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Eat at least three servings of vegetables and two servings of fruit daily (more is even better). 

How do vegetables and fruits protect the heart? 

The fiber, potassium, vitamin C, and antioxidants found in vegetables and fruits help lower heart disease risk. Hundreds of powerful nutrients called phytonutrients reduce both total and LDL (bad) cholesterol and may inhibit blood clot formation (which can lead to heart attack and stroke). 

I like fruits. Can I choose five servings of fruit each day and eliminate vegetables? 

Because of their low calorie content and their high phytonutrient content, vegetables are the preferred choice over most fruits. But, as with most dietary recommendations, balance and variety are the key. Try to vary your daily fruit and vegetable choices, as no one food contains all the nutrients our bodies need in the right amounts. 

Are some fruits or vegetables better than others? 

Use color to guide your choices. Deeply colored fruits and vegetables provide a healthy dose of vitamins, minerals, fiber and especially phytonutrients, which reduce the risk of heart disease and cancer. Blue/purple, green, white, yellow/orange and red are the best choices. Here are some examples:

Does it matter if my vegetables and fruits are fresh, canned, frozen, peeled or dried? 

Fresh or frozen vegetables and fruits have the highest nutrient value. But dried and canned products still offer good nutritional benefits, and they can be very economical. 

Peeling fruits and vegetables has advantages and disadvantages. When the peel is removed, a concentrated source of fiber is also removed. At the same time, removal of the outer coating or peel removes a majority of the pesticides and chemical residues that may be present on the outside of some produce. The best option is to leave the edible peels on and wash thoroughly. 

How much is a serving? 

• 1/2 cup chopped fruit or vegetable (peaches, broccoli) 
• 1 cup raw leafy greens (romaine lettuce, spinach, Swiss chard, kale) 
• 1 cup cubed melon or berries (cantaloupe, strawberries) 
• 1/2 cup 100 percent fruit or vegetable juice (orange, grape, tomato) 
• 1/2 cup dried fruit (raisins, cranberries, apricots) 

What can I do?

• Add fresh, frozen or canned fruit to a morning bowl of breakfast cereal.
• Buy fresh fruits and vegetables in season when their flavor and price are best.
• Blend frozen fruit and a banana with skim or soy milk and/or tofu for a delicious breakfast smoothie.
• Add vegetables to lunch by having them in soup, salad or on a sandwich. 
• Choose fruit for dessert. Try poached, broiled and baked fruit dishes. 
• Buy cut-up fruits and vegetables from the salad bar when in a hurry. 
• Add extra vegetables to prepared soups, sauces and casseroles (for example, grate carrot and zucchini into spaghetti sauce). 
• Keep a fruit bowl, small packs of applesauce, raisins or other dried fruit on the kitchen counter or in your office snack drawer. 
• Keep a covered bowl of cut-up vegetables on the top shelf of the refrigerator.
  

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Eat more cooked, dry beans- especially soy products 

Include at least four to five servings each week of a variety of cooked, dry beans, such as lentils, split peas, black, navy, pinto, along with garbanzo beans and soy products. 

Why should I eat more beans? 

Beans are an inexpensive, fat free, cholesterol free source of protein containing a type of fiber that lowers cholesterol. Cooked, dry beans contain phytonutrients that are known to be beneficial for lowering the risk of many diseases, particularly heart disease. 

Why is soy unique? 

Soybeans have a unique nutritional profile compared with other beans. In fact, the Food & Drug Administration (FDA) has determined that including soy protein (about 25 grams/day), as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease by reducing total and LDL cholesterol levels. Soybeans are also the only significant source of isoflavones in the human diet. Isoflavones are a particular type of phytonutrient that seem to protect the human body from disease. Data suggests that even 10 grams of isoflavone-rich soy protein per day (similar to typical consumption by Asian populations) may be associated with health benefits. This recommended intake is also appropriate for most breast cancer patients and those with diagnosed thyroid disease. Check with your physician about your particular situation. 

What are examples of the best soy foods? Can I eat too much soy? 

