Heart Health! 2015

FREE

Franciscan Heart Center

hearthealth!

CHI Franciscan Health • Puget Sound’s Leader in Heart Care

2015

Know your controllable symptoms — and what to do about them

Recipes and tips

Classes and support groups

Heart-healthy living for the whole family!

At CHI Franciscan Health, we appreciate that life and good health are great gifts. That’s why we surround you with expertise and friendly encouragement to live a heart-healthy life. Wherever you live in Puget Sound we’re nearby, and with you every step of the way.

From our caring neighborhood family doctors attentive to your heart health, to our community educators helping you ‘eat the rainbow’ or quit smoking, we help you live life a little better. Should you or a loved one encounter more serious health concerns, Franciscan Heart Center has many expert cardiologists to care for our neighbors throughout King, Pierce and Kitsap counties and the Olympic Peninsula. All are backed by local, quality diagnostic services using the latest technology. And should you ever need them, Franciscan Heart Center’s exceptional heart and vascular surgeons are here for you. eart Failur eS dH Together, we’ll help you get back to life ite on your terms as quickly as possible.

Life is just too precious to miss a beat!

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We hope you enjoy this free gift from CHI Franciscan Health.

May these resources, recipes and tips inspire you and your family to better heart health all year long!

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Need a doctor? Let us help you find the primary care provider or specialist physician right for you. Call 1 (888) 825-3227 or visit FranciscanDoctors.org today.

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World-class heart care, close to home What if someone you love suffers a heart attack, needs heart surgery or requires a complex diagnostic procedure? Whether you live on the Kitsap Peninsula, in West Seattle or in Tacoma, CHI Franciscan Health offers the strength of a system to ensure you receive lifesaving treatment, the latest in technology and exceptional patient care — all close to home.

With two excellent cardiac surgery centers, at St. Joseph Medical Center in Tacoma and at Harrison Medical Center in Bremerton, you’re in skilled hands with CHI Franciscan. Our centers offer a full spectrum of procedures, with an emphasis on minimally invasive heart surgery including valve repair and replacement.

Our cardiothoracic surgeons and interventional cardiologists use the latest minimally invasive and non-surgical techniques – options to traditional open surgery that provide huge benefits to our patients.

They recover more quickly, with shorter hospital stays and a faster return to everyday life.

CHI Franciscan Health offers the strength of a system, with skilled hands and compassionate hearts—all close to home.

CHI Franciscan Health is proud to be the first Accredited System for Heart Failure in the Northwest. We’re working hard to better manage this condition and improve quality of life. To learn more, visit FranciscanHeart.org.

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Franciscan Well-Fed Heart NEW! YEAR-ROUND SUPPORT With our Heart Health-e News, we’re with you every step of the way — from grocery cart to dinner table! We meet you in the kitchen, where the decisions you make each day affect the future heart health of those you love and live with.

Franciscan Heart Health-e News Sign up today!

This breezy newsletter goes straight to your in-box. Each month you’ll receive heart-healthy tips and seasonal recipes to help you plan fresh, local meals on a budget.

FranciscanWellFedHeart.com Our Franciscan Well-Fed Heart web site is a treasure trove of support, with new recipes, kitchen makeover videos and recipe demos added each month. Here are just a few of the topics we’ll cover over the year to help you stay motivated and on track: • How to read a food label • Pantry clean-out • Portion control • Meal planning • Grazing and snacking for success Visit FranciscanWellFedHeart.org and sign up for Heart Health-e News today!

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Your Lifestyle Matters YOU ARE MORE IN CHARGE THAN YOU THINK

EASY CHANGE

You can’t choose your age, gender or family health history, but you can can choose your habits. Research shows that you can reduce your risk of heart disease, stroke and other chronic illnesses up to 80% through healthy lifestyle choices.

Here you’ll find small changes that make a difference

That’s what this booklet’s about: Making better choices for life.

7 Ways to reduce your risk: • Exercise at least 40 minutes daily • Maintain a healthy weight • Plan heart-healthy meals to cook at home • Schedule regular check-ups • Sleep at least 7 hours a night • Drink alcohol in moderation • Don’t smoke

© 2015, wellfedheart.com

When you see this icon, go to franciscanwellfedheart.org

DE-STRESS YOURSELF: Chronic stress is more damaging than you think.

It increases cortisol, a hormone that has a direct impact on our blood vessels, blood sugars and hormonal balance. This can lead to inflammation and increased risk for cardiovascular diseases.

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Know Your Controllable Risk Factors DO ANY OF THESE APPLY TO YOU?

Waist Circumference Triglycerides

HDL

3 or more of these risk factors chronic diseases such Stroke A stroke occurs when a blood vessel in the brain becomes blocked, interrupting blood flow.

Signs include: trouble speaking, confusion, numbness and severe headache.

Type II Diabetes

Vascular Disease

Co Di

People with diabetes have a three times higher risk of developing cardiovascular disease. The same good habits that prevent heart disease can also prevent diabetes.

Clogging and hardening of the arteries occurs when blood vessels become damaged from chronic high blood pressure, cholesterol or fatty buildup and inflammation. Restricted blood flow can cause tissue damage, stroke or death.

One dise and Sym lifeas h hea No. for

Source: National Cholesterol Education Program 4

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Factors EASY CHANGE

Fasting Blood Sugar Blood Pressure

DL

Choose One Risk Factor to Improve Turn the page to see where you stand

k factors can lead to ses such as:

dening urs ls from d erol nd tricted use roke

Coronary Heart Disease One e of many cardiovascular diseases of the heart and blood vessel system.

Symptoms can be life-threatening such as heart-attack or heart-failure. It is the No. 1 cause of death for Americans.

