musc nutrition guide

7/31/2019 MUSC Nutrition Guide

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Hh

From Charlestons Most Preferred Hospital for Heart Care

NUTR I T I ON

GU I D E

2009


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Contents

1 Introduction

2 Knowyourriskforheartdisease

4 Heartattackwarningsigns

5 Understandinghealthycholesterollevels

6 Nutritionandheartdisease

6 Cardioprotectivefoods

8 Unsaturatedfats

9 Omega-3fats

10 Legumes,nutsandseeds11 Heartbusters

15 AmericanHeartAssociationeatingplan

16 Healthybodyweightrecommendations

19 Findoutyourcalorieneeds

22 Foodgrouprecommendations

29 Foodlabelscanhelpyoueathealthfully

32 Plantstanols34 Puttingitalltogether

35 Thewayyoueatmakesadifference

36 Diningawayfromhome

37 Personalassessment

38 Everybodyneedsexercise

39 MUSCsAshleyRiverTower:Aneweraofexcellence

Recipes

46 Soupsandsalads

52 Appetizers

54 Entrees

64 Vegetablesidedishes

68 Desserts

71 Breakfast


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Te MUSC Nutrition Guide

is produced as a community

outreach service o the MUSC

Heart & Vascular Center and

its Seinsheimer Cardiovascular

Health Program.

Managing Editor

Amy H. Mendez, MPH, RD, LD

Copyright 2009 Medical University

o South Carolina. All rights reserved.


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1MUSCNutritionGuide

Thisnutritionguideisdesigned

tohelpyoulterthroughthe

confusioninthesupermarket.

Learnhowtoeatwholesome

mealsandnourishyourbody

withthefoodsthatpromote

wellnessandreduceyour

riskofheartdisease.Itwill

introduceyoutotheriskfactors

forheartdisease,ahealthy

eatingplanandtipsforweight

management,labelreading,

diningoutandportioncontrol.

Heart disease is the leading causeof death in the United States for

both men and women.Although some risk actors or heart and vascular disease cannot be changed,

such as gender or age, we can lower our cholesterol, blood pressure and weight

by leading a healthy liestyle. Choosing to be active, avoiding tobacco and

making smart ood choices can signicantly lower the risk o dying rom both

heart disease and cancer.

But making ood choices in our modern world is tough. Are you supposed to

eat what your mother and grandmother cooked or you? Are you supposed

to buy the more expensive items in the store plastered with claims that they

will improve your health and extend your lie? What i you have risk actors

or heart disease what then?


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2 MUSCNutritionGuide

Know your risk for heart disease

Great news! Heart and vascular disease can be prevented by making heart-

healthy liestyle changes and controlling your heart disease risk actors.Knowing your risk actors is an important step toward taking charge o your

health. Tere are some risk actors that cannot be changed, but many can

be improved by implementing simple modications in dietary and exercise

habits. First it is important to know the enemies youre up against so you can

begin to ght them.

Majorriskfactors

What you cannot change:nAge: Te risk o heart disease increases or both men and women as we age.

Men older than 45 and women greater than 55 are at greater risk.n Gender: Women tend to develop heart disease slightly later in lie than

men. Ater age 55, however, risk is equal or men and women.n Family history o premature heart disease: Father beore age 55, mother

beore age 65.n Personal history o heart or vascular disease: Individuals with known

cardiovascular disease are at higher risk or recurrent problems.What you can change:

n High blood pressure (see page 21 or dietary guidelines and page 38 or

exercise recommendations)n obacco usen Abnormal blood lipids (See page 5 or recommended lipid levels.)

High total cholesterol

High LDL, or bad cholesterol

Low HDL, or good cholesterol

High triglyceridesn Physical inactivity (See page 19 or exercise guidelines.)n Obesity or overweight especially i you carry excess weight

around the waistn Diabetes mellitus or pre-diabetes


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3MUSCNutritionGuide

Secondary risk actors

n Metabolic Syndrome (see table below)n Stressn Depressionn Erectile dysunctionn Excessive alcohol intake

Other indicators o risk

n Coronary calcium as measured by calcium scoringn Carotid thickness as measured by carotid intima media thickness (CIM)n High-sensitivity C-reactive protein (hs-CRP) and other markers o

inammation

n Other lipid markers (Lp(a), LDL particle number and size, HDL particlenumber and size, LpPLA

2)

Recognizingmetabolicsyndrome

Metabolic syndrome is a cluster o risk actors that tend to occur in people

with abdominal obesity. Excess belly at causes a condition called

insulin resistance, an inability o the bodys cells to use insulin eectively.

Abdominal obesity and insulin resistance tend to cause high blood pressure,

high triglycerides, low HDL (good cholesterol) and elevated blood glucoselevels. Metabolic Syndrome is present when any 3 o 5 criteria are diagnosed

(see table below) and is associated with an increased risk o heart disease

as well as a higher likelihood o developing diabetes. With the epidemic

o obesity and overweight in our nation, the metabolic syndrome is being

diagnosed more requently and raises concerns o a developing epidemic o

heart disease soon to ollow.

Diagnosis o metabolic syndrome

(Any 3 criteria)

Criteria

Waistcircumference >40inchesformen

>35inchesforwomen

Bloodpressure >130/85

Bloodglucose(mg/dL) >100

HDL(mg/dL)


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Heart attack warning signs

Formen:

n Uncomortable pressure, centralized chest pain that lasts more thana ew minutes or goes away and comes back

n Pain that spreads to the shoulders, neck, arms or jawn Chest pain that increases in intensityn Chest pain that is not relieved by rest or by taking a cardiac

prescription medicationn Chest pain that occurs with any or all additional symptoms:

Sweating, cool, clammy skin and/or paleness

Shortness o breathNausea or vomiting

Dizziness or ainting

Unexplained weakness or atigue

Rapid or irregular pulse

Forwomen:

Te same symptoms may occur in women and men; however, symptoms more

common to women may include:n Chest pain or a eeling o pressure that comes and goesn Pain that occurs in the upper abdomen (rather than in the center o the chest)n Chest pain that is not relieved by rest or by taking a cardiac prescription

medicationn Chest pain that occurs with any or all additional symptoms:

Nausea or dizziness

Shortness o breath and diculty breathing

Unexplained anxiety, weakness or atiguePalpitations, cold sweat or paleness

Heart disease is the number one killer o adults in the United States.

According to the American Heart Association, 250,000 heart attack

suerers die beore reaching the hospital. Many o these deaths could

have been prevented i quick action were taken.

n Uncertainty is normal. But i you suspect a heart attack, dont delay!n Call 911 or your local emergency services immediately.

n ake one aspirin tablet (unless you are allergic). Tis may help thin the blood.n I you cant access emergency personnel, have someone drive you to the

nearest hospital right away.n Dont drive yoursel unless you have no other option.


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5MUSCNutritionGuide

Understanding healthycholesterol levels

A ull lipid profle shows the actual level o each type o at in your blood:total cholesterol, LDL, HDL and triglycerides. Each is measured in milligrams per

deciliter (mg/dl).

Cholesterol: a at-like substance in your blood. It can build up inside your arteries

when it is present in greater-than-normal amounts. Tis cholesterol buildup occurs

slowly over time and can cause damage. Although your body needs cholesterol

to unction, it makes all the cholesterol it needs. Tereore, it is wise to limit the

amount o cholesterol in your diet to less than 300 mg per day, especially i you have

high cholesterol.

LDL, or low-density lipoprotein: known as bad cholesterol. Its a type o

molecule that carries cholesterol throughout the bloodstream and contributes

to artery-clogging plaque buildup. An optimal LDL level is less than 100 mg.

You can decrease your LDL level by losing weight and cutting back on oods

high in saturated at, such as butter. I diet alone does not reduce your LDL

level, medication might be needed.

HDL, or high-density lipoprotein: reerred to as good cholesterol. Its atype o molecule in the blood that helps remove the bad cholesterol rom

the bloodstream. An HDL level o less than 40 mg is low and puts you at

risk or heart disease. An HDL level o greater than 60 mg may help protect

the heart. You can increase your HDL level by losing weight, increasing

physical activity 30 minutes o exercise on most days will help cutting

out cigarettes and choosing monounsaturated oils, such as olive and canola,

instead o saturated ats, such as butter.

Triglycerides: a chemical name or another type o at ound in thebloodstream. A high triglyceride level may be present in people with high

blood pressure or diabetes or those who carry extra weight around the

waist (abdominal obesity). Certain medicines might also raise the level.

riglycerides should be less than 150 mg. Ways to lower triglyceride levels

include reducing alcohol, sugar and at intake, increasing physical activity and

losing weight.

Whatisadesirablecholesterollevel?Lessthan200mg/dL=desirable

200-239mg/dL=borderlinehigh

240mg/dLormore=high


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Nutrition and heart diseaseProtecting your heart with better food choices

Tere are many reasons or choosing to eat certain oods. Our culture, tastepreerences, amily habits and ood availability are just a ew o the actors

that inuence our ood choices. Te medical research is clear those who

eat a diet rich in ruits, vegetables and whole grains and low in saturated and

trans at have less heart and vascular disease than those who make dierent

choices. Certainly, all oods can t in a balanced diet but Americas intake

has gotten out o balance.

Te nutrients in ood aect our bodies in both positive and negative ways.

Balance is achieved by including cardio-protective oods rich in vitamins,ber and good ats while limiting oods rich in saturated at, trans at and

sodium. Cardio-protective oods are those that keep cholesterol levels healthy,

lower blood pressure, and help keep your weight down. Lets start with these

positive superstars.

