Heart Failure Nutrition€¦ · Choose Vegetables: 5 serves a day . Choose Fruit: 2 serves per day....
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HEART FAILURE NUTRITION Eating for a Healthy Heart NEMO Nutrition Education Materials Online This is a consensus document from Dietitian/ Nutritionists from the Nutrition Education Materials Online, "NEMO” Team. Disclaimer: http://www.health.qld.gov.au/masters/copyright.asp Date August 2015 Review Date: August 2017
Heart Failure Nutrition€¦ · Choose Vegetables: 5 serves a day . Choose Fruit: 2 serves per day. What is a Healthy Diet? Cereals, breads etc\爀屮1sliceof bread 1/2 medium bread
So what is a heart healthy diet? Have you seen The Australian Guide to Healthy Eating before? It used to be the pyramid but now it is the plate. What the plate shows us is the 5 core food groups needed for good health. The core food groups are: The breads and cereals group Vegetables and legumes Fruit Milk, yoghurt and cheese Lean meat, fish, poultry, eggs, nuts and legumes. The Australian Guide to Healthy Eating also shows us the proportion of each core food group needed to make up a healthy diet. We are going to go through each of the core food groups one at a time. As we do, compare what you would typically eat in a day to the amounts recommended. If the amounts you eat vary a lot from what’s suggested for a healthy diet you might need to think about making some changes. In general though, a healthy diet is: High in plant based foods High in fibre Moderate in good fats Low in bad fats, sugar and salt. Also remember that a low fat diet is not recommended. The most important thing to do is look at the TYPE of fat - replacing saturated and trans fat with good fats.
Breads & Cereals: to match energy needs
Choose Vegetables: 5 serves a day
Choose Fruit: 2 serves per day
What is a Healthy Diet?
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Cereals, breads etc 1sliceof bread 1/2 medium bread roll 1/2 cup cooked rice, pasta, noodles 1/2 cup porridge 2/3 cup breakfast cereal flakes or ¼ cup muesli Vegetables and legumes (choose a variety) Starchy vegetables 1/2 med potato/yam, medium sweet potato, 1 medium parsnip Vegetables 1 cup lettuce or salad vegetables ½ cup cooked veg Fruit 1 piece medium sized fruit eg apple, orange, mango, mandarin, banana, pear, etc 2 pieces of smaller fruit (apricots, kiwi, plum, fi gs) About 8 strawberries About 20 grapes or cherries . cup fruit juice . med melon (eg. rockmelon) Dried fruit (4 dried apricots) 1. tblspn sultanas 1 cup diced pieces/canned fruit
Have fresh or tinned fruit as snacks
Add chopped fruit or dried fruit to your cereal
Include salad vegetables on sandwiches or rolls
Make plant based foods the main part of each meal e.g: salad with chickpeas or kidney beans,
Try a vegetarian meal once or twice a week
How to eat more fruit and vegetables
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So you can see that for a healthy diet you need to eat mostly plant based foods. Here are some ways to increase the amount of fruit and vegetables you eat daily.
Eat moderate amounts of: Fish Lean red meat Lean chicken Legumes Nuts Eggs
What is a healthy diet?
One serve = • 65-80g lean meat cooked (palm size)•100g cooked or one small can of fish•1 cup(150g) cooked legumes/beans • 30g (small handful) nuts•2 eggs
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Meat, fi sh, poultry & alternatives 65-100m cooked meat/chicken (eg .1/2 cup mince/2 small chops/2 slices roast meat) 80-120g cooked fi sh fi llet, or, as an alternative try: 2 small eggs ⅓ cup cooked dried beans, lentils, chick peas, split peas or canned beans 1/3 cup peanuts/almonds As well as plant based foods, for a healthy diet you also need moderate amounts of protein. This is where you need to be particularly careful what you choose. Because most of these foods come from animal sources they can be a source of saturated fat. Too much saturated fat in the diet can lead to high blood cholesterol. You need moderate amounts of meat, chicken, fish and meat alternatives for the protein, iron, zinc and B vitamins they provide. You need 100-150g meat, fish, chicken etc a day which is a piece about the size of a deck of cards. Try to limit processed meats like sausages and deli meats like salami and luncheon. Trim any meats of fat and remove the skin from chicken before cooking. A recent report from the Heart Foundation recommends up to 6 eggs per week, as long as you are eating a low saturated fat diet.
