How's this diet plan for my dad?

[LuluDeren]

Hey Everyone! My dad suffered a mild heart attack this past Monday, was hospitalized until Friday. He underwent an angioplasty and is now recovering. He is on nine different meds, an inhaler and a nicotine patch for, at least, the next month. He also must carry the nitro tabs with him at all times.

Anywhoooo, my questions are in regards to his diet and exercise programs. He was given an outline for the DASH (Dietary Approaches to Stop Hypertension) Eating Program and was advised to start out with (2) ten minute walks per day. I plan on incorporating weights in his program when his doctor gives the ok....biggest problem there: he's a former high school football player who hasn't lifted weights in years....and now spends most of his time traveling in a car for his job. Ughhh. He is 197 pounds, 6', not sure of BF, I'll try to see if his doctor can guesstimate at his next appointment on monday.


Here is an excerpt from one day's menu:
M1-1 cereal
1 fruit
1 dairy

M2-1 grain
1 fruit
1 dairy
1 oil

M3-2 grains
1 protein
1 veg

M4-1 protein
1 oil/fat
1 veg
1 grain

M5-3 veg

M6-1 dairy
1 fruit

This is a schedule my dad was satisfied with...I realize fruit so late in the day isn't ideal, but he likes it with his yogurt. I have a question in regards to whey shakes, do you think I could use these for a couple of his diary requirements? He would get the extra protein and I could give it to him in the two meals following his two abbreviated walks.

I'll post up his exercise routines when he gets past the *walk* stage.

Thanks for listening.

 

[jeepboi]

you need to clarify what your giving him, ie: 1 veg 1 protein , say 1 cup broccolli and 6oz chicken breast.

hope hes doing better

 

[LuluDeren]

you need to clarify what your giving him, ie: 1 veg 1 protein , say 1 cup broccolli and 6oz chicken breast.

hope hes doing better

Thanks jeepboi, he's doing really well.

Here is what he's eaten for the past two days (since being released from the hospital).

Sat

M1-Bowl of cereal
1 cup mixed fruit
4 ounces lowfat milk

M2-Bowl of cereal (he insisted)
4 ounces milk
1 cup mixed fruit

Since the first two meals were 6am and 9am, he insisted on eating *traditional* breakfast foods.

M3-2 pieces whole wheat bread
1/2 can of tuna
1 fat/oil in the form of 1 tablespoon of lowfat mayo
1 serving green beans

M4-1 sm pork chop
Small red potato
1 serving corn

M5-8 ounces low sodium V8 juice
1 can of string beans

M6-1 carton of yogurt
1 cup of fruit

He also had a couple cups of decaf coffee/green tea.

Sunday

M1-1 pancake
1/2 cup mixed berries
4 ounces lowfat milk
tbsp of syrup

M2-Bowl of cereal
1/2 cup mixed fruit
4 ounces lowfat milk

M3-2 pieces whole wheat bread
1/2 can of tuna
1 tbsp of lowfat mayo
1 serving of peas (for nuts requirement)

M4-1 slice of ham
1 slice whole wheat bread
1 serving stewed tomato
1/2 cup mixed fruit
sm red potato


M5 & 6 to come.


Well, it sure sounds like alot when written down, but I'm trying to follow the daily recommended requirements...believe me, they are smaller portions then he's used to, so I think I'm heading in the right direction.

Thanks again, everyone!

 

[herselftheelf]

What kind of cereal?
See if he likes Uncle Sam. The stuff has 10 grams of fiber per serving, and whole flax seeds.
Kashi go lean is also good, as is Speacial K heartsmart.

Check with his doctor about protein supps. Excess protein is converted to fat, so it's important that he not get too much. Conversely, why isolate protein has shown potential to reduce LDL and to lower blood pressure.

 

[LuluDeren]

What kind of cereal?
See if he likes Uncle Sam. The stuff has 10 grams of fiber per serving, and whole flax seeds.
Kashi go lean is also good, as is Speacial K heartsmart.

For his cereal requirement, he is eating his favorite corn flakes. I've not heard of Uncle Sam, I'll do a little research there. I could switch him to Special K in the meantime, that seems to be more readily available in our area.

Check with his doctor about protein supps. Excess protein is converted to fat, so it's important that he not get too much. Conversely, why isolate protein has shown potential to reduce LDL and to lower blood pressure.

Good to know! He's getting 2 protein servings a day, as is, and in the form of 3 ounces meat or tuna. I'll check with his doctor as you suggested.

Thanks Herselftheelf!

 

[H_T_]

wow. i'll tell you, those nicotine patches are effing horrible. i hope he's got the minerals to quit smoking, cuz those patches come with their own dangers. they jacked up my bp so high....

 

[LuluDeren]

wow. i'll tell you, those nicotine patches are effing horrible. i hope he's got the minerals to quit smoking, cuz those patches come with their own dangers. they jacked up my bp so high....

