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STEP by STEP Eating to Lower Your High Blood Cholesterol National Institutes of Health National Heart, Lung, and Blood Institute Anyone can have high blood cholesterol. But, because there are no warning signs, you may have been surprised to learn that you have high blood cholesterol. The good news is that you can take steps to lower it. The best way to lower your high blood cholesterol is to eat foods low in saturated fat, total fat, and cholesterol; be more physically active; and lose weight, if you are overweight. To help you do these things, this booklet is divided into four parts: Ready...Gives you some facts about high blood cholesterol and how it relates to heart disease. Get Set...Gives you general rules for diet, physical activity, and weight loss to lower blood cholesterol. It also tells you about the Step I and Step II diets. Go! Gives you practical tips for adopting heart-healthy eating habits and increasing physical activity. It tells you how to buy and prepare foods, and how to follow your new way of eating when in restaurants or at social events. It also gives tips for being more physically active and tells you what to look for, if you are choosing a weight loss program. Finally, the tables at the back of the booklet list the saturated fat and cholesterol content in foods, show serving sizes for meat and cheese, and give you information on different types of physical activity. The advice in this booklet is for adults who want to lower their blood cholesterol level. The booklet is part of a series from the National Cholesterol Education Program (NCEP). Another booklet, So You Have High Blood Cholesterol, gives more detailed information to answer the basic questions about high blood cholesterol. The NCEP also has booklets for children with high blood cholesterol and their parents. See page 57 for more information. Table of Contents Ready What You Need To Know About High Blood Cholesterol What Is Blood Cholesterol - and Why Does It Matter? What Do Your Cholesterol Numbers Mean? What Affects Your Blood Cholesterol Levels? What if You Already Have Heart Disease? Get Set What You Need To Do To Lower Blood Cholesterol Choose foods low in saturated fat Choose foods low in total fat Choose foods high in starch and fiber Choose foods low in cholesterol Move it...Be more physically active Lose weight, if you are overweight A Look at Your Way of Eating Heart-Healthy Eating: The Step I and Step II Diets A Word About Sodium What Kind of Success Can You Expect? Go! How To Change Your Eating Habits and Be More Physically Active Follow the Daily Food Guide for Heart-Healthy Eating Shop for Foods Low in Saturated Fat and Cholesterol Food Groups Meat, poultry, fish, and shellfish Dairy foods Eggs Fats and oils Fruits and vegetables Breads, cereals, pasta, rice and other grains, and dry peas and beans Sweets and snacks If You Also Have High Blood Pressure, Watch Your Sodium Too Read Food Labels Read the nutrition information Look at the ingredients Know what the claims mean Cook the Low Fat Way New ways to use old recipes Eat Right When Eating Out Eat Right at Social Events Look at the Sample Menus Fit Physical Activity Into Your Routine Lose Weight the Sensible Way Look Here for More Help Tables 1. Meats 2. Poultry 3. Fish and shellfish 4. Dairy and egg foods 5. Fats and oils 6. Nuts and seeds 7. Breads, cereals, pasta, rice and other grains, and dry peas and beans 8. Sweets and snacks 9. Miscellaneous 10. Fast foods 11. Serving sizes for meat and cheese 12. A sample walking program 13. Calories burned during physical activities 14. The low-down on food label claims Shopping List - Foods To Choose When You Shop (Tear Off) 1 Ready What You Need To Know About High Blood Cholesterol Ready...What You Need to Know About High Blood Cholesterol What Is Blood Cholesterol - and Why Does It Matter? High blood cholesterol is a serious problem: it is a "risk factor" for heart disease. That means that having high blood cholesterol increases your chance, or risk, of getting heart disease. The higher your blood cholesterol, the greater your risk of getting heart disease. And heart disease is the number one killer of both men and women in the United States. Two specific kinds of blood cholesterol are called low density lipoproteins (LDL) and high density lipoproteins (HDL). LDL-cholesterol, sometimes called "bad" cholesterol, causes the cholesterol to build up in the walls of your arteries. Thus, the more LDL you have in your blood, the greater your heart disease risk. In contrast, HDL- cholesterol, sometimes called "good" cholesterol, helps your body get rid of the cholesterol in your blood. Thus, if your levels of HDL are low, your risk of heart disease increases. What Do Your Cholesterol Numbers Mean? Every adult, ages 20 and older, should have his or her blood cholesterol checked at least once every 5 years. Here's a quick look at the numbers and what they mean. Total Cholesterol. Your total cholesterol level falls into one of these categories: Classification: Total and HDL-Cholesterol* Total Cholesterol ____________________________________________________________ Desirable Blood Borderline-High High Blood Cholesterol Blood Cholesterol Cholesterol ____________________________________________________________ less than 200-239 mg/dL 240 mg/dL 200 mg/dL and above HDL-Cholesterol Low HDL- Cholesterol Less than 35 mg/dL ____________________________________________________________ *These levels are for anyone 20 years of age or older Cholesterol levels less than 200 mg/dL are considered desirable while levels of 240 mg/dL or above are high and require more specific attention. Levels from 200-239 mg/dL also require attention especially if your HDL-cholesterol is low or if you have two or more other risk factors for heart disease. Look at the chart to see how many risk factors you have. Your doctor looks at all your risk factors to decide what you need to do to lower your blood cholesterol and reduce your risk of heart disease. Risk Factors for Heart Disease Factors You Can Do Something About + Cigarette smoking + High blood cholesterol(high total cholesterol and high LDL-cholesterol) + Low HDL-cholesterol + High blood pressure + Diabetes + Obesity/overweight + Physical inactivity Factors You Cannot Control + Age: 45 years or older for men 55 years or older for women + Family history of early heart disease (heart attack or sudden death): Father or brother stricken before the age of 55 Mother or sister stricken before the age of 65 HDL-Cholesterol. Unlike total and LDL-cholesterol, the lower your HDL, the higher your risk for heart disease. An HDL level less than 35 mg/dL is considered low and increases your risk for heart disease. The higher your HDL, the better. An HDL level of 60 mg/dL or above is high. LDL-Cholesterol. Your doctor will likely check your LDL- cholesterol level if your: + HDL-cholesterol is low, + total cholesterol is high, OR + total cholesterol is borderline-high, and you have two or more other risk factors for heart disease. Your LDL level gives a better picture of your risk for heart disease than your total cholesterol. Here are the categories for LDL levels: Classification: LDL-Cholesterol* ____________________________________________________________ Borderline- Desirable High Risk High Risk ____________________________________________________________ less than 130 mg/dL 130-159 mg/dL 160 mg/dL and above ____________________________________________________________ * These levels are for anyone 20 years of age or older without heart disease. A person with heart disease should have an LDL level of 100 mg/dL or less. Lowering LDL is the main aim of treatment for a cholesterol problem. If your LDL level puts you at high-risk and you have fewer than two other risk factors for heart disease, then your treatment goal is an LDL level of less than 160 mg/dL. However, if you have two or more other risk factors for heart disease, your LDL goal should be less than 130 mg/dL. If you already have heart disease, your LDL should be even lower - 100 mg/dL or less. What Affects Your Blood Cholesterol Levels? Your blood cholesterol levels are affected by: + What you eat - The saturated fat and cholesterol in the food you eat raise total and LDL-cholesterol levels. + Overweight - Being overweight can make your LDL- cholesterol level go up and your HDL level go down. + Physical activity/Exercise - Increased physical activity helps to lower LDL-cholesterol and raise HDL-cholesterol levels. + Heredity - Your body makes all the cholesterol it needs, and your genes influence how your body makes and handles cholesterol. + Age and sex - Blood cholesterol levels in both men and women begin to go up at about age 20. Women before menopause have levels that are lower than men of the same age. After menopause, a woman's LDL-cholesterol level goes up - and so does her risk for heart disease. What if You Already Have Heart Disease? If you already have heart disease, you have a great deal to gain by lowering your cholesterol level. If you lower your blood cholesterol, you can possibly prevent future heart attacks, and maybe even slow down or reverse some of the cholesterol buildup in the arteries. Remember, your LDL should be 100 mg/dL or less.+ 2 Get Set What You Need To Do To Lower Blood Cholesterol Get Set...What You Need to Do to Lower High Blood Cholesterol Now that you know about blood cholesterol, get set to lower it. All healthy Americans, regardless of their blood cholesterol level, should eat in a heart-healthy way. This is true beginning with toddlers (about age 2) on up to their parents, grandparents, and even great-grandparents. The whole family should also be physically active. And if you have a high blood cholesterol level - whether due to what you eat, heredity, or both - it is even more important to eat healthfully and to be physically active. Adopting these behaviors also can help control high blood pressure as well as diabetes. You'll find more help on heart-healthy eating and physical activity a little later in this booklet. First, here are some general rules to lower blood cholesterol: Choose foods low in saturated fat All foods that contain fat are made up of a mixture of saturated and unsaturated fats. Saturated fat raises your blood cholesterol level more than anything else that you eat. It is found in greatest amounts in foods from animals, such as fatty cuts of meat, poultry with the skin, whole- milk dairy products, lard, and in some vegetable oils like coconut, palm kernel, and palm oils. The best way to reduce your blood cholesterol level is to choose foods low in saturated fat. One way to do this is by choosing foods such as fruit, vegetables, and whole grain foods naturally low in fat and high in starch and fiber. Choose foods low in total fat Since many foods high in total fat are also high in saturated fat, eating foods low in total fat will help you eat less saturated fat. When you do eat fat, you should substitute unsaturated fat for saturated fat. Unsaturated fat is usually liquid at room temperature and can be either monounsaturated or polyunsaturated. Examples of foods high in monounsaturated fat are olive and canola oils, those high in polyunsaturated fat include safflower, sunflower, corn, and soybean oils. Any type of fat is a rich source of calories, so eating foods low in fat will also help you eat fewer calories. Eating fewer calories can help you lose weight - and, if you are overweight, losing weight is an important part of lowering your blood cholesterol. Choose foods high in starch and fiber Foods high in starch and fiber are excellent substitutes for foods high in saturated fat. These foods - breads, cereals, pasta, grains, fruits, and vegetables - are low in saturated fat and cholesterol. They are also usually lower in calories than foods that are high in fat. Foods high in starch and fiber are also good sources of vitamins and minerals. Diets low in saturated fat and cholesterol, and high in fruits, vegetables, and grain products - like oat and barley bran and dry peas and beans - may help to lower blood cholesterol. Choose foods low in cholesterol Dietary cholesterol also can raise your blood cholesterol level, although usually not as much as saturated fat. So, it is important to choose foods low in dietary cholesterol. Dietary cholesterol is found only in foods that come from animals. Many of these foods also are high in saturated fat. Foods from plant sources do not have cholesterol but can contain saturated fat. Move it...Be more physically active Moving it - being physically active - helps your blood cholesterol levels: It can raise HDL and may lower LDL. Being more active also can help you lose weight, lower your blood pressure, improve the fitness of your heart and blood vessels, and reduce stress. Lose weight, if you are overweight People who are overweight tend to have higher blood cholesterol levels than people of desirable weight. And overweight people with an "apple" shape - bigger (pot) belly - tend to have a higher risk for heart disease than those with a "pear" shape - bigger hips and thighs. Whatever your body shape, when you cut the fat in your diet, you cut down on the richest source of calories. An eating pattern high in starch and fiber instead of fat is a good way to lose weight: many starchy foods have little fat and are lower in calories than high fat foods. If you are overweight, losing even a little weight can help to lower LDL-cholesterol and raise HDL-cholesterol. You don't need to reach your desirable weight to see a change in your blood cholesterol levels. To lower your blood cholesterol, remember to: + Choose foods low in saturated fat and cholesterol; + Be more physically active; and + Lose weight, if you are overweight. A Look at Your Way of Eating Take a minute to look at your current way of eating. "MEDFICTS" on pages 10-11 is a checklist of foods for you to fill out. Don't worry, it's not a test. Foods from each of the various food groups are listed in two groups, Group 1 and Group 2. The number of servings eaten each week is listed in the "Weekly Consumption" column, and the size of the servings is listed in the "Serving Size" column. Think about the foods you eat each week. Look at each food category - are the foods you eat listed under Group 1 or Group 2? Once you know the group, follow the line over to the circles under "Weekly Consumption." Check the circle that best describes the number of servings of those foods you usually eat in one week. Then check the circle for the portion size you usually eat. Do the same thing for each of the food groups. Check your score on the bottom of page 11. It will show you whether you are following the Step I or Step II diet, or whether you need to make some further changes. If you need help with MEDFICTS, bring it with you the next time you visit your doctor. Medficts In each food category for both Group 1 and Group 2 foods: check one from the "Weekly Consumption" column (number of servings eaten per week), and then check one circle from the "Serving Size" column (size of the serving). If you check Rarely/Never, do not check a serving size circle. See bottom of chart for score. Food Category ____________________________________________________________ Meats + Recommended amount per day: < or = to 6 oz (equal in size to 2 decks of playing cards). + Base your estimate on the food you consume most often. + Beef and Lamb selections are trimmed to 1/8" fat. ____________________________________________________________ 1 o 10 grams or more total fat in 3 oz. cooked portion Other Meat, Beef Processed meats Poultry, Seafood Ground beef 1/4 lb. Burger or Pork chops Ribs Large Sandwich (Center loin) Steak (T-bone, Bacon Pork roast (Blade Flank, Lunchmeat Boston Sirloin) Porterhouse, Sausage/Knockwurst Pork spareribs Tenderloin) Hot Dogs Ground pork Chuck blade roast Ham (Bone-end) Lamb chops Brisket Ground turkey Lamb (Rib) Meatloaf (w/ground Organ meats* beef) Chicken w/skin Corned beef Eel, Mackerel, Pompano Weekly Consumption _____ _____ _____ Rarely/Never 3 or less 4 or more (3 pts) (7 pts) (multiplied by:) Serving Size _____ _____ _____ Small Average Large <6 oz. 6 oz. >6 oz. per day per day per day (1 pt) (2 pts) (3 pts) SCORE = _______ 2 o Less than 10 grams total fat in 3 oz. cooked portion Low fat Other Meat, Lean Beef Processed Meats Poultry, Seafood Round steak Low fat lunchmeat Chicken, Turkey (Eye of round, Top Canadian bacon (w/o skin)**** round) "Lean" fast-food Most Seafood* Sirloin** sandwich Lamb (Leg-shank) Tip & Bottom round** Boneless ham Pork tenderloin Chuck arm pot roast** Pork sirloin, Top Top loin** loin Low fat Veal cutlets, Sirloin, Shoulder Ground veal, Venison Veal chops and Ribs** Lamb (whole leg, loin, fore- shank, sirloin)** Weekly Consumption _____ _____ _____ Rarely/Never 3 or less 4 or more (3 pts) (7 pts) (multiplied by:) Serving Size _____ _____ _____ Small Average Large*** <6 oz. 6 oz. >6 oz. per day per day per day (1 pt) (2 pts) (6 pts) SCORE = _______ ____________________________________________________________ Eggs o Weekly consumption is the number of times you eat eggs each week ____________________________________________________________ 1 Whole eggs, Yolks Weekly Consumption _____ _____ _____ Rarely/Never 3 or less 4 or more (3 pts) (7 pts) (multiplied by:) Serving Size _____ _____ _____ Small Average Large < or = to 1 2 > or = to 3 per day per day per day (1 pt) (2 pts) (3 pts) Check the number of eggs eaten each time? SCORE = _______ 2 Egg whites, Egg substitutes (1/2 cup = 2 eggs) Weekly Consumption _____ _____ _____ Rarely/Never 3 or less 4 or more (3 pts) (7 pts) (multiplied by:) Serving Size _____ _____ _____ Small Average Large < or = to 1 2 > or = to 3 per day per day per day (1 pt) (2 pts) (3 pts) Check the number of eggs eaten each time? SCORE = _______ ____________________________________________________________ Dairy ____________________________________________________________ 