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Nutrition Recommendations Your Clients Can Take to Heart

Heart disease remains the number one killer in the U.S. for both men and women. February is a great month to encourage your clients to renew their commitment to heart healthy habits

February’s focus on heart health is near and dear to me. My loving dad had heart disease from the time I was 3 years old and died 10 years later, at age 56. I was only 13 at the time, and it changed my life. A cherished uncle followed, and then another uncle (my dad’s brothers). Years later my mom had a heart attack, which was the beginning of her health decline at age 80. Then, a few years ago, I was challenged with a heart arrhythmia – I was the same age my dad was when he died. I never thought I’d see the day when I was the heart patient! But I was fortunate to have great care at the Cleveland Clinic where an ablation procedure cured my symptoms. However, I am careful to follow lifestyle habits to avoid future issues. My story is not unique  – more than 1 in 3 adults have at least one type of cardiovascular disease (1).

Anyone who knows me, knows that I have focused my career on improving nutrition care for older adults. Well, I celebrated a milestone birthday last year – and I’m getting closer to being an “older adult” myself, so my health is at the center of my thoughts. Just because I’m a registered dietitian nutritionist, doesn’t mean that I’m immune to health issues – or bad habits for that matter. Heart month is a time to renew the commitment to heart-healthy lifestyle habits. I hope this information will help you coach your clients to make changes to improve both the quality and quantity of their lives – so that their children can enjoy them for many years to come.

Background Information

About 1 of every 3 deaths in the US is a result of heart disease, stroke or other cardiovascular disease. There are some risk factors that cannot be controlled: age over 45 for men, over 55 for women, heredity (including race), or previous stroke or heart attack. But there are many risk factors that can be controlled: hypertension, tobacco smoking, hypercholesterolemia, physical inactivity, overweight/obesity, and diabetes. (2) Almost half (47%) of Americans have high blood pressure, high cholesterol, or are smokers (3), risk factors that can be addressed through lifestyle change.

Encourage your clients to know their numbers.

Heart disease risk is based on many factors. Each person will have goals for blood sugar, blood pressure, blood lipids (total cholesterol, LDL-cholesterol, HDL-cholesterol), and BMI based on their family history and medical condition, so encourage your clients to talk to their health care providers about setting goals. The “normal” targets are listed below:

  • Blood lipids: Goal levels vary for each individual depending on other heart disease risks (4) and treatment is recommended accordingly.
  • Blood pressure: 120/80 is considered normal. A BP of 130/80 is now used for a diagnosis of hypertension (5).
  • Fasting blood sugar: Less than 100 md/dL is considered normal; greater than or equal to 126 mg/dL is used to diagnosis diabetes (6)
  • A1c: 4 – 5.6% is considered normal; greater than or equal to 6.5% is used to diagnose diabetes. For those with diabetes, a higher A1c may be acceptable. (6)
  • Body Mass Index (BMI): 18.5-24.9 is considered a normal or healthy weight. (7)

Essential Steps for Heart Health

The American Heart Association (AHA) encourages people to follow “Life’s Simple Seven” manage blood pressure, control cholesterol, reduce blood sugar, get active, eat better, lose weight, and stop smoking (8). The detailed information below provides more specific guidelines and goals your clients can aim for.

1. Manage blood pressure.

Almost 1 in 3 American adults have high blood pressure, which is a major risk factor for first heart attack, stroke, chronic heart failure and kidney disease. (9,10) Smoking, eating high sodium and low potassium foods, physical inactivity, obesity and drinking too much alcohol are risks for hypertension. (11)

About 90% of Americans over age 2 consume too much sodium. (12) The Dietary Approaches to Stop Hypertension (DASH) eating plan is well known as an effective intervention for lowering blood pressure. There is an abundance of information about the DASH eating plan available from the National Heart, Lung, and Blood Institute.

It’s also helpful to reduce stress. Encourage your clients to take time out each day to relax, renew, and reenergize: go for a walk, do some deep breathing, enjoy their favorite music, yoga, meditation, a hot bath, or talking to a friend. Even 10-15 minutes a day can be helpful.

2. Control cholesterol.

Educate clients on the benefits of choosing healthy polyunsaturated fats found in liquid vegetable oils such as canola and soybean oil, and monounsaturated fats found in nuts, nut butters, olives, olive oil and avocados.

