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HEARTWISE NUTRITION EDUCATION PROGRAM TABLE OF CONTENTS Contributors: Caroline Bohl, M.S., R.D. Leila Bruno, M.S., R.D. Paul Cannon, M.D. Laura Cipullo, R.D. Sonia Cruz, R.D. Andrea Dmitruk, M.A., R.D. Judy Fogel, M.S., R.D. Stacey Freis, M.S., R.D. C.N.S.D. Ann Gaba, EdD, R.D., C.D.E. Henry Ginsberg, M.D. Kristin Greenspan, M.S., R.D. O. Wayne Isom, M.D. Soon Juhng, M.S,, R.D. Wahida Karmally, DrPH, R.D., C.D.E. June Levine, R.D. Lisa Mainieri, MPH, MSW Martha McKittrick, R.D. Louise Merriman, M.S., R.D. Jennifer Nelson, R.D. Gerald Neuberg, M.D. Renee Radenberg, R.D. Elaine Rosenthal, M.S., R.D. Mehmet Oz, M.D. Milton Packer, M.D. Richard S. Rivlin, M.D. Myron Weisfeldt, M.D. Introduction ............................................................................... 1 NewYork-Presbyterian The University Hospitals of Columbia and Cornell HeartWise Snacks ...................................................................... 26 NewYork Weill Cornell Medical Center Department of Food and Nutrition 525 East 68th Street New York, NY 10021 (212) 746-0838 How Much Fat Should You Eat? ................................................ 29 Columbia University Medical Center Department of Food and Nutrition 622 West 168th Street New York, NY 10032 (212) 305-9969 Dining Out ...............................................................................34 www.nyp.org/nutrition Definitions ...............................................................................3 The Food Guide Pyramid .........................................................9 Choosing HeartWise Foods ....................................................... 10 Breads, Cereals, Rice and Pasta .......................................... 11 Vegetables ............................................................................ 12 Fruits .................................................................................. 13 Milk, Yogurt and Cheeses .................................................... 13 Dried Beans, Fish, Poultry, Meat and Eggs .......................... 14 Fats and Oils ...................................................................... 17 Sweets ................................................................................. 19 Beverages and Miscellaneous Foods ................................... 21 High Sodium Foods ................................................................22 In Your Grocery Store ................................................................. 23 HeartWise Meal Planning ............................................................ 25 Portion Sizes ............................................................................... 27 Reading Food Labels ................................................................... 30 HeartWise Cooking Tips ............................................................ 32 HeartWise References ...............................................................35 Notes HeartWise Resources © 2004 NewYork-Presbyterian, The University Hospitals of Columbia and Cornell ID 510:0204 INTRODUCTION Welcome to the NewYork-Presbyterian Hospital HeartWise Cardiac Nutrition Rehabilitation Program. This Program is designed to help you understand the dietary prescription recommended by your Physician. This HeartWise Booklet was written to recommend food choices that will help you to modify and reduce your intake of sodium, total fat, saturated fat, trans fatty acids and cholesterol. You and your family will meet with a Registered Dietitian to learn about the information provided in the HeartWise Booklet. ♥ Prepare HeartWise food items at home using recommended foods. ♥ Be HeartWise while using the Food Guide Pyramid as a plan to help you select a variety of foods daily. ♥ Maintain energy balance by limiting Calorie/energy intake, and increasing daily physical activity for energy expenditure. The purpose of the HeartWise Cardiac Nutrition Rehabilitation Program is to teach you how to: ♥ Reduce your daily fat intake to 30 percent or less of total Calories by making informed food choices and controlling portion sizes of high fat foods. ♥ Reduce your daily intake of foods containing saturated fats to 10 percent or less of total Calories, cholesterol to less than 300 milligrams, and to substitute polyunsaturated and particularly monounsaturated fats for saturated fats. ♥ Reduce your sodium intake by selecting foods lower in salt or sodium. The general recommendation for sodium intake is 2400 milligrams per day. Some people do not need to restrict their sodium intake and can use the list on page 22 for greater variety in their diet. Consult with your Dietitian or Physician. ♥ Increase your intake of complex carbohydrates found in whole grain products, fruits and vegetables aiming to achieve an intake of 25-30 grams of dietary fiber per day. ♥ Increase your intake of Omega-3 fatty acids. The current recommendations for omega-3 fatty acid is 1.6 grams per day for men, and 1.1 grams per day for women. ♥ Evaluate specific food items according to HeartWise guidelines as all foods (especially commercial products) cannot be listed in this booklet and manufacturers may alter ingredients or develop new products. 1♥ 2 DEFINITIONS SOME DEFINITIONS YOU WILL FIND HELPFUL IN UNDERSTANDING YOUR DIET: Atherosclerosis – A disease in which plaque containing cholesterol and inflammatory cells builds up on the inner lining of arteries. As atherosclerosis progresses, arteries may narrow so that oxygen-rich blood and other nutrients may have difficulty reaching the heart, limbs and other vital organs. High blood pressure and inflammation may cause plaques to rupture, with blood clotting on the inner surfaces of arteries, leading to a heart attack or stroke. Atherosclerosis can be prevented by lifestyle changes (including diet, aerobic exercise, smoking cessation and stress reduction) and by treatment of cardiovascular risk factors (including diabetes, high blood pressure, high cholesterol and blood clotting). • Dietary Cholesterol – Cholesterol that is in the food you eat. It is present only in foods of animal origin including whole milk, whole milk dairy products, egg yolks, meats, poultry and seafood. Dietary cholesterol and saturated fat tend to raise blood cholesterol, which increases the risk for heart disease. Plants do not contain cholesterol; however, some plant products do contain saturated fat, such as coconut