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Vital Statistics EASY CHANGE

Vital Statistics

WHAT’S YOUR NUMBER? WHAT’S YOUR NUMBER?

Healthy

At Risk

High R

TOTAL CHOLESTEROL (TC)

Less than 180

181-239

240 and

LDL (Lousy) CHOLESTEROL

Less than 100

101-159

160 and

Women

60 or higher

51-59

50 or

Men

60 or higher

41-59

40 or

HDL (Healthy) CHOLESTEROL

Have A Conversation Create a partnership with your doctor.

The numbers on this chart are only part of your health profile. Talk with your doctor about what’s most important for you.

TC:HDL RATIO

Less than 5:1

TRIGLYCERIDES

Less than 150

151-199

200 and

FASTING BLOOD SUGAR

Less than 100

101-125

126 and

Systolic

Less than 120

121-139

140 or h

Diastolic

Less than 80

81-89

90 or h

Women

Less than 35”

35” or greater

Men

Less than 40”

40” or greater

Women

Less than 0.8

0.81-0.84

0.85 or g

Men

Less than 0.9

0.91-0.99

1.0 or g

19-24

25-29

30 or h

BLOOD PRESSURE

WAIST CIRCUMFERENCE

WAIST:HIP RATIO*

BODY MASS INDEX (BMI)

Measuring your total risk takes more thanRatio filling inCalculation the chart above, it requires an Waist:Hip factors such as age, sex and genetics should also be considered. For a project number visit americanheart.org orWaist ask your doctor to be screened. If you'd prefer to t = database Ratio program.

American Heart Association's Heart360 secure 6

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Hip number

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Risk

High Risk

1-239

240 and above

1-159

160 and above

1-59

50 or less

1-59

40 or less

1-199

200 and above

1-125

126 and above

1-139

140 or higher

1-89

90 or higher

Date

Your Numbers

Date

Your Numbers

r greater

r greater

1-0.84

0.85 or greater

1-0.99

1.0 or greater

5-29

30 or higher

above, honest conversation doctor. Other Foran a projected 10-year with risk your evaluation of cardiovascular disease, visit tion it requires dered. For a projected 10-year risk evaluation of cardiovascular americanheart.org or ask your doctor for adisease, screening. To track your d. If you'd prefer to track your numbers electronically, out Heart Association’s Heart numbers electronically, check outcheck American ogram.

360 secure database program.

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Heart-Healthy Plate USE THIS SIMPLE GUIDE

1/2

Fruits and Nonstarchy Vegetables

1/4

Whole Grains or Starchy Vegetables

1/4

Lean Protein

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Eat The Rainbow EMBRACE VARIETY for a Healthy Heart.

EASY CHANGE

Phytochemicals are substances found in plants that give fruits, vegetables, beans and legumes their vibrant colors. We are just beginning to understand their health benefits. The most important thing to understand is that no fruit or vegetable is more ‘super’ than the rest.

Each contributes its own unique set of fibers, vitamins, minerals and phytochemicals.

Highlight 2 foods (one fruit and one vegetable) from each color category to add to your next grocery list.

Strawberries Raspberries Apples Grapefruit Watermelon Pomegranate Tomatoes Red Peppers Radishes Rhubarb Cranberry Beans Kidney Beans Red Lentils Pineapple Mango Apricot Oranges Peaches Cantaloupe Lemons Papaya Sweet Potatoes Orange Bell Peppers Yellow Bell Peppers Carrots Pumpkins Squash Corn Yellow Lentils

Kiwi Avocado Green Grapes Figs Pears Green Apples Limes Honeydew Green Bell Peppers Sugar Snap Peas Asparagus Leafy Greens (Collards, Kale, Spinach, Romaine) Celery Brussels Sprouts Bok Choy Broccoli Zucchini Okra Artichokes Lima Beans Edamame Fresh Herbs

Blueberries Blackberries Cherries Cranberries Plums Red Grapes Dates Red Cabbage Eggplant Red Onion Purple Potatoes Beets Black Beans Potatoes Mushrooms Jicama Onions Garlic Shallots Leaks Green Onions Cauliflower Turnips Cannellini Beans Navy Beans

Red

Orange/Yellow

Green

Blue/Purple

White

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Sugar, Salt, Fat and Fiber WHAT YOU NEED TO KNOW SUGAR

SALT/SODIUM

FAT

Guidelines

Guidelines

Guid

• Refined sugar promotes inflammation in the body and contributes to empty calories • Sugar can raise your triglycerides • 1 teaspoon sugar = 4 grams • Daily Added Sugar Guide Women - up to 6 tsp (24 grams) Men - up to 9 tsp (36 grams) Children Childre - up to 3 tsp (12 grams)

Tips • Look for sugar under other names: sucrose, corn syrup, fructose, cane juice or syrup, maple syrup, honey or blackstrap molasses • Minimize sugar substitutes like aspartame, xylitol, mannitol, sorbitol, stevia • Take advantage of fruits’ natural sweetness and have them for dessert, a snack or to sweeten up just about anything!

• Aim for less than 2300 mg daily (about 1 tsp)

• African-Americans, adults 50+ and all people with hypertension or diabetes may benefit from diets with less than 1500 mg daily • Eating foods high in potassium, magnesium and calcium helps reduce blood pressure

Tips

Tips T

• Avoid highly processed and prepared foods that can contribute 75% or more to sodium intake • Foods highest in potassium: sweet potatoes, squash, coconut water, avocado, spinach, swiss chard, beans and legumes • Foods highest in magnesium: leafy greens, sesame and pumpkin seeds, beans, legumes and whole grains

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FAT Guidelines • Increase intake of mono- and polyunsaturated fats, those liquid at room temperature • Reduce intake of saturated fats, those solid at room temperature • Avoid foods containing trans fats, listed in the ingredients under "hydrogenated" • Focus on omega-3’s, known to reduce inflammation and prevent heart disease, stroke and some cancers Tips • Add omega-3’s: salmon, herring or sardines. Use flax and walnut oils to make your own dressings and marinades • Use an avocado in place of butter or mayonnaise • Broil, bake and roast instead of frying • Cook primarily with olive oil and canola oil • Nuts are a good source of healthy fats

FIBER Guidelines • Fiber is found mostly in plant foods.

