Eating Healthy with Pulmonary Hypertension
For PAH patients, we spend a great deal of time talking about low salt diets and fluid restriction. I want to focus on a broader aspect of healthy eating. Enjoying food is a core pleasure. As our lifestyles have become more rushed and our foods more processed it has become more challenging to make good food choices. More than a third of all adults are obese. 75% of American men are now overweight or obese. The statistics are alarming. Patients with heart and lung disease are at particular risk for being overweight and experiencing the health consequences.
Imagine that you are carrying a backpack. Now imagine carrying an additional 20 pounds inside your backpack. You would be more tired and short of breath if you had to get through the day carrying the extra weight. This is no different than carrying extra body weight.
The first step in solving a problem is recognizing that a problem exists. Talk to your pulmonary hypertension doctor and ask about what a healthy goal weight should be. Next you need to do some honest self-evaluation. In my experience bad eating habits come in a few forms.
- The problem of enormous portions
- Liquid calories
- The after dinner hand to mouth habit (snacking after dinner)
Do you know how many calories you need to eat in order to maintain a stable weight? How about how many calories you need to consume in order to lose one pound per week? There are many calorie calculators on the internet that can tell you specifically what your goals should be. Using Calculator.net I plugged in the age, gender, height and weight and activity level for a hypothetical 50 year old woman who is 5’5’’ tall and weighs 140 lbs. You may be surprised to learn that in order to maintain her weight this person would need to eat no more than 1,500 calories per day. If she wanted to lose one pound per week she could eat no more than 1,000 calories per day.
Let’s return to the common bad eating habits. If you go to a restaurant and order an appetizer, a main course and a dessert, chances are you just consumed far greater than 2,000 calories. To make this more concrete let’s do an example.
Cheesecake Factory Meal #1
- Appetizer: crab cakes (share an order with your date) = 490 calories
- Main: Chicken marsala with mushrooms = 1480 calories
- Dessert: Original cheesecake = 710 calories
- Total = 2,190 calories
Now Cheesecake Factory is notorious for serving enormous portions of very tasty food. Even if you had exactly half of the above meal, you would still be eating over 1,000 calories. So if our hypothetical 50 year-old woman ate the above meal and nothing else the entire day she would still gain about 1 pound per week. If she ate half of the above meal she would have only 500 calories left to eat the whole day if she is to target a weight neutral diet. The moral of the story is that portion size makes a huge difference in how many calories you eat.
Food selection is also very important. Many people think that by eating a salad or pasta that they are choosing lower calorie choices. This is usually not the case in a restaurant. For example, a small Caesar salad with chicken at Cheesecake factory is 980 calories. Now there are other options.
Cheesecake Factory Meal #2
- Appetizer: Edamame or Boston Salad = 320 calories
- Main: Grilled Tuna = 520 calories
- Dessert: Fresh strawberries = 110 calories
- Total = 950 calories
If you ate meal option #2 you would still leave the restaurant feeling stuffed. If you shared the above meal you would have plenty of food and you would be less than 500 calories. You would not feel stuffed but you would be on your way to a much healthier lifestyle.
Learning what a reasonable portion is can make a huge difference. A healthy portion of meat is four ounces (about the size of a small adult’s palm or a deck of playing cards). A healthy serving of rice is half a cup of cooked rice. Go to town on the fresh vegetables (as long as they are not a tool to bring ranch dressing or cheese dip into your mouth). Serve your food on a small plate. Research studies have shown us that if you serve yourself on a small plate you think that you are eating more than you really are. In contrast if you serve your food on a big plate you will consume much more food.
The Problem of Grazing
Another eating style that leads to weight gain is constantly eating small bites here and there. This is especially problematic if you are in an environment where snack food is abundant. A potato chip here, a chocolate cookie there. Next thing you know you have eaten 1,000 calories of junk food. Eat at meal time. If you need to snack, enjoy raw carrots or celery (minus the cheese dip and ranch dressing).
Many people are very disciplined 95% of the time but periodically lose it. This is a very challenging eating style. You feel like you have been so well behaved that a small indiscretion won’t matter. Or perhaps you had a really bad day and you are looking for some comfort in the bottom of an ice cream tub. Be honest with yourself. If you have a problem with binging, talk about it with your doctor. There is help available.
Having a small glass of wine or a glass of juice on occasion is not the end of the world. However, if you drink a six-pack of soda or beer or a bottle of wine a day, you are dramatically increasing your calorie intake. A can of soda has about 150 calories. A small glass of wine has about 110 calories. A can of beer has between 100-150 calories. Do the math, a six-pack of soda is 900 calories per day and you have not yet had anything to eat. My advice is drink water in moderation and save your calories for a small dessert.
After Dinner Snacking
One of the most common American hobbies is watching TV after dinner. And many of us seem to have a reflex of putting something salty or sweet in our mouth while we do this. Whether it is popcorn with butter or candy or potato chips, without paying attention we can take in another 500 calories easily. The best policy is to close the kitchen and stop eating after a small dessert (preferably fresh fruit or berries).
If you are having trouble figuring out why you are unable to lose weight then start by determining your target calorie intake. Next keep a food diary to understand how many calories you are consuming. Then make the appropriate changes. You will be rewarded. Combine good food choices, portion control and avoiding liquid calories with daily walking and you are on your way to a healthier lifestyle.