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Living with diabetes – Looking after your heart

What can I do to keep my heart and circulation healthy?

The most important things you can do are to stay or become active, eat healthily, and stop smoking and lose weight if you need to. Also, take any prescribed treatment to help keep your blood glucose, blood pressure, and cholesterol levels within healthy limits.

I’ve had so much advice about what to eat – what are the most important things to remember?

Eating healthy types of fats, for example, monounsaturated fat rather than saturated fat, and limiting your overall fat intake will help protect your heart. High-calorie foods can cause weigh gain, which in turn will increase your risk of heart disease, so trying to keep your calorie intake within the recommended limits will help. If you have high blood pressure, keep the amount of salt you eat to a minimum. Foods that are rich in fiber and antioxidants, such as fruit, vegetables, whole grains, and legumes, can provide some protection against heart disease.

What sort of exercise will help reduce my risk of heart disease?

Any aerobic activities – these that increase your heart rate and make you feel warm and slightly out of breath – such as walking, swimming, or digging the garden, are all good for your heart. If you already have a heart problem, physical activity is likely to improve your health, but your health professional can help you decide which activities will most benefit you.

What help can I get to stop smoking?

Your doctor can help you find local programs to help you stop smoking. Such programs may necessitate regular attendance, and you may be asked to talk about how you are coping, or you may be offered information about using nicotine replacement therapy (such as patches or chewing gum) to help deal with your cravings. You can also buy self-help books that you might find useful.

My doctor has prescribed eight different pills. Do I really need to take all of them?

Type 2 diabetes is a complex disease and you probably have a number of conditions: a high blood glucose level, high blood pressure, and a high level of blood fats, often accompanied by being overweight. Each one of these increases your chance of developing heart disease, so you may have been prescribed pills for each of these. You may need two or more types of pill just to control your blood glucose level and possibly insulin as well; you may need three or more different types of pills to treat your blood pressure; and you may need more pills to lower your blood fat levels. In addition to these, you may be prescribed aspirin to protect your heart, and pills to reduce your appetite.

I’ve already had a heart attack. Is there any point trying to keep healthy?

Your heart attack shows that heart disease has already done some damage, but taking steps toward better health will prevent this from getting worse and improve the health of your heart. Taking action now, such as becoming more active and giving up smoking if you smoke, will greatly reduce your chances of having another heart attack or a stroke. Your heart is able to recover, and each step you take toward healthier living will help.

Food and drink for diabetes

Eating healthily is one of the main ways in which you can manage your diabetes and help keep your heart and blood vessels working efficiently. You may be overweight if you have Type 2 diabetes. If you want to lose weight, it’s good to know which foods to choose.

Types of food

What different types of food are there?
There are a number of main food types that, in combination, provide a healthy and balanced diet.

Why is it important not to eat too much salt, sugar, and fat?
Eating too much salt increases your risk of high blood pressure or makes high blood pressure worse if you already have it. Too much sugar can cause you to put on weight and make it more difficult for you to control your blood glucose level. Fat is high in calories and eating more than the recommended amount can lead to weight gain. Eating too much saturated fat also increases your risk of heart disease.

What are antioxidants?
Antioxidants are a group of healing substances found in foods. Vitamins A, C, and E, beta-carotene, and selenium – as well as many substances found in plants (phytochemicals) – have an antioxidant action. Eating foods that are rich in antioxidants has many health benefits, including protecting you from heart disease.

Can I take pill supplements such as fish oils, vitamins, and minerals?
You can, but a balanced and varied diet will provide all the nutrients you need to stay healthy. The only reason you might be advised to take nutritional supplements is if your healthcare team have diagnosed a deficiency. If you believe that you are deficient in a particular nutrient, your health professional will discuss possible actions with you.

Eat to Cut Your Risk for Heart Disease

Check out your pantry. Take stock of your fridge. Experts believe what you eat can play a critical role in cutting your risk for heart disease. As part of our special report, “Healthy Cooking,” here’s what it took for one couple to have a change of heart.

Carol Pock enjoys teaching others the dos and don’ts of eating healthy. She’s a breast cancer survivor, but it was her husband’s illness that changed her life.

“I used to say to Carol, “The world is full of good things to eat, and I’m going to have my way with them all,” and that was wrong. That statement actually almost took my life,” says her husband, Les.

After a scare with heart disease, they made a drastic change. Carol spent years doing research and is now a wellness consultant.

“A lifestyle change doesn’t have a beginning, middle and an end,” explains Carol. It’s ongoing, and every day you get to start again.”

Carol’s written a cookbook that outlines six steps to heart-healthy eating called Recipes for the Heart, Morsels for the Soul.

“We’re looking at five servings a day of fruits and vegetables. They have been known to be fantastic for prevention for heart disease,” she says.

Some are also known as good sources of anti-oxidants, foods rich in vitamins A, C and E.

