim for 60 to 90 minutes of moderate activity on most days. For those who have trouble finding time to exercise, here’s good news: short bouts of physical activity—10 to 15 minutes at a time—appear to be as beneficial as longer sessions. In fact, a 2006 study published in the Journal of Hypertension found that taking four short walks a day may be even more effective in reducing blood pressure than one long walk. The research compared the effects of four 10-minute walks to one 40-minute walk in people with prehypertension (blood pressure ranging from 120/80 mm Hg to 139/89 mm Hg). Both short and long walks decreased blood pressure by the same amount, but four short walks had a longer-lasting effect than a single long walk: 10 to 11 hours of lower blood pressure versus seven hours. Other research has shown that regular physical activity, even when done in short chunks, also improves blood cholesterol levels. Before starting an exercise program, check with your doctor, especially if you are over age 40, are overweight, or have heart disease. Begin slowly and gradually build up, setting short-term goals for yourself (such as walking a mile) along the way. Choose activities that you like, so that you’ll stick with it. And remember, the more muscles you use, the more calories you’ll burn. 24

Healthy Eating for a Healthy Heart

Strive for a combination of the three basic kinds of exercise: ■ Aerobic exercise. Also called cardiovascular exercise, this form of activity strengthens the heart and lungs and is the foundation of any fitness program. Consisting of continuous movement of large muscle groups in the legs and arms, aerobic exercise includes walking, jogging, cycling, dancing, and swimming. To avoid injury, it’s best to warm up before doing aerobic exercise, and cool down afterward by doing low­intensity exercises. ■ Strength training. These activities tone and build muscles and bone mass. Strength training includes working out with weight machines, free weights, and resistance bands. Sit-ups, push-ups, and leg lifts are also strengthening exercises. So is Pilates, which especially builds strength in the core abdominal and back muscles. ■ Stretching. Another essential part of exercising, stretching muscles increases your range of motion and relieves stress. Yoga and tai chi are examples of this flexibility-building type of exercise.

Track your progress A weekly weigh-in can be helpful to keep you on track; just don’t get discouraged by the occasional spike in weight. As long as the trend over time is downward, you’re heading in the right direction. When you visit your doctor, check to see if your blood pressure and total cholesterol levels are normal or have dropped. Also find out if your LDL cholesterol is lower and your HDL cholesterol is higher. Changing habits isn’t easy, so reward yourself when you make progress. Of course, the biggest reward will be knowing that you’re doing something good for your heart and your overall health.

Weight-loss diets and your heart

A number of diets have been touted for helping people both lose weight and improve heart health. The growing consensus on weight-loss diets in general (regardless of any health issues you may have) is that specific components of the diet matter less than how well you can stick to the diet plan. To help your heart, the Medwww.health.har vard.edu

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iterranean diet (see page 26) has a long and strong track record. A study led by Harvard researchers, published in 2009 in The New England Journal of Medicine, reaffirmed the weight-loss story. The multisite study compared four different low-calorie diets (high fat, high protein; high fat, average protein; low fat, high protein; and low fat, average protein) in 811 overweight adults. Although all the participants lost an average of about 13 pounds in the first six months (about 7% of their initial weight), they started to regain at the oneyear mark. After two years, average weight loss was the same in all groups—about 9 pounds, on average. Following are brief summaries of popular diets and their effects on heart disease and related risk factors. ■ Very low-carbohydrate diets. This protein-rich eating style, popularized by the Atkins diet, strictly limits carbohydrates, including most fruits and vegetables, but allows free rein on calories and fat. The short-term weight loss often seen with this diet has been attributed to a boost in fat metabolism and its satiating properties­—people usually don’t feel hungry on this diet. A study that combined results from six different trials of very low-carb diets found that while people lost more weight on this diet than on a comparison diet (usually a low-fat, low-calorie diet) over six months, the weight loss among the different diets was the same after one year. Of note, LDL cholesterol levels were the same in people on the different diets, while HDL and triglyceride levels improved at six and 12 months on the very low-carb diets. However, no studies have examined whether an Atkins-style diet can lower the rate of heart disease and death. ■ Low-carbohydrate diets. The South Beach diet is perhaps the best known of the low-carb diets, which also include the Zone diet and Sugar Busters. Many are based on the glycemic index (see “Glycemic index and load,” page 10) and recommend healthy (monounsaturated and polyunsaturated) fats. A trial that compared the South Beach diet with the National Cholesterol Education Plan (NCEP) diet for 12 weeks found no lipid level differences between the two groups, but the South Beach dieters lost an average of about six more pounds than the NCEP group. A year-long trial comparing the Zone diet with three other diets revealed www.h e a l t h . h a r v a r d . e d u

comparable weight loss and lipid improvements among all four plans. Large population-based studies have linked lower HDL cholesterol levels (a risk factor for heart disease) with consumption of foods that have high glycemic index values. But there aren’t any studies documenting lower rates of heart disease among people on low-carb diets. ■ Very low-fat diets. The rationale for these diets stemmed from the connection between saturated fat and atherosclerosis. The most-studied version, the Ornish diet, is a vegetarian diet that restricts fat to just 10% of total calories—far lower than the 30% consumed by most Americans. The Ornish program also integrates exercise and meditation along with smoking cessation, and advises dieters to avoid alcohol and caffeine. A five-year study of men with heart disease showed the diet cut LDL cholesterol by about 20%, with no effect on HDL and triglycerides. The men lost an average of nearly 13 pounds compared with no change in the control group. The findings also revealed a 91% decrease in angina symptoms after a year and a 72% decrease after five years among men following the diet. But men in the control group experienced a 186% increase in angina symptoms after one year. Within five years, the control group’s angina symptoms had

Figure 3 Mediterranean diet pyramid Meats and sweets Less often Wine In moderation

Drink water

Poultry and eggs Moderate portions, every two days or weekly Cheese and yogurt Moderate portions, daily to weekly Fish and seafood Often, at least two times per week Fruits, vegetables, grains (mostly whole), olive oil, beans, nuts, legumes and seeds, herbs and spices Base every meal on these foods Be physically active; enjoy meals with others

Illustration by George Middleton

©2009 Oldways Preservation and Exchange Trust www.oldwayspt.org

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25


The Mediterranean way Here are the general guidelines of this heart-friendly diet: • Four or more servings of vegetables a day. A serving is

½ cup of raw or cooked vegetables, 1 cup of raw leafy greens, or ½ cup of vegetable juice. • Four or more servings of fruit a day. A serving is ½ cup

of fresh, frozen, or canned fruit, ¼ cup of dried fruit, one medium-sized piece of fruit, or ½ cup of fruit juice. • Six or more servings of grain— mostly whole grain—

a day. A serving is 1 cup of dry breakfast cereal; ½ cup of cooked cereal, rice, or pasta; or one slice of bread. • Two or more servings of fish a week. A serving is

4 ounces. • One serving of yogurt (1 cup) or cheese (1½ to

2 ounces) a day. • One serving of beans or nuts a day. For cooked beans,

½ cup is a serving; for nuts it’s a handful (about 1 ounce). • If you enjoy alcohol, limit yourself to one (for women)

or two (for men) drinks a day.

decreased 36%, but that was attributed to their higher rates of angioplasty and bypass procedures. ■ The Mediterranean diet. The inspiration for this diet dates back to the 1970s, with the publication of the Seven Countries Study, which showed low heart disease rates in Greek islanders despite their high fat intakes (35% to 40% of calories). The diet features mainly vegetables, fruits, whole grains, and fish as well as some dairy products (mostly cheese or yogurt), a small quantity of meat and poultry, and a regular

26

Healthy Eating for a Healthy Heart

but moderate amount of red wine (see Figure 3). The higher levels of healthy monounsaturated fats (found in olive oil) and polyunsaturated fats (found in fish) in the Mediterranean diet replace the less healthy saturated and trans fats—a practice proved to help lower cholesterol levels. Yet some studies of people on the diet found improvements in LDL, HDL, and other factors associated with heart disease risk, while others showed only minimal benefits. However, when it comes to cutting heart disease risk, the Mediterranean diet is a clear winner. One study involving more than 22,000 adults in Greece revealed that people who closely followed a Mediterranean diet had a 33% lower risk of heart disease. The Lyon Diet Heart study, which included 300 people with heart disease, documented a 73% lower risk of fatal and nonfatal heart attacks among those following the diet for 27 months. The first U.S.-based study of the diet confirmed that the more closely people followed the Mediterranean eating style, the lower their risk of dying from either heart disease or cancer. A 2009 study examining the relative importance of each component of the diet found that its longevity-promoting benefits stemmed mainly from drinking wine with meals, eating little meat, and eating lots of vegetables, fruits, nuts, olive oil, and legumes. (Eating lots of fish, seafood, and cereals, as well as eating small amounts of dairy products, didn’t seem to make much of a mortality difference.) Finally, a two-year-long study found that people lost more weight on the Mediterranean diet than a lowfat diet.

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Putting theory into practice

T

he next step is to put your eating plan into action. But the wide selection of foods at grocery stores and restaurants can be daunting to even the most knowledgeable consumers. So here is a guide for making healthy and tasty food choices for meals you prepare at home or eat out.

