Dietitian's Journal

Entries in Education (4)


Cardiovascular Health & Nutrition Education Resources -- 2008 Update

coloured_vegetables.jpgThis morning, as part of preparing for tomorrow's stroke clinical pathway subcommittee meeting, I updated my inventory of patient/client and family education tools and resources on cardiovascular health. Here is Part 1 (original PEN and PEN-recommended resources) of the inventory. I'm going to continue working on it over the next day-and-a-half.

Image credit: Colored vegetables by christing-O


Dietitians of Canada's PEN resources (subscription required to access resources):

Resources recommended by PEN (external sites; PEN subscription not required):


Highlights, Summaries & Resources from "Keeping Current 2007"

Rather than recopy and wordsmith my notes,  I'll review my learning and transfer knowledge (I hope) by posting highlights, summaries  and online references. These brief blog entries cannot replace the inspirational, *real-time*, *in-person* experience of participating in and networking at the Nestlé Nutrition education day, but the information is so valuable and practical that I want to share it with colleagues who read my blog.  You still will have work to do -- reading and critically thinking -- before you can apply this information to practice, but I'll try to save you time by sharing the up-top-date references and "state-of-the-knowledge" as presented by the expert speakers.

Note: If possible, I've linked to full-text articles. If I've linked to an abstract only, a subscription or pay-per-view fee is needed to read the complete article.

Session 1: Pre-and probiotics: bugs as body armor against sick days. Speaker: Dr. R. Reimer, Associate Professor, University of Calgary.

Evidence for benefit in selected conditions

  • Inflammatory bowel disease: Hedin et al, 2007 (abstract)
    • most compelling evidence is use of VSL#3 in pouchitis
  • Prevention of allergies: Precott & Bjorksten, 2007
    • at this stage, not appropriate to recommend probiotics for allergy prevention
  • Acute infections diarrhea and antibiotic-associated diarrhea: Lemberg et al, 2007 (abstract)
    • several systematic reviews provide evidence-based support for benefit of specific strains
  • C. difficile-associated diarrhea: Isakow et al, 2007 (abstract)
    • S. boulardii effective but often combined with antibiotics

Prebiotics as obesity treatment

  • Dr. Reimer shared positive, exciting results from her randomized, double-blind, placebo-controlled trial. Research to be published in 2008.

Conclusions (excerpt)

  • Specific bacterial strains are needed for specific conditions
  • Probiotics appear to be well tolerated and have significant potential impact for improved gut function
  • Synbiotics (products containing both pre- and probiotics) may result in best delivery and survival of probiotics

Dr. Reimer also provided a list of foods in the Canadian marketplace containing pre- and probiotics and encouaged us to "enjoy" more of them. In a subsequent post, I will list these food items and supplements.

Also, in subsequent posts, I will share information from the other six sessions.


Keeping Current -- Topics in Nutrition Support 2007

I sneaked out of the early afternoon session of this conference NOT because it was boring, but because I'm so excited.  I wanted to write a short post. This day, which I announced a few weeks ago, has exceeded my expectations, as I knew it would.

Next week, I will be posting summaries of and key points from each speaker's talk. This to me is one of the greatest values of blogging: sharing information so we can provide "best practice" to our clients/patients.

If you'd like to get ahead and do some background reading on the topics, here are some links to full-text articles --

Have to head back now for the calcium/vitamin D session.

(Source of links: one of the speakers, Liz daSilva)


Education on secondary stroke prevention

Earlier today I provided some last-minute nutrition counseling to a stroke patient and wife just before the patient's discharge -- it was an ideal opportunity to test some new education checklists and resources to see if they'd be suitable for our unit's stroke program.

First, I needed to determine if the the patient and his wife were competent Internet-users. After confirming they were, I compiled the resources listed below and wrote a brief covering page explaining how to use them and listing all the web links.

1. Preventing another stroke: Lifestyle changes (Section 7 in the Heart & Stroke Foundation's information guide Let's Talk About Stroke).

I am going to reproduce the excerpt on eating so we know what the Heart & Stroke Foundation is recommending in one of their widely-used publications [I have bolded words for emphasis]:

The basic rule of eating a healthy diet is to follow Canada's Food Guide to Healthy Eating. The Food Guide recommends that you:
- Enjoy a variety of foods
- Emphasize cereals, breads, other grain products, vegetables and fruit
- Choose lower fat dairy products, leaner meats, and foods prepared with little or no fat
- Limit the amount of fat and trans fats in your diet
- Limit your use of salt, alcohol and caffeine

No more than 20% to 35% of your total daily calories should come from fat. This is about 45 to 75 grams of fat per day for a woman, and about 60 to 105 grams per day for a man. Whenever possible, eat polyunsaturated fat, especially omega-3 fatty acids and monounsaturated fats. Reduce the amount of saturated and trans fat in your diet.

Homocysteine is a substance that is produced naturally in the body as the body breaks down protein for fuel. In some studies, a high level of homocysteine in the blood was associated with a higher risk of stroke. Folic acid (a B vitamin) can help to keep homocysteine levels in the blood low. However, doctors still do not know if taking folic acid or redcuing homocysteine levels also reduces the risk of stroke (pages 24-5).


You may already know why I highlighted selected words in this excerpt. These are key concepts, perhaps not even all of them, that needed to be explained and illustrated with practical examples of real food and simple, visual rules-of-thumb for portion sizes. As good as it is, Let's Talk About Stroke needs to be supplemented with more how-to advice. And this is where resources #2 - 5 are so valuable in providing practical, up-to-date tips and more detailed explanations.

2. Heart & Stroke Foundation home page (this page changes monthly and always contains nutrition tips and links to other nutrition content on the site)

3. Health Check (Heart & Stroke Foundation's food information program)

4. EATracker

5. Dial-A-Dietitian

I must also state that in a ten-minute, bed-side counseling session with a patient and family member eager to go home I obviously was not able to cover everything in-depth. I also provided information on how they could access nutrition counseling through their local hospital, particularly because the patient is hypercholesterolemic, had a mild stroke that left him with minimal or no deficits and is hightly motivated to make lifestyle changes to prevent a second stroke.