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The Ultimate Way to Fitness
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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.
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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.
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
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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. 
| Nuts, seeds, and legumes | 3-4 servings per week for 1600 calorie diet | 4-5 servings per week for 2000 calorie diet |
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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.
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 |
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