Choose a diet that is low in saturated fat and cholesterol and moderate in total fat

Fats supply energy and essential fatty acids, and they help absorb the fat-soluble vitamins A, D, E, and K, and carotenoids. You need some fat in the food you eat, but choose sensibly. Some kinds of fat, especially saturated fats, increase the risk for coronary heart disease by raising the blood cholesterol (see box 15). In contrast, unsaturated fats (found mainly in vegetable oils) do not increase blood cholesterol. Fat intake in the United States as a proportion of total calories is lower than it was many years ago, but most people still eat too much saturated fat. Eating lots of fat of any type can provide excess calories.

Choose foods low in saturated fat and cholesterol

See box 16 for tips on limiting the amount of saturated fat and cholesterol you get from your food. Taking these steps can go a long way in helping to keep your blood cholesterol level low.

Box 15

KNOW THE DIFFERENT TYPES OF FATS Saturated Fats Foods high in saturated fats tend to raise blood cholesterol. These foods include high-fat dairy products (like cheese, whole milk, cream, butter, and regular ice cream), fatty fresh and processed meats, the skin and fat of poultry, lard, palm oil, and coconut oil. Keep your intake of these foods low. Dietary Cholesterol Foods that are high in cholesterol also tend to raise blood cholesterol. These foods include liver and other organ meats, egg yolks, and dairy fats. Trans Fatty Acids Foods high in trans fatty acids tend to raise blood cholesterol. These foods include those high in partially hydrogenated vegetable oils, such as many hard margarines and shortenings. Foods with a high amount of these ingredients include some commercially fried foods and some bakery goods. Unsaturated Fats Unsaturated fats (oils) do not raise blood cholesterol. Unsaturated fats occur in vegetable oils, most nuts, olives, avocados, and fatty fish like salmon. Unsaturated oils include both monounsaturated fats and polyunsaturated fats. Olive, canola, sunflower, and peanut oils are some of the oils high in monounsaturated fats. Vegetable oils such as soybean oil, corn oil, and cottonseed oil and many kinds of nuts are good sources of polyunsaturated fats. Some fish, such as salmon, tuna, and mackerel, contain omega-3 fatty acids that are being studied to determine if they offer protection against heart disease. Use moderate amounts of food high in unsaturated fats, taking care to avoid excess calories.

Box 16

FOOD CHOICES LOW IN SATURATED FAT AND CHOLESTEROL AND MODERATE IN TOTAL FAT Get most of your calories from plant foods (grains, fruits, vegetables). If you eat foods high in saturated fat for a special occasion, return to foods that are low in saturated fat the next day. Fats and Oils Choose vegetable oils rather than solid fats (meat and dairy fats, shortening). If you need fewer calories, decrease the amount of fat you use in cooking and at the table. Meat, Poultry, Fish, Shellfish, Eggs, Beans, and Nuts Choose 2 to 3 servings of fish, shellfish, lean poultry, other lean meats, beans, or nuts daily. Trim fat from meat and take skin off poultry. Choose dry beans, peas, or lentils often. Limit your intake of high-fat processed meats such as bacon, sausages, salami, bologna, and other cold cuts. Try the lower fat varieties (check the Nutrition Facts Label). Limit your intake of liver and other organ meats. Use egg yolks and whole eggs in moderation. Use egg whites and egg substitutes freely when cooking since they contain no cholesterol and little or no fat. Dairy Products Choose fat-free or low-fat milk, fat-free or low-fat yogurt, and low-fat cheese most often. Try switching from whole to fat-free or low-fat milk. This decreases the saturated fat and calories but keeps all other nutrients the same. Prepared Foods Check the Nutrition Facts Label to see how much saturated fat and cholesterol are in a serving of prepared food. Choose foods lower in saturated fat and cholesterol. Foods at Restaurants or Other Eating Establishments Choose fish or lean meats as suggested above. Limit ground meat and fatty processed meats, marbled steaks, and cheese. Limit your intake of foods with creamy sauces, and add little or no butter to your food. Choose fruits as desserts most often.

