Vitamin C
2%
of These
Nutrients
Calcium
20%
Iron
4%
* Percent Daily Values are based on a 2,000 calorie diet.
Your Daily values may be higher or lower depending on
your calorie needs. Calories:
2,000
2,500
Total Fat
Less Than
65g
80g
Footnote
Sat Fat
Less Than
20g
25g
Cholosteral
Less Than
300mg
300mg
Sodium
Less than
2,400mg
2,400mg
Total Carbohydrate
300g
375g
Dietary Fiber
25g
30g
— 65 —
Blood Pressure and the DASH Eating Plan
If you have high blood pressure or prehypertension, you may
want to follow an eating plan called “DASH.” DASH stands for
“Dietary Approaches to Stop Hypertension,” and the DASH
eating plan emphasizes fruits, vegetables, fat-free or low-fat milk
and milk products, whole grain products, fish, poultry, beans,
seeds, and nuts. The DASH eating plan also contains less
salt/sodium, sweets, added sugars, sugar containing beverages,
fats, and red meats than the typical American diet. This heart
healthy way of eating is also lower in saturated fat and cholesterol
and is rich in nutrients that are associated with lowering blood
pressure—mainly potassium, magnesium, calcium, protein, and fiber.
A major study found that people who followed this eating plan
reduced their blood pressure more than those who ate more
“typical” American diets, which have fewer fruits and
vegetables. A second study found that people who followed the
DASH eating plan and cut down on sodium had the biggest
reductions in blood pressure. (Salt, or sodium chloride, and
other forms of sodium are found in many processed foods.)
So, for a truly winning combination, follow the DASH eating
plan and lower your sodium intake as much as possible. The
study found that the less sodium people consumed, the more
their blood pressure dropped.
The DASH eating plan is geared especially to people with high
blood pressure or prehypertension, but it is a healthy plan for
anyone, so share it with your family. When people who have
normal blood pressure follow the DASH eating plan, especially
when they also consume less sodium, they may lessen their
chances of developing high blood pressure. Remember, 90
percent of middle-aged Americans go on to develop high blood
pressure. Use the DASH plan to help beat the odds!
— 66 —
“ I H A V E T O L O S E W E I G H T A N D R E D U C E M Y
C H O L E S T E R O L . T H I S I S J U S T T H E B E G I N N I N G
O F A L O N G B A T T L E , A N D
I K N O W I T W O N ' T
B E E A S Y , B U T I K N O W
I H A V E T O D O I T . "
—Rosario
— 67 —
T H E D A S H E AT I N G P L A N
The DASH eating plan shown below is based on 2,000 calories a day. The
number of daily servings in a food group may vary from those listed, depending on how many daily calories you need.
Food Group
Daily Servings
Serving Sizes
(except as noted)
Grains*
6–8
1 slice bread
1 oz dry cereal†
1/2 cup cooked rice, pasta, or cereal
Vegetables
4–5
1 cup raw leafy vegetables
1/2 cup cooked vegetables
6 oz vegetable juice
Fruits
4–5
1 medium fruit
1/4 cup dried fruit
1/2 cup fresh, frozen, or canned fruit
1/2 cup fruit juice
Low-fat or fat-free
2–3
1 cup milk or yogurt
milk and milk
11/2 oz cheese
products
Lean meats, poultry,
6 or less
1 oz cooked meats, poultry, or fish
and fish
1 egg‡
Nuts, seeds,
4–5 per week
1/3 cup or 11/2 oz nuts
and legumes
2 tbsp peanut butter
2 tbsp or 1/2 oz seeds
1/2 cup cooked legumes
(dry beans and peas)
— 68 —
Food Group
Daily Servings
Serving Sizes
(except as noted)
Fats and oils§
2–3
1 tsp soft margarine
1 tsp vegetable oil
1 tbsp mayonnaise
2 tbsp light salad dressing
Sweets and
5 or less
1 tbsp sugar
added sugars
per week
1 tbsp jelly or jam
1/2 cup sorbet or gelatin
1 cup lemonade
* Whole grains are recommended for most grain servings as a good source of fiber and nutrients.
† Serving sizes vary between 1/2 cup and 11/4 cups. Check the product’s
Nutrition Facts label.
‡ Since eggs are high in cholesterol, limit egg yolks to no more than four per week. Two egg whites have the same amount of protein as 1 ounce of meat.
§ Fat content changes the serving amount for fats and oils. For example, 1 tbsp of regular salad dressing equals 1 serving; 1 tbsp of a low-fat dressing equals one-half serving; 1 tbsp of a fat-free dressing equals zero servings.
