COPYRIGHT 2001, 2006, 2007, 2008 PRODUCED BY THE DIETITIANS AT TRILLIUM HEALTH CENTRE, MISSISSAUGA, ONTARIO

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2 2 The Inside Scoop Welcome to the wonderful world of cholesterol...3 What changes our cholesterol?...3 Types of fat in our diet...4 Added fats and oils...5 Milk products...5 Meats and Alternatives...6 Increase your fibre intake...7 So how can we increase the fibre in our diet?...7 Grains...8 Fruits & Vegetables...9 Alcohol...9 Seasoning without salt Space on your Plate Heart Healthy Resources... 12

3 Welcome to the wonderful world of cholesterol When your doctor orders your cholesterol to be tested she/he is looking for 4 main things: 3 1) Total cholesterol = LDL + HDL + other blood fats. This number does not give much information. That is why it is important to find out what numbers 2 and 3 are. 2) LDL (low density lipoprotein) Think L for lousy, this is the BAD cholesterol. High amounts can cause plaque build up and eventually block your vessels. 3) HDL (High density lipoprotein) Think H for healthy, this is the GOOD cholesterol. High amounts are good because HDL acts as a garbage truck and gets rid of the BAD cholesterol from the body. 4) Triglycerides These are little fats that float around in your blood. When triglycerides are high they can stick to blockages made in your heart by LDL cholesterol. What Changes Our Cholesterol? Cholesterol Type Improves by following: Worsens by following: LDL Cholesterol A diet that is. low in saturated fat (see next page for explanation) in soluble fibre (see fibre section for explanation) A diet that is. in saturated fat Triglycerides HDL Cholesterol A diet that is... in refined carbohydrates in alcohol in cold water fish Omega 3 fatty acids specifically DHA and EPA (1 gm/day) Weight loss Exercise/weight loss Smoking Cessation A diet that is. in sugar in alcohol A diet that is in trans fats

4 Did You Know.. Eating a heart healthy diet is not only about lowering your total fat intake, but also about choosing the right kinds of fats. So make the switch from saturated fats to unsaturated fats to help improve your blood cholesterol! What should I do Choose unsaturated fats more often Limit Cholesterol Type of Fat What do they do? Where are they found? Polyunsaturates Monounsaturates Saturates TRANS FATS*** (HYDROGENATED) Will lower blood cholesterol levels Will lower blood cholesterol levels Raise blood cholesterol levels Raise blood cholesterol levels & decrease HDL Dietary cholesterol increases blood cholesterol but not as much as saturated fats do Are found mainly in soft fats such as vegetable oils and foods that contain these oils like soft-tub margarines. Fish, flax seeds, sesame seeds, safflower, sunflower, corn, and soybean oils are all high in polyunsaturates. Are found mostly in avocados, some nuts and soft fats including olive oil and canola oil, and foods that contain these oils like soft tub non-hydrogenated margarines. Are found mostly in palm kernel oil and firm fats that come from animal food sources such as meat, lard, butter, milk, yogurt, and cheese. Are found mainly in many processed foods that contain shortening or partially hydrogenated fats like some but not all margarines, cookies, crackers, French fries, potato chips, donuts, and commercial baked goods. Is found only in animal food sources such as meat, eggs butter, yogurt and cheese.

5 Added Fats & Oils: 1-2 tbsp per day Healthy Choices Foods to Enjoy in Moderation (once a month) 5 Vegetable oils canola, olive, peanut, safflower, sunflower, corn, soybean Non-hydrogenated margarines Salad dressings Make your own with oil/vinegar/lemon juice/spices Light mayonnaise or miracle whip Palm kernel oils Animal or vegetable shortening Butter Hydrogenated and partiallyhydrogenated margarines Salad dressings made with cheese, cream or regular sour cream Coffee creamer, ½ & ½ cream, coffee mate, coffee rich Whipping cream Regular mayonnaise Healthy Choices Skim or 1% milk Skim milk powder Buttermilk Evaporated skim or 1% milk Calcium enriched Skim or 1% soy milk Calcium enriched rice milk Part skim, skim or light cheese (20% M.F. or less) Low fat cottage cheese (1% M.F. or less) Nonfat or low fat yogurt. frozen yogurt or ice cream (1% M.F. or less) 1% M.F. or less sour cream Milk Products B.F = Butter Fat M.F = Milk Fat and can be found on dairy product labels Foods to Enjoy in Moderation (once a month) Homo milk or 2% milk Condensed milk Cheeses with more than 20% M.F 4% Cottage cheese Yogurt with more than 2% M.F. Regular sour cream Regular ice cream Did you know? Homo milk has 45% of calories from fat 2% milk has 35% calories from fat 1% milk has 21% calories from fat Skim milk has 0 calories from fat.

