Cardiology Clinic Nutrition Guidelines for Heart Failure

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Nutrition Guidelines for Heart Failure

This guide provides basic information to help you begin, or continue following, your heart failure diet. It is very important to plan for what you eat to help manage your heart health. This often means making some changes in your current eating habits.

These guidelines will help you get started and are explained in more detail in the pages to follow.

1. Limit Sodium Intake: One of the most important ways to manage heart failure is to decrease the total amount of sodium you consume to 2,000 mg (2 grams) per day.

2. Learn to Read Food Labels: Sodium is added to many packaged foods. Reading the Nutrition Facts label will help you make the best low sodium food choices.

3. Eat a Heart Healthy Diet: There are a wide variety of foods to enjoy for heart health and to help satisfy your appetite. Fruits, vegetables, whole grains, legumes, plant oils, poultry, fi sh, lean meats, and skim and low fat dairy products are the basics of most meals and snacks.

4. Achieve and Maintain a Healthy Body Weight: Losing a few pounds can help to lower blood pressure and cholesterol. It can also improve blood glucose control, and lower your risk for other health problems.

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2 Gram Sodium Diet

Purpose: Sodium is the mineral in the human body that helps to balance fl uid volume. Following a low-sodium diet helps control high blood pressure (hypertension), swelling and water build-up (edema), and/or decrease shortness of breath.

For people who have Congestive Heart Failure (CHF), the heart is unable to pump enough blood to meet the body’s needs. If you limit the amount of sodium in the foods you eat, it can help prevent fl uid overload on the heart. The heart will not have to pump as hard if there is less fl uid to move through the blood vessels.

A low-sodium diet is necessary for the health of your heart even if you do not have any symptoms, or if you are taking diuretic medication.

A 2 gram (g) sodium diet is equivalent to 2000 milligrams (mg).

Where does Sodium come from?

In addition to the sodium in our body, it is also found in almost all foods. The most common food source of sodium is Salt (sodium chloride), of which 40% is pure sodium. Many people refer to sodium and salt as one and the same. One teaspoon of salt contains about 2300 mg of sodium. Although a whole teaspoon of salt may not be used at the table or in cooking, the total amount of sodium can add up quickly when combined with all foods eaten in a day.

Our body does in fact need about 500 mg of sodium per day to maintain fl uid balance. Yet, the average person consumes much more, often 3000-6000 mg daily.

But, I never use the Salt Shaker!

You need to remove the salt shaker from the table and to avoid using any salt when preparing food. It is also important to realize that the sodium in our diet comes mostly from processed and convenience foods.

Processed Foods make up the largest source of sodium in our diets. Processed foods include canned foods (soups), cured meats (hotdogs, bacon, ham, etc.) packaged-convenient foods (instant potatoes), many condiments (mustard, pickles) snack foods (potato chips, pretzels) and many more foods.

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A Matter of Taste

Humans were born with a preference for sweet tastes. Yet, over time, our taste buds have learned to prefer salty foods. If you gradually decrease the sodium and salt in your diet, you can re-train your taste buds and reduce your desire for salt.

Food companies use both salt and sodium to enhance the fl avor and preserve the food. Check food labels for some of these common sodium sources:

• Sodium nitrate – curing agent for ham, sausage• Monosodium Glutamate (MSG) – fl avor enhancer• Sodium saccharin – artifi cial sweetener• Sodium bicarbonate – leavening agent• Sodium benzoate – preservative• Soda or Brine – sodium added, salty liquid

Examples: Sodium Content of Processed Foods

Food Item Serving Size Sodium (mg)Deli Meats 3 ounces 500-900

Cheese 1 ounce/1 slice 170-400Instant Potatoes 1 cup 550-700

Potato Chips 10 chips 175Bacon 1 slice 185

Canned Corn ½ cup 325Canned Soup 1 cup 800-1000

Instant Pudding 1 cup 150-700Ketchup 1 Tablespoon 165Mustard 1 teaspoon 80

Instant Noodles 1 cup 1345USDA National Nutrient Database for Standard Reference

Learn to Read Food Labels

Food labels tell you what you need to know about choosing foods that are lower in sodium. Learning to read food labels takes just a few simple steps.

