The Foodsmart Heart Smart Program is a comprehensive lifestyle intervention program that incorporates changes to food intake, exercise, and behaviors to support heart health goals. This 12-session program is delivered by an RDN over five months as follows: weekly meetings with RDN for the first 8 sessions followed by meeting every other week for sessions 8-12. Upon completion of the 12-week program, patients are encouraged to schedule a one-month follow up visit for accountability and progress.
Upon completion of this program, participants can expect to see improvements in cholesterol levels and/or blood pressure readings, as well as weight loss and increased energy levels.
Introduction Script
Welcome to Heart Smart! My name is <YOUR NAME>, I’m a Registered Dietitian <INCLUDE OTHER RELEVANT CREDENTIALS>. I am so excited to be working with you.
We are pleased you have decided to join the Foodsmart Heart Smart Program. Our program focuses on helping you make sustainable lifestyle changes with the help of a Registered Dietitian Nutritionist (RDN). There are no gimmicks or special rules. Your individual and personalized meetings with your RDN will help you make the changes you need to make to meet your health goals by helping you improve your eating habits, health behaviors, and confidence to maintain all of the changes you make.
Healthy lifestyle changes take time; this is why our unique program takes three months to complete. Over this time, you will discover what works for you, and you will get assistance in setting and tracking goals that you can meet.
Many of our participants report that one of the greatest benefits of getting to meet with their dietitian so often is that it helps them stay accountable. During our program, you can expect to see overall improvements in areas such as cholesterol levels, blood pressure readings, and weight. We also teach you strategies for maintaining these improvements and continuing to engage in your new healthy habits.
At the end of our twelve sessions we’ll talk about ways to give you ongoing support, whether it’s through additional work together or other resources that are helpful for you.
Are you ready to get started? What questions do you have for me about my background, or Heart Smart?
Welcome to Heart Smart
Congratulations on your decision to work on your health goals!
We are pleased you have decided to join the Foodsmart Heart Smart Program. Our program focuses on helping you make sustainable lifestyle changes with the help of a Registered Dietitian Nutritionist (RDN). There are no gimmicks or special rules. Your individual and personalized meetings with your RDN will help you make the changes you need to make to meet your health goals by helping you improve your eating habits, health behaviors, and confidence to maintain all of the changes you make.
Healthy lifestyle changes take time; this is why our unique program takes three months to complete. Over this time, you will discover what works for you, and you will get assistance in setting and tracking goals that you can meet.
Many of our participants report that one of the greatest benefits of getting to meet with their dietitian so often is that it helps them stay accountable. During our program, you can expect to see overall improvements in areas such as cholesterol levels, blood pressure readings, and weight. We also teach you strategies for maintaining these improvements and continuing to engage in your new healthy habits.
Again, congratulations on your decision to join our program!
Goals & Objectives
Lesson/Visit Objective
Participants will be able to identify the leading causes of heart disease, hypertension, and high cholesterol:
Diets that are high in saturated fat and sodium and low in fiber, unsaturated fats, and vitamins/minerals (calcium, potassium, magnesium)
Sedentary lifestyle
Overweight and obesity
Alcohol and tobacco use
Genetics
Chronic conditions (diabetes, autoimmune disorders)
Participants will be able to identify the components of a heart-healthy diet/lifestyle, which include:
A focus on fiber, lean protein, unsaturated fats, potassium, calcium, and magnesium
Fruits, vegetables, whole grains, fat free/low fat dairy products, fish, poultry, beans, nuts, seeds, vegetable oils
Limiting saturated fat, trans fat, sodium, and added sugars
Fatty meats, full fat dairy, sugar-sweetened beverages, sweets
Regular exercise
At least 30 minutes a day, 5 times a week
Maintaining a healthy weight
Participants will verbalize the importance of supporting heart health through healthy diet and lifestyle choices.
Participants will set a personal goal to achieve within 4-6 months, such as:
Lower LDL cholesterol and increase HDL cholesterol
Lower blood pressure
Decrease weight by 5%
Increase energy and/or stamina while exercising
Eat at least 3 servings of fruits and/or vegetables every day
Replace all refined grains with whole grains
Replace saturated fats with unsaturated fats while cooking
Participants will show a hematological improvement in HDL/LDL ratio and/or consistent BP readings WNL at completion of the program.