Following the tips in the box above will help you keep your intake of saturated fat at less than 10 percent of calories. They will also help you keep your cholesterol intake less than the Daily Value of 300 mg/day listed on the Nutrition Facts Label. If you want more flexibility, see box 17, below, to find out your saturated fat limit in grams. The maximum number of saturated fat grams depends on the amount of calories you get daily. Use Nutrition Facts Labels to find out how much saturated fat is in prepared foods.  If you choose one food that is higher in saturated fat, make your other choices lower in saturated fat. This will help you stay under your saturated fat limit for the day.

Box 17
WHAT IS YOUR UPPER LIMIT ON FAT FOR THE CALORIES YOU CONSUME?
Total Calories per Day	Saturated Fat in Grams	Total Fat in Grams
1,600	18 or less	53
2,000*	20 or less	65
2,200	24 or less	73
2,500*	25 or less	80
2,800	31 or less	93
* Percent Daily Values on Nutrition Facts Labels are based on a 2,000 calorie diet. Values for 2,000 and 2,500 calories are rounded to the nearest 5 grams to be consistent with the Nutrition Facts Label.

Different forms of the same food may be very different in their content of saturated fat. Box 18 provides some examples. Try to choose the forms of food that are lower in saturated fat most often.

Keep total fat intake moderate
Aim for a total fat intake of no more than 30 percent of calories, as recommended in previous editions of the Guidelines. If you need to reduce your fat intake to achieve this level, do so primarily by cutting back on saturated and trans fats. Check box 17 to find out how many grams of fat you can have for the number of calories you need. For example, at 2,200 calories per day, your suggested upper limit on fat intake would be about 73 grams. If you are at a healthy weight and you eat little saturated fat, you'll have leeway to eat some plant foods that are high in unsaturated fats. To see if you need to lose weight, see the guideline "Aim for a Healthy Weight."

Advice for children

Advice in the previous sections applies to children who are 2 years of age or older. It does not apply to infants and toddlers below the age of 2 years. Beginning at age 2, children should get most of their calories from grain products; fruits; vegetables; low-fat dairy products; and beans, lean meat and poultry, fish, or nuts. Be careful, nuts may cause choking in 2 to 3 year olds.

ADVICE FOR TODAY

To reduce your intake of saturated fat and cholesterol:

• Limit use of solid fats, such as butter, hard margarines, lard, and partially hydrogenated shortenings. Use vegetable oils as a substitute.
• Choose fat-free or low-fat dairy products, cooked dry beans and peas, fish, and lean meats and poultry.
• Eat plenty of grain products, vegetables, and fruits daily.
• Use the Nutrition Facts Label to help choose foods lower in fat, saturated fat, and cholesterol.

Box 18
A COMPARISON OF SATURATED FAT IN SOME FOODS
Food Category	Portion	Saturated Fat Content in Grams
Cheese
Regular Cheddar cheese Low-fat Cheddar cheese*	1 oz 1 oz.	6.0 1.2
Ground Beef
Regular ground beef Extra lean ground beef*	3 oz. cooked 3 oz. cooked	7.2 5.3
Milk
Whole milk Low-fat (1%) milk*	1 cup 1 cup	5.1 1.6
Breads
Croissant Bagel*	1 medium 1 medium	6.6 0.1
Frozen Desserts
Regular ice cream Frozen yogurt*	1/2 cup 1/2 cup	4.5 2.5
Table Spreads
Butter Soft margarine*	1 tsp. 1 tsp.	2.4 0.7
NOTE: The food categories listed are among the major food sources of saturated fat for U.S. adults and children. * Choice that is lower in saturated fat.

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Choose beverages and foods to moderate your intake of sugars

Sugars are carbohydrates and a source of energy (calories). Dietary carbohydrates also include the complex carbohydrates starch and dietary fiber. During digestion all carbohydrates except fiber break down into sugars. Sugars and starches occur naturally in many foods that also supply other nutrients. Examples of these foods include milk, fruits, some vegetables, breads, cereals, and grains.

