Nutritional Considerations for the Congenital Heart Defect Community

Skylar Griggs is a licensed registered dietitian and nutrition counselor specializing in a variety of nutrition-related conditions. She has experience working in pediatric and family nutrition as well as pre/post-natal nutrition, eating disorders, weight management, cardiac risk factors including hypertension, high cholesterol and obesity, diabetes, and overall wellness. Skylar is the lead dietitian for the preventive cardiology division at Children’s Hospital Boston, the teaching hospital of Harvard Medical School. 

In this episode, Skylar talks with Anna about the special dietary concerns of members of the congenital heart defect community. She shares with Anna why she is passionate about nutrition and being a dietician and she explains how taking care of ourselves by eating healthy food doesn't have to be that hard.

In addition to talking with Anna, Skylar spends the last segment of the show answering questions from a live, studio audience. The audience features members from around the world! You won't want to miss this very special episode!

Thanks to our newest HUG Patron, Ayrton Beatty and long-standing Patrons: Laura Redfern, Pam Davis, Michael Liben, Nancy Jensen, Alicia Lynch, Deena Barber, Carlee McGuire, Carter & Faye Mayberry, and Frank Jaworski. We appreciate you!

Transcript

spk_0:   0:00
If you're looking for a diet for a congenital heart disease patients, I would look no further than the Mediterranean

spk_1:   0:06
diet. Welcome to heart to Heart With Anna I am Enna, Gorski and a host of your program. I am so excited today to feature as nutritionist. Today show is entitled Nutritional Considerations for the Congenital Heart Defect Community. Skylar Griggs is a licensed registered dietitian and nutrition counselor specializing in a variety of nutrition related conditions. She has experience working in pediatrics and BMO Nutrition as well. A CZ pre and post natal nutrition eating disorders, waits management, cardiac risk factors including hypertension, high cholesterol and obesity, diabetes and overall wellness. Skylar is the lead dietitian for the Preventive Cardiology Division at Children's Hospital Boston Teaching Hospital of Harvard Medical School. In addition to working with clients,

spk_2:   1:09
Skyler is a lecturer, consultant, spokesperson, immediate contributor. Providing nutrition news for Fox 25 News Boston in Boston Magazine Online. Skylar also provides corporate nutrition consulting for a number of companies, including savings. Our supermarkets, scholars, personal blawg, Newbury Street Nutrition offers, nutrition and meal tips for busy individuals and families on the Go Scholar is an active member of the American Dietitian Association, the previous membership chair of the Greater New York Dietetic Association and a member at the Massachusetts Dietetic Association. Welcome to heart to Heart with Anna Skylar

spk_0:   1:49
Thank you so much and happy to be here.

spk_2:   1:52
Well, I am so excited to have somebody who is so passionate about diet and nutrition and who also knows about adults with congenital heart defects. They're one of my savior, it possible stones.

spk_0:   2:05
I've had some experience working with them, and I really, really enjoy the spirit of those takes patience.

spk_2:   2:11
Oh, that's so good to know you are so passionate about nutrition. So tell me what started you on this passion? So it's kind of

spk_0:   2:21
about winding road story. When I was about 16 years old, my mother was diagnosed with breast cancer and he was working with a dietician on ways that she could be healthier around chemotherapy and radiation on. I saw the way that changes the whole diet and not incredibly significant changes. Small changes to her diet really made a difference. So did think, like including more fruits or vegetables or cutting out some of the more processed snack foods I started to see and she started to a bird that she was feeling a bit better. And I thought, Wow, that's really interesting that the food that we eat, the things that we put in our body, especially during the time of high stress, something like cancer or heart disease or congenital heart disease. It can be applied to any different illness or just a normal, healthy person. How what we eat and what we put in our bodies makes us feel better or worse.

