Exploring the Gap

The Challenge of prescribing and implementing lifestyle change for prevention and reversal of CVD

Reversal of Promising Trends??

2

Retrieved from: https://www.wsj.com/articles/after-decades-of-progress-america-backslides-on-heart-disease-11561129106

Comparison of Diets Mediterranean DASH OMNI Heart

1 2KetoModified Atkins Diet

Total Fat % 35-40 27 27 37 55-60

Saturated Fat % 6 6 6 6

Protein % 15-20 18 28 18 25-30

Carbohydrates % 40-50 55 45 45 5-10

Legume, vegetable, fruit, nut, whole grain, low sugar

Whole grain, lean meats, vegetable, fruit, low-fat dairy, moderate sweets

Omni 1- DASH with 10% more protein; 10% less CHO

Omni 2- DASH with 10% more fat;10% less CHO

4 g fat:1 g pro/carbTypical diet 0.2 g fat:1 g pro/carb

Carb <50 gFats embracedSatiety is indicator for calories

The Heart Disease Bermuda Triangle

Sugar Meat

Dairy

(salt and fat)(carbs)

Simple, Powerful Therapy

Blue Zones

• Total fat 20%

• Protein 15%

• Carbohydrates 65%

Legumes, green leafy, olive oil, limited added sugars & dairy

Change is a Journey

Precontemplation

(not ready)

Contemplation

(getting ready)

Preparation

(ready)

Action

(making changes)

Maintenance

(keeping up the changes)

Meeting the patient where they are

24Hr Dietary Recall

• Breakfast

• Snack

• Lunch

• Snack

• Dinner

• Snack

What do you drink during the day?

What is your overall health goal?

• Eat less fast food?

• Drink less SSB?

• Avoid skipping meals?

• Ready for plant-based eating?

• Meal prep/recipes?

Culinary Medicine in Action

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Virtual Health Coaching Goal setting, self-efficacy; personalized plans, readiness to

change, motivational interviewing

My Health Accountability, support, nudging, reinforcement

management

Teaching Kitchen

Group Sessions

Education, consciousness raising, benefits, education,

skill building, peer supports, helping relationships

AppScript

• Apps

• Recipes

Tracking, monitoring, support, self-efficacy, nudge,

Skills building

Access YMCA Veggie Van, Community Food Club (food pantries),

shared meals, leftovers, SWAG bag, childcare,

Social Determinants of Health

Transportation UBER, Social Determinants of Health

Intermittent Fasting

Limited research on humans, studies with n< 100

Possible benefits

• Reduce calories

• Less insulin resistant

• Reduce inflammation

• Improve cognitive function

Intermittent Fasting

• Time-Restricted: Fast 16 hours, 8 hour eating window

• Alternate Day: Fast 24 hours, once or twice a week

• Modified Fasting: 500–600 calories on two non-consecutive days, eat normal the other 5 days.

• UME/GME suggest 25hrs of nutrition education

• 2010 survey: 44% of cardiology fellowship directors reported providing a nutrition lecture, but only 27% of their chief fellows recalled a nutrition topic

• 56% of senior cardiology fellows reported receiving no nutrition education during their training, and 90% of >600 practicing cardiologists reported receiving no or minimal nutrition education during fellowship

Patient/Physician Resources:www.nutritionfacts.orgHenryfordlivewell.comThat Sugar FilmForks Over KnivesSuperSize MeThe Spectrum – Dean OrnishThe Whole Heart Solution – Joel Kahn