Shop smart

If your cupboard is loaded with chips, cookies, and candy, you’re likely to give in to temptation. So, stock up on healthy foods instead. And be sure to prepare a grocery list in advance to prevent impulse buying. When you shop, look for fresh foods. As much as possible, stick to the produce, meat, dairy, and bread sections of the store, to avoid the temptations lurking in aisles containing packaged and processed foods. Substitute healthy foods for unhealthy ones whenever possible (see Table 10). Remember that the healthiest fruits and vegetables are the deeply colored ones, which are chock-full of nutrients. Choose spinach, for example, instead of iceberg lettuce, and sweet potatoes instead of white potatoes. Experiment with new fruits and vegetables (perhaps mangoes, papayas, or leeks) for added food choices. If fresh produce isn’t available, buy frozen (without added sauce). Many companies now use flashfreezing technology at harvest to preserve nutrients. In the meat department, select heart-healthy proteins like skinless chicken or turkey breast (white meat is leaner than dark meat). Stay away from processed deli meat, which tends to be high in fat and sodium. Look for fresh fish (without breaded or battered coatings) or canned fish, and give preference to those rich in omega-3 fats, such as salmon, herring, sardines, or tuna. If you occasionally eat red meat, look for leaner cuts with less saturated fat, such as round, loin, and sirloin. The best choice for ground beef, which is higher in fat than these cuts, is a substitution: ground www.h e a l t h . h a r v a r d . e d u

turkey (even extra-lean ground beef has a fair amount of saturated fat). For pork, the leanest cut is the tenderloin, but remember that pork counts as red meat, despite the pork industry’s advertising of “the other white meat.” In the dairy department, look for nonfat or low-fat versions of milk, cheese, and yogurt. Instead of butter or regular margarine, both of which contain unhealthy fats, try a trans fat–free margarine (such as Smart Balance) or one with cholesterol-lowering plant sterols or

Table 10 Building a better grocery list

The next time you go grocery shopping, try substituting healthy choices for less healthy ones— and do your heart some good. Unhealthy choices

Healthy substitutes

Beverages Sweetened soda, juices

Water, no-calorie flavored bottled water, or sparkling (carbonated) water

Dairy Butter, margarine, shortening

Olive oil, canola oil, safflower oil, tub margarine without trans fat

Cheese

Reduced-fat cheese (less than 2 grams saturated fat per serving)

Ice cream

Low-calorie fudgesicles or popsicles, sorbet, or frozen yogurt

Whole eggs

Egg whites or egg substitutes

Whole milk

Fat-free or 1% milk

Cereals, grains, baked goods Cornflakes and other refinedgrain cereals

Shredded Wheat, Fiber One, AllBran Buds, Kashi, old-fashioned oatmeal, or other whole-grain or high-fiber cereal

Donuts, muffins, pastries

Whole-grain English muffins

White bread

Whole-grain bread, pita, or wraps

White pasta

Whole-wheat pasta

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stanols (such as Take Control or Benecol). Choose either whole eggs (white or brown) or a yolk-free egg product; limit egg yolks to three to four per week. Looking for a frozen treat? Select a low-calorie, sugar-free fudgesicle or popsicle instead of premium brands of ice cream, which are loaded with unhealthy saturated fat. In the bread aisle, seek out whole-grain products. Check the label to make sure the word “whole” heads the list of ingredients; for example, “whole wheat.” Or better yet, look for “100% whole grain” on the package, as this indicates the product has a high fiber content. Other fiber-filled options include brown rice, whole-grain cereals, and whole-wheat pasta. Popcorn is another healthy whole grain, but be sure it’s not cooked in butter or in an oil with trans fats. Your best bet may be to buy popcorn kernels to air-pop on your own, or cook them on the stove with some healthy olive or canola oil.

Read labels If you’re buying a packaged food, read the Nutrition Facts label (see Figure 4) on the box to find out if it’s a wise choice. Start by looking at the serving size. Just remember that the amount you eat may be bigger or smaller than the serving size listed on the label. So if the serving size is, say, half a cup for cereal, and

Figure 4 How to read the label Here, the label gives the serving size and number of servings in the container. Here, the label gives the amounts of different nutrients in one serving. Use it to help you keep track of how much fat, saturated fat, cholesterol, and calories you are getting from different foods. Pay attention to the actual amounts (in grams or milligrams). Also look for the ingredients listed in order by weight (not shown here). The first several ingredients are most important.

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Healthy Eating for a Healthy Heart

Expert advice To find a dietitian, consult your physician or the nutrition department of a large teaching hospital. Or you can locate one in your area through the American Dietetic Association Web site (go to www.eatright.org and click on “Find a Nutrition Professional”). While health insurance may cover the cost of an initial visit, plans vary, so check with your provider. A dietitian can analyze your eating and lifestyle habits. When you meet, bring along your food diary as well as a list of your medications. Also be prepared to talk about how often you eat out, how often you exercise, and how your weight has changed over the years. Based on this information, the dietitian will help you target a healthy body weight and devise an eating plan that’s right for you.

you actually eat a full cup, you need to double all the amounts listed on the label—twice as many calories, twice as much fat, and twice as much sodium and sugar. Then check the calories, and try to choose foods that are lower in calories. Next on the list of items to watch out for: saturated fat and trans fat. Try to choose foods that are lowest in saturated fat and contain zero trans fat and that are low in sodium (no more than 140 mg per serving). And don’t be concerned about the total number of carbohydrates as much as whether the food contains good carbohydrates like whole grains. One way to identify a healthy carbohydrate is by looking at its fiber content: the higher, the better. Likewise, don’t worry about sufficient protein, which is an issue only for children ages 4 and under. Finally, look at the list of ingredients to see what you’re really getting. Beware of products with forms of sugar listed among the primary ingredients, which appear first. On a juice bottle, for example, water and high-fructose corn syrup or sugar may top the list rather than grape or apple juice. These added sugars can add on pounds.

Choose convenience foods wisely

Today you can find a wide assortment of frozen entrées and ready-to-eat meals in your grocery store. Two-income households have increased the demand for these products, and the introduction of the microwave oven has added to their convenience. www.health.har vard.edu

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Responding to consumer nutrition concerns, the frozen food industry now offers low-cholesterol, low-fat, and low-carb products. For weight control and heart health, look for entrées that contain less than 400 calories, less than 4 grams of saturated fat, less than 500 mg of sodium, zero trans fat, and some fiber. Stay away from frozen dishes high in calories and sodium, frozen fries and onion rings, fried or stuffed seafood, pizza with extra cheese, and largeportion meals. Many supermarkets now have available complete easy-to-cook meals as well as individual items like salads and sushi. Stick with foods that are baked or broiled, not fried, and that don’t have added sauces. As with frozen foods, check the nutrition label for calories, saturated fat, and trans fat. And if you buy a roast chicken at the store, do your health a favor and remove the skin before eating.

Eat out the healthy way

The good news is that today’s chefs are becoming more nutrition-conscious and preparing healthier foods. Healthful options are now a selling point for fine-dining restaurants as well as fast-food chains. Yet despite the increased focus on fresh produce and healthy fats, many still serve old standbys like cheeseburgers and fries. So whether you dine in or take out, here are a few guidelines to follow: ■ Watch portions. Restaurants often serve overly generous portions. Consider ordering a salad and appetizer or sharing an entrée with someone else. Or, if you get more than one serving, section off extra food to bring home in a “doggie bag.” ■ Don’t fill up on bread. Leave room for the more nutritious part of your meal and resist the bread basket (especially one filled with refined white bread). ■ Be savvy at the salad bar. Stick to dark green leafy lettuces, raw vegetables, and fruits, not mayonnaisecoated pasta and potato salads. Serve yourself a small amount of olive oil–based dressing.

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10 ways to slim down 1. Don’t race; eat foods slowly and mindfully. 2. Serve yourself small portions (one easy trick: use smaller plates). Then wait 20 minutes to see if you’re hungry for more. 3. Eat breakfast. Have a high-fiber, whole-grain cereal with skim milk or an omelet made with an egg substitute (such as Egg Beaters) and a slice of wholegrain toast. 4. Don’t try to “clean” your plate; you can save uneaten portions for a future meal. 5. “Close” the kitchen at night. Follow a “no eating after 8 p.m.” rule whenever possible. 6. Take small steps to reach your goal. For example, buy three types of vegetables at the store or switch from white to whole-grain bread. 7. Get off the couch and move more. Make exercise a priority. 8. Be positive. Eat healthy most of the time, but allow yourself some indulgences without self-recrimination. 9. Change slowly but steadily instead of trying to do it all at once. Involve your loved ones for support. 10. If you slip from time to time, don’t be too selfcritical or discouraged. Weight control is a lifelong process and there are sure to be ups and downs. Think of it as a marathon, not a sprint.

■ Avoid deep-fried foods. Order seafood, meats, and vegetables that are grilled, roasted, steamed, or sautéed, instead of fried. This not only cuts down on calories but also avoids the trans fats often found in restaurant fryers. ■ Steer clear of added fats. Avoid gravy, cheesy sauces, creamy salad dressings, and anything “swimming” in butter. ■ Avoid sodium. Condiments and sauces are often laden with sodium; ask for these to be served on the side, and use them sparingly. ■ Share desserts. Split sinful sweets with your dining companions, or look for choices lower in fat, sugar, and calories, such as fresh fruit.

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30

Place

(kitchen, living room, bedroom, car, desk at work)

Time

(record start and end time of meal or snack)

Food diary (alone, or with family, friends, colleagues)

With whom

(reading, watching TV, talking, cooking)

Activity

(neutral, happy, tense, depressed, angry, bored, rushed, tired)

Mood

(1–5, with 0=no hunger, 5=starving)

Hunger

Amount

Food

Healthy Eating for a Healthy Heart

Total:

(if unknown, leave blank)

Calories

(after eating: 1=still hungry 2=quite satisfied 3=uncomfortable)

Fullness

(X=yes)

Filled out just before or after eating

Appendix: Food diary

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S p e c i a l S e c t ion

Recipes

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he following 40 recipes were created by EatingWell, publisher of the acclaimed national consumer food magazine EatingWell and cookbooks that emphasize good nutrition. Developed by professionally trained chefs and reviewed by registered dietitians, these easy, delicious recipes meet stringent guidelines for taste and adhere to the healthy-eating guidelines outlined in this report. The recipes are organized into five main categories: breakfast foods; lunch and dinner entrees; side dishes, salads, and soups; snacks; and desserts. To find particular recipes quickly—one that includes chicken or fish, for example—see the index on page 45, which is organized by main ingredient. Finally, see the sample meal plan on page 43 for suggestions on how to use some of these recipes throughout the week while counting calories and accumulating nutrients.

