ndr-uk heart health resources update peer review pack draft... · 200304 draft healthy eating...

1 | P a g e 200304 DRAFT Healthy Eating Heathy Heart (Peer Review)

NDR-UK Heart Health Resources – Update

Peer Review Pack

Contents

Page

• Health Eating Healthy Heart 2

Resource Aims The resource aims to improve the target group’s knowledge and understanding of the main dietary factors for primary and secondary prevention of CVD. Learning Outcomes The target group (TG) will:

• understand the common risk factors of CVD

• understand how to make dietary changes to decrease CVD risk/further CVD events and improve overall health

• know what a Mediterranean diet is, how to have a Mediterranean diet and be more aware of the benefits

• know the different types and sources of fat in the diet and their effect on cardiovascular health

• know the benefits of fibre and how to include more fibre in the diet

• know the benefits of reducing salt and alcohol intake

• understand food labels.


Title: Healthy Eating Healthy Heart *Front page*


This booklet provides guidance on how to make dietary changes to help keep your heart healthy. The advice will help you lower your risk of developing cardiovascular disease and help prevent further complications.

What is cardiovascular disease? Cardiovascular disease (CVD) is a term used to describe diseases of the heart and blood vessels. It begins when blood vessels, known as arteries, become blocked or narrowed because of a build-up of fatty deposits. Examples of conditions caused by these blockages include heart attack, angina and stroke.

*Image* *Image*

You can’t change all your risk factors, but there are many things you can do to protect your heart. Making good choices about your food and drink can reduce your risk of developing CVD and help prevent further complications if you have CVD. Changing your diet can reduce your blood pressure, cholesterol, triglycerides and weight, if needed. Making successful changes to your diet takes time. Begin slowly and stick with it and you will have a healthier heart. If you take prescribed medication, you must continue to do so while making these additional changes.

Normal blood flow

inside an artery

Fatty deposits

building up

Controllable risks

• High blood pressure (hypertension).

• Raised blood cholesterol. • Raised blood triglyceride levels. • Being inactive. • Being overweight, obese or having

an increased waist size. • Smoking. • Poorly controlled diabetes.

Uncontrollable risks

• Being male. • Having a family history of

premature heart disease. • Being of South Asian, African

or African Caribbean origin. • Age.


What should I eat to keep my heart healthy? A Mediterranean style of diet has a protective effect on heart health. The focus is on cooking with fresh ingredients and using herbs and spices to flavour food rather than salt. A Mediterranean diet includes:

Modifying your fat intake Some fat in the diet is essential, but some fats are better for your heart health than others. There are two main types of fat found in foods:

• Saturated fat – eating too much can increase your blood cholesterol and risk of having CVD. Saturated fat is mainly found in animal products, such as lard, butter, ghee, cakes, biscuits, full-fat dairy products, take-away meals and in processed foods such as pies and pastries.

• Unsaturated fats – healthier fats that are usually from plant-based sources and in the form of liquid or oil. Examples include olive, rapeseed and vegetable oils.

Generally, we are eating too much saturated fat and need to reduce our intake. A Mediterranean diet is low in saturated fat. Swapping from saturated fats to unsaturated fats can help reduce cholesterol in the blood and reduce your risk of CVD.

What is cholesterol? Cholesterol is an essential fatty substance. There are two types of cholesterol in your body.

• HDL cholesterol protects you from having CVD.

• LDL is harmful and too much can increase your risk of having CVD. It is important to try and have high levels of HDL cholesterol and low levels of LDL cholesterol in your blood. You can do this by eating a healthy balanced diet that is low in saturated fat.

Less of:

• Red and processed meat

• Saturated fat

• Salt

• Sugar

Plenty of:

• Fruit and vegetables

• Wholegrain cereals

• Fish

• Pulses

• Nuts and seeds

Some:

• Dairy products

• Plant oils


Follow the advice in this resource to help reduce your saturated fat intake and keep your heart healthy. Eatwell Guide The Eatwell Guide shows the food groups that form a balanced healthy diet. It includes foods in a Mediterranean diet. Aim to eat foods in the proportions shown to get the balance right and keep your heart and body healthy.


Potatoes, bread, rice, pasta and other starchy carbohydrates Carbohydrate is our main source of energy. Aim to include some carbohydrate at each meal. Choose higher-fibre wholegrain varieties to keep you feeling fuller for longer. Soluble fibre can help to reduce cholesterol levels: this type of fibre is found in foods including oats, barley and rye.

Top Tips:

• Start the day with a wholegrain breakfast cereal; choose one lower in salt and sugar, e.g. porridge, Weetabix, shredded wheat, All Bran.