Whole soy foods like tempeh, tofu and green or dry roasted soybeans seem to be the best sources of soy's special phytonutrients. Most soy protein powders also contain these beneficial isoflavones and phytonutrients, but some don't. The best sources will list "soy protein" first on their ingredient label. We recommend choosing whole soy foods over soy pills or capsules. It's unlikely anyone would consume too much soy with a normal diet that included whole food sources of soybeans.

Is there anything that will help with the uncomfortable gas? 

Yes, here are a few suggestions:

• Discard soaking water and use fresh water when cooking beans from scratch. 
• Drink eight to 10 of glasses of fluid each day. We recommend water, skim milk, tea and 100 percent fruit or vegetable juice. 
• Try Beano - a product available at the grocery store. This natural enzyme, available in pills or drops, helps digest the gas-causing carbohydrates. 
• Gradually add more beans to your diet; be consistent and your body will adjust. 
• Anise, caraway, coriander, fennel and turmeric have been suggested as seasonings that can be used to minimize gas formation in the intestines.

How much is a serving? 

• 1/2 cup cooked beans, lentils or split peas 
• 2 tablespoons soy nuts or soynut butter 
• 1 cup soymilk (enriched or fortified is best) 
• 1 soy burger or soy hot dog, or 2 soy sausage-style breakfast patties or links 
• 3 ounces tofu or tempeh

What can I do? 

• Substitute soymilk for low-fat milk on breakfast cereal and in soups, pudding, breads, pancakes and muffins. 
• Replace one fourth of the flour in your favorite bread, muffin or pancake recipe with soy flour. 
• Add soy nuts to trail mix, granola or green salad. o Use a soy-based meat substitute in casseroles, sloppy joes or spaghetti sauce.
• Replace the meat in your favorite stir-fry recipe with tofu or tempeh. 
• Choose split pea, lentil or bean soup at a restaurant or deli. 
• Make or buy a bean dip and serve with vegetables or crackers. o Have canned baked beans or chili beans as an easy side dish. 
• Add beans to salads. Try kidney beans, garbanzo beans and three-bean salads. 

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Choose mostly whole grains 

Include three or more servings of whole grain cereals, pastas, breads and crackers daily. 

What is a whole grain? 

It's a grain that still has its outer covering, which contains the grain's fiber and many of its vitamins and minerals. Grains that have been refined and processed have lost this outer coating and much of their nutritional value. 

Why should I choose whole grains? 

A Harvard study followed 75,000 middleaged women with no previous heart disease for 10 years. Those who ate the most whole grains (about three servings a day) were a third less likely to experience a heart attack than those women who chose virtually no whole-grain foods. Each additional serving of whole grains included each day reduced heart disease risk by about 10 percent. It is likely a combination of protective nutrients that account for this reduction of risk, including fiber, vitamin E, folate, selenium, lignans and phytonutrients. 

How do I know if a food I choose is made from whole grains? 

Look for the word "whole" on the ingredient label of bread, breakfast cereals, grain mixes or crackers: whole-wheat, whole oats, whole rye. Ingredients such as enriched flour, wheat flour or unbleached wheat flour are not whole grain ingredients. Check the dietary fiber content of a serving. A good rule of thumb is at least 3 grams of dietary fiber per serving. See the list at right for a more complete list of other whole grains. 

How much is a serving?

• 1 slice 100 percent whole-wheat or rye bread 
• 1 ounce whole-grain breakfast cereal 
• 1/2-3/4 cup whole-grain crackers 
• 1/2 cup cooked oats, barley, bulgur or quinoa (pronounced keen-wa) 
• 6-8 100 percent whole-wheat crackers 

What can I do? 

• Substitute 100 percent whole-wheat flour or whole-wheat pastry flour for a quarter to half of the all-purpose flour in your favorite cookies, muffin or bread recipe. 
• Look for whole grains in the bulk section of your grocery store, and buy just a small amount to experiment with. 
• Quinoa and bulgur are grains that taste similar to rice - season as you would a rice dish. 
• Barley, quinoa and many other whole grains are perfect additions to soups. 
• Try mixing a favorite refined cereal with a whole grain cereal for a more nutritious and higher fiber breakfast. 
• Granola made with whole grains, nuts and canola oil is a good breakfast cereal.

