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.

Vitamin K and Coumadin

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.

Click to access coumadin1.pdf

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
desired range.

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.

Source: http://ods.od.nih.gov/pubs/factsheets/coumadin1.pdf

Fat and Calories

Diabetes and Your Heart

Know your family history, does it include diabetes?

If so make sure you know your numbers. A blood sugar greater than 1oo when fasting  140 for someone two hours after eating is considered high. When you go to your health care professional for blood tests do you ask for a copy of the results, or do you simply get a call from the nurse saying it is normal? I recommend always getting a copy of your results. Over the years many are told there blood sugars are normal when in fact they are prediabetic. This should trigger either a conversation or a referral for education on how diet and exercise can help to avoid having full blown diabetes. Unfortunately this piece is often missing in many health care visits. Make sure you advocate for yourself. The infographic below is posted to help you advocate for yourself or your loved one.   Keep records of your lab reports track and trend them, are they improving or worsening. You know best how well you have adhered to a healthy diet, but the numbers give you concrete data.

Heart patients need to be more aware than most as several heart medication can pre-dispose one to diabetes.

Great fix the heart but then get diabetes! Yes, it is a real issue, but again through tracking, diet and exercise, medications hopefully we can prevent this from occurring.

There  is a strong link of heart disease  in people who  have high cholesterol and are diabetic.  Cardiovascular disease  is much more prevalent if their  Hemoglobin A1c is chronically elevated. This significant contribution by elevated HbA1c to increased CVD is independent of statin therapy (cholesterol lowering medications), and thus requires appropriate HbA1c management in addition to lipids reduction. It is vitally important that any individual with known heart disease and diabetes gets their hemoglobin A1c measured approximately 4 times per year by their primary health care provider. Once a year is not enough. Tight control is imperative. If the blood sugars are constantly running high the vessels that deliver blood to the heart are constantly inflamed setting the stage for further heart issues.

There are many hemoglobin A1c calculators can be found on the internet. Here is Medscapes version

http://reference.medscape.com/calculator/hemoglobin-a1c-est-plasma-glucose

Sodium intake affects on heart vessels

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.

http://newsroom.heart.org/news/change-your-salty-ways-in-only-241917

http://www.medwirenews.com/463/103163/Dietetics/Multiple_vascular_benefits_in_salt_restriction.html

Holiday Sweets

http://nomoreaddedsugar.com/2011/12/why-is-santa-fat-infographic/

The average American consumes 50 pounds of cookies a year and a lot of these will be consumed over the holidays.

How much added sugar is in a cookie? That all depends on the cookie of course but one little Oreo is 7 grams of added sugar. A homemade cookie can contain twice that.

So when you are craving cookies, how about clementines, grapes, pomegranate,  chestnuts, almonds dusted in chocolate powder, a cup of cinnamon tea, flavored coffee. If you do indulge try to keep in mind serving sizes. Follow it up with a walk or using some weights.