Julia Zampano, RD, LD
Friday, May 18, 2012 - Noon
A heart healthy diet can help control cholesterol, blood pressure, blood sugars and weight. Julia Zumpano, RD, LD answers your questions about nutrition and heart healthy diet.
Low Fat Vegan Diet
MikeN: am a 61 yr old male and had a heart attack 12 yrs ago. At that time I totally changed my diet and lifestyle. My most recent lipids were: Total-121, HDL-72, LDL-41, Triglycerides-42, glucose-88. My HDL has been higher than my LDL for the past 7 or 8 years. I was confident I would never again have an issue with a clogged artery. Two years ago a routine physical found a carotid artery blockage over 60%, which progressed to over 80% in one year, resulting in an endarterectomy. I haven't eaten any red meat in well over 10 years, sticking with fish, lean chicken and turkey. In your opinion, based on the lipids above, would a vegetarian or vegan diet likely reverse or slow the progression of the blockage issue better than what I am doing now?
Julia_Zumpano_RD: A low fat vegan diet would help. A very low-fat vegan diet emphasizes whole, unprocessed foods rich in complex carbohydrates, such as whole grain breads, cereals, cooked grains, fruits, and vegetables. All animal meat, fish, and poultry are eliminated. Protein in the diet comes from plant foods such as beans, legumes, lentils, peas, tofu, soy, and nutritional yeast. The diet is high in heart-healthy fiber, vitamins, minerals, antioxidants, and phyto-chemicals. No added fats, oils, or foods high in fat (avocado, olives, nuts, or seeds) are allowed.
Here are four tips that may help you when planning to eat a vegan diet:
- Minimize the intake of heavily refined foods by choosing whole unrefined breads and grains.
- Choose fat-free soy dairy products, soy cheeses, and soy yogurt.
- In order to incorporate many vitamins, minerals, and nutrients, choose from a variety of whole grains, fruits, vegetables, and legumes.
- Build meals around protein sources that are naturally low in fat, such as lentils and beans.
- And one more: Soy-based sausage patties or links, veggie burgers, soy hot dogs, marinated tofu or tempeh, and soy cheese are all low in total fat and saturated fat and contain no cholesterol.
Low Fat, Low Calorie, Healthy Snack Foods
MarileeV: My son had a physical. He is very active, athletic but we have high cholesterol in our family and his cholesterol came out on the high side. Can you tell me some tips for diet for him, snacks for after school or that he can bring to practice.
Julia_Zumpano_RD: Tips for diet include:
- Lower animal fat - meats, cheeses, eggs and dairy. Choose all low fat (1%) and fat free dairy products.
- Choose foods without transfats or hydrogenated oils.
- Increase fiber in the diet. Whole grains, dried beans, fruits and vegetables.
- For after school snacks, you want to avoid snacks that require refrigeration
Here are some 100 calorie snacks:
- ½ whole grain bagel with 1 tbs. light cream cheese
- ½ cup bran cereal with ½ cup blueberries
- ½ cup trail mix with dried cranberries and raw almonds
- 2 tbs. hummus spread with ¼ pita pocket
- medium carrots with 1 tbs. low-fat ranch dressing
Here are some snacks that are less than 200 calories - particularly if he is exercising:
- 3 peanut butter-filled wheat crackers with 6 ounces skim milk
- 1 packet plain oatmeal with 8 oz skim milk
- 1 ounce whole wheat or oat bran pretzels, lightly salted
- 1 Nature Valley crunchy granola bar
- 1 Nature Valley chewy trail mix bar
- 3 cups air-popped popcorn
- 1 ounce dry whole grain cereal
- 1 medium serving of most fruits
- ½ cup fruit canned in own juice or light syrup
- 8 oz of 100% fruit juice
- 6 oz skim milk, ¾ cup diced strawberry and banana, 1 Tbsp chocolate syrup and 1 cup ice blended to make a smoothie
- 1 Tbsp peanut butter spread over a medium apple
- 1 8-oz can reduced sodium V8 juice and 3-6 whole wheat crackers
- 1 cup or more of raw vegetables, your choice
- 1 cup raw vegetables of choice, dipped in 2 Tbsp reduced fat salad dressing
- 1 cup raw vegetables of choice, dipped in ¼ cup hummus
- 1 Tbsp peanut butter spread over 2 celery stalks and topped with 2 Tbsp raisins
- 1 cup cooked vegetables with 1 ounce melted 2% fat cheese
- 1 cup sliced raw or cooked vegetables on top of 2 slices reduced-fat, whole wheat bread with 1 ounce slice of nonfat cheese
This should give you some nice choices.
