Expert Insights is an ongoing medical education podcast. The Carle Division of continuing education designates that each episode of this enduring material is worth a maximum of 0.25 AMA PRA category 1 credit. To collect credit, please click on the link and complete the episode's post-test.

This podcast forum is brought to you to share expertise and insights within our integrated delivery system to help us improve the health of the people we serve and achieve world-class accessible care. This is Expert Insights. Here's your host, Melanie Cole.

Dr David Hill (Host): This is Expert Insights with the Carle Foundation Hospital. I'm Dr. David Hill. Today, we're talking with Bryce Yantis, certified family nurse practitioner about how to eat better for a healthier heart. Bryce, welcome.

Bryce Yantis: Thank you so much for having me today, Dr. Hill.

Dr David Hill (Host): Thanks for being here. Now, let's talk about a healthy lifestyle. The American Heart Association has come down on like eight things that they think are really important for people to do to make sure that they keep their hearts and blood vessels healthy. Can you run us through what some of those are?

Bryce Yantis: Absolutely. So yes, the American Heart Association and the American College of Cardiology have put forth a joint effort to try and highlight those areas in a patient's life, that simple changes, adjustments, focuses can have to lead to a better, healthier life. The whole point is to reduce morbidity and mortality, limit chronic diseases, manage things without medications. And also, early management of medical problems can lead to long-term overall health.

So, those healthy behaviors are, just like you said, broken down into eight categories. Eat better. So, looking to have a well-balanced diet of fruits, vegetables, whole grains, watching portion control. Focusing on being active, you know, 150 minutes of moderate exercise per week or 75 minutes of vigorous activity in a week as well. So, that is on average about two and a half hours of moderate to vigorous activity per week. Quit tobacco. Smoking is going to be one of our number one causes for atherosclerotic disease, whether that be vascular disease, risk of stroke, heart disease. So, looking to quit tobacco.

A new one that they added here the most recent year is sleep. I feel sleep is one of the more underrated focuses in healthcare. Making sure that we're getting our seven to nine hours of sleep each night, having that sleep hygiene, trying to eliminate screen time, two hours before we are partaking in sleep. And we know that sleep promotes healing, improves brain function and reduces those risks for cardiac disease.

Along with that, continuing weight management. And I think weight management is something that highlights and is a part of everything. By controlling weight, by trying to reduce our weight and trying to have that healthy BMI, that healthy weight, we also eliminate or reduce our risk for high blood pressure and helps control cholesterol. It helps manage blood sugar and manage blood pressure. So, weight management is going to be a big focus, and this can be achieved by being more active and eating better. So yes, the rest of the factors that they highlight are controlling cholesterol, managing blood sugar, and managing blood pressure.

Dr David Hill (Host): Well, eight things. It seems so simple, but I know each of those things can get pretty complicated with time. I want to ask you a little bit about a heart-healthy diet. Now, I trained in the 1990s. And what we thought was a heart-healthy diet, avoid all fats, eat egg whites if you have to eat eggs and load up on sugar, ended up maybe not being quite right. So, let's talk about 2023. What's a heart-healthy diet today?

Bryce Yantis: So today, we focus on a good, well-portioned diet and we talk about portion control. We want a wide variety of fruits and vegetables, whole grains and products. A healthy source of protein such as nuts, fish, and seafood, focusing on low fat or non-fat dairy. We are looking at our minimally processed foods, minimize our intake of added sugars and looking to prepare our meals with a little or no salt.

Dr David Hill (Host): All right. That's a major change and sounds really tasty actually. Let's talk about some barriers. Though as simple as that sounds, there are some things that keep people from being able to follow a diet like that. What sorts of barriers do you encounter that we have to help people overcome?

Bryce Yantis: Absolutely. So, education and understanding, like we talked about just now, the changes that we have recommended for different dietary pattern. The next would be cost. It is not cheap to eat healthy. Most of the time, the more inexpensive food are going to be the ones that are processed foods. They're high in sugar, they're prepared with a lot of salt because they last longer. And sometimes, it's access. Patients who may live in an underprivileged area, or they do not have a vehicle to get to the store, or they're focusing on whatever is available in their immediate area, a couple blocks from where they reside. So, those are going to be our main barriers to being able to even start looking at healthy diet.

Dr David Hill (Host): I think with some of those barriers, you have people saying, "Look, I know I should be eating healthy. I know I should be exercising. I just can't." What sort of resources are you able to direct people to or help them out with to get them on that first step of the staircase toward being healthier?