spk_2:   3:16
Riles right after yesterday,

spk_0:   3:19
kind of observing that and seeing what a great relationship she had with her dietitian. And this was the dean of Farber Cancer Center in Boston. She brought me home from pamphlets because she could see that I was particularly interested in it and said, You know, when you go to college someday, maybe this is something that you want to think about. Maybe this is something that you wanna get more involved in, or maybe you want to learn a little bit more about. And so I packed my bags, went off the Syracuse was a freshman and started in pre med and really interested in medicine and especially pediatrics, but kind of always had nutrition in the back of my head and then myself weren't here. I declared consistent my major, and it was probably one of the best decisions I ever made, because how was my nutrition to be a field that's ever evolving? And I know something that I just enjoy helping people kind of the,

spk_2:   4:07
you know, it ISS ever evolving. And I think that's what's so interesting, even though you would wonder, What more could we learn from this? But food's air changing all of the time. The additives that they're put in, the foods that we buy at the grocery store and hormones that are used in all of these things come into play. And it does seem like it's changing on an almost daily basis, doesn't it? It really

spk_0:   4:34
does. And I think with the clipping book, Remember It. But by industry is a multibillion dollar business, and so you'll see that nutrition recommendations are being advertised by everyone, and I'm warning that wheat, it's not just the dietician that's providing nutrition information, it's the personal trainer. It's mean how, coach, It's the life coach. And while I think that those are, you know, done with the best of intentions. I think sometimes things get lost getting the accurate information and difficult.

spk_2:   5:06
Well, it's not just that. It's says you're buying your groceries at the grocery store. How many different magazines talk about this diet or that diet? You see famous people who are promoting this clans or that close? I mean, it seems like we're almost black hearted with information about diet and the nurse, Dr Oz and other people who are on television that you're a take is an authority. So the problem is that you get so much conflicting information. Some people sake Ito. Some people say Paleozoic people say vegetarian or vegan, and so there's a lot of different conflicting information out there. Let's take a step back for just a second, because I'm really interested in your early days. So at 16 you were influenced greatly. It sounds like to go into the field of nutrition. Tell me how you decided to start working specifically with the pediatric of family populations. Well,

spk_0:   6:02
I always had an interest in pediatrics, and they think it was something that always piqued my interest. Begin when I waas in my dietetic internship, it and why you I actually had the opportunity to do some work with the pediatric practice in Queens, and I got to see a bunch of different types of conscience there and what I was seeing the most of with pediatric obesity being a lot of Children coming in with no significant past medical history of dealing with a lot of weight issues, particularly in a in an urban environment, we're access to healthy suits that sometimes can be more difficult. I also observed that eating healthy is expensive. So for many of these families, there are ways to eat healthy on a budget. For many of the families they were really struggling with, how could I gain access to healthy foods, and where can I find them? That's really my interest, My experience working with the pediatric practice in Queen. It went on, and I started looking at a center in the Bronx. My first job was in the Bronx, and it was at a center for women and families with the charm peonies, and it was a soup kitchen and petition kind of education cross job. So I was working with people who were receiving emergency food but also showing them how to cook with healthy food items that were inexpensive. I really like that. Yeah, Yeah, it was really, really experience,

spk_2:   7:29
right? So is that kind of what inspired you to start working on the news as well? Yeah, well,

spk_0:   7:35
I think the kind of fell into my lap just as an opportunity of being a part of Boston Children, you are given the opportunity to be an expert contract. You're from time to time on different nutrition trending topics. So I had the opportunity, and I believe it was 2000 and 14 to really spend a lot of time doing media interviews with, with great experience for me and also really interesting because, as you said, many emerging topics, but come across and people are interested in kind of hearing an expert opinion, which is really,

spk_2:   8:05
absolutely

spk_0:   8:06
but the job. It's Boston Children. So I kind of came upon me after I had left my job in Harlem. I was working in eating disorders ironically, and I saw a job opportunity come up the preventive cardiology. So working with patients with congenital heart disease, but also patients with high cholesterol and high blood pressure. So I thought that's really interesting, using Nutricia as a way

spk_1:   8:32
to manage lipid reporters and blood pressure issues. And it really people Donna Forever by the Baby Blue Sound collective. I think what I love so much about this CD is that some of the songs were inspired by the patient's many listeners will understand many of the different songs and what they've been inspired by. Our new album will be available on iTunes. Amazon dot com. Spotify I love the fact that the proceeds from this CD are actually going to help those with heart defects. Join Music Home Tonight Forever.

