Dietary Strategies to Prevent and Manage Cardiometabolic Disease

Have you been diagnosed or do you know someone with Type II Diabetes, Heart Disease, High Blood Glucose or Insulin Resistance?

If this is you or your friend, then this 🎙 episode is for your and their empowerment to manage or prevent these cardiometabolic conditions. Cardiometabolic diseases are the number one killer across the world.  Therefore, it is timely to discuss these conditions with our special guest, Dr. Kristina Petersen. She will enlighten your wellbeing on the subject of dietary strategies to prevent and manage cardiometabolic disease. 

About Kristina Petersen PhD, APD, FAHA

Kristina Petersen has a Bachelor of Nutrition and Dietetics (Honors) from Flinders University (Australia) and a Ph.D. in Nutrition from the University of South Australia (Australia). In addition, she completed postdoctoral training in public health and epidemiology at The George Institute for Global Health (Australia), and in clinical nutrition at The Pennsylvania State University. Dr. Petersen was an Assistant Research Professor at The Pennsylvania State University from 2018 to 2020. Her research focuses on nutritional strategies to delay and prevent the onset of cardiometabolic diseases.

Connect with Dr. Kristina Petersen
Email: Kristina.Petersen@ttu.edu
Website: DCHLab@ttu.edu

Links mentioned in the episode:
The following website describes the principles for a healthy diet

This is the publication that includes the scientific description


About me&my Health Up & Host

me&my Health Up seeks to enhance and enlighten the wellbeing of others. Host Anthony Hartcher is the CEO of me&my wellness which provides holistic health solutions using food is medicine, combined with a holistic, balanced, lifestyle approach. Anthony holds three bachelor's degrees in Complementary Medicine; Nutrition and Dietetic Medicine; and Chemical Engineering.

Credits
Podcast editing: WE EDIT PODCASTS

Podcast Disclaimer
Any information, advice, opinions or statements within it do not constitute medical, health care or other professional advice, and are provided for general information purposes only. All care is taken in the preparation of the information in this Podcast. [Connected Wellness Pty Ltd] operating under the brand of “me&my health up”..click here for more

Transcript

Anthony Hartcher: 0:02

Welcome back to another episode of me and my health up. I'm your host Anthony Hartcher. I'm a clinical nutritionist and lifestyle medicine specialist. The purpose of this podcast is to enhance and enlighten your well being. And we have on the show today, Dr. Kristina Petersen. She is going to enhance and enlighten your well being on the subject of dietary strategies to prevent and manage cardiovascular disease. Yes, the number one killer in the world cardiovascular disease, we're going to be discussing dietary strategies to best prevent it and manage it. So Dr. Kristina Petersen is an assistant professor in the department of nutritional science at the Texas Tech University. She is a director of the diet and cardio metabolic health lab, which studies the efficacy and effectiveness of dietary interventions to delay and prevent the onset of cardio metabolic diseases. What a mouthful. That is. I hope you got it. The laboratory conducts human clinical trials to examine the effect of individual foods bioactives and the dietary patterns on risk factors for cardio metabolic diseases. So yes, without much further ado, I'd love to welcome you into the discussion I'm having with Dr. Kristina Petersen. Welcome Dr. Kristina Petersen to the me and my health up podcast show. How are you today?

Kristina Petersen: 1:31

Good. Thank you.

Anthony Hartcher: 1:32

So great to have you on and looking forward to discussing your area of expertise around cardiovascular disease management and prevention and looking at dietary strategies to help prevent that. So before we get into the topic today, I'm really keen to find out how you have arrived at being a nutritional scientists, please share your story.

