Your Health
Managing Nutrition
Advertorial
An essential for patients with chronic diseases. It’s a Monday afternoon, and VCU Health dietitian, Nick Fischetti, is talking with patients attending “Nutrition 101.” His class is part of the VCU Pauley Heart Center’s weekly clinic designed for recently discharged patients who have congestive heart failure, a chronic condition in which a heart is unable to pump sufficiently. In the nutrition class, the group learns Nick Fischetti, M. S., R. D. about topics such as salt and fluid restrictions, Clinical Dietician II healthy vs. unhealthy VCU Health fats, and how to create a heart healthy diet. Many in the class were admitted to the hospital for an acute myocardial infarction — more commonly known as a heart attack. Patients attend the Monday clinic for four weeks, following their discharge. Other classes on medication, exercise and self-care are also tailored specifically to the needs of a heart failure patient.
“There aren’t many foods I will say you can’t have, but condensed soup is one of them,” Fischetti tells the group. Since their diet requires stringent salt restriction, he explains how to create lower-sodium soups by using frozen vegetables, a protein such as beans or chicken, and broth with an extra cup of water. “It requires a little work on your part,” he said. Fischetti specializes in nutrition for cardiology patients. However, “we rarely see patients with just one chronic disease.” Frequently, his patients also suffer from Type II diabetes. According to the American Heart Association, adults with Type II diabetes are two to three times more likely to have heart disease or stroke than those without diabetes. High blood pressure, poor cholesterol levels, high triglycerides, obesity and physical inactivity — common factors in Type II diabetes — can contribute to the development of cardiovascular disease. African-Americans are especially vulnerable to diabetes. The U.S. Department of Health and Human Services Office of Minority Health reports that blacks are almost twice as likely to be diagnosed with diabetes as non-Hispanic whites, and are also more vulnerable to complications from diabetes, such as endstage renal disease and lower extremity amputations. Fortunately, both Type II diabetes and cardiovascular disease can be improved through careful management of diet and exercise, along with any needed medications. While many patients first meet Fischetti following an acute incident that requires hospitalization, he is also available for outpatient, oneon-one nutritional counseling for patients with referrals from
their family physicians. Often, patients will receive a diagnosis from their doctors of “prediabetes,” a precursor to Type II diabetes. “Hopefully, that’s enough of a wakeup call for people,” he says. “It’s a nice reprieve. If they can make enough diet, exercise and lifestyle changes, then they can hopefully avoid being put on any type of medication regimen for diabetes and cut down on the negative side effects of that disease.” Fischetti enjoys seeing the often dramatic progress his patients can make in improving their health by controlling their diet and making other lifestyle changes — often with great tenacity. “I have one patient with really severe heart failure, and he certainly has to watch his salt intake,” he says. “So, a lot of what that kicks out are things with cheese on them or a lot of added salts. But he loves pizza.” To overcome the challenge, the patient and his wife learned to make pizza from scratch. “They came back to the clinic one day and said, `Hey, we made a mozzarella cheese pizza, but it only has about 200 milligrams of sodium a slice’” — which is about half the sodium content of most commercially prepared versions. The patient now enjoys the delicacy once a week without straying from his diet.” “It’s one of those things, that if you really want it, you can have it, you just may have to put in some time and effort,” says Fischetti. “But he does it every week, and he’s doing fine.”
Your Journey to Wellness Starts Here Healthy Eating
Simple ways to stay on track during the holidays.
