Ask the RD | October

Our registered dietitian, Jamie, offers answers to nutrition-related questions our community has submitted over the past month. If you have a question to submit, please click here and check our next newsletter for your answer.

The information shared within this blog is meant for informational purposes only and should not be received as medical advice.

• How much olive oil can be consumed for optimal heart health? 

  All fats and oils are essentially equal when it comes to calories, packing an impressive 9 calories per gram! However, olive oil is certainly a superior oil to choose as part of a heart healthy eating plan due to its low saturated fat and high monounsaturated fat content. 

  Even though it is a heart friendly oil, we still need to consume olive oil in moderation, as to not “tip the scales” in the wrong direction when it comes to daily caloric intake as well as total fat intake. If your dietary fat intake came exclusively from olive oil, you could consume roughly 4-5 tablespoons per day. But, to allow for fat intake from alternative food sources such as lean meats and poultry, fish, eggs, nuts, seeds, avocados, and reduced fat dairy products, I would recommend sticking to 1-2 tablespoons of olive oil per day.   

  Sources: PREDIMED trial 

• I’ve been on a Keto diet since the start of 2023. How can I increase carbs that helps support/maintain my weight loss and continued weight goals?

  The good news is this transition can be done successfully, hopefully resulting in better cholesterol control and a happier gut microbiome without causing weight gain.

  First, I would continue to focus on eating A LOT of non-starchy veggies. Think half of each meal plate!

  Second, let's tackle the fats.

  Choose mostly heart-friendly unsaturated fats such as those coming from fish, olive oil, nuts, seeds, and avocados.

  Limit saturated fats coming from animal products and tropical oils.

  Please stop adding extra fat to your foods and beverages. Say goodbye to bullet proof coffees, heavy cream, extra mayonnaise, loads of butter and bacon!

  Next, I would slowly add back small servings of complex carbohydrate foods such as fruits, minimally processed whole grains, beans, and legumes. Not only are these previously forbidden foods rich in vitamins, minerals, antioxidant and anti-inflammatory compounds, but they also pack a ton of fiber! These fiber-foods not only work to keep your gut healthy and your cholesterol in check, but they will also help keep you feeling full and satisfied as you transition away from your high fat keto diet. Do remember to keep carbohydrate portions small so as to not overdo it and cause undesired weight gain.

  Caloric intake and macronutrient balance are still important as well. You may find it helpful to track your eating for a couple of weeks to make sure you are staying on target with your specific needs. For a lower carb but heart healthy eating plan, I typically recommend keeping carb intake to ~40% of daily calories, protein intake as ~25%, and fat intake as ~25-35%.

  Lastly, manage your stress, get good sleep, and maintain adequate amounts of physical activity. Trying to control your weight via dietary modifications alone can be tricky, especially when transitioning to a less restrictive eating plan. Remember that regular and adequate movement helps to promote healthy metabolism and body weight.

• For health reasons, I must follow a gluten-free, low-fat diet, as a result it's difficult to manage my weight. What are my options with this restricted diet plan while needing to lose weight and then maintain it long term?

  Avoiding certain foods for medical conditions may be necessary for some people. Those with Celiac disease need to avoid gluten. People with heart disease likely need to limit their fat and sodium intake. Folks with diabetes need to limit their sugar intake. While people with kidney disease need to limit their protein intake. Nutrition is not a one-size-fits-all kind of science and finding the appropriate diet for your health needs and personal goals is important. I would recommend meeting with a registered dietitian to establish an individualized eating plan that can work safely and effectively for you.

  Generally, for those looking to lose a bit of weight, I would recommend a diet that is high in fiber-rich foods with a big push on non-starchy vegetables. As always, focus on consuming mostly fresh/ whole foods and homemade meals instead of their highly processed alternatives. Choose satisfying meals and snacks that are well balanced by pairing a fiber-rich food with a lean protein food or healthy fat.

  Avoid skipping meals to keep you on track with making healthful food choices and maintaining proper portion control. Practice eating mindfully by listening to your body’s hunger and fullness cues and avoid slipping into emotional eating.

  Lastly, incorporate regular physical activity into your day. The goal is 30 or more minutes of exercise most days of the week, though you may need more to promote and/or maintain desired weight loss.

• I have IBS-D and use a FODMAP diet to manage. How can I follow a healthy nutrition plan with so many food sensitivities?

