MAKING YOUR NUTRITION
MESSAGE POSITIVE
ISCVPR ANNUAL MEETING
Kathleen Cowden, RD,CD
Franciscan – St Francis Health
April 16, 2015
Objectives
1. Participants will have a working knowledge of
the AHA Dietary Guidelines
2. Participants will verbalize approaches to
impact changes in clients eating habits
3. Participants will identify their role in putting
the healthy diet/ lifestyle message together
Ideal Cardiovascular Health is Associated
with…
•
•
•
•
Longevity
Disease-free survival
Improved quality of life
Less health care costs
The prevalence of “ideal cardiovascular
health” at present in the U.S. is. . .
A)
B)
C)
D)
0%
5%
20%
25%
“It’s simple. Of all the treatment
strategies that work for heart
disease and stroke, the best
treatment is to avoid disease
altogether.”
Clyde W. Yancy, MD
American Heart Association President
Medical Director, Baylor Heart and Vascular Institute
LET FOOD BE THY MEDICINE
HIPPOCRATES
AHA Diet
Recommendations
• EAT A VARIETY OF LOW FAT, HIGH FIBER, NUTRIENT
DENSE FOODS
• SODIUM LIMITED TO 1500 mg daily
• TOTAL FAT <25%-35 OF CALORIES (55 – 77 gms)
• LIMIT SATURATED FAT TO < 7%
• CALORIES TO ATTAIN & MAINTAIN A HEALTHY
WEIGHT
Recommendations
(based on 2000 calorie/day diet)
-
Fruits and vegetables – 4 ½ cups or more per day
Fish – 2 or more 3.5 ounce servings per week (oily)
Fiber-rich whole grains –> 3 (1 ounce) servings /day
Beans, Seeds, Nuts – 4 or more servings / week
Sweetened Beverages – Limit to 36 oz / week
Processed Meats – Limit to 2 (2 oz servings) / week
Let’s Pick The Recommendations Apart
• Attain & Maintain a Healthy Weight
BMI = RISK FACTOR FOR CVD
OVERWEIGHT = BMI 25-29.9 = 33% OF
ADULTS
OBESE – BMI > 30 = 34% OF ADULTS
Sounding the Alarm
Frightening rise in obesity holds deadly implications for health.
OBESITY TRENDS
AMONG U.S. ADULTS
1990-2008
1990
1998
2008
Out-of-control trends signal the need to bring clear guidance
to Americans on matters of health and nutrition.
10
Obesity Defined as BMI > 30
(CDC.gov)
Due to the obesity level…
• 2/3 of Americans are vulnerable
to fatal diseases such as diabetes,
stroke, and cancer…
• Preventable disease
Trust for America’s Health Report, 2006
Dieting on the Rise
The dieting industry is a $61 billion dollar industry
Money Spent on the Diet Industry (Billions)
$70.0
$60.0
$50.0
$40.0
$30.0
$20.0
$10.0
$0.0
Marketdata Enterprises, Inc., 2011
Money Spent on the
Diet Industry (Billions)
Lifestyle Secrets
to Success
1. Nutrition – 80% of the time a diet high fiber, low fat.
2. Physical Activity – A Consistent & Dedicated Exercise
Routine.
3. Emotional Well-being – Learn to identify habits like
4.
stress eating, boredom eating or emotional eating and
replace them with a more healthful coping response
A Support System – Create a support system that
will help you hang on to & continue to establish healthy
habits
Words of Wisdom…
“People often say that motivation
doesn’t last. Well, neither does
bathing- that’s why we recommend
it daily.”
-Zig Zigler
More Confusion
• IS OUR MESSAGE CLEAR?
The Story of Hamburger Helper
1 c = 320 calories; 13 gm fat; 25% saturated fat;
1 gm Trans Fat; 750 mg Sodium; 1 gm Fiber
QUIZ TIME
Which food has more Sodium?
Raisin Bread
90 mg
American Cheese
250 – 400 mg
Potato Salad 1/3 c
vs
600 mg
Raisin Bran cereal 1 c
vs
342 mg
Reduced Fat Italian dressing
405 mg/ 2 T
vs
vs
French / Italian Bread
208 mg
Swiss Cheese
55 – 75 mg
Mashed potatoes (fast food)1/3 c
320 mg
1 raisin-cinnamon English muffin
170 mg
vs
Reduced-fat Ranch dressing
vs
272 mg/ 2 T
Sodium – 1500 mg. a day limit
• Americans consume an average of 3436 mg. per day.
2300 mg per day for healthy adults
1500 mg/day for “at risk for coronary heart disease”
(African Americans, 40+ year old adults, hypertensive people).
• CDC found. . .