6 Meats and Alternatives Healthy Choices Lean cuts of meat with fat trimmed: Beef/veal round, sirloin, chuck, loin, flank, x-lean ground Lamb leg, arm, loin, rib Pork tenderloin, leg, shoulder Poultry without skin Lean deli meats e.g. lean ham, roast chicken, roast beef, lean pastrami Fish Foods to Enjoy in Moderation (once a month) Heavily marbled meat Regular ground beef/pork Poultry with skin, fried chicken Processed meats (wieners, salami, bologna) 6 Good sources of DHA and EPA: Mackerel* = 2500 mg/100gm Sardines = 2000mg/100gm Herring = 1600 mg/100 gm Salmon = 1200mg/100 gm Lake trout = 500 mg/100 gm Low fat soy products (tofu, tofu cheese) Unsalted nuts such as walnuts, peanuts, almonds, pecans ¼ - ½ cup per day Unsalted seeds such as flax, sunflower, sesame, pumpkin Natural Peanut butter Legumes, kidney beans, chick peas, lentils, all other peas and beans Egg whites, egg substitutes Ham hocks, short ribs, spare-ribs, side bacon, sausages, pigs feet Fried or battered fish, poultry Egg yolks: limit to 2 per week (speak with your dietitian if this is a primary source of protein for you) Did you know? You should bake, grill, roast, stir-fry, steam, boil, Bar-BQ food instead of frying. Did you know? Fish is high in DHA and EPA omega-3 fatty acids. These fatty acids have been shown to lower blood cholesterol. So enjoy fish 2 to 3 times a week!! * Did you know? Some fish may contain higher levels of toxins. Limit swordfish, shark, King mackerel, tilefish and fresh and frozen tuna.

7 7 Increase Your Fibre Intake Why do we need more fibre in our diet? Lower our risk of certain types of cancers Improve our blood sugars Help lower our cholesterol Give us a feeling of fullness to help us eat less Type of fibre What it does Where its found Soluble Fibre Helps to lower LDL cholesterol Oat bran, oatmeal, Bran Buds with psyllium fibre, legumes, barley, some fruits/veggies (apples, citrus fruits and strawberries) Insoluble Fibre Helps keep you regular Wheat bran, whole grains such as whole wheat and brown rice, seeds, skins of fruits and vegetables Things to remember Make sure you increase the fibre in your diet slowly to give your body a chance to get used to it and to prevent bloating and gas. Remember to drink plenty of water as your body needs water to use the fibre properly. Increase Your Fibre Intake Snacks with fibre Grab a homemade carrot or bran muffin Spread natural peanut butter or almond butter on a whole wheat cracker Grab a handful of unsalted nuts and seeds. Enjoy fresh unpeeled fruits and vegetable sticks with a yogurt dip. Very High Source of Fibre (6 grams per serving or more) High Source of Fibre (at least 4 grams per serving) Source of fibre (at least 2 grams per serving) All Bran 100% bran cereal Baked beans Kidney beans/white beans Lima beans Split peas Dates, Raisins Frozen raspberries Bran Flakes Cereal Dried Apricots Sweet potato Almonds Green peas Prunes, Pears Baked potato 1 shredded wheat biscuit Orange, Banana Broccoli, Turnip, Carrots, Corn Stewed tomatoes Frozen mixed veggies Mushrooms Red River cereal Homemade Bran muffin

8 Healthy Choices Breads such as: Whole Grain, Whole Wheat, Cracked Wheat, Bran, Rye, Pumpernickel, Oat Whole grain unsalted crackers (i.e. Melba Toast, Rvyita, Stone Wheat Thins, Rice Cakes etc.) Cereal- such as wheat, rice, oats, barley, corn, wild rice, rye, Hot: oatmeal, Red River, Grains Foods to Enjoy in Moderation (one a month) Refined Grains or Carbohydrates Egg bread, commercial garlic bread, cheese bread/buns, butter rolls, croissants High fat crackers (contain more than 3 grams of fat per serving) Granola type cereal Egg Noodles, chow mein noodles or instant noodles 8 Cold: choose one with minimum of 2 grams of fibre Whole Grains such as: cracked wheat, oats, barley, corn, wheat bran, oat bran, couscous, bulgur, quinoa, buckwheat Did you know..? Most trans fatty acids (hydrogenated) in the Canadian diet come from commercially prepared foods such as cookies, crackers, doughnuts, cakes, muffins, and hamburger buns. Therefore AVOID them. Pasta: whole wheat, enriched vegetable Rice: brown, wild, basmati Limit intake to once/week: White rice, white pasta, products made with white flour, grits, Cream of Wheat Did you know? 1. Whole Grains contain all three parts of the kernel. 2. Products labeled with words such as multigrain or organic may not be whole grain. 3. Whole wheat is not necessarily whole grain. However, it is still a healthy choice that provides dietary fibre 4. You should have a whole grain product at every meal!

