Welcome to the Cardiac Pyramid, which is designed to help manage coronary artery disease and improve your overall health. There are several important items to note about the cardiac pyramid:

• The majority of the pyramid is made up of plant products in order to increase fiber and decrease dietary cholesterol and saturated fat.
• Vegetables, whole grains, and fruit contribute fiber and provide a variety of phytochemicals (plant nutrients), vitamins, and minerals.
• Legumes (beans, lentils, peas) are the major source of soluble fiber and also contain protein.
• Soy products are the major contributor of plant protein.
• The animal products are limited because they are the only source of dietary cholesterol and the main source of saturated fat. The animal products allowed are fish, skinless poultry, egg whites, low-nonfat dairy and lean meats.
• The pyramid recommends incorporating healthy fats that would be liquid at room temperature along with nuts, seeds, and avocado. These provide beneficial fats.
• The pyramid recommends decreasing the use of sugar, salt and refined white flour products.
• There is an emphasis on omitting fats that are solid at room temperature. Solid fats contain the undesirable saturated and trans fats which contribute to the progression of coronary artery disease.

Servings and Best Choices from the Cardiac Pyramid

Use the following information to help make the best selections in appropriate portions from each section of the cardiac pyramid.

Vegetables | Fruit | Soy | Low-Nonfat Dairy | Nuts, Seeds & Oils
Fish, Skinless Poultry, eggs, Lean Beef & Pork

Vegetables

Vegetables are good fiber sources and are naturally low in fat. They provide vitamins A and C and the minerals folate, iron, potassium, and magnesium.

Aim for more than 5 servings daily - one serving equals

• 1 cup raw, leafy vegetables
• 1 small potato
• 1/2 cup chopped, raw, or cooked vegetables
• 1/2 cup vegetable juice/tomato sauce

Best Choices

• All fresh, frozen, or canned vegetables without added salt or fats that are solid at room temperature.

Limit

• Salads with regular mayonnaise-based sauces (e.g. potato salad and coleslaw).
• Breaded and deep-fried vegetables.
• Vegetables in brine are high in sodium (e.g. pickles, beets, olives, and sauerkraut).
• Commercially made salsa, regular tomato juice, canned tomato products and other canned vegetables are all high in sodium.

Ideas

• Start adding vegetables earlier in the day to increase servings. For example: Low sodium V8® juice as a morning or afternoon snack.
• Get acquainted with the produce section of your grocery store and incorporate vegetables that you don't usually use.
• Think color! A variety of color equals a variety of nutrients.
• Choose low sodium tomato products.
• Make your own fresh salsa.
• For mayonnaise based salads, use fat free or reduced fat mayonnaise/Miracle Whip®.
• Visit your local farmers market in season.
• Plant a vegetable garden. If space is limited try potted tomato plants.
• Consider joining a Community Supported Agriculture (CSA) farm in your area. Purchasing a "share" of the harvest at the beginning of each year will provide you with a weekly or bi-weekly supply of fresh, organic produce. Visit www.macsac.org for a list of CSA farms in the Dane County area.

Legumes, Oats, and other Whole Grains

Legumes (i.e. dried beans, peas, and lentils) are excellent sources of both fiber and non-meat protein. Oats are another excellent fiber source. These and other whole grains supply B-vitamins and iron.

Aim for 4-8 servings daily - one serving equals

• 1/2 cup cooked beans, peas, or lentils
• 2 T. hummus
• 1/4 cup oat bran
• 1/2 cup cooked oats
• 1 oz. (1/2 -1 1/4 cup) whole grain ready-to-eat cereal
• 1/2 cup cooked whole wheat or soy enriched pasta, brown rice, barley, quinoa, couscous, or bulgur (cracked wheat)
• 1 slice whole grain bread
• 1 oz. (1/2) whole grain bagel
• 1 (7-8") whole wheat or corn tortilla

Best Choices

• Dried/canned beans, peas and lentils
• Oat bran, rolled and steel cut oats
• Whole grain cereals with at least three grams of fiber per serving
• Whole wheat and soy enriched pastas
• Brown and wild rice, barley, quinoa, couscous, millet, and bulgur (cracked wheat)
• Whole wheat, rye, and oat: bread, bagels, buns, tortillas, and crackers
• Popcorn: unbuttered air popped and unbuttered stove top popped using canola, soybean, or olive oil

