Eating for a Healthy Heart
Healthy Eating will reduce your risk of further heart problems. Indeed, a healthy diet, regular exercise and
appropriate medication are the 3 cornerstones of preventing heart disease. A healthy diet will help
improve many of the risk factors that cause heart disease. By changing your diet you can lower the “bad”
(LDL) cholesterol, increase the “good” (HDL) cholesterol, lower your blood pressure and blood sugar and
reduce your weight. Many of these diet changes are simple, requiring only that you make healthy choices
when buying food and cooking. You can improve your diet and reduce your risk of future heart problems.
Here are some simple steps to get you started.
Divde your lunch and dinner plate
as follows:
1/2 vegetables (raw or cooked)
1/4 meat, fish, chicken, skim milk,
cheese or legumes (i.e. kidney
beans, lentils)
1/4 grain (bread, rice potato,
pasta)
Complete the meal, add. . .
An easy way to improve the balance of the foods you
eat is to divide your dinner plate as in the example shown.
Avoid fad diets.
Eat more fresh or frozen fruit and vegetables daily.
They are low in fat and salt and rich in vitamins and minerals.
Eat whole grain breads and cereals,
rice, potatoes, and beans more often.
Start off the day with a high fibre cereal
(6 or more grams of dietary fibre per serving)
with skim or 1% milk.
Diet
33
Eat less fat.
Use small amounts of unsaturated oil such as olive, corn and canola or
an appropriate margarine in cooking. Avoid using saturated fats such as
lard, shortening or butter. Buy a good non-stick frying pan
Buy lean cuts of meats.
Cut the fat off meat before cooking.
Remove skin from chicken before cooking.
Boil, broil, bake, steam, barbecue, or poach instead of frying.
Eat fish 2 to 3 times per week.
Limit eggs to 2 whole eggs a week. This includes those used in cooking.
Egg whites can be used as desired.
Choose low fat cheeses (cottage cheese, skim mozzarella)
instead of high fat cheeses (cream cheese, regular cheddar & mozzarella).
Choose low-fat milk and yogurt.
Buy: skim or 1% milk and 0.1 % M.F. yogurt.
Use less salt in cooking.
Avoid adding salt at the table.
Flavour foods with a variety of herbs and spices such as:
basil, rosemary, thyme, garlic, onion, and black pepper.
Lemon and vinegar add a lot of flavour too.
Limit foods high in salt such as:
Bouillon cubes
Many convenience/prepared foods
Canned vegetables
Processed meat like salami, cappicolo, prosciutto, ham,
Canned meats
Sausage
Bacon
Processed cheese
Canned and dehydrated soup mixes
Use less of: coffee, tea, colas, cocoa and chocolate.
They all have caffeine. Limit to 2-3 cups/day.
If you drink alcohol, drink no more than
1 to 2 servings of the following size daily:
Wine 5 oz (150 mL) OR Beer 1 bottle (350 mL) OR Liquor 1 1/2 oz (50 mL)
Don’t drink and drive
34
Diet
Exercise and your Heart
Exercise should be an important part of everyone’s life, especially people with heart disease. Exercise
improves all of the risk factors that cause heart disease. Exercise lowers blood pressure, increases HDL
(good cholesterol),lowers blood sugar in people with diabetes, reduces weight and relieves stress.
Most people with heart disease can exercise and should exercise at least 3-4 times per week.
Indeed many people increase their exercise level after a heart attack. By increasing your amount of exercise,
and tackling all your other risk factors, you will significantly reduce your risk for further heart trouble, and
feel a lot healthier. You don’t have to run marathons to make a difference – though some people do
after a heart attack. Simply walking briskly for 30 – 40 minutes, 3 - 4 times per week provides important
health benefits.
Why Exercise?
Exercise makes your heart work better and gives your body the oxygen rich blood it needs. If you haven’t
exercised before, starting an exercise programme can be intimidating. Being active does not mean sweating in a gym. Instead, start by focusing on ways to be more active in your day to day life. Little bits of
activity throughout your day to day life adds up.
Did you know?
The heart is a muscle. Physical activity keeps it strong. If the heart is not strong, it can not pump blood
around your body as it should. This reduces the risk of heart disease and heart attack. Lack of physical
activity can also be linked to weight gain. Excess weight and lack of physical activity increase the risk of
diabetes. Keeping active helps reduce your health risks. Activity improves your cholesterol levels, helps
lower your blood pressure, helps control your weight. Losing even a few pounds reduces your risks for
heart disease and diabetes. Activity reduces stress. It helps keep your bones and muscles strong. This
helps you stay active as you age. It may also help you sleep better and think more clearly.
What’s Holding You Back?
What’s keeping you from being active?
