Maintaining Cardiovascular Health through Diet: Tips from a Dietitian

On this episode of Inside the Texas Heart Studio, Dr. Nikolaos Diakos sits down with dietician Kathleen Allen on how to maintain cardiovascular health through diet.

They discuss the following topics during their conversation:

• Significance of the Plant-Based Diet
• Healthy Protein and Fat Sources
• Mindful Eating
• Strategies for Weight Loss
• The Management of Cachexia in Heart Failure

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Watch the sit-down interview here.

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Chapters

• 1:07 Healthy Diet & Balance Plate
• 2:38 Protein, Fat Sources & Cooking
• 8:50 Weight Loss & Calorie Intake
• 15:48 Supplements & Processed Odds
• 21:11 Cachexia & Protein Intake
• 25:02 Referring to a Dietician
• 26:16 Consultation with a Dietician

Transcript

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Good afternoon.

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My name is Nico Diacos.

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I'm a cardiologist at the Texas Heart Institute,

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and I'm very happy today

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to be joined at the studio by Kathleen Allen.

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Kathleen has a unique training.

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Uh, she graduated as a dietician from NYU,

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and she's currently pursuing a combined degree in medical

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school and a master

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of business administrations at the

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Dartmouth College of Medicine.

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Kathleen has this, uh, unique training

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that would allow her in the future to be a doctor

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and be able to give, uh, dietary advices,

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uh, to her patients.

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But today, uh, we're gonna take advantage of, uh,

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Kathleen being with us, and, uh, she's gonna give advice on

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what diet should we follow,

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what diet should our patients follow

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to maintain their cardiovascular health.

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Kathleen, thank you for being here today.

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Thank you for having me. So the first question is gonna

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be the question I get from almost all my patients.

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Um, patients come to me, uh,

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after they had a cardiovascular event,

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or, uh, they come to me as a prevention

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and they are saying, doctor, uh, I want to change my habits.

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I wanna start eating healthy.

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So as a dietician, what defines a healthy diet?

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Mo research points too.

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The fact that healthy diet is really foods

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that are not processed

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and foods that are whole and plant-based.

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So that's what I would say is the more you are towards a

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whole plant-based diet, the better.

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Let's say someone, uh, wants to start following this diet,

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but um, does not know how, how to balance it, how to create

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what we call a healthy plate.

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Mm-Hmm. And, uh, let's imagine this plate is round, okay?

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Mm-Hmm. And you want to guide this, uh, patient.

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Say, okay, now you have a round plate there.

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How is the patient going to fill out this plate so

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that we have balanced nutrition between, you know, proteins,

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carbohydrates, uh, plant, uh, uh, sugars. Uh,

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That's a great question. So

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for sugars, definitely limiting those as much

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as possible, having those last in your meal.

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But in terms of the circular plate,

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which I would recommend a smaller plate,

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especially if you're trying to lose weight.

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Exactly. And so you can pace yourself better.

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So you can see in this image right here, um, that

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vegetables make up the majority of the left side

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with fruits being a little bit at the bottom.

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Mm-Hmm. And on the right hand side,

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you're gonna see about a fourth

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of the plate is whole grains,

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and about a fourth of the plate is protein.

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And that's kind of a good way, um, to kind

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of balance your plate while also adding, of course,

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a healthy fat source.

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So for example, not to be a great addition to your plate

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as well, and maybe a little bit of olive oil

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for dressing and things of that nature.

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That sounds great. And can you give us a few examples of,

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uh, um, healthy fat source or healthy protein source?

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Is it like fried chicken, deep fried chicken,

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one of those, or not really?

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Um, I think we all wish, but no. Okay.

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So I would say anything

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that's a plant would be a healthy source

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of a food in general.

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So a healthy protein, for example, would be a nut,

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but initially enough that also is a healthy fat.

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So the interesting thing about vegetables is they really do

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have more than one macronutrient in them.

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So macronutrients being the carbohydrate,

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the protein, and the fat.

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So it's much harder when you're looking at plants

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to really dissect them into their individual macronutrients.

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And that's what's so special about them, um, is they kind

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of are more of a complex food versus,

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like in animal proteins are typically all protein

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and, you know, some saturated fat,

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but that's actually the fat you don't want.

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Mm-Hmm. So vegetables are a much more balanced source

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of food, which is what I love about them.

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So, as I mentioned, nuts are a great source

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of fat and protein.

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Avocado, great source of fat, one

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of my particular favorites.

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But again, keeping in mind that fats

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actually are the most calorically dense

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of the macaroni nutrients.

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So if you're trying to lose weight, again,

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you don't wanna overdo it on those fats.

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For those who like to include meat in their diet.

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Um, what would be the healthy options for meat fish?

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You know, we are usually told that it's a good,

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uh, source of protein.

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Yes. Yes. Uh, especially, uh, uh, the fatty fish

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that has these Omega-3, uh, like salmon Mm-Hmm, exactly.

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So, um, what are your thoughts about that?

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Is it indeed the good source of protein and,

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and fat? The, the fish,

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I think of the animal-based proteins,

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it definitely is the best.

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I focus on those fishes rather than,

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you know, the poultry Mm-Hmm.

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Or the red meats, especially avoiding the red meats as much

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as, as much as possible.

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But that being said, like you have to live your life.

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You know, if you really enjoy having a red meat, you know,

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once a week or um,

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once every two weeks, I think that's fine.

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But just keep in mind your portion size.

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I think that restaurants really do a, at a service Mm-Hmm.

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And having, you know, the protein being the whole plate.

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So we talked about before the plate with

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that protein being no more than one fourth of your plate.

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Um, so I think that's the biggest thing to keep in mind.

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I think it's kind of up to you what you want to do,

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but I would say limit red meat the most as possible

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and probably fish twice a week.

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I just ask my patients to focus on as much as they can,

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getting whole foods into their diet

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and kind of making slow changes

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If you wanna give any advice on

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how should they be cooking their food.

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Okay. Um, is it, uh, as we said,

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I guess deep fried food is not the healthiest, I guess,

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baking is it, uh, is a good way to go or,

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or are maybe using a pan with a little bit of, um, uh,

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of olive oil in there?

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Or are there any other

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suggestion on how do they cook their food?

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Because I think people are so attached to using processed

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ready cooked meat that they find

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or ready cooked vegetables

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that they find in the grocery store,

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and they're not taught how

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to cook it in a way that is healthy.