1. First look at the Serving Size.

2. Next look at the amount of sodium and compare to your 2000 mg daily ‘budget’.

3. Finally, look at the % Daily Value, which should be 5% or less.

Sodium should be as low as possible, certainly less than 140 mg per serving.

Note: Fat Free does not mean Sodium Free!

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Compare Fresh to Canned Foods

These labels show that fresh food is naturally much lower in sodium than processed foods. A serving of canned tomatoes contains 6 times as much sodium as a serving of fresh tomatoes!

More Food Label Terms

Food companies are allowed to use these claims to help highlight the amount of sodium per serving in certain foods:

* Sodium Free – contains 5mg or less * Very Low Sodium – contains 35mg or less * Low Sodium – contains 140mg or less * Reduced Sodium – at least 25% less sodium than usual* No Salt Added – no salt was added during processing, but

the product may still contain sodium by nature. American Dietetic Association Fact Sheet 2003

Sodium is much higher for canned tomato products.

Avoiding High-Sodium Foods

To help lessen your heart failure symptoms, you must cut back and further rid of all high sodium foods from your diet. The foods below are usually high in sodium (but read the labels, because some may be available as low-salt or unsalted).

• Canned soups and dry soup mixes • Canned meats and fi sh• Deli Meats, Cold Cuts• Cheese• Ham, Bacon, Hot Dogs and Sausage • Salted nuts and salted peanut butter • Instant cooked cereals • Salted butter and margarine • Prepared mixes (pancake, muffi n, cornbread, etc.) • Prepackaged frozen dinners (unless eating only one

serving, having less than 400 mg of sodium) • Preseasoned mixes (tacos, chili, rices, sauces, gravies, etc.) • Pretzels, potato chips, olives, cheeses, pickles• Salad dressings, Marinades, Soy Sauce• Fast foods, Fried Foods• Prepared Tomato or Vegetable Juice

1 cup

66 mg

½ cup

360 mg

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Foods to Enjoy for Heart Health

These lower sodium foods should make up the bulk of your diet:

• Fresh or Frozen Fruits

• Fresh or Frozen plain Vegetables in abundance!

• “No salt added”, “low-salt” or “low-sodium” canned or packaged foods. However, it’s still important to read the label to see exactly how much sodium it contains. The less salt, the better!

• Fresh skinless Poultry, Fish, Lean meats

• Unsalted Nuts and unsalted Peanut Butter

• Whole grain Cereals (Shredded Wheat, Oatmeal)

• Barley, brown rice, whole wheat pasta cooked without salt

• Whole grain breads, crackers, chips, pretzels with little or no salt

• Home cooked beans or chili without salt

• Low or nonfat Dairy products (limit to 2 servings per day)

• Salad dressings made with Heart Healthy Oils, Vinegar, herbs and no salt spices

• Unsalted Butter or ‘Liquid’ Margarine (sparingly)

• Low Salt Cheese in moderation

• No added salt condiments (ketchup, etc.)

What about Salt Substitutes?

Check with your doctor or registered dietitian to see if the use of a salt substitute is safe for you to use. Many salt substitutes are high in potassium which may confl ict with one or more of your medications. Too much potassium may also be harmful to your kidneys. It’s better to avoid these substitutes and use either a salt-free herb and spice blend (such as Mrs. Dash®) or make your own. See the recipe section for more information. Be aware that Sea Salt, Kosher Salt and Lite Salt all contain high amounts of sodium and should also be avoided.

Other Sources of Sodium

Over-the-counter drugs — Some over-the-counter drugs contain lots of sodium. Make a habit of carefully reading the labels of all over-the-counter drugs. Look at the ingredients list and warning statements to see if sodium is listed. A statement of sodium content must appear on labels of antacids containing 5 milligrams or more per dosage unit (tablet, teaspoon). Some companies produce low-sodium over-the-counter products. If in doubt, ask your physician or pharmacist if the drug is OK for you.