Put a check mark by all your roadblocks:
• I don’t have enough time
• I’d have to find a babysitter for the kids
• It’s either too hot or too cold to exercise
• I get bored doing the same thing every day
• I don’t like exercising alone
• I don’t have the right shoes or clothes
• I travel for work so I can’t keep a regular exercise schedule
• Other things:
The more things you checked, the more roadblocks you have to getting active. There are many more
ways to be active than you think and there are simple ways around these roadblocks. Read on to find
ways you can enjoy being active as part of your daily life.
Exercise
35
Where should I start?
Look at your day. Could you make the way you do some things more active? This is the first step toward
keeping active for your heart. Add some movement. A more active lifestyle starts with a few small steps
that become habits.
Take the stairs instead of the elevator or escalator.
Park at the far end of the parking lot, then walk to the mall or the grocery store.
Walk to do some of your errands instead of using the car. Get up and walk to a co-worker office rather
than sending an e-mail or calling by phone.
The idea is to build movement into the things you already do. That way you can be more active without
having to find more time, get a babysitter or buy special clothes. Once you get into the habit of being
active, you can make your activity breaks longer and a little more brisk. Think of the way you would move
if you were hurrying to catch a bus. You feel your breathing and your pulse get a little faster. This is the
next level of activity, and it means greater health benefits. A good goal is to work up to 30 minutes or
more of physical activity on most days.Physical inactivity is the most common modifiable risk factor for
heart disease. Regular exercise will make your heart and coronary arteries healthier. It helps increase
strength, lower blood pressure and relieve stress. It can also help you control your weight. Sticking to an
exercise programme, you will lower your risk for future heart attack and stroke. You will feel better and
look better, too.
When should I increase my exercise?
Increase your activity safely. The goal is to be active 30 – 60 minutes a day most days of the week. The key is
to start slowly and get used to being active. Then add more activity, as you are ready. The first week you might
start by climbing the stairs at work instead of taking the elevator. The next week you can add a 5 – 10 minute
walk around the block or in the mall. When your walk gets easier, increase the time to 15 – 20 minutes.
Stepping up your activity slowly is the best way to make exercise safe. You are also more likely to stick with it.
Always check with your health care provider before starting an exercise programme as you may need to start
more slowly or avoid certain exercise.
tip
• To lose weight, you need to burn off 3500 calories more than you take in to lose one pound
• Inactive people are twice as likely to have heart disease as active people
Are there more benefits to exercise?
PHYSICAL
• Improves your heart & lungs
• Decreases your resting blood pressure
• Decreases body fat
• Decreases total and LDL cholesterol
(bad cholesterol)
• Raises HDL cholesterol (good cholesterol)
• Controls or prevents the onset of diabetes
• Decreases risk of bone and muscle injury
• Tones your muscles
• Burns off calories to lose extra pounds
• Helps you stay at your desirable weight
• Helps control your appetite
36
Exercise
MENTAL
• Decreases stress
• Decreases depression
• Better sleep
• More energy
Taking Your Pulse
Periodically, you must take your pulse. In order to be sure that you are in your individual training heart
range – a heart range which is safe and effective while exercising. It shows you are exercising at a good
pace for you – not so hard it hurts and it discourages you but not so easy that you don’t see results.
Radial Pulse
Every time your heart beats, it pumps blood throughout your body. The beat or pulse can be felt by placing your fingertips of your index and middle finger on the inside of your other wrist, in line with your
thumb.
Carotid Pulse
To take your pulse using the Carotid artery, first find your Adam’s Apple. Touch the Adam’s Apple with
your thumb and then reach the first two fingers toward either side of your neck. You will find the carotid
pulse approximately four finger breaths from the Adam’s Apple. The pulse is best felt using the index and
middle fingers. Do not use your thumb as you may feel its pulse and it may confuse you. Never push
hard. Only a light touch is necessary to feel the carotid pulse. Pushing too hard can constrict the carotid
artery and cause light-headedness or even damage to the artery.
Once you have located your pulse you can count for ten seconds and then multiply by six or count for
fifteen seconds and multiply by four. Both of these methods will give you heart beats per minute. To
determine if you are in the target heart range take your pulse when you complete your exercise programme.
You can also take your pulse at any point during your exercise programme, especially if you feel fatigued.
tip
It is normal for your pulse to increase with activity
Your pulse should return to normal (resting rate) 10 – 15 minutes after the activity.
What is cardiovascular exercise? (aerobic exercise)
Like your other muscles, the heart muscle can become stronger through exercise. During exercise all muscles
need more oxygen rich blood to produce energy. This oxygen demand causes your breathing to increase and
your heart to beat faster. Making your heart beat faster is how you strengthen and condition your heart.
To train your heart and other muscles to better use oxygen, you must perform longer, non-stop movement at
a faster pace. This gives you even more health benefits. Remember during exercise, the heart, lungs, and blood
vessels (cardiovascular system) supply oxygen to the exercising muscles for fuel. If you continue doing aerobic
exercise regularly, your system will improve its ability to take in and use oxygen. Your activities should include
all large muscle groups of the body. Try to use these three ways to make your activities even more effective in
strengthening your heart.