Breakfast foods Apricot-Walnut Cereal Bars Makes 16 servings

Nutrition information per serving

Calories 3 cups old-fashioned rolled oats Total fat ½ cup chopped walnuts Saturated fat (about 2 ounces) Trans fat Cholesterol 12 ounces silken tofu, drained Sodium (about 1¹⁄³ cups) Total 1 large egg carbohydrates ½ cup canola oil Fiber Protein 1 cup honey 1 tablespoon vanilla extract 2 tablespoons freshly grated lemon zest 3 cups unsweetened puffed-grain cereal, such as Kashi 2 cups chopped dried apricots ¼ cup all-purpose flour ½ teaspoon salt

306 12 g 1g 0g 13 mg 87 mg 46 g 3g 6g

Preheat oven to 350° F. Coat a large (10¼x15¼-inch) jellyroll-style pan with cooking spray. Spread oats and walnuts on a baking sheet with sides. Bake until fragrant and light golden, 8 to 10 minutes. Meanwhile, purée tofu, egg, oil, honey, vanilla, and lemon zest in a food processor or blender until smooth, scraping down the sides as needed; set aside. When the oats and walnuts are done, transfer them to a large bowl and add puffed cereal, dried apricots, flour, and salt; stir to combine. Make a well in the center of the oat mixture; fold in the tofu mixture until combined. Spread evenly in the prepared pan. Bake until firm in the center and golden brown, 35 to 40 minutes. Let cool completely in the pan on a wire rack before cutting into 16 bars with a sharp knife. www. h e a l t h . h a r v a r d . e d u

Poppy Seed Waffles

Nutrition information per serving

Makes 6 servings

2 tablespoons poppy seeds 1¾ cups all-purpose flour 1½ teaspoons baking powder ½ teaspoon baking soda ½ teaspoon salt 2 large egg whites 1 large egg 2 cups nonfat plain yogurt ½ cup sugar 1 tablespoon canola oil 1 tablespoon vanilla extract 2 teaspoons freshly grated lemon zest Confectioners’ sugar (optional) 

Calories 284 Total fat 5g Saturated fat 1g Trans fat 0g Cholesterol 37 mg Sodium 475 mg Total 50 g carbohydrates Fiber 1g Protein 10 g

Preheat waffle iron. Preheat oven to 200° F. Toast poppy seeds in a small dry skillet over medium heat until fragrant, 30 to 60 seconds. Transfer to a mixing bowl and whisk in flour, baking powder, baking soda, and salt. In a medium bowl, whisk egg whites, egg, yogurt, sugar, oil, vanilla, and lemon zest. Whisk into dry ingredients until just moistened. Lightly coat waffle iron with cooking spray. Spoon in batter and cook until waffle is crisp and golden. Transfer to oven to keep warm. Repeat with remaining batter, lightly coating iron with cooking spray each time, if necessary. Dust the waffles with confectioners’ sugar before serving, if desired.

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Special Section

| Lunch and dinner entrees

Lunch and dinner entrees Tuna Melt Makes 4 servings

12 ounces canned chunk light tuna, drained (see note) 1 medium shallot, minced (2 tablespoons) 2 tablespoons low-fat mayonnaise 1 tablespoon lemon juice 1 tablespoon minced flat-leaf parsley ¹⁄8 teaspoon salt Dash of hot sauce Freshly ground pepper to taste 4 slices whole-wheat bread, toasted 2 tomatoes, sliced ½ cup shredded sharp Cheddar cheese

Nutrition information per serving Calories 252 Total fat 6g Saturated fat 3g Trans fat 0g Cholesterol 66 mg Sodium 408 mg Total 16 g carbohydrates Fiber 3g Protein 31 g

Preheat broiler. Combine tuna, shallot, mayonnaise, lemon juice, parsley, salt, hot sauce, and pepper in a medium bowl. Spread ¼ cup of tuna mixture on each slice of toast; top with tomato slices and 2 tablespoons cheese. Place sandwiches on a baking sheet and broil until cheese is bubbling and golden brown, 3 to 5 minutes. Note: Chunk light tuna, which comes from the smaller skipjack or yellowfin, has less mercury than canned white albacore tuna. The FDA recommends adults consume no more than 6 ounces of albacore a week; up to 12 ounces canned light tuna is considered safe.

Turkey and Pepper Roll-Up Makes 1 serving

1 tablespoon reduced-fat cream cheese 2 slices reduced-sodium deli turkey ½ cup sliced red bell pepper Spread cream cheese on turkey slices, top with bell pepper, and roll up.

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Nutrition information per serving Calories 114 Total fat 5g Saturated fat 3g Trans fat 0g Cholesterol 28 mg Sodium 486 mg Total 6g carbohydrates Fiber 1g Protein 12 g

Mediterranean Portobello Burger Makes 4 servings

Nutrition information per serving Calories

1 clove garlic, minced Total fat ½ teaspoon kosher salt Saturated fat Trans fat 2 tablespoons extra-virgin olive oil, Cholesterol divided Sodium 4 portobello mushroom caps, stems and Total gills removed carbohydrates 4 large slices country-style sourdough Fiber bread, cut in half Protein ½ cup sliced jarred roasted red peppers ½ cup chopped tomato ¼ cup crumbled reduced-fat feta cheese 2 tablespoons chopped pitted Kalamata olives 1 tablespoon red wine vinegar ½ teaspoon dried oregano 2 cups loosely packed mixed baby salad greens

301 11 g 2g 0g 2 mg 795 mg 40 g 4g 10 g

Preheat grill to medium-high. Mash garlic and salt on a cutting board with the side of a knife until they form a smooth paste. In a small dish, mix the paste with 1 tablespoon oil. Lightly brush the oil mixture over portobellos and then on one side of each slice of bread. In a medium bowl, combine red peppers, tomato, feta, olives, vinegar, oregano, and the remaining 1 tablespoon oil. Grill the mushroom caps until tender, about 4 minutes per side; grill the bread until crisp, about 1 minute per side. Toss salad greens with the red pepper mixture. Place the grilled mushrooms top-side-down on 4 half-slices of the bread. Top with the salad mixture and the remaining bread.

Summer Paella

Nutrition information per serving

Makes 6 servings

1 green bell pepper 1 red or orange bell pepper 1 small red onion, sliced in ½-inch-thick rounds Olive oil cooking spray ¾ pound raw shrimp (21–25 per pound), peeled and deveined, tails left on 3 tablespoons extra-virgin olive oil 2 teaspoons minced garlic 4 cups reduced-sodium chicken broth 1 scant teaspoon crumbled saffron threads

Calories 386 Total fat 15 g Saturated fat 3g Trans fat 0g Cholesterol 127 mg Sodium 683 mg Total 32 g carbohydrates Fiber 2g Protein 29 g

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Lunch and dinner entrees | Special Section

¼ teaspoon kosher salt 2 cups short-grain white rice, such as bomba, Valencia, or arborio 12 hard-shell clams (such as littlenecks or cherrystones) or mussels 10 ounces raw spicy turkey or chicken sausage links ½ cup frozen baby peas, thawed ¼ cup halved pitted briny black olives ¼ cup halved pitted briny green olives ¼ cup minced fresh parsley Preheat grill to medium-high. Grill bell peppers, turning occasionally, until softened and charred in spots, about 8 minutes. Coat onion slices lightly with olive oil spray, and grill, flipping once, until slightly softened and beginning to caramelize, about 2 minutes per side. Transfer the peppers to a plastic bag and let them sit until cool enough to handle. Peel off the skins and discard; remove and discard the stems and seeds. Chop the peppers and onion. Thread shrimp onto three 12-inch skewers. Lightly coat with olive oil spray. Heat oil in a 13-inch paella pan or large highsided skillet over medium heat. Add the bell peppers, onion, and garlic and cook, stirring, until fragrant, 1 to 2 minutes. Stir in broth, saffron, and salt; bring to a boil. Add rice, stir just to combine, and spread to form a thin, even layer in the pan. Reduce heat to a gentle simmer and cook the rice, uncovered, for 10 minutes, and then gently fold the outside portions of the rice into the center of the pan to ensure even cooking. Continue simmering, without stirring, until the rice looks dry and is just barely tender, about 10 minutes more. Watch carefully, and be prepared to shift the pan partially off the burner as necessary to keep the rice cooking at the same rate and prevent burning. Meanwhile, place the skewered shrimp, clams (or mussels), and sausage on the grill. Grill the shrimp until firm and pink, 1 to 2 minutes per side. Remove from the skewers and place in a large bowl. Grill the clams (or mussels) until their shells pop open, 2 to 4 minutes total. (Discard any clams or mussels that don’t open.) Add to the bowl with the shrimp, keeping them level to avoid losing their juices. Grill the sausage, turning occasionally, until cooked through, 10 to 14 minutes. When cool enough to handle, slice thinly and add to the bowl with the seafood. When the rice is done, remove the pan from the heat, cover with a lid or a heavy kitchen towel, and let stand for 5 minutes. Gently stir in peas and black and green olives. Scatter the sausage and seafood, plus any accumulated juices, over the rice and sprinkle with parsley.

Spicy Beef with Shrimp and Bok Choy Makes 4 servings, about 1 cup each

Nutrition information per serving Calories 204 Total fat 8g Saturated fat 2g Trans fat 0g Cholesterol 54 mg Sodium 384 mg Total 6g carbohydrates Fiber 1g Protein 22 g

¼ cup Shao Hsing rice wine (see note) 1½ tablespoons oyster-flavored sauce 2 teaspoons cornstarch 4 teaspoons canola oil, divided ¾ pound sirloin steak, trimmed of fat, cut in half lengthwise and thinly sliced ¼ to ½ teaspoon crushed red pepper 10 raw shrimp (21–25 per pound), peeled, deveined, and chopped 1 pound bok choy (preferably baby bok choy), trimmed and sliced into 1-inch pieces

Whisk rice wine, oyster sauce, and cornstarch in a small bowl until the cornstarch is dissolved; set aside. Heat 2 teaspoons oil in a large nonstick skillet or wok over medium-high heat. Add beef and crushed red pepper to taste; cook, stirring, until the beef begins to brown, 1 to 2 minutes. Add shrimp and continue to cook, stirring, until the shrimp is opaque and pink, 1 to 2 minutes. Transfer the beef, shrimp, and any juices to a plate. Heat the remaining 2 teaspoons oil over medium-high heat in the same pan. Add bok choy and cook, stirring, until it begins to wilt, 2 to 4 minutes. Stir in the cornstarch mixture. Return the beef-shrimp mixture to the pan and cook, stirring, until it is heated through and the sauce has thickened slightly, about 1 minute. Note: Shao Hsing (or Shaoxing) is a seasoned rice wine. It is available in most Asian specialty markets and some larger supermarkets in the Asian section. Dry sherry is an acceptable substitute.

Golden Polenta and Egg with Mustard Sauce Makes 4 servings

Nutrition information per serving Calories 278 Total fat 13 g Saturated fat 3g Trans fat 0g Cholesterol 219 mg Sodium 528 mg Total 27 g carbohydrates Fiber 4g Protein 12 g

½ cup low-fat plain yogurt ¹⁄³ cup reduced-fat mayonnaise 1 tablespoon Dijon mustard 1 tablespoon lemon juice 1 tablespoon water 1 pound green beans, trimmed 4 eggs 2 teaspoons extra-virgin olive oil 12 ounces prepared polenta, sliced into eight ½-inch rounds

Combine yogurt, mayonnaise, mustard, lemon juice, and water in a small bowl. Bring 6 cups of lightly salted water to a boil in a medium saucepan. Add green beans and cook until just tender, continued

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Special Section

| Lunch and dinner entrees

about 4 minutes. Remove the green beans with a slotted spoon and divide among 4 plates. Return the water to a boil; place eggs, one by one, into the boiling water and set the timer: 5 minutes for a soft-set egg, 8 minutes for hard-boiled. Remove when time is up. When the eggs are cool enough to handle, peel them and slice in half. Meanwhile, heat the oil in a large nonstick skillet over medium-high heat, add polenta rounds in a single layer, and cook, turning once, until they are crispy and golden, about 4 minutes per side. Remove and keep warm. Add the reserved sauce to the pan and cook over medium-low heat, stirring constantly to avoid scorching, until heated through, about 3 minutes. Place 2 polenta rounds on each plate next to the green beans, top each round with an egg half, and drizzle the eggs, polenta, and beans with the sauce. Serve immediately.