1 Milk + Average serving: 1 cup Whole milk, 2% milk, 2% buttermilk, Yogurt (whole milk) Weekly Consumption _____ _____ _____ Rarely/Never 3 or less 4 or more (3 pts) (7 pts) (multiplied by:) Serving Size _____ _____ _____ Small Average Large <6 oz. 6 oz. >6 oz. per day per day per day (1 pt) (2 pts) (3 pts) SCORE = _______ 2 Skim milk, 1% milk, Skim milk-buttermilk, Yogurt (nonfat & lowfat) Weekly Consumption _____ _____ _____ Rarely/Never 3 or less 4 or more (3 pts) (7 pts) (multiplied by:) Serving Size _____ _____ _____ Small Average Large <6 oz. 6 oz. >6 oz. per day per day per day (1 pt) (2 pts) (3 pts) SCORE = _______ 1 Cheese o Average serving: 1 oz. Cream cheese, Cheddar, Monterey Jack, Colby, Swiss, American Processed, Blue cheese, Regular cottage cheese (1/2 C) and Ricotta (1/4 C). Weekly Consumption _____ _____ _____ Rarely/Never 3 or less 4 or more (3 pts) (7 pts) (multiplied by:) Serving Size _____ _____ _____ Small Average Large <6 oz. 6 oz. >6 oz. per day per day per day (1 pt) (2 pts) (3 pts) SCORE = _______ 2 Low fat & fat free cheeses, Skim milk mozzarella String cheese, Low fat, skim milk & fat free cottage cheese (1/2 C) and Ricotta (1/4 C). Weekly Consumption _____ _____ _____ Rarely/Never 3 or less 4 or more (3 pts) (7 pts) (multiplied by:) Serving Size _____ _____ _____ Small Average Large <6 oz. 6 oz. >6 oz. per day per day per day (1 pt) (2 pts) (3 pts) SCORE = _______ Frozen Desserts o Average serving: 1/2 cup 1 Ice cream, Milk shakes Weekly Consumption _____ _____ _____ Rarely/Never 3 or less 4 or more (3 pts) (7 pts) (multiplied by:) Serving Size _____ _____ _____ Small Average Large <6 oz. 6 oz. >6 oz. per day per day per day (1 pt) (2 pts) (3 pts) SCORE = _______ 2 Ice milk, Frozen yogurt Weekly Consumption _____ _____ _____ Rarely/Never 3 or less 4 or more (3 pts) (7 pts) (multiplied by:) Serving Size _____ _____ _____ Small Average Large <6 oz. 6 oz. >6 oz. per day per day per day (1 pt) (2 pts) (3 pts) SCORE = _______ ____________________________________________________________ Frying Foods o Average serving: see below This section refers to method of preparation for vegetables and meat. ____________________________________________________________ 1 French fries, Fried vegetables: (1/2 cup) Fried chicken, fish, and meat: (3 oz.) Weekly Consumption _____ _____ _____ Rarely/Never 3 or less 4 or more (3 pts) (7 pts) (multiplied by:) Serving Size _____ _____ _____ Small Average Large <6 oz. 6 oz. >6 oz. per day per day per day (1 pt) (2 pts) (3 pts) SCORE = _______ 2 Vegetables, not deep fried (1/2 cup) Meat, poultry, or fish-prepared by baking, broiling, grilling, poaching, roasting, stewing: (3 oz.) Weekly Consumption _____ _____ _____ Rarely/Never 3 or less 4 or more (3 pts) (7 pts) (multiplied by:) Serving Size _____ _____ _____ Small Average Large <6 oz. 6 oz. >6 oz. per day per day per day (1 pt) (2 pts) (3 pts) SCORE = _______ ____________________________________________________________ In Baked Goods o Average serving: 1 serving ____________________________________________________________ 1 Doughnuts, Biscuits, Butter rolls, Muffins, Croissants, Sweet rolls, Danish, Cakes, Pies, Coffee cakes, Cookies Weekly Consumption _____ _____ _____ Rarely/Never 3 or less 4 or more (3 pts) (7 pts) (multiplied by:) Serving Size _____ _____ _____ Small Average Large <6 oz. 6 oz. >6 oz. per day per day per day (1 pt) (2 pts) (3 pts) SCORE = _______ 2 Fruit bars, Low fat cookies/cakes/pastries, Angel food cake, Homemade baked goods with vegetable oils, breads, bagel Weekly Consumption _____ _____ _____ Rarely/Never 3 or less 4 or more (3 pts) (7 pts) (multiplied by:) Serving Size _____ _____ _____ Small Average Large <6 oz. 6 oz. >6 oz. per day per day per day (1 pt) (2 pts) (3 pts) SCORE = _______ ____________________________________________________________ Convenience Foods ____________________________________________________________ 1 Canned, Packaged, or Frozen dinners; e.g., Pizza (1 slice), Macaroni & cheese (about 1 cup), Pot pie (1), Cream soups (1 cup) Potato, rice, & pasta dishes with cream/cheese sauces (1/2 cup) Weekly Consumption _____ _____ _____ Rarely/Never 3 or less 4 or more (3 pts) (7 pts) (multiplied by:) Serving Size _____ _____ _____ Small Average Large <6 oz. 6 oz. >6 oz. per day per day per day (1 pt) (2 pts) (3 pts) SCORE = _______ 2 Diet/Reduced calorie or reduced fat dinners (1 dinner) Potato, rice, & pasta dishes without cream/cheese sauces (1/2 cup) Weekly Consumption _____ _____ _____ Rarely/Never 3 or less 4 or more (3 pts) (7 pts) (multiplied by:) Serving Size _____ _____ _____ Small Average Large <6 oz. 6 oz. >6 oz. per day per day per day (1 pt) (2 pts) (3 pts) SCORE = _______ ____________________________________________________________ Table Fats o Average serving: 1 Tablespoon ____________________________________________________________ 1 Butter, Stick margarine; Regular salad dressing; Mayonnaise, Sour cream: 2 Tbsp. Weekly Consumption _____ _____ _____ Rarely/Never 3 or less 4 or more (3 pts) (7 pts) (multiplied by:) Serving Size _____ _____ _____ Small Average Large <6 oz. 6 oz. >6 oz. per day per day per day (1 pt) (2 pts) (3 pts) SCORE = _______ 2 Diet and tub margarine, Low fat & fat free salad dressings, Low fat & fat free mayonnaise Weekly Consumption _____ _____ _____ Rarely/Never 3 or less 4 or more (3 pts) (7 pts) (multiplied by:) Serving Size _____ _____ _____ Small Average Large <6 oz. 6 oz. >6 oz. per day per day per day (1 pt) (2 pts) (3 pts) SCORE = _______ ____________________________________________________________ Snacks ____________________________________________________________ 1 Chips (potato, corn, taco), Cheese puffs, Snack mix, Nuts (1 oz.) Regular crackers (1/2 oz.) Candy (milk chocolate, caramel, coconut) (about 11/2 oz.) Regular popcorn (3 cups) Weekly Consumption _____ _____ _____ Rarely/Never 3 or less 4 or more (3 pts) (7 pts) (multiplied by:) Serving Size _____ _____ _____ Small Average Large <6 oz. 6 oz. >6 oz. per day per day per day (1 pt) (2 pts) (3 pts) SCORE = _______ 2 Pretzels, Fat free chips (1 oz.) Low fat crackers (1/2 oz. ) Fruit, Fruit rolls, Licorice, Hard candy (1 med. piece) Bread sticks (1-2 pc.), Air-popped or low fat popcorn (3 cups) Weekly Consumption _____ _____ _____ Rarely/Never 3 or less 4 or more (3 pts) (7 pts) (multiplied by:) Serving Size _____ _____ _____ Small Average Large <6 oz. 6 oz. >6 oz. per day per day per day (1 pt) (2 pts) (3 pts) SCORE = _______ (Total all scores to get a final score) FINAL SCORE = _______ ____________________________________________________________ To Score: For each food category, multiply points in weekly consumption box by points in serving size circle and record total in score column. If group 2 foods checked, no points are scored (except for Group 2 meats, large serving = 6 pts). E X A M P L E Weekly Consumption X _____ _____ _____ Rarely/Never 3 or less 4 or more (3 pts) (7 pts) (multiplied by:) Serving Size X _____ _____ _____ Small Average Large <6 oz. 6 oz. >6 oz. per day per day per day (1 pt) (2 pts) (3 pts) 21 SCORE = _______ ____________________________________________________________ Group 1 Foods = Foods high in fat, saturated fat, and/or cholesterol < = less than > = greater than ____________________________________________________________ Key > or equal to 70 = Need to make some dietary changes 40 to 70 = Step I Diet < 40 = Step II Diet ____________________________________________________________ * Organ meats, shrimp, abalone, and squid are low in fat but high in cholesterol. ** Only lean cuts with all visible fat trimmed. If not trimmed of all visible fat, score as if in Group 1. *** Score 6 points if this box is checked. **** All parts not listed in Group 1 have <10 grams total fat. Heart-Healthy Eating: The Step I and Step II Diets All Americans should follow the general rules to lower blood cholesterol. In fact, this is a way that the whole family can eat (except infants under 2 years who need more calories from fat), because these guidelines are similar to those recommended for the general population. And if the whole family eats in this way, it will help you make your blood cholesterol-lowering diet your everyday way of eating. If you have high blood cholesterol, you will have to pay attention to what you eat by following either the Step I diet or Step II diet, as advised by your doctor. Step I Diet On the Step I diet, you should eat: + 8-10 percent of the day's total calories from saturated fat. + 30 percent or less of the day's total calories from fat. + Less than 300 milligrams of dietary cholesterol a day. + Just enough calories to achieve and maintain a healthy weight. (You may want to ask your doctor or registered dietitian what is a reasonable calorie level for you.) If you do not lower your blood cholesterol enough on the Step I diet or if you are at high risk for heart disease, your doctor will ask you to follow the Step II diet. If you already have heart disease, you should start on the Step II diet right away. The Step II diet helps you cut down on saturated fat and cholesterol even more than the Step I diet. This helps lower your blood cholesterol even more. Step II Diet On the Step II diet, you should eat: + Less than 7 percent of the day's total calories from saturated fat. + 30 percent or less of the day's total calories from fat. + Less than 200 milligrams of dietary cholesterol a day. + Just enough calories to achieve and maintain a healthy weight. (You may want to ask your doctor or registered dietitian what is a reasonable calorie level for you.) To get the full benefits of the Step II diet, you should have help from a registered dietitian or other qualified nutritionist. For help in locating these health professionals, see page 56. If your levels do not go down enough, you may need to take medicine along with your diet. The recommendations for saturated fat and total fat are based on a percentage of the calories you eat; the actual amount you should eat daily will vary depending on how many calories you eat. See the chart below to get an idea of the number of grams of saturated fat and total fat you should be eating. Counting Saturated Fat and Total Fat on the Step I and Step II Diets If you eat this many calories... ____________________________________________________________ 1,200 1,500 1,800 2,000 2,500 ____________________________________________________________ This is the recommended amount of fat for each day: Saturated Fat (grams)* Step I 12 15 18 20 25 Step II 8 10 12 13 17 Total Fat (grams)** Step I and 40 50 60 65 80 Step II ____________________________________________________________ * Amounts are equal to 9 percent of total calories for Step I and 6 percent of total calories for Step II. Remember 1 gram of fat equals 9 calories. ** Amounts are equal to 30 percent of total calories (rounded down to the nearest 5); your intake should be this much or less. Note: On average, women consume about 1,800 calories a day and men consume about 2,500 calories a day. A Word About Sodium If you have high blood pressure as well as high blood cholesterol (and many people do), your doctor may tell you to cut down on sodium or salt. As long as you are working on getting your blood cholesterol number down, this is a good time to work on your blood pressure, too. Try to limit your sodium intake to 2,400 milligrams a day. We'll give you tips on how to do this later. For more detailed sodium information on specific foods, look at the chart on pages 31 to 33 and tables 1-10 on pages 58 to 91 of this booklet. What Kind of Success Can You Expect? Generally your blood cholesterol level should begin to drop a few weeks after you start on a cholesterol-lowering diet. How much your level drops depends on the amounts of saturated fat and cholesterol you used to eat, how high your high blood cholesterol is, how much weight you lose if you are overweight, and how your body responds to the changes you make. Over time, you may reduce your blood cholesterol level by 10-50 mg/dL or even more. + 3 Go! How to Change Your Eating Habits and Be More Physically Active Go! - How to Change Your Eating Habits and Be More Physically Active Follow the Daily Food Guide for Heart-Healthy Eating So far, we've been talking about general rules for heart- healthy eating, and things like percent of calories from fat and grams of saturated fat. But what it all boils down to is the foods you eat. Here's a list of the food groups to choose from when you plan your new way of eating. Be sure to note the number of servings and serving sizes. Turn back to the checklist of your current eating habits on pages 10 and 11 (MEDFICTS). As you read through the shopping and cooking tips for each food group in the next sections, look to see where you need to make changes. Think about how you can change your eating habits so that you can meet your goal to eat in a heart-healthy way. To help you compare the Step I and Step II diets, here's how they differ: + The Step II diet calls for smaller amounts from the meat and egg groups. Also, the Step II diet allows only the leanest cuts of meat, fish, and poultry (see pages 58 to 69 for examples). + The Step II diet allows more servings of vegetable fats and oils (unsaturated fats) since total calories from fat remain at about 30 percent, and saturated fat is cut back. Remember that the food choices in the Step I diet are similar to those for the entire family (except infants under age 2). However, adults with high blood cholesterol need to be especially careful to keep the saturated fat low and may need special help to stay on their diets. Shop for Foods Low in Saturated Fat and Cholesterol Now that you know more about what to eat to lower your blood cholesterol, it's time to stock the kitchen. This part of the booklet is divided into the same food groups as the "Daily Food Guide" table to help you make out your grocery lists. Daily Food Guide ____________________________________________________________ Food Group No. of Servings Serving Size ____________________________________________________________ Lean meat, poultry, < or equal to 6 fish, and shellfish ounces a day on Step 1 diet < or equal to 5 ounces a day on Step II diet (leanest cuts only) Skim/low fat dairy 2-3 1 cup skim or foods 1 percent milk 1 cup nonfat or low fat yogurt 1 ounce low fat or fat free cheese that has 3 grams of fat or less in a serving Eggs < or equal to 4 yolks a week on Step I diet* < or equal to 2 yolks a week on Step II diet* Fats and oils < 6-8* 1 teaspoon soft margarine or vegetable oil 1 tablespoon salad dressing 1 ounce nuts Fruits 2-4 1 piece fruit 1/2 cup diced fruit 3/4 cup fruit juice Vegetables 3-5 1 cup leafy or raw 1/2 cup cooked 3/4 cup juice Breads, cereals, 6-11 1 slice bread pasta, rice, dry 1/2 bun, bagel, peas and beans, muffin grains, and 1 ounce dry potatoes cereal 1/2 cup cooked cereal, dry peas or beans, potatoes, or rice or other grains 1/2 cup tofu Sweets and snack Now-and-then ____________________________________________________________ * Includes food preparation; for fats and oils also includes salad dressings and nuts. < = less than (See also the back of the booklet for a handy pocket-size shopping list.) Remember to eat foods from the different groups each day as well as a variety of foods from within each group to get all the nutrients you need. Food Groups Meat, poultry, fish, and shellfish Meat, poultry, fish, and shellfish are good sources of protein and other nutrients - but they also contain saturated fat and cholesterol. Saturated fat is found in the fat that surrounds meat and in the streaks of fat - called "marbling" - in meat. Poultry and fish also have some saturated fat, but generally less than meat. Shellfish have little saturated fat. Meat, Poultry, and Fish: A Comparison ____________________________________________________________ Food Type Saturated Dietary Total (3 oz., Fat Cholesterol Fat cooked) (grams) (milligrams) (grams) Calories ____________________________________________________________ Beef, top round, broiled 3 73 8 185 Beef, whole rib, broiled 10 72 26 313 Chicken, light meat without skin, roasted 1 64 4 130 Chicken, light meat with skin, roasted 3 71 19 189 Ground turkey - breast meat only <1 35 <2 130 Ground turkey (meat and skin), cooked 3 87 11 200 Cod, baked <1 47 <1 89 Mackerel 4 64 15 223 Note: < = less than ____________________________________________________________ To lower your blood cholesterol level, choose only the leanest meats, poultry, fish, and shellfish. It is especially important to go for the leanest on the Step II diet. Look at the chart on page 18 to compare lean and fatty examples of meat, poultry, and fish. As you can see, + Some cuts of beef are lower in saturated fat than others. + Chicken or ground turkey without skin has less saturated fat than chicken with skin or ground turkey that includes skin. + Some fish, like cod, has less saturated fat and cholesterol than either chicken or meat. + Foods with less fat also have fewer calories. See tables 1 to 3 on pages 58 to 69 for more comparisons. Since even the leanest meats, poultry, fish, and shellfish have some saturated fat and cholesterol, the amount you eat is also important. See the "Daily Food Guide" table on page 17. + The recommended amount of lean meat, poultry, fish, or shellfish is: - up to 6 ounces a day for the Step I diet, and - up to 5 ounces a day for the Step II diet. To give you an idea of what these recommendations look like, a 3-ounce serving is about the size of a deck of cards. (See table 11 on page 92 for pictures of serving sizes.) Let's take a closer look at meat, poultry, fish, and shellfish. Meat. Follow these tips to make sure you buy low fat meats: + In the supermarket, look for these low fat meat clues: - "lean" or "extra lean" labels - "select" grade of beef, veal, and lamb. "Select" is lower in fat than "choice" and "prime" grades. Choose Lean Remember that you can still eat red meat, as