Accumulate 30-60 minutes of exercise by the end of the day
Go at a faster pace
Exercise most days of the week
Exercise
37
Exercise improves the working of your heart, lungs and blood vessels. It makes you breathe harder and
perhaps sweat a bit. Examples are brisk walking, biking, skating or swimming. Be sure to choose one or
more things you enjoy, as this will help you stay with your exercise programme. The aerobic training
period should consist of exercising 20 – 30 minutes within your training heart rate range to provide
significant improvement in your cardiovascular system. To achieve a reasonable level of cardiovascular
fitness you should exercise a minimum of four times per week, preferably every day of the week. If 20-30
minutes is too long for you, try exercising for at least 10 minutes, or a little more, without stopping.
Ten minutes of exercise will give you most of the benefits of longer exercise times.
Your exercise session should look like the following diagram:
Warm up
5-10 min
150
Training Period
20-30 minutes
Cool down
5-10 min
140
inc W
rea arm
se
u
he p
art
rat
e
120
110
100
90
te
wn
do art ra
ol
Co e he
as
cre
de
Heartbeats per minute
130
Training period
80
70
60
0
10
15
20
25
30
35
40
45
50
55
60
Minutes in exercise
What activity is right for me?
Sometimes people stop exercising because they set goals that are too high. You don’t have to become an
athlete. You don’t have to learn a new sport. Right now you may only be able to walk to the corner and back That’s okay. Set goals that work for you. Make an exercise plan that you will enjoy and will fit into your
lifestyle. The more you make exercise a part of your life, the more benefit you are likely to get from being
active. Each exercise session should consist of 5 – 10 minute warm up period followed by 20 – 30 minutes of
cardiovascular training and 5 – 10 minute cool down.
Warming Up
Each time you exercise you should include a warm up. This warm up will send a message to your muscles that
they are about to be used. Each warm-up period should be 5 – 10 minutes. Proper warm up may prevent
possible muscle and bone injuries as well as heart problems. You do this to increase your metabolic rate (heart
rate, blood pressure) gradually from a resting level, to a level of energy needed for the conditioning phase of
your exercise session. To warm up, do slow stretching or do what you are about do but at a slower pace. For
example before a brisk walk, walk slowly for at least 5 minutes before picking up the pace.
38
Exercise
Cool Down
The cool down period is of the same importance as the warm up period. The major reason we cool down is
to keep active the main muscle groups that were involved in the exercise being done. Most cardiovascular
exercise involves the muscle of the legs and is performed in the upright position. Blood tends to pool in the
lower part of the body when you finish your exercise.
Training Period and Target Heart Rate
To become stronger, your heart has to beat faster than usual for at least 10 minutes at a stretch, and
preferably longer. Your ideal heart rate during exercise is called your “target heart rate,” and is determined
from your maximum heart rate during exercise. To figure out your maximum heart rate, you will have an
exercise stress test before you start your exercise program. Most people’s “target heart rate” is 60%-80% of
their maximum heart rate.
Some Examples Of The Activities You Can Do
Range of Motion (ROM)
ROM may improve muscle strength and flexibility and prevent the development of
undue weakness and poor posture. Each activity motion should be performed one or
two times daily. Start at 5 repetitions of each activity, gradually increasing to
10 – 15 repetitions twice daily. An example would be stretching activities.
Walking
Many people don’t realize that walking is “exercise”. Walking is safe to do. There is
little risk of injury to your heart, muscle and bones. It has been found to be an excellent
activity for improving aerobic activity. Because walking is a simple exercise most people
can participate. Walking requires no special skills, facilities or equipment and can be
included into most busy lifestyles. Indeed, simply walking briskly for 30 minutes
4 times a week will significantly reduce your risk of a future heart attack. People who
walk to work have fewer heart attacks than those who drive.
Jogging
Considered a higher intensity exercise. It is not recommended for patients in the
early stages of cardiac recovery.
Cycling
One of the best activities for rhythmic, large muscle group activities.
Swimming
Not recommended until at least 8 - 12 weeks after a cardiac event such as bypass
surgery. This period allows for enough time for healing of your chest and leg
incisions in the surgical patient and the heart tissue of the heart attack patient.
Advantages of a swimming programme are many.
• It is an aerobic activity that involves both the arms and legs
• The water buoyancy helps venous return and heart rate
• Causes fewer muscle and bone injuries
• Can be therapeutic for patients with arthritis
Exercise
39
Strength Training
Should not be done until at least 8 weeks after a cardiac (heart) event. Strength training is exercise that
uses resistance, an example would be weights. Strength exercises (resistance training) help build muscle.
Strong muscles help keep your heart rate and blood pressure under control. It also helps you do daily
activities like housework and yard work. Strength activities help your muscles and bones stay strong and
improve your posture. Most home and job related activities require upper and lower body strength.
Improvements in muscle strength and endurance may help your return to a fully active lifestyle. If you
plan to include strength training as part of your exercise routine, you should discuss it first with your
physician.