Kristina Petersen: 1:52

Thank you. So it's kind of a long story. But I actually did all of my training in Australia. So I'm from outside of Adelaide, in South Australia. And so I did my undergraduate degree in nutrition and dietetics, and then went on to do a PhD in nutrition at the University of South Australia. Following my training, I moved to the US for a research position. So I was working at Penn State University for a number of years doing research related to the influence of diet on cardiovascular disease. And then a few years ago, I moved to Texas. So I took a position at Texas Tech University. And here I'm an assistant professor of nutritional science and lead a lab that investigates dietary strategies to prevent and delay cardio metabolic diseases. So cardiovascular disease, as well as type two diabetes. So I've been working in this area for more than a decade. And I think my interest in health and wellness and nutrition has started well, before I got on this particular path.

Anthony Hartcher: 2:57

Please share that interest you've had in health nutrition. Before you embarked on your journey, I'd like to hear that little story as to what made you so fascinated and intrigued about the importance of health and nutrition.

Kristina Petersen: 3:10

Yeah, so I grew up in a rural town on a farm, and my dad is a food producer. But always, you know, within our family food was important. You know, we always ate meals together, it was a time of, you know, social interaction. So always from a young age, I was interested in food and preparation of that food cooking, I always enjoyed cooking as a child, and still do. And as I became older, so in high school, I discovered the link between food and nutrition and how what we eat can really influence our health. And so at that point, that's when I decided to, you know, pursue higher education related to nutrition and health.

Anthony Hartcher: 3:54

That's fantastic that you discovered your path. So early on in your life, I certainly took a bit longer. So I could classify myself as a slow learner. But it's wonderful to have you on Dr. Christina Petersen and a really keen to get into this area of cardiovascular disease. It's number one killer across the world, number one in Australia and number one in the states and it's growing, it's not getting any less in terms of numbers that are affected. And really keen to, you know, for you to share your knowledge around dietary strategies to prevent the or they start with the prevention side as it could be similar to the management side, but it really keen to help other citizens around the world to prevent being a statistic in this area.

Kristina Petersen: 4:37

Yeah, so when we think about the key risk factors for cardiovascular disease, we often think of things like genetics. So basically that makeup of your genetics and what you were born with, however, actually the leading risk factor for cardiovascular disease is dietary risks. So things that we either Eat or Do not eat enough of that influence that risk. And that actually accounts for more than 50% of all cardiovascular cases. So it's huge in terms of the risk factor contribution that dietary habits make to cardiovascular disease. And when we actually look at what those dietary contributors are, they're more frequently things that we're not eating enough of, as opposed to things that we're eating too much of. So oftentimes, when we're thinking about diet and health, where we think about the things that we shouldn't be eating, versus the things that we should be eating, so we always think, you know, we should be avoiding XYZ, because that will make us healthier. But actually, when we look at the data, we should be focusing more on the things that we should, in fact, be consuming. So things like fruits and vegetables, whole grains, nuts, and seeds, these are all things we should be eating more of. And they're often things that people are not eating enough of. So when we think about preventing cardiovascular disease, or really any diet related disease, what we're thinking about is having a healthy dietary pattern. And that's obviously, you know, a very loose phrase, you know, what is a healthy dietary pattern? And the answer is, there is no one healthy dietary pattern. So there's many considerations that go into a healthy dietary pattern. And we do have features of healthy dietary patterns. So broad things that we know healthy dietary patterns include more of, or include less of, but they tend to be less prescriptive. So you know, historically, dietary guidelines were very prescriptive. So you need to have less than 30% of calories from fat, or, you know, 50% of calories from carbohydrates, those kinds of things, we have less of those kinds of restrictions, now, we've really evolved to a place where we can have some key principles, and then how you choose to adapt that to your individual diet is up to you. So it gives individuals some ability to customize their diet to their specific needs, so their health goals, maybe, but also, you know, maybe some of their environmental and social factors.

Anthony Hartcher: 7:16

And just share some of those principles around healthy eating and getting some more of these foods such as you mentioned, fruit and vegetables, whole grains, nuts and seeds. it please share how these principles work, so that the listeners can apply them in their day.

