Healthy Body

‘I’m a Preventive Cardiology Nutritionist and These Are the 5 Questions I Ask Patients During Their First Visit’

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Having food and lifestyle habits in place that support heart health is, of course, beneficial for everyone. Forty-eight percent of American adults suffer from some form of cardiovascular disease and heart disease is the leading cause of death in the country. While anyone could experience a heart attack, stroke, or cardiovascular disease, some people are at increased risk because of family history, genetics, pre-existing conditions, or other social determinants of health.

That's where a preventive cardiology nutritionist can come in handy. While all nutritionists and registered dietitians can be helpful in putting in place eating habits that support overall health goals, preventive cardiology nutritionists (part of the larger field of preventive cardiology) focus specifically on heart health. "As a preventive cardiology nutritionist, I focus on managing the risk factors associated with cardiovascular disease," says Julia Zumpano, RD, who works at Cleveland Clinic.

Zumpano says that The Academy of Nutrition and Dietitians is a good place to find a preventive cardiology nutritionist in your area through the website's "Find an Expert" tab, and adds that many providers are also offering virtual appointments as well as in-person. Whether or not these appointments are covered by insurance varies, Zumpano says. "It depends on your plan and also what your risk factors are," she says. "For example, some insurance providers cover appointments if you have high cholesterol, but it may not cover it if you are overweight. And some insurance providers cover virtual appointments while other providers only cover in-person providers."

Besides figuring insurance and payment, the other major question many people have when scheduling an appointment is what to expect. While Zumpano says appointments can very individual, there are some general questions she always asks, which she shares below.

1. What's your family health history?

Zumpano explains that people who have a strong family history of heart disease, blood pressure, blood sugars, elevated triglycerides, or weight metabolic syndrome are at a higher risk of cardiovascular disease than people who don't. So if your grandparents or anyone in your immediate family has experienced any heart-related diseases or issues, she wants to know.

She will of course ask about your health history, too. Are you on any medications? Do you have diabetes? Have you had a stroke or any other cardiovascular issues before? This is one appointment where you definitely want to bring it up.

2. What do you like to eat?

Here's the good news about heart disease: It's largely preventable even if you have a strong family history of it. One major way to do this is by eating foods that are good for your heart. "I generally focus on a whole food diet or a Mediterranean diet," Zumpano says, namechecking the eating style with hundreds of scientific studies linking it to benefitting the heart.

Zumpano says the principles of a whole foods diet (which focuses on unprocessed or unrefined foods without unnecessary additives like added salt, sugars, unhealthy oils, or preservatives) and the Mediterranean diet (which includes foods high in omega-3s and unsaturated "healthy" fats, like fish, extra-virgin olive oil, nuts, grains, legumes, fruits, and veggies) can be implemented in someone's life no matter what types of foods they love; it's about the nutrient principles, not the specific region. This is why she asks people what they like to eat. Then, she can help a client brainstorm meal ideas they're sure to love that are also heart-healthy.

Watch the video below to learn more about the Mediterranean diet:

3. How much time do you have and what's your food budget?

What you eat isn't just about taste preferences; it's also about how much time and money you have to devote to it. That's why Zumpano says she asks for more details on what a client's daily routine is and what mealtime looks like for them. A heart-healthy meal plan for someone who lives alone and loves to cook is going to look vastly different from a parent pressed for time because they are working full-time while also helping their kids with virtual school. "If someone tells me they're super busy, we come up with quick and easy meals together that they can try at home," Zumpano says. "Convenience is a strong factor for someone when figuring out what they are going to eat, so it's important." Similarly, a person's income and food budget also shape Zumpano's recommendations.

But Zumpano has more good news: You can stick to a heart-healthy diet even if your time and income are limited. A few inexpensive heart-healthy foods: beans, chickpeas, canned tuna, and frozen veggies.

4. What is your favorite way to stay active?

Preventing cardiovascular disease isn't just about food; physical activity is important, too. That's why Zumpano always brings it up during appointments. "We make appropriate exercise goals based on where they are at and what is attainable for them," she says. "Then, we come up with concrete ways to meet these goals."

Zumpano says what someone likes to do as well as how busy they are both are part of this conversation, similarly to when she talks about food with a client. If someone expresses interest in yoga, for example, she may share with them some yoga videos on YouTube since going to an in-person class may not be an option right now. Or if someone is a parent with young kids, they may discuss a type of physical activity they can do together, or alternatively, figuring out a plan for when he or she can get a 45-minute break from caregiving to focus on doing something solo. "Again, it really depends on the individual," Zumpano says.

5. How are you managing the stress in your life?

High levels of psychological stress directly increase the risk for cardiovascular disease, so Zumpano says it's something she makes it a point to ask every single client. "I ask what they are doing to manage the stress in their life and how they're sleeping," she says. "If someone doesn't have a stress management plan in place, often I start by teaching them some deep breathing exercises. I also often recommend journaling or meditation," she says. If someone's stress levels are so high that they can't manage them on their own, Zumpano may refer them to a therapist who can offer more in-depth and on-going support.

The initial appointment with a preventive cardiology nutritionist is meant for the nutritionist to learn more about you and to lay the groundwork for new heart-healthy habits to put in place. Then, Zumpano says, the follow-up appointments are used as checkpoints to see what's working and to make new, necessary changes if something isn't working. She also adds that over time, someone's circumstances or health needs may change, which may also mean the plan may need to be tweaked as well.

What's most important to remember is that we have a lot of control over our cardiovascular health and seeing a preventive cardiology nutritionist can be an important step in figuring out how to use that control. Keeping in mind your family history, income level, and time constraints, they're there to figure out what will work for you.

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