By Audrey Shively, MCHES
Official ACCN16 Blogger
Dr. Scott Hummel’s presentation on heart failure (HF) and nutrition provided great insights in to what research has told us to date and what we still need to learn.
One in five people have congestive heart failure which equates to six million people and one in nine deaths in the United States. It is a large and growing problem defined as the heart not being able to meet the physiologic demands of the body.
The presentation focused on dietary guidelines, malnutrition and frailty, micronutrient deficiencies, and energy interventions. It was full of lots of great data and I strongly encourage you to view this recorded session to see the complete picture. I am only going to be able to address the highlights here.
Nutrition intervention in heart failure encompasses a variety of issues such as diet adherence, neurohormonal affects, metabolic aspects, and the physical effects of malnutrition. We often ask why our HF patients cannot eat a more healthy diet but such things as a decreased sense of smell, early satiety, and medications all affect how patients eat.
There are several comorbidities associated with HF such as cognitive dysfunction, disability, and polypharmacy with studies showing HF patients can easily have five or more comorbidities to be addressed.
Dr. Hummel focused a great deal of his talk on the Academy of Nutrition and Dietetics (AND) guidelines for heart failure. I will share in overview of his remarks here.
Sodium and fluid intake: should be adapted to the patient and should allow for adequate protein in the diet.The dietary sodium debate has not been answered based on both observational and random control studies.
Malnutrition: if a patient is deemed malnourished there are more adverse outcomes; this is true of fragility as well. If one is malnourished most often they are also frail.
Micronutrients: HF patients are encouraged to take folate, vitamin B6, vitamin B12, thiamine, and magnesium; it is felt these prove to be more beneficial when coming from foods rather than supplements.
Energy metabolism: HF patients have impaired energy production and nutrient deficiency can affect this.
Dr. Hummel spent time addressing new mechanisms that may be promising for HF treatment. These include dietary nitrates, metabolic improvements, microbiomes, and vascular salt sensitivity.
There are also many studies still underway that will have an impact on HF treatments including those looking at the effect of calorie restrictions, sodium intake and quality of life, and the correlation between sodium intake and energy.
His overall takeaway messages were:
  1. Heart failure is a large and growing problem
  2. Nutrition is important but is incompletely understood
  3. Sodium intake must be adapted to each patient
  4. New mechanisms may improve our knowledge base
His final message gives us all sound advice about our nutrition and health and that is we should adopt a whole food dietary approach to eating healthy.
Colleen Doyle, MS, RD, from the American Cancer Society shared both the myths and realities relating to cancer risk. Her overall message? Live healthier lives!
We know there are 160 million people overweight in the United States, we also know 120 million don’t meet the physical activities guidelines and 95 million don’t eat enough fruits and vegetables. How this relates to cancer risk lies in the data that tells us obesity, poor nutrition, inactivity, and smoking are the leading causes of cancer and that eating well, maintain a healthy weight, and exercise is the best way to avoid it.
The 2012 American Cancer Society guidelines recommend:
Maintain a  healthy weight: up to 20% of all deaths in the United States are related to obesity
Adapt a physically active lifestyle: Adults should get at least 150 minutes of moderate exercise a week and adolescents should have one hour per day. People are encouraged to limit sedentary behavior such as sitting and watching television.
Consume a healthy diet with focus on plant sources: We should eat two and a half cups of fruits and vegetables a day as well as limit processed and red meat while choosing whole grains over refined produce. The only known cancer risk is associated with eating processed meats and colon cancer.
Drink alcohol in moderation: Limit consumption to one or two glasses per day.
As nutrition professionals, how do we support cancer survivors? Studies have shown that patients who adhere to the ACS guidelines do have lower rates of cancer and cardiovascular disease. Unfortunately, too many people are not aware of these guidelines.
The presentation also addressed several myths surrounding the risk of cancer, including sugar feeds cancer, soy is dangerous, superfoods have special health powers, alkaline diets are best,  organic foods add protective value, and GMOs, artificial sweeteners, or supplements reduce cancer risk. There is no research that shows any of these myths to be true.
Ms. Doyle concluded her presentation with an insightful look at how environmental factors conspire against us and affect our ability to make healthy food choices.
She emphasized we all have a role to play in reducing the barriers to a healthy diet and exercise. We can influence changes in policies and systems to make healthier communities.
The bottom line is that we all need to look at the big picture in creating healthy communities, living healthier lives,  and improving our quality of life.
The session held Thursday afternoon on Aging and Cognition presented by Barbara Shukitt-Hale, PhD focused on the increase in inflammation and oxidative stress in brain aging.
Thirty percent of the United States population is over the age of 65. If these individuals suffer from decreased motor and cognitive function there could be a healthcare crisis in this country.
Dr. Shukitt-Hale and her staff have conducted several research studies looking at impaired motor performance and cognitive function in aging rats. Their results showed a  decrease in motor behavior, learning,  and spatial memory.
Their research question was whether this impaired function could be stopped or improved by altering the diet of the rats.  They specifically looked at polyphenols found in dark fruit and vegetables, wine, chocolate, and walnuts.
Polyphenols show many neuroprotective features such as anti-inflammation, antioxidants, and reduced risk of cardiovascular disease and cancer as well as improved vision.
The overall findings of their research show that nutrition intervention can forestall age related deficits in learning and memory and reverses deficits in learning and memory and declines in motor behavior performance.
But, can this translate to humans now becomes the question. The research group expanded their studies to assess exactly that.
Initial studies looked at the effects of aging on balance, gait, and cognition. Both cognition and mobility decrease with age and these declines are measurable at younger ages than expected.
The introduction of blueberries and strawberries into the diet of their human subjects improved both the measures of executive function and spatial recognition.
Their results showed:
  • Berries can reduce proinflammatory signals in cells
  • Functional declines in mobility and cognition are key features of aging
  • Berry fruit can improve cognition
  • Different berry fruits affect different aspects of cognition
In summary, polyphenols have direct effects on the brain and they can reverse age related declines.
And most importantly, eat more berries!

Culinary medicine combines two of my favorite things…food and health. The first in a series of Culinary Medicine Workshops being offered to ACCN attendees focused on disease implications of diet. The faculty from the Goldring Center for Culinary Medicine, a physician, dietitian, and chef, spent three hours discussing the benefits of both the Mediterranean and DASH diets. The workshop participants included physicians, dietitians, food scientists, and a nurse practitioner. This diversity provided a lively discussion with all sharing their different perspectives. Using a flipped classroom approach, the participants were asked to view an online webinar, read reference material, and pass a post test. This was a helpful way to introduce the concepts of both these diet interventions. In a very interactive format, the participants were given a patient case study and asked to reflect on the weight loss, nutrition, and exercise treatment options for the patient. The most fun was a cooking session where six different recipes for spaghetti and meat sauce were prepared. With each successive recipe healthy alternatives were introduced to increase the health benefits of this traditional dish. These alternatives included whole wheat pasta, lentils, and plenty of fresh vegetables. These modifications lowered the calorie and fat content as well as raised fiber and protein intake. The food tasting that followed made for a very healthy lunch. The key takeaway message was to move people as far as they can toward making healthier food choices. Tim Harlan, MD, Executive Director of the Goldring Center, gave great advice on how to discuss nutrition and diet with patients. He emphasized “It is important to meet the patients where they live”, suggesting healthy food alternatives that are both affordable and accessible in their daily lives. As Dr. Harlan reminded us, our focus should be less on weight loss and more on healthy food choices to improve our overall health and well being. Sound advice for us all to follow.