These are the important things to know and keep in mind when you go home:

• Return to your pre-surgery diet for the next 4 weeks or until you see your heart surgeon after leaving the hospital. For now, it is better to eat what you like to build strength and heal your incision.
  
  
• Make changes in your eating habits slowly. It may take about 3 months to change to heart healthy eating.
  
  
• Use less salt. Do not add salt at the table. In cooking, use half the amount of salt you usually use or half of what a recipe calls for. Limit or avoid cured or processed meats, convenience foods, and canned products.
  
  
• Limit meat to 6 ounces a day. Three ounces of meat is about the size of a deck of cards. Red meat such as beef, pork, lamb and veal should be eaten no more than 3 times a week unless your doctor has told you otherwise. Eat chicken, fish or turkey more often. Avoid organ meats. Limit shrimp and crayfish to 4 ounces per week.
  
  
• Limit egg yolks to 3 a week, including those used in cooking. You may use 2 egg whites or 1/4 cup cholesterol-free egg substitute to equal one whole egg in your recipes.
  
  
• Choose milk and dairy products that are 1% milkfat or less. Cheeses should contain no more than 5 grams of fat per ounce.
  
  
• Eat 5 or more servings of fruits and vegetables a day. DO NOT fry your vegetables or add high fat sauces such as butter, cream or cheese sauce to them.
  
  
• Limit fat to 5 servings a day. Best choices are vegetable oils such as canola, olive, or peanut oil. Margarines should have liquid oil listed as the first ingredient on the label. DO NOT use animal fats, shortening or any fat that is hard at room temperature.
  
  
• Do not fry your foods. It is best to grill, bake, broil, roast, stew, microwave, or pan broil. When pan-broiling, use a non-stick skillet and non-stick cooking spray.
  
  
• Practice moderation. A splurge or treat is O.K. once in a while, but do not make poor choices everyday. Remember that heart healthy eating is for a lifetime.

To help you learn how to cook with less fat, cholesterol, and salt, please join us for our free Heart Healthy Cooking School sponsored by the Saint Thomas Heart Institute. Call 1-800-298-3200 to make your reservation and for exact dates, time, and location within the hospital.

Recommended References and Cookbooks

To help you with heart healthy cooking at home, we recommend:

A Taste of the Good Life from the Heart of Tennessee, published by the Saint Thomas Heart Institute and available at the Saint Thomas Hospital Gift Shop or call (615) 222-2008 to order by mail.

The American Heart Association Cookbook

The American Heart Association Quick and Easy Cookbook

The American Heart Association Low Salt Cookbook

Available at your local bookstore.

For help or if you have questions once you get home, please call our Medical Nutrition Therapy department at (615) 222-6671.

LOW FAT, LOW CHOLESTEROL
Nutrition Labeling, Dining Out, and Cooking Tips

Dining Out

• When in a restaurant, order plain entrees, potatoes and vegetables. Ask that margarine be served on the side. Order salads with dressings on the side.
  
  
• For variety, consider dried beans or legumes as a main dish.
  
  
• If fast food establishments are part of your lifestyle, better choices are salads, baked potatoes, plain small hamburgers, or grilled chicken sandwiches without the sauces. Rotisserie-type chicken products are not necessarily lower in fat. Most fast food items are also high in sodium, so balance fast food meals by making lower fat and sodium choices at your other meals. Ask for nutrition information before you make your choices.

Cooking Tips

These are some helpful recipe substitutions:

INSTEAD OF:	USE:
1 whole egg	2 egg whites 1/4 cup egg substitute 1 egg white plus 1 tsp Vegetable oil*
1 cup butter, or shortening	1 cup margarine** 2/3 to 3/4 cup vegetable oil Molly McButter/ Butter Buds for seasoning vegetables, baked potatoes
1 cup whole milk	1 cup skim milk 1 cup 1% milk
Sour cream	Low or nonfat sour cream plain nonfat yogurt blended 1% milkfat cottage cheese
Cream cheese	Nonfat cream cheese "light" cream cheese containing 5 grams (or less) fat per ounce neufchatel cheese nonfat yogurt cheese
Creamed cottage cheese	1% milkfat cottage cheese nonfat cottage cheese
Fat for sautéing, stir-frying	"sauté" in stock/water "sauté" in vegetable spray
Sautéed vegetables	Steamed vegetables
Gravy	Use 1 tbsp cornstarch or 2 tbsp flour to thicken 1 cup fat free broth
1 ounce baking chocolate	3 tbsp powdered cocoa plus 1 tbsp vegetable oil

To help you follow the Heart Healthy eating plan, refer to the list below to make your selections.