spk_4:   9:22
Hi, my name is Jaime Al Croft, and I just published my new book, The Tin Man Diaries. It's an amazing story of my sudden change of heart as I went to Ah, heart liver transplant. I can think of no better way to read The Tin Man diaries than to cuddle up in your favorite hearts. Unite the Globe sweatshirt and your favorite hot beverage, of course, in your hearts Unite Blow mug, both of which are available. The hug podcast network, online store or visit hearts unite theglobe dot Take this hot industry. We're offering us a mechanical hot And he said, Now that I've had enough to give it to someone I was with my father promised me a golden dressed world held my hand and asked me where I wanted to go. Whatever stripe for conflict that we experienced in our long career together was always healed by humor.

spk_1:   10:14
Heart to heart With Michael Please join us every Thursday at noon, Eastern as we talked with people from around the world who have experienced those most difficult moments before the break. We were talking with Scholar about because you nutritionists working

spk_2:   10:28
with Children and families. Now I'd like to talk to you, Skyler, about your expertise with congenital heart disease. What do you feel are the specific nutritional requirements of patients with congenital heart disease? I

spk_0:   10:41
think that's a great question, and I think that being nutritional consideration and across the course of a patient's treatment, So when a young Devi presents with congenital heart disease, even sometimes grow and then once they're born, we know that there's many specific nutrition consideration based on the type of congenital heart disease that that has, and one of the biggest challenge is for cardiologists and for dietitians working the kids with congenital heart to be is making sure that they're getting enough calories because the bodies right

spk_1:   11:10
so

spk_0:   11:10
much, but a shift that we've noticed lately and a really interesting shift that I was not aware of until I really spent some time working with these patients is 10. 15 years ago, we were spending time really encouraging foods that were not particularly healthy but we knew would move in the calories of these patients. Number example. Load him up with butter, load him up with any calories in them if you can. Well, now we know that while that may have been effective from a week perspective, it's possible that we could have instituted dietary habits in those patients that might not be beneficial in the long term,

spk_2:   11:48
right? Don't right. You

spk_0:   11:50
know we have kids that congenital heart disease patients that are living for a really long time, but they've never had a vegetable because all of the foods that have been pushed on those have been patrolling high fat, high calorie, not healthy options. And so what we're trying to do, at least in the cardiology department, Boston Children encouraged the intake of not only some of them what we call saturated fats, but also really good sort of the fat. So things like peanut butter's almond butter, avocado and healthy oils fish season olives because we know that those were good for the heart in addition

spk_5:   12:23
to being

spk_2:   12:24
high calories. Wow, I just left. What? She just said That is so totally perfect. My son is 24 years old. He was born with a congenital heart defect. They did exactly what you said. In fact, it was discouraged from breast feeding my son because they said there weren't enough calories in the breast milk. And that's not the case anymore. Yeah, I said, I don't care if you don't think there are enough calories. I know that my inner bodies and that there are other things in breast milk that are important for my son. And so I continue to breastfeed him anyway, and he ended up doing just fine. And now it's just the opposite. They realize how imported the breast milk ISS, and so that seems to be encouraged a lot more than it was 24 years ago. I just think that the whole scientific arena around babies with congenital heart disease and boot has changed. I remember friends of mine 24 years ago saying, I don't know what to do. They're still saying my baby's emaciated and by baby, I mean, maybe an eight or a 10 month old baby. I'm just giving him macaroni and cheese and chicken fingers, and we kind of cringe because I thought but But where's salad and broccoli and right

spk_0:   13:43
pattern when you could be developed about age? And I think you have to keep in mind that many of these patients already feel special, singled out different right because they're born with congenital heart of you. So you don't want that to be an opportunity to steer them away from healthy foods because they feel like they're different or they don't need to have those. And I think that eating healthy for your heart is eating a variety of foods. Finding calories from healthy fats can be justice beneficial,

spk_2:   14:16
right, right? I love Avocado said. That's one of my go to foods is Qatar's. They're just great in so many ways. And yeah, I'm from Texas, so guacamole just gotta have it. I'm sure David might say this day because he's from Austin. You just can't go visit many restaurants of this area without having some avocado in one way or another. But why don't you tell us about some of those healthy snacks and healthy meals that heart parents can prepare for their Children who have congenital heart defects? Especially parents like me who was dealing with a child who was labeled emaciated, who was labeled failure to thrive at one time in his life? Right? So