Carol says, “Another thing: We want to cut down on that saturated fat. You want to eat peels, seeds, anything that adds fiber that makes it easier for the body to digest foods.”

She also suggests cutting down on salt and processed food, but that doesn’t mean cutting out taste, as she shows her classes when she makes fruit trifles.

Lou says, “I can’t imagine cooking the way I did before. It just doesn’t taste good anymore. I feel better when I cook healthy.”

Carol says abstain from alcohol when possible, and she stresses regular exercise is always important to maintain a healthy lifestyle.

Diet and Lifestyle Prevention Recommendations for Cardiovascular Disease

In 2006, the AHA created diet and lifestyle recommendations to reduce the risk for or manage cardiovascular disease in adults and children over the age of 2. Here are some highlights of their recommendations:

• Balance calorie intake and physical activity to achieve or maintain a healthy body weight.
• Consume a diet rich in fruits, vegetables, whole grains, and other high-fiber foods; high-fiber diets can reduce cardiovascular disease risk by decreasing cholesterol production in the body and increasing removal of harmful cholesterol from the body. High-fiber diets can also slow the progression of cardiovascular disease in those at high risk.
• Eat fish, especially oily fish, at least twice a week (for a total of about 8 ouces); fish provides the omega-3 fats EPA and DHA, which can lower the risk of both sudden death and death from cardiovascular disease. For those with cardiovascular disease, the AHA recommends 1 gram of EPA and DHA from fish and/or fish oil supplements. For those with hypertriglyceridemia, the AHA recommends 2-4 grams of EPA and DHA from supplements (in capsule form). Be sure to consult a physician before you take fish oil supplements.
• Limit saturated fat intake to less than 7 percent of total calories, trans fat intake to less than 1 percent of total calories, and dietary cholesterol to less than 30 mg per day.
• Minimize intake of beverages and foods with added sugars.
• Choose and prepare foods with little or no sodium.
• If you consume alcohol, so in moderation (up to 1 drink per day for women and up to 2 drinks per day for men).

Consuming foods that are naturally rich in and enriched with plant stanols / sterols can reduce the absorption of cholesterol to lower total and LDL cholesterol levels. According to the AHA, maximum effects are seen with intakes of 2 grams per day of plant stanols. Those who reduce their cholesterol levels by taking plant stanols and sterols will need to consume them each day to maintain their benefits.

Following the previous recommendations and those of MyPyramid can reduce the risk for cardiovascular and other diet-related diseases by promoting weight loss, reducing LDL cholesterol and triglycerides, and raising HDL cholesterol.

Those with diagnosed cardiovascular diseases or with risk factors such as high total and/or LDL cholesterol levels can also be prescribed medications as part of treatment, and many (or all) work more effectively when taken as part of an overall healthful dietary pattern.

Coronary heart disease (CHD) is a condition in which coronary arteries, which carry blood to the heart, are narrowed so much they may slow or stop blood flow to the heart.

Myocardial infarction (MI), or heart attack, occurs when blood flow to the heart is blocked.

Angina pectoris, or angina, is chest pain that occurs when the heart can’t get enough oxygen from the blood. It is a common symptom of CHD.

Heart failure resulting from a cardiac disease, which compromises ventricular systolic or diastolic function, or both. Heart failure results when the heart is unable to generate a cardiac output sufficient to meet the demands of the body without unduly increasing diastolic pressure. Heart failure can be of the body without unduly increasing diastolic pressure. Heart failure can be manifested by symptoms of poor tissue perfusion alone (for example, fatigue, poor exercise tolerance, and confusion) or by both symptoms of poor tissue perfusion and congestion of vascular beds (for example, dyspnea, chest rales, pleural effusion, pulmonary edema, distended neck veins, congested liver, and peripheral edema).

Plaque is made up of cholesterol, fat, and other substances that build up on the inner walls of blood vessels.

Cardiomyopathy is a weakening or change in the structure of the heart muscle; it often manifests as inadequate heart pumping or other problems with heart function.

Lipoproteins are made up of lipids, and protein; they dissolve in water and carry cholesterol through the blood and around the body either to or from blood vessels.

Refined carbohydrates are simple sugars or starches that have undergone processing.

The National Cholesterol Education Program (NCEP) – created in 1985 by the National Heart, Lung, and Blood Institute (NHLB) – provides information for educators and the public to reduce the number of Americans with high blood cholesterol and prevent illness and death from CHD.

Inflammation is the body’s response to injury or infection both externally and internally.

Hypertriglyceridemia is elevated blood triglycerides (blood fats).

Plant Stanols / Sterols are beneficial compounds found naturally in small amounts in plant foods that block cholesterol absorption.

Dietary Cholesterol

Dietary cholesterol is a fatlike substance found only in animal foods such as organ meats, egg yolks, fish and shellfish, beef and poultry, and dairy products. Plant foods do not naturally contain cholesterol.