Considerations:
Baseline Data
Nutriquiz data (unsaturated fat, saturated fat, fiber, sodium values)
Diet recall
Relevant diagnoses
Relevant medications
Recent lipid panel
BP readings
Improvements
Participants can achieve hematological and hypertensive improvements by increasing unsaturated fats/fiber, decreasing saturated fat intake, reducing sodium intake, and incorporating regular exercise.
Measured by pre- and post-program:
Lipid panel
Nutriquiz/diet recall
Frequency of exercise/activity
BP readings
Outcomes
To show improvement in HDL/LDL ratio (increase HDL, decrease LDL, decrease total cholesterol, change in triglycerides?).
To show improvement in fruit, vegetable, healthy fat, whole grain, and fiber intake.
To show a decrease in saturated fat and sodium intake.
To show an improvement in BP readings.
% WNL?
To show an increase in exercise/activity and stamina.
Background Information
Dietary Approaches to Stop Hypertension (DASH) Diet is shown to lower blood pressure and reduce LDL cholesterol levels
Rich in potassium, calcium, magnesium, fiber, unsaturated fats, and lean protein
Fruits, vegetables, whole grains, fat free/low fat dairy products, fish, poultry, beans, nuts, seeds, vegetable oils
Low in saturated fat, trans fat, sodium, and added sugars
Fatty meats, full fat dairy, SSB, sweets
“What’s On Your Plate?” worksheets
Heart disease is a term that encompasses multiple heart conditions, some that develop through lifestyle habits and some that are genetic/congenital.
The most common type of heart disease is coronary artery disease (CAD)
CAD is the narrowing or blockage of the coronary arteries leading to decreased flow of blood and oxygen to the heart
CAD is caused by plaque buildup (atherosclerosis) that narrows the arteries and causes blood flow restriction
Plaque buildup is caused by HTN, diabetes, unhealthy diet (high in saturated fat), genetics, inflammatory diseases (RA, lupus, IBD)
Hypertension is defined as blood pressure readings consistently measured at above normal ranges
Normal BP
systolic: less than 120 mm Hg
diastolic: less than 80 mm Hg
Elevated
systolic: 120–129 mm Hg
diastolic: less than 80 mm Hg
High
systolic: 130 mm Hg or higher
diastolic: 80 mm Hg or higher
HTN increases risk for developing heart disease, chronic kidney disease, heart attack, and stroke
Causes/risk factors include diabetes, obesity, unhealthy diet (high in sodium, low in potassium), alcohol and tobacco use, genetics, pregnancy, physical inactivity
Treatment includes medications, changes in diet, and regular exercise
High cholesterol (hyperlipidemia) is the presence of too much cholesterol in the bloodstream
Caused by high triglycerides, high LDL, and low HDL (types of cholesterol)
Triglycerides are a type of fat that is acquired through diet (saturated fats, excess calories) and are made by the body
Normal = >150 mL/dL
Borderline high = 150-199 mL/dL
High = 200-499 mL/dL
Very high = 500+ mL/dL
LDL cholesterol is the “bad” type that can cause atherosclerosis
Found in foods with saturated fat and trans fat
HDL cholesterol is the “good” type that carries LDL cholesterol to the liver to be eliminated from the body
Found in foods with unsaturated fats
Hematological improvements can be seen within 6 weeks
Week 1: What Makes a Healthy Heart?
Topic: What makes a healthy heart?
Handout: pages 5-6 of the program packet
Description:
Discuss the causes of heart disease/HTN/high cholesterol and how they affect heart health
Heart disease is a term that encompasses multiple heart conditions, some that develop through lifestyle habits and some that are genetic/congenital Heart disease
The most common type of heart disease is (CAD) coronary artery disease, which is the narrowing or blockage of the coronary arteries leading to decreased flow of blood and oxygen to the heart
CAD is caused by plaque buildup (atherosclerosis) that narrows the arteries and causes blood flow restriction atherosclerosis
Plaque buildup is caused by HTN, diabetes, unhealthy diet (high in saturated fat), genetics, inflammatory diseases (RA, lupus, IBD)
Hypertension is defined as blood pressure readings consistently measured at above normal ranges Hypertension
High cholesterol (hyperlipidemia) is the presence of too much cholesterol in the bloodstream hyperlipidemia
Causes/risk factors include diabetes, obesity, unhealthy diet (high in sodium, low in potassium), alcohol and tobacco use, genetics, pregnancy, physical inactivity Causes/risk factors
How HTN/high cholesterol can be managed through lifestyle changes
Dietary Approaches to Stop Hypertension (DASH) Diet is shown to lower blood pressure and reduce LDL cholesterol levels Dietary Approaches to Stop Hypertension (DASH) Diet
Rich in potassium, calcium, magnesium, fiber, unsaturated fats, and lean protein
Fruits, vegetables, whole grains, fat free/low fat dairy products, fish, poultry, beans, nuts, seeds, vegetable oils
Low in saturated fat, trans fat, sodium, and added sugars
Fatty meats, full fat dairy, SSB, sweets
Identify the patient’s reason(s) behind starting the curriculum, aka their “why” (increase energy to play with grandkids, learn healthy habits to pass onto children, live a longer and healthier life, etc.)