Prescription drugs — Consumers can’t know whether a prescription drug contains sodium. If you have high blood pressure, ask your physician or pharmacist about the sodium content of prescription drugs. NEVER stop taking your medication without checking with your doctor.

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How to Change Eating Habits to Lower Sodium

Compare the two menus below for food choices and the amount of sodium. Look at the differences in the sodium content just by making a few food changes. For example, switching from salted butter to unsalted peanut butter can save you over 50 mg of sodium. The peanut butter also has a healthy type of fat (monounsaturated) for your heart.

Think about the foods that you prefer and how you can avoid those that are high in sodium. Choosing a cup of yogurt instead of salted pretzels helps to cut about 400 mg of sodium out of your diet. Making the switch from canned green beans to frozen green beans helps to cut out 170 mg of sodium. These types of changes and more all help you stay within your 2000 mg (2 gram) sodium budget for the day, and helps you to prevent harmful fl uid build-up.

The low sodium menu example also shows that there is room for some heart-healthy snacks and still stay within your sodium limit. For example, 7 whole-grain, Reduced Sodium Triscuits® have only 75 mg of sodium. You can enjoy these with 2 ounces of reduced sodium Swiss cheese that has 70 mg of sodium.

Keep in mind these key points:

1. Read labels and choose low sodium products.2. Buy fresh or frozen products, or no salt added canned goods.3. Use fresh Poultry, Fish, and Meat, not Deli or processed. 4. Cook with Herbs and Spices and salt free seasoning blends.

Example of a High Sodium-Intake Day…

Food Amount of sodium

Breakfast Scrambled eggs, 2 large 342 mgBacon, 1 slice 192 mg

Whole-wheat bread, 1 slice 148 mgButter, 2 teaspoons 54 mg

Total sodium for meal 736 mg

Lunch Whole-wheat bread, 2 slices 296 mgHam, luncheon meat, 1 slice 350 mgMayonnaise, 1 tablespoon 105 mg

Dill pickle, 1 spear 385 mgPretzels, 1 ounce 485 mg

Orange, 1 medium 1 mgTotal sodium for meal 1,622 mg

Dinner Spaghetti noodles, 1 cup 140 mgSpaghetti sauce, 1/2 cup 515 mg

Parmesan cheese, 1 tablespoon 76 mgGreen beans, canned, ½ cup 177 mg

Garlic bread, 1 slice 200 mgTotal sodium for meal 1108 mg

Total sodium for the day: 3,466 mgSource: Department of Agriculture, Nutrient Data Laboratory, 2004

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Example of a Low Sodium-Intake Day…

Food Amount of sodium

Breakfast 2 Hard Boiled Eggs 125 mgBanana, 1 medium 1 mg

Pepperidge Farm, Natural Whole Grain Oat Bran bread, 1 slice

115 mg

Unsalted Peanut Butter, 1 tablespoon 3 mgTotal sodium for meal 244 mg

Lunch ½ Whole Wheat Lavash Bread 125 mg½ chicken breast, baked w/herbs, no salt 60 mg

Sliced tomatoes, Red onion slice, 2 Romaine lettuce leaves

12 mg

Olive oil vinaigrette, no salt, 1 T. 10 mgBlueberry Fat-free yogurt 100 mg

Orange, 1 medium 1 mgTotal sodium for meal 308 mg

Dinner 1 cup Barilla Plus Thin Spaghetti 75 mgFresh tomato, basil, olive, oil, garlic

and herb sauce, 1.5 cups60 mg

Part skim, Parmesan cheese, 1 T. 76 mgGreen beans, frozen, 1/2 cup 8 mg

½ cup Cannellini beans, no salt added 40 mgWhole grain roll w/ olive oil, garlic 125 mg

Total sodium for meal 384 mg

Total sodium for the day: 936 mg

Source: Department of Agriculture, Nutrient Data Laboratory, 2004

Season Instead of Salt

The American Heart Association has published a listing of herbs and spices to add at the table and in cooking. These fl avors are matched with foods to taste great.