Kristina Petersen: 7:31

Yeah, so actually, the American Heart Association published the features of healthy dietary patterns towards the end of last year. So these are the most up to date evidence that we have about what healthy dietary patterns are for reducing the risk of cardiovascular disease as well as other cardio metabolic conditions. And so there are 10 of them in total. And so they do center around eating plenty of fruits and vegetables and trying to get a variety where possible, eating mostly whole grains. So this is as opposed to refined grains. So for example, eating whole grain bread instead of refined grain bread, also choosing healthy sources of protein. So when we say healthy sources of protein, here, we're predominantly talking about sources of plant protein, so things like nuts, legumes, beans, those kinds of things, but also including fish and seafood, or if you do not eat fish, or seafood having plant sources of Omega three, so things like walnuts are a good source of the plant source of Omega three, which we know omega threes are important for heart health, but also for a number of other conditions, including brain related conditions. If people are consuming dairy products, they should be low fat or fat free. And then if you are choosing to include poultry or meats, they should be lean, and they should be in the unprocessed form. But again, the focus here is really on predominantly plant sources of protein. We should also be using liquid plant oils where possible. So this is in place of things like tropical oils, so those are coconut oil and palm oil, which are high in saturated fats. We should also be trying to avoid animal fats, so solid fats, butter, things like that, as well as partially hydrogenated fats, so they're high in trans fats. They also specifically call out choosing mostly minimally processed foods as opposed to ultra processed foods. And these are some of the first guidelines to really explicitly call out this distinction between minimally processed versus Ultra processed. And this is really because we're starting to get a lot more evidence showing that there may be potential adverse effects of consuming Ultra processed foods. So these are foods that have Very highly processed, they include a lot of different additives or processes in order to achieve palatability mostly. So these are usually foods that are very appealing to us, we should also be minimizing foods and beverages that have added sugars, which should be trying to limit a salt. So choosing low salt products where possible and not adding salt to the foods that we're cooking. There's also guidance around alcohol. So if you're choosing to drink having moderate intake, so that's classified, it's less than two drinks per day for men and less than one drink per day for women. And then there's also a guideline around adjusting energy intake to needs. So here this is around, achieving and maintaining a healthy body weight. And then the final guideline is around always adhering to this guidance, regardless of where you're preparing or consuming food. So this is really getting at trying to have a healthy dietary pattern at all times, not just when you're cooking at home, for example, but also trying to choose unhealthy option when you're eating out or purchasing food from another place. So the great thing about these 10 principles is they're very flexible. You can apply these to whatever your favorite diet is, or whatever the diet is that you're currently following. You could try to make adjustments to move more in line with this guidance. It's not prescriptive and saying you need to consume this specific vegetable, for example, it's more general around just including a variety and picking the ones that you like.

Anthony Hartcher: 11:41

You mentioned trans fats, could you give some examples to the listeners as to what is a trans fat because that's one thing that they should be avoiding. So yeah, if you could just share some examples of where trans fats are found.

Kristina Petersen: 11:54

So trans fats are fat that is created in the food manufacturing process. So historically, they were used as a replacement for saturated fat. So saturated fat increases LDL cholesterol salts associated with increased risk of cardiovascular disease. And when they started to realize that saturated fat was bad, the evolution was to create trans fats because these are a form of unsaturated fat, and at the time, we didn't realize they were harmful. But then research emerged showing they were in fact harmful. And so there's been a lot of effort to remove trans fats from the food supply. In the US, the food industry is no longer allowed to add partially hydrogenated fats, which are trans fats to foods. I'm not quite sure what the situation is in Australia, but I expect it's heading in the same direction. The one caveat there. So the food industry is not allowed to add partially hydrogenated oils. But trans fats can be created when we heat and cool oil. Okay, so if you're buying a lot of deep fried foods, in the process, where every day they heat up that deep fryer, and then in the evening, they shut it down, that process can create trans fats. So if you're eating a lot of fried foods, you may be getting a substantial amount of trans fats. But historically, trans fats were added by the food industry to a lot of baked goods or cakes, cookies, those kinds of things. And a lot of that has been removed now.

