Meet Lauren Mehta, MS, RD, CDN, registered dietitian at NYU Langone Health RUSK Cardiopulmonary Rehabilitation in New York. A Pennsylvania native, who started her career 12 years ago at NYU teaching hospital as an inpatient dietitian. Due to unforeseen circumstances by hurricane Sandy, she transitioned to outpatient care temporarily and haven’t looked back since. As she stated, ‘I found my calling’, and fits well with her chatty, laid back personality.
I had the chance to chat with Lauren and talked about how she helps her patients combat heart disease using a plant-based approach. She provides us meaningful practical insight into the behavioral and social challenge one face with this population. Most of her patients are between the age of 40-70 years old and have histories of heart disease, stents, heart transplants, and other comorbidities.
Here are some takeaways to our interview.
One of the preventative measures often recommended to people as it relates to heart health is to eat a plant-forward (plant-based) diet, how does that play into the work that you do with your patients?
It is very difficult to get people to eat more plants if they have never had plants. If they haven’t incorporated into their life, it’s hard for them to start eating or cook new food items, like vegetables, especially the population I work with.
I do not use the word vegetarian, vegan. I simply tell people to get more plants, however they can. It’s baby steps. With a good dietary recall, I am able to understand what’s going on culturally, where do they live, what type of food they like and dislike, what type of stores are around them. Based on how they are living, I make recommendations around that and at the core, the message always go back to heart health.
For example, if there’s no vegetable in their intake, try to get 1 or 2 vegetable in a week. I set the bar low in the hopes they can do more – and it usually works. As opposed to saying to them, you should have several days of this, because it doesn’t work as well in my experience. With the baby steps approach, people want to prove to me and their family that they can do it and show they are trying to make a change.
What has proven to be the most successful nutrition advice or dietary recommendations for your population?
I have two methods, but they are different because the issue and the outcomes are different. For the patients that have somewhat of a normal eating pattern (3 meals a day), the healthy plate model (½ vegetable, ¼ protein, ¼ grain) is my go-to. The key is to make the vegetable the star and the protein and the grain the side dishes. This works well with people because of the visual and most of the time I get ‘oh my plate doesn’t look like that’. Heart disease, diabetes, hypertension, cholesterol can all be addressed with a diet high fiber. It helps with weight loss, and satiety, amongst many other things. For people that’s very important b/c they know it’s related with decrease risk of cardiac event.
The other method is to try to get people to eat more than one meal a day. Some of our patients come in eating one meal a day. So, I spend time helping them understand why it is important to eat more often and discuss glycemic control, etc. Sometimes you can’t tell them to go plant-based, you focus on how to get them to eat more and drink more water. Discuss how overall that will help with weight loss, high blood pressure. Young professionals don’t have time. They often tell me they are busy, or they are too tired to cook. The key for me is how do I meet them where they are and get them to incorporate time into developing a better eating pattern.
Let’s say you have a patient who’s being released home with a history of heart disease and high blood pressure, what would you recommend as their nutrition intervention? Feel free to take us through a case study that’s you’ve done in the past.
I try different methods depending on how the conversation is going during our initial hour meeting. Questions like, what’s motivating to them? As you talk to them, you get to know more information about their life and from there you can determine their goals and motivation. Some people are not motivating by health, but they are by appearance. I’ll say here’s how your diet can help you meet your weight loss goal but also will address other issues – focus on helping them see the bigger picture. Others want to get off medication and we discuss how your diet can help accomplish that specific goal.
Some people don’t’ want to change and it’s very difficult to get through them. Their attitude is I am old, it doesn’t matter. In a sense, they’ve giving into the disease. In those situations, focus on high level benefits of eating fruits and vegetables. Keep priding and talking to them to see what can work. A lot of times, I just tell them to drink more water and discuss the benefit to gut health, and heart. You can scare people by staying, you can get an UTI and be dehydrated, which can lend you in the hospital. It is a very small change but overtime, it affects other things. That usually work. Eventually, they learn can do better and hit their goals better with sample changes in their diet.
Other times, what helps is coming their regular visits and meeting other patients. Eventually, they start being open to the idea of seeing me. Sometimes timing is the best thing, just wait and the other clinicians will nudge them towards seeing me. At times, the session ends up more therapeutic because they are sad about their current condition, and there’s nothing I can do to impact their dietary choices. In those situations, I make referrals to mental health specialist.
What’s one piece of nutritional advice you would have for a patient whose is ‘high risk’ for heart disease?
Definitely eat more fruits and vegetables. The reason we have heart disease to me is not because we eat too much sugar and salt but because we don’t eat enough fiber. Add one fruit a day or add one vegetable a day. Helping people eat whole foods is important. Understand that snacks like almonds are more cost effective and provide a greater benefit.
What’s your favorite plant-based dish?
I love lentils – they are fast, cheap and don’t go bad easy. It is a basic staple. They are very filling, complex carbs. A lot of people don’t know what to do with lentils, but I enjoy them quite a bit.
What’s the takeaway message?
All in all, do what’s best for you. Don’t focus on what you need to eat more of but what you to eat less of.
Interviewer: Daphene Altema-Johnson, John Hopkins Center for a Livable Future (CLF)