Broken heart: how diet therapy helps treat heart attack

Cause of heart attack
Broken heart: how diet therapy helps treat heart attack
How diet therapy helps treat heart attack

Many doctors, alas, know the sign of heart problems- How to contain it and not know that the patient can only use water in the first days after a heart attack. what the author of these lines was convinced of a couple of weeks ago when a close relative was admitted to the hospital with acute myocardial infarction. Thanks to the doctors - they saved, extended the lifeline in the palm of another patient. By the way, he is a little over forty, very active, and regularly involved in sports.

Heart disease ranks first among the causes of death in Ukraine. The statistics are depressing: about 40 thousand heart attacks happen every year. This is approximately the entire population of Mirgorod or Podolsk. Human destinies and lives are behind the faceless numbers. It is regrettable, but the heart attack is getting younger. The problem was especially actual during the pandemic because the risk of heart attack against the background of COVID-19 increases. We are used to treating diseases with "magic" pills. Of course, one cannot do without drugs, but few people are aware that diet therapy is the most important and main recommendation in the treatment of all pathologies of organs and systems. Very often, the importance of nutritional therapy is blithely understated.

About how to recognize a heart attack, the peculiarities of the medical nutrition of cardio patients, whether it is possible to influence the "bad" genetics, and what patients need to know after COVID-19 "Rakurs" talked with a candidate of medical sciences, a dietitian at the Heart Institute of the Ministry of Health of Ukraine, the head of the supervisory board of the Association nutritionists of Ukraine Alexandra Kirilenko.

The first three days after a heart attack are the most difficult for the patient and the doctor

  • Alexandra Evgenievna, how can nutrition help in the treatment of a heart attack? What is the most important thing in rehabilitation nutrition for this disease?
  • Nutrition in case of a heart attack is a very relevant topic for every patient and cardiologist conducting a therapeutic appointment. For every healthy person, because absolutely everyone can face it, regardless of age, gender, weight, and lifestyle.
  • Previously, for such patients, the standard Pevzner diet No. 10 was used (Pevzner diet tables are a system of 15 diets, developed at one time by a general practitioner for groups of diseases. -  Ed.). Diet tables took into account only the disease, but not the person as a whole. Now, this is history. At present, nutrition programs are prepared individually by dietitians. The main pathologies and physiological characteristics of the body are taken into account, taking into account the nutritional standards developed by the Association of Nutritionists of Ukraine. For example, a patient has multiple organ pathology, that is, there is a pathology of the heart, pancreas, liver plus kidneys. In this case, not one diet is needed, but diet therapy is selected personally for all nosological units. It is these problems that clinical nutrition is concerned with.
  • If we talk about a heart attack, recovery processes must take place in the heart muscle. It is necessary to improve the process of blood circulation, metabolism, reduce the load on the heart and blood vessels, and normalize the motor activity of the intestines. This is what the diet is aimed at. The most important thing in the process of rehabilitative nutrition during a heart attack is not to force food intake events. In the first three days after a heart attack, it is mainly only warm water.

What is it connected with?

The first three days are the most difficult for the patient and the doctor. Especially if it is an acute myocardial infarction and it is in progress (an attack of angina pectoris in twenty minutes may end with a heart attack, there may be acute conditions - a manifestation of coronary heart disease). Of course, a lot depends on the zone of infarction - transmural, focal, or small-focal. With transmural, a deep lesion occurs with a necrotic area (death) of a large amount of myocardium due to thrombosis of the leading coronary artery. In other words, the blood does not come to this area and a heart attack begins - rupture. In this case, certain biological substances are produced, leading to a violation of microcirculation. Very high lipid peroxidation occurs because the membranes of all cells are damaged. All this gives general intoxication. How does it manifest? Loss of consciousness collapse, acute chest pain. Disturbance of breathing, palpitations, is fraught with death.

What are the signs of a heart attack?

Sharp pain behind the sternum, spreading to the left arm, scapula, lower jaw. The pain is not relieved within 15-20 minutes after taking valid, cortisol, nitroglycerin. I need hospitalization. Urgently! Within two hours - the so-called therapeutic window - such a patient needs to undergo coronary angiography, administer anticoagulants and decide on stenting. And lead such a patient to intensive care. On the first day of a heart attack, in no case should a person be fed.