long as you choose lean cuts. Choosing lean red meat gives you all the benefits of the meat's protein and iron. Women before menopause especially need the iron in lean meat. Lean* Cuts of Meat ____________________________________________________________ Beef Veal Pork Lamb ____________________________________________________________ Eye of the round Shoulder Tenderloin Leg-shank Top round Ground veal Sirloin Cutlets Top loin Sirloin ____________________________________________________________ * Lean defined as less than 10 grams of fat and 4.5 grams or less of saturated fat in 3 cooked ounces, as currently used on food labels. + Limit high fat processed meats like bacon, bologna, salami, hot dogs, and sausage. They are high in saturated fat and total fat. They are also high in sodium. Look for low fat processed meats, but watch out for their sodium content. + Limit organ meats, like liver, sweetbreads, and kidneys. Organ meats are high in cholesterol even though they are fairly low in fat. See table 1 on pages 58 to 63 for a listing of more meats. Poultry. In general, chicken and turkey are low in saturated fat, especially when the skin is removed. When shopping for poultry, remember: + You can buy chicken and turkey pieces with the skin already removed. Or buy the pieces with the skin on and remove it yourself before eating...it's easy to do. Remember, the white meat itself always contains less saturated fat than the dark meat. Removing the skin, particularly from the white meat pieces, can help you get rid of almost all of the saturated fat. Removing the skin from the dark meat thighs and drumsticks also helps, but not as much. + Limit goose and duck. They are high in saturated fat, even with the skin removed. ____________________________________________________________ Quick Check Meat, Poultry, and Fish - TRY IT! You can make changes a little at a time! Check off one of these things to try. Do it today! + The next time I buy chicken or turkey, I'll get the skinless kind - or take the skin off myself. + I'll limit my daily meat servings to the size of two decks of cards. + This week, I'll try a new type of fresh or plain frozen fish. ____________________________________________________________ + Try fresh ground turkey or chicken that is made from white meat like the breast. Types that don't say "white meat," "light meat," or "breast" on the label may include the skin and dark meat, so they are higher in fat. + Remember that some chicken and turkey hot dogs are lower in saturated fat and total fat than pork and beef hot dogs. There are also "lean" beef hot dogs that are low in fat and saturated fat. Usually, processed poultry products have more fat and cholesterol than fresh poultry. To be sure, check the nutrition label on deli products such as hot dogs and luncheon meats to find those that are lowest in fat and saturated fat. See table 2 on pages 64 to 66 for a more complete listing of chicken and turkey. Fish and shellfish. When shopping for fish and shellfish, remember that: + Most fish is lower in saturated fat and cholesterol than meat and poultry. + Shellfish varies in cholesterol content. Some, like squid and shrimp are fairly high in cholesterol. Others, like scallops, mussels, and clams, are low. Shellfish have little saturated fat and total fat. Even shrimp can be enjoyed occasionally on a diet to lower blood cholesterol provided you stay within the limits for dietary cholesterol. You may have heard that a type of unsaturated fat called "omega-3 fatty acids" found in fish and shellfish is good for your heart. Health benefits have not been proven. Still, any fresh or frozen fish is a smart food choice because it is low in saturated fat. Avoid fish oil pills because they are high in fat and calories, and they may have long-term side effects. See table 3 on pages 66 to 69 for a listing of more fish and shellfish. Dairy foods Like high fat meats, regular dairy foods that have fat - such as whole and 2 percent milk, cheese, and ice cream - are also high in saturated fat and cholesterol. Here is a guide to buying low fat or nonfat dairy foods: Milk. Milk is a good source of protein, and it has lots of vitamins and minerals, especially calcium. So: + Buy skim and 1 percent milk rather than whole or 2 percent milk. They have just as much or more calcium and other nutrients as whole milk - with much less saturated fat and cholesterol and fewer calories. Make the Change, Step by Step If you now drink whole milk, you will probably find it easier to change to skim milk in steps so your taste buds can adjust. Drink 2 percent milk for a few weeks, then 1 percent, and finally skim. You'll get used to the new taste gradually. And, with each step, you'll cut down on the saturated fat, cholesterol, and calories. Cheese. Because they are made with whole milk or cream, most cheeses are high in saturated fat and cholesterol. Fortunately, many cheese makers are starting to offer low fat versions of cheese favorites like cheddar, swiss, and mozzarella. They use skim milk and vegetable oils to replace some of the cream and other fat. The result is more reduced fat and fat free cheeses to choose from. Cheeses with 3 grams of fat or less in an ounce can be included in the Step I and Step II diets. Follow these tips to find your way through the cheese aisle: Say Cheese? Think Again. Often, when people cut back on meat they eat cheese instead, thinking they are cutting back on saturated fat and cholesterol. What do you think? A serving of cheddar cheese has less saturated fat than a serving of lean round steak. _____ TRUE _____ FALSE Check out the chart below for the answer. + When looking for hard cheeses, go for versions that are "fat free," "reduced fat," "low fat," "light," or "part- skim" (See pages 69 to 73.) Some versions have 3 grams of fat or less in an ounce. + When looking for soft cheeses, choose low fat (1 percent) or nonfat cottage cheese, farmer cheese, or part skim or light ricotta. Some of these cheeses have 3 grams of fat or less in an ounce. + If you are watching your sodium intake, choose lower- sodium cheeses. Read the label to compare sodium content (See page 35.) Poultry, Meat, and Cheese: A Comparison ____________________________________________________________ Food Saturated Cholesterol Total Fat (Per serving) Fat (grams) (milligrams) (grams) ____________________________________________________________ Roasted chicken - without skin, light meat roasted (3 ounces)* 1 64 4 Beef - top round broiled (3 ounces)* 3 73 8 Natural cheddar (1 ounce)* 6 30 9 Answer: False A serving of most natural and many processed cheeses has less cholesterol, but more than six times the saturated fat in a serving of chicken without the skin and almost twice that of lean round steak. ____________________________________________________________ *Based on serving sizes currently used on food labels. ____________________________________________________________ Quick Check Dairy Products - TRY IT! Check off one of these things to try. Do it today! _____ I'll try a low fat cheese, like low fat cheddar or swiss. _____ I'll switch from 2 percent milk to 1 percent or skim. _____ I'll try sherbet or ice milk for dessert instead of ice cream - and enjoy the fat savings. ____________________________________________________________ See table 4 on pages 69 to 73 for information on lower fat cheeses. And remember to choose low fat cheeses with no more than 3 grams of fat per ounce. Ice cream. Ice cream is made from whole milk and cream, so it is fairly high in saturated fat and cholesterol. Remember to: + Buy other frozen desserts that are low in saturated fat, like ice milk, low fat frozen yogurt, low fat frozen dairy desserts, fruit ices, sorbet, and popsicles. + Eat ice cream less often and in small amounts. See table 8 on page 84 to compare the saturated fat and cholesterol in some frozen desserts. Other dairy foods. Other dairy foods are available in low fat or nonfat versions (See table 4): + Buy low fat or nonfat yogurt; like many other dairy foods, it is an excellent source of protein and calcium. Eat low fat or nonfat yogurt plain or use it as toppings or in recipes. + Try low fat or nonfat sour cream or cream cheese blends. Many taste as rich as the real thing, but have less fat and calories. ____________________________________________________________ Quick Check Eggs - TRY IT Check off one of these things to try. Do it today! _____ I'll try a cholesterol free egg substitute instead of whole eggs. _____ I'll count the number of eggs I eat a week and see if I meet the recommendations. ____________________________________________________________ Eggs Egg yolks are high in dietary cholesterol - each contains about 213 mg. So, egg yolks are limited: + On the Step I diet, eat no more than 4 egg yolks a week. + On the Step II diet, eat no more than 2 egg yolks a week. This includes the egg yolks in baked goods and processed foods. Egg whites have no cholesterol, and you can substitute them for whole eggs in recipes - two egg whites are equal to one whole egg. You can also buy egg substitutes and use them instead of whole eggs: In many baked goods, you can't tell the difference. Fats and oils When you buy fats and oils, look for those that are unsaturated - either polyunsaturated (safflower, sunflower, corn and soybean oils) or monounsaturated (olive and canola oils). Unsaturated fats help to lower blood cholesterol when they are substituted for saturated fat. Just be sure to limit the total amount of any fats or oils, since even those that are unsaturated are rich sources of calories. A Word About Margarine You may have heard that margarine has a type of unsaturated fat called "trans" fat. "Trans" fats appear to raise blood cholesterol more than other unsaturated fats, but not as much as saturated fats. "Trans" fats are formed when vegetable oil is hardened to become margarine or shortening, through a process called "hydrogenation." The harder the margarine or shortening, the more likely it is to contain more "trans" fat. Read the ingredient label to choose margarines containing liquid vegetable oil as the first ingredient rather than hydrogenated or partially hydrogenated oil. Use the nutrition label to choose margerines with the least amount of saturated fat. When buying fats and oils, remember to: + Choose liquid vegetable oils that are high in unsaturated fats - like canola, corn, olive, peanut, safflower, sesame, soybean, and sunflower oils. + Buy margarine made with unsaturated liquid vegetable oils as the first ingredient. Choose tub or liquid margarine or vegetable oil spreads. The softer the margarine, the more unsaturated it is. If you are watching your sodium intake, try unsalted margarine. + Limit butter, lard, fatback, and solid shortenings. They are high in saturated fat. + Buy light or nonfat mayonnaise instead of the regular kinds that are high in fat. Most salad dressings are lower in fat than mayonnaise. ____________________________________________________________ Quick Check Fats and Oils - TRY IT! Check off one of these things to change. Do it today! _____ Instead of using butter as a spread on my toast, I'll switch to a soft tub margarine. _____ To cut back on calories and fat, I'll try to use a lower fat margarine, salad dressing, or mayonnaise. ____________________________________________________________ For tips on cooking with unsaturated fats, see page 40; for more information on fats and oils, see table 5 on pages 73 to 74. Since nuts and seeds are high in fat, they are often grouped with fats and oils. The fat in nuts and seeds is mostly unsaturated, but these foods are still high in total fat and calories. Salted nuts are also high in sodium. See table 6 on pages 75 to 76 to compare the fat and calories in nuts and seeds. Fruits and vegetables Fruits and vegetables are very low in saturated fat and total fat, and have no cholesterol. They are good sources of starch and fiber and are low in sodium. Fruits and vegetables are also low in calories, except for avocados and olives, which are high in both fat and calories. Many fruits and vegetables are also high in vitamin C, vitamin E, and beta-carotene - so-called "antioxidants." A diet high in these fruits and vegetables may also help to lower risk for heart disease. So fruits and vegetables are great substitutes for foods high in saturated fat and cholesterol. Also most fruit and vegetables except for avocados, coconut, and olives are low in total fat. When shopping, remember to: + Buy fruits and vegetables to eat as snacks, desserts, salads, side dishes, and in main dishes. Season with herbs, spices, lemon juice, fat free or low fat mayonnaise. Limit the use of regular mayonnaise or other fatty sauces. ____________________________________________________________ Quick Check Fruits and Vegetables - TRY IT! Check off one of these things to try. Do it today! _____ For a flavor change, I'll try serving applesauce as a side dish. _____ I'll keep more fruit in the refrigerator so it will be handy for a snack instead of chips. _____ If I have a small amount of leftover meat, I'll make a stew that has lots of vegetables. ____________________________________________________________ Breads, cereals, pasta, rice and other grains, and dry peas and beans Breads, cereals, pasta, rice and other grains, and dry peas and beans are generally high in starch and fiber and low in saturated fat and calories. They also have no dietary cholesterol. Except for some breads and cereals, most foods in this group also are low in sodium. Check the food label to be sure. Like fruits and vegetables, foods in this group are good choices. When buying foods from this group, remember to: + Choose whole-grain breads and rolls often. If you are watching your sodium intake, compare labels (see page 35) and choose those lower in sodium. + Buy dry cereals; most are low in fat. Limit the high fat granola, muesli, and oat bran types that are made with coconut or coconut oil, which increases the saturated fat content. Granola and muesli often have nuts as well, which increases total fat and calories. Some cereals are high in sodium. + Buy pasta, rice, and dry peas and beans to use as entrees, or in casseroles or soups. Hold the high fat sauces. + Limit baked goods that are made with lots of saturated fat, like croissants, muffins, biscuits, butter rolls, and doughnuts. See table 7 on pages 77 to 81, for a list of more foods in this group. ____________________________________________________________ Quick Check Breads and Cereals - TRY IT! Check off one of these things to try. Do it today! _____ For breakfast instead of doughnuts and muffins, I'll try a hot or cold cereal with skim milk and toast with jelly. _____ I'll top my spaghetti with stir-fried vegetables instead of a creamy sauce. ____________________________________________________________ Sweets and snacks Some sweets and snacks - like cakes, pies, cookies, cheese crackers, and some chips - often are high in saturated fat, cholesterol, and calories. Buy them only seldom, if at all. But other foods in this group can be used as part of a well- balanced diet. Here are some low fat sweets to buy and use now-and-then: + angel food cake topped with fruit puree or fresh fruit slices + fat free or low fat brownies, cakes, cheesecakes, cupcakes, and pastries + fat free or low fat cookies like animal crackers, devil's food cookies, fig and other fruit bars, ginger snaps, and vanilla or lemon wafers + frozen low fat or nonfat yogurt, fruit ices, ice milk, sherbet, and sorbet + gelatin desserts + graham crackers + puddings made with skim or 1 percent milk Just remember that, while these treats may be low in fat, most are not low in calories. So choose them only every now-and-then, especially if you are trying to control your weight. ____________________________________________________________ Quick Check Sweets and Snacks - TRY IT! Check off one of these things to try. Do it today! _____ The next time I crave a cookie, I will try a new fat free type. (But not too many - remember the calories!) _____ Instead of buying ice cream, I will try ice milk or nonfat frozen yogurt. _____ Instead of snacking on regular chips, I'll try pretzels or air-popped popcorn. ____________________________________________________________ Not all snack foods are high in saturated fat and cholesterol. Buy some of these low fat ones and keep them on hand for snack attacks: + bagels + bread sticks* + unsweetened ready-to-eat cereals* + frozen grapes or banana slices; other fresh fruit + fruit leather or other dried fruit + low fat or fat free crackers* like melba toast, rice cakes, rye crisp, and soda crackers + no-oil baked tortilla chips* + popcorn (air-popped or "light")* + pretzels* + raw vegetables with nonfat or low fat dip (* If you are watching your sodium intake, be sure to look for low sodium or unsalted types.) See table 8 on pages 81 to 86 for more information on sweets and snack foods. If You Also Have High Blood Pressure, Watch Your Sodium Too If you have high blood pressure along with high blood cholesterol, you should choose lower-sodium foods from each group. Many low fat foods are naturally low in sodium, but there are some you should watch out for, like regular canned vegetables and soups, some crackers, breads and cereals, pickles, and soy sauce. Check out the chart on pages 31 to 33 to compare the amount of sodium in some foods that are also low in saturated fat and cholesterol. Sodium Content of Heart-Healthy Foods Sodium Types of Food (milligrams) + Meat, poultry, fish, and shellfish Fresh meat (like beef, pork, veal, Less than 90 and lamb), poultry, finfish, cooked, 3 ounces Clams, steamed, 3 ounces 95 Tuna, canned, 3 ounces 300 Chicken hot dog, 1 755 Lean ham, 3 ounces 1,025 + Dairy products Milk Skim or 1% milk, 1 cup 125 Buttermilk (salt added), 1 cup 260 Yogurt Low fat or nonfat yogurt, fruited, 120-150 8 ounces Low fat or nonfat yogurt, plain, 8 ounces 160-175 Cheese Low fat