Cardio-protective foods

ProduceAlthough research hasnt proved that a multivitamin can prevent disease, it

has clearly shown that eating a variety o ruits and vegetables can prevent

many chronic diseases. Te 5-A-Day campaign recently has been replaced

with the slogan More Matters to emphasize the importance o eating

produce. Because most ruits and vegetables are low in calories, they are great

or helping with weight control.

Fruits and vegetables provide valuable ber and antioxidants natural

chemicals that help your body ght everything rom aging to cancer toheart disease. In general, the darker the color o the produce, the healthier it

will be. Tat means that dark greens such as spinach and broccoli and blue/

purple ruits such as blueberries and pomegranates are superstars. I you preer

iceberg lettuce to romaine and canned applesauce to cantaloupe, thats okay.

Just try to challenge yoursel to use more resh, unprocessed and unsweetened

ruits and vegetables in the uture.

Dont wait until the evening meal to start with your produce. Add berries to

your breakast cereal or pancake batter, and take a banana or raw veggies towork or a mid-morning snack. Many restaurants will swap out a salad or

French ries with a sandwich at lunch, or you could order a soup and salad.

Serve larger portions o vegetables at supper and look or ways to sneak extra

servings in your pasta sauce, casseroles and stews.


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7MUSCNutritionGuide

Focusonber

Dietary ber is the indigestible part o plant oods such as grains, ruits and

vegetables. Consuming dietary ber is an important part o taking care o

your heart. Research shows that eating oods that are rich in ber can lowerLDL (bad cholesterol) levels, help decrease appetite, assist with weight loss

and prevention o weight gain, to prevent and manage diabetes, and might

help prevent cancer. For something thats not digested, thats a lot o work!

You should aim to eat at least 20 - 35 grams o ber each day. Although

there are many new oods available in the market that have added bers, it

seems the best kind to get is whats naturally ound in oods. Foods that are

minimally processed will have more ber than highly processed ones. So

choose the old-ashioned oats more oten than the instant kind.Foods that are rich in soluble ber are especially good at helping to lower

cholesterol. Soluble (or viscous) ber orms a gel in the intestinal system

that traps cholesterol and keeps it rom being absorbed. Examples include oats

and oat bran, citrus ruits, okra, dried beans, peas and eggplant. Ideally, you

should aim or 8-10 grams o this type o ber a day. Although some breakast

cereals are advertised as cholesterol-busters, you might nd some beans and

vegetables have twice as much soluble ber at a much lower cost!

Wholegrainsandgrainproducts

n Fiber is located in the bran and the germ o the grain, so look or whole-

grain and whole-wheat products.n Look into high-ber breakast cereals, which range rom 1 to 13 grams per

serving. Oats and oat bran are also good sources.n Whole-grain products include more than whole-wheat bread. Consider

brown rice, corn tortillas, plain popcorn, barley, bulgur wheat and whole-

wheat pasta.


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Driedbeans,peasandlentils

n Choose soups such as bean, split pea or lentil. Add beans to soups

and stews.n

Add beans such as kidney beans and chickpeas to salads.n Combine beans with vegetables or grains, serve in casseroles or puree beans

into sandwich spreads and dips. Most grocery stores carry ready-made

hummus a blend o chickpeas, tahini (sesame seed) paste, olive oil,

lemon juice and spices.

Fruitsandvegetables

n Choose those with edible skins and/or seeds, such as apples, okra,

strawberries, blackberries, gs, etc.n Eat resh ruit instead o drinking ruit juice. Use resh ruit on breakast

cereals and between meals or snacks.n Snack on crisp, raw vegetables and load up your plate at mealtime with

extra servings o vegetables.

Unsaturated fats

By now youve probably heard that not all ats are bad or your health.Including some small portions o unsaturated ats daily can help keep the

HDL (good cholesterol) level high and might also make the bad LDL (bad

cholesterol) less likely to stick to artery walls. Most healthy ats are liquid at

room temperature the best are extra virgin olive oil, canola oil and peanut

oil. You might even keep all three in the pantry and use them or diferent

recipes.

Besides oils that you might cook with, unsaturated ats are ound in other

oods. Consider a snack o almonds, peanuts or walnuts. Sunower seeds are agood topping on salads or mixed into yogurt. Avocados mixed into guacamole

make a good dip or parties as an alternative to recipes made with cream

cheese or sour cream.

Since even healthy ats are rich in calories, you should be cautious about your

portion sizes. Measure the oil you saut with and check your salad dressing

portions occasionally to make sure youre not over doing it. Limit your

portions o nuts to cup and seeds to 2 tablespoons.


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9MUSCNutritionGuide

Omega-3 fats

Omega-3 atty acids are one type o at your body needs to stay healthy.

Tats why they are one type o at called essential. Tere are three typeso omega-3 ats ound in our oods: DHA (docosahexaenoic acid), EPA

(eicosapentaenoic acid) and ALA (alpha-linolenic acid.) DHA and EPA are

commonly ound in atty sh and seaood, while ALA is plentiul in plant-

based oods. EPA and DHA are the types o omega-3 ats that have been

linked to improved cardiovascular health. Your body can convert ALA into

EPA and DHA, but less is known about its benets to the heart.

Omega-3s seem to help reduce inammation in the body a key component

or heart protection. Tey also have been cleared by the FDA or use to lowerthe level o blood at called triglycerides part o the cholesterol package.

Te American Heart Association recommends that all o us consume

2 servings (3-4 ounces each) o atty sh a week as a way to obtain our

recommended goal o omega-3 ats. Examples might include salmon, sardines,

mackerel and tuna. Because o high levels o contaminants such as mercury,

large predatory sh such as tilesh, swordsh, king mackerel, albacore tuna

and shark should be eaten less oten. Women who are pregnant or nursing

should avoid these types o sh altogether. Other types o sh or shellsh stillcontain omega-3s, but in lower concentrations. Tey still make heart-healthy

protein choices when cooked in a healthy manner such as broiling or grilling.

I you dont care or the atty sh listed above, consider using more o the plant

products that are rich in the ALA version o omega-3. Use ground axseed in

baked goods, snack on walnuts or use canola oil when sauting vegetables.

Some physicians recommend that you use sh oil supplements as a way to get

a reliable dose o omega-3s every day. Read the back o the supplement bottle

and nd the specic amount o EPA and DHA in each capsule. ake enough

capsules to reach a total o 1,000 milligrams o the EPA and DHA combined

(usually 1-3 capsules per day). Tey can be taken at any time o day with or

without ood. o reduce the risk o a shy atertaste, look or ormulations that

are enteric coated and consider taking them at bedtime.


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Legumes, nuts and seeds

Just like omega-3 ats, the unsaturated at ound in nuts and seeds is benecial

to the heart. Unlike the saturated at ound in cheese or meats, it doesnt raisethe level o LDL and might help boost sagging HDL levels. ry including

these oods at least 4-5 times a week or optimal health. You could replace

your aternoon snack o potato chips with a -cup serving o almonds, or

spread 1 tablespoon o peanut butter on your toast instead o melted cheese.

Beans and peas are members o the legume amily and are terric sources o

the soluble ber that lowers LDL. Fresh, dried or low-sodium canned beans

provide protein, complex carbohydrates and ber all in one. oss some

garbanzos on your next salad, choose lentil soup or lunch or trya pre-made hummus dip with baby carrots or a snack.

NOTE:Youmightnoticethatthese

recommendationsaresimilartowhat

isoftencalledtheMediterranean

diet.Thistraditionalstyleofeatingin

countriessurroundingtheMediterranean

Seaemphasizessh,legumes,whole

grainsandvegetables.Theprimary

sourceoffatisfromoliveoil,andthough

redmeat,dairyandsweetsarenot

forbidden,theyareonlyincludedafew

timesamonth.Signicantreductions

intheriskofheartdisease,TypeII

diabetes,andstrokehavebeenfoundin

thosewhofollowtheguidelines.Those

whomightbenetthemostseemtobethosewhohavemetabolicsyndrome.


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Heart busters

Tere are no orbidden oods in a healthy liestyle. But there are certainly

nutrients or oods that we should eat less oten, or limit to special occasions.

It is unrealistic to assume that you will always avoid ried oods or oods

rich in saturated at, such as butter or cream. I you nd that you have been

consuming a lot o the oods mentioned in this section, work on slowly

nding replacements.

Transfattyacids

Avoid rans at whenever possible. Tese types o man-made ats are created

when liquid oils are partially hydrogenated, as in manuactured shortening.

You might not have bought a can o Crisco in years, but i youve eaten a

doughnut or ast ood or used stick margarine, youve eaten your share. rans

atty acids not only raise the artery clogging LDL levels in the blood, they also

decrease the protective HDL a nutritional double whammy.

Recent research indicates that people who consume more trans ats have a

higher risk o heart disease, sudden death rom heart attack and possibly

diabetes. Since these negative eects are seen at even low levels (2-7 grams

per day), it is recommended that you avoid these oods as much as possible.rans ats can be ound in shortening, stick margarine, ried ast oods such

as French ries, crackers, piecrusts, doughnuts, cookies and other processed

oods. Tese ats are listed on the Nutrition Facts label, so look or rans

at: 0. You also can check the ingredients to be sure there are no partially

hydrogenated oils listed.

