Can a Registered Dietitian Nutritionist Help Your Heart Health?

Podcast Transcript

Announcer:

Welcome to Love Your Heart, brought to you by Cleveland Clinic's Sydell and Arnold Miller Family Heart Vascular and Thoracic Institute. These podcasts will help you learn more about your heart, thoracic and vascular systems, ways to stay healthy, and information about diseases and treatment options. Enjoy!

Natalie Salvatore, RN,BSN:

Hello, my name is Natalie Salvatore. I'm a registered nurse in the Heart, Vascular and Thoracic Institute at Cleveland Clinic. March is National Nutrition Month, and focuses on the importance of making informed food choices in developing healthy eating and physical activity habits. When it comes to your heart, what you eat or don't eat matters. I'm joined today by Julia Zumpano, a registered dietician in the Department of Preventive Cardiology at Cleveland Clinic to tell us a little bit about her role and tips on how to eat for heart health.

Julia Zumpano, RD:

Hi, Natalie. Thanks for having me today.

Natalie Salvatore:

I think the first thing we should start with is what is a registered dietician nutritionist? I know I've seen a lot of different ways to say this, nutritionist, dietician, are they the same thing?

Julia Zumpano:

That can be very confusing. There are several ways to classify dieticians. Most commonly, we are classified as a registered dietician and then a licensed dietician. The LD is the licensed dietician, and certain states require dieticians to be licensed. Certain states do not require licensure, so you may or may not see the LD next to the RD, which is the registered dietician. Now, more recently we have added the RDN. The N is the nutritionist, so it stands for registered dietician nutritionist. Essentially, the same as a registered dietician, but adding that nutritionist on the end for people to have more of a general understanding on what dieticians really do.

We are advocates for advancing the nutrition status of Americans and people all around the world. RDNs are food and health experts who can translate the science of nutrition into practical solutions for healthy living. RDNs have degrees in nutrition, dietetics, or a related field from a well-respected accredited college or university. They've completed an internship, passed a registration exam, and maintain continuing education units each year to maintain their registration and licensure. RDNs use their nutrition expertise to help individuals make personalized, positive lifestyle changes. RDNs work in a variety of settings, in the community and hospital settings. They may work at a school or at a health clinic, a gym. They work in so many different ways across the lifespan.

Natalie Salvatore:

It sounds like your expertise can be used in many different facets of health. Now, if somebody was interested in working with an RDN, how could they get connected? Do they need a referral and how would they even find somebody to work with? I can imagine it's important that they find somebody who specializes in their unique needs. How can someone find that person?

Julia Zumpano:

That's a great question. I would start off with your insurance company. If you want to use insurance for the visit with a registered dietician nutritionist, you'd start there. See what coverage you have, what dieticians in your area are covered under your plan, and start to reach out to those specific dieticians and see what they specialize in. If you don't want to use insurance, then there's several options. There's often dieticians that work in private practice that you are required to self-pay for, and they may also have a variety of different specialties.

Eatright.org is the Academy of Nutrition and Dietetics main website. They have a tab where you can find a registered dietician in your area. That would be another great place to start because they do list the registered dietician nutritionist in their order of specialty. That would be a great place to start. It's just a matter of troubleshooting how you want to pay for the service, if the insurance is being involved, if you want to maybe go through your local health system, or if you want to go more of a private practice route.

Natalie Salvatore:

Julia, that's great recommendations on how to find a registered dietician to work with. At Cleveland Clinic is there anything specific to help our patients find someone?

Julia Zumpano:

Yes, clevelandclinic.org. We have a website under the Digestive Disease Institute, which is nutrition, and it does provide an overview of what we do, what conditions we treat, has a list of registered dietician nutritionists, and then also has the information on the locations that a dietician can be found and how to make an appointment with a dietician. We offer varieties of different types of appointments. They might be in person, virtual, shared nutrition appointments, shared medical appointments, and we have group nutrition classes. There's a variety of registered dietician nutritionists that can really serve and really tailor your specific needs at Cleveland Clinic.

Natalie Salvatore:

Of course, individual recommendations are great, which I think would be very helpful if our patients and listeners did find somebody who worked specifically with their conditions. But what advice could you offer our listeners today that might be a little bit more general for heart health?

Julia Zumpano:

Another great question, Natalie. One thing I found with a majority of the patients that I see is that they're lacking an essential nutrient called fiber. Fiber is the building blocks of plants, and it's a non-digestible, non-absorbable carbohydrate. What fiber does is it can formulate and excrete toxins, so it helps pull things that we don't need in our body and helps get rid of them in the form of stool. It creates stool and is your body's own cleansing system. Fiber also expands in your belly, so it makes you feel fuller longer. Fiber can lower cholesterol by binding around something called bile in our guts, and bile composed of cholesterol. It can eliminate that bile with the body's waste. It can lower or control blood sugars by slowing down the rate of glucose from going into the bloodstream after you eat something that may have carbohydrates in it. But if it's high in fiber, it will really slow down that rate.

Fiber also feeds your good gut bacteria. Fiber is the food that all those good bacteria in your stomach, which is called the gut microbiome, they feed off fiber rich foods. Fiber is essential to health and it's commonly under consumed.

Where can you get fiber? From plant-based foods, so really anything that grows from the ground that's a plant has some fiber in it. What we're thinking is things like fruits and vegetables, nuts and seeds, and beans or legumes. Those are very rich, fibrous foods. When you do consume fibrous foods, you really want to add a lot of variety to your diet as much as you can and get a certain food from each food group at least once a day.

