Step by Step: Chapter 3

Go!
How to Change Your Eating Habits & Be More Physically Active
Go to:
Follow the Daily Food Guide for Heart-Healthy Eating
Shop for Foods Low in Saturated Fat and Cholesterol
Food Groups
If You Also Have High Blood Pressure, Watch Your Sodium, Too
Read Food Labels
Cook the Lowfat Way
Eat Right When Eating Out
Eat Right at Social Events
Look at the Sample Menus
Fit Physical Activity Into Your Routine
Lose Weight the Sensible Way
For More Help

Follow the Daily Food Guide for Heart-Healthy Eating

So far, we've been talking about general rules for heart-healthy eating, and things like percent of calories from fat and grams of saturated fat. But what it all boils down to is the foods you eat. Here's a list of the food groups to choose from when you plan your new way of eating. Be sure to note the number of servings and serving sizes.

Turn back to the checklist of your current eating habits in (MEDFICTS). As you read through the shopping and cooking tips for each food group in the next sections, look to see where you need to make changes. Think about how you can change your eating habits so that you can meet your goal to eat in a heart-healthy way.

Daily Food Guide

Food Group	Number of Servings	Serving Size
Lean meat, poultry, fish, & shellfish	Step I: 6 ounces or less Step II: 5 ounces or less	N/A
Skim/low fat dairy foods	2-3	1 cup skim or 1% milk; 1 cup nonfat or low fat yogurt; 1 ounce low fat or fat free cheese that has 3 grams of fat or less in a serving
Eggs	Step I: 4 yolks per week* Step II: 2 yolks per week*	N/A
Fats and oils	6-8*	1 tsp. margarine or vegetable oil; 1 tbsp. salad dressing; 1 ounce nuts
Fruits	2-4	1 piece fruit; ˝ cup diced fruit; ž cup fruit juice
Vegetables	3-5	1 cup leafy or raw; ˝ cup cooked; ž cup juice
Breads, cereals, rice, pasta; dry peas & beans; grains; potatoes	6-11	1 slice bread; ˝ bun, bagel, muffin; 1 ounce dry cereal; ˝ cup cooked cereal, dry peas or beans, potatoes, rice or other grains; ˝ cup tofu
Sweets and snacks	Every now & then	N/A

*Includes food preparation. For fats and oils, includes salad dressings & nuts.

To help you compare the Step I and Step II diets, here's how they differ:

The Step II diet calls for smaller amounts from the meat and egg groups. Also, the Step II diet allows only the leanest cuts of meat, fish, and poultry.

The Step II diet allows more servings of vegetable fats and oils (unsaturated fats) since total calories from fat remain at about 30 percent, and saturated fat is cut back.

Remember that the food choices in the Step I diet are similar to those for the entire family (except infants under age 2). However, adults with high blood cholesterol need to be especially careful to keep the saturated fat low and may need special help to stay on their diets.

Shop for Foods Low in Saturated Fat and Cholesterol

Now that you know more about what to eat to lower your blood cholesterol, it's time to stock the kitchen. This part of the booklet is divided into the same food groups as the "Daily Food Guide" table to help you make out your grocery lists.

See the shopping list for help in choosing heart-healthy foods at the market. Remember to eat foods from the different groups each day as well as a variety of foods from within each group to get all the nutrients you need.

Food Groups

For information and tips on each of the following food groups, access the appropriate link:

Meats, Poultry, Fish, & Shellfish
Dairy Foods
Eggs
Fats & Oils
Fruits & Vegetables
Breads, Cereals, Pasta, Rice & Other Grains, and Dry Peas & Beans
Sweets & Snacks

If You Also Have High Blood Pressure, Watch Your Sodium, Too

If you have high blood pressure along with high blood cholesterol, you should choose lower-sodium foods from each group. Many low fat foods are naturally low in sodium, but there are some you should watch out for, like regular canned vegetables and soups, some crackers, breads and cereals, pickles, and soy sauce. Check out the chart "Sodium Content of Heart-Healthy Foods" to compare the amount of sodium in some foods that are also low in saturated fat and cholesterol.