and palm oil. Saturated fat will raise the blood cholesterol level as noted below. Carbohydrates – Carbohydrates (sugars and starches) are the body’s main source of fuel. They are mainly found in plant foods like grains, fruits, vegetables, legumes, milk and yogurt. All carbohydrates are sugar. The shorter chains of sugar molecules like table sugar are termed “sugars” and the longer chains are called “starches.” Starches with fiber like whole wheat, oats, legumes, fruits and vegetables have more health benefits, because in addition to fiber, they provide antioxidants and phytochemicals. The National Academy of Sciences recommends at least 130 grams (more in pregnancy) of carbohydrates a day. Coronary Artery Disease (CAD) – Atherosclerosis affecting the arteries that provide blood to heart muscle. When coronary arteries become partially blocked, exercise, eating or stress may provoke chest pains called angina pectoris. Severe and prolonged chest pain (along with shortness of breath, vomiting or sweating) may indicate a heart attack, in which a blood clot completely blocks an artery, causing permanent damage to heart muscle. Coronary artery disease is treated with lifestyle changes and medication and sometimes with surgical interventions, such as stents intended to keep arteries open. Dietary Fiber – A type of carbohydrate that your body cannot digest or absorb. Because dietary fiber is excreted, it does not provide Calories in the diet. There are two types of dietary fiber: insoluble and soluble. Insoluble fiber functions to provide bulk to stool and passes through the digestive tract largely intact. It is found mainly in wheat and corn brans, nuts, and most fruits and vegetables. Soluble fiber also aids in maintaining bowel regularity but may also lower blood sugar and blood cholesterol levels, which may help reduce the risk of heart disease. Soluble fiber is found primarily in dried beans, apples, oranges, pears and oats. Vitamins and Minerals – Substances your body needs in small amounts for normal growth, function and health. Together, vitamins and minerals are called micronutrients. Your body can’t make most micronutrients, so you must get them from the foods you eat or, in some cases, from supplements. For most people, healthy balanced diet (including at least 5 servings of fruits and vegetables per day) provides adequate amounts of vitamins and minerals. However, a daily multivitamin supplement may be recommended for the elderly, and for others with nutritional problems. Folate (folic acid) and other B vitamins help to break down the amino acid homocysteine. High levels of homocysteine in the blood may be a risk factor for cardiovascular disease, but so far there is no proof that treating a mildly elevated homocysteine level improves heart health. Vitamin E supplements are very popular but, unfortunately, recent studies have shown that they do not prevent heart attacks, and they actually may interfere with cholesterol medication. Please inform your physician if you take any herbs or nutritional supplements, since there may be drug interactions. Cholesterol – A soft, waxy, fat-like substance. Cholesterol is found in foods of animal origin. Cholesterol is also made by the body. It is necessary for the manufacture of hormones, bile acids and vitamin D. Cholesterol is present in all cells of the body including the nervous system, muscle, skin, liver, intestines and heart. 3 • Blood Cholesterol – Cholesterol that is manufactured by the liver and absorbed from the food you eat. It is carried in the blood for use by all parts of the body. A high level of blood cholesterol may lead to atherosclerosis and coronary heart disease. 4 Obesity – It is defined as an excessive accumulation of fat in the body and is associated with numerous health problems including coronary heart disease, insulin resistance, type 2 diabetes, hypertension and certain types of cancer. We have an epidemic of obesity, diabetes and cardiovascular diseases, largely because we eat too much and move too little. 60% of Americans are overweight. To avoid weight gain, we cannot consume more energy than our bodies actually need. We should also increase energy expenditure via moderate physical activity for 30-60 minutes a day (if approved by your physician). People on low-fat diets often make the mistake of overeating refined starches (bread, pasta, rice, potatoes) and sweets (including sugar-containing beverages). Since they are rapidly absorbed into the bloodstream, they cause insulin release, which can increase hunger. Fruits, vegetables and whole grains are preferred. Body mass index (BMI) is a measure of body fat based on height and weight that applies to both adult men and women. According to World Health Organization guidelines, individuals with a BMI of 25.0-29.9 are considered overweight and those with a BMI of >30 are obese (see graph). Height 6’6” 6’5” 6’4” 6’3” 6’2” 6’1” 6’0” 5’11” 5’10” 5’9” 5’8” 5’7” 5’6” 5’5” 5’4” 5’3” 5’2” 5’1” 5’0” 4’11” BMI (Body Mass Index) 25 30 5 ht yW eig Ob ese Ov erw eig alth He 75 100 125 150 Pounds** 175 200 • Saturated Fat – A type of fat found in greatest amounts in foods from animals such as meat, poultry and whole-milk dairy products like butter, cream, milk, ice cream and cheese. Saturated fats are generally solid at room temperature. The saturated fat content is high in some vegetable oils – such as coconut, palm kernel and palm oils – which remain liquid at room temperature. Saturated fat raises blood cholesterol more than anything else in the diet. When excess amounts of saturated fat are consumed, this fat is broken down and converted to body fat. In this process, compounds are formed which cause the body to make cholesterol. – Monounsaturated Fat – An unsaturated fat that is found in greatest amounts in foods from plant origin. Examples are olive oil, canola (rapeseed) oil, peanut oil and most nuts. When substituted for saturated fat (refer to page 17), monounsaturated fat helps reduce total blood cholesterol without lowering HDL levels. – Polyunsaturated Fat – An unsaturated fat that is found in greatest amounts in foods from plant origin and fatty fish. When substituted for saturated fat, polyunsaturated fat helps reduce blood cholesterol. There are two types of polyunsaturated fat: 4’10” 50 • Total Fat – The sum of the saturated, monounsaturated and polyunsaturated fats that are present in food. A mixture of all three types of fat is found in most foods, including oils. • Unsaturated Fat – A type of fat that is usually liquid at room temperature. There are two kinds of unsaturated fat: ht 18.5 Fats – One of the three nutrients that supply Calories to the body. Fats provide nine calories per gram – more than twice the number of Calories than are provided by carbohydrates or protein. In addition to providing Calories, fat helps in the absorption of certain vitamins and other important compounds found in food. Small amounts of fat in your diet are necessary for normal body function. 