Provide overview of Heart Disease curriculum
Complete nutrition assessment (height, weight, PMHx, medications, diet recall, exercise, etc.)
Review bloodwork (HDL, LDL, triglycerides) and BP readings
Discuss NQ results and set SMART goal
Week 2: Build a Heart Healthy Plate
Topic: Heart-Healthy Plate
Handout: pages 7-8 of the program packet
Description:
Discuss the components of a heart-healthy plate
An emphasis on fruits, vegetables, whole grains, fat free/low fat dairy products, fish, poultry, beans, nuts, seeds, vegetable oils
Provides potassium, calcium, magnesium, fiber, unsaturated fats, and lean protein
Limiting intake of fatty meats, full fat diary, sugar-sweetened beverages, and sweets
Reduces intake of saturated fat, trans fat, sodium, and added sugars
Identify heart-healthy foods that are already part of their diet
Create goal relating to transforming their plate (make more room for vegetables, reduce servings of red meat, swap SSB for unsweetened iced tea)
Reflect on their “why” - do they feel they are ready to make steps towards achieving their goal?
Week 3: Finding Healthy Fats
Topic: Healthy Fats
Handout: page 9 of the program packet
Description:
Discuss the role of saturated and unsaturated fats in the body, how they affect cholesterol and the heart
Identify foods that are high in saturated fat
Fatty meat (<90% lean ground beef, steak, pork, lamb, bacon, poultry with skin, hot dogs, sausage)
Full fat dairy (whole milk, cream, butter)
Desserts (cookies, pie, ice cream, cake, donuts, etc.)
Tropical oils (coconut, palm)
Lard
Hydrogenated oils (vegetable shortening, margarine)
Identify foods that are high in unsaturated fats
Oils (olive, canola, vegetable, avocado, corn, soy, flaxseed, peanut)
Avocados
Nuts (almonds, hazelnuts, pecans, peanuts, walnuts, cashews)
Seeds (sunflower, pumpkin, flax, chia, sesame, hemp)
Fish (salmon, sardines, anchovies, mackerel, tuna, cod, halibut, herring)
How to incorporate healthy (unsaturated) fats into the diet while reducing unhealthy (saturated) fats
Cook with oils instead of butter, lard, or shortening
Choose lean meats such as 90% ground beef, boneless skinless chicken breast, tuna, and salmon
Add nuts and seeds to oatmeal, cereal, smoothies, etc.
Choose fat-free or 1% dairy products (milk, yogurt, cottage cheese, part-skim cheese, etc.)
When eating at a restaurant, choose baked/grilled foods when available (i.e. grilled chicken sandwich instead of deep-fried chicken sandwich)
Create goal relating to healthy fats
Reflect on their “why” - do they feel prepared to make more changes based on the information learned so far?
Week 4: Scaling Back on Sodium
Topic: Sodium
Handout: pg 10 of the program packet
Description:
Discuss how excess sodium intake affects blood pressure and heart health
AHA recommends no more than 2300 mg/day
Identify foods that are high in sodium (>20% DV per serving)
Processed meats (deli meat, sausage, bacon, ham)
Convenience foods (frozen meals, soup, pizza, fast food, flavored rice/pasta)
Condiments (mustard, ketchup, soy sauce, barbecue sauce, salad dressings)
Bread
Savory snacks (chips, popcorn, pretzels, snack mixes, crackers)
Seasoning blends (taco, chili, salt blends)
Identify ways to reduce sodium
Grocery shopping (choosing lower-sodium foods)
Cooking (using herbs and spices instead of salt/seasoning blends, incorporating acids, draining/rinsing canned foods)
Eating out (order vegetables as side dish, avoid adding salt at the table, split a meal to reduce portion size, ask server for low-sodium recommendations)
Create a goal relating to reducing sodium intake
Reflect on their “why” - have the changes made them feel closer to their goal?