spk_0:   14:58
I think what I would say to someone is, Let's focus on healthy fat and protein. So we want to make sure that the child's getting enough protein to insure their growing properly. So, including things like apples with cheese stick or a little bit of yogurt making smoothies with fresh frozen fruit and Greek yogurt encouraging pro animal proteins things like chicken and fish. But then also integrating some of those healthy fats that we were talking about. So you mentioned about Gatto's and guacamole, and that's a great one. But something people often don't think about is you can actually add something like avocado to a movie that's gonna boost the calendar, huh? Yeah, it might change the consistency a little bit but you're mean. An avocado has somewhere around 300 calories in it. No, that's a pretty hefty dose for a child. Even getting half of that would be beneficial. The other thing that you can think about is often people forget something like a fish. He's a great source of omega three healthy fats. Putting that on some kind of whole grain cracker or on a sandwich with whole wheat bread. That's a great snack or a great meal on a good way to boost calories. The other ways of things, like trail mix is not mixes. Sunflower seed, pumpkin seed. Those are all really good ways to boost calories, but also protect the heart because they provide a types of that that call HDL or good cholesterol. So getting in snacks that have those tapes that fast in them is really helpful.

spk_2:   16:33
Oh, that's all such good and important news. I think that's something that ah lot of parents do not really think about. Site. One thing that I discovered when my husband and I decided to do more of a key toe diet is that welcome away, taste really good with celery sticks. You don't have to have fatty chips. There are other things that you can have that are better for you. Fresh vegetables, for example,

spk_0:   17:01
even talking about something like the key toe diet, the Keio diet although it's very high and that there's things that you can take from each diet right, whether it's taquito diet, the Mediterranean diet, the paleo diet clean that film, there are common strings and all of those diets and one of the most common stranded. The emphasis on heart healthy catch is the emphasis on whole grade is the emphasis on fruits and vegetables. If you're looking for a diet for a congenital heart disease patients, I would look no further than the Mediterranean diet. It's the most well study dietetic out there, and it's just an emphasis on fiber healthy, fat, lean proteins and whole grains. That's a really good place to start.

spk_2:   17:45
My husband and I love to travel, and so we've been to Italy and we've been to Germany. Those people are thin. There are a lot better than when you walk around America, and I'm sure there are several reasons. One thing is a lot of those countries are better walking countries thing what the United States eyes, especially Texas. You can't just walk to the grocery store in most areas because it's too far and it's too hot, so it's not as reasonable. Whereas when we were in Vienna, we just walked everywhere. It was amazing when we were in Italy, we just tended to walk everywhere or use the public transportation. And so I think that's one disadvantage that we have, at least in Texas. Maybe not so much in Washington, D. C. Or New York City, where you can get on a subway and be where you want to butt. In Texas anyway, where I live in Central Texas, that's a lot harder. But the other thing is the diet. You see a lot of people with the Mediterranean diet. When you go into restaurants, the portions that they serve you are much smaller than what you get served here in the United States. And I think all of that contributes to people eating more than they should and not eating what they should. Yes,

spk_0:   18:52
and people are actually walking to the grocery store every day to pick up their grocery, right,

spk_2:   18:57
right, using

spk_0:   18:58
your often believe their home every day to go pick up some fresh food in nighttime two states. Explosion doesn't work as fast thinking. There's fruit, vegetables and frozen fish, and you could get a much nutrition from those of you come from the fresh version. But the reason that the Mediterranean diet has worked so well is that people are just buying what they need, as opposed to filling their homes up with snacks and kind of what we call empty calories. We think they're right. I'm not part of the world.

spk_2:   19:26
Oh, I think there is, too. Well, you know, one thing that I noticed when we were over there is they have thes tiny refrigerators. It looks more like a refrigerator that you see in a common dormitory in the United States versus the big, gigantic refrigerators and freezers that we have here. And so I think that kind of encourages people to stock up and may be over by and maybe over by things that are so good for you,

spk_0:   19:53
right? Right. And I think when we have those from around, especially with kids we're trying to promote, will be like to call a food shaped house, right? So meeting that all of the healthy options are available at home, and there's limited access to unhealthy options because if the unhealthy options air their kids, you're gonna go for them.