-70% of population is salt sensitive
-90% of middle-aged Americans will have high blood pressure
in their lifetime
-97% of all children are eating too much sodium  early high
blood pressure
Tweaking Recipes; Cooking
NSA tomatoes; spices; unsalted stock; fresh
(not shown: cilantro & chicken)
Mexican Tortilla Soup – Mr Foods
1 c – 155 calories; 4 gm fat; 300 mg Na; 13 gm carb;2 gm fiber; 16 gm protein
Tweaking with Beans, Seasonings
Taco Bean Dish – 1/5 c = 208 cals, 19 g fat, 27 g carb 9 g fiber, 90 mg Na, 15 g protein
8 oz NAS tomato sauce, 2 - 15 oz can NAS Stewed tomato, 1 can chilis, 1 packet Mrs
Dash Taco Seasoning, 1 can Kuner Black Beans, 1 package frozen corn, 1 can Kuner
Kidney Beans and 2 large chicken breast (before serving shred chicken breast & mix)
More Tweaking
Stir Fry – Quick & Easy
Sesame seed oil,
Ginger paste and
Mrs. Dash Teriyaki makes
a quick, flavorful Stir fry…
 Add some Edamame
and Tofu for quick, easy,
low fat
The Story of Olive Oil
DM 2 - 10 years
Counseled 3 years ago – lost weight,
A1c = 6.5%
Called me 3 years later…
“I need to see you!!!…. My
weight is up 30 lbs, my A1c =
8.5%!”
So… “What Have You Been
Doing?”
QUIZ TIME
Do You Know Your Fat Facts
1. Which Fat raises your LDL Cholesterol?
Saturated fats / Trans fats
2. Partially hydrogenated oils are closely related to which fat?
Trans fats
3. How many calories in 1 gram of fat
9 calories
4. If the AHA recommends < 7% calories from Saturated fats
how many grams is that in a 2000 calorie diet?
<15 grams
5. All oils contain how many calories / 1 TBS?
120 – 140 calories
Fat Facts
Americans consume >11% Saturated Fats; recommendation is <7%
• Saturated fat – Solid at room temperature
– significantly raises blood cholesterol levels and LDL “bad
cholesterol”
– included in butter, meat, high-fat dairy products
• Monounsaturated fat – Liquid at room temperature
– may lower cholesterol and protect (good) HDL
– included in olive, canola, and nut oils
• Polyunsaturated fat – Liquid at room temperature
– may decrease LDL but too much could decrease (good)
HDL cholesterol
– included in corn, soy, and safflower oil
– Coconut Oil – there is no strong scientific evidence that it
– Reduces LDL / Total Cholesterol
If You Want Fat…Go Whole Plant Fats
Whole Plant Food Fat
Nutritional Benefits
Culinary Uses
Avocados
Packed with monounsaturated fatty
acids; vitamins B6, C,E & K; folate; K,
Magnesium, fiber & lutein
Mashed as dip, salad dressing,
spread on bread, fat replacer in
baked goods, add to sandwiches &
salads
Tree nuts & nut
butters
Rich in protein, flavonoids, phytosterols,
MUFAs, PUFAs, thiamin, folate, Vit. B6,
E, iron, calcium, magnesium, K, zinc,
copper, manganese
Spread on bread, crackers,
ingredients in sauces, vinaigrettes,
marinades. Add nuts to salads,
side dishes, stir-fries, baked
goods, cereals
Peanuts & peanut
butter
Source of protein; MUFAs & PUFAs;
fiber; niacin, folate, pantothenic acid,
Vit. B1, B2, B6, E; choline, etc.
Same as above
Olives
Rich in fiber, MUFAs, vitamins A, E,
calcium, iron, copper, phytochemicals
Finely chopped as spread on
breads, crackers, dip for veg &
ingredient in entrée, side dishes,
salads, dressings
Seeds (sesame,
sunflower, flax, chia,
pumpkin & hemp
Depending on variety, rich in Alphalinolenic acid; MUFAs, PUFAs, protein,
fiber, vitamins A, B1, E, K, pantothenic
acid, folate, manganese, calcium,
phosphorus, selenium, lignans &
phytosterols
Use ground seeds as a spread for
breads & sandwiches, dip for
crackers, veg, fat replacer in baked
goods, & ingredient in sauces,
dips, dressings.
If You Want Fat…Go With Fish
• Fatty fish (salmon, tuna, sardines) don’t lower
LDL but they do provide plenty of other hearthealthy advantages, like preventing blood
clots, reducing inflammation, & keeping your
heart rhythm working smoothly.