Although it is indigestible, our bodies use fiber to aid in the digestion process • Fiber keeps us full longer, stabilizes blood sugar and reduces cholesterol • Aim for 21-38 grams of total fiber per day • Increase fiber slowly, it may take time for your body to adjust Tips • Add beans, ans, legumes and whole grains to soups, sauces and other dishes • Choose breads, cereals and crackers that say “100% whole grain” • At breakfast, add ground flax, oat bran or wheat germ to your yogurt, hot cereal or smoothie • To help lower cholesterol, consume foods high in soluble fiber such as citrus fruits, oats, brussels sprouts, pears and mushrooms

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How Heart-Friendly Is Your Kitchen?

PHASE IN PHASE OUT 1. Homemade dressings, marinades and sauces

1. Store-bought dressings, marinades and sauces

2. Plain, low-fat yogurt.

Add real fruit and/or honey

2. Fruit-flavored or “fruit-on-bottom� yogurts

3. Whole grains: barley, quinoa, oats, whole-wheat pasta, bulgur and 100% whole grain bread and crackers

3. Refined grains: white and highly processed pasta, rice, bread or crackers

4. Low-fat milk, unsweetened iced tea, coffee, flat or sparkling water

4. Sweetened and artificially flavored waters, teas, coffee and juices

5. Legumes: black, white, navy, kidney, garbanzo beans, lentils, peas and edamame

5. Canned baked beans, chilis and soups

6. Fresh or frozen veggies: steamed, sauteed or roasted

6. Mashed potatoes and veggies with added cream and butter

7. Plant-based fats: avocados, nuts and nut-butters and plant-oils (olive, flax, walnut)

7. Margarine, butter, mayonnaise, lard, animal fats

8. Canned fish: herring, tuna, salmon, sardines

8. Heavily processed and salted meats

Go to franciscanwellfedheart.org

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Five Golden Food Rules YOUR WELL-FED HEART

EASY CHANGE

• Eat the rainbow. Think color when preparing meals and snacks. The more colorful, the better!

Use the plate model in addition to a food scale and these visual cues for a single serving of:

• Get hooked on fish. Meatless Monday, Tuna Tuesday and Salmon Sunday. You get the idea: less meat and more fish with heart-protecting omega-3’s.

Grey

Olive

Turquoise

70 grains c 60 c Three or80more daily servings • Make whole.

15 55 m 40 m of whole 60grains, such as 50 yor minimally 70 processed y 1 30 quinoa k k will reduce oats, and 25 bulgur, your risk of cardiovascular disease, diabetesGreen and obesity.

Purple Brown 85 c 50 c 100 m 65 m • Learn to love legumes.

30 y 90 y Beans, peas, 25 lentils, k 55 soybeans k

and nuts are all great choices high in fiber, protein, iron and other minerals.

• Correct your carbs.

Pass on processed snacks, such as chips and crackers.

Remember that healthy carbs are found in all plant foods and are essential fuel for your body and brain.

Lean protein

30 15 70 0

Cheese or nuts

Pasta, rice, beans

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Understanding Labels HOW TO READ A FOOD LABEL Ignore nutrition claims on the front of the package; the truth is on the Nutrition Facts label. Use this guide to make informed choices.

Is this serving size reasonable?

If you know you’re going to consume twice as much, multiply the numbers by 2 Limit these nutrients Aim for at least 3-5 grams of fiber per serving Most adults need between 1,500 and 2,000 calories per day.

Adjust your numbers as needed.

Nutrition Facts Serving Size: 1 cup (226 g) Serving Per Container: 1 Amount Per Serving

Calories 170

Calories from Fat 27 % Daily Value*

Total Fat 3g Saturated Fat 1.5g Trans Fat 0g Polyunsaturated Fats 1g Monounsaturated Fats 0.5g Cholesterol 5 mg Sodium 80 mg Total Carbohydrate 25g Dietary Fiber 0g Sugars 18g Protein 10 mg

6% 8% 0%

1% 3% 8% 0%

Vitamin A 15% • Vitamin D3 20% Calcium 20% • Iron 10% *Percent daily are based on a 2,000-calerie diet. Your daily values may be higher or lower depending on your calorie needs:

Calories: Total Fat Less than Sat Fat Less than Cholesterol Less than Sodium Less than Potassium Total Carbohydrate Dietary Fiber

2,000 65g 20g 300mg 2,400mg 3,500mg 300g 25g

Calories per gram: Fat 9 • Carbohydrate 4

•

2,500 80g 25g 300mg 2,400mg 3,500mg 375g 30g

Protein 4

Other Ingredients: Cultured Pasteurized Grade A Milk. Sugar,Peaches, Modified Corn Starch, Kosher Gelatin, Natural and Artificial Flavor, Aspartame, Potassium Sorbate Added to maintain Freshness, Acesulfame Potassium, Citric Acid, Vitamin A Acetate, Vitamin D3

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The 5/20 Rule 5% or less is low and 20% or more is high

Watch out for added sugars highlighted below Get enough of these nutrients

Ingredients are listed in descending order by weight

Go to franciscanwellfedheart.org

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How To Read A Menu EATING OUT SMART

EASY CHANGE

For most people, enjoying a meal out is one of the biggest hurdles in staying on track to heart health. Knowing about food preparation techniques and making small ‘tweaks’ to your order can have a lasting impact on your health and your waistline.

