February is American Heart Month, so it’s a great time to focus on how Americans can do a better job of taking care of their hearts. The numbers show that we have a lot of work to do. The CDC reports that 600,000 people die of heart disease in the United States every day. That’s one in four deaths. Also, heart disease is the leading cause of death for both men and women. Coronary heart disease is the most common type of heart disease killing nearly 380,000 people every year.

The good news is that there’s some pretty simple changes we can make to get our hearts healthier.

Listen to an interview with Kim Evans, MS, RD, to get tips on eating a heart healthy diet, or read the transcript of the interview below.

Learn more about UVM Medical Center’s Cardiac Rehabilitation and Prevention Program.

UVM Medical Center: We are joined today by Kim Evans, MS, RD, a clinical dietitian for the UVM Medical Center’s Cardiac Rehabilitation and Prevention Program. She’s going to talk to us about those healthy changes. Welcome to the show, Kim.

Kim Evans: Thanks for having me.

UVM Medical Center: You hear about a lot of new diet trends every year, the Paleo diet, the Mediterranean diet. What in your opinion is truly a heart healthy diet?

Kim Evans:  You’re right. There are lots and lots of diet trends ranging from as you said, Paleo all the way down to vegan. Even in the heart healthy diet trends, Dean Ornish versus the Mediterranean diet, you see a lot of variation. When it really comes right down to it at the end of the day, the research really points us in a common direction of moving towards a more plant-based diet, really focusing in on legumes and grains and of course, fruits and vegetables. Really, that common theme of a heart healthy diet is a diet that is heavily based in plants.

UVM Medical Center: What are some of the heart healthy foods listeners should have in their pantry then?

Kim Evans: Sure. When we come to some of those plant-based foods, I really steer people towards simple changes that can have a really big impact on their cardiovascular health. Things like sweet potatoes are a great addition. Swap out those regular potatoes or maybe hold off on the pasta at dinner and substitute in a sweet potato.

Flax seed is another great heart healthy, high in what are called short-chain omega-3 fats, alpha-Linolenic acid. Sprinkling a few flax seeds in your oatmeal or on your yogurt, also a great cardiovascular-friendly food and walnuts. Walnuts on your rice, walnuts on your salad, walnuts on your yogurt. I guess the other thing that comes to my mind right off the bat are oats.

We know that oats really help to reduce cholesterol. They’re also a very easy breakfast food. We’re seeing a trend in 2015 towards a lot of add-ins in yogurts. You’ll be seeing a lot of Chobani and other yogurts that actually have the oats added right in. That makes it really simple and easy.

UVM Medical Center: Super simple. You probably see a lot of patients at cardiac rehab who obviously need to change their diet. What are some of the common mistakes you see people making?

Kim Evans: That’s a great question. I do facilitate a program for cardiac rehab called the Move to Lose program. It’s both a weight lost and heart healthy lifestyle intervention program. My feeling and my common observation is that even when people think that they’re doing a great job at eating fruits and vegetables, when they add it up at the end of the day, we find that on average, people are eating less than three servings of fruits and vegetable in the day even when they think they’re doing a great job. Our recommendations as registered dietitians is to stir people towards five to nine servings of fruits and vegetables per day. More veggies than fruits, but five to nine.

UVM Medical Center: That’s a big change. What are some ways that people can actually integrate that into their daily diet? It’s hard to add five fruits or vegetables on top of the regular three that you’re mentioning.

Kim Evans: Start early. Start with breakfast. Sometimes I think people are just in such a hurry that they leave the house without having breakfast or they just go to what is quick and easy, a grab-and-go item like a bagel with cream cheese. Throw a slice of tomato or a couple of slices of tomato on that bagel with cream cheese if you’re not ready to make a big, big change or maybe adding some fruit to a yogurt for breakfast in the morning.

Once you get in those routines and habits, the next step might be to do something like a smoothie, where you can add your berries and you can add your oats right to your smoothie. Then when you’re really getting brave, you can throw in a big handful of raw spinach or kale. You’ve got almost two to three servings of fruits and vegetables right there at breakfast alone.

UVM Medical Center: Fats have been in the news a lot lately, saturated fats versus other fats. What are really good fats and bad fats? Can you break that down for our listeners?

Kim Evans: Sure, and I want to go back to that discussion as well about trending diets and heart health. There was a meta analysis just published recently in the New England Journal of Medicine looking at outcomes for cardiovascular healthy comparing the Ornish diet, which is notoriously a very, very low, low, low fat diet, and then the Mediterranean diet, which is also a plant-based diet, but favors the monounsaturated fats, which have a cardiovascular protective effect.

Those healthy fats, the MUFAs we call them, monounsaturated fats come from things again that are plant-based, walnut oil, olive oil, avocados, avocado oils. They seem to help reduce inflammation systemically in the body and protect your veins and arteries from damage. The monounsaturated fats, those are some of the heart healthy fats, as well as of course, we hear a lot about omega-3 fats, which we find in things like flax seed and also in things like salmon or steelhead trout. Those also have a cardiovascular-protective effect.