What is meant by components of exercise?
Frequency, duration, intensity and type are what are called components of exercise. Each patient is
individual. Each has different characteristics that affect his or her readiness to safely begin the exercise
portion of a healthy lifestyle change. Through careful consideration of an individuals health status, risk
factor profile, behavioural characteristics, personal goals and exercise preference, the appropriate exercise
prescription (plan) is developed incorporating frequency (how often), duration (how long), Intensity (how
hard), and type (activity being performed). Your exercise prescription, is an individual exercise plan
developed for you, by a trained health care professional and should include the following:
Training heart rate range (THR) ........how high your heart rate (heart beat) should be when exercising
Frequency ..........................................how often you do the activity
Intensity..............................................how hard you are working to do the activity
Type....................................................type of activity being done
Duration ............................................how long you should do the activity
The goal of the exercise plan is for you to improve your physical fitness and reduce cardiac risk factors.
If you are involved in a home exercise programme, you should choose activities that can be alternated
from day to day. An exercise prescription should be developed for you using all components as
mentioned above. Periodically you should attend a hospital based outpatient facility to further evaluate
and monitor your progress.
What is home exercise?
It is an exercise programme you will do at home. Home exercise should only be done if you are:
1. clinically stable
2. have knowledge about your cardiac symptoms
3. able to independently regulate your exercise programme
4. have a minimum functional capacity of 7 MET’s, a measurement made during your exercise stress test
My METs are
40
Exercise
(please ask your health care provider)
How much can I do?
Hospital Discharge
to 3 month
After 3 months
Frequency
1 –2 times per day
3 –5 times per week
3 – 5 times per week
Intensity
*My THR range _________
or **RPE
*My THR range _________
or **RPE
* see cardiac rehab nurse
* see cardiac rehab nurse
Duration
10 – 15 minutes
20 – 60 minutes
Activity Example
range of motion, treadmill
walking, biking, jogging,
walking, biking, calisthenics, swimming, calisthenics,
gardening
endurance sports, golfing,
ballroom dancing
* THR = training heart rate
**RPE = rating of perceived exertion
Remember:
* If you are monitoring your heart rate keep it within your prescribed training heart rate range.
** If you are using ratings of perceived exertion during exercise, remember to be honest about your feelings.
Rating of Perceived Exertion (BORG Scale)
While exercising we want you to rate your perception of exertion (how
heavy and strenuous the exercise feels to you). The perception of
exertion depends mainly on the strain and fatigue in your muscles and
on the feeling of breathlessness or aches in your chest. You measure
your perception of exertion using the BORG scale.
Exercise
41
What is a BORG Scale?
It is a measure of perceived exertion,it grades the degree of heaviness and strain experienced in physical
work according to a specific rating method.
20
Maximal Exertion
19
Extremely Hard
18
17
Very Hard
16
15
Hard (heavy)
tip
9 “Very light” exercise. For a normal ,
healthy person it is like walking slowly at
his or her pace
13 “somewhat hard” exercise, but still feels
OK to continue
Somewhat Hard
17 “very hard” is very strenuous.
A healthy person can still go on, but he
or she really has to push him or herself.
It feels very heavy, and the person is
very tired
10
Light
9
Very light
19 This is an extremely strenuous exercise
level. For most people this is the most
strenuous exercise they have experienced.
8
Extremely light
14
13
12
11
7
6
No exertion at all
Sexual Activity
The maximal heart rate achieved during sexual activity is usually about 120 heartbeats per minute. This is
roughly what your heart rate will reach after walking up two flights of stairs. If you do not experience
chest pain or severe shortness of breath after walking up two flights then you can engage in sexual
activities safely. You should wait at least one hour after eating a meal before engaging in sexual activity.
Special Populations
Older Individuals
No matter what your age, the benefits of exercise are the same. Your activities of daily living should be
taken into consideration and should be resumed as soon as possible. Exercise is important for you to lower
the risks of heart, bone and muscle complications. The goal for you is to maintain your day to day
activities for independent living. It is recommended that those with limited exercise ability have 3 to 4
shorter training periods per day. A gradual approach to increasing physical activity is recommended for
improvement without injury or complication. Activities should be chosen by your individual preference.
However walking remains one of the easiest exercises. If walking is not something you prefer, other
exercise can be used within your physical limitations. There are many activities you can choose from in
order to achieve your fitness goals such as gardening, golfing and cycling. The best choices however are
those that you truly enjoy. It is much easier to stay with something that is fun to do. While exercising
42
Exercise
you should wear comfortable, loose fitting clothes to prevent
circulatory changes caused by tight fitting clothing and improper
fitting footwear.
