Question 1
What do you foresee being challenges in recommending heart
patients follow more of a traditional Korean diet filled with plants, rice, and
fermented foods? How could recommending a traditional Korean diet be valuable?
posted by Unknown @ 10:23 AM
14 comments
14 Comments:
One of the first challenges I see with recommending that patients follow a traditional Korean diet is that their current diet probably looks nothing similar to the one that is being recommended. If the heart patient's condition is related to lifestyle and diet factors, then they are likely eating a diet higher in saturated fats, perhaps sodium, and not exercising regularly. Therefore, to recommend that they go on a diet that is more plant-based and also consists of fermented foods, I don't forsee the patient being very successful in adhering to the diet. As we can see from the results of this study, there is much value in modeling your diet after a traditional Korean diet. I think the take home message for working with patients is to try and set goals of increasing fruit and vegetable intake. Maybe you could even consider setting a goal of eating a plant-based diet just one day a week (ie. Meatless Monday.)
The biggest challenge I foresee is limited food acceptance. The types of food are very different in appearance and flavor from what most Americans are familiar with. If we can’t even get people to eat the vegetables that are already widely available in the US, it doesn’t seem like jumping to kimchi is a realistic step forward. America very far entrenched in unhealthy habits and a cheap food model of high sugar and high fat. We have a deep hole to dig ourselves out of. It is going to be a marathon, not a sprint. Making steps toward recommending patients to follow a more Korean style diet will take a long time. Some health conscious people may be ready to hop on board instantly. It is really about finding a dietary solution that works for the client though. We must be conscious of the population we are working with. If we move to far too fast, it is like setting an unrealistic goal. It could easily end with discouragement or make healthy eating seem even more “impossible” to many Americans.
There is certainly value in understanding what dietary patterns are most healthful. It is another tool added to the toolbox which we can offer as an option for patients. Most ideas are good ideas, but the way you choose to introduce and implement them often determines success/failure or outcome value. For most of America, the introduction would need to go piece by piece, behavior by behavior, and not be strongly identified as a “Korean diet.” One subtle step at a time without the putting a label on it. Labeling it as such would likely drive most people away because they don’t know what a “Korean diet” consists of. The word “healthy” is already interpreted by many as “cardboard” “gross” and “tasteless.” I’ve even started trying to use that label less opting for “’smart’ choices” instead. Education would be a huge piece, but making recommendations for just the patterns themselves, like including more fermented foods, would make it seem less like this obscure, strange thing. The Blue Zones Project is a great approach to focusing on a collection of healthy behaviors under a neutral label if anyone is interested in looking at community wellness initiatives.
The first challenge that comes to my mind is like what Amanda and Gina mentioned: accepting a traditional Korean diet for its taste. It is difficult to ask patients to change up all their food choices and the way they cook their meals completely and have them adhere to the traditional Korean diet. The traditional Korean diet consists of fermented (sour) and spicy foods. Spicy foods is especially not well accepted by everyone. Additionally, patients will have to learn to cook traditional Korean dishes, which is much more difficult than one may imagine. Personally, I've tried cooking traditional Korean dishes without much success. And it would not be realistic to ask patients to eat at a Korean restaurant everyday. Therefore, there are already two big obstacles in asking patients to change their diets and palates completely, like it, adhere to it, and start cooking it.
Recommending a traditional Korean diet could be valuable to those who grew up with the Korean culture and are used to the type of cuisine. Otherwise, we can use the guidelines of the traditional Korean diet, which would be balanced in carbohydrates, plant based, low-sodium and including more fermented products which can be yogurt and kefir for the more American diet.
Like Gina, Amanda and Vivian all commented, I think the biggest challenge would be food/taste acceptance. Americans have a pretty stereotypically meat and potatoes kind of diet and recommending that dramatic of a diet change would more than likely set the client up for failure. Smaller, less dramatic changes would be more likely to be accepted by the client such as Meatless Mondays like Amanda mentioned or even one meatless meal each day and education of fatty versus lean meats.
Recommending a traditional Korean diet could be valuable because with less meat and more plants, rice, and fermented foods, there would be less saturated fat consumption which would be beneficial for a cardiac patient. However, if the client is not going to comply with the diet, there is no value. Therefore, this diet would be most valuable to either a client who is very willing to change their dietary habits, a client who is accustom to the traditional Korean diet or recommending to a client to follow the diet for only one meal each day would be most valuable.
I think everyone has made very good points so far! When creating the study, I think the researchers were also concerned about the participants not liking the taste of the traditional Korean food. When they were recruiting participants, they had them eat several Korean foods so only those who liked the foods would participate in the study. They also had a professional Korean chef prepare the Korean foods, so it was well prepared. I was surprised that only two out of the 31 participants dropped out of the study while on the Korean diet.
The challenges I for see are drastic differences between the patient's routine diet and a more traditional Korean diet, and the accessibility to the Korean food items. If the patient does not live in a diverse area the grocery shops might not carry the items recommended. I also agree with Amanda that the diet will be more adhered to if the change were gradual and modified to the specific patient.
As stated in some way or another from all of you above I think acceptance and adherence to a Korean diet would be a big challenge for many Americans. Korean foods are created using different spices and seasonings that most Americans are not familiar with. Therefore, at the beginning of integrating more Korean foods into a person's diet I can see that there might be some resistance and the foods might not be readily accepted right away. Overtime, like everything I think that these patients can accept the new diet, but whether or not the patient is willing to experience with the diet long enough to become accepting of it is another story. I think rather than suggesting a Korean diet to patients the doctors may try suggesting simply a more heavily plant- based diet. Using the word plant- based might be more familiar to people and they might be more willing to try that type of diet while still be cutting out a lot of saturated fat and processed foods.
