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A cardiac patient's platter

Updated on December 5, 2015

Atherosclerosis- a major cause of heart problems

Coronary artery disease is the most common, serious, chronic, life-threatening illness throughout the world, with more than 11 million people suffer from this problem. When the blood vessels supplying the heart, the coronary arteries, get hardened with fat deposits, the blood supply to the heart is compromised, leading to angina pectoris and heart attack, that is called myocardial infarction in medical language.

Atherosclerosis the name, derived from Greek, refers to the thickening of the inner lining of arteries, the arterial intima (sclerosis, "hardening") and accumulation of lipid (athere, "gruel") that characterize this condition.

Atherosclerosis of arteries supplying the brain leads to transient cerebral ischaemia and strokes. When blood supply to the limbs is compromised, it causes intermittent claudication (pain or weakness in the muscles of limbs brought on by activity, and relieved after rest), gangrene, and can jeopardize limb viability.

Risk factors for cardiovascular diseases include-

Modifiable

  • Smoking
  • High blood pressure
  • High cholesterol
  • Glucose intolerance
  • Obesity
  • Physical inactivity
  • Elevated blood homocysteine levels
  • Low estrogen levels in women

Non-modifiable

  • Positive family history (particularly when onset is before age 50)
  • Age
  • Male gender


Is this what a cardiac patient should eat?
Is this what a cardiac patient should eat?

The role of dietary modifications in cardiovascular diseases

The main dietary hazard is that people eat food, rather than nutrients. Effective diet therapy for cardiovascular diseases should not rely on a "good food versus bad food" approach, but should aim to modify the eating habits to attain a desirable body weight, and to reduce the intake of saturated fats.

Diet therapy is the first line of intervention to prevent heart diseases, and pharmacological agents are only adjunct therapy.

Low cholesterol, a healthy heart

Elevation of plasma cholesterol, especially of Low-Density Lipoprotein (LDL) cholesterol, is a major risk factor that can at least be partially modified by dietary intervention.

Cholesterol deposits in your arteries is a disaster waiting to happen. It could trigger a heart attack or stroke, sooner or later.

The National Cholesterol Education Program (NCEP) has identified levels of risk as-

  • Serum cholesterol concentration < 200 mg/dl as low risk.
  • Serum cholesterol concentration between 200-239 mg/dl as moderate risk.
  • Serum cholesterol concentration > 240 mg/dl as high risk.

The aim is to lower total cholesterol to less than 180 mg/dl. The various types of cholesterol include-

LDL or bad cholesterol

Low LDL (low-density lipoprotein) cholesterol is good for heart health. But LDL number should not be the main factor in guiding the treatment of cardiac patients according to the latest guidelines of American Heart Association.

HDL or good cholesterol

Higher levels are better. People with high triglycerides have low HDL cholesterol. Genetic factors, type II diabetes, certain blood pressure lowering medicines as beta-blockers, anabolic steroids, smoking, obesity and a sedentary lifestyle contribute to low HDL cholesterol levels.

Triglycerides

A high level of triglycerides, along with low HDL cholesterol or a high LDL cholesterol, is associated with a fat build up in arterial walls, causing hardening of arteries.

The basic diet therapy for people with elevations of LDL cholesterol, involves reduction in the intake of total and saturated fat to <30% and <10% of total calories, respectively.

Sources of saturated fat include animal fats (fatty meat, poultry skin and butter fat) and some vegetable fats (coconut oil, cocoa butter and palm oil).

Cholesterol found in foods of animal origin is not as important a determinant of plasma cholesterol, as is saturated fat.

Nevertheless, dietary intake of cholesterol should be <300 mg/day.

In persons whose serum cholesterol does not respond to this degree of diet modification, the NCEP step-2 diets, which involve a greater reduction of saturated fat and cholesterol intake are recommended, with up to <7% saturated fat and <200 mg cholesterol per day.

These diets replace fat, particularly saturated fat with carbohydrates. This approach will result in fewer total calories consumed and facilitate weight loss in overweight people.

Low fat, high carb diets may, in turn result in a reduction in HDL cholesterol.This becomes a cause of concern when the baseline level of HDL cholesterol is low (35 mg/dl).

