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2015-2020 DIETARY GUIDELINES CARDIAC AND PULMONARY PATIENTS

Abbie Brekken, RD, LD

Kathryn Magnuson, MS, RD, LD

DIETARY GUIDELINES 2015-2020

Inform the development of Federal food, nutrition, and healthy

policies and programs Primary audience: policymakers, nutrition and healthcare providers

Critical tool for professionals to help Americans to make healthy choices in their daily lives to help prevent chronic disease and enjoy a healthy diet

Encourage healthy eating patterns and focus on disease prevention

DIETARY GUIDELINES 2015-2020

Terms To Know:

Eating Pattern: the combination of foods and beverages that constitute an individual’s complete dietary intake over time. For example the USDA Food Patterns and the Dietary Approaches to Stop Hypertension (DASH) Eating Plan

Nutrient Dense: a characteristic of foods and beverages that provide vitamins, minerals, and other substances that contribute to adequate nutrient intakes or may have positive health effects, with little or no solid fats and added sugars, refined starches and sodium. These foods and beverages are in forms that retain naturally occurring components, such as dietary fiber.

Variety: a diverse assortment of foods and beverages across and within all food groups selected to fulfill the recommended amounts without exceeding the limits for calories and other dietary components.

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DIETARY GUIDELINES 2015-2020

Summary of Guidelines :

1. Follow a healthy eating pattern across the lifespan

2. Focus on variety, nutrient density, and amount

3. Limit calories from added sugars and saturated fats and reduce sodium intake

4. Shift to healthier food and beverage choices

5. Support healthy eating patterns for all

DIETARY GUIDELINES 2015-2020

Healthy Eating Pattern Includes:

A variety of vegetables from all the subgroups – dark green, red and orange, legumes (beans/peas)

Fruits – especially whole fruits

Grains, at least half of which are whole grains

Fat free or low fat dairy, including milk, yogurt, cheese, and/or fortified soy beverages

A variety of protein foods, including seafood, lean meats and poultry, eggs, legumes, nuts, seeds and soy products

Oils such as canola and olive oil

DIETARY GUIDELINES 2015-2020

Healthy Eating Pattern Limits:

Saturated and trans fats, added sugars and sodium

Consume less than 10% of calories per day from added sugars

Consume less than 10% of calories per day from saturated fats

Consume less than 2300 mg per day of sodium

If alcohol is consumed, it should be consumed in moderation – up to one drink per day for women and up to two drinks per day for men

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DIETARY GUIDELINES 2015-2020

Natural Sugars

Fruits (fructose)

Vegetables Potatoes, corn, peas, squash

Milk (lactose)

100% fruit juice (up to 1 cup daily)

Added Sugars

Sugars and syrups added to food/beverages during processing

Candy, cake, cookies, ice cream, sweetened yogurt, flavored milk, energy/sports drinks, soda, fruit juice from concentrate, sweetened breakfast cereals, instant hot cereal

10 ounce can of soda contains 10 teaspoons sugar!

MYPLATE: WWW.CHOOSEMYPLATE.GOV/

EAT RIGHT WITH MYPLATE

Make half of the plate fruits and vegetables

Make at least half of the grains whole

Switch to fat-free or low-fat milk

Vary protein choices – seafood, nuts, beans (legumes), lean meat, poultry, eggs

Cut back on sodium and empty calories from solid fats and added sugars

Enjoy food but eat less – avoid oversized portions

Be physically active – goal is 150 minutes per week for adults

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CARDIAC

GENERAL NUTRITION GUIDELINES

Focus on fruits and vegetables

Go for grains

Lean towards low-fat dairy

Choose lean meats

Heart-healthy oils and fats

Limit sodium

FRUITS AND VEGETABLES

Aim for 2 cups fruit and 2.5 cups vegetables per day

Choose whole fruits and 100% fruit juices

Choose fresh or frozen vegetables (without cream, butter, seasonings or cheese sauces) and low-sodium vegetable juices

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GRAINS

Eat 6 servings per day

Make at least half of the servings whole grains Check the ingredient label; the first

ingredient should contain the word “whole” or packages that state “100% Whole Grain”

100% whole wheat bread, English muffins and tortillas; barley, bulgur, quinoa, oatmeal, whole wheat pasta, brown rice

DAIRY

Aim for 3 cups per day

Skim or 1% milk

Low-fat yogurt/frozen yogurt

Fat-free or low-fat cheese, sour cream and cottage cheese

Limit intake of whole milk, cream, whole-milk cheeses

PROTEIN

Recommend no more than 6 ounces cooked lean meat, poultry, fish or seafood per day

Fish high in omega-3 fatty acids – salmon, mackerel, lake trout, herring, sardines, albacore tuna

