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HEART HEALTH LIFESTYLE MANAGEMENT NUTRITION FOR MEN WITH PROSTATE CANCER TURKEY & BULGUR STUFFED PEPPERS Serves 5. Ready in 60 minutes. Recipe credit: www.ellicsrkitchen.ca Nutrition Facts Serving Size (78 g) Amount % DV Calories 00 Fat 9 g 14% Saturated 2 g + Trans 0 g 10% Cholesterol 45 mg Sodium 80 mg 16% Carbohydrate 28 g 9% Fibre 6 g 24% Sugars 10 g Protein 29 g Vitamin A 70% Vitamin C 280% Calcium 10% Iron 25% INSTRUCTIONS 1. Preheat the oven to 50 degrees F. 2. Cut the tops off the peppers, leaving the stems intact, and remove all the seeds and membrane from inside. INGREDIENTS 1lbs (454g) extra lean ground turkey 5 medium bell peppers (mixture of colours) 1 large onion, medium dice 2 cloves garlic, minced 1 carrot, grated 1 cup cooked bulgur (follow package directions) 2 tbsp parsley, roughly chopped 2 tbsp parmesan cheese, grated 1/4 cup whole grain breadcrumbs 1 1/2 cups tomato puree 2 tbsp olive oil sea salt and freshly ground black pepper (to taste) (Instructions continued on page 2)

2 TURKEY AND BULGHER STUFFED PEPPERS INSTRUCTIONS (continued from cover). Add olive oil to a large saute pan over medium high heat. Add onions, garlic and carrot and cook for about minutes or until the vegetables are soft. 4. Add the turkey to the pan and cook, breaking up the meat with a spoon. Cook for about 10 minutes or until the turkey has browned. 5. Remove from heat and fold in cooked bulgur. In a separate bowl combine the bread crumbs with 2 tbsp of parsley and 2 tbsp of parmesan. Season with a pinch of salt and pepper. 6. Fill the peppers with the turkey mixture and top with a couple tbsp. of the breadcrumb mixture. Put the tops of the peppers back on. 7. Pour the tomato puree into the bottom of a medium baking dish. Gently place the peppers in the dish. Bake for about 20 minutes or until peppers are tender when poked with a fork. Looking at the big picture, we know that heart disease and diabetes are common health concerns in men with prostate cancer. Some cancer treatments can also increase the risk of developing these health conditions. This is an important fact that is often overlooked when prostate cancer is diagnosed. A HEART HEALTHY DIET

2 The good news is that a heart healthy diet is good for prostate cancer. In other words, some of the same foods and nutrients as part of a plant-based diet (introduced in session 2) can lower the risk of other health conditions like heart disease or diabetes. Later in session 6 you will see that a plant-based diet also plays a role in lowering the risk of prostate cancer recurrence. There are several foods that are rich in vitamins, minerals, fibre and phytonutrients (various plant nutrients ) that play a role in preventing and managing heart disease. Focus on foods in the Shopping List on the following pages. Spotlight on Plant Foods Several plant foods have unique properties. Fibre found in grains such as oats and barley lowers bad cholesterol. Legumes (beans) such as soybeans and some soy products are also a source of fibre and help to lower cholesterol and lower the risk of heart disease in other ways.

A heart-healthy diet also includes limiting foods that contribute to heart disease development such as saturated and trans fats. This includes reducing mostly animal-based foods such as processed red meats (bacon, sausage, some deli meats), higher fat milk, yogurt or cheeses, ice cream and butter. Other foods, which may be from plants, are also a source of saturated and trans fats and should be eaten in moderation. This includes hard ( stick ) margarine, vegetable shortening, highly processed foods like packaged snack foods (potato chips, crackers) non-dairy creamer, baking mixes, some fast foods (French fries and chicken wings) and many baked goods (pie, cookies, crackers) that use so called hydrogenated or partially hydrogenated fats or oils. Coconut oil is a saturated fat. Although it s a different type than the saturated fat found in foods that come from animals, it s still unclear what the health effects are. For example, whether the saturated fat from coconut oil raises, lowers or has no effect on heart disease. You may have heard that cholesterol in your food is harmful to your heart. Cholesterol in food has less of an effect on cholesterol in your blood than the amount of saturated fat in your diet. That s why we are focusing on reducing saturated fat in this session. Common myths about food and heart health: Foods high in cholesterol cause heart disease Low fat diets don t work