Why?

- This is a borderline state between life and death, let the body focus on rehabilitation. Only warm, slightly alkaline drinks, for example, "Polyana Kvasova", "Polyana Kupel". If mineral water is not at hand, you can add soda to ordinary drinking water at the tip of a knife. Water is given warm and without gas, two to three sips every couple of hours. Drinking is not plentiful, we do not need to increase the volume of circulating blood. The heart is a constantly working organ that pumps blood like a motor. Here he works to the limit, to wear and tear.

So, for the first three days, the patient drinks only water. During this period, the autophagy process starts. In 2016, the Japanese scientist Yoshinori Osumi was awarded the Nobel Prize for researching the mechanisms of autophagy. An active lysosome is formed, it absorbs all toxic substances, debris of cells, debris of necrotic tissue - the patient's condition improves. In this case, you need to give a sufficient amount of liquid. In addition to slightly alkaline water, it can be a decoction of rose hips, dried fruits - without added sugar.

And if a patient wakes up a strong appetite, he cannot hold out for three days on the water?

In the first three days of a heart attack, the patient should try not to eat. If you really want to, the patient can be given a vegetable soup grated in a blender. Prepare it from potatoes, carrots, pumpkin, a little celery root, you can add amaranth grits. But it is better to refuse white cabbage, you can add cauliflower. In addition to soup, slimy porridge is allowed - it can be oatmeal, buckwheat, or amaranth. The latter is often forgotten. Amaranth groats are well digested because they do not contain gluten. It contains complete plant proteins and squalene, a very powerful antioxidant that helps fight free radicals. In amaranth porridge, you can add, for example, a few drops of linseed or black cumin oil.

Relatives always want to please the patient with their favorite dishes.  How does a heart attack survivor's diet change over time?

In case of a heart attack, it is worth carefully discussing with the doctor everything that the patient is going to eat. A dietitian should schedule all meals in parallel with the resuscitator. After a heart attack, the energy content of the diet is significantly reduced - a decrease in protein in the diet, carbohydrates, and fats are minimized. The use of salt, spicy, fried, fatty, pickles is excluded.

So, in the first three days  - only warm drink, we let the body adapt to a difficult situation. Then, fractional meals are recommended, that is, in small portions 5-6 times a day. These should be well-cooked, stewed, chopped dishes. Served to the patient at a comfortable temperature - warm, but not hot or cold. This can worsen the course of a heart attack.

The first week after a heart attack is an acute period. The patient can eat mashed vegetable puree soups, grated whole grain cereals, low in gluten (to avoid fermentation). Amaranth, oatmeal, or buckwheat is cooked and ground with a blender, with a small addition of butter (melted). A ready-made formula for resuscitation patients (for example, Nutrition) can be added to the diet. The daily diet should not contain more than 30-50 grams of protein (mainly due to vegetable proteins contained in cereals, vegetable soups, in no case in broth!). Carbohydrates - 150 grams. Not more than 30 grams of fat - vegetable polyunsaturated - about 3 dessert spoons.

The second or third week after a heart attack is a subacute period. The use of chopped food is allowed, not as homogenized as in the first stage. The number of protein increases (60-70 grams), fat - 50-60 (unsaturated, polyunsaturated), complex carbohydrates - up to 250, excluding sugar. From about the third week, you can add salt to food. But no more than 3 grams of salt per day.

The fourth week - scarring stage... You can already eat food cut into small pieces. The diet includes white meats (turkey, chicken, rabbit), but it is better to start with white varieties of fish (cod, dorado, trout, pollock). But the red one should be abandoned because industrially grown redfish contain toxic substances. I especially want to note the rich in omega-3 fatty acids mackerel, herring, mackerel. They help both in the prevention of heart attack and in its treatment. Omega-3 - modifiers of cell membranes, also affect the blood coagulation system - have an anticoagulant effect. Omega-3 is the collective name for fatty acids. Fish and seafood contain EPA (eicosapentaenoic) and DHA (docosahexaenoic) fatty acids. And in flaxseed, for example, the vegetable alpha-linolenic omega-3. I advise you to also include 2 tablespoons of ground flax seeds in your daily diet, it is healthy and tasty with bioyogurt or bio kefir. Opt for polyunsaturated vegetable fats - rapeseed, olive, flaxseed, sesame, black cumin oil, and amaranth. Rapeseed oil is an excellent antioxidant, with a very high content of alpha-linolenic acid, which reduces lipid peroxidation.