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Exactly. And, um, with the ready cooked foods,

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another big problem is the salt content of those,

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because there's this very interesting book

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called Salt sugar Fat.

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I don't know if you've read it. No, I haven't.

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It's by Michael Moss. And I would definitely recommend it.

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And it's all about how the food industry adds salt, sugar,

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and fat to make foods essentially addictive.

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Mm-Hmm. So that's a big problem

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with the pre-processed foods in terms of the best way

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and the best, um, to cook your food.

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I would say, as you mentioned, baking is great.

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I also really like air fryers

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because they do the same sort of Christmas

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of the fryer without that added fat

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that they're getting into that food with the frying,

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that's a big problem with that.

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And also, sometimes the oil can get oxidized too,

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which you definitely don't want.

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Um, and there's a whole study of actually,

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interestingly enough, um, how you want

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to preserve your olive oil.

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Mm-Hmm. So that's definitely how we can get into as, as well

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as you, if you want being

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A Greek, I would like you to let us know

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how should we preserve our olive oil.

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Um, so I actually just did a consulting project in, um,

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Chile on olive oil.

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And so the reason that a lot of the bottles are darker is

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because the light, the UV light can oxidize the olive oil.

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So you wanna make sure that you keep it in as dark a bottle

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as possible, even darker than

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what it comes in would be best.

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Never keep it next to the stove,

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because that also allows for it to be oxidized.

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So always in a cool pantry away and by the smaller bottles.

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And use it quickly because actually the reason olive oil we

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say is so good is

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because it's supposed to be high in antioxidants.

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But if it's allowed to be oxidized,

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then it's no longer high in those antioxidants

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that can be kind of, um, dampened

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by those, by the oxidation.

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That's very interesting. Uh, I remember my grandma was,

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uh, back in Greece, were keeping her oil olive, uh,

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in the dark place, as you said.

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So now I know why she was doing it.

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I don't know if she knew the background,

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but uh, she was doing it right, I guess. Exactly.

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And you can taste the difference too.

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You exactly can taste the rancidity if it becomes oxidized.

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Yes. And the last thing I will say is you wanna look at the

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bottle and see when it was, um, the, uh,

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olives were actually taken and harvested,

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because that plays a big role in

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how much nutrients

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you're getting from that olive oil as well.

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Moving now to, uh, one of our, um,

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you know, greatest pandemics, um, obesity, um, I was,

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I was, uh, reading an article,

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it was published in Lancet a couple of years ago,

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and what they did is that, uh, they,

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the World Health Organization, um, saw the prevalence

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of obesity and reported it.

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And, uh, overweight people were, uh, along the lines of, uh,

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I think one point, uh, uh, 9 billion in the world,

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and about 600 million of them,

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they were ob These are huge numbers.

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And from 1975 to 2016,

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I wanna say those numbers tripled.

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I don't even wanna know what these numbers look like in, uh,

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2023, being able to lose weight.

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I think it's a, it's a cornerstone along with exercise

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to maintaining your cardiovascular health.

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Um, what is your advice for those

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that they want to lose weight?

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Is there a special diet that would, they should follow?

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Uh, what is the role of, uh, um, counting their calories

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and how should they be doing that?

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So I think counting calories,

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it really depends on the person.

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For individuals who are predisposed to an eating disorder,

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I definitely don't ever recommend counting calories.

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Um, but for individuals who don't, um, struggle with that,

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I think that using, you know, apps like,

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I guess MyFitnessPal is one of the most, um, well known

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of the apps is perfectly fine.

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I will say we have a lot of patients

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who follow a whole food plant-based diet

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and don't actually need to count their calories at all.

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Mm-Hmm. Because with the whole food plant-based diet,

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especially if you're focusing on those non-starchy

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vegetables, so like the broccoli and the leafy greens

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and things of that nature, and eating those first,

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that fiber will fill you up.

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So you won't actually need to consume

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as many calories to feel full.

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So that's one thing I really like about the whole food

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plant-based diet, keeping in mind that diet is a spectrum.

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So, you know, you have to be gentle with yourself.

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And if you can only get it this far when you know a whole

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food plant-based diet is here,

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that's perfectly perfectly fine.

245
00:09:44.845 --> 00:09:46.005
You do what you can. Um,

246
00:09:46.025 --> 00:09:49.165
but I think, again, it's, it's all per the individual. So

247
00:09:49.585 --> 00:09:52.725
Is there, um, uh, a, a special diet

248
00:09:52.725 --> 00:09:53.765
that people should follow?

249
00:09:53.965 --> 00:09:56.485
I, we know we, we, you know, hearing in the news

250
00:09:56.505 --> 00:09:58.565
or in social media about the keto diet,

251
00:09:58.575 --> 00:10:01.965
about intermittent fasting, about uh, uh, paleo diet.

252
00:10:02.185 --> 00:10:04.165
Um, there's so many things out there

253
00:10:05.185 --> 00:10:07.685
and I don't know, I don't think we have data to say

254
00:10:07.685 --> 00:10:09.365
that one diet or the other is better

255
00:10:09.385 --> 00:10:10.485
for cardiovascular health.

256
00:10:10.715 --> 00:10:12.085
What would be your recommendation?

257
00:10:12.085 --> 00:10:14.085
Should people follow any particular of those?

258
00:10:14.865 --> 00:10:16.965
So I would say that most of the evidence points

259
00:10:16.985 --> 00:10:20.325
to consuming more fruits and more vegetables in your diet

260
00:10:20.325 --> 00:10:22.485
and whole grains and like, you know, plant-based foods.

261
00:10:22.785 --> 00:10:24.845
So I guess the Mediterranean diet gets a lot of attention.

262
00:10:24.905 --> 00:10:27.165
The dash diet and the whole food plant-based diet.

263
00:10:27.165 --> 00:10:29.445
And what those all have in common is they're based

264
00:10:29.445 --> 00:10:34.085
predominantly on the fruits, vegetables, legumes, um,

265
00:10:34.085 --> 00:10:35.525
whole grains and things of that nature.

266
00:10:36.205 --> 00:10:37.325
I think the ketogenic diet

267
00:10:37.505 --> 00:10:39.885
and other diets of that nature get a lot of attention

268
00:10:39.885 --> 00:10:41.285
because you lose weight

269
00:10:41.285 --> 00:10:42.445
because you're emitting a whole food group

270
00:10:42.785 --> 00:10:45.085
and with a ketogenic diet, um, you know,

271
00:10:45.085 --> 00:10:46.965
you're emitting sweetss and which a lot

272
00:10:46.965 --> 00:10:47.965
of people love their sweets

273
00:10:47.965 --> 00:10:49.325
and they overconsume their sweets.