Anthony Hartcher: 13:33

Thanks for sharing. And you mentioned the link between saturated fats and elevated levels of LDL, the what they consider or classified bad cholesterol. What about the link between eggs where we at with eggs and understanding their risk towards cardiovascular disease? And like what's too much in terms of consumption?

Kristina Petersen: 13:54

Yeah, so Eggs are an interesting one, because they're not technically high in saturated fat in and of themselves, but they do contain a lot of dietary cholesterol. And so dietary cholesterol, most of the evidence currently suggests it does not cause an increase in blood cholesterol levels. However, from the research that has been conducted, it's very hard to disentangle the effects of the dietary cholesterol and eggs from the saturated fat because usually when they're making these comparisons, saturated fat is bearing so we know saturated fat influences blood cholesterol levels to a much greater extent than dietary cholesterol levels. So currently, there are few restrictions on egg intake, even for people who have dyslipidemia, or elevated blood cholesterol levels. However, we say, you know, usually no more than two eggs per day. But I think when we're talking about eggs, the really important point to make and why research has been so intense descent with regard to eggs is what is consumed with eggs. So oftentimes, when we think of a breakfast meal, people are not just eating an egg, they're also eating bacon or sausages. Okay, so when we have that kind of pattern of intake, it becomes very difficult to distinguish what is the effect of the egg versus the effect of the bacon and sausage. So I think we need to when we're consuming eggs, we just need to be mindful of what we're consuming them with. So if you're making something like an omelet with vegetables and having some whole grain toast, that's a very healthy breakfast. But if you're having eggs and bacon, then the bacon is certainly going to elevate your blood cholesterol levels. And potentially there may be some influence of the egg, too.

Anthony Hartcher: 15:49

Thanks for explaining the eggs because it constantly comes up in the media in terms of eggs. And you know, as you mentioned, they're high in dietary cholesterol. And yeah, so I just wanted to see if there was a strong link there to cardiovascular disease, and you answered it really well. So thanks for sharing that. My other question comes around, you mentioned fruit and vegetables, and we don't eat enough of them. And when I look at the statistics, like only 4% of Australians are getting an adequate intake of vegetables per day. And I can imagine that probably translates throughout the world just also certainly to the western part of the world. So I'm not quite sure about the underdeveloped but yeah, so I'm just really wanting to get some ideas because, like you mentioned in the principles that it's important to eat more of them. And the question comes up is to how how can the listeners increase their vegetable consumptions? Has it been any studies looking into strategies to help people to increase their vegetable consumption, this is always

Kristina Petersen: 16:51

a challenge. And I think, you know, I'll make two points here. So the first one is that you should pick the vegetables that you enjoy, if there are specific vegetables that you do not like, you do not need to eat them. So there are so many different vegetables and they're in different forms, right, you can buy fresh vegetables, but you can also buy canned vegetables, you can buy frozen vegetables, and all these forms are equivalent. Okay, so there is no nutritional deficits in canned or frozen vegetables, in some cases, they may actually be nutritionally superior. So in the case of frozen vegetables, frozen vegetables are sat frozen as soon as they're picked. So their nutritional quality can actually be higher than the vegetables that have been sitting in warehouses and sitting in the grocery store for a period of time. So you know, I think accepting that we can have canned and frozen vegetables can help with things like the accessibility and also the issue that vegetables perish, right. So some people don't want to purchase a lot of vegetables, because they're worried they're going to go to waste before they can actually consume them. When you are buying canned vegetables, just try and choose the lower sodium ones, or make sure you're washing the vegetables before you're eating them. And then I think the second point related to vegetables is on average, the flavor profile is is quite bland, right? So what that means is it lends themselves to being flavored. So I think, you know, we need to think creatively about the tastes that we enjoy. And think about what kinds of herbs and spices are great, right, because they don't add any calories, they don't add any sodium. But we can get a whole range of different taste profiles just from adding some herbs or spices to their vegetables. So I think playing around with herbs and spices particularly, but there are other sauces and condiments and things that you can add to vegetables to make them suit the kind of taste profile that you like. So I think we need to reframe the message around vegetables that it's not something that you have to do. It's something that you do, but you need to enjoy it right. So you need to think about all the ways that you may enjoy consuming your vegetables. And that should extend to your family as well.