  Unfortunately, there is no one diet to treat irritable bowel syndrome. It is a matter of trial and error in finding which foods you may tolerate and those that you may not. Think of FODMAPs not as a long-term diet, but instead as a temporary tool to help identify your problem foods.

  A FODMAP is an elimination diet that cuts out foods containing certain sugars (Fermentable Oligosaccharides, Disaccharides, Monosaccharides and Polyols) and then slowly adds them back to help identify which foods may be causing gastrointestinal (GI) symptoms such as abdominal cramping, bloating, gas, diarrhea, and/or constipation.

  The hope is that once you’ve figured out which FODMAP foods you don’t tolerate, you can continue to avoid them while adding back those that you do. As this diet is quite complicated and restrictive in nature, it should only be used short term (2-6 weeks) and under medical supervision from a GI doctor or registered dietitian.

• What are the important nutrition factors for those with heart failure and kidney issues? Does it mean NO salt, alcohol and red meat?

  A heart healthy and kidney friendly diet can be achieved with a bit of creativity. Yes, you will need to limit your intake of sodium and red meat, however, that doesn’t mean total elimination.

  I would aim to keep your sodium intake around 1500-2000 mg per day by choosing mostly fresh foods and homemade meals. Over 75% of our sodium comes from processed foods and restaurant meals, so start by reading labels at the grocery store, ensuring only sodium-appropriate food products make the cut. Then get to work in the kitchen doing as much scratch cooking as you can. Add flavor with herbs, spices, garlic, peppers, citrus, or vinegars instead of table salt, bullion, seasoning packets, soy sauce, and other salt-heavy condiments.

  Limit red meat to one 3-4 ounce serving per week. Keep it lean and unprocessed by choosing choice or select cuts or even better if you can choose grass-fed beef, venison, elk, or bison meat as these have significantly less saturated fat.

  Additionally, incorporate a variety of vegetables, fruits, whole grains, and plant-based proteins as well. Choose mostly unsaturated fats from plant and fish sources while limiting animal-based fats and tropical oils. Limit or avoid alcohol completely as recommended by your doctor.

• How can I increase the proteins, and lower the carbs with a vegan diet?

  Plant-based diets are often higher in carbs as compared to standard diets as many plant-based protein foods also contain carbohydrates. When done well, a vegan diet can be very healthy and adequate, but it does take a bit of thought to meet not only your protein goals but also your nutrient needs.

  Think of layering your protein foods at each meal. Combining beans or lentils with some quinoa for example or keep it lower carb by choosing a high protein food like tofu paired with mixed non-starchy veggies. Nuts and seeds can also be helpful in adding a bit of protein and healthy fat. I like to use these at snacks or add a bit to hot cereal, salads, or grain and veggie bowls for a nice crunch. Try switching to soy milk for more protein plus needed calcium and vitamin D.

  Still having a hard time getting enough protein? You can think about using a plant-based protein powder to fortify your smoothies, soups, and other dishes. I would, however, recommend using vegan meat substitutes sparingly as these often contain unhealthy fats and emulsifiers and typically have high sodium counts. Keep your foods real and minimally processed, as with any healthy diet.

• What suggestions do you have for gaining weight without resorting to high fat or sugary foods?

  Healthy weight gain or weight restoration can be achieved with some careful modifications to your eating habits. We want to avoid turning to junk foods and instead choose foods that are both calorie and nutrient rich.

  For example, adding a little extra olive oil to your cooked veggies or using peanut butter or avocado on your toast in the place of butter can boost up the calories coming from heart healthy unsaturated fats. I typically recommend eating at least 3 meals and 2-3 snacks per day to help get the calories in throughout the day instead of trying to stuff yourself full at a couple of large meals.

  In addition to taking in adequate calories, you will also want to ensure adequate protein intake. I recommend including a good source of protein at each feeding with goal of 20-30 grams of protein per meal as well as a bit at snacks. Support muscle health by staying physically active with both cardio and strengthening exercises.

Jamie Libera, RD, LD, is a clinical dietitian within the Providence health system. She works closely with the heart programs in offering consultations for heart failure patients, cardiac rehab patients, and serves as the nutrition consultant for Basecamp Prevention + Wellness. Jamie offers monthly nutrition-based classes and a monthly heart-healthy recipe as part of Basecamp’s free community programming.