274
00:10:49.395 --> 00:10:51.885
Sometimes it happens to me as well, I do confess.

275
00:10:52.305 --> 00:10:54.245
Um, so I think that's why that gets a lot of attention.

276
00:10:54.305 --> 00:10:55.965
But I never recommend, um,

277
00:10:56.245 --> 00:10:57.845
omitting a full macronutrient group.

278
00:10:58.005 --> 00:10:59.445
I think with ever a macronutrient group,

279
00:10:59.445 --> 00:11:00.925
you're getting essential nutrients

280
00:11:01.265 --> 00:11:02.965
and so you just, that's just not something you wanna do.

281
00:11:02.965 --> 00:11:05.005
And also I feel like that's not a lifestyle,

282
00:11:05.265 --> 00:11:07.765
that's a temporary diet that's very hard to follow.

283
00:11:08.305 --> 00:11:11.765
So I would say, you know, make it a lifestyle, not a diet,

284
00:11:11.985 --> 00:11:15.485
and consume as many, uh, non-starchy vegetables as possible.

285
00:11:15.705 --> 00:11:17.725
Eat your fruits, eat your whole grains,

286
00:11:18.225 --> 00:11:22.005
and yeah, eat unprocessed, whole food plant base as much

287
00:11:22.005 --> 00:11:24.205
as you can and then go, go from there.

288
00:11:24.665 --> 00:11:28.325
Um, I think mindful eating is a big important factor in

289
00:11:28.325 --> 00:11:29.685
terms of decreasing calories.

290
00:11:30.145 --> 00:11:31.205
So one thing I really like

291
00:11:31.205 --> 00:11:32.925
to say is out of sight, out of mind.

292
00:11:33.425 --> 00:11:36.605
So definitely keeping your higher calorie items if you're

293
00:11:36.605 --> 00:11:38.605
gonna have them in the home in a pantry,

294
00:11:39.185 --> 00:11:42.725
or if you buy a giant, um, I don't know, box

295
00:11:42.725 --> 00:11:43.805
of chips, for example.

296
00:11:44.125 --> 00:11:46.605
'cause you love your chips, making sure you portion those

297
00:11:46.605 --> 00:11:48.445
out into little, um, little different bags

298
00:11:48.505 --> 00:11:49.845
and putting the rest in the pantry

299
00:11:50.145 --> 00:11:52.045
or don't buy them at all, that's the easier solution.

300
00:11:52.065 --> 00:11:53.805
But, you know, we all want a little bit

301
00:11:53.805 --> 00:11:55.085
of chip sometimes, for example.

302
00:11:55.225 --> 00:11:56.445
So I think that's one solution.

303
00:11:56.565 --> 00:11:58.165
I think another solution I mentioned is having

304
00:11:58.165 --> 00:11:59.605
smaller plates Yes.

305
00:11:59.825 --> 00:12:00.925
Is a big thing as well.

306
00:12:01.665 --> 00:12:04.685
And, um, taking breaks, you know, with your meals.

307
00:12:04.865 --> 00:12:06.925
So taking breaks to talk to people at the table

308
00:12:06.925 --> 00:12:08.125
and things of that nature, really.

309
00:12:08.265 --> 00:12:11.005
And asking yourself, have I eaten enough?

310
00:12:11.685 --> 00:12:13.125
I think it's interesting in the US culture

311
00:12:13.225 --> 00:12:14.245
we say, am I full?

312
00:12:14.885 --> 00:12:16.205
But in other cultures they don't,

313
00:12:16.205 --> 00:12:17.205
they don't say the same thing.

314
00:12:17.205 --> 00:12:18.445
They say like, I'm satisfied,

315
00:12:18.545 --> 00:12:20.245
or like, yes, you know, I've had enough. So,

316
00:12:20.865 --> 00:12:24.285
And, and is there any, for those that they want

317
00:12:24.285 --> 00:12:25.885
to go down, down that, that pathway

318
00:12:26.025 --> 00:12:28.605
and they wanna count their calories, they want

319
00:12:28.605 --> 00:12:32.885
to use an app, um, how would they define what is, uh,

320
00:12:33.065 --> 00:12:36.285
the amount of calories that their body needs so

321
00:12:36.285 --> 00:12:38.525
that they can cut it down by X amount

322
00:12:38.585 --> 00:12:39.765
to start losing the weight?

323
00:12:39.985 --> 00:12:41.845
And of course, following, as you said, the balance,

324
00:12:42.035 --> 00:12:43.325
nutrition and the balanced diet,

325
00:12:44.405 --> 00:12:46.765
I think it depends on the person fully

326
00:12:46.865 --> 00:12:50.165
and you know, whether they're sick, they would be, you know,

327
00:12:50.215 --> 00:12:51.605
going through more calories

328
00:12:51.905 --> 00:12:54.445
or whether they're perfectly sedentary, fewer calories.

329
00:12:54.565 --> 00:12:57.685
I think to maintain weight we typically say 25 to 30,

330
00:12:58.225 --> 00:12:59.885
um, calories per kilogram.

331
00:12:59.885 --> 00:13:01.525
Mm-Hmm. So you would decrease that.

332
00:13:01.865 --> 00:13:04.645
But I think that one way you can tell, um, if you're,

333
00:13:04.865 --> 00:13:06.725
you just, if you're losing weight, if you decrease

334
00:13:06.725 --> 00:13:07.845
what you're currently eating

335
00:13:07.865 --> 00:13:09.085
and you start losing weight, that's

336
00:13:09.085 --> 00:13:10.165
the best way to tell Yes.

337
00:13:10.195 --> 00:13:11.245
That the diet is going

338
00:13:11.245 --> 00:13:12.925
to be a good diet for you to lose weight.

339
00:13:13.025 --> 00:13:16.925
So I think slowly omitting different things from your diet

340
00:13:17.105 --> 00:13:20.405
and going on a kind of step by step process is, um,

341
00:13:20.405 --> 00:13:21.565
simple enough and, you know, seeing

342
00:13:21.565 --> 00:13:23.405
what your baseline caloric intake is

343
00:13:23.785 --> 00:13:26.205
and then maybe subtracting 500 calories at first

344
00:13:26.225 --> 00:13:28.365
or 250, whatever's reasonable for you.