Allspice — Lean ground meats, stews, tomatoes, peaches, applesauce, cranberry sauce, gravies, lean meat

Almond extract — Puddings, fruits

Basil — Fish, lamb, lean ground meats, stews, salads, soups, sauces, fi sh cocktails

Bay leaves — Lean meats, stews, poultry, soups, tomatoes

Caraway seeds — Lean meats, stews, soups, salads, breads, cabbage, asparagus, noodles

Chives — Salads, sauces, soups, lean meat dishes, vegetables

Cider vinegar — Salads, vegetables, sauces

Cinnamon — Fruits (especially apples), breads, pie crusts

Cilantro – Vegetables, pairs well with lime juice

Curry powder — Lean meats (especially lamb), veal, chicken, fi sh, tomatoes, tomato soup, mayonnaise

Dill — Fish sauces, soups, tomatoes, cabbages, carrots, caulifl ower, green beans, cucumbers, potatoes, salads, macaroni, lean beef, lamb, chicken, fi sh

Garlic (not garlic salt) — Lean meats, fi sh, soups, salads, vegetables, tomatoes, potatoes

Ginger — Chicken, fruits

Lemon and Lime juice — Lean meats, fi sh, poultry, salads, vegetables

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Mace — Hot breads, apples, fruit salads, carrots, caulifl ower, squash, potatoes, veal, lamb

Mustard (dry) — Lean ground meats, lean meats, chicken, fi sh, salads, asparagus, broccoli, Brussels sprouts, cabbage, mayonnaise, sauces

Nutmeg — Fruits, piecrust, lemonade, potatoes, chicken, fi sh, lean meat loaf, toast, veal, pudding

Onion (not onion salt) — Lean meats, stews, vegetables, salads, soups

Paprika — Lean meats, fi sh, soups, salads, sauces, vegetables

Parsley — Lean meats, fi sh, soups, salads, sauces, vegetables

Peppermint extract — Puddings, fruits

Pimiento — Salads, vegetables, casserole dishes

Rosemary — Chicken, veal, lean meat loaf, lean beef, lean pork, sauces, stuffi ngs, potatoes, peas, lima beans

Sage — Lean meats, stews, biscuits, tomatoes, green beans, fi sh, lima beans, onions, lean pork

Savory — Salads, lean pork, lean ground meats, soups, green beans, squash, tomatoes, lima beans, peas

Thyme — Lean meats (especially veal and lean pork), sauces, soups, onions, peas, tomatoes, salads

Turmeric — Lean meats, fi sh, sauces, rice

When Eating Away From Home

Let friends and family know that you have to limit your salt intake. Be selective where you dine and ask the waiter or chef to prepare your order without added salt. Avoid Fast Food restaurants and convenience take-out foods which are prepared and preserved with sodium. Keep these tips in mind:

• Use oil and vinegar for salad dressing• Request that butter not be added to your vegetables or other

meal items• Ask for sauces and broths to be served on the side• Avoid smoked, pickled or foods in a brine• Avoid casseroles, or mixed dishes, and dishes made with

cheese• Your best choice is to order something which is steamed,

baked or broiled with wine, lemon juice, herbs and pepper• Take a portion home with you for the next day

Key Words for Menu Items to Avoid Au gratin Cream Gravy Crispy Hash Hollandaise Casserole Scalloped Potpie Cheese Sauce Fried Parmesan Sautéed Stuffed

Better Menu Choices Baked Broiled Grilled Steamed Poached Stir Fry

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♥ Eating Well for Heart Health ♥

Replace high sodium foods with the many other foods you’ll want to include for a healthy heart.

VEGETABLES – Enjoy a variety of non-starch vegetables in abundance!

• Enjoy at least 4 cups daily• Enjoy dark-green, leafy vegetables; yellow, orange, and red

vegetables and cooked tomatoes every week

FRUITS – Enjoy a variety of 2-3 pieces, ½ cup of fresh, or ¼ cup dried fruit servings daily

WHOLE GRAIN FOODS are the best sources of carbohydrates.

