THERAPEUTIC CARDIAC DIET

PRESENTED BY: SARAH ALZAHRANI & AMAL ALHARBI

UNDER SUPERVISION: DR/ ENAS KASSEM

OBJECTIVES:

▪ Explain the connection between diet and CVD.

▪ Define heart healthy diet.

▪ Identify goals of heart healthy diet.

▪ Discuss keys to cardiac nutrition therapy. (Basic Nutrition)

▪ Explain Sample for 1-day menu.

▪ Define DASH diet.

▪ Discuss DASH diet recommendations.

THE CONNECTION BETWEEN DIET AND CARDIOVASCULAR DISEASE

▪ Diet directly affects the development of atherosclerosis

(lesions which can block arteries), the underlying cause for

CVD. Diet also affects blood cholesterol levels, body weight,

blood pressure, and blood glucose levels.

WHAT IS A HEART-HEALTHY DIET?

A heart-healthy diet is:

▪ High in omega-3 fats, found in many fishes, especially salmon

▪ High in fiber

▪ High in fruits and in green, red and orange vegetables

▪ Low in saturated fats and trans fats

▪ Low in sodium

▪ Low in sugar

▪ Low in cholesterol

▪ Low in alcohol or alcohol-free

▪ Calorie-balanced to support a healthy weight

The goals of a heart-healthy diet are to eat foods that help obtain or maintain healthy levels of cholesterol and fatty molecules called lipids. You can achieve this by:

• -Reducing overall cholesterol levels and low-density lipoproteins (LDL), which are harmful to the heart

• -Increasing high-density lipoproteins (HDL), which are beneficial for the heart

• -Reducing other harmful lipids (fatty molecules), such as triglycerides and lipoprotein.

Any diet should also help keep blood pressure and weight under control.

KEYS TO CARDIAC NUTRITION THERAPY

FATS AND OILS

Limit saturated fats and trans fat:

▪ Foods high in saturated fat include fatty meat, poultry skin, bacon, sausage, whole milk, cream , and butter.

▪ Trans fat are found in some fried foods, and backed foods made with hydrogenated oils.

Limit amount of cholesterol that you eat less than 200 mg per day:

▪ Food high in cholesterol include egg yolks ,fatty meat, whole milk ,cheese, shrimp, lobster, and crab.

Eat more omega-3 fats (heart healthy fats):

▪ Good choice include salmon, tuna, mackerel and sardines.

▪ Other foods with omega-3 fats include walnuts and canola and soybean oils.

Limit that total amount of fat that you eat including heart healthy fats to 25% to 35% of the calories that you eat

Diet can influence LDL-cholesterol levels :

A typical American diet contains about 40% of its total energy content as fat;

▪ Half this energy is in the form of saturated fatty acids

▪ One-fourth as monounsaturated fatty acids

▪ One-fourth as polyunsaturated fatty acids.

The quantity and nature of dietary fats can influence the level of plasma cholesterol. High levels of saturated fats in the diet result in an increase in plasma LDL cholesterol

CARBOHYDRATES, FIBER, AND SUGAR

▪ Carbohydrates are either complex (as in starches) or simple (as in sugars).

▪ Many studies report that people can protect their heart and circulation by eating plenty of fruits and vegetables.

▪ Complex Carbohydrates (Fiber). found in whole grains and vegetables are preferred over those found in starch-heavy foods, such as pastas, white-flour products, and white potatoes.

▪ Most complex carbohydrates are high in fiber, which is important for health. Whole grains are extremely important for people with diabetes or those at risk for it.

▪ The recommended daily intake of dietary fiber for heart protection :

(19 to 50)

▪ at least 25 grams for women and 38 grams for men .

(Older women and men )

▪ at least 21 and 30 grams of fiber, respectively

Different fiber types may have specific benefits:

▪ Insoluble fiber (found in wheat bran, whole grains, seeds, nuts, legumes, and fruits and vegetables) may help achieve weight loss. Consuming whole grains on a regular basis may lower the risk for heart disease and heart failure.