spk_2:   20:12
Sure. So we're the grown up,

spk_0:   20:14
right? Exactly. I came over. I'm gonna go for those. And especially if you're trying to encourage your child to trying new foods. If they know that there's an alternative or something that they can have instead the chances of them starting to conclude that healthy food more often become less and less

spk_2:   20:34
right, Right. I noticed that one thing that really encouraged my boys to try new foods was when I involved them in the food preparation and my boys like to cook. And we did some gardening because I thought that would be a really good way for them to understand where their food came from and said we would garden together, and then we would harvest things from the garden together and immediately come in and cook them or put them in a salad or make tea. We grew fresh, peppermint, and we made peppermint tea, and that really excited them. So they were more eager to try something because they had had a hint in helping to grow it.

spk_0:   21:12
I'm so glad you brought that up. I think that's a huge piece of getting Children to Chinese food just to get them involved in the process and help them to understand the way that foods were made and where they come from. Because oftentimes, when Children prepared their

spk_1:   21:25
own food, they learn how one where they're coming from. They're much more likely to try them manage. Dworsky has written several books to empower the congenital Heart Defect, or CHD community. These books can be found at amazon dot com or at our website www dot baby hearts press dot com. Her best seller is The Heart of a Mother, an anthology of stories written by women for women in the CHD community and as other books, My Brother Needs an Operation, the Heart of a Father and hypoplastic Left Heart syndrome. A handbook for parents will help you understand that you are not alone. Visit baby hearts press dot com to find out more. You are listening to heart to heart with Anna. If you have a question or comment that you would like to address the show, please send an email to Anna Dworsky at Anna at heart to heart with anna dot com. That's Tanna at heart to heart with anna dot com Now back to heart to heart with them

spk_2:   22:31
collar Before the break, we were talking about what kinds of nutritional considerations for different members of the congenital heart defect community and really for everybody, for the parents, a swell for even the heart, healthy Children in the family. But now we have a live studio audience, and I see some of these members of our audience already have some questions for you, and we're going to start with Cindy. Welcome to heart to heart with anise Cindy. Hello. Hi. I hear you have a question for Skylar.

spk_3:   22:59
I just graduated nursing school, and one of the things that we learned a nursing school is when a baby is breastfeeding, it's a two way highway. And so, as the mother's milk goes into the baby, some of the baby spit actually goes into the mother's breast, and the body chemically changes the formula for the breast milk. For the next time the baby needs to feed. So it gets exactly what it means

spk_0:   23:28
really, really interesting. And I think It just highlights the idea that no, the more that we can encourage something that feels natural like that, that kind of natural given take from the body, the body kind of knowing the best way to handle a situation to support the baby's. It's wonderful. Thanks so much for sharing that.

spk_2:   23:49
Wow, that's fascinating. I have never heard of that before. Cindy. I am sure that's a sig that base. We feel even better that I fought with the doctor that did it anyway. Yeah. Hey, did it right? Yeah. Maybe it was good for me. And I was good for my baby sister. Would you do something right? Especially 24 years later? Because, you know, you don't know Jack while our show is international today and we have Megan from Australia. Welcome to her tart with Anna Megan. Thanks.

spk_5:   24:25
And, uh, thanks for inviting me along. I've really enjoyed listening to this show, and I think that it's going to help a lot of people. I have a couple of diet questions. One is a very simple question. So start with that one. The 1st 1 is what about Kai Cannot. Oil is a healthy fat. That's used in a lot of time made desserts and things like that.

spk_0:   24:48
I'm so glad you asked that question. That was a topic that I actually wanted to mention. I'm so glad you brought up coconut oil impatience with congenital heart disease In any type of cardiology, patients are really in the general population of the whole No, but coconut oil, especially in people who have high cholesterol, will make their cholesterol worse. So what I would say for coconut oil is, if you have a family has to have high cholesterol, especially for patients with continual heart to you. We really want to just be aware of high cholesterol. I would skip the coconut oil because coconut oil has been found in people with high cholesterol to actually worship the LDL cholesterol. I'll go. It's a George differently. It does still have a lipid raising effect, so it does still read the cholesterol. There are many other types of oils on. One of my favorite is avocado oil for high heat cooking, if you're doing a lot of high heat cooking like avocado oil, canola oil, sunflower oil. But the coconut oil we have found will raise cholesterol levels and teaches with congenital heart disease. That's not something that we want to kind of add to the fight. So I would say Use it on your hair. You've been on your skin, but try not to use it in your food,