Read Food Labels

We've already mentioned that reading food labels will help you choose foods low in saturated fat, cholesterol, calories, and sodium. What will the labels tell you? Food labels have two important parts: the nutrition information and the ingredients list. Also, some labels have different claims like "low fat" or "light." Here's a closer look at labels and some tips:

1. Read the nutrition information.

Look for the amount of saturated fat, total fat, cholesterol, and calories in a serving of a product. Compare similar products to find the one with the smallest amounts. If you have high blood pressure, do the same for sodium.

2. Look at the ingredients.

All food labels list the product's ingredients in order by weight. The ingredient in the greatest amount is listed first. The ingredient in the least amount is listed last. So, to choose foods low in saturated fat or total fat, limit your use of products that list any fat or oil first -- or that list many fat and oil ingredients. If you are watching your sodium intake, do the same for sodium or salt. Use the chart below to find the sources of saturated fat and cholesterol in foods as they may appear in the list of ingredients.

Sources of Saturated Fat & Cholesterol

Animal fat	Cream	Palm kernel oil
Bacon fat	Egg and egg-yolk solids	Palm Oil
Beef fat	Ham fat	Pork fat
Butter	Hardened fat or oil	Turkey fat
Chicken fat	Hydrogenated vegetable oil	Vegetable oil*
Cocoa butter	Lamb fat	Vegetable shortening
Coconut	Lard	Whole-milk solids
Coconut oil	Meat fat	*Could be coconut or palm oil

3. Know what the claims mean.

Besides the ingredients list and the nutrition information that are on all packaged foods, you'll see certain claims on some food packages. These claims include words like "light" and "low fat" and are regulated by the government. To figure out what the claim on a food label means, access Table 14: The Low-Down on Food Label Claims.

Food Shopping -- TRY IT!

Check off one of these things to try. Do it today!

I'll check the labels on the canned and packaged foods in my cupboards. If they have any of the saturated fat and cholesterol sources, shown in the chart above, I'll buy foods that are lower in saturated fat and cholesterol next time.

I'll tuck the shopping list into my wallet or purse right now-and I'll use it at the grocery store when I shop.

Cook the Lowfat Way

By following the shopping tips we just talked about, you can stock your kitchen with great tasting foods that are low in saturated fat and cholesterol. Now it's time to cook the low fat way. For information and tips on cooking to cut down on saturated fat and cholesterol for each of the following food groups, access the appropriate link:

Meats, Poultry, Fish, & Shellfish
Sauces, Soups, & Casseroles
Seasonings & Condiments
Convenience Foods

New Ways to Use Old Recipes

There are lots of special cookbooks and recipe booklets to help you with low fat cooking. But maybe you have a favorite cookbook that you've been using for years. You don't have to throw it out -- just cut down on the high fat ingredients and substitute ingredients lower in fat or saturated fat as much as possible.

Fat-Saving Recipe Substitutions

Instead of...	Use...
Whole milk	Skim or 1% milk
Evaporated milk	Evaporated skim milk
Light cream	Equal amounts 1% milk & evaporated skim milk
1 cup butter	1 cup margarine or ²/₃ cup vegetable oil*
Shortening	Margarine*
Mayonnaise	Nonfat or light mayonnaise or salad dressing
1 whole egg	¹/₄ cup egg substitute or 2 egg whites
Cheese	Low fat cheese
Sour cream	Nonfat or low fat sour cream or yogurt
Fat for "greasing" pan	Nonstick cooking spray


*Note: The texture of baked goods may be different when you use these substitutions. Experiment to find out what works best for you.

Recipe Substitutions -- TRY IT!

Check off one of these things to try. Do it today!

The next time I bake, I'll use two egg whites for each whole egg, and I'll use margarine or oil instead of butter.

I'll switch from regular mayonnaise to light mayonnaise.

