For a healthy heart eat a rainbow every day!

Fiber, vitamins, minerals, electrolytes, high nutrients, low-calorie, no artificial flavors or colors, natural sugars are part of a heart healthy diet and all easily available in a diet rich in colorful vegetables. If it is hard to get your servings of vegetables per day consider smoothies, chopping into small pieces adding small amounts to every meal you make. Ask yourself are you getting 4 1/2 cups a day of vegetables? Most will say no. Try new vegetables, search the internet for recipes.

Grief triggered from news

Most of us in the US tonight are feeling an overwhelming sensation of grief following the news of the school shooting in Connecticut.

I could not help but to feel grief upon hearing the horrible news today coming out of Connecticut. My heart aches for these families. The raw pain they must be feeling, the heaviness in their hearts, the overwhelming anger towards those who did the crimes, the loss,  and the timing of the holidays makes it even worse. I feel compelled to reminded my readers how grief and heart disease are connected. The hospitals need to be prepared. With grief comes increased heart pain. Emotional distress is a trigger for angina as well as heart attacks.

How will you grieve?

Is it possible to grieve and not have heart ache?  Should I use nitro if my heart aches?

Some suggestions if you are overwhelmed by grief I tell myself include:

  • Count your Blessings
  • Hug those you can
  • Express your love others
  • Light a candle
  • Meditate
  • Pray
  • Write about your emotion
  • Don’t allow your emotions over the situation compromise your health
  • Tune out…turn the news off…take a walk…..breathe the fresh air, enjoy the lights, listen to music

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Emotional distress is a common trigger of angina.

With loss many experience increased heart symptoms of chest pressure, chest discomfort, pain, heaviness, fatigue and energy loss.

 Heartache the emotional pain recognition site in the brain is located near the region that senses and interprets sensations. When we suffer emotionally, the brain responds by releasing neurochemicals we experience in our body as an intense aching in our upper abdomen and lower chest. Grief-related stress can increase blood pressure and heart rate, raise levels of the stress hormone cortisol, constrict blood vessels, and disrupt cholesterol-filled plaques that line arteries. Any one of these changes raises the risk of heart attack.

Grief also makes blood “stickier” and therefore more likely to clot. Acute stress tends to increase levels of the hormones known as catecholamines which causes platelets to stick together. If a plaque bursts, the resulting clot is more likely to cut off blood to the heart.

American Heart Association’s Circulation reports scientists have found evidence that grief might actually break your heart. Studies show that people grieving the death of a close loved one could have a heart attack risk that is higher than normal.

The calculated the risk of a heart attack as 21 times higher in the first day after the loss of a loved one.  Risk declines steadily with each day after a loved one’s passing, but it remains eight times higher one week after the death and four times higher one month afterward, according to the American Heart Association journal Circulation

The link between grief and bereavement was strongest among people who had preexisting risk factors for heart disease and heart attacks, such as high blood pressure or unhealthy cholesterol levels. People mourning the loss of a loved one might further increase their heart-attack risk by sleeping poorly, eating less,  and skipping their medications. Other factors may include binge eating of comfort foods, increased alcohol or tobacco in an effort to comfort oneself from the intense loss.

.Grief

Broken Heart Syndrome; 

Takotsubo Cardiomyopathy is a type of heart failure caused by grief or stress where the left ventricle balloons out taking on an unusual shape like a Japanese fishing pot. The symptoms are the same as a heart attack but an electrocardiogram does not always show the problem. You experience chest pain, shortness of breath, arm pain, and sweating as in a classic heart attack but its different. Postmenopausal women who are grieving are the main patients who experience this type of heart failure. It is caused when experiencing grief, stress, emotional trauma, or physical stress. The best test to confirm this heart problem is a contrast echocardiogram or an angiograph which takes pictures of your heart. The recovery for this type of heart failure usually takes less time than a classic heart attack.

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So that nitro bit….yep if you are feeling chest pain, sitting and  relaxing  controlling your emotional health by avoiding anger response or  intensive grief, …… and your doctor has  prescribed nitro  for you this would be an indication to  use it. Of course if it doesn’t get better and  your symptoms are worsening call 911.  Hospitals are you prepared?

Do you eat vegetable and legumes?

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.

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? Start slowly, to avoid gas issues, unless your house is full of teenagers who think it is hilarious to see who can produce the loudest and stinkiest farts.

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. How Fiber Works Infographic

Nuts, seeds, and legumes 3-4 servings per week for 1600 calorie diet 4-5 servings per week for 2000 calorie diet
  • 1/3 cup or 1 and 1/2 oz nuts
  • 2 Tbsp peanut butter
  • 2 Tbsp or 1/2 oz seeds
  • 1/2 cup dry beans or peas



 

 

 

 

 

There is very good evidence that eating legumes lowers the risk for heart disease.