Thank you for this information, HT. I found this regarding the patch and elevated BP levels:


http://www.health.harvard.edu/newsweek/Can_a_nicotine_patch_boost_my_blood_pressure.htm

"Can a nicotine patch boost my blood pressure?

Q. On the day I stopped smoking a few weeks ago, I started using a nicotine patch. When I smoked, my blood pressure was great — 100/70. Now it is up to 160/90. I would hate to stop the patch, since it really helps, but I’m worried that it could cause a problem.
A. First off, congratulations for trying to stop smoking. Every part of your body will benefit if you quit.
Nicotine stimulates the central nervous system. Whether you smoke a cigarette or absorb nicotine from a patch, your body responds by releasing a hormone called epinephrine (adrenaline). Its effects range from increased energy and awareness to high blood pressure, a rise in heart rate, and nervousness. High blood pressure with the use of a nicotine patch (or gum, inhaler, lozenge, or nasal spray) may mean you are taking too much nicotine.
High blood pressure by itself, or accompanied by nervous jitters and a fast heart rate, can be a sign of nicotine withdrawal. So the increase in your blood pressure could also mean you are not getting enough nicotine in the patch. For heavy smokers, a nicotine patch sometimes doesn’t deliver enough nicotine to replace what they had been getting from their cigarettes.
Talk with your doctor to make sure you are taking the dose that’s right for your weight and former smoking habit.
Another source of the problem could be if you are smoking a cigarette here and there while wearing the patch. Your body doesn’t care where the substance is coming from, and the extra dose could affect your blood pressure.
If you have heart disease it could do much more — smoking while using a nicotine patch has led to heart attacks in some people.
— Thomas H. Lee, M.D.
Editor-in-Chief, Harvard Heart Letter"



We did substitute an over the counter patch in lieu of the prescription...by the time we got all his other meds, the pharmacist suggested the commercial dosage (21mg) to cut costs. My dad's bp seems to be okay, but we will be asking the doctor about an oral. Thanks again

 

[guest username]

When I rotated in the CCU and dealt with heart attack patients on a daily basis as part of my residency training, we never wrote for nicotine supplements. Why? Think about it. What does nicotine do? It causes vasoconstriction and predisposes to clotting. This is why cigarettes are so dangerous -- they cause the arteries to clamp down, not only raising your blood pressure, but also closing up the arteries if you have a predisposed blockage. Giving a patient with a recent cardiac stent nicotine is begging to have the stent close and have another heart attack.

We prescribed anxiolytics (which have their own problems).

Some thoughts on the diet:

1. The DASH diet has been shown to dramatically help cholesterol levels, lower blood pressure, etc. It's a great diet. A lot of emphasis is being placed on the South Beach diet as well. Ask his cardiologist about this. (Do not change diets until advised to do so by his cardiologist.)

2. Adding protein can offset the benefits of the DASH diet. If you add protein supplements, they should substitute for meat products already allowed (and not be additive).

3. I would caution you about instituting weight training early in his recovery. The reason is that weight training significantly raises blood pressure during lifts, especially heavy lifts. Even with proper breathing your blood pressure will rise substantially during lifting. One prominent cardiothoracic surgeon put arterial lines in powerlifters and found that systolic blood pressures reached 400 mmHg during squats. I know your dad will hardly reach this level, but even if his blood pressure increased to 200 mmHg it could have devastating consequences. I would stick to cardiac rehab exercises only for the first few months (i.e., exercise bike, walking, etc.). There is a reason why cardiologists transition post-MI patients into exercise so gradually: if the heart becomes ischemic during this post-MI recovery period, there is a higher chance of the ischemia triggering an arrhythmia causing sudden cardiac death. The strain placed by weight training can cause a recovering heart to develop ventricular hypertrophy or dilatation, which would ultimately cause CHF (congestive heart failure). Stick with their cardiac rehab plan until he's cleared. They've done it for years and know what's safe. After he completes his rehab, then you could institute weight training if cleared by his cardiologist.

4. Most leading cardiologists and European cardiologists now advocate discharging post-MI patients with high-dose omega-3 fatty acid supplements. They've been shown to reduce the likelihood of another heart attack. Although one study demonstrated a higher rate of arrhythmia with omega-3 fatty acid supplements, the consensus on research and professional opinion by leading cardiologists is that omega-3 fatty acids will prevent arrhythmia. Usual prescriptions are in the 2 - 4 gram range. However, buying over-the-counter omega-3's in this amount could lead to significant mercury and PCB poisoning. Therefore, you should order a purified form. There are some forms available on the internet, but they are expensive and not guaranteed to be pure. Omacor is the only omega-3 fatty acid available by prescription. Its production is monitored by the FDA and likely to be more adherent to purity guidelines about elimination/filtering of toxins. A word of warning: Omacor is extremely expensive. It may or may not be covered by your dad's prescription drug plan. I'm fortunate enough that Omacor is covered by my prescription plan. (No, I haven't had an MI [heart attack], but I do take omega-3's religiously due to family risk.)