Sugars and tooth decay

Foods containing sugars and starches can promote tooth decay. The amount of bacteria in your mouth and lack of exposure to fluorides also promote tooth decay. These bacteria use sugars and starches to produce the acid that causes tooth decay. The more often you eat foods that contain sugars and starches, and the longer these foods remain in your mouth before you brush your teeth, the greater your risk for tooth decay. Frequent eating or drinking sweet or starchy foods between meals is more likely to harm teeth than eating the same foods at meals and then brushing. Daily dental hygiene, including brushing with fluoride toothpaste and flossing, and adequate intake of fluorides will help prevent tooth decay. Follow the tips in box 19 for healthy teeth.

Box 19 FOR HEALTHY TEETH AND GUMS Between meals, eat few foods or beverages containing sugars or starches. If you do eat them, brush your teeth afterward to reduce risk of tooth decay. Brush at least twice a day and floss daily. Use fluoride toothpaste. Ask your dentist or health care provider about the need for supplemental fluoride, or dental sealants, especially for children and if your drinking water is not fluoridated.

Box 20 MAJOR SOURCES* OF ADDED SUGARS IN THE UNITED STATES Soft drinks Cakes, cookies, pies Fruitades and drinks such as fruit punch and lemonade Dairy desserts such as ice cream Candy       * All, except diet or sugar-free

Added sugars

Added sugars are sugars and syrups added to foods in processing or preparation, not the naturally occurring sugars in foods like fruit or milk. The body cannot tell the difference between naturally occurring and added sugars because they are identical chemically. Foods containing added sugars provide calories, but may have few vitamins and minerals. In the United States, the number one source of added sugars is nondiet soft drinks (soda or pop). Sweets and candies, cakes and cookies, and fruit drinks and fruitades are also major sources of added sugars.

Intake of a lot of foods high in added sugars, like soft drinks, is of concern. Consuming excess calories from these foods may contribute to weight gain or lower consumption of more nutritious foods. Use box 20 to identify the most commonly eaten foods that are high in added sugars (unless they are labeled "sugar free" or "diet"). Limit your use of these beverages and foods. Drink water to quench your thirst, and offer it to children.

Some foods with added sugars, like chocolate milk, presweetened cereals, and sweetened canned fruits, also are high in vitamins and minerals. These foods may provide extra calories along with the nutrients and are fine if you need the extra calories.

The Nutrition Facts Label gives the content of sugars from all sources (naturally occurring sugars plus added sugars, if any. You can use the Nutrition Facts Label to compare the amount of total sugars among similar products. To find out if sugars have been added, you also need to look at the food label ingredient list. Use box 21 to identify names of some added sugars.

Box 21
NAMES FOR ADDED SUGARS THAT APPEAR ON FOOD LABELS A food is likely to be high in sugars if one of these names appears first or second in the ingredient list, or if several names are listed.
Brown sugar Corn sweetener Corn syrup Dextrose Fructose Fruit juice concentrate Glucose High-fructose corn syrup Honey	Invert sugar Lactose Malt syrup Maltose Molasses Raw sugar Sucrose Syrup Table sugar

Sugar substitutes

Sugar substitutes such as saccharin, aspartame, acesulfame potassium, and sucralose are extremely low in calories. Some people find them useful if they want a sweet taste without the calories. Some foods that contain sugar substitutes, however, still have calories. Unless you reduce the total calories you eat or increase your physical activity, using sugar substitutes will not cause you to lose weight.

Sugars and other health issues

Behavior. Intake of sugars does not appear to affect children's behavior patterns or their ability to learn. Many scientific studies conclude that sugars do not cause hyperactivity in children.

Weight control. Foods that are high in sugars but low in essential nutrients primarily contribute calories to the diet. When you take in extra calories and don't offset them by increasing your physical activity, you will gain weight. As you aim for a healthy weight and fitness, keep an eye on portion size for all foods and beverages, not only those high in sugars. See box 3.

ADVICE FOR TODAY

• Choose sensibly to limit your intake of beverages and foods that are high in added sugars.
• Get most of your calories from grains (especially whole grains), fruits and vegetables, low-fat or non-fat dairy products, and lean meats or meat substitutes.
• Take care not to let soft drinks or other sweets crowd out other foods you need to maintain health, such as low-fat milk or other good sources of calcium.
• Follow the simple tips listed in box 19 to keep your teeth and gums healthy.
• Drink water often.

