User's comments:
I am looking for a menu of foods that are safe to eat for someone like myself who has had a bypass, for example:

Breakfast:
2 x wholewheat slices of toast
2 x scrambled or poached eggs
1 x plate mealie pap
3 x grilled chicken livers
1 x cup of black tea or glass of orange juice.

This is a real "boere breakfast". I need to know if I can have this type of breakfast? I also need to find a variety of menus for breakfast, lunch and supper.

Expert's comments:
There are various risk factors involved in the development of cardiovascular disease. Interventions for the following risk factors have been shown to reduce cardiovascular risk: cigarette smoking; high LDL (“bad”) cholesterol; high-fat-high-cholesterol diet; high blood pressure; diabetes mellitus; physical inactivity; obesity; and postmenopausal status (women).

Diet is considered the predominant environmental cause of coronary arthrosclerosis. Diet modifications can unequivocally reduce risk of heart disease.

I am unaware of the risk factors that you may have, but am going to touch on the most important things to consider when it comes to making the necessary lifestyle adjustments.

Firstly, just to recap: cholesterol is present in body tissues and is necessary for normal functioning. Unfortunately, western diets tend to contain large amounts of cholesterol, which in combination with the cholesterol made by the body, can lead to a surplus of cholesterol circulating in the blood. Arteries may become clogged up, hampering blood flow and ultimately leading to stroke or heart attack.

There are two main types of blood cholesterol – HDL cholesterol is the “good” cholesterol, which carries cholesterol away from the arteries back to the liver to be broken down and excreted; and LDL cholesterol is the “bad” cholesterol responsible for clogging up the arteries.

To reduce levels of blood cholesterol in general and particularly LDL-cholesterol, saturated and trans fats should be removed from the diet and you should increase your exercise levels (this will increase levels of HDL). For improved general health, prevention of lifestyle-related diseases and weight management, you should aim to decrease your total fat intake, consume less saturated fats and more unsaturated fats (poly- and monounsaturated)

I have summarised the important points below for when one is living and eating for a healthy heart (to help achieve appropriate weight, a lower-fat and cholesterol status, and improved blood pressure):

• Follow an overall healthy eating pattern – include a variety of fruits, vegetables, wholegrains, low-fat or fat-free dairy products, fish, legumes and beans, poultry and lean meats (ostrich, venison).
• Reach and maintain an appropriate body weight – match energy intake to energy needs.
• Ensure a desirable cholesterol blood profile – limit foods high in saturated fats and cholesterol; substitute with unsaturated fats from vegetables, legumes, nuts and fish.
• Maintain a healthy blood pressure – limit salt and alcohol consumption; maintain a healthy body weight.
• Exercise regularly – aim for 4-5 times a week for at least 30 minutes at a time. Try to be more active in everyday activities, e.g. take the stairs and not the lift.
• Avoid excessive alcohol consumption – 1-2 glasses of wine (especially red) may actually be beneficial for your heart.
• Stop smoking.

Improving your fat profile:
Saturated fats are found in all animal products, e.g. meat, cheese, dairy, butter, cream, as well as in coconut and palm kernel oil. These increase “bad” blood cholesterol levels and should be avoided whenever possible.

The main sources of monounsaturated fats are olive oil, olives, canola oil, avocados, nuts and peanuts. These fats contain properties which lower “bad” blood cholesterol. Polyunsaturated fats are found in sunflower oil, soft margarines packaged in tubs, cod-liver oil, evening primrose oil and oily fish, e.g. mackerel, salmon and sardines. These have a neutral effect on blood cholesterol levels and should be used in moderation.

• To lower total and LDL cholesterol – decrease total fat, saturated fat and trans/ hydrogenated fat intake; eat sources of soluble fibre e.g. fruit, oat bran, oats, legumes.
• To improve HDL cholesterol – eat more mono- and poly-unsaturated fats, exercise, decrease alcohol.
• To improve triglycerides – decrease total fat intake, sugar and alcohol.

Feedback:
You asked for a healthier alternative to the traditional “boere ontbyt”. Here is my suggestion, to be eaten ideally on special occasions, but no more than once a week:

• 1-2 poached eggs OR 1-2 boiled eggs OR scrambled eggs made with skim milk.
• 2 reduced fat bacon rashers (choose shoulder or back bacon; cut visible fat away) – grilled or cooked with very little oil.
• 2 tomato halves (raw or grilled).
• 1-2 slices of wholewheat (low-GI) toast (no butter or margarine).
• 1 Tbsp of baked beans.
• Use very little olive or canola oil in the pan (2 tsp). If the bacon starts sticking, add a little water.
• 1 cup of tea with low-fat milk.
• ½ cup of fruit juice (dilute with water if possible).

A basic meal plan for a male with low activity levels, requiring weight maintenance:

Breakfast	Morning snack	Lunch	Afternoon snack	Supper	TOTAL
2 starches	1 starch	3 starches	1 starch	3 - 4 starches	10 - 11 starches
0 - 1 protein		1-2 proteins		2 proteins	4 proteins
1 dairy	1/2 - 1 dairy		1/2 - 1 dairy		2 - 3 dairy
1 fruit	1 fruit		1 fruit		3 - 4 fruits
		2 vegetables		2 - 3 vegetables	4 - 5 vegetables
		2 fats		2 fats	4 fats

* These are suggestions and can be changed to suit your preferences, e.g. you may prefer more starches with breakfast and lunch rather than at snacktime.