Saturatedfat

Limit your intake o saturated at. Tis is the original bad at ound lurkingnaturally in ood that is associated with an increased risk o heart and vascular

disease. Medical research has clearly shown that reducing your intake o

saturated at by substituting healthy unsaturated ats can lower your LDL.

Saturated at is usually solid at room temperature. Animal ats (such as lard,

bacon grease, butter, cheese, and atty red meat) are usually saturated, but

coconut and palm oils are also highly saturated. Although dairy products

are oten liquid (cream, hal-and-hal, whole and 2% milk), they are also rich

in saturated at.


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Read nutrition labels to determine the amount o saturated at you are eating.

Although the numbers might seem small, you need to keep your intake to less

than 15-20 grams o this type o at daily.

Tere are two important steps to lowering your saturated at intake. One is to

commit to using low-at or skim dairy products, and the other is to use leaner

cuts o bee, pork and veal and to trim away what at you can see. Skinless

poultry and seaood products are almost always lower in saturated at i they

are cooked in a healthy manner.

Dietarycholesterol

Limit your intake o dietary cholesterol.Cholesterol is produced by the liver

and can be ound in the animal products we eat. Although saturated at morepowerully aects how much LDL our own bodies make, you still should be

careul to keep your dietary cholesterol intake under 200-300 milligrams a

day.

Although saturated at can be avoided by using extra-lean cuts o meat and

trimming visible at, dietary cholesterol is ound in the actual muscle portion

o the animal protein. Tereore, you must eat smaller portions o even lean

cuts o meat and poultry. Most men should shoot or less than 9 ounces

o meat per day, and most women less than 6 ounces per day. A 3-ounceportion is about the size o a deck o cards. Since one egg yolk has about

215 milligrams o cholesterol, you might have success i you use more egg

substitutes or egg whites.

Sugarandwhitestarches

Carbohydrates are the oods your body breaks down into sugar. I the ood is

very complex, such as oats or beans or peas, this process happens slowly. But i

the ood is a simple carbohydrate such as sugar or a white bread, your blood

sugar can jump up quickly. Tis might cause trouble i you have diabetes, and

it may also cause trouble i you have metabolic syndrome, low HDL or high

triglycerides. Te glycemic index o a ood is how quickly blood glucose

levels increase ater eating a measured portion o the ood. For the most part,

i you stick with whole grains, beans and peas, youll be choosing oods with a

lower glycemic index.

Te rst step is to limit your intake o sugar. Tis includes all sugars such

as table sugar, honey, high ructose corn syrup, cane sugar and the oods

sweetened with them (ice cream, cookies, sodas, sweet tea, cakes, candies,

ruit punch and more). ry using articial sweeteners such as Equal or


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Splenda, or drink unsweetened beverages such as water, seltzer and

unsweetened tea. Look or light yogurts, sugar-ree or diet beverages, and

limit the portion and requency when indulging in sweets and desserts.

Use whole grain and unprocessed grains when possible. Te Nurses Health

Study ound that post-menopausal women who choose mostly white rice,

white bread, crackers such as saltines and processed breakast cereals have

lower HDL (good cholesterol) levels when compared to others. Good choices

are whole-grain breads, bran cereals and oatmeal, beans and peas, whole grain

pastas and brown rice. (American Journal o Clinical Nutrition 73(3): 560-

566 (March 2001)) Whole grains are also good sources o magnesium an

important nutrient that helps regulate blood pressure and might be linked to

other heart conditions.

Watch your portion sizes o starches as well. Since the calories are higher in

these oods, a large portion o pasta (even whole grain) can pack more calories

than you expect. Tose with diabetes get the best blood glucose control when

they monitor their carbohydrate intake rst, then worry about whole grains.

Sodium

Cut back on sodium to help prevent or lower high blood pressure. I you

have high blood pressure, lowering it can reduce your risk o heart disease andstroke.

Te majority o sodium we consume sneaks into our diet through the

packaged oods we bring home rom the grocery store and rom restaurant

oods. Te daily limit or healthy eating is 2,300 milligrams, but those over

age 65 and those with hypertension might benet rom getting less than 1,500

mg per day.

Label reading is your best strategy, but you can also watch out or

the Four Cs.

n Canned: soups, vegetables, meatsn Cured: ham, bacon, smoked sh, meats and poultry. Also watch out or

circular processed meats such as bologna, sausages and hot dogsthis type

o meat is usually processed and has salt added.n Condiments: ketchup, bottled salad dressings, soy sauce, teriyaki saucen Convenience: pre-seasoned rice mixes and noodles, rozen dinners,

seasoning packets (taco, bee stew, etc.)


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Dothistoeatlesssodium:

n Choose oods in their least processed state.n East resh, rozen or no-salt-added canned vegetables.n

Use resh or rozen sh, poultry and meats. Buy higher quality lunch meatsat the deli counter.

n Rinse canned oods with resh water to lower the sodium content about .n Look or canned products labeled no salt added or low sodium.n Compare brands. Sometimes two companies can have drastically dierent

amounts o sodium in the same product.n Look or unseasoned dry grains such as rice, pasta or couscous that you can

add your own low-sodium seasonings to.n Keep low-sodium seasonings on hand such as Mrs. Dash, lemon juice,

avored vinegars, garlic, onions, dry spices and herbs. Tey dont taste like

salt, but they help distract your taste buds by avoring the ood.n Use table salt sparingly 1 teaspoon has about 2,100 mg o sodium,

a dash has about 125 mg.n Know your labels. Reduced sodium means the product has at least 25

percent less than the original but this can still pack a punch. Look or

low sodium on the label that way the ood cant have more than

140 milligrams o sodium per serving.


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American Heart Associationeating plan

Here is a summary o the American Heart Associations guidelines orhealthy eating:

n Choose lean meats and poultry without skin and prepare them without

added saturated and trans at.n Select at-ree, 1 percent at and low-at dairy products.n Cut back on oods containing partially hydrogenated vegetable oils to

reduce trans at in your diet.n Cut back on oods high in dietary cholesterol. Aim to eat ewer than 300

milligrams o cholesterol each day.n Cut back on beverages and oods with added sugars.n Choose and prepare oods with little or no salt. Aim to eat ewer than

2,300 milligrams o sodium per day.n I you drink alcohol, drink in moderation. Tat means one drink per day i

youre a woman and two drinks per day i youre a man.n Follow the American Heart Association recommendations when you eat

out, and keep an eye on your portion sizes.

Te American Heart Association Eating plan is recommended or all

healthy Americans and children older than 2. Women who are pregnant

or breasteeding or people who have a medical disorder such as diabetes

or kidney disease should talk to their health care provider or a registered

dietitian about their special dietary needs. I you need assistance, call MUSC

Heart & Vascular Center at 792-1616.


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Healthy body weightrecommendations

Locate your height in the let-most column and read across the row until youlocate your weight. Follow that column up to the top row that lists the body

mass index (BMI). A BMI o 18.5-24.9 is in the healthy weight range. A BMI

o 25-29.9 is in the overweight range, and a BMI o 30 and above is in the

obese range.

Source: he Report o the Dietary Guidelines Advisory Committee on the DietaryGuidelines or Americans, 2005.


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WhatdoesmyBMIrangemean?

n BMI values o less than 18.5 are considered underweight.n BMI values rom 18.5 to 25 are desirable.n

Overweight is dened as a BMI o 25.0 up to 30.0. A BMI o approximately25 corresponds to about 10 percent over ideal body weight. People with a

BMI in this range have a moderate risk o heart disease.n Obesity is dened as a BMI o 30.0 or greater (based on criteria rom the

World Health Organization). People with a BMI o 30 or more are at high

risk or developing heart disease.n Extreme obesity is dened as a BMI o 40 or greater.

I your BMI is above the desirable range, you might benet rom weight loss,

especially i you have other risk actors or heart disease listed on pages 2and 3. I you all into the obese BMI category, please consult your physician.

I you do not have a physician, please call MUSC Health Connection at

792-1414 to speak with a health resource nurse, or consult a nurse online at

MUSChealth.com/medunurse.

Pleasenote:Differentmethods

shouldbeusedtodeterminehealthy

weightsforchildren.Childrenand

teenagershavespecialneeds.Theymustgetenoughcaloriesand

nutrientseachdaytosupportgrowth

anddevelopmentandshouldnotbe

placedonaweight-lossdietunless

itisdeemedmedicallynecessary.

Ifyouhaveaconcernaboutyour

childsweight,talkwithyourhealth

careprovider.

You can get a more precise BMI calculation by using the online body mass

index calculator at MUSChealth.com/weight/bmi


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Whereyoucarryyourweightisalsoimportant

In addition to looking at the healthy body weight chart on page 16 and

nding your BMI, it is also important to look at where you carry your body

weight. You can do this by measuring your waist just above your hipbones,while standing. Health risk increases as waist measurement increases,

particularly i the waist is greater than 35 inches or women or 40 inches

or men. Excess weight carried around the waist (known as abdominal

obesity) may place you at greater risk o health problems, even i your BMI

is in a healthy range. Abdominal obesity is one o the criteria or metabolic

syndrome (see page 3).

Benetsofweightloss

Te higher your BMI and waist measurement, and the more risk actors you

have, the more likely you are to benet rom weight loss. A weight loss goal o

10 percent can signicantly lower blood pressure, risk o developing diabetes

and triglyceride levels.


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Find out your calorie needs

Step1

Find your calorie range rom the chart below. Be honest about your activitylevel although you might consider yoursel moderately active, you may nd

that you actually all in the sedentary column at the moment.