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Choose and prepare foods with less salt

Many people can reduce their chances of developing high blood pressure by consuming less salt. Several other steps can also help keep your blood pressure in the healthy range (see box 22). In the body, sodium-which you get mainly from salt-plays an essential role in regulating fluids and blood pressure. Many studies in diverse populations have shown that a high sodium intake is associated with higher blood pressure.

There is no way to tell who might develop high blood pressure from eating too much salt. However, consuming less salt or sodium is not harmful and can be recommended for the healthy, normal person (see box 23).

At present, the firmest link between salt intake and health relates to blood pressure. High salt intake also increases the amount of calcium excreted in the urine. Eating less salt may decrease the loss of calcium from bone. Loss of too much calcium from bone increases the risk of osteoporosis and bone fractures.

Box 22 STEPS THAT MAY HELP KEEP BLOOD PRESSURE IN A HEALTHY RANGE Choose and prepare foods with less salt. Aim for a healthy weight: blood pressure increases with increases in body weight and decreases when excess weight is reduced. Increase physical activity: it helps lower blood pressure, reduce risk of other chronic diseases, and manage weight. Eat fruits and vegetables. They are naturally low in salt and calories. They are also rich in potassium (see box 12, which may help decrease blood pressure. If you drink alcoholic beverages, do so in moderation. Excessive alcohol consumption has been associated with high blood pressure.

Box 23 IS LOWERING SALT INTAKE SAFE? Eating too little salt is not generally a concern for healthy people. If you are being treated for a chronic health problem, ask your doctor about whether it is safe for you to reduce your salt intake. Some table salt is fortified with iodine. If you use table salt to meet your need for iodine, a small amount-about 1/4 teaspoon of iodized salt-provides more than half the daily iodine allowance. Your body can adjust to prevent too much sodium loss when you exercise heavily or when it is very hot. However, if you plan to reduce your salt intake and you exercise vigorously, it is sensible to decrease gradually the amount of salt you consume.

Salt is found mainly in processed and prepared foods

Salt (sodium chloride) is the main source of sodium in foods (see box 24). Only small amounts of salt occur naturally in foods. Most of the salt you eat comes from foods that have salt added during food processing or during preparation in a restaurant or at home. Some recipes include table salt or a salty broth or sauce, and some cooking styles call for adding a very salty seasoning such as soy sauce. Not all foods with added salt taste salty. Some people add salt or a salty seasoning to their food at the table. Your preference for salt may decrease if you gradually add smaller amounts of salt or salty seasonings to your food over a period of time.

Aim for a moderate sodium intake

Most people consume too much salt, so moderate your salt intake. Healthy children and adults need to consume only small amounts of salt to meet their sodium needs-less than 1/4 teaspoon of salt daily. The Nutrition Facts Label lists a Daily Value of 2,400 mg of sodium per day. This is the amount of sodium in about 1 teaspoon of salt. See box 25 for helpful hints on how to keep your sodium intake moderate.

Box 24

SALT VERSUS SODIUM Salt contains sodium. Sodium is a substance that affects blood pressure. The best way to cut back on sodium is to cut back on salt and salty foods and seasonings. When reading a Nutrition Facts Label, look for the sodium content. Foods that are low in sodium (less than 5% of the Daily Value or DV) are low in salt.

Box 25
WAYS TO DECREASE YOUR SALT INTAKE
At the Store Choose fresh, plain frozen, or canned vegetables without added salt most often-they're low in salt. Choose fresh or frozen fish, shellfish, poultry, and meat most often. They are lower in salt than most canned and processed forms. Read the Nutrition Facts Label to compare the amount of sodium in processed foods- such as frozen dinners, packaged mixes, cereals, cheese, breads, soups, salad dressings, and sauces. The amount in different types and brands often varies widely. Look for labels that say "low-sodium." They contain 140 mg (about 5% of the Daily Value) or less of sodium per serving. Ask your grocer or supermarket to offer more low sodium foods.	Cooking and Eating at Home If you salt foods in cooking or at the table, add small amounts. Learn to use spices and herbs, rather than salt, to enhance the flavor of food. Go easy on condiments such as soy sauce, ketchup, mustard, pickles, and olives-they can add a lot of salt to your food. Leave the salt shaker in a cupboard. Eating Out Choose plain foods like grilled or roasted entrees, baked potatoes, and salad with oil and vinegar. Batter-fried foods tend to be high in salt, as do combination dishes like stews or pasta with sauce. Ask to have no salt added when the food is prepared. Any Time Choose fruits and vegetables often. Drink water freely. It is usually very low in sodium. Check the label on bottled water for sodium content.

