Delivering the Diet Information Your Patient Needs April 6, 2019 Lynda Hesse RD
Dietary Assessment Tools Dietary assessment help clinicians formulate an individualized treatment plan for patients Self Assessment Tools Rate Your Plate AACVPR recommending new assessment tool/tools Promote tracking dietary changes DRA: A New Leaf Developed by UNC Low-literacy format, paper survey Provides total nutrition score and discrete score for food groups Nutra-Screen Assessment Tool On-line tool, assess overall diet quality and saturated fat intake Patient summary tool and breakout reports Low-literacy format
Changes to Cardiovascular Nutrition Primary Focus Limiting Dietary fat Limiting Saturated fat Limiting Dietary cholesterol Broad Focus Heart healthy eating patterns
Cardiovascular Nutrition Dash Diet Therapeutic Lifestyle Change Mediterranean Diet Plant based - Ornish
DASH Eating Plan Based on 2 key studies conducted by the National Heart, Lung and Blood Institute, conducted at 4 medical centers Follows heart healthy guidelines to limit saturated fat, total fat and cholesterol Rich in fruit and vegetables, low fat or non fat dairy products, whole grains Include nutrient rich food high in minerals, potassium, calcium and magnesium, protein and fiber Limit Sodium intake Dramatic results within 2 weeks of starting
DASH EATING PATTERN Encourage 30 min. of moderate physical activity on most days Rich in fruits, vegetables, fat-free/low-fat milk and milk products, whole grains, fish, poultry, beans, seeds, and nuts
Dash Diet Slowly increase intake of fruits and vegetables strive for 8 or more per day ½ cup of cooked vegetables or fruit 1 cup raw vegetable or fruit Two to three servings of non-fat or low-fat dairy products 8 oz skim milk 6 oz fat-free or low fat yogurt 1 ½ oz fat-free or low-fat cheese Substitute dried beans, peas, legumes, nuts and seeds as meat substitutes 4 to 5 times per week
Dash Diet Choose whole grain products 6 to 8 servings per day 1 slice bread, 1/3 cup cooked pasta, 1/3 cup cooked rice, ½ cup cooked cereal Keep meat, fish and poultry servings small and low in fat, 6 ounces or less per day Small amounts of liquid oil, max. 2 to 3 servings per day (1 tsp. oil, 2 tbsp salad dressing) Limit refined grains, sweets and snacks
Dietary Guidelines for Sodium 2300 mg per day - Tolerable Upper Intake Level (UL) The highest daily nutrient intake level that is likely to pose no risk of adverse health effects to almost all individuals in the general population. <1,500 mg Adequate Intake Level (AI) Based on the amount that is needed to meet the sodium needs of healthy and moderately active individuals. Recommended for those 51 and older, African American, or have hypertension, diabetes, or chronic kidney disease
Where is the sodium An adult needs about 500mg of sodium per day The typical American diet contains 3-7 g per day
Sources of Sodium
Therapeutic Lifestyle Changes Major recommendations, diet to lower cholesterol, exercise, weight loss if needed, stop smoking, reduce stress TLC Diet Saturated fat: < 7% of total calories Polyunsaturated fat: < 10% of total calories Monounsaturated fat: < 20% of total calories Carbohydrate: 50 to 60% of total calories Soluble fiber: minimum of 5 to 10g per day Cholesterol: < 200 mg per day Total calories: balance calories in and calories burned to reach and stay in a healthy weight * Avoid trans fat
TLC Food Group Lean meat, poultry, fish, dry beans, peas No more than 5 oz a day (substitute ¼ cup dry beans or peas for 1 oz meat) Eggs No more than 2 yolks a week (1 whole egg), egg whites or substitutes are not limited Low-fat milk and milk products 2 to 3 servings a day Fruits 2 to 4 servings a day Vegetables 3 to 5 servings a day Bread, cereal, pasta, rice and other grains At least 6 per day Sweet and snacks (within calorie limit) Choose snacks that are low in fat and are made with unsaturated fat
Soluble or Viscous Fiber Types and Sources Beta-glucan Grains (oats, rye, barley) Pectin (sugar acids) Fruits, vegetables, legumes, sugar beets Natural gums Seeds (guar and locust bean), trees (gum acacia), seaweed (carrageenan), microbes (xanthan gum) Inulin Chicory, onions, wheat, Jerusalem artichokes; increasingly added to processed foods Source: Tungland BC, Meyer D. Nondigestible oligo- and polysaccharides (dietary fiber):
Soluble or Viscous Fiber Top 5 Foods Beans Oat Brussel sprouts Oranges Flax Seeds
Comparison of Fats
Saturated Fat Foods highest in saturated fat Fatty Beef, Lamb, Pork Poultry with skin Beef Tallow Lard and Cream Butter and Cheese Whole milk and reduced fat dairy products (2 %) Tropical oils coconut, palm oil
Mediterranean Diet No single Mediterranean diet plan lifestyle Mostly plant based, fruit, vegetables, potatoes, whole grains, beans, nuts and seeds Fish and seafood about 2 times per week Yogurt, cheese, poultry and eggs in small portions Good fats - olives, extra virgin olive oil, nuts, sunflower seeds, avocadoes Rich in herbs and spices Fruit for dessert