345
00:13:28.715 --> 00:13:31.725
It's kind of the best approach that I see, um, fit.

346
00:13:31.725 --> 00:13:35.045
Because, you know, it's hard to say exactly how many

347
00:13:35.805 --> 00:13:39.165
calories someone needs without doing like calorimetry Yes.

348
00:13:39.335 --> 00:13:40.965
Which is not feasible for everybody. Exactly.

349
00:13:41.125 --> 00:13:43.045
I was, I was trying to kind of give them a number

350
00:13:43.515 --> 00:13:46.245
that it's not gonna come through a fancy test Yeah.

351
00:13:46.245 --> 00:13:47.685
That everybody can follow.

352
00:13:47.825 --> 00:13:51.245
So the 25, 30 per kilo, that's a good number typically

353
00:13:51.605 --> 00:13:52.085
Maintain. Yeah.

354
00:13:52.145 --> 00:13:55.765
And then you then maybe they cut down 250 or 500. Yeah.

355
00:13:55.945 --> 00:13:57.525
And then I think it it is,

356
00:13:58.435 --> 00:14:00.005
it's not like a sprint, it's a marathon.

357
00:14:00.005 --> 00:14:04.805
Right, exactly. So, um, I've seen people losing really, uh,

358
00:14:04.835 --> 00:14:06.805
fast weight and then getting it back up.

359
00:14:07.185 --> 00:14:10.245
Um, so maybe as you said, you make it a lifestyle Mm-Hmm.

360
00:14:10.325 --> 00:14:11.685
Uh, you made a goal to lose weight

361
00:14:11.745 --> 00:14:13.965
and then you take your time, I guess.

362
00:14:14.065 --> 00:14:15.925
And uh, you try to do it over the period

363
00:14:15.945 --> 00:14:17.525
of a few months rather than doing it over

364
00:14:17.525 --> 00:14:18.565
a period of a couple of weeks.

365
00:14:18.825 --> 00:14:20.285
Of course. Yeah. 'cause if you do it short,

366
00:14:20.285 --> 00:14:22.845
just like you said, you get an increased risk of rebound.

367
00:14:23.225 --> 00:14:25.085
And I think too, operating within the framework

368
00:14:25.085 --> 00:14:27.085
that you're currently, your diet currently is,

369
00:14:27.105 --> 00:14:29.525
so if I'm having, I dunno, for example, a liter

370
00:14:29.525 --> 00:14:32.285
of coke a day, the first thing I can do is cut it down

371
00:14:32.285 --> 00:14:34.005
to maybe half a liter of coke a day.

372
00:14:34.025 --> 00:14:35.325
So, you know, using the same sort

373
00:14:35.325 --> 00:14:36.365
of diet I'm already operating in,

374
00:14:36.365 --> 00:14:38.045
but making it healthier piece by piece

375
00:14:38.425 --> 00:14:41.045
to make it work well within my current framework.

376
00:14:41.665 --> 00:14:43.845
Or maybe you meeting totally the Coke. Right? Yeah.

377
00:14:43.965 --> 00:14:45.405
I would say that would be helpful too,

378
00:14:45.545 --> 00:14:47.005
but I think that might be like a later

379
00:14:47.035 --> 00:14:48.165
step, you know, for example.

380
00:14:48.165 --> 00:14:49.805
Yes. So be gradual in your step because

381
00:14:49.875 --> 00:14:51.845
Something gradual yourself of your bad habits.

382
00:14:52.035 --> 00:14:54.725
Exactly. Exactly. And make, you know, smart goals.

383
00:14:55.385 --> 00:14:58.205
Um, so smart goals that are smart, measurable, attainable,

384
00:14:58.395 --> 00:15:00.245
realistic, and time-based.

385
00:15:01.025 --> 00:15:03.005
And make them very small and realistic

386
00:15:03.005 --> 00:15:04.845
because I think some people, they make, you know,

387
00:15:04.845 --> 00:15:07.445
crazy goals, like, I'm gonna lose 10 pounds by next week.

388
00:15:07.475 --> 00:15:09.325
They don't obtain them. And then that kind

389
00:15:09.485 --> 00:15:11.445
of fosters a sense of learned helplessness.

390
00:15:11.465 --> 00:15:13.045
You know, they keep not attaining their goals.

391
00:15:13.045 --> 00:15:14.085
So why would I set a goal?

392
00:15:14.715 --> 00:15:18.405
What is the role of, uh, micronutrients?

393
00:15:18.405 --> 00:15:21.205
Like the vitamins, uh, people come to my clinic

394
00:15:21.265 --> 00:15:23.165
and they have a big list of things that they're taking.

395
00:15:23.225 --> 00:15:25.325
So, you know, I, I short out their medications

396
00:15:25.345 --> 00:15:27.325
or this for blood pressure, this for cholesterol.

397
00:15:27.325 --> 00:15:29.645
And then at the bottom they have probably five

398
00:15:29.705 --> 00:15:32.765
or six different vitamins that they've been taking.

399
00:15:33.075 --> 00:15:37.205
Like B six thi mean zinc, uh, vitamin C.

400
00:15:37.675 --> 00:15:41.525
Like, do we really need to be on vitamin supplementation

401
00:15:41.525 --> 00:15:43.565
or like micronutrient supplementation

402
00:15:44.025 --> 00:15:48.685
or our diet can, can provide us those and we don't need.

403
00:15:49.065 --> 00:15:52.165
And I'm asking that because I've noticed that the, um,

404
00:15:53.205 --> 00:15:55.205
industry of those supplements is exploding.

405
00:15:55.205 --> 00:15:57.485
There are different brands, there are different sizes,

406
00:15:57.485 --> 00:15:58.925
there are different pills.

407
00:15:59.185 --> 00:16:01.285
And uh, you know, you always get this question from your

408
00:16:01.285 --> 00:16:02.365
patient, oh, should I be taking that?

409
00:16:02.365 --> 00:16:04.725
Someone gave it to me, but I don't know if I need it.

410
00:16:05.065 --> 00:16:06.065
So what do I tell them?

411
00:16:07.365 --> 00:16:10.965
I typically say that most people don't need supplements.

