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

To learn more about how to lower sodium in diet click here.

To learn more about sodium and it’s effects on the body

Advertisements

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.

Vitamin K can help prevent Cardio Vascular Disease. Good sources from cabbage, cauliflower, spinach, and other green leafy veg.

http://www.cc.nih.gov/ccc/patient_education/drug_nutrient/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

Nutrition recommendation for heart patients

Load up on nutritionally dense low caloric foods. Don’t let the day go by without eating vegetables. Challenge yourself with legumes and  beans which provides essential fiber in the diet. Drink water regularly. Avoid fast food and eating out as much as possible. Use fresh herbs and spices, yet avoid salt.

Mediterranean Diet PyramidHow Fiber Works Infographic

Carbohydrates and Heart Disease

Info graph about the benefits of low carbohydrate foods explaining the difference between "good" carbs and "bad" carbs. Learn why you gain weight when

The following link is a research study looking at how sucrose (a form of sugar) affects the heart.  Regularly consuming sucrose — the type of sugar found in many sweetened beverages — increases a person’s risk of heart disease, new research suggests. Scientists used fruit flies, a well-established model for human health and disease, to determine exactly how sucrose affects heart function. In addition, the researchers discovered that blocking this cellular mechanism prevents sucrose-related heart problems.http://tinyurl.com/bey4lox