1. Choose a restaurant or deli with heart health in mind

Deli: Choose whole-grain bread and swap out chips or fries for a salad or fresh fruit. Order an open-faced sandwich with low-cal dressing like mustard or vinaigrette.

Asian: Look for entrees with lots of fresh vegetables and ask the chef to cook them in broth or a little oil. Avoid foods high in fat and sugar; fried tofu, wontons, dumplings, sweet and sour dishes, fried rice and tempura. Choose brown rice instead of white.

2. Look for terms like “Grilled, Poached, Roasted, Steamed, Broiled, and Braised” 3. Keep dessert for special occasions 4. Skip sugary drinks that add empty calories.

Hispanic: Opt for corn tortillas. Choose fish or chicken, or stick to beans and rice, which offer a complete protein.

Skip the cheese -- salsa, cilantro, lemons, limes, pico de gallo and jalapenos add lots of heart-friendly flavor. Order a wrapless burrito or a taco salad without the tortilla.

Avoid chimichangas, flautas, chile rellenos and other fried items. Ask for a side of fajita veggies. Top with heart healthy guacamole, not sour cream.

Italian/Pizza/Pasta: Choose a sauce based on tomatoes (marinara), not cream or wine. Request whole-grain pasta, and avoid breaded, fried or cheese-heavy dishes such as scaloppini or parmigiana.

Choose thin crust pizza and pile on the veggies.

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Physical Activity EASY CHANGE

SITTING: THE NEW SMOKING

Moving Adds Up!

We all know it’s important to exercise 30-60 minutes per day. Research reveals that it’s just as important to reduce sitting time. The more often you stand and move, the better.

Your body burns 3x as much energy walking or doing light activities as it does at rest.

How much do you sit?

Add up the hours, you may be surprised!

Work

Hours

B

Commute

S

Socializing

L

TV

S

Computer

D

Entertainment

D

Waiting (ie: bus stops, airports, waiting rooms)

T

Total

Ideas for Movement • Stand during meetings or phone calls • Get up during commercials on TV • Stand while folding laundry, riding on the bus or train • Rethink your office; are there any high countertops you could work at on your computer?

• Set timers on your phone or send email reminders to get up and move • To optimize your metabolism and build muscle strength, walk at least 10,000 steps daily.

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Food Journal FOOD & ACTIVITY LOG

EASY CHANGE

Tracking our daily food intake and activities makes us accountable for the choices we make, setting us up for greater success.

Keep a journal for three days, recording all your activity and food intake.

This will show where you can improve.

There are a lot of online food and exercise tracking programs, as well as apps. If you like pencil and paper, here’s what to include: Breakfast Snack 1 Breakfast Lunch Snack 1 Snack 2 Lunch Dinner Snack 2 Drinks/Fluids Dinner Total Drinks/Fluids

What I Ate

How Much

What I Ate

How Much

Total Depending on your goals, you can also track servings of fruits and vegetables, fish, whole grains and lean proteins.

Pay attention to foods that contribute to excess sodium, sugar and fat.

Activity

Duration

Activity

Duration

Including goals in your food and activity log will result in more favorable outcomes.

Here are a few examples of goals to set: Goal 1: Cook dinner at home Pack lunches at night Goal 2: Drink more fluids Goal 3: Set alarm to get up from computer every 30 minutes

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Meal Planning EASY CHANGE

START SAVING TIME AND MONEY

Cook Once, Eat Twice

Here’s a common complaint: “Eating healthy at home takes too much time.”

By doubling or tripling favorite recipes, you’ll have leftovers in the fridge or freezer to save time on busy nights.

Our answer: In just 15-20 minutes, you can plan the coming week’s meals and snacks.

MEAL PLANNING TIPS: • Incorporate 2-3 new recipes each week, mingling our recipes with yours. Plan to use what’s already in your freezer and pantry • Make tonight’s dinner tomorrow’s lunch • After planning for one month, you’ll have a model for the rest of the season. For more heart healthy recipe ideas, go to hearthealthywoman.com • Don’t forget to plan for snacks For satisfying and healthy ideas, read on for “Grazing, the New Snacking”

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Sample Meal Planner

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thy azing,

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Quinoa Stuffed Red Peppers Serves 4

Surprisingly, red peppers contain twice as much vitamin C as oranges.

Vitamin C is necessary to absorb the iron found in quinoa.

A match made in heaven!

Seasoned Cook To switch up the greens, use Swiss Chard or curly kale and sauté a few minutes longer.

To add heat, sprinkle some cayenne into the sauté.

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2 2 1 3 2

cups cooked quinoa Tbsps olive oil cup sweet onion, diced garlic cloves, minced cups mushrooms, sliced into bite-sized pieces 4 cups fresh spinach, roughly chopped

4 2 1 1 1 ½ 1 ¼

large red bell peppers tsps cumin tsp turmeric tsp ginger tsp cinnamon tsp salt Tbsp fresh lemon juice cup shredded Parmesan

1. Preheat oven to 350°.

2. In a large skillet, heat oil. Add onions and sauté until softened, about 5 minutes. Add garlic and mushrooms and sauté another 5 minutes.

3. Cut the tops off the red peppers and scoop out any remaining membranes and seeds.

4. Add spinach and spices to the sauté. Stir continuously until spinach has become a dark green. Don’t overcook!

Remove from heat and combine sautéed vegetables with cooked quinoa in a large bowl. Add salt, lemon juice and toss.

5. Stuff peppers with mixture and place in a glass or ceramic baking dish with ½ inch water in bottom. Bake for 35 minutes or until peppers are soft. Sprinkle 1 Tbsp of cheese on each pepper and return to oven for 3-5 minutes.