I'll make dips with nonfat yogurt instead of sour cream.

I will try to make puddings with skim or 1 percent milk instead of whole or 2 percent milk.

Eat Right When Eating Out

Eating out while following a heart-healthy diet is getting easier: Many restaurants have at least some menu items that are low in saturated fat and cholesterol. Here are some menu items to choose -- and some to decrease:

Choosing Menu Items

Breakfast

Choose:	Decrease:
egg substitute	egg yolks, any style
hot or cold cereal	fried potatoes
toast with margarine and jam	bacon or sausage
English muffin w/ nonfat cream cheese	biscuit, croissant, or sweet roll
fruit or juice

Lunch

Choose:	Decrease:
salad (with dressing on the side)	deluxe sandwiches
regular-sized hamburger (hold the mayo)	hot dog or sausage
turkey, chicken, or roast beef sandwich	fried chicken or fish
soup (other than cream-based)	cream-based soups
	french fries, onion rings, chips

Dinner

Choose:	Decrease:
pasta with low fat sauce	prime rib
grilled or broiled fish or skinless chicken	untrimmed steaks or chops
lean steak, trimmed of fat	fried chicken
vegetarian entree (little or no cheese)	cream sauce or gravy
baked potato w/ a little margarine	fried fish
low fat desserts -- such as fresh fruit, sorbet, sherbet, or nonfat frozen yogurt	rich desserts -- such as cake, cheesecake, tortes, etc.

Here are more tips for eating out:

Choose restaurants that have low fat, low cholesterol menu choices. And don't be afraid to make special requests: it's your right as a paying customer.
Control serving sizes by asking for a small serving, sharing a dish with a companion, or taking some home.
Ask that gravy, butter, rich sauces, and salad dressings be served on the side. That way, you can control the amount you eat.
Ask to substitute a salad or baked potato for chips, fries, or other extras -- or just ask that the extras be left off your plate.
When ordering pizza, choose vegetable toppings like green pepper, onions, and mushrooms instead of meat toppings or extra cheese.
At fast food restaurants, go for salads, grilled (not fried or breaded) chicken sandwiches, regular-sized hamburgers, or roast beef sandwiches. Go easy on the regular salad dressings and fatty sauces. Limit jumbo or deluxe burgers or sandwiches.
At the salad bar, fill up on vegetables. Limit foods like eggs, bacon, and cheese, and prepared salads like potato or macaroni salad. Go easy on the salad dressings -- and choose low-calorie dressing or oil and vinegar when it's offered.
Try different ethnic cuisine's. Many such as Chinese and Middle Eastern offer lots of low fat choices.

Eating Out -- TRY IT!

Check off one of these things to try. Do it today!

The next time I go out for lunch, I'll try a regular hamburger instead of the deluxe -- and save on saturated fat and cholesterol.

The next time I order pizza, I'll spice it up with vegetable toppings instead of fattier meat toppings like sausage or pepperoni.

The next time I'm out for dinner, I'll ask that salad dressing and other sauces be served on the side. To cut down on fat, I'll use just a little bit.

Eat Right at Social Events

Eating at social events like parties, receptions, family gatherings, and church socials can be a challenge to your heart-healthy eating style. Since you can't control what is served, you may feel pressured to eat foods high in saturated fat and cholesterol.

Here are some tips that will help you eat healthfully at social events:

At a buffet, look ahead in line to see what low fat foods are available. Fill up on low fat items and take only small servings of high fat foods.
Bring a low fat dish to a potluck dinner. That way, you'll have at least one low fat item from which to choose.
At parties, focus on activities other than eating. Sit away from the area where the food is being served so you won't be tempted to overeat.
Ask for help from your family and friends who know you are following a cholesterol-lowering diet. See if they will include some low fat dishes instead of the high fat favorites.
Have a few ready answers to politely say no to high fat foods. For example, "thank you, but I couldn't eat another bite -- everything was delicious."
If you do eat too many high fat foods at a social event, don't feel guilty. Just eat lightly the next day and get back on track.