412
00:16:11.565 --> 00:16:13.365
I think that's one thing that's interesting about the

413
00:16:13.365 --> 00:16:15.925
supplement interest rate is it's not regulated by the FDA.

414
00:16:15.985 --> 00:16:17.485
So I was talking to a pharmacist today

415
00:16:17.485 --> 00:16:19.685
and they said you could basically put sand in a

416
00:16:19.685 --> 00:16:21.045
pill and sell it.

417
00:16:21.465 --> 00:16:22.525
Um, you know,

418
00:16:22.555 --> 00:16:24.925
because there's really no regulation about

419
00:16:24.925 --> 00:16:26.245
what's in those capsules.

420
00:16:26.265 --> 00:16:27.405
Yes. So I think the first thing,

421
00:16:27.405 --> 00:16:28.805
if you are gonna take a supplement,

422
00:16:28.835 --> 00:16:31.365
make sure it is a reputable brand Mm-Hmm.

423
00:16:31.835 --> 00:16:33.645
That is actually selling you

424
00:16:33.645 --> 00:16:34.685
what they say you're selling you

425
00:16:34.685 --> 00:16:36.285
because you don't wanna spend a lot of money on,

426
00:16:36.805 --> 00:16:38.205
I don't know, sand, essentially.

427
00:16:38.205 --> 00:16:41.445
Exactly. Um, so that's the first, um, tip I would say.

428
00:16:41.545 --> 00:16:42.565
But I think most people,

429
00:16:42.625 --> 00:16:46.445
if they're eating a well-balanced diet with a variety

430
00:16:46.585 --> 00:16:48.125
of foods, they don't need.

431
00:16:48.395 --> 00:16:49.845
Okay. Um, micronutrients.

432
00:16:49.985 --> 00:16:52.645
Um, there are people, for example, who might are predisposed

433
00:16:52.645 --> 00:16:54.285
to B12 deficiency, whether it's

434
00:16:54.285 --> 00:16:57.845
because they're missing, you know, a certain enzyme or it's

435
00:16:57.845 --> 00:17:01.045
because they're on a completely vegan diet, in which case,

436
00:17:01.305 --> 00:17:04.005
uh, B12 would be realistic to be supplemented.

437
00:17:04.465 --> 00:17:05.965
And I think the same is true for iron.

438
00:17:06.075 --> 00:17:08.125
Some people have are predisposed to iron deficiency.

439
00:17:08.665 --> 00:17:10.765
But unless you have an efficiency, I think

440
00:17:10.765 --> 00:17:12.765
for the most part you don't need that supplementation.

441
00:17:12.925 --> 00:17:14.405
I think the best way to get it

442
00:17:14.405 --> 00:17:17.085
and is in that whole food based format.

443
00:17:17.825 --> 00:17:20.045
So I would say most of the time, don't spend your money.

444
00:17:20.045 --> 00:17:21.885
That being said, if you do have an efficiency,

445
00:17:21.885 --> 00:17:22.965
definitely supplement it.

446
00:17:23.505 --> 00:17:25.085
As you said, there are people that they are

447
00:17:25.085 --> 00:17:27.005
completely vegetarian or vegan.

448
00:17:27.145 --> 00:17:29.605
Mm-Hmm. So those, those patients we like to test

449
00:17:29.665 --> 00:17:31.725
and we like to recommend supplementation

450
00:17:31.825 --> 00:17:35.205
or, uh, we know that some of the patients, uh, for example,

451
00:17:35.205 --> 00:17:37.005
those with heart failure, they're predisposed

452
00:17:37.005 --> 00:17:39.085
to have iron deficiency anemia.

453
00:17:39.145 --> 00:17:40.725
And we are on the looks for that.

454
00:17:40.825 --> 00:17:42.605
And when we find it, then uh,

455
00:17:42.605 --> 00:17:44.245
we give them supplementation. Of

456
00:17:44.245 --> 00:17:45.245
Course. Yes. Now

457
00:17:45.245 --> 00:17:48.725
moving to, um, uh, to patients,

458
00:17:48.825 --> 00:17:49.965
uh, that have heart failure.

459
00:17:49.985 --> 00:17:52.005
And that's one of my, my personal interests.

460
00:17:52.505 --> 00:17:56.805
Um, and my first question is gonna be about my,

461
00:17:57.065 --> 00:17:58.325
uh, greatest enemy.

462
00:17:58.425 --> 00:18:01.285
My greatest enemy as a heart failure doctor, is the salt.

463
00:18:02.225 --> 00:18:04.165
So as you said, salt is everywhere. Mm-Hmm.

464
00:18:04.345 --> 00:18:08.285
As patients that they do have heart failure by consuming,

465
00:18:08.345 --> 00:18:10.365
uh, large amounts of salt, uh,

466
00:18:10.475 --> 00:18:12.365
they can get into heart failure exacerbation.

467
00:18:12.425 --> 00:18:16.005
Mm-Hmm. Uh, and they can, um, have their heart failure, uh,

468
00:18:16.005 --> 00:18:17.085
difficult to be managed.

469
00:18:17.625 --> 00:18:20.965
Um, so the question for you is that what are those foods

470
00:18:20.965 --> 00:18:23.325
that they have really high salt content

471
00:18:23.905 --> 00:18:26.765
and people that specifically people

472
00:18:26.765 --> 00:18:28.325
that they have heart failure, they should be avoiding.

473
00:18:28.385 --> 00:18:31.405
But I think in general, uh, people should be avoiding, uh,

474
00:18:31.405 --> 00:18:32.525
overconsumption of salt.

475
00:18:33.365 --> 00:18:34.565
I think, like I mentioned

476
00:18:34.565 --> 00:18:36.525
before, the processed foods tend to have a lot

477
00:18:36.525 --> 00:18:38.005
of salt. So salt,

478
00:18:38.115 --> 00:18:39.115
Tell us a few examples.

479
00:18:39.185 --> 00:18:40.925
So, um, I would say for example,

480
00:18:41.355 --> 00:18:43.565
like canned beans may have a lot of salt.

481
00:18:43.565 --> 00:18:46.165
Mm-Hmm. Can soups have a ton of salts,

482
00:18:47.255 --> 00:18:48.765
meats can have a lot of salt added.

483
00:18:49.005 --> 00:18:50.405
'cause salt is really as a preservative

484
00:18:50.505 --> 00:18:52.205
and by the food industry, like I said,

485
00:18:52.205 --> 00:18:53.645
to make the food more palatable.

