Diet taboos for heart disease

Long-term high sodium intake, excessive intake of trans fat/saturated fat, large intake of free sugars, and excessive intake of irritating ingredients at one time. All taboos are essentially "quantity" taboos, not "absolute fasting". Don't be overly anxious just because you've eaten a bite of pickles or a piece of fat meat, and don't go out on a limb every day with the mentality of "a small amount is fine".

To be honest, I have been doing clinical nutrition follow-up in the cardiology department for almost 8 years, and the biggest pitfall I have seen is that everyone’s understanding of “salt control” is limited to adding less salt in cooking. Uncle Zhang, who was followed up last year, had two stents put in and was discharged from the hospital. He was told not to exceed one beer cap a day in salt. However, half a year later, his blood pressure soared to 160/95, and his blood lipids were not up to standard. After careful questioning, he said he had no appetite in the summer, so he just ate home-pickled radishes and plausibly said, "I only eat a few radishes every meal, and I don't eat too much." Do the math and you will understand: 100g of pickled dried radish contains nearly 7000mg of sodium. Even if you only eat 10g, you will have 700mg of sodium. After three meals a day, the dried radish alone accounts for half of the recommended sodium intake for the day. Add in the salt, soy sauce, oyster sauce used in daily cooking, as well as the invisible sodium in biscuits and bread. Overdosage is a matter of minutes. Current mainstream guidelines recommend that patients with heart disease limit their daily sodium intake to 1,500 mg (equivalent to 3.75 g of table salt). However, clinical studies in recent years have also suggested that elderly heart failure patients with low sodium and repeated hypotension should not be so stuck to avoid dizziness, fatigue or even coma caused by hyponatremia. You can ask your doctor based on your blood test results.

Less controversial than sodium, whether saturated fat can be eaten has been a topic that has been debated in the nutrition community for almost 20 years. A few years ago, I met a 70-year-old Aunt Li. After she was diagnosed with coronary heart disease, she threw away all the egg yolks, didn't touch any red meat, and ate boiled vegetables every day. As a result, a year later, her albumin was only 32g/L when she was retested. She started to gasp after taking only two steps, and her condition was worse than when she was first discharged from the hospital. The traditional view is that excessive intake of saturated fat will increase low-density lipoprotein and aggravate atherosclerosis. It is recommended that patients with heart disease have a saturated fat energy supply ratio of less than 10% and trans fat is best reduced to 0. However, cohort studies in recent years have also found that natural sources of saturated fat (such as fat, butter, coconut oil) have much lower negative cardiovascular effects than trans fat in processed foods. As long as the total calories throughout the day do not exceed the standard, it is perfectly fine to occasionally eat a piece of braised pork or two egg yolks. Here is an important point: trans fat is something that all guidelines clearly require to be avoided. It means things that have "margarine, shortening, non-dairy cream, and hydrogenated vegetable oil" in the ingredient list, such as crispy wife cakes sold on the street, pearl milk tea that costs 10 yuan a cup, and quick-frozen pastries. These are the things you really want to avoid.

Many people's understanding of diet for heart disease is limited to "it should be light and add less salt". They think that they can eat sweet things casually. This is really a huge misunderstanding. Last year, I treated a 32-year-old patient with myocardial infarction. He recovered quickly at a young age. When he was discharged from the hospital, he firmly remembered to control salt. He gave up all pickles and bacon, but he drank two cups of freshly squeezed juice every day. He also liked to stock up on "sugar-free biscuits" on the market for snacks. However, after three months of rechecking, he found that his fasting blood sugar had risen to 6.8mmol/L, and his triglycerides were almost double the normal value. I was stunned. In fact, free sugar (that is, additional added sucrose and fructose, including sugar in honey and freshly squeezed juice, excluding natural sugar in whole fruits) will increase triglycerides and induce obesity. It is a hidden killer of cardiovascular disease. The World Health Organization has long recommended that the energy supply ratio of free sugar should be less than 10%, preferably less than 5%, which means that you should not eat more than 25g of extra sugar a day. A 500ml bottle of Coke contains 35g of sugar, which is already exceeded.

Finally, let’s talk about the most frequently asked question: “Can we eat spicy food?”, such as coffee, wine, and spicy food. There is more controversy here. For example, coffee. In the past, many people said that people with heart disease should not drink coffee, as it will speed up the heart rate and induce premature beats. However, more and more studies now show that drinking 1-2 cups of black coffee without sugar and non-dairy creamer every day can actually reduce the risk of cardiovascular disease. Only people who feel palpitation and chest tightness after drinking it need to avoid it. I have an old patient with premature beats. He used to feel uncomfortable after drinking regular coffee every day. Later, he switched to drinking decaffeinated coffee, one cup a day. Now he has been followed up for two years, and the indicators are quite stable. It really doesn’t need to be one-size-fits-all. Let’s talk about wine. The rumor that “drinking red wine softens blood vessels” has long been falsified. Alcohol is a clear carcinogen. No matter how much you drink, it will put a burden on the cardiovascular system. Therefore, it is best for heart disease patients not to drink alcohol at all. If you really can’t avoid it, the amount of alcohol per day should not exceed 15g, which is about half a liang of white wine or half a glass of red wine. If you can do it without drinking it, don’t drink it. There are also spicy foods. Many family members do not allow patients with heart disease to eat spicy food. In fact, it is completely unnecessary. As long as they do not feel uncomfortable after eating and do not cause their blood pressure to rise suddenly, it is perfectly fine to eat spicy food normally. People in Sichuan and Chongqing who eat spicy food every day have no higher incidence of coronary heart disease than those in areas with a light diet.

After so many years of follow-up, I feel that the most harmful thing to the body is not eating a certain bite of something "should not be eaten", but two extremes: either not eating anything, drinking alcohol and eating meat all the time, and not long after that, I was hospitalized for the second time.； Either they dare not eat anything, and in the end, malnutrition drags down the body. The diet for heart disease really doesn’t have so many rules. The core is “balance and moderation”. Don’t stick to a certain kind of food, and don’t follow the uniform taboos on the Internet. If you have high blood pressure, control more salt, if you have diabetes, control more sugar. If you have heart failure, you should also pay attention to controlling the amount of water you drink. What suits you is the best.