Look at the Sample Menus

Now that you are an expert on what foods from the different food groups fit into the Step I and Step II diets, let's get down to the nitty gritty to see how to fit this into what to eat for a whole day. Here are some sample menus to give you some ideas to get started. There are three menus: one for traditional American-style foods, one for Southern-style foods, and one for Mexican American-style foods.

For each style of food there are menus at two different calorie levels -- the average American man eats about 2,500 calories a day and the average American woman eats about 1,800 calories a day. For each of these calorie levels there is a menu that follows the guidelines for the Step I and Step II diets. So choose the kind of food you like, how many calories you should be eating, and which diet you need to follow:

American-style
Southern-style
Mexican American-style

Check Your Menu IQ

Which menu item is the lower-fat selection?

1)	Lean roast beef sandwich OR Chicken salad sandwich
2)	Cream of broccoli soup OR Minestrone


1) Answer: The lean roast beef sandwich is usually lower in fat. You can also ask that no mayonnaise, margarine, or butter be put on the sandwich roll. While a plain chicken sandwich would also be a good low fat choice, commercially made chicken salad usually is made with lots of regular mayonnaise, which adds fat calories.
2) Answer: The minestrone is the lower-fat choice: clear, broth-based soups are almost always lower in fat than cream-based soups. Both soups could be high in sodium, so you might want to skip soup if you're trying to lower high blood pressure.

Fit Physical Activity Into Your Routine

Being physically active helps improve your blood cholesterol levels. It can also help you lose weight, if you are overweight (see Table 13: Calories Burned During Physical Activities). But you don't have to train like a marathon runner to benefit from physical activity! Any exercise, even if it's done for just a few minutes each day, is better than none at all.

You can fit physical activity into your daily routine in small but important ways.

Be More Active Every Day

Take a walk.

Use the stairs.

Get off the bus one or two stops early and

walk the rest of the way.

Park farther away from the store.

Ride a bike.

Work in the yard or garden.

Go dancing.

And being active together is great for the whole family: take trips that include hiking, swimming, or skiing. Use your backyard or park for basketball, baseball, football, badminton, or volleyball games.

Regular, vigorous physical activity -- called "aerobic" -- is especially good for your heart and can burn off extra calories. In aerobic activity, the body uses oxygen to produce the energy needed for the activity. Some aerobic activities are swimming, brisk walking, running, and jumping rope. This type of activity can condition your heart and lungs if you do it for at least 30 minutes, three to four times a week. But even if you don't have 30 minutes for an activity break, try to find two 15-minute periods or even three 10-minute periods. See Table 12: A Sample Walking Program to help you get started.

Lose Weight the Sensible Way

If you are overweight, losing even a small amount of weight -- 5 to 10 pounds -- can improve your blood cholesterol levels. But don't go on a crash diet to see how quickly you can lose those pounds. The healthiest and longest-lasting weight loss happens when you take it slowly, losing 1/2 to 1 pound a week. Like a cholesterol-lowering diet, a weight-loss diet is really a new way of eating for life.

The eating plans in this booklet easily lend themselves to weight loss because cutting down on fat is a good way to cut down on calories. And you should take care to eat foods high in starch and fiber (like vegetables, fruits, and breads and cereals) instead of high fat foods. Choose low fat and low calorie items from each food group; the food charts in the back of the booklet will help. Finally, in addition to the kinds of foods you eat, you'll have to limit the amount -- or serving sizes -- as well.

But there's more to losing weight than just eating fewer calories. The most successful weight-loss programs seem to be those that combine changes in what you eat and increased physical activity. Combining changes in eating and physical activity leads to greater weight loss than either way achieves alone.

When to Play It Safe

Most people don't need to see a doctor before they start to be physically active, since a gradual, sensible activity program has few health risks. But you should check with your doctor first if you:

have a medical condition;
have pains or pressure in the chest and shoulder area;
tend to feel dizzy or faint;
get very breathless after mild exertion; or
are middle-aged or older, have not been physically active, and plan a fairly vigorous activity program.