Week 5: Fill Up on Fiber & Veggies
Topic: Fiber
Handout: pages 11-12 of the program packet
Description:
Discuss the benefits of fiber
Discuss soluble and insoluble fiber
Soluble fiber absorbs water and forms a gel-like texture, which slows digestion and prevents spikes in blood sugar
Also removes excess cholesterol from the bloodstream
Insoluble fiber promotes the movement of material through your digestive system, keeping your bowels healthy
Also provides bulk to meals which promotes satiety, leading to healthy weight/weight loss
Identify foods high in soluble fiber
Oats
Peas
Beans
Apples
Citrus fruits
Nuts
Carrots
Barley
Identify foods high in insoluble fiber
Whole wheat flour
Wheat bran
Vegetables (cauliflower, green beans and potatoes)
How to add fiber into the diet
Buy whole grains when grocery shopping, such as whole wheat bread, pita, English muffins, tortillas, etc.
Incorporate fruits and/or vegetables at each meal
Keep the peel on apples and potatoes
Create a goal relating to fiber intake
Reflect on their “why” - have they noticed any changes so far (energy, stamina, mental clarity, etc.)? How can that support reaching their main goal?
Week 6: Avoiding Added Sugars
Topic: Added Sugars
Handout: pg 13 of the program packet
Description:
DGA 2020-2025 recommends no more than 10% of daily calories come from added sugars (~12 teaspoons or 50 g)
AHA recommends no more than 9 teaspoons (36 g) for men and 6 teaspoons (25 g) for women
The consensus is that the less added sugars, the better
Identify common sources of added sugars
Sugar-sweetened beverages (soda, sports drinks, fruit drinks)
Desserts (pie, cake, cookies, ice cream, donuts, etc.)
Coffee and tea
Condiments (ketchup, salad dressing, BBQ sauce)
Breakfast cereal
Discuss ways to reduce added sugars
Slowly decrease amount of sugar added to coffee and tea
Decrease serving size of desserts, condiments, and cereal
Swap soda for unsweetened seltzer, iced tea, or infused water
Read nutrition labels to identify low-sugar items
Create a goal relating to added sugar intake
Reflect on their “why” - what are some of the best changes so far? How are they supporting the overall goal?
Week 7: Staying Hydration
Topic: Water Intake
Handout: page 14 of the program packet
Description:
Discuss the importance of hydration
Works hand-in-hand with fiber
Regulates body temperature through perspiration
Supports all bodily processes
Amount of water needed per day depends on factors such as activity level, medications, and certain medical conditions
The general recommendation for total water intake is about 11 cups/day
Discuss ways to increase water intake
Drink water throughout the day
Incorporate water-packed foods
Fruits (melon, strawberries, bananas, grapes, oranges, pineapple)
Vegetables (lettuce, cabbage, broccoli, carrots, squash, spinach)
Soup and other broth-based dishes
Low-fat milk
Use flavors to keep water interesting and sugar-free
Citrus fruits, herbs, ginger, cucumber, berries
Infuse with tea
Unsweetened seltzer
Create goal relating to water intake
Reflect on their “why” - what do they think about their plan? Is it working? How can motivation be maintained?
Week 8: Principle 7 - Grocery Store Guide
Topic: Grocery Shopping
Handout: pages 15-16 of the program packet
Description:
Discuss how to read a nutrition label, how to understand food label claims, and learn how to build a healthy pantry.
How to read a nutrition label
Number of servings per container and serving size
Understanding label claims
The FDA regulates what claims can be printed on a nutrition label
Most commonly used claims are for calories, fat, sugar, cholesterol, sodium, and fiber
Helpful claims to look for include:
Low in saturated fat
Low cholesterol
Reduced, low, or very low sodium
Sodium-free, unsalted, or no salt added
High fiber or excellent source of fiber
Reduced sugar or no added sugar
Claims that are not regulated (i.e. can be used however the brand wants) include:
Natural or all natural
Net carbs
Superfood
How to utilize budget-friendly foods to build a healthy pantry
Beans, lentils, brown rice, whole wheat pasta, oats, split peas
Low sodium or no salt added canned vegetables
Canned fruit packed in 100% fruit juice
Nut butters (peanut butter)
Oils (vegetable, canola, olive)
Canned chicken breast, tuna, salmon, sardines, mackerel
Low sodium soup/broth
Create a goal relating to grocery shopping
Reflect on their “why” - do they feel excited to find new foods? How does that support reaching their goal?