Lean beef: round, tip, loin, flank

Lean pork/lamb: loin chops, roasts, butterfly chops, tenderloin

Chicken or turkey without skin

Wild game

Beans, lentils, peas, low-fat tofu

Eggs

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TYPES OF FAT

Saturated Fat

Raise LDL cholesterol levels

Solid at room temperature

Animal products Butter, cheese, whole milk, ice cream,

fatty meats

Vegetables products Coconut, palm, and palm kernel oil

Trans Fat

Raise LDL cholesterol levels, lower HDL cholesterol

Commercial baked goods

Occur naturally in meat and milk, less harmful

-Examples: Shortening, partially hydrogenated

vegetable oil and hydrogenated vegetable oils

TYPES OF FAT

Unsaturated Fat (Poly and Mono)

Lower LDL cholesterol levels

Liquid at room temperature

Olive, peanut, canola, corn, safflower, soybean, sunflower, sesame seed oils

Avocados, seeds, nuts

Omega-3 Fatty Acids

Lower triglyceride levels, slow development of plaque in arteries, and may lower blood pressure slightly

Flaxseed, flaxseed oil, canola oil, walnuts, fatty fish such as salmon, mackerel, herring, and trout

AHA recommend to eat at least two servings of fish (particularly fatty fish) per week

Fish oil supplements

FATS AND OILS

Limit to 5 teaspoons per day

Recommended Vegetable oils: olive, canola, peanut, sunflower, safflower, corn, flaxseed, sesame

Margarines: spray, tub or squeeze with one of the vegetable oils listed as the first ingredient (no trans fat)

Salad dressing/mayonnaise made with recommend oil

Spreads with stanols/sterols

Use sparingly Solid fats and shortenings: butter, lard

Chocolate, coconut oil, fried foods, heavy whipping cream

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COOKING METHODS AND EATING OUT

Recommended to prepare without added saturated and trans fat

Baked, broiled, grilled, steamed, roasted, poached

Avoid breaded, battered, fried, in butter or cream sauce

Salad dressings and sauces serving on the side

Substitute lemon juice or vinegar and oil for salad dressings

Order plain chicken breast and hamburger and skip bacon, cheese and sauces

Split a meal

SODIUM

Limit to 2,000 mg per day for those with cardiovascular disease Patients with heart failure limit to 1,500-2,000 mg per day

Hide the salt shaker and limit/omit amount of salt added in cooking and baking

Recommended: fresh/frozen meats, vegetables and fruit, unsalted snack foods, low-sodium soups, oil, vinegar and lemon juice

Sodium-free seasonings: fresh/dried herbs, Mrs. Dash, pepper, garlic/onion powder

Rinsing canned beans and vegetables

Cooking from scratch; limit intake of boxed stuffing, rice, and potato mixes

CAFFEINE

According to the American Heart Association:

Still under study to determine whether high caffeine intake increases risk of coronary heart disease

Many studies have been done to see if there is a direct link between caffeine, coffee drinking and coronary heart disease, however results are conflicting

Moderate coffee drinking (1-2 cups per day) does not seem to be harmful

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NUTRITION LABEL

- Serving Size - Total Fat

- Saturated fat - Unsaturated fat - Trans fat

- Sodium - <140 mg per serving is

considered a low sodium option

PULMONARY

GENERAL NUTRITION GUIDELINES

1. Maintain a healthy weight.

2. Eat a balanced diet with variety.

3. Focus on getting enough calories, protein, vitamins, and minerals.

+Presence of inflammation may increase the amount of calories the body burns at rest.

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HEALTHY WEIGHT

Extra body weight can make it more difficult to breathe

Too little body weight can put you at greater risk for infection and can cause you to fatigue very quickly

WHAT IS A HEALTHY WEIGHT

Can be different for everyone

Health care providers often use BMI Normal BMI: 18.5-24.99

Current research shows that pts with chronic respiratory disease should maintain BMI of 21-25

Low BMI with chronic respiratory disease is not desirable. Those with low BMI may be at higher risk of death and have lower lung function and more SOB

BMI does not take into account muscle and bone mass, however can be an indicator of disease risk or mortality risk

CHRONIC RESPIRATORY DISEASE AND NUTRITION

What Can Hinder Nutrition and Balance?

Medications Loss of appetite, weight changes, upset stomach

Shortness of breath

Fatigue, weakness

Task of cooking and shopping

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ADEQUATE NUTRITION IS KEY

Calorie and protein needs vary from person to person

Individuals with Chronic Respiratory Disease are at risk for inadequate nutrition.

Without enough calories and protein, the body burns muscle for energy.

This weakens the muscles, including the those used to breath.

With less muscle, weight loss, and decreased ability to exercise and move around can result.

CARBOHYDRATES

A diet high in simple carbohydrates produces more carbon dioxide, making breathing more difficult

Simple carbohydrates - limit

Complex carbohydrates - encourage

METABOLISM OF CARBOHYDRATES

Your body changes food to fuel= metabolism.