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Strive to meet the recommended fiber intake from whole foods 

Women should aim for at least 21 grams of fiber each day.  Men should aim for at least 30 grams of fiber each day. 

What is fiber and why do we need it?

Fiber is a non-digestible carbohydrate found only in foods of plant origin. It can be either water soluble fiber (dissolves in water) or water insoluble fiber (doesn't dissolve in water). Even though we don't actually digest and absorb it, it seems to offer health benefits when consumed on a regular basis. Dietary fiber, especially soluble fiber, can lower total cholesterol and reduce the overall risk of heart disease. 

What about a fiber supplement? 

The FDA has allowed a health claim on food products and supplements containing a certain type of fiber called psyllium seed husk. As part of a diet low in saturated fat and cholesterol, 7 grams daily of this fiber may reduce the risk of coronary heart disease by reducing total and LDL cholesterol in as little as four weeks. Ask your doctor about whether a fiber supplement is an appropriate part of your prevention or treatment plan. 

How much fiber is recommended each day? 

Total fiber for men (adequate intake) 
19-50 years 38 grams daily 
51 years and older 30 grams daily 

Total fiber for women (adequate intake) 
19-50 years 25 grams daily 
51 years and older 21 grams daily 

How much fiber is in common foods? 

The best source for information about the fiber content of foods is the Nutrition Facts Label (look for "Dietary Fiber"). The table below gives an introduction to the fiber content of common foods.

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Choose healthy beverages that support your goals 

Adequate fluid intake each day of about 64 fluid ounces is a goal for every healthy person. Choosing the right fluids can further reduce your risk of heart disease, just as choosing the right food does. 

Is water the only drink that counts toward this recommendation? 

Water is definitely the best choice because it is calorie free. However, skim milk, 100 percent fruit or vegetable juice and tea count toward your ounces to meet this goal. 

Are there beverages that can actually reduce my risk of heart disease? 

There is emerging evidence that black and green tea consumption may reduce the risk of heart disease because of the phytonutrients they contain. The phytonutrient content (specifically phenolic flavonoid and red anthocyanin pigment) of red wine and red grape juice, not the alcohol content, may offer protection by serving as antioxidants, protecting against LDL oxidation and limiting clot formation. Current research hopes to identify which type of alcoholic beverages offer the most benefits: wine, beer or other spirits. 

It's a good idea to weigh the risks and benefits of alcohol with your physician, while considering your particular situation. Starting to drink alcohol to improve heart health is not advised. The other recommendations outlined in this booklet provide greater benefits than does alcohol, without the added risks. 

What else should I consider about alcohol? 

Alcohol may increase the risk of developing certain cancers (specifically mouth, esophageal, lung, liver, breast and colon). Heavy alcohol intake is also associated with liver disease, hypertension, traffic accidents and stroke. Remember to consider the possibility of unsafe alcohol interactions with medications you may be taking. 

If I do drink alcohol, what is the safest amount of alcohol I should drink?

Remember to weigh the risks and benefits and be honest about moderation. Women are encouraged to limit intake to no more than one drink per day, and men to no more than two drinks per day. One drink is equal to 12 ounces beer, 5 ounces wine or 1 ounce spirits.

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Watch for hidden salt 

Learn to read food labels to discover sources of salt and sodium. Limit sodium to 2,000-3,000 milligrams (mg) a day. Use fresh or dried herbs and spices in place of salt. 

Why should I limit my salt intake? 

In some individuals, a high salt intake can increase blood pressure (a risk factor for heart disease). Salt can also contribute to water retention which can cause the heart to work harder. We currently have no way to identify who is sensitive to these negative effects, so a moderate restriction of sodium is recommended for all. 

Is there a difference between salt and sodium? 

Sodium is a naturally occurring mineral in food and is part of salt. Sodium and chloride together make up what we call table salt. Table salt is about 40 percent sodium. One teaspoon of salt contains about 2,000 mg of sodium. 

I never salt at the table. Does that mean I'm doing all I can to reduce my sodium intake? 

Most of the sodium in our diet comes from the variety of packaged and prepared foods that we eat - particularly fast foods and convenience foods. Look for low-sodium options and read the nutrition label that lists the "sodium" content in milligrams. Aim for no more than 800 mg of sodium per meal. 