Te calorie ranges shown in this table allow or the needs o people o

dierent ages within an age group. Adults need ewer calories at older ages.

For example, an active 31-year-old man needs about 3,000 daily calories, but

an active 50-year-old man needs only about 2,800 calories.

ActivityLevelandEstimatedCaloriesBurned

Gender Age(years)

Sedentary1 ModeratelyActive2

Active3

Female

1930 2,000 2,000-2,200 2,400

3150 1,800 2,000 2,200

51+ 1,600 1,800 2,000-2,200

Male

1930 2,400 2,600-2,800 3,000

3150 2,200 2,400-2,600 2,800-3,000

51+ 2,000 2,200-2,400 2,400-2,800

1 Sedentary means you have a liestyle that includes only the light physical

activity associated with typical day-to-day lie.

2 Moderately active means you have a liestyle that includes physical activity

equivalent to walking about 1.5 to 3 miles per day at 3 to 4 miles per hour, in

addition to the light physical activity associated with typical day-to-day lie.3 Active means you have a liestyle that includes physical activity equivalent

to walking more than 3 miles per day at 3 to 4 miles per hour, in addition to

the light physical activity associated with typical day-to-day lie.

Your calories needed per day:


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Step2

Find your weight on the BMI chart on page 16. I your BMI is in the healthy

range between 18.5-25, aim or the calorie level recommended rom the chart

on the preceding page. I your BMI is above 25, subtract 500 calories rom theabove number to help you lose about 1 pound a week. For example, a 50-year-

old man who is sedentary would need approximately 2,200 calories a day to

maintain his weight. I he wants to lose weight, he would subtract 500 calories,

making his new goal 1,700 calories a day. He also could lose weight by walking

daily that would move him up to the moderately active category.

Pleasenote:Nevergobelow1,200

caloriesperday.Calorielevels

belowthisarenotadequateto

meetnutrientneeds.

Choosetherightfatbalanceforyourheart

While there are some things about healthy nutrition or the heart that are the

same or all o us, such as eating whole grains and plenty o colorul vegetables,

there are some diferences. For most Americans, including those with diabetes

and metabolic syndrome, ollowing a diet plan that includes a moderate

amount o healthy, unsaturated at (about 35 percent o calories) and a

moderate amount o starch is a good idea. However, there are some individuals

that would benet rom ollowing a lower-at diet, even limiting some o the

good ats. Tese individuals usually have good triglyceride, HDL and blood

sugar levels, but their LDL level is elevated. (Reer to page 5 or an explanation

o cholesterol.) In this case, a lower-at diet with 20-25 percent o calories rom

at and a little more starch would be a good plan.


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FoodGroups ModerateFat(30-35%) LowFat(20-25%)

Calories 1600 2000 1600 2000

Grains 5-6 7-8 7 11

Vegetables 3-4 5-6 3-4 5-6

Fruits 3 4 4 5

Fat-freeor

low-fatmilk 2-3 3-4 2-3 3-4

Leanmeat,poultry,

seafood,lowfat

cheese

6-7oz 8-9oz 4-5oz 6oz

Fatsandoils,nuts 6 8 3 4

Totalfatgrams

perday62 78 44 56

Saturatedfatgramsperday(prevention


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Food group recommendations

Te ollowing recommendations are based on the American Heart Association

Eating Plan. Suggested serving sizes and healthy choices are listed or eachood group.

Fruitsandvegetables

Fruits and vegetables are naturally high in vitamins, minerals and ber and

low in at, calories and sodium. Tey contain no cholesterol.

Fruits

Servings per day: 3 to 5

A serving equals one o the ollowing:

1 medium piece o resh ruit

1 cup o berries or melon

cup unsweetened canned ruit

cup ruit juice

2 tablespoons dried ruit

Healthy choices

n Whole ruits and 100 percent ruit juicen Frozen ruit without added sugarn Choose a variety o colors and

types each day

Vegetables



1 cup o leay greens cup chopped or cooked vegetables

Healthy choices

n Fresh or rozen vegetables without

added butter or saucen Canned no-salt-added vegetables


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Bread,cereal,rice,pastaandstarchyvegetables

Foods in this group supply energy and are rich in vitamins (especially

B vitamins), minerals, iron and ber. Starchy vegetables are listed in this

group because they are similar in calories and carbohydrates per serving.



1 slice o bread

large bagel

cup aked, unsweetened cereal

cup hot cereal or grits

cup cooked rice

cup cooked pasta

cup starchy vegetable

3 cups popcorn

Healthy choices:

n Breads and rolls: (Aim or 100 percent whole wheat or whole grain when

available) Sandwich bread, English muns, hot dog and hamburger buns,

bagels, pita bread, corn and 4 tortillasn Crackers and snacks: Whole-wheat crackers, matzo, melba toast, at

bread, pretzels, low-at popcorn

n Hot or cold cereals: All kinds that dont have added sugar.

(Note: Granola-type might be high in calories and at or saturated at)

n Rice and pasta: Brown rice, whole-grain pasta and pasta made without eggs

n Starchy vegetables: all kinds, including potatoes, corn, lima beans, kidney

beans, black-eyed peas, green peas, winter squash and sweet potatoes


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Milkproducts

Milk products are an excellent source o protein, calcium, phosphorous,

niacin, riboavin and vitamins A and D. But many, such as ice cream and

whole milk, are rich in saturated at. It is important to look or non-at andlow-at varieties.

Servings per day: 2-4


1 cup skim or 1 percent milk

1 cup non-at or low-at yogurt

Pleasenote:Cheeseislistedinthe

meatgroupbecauseitissimilarincaloriesandproteinperservingto

thatgroup.

Healthy choices:

Milk products with 0-1 percent at: skim or at-ree milk, percent milk, 1

percent milk, evaporated skim milk, at-ree or low-at yogurt

Vegetarian alternatives: Light or low-at soy milk

Tip:Ifyoureusedtowholemilk(3.5

percentfat),youmightnditeasier

totaperdownslowly.Try2percent

milkrst,thenchangeto1percent

milk.Soonyoullbeabletoswitchto

skimmilkwithnotrouble.

Meat,poultry,seafoodandsh

Servings per day: Aim or no more than 6 ounces cooked lean meat, poultry

or sh. Tose who need calorie levels o 2,000 and above might need up to

8-9 ounces. Be sure to include 2 servings o baked or grilled sh each week.


3 ounces cooked (4 ounces raw) lean meat, poultry or sh. Examples:

chicken breast, cup aked sh (o judge serving sizes o meat, just

remember that 3 ounces is about the size o a deck o playing cards.)


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Healthy choices:

n Fish and shellsh. Shrimp and craysh are higher in cholesterol than

most types o sh but lower in saturated at and total at than most

meat and poultry.n Fish high in omega-3 atty acids, such as albacore tuna, salmon

and mackerel.n Chicken and turkey (without skin), lean ground turkey.n Lean bee. Look or round, chuck or loin in the names and buy choice

or select grades o bee rather than prime.n Lean or extra lean ground bee (with no more than 10 percent at).n Lean ham and lean pork, such as tenderloin or loin chops. Ham and

Canadian bacon are higher in sodium than other meats. Look or lower

sodium varieties.n Lean lamb (leg, loin)n Lean cuts o bualo, emu and ostrich. Tese are very low in at, saturated

at, cholesterol and sodium.n Wild game including rabbit, venison, pheasant, duck (without skin)n Lean sandwich meats, such as turkey, chicken, turkey ham, turkey pastrami

or lean boiled ham. Check the label or those with less sodium.

Importantnote:Organmeatsareveryhighincholesterol.

Asmallserving(3ounces)

aboutonceamonthisokay.

Meat shopping and preparation tips:n Choose cuts o meat that have the least amount o visible at. rim o the

visible at beore cooking.n

Instead o rying, prepare meats by baking, broiling, roasting, microwavingor stir-rying. Pour o the at ater browning.n Remove the skin and at under the skin beore cooking poultry pieces. (Te

exception is when roasting a whole chicken or turkey. Ten remove the skin

beore carving and serving the meat.) Choose whole turkeys that have not

been injected with ats or broths.n Chill meat juices ater cooking, so you can easily skim o the hardened at;

then, add the juices to stews, soups and gravies.

Meat substitutesEggs, dried beans, nuts and soy products are high in protein and can be

substituted or meat.


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Eggs

n 1 egg, 2 egg whites or cup cholesterol-ree egg substitute = 1-ounce

serving o lean meat

Healthy choices: Use 2 egg whites (equal 1 whole egg) or cholesterol-ree eggsubstitutes.

Eggs have a high cholesterol content (213 milligrams per yolk). ry to limit

the number o whole eggs you eat to no more than 34 per week.

Driedbeans

n 1 cup cooked beans, peas or lentils = 3-ounce serving o lean meat

ry to serve meatless meals a ew times per week using dried beans asa substitute.

Nuts

Although nuts and peanut butter are excellent sources o protein, they are high

in at. Because o the at content, they are listed in the ats and oils group below.

Soyproducts

n 3 ounces tou = 3-ounce serving o lean meat

Soy products oer a wide variety o meat substitutes in addition to tou.

Look or these items in the rozen-ood section o your grocery store. Tere

youll nd no-cholesterol and low-saturated-at substitutions or hamburgers,

sausage, and chicken patties. Check labels or

sodium content as some o these can be salty.