Daily Intake: 2-4 serves per day
Low fat milk or soy milk
Low fat yoghurt
Reduced fat cheese
One serve =
1 cup of milk (250ml)
200g tub of yoghurt
40g of hard cheese
½
cup ricotta
What is a healthy diet?
Try to limit cheese and ice-cream to twice a week
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Milks, yoghurt, cheese & alternatives We need 2-4 serves of milk, yoghurt or cheese for the protein, calcium and B group vitamins these foods provide. 4 serves of dairy for women over the age of 50 A serve is a cup of milk, 200g of yoghurt, 2 slices of the ready sliced cheese or matchbox size of block cheese. The key to choosing heart healthy dairy products is to choose low fat products such as reduced fat or skim milks, yoghurts and reduced fat cheeses or soy products. Include small portions of reduced fat cheese (20-40g) up to 4 times a week is recommended. By including these dairy products you can get the protein, calcium and B vitamins you need without the artery clogging saturated fat.
¼ meat, fish,
chicken
¼ potato, rice, pasta
½ vegetables
Heart Healthy Choice
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So to put all these recommendations into terms of meals (you might like to use food models for this) to put together a well balanced meal, half of what you eat needs to be free vegetables, ¼ needs to be some sort of carbohydrate such as bread, starchy vegetable, rice or pasta, and ¼ needs to be protein such as meat, chicken, fish or legumes.
Fruit: all types
Low fat yoghurt
Fruit bread
Nuts (unsalted)
Air popped corn
Wholegrain crackers with tomato
Vegetable pieces with hummus
Fruit scones (without cream)
Heart Healthy Snacks
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Try some heart healthy snacks, these are great for everyone!
Does it matter if I am UNDERWEIGHT?
Your muscles lose
strength, including the heart which increases shortness of breath
Your body has less energy and nutrient stores
You can become even more tired
You have
reduced resistance to infection
Poor Appetite and Weight Loss
High energy, high protein foods to prevent weight loss
Choose foods high in healthy fats/oils
Eat in between meals
Try milk drinks in between meals
Fats and Oils
What is dietary fat?Dietary fatDietary fat
Saturated Unsaturated
Trans Polyunsaturated Monounsaturated
n-6 PUFA n-3 PUFA
Plant n-3 Marine n-3
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Before we go any further - this is a chart of relationship between types of fat: Saturated fat – called this because of chemical structure meaning that there are no free spaces for other atoms to join the molecule. This means that they will pack closely together like if you were packing rulers in to a box. In the majority of cases this gives them usually a more solid form at room temperature like butter, lard, dripping etc. However, there are 2 exceptions to this – coconut and palm oil. Unsaturated – means that there are places on the molecule where other atoms can join in, at points where there is a double bond in the carbon chain. Mono =one spot or poly = many spots or more than one spot. This means that the molecule’s chemical structure is bent at the double bond and therefore not able to pack as readily together like coat hangers being packed in a box. This means that the form of these types of fats are usually softer or more likely an oil at room temperature. Omega-3s or n-3s are a type of PUFA. Although the focus is on the marine n-3s, this paper discusses both marine as well as plant and other animal types of n-3s. All these types of fats and their relationship to cardiovascular health are included in the 2009 Summary of Evidence: Dietary Fats, dietary cholesterol and Cardiovascular Health. This current presentation will focus only on omega-3s.
•
LDL (‘BAD’)
CholesterolCan block blood vessels
•
HDL (‘Good’)
Cholesterol Protects against heart disease
•
TriglyceridesHigh levels may increase the risk of heart disease
Dietary cholesterol can increase blood cholesterol but not as much as saturated fat.
What is Cholesterol?
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Firstly I will explain what cholesterol actually is and why having high levels is risky in terms of heart disease: Cholesterol is a white waxy substance that circulates around the body in the blood. Most of the cholesterol in the blood is made by the liver. Only a very small percentage comes from the foods we eat. Cholesterol has some very important jobs in the body like producing hormones and digesting food in the gut. The problem occurs when the liver makes too much cholesterol. There are two main types of cholesterol that make up your total cholesterol. “bad cholesterol” or LDL cholesterol acts like a delivery van and deposits cholesterol as it is needed around the body. If LDL cholesterol is too high, then over a period of time it can cause a build-up of plaque in the arteries, particularly those of the heart, causing the inside of the arteries to harden and become narrow. By following the heart healthy diet I am about to show you, you can help prevent the liver from making too much cholesterol. “good cholesterol” or HDL cholesterol acts more like garbage trucks. They tend to “mop up” excess cholesterol, moving it away from artery walls and back to the liver. So the higher your levels of HDL’s the better. Regular exercise can help increase HDL Cholesterol. Triglycerides - these are another type of blood fat. High TGs also increase your risk of heart disease. Triglycerides tend to be high in people who are overweight and inactive. They also tend to be high in people who eat a lot of sugary or fatty foods or who drink a lot of alcohol.
