Since February is American Heart Month, we wanted to take a deep dive into how Registered Dieticians deal with heart health for their clients. Guest writer and RD Grace Engels gives us the deets.

Author: Grace Engels

Research has shown that the top two reasons for death worldwide are ischemic heart disease and stroke. By addressing heart health, we can improve the quality of life for countless individuals and significantly cut down healthcare costs around the world!

As a clinical dietitian, I am consistently consulted to speak with patients about heart health. A common consult for me is to teach how diet can improve a lipid panel, for example. In my other role as an eating disorder dietitian, I am regularly educating my patients on the risks under-nutrition poses to their hearts, including heart failure due to muscle wasting.

Registered dietitians play a crucial role in helping individuals and the general public keep their hearts healthy but face many roadblocks when it comes to doing so. Whether it’s working with an unmotivated patient or helping individuals learn a new recipe, there are many techniques dietitians employ to make a positive impact on heart health.

The Dietitian’s Role in Heart Health

Many chronic diseases either directly impact the heart or will do so in the future if the disease is not attenuated. For example, diabetes can lead to high blood pressure as blood vessels are constricted, and chronically high blood pressure can strain the heart and ultimately lead to heart failure.

Research shows a balanced diet can improve heart health. As dietitians, we study the latest research and help individuals and the general public apply that information in their daily lifestyles.

Dietitians vs. Heart Health:  The Difficulties 

The main variable when tackling the issue of heart health of the general population is the population itself! Every person a dietitian works with has a unique background, and dietitians need to adapt accordingly. To help standardize care across the array of patients, dietitians have developed the Nutrition Care Process (NCP), which consists of five elements:

Assess:  Dietitians collect information from their patients including diet history/intake, bloodwork reports, anthropometric measurements, and medical tests/procedures.

Diagnose:  Using the information collected in the assessment process, dietitians determine what the patient’s specific nutrition diagnosis is.

Intervene:  Dietitians create an action plan to work at the root cause of the nutrition diagnosis and to help reduce any negative side effects that may be occurring.

Monitor & Evaluate:  Dietitians keep an eye on specific variables in the patient’s case to determine what progress they have made.

How Does the NCP Work? 

The Nutrition Care Process looks slightly different depending on which setting the dietitian is in. But regardless of the setting, the Intervention phase of the NCP is where many dietitians run into difficulties when they address heart health with their patients.

Common issues dietitians face related to heart health include:

Misinformation & Lack of Knowledge. The internet is the modern-day Wild West. While the Registered Dietitian credential is strictly regulated, there are zero regulations for the title ‘nutritionist.’ Anyone can call themselves a nutritionist, and many people do. Countless ‘influencers’ across social media feel their personal experience qualifies them as ‘nutritionists.’ They often lead their followers astray by sharing nutrition misinformation.

I cannot tell you how many people have asked me if they should go on a ketogenic diet because they heard it’s the best way to burn fat. People who promote the ketogenic diet to burn fat don’t tell about the high rate of adverse side effects, some of which can include detrimental effects on heart health!

Dietitians need to accurately assess a patient’s knowledge base to determine what information would best suit that particular patient and if they need to redirect any misinformation.

Varying Levels of Motivation. A dietitian may have the best heart health educational spiel ready-to-go for her patient, but if the patient is in pain because they just had a foot amputated, the dietitian probably won’t get through to them. A tool many dietitians use to determine their patient’s motivation level is the Stages of Change Model. The model outlines five stages a patient could be in with respect to the issue at hand (let’s use heart health as an example):

Precontemplation:  In this stage, the patient either is not aware of the problem or has no interest in thinking about it. The dietitian can gently introduce concepts, such as the impact diet can have on heart health, and hope this plants a seed that might grow down the road.

Contemplation:  At this stage, the patient is aware of the issue but may not be sure how to handle it. Dietitians work to inform and motivate patients, maybe by discussing barriers to change or helping to set attainable goals. An attainable goal for heart health might be choosing to drink water instead of soda at lunch each day.

Preparation:  A patient in this stage is motivated to make the change but just needs help doing so. Their dietitian can serve as an accountability partner and help the patient find other ways to support the positive change. For example, at the next session, the dietitian might check in to see if the patient followed through on the goal to drink water at lunch.

Action:  In this stage, the patient is actively making the change in their lives. Here, the dietitian works to continue motivating the patient to keep up the good work and to assess whether the change is sustainable. If the patient found replacing soda with water at lunch to be easy, the dietitian might push the patient to do the same thing at dinner.

Maintenance:  At this point, the patient has developed a new, positive habit. The dietitian now can work to help the patient determine ways to not fall back into old patterns. For our patient cutting soda out of their daily routine, maintenance could include not buying cases of soda to have at the house.

After the dietitian determines which stage of change her patient is in, she can move forward with the intervention component of the Nutrition Care Process that is most appropriate.

Limited Food Access. It is necessary to acknowledge patients have varying degrees of food access, a fact often apparent to dietitians who work in community nutrition. Community nutrition typically involves low-income families that may not be able to afford or have access to healthier foods.

For example, food bank dietitians teach cooking classes that highlight healthy recipes that use food pantry ingredients like canned and boxed goods. If a dietitian is working with a patient who has limited resources but still wants to improve his heart health, it is essential to tailor nutrition interventions accordingly.

Instead of motivating the patient to buy fresh veggies or a gym membership, the dietitian might recommend rinsing canned veggies or going on a daily neighborhood walk.

Summary

Dietitians are dynamic individuals who take many variables into account when working with patients. While there are untold barriers to helping patients improve heart health, there are numerous tools available to help dietitians do just that, including the Nutrition Care Process, the Stages of Change Model, and their own creativity.