3/31/2016
1
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.
3/31/2016
2
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
3/31/2016
3
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
3/31/2016
4
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
3/31/2016
5
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
3/31/2016
6
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
3/31/2016
7
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
3/31/2016
8
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.
3/31/2016
9
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
3/31/2016
10
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.
3/31/2016
11
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
3/31/2016
12
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
3/31/2016
13
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.
3/31/2016
14
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
3/31/2016
15
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
3/31/2016
16
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!!!