17 | Healing Hearts: A Clinician's Guide to the Cardiac Diet

Join Colleen and the heart dietitian, Kiran Campbell, as we unpack the basics of a heart-healthy diet. Having a cardiac event is life-changing, not only for the patient, but for their loved ones too. Telling the patient to "just follow a cardiac diet" is not helpful and doesn't lead to lasting changes that will protect the patient from having a recurrent cardiac event. In today's episode, we break down the components of a cardiac diet so that you can help your patient choose their food wisely and make changes that are sustainable.

You'll learn:

• How to ask the right questions that will guide your nutrition recommendations
• The different types of fats and which one's are cardioprotective and which ones the patient should limit. 
• The American Heart Association's recommendation for daily sodium intake and which foods are high in sodium that the patient needs to be aware of 
• The role fiber plays in heart health and which foods you should recommend your patients eat more of.

Connect with us on Instagram! =============================

Exam Room Nutrition IG: ➡︎@examroomnutrition

Kiran IG: ➡︎ @kcampbellnutrition

Resources and Articles ===================================

https://www.lipid.org/TearSheets - patient and clinician fact sheets

https://www.heart.org/en/healthy-living/healthy-lifestyle/lifes-essential-8 - direct patients to this awesome American Heart Association tool/quiz which can help patients better understand what they can do to improve heart health.  

https://www.lipidjournal.com/article/S1933-2874(23)00185-X/fulltext - recently updated guidelines (June 2, 2023) from the National Lipid Association

** If you enjoyed this episode, I would love if you could leave me 5-stars rating or write a positive review. This helps me empower more clinicians how to have more impactful nutrition discussions.

Transcript

Kiran: 0:00

That's why it's so critical for clinicians to get these patients on board with the diet changes, the lifestyle changes, but do it in a way that is sustainable for them and they can make it a part of their lifestyle.

Colleen: 0:15

Welcome back to the Exam Room Nutrition Podcast. I'm your host, colleen Sloan. I'm a registered dietitian and pediatric PA. Today, we're going to equip you with the essential knowledge to educate your patients on the life-altering power of a heart-healthy diet. With heart attacks striking every 40 seconds and cardiovascular disease claiming a life every 33 seconds, we really can't afford to take this topic lightly. Rather than telling your patient who might have just suffered a cardiac event to follow a cardiac diet, let's give them more specific, practical advice. And I'm so excited because we have the absolute expert on with us today to help us unpack this topic.

Colleen: 0:56

Kiren Campbell is with us today. She's a registered dietitian nutritionist with 14 years of experience. She's passionate about educating adults on nutrition for heart health. She offers guidance for both prevention and recovery from cardiac events through her website, Kirren Campbell Nutrition. You can find her on Instagram at kcampbellnutrition. Kiren, I'm so glad that you're with us today. I can't wait to unpack this topic with you. Welcome to the show. Thank you so much. I'm happy to be here.

Colleen: 1:24

This is such a big topic and there are so many different avenues that we can take this, and I know it's just so easy as clinicians to say, hey, follow this cardiac diet. Good luck, I'll see you in a year. And that's really not helpful because there are so many specifics when it comes into the cardiac diet and really there's a lot of different heart healthy dietary patterns that really address all the different components of low salt, low cholesterol. But I really wanted to start off first by addressing the patient who just had their first cardiac event and now they're told hey, let's have a heart healthy diet. Where do we as clinicians start? What does that mean and what can we recommend our patients to start off with?

Kiran: 2:08

I do want to start out with a few statistics for you 15% of individuals that have a cardiac arrest actually have a recurrence and 35% of the ones that have a recurrence end up having eight second reoccurrence. So that's generally about one in five patients that have a cardiac arrest that will have another recurrence, with the second arrest happening within the first five years of the first one. So that's why it's so critical for clinicians, dietitians, anyone on the healthcare team to get these patients on board with the diet changes, the lifestyle changes, but do it in a way that is sustainable for them and they can make it a part of their lifestyle. First of all, you need to know where they came from, what type of diet they were following beforehand. They could have been following an unhealthy, high saturated fat, high sodium diet their whole entire life and now they're at this point and we need to pinpoint where. Is it actually doable for them to start without overwhelming them?

Colleen: 3:11

And I think that's a good point, because it can be really overwhelming when you're like, hey, let's completely transform all the foods that you've been eating for the last 30 years. So really, that key question of how would you describe your diet. What are some other questions that clinicians can ask to get to the details of where they're starting out?