486
00:18:54.025 --> 00:18:56.085
And I would say even butter can have a lot of salt added.

487
00:18:56.225 --> 00:18:58.085
So what you wanna look for on the back of the label,

488
00:18:58.085 --> 00:19:00.645
as you're talking about before, is really looking

489
00:19:00.705 --> 00:19:04.645
for less than 140 milligrams of sodium in the package.

490
00:19:05.025 --> 00:19:06.805
Yes. You know, less is even better.

491
00:19:07.465 --> 00:19:10.445
Um, and tallying up how much you have in a day.

492
00:19:10.525 --> 00:19:13.045
I think you typically tell your patients about two, two

493
00:19:13.125 --> 00:19:14.125
Grams grams a day. Yes. I

494
00:19:14.125 --> 00:19:15.925
like them to stay less than two grams for sure.

495
00:19:16.305 --> 00:19:18.285
And as you said, I kind of alarm them for foods,

496
00:19:18.345 --> 00:19:22.485
as you said, canned food, uh, foods that they, um,

497
00:19:22.745 --> 00:19:24.925
for example, some, some soups that they buy

498
00:19:25.585 --> 00:19:29.565
in bulk from a store and they need salt to be preserved.

499
00:19:30.025 --> 00:19:34.365
Um, I think the safest that I've noticed is, uh, patients

500
00:19:34.385 --> 00:19:36.285
to try to cook their own food. Yes.

501
00:19:36.285 --> 00:19:39.605
Yeah. And, you know, salt gives some taste.

502
00:19:39.745 --> 00:19:42.445
So, you know, they can, they can cook with a little bit

503
00:19:42.445 --> 00:19:45.445
of salt, but I tell them, do not add any more salt.

504
00:19:45.445 --> 00:19:46.765
Like, you know, you can use a little bit

505
00:19:46.765 --> 00:19:47.965
of salt when you cook your own food

506
00:19:47.965 --> 00:19:50.365
because that's the way to control the salt

507
00:19:50.365 --> 00:19:51.365
that you're consuming.

508
00:19:51.905 --> 00:19:54.925
And when the food comes, uh, to your table, you know,

509
00:19:54.925 --> 00:19:56.125
don't take the the salt

510
00:19:56.125 --> 00:19:57.845
and then start adding on top of that. Uh,

511
00:19:58.355 --> 00:19:59.355
Exactly.

512
00:19:59.685 --> 00:20:01.725
I think that's 1.2 is when you eat out at restaurants,

513
00:20:01.725 --> 00:20:04.125
they tend to add a lot of salt as well.

514
00:20:04.145 --> 00:20:06.605
Yes, yes. Tend to add that, uh, flavor profile.

515
00:20:06.805 --> 00:20:08.965
I think one thing I love is herbs and spices.

516
00:20:09.495 --> 00:20:10.685
First of all, they're not salt

517
00:20:11.105 --> 00:20:13.485
and second of all, they're very high in antioxidants,

518
00:20:13.665 --> 00:20:16.005
so they give you that added benefit Oh, interesting.

519
00:20:16.065 --> 00:20:17.805
Of decreasing the oxidation in,

520
00:20:17.805 --> 00:20:19.245
in your body, which is fantastic.

521
00:20:19.425 --> 00:20:21.885
And they're very flavorful and honestly yes.

522
00:20:22.115 --> 00:20:23.565
More complex in, uh,

523
00:20:23.565 --> 00:20:25.285
flavor profile than salt, in my opinion.

524
00:20:25.515 --> 00:20:28.285
I've noticed by adding some lemon to, you know,

525
00:20:28.545 --> 00:20:31.045
of course the lemon has to fit with it with the food,

526
00:20:31.145 --> 00:20:33.165
but you know, if you add a little bit of extra not

527
00:20:33.165 --> 00:20:34.165
For your birthday cake. Exactly.

528
00:20:34.165 --> 00:20:36.805
So, uh, if you add a little bit of extra lemon,

529
00:20:37.075 --> 00:20:38.765
I've noticed that you don't get the urge

530
00:20:38.825 --> 00:20:40.565
to consume more salt in that food.

531
00:20:42.295 --> 00:20:45.075
Lastly, I would like to talk about a controversial topic,

532
00:20:45.255 --> 00:20:47.765
uh, uh, controversial in terms of treatment.

533
00:20:47.945 --> 00:20:50.605
Uh, and it's, uh, what we call cachexia.

534
00:20:51.105 --> 00:20:54.445
Uh, and specifically in people with advanced heart failure.

535
00:20:54.945 --> 00:20:58.805
Uh, we use the term, uh, uh, cardiac cachexia and,

536
00:20:58.985 --> 00:21:03.925
and cachexia is, uh, when you lose muscle,

537
00:21:05.225 --> 00:21:08.485
and the way it happens in people with advanced disease,

538
00:21:08.925 --> 00:21:12.165
advanced heart failure, uh, is that there is an imbalance

539
00:21:12.755 --> 00:21:16.605
from muscle breakdown to, uh, muscle formation.

540
00:21:17.225 --> 00:21:20.125
And you pretty much lose your muscle without being

541
00:21:20.125 --> 00:21:21.245
able to form it back.

542
00:21:21.825 --> 00:21:23.485
And, you know, there are different theories.

543
00:21:23.485 --> 00:21:25.325
There's this theory that says, you know,

544
00:21:25.325 --> 00:21:26.485
you're very sick from heart failure

545
00:21:26.665 --> 00:21:29.245
and there is a lot of inflammation in your body,

546
00:21:29.265 --> 00:21:31.125
and that causes the muscle breakdown.

547
00:21:31.125 --> 00:21:33.125
There's the other theory that says, you know, uh,

548
00:21:33.305 --> 00:21:35.085
you don't absorb enough protein.

549
00:21:35.985 --> 00:21:40.965
Um, so what we like to tell to our patients with, uh,

550
00:21:41.085 --> 00:21:43.885
cachexia is, you know, try to exercise a little more, try

551
00:21:43.885 --> 00:21:45.725
to keep active, but

552
00:21:46.505 --> 00:21:50.245
so far we don't have good treatment in terms of diet

553
00:21:50.945 --> 00:21:52.005
to, to prevent it.