Raise blood cholesterol
Should be avoided
Fatty meats, pies, pastries
Fried foods, takeaway foods
Full fat dairy products, butter, cream,
Coconut oil
Saturated Fat
Usually found in animal products
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Fats are an important part of a healthy balanced diet and should not be excluded however it is important we look at the types of fats we are consuming Saturated fat is the type of fat we are aiming to eat less of as they are the less healthy fats. These fats tend to be found in animal products and have been shown to raise blood cholesterol levels. EXAMPLES
Trans Fat
Acts like saturated (“bad”)
fat in the body
Formed during the hydrogenation process
Reducing the amount of saturated fat in your diet will reduce the amount of Trans fats as well
‘In Australia hydrogenation is no longer used, margarines and polyunsaturated oils in the
supermarket contain negligible amounts of trans fats.’ The Heart Foundation 2013
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Trans fat is another type of fat you may have heard of.. Trans fats act like the saturated fat (we’ve just discussed) in the body –contributing to increase cholesterol Trans fats are found in some foods such as dairy products and meat in small amounts, but are primarily found in foods which used hydrogenated or partially hydrogenated vegetable fats such as baked products like pies, pastries, cakes, biscuits and buns. Years ago, most margarines had high levels of trans fats –although this is no longer the case in Australia as processing techniques have improved (choosing a product with the heart foundation tick is always a good choice, as these products are subject to ongoing random testing to ensure they remain compliance with a low trans fat content.) **’In Australia the process of esterification is now used in margarines –the healthier oils are combined with other ingredients such as milk, water and salt to develop a smooth consistency for spreading. Lecithin (found in egg yolk) is added for helping to mix water with oil. This makes it possible to develop margarines that are lower in saturated fats and virtually free of trans fats’ The Heart Foundation 2013 The main point to take away from this slides is that trans fats act like saturated fats, trans fats can raise total blood cholesterol levels, as well as raise the LDL or bad component of blood cholesterol. However, unlike the saturated fat they can also lower the good HDL component of cholesterol. Reducing amount of saturated fat (the products we have already talked about) in your diet will reduce the amount of Trans fats. It is understood that high cholesterol foods for eg. eggs, prawns do not contribute to increases in blood cholesterol levels.
Monounsaturated Fat
Neutral effect on cholesterol
Polyunsaturated Fat
Helps reduce “bad”
LDL cholesterol
Most ofthe fatyou eatshould be
Unsaturated Fat
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So in summary: Saturated fats raise blood cholesterol and should be avoided. We need to include moderate amounts of mono and polyunsaturated fats in the diet because these help lower blood cholesterol.
Eat moderate amounts of Mono & Polyunsaturated Fats
Unsaturated Fats
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Good sources of Monounsaturated & Polyunsaturated fats include… Vegetable/Plant based oils (Olive, canola, peanut, sunflower, safflower, corn and soybean oils) Polyunsaturated margarine Nuts & Seeds Avocado Fish (salmon, tuna, mackerel, sardines, pilchards). Think about how you could include some of these in your diet.
The Heart Foundation is urging all Australians to eat two-three serves of fish, including oily fish (canned sardines, atlantic salmon, canned tuna, frozen and fresh) each week to reduce their risk of heart disease
Omega 3 (Fish)
Polyunsaturated Omega 3
Omega 3 (Plant)•
nuts and seeds , particularly walnuts, flaxseeds (linseeds)
•
oils or spreads made from soybeans and canola.