225 250 275 Omega–6 Fatty Acid – A polyunsaturated fat found in greatest amounts in oils from plants. Examples are corn, cottonseed, safflower, soybean and sunflower oils. 6 Omega–3 Fatty Acid – A polyunsaturated fat found mostly in fatty fish, such as tuna, salmon, sardines, bluefish and mackerel as well as soy beans, flaxseed/linseed oil, canola (rapeseed oil), walnuts and pumpkin seeds. Omega-3 fatty acids are natural blood thinners and may reduce the risk of blood clots and stroke. Eating fatty fish at least 2 times per week is recommended, but the benefit, if any, of taking fish oil supplements has not been established and is, therefore, not recommended at this time. Trans Fatty Acids (or Trans Fats) – Trans fatty acids are formed when unsaturated fats go through a process called hydrogenation which changes liquid vegetable oils into a more solid fat product. Studies have shown that trans fatty acids may raise total blood cholesterol levels and increase the risk of heart disease. Foods that contain high amounts of trans fatty acids include stick margarines, shortenings, fried foods, commercial cakes, cookies and crackers. Read labels and look for “partially hydrogenated vegetable oils” as an indication that trans fatty acids may be present. Sodium – A mineral contained naturally in many food items which may be added to foods as “table salt” or during processing. Almost 50 percent of “table salt” is sodium. Decreasing consumption of salt or foods with a high sodium content, such as many processed foods, may be recommended for some patients in the management of hypertension, cardiovascular disease and congestive heart failure. Triglyceride – A fat in the blood which comes from the body’s fat stores or from the food we eat. Elevated levels of serum triglycerides can result from consuming too much sugar, alcohol or fat. High levels can also result from being overweight or from certain diseases, such as diabetes. Lipoproteins – Protein-coated packages that carry fat and cholesterol through the blood. Lipoproteins are classified according to their density: • High Density Lipoproteins (HDL) – Lipoproteins that contain a small amount of cholesterol and carry cholesterol away from body cells and tissues to the liver for excretion from the body. Low levels of HDL are associated with an increased risk of coronary heart disease; therefore, the higher the HDL level, the better. • Low Density Lipoproteins (LDL) – Lipoproteins that contain the largest amount of cholesterol in the blood. LDL are responsible for depositing cholesterol in the artery walls. Low levels of LDL are associated with a decreased risk of coronary heart disease; therefore, the lower the LDL level, the better. 7 8 THE FOOD GUIDE PYRAMID CHOOSING HEARTWISE FOODS HeartWise Guide To Daily Food Choices The food lists on the following pages will help you make more healthful food choices. There are no “good” or “bad” foods, only “good” or “bad” diets. Selecting most of your foods from the “CHOOSE” column will help you to achieve a HeartWise Diet. This program: • Eat a variety of foods from each food group every day. • Follow the recommended number of servings and suggested serving sizes. • Means a good choice for increased fiber content. • Substitute unsaturated fats like nuts, seeds and liquid vegetable oils for saturated fats like butter, shortenings, stick margarine • Substitute reduced fat/Calorie salad dressing, for higher fat/Calorie versions FATS, OILS & SWEETS (USE SPARINGLY) Serving Examples 1 teaspoon tub margarine 1 teaspoon oil 1 tablespoon salad dressing 1 tablespoon nuts/seeds Note: Nuts now have a health claim and seeds such as ground flax seeds are high in omega-3 fatty acids. MILK, YOGURT & CHEESES DRIED BEANS, FISH, 2–3 SERVINGS POULTRY, MEAT & EGGS Serving Examples 2–3 SERVINGS 1 cup skim milk or Serving Examples soy milk 1 cup cooked beans 1 cup fat free yogurt or 1/2 cup tofu soy yogurt 2-3 oz. cooked fish, lean 1-1/2 oz. low fat cheese or meat or poultry soy cheese 1/2 cup egg substitute VEGETABLES 3–5 SERVINGS Serving Examples 1 cup raw leafy greens 1/2 cup any other vegetable 1/2 cup vegetable juice FRUITS 2–4 SERVINGS Serving Examples 1 medium raw fruit 1/2 cup raw, cooked or canned fruit 1/2 cup fruit juice BREAD, CEREALS, RICE & PASTA 6-11 SERVINGS Serving Examples 1 slice whole grain bread 3/4 cup unsweetened, whole grain, cold cereal 1/2 cup cooked brown rice or pasta or cooked whole grain cereal 9 ♥ Defines low fat foods (commercial or homemade) as those foods containing no more than 3 grams of fat per 100 calories. ♥ Recommends substituting unsaturated fats for saturated fats in your diet. ♥ Recommends selecting a variety of foods from the “choose” column. Some items in these lists contain more than 3 grams fat per 100 calories; however, they are high in polyunsaturated and/or monounsaturated fats. Examples include salmon and peanuts. ♥ Recommends limiting beef, lamb and veal (red meats) to a 3-ounce cooked lean portion no more that 3 times per week. ♥ Recommends that you consume at least 5 servings of fruits and vegetables per day. ♥ Defines foods to choose as being less than 300 milligrams of sodium per serving. ♥ Recommends that you increase the variety of foods in your diet. ♥ Recommends that you increase your fiber intake. Follow the wheat symbol to select foods high in dietary fiber (2 grams or more per serving), in order to meet a daily goal of 25-30 grams of fiber, both soluble and insoluble. ♥ Recommends that you increase your fluid intake. A guideline to use is 8 glasses of water or other low Calorie, sodium- caffeine- and alcohol-free beverages. Remember that caffeine and alcohol containing beverages may be dehydrating, and do not count as part of your total fluid intake. Source: Adapted from U.S. Department of Agriculture. 