I think that Steph made a great point that the diet is pointless if the patient is not comfortable and will not comply. Educating the patient on the value of the Korean diet such as the increased vegetable based dishes and fermented foods that can help cardiac patients is important because by explaining the benefits this diet will have for the patient it will add value to the diet. I think by showing the value of the Korean diet to the patient, the patient will be more willing to adhere to the diet.
I agree with my fellow DI journal club companions in that adherence might be a big issue when recommending the Korean diet to patients struggling with heart health. Like many have stated, I feel as though adherence issues could come in the form of limited food acceptance or limited food identification skills. I know that I for one wouldn't be able to differentiate between the staples of various Asian culture's cuisine...let alone determine the nutritional composition of the unfamiliar foods just by looking at them like we might be able to do if the food in question was of American origin.
I think some additional hurdles to overcome when recommending a Korean diet could be limited availability and the "Americanization" of once healthy Korean dishes. Clients might be able to find certain traditional Korean ingredients at specialty stores or in the cultural sections of regular supermarkets, but purchasing these items in a cost-efficient manor may be difficult for someone new to the cuisine. Once a client was able to identify healthful Korean dishes it would be important to train them on what makes the dishes healthy, chances are if they are eating at a restaurant the food might not be prepared traditionally (aka Americanized) and the health benefits may be lost during preparation.
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I definitely agree with all previously mentioned comments about patient acceptance and adherence to a Korean-style diet as being the most limiting factors. There would most likely be a lot of unfamiliarity and apprehension to trying the different food items and this would be difficult to overcome. I could see that individuals may be willing to try a few of the different food items such as incorporating more rice as a healthy option; but I certainly cannot see them wanting to entirely switch over, no matter what the health benefits.
Another challenge that I might add is that there may be limited accessibility to traditional Korean foods for some individuals. If they have never purchased things such as kimchi before they may not know where to find it in the store, if it is stocked there at all. Their particular grocery store that they shop at may not have a very wide variety of different ethnic foods so finding these foods at all might be a challenge.
I feel that Steph and Carly brought up excellent points about the added value to the Korean diet, if the patient were willing to comply. As dietitians, we certainly need to educate others about all of the potential benefits that incorporating more of a plant-based diet can entail. Providing them with all of the pertinent information and educating them as much as possible is important but in the end it will be left up to the individual to decide whether they choose to lead this dietary lifestyle or not.
I certainly agree with the step-based approach in advocating for a plant-based diet. I think this is certainly one of the ways that we can promote the benefits of the Korean diet without turning it into a rigorous, fad diet. I do agree that challenges related to accessibility of food items, knowledge of preparation methods, and acceptance of both taste and presentation. The Korean diet would be an intense cultural shock to the majority of the population and would likely seem intimidating, abstract, and unknown. I think one of the greatest challenges would be encouraging clients to even try some of these foreign foods.
The Korean diet overall may help to lower cholesterol and help with reducing the risk of cardiovascular disease, however I believe with knowledge of the DGA we could likely make more appealing recommendations to clients that would yield similar results. I do think that having a Korean Diet cooking demo would be very interesting, however!!
I loved the suggestion for Meatless Monday that Amanda brought up and also agreed with Sophie that there may be limited cultural grocers in the area that offered ingredients consistent with the Korean diet. This Korean diet does pose benefits, but there may be more challenges/effort in locating and preparing these Korean dishes than are worth it for most people to work towards and achieve these benefits.
I thought Gina made such an appropriate comment in saying “Most ideas are good ideas, but the way you choose to introduce and implement them often determines success/failure or outcome value.” If we really want American to begin to adapt more of a Korean type diet, there would need to be a great deal of strategy involved. Vivian brings up a great point about many people not knowing how to cook Korean foods. Now that I think about it, I don’t know where I would even begin to look for appropriate recipes. Steph also highlights a valuable point in saying that some of the benefit of the diet revolves around its content of less meat and more plants and fermented foods. Would a person necessarily have to eat Korean foods to reap the benefits? Or could they just transition their diet to one that is more plant-based?
Cost and availability are indeed barriers as well as mentioned by Des Sophie and others. Something else we need to think about in addition to availability is the current food environment in general. We have had a trend toward healthy and clean eating; however, many Americans are still invested in the highly processed RTE foods. My preceptor and I were discussing some of the choices people make at the food bank. People will often select a single box of hamburger helper over a 2lb bag of rice. The rice would certainly be a better investment for the volume of food it produces, but people often don’t know what to do with it. It comes down to familiarity. Prepackaged foods have become such a part of American society that we are losing the ability to cook with real food. If a person can't cook a basic food like rice, how can we expect them to cook something with the complexity of Korean dishes?
Des brings up a great point about Americanization of traditional Korean dishes if cardiac patients were to follow this type of diet for a long term period. The traditional Korean diet would not be valuable if cardiac patients are eating "Americanized" Korean food at restaurants since many restaurant dishes are higher in calories, fats and sodium than what is likely to be "home-cooked". I agree with Steph and Carly to emphasize a plant-based diet among these cardiac patients instead of asking them to change their whole cuisine. And like Steph mentioned also about less dramatic changes, one "traditional Korean" meal per day may still be beneficial to the patient if they are accepting of Korean food.
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