Cardiac Diet
Cardiac diets are widely prescribed in the hospital setting for patients with heart disease, hypertension, myocardial infarction, hyperlipidemia, and dyslipidemia. A cardiac diet can be part of a plan for either treatment or prevention of cardiovascular disease. In general, it consists of foods the patient may classify as "healthy."
The cardiac diet increases consumption of fruits and vegetables, whole grains, and fiber and decreases consumption of fats and sodium. The diet prescription for long-term management may need to be adjusted depending on the goals of the diet or the diagnosis. A referral to a dietitian is recommended for outpatient diet evaluation and education.
The usual cardiac or "heart healthy" diet prescription includes a restriction on fat, cholesterol, sodium, and may or may not contain a caffeine restriction. Often it follows the guidelines of the National Cholesterol Education Program which include:
- Total fat 25-35% of daily calories.
- Saturated fat less than 7% of daily calories.
- Monounsaturated fats up to 20% of daily calories.
- Polyunsaturated fats up to 10% of daily calories.
- Trans fat "kept at a low intake."
- Cholesterol less than 200 milligrams per day.
- Carbohydrates 50-60% of daily calories.
- Fiber 20-30 grams per day.
A brief explanation of the different fats may be beneficial when dealing with patient questions. Dietary fats, particularly saturated and trans fats, can contribute to increasing total cholesterol, low-density lipoproteins (LDL), and triglycerides, which can cause plaque build-up on the blood vessel walls, decreasing the size of the blood vessel lumen. Restriction of the blood vessels increases the load on the heart because it needs to pump harder to get the blood through smaller openings.
Saturated fats are found mainly in animal products. They are termed "saturated" because on the molecular level they contain all single bonds. Unfortunately, this type of fat has been shown to increase low-density lipoprotein levels (LDL), which are associated with increased heart disease risk. Unsaturated fats contain double bonds and are encouraged in place of saturated fats because they help decrease LDL levels.
The newest addition to the identified fat family is the trans fat. Trans fat found its way into the spotlight because it has been shown to increase LDL and decrease high-density lipoproteins (the good blood cholesterol). As of January 2006, law requires that the trans fat content of foods be listed on the nutrition facts panel. This fat, found often in processed foods, is formed when hydrogen atoms are added to unsaturated fat to, in a sense, saturate them and create a solid product. Processed foods often contain these fats because they increase the shelf life. In the past there has been no dietary recommendation for trans fat. The most recent recommendation from the American Heart Association is to "limit…trans fat to less than 1% of daily calories" (Lichtenstein et al., 2006).
Sodium is restricted due to its tendency to increase blood pressure, as well as for its negative effect on the diuretic properties of some medications. Sodium is often restricted to 2,000-4,000 mg per day, depending on the diagnosis and medical plan of care.
In addition to fat and sodium restrictions, cardiac diets in the hospital may contain a caffeine restriction of 0-2 caffeine-containing items per day. Caffeine is a stimulant and can increase heart rate.
A cardiac diet takes into consideration both the benefits of restricting some food components as well as increasing consumption of healthy foods and food components.
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Cardiac Diet Survival Skills
- Avoid high saturated fat foods such as bacon, high-fat red meats, luncheon meats, fatty dairy foods (cheeses, Vitamin D whole milk), and some bakery products/candy.
- Limit dietary cholesterol by decreasing consumption of red meat to no more than three times per week, choosing low fat dairy, and limiting egg yolks.
- Review food labels for amount of trans fat and choose products with 0 grams listed. Keep in mind that if a product contains less than .5 grams, the manufacturer may round it down to zero. If you are trying to strictly limit trans fat, review the ingredient list. Hydrogenated or partially hydrogenated in the list may mean it contains less than .5 grams of fat rather than zero.
- Replace butter or some margarines with a trans fat free margarine.
- Avoid adding salt. Limit salty snack foods, and review food labels for less than 140 milligrams of sodium for most foods consumed.
- Increase fruit and vegetable consumption.
- Add fish (non-fried) to your diet.
- Look for products that contain "plant stanols," as found in certain margarines and yogurts.
For a more individualized diet prescription guidelines, encourage the patient to contact the registered dietitian after hospital discharge.
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