Per serving: 287 calories,10g protein, 39g carbohydrate,11g fat (2g sat, 9g mono/poly), 3mg cholesterol, 9g fiber, 414mg sodium

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ake bsp

Cranberry Pecan Energy Balls Makes 18 Balls 2 1 ¾ ¼ ¾

cups pecans cup dried dates, pitted, roughly chopped cup dried cranberries tsp each, cinnamon, ginger and nutmeg cup shredded coconut, unsweetened

1. Place pecans, dates, cranberries and spices in a food processor bowl fitted with an “s” blade.

2. Process for at least 1 minute, pausing and pulsing as needed to break down mixture.

3. Once mixture has become thick and sticky, begin rolling into small, 1-inch balls.

4. Roll balls in shredded coconut and store at room temperature for up to 3 days or in the refrigerator for up to a week.

These simple, no-bake energy balls are easy to make and provide a perfect little sphere of nourishment.

Naturally sweetened by dates and dried cranberries, these treats also offer healthy fats from the pecans and coconut flakes.

Per one ball: 161 calories, 2g protein,13g carbohydrate, 9g fat (2g sat,7g mono/poly), 0mg cholesterol, 3g fiber,1mg sodium

Seasoned Cook In a hurry? Simply transfer mixture to a 9 x 9 baking dish and press into an even layer. Top with coconut. Refrigerate for 1 hour, remove and cut into squares for energy bars on the go.

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Carrot Coconut Ginger Soup Yields 10 cups To warm up a cold day, look no further. Carrots and coconut give this soup a sweet base while the ginger and jalapeño heat it up!

Seasoned Cook If fresh ginger isn’t available to you, use 1 tablespoon ground instead.

2 Tbsps olive oil 1 medium onion, cut into 1-inch pieces (2 cups) ½ tsp salt 4 celery stalks, cut into 1-inch pieces (2 cups) 6 carrots, cut into 1-inch pieces (4 cups) 1 large sweet potato, cut into 1-inch pieces (2 cups)

1 3 4 1-2 4

5 oz can tomato paste Tbsps fresh grated ginger cloves garlic, minced jalapeños cups low-sodium chicken or vegetable broth 14 oz can low-fat coconut milk 1 Tbsp lime juice Cilantro and yogurt for garnish

1. Heat olive oil in a large soup pot. Add the onions and salt.

Sauté until softened, about 5 minutes.

2. Add celery, carrots, sweet potato, tomato paste, ginger, garlic, jalapeños and stock to the pot and bring to a boil.

Reduce heat and simmer until sweet potatoes and carrots are soft, 30-35 minutes.

3. Add the coconut milk and bring to a boil. Remove pot from heat. Using an immersion stick or food processor, blend soup until smooth.

4. Return soup to the pot and keep on low heat. Add lime juice to finish. Serve hot. Garnish with cilantro and yogurt.

Per 1 cup serving: 177 calories, 4g protein, 18g carbohydrates, 12 g fat (8g sat, 4g mono/poly), 0mg cholesterol, 4g fiber, 424mg sodium

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ger

ken

t milk

nish

d salt.

ger, boil.

1 1 1 ½

medium spaghetti squash cup fresh basil cup fresh curly parsley cup fresh grated Parmesan cheese, divided

2 cloves garlic 1 Tbsp lemon juice 3 Tbsps olive oil Salt & pepper to taste

1. Preheat oven to 375°. Wash squash, cut in half lengthwise and spoon out the seeds. Punch a few holes in outer skin with a fork. Place squash cut-side down in a baking pan with a 1/2” of water. Bake for 30 minutes.

2. Meanwhile, to make the pesto, pulse the basil, parsley, garlic, ¼ cup Parmesan and lemon juice in a food processor.

3. With food processor running, gradually add olive oil in a steady stream.

ot sor,

4. Remove squash from oven, let cool until manageable.

Using a fork, scrape out spaghetti-like strands of squash into a colander and let drain.

ime ogurt.

5. Gently toss pesto with spaghetti squash in a large bowl. Serve with remaining Parmesan cheese sprinkled on top.

8g sat,

Per serving: 180 calories, 5g protein, 12g carbohydrate, 13g fat (3g sat, 10g mono/poly), 7mg cholesterol, 3g fiber, 197mg sodium

Go to franciscanwellfedheart.org

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Pasta is great but sometimes it can be less than nutritious, especially when it’s made from white refined flour.

So, here’s a different take on your next pasta night using spaghetti squash, a great fall vegetable, as your ‘pasta’ instead.

Seasoned Cook Top with a lean protein like shrimp, as shown here.

If you can’t walk away from pasta all together, start mixing these noodles with your pasta, half and half.

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Triple Green Salad Arugula, Avocado and Kiwi Serves 4

In this salad, all things green work in perfect harmony to provide the benefits of these nutrition powerhouses.

Healthy monounsaturated fats from the avocado aid in the absorption of vitamin A & K from the leafy greens while acids in vinegar aid the absorption of minerals from the greens and avocado.

4 1 2 1 1 1

cups arugula or other leafy greens mix medium avocado, peeled and cubed small kiwis, peeled, halved and sliced Tbsp rice vinegar or other sweet white vinegar Tbsp honey mustard tsp black sesame seeds

1. In a large bowl, toss together the first 3 ingredients.

2. In a small bowl, whisk together the remaining ingredients.

3. Pour dressing over salad. Serve immediately.

Per serving: 117 calories, 2g protein,11g carbohydrate, 8g fat (1g sat, 7g mono/poly fat), 0mg cholesterol, 5g fiber, 59mg sodium

Seasoned Cook If you don’t like sesame seeds or have them around, feel free to substitute other seeds like sunflower, chia or flax to keep the crunchy texture and soluble fibers.

