Nutrition After a Cardiovascular Event

What’s Best and Why?

In this edition of Patient Pulse, we’re pleased to welcome Dr. Sara Folta for a discussion on nutrition after a cardiovascular event. Dr. Folta is an Associate Professor and Associate Dean for Diversity and Inclusion at the Friedman School of Nutrition Science and Policy at Tufts University. Her research interests focus on community-based strategies for improving diet, physical activity, and weight. A major line of her research involves community-based interventions to improve heart health among women. 

In this webinar, Dr. Folta addresses:

  • The evidence around which eating patterns work to prevent cardiovascular events
  • What the recommended eating patterns actually look like
  • Practical strategies to shift your eating pattern
  • Eating on a budget

Key Takeaways

  • The DASH and Mediterranean diets are proven heart-healthy eating patterns.
  • To make sustainable changes to your eating habits, choose one change to focus on first, such as “I will add a serving of vegetables to each meal for the next 3 weeks.”
  • Assess, revise, and reassess your goals and eating patterns over time to see if they’re working for you.
  • Practice CART to maximize your food budget:
    • Cook more, coupons, canned and frozen foods (be mindful of sodium), cut the amount of olive oil you use to save money (or use canola oil)
    • Avoid ready-to-eat and highly processed foods
    • Recipes and menu planning
    • Try to go meatless

Full Transcript

Sara Folta, PhD: So, here’s the overview of what we’ll talk about. First, we’ll talk about eating patterns to prevent another cardiovascular event, briefly touch on the scientific evidence on what those eating patterns actually look like, practical strategies, and then eating on a budget. It’s hard to get people to eat in an exact way for long periods of time, and there’s always all kinds of things that impact risk of a cardiovascular event. And because of that, there’s no perfect studies about diet and prevention after you’ve had an event, so we have to rely on a collection of imperfect studies. And that’s what we do, but we do have these collections of studies. And keep that in mind, the best evidence, to date, suggests that these two eating patterns likely give the best chance of preventing another event. 

The Mediterranean and DASH diets are really best for primary and secondary prevention. And you’ve probably heard of the Mediterranean diet. It’s gotten a lot of press. It’s based around vegetables, fruits, nuts, legumes, and refined grains, moderate fish and shellfish, fermented dairy products in moderate amounts. And the DASH diet, or Dietary Approaches to Stop Hypertension, is also rich in fruits and vegetables, whole grains, low-fat dairy, nuts, legumes, and low in red and processed meat, and a very low-sodium diet too. And there’s a lot of overlap between these two dietary patterns. And that’s kind of summed up here, in what we created, at Tufts – HEART. So, Heap on the vegetables and fruits, Emphasize the right fats, Accentuate whole grains, Revere dairy foods in moderation, and Target heart-healthy proteins. And I’ll go a little more deeply into each of these. 

But you can see overall, this is the idea. It’s also very possible to adapt this overall heart-healthy eating pattern to your own tastes and cultural preferences and the way that works best for you. So just to dive into that a little bit more, the graphic there sums up the evidence for various food groups and either their impact on risk in a positive way or a negative way or sometimes in a, you know, more neutral way too. First, heap on the vegetables and fruits. You can see those are right at the top there. So practical strategies – at least 2 servings at lunch and dinner, including raw fruits as a frequent dessert. So that’s a good way to incorporate them. 

Emphasize the right fats – extra virgin olive oil is a go-to oil. I understand completely that’s an expensive oil, and I’ll talk about that a little bit more towards the end. Whole grains – 1 to 2 servings per meal. And there’s many ways to incorporate those, which we’ll talk about a little more. But revere dairy – so 2 servings daily – plain greek yogurt, cheese in moderation, things like that. And then, target heart-healthy proteins – so getting more specific on that in looking to the right at that graphic…poultry in moderation, trying to cut down on red and processed meats, eggs in moderation, beans and lentils as common protein sources, as well as nuts and fish ideally a couple of times a week or more. So that’s kind of an overview and, again, there’s a lot of ways to incorporate this into many different preferences, and in what you would like to eat. 

So, I’d like to talk a little bit about popular diets and, again, thinking of that graphic, and we’ll compare a couple of popular diets to that graphic with the idea that they’re coming out with new ones all the time. Hopefully in going through these two, you’ll see how you can compare these healthy eating patterns with what they’re recommending and compare and contrast and learn is it going to be good for me, or should I stay away, or should I modify it and so forth? So, the Keto Diet – certainly very popular right now. So it suggests eating very, very few carbohydrates, cut down on breads and pasta, but they’re really talking about carbs from any source. So that would include some carb-rich fruits, whole grains, things like that as well and the things you want to avoid like sugar or eat in moderation. The things that it emphasizes are fat-rich foods, oils. It does emphasize fatty meats, dairy, and leafy greens. 

So how does that stack up to what we just talked about in terms of the more ideal diet for preventing another event? So, it does emphasize oils and fish, so that’s emphasizing those benefit foods. But it does eliminate other benefit foods. So fruits, whole grains, beans, which are higher in carbohydrates but are the healthier carbohydrates and have a lot of benefits to them. Some good, some bad there. It minimizes refined grains, starches, sugars, but it really emphasizes things in the middle like eggs, milk, butter, some red meats and things. It seems to be kind of hard to sustain it. People have trouble sticking to it. It can be high cost. There’s no evidence really for effectiveness. It hasn’t been studied hat well. And there’s potential for harm, as it suggests going into a ketosis in the initial phase, and that can be dangerous for some people. 

Paleo, another example. So again, it’s eliminating some food groups and emphasizing more. And again, comparing it to the ideal, it emphasizes fish, fruits and vegetables and nuts, but it does cut out beans, dairy, whole grains. It minimizes harm foods like refined grains, sugars, but it does emphasize meats, including processed meats. It seems to be hard for people to sustain, especially when you’re cutting out entire food groups – that’s always difficult. And it can be expensive – meat and produce are the most expensive sections of the grocery store. And whenever you cut out entire food groups, there’s potential for nutrient deficiencies, and it seems to be so it’s low in fiber, high in sodium. And based on studies I’ve been involved in, it seems to be people would be low in calcium as well. 

All right, I’ll go through this quickly. This is the way to change – like one change at a time – using these smart goals and really slowly building changes in, and we know that’s really what works best. And then, just finally, eating on a budget. So buying seafood in cans, pouches, or frozen plain, canned or frozen produce – but watch the salt in canned produce like canned vegetables. Making use of coupons and sales goes along with recipes and menu planning, which I strongly recommend. That way you can really plan out and make use of coupons and sales to incorporate those into low cost. And cutting the olive oil using less or using some canola oil is a way to cut down on that cost too. And a lot of times the more plant-based diet is also cheaper. So the key points here – eat by heart, be smart, and careful in the cart. Thank you very much. 

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