Heart Failure and Diet
SuzanneH: My mom has heart failure. I know you need to reduce sodium in the diet, but are there things that she should include in her diet to make her heart better or stronger?
Julia_Zumpano_RD: There is no specific food that has been shown through research to strengthen a patient's heart that has heart failure. Although, following a general heart healthy low sodium diet and maintaining a healthy weight has been proven to manage heart failure well. A heart healthy diet is one very low in animal fat, high in fiber, and low in sodium.
Many people with heart failure do have difficulty when starting out with their diet, especially if they need to be on a fluid restriction as well. A consult with a dietitian can be very helpful to get you started on your way.
Weight Loss Diet
Ogden99: Do you know about the diet to lose weight that was online sometime ago called "Cleveland Clinic Diet" - it helped you lose weight - do you still recommend that?
Julia_Zumpano_RD: There is no such thing as "Cleveland Clinic diet". Cleveland Clinic does not endorse a "Cleveland Clinic Diet."
MsDuPont: I have struggled with my weight for many years. I have Type II diabetes and have 3 stents in a heart artery. I have 100 plus pounds to lose. I have tried every diet. Did fairly well on Weight Watchers, but the more carbs I eat, the more I crave them. I am contemplating going on a low-carb diet. Any suggestions to help me be successful?
Julia_Zumpano_RD: The first recommendation would be to meet with a dietitian, especially if you have diabetes for an individualized carb controlled diabetic meal plan.
carolina89: What is the best diet for weight loss? Low carb diet?
Julia_Zumpano_RD: It depends on the person what the best diet is. Overall calorie reduction will produce weight loss regardless if it is coming from fat, carbohydrate or protein. Make an appointment with a dietitian for a more specific plan.
Barbara_CT: Hi. I wrote in before and was told that Cleveland Clinic encourages Mediterranean diet. Is that just a low in fat diet?
Julia_Zumpano_RD: Mediterranean diet provides 25 - 35% of calories from fat although fat choices come from oil, particularly olive oil; fish; nuts; and seeds. The diet is very low in animal fat. It encourages whole grains; fruits and vegetables and minimally processed foods.
fit4life: I am a 59 year old male, 6' 0" tall and 150 Lb. I adhere to a Mediterranean style, plant and fruit-based diet. As part of this diet, I use organic extra-virgin olive oil as a replacement for butter and margarine. I have heard that the recommended daily allowance for extra-virgin olive oil is about two (2) tablespoons. Could you please confirm that this is a safe and recommended consumption? Is there a daily allowance above which the there is no additional health benefit or is unhealthy? Thank you.
Julia_Zumpano_RD: 2 tablespoons is an acceptable serving. The Mediterranean diet recommends no more than 35% of your calories from fat. So on a 2000 calorie diet, 35% fat would = 77 grams of total fat. Although less than 7% of this should be from saturated fat. That is equal to no more than 15 grams of saturated fat per day.
Calcium and Vitamin D in Diet
PeggyS: The other day Dr. Cho talked about getting your calcium through your diet. What are the best sources to get enough calcium in your food?
Julia_Zumpano_RD: Low fat or fat free dairy products such as skim milk; fat free yogurt; cottage cheese (fat free or low fat); low fat cheese. Calcium fortified foods such as soy, almond or rice milk; orange juice fortified; tofu. Plant based sources; leafy greens
LyndaD: If the normal range for Vitamin D is 30.0 to 74.0. Is it better to be on the higher level to prevent osteoporosis? What food or supplements would you recommend for the prevention of osteoporosis?
Julia_Zumpano_RD: Vitamin D is variable. Therefore, keeping within the mid to upper range would help to prevent a deficiency. The best source of vitamin D is the sun. Foods provide limited vitamin D. For prevention of osteoporosis, I would suggest 1000-1400 mg of calcium a day.
Healthy Foods in the News
bonitagirl: can you talk about some of the new products people are talking about like quinoa and chia and acai?
Julia_Zumpano_RD: Quinoa is the only natural plant based source of complete protein. It is an ancient grain which is high in fiber and protein, which helps control appetite, blood sugars and in turn, weight by filling you up faster.