554
00:21:52.705 --> 00:21:56.005
It makes sense. I guess if you consume a little more

555
00:21:56.005 --> 00:21:58.485
protein, but I, I wanted to gather your thoughts

556
00:21:58.485 --> 00:22:00.125
and I know it's, it's, it's a hard topic

557
00:22:00.125 --> 00:22:03.245
because we don't have data and uh, there are trials

558
00:22:03.345 --> 00:22:05.685
and studies that they're gonna come down, uh, the road.

559
00:22:05.825 --> 00:22:08.645
But please tell me what you think about that.

560
00:22:09.685 --> 00:22:11.725
I would say that to your point, you're, you know,

561
00:22:11.925 --> 00:22:14.085
breaking down muscle, um,

562
00:22:14.425 --> 00:22:15.965
faster than you're able to build it.

563
00:22:15.985 --> 00:22:18.685
So you do need more protein in your diet.

564
00:22:18.745 --> 00:22:23.045
The recommendation that I saw was about 1.2 mm-Hmm.

565
00:22:23.225 --> 00:22:26.765
Um, grams per kilogram when you're not visibly

566
00:22:27.565 --> 00:22:31.805
malnourished and higher than 1.37

567
00:22:32.525 --> 00:22:34.605
grams per kilogram when you are visibly malnourished.

568
00:22:34.605 --> 00:22:36.885
So definitely increasing that protein

569
00:22:36.985 --> 00:22:38.325
for kilogram threshold,

570
00:22:38.325 --> 00:22:41.245
when you normally see in the typical population, it's 0.8

571
00:22:41.765 --> 00:22:44.285
grams per kilogram and they say that's an overestimate of

572
00:22:44.285 --> 00:22:45.405
what you need actually.

573
00:22:45.705 --> 00:22:49.085
So it's a lot higher Yes. Amount of protein that you need.

574
00:22:49.285 --> 00:22:51.245
I think one thing too is since you are using

575
00:22:51.265 --> 00:22:53.845
so many calories, 'cause it's chronic disease is definitely

576
00:22:53.965 --> 00:22:57.045
a kind of aware on your, on your body, um,

577
00:22:57.045 --> 00:22:58.685
increasing your caloric intake

578
00:22:58.745 --> 00:23:02.765
and having multiple frequent meals Mm-Hmm.

579
00:23:03.065 --> 00:23:04.245
Um, to make sure you're, you know,

580
00:23:04.525 --> 00:23:06.405
'cause you can only consume so much in one sitting,

581
00:23:06.585 --> 00:23:09.885
so probably at least three snacks a day and three meals,

582
00:23:10.425 --> 00:23:12.485
and making sure you're focusing on those high protein,

583
00:23:13.115 --> 00:23:15.885
high calorie foods at each sitting as well.

584
00:23:16.185 --> 00:23:17.965
And then I've noticed some of my patients

585
00:23:17.965 --> 00:23:21.685
that are in the hospital very sick, uh, um, with,

586
00:23:21.755 --> 00:23:23.525
with end stage heart failure, you know,

587
00:23:23.525 --> 00:23:24.925
their appetite is not that good.

588
00:23:25.065 --> 00:23:27.885
So, um, uh, I've noticed that

589
00:23:28.085 --> 00:23:29.325
whenever I consult a dietician,

590
00:23:29.355 --> 00:23:32.285
they always recommend this high concentration protein sakes

591
00:23:32.285 --> 00:23:34.925
that they can take so that, you know, you get your protein

592
00:23:34.955 --> 00:23:38.725
that you need without, uh, needing to consume a big meal

593
00:23:38.725 --> 00:23:41.605
that you, you cannot tolerate it because you're very sick.

594
00:23:41.605 --> 00:23:44.005
Your heart does not perfuse your stomach and your bowels.

595
00:23:44.785 --> 00:23:46.725
And I think that helps sometimes.

596
00:23:46.955 --> 00:23:48.965
That definitely helps. I think one thing they really like

597
00:23:48.965 --> 00:23:50.045
about, I think you're referring to like

598
00:23:50.045 --> 00:23:51.485
insurer, glucerna, all those.

599
00:23:51.485 --> 00:23:54.325
Yes. Um, they have added like micronutrients Mm-Hmm.

600
00:23:54.405 --> 00:23:55.445
So if you're not consuming a lot of food,

601
00:23:55.445 --> 00:23:58.245
that's when a supplementation, um, would come into play.

602
00:23:58.245 --> 00:24:00.325
So sometimes you could even give like a supplement

603
00:24:00.325 --> 00:24:01.765
of like a caps rather than a drink.

604
00:24:02.205 --> 00:24:04.925
I think one thing people like, even better than the Glucerna

605
00:24:04.925 --> 00:24:07.965
and the Ensurer is making their own milkshakes at home.

606
00:24:08.425 --> 00:24:10.285
So adding like an almond butter

607
00:24:10.785 --> 00:24:14.205
or, um, things of that nature, chia seeds, flax seeds,

608
00:24:14.445 --> 00:24:17.885
anything to really increase the clo um, density of that,

609
00:24:18.745 --> 00:24:19.805
of what they're consuming.

610
00:24:19.985 --> 00:24:22.005
That's, you know, it's typically more palatable. Yes.

611
00:24:22.245 --> 00:24:23.445
I find that people don't tend

612
00:24:23.445 --> 00:24:25.805
to love those milkshakes they're given in the, uh,

613
00:24:26.005 --> 00:24:27.645
hospital in terms of insurance glucerna.

614
00:24:27.865 --> 00:24:30.365
So I think that's one tip is like decrease the volume

615
00:24:30.515 --> 00:24:31.885
because your stomach, a lot

616
00:24:31.885 --> 00:24:33.925
of its satiety actually depends on the

617
00:24:33.925 --> 00:24:35.085
volume of what you consume.

618
00:24:35.745 --> 00:24:37.405
Um, so the mu as much you can do

619
00:24:37.405 --> 00:24:39.765
and make it a smaller volume and eat more,

620
00:24:40.505 --> 00:24:41.685
um, the, the better.

621
00:24:42.225 --> 00:24:43.885
That's, that's, uh, that's exactly

622
00:24:44.155 --> 00:24:45.485
what my experience been so far.

623
00:24:45.985 --> 00:24:48.245
Uh, and now I would like to close with, uh,

624
00:24:48.245 --> 00:24:52.685
the last question, which is, uh, when should I refer, uh,

625
00:24:52.705 --> 00:24:53.885
my patient to a dietician?