• Have a sandwich for lunch – choose wholemeal, granary, rye or seeded bread.

• Round off the day with potatoes, pasta or rice as the base for your meal. Try leaving the skins on potatoes, choose brown rice or whole-wheat pasta to boost fibre intake.

• If adding oils or spreads, choose unsaturated options and use in small amounts (see page X for more information).

Fruit and vegetables Aim to eat at least five different portions of fruit and vegetables daily. They are a good source of vitamins, minerals and fibre. Fruit and vegetables make great snacks and can also be used to bulk up meals.

A portion is roughly 80g or a handful: fresh, frozen, dried or canned varieties all count.

• 1 medium sized fruit, e.g. apple, orange, pear or banana.

• 2 smaller fruits, e.g. 2 plums, 2 satsumas or 2 kiwi fruits.

• 1 handful of berries or grapes.

• 1 tablespoon of dried fruit.

• 3 tablespoons of canned fruit (choose canned fruit in juice instead of syrup).

• Small bowl of salad or soup containing vegetables beans and/or pulses.

• 3 heaped tablespoons of vegetables or legumes, e.g. chickpeas, lentils or kidney beans.

• A small glass (150ml) of pure, unsweetened fruit or vegetable juice.


Beans, pulses, fish, eggs, meat and other proteins These foods are good sources of protein, iron and are rich in vitamins and minerals. Aim to include a food from this group twice a day.

Beans and pulses

• These are good alternatives to meat as they are naturally low in fat, high in soluble fibre and protein.

• Aim to include three servings weekly e.g. tinned chickpeas added to salad, lentil soup or kidney beans in chilli.

Fish

• Aim to have 2-3 servings of fish each week, including 1 serving of oily fish.

• Oily fish such as salmon, sardines and mackerel are high in omega 3 which can help protect your heart health.

• Fresh, frozen or canned fish all count.

• Avoid breaded and battered fish as these are higher in fat. Avoid fish canned in brine and smoked fish as these are high in salt. Choose plain varieties and add your own flavours.

Eggs

• Cook eggs without fat e.g. boiled or poached.

• There is no limit on how many eggs you can eat unless your healthcare professional advises

otherwise. A portion is 2 eggs.

Meat

• Red meat includes beef, pork, lamb, gammon, mince and burgers.

• Processed meat includes bacon, sausages, and packaged meats such as ham, sausage rolls

and meats in pastry.

• Some meat is high in saturated fat. The type you choose and the way you cook it can make

a difference:

✓ Choose leaner meats and avoid adding extra fat or oil when cooking – grill instead of fry.

✓ Cut the fat off meat and remove the skin from chicken and turkey. ✓ Try to reduce red and processed meat to no more than 70g a day and limit to a

maximum of 3 times a week. ✓ Swap red and processed meat for chicken, turkey, fish or pulses instead.

Nuts and seeds

• These are high in fibre and contain healthy unsaturated fats. They are a healthy snack or great addition to meals.

• Choose unsalted varieties and aim to have a small handful (30g) of plain nuts or seeds at

least 3 times a week.

• Eat no more than a handful at a sitting as they are still high in calories.


Dairy foods and alternatives

This group includes milk and fortified milk alternatives, yoghurt and cheese. Try to have 2-3 servings of dairy products each day as they are a rich source of calcium, vitamins and protein. One serving = 1/3 pint of milk, 125g pot of yoghurt or 30g (small matchbox) of cheese. Some dairy foods can be high in saturated fat, but there are plenty of low-fat options to choose.

• Milk – Choose semi-skimmed or skimmed milk.

• Yoghurt – Go for low fat natural or Greek yoghurt or choose a diet yoghurt which is low in fat and sugar.

• Cheese – Try reduced-fat cheddar or soft options such as reduced-fat cottage cheese. If you like strong hard cheese, cut it thinly or grate it to use less.


Oils and spreads

Choose unsaturated instead of saturated oils and spreads. The following simple swaps will help you. *Images will be added to the table below*

Avoid Choose

Coconut oil (87% saturated fat)

Rapeseed oil (7 % saturated fat)

OR Olive oil (13% saturated fat)

Butter (54% saturated fat)

Olive oil spread (12% saturated fat)

Another good way to reduce your saturated fat intake is to choose lower fat spreads instead of

butter. Examples include Golden Olive, Bertolli and Flora Light.