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. Eating fish is the best and the recommended way to consume essential Omega-3 nutrients for heart health, however supplements will provide people who do not eat fish with some level of marine-sourced Omega-3s. There is no evidence to suggest that Omega-3 supplements are harmful in any way. - We recommend that you read the labels on supplements or consult with your local pharmacist or health professional to identify supplements that contain the correct levels of omega-3s. Primary prevention of coronary heart disease (CHD) Consume between 250-500mg per day of combined docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA) through the consumption of two to three servings of fish (around 150-200g serve), including oily fish, per week. Secondary prevention of CHD Consume about 250-500mg per day of combined DHA & EPA through the consumption of two to three serves of fish (150-200g), including oily fish, per week. Provide omega-3 LCPUFA supplementation as an additional therapy for patients with heart failure. Hypertriglyceridaemia Consider use of supplements to achieve up to 4000 – 5000mg in addition to standard therapy Alpha-Linolenic Acid Consume at least 1 g per day of alpha-linolenic acid (ALA) consistent with NHMRC recommendations - Looking for omega 3 foods enriched with omega 3 (milk, yoghurt, bread, eggs, soymilk)
Plant Sterols (Phytosterols)•
Plant sterols are a naturally occurring part of all plants.
•
Plant sterol enriched foods are foods which have had plant sterols added to them.
•
Consume 2–3 g per day from margarine, breakfast cereal, reduced fat yoghurt or reduced fat milk
•
In particular, choose at least one daily serve of fruit or vegetable high in beta-carotene such as:
carrots, pumpkin, broccoli, spinach, squash
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Consume at least 1 g per day of alpha-linolenic acid (ALA) consistent with NHMRC recommendations Plant sterols (or phytosterols) are a naturally occurring part of all plants. They are mainly found in vegetable oils but are also present in smaller amounts in nuts, legumes, grains, cereals, wood pulp and leaves. What are plant sterol enriched foods? Plant sterol enriched foods are foods which have had plant sterols added to them. The main sources of plant sterols added to foods in Australia are soybean oil or tall (pine) oil. What effect do plant sterols have on blood cholesterol levels? Plant sterols have been shown to lower blood cholesterol levels by about 10% depending on the age and individual metabolism of the person. The lower your blood cholesterol level the lower your risk of heart disease. Plant sterols and cholesterol have a similar chemical structure. Because of their similarity, plant sterols and cholesterol compete for absorption in the Position statement on phytosterol/stanol enriched foods The key findings in relation to phytosterol/stanol enriched foods are as follows. • A daily intake of 2–3 g phytosterols have been shown to lower blood cholesterol levels by up to 10% depending on the age and individual metabolism of the person. • Consuming more than 3 g per day phytosterols provides no additional benefits. And recommendations are as follows: Adult Australians with high absolute risk of CVD benefit from the cholesterol-lowering effect of consuming naturally occurring phytosterols in plant foods and phytosterol enriched foods. Therefore, the Heart Foundation recommends they do the following. 1. Consume 2–3 g of phytosterols per day from margarine, breakfast cereal, reduced fat yoghurt or reduced fat milk enriched with phytosterols. As Australian regulations allow a minimum of 0.8 g and a maximum of 1.0 g phytosterols per serve of food, this is two or three serves per day of these fortified foods. 2. Consume phytosterols within a healthy balanced diet low in saturated and trans fat and high in oily fish, wholegrains, fruits and vegetables. See the Heart Foundation’s Healthy eating and drinking tips at www.heartfoundation.org.au for more information. In particular, choose at least one daily serve of fruit or vegetable high in beta-carotene such as: • carrots, pumpkin, broccoli, spinach and squash • apricots, mangoes and rockmelon.
Margarine or avocado not butter
Oils for cooking
Salad dressings and
mayonnaise (97% fat free)
Nuts (unsalted) as snacks or on breakfast cereal
Fish at least
twice a week
Ways to include heart healthy fats
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Here are some more suggestions.
Salt
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Salt / Sodium
Salt in the diet =
Causes fluid retention in the legs and lungs
This makes your heart have to work harder
This can increase your blood pressure
Water stays in the body
Eat more fresh & unprocessed foods!
Go easy on the saltOccurs naturally
Added during cooking or at the table
Supermarket & takeaway foods
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Remember is to go easy on salt particularly if you have high blood pressure. Avoid adding salt to cooking or at the table. However, 80% of the salt we eat is added to processed foods that we buy at the supermarket. 1/3 of this hidden salt is from cereals, bread, cakes and biscuits. The easiest way to avoid salt is to eat more fresh/unprocessed food, read nutrition panels carefully and avoid highly salted foods.
