heart health & my new diet

May 16, 2008 10:30 AM

I am 37, 5'9", 185 & just had a minor heart attack. Diagnosis: diffuse coronary disease. I swim several times a week, and eat well. But I have questions about my new diet, the one that will help me lose 30 - 50 lbs in 2 years, as my cardiologist wants.

Since the angioplasty & 3 stents, I'm changing the way I eat - eating more whole grains and fruit, hardly any meat. I am taking fish oil (1750 a day) plus my plavix and other drugs. My cholesterol is not particularly high, but my blood pressure was (I haven't smoked in 5 years and even then I never smoked more than a pack a week).

One thing a friend said was to eat lots and lots of sushi, which I love. I know that shellfish is high in cholesterol, but what about my favorite - unagi? It's very fatty, but is that the good kind of fat or the bad kind? I looked up how much fat was in it, but it didn't tell me if that fat was OK - are fish fats better than meat fats, or is it just a case of them being less bad for me, but not actually good?

I think I can do this new way of eating - lots of low-fat middle eastern, no salt, very little animal grease. But I am looking for other suggestions for interesting dishes and things I can order in restaurants that will keep me from getting bored of green salads when my friends are eating steaks and chicken wings (my favorite junk food!). Are turkey meatballs from trader joe's OK? I like them.

Anyway, just wondering if people could share their favorite low-fat recipes & tips for eating safe in restaurants. I have reservations at Incanto in SF in 2 weeks so I hope there's stuff I can eat there... :(

posted by luriete to health & fitness (26 comments total)

Sorry this is all over the place but I have a lot of questions and am still reeling from this as there's no history of heart disease in my family and aside from my high BP (treated for the past year with lisinopril), I didn't have any of the risk factors.
posted by luriete at 10:31 AM on May 16, 2008

Have you considered making an appointment with a nutritionist? They will help educate you about food in general so that you can make informed decisions on a more on-the-spot basis. Also, they could probably come up with a meal plan to start off with. I say this because with so many questions and so many things to consider, a nutritionist will be best equipped to put it all together for you.
posted by DrGirlfriend at 10:40 AM on May 16, 2008

Unless you're really thinly built, 135lb on a 5'9 guy is gonna look almost sickly thin. Just sayin'.

Quite frankly, unless you're going for the morality of it, don't plan to perfectly cut out every chicken wing for the rest of your life - just eat crap sparingly. Moderation is the key, etc.
posted by notsnot at 10:46 AM on May 16, 2008

Shellfish is OK.
posted by peep at 10:48 AM on May 16, 2008

When I got my "you've got high cholesterol" shocker, I got my levels down to normal through diet and exercise within 6-8 months. (I know not everyone can do this - I was lucky.) Anyway, the Moosewood Low-Fat Favorites cookbook really helped my wife and I with many tasty low-fat recipes. (Really we never had a dud recipe from it.)

And also - I did eat "crap" in moderation while getting my cholesterol down (cheese and mayo on a sub once or twice a week, etc.)
posted by chr1sb0y at 10:48 AM on May 16, 2008

I think sushi rice would be less a whole grain than a refined carb, so maybe relying on sushi as a staple may not be a great idea. But yum.

2nding an appointment with a nutritionist and wish you good health.
posted by quarterframer at 10:57 AM on May 16, 2008

I like Dr. John McDougall's ideas and recipes. He seems very common-sense, although I've yet to switch over to a completely vegan diet.

Good luck to you.
posted by SuperSquirrel at 11:40 AM on May 16, 2008

I too am shocked that your doc wants you to lose 50 pounds at your weight, but I am not a doctor. I recommend looking into Kathleen Daeleman's cookbooks. She used to have a show on Food Network. The focus of the cookbooks is indeed on weight loss, but her recipes are for good, simple, staple meals and side dishes that should work with your new diet. She also preaches moderation and not "banning" foods from your life. Like posters above, I also have the Moosewood Low Fat cookbook and have found a few winners there are well.

I like those turkey meatballs from TJ too! I've checked the nutritional info, and they're definitely better than the classic beef meatballs, but perhaps you could look into making your own turkey meatballs? Meatballs freeze very well (obviously), so you could make lots and have them on hand for quick dinners.

I'd recommend looking into beans and barley as new additions to your diet. I never used to eat these growing up -- it just wasn't common in my family. As I've gotten older, I've come to rely on them as staple foods in my diet. Cold bean salads with vegetables and corn are a must have for me in the summer. I make white bean purees and eat them like mashes potatoes. Hot chick pea salad is to die for. Barley is a great replacement for white rice. You must get the whole pearled barley -- not the quick quaker oats kind. Simmer it in low sodium chicken broth and freeze it in one cup batches.

Boy, that's a long comment. I'll shut up now! Good luck to you.
posted by theantikitty at 11:41 AM on May 16, 2008

Look at carbs from vegetables as well - root veg, peas, squashes that kind of thing and also fish.
posted by koahiatamadl at 12:14 PM on May 16, 2008

The Pritikin dieat may be for you. Even if you are not able to be that strict, the cookbooks are filled with good recipes. The Pritikin soups, available in many supermarkets, are the best low fat, low sodium, low carb things going. I add a little salt to taste, but it is still less salt than most low sodium brands, and the taste is excellent for a canned soup. It would be great if we could all make fresh soup everyday, but this is a pretty good, and very healthy substitute. Throw in a handful of edamame and you have enough calories and protein for a whole meal.