Fatsandoils

Good quality choices in this category can

provide vitamins A and E and the unsaturated

atty acids that keep your heart healthy.

However, all choices are high in calories, so it is

very important to monitor your portions.


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Servings per day: Varies based on individual calorie needs (see page 21)

A serving equals one o the ollowing::

1 teaspoon liquid vegetable oil

1 ablespoon sot (tub) margarine spread

1 ablespoon salad dressing1 ablespoon Light Mayonnaise

1 ablespoon peanut butter or nut butter

1 ablespoon nuts or 2 teaspoons seeds

medium avocado

10 small or 5 large olives

Healthy choices:

n

Vegetable oils such as canola, olive, peanut and sesamen Reduced-at and low-at salad dressings and mayonnaise with no more than

2 grams o saturated at per tablespoonn Liquid (spray or squeeze) or tub margarines. Choose brands with liquid

vegetable oil or water as the rst ingredient and no more than 1.5 grams

o saturated at per tablespoon. Also look or non-hydrogenated

margarine spreads.n Natural peanut butter that does not have hydrogenated oil in the

ingredient listing.n All raw or dry-roasted nuts. A handul (or cup) o most nuts has about

15 grams o at and is the same as 3 at servings.

Desserts

Since the calories in desserts and sweets dont count in your ood group goals,

try to limit how oten you have them. When you do choose sweets,

look or those low in saturated at, cholesterol and calories.

Healthy Choices:n Fruit: resh, rozen, dried or canned (in natural juice)n Light yogurt with ruitn Cookies low in at such as gingersnaps, graham crackers, vanilla waers, g

bars or angel ood caken Fat-ree or low-at rozen yogurt or light ice cream with no more than 3

grams o saturated at per servingn Sugar-ree gelatinn

Fruit ices, sherbets or sorbets


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Shoppingandpreparationtips:

Store-bought desserts: Be sure to read the ingredient listing careully to avoid

hydrogenated oils.

Homemade desserts: Prepare using liquid oil rather than butter i possible,try 1 percent or at-ree evaporated milk instead o cream and egg whites

instead o whole eggs.

Beverages

You cant do better than water drink at least 8 cups per day. ry to

eliminate sugar-sweetened beverages such as soda, sweet tea and ruit punch.

Limit your intake o ruit juice to no more than 6 ounces daily.

I you drink alcoholic beverages, do so in moderation. Have no more than

1 drink per day or women or 2 drinks a day or men o wine, beer or liquor.

Here are the amounts that count as one drink:

n 12-ounce beern 1 ounces 80-proo spirits (including bourbon, gin, rum, scotch, tequila,

vodka and whiskey)n 1 ounce 100-proo liquorn

5 ounces o wineAlthough some studies indicate that including

moderate amounts o alcohol might be healthy or

the heart, you shouldnt start drinking just

or the small health benets. I

you are trying to cut calories to

manage your weight, limiting

alcohol is a good rst step.


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Food labels can help youeat healthfully

Food labels are a valuable tool or helping you make healthy ood selections.Look or the Nutrition Facts panel on each item to nd out what youre really

eating. By comparing product labels, you can cut down on at, saturated at,

cholesterol, sodium and sugar.

Food manuacturers try to get your attention with the words, pictures and

colors on their ood packages. Although the FDA regulates direct nutrition

claims such as low at and at ree, other claims are deliberately vague, but

suggestive. For example: Helps support healthy arteries is not the same claim

as helps to lower cholesterol. Remain a little skeptical and spend your timereading the Nutrition Facts panel where the specic nutrition content is listed.

Becomefamiliarwiththefollowingfoodlabelinformation:

Serving size: Serving size is considered an average portion. All the values

listed on the label are based on this amount. Similar products will have

similar serving sizes, making it easy to compare products.

Calories: I youre watching your weight, limit your calories rom all oods to

stay within your goal.

Total at: Tis number includes all the good ats added together with the bad

ones. Aim to stay within the goal shown on page 21.

Trans at, saturated at and cholesterol: Saturated and trans ats are shown

in grams. Everything you buy should have 0 grams o trans at. Its okay to

have some saturated at, but choose the oods with the lowest amounts. Te

goals listed on page 21 can be helpul. Remember, daily cholesterol intakeshould not exceed 300 mg.

Sodium: Processed and packaged oods are usually high in sodium. Te less

sodium, the better. In general, the more processed a ood is, the higher it is

in sodium. For example, 3 ounces o processed ham has 1,080 mg o sodium,

while a 3-ounce lean pork chop has only 47.

Total carbohydrates: Starches, ruits, milks and oods made with sugar will

have carbohydrates. ry to choose oods with dietary ber and a low amount

o sugar.


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Percent daily value: Tis

column tells you what

percentage o the total

recommended daily intake o

nutrients a ood provides in asingle serving. Tese values are

based on a 2,000 calorie-per-

day diet. Your optimal calorie

intake may be higher or lower,

but you can use these numbers

to help you compare products.

Vitamins and minerals:

Most oods will not giveyou all you need o any one

vitamin or mineral, so its

important to eat a variety o

oods every day.

Ingredients: Ingredients are

listed by weight, rom most

to least. I a at or sugar is

listed within the rst ew

ingredients, a dierent choice

might be healthier. Look or

products with short ingredient

lists as they will usually

be less processed.

Tipsforusingfoodlabels

Food labels are a valuable tool or helping choose oods wisely, but all the

numbers can be conusing at rst. Follow these tips to help you get started

using ood labels and avoid conusion.

n Begin by comparing how much you really eat to the serving size shown on

the label. I you eat more, multiply the numbers on the label by the number

o servings you will eat.

n Compare the labels on diferent brands o oods you normally buy. Focus

on one thing at a time. I you want to eat less at, compare total at. I you

want to eat less salt, compare sodium. Ten select the brand with the least

at or sodium.


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odays ood labels may include terms such as lite or low-at. o make

such claims, a product must meet the requirements listed below. You can use

these terms to help you make healthy choices, but be sure to read each items

Nutrition Facts panel or more detailed inormation.

Foodlabelingterms

n Calorie ree: Less than 5 calories per servingn Low calorie: 40 calories or less per servingn Sodium ree: Less than 5mg o sodium per servingn Very low sodium: Less than 35mg o sodium per servingn Low sodium: 140mg o sodium or less per servingn Light in sodium: 50 percent less sodium per servingn Fat ree: Less than g o at per servingn Low at: 3g o at or less per servingn Extra lean: Less than 5g o at, 2g o saturated at and

95mg o cholesterol per servingn Lean: Less than 10g o at, 4.5g o saturated at and

95mg o cholesterol per servingn Cholesterol ree: Less than 2mg cholesterol per serving

and 2g or less saturated at per serving

n Low cholesterol: 20mg or less cholesterol per servingand 2g or less saturated at per serving

n Light or lite: or ewer calories, or 50 percent less at

per serving than the regular productn Reduced at, sodium, sugar or calories: less at, sodium,

sugar or calories than the regular productn High in ber: 5g o ber or more per serving

Bloodpressureguidelines:

GuidelinesreleasedinMay2003

classifynormalbloodpressureas

below120/80andreadingsfrom

120/80to140/90asprehypertensive.

Readingsfrom140/90andaboveare

hypertensive.

Source:NationalHeartLungandBloodInstitute,December2003


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Portiondistortion:Enjoyallfoods,justdontoverdoit.

Although its important to choose oods that are healthy or your heart,

its also important to make sure that youre eating the right portion o thoseoods. While we might consider a serving to be what we put on the plate,

it may be more than one portion according to the recommendations in the

table below. I youre working on weight loss, pay special attention to your

portion sizes. You might even use measuring cups or spoons to check

yoursel occasionally.

Check this ollowing guide or some easy-to-remember reerences:

PortionEquivalents:

1cup Sizeofbaseball 1servingfreshfruit

cup Sizeoflightbulb 1servingcookedcereal

cup Sizeofegg 1servingcookedrice

2Tbsp Sizeofgolfball Smallscoopofpeanutbutter

1Tbsp Sizeofthumb Dollopofmayonnaise

1tsp Sizeofpenny Servingofoliveoil

3ouncesSizeandthickness

ofadeckofcards

Servingofmeat,poultry

orsh

1ounce Sizeof4dice Servingofcheese

Computermouse Onesmallbakedpotato


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The way you eat makes a difference

Its important to understand that the amount and types o ood you eat are

only part o weight management. Te way people eat has to do with cultureand inuences rom amily and riends. Not only is ood essential or survival,

it is also used or celebration and to make us eel better.

I you want to make changes in how much and what you eat, ocus on

making small, gradual changes. Drastic, unrealistic changes (like those

required with many ad diets) can set you up or ailure and contribute to

low sel-condence about your eating habits. Although you may eel that you

could eat cabbage soup every day until your weight is normal, you probably

wont address the underlying reasons your weight climbed in the rst place.I you nd that you need support and guidance to help you with weight

management, consult your doctor or a registered dietitian.

Te MUSC Weight Management Center can help you achieve your healthy

weight loss goals. Keeping your weight under control involves a persistent

eort at maintaining a balance o nutrition, activity and a healthy liestyle.

Please visit MUSChealth.com/weight or nutrition.musc.edu or call 792-1616

or more inormation. See pages 39 to 43 or additional resources at MUSC.

