Weight Loss
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Do you make an effort to include plant sterols in your diet?
The Ultimate Way to Fitness
Grocery shopping after a heart attack
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.
Sodium: What gives Caregivers and Cardiac Rehab Staff Nightmares
Working cardiac rehabilitation, one wants to take time off around Saint Patrick’s day and Easter. Often patients come in with weight up 10 lbs in one to three days, short of breath, swollen, and having elevated blood pressure. When asked, they report celebrating Saint Patrick’s day with sauerkraut and sausage, corned beef and cabbage, with lots of bread on the side, then celebrated Easter early with a ham dinner with gravy.
Caregivers take note, well-intentioned friends and family may have prepared meal or stocked freezers full of sodium laden foods thinking they are helping out during a medical crisis. Be alert to sodium and it’s effect on heart health. Programs such as Meals on wheels also has a tendency to have very salty meals.
If you find weight up, swollen feet/ankles/belly/face, shortness of breath and elevated blood pressure consider the dietary sources of sodium.
Sodium causes fluid retention, weight goes up, and is often treated with increased diuretics (Lasix, Aldactone, Demedex, Bumex, Zaroxolyn etc.). The body can become resistant to diuretics however, so adding more and more diuretics can be dangerous. These throw off the electrolytes and disrupt the sodium potassium balance of the body, which can set in motion additional heart problems including arrhythmia’s - irregular heart beats that could be deadly. Other side effects of diuretics include:
- increased blood glucose levels
- increased calcium
- increased cholesterol
- potassium loss
- increased uric acid, which might trigger a gout attack in certain people
Bought raw or in a can, corned beef brisket is very salty. One 3 ounce serving of cured corned beef has 964 mg of sodium, 40 percent of your daily value of sodium. In addition to sodium, corned beef is generally made from the fattier brisket areas, so the fat and cholesterol levels tend to be on the high side when compared to some of the more commonly available beef cuts. 1 cup of Cooked Sauerkraut has about 900 mg of sodium. Ham isn’t better - 4 oz. of ham can have between 1000 and 3000 milligrams of sodium.
Sodium, Salt, Na, MSG, natural flavors, natural spices, Sodium Nitrate,
- Monosodium glutamite,
- Sea salt,
- Disodium phosphate,
- Baking soda,
- Sodium citrate, sodium bicarbonate, sodium algonate, are all names of sodium.
If your diet is going be high in sodium, eat more potassium-rich foods. Potassium helps to lessen the dangerous effects of sodium. Foods high in potassium include bananas, potatoes, squash, spinach, raisins, cantaloupe, beans and lentils.
Rinsing foods such as sauerkraut, or canned beans or veggies in a colander can remove up to 40%. Read labels and aim for foods with 300 milligrams or less of sodium per serving.
To learn more about salt and heart health click here
Mediterranean Diet: Follow the Pyramid
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.
