Posts Tagged ‘salt’

Tougher than a salt shaker!

June 10, 2010

Remember: Grand Rounds hosted on Adventures of a Funky Heart! June 15, 2010! Entry guidelines are HERE.

I hate salt.

Actually, I love a little salt; but salt doesn’t like me. I have Congestive Heart Failure (CHF), which is caused when the heart muscle weakens to the point that it has difficulty pushing the blood through the body.  Think of it like this: You buy a red rubber ball. Day after day you bounce your rubber ball – against the floor, toss it against the wall, ricochet it off the ceiling (I’m assuming you live in a house with unbreakable furniture!) and your rubber ball always works as designed. It always bounces just as high and just as well as the day you bought it. That rubber ball represents a normal heart.

Now imagine that you buy a red rubber ball and bounce it all day long. But as time passes, the ball doesn’t bounce as high as it once did. Either through some flaw in the manufacturing or a flaw in the rubber itself, your ball begins to lose its “bounce” and soon you have to toss the ball twice as hard to get it to bounce as high as it once did. That rubber ball represents a heart going through Heart Failure.

Since your heart can’t pump blood as well as it once did, you have to help it any way you can. One of the ways you help is to go on (and follow!) the diet plan. The diet has two rules: Consume no more than 2000 milligrams of sodium per day, and consume no more than 2000 milliliters of liquid per day. The 2000 milliliters of liquid isn’t that difficult to comply with – that’s a two liter bottle full of liquid per day. I have friends who drink a lot of water, especially when it is hot, and they may find it difficult to keep their consumption to under two liters per day, but for most of us it is not a problem. The problem is the 2000 milligrams of sodium.

How much is 2000 milligrams? A packet of Sweet’n Low contains 1 gram (1000 milligrams). So open up two packets of Sweet’N Low and pour the contents out on your counter. That’s how much sodium you are allowed per day.

You can cry now, I’ll certainly understand!

But you need to follow the diet plan that you doctor give you (your plan may not exactly be 2000 milliliters/2000 milligrams, it will be what your doctor feels is best for you) because you need to have to get the excess fluid out of you. Fluid makes you weigh more, and your heart has to work harder to get your blood through your body. Every pound you can lose helps your heart do its job better. So tighten up, we’re gonna fight this thing.

When you go to the store you are going to learn how to read a nutritional label. For the CHF diet, you are interested in two things: Serving size and sodium content. Both are clearly marked. Be careful – a common strategy to reduce the numbers is to reduce the portion size! So double-check that – can you really limit yourself to 2 ounces of chocolate? (My answer is “No!”)

You will find that many processed meats are no longer your friend. Soups don’t pass the sodium test very easily, either. And when labels brag about how they contain Sea Salt, your response should be “So what?” Sea Salt, Regular Salt, Moon Salt – they all contain sodium!

There are many salt substitutes available; Mrs. Dash is popular. I am not a fan of Mrs. Dash, but that’s just personal. it doesn’t appeal to me, but if you like it, enjoy it. You have to be careful with your salt substitutes – some of them replace the sodium with a little extra sugar, and some of them drop the Sodium Chloride in favor of Potassium Chloride. Some medications don’t mix well with Potassium, so read the label. I use Benson’s Gourmet Seasonings – it tastes really good, I recommend Table Tasty, their salt substitute, and Bravado, their chili seasoning. (And I’m not getting anything from Benson’s if you order, I’m just telling you what I like. You may find something else that appeals to you!)

CHF patients also need to monitor their weight. The best way to do this is after getting up in the morning, go to the bathroom and then weigh yourself. Do this before you shower or get dressed. When you are done, write your weight down and keep track of it day by day. If your weight goes up more than three pounds in a 24 hour period without an explination (birthday party, for example) call your doctor – you probably need a medication adjustment. Most likely you’ll be told to take an extra dose of diuretics (water pills) but the doctor may ask you to come by his/her office. Weight gain is usually a sign of fluid retention, and you already know that is not good for someone dealing with heart failure.

Fighting CHF will not be easy, especially at first when you are trying to get used to the new diet plan. But you can tough it out. After all, you are stronger than a little salt shaker, aren’t you?

“Low Sodium” Salt – coming soon!

March 24, 2010

A big announcement came out of a PepsiCo investors meeting yesterday – the company is working on a “Low Sodium salt.” Now I know a bunch of my readers just shouted “There ain’t no such thing!” at their computer screen, so I will try to explain.