Potato-Horseradish-Crusted Mahi-Mahi Makes 4 servings

1 cup precooked shredded potatoes (see note) 1 shallot, finely chopped 1 tablespoon prepared horseradish 1 teaspoon Dijon mustard ½ teaspoon garlic salt ¼ teaspoon freshly ground pepper 1¼ pounds mahi-mahi, skin removed, cut into 4 portions 4 teaspoons reduced-fat mayonnaise 1 tablespoon canola oil 1 lemon, quartered

Nutrition information per serving Calories 205 Total fat 6g Saturated fat 1g Trans fat 0g Cholesterol 105 mg Sodium 311 mg Total 9g carbohydrates Fiber 1g Protein 27 g

Combine potatoes, shallot, horseradish, mustard, garlic salt, and pepper in a medium bowl. Spread each portion of fish with 1 teaspoon mayonnaise, then top with one-fourth of the potato mixture, pressing the mixture onto the fish. Heat oil in a large nonstick skillet over medium-high heat. Carefully place the fish in the pan potato-side-down and cook until crispy and browned, 4 to 5 minutes. Gently turn the fish over, reduce the heat to medium, and continue cooking until the fish flakes easily with a fork, 4 to 5 minutes more. Serve with lemon wedges. Note: Look for precooked shredded potatoes in the refrigerated section of the produce department, near other fresh prepared vegetables.

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Pan-Seared Salmon with Fennel and Dill Salsa

Nutrition information per serving

Makes 4 servings

1 large tomato, chopped 1 cup finely chopped fennel (about ½ bulb, stalks trimmed) 2 tablespoons minced red onion 2 tablespoons minced dill 1 tablespoon red wine vinegar ½ teaspoon salt, divided 1 pound salmon fillet, skinned (see tip) Freshly ground pepper to taste 2 tablespoons extra-virgin olive oil

Calories 289 Total fat 20 g Saturated fat 3g Trans fat 0g Cholesterol 67 mg Sodium 373 mg Total 4g carbohydrates Fiber 1g Protein 23 g

Combine tomato, fennel, onion, dill, vinegar, and ¼ teaspoon salt in a medium bowl. Cut salmon into 4 equal portions, sprinkle with the remaining ¼ teaspoon salt and pepper. Heat oil in a large nonstick pan over high heat until shimmering but not smoking. Cook the salmon, skinned-side-up, until golden brown, 3 to 5 minutes. Turn the salmon over and remove the pan from the heat. Allow the salmon to finish cooking off the heat until just cooked through, 3 to 5 minutes more. Serve immediately with the salsa. Tip: To skin a salmon fillet: Place it on a clean cutting board, skin-side-down. Starting at the tail end, slip the blade of a long, sharp knife between the fish flesh and the skin, holding the skin down firmly with your other hand. Gently push the blade along at a 30-degree angle, separating the fillet from the skin without cutting through either. Or have your fishmonger do it for you.

Spicy Chicken Tacos Makes 4 servings, 2 tacos each

Nutrition information per serving Calories

303

8 corn tortillas Total fat 6g 1 pound boneless, skinless chicken Saturated fat 1g breasts, trimmed of fat and cut into Trans fat 0g Cholesterol 66 mg thin strips Sodium 421 mg ¼ teaspoon salt, or to taste Total 32 g 2 teaspoons canola oil, divided carbohydrates Fiber 5g 1 large onion, sliced Protein 31 g 1 large green bell pepper, seeded and sliced 3 large cloves garlic, minced 1 jalapeño pepper, seeded and minced 1 tablespoon ground cumin ½ cup prepared hot salsa, plus more for garnish ¼ cup chopped fresh cilantro Sliced scallions, chopped fresh tomatoes, and reduced-fat sour cream for garnish

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Lunch and dinner entrees | Special Section

Preheat oven to 300° F. Wrap tortillas in foil and bake until heated through, 10 to 15 minutes. Meanwhile, season chicken with salt. Heat 1 teaspoon oil in a large heavy skillet over high heat until very hot. Add chicken and cook, stirring until browned on all sides, about 6 minutes. Transfer to a bowl. Reduce heat to medium and add the remaining 1 teaspoon of oil to skillet. Add onion slices and cook, stirring, until they start to brown around the edges, 3 to 5 minutes. Add bell pepper, garlic, jalapeño, and cumin. Cook, stirring, until bell pepper is bright green but still crisp, 2 to 3 minutes more. Stir in salsa and reserved chicken. Cook, stirring, until chicken is heated through, about 2 minutes. Remove from heat and stir in cilantro. Spoon into warmed tortillas and garnish with scallions, tomatoes, and sour cream.

Asian Turkey Burgers Makes 4 servings

Nutrition information per serving Calories

2 slices whole-wheat sandwich bread, Total fat crusts removed, torn into pieces Saturated fat 12 ounces lean ground turkey breast Trans fat (see note) Cholesterol Sodium 1 (8-ounce) can sliced water chestnuts, Total rinsed and chopped carbohydrates 2 tablespoons hoisin sauce (see note) Fiber Protein 2 scallions, trimmed and sliced 1 tablespoon minced fresh ginger 2 cloves garlic, minced ¼ teaspoon salt 1½ teaspoons toasted sesame oil Vegetable oil (for grill) Sesame Mayonnaise, optional (recipe follows)

207 3g 1g 0g 53 mg 392 mg 20 g 4g 24 g

Preheat grill to medium-high. Place bread in a food processor and pulse into fine crumbs. Transfer to a large bowl. Add ground turkey, water chestnuts, hoisin, scallions, ginger, garlic, and salt; mix well. (The mixture will be moist.) With dampened hands, form the mixture into four ½-inch-thick patties (see tip). Oil the grill rack (see tip). Brush the patties with sesame oil. Grill until the patties are browned and no longer pink in the center, about 5 minutes per side. (An instant-read thermometer inserted in the center should register 165° F.) Meanwhile, prepare Sesame Mayonnaise, if desired, to serve with the burgers. Notes: Check labels carefully and select ground turkey breast. Regular ground turkey, which is a mixture of dark and white meat, has a higher fat content (similar to that of lean ground beef). Hoisin sauce is a spicy, sweet sauce made from soybeans, chiles, garlic, and spices. It will keep in the refrigerator for at least a year. Tips: When forming burger patties, make them thinner at the center to prevent them from steaming as they cook. To oil the grill, oil a folded paper towel. Hold it with tongs and pull it toward you over the rack. Do not use cooking spray on a hot grill. www.h e a l t h . h a r v a r d . e d u

Sesame Mayonnaise

Nutrition information per serving

Makes about ¼ cup

2 tablespoons reduced-fat mayonnaise 2 tablespoons nonfat or low-fat plain yogurt ½ teaspoon reduced-sodium soy sauce ½ teaspoon toasted sesame oil Combine mayonnaise, yogurt, soy sauce, and oil in a small bowl; whisk until blended.

Calories Total fat Saturated fat Trans fat Cholesterol Sodium Total carbohydrates Fiber Protein

31 3g 0g 0g 2 mg 71 mg 2g 0g 0g

Variation: For Scallion-Lemon Mayonnaise, combine 2 tablespoons reducedfat mayonnaise, 2 tablespoons nonfat plain yogurt, 1 tablespoon chopped scallions, ½ teaspoon freshly grated lemon zest, 1 tablespoon lemon juice, and salt and pepper to taste in a small bowl; whisk until blended.

Tofu with Peanut-Ginger Sauce Makes 4 servings, generous ¾ cup each

Nutrition information per serving Calories

5 tablespoons water Total fat 4 tablespoons smooth natural Saturated fat peanut butter Trans fat Cholesterol 1 tablespoon rice vinegar (see note) or Sodium white vinegar Total 2 teaspoons reduced-sodium soy sauce carbohydrates Fiber 2 teaspoons honey Protein 2 teaspoons minced ginger 2 cloves garlic, minced 14 ounces extra-firm tofu, preferably water-packed 2 teaspoons extra-virgin olive oil 4 cups baby spinach (6 ounces) 1½ cups sliced mushrooms (4 ounces) 4 scallions, sliced (1 cup)

225 15 g 2g 0g 0 mg 233 mg 15 g 5g 14 g

Whisk water, peanut butter, vinegar, soy sauce, honey, ginger, and garlic in a small bowl; set aside. Drain and rinse tofu; pat dry. Slice the block crosswise into eight ½-inch-thick slabs. Coarsely crumble each slice into smaller, uneven pieces. Heat oil in a large nonstick skillet over high heat. Add tofu and cook in a single layer, without stirring, until the pieces begin to turn golden brown on the bottom, about 5 minutes. Then gently stir and continue cooking, stirring occasionally, until all sides are golden brown, 5 to 7 minutes more. Add spinach, mushrooms, scallions, and the reserved peanut sauce and cook, stirring, until the vegetables are just cooked, 1 to 2 minutes more. Note: Rice vinegar (or rice wine vinegar) is a mild, slightly sweet vinegar made from fermented rice. You can find it in the Asian section of supermarkets and specialty stores.

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Cider-Vinegar-and-Molasses-Glazed Pork Chops Makes 2 servings

1 teaspoon extra-virgin olive oil 2 thin-cut boneless pork chops (8 ounces), trimmed of fat 1 shallot, finely chopped ½ jalapeño pepper, seeded and finely chopped 1 clove garlic, finely chopped 2 tablespoons molasses 2 tablespoons cider vinegar 1 tablespoon Dijon mustard 1 teaspoon reduced-sodium soy sauce

Heat oil over medium-high heat in a Nutrition information per serving medium skillet. Add pork, and cook until browned and no longer pink in the Calories 262 middle, 1 to 2 minutes per side. Transfer Total fat 9g Saturated fat 3g to a plate and cover with foil to keep 0g warm. Add shallot, jalapeño, and garlic to Trans fat Cholesterol 65 mg skillet; cook, stirring often, until slightly Sodium 245 mg softened, 2 to 3 minutes. Add molasTotal 19 g ses, vinegar, mustard, and soy sauce carbohydrates and bring to a simmer. Reduce heat to Fiber 0g maintain a simmer and cook, stirring Protein 25 g occasionally, until thickened, 2 to 4 minutes. Return the pork and any accumulated juices to the pan and turn to coat with the sauce. Serve the pork with the sauce.

