Diet After Heart Attack: Foods to Eat, Portion Sizes, and Medications
Introduction
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Welcome back to the third installment in our series about diet after heart attack. In this post, we’ll be discussing the more positive principles of making heart-healthy food and beverage choices, as well as a few other considerations that relate to your nutrition plan after a heart attack.
If you didn’t catch the first two posts in the series, feel free to visit them at the links below:
Diet After Heart Attack: Managing Your Sodium Intake
Diet After Heart Attack: Reducing Added Sugars and Saturated and Trans Fats
Quick disclaimer—although I am a registered dietitian nutritionist, your reading of this or any articles on this website does not constitute medical nutrition therapy advice nor create a practitioner-client relationship. The information I provide here on this website is for educational and informational purposes only. Please see my full disclaimer for more information.
Foods to Choose
As we discussed in the two previous posts, there are certain types of foods that it is wise to cut back on after you’ve had a heart attack. But there’s definitely more to the story. In this section, we’ll discuss the foods that you can choose more of as you make changes to your eating pattern.
And as a quick side note, many of these foods to choose are wonderful for improving cholesterol levels, since oftentimes heart patients have to monitor their cholesterol levels closely after a heart attack.
If you want to learn more specifically about which foods can help improve LDL and HDL cholesterol, visit the following posts (links below):
Breakfast Foods to Lower Cholesterol: A Dietitian’s Picks
Viscous Fiber Foods: How Can They Benefit Your Heart?
So what are some of these foods to choose, and how can you add them in to your day or week? Let’s find out!
Fruits
Our first general food category, and one which many people have questions about, is that of fruits. There’s often misinformation in the media, such as claims that certain types of fruit are bad for us or that fruit has too much sugar.
In reality, although fruit does contain naturally occurring sugars, it comes in a package that includes multiple vitamins and minerals, fiber, and water. All of these components in a serving of fruit can benefit your body in some way or another, like hydrating, improving your gut health, and helping prevent nutrient deficiencies.
For maximum benefit, choose whole fruit, dried fruit without any added sugars, frozen fruit, 100% fruit juice (in small amounts—consider less than an 8 oz cup per day), and canned fruit that is canned in its own juices (avoid syrups).
You can add fresh or frozen fruit to smoothies (keep it to about a cup of fruit or so at a time), pair with cheese or nuts, toss dried fruit on salads, or add a piece of fresh fruit to your meals. Some people enjoy grilling fruits like pineapple for another fun meal accompaniment.
Some people have told me that they use their air fryers to cook fruit with a drizzle of oats and honey. Use your imagination and you never know what interesting combo you may come up with.
Vegetables
Our next category, vegetables, is perhaps a more challenging category of food to want to think about. But if you’re open to giving them a try, you may find that you can add vegetables in more than you had originally thought.
In terms of what look for when choosing vegetables, aim for frozen veggies without added sauces or flavorings, canned vegetables that are reduced-sodium or no-salt-added, or even fresh vegetables from the produce section of your local grocery store or farmers market.
Finding recipe ideas for vegetables may sound like a more daunting task, but if you start with basic preparation, you can move on to more involved, more flavorful recipes later on.
One of my favorite ways to quickly provide a serving of vegetables is by using the frozen bags that steam in the microwave. Although the vegetables may be plain, you could sprinkle some cheese or drizzle olive oil over them to start.
Another quick option is pre-cut raw vegetables that you could serve with hummus or another type of dip or sauce. There are some enjoyable pre-made bean or avocado dips that could work well with the raw veggies.
Ideas for cooked vegetables could include roasting them in the oven with a little olive oil and herbs like parsley or spices like garlic; or adding them into sauces or soups; or lightly sautéing them to serve with pasta.
Another example when it comes to vegetables is the classic salad (which I know we often think of as the go-to “healthy option” when we’re trying to make nutrition changes). But salad doesn’t have to be just lettuce and dressing.
You can use salads as vehicles to add extra fruits and vegetables, protein sources like chicken or fish, and other types of carbohydrate like grains and beans. Salads can end up turning into a complete balanced meal if you include protein, carbohydrate, and a little healthy fat like avocado or olive oil or nuts and seeds.
So now that we’ve looked at vegetables, hopefully they don’t feel as intimidating to you as they may have before.