626
00:24:54.345 --> 00:24:55.645
Um, you know, as,

627
00:24:55.665 --> 00:25:00.085
as physicians we get some basic training on dietary

628
00:25:00.085 --> 00:25:01.485
consultation for our patients,

629
00:25:01.545 --> 00:25:03.965
but I think, um, in some

630
00:25:04.525 --> 00:25:06.645
specific cases I think we're lacking the expertise

631
00:25:07.225 --> 00:25:10.565
and um, that's something that we should be doing more often.

632
00:25:11.105 --> 00:25:13.685
Uh, and I would like your opinion on what are those cases

633
00:25:13.685 --> 00:25:16.165
that it's, it's good for the patient

634
00:25:16.225 --> 00:25:17.805
to be referred to that issue.

635
00:25:18.885 --> 00:25:21.525
I honestly think any time a patient is open

636
00:25:21.945 --> 00:25:23.765
to making significant changes to their diet

637
00:25:23.825 --> 00:25:26.125
and you feel ill-equipped to help them,

638
00:25:26.665 --> 00:25:27.685
um, making those changes.

639
00:25:27.985 --> 00:25:30.245
So any sort of granular change would probably more

640
00:25:30.245 --> 00:25:31.285
difficult for you to help them with?

641
00:25:31.285 --> 00:25:33.005
Mm-Hmm. Because you only have so much time in your day.

642
00:25:33.005 --> 00:25:35.725
Mm-Hmm. Yes. Um, so I would say in those cases when the

643
00:25:35.965 --> 00:25:37.805
patient's open, and especially if insurance is willing

644
00:25:37.805 --> 00:25:40.365
to cover it, then I would, I would go for it.

645
00:25:40.785 --> 00:25:42.165
Um, if they're, you know,

646
00:25:42.475 --> 00:25:44.845
have very glaring obvious things they could change in their

647
00:25:44.845 --> 00:25:46.045
diet without seeing a dietician.

648
00:25:46.045 --> 00:25:47.365
Like if they're not even wanting to decrease

649
00:25:47.385 --> 00:25:49.605
how much soda they're drinking, they're drinking a liter

650
00:25:49.605 --> 00:25:51.125
of soda and they're completely un willing to change that.

651
00:25:51.925 --> 00:25:53.605
Probably not the time to talk to a dietician. Yes.

652
00:25:53.625 --> 00:25:55.245
But if they're really looking for things

653
00:25:55.305 --> 00:25:56.485
to change in their diet

654
00:25:56.485 --> 00:25:58.005
and looking for specific recommendations,

655
00:25:58.185 --> 00:25:59.205
that's the perfect time.

656
00:25:59.825 --> 00:26:02.685
And then when, when you first see a patient in your clinic

657
00:26:02.825 --> 00:26:04.245
as a dietician, uh,

658
00:26:04.515 --> 00:26:07.325
what is the first thing you would like to talk to them about?

659
00:26:07.435 --> 00:26:08.965
Like lifestyle changes,

660
00:26:09.725 --> 00:26:11.485
specific changes, big picture changes.

661
00:26:11.595 --> 00:26:13.325
What, what should someone expect when it comes

662
00:26:13.325 --> 00:26:15.325
to see you in, in your clinic as a dietician?

663
00:26:15.705 --> 00:26:18.205
Uh, to talk about diet a lot, I,

664
00:26:18.425 --> 00:26:19.845
the first thing we do is we go through

665
00:26:19.845 --> 00:26:20.925
what they're currently eating

666
00:26:21.465 --> 00:26:22.565
and kind of decide

667
00:26:22.695 --> 00:26:24.605
where they are in their readiness to change.

668
00:26:24.745 --> 00:26:26.565
So if someone's totally not willing to change,

669
00:26:26.675 --> 00:26:28.205
then you know, we can talk about

670
00:26:28.205 --> 00:26:29.325
what a healthy diet might look like.

671
00:26:29.325 --> 00:26:31.845
Mm-Hmm. But not make specific recommendations for that.

672
00:26:32.425 --> 00:26:36.405
Um, I think typically, uh, we make smaller changes

673
00:26:36.405 --> 00:26:38.925
because it's easier to keep track of

674
00:26:39.225 --> 00:26:41.325
and to feel like you're making progress on that front.

675
00:26:41.395 --> 00:26:44.165
That being said, if someone just had a, a heart attack, um,

676
00:26:44.315 --> 00:26:46.725
there's this help leave model where they feel ready

677
00:26:46.725 --> 00:26:48.925
to change and they feel the urgency of changing.

678
00:26:48.925 --> 00:26:51.005
Mm-Hmm. That's when I would make a bigger change

679
00:26:51.005 --> 00:26:52.565
to their diet and overhaul their diet.

680
00:26:52.725 --> 00:26:54.165
'cause they're ready to make that change. Yes.

681
00:26:54.185 --> 00:26:56.805
But on a day-to-day basis, typically we make smaller changes

682
00:26:57.345 --> 00:26:58.605
and they follow through with that

683
00:26:58.625 --> 00:27:00.405
and then they put, add another one on.

684
00:27:00.825 --> 00:27:02.045
Um, using again that kind

685
00:27:02.045 --> 00:27:03.925
of smart goal framework, which I love so much.

686
00:27:05.135 --> 00:27:07.285
Thank you so much for being with us today, Kathleen.

687
00:27:07.425 --> 00:27:11.365
Um, it was, uh, it was I think a great talk

688
00:27:11.465 --> 00:27:14.125
and, uh, we learn a lot, uh, from you today

689
00:27:14.665 --> 00:27:17.245
and, uh, at the Texas Heart Institute, uh,

690
00:27:17.255 --> 00:27:20.525
we're looking forward to educate more our patients.

691
00:27:20.535 --> 00:27:24.245
We're not only treating, uh, the heart disease, uh, when,

692
00:27:24.245 --> 00:27:26.445
when, when it happens, but we like to prevent it.

693
00:27:26.445 --> 00:27:29.965
And, uh, as we said, the cornerstone is diet and exercise.

694
00:27:29.965 --> 00:27:32.325
And I think we covered a lot of things today, uh,

695
00:27:32.325 --> 00:27:33.365
with regards to the diet.

696
00:27:33.365 --> 00:27:34.565
Thank you so much again. Thank

697
00:27:34.565 --> 00:27:35.085
You for having me.