What I mean by that is you want to make sure you're getting a fruit, a vegetable, a grain, a nut, and a seed, and a bean. That's a lot to keep track of, but they're all very fiber rich and have a lot of other nutrients in addition to the fiber. We know the plant-based foods are very nutrient dense.

Natalie Salvatore:

It sounds like fiber is a pretty important component of foods that we eat and we should increase our fiber intake, but I'm sure there are some things that we should be decreasing. What should we be decreasing in our diet?

Julia Zumpano:

For heart health, we really focus on looking at the kinds of fats that you're consuming in your diet. We know that saturated fats and trans fats are not supportive to heart health. They can cause the cholesterol to rise, they can cause triglycerides to rise, which are another kind of fat in our blood. Those can lead to plaque buildup in our arteries, which can eventually lead to heart disease. What we're trying to do is prevent that from happening. How we can do it is decreasing those animal fats, including saturated fats and trans fats.

What I mean by animal fats would be things like fatty cuts of meats, fried foods like fried or breaded chicken, fast foods that may have a lot of processed meats in them like bologna, or salami, or pepperoni. It will also include some of the dairy fats like butter, or processed cheeses are high in fat, or some of the really high fat condiments like sour cream, and cream cheese, mayonnaise. Some of those fatty condiments and animal fats are really the place where we're going to consume the most amount of saturated fat and trans fats.

But fat is really good for us. We need fat. They provide essential fatty acids, fat soluble vitamins. These are all essential for growth, and development, and brain health as well. We want to increase the fats that come from plant-based foods and fish. The reason for that is plant-based foods and fish provide what we call monounsaturated or polyunsaturated fats. These fats have been shown to support heart health. They help decrease your LDL, that bad cholesterol when you use good fats to replace bad. They increase your HDL, your good cholesterol, which is like that dump truck that removes the bad cholesterol out and transports it to the liver to be removed. We really want to focus on increasing plant fats such as extra virgin olive oil, avocados, or avocado oils, nuts and seeds, specifically things like walnuts, and almonds, and hazelnuts, chia seeds, and flax seeds because they really hone in on those good fats.

Then fatty oily fish like salmon, herring, tuna, mackerel, those have that omega fatty acid that has been shown to even further support health by helping with lowering triglycerides and lowering blood pressure and the stickiness of your platelets helps decrease that, so all supportive to heart health. Second tip really to focus on is decreasing the bad fats, increasing the good ones.

Natalie Salvatore:

Anything else we should be decreasing?

Julia Zumpano:

Yeah. Lastly, we want to focus on processed foods and decreasing those. The reason for that is I mentioned a little bit with the fat. A lot of the highly processed foods are very high in fat, but they're also high in salt and sugar. Too much salt and sugar is not good for our heart health. So sodium, which is what salt is made of, salt is sodium chloride. Sodium can cause blood pressure to rise if you're consuming too much. Increased blood pressure can be a risk factor for developing a stroke. We want to really keep that blood pressure well controlled by decreasing the amount of salt or sodium that we have in our diet.

The first step would be decreasing processed foods because processed foods also have all those other unhealthy ingredients like the bad unhealthy fats and the sugar, and of course the salt that will help you decrease all of those things. Now, if you're eating a whole foods rich, plant rich diet with a lot of good healthy fats and you're adding a little bit of salt, that's really rarely the issue. Excess sodium typically comes from those processed foods, convenience foods, fast foods, and a lot of those store bought, maybe even commercial, dessert foods and sweets. That's where you're going to get majority of them.

Natalie Salvatore:

Those are some great suggestions of things that we should decrease. Now, I know we've talked about this in other podcasts, but all of this advice can be pretty overwhelming sometimes for patients going grocery shopping and looking at food labels and making all these big lifestyle changes to how we're eating. What would be your biggest piece of advice to somebody who's looking to start their journey on a heart healthy diet?

Julia Zumpano:

I would recommend starting small. Pick one thing you want to work on, what you think is most realistic for you, whether maybe you start with having a vegetable every day and that's your main goal. It could be the same vegetable every day, but you just have it every day. Then from there, maybe your next step is that you add a little bit of variety to that vegetable. You try to switch it up every couple days, and then as you get comfortable, maybe you add a vegetable twice a day and then you can take it a step further by adding a fruit a day and so forth and so on.

Or maybe you really want to focus on some of the things that aren't serving you. Maybe you focus on decreasing your sugar sweetened drinks to maybe one to two times a week or whatever you think is realistic to you. Or your fast food intake, you try to cut it down to once a week or whatever you think is realistic. Start with a realistic, attainable goal that you know will positively impact your health and know that you're taking the right step. Small steps can make a huge impact in the long run. Instead of setting unrealistic unattainable goals that are overwhelming, that won't get you really anywhere, start with a really small step that you can take. Then expand upon that step as to where you think you can go next.

Natalie Salvatore:

Wow, that's great advice. Starting small and making those little changes and have a big impact.

Julia Zumpano:

Absolutely.

Natalie Salvatore:

Well, thank you so much for taking time out of your day to review what a registered dietician nutritionist is and how they can be supportive to someone's heart health.

Julia Zumpano:

Thank you so much for having me today, Natalie. I hope that you are able to find a registered dietician nutritionist to help you along your health journey.

Announcer:

Thank you for listening. We hope you enjoyed the podcast. We welcome your comments and feedback. Please contact us at heart@ccf.org. Like what you heard? Subscribe wherever you get your podcasts, or listen at clevelandclinic.org/LoveYourHeartpodcast.