Whole Grains
Let’s move on from there to whole grains. The benefits of choosing whole grains, and not the more “refined” types of grains, are that you end up with more fiber and the whole package of different vitamins and minerals. In other words, you’ll get plenty of nutrients to help support a healthy weight, gastrointestinal (GI) system, and cholesterol levels.
But it may seem a little confusing to figure out exactly how to go about finding whole grain products. Although labeling is not always as consistent or easy to understand as it could be, I’d like to share a few tips to point you in the right direction as you start looking.
For the most part, you can find out if a product contains whole grains by checking the ingredients list. Ideally, the first ingredient on the list should have wording like “whole wheat” or “whole grain.
Often, products with whole grains will also have some fiber—you can check the nutrition facts panel for the fiber content to be sure.
Sometimes, though, whole grains come as standalone items. For example—brown rice, quinoa, farro, bulgur, millet, and oats are all considered whole grains, but the wording in the packaging might just say the item name without the “whole grain” wording in front of it.
If in doubt, although it probably isn’t wise to just “google” everything, a quick search can probably tell you if a grain you’re considering is a whole grain or not. Another great resource from the American Heart Association that may give you more ideas is this page on whole grain foods.
When preparing plain whole grains, check the cooking instructions on the packaging first. You can also search for “heart healthy grain recipes” or another similar query on your preferred web browser, or consider picking up a book of grain recipes at the library.
A quick note for popcorn lovers—because of the way it is processed, popcorn is categorized as a whole grain rather than a starchy vegetable. When you do have popcorn, make sure to keep it simple—a lightly salted or oiled version is a wiser choice than cheesy, caramel coated, or other type of candy drizzled preparation.
Legumes
Next on the list is the category of legumes. Although you may not hear about them as often, they are still great sources of protein, carbohydrate, and fiber. Legumes include most of our beans, certain peas, lentils, soybeans, and even peanuts.
Ways to consume them include bean salads, lentil soup, tossing beans onto a green salad, or adding them into grain or pasta salads. They can even be pureed to make a simple, creamy soup.
When you’re choosing beans, aim for no-salt-added or reduced sodium canned beans. If you decide to cook them from scratch, follow the instructions on the package and be mindful of how much salt you add to them (try to keep it limited).
A great resource for more ideas for cooking legumes would be this page from the USA Pulses website.
Healthy Fats
Let’s transition now to heart-healthy fats, which can be found in several different types of foods. Let’s discuss a few below.
Nuts and Seeds
Nuts and seeds are great sources of heart-healthy fats and fiber, both of which can help improve cholesterol levels.1 As you choose nuts and seeds, try to avoid heavily salted or sugary versions. Instead, aim for unsalted varieties or dry roasted with minimal salt, or try roasting them at home with a little oil and very tiny sprinkle of salt.
(As a quick side note, although peanuts are technically a legume as mentioned in the previous section, they tend to be grouped in with nuts and seeds since they are often used in similar situations and are also full of heart-healthy fats.)
You can pair nuts with fruit or dried fruit for a snack; sprinkle on yogurt or cereal or into baked goods; toss on salads for an extra crunch; use as a crunchy coating for baked chicken; or mix with popcorn for another type of snack.
If you like chia seeds, there are plenty of unique chia seed pudding recipes available online today. Some people also sprinkle them on cereal or yogurt or mix them into overnight oats.
Plant Oils
Another type of heart-healthy fat to mention is the category of plant oils. While opinions may differ on specific oils to use, we do have good research to demonstrate the benefits of avocado oil and extra virgin olive oil in relation to heart health.2-3
Another acceptable oil4 some people may choose to use in cooking or baking is canola oil.
When using oils, for cooking, you probably won’t want the entire pan to be swimming with oil. Many times a few tablespoons or less can be enough for sautéing purposes.
If you’re adding oils as a flavor enhancer in salads or similar recipes, consider a light drizzle, and double check instructions if you’re following a more heart-healthy type of recipe.
Avocado
As for avocados, they are actually considered to be fruits, but they also contain a good amount of heart-healthy fats. Some recipe ideas featuring avocados include guacamole, avocado toast, tuna salad (using avocado in place of mayo), and pasta salad. They can also be added to tacos, sandwiches, and salads for an extra boost of flavor and creaminess.