Quick & Easy Fish
Seasoned Fish with Veggies
126 calories; 4 gm fat; 4 gm carb; 18 gm protein; 120 mg sodium
WORDS OF WISDOM
“Seeing Is Believing”
Thomas Edison
• “The doctor of the
future will no longer
treat the human
frame with drugs
but rather will CURE
and PREVENT
disease with
NUTRITION”
So This Is What You Are Going To Say
The EASIEST Way To Heart Health
DASH
•
•
•
•
•
•
PER DAY
5 – 9 servings Fruits & Vegetables
6-12 whole grains
2-3 servings Low Fat Dairy
2 or less lean meat,fish,poultry
3-6 servings / week nuts, seeds,
legumes
2-4 or less sweets & fats
Phytochemicals – the color in our fruits
and veggies
• Over 10,000 in fruits and vegetables
• Help in prevention of cancer, heart disease, and
many others.
• Promotes vision health, memory, and healthy
cholesterol levels
• Benefit of whole food vs. supplements/pills
• Grouped in: red, orange/yellow, green, blue/
purple, and white
What a Ride…
Lots of Decisions – So much info….
Nutrition shouldn’t feel like a Cedar Point Ride!
LOW FAT DAIRY
2-3 SERVINGS / DAY
DASH Diet Foods are HIGH in
Potassium, Calcium, Magnesium and Fiber
Fiber Rich Whole Grains
3 servings / day was associated with a 28% lower risk of CAD
2003 study by University of Minnesota on Atherosclerosis Risk in Communities
AHA Rationale - Reduce CVD by improving:
Blood lipid profiles – Reduced LDL by 4%
Body Weight
Vascular function
Blood Pressure
Antioxidant intake- rich source of polyphenols
Metabolic responses
Improved Blood sugar control
Current consumption- less than 1 serving per day
Add Whole Grains
Look for 1-4 grams fiber/serving
• Use 100% whole grain bread, pita, wraps for
sandwiches
• Opt for whole grain cereals and oatmeal
• Mix granola into yogurt
• Offer air-popped popcorn as an
afterschool snack
• Replace white pasta with whole
grain pasta
• Replace white rice with brown
rice
Functional Foods
•
•
•
•
Plant Sterols and Stanols
Viscous Soluble Fiber
Soy Protein
Tree Nuts and Peanuts
Help lower the LDL “bad” cholesterol!
Viscous Soluble Fiber
10 – 15% reduction in LDL has been proven
This fiber acts like a sponge soaking up water
and cholesterol in the intestine so it can be
excreted. It also encourages the liver to “pick
up” the LDL cholesterol that is circulating.
Legumes / Beans = Soluble Fiber
2 c. cooked / week lowers risk of heart disease by 22%
• Loaded with heart-protecting
nutrients, potassium,
magnesium, folate, fiber
• 1 c = 4 grams soluble fiber
• Beans: soy, kidney, black, white,
pinto, lima and more
• Lentils: brown, French, red,
Beluga lentils
• Peas: green, yellow, chickpeas,
split
Easy Ways to Add Legumes
•
•
•
•
•
•
•
•
Toss in salads.
Eat veggie burgers.
Add to stews, casseroles or soups.
Make black bean or chickpea
dips.
Toss in veggie fajitas.
Roast in oven for a crunchy snack.
Offer edamame as an appetizer.
Great as a finger food for new
eaters!
Soy Protein
• AHA has backed off on heart claims on soy other
than to endorse it’s low saturated fat content.
• FDA allows manufacturers with soy products
containing 6.25 grams of soy protein/ serving to
stated that “Diets that include 25 grams of soy
protein daily & low in saturated fat & cholesterol
may reduce the risk of heart disease.
Soy Protein
Reduces cholesterol by 2%
• Recently Soy protein has also been found to benefit blood
pressure by lowering systolic (the top number)blood
pressure.
