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Berwick Area Heart Support Group
August 2007 newsletter
Next meeting Wednesday August 1st at the day Hospital, Berwick Infirmary from 7.00pm – 9.00pm Guest speaker:Katie Kennedy. Katie is a State Registered Dietitian based in the East Midlands, and is employed by Alpro Soya. Katie will give a presentation on 'healthy eating for a healthy heart' - 'food for your heart', to include the science behind health claims for functional foods such as soya in heart health and cholesterol lowering.There will also be samples of soya foods for you to try if desired.
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At our last meeting on 4th July 2007, Mandy Thompson, Practice Nurse at Well Close Surgery, gave us deeper insight into aspects of her work, as Cardiac Rehab Nurse at the practice and working with the Cardiac Rehab. Unit at the Swan Centre.
Mandy did give us a talk in Jan. 2004 when things were very new. This time she told us how things had progressed and where changes had been made. Most of the following information is gleaned from the question and answer format the evening took.
Stroke victims are now within Mandy’s remit as strokes like heart events are mostly caused by a blockage in a blood vessel (artery) causing tissue to suffer beyond the point of the blockage/restriction.
Statins are proving very effective as they are very good at sealing or stabilising the risky plaque on the artery walls. Statins chiefly help reduce our cholesterol level, which incidentally is recommended at 5 or less, but a consensus of medical opinion suggests this figure may soon be 4
There are a large number, around 1200, of patients with vascular (blood vessel ) problems attached to the Well Close Surgery. Mandy did not know the numbers for Union Brae.
The Rehab Unit commenced in September 2003, and is held on Tuesdays and Thursday
The exercise programme involves and extends the exercises from the heart manual, which many of us might remember, although I think Mandy did say that some of it had changed. The programme includes both cardiovascular and more relaxing recovery type exercises, and the meeting on Thursdays involves a health talk. Referrals are still made by local Doctors, and hospital Chest Pain Clinics. It covers North Northumberland, and is now beginning to stretch up through the Borders, with referrals from the Borders General.
Mandy said that her work now includes all aspects of Cardiac enquiries, including the yearly ‘MOTs’, many of us already get in addition to the usual checks, ie checking medicines, blood pressure, cholesterol levels, (and that we have a pulse!). There are now kidney and liver function tests in order to ensure that both are working correctly. Kidneys, like the heart can be affected by blood vessel problems and the liver also needs a check because some of our daily pills, especially the ‘statins’ work directly on the liver to inhibit the enzyme releasing cholesterol. To prepare for the tests, when attending the surgery for your ‘MOT’ you will be asked to bring a urine sample, which is checked for any blood or protein, and other indicators used for the calculating of kidney function.
Angina is now included in cardiac rehab, with preventative and lifestyle advise.
Running alongside this work is an Angina Support Programme, with preventative and lifestyle advice.
Mandy did read out a passage from the British Heart Foundation booklet, entitled “Cardiac Rehabilitation… recovery or bypass” this is a quote by a Professor Bob Lewin, of the European Society of Cardiology in Amsterdam.
“If there were a pill that cost very little, reduced cardiac deaths by 27%, improved quality of life, and reduced anxiety and depression, every cardiac patient in Europe would be expected to take it. There is no such pill, but taking part in a cardiac rehabilitation programme can provide all these benefits. In the UK only a small number of those in need are offered the chance to take part”
The booklet does go on to say that unfortunately it is a postcode lottery as which areas receive this. Berwick has therefore won the lottery because it is available here in Berwick
Four points raised in the booklet, but also asked in a slightly different way were.
Can it reduce direct costs and readmissions to hospital?
Rehab. showed a cost saving of 30% in unplanned readmissions to hospital. This was dependant on the quality of the rehab.
How much does it cost per patient?
The National Audit Office of Cardiac Rehab. found in 2005/6 that the average cost was £413, which incidentally was cheaper than the average holiday for the same period.
How does the cost compare with other cardiac treatments?
A single day in coronary care costs £1400, an angioplasty £3000, and by-pass surgery £8000.
The booklet covers all aspects of Cardiac Rehab, with many, many more questions answered, if you want a copy they are available from British Heart Foundation. (If you want the Group to get some copies, let us know. Ed.)
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Healthy Eating for a Healthy Heart
Raised cholesterol remains one of the biggest risk factors for heart disease. It is known that over 80% of men and women aged 45-64 have cholesterol above the recommended upper limit of 5mmol/L (British Heart Foundation statistics). However, the current dietary & lifestyle recommendations to promote a healthy heart are aimed not just at lowering cholesterol – instead they focus on a ‘cardioprotective diet’ – ie a diet that will keep the heart healthy from many different aspects. In addition to cholesterol-lowering advice, this includes advice to keep blood pressure and weight in check, improve the health of blood vessels and reduce clotting and narrowing of arteries. I use the word ‘diet’ loosely since it is often the case that those who have ever tried to follow a ‘diet’, feel defeated from the outset! Changes to what you eat should be gradual manageable and realistic if they are going to be maintained. Research tells us that the greatest improvement in health for people who manage to reduce their cholesterol is seen in those who maintain this reduction over at least 2 years.