10 CRACKERS AND SNACKS: BREAD, CEREALS, RICE AND PASTA (Eat 6-11 servings a day.) BREADS AND BAKED PRODUCTS: CHOOSE DECREASE White, whole wheat, pumpernickel, rye, raisin, Italian, French, pita, bagels, English muffins, fat free tortillas, hard rolls, hamburger and hot dog buns, Low fat or fat free: coffee cake, pancakes, waffles, French toast, cornbread, muffins, biscuits. Cheese or egg breads (challah), egg bagels, sweet rolls, fried tortillas, taco shells, Matzo balls, salted bagels, croissants, Danish pastry, donuts, biscuits, nut breads, breakfast bars, toaster products, fritters, popovers, hush puppies, other coffee cakes, muffins, pancakes, waffles and French toast. CEREALS: CHOOSE DECREASE 3/4 cup Hot or cold whole grain cereals; choose those that are less than 300 milligrams sodium and less than 3 grams of fat per serving. Granola, hot or cold cereals containing coconut or other high fat ingredients, any cereal with more than 3 grams of fat and/or 300 milligrams of sodium per serving. PASTA, RICE AND GRAINS: CHOOSE DECREASE Pasta, noodles, whole wheat pasta, bulgur, kasha, millet, quinoa, white brown rice, rice, wild rice, barley, cous cous, cornmeal, kamut, spelt. Egg pasta, egg noodles, chow mein noodles, pasta dishes with cheese or cream sauce; commercial mixes for pasta, rice, casserole or stuffing. 1 slice bread 1/2 English muffin, bagel, bun, 1 ounce baked product 1/2 cup cooked pasta 1/2 cup cooked rice 11 1 ounce serving (about 3-4 crackers) with no more that 3 grams of fat and 300 milligrams sodium per serving CHOOSE DECREASE Graham and oyster crackers; bread sticks, flatbread, lavasch, matzoh, melba toast, rice wafers or cakes, rusk, low fat or fat free croutons, unsalted: pretzels, fat free snack crackers, airpopped popcorn, baked or low fat potato/tortilla chips. Butter, cheese or peanut butter sandwich crackers; salted pretzels, crackers with salted tops, bread crumbs, all other fried chips. VEGETABLES (Eat or drink at least 3-5 servings a day.) VEGETABLES: CHOOSE DECREASE 1 cup raw 1/2 cup cooked 1/2 cup juice Plain: fresh, frozen (without added salt) and canned that has been drained and rinsed; mashed potatoes made without salt or fat; vegetable salads made with fat free dressings; low sodium vegetable juices (limit regular tomato and vegetable juice to 1/2 cup per day). Vegetables that are creamed, scalloped or made with cheese sauce or hollandaise sauce; vegetable salads made with regular mayonnaise, sour cream or oil-based dressings; instant mashed potatoes, sauerkraut, pickles. 12 FRUITS (Eat or drink at least 2-4 servings a day.) FRUITS: CHOOSE Fresh, frozen, 1 medium piece fresh canned or dried; fruit 1/2 cup cooked or canned juices and nectars. 1/2 cup juice CHEESES: CHOOSE DECREASE 1-1/2 ounces Fat free or low fat and low sodium cheeses, including ricotta cheese and mozzarella cheese; 1% or fat free farmer or pot cheese; any other low fat, low sodium or fat free, low sodium cheese (low fat should be less than 3 grams per serving and low sodium should be less than 140 milligrams per serving); no salt added, 1% or fat free cottage cheese. All other high fat and high sodium cheeses. DECREASE Dried fruit or fruit juice where sodium has been added as a preservative. MILK, YOGURT AND CHEESES (Eat or drink 2-3 servings a day.) MILK: 1 cup CHOOSE DECREASE Skim milk, 1% milk 2% milk, whole milk (chocolate, (chocolate, evaporated, evaporated, condensed, fluid or condensed, fluid, powdered), malted powdered), buttermilk (no more milk, coconut milk. than 1 cup per day), low fat or skim lactose reduced milk, low fat chocolate milk; fat free or 1% calcium enriched soy and rice milk. YOGURT: CHOOSE DECREASE 1 cup Low fat or fat free: yogurt, frozen yogurt and soy yogurt. Whole milk yogurt. 13 DRIED BEANS, FISH, POULTRY, MEAT AND EGGS (Eat 2-3 servings a day; eat no more than 3 servings a week of lean red meat and no more than 4 egg yolks a week.) FISH: CHOOSE DECREASE 2-3 ounces cooked Plain: fresh or frozen; low sodium, water-packed tuna or salmon; herring without cream sauce or pickling. Roe, caviar, anchovies, gefilte fish, smoked fish; fish battered and fried; fish cooked in butter, stick margarine or oil; fish canned in oil. 14 SHELLFISH: CHOOSE DECREASE LAMB: CHOOSE DECREASE 2-3 ounces cooked Plain: fresh or frozen such as shrimp, mussels, clams, oysters, lobster, crab, scallops. Fried or batter-baked shellfish, shellfish salads made with mayonnaise, canned shellfish. 2-3 ounces cooked Plain: fresh or frozen – trimmed foreshank, leg (shank half or top round), loin chops. Leg (sirloin half), loin roast, rib chops or roast, shoulder arm or blade chops, shoulder roast, ground lamb. POULTRY: CHOOSE DECREASE VEAL: CHOOSE DECREASE 2–3 ounces cooked Plain and skinless: fresh or frozen white meat – lean ground chicken or turkey (99% fat free). Poultry skin, ground chicken and turkey (less than 99% fat free), chicken or turkey wings, turkey or chicken giblets; goose, duck or poultry cooked with butter, breaded poultry cutlets, turkey or chicken roll, canned poultry, other poultry, lunch meats, chicken or turkey bacon or sausage. 2-3 ounces cooked Plain: fresh or frozen – arm steak, loin chops, cutlets, shank cross cuts. Breast, rib roast or chops, riblets, ground veal, lunch meats. PORK: CHOOSE DECREASE 2-3 ounces cooked Plain: fresh or frozen – tenderloin, boneless loin roast, boneless sirloin chops, boneless top loin chops, loin chops. BEEF: CHOOSE DECREASE 2–3 ounces cooked Plain and lean: fresh or frozen choice or select grade – chuck arm pot roast, top loin steak, tenderloin steak (filet mignon), wedge bone sirloin steak, porterhouse steak, t-bone steak, top sirloin steak, eye round, top round steak, bottom round roast, round tip roast, shank cross cuts, flank steak, 95% lean ground beef. All prime grade meats, chuck blade roast, short ribs, rib roast or steak, rib-eye roast or steak, cubed steak, fresh brisket, corned beef, skirt steak, organ meats, beef lunch meats, chipped beef, kosher meats, frankfurters; canned, smoked or salt cured meats. Note: Due to koshering process, kosher meats have a higher sodium content. Blade chops, fresh or smoked Boston shoulder cuts, fresh or smoked arm roast or steak, fresh or smoked arm picnic, smoked ham–butt or shank portion, ground pork, sausage, bacon, spareribs, fresh or smoked hock, pigs feet, salt pork, fat back, scrapple, chitterlings, luncheon meats, frankfurters. 