PepsiCo’s new salt is designed differently. When you eat a potato chip, only 20% of the salt (if it is “normal salt”) dissolves on your tongue and gives you the salty taste. You chew and swallow before the rest of the salty flavor has a chance to kick in.

PepsiCo’s new salt is shaped and sized to allow more of the salt to dissolve in your mouth – consequentially, they can use less of it. This is also a part of PepsicCo’s plan to cut the amount of sodium in its food products by 25% over the next 5 years. The new low-sodium salt chips will be introduced in a few days.

This could be great news for those of us with Congestive Heart Failure (CHF). When the doctor tells you that you have Heart Failure and puts you on a low sodium diet, the snacks go out the window… at the very least, they have to become an occasional treat. A very occasional treat. Perhaps now we can have a chip or two without worrying if we are bumping into our daily sodium limit.

But this is Pepsico’s newest Secret Weapon (not only against Sodium, but all the other snack producers) so we don’t know what is in their formula. If it contains a lot of Potassium Chloride (a popular “Salt Substitute”, just replace the Sodium Chloride with Potassium Chloride) then it won’t do CHF patients any good. Potassium can affect any number of our drugs. And if you are on Warfarin, then you really need to avoid Potassium Chloride. Potassium is Vitamin K, which causes blood to clot. Warfarin reduces the ability of the blood to clot, and the two substances almost cancel each other out.

Reducing your salt intake is a good choice, especially if you have Heart Failure. It remains to be seen if the new “Low-Sodium Salt” is a step in the right direction or much ado about nothing.

Heart Failure

December 30, 2009

“You’re in heart failure,” the doctor told me in the spring of 2002. Oh, boy… I wasn’t sure what heart failure was but I knew that the last time I had it, I was rushed to Johns Hopkins for surgery. That’s a comforting thought. And the doctor said it calmly, casually, as if he had just told me a fact that was common knowledge. Don’t take it so hard, doc.

I learned later that my first bout with heart failure was because I was five months old and I hadn’t had any surgical intervention yet. Once the surgery was done and I stabilized, my heart was functional enough to do its job. What I had this time was Congestive Heart Failure (CHF). Back then my heart was failing rapidly, really just coming apart at the seams. With CHF, my heart is failing again… just very, very slowly.

Imagine that you have a rubber ball. Day after day, you bounce your ball for hours on end. It’s nice and rubbery and no matter how many times you bounce it, it always bounces as high as the day you bought it. That’s how a normal heart works.

Now imagine you have a rubber ball, and you bounce it all the time. But this rubber ball has a flaw – maybe it isn’t formed well, or maybe the  rubber isn’t the highest quality, almost anything – but you begin to notice that your ball is losing its bounce. It takes more and more effort to make it bounce as high as it once did, and eventually no matter how hard you slam it into the floor, it just won’t bounce as high. That’s a heart going through Congestive Heart Failure.

If you google Congestive Heart Failure, you are going to get scared: A lot of the studies say that the average survival rate after a CHF diagnosis is five years. Obviously, you have to read deeper to find the truth. The studies that show a five-year survival rate usually take into account all diagnoses of heart failure during the study period – including the people who are already in the hospital with another illness and then receive the CHF diagnosis shortly before they pass. Since Heart Failure is fairly common in the late stages of life, they get counted in the study, even if that is not the main cause of their death.

Survival and quality of life with CHF relies heavily on the patient. You will be prescribed diuretics to keep fluid from building up in your body, and these will cause you to go to the restroom more often. You will also be put on a diet to help your heart beat easier, the standard CHF diet usually has two rules: consume less than 2000 milliliters of liquid and less than 2000 milligrams of sodium per day. That’s the standard diet, everyone is different.

The 2000 milliliters isn’t hard – that’s a two liter bottle of any liquid. (A friend of mind says that the 2000 milliliter part is harder, because she drank about a gallon of water a day before developing CHF.) Many people keep a two liter bottle in their home, and when they have a drink, they pour an equal amount into the bottle. This gives them a quick visual guide to how much that have consumed. Others just scribble the amount on a piece of paper (A 12 ounce can of soda is 355 milliliters, for example; almost all liquid products list the amount in ounces and milliliters) or do the math in their head.

The sodium restriction is much harder. For a few weeks, you’re going to have to read the nutritional labels on the food you buy closely, to check out the amount of sodium per serving. Processed meats are loaded with sodium, so if you are a fan of sub sandwiches… well, that might have to become an occasional treat, rather than lunch every day. And do yourself a favor and split it with a friend.

