Counseling Tips for Newly Diagnosed Heart Disease Patients
By Lenora Dannelke
Once clients or patients have been diagnosed with heart disease, dietitians have the delicate but rewarding task of discussing the dietary and lifestyle changes they will need to make to reverse the disease or at least prevent a heart attack or stroke.
Heart disease is the leading cause of death in the United States, according to the Centers for Disease Control and Prevention. It comprises multiple conditions, such as congestive heart failure, atherosclerosis, heart attack, and stroke, which require specific nutritional recommendations. RDs need to communicate these recommendations as clearly and simply as possible to maximize patient comprehension and adherence.
The Initial Visit
Patients newly diagnosed with heart disease usually have plenty of questions about their condition during their first visit with a nutrition professional, and dietitians agree they need to be ready with clear answers.
During the initial session, it’s important for RDs to explain the connection between heart health and diet. “We’ll do an in-depth history-taking of their current lifestyle,” says Jeannie Gazzaniga-Moloo, PhD, RD, a national spokesperson for the Academy of Nutrition and Dietetics (the Academy). “In order for any healthy-eating plan to be effective, it’s critical that dietitians get a full, aerial view of what that person’s life is like. Talk about their job, the number of hours they work, the structure of their job, and when they eat—not just what they eat—their social life, family life, and who does the shopping and cooking.”
Depending on the patient’s circumstances, all they may need to do is add more fruits and vegetables to their diet during the first week, begin eating breakfast, and keep a food journal for a few days.
The following strategies will help guide dietitians when counseling clients and patients:
• Weed out the unhealthful foods. Review all the foods the patient is eating and hone in on the ones related to heart disease risk, including foods high in saturated fat and refined carbohydrates, and determine what changes must be made, such as restricting sodium or increasing soluble fiber. “Focus on the positive side—what you can add to the diet,” Gazzaniga-Moloo says.
• Add nutritious foods. Meeting resistance in newly diagnosed heart disease patients is common. “The hardest thing for a person who has to make dietary changes is the feeling of having to give up what they really like,” says Marisa Moore, MBA, RD, LD, a spokesperson for the Academy. “They may need to eliminate high-fat meats and cheeses, fried foods, sweets, and candies, so I look for things that can be healthful additions to the diet that they enjoy and build on those. In the case of a person with high cholesterol, it would help to increase their intake of beans. If that person hates black-eyed peas but likes pinto beans, talk about making a pinto bean burger.”
• Tell patients snacking is good. A positive emphasis on snacking also may be reassuring to clients. “Snacking is a good addition to most diets,” Moore says. “It can [prevent] you from overeating at the next meal and fill the gap if you typically miss out on certain nutrients. Say you’re not a big milk drinker. One way to get calcium is to have nonfat yogurt as a snack. If a person doesn’t want fruit for dessert, eat it during the day. Portion control is always at play. They can try healthful options such as whole grain crackers instead of buttery ones or a handful of nuts instead of potato chips.” Nuts not only contain heart-healthy fats but keep a person feeling full longer.
• Encourage a slow start. Suggest patients gradually introduce new foods, such as edamame, and ensure they have resources for heart-healthy recipes and cooking tips. “You don’t want to overwhelm the patient, but ensure they have the tools they need to make changes,” Moore says. “Find out what kinds of fats or oils they’re using at home. If they’re using shortening in tubs, recommend they swap that for canola, peanut, or olive oil.”
• Develop a customized eating plan. An eating plan tailored to the patient may involve behavior change. If someone is skipping breakfast every day or not adhering to the guidelines, you need to find out why so you can develop meal plans they’ll be more inclined to follow, Moore says.
• Make recommendations for eating out. Since the average American diet frequently includes restaurant dining, takeout, and fast foods, it’s important to advise clients and patients to read menus and nutrition information carefully. “There’s nutrition information available on many menus, so [have patients] look at the number of calories, the amount of fat, saturated fat, and sodium in items,” Gazzaniga-Moloo says. “Go to establishments that offer healthier food options. Salads are a good choice, but [tell them] to be careful about what [they put] on them, such as high-fat dressings, cheeses, and meats.”
• Suggest clients watch portions. “Serving sizes in restaurants are typically so much larger than what we eat at home,” Gazzaniga-Moloo says. Recommend they share a dish or eat only half and take the rest home for another meal. Remind patients that two-thirds to three-quarters of their plates should contain vegetables and whole grains. Meat portions should be the size of a deck of cards or no more than one-third of the meal. “It’s really a matter of the patient becoming aware,” she adds.
• Go easy on the alcohol. Gazzaniga-Moloo recommends patients be “honest and open with their physician about the amount they’re drinking and its potential risk for causing heart disease.” According to the American Heart Association, alcoholic drinks should be limited to two per day for men or one per day for women. Due to the trends in increased portion sizes, RDs must clearly define what’s meant by one drink: 5 oz of wine, 12 oz of beer, or 1 1/2 oz of 80-proof liquor.
— Lenora Dannelke is an independent journalist who covers food, health, and travel for numerous publications.