Tipstocontrolfoodintake

1. Reduce triggers that prompt eating. Many things stimulate eating besides

physical hunger. Certain locations, activities and the sight or smell o ood

can trigger eating, whether or not youre hungry. ry these suggestions:

n Eat only when sitting down. Dont eat while standing, walking or driving.n Eliminate all activities, except talking, while youre eating.n

Keep tempting oods out o sight.2. Eat slowly. Eating slower helps you eel ull beore youre overstufed.

People get more satisaction with less ood when they eat slowly.

ry putting eating utensils down ater each bite and picking them up

only ater swallowing.

3. Balance the foods you eat. Remember its what you do most o the time

that makes a diference. I you sometimes have a high-at dish or dinner,

balance it with lower-at oods, such as steamed vegetables or ruit or dessert.

4. Keep a ood diary. People who record their ood intake are more ocused

and tend to do better with weight control than those who dont.


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Dining away from homeThewayyoueatmakesadifference

Now that most American amilies spend about hal o their ood budget onmeals prepared away rom home, its important to know how to eat wisely

when you dine out. Special occasions may still be splurges, but try to stick

with heart-healthy items the rest o the time. Te ollowing tips or dining

away rom home can help keep you on track.

n Go easy on bread and butter or olive oil beore your main dish is served.

Its easy to load up on calories and at without realizing it.n Ask your server how the ood is prepared. Order menu items as you want

them prepared. For example, when ordering a stir-ry dish, request that oiland soy sauce be used sparingly.

n Start your meal with a salad to satisy your appetite and obtain

valuable nutrients.n Substitute steamed vegetables or a salad or high-at side items.n Ask or sauces and dressings on the side so you can control the

amount you eat.n aste your ood beore adding salt or use vinegar or lemon juice

to avor oods.n When you are ull, stop eating and signal the server to remove your plate to

prevent nibbling. Ask or letovers to be placed in a to-go box to take home

(you might consider dividing your meal and putting hal in the box at the

beginning o the meal).n I portions are large, you might consider an appetizer as your main course

or share an entre with someone else.

Uncover clues to the nutritional value o ood items by checking the

menu descriptions:Green light: Grilled, broiled, boiled, roasted, baked, broiled, steamed,

poached, resh

Warning: Crispy, ried, creamy, buttery, au gratin, light cream sauce,

alredo, king-sized, hearty, country-style


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Personal assessmentSettinggoalsandrewardingyourself

I you are overweight and want to manage your weight successully in thelong run, youll need to change some behaviors and maintain those changes.

Ater a while, theyll become habits that require no more thought than the

habits that promoted weight gain.

Te best way to develop new permanent habits is to break them down into

manageable parts, set short-term goals and reward yoursel or reaching each

goal. Goals should be specic, attainable and a little orgiving. Dont throw

in the towel just because you get o track once in a while. Rewards should be

tangible things, activities or just time o to yoursel not ood!Write down at least our behavior-change goals and a reward or each.

Identiy the easiest one to reach. Ten get started.

Example

Goal Walk two miles our times a week.

Reward reat yoursel to a movie.

FreeonlineHeartAwarerisk

assessment:Forafreeonline

assessmentofyourcardiovascularrisks,

visitMUSChealth.com/heartaware.

Youllreceiveadetailed,personaliized

reportoutliningyourriskfactorsand

whatyoucandotoloweryourriskof

developingcardiovasculardisease.Itsquick.Itsprivate.Anditcould

saveyourlife.


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Everybody needs exercise

A century ago, physical activity was an unavoidable part o everyday lie.

Walking was a primary means o transportation and work involved a greateramount o physical activity. Unortunately our liestyle over the years has

morphed into more sedentary ways with inventions such as the car, computer,

television, and microwave. All o the conveniences have led to a less t, heavier

and thereore less healthy society.

o improve the health o our nation, it is very important that we integrate

both ormal exercise and inormal activity into our daily liestyles. Formal

daily exercise involves rhythmic sustained activity such as walking, jogging,

biking, rowing, dancing or swimming. Recently established guidelinesstate that adults should exercise at a moderate intensity at least 30 minutes,

5 days per week. For those trying to lose weight, success is more likely i

you engage in 60 minutes o exercise or more per day. When initiating an

exercise program, start with a 10- to 15-minute session, and over several weeks

gradually increase the duration and intensity o the exercise. We can increase

inormal activity in various dierent ways throughout the day: choose to use

the stairs, park arther rom the store, walk over to a co-worker to talk instead

o e-mailing or phoning, walk the dogkeep moving and sit sparingly!

A 30-minute exercise session, 5 days per week is a small investment or the

benet gained, and the more time invested, the greater the health and tness

improvements. Exercise helps decrease ones risk or heart problems: Blood

pressure, cholesterol and blood glucose control can all show improvements.

Habitual exercisers report reduction in atigue, enhanced sel-condence, an

improved ability to perorm daily activities, and decreased stress and anxiety.

Incorporating exercise into an already busy day can be dicult. It is essential

to nd activities that you enjoy. Te more enjoyment discovered in exercise,the more likely it will become a habitor possibly a time to look orward to.

For a greater chance o adherence: make a plan; designate a time and place to

exercise; mark it on the calendar; make it convenient; set specic, attainable

goals; and reward yoursel or milestones achieved.


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MUSCs Ashley River Tower:A new era of excellence

MUSCs Ashley River ower, located at 25 Courtenay Drive on the beautiulCharleston peninsula, is home to the MUSC Heart & Vascular Center,

MUSC Digestive Disease Center and MUSC Surgical Oncology. Opened in

February 2008, this state-o-the-art acility specically addresses the increased

incidence o cardiovascular and digestive disease among the growing patient

population in South Carolina and the region.

Ashley River ower oers the latest technologies and world-renowned

physicians in a convenient, hotel-like atmosphere. Highlights o the

acility include:

n 156 beds, including 32 ICU beds and 22 beds designed or

bariatric patientsn Nine state-o-the-art operating roomsn Nationally accredited Chest Pain Centern Tree leading-edge electrophysiology labsn Four interventional/diagnostic catheterization labsn Tree interventional radiology labsn Nine endoscopy suites

Wherepatientscomerst

Ashley River ower is designed to be a resh new hospital experience or our

patients and their amilies. All in-patient services or heart and vascular or

digestive disease are housed in the acility.

Te progressive and organized design is more convenient to patients and

enables better coordination o care, which means better outcomes. Separatecorridors or sta and visitors assure easy transport, as well as the privacy o

our patients. Family waiting rooms are easily accessed and near patients.

I you are reerred here with a heart problem, you will nd everything

necessary to get you seen, promptly diagnosed and appropriately treated in

the best possible way, said John S. Ikonomidis, M.D., chie o cardiothoracic

surgery. You wont have to go to six or eight dierent locations.


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Every detail o Ashley River ower reects MUSCs commitment to its

patients and employees. Amenities include:

Toviewphotosandlearnmore

aboutAshleyRiverTower,visit

MUSChealth.com/ashleyrivertower.

PleasecalltheMUSCHeart&

VascularCenterat843.792.1616formoreinformationorto

scheduleanappointmentwith

oneofourworld-classheartand

vascularphysicians .

Congestiveheartfailure&transplantprogram

It might begin with simple atigue. As the condition progresses, individualscan experience shortness o breath, wheezing, an inability to sleep except

when propped up, swollen legs and ankles, nausea and weight gain.

Tese are signs o congestive heart ailure (CHF), a condition in which the

heart cannot pump enough oxygenated blood to serve the bodys needs.

Its a condition aficting more than ve million Americans and is the leading

cause o hospitalization or adults over the age o 65.

From minimally invasive surgeries to cardiac rehabilitation and heart

transplantation, the MUSC Heart & Vascular Center supports teams that

integrate care and make the experience easier. CHF patients can be seen by

all the specialists their condition requires in one visit. In addition, at MUSC,

patients have the opportunity to participate in drug and therapy studies and

take advantage o technological advances.

Te upheaval that comes rom a diagnosis o CHF need not include pro-

longed or repeated hospitalizations or hour upon hour spent in doctors

oces. With appropriate treatment, individuals who develop congestive

heart ailure oten can enjoy many years o productive lie. Appropriate

and timely intervention is key.

n Private roomsn

Concierge servicen Valet parkingn Dedicated amily lounges

n Wireless capabilitiesn

Retail shopsn Convenient dining


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Te team o specialists at MUSC includes physicians, nurse practitioners,

dietitians, social workers and pharmacists who work together to help patients

manage the daily schedule o medicines, diet and exercise. Members o the

team maintain regular telephone contact with patients to answer questions

and provide guidance.

About hal the treatment o CHF is medical; the other hal involves the

patient making liestyle changes, such as ollowing a low-salt diet, exercise,

weight control and contact with members o the medical team as soon as

problems arise.

SeinsheimerCardiovascularHealthProgram

Located in MUSCs Ashley River ower and cardiology clinics, theSeinsheimer Cardiovascular Health Program is dedicated to improving

cardiovascular health by oering one-stop access to a ull range o

preventive cardiology services. Te program brings together comprehensive

cardiovascular exams, nutrition counseling, weight management, exercise

prescription, diabetes management and vascular services, as well as early

detection and diagnostic imaging.

Youre never too young or too old to begin taking preventive measures.

More than 78 percent o U.S. adults between the ages o 20 and 80 haveone or more risk actors or cardiovascular disease. Te good news is that

prevention works since 1968, U.S. deaths rom heart attack and stroke

have been reduced by almost 50 percent largely by addressing the most serious

risk actors. Seinsheimer program services are oten covered by insurance

plans. Visit MUSChealth.com/hearthealth to learn more or to make an

appointment.

