DIETARY GUIDELINES

2015-2020 DIETARY GUIDELINES CARDIAC AND PULMONARY PATIENTS Abbie Brekken, RD, LD Kathryn Magnuson, MS, RD, LD DIETARY GUIDELINES 2015-2020 Inform the development of Federal food, nutrition, and healthy policies and programs Primary audience: policymakers, nutrition and healthcare providers Critical tool for professionals to help Americans to make healthy choices in their daily lives to help prevent chronic disease and enjoy a healthy diet Encourage healthy eating patterns and focus on disease prevention DIETARY GUIDELINES 2015-2020 Terms To Know: Eating Pattern: the combination of foods and beverages that constitute an individual s complete dietary intake over time. For example the USDA Food Patterns and the Dietary Approaches to Stop Hypertension (DASH) Eating Plan Nutrient Dense: a characteristic of foods and beverages that provide vitamins, minerals, and other substances that contribute to adequate nutrient intakes or may have positive health effects, with little or no solid fats and added sugars, refined starches and sodium. These foods and beverages are in forms that retain naturally occurring components, such as dietary fiber. Variety: a diverse assortment of foods and beverages across and within all food groups selected to fulfill the recommended amounts without exceeding the limits for calories and other dietary components. 1

DIETARY GUIDELINES 2015-2020 Summary of Guidelines : 1. Follow a healthy eating pattern across the lifespan 2. Focus on variety, nutrient density, and amount 3. Limit calories from added sugars and saturated fats and reduce sodium intake 4. Shift to healthier food and beverage choices 5. Support healthy eating patterns for all DIETARY GUIDELINES 2015-2020 Healthy Eating Pattern Includes: A variety of vegetables from all the subgroups dark green, red and orange, legumes (beans/peas) Fruits especially whole fruits Grains, at least half of which are whole grains Fat free or low fat dairy, including milk, yogurt, cheese, and/or fortified soy beverages A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes, nuts, seeds and soy products Oils such as canola and olive oil DIETARY GUIDELINES 2015-2020 Healthy Eating Pattern Limits: Saturated and trans fats, added sugars and sodium Consume less than 10% of calories per day from added sugars Consume less than 10% of calories per day from saturated fats Consume less than 2300 mg per day of sodium If alcohol is consumed, it should be consumed in moderation up to one drink per day for women and up to two drinks per day for men 2

DIETARY GUIDELINES 2015-2020 Natural Sugars Fruits (fructose) Vegetables Potatoes, corn, peas, squash Milk (lactose) 100% fruit juice (up to 1 cup daily) Added Sugars Sugars and syrups added to food/beverages during processing Candy, cake, cookies, ice cream, sweetened yogurt, flavored milk, energy/sports drinks, soda, fruit juice from concentrate, sweetened breakfast cereals, instant hot cereal 10 ounce can of soda contains 10 teaspoons sugar! MYPLATE: WWW.CHOOSEMYPLATE.GOV/ EAT RIGHT WITH MYPLATE Make half of the plate fruits and vegetables Make at least half of the grains whole Switch to fat-free or low-fat milk Vary protein choices seafood, nuts, beans (legumes), lean meat, poultry, eggs Cut back on sodium and empty calories from solid fats and added sugars Enjoy food but eat less avoid oversized portions Be physically active goal is 150 minutes per week for adults 3

CARDIAC GENERAL NUTRITION GUIDELINES Focus on fruits and vegetables Go for grains Lean towards low-fat dairy Choose lean meats Heart-healthy oils and fats Limit sodium FRUITS AND VEGETABLES Aim for 2 cups fruit and 2.5 cups vegetables per day Choose whole fruits and 100% fruit juices Choose fresh or frozen vegetables (without cream, butter, seasonings or cheese sauces) and low-sodium vegetable juices 4

GRAINS Eat 6 servings per day Make at least half of the servings whole grains Check the ingredient label; the first ingredient should contain the word whole or packages that state 100% Whole Grain 100% whole wheat bread, English muffins and tortillas; barley, bulgur, quinoa, oatmeal, whole wheat pasta, brown rice DAIRY Aim for 3 cups per day Skim or 1% milk Low-fat yogurt/frozen yogurt Fat-free or low-fat cheese, sour cream and cottage cheese Limit intake of whole milk, cream, whole-milk cheeses PROTEIN Recommend no more than 6 ounces cooked lean meat, poultry, fish or seafood per day Fish high in omega-3 fatty acids salmon, mackerel, lake trout, herring, sardines, albacore tuna Lean beef: round, tip, loin, flank Lean pork/lamb: loin chops, roasts, butterfly chops, tenderloin Chicken or turkey without skin Wild game Beans, lentils, peas, low-fat tofu Eggs 5