15 16 MEAT SUBSTITUTES: CHOOSE 1 cup cooked beans 1/2 cup tofu 1/2 cup egg substitute 2 eggs Texturized Vegetable Protein (TVP)– 1/2 cup dry chunks, 1/4 cup dry granules Whole eggs (no Egg yolks exceeding 4 more than 4 per per week, canned week), egg whites, pork and beans. fat and cholesterol free egg substitutes; tempeh, TVP, tofu, peanut butter (no more than 4 tablespoons per serving and no more than twice per week), all dried peas and beans. DECREASE FROZEN DINNERS: CHOOSE DECREASE 1 boxed meal Those that are less than 3 grams of fat per 100 calories and less than 600 milligrams sodium per dinner. All other frozen dinners. OILS: CHOOSE DECREASE 1 teaspoon Monounsaturated oils: olive, canola, peanut. SALAD DRESSINGS: CHOOSE DECREASE 1 tablespoon Fat free mayonnaise and mayonnaisetype dressing; fat free commercial salad dressing, low fat mayonnaise, and low fat salad dressing. Regular mayonnaise and mayonnaise-type dressing; regular salad dressing. MARGARINE: CHOOSE DECREASE 1 teaspoon Soft margarine or spreads made from monounsaturated oils, polyunsaturated oils or as listed previously, diet margarine. Margarine or shortening made from fats listed previously under “Decrease,” partially hydrogenated or hydrogenated stick margarine. CREAM CHEESE: CHOOSE DECREASE 2 tablespoons Fat free, low fat, reduced fat, or light cream cheeses. Regular cream cheese. FATS AND OILS (Use sparingly.) 17 VEGETABLE SPRAYS: Saturated fats: coconut, palm and palm kernel oil, butter, lard, cocoa butter, bacon, chicken fat, Polyunsaturated oils: safflower, corn, solid shortenings made from partially soybean, cottonhydrogenated or seed, sesame, hydrogenated oils sunflower. (may contain trans fats). CHOOSE All NUTS AND SEEDS: CHOOSE 1 tablespoon seeds, 1 ounce nuts Unsalted: almonds, Brazil nuts, cashews, beechnuts, buttercoconut, macadamia nuts, chestnuts, nuts, pine nuts. filberts, hickory nuts, peanuts, pecans, pistachios, walnuts, sunflower seeds, soy nuts. DECREASE 18 OTHER: CHOOSE DECREASE Au jus gravy, fat free or low fat sour cream and coffee creamers. Regular non-dairy creamer, cream, regular sour cream, imitation sour cream, whipped cream, gravy mixes, gravy prepared with meat drippings, added salt or added fat, snack chips made with processed cheese, dips made with instant soup mixes. CHOOSE DECREASE DESSERTS AND SNACKS: CHOOSE DECREASE Gelatin (all kinds), fig bars, ginger snaps, angel food cake, low fat or fat free: ginger bread, cakes, pies, tapioca, vanilla or chocolate pudding (made with skim milk), frozen yogurt, ice cream, sherbet, fruit ice, popsicles, sorbet. All other desserts including: commercially baked cookies, cakes, pies, pastries, ice cream; pudding made with whole milk, salt, baking soda, baking powder; nuts, candy containing nuts, salted nuts or milk chocolate. SWEETS (Use sparingly.) SWEETS AND CANDY: 19 Milk chocolate, Sugar, cocoa, chocolate baking chocolate syrup, squares; chocolate fruit and fudge topping, custard butterscotch and hard sauce, carob, toppings, maple other candy. syrup, honey, marshmallow sauce, molasses, sorghum, jam, jelly, marmalade, fruit spreads, fruit butters, preserves, hard candy, jelly beans, gumdrops, marshmallows, peppermint, gummy bears, lollipops. 20 BEVERAGES AND MISCELLANEOUS FOODS (Drink at least 8 servings of decaffeinated non–alcoholic beverages a day.) BEVERAGES: CHOOSE DECREASE 8 ounces (1 cup) Water, seltzer, caffeine free carbonated drinks, decaffeinated coffee, decaffeinated tea, herbal tea, fruit– flavored drinks, instant breakfast– type milk beverage mixes (mixed with skim milk), chocolate malted mix, hot cocoa flavored mix (mixed with skim milk or water). Flavored instant– coffee beverages, commercially prepared milk–based drinks, milkshakes, eggnog, commercially softened water. SAUCES: CHOOSE DECREASE 1/4 cup Low sodium or homemade: marinara, tomato, clam, spaghetti, barbecue, sweet and sour, chili, salsa. White sauce, cheese sauce, sour cream– based sauce, hollandaise, Bearnaise, Alfredo, pesto, bechamel, curry, mushroom, tartar sauce. CHOOSE DECREASE Aromatic bitters, fresh horseradish, lemon and lime juice, vinegar, herbs, spices, flavor extracts, tabasco sauce. Salt*: onion salt, celery salt, seasoned salt, garlic salt, rock salt, sea salt, kosher salt, MSG (Monosodiumglutamate), soy sauce, meat tenderizers containing MSG. *NOTE: Salt substitutes may be used with your physician’s approval. NOTE: Consumption of caffeinated and alcoholic beverages is upon the advice of your physician. SOUPS: CHOOSE DECREASE 1 cup Commercial low sodium and reduced fat, low fat or fat free soups. All others. 21 CONDIMENTS AND SPICES: HIGH SODIUM FOODS Each of the following items contains about 300-400 milligrams of sodium. Only two of these items may be eaten each day: Miscellaneous Breads/Desserts 1/4 teaspoon salt (added at the table or in cooking) 4 tablespoons Worcestershire sauce 4 tablespoons low fat salad dressing 2 tablespoons chili sauce or barbecue sauce 4 medium, 3 extra large, or 2 giant olives 1 tablespoon imitation butter granules 1 teaspoon soy or teriyaki sauce 2 tablespoons mustard 4 tablespoons sweet pickle relish 2 tablespoons catsup Salted pretzels: 20 small, 3 medium twisted, 1 Dutch or 1 soft Soups 1/2 cup reconstituted, canned or dehydrated regular soups Vegetables 2 servings (1/2 cup each) regular canned vegetable from Choose list (not rinsed and drained) 1/3 canned regular sauerkraut, drained 1/2 large dill pickle Meat or meat substitutes 1-1/2 ounce regular canned tuna 3 ounces regular canned salmon 1-1/2 ounce regular canned crab 1 ounce Canadian bacon 3/4 cup 1% or fat free cottage cheese 2 ounces low fat cheese 1 ounce herring 22 IN YOUR GROCERY STORE Here are some food products that you may be wondering about... Flaxseed: A growing body of research suggests that diets high in omega-3 fatty acids may offer some degree of protection against heart disease. Omega-3 fatty acids may lower total blood cholesterol as well as LDL cholesterol. Flaxseeds and their oil are sources of omega-3 fatty acids. Flaxseeds must be ground for the omega-3 fatty acids to be absorbed by the body. This can be done with a coffee grinder or ground flaxseeds may be purchased. The fiber in flaxseeds may also lower cholesterol as it is considered a soluble fiber. Flaxseeds can be a healthful addition to an overall balanced, low fat diet. Flaxseeds have a pleasant nutty flavor and can be sprinkled on salads, cooked vegetables and cereals. Flaxseeds can be stored in the refrigerator for no more than a month. Flaxseed oil cannot be