You might be surprised to learn that although most foods that are high in cholesterol are also high in total fat and saturated fat, some low-fat foods such as shrimp and squid are also high in cholesterol; other shellfish contain lower amounts of cholesterol. Organ meats contain extremely high levels of cholesterol – 3 ounces of beef brain, for example, contains a whopping 1,696 mg cholesterol!

Although it might have less of an impact than high intakes of saturated and trans fats, too much dietary cholesterol can increase serum or blood cholesterol levels. When too much cholesterol builds up in blood vessel walls, it’s hard for blood to travel through the body and can cause a heart attack or stroke. When blood vessels that lead to the heat or brain become blocked, a heart attack or stroke can occur.

Some people in particular experience wide swings in their blood cholesterol levels in response to consuming varying amounts of dietary cholesterol. Although there’s not test to identify who is sensitive to dietary cholesterol, it’s prudent for all of us to limit or reduce our intake of dietary cholesterol.

Serum or blood cholesterol is cholesterol that circulates in the blood stream. Although most is made by the liver, some is obtained from the diet. Two main types of serum cholesterol include LDL (low-density lipoprotein cholesterol, also known as “bad” cholesterol) and HDL (high-density lipoprotein cholesterol, also known as “good” cholesterol).

Heart attack, also known as myocardial infarction (MI), occurs when blood flow to the heart is blocked.

Stroke, also known as a cerebrovascular accident (CVA), occurs when blood flow to the brain is blocked; this causes brain cells to die because they don’t’ get enough oxygen.

Daily Fat and Cholesterol Recommendations

The Institute of Medicine’s dietary reference intakes (DRIs) recommend acceptable macronutrient distribution ranges (AMDRs) for fat for children and adults. These ranges of daily fat intake (expressed as a percentage of total calorie intake) that provide enough fat to meet individual needs while reducing the risk of chronic disease:

• Children from 1 to 3 years old – 30-40 percent of total calorie intake from fat
• Children from 4 to 18 years old – 25-35 percent of total calorie intake from fat
• Adults from 19 to 70 years and above – 20-35 percent of total calorie intake from fat

The DRIs also recommend specific amounts of total fat (in grams) infants should consume each day; these estimated needs are based on adequate intakes (AIs), average intakes of dietary fat by most healthy infants:

• Infants 0 to 6 months – 31 grams of fat
• Infants 7 to 12 months – 30 grams of fat

Monounsaturated Fat

Although there are no specific DRIs for monounsaturated fats, the National Cholesterol Education Program Expert Panel on the Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) recommend up to 20 percent of total daily calorie intake to come from monounsaturated fats.

Polyunsaturated Fat

The Institute of Medicine’s DRI recommends a range of intake (expressed as a percentage of total calorie intake) for linoleic acid (an omega-6 PUFA) and alpha linolenic acid (an omega-3 PUFA) for children and adults as follows:

• Linoleic acid (LA) – 5-10 percent of total calories
• Alpha-linolenic acid (ALA) – 0.6-1.2 percent of total calories

Although there are no specific recommendations for EPA and DHA (the omega-3 fats found in fish), the American Heart Association (AHA) recommends everyone eat at least two fish meals (about 8 ounces cooked) each week, which provides about 500 mg/day EPA and DHA.

Saturated Fat

Dietary Guidelines for Americans and the AHA recommends that Americans should consume less than 10 percent of total calories from saturated fat. The AHA also recommends those with elevated bad LDL cholesterol (> 130 mg/dL) to aim for less than 7 percent of total calories from saturated fat.

Trans Fat

Although the current Dietary Guidelines for Americans recommend that people limit their intake of trans fats, and the Institute of Medicine’s DRIs recommend that trans fat intake should be as low as possible, the AHA has set a firm guideline for daily intake of trans fats. Based on their recent 2006 Dietary Guidelines, the AHA recommends that less than 1 percent of total calories should come from trans fats. That equals 1-3 grams of trans fat a day. Here are individual recommendations based on yoru daily calorie intake:

• If you consume 1,000-1,200 calories a day, consume no more than 1 gram per day.
• If you consume 1,400 calories a day, consume no more than 1.5 grams per day.
• If you consume 1,600-2,000 calories a day, consume no more than 2 grams per day.
• If you consume 2,200-2,400 calories a day, consume no more than 2.5 grams per day.
• If you consume 2,600 calories a day, consume no more than 3 grams per day.

Dietary Cholesterol

Dietary cholesterol is not something we need to consume; our bodies produce about 1,000 mg each day to meet our daily needs. Despite this, it would be very difficult for all but those who follow a vegan diet to eliminate dietary cholesterol from their diets.

The current Dietary Guidelines for Americans recommend a cholesterol intake of less than 300 mg per day. Less than 200 mg (or even less) is recommended for those with elevated LDL cholesterol level (> 130 mg/dL) or those diagnosed with heart disease.

A vegan diet is one that excludes all animal-derived foods (including meats, eggs, diary products, and foods made with animal fats).

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