Monday, November 4, 2013

Heart Healthy Diet

By: Christina Kalafsky, UMD Dietetic Intern

I’m currently in my clinical rotation at Baltimore Washington Medical Center. Over the past few weeks I’ve gotten a chance to see the registered dietitians educate patients on heart healthy diets. The hospital uses education materials from the Nutrition Care Manual. However, when you see the size of these handouts, they can be overwhelming. The “Heart Healthy Eating Nutrition Therapy” is six pages long and loaded with information on saturated fat, trans fat, cholesterol, sodium, total fat, omega-3 fats, fiber, physical activity, and more.

When it was finally time for me to educate patients on my own, just thinking about all the topics on that list that I was suppose to cover had me really intimidated. But if was intimidating for me just to talk about, imagine how it must feel for the patient who just had a heart attack and is now in the hospital. So what should you do? Make it simple. While the RDs all have their own unique way of providing a heart healthy diet education, the basic message is the same—limit your sodium intake and your fat intake.

Tailoring the information specifically to the patient is a key component in any nutrition education. Ask the patient to go through a typical day with you and find out what they eat. Then use this information to make the education personal to the patient. If they tell you they never eat frozen dinners, then it’s pointless to tell them to avoid these foods because they are high in sodium. However, if the patient tells you they eat turkey and cheese sandwiches for lunch, use that! Inform them that there are low-sodium deli meat options available, and cheeses such as mozzarella are lower in sodium than ones like cheddar or American.

I find that using a food label is much less intimidating than a long six page bulleted list of things to avoid. I highlight the parts on the food label I really want the patient to pay attention to—amount per serving, total fat, and sodium—and go from there.
  • Fat:
    • Total fat- choose foods with less than 5 grams of total fat per serving
    • Saturated fat- choose foods with less than 3 grams of saturated fat per serving.
  • Sodium:
    • Explain to the patient that consuming a lot of sodium can cause fluid to build-up in the body and this extra fluid makes it harder for the heart to pump. Following a low-sodium diet can help with this.
    • It is recommended to eat less than 2,000 mg of sodium per day. A helpful way to explain this concept is to tell the patient to think of this as $2,000 that they can spend on sodium however they want. When they look at a food label, see how much sodium is in one serving of the product and subtract that amount from their $2,000 sodium budget. If they want to eat two servings, they will have to double the sodium amount.
Keep in mind that encouragement/praise goes a long way. Even if it’s only a little change, such as going from eating regular potato chips to reduced-sodium chips, it’s still an improvement. Patients may still not be following a heart healthy diet 100%, but the fact that they have made an effort should not go unnoticed. Also, being nice to them instead of scolding them for their bad behavior makes it more likely that the patient will listen to you!

So just remember to read over your education material before educating the patient (learned that lesson the hard way) and to keep it simple!

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