SAMPLE MENU

Meal	Option 1	Option 2	Option 3
Breakfast	- 2 Weetbix or 1 and a 1/2 cups of high-fibre, low-fat cereal, e.g. All-Bran Flakes, Special K, Hi-Fibre Bran, Pronutro - 1 cup of low-fat/fat-free milk or 1 small tub of yoghurt (fruit/plain) - 1 fruit OR 1/2 glass of fruit juice - Tea or coffee with low-fat milk	- 1 cup of cooked porridge (oats mixed with oat bran) - 1 cup of low-fat (2%) milk (for cereal & to drink) - 1/2 cup of orange juice - Tea or coffee with low-fat milk	- 2 slices of wholewheat (low-GI) bread - 2 slices of low/medium fat cheese (1 matchbox size) and Oxo - 1 small tub of yoghurt - 1 fruit - Tea or coffee with low-fat milk
Lunch	- 2 slices of wholewheat (low-GI) bread - 1-2 boiled eggs - Oxo or Marmite spread thinly on the bread - Slices of tomato and shredded lettuce	- 2 slices of wholewheat (low-GI) bread - 90g of shredded chicken (no skin) - 1 Tbsp of low-fat mayonnaise - Salad (tomato, lettuce, cucumber)	- 1 large baked potato - 2-3 Tbsp (1/2 tin) tuna in brine - 1 Tbsp low-fat mayonnaise - Mixed salad
Supper	- 1 cup of cooked rice - 90g grilled skinless chicken breast - Mixed vegetables OR stir-fry chicken strips with mixed vegetables - Green salad - 1 Tbsp of olive or canola oil	- 1 cup of cooked pasta - 2 Tbsp Bolognaise sauce made with lean beef or ostrich mince - Carrots - Broccoli - 1 Tbsp olive or canola oil	- 2 medium baked potatoes - 80g grilled fish - Cooked spinach - Cooked cauliflower - 1 sliced tomato - 2 tsp of olive or canola oil
Mid-morning snack	- 1 slice of wholewheat (low-GI) toast or 3 high-fibre crackers (Provita) with a thin spread of fish paste, Oxo, Marmite, low-fat or fat-free cottage cheese - 1 fruit	- 1 small tub of fat-free/low-fat yoghurt - 1 Tbsp Jungle Oats bran mixed into yoghurt (optional) - 1 small banana	- 1 small OR 1/2 large bran/banana muffin - 250ml low-fat/fat-free milkshake - 1 small apple
Mid-afternoon snack	- 250ml low-fat or fat-free drinking yoghurt - 1 small banana	- 1 handful of nuts and raisins - 1 fruit	- 1 Jungle Oats Berry bar - 1 fruit
Drink at least 6-8 glasses of clean water daily. (This may be more in summer or if you're exercising more.)

Although, the above sample menu has measurements for some of the portions, I suggest you follow this simple guide to help you visualise portion sizes of the various food groups without having to measure any of the food:

• CARBOHYDRATES/ STARCH: Approximately the size of your fist; a tennis ball; 1 slice of bread.
• PROTEIN: The palm of your hand (no thicker than the ‘pinky joint’); 1-2 packs of cards.
• FRUIT: Size of your fist; a tennis ball.
• VEGETABLES: Unlimited.
• DAIRY: 1 cup of low-fat milk; 1 small tub of low-fat/ fat-free yoghurt; matchbox block of cheese; 250-300ml drinking yoghurt.
• FAT: 1-2 level teaspoons oil (canola/ olive), ‘lite’ margarine, butter, peanut butter, regular mayonnaise; 1 tablespoon of reduced oil/ ‘lite’ mayonnaise and salad dressing; ¼ medium avocado; any spreads ‘thinly’ on breads/ crackers; 1 small handful of nuts or seeds.

Understanding food labels:
Processed foods and commercially prepared foods tend to be high in hidden and unwanted fats, sugar and salt. It is helpful to read food labels in order to control the content of the food purchased.

TERM	WHAT IT MEANS
Fat free	Less than 0,5g fat per 100g (solids) Less than 0,5g fat per 100ml (liquids)
Low fat	Less than 3g fat per 100g (solids) Less than 1,5g fat per 100ml (liquids)
Low in saturated fat	1g or less per serving, and not more than 15% of total calories from saturated fatty acids Less than 1,5g per 100g solids Less than 0,75g per 100ml liquids
Reduced fat	At least 25% less fat per serving than regular version of the food
Cholesterol free	Less than 5mg cholesterol per 100g/100ml AND less than 1,5g saturated fat per 100g solids OR 0,75g saturated fat per 100ml liquids
Low cholesterol	Less than 20mg per 100g solids Less than 10mg per 100ml liquids
No added sugar	Free of sucrose (cane sugar)
Sugar free	Less than 0,5g per serving
Sodium free	Less than 5mg per serving
Low sodium	140mg or less per serving
High in fibre	5g fibre or more per serving
Good source of fibre	2,5 - 4,9g fibre per 100g

Ultimately, permanent lifestyle changes, with diet as the cornerstone, are pivotal to maintaining cardiovascular health.

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