▪ Soluble fiber (found in dried beans, oat bran, barley, apples, and citrus fruits) may help achieve healthy cholesterol levels and possibly reduce blood pressure .

(Sugar):

Doctors recommend that no more than 10% of daily calories should come from sugar. Sugars are usually one of two types:

▪ Naturally occurring sugars are found naturally in foods such as fruit (fructose) and milk (lactose).

▪ Added sugars include any sugars or caloric sweeteners that are added to foods or beverages during processing or preparation (such as putting sugar in your coffee or adding sugar to your cereal). Added sugars can include natural sugars such as white sugar, brown sugar and honey as well as other caloric sweeteners that are chemically manufactured (such as high fructose corn syrup).

PROTEIN

▪ Protein is found in animal-based products (meat, fish, and dairy) as well as vegetable sources such as beans, soy, nuts, and whole grains.

▪ In general, doctors recommend that proteins should provide 12 - 20% of daily calories.

▪ Fish is probably the best source of protein. Evidence suggests that eating moderate amounts of fish (twice a week) may improve :

▪ Triglyceride

▪ HDL levels

▪ Help lower :

1/the risks for death from heart disease,

2/ Dangerous heart rhythms,

3/ Blood pressure,

4/ A tendency for blood clots,

5/ The risk for stroke.

Finding balance, choosing the right kind and amount of protein:

▪ When choosing protein, opt for low-fat options, such as lean meats, skim milk or other foods with high levels of protein.

▪ Choose main dishes that combine meat and vegetables together, such as low-fat soups, or a stir-fry that emphasizes veggies.

▪ Watch portion size. Aim for 2- to 3-ounce servings.

▪ If you’re having an appetizer, try a plate of raw veggies instead of a cheese plate. Cheese adds protein, but also fat.

VITAMINS

▪ Antioxidant Vitamins.

▪ Are a group of compounds that help to protect the body from the formation and elimination of free-radicals. Free-radicals are formed from exposure to sunlight and pollution and also as a byproduct of cell metabolism. Alcohol, cigarette smoke, stress and even diet also affect the level of free-radical development in the body.

Vitamin E : a fat soluble vitamin present in nuts, seeds, vegetable and fish oils, whole grains (esp. wheat germ), fortified cereals, and apricots.

Vitamin C : a water soluble vitamin present in citrus fruits and juices, green peppers, cabbage, spinach, broccoli, kale, cantaloupe, kiwi, and strawberries.

▪ Vitamin K stop vascular calcification. It appears to activate a protein in artery walls that keep calcified hardened section of blood vessels from expanding and causing more damage.

▪ Beta-carotene is present in liver, egg yolk, milk, butter, spinach, carrots, squash, broccoli, yams, tomato, cantaloupe, peaches, and grains.

▪ (NOTE: Vitamin A has no antioxidant properties and can be quite toxic when taken in excess.)

MINERALS

▪ Potassium. A potassium-rich diet can provide a small reduction in blood pressure. Potassium-rich foods include bananas, oranges, pears, prunes, cantaloupes, tomatoes, dried peas and beans, nuts, potatoes, and avocados. Potassium supplements should not be taken by patients without checking with your doctor first.

▪ For those using potassium-sparing diuretics (such as spironolactone), or have chronic kidney problems, potassium supplements may be very dangerous.

▪ Magnesium. Some studies suggest that magnesium supplements may cause small but significant reductions in blood pressure. The recommended daily allowance of magnesium is 320 mg.

▪ Calcium regulates the tone of the smooth muscles lining blood vessels. Studies have found that people who consume enough dietary calcium on a daily basis have lower blood pressure than those who do not.

▪ Studies have indicated that calcium supplements do not prevent heart disease and some controversial reports suggest that they might even increase risk.

SODIUM (SALT)

▪ sodium increases blood pressure because it holds excess fluid in the body, creating an added burden to your heart.