The American Heart Association recommends 5-10% of daily calories from omega fatty acids. (13) Omega-3 fatty acids can help lower triglyceride levels, and can be found in fatty fish, walnuts, flaxseed, eggs. (13) Vegetable oils are major sources of omega-6s. Substitute these over solid fats and tropical oils (coconut, palm and palm kernel oil).

Encourage reduced portions of foods high in saturated fats, which have been linked to heart disease. Cut visible fat from meat, remove skin from poultry, prepare foods using low fat cooking methods (baking, broiling, roasting), choose low fat or no fat dairy products, and read labels to identify healthier foods.

3. Reduce blood sugar.

This is especially important for people with diabetes, but important for others as well. Researchers have recently made the connection between high levels of sugar intake and heart disease. One study documented a 38% higher risk of CVD mortality for people who consumed 17-21% of their calories from added sugars compared to those who consumed 8% of calories from added sugars. This was largely consistent across age group, gender, healthy eating index, BMI or physical activity level. (14) This study indicated that the average sugar consumption of adults in the US is 22 teaspoons of sugars each day, which is more than 3 times the recommended level. Major sources of added sugars in the US diet can be found here.

Encourage clients to eliminate sugary beverages and foods for at least 30 days to break the habit; and drink unsweetened beverages such as water, sparkling water, diffused water (lemons, limes, cucumbers or fruit), or hot or iced tea. Start with limiting or eliminating obvious sources of sugar and switch to naturally sweet foods such as fruits. Remind them that raw sugar, honey and agave syrup are all simple sugars. Encourage label-reading and selection of choices that are lower in sugar. One more caution: some studies indicate that even artificially sweetened foods and beverages may still create cravings for sweets. (15)

4. Get active.

More than 80% of adults do not meet the 2008 Physical Activity Guidelines for Americans for both aerobic and muscle-strengthening activities. (16) Encourage clients to include physical activity on most days of the week. (People with health issues should get their doctor’s approval before starting an exercise program.) Exercising lowers blood pressure, strengthens the heart, helps maintain lean body mass, burns calories, and produces endorphins, the feel good hormone. Experts recommend at least 150 minutes of moderate-intensity physical activity, or 75 minutes a week of vigorous intensity aerobic physical activity, along with muscle strengthening exercises on 2 or more days a week for adults aged 18-64. (17)

People 65 and older, are also encouraged to follow the same guideline unless they are physically unable. In that case, they should be as physically active as they are able. They should also do exercises to improve balance and reduce risk for falls. For beginners, even 10 minutes at a time can be positive, and they can work up to the minimum of 60 minutes on most days to meet the recommendations. (17)

Fitness trackers or pedometers can motivate clients and keep you informed of their progress. I love the Fitbit feature that reminds you to do a minimum of so many steps every hour! It’s especially nice for people who work in sedentary jobs.

5. Eat better.

Sadly, US adults only consume vegetables about 1.6 times per day and fruit about 1.1 times per day. (18) Most Americans do not follow a healthy eating pattern, and as a result about 36% of US adults are obese (19). Start with encouraging individuals to follow a healthy eating pattern such as USDA Food Patterns, DASH-style diets, Mediterranean-style diets, Healthy Vegetarian Food Pattern as outlined in the Dietary Guidelines 2015-2020.

6. Lose weight (if overweight).

There are many benefits to losing weight and maintaining a healthy weight including better control of hypertension, blood sugar, and hypercholesterolemia. (20) Even a 10 pound weight loss can lower heart disease risk. There is an abundance of good information on this subject available so I won’t go into detail here. Controlling portion sizes of all foods is one simple way for your clients control their calorie intake.

7. Stop smoking.

Unfortunately 15% of US adults still smoke (21). Encourage your clients to stop smoking and refer them to a good smoking cessation program.

One more note: People sometimes alter doses or stop taking medications altogether which can cause negative health outcomes. Encourage your clients to take medications as prescribed, and talk to their doctor if they have concerns.

It takes time to develop new healthy habits. Encourage your clients to take one step that they believe they can be successful with, and move forward from there. The most important key is that they believe they can make changes that become lifelong commitments for better health and quality of life.

Becky Dorner, RDN, LD, FAND

©2019, 2018 Becky Dorner & Associates, Inc.
For more information on this topic, refer to Diet and Nutrition Care Manual: Comprehensive Edition from Becky Dorner & Associates, Inc.