Limit

• Refined white flour and/or high fat products (i.e. white bread, croissants, pastries, pie crust, muffins, biscuits, pasta, cookies, and cakes)
• White rice
• Buttered popcorn and most microwave popcorn
• Snack foods made with hydrogenated and partially hydrogenated oils
• Pretzels—These are low fat; however, they are a refined white flour product therefore low in fiber and they are high in salt

Ideas

• Aim for one cup of oats and/or legumes per day.
• Rinse canned beans to reduce the sodium.
• Add dry oat bran or rolled oats to ready-to-eat cereal.
• Modify recipes by replacing 1/2 the white flour with whole grain flour.
• Increase your variety of grains by replacing rice/pasta with cracked wheat, barley, millet, quinoa, or couscous.

Fruit

• 1 medium fruit
• 1/2 cup fruit juice
• 1/2 cup chopped, cooked, or canned fruit
• 1/4 cup dried fruit
• 2 Tbsp Avocado

Best Choices

• All fresh fruit
• Canned or frozen fruit packed in it's own juice
• Fruit juice labeled light or diet (e.g., Light Ocean Spray® or Diet V-8 Splash®)

Limit

• Canned fruit in light or heavy syrup
• Fruit juice—the calories add up quickly and the fiber content is zero

Ideas

• Think color! A variety of color equals a variety of nutrients.
• Use avocado as a sandwich spread in place of mayonnaise, butter, or margarine.
• Add avocado cubes to a tossed salad.

Soy

Soy, being a plant product, contains no cholesterol. It is very low in saturated fat and is an excellent source of protein. Soy also provides fiber, calcium, iron, zinc, thiamine, folate and Vitamin B6. The Food and Drug Administration (FDA) recommends at least 25 grams of soy protein daily as part of a heart healthy diet.

Best Choices

• Canned soybeans, edamame, tofu, unsalted soy nuts, plain or vanilla fortified soy milk and soy creamer.

Limit

• High sodium soy products such as: salted soy nuts, soy cheese, baked tofu, soy burgers, soy hotdogs, and soy lunch meats.

Ideas

• For people with diabetes, limit high carbohydrate soy products such as: flavored soy yogurt, chocolate soymilk, soy ice cream, and soy energy bars.
• Add canned soybeans to chili, soups, salads, and casseroles.
• Edamame plus a fruit or vegetable makes a great snack. It can also be easily added to a tossed salad.
• Puree 4 oz. soft tofu in with a 15 oz. low-fat or fat-free dill, ranch, or French dip.
• Make a smoothie using 4 oz. soft tofu, 1/4 - 1/2 cup vanilla soymilk and fresh or frozen fruit of your choice.
• Use 1/2 soft tofu and 1/2 fat free cottage/ricotta cheese when making vegetarian or meat lasagna.
• Mix unsalted soy nuts with a variety of other unsalted nuts. Have 1/4 - 1/3 cup with a fruit or a vegetable for a healthy snack.
• Add unsalted soy nuts to cereal and yogurt for some added crunch.
• Use soy creamer in place of half & half in your morning cup of coffee or tea and when making cream soups and sauces.
• For soy recipes, visit www.soyfoods.com.

Low-Nonfat Dairy

These foods are good sources of calcium and other vitamins and minerals. Calcium is one of the minerals necessary for good blood pressure control and maintaining strong bones and teeth.

Aim for 3-4 servings and/or a calcium supplement with Vitamin D daily - one serving equals

• 1 cup milk (300 mg.)*
• 6 oz. yogurt (235 mg.)*
• 1 oz. cheese (varies 100-200 mg.)*
• 1/2 cup cottage cheese (35 mg.)*
• 1/2 cup low-nonfat ice cream or nonfat frozen yogurt (100 mg.)*

How Much Calcium Do You Need?