Oxygen and food go in.

Carbon dioxide and energy go out.

Carbon dioxide is the waste product and must be excreted.

Metabolism of carbohydrates produces the most CO2 for the amount of oxygen used, hence making the lungs work the hardest.

Fat produces the least amount of CO2.

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LIMIT SIMPLE CARBOHYDRATES:

Sugar

Syrups

Honey

Regular soda

Sweetened Juice Drinks

Jams and Jelly

Sugar Cereals

Sweet deserts, pastries

Candy

Eat desserts sweetened with fruits instead of sugar.

INCLUDE HEALTHY COMPLEX CARBOHYDRATES

Cooked Cereals, Unsweetened Cereals

Breads

Bagels

Rice

Pasta

Potatoes and Squash

Corn and peas

Muffins, Pancakes, Waffles

CHOOSING WHOLE GRAIN CARBOHYDRATES

Look for 100% whole grain on label; Multi-grain does not mean whole grain.

Whole grain is more nutritious than refined (has antioxidants!).

Whole grain has fiber= cholesterol, weight management.

Examples of whole grains: 100% whole wheat Oats and oatmeal Quinoa Corn Barley Brown and wild rice Buckwheat, bulgur, kamut, amaranth, millet, spelt, and teff

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EAT PLENTY OF PROTEIN

The body needs protein to build muscles and fight infection.

Eat protein with meals and snacks daily.

Protein can help one feel full and satisfied.

PROTEIN SOURCES

Meats: Beef, Pork, Veal

Poultry: Turkey, Chicken, Eggs

Seafood: Fish, Shrimp, Crab

Dairy: Milk, Cheese, Yogurt, Cottage Cheese

Nuts: Peanut butter, Almonds, Cashews

Beans (Legumes): Dried and canned, Lentils

Other: Tofu, Soybeans, Peas

PROTEIN SUPPLEMENTS

If weight loss is a goal for specific individual, replacing one meal a day with a protein supplement + fruit or vegetable can be considered

Protein supplements should be high protein (approximately 20 grams) and low carbohydrate (~15 grams)

Examples: Body Fortress (Whey protein supplement)

EAS

Muscle Milk Light

Pure Protein

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SUPPLEMENTS

Boost

Ensure

Generic

Carnation Instant Breakfast

Protein Bars

Rice, Whey or Soy protein shakes and powders.

+ Small, frequent amounts of supplements are

preferred to avoid SOB and fullness.

DAIRY PRODUCTS

According to research, dairy products are unrelated to mucus production. Some do perceive increased mucus production related to mouth feel.

Dairy products are important sources of calcium and vitamin D= Individuals with Chronic Respiratory Disease are at risk for fractures and osteoporosis.

Possible use of steroids can decrease bone mineral density and increase risk of fractures (conflicting evidence).

DIARY CONTINUED

Sources: Milk= chose low fat options. Yogurt= low fat or Greek. Added benefit of healthy bacteria for

your general gut health. Cheese and cottage= choose low fat and/or low sodium.

Alternative Calcium and Vitamin D Sources: Lactaid milk Almond, soy, hemp, rice (remember some are not good protein

sources; some have MORE calcium and vitamin D than regular milk!).

Supplements= as directed by your doctor.

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HEALTHY VS UNHEALTHY FATS:

Saturated and Trans fats= limit

Unsaturated (mono & poly)= encourage

Omega 3’s= encourage

SATURATED AND/OR TRANS FAT SOURCES:

Butter and Margarine and Spreads

Cheese, Sour Cream, Mayo

Whole Milk and Ice Cream

Fried foods

Commercially Baked Products

Frosting

Fatty Meats

UNSATURATED FATS

Oils: Canola, Olive, Vegetable, Peanut, Safflower

Salad Dressings

Nuts and Seeds

Nut butters

Avocado and Guacamole

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LIMITING SODIUM

Too much sodium can cause fluid retention that can make breathing more difficult

Avoid processed foods, salty snacks and canned foods

Avoid adding salt to foods

NOT GETTING ENOUGH NUTRITION

Chronic Respiratory Disease puts one at risk for inadequate nutrition

Nutritional needs are increased when patients have decreased appetite or fatigue – as SOB interfere with food intake

HEALTHY EATING

Eat 3 balanced meals daily

Planning snacks

Fresh, minimally processed foods

Limiting high calorie, high fat, high sodium convenience foods

Choose MyPlate

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REFERENCES

United States Department of Agriculture, http://www.choosemyplate.gov/

American Heart Association, http://www.heart.org/HEARTORG/

Academy of Nutrition and Dietetics Nutrition Care Manual

Patient Education Catalog, www.AllinaHealth.org

American Thoracic Society, http://www.thoracic.org/copd-guidelines/for-health-professionals/management-of-stable-copd/nutrition/assessment-of-body-composition.php

THANK YOU!!!