Kiran: 3:27

First, you need to get an idea of the patient's nutritional status at home, so ask them how would you describe your diet? What types of foods do you eat? Do you eat breakfast every day? A lot of people don't. What typical protein sources do you like? Maybe it's a lot of processed foods that you've found. Do they eat out very much? The biggest sources of the sodium and the fat and cholesterol in people's diets are highly processed foods and ultra processed foods, and it doesn't take long after talking to a patient to find information like that out. Also, what types of beverages are they consuming? Because a lot of beverages are the sugar sweetened ones. Added sugars aren't good for the heart. Maybe that's an issue too. So there's multiple questions you need to ask in order to find out what you're really dealing with here.

Colleen: 4:17

Yeah, those are really, really helpful questions that we can start the conversation to really find out. Okay, where are we starting from? What are some areas that we need to improve? We all understand that a cardiac diet is going to be lower in fat, lower in sodium, lower in cholesterol, but maybe the fat isn't the problem in the patient's diet. Maybe after those few questions, you're realizing oh hey, you're eating a lot of salt, or maybe it's the opposite. So, rather than just giving blanket suggestions or dietary advice, it is important to ask those specific questions. So we got some of the basics down. Let's dig a little bit deeper into our clinicians on the specific key points, on those nutrients and those components of a heart healthy diet. Let's first start by talking about fat. What can you tell us about fat in the diet?

Kiran: 5:03

While reducing dietary fat and trans fat are the main two, the ones you're going to want them to limit, the most obviously there are, the better for you fats, and then the saturated and trans fats. They need to know the difference between the two. You know, to some patients fat is fat. So if you tell them reduce the fat in your diet, they're going to be like okay, and they might just stay away from all fat, including the mono and polyunsaturated fats. Also, start by asking about the types of animal meats they're eating. How do they prepare them? Are they baking them, grilling them using lower fat cooking methods, or are they smothering them in rabies or deep frying everything? Do they include any unsaturated fats in their diet already, versus the unhealthy trans and saturated fats?

Colleen: 5:52

I want to stop there, because I'm going to pretend that maybe some of our clinicians are nutrition newbies and they might have forgotten what is the difference, what are the saturated and trans fats and which ones are the good fats. So educate us, so we can properly educate our patients on those differences and give us some specific foods that would fit into each type. Sure.

Kiran: 6:17

The saturated fats are typically the ones that are solid at room temperature, so I think like butter, a stick of butter or Crisco lard bacon fat, you know, it cools down and it solidifies specific forms of saturated fats that show more of a negative effect on lipid levels. Specifically, these are the saturated fats that are butter, full fat dairy products, processed and high fat meats, and tropical oils like coconut oil, palm and palm kernel oils. Okay, so those are the three types of fat that generally have more of a negative effect, whereas the mono and polyunsaturated fats are the good types that you get from olive oil, canola oil, avocado, nuts, seeds, things like that. Okay, which is why the Mediterranean diet is still healthy, because it's very high in those mono and polyunsaturated fats.

Colleen: 7:11

Excellent. Thank you so much, because sometimes we all need a little refresher too on the different types of fats. Okay, so we've asked about the animal meats and how they're preparing them. Now I know you had asked if they include any of the unsaturated fats in their diet. So like what types of foods and questions would that be?

Kiran: 7:29

The unsaturated fats could be using more olive oil, like in the Mediterranean diet. People in the Mediterranean tend to have one to four tablespoons of olive oil every single day. Also, they eat a lot of fish, you know, including fatty fish. But it's not bad fatty fish, it's the good fatty fish, like salmon, tuna, mackerel, sardines, that have those good Omega 3 fatty acids in them, you know, versus the Omega 6s and 9s that are, you know, more prone to cause inflammation and oxidative stress.

Colleen: 7:58

All right. Is there anything else that we should touch on regarding fats and maybe processed meats or any like plant-based foods that we can recommend that they eat?

Kiran: 8:08

Yes, it also might be a good time, like after they have a cardiac event If you find they are eating more processed, ultra-processed types of meat, maybe sort of lean into a conversation about adding more unprocessed meats into their diet, including maybe plant-based sources of protein. So maybe soy-based tofu, tempeh, you know, black bean burgers, things like that, chickpeas, hummus, you know those types of more plant-based proteins might be beneficial to them if they're willing to do that.

