heart matters 11/22/2019 on BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3d0gbN0a5/T9JmmD8ac1jAYPDFWV8bEl4jjo2RC/9XaU= by https://journals.lww.com/nursingmadeincrediblyeasy from Downloaded The cardiac diet explained By Julie Nyhus, FNP-BC Downloaded from https://journals.lww.com/nursingmadeincrediblyeasy Managing cardiovascular disease (CVD) fish, whole grains and cereals, and moder- often involves a combination of pharma- ate amounts of red wine and dairy. The cologic therapy and a solid dietary ap- gaps that exist within the Mediterranean proach known as the “cardiac diet.” It’s diet regarding positive outcomes on heart critical that the foods we recommend for health are limited to the recommendations our patients be as carefully planned as of wine and dairy in moderation and the by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3d0gbN0a5/T9JmmD8ac1jAYPDFWV8bEl4jjo2RC/9XaU= the pharmacologic care they receive be- inclusion of whole grains and cereals. cause diet is an important part of cardiac The Lyon Diet Heart Study showed a health. Although there are often nutrition remarkable 72% decrease over a nearly controversies in scientific journals and 5-year period in major cardiovascular events among the lay press, there are evidence- for those who consumed a Mediterranean- based and broadly recognized recom- type diet compared with control groups. mendations that you can consider when This randomized controlled trial validated caring for patients with CVD, whether that diet plays a significant role in the sec- inpatient or outpatient. This article re- ondary prevention of CVD, and numerous views the top evidence-based cardiac diet prospective studies have also confirmed recommendations and discusses interven- these findings. The Lifestyle Heart Trial, a tions for nurses who assess, educate, and randomized controlled study that included care for patients with CVD. a low-fat vegetarian diet, stress reduction measures, and physical activity, showed a Overview regression in CVD. Since the 1960s when the Seven Countries It’s important to follow the trail of evi- study revealed that certain Mediterranean dence, especially when it comes to CVD. The populations experienced decreased CVD evidence overwhelmingly points toward a mortality due to their unique dietary patterns, several eating plans to sup- port heart health have emerged. Some of on 11/22/2019 the more popular ones are the American Heart Association (AHA) plan, DASH diet, Mediterranean diet, Ornish diet, and the US Dietary Guidelines for Americans. The heart-healthy benefits of the Medi- terranean diet continue to be the most widely examined. Several prospective cohort studies have evaluated the impact of primary and secondary prevention of CVD and confirmed that specific dietary patterns found in the Mediterranean diet are the cornerstone of CVD prevention. The Medi- terranean diet consists of olive oil, legumes, UDRA11 / SHUTTERSTOCK fruits and vegetables, nuts, lean meats and www.NursingMadeIncrediblyEasy.com November/December 2019 Nursing made Incredibly Easy! 5 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. heart matters refined grains; trans and saturated fats; sodi- key points um; and red meats, including processed Encourage meats such as bacon, salami, ham, hot dogs, • Fresh, frozen, or canned fruits and veg- and sausages. etables (unsalted) • Olive, canola, or peanut oil when cooking Implications for nursing practice • Raw or unsalted nuts and seeds, unsweet- History taking and the physical exam are ened nut butters essential evaluation tools that allow you • Fish, poultry, and small amounts of lean, red to determine the optimal dietary approach meat that are grilled, baked, or boiled (avoid for your patient. Correlate your patient’s fried) health history and head-to-toe assessment • Legumes and beans, such as great northern, with the cardiac diet but remember that pinto, black, garbanzo, and kidney beans • Low-fat dairy products, such as milk, cheese, cardiac knowledge isn’t limited to anat- yogurt, and cottage cheese omy and physiology—it encompasses the • Whole grains in moderation, such as oat- patient’s medications, risk factors, stress, meal, dried beans, barley, and brown rice exercise, and management skills. Primary Discourage areas of focus for cardiac assessment are • Sugars, such as table sugar, high-fructose serum lipids and glucose, body mass in- corn syrup, honey, candy, soda, sweetened dex (BMI), and BP. These should be rou- beverages such as fruit drinks or lemon ade, tinely assessed in patients with CVD and cane sugar, and agave taken into consideration when the cardiac • Artificial sweeteners diet is prescribed. • High-carbohydrate diets Knowledge of lab values such as total cho- • Low-carbohydrate