One of my go to healthy snacks is a low carb tortilla with corn, black beans, jalapeno and a little bit of low fat cheese. Put it on a paper (keeps it from getting soggy) towel and microwave. I use frozen corn and beans for convenience, but fresh is better. In the morning I might substitute a few egg whites for the cheese and prepare the filling in a pan.

Your local library and the cheap section of the local bookstore will have lots of cookbooks devoted to this type of cooking. They will be good for ideas and recipes that suit your taste. I have one called something like "Real Age...." which has a big hokey thing on estimating some age factor, but despite that has tasty recipes.

I will second the lowfat Moosewood book(s), but the regular ones are off your diet. Vegan and vegetarian cooking with some lean meat thrown in is really what you are looking for. This recent askme has some great cooking sites.

Fresh ingredients, and some spices will keep this new diet from seeming bland or a chore.

Now that I have said all that, the young age at which this occurred might make you want to seriously embrace the Pritikin diet. It is quite strict, but if you can stick to it heart disease will not likely be your undoing.
posted by caddis at 12:43 PM on May 16, 2008

I work with patients that are recovering from a cardiac event.

My best advice would be to make exercise a part of your lifestyle. You cannot stop exercising. Ever. Unless you are in a body cast you can stop exercising.

Also, eat well 99 percent of the time. Don't get into a mindset that you are deprived. You're eating to live now. You have different priorities. Don't be one of those people that think life is less fun without chicken wings. You're not a kid that doesn't get to have his candy and pouts. You're a person that is going to take control of his health and do what needs to be done to have a healthy life and to prevent further disease. It sounds like you're doing well so far and being proactive.

Chicken wings are one of the most horrible things to eat. Avoid chicken wings (hot wings). There is an education packet we give to our patients and there is an article devoted to chicken wings and their horrors, and how they should be avoided.

It's common sense and info you have heard probably a million times: Eat fresh. Avoid packages. Shop the aisles on the perimeter. Eat lean fish and poultry. Avoid fast-food like the plague. Avoid eating out; save it for special occasions. Don't eat too much. Cheeseburgers and porterhouses, donuts and chips, hotwings with blue cheese are not on the menu.

Good luck.
posted by LoriFLA at 1:38 PM on May 16, 2008 [6 favorites]

If you want low-sodium, which you are probably on a low sodium diet if you have hypertension, check out the DASH diet. Check with your doctor, of course. Listen to your doctor first and foremost. Use common sense when preparing meals and ordering out.
posted by LoriFLA at 1:41 PM on May 16, 2008

Thank you for this great advice everybody.

Yes I am going low sodium although weve never had table salt at our house and very rarely use more than a pinch when cooking. Really, I'm a bit at a loss since I do excercise (I swim relatively competetively/hard several times a week, walk and run), don't smoke, eat well - although I do tend to go for large servings of meats - etc.

I guess I'm switching from pho tai to pho ga, too.

Thanks for the advice on beans. I love bean soups and a white bean puree with some garlic sounds terrific.

I will try to eat out much less.
posted by luriete at 1:53 PM on May 16, 2008

If you enjoy sushi, you might consider going with sashimi instead, and ordering a bowl of sushi rice on the side (even if it's not on the menu, a real sushi restaurant would have no problem serving you this). You could go with chirashizushi but that usually has about 2 cups of rice or more - and sushi rice is normally white refined rice with added sugar, vinegar and quite a lot of salt.

As for unagi (eel) it has the good type of oil, lots of Vitamin A and E and so on, but is pretty high in calories, and that sweet-sticky sauce that it's served with at sushi restaurants has lots of salty soy sauce and sugar, so you may want to go easy on it. A somewhat quaint page about eel.
posted by thread_makimaki at 2:03 PM on May 16, 2008

Beware of other people's knowledge of nutrition, diet, and health.

Beware of diets. The way you'll be using the word is "the nutrition of what you eat", not in the sense of "I'm on a diet." Your nutrition will be healthy for the rest of your life, and won't rely on someone's clever new trick for losing weight in a 60 day program.

Diet and exercise are quantified not just by "what," but by "how much" and "how long." In example, your swimming: How hard do you swim, for how long, how frequently? I swim a yard per second for mile+ distances, usually 3500 yards in under an hour, twice a week. (YMMV)

Congratulations on surviving your wakeup call. The rest of your life starts now. You'll probably want to do your own research on health and exercise, so that you'll recognize just how amazingly often advice you hear is wrong. Learning a few recipes will be much less effective than having implicit nutrition knowledge.