Key Points
RPE (rate of perceived exertion) BORG scale is recommended
(see scale in previous section)
Alternate between days that involve primarily weight bearing
(i.e.walking)and non weight bearing
(i.e. cycling/ swimming) exercise
Daily exercise at lower intensities can also be beneficial
3 – 4 shorter training periods per day of 10 – 15 minutes
People with Diabetes
Exercise - induced hypoglycemia (low blood sugar) is the most common problem, experienced by the exercising diabetic. Hypoglycemia
may result when too much insulin is present, or when insulin is
absorbed more quickly from the injection site, both of which may
occur with exercise. Hypoglycemia can occur during exercise, but may
also occur up to 4 to 6 hours following an exercise session.
Key Points
Monitor glucose frequently when exercising
Inject insulin in an area such as the abdomen that is not active
during exercise
Avoid exercise during peak insulin activity
Eat carbohydrate snacks before and during prolonged
Tips before getting started !!
• Make sure you have a
comfortable pair of shoes
to prevent blisters or
injury
• If you are buying walking
shoes, shop for them at the
end of the day when your
feet are larger
• Try on both shoes and
walk around the store
before you buy them make
sure they fit well
A good pair of walking
shoes will have:
• Nylon mesh or leather to
allow your feet to breathe
• Support around the heel to
prevent sliding
• A slightly elevated heel
• Enough room to wiggle
your toes
• Firm arch support
• A flexible sole that bends
where your foot bends
exercise periods
Be aware of the signs and symptoms of hypo and hyperglycemia
Exercise with a partner
Wear appropriate footwear
Take very good care of your feet
People with Heart Failure
Exercise should begin gradually. Engage in aerobic activity 4 to 7 times a week. While exercising you
should use ratings of perceived exertion (BORG scale) in the range between 11 to 13. You should avoid
exercise levels that cause angina or excessive fatigue or shortness of breath. For people with very limited
exercise tolerance, non-weight – bearing activities such as stationary bike should be considered. An activity
such as this with no or minimal external resistance allows for a very low exercise energy use.
Exercise
43
Key Points
Warm up and cool down with a low intensity activity
You should not exercise in hot/ humid or cold weather conditions
because of the extreme increased demand on your heart muscle.
Wait at least one hour after a meal before performing exercises
Medication scheduled for morning usage should be taken before
morning exercise
People with Pacemakers
Use ratings of perceived exertion when judging the intensity of your
exercise. The average age for pacemaker insertion is 70 years. Use the
same guidelines as mentioned in the section of exercise and your heart
for older people.
Key Points
Notify your doctor if you experience any of the following
symptoms:
Dizziness, light headedness, shortness of breath, chest discomfort,
drowsiness or palpitations
Clothing Tips
• Wear loose, comfortable
clothing made of cotton,
wool or breathable nylon
• Choose cotton or wool
socks to let your feet
breathe
• In warm months, wear
loose lightweight clothing.
Wear a hat to prevent
sunstroke
• In colder months, layer
your clothing so layers can
be easily removed as your
body gets warmer. Keep
your ears, head and fingers
covered to avoid frostbite
People with Peripheral Vascular Disease
Intermittent claudication – when a muscle is exercised to the point that blood supply cannot meet the demand
of the exercising muscle, discomfort occurs (usually in your leg). This is called “intermittant claudication”
The discomfort usually quickly goes away with rest. You should exercise 5 to 7 times per week. Walking is the
preferred exercise. You should walk until you start to feel discomfort, rest, and then continue.Walking improves
the blood supply to your leg and may, over time, improve your claudication.
People with Cardiac Transplant
Exercise should be performed in a supervised setting. Starting gradually, then extending your exercise
sessions to 4 – 7 times a week for greater than 30 minutes. While exercising you should use ratings of
perceived exertion in the range between 11 to 14. Upper body exercise should not be done until at least
eight weeks after surgery to allow the sternum to heal.
Key Points
Transplant recipients benefit as much from a structured cardiac rehabilitation and secondary prevention
programme as other cardiac participants.
Remember: Before beginning any exercise programme,
it is important that you discuss it first with your doctor
44
Exercise
What Do These Words Mean?
Cardiovascular Endurance
improvement in the ability of the body to use oxygen better so that you
can exercise longer
Training Heart Rate
the heart rate needed to get maximum benefit from the activity being done
Mode of training
the type of activity being performed
Frequency
how often you are doing the activity
Duration
how long you are doing the activity
Intensity
how hard you are working to do the activity
Rate of Progression
when you should increase your level of activity
Repetitions
the act of a repeated activity
Interval Training
breaks in between activities
METs (metabolic)
the energy used for activity being done
Aerobic
activities that use oxygen to create energy you need to do the exercise
Conditioning phase
activity length to produce cardiovascular fitness
Exercise
45
46
Exercise
Helpful hints to taking
your medication correctly
Do you remember to take your pills at the same time every day and near activities that
you do every day?
HINT: if you take medication in the morning, try taking them before you brush your teeth.
If you take pills during the day, think about getting a watch with an alarm.
Have you found a way to keep your medication in order?