The best thing you can do is to stop using salt when you cook and allow everyone to season their own meal. And make sure that the salt shaker stays at the other end of the table. Mrs. Dash seasoning is popular when you are on a low sodium diet. Personally, I am not a fan of Mrs. Dash, so I use a Garlic and Herb salt free seasoning.

Every morning, a CHF patient should go to the restroom immediately after getting up, and then weigh themselves. Keep track of your weight, and if you gain more than 3 pounds in one 24 hour period that you can’t explain, call your doctor. The doctor will probably tell you to take a larger dose of diuretics that day, and if you are still up tomorrow morning, come by the office. After you get used to your diet and medications, you’ll know what to do and you won’t even call unless the weight just won’t come off.

The two most important factors in living a good life in spite of heart failure are a good initial examination and diligent self care. The people who are able to adhere to the diet, take their medications, and get some exercise do much better than those who don’t. Congestive Heart Failure requires a lifestyle change, you don’t get a vacation, and you can’t take a day off. Even if you are traveling and do not have easy access to a scale for your daily weight, that doesn’t mean that you can ignore all the other rules. In fact, maintaining your CHF control can be very difficult while away from home. But if you are determined to not let it beat you and to live your life to its fullest, Congestive Heart Failure can be controlled.

It’s all up to you.

Chinese Food, Cavities, and your Dog

July 7, 2009

Here’s a general interest article about healthy eating, but it points out several things of interest to those of us with Congestive Heart Failure (CHF). Chinese food, for example, is loaded with salt.

Gosh darn it. I love me some Egg Drop Soup along with the Sweet and Sour Chicken. Looks like both of those dishes are now “occasional treats.”

Looking on the positive side of things, the sweetener Xylitol can help prevent tooth decay! Given as an oral syrup to toddlers, it can prevent up to 70% of cavities. The California Dental Association recommends five grams of Xylitol per day (“taken” in chewing gum or mint form), and the US military has been including Xylitol gum in their Meals Ready to Eat (MRE) packs since 2007. It obviously won’t replace brushing and flossing, but every little “trick” you can use to improve your overall health is useful.

While Xylitol can help your teeth, it can kill your dog. So don’t let Fido steal your snacks. If you buy Xylitol in the powdered form and use it in baking, don’t give Rover a Xylitol cookie.

Human treats are for humans, and doggie treats for dogs. That’s only fair!

Heart Failure, Salt, and Exercise

May 8, 2009

The two rules of the Congestive Heart Failure (CHF) diet are 1) keep your liquid intake below 2000 milliliters of liquid per day; and 2) reduce your daily salt intake to below 2000 milligrams of sodium per day. Keeping your salt intake down is crucial: less sodium means less liquid trapped in your body, which makes it easier for your weak heart to do its job.

Lowering your salt intake is also the hardest goal to accomplish. Putting down the salt shaker usually isn’t enough – processed foods are notorious for having high salt content.  Sandwich meats are among the worst, and those “heart healthy” soups are low in fat… but the sodium is so high, you can see it from below!

A new study shows that even people who were trying to keep their salt intake below 2000 mg overshot the mark. Ouch! And this just isn’t a suggestion – for a Heart Failure patient it is a critical lifestyle change. So if you are on the CHF diet, keep a close eye on your sodium intake. It may be higher than you think!

There is also a report out on something you can do to actively combat Heart Failure: exercise! Obviously, we are all different, so you should discuss an exercise program with your doctor  before you start. What works for me may not be good for you, so check first. But CHF patients who are able to add moderate exercise to their diet and medication have a higher quality of life.

So what is considered “moderate exercise”? Walking! 100 steps per minute for 30 minutes daily, (3000 steps in 30 minutes, if you are using a pedometer) five days a week is a good exercise program. That’s a pretty fast pace, so start slow and work up to it. After all, Rome wasn’t built in a day, and you don’t have to turn yourself into a treadmill trackstar overnight.

While you are walking, why not use the new FiTrainer? FiTrainer is a pair of  headphones that also includes an ear clip with a built in heart rate monitor. It is pre-programmed with several workouts (with music!) or you can plug in your own MP3 player. An electronic voice reports your heart rate through the earphones, so you never have to check a display!

A low salt treat!

January 22, 2009

“Hey, you want some popcorn?”

If you’re me, you almost say yes… and then you remember that most commercial popcorn recipes are full of sodium. Gosh darn it, this Congestive Heart Failure (CHF) diet makes me angry at times. Whenever I went to the movies, I would almost always buy the largest tub of popcorn they had! And I would ask the person behind the counter for an extra spurt or two (or three!) from the butter machine! Well, that’s not happening any more.