used for frying or sautéing as other oils can. One tablespoon of ground flaxseed will provide 1.29 grams of omega-3 fatty acid and 1 tablespoon of flaxseed oil will provide 6.39 grams of omega-3 fatty acid. Tips for including flaxseed in the diet: • Add a tablespoon of ground flaxseeds to breakfast cereal. • Mix a tablespoon of ground flaxseeds or flaxseed oil into an 8 ounce container of yogurt as a snack. • Add a teaspoon of flaxseed oil to your low fat mayo or mustard as you spread it onto bread. • Add a tablespoon of ground flaxseeds or flaxseed oil to your sauce, rice, pasta, or mixed dish. • Bake ground flaxseed into cookies, muffins, and other baked goods. • Ready-made flaxseed products are available on the market as well (breads, muffins, cereals). Note: Skip flaxseed supplements Simple ways to add soy to your diet: • Include 2 tablespoons of soy flour to each cup of bread flour when making bread to make a dense, moist, bread with a nutty flavor. • Replace milk with soy milk in cereal, cream soup and sauce. • Add tofu to recipes such as stir-fry, chili, kabobs and vegetable lasagna; tofu takes on the flavor of other ingredients. • Add toasted soy nuts to salads, or enjoy as a snack. • Try a variety of tasty “veggie” burgers containing soy. • Use boiled green soybeans (edamame) as a great side dish or replacement for other beans in many dishes. Plant Stanols and Sterols: Plant stanols and sterols are structurally similar to cholesterol. Because of this similarity, they can compete with cholesterol for absorption, even in people already eating low cholesterol diets. Consumption of plant stanols and sterols significantly lowers cholesterol absorption. The amount needed for this competition to take place is at least 1 gram per day and is maximal at 2 grams to 3 grams per day. Usual daily intake of plant stanols and sterols from plant-based foods is about 300 mg/day, not enough to interfere with cholesterol absorption. Research has determined that fat-based foods serve as the most effective way to deliver plant stanols/sterols to the body and they have been incorporated into some soft margarines. In the commercial products available, 1 serving of the product is formulated to contain ~ 1 gram of plant stanols (Benecol*) or plant sterols (Take Control*). To obtain maximal effect, 2 to 3 servings of these products should be consumed daily. Currently, only margarine spreads fortified with plant stanols/sterols are available in the United States for purchase in stores. *Use of brand names does not constitute an endorsement. Soy: Recent evidence has shown that consumption of soy protein as part of a low fat diet may help reduce the risk of heart disease. In addition to being a good source of protein, omega-3 fatty acids, calcium and fiber, soy contains a variety of plant estrogens (phytoestrogens) known as isoflavones, which may have an effect on total cholesterol, LDL cholesterol and triglycerides. While the optimal level of soy needed to achieve a significant effect remains unknown, soy products may be a heart-healthy addition to a balanced diet. 23 24 HEARTWISE MEAL PLANNING This sample meal plan is low in fat, high in fiber, moderate in sodium and follows the recommendations of the Food Guide Pyramid. HEARTWISE SNACKS Consider these heart healthy options: ♥ Fresh fruits and raw vegetables are low Calorie and chock-full of nutrients. ♥ Air-popped plain popcorn flavored with a small amount of imitation butter granules or spiced with chili or garlic powder. ♥ Whole grain breads, matzoh, breadsticks or low sodium crackers spread with low-fat bean dip or fat free yogurt dip. ♥ Rice cakes, whole wheat crackers or English muffins topped with apple butter or fruit spread. ♥ Bite-size, whole grain cereals and nuts and soy nuts mixed together. ♥ Graham crackers topped with no-salt-added fat free cottage or fresh fruit slices. ricotta cheese and ♥ Equal parts fat free yogurt, skim milk and fresh or frozen fruit whipped in a blender and frozen in paper cups. ♥ Skim milk or fortified soy milk whipped in a blender with ice fresh banana, strawberries or cubes and fresh fruit such as a peaches. ♥ Fat free yogurt with 1/4 cup berries. ♥ Frozen sliced ♥ Unsalted nuts and soy nuts (watch portion sizes as nuts are high in Calories). BREAKFAST 1/2 medium banana 1/2 cup whole grain cereal, cooked 1 slice whole grain bread 1 teaspoon soft tub margarine 8 ounces skim milk or soy milk Coffee/tea 1 fruit serving 1 bread serving 1 bread serving 1 fat serving 1 milk serving 1 beverage serving LUNCH 3 ounces sliced turkey breast on 2 slices whole grain bread with lettuce, tomato, fat free mayonnaise 1/2 cup carrot sticks fresh apple 8 ounces skim milk or soy milk Water or seltzer water 1 meat serving 2 bread serving 1/2 vegetable serving 1 vegetable serving 1 fruit serving 1 milk serving 1 cup or more DINNER 3 ounces baked salmon with lemon 1/2 cup steamed brown rice 1/2 cup steamed broccoli 1 cup mixed greens 1 tablespoon oil and vinegar 1 whole grain roll 1 teaspoon soft tub margarine 1/2 cup fat free frozen yogurt water or seltzer water 1 meat serving 1 bread serving 1 vegetable serving 1 vegetable serving 1 fat serving 1 bread serving 1 fat serving 1 milk serving 1 cup or more SNACKS 10 almonds 3 cups plain popcorn 1 medium orange 4 ounces, low sodium vegetable juice 1 cup fat free yogurt water or flavored seltzer 25 2 fats serving 1 bread serving 1 fruit serving 1 vegetable serving 1 milk serving 1 cup or more bananas and dried fruits and unsalted whole grain cereal and 1/2 cup grapes. 26 PORTION SIZES These drawings represent portion sizes for cooked animal protein (lean steak, lean roast beef, skinless chicken breast or fish), and low fat or fat free cheeses. For a serving of cooked animal protein, your slice should be as big as the large drawing and as thick as the 2–or 3–ounce rectangle. For a 1–ounce serving of cheese, your slice should be as big as the square and as thick as the 1–ounce rectangle. For animal protein products that are more round in shape (lean burgers and trimmed chops), use these drawings. For a 2-ounce cooked serving, your slice should be as big as the circle drawing and as thick as the 2ounce rectangle. For a 3-ounce cooked serving, your slice should be as big as the circle and as thick as the 3-ounce rectangle. dimensions for low fat or fat free cheeses dimensions for cooked animal protein 1-ounce thickness 2-ounce thickness 2-ounce thickness 3-ounce thickness 3-ounce thickness 27 28 HOW MUCH FAT SHOULD YOU EAT? READING FOOD LABELS Your fat intake should be controlled, but not eliminated from your diet. The following Guidelines and Definitions from the Department of Health and Human Services will help you to better understand food labels: 1. How many Calories should you consume each day? 13 Calories per pound body weight if you are not active (office work only). 