HINT: Try using a pillbox and keep it in an area that you will easily see every day, like your kitchen or
on a table. Remember that the medication must be kept away from children.
Keep an extra supply (1-2 days) of your pills at work, at a family member’s home, or carry them in
your purse in case of an emergency. Don’t forget to check the expiry date on the pill bottles.
Every heart patient should keep a medication journal to record information such as a missed dose, or
to report side effects you may be having due to medication that you are taking. Take this journal to
your next doctor’s visit.
Do you always check with your health care provider before you take any over-the-counter medications
(medications that you can buy without a prescription)?
HINT: Some of these medications can interact with your prescription medication. Drug interactions
can cause side effects or reduce the usefulness of your prescription medication.
See Table 2 for more information.
Many alternative medicine products can affect your prescription medication. Do not take alternative
products instead of your prescribed medication. Always talk to your doctor or pharmacist if you have
any questions about alternative products. See Table 5 for more information.
When you travel, do you carry your medication in your suitcase?
HINT: Carry your prescription medication with you, not in your suitcase. Bring enough with you for
your trip so that you won’t need to buy medication in an unfamiliar area.
Your personal information
Take care of yourself and take an active role in your care.
Review the individual medication sheets that were given to you by the pharmacist.
These sheets include:
• the names of your medication (both chemical and company names are listed)
• the dose that you take
• what they are used for
• how you should take them
• what side effects may occur
• what to do if you have side effects
Medication
47
What does that mean ???
A guide to taking medication that must be taken with or without food:
Table 1
If the prescription says take:
You can take your medication:
On an empty stomach
1 hour before or 2 hours after meals
Before meals
Usually 15 – 30 minutes before meals
With or after meals
Within 1 hour of eating a meal
With or without food
May be taken with or without food
Always ask your doctor, nurse or pharmacist exactly how the prescribed medication should be taken
and at what time(s) of the day. This will help the drug to work best in your body.
Other medications that you take may interfere with the way drugs get into your system.
Certain medications must be taken apart from your other medication to avoid a drug interaction. If
you have any questions about your particular medication, ask your pharmacist.
Pills labeled CD, SR, or XL (examples: Cardizem CD, Lopressor SR or Adalat XL) should not be
crushed or chewed, but swallowed whole.
CD = controlled delivery, SR= sustained release, XL = extended release
48
Medication
Table 2
POSSIBLE DRUG-DRUG INTERACTIONS WITH
OVER-THE-COUNTER (OTC) PRODUCTS
(Pills that can be bought without a prescription)
Drug
Plus
Result
Comment
NSAIDS*
ibuprofen, (Advil,
Motrin IB, Nuprin)
Naproxen, (Aleve,
Anaprox), others
1.beta blockers or
2 hydralazine or
3. water pills
Increased blood
pressure
Tell your doctor if
you use any over
the counter pain
medications
Antacids
(magnesium
hydroxide,
aluminum hydroxide)
Digoxin, iron
The amount of
digoxin or iron in
your blood may
be decreased
The amount of
asprin in your
blood may be
decreased.
Space the doses
of these drugs
as far as
possible from
when you take
antacids.
Aspirin
Enteric
Coated Aspirin
Aspirin
(and other NSAIDS)
in OTC products
Increased risk
of bleeding
(delayed effect)
Always check
labels of OTC
products to look
for additional
ingredients which
may have been
added to the product
Smoking,
Nicoderm Patch
or Nicotrol Patch
Metoprolol
Decreased blood
pressure lowering
effects. Can increase
heart rate.
Contact your health
care provider if you
are interested in
quitting smoking.
H2-blockers
cimetidine
(Tagamet)
Metoprolol
Increased blood
pressure lowering
effects.
Axid (Nizatidine) and
Zantac (Ranitidine) do
not have an effect
on metoprolol.
Laxatives
Phenothalein,
senna (Senokot),
bisacodyl, magnesium
hydroxide
(Milk of Magnesia)
bisacodyl and
magnesium
hydroxide have
been shown to
decrease Digoxin
levels.
Tell your doctor
about OTC laxatives
that you may take.
Alternatives: stool
softeners, fiber
supplements.
*NSAID is a term for Non Steroidal Anti-Inflammatory Drugs …in other words, a group of different
medications which work in a similar way to decrease inflammation and/or pain.
Always check with your health care provider before using OTC products
with your prescription medication
Medication
49
Table 3
IMPORTANT SIDE EFFECTS OF LAXATIVES,
DECONGESTANTS, ALCOHOL AND ANTIHISTAMINES
Product
Example(s)
Side effects
Comment
Laxatives
Phenothalein,
senna (Senokot),
bisacodyl, magnesium
hydroxide
(Milk of Magnesia)
May cause
diarrhea and
potassium loss.
Tell your doctor about
OTC laxatives that you
may take.
Alternatives:stool
softeners, fiber
supplements.
Oral
Pseudoephedrine,
(Sudafed), phenylephrine
May increase
blood pressure.