MUSCCardiacRehabilitationProgramTe MUSC Cardiac Rehabilitation Program is individualized or each patient

and draws on the expertise o cardiologists, nurses, an exercise physiologist,

a registered dietitian and a vocational counselor. Tis our-phase program

begins during hospitalization and continues ater discharge.

Te cardiac rehabilitation program teaches patients and their amilies how to

modiy liestyles to reduce risk actors. Because coronary heart disease can

be attributed to both liestyle and inherited risk actors, all members o the

amily benet by reducing their own risk actors.


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Patients receive an individualized exercise program based on their medical

history and personal goals, gaining condence in a medically supervised

setting where heart rate, blood pressure and electrocardiogram can be

monitored as they exercise.

Te MUSC Cardiac Rehabilitation Program also links patients and their

amilies with others going through the same experience so they can help one

another and provide encouragement.

MUSCheartandvascularoutreachservices

MUSC oers heart and vascular outreach services throughout South

Carolina. MUSC cardiologists travel beyond the MUSC campus to these

sites regularly, providing care on an outpatient basis.

NutritionCounseling

MUSC Dietary Services and the Seinsheimer Cardiovascular Health Program

provide nutrition counseling or those who need individualized assistance

with heart-healthy meal planning and weight management.

A registered dietitian can provide counseling according to your physicians

medical recommendations. Contact Amy Mendez o Seinsheimer

Cardiovascular Health Program at 843-792-1616 or visit online at

www.MUSChealth.com/hearthealth.

Pediatric outreach sites:

n Greenvillen Beauortn Myrtle Beachn Pawleys Islandn Surside Beach

Adult outreach sites:n Greenvillen Myrtle Beachn Conwayn Beauortn Georgetown

Charleston area

outpatient clinics:

n Ashley River owern Mount Pleasantn West Ashleyn North Charleston


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Additionalresourcestohelpyouonyourheart-healthyjourney:

MUSC Seinsheimer Cardiovascular Health Programwww.MUSChealth.com/hearthealth

National Heart Lung and Blood Institute

www.nhlbi.nih.gov

(inormation about cholesterol and blood pressure)

Heart Truth Campaign

www.nhlbi.nih.gov/health/hearttruth/

American Heart Association (AHA)

www.americanheart.org

AHA Go Red or Women

www.goredorwomen.org

WomenHeart: National Coalition or Women with Heart Disease

www.womenheart.org

Small Step

www.smallstep.gov

American College o Cardiology

www.cardiosmart.org


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Hh

From the American Heart Association

REC I P ES


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Soups and salads

GazpachoSoup

Serves4:1cupperserving2 medium shallots, coarsely chopped

1 medium garlic clove, chopped

4 medium tomatoes, coarsely chopped

1 medium bell pepper (yellow preerred), coarsely chopped

1 medium cucumber, peeled, seeded and chopped

2 bsp white wine vinegar

tsp salt

tsp pepperOptional 4 medium bell peppers, any color or combination

1 medium carrot (optional)

1 medium rib o celery (optional)

Put the shallots and garlic in a blender or ood processor and process until

nely chopped. Add the remaining soup ingredients (you may need to do this

in batches) and process until slightly chunky. Pour into a medium bowl, cover

and rerigerate or at least 4 hours beore serving.

For a estive presentation, slice o and discard the stem ends rom theremaining 4 bell peppers, leaving the peppers whole. Making sure you dont

pierce the peppers, discard the ribs and seeds. Cut the carrot and celery into 4

sticks each. Ladle the cold soup into the peppers. Put a carrot stick and celery

stick in each.

Cookstip:Turnthissoupintosalsa

byadding1or2choppedcanned

jalapenopeppers.Servethesalsawithbakedtortillastripsorspoon

itoverpoachedshoronsalads.

Nutrition inormation: Calories 45, otal Fat 0.5g, Saturated Fat 0.0g, rans

Fat 0.0g, Polyunsaturated Fat 0.0g, Monounsaturated Fat 0.0g, Cholesterol

0mg, Sodium 154mg, Carbohydrates 10g, Fiber 2g, Sugars, 5g, Protein 2g


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HotandSourSoupServes6:cupperserving

4 cups at-ree, low-sodium chicken broth

2 bsp cornstarch1 bsp water

cup thinly sliced green cabbage or bok choy

cup sliced resh shiitake, cloud ear or other exotic mushrooms

(shiitake stems discarded)

3 medium green onions, sliced

1 bsp minced peeled gingerroot

1 bsp soy sauce (lowest sodium available)

4 ounces rm light tou, cut into bite-size strips

cup vinegar, or to taste

1 tsp pepper or to taste

cup egg substitute

tsp toasted sesame oil

In a stockpot, bring the broth to a boil over high heat. Meanwhile, put the

cornstarch in a small bowl. Add the water, stirring to dissolve.

Add the cabbage, mushrooms, green onions, gingerroot and soy sauce to the

boiling broth. Return to a boil. Stir in the cornstarch mixture. Boll or 1 to 2minutes. Stir in the tou, vinegar and pepper. Reduce heat to a simmer.

Stirring constantly and gently, slowly drizzle the egg substitute into the

simmering soup. Remove rom the heat. Stir in the sesame oil.

Cookstip:Thehandfulofwhatevers

handymethodworksjustneinthis

veryadaptablesoup.Snowpeas,

broccoliorets,shreddedcarrots,cannedwaterchestnutsorbamboo

shootswouldbegoodsubstitutesor

additionstotherecipe.

Nutrition inormation:: Calories 47, otal Fat 0.5g, Saturated Fat 0.0g,

rans Fat 0.0g, Polyunsaturated Fat 0.5g, Monounsaturated Fat 0.0g,

Cholesterol 0mg, Sodium 147mg, Carbohydrates 5g, Fiber 1g,

Sugars 1g, Protein 4g


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BayouAndouilleandChickenChowderServes4:1cupsperserving

Vegetable oil spray

2 ounces andouille sausage, cut into -inch pieces2 ounces boneless, skinless chicken breasts, all visible at discarded,

cut into -inch pieces

14-ounce can at-ree, low-sodium chicken broth

1 medium green bell peppers, chopped

8 ounces baking potatoes (russet preerred), cut into inch pieces

cup rozen whole-kernel corn

tsp dried thyme, crumbled

cup at-ree hal and hal

4-ounce jar diced pimentos, drained

cup nely snipped resh parsley

tsp salt

tsp pepper

2 ounces shredded at-ree or low-at sharp cheddar cheese

Heat a Dutch oven over medium heat. Remove rom heat and lightly spray

vegetable oil (being careul not to spray near a gas ame). Cook the sausage

or 3 minutes or until it begins to richly brown on the edges, stirring

constantly. ranser to a plate. Lightly spray the Dutch oven with vegetable

oil spray. Add the chicken. Cook or 3 minutes, stirring requently. Stir in the

broth, bell peppers, onion, potatoes, corn and thyme. Bring to a boil. Reduce

heat and simmer, covered, or 20 minutes or until the potatoes are tender.

Remove rom heat. Stir in the sausage, hal-and-hal, pimentos, parsley, salt

and pepper. Let stand, covered, or 15 minutes to allow the avors to blend

and the liquid to thicken slightly. o serve, ladle into bowls. Sprinkle with

cheddar.

Cookstip:Besuretoallowthe

chowdertostandforafull15minutes

forpeakavor.Youcanreheatthe

chowderovermediumheatfor2to3

minutesifneeded.

Nutrition inormation: Calories 206, otal Fat 4.5g, Saturated Fat 1.5g,

Polyunsaturated Fat 0.0g, Monounsaturated Fat 0.0g, Cholesterol 19mg,

Sodium 440mg, Carbohydrates, 30g, Fiber 5g, Sugars 9g, Protein 16g


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Lemon-CurriedBlack-EyedPeaSaladServes8

In a medium bowl, combine salad ingredients. Set aside. In a jar with a tight-tting lid, combine dressing ingredients. Cover and shake well. Pour dressing

over black-eyed pea mixture. Stir until well-coated. Cover and rerigerate or

1 to 24 hours.

Nutrition inormation: Calories 80, Carbohydrate 15g, otal Fat 1g,

Saturated Fat 0g, Polyunsaturated Fat 0g, Monounsaturated Fat 0g,

Cholesterol 0mg, Sodium 62mg

PearandGoatCheeseSaladServes8:1pearhalfperserving

cup pecans (about 1 ounce)

3 to 4 cups chopped or torn salad greens

4 Bartlett or Anjou pears

2 ounces goat cheese or chevre

2 bsp balsamic vinegar

1 tsp sugar (optional)

1 bsp olive oil

In a small skillet, dry-roast pecans over medium heat or 1 to 5 minutes,

stirring requently. Finely chop. Meanwhile, arrange cup salad greens on

each o eight plates; set aside. Cut pears in hal lengthwise. With a melon baller,

remove seeds and make a small round cavity in each pear hal. Cut the cheese

into eight pieces and shape each into a ball. Roll in pecans and place one in

each pear cavity. Arrange pears on lettuce. Pour vinegar into a small bowl, add

sugar and whisk until dissolved. Add oil in a ne stream, whisking constantly

until smooth. Drizzle evenly over pears and sprinkle any remaining pecans.