Research by a group looking at almost 10,000 men published in November 2001 showed that even one serving of lentils or chick peas a week lowers the risk of heart disease. And the best part is that the more you eat, the lower the risk. Eating legumes 4 times or more per week reduces the risk of heart disease by as much as 22%.

The risk of developing diabetes or heart disease is lower when legumes are regularly eaten instead of protein foods that are high in fat, such as meats and cheeses and other whole-milk dairy produces, and refined carbohydrates that are low in fiber, such as baked goods made with sugar and white flour.

Some people avoid beans due to the intestinal gas or bloating they may produce. But if you gradually increase the amount of beans you eat over several weeks, you can overcome that concern. Soak beans for 8 to 12 hours, replacing the water every few hours, and this also helps. Slow cook them, to help reduce the gas-forming compounds. Adding a little baking soda will also help, or you can buy enzyme products at the drug store that break down the gas-forming parts of the bean. Note: Since legumes have high amounts of fiber, it is very important to drink plenty of fluids, especially water, to avoid constipation as you increase them in your diet.

 

legumes

Oh yeah I mentioned vegetable earlier didn’t I?

Well as I tell my kids I don’t care if they aren’t your favorite food, they are a very important part of a healthy diet.  Learn to like them. Branch out, try different vegetables. Fresh is best, followed by frozen, and lastly canned. We joined a CSA this year. This is a community sustained agriculture program where you own a share of the farm. You get a box full of vegetable every week. So when meal planning we start with what fresh vegetables are on hand? What needs to be used first and plan the meals around the vegetables. Now how many heart patients do this? Initially not many, but after suffering a heart problem many are open to trying it. Get on the web and look up recipes that include veggies you have on hand or are willing to use. Break out of the old cooking methods, try roasting, grilling, satisfying, steaming, fresh.  Again they might not be your favorite part of the meal, but such an important part. About half your plate should be veggies. When you are in need of a snack, make sure it includes vegetables.  Neufchatel cheese – mixed with your favorite spices, or veggies such as dried tomatoes and dried peppers, chives and garlic,  together with fresh-cut veggies are a good snack to always have on hand. Take one day to prepare a boat load of fresh veggies every week so they are on hand, and an easy go to snack item.

Vegetables

Eat a variety of colors and types
3-4 servings per day for 1600 calorie diet 4-5 servings per day for 2000 calorie diet
  • 1 cup raw leafy vegetables (about the size of a small fist)
  • 1/2 cup cut-up raw or cooked vegetables
  • 1/2 cup vegetable juice

Sodium and fluid retention

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. So if you are cooking or know the cook for pass this info on!

 

When holiday meal are  upon us  remind heart patients of being acutely aware of the sodium content in foods. The holiday meal contributes to many heart patients having increased symptoms of  high blood pressure, congestive heart failure, fluid retention, shortness of breath. The holiday meals  can be the culprit. Traditional foods like the turkey are often injected with  approximately 8% solution sodium to enhance moistness and flavor. If you read the ingredients you will often note: turkey broth, salt, sodium phosphates, sugar & flavoring. Then many a cook will soak the already salt injected turkey in a brine solution or salt it well, prior to cooking. The turkey alone gets many into trouble, then you add pre-packaged stuffing, broth, or use canned mushroom soups in casseroles. Did I mention the relish tray with pickled foods?

                                                        

A little extra salt in or on your holiday foods makes a difference.

1 teaspoon salt = 2131 mg sodium                                          1/2 teaspoon salt = 1066 mg sodium

1/4 teaspoon salt = 533 mg sodium                                        1/8 teaspoon salt = 266 mg sodium

75 mg—the average sodium content of 3 ounces fresh, unsalted beef, turkey, chicken, pork

240 mg sodium in 3 ounces self-basting frozen turkey, cooked (that’s without the gravy!)

580 mg sodium in 3 ounces frozen fully cooked baked turkey

820 mg sodium in 3 ounces honey baked ham

Bread is a major sodium contributor if you eat more than a couple of pieces a day unless you buy special low sodium bread. A slice (1 ounce) of loaf bread has 150 to 200 mg sodium—not including salted butter or other spreads or toppings. Consider using a bread maker to make a low sodium recipe.

