Does this seem like a strange title? Well if you or a loved one has experienced a heart attack once back home the undertaking of grocery shopping can go from a one hour task to a two or three-hour task. This is common complaint heard in Cardiac Rehabilitation. Why? The task of determining which foods are to be avoided and what to replace them with takes a great deal of time. Reading the labels for fat and sodium content, determining vitamin K sources, or if the food contains grapefruit or others that could interact with medicines takes time.
Shop the perimeter
Discharge instructions include following a heart healthy diet. For most that means eliminating much of the processed and pre-packaged foods from the diet, as they are too high in saturated or trans fats, or too high in sodium. The best way to speed this process up is to try to shop the perimeter of the grocery store. Get your fresh fruits and veggies, stop by the butcher and select fresh-cut lean meats, get your low-fat dairy products,and purchase your baked goods that are whole grain, then be done. Eliminate the inner isles of the store (well other than the cleaning isle). The boxed foods are often high in saturated or trans fats because they replace butter. Butter goes rancid quickly and thus the products would have a short shelf life, so they substitute trans and saturated fats so the product can remain on the shelf for a year or more, although eating it reduces your shelf life
Vitamin K is an issue if you are discharged on the blood thinner Coumadin. While it is not necessary to eliminate vitamin K from the diet, it is important to get approximately the same dosage daily, to help avoid large swings in your INR rates. Try to eat the same portions of vitamin K each day. Many patients report they cannot eat foods with vitamin K, in fact we want them too, but we want them to understand the content and keep it similar from day-to-day. To learn more about Vitamin K and Coumadin click here
Grapefruit, blood oranges are a couple of items that effect the potency of medications and should be avoided at all cost. Statin – cholesterol lowering medications in particular are effected. Know what items contain grapefruit juice and avoid these. For more information about heart medication that interact with grapefruit click here
Sodium is in just about everything in the middle shelves. It is the preservative which again allows for the long shelf life. Avoid foods with 800 milligrams or more per serving. Remember the 1500 milligram daily goal shouldn’t be exceeded. Again if buying fresh foods and not processed is the easiest way to adhere to the guidelines. Learn more about sodium
It gets easier, and takes less time after a while. You learn what brands are best, and where to find them. You try new foods and decide what you like. Some hospitals have grocery store tours with dietitians to help you learn what is marketing and what is healthy.
Common marketing issues where you think you are purchasing healthy foods but are not
Ground turkey. Everyone comes to rehabilitation and tells me they had ground turkey burgers. I challenge them to go back and look at the percentage of fat in the ground turkey. Most of it contains 80% protein 20% fat, that is the same as most hamburger contains. It would be better to eat ground sirloin of 90% protein and 10% fat. Better yet, learn to make bean burgers – super easy to make and much better and less expensive as the pre- packaged bean burgers. Another one that I chuckle at is the milk choices. Patients come in proud they are no longer drinking whole milk, and report they are at 2%. Well I educate them to consider a glass of whole milk is about equal to three restaurant size pats of butter, 2% would equal 2 pats of butter, 1% equals 1, skim equals no saturated fat. Green labels also don’t mean. Peanut butter – read the labels it may say no trans fats, but contains partially hydrogenated oils…hmmmm….not a good choice. Select the peanut butter that is natural the kind that you must stir the oil into the peanut butter. Many foods are labeled trans fat-free, as if it were a recent change to make it healthier, when in fact they never contained trans fats.
A funny story one time I had a very young woman with serious heart disease proudly announce she made a good selection when she picked chicken gravy over beef….missing the point that gravy is fat and salt completely.
The recent study on the Mediterranean diet decreasing the risk of heart attack is all over the news and the emphasis seems to be on eating healthy fats and nuts. To me that is important but don’t overlook the vegetables. The Mediterranean diet is rich in vegetables, legumes, nuts, whole grains which provide good sources of fiber.
While working in cardiac rehabilitation I regularly reviewed patients diets. One very consistent issue was lack of eating enough dietary fiber. Many do not get adequate intake of vegetables, legumes and seeds. It wasn’t uncommon for a significant other to shake their head and report their loved one never eats vegetables, or if they do it is only one or two types, such as corn, and carrots. When discussing intakes of legumes, you would see many look at you with that what is she talking about face. I don’t want heart patients to think of the Mediterranean diet as frying everything in olive oil being ok and skip the biggest part of the diet. Make sure you follow the balance of the Mediterranean Food Pyramid.