Becky Dorner, RDN, LD, FAND is widely-known as one of the nation’s leading experts on nutrition, aging and long-term health care. Her company, Becky Dorner & Associates, Inc. is a trusted source of valuable continuing education and resources dedicated to improving quality of life for older adults. Visit beckydorner.kinsta.com and sign up for the free membership.

Resources:

References:

  1. Benjamin EJ, Blaha MJ, Chiuve SE, et al. Heart disease and stroke statistics—2017 update: a report from the American Heart Association. Circulation. 2017;135:e1–e458.
  2. US Department of Health and Human Services. Healthy People 2020: Heart Disease and Stroke. https://www.healthypeople.gov/2020/topics-objectives/topic/heart-disease-and-stroke. Accessed February 12, 2018.
  3. Centers for Disease Control and Prevention. Heart Disease Risk Factors. https://www.cdc.gov/heartdisease/risk_factors.htm. Accessed February 12, 2108.
  4. My Life Check-Life’s Simple 7. American Heart Association web site. http://www.heart.org/HEARTORG/Conditions/My-Life-Check—Lifes-Simple-7_UCM_471453_Article.jsp#.WoGHWkxFxPa. Updated October 5, 2017. Accessed February 12, 2018.
  5. Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA Guidelines on the Treatment of Blood Cholesterol in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129:S1-S45. Doi:10:1161/01.cir.0000437738.63853.7a.
  6. New ACC/AHA High Blood Pressure Guidelines Lower Definition of Hypertension. American College of Cardiology web site. http://www.acc.org/latest-in-cardiology/articles/2017/11/08/11/47/mon-5pm-bp-guideline-aha-2017. Published November 13, 2017. Accessed February 12, 2018.
  7. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes—2018 Diabetes Care. 2018 Jan; 41(Supplement 1): S13-S27. https://doi.org/10.2337/dc18-S002
  8. About Adult BMI. Centers for Disease Control and Prevention Web site. https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/index.html. Reviewed August 29, 2017. Accessed February 12, 2018
  9. Merai R, Siegel C, Rakotz M, Basch P, Wright J, Wong B; DHSc., Thorpe P. CDC Grand Rounds: A Public Health Approach to Detect and Control Hypertension. MMWR Morb Mortal Wkly Rep. 2016 Nov 18;65(45):1261-1264
  10. Mozzafarian D, Benjamin EJ, Go AS, et al. Heart Disease and Stroke Statistics-2015 Update: a report from the American Heart Association. Circulation. 2015;e29-322.
  11. High Blood Pressure Fact Sheet. Centers for Disease Control and Prevention web site. Reviewed June 16, 2016. Accessed February 12, 2018.
  12. Jackson SL, Coleman King SM, Zhao L, Cogswell ME. Prevalence of sodium intake in the United States. 2016;64(52):1394–1397.
  13. Good Fat Versus Bad Fat. The American Heart Association Go Red for Women website. https://www.goredforwomen.org/live-healthy/good-fat-versus-bad-fat/. Accessed February 9. 2018.
  14. Yang Q, Zhang Z, Gregg EW, Flanders WD, Merritt R, Hu FB. Added sugar intake and cardiovascular diseases mortality among US adults. JAMA Intern Med. 2014 Apr;174(4):516-24. doi: 10.1001/jamainternmed.2013.13563. Accessed February 9, 2018.
  15. Artificial Sweeteners. Harvard T.H. Chan School of Public Health web site. https://www.hsph.harvard.edu/nutritionsource/healthy-drinks/artificial-sweeteners/. Accessed February 12, 2018.
  16. S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. https://health.gov/paguidelines/guidelines/summary.aspx. Accessed February 12, 2018.
  17. US Department of Health and Human Services. Healthy People 2020: Physical Activity. https://www.healthypeople.gov/2020/topics-objectives/topic/physical-activity. Accessed June 9, 2017.
  18. Centers for Disease Control and Prevention. State Indicator Report on Fruits and Vegetables 2013. https://www.cdc.gov/nutrition/downloads/state-indicator-report-fruits-vegetables-2013.pdf. Accessed February 12, 2018.
  19. Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, 2011–2014. NCHS Data Brief. 2015 Nov;(219):1-8.
  20. Losing Weight: What is Healthy Weight Loss? Centers for Disease Control and Prevention web site. Updated January 29, 2018. Accessed February 12, 2018.
  21. Jamal A, King BA, Neff LJ, Whitmill J, Babb SD, Graffunder CM. Current cigarette smoking among adults — United States, 2005–2015. 2016;65(44):1205–1211.

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