Mediterranean Diet
Ornish Program Four equally weighted elements Exercise - cardio and strength training Stress management - gentle stretching, progressive deep relaxation, imagery, breathing techniques, meditation Group Support - psychosocial support Nutrition - whole food plant based, naturally low in fat and refined carbohydrates
Plant Based Ornish Whole food, plant based, abundant in nutrient-rich foods Protein - 55 to 65g Animal protein - no meat, poultry, fish or seafood, limited amount of dairy and egg whites Fat - < 25 g fat Refined carbohydrates - Limited to < 2 servings with < 25 g of added sugars (less is better) Cholesterol - Limit to < 10 mg per day Calories - unrestricted Sodium - < 2300mg Caffeine - Coffee < 1 cup or < 2 cups decaf, < 2 cups tea or green tea Alcohol - 0 to 1 servings Daily supplements - MVI w/ 100% RDA without iron, 2 to 3 g Omega 3
Plant Based Ornish Whole Grains and Starchy Vegetables 6+ servings per day Vegetables 3+ servings per day Fruit 2 to 4 servings per day Protein 3 to 5 servings per day Nonfat Dairy 0 to 2 servings per day Refined Carbohydrates and Nonfat Sweets 0 to 2 servings per day Low-fat food 0 to 3 servings per day Alcohol 0 to 1 serving per day
Nutrition Therapy/Pulmonary Patients Eat whenever you are hungry Smaller more frequent meals/snacks Drink fluid throughout the day Drink high-calorie, high-nutrient beverages Choose nutrient dense food and add heart healthy oils, nuts and nut-butter to meals and snacks Eat plenty of high protein food throughout the day Choose high fiber food Choose nutrient dense food filled with vitamins and minerals Use enriched grains/cereal
Don t Smoke Limit your alcohol intake to < 1 per day 12 oz beer 5 oz wine 1.5 oz liquor Reduce stress Control your weight Take your medication Optimize diet and exercise
Common Thread Focus on overall diet quality, rich in nutrient dense whole foods Fruit Vegetables Whole grains Nuts and seeds Vegetarian protein sources (include more) Fat free or low fat dairy products
Front of the Label - Sodium Sodium Free <5 mg per serving Very Low Sodium <35 mg per serving Low Sodium <140 mg per serving Light/Lite in Sodium 50% of the original product Reduced Sodium 25% of the original product Lightly Salted 50% less sodium than normally added No salt added or unsalted No salt added during processing
Front of the Label - Calories and Sugar Calories Calorie Free Less than 5 calories Low Calorie 40 calories or less Reduced Calorie At least 25% less calories than the original product Sugar Sugar Free Less than 0.5 grams sugar and no ingredient that is a sugar Reduced Sugar or less sugar At least 25% less sugars than the regular product No added sugar No sugar or sugar containing ingredient added during processing or packaging
Front of the Label - Fat Fat Fat Free Less that 0.5g and no ingredient that is fat Low Fat 3g of fat or less (not more than 30% of calories from fat) Reduced fat or less fat At least 25% less fat than the regular product Low in saturated fat 1g or less saturated fat and 15% less of the calories coming from saturated fat Lean Less than 10g of fat, 4.5g of saturated fat and 95mg of cholesterol Extra Lean Less than 5g of fat, 2g of saturated fat and 95mg of cholesterol Light or (Lite) At least 50% less fat than the regular product
Front of the Label Cholesterol Cholesterol Cholesterol Free Less than 2 mg of cholesterol and no ingredients that contain cholesterol Low cholesterol 20 mg of cholesterol Reduced cholesterol At least 25% less cholesterol than the regular product
Front of the Label - Fiber Fiber High Fiber 20% or more of the daily value for fiber Good Source of Fiber 10 to 19% of the Daily Value for Fiber
Back of the Label
Label Simplified Free Food has the least possible amount of that specific nutrient Very Low or Low Food has little more than the food labeled free Reduced or Less Food has 25% less of the specific nutrient than the original product Light or Lite Food has 50% less than the original product Back of the Label 5% of the daily value is low and 20% of the daily value is high
Lose Weight if Overweight Even small amount of weight loss 10 to 20lbs can help patients reach your goals First goal for overweight patients lose 10% of your current weight Making dietary changes and being more active can help the pounds slip away Reduce calories by 500 to 1000 per day for 1 to 2lb weight loss per week Increase physical activity Keep a food diary Be a smart shopper
What about Gluten Free Coconut Oil Butter Eggs Fad Diets Atkins, Paleo, Keto..
Make a Dash for more. Fruits, vegetables Whole grains Nonfat dairy Dried beans and peas, nuts, seeds
Keys to Success It s a lifestyle change Help patients set reasonable and measurable goals Don t fear failure, everyday is a new opportunity Experiment with new food items & recipes Seek out support
The more you change, the better your results!