Note the largest portion of the pyramid is fruits, vegetables,beans, legumes, seeds, nuts.
How do you get people to eat veggies?
I wish I had a dollar for every time I have heard someone say they don’t like to eat vegetables. Funny how often I would hear this while working in Cardiac Rehabilitation. Coincidence? I don’t think so. A healthy diet includes 5 servings a day of fruit and veggies, many people are ok with the fruit but entirely skip the veggies. Women are instructed to get 4 1/2 cups a day of vegetables for heart health. Children are picky and it can take years to get them to eat a variety of vegetables. Don’t give up!!! Keep trying new vegetables, new textures, new recipes.
Beans, dried beans, chick peas, soy beans, lentils, kidney beans.
All of these foods are chocked full of fiber and protein, and are loaded with nutrition including potassium, iron, magnesium, B vitamins. So how does one incorporate eating more legumes in their diet?
- Add chickpeas, black beans or kidney beans to salads.
- Mix lentils into your rice dishes.
- Throw a handful into soups.
- When making foods such as sloppy joes, or tacos make with half the amount of meat and add in a cup or two of pinto, black, white or navy beans.
- Hummus is a great way to incorporate legumes. Use as a dip for vegetables, put on a Wasa or Rye crisp cracker.
- Use beans as a base for casseroles.
- Soups are a great way to add beans and legumes.
If your beans are coming out of a can, rinse them first, this will reduce the sodium in them by almost half. Dried beans are very inexpensive, therefore try to get into a habit of one to two times per week soaking and cooking up a batch. A favorite snack may be roasted chickpeas. I like to season them up with olive oil, cumin and chili peppers, but also use a Tuscon blend seasoning, or garlic and onion powder/salt. Lentils sprout very easily. Try putting a in a jar, cover with water, rinse with new water daily and in three days you will have lentil sprouts to add to your salads. A side dish this week was roasted chickpeas, brussel sprouts and cauliflower. Roast each, but not until mushy, keep the crunch, then toss in a bowl with seasoning of choice and fresh parsley. Even the kids will eat this dish.
A common concern many heart patients first share is their diet concern following a cardiac event. Blood thinners are very commonly prescribed for heart conditions such as atrial fibrillation, or post valve replacements. Many are told to be careful about leafy green vegetables. What the heck does be careful mean? Many take it to mean they can’t eat green vegetables, but then question how they are to eat a healthy diet. This is a very common misconception. It is important to get vitamin K in the diet, and the goal if taking coumadin/warfarin is to get the approximate same intake each day. This is very difficult to do, thus INR levels are fluctuate greatly and this creates health issues if not closely monitored. Most doctors aim to keep INR around 2.5-3.5.
Important Drug and Food Information
From the National Institutes of Health Clinical Center
Drug-Nutrient Interaction Task Force
Important information to know when you are taking: Warfarin (Coumadin) and Vitamin K
The food you eat can affect how your medicine works. It is important to learn about
possible drug-nutrient interactions for any medicines you take.
Why was warfarin (Coumadin) prescribed for you?
Warfarin (Coumadin) is a medicine prescribed for people at increased risk of forming
blood clots. Sometimes medical conditions can make blood clot too easily and quickly.
This could cause serious health problems because clots can block the flow of blood to
the heart or brain. Warfarin (Coumadin) can prevent harmful blood clots from forming.
How does warfarin work?
Blood clots are formed through a series of chemical reactions in your body. Vitamin K is
essential for those reactions. Warfarin (Coumadin) works by decreasing the activity of
vitamin K; lengthening the time it takes for a clot to form.
International Normalized Ratio (INR) and Prothrombin Time (PT) are laboratory test
values obtained from measurements of the time it takes blood to clot. Individuals at
risk for developing blood clots take warfarin (Coumadin) to lengthen the usual time it
takes for a clot to form, resulting in a prolonged INR/PT. Doctors usually measure the
INR/PT every month in patients taking warfarin (Coumadin) to make sure it stays in the
What can help keep INR/PT in the desired range?