Side dishes, salads, and soups Tex-Mex Summer Squash Casserole Makes 12 servings

Nutrition information per serving Calories 101 Total fat 5g Saturated fat 3g Trans fat 0g Cholesterol 15 mg Sodium 217 mg Total 9g carbohydrates Fiber 3g Protein 5g

2¼ pounds summer squash, quartered lengthwise and thinly sliced crosswise (about 10 cups) ²⁄³ cup finely chopped yellow onion 1 (4-ounce) can chopped green chiles 1 (4½-ounce) can chopped jalapeños (about ½ cup), drained ½ teaspoon salt, or to taste 2¼ cups grated extra-sharp Cheddar cheese (about 7 ounces), divided ¼ cup all-purpose flour ¾ cup mild salsa 4 scallions, thinly sliced, for garnish ¼ cup finely chopped red onion for garnish

Preheat oven to 400° F. Coat a 9x13-inch baking dish with cooking spray. Combine squash, onion, chiles, jalapeños, salt, and ¾ cup cheese in a large bowl. Sprinkle with flour; toss to coat. Spread the mixture in the prepared baking dish and cover with foil. Bake the casserole until it is bubbling and the squash is tender, 35 to 45 minutes. Spoon salsa over the casserole and sprinkle with the remaining 1½ cups cheese. Bake, uncovered, until golden and heated through, 20 to 30 minutes. Sprinkle with scallions and red onion.

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Cheesy Broccoli-Potato Mash Makes 6 servings, ²⁄³ cup each

1 pound Yukon Gold potatoes, cut into wedges ¾ pound broccoli crowns, chopped (4 cups) ¾ cup shredded fontina cheese ½ cup nonfat milk, heated ½ teaspoon salt Freshly ground pepper to taste

Nutrition information per serving Calories 135 Total fat 4g Saturated fat 3g Trans fat 0g Cholesterol 16 mg Sodium 329 mg Total 17 g carbohydrates Fiber 2g Protein 7g

Bring 1 inch of water to a boil in a large pot. Place potatoes in a steamer basket and steam for 10 minutes. Place broccoli on top, cover, and steam until the potatoes and broccoli are tender, 6 to 8 minutes more. Transfer the broccoli to a large bowl and coarsely mash with a potato masher. Add the potatoes, cheese, milk, salt, and pepper and continue mashing to desired consistency. Serve immediately.

Mashed Maple Squash Makes 2 servings, ²⁄³ cup each

1 acorn squash (1¼ pounds), halved and seeded 2 tablespoons pure maple syrup 1 teaspoon butter ¼ teaspoon ground cinnamon ¼ teaspoon salt

Nutrition information per serving Calories 156 Total fat 2g Saturated fat 1g Trans fat 0g Cholesterol 5 mg Sodium 299 mg Total 36 g carbohydrates Fiber 3g Protein 2g

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Preheat oven to 400° F. Coat a 9x13-inch baking pan with cooking spray. Place squash halves cut-side-down in the prepared pan. Bake until soft, about 50 minutes. Let cool for 10 minutes. Scrape the soft squash flesh into a medium bowl. Stir in syrup, butter, cinnamon, and salt with a fork, mashing the squash until somewhat smooth.

Roasted Asparagus with Pine Nuts Makes 4 servings

2 tablespoons pine nuts 1½ pounds asparagus 1 large shallot, thinly sliced 2 teaspoons extra-virgin olive oil ¼ teaspoon salt, divided Freshly ground pepper to taste ¼ cup balsamic vinegar

Nutrition information per serving Calories 112 Total fat 5g Saturated fat 1g Trans fat 0g Cholesterol 0 mg Sodium 150 mg Total 12 g carbohydrates Fiber 4g Protein 5g

Preheat oven to 350° F. Spread pine nuts in a small baking pan and toast in the oven until golden and fragrant, 7 to 10 minutes. Transfer to a small bowl to cool. Increase oven temperature to 450° F. Snap off the tough ends of asparagus. Toss the asparagus with shallot, oil, ¹⁄8 teaspoon salt, and pepper. Spread the mixture in a single layer in a large baking sheet with sides. Roast, turning twice, until the asparagus is tender and browned, 10 to 15 minutes. Meanwhile, bring vinegar and the remaining ¹⁄8 teaspoon salt to a simmer in a small skillet over medium-high heat. Reduce heat to medium-low and simmer, swirling the pan occasionally, until slightly syrupy and reduced to 1 tablespoon, about 5 minutes. To serve, toss the asparagus with the reduced vinegar and sprinkle with the pine nuts.

Asian Brown Rice Makes 2 servings, about ²⁄³ cup each

⁄ cup water or broth ¹⁄³ cup brown rice 1 teaspoon minced fresh ginger ½ red bell pepper, diced ¼ cup chopped water chestnuts Splash of reduced-sodium soy sauce Splash of toasted sesame oil 78

Nutrition information per serving Calories Total fat Saturated fat Trans fat Cholesterol Sodium Total carbohydrates Fiber Protein

130 3g 0g 0g 0 mg 49 mg 38 g

Minted Peas and Rice with Feta Makes 4 servings, ¾ cup each

1¼ cups reduced-sodium chicken broth ¾ cup instant brown rice 1½ cups frozen peas (6 ounces) ¾ cup sliced scallions ¼ cup finely crumbled feta cheese ¼ cup sliced fresh mint Freshly ground pepper to taste

Nutrition information per serving Calories 134 Total fat 3g Saturated fat 1g Trans fat 0g Cholesterol 8 mg Sodium 321 mg Total 22 g carbohydrates Fiber 4g Protein 7g

Bring broth to a boil in a large saucepan over high heat. Add rice and bring to a simmer; cover, reduce heat to medium-low, and cook for 4 minutes. Stir in peas and return to a simmer over high heat. Cover, reduce heat to medium-low, and continue to cook until the peas are hot and the rice has absorbed most of the liquid, about 6 minutes. Remove from heat and stir in scallions, feta, mint, and pepper. Cover and let stand until the liquid is absorbed, 3 to 5 minutes.

Corn, Arugula, and Tomato Salad Makes 6 servings, 1 cup each

3 tablespoons red wine vinegar 3 tablespoons minced shallots 6 tablespoons extra-virgin olive oil ¼ teaspoon salt Freshly ground pepper to taste 6 cups loosely packed arugula (about 6 ounces) 2 cups corn kernels (about 4 ears) 1½ pints cherry tomatoes, halved

Nutrition information per serving Calories 195 Total fat 15 g Saturated fat 2g Trans fat 0g Cholesterol 0 mg Sodium 118 mg Total 15 g carbohydrates Fiber 3g Protein 3g

Combine vinegar and shallots in a large bowl and let stand at room temperature for 10 minutes. Whisk oil into the vinegar mixture until blended. Season with salt and pepper. Add arugula and toss to coat. Arrange the arugula on serving plates. Add corn and tomatoes to the dressing that remains in the bowl, toss to coat, then spoon the mixture over the arugula and serve.

4g 4g

Bring water (or broth), rice, and ginger to a boil. Reduce heat to low and simmer, covered, until rice is tender and most of the liquid has been absorbed, about 25 minutes. Let stand 5 minutes, then fluff with a fork. Stir in bell pepper, water chestnuts, soy sauce, and oil.

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Fennel and Orange Salad with Toasted Pistachios Makes 4 servings, 1 cup each

Nutrition information per serving Calories 186 Total fat 13 g Saturated fat 2g Trans fat 0g Cholesterol 0 mg Sodium 180 mg Total 17 g carbohydrates Fiber 5g Protein 4g

2 navel oranges, peeled, quartered, and thinly sliced 1 small bulb fennel, quartered, cored, and very thinly sliced crosswise 1 cup very thinly sliced radishes (about 8 radishes) or diced peeled jicama (see note) ¼ cup coarsely chopped fresh cilantro 2 tablespoons extra-virgin olive oil or pistachio oil 1 tablespoon plus 1 teaspoon lime juice ¼ teaspoon salt Freshly ground pepper to taste 6 tablespoons shelled salted pistachio nuts, toasted and chopped

Combine orange slices, fennel, radishes (or jicama), cilantro, oil, lime juice, salt, and pepper in a bowl. Gently toss to mix. Just before serving, sprinkle nuts over the salad. Note: Jicama is an onion-shaped root vegetable with thin brown skin and white crunchy flesh. It has a slightly sweet and nutty flavor.

Chickpea Salad Makes 6 servings, 1 cup each

1 (7-ounce) can chickpeas, rinsed 3 cups peeled, seeded, and diced cucumber 2 cups grape tomatoes (or cherry tomatoes), halved ¼ cup crumbled reduced-fat feta cheese ¼ cup diced red onion ½ cup Creamy Dill Ranch Dressing (recipe follows) Freshly ground pepper to taste

Nutrition information per serving Calories 90 Total fat 2g Saturated fat 1g Trans fat 0g Cholesterol 3 mg Sodium 238 mg Total 14 g carbohydrates Fiber 3g Protein 5g

Place chickpeas, cucumber, tomatoes, cheese, onion, dressing, and pepper in a medium bowl. Mix until coated.

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Creamy Dill Ranch Dressing Makes 1¼ cups (2 tablespoons per serving)

1 small shallot, peeled ¾ cup nonfat cottage cheese ¼ cup reduced-fat mayonnaise 2 tablespoons buttermilk powder (see note) 2 tablespoons white wine vinegar ¼ cup nonfat milk 1 tablespoon chopped fresh dill ¼ teaspoon salt ¼ teaspoon freshly ground pepper

Nutrition information per serving Calories 19 Total fat 1g Saturated fat 0g Trans fat 0g Cholesterol 1 mg Sodium 125 mg Total 2g carbohydrates Fiber 0g Protein 2g

With the food processor running, add shallot through the feed tube and process until finely chopped. Add cottage cheese, mayonnaise, buttermilk powder, and vinegar. Process until smooth, scraping down the sides as necessary, about 3 minutes. Pour in milk while the processor is running. Scrape down the sides, add dill, salt, and pepper, and process until combined. Note: Look for buttermilk powder, such as Saco Buttermilk Blend, in the baking section or with the powdered milk in most supermarkets.

Vinegary Coleslaw Makes 2 servings, about 1 cup each

2 tablespoons white wine vinegar 1 tablespoon canola oil 1 teaspoon sugar 1 teaspoon Dijon mustard Pinch of celery seed Pinch of salt 1½ cups shredded cabbage 1 carrot, peeled and grated ¼ cup slivered red onion

Nutrition information per serving Calories 101 Total fat 7g Saturated fat 1g Trans fat 0g Cholesterol 0 mg Sodium 138 mg Total 9g carbohydrates Fiber 2g Protein 1g

Whisk vinegar, oil, sugar, mustard, celery seed, and salt in a medium bowl. Add cabbage, carrot, and onion and toss to coat.

