NUTRITION411: THE PODCAST, EP. 54

Keeping the “Heart” in Heart Health: Cardiovascular Risk and Ultra-Processed Foods, Pt. 2

Lisa Jones, MA, RDN, LDN, FAND,
Grace A. Derocha, MBA, RD, CDCES

Key Highlights

  • Clinicians should guide patients away from rigid food rules and toward sustainable dietary patterns, emphasizing progress over perfection to support cardiovascular health.
  • Using empowering, non-judgmental language that avoids absolutes helps reduce guilt and stress while building trust and improving patient engagement.
  • Small, realistic swaps — such as upgrading convenience foods or adding fiber, color, or heart-healthy fats — can lead to meaningful improvements without feelings of deprivation.
  • An equity-centered approach that respects cultural food traditions, affordability, and access is essential for delivering effective and compassionate heart-healthy nutrition care.

In part two of this four-part series, Lisa Jones, MA, RDN, LDN, FAND, and Grace A. Derocha, MBA, RD, CDCES, registered dietitian and a certified diabetes care and education specialist, discuss how clinicians can translate evidence linking ultra-processed foods and heart health into clear, practical guidance.

Additional Resources:

Transcript:

Lisa Jones, MA, RDN, LDN, FAND: And welcome back to Nutrition411, the podcast. We are here with Grace again for another segment. We're going to be talking about data and daily practice. And as we've seen from our first episode, Grace, the science around UPFs and heart health, it is complex, but you helped us understand the mechanisms is only the first step. So let's talk next about how dieticians can translate this evidence into practical, compassionate care, because that's what we really all aim to do. So, yeah, welcome back.

Grace A. Derocha, MBA, RD, CDCES: Thank you so much for having me again. I love like where we're taking this and how we can help people, you know, as we discuss the process and the science and looking at it from a clinical lens, but then also taking it into what we do day to day as dieticians with our patients.

So clinically, an important shift is really thinking about how can we move from food rules and restrictions, if you will, into food patterns for people. So we know that the evidence does link UPFs to cardiovascular risk. And a lot of that is observational, but it is consistent. And that allows us to kind of focus on how can we work with our patients to guide them through things rather than live in absolutes because we know the science does support that helping people through process and like learning and doing an action is really what gets them the results that they need and want.

Jones: Yeah, that's so true. I mean, it's often hard too, right? Like patients feel overwhelmed. They go to their doctor's appointment, they go to the dietician and they're like, okay, here's some recommendations. But they feel overwhelmed by the idea of, let's say, cutting back on UPFs. So what language would you say helps you promote and other clinicians promote heart healthy changes without triggering guilt or perfectionism?

Derocha: Oh, geez, this is deep and it cuts, right? So instead of saying things like you cannot or you have to cut this out or this is bad or unhealthy or things that feel absolute or put people into that shame and guilt cycle in their mind. Because shame and guilt increases stress hormones, which then usually worsens cardiometabolic health. So what we want to do is recommend language and using things that allow the patient to feel empowered in the process. So things like, let's look for opportunities to balance. Or what are foods that help your heart feel supported? Or what are foods that you can add in that maybe you're not getting enough of that you know that could nourish you? And talking about progress over perfection. So, you know, trying to make sure that in the process, no one is feeling guilty or bad or shamed. Because really, if you're working with a dietician and you're having those feelings, actually taking then new behaviors and trying to make change happen isn't going to, because now there's no trust built, there's no rapport, you feel judged as a patient. So we want to be there for them in a realm of education, but also support and accountability and guidance.

Jones: Yeah, yeah, that's so true. And I think too, and I'm sure you've had this happen to yourself, like when I was a practicing, private practice dietician, I would have clients that would come in that would be referred from a doctor. And the doctor would be like, okay, well, you have inflammation on your, I see it on your labs. You can't have any dairy anymore. Like just cut out the dairy. Like they would come and be like, the doctor told me I can't have any bread, carbs, like any type of carbs, no dairy, no, you know, and they would be really upset. They're like, what am I supposed to eat?

Derocha: Right. Yeah. Yeah, totally. They're like. You can never have white foods again. And the person you're talking to is like, I eat a sandwich for lunch every day with bread. You know what I mean? They're like, what am I going to do? And then they think, then they feel guilty and bad because they got yelled at, quote unquote, by the doctor and that they were doing all these bad things to their body. And so like, yeah, taking them out of that guilt mindset and like trying to effectively help with change in a positive way that doesn't feel like that.

Jones: Yeah. So we don't want them to feel like that. Like that's, that's kind of horrible that they come in and you're like, and then you have to, it takes us as dieticians time to kind of change that. Like that's not an overnight process because then saying they go back to the doctor in the doctor's setting, oh, or how are you doing? Oh, you haven't lost enough weight here or like, or whatever the issue is. So talking about that and in that vein, what is one small sustainable swap, or let's say - it's all about mindset - a mindset shift that you would recommend to help patients eat for heart health without feeling deprived?

Derocha: Yeah. So I think working with them on what they feel like can be like the small hanging fruit, like that goal that feels easier. Maybe it's swapping the base of the meal and not the whole meal, right? Or maybe it's upgraded convenience food. So you're having frozen veggies because it's winter and you don't have any fresh, but or using the bag salad, right? There are definitely things that can upgrade convenience foods that are like the minimally processed foods that still link with that better diet quality. I love this one. I always say, let's crowd in some good things that we want to add in instead of cut out. So crowd in, not cut out. So like adding more fiber or adding heart healthy fat or adding more color or adding more protein, whatever it might be that we're working on, you know, and then in that process, usually what happens when you add more fiber or heart healthy fat or protein or whatever it might be, you usually then start to cut out extra sugar, extra sodium. And it's kind of like this without a plan, but like that intentional restriction, but it kind of happens naturally. And again, that mindset shift of like, maybe it's not I can never have white foods ever again. But maybe it's like, you know what? I do notice I don't have very many vegetables on a daily basis. What if I could add one or two a day? And allowing them to feel, again, empowered and like feeling like it's an actionable goal that they can be accountable to and that they can actually accomplish.

