Medical Nutrition Therapy for Heart Failure. WHY The NAS Diet is NOT Enough

Transcription

1 Medical Nutrition Therapy for Heart Failure WHY The NAS Diet is NOT Enough Kathleen Cowden, R.D. Clinical Dietitian Franciscan - St. Francis May 2012 OBJECTIVES Explain the benefits of Medical Nutrition Therapy for Heart Failure Provide Education Resources to Improve Compliance Provide Options to Provide a Therapeutic Diet 1

2 HF It s A Worse Prognosis than Many Common Cancers Maryrose Cowden 2000 Maryrose Cowden 2003 STOP SALT STUDIES & FINDINGS AHA National Institute for Heart Lung & Blood NIH National Institutes of Health 2010 US Dietary Guidelines Heart Failure Society of America WHAT S the HOLD UP 2

3 TIME FOR HISTORY For several million years, humans ate a diet containing very small amounts of salt (<.5 gm/d) Only 5,000 years ago the Chinese discovered salt could preserve foods peak reached 1870 However the invention of the deep freezer & refrigerator, salt was no longer required for preservation of food. Salt intake had been DECLINING until our diets turned to consumption of highly salted process foods 5 8 gram Sodium Intake This large increase is relatively recent in evolutionary terms. It presents a major challenge to the physiological systems to excrete these large amounts of salt through the kidneys Consequence: rise in blood pressure, increase risk of stroke, heart attack, heart failure & renal disease 3

4 Why Do We Need to Change Advances in Medical Therapy, the prevalence & mortality rate related to CAD have stabilized over the last 10 years This along with an aging population has contributed to an increase in the incidence & prevalence of HEART FAILURE and To increase in HF Hospitalization & Mortality 2010 U.S. Dietary Guidelines SEVEN CORE MESSAGES 1. Enjoy your foods, but eat less 2. Avoid oversized portions FOODS TO INCREASE 3. Make ½ your plate fruits & vegetables 4. Make at least ½ your grains WHOLE 5. Switch to fat-free or low-fat milk FOODS TO REDUCE 6. Compare sodium in foods choose lower numbers 7. Drink water instead of sugary drinks 4

5 What is Your HF IQ? Name 4 treatments to controlling symptoms of HF: How much Na in ½ c Cottage Cheese? How much Na in 1 c canned soup? How much Na in 1 oz American cheese? How much Na in 1 saltine? How much Na in 1 LS saltine? Heart Failure Society of America EASY AS: Stop Adding Salt to your Food. 2. Adapt your preferred foods to low-sodium versions. 3. Pick foods naturally low in sodium 4. Learn to read food labels 5

6 Naturally Low Sodium Foods Beans, peas, rice, lentil, pasta (dried, fresh, cooked w/o salt) Fruits (fresh, frozen, canned) Hot cereals & some Cold Cereals Coffee / Tea/ Regular & Diet Pop Yogurt Vegetables (fresh or plain frozen) Milk Meats, fish, & poultry (fresh) High-Sodium Foods Meats: Bacon, Bologna, Breaded (frozen) meats, Hot dogs, Knockwurst, Pot pies (frozen), Tuna, salmon,chicken (canned regular) Vegetables: Pickles, Pizza & spaghetti sauce, Tomato sauce & juice, regular canned vegetables Milk: Cottage cheese, american cheese, buttermilk Starches: baked beans, batter mixes, biscuit & pancake mixes, corn & potato chips, macaroni & cheese, popcorn, stuffing mixes, frozen waffles Other: broth & bouillon cubes, canned soups 6

7 Processed Foods 75% of salt consumed comes from processed foods 10 Foods Provide 50% of Sodium Eaten in U.S. Bread Cold Cuts, Cured Meats, Poultry Pizza, Soups, Sandwiches, Cheese Savory Snacks, Meat Mixed Dishes, Pasta Mixed Dishes SOME FOOD INDUSTRIES ARE ON BOARD Japan, Finland & UK has enlisted food industries help With Salt-Reduction Programs 7

8 Define Low Sodium < 140 mg per serving ½ c LS Spaghetti Sauce 30 ½ c Reg Spaghetti Sauce 560 ¾ oz American Cheese 250 ¾ oz Swiss Cheese 50 1 c Canned Soup c LS Can Soup 100 GFS Hashbrowns or Fries Nutrigrain bar T Litehouse Poppyseed 68 St Francis Nice Technology At Your Request Dining A Balancing Act 8

