| Food for the Day | ||
| Recommended | Restrict | |
| Vegetables 1–4 cups | All fresh, frozen, or canned vegetables (choose low sodium varieties or rinse before serving); 100% vegetables juice. | Commercial fried vegetables, vegetables in butter, cream sauce, or cheese sauce, fried potatoes, French fries, chips |
| Fruits 1–2.5 cups | Any fresh, frozen, dried, or canned fruits or 100% fruit juice. | Dried fruit with added sugar, fried fruit, fruit served with added fat. |
| Grains 3–10 ounce-equivalents | Whole-grain breads, cereals, rice, pasta, crackers, and tortillas; brown rice, quinoa, whole wheat couscous, barley, oats. Products made with oat bran. Flaxseed, chia seed. | Egg noodles; fried rice; commercial muffins, biscuits, doughnuts, sweet rolls, croissants; egg or cheese breads; party crackers; regular granolas, regular granola bars, sweets made with partially hydrogenated oils. |
| Dairy Products 2–3 cups | Fat-free or low-fat (1%) milk, fat-free dry milk, evaporated fat-free milk, buttermilk made from fat-free milk, fat-free soy milk or milk substitutes; almond milk, fat-free and low-fat yogurt including Greek yogurt, low- fat cottage cheese, low-fat cheese. | Cream, sour cream, whole or reduced fat milk, regular evaporated milk, whole or reduced fat yogurt, cheese, whole milk ice cream, half and half |
| Protein Foods 2–7 ounce-equivalents Note: Eggs limit yolks to 1 per day | Lean beef, and pork (loin, leg, round, extra lean hamburger), lamb, veal, skinless poultry, 95–99% fat-free luncheon meats, fish, dried beans, nuts and nut butters, meat alternatives /substitutes. Egg whites, egg substitutes or omega-3 fortified eggs; hard-cooked or scrambled. | High fat cuts of beef, pork, lamb. Bacon, salt pork, hot dogs, sausage, regular cold cuts, canned meats, skin of chicken or turkey, fish canned in oil, or organ meats. Whole eggs and egg yolks especially fried in partially hydrogenated (trans fat) oils. |
| Oils. Solid Fats Use sparingly | Unsaturated oils (Canola oil, olive oil, sesame oil, flax seed oil, soy); nonhydrogenated margarines, low-fat or nonfat salad dressings or those made with canola or olive oil; see Fat List in Appendix 17. | Butter, margarine, solid shortening, lard, salt pork, chicken fat, coconut oil, palm oil, palm kernel oil, creamy salad dressings; nondairy creamers, partially hydrogenated oils (trans fat) |
| Added Sugars Use sparingly | 70% dark chocolate, sugar-free gelatin desserts, angel food cake. Any low-fat cookies, pies, cakes, or other desserts. Sherbet, low-fat ice cream or frozen yogurt. | Any full fat cakes, cookies, pies, or other desserts. Milk chocolate, puddings, custards, and ice creams unless made with fat-free milk or fat-free dry milk. |
| Fluids | Water and other fluids, such as milk, coffee, tea, fruit or vegetables juice | High sugar beverages including sweetened fruit juices and pop |
Table 7.2 Heart Healthy
Suggested Menu Plan for Heart Healthy Diet
| Breakfast |
| ½ c. orange juice 1 egg or egg substitute ½ c. oatmeal 1 slice whole wheat toast 1 tsp. jelly 1 tsp. margarine (trans fat-free) 1 c. fat-free milk Hot beverage Sugar, pepper (optional) NO SALT |
| Lunch |
| 2 oz. roasted chicken breast ½ c. mashed potatoes (cooked from fresh) ½ c. mixed vegetables (cooked from fresh or frozen) 1 oz. whole wheat roll 1 tsp. margarine (trans fat-free) 1 c. fat-free milk Water NO SALT |
| Supper |
| 2 oz. albacore tuna salad made with 2 tsp. reduced-fat mayonnaise on 2 slices whole wheat bread (choose fatty fish 2 times per week) 2 tomato slices 1 c. leafy greens salad 1 Tbsp. sunflower oil and vinegar dressing ½ c. fruit cocktail 1 c. fat-free milk Water NO SALT |
| Snack Ideas |
| ½ c. cantaloupe ½ c. carrot sticks 3 c. popcorn, lower fat, trans-fat free, no added salt |
Table 7.3 Common Sources of Trans Fat
|
THERAPEUTIC LIFESTYLE CHANGE DIET
This is formally known as the Step II Diet.