Hope this helps!

 

[LuluDeren]

When I rotated in the CCU and dealt with heart attack patients on a daily basis as part of my residency training, we never wrote for nicotine supplements. Why? Think about it. What does nicotine do? It causes vasoconstriction and predisposes to clotting. This is why cigarettes are so dangerous -- they cause the arteries to clamp down, not only raising your blood pressure, but also closing up the arteries if you have a predisposed blockage. Giving a patient with a recent cardiac stent nicotine is begging to have the stent close and have another heart attack.

We prescribed anxiolytics (which have their own problems).

Makes complete sense. I think his surgeon is worried that if he didn't prescribe the patches, my dad would continue his, almost three packs a day, habit. I'll ask the doctor about an anxiolytic prescription.

Some thoughts on the diet:

1. The DASH diet has been shown to dramatically help cholesterol levels, lower blood pressure, etc. It's a great diet. A lot of emphasis is being placed on the South Beach diet as well. Ask his cardiologist about this. (Do not change diets until advised to do so by his cardiologist.)

Will do.

2. Adding protein can offset the benefits of the DASH diet. If you add protein supplements, they should substitute for meat products already allowed (and not be additive).

Okies...I will not add any whey shakes to his plan...but, there's no way he will substitute a shake for meat

3. I would caution you about instituting weight training early in his recovery. The reason is that weight training significantly raises blood pressure during lifts, especially heavy lifts. Even with proper breathing your blood pressure will rise substantially during lifting. One prominent cardiothoracic surgeon put arterial lines in powerlifters and found that systolic blood pressures reached 400 mmHg during squats. I know your dad will hardly reach this level, but even if his blood pressure increased to 200 mmHg it could have devastating consequences. I would stick to cardiac rehab exercises only for the first few months (i.e., exercise bike, walking, etc.). There is a reason why cardiologists transition post-MI patients into exercise so gradually: if the heart becomes ischemic during this post-MI recovery period, there is a higher chance of the ischemia triggering an arrhythmia causing sudden cardiac death. The strain placed by weight training can cause a recovering heart to develop ventricular hypertrophy or dilatation, which would ultimately cause CHF (congestive heart failure). Stick with their cardiac rehab plan until he's cleared. They've done it for years and know what's safe. After he completes his rehab, then you could institute weight training if cleared by his cardiologist.

Will do. He is walking 5-10 minutes twice a day...and will be starting a rehab program next Wednesday.

4. Most leading cardiologists and European cardiologists now advocate discharging post-MI patients with high-dose omega-3 fatty acid supplements. They've been shown to reduce the likelihood of another heart attack. Although one study demonstrated a higher rate of arrhythmia with omega-3 fatty acid supplements, the consensus on research and professional opinion by leading cardiologists is that omega-3 fatty acids will prevent arrhythmia. Usual prescriptions are in the 2 - 4 gram range. However, buying over-the-counter omega-3's in this amount could lead to significant mercury and PCB poisoning. Therefore, you should order a purified form. There are some forms available on the internet, but they are expensive and not guaranteed to be pure. Omacor is the only omega-3 fatty acid available by prescription. Its production is monitored by the FDA and likely to be more adherent to purity guidelines about elimination/filtering of toxins. A word of warning: Omacor is extremely expensive. It may or may not be covered by your dad's prescription drug plan. I'm fortunate enough that Omacor is covered by my prescription plan. (No, I haven't had an MI [heart attack], but I do take omega-3's religiously due to family risk.)

Unfortunately, Omacor is not covered by his prescription plan, most of his prescriptions aren't. If both his protein requirements on the DASH program were thoroughly washed fish, would he be getting a sufficicent 'dosage' of omega 3's to mimic the effects of Omacor?

Hope this helps!

Thank you so very much, Swatdoc! You have provided priceless information. My family and I thank you.

 

[guest username]

The level of omega-3's in Omacor is pretty high. The normal prescription is 2-4 grams and contains more than 840 mg of EPA and DHA for every gram.

Salmon contains about 2 g of omega-3's for each 4 ounce serving. I'm not sure how much of that is EPA and DHA (what really counts). Fish such as snapper, tilapia, etc. have lower amounts (about 300 mg).

The amount of salmon eaten in order to get 2 g of omega-3's daily would be hazardous to your health because of the amount of PCB's, mercury, etc. that is in farmed salmon. Wild salmon has less, but it's expensive to buy.

Drugstore.com has 1 g capsules available (you still need a prescription). For 2 grams daily, a 90-day supply would cost $225.

Again, I must caution you, do not supplement at these levels with standard over-the-counter omega-3's. OTC omega-3's in high doses have high levels of mercury and PCB's.