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Zucchini Ribbon Salad Serves 4

1 large zucchini 1½ cups cherry tomatoes, halved ¼ cup fresh basil, thinly sliced

1

Tbsp fresh-squeezed lemon juice 2 Tbsps olive oil ¼ tsp each salt and pepper

1. Using a vegetable peeler shave the zucchini lengthwise to get lasagna-like ribbons. Continue until you get to the seeds in the center, for approximately 3 cups ribbons.

2. Place ribbons in large bowl. Add tomatoes and basil.

Looking for more ways to get vegetables on your plate? Look no further than this recipe, which uses zucchini in place of grain noodles for a low-calorie, fresh salad. Have fun with it!

3. In a small bowl, whisk together the lemon juice, olive oil, salt & pepper. Just before serving, pour over ribbons and toss.

Per serving: 90 calories, 2g protein, 7g carbohydrates, 7g fat (1g sat, 6g mono/poly), 0mg cholesterol, 2g fiber, 161 mg sodium

Seasoned Cook This recipe is perfect when you get that “What am I supposed to do with THIS?” sized zucchini from your garden... or your neighbor!

Shave and discard the tougher skin on larger zucchini; smaller, more tender zucchini can be prepared with the skin on. Double the recipe and bring to your next potluck. To add more color, use yellow summer squash too!

Go to franciscanwellfedheart.org

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Recipe Headline Serves For a twist on the traditional caprese salad, this recipe substitutes plums for tomatoes.

Paired with the protein of the fresh mozzarella and the fat of the olive oil, this recipe assists in maintaining stable blood sugars, reducing the risk for Type 2 Diabetes.

4 4 10 2 1

plums oz fresh mozzarella, sliced basil leaves Tbsps olive oil Tbsp balsamic vinegar Salt & pepper to taste

1. Using a sharp knife, slice plums into thin half moon slices, carving out the pit.

2. Layer slices of plum with mozzarella and basil leaves for a beautiful presentation.

3. Just before serving, drizzle with olive oil and balsamic vinaigrette.

Per serving: 180 calories, 8g protein, 9g carbohydrate,13g fat (5g sat, 8g mono/poly),15 mg cholesterol, 1g fiber,151mg sodium

Seasoned Cook If you can’t find plums, use peaches instead.

For thicker dressing, reduce the balsamic vinegar to a syrup over a low heat on the stove.

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Go to franciscanwellfedheart.org

12/3/14 11:04 AM

1 medium red cabbage (about 2 pounds)

1 Tbsp sea salt 2 large carrots, grated

1 bunch green onions, diced 1 tsp cumin, coriander, caraway, dill or fennel seeds

1. Cut cabbage in half core-to-tip. Remove core and peel away outside layer. Slice cabbage thinly and place in large bowl or crock. Evenly distribute salt. Avoid using metal utensils, bowls or containers.

2. Using a pestle, mallet or other large wooden kitchen utensil, aggressively pound the cabbage until it begins to release juices. This will take a while. Add carrots, green onions and seeds.

3. Let it ferment in the crock or place in 3 one quart glass wide-mouthed jars. Use the utensil to compact the cabbage mixture. Cover with a breathable material such as dish towel or cheesecloth.

4. Check cabbage every 8 hours, pounding out more juice. The goal is to submerge the cabbage completely in its own juice. After 24 hours, if cabbage hasn’t released enough juice, add water to cover.

5. Place a weight over cabbage to keep it submerged; cover and leave in a warm, dark place. Fermentation time varies greatly so check on it daily. When the cabbage produces bubbles and the texture and taste are what you like, bottle, seal and refrigerate.

Sauerkraut is traditionally a fermented food.

Today, it’s usually pasteurized and sold in jars. This recipe brings cabbage back to life and embraces the power of probiotics!

Seasoned Cook A crock is preferable because it makes Step 5 easier.

Fermentation times may vary from 3-10 days.

Per ž cup serving: 22 calories,1g protein, 5g carbohydrate, 0g fat, 0 mg cholesterol, 2g fiber, 350mg sodium

Go to franciscanwellfedheart.org

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Onions are high in chromium, a mineral that helps regulate blood sugar, and the phytonutrient quercetin, a natural antioxidant that protects our blood vessels from high blood pressure and oxidative stress.

2 1 4 4 4

Tbsps olive oil pound sweet onions, halved and thinly sliced cups low-sodium beef broth scandinavian-style crispbread or other dense crackers. oz Gruyere or sharp cheddar cheese

1. Heat oil in soup pot, add onions and sautĂŠ on medium heat until caramelized, about 10-15 minutes.

Stir frequently to prevent burning. Add broth and bring to a boil. Reduce heat and simmer 10 minutes.

Preheat broiler.

2. Place 4 small ovenproof soup bowls on a baking sheet. Divide soup evenly among bowls. Float 1 cracker (broken in half) in each bowl and top with cheese.

3. Place baking sheet on a rack positioned at least 6� from broiler. Broil for 2-3 minutes or until cheese is melted and slightly browned.

Per serving: 297 calories,15g protein, 22g carbohydrate,18g fat (7g sat, 11 mono/poly), 31mg cholesterol, 4g fiber,198mg sodium

Seasoned Cook Caramelizing turns ingredients brown and releases their sugars. Caramelized onions are essential to many dishes, such as this heart-healthy version of French Onion Soup.

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s. ng

16 baby red and yellow potatoes (less than 2” in diameter) 1 Tbsp olive oil Fresh thyme for garnish

1. Steam potatoes whole until tender enough to be very easily pierced by a knife (approx. 15 minutes).

2. Place potatoes on cutting board. With the point of a paring knife, make an X on each potato but don’t cut all the way through. With rounded bottom of a large spoon, gently press down on the potatoes until they break. Try for the sweet spot where they flatten out but still retain their round shape and can be lifted in one piece with a spatula.