An alternative strategy is the "Mediterranean diet". which maintains total fat at approximately 35-40% of total calories but replaces saturated fat with monounsaturated fat such as that found in canola oil and in olives, peanuts, avocados, and their oils. This diet is equally effective at lowering LDL cholesterol but is less likely to lead to reductions in HDL cholesterol.

Maintain a healthy body weight

Obesity is a major risk factor for heart diseases. For every excess kilogram of body weight, endogenous cholesterol synthesis is increased by 20 mg/day, that with 10 kg excess weight, 200 mg of additional cholesterol enters the body pool daily to be used, excreted or stored.

Obesity is also associated with raised levels of triglycerides, LDL cholesterol and lower levels of HDL cholesterol. The insulin resistance associated with obesity and the resulting hyperinsulinaemia improve with even a modest weight reduction of 5 to 10 kgs.

Use heart healthy oils

Monounsaturated fats (canola oil, olive oil, peanut oil) maintain HDL cholesterol and lower LDL cholesterol concentration, and when saturated fat is reduced to <10% of calories and monounsaturated fats make for the remainder of fat, a significant reduction in total cholesterol can be achieved without decreasing the total fat intake or increasing the proportion of calories from carbohydrates.

Avoid Trans fats

Trans fatty acids are formed when vegetable oils are hydrogenated to be solid at room temperature. Margarine is a major source of trans fats in the diet. Consumption of trans fats in amounts >7% of calories may cause an increase in total and LDL cholesterol and a decrease in HDL cholesterol.

Stop smoking

If you smoke, then quit. If someone in your household smokes, encourage them to quit.

Cigarette smoking accelerates coronary artery disease in both sexes and at all ages and increases the risk of heart attacks, also aggravates angina.


Healthy heart parameters
Healthy heart parameters

Heart healthy diet

  • High in omega-3 fats found in cold water fatty fish-salmon, tuna, mackerel.
  • High in fiber.
  • High in fruits and in green, red and orange vegetables.
  • Low in saturated fat and trans fats.
  • Low in sodium.
  • Low in sugar.
  • Low in cholesterol.
  • Low in alcohol or alcohol-free.
  • Calorie balanced to support a healthy weight.

Heart health parameters

  • 0 tobacco products used.
  • 5 or more servings of fruits and vegetables each day.
  • <25 kg/meter square Body Mass Index.
  • At least 30 minutes of exercise 5 days a week.
  • 40 inches or less waist circumference for men.
  • 50 mg/dl or higher HDL cholesterol for women.
  • <100 mg/dl fasting glucose.
  • <120/80 mm Hg blood pressure.
  • 130 mg/dl or less LDL cholesterol for people with an intermediate risk of heart disease.
  • 150 mg/dl triglyceride level.
  • < 1500 mg of sodium per day.

Composition of cholesterol lowering diets

Nutrient
NCEP Step 1 Diet
NCEP Step 2 Diet
Mediterranean Diet
Total Fat
< 30% of calories
<30% of calories
<40% of calories
Saturated Fat
<10% of calories
,<7% of calories
<10% of calories
Polyunsaturated Fat
<10% of calories
<10% of calories
<10% of calories
Monounsaturated Fat
<10% of calories
<10% of calories
<20% of calories
Carbohydrate
50-60% of calories
50-60% of calories
40-50% of calories
Protein
10-20% of calories
10-20% of calories
10-20% of calories
Cholesterol
<300 mg/day
<200mg/day
<300mg/day

Omega-3 the heart friendly fats

Fish oils extracted from cold water fatty fish, with polyunsaturated fats of the omega-3 type (Eicosapentaenoic acid EPA and Docosa hexenoic acid DHA) have potent triglyceride-lowering effects but do not lower LDL cholesterol.

Any anti-atherogenic effects of fish and fish oil consumption are mediated through blood thinning, clot-preventing and anti-inflammatory effects.

Have a hearty meal !
Have a hearty meal !

You are what you eat

A healthy diet is one of the best weapons in the armamentarium of heart health interventions. The food you eat has an effect on the controllable risk factors of heart diseases (high cholesterol, blood pressure, diabetes, and obesity).