What can I do?

• Look for low-sodium versions of your favorite foods.
• Drain and rinse canned vegetables and beans.
• Use only half of the seasoning packet in packaged foods (noodles, rice mixes, soups).
• Use garlic, onion, black pepper, herbs, lemon and other spices to add flavor to meals. Many of these herbs and spices contain phytonutrients that further protect against heart disease. For instance, one fresh clove of garlic each day has been shown to reduce blood pressure and total cholesterol.
• Use low-sodium broth or bouillon or use homemade chicken or vegetable stock.

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Make healthy food choices when dining out 

Follow the nutrition recommendations outlined below when eating away from home. 

Dining out is no longer the special occasion it was years ago. Americans now eat about 30 percent of their meals each week away from home. Therefore, healthy food choices should be considered when dining out. The key to making good choices away from home is to take charge! Ask questions and don't be afraid to make special requests.

What can I do? 

• Always try to make a better, if not "best" choice, even when your options are limited. 
• Select broiled or grilled rather than fried foods. For example, choose the baked potato instead of french fries, or get the grilled chicken sandwich instead of the deep fried chicken patty. 
• Ask for a "doggie bag" if portions are larger and take part of your meal home. It's an even better value if you get two meals for the price of one.
• Split an entree with a friend.
• Be aware of "bottomless" baskets of bread and chips.
• Choose the leanest cuts of beef - usually the "loin" cuts.
• Be wary of "super sizing" and "extras" like extra cheese, extra pepperoni or extra sauce. The extra fat, calories and sodium really aren't a better deal.
• Build a meal from à la carte options, like a baked potato, salad and sautéed vegetables.
• Select a restaurant that has many choices and avoid "all you can eat" buffets.
• Plan ahead. If you're planning dinner out, eat a lighter breakfast and lunch than usual; never arrive at a restaurant famished.

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Consider a vitamin-mineral supplement 

Vitamins and minerals taken in appropriate doses may aid in lowering heart disease risk. However, the greatest benefit appears to be with whole foods that are naturally good sources of vitamins and minerals. 

Why should I consider a supplement? 

While foods should be the main source of nutrients, research shows that many individuals fall short of achieving recommended intakes. The actual amounts needed to prevent chronic diseases have not been established. While there are no conclusive studies proving that taking additional supplements can prevent heart disease, numerous studies suggesting positive associations exist. Vitamin and mineral supplements can be safe and inexpensive and may provide a health benefit. 

I eat poorly, so a supplement is a good idea, right? 

Supplements are designed to "supplement" a healthy diet, not make up for a poor diet. Foods contain thousands of helpful nutrients that promote health and prevent diseases. Vitamin and mineral supplements cannot replace all the good nutrition found in foods. 

Do I need to be careful when selecting supplements? 

Yes. There are many misleading products available for very high prices and sometimes in dangerous doses. Use the guidelines outlined in this booklet when selecting supplements and follow your physician's recommendations. 

Should men avoid supplements with iron? 

Unless anemic, men should not routinely take an iron supplement. Excess iron can build up in the blood and cause a condition called hemochromotosis, which increases risk for heart disease. Men should look for supplements that contain 9 mg or less of iron. 

Are garlic supplements helpful? 

The regular use of garlic can be effective in lowering the risk of heart attacks and strokes because it lowers total cholesterol, triglycerides and LDL without affecting HDL. The odor-modified garlic extract and enteric-coated garlic pills appear to be just as effective as fresh garlic in this respect.

What are homocysteine and C-reactive protein? Are they something I should be concerned about? 

Excess amounts of the amino acid homocystiene can increase the risk of heart disease. In high-risk patients, the level of this amino acid can be checked with a blood test. Adequate amounts of folic acid, vitamin B6 and vitamin B12 can correct this elevation. C-reactive protein can measure inflammation in the body and appears to be associated with coronary heart disease. Consider asking your physician to check your homocysteine or C-reactive protein level. 

What can I do?