This recipe produces potatoes that approximate the taste and texture of French fries but without the added fat and calories from deep-frying.

3. Place flattened potatoes on broiler pan and brush with oil.

4. Place under broiler on middle rack for 3 to 4 minutes.

Potatoes are done when the exposed flesh begins to brown and get a little crisp. Garnish with thyme.

Per serving: 109 calories, 2g protein, 18g carbohydrate, 4g fat (1g sat, 3g mono/poly), 0 mg cholesterol, 2 g fiber, 7 mg sodium

Seasoned Cook Since “Roasties” are made with the skin on, varieties with thinner skins work best.

Go to franciscanwellfedheart.org

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SNACKING TIPS

Keep your blood sugar stable and your hunger at bay by enjoying snacks with whole grains, healthy fats and lean proteins.

Plan Ahead Keep healthy snacks individually portioned and conveniently located in your desk drawer at work, or at eye-level in the pantry or fridge.

Keep tempting, unhealthy snacks off the counters

Whether we’re at home or on the go, it’s tempting to grab convenient snacks that are often unhealthy. Plan for two healthy snacks daily and keep items on hand.

10 Snack Ideas • Hummus or yogurt dip with carrots, celery, cucumber, cherry tomatoes or radishes • Apple or veggie slices with nut butter • High-fiber crackers or leaf lettuce with mustard and a slice of low sodium cheese, lean protein or avocado • Fresh fruit with low-fat cottage cheese or plain yogurt • String cheese and fruit • Popcorn • Tuna or chicken salad on crackers, lettuce or with raw dipping vegetables • Hard-boiled egg • Roasted garbanzo beans • Small corn or whole wheat tortilla with beans and low-fat cheese, melt for quesadilla

and out of sight.

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Water infused with the fresh essence of herbs and fruit is a great alternative to sugar-sweetened beverages. Any fruit or herb works – be creative! Here are some combinations to get you started.

Orange + Mint Raspberry + Lime Strawberry + Basil Peach + Thyme Apple + Cinnamon Watermelon + Rosemary

To ‘sandwich’ fruit and herbs between ice cubes, place a layer of ice in bottom of pitcher, top with herbs and fruit and layer with more ice.

Fill with water.

Tips & Tricks • Use seasonal fruit and herbs. Stone fruits and berries are best in summer, apples and pears in fall and citrus in the winter.

•

You can also use frozen fruit as ice-cubes!

•

To ‘sandwich’ fruit and herbs between ice cubes, place a layer of ice in bottom of pitcher, top with herbs and fruit and layer with more ice. Fill with water.

•

Let stand for at least 1 hour for optimal flavor infusion.

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Heart-Friendly Kitchen Basics * = ITEMS USED IN RECIPES IN THIS BOOKLET In the Pantry Grains q Barley q Brown rice q Bulgur q Rolled oats q Polenta q Quinoa* q Whole-wheat bread, pita or tortilla wrap q Whole-wheat pasta q Whole-wheat or rye crackers* _____________ _____________ Beans/Peas (canned and dry) q Black beans q White (cannellini, navy) q Kidney q Garbanzo (chickpeas) q Lentils (brown, green, black, red, French) q Split peas _____________ _____________ Produce Basics q Onions* q Garlic* q Seasonal fruit q Seasonal vegetables q Fresh herbs _____________ _____________ 32

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Nuts, Seeds and Dried Fruit q Almonds q Flaxseeds q Sunflower seeds q Walnuts q Pecans* q Raisins q Apricots q Cranberries* q Dates* q Shredded coconut* _____________ _____________

Oils q Olive* q Olive oil spray q Canola q Sesame q Flax q Walnut _____________ _____________

Seasonings q Allspice, basil*, bay leaf, black pepper*, caraway seeds*, cayenne, chili Canned Goods powder, q Broth, low-sodium cinnamon*, (chicken, vegetable coriander ground or beef)* and seeds*, cumin q Tomatoes, diced, ground and seeds*, low-sodium curry blends, dill*, q Tomato or pasta fennel seeds* sauces, low-sodium ginger*,marjoram, q Black olives nutmeg*, oregano, q Fish (salmon, tuna, red pepper flakes, herring, mackerel) rosemary, sage, q Salsa salt*, sesame seeds q Tomato paste* q Low fat coconut milk* (black)* regular or smoked paprika, _____________ thyme*, turmeric* _____________ _____________ _____________ Vinegars q Cider Other Staples q Red wine q Honey q White wine q Soy sauce, q Balsamic* low-sodium q Sherry q Hot pepper q Rice wine* sauce _____________ q Ketchup _____________ q Maple syrup

q Mustard (dijon, whole-grain, honey)* q Baking soda q Baking powder q Cornstarch* q Flour, whole-wheat and whole-wheat pastry q Sugar q Vanilla extract _____________ _____________ In the Fridge q Eggs q Parmesan cheese* q Milk, low-fat q Yogurt, low-fat* q Butter, unsalted q Lemon and lime juices* q Lean protein _____________ _____________ In the Freezer q Edamame q Green beans q Mixed vegetables q Peas q Berries q Homemade broth q Lean protein _____________ _____________

12/3/14 11:04 AM

s

Fresh Ingredients 1. Quinoa Stuffed Red Peppers • 2 cups mushrooms • 4 cups fresh spinach • 4 large red bell peppers 2. Cranberry Pecan Energy Balls All items under “In the Pantry”