Bryce Yantis: Right. And I tell patients it's not easy. It is a lifestyle change. Same thing with anything that we try to undertake and make changes with our lives, we need to form habits essentially. Reading food labels is going to be big in trying to understand what are you actually consuming now versus how do we need to change that. So being able to interpret and read food labels onto what is high fat intake, what is the higher salt intake and then maybe trying to see what options are available within either your immediate area. Or I know here at Carle Foundation Hospital, we have started some programs to where we are trying to get into those underprivileged communities with either our mobile health clinic, but also they have a mobile, like a grocery store that they're going to have these different options. So, they can teach people on how to focus on making better choices for their healthy diet.

Dr David Hill (Host): Oh, that is a fantastic resource. That is super exciting. Let's talk a little bit about one of the things that is hardest. When people have started smoking, and almost all of them do when they're teenagers or even younger and don't really understand what's going on, how do they stop? This can be impossible for some people.

Bryce Yantis: Absolutely. Nicotine is an addiction and it's an addictive chemical, which is why people just haven't stopped. They've continued all these years because they like it, they like the way that it makes them feel. And it's just trying to let patients be aware that there are resources available to allow them to help them quit, whether that be state-funded resources or local resources to help patients bridge or with nicotine gum, nicotine patches or some way to bridge them off of cigarette use. And I tell patients, I say, "How can you afford it?" You know, go into the convenience store and you see what the price of cigarettes was now as compared to back then, it's just this costly habit. And you often think that maybe smoking is taking the place of maybe eating healthier or other choices. And so, it's just trying to start the conversation. And there are some patients that aren't ready to quit, but you hope that as you see these patients, you build a relationship, you continue to try and prove how much you care about their health, and you talk to them about the importance of quitting and try to allow them to understand and have those resources available so they can't quit.

Dr David Hill (Host): I love that idea of sort of leveraging one good habit into another. If you don't have to buy a pack of cigarettes, maybe you can get a package of unsalted almonds and a little bit of salad greens, huh?

Bryce Yantis: Absolutely.

Dr David Hill (Host): Correct. Speaking of building healthy habits, I think another one that's really tough for some people is exercise. You look at people on TV or on the internet and think, "Oh, I'm never going to look like that. There's no point." How do you get people started on exercise and how much does it take to start feeling better?

Bryce Yantis: Right. And I think that's the problem that we have. Social media is good in getting out some information, but it can also set up unrealistic expectations. And so, maybe that is a daunting task. You know, "Well, this is what I need to be healthy," and "No, that's not it." What we need is simple things. I tell patients it's a marathon, not a sprint. It's a slow process. Let's start with, "Hey, instead of parking in the second spot at the grocery store, let's park at the back. Maybe let's try and walk around the grocery store with a cart instead of using that power wheelchair or an assist device if you're able." Small changes.

Our goal is, yes, to get to the 150 minutes of exercise per week, but that's not where we should go from sitting on the couch to trying to have those vigorous types of activities. Let's try an uninterrupted walk for 10 to 15 minutes a day, whether that be at a local Walmart, or a convenience store or some public place or where it's nice out, just around the block. And understanding that as you lose weight, as you exercise more, those daily activities become easier. You notice that I would say within the first couple weeks, I have patients come back to the clinic like, "Yeah, you know, I've lost 10 pounds. I feel better." It just reinforces that behavior of how much this can be beneficial to your health.

Dr David Hill (Host): I love that. Focusing on how good you're going to feel even if you're doing a little bit. Bryce Yantis, do you have any last thoughts you want to leave us with when we're talking about developing a heart-healthy lifestyle?

Bryce Yantis: I tell patients that it's not easy. And again, we have had these habit-forming for however many years, we've been stuck in this cycle. But to know that simple changes early and weight reduction, better healthy lifestyle choices with heart-healthy diet will only save patient's time, effort, and energy in most instances that may lead to more complex health problems. So, trying to make those simple changes rather than averting to a medication is always best practice in my book.

Dr David Hill (Host): I love that. Well, Bryce, thank you so much for talking with us today.

Bryce Yantis: Absolutely. Thank you so much.

Dr David Hill (Host): For a listing of Carle providers and to Carle-sponsored educational activities, head on over to our website at carleconnect.com. And that wraps up this episode of Expert Insights with the Carle Foundation Hospital. I'm Dr. David Hill.