Nutrition Intervention of CHDAmanda I’Ons Registered

Dietitian

Water

• Drink 2 litres or less of water per day • (if you on fluid restriction, adhère to doctors

recommandations)• Water is the most important nutrient• Restrict your intake of sodium to 1.5 g per

day. Non CHD adults restrict to 2.3g/day• Eat potassium rich foods each day such as

banana, pawpaw, potatoes, tomatoes, strawberries

Water- our most important nutrient

The Importance of Drinking Water

Salt

• Is often ‘HIDDEN’ in food• Names: mono sodium glutamine or

glutamate• Powders- sauces, soups, biltong• Pies, chips, fizzy colddrinks,

processed/instant foods• Be careful with potassium salt or salt

replacements• Use herbs and spices

6-8 glasses per dayhigh salt intake and high fluid intake may lead to fluid

retention and high blood pressure

Vitamins and Minerals

Vitamin D- deficiency may cause RicketsHypertensionCVDHeart FailurePeripheral arterial diseaseSources: sunlight 20minutes/dayDairy products, oily fish, egg yolk and cod liver oil or fish oils, supplement

Vitamin CVitamin EB-vitamins Magnesium and PotassiumZinc, Selenium

Fruit and VegetablesTwo main functions:•Soluble fibre• Plant sterols , sterolins and other phytontutrients•Vitamins and minerals•Also a source of CHO•* apple – pectin and phytonutrients•“An apple a day keeps the doctor away”.

Berries (mixed)All Berries are a very nutritious food source.They are one of fruit and foods with the most alkalising effect on the body.A poor diet, high in alcohol, coffee, sugar, smoke and unhealthy red meat will cause the body to become more acidic. Often manifesting as gout (purines) or other inflammatory diseases. Very high vitamin C Phyto chemicals in skin and fruitEat as desert or smoothie.

FibreWe need a total of 25-35g fibre (both soluble and insoluble)

dailyor 14g fibre per 1000kcal AI.

Whole grains (insoluble fibre) Fruit and Veg (soluble fibre)

FibreNeed 25-35g fibre per day

• Fibre is very important for gut health and to lower serum cholesterol levels.

• Gut micro-flora• Bile secretion- reduce serum cholesterol• Satiety effect, consequently reduce fat intake• Get soluble fibre: fruit, vegetables, oats, oat

bran, legumes- most important fibre.• Insoluble fibre: wheat, bran, whole grains- stool

bulking effect

How to increase your fibre intake

• Eat high fibre cereals, whole wheat breads, pasta and brown rice. And Legumes.

• Eat 5-6 servings fruit and vegetables per day and try to leave skins on.

• Eat high fibre low fat snacks e.g. Raw vegetables, fresh fruit and popcorn.

• Check labels for fibre facts- list the amount of fibre per serving or the words bran, whole wheat flour listed as one of the 1st five ingredients.

Fibre Content of Various Foods

Food Amount Soluble Fiber, g

Total Fiber, g

Legumes (cooked)

Kidney beans 1/2 cup 2.0 6.7

Pinto beans 1/2 cup 2.0 6.7

Vegetables (cooked)

Brussels sprouts

1/2 cup 2.0 3.8

Broccoli 1/2 cup 1.1 2.6

Spinach 1/2 cup 0.5 2.1

Zucchini 1/2 cup 0.2 1.6

Fruits (raw)

Apple 1 medium 1.2 3.6

Orange 1 medium 1.8 2.9

Grapefruit 1/2 medium 1.1 1.8

Grapes 1 cup 0.3 1.1

Prunes 6 medium 3.0 8.0

Grains

Oatmeal (dry)

1/3 cup 1.3 2.8

Oat bran (dry)

1/3 cup 2.0 4.4

Corn flakes 1 ounce 0.1 0.3

Brown rice (cooked)

1/2 cup 0.4 5.3

Whole-wheat bread

1 slice 0.4 2.1

White bread 1 slice 0.2 0.4

Selected Sources and Amounts of Dietary Fiber

Legumes•Hydro ½ cup cooked dried beans, lentils per day.•Include in meat/salads/rice/veg•? Glycaemic Index•Insulin- explained•Contribute to euglycaemia •Tolerance- bacterial overgrowth•Vegetarian meals approximately 3 times a week.