In a few weeks, Thanksgiving will kick off the holiday season, as families and friends gather around dinner tables and fill their plates with delicacies such as oven-roasted turkey, stuffing and pumpkin pie. With Hanukah, Christmas and work parties around the corner, it can prove a difficult time for those who struggle with their weight. As families come together, “everybody busts out their special recipes and things that they don’t normally make week in and week out,” said Nick Fischetti, M.S., R.D., Clinical Dietitian II with VCU Health. Often, the special dishes
are high in fats and calories, and guests tend to eat more servings than usual. “Despite the challenges, it’s possible to maintain healthy eating habits during the holidays,” he said. Here are some suggestions: Use moderation. It’s OK to eat a wide variety of foods, but enjoy them in smaller portions. One easy way to do this is to select a smaller plate so that it fills up faster. That way, you can have those little indulgences, but you can keep a cap on it. Eat slowly. It takes about 20 minutes before your stomach gets the signal that it’s full. He suggests rotating eating with drinking water and engaging in dinner conversation. After about 20 minutes, it’s going to be a lot harder to go back for seconds because you’re really going to start to feel full. Follow a “give and take” approach. A lot of times, we see weight gain because people add foods to their diets during the holidays but don’t necessarily take anything away. So, they’re usually just piling it on. If you don’t normally eat dessert, for instance, then consider cutting back on something else — or
add some exercise to your day — if you really want that slice of pie. While cutting back is OK, don’t skip meals. Sometimes people try to save their calories for larger feasts at the end of the day. That’s a no-no. Forgoing meals increases hunger, and it sets you up to overeat in the future. You want to try to have something every four to five hours so that you are not ravenous when you get to the [main] meal. “Those on diets should take special precautions. Sometimes, loved ones will put pressure on individuals to over-indulge. Hold your ground.” Fischetti said. “Nobody wants to `diet’ during the holidays, but it’s not a reason to throw everything out the window that you’ve accomplished. It takes about 30 days to ingrain a new good habit, but it can only take a few days to break that. So, I think it’s important for people not to lose sight of their longterm goals.” he said.
Lighten Up for the Holidays As special family gatherings approach, it’s easy to find healthy dishes that will still please the crowd. The American Heart Association and the American Diabetes Association offer lots of ideas for main dishes, appetizers, side dishes and desserts that can be enjoyed during the holidays, or all year round.
A Heart Healthy Guide to Grocery Stores “It’s easy to find nutritious foods once you know how grocery stores are set up,” says VCU Health dietitian, Nick Fischetti. “Every store is relatively similar.” The healthiest foods — fruits and vegetables, meat and seafood, milk and dairy/refrigerated items — are located on the perimeter. The inside aisles hold canned and boxed foods and snacks. These processed foods are often high in sodium, sugars, fats and calories. He suggests that customers “do an outside lap once,” before moving to the interior. He often hears complaints that healthy foods are too expensive. He understands this concern, because “with the organic foods or the naturally selected foods, there’s a huge price hike for them,” he says. “But what we would advocate for is we want people to have lots of fruits and vegetables, with the skins on them, lots of whole grains, lean proteins and lean dairy products. And you can find those things in the grocery store for really cheap prices if you’re savvy.” For instance, Fischetti suggests that there are lots of frozen fruits and vegetables that you can get a lot of bang for your buck from. They have just as much nutritional value as fresh produce. That’s less true for canned fruits and vegetables, which can have more added sugar and salt,
and generally don’t have skins. Also, avoid frozen foods with added sauce, butter or cheese. Additionally, many healthy items — such as beans, brown rice, whole grain pasta — can be purchased in bulk. Whole wheat is comparable in price to its white, unrefined counterparts, but much better for you. When shopping, it’s important to understand how to read food labels. “The number one thing is to start at the top, on the serving size. You’ve got to know how much they’re talking about, whether it’s the whole box, one cup, or one teaspoon,” he says. “If you eat two servings, you need to double the calorie count.” He also recommends choosing foods with less than three grams of saturated fat, per serving. If possible, avoid trans fats, which are found in partially hydrogenated oils. Also, select foods that have less than 140 mg of sodium per serving or less than 500 mg for a meal. Finally, choose foods with at least five grams of dietary fiber to help meet the daily goal of 25-30 grams per day. “Ultimately, plan your meals and make a list before going to the grocery store,” Fischetti says. “And shop on a full stomach.”