diets lesterol, low-density lipoprotein cholesterol, • Red meat high-density lipoprotein cholesterol, and tri- • Sodium glyceride levels allows you to focus on lipid- • Refined grains • Fried foods lowering dietary options, such as healthy fats • Trans saturated fats found in fatty meats, found in fish and olive oil. Information about poultry skin, butter, whole milk dairy prod- serum glucose levels enables you to recom- ucts, tropical oils (such as palm, palm kernel, mend fewer refined and fried foods, along and coconut), and egg yolks with daily exercise to decrease insulin resis- • Processed foods such as packaged or fast tance. Direct patients with elevated lipid or foods glucose levels to the AHA website to discover • Processed meats, such as bacon, lunch that most fruits and vegetables are low in cal- meat, salami, ham, hot dogs, and sausages ories, fat, sodium, and cholesterol and are good sources of fiber, vitamins, and minerals. plant-based diet. Indeed, in its 2019 guide- Obtaining routine BP measurements lines on the primary prevention of CVD, the guides you to recommend significant American College of Cardiology and the lifestyle changes, such as smoking cessa- AHA confirmed beneficial dietary patterns tion or weight loss. Tracking BMI ensures that include plant-based diets or diets high that you focus on one of the most crucial in fruits and vegetables, nuts, whole grains, dietary recommendations for cardiac lean animal protein such as fish, and vegeta- patients: avoiding foods that contain par- ble fiber have been shown to lower all-cause tially hydrogenated vegetable oils, thereby mortality compared with a standard diet. In decreasing the amount of trans fat. This addition, longstanding dietary patterns intervention will assist with weight loss known to increase cardiovascular mortality while also impacting cardiovascular health. include sugar; artificial sweeteners; high- Encourage patients to replace the danger- carbohydrate diets; low-carbohydrate diets; ous fats found in beef, pork, lamb, poultry 6 Nursing made Incredibly Easy! November/December 2019 www.NursingMadeIncrediblyEasy.com Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved. with skin, lard, cream, butter, cheese, and full-fat dairy products with monounsatu- on the web rated and polyunsaturated fats. Healthy For you fats can be found in olive oil, fatty fish, and CDC: unsalted nuts. www.cdc.gov/heartdisease/healthy_living.htm Tools such as nurse-generated pam- Mayo Clinic: www.mayoclinic.org/diseases- phlets that outline dietary guidelines conditions/heart-disease/in-depth/heart- specific to patients with elevated BMI or healthy-diet/art-20046702 BP can assist in implementing changes. For your patients Patients with elevated BMI may ben- American Heart Association: www.heart. efit from understanding the difference org/en/healthy-living/healthy-eating/eat- between complex and simple carbohy- smart/nutrition-basics/aha-diet-and-lifestyle- recommendations drates, learning how to read food labels, or discovering that the cardiac diet isn’t CDC: www.cdc.gov/dhdsp considered “dieting” but is a lifestyle change aimed at decreasing the progres- provider to be assessed for any potential sion of CVD. dietary safety issues or undiagnosed med- Understand how overwhelming it can ical conditions. be for patients to cope with CVD, let alone change their diet at the same time. Encour- Follow the evidence age patients with CVD to make gradual Because CVD remains the leading cause dietary changes. For example, swapping of death in the US, with over 635,000 out processed foods for fresh or frozen deaths annually, the cardiac diet is a vegetables. Teach patients to replace sug- common adjunct to pharmacologic inter- ary snacks with fresh fruit, switch butter or ventions. As nurses, we’re a respected margarine for olive oil, and dine on and trusted source regarding lifestyle legumes on meatless Mondays. modifications and should be knowledge- As nurses, we’re a respected and trusted source regarding lifestyle modifi cations such as diets that will improve health outcomes for our patients. Point patients toward evidence-based able about diets that will improve health resources such as the AHA website, which outcomes for our patients. Familiarize provides patient-friendly information on yourself with the evidence surrounding specific diet and lifestyle recommenda- the cardiac diet and supporting resources. tions. Patients who face additional health Linking your patient’s health history challenges such as diabetes or other and physical exam with specific dietary chronic diseases may be best served by changes is one way you can make an im- discussing their specific nutritional needs pact. You can also provide informational with