The Nation's Health

1. Limit unhealthy fats and cholesterol.

Of the possible changes, limiting how much saturated and trans fat you eat is the most important step you can take to reduce your blood cholesterol and lower your risk of coronary artery disease. A high blood cholesterol level can lead to a buildup of plaques in your arteries, called atherosclerosis, which can increase your risk of heart attack and stroke.

The American Heart Association offers these guidelines for how much fat and cholesterol to include in a heart-healthy diet:

When you do use fats, choose monounsaturated fats, such as olive oil or canola oil. Polyunsaturated fats, found in nuts and seeds, also are good choices for a heart-healthy diet. When used in place of saturated fat, monounsaturated and polyunsaturated fats may help lower your total blood cholesterol. But moderation is essential. All types of fat are high in calories.

If you're not sure which fats or oils to use when cooking or baking, use this guide:

• Olive oil
• Canola oil
• Margarine labeled 'trans fat-free'
• Cholesterol-lowering margarine, such as Benecol, Promise activ or Smart Balance

• Butter
• Lard
• Bacon
• Gravy
• Cream sauce
• Nondairy creamers
• Hydrogenated margarine and shortening
• Cocoa butter, found in chocolate
• Coconut, palm, cottonseed and palm-kernel oils

2. Choose low-fat protein sources.

Lean meat, poultry and fish, low-fat dairy products and egg whites or egg substitutes are some of your best sources of protein. But be careful to choose lower fat options, such as skim milk rather than whole milk and skinless chicken breasts rather than fried chicken patties.

Fish is another good alternative to high-fat meats. Some types of fish — such as cod, tuna and halibut generally have less total fat, saturated fat and cholesterol than do meat and poultry. And certain types of fish are heart healthy because they're rich in omega-3 fatty acids, which can lower blood fats called triglycerides and may reduce your risk of sudden cardiac death. You'll find the highest amounts of omega-3 fatty acids in cold-water fish, such as salmon, mackerel and herring. Other sources are flaxseed, walnuts, soybeans and canola oil.

Legumes — beans, peas and lentils — also are good sources of protein and contain less fat and no cholesterol, making them good substitutes for meat. Substituting soy protein for animal protein — for example, a soy burger for a hamburger — will reduce your fat and cholesterol intake.

To help you decide which high-protein foods are best, use this guide:

• Skim or low-fat (1 percent) milk
• Fat-free or low-fat dairy products, such as yogurt and cheese
• Egg whites or egg substitutes
• Fish, especially fatty, cold-water fish, such as salmon
• Skinless poultry
• Legumes
• Soybeans and soy products, for example, soy burgers
• Lean ground meats

• Full-fat milk and other dairy products
• Organ meats, such as liver
• Egg yolks
• Fatty and marbled meats
• Spareribs
• Cold cuts
• Frankfurters, hot dogs and sausages
• Bacon
• Fried, breaded or canned meats

3. Eat more vegetables and fruits.

Vegetables and fruits are good sources of vitamins and minerals; they are low in calories and rich in dietary fiber. A diet high in soluble fiber, the kind found in fruits and vegetables, can help lower your cholesterol and reduce your risk of heart disease. Vegetables and fruits also contain substances found in plants that may help prevent cardiovascular disease. Eating more fruits and vegetables may help you eat less high-fat foods, such as meat, cheese and snack foods.

Featuring vegetables and fruits in your diet may not be as difficult as you might think. Keep carrots, cauliflower and broccoli washed and cut in your refrigerator for quick snacks. Keep apples, bananas, grapes or peaches in a bowl in your kitchen so that you'll remember to eat them. Choose recipes that have vegetables or fruits as the main ingredient, such as vegetable stir-fry or fresh fruit mixed into salads. Even frozen or canned fruits and vegetables are good choices, provided they don't have lots of added sodium or sugar. Don't smother vegetables in butter, dressings, creamy sauces or other high-fat garnishes.

This guide can help you sort out which fruits and vegetables offer the most health benefits:

• Fresh or frozen vegetables and fruits
• Low-sodium canned vegetables
• Canned fruit packed in juice or water

• Coconut
• Vegetables with creamy sauces
• Fried or breaded vegetables
• Canned fruit packed in heavy syrup

4. Select whole grains.

Whole grains are good sources of fiber and other nutrients. Whole grains are also a source of vitamins and minerals, such as thiamin, riboflavin, niacin, vitamin E, magnesium, phosphorus, selenium, zinc and iron. Various nutrients found in whole grains play a role in regulating blood pressure and heart health.