Sudafed not likely
to affect blood pressure
at doses of 15 to 30 mg.
Effects of oral
phenylephrine unknown
(has not been studied).
Topical
Ephedrine
Unknown
May not be safe,
not enough information
available.
Nasal
Phenylephrine,
oxymetolazone,
naphazoline(Privine)
Less likely to cause
changes in
blood pressure.
No change found
in trials of patients
with high blood
pressure.
Rebound congestion
may occur with
use more than 3 days.
Alcohol
Drugs that are cleared
from the body by the liver
Regular use of
large amounts is a
risk factor for the
development of high
blood pressure.
Alcohol may increase
triglyceride levels.
Ask your doctor how
drinking alcohol affects
your condition or
medication. See table 8
for information about
drug interactions
with alcohol.
Antihistamines
diphenhydramine
(Benadryl), fexofenadine
(Allegra), loratadine
(Claritin), cetirazine
(Reactine)
Usually do not cause
an increase in blood
pressure. May cause more
tiredness if you take
beta-blockers
Decongestants
Always check with your health care provider before using OTC products
with your prescription medication
50
Medication
SPECIAL GROUPS
Information for Patients with Congestive Heart Failure (CHF)
Table 4
POSSIBLE SIDE EFFECTS OF OVER-THE-COUNTER (OTC) MEDICATIONSSide
effects
Comment
Nonprescription
medication
Cough syrups
ammonium chloride
potassium chloride
Oral Decongestants
pseudoephedrine (Sudafed)
Pain Relievers
ASA (Aspirin)
Ibuprofen and other
NSAIDS*
Antacids
sodium bicarbonate/
sodium citrate
alginic acid compound
Antidiarrheals
bismuth
subsalicylate
Laxatives
Phenothalein, senna,
bisacodyl, magnesium
hydroxide
Potential effect in CHF or
interaction with medication
Alternatives
or management
May decrease potassium
Contains large amounts
of potassium
Do not Use:
Alternative: guiafenesin
May increase the risk of
abnormal heart rhythm in
patients taking Digoxin
Do not Use:
Alternatives:decongestant
nasal sprays (use less
than 3 days only)
ASA in OTC products may
increase the chance of bleeding
if you take Aspirin or Coumadin.
Be aware of hidden sources
of salicylates, like bismuth
subsalicylate. Do not take
Aspirin on your own.
May cause salt and water
retention. They may interfere
with the actions of water pills.
Use under doctor’s
supervision only
May contain large amounts of
sodium (each Alka Seltzer tablet
contains approx. 550 mg
of sodium)
Do not use due to high
salt content. Alternative:
aluminum/magnesium
antacids, calcium carbonate
Gaviscon contains a lot of
sodium (22 mg per tablet)
Do not use.
Alternative: Maalox HRF
Salicylate may interfere
with aspirin therapy or Coumadin
Avoid:
Alternative: loperamide
or attapulgite
May cause a lot of diarrhea,
and potassium loss.
Bisacodyl and magnesium
hydroxide have been shown
to decrease Digoxin levels.
Avoid:
Alternatives: fibre
supplements, stool
softeners
*NSAIDS= A group of drugs used to reduce pain and/or inflammation
Always check with your health care provider before using OTC products
with your prescription medication
Medication
51
Information for those taking Alternative Products
• Always talk to your health care provider before taking an alternative product to check for safety
• Many alternative products do not contain the amount of active ingredient that is needed for the
product to work in your system
• Health Canada is developing strict regulations for alternative products. The content, quality and safety
of the product cannot be relied upon
• Never substitute your prescription medication with alternative medicine products on your own
• Always check the reliability of internet sites which give information on alternative products.
• References: www.herbmed.org (internet)
Health Professional’s Guide to Popular Dietary Supplements, Allison Sarubin MS RD.
Table 5
POSSIBLE INTERACTIONS BETWEEN COMMONLY
USED ALTERNATIVE PRODUCTS AND PRESCRIPTION DRUGS:
Product
Stated Use
Potential side effects and management
Astragalus
Common cold
Low blood pressure
Black Cohosh
Heart disease
Slows heart rate, dilates blood vessels, may
reduce your blood pressure
Capsicum
Dyspepsia,
vascular disease, arthritis
Increases blood pressure
Chamomile
Sedative
Contains coumarin, which may interact with warfarin. This has not been studied yet, therefore
monitor Coumadin therapy if products are used
together.
Co Q10
Heart failure,
high blood pressure,
chest pain
More than 300 mg daily may affect the
liver. Use with caution if you have high
blood pressure or use insulin. C0Q10 may have
additive effects. May decrease the effectiveness
of Coumadin, avoid use. If used together,
monitor INR within the first 2 weeks on C0Q10.
Dan Shen
Blood thinner
May affect Coumadin activity
Echinacea
Immune stimulation
Do not use more than 8 weeks. Avoid use with
other drugs that may cause liver problems. May
cause an unpleasant taste. Do not use if you
have rheumatoid arthritis.