3. Carrot Coconut Ginger Soup • 4 celery stalks • 1 large sweet potato • 6 carrots • fresh ginger, cilantro, jalapeño 4. Spaghetti Squash with No-Nut Pesto • 1 medium spaghetti squash • 1 cup fresh parsley • 1 cup fresh basil 5. Triple Green Salad-Arugula, Avocado and Kiwi • 4 cups arugula • 2 small kiwis • 1 medium avocado 6. Zucchini Ribbon Salad • 1 large zucchini • 1 ½ cups cherry tomatoes

• ¼ cup fresh basil

7. Plum Caprese Salad • 4 plums • 4 oz. fresh mozzarella

• 10 fresh basil leaves

8. Power-to-the-Purple Sauerkraut • 1 medium red cabbage • 2 large carrots • 1 bunch green onions 9. Sweet & Satisfying Onion Soup • 4 scandinavian-style crispbread crackers • 4 oz. gruyere or sharp cheddar cheese 10. Red and Yellow Potato Roasties • 16 baby red and yellow potatoes • Fresh thyme for garnish 33

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Summary 8 EASY CHANGES = A HEALTHIER HEART! Making big changes can be daunting, but little ones don’t have to be.

Consider taking one easy step per week to boost your heart health.

1. Keep up with regular health screenings.

2. Use the heart-healthy plate

as a guide to plan meals.

3. Eat the rainbow. Eat more

fresh, unprocessed foods.

4. Learn how to read the

Nutrition Facts Label on food and beverage products. Watch out for excess sugar, salt and fat.

Emphasize foods with fiber.

5. Shop with a food list;

make sure heart-friendly foods are on it.

6. Create movement

in your day.

7. Keep a food and

exercise journal with goals - so you can track your progress.

8. Get seven or more

hours of sleep each night.

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Hormones and Your Heart MANAGING THE CHANGE When it comes to menopause, decisions around hormone replacement therapy (HRT) are unique for each woman. Be sure to talk with a trusted primary care provider familiar with your personal and family health history. Weigh risks and benefits. And consider these tips to help protect your heart health over time: Know that mass matters. Weight is not just about pounds, but pudge. You lose lean muscle mass after menopause if you don’t work – hard – to avoid the shift from muscle to fat.

Move more. Walking is an excellent form of weightbearing exercise that helps retain muscle mass.

It even helps control fat accumulation around the middle. It’s free, and you can do it anywhere.

Lighten your libations. You now need far fewer calories to maintain your same weight. Skip the soda, flavored lattes and alcohol to reduce calories. Try sparkling water with a twist, or infuse waters with herbs and fruit for a refreshing drink.

Don’t smoke. Quitting will cut your risk of heart disease in half after just one year.

“Women’s risk of heart disease does increase after menopause,” said Rosemary Peterson, MD, a CHI Franciscan Health cardiologist. “Lifestyle changes can help counteract a natural rise in blood pressure and possibly LDL cholesterol and triglycerides.”

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Franciscan Heart Care IT’S EVERYWHERE YOU FIND CHI FRANCISCAN. Our heart and vascular care encompasses providers and services throughout Puget Sound. Through the strength of a system, CHI Franciscan Health offers all the heart care you’ll ever need — with a high level of coordination and a strong dose of compassion.

CHI Franciscan Health Facilities

Port P Townsend T

Sequim

Heart/Vascular Care

Hospitals

Prompt Care, Primary Care and Specialty Care Clinics

Port Ludlow

Forks

Sequim

Poulsbo

Po Bainbridge Island

Silverdale Bremerton

Belfair

Port Orchard

West Seattle

Burien Vashon

Silv

Tukwila

Des Moines Gig Harbor University Place Lakewood

Tacoma

Federal Way

Auburn Belfair

Milton Puyallup

Bonney Lake

Spanaway

For services and providers, visit FranciscanHeart.org or HarrisonMedical.org/heart.

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Enumclaw

Helping You to Better Health LOCAL CLASSES AND SUPPORT GROUPS Freedom from Tobacco Support Group Multiple locations to choose from.

No registration required; drop-ins welcome. Call for more information: (253) 223-7538. stop smoking pic

Franciscan Center for Weight Management Full range of surgical options, including gastric bypass and sleeve gastrectomy, to help patients reduce and manage their weight for life and lower the risk of chronic health problems.

Learn about our free seminars and our Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) Bariatric Surgery Center of Excellence at St. Francis Hospital at FranciscanWeightLoss.org.

Franciscan Outpatient Nutrition Education Center Individual nutrition counseling, body composition analysis and more. Call (253) 426-4926.

Healthy Heart Nutrition Series Covers types of fat, label reading, recipe substitutions, strategies for dining out and more. Call 1 (888) 825-3227.

Diabetes Education Certified educators help you manage diabetes and live well.

Call (253) 426-4352 or visit chifranciscan.org.

Franciscan Health eNews Tailor topics to your health needs and interests. Subscribe today at chifranciscan.org/eNews. Be sure to choose “Heart Disease”!

Blood pressure checks Monitor your blood pressure between doctor visits at our updated Heart Check Center™ kiosks: • Commons Mall, Federal Way • Tacoma Mall, Tacoma • South Hill Mall, Puyallup A.W.A.K.E. Support Group The “Alert Wakefulness and Keeping Energetic” (A.W.A.K.E.) supports Continuous Positive Airway Pressure (CPAP) wearers and their families, and covers topics related to obstructive sleep apnea.

For more information, call (253) 985-6951.

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Say hi to feeling better fast.

Get care now with Franciscan Virtual Urgent Care.

Talk to a doctor via phone or video chat—24/7 for $35.* Visit FranciscanCareNow.org or call (855) 356-8053.

*If your situation is quickly determined to be inappropriate for Virtual Care, you won’t be charged for the visit.

Due to federal regulations, patients who participate in Medicare and Medicaid are not eligible for telemedicine “virtual visit” services at this time.