MAKING YOUR NUTRITION MESSAGE POSITIVE

ISCVPR ANNUAL MEETINGKathleen Cowden, RD,CD

Franciscan – St Francis HealthApril 16, 2015

Objectives

1. Participants will have a working knowledge of the AHA Dietary Guidelines2. Participants will verbalize approaches to impact changes in clients eating habits3. 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) 0%B) 5%C) 20%D) 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 PresidentMedical Director, Baylor Heart and Vascular Institute

LET FOOD BE THY MEDICINEHIPPOCRATES

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

OBESITY TRENDS AMONG U.S. ADULTS

1990-2008

1990 1998 2008

Frightening rise in obesity holds deadly implications for health.

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 RiseThe dieting industry is a $61 billion dollar industry

19881990

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20082010

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Money Spent on the Diet Industry (Billions)

Money Spent on the Diet Industry (Billions)

Marketdata Enterprises, Inc., 2011

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 stress eating, boredom eating or emotional eating and replace them with a more healthful coping response

4. 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 TIMEWhich food has more Sodium?

Raisin Bread vs French / Italian Bread 90 mg 208 mgAmerican Cheese vs Swiss Cheese 250 – 400 mg 55 – 75 mgPotato Salad 1/3 c vs Mashed potatoes (fast food)1/3 c

600 mg 320 mgRaisin Bran cereal 1 c vs 1 raisin-cinnamon English muffin 342 mg 170 mgReduced Fat Italian dressing vs Reduced-fat Ranch dressing 405 mg/ 2 T 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 adults1500 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 Foods1 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 protein8 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 OilDM 2 - 10 yearsCounseled 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 TIMEDo You Know Your Fat Facts

1. Which Fat raises your LDL Cholesterol? Saturated fats / Trans fats2. Partially hydrogenated oils are closely related to which fat? Trans fats3. How many calories in 1 gram of fat

9 calories4. If the AHA recommends < 7% calories from Saturated fats

how many grams is that in a 2000 calorie diet? <15 grams5. All oils contain how many calories / 1 TBS? 120 – 140 calories

Fat FactsAmericans 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 FatsWhole 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 Alpha-linolenic 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 heart-healthy advantages, like preventing blood clots, reducing inflammation, & keeping your heart rhythm working smoothly.

Quick & Easy FishSeasoned 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 HealthDASH

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 DAIRY2-3 SERVINGS / DAY

DASH Diet Foods are HIGH in Potassium, Calcium, Magnesium and Fiber

Fiber Rich Whole Grains3 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 GrainsLook 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 Fiber10 – 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 Fiber2 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 ProteinReduces 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/dayFOOD 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

Prunes (1/4 c) 1.5 3

Plan a Menu with 10 grams Soluble Fiber & The DASH Diet

Food Soluble Fiber

Food Soluble Fiber

Food SolubleFiber

Breakfast Lunch 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 PeanutsAdding 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 & SeedsServing 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

ReferencesMcCulloch . Saturated Fat: Not So Bad or Just Bad Science? Today’s Dietitian. November 2014Watson E. Heart healthy foods, the next generation: “It’s not just about cholesterol anymore…it’s about healthy arteries. Foodnavigator-usa.comwebsite. March 22, 2013Know your fats. American Heart Association website. April 21, 2014Eckel 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. 2014Thalheimer,J. New Cholesterol Guidelines Released – Lifestyle Changes and Statin Use Said to Make the Most Impact on Cutting Risk. Today’s Dietitian. March 2014Slavin JL. American Dietetic Association. Position of the American Dietetic Association: health implications of dietary fiber. J Am Diet Assoc. 2008Wlland, D. The Complete Idiot’s Guide to The TLC Diet. Indianapolis, IN; Alpha Books,2013NHLBL. “Lifestyle Intervention To Reduce Cardiovascular Rise: Systematic Evidence Review from The Lifestyle Work Group”. 2013Brill J. Prevent A Second Heart Attack: 8 Foods 8 Weeks to Reverse Heart Disease. Harmony Books, 2013