cheese, 1 ounce 150 Low fat and low sodium cheese, 1 ounce Read the label Cottage cheese, low fat, 1/2 cup 460 + Eggs Egg white, 1 55 Egg substitute, 1/4 cup = 1 egg 80-120 + Fats and oils Oil, 1 tablespoon 0 Unsalted tub margarine, 1 teaspoon Less than 5 Salted tub margarine, 1 teaspoon 45 Prepared salad dressings, low calorie, 2 tablespoons 50-310 Imitation mayonnaise, nonfat, 1 tablespoon 110 + Fruits Fruits (fresh, frozen, canned), 1/2 cup Less than 10 + Vegetables Fresh or frozen vegetables (cooked without salt), 1/2 cup Less than 70 Tomato juice, canned, 3/4 cup 660 + Breads, cereals, rice, pasta, and dry peas and beans Breads and crackers Corn tortilla 40 Bread, 1 slice 110-175 Melba toast, 3 rectangles 120 English muffin, 1/2 130 Bagel, 1/2 190 Cracker, saltine type, 5 squares 195 Cereals, rice, and pasta Ready-to-eat cereal, 1 ounce Shredded wheat, 3/4 cup Less than 5 Puffed wheat and rice, 1 1/2 - 1 2/3 cup Less than 5 Granola type, 1/2 cup 5-25 Ring and nugget cereals, 1 cup 170-310 Flaked cereals, 2/3 -1 cup 170-360 Cooked cereal (unsalted), 1/2 cup Less than 5 Instant cooked cereal, 3/4 cup 180 Rice and pasta (unsalted), 1/2 cup Less than 10 Peas and beans Peanut butter (unsalted), 2 tablespoons Less than 5 Dry beans, home cooked (unsalted), Less than 5 or no-salt added, canned, 1/2 cup Peanut butter, 2 tablespoons 150 Dry beans, plain, canned (salted), 1/2 cup 350-590 + Snacks Popcorn and nuts Popcorn and nuts (unsalted), 1 ounce Less than 10 Popcorn and nuts (salted), 1 ounce 170-250 Cake and candy Jelly beans, 10 large 5 Hard candy, 1 ounce 10 Vanilla wafers, 1 10 Fig bar cookies, 1 55 Angel food cake, 1/12 of a 9 inch cake 210 Frozen Desserts Ice pop, 1 10 Frozen nonfat or low fat yogurt, 1/2 cup 40-55 Ice milk, 1/2 cup 55-60 + Condiments Mustard, chili sauce, hot sauce, 1 teaspoon 35-65 Catsup, steak sauce, 1 tablespoon 100-230 Salt, 1/6 teaspoon 390 Pickles, 5 slices 280-460 Soy sauce, lower sodium, 1 tablespoon 600 Soy sauce, 1 tablespoon 1,030 + Convenience foods Canned and dehydrated soups, 1 cup* 600-1,300 Lower sodium versions* Read the label Canned and frozen main dishes, 8 ounces** 500-1,570 Lower sodium versions**Read the label * Creamy soups are higher in saturated fat and cholesterol. ** Choose main dishes that have ingredients lower in saturated fat and cholesterol. Source: Adapted from Home and Garden Bulletin 253-7, United States Department of Agriculture, 1993. See tables 1-10 on pages 58 to 91 to compare the amount of sodium in other foods. Also see page 34 to learn how to read food labels to compare the amount of sodium in different brands. Read Food Labels We've already mentioned that reading food labels will help you choose foods low in saturated fat, cholesterol, calories, and sodium. What will the labels tell you? Food labels have two important parts: the nutrition information and the ingredients list. Also, some labels have different claims like "low fat" or "light." Here's a closer look at labels. Read the nutrition information Look for the amount of saturated fat, total fat, cholesterol, and calories in a serving of a product. Compare similar products to find the one with the smallest amounts. If you have high blood pressure, do the same for sodium. Look at the ingredients All food labels list the product's ingredients in order by weight. The ingredient in the greatest amount is listed first. The ingredient in the least amount is listed last. So, to choose foods low in saturated fat or total fat, limit your use of products that list any fat or oil first - or that list many fat and oil ingredients. If you are watching your sodium intake, do the same for sodium or salt. Use the chart below to find the sources of saturated fat and cholesterol in foods as they may appear in the list of ingredients. Sources of Saturated Fat and Cholesterol ____________________________________________________________ Animal fat Egg and egg-yolk solids Palm kernel oil Bacon fat Ham fat Palm oil Beef fat Hardened fat or oil Pork fat Butter Hydrogenated vegetable oil Turkey fat Chicken fat Lamb fat Vegetable oil* Cocoa butter Lard Vegetable Coconut Meat fat shortening Coconut oil Whole-milk Cream solids *Could be coconut or palm oil. ____________________________________________________________ PRODUCT: (Reproduction of a Food Nutrition Facts Label ommitted.) CHECK FOR: + Serving size + Number of servings + Calories + Total fat in grams + Saturated fat in grams + Cholesterol in milligrams (Amount Per Serving, Calories, Calories From Fat, Total Fat, Cholesterol, Sodium, Total Carbohydrate, and Protein) Here, the label gives the amounts for the 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. The "% Daily Value" shows you how much of the recommended amounts the food provides in one serving, if you eat 2,000 calories a day. For example, one serving of this food gives you 18 percent of your total fat recommendation. Calories 2,000 2,500 ____________________________________________________________ Total Fat Less than 65g 80g Sat Fat Less than 20g 25g Cholesterol Less than 300mg 300mg Sodium Less than 2,400mg 2,400mg Total Carbohydrate 300g 375g Dietary Fiber 25g 30g ____________________________________________________________ Calories per gram: Fat 9 Carbohydrates 4 Protein 4 Here you can see the recommended daily amounts for each nutrient for two calorie levels. The amounts listed are the same as the upper limit of the Step I diet. The Step II diet would be lower. Look back at the table on page 13. If you eat a 2,000 calorie diet, you should be eating less than 65 grams of fat and less than 20 grams of saturated fat. Your daily amounts may vary higher or lower depending on your calorie needs. Know what the claims mean Besides the ingredients list and the nutrition information that are on all packaged foods, you'll see certain claims on some food packages. These claims include words like "light" and "low fat" and are regulated by the government. To figure out what a claim on a food label means turn to table 14 on pages 96 to 97. ____________________________________________________________ Quick Check Food Shopping - TRY IT! Check off one of these things to try. Do it today! _____ I'll check the labels on the canned and packaged foods in my cupboards. If any of them have any of the saturated fat and cholesterol sources shown in the chart on page 34, I'll buy foods that are lower in saturated fat and cholesterol next time. _____ I'll tuck the shopping list into my wallet or purse right now - and I'll use it at the grocery store when I shop. ____________________________________________________________ Cook the Low Fat Way By following the shopping tips we just talked about, you can stock your kitchen with great tasting foods that are low in saturated fat and cholesterol. Now it's time to cook the low fat way. Here are some cooking tips to cut down on saturated fat and cholesterol. Meat, poultry, fish, and shellfish Before cooking meat, poultry, fish, and shellfish: + Trim fat from meat. + Remove the skin and fat from chicken, turkey, and other poultry. + If you buy tuna or other canned fish packed in oil, rinse it in a strainer before cooking with it. Better yet, buy canned fish packed in water. If you are watching your sodium to help lower blood pressure, be sure to rinse the fish whether it is packed in oil or in water. Changes in your cooking style can also help you remove fat: + Bake, broil, microwave, poach, or roast 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. + When you roast, place the meat on a rack so that the fat can drip away. + When a recipe calls for ground meat, brown the meat and drain well before adding to other ingredients. + If you baste meats and poultry, use fat free ingredients like wine, tomato juice, lemon juice, or defatted beef or chicken broth instead of the fatty drippings. + Cook turkeys that are not self-basting - self-basting turkeys can be high in saturated fat. ____________________________________________________________ Quick Check Cooking with Meat, Poultry, Fish, and Shellfish - TRY IT! Check off one of these things to try. Do it today! _____ The next time I cook meat, I'll trim all the fat off before cooking it. _____ The next time I cook chicken, I'll bake, broil, or roast it without adding any fat. _____ From now on I'll buy turkey that is not self-basting. For basting, I'll use defatted drippings. _____ I'll try baking or poaching fish and shellfish in wine, instead of breading and frying it. ____________________________________________________________ Sauces, soups, and casseroles + After making sauces or soups, cool them in the refrigerator and skim the fat from the top. Treat canned broth-type soups the same way. Try low sodium or reduced sodium soups to help cut down on sodium. + When making casseroles with cheese, try low fat cheese. Or use less regular cheese than the recipe calls for: If you use one that is sharp-flavored, you won't taste a difference. Mix just a little cheese into the dish, saving the rest for the top. That way, the dish still looks good and cheesy. + When you make creamed soup or white sauces, use skim, 1 percent, or evaporated skim milk instead of 2 percent, whole milk, or cream. To make a low fat sauce, thicken it with corn starch or flour. Or, if you have any leftover rice, grind it up in the blender and then add to the rest of the ingredients. + Make main dishes with pasta, rice, or dry peas and beans. If you add meat, use small pieces just for flavoring instead of as the main ingredient. Make extras and freeze the leftovers for other meals. ____________________________________________________________ Quick Check Sauces, Soups, and Casseroles - TRY IT! Check off one of these things to try. Do it today! _____ The next time I make a casserole with cheese, I'll cut down on the amount called for or use low fat cheese. I'll try using a sharp cheese for more flavor. _____ I'll experiment with a new bean dish or two. If I use meat, I'll use just a little for flavor. ____________________________________________________________ Seasonings and condiments + Use small amounts of lean meats to flavor vegetables while cooking, instead of salt pork or fat back. + Flavor cooked vegetables with herbs or butter-flavored seasoning instead of butter or margarine. + Use herbs, spices, and no-salt seasoning blends to bring out the flavor of foods. Use salt sparingly in cooking and stop using the salt shaker at the table. Limit salty condiments like olives and pickles. ____________________________________________________________ Quick Check Seasonings and Condiments - TRY IT! Check off one of these things to try. Do it today! _____ I'll try cooking greens with turkey thigh meat instead of salt pork. _____ For flavor, I'll sprinkle lemon juice and dill on green beans after I cook them. _____ For tomorrow night's dinner, I'll try skinless chicken with tomatoes, rosemary, and peppers. ____________________________________________________________ Convenience foods. And for those times when you don't feel like cooking: + Use your own convenience foods - low fat casseroles and soups that you have cooked ahead and then frozen in small batches. + Choose frozen dinners and pizzas that are low in saturated fat, cholesterol, and sodium. Make sure the dinners have vegetables, fruits, and grains - or add them on the side. ____________________________________________________________ Quick Check Convenience Foods - TRY IT! Check off one of these things to try. Do it today! _____ I'll check the label next time I buy a frozen dinner to make sure it's one of the lowest in saturated fat and cholesterol. _____ When I have the time to cook, I'll make extra to freeze in single portion sizes. That way I'll know my frozen dinner will be low in saturated fat and cholesterol. ____________________________________________________________ ____________________________________________________________ Quick Check Recipe Substitutions - TRY IT! Check off one of these to try. Do it today! _____ The next time I bake, I'll use two egg whites for each whole egg, and I'll use margarine or oil instead of butter. _____ I'll switch from regular mayonnaise to light mayonnaise. _____ I'll make dips with nonfat yogurt instead of sour cream. _____ I will try to make puddings with skim or 1 percent milk instead of whole or 2 percent milk. ____________________________________________________________ New ways to use old recipes There are lots of special cookbooks and recipe booklets to help you with low fat cooking. But maybe you have a favorite cookbook that you've been using for years. You don't have to throw it out: Just cut down on the high fat ingredients and substitute ingredients lower in fat or saturated fat as much as possible. Here's a list of substitutions. Fat - Saving Recipe Substitutions Instead of... Use... Whole milk Skim or 1 percent milk Evaporated milk Evaporated skim milk Light cream Equal amounts 1 percent milk and evaporated skim milk 1 cup butter 1 cup margarine or 2/3 cup vegetable oil* Shortening Margarine* Mayonnaise or salad dressing Nonfat or light mayonnaise or salad dressing 1 whole egg 1/4 cup egg substitute or 2 egg whites Cheese Low fat cheese Sour cream Nonfat or low fat sour cream or yogurt Fat for "greasing" pan Nonstick cooking spray * Note: The texture of baked goods may be different when you use these substitutions. Experiment to find out what works best for you. Eat Right When Eating Out Eating out while following a heart-healthy diet is getting easier: Many restaurants have at least some menu items that are low in saturated fat and cholesterol. Here are some menu items to choose - and some to decrease: Breakfast Choose: egg substitute hot or cold cereal toast with margarine and jam English muffin or bagel with nonfat cream cheese fruit or juice Decrease: egg yolks, any style fried potatoes bacon or sausage biscuit, croissant, or sweet roll Lunch Choose: salad (with dressing on the side) regular-sized hamburger (hold the mayo) turkey, chicken, or roast beef sandwich (hold the mayo) soup (other than cream-based) Decrease: deluxe sandwiches hot dogs or sausage breaded and fried chicken or fish cream-based soups french fries, onion rings, or chips Dinner Choose: pasta with low fat sauce grilled or broiled fish or skinless chicken lean steak, trimmed of fat vegetarian entree (little or no cheese) baked potato with a little margarine or nonfat yogurt vegetables, plain or with a little oil low fat desserts like fresh fruit, sorbet, sherbet, ice milk, or nonfat frozen yogurt Decrease: prime rib or untrimmed steaks or chops fried chicken or fish cream sauces or gravies rich desserts, such as cake, cheesecake, tortes, etc. Here are more tips for eating out: + Choose restaurants that have low fat, low cholesterol menu choices. And don't be afraid to make special requests: it's your right as a paying customer. + Control serving sizes by asking for a small serving, sharing a dish with a companion, or taking some home. + Ask that gravy, butter, rich sauces, and salad dressing be served on the side. That way, you can control the amount you eat. + Ask to substitute a salad or baked potato for chips, fries, or other extras - or just ask that the extras be left off your plate. + When ordering pizza, order vegetable toppings like green pepper, onions, and mushrooms instead of meat toppings or extra cheese. + At fast food restaurants, go for salads, grilled (not fried or breaded) chicken sandwiches, regular-sized hamburgers, or roast beef sandwiches. Go easy on the regular salad dressings and fatty sauces. Limit jumbo or deluxe burgers or sandwiches. ____________________________________________________________ Quick Check Eating Out - TRY IT! Check off one of these things to try. Do it today! _____ The next time I go out for lunch, I'll try a regular hamburger instead of the deluxe - and save on saturated fat and cholesterol. _____ The next time I order pizza, I'll spice it up with vegetable toppings instead of fattier meat toppings like sausage or pepperoni. _____ The next time I'm out for dinner, I'll ask that salad dressing and other sauces be served on the side. To cut down on fat, I'll use just a little bit. ____________________________________________________________ + At the salad bar, fill up on vegetables. Limit foods like eggs, bacon, and cheese, and prepared salads like potato or macaroni salad. Go easy on the salad dressing - and choose low-calorie dressing or oil and vinegar when it's offered. + Try different ethnic cuisines. Many such as Chinese and Middle Eastern offer lots of low fat choices. Eat Right at Social Events Eating at social events like parties, receptions, family gatherings, and church socials can be a challenge to your heart-healthy eating style. Since you can't control what is served, you may feel pressured to eat foods high in saturated fat and cholesterol. Here are some tips that will help you eat healthfully at social events: + At a buffet, look ahead in line to see what low fat foods are available. Fill up on low fat items and take only small servings of high fat foods. + Bring a low fat dish to a potluck dinner. That way, you'll have at least one low fat item from which to choose. + At parties, focus on activities other than eating. Sit away from the area where the food is being served so you won't be tempted to overeat. + Ask for help from your family and friends who know you are following a cholesterol-lowering diet. See if they will include some low fat dishes instead of the high fat favorites. + Have a few ready answers to politely say no to high fat foods. For example, "thank you, but I couldn't eat another bite - everything was delicious." + If you do eat too many high fat foods at a social event, don't feel guilty. Just eat lightly the next day and get back on track. Check Your Menu I.Q. Which menu item is the lower-fat selection? 