Jones: Yes. That is great. I love that word. And feel free for all dieticians listening to borrow the word crowd in. And I think, Grace, I'm going to test that with my seven-year-old who does not like vegetables. I'm going to just try to crowd more of them in. So I'll keep you posted on how that goes.

Derocha: Yeah, let me know.

Jones: How do you approach these conversations differently? Let's talk about diverse populations because you deal with diverse populations, whether that be youth, communities of color, or those with just limited food access, which is a real problem right now.

Derocha: Gosh, this is such a great question and like near and dear to me. So I'm American, but I'm Filipino-American. I come from a Filipino heritage. So I think this conversation is important because this is where like evidence can meet equity, right? When we're talking about youth, research shows that being overly restrictive with some of the things we say and our messaging can increase disordered eating in the long run. So trying to use words like energy and focus, or if they play sports, like sports performance, mood, simple language like fuel foods, instead of saying sometimes foods, I love fuel foods. I think it reminds them that, again, it gives them power to either play their sports, to be focused in school, and then family-based changes rather than singling out the child, right? If it's one child that you're trying to impact, making the whole family. Like with your seven-year-old, we're all going to have more vegetables and try different colors. You know what I mean? So making sure that the child or the young person doesn't feel like, oh, I'm the one who's quote-unquote bad for not eating my veggies.

And then when it comes to communities, communities of color and tradition and culture, it's really important to honor that, honor their cultural food traditions instead of making them feel like they can't have that. And a lot of them, if you actually look at different cultures around the world, many of them are really inherently heart healthy, right? Avoid some of that framing that UPFs, like using UPFs as part of their culture of foods is, again, bad. And finding ways to really develop and play with how can we use the convenience of the UPFs when we need them, keep our traditional staples, right? Whether that be certain kinds of beans or greens or vegetables and allow that to align with traditions and also what's available, right? I think that's kind of the hard part in some areas is some of the structural barriers that we have, whether it be like food deserts or access or quality.

And just thinking of social determinants of health and what that might look like. So really emphasizing affordable, accessible options. And even like talking to them about what store do you go to? What do they have there? What do you see from what you have discussed with them with like changes that they do want to make? And acknowledging that shelf stable does not automatically mean unhealthy.

Jones: Yes.

Derocha: I think that's such a key. Before I did like, I think it was for a new segment, but like the dollar store and how we can make dollar store foods like a little bit more nutritious. And we did it. Everything I got was from there. It was interesting for me to do as a project, but also then to like, you know, in my own privilege of my life, like dialing into like what do my patients deal with day to day and how can I help them?

Jones: Yeah, that's such a great one. I would love the link to that and we can share it as well on the show notes. I think that's like a really great example because a lot of times we have patients and clients that come to us and say, well, I don't, I don't have, I don't have any money. Like how can I afford this? Like I shop at like people that shop at like Walmart, the dollar store places like that. Like how could they do it? And they don't, it's like, overwhelming so I think that's really helpful to kind of show you had a news segment this is what I did. That’s a great example.

Derocha: And I think just like across all populations like the most evidence-based approach when we're looking at different culture is respect and flexibility, right? I always say if you if you're not flexible, if you don't bend, you break, and having cultural humility, especially if you're working with a different culture because heart health can improve mostly when people feel seen and not judged. People will not make changes or really be able to tap into what changes need to be made if they're feeling judged or guilt or shamed in the process of trying to do better.

Jones: Yeah. And you're making them feel seen and heard and acknowledged. And I think like here's how and helping them, you're a partner with them versus someone that's just talking at them, which I think is the best thing that dieticians can do. And the other thing that when you were talking came up for me and is that the whole dietary guidelines and how MyPlate is just erased pretty much. Like they still have the resource. You can't really access it. But all that money, the millions of dollars that was spent on the MyPlate resources, the cultural ones for each, like I can't find it anymore. So unless you have it downloaded somewhere, I don't know how. So has that impacted you in your practice already?

Derocha: It hasn't yet because I do try to tap into like where that patient is at presently. But as far as like the erasure of the MyPlates and the cultural MyPlates, that hasn't. But definitely having the, I keep calling it the pizza slice, but the upside down food guide pyramid, which is it's the irony I think here too is that with that, the food guide pyramid has been gone for like I don't 15-ish years and I think people just kind of forgot about MyPlate. And then now they're like the food guide pyramid is back I’m like, is it? Well, when I saw the pyramid too, it's upside down. Three, there's a lot of things that I think could be fine-tuned with the imagery. Reading through it, it's a little bit different, but people are very visual. So when you see that, I don't want it to be more confusing for people. And I have seen working with people already, they are a little confused. Like we talked about in our first podcast episode today, there's a lot of information out there. And we want, again, people to be able to walk away feeling empowered with what they're learning and what they're seeing. And sometimes that isn't always the case.

Jones: Yes. Yeah. Especially with new things like that and changes happen in that. That goes back to our conversation about what's new in the media. Like, which thing do I follow? And again, it goes back to thankful for registered dietitians to help clarify and move people along with the right information. So, Grace. Thank you so much for sharing your insight, energy, and heart with us today. And thanks to our listeners for joining this episode of Nutrition411, the podcast.