Counseling patients on healthy dietary patterns is challenging. So much information abounds that it can be hard to separate the wheat from the chaff. According to Isabel Maples, MEd, RDN, a spokesperson for the Academy of Nutrition and Dietetics, initial diet advice should focus on encouraging patients to add missing components—most commonly fruits, vegetables, whole grains, and dairy—rather than restriction. "When people are resistant to change and they don't want to give up their favorite foods, but they're scared because they have heart disease or diabetes, I start by focusing on what they can add to their diet instead of what they should subtract, to help them feel successful," says Maples. Here are five evidence-based tips to share with your patients. 1. Get the right nutrients. Patients should aim to fulfill their recommended calorie intake with a variety of nutrient-dense foods that span all food groups to boost long-term health. Healthy eating styles may vary from individual to individual and frequently reflect cultural and personal preferences.[1] In a 2017 study by Micha and colleagues,[2] nearly one half of all cardiometabolic deaths (ie, deaths from heart disease, stroke, and type 2 diabetes) among adults in the United States were found to be associated with suboptimal intake of vegetables, fruits, nuts, seeds, and omega-3 fatty acids. The US Department of Agriculture (USDA) replaced its food pyramids of yore with MyPlate in 2011.[3] MyPlate illustrates the concepts of balance and portion size that are evident at a glance. The plate is divided into four, roughly equal parts—fruits, vegetable, grains, and proteins—as a simple reminder of how to eat healthier. Lying beside the plate is the fifth food group, dairy, positioned as a beverage. Dairy can be a glass of milk, cheese, or yogurt, or can be substituted with a fortified soy-based beverage. Advice from the USDA focuses on discovering the individual's own healthy eating style, which entails the following: Fill half the plate with a variety of fruits and vegetables; Ensure that half of grains consumed are whole grains; Shift to low-fat and fat-free dairy products; and Regularly switch proteins to include such choices as seafood, lean meats and poultry, eggs, nuts, legumes, and seeds. Vegetables should be consumed in a variety of colors and consistencies, such as dark green, red, orange, leafy, and starchy. Finally, dairy is important for more reasons than just calcium. "When you eat dairy, you get vitamin D, magnesium, and potassium," says Maples. "One of the reasons MyPlate increased dairy to three servings from two was to get more potassium in the diet." 2. Cook meals at home (from scratch, if possible). Processed foods and beverages—including packaged snacks, smoked meats, white flour, and sugar-sweetened items—should be eaten only occasionally. More specifically, the USDA has quantified limits[4] that may help patients understand exactly how much added sugars, saturated fats, and sodium is healthy: Less than 10% of calories should come from added sugar, less than 10% of calories should come from saturated fats, and less than 2300 mg of sodium should be eaten per day. The average American consumes about 50% more sodium than is recommended, which can raise blood pressure and increase the risk for stroke and heart disease.[5] Mixed dishes (ie, dishes comprising more than one food group) account for 44% of the average American's sodium intake.[6] Furthermore, most sodium is consumed in the form of processed or prepared foods and restaurant foods. The remaining salt that people eat comes from snacks, protein foods, grain-based foods, condiments, gravy, salad dressings, and dairy. Contrary to what some may think, the salt shaker is not a substantial source of sodium. Ultimately, to decrease consumption of added sugars, saturated fats, and sodium, preparing foods at home is key, with premade sauces, mixes, and instant products (ie, instant noodles) used sparingly.[6] Choosing fresh or frozen meats, fish, and poultry instead of processed animal foods is ideal. Fresh or frozen vegetables (without sauce or salt) are healthier than canned foods. Instead of reaching for the salt shaker, consider seasoning vegetables with herbs and spices. 3. For weight loss, choose realistic, balanced diets. The most successful diet is one that patients can stick to. Plenty of diets have proven effective for weight loss and weight maintenance. When dieters fail, it is because they attempt to follow diets that are too restrictive, are unbalanced, or cause rapid weight loss, which leads to yo-yo dieting. Diets that promote weight loss and weight maintenance include increased consumption of vegetables, fruits, and high-fiber and whole-grain foods; increased intake of water; and reduced consumption of dietary sugar and sugar-sweetened beverages[7] Low-carb, high-protein diets result in greater weight loss over a given period compared with calorically equivalent diets that contain relatively more carbohydrates.[7] Furthermore, high-protein diets are linked to better long-term benefits with regard to waist circumference, body fat composition, reduced loss of muscle mass, improved cardiometabolic risk factors, and decreased diameter of adipocytes. However, moderate-carbohydrate, moderate-protein diets have also been linked to improved body composition, lipid profiles, and postprandial insulin response. Specific diets that have proven effective at weight loss plus reduction in body mass index include the DASH (Dietary Approaches to Stop Hypertension) diet, Mediterranean diet, Nutrisystem®, Weight Watchers®, and Jenny Craig®.[7] The Mediterranean diet is heavy in vegetables; fruits; nuts; whole grains; and healthy unsaturated fats found in olive, avocado, and other plant oils. It focuses more on fish and poultry, and less on lean red meat and dairy. The Mediterranean diet has been correlated with lower risks for cardiovascular disease, cancers, type 2 diabetes, Parkinson disease, and death. Of note, part of the benefit of the Mediterranean diet may be biopsychosocial, with family-style eating, genetics, and active lifestyles all playing a role.[6] The DASH diet[8] focuses on meeting daily and weekly nutritional goals, and is convenient because no special foods are required. It works well for vegetarians and people who require gluten- or allergen-free foods. Overall, the DASH diet promotes general healthy eating that includes vegetables, fruits, whole grains, fish, poultry, beans, nuts, vegetable oils, and no- or low-fat dairy products. Sugar-sweetened foods and beverages and saturated fats (eg, tropical oils, such as coconut, palm kernel, and palm oils) should be limited.[6]Oft-cited research suggests that 6 months on the DASH diet plus counseling results in significantly lower levels of hypertension in addition to weight loss.[9] Source
