Professional help works with diet compliance
What happens after you tell CHF patients to limit sodium intake to 2 gm a day? Taking the salt shaker off the table may be a good start. But judging from the amount of salty processed food available today, that alone probably won’t be enough to follow the restriction. Here is where a registered dietician can be a helpful physician extender to educate and counsel patients about changing their diets.
"Quite frankly, most doctors don’t know a lot of things about dietary counseling," says William T. Abraham, MD, director of the heart failure and cardiac transplantation section of the University of Cincinnati College of Medicine. When it comes to diet, Abraham says the physician’s role is to reinforce the major themes. The logistics and strategies can be worked out with the support staff.
Do they know how to read food labels?
"It may require patients to see a registered dietitian to develop a meal plan and assist with specific needs," says Kathleen Zelman, RD, a spokeswoman for the American Dietetics Association."
She says a dietitian can help people implement healthy eating habits according to the rules that doctors prescribe, such as low-salt or low-fat. Patients also can get some lessons about finding their way around the grocery store. "People need to know what they are eating. They need to learn to read food labels." (For more information, see food label handout, p. 11.)
Older people may not be in the habit of reading food labels, particularly those who have been shopping for so many years before the information was commonly available. Keeping in mind the general direction of limiting daily sodium intake to 2 gm per day, they can learn to budget their sodium just as they would their personal finances. It becomes a matter of counting grams of sodium (or fat, or another nutritive element) to keep diets within a healthy range.
Fit in some their favorites
If someone really has a craving for a particular food that was not a low-salt product, the daily diet may be able to accommodate it. The trick is to be able to adjust the food eaten during the rest of the day so it doesn’t contribute more than the balance of what is permitted.
"We believe that all foods fit," says Zelman. "It’s just that you may have to do some balancing." She notes that patients often feel more in control of what they eat and are less likely to feel like they have to make huge sacrifices in order to eat better and follow their treatment plan.
A dietician, especially one that specializes in working with cardiac patients, also will be able to suggest different ways to season foods without adding extra salt. (Common substitutes could be pepper and fresh herbs.) Zelman notes that there are many commercially available salt-substitute products, but patients should check back with their doctors to make sure some of the chemicals they contain are safe for them to use.
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