* * Anonymous Doc

Saturday, July 16, 2011

Dietary Changes

"So, we're releasing you from the hospital, but that doesn't mean you're well. Your heart failure is only going to improve with changes to your diet. And because you also have diabetes, it's very important to understand the types of food that are good to eat, and what you should avoid."

"Oh, we know a lot about nutrition. We read labels."

"That's great. So you know how many calories you should be eating in a day."

"Yep, three meals a day."

"I asked about calories."

"Yeah. I can't remember the number. Fifty?"


"Five thousand."

"No. Two thousand calories a day."

"Okay. Gotcha."

"And one of the biggest things is going to be really limiting the salt intake."

"We know, absolutely. We never put salt on anything."

"It's not just about adding salt. It's also about foods that already have salt. Canned food, restaurant food--"

"The restaurants we go to don't use salt."

"Most restaurants use a surprising amount of salt."

"No, we go to good places. Cheesecake Factory, California Pizza Kitchen, Wendy's..."

"All of those places serve very unhealthy food, that has a lot of salt. You need to look at the nutritional information on line. You should not be having more than 2,000 milligrams of sodium per day, or more than the recommended amount of cholesterol."

"We never have cholesterol."

"Do you eat red meat?"

"What do you mean?"

"Beef, lamb--"

"Yeah, but it's not red after we cook it."

"Sure, but it's called red meat. You have to really limit your beef intake. Think fish, think chicken."

"But veal is okay, right?"

"Veal is from a cow, like beef."

"But it's not red."

"It still has a lot of cholesterol. You need to not eat veal regularly."

"Are you sure veal is from a cow?"


"It doesn't seem like it."

"It's from a baby cow."

"And babies still have cholesterol?"

"They do."

"But chicken is okay?"

"Skinless chicken breast, grilled or steamed, is okay."

"And other things from chickens?"

"What do you mean? Chicken liver is high in cholesterol--"

"Eggs are okay, right? We really like omelets."

"You can have egg white omelets."

"What about the yolks?"

"They have a lot of cholesterol."

"But sometimes is okay?"

"In moderation."

"We usually have an omelet for breakfast."

"You need to use egg whites only."

"So a three-egg omelet for breakfast isn't good?"

"No, not at all. You need to look at the labels. One egg has almost a full day's worth of cholesterol."

"I don't think there's a label on our eggs."

"Well, I'm telling you eggs have a lot of cholesterol."

"What if we stop having veal in the omelet?"

"You still have to switch to egg whites only."

"When we go to Wendy's, we get the bacon, egg and cheese on a bagel. I don't think there's three eggs in that."

"Everything about that meal is bad for your heart, and your diabetes. The egg, the cheese, the bacon, and the bagel. You should not go to Wendy's."

"What if I get the salad?"

"The dressing is often very salty and fattening. You should be making your own foods at home, and trying to avoid most restaurant meals, because you never know what they're putting in there."

"But we can't have chicken every day."

"Chicken, fish, vegetables, fruit, beans that aren't from a can, unsalted nuts, tofu, there are a lot of healthy choices."

"But we like to go to restaurants."

"Your heart muscle is very weak. You have to make these changes if you want to live for years to come."

"But what if we just don't add any salt to our omelet?"

"That's not enough."

"Pork chops are okay?"

"They're not great."

"What if we get the ones without the bone?"

"That doesn't make a difference."

"Sure it does. The boneless ones are healthier, aren't they?"

"You're thinking of things that are skinless, not boneless."

"So bones are okay, but not skin."

"You should try to limit the amount of meat you are eating."

"What about vegetable skin, and fruit skin?"

"That's fine."

"So apple skin is okay even though the cholesterol?"

"There's no cholesterol in apple skin."

"Okay, I'll write that down."



  1. Written lists can be really helpful in situations like this. Even better would be a sample menu, perhaps even with recipes, or book suggestions where the information can be found. It's overwhelming to change your entire lifestyle - and people who often eat in restaurants are in need of a dramatic lifestyle change.

    My MIL thought that using half-and-half instead of cream on their breakfast cereal was low-fat/low-cholesterol.

  2. This is where writing a rx for Kayln's Kitchen saves lots of time (her food is South Beach which is low fat and cholesterol conscious).

    Not affiliated with the site in any way, it's just one of the more comprehensive low carb recipe sites online. And most docs like low fat low carb (although I am not a fan of low fat).


  3. Wow, so many dietary issues to latch on to here.

    Regarding salt intake, the newest cochrane review (http://onlinelibrary.wiley.com/o/cochrane/clsysrev/articles/CD009217/frame.html) found no evidence to sustain the recommendations you are making. Actually the only included study concerning dietary salt restrictions in patients with heart failure found a small but significant increase in all-cause mortality in the patients on low-sodium diets.

  4. It must be really hard to tell a patient whose quality of life has been curtailed by illness that his engagement with one of the few things that still gives him pleasure -- food -- has to be modified. This blog is also awesome because it highlights the non-obvious elements of healthy eating -- what the heck *is* red meat? and if it looks healthy, how can it be toxic?