Nutrition inormation: Calories 111, Protein 2g, Carbohydrates 14g, Fiber

3g, Cholesterol 3mg, otal Fat 6g, Saturated Fat 1g, Polyunsaturated Fat 1g,

Monounsaturated Fat 3g, Sodium 28mg

Salad:

15-ounce can black-eyed peas,rinsed and drained

11-ounce can no-salt-added

whole kernel corn, drained

cup chopped red onion

cup thinly sliced celery

(1 to 2 stalks)

1 tsp nely shredded lemon peel

Dressing:

2 bsp resh lemon juice1 bsp water

1 tsp olive oil

1 clove garlic, minced, or tsp

bottled minced garlic

tsp curry powder

tsp Dijon mustard

tsp pepper


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Double-OnionSoupServes6:1cupperserving

Olive oil spray

2 tsp olive oil2 cups (about 10 ounces) thinly sliced yellow onion, halved

1 cup (about 5 ounces) thinly sliced red onion, halved

tsp sugar

4 cups at-ree, low-sodium chicken broth

2 to 3 bsp dry sherry or dry red or white wine (regular or nonalcoholic)

1 bsp Worcestershire sauce (lowest sodium available)

3 medium garlic cloves, crushed or minced

tsp dried sage or dried oregano, crumbled

tsp pepper (white preerred)

Lightly spray a large saucepan with olive oil spray. Add the oil, swirling to coat

the bottom. Cook the onions over medium-low heat or about 20 minutes or

until sot and amber colored, stirring occasionally. (Dont rush this step it is

the key to the soups avor.)

Stir in the sugar. Increase the heat to medium and cook or 5 minutes, stirring

requently. Stir in the remaining ingredients. Increase the heat to high and

bring to a boil. Reduce the heat and simmer, covered, or 20 minutes.Nutrition inormation: Calories 52, otal Fat 1.5g, Saturated Fat 0.0g, rans

Fat 0.0g, Polyunsaturated Fat 0.0g, Monounsaturated Fat 1.0g, Cholesterol

0mg, Sodium 46mg, Carbohydrates 7g, Fiber 1g, Sugars 3g, Protein 2g


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AsparagusSaladwithLemon-GarlicDressingServes4:6asparagusspearsperserving

2 bsp at-ree sour cream

1 bsp low-at buttermilk or at-ree milk1 tsp grated lemon zest

1 medium garlic clove, minced

24 medium asparagus spears, trimmed

Poppy seeds (optional)

In a small bowl, stir together the sour cream, buttermilk, lemon zest and

garlic. Cover and rerigerate until serving time.

In a large saucepan or skillet, pour in enough water to barely cover the

asparagus (but dont add the asparagus yet). Bring the water to a boil overhigh heat. Add the asparagus and cook or 5 minutes or until crisp-tender.

Drain in a colander. Rinse with cold water and drain well. I desired, cut on

the diagonal into bite-size pieces. ranser to a serving bowl.

Add the dressing, tossing gently to coat. Lightly sprinkle with poppy seeds.



Cholesterol 1mg, Sodium 10mg, Carbohydrates 7g, Fiber 3g, Sugars 3g,Protein 3g


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Appetizers

GrilledVegetableQuesadillas

Serves4Vegetable oil spray

1 ear o corn, shucked and desilked

1 red bell pepper, cut in hal, seeds and ribs removed

1 medium yellow squash, end trimmed, cut in hal lengthwise

small onion

4 ounces shredded low-at Monterey Jack cheese (about 1 cup)

1 Italian plum tomato, diced

2 tsp lime juice tsp chili powder

tsp pepper

4 six-inch corn tortillas

cup low-sodium salsa

cup nonat or low-at sour cream

Using vegetable oil spray, lightly spray all surace areas o corn, bell pepper,

squash and onion. Over medium-hot coals (or medium-high heat i using gas,

electric, propane or stove-top grill), grill corn on all sides until done, about 2minutes per side. Bell pepper, squash and onion should take 1 to 2 minutes.

Place vegetables on a cutting board and let cool or about 10 minutes.

Dice bell pepper, squash and onion and place in a medium bowl. Using a

sharp knie, slice corn kernels o cob. Stir corn, cheese, tomato, lime juice,

chili powder and pepper into vegetable mixture. Set aside. Preheat a nonstick

griddle or cast-iron skillet over medium heat. Using vegetable oil spray, lightly

spray one side o a tortilla. Place tortilla, sprayed side down, on the griddle.

Spread a heaping cup vegetable-cheese mixture on hal o the tortilla. Foldthe other hal o the tortilla over the lling. Cook or 1 to 2 minutes on each

side, or until tortilla is golden-brown and cheese is melted. Remove and place

on a cutting board. Repeat with remaining tortillas and lling. o serve, cut

quesadillas in hal and place on a serving platter. op each quesadilla with 1

tablespoon each o salsa and sour cream.

Nutrition inormation: Calories 183, Protein 10g, Carbohydrate 30g, otal

Fat 4g, Saturated Fat 2g, Polyunsaturated Fat 1g, Monounsaturated Fat 1g,

Cholesterol 9mg, Sodium 161mg


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CucumberandAvocadoDipServes12:2Tbspperserving

1 medium cucumber

1 small avocado (about 4 oz) cup at-ree or light sour cream

2 tsp snipped resh dill weed or tsp dried, crumbled

1 tsp grated lime zest

1 bsp resh lime juice

tsp salt

Peel the cucumber and cut in hal length-wise. Using a spoon, remove and

discard the seeds. Cut the cucumber into 1-inch slices. Peel and dice the

avocado. In a ood processor or blender, process all the ingredients untilsmooth. Serve immediately or cover and rerigerate or up to 2 days.

Nutrition inormation: Calories 23, otal Fat 1.5g, Saturated Fat 0.0g, Poly

0.0g, Mono 0.0g, Cholesterol 1 mg, Sodium 54mg, Carbohydrates 2g, Fiber

1g, Sugar 1g, Protein 1g

Chili-CheeseStuffedMushroomsServes8:3mushroomsperserving

24 medium button mushrooms (about 1 pound), stems discarded

Vegetable oil spray

1 4- or 4.5-ounce can chopped green chiles, rinsed and drained

cup shredded, reduced-at sharp cheddar cheese (about 2 ounces)

Preheat the oven to 400 degrees. Line a baking sheet with aluminum oil.

Place the mushrooms with the stem side down on the oil. Lightly spray the

mushrooms with the vegetable oil. Bake or 10 minutes. ranser the baking

sheet to a cooling rack. urn the mushrooms over. Fill each with the chiles.

Sprinkle with the cheddar. Bake or 5 minutes or until the cheddar is melted.

Remove rom the oven and let stand or 3 minutes to absorb avors.

Nutrition inormation: Calories 35, otal Fat 1.5g, Saturated Fat 1g,

Polyunsaturated Fat 0g, Monounsaturated Fat 0.5g, Carbohydrates 2g, Sugars

0g, Fiber 1g, Cholesterol 4mg, Protein 4g, Sodium 96mg


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Entrees

GreekFishFilletswithFreshTomatoes

Serves4:3ouncesshperserving2 bsp olive oil

1 large rib o celery, chopped

cup chopped onion

3 large garlic cloves, crushed or minced

10 to 12 ounces Italian plum (Roma) tomatoes, chopped

1 small carrot, thinly sliced

1 small bay lea

tsp pepper tsp (heaping) ground cinnamon

tsp salt

4 thin mild sh llets, such as sole, cod or tilapia (about 4 ounces each),

rinsed and patted dry

1 to 2 bsp resh lemon juice

Snipped resh parsley (optional)

In a large skillet, heat the oil over medium heat, swirling to coat the bottom.

Cook the celery, onion and garlic or about 2 minutes, stirring constantly,adjusting the heat i necessary so the mixture doesnt brown. Stir in the

tomatoes, carrot, bay lea, pepper, cinnamon and salt. Cook or 5 minutes.

Make 4 depressions in the tomato mixture. Place the sh in the depressions.

Spoon the tomato mixture over the sh to cover. Cook or 3 to 5 minutes, or

until the sh is almost done (there should be just a little resistance when you

try to ake the sh with a ork). Remove rom heat.

Drizzle the sh with the lemon juice. Let stand, covered, or about 5 minutes

so the sh nishes cooking and the avors blend. Discard the bay lea.

Garnish with the parsley.



Cholesterol 53mg, Sodium 181mg, Carbohydrates 7g, Fiber 2g, Sugars 4g,

Protein 20g.


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CrunchyBakedSoleServes4:3ouncesshperserving

4 resh sole llets (about 4 ounces each), rinsed and patted dry

2 bsp resh lime juiceCooking spray

cup all-purpose our

cup egg substitute

1 cup panko or plain dry bread crumbs

tsp garlic powder

tsp onion powder

tsp pepper

Put the sh in a shallow casserole dish. Pour the lime juice over the sh. urnto coat. Cover with plastic wrap and rerigerate or 15 minutes, turning once.

Meanwhile, preheat the oven to 400 degrees F. Lightly spray a baking sheet

with cooking spray.

Put the our on a plate and pour the egg substitute into a shallow bowl. On

a separate plate, stir together the remaining ingredients. Set in a row with the

baking sheet. Remove a llet rom the lime juice and dip in the our, turning

to coat and gently shaking o any excess. Dip in the egg substitute, turning to

coat and letting any excess drip o. Dip in the panko mixture, turning to coatand gently shaking o any excess. Place on the baking sheet.

musc nutrition guide

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