Currently the average Australian eats around 9.5g of salt per day. However the Heart Foundation recommends no more than 6g (2300mg sodium). For people with high blood pressure or at risk of cardiovascular disease it is recommended to have no more than 4g (1550mg). Heart Foundation Steps to reduce salt: 1. Choose Mainly fresh foods and processed foods labelled with no added salt, low salt and salt reduced (<120mg/100g) 2. Avoid adding salt in cooking. This includes sea salt, rock salt, cooking salt, salt flakes, flavoured salt, stock cubes/ powder/ paste, gravy powder 3. Use alternative flavourings for example herbs and spices, garlic, onion, lemon or lime juice 4. Choose Heart Foundation Tick products 5. Avoid highly salted foods such as takeaway, processed meats, sausages, sauces, mayonnaise, salad dressings 6. Include plenty of high potassium foods, particularly fruit and vegetables
For more information There is more information about food labelling on the FSANZ website www.foodstandards.gov.au
Reading Labels: Nutrition PanelMeasured in kilojoules (kJ)
or calories (cal).
Includes ALL fats including saturated fat
•Includes both sugars and starches
•Includes natural and added sugar
Look for 100gram column
Saturated fat
Salt
Know what you are eating!
Read the
LABEL
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Presentation Notes
Become a label reader. This way you will know what is in the products you pick up at the supermarket. Being able to understand the nutrition panel on products will empower you to be able to make healthy choices and to see through the bogus claims you see on product labels. Provide the label reading handout. Since December 2002 it became law that almost all packaged products need to provide a nutrition panel. The nutrition panel tells you how much energy, protein, total and saturated fat, carbohydrate, sugars, fibre and sodium is in the product per serve and per 100g. The per 100g column allows you to compare different products. The following are some general guidelines to help you choose healthier products. Firstly, look at the total fat per 100g. Try to choose products that have less than 10g of fat per 100g of the product. Also look at the amount of saturated fat per 100g. The lower the saturated fat content, the healthier the product. It is also important to check how much sugar per 100g the product has. Many products are labelled as “low fat” but contain a lot of added sugars. Try to choose products that have less than 10g of sugar per 100g of the product. To find out how much fibre is in a product, check the per serve column. It is important to check the fibre content of bread, breakfast cereals, crisp breads etc. Try to choose foods that have more than 2-3g of fibre per serve. Finally, the sodium content tells you how much salt has been added to the product. A low sodium product is one that has less than 120mg sodium per 100g. Most fresh foods like fresh meat, vegetables, fruit and dairy products would have less sodium than this. Watch the sodium content of bottled and canned products, processed meats and pre-prepared meals. Try to avoid products that have more than 400mg sodium per 100g.
A good choice:
Less than 3g saturated fat per 100g food
Less than 10g sugar per 100 g food
Know what you are eating!Read the label
For salt (sodium):
Aim for 120mg sodium per 100g
Avoid if more than 400mg sodium per 100g as a guide for processed foods
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This is a guide only, so some exceptions include: Breakfast cereals with added dried fruit will have a higher sugar content, so read the ingredient list. Low fat yoghurts are usually less than 1% fat
Reading Labels: Ingredients in disguise!
FAT=vegetable oil/fat
beef fat shortening
cophalard, tallow
hydrogenated oilspalm oil
coconut oil milk solids
SUGAR =honey, golden syrup
sucrose, dextrose malt, maltose
glucose, glucose syrup
corn syrup fruit juice concentrate
molasses fruit syrup
Helps you to compare foods to make a healthier choice when shopping
The more stars the healthier the choice
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What is the Health Star Rating? It is a guide to assist consumers to make informed, healthier choices when buying packaged foods. What do the stars mean? The Health Star Rating or Stars or HSR is a guide on the front of a food pack to help consumers understand the nutrition content of a food at-a-glance, and to make informed food purchases and healthier eating choices. The Stars rating is from a ½ star up to 5 stars. The more stars, the more nutritious the product. How are stars calculated? The HSR rating is determined using a calculator based on food components - energy, saturated fat, total sugars, sodium, protein, dietary fibre, and fruit, vegetable, nut and legume content.
Choose 3 food packets
Look for the 100g column
Look at FATLook at
SATURATED FAT
Look at SODIUM
Key Recommendations
Enjoy a wide range of foods from all food groups
Learn to read food labels
Watch salt intake to help control heart failure
Watch fluid to help control heart failure
Questions?