Insulin/Glucose Peak

Glycaemic Index Chart

Glycaemic Load

Sugars and Sweeteners

• Sugar- sucrose has medium glycaemic index• Honey- health properties, but high glycaemic

index• Insulin-peak, dip (revisited)• Artificial sweeteners• www.gifoundation.com

Confectionary

• Limit* low GI (avoid insulin peak)• Look for healthy recipes and alternatives• Eating for Sustained Energy by Liesbet Delport

and Gabbi Steenkamp• Chocolate- limit, black chocolate, 70% and

more cocoa. Or cocoa drink with low fat milk, limit sweetener.

Dairy Products•Very important source calcium, B-vitamins, vitamin A ,D and protein.•Not essential in adult diet- easily replaced•Vitamin D- deficiency may cause hypertension, CVD, Heart Failure, Peripheral Arterial Disease

•Calcium supplement•For cholesterol lowering purposes and weight management, low fat is best.•Nutritious, Organic vs non-organic•rBST free, free antibiotics, free range

Healthy cows in natural environment

BeefNot all beef is unhealthyAlways remove visible fat from meatAlways eat lean meat e.g. Lean minceFree range beef- during winter months reduced saturated fat and omega 6 fatty acids from grass diet.High corn diet, high hormone rich meat, usually with antibiotics.Meat bought may or may not be grass fed beef.

Lean meat cutsLean cutsAvoid organ meats- high in saturated fat and cholesterolAvoid shell fish- high cholesterolEggs- err on caution- use 3/ weekNo evidence increase cholesterolSerum cholesterol levels more affected by types and amount of fats we eat, fibre content diet, exercise and water than the amount of cholesterol eaten.All animal products contain cholesterolNo plant product contains cholesterol

Ostrich meat, considered healthy alternative

Free range chickensHealth benefits of diet free of antibiotics and hormonesThe chicken meat has lower fat content, fowl eats natural diet.

• Chickens on natural diet

Tunnel Produced Chickens

Free Range ChickensCholesterol:Less than 300mg/ day for healthy adultsLess 200mg/day for adults with high levels of LDL (BAD) cholesterol or who taking cholesterol lowering medication.Eggs- fatty acid content and cholesterol content1 egg on average has 200mg cholesterol and 5g fatBenefits; protein, vit D, riboflavinfolate folate

NutsContain fibre, calcium, protein and essential fatty acids.Most nutritious nut to eat is the raw, unsalted almond.Concentrated energy source, eat it in limited quantities ¼ cup or 7-14 nuts.Natural energy from the sun- we can’t measure it in calories.

NutsOmega 3 fatty acid :WalnutsOmega 6 Fatty acid:Soy nutsMonounsaturated fat:Almonds, cashews, peanuts, pecans, and butters made from these nuts.

Fats and OilsAll Seeds are importantThey contain essential poliunsaturated fatty acids.Fats and fatty acids are a very important part of management of Heart disease.Saturated fat- animal fats, must be reduced to 7% or less than 14g if you follow a 2000 calories diet.Poliunsaturated fats 10% of total fat intake e.g. Omega 3 and 6 fatty acids.Trans fats- dangerous, rancid fats, found in brick margarine and damaged sunflower oil. Try and have none- must be less 1% of your total calories. Read labels

Oils* Olive oil mono-unsaturated oil(only one unbound carbon)•Canola mix •Avocado pear oil•Grape seed- polyunsaturated oil with highest smoking temperature•Fry food- avoid, only occasionally, •All oils are damaged when heated• look for cold pressed oils

Comparison of Dietary Fats

Fish-wild salmon, pilchards

Fatty acid supplementsDosage: 1000mg ( EPA and DHA) omega 3 fatty acid for CHD patients.2-4g EPA and DHA per day for triglyceride lowering effect.Non cardiac patients 1000mg/day of EPA and DHA. OR eat oily fish 2 x per week (rich in linolenic acid) also include flaxseed, canola oil, soybean oil, flaxseeds and walnuts.Caution: contraindicated if on blood thinnersCholesterol lowering properties higher in fish source of oil than plant (more active molecules and body just absorb)Omega 6 fatty acids: 1000mg / dayStar flower, flax seed oil, evening primrose oil.

The Benefits of Omega 3 fatty acids

Flaxseed oil vs. Salmon oil

Flaxseed Oil Salmon or fish oil

Conclusion

• Watch your:• Water• Fibre• Fats and oils• Sufficient plant phytonutrients and vitamins

and minerals• Exercise/relaxation/Sunshine

Laughter is good for the heartand strength to the bones.

Contact Details

• Amanda I’Ons • Cellphone number 0792973936• Email address: avions.burg@gmail.com• High Rustenberg Hydro: 021-8093800• Stellenbosch