Skip the gravy! But if you must go for low or reduced sodium gravy instead of regular salted gravy which has more than 300 mg sodium for 1/4 cup.                                                                                                                                                              

Measurements and labels of sodium

  •  1/4 teaspoon salt= 600 mg sodium
  • 1/2 teaspoon salt= 1,200 mg sodium
  • 3/4 teaspoon salt=1,800 mg sodium
  • 1 teaspoon salt= 2,300 mg sodium
  • 1 teaspoon baking soda =1,000 mg sodium
  • Sodium-free: Less than 5 milligrams of sodium per serving
  • Very low-sodium: 35 milligrams or less per serving
  • Low-sodium: Less than 140 milligrams per serving
  • Reduced sodium: Sodium level reduced by 25%
  • Unsalted, no salt added, or without added salt: Made without the salt that’s normally used, but still contains the sodium that’s a natural part of the food itself.

Names for salt

  • sodium alginate
  • sodium ascorbate
  • sodium bicarbonate (baking soda)
  • sodium benzoate
  • sodium caseinate
  • sodium chloride
  • sodium citrate
  • sodium hydroxide
  • sodium saccharin
  • sodium stearoyl lactylate
  • sodium sulfite
  • disodium phosphate
  • monosodium glutamate (MSG)
  • trisodium phosphate
  • Na

Some drugs contain high amounts of sodium.

Need an antacid after that holiday meal?  Watch out there is excess sodium there too. Carefully read the labels on all over-the-counter drugs. Look at the ingredient list and warning statement to see if the product has sodium. A statement of sodium content must be on labels of antacids that have 5 mg or more per dosage unit (tablet, teaspoon, etc.). Some companies are now producing low-sodium over-the-counter products. If in doubt, ask your healthcare practitioner or pharmacist if the drug is OK for you.

 

Fitness as we age

It is important to work on physical fitness life long.

Physical fitness benefits include reduction of heart disease, reduction in Alzheimer’s and most importantly independence.  A recent study showed Finnish men who lost more than 15% of their cardiorespiratory fitness over a 10-year period faced a near doubling of their risk of acute MI over the subsequent decade and more than twice the risk of dying of any cause, a new study shows. But as we age fitness programs change. It isn’t realistic to ask the very elderly to jog, participate in spinning classes, hit the elliptical or rowing machine like those who are younger. The issues with mobility and frailty prevent such activities for most. So what does one do for fitness as they age?

Walking, stationary biking, water aerobics, swimming laps with a kick board, recumbent bike or  recumbent steppers are some of my favorite means of obtaining aerobic exercise. Also programs such as Sit and Be Fit. http://www.sitandbefit.org/   Any is exercise is better than no exercise. If exercise is done in a group or a class you also get the additional benefits of socialization. As we age socialization is vital. The more socially isolated a person becomes the worse the predictors for health. I found over the years many adhered to light continuous aerobic exercise because of the socialization of the classes more than the physical benefits of the exercise. New interns would come aboard and roll their eyes when they noted the workloads of many of the elderly, then I would point out the ages of many of my clients being in upper 80′s to mid 90′s and regularly attending classes 2-3 times per week, aerobically exercising, resistance training, stretching and socializing.

Resistance training is very important as we age as well as I am frequently promoting the following:

Your Strength is your Independence

This is what allows you to live in your own home, to care for yourself, to get up off the floor if you fall, to carry in the groceries.  It is your ability to cope with emergencies, to interact with the grandkids by walking up the bleachers, or across the soccer field, to lift up the two-year old, to get to their musicals across a long parking lot, to walk the hills at the nature center etc.

 

Here are a few simple strengthening exercise that most can perform. Wall squat

Wall Squats

With feet 8-12 inches apart and approximately 6 inches from the wall, slide down the wall a few inches. Hold this position as long as able. Push back up to standing. Repeat as many times as possible. Don’t go down to far, and if you fear not being able to stand all the way back up, keep a chair next to you for assistance. Breath out as you push back  up.

calf raises

Toe Raises

This exercise is surprisingly hard for many of the elderly to perform. Go up on tip toes and back down as many times as possible. To make harder try on a stair step or try doing on only one leg.

Wall push ups

Just like the old-fashioned push up but do against a wall. Breath out as you are pushing yourself back from the wall. Exhale on Exertion! I say this because many hold their breath which is hard on the heart and blood pressure.

Lateral leg exercises

These are really important for maintaining a good gait when we walk as we get older. Lying on side – do in bed – as easier than getting up from the floor. Lift leg out and back down. Do as many as possible.

Be a mentor, assist to make it happen

As most blog readers tend to be younger, pass this advice on to your elders, work out with them, purchase and arrange for transportation to fitness classes, make a big deal out of wanting them to stay fit and healthy to participate in life with you. We all need encouragement at times. Don’t assume being old means sitting in the recliner all day. Keep those in your live vital through physical activity. And have a great day!