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Any Questions? Provide handouts
Myth Busters
“Coconut oil is healthy, and should be used in cooking wherever possible.”
False!Coconut oil is made up of 85-90%
saturated fat. Saturated fat increases total cholesterol and LDL (bad) cholesterol,
and thus increases the risk of heart disease.
At this point in time, the Heart Foundation does NOT recommend using coconut oil.
Myth Busters
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Presentation Notes
“Coconut oil is healthy, and should be used in cooking wherever possible.” False! Recently, there has been discussion around the potential benefits of coconut oil. However, in reality, coconut oil is around 85-90% saturated fat. We know saturated fat increases total cholesterol and LDL (bad) cholesterol, and thus increases the risk of heart disease. Furthermore eating high fat foods (like coconut oil), which are therefore higher in energy, makes weight control more difficult. Therefore at this point in time, with current evidence, the Heart Foundation recommends avoiding coconut oil.
“The dietary cholesterol found in eggs will increase my blood cholesterol.”
False!Cholesterol in food, such as eggs, has only
a small effect on LDL cholesterol. Saturated and trans fats in food causes a much greater increase in LDL cholesterol.
You can eat up to 6 eggs per week without increasing your risk of heart
disease.
Myth Busters
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Presentation Notes
“The dietary cholesterol found in eggs will increase my blood cholesterol” False! Cholesterol in food, such as eggs, has only a small effect on LDL cholesterol. Saturated and trans fats in food causes a much greater increase in LDL cholesterol. All Australians, including those with type 2 diabetes or metabolic syndrome, can eat up to six eggs a week as part of a healthy balanced diet low in saturated fat without increasing their risk of heart disease.
“Butter is healthier for me than margarine”
False!Butter is around 50% saturated fat –
that’s
the unhealthy fat that raises our cholesterol levels. Margarine is a much
healthier choice because it has a maximum of only 20% saturated fat.
Myth Busters
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Presentation Notes
“Butter is healthier for me than margarine because it is more natural” Butter is around 50% saturated fat – that’s the unhealthy fat that raises our cholesterol levels. Margarine is a much healthier choice because it has a maximum of only 20% saturated fat. Used daily in place of butter, margarine helps us to maintain a healthy cardiovascular system.
“The Paleo diet is healthy and will help me lose weight once and for all”
False!The Paleo diet is based on vegetables, fruit, nuts, roots and meat. While these foods are healthy, the diet excludes grain foods (breads and cereals) which are an important source of
energy and fibre, and dairy foods which provide calcium, vitamins and minerals.
By following the Paleo diet, you may be missing out on important nutrients. Even if you lose weight in the short term, diets that are too restrictive (ie. cut out whole food groups),
are often too hard to follow ongoing. For long-term sustainable weight loss, the Dietitians Association of
Australia recommends following the Australian Dietary Guidelines.
Myth Busters
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Presentation Notes
“The Paleo diet is healthy and will help me lose weight once and for all” False! The Palaeolithic period is a period of human history extending from approximately 2.5 million to approximately 10,000 years ago. Early in this period, people ate primarily vegetables, fruit, nuts, insects, roots, and meat, which varied depending on season and availability. While these foods are healthy, the diet excludes whole food groups including dairy and grains. Dairy foods are an important source of calcium, Vitamin D, magnesium and phosphorus. We know that most Australians do not get enough calcium which is important to build strong bones and teeth. Avoiding dairy foods is a difficult choice and places limits on what can be cooked at home and eaten when eating out. Grains and grain-based foods are an important energy source for our brain and muscles and they provide essential vitamins, fibre and satiety value in the diet. These carbohydrate foods are fuel to the probiotic (helpful) bacteria in our gut and are critical for a healthy digestive tract. There is strong evidence that a diet high in whole grains is associated with lower body mass index, smaller waist circumference, and reduced risk of being overweight and that a diet high in whole grains and legumes can help reduce weight gain; and that significant weight loss is achievable with energy-controlled diets that are high in cereals and legumes. The secret to combating weight gain and chronic disease is understanding that certain foods are needed each day for good health and whole food groups shouldn’t be excluded. What we all need to review is the frequency of ‘extra’ or ‘discretionary’ foods that we eat. While the emphasis on fruit and vegetables, and high- quality food choices rather than processed options is a positive feature, the diet fails to provide all nutrients as per current recommendations and excludes foods and whole food groups. The modern Paleo diet has been tested in very few people and only over the short term. Participants often drop out of the studies because the diet is difficult to adapt to and it is reportedly more expensive. Even if you lose weight in the short term, diets that are too restrictive (cut out whole food groups), are often too hard to follow ongoing, and any weight that is lost may be regained in the long term. For long-term sustainable weight loss, the Dietitians Association of Australia recommends following the Australian Dietary Guidelines. Many Australians are overweight, and are seeking options for weight loss. Accredited Practising Dietitians (APDs) adapt the current Australian Dietary Guidelines (ADGs) to assist individuals with weight loss, considering their lifestyle, food preferences, food availability, economic factors and their current health status.