On the other side of the coin, we hear a lot about the dangers of saturated fat and the dangers of trans fats, those chemically manipulated fats that show up in our food supply, more in processed foods than other things. My advice generally is to really focus on those plant-based fats. Enjoy saturated fats from cheese and dairy products and maybe some animal products that you eat in moderation and then to try and really limit or stay away from trans fats in your food.

UVM Medical Center: We had mentioned fats earlier, good and bad.

Kim Evans: The good, the bad and the ugly.

UVM Medical Center: Exactly, the good, the bad and the ugly. What is the good, the bad and the ugly?

Kim Evans: In that order, I would say I changed the language a bit to be the good, the moderate and the ugly, really focusing in those monounsaturated fats and omega-3 fats as your good heart protective fats. The moderation with the saturated naturally occurring animal fats from things like dairy products and cheese, and the ugly we reserve for those chemically manipulated or modified trans fats that often show up in packaged and processed foods.

UVM Medical Center: Got it. What about salt and sugar?

Kim Evans: Great question. I’m a foodie at heart. I love, love, love food. We know that a big part of what makes food taste good is the FASS balancing, the fats, the acids, the sweets and the salts in our diet. That’s an important part of eating. I want people to really love the food that they’re eating. Salt in moderation as a flavor enhancer is fine, and especially when you’re balancing that salt with a little sweet, a little acid, a little fat. You don’t need a whole lot of salt.

In large amounts, sodium, salt looks for water to hold on to in our body, and then a place to park itself. It can put added strain on our circulatory system and added strain on our heart when our body just has all that fluid to move around and to deal with.

UVM Medical Center: How much is too much though? What is a good rule of thumb?

Kim Evans: That’s a tough question, and I will be honest. The American Heart Association recommendations are generally less than 2,500 mg a day, but it really is very individualized. I work with a lot of athletes and their needs for sodium are quite different than somebody who maybe more sedentary.

UVM Medical Center: Lifestyle dependent.

Kim Evans: Lifestyle dependent and also there are ways to increase your intake of potassium-rich foods that help to balance the sodium in your diet as well. Adding things again like sweet potatoes or coconut water or something that’s rich in potassium can help to offset some of the concerns about sodium.

UVM Medical Center: A lot of people are overeating sugar as well though. I’m wondering what your advice is when it comes to sugar?

Kim Evans: My advice when it comes to sugar is to follow what I call my 80/20 rule of healthy eating, 80% of your eating for health, so really investing 80% of your plate or 80% of what you’re choosing in a day in foods that you know will add to your health, and saving about 20% for fun and pleasure. I would say that those sweet treats are part of that 20%.

UVM Medical Center: What about chocolate?

Kim Evans: Chocolate is an interesting sweet treat, right? If you’re going to have a sweety treat, why not make it something that may have some cardiovascular benefits? The thing about chocolate is that it really does have to be that dark chocolate, a 70% to 80% cacao content or higher. You will find that a lot of those chocolates really don’t have much sugar in them at all. You’re going to know it when you taste it. It’s going to taste a little more on the bitter side, but the flavonols and flavonoids in chocolate do seem to have a cardiovascular protective effect. That’s a great way to enjoy your sweet treat and protect your heart at the same time.

UVM Medical Center: What would you say for listeners are three things they might be able to do after listening to you in their diet tomorrow?

Kim Evans: First, increase your intake of vegetables. The more colors, the better. Try a new vegetable this week. Make it something you haven’t had before. Number two, fish. Really working towards getting fish three times to five times a week. Add some variety. Try steelhead trout, buy some wild salmon, just increasing that fish. Lastly, maybe thinking about one thing that you’re eating that you know may not be the best choice for your health in general and your heart in particular, and leaving it out of your grocery cart this week.

UVM Medical Center: Let me turn the tables on the interview then. Are there some things that we may have not mentioned about heart health that you think are really important for us all to keep in mind?

Kim Evans: A little outside of my scope of practice, but really going for that total lifestyle change. Really focusing on improving your dietary health absolutely, and as well working on incorporating more daily movement and physical activity is a really essential part of cardiovascular health. I have a great slide in mind that I’ll be sharing at the Go Red for Women luncheon coming up this week. It’s a picnic basket fastened on the front of a bicycle and really thinking about increasing our physical activity, our daily activity and working on our nutrition all at the same time. They all go hand-in-hand.

UVM Medical Center: Fantastic. So many great heart healthy tips and great diet advice from again, Kim Evans, who is a registered dietitian, and works with the University of Vermont Medical Center’s Cardiac Rehabilitation and Prevention Program. For more information about that program and all of our medical services and programs, please visit uvmhealth.org/medcenter and you can always check us out on social media. You can visit our blog at medcenterblog.uvmhealth.org and follow us on Facebook and Twitter.

Kim Evans, RD, is a clinical dietitian for UVM Medical Center's Cardiac Rehabilitation and Prevention Program.

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