A healthy diet can prevent heart disease or slow its progression. Even if you already have heart disease, it is not too late to adopt better eating habits to arrest the process of atherosclerosis - hardening of the arteries due to plaque formation - a leading cause of heart attack and stroke. Here's a review of foods to exclude and include.

Vegetables and fruits

They not only are low in calories and rich in fiber, but contain plant-based nutrients that may help prevent cardiovascular disease. The standard recommendations has been five servings a day, but recent studies indicate that the more vegetables and fruit you eat, the greater your risk reduction.  Eat fresh whenever possible to avoid additives such as salt and sugar.

Fat and cholesterol

Some fats lower your risk by reducing harmful cholesterol (LDL), while others raise risk by increasing harmful cholesterol. The good fats are monounsaturated and polyunsaturated, found in "oily" fish such as salmon, mackerel and tuna; flax and sunflower seeds; and plant-based oils such as canola, olive and sunflower. We recommend at least two to three fish meals a week. The bad fats are saturated and trans fat, found in animal products such as meat and dairy, and in some plant-based foods such as coconuts and coconut oil.

Whole grains

They are good sources of fiber, which lowers cholesterol, and can help regulate blood pressure. Whole grains are foods that leave the entire grain kernel intact. They include whole wheat bread, brown rice, oats, corn and barley. Popcorn - without all the butter and salt - is an excellent whole grain snack. Food made with refined flour strip the grain kernel of fiber and nutrients. They include white bread and white rice. Make sure you buy bread labeled "whole grain" on the package.

Protein

The most popular protein options in the United States come from meat high in saturated fat. Instead, choose low-fat options such as lean meat, skim milk, skinless poultry and tofu. Legumes such as peas, beans and lentils and nuts such as almonds, walnuts and pistachios are excellent heart-healthy sources of protein.  Avoid organ meats, egg yolks, marbled meats, spare ribs and cold cuts.

Sodium

Salt consumption contributes to high blood pressure, a major heart disease risk factor. Much of the salt in our diet is "hidden" in canned soups, processed foods (such as frozen dinners) and restaurant meals. Look for reduced sodium versions of processed food products, and ask your server to prepare your restaurant meal without salt. Keep your salt intake to less than 2,300milligrams (one teaspoon) a day, and below 2,000 milligrams if you have high blood pressure.

 Portion size

 Most people simply eat too much. One serving of pasta is about one-half cup; one serving of meat, chicken or fish is about the size and thickness of a deck of cards. Bigger portions equal more calories.

Preparation

Baking, broiling, grilling, roasting, steaming, and poaching, instead of pan-frying or deep-frying, reduce fat calories. Avoid vegetables smothered in cream sauce, and fruit canned in syrup.

 Whether eating out or at home, we encourage people to know not only the types of foods they are eating, but the sources of those foods to avoid the unknowing consumption of fat, salt and sugar. Fried food and fast food generally are not heart healthy.

Visit www.ChooseMyPlate.gov from the United States Department of Agriculture for more information about diet including heart-healthy tips and daily meal plans.

By: Dr. David Nicholson, DO, a cardiologist and practices at OhioHealth Grady Memorial Hospital.