How to Make Meals More Mediterranean *Image will be added for each meal below* Breakfast Lunch

Instead of Choose

Fried breakfast

Wholegrain toast with mashed avocado and poached egg

Cornflakes

Porridge with berries and flaked almonds

Evening Meal Snacks

Instead of Choose

Beef casserole

Chicken and chickpea stew

Spaghetti Carbonara

Tomato and basil penne pasta

Instead of Choose

Quiche Lorraine

Omelette with Mediterranean vegetables

Ham and cheese on white bread

Tuna salad, low fat salad dressing on granary bread

Instead of Choose

Crisps

Nuts

Fruit scone

Fruit and 0% fat yoghurt


Foods high in fat, salt and/or sugar This includes cakes, biscuits, chocolate, sweets, crisps, ice cream and sugary drinks. Sugar, honey and syrup added to food and drinks are also included in this group. These foods are not needed in the diet. They are high in calories with little nutritional benefit. If you do have them, try to have them less often and in small amounts.

• Try sugar-free soft drinks or no-added-sugar squash. • If you take sugar in hot drinks, reduce it gradually or use a sweetener instead. • Reduce bacon, sausages, smoked meat, cheese, crisps and salted nuts. • Swap sweet pastries, biscuits and cakes for a piece of fruit or crackers instead. • Try reduced-fat mayonnaise, salad cream and dressings, and use only in small amounts.

Salt Eating too much salt can increase your risk of high blood pressure and further increase your risk of coronary heart disease.

Adults are advised to limit salt intake to no more than 6g (1 teaspoon) a day.

Be aware that up to 75% of the salt we eat is already in everyday foods we buy such as bread, breakfast cereals, cheese and sauces.

To reduce your salt intake:

• Try replacing salt with pepper, herbs and spices to flavour foods when cooking.

• Avoid adding salt at the table.

• Reduce ready meals and processed foods as they contain higher amounts of hidden salt – switch to homemade options of favourite dishes and batch freeze for convenience.

• Swap processed meats such as bacon, sausages, smoked meat, and pies for chicken, turkey or fish.

• Choose foods canned in water instead of brine.

• Check food labels and choose products that contain less salt, such as reduced salt stock cubes and soups, or try making your own instead.

• Avoid sea salt, rock salt, garlic salt and Himalayan pink salt – they have the same effect on blood pressure as table salt.

• Avoid salt substitutes as they are usually high in potassium. This can be harmful to people with heart failure or kidney disease.


Fluid Aim to drink 6-8 glasses of fluid every day. Water, lower fat milk and sugar-free drinks including tea and coffee all count. Some people are advised to limit their fluid intake; if you have been advised to follow a fluid restriction, continue to do so until advised otherwise by your Doctor or Nurse. Alcohol

If you enjoy alcohol and can safely include it in your diet, follow sensible guidelines. Alcohol is not recommended for some heart conditions and should not be taken with certain medications. Ask your healthcare professional if you are unsure whether you can include alcohol in your diet. How much can I drink?

• Men and women are advised to limit alcohol intake to no more than 14 units each week. Too much alcohol can increase the risk of high blood pressure, stroke, heart disease, some cancers, liver damage and brain damage.

• If you drink up to 14 units each week, spread this evenly over 3 days or more. Aim to have at least two alcohol-free days a week.

*Image showing what 1 unit of alcohol looks like for a variety of drinks including lager, wine,

spirits.*


Hidden calories in alcohol

Alcoholic drinks are high in calories. Beware, the extra calories in these drinks can quickly add

up, leading to weight gain in the long term. The examples below show how many calories are in

some alcoholic drinks.

*Image showing:

• 1 large glass of wine equivalent to 1 ice cream (228kcals)

• 1 pint of cider equivalent to 1 doughnut (210kcals)

• 2 bottles of beer equivalent to 1 steak (275kcals)

• 2 gin and tonics equivalent to 1 chocolate pancake (150kcals).


A guide to food labelling Checking food labels help us to make food choices that best meet our nutritional needs. Some foods use front of pack traffic light labelling to make it easier to see at a glance how much energy, fat, saturated fat, salt and sugar a food contains.

Many foods will have a mixture of colours on them. When choosing between similar products try to opt for more greens and ambers.

‘Reference Intakes’ indicate how much energy an average adult needs and how particular nutrients fit into their daily diet. Labels often show the amount of nutrients that are in the manufacturer’s suggested portion or serving size. If you are having a small amount out of the pack (e.g. mayonnaise), look at the information per 100g to compare foods. If you are eating larger amounts such as ready meals, sandwiches or yoghurt, look at the amount per portion or serving size. 7 Remember: the portion/serving size on the pack may be different from the size that you eat or drink. Food Per 100g or portion/serving greater than 100g


If you can’t see a colour-coded label or are having a different amount from the suggested portion size, use the nutritional information on the back/side of packet and the table below to help you make a healthier choice.