So what do the experts recommend? Firstly you should aim to reduce your intake of saturated fat and replace this with unsaturated fats – either polyunsaturated or monounsaturated. Saturated fats are found in animal products such as full fat dairy products – including full fat milk, cheese and butter, processed meat (e.g sausages, burgers, faggots and corned beef), and baked foods (e.g cakes, biscuits and pastry). Polyunsaturated fats are found in sunflower/ rapeseed/ soya and walnut oils and spreads made from these, nuts and seeds. Monounsaturated fats are found in olive oil and olive oil spreads. Therefore a practical way to follow this advice would be to choose low fat dairy foods – either skimmed or semi-skimmed milk/ soya milks, remove all visible fat from meat, use lower fat cooking methods (such as grilling or frying) and reduce the amount of biscuits and pastries eaten. Changing your spread and cooking oil to a healthier version based on unsaturated fat & using this in place of butter/ lard in baking is also a good idea. This change in the type of fat you eat will help to reduce the ‘bad’ cholesterol in your blood (called LDL cholesterol) which sticks in arteries to cause blockages (atherosclerosis).
Other changes you could consider making to your diet include increasing your intake of omega-3 fats – a type of polyunsaturated fat with extra heart health benefits. The names of these omega-3 fats are often shortened to ‘EPA’ and ‘DHA’. The richest source of EPA and DHA is oily fish. It is recommended that you aim to consume 2 portions of fish per week, one of which should be an oily fish such as Mackerel, sardines, pilchards or salmon. If you have suffered a heart attack you may benefit from additional omega-3 fats, eating 2-3 portions of oily fish per week or if this is not possible, taking a fish body oil supplement providing 0.5-1g EPA and DHA per day. Fish liver oil supplements often do not contain enough EPA and DHA in the doses recommended, therefore it is wise to consult a pharmacist or your doctor to advise on the best brand of supplement should you wish to take one. This advice has been shown to reduce deaths from heart disease as omega-3 fats can reduce blood clotting and swelling in the body.
Eating plenty of fresh fruit and vegetables – at least 5 portions per day seems like a difficult task for some. A few simple steps to achieving this include; adding extra fresh or dried fruit to cereals, adding chopped peppers/ courgette/ peas/ carrots to casseroles and stews and using tinned fruit as a pudding (see recipe idea at the end of this article). Fruit and vegetables are rich in antioxidants which help to protect the heart and blood vessels from damage, they are also a good source of soluble fibre which can help reduce cholesterol levels.
Too much salt can increase your blood pressure which can damage your heart and blood vessels. Try to avoid adding salt at the dinner table and use herbs/ spices, lemon juice and garlic to flavour your food instead. Avoid eating too many processed or packet foods such as instant soups and sauces, and salted snacks. Read labels more often when you are buying your food – try to avoid foods that contain more than 0.5g sodium per 100g.
What about the ‘W’ word?! If there was a quick and easy way to help people lose excess weight, dietitians everywhere would delight. However, shedding extra pounds or simply keeping your weight stable requires motivation and effort. Some simple steps to get you started include: Reduce your portion sizes – try using a smaller plate and always fill 1/3 of your plate with vegetables or salad – these will fill you up and provide extra vitamins too! Including more high-fibre foods such as granary breads and wholegrain cereals will help to keep you feeling fuller for longer and also contain lots of vitamins and minerals that are good for your heart. Be as active as you can, whenever you can, enjoy regular walks, park further from the shops and use the stairs instead of a lift. For some people, increasing their activity level is simply impossible due to poor health. If this sounds like someone you know, investigate whether your local PCT employs an exercise co-ordinator or knows of any chair-based exercise classes or instructors that could help. Ask at your GP surgery.
So what about all the foods which have appeared on our shelves recently which claim to reduce your cholesterol? Are they really of benefit? Well, the evidence is that these foods can make a healthy addition to a cardioprotective diet, although they are no ‘miracle cure’, they offer extra help for people already following the advice I discuss above but who want/ need to reduce their cholesterol further. These foods include plant sterols/ stanol spreads and drinks (e.g Benecol/ Danecol/ Flora Proactive), oat fibre (from porridge oat cereal) and soya protein (from soya beans/ soya nuts and soya alternatives to milks, yogurts and desserts).
Plant sterol/stanol products are now sold in the form of spreads, yogurts and mini-drinks containing these natural plant compounds. If you choose the spreads and yogurts/ milks, you will need to consume 3 portions per day to lower your cholesterol. If you choose the new mini-drinks that many of these companies are now producing, one drink will provide all the plant sterol/stanol that you need.