15 Calories per pound body weight if you are moderately active (you walk or bike 30 to 45 minutes 3 times per week). 17 Calories per pound body weight if you are very active (you jog, run, do aerobics 45 to 60 minutes 5-7 times per week). 20 Calories per pound body weight if you are extremely active (you are a professional athlete). If you are overweight, multiply your desired weight, in pounds, by the number of Calories which matches your level of physical activity. 2. How many grams of fat should you consume per day? Your total fat intake each day should not exceed 30% of your daily caloric intake or a minimum of 15%, with saturated fat providing no more than 10% of total Calories. To calculate your daily fat allowance: Example: Estimate daily Calorie requirement Drop the last digit Divide by 3 Multiply by 9(Cal/g) ♥ “Low fat” is less than or equal to 3 grams of fat per serving. ♥ “Low in Saturated Fat” is less than or equal to 1 gram of saturated fat per serving. ♥ “Low Cholesterol” is less than or equal to 20 milligrams of cholesterol per serving. Note: Low cholesterol or cholesterol free does not mean Calorie or fat free. ♥ “Fat free” or “Non Fat” is less than or equal to 0.5 grams of fat per serving. ♥ “Reduced Fat” or “Lower Fat” is at least 25% less fat per serving than the original item. ♥ “Light” is at least 33% fewer Calories or 50% less fat per serving than the original item. ♥ Remove skin from cuts of chicken and turkey; choose cuts of beef labeled “lean.” Read labels to determine the percentage of fat. ♥ Read labels on snack foods for hydrogenated oils as these foods may contain trans fats. 2100 210 70 = fat grams/day 630 = total Calories from fat per day In this example, the daily fat allowance is 70 grams which represents 30% of the Caloric intake. This means that, over several days, fat intake should average no more than 70 grams a day. Although this booklet does not give you the specific fat content of foods, you can review the Reference List for recommended books that do provide this information. 29 Nutrition information is based on one serving and standard serving sizes. If you consume greater than this amount, be sure to adjust the nutrient calculations. ♥ Look for food products which have a maximum of 3 grams of fat per 100 Calories, which translates into a maximum of 30 percent Calories as fat. The percentage of Calories coming from fat can be calculated by using the following method: Fat Calories = grams of fat per serving X 9 Calories per gram of fat. Fat Calories X 100 = % of Calories coming from fat per serving Total Calories Example: Food Amount 8 ounces Skim milk 8 ounces 1% milk 8 ounces 2% milk 8 ounces Whole milk 1% cottage cheese 1/2 cup 2% cottage cheese 1/2 cup 4% cottage cheese 1/2 cup Total Calories % of Calories Fat Grams of Fat As Fat Per Serving Calories Per Serving 86 0% 0 0 102 23% 23 2.5 125 36% 45 5 150 72 48% 8 82 9 11% 1 100 18 18% 2 117 39% 45 5 30 READING FOOD LABELS HEARTWISE COOKING TIPS Don’t be fooled by food products that are labeled by weight such as 85% lean or 85% fat free. These foods may be only 15% fat by weight, but can provide over 50% of their calories from fat. It is better to evaluate foods based on grams of fat per serving. high fiber cereal Packaged foods have standard nutrition label format. An example of this labeling format is presented on the following page. Total Fat 1g* Saturated Fat 0g Cholesterol 0mg Sodium 90mg Total Carbohydrate 43g Dietary Fiber 5g Soluble Fiber 2g Insoluble Fiber 3g Sugars 10g Protein 5g MEATS Nutrition Facts Serving Size 2/3cup (55g) Servings Per Container about 6 Amount per Serving Cereal Cereal with 1/2 cup Skim milk Calories Calories from Fat 190 10 230 10 % Daily Value** Example: Ingredients: oats, dates, cane juice, brown rice flour, sprouted barley malt, concentrated grape juice, natural vanilla flavor, rice bran, natural almond flavor, baking soda, sea salt, natural beta carotene, natural vitamin E (D-alpha tocopherol), niacin, vitamin B6 (pyridoxine hydrochloride), riboflavin, vitamin B1(thiamin hydrochloride), folic acid, vitamin B12 (cyanocobalamine). Vitamin A Vitamin C Calcium Iron Thiamine Riboflavin Niacin Vitamin B6 Folate Vitamin B12 2% 0% 7% 16% 24% Calories per gram: Fat 9 • Carbohydrate 4 Exchanges: 1-1/2 Starch, 1 Fruit 2,000 65g 20g 300mg 2,400mg 3,500mg 300g 25g • Drain fat from browned meats before adding other ingredients. Vegetables and starches absorb fat. Cook stews, soups and boiled meats a day ahead and then refrigerate. Skim off the hardened fat at the top, reheat and serve. VEGETABLES SENSATIONAL SUBSTITUTIONS 2% 4% 2% 8% 10% 10% 10% 10% 10% 10% Calories Less than Less than Less than Less than Trim visible fat from meat before cooking. Use a rack to broil, roast or bake meat so that fat will drip away. Baste with fat free salad dressing, fruit or vegetable juice, wine or bouillon. Steam, microwave or stir-fry in non-stick cookware with a small amount of vegetable spray or liquid vegetable oil from allowed oils. Season with herbs, spices, seasoned vinegar or imitation butter granules. 8% 6% 15% 8% 10% 10% 10% 10% 10% 20% * Amount in cereal. One half cup of skim milk contributes an additional 40 calories, 65 mg sodium, 6g total carbohydrate (6g sugars) and 4g protein. **Percent Daily Values are based on a 2,000 calorie diet. Your daily values may be higher or lower depending on your calorie needs: Total Fat Sat. Fat Cholesterol Sodium Potassium Total Carbohydrate Dietary Fiber 31 2% 0% 4% 14% 24% Alter your thinking about meat. Make it an addition to grains and vegetables rather than the main item. Protein 4 2,500 80g 25g 300mg 2,400mg 3,500mg 375mg 30g You can easily increase nutrition and trim the fat in many of your favorite recipes by using the healthier alternatives listed below. COOKING Instead of ... 1 cup cream Cream to thicken soups Oil base for marinade Stick margarine/butter 2 oz. Mild cheddar cheese High-fat sauces over meat/poultry White rice Bread crumbs Meat/poultry for stir-fry Ground meat Try this ... 