Chia is a seed that provides a good plant source of omega 3 fatty acids and soluble fiber, which help cholesterol numbers.
Acai is a berry that provides the highest amounts of anti-oxidants.
CharlesS: I have heard coconut water is good for you. Isn't coconut oil bad for your but the water is good for you? what do you think about coconut?
Julia_Zumpano_RD: Yes - I would avoid coconut oil due to its high level of saturated fat. Although coconut water is fine. Keep in mind it has additional calories if you are trying to maintain your weight.
boomer46: What foods contain high levels of soluble fiber?
Julia_Zumpano_RD: Oats, dried beans and legumes, root vegetables, berries, apples, pears and citrus fruits.
Blood Thinners and Vitamin K in Diet
nutzy: my question is about people taking Warfarin after valve replacement. They need a healthy diet after heart surgery but they need to watch all the time about the amount of green vegetables, grains, beans and everything that has vitamin k - the opposite of warfarin. I have a lot of brochures and medical articles about it but it is still difficult to handle with this problem. What is your opinion? Maybe you have some new ideas from your work experience?
Julia_Zumpano_RD: There is no need to limit the amount of vitamin K foods - it is important to keep the amount of vitamin K foods in your diet CONSISTENT. This means you can eat a vitamin K rich food every day as long as you do it every day within the same portion.
For example, if you like leafy greens you can have one cup every day but must do this EVERY day - otherwise your vitamin K level will vary and affect your INR (blood level). Be sure to discuss this with your physician and let them know that you choose to have a vitamin K rich food every day because initially it may increase your INR (and affect your warfarin dose), but it will stabilize.
Medications and Supplements
BPG: What is your opinion on supplements to help the heart? Such as fish oil and such?
Julia_Zumpano_RD: Ideally if you follow a heart healthy diet you would not need to supplement. Supplements are used to treat a diet deficient in that specific nutrient. Fish oil has been proven to be helpful for triglycerides. If yours is high, consult your doctor regarding taking a fish oil supplement.
Cassie: Since a lot of medications have side effects that have an impact on your digestive system, are there foods that we can eat to help circumvent some of those side effects?
Julia_Zumpano_RD: Minimally processed foods and a high fiber diet help with constipation and diarrhea. Digestive enzymes or probiotics have been known to help regulate an irregular digestive system.
F94jL63: Is pharmaceutical grade fish oil supplements (such as Lovaza) as "heart healthy" as eating fish?
Julia_Zumpano_RD: Food is always more preferred although if a prescription supplement is advised, it is typically due to needing more than diet can provide.
Eating Low Fat on a Budget
MEegan: What are some cost savings measures to help keep a heart healthy diet?
Julia_Zumpano_RD: By cutting out "junk foods" such as chips, soda, sweetened beverages, packaged desserts you can save a significant amount of money to put towards higher priced healthy items. Leaner meats tend to be more expensive, although cutting back on the portion will help offset the cost. If you are concerned with getting in enough protein, add beans as a good source of fiber and protein.
In regards to fruits and vegetables, buy seasonal, buy local, plant a garden or choose frozen forms without any added salt or sugar.
Charlotte: Can you provide some good online resources for finding nutrition information - good references?
Julia_Zumpano_RD: Our website is of course a good resource. We have many articles on low fat - heart healthy nutrition. Here are additional website resources for you:
Here are Cookbooks:
- Cleveland Clinic Healthy Heart Lifestyle Guide & Cookbook
- Reverse and Prevent Heart Disease
- Cooking the Real Age Way
- Clean Food
- The Food You Crave
Diet and Other Types of Heart Disease
JimT56: Can diet slow down the progression of aortic stenosis?
Julia_Zumpano_RD: No. We would encourage management of risk factors in where diet is concerned: weight; blood pressure; cholesterol.
nahant: What is your view on caffeine and wine for a person with ascending aortic aneurysm? What are other foods and exercises to avoid?
Julia_Zumpano_RD: Both caffeine and wine guidelines are specific to medications and medical history therefore refer to your doctor for personal guidance.
This information is provided by Cleveland Clinic as a convenience service only and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. Please remember that this information, in the absence of a visit with a health care professional, must be considered as an educational service only and is not designed to replace a physician's independent judgment about the appropriateness or risks of a procedure for a given patient. The views and opinions expressed by an individual in this forum are not necessarily the views of the Cleveland Clinic institution or other Cleveland Clinic physicians.