spk_5:   26:11
okay? And the other question is, a lot of us have problems with fatigue, and I have seen on different groups around Facebook. People falling diets are wondering about dance like a vegetarian or vegan Don't or Kito dark. Is there anything to be really concerned about with these sorts of diets? Or alternatively, is there anything that you would recommend that would really help people's fatigue? Food wise? Because it's a big problem,

spk_0:   26:45
right? Right. And I think that makes a lot of fun. As I said before, I think that everybody's diet issues the SEC. It completely depends on the individual. So if you're mumbling, has died because of my high blood pressure. High cholesterol diet that's recommended to you in addition to the congenital heart disease might be different, but I can say from a general perspective when you're thinking about fighting fatigue, one of the best things that you can do is to try to eat every 3 to 4 hours because that at least much of the levels stable and it's not gonna worsen the fatigue. The other thing you can think about is whenever you're having a carbohydrate or fruit, you could think about combining it with some kind of protein or fat. The that's not gonna work in your blood sugar fluctuations. The blood sugar does have a role in. He has a role in energy levels. He's thinking about the way that you combine it and how often food is really helpful. I think that whatever diet works best with individual works best for them. And the only kind of risk I would say to watch out for, especially with something like a vegan diet would be just making sure that your supplementing with the appropriate vitamins and minerals. So taking

spk_5:   28:00
something like

spk_0:   28:01
a multi vitamin is really important for someone on a vegan diet is not getting any of those B vitamins. It might not be getting enough iron or vitamin A, which could just compelling those feelings of teeth.

spk_5:   28:13
Yes, yeah, now that's really helpful. Thank you

spk_2:   28:18
work. The one thing I noticed when I was on the vegan diet. I ate a lot more dark green leafy vegetables so iron that wasn't really a problem for me. And I think that a lot of people, if they're doing it right, they are eating a lot of those dark green leafy vegetables that are high in iron.

spk_0:   28:39
Absolutely. When I still can't quite, it's generally okay, but I think

spk_5:   28:44
what often

spk_0:   28:44
happens is I can't tell you how many heart patients I have come in to see that say that they're on a vegan diet and their carbs. I don't know. And I think I'm being that alternative. Source of protein can be really challenging for those. Sometimes you should take some general diet education. How could the insurance get adequate protein Hell country get adequate fiber iron. And I think that justice on vegetables is great. I mean, they're one of the most beneficial food we can eat. No, I think that that's a really good point.

spk_5:   29:19
Thank

spk_2:   29:20
you. May Is this where great questions?

spk_0:   29:22
Great questions,

spk_5:   29:23
kid.

spk_2:   29:25
OK, so, David, did you have Ah, question for scholar. This is David from Austin, Texas, and also the producer of her tour within a week.

spk_4:   29:37
Hi, Skylar. Thanks. for taking my question. Quick question. This may be too simplistic, but the number one mistake that people make regarding their nutritional or there

spk_0:   29:50
I think the question was the number one mistake people make with regard to nutrition.

spk_4:   29:55
Yes,

spk_0:   29:57
it's a really great question. I think the number one mistake that I tend to see people make a general population pieces is that they don't eat breakfast. And we know from data of something called the National Week Control that it's driven over 90% of people who eat breakfast seep off wait, and they stay at a healthy weight. So eating breakfast, in addition to kind of promoting a healthy weight, it also keeps your energy levels people throughout the day, and it helped turn on the machine in your huma capitalism and helps you burn calories more efficiently. So the best thing that people can do is to eat breakfast because it'll kind of set you up for success for the rest of the day, not me. Breakfast is gonna lead to overeating as the day goes on, and we might not feel it at lunch might not feel excessively hung by the time we get to lunch. But what will have the passing it by dinner, like George, give our calories just between the hours of 40 PM and that over time is gonna have some not so beneficial effects on the body.

spk_4:   30:58
Correct. Sleeping right after you ate. And thank you very much for answering because I've heard this before. I didn't think you would say that. I really didn't. Can I ask another question very quickly. Court I I'm about fluid retention on adult here with CH Day. And my problem now is I'm battling Lasix against my own fluid retention. But do you finding that some concoctions that people make up such as pineapple and cilantro or other concoctions? Do they work as well? And do you know of one that does work?

