Nutrition

Changing the type of food you are accustomed to is not easy. Today Clinical dieticians are of the opinion that no drastic change in the food pattern is necessary, unless you have been brought up on junk.

A traditional diet could be continued, provided you work around the problematic food groups/cooking styles.

Areas that need to be looked into:

• Fats
• Salt (Sodium)
• Fibre
• Alcohol and Caffeine
• Food Groups and the Choice Available
• Tips for Healthy Cooking
• Eating Out

Fats

Fats are an essential part of the diet but too much of the wrong kind can be bad for your health.

• Saturated fat is the main culprit in raising blood cholesterol.
• Unsaturated fat is of two types:

Polyunsaturated fat lowers blood cholesterol.

Monounsaturated fat is considered neutral where blood cholesterol is concerned. It is said to be protective of HDL-C level, the good cholesterol fraction.

Cooking fat may contain saturated, mono-or poly-unsaturated fatty acids in varying proportions. They are classified according to the predominant type of fatty acid present.

Polyunsaturated	Monounsaturated	Saturated
Sunflower	Olive	Butter
Safflower	Canola	Ghee
Corn	Peanut (Groundnut)	Coconut
Soybean		Palm
Mustard		Lard
Gingelly(til)		Dalda
		Blended Vegetable Oil

Use mono saturated or polyunsaturated oils and lower consumption of saturated fats.

It is important to limit amount of cooking oil you use, no matter which Oil you choose. It is advisable to use only 4-5 teaspoons of cooking oil per day (not more than 25% of your calories should come from the fats in your diet).

Fat Consumption and Reduction of Blood Cholesterol

• Substantially reduce all saturated fat in your diet. Trim all visible fat from meats.

• Limit dietary cholesterol - reduce intake of animal products to not more than 240g per day.

• Use low fat dairy products and limit milks consumption to two cups a day. Avoid high fat products such as butter and cream.

• Limit egg yolks to a maximum of three per week.

• Commercially baked goods (cakes, biscuits, pastries and puffs are often made with egg yolk and saturated fats such as shortening and lard. Consume such foods only rarely.

• It would be best to severely limit fried food and snacks.

Heart Disease And Sodium

You may be advised by your doctor to reduce sodium if you have high blood pressure, congestive heart failure or kidney disease.

When you think of sodium, the salt you sprinkle on food probably comes to mind. Salt in fact is made up of sodium and chloride.

Indians consume as much as 10 g of salt per day in the form of added salt. Some of the sodium in your diet occurs naturally in foods. The rest comes from salt added to foods when cooking or processing.

Foods to avoid or limit (which contain a high amount of sodium):

Bacon	Ham	Baked goods	Salted snacks
Fat foods	Salted nuts	Canned foods	Papads
Bottled sauces	Processed meats	Pickles	Cheese
Dry fish	Salt preserved meat	MSG (Monosodium glutamate)

Simple steps in cutting down salt:

Since taste for slat is an acquired habit, it should be possible to cut down its intake gradually without much difficulty. Here are some general rules to keep the sodium intake within the recommended guidelines.

• Cut down on convenience foods - many processed foods (baked foods, cakes, biscuits, pastries, cheese, canned foods, soup cubes) are high in sodium even when they do not taste salty.
  
  

• Avoid foods preserved in salt, such as salt fish.
  
  

• Limit the salt used in cooking and do not add salt at the table.
  
  

• Use herbs and spices to enhance the flavour of foods in place of salt.
  
  

(For example: A dash of lime on vegetables and lentils or garlic, onions and vinegar and the use of spices like Nutmeg, bay leaf, dry chillies, mustard seeds, pepper, or turmeric)

The amount of salt you can use will depend on your specific needs and may range from 1/2 to 1 teaspoon per day.

A word of caution about salt substitutes:

Salt substitutes may contain potassium salts which are contraindicated for patients with kidney problems. Bring the salt substitute container to you dietician for her before using the product.

Dietary Fibre

Foods high in fibre tend to be low in fat and calories. Consequently, eating more fibre-rich foods may help to keep your weight in control. Foods high in fibre also tend to be high in antioxidants such as vitamin E, C and beta-carotene. Eating a diet consisting of high fibre foods has been associated with minimising your risk of constipation, colon and rectal cancer, diverticulosis, hiatus hernia, heart disease, diabetes and obesity.