Ephedra
(Ma Huang)
Mood alteration,
obesity, asthma
Increases heart rate and blood pressure.
May cause irregular heart beats.
Evening Primrose Hot flashes, cholesterol
Oil (Omega-6)
52
Medication
May cause increase in sodium, potassium or
chloride. Do not take if you take phenobarbital or
phenytoin (increased risk of seizure)
POSSIBLE INTERACTIONS BETWEEN COMMONLY
USED ALTERNATIVE PRODUCTS AND PRESCRIPTION DRUGS:
Product
Stated Use
Potential side effects and management
Feverfew
Migranes, arthritis, allergies
May alter blood clotting by making blood less
sticky. Should not be used with Coumadin, ASA,
NSAIDS or Plavix
Flaxseed Oil
& Powder (Linolenic
Acid-Omega 3)
Reduce stroke and
heart attack risk
Makes blood less sticky, may increase your
risk of bleeding. Use with caution if you take
Coumadin, ASA or NSAIDS or Plavix. May affect
absorption of Digoxin or Metformin. Doses > 45
gms of the powder may cause diarrhea.
Garlic
Potential lowering of
blood pressure
and cholesterol
Likely safe when used in amounts in food.
Very large doses (more than 1 clove daily
[4 grams] or 900 mg of the powder) may cause
an elevation in your INR (if you take coumadin).
May increase the effects of aspirin, Plavix and
other NSAIDS. May reduce blood sugar. Use
with caution if you have diabetes.
Ginkgo
Cognitive performance
May increase your risk of bleeding. Do not use
with Coumadin. May affect blood sugar.
Ginger
Antinauseant, Arthritis
Likely safe when used in amounts used in
cooking. Doses greater than 4 grams (of the
root) daily may increase the risk of bleeding or
decrease blood sugar. Should not be used with
Coumadin because may increase the INR. May
cause an increase or decrease in your blood
pressure. May cause heart rate to increase.
Ginseng
Mental clarity, mood,
heart conditions, others
May cause diarrhea. Should not be used with
estrogen because of possible additive effects.
May interfere with digoxin monitoring or activity.
May affect blood glucose levels and should not
be used in patients with diabetes. May increase
blood pressure. May decrease the effectiveness
of Coumadin by increasing blood stickiness. Do
not use with Coumadin, heparin, aspirin or
NSAIDS.
Glucosamine
Arthritis
Early evidence suggests that those who are overweight or diabetic may be at risk of side effects
with glucosamine (increased blood sugar).
Hawthorn
Heart disease, high cholesterol High doses; drowsiness, abnormal heart
rhythms; has additive effects with digoxin and
may result in toxicity.
Kyushin
Many
May interfere with digoxin monitoring or digoxin
activity.
Medication
53
POSSIBLE INTERACTIONS BETWEEN COMMONLY
USED ALTERNATIVE PRODUCTS AND PRESCRIPTION DRUGS:
Product
Stated Use
Potential side effects and management
Licorice
PUD, cough
May cause low potassium: resulting in salt retention (can decrease effects of Spironolactone) or
abnormal heart rhythms. May interfere with
digoxin monitoring or digoxin activity. May
increase blood pressure.
Lobelia
Breathing problems
Increases heart rate.
St. John’s Wort
Anxiety, Sleep Depression
Avoid use with some antidepressants
[ie. paroxetine (Paxil), fluoxetine (Prozac)].
May affect blood pressure, monitor closely. May
inhibit the absorption of iron. Causes sensitivity
to sun. Avoid tyramine containing foods.
Valerian
Insomnia
Do not use with barbituates (phenobarital,
butalbital) because excessive drowsiness
may occur.
This list is not complete. Many alternative internet sites offer limited information on products.
Always talk with your health care provider before taking alternative therapies.
Information for Patients Taking Warfarin (Coumadin)
Possible and Documented Interactions between Alternative Products and Coumadin
These products may increase your risk of bleeding:
Talk with your pharmacist before using these products on your own.
Alfalfa
Anglica root
Arnica flower
Anise
Asafoetida
Bogbean
Borage seed oil
Bromelain
Capsicum
Chamomile
Clove
Fenugreek
Feverfew
Fish Oil
Flaxseed
Garlic (> 1 clove daily)
54
Medication
Ginger
Ginkgo
Ginseng
Horse chestnut
Horseradish
Kava kava
Licorice root
Lovage root
Onion
Parsley
Passionflower herb
Poplar
Quassia
Red Clover
Rue
Sweet clove
Turmeric
Vitamin E
Willow bark
Information for Patients Taking Warfarin
(Coumadin) cont. . .
Documented Reports of Possible Increase in Coumadin’s effects
(Increased Risk of Bleeding):
Dan-Shen
Donq Quai
Vitamin E
Devil’s Claw
Quinine
Papain (Papaya