Summary Points

·  Current dietary recommendations are that individuals should be taking in at least 2 cups of fruits a day and 2-3 cups of vegetables

·  We should be moving toward a plant-based pattern of eating

·  To make meaningful lifestyle changes, focus on one goal at a time

·  Take advantage of professional help and technology

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Lynda: Hello, my name is Lynda Murdock and I have with me Nancy Houston Miller, the Chief Medical Officer for Moving Analytics. Today we are talking about diet and cardiovascular health. Nancy, can you give us a brief intro and tell us a little about your background?

Nancy: Certainly, I am a registered nurse and have worked in the School of Medicine at Stanford for three decades and I'm heavily involved with the dietary therapy and management of patients with cardiovascular disease. It is a pleasure for me to be here today.

Lynda: I understand that you recently attended a conference where dietary guidelines for the cardiac patient were discussed in detail. What were your key takeaways from that conference?

Nancy: This presentation was given by a well-known dietician, Catharine Christie, at the Preventive Cardiovascular Nurses Association national symposium and focused on diet and cardiovascular health. There were many take-away messages. I think initially it's important for me to point out that the American public receives dietary guidelines every five years and the next guidelines will be presented in 2021. The Dietary Guidelines right now indicate that we are well below our consumption of daily fruits and vegetables.

The recommendations are that individuals should be taking in at least 2 cups of fruits a day and 2-3 cups of vegetables. Presently we are eating about 1 cup of fruit and 1.5 cups of vegetables, well below these recommendations. Our diet is also too high in sodium, sugar, and saturated fats. In fact, if you look at an analysis of dietary scores based upon these current recommendations, less than 1% of adults in the United States really have a healthy dietary score. Finally, we’re eating too many pro-inflammatory foods such as red meats, saturated fats, and sweets rather than a diet which is high in fruits and vegetables, as well as whole grains.

Lynda: What is the best way to assess or measure a person’s current diet, so they know where to begin when making necessary changes?

Nancy: Well there are many dietary assessment tools that have been widely researched. These are crude measures of dietary intake but can form the basis for a discussion about diet. One of these is known as the Mediterranean index adequacy score or index which measures the adequacy of the Mediterranean diet as a dietary pattern. The tool is a 14-item scale which has been well-validated and was used in the PREDIMED study in Spain, a randomized controlled trial of the Mediterranean diet. If you score a 10 or greater on that particular dietary assessment tool you're eating well within the Mediterranean diet.

Lynda: What are some actionable items that people with cardiovascular disease can do to improve?

Nancy: So ideally, as I mentioned, we should be moving toward a plant-based pattern of eating which includes more fruits and vegetables, whole grains, dietary fiber and healthy fatty acids.

And these are also foods that are rich in vitamins, antioxidants, potassium, and in phytochemicals.

Examples of the plant-based diet that people can choose include the DASH diet, the Mediterranean diet, the vegetarian diet, as well as the USDA diet that is recommended as part of the guidelines. These diets involve increasing our fruits and vegetable intake as I mentioned to 2.5 cups of vegetables a day and at least 2 cups of fruits per day. They also include a lot of whole grains, legumes, nuts and seeds which are complex carbohydrates, and add fiber and protein. It's also been suggested that we decrease our meat, fish, and poultry intake to less than six ounces a day if you're looking at a dietary pattern such as the Dash diet.

Lynda: How can we help people adapt to these lifestyle changes?

Nancy: Well diet is never easy, and my recommendation is that you really look at your overall dietary pattern by measuring it through some form of a dietary assessment tool such as the Mediterranean index, and then focus on one goal.  That goal might be to increase your weekly consumption of vegetables or fruits or to increase your consumption of whole grains. Once you have succeeded with a goal and maintained that change over a period of a month or so, you then could move to working on another goal. Because we're faced with making dietary decisions at least three times a day and sometimes five times a day if we're having snacks, it’s my suggestion that you master one change at a time which may greatly improve your success with that change.

Lynda: For those people who have difficulty in setting, achieving and or maintaining their goals, what would you recommend for them to increase their chances of success?

Nancy: Patients can always benefit from going to a dietitian to learn more about how to make small incremental changes. And the coaching aspect of being supported, by a dietician is important. We also know from the literature that those who seek out a dietitian often benefit in major way from not only making dietary changes but encountering weight loss as well. There are also many apps that are now available to support individuals with dietary change. These apps provide education and positive re-enforcement to help people stay on track. I would suggest looking at apps online and talking with healthcare professionals about which are those that support individuals with dietary change.

Lynda: Thank you so much for taking the time today to summarize the current recommendations for eating for cardiovascular health and identifying ways to improve our eating patterns. I look forward to continuing the conversation in the future.

Nancy: Thank you. It's been my pleasure.

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