“I should eat dark chocolate, and drinking red wine to reduce my risk of heart disease, because they contain
antioxidants”False!
Whilst there is evidence to suggest antioxidants found in foods can contribute to reducing heart disease, dark chocolate
and red wine are not good sources for heart health.
Myth Busters
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Presentation Notes
“I should eat dark chocolate, and drinking red wine to reduce my risk of heart disease, because they contain antioxidants” False! Whilst there is evidence to suggest antioxidants found in foods can contribute to reducing heart disease, dark chocolate and red wine are not good sources for heart health. (Outlined in next slide)
Antioxidant source
Good choice for heart health
Recommendation as per the Heart Foundation
Fruits and vegetables True Eat 2 serves of fruit, and 5 serves of vegetables per day.
Tea True Black or green tea made with leaves or tea bags. (May add reduce, low or no fat milk).
Coffee True People who already drink coffee, should drink less than 5 cups per day of instant, paper-filtered, percolated, or café-
style coffee in preference to boiled or plunger coffee.
Raw cocoa powder True Use raw cocoa powder in drinks and cooking.
Dark chocolate False Most commercial chocolate will be a poor source of
antioxidants.
Red Wine False The amount
of alcohol has more impact on cardiovascular health than the type
of alcohol consumed. People who already drink, should consume no more than two standard drinks per day.
Antioxidant supplements False Combination or individual antioxidant supplement are not
recommended for the prevention of cardiovascular disease.
Antioxidants for the heart
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This table outlines which antioxidant containing foods are a good choice for heart health, and the recommendations as per the Heart Foundation. Fruits and vegetables – Whole fruits and vegetable naturally contain antioxidants, as well as fibre, vitamins and minerals. The Heart Foundation recommends consuming at least two serves of fruit and five serves of vegetables every day, and recommend their consumption to lower risk of heart disease. Tea – Black and green teas made with leaves or tea bags can contribute to daily antioxidant intake because they contain some polyphenols. Remember that adding milk and sugar to tea may increase energy intake, depending on the number of cups consumed. Choose reduced, low or no fat milk. Coffee - Coffee can provide some polyphenols, but the Heart Foundation recommends fewer than five cups per day and only of paper-filtered, percolated, café-style or instant coffee, as these types of coffee have little effect on LDL cholesterol levels. Coffee contains oils that raise LDL cholesterol levels. These oils are removed though paper, so instant coffee or coffee that is filtered through paper or the fine metal filter on an espresso machine won t contain these oils. Coffee made with a plunger or by boiling grounds on the stove top (such as Greek or Turkish boiled coffee) contains the oils at levels that will raise LDL cholesterol more than paper-filtered (drip coffee), café-style (such as espresso, latte and cappuccino) or instant (regular and decaffeinated) coffee. Raw cocoa powder - Scientific studies have found that consuming high polyphenol cocoa/chocolate reduced risk factors for cardiovascular disease, such as endothelial function and high blood pressure. While the research showed benefits from high polyphenol cocoa/chocolate, everyday products that use high polyphenol cocoa/chocolate are not widely available. Raw cocoa powder has high levels of polyphenols, and we support using raw cocoa powder in drinks and cooking. Raw cocoa powder is made from raw cocoa beans (cocoa beans that have not been fermented and roasted, a process that can lower their levels of polyphenols). However, roasted cocoa powder is used in most drinking chocolates and commercially available chocolates. Raw cocoa powder and beans are not widely available in supermarkets, but may be found in health food shops. You can use raw cocoa powder by: making a cocoa drink using warm reduced, low or no fat milk adding it to drinks, adding it to fruit smoothies, sprinkling it on dessert, chopped fruit and salads and using it in desserts. Dark chocolate - Dark chocolate is generally thought of as being a healthier than milk chocolate, because it has higher levels of cocoa solids and therefore higher levels of antioxidants. However this is not true of all dark chocolate. Some dark chocolate is processed to remove the bitter astringent taste of the antioxidants, and