Fibre is actually a group of widely different compounds. There are generally two forms of fibre - soluble and insoluble.

Insoluble fibre, commonly referred to as 'roughage' is the chewy outer skin and fibres of seeds, fruit, vegetable and legumes. In addition to reducing the risk of constipation and other digestive disorders, diets high in insoluble fibre may protect against cancers of the colon and rectum.

Soluble fibre helps the digestive tract to function normally and helps to reduce blood cholesterol levels. Good sources of soluble fibre include oat bran, legumes, fruit and vegetables.

Most plant foods contain both types. Certain foods, however, are rich in one or the other. Fibre is lost when food is processed and refined as in pasta, white rice, maida and white bread. Animal products contain no dietary fibre.

About 30 grams of fibre a day is recommended. Remember that plenty of water is needed to help the fibre to move along the intestines. Drink 8-10 glasses of water a day.

Increasing Fibre Intake

• Incorporate more grains, cereals and millets such as whole wheat flour (avoid sifting) ragi, bajra, oats, corn, etc.
  
  

• Eat some lentils, legumes and dhals such as toor dhal, urud djal, green grams, etc. every day.
  
  

• Consume adequate amounts of fruits and vegetables. This means at least three helpings of vegetables and two of fruits a day.
  
  

• Eat fruits and vegetables with their skin as fat as possible.
  
  

• Include salads and sprouts in your diet.

Alcohol and Caffeine

Alcohol is a source of empty calories (it includes no vitamins, minerals or proteins) and can be turned into fat, adding weight to the body. It increases the level of triglycerides in your blood.

Consume only occasionally and limit to two drinks/day.

Caffeine is a stimulant that gives a boost of 'borrowed energy'. Stimulants containing caffeine are found in tea, coffee, cocoa, chocolates and cola. They may increase the frequency and severity of irregular heartbeats and can increase blood pressure.

Limit to two cups per day.

Guide To Food Choices

Cultivate the habit of reading the food label on commercial food packages, to get information on the amount and type of fat and amount of sodium in the contents.

Heart Healthy Cooking

Make your favourite recipes heart healthy by following these simple tips

• Substitute a lower fat ingredient for a higher fat one. Try skim milks instead off full milk.
  
  

• Choose unsaturated fats. Use oil instead of butter, shortening or ghee.
  
  

• Use less of the high fat ingredients. Use less meat, eggs or cheese than the recipe states. Use only part of the fat or oil called for.
  
  

• Remove the fat. Trim visible fat and skin. Refrigerate curries, gravy soup or stew until the fat rises to the top of the bowl and skim it off.
  
  

• Change the cooking method. Steam, boil, roast or microwave without adding fat. Sauté with water, juice or both.
  
  

• Try low fat recipes.

Eating Out

Indian eating patterns are undergoing revolutionary changes with the spectacular growth of restaurants. To eat healthfully away from home without missing out the fun, here are some suggestions:

• Eat something (fruits, a vegetable sandwich made without butter, salads) to take the edge off your appetite before you leave home.
  
  

• At a South Indian restaurant select steamed preparations like iddlis, idiapppams and rice and avoid oily dishes such as vadas, bajjis, papads and crisp dosas.
  
  

• Limit or avoid dishes with coconut or cream.
  
  

• At a north Indian restaurant order plain tandoori breads instead or puris, parathas, batura, etc.
  
  

• Among beverages, select an unsweetened juice such as fresh lime, fruit juice or tomato juice. Alcoholic beverages always mean extra calories.
  
  

• Choose lean meat, fish or chicken without skin.
  
  

• Cooking methods - choose foods which are boiled, grilled, broiled, steamed, poached roasted or baked. Avoid foods which are fried, au gratin or made with a gravy.
  
  

• Order fruit for dessert instead of a high calorie item such as ice cream, pie or Indian sweet.
  
  

Source: The above material was prepared with the help of the Cardiac Rehabilitation unit at the Institute of Cardio Vascular Diseases, Chennai.