• Eat Soy Foods (not supplements) – they are low in saturated
fat; have no cholesterol, & contain polyunsaturated fats,
fiber, vitamins, & minerals
• How to add: Drink soy milk, Make tofu a main entrée, Try
soy burgers, soy meats, much on soy nuts, add edamame to
soups & salad, experiment with other soy products, like
tempeh
Soluble Fiber – goal = 10 grams/day
FOOD
Soluble
TOTAL FIBER
(gms)
FOOD
Soluble
Total Fiber
(gms)
Barley (1/2 c cooked)
1
4
Black beans (1/2 cooked)
2
5.5
Oatbran (1/2 c cooked)
1
3
Black-eyed peas (1/2 cooked)
1
5.5
Oatmeal (1/2 c cooked)
1
2
Chickpeas (1/2 c cooked)
1
6
Psyllim seeds, grd (1 T)
5
6
Kidney Beans (1/2 c cooked)
3
6
Apple (1 medium)
1
4
Lentils (1/2 c cooked)
1
8
Banana (1 medium)
1
3
Lima Beans (1/2 c cooked)
3.5
6.5
Blackberries (1/2 cup)
1
4
Navy Beans (1/2 c cooked)
2
6
Citrus (orange, grapefruit 1
med)
2
2-3
Northern Beans (1/2 c cooked)
1.5
5.5
Nectarine (1 medium)
1
3
Pinto Beans (1/2 c cooked)
2
7
Peach (1 medium )
1
2
Broccoli (1/2 c cooked)
1
1.5
Pear (1 medium)
2
4
Brussels sprouts (1/2 c cooked)
3
4.5
Plum (1 medium)
1
1.5
Carrots (1/2 c cooked)
1
2.5
Plan a Menu with
10 grams Soluble Fiber & The DASH Diet
Food
Soluble
Fiber
Breakfast
Food
Soluble
Fiber
Lunch
Food
Soluble
Fiber
Supper
1 c oatmeal
2
Black Bean
Burrito
2
3 oz chicken
0
½ banana
1
Toss salad
0
½ c lima beans
3.5
1 c milk
0
1 orange
2
1 c broccoli
2
1 whole wheat
toast
0
Ice Tea
0
1 c brown rice
0
Snack –
1 large Apple
2
1 c milk
0
Total
14.5
Tree Nuts and Peanuts
Adding nuts to a healthy diet reduces LDL by 3- 19%
•
•
•
•
•
•
Help lower cholesterol
Improve dilation of blood vessels
Reduce inflammation
Combat blood pressure
Moderate blood sugar levels
Aid in Weight loss
Nuts & Seeds
Serving size – 1.5 oz
Nutritional Powerhouses
Loaded with Good-For-You Nutrients • Protein, FIBER
• Vitamins: B complex, E
• Minerals: iron, zinc, magnesium
• Healthy fats
Easy Ways to Add Nuts & Seeds
•
•
•
•
•
Add on top of hot oatmeal or cold cereal
Sprinkle on top of a salad
Add slivered almonds to cooked veggies
Mix with dried fruit
Include in a homemade trail mix with dry whole grain cereal and
dried fruit
• Mix into yogurt
• Don’t forget nut butters! Spread on whole grain bread or
crackers; use as a dip for fruit
Plant Sterols – Just another option
• Cholesterol “blockers”
• Use at meal times- especially higher
cholesterol meals
Naturally occur in whole grains, fruits,
vegetables, legumes, nuts & seeds
Fortified products Available
A little is GOOD…
• 2 grams / day can lower LDL
cholesterol by as much as
15% in weeks BUT
• No more…
• 3 grams can interfere with
beta-carotene absorption &
possibly other fat-soluble
vitamins
Bottom Line – K.I.S.S.
•
•
•
•
EATING FOOD SHOULD NOT BE COMPLICATED
COOKING IS A LOST ART – TALK FOOD
ASSUME NOTHING –
ACKNOWLEDGE THE BARRIERS TO GOOD
NUTRITION
• A PICTURE IS WORTH A 1000 WORDS….
It’s Not Flashy but It’s Accurate
TALK FOOD
MAKE YOUR MESSAGE CLEAR
RESOURCES
• My Favorites… what are yours?
Quote for the Day
“I like to always look on the optimistic side
of life, but I am realistic enough to know
that life is a complex matter”
Walt Disney
References
McCulloch . Saturated Fat: Not So Bad or Just Bad Science? Today’s Dietitian. November 2014
Watson E. Heart healthy foods, the next generation: “It’s not just about cholesterol anymore…it’s
about healthy arteries. Foodnavigator-usa.comwebsite. March 22, 2013
Know your fats. American Heart Association website. April 21, 2014
Eckel RH, Jakicic JM, Ard JD, et al. 2013 AHA/ACC guidelines on lifestyle management to reduce
cardiovascular risk: a report of the American College of Cardiology American Heart Association
task force on practice guidelines. J Am Coll Cardio. 2014
Thalheimer,J. New Cholesterol Guidelines Released – Lifestyle Changes and Statin Use Said to
Make the Most Impact on Cutting Risk. Today’s Dietitian. March 2014
Slavin JL. American Dietetic Association. Position of the American Dietetic Association: health
implications of dietary fiber. J Am Diet Assoc. 2008
Wlland, D. The Complete Idiot’s Guide to The TLC Diet. Indianapolis, IN; Alpha Books,2013
NHLBL. “Lifestyle Intervention To Reduce Cardiovascular Rise: Systematic Evidence Review from
The Lifestyle Work Group”. 2013
Brill J. Prevent A Second Heart Attack: 8 Foods 8 Weeks to Reverse Heart Disease. Harmony
Books, 2013