1) Lean roast Chicken salad beef sandwich ___ OR sandwich ___ 2) Cream of broccoli soup ___ OR Minestrone ___ 1) Answer: The lean roast beef sandwich is usually lower in fat. You can also ask that no mayonnaise, margarine, or butter be put on the sandwich roll. While a plain chicken sandwich would also be a good low fat choice, commercially made chicken salad usually is made with lots of regular mayonnaise, which adds fat calories. 2) Answer: The minestrone is the lower-fat choice: clear, broth-based soups are almost always lower in fat than cream- based soups. Both soups could be high in sodium, so you might want to skip soup altogether if you're trying to lower high blood pressure. Look at the Sample Menus Now that you are an expert on what foods from the different food groups fit into the Step I and Step II diets, let's get down to the nitty gritty to see how to fit this into what to eat for a whole day. Here are some sample menus to give you some ideas to get started. There are three menus - one for traditional American-style foods, one for Southern-style foods, and one for Mexican American-style foods. For each style of food there are menus at two different calorie levels - the average American man eats about 2,500 calories a day and the average American woman eats about 1,800 calories a day. For each of these calorie levels there is a menu that follows the guidelines for the Step I and Step II diets. So choose the kind of food you like, how many calories you should be eating, and which diet you need to follow. Traditional American-Style Foods Step I - 2,500 calories Breakfast 1 medium bagel 2 teaspoons low fat cream cheese 1 1/2 cups shredded wheat cereal 1 small banana 1 cup 1 percent milk 3/4 cup orange juice 1 cup coffee 2 tablespoons 1 percent milk Lunch 1/2 cup minestrone soup, canned 1 lean roast beef sandwich 2 slices whole wheat bread 3 ounces lean roast beef, unseasoned 3/4 ounce American cheese, low fat 1 leaf lettuce 3 slices tomato 2 teaspoons mayonnaise, low fat 1 cup fresh mixed fruit salad 1 cup lemonade Snack 1 fresh large apple Dinner 3 ounces salmon 1 medium baked potato 2 teaspoons tub margarine 1/2 cup green beans 1/2 teaspoon tub margarine 1/2 cup carrots 1/2 teaspoon tub margarine 1 medium white dinner roll 1 teaspoon tub margarine 1 cup ice milk 1 cup iced tea, unsweetened Snack 3 cups popcorn 1 tablespoon tub margarine Step II - 2,500 calories Breakfast 1 medium bagel 2 teaspoons jelly 1 1/2 cups shredded wheat cereal 1 small banana 1 cup skim milk 3/4 cup orange juice 1 cup coffee 2 tablespoons skim milk Lunch 1/2 cup minestrone soup, canned 1 lean roast beef sandwich 2 slices whole wheat bread 2 ounces lean roast beef, unseasonsed 3/4 ounce American cheese, low fat 1 leaf lettuce 3 slices tomato 2 teaspoons tub margarine 1 cup fresh mixed fruit salad 1 cup lemonade Snack 1 fresh large apple Dinner 3 ounces flounder 1 teaspoon vegetable oil 1 medium baked potato 2 teaspoons tub margarine 1/2 cup green beans 1/2 teaspoon tub margarine 1/2 cup carrots 1/2 teaspoon tub margarine 1 medium white dinner roll 1 teaspoon tub margarine 1 cup frozen yogurt 1 cup iced tea, unsweetened Snack 3 cups popcorn 1 tablespoon tub margarine Note: No salt is used when making the food. Calories 2,471 2,453 Percent calories from fat 29 28 Percent calories from saturated fat 8 7 Cholesterol (milligrams) 162 144 Sodium (milligrams) 2,400 2,426 ____________________________________________________________ Step I - 1,800 calories Breakfast 1/2 medium bagel 1 teaspoon low fat cream cheese 1 cup shredded wheat cereal 1 small banana 1 cup 1 percent milk 3/4 cup orange juice 1 cup coffee 2 tablespoons 1 percent milk Lunch 1/2 cup minestrone soup, canned 1 lean roast beef sandwich 2 slices whole wheat bread 3 ounces lean roast beef, unseasoned 3/4 ounce American cheese, low fat 1 leaf lettuce 3 slices tomato 2 teaspoons mayonnaise, low fat 1 medium apple 1 cup water Dinner 3 ounces salmon 1 medium baked potato 1 teaspoon tub margarine 1/2 cup green beans 1/2 teaspoon tub margarine 1/2 cup carrots 1/2 teaspoon tub margarine 1 medium white dinner roll 1 teaspoon tub margarine 1/2 cup ice milk 1 cup iced tea, unsweetened Snack 2 cups popcorn 1 teaspoon tub margarine Step II - 1,800 calories Breakfast 1/2 medium bagel 1 teaspoon jelly 1 cup shredded wheat cereal 1 small banana 1 cup skim milk 1 cup orange juice 1 cup coffee 2 tablespoons skim milk Lunch 1/2 cup minestrone soup, canned 1 lean roast beef sandwich 2 slices whole wheat bread 2 ounces lean roast beef, unseasoned 3/4 ounce American cheese, low fat 1 leaf lettuce 3 slices tomato 2 teaspoons tub margarine 1 medium apple 1 cup water Dinner 3 ounces flounder 1 teaspoon vegetable oil 1 medium baked potato 1 teaspoon tub margarine 1/2 cup green beans 1/2 teaspoon tub margarine 1/2 cup carrots 1/2 teaspoon tub margarine 1 medium white dinner roll 1 teaspoon tub margarine 1/2 cup low fat frozen yogurt 1 cup iced tea, unsweetened Snack 3 cups popcorn 2 teaspoons tub margarine Note: No salt is used when making the food. Calories 1,821 1,870 Percent calories from fat 30 29 Percent calories from saturated fat 9 7 Cholesterol (milligrams) 150 130 Sodium (milligrams) 2,046 2,148 ____________________________________________________________ Step I - 2,500 calories Breakfast 1 cup oatmeal, made with 1 percent milk 1 cup 1 percent milk 1 medium English muffin 2 tablespoons low fat cream cheese 1 cup orange juice 1 cup coffee 2 tablespoons 1 percent milk Lunch 3 ounces baked chicken, without the skin 1 teaspoon vegetable oil Salad 1/2 cup lettuce 1/2 cup tomato 1/2 cup cucumber 1 tablespoon regular oil and vinegar dressing 1 cup white rice 1 teaspoon tub margarine 1 medium biscuit, made with vegetable oil 2 teaspoons tub margarine 1 cup water Dinner 3 ounces lean roast beef 1/4 cup onion 1 tablespoon beef gravy, made with 1 percent milk 1/2 cup turnip greens 1/2 teaspoon tub margarine 1 medium sweet potato 1 teaspoon brown sugar 1 medium slice cornbread, made with tub margarine 1 teaspoon tub margarine 1/4 medium honeydew melon 2 medium pumpkin cookies, made with vegetable oil 1 cup iced tea, sweetened with sugar Snack 8 saltine crackers, with unsalted tops 1 1/2 ounces part skim mozzarella cheese 2 medium dried prunes Step II - 2,500 calories Breakfast 1 cup oatmeal, made with skim milk 1 cup skim milk 1 medium English muffin 2 teaspoons tub margarine 2 teaspoons jelly 1 cup orange juice 1 cup coffee 2 tablespoons skim milk Lunch 3 ounces baked chicken, without the skin 1 teaspoon vegetable oil Salad 1/2 cup lettuce 1/2 cup tomato 1/2 cup cucumber 1 tablespoon regular oil and vinegar dressing 1 1/4 cups white rice 1 1/4 teaspoon tub margarine 1 medium biscuit, made with vegetable oil 2 teaspoons tub margarine 1 cup water Dinner 2 ounces lean roast beef 1/4 cup onion 1 tablespoon beef gravy, made with water 1/2 cup turnip greens 1/2 teaspoon tub margarine 1 medium sweet potato 1 teaspoon brown sugar 1 medium slice cornbread, made with tub margarine 1 teaspoon tub margarine 1/4 medium honeydew melon 2 medium pumpkin cookies, made with vegetable oil 1 cup iced tea, sweetened with sugar Snack 8 saltine crackers, with unsalted tops 3/4 ounce part skim mozzarella cheese 2 medium dried prunes Note: No salt is used when making the food. Calories 2,560 2,536 Percent calories from fat 30 29 Percent calories from saturated fat 10 7 Cholesterol (milligrams) 241 177 Sodium (milligrams) 2,174 2,035 ____________________________________________________________ Southern-Style Foods Step I - 1,800 calories Breakfast 3/4 cup oatmeal, made with 1 percent milk 3/4 cup 1 percent milk 1 medium English muffin 2 tablespoons low fat cream cheese 3/4 cup orange juice 1 cup coffee 2 tablespoons 1 percent milk Lunch 3 ounces baked chicken, without the skin 1 teaspoon vegetable oil Salad 1/2 cup lettuce 1/2 cup tomato 1/2 cup cucumber 2 teaspoons regular oil and vinegar dressing 1/2 cup white rice 1/2 teaspoon tub margarine 1/2 medium biscuit, made with vegetable oil 1 teaspoon tub margarine 1 cup water Dinner 3 ounces lean roast beef 1/4 cup onion 1 tablespoon beef gravy, made with 1 percent milk 1/2 cup turnip greens 1/2 teaspoon tub margarine 1 medium sweet potato 1/2 teaspoon brown sugar 1/2 medium slice cornbread, made with tub margarine 1/2 teaspoon tub margarine 1/4 medium honeydew melon 1 medium pumpkin cookie, made with vegetable oil 1 cup iced tea, sweetened with sugar Snack 4 saltine crackers, with unsalted tops 3/4 ounce part-skim mozzarella cheese 2 medium dried prunes Step II - 1,800 calories Breakfast 3/4 cup oatmeal, made with skim milk 1 cup skim milk 1 medium English muffin 2 teaspoons tub margarine 2 teaspoons jelly 3/4 cup orange juice 1 cup coffee 2 tablespoons skim milk Lunch 3 ounces baked chicken, without the skin 1 teaspoon vegetable oil Salad 1/2 cup lettuce 1/2 cup tomato 1/2 cup cucumber 2 teaspoons regular oil and vinegar dressing 1/2 cup white rice 1/2 teaspoon tub margarine 1/2 medium biscuit, made with vegetable oil 1 teaspoon tub margarine 1 cup water Dinner 2 ounces lean roast beef 1/4 cup onion 1 tablespoon beef gravy, made with water 1/2 cup turnip greens 1/2 teaspoon tub margarine 1/2 medium mashed sweet potato 1/2 teaspoon brown sugar 1/2 medium slice cornbread, made with tub margarine 1/2 teaspoon tub margarine 1/4 medium honeydew melon 1 medium pumpkin cookie, made with vegetable oil 1 cup iced tea, sweetened with sugar Snack 4 saltine crackers, with unsalted tops 1/2 ounce part skim mozzarella cheese 2 medium dried prunes Note: No salt is used when making the food. Calories 1,823 1,841 Percent calories from fat 30 29 Percent calories from saturated fat 9 7 Cholesterol (milligrams) 191 159 Sodium (milligrams) 1,471 1,492 ____________________________________________________________ Mexican American-Style Foods Step I - 2,500 calories Breakfast 1/2 cup cantaloupe 1 cup farina, made with 1 percent milk 2 slices white bread 2 teaspoons tub margarine 2 teaspoons jelly 3/4 cup orange juice 1 cup hot cocoa, made with 1 percent milk Lunch Beef Enchilada 2 corn tortillas 3 ounces lean roast beef 1 teaspoon vegetable oil 1 ounce low fat cheddar cheese 1/8 cup onion 1/8 cup tomato 1/4 cup lettuce 2 teaspoons chili peppers 3/4 cup refried beans, made with vegetable oil 6 carrot sticks 6 celery sticks 1/2 cup 1 percent milk Dinner Chicken Taco 2 corn tortillas 3 ounces chicken breast without the skin 1 teaspoon vegetable oil 1 ounce low fat cheddar cheese 2 tablespoons guacamole 2 tablespoons salsa 1/2 cup corn 1/2 teaspoon tub margarine 1 cup Spanish rice, made with tub margarine 1 medium banana 1 cup coffee 2 tablespoons 1 percent milk Snack 3/4 cup ice milk Step II - 2,500 calories Breakfast 1/2 cup cantaloupe 1 cup farina, made with skim milk 2 slices white bread 2 teaspoons tub margarine 2 teaspoons jelly 3/4 cup orange juice 1 cup hot cocoa, made with skim milk Lunch Beef Enchilada 2 corn tortillas 2 ounces lean roast beef 1/2 teaspoon vegetable oil 1 ounce low fat cheddar cheese 1/8 cup onion 1/8 cup tomato 1/4 cup lettuce 2 teaspoons chili peppers 3/4 cup refried beans, made with vegetable oil 6 carrot sticks 6 celery sticks 1/2 cup skim milk Dinner Chicken Taco 2 corn tortillas 3 ounces chicken breast without the skin 1/2 teaspoon vegetable oil 1 ounce low fat cheddar cheese 2 tablespoons guacamole 2 tablespoons salsa 1 cup corn 1 teaspoon tub margarine 1 cup Spanish rice, made with tub margarine 1 medium banana 1 cup coffee 2 tablespoons skim milk Snack 3 cups popcorn 1 tablespoon tub margarine Note: No salt is used when making the food. Calories 2,557 2,574 Percent calories from fat 29 28 Percent calories from saturated fat 8 6 Cholesterol (milligrams) 185 136 Sodium (milligrams) 2,100 2,395 ____________________________________________________________ Step I - 1,800 calories Breakfast 1/2 cup cantaloupe 3/4 cup farina, made with 1 percent milk 1 slice white bread 1 teaspoon tub margarine 1 teaspoon jelly 3/4 cup orange juice 3/4 cup hot cocoa, made with 1 percent milk Lunch Beef Enchilada 2 corn tortillas 3 ounces lean roast beef 2/3 teaspoon vegetable oil 1/2 ounce low fat cheddar cheese 1/8 cup onion 1/8 cup tomato 1/4 cup lettuce 2 teaspoons chili peppers 1/2 cup refried beans, made with vegetable oil 4 carrot sticks 4 celery sticks 1/2 cup 1 percent milk Dinner Chicken Taco 1 corn tortilla 3 ounces chicken breast without the skin 2/3 teaspoon vegetable oil 1/2 ounce low fat cheddar cheese 1 tablespoon guacamole 1 tablespoon salsa 1/2 cup corn 1/2 teaspoon tub margarine 1/2 cup Spanish rice, made with tub margarine 1/2 medium banana 1 cup coffee 2 tablespoon 1 percent milk Snack 1/2 cup ice milk Step II - 1,800 calories Breakfast 1/2 cup cantaloupe 3/4 cup farina, made with skim milk 1 slice white bread 1 teaspoon tub margarine 1 teaspoon jelly 3/4 cup orange juice 3/4 cup hot cocoa, made with skim milk Lunch Beef Enchilada 2 corn tortillas 2 ounces lean roast beef 2/3 teaspoon vegetable oil 1/2 ounce low fat cheddar cheese 1/8 cup onion 1/8 cup tomato 1/4 cup lettuce 2 teaspoons chili peppers 2/3 cup refried beans, made with vegetable oil 4 carrot sticks 4 celery sticks 1/2 cup skim milk Dinner Chicken Taco 2 corn tortillas 3 ounces chicken breast without the skin 2/3 teaspoon vegetable oil 1/2 ounce low fat cheddar cheese 1 tablespoon guacamole 1 tablespoon salsa 1/2 cup corn 1/2 teaspoon tub margarine 1/2 cup Spanish rice, made with tub margarine 1 medium banana 1 cup coffee 2 tablespoons skim milk Snack 1 cup popcorn 1 tablespoon tub margarine Note: No salt is used when making the food. Calories 1,852 1,860 Percent calories from fat 29 28 Percent calories from saturated fat 9 6 Cholesterol (milligrams) 169 127 Sodium (milligrams) 1,616 1,787 ____________________________________________________________ Fit Physical Activity Into Your Routine Being physically active helps improve your blood cholesterol levels. It can also help you lose weight, if you are overweight. (See table 13 on page 95 to see how many calories you burn doing different activities.) But you don't have to train like a marathon runner to benefit from physical activity! Any exercise, even if it's done for just a few minutes each day, is better than none at all. You can fit physical activity into your daily routine in small but important ways. (See box below.) And being active together is great for the whole family: take trips that include hiking, swimming, or skiing. Use your backyard or park for basketball, baseball, football, badminton, or volleyball games. Regular, vigorous physical activity - called "aerobic" - is especially good for your heart and can burn off extra calories. In aerobic activity, the body uses oxygen to produce the energy needed for the activity. Some aerobic activities are swimming, brisk walking, running, and jumping rope. This type of activity can condition your heart and lungs if you do it for at least 30 minutes, three to four times a week. But even if you don't have 30 minutes for an activity break, try to find two 15-minute periods or even three 10-minute periods. See table 12 on pages 94 to 95 for a sample walking program to help you get started. See page 56 for other sources of information on physical activity. Be More Active Every Day + Take a walk. + Use the stairs. + Get off the bus one or two stops early and walk the rest of the way. + Park farther away from the store. + Ride a bike. + Work in the yard or garden. + Go dancing. Lose Weight the Sensible Way If you are overweight, losing even a small amount of weight - 5 to 10 pounds - can improve your blood cholesterol levels. But don't go on a crash diet to see how quickly you can lose those pounds. The healthiest and longest- lasting weight loss happens when you take it slowly, losing 1/2 to 1 pound a week. Like a cholesterol-lowering diet, a weight-loss diet is really a new way of eating for life. The eating plans in this booklet easily lend themselves to weight loss because cutting down on fat is a good way to cut down on calories. And you should take care to eat foods high in starch and fiber (like vegetables, fruits, and breads and cereals) instead of high fat foods. Choose low fat and low calorie items from each food group; the food charts in the back of the booklet will help. Finally, in addition to the kinds of foods you eat, you'll have to limit the amount - or serving sizes - as well. But there's more to losing weight than just eating fewer calories. The most successful weight-loss programs seem to be those that combine changes in what you eat and increased physical activity. Combining changes in eating and physical activity leads to greater weight loss than either way achieves alone. When To Play It Safe Most people don't need to see a doctor before they start to be physically active, since a gradual, sensible activity program has few health risks. But you should check with your doctor first if you: + have a medical condition; + have pains or pressure in the chest and shoulder area; + tend to feel dizzy or faint; + get very breathless after mild exertion; or + are middle-aged or older, have not been physically active, and plan a fairly vigorous activity program. Some people lose weight on their own. But others like the support of a structured program. If you are interested in enrolling in a weight-loss program, here are some things you should ask about: + Does the program include working with you to help change your eating, activity, and personal habits? + Is counseling offered? How much? + Is the staff made up of a variety of qualified counselors and health professionals such as nutritionists, registered dietitians, doctors, nurses, psychologists, and exercise physiologists? + Is there training on how to deal with times when you may feel stressed and slip back to your old habits? + Is attention paid to keeping the weight off? How long is this phase? + Are food choices flexible and suitable? Are weight goals set by the client and the health professional? ____________________________________________________________ Quick Check Physical Activity - TRY IT! Check off one of these things to try. Do it today! _____ Instead of using the elevator, I'll