And to maintain a healthy body weight, coordinate this diet with your physical activity level, that you burn the extra calories that you take in.

Eat at least five servings of fresh fruits daily. These include blueberries, cranberries, strawberries and raspberries loaded with anthocyanins and polyphenols, apples with high fiber content and antioxidant quercetin, oranges rich in beta-cryptoxanthin and vitamin-C, cantaloupe with a high amount of potassium that aids in lowering blood pressure and papaya loaded with vitamins and minerals.

Have fruit for dessert. Eat whole fruits instead of fruit juices to add fiber.

Add chopped, dried and fresh fruits to your cookies, muffins and bread before baking. Nuts like almonds and walnuts are rich in plant based omega-3 fats, vitamin-E, folate, phytosterols and have a high fiber content.

Add slices of banana or peach or any other fruit to your cereal.

Grate carrots on salads. Carrots being a rich source of alpha and beta carotene are good for heart health. Keep prepared carrot and celery sticks, cucumber rounds and other fresh vegetables.

Choose a side salad instead of fries for lunch. Red bell peppers, asparagus, tomatoes, squash, broccoli and sweet potato are good nutrient-packed options.

Consider alternatives to routine meals. Choose restaurants with healthier choices, as vegetable side dishes, whole grain bread, fruits and salads.

Avoid food that is high in fat and low in fiber.

Add kidney beans and black beans to your salads. Substitute legumes for meat at least three times per week.

Incorporate fiber-rich food in your diet containing at least 25-30 gms of it every day. Both soluble and insoluble fiber help in maintaining a good digestion and provide a sense of fullness, preventing overeating and weight gain.

Sprinkle oat bran or wheat germ on your soups, salads, breakfast cereal, and yogurt.

Use whole wheat flour for cooking and bakery. Choose whole grain bread and cereals with at least 5 gm fiber per serving.

Keep whole wheat crackers for an easy snack.

Replace your regular white rice with brown rice.

Grilled salmon or tuna salad are great sources of omega-3 fats.

Sprinkle ground flaxseed powder on your yogurt parfaits and morning cereal.

Add tofu (marinated and grilled or stir fried) and soy milk in your diet to provide that extra dose of phytoestrogens and phytosterols.

Have a small piece of dark chocolate to satisfy your cravings. Being rich in resveratrol and polyphenols, it should have 70% or higher cocoa content.

Have some tea. White tea, green tea, oolong tea and black tea are rich in catechins and polyphenols that help in lowering cholesterol.

Get active

Exercise for a minimum of 30 minutes every day on 5 or more days per week helps to lower high blood pressure and cholesterol and maintain a healthy body weight. Even 10 minutes of activity at a time has health benefits. Isotonic exercises (jogging, swimming) are better than isometric exercises (weightlifting) since the latter, if anything, raise arterial blood pressure.

Shake That Salt Habit

Although not all suffering from high blood pressure are salt sensitive, dietary sodium should be reduced to <1500 mg/day.

Avoid processed meat, pickles and salted cheese.

Limit Your Alcohol Intake

Drinking too much can increase fat in the blood (triglycerides), raise blood pressure and add extra calories that lead to weight gain. It can lead to heart failure, stroke, irregular beats and cancer risk.

The risk of heart disease in people who drink in moderate amounts ( an average 1 drink for females and 2 drinks for males per day) is lower than non-drinkers. But it is not recommended that non-drinkers start using alcohol for that.

Congestive Heart Failure

In case of a heart failure, follow a fluid restricted diet (1-1.5 litres/day), with adequate calories, protein and other nutrients, and sodium 1000-2000mg/day.

Disclaimer:This information is for educational purposes only and is not intended to replace the advice of your doctor or healthcare provider.

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    • shraddhachawla profile image
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      Metreye 3 years ago

      Thank you Jackie Lynnley, for your acknowledgement and appreciation. It's a real pleasure being encouraged.

    • Jackie Lynnley profile image

      Jackie Lynnley 3 years ago from The Beautiful South

      This is a really great article. Welcome to HubPages; I can see you will do really well. Will get back soon and look at your other writings. ^+

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