Colleen: 8:38

And you know it's not going to be like an All or nothing approach right like they can maybe just start to eat a little bit more of the plant based proteins instead of red meat, maybe like once a week or something like that. Or is this something that they need to cut cold turkey right now? Stop eating all this fatty foods.

Kiran: 8:57

Right, if you tell him to do a cold turkey, it's going to be overwhelming and it's gonna feel like it's not, it's not sustainable. So you know, I feel like most of us have heard of like meatless Mondays. Maybe start with a meatless Monday and then you know it's, maybe, instead of doing meat in your spaghetti sauce, maybe can try tofu crumbles or something, or instead of a, a Western omelet, maybe you can try like a Southwest tofu scramble, you know, for breakfast. So little bits here and there is not going to feel so overwhelming and it's probably going to meet. You know, end up being cheaper to this plant. A lot of the plant based stuff is a lot cheaper than meat these days, absolutely right.

Colleen: 9:36

Okay, so we've covered fat pretty well here. I'd like to move on to. The really big topic is the sodium intake. So start up by just reminding us what the American Heart Association recommendations are for total milligrams of sodium in a day.

Kiran: 9:52

The American Heart Association. They recommend limiting sodium to two thousand three hundred milligrams a day. But if you have had a cardiac event or if you have high blood pressure, the recommendation is a little more strict. It's fifteen hundred milligrams a day. So, and for reference, you know, one teaspoon of of salt is two thousand three hundred milligrams, right there.

Colleen: 10:14

Thank you for giving us that visual, because it's hard for me to visualize milligrams. You know that we can't really quantify that in our minds. That's not a lot of salt. A teaspoon of salt is pretty much your total daily limit for sodium, so that's really important to be mindful of that. So where can we start by educating our patients on like okay, well, what sources are you getting this sodium from?

Kiran: 10:38

Well, from what I have found a lot of patients they way underestimate the amount of sodium they're consuming every day. They think that it only comes from the salt shaker and they don't think about the processed foods that they're they're eating or the sodium that's already in certain foods like milk and bread. So maybe first inform them that much of their sodium intake might be coming from the commercially prepared foods or processed foods like deli meat, fast food, the restaurant meals, boxed meals, tv dinners, even things like cheese condiments, tomatoes like tomato sauce, tomato products, barbecue sauce, soy sauce, things like that. Also, maybe explain some of the immediate signs that they might see if they're they're consuming too much sodium, because they might see, you know, a Dima in their lower extremities or ankles or something they might have a lot of your increased thirst or or elevated blood pressure, and they might not know why. They might not associate it with the high sodium intake.

Colleen: 11:39

You know, salts everywhere it's a preservative. So you know, couple hundred years ago it was like finding gold, once they figured out that salt can preserve things and we can keep our food for much longer. But little did they know it's, you know, quite harmful to our health in excess. And it really is astounding, if you look, turn over and look at the food label, that amount of sodium in Pretty much anything that you can purchase on the shelves. So that's a really good, important piece of information that we should be recommending our patients to just pay attention to how much deli meat, how much box meals or TV dinners are you eating? Your other one that's really heavy and sodium that we see a lot in pediatrics is the cup noodles or the ramen noodles Unbelievable, and kids just devour three, four of those in a day.

Kiran: 12:25

Yes, my kids love macaroni and cheese, the craft macaroni and cheese, yeah, yeah, and it's got a lot of salt.

Colleen: 12:32

So what are some things that we can recommend? Okay, we've got a patient and they are eating all these things. They are eating box dinners. They're maybe eating cup noodle, a box thin. Minimize their sodium intake. What are some recommendations that we can provide to them?

Kiran: 12:45

Right away. What comes to mind is instead of using. If they do use salt, instead of using salt, they can try salt substitutes. I mean, obviously you're going to have to watch which ones you choose. You might not want to do one with potassium, depending on their needs, but you can always do herbs and spices. You know, I recommend a lot of garlic powder and onion powder. There's, you know, completely salt-free options. I know a lot of Mrs Dashes are like that. But also, if you do like things like the you know noodles, the ramen noodles, instead of using that flavor packet, you can even do things like just cut the amount in half Instead of using the whole packet. Maybe use half the packet, you know, and add some vegetables into the noodles as well, so that way you're not just getting all carbs and sodium, you're also getting a serving of vegetables in there too.