Some people lose weight on their own. But others like the support of a structured program. If you are interested in enrolling in a weight-loss program, here are some things you should ask about:

Does the program include working with you to help change your eating, activity, and personal habits?
Is counseling offered? How much?
Is the staff made up of a variety of qualified counselors and health professionals such as nutritionists, registered dietitians, doctors, nurses, psychologists, and exercise physiologists?
Is there training on how to deal with times when you may feel stressed and slip back to your old habits?
Is attention paid to keeping the weight off? How long is this phase?
Are food choices flexible and suitable? Are weight goals set by the client and the health professional?

Physical Activity -- TRY IT!

Check off one of these things to try. Do it today!

Instead of using the elevator, I'll try walking up the escalator or even the stairs.

I'll take a walk after dinner instead of watching television.

I'll choose a parking space at the far end of the lot instead of one closer to the door.

There are some other questions you can ask about how well a program works. You may not get answers, because many programs don't gather this information. But it's still important to ask:

How many people who start the program finish it?
How much weight do people who finish the program lose?
How much weight do people keep off at 1, 3, and even 5 years?
How many people have problems or side effects-and what are they?

Remember: quick weight-loss methods don't yield lasting results! Weight-loss methods that rely on diet aids like drinks, prepackaged foods, or diet pills don't work in the long run. Whether you lose weight on your own or with a group, remember that the most important changes are long term. No matter how much weight you have to lose, modest goals and a slow course will increase your chance of both losing the weight and keeping it off.

Habits Are Made to be Broken

Here's a good tip to help you control or change your eating habits:

Keep track of what you eat, and when you eat by writing it down. Note whether you snack on high fat, high calorie foods in front of the television, or if you skip breakfast and then eat a large lunch.
Once you see your habits, you can set goals for yourself: Cut back on TV snacks and, when you do snack, have fresh fruit, unsalted popcorn, or unsalted pretzels.
If there's no time for breakfast at home, take a low fat muffin, bagel, or cereal with you to eat at work. Changing your behavior will help you change your weight for the better.

For More Help

Designing a new eating plan. If you want more help in planning a Step I or Step II diet, make an appointment with a registered dietitian or other qualified nutritionist. They can help you design an eating plan for your own needs and food likes. The help of a dietitian or qualified nutritionist is especially important if you are following a Step II diet. To find a registered dietitian, contact:

The National Center for Nutrition and Dietetics' Consumer Nutrition Hotline at 1-800-366-1655;
Your local hospital and/or public health department; or
Your doctor.

Starting An Activity Program. If you'd like to find out more about how to increase your physical activity, help is only a phone call away. Check your local parks and recreation department or YMCA to locate nearby gyms, parks, walking/biking trails, or exercise classes. Check your local shopping mall too; many malls open early or stay open late for people who want to walk there.

Reading More About It. If you would like more written material about cholesterol, healthy eating, and physical activity, write the National Cholesterol Education Program (NCEP) of the National Heart, Lung, and Blood Institute at the address on the next page. The advice in this publication is for adults who want to lower their blood cholesterol level. This resource is part of a series from the National Cholesterol Education Program (NCEP). For more information, consult other publications from the NCEP:

	"So You Have High Blood Cholesterol" gives more detailed information to answer the basic questions about high blood cholesterol;
	"Exercise and Your Heart: A Guide to Physical Activity" tells you more about physical activity and how to get started; and
	other resources for children with high blood cholesterol and their parents.

To request more information and a catalog of publications, contact:

National Cholesterol Education Program
NHLBI Information Center
P.O. Box 30105
Bethesda, MD 20824-010

The American Heart Association can also provide you with additional information. Contact your local American Heart Association or call 1-800-AHA-USA1 (1-800-242-8721).

Home | Previous: Chapter 2 | Next: Tables