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Spicy Vegetable Soup Makes 4 servings, about 2¼ cups each

Nutrition information per serving Calories

2 tablespoons extra-virgin olive oil Total fat 1 large onion, diced Saturated fat 1 to 3 teaspoons hot paprika, or to taste Trans fat Cholesterol 2 (14-ounce) cans vegetable broth Sodium 4 medium plum tomatoes, diced Total carbohydrates 1 medium yellow summer squash, diced Fiber 2 cups diced cooked potatoes (see note) Protein 1½ cups green beans, cut into 2-inch pieces 2 cups frozen spinach (5 ounces) 2 tablespoons sherry vinegar or red wine vinegar ¼ cup chopped fresh basil or prepared pesto

253 8g 1g 0g 0 mg 485 mg 40 g 10 g 9g

Heat oil in a Dutch oven over medium heat. Add onion, cover, and cook, stirring occasionally, until beginning to brown, about 6 minutes. Add paprika and cook, stirring, for 30 seconds. Add broth, tomatoes, squash, potatoes, and beans; bring to a boil. Reduce heat to a simmer and cook, stirring occasionally, until the vegetables are just tender, about 12 minutes. Stir in spinach and vinegar; continue cooking until heated through, 2 to 4 minutes more. Ladle soup into bowls and top with fresh basil or a dollop of pesto. Note: Convenient cooked and diced potatoes can be found in the refrigerated section of the produce or dairy department of the supermarket.

Chicken Noodle Soup with Dill Makes 6 servings, about 1½ cups each

10 cups reduced-sodium chicken broth 3 medium carrots, diced 1 large stalk celery, diced 3 tablespoons minced fresh ginger 6 cloves garlic, minced 4 ounces whole-wheat egg noodles (3 cups) 4 cups shredded cooked skinless chicken breast (about 1 pound; see tip) 3 tablespoons chopped fresh dill 1 tablespoon lemon juice, or to taste

Nutrition information per serving

Golden Gazpacho Makes 6 servings, 1 generous cup each

1 large orange or yellow bell pepper 3½ pounds yellow or orange tomatoes, peeled (see tip) and cored, divided 1 cup coarsely chopped sweet onion 2 tablespoons extra-virgin olive oil 1 teaspoon salt, or to taste Freshly ground pepper to taste 2 to 3 red or green jalapeño peppers, seeded and minced, for garnish (optional)

Nutrition information per serving Calories 104 Total fat 5g Saturated fat 1g Trans fat 0g Cholesterol 0 mg Sodium 452 mg Total 13 g carbohydrates Fiber 3g Protein 3g

Position rack in upper third of oven; preheat broiler. Place bell pepper on a baking sheet and broil, turning every 4 to 5 minutes, until the skin is blackened and blistered on all sides, 20 to 25 minutes. Transfer the pepper to a bowl, cover, and let sit until the skin is loosened, about 10 minutes. Uncover; when cool enough to handle, remove the skin and discard. Discard stem, seeds, and ribs. Place the roasted pepper and half the tomatoes in a blender; add onion and oil and purée until smooth. Transfer to a large metal bowl. Purée the remaining tomatoes until smooth and add to the bowl; stir to combine. Refrigerate the gazpacho until chilled, at least 2 hours. Season with salt and pepper. Serve garnished with jalapeños, if desired. Tip: To peel tomatoes: Make a small X with a knife in the bottom of each tomato and plunge into boiling water until the skins are slightly loosened, 30 seconds to 2 minutes. Transfer to a bowl of ice water for 1 minute. Peel with a paring knife, starting at the X.

Calories 267 Total fat 4g Saturated fat 2g Trans fat 0g Cholesterol 90 mg Sodium 329 mg Total 18 g carbohydrates Fiber 2g Protein 38 g

Bring broth to a boil in a Dutch oven. Add carrots, celery, ginger, and garlic; cook, uncovered, over medium heat until vegetables are just tender, about 20 minutes. Add noodles and chicken; simmer until the noodles are just tender, 8 to 10 minutes. Stir in dill and lemon juice. Tip: To cook boneless, skinless chicken breasts, place them in a medium skillet or saucepan and add lightly salted water to cover; bring to a boil. Cover, reduce heat to low, and simmer gently until chicken is cooked through and no longer pink in the middle, 10 to 12 minutes. www.h e a l t h . h a r v a r d . e d u

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Special Section

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Snacks Cheddar-Apple Melt Makes 1 serving

1 whole-wheat English muffin, split and toasted 2 teaspoons jam or chutney 4 thin apple slices 2 slices reduced-fat Cheddar cheese Top each English muffin half with 1 teaspoon jam (or chutney), 2 apple slices, and 1 slice of cheese. Toast in a toaster oven or under the broiler until the cheese is melted.

Cumin-Roasted Almonds Makes 2 cups

2 cups whole blanched almonds 2 teaspoons extra-virgin olive oil 2 teaspoons ground cumin ½ teaspoon salt, or to taste ¼ teaspoon freshly ground pepper

Nutrition information per serving Calories 253 Total fat 5g Saturated fat 3g Trans fat 0g Cholesterol 12 mg Sodium 769 mg Total 33 g carbohydrates Fiber 5g Protein 20 g

Nutrition information per serving Calories Total fat Saturated fat Trans fat Cholesterol Sodium Total carbohydrates Fiber Protein

58 5g 0g 0g 0 mg 37 mg 2g

Preheat oven to 300° F. Place almonds in 1g a baking pan; toss with oil, cumin, salt, 2g and pepper. Bake until lightly toasted, about 25 minutes. Let cool on a wire rack. Variation: Use curry powder and cayenne pepper in place of cumin and black pepper.

Crunchy Cereal Trail Mix Makes 1 serving

¼ cup Cheerios 1 tablespoon pepitas (pumpkin seeds) 2 teaspoons raisins 2 teaspoons semisweet mini chocolate chips Combine Cheerios, pepitas, raisins, and chocolate chips in a small bowl.

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Nutrition information per serving Calories Total fat Saturated fat Trans fat Cholesterol Sodium Total carbohydrates Fiber Protein

98 3g 2g 0g 0 mg 78 mg 17 g 2g 2g

Cheesy Popcorn

Nutrition information per serving

Makes 4 servings, about 1 cup each

Calories 75 Total fat 3g Saturated fat 2g Trans fat 0g Cholesterol 9 mg Sodium 153 mg Total 7g carbohydrates Fiber 1g Protein 5g

4 cups hot air-popped popcorn ½ cup freshly grated Parmesan cheese Cayenne pepper to taste Toss popcorn with Parmesan and cayenne to taste.

Whole-Wheat Blueberry Bars Makes 15 servings

Crust 1¹⁄³ cups plus about 3 tablespoons whole-wheat pastry flour, divided ½ teaspoon baking powder ½ teaspoon baking soda ½ teaspoon salt 1 cup packed light brown sugar 2 tablespoons butter, softened 2 tablespoons canola oil 1 large egg 1 teaspoon vanilla extract Blueberry filling ½ cup granulated sugar 2 tablespoons all-purpose flour 1 teaspoon freshly grated lemon zest 2 cups fresh or frozen blueberries 1 tablespoon lemon juice Confectioners’ sugar for dusting (optional)

Nutrition information per serving Calories 169 Total fat 4g Saturated fat 1g Trans fat 0g Cholesterol 18 mg Sodium 104 mg Total 32 g carbohydrates Fiber 2g Protein 2g

To make crust: Preheat oven to 350° F. Coat an 8x12-inch baking dish with cooking spray. Whisk together 1¹⁄³ cups whole-wheat pastry flour, baking powder, baking soda, and salt in a large bowl. In another large bowl, beat together brown sugar, butter, oil, egg, and vanilla with an electric mixer on high speed about 1 minute, until mixture is smooth and no lumps of brown sugar remain. Add the dry ingredients and stir with a wooden spoon until well blended. (The dough will be quite firm.) Transfer two-thirds of the dough to the prepared baking dish. Cover the dough with a piece of plastic wrap and press through the wrap to spread the dough into an even layer in the bottom of the dish. Remove the plastic wrap. Bake until puffed and golden, about 15 minutes.

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To make topping: Gradually work enough of the remaining 3 tablespoons whole-wheat pastry flour into the remaining dough using your fingertips, until it resembles coarse crumbs. To make filling: Stir together sugar, all-purpose flour, and lemon zest in a small bowl. Combine blueberries and lemon juice in a medium saucepan; cook, stirring, over medium heat until the berries begin to exude juice. Add the sugar mixture and stir until the filling reaches a simmer and thickens.

To assemble and bake: Push down the higher outside edges of the baked crust with a wooden spoon; pour the hot filling over the crust and spread it all the way to the sides of the dish. Sprinkle the crumb topping over the top. Bake until the topping is golden, 15 to 20 minutes. Transfer the baking dish to a rack and let cool, covered with a kitchen towel to soften the crumbs slightly. Cut into 15 bars. Dust lightly with confectioners’ sugar (if using). Store at room temperature in an airtight container.