I miss my popcorn.

But then a friend passed this recipe along to me. It is simple, takes hardly any time, and best of al, has almost no sodium! So if you have to watch the sodium content like I do (or just want a fairly healthy treat) try this popcorn recipe:

Buy a jar or bag of plain popcorn. A bag of a store brand of popcorn will usually cost about $1.00; there shouldn’t be any sodium in it but double check the nutritional statement on the bag to make sure.

Pour 3/4 of a cup of popcorn into a mixing container. A small bowl will do just fine. Fill a spoon with cooking oil… and then pour the oil out. You want just enough to wet the spoon. Use the oil coated spoon to stir your popcorn until it is coated with oil.

Pour the popcorn into a paper bag and fold the open end closed. Shake it good, then place it in the microwave oven. Cook it for three to four minutes. You’ll be estimating the first few times you cook popcorn, but you want to cook it until there is at least a second between pops.  Take the bag out and pour your popcorn into a large mixing bowl.

If you want to you can add some melted unsalted butter; I usually add some Lemon and Pepper Seasoning. The good L&P Seasoning is cut very fine, you will sneeze after shaking it out of the dispenser!

You’ve got a good movie on the TV, right? If so, sit back and enjoy your popcorn!

Salty Language!

October 31, 2008

Yes, be careful… this post is chock full of salty language!

If you have heart failure, you have to really watch your sodium. The standard Congestive Heart Failure (CHF) diet allows you 2000 milligrams of sodium a day, and 2000 milliliters of liquid. Now the 2000 milliliters isn’t hard – that’s a two liter drink. In fact, I know some people who monitor their liquid intake by keeping a two liter bottle handy. Whenever they drink something, they pour an equal amount into the bottle – the bottle fills up, they have to stop. Summer months can be harder, of course, but I’m figuring out that the trick is to drink throughout the day, just keep the amounts low. Instead of a 20 ounce bottle, why not just grab a six ounce bottle of Coca-Cola… what us Southerners occasionally call a “Short Coke.” (Specifically the 1991 bottle) Along with the reduced amount,  a lot of people swear that cold soda in a glass bottle just tastes better!

The sodium restriction is much more difficult – 2000 milligrams a day. A packet of Sweet ‘n Low holds a gram of sweetener, so you get two packets.

That’s depressing.

Open them up and pour them on the counter. That’s even more depressing.

Shopping is quite the adventure as you compare the nutrional panels on all of the products you want to purchase. Here’s a standard US Nutritional Value Chart, for those of you who may not live in the United States. One of the standard tricks for reducing the amount of calories, sodium, cholesterol, or whatever is bad for you is to reduce the serving size. And if you eat more than a “serving” – well, that’s your fault.

Some of our favorite things are out, as you may guess. Prepared meat is high in sodium, so no more lunch at Subway.  Forget that ad on their front page about being “Heart Healthy”, we’ve discussed that before. As a friend of mine once said in a moment of frustration, “If God were fair, he’d have made Spinach bad for you and made ice cream with three calories per gallon!”

But there are a few things out there that will surprise you – Heinz is making a No Salt Added Ketchup, and it tastes really good. Regular Ketchup is sky high in sodium, so it is on the no-no list, but now I can enjoy a little something on my no-sodium French Fries.

And watch out for those salt substitutes. A lot of them replace the Sodium Chloride with Potassium Chloride. If you’re taking Warfarin, you can’t use the salt substitute… heavy amounts of Potassium makes your blood clotting medication not work properly. (I usually use no salt Lemon and Pepper seasoning)

Pickles are strange. Pickle slices seem to have more – sometimes much more – sodium than pickle spears. Remember all pickles are not created equal, so read that label. Another treat that I miss is boiled peanuts. The recipe is simple: Peanuts, water, salt, a pot to cook in, and a heat source. Mix the water and salt – a generous amount of salt – in the pot and bring to a full boil. Toss in the peanuts, bring the pot back to a full boil, and reduce the heat. Let ’em simmer at a low boil, stirring occasionally. In a couple of hours turn the heat off and let them cool.

Trouble is, no one’s figured out yet how to make a decent boiled peanut without using salt. I keep trying, though. Discovering Salt Free Boiled Peanuts will be nearly as important as sliced bread and inventing the remote control!

There are NO limits!