The Therapeutic Lifestyle Change (TLC) Diet is recommended for those identified at high risk or have known cardiovascular disease according to the National Cholesterol Education Program. (4)
Use
This diet is prescribed for those individuals who have LDL cholesterol above the goal range for their category of risk for heart disease. This diet specifically focuses on the reduction of LDL with food choices and incorporates functional foods. Functional foods are whole foods and fortified, enriched, or enhanced foods that have a potentially beneficial effect on health when consumed at effective levels as part of a varied diet on a regular basis. (1)
Adequacy
The suggested food plan includes food in the amounts that will provide the DRIs recommended by the National Academy of Sciences for adults.
TLC Diet Principles
The TLC Diet follows the same diet principals as the Heart Healthy Diet but also incorporates functional foods.
TLC Diet Guidelines
- Total of 25–35% calories from fat
- Less than 7% total calories from saturated fats
- Less than 1% of calories from trans fats
- Up to 10% calories from polyunsaturated fat
- Up to 20% of calories from monounsaturated fats
- Less than 200 mg dietary cholesterol per day
- Total of 50–60% calories from carbohydrate
- Total of 15% calories from protein
- Consume 2 grams per day of plant stanols/sterols (Table 7.5). Most natural foods are below 500 mg per serving, therefore food manufactures supplement foods to meet the recommendations.
- Consume 10–25 grams per day of soluble fiber. Sources include oat bran, beans, legumes, ground flax seed, and chia seed.
- Maintain desirable body weight and prevent weight gains
- Moderate exercise to expend an additional 200 calories per day
- Soy protein can be used to replace animal products. Sources include tofu, soy milk, and temph.
Table 7.4 TLC Diet
| Food for the Day | ||
| Recommended | Restrict | |
| Vegetables 1–4 cups | All fresh, frozen, or canned vegetables (choose low sodium varieties or rinse before serving); 100% vegetables juice. | Commercial fried vegetables, vegetables in butter, cream sauce, or cheese sauce, fried potatoes, French fries, chips |
| Fruits 1–2.5 cups | Any fresh, frozen, dried, or canned fruits or 100% fruit juice. *Especially any 100% fruit juices with added plant sterols. | Dried fruit with added sugar, fried fruit, fruit served with added fat. |
| Grains 3–10 ounce-equivalents | Whole-grain breads, cereals, rice, pasta, crackers, and tortillas; brown rice, quinoa, whole wheat couscous, barley, oats. Products made with oat bran. *Oat bars made with plant sterols. Flax seed and chia seeds. | Egg noodles; fried rice; commercial muffins, biscuits, doughnuts, sweet rolls, croissants; egg or cheese breads; party crackers; regular granolas, regular granola bars, sweets made with partially hydrogenated oils. |
| Dairy Products 2–3 cups | Fat-free or low-fat (1%) milk, fat-free dry milk, evaporated fat-free milk, buttermilk made from fat-free milk, fat-free soy milk or milk substitutes; almond milk, fat-free and low-fat yogurt including Greek yogurt, low- fat cottage cheese, low-fat cheese. *Functional foods that contain added plant sterols. | Cream, sour cream, whole or reduced fat milk, regular evaporated milk, whole or reduced fat yogurt, cheese, whole milk ice cream, half and half |
| Protein Foods 2–7 ounce-equivalents Note: Eggs limit yolks to 1 per day | Lean beef, and pork (loin, leg, round, extra lean hamburger), lamb, veal, skinless poultry, 95–99% fat-free luncheon meats, fish, dried beans, nuts and nut butters, meat alternatives/substitutes. Egg whites, egg substitutes or *Omega-3 fortified eggs; hard-cooked or scrambled. | High fat cuts of beef, pork, lamb. Bacon, salt pork, hot dogs, sausage, regular cold cuts, canned meats, skin of chicken or turkey, fish canned in oil, or organ meats. Whole eggs and egg yolks especially fried in partially hydrogenated (trans fat) oils. |
| Oils, Solid Fats Use sparingly | Unsaturated oils (Canola oil, olive oil, sesame oil, flax seed oil, soy); nonhydrogenated margarines, low-fat or nonfat salad dressings or those made with canola or olive oil; see Fat List in Appendix 17. *Margarine spreads with added plant sterols. | Butter, margarine, solid shortening, lard, salt pork, chicken fat, coconut oil, palm oil, palm kernel oil, creamy salad dressings; nondairy creamers, partially hydrogenated oils (trans fat) |
| Added Sugars Use sparingly | 70% dark chocolate, sugar-free gelatin desserts, angel food cake. Any low-fat cookies, pies, cakes, or other desserts. Sherbet, low-fat ice cream or frozen yogurt. | Any full fat cakes, cookies, pies, or other desserts. Milk chocolate, puddings, custards, and ice creams unless made with fat-free milk or fat-free dry milk. |
| Fluids | Water and other fluids, such as milk, coffee, tea, fruit or vegetables juice | High sugar beverages including sweetened fruit juices and pop |
*Include functional foods as italicized herein and as listed in Table 7.5.