— 69 —
H O L D T H E S A LT: H O W T O reduce
S A LT A N D S O D I U M I N Y O U R D I E T
You can help prevent and control high blood pressure by cutting
down on salt and other forms of sodium. Try to consume no
more than 2,300 mg of sodium a day—or, if you can, no more
than 1,500 mg a day (2,300 mg of sodium equals 1 tsp of
table salt, while 1,500 mg equals 2/3 tsp). Here are some tips
on limiting your intake of salt and sodium:
■ Choose low-sodium, reduced-sodium, or no-salt-added versions
of foods and condiments, when available.
■ Choose fresh, frozen, or canned (low-sodium or no-salt-added)
vegetables.
■ Use fresh poultry, fish, and lean meat, rather than canned,
smoked, or processed types.
■ Choose ready-to-eat breakfast cereals that are lower in
sodium.
■ Limit cured foods (such as bacon and ham), foods packed in
brine (such as pickles, pickled vegetables, olives, and
sauerkraut), and condiments (such as mustard, horseradish,
ketchup, and barbeque sauce). Limit even lower sodium
versions of soy sauce and teriyaki sauce. Use these
condiments sparingly, as you do table salt.
— 70 —
■ Cook rice, pasta, and hot cereals without salt. Cut back on
instant or flavored rice, pasta, and cereal mixes, which usually
have added salt.
■ Choose “convenience foods” that are lower in sodium.
Cut back on frozen dinners, mixed dishes such as pizza,
packaged mixes, canned soups or broths, and salad dressings.
These foods often have a lot of sodium.
■ Rinse canned foods, such as tuna and canned beans, to
remove some of the sodium.
■ Salt substitutes containing potassium chloride may be useful
for some individuals, but they can be harmful to people with
certain medical conditions. Ask your doctor before trying salt
substitutes.
■ When you cook, be “spicy” instead of “salty.” In cooking and
at the table, flavor foods with herbs, spices, wine, lemon, lime,
vinegar, or salt-free seasoning blends. Start by cutting your
salt use in half.
— 71 —
What Else Affects Blood Pressure?
A number of foods and other factors have been reported to affect
blood pressure. Here are the latest research findings:
■ Garlic and onions. These foods have not been found to
affect blood pressure, but they are tasty, nutritious substitutes
for salty seasonings and can be used often.
■ Caffeine. This may cause blood pressure to rise, but only
temporarily. Unless you are sensitive to caffeine, you do not
have to limit how much you consume to prevent or control high
blood pressure.
■ Stress. Stress, too, can make blood pressure go up for a
while and has been thought to contribute to high blood
pressure. But the long-term effects of stress are not clear.
Furthermore, stress management techniques do not seem to
prevent high blood pressure. However, stress management
may help you to control other unhealthy habits, such as
smoking, overeating, or using too much alcohol.
High Blood Cholesterol and the TLC Program
The TLC Program can help you to lower high blood cholesterol and
protect your health. TLC stands for “Therapeutic Lifestyle Changes,”
a program that includes an eating plan that is low in saturated fat,
trans fat, and cholesterol. The eating plan also adds plant stanols
and sterols to your diet as well as more soluble fiber. The TLC
Program also calls for increased physical activity and weight
control. Adopt the TLC Program and you’ll lower your chances of
developing heart disease, future heart attacks, and other heart
disease complications. (The main difference between the TLC
and the DASH eating plans is that the TLC plan puts more
emphasis on decreasing saturated fat and trans fat to
lower blood cholesterol levels.)
— 72 —
eatingTHE TLC WAY
If your LDL cholesterol is above your goal level (see pages 32
and 33), you should start on the TLC eating plan right away.
The TLC eating plan will help to reduce your LDL cholesterol and
lower your chances of developing heart disease. If you already
have heart disease, it will lessen your chances of a heart attack
and other heart-related problems. On the TLC eating plan, you
should eat as follows:
■ Less than 7 percent of the day’s total calories from saturated fat.
Lowering saturated fat is the most important dietary change for
reducing blood cholesterol.
■ Less than 200 mg of dietary cholesterol a day.
■ No more than 25 to 35 percent of daily calories from total fat
(includes saturated fat calories).
■ Just enough calories to reach or maintain a healthy weight.
■ In addition, you should get at least 30 minutes of moderate-
intensity physical activity on most, and preferably all, days of
the week.
If your blood cholesterol is not lowered enough on the TLC Program,
your doctor or registered dietitian may advise you to increase
the amount of soluble fiber and/or add cholesterol-lowering
food products. These products include margarines that contain
ingredients called “plant sterols” or “plant stanol esters,” which
lower LDL cholesterol. If your LDL level is still not lowered
enough, your doctor may prescribe a cholesterol-lowering drug
along with the TLC Program. (See “To Learn More” on page 119.)