try walking up the escalator or even the stairs. _____ I'll take a walk after dinner instead of watching television. _____ I'll choose a parking space at the far end of the lot instead of one closer to the door. ____________________________________________________________ There are some other questions you can ask about how well a program works. You may not get answers, because many programs don't gather this information. But it's still important to ask: + How many people who start the program finish it? + How much weight do people who finish the program lose? + How much weight do people keep off at 1, 3, and even 5 years? + How many people have problems or side effects - and what are they? Remember - quick weight-loss methods don't yield lasting results! Weight-loss methods that rely on diet aids like drinks, prepackaged foods, or diet pills don't work in the long run. Traditional American-Style FoodsWhether you lose weight on your own or with a group, remember that the most important changes are long term. No matter how much weight you have to lose, modest goals and a slow course will increase your chance of both losing the weight and keeping it off. Habits Are Made To Be Broken Here's a good tip to help you control or change your eating habits: Keep track of what you eat, and when you eat by writing it down. Note whether you snack on high fat, high calorie foods in front of the television, or if you skip breakfast and then eat a large lunch. Once you see your habits, you can set goals for yourself: Cut back on TV snacks and, when you do snack, have fresh fruit, unsalted popcorn, or unsalted pretzels. If there's no time for breakfast at home, take a low fat muffin, bagel, or cereal with you to eat at work. Changing your behavior will help you change your weight for the better. Look Here for More Help Designing a new eating plan. If you want more help in planning a Step I or Step II diet, make an appointment with a registered dietitian or other qualified nutritionist. They can help you design an eating plan for your own needs and food likes. The help of a dietitian or qualified nutritionist is especially important if you are following a Step II diet. To find a registered dietitian, contact: + The National Center for Nutrition and Dietetics' Consumer Nutrition Hotline at 1-800-366-1655, + Your local hospital and/or public health department, or + Your doctor. Starting An Activity Program. If you'd like to find out more about how to increase your physical activity, help is only a phone call away. Check your local parks and recreation department or YMCA to locate nearby gyms, parks, walking/biking trails, or exercise classes. Check your local shopping mall too; many malls open early or stay open late for people who want to walk there. Reading More About It. If you would like more written material about cholesterol, healthy eating, and physical activity, write the National Cholesterol Education Program (NCEP) of the National Heart, Lung, and Blood Institute at the address on the next page. In addition to this booklet, the NCEP has developed other publications to help you lower your blood cholesterol. One of these, So You Have High Blood Cholesterol, gives more detailed information on high blood cholesterol and how it affects your health. Other booklets are for children with high blood cholesterol. Another pamphlet, Exercise and Your Heart: A Guide to Physical Activity, tells you more about physical activity and how to get started. To request more information and a catalog of publications, contact: National Cholesterol Education Program NHLBI Information Center P.O. Box 30105 Bethesda, MD 20824-0105 The American Heart Association can also provide you with additional information. Contact your local American Heart Association or call 1-800-AHA-USA1 (1-800-242-8721). Table 1: Meats The foods within each group (beef, lamb, pork, veal) are ranked from low-to-high saturated fat. So, when you are shopping, choose cuts from the upper portion of each group. Some of these cuts may also be labeled "lean" or "extra lean" in the store. Remember to eat no more than 5 to 6 ounces of lean meat a day. And, if you are trying to lose weight, the information on total fat, percent calories from fat, and calories should be helpful. The values listed are for meats with the fat trimmed to 1/4 inch, except where noted. Be sure to trim off any fat before cooking. All meats listed are "choice" grade; "select" grade meats are lower in fat but are not always available. Lastly, all serving sizes shown are the amounts that people typically eat. These are the same serving sizes that are used on food labels. ____________________________________________________________ Product (3 oz. Sat. Chol. Total Cal. Total Sdm. cooked, unless Fat (mgs) Fat* from Cal. (mgs) noted otherwise) (gms) (gms) Fat** (%) ____________________________________________________________ Beef Processed lunch meat, lean roast beef # (2 oz.) 1.2 17 3.0 39 70 440 Processed lunch meat, lean corned beef # (2 oz.) 1.5 29 3.3 37 80 680 Processed lunch meat, lean pastrami # (2 oz.) 1.5 40 3.3 37 80 700 Liver, braised*** 2.2 331 4.2 27 137 59 Eye of round, roasted, 1/8 inch trim 2.9 60 7.7 40 71 52 Top round, broiled, 1/8 inch trim 3.0 73 8.1 39 85 51 Tip round, roasted, 1/8 inch trim 4.0 70 10.6 49 195 54 Meat loaf 4.6 64 11.7 53 197 463 Bottom round, braised, 1/8 inch trim 5.0 82 13.6 53 230 43 Top sirloin, broiled, 1/8 inch trim 5.3 77 13.3 54 222 54 Ground beef, extra lean, broiled medium 6.2 71 13.9 58 217 59 Corned beef, cured, brisket, cooked, 1/4 inch trim 6.3 83 16.1 68 213 964 Link sausage, smoked, beef and pork# 6.4 39 16.6 81 184 517 (about 1 link, each 4 in. long, 1 1/8 in. around) Short loin, top loin, broiled, 1/8 inch trim 6.5 68 16.4 61 243 55 Flank, braised**** 6.7 62 14.0 56 224 60 Short loin, tenderloin, broiled, 1/8 inch trim 6.9 74 17.7 63 253 51 Ground beef, lean, broiled medium 7.0 74 15.7 61 231 65 Bologna# (about 2 slices) 7.2 31 15.6 83 170 536 Frankfurter, cured# 7.2 33 15.6 81 173 562 (about 1 frank, 5 in. long, 7/8 in. around; 8 per 1-lb. package) Salami, cooked 7.2 51 17.1 71 216 984 (3 oz. is about 4 slices, 4 in. around, 1/8 in. thick) Chuck, arm pot roast, braised, 1/8 inch trim 7.5 86 19.3 63 277 52 Ground beef, regular, broiled medium 7.8 76 17.6 64 246 70 Rib eye, small end (ribs 10-12), broiled**** 8.4 70 18.9 65 261 54 Short loin, T-bone steak, broiled, 1/4 inch trim 8.6 70 18.0 64 253 52 Short loin, porterhouse steak, broiled, 1/4 inch trim 8.9 70 18.8 65 260 52 Chuck, blade roast, braised, 1/8 inch trim 9.3 88 23.4 68 308 56 Rib, whole (ribs 6-12), roasted, 1/8 inch trim 10.3 72 25.5 74 313 55 Brisket, whole, braised, 1/4 inch trim 12.1 80 26.8 74 327 52 Rib, short ribs, braised, 1/4 inch trim 16.6 80 35.7 80 400 43 ____________________________________________________________ Lamb (all cuts are trimmed to 1/8 inch fat except ground lamb) Leg, shank, roasted 3.9 77 9.8 47 186 56 Fore shank, braised 4.8 91 11.5 50 208 62 Leg, whole, roasted 5.1 79 12.4 54 207 58 Shoulder, blade, broiled 6.4 81 15.9 62 229 71 Loin, broiled 7.4 85 17.7 63 255 67 Ground lamb, broiled 7.6 82 16.7 63 240 69 Shoulder, arm, braised 7.9 103 19.4 61 289 62 Rib, roasted 10.0 82 23.6 73 292 63 ____________________________________________________________ Pork (fresh unless noted otherwise) (all cuts are trimmed to 1/4 inch fat) Processed lunch meat, lean ham# (2 oz.) 1.1 31 3.3 42 71 680 Ham steak, cured, boneless, extra lean, cooked, cold 1.3 39 3.6 31 105 1080 Canadian-style bacon, grilled# 1.6 32 4.6 41 101 850 (about 2 1/2 slices) Liver, braised*** 1.6 302 3.7 24 141 42 Ham, cured, boneless, extra lean, roasted 1.7 45 4.7 34 123 1023 Loin, tenderloin, roasted 2.2 67 5.1 31 147 47 Ham, cured, boneless, regular, roasted 3.0 50 7.7 46 151 1275 Loin, sirloin (sirloin roasts), boneless, roasted 3.4 73 8.0 41 176 47 Top loin, loin chop, boneless, broiled 3.9 69 9.6 44 195 53 Loin, top loin (loin roasts), boneless, roasted 4.0 66 9.7 46 192 38 Loin, center loin (loin roasts), bone-in, roasted 4.9 68 11.4 52 199 54 Leg (ham), rump half, roasted 4.9 81 12.1 51 214 52 Loin, roasted 5.3 70 12.5 53 211 45 Italian sausage, cooked# 5.5 43 14.1 72 177 504 (about 2/3 link; links packed 4 per pound) Loin, center rib, rib chop, bone-in, broiled 5.5 70 13.2 53 223 53 Bratwurst, cooked# 5.6 33 14.2 78 164 305 (about 2/3 link; links packed 4 per 12-oz. package) Loin, sirloin (sirloin roasts), bone-in, roasted 5.6 74 13.6 55 222 51 Loin, center rib (rib roasts), bone-in, roasted 5.7 62 13.0 54 217 39 Leg (ham), shank half, roasted 6.4 78 17.1 62 246 50 Liver sausage, liverwurst# 6.4 87 15.6 79 178 n/a (about 3 1/4 slices; slice is 2 1/2 in. diameter, 1/4 in. thick) Shoulder, blade, Boston (roasts), roasted 6.6 73 16.0 63 228 57 Smoked link sausage# 6.8 37 17.4 73 213 820 (about 1 link; link is 4 in. long, 1 1/8 in. diameter) Shoulder, cured, arm picnic, roasted 7.1 49 18.2 69 238 912 Ground pork, cooked 7.3 80 17.7 63 252 62 Shoulder, cured, blade roll, roasted 7.9 57 20.0 74 244 827 Ribs, country- style, roasted 8.6 78 21.5 69 279 44 Loin, blade (roasts), bone-in, roasted 8.6 79 20.9 69 275 26 Knockwurst 8.7 48 23.7 82 261 858 Chitterlings, simmered 9.2 122 24.4 85 258 33 Bacon, cooked (broiled, pan fried, or roasted)# 10.6 46 27.0 77 314 872 (about 9 slices) Spareribs, braised 10.6 103 25.8 69 338 79 Salami, dry or hard 11.1 n/a 28.6 75 345 1916 (3 oz. is about 8 1/2 slices; slice is 3 1/8 in. diameter, 1/16 in. thick) ____________________________________________________________ Veal (all cuts are trimmed to 1/4 inch fat) Shoulder, whole (arm and blade), braised 2.7 107 8.6 40 194 80 Ground veal, broiled 3.1 87 6.4 40 146 70 Cutlet (leg, top round), breaded and pan-fried 3.1 95 7.8 36 194 386 Shoulder, blade, roasted 3.4 100 7.4 42 158 85 Shoulder, arm, roasted 3.5 92 7.0 40 156 76 Sirloin, roasted 4.4 87 8.9 47 171 71 Rib roast, lean and fat, roasted 5.4 94 11.9 55 194 78 Venison, roasted 1.1 95 2.7 18 134 46 * Total fat = saturated fat plus monounsaturated fat plus polyunsaturated fat ** Percent calories from fat = (total fat calories/total calories) x 100. Total fat calories = total fat in grams x 9. Each gram of fat equals 9 calories. *** Liver and most organ meats are low in fat but high in cholesterol. **** All fat trimmed. # The typical serving size for most meats is 3 ounces. However, the typical serving size for these marked foods is 55 grams, or about 2 ounces. in. = inch n/a = not available oz. = ounce Sources: Composition of Foods: Beef Products - Raw-Processed-Prepared, Agriculture Handbook 8-13. United States Department of Agriculture, Human Nutrition Information Service, (August 1986; revised May 1990). New beef and lamb nutrient data for cuts trimmed to 1/8 inch external fat. United States Department of Agriculture, Human Nutrition Information Service, unpublished data, 1994. Composition of Foods: Pork Products - Raw-Processed-Prepared, Agriculture Handbook 8-10. United States Department of Agriculture, Human Nutrition Information Service (August 1983; revised December 1992). Composition of Foods: Sausages and Luncheon Meats - Raw-Processed-Prepared, Agriculture Handbook 8-7. United States Department of Agriculture, Human Nutrition Information Service (September 1980; revised 1981 and 1985). Composition of Foods: Lamb, Veal, and Game Products - Raw-Processed-Prepared, Agriculture Handbook 8-17. United States Department of Agriculture, Human Nutrition Information Service (April 1989). Living Heart Brand Food Shopper's Guide-see reference as noted on page 66. Table 2: Poultry The foods within each group (chicken, turkey, and other poultry) are ranked from low-to-high saturated fat. So, when you are shopping, choose cuts from the upper portion of each group. Remember to eat no more that 5 to 6 ounces of lean meat, poultry, fish, or shellfish a day, and to take the skin off of poultry before you cook it. Most poultry, especially without the skin is lower in saturated fat than most cuts of meat. If you are trying to lose weight, the information on calories, total fat, and percent calories from fat should be helpful. All serving sizes shown are the amounts that people typically eat. These are the same serving sizes used on food labels. ____________________________________________________________ Product (3 oz. Sat. Chol. Total Cal. Total Sdm. cooked, unless Fat (mgs) Fat* from Cal. (mgs) noted otherwise) (gms) (gms) Fat** (%) ____________________________________________________________ Chicken Processed lunch meat, lean chicken breast 0.5 30 1.7 25 59 637 (2 oz.) Chicken, roasting, light meat without skin, roasted 1.2 64 3.5 24 130 43 Breast, without skin (3 oz. is about 1/2) 1.2 72 3.0 20 140 63 Chicken roll, light meat, about 2 slices or 2 oz. 1.4 27 4.1 42 87 321 Drumstick, without skin (3 oz. is about 2) 1.6 79 4.8 30 146 81 Breast, with skin (3 oz. is about 1/2) 2.1 71 6.6 35 168 60 Wing, without skin (3 oz. is about 4 wings) 2.3 72 6.9 36 173 78 Chicken, roasting, dark meat without skin, roasted 2.6 63 7.4 44 152 81 Chicken, light meat, with skin, roasted 2.6 71 9.2 44 189 64 Drumstick, with skin (3 oz. is about 1 1/2) 2.9 77 9.5 46 184 77 Leg with skin 3.2 79 11.5 52 199 75 Thigh, without skin (3 oz. is about 1 1/2) 3.2 81 9.3 47 178 75 Chicken hot dog, about 1 3.3 55 10.7 68 142 754 Thigh, with skin (3 oz. is about 1 1/2) 4.1 79 13.2 56 210 71 Wing, with skin (3 oz. is about 2 1/2 wings) 5.1 71 16.6 60 247 70 ____________________________________________________________ Turkey Breast, without skin 0.3 71 0.6 5 115 44 Ground turkey, breast meat only, cooked 0.5 35 2 20 130 55 Processed lunch meat, lean turkey breast# (2 oz.) 0.6 23 1.9 28 61 602 Breast, with skin 0.8 77 2.7 19 130 45 Wing, without skin 1.0 87 2.9 19 139 66 Processed lunch meat, lean turkey ham# (2 oz.) 1.1 34 3.6 43 75 576 Leg, without skin 1.3 101 3.2 21 135 69 Turkey roll, light meat, about 2 slices or 2 oz. 1.4 23 4.0 44 81 269 Leg, with skin 1.4 60 4.6 29 145 68 Wing, with skin 2.3 98 8.4 43 176 62 Ground turkey, meat and skin, cooked 2.9 87 11.2 50 200 90 Turkey bologna, about 2 slices or 2 oz. n/a 54 8.4 69 110 483 Turkey hot dog, about 1 n/a 59 9.7 70 125 785 ____________________________________________________________ Other Duck, domestic, meat only, roasted 4.2 76 9.5 50 171 55 Goose, domestic, meat only, roasted 4.7 82 10.8 48 202 65 * Total fat = saturated fat plus monounsaturated fat plus polyunsaturated fat. ** Percent calories from fat = (total fat calories/total calories) x 100. Total fat calories = total fat in grams x 9. Each gram of fat equals 9 calories. # The typical serving size for most meats and poultry is 3 ounces. However, the typical serving size for these marked foods is 55 grams, or about 2 ounces. n/a = not available oz. = ounce Sources: Composition of Foods: Poultry Products - Raw-Processed-Prepared, Agriculture Handbook 8-15. United States Department of Agriculture, Human Nutrition Information Service (August 1979; 1991 supplement). The Living Heart Brand Name Shopper's Guide. Michael E. DeBakey, Antonio M. Gotto Jr., Lynne W. Scott, John P. Foreyt. Master Media Limited, New York, 1992. Individual manufacturers for items not available from USDA. Table 3: Fish and shellfish This table ranks fish and shellfish from low-to-high saturated fat content. You want to select the lower fat and cholesterol fish and shellfish from the upper portion of the table. Generally fish and shellfish have a lot less saturated fat and cholesterol than meat and poultry. However, some shellfish is relatively high in cholesterol and should be eaten less frequently and in smaller portions. The way the food is cooked can make a difference. In the table below - + dry heat means baked, broiled, or microwaved + moist heat means steamed, poached, or boiled Remember to eat no more that 5 to 6 ounces of lean meat, poultry, fish or shellfish a day. If you are trying to lose weight, the information on calories, total fat, and percent calories from fat should be helpful. All serving sizes shown are the amounts that people typically eat. These are the same serving sizes used on food labels. ____________________________________________________________ Product (3 oz. Sat. Chol. Total Cal. Total Sdm. cooked, unless Fat (mgs) Fat* from Cal. (mgs) noted otherwise) (gms) (gms) Fat** (%) ____________________________________________________________ Finfish Orange roughy, dry heat 0.0 22 0.8 9 75 69 Cod, dry heat 0.1 47 0.7 7 89 66 Haddock, dry heat 0.1 63 0.8 7 95 74 Tuna, light meat, canned water pack, drained 0.2 25 0.7 6 99 287 Surimi, imitation fish and shellfish 0.2 25 0.8 8 84 122 Walleye pollock, dry heat 0.2 82 1.0 9 96 98 Grouper, dry heat 0.3 40 1.1 10 100 45 Snapper, dry heat 0.3 40 1.5 12 109 48 Atlantic ocean perch, dry heat 0.3 46 1.8 16 103 82 Flounder or sole, dry heat 0.3 58 1.3 12 99 89 Whiting, dry heat 0.3 71 1.4 13 98 113 Monkfish, dry heat 0.4 27 1.7 18 82 20 Halibut, dry heat 0.4 35 2.5 19 119 59 Pacific rockfish, dry heat 0.4 38 1.7 15 103 65 Sea bass, dry heat 0.6 45 2.2 19 105 74 Freshwater bass, dry heat*** 0.9 74 4.0 29 124 76 Bluefish, dry heat 1.0 64 4.6 31 135 65 Atlantic salmon, dry heat 1.1 60 6.9 40 155 48 Swordfish, dry heat 1.2 43 4.4 30 132 98 Tuna, light meat, canned in oil, drained 1.3 15 7.0 37 169 301 Sardines, canned in oil, drained 1.3 121 9.7 50 177 430 Sockeye (red) salmon, canned, drained 1.4 37 6.2 43 130 458 Bluefin tuna, fresh, dry heat 1.4 42 5.3 31 157 43 Catfish, dry heat 1.5 54 6.8 48 129 68 Sockeye salmon, dry heat 1.6 74 9.3 46 183 56 Rainbow trout, dry heat 1.8 58 6.1 39 143 36 Anchovy, smoked, canned in oil, drained 1.9 72 8.3 42 179 3120 Herring 2.2 65 9.9 52 172 98 Eel, dry heat 2.6 137 12.7 57 200 55 Mackerel, dry heat 3.6 64 15.1 61 223 71 Pompano, dry heat 3.8 54 10.3 52 179 65 ____________________________________________________________ Shellfish Scallops, dry heat 0.1 47 1.1 8 125 228 Northern lobster, moist heat 0.1 61 0.5 5 83 323 Clams, canned, drained solids 0.2 57 1.7 12 126 95 