Several lifestyle factors are important in preventing and managing heart disease. The more of these factors you do, the better it is for your health! Diet, regular physical activity, not smoking and maintaining a healthy body weight are all key things you can do to lower your risk of heart disease. Alcohol in moderation (up to 2 drinks per day) may also help lower the risk of developing heart disease or reduce the risk of death from heart disease (see Session 2 for the definition of a standard drink ). Resources: Heart and Stroke Foundation of Canada www.heartandstroke.com This website has some great resources on heart health. Check out the information under Healthy Living, which includes information on Healthy Eating, Physical Activity and Healthy Weights. Shopping List: Foods to Stock Up On Fatty fish such as salmon, mackerel, herring, sardines, trout, Arctic char Legumes such as black beans, kidney beans, lentils, garbanzo beans (chickpeas) Soybeans (cooked soybeans, roasted soy nuts and edamame) Soy-based products* (soy beverage, tofu, tempeh) Nuts such as almonds and walnuts Seeds such as ground flaxseed, chia or hemp Whole grains such as brown rice, oats, barley, quinoa, millet Fruits and vegetables (choose a variety) Recommended oils include olive, canola, grapeseed, avocado, hemp, flax *It s best to choose soy foods that are as close to their original form as possible. For example, soy patties, soy yogurt, soy sauce, etc. are highly processed and do not contain a significant amount of soy.

Heart-healthy diet tips 1. Enjoy at least 2 servings of oily fish a week 2. Start your day with whole grain bread or cereal. Use lower-fat cooking methods like baking, broiling, grilling, steaming (or use less oil when sautéing) 4. Choose vegetable oils (olive is best) 5. Choose lower-fat cuts of meat or lean poultry and try vegetarian options 6. Choose low fat dairy products such as 0% or 1% M.F. yogurt and skim or 1% milk 7. Fresh and frozen vegetables and fruit are healthy choices. Choose frozen fruit without added sugar and frozen vegetables without added salt.

Ask the Dietitian I heard a low fat diet doesn t cut the risk of heart disease. What type of diet works? Low fat diets can be effective in preventing and managing heart disease. The key is to follow a lower fat diet but to not replace fat with refined carbohydrates such as white rice, white bread, cakes and cookies. Instead, choose higher fibre grains such as brown rice, oatmeal, whole grain breads and other high fibre foods such as vegetables and fruit and legumes (beans). The Mediterranean diet is not necessarily lower fat, but is also a good choice because it includes heart healthy fats from fatty fish, plant foods such as avocado, nuts and seeds, and the variety of foods in your Shopping List. If you include more fat in your diet be sure to replace fats from animals with those from plant sources. What are processed foods? Not all food processing is bad. Some minimal processing of foods can help make nutrients more available for your body to absorb. For example, cooking whole grains and legumes (beans). A food is highly processed when ingredients such as sugars, trans fat, and salt are added in excess and when important nutrients are removed, such as fibre. This makes processed food less healthy. It s best to choose processed foods less often and try to eat foods as close to their natural state when possible. Some examples of highly processed foods are white bread, white rice, deli meats, bacon, sausage, etc. Are there supplements that are recommended to prevent or manage heart disease? When it comes to heart disease, whole foods are best. Supplements such as fish oils or other vitamin and mineral supplements haven t been shown to be effective. In some cases, there can also be a risk. For example, taking too much fish oil from capsules can thin the blood. See session 10 on Dietary Supplements.