Desserts Chocolate Crepes with Orangeand-Chocolate Sauce Makes 8 crepes

Crepes 6 tablespoons all-purpose flour 2 tablespoons unsweetened cocoa powder 1 tablespoon sugar Pinch of salt ¼ cup skim milk 1 large egg 2 teaspoons canola oil, divided ¼ cup water Orange syrup ½ cup sugar ½ cup water Zest from 2 oranges, cut into very thin strips Filling 1 cup yogurt cheese (see tip) 2½ tablespoons confectioners’ sugar 1 teaspoon vanilla extract Chocolate Sauce (see page 42)

Nutrition information per serving Calories 221 Total fat 4g Saturated fat 2g Trans fat 0g Cholesterol 32 mg Sodium 108 mg Total 41 g carbohydrates Fiber 1g Protein 7g

To make crepes: Combine flour, cocoa, sugar, salt, milk, egg, 1 teaspoon oil, and water in a food processor or blender and blend until smooth. Transfer to a bowl and refrigerate for 1 hour or for up to 24 hours. To make orange syrup: Combine sugar and water in a small saucepan. Bring to a boil, add orange zest, reduce heat to low,

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and simmer, uncovered, for 20 to 25 minutes, or until the syrup has thickened and the zest is tender. Several times during the cooking, brush the sides of the saucepan with a pastry brush dipped in cold water to keep sugar crystals from forming on the sides. Remove from heat and let cool. To make filling: Whisk together yogurt cheese, confectioners’ sugar, and vanilla in a small bowl until well-blended. Cover and refrigerate. To cook and assemble crepes: If necessary, add 1 to 2 tablespoons water to crepe batter so that it has the consistency of light cream. Heat a small nonstick skillet or crepe pan over medium heat until a drop of water sizzles when sprinkled on the surface. Reduce heat to medium-low. Brush pan with a little of the remaining 1 teaspoon oil as needed to prevent sticking. Pour about 2 tablespoons batter on the skillet and swirl to coat the bottom evenly. Cook 30 to 40 seconds until the top of the crepe has a dull surface and the edges begin to curl. Flip and cook for 20 to 30 seconds, or until the crepe is firm. Remove to a plate and cover with a dry cloth. Repeat with remaining crepes. (The crepes may be stacked until served.) Place a crepe on a dessert plate. Spread 2 tablespoons of filling across the middle. Fold in half and spoon 1 tablespoon Chocolate Sauce over top or beside it. Spoon 2 teaspoons orange syrup and zest over the crepe. Repeat with remaining crepes. Tip: To make 1 cup of yogurt cheese, line a colander with a large cotton towel or double thickness of cheesecloth, and place the colander in the sink. Pour in 3 cups low-fat yogurt. After 15 minutes, transfer the colander to a bowl. Cover with plastic wrap and refrigerate for 24 hours or overnight. Gathering the edges of the towel together, gently squeeze out any remaining liquid. Transfer cheese to a separate container. Refrigerate until ready to use. Keeps 1 week.

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Special Section

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Chocolate Sauce Makes ½ cup (8, 1-tablespoon servings)

3 tablespoons unsweetened cocoa powder 1½ teaspoons cornstarch 1½ teaspoons sugar 3 tablespoons skim milk ¹⁄³ cup corn syrup ½ teaspoon canola oil ½ teaspoon vanilla extract

Nutrition information per serving Calories Total fat Saturated fat Trans fat Cholesterol Sodium Total carbohydrates Fiber Protein

56 1g 0g 0g 0 mg 13 mg 14 g 1g 1g

Sift together cocoa, cornstarch, and sugar in a small saucepan. Gradually whisk in milk. Whisk in corn syrup. Bring to a boil, whisking. Reduce heat to low and simmer until thickened. Remove from heat and whisk in oil and vanilla.

Chocolate-Cinnamon Bread Pudding Makes 6 servings

4 slices whole-wheat or white bread, torn into small pieces 2 large eggs 1 (12-ounce) can evaporated skim milk ¾ cup light brown sugar ¼ cup cocoa powder, preferably Dutch-process 2 teaspoons vanilla extract 1 teaspoon ground cinnamon 1 ounce semisweet chocolate, chopped 3 cups nonfat vanilla or coffee frozen yogurt

Nutrition information per serving Calories 275 Total fat 4g Saturated fat 2g Trans fat 0g Cholesterol 73 mg Sodium 130 mg Total 54 g carbohydrates Fiber 2g Protein 10 g

Preheat oven to 350° F. Coat an 8-inch square baking dish with cooking spray. Spread bread in the dish in an even layer. Whisk eggs in a medium bowl. Add evaporated skim milk, sugar, cocoa, vanilla, and cinnamon; whisk the mixture until the sugar and cocoa dissolve. Pour the cocoa mixture over the bread. Mix in any unsoaked bread pieces. Sprinkle chocolate over the top and let stand for 10 minutes. Bake until puffed and set in the center, 35 to 40 minutes. Serve warm, with a scoop of frozen yogurt on top. The pudding is also good cold.

Roasted Peach Sundae

Nutrition information per serving

Makes 6 servings

Calories Total fat Saturated fat Trans fat Cholesterol Sodium Total carbohydrates Fiber Protein

3 ripe peaches, halved and pitted 1 tablespoon brown sugar 2 teaspoons lemon juice 3 cups nonfat vanilla frozen yogurt 6 gingersnaps, crumbled (optional)

138 0g 0g 0g 2 mg 64 mg 30 g

Preheat oven to 425° F. Coat a baking 1g sheet with cooking spray. Toss peach 5g halves with brown sugar and lemon juice, and place them cut-side-up on the prepared baking sheet. Roast until the peaches are tender, 20 to 30 minutes. If the juice on the pan begins to burn, add a little water and loosely cover the fruit with foil. Top each peach half with a ½-cup scoop of frozen yogurt and a sprinkle of crumbled gingersnaps (if using). Serve immediately.

Pineapple-Raspberry Parfait

Nutrition information per serving

Makes 4 servings

2 (8-ounce) containers nonfat peach yogurt (2 cups) ½ pint fresh raspberries (about 1¼ cups) 1½ cups fresh, frozen, or canned pineapple chunks Divide and layer yogurt, raspberries, and pineapple into 4 glasses.

Grilled Apples with Cheese and Honey

Calories Total fat Saturated fat Trans fat Cholesterol Sodium Total carbohydrates Fiber Protein

109 0g 0g 0g 2 mg 58 mg 23 g 3g 5g

Nutrition information per serving

Makes 2 servings

1 large or 2 small tart apples, peeled, cored, and sliced into ½-inch-thick rounds 2 teaspoons almond or canola oil 1 teaspoon confectioners’ sugar 1 ounce sharp Cheddar or Parmigiano-Reggiano cheese 2 tablespoons chopped pecans, toasted 4 teaspoons honey

Calories Total fat Saturated fat Trans fat Cholesterol Sodium Total carbohydrates Fiber Protein

250 14 g 3g 0g 15 mg 93 mg 30 g 3g 5g

Preheat grill or grill pan to medium heat. Toss apple slices with oil and sugar in a large bowl. Grill the apple slices until just tender and lightly marked, turning once, about 6 minutes total. Shave cheese into thin strips with a vegetable peeler. Top the apple slices with a sprinkling of cheese and nuts and drizzle with honey.

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Sample meal plan for a week Monday

Breakfast

Dinner

1 whole-wheat English muffin with 2 tablespoons peanut butter 1 banana

6-ounce baked chicken breast with ¾ cup brown rice Mashed Maple Squash (see page 36) Salad of 1 cup baby spinach, 5 slices cucumber, and 3 slices avocado with 1 tablespoon oil-and-vinegar dressing

Lunch Tuna Melt (see page 32) Mixed green salad with 1 tablespoon olive-oiland-vinegar dressing ¼ cantaloupe

Snack

Nutrition information

Snack ¾ cup apple slices with ½ cup nonfat vanilla yogurt and sprinkle of cinnamon

Calories

1,839

Total fat

70 g

Saturated fat

14 g

Trans fat

0g

Cholesterol Sodium

170 mg 1,721 mg

Total carbohydrates

217 g)

Fiber

30 g

Protein

100 g

1 ounce almonds

tuesday

Breakfast

Snack

Nutrition information

¾ cup nonfat vanilla yogurt with 1 cup sliced fresh peach and 2 teaspoons wheat germ 1 slice whole-wheat toast with 1 teaspoon almond butter

1 low-fat mozzarella cheese stick with 2 whole-grain flatbread crackers

Calories

1,786

Total fat

68 g

Dinner

Saturated fat

11 g

Snack 1 Whole-Wheat Blueberry Bar (see page 40)

Lunch Sandwich of 4 ounces turkey breast with 1 tablespoon canola mayonnaise, 4 tomato slices, and romaine lettuce on 2 slices whole-wheat bread 1 nectarine

Trans fat

Pan-Seared Salmon with Fennel and Dill Salsa Cholesterol (see page 34) Sodium 1 cup whole-wheat couscous Total carbohydrates Salad of 2 cups romaine lettuce, Fiber 2 tablespoons chopped walnuts, and 4 cherry tomatoes with 1 tablespoon olive-oil- Protein and-vinegar dressing 1 cup snap beans, sauteed in 2 teaspoons olive oil

0g 174 mg 1,479 mg 210 g 34 g 93 g

Wednesday

Breakfast

Dinner

1 cup old-fashioned oatmeal with 2 tablespoons chopped pecans and ½ cup blueberries

6-ounce baked or broiled haddock fillet 1 baked sweet potato ¾ cup broccoli and ¾ cup cauliflower sauteed in 1½ tablespoons olive oil Fennel and Orange Salad with Toasted Pistachios (see page 38)

Lunch Mediterranean Portobello Burger (see page 32) 1 ounce whole-grain corn chips 1 cup skim milk 1 pear

Snack ¼ cup hummus, 1 cup baby carrots www.h e a l t h . h a r v a r d . e d u

Nutrition information Calories

1,820

Total fat

67 g

Saturated fat

10 g

Trans fat

0g

Cholesterol Sodium

111 mg 1,740 mg

Snack

Total carbohydrates

1 cup nonfat strawberry banana yogurt

Fiber

42 g

Protein

84 g

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230 g

43


Thursday

Breakfast

Snack

1 cup egg substitute cooked in 1 tablespoon canola oil with 1 ounce low-fat cheddar cheese, ¼ cup green bell pepper, and ¼ cup onion 2 slices whole-wheat toast 1 cup strawberries

½ banana 1 tablespoon peanut butter

Calories

1,793

Total fat

63 g

Dinner

Saturated fat

10 g

Lunch Spicy Vegetable Soup (see page 39) Salad of 2 cups mixed greens with 2 radishes and 1 tablespoon oil-and-vinegar dressing 1 whole-wheat roll 1 cup skim milk 1 cup grapes 1 whole-wheat dinner roll

Tofu with Peanut-Ginger Sauce (see page 35) 1½ cup cooked whole-wheat noodles Roasted Peach Sundae (see page 42)

Nutrition information

Trans fat

0g

Cholesterol Sodium

13 mg 1,786 mg

Total carbohydrates

239 g

Fiber

37 g

Protein

82 g

Friday

Breakfast

Dinner

1 cup Bran Flakes cereal with ½ cup skim milk and ½ cup raspberries 1 cup nonfat blueberry yogurt

Spicy Chicken Tacos (see page 34) ¾ cup zucchini stir-fried in 2 teaspoons olive oil with ½ garlic clove, minced Salad of 2 cups baby spinach, ½ sliced apple, and 2 tablespoons chopped walnuts with 1 tablespoon oil-and-vinegar dressing

Lunch Sandwich of 3 ounces chicken breast with 1 tablespoon canola mayonnaise and romaine lettuce on 2 slices whole-wheat bread 1 orange