Clams, moist heat*** 0.2 57 1.7 12 126 95 Blue crab, canned, drained 0.2 76 1.0 11 84 283 Blue crab, moist heat 0.2 85 1.5 16 87 237 Shrimp, moist heat 0.2 167 0.9 10 85 192 Mussel, moist heat 0.7 48 3.8 23 147 313 Oyster, moist heat 1.3 89 4.2 33 116 359 Squid, fried 1.6 221 6.4 38 149 260 * Total fat = saturated fat plus monounsaturated fat plus polyunsaturated fat. ** Percent calories from fat = (total fat calories/total calories) x 100. Total fat calories = total fat grams x 9. Each gram of fat equals 9 calories. *** Dry heat = baked, broiled, or microwaved; Moist heat = steamed, poached, or boiled. Sources: Composition of Foods: Finfish and Shellfish Products - Raw-Processed-Prepared, Agriculture Handbook 8-15. United States Department of Agriculture, Human Nutrition Information Service (revised 1991). Minnesota Nutrition Data System (NDS) software, developed by the Nutrition Coordinating Center, University of Minnesota, Minneapolis, MN. Food Database version 5A; Nutrient Database version 20. Table 4: Dairy and egg foods The dairy and egg products in this table are ranked from low-to-high saturated fat. Choose foods from the upper portion of each group. If you are trying to lose weight, choose dairy foods low in calories, total fat, and percent calories from fat. All serving sizes shown are the amounts that people typically eat or use in recipes. These are the same serving sizes that are used on food labels. ____________________________________________________________ Product Sat. Chol. Total Cal. Total Sdm. Fat (mgs) Fat* from Cal. (mgs) (gms) (gms) Fat** (%) ____________________________________________________________ Milk (1 cup unless noted otherwise) Evaporated skim milk, undiluted, 2 tbsp. 0.0 1 0.1 2 25 37 Skim milk 0.3 4 0.4 4 86 126 Buttermilk 1.3 9 2.2 20 99 257 Evaporated milk, whole, undiluted, 2 tbsp. 1.4 9 2.4 50 42 33 Low fat milk, 1% fat 1.6 10 2.6 22 102 123 Low fat milk, 2% fat 2.9 18 4.7 34 121 122 Whole milk, 3.3% fat 5.1 33 8.2 48 150 120 ____________________________________________________________ Yogurt and sour cream (1 cup unless otherwise noted) Plain yogurt, nonfat 0.3 4 0.4 3 127 174 Yogurt, fruited, low fat 1.6 10 2.5 10 231 133 Plain yogurt, low fat 2.3 14 3.9 21 144 159 Sour cream, imitation, 2 tbsp. 3.0 0 3.3 85 35 17 Sour cream, 2 tbsp. 3.1 10 5.0 87 52 12 Plain yogurt, whole milk 4.8 29 7.4 47 139 105 ____________________________________________________________ Cheese (1 ounce unless noted otherwise) Pot cheese or uncreamed dry curd cottage cheese, 1/3 cup 0.1 3 0.2 4 41 189 Fat free, low- cholesterol imitation cheese 0.2 1 0.3 6 41 439 Cottage cheese, low fat (1%), 1/2 cup 0.7 5 1.2 13 82 459 Romano, grated, 1 tbsp. 0.9 5 1.3 63 19 60 Parmesan, grated, 1 tbsp. 1.0 4 1.5 59 23 93 Farmer cheese, soft, 1/4 cup 1.4 8 2.1 43 45 120 Swiss cheese, reduced fat 2.5 9 4.0 52 70 35 Reduced fat and low sodium cheese - American, cheddar, colby, monterey jack, muenster, or provolone*** 2.7 18 4.3 54 71 88 Mozzarella, part-skim 2.9 16 4.5 55 72 132 Reduced fat cheese - American, cheddar, colby, monterey jack, muenster, provolone, or string cheese*** 3.1 15 4.9 55 79 150 Ricotta, part-skim (1/4 cup) 3.1 19 4.9 52 86 78 Cottage cheese, creamed, 1/2 cup 3.2 17 5.1 38 117 457 Cream cheese, light, 2 Tbsp. 3.5 18 5.5 75 65 166 Mozzarella 3.7 22 6.1 69 80 106 American processed cheese spread, pasteurized 3.8 16 6.0 66 82 381 Feta 4.2 25 6.0 72 75 316 Neufchatel 4.2 22 6.6 81 74 113 Camembert 4.3 20 6.9 73 85 239 American processed cheese food, pasteurized 4.4 18 7.0 68 93 337 Provolone 4.8 20 7.6 68 100 248 Limburger 4.8 26 7.7 75 93 227 Brie 4.9 28 7.9 74 95 178 Edam 5.0 25 7.9 70 101 274 Swiss 5.0 26 7.8 65 107 74 Gouda 5.0 32 7.8 69 101 232 Ricotta, whole milk, 1/4 cup 5.2 32 8.1 67 108 52 Blue 5.3 21 8.2 73 100 396 Brick 5.3 27 8.4 72 105 159 Muenster 5.4 27 8.5 74 104 178 Gruyere 5.4 31 9.2 71 117 95 Monterey Jack 5.5 25 8.6 73 106 152 Roquefort 5.5 26 8.7 75 105 513 American processed cheese, pasteurized 5.6 27 8.9 75 106 406 Colby 5.7 27 9.1 73 112 171 Cheddar 6.0 30 9.4 74 114 176 Cream cheese, 2 tbsp. 6.4 32 10.1 90 101 86 ____________________________________________________________ Eggs and egg substitutes Egg white 0 0 0 0 17 55 Egg substitute, frozen, 1/4 cup 1.2 1 6.7 63 96 120 Whole egg, large 1.6 213 5.0 60 75 63 Egg yolk 1.6 213 5.1 78 59 7 * Total fat = saturated fat plus monounsaturated fat plus polyunsaturated fat. ** Percent calories from fat = (total fat calories/total calories) x 100. Total fat calories = total fat grams x 9. Each gram of fat equals 9 calories. *** The nutrient values shown for these cheeses are averages of the different types and brands. tbsp. = tablespoon Sources: Composition of Foods: Dairy and Egg Products - Raw-Processed-Prepared, Agriculture Handbook 8-1, United States Department of Agriculture, Agricultural Research Service (November 1976 and 1989-1991 supplements). Minnesota Nutrition Data System (NDS) software, developed by the Nutrition Coordinating Center, University of Minnesota, Minneapolis, MN. Food Database version 5A; Nutrient Database version 20. Table 5: Fats and oils This table lists fats and oils from low-to-high saturated fat. When you use fats, choose those from the upper portion of the table. Remember to limit the total amount of fat and oil you use, especially if you are trying to lose weight. Oils are high in calories - about 120 calories per tablespoon - and have little or no sodium. The serving size shown (1 Tbsp.) is the amount people typically eat and the amount shown on food labels. Regular margarines and butter are also high in calories - about 100 calories in a tablespoon. Check the label for the amount of sodium. If you are cutting back on sodium, look for unsalted and low sodium kinds. ____________________________________________________________ Product Sat. Chol. Poly- Mono- Fat (mgs) unsat. unsat. (gms) Fat Fat (gms) (gms) ____________________________________________________________ Margarine, diet 1.0 0 2.0 2.6 Canola oil 1.0 0 4.3 8.6 Safflower oil 1.2 0 10.6 1.7 Sunflower oil 1.5 0 5.7 6.5 Corn oil 1.8 0 8.4 3.5 Olive oil 1.9 0 1.1 10.4 Margarine, soft, tub 1.9 0 5.0 4.1 Margarine, liquid, bottled 1.9 0 5.3 4.1 Sesame oil 2.0 0 5.9 5.6 Soybean oil 2.1 0 8.3 3.3 Margarine, stick 2.2 0 3.8 5.3 Peanut oil 2.4 0 4.5 6.5 Shortening 3.3 0 3.5 6.0 Cottonseed oil 3.7 0 7.4 2.5 Lard 5.2 12 1.5 6.1 Beef tallow* 6.7 14 0.5 5.5 Butter 6.8 28 0.5 3.3 Palm oil* 7.0 0 1.4 5.2 Cocoa butter* 8.5 0 0.4 4.7 Palm kernel oil* 11.7 0 0.2 1.7 Coconut oil* 12.5 0 0.2 0.8 * These fats and oils are used in commercially prepared goods. They are included in this list for comparison purposes. Source: Composition of Foods: Fats and Oils - Raw-Processed-Prepared, Agriculture Handbook 8-4, United States Department of Agriculture, (June 1979, revised 1990). Table 6: Nuts and seeds This table ranks nuts and seeds from low-to-high saturated fat. Most nuts and seeds have little saturated fat, but all except chestnuts are high in total fat and calories. If you are trying to lose weight, limit your use of nuts and seeds. And if you are watching your sodium intake, choose unsalted types. ____________________________________________________________ Product (1 oz. Sat. Chol. Total Cal. Total Sdm. cooked, unless Fat (mgs) Fat* from Cal. (mgs) noted otherwise) (gms) (gms) Fat** (%) ____________________________________________________________ Nuts and seeds (all are unsalted unless noted otherwise.) European chestnuts 0.2 0 1.1 9 105 11 Filberts or hazelnuts 1.3 0 17.8 89 179 1 Almonds 1.4 0 14.8 80 167 3 Sunflower seed kernels, roasted 1.5 0 14.1 77 165 1 Sunflower seed kernels, roasted and salted 1.5 0 16.3 84 175 171 Pecans 1.5 0 19.2 91 190 0 English walnuts 1.6 0 17.6 87 182 3 Pistachio nuts 1.7 0 13.7 75 164 2 Sesame seeds, roasted 1.9 0 13.6 76 161 3 Peanuts 1.9 0 13.8 73 159 5 Peanuts, dry roasted and salted 1.9 0 13.9 71 164 228 Pistachio nuts, roasted and salted 1.9 0 15.0 78 172 222 Hickory nuts 2.0 0 18.3 88 187 0 Pine nuts, pignolia 2.2 0 14.4 80 161 1 Pumpkin and squash seed kernels 2.5 0 13.0 76 154 5 Cashew nuts, roasted 2.6 0 13.7 76 163 5 Cashew nuts, roasted and salted 2.7 0 13.7 76 163 178 Macadamia nuts 3.1 0 20.9 95 199 1 Peanut butter, smooth, made with added salt, 2 tbsp. 3.3 0 16.3 72 190 149 Brazil nuts 4.6 0 18.8 91 186 0 Coconut meat, unsweetened 8.4 0 9.5 85 101 6 * For most nuts, 1 ounce is about 1/4 cup. ** Total fat = saturated fat plus monounsaturated fat plus polyunsaturated fat. *** Percent calories from fat = (total fat calories/total calories) x 100. Total fat calories = total fat grams x 9. Source: Composition of Foods: Legumes and Legume Products - Raw-Processed-Prepared, Agriculture Handbook 8-16. United States Department of Agriculture, Human Nutrition Information Service (December 1986). Composition of Foods: Nut and Seed Products - Raw-Processed-Prepared, Agriculture Handbook 8-12. United States Department of Agriculture, Human Nutrition Information Service (September 1984; 1986 supplement). Table 7: Breads, cereals, pasta, rice and other grains, and dry peas and beans Each category in the breads group (breads, cereals, pasta, rice, other grains, and dry peas and beans) is ranked from low-to-high in saturated fat content. When cutting back on foods higher in saturated fat and cholesterol, substitute foods from this group that are in the upper portion of each category. All cooked grains, cereals, pasta, and legumes are cooked without added salt. If you need to cut back on the amount of sodium you eat, select foods from this group that are also lower in sodium. Rinsing canned beans and peas with water will reduce the sodium content. ____________________________________________________________ Product Sat. Chol. Total Cal. Total Sdm. serving Fat (mgs) Fat* from Cal. (mgs) (gms) (gms) Fat** (%) ____________________________________________________________ Breads Corn tortilla, 1 (6-7 in. around) 0.1 0 0.6 10 56 40 Pita, white, 1 (6 1/2 in. around) 0.1 0 0.7 4 165 322 English muffin, 1 muffin 0.1 0 1.0 7 134 265 White bread, 1 slice 0.2 0 0.9 12 67 135 Bagel, plain, 1 (3 1/2 in.) 0.2 0 1.1 6 195 379 Rye bread, 1 slice (5 x 4 x 1/2 in.) 0.2 0 1.1 12 83 211 Pancake, prepared from mix, 1 (4 in.) 0.2 12 1.0 12 74 239 Biscuit, baked from refrigerated dough, lower fat (2 1/4 in. around) 0.3 0 1.1 16 63 305 Whole wheat bread, 1 slice 0.3 0 1.2 15 70 149 Taco shell, baked, 1 (5 in. around) 0.4 0 2.9 43 61 48 Rolls, hamburger or hotdog, plain, 1 0.5 0 2.2 16 123 241 Waffles, plain or buttermilk, frozen, toasted, 1 (4 in. square) 0.5 7 2.7 28 87 260 Biscuit, baked from refrigerated dough, higher fat, 1 (2 1/2 in. around) 1.0 0 4.0 39 93 324 Bran muffin, prepared from mix, 1 (2 1/4 in. around) 1.2 34 4.6 30 138 233 Corn muffin, from mix, 1 (2 1/4 in. around) 1.4 31 5.1 29 160 397 Croissant, butter, 1 medium (4 1/2 x 4 x 1 3/4 in.) 6.7 0 12.0 47 232 424 ____________________________________________________________ Crackers Rye crispbread, 1 1/2 wafer 0 0 0.2 3 56 39 Melba toast, 3 rectangles 0.1 0 0.6 9 57 123 Breadstick, 1 1/2 medium (7 5/8 x 5/8 in.) 0.2 0 1.5 22 62 99 Saltine or soda cracker, 5 0.3 0 2.0 28 65 195 Graham cracker, 2 (2 1/2 in. square) 0.4 0 1.4 21 60 84 Wheat cracker, 15 thin squares 1.1 0 6.0 40 135 240 ____________________________________________________________ Cereals Grits, quick, cooked without salt, 1 cup 0.1 0 0.5 3 146 0 Oatmeal, instant, 1 packet = 3/4 cup 0.3 0 1.7 15 108 180 Oatmeal, quick, cooked without salt, 1 cup 0.4 0 2.4 15 145 1 Corn flakes, 1 cup n/a 0 0.2 4 98 240 Cream of wheat, cooked without salt, 1 cup n/a 0 0.5 3 134 2 40% bran flakes, 1 cup n/a 0 0.8 12 128 364 Granola, 1/2 cup 2.9 0 16.6 50 298 6 100% natural cereal with raisins and dates, 1/2 cup 6.8 0 10.2 37 248 24 ____________________________________________________________ Pasta (1 cup cooked) Spaghetti or macaroni+ 0.1 0 0.9 4 197 1 Egg noodles+ 0.5 53 2.4 10 212 11 Chow mein noodles, canned 2.0 0 13.8 52 237 197 ____________________________________________________________ Rice and other grains (1 cup cooked) Bulgur+ 0.1 0 0.4 3 152 9 White rice+ 0.1 0 0.4 2 205 1 Barley+ 0.1 0 0.7 3 193 5 Brown rice+ 0.4 0 1.8 7 216 9 ____________________________________________________________ Dry peas and beans (1/2 cup cooked) Kidney beans, canned, solids & liquid 0.1 0 0.4 3 104 445# Lima beans 0.1 0 0.4 3 108 2 Kidney beans 0.1 0 0.4 3 112 2 Lentils 0.1 0 0.4 3 115 2 Split peas 0.1 0 0.4 3 116 2 Pinto beans, canned, solids & liquid 0.1 0 0.4 4 93 499# Black beans 0.1 0 0.4 4 113 1 Navy beans, canned, solids & liquid 0.1 0 0.6 3 148 587# Baked beans, canned, plain or vegetarian 0.1 0 0.6 4 118 504 Garbanzo beans/ chickpeas, canned, solids & liquid 0.1 0 1.4 9 143 359# Black-eyed peas, canned, solids & liquid 0.2 0 0.7 6 92 359# * Total fat = saturated fat plus monounsaturated fat plus polyunsaturated fat. ** Percent calories from fat = (total fat calories/total calories) x 100. Total fat calories = total fat grams x 9. # Rinsing canned beans and peas with water will reduce the sodium content. + Cooked without salt. n/a = not available Sources: Composition of Foods: Breakfast Cereals - Raw-Processed-Prepared, Agriculture Handbook 8-8, United States Department of Agriculture, Human Nutrition Information Service (revised July 1982; 1989 supplement). Composition of Foods: Legumes and Legume Products - Raw-Processed-Prepared, Agriculture Handbook 8-16, United States Department of Agriculture, Human Nutrition Information Service (revised December 1986). Composition of Foods: Baked Products - Raw-Processed-Prepared, Agriculture Handbook 8-18, United States Department of Agriculture, Human Nutrition Information Service (revised August 1992). Composition of Foods: Cereal Grains and Pasta - Raw-Processed-Prepared, Agriculture Handbook 8-20, United States Department of Agriculture, Human Nutrition Information Service (revised October 1989). Table 8: Sweets and snacks This table ranks sweets and snacks from low-to-high saturated fat. To reduce saturated fat choose the sweets and snacks from the upper portion of each category. Note that some low-fat frozen desserts still are high in calories because they are high in sugar. If you are trying to lose weight, choose those foods that are low in both fat and calories. The serving sizes shown are what people typically eat. These are the same serving sizes that are used on food labels. ____________________________________________________________ Product Sat. Chol. Total Cal. Total Sdm. Fat (mgs) Fat* from Cal. (mgs) (gms) (gms) Fat** (%) ____________________________________________________________ Beverages Club soda, salt free, 12 oz. can 0 0 0 0 0 0 Ginger ale, 12 oz. can 0 0 0 0 124 25 Lemonade, 1 cup 0 0 0.1 1 100 8 Cola, 12 oz. can 0 0 0.1 1 151 14 Chocolate shake, 10 oz. 6.5 37 10.5 26 360 273 ____________________________________________________________ Cakes, doughnuts, muffins, and pies Angel food cake, purchased, 1/12 of 9 in. cake 0 0 0.2 2 73 212 Blueberry muffin, purchased, 1 (2 1/2 in. around) 0.7 17 3.7 21 158 255 Coffee cake, cinnamon with crumb topping, from mix, 1/8 of 8 x 5 3/4 in. cake 1.0 28 5.4 27 178 236 Wheat Bran muffin, from mix, 1 (2 1/4 in. around) 1.2 34 4.6 30 138 233 Gingerbread, from mix, 1/9 of 9 in. square cake 1.7 24 6.8 30 207 307 Cake doughnut, plain, 1 medium 1.8 18 10.8 49 198 257 Lemon meringue pie, purchased, 1/6 of 8 in. pie 1.8 51 9.8 29 303 165 Pumpkin pie, purchased, 1/6 of 8 in. pie 2.2 22 10.4 41 229 308 Boston cream pie, purchased, 1/6 of 19.5 oz. pie 2.3 34 7.8 30 232 132 Apple pie, double crust, purchased, 1/8 of 9 in. pie 2.6 0 13.8 42 297 333 Chocolate cake with chocolate frosting, purchased, 1/8 of 18 oz. cake 3.0 29 10.5 40 235 213 Yellow cake with chocolate icing, purchased, 1/8 of 18 oz. cake 3.0 35 11.2 42 242 216 Pound cake, purchased, 1/10 of 10.75 oz. cake 3.4 66 6.0 46 117 119 Cheesecake, purchased, 1/6 of 17 oz. cake 9.2 44 18.0 63 256 165 ____________________________________________________________ Candy (1 ounce piece) Hard candy 0 0 0 0 106 11 Jelly beans (1 oz. is 10 large) 0 0 0.1 1 104 7 Chocolate fudge 1.5 4 2.4 20 108 18 Milk chocolate bar 5.2 6 8.7 54 145 23 ____________________________________________________________ Cookies and bars Ginger snap, 1 (about 1/4 oz.) 0.1 0 0.7 22 29 46 Vanilla wafer, 1 0.1 2 0.6 30 18 12 Fig bar, 1 (about 1/2 oz.) 0.2 0 1.2 19 56 56 Chocolate chip cookie, lower fat, 1 (2 1/4 in. around) 0.4 0 1.5 30 45 38 Oatmeal cookie, 1 (about 2/3 oz.) 0.6 0 3.3 37 81 69 Granola bar, plain, 1 oz. bar 0.7 0 5.6 38 134 83 Chocolate chip cookie, 1 (2 1/4 in.around) 0.8 0 2.3 43 48 32 Chocolate brownie from mix, 1 (about 2 in. square) 1.3 9 6.6 43 139 83 ____________________________________________________________ Frozen desserts (1/2 cup, unless otherwise noted) Ice pop or fruit juice bar, 1 pop or bar 0 0 0 0 55 9 Fruit ice/Italian ice 0 0 0 0 124 0 Sorbet, lemon 0.1 0 0.3 2 125 18 Frozen fudge bar, 1 bar 0.1 1 0.2 2 98 124 Frozen yogurt, fruit or vanilla, nonfat 0.1 2 0.2 2 82 39 Frozen yogurt, fruit or vanilla, lowfat 0.7 4 1.1 10 99 57 Frozen dairy dessert (less than 3% fat) 0.9 4 1.4 11 116 25 Sherbet, orange 1.1 5 1.9 13 132 44 Ice milk, vanilla, soft serve 1.5 10 2.3 19 111 62 Ice milk, vanilla, hard 1.8 9 2.8 27 92 56 Frozen yogurt, whole milk, fruit or vanilla 2.1 10 3.2 25 115 55 Pudding pop, chocolate, 1 pop 2.5 1 2.2 28 72 77 Ice cream, vanilla, regular 4.5 29 7.3 50 132 53 Ice cream, french vanilla, soft serve 6.4 78 11.2 54 185 52 Ice cream, vanilla, rich, 16% fat 7.4 45 12.0 61 178 41 Ice cream, chocolate, premium, 23% fat 9.1 98 15.3 64 216 33 ____________________________________________________________ Gelatin and pudding Gelatin, made with water, 1/2 cup 0 0 0 0 80 57 Chocolate pudding, ready to eat (5 oz. package) 1.0 5 5.7 27 189 183 ____________________________________________________________ Snacks (1 ounce) Pretzels, salted (1 oz. is about 5 twists, 3 1/4 x 2 1/4 x 1/4 in.) 0.2 0 1.0 8 108 486 Popcorn, air popped without salt (1 oz. is