Diet taboos for coronary heart disease

After being diagnosed with coronary heart disease, there are three types of foods that must be avoided, namely processed foods containing trans fatty acids, excessive amounts of refined free sugars, and excessive daily sodium intake.； The intake of saturated fat and alcohol must be strictly controlled. At the same time, the two common dietary misunderstandings of overeating and extreme vegetarianism must be avoided. There is no need to overeat or eat and drink indiscriminately.

Don’t believe it. Last month, I just received a 62-year-old patient for review after stent surgery. His blood lipids have been well controlled for more than half a year. However, in the past two months, I went to the park entrance every day to buy 3 boxes of cream puffs for 10 yuan for afternoon tea. This time, the low-density lipoprotein soared to 3.8mmol/L, and the angiogram showed that the original location where the stent was placed was blocked by 15%. The trans fatty acids hidden in cheap butter, crispy bread, and old oil that has been used to fry fried dough sticks over and over again are, to put it bluntly, "pasting cement" on the blood vessel walls. The artificial structure is difficult to be metabolized by the body. If it accumulates, it will block the blood vessels. Don't touch this kind of thing more than once.

At this point, many people may ask, does that mean we should stay away from all fats? When many of the patients I came into contact with were first diagnosed, they even picked out the yolks of boiled eggs and threw them away. They only dared to boil them in water when cooking. In fact, it was completely unnecessary. Interestingly, the academic community’s attitude towards saturated fat has been changing in recent years. The traditional view is that patients with coronary heart disease should consume less than 7% of their total calories from saturated fat. However, a follow-up study published by the New England Journal of Medicine last year showed that the relationship between natural sources of saturated fat, such as fat and butter, and cardiovascular adverse events is not as strong as previously thought. On the contrary, refined carbohydrates are much more harmful. I usually tell patients that they don’t have to give up braised pork completely. It’s perfectly fine to eat one or two pieces at a time to satisfy their cravings. Just don’t drink the oily soup floating on it. On the contrary, patients who eat white rice, white steamed buns and gruel all the time will have large blood sugar fluctuations and a higher risk of vascular endothelial damage.

By the way, the most overlooked thing is actually the intake of invisible sodium. Many patients went home and said that they did not add salt at all in their cooking, but their blood pressure still fluctuated. After asking, they found out that they should put two tablespoons of light soy sauce in every meal, and even eat pickled radish with rice. You may not know that the sodium content of a takeaway braised chicken is close to the recommended daily amount for adults, not to mention the invisible salt hidden in noodles, bread, chicken essence, and oyster sauce. It is best for patients with coronary heart disease not to exceed the daily total sodium intake. If it exceeds 2000mg, it is about 5g when converted into table salt, which is about the amount of a beer bottle cap. If you add light soy sauce or oyster sauce when cooking, you should add less or even no salt. It is best not to touch high-sodium foods such as bacon and pickles. I once had a 70-year-old patient who had been eating pickled dried radish for half his life. Later, he was advised to stop completely. He even reduced his antihypertensive pills by half, and his symptoms of chest tightness were reduced by more than half.

There are also many people who fall into the trap of refined free sugars. For example, they drink honey water every day for laxatives, eat half a catty of lychees and mangoes every day, and even think that freshly squeezed juice is healthy and drink two cups a day. These free sugars rise quickly and can directly damage the vascular endothelium, which is especially important for patients with coronary heart disease and diabetes. Of course, there are different opinions here. Some nutritional schools believe that the dietary fiber in whole fruits can delay sugar absorption and does not need to be deliberately restricted. However, in clinical practice, we have seen many patients who eat high-sugar fruits every day, which leads to excessive blood sugar. My suggestion is that for fruits with high glycemic index, such as lychees, mangoes, and watermelons, eating two or three pieces or one or two pieces at a time is enough. Don’t eat them in a bowl. It is better to eat the whole fruit directly with freshly squeezed juice, which can reduce the intake of a lot of free sugar.

As for the often asked question "Can drinking a small amount of red wine soften blood vessels?", now the WHO has made it clear that even a small amount of alcohol can increase the risk of cardiovascular events. For the so-called resveratrol in red wine, you have to drink more than a dozen bottles a day to achieve the effective amount. There is no need to take this risk. I went to three emergency rooms during the New Year's Eve last year. They all recovered well after stent surgery and I thought I was fine. I drank two taels of white wine at a friend's party, and the pain came directly from my chest. I should try to stop drinking if I can. If I really can't let it go, just take a sip and forget about it. Don't make fun of your blood vessels.

To be honest, I have been practicing cardiology for so many years, and I have seen too many patients who either go to extremes and dare not eat anything, and end up so thin that they stagger when walking. Poor immunity is prone to problems, or they eat and drink too much and end up in the hospital three times a year. In fact, there are not so many black and white rules when it comes to diet. The core is to screen out those things that are clearly harmful to blood vessels. The rest should be done in moderation. Occasionally, if you are craving for a piece of cream cake or two bites of braised pork, you don’t have to feel any psychological burden at all. After all, a good mood is as good for the heart as eating less meat.