spk_0:   31:37
I haven't seen as many concoctions nominations that I worked with on I don't know of one specifically that works. But what I can tell you when you're thinking about counting your fluid need something that often gets overlooked a fruit. The fruit actually contains a decent amount of fluid. Um, so when you're thinking about your if an individual does help a former restriction, I would think about counting fruit into that because that is gonna contribute a decent amount of fluid. And there are different ways that you can go online and look what each of my equal in terms of fluid but sometimes just accounting for the additional amount of fruits. And sometimes things like suits people don't take into account actually makes a difference with kind of decreasing some of that fluid retention. But I don't know of any specific shakes or supplements that would help to reduce that. I can say that something like fiber, which we know is good for your heart. Um, so fiber comes from fruits and a comfortable vegetables and whole grains fiber is gonna help someone usefully attention at baseline, regardless of whether they had congenital heart to be. They're not thinking about ways that you might be able to increase. Your fiber might actually help with some of the fluid retention and kind of decreasing that,

spk_4:   32:54
Thank you very much. I appreciate it.

spk_0:   32:57
Thank you.

spk_2:   32:59
So I have a question for you. Skylar, can you talk test about blow sodium diet just a little bit? Yeah.

spk_0:   33:06
So it's actually quite similar to the guy that you would put someone on for high blood pressure, which we call the dash diet. So a low sodium diet or the dash diet is an emphasis on first vegetables. Whole grains limited intake of sugar sweetened beverages and read me, including other sources of leaner types of protein. What we ask patients to do is when they're in the store. If they can flip over the food label of the food that they're looking at, cried first, pay attention to the serving size because that tells us how much is in the table. For example, something like Catch up you look at catch up. That's something that people often overlook is being a source of sodium, but it can contribute quite a bit. When you look at something like Catch up and you go down to sodium, you want to make sure that the amount of so him is 10% or lost. That's how we know that something is low sodium. There's a number of low sodium foods on the market, especially when we think of the high civilian things like deli meat. You can often find a lower sodium alternatives, sodium preserve it, and so it's gonna be found in a lot of processed and packaged food, so they're the ones that you really want to pay attention to. You don't need to pay attention as much to the fresh fruits and vegetables.

spk_2:   34:23
So

spk_0:   34:23
paying attention to sodium is really important in addition to fiber. And I think the other thing that people can kind of keep in mind is there's so many lower sodium or sodium free seasoning alternatives. Some people use things like dash onion powder, garlic powder, all of these things. Add later without adding fruit him. And if someone was following a lower sodium diet and actually just suggest that they pick up the Dash Diet Cookbook, it's D A S H because that provides a lot of really helpful recipes and is the same lines of a low sodium diet

spk_3:   34:59
geiler. Yeah, with theirs in so many people now that are getting trained in nutrition, whether you're ah, dietitian or a nurse or the trainer down at the gym. Like you said earlier, if you want to hire somebody and you say your insurance doesn't cover the dietician, but you do have access to a nutritionist, what would you look for to make sure that you're getting the help that you need.

spk_0:   35:26
I'm really glad you asked that question. That's a really important question.

spk_2:   35:30
So I

spk_0:   35:30
think that that's tricky, because Massachusetts at least has life insurance place into requirements, meaning that you cannot go around providing medical nutrition therapy had rice without being a dietitian. There's many ways around that. But in order to be referred by a doctor to be seen by an individual in the hospital, dietitians were the only nutrition professionals that can work in hospital. It would have to be a registered dietitian, and the reason for that is that we received a law of hours of training and our specialty. And we really haven't understanding of not just nutrition but different disease states and what we call medical nutrition there, these diet education that goes along with conditions. So I think it would be hard to a identify what to look for in an individual who wasn't a dietitian, because my cure would be that for the general population. They might have good ideas, but when we think about our patients with heart disease, it's a lot more specific. Um, and you really have to understand the things that they're dealing with whether it's a fluid restriction of sodium restrictions, making sure that they're getting enough calories are do they have a potassium restriction recorded about other organ systems? But I think it would be tough to identify someone who wasn't a die. Attention to provide Nutrition Invite My hope is that most insurance will cover nutrition, and if they don't, you can often resubmit with something called the Super Bill to see if your insurance will cover it. And at least in the clinical setting we've seen. But the hospital, most patients. If they obtain a prior authorization, most are able to be covered from nutrition.