Fatty Fish
Although fish serve as a source of protein (see our next category below), certain fish also contain some heart-healthy omega-3 fats, which can be helpful for lowering triglyceride levels and improving HDL (“good cholesterol”) levels.1 A few examples include salmon, mackerel, anchovies, sardines, and herring.
Some people enjoy fish from the can (remember to drain before eating) or baked or lightly sautéed. In the next section, you’ll find a few more ideas for cooking lean protein sources like fish.
Lean Proteins
As we move on to lean proteins, some of this information may be a review for you, but it doesn’t hurt to go over it again. To reduce saturated fat (which can potentially raise LDL cholesterol1), aim to keep as much fat off of your meat and poultry as possible.
Take the skin off chicken and turkey; cut off the rim of fat around pork chops and steaks; avoid marbling for the most part; and drain the excess fat from ground meat. If choosing ground poultry, check to make sure the % lean number is as close to 100% lean as possible (you may see a number like 98% lean on ground turkey).
When cooking these protein sources, aim to grill, bake, broil, air fry, steam, poach, etc. as often as you can. Try out simple fruit juice marinades (like lemon or pineapple juice) or balsamic vinegar to help tenderize with less sodium, added sugar, and fat. You may also want to try making your own marinades to avoid store-bought versions, which can sometimes be higher in added sugar, sodium, and fat.
Dairy
As we discuss dairy, I do want to mention that full fat dairy can be included at times in a heart-healthy eating plan. For many people though, to help manage overall energy balance and saturated fat intake (even though most dairy products may not have the same associations with LDL cholesterol that other animal products do5), it would be suggested to consider lower or reduced-fat dairy for most purposes.
Lower or reduced-fat dairy can work fairly well in many recipes, such as if you’re using reduced-fat ricotta cheese for lasagna or lower fat cottage cheese for a snack with fruit. Part skim mozzarella cheese also seems to melt well.
In some cases, full fat dairy may be more useful. Examples could include homemade macaroni and cheese (I learned this by personal experience in my food science class years ago) or recipes where a small amount of hard cheese (like Parmesan) may be needed for a flavor accent.
Another important point in our discussion on dairy is to generally avoid dairy with larger amounts of added sugar. Examples might include ice creams, frozen yogurts, flavored milks, yogurts with candy pieces, etc.
These items aren’t wrong to be enjoyed as a treat, but I would encourage you to consider how important these items are to you and how often you usually have them. If you feel you could have them less often, then that could be a beneficial plan.
So now that we’ve discussed all of the foods you can aim to include more often in your eating plan, let’s talk about how that might look in terms of portions.
Managing Your Portions
When you’re working on making changes in your eating pattern, it’s important to know what foods to eat more often and less often as a first step. But an additional consideration is how much of these foods to have at meals and throughout the day.
When you’re creating your meals, aim to have a balanced plate as much as you can. This means including a source of protein, a source of carbohydrate, some non-starchy vegetables as able, and a source of healthy fat as an accent.
But also you’ll want to look at the amounts of these items that you add to your plate or bowl. While each person’s energy and protein needs may look a little different, I’d still like to share some general tips I offer to my patients.
If you feel you need to go up or down with the amounts suggested, feel free to do so. You may also want to consider talking to a registered dietitian to figure out the portions that are just right for you.
Food Portions
First of all, for protein sources, such as lean beef, pork, poultry, or fish, a helpful guide would be using the palm of your hand as a general size estimate. If you’re having a more plant-based protein like beans or lentils, you may want to aim for about the size of half a fist or so.
For dairy products, a serving of shredded cheese might be the amount you could fit in the middle of a cupped hand. A portion of block cheese could be closer to the size of your thumb or the first finger from your thumb.
For starches like rice, potatoes, pasta, and other types of grains, you could aim for anywhere from half a fist to about a whole fist or a little more, depending on how hungry you are. (Please note—if you have diabetes, your healthcare provider may have specific instructions for you when it comes to these types of foods.)
Similarly for fruits, consider having less than a closed fist-sized amount for fresh or frozen varieties. For dried fruits, you’ll want to have less, probably closer to the size of 1-2 thumbs or the space inside a cupped hand.
For non-starchy vegetables like salads, broccoli, bell peppers, cabbage, etc., try to have at least one fist’s worth, even up to 2 fists’ worth if you can—use the larger measurement for raw veggies and the smaller measurement for cooked vegetables.