TYPES OF FAT Saturated Fat Raise LDL cholesterol levels Solid at room temperature Animal products Butter, cheese, whole milk, ice cream, fatty meats Vegetables products Coconut, palm, and palm kernel oil Trans Fat Raise LDL cholesterol levels, lower HDL cholesterol Commercial baked goods Occur naturally in meat and milk, less harmful -Examples: Shortening, partially hydrogenated vegetable oil and hydrogenated vegetable oils TYPES OF FAT Unsaturated Fat (Poly and Mono) Lower LDL cholesterol levels Liquid at room temperature Olive, peanut, canola, corn, safflower, soybean, sunflower, sesame seed oils Avocados, seeds, nuts Omega-3 Fatty Acids Lower triglyceride levels, slow development of plaque in arteries, and may lower blood pressure slightly Flaxseed, flaxseed oil, canola oil, walnuts, fatty fish such as salmon, mackerel, herring, and trout AHA recommend to eat at least two servings of fish (particularly fatty fish) per week Fish oil supplements FATS AND OILS Limit to 5 teaspoons per day Recommended Vegetable oils: olive, canola, peanut, sunflower, safflower, corn, flaxseed, sesame Margarines: spray, tub or squeeze with one of the vegetable oils listed as the first ingredient (no trans fat) Salad dressing/mayonnaise made with recommend oil Spreads with stanols/sterols Use sparingly Solid fats and shortenings: butter, lard Chocolate, coconut oil, fried foods, heavy whipping cream 6

COOKING METHODS AND EATING OUT Recommended to prepare without added saturated and trans fat Baked, broiled, grilled, steamed, roasted, poached Avoid breaded, battered, fried, in butter or cream sauce Salad dressings and sauces serving on the side Substitute lemon juice or vinegar and oil for salad dressings Order plain chicken breast and hamburger and skip bacon, cheese and sauces Split a meal SODIUM Limit to 2,000 mg per day for those with cardiovascular disease Patients with heart failure limit to 1,500-2,000 mg per day Hide the salt shaker and limit/omit amount of salt added in cooking and baking Recommended: fresh/frozen meats, vegetables and fruit, unsalted snack foods, low-sodium soups, oil, vinegar and lemon juice Sodium-free seasonings: fresh/dried herbs, Mrs. Dash, pepper, garlic/onion powder Rinsing canned beans and vegetables Cooking from scratch; limit intake of boxed stuffing, rice, and potato mixes CAFFEINE According to the American Heart Association: Still under study to determine whether high caffeine intake increases risk of coronary heart disease Many studies have been done to see if there is a direct link between caffeine, coffee drinking and coronary heart disease, however results are conflicting Moderate coffee drinking (1-2 cups per day) does not seem to be harmful 7

NUTRITION LABEL - Serving Size - Total Fat - Saturated fat - Unsaturated fat - Trans fat - Sodium - <140 mg per serving is considered a low sodium option PULMONARY GENERAL NUTRITION GUIDELINES 1. Maintain a healthy weight. 2. Eat a balanced diet with variety. 3. Focus on getting enough calories, protein, vitamins, and minerals. +Presence of inflammation may increase the amount of calories the body burns at rest. 8

HEALTHY WEIGHT Extra body weight can make it more difficult to breathe Too little body weight can put you at greater risk for infection and can cause you to fatigue very quickly WHAT IS A HEALTHY WEIGHT Can be different for everyone Health care providers often use BMI Normal BMI: 18.5-24.99 Current research shows that pts with chronic respiratory disease should maintain BMI of 21-25 Low BMI with chronic respiratory disease is not desirable. Those with low BMI may be at higher risk of death and have lower lung function and more SOB BMI does not take into account muscle and bone mass, however can be an indicator of disease risk or mortality risk CHRONIC RESPIRATORY DISEASE AND NUTRITION What Can Hinder Nutrition and Balance? Medications Loss of appetite, weight changes, upset stomach Shortness of breath Fatigue, weakness Task of cooking and shopping 9

ADEQUATE NUTRITION IS KEY Calorie and protein needs vary from person to person Individuals with Chronic Respiratory Disease are at risk for inadequate nutrition. Without enough calories and protein, the body burns muscle for energy. This weakens the muscles, including the those used to breath. With less muscle, weight loss, and decreased ability to exercise and move around can result. CARBOHYDRATES A diet high in simple carbohydrates produces more carbon dioxide, making breathing more difficult Simple carbohydrates - limit Complex carbohydrates - encourage METABOLISM OF CARBOHYDRATES Your body changes food to fuel= metabolism. Oxygen and food go in. Carbon dioxide and energy go out. Carbon dioxide is the waste product and must be excreted. Metabolism of carbohydrates produces the most CO2 for the amount of oxygen used, hence making the lungs work the hardest. Fat produces the least amount of CO2. 10