Best Choices

• Skim (fat free) and 1% milk
• Fat free half & half (e.g., Land O' Lakes® or Kemps®)
• Low and nonfat yogurt, sour cream, and cream cheese
• Part skim, low fat or fat free cheese (e.g. mozzarella, string cheese, farmer's, alpine lace) 1% or fat free cottage cheese, reduced fat ricotta and feta or any cheese which contains 5 grams or less fat per ounce
• Low-nonfat ice cream or nonfat frozen yogurt

Limit

• Heavy cream, whipping cream, half & half, whole and 2% milk
• Cheese spreads, natural and processed cheese with greater than 5 grams of fat per ounce

Ideas

• Use fat free half & half in your coffee or tea and when making cream soups and sauces.
• If using canned soups, look for brands with 3 grams or less fat per serving and 600 mg. or less sodium per serving.
• Use skim or 1% milk when making pudding, hot chocolate and baked products.
• Sprinkle fresh grated parmesan to top salads or pasta dishes.
• For people with diabetes, use sugar free pudding and sugar free yogurt. Limit fat free ice cream, low fat ice cream and nonfat yogurt to 1/2 cup serving.
• To increase your calcium intake, try to have a glass of milk with each meal instead of coffee or soda.
• Pack yogurt or string cheese in your lunch or have as a snack.
• If you have lactose intolerance, try skim or 1% Lactaid® milk or other similar products.
• If you cannot consume adequate calcium to meet nutritional needs, consider taking a calcium supplement. If you are not taking a multivitamin, choose a calcium supplement with Vitamin D. Look for the active ingredient calcium carbonate or calcium citrate. Choose a 500-600 mg. supplement and take one with meals 2-3 times per day.

Nuts, Seeds, and Oils

These are all cholesterol free. They provide monounsaturated and polyunsaturated fats and omega-3 fatty acids which are beneficial in managing coronary artery disease. Nuts provide protein, fiber, vitamin E, and the minerals phosphorus, zinc, magnesium and selenium. Flax seed provides omega 3 fatty acids and fiber.

Aim for a healthy fat source with each meal.

• 1/4 cup (1 oz.) nuts
• 2 Tbsp. natural peanut butter
• 2 Tbsp. ground flax seed
• 1 Tbsp. oil

Best Choices

• Unsalted nuts
• Natural peanut butter - the oil will be liquid at room temperature because it is non-hydrogenated
• Ground flax seed, also referred to as flax-meal
• Canola, olive, peanut, and soybean oils
• Salad dressings using any of the above oils or any low fat dressing
• Fat free or reduced fat mayonnaise/Miracle Whip®
• Pump, squeezable or pressed margarine/spread

Limit

• All fats that are solid at room temperature - these fats (i.e. meat marbling, poultry skin, butter, stick and tub margarine, coconut and palm oils, all hydrogenated and partially hydrogenated products) are sources of saturated and trans fatty acids which can contribute to the progression of coronary artery disease

Ideas

• To purchase unsalted nuts, look in the baking aisle near chocolate chips and cake mixes.
• Unsalted peanuts can be found in the snack aisle with other salted nuts.
• Make your own trail mix using a variety of nuts with Quaker Oat Squares® or Shredded Wheat ‘n Bran cereal.
• To extend the shelf life of nuts, store in the freezer.
• Natural Peanut Butter can be found in several places at the grocery store. One place is the cooler section near tub margarine. When found here, the oil has been stirred in for you. Therefore, take home and refrigerate. It can also be found on the shelf near other peanut butter. The oil will be separated and will require stirring and storage in the refrigerator. Here is a tip to make mixing easier. Before opening the jar, tip it upside down and let it sit until the oil goes to what will be the bottom of the jar. Mix and store in the refrigerator so the oil will no longer separate.
• Flax seed can be found in the produce section or health food isle of most grocery stores. If already ground, it may be called flax meal.
• In order to grind flaxseed, use a coffee grinder. Both store bought flax-meal as well as home ground should be kept in a dark container and refrigerated.
• Add 1-2 Tbsp. of ground flax seed to cereal or yogurt.
• For baked goods, 1 1/2 cups of flaxseed meal can replace 1/2 cup of butter, margarine, or shortening in a recipe.
• Dip bread in olive oil instead of using a margarine or butter.