Meat/Meat Substitute
Maximum: 6 ounces per day
Serving sizes below are one ounce equivalents

Milk
Minimum: 2 servings daily
· each of the items below equals 1 serving

Fruit
Minimum: 3 servings daily
· each of the items below equals 1 serving

Starch/Bread
Minimum: 6-11 servings daily
· each of the items below equals 1 serving

Vegetables
Minimum: 4 servings daily
Suggested serving size = 1/2 cup cooked or one cup raw

Fat
Maximum: 5-8 servings daily
n each of the items below equals 1 serving

Alcohol
Check with your physician about drinking alcohol. The American Heart Association recommends using alcohol in moderation only, if at all; no more than two drinks per day of wine, beer, or liquor, and only when calorie limits allow.

The following counts as one drink:

NUTRITION LABELING
Nutrition Labeling

• Learn how to read food ingredients labels. All food labels list the product ingredients in order by weight. The ingredient in the greatest amount is listed first. Read the Nutrition Facts label; look for the amount of fat, polyunsaturated fat, saturated fat and cholesterol.
  
• A good rule of thumb is to choose foods with 3 grams or less total fat per 100 calories for the standard serving size listed on the label.
  
• The following chart refers to nutrition labeling terms related to Step I and Step II Diet:

What Does It Mean?
Terms commonly found on food labels are listed below

Low: This term is used on foods that could be eaten frequently without exceeding dietary guidelines for one or more of these components: fat, saturated fat, cholesterol, sodium and calories. Synonyms of low include "little", "lite", and "low source of".

Low Fat: 3 grams of fat or less per serving

Low Saturated Fat: 1 gram of fat or less per serving

Low Sodium: Less than 140 milligrams of sodium per serving

Very Low Sodium: Less than 35 milligrams of sodium per serving

Low Cholesterol: Less than 20 milligrams per serving

Low Calorie: 40 calories or less per serving

Lean and Extra Lean: These terms can be used to describe the content of meat, poultry, seafood and game meats.

Lean: Less than 10 grams of fat, less than 2 grams of saturated fat and less than 95 milligrams of cholesterol per serving and per 100 grams.

Extra Lean: Less than 5 grams of fat, less than 2 grams of saturated fat and less than 95 milligrams of cholesterol per serving and per 100 grams.

Good Source: This term means that one serving of a food contains 10 to 19% of the Daily Value for a particular nutrient.

Reduced: This term means that a nutritionally altered product contains 25% less of a nutrient or of calories than the regular or reference product. However, a reduced claim cannot be made on a product if the product it is compared to already meets the requirement for a "low"claim.

Less: This term means that a food, whether altered of not, contains 25% less of a nutrient or of calories than the reference food. For example, pretzels that have 25% less fat than potato chips could carry a "less"claim. "Fewer"is an acceptable synonym.

High: This term can be used if the food contains 20% or more of the Daily Value for a particular nutrient in a serving.
More: This term means that a serving of food, whether altered or not, contains a nutrient that is at least 10% more of the Daily Value than the reference food.

Free: This term means that a product does not contain any, or only a small amount of a particular nutrient.

Calorie Free: A product with this claim contains fewer than 5 calories per serving.

Sugar Free: Less than 0.5 grams per servings

Fat Free: Less than 0.5 grams per serving

No Cholesterol: This means that a product does not contain animal fat but may contain a large amount of total fat, particular saturated fats such as palm or coconut oils, vegetable shortening or hydrogenated oils.

Light or Lite: It can mean a product contains 1/3 fewer calories or 1/2 the fat of the regular product OR that the sodium content of a low-fat, low-calorie food has been reduced. Light can still be used for products which are light in texture or color, but must state what the claim is referring to; for example, "light"and "fluffy"or "light brown sugar".