February is American Heart Month. If we are honest with ourselves and our patients, much of what we ask them to do regarding a heart-healthy diet requires that they stop or significantly reduce consumption of a food or beverage that they currently enjoy.
We want them to stop eating so much saturated fat, so if we are talking to patients, that means we are telling them, “Do not have that grilled cheese sandwich.” “You should not be eating pizza on Friday night.” “No more of your spouse’s favorite pot roast.”
We ask them to cut back on sodium: “No more of those delicious, salty Chinese lunches.” “Skip the onion soup at your favorite restaurant.”
We want them to avoid added sugars: “Walk by the just-baked chocolate chip cookies.” “Skip the sweet-tea you grew up with.”
We also encourage them to eat a whole-food, less processed diet more of the time. We know that this will, in most cases, dramatically reduce the amount of sodium and sugar patients are consuming. If the percentage of plant products that patients eat as part of their diet increases, so will the reduction in their saturated fat intake. “That BBQ that you enjoyed last week with your family, next time skip the ribs and stick to the salads.”
And although all these directions are grounded in science and will achieve their stated goal if followed, constant admonishment and setting inflexible standards is not always effective. Telling people all the things they are doing wrong, especially if those things have brought them enjoyment for most of their lives, can make patients feel resentful and defeated before they even begin to make changes. Worse, if they cannot easily follow all the restrictions, it may make them less inclined to listen to you in the future.
Luckily, there are many positive, heart-healthy actions that providers can promote that can build on what patients are already doing successfully and that are easier to undertake gradually. As patients do more of these healthy behaviors, they will be more satiated; their tastes will change, and they will be less inclined to engage in destructive dietary habits. What are some of these positive nutritional steps?
- Eating more fiber is a good place to start. Fiber, especially soluble fiber, can reduce cholesterol buildup in the arteries and reduce hunger, helping with weight control. Most patients already include some foods with fiber in their diet, but they can add more by throwing chickpeas onto their salads or adding fresh berries and a sprinkle of nuts to their oatmeal.
- More potassium in the diet is another great step. Increasing potassium intake can negate some of the detrimental effects of sodium on blood pressure. Potassium is present in some popular foods such as orange and potatoes, but patients should be encouraged to add some other great sources, such as leafy greens (kale, spinach, Swiss chard), broccoli, halibut, tuna, and beans.
- Patients can also lower sodium consumption by cooking more dinners at home and choosing more minimally processed foods. Overall, more than 70 percent of the sodium we eat comes from processed, prepackaged, and restaurant foods. While most people do eat several meals at home, increasing this number gradually by exploring new, simple recipes for breakfast, lunch, or dinner, will make a difference.
For most patients, the goal is not to abruptly have them eat every meal at home, throw away the saltshaker, never eat processed foods, and change to a vegetarian diet. Nor is it to precisely meet recommended intakes of saturated fat and sodium every day. If our primary goal is to improve their health and quality of life, then the approach that is most likely to succeed is to offer suggestions that will fit into the patient’s lifestyle, their preferences, and their goals.
The more you know your patients, the better you will be able to help them build on the foundations they already have. That’s the reason Silver Fern’s Meal Plan assessment module is structured to tease out patient’s current eating behaviors, barriers to healthy eating, and goals for healthy eating. It asks 27 structured questions and provides suggested actions for clinical steps based on the patient’s responses.
Building on the patient’s positive behaviors, goals, and interests makes the tone of the conversation different – more supportive and personal. “Enjoy more of the black bean burritos you made last week.” “You mentioned you like Bartlett pears; they are in season now. Why don’t you consider slicing one up when you get home from work? If I remember, you said that is the time of day when you are starving.”
Almost all patients are eating some of the right things some of the time. Giving them positive, achievable steps and helping them expand on their successes can help them achieve a healthier heart for life.
—
Nora Saul is a Registered Dietitian and Certified Diabetes Care and Education Specialist. Nora has more than 25 years of experience in the field of diabetes education, consulting for the Joslin Diabetes Center and other industry partners. Nora leads content development for Silver Fern’s diabetes products and training.