On the bright side, being in shape makes everything a lot more fun. Except you notice just how darned poofy and spongy everyone else is.
posted by lothar at 3:12 PM on May 16, 2008

Lothar, 3500 in under an hour is fantastic. Good on you. I do about 2300 in an hour, and that wears me out something fierce. I usually keep going until I hit 2500 thought no matter how long it takes. I have done a 2-mile swim but thats my personal best (3400 yards i think?). I wonder how long it will take before I have the energy to swim again, I already miss it after just a few days.
posted by luriete at 5:39 PM on May 16, 2008

Wow, that's scary. Glad you came out ok.

Now for my answer- what's your history? Have you always been this active and eating this healthfully? I'm wondering if your heart disease is a combination of unique physiology and former bad habits. What did the doctor say, specifically, as to what the cause was?
posted by gjc at 7:22 PM on May 16, 2008

Really, I'm a bit at a loss since I do excercise

Read what LoriFla said, again, and then again. You are eating to live. Even with superlative BP control, and Plavix, and statins, you are at risk for a recurrent MI. The next one might erase your life.

You need to spend time completely revising how you view food. And sushi? Sushi is basically candy. Eat the real thing (fish). Consider vegetarianism. Read up on the Mediterranean diet (not really a 'diet' per se, just a philosophy of eating minimal amounts of animal protein and lots of grains and vegetables). Every time you consider your next meal or snack, ask yourself if it's worth it. The less crap you consume, the less you will miss it.

Eating in restaurants? Assume you will be served the equivalent of three whole dinners in one sitting and three days worth of fat and sodium. If that seems OK, go for it.

Stop taking advice from your friends. They may mean well, but they aren't facing down death at 37. And yeah, 185, unless you are solid muscle, is way too much for a 5' 9" ex-smoker with heart disease.

Good luck. You can do this, but from what you've said, you really need some formal guidance and an epiphany in the way you view the role of food in your life.
posted by docpops at 8:33 PM on May 16, 2008

Raw fish is problematic in other areas (parasites, mercury). Ok occasionally in small quantities.
posted by stbalbach at 8:59 PM on May 16, 2008

I don't see why you have to lose 30 to 50 lbs- in fact I can't imagine why a fit (you say you exercise regularly) man of 5'9" who weighs 185 would have to lose any weight at all. You didn't have a heart attack because you're morbidly obese and I'd suggest you get a second opinion. Nobody has a heart attack at 37 because he's basically normal weight.

Does your cardiologist say WHY he wants you to lose all this weight? Is he of the opinion that people who are dangerously underweight (as you'd be at 135) never have heart attacks?
posted by ethnomethodologist at 9:46 PM on May 16, 2008

Losing 30 pounds puts him at 155, right in the middle BMI for normal weight. So again, unless you are solid muscle, lose some weight.
posted by docpops at 9:56 PM on May 16, 2008

Elyse Robin is a registered dietician and nutrition therapist in San Francisco who is very skilled and personable. You might find it helpful to see her for a few sessions to make some meal plans. And then you should absolutely enjoy Incanto - it's delicious.
posted by judith at 11:58 PM on May 16, 2008

You should read "Fats that Heal, Fats that Kill," which was linked to by P.o.B. in this recent post on Omega 3's.
posted by holympus at 12:04 AM on May 17, 2008

Losing 30 pounds puts him at 155, right in the middle BMI for normal weight. So again, unless you are solid muscle, lose some weight.

Being 5'9" and 185 puts him at risk of practically zero- being 37 and having a BMI of 27 might be "overweight" on that silly draconian scale, but epidemiologically it's irrelevant. Nobody is having heart attacks at 37 with a BMI that is trivially high BECAUSE of weighing 185. I'll bet that the risk at age 37 for this guy weighing 155 or 185, being active as he is, is zero (or close to it) either way. There has to be some other reason for his heart attack, otherwise half the adult population will be dropping dead by 40. They're not. Being mildly overweight doesn't give people heart attacks, especially when they're active (and can't, then, have metabolic disorder, which is FAR more dangerous than being a little overweight).

Incidentally when my doc and I computed my Framingham risk score at my last medical exam, BMI wasn't even one of the risk factors. Doctors know that only morbid obesity or being UNDERWEIGHT play into this risk independently. Active people who are a little overweight are healtht people, full stop. Your little bit of extra padding is not going to klll you, but heart disease will, and it's not that little extra padding that CAUSED your heart disease at 37- I mean jeez people, use some common sense!

Get a second opinion. Your cardiologist is grasping at straws.
posted by ethnomethodologist at 12:54 PM on May 17, 2008

ethno - you're correct that BMI isn't always useful. Far more relevent in males is waist circumference, which we can't know in this guy.

My point is that, precisely because of the unusual nature of his young-age heart disease (although really not that rare, esp. in a smoker), he needs to come at this like a religious conversion. Most post-MI treatment is meant to stabilize or slow progression of atherosclerosis. He needs to reverse it.

Again, there is no possible way that he will not be at an advantage if he institutes a lifestyle that maintains his weight at 155-165 than his current size. The caloric restriction alone would give him a benefit.
posted by docpops at 7:02 AM on May 18, 2008

my belly doesn't hang over my pants. it's maybe an inch bigger around than my waist, with is 32.5 inches.
posted by luriete at 2:22 PM on July 25, 2008