To help warfarin (Coumadin) work effectively, it is important to keep your vitamin K
intake as consistent as possible. Sudden increases in vitamin K intake may decrease
the effect of warfarin (Coumadin). On the other hand, greatly lowering your vitamin K
intake could increase the effect of warfarin (Coumadin).
To keep INR/PT stable and within the recommended range, it is important to:
• Take your medicine exactly as your doctor directed.
• Have your INR/PT checked regularly.
• Keep your vitamin K intake consistent from day to day.
How do I keep my vitamin K intake consistent?
• Keep your intake of foods rich in vitamin K about the same each day. For
example, you may plan to eat only ½ cup of these foods per day. If you like
these foods and eat them often, you can eat more, but be consistent.
- Eat no more than 1 serving of food that contains 200%-600% DV of vitamin K
- Eat no more than 3 servings of foods that contain 60-200% DV of vitamin K
- Eliminate alcohol if you can, or limit yourself to no more than 3 drinks a day
- Take no more than 800IU of vitamin E supplements
- Avoid cranberries and cranberry juice as they can raise INR and risk of bleeding
- Limit or avoid grapefruit and grapefruit juice
- Work with your doctor when taking CoQ10 as it can hamper the effectiveness of Warfarin
- Many natural supplements affect PT/INR levels, so it is best to avoid them unless your doctor advises otherwise. The following supplements definitely affect PT/INR levels: arnica, bilberry, butchers broom, cat’s claw, dong quai, feverfew, forskolin, garlic, ginger, gingko, horse chestnut, insositol hexaphosphate, licorice, melilot(sweet clover), pau d’arco, red clover, St. John’s wort, sweet woodruff, turmeric, willow bark, and wheat grass.
- To find foods low in vitamin K, see the article on low vitamin K foods, check the nutrition facts for a particular food, or use the nutrient ranking tool to find low vitamin K foods in a particular food group.
Learn your sodium intake,read food labels. Do the math. How much are you getting on a daily basis?
medwireNews: Restricting salt intake reverses vascular endothelial dysfunction in people with moderately increased blood pressure (BP), shows a randomized study published in the Journal of the American College of Cardiology. To read more on this go to link at the bottom of this page.
How Sodium Causes Fluid Retention
The job of the kidneys is to filter the excess sodium into the urine so that the body can get rid of it. Many with heart disease and diabetes kidneys cannot handle all the extra work. The kidneys become less efficient at filtering the blood stream. This causes excess sodium to enter the bloodstream. Sodium attracts water to it and effect known as being osmotic. Water follows the sodium and is drawn into the bloodstream. Excessive salt keeps the circulatory volume higher than it should be, creating and increased pressure in the blood stream and pressing on the blood vessel walls. The stress of the pressure on the walls creates thickening and narrowing of the vessel, leaving less space for the fluid in the blood vessels and raising resistance. The body then requires higher pressure to move blood to the organs. The heart has to pump against this high pressure system.
I equate it to trying to blow up one of those kids balloons that is turned into animal shapes. They are really tough to blow air into, your cheeks get really sore – this is the resistance of air, similar to the resistance pressure of blood in the arteries. If you stretch the balloon (relax the arteries) then there is less resistance in blowing up the balloon (filling the artery with blood). Twenty percent of the blood pumped from the heart goes first to the kidneys. High blood pressure within the kidneys cause damage to the heart and to the vascular system in the kidneys. Salt makes you thirsty so limit salty foods, especially if on a fluid restriction.
I once had a patient who lost 45 lbs simply from adhering to low sodium diet. He had a very weak heart with only 10% ejection fraction meaning very limited pumping ability. So a weak heart and sodium in the diet made him retain fluid more than most. He began to measure and count sodium with every meal for a few months and was shocked by how much sodium he consumed even though he thought he ate pretty healthy. By reading labels, doing the math every day and making changes such as eating out less, ordering special, reviewing his medication he lost the fluid and added years to his life, not to mention the improved quality of life with less shortness of breath and fatigue by easing the workload of the heart.
According to the American Heart Association, eating more than the recommended 1500 milligrams a day puts you at direct risk of high blood pressure. Yet in America we consume an average of 3400 milligrams a day; more than twice what we should. While people with hypertension, heart and kidney disease are always advised by doctors to eat less salt, the AHA wants all of us to do this, whether or not our blood pressure is currently in the normal range.