some may have been artificially coloured to make it look darker. Unfortunately, because food labelling laws in Australia don t require the levels of antioxidants in foods to be written on the label. It is very difficult to know if a type of chocolate is high in polyphenols. Some products are labelled with % cacao (total chocolate liquor, cocoa butter and cocoa powder). The higher the percentage, the less sweetness and more flavour, but this is not an indication of the antioxidant content of the chocolate. Therefore, we don t recommend some types of chocolate as being a better choice than others. Even good quality dark chocolate that contains some antioxidants may also contain cocoa butter, sugar and whole milk powder, making it high in energy (kJ) and saturated fat. Saturated fat in food raises low-density lipoprotein (LDL) cholesterol, and too much energy can increase weight. Although a chocolate may contain antioxidants, there are other foods and drinks that are better sources of antioxidants for cardiovascular health that do not have the negative effects of unhealthy fats. These foods include fruit, vegetables, nuts, seeds, wholegrains, cereals, black and green tea, garlic, herbs and spices. Red Wine - The Heart Foundation found a lack of consistent evidence to confirm that the antioxidants in red wine can either prevent cardiovascular disease or be beneficial after a heart attack. It is more important to abstain from drinking or if you drink alcohol, to avoid binge drinking to maintain long-term health. Therefore the quantity of alcohol drunk is more important than the type of alcohol drunk. While red wine contains a variety of polyphenols (the amount varies greatly between each bottle), red wine is not a good source of antioxidants for preventing coronary heart disease or maintaining cardiovascular health. As per our discussion earlier, The Australian National Health and Medical Research Council recommends that healthy men and women drink no more than two standard drinks a day to reduce their risk of harm from alcohol-related disease or injury. Antioxidant supplements - Currently, there is insufficient data to recommend the consumption of a combination of antioxidants or individual antioxidant vitamin supplements for the prevention or treatment of coronary heart disease. The best way to ensure adequate antioxidant intake is to eat a variety of plant-based foods, such as vegetables, fruits, legumes, wholegrain breads and cereals, nuts and seeds every day.
Fluid
Presenter
Presentation Notes
Any Questions? This education on fluid maybe provided by nursing.
Controlling Fluid Intake
You may be asked to limit the amount
of fluid you drink each day to help
control your heart failure
What is Fluid?
Anything you drink→Tea, Coffee, Water, Milk, Fruit Juice, Soft Drink,
Cordial, Alcohol
Any foods which can become a liquid in your mouth→ Soup, Ice-cubes, Juice in canned fruit, Ice-cream,
Jelly, Custard, Yoghurt, Sauces, Gravy, Watermelon (more than one slice)
How to Control Fluid Intake
Measure the amount of liquid your
drinking
container holds so you can accurately record your daily intake (mugs, cups, glasses)
Write down the quantity of fluid you drink during the day
Regularly check with your GP and/or specialist regarding how much fluid you require
How to Control Fluid Intake
Have your fluids at the time of day that is most important to you
Limit fluid intake at home so you can drink more on social occasions
Reduce salt and salty foods in your diet to help reduce thirst
Some medications may be able to be taken with foods rather than liquids
Use smaller cups and glasses
Presenter
Presentation Notes
Remember not to over-restrict your fluid intake. If you don’t drink enough fluid you can become dehydrated. Ensure you meet your fluid limit each day, less is not always better.
How to moisten a dry mouth
Suck on fresh fruit that has been refrigerated or frozen
Suck on ice cubes or ice blocks
Rinse your mouth with water or mouth wash
Suck lemon or mints to increase saliva
Chew gum
Fluid intake in Summer
Check with your Doctor, if you are allowed to increase your fluid intake in Summer
Use a wet washer to cool down when it’s hot or take a shower
Remember: 1 litre of fluid weighs 1 kilogram
Weigh Yourself Daily
Weigh yourself every day
Weigh at the same time each morningStep 1: wake up
Step 2: go to the toilet
Step 3: weigh yourself, with the same clothing.
Step 4: write down your weight
Weight gain = fluid is building up in the body
Weight gain more than 1.5kg per day = restrict your fluid and see your doctor immediately
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