Nutrition Intervention of CHD

1. Nutrition Intervention of CHD Amanda I’Ons Registered Dietitian

2. Water • Drink 2 litres or less of water per day • (if you on fluid restriction, adhère to doctors recommandations) • Water is the most important nutrient • Restrict your intake of sodium to 1.5 g per day. Non CHD adults restrict to 2.3g/day • Eat potassium rich foods each day such as banana, pawpaw, potatoes, tomatoes, strawberries

5. Water- our most important nutrient

6. The Importance of Drinking Water

7. Salt • Is often ‘HIDDEN’ in food • Names: mono sodium glutamine or glutamate • Powders- sauces, soups, biltong • Pies, chips, fizzy colddrinks, processed/instant foods • Be careful with potassium salt or salt replacements • Use herbs and spices

8. 6-8 glasses per dayhigh salt intake and high fluid intake may lead to fluid retention and high blood pressure

9. Vitamins and Minerals Vitamin D- deficiency may cause Rickets Hypertension CVD Heart Failure Peripheral arterial disease Sources: sunlight 20minutes/day Dairy products, oily fish, egg yolk and cod liver oil or fish oils, supplement Vitamin C Vitamin E B-vitamins Magnesium and Potassium Zinc, Selenium

10. Fruit and Vegetables Two main functions: Soluble fibre Plant sterols , sterolins and other phytontutrients Vitamins and minerals Also a source of CHO * apple – pectin and phytonutrients “An apple a day keeps the doctor away”.

11. Berries (mixed) All Berries are a very nutritious food source. They are one of fruit and foods with the most alkalising effect on the body. A poor diet, high in alcohol, coffee, sugar, smoke and unhealthy red meat will cause the body to become more acidic. Often manifesting as gout (purines) or other inflammatory diseases. Very high vitamin C Phyto chemicals in skin and fruit Eat as desert or smoothie.

12. FibreWe need a total of 25-35g fibre (both soluble and insoluble) dailyor 14g fibre per 1000kcal AI. Whole grains (insoluble fibre) Fruit and Veg (soluble fibre)

13. FibreNeed 25-35g fibre per day • Fibre is very important for gut health and to lower serum cholesterol levels. • Gut micro-flora • Bile secretion- reduce serum cholesterol • Satiety effect, consequently reduce fat intake • Get soluble fibre: fruit, vegetables, oats, oat bran, legumes- most important fibre. • Insoluble fibre: wheat, bran, whole grains- stool bulking effect

14. How to increase your fibre intake • Eat high fibre cereals, whole wheat breads, pasta and brown rice. And Legumes. • Eat 5-6 servings fruit and vegetables per day and try to leave skins on. • Eat high fibre low fat snacks e.g. Raw vegetables, fresh fruit and popcorn. • Check labels for fibre facts- list the amount of fibre per serving or the words bran, whole wheat flour listed as one of the 1st five ingredients.

15. Selected Sources and Amounts of Dietary Fiber Fibre Content of Various Foods

16. Legumes Hydro ½ cup cooked dried beans, lentils per day. Include in meat/salads/rice/veg ? Glycaemic Index Insulin- explained Contribute to euglycaemia Tolerance- bacterial overgrowth Vegetarian meals approximately 3 times a week.

17. Insulin/Glucose Peak

18. Glycaemic Index Chart

19. Glycaemic Load

20. Sugars and Sweeteners • Sugar- sucrose has medium glycaemic index • Honey- health properties, but high glycaemic index • Insulin-peak, dip (revisited) • Artificial sweeteners • www.gifoundation.com

21. Confectionary • Limit * low GI (avoid insulin peak) • Look for healthy recipes and alternatives • Eating for Sustained Energy by Liesbet Delport and Gabbi Steenkamp • Chocolate- limit, black chocolate, 70% and more cocoa. Or cocoa drink with low fat milk, limit sweetener.