August 4, 2008

“Young man,” the Emergency Room doctor said, “You are in Congestive Heart Failure.” (CHF)

Oh…. shoot! That is not what I wanted to hear. The last time I was in CHF, I was 5 months old and on my way to Johns Hopkins Hospital. This time, I had recently gotten back from the best vacation of my life, and for a few moments I wondered if it would be my last vacation.

I had traveled by AMTRAK to four different cities, watching Minor League Baseball at each stop. At the first stop in Charleston, South Carolina, I got caught in a rainstorm while waiting for the transit bus and got soaked, and woke up the next morning feeling like I was getting a bad cold. I may actually have had a small cold, I don’t know, but as I look back I think that the Heart Failure was beginning to show itself. When I got home, I was still feeling draggy and tired, but I thought it was a result of my trip. Steve had just had too much fun! But when I went out to sweep the carport — something I had done countless times before — I was so tired that I had to stop and rest twice. That’s when I realized that something may be seriously wrong here.

So what exactly is Congestive Heart Failure? Your heart is losing its ability to efficiently pump blood. Imagine that you buy a rubber ball. You bounce that rubber ball all day long, every day, for years. And it always bounces just as high as it did on the day you bought it — that’s the way a heart is supposed to work. Now imagine that you have another rubber ball, and you bounce it just as much as you did the first one. But after some time passes your ball begins to wear out, and it won’t bounce as well as it did when it was new — that’s a heart going through heart failure.

If you get a diagnosis of CHF, naturally you want to know everything about it. Most people are going to head for their computer and Google it. You’ll read that the average person with heart failure passes five years after the diagnosis. Don’t believe that!

That figure takes into account EVERYONE… the elderly who develop CHF late in life, people who are sick with something else and then go into CHF, and the small number of people who read “5 years” and decide their life is over. It doesn’t have to apply to you.

Your doctor will probably put you on a low sodium, low liquid diet. The diet is very simple but extremely difficult, all at the same time. My personal limits are 2000 milliliters of liquid a day, and 2000 milligrams of sodium per day.

The liquid is the easy part. 2000 milliliters is two liters, and you’ve seen a two liter bottle of your favorite soft drink. You can’t drink any more than that 2 liter bottle per day. That’s not really difficult. Summer months will tempt you to go over your limit, but you learn to space it out and little tricks such as popping an ice cube into your mouth.

2000 Milligrams of Sodium is the hard part. How much is that? Take two individual serving size envelopes of Sweet ‘N’ Low and pour the contents onto the table. That’s 2000 milligrams.

The first thing to do to get down to 2000 milligrams is take the salt shaker off the table. Get it away from the stove, also. No longer do you cook with it, nor do you wave the salt shaker over your food.

The next step is pretty intensive label reading. The first time I went grocery shopping after being put on the diet, it took an hour and a half longer than usual, and all that time was reading labels. Prepared meats (in general) are no longer on your list, and it seems that soups are loaded with sodium. (Soup is a double whammy; it counts against your sodium limit AND your liquid limit. So be careful with soups.)

Every morning, as soon as your feet hit the floor, you do two things: You go to the bathroom, and then you weigh yourself. Try not to wear too many clothes when you weigh and also try to wear about the same thing each time. Record your weight and keep track of it. Most Cardiologist tell you that if you gain three pounds or more in a 24 hour period and you don’t have a good explanation for it (Overindulged at a birthday party, for example) then you are having problems. Most of them ask that you call the office; usually they’ll just tell you to take an extra diuretic to get you through the day. But repeated weight gain is a good indicator of a problem.

The next step you can take is exercise. Get a good pair of shoes, a pedometer, and start walking. Can’t walk far? No problem, start small and ease into it. The first day that I walked I could barely make it half a mile; now I’m up to three miles, and could probably go further. I’m “training” for a trip to Boulder, Colorado next year; my hometown is about 200 feet above sea level. Boulder is at about 6,000 feet. I want to be able to breathe comfortably when I go out there, so I’m really trying to push myself.

Another thing is your attitude. A small percentage of people hear the dreaded phrase “You have CHF” and they quit. “Woe is me!”, they say, and they roll into a little ball and quit participating in life, and they are not long for this world. You need to have the attitude that this is just one of many challenges in your life. Do things! Go places! Even when you don’t feel 100%, go as far as you can and do as much as possible. Never give in!

Remember, I am not a medical professional, but do you remember at the beginning of this story when that doctor told me that I was in Congestive Heart Failure? That was in the spring of 2002! I weighed 206 pounds back then. Today I weigh 158, and other than this hernia (See previous post) I feel like a million bucks! So five years is not a limit!