FOOD Fat Saturates Sugar Salt

Low 3.0g or less 1.5g or less 5.0g or less 0.3g or less

Medium 3.1-17.5g 1.6-5.0g 5.1-22.5g 0.31-1.5g

High More than 17.5g More than 5.0g More than 22.5g

More than 1.5g

FLUIDS Fat Saturates Sugar Salt

Low 1.5g or less 0.75g or less 2.5g or less 0.3g or less

Medium 1.6-8.75g 0.76-2.5g 2.6-11.25g 0.31-0.75g

High More than 8.75g More than 2.5g More than 11.25g

More than 0.75g

Per 100g or portion/serving greater than 100g Tables containing values per 100g food and 100ml fluid. When you go shopping, take care with claims such as “low“ or “reduced” fat or salt as these foods may still be high in other nutrients you are trying to eat less of, such as sugar, fat or salt.

Note: Traffic light labelling does not indicate the fibre content of a product, so you will

need to look at the nutrition label on the back of the product. When comparing

products, choose the one with the higher fibre value.


What other changes can I make to help reduce my risk of developing CVD or further complications? Stop smoking

Smoking seriously increases your risk of having a heart attack/ stroke. Passive smoking increases the risk for people around you of developing CVD. Your healthcare professional will be able to give you advice and support on how to stop smoking. Get active

Being physically active helps reduce the risk of having a heart attack/stroke. Build up to at least 30 minutes of moderate physical activity, for example a brisk walk, at least 5 days of the week. Watch your weight

Being overweight is another risk factor linked to having a heart attack/stroke. Talk to your healthcare professional about how to lose weight, and keep a note of your weight here.

Date Weight Date Weight


Frequently asked questions Q1. Is there any point changing what I eat? I have been given drugs to treat my heart condition.

A. Yes. We know that eating more fruit and vegetables and less saturated fat reduces the risk of coronary heart disease. So changing what you eat is as important as stopping smoking, taking regular exercise or taking your medication.

Q2. Do I need to take any vitamin or mineral supplements? Are there any herbal remedies I could try?

A. If you are eating a healthy diet, then it should not be necessary to take vitamin supplements. Research shows no benefit for people with heart disease who take omega 3, vitamin C, vitamin E, beta-carotene or cod liver oil supplements, alone or in combination.

There is also no clear evidence to support the use of complementary therapies or herbal remedies to reduce your risk of further heart disease. Some herbal remedies can interact with your medicines, so it is always best to check with your GP or health professional before taking any.

Q3. Should I use cholesterol-lowering products, for example, special margarines, yoghurts and cereal bars?

A. Products such as Benecol and Flora ProActiv are specially formulated to lower cholesterol. By using the recommended amounts, they will lower your cholesterol, but they must not be taken instead of cholesterol-lowering medication. They are not routinely recommended, can be expensive and there are other changes you can make to your diet as described throughout this booklet.

Q4. Can I eat eggs? A. Eggs are a rich source of dietary cholesterol which was once believed to affect blood

cholesterol levels. However, it is now known that it is the saturated fat in our food that affects our blood cholesterol. So, it is more important to reduce the amount of saturated fat in your diet.

Eggs and other sources of dietary cholesterol (including liver, shellfish and molluscs), eaten in moderation, should only have a small effect on your blood cholesterol, and can be a part of a balanced diet.


Q5. Will soya products lower my cholesterol?

A. Yes, but to achieve this, large amounts of soya are required which could lead to other complications. Ask your Dietitian for information on safe levels of soya for your health needs.

Q6. Can I take grapefruit while on my statin medication?

A. Grapefruit and grapefruit juice affect some statins as they increase the level of

medication in your blood and can increase side-effects. Whilst it is safe to take

grapefruit with some statin varieties, it is generally safer to avoid grapefruit and

grapefruit juice whilst on statin therapy, in case your GP makes changes to your

prescription.

Q7. Should I have red wine as part of a Mediterranean diet?

A. The benefits of moderate drinking for heart health are not as strong as previously

thought. Drinking more than the recommended amount of alcohol can have a harmful

effect on your heart and general health. Alcohol is also very high in calories and long-

term regular intake can lead to weight gain and further associated health risks.

Therefore, it is recommended that you limit alcohol within safe drinking limits of 14

units per week and reduce further if you are trying to lose weight.

Useful websites British Heart Foundation: www.bhf.org.uk Chest Heart & Stroke Scotland: www.chss.org.uk Heart UK: www.heartuk.org.uk NHS choices: www.nhs.uk


Making changes to your diet? List positive steps to change your diet here:

For further information, please contact:

Dietitian: Telephone no: Remember to bring this book with you to your next appointment. Date Weight

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