Fish, Skinless Poultry, Eggs, Lean Beef and Pork

These are all sources of B-vitamins, iron, zinc, protein, and cholesterol. Cholesterol is manufactured by the liver and therefore is found in animal products. We are not able to see cholesterol. It is found in liver, egg yolks and within the flesh of animals. Any visible fat is referred to as saturated fat and should be limited. Oily fish is the richest source of Omega-3 fatty acids which are beneficial in managing coronary artery disease.

Aim for 7 or less servings per week - one serving equals

• 3 oz. cooked skinless poultry, fish, lean beef or pork
• 1 egg

Best Choices

• Poultry: skinless cuts, and ground turkey that specifies 100% skinless turkey breast
• Baked, broiled, or grilled fish: Atlantic salmon*, Atlantic herring*, whitefish*, tuna*, Atlantic mackerel*, rainbow trout*, bluefish*, and sardines*, cod, perch, walleye, Tilapia, etc. *fish that provide heart-healthy Omega-3 fatty acids
• Egg white
• Beef and Pork: Flank, Round, and Loin cuts
• Venison: Steaks, chops, and ground without added fat
• Lamb: foreshank

Limit

• Poultry: chicken/turkey thighs and wings, duck and goose
• Fish/seafood: breaded and deep fried
• Egg yolks: 2 per week
• Beef: ground chuck, ground beef (i.e. hamburger), corned beef, frankfurters, bratwurst, sausage, prime rib, porterhouse, and rib eye
• Pork: ham, bacon, sausage, frankfurters, bratwurst, and ribs
• Lamb: ground, rib, blade
• Venison: Sausage and frankfurters
• Deli/luncheon meats: bologna, pastrami, salami, pepperoni
• Organ meats: liver

Ideas

• The American Heart Association recommends that people with heart disease should consume one gram of omega-3 fatty acids per day. If you like fish, consume at least 2 servings per week of the fish listed in our best choice section. On the days you don't eat fish or if you dislike fish, take 1000 mg. of an omega-3 fish oil supplement. If you are interested in more information about fish oil supplements, visit www.americanheart.org.
• If choosing a frozen entrée/meal, look for brands with 10 grams or less fat and 600 mg. or less sodium per serving.

Suggested Resources

We provide the following resources to help you in making dietary changes. Many of the resources can be found at local libraries and bookstores.

Web Sites

For Recipes

• American Heart Association
• American Dietetic Association
• American Diabetes Association
• Meriter Hospital
• U.S. Soyfoods Directory
• Extensive Recipe Database

For Education & Lifestyle Change

• Harvard School of Public Health
• Mayo Clinic
• National Institute of Health
• Madison Area Community Supported Agriculture
• Meriter Hospital Heart Hospital
• Tuft's University Health and Nutrition Letter
• USDA's Center for Nutrition Policy and Promotion
• The National Coalition for Women with Heart Disease
• Nutrition Action Health Letter
• For Restaurant Nutrition Facts: www.dietfacts.com

Cookbooks

• Diabetes and Heart Healthy Cookbook, 2004, American Heart Association and The American Diabetes Association, Inc.
• The New American Heart Association Cookbook, 7th Edition
• The American Heart Association Low Salt Cookbook
• Vegetarian Cooking for Everyone, Deborah Madison, 1997
• Vegetables Every Day by Jack Bishop
• Diabetic Meals in 30 Minutes Or Less, American Diabetes Association
• The Formula: A Personalized 40-30-30 Weight Loss Program by Gene and Joyce Daoust
• How to Cook Everything by Mark Bittman

Magazines

• Eating Well Magazine

References

• American Dietetic Association Complete Food and Nutrition
  Guide 2nd edition
• American Dietetic Association and American Diabetes Association 2003 Exchange Lists for Meal Planning
• Bowes and Church's Food Values 17th edition
• Self Magazine, 2003
• United Soybean Board, 2003 Soyfoods Guide
• www.americanheart.org
• www.diabetes.org
• www.dietfacts.com
• www.eatingwell.com
• www.eatright.org
• www.foodandhealth.com
• www.healthletter.tufts.edu
• www.macsac.org
• www.nutritiondata.com
• www.soyfoods.com
• USDA Center for Nutrition and Policy Promotion Interactive Healthy Eating Index

6/23/2008