LIMIT SIMPLE CARBOHYDRATES: Sugar Syrups Honey Regular soda Sweetened Juice Drinks Jams and Jelly Sugar Cereals Sweet deserts, pastries Candy Eat desserts sweetened with fruits instead of sugar. INCLUDE HEALTHY COMPLEX CARBOHYDRATES Cooked Cereals, Unsweetened Cereals Breads Bagels Rice Pasta Potatoes and Squash Corn and peas Muffins, Pancakes, Waffles CHOOSING WHOLE GRAIN CARBOHYDRATES Look for 100% whole grain on label; Multi-grain does not mean whole grain. Whole grain is more nutritious than refined (has antioxidants!). Whole grain has fiber= cholesterol, weight management. Examples of whole grains: 100% whole wheat Oats and oatmeal Quinoa Corn Barley Brown and wild rice Buckwheat, bulgur, kamut, amaranth, millet, spelt, and teff 11

EAT PLENTY OF PROTEIN The body needs protein to build muscles and fight infection. Eat protein with meals and snacks daily. Protein can help one feel full and satisfied. PROTEIN SOURCES Meats: Beef, Pork, Veal Poultry: Turkey, Chicken, Eggs Seafood: Fish, Shrimp, Crab Dairy: Milk, Cheese, Yogurt, Cottage Cheese Nuts: Peanut butter, Almonds, Cashews Beans (Legumes): Dried and canned, Lentils Other: Tofu, Soybeans, Peas PROTEIN SUPPLEMENTS If weight loss is a goal for specific individual, replacing one meal a day with a protein supplement + fruit or vegetable can be considered Protein supplements should be high protein (approximately 20 grams) and low carbohydrate (~15 grams) Examples: Body Fortress (Whey protein supplement) EAS Muscle Milk Light Pure Protein 12

SUPPLEMENTS Boost Ensure Generic Carnation Instant Breakfast Protein Bars Rice, Whey or Soy protein shakes and powders. + Small, frequent amounts of supplements are preferred to avoid SOB and fullness. DAIRY PRODUCTS According to research, dairy products are unrelated to mucus production. Some do perceive increased mucus production related to mouth feel. Dairy products are important sources of calcium and vitamin D= Individuals with Chronic Respiratory Disease are at risk for fractures and osteoporosis. Possible use of steroids can decrease bone mineral density and increase risk of fractures (conflicting evidence). DIARY CONTINUED Sources: Milk= chose low fat options. Yogurt= low fat or Greek. Added benefit of healthy bacteria for your general gut health. Cheese and cottage= choose low fat and/or low sodium. Alternative Calcium and Vitamin D Sources: Lactaid milk Almond, soy, hemp, rice (remember some are not good protein sources; some have MORE calcium and vitamin D than regular milk!). Supplements= as directed by your doctor. 13

HEALTHY VS UNHEALTHY FATS: Saturated and Trans fats= limit Unsaturated (mono & poly)= encourage Omega 3 s= encourage SATURATED AND/OR TRANS FAT SOURCES: Butter and Margarine and Spreads Cheese, Sour Cream, Mayo Whole Milk and Ice Cream Fried foods Commercially Baked Products Frosting Fatty Meats UNSATURATED FATS Oils: Canola, Olive, Vegetable, Peanut, Safflower Salad Dressings Nuts and Seeds Nut butters Avocado and Guacamole 14

LIMITING SODIUM Too much sodium can cause fluid retention that can make breathing more difficult Avoid processed foods, salty snacks and canned foods Avoid adding salt to foods NOT GETTING ENOUGH NUTRITION Chronic Respiratory Disease puts one at risk for inadequate nutrition Nutritional needs are increased when patients have decreased appetite or fatigue as SOB interfere with food intake HEALTHY EATING Eat 3 balanced meals daily Planning snacks Fresh, minimally processed foods Limiting high calorie, high fat, high sodium convenience foods Choose MyPlate 15

REFERENCES United States Department of Agriculture, http://www.choosemyplate.gov/ American Heart Association, http://www.heart.org/heartorg/ Academy of Nutrition and Dietetics Nutrition Care Manual Patient Education Catalog, www.allinahealth.org American Thoracic Society, http://www.thoracic.org/copd-guidelines/for-healthprofessionals/management-of-stable-copd/nutrition/assessment-of-bodycomposition.php THANK YOU!!! 16