Features October 2016 Issue

How to Work with a Dietitian to Achieve a Heart-Healthy Lifestyle

Dietitians can help with meal planning, nutrition education, weight control, and be a resource for questions about heart and diabetes health.

Calories, sodium, cholesterol, healthy fats, unhealthy fats...there’s a lot to consider when you’re trying to develop a more heart-healthy eating plan. If you need some help in that department, you may want to turn to a dietitian for help.

Your doctor may have even suggested working with a dietitian, or you learned some about how dietitians work in cardiac rehab. Dietitians work with heart patients in a variety of settings, though they all have the same goal of helping individuals adopt a heart-healthy eating strategy and an overall lifestyle that will improve their cardiovascular health, says dietitian Katherine Patton, RD, LD, with Cleveland Clinic’s Preventive Cardiology & Rehabilitation Section.

“Here at Cleveland Clinic we have dietitians who work inpatient (for patients who are admitted to the hospital), as well as outpatient,” she explains. “For example, in the Preventive Cardiology Clinic where patients see their cardiologist, in the same office there is a dietitian who will see patients. There are also private practice dietitians who provide nutrition therapy to heart patients.”

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A dietitian can help you work out a healthier eating plan and educate you about nutrition, weight management, cholesterol and blood pressure control.

Finding a Registered Dietitian

If your doctor doesn’t refer you to a registered dietitian (RD), you may be able to refer yourself. Talk with your doctor about it, and investigate whether the nutrition counseling program at your local hospital or private dietitians would be the best option for you. Some dietary services are covered by insurance, but if you’re not eligible, keep in mind that the per-visit sessions are usually priced reasonably if you’re paying out of pocket.

The first session involves a lot of information gathering: weight history (highest weight, lowest weight, usual body weight, goal weight); previous weight loss/diet strategies (previous diets, plans, programs or education); and diet recall.

“We obtain typical day-to-day eating habits, food frequency, likes and dislikes,” Patton says. “That’s followed by education on cholesterol-lowering and blood pressure-lowering strategies, carbohydrate counting, how to read a nutrition facts label, and meal plan development. Then you go through some goal setting and summarize everything you covered.”

Your Dietitian's Program

Subsequent sessions address goals that were established at the initial consult.

Patton says your dietitian will go over with you whether the goals are being met, not met, partially met, and will address questions and concerns you have. “This may require clarification or education on a new topic,” she says. “We’ll review any recent lab values to assess if dietary interventions have had a positive or negative impact. Often we have to establish new or modified goals.”

In between sessions, you have “homework” to help you meet your goals and simply to become more educated about a heart-healthy diet. Among the assignments is keeping a food journal, either on paper or with a computer or smartphone application. By tracking your food intake, you can often get a clearer picture of what aspects of your diet and lifestyle need attention.

Other work during the program involves becoming a smarter consumer and approaching shopping with an eye on heart health.

“They start reading nutrition facts labels to assess saturated fat, sodium, and carbohydrate content,” Patton says of her patients. “They start measuring portions. They start eating more consistently breakfast, lunch, dinner and snacks if need be. They eat out less often and eat more at home.”

If the progam is going well, most heart patients start increasing their intake of fruits and vegetables, while consuming fewer sugary drinks and foods with lots of added sugar.

Frequency of Dietitian Sessions and Finishing

The number and frequency of sessions with a dietitian varies considerably, Patton says. “It’s often dependent on how often they come to our clinic to follow up with the cardiologist or nurse practitioner (NP),” she says. “When they come to see a doctor or NP, they schedule follow-up with the dietitian also, which could be every three, four or six months. Some patients who want to focus on weight loss will come once per month.”

Once you feel you’ve transitioned into a healthier way of eating and living, you may put things on hold with your dietitian. Patton says it’s common for that relationship to be left open, which means you can resume sessions as circumstances dictate.

“A patient may achieve weight loss goals or lower cholesterol and blood pressure to within normal limits, but a few years down the road things may change and the doctor or nurse practitioner will refer a patient to see the RD again,” Patton says.

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