• Check with your physician. He or she may recommend different or additional doses of supplements depending on your medical condition. 
• Take a daily multivitamin and mineral formula that provides 100-200 percent daily value for the major nutrients. Make certain that it contains 100 percent daily value for vitamins B6, B12 and folic acid. Daily values are determined by the National Academy of Sciences.
• Take extra calcium (500 mg daily if you are younger than 50 and 1,000 mg daily if you are older than 50). Calcium is involved in the regulation of blood pressure as well as the maintenance of strong bone health. Avoid using supplements made from oyster shells because of possible contamination. To maximize absorption, look for either calcium carbonate or calcium citrate.
• Look for the "USP" endorsement on the supplement container. This means that the supplement was made to U.S. Pharmocpeia standards to guarantee potency, purity and quality.
• Additional vitamin C and vitamin E in supplement form are not recommended at this time. Use of beta carotene supplements is discouraged.

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Shopping List

This list is not intended to include all recommended foods. It highlights a few of our favorite foods that meet criteria for convenient heart-healthy foods. 

BASIC FOODS 
Beans: any canned, dried or dehydrated beans; fat-free refried beans 
Milk and cheese: most low-fat and fat-free cheeses; look for no more than 3 grams of fat per ounce of cheese; soymilk and skim or fat-free cow's milk 
Grains, breads and cereal: whole-grain breads, crackers, cereals, pancake mixes or grains; look for whole-grain varieties containing more than 3 grams of fiber per serving 
Soy or meat substitutes: any tofu, tempeh, soynuts and canned or frozen chicken, pork or beef substitute 
Meat, fish and poultry: any fresh fish or shellfish, skinless poultry, lowfat or lean beef, and low-fat or lean pork or sausage; look for less than 3 grams of fat per ounce 

PREPARED FOODS 
Soups: any soup containing beans, vegetables or whole grains; vegetarian chili; look for at least 5 grams of fiber and less than 500 mg sodium per serving 
Frozen entrees: look for those with less than 10 grams of fat and less than 600 mg of sodium per serving 

MISCELLANEOUS FOODS 
Fats, oils and spreads: any oil or spray; look for non-hydrogenated or trans fatty acid-free spreads 
Salad dressings and condiments: look for fat-free varieties, or those made with canola or olive oil 
Desserts: fruited cookie bars, sorbet, frozen yogurt, sherbet, fruit and juice bars, fudgesicles, popsicles, low-fat pudding or jello 
Snacks: nuts (1/4 cup), air-popped or light microwave popcorn, seeds or whole grain crackers 

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Recommended resources 

General Cookbooks 

• 5 A Day: Savor the Flavor of Fruit and Vegetables. Pivonka, E, and Berry, B. Rodale Press. 2003.
• American Heart Association Meals in Minutes Cookbook. Clarkson Potter Publishers. 2000.
• The Pea and Lentil Cookbook, From Everyday to Gourmet. US Dry Pea and Lentil Council. 2000.
• The Phytotopia Cookbook. Gollman, B, and Pierce, K. Phytotopia, Inc. 1998.
• The Best 125 Lowfat Fish and Seafood Dishes. Geiskopf-Hadler, S, and Toomay, M. Prima Lifestyles. 1993.
• The New American Diet System. Connor, S, and Connor, W. Simon & Shuster, 1992. 

Vegetarian Cookbooks

• The Whole Soy Cookbook. Greenberg, P. Random House, 1998.
• Cooking Vegetarian. Melina, V, and Forest, J. Book Publishing Co. 1998.
• The Vegetarian Way: Total Health for You and Your Family. Messina, M, and V. Crown Pub., 1996.
• Moosewood Restaurant Low-Fat Favorites: Flavorful Recipes for Healthful Meals. Krauss, P, editor. Moosewood Collective. Clarkson Potter Publishers. 1996.
• Everyday Cooking with Dean Ornish. Ornish, D. HarperCollins. 1996.
• Magic Beans. Geil, P. John Wiley & Sons, 1995.
• Vegetarian Express. Atlas, N. Little, Brown & Co., 1995. 

Nutrition Books 

• The American Dietetic Association's Complete Food and Nutrition Guide, 2nd edition. Duyff, R L, and American Dietetic Association. John Wiley & Sons, 2002.
• Vegetables From Amaranth to Zucchini. Schneider, E. Morrow Cookbooks. 2001.

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