Colleen: 13:32

I love that you are just meeting them where they are. You know, if they are like nope, can't give up my ramen noodle, then okay, let's just cut the packet in half so you're not getting as much sodium, but they still get to enjoy foods that they've known and loved for so long. You know, they don't feel like they're missing out or just having to completely change everything that they've known for the last 30 years, so that's a really great suggestion.

Kiran: 13:54

Another thing that I do tell a lot of my heart patients is it's not that you can never eat bacon again or you can never eat a hot dog ever again because you can. But if you know you're going to go to a birthday party and there's going to be pizza and cake, if you know you're going to have a high sodium, high fat dinner that night, just make sure all the rest of your meals that day are a lot more decent. You know, limited when it comes to the fat and the sodium is all about balance and moderation. Watch the portion sizes too, of course.

Colleen: 14:22

Yeah, that's great. So making sure that it's a balance All right, so that actually moves really nicely into the next nutrient that is important to monitor in a cardiac diet, and that's cholesterol. So what are some things that we, as clinicians, can start to talk about regarding cholesterol for our patients?

Kiran: 14:38

Well, high cholesterol or hyperlipidemia, maybe diet and lifestyle related, or genetic or, in this case, with familial hypercholesterolemia. Cholesterol takes. It takes years to build up in your arteries and it really starts in childhood. So the first time you know your child might get a cholesterol test and they're they could be 10 years old. My daughter just got hers checked and it was high, which was a little embarrassing because I'm a dietitian, but she likes her carbs. All she eats is carbs. The type and severity of this lipidemia present should direct you to the best way to manage your patient's condition. So, following a cardiac event, there's no question that plaque buildup has already occurred. It's there, it's already present. So your goal as a clinician should be to help them prevent or slow down that buildup.

Colleen: 15:28

We know that there are different types of cholesterol, but give us your terminology that you use to educate the patients on what those differences are. Right, because we know that there is a type of cholesterol that's not necessarily bad and we want it to be a little bit higher. So how can we explain, maybe, their lab results in an understandable way?

Kiran: 15:48

I always use the H in HDL cholesterol.

Kiran: 15:52

You know the better cholesterol H is for happy, and with the LDL I say L is for lousy.

Kiran: 15:59

So hopefully that kind of is a good way for them to remember it too. So maybe you can start by discussing what your patient's lipid levels are, explain it to them in simple terms, what their recommended goals should be. So for LDL, for example, the goal is should be to get them between 50 and 70 milligrams per deciliter. So compare that to what they are, let them know what their level is and say, okay, this is where you need to be and here's some options on how to get there, when they can start talking about maybe statin therapy to help lower it, which can significantly reduce that your LDL cholesterol, as well as the APOB cholesterol, apo lipid. You can also mention cholesterol friendly diets like the Mediterranean diet and the DASH diet, and they might not know what those are, but that's where you can also put in a consult to the dietitian who can come explain further. But if you want to give them a quick recommendation as far as foods to lower cholesterol fruits, vegetables, whole grains those are obvious and excellent choices for any low cholesterol diet.

Colleen: 17:06

Now I'm curious what role does fiber have in this heart?

Kiran: 17:08

healthy diet, Adding dietary fiber, especially beta-glucan and other viscous fibers, like things you get from legumes, nuts, seeds, fruits, vegetables, whole grains. Following a cardiac event is associated with lower alcohol cause mortality, and fiber has also been shown to support the reduction of the LDL cholesterol and the non-HDL cholesterol and ApoB so and these naturally occur in plant foods. So for clinicians, you might want to start by discussing the benefits of fiber for heart health and explaining how it's beneficial, what it does in the body. Encourage their intake of more whole grains versus the refined, processed grains which have. The whole grains are going to have much more fiber than the processed ones. Maybe try and list certain specific food options that they can include on a daily basis, like oatmeal for breakfast adding one and a half cups of beans each week, karen.

Colleen: 18:08

that's really helpful and informative about adding fiber to the diet. So it sounds like fruits, vegetables, those whole grains are really good sources of fiber. But I'm curious is there a goal that our patients should be trying to get to in regards to how much fiber they should have every day?

Kiran: 18:24

Absolutely. In general, an adult should get anywhere between 20, 25 to 30 grams of fiber each and every day from multiple sources. But it's also important to let them know that if they're not used to eating a whole lot of fiber and all of a sudden they start introducing it into their diet, they might get, you know, gas, bloating, abdominal discomfort. So have them introduce it slowly, you know, maybe try one fruit or vegetable at every single meal, start from there and also make sure they're getting enough fluids. So because that fluid is just going to help, you know, bulk up this stool, you're not going to get a solid mass of and end up being constipated from all this fiber. So water intake, fluid intake, is very important too.