Week 9: Becoming a Pro-Chef
Topic: Cooking techniques
Handout: page 17 of the program packet
Description:
Discuss how to use cooking techniques to build flavor while creating a healthy meal, and ways to cook lean meat and plant-based proteins.
How to build flavor throughout cooking process
Using aromatics
Cooking methods that bring out flavor (Maillard reaction, caramelization, searing meat, deglazing the pan, toasting spices, reducing sauces)
When and how to add fresh vs dried herbs/spices for maximum flavor
Add dried spices in the beginning of cooking
Add fresh spices at the end of cooking
Discuss ways to incorporate plant-based proteins
Review recipes for each protein (tofu, beans, quinoa, edamame, peas, nuts)
Best ways to cook lean meat
Turn the meat using tongs instead of piercing with a fork to keep juices from escaping
Fast and hot, then low and slow
Sear a roast in a small amount of vegetable oil
Transfer to a slow cooker or pot with sauce/water
Cook on low temp until done
Mix extra lean ground beef with vegetables that add moisture (onions, zucchini, etc.)
Create a goal relating to healthy cooking
Reflect on their “why” - can they utilize these techniques to cook a healthy meal for family/friends/loved ones?
Week 10: Movement & Exercise
Topic: Physical Activity
Handout: pages 18-19 of the program packet
Description:
Discuss how activity is an important part of heart health and tailor an exercise plan to fit your lifestyle.
Discuss the benefits of regular exercise
Reduces in body weight, BP, LDL cholesterol
Increase in insulin sensitivity and stamina/energy
Reduces likelihood of injury (stabilizes joints, strengthens bones, improves flexibility)
Recommended amount of at least 30 minutes a day, 5 times per week of moderate exercise (Meaning of Moderate would make a good handout)
Aerobic exercise (cardio)
Strength training (weight lifting, bodyweight exercises, etc.)
Identify ways to stay active and/or incorporate an exercise routine
Set a reminder to get up and stretch/walk every 30 minutes of sitting (at desk, computer, etc.)
Take the stairs instead of an elevator or escalator
Park farther away from entrances
Meet a friend at the gym or park
Take a lunchtime walk
Stretch or do simple bodyweight exercises during commercials while watching TV
Create a goal relating to physical activity
Reflect on their “why” - what positive phrases/mantras can be said to provide motivation to exercise?
Week 11: Improving Sleep & Stress
Topic: Sleep and Stress
Handout: page 20 of the program packet
Description:
How lack of sleep affects the body
Adequate sleep gives the body time to repair and recover from strain by reducing heart rate and BP
Insufficient sleep can raise BP/LDL cholesterol and increase the risk of heart disease, heart attack, kidney disease, diabetes, and stroke
Identify ways to improve quality of sleep
Stick to a regular sleep schedule (7-9 hours)
Be physically active during the day
Avoid eating 2-3 hours before bed
Keep your bedroom dark, quiet, and cool
How unmanaged stress affects the body
Chronic stress can cause a consistent increase in heart rate/BP and elevated levels of stress hormones
Increases the risk for HTN, heart attack, and stroke
Identify ways to manage stress
Be physically active
Spend time with family and friends
Setting aside time for hobbies
Practice meditation, yoga, etc.
Work with a mental health professional
Create a goal relating to sleep and stress management
Reflect on their “why” - how can adequate sleep and stress management help them in reaching goals and maintaining progress?
Encourage pt to obtain lipid panel/BP/weight before next appt, as applicable
Week 12: Maintain Your Heart-Healthy Lifestyle
Topic: How to Maintain a Heart-Healthy Lifestyle
Handout: pg 21-23 of the program packet
Provide overview of past lessons
Re-take NQ
Discuss changes in bloodwork/BP trends/weight
Identify goals that have become second-nature and that the patient can continue on their own