You can increase the amount of whole grains in a heart-healthy diet by making simple substitutions. For example, choose breads made from 100 percent whole grain instead of those with refined white flour, whole-wheat pasta over regular pasta and brown rice instead of white rice. Select high-fiber cereals for breakfast, such as bran flakes, oats, or shredded wheat, instead of sugar-sweetened cereals, muffins or doughnuts. And select whole-wheat flour rather than white flour for baking at home.

Another easy way to add whole grains to your diet is ground flaxseed. Flaxseeds are small brown seeds that are high in fiber and omega-3 fatty acids, which can lower your total blood cholesterol. You can easily grind the seeds in a coffee grinder or food processor and add them to your diet by stirring a teaspoon of them into yogurt, applesauce or hot cereal.

Use this guide to help you choose cereals, breads, rice or pasta:

• Whole-wheat flour
• Whole-grain bread, preferably 100 percent whole-wheat or 100 percent whole-grain bread
• High-fiber cereal with 5 or more grams of fiber per serving
• Brown rice
• Whole-grain pasta
• Oatmeal (steel-cut or regular)
• Ground flaxseed

• Muffins
• Frozen waffles
• Corn bread
• Doughnuts
• Biscuits
• Quick breads
• Granola bars
• Cakes
• Pies
• Egg noodles
• Buttered popcorn
• High-fat snack crackers
• Potato chips

5. Reduce the salt in your food.

Eating a lot of salt can contribute to high blood pressure, a risk factor for cardiovascular disease. Reducing the salt in your food is an important part of a heart-healthy diet. The American Heart Association recommends that healthy adults eat less than 2,300 milligrams of sodium a day (about a teaspoon).

You might think the best way to cut back on salt is to stop reaching for the shaker. True, but don't forget about the processed foods. Although reducing the amount of salt you add to food at the table or while cooking is a good first step, much of the salt you eat comes from canned or processed foods, like soups and frozen dinners. Eating fresh foods and making your own soups and stews can reduce the amount of salt you eat. If you like the convenience of canned soups and prepared meals, look for ones with reduced sodium. Some brands offer the same soups or meals you already eat with as much as 40 percent less sodium.

Another way to reduce the amount of salt you eat is to choose your condiments carefully. Reduced-sodium ketchups and soy sauces are available. Instead of regular table salt, reach for a salt substitute or other herbs and spices that can flavor your food. If using a salt substitute or reduced-sodium condiment, it is still important to use it sparingly. The amount of salt, although reduced, adds up quickly.

Use this guide to help you choose lower salt alternatives:

• Herbs and spices
• Salt substitutes
• Reduced-salt canned soups or prepared meals
• Reduced-salt versions of condiments, such as reduced-salt soy sauce

• Table salt
• Canned soups and prepared foods, like frozen dinners
• Soy sauce

6. Practice moderation.

In addition to knowing which foods to eat, you'll also need to know how much you should eat. Overloading your plate, taking seconds and eating until you feel stuffed can lead to eating more calories, fat and cholesterol than you should. Portions served in restaurants are often more than anyone needs. Keep track of the number of servings you eat — and use proper serving sizes — to help control your portions.

A serving size is a specific amount of food, defined by common measurements such as cups, ounces or pieces. For example, one serving of pasta is 1/2 cup, or about the size of an ice cream scoop. A serving of meat, fish or chicken is 2 to 3 ounces, or about the size and thickness of a deck of cards. Judging serving size is a learned skill. You may need to use measuring cups and spoons or a scale until you're comfortable with your judgment.

A heart-healthy diet is also about balance. A simple rule of thumb is to remember to keep your portion size for meat, poultry and fish about the size of a deck of cards. This makes room on your plate for servings of vegetables, fruits and whole grains.

Allow yourself an indulgence every now and then. Don't let it turn into an excuse for giving up on your healthy-eating plan. If overindulgence is the exception, rather than the rule, you'll balance things out over the long term. What's important is that you eat healthy foods most of the time.

7. Plan ahead: Creating daily menus.

You know what foods to feature in your heart-healthy diet and which ones to limit. Now it's time to put your plans into action.

Create daily menus using the six strategies listed above. When selecting foods for each meal and snack, emphasize vegetables, fruits and whole grains. Choose lean protein sources and limit high-fat and salty foods. Watch your portion sizes and add variety to your menu choices. For example, if you have grilled salmon one evening, try a black bean burger the next night. This helps ensure that you'll get all of the nutrients your body needs. Variety also makes your meals and snacks more interesting.

Incorporate these seven tips into your life, and you'll continue to find that heart-healthy eating is both doable and enjoyable. With planning and a few simple substitutions, you can eat with your heart in mind.