9 Modification of a FEW Foods 2 gm Na St Francis Hospital Regular St Francis Mod. Mash Potato 100 Mash Potato 460 Pot Roast 210 Pot Roast 210 LS Green Beans 5 Green Beans 350 Bread & Marg 160 Dinner roll & Marg c milk c milk 124 Cherry Cobbler 206 Chocolate Cake 650 TOTAL 806 TOTAL

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11 ITEM INFORMATION Item Qty: 1.00 Item Desc: Mashed Potato Item Cost:.19 One Portion contains the following nutritionals: 460 mg Sodium 22 gm Carbohydrate 100 Calories 4 g Fat 370 mg Potassium 3 mg Vitamin C 1.5 Carbohydrate Count 2 g Total Dietary Fiber 2 g Protein 11

12 ITEM INFORMATION Item Qty: 1.00 Item Desc: Modified Mashed Potato Item Cost:.19 One Portion contains the following nutritionals: 100 mg Sodium 19.8 gm Carbohydrate 98 Calories 1 g Fat 370 mg Potassium 7 mg Vitamin C 1.0 Carbohydrate Count 1.7g Total Dietary Fiber 2 g Protein ITEM INFORMATION Item Qty: 1.00 Item Desc: LS Green Beans Item Cost:.19 One Portion contains the following nutritionals: 6 mg Sodium 4 gm Carbohydrate 20 Calories 0 g Fat 85 mg Potassium 3 mg Vitamin C 2 g Total Dietary Fiber 1 g Protein 12

13 ITEM INFORMATION Item Qty: 1.00 Item Desc: Green Beans Item Cost:.20 One Portion contains the following nutritionals: 380 mg Sodium 4 gm Carbohydrate 20 Calories 0 g Fat 75 mg Potassium 3.3 mg Vitamin C 2 g Total Dietary Fiber.5 g Protein FLUID RESTRICTIONS The more fluid carried in blood vessels, the harder the heart must work to pump excess fluid through the body. Fluid Definition: Any thing that is liquid at room temperature 13

14 I.D. Those on Fluid Restriction COUNTS Preportioned Size Fluid Content ½ c Ice cream / Sherbet 4 oz 60 ml Frozen ice, Jello ½ c 4 oz 120 ml 1cup milk 8 oz 240 ml 6 oz soup 6oz 180 ml ½cjuice 4 oz 120 ml Creamer ½ oz packet 15 ml Salad dressing ½ oz packet 15 ml Syrup packet 1.25 oz packet 45 ml Coffee / Tea Measure Mug content ml RESOURCES SHARE RESOURCES SIZED RIGHT! Calorieking.com MrsDash.com dick@dicklogue.com AHA 14

15 Traditional Cookout ½ c Baked Beans hot dog on bun 750 Catsup, mustard, relish 180 ½ c potato salad 600 Brownie Potato chips 350 TOTALS 2570 Healthy Cookout ½ Homemade Baked Beans 34 3 oz hamburger on bun 260 Lettuce, tomato, mayo (1 T) 80 1c fruit salad 10 Sherbet 44 ½ c waldorf salad w/ mayo 123 TOTALS 551 FOOD IS PERSONAL Food is a source of pleasure Food is happy memories, traditions, holidays Food is a Health Connection Change a person s diet & you are getting personal! 15

16 DEPRESSION Depression is 4-5 X s more common in patients with HF as in the general population Depression predicts worse prognosis Depressive symptoms linked to non-adherence Patients with depressive symptoms are more likely to be non-adherent to the low sodium diet LIBERALIZING THE DIET IS NOT THE ANSWER Chronic Disease = Grief 7 Stages 1. Shock & Denial 2. Pain & Guilt 3. Anger & Bargaining 4. Depression 5. Upward Turn 6. Reconstruction 7. Working Through it 16

17 EDUCATION & MORE EDUCATION Liberlizing the Diet is not the Key to Happiness Educate your Staff, Patients & Families 17

18 DASH DIET 18

19 The Families & Fast Food Fried Chicken Mash Pot w/gravy 297 Sm hamburger 506 Sm cheeseburger 743 Lg cheeseburger 1,220 Chef Salad 850 Bean Burrito 922 Taco 273 mg Enchilada 1,260 Taco salad 1,368 Arby s rst beef Pizza 1 slice subway Your To-Do List Meet Your HF Residents Know the Sodium Content of Every Single Thing You Serve Educate Staff It s not Bad It is Different Make some Simple Modifications Start with the DASH Diet or US Dietary Guidelines 19

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