22. Dairy Products Very important source calcium, B-vitamins, vitamin A ,D and protein. Not essential in adult diet- easily replaced Vitamin D- deficiency may cause hypertension, CVD, Heart Failure, Peripheral Arterial Disease Calcium supplement For cholesterol lowering purposes and weight management, low fat is best. Nutritious, Organic vs non-organic rBST free, free antibiotics, free range

23. Healthy cows in natural environment

24. Beef Not all beef is unhealthy Always remove visible fat from meat Always eat lean meat e.g. Lean mince Free range beef- during winter months reduced saturated fat and omega 6 fatty acids from grass diet. High corn diet, high hormone rich meat, usually with antibiotics. Meat bought may or may not be grass fed beef.

25. Lean meat cuts Lean cuts Avoid organ meats- high in saturated fat and cholesterol Avoid shell fish- high cholesterol Eggs- err on caution- use 3/ week No evidence increase cholesterol Serum cholesterol levels more affected by types and amount of fats we eat, fibre content diet, exercise and water than the amount of cholesterol eaten. All animal products contain cholesterol No plant product contains cholesterol

26. Ostrich meat, considered healthy alternative

27. Free range chickens • Chickens on natural diet Health benefits of diet free of antibiotics and hormones The chicken meat has lower fat content, fowl eats natural diet.

28. Tunnel Produced Chickens

29. Free Range Chickens Cholesterol: Less than 300mg/ day for healthy adults Less 200mg/day for adults with high levels of LDL (BAD) cholesterol or who taking cholesterol lowering medication. Eggs- fatty acid content and cholesterol content 1 egg on average has 200mg cholesterol and 5g fat Benefits; protein, vit D, riboflavinfolate folate

30. Nuts Contain fibre, calcium, protein and essential fatty acids. Most nutritious nut to eat is the raw, unsalted almond. Concentrated energy source, eat it in limited quantities ¼ cup or 7-14 nuts. Natural energy from the sun- we can’t measure it in calories.

31. Nuts Omega 3 fatty acid : Walnuts Omega 6 Fatty acid: Soy nuts Monounsaturated fat: Almonds, cashews, peanuts, pecans, and butters made from these nuts.

33. Fats and Oils All Seeds are important They contain essential poliunsaturated fatty acids. Fats and fatty acids are a very important part of management of Heart disease. Saturated fat- animal fats, must be reduced to 7% or less than 14g if you follow a 2000 calories diet. Poliunsaturated fats 10% of total fat intake e.g. Omega 3 and 6 fatty acids. Trans fats- dangerous, rancid fats, found in brick margarine and damaged sunflower oil. Try and have none- must be less 1% of your total calories. Read labels

34. Oils * Olive oil mono-unsaturated oil (only one unbound carbon) Canola mix Avocado pear oil Grape seed- polyunsaturated oil with highest smoking temperature Fry food- avoid, only occasionally, All oils are damaged when heated look for cold pressed oils

35. Comparison of Dietary Fats

36. Fish-wild salmon, pilchards

38. Fatty acid supplements Dosage: 1000mg ( EPA and DHA) omega 3 fatty acid for CHD patients. 2-4g EPA and DHA per day for triglyceride lowering effect. Non cardiac patients 1000mg/day of EPA and DHA. OR eat oily fish 2 x per week (rich in linolenic acid) also include flaxseed, canola oil, soybean oil, flaxseeds and walnuts. Caution: contraindicated if on blood thinners Cholesterol lowering properties higher in fish source of oil than plant (more active molecules and body just absorb) Omega 6 fatty acids: 1000mg / day Star flower, flax seed oil, evening primrose oil.

39. The Benefits of Omega 3 fatty acids

40. Flaxseed oil vs. Salmon oil Flaxseed Oil Salmon or fish oil

42. Conclusion • Watch your: • Water • Fibre • Fats and oils • Sufficient plant phytonutrients and vitamins and minerals • Exercise/relaxation/Sunshine

43. Laughter is good for the heartand strength to the bones.

44. Contact Details • Amanda I’Ons • Cellphone number 0792973936 • Email address: avions.burg@gmail.com • High Rustenberg Hydro: 021-8093800 • Stellenbosch