• At most meals, enjoy oatmeal, whole grain bread, brown rice, barley, or one of many other whole grains

LEGUMES, such as black beans, kidney beans, lentils, garbanzos, soy beans and other beans, are excellent sources of protein, fi ber, vitamins, and minerals.

• Enjoy at least two meals a week using legumes in place of meats.

NUTS, such as almonds, walnuts, pecans, peanuts, hazelnuts, and pistachios, contain healthy monounsaturated and polyunsaturated fats

• Choose unsalted varieties and limit portions to 2-3 Tablespoons a day.

PLANT OILS, such as olive, canola, soy, corn, sunfl ower, peanut, are good sources of healthy unsaturated fats.

• Limit amounts to 2-3 Tablespoons daily for spreads, dressings, cooking

• If using a spread, choose one with liquid vegetable oil as fi rst ingredient

POULTRY

• Choose/Enjoy chicken or turkey breast (skinless or ground)• Limit/Avoid fried chicken and skin from chicken/turkey

FISH

• Choose/Enjoy twice per week : salmon, tuna (if canned, low salt) and most white fi sh

• Limit/Avoid fried fi sh and excess shellfi sh

EGGS – Limit to 3-5 egg yolks per week

DAIRY – Choose nonfat/skim or 1% milk products

CHEESE – Low fat cheeses such as 50-75% Reduced-Fat Cabot Cheddar, limit portions

MEAT

• Choose/Enjoy very lean red meats such as: eye round, ground round, pork tenderloin

• Limit/Avoid: sausage, bacon, fatty steaks, regular ground chuck, bologna, and hot dogs

Note: Portion Sizes for Meat, Fish and Poultry are 3-4 ounces, about the size of a deck of cards

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Lean Red Meats to Enjoy

One serving is a 3-4 oz serving - about the size of a deck of cards.

Eye RoundTop Round SteakChuck mock tender steakTop Sirloin SteakRound Tip95% Lean Ground BeefBrisket (fl at half)Shank CrosscutsChuck Shoulder RoastChuck Arm Pot RoastChuck Shoulder Steak

Source: National Cattleman’s Beef Association

Examples of Lower Sodium Deli Choices140 mg sodium or less

2 Ounce Serving of Meats Sodium in mgBoar’s Head Brand Deluxe Roast Beef• 80Dietz & Watson Gourmet Lite Turkey Breast• 55

1 Ounce Serving of Cheeses Sodium in mgBoar’s Head Emmentaler Swiss• 50Land O’Lakes• 35Saputo Lorraine Swiss• 14McKenzie Swiss Premium• 60Finlandia Swiss• 60North Country Smoked Swiss• 75

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Menu Ideas

Breakfasts

1. 1 cup Fresh Berries 1 cup Skim or 1% Milk 1 cup plain Oatmeal or Shredded Wheat Cereal ½ Whole Wheat English Muffi n 1 T. Unsalted Peanut Butter

2. 1 egg, poached, scrambled or fried in non-fat cooking spray 2 slices whole grain toast 1 Kiwi or Favorite Fruit 1 low fat, low sugar yogurt

3. Whole Wheat Blueberry Pancakes 2 T. Maple Syrup Turkey Breakfast Sausage – low sodium 1 cup Skim Milk

Lunches

1. Whole wheat tortilla Vegetarian chili made with no salt added tomatoes, beans 2 ounces Reduced Fat and Salt Cheddar Cheese Raw carrots and sugar snap peas with yogurt/herb dressing ½ cup Sliced Strawberries, Blueberries or Raspberries 2. 4 oz. Broiled Salmon ½ cup Steamed Spinach ½ cup Cooked Barley ¼ cup Mushrooms, sautéed in garlic and Olive Oil Fresh Peach

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3. Homemade Low Sodium Chicken & Rice Soup 8 Triscuit crackers, reduced sodium Low fat yogurt 2 Graham Crackers Apple