about 3 1/2 cups) 0.2 0 1.2 10 108 1 Tortilla chips, lower fat (light) nacho flavor 0.8 1 4.3 31 126 284 Corn chips 1.3 0 9.5 56 153 179 Popcorn, popped with oil and salt*** (1 oz. is about 2 1/2 cups) 1.4 0 8.0 51 142 251 Tortilla chips, nacho flavor 1.4 1 7.3 47 141 201 Trail mix**** (1 oz. is about 1/5 cup) 1.6 0 8.3 57 131 65 Potato chips 3.1 0 9.8 58 152 168 ____________________________________________________________ Other Jams & preserves, 1 tbsp. 0 0 0 0 48 8 Chocolate syrup, thin, 2 tbsp. 0.2 0 0.3 3 82 36 * Total fat = saturated fat plus monounsaturated fat plus polyunsaturated fat. ** Percent calories from fat = (total fat calories/total calories) x 100. Total fat calories = total fat grams x 9. Each gram of fat equals 9 calories. *** Includes microwave popcorn. **** Made with raisins, oil-roasted peanuts, dried sunflower seeds, dates, oil-roasted cashews, oil-roasted almonds, dried coconut, and oil-roasted pumpkin seeds. oz. = ounce tbsp. = tablespoon Sources: Composition of Foods: Dairy and Egg Products - Raw-Processed-Prepared, Agriculture Handbook 8-1, United States Department of Agriculture, Agricultural Research Service (November 1976 and 1989-1991 supplements). Composition of Foods: Baked Products - Raw-Processed-Prepared, Agriculture Handbook 8-18, United States Department of Agriculture, Human Nutrition Information Service (revised August 1992). Composition of Foods: Snacks and Sweets - Raw-Processed-Prepared, Agriculture Handbook 8-19, United States Department of Agriculture, Human Nutrition Information Service (revised August 1991). Composition of Foods: Fast Foods - Raw-Processed-Prepared, Agriculture Handbook 8-21, United States Department of Agriculture, Human Nutrition Information Service (revised September 1988). Minnesota Nutrition Data System (NDS) software, developed by the Nutrition Coordinating Center, University of Minnesota, Minneapolis, MN. Food Database version 5A; Nutrient Database version 20. Table 9: Miscellaneous This table ranks gravies, sauces, salad dressings, and other high fat foods according to saturated fat content. Choose foods in the upper portion of each category. Generally these foods are extras, high in fat and sodium. For taste, choose smaller portion sizes, especially if you are trying to lose weight or cutting back on sodium. The serving sizes listed are typically what people eat. These are the same serving sizes that are used on food labels. ____________________________________________________________ Product Sat. Chol. Total Cal. Total Sdm. (serving) Fat (mgs) Fat* from Cal. (mgs) (gms) (gms) Fat** (%) ____________________________________________________________ Gravies (1/4 cup) Au jus, canned 0.1 0 0.1 11 10 n/a Turkey gravy, canned 0.4 1 1.2 29 31 n/a Beef gravy, canned 0.7 2 1.4 40 31 326 Chicken gravy, canned 0.8 1 3.4 65 47 344 ____________________________________________________________ Sauces Sweet and sour sauce, 2 tbsp. 0 0 0 0 28 75 Salsa, 2 tbsp. 0 0 0.1 6 7 84 Barbecue sauce, commercial, 2 tbsp. 0.1 0 0.6 23 24 255 Spaghetti sauce, without meat, 1/2 cup 0.8 0 5.9 75 136 618 White sauce, 1/4 cup 1.4 5 4.2 50 66 205 Tartar sauce, 2 tbsp. 2.2 11 14.9 91 148 205 Cheese sauce, 1/4 cup 4.9 23 9.1 67 120 299 Hollandaise sauce, 2 tbsp. 5.2 24 8.5 87 88 142 Bernaise, made with milk & butter, 1/4 cup 10.4 47 17.1 88 175 316 ____________________________________________________________ Salad dressings (2 tablespoons) Russian, low calorie 0.2 2 1.4 27 46 52 French, low calorie 0.2 2 1.8 37 44 256 Mayonnaise, nonfat, imitation, 1 tbsp. 0.2 3 0.7 27 23 111 Italian, low calorie 0.4 2 3 84 32 236 Thousand Island, low calorie 0.4 4 3.2 60 48 306 Mayonnaise, 1 tbsp. 1.6 8 11.0 100 99 78 Thousand Island 1.8 0 11.2 85 118 218 Italian 2.0 0 14.2 92 138 232 Russian 2.2 0 15.6 92 152 266 French 3 0 12.8 86 134 428 Oil & vinegar, homemade 3 0 16 100 144 0 Blue cheese 3 6 16 93 154 143 ____________________________________________________________ Other Green olives, 4 small 0.2 0 1.4 76 16 72 Olives, ripe, large 0.2 0 1.9 85 20 152 Avocado, 1 ripe 5.3 0 27.0 72 339 14 * Total fat = saturated fat plus monounsaturated fat plus polyunsaturated fat. ** Percent calories from fat = (total fat calories/total calories) x 100. Total fat calories = total fat grams x 9. Each gram of fat equals 9 calories. tbsp. = tablespoon Sources: Composition of Foods: Soups, Sauce, and Gravies - Raw-Processed-Prepared, Agriculture Handbook 8-6, United States Department of Agriculture, Human Nutrition Information Service (revised 1991). Minnesota Nutrition Data System (NDS) software, developed by the Nutrition Coordinating Center, University of Minnesota, Minneapolis, MN. Food Database version 5A; Nutrient Database version 20. Table 10: Fast foods The food items listed here that are served at fast food restaurants (entrees, side orders, and breakfast items) are ranked according to saturated fat. Choose foods in the upper portion of each group. All serving sizes shown are the amounts that are typically served. ____________________________________________________________ Product Sat. Chol. Total Cal. Total Sdm. Fat (mgs) Fat* from Cal. (mgs) (gms) (gms) Fat** (%) ____________________________________________________________ Entrees Grilled chicken breast sandwich, plain 1 60 7 22 288 758 Cheese pizza, 1/8 of 12 in. pizza 1.5 9 3.2 21 140 336 Chili con carne, 1 cup 3.4 133 8.3 29 254 1008 Roast beef sandwich, plain 3.6 52 13.8 36 346 792 Lower-fat hamburger, plain 4.0 60 10.0 28 320 670 Hamburger, plain 4.1 36 11.8 39 275 387 Hot dog 5.1 44 14.5 54 242 671 Fish sandwich with tartar sauce 5.2 55 22.8 48 431 615 Chicken, breaded & fried, boneless pieces, 6 5.5 62 17.7 55 290 542 Taco salad with chili, 1 1/2 cup 6.0 4 13.1 41 288 886 Cheeseburger, plain, single patty 6.5 50 15.2 43 320 500 Burrito with beans & cheese, 2 6.8 27 11.7 28 377 1166 Sub sandwich with cold cuts (cheese, salami, ham) 6.8 35 18.6 37 456 1650 Chicken fillet sandwich, plain 8.5 60 29.5 51 515 957 Baked potato, with cheese sauce and chili 13.0 31 21.9 41 481 701 Cheeseburger, large, double patty with condiments 17.7 141 44.0 56 706 1149 ____________________________________________________________ Side orders Tossed salad, no dressing, 1 1/2 cup 0 0 0.2 5 32 53 French fries, regular order 3.8 0 12.0 47 235 124 ____________________________________________________________ Breakfast items English muffin with butter 2.4 13 5.8 27 189 386 Scrambled eggs, 2 5.8 400 15.2 68 200 211 Pancakes with butter and syrup, 3 5.9 57 14.0 24 519 1103 Egg & bacon biscuit, 1 9.9 353 31.1 61 457 999 Egg, cheese, & bacon biscuit, 1 11.4 261 31.4 59 4771261 ____________________________________________________________ Beverages Low calorie cola, 12 oz. 0 0 0 0 2 21 Cola, 12 oz. 0 0 0 0 151 14 Milk, 2%, 1 cup 2.9 18 4.7 34 121 122 Chocolate shake, 10 oz. 6.5 37 10.5 26 360 273 * Total fat = saturated fat plus monounsaturated fat plus polyunsaturated fat. ** Percent calories from fat = (total fat calories/total calories) x 100. Total fat calories = total fat grams x 9. Each gram of fat equals 9 calories. oz. = ounce Source: Composition of Foods: Fast Foods - Raw-Processed-Prepared, Agriculture Handbook 8-21, United States Department of Agriculture, Human Nutrition Information Service (revised September 1988). Individual manufacturers for items not available from USDA. Table 11: Serving sizes for meat and cheese (Graphic of thickness of meat omitted) This thick (Graphic of meat piece omitted) One piece of cooked roast beef or steak this size weighs 3 ounces. (Graphic of thickness of hamburger omitted) This thick in the middle (Graphic of hamburger omitted) One cooked hamburger this size weighs 3 ounces. (Graphic of 1 oz. piece of cheese sliced 1/8" thick omitted) This is the size of one ounce of cheese, sliced 1/8 inch thick. (Graphic of 1 oz. piece of cheese sliced 1/4" thick omitted) This is the size of one ounce of cheese, sliced 1/4 inch thick. Table 12: A sample walking program ____________________________________________________________ Warm up Target zone* Cool down Total exercising time ____________________________________________________________ Week 1 Session A Walk Then walk Then walk 15 min. 5 min. briskly 5 normally 5 min. 5 min. Session B Repeat above pattern Session C Repeat above pattern Continue with at least three exercise sessions during each week of the program. If you find a particular week's pattern tiring, repeat it before going on to the next pattern. You do not have to complete the walking program in 12 weeks. Week 2 Walk 5 min. Walk briskly Walk 5 min. 17 min. 7 min. Week 3 Walk 5 min. Walk briskly Walk 5 min. 19 min. 9 min. Week 4 Walk 5 min. Walk briskly Walk 5 min. 21 min. 11 min. Week 5 Walk 5 min. Walk briskly Walk 5 min. 23 min. 13 min. Week 6 Walk 5 min. Walk briskly Walk 5 min. 25 min. 15 min. Week 7 Walk 5 min. Walk briskly Walk 5 min. 28 min. 18 min. Week 8 Walk 5 min. Walk briskly Walk 5 min. 30 min. 20 min. Week 9 Walk 5 min. Walk briskly Walk 5 min. 33 min. 23 min. Week 10 Walk 5 min. Walk briskly Walk 5 min. 36 min. 26 min. Week 11 Walk 5 min. Walk briskly Walk 5 min. 38 min. 28 min. Week 12 Walk 5 min. Walk briskly Walk 5 min. 0 min. 30 min. Week 13 on: Check your pulse periodically to see if you are within your target zone. As you get more in shape, try to be within the upper range of your target zone. Gradually increase your brisk walking time to 30 to 60 minutes, three or four times a week. Remember that your goal is to get the benefits you are seeking and enjoy your activity. * Here's how to check if you are within your target heart rate zone: 1. Right after you stop moving, take your pulse: Place the tips of your first two fingers lightly over one of the blood vessels on your neck, just to the left or right of your Adam's apple. Or try the pulse spot inside your wrist just below the base of your thumb. 2. Count your pulse for 10 seconds and multiply the number by 6. 3. Compare the number to the right grouping below: Look for the age grouping that is closest to your age and read the line across. For example, if you are 43, the closest age on the chart is 45; the target zone is 88-131 beats per minute. Age Target Heart Rate Zone 20 years 100-150 beats per minute 25 years 98-146 beats per minute 30 years 95-142 beats per minute 35 years 93-138 beats per minute 40 years 90-135 beats per minute 45 years 88-131 beats per minute 50 years 85-127 beats per minute 55 years 83-123 beats per minute 60 years 80-120 beats per minute 65 years 78-116 beats per minute 70 years 75-113 beats per minute Table 13: Calories burned during physical activities ___________________________________________________________ Activity Calories Burned Per Hour ___________________________________________________________ Bicycling, 6 mph 240 Bicycling, 12 mph 410 Cross-country skiing 700 Jogging, 5 1/2 mph 740 Jogging, 7 mph 920 Jumping rope 750 Running in place 650 Running, 10 mph 1,280 Swimming, 25 yds/min. 275 Swimming, 50 yds/min. 500 Tennis-singles 400 Walking, 2 mph 240 Walking, 3 mph 320 Walking, 4 1/2 mph 440 min. = minutes yds. = yards mph = miles per hour *Note: These figures are for a 150-pound person. The amount of calories you burn up depends on how much you weigh. The more you weigh, the more calories you burn. For example, a 100-pound person burns only 0.67 times the calories of a 150-pound person (100/150=0.67). So, to find the number of calories a 100-pound person burns in an activity, multiply the number of calories in the chart by 0.67. For a 200- pound person, multiply by 1.3. To find the number of calories you burn up in any activity, divide your weight by 150 and multiply the number of calories in the chart by that number. Source: Exercise and Your Heart - A Guide to Physical Activity, National Heart, Lung, and Blood Institute/American Heart Association, DHHS, PHS, NIH Publication No. 93-1677. Table 14: The low-down on food label claims Here are the main label claims used on food packages - and what they mean: + Saturated Fat * Saturated fat free: Less than 1/2 gram saturated fat in a serving; levels of trans fatty acids must be 1 percent or less of total fat. ** Low saturated fat: 1 gram saturated fat or less in a serving and 15 percent or less of calories. For a meal or main dish (like a frozen dinner): 1 gram saturated fat or less in 100 grams of food and less than 10 percent of calories from saturated fat. + Cholesterol * Cholesterol free: Less than 2 milligrams (mg) cholesterol in a serving; saturated fat content must be 2 grams or less in a serving. ** Low cholesterol: 20 mg cholesterol or less in a serving; saturated fat content must be 2 grams or less in a serving. For a meal or main dish: 20 mg cholesterol or less in 100 grams of food, with saturated fat content less than 2 grams in 100 grams of food. + Fat * Fat free: Less than 1/2 gram fat in a serving. ** Low fat: 3 grams total fat or less in a serving. For a meal or main dish: 3 grams total fat or less in 100 grams of food and not more than 30 percent calories from fat. Percent fat free - A food with this claim must also meet the low fat claim. + Calories * Calorie free: Less than 5 calories in a serving. ** Low calorie: 40 calories or less in a serving. + Sodium * Sodium free: Less than 5 mg sodium in a serving. ** Low sodium: 140 mg sodium or less in a serving. For a meal or main dish: 140 mg sodium or less in 100 grams of food. Very low sodium: 35 mg sodium or less in a serving. * Words that mean the same thing as "free": "no," "zero," "without," "trivial source of," "negligible source of," and "dietarily insignificant source of." ** Words that mean the same thing as low: "contains a small amount of " and "low source of." + Light A product has been changed to have half the fat or one-third fewer calories than the regular product; or the sodium in a low calorie, low fat food has been cut by 50 percent; or a meal or main dish is low fat or low calorie. "Light" also may be used to describe things like the color or texture of a food, as long as the label explains this: for example, "light brown sugar" or "light and fluffy." + Reduced/Less/Lower/Fewer A food (like a lower-fat hot dog or a lower-sodium cracker) has at least 25 percent less of something like calories, fat, saturated fat, cholesterol, or sodium than the regular food or a similar food to which it is compared. + Lean/Extra Lean Terms used to describe the fat content of meat, poultry, fish, and shellfish: Lean - Less than 10 grams fat, 4.5 grams or less of saturated fat, and less than 95 mg cholesterol in a serving and in 100 grams of food. Extra lean - Less than 5 grams fat, less than 2 grams saturated fat, and less than 95 mg cholesterol in a serving and in 100 grams of food. (Tear Off Card) Foods To Choose When You Shop ____________________________________________________________ Meat, poultry, fish, and shellfish Lean cuts of meat Beef: eye of the round, top round Pork: tenderloin, sirloin, top loin Veal: shoulder, ground veal, cutlets, sirloin Lamb: leg-shank Lean or extra lean ham and ground beef Chicken or turkey (remove skin) Fish Shellfish ____________________________________________________________ Dairy foods Skim or 1 percent milk Cheeses* labeled "reduced fat," "low fat," "light," "part- skim," or "fat free" Low fat or nonfat yogurt ____________________________________________________________ Fats and oils Margarine* (diet, tub, liquid) Oils (like canola, corn, olive, peanut, safflower, or sesame oil) Peanut butter ____________________________________________________________ Fruits and vegetables Fruits: any fresh, frozen, canned, or dried Vegetables: any fresh, frozen, or canned* without cream or cheese sauces Fresh or frozen juices ____________________________________________________________ Breads, cereals, pasta, rice and other grains, and dry peas and beans Breads* (like whole wheat, rye, pumpernickel, or white) Buns, dinner rolls, bagels, English muffins, pita breads* Low fat crackers (like bread sticks or saltines)* Tortillas Hot and cold cereals* (except granola or muesli) Pasta (like plain noodles, spaghetti, macaroni) Rice Dry peas and beans: black-eyed peas, chick peas, kidney beans, lentils, navy beans, soybeans, split peas Refried beans made with vegetable oil instead of lard Tofu ____________________________________________________________ Sweets and snacks Low fat cookies: animal crackers, devil's food cookies, fig and other fruit bars, ginger snaps, graham crackers, vanilla or lemon wafers Angel food and other low fat cakes Frozen yogurt, fruit ices, ice milk, sherbet Pudding (make it with skim or 1 percent milk), gelatin desserts Popcorn without butter, pretzels, baked tortilla chips* * If you are watching your sodium intake, be sure to check the label to find low-sodium types. Discrimination Prohibited: Under provisions of applicable public laws enacted by Congress since 1964, no person in the United States shall, on the grounds of race, color, national origin, handicap or age, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity (or, on the basis of sex, with respect to any education program or activity) receiving Federal financial assistance. In addition, Executive Order 11141 prohibits discrimination on the basis of age by contractors and subcontractors in the performance of Federal contracts, and Executive Order 11246 states that no federally funded contractor may discriminate against any employee or applicant for employment because of race, color, religion, sex, or national origin. Therefore, the National Heart, Lung, and Blood Institute must be operated in compliance with these laws and Executive Orders. Developed and produced by: National Cholesterol Education Program NHLBI Obesity Education Initiative Coordinated by the National Heart, Lung, and Blood Institute Endorsed by: American Heart Association U.S. Department of Health and Human Services Public Health Service National Institutes of Health National Heart, Lung, and Blood Institute NIH Publication No. 94-2920 Revised August 1994 .