9 FRUITS & VEGETABLES Healthy Choices Foods to Enjoy in Moderation (once a month) Fruits and Vegetables: Fresh Frozen veggies in cream or butter sauces 9 Frozen Dried (6 pieces) Canned (low sodium) Avocado (watch your portion size! = 1/6 avocado) Did you know? For optimum fibre and less sugar and sodium, it is best to select fruit and vegetables in this order: Fresh Frozen Dried Canned Cream based soups Scalloped Veggies Pickled vegetables and olives Canned vegetables (regular sodium) Eat your antioxidants. Antioxidants are vitamins and other compounds that help fight diseases like cancer and heart disease.so remember to eat lots of dark green, yellow, orange, red fruits and veggies! Alcohol Too much alcohol can contribute to Obesity High blood pressure High blood triglycerides Recommendations are If you drink alcohol, recommendations are that you consume no more than 1-2 drinks per day. Please check with your doctor before consuming any alcohol as it may interfere with certain medications. One drink = 1 ½ oz. (45 ml) liquor OR 12 oz (360 ml bottle) beer OR 2 oz (60 ml) sherry OR 4 oz (125 ml) dry wine

10 Seasoning Without Salt Salt may cause an increase your blood pressure and/or fluid retention putting extra pressure on the heart and other organs The words sodium, brine, MSG, Na mean Salt Take the salt shaker off the table a pinch (250 mg) of salt is allowed in cooking. Season your food without salt. Do not use any form of salt including sea salt, kosher salt, Fleur de Sel or other salt varieties. Try a blend of herbs and spices or use a salt-free product such as Mrs. Dash. Replace garlic, onion and celery salt with the fresh product or garlic, onion and celery powder. Lemon juice also works well in cooking and at the table. Do not use salt substitutes such as No Salt, Half Salt or Morton Salt Look for sodium-reduced foods or no-salt-added foods. Choose less often, foods that pickled, processed, cured, smoked or salted: -All processed meats: bacon, luncheon meats, sausage, canned or salted fish -Cheese slices and cheese spread, buttermilk -Dried soup mixes, bouillon cubes, canned soup -Salted snack foods i.e. nuts, pretzels, potato chips -TV dinners, pre-packaged noodles and rice/casserole mixes -Condiments such as: ketchup, soy sauce, mustard, relish, pickles, olives 10 Beef Bay leaf, dry mustard powder, green pepper, marjoram, fresh mushroom, nutmeg, onion, pepper, sage, thyme Chicken Green pepper, lemon juice, marjoram, fresh mushroom, paprika, parsley, poultry seasoning, sage, thyme Fish Bay leaf, curry powder, dry mustard powder, green pepper, lemon juice, marjoram, fresh mushroom, paprika Lamb Pork Veal Potato Curry powder, garlic, mint, mint jelly, pineapple, rosemary Apple, applesauce, garlic, onion, sage. Apricot, bay leaf, curry powder, ginger, marjoram, oregano Green pepper, mace, onion, chive, parsley Asparagus Garlic, lemon juice, onion, vinegar Corn Green pepper, pimento, fresh tomato Cucumber Chive, dill, garlic, vinegar Tomato Basil, marjoram, onion, oregano

11 Space on your plate at meal time 11 VEGETABLES Choose as much as you can hold in both hands. GRAIN Choose an amount up to the size of your fist. MEAT & ALTERNATIVES Choose an amount up to the size of the palm of your hand and the thickness of your little finger. FRUIT Choose an amount up to the size of your fist. ADDED FAT Limit fat to an amount the size of the tip of your thumb. MILK

12 Heart Healthy Cookbooks 12 HeartSmart Cooking for Family and Friends, Bonnie Stern. Random House Canada, Crazy Plates: Low-Fat Food So Good, You ll Swear it s Bad for You, Greta and Janet Podleski, Granet publishing, Sensationally Light Pasta & Grains, Rose Reisman. Penguin Books of Canada, New Light Cooking, Anne Lindsay. Random House Canada, When in Doubt Eat Broccoli!, Liz Pearson, RD. Penguin Books of Canada, Light Vegetarian Cooking, Rose Reisman. Robert Rose Inc., Looneyspoons: Low-Fat Food Made Fun, Greta and Janet Podleski. Granet Publishing, More HeartSmart Cooking with Bonnie Stern. Random House Canada, Rose Reisman s Enlightened Home Cooking, Rose Reisman. Robert Rose Inc., More Choice Menus, Marjorie Hollands, MSc RD and Margaret Howard, RD. Macmillan Canada, Light Kitchen, Anne Lindsay. Macmillan Canada, Simply HeartSmart Cooking, Bonnie Stern. Random House Canada, Lighthearted Everyday Cooking, Anne Lindsay. Macmillan Canada, Websites Dietitians of Canada Heart and Stroke Foundation Canadian Diabetes Association Becel