ADVICE FOR TODAY

• Choose sensibly to moderate your salt intake.
• Choose fruits and vegetables often. They contain very little salt unless it is added in processing.
• Read the Nutrition Facts Label to compare and help identify foods lower in sodium-especially prepared foods.
• Use herbs, spices, and fruits to flavor food, and cut the amount of salty seasonings by half.
• If you eat restaurant foods or fast foods, choose those that are prepared with only moderated amounts of salt or salty flavorings.

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If you drink alcoholic beverages, do so in moderation

Alcoholic beverages supply calories but few nutrients. Alcoholic beverages are harmful when consumed in excess, and some people should not drink at all. Excess alcohol alters judgment and can lead to dependency and a great many other serious health problems. Taking more than one drink per day for women or two drinks per day for men (see box 26) can raise the risk for motor vehicle crashes, other injuries, high blood pressure, stroke, violence, suicide, and certain types of cancer. Even one drink per day can slightly raise the risk of breast cancer. Alcohol consumption during pregnancy increases risk of birth defects. Too much alcohol may cause social and psychological problems, cirrhosis of the liver, inflammation of the pancreas, and damage to the brain and heart. Heavy drinkers also are at risk of malnutrition because alcohol contains calories that may substitute for those in nutritious foods. If adults choose to drink alcoholic beverages, they should consume them only in moderation - and with meals to slow alcohol absorption.

Box 26

WHAT IS DRINKING IN MODERATION? Moderation is defined as no more than one drink per day for women and no more than two drinks per day for men. This limit is based on differences between the sexes in both weight and metabolism. Count as a drink- 12 ounces of regular beer (150 calories) 5 ounces of wine (100 calories) 1.5 ounces of 80-proof distilled spirits (100 calories) NOTE: Even moderate drinking provides extra calories.

Drinking in moderation may lower risk for coronary heart disease, mainly among men over age 45 and women over age 55. However, there are other factors that reduce the risk of heart disease, including a healthy diet, physical activity, avoidance of smoking, and maintenance of a healthy weight.

Moderate consumption provides little, if any, health benefit for younger people. Risk of alcohol abuse increases when drinking starts at an early age. Some studies suggest that older people may become more sensitive to the effects of alcohol as they age.

Who should not drink?

Some people should not drink alcoholic beverages at all. These include:

• Children and adolescents.

• Individuals of any age who cannot restrict their drinking to moderate levels. This is a special concern for recovering alcoholics, problem drinkers, and people whose family members have alcohol problems.

• Women who may become pregnant or who are pregnant. A safe level of alcohol intake has not been established for women at any time during pregnancy, including the first few weeks. Major birth defects, including fetal alcohol syndrome, can be caused by heavy drinking by the pregnant mother. Other fetal alcohol effects may occur at lower levels.

• Individuals who plan to drive, operate machinery, or take part in other activities that require attention, skill, or coordination. Most people retain some alcohol in the blood up to 2 to 3 hours after a single drink.

• Individuals taking prescription or over-the-counter medications that can interact with alcohol. Alcohol alters the effectiveness or toxicity of many medications, and some medications may increase blood alcohol levels. If you take medications, ask your health care provider for advice about alcohol intake, especially if you are an older adult.

ADVICE FOR TODAY

• If you choose to drink alcoholic beverages, do so sensibly, and in moderation.
• Limit intake to one drink per day for women or two per day for men, and take with meals to slow alcohol absorption.
• Avoid drinking before or when driving, or whenever it puts you or others at risk.