When it comes to healthy fats, smaller amounts are more suitable. Examples might include half of a small avocado; about half of the size of your thumb (or use a teaspoon) for oils (if you’re drizzling them on salads or vegetables); and a little less than a cupped hand’s worth for nuts and seeds.
While these examples are just estimates and not precise measurements, they can still encourage you to think more carefully about how much of different types of foods you are adding to your plate.
And portion management can be very helpful if you are looking to watch your weight. For many heart patients, losing a little weight (gradually and sustainably, not by a fad diet or extreme restriction) can be very beneficial for heart health.1
Beverage Amounts
One other topic of note as you’re planning what to eat after a heart attack is what to drink. (Visit this post to learn more about heart-healthy beverages that are also great for weight management.)
What you drink matters. Ideally, water is a wonderful beverage that many of us are not getting enough of. Checking your water intake is a great first step.
A second potentially positive comment is that although beverages like coffee and caffeinated tea may have a slight diuretic effect (making you go to the bathroom more), they can still count toward your daily fluid needs. So if you have a cup or two of these beverages per day, you will likely be able to stay hydrated. Alcoholic beverages can be a different story, so talk to your doctor or dietitian about that part.
As for how much liquid you need per day, it would be wise to check with your doctor for any specific instructions for your situation. Some people may be on fluid restrictions or need a certain amount of fluid due to certain medications.
If your doctor doesn’t have any specific instructions for you, here are a few tips you might try.
One common method of figuring out ounces of fluid per day is by dividing your weight in pounds by 2. Once you get that number, you can divide it by 8 ounces to get a rough idea of how many cups of liquid you need per day.
Another way is to drink according to thirst, also checking the color of your urine (aim for pale yellow, not necessarily clear, and avoid dark yellow). Side note—if you take a B vitamin complex, this method may not work as well due to the B vitamins making your urine color basically neon yellow. Also, with age can come a decrease in ability to sense thirst levels, so keep that in mind when planning out your hydration strategy.
Again, when in doubt, check with your healthcare provider for more instructions.
Medication Considerations
The last main topic of this post is that of medications. After a heart attack, you may be put on multiple different medications. Some of these can interact with foods and beverages, so it’s really important to check the instructions that come with your medication and talk to your doctor or pharmacist about anything you need to be aware of.
As for more specific tips, some blood thinning, cholesterol lowering, and blood pressure medications may interact with foods/beverages like grapefruit and grapefruit juice, alcohol, or foods high in Vitamin K (like kale, spinach, cabbage, etc.). If you can’t find information like that on the medication instructions, definitely ask a professional for guidance.
Conclusion
That brings us to the end of this post and our series on diet after heart attack. Although I could probably have written even more than I did, I hope this series has been helpful to you in some way if you’ve had a heart attack or if you’re caring for someone who has.
I know there was a lot of information here, and it probably can feel overwhelming; but try to pick just one or two things to get started on, and add on to those things as you feel able to. And in several months or a year from now, you’ll be able to look back and see how far you’ve come!
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References
- Kirkpatrick CF, Sikand G, Petersen KS, et al. Nutrition interventions for adults with dyslipidemia: a clinical perspective from the National Lipid Association. J Clin Lipidol. 2023;17(4):428-451. doi:10.1016/j.jacl.2023.05.099.
- Choosing and Using Cooking Oils: What to Use and When. Health.clevelandclinic.org. Published January 18, 2023. Accessed September 1, 2024. https://health.clevelandclinic.org/how-to-choose-and-use-healthy-cooking-oils.
- American Heart Association Editorial Staff. Healthy Cooking Oils. Heart.org. Updated October 24, 2023. Accessed September 1, 2024. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/healthy-cooking-oils.
- Corliss J. Choosing Heart-Healthy Oils for Home Cooking. Health.harvard.edu. Published February 1, 2023. Accessed September 1, 2024. https://www.health.harvard.edu/heart-health/choosing-heart-healthy-oils-for-home-cooking.
- Full-Fat Dairy Foods and Cardiovascular Disease: Is There a Connection? Mcpress.mayoclinic.org. Published January 5, 2024. Accessed September 1, 2024. https://mcpress.mayoclinic.org/dairy-health/full-fat-dairy-foods-and-cardiovascular-disease-is-there-a-connection/.
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