You can use drugs with omega-3, therapeutic doses of which are selected individually. General recommendations are as follows: 600-800 mg per day, long-term intake. Omega-3 is well combined with drugs prescribed by the doctor, anticoagulants, which allow you to adjust their dose.

It is important not to bake meat and fish in a piece, but to cook it in the form of a soufflé. Don't forget the eggs! They do not raise the level of atherogenic cholesterol as previously thought. The eggs were "rehabilitated". It is better to give preference to quail, be sure to boil it a little (eat 2 eggs a day).

We begin to replenish the body with potassium and magnesium. A diet rich in boiled, stewed, baked vegetables and fruits (baked apples, pumpkin, root vegetables) will help. The so-called Strazhesko mixture is very useful. Grind soaked dried apricots, raisins, nuts, honey, and lemons without skin and take 2 tablespoons a day (store in the refrigerator).

After a heart attack, you will have to forget about Armenian and Georgian cuisines

What foods do you advise to add to your diet for those who have experienced a heart attack, and what is absolutely forbidden?

it is forbidden to eat foods that are difficult to digest, cause fermentation in the intestines, provoke flatulence. Cholesterol-rich foods are offal (liver, heart). Animal fats and sugars are also excluded. A ban on extractives - broths, decoctions, jellied meat ... Milk jelly on gelatin or agar-agar is allowed. It is useful to add vegetable or fruit puree from baked apples, pumpkin, blueberries, and black currants to the jelly (they contain bioflavonoids).

A month after a heart attack, secondary chicken broth can be added to the diet to help fibroblasts in the scarring stage.

The diet of a patient who has experienced a heart attack should contain lipotropic substances. These are vitamin C, potassium, products that stimulate intestinal motor function - prebiotics and probiotics. Probiotics are bifidum and lactobacilli contained in yogurt cultures - booker, biorezonanca, bioyogurt. They must be fresh, no more than three days old. The best option is a product prepared by yourself in a sourdough yogurt maker. Prebiotics are a substrate for the growth of normal intestinal microflora. Fiber or pectin can be added to yogurt.

Add quercetin-rich foods to your diet. This polysaccharide reduces lipid peroxidation. Quercetin is found in apples, red paprika, and pomegranate. Most of all quercetin is found in Jerusalem artichoke (earthen pear), as well as in celery root. You can boil and make mashed potatoes from them, and after the third week of a heart attack, including in food and freshly grated. There are also Ukrainian-made quercetin preparations (quercetin or water-soluble corvette) on our market.

How long should a patient follow a medical diet after a heart attack?

A healthy diet with limited salt should be lifelong. The so-called DASH diet is most suitable for cardiac patients. This diet consists mainly of whole grains. It contains a lot of potassium and magnesium, a little protein, fermented milk products. You can eat any fruits and vegetables, except hot peppers, ginger, which can provoke angina attacks. After a heart attack, you will have to forget about Armenian and Georgian cuisines. Spicy foods can cause arrhythmias, so cardiac patients should refrain from them.

How often does the next one happen after the first heart attack?

Much depends on the lifestyle, food style. Sometimes people just stop taking their prescribed drugs. For example, if there was stenting, then most often the life-long intake of thrombolytics is added to the treatment. Diet is the foundation. If the doctors got you out of the afterlife, gave you another chance at life and you left the hospital with your own feet, you need to completely change your lifestyle

What about physical activity?

Dosed physical activity is encouraged. Not weightlifting, not a gym. Aerobic exercise in the fresh air. Better to give preference to walking at a moderate pace, Nordic walking with sticks

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