Diet After Open Heart Surgery 101

Q: What are the three most important diet needs for post-heart surgery patients and do the needs of those differ i.e. open heart surgery patients/stenting patients?

The three most important dietary needs would be to:

• Have a healthy, balanced diet consisting of high fibre foods – with reference to the Health Promotion Board’s “My Healthy Plate”. ²

• Limit intake of saturated fat, high cholesterol foods, and food containing trans-fat
• Reduce intake of saturated fat from animal fats (e.g. lard, fatty meat, the skin of poultry); full-fat dairy products (e.g. full cream milk, butter, ghee) and palm-based vegetable oil. Reduce intake of foods high in cholesterol such as organ meats (e.g. liver, kidney, and brain) egg yolks, and shellfish. Avoid trans-fat foods such as pastries, cakes, cookies, biscuits, commercially deep-fried food, and products containing coconut milk, vegetable shortening, and hydrogenated or partially hydrogenated oils.

• Reduce excessive intake of salt in the diet – Avoid the use of stock powders, bottled sauces, can food items, salted and preserved food such as ikan bilis, salted fish, salted eggs, luncheon meat, sausages, and ham

There are no such differences in terms of dietary needs between open heart surgery and stenting patients. Both types of patients would be advised to adhere to the above-mentioned dietary needs in general unless patients have other comorbidities like diabetes to be catered for as well. However, for open heart surgery patients undergoing e.g. coronary artery bypass graft surgery may have nausea, poor appetite, or constipation during the initial post-operative period. Having small frequent meals, a diet rich in fruits and vegetables for fibre, and drinking sufficient water will be recommended during the period. Some patients may be prescribed warfarin medication which is a drug that prevents the blood from clotting. These patients may then require low warfarin or low vitamin K diet.

Q: Why is healthy eating post-surgery so important?

Healthy eating post-surgery is very important to prevent future complications after surgery. Keeping in mind that surgery is not a cure for the heart problem, patients are encouraged to adopt a healthy lifestyle with healthy eating habits and physical activity as advised by their physician, to reduce the risk of developing further complications. For overweight patients, it is crucial to reduce their weight to the healthy range, therefore reducing their calorie intake and performing some physical activity is also important. Body weight maintenance is achieved by balancing energy intake (e.g. in the form of calories from food) and energy output (e.g. physical activity). A diet low in saturated fat and cholesterol can prevent the formation of new or recurring blockages in the coronary arteries. A diet low in salt can prevent fluid gain and swelling and also prevent an increase in blood pressure.

Q: How should people amend their diet after surgery for long-term good (heart) health?

Same principles as described in the previous questions. Have a healthy, balanced diet with reference to the Health Promotion Board, “My Healthy Plate” with recommendations on healthy eating habits 2 to maintain weight in the healthy range, reduce intake of saturated fat and foods high in cholesterol and trans-fat, reduce intake of an excessive amount of salt in the diet by avoiding processed foods. Choose high-fibre foods like wholegrain products, fruit, and vegetables. Please refer to Q1 for the extended list of examples of food to avoid.

Q: If there is one food people should cut from their diet what should it be and why?

N/A. There is no one food that people should specifically cut off.

Q: People like to be led by example, could you share your typical daily meal plan?

Writing a meal plan is usually done after assessing an individual’s caloric requirements and needs/conditions. This is often done after individual consultation, therefore it is not advisable to issue a standard meal plan for the general public.

You may refer to Singapore’s Health Promotion Board, “My Healthy Plate”, as it serves as a guide to help you follow a healthy diet. My Healthy Plate helps individuals to achieve a well-balanced diet that provides all the nutrients needed on a daily basis.² 

In general choose wholegrain products over refined products. Consuming whole grains over refined grains can also help you manage your weight, as it improves your satiety. Choose to have foods such as brown rice, wholemeal bread, and rolled oats which are not only higher in fiber but contain B vitamins and important minerals like iron, zinc, and magnesium.

Reduce intake of saturated fat from animal fats (e.g. lard, fatty meat, the skin of poultry); full-fat dairy products (e.g. full cream milk, butter, ghee) and food prepared with palm-based vegetable oil. Reduce intake of foods high in cholesterol such as organ meats (e.g. liver, kidney, and brain) egg yolks, and shellfish. Avoid trans-fat foods such as pastries, cakes, cookies, biscuits, commercially deep-fried food, and products containing coconut milk, vegetable shortening, and hydrogenated or partially hydrogenated oils. Replace saturated fat in your diet with mono and polyunsaturated fats instead. However, use them in moderation as well. This helps lower your blood cholesterol, especially the bad cholesterol called LDL-cholesterol. Examples of monounsaturated fats would be olive oil, canola oil, and nuts like almonds, cashew nuts, hazelnuts, and avocados. An example of polyunsaturated fat would be Omega-3, which protects your blood vessels by preventing them from hardening and reducing blood clotting. Choose to have these types of fish which are high in omega 3; salmon, sardine, longtail shad (terubok), and Spanish mackerel (tenggiri papan).

Q: If people are scheduled for heart surgery what amendments can they make to their diet beforehand that will aid them in their recovery?

The diet amendments that patients may make before their surgery is actually similar to the changes they would be advised to make after the surgery as explained in the previous questions.

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References:

1. Singapore Heart Foundation, 2012. http://www.myheart.org.sg/resources/a-heart-healthy-lifestyle/1/21

2. Health Promotion Board, “My Healthy Plate”, http://www.hpb.gov.sg/HOPPortal/article?id=2638 Last updated 4 Sept 2015

3. Eat Right, Academy of Nutrition and Dietetics. Heart Health and Diet. http://www.eatright.org/resource/health/wellness/heart-and-cardiovascular-health/heart-health-and-diet Published January 31, 2014

4. Cardiac Health, Diet after Coronay Artery Bypass Surgery. http://www.cardiachealth.org/patients/diet/diet-after-coronary-artery-bypass-surgery September 10, 2015

5. Cardiothoracic Surgery. University of Southern California. http://www.cts.usc.edu/hpg-dietandnutrition.html

6. Health Promotion Board, Combat high blood cholesterol http://www.hpb.gov.sg/HOPPortal/health-article/2860 4 Apr 2014