— 73 —
P A T T I E
“There are a lot of things I want to do in my life,
so I know it’s important to take care of my health.
Most women put everyone else before themselves,
but you can’t put off taking care of your heart.”
The Lowdown on Low Fat
Recently, a large study reported what seemed to be startling
results: women who reduced their total fat intake did not
significantly reduce their risks for heart disease and other serious
disorders. This widely publicized Women’s Health Initiative (WHI)
study, which tracked more than 48,000 postmenopausal women,
found that those who ate lower fat diets for an average of 8 years
had about the same risk of heart attack, stroke, breast cancer, and
colon cancer as did women who ate whatever they wanted.
Does this mean we can feast on french fries and fudge without a
second thought? Not at all. The WHI study was designed to
study the impact of reducing total fat, without distinguishing
between “good” fats found in fish, nuts, and vegetable oils, and
“bad” fats like saturated fat and trans fat, which are found in
processed foods, meats, and some dairy products. The type of
fat you eat affects your heart disease risk. Other studies have
found that reducing “bad” fats lowers risks for heart disease and
future heart attacks, while consuming small amounts of “good”
fats may be protective. In fact, a closer look at the WHI study
supports the heart benefits of reducing “bad” fats.
The bottom line is that women should continue to follow an
eating plan that is low in saturated fat, trans fat, and cholesterol
to reduce their risk of heart disease. (For specifics, see “Figuring
Out Fat” on page 79.) Most of the fat you consume each day
should come from vegetable oils, fish, nuts, and other sources of
polyunsaturated and monosaturated fats.
— 74 —
Now You’re Cooking: Limiting Saturated Fat,
Trans Fat, and Cholesterol
Planning and preparing nutritious meals may take a little extra
effort, but the health benefits are huge. Here are some tips for
cutting down on saturated fat, trans fat, and dietary cholesterol,
which will help to lower your LDL cholesterol and reduce your
heart disease risk. It will improve heart health for all women, and
may be particularly helpful for those following the TLC eating plan.
Meat, Poultry, and Fish
■ Choose fish, poultry, and lean cuts of meat. Trim the fat from
meats; remove the skin and fat from chicken. Keep portion
sizes moderate.
■ Broil, bake, roast, or poach instead of frying. When you do fry,
use a nonstick pan and a nonstick cooking spray or a very small
amount of oil or margarine.
■ Cut down on sausage, bacon, and processed high-fat cold cuts
(which are also high in sodium).
Milk Products and Eggs
■ Instead of whole milk or cream, use fat-free or 1-percent milk.
■ Use fat-free or low-fat cheeses and yogurt.
■ Replace ice cream with sorbet, sherbet, and fat-free or low-fat
frozen yogurt. Keep portion sizes moderate.
■ Limit the number of egg yolks you eat. Two or fewer yolks per
week—including yolks in baked goods and in cooked or
processed foods. Egg whites contain no fat or cholesterol, so
you can eat them often. In most recipes, you can substitute
two egg whites for one whole egg.
■ Use soft margarines (liquid or tub types) that contain little or no
trans fat. Trans fat is another type of dietary fat that raises LDL
cholesterol.
— 75 —
Grains and Grain Products
■ Eat foods with lots of fiber and nutrients and make sure that at
least half of your grain products are whole grain. These
include whole-grain breads, pastas, and cereals, as well as
brown rice. When you check package labels, look for the
word “whole” in the ingredients. Make sure that whole grains
appear among the first items listed.
Sauces, Soups, and Casseroles
■ After making sauces or soups, cool them in the refrigerator and
skim the fat from the top. Do the same with canned soups.
■ Thicken a low-fat sauce with cornstarch or flour.
■ Make main dishes with whole-grain pasta, rice, or dry peas
and beans. If you add meat, use small pieces for flavoring
rather than as the main ingredient.
When You Can’t Face Cooking
■ Check nutrition labels to choose frozen dinners and pizzas that
are lowest in saturated fat, trans fat, and cholesterol. Make
sure the dinners include vegetables, fruits, and whole grains—
or add them on the side.
■ Choose store-bought baked goods that are lowest in saturated
fat, cholesterol, trans fats, and hydrogenated (hardened) fats.
Trans fats, or trans fatty acids, are formed when vegetable oil
is hardened to become margarine or shortening in a process
called “hydrogenation.” Foods high in trans fats tend to raise
blood cholesterol. Read labels. To reduce trans fats, limit
products that list “hydrogenated oil” or “partially hydrogenated
oil” as an ingredient. Also, remember that even no cholesterol
and fat-free baked goods still may be high in calories.