Snack

Snack 1 oatmeal raisin cookie ½ cup skim milk

Nutrition information Calories

1,797

Total fat

69 g

Saturated fat

10 g

Trans fat

0g

Cholesterol

155 mg

Sodium

1,524 mg

Total carbohydrates

218 g

Fiber

37 g

Protein

96 g

1 ounce peanuts

saturday

Breakfast

Dinner

¾ cup pineapple slices 2 oat-bran mini-bagels with 1½ ounces smoked salmon (lox) and 1 tablespoon cream cheese

Cider-Vinegar-and-Molasses-Glazed Pork Chops (see page 36) 1 medium baked yam

Lunch

Roasted Asparagus with Pine Nuts (see page 37) 1 fresh pear

Salad of 4 ounces grilled chicken breast strips on 2 cups field greens with ¼ cup shredded carrots, ¼ cup chopped onion, and 1 tablespoon oil-andvinegar dressing 2 whole-grain crackers 1 peach

Snack 1 slice whole-wheat bread 1 tablespoon peanut butter

Nutrition information Calories Total fat Saturated fat Trans fat Cholesterol Sodium Total carbohydrates

1,808 59 g 11.7 g 0g 143 mg 2,655 mg 238 g

Fiber

39 g

Protein

97 g

Snack 1 ounce pistachios

44

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sunday

Breakfast

Snack

Poppy Seed Waffles (see page 31) ½ cup plain nonfat yogurt ½ cup blueberries

¾ ounce sunflower seeds

Calories

1,805

Dinner

Total fat

63 g

Saturated fat

14 g

Nutrition information

5 ounces scallops sauteed in 1 tablespoon olive oil with ½ cup each broccoli, onions, yellow pepper, and carrots ¾ cup brown rice Corn, Arugula, and Tomato Salad (see page 37) Pineapple-Raspberry Parfait (see page 42)

Lunch Pizza made from 1 whole-wheat English muffin, split, each half topped with 2 ounces low-fat mozzarella cheese, 3 slices fresh tomato, and sliced green bell pepper 1 apple

Trans fat

0g

Cholesterol

182 mg

Sodium

2,068 mg

Total carbohydrates

223 g

Fiber

28 g

Protein

102 g

Recipe index The index below is organized by main ingredient. Recipes adapted from EatingWell Magazine. Beans, nuts, and soy

Eggs

• Chickpea

•G  olden

Salad (see page 38)

• Cumin-Roasted Almonds

(see page 40)

•T  ofu

with Peanut-Ginger Sauce (see page 35)

Breads and grains •A  pricot-Walnut

(see page 31)

• Asian

Cereal Bars

Brown Rice (see page 37)

•C  hocolate-Cinnamon

(see page 42)

Bread Pudding

•C  hocolate

Crepes with Orange-andChocolate Sauce (see page 41)

• Crunchy

Cereal Trail Mix (see page 40)

•G  olden

Polenta and Egg with Mustard Sauce (see page 33)

•M  inted

Peas and Rice with Feta (see page 37)

• Poppy

Seed Waffles (see page 31)

•W  hole-Wheat

(see page 40)

Blueberry Bars

• Cheddar-Apple

Melt (see page 40)

•C  heesy

Broccoli-Potato Mash (see page 36) Popcorn (see page 40)

•G  rilled Apples

(see page 42)

Polenta and Egg with Mustard Sauce (see page 33)

•P  an-Seared

Salmon with Fennel and Dill Salsa (see page 34)

•P  otato-Horseradish-Crusted

(see page 34)

with Cheese and Honey

Beef with Shrimp and Bok Choy (see page 33)

• Summer

Paella (see page 32)

Melt (see page 32)

• Spicy

Chicken Tacos (see page 34)

• Cheddar-Apple •G  rilled Apples

(see page 42)

Melt (see page 40)

with Cheese and Honey

•P  ineapple-Raspberry

(see page 42)

• Roasted

• Turkey

Paella (see page 32)

and Pepper Roll-Up (see page 32)

Sauces, dressings, and dips • Chocolate

Sauce (see page 42)

• Creamy

Dill Ranch Dressing (see page 38)

• Sesame

Mayonnaise (see page 35)

Vegetables • Cheesy

Fruit

Parfait

Peach Sundae (see page 42)

•W  hole-Wheat

Blueberry Bars

Broccoli-Potato Mash (see page 36)

• Corn, Arugula, and Tomato

(see page 37)

Salad

• Fennel

and Orange Salad with Toasted Pistachios (see page 38)

• Golden

Gazpacho (see page 39)

• Mashed

Maple Squash (see page 36)

• Mediterranean

(see page 32)

Portobello Burger

• Minted

Meat •C  ider-Vinegar-and-Molasses-Glazed

Pork Chops (see page 36)

•S  picy

Beef with Shrimp and Bok Choy (see page 33)

Peas and Rice with Feta (see page 37)

• Roasted Asparagus

(see page 37)

• Spicy Vegetable

with Pine Nuts

Soup (see page 39)

• Tex-Mex

Summer Squash Casserole (see page 36)

Poultry • Asian Turkey

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Mahi-Mahi

•S  picy

• Tuna

Noodle Soup with Dill (see page 39)

• Summer

Fish

(see page 40)

Cheese

• Cheesy

•C  hicken

Burgers (see page 35)

• Vinegary

Coleslaw (see page 38)

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45


Resources Organizations American Dietetic Association 120 S. Riverside Plaza, Suite 2000 Chicago, IL 60606 800-877-1600 (toll-free) www.eatright.org

EatingWell www.eatingwell.com

A professional organization of registered dietitians. Provides information on nutrition and a list of dietitians in your area.

The Nutrition Source Harvard School of Public Health Department of Nutrition www.hsph.harvard.edu/nutritionsource

American Heart Association 7272 Greenville Ave. Dallas, TX 75231 800-242-8721 (toll-free) www.americanheart.org Operates a consumer hotline to answer questions on general heart health and offers educational pamphlets, posters, and audiovisual material for free or a nominal fee. Its Web site has news on heart disease research as well as background information on prevention and treatment. (Check your telephone directory for local AHA groups.) National Heart, Lung, and Blood Institute NHLBI Information Center P.O. Box 30105 Bethesda, MD 20824 301-592-8573 www.nhlbi.nih.gov Offers educational pamphlets on heart disease, blood pressure, cholesterol, obesity, and physical activity for free or a nominal fee. These pamphlets are available on the Web site, or you can order them by phone.

Web sites CalorieKing www.calorieking.com Offers a database of over 30,000 foods, including ethnic items and selections from popular restaurants. (Membership is not required for database access.) The pages include data on calories, fat, fiber, and carbohydrates for both brand-name and generic products. The Web site also includes articles on nutrition, a free newsletter, and interactive exercises.

46

Healthy Eating for a Healthy Heart

Provides delicious healthful recipes and food and nutrition information reviewed by registered dietitians and science editors.

Offers free access to the latest information on nutrition and health. The Web site has news of findings from ongoing Harvard studies as well as background information on macronutrients, vitamins and minerals, weight loss, and other nutrition topics.

Book Eat, Drink, and Be Healthy: The Harvard Medical School Guide to Healthy Eating Walter C. Willett, M.D., with P.J. Skerrett (Simon and Schuster, 2005) Based on the latest nutritional science, this easy-to-understand book presents state-of-the-art information about the links between diet and health, including coronary artery disease. It also provides a practical approach to healthy eating.

Newsletter Harvard Heart Letter Harvard Medical School P.O. Box 9308 Big Sandy, TX 75755 877-649-9457 (toll-free) www.health.harvard.edu/subinfo Edited by Harvard Medical School cardiologist Thomas H. Lee, M.D., the monthly Harvard Heart Letter provides timely, practical information on heart health.

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Glossary atherosclerosis: The buildup of fatty deposits in the walls of arteries; the disease responsible for most heart attacks and many strokes. blood pressure: The force of the blood pushing against the walls of the arteries. Systolic pressure (the higher number) is the pressure when the heart pumps. Diastolic pressure (the lower number) is the pressure when the heart is refilling with blood between beats. calorie: The unit for measuring the amount of energy in food. carbohydrate: The major component of fruits, vegetables, milk, and starches such as bread, pasta, rice, and potatoes. Carbohydrates are one of the three primary nutrients (along with fats and proteins) and provide most of your body’s fuel. cholesterol: A waxy, fatlike substance that is present in animal tissues and produced by the liver. Excess levels can build up in artery walls. coronary arteries: Two major blood vessels that carry oxygen-­rich blood to the heart. coronary artery disease: The most common form of heart disease, caused by the buildup of fatty plaques in the coronary arteries. diabetes: A chronic metabolic disorder in which levels of blood glucose, or sugar, are elevated. Excess body weight raises the risk of developing this condition. fat: One of the three major nutrients (along with carbohydrates and proteins). Fat is found in both animal and plant foods; the chemical compositions and health effects of fats differ depending on the source. fiber: An indigestible substance found in plant foods that helps fill you up without adding calories.

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high-density lipoprotein (HDL): Commonly called “good” cholesterol; a lipoprotein that protects the arteries by transporting cholesterol from body cells to the liver for metabolism or elimination. hypertension: Abnormally high blood pressure. Individuals who are overweight are at greater risk of developing high blood pressure. lipoprotein: Protein-covered fat particles that transport cholesterol and triglycerides through the blood. (See low-density lipoprotein and high-density lipoprotein.) low-density lipoprotein (LDL): Commonly called “bad” cholesterol; can cause buildup of plaque in the arteries. monounsaturated fat: A healthful type of fat found in peanut oil, canola oil, peanuts, cashews and other nuts, and avocados. omega-3 fats: Essential fatty acids found in large quantities in cold-water fish. Also found in plant foods and oils, such as walnuts, flaxseed, and canola and soybean oils. plaque: Deposits of cholesterol and fatty and fibrous substances in the walls of the arteries. polyunsaturated fat: A healthful type of fat found in corn, soybean, and other vegetable oils; also found in seeds, legumes, whole grains, and fatty fish, such as salmon and tuna. protein: One of the three major nutrients (along with carbohydrates and fats); used by the body for building and repairing tissue. Derived primarily from animal sources but also present in some vegetables. saturated fat: A type of fat found in animal foods that raises unhealthy LDL cholesterol levels. trans fat: An unhealthy processed fat found in hydrogenated or partially hydrogenated vegetable oils and shortening.

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47


Notes

48

Healthy Eating for a Healthy Heart

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This Harvard Health Publication was prepared exclusively for Guest - Purchased at http://www.health.harvard.edu/


This Harvard Health Publication was prepared exclusively for Guest - Purchased at http://www.health.harvard.edu/


Order this report and other publications from Harvard Medical School online

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phone

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mail

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HEHH09

Healthy Eating for a Healthy Heart - Harvard  

Guidelines for healthy eating for optimal heart health.