▪ Blood pressure rises with age, and eating less sodium now will help curb that rise and reduce your risk of developing other conditions associated with too much sodium, such as stroke, heart failure, osteoporosis, stomach cancer, and kidney disease.

Some tips to lower your sodium (salt) intake:

▪ Look for foods that are labeled “low-sodium,” “sodium-free,” “no salt added,” or “unsalted.” Check the total sodium content on food labels.

▪ Don’t cook with salt or add salt to your food. Try pepper, garlic, lemon, or other spices for flavor instead.

▪ Avoid processed meats (particularly cured meats, bacon, hot dogs, sausage, and ham). Processed meats have been associated with increased risk for heart disease.

▪ Avoid foods that are naturally high in sodium, like, nuts, olives, pickles, sauerkraut, soy tomato and other vegetable juices, and cheese.

▪ Take care when eating out. Stick to steamed, grilled, baked, boiled, and broiled foods with no added salt, sauce, or cheese.

▪ Use oil and vinegar, rather than bottled dressings, on salads.

▪ Eat fresh fruit or sorbet when having dessert.

SAMPLE 1-DAY MENU

Meal Food choices

Breakfast

½ cup apple juice¾ cup oatmeal with 1 small banana and 1 cup skim milk1 cup brewed coffee

LunchTurkey and cheese sandwich , 2 slices whole wheat bread ,1 Oz low-fat swisscheese, mustard , 1 medium sliced tomato ,shredded lettuce , 1 cup skim milk

Evening meal

3 Oz broiled fish , 1 cup brown rice with 1 teaspoon soft margarine1 medium stalk broccoli and 1 medium carrotTossed salad with mixed greens, tomatoes, chickpeas, and olive oil and vinegar dressing1 cup of tea ½ cup nonfat frozen yogurt with fruit

Snacks1 Oz trail mix made with nuts, seeds, raisins ,and other dried fruit1 cup blueberries1 cup skim milk

DASH DIET

DASH DIET

▪ An eating plan designed to lower the blood pressure. DASH is an acronym for Dietary Approaches to Stop Hypertension. The DASH "combination diet" has been shown to decrease the blood pressure and so helps prevent and control high blood pressure.

▪ DASH diet (Dietary Approaches to Stop Hypertension) is proven to help lower blood pressure, and may have additional benefits for preventing heart disease, stroke, and heart failure.

▪ This diet is rich in important nutrients and fiber. It also provides far more potassium (4,700 mg/day), calcium (1,250 mg/day), and magnesium (500 mg/day) but much less sodium.

DASH DIET RECOMMENDATIONS:

Limit sodium (salt) intake to no more than 2,300 mg a day (a maximum intake of 1,500 mg a day .

Reduce saturated fat to no more than 6% of daily calories and total fat to 27% of daily calories. (But, include calcium-rich dairy products that are non- or low-fat.

When choosing fats, select monounsaturated oils, such as olive or canola oils.

Choose whole grains over white flour or pasta products.

Choose fresh fruits and vegetables every day. Many of these foods are rich in potassium, fiber, or both, which may help lower blood pressure.

Include nuts, seeds, or legumes (dried beans or peas) daily.

Choose modest amounts of protein (no more than 18% of total daily calories). Fish, skinless poultry, and soy products are the best protein sources.

Other daily nutrient goals in the DASH diet include limiting carbohydrates to 55% of daily calories and dietary cholesterol to 150 mg. Patients should try to get at least 30 g of daily fiber.

REFERENCE:

▪ Gail C. Frank , Community Nutrition, second edition,2008

▪ David Ed. Cavanagh ,Nutritional Biochemistry, second edition, 1999

▪ Dairy Australia , Cardiovascular Health, http://www.nutritionaustralia.org/

▪ University of Maryland Medical Center ,Heart-healthy diet, http://umm.edu/

▪ American dietetic association, Cardiac nutrition therapy http://www.eatright.org/

▪ American Heart Association, Basic Nutrition, http://www.heart.org

▪ MedicineNet.Com, DASH diet, http://www.medicinenet.com

THANK YOU