Porridge oats contain a special type of soluble fibre which also helps to lower blood cholesterol, try having a bowl of porridge in the morning with chopped fruit, or adding oats into baking.
Soya foods are low in saturated fat and contain a plant source of omega 3 and 6 polyunsaturated fats. The protein found in soya foods has also been found to lower cholesterol*. You will need to consume on average 3-4 portions soya foods per day to reduce your cholesterol levels – try using soya milk on cereal and in tea/ coffee, a soya yogurt or soya nuts (roasted soya beans) as a snack and a soya dessert after your evening meal.
(Katie will be discussing each of these foods in more depth when she visit the group meeting on 1st August, She will also bring along some soya foods for you to taste. In the mean-time why not try out the healthy heart recipe idea below. Ed.)
*25g soya protein per day as part of a diet low in saturated fat can help to lower blood cholesterol levels JHCI 2002.
Katie Kennedy MNutr RD
Senior Dietitian
Alpro - A company of the Vandemoortele Group
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Recipe of the Month
Refreshing Summer Fruit Smoothie
Makes an ideal summer-time snack or after dinner treat
Method
Cut strawberries and banana into large chunks
Place all fruit in a large cup or bowl and blend using a hand-held electric blender or mach using the back of a fork until smooth and ‘pulpy’
Pour in Alpro Soya milk and mix well
Serve in tall glasses with a sprig of mint and ice cubes
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NEWS THIS MONTH
(These snippets are a selection of some of the more interesting research news that comes our way and that could encourage us to go in the right direction. We put them in the newsletter and on the website as an occasional feature.)
Look after your heart, look after your brain?
Although Simvastatin (Zocor) is only prescribed to lower cholesterol, it may protect the brain as well as help sustain the heart, according to researchers Wolozin Bet al in their article "Simvastatin is associated with a reduced incidence of dementia" BMC Medicine 2007 (in press). The older statin drug, Lovastatin, did not appear effective.
Exercise is an important help for diabetes.
An English review of research confirms the value of exercise for diabetics.Exercise programs, for example, included 20 minutes of low- impact aerobic exercise, joining an aerobic exercise group or a structured exercise program, or walking three miles a day three times a week plus other additional exercise.
Although diet and keeping weight down is believed also to be vitally important, the researchers say there is a shortage of really good studies.
Source: Nield L, et al "Dietary advice for treatment of type 2 diabetes mellitus in adults (review)"The Cochrane Library 2007; Issue 3.
Lentils help keep the weight down.
White bread (and similar food) is converted very rapidly during digestion to easily absorbed sugar and is called “high glycemic” because of the effect it has on blood sugar. Apparently such food also makes it harder to lose weight. Calorie for calorie, weight loss may be easier if diets are mostly foods with a low glycemic index, such as lentils, beans and ‘whole grains’, according to a systematic literature review. Compared with those on high glycemic index or conventional weight-loss diets, people who were overweight and obese lost a mean of 1 kg more on low glycemic index diets.
Source: Thomas DE, et al "Low glycaemic index or low glycaemic load diets for overweight and obesity (Review)"Cochrane Library 2007
Phil.Harris
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Wally’s Yarn
Far away in the tropical waters of the Caribbean, two prawns were swimming around in the sea. One was called Justin and the other called Christian.
The prawns were constantly being harassed and threatened by sharks that inhabited the area. Finally one day Justin said to Christian, "I'm fed up with being a prawn; I wish I was a shark, and then I wouldn't have any worries about being eaten."
A large mysterious cod appeared and said, "Your wish is granted" Lo and behold, Justin turned into a shark.
Horrified, Christian immediately swam away, afraid of being eaten by his old mate.
Time passed (as it invariably does) and Justin found life as a shark boring and lonely.
All his old mates simply swam away whenever he came close to them. Justin didn't realize that his new menacing appearance was the cause of his sad plight.
While swimming alone one day he saw the mysterious cod again and he thought perhaps the mysterious fish could change him back into a prawn.
He approached the cod and begged to be changed back, and, lo and behold, he found himself turned back into a prawn. With tears of joy in his tiny little eyes Justin swam back to his friends and bought them all a cocktail.
The punch line does not involve a prawn cocktail (- it's much worse).
Looking around the gathering at the reef he realized he couldn't see his old pal. "Where's Christian?" he asked.
"He's at home, still distraught that his best friend changed sides to the enemy & became a shark", came the reply.
Eager to put things right again and end the mutual pain and torture, he set off to Christian's abode.
As he opened the coral gate, memories came flooding back. He banged on the door and shouted, "It's me, Justin, your old friend, come out and see me again."
Christian replied, "No way man, you'll eat me. You're now a shark, the enemy, and I'll not be tricked into being your dinner."
Justin cried back "No, I'm not. That was the old me. I've changed.".........
I've found Cod. I'm a Prawn again Christian".
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