— 76 —
Dining Out for Health
With a little planning—and a willingness to speak up—you can
eat healthfully when you dine out. Here are some tips:
■ You’re the customer. Ask for what you want. Most restaurants
will honor your requests. You have nothing to lose by asking!
■ Order small. To reduce portion sizes, try ordering heart
healthy appetizers or children’s portions as your main meal.
Or, take half of your entree home with you for lunch the next day.
■ Ask questions. Don’t hesitate to ask your server how foods are
prepared and whether the restaurant will make substitutions.
Ask if they will:
• Serve low-fat or fat-free milk rather than whole milk or cream.
• Tell you the type of cooking oil used. (Preferred types, which
are lower in saturated fat, are canola, safflower, sunflower,
corn, and olive oils.)
• Trim visible fat off poultry or meat.
• Leave all butter, gravy, and sauces off an entree or side dish.
• Serve salad dressing on the side.
• Meet special requests if you make them in advance.
■ Select foods cooked by low-fat methods. Look for terms such
as broiled, baked, roasted, poached, or lightly sauteed.
■ Limit foods high in calories and fats, especially saturated fat
and trans fat. Watch out for terms such as fried, crispy,
creamed, escalloped, Hollandaise, Bearnaise, casserole, and
pastry crust.
— 77 —
Make Healthy Choices For:
■ Breakfast: Fresh fruit, a small glass of citrus juice, low-fat or fat-free milk and yogurt, whole-grain bread products and
cereals, or an omelet made with egg whites or egg substitute.
■ Beverages: Water with lemon, flavored sparkling water,
juice spritzer (half fruit juice and half sparkling water),
unsweetened iced tea, or reduced-sodium tomato juice.
■ Breads: Most yeast breads are low in calories and fat—as
long as you limit the butter, margarine, or olive oil. Choose
whole-grain breads, which are packed with important nutrients
and are full of fiber to make you feel fuller faster. Also, watch
the sodium content.
■ Appetizers: Steamed seafood, fresh fruit, bean soups, or
salad with reduced-fat dressing.
■ Entrees: Skinless poultry, fish, shellfish, vegetable dishes, or pasta with red sauce or vegetables. Limit your use of butter,
margarine, and salt at the table.
■ Salads: Fresh lettuce, spinach, and other greens; other fresh
vegetables, chickpeas, and kidney beans. Skip high-fat and
high-calorie nonvegetable choices such as deli meats, bacon,
egg, cheese, and croutons. Choose lower calorie, reduced-fat,
or fat-free dressings, lemon juice, or vinegar.
■ Side dishes: Vegetables and grain products, including
whole-grain rice or noodles. Ask for salsa or low-fat yogurt
instead of sour cream or butter.
■ Dessert: Fresh fruit, fat-free frozen yogurt, sherbet, or fruit
sorbet (usually fat-free, but ask for the calorie content). Try
sharing a dessert. If you drink coffee or tea with dessert, ask
for low-fat or fat-free milk instead of cream or half-and-half.
— 78 —
L A B E L L A N G U A G E
Food labels can help you choose items that are lower in sodium, saturated and total fat, trans fat, cholesterol, and calories. When you shop for groceries, look for these claims on cans, bottles, and other packaging:
Sodium claims
What they mean
Sodium free or salt free
Less than 5 mg of sodium per serving
Very low sodium
35 mg or less per serving
Low sodium
140 mg or less per serving
Low-sodium meal
140 mg or less per 31/2 oz
Reduced or less sodium
At least 25% less than the regular version
Light in sodium
50% less than the regular version
Unsalted or no salt added
No salt added to product during processing,
but this is not a sodium-free food
Fat claims
What they mean
Fat free
Less than 1/2 g of fat per serving
Low saturated fat
1 g or less per serving and 15% or less of
calories from saturated fat
Low fat
3 g or less per serving
Reduced fat
At least 25% less fat than the regular version
Light in fat
Half the fat compared to the regular version
Calorie claims
What they mean
Calorie free
Less than 5 calories per serving
Low calorie
40 calories or less per serving
Reduced or less calories
At least 25% fewer calories per serving than
the regular version
Light or lite
50% less fat or 33% fewer calories than the
regular version
— 79 —
Know Your Foods
The following are some additional tips on shopping, cooking,
and eating for heart health:
■ To choose foods wisely, see “How To Read a Nutritional Facts
Label” on page 65 and “Label Language” on page 77.
■ To prepare and eat heart healthy meals, see “Figuring Out Fat”
on the next page and “What’s in a Serving?” on page 80.
■ For other tips on making good food choices, see “Healthy Snacking”
below and “Vitamins for Heart Health” on page 82.
Healthy Snacking
Many snacks, including many types of cookies, crackers, and
chips, are high in saturated fat, trans fat, cholesterol