Anthony Hartcher: 19:17

Absolutely, it makes total sense in terms of people eat food for enjoyment, as well as you know, for the nutritional needs. So it's it needs to be palatable in order for people to consume more vegetables, for example. So really keen to understand this link between I guess there's a real absence today in terms of people's ability to be able to cook and you mentioned you grew up with your family cooking and fresh produce and you love sitting around the dinner table and conversing and it was a real experience. And as a result of that you had a great association with food and then you realize the link between food and health. Now today there's a bit of a disassociation around cooking you know It's an inconvenience, I don't have time and, and takeaways really convenient. And so if you've got any words of wisdom to share, or if there's any studies that you've done around this thing of cooking, eating well, and that enjoyment around eating good food together.

Kristina Petersen: 20:17

Yeah, so I think, you know, here often when we hear the term cooking, we think about, you know, all the things that involves, right, we need to go to the supermarket, we need to get food, we need to spend time finding recipes, we need to cook that food, and this whole thing is going to, you know, take up a huge amount of time that we all don't have, right, we're all busy. And we don't have time to spend hours shopping and cooking for our foods. But I think, you know, the way that we need to think about this is how can we do this in an efficient way. So, you know, there are so many very quick, simple recipes that do not take a lot of time. And with a little bit of preparation. So you know, making sure that you go to the store maybe once per week and pick up groceries, so you have things in the fridge that you can quickly assemble a meal. So I think we need to think more about rather than, you know, cooking and making things from scratch, if you don't have time or skill to do those things, think about how you can kind of assemble a meal. So you know, buying fruits and vegetables that you can quickly chop up and make a salad or, you know, put in the microwave to cook and then cooking, you know, some kind of lean protein sauce, you know, with things like air fryers, you know, you can cook something very quickly. And again, thinking about making the whole experience enjoyable. So, you know, maybe this is something that you can do with the people that you live with, with your family can get your kids involved in, in all of this, it's a learning experience for them as well. Because, you know, ultimately, these are lifelong skills, and they serve us. So I think we need to think about it as an investment in our health, but also potentially, in the people that we live with.

Anthony Hartcher: 22:06

Yeah, 100% agree. It's about making it a positive experience and an enjoyable and an experience where you're having great conversation, really building relationships and having some fun whilst doing it and then enjoying the food. And I think that's certainly been lost in terms of that family dinner with the rise of digital media and in the you got the television and all these streaming services, we've really gone into that TV sort of eating scenario, as opposed to around the table and really embracing the connection with relationships and food and really combining the two. I just wanted to base out that one, the discussion we had previously about vegetables in terms of is there like an amount of vegetables that should be consumed per day to really help the prevention of cardiovascular disease? Have you got some data there? Yeah, so

Kristina Petersen: 22:59

what we say is equivalent to about two and a half to three cups of chopped vegetables, okay, so if you're chopping vegetables and cooking them, you should be aiming for three cups per day. If you're having a lot of leafy greens and things like that, that's going to be a slightly more so more like six cups just because it's so much volume, right? So about three cups per day. But again, that doesn't have to be all one kind of vegetables. So you can mix, you can mix a whole bunch of different vegetables together. It also doesn't need to be consumed all at once. So you can have you know, some veggies at lunch and there may be some at dinner or if you enjoy snacking on carrot sticks, for example, you can do that as a snack and then have, you know, some other veggies for dinner. So we can kind of spread it out across the day.