1 cup evaporated skim milk Pureed potatoes or vegetables Small amount of olive or canola oil Liquid margarine 1 oz. Reduced-fat sharp or extra- sharp cheddar cheese Vegetable purees (blend steamed broccoli, sauteed onion, garlic, salt and pepper), fruit salsa Brown rice, Bulgur, Kasha, Quinoa, whole wheat couscous Toasted wheat germ, whole wheat bread crumbs Extra-firm tofu, cubed; more vegetables Ground turkey breast, plus finely chopped vegetables; crumbled tofu, tempeh or TVP; 32 cooked beans DINING OUT BAKING Instead of… 1/2 cup butter /margarine 1 egg sweetened condensed milk Evaporated milk 1 cup all-purpose flour Pastry pie crust 1 oz. baking chocolate 1 cup chocolate chips Fudge sauce Frosting Try… 1/2 cup canola oil, or soft margarine 2 egg whites or 1/2 cup liquid egg substitute Fat free sweetened condensed milk Evaporated skim milk 1 cup finely milled whole wheat flour. 1 cup “white” whole wheat flour. 7/8 cup all-purpose flour + 2 tablespoon soy flour Phyllo crust (use cooking spray between layers); graham cracker crust 3-4 tablespoon cocoa powder + 1 tablespoon oil + 1 tablespoon sugar(for frosting or sauces). 1/4 cup cocoa (for cakes or cookies) 1/2 cup mini chocolate chips; chopped dried fruit such as cranberries,raisins, apricots, cherries; chopped nuts Chocolate syrup Sliced fresh fruit; pureed fruit; light dusting of powdered sugar Experiment with new spices, which can add flavor to foods without adding fat or Calories. Read labels to be sure that seasonings do not contain sodium (salt). Before you go out to eat, review your recommended food lists. At breakfast time, fresh fruit is always a good choice. Order whole grain bread, a bagel or English muffin with soft margarine or low fat cottage cheese served on the side. Cereals are good choices with skim milk. Some restaurants offer egg substitutes or egg whites. Ask for Omelettes to be prepared without butter or oil. Low fat yogurt may also be available. For lunch or dinner, poached seafood and raw vegetables are fine, but check the sauces for fat content. Melon or other fruits or juices are also good choices. Breadsticks or bread can be a healthful starter if you skip the spreads. Beverages can include sparkling water with lemon or lime. Ask that salted nuts, buttery crackers and chips be removed from your table. Salads can be lean and flavorful. Choose fresh greens and other vegetables but avoid cheese, eggs, high-fat meat, bacon, croutons and creamy dressings. Request your dressing on the side so you can control the amount added. Lemon juice can be used instead of a higher Calorie dressing. As you choose your entree, look for poultry, fish, shellfish or vegetable dishes that are simply prepared without added salt or fat. If lean red meats are trimmed and prepared by a lower fat method, they are also acceptable. Choose small serving sizes (about 4 ounces cooked) instead of large portions. Accompaniments of vegetables or starches should be cooked by fat free methods. Request yogurt in place of sour cream for baked potatoes. Lemon is also good on vegetables. When it’s time for dessert, remember fresh fruit, fruit ices, sherbets, gelatin and angel food cake ... or have decaf espresso or herbal tea with a lemon or orange twist. Use the 50 percent rule. You can still enjoy your favorite foods, but ask that half of the usual portion be served. Take the other half home. Do not be afraid to ask questions. Restaurants are often willing to accommodate customer requests regarding preparation of dishes. 33 34 HEARTWISE REFERENCES HEARTWISE RESOURCES The American Dietetic Association, Cut the Fat. New York, NY: 1996 American Dietetic Association 120 South Riverside Plaza, Suite 2000 Chicago, IL 60606 (800)877-1600 www.eatright.org The American Heart Association One-Dish Meals. New York, NY: 2003 The American Heart Association Low-Calorie CookBook. New York, NY: 2003 The American Heart Association Quick & Easy Cookbook. New York, NY: 2001 The American Heart Association Low-Salt Cookbook. New York, NY: 2001 The American Heart Association Low-Fat & Luscious Desserts. New York, NY: 2000 The American Heart Association Meals in minutes Cookbook. New York, NY: 2000 The American Heart Association Cookbook. New York, NY: 1999 The American Heart Association Low- fat, Low-Cholesterol Cookbook. New York, NY: 1997 DeBakey, M.E., Gotto, Jr., A.M., and Scott, L.W. The Living Heart Guide to Eating Out, New York, NY: MasterMedia; 1993 DeBakey, M.E., Foreyt. J.P., Gotto, Jr., A.M., Scott, L.W. The New Living Heart Diet. New York, NY: Fireside; 1996 The Moosewood Collective. Moosewood Restaurant Low Fat Favorites. New York, NY: Clarkson Potter Publishers; 1996 Natow, A.B., Heslin, J. The Fat Counter. New York, NY: Pocket Books; 1993 Piscatella, J.C. Don’t Eat Your Heart Out Cookbook. New York, NY: Workman Publishing; 1991 Shaw, D. The Essential Vegetarian Cookbook. New York, NY: Clarkson Potter Publishers; 1997 NewYork-Presbyterian Hospital Department of Food and Nutrition Website: www.nyp.org/nutrition 35 National Center for Nutrition and Dietetics Consumer Hot Line: (800)366-1655 (Available 10 a.m.-5 p.m. Eastern Standard Time) American Heart Association (AHA) National Center 7320 Greenville Avenue Dallas, TX 75231 (800)AHA-USA-1 www.americanheart.org American Heart Association New York City Affiliate 122 East 42nd Street New York, NY 10168 (212)661-5335 American Institute for Cancer Research 1759 R Street, NW Washington, DC 20009 (800)843-8114 www.aicr.org Nutrition Consultation Service Department of Food and Nutrition NewYork Weill Cornell Medical Center Greenberg Pavilion 525 East 68th Street New York, NY 10021 (212)746-0838 Columbia University Medical Center 177 Fort Washington Avenue New York, NY 10032 (212)305-9969 Fauth Cardiopulmonary Rehabilitation Center Columbia University Medical Center 622 W 168th Street Vanderbilt Clinic, Rm 3-363 New York, NY 10032 (212)305-4695 The Coronary Risk Reduction Program Lectures and Support Groups Available (212)746-2150 Cardiac Health Center NewYork Weill Cornell Medical Center 1153 York Avenue New York, NY 10021 (212)746-1200 Special Surgery – Sports Medicine at Chelsea Piers 23rd Street and the Hudson River (Pier 60) New York, NY 10011 (212)366-5100 36 ©MMIV Medical Center Marketing For referral call 1-877-NYPWELL NewYork Weill Cornell Medical Center 525 East 68th Street, New York, NY 10021 Columbia University Medical Center 622 West 168th Street, New York, NY 10032