Table 7.5 Food Sources of Plant Sterols
| Food Sources | Amount (grams) |
| Avocado, 1 small | 0.13 |
| Sunflower seeds, ¼ cup | 0.19 |
| Nature Valley Healthy Heart®, 1 bar | 0.40 |
| Corazonas Chips | 0.40 |
| Rice Dream® Heart Wise Rice Milk, 8oz | 0.65 |
| Silk Heart Health Soymilk, 8oz | 0.65 |
| Lifetime® Low-Fat Cheese Slices 1 slice | 0.65 |
| Minute Maid HeartWise®, 8oz | 1.00 |
| Benecol®, Take Control®, 1 Tbsp | 1.00 |
| Kardea Bar | 1.00 |
| Smart Balance® Heart Right Buttery Spread, 1 Tbsp | 1.70 |
Table 7.6 TLC Diet
Suggested Menu Plan for TLC Diet
| Breakfast |
| ½ c. orange juice with plant sterols 1 omega-3 egg ½ c. oatmeal with up to 1 Tbsp ground flaxseed 1 slice whole wheat toast 1 tsp. jelly 1 tsp. margarine (trans fat-free of added plant sterols) 1 c. fat-free milk or milk fortified with plant sterols Hot beverage Sugar, pepper (optional) NO SALT |
| Lunch |
| 2 oz. baked chicken- no skin ½ c. mashed potatoes (cooked from fresh) ½ c. mixed vegetables (cooked from fresh or frozen) 1 oz. whole wheat roll 1 tsp. margarine (trans fat-free of added plant sterols) 1 c. fat-free milk Water NO SALT |
| Supper |
| 2 oz. albacore tuna salad made with 2 tsp reduced-fat mayonnaise on 2 slices whole wheat bread (choose fatty fish 2 times per week) 2 tomato slices 1 c. leafy greens salad 1 Tbsp. sunflower oil and vinegar dressing ½ c. fruit cocktail 1 c. fat-free milk Water NO SALT |
| Snack Ideas |
| ½ c. cantaloupe ½ c. carrot sticks 3 c. popcorn, lower fat, trans-fat free, no added salt |
LOW-FAT DIET
This diet allows only 40–50 grams of fat per day.
Use
The Low-Fat Diet may be prescribed to reduce the fat intake for clients with diseases of the gallbladder, liver, or pancreas, or if disturbances in digestion and absorption of fat occur. For diet management of high blood cholesterol and other blood lipids, see the Heart Healthy Diet.
Adequacy
The suggested food plan includes foods in amounts that will provide the DRIs recommended by the National Academy of Sciences for adults. Restriction of fat (the most concentrated source of calories) may result in a diet low in calories. When additional calories are needed, add them in the form of complex carbohydrates. Medium chain triglycerides (MCT) may be useful in meeting energy needs.
Diet Principles
1. The diet is designed to limit fat intake to 40–50 grams daily.
2. Foods may cause distress for reasons other than fat content; refer to Guidelines for Peptic Ulcer, GERD, Hiatal Hernia in Chapter 11. If a food is tolerated, it should be allowed.
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