Colleen: 19:08

All right. So I love science and I love when all my dietitians bring science to the table. Are there any additional resources that you can recommend that clinicians can read on their own just to stay up to date with the latest cardiac guidelines and nutrition?

Kiran: 19:23

Yep, I have a few different references I always refer people to. One is the National Lipid Association website, where anyone can go on this website and gain access to their wonderful tear sheets. They have tear sheets for patients. They have tear sheets for clinicians, so for clinicians, you can print off these handouts to help educate your patients. They have a lot of lifestyle change ones available. And then there's also the American Heart Association. They have something called the my Life Check, which you can direct patients to. This tool. It's a quiz that can help them better understand what they can do to improve their heart health, and it goes over diet questions, it goes over whether or not they smoke and at the end they'll get a score and it will tell them what they need to improve upon. And also, just very recently there was an update from the National Lipid Association Do they just publish their new nutrition interventions for adults with dyslipidemia, and there's a lot of helpful information in that.

Colleen: 20:23

Awesome. Thank you so much, and so I'm going to link all of that down below in the show notes so you can go ahead and click through and then recommend that your patients also do the same. Kiran, this was so extremely helpful and I know this is such like a huge topic so you did a fantastic job narrowing it down, giving us really helpful practical tips and questions that we can at least start to guide our patients on how to follow a cardiac diet after a cardiac event. If you want to follow Kiran, she's all over the internet, but on Instagram you can find her at kcampbellnutrition. Kiran, thank you so much for the gift of your time. I'm so grateful that you were here. Is there anything else that you would like to close out with?

Kiran: 21:03

I just want to thank you guys and clinicians. Just do the best you can, and if you need help from us dietitians, we're here for you. Okay, we're all. We're all in this together. We all became what we became, you know, in this profession for a reason, and it's to help people. So let's work as a team.

Colleen: 21:20

I love that, and I cannot agree with you more about how important dietitians are on the team with everything but really cardiac diet, because anytime anybody has a cardiac event, it is usually directly related to their diet and their physical activity, and that's what you guys do. So thank you so much for sharing your expertise and your experience with us. Kiran, thank you so much.

Kiran: 21:42

Thank you.

Colleen: 21:43

All right, guys. Now it's time for my nutrition notes In this section is where I like to share a nutrition tip, an encouraging quote or an interesting case that I think might add value to your day. So, in keeping with the topic of having a cardiac event, a very near and dear family member recently had their own cardiac event and it had been the first time in a long time that I had been on the receiving end of medical care. When the clinician becomes the patient or the family member of the patient, it feels a whole lot different, and we had plenty of people come over and tell us hey, you need to follow a cardiac diet. And I just wanted to bring it back down to a human level, because having a cardiac event is really life changing and really stressful and scary for everyone involved. Not only does this impact the patient, which absolutely it does, because now they're having to completely transform the foods that they eat. They feel like all the things that they knew and loved in the past are now bad for them. Everyone's telling them they can't have it anymore, and it's really overwhelming and really stressful. But also remember that it's really overwhelming and stressful for the caretakers and the family members who either witnessed that event or who are now having to help shop and prepare those foods.

Colleen: 22:59

So I would just like to leave you with the advice to be sympathetic, be encouraging and continue to have compassion. In medicine, it's so easy to just kind of get numb to everything because we do this on a daily basis and it doesn't affect us personally. But just remember that on the other side of your stethoscope is a patient and is a family who this has completely transformed their life. So just please be encouraging. Give them an encouraging word, give them a warm hug or a pat on the shoulder and let them know everything's gonna be okay and that you really are there to help them and that they can do this and that small steps do make a difference.

Colleen: 23:38

Well, I hope that this topic was informative and it added value to your day. If you haven't already, I would love if you could subscribe to my YouTube channel or like this video. If you're listening on a podcast app, please just hit the five star rating, or if you could write me a little review. That would be awesome and it would just help other clinicians find this podcast. If you would like to connect with me or send me a question that you would like answered on our podcast. You can reach out to me on Instagram at exam room nutrition. That's all for today and, as always, let's continue to make our patients healthier, one exam room at a time. We'll see you next time, thank you.