spk_2:   37:11
Wow, that was such a good question, Cindy, thank you for as getting out, because I'd be Oh, my gosh, I think so many people are confronted with different people in different walks of life who are like, Well, I can help you lose weight. I I could help a. It'd shake.

spk_0:   37:27
Okay, you have to be careful, and I would love to say, Look for X y Z and an individual. This is how you know that they know what they're talking about, but it's really hard in this day, and each two people to identify those people because anyone can call themselves a nutritionist,

spk_2:   37:42
Right? Right. So let me ask you this. We have a whole new specialty now that didn't exist 24 years ago, And that is a specialty of doctors who specialize in working with adults with congenital heart disease. Are there dietitians who have that kind of specialization as well? So

spk_0:   38:01
I actually myself, I see the Boston stations with the adults with congenital heart disease. There's a clinic of Boston Children called Bok the Boston don't opinion over to the clinic. And I think that, as I mentioned before, many of the issues that we see in our pediatric patients with high cholesterol and high blood pressure we're seeing in our congenital heart disease patients because they're living longer. So I think that while there might not be a specialty for working with adults with congenital heart disease, there are absolutely special teams off walking with adults and then working with congenital heart disease. But I think kind of, you know, harnessing the resource is from those specialty than bringing it together is really helpful. And I think it's great that we now have as awful as it sounds. I think it's great that his adults with congenital heart disease are living so long because we're starting to see things that we would notice in a normal, generally healthy patient, right without control

spk_2:   38:59
varieties thanks erratically.

spk_0:   39:02
That's the silver lining.

spk_2:   39:04
Mm. Oh, I think so, too. For a long time, we all wondered if our Children would make it through infancy and then through childhood. And so now, to see these same Children grown up as adults and some of them even having their own Children, which is all the water show we're gonna have to have you come into it is a wonderful thing. It is a wonderful thing. And it is sad that we're seeing so buddy of these adults with congenital heart defects have the issues that plague those of us like me who are just old. But I have to get that far is actually a wonderful thing. So I'm just helping it. Medical technology will continue to stay a step ahead of my son so he could continue to have a good quality of life. Because, as you know, Skyler, nutrition plays a key role in our quality of life of all. So

spk_0:   39:58
a huge role, a huge role. And I think the advancements that we're seeing just speak to the amazing work that cardiologists are doing and how much more they're understanding and nutrition plays a huge part. And generally, the recommendations that I would give to a patient in even if they hide congenital heart disease would be a general heart healthy diet, which 100% of the population should be following anyway. I think it's great that we're so aware of these things.

spk_2:   40:28
Well, it has been a delight talking with you. Thank you so much for coming on the program today, Skylar. So

spk_0:   40:34
thank you for having me. It was really, really a pleasure.

spk_2:   40:37
And thank you to my studio audience, people from all over the world. What is it about joining? Did they have great questions? Skylar. They

spk_0:   40:48
had great questions, and I actually learned quite a bit.

spk_2:   40:51
I know

spk_0:   40:52
everyone finding on, especially from Australia. I

spk_2:   40:56
know I loved having a nurse on and other people who do research like Megan. She's always investigating different things and bringing up good points. So I just loved having the studio audience today. It was so fantastic and it gave us a whole other perspective. I love being the one who interviews, but I love hearing what other people's questions are as well.

spk_0:   41:18
Absolutely. I really appreciate everyone see back in question.

spk_2:   41:22
Well, that does conclude this episode of Hart to Hart within a thanks for coming today and for listening. Folks, please find us on I heart radio and subscribe. I remember my friends. You are not alone.

spk_1:   41:35
If you've enjoyed listening to this program, please visit our website hearts, Unite the globe dot or GE and make a contribution. This'll Program is a presentation of hearts, Unite the Globe and is part of the Hug Podcast Network are tonight. The Globe is a nonprofit organization devoted to providing resources to congenital heart defect community to educate and power and enrich the lives of our community members. If you would like access to free resource, is pretending to CFC community. Please visit our website at congenital heart defects dot com for information about CHD hospitals that treat CHD survivors summer camps for CHD families and much, much more. Yeah, thank you again for joining us this week way Hope you have been inspired on. Empowered to become an advocate for the congenital heart defects community. Heart to heart With Anna With your hose down, Jaworski can be heard every Tuesday at 12 noon Eastern time.