Anthony Hartcher: 23:52

And does it differ between the prevention and management of cardiovascular disease? So if you've been deemed high risk in terms of cardiovascular disease, in terms of what you shared today, does it change at all between what people should be eating around dietary patterns and principles to compared to the prevention and management

Kristina Petersen: 24:13

get broadly it is very similar, however, for patients that are undergoing cardiovascular management. So this means they've already had a cardiovascular event. So maybe they've had a heart attack or stroke, something like that. So once a patient has had a cardiovascular event, we may need to more aggressively manage their risks. So for example, if they do have elevated LDL cholesterol, usually at this point they will be on lipid lowering therapy. So they will be taking a statin or another kind of drug to lower their LDL cholesterol, but we can still try and optimize that with dietary intervention. So for that kind of a patient we may put them on a lower saturated fat diet so even low than what's recommended for general health just to try to get their LDL cholesterol under control. Similarly, for a patient that has hypertension, we may be a little bit more concerned about their sodium intake. So we may try to get that as low as possible. So broadly, the principles are very similar, but we can adapt to the needs of the specific patient. And it is recommended that for patients who have cardiovascular disease, they would be seeing a dietician, so they would have nutritional management of their cardiovascular disease.

Anthony Hartcher: 25:35

Thank you so much for sharing today, I'm really keen for you to provide I guess, your top three tips. So out of everything you've shared today, where do you see the most benefit or where people are under done in terms of deficient or you know, just not doing enough of to help the prevention of cardiovascular disease? So if you could just summarize it in top three tips, that would be great. Yes, I

Kristina Petersen: 25:58

think the first tip here would be there is no one diet. So you know, we often hear a lot of messaging around, you need to follow a specific diet to have this specific health outcome, there is no one diet, and the best diet for you is gonna be the one that aligns most closely with the 10 principles that we talked about, but also the one that you can enjoy. And that you can sustain long term right, because in order to derive health benefit, we need to choose a diet for the long term, we can't just consume it for a short period of time. I think, you know, my second tip, which is kind of related to that, but is to, you know, not be convinced by all the fat diets and then nutritional messaging out there, there is no silver bullet. So you know, adhering to a healthy diet is not simple. It can be challenging. However, it can also, you know, substantially benefit your health. And, you know, we know from a lot of the data that you can live 20 or 30 years longer if you have a healthy diet. And even when you have a genetic predisposition to be at higher risk of cardiovascular disease, you can still lower your risk by having a healthy diet, but you need to do it throughout life. And then I think the final point would just be around, you know, enjoying your diet. Don't feel like it's something that you that you have to do. Pick the healthy foods that you like eating that your family likes eating, you know, try and prepare and cook foods together and enjoy them together. Don't make this a chore or something that you feel obligated to do every day

Anthony Hartcher: 27:45

are fantastic tips. Dr. Petersen, I really appreciate you sharing your wisdom with me and my health up listeners, how can they best connect with you.

Unknown: 27:52

So you can contact me at my email address. So that's kristina.petersen@ttu.edu, you can also check out our work on our labs webpage. So that's DCHlab@ttu.edu, where you can find out about our latest research or projects that we are currently working on.

Anthony Hartcher: 28:14

Fantastic. And for the listeners. I'll include those links in the show notes. In terms of your website, Dr. Petersen, does it have any links to meals? Or any suggestions or anything around good healthy eating or the 10 principles that you shared? Or is there some other resources that you could share that I could then put in the show notes for the listeners?

Kristina Petersen: 28:33

Yeah, we don't actually have anything currently on the website related to healthy recipes or the 10 principles that I shared, but I can send you the resources so the listeners can access those.

Anthony Hartcher: 28:48

Fantastic, really appreciate it. Dr. Petersen, and thank you for your time really appreciate you putting aside the time and coming in and passing on your wisdom around cardiovascular disease and how we can prevent that through healthy eating. And to the listeners. Thank you for tuning in to another insightful episode of me and my health up. If you know someone out there that's also wanting to hear more about how they can improve their heart health and prevent the cardiovascular disease, then please share it with them. I'd love to get the word out there. So please like and share the episode and get it out to helping more people and I appreciate you tuning in. Thank you