Dinners

1. Lemon BBQ chicken Grilled Zucchini and Tomato kebabs Corn on the Cob with Lemon-Basil Vinaigrette 3 cups Dark green tossed salad w/Olive Oil/Vinegar

dressing Sliced cantaloupe

2. Pork Tenderloin ½ cup Brown Rice, with chopped apricots, herbs, and

toasted almonds Broccoli, Garlic Stir Fry Sliced Tomatoes with olive oil and fresh basil Sliced banana and low fat vanilla yogurt

3. Baked Halibut w/wine, olive oil, herbs, pepper ½ Baked Sweet Potato 1/3 cup steamed Green Beans Spinach salad toasted pine nuts, mandarin oranges and

nonfat yogurt herb dressing. Fresh Strawberries

Note: Enjoy Water, Iced Tea or other non-caloric beverages with meals. A cup of skim or 1% milk may be added to lunches or dinners.

Recipes

Salt-less Surprise Seasoning Blend

• 2 tsp Garlic Powder (not salt)• 1 tsp Dried Basil• 1 tsp Dried Oregano• 1 tsp Powdered Lemon Rind

Mix well in a bowl with a whisk. Can be stored in shaker container with some rice to prevent caking.

“Salt” Substitute

• 3 tsp. Dried Basil• 2 tsp Dried Savory• 2 tsp. Celery Seed• 2 tsp. Ground Cumin• 2 tsp. Dried Sage• 2 tsp. Dried Marjoram• 1 tsp. Dried Lemon Thyme

Mix well, then crush with mortar and pestle.

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Vegetable Stir-Fry

Ingredients• 1 cup uncooked Whole grain Brown Rice• 2 T. extra virgin Olive Oil• 1 large Carrot, sliced thinly• 1 small Onion, sliced thin• 6 cloves fresh Garlic, minced• 1 T. Fresh Ginger, minced• 10-12 Asparagus spears, sliced into bite size pieces• ½ head Broccoli, sliced into fl orets• 1 teaspoon Sesame Oil• 1 yellow Summer Squash, sliced thin• 16-20 whole Snow Pea Pods• 4 ounces or so of Mushrooms, sliced• ½ cup dry-roasted, unsalted Peanuts or Cashews

Directions1. Cook rice according to package directions (basically add

rice to 2 cups boiling water, stir, cover, lower heat to simmer ~35-40 minutes).

2. Prepare vegetables by washing and slicing or mincing.3. Heat Olive oil in large nonstick skillet or wok set over

medium-high heat.4. Add Carrot fi rst. After a few minutes add, Onion, Garlic,

Asparagus, Broccoli and Sesame Seed Oil. Stir fry for about 3 minutes.

5. Add Ginger, Squash, Snow Peas, Mushrooms, (and Tofu if desired). Stir fry for another 4-5 minutes, turning continuously.

6. Serve hot over rice and sprinkle with nuts.

Lemon Barbeque Chicken

Ingredients• 2 whole Boneless, Skinless Chicken Breasts or 4 halves• ¼ cup Fresh Lemon Juice• 2 T. Honey• 2 T. Olive or Canola Oil• Dash of Cayenne Pepper• ¼ tsp. of Paprika• ½ tsp. Dried Italian Seasoning• 1 T. Sesame Seeds Toasted (either over medium temp range

top or in 350ºF oven for a few minutes)

Directions1. Place chicken in a dish to marinade2. Combine all other ingredients, except sesame seeds,

together and mix well with a whisk or in blender.3. Pour over chicken and marinate 30 minutes – 2 hours4. Prepare oven broiler or grill.5. Cook chicken 15 minutes per side 5 inches under broiler or

5-10 minutes per side on grill until tender and the center is white.

6. Sprinkle with sesame seeds to serve.

Serves 4

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Corn Toppers

Traditionally, corn on the cob is eaten slathered and dripping with butter and heavily salted. Try these imaginative, heart-friendly alternatives, low in saturated fat and sodium free. Each recipe makes enough for 4 ears. These are also great toppings for steamed vegetables and fresh salads.

Lemon-Basil Vinaigrette

In a small bowl, whisk together 1 T. fresh Lemon Juice, 2 tsp. extra virgin Olive Oil, and 2 tsp. fresh Basil, minced. Season to taste with pepper.

Azetec Lime

In a small bowl, whisk together 1 ½ T fresh Lime Juice, 1 tsp extra virgin Olive Oil, and ½ tsp Chili powder. Season to taste with pepper.

Moroccan Spice

In a small bowl, mix together 2 tsp ground Cumin, 2 tsp ground Coriander, 1 tsp dried oregano, and ½ tsp ground ginger. Brush ½ tsp. extra virgin Olive Oil over ear of hot corn and then sprinkle with spice mixture.

Eating Well Magazine 2004

Baked Beans

Ingredients• ½ pound (1 cup) dried Navy Beans (or 3 cans No Salt

Added Beans – Eden is one brand)• 4 cups Water (if soaking beans)• 1 Loin-end Pork Chop, Very Lean• 1 cup No Salt Added Chili Sauce or Tomato Sauce• ¾ cup chopped Onion• 2 T. Light Molasses• 1 T. packed Brown Sugar• 1 ½ tsp. Dry Mustard Powder• ¼ tsp. Garlic Powder, or more to taste• 1 cup Water • Optional spices: Cumin, Chili Powder, experiment!

Directions1. Place beans and water in large saucepan over high heat.

Bring to a boil and cook 2 minutes.2. Remove from heat and let stand 1 hour.3. Return beans to heat and simmer 1 more hour or until beans

are tender. Drain, rinse, set aside.4. Preheat oven to 350ºF.5. Lightly spray a 1 ½ quart casserole dish with vegetable oil

spray or grease lightly with canola or olive oil.6. Place beans in prepared casserole and set aside.7. Brown pork in a small non-stick skillet over medium-high

heat. Cut into small cubes and add to beans.8. Add remaining ingredients and mix well. Cover, bake 4

hours. If needed, add additional water during cooking.

Reprinted with permission: American Heart Association Low-Salt Cookbook.

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Baked Apples

Ingredients4 Apples, cored, unpeeled1 T. unsweetened Apple Juice or Water2 T. Chopped Walnuts1 T. Raisins1 tsp. ground Cinnamon¼ tsp. grated nutmeg

Directions1. Preheat oven to 350F.2. Place apples and juice or water in baking dish.3. Mix together walnuts, raisins and spices and fi ll center of

apples.4. Cover and bake for 30-45 minutes.

Optional: Serve with Non fat plain or vanilla yogurt

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Cookbooks

No-Salt, Lowest Sodium CookbookDonald A. Gazzaniga, 2001ISBN 0-312-29164-7

American Heart Association Low-Salt Cookbook, Second Edition : A Complete Guide to Reducing Sodium and

Fat in Your Diet. 2002ISBN 0-609-80968-7

The No-Salt CookbookDavid C. and Thomas D. Anderson, 2001ISBN 1-58062-525-8

Get the Salt OutAnn Louise Gittleman, MS, CNS, 1996ISBN 0-517-88654-5

Pocket Guide to Low Sodium FoodsBobbie Mostyn, 2003ISBN 0-9673969-1-3

For patients with Heart Disease AND Diabetes

The Diabetes & Heart Healthy CookbookAmerican Diabetes Association, 2004ISBN 1580401805

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Resources

American Heart AssociationNew HampshireEllen McCooeyCommunications DirectorPhone: 603-518-1554Fax: 603-669-6745Email: ellen.mccooey@heart.org

National Heart Lung and Blood Institutehttp://www.nhlbi.nih.gov

Healthy Heart Market – www.healthyheartmarket.com

DHMC HF Clinic Contact Info

• Clinic Emergencies: Call 603-650-2929

• Dietitian Kc Wright, MS, RD, LD 603-650-9495 kc.s.wright@hitchcock.org

Dartmouth-Hitchcock Medical Center is a charitable organization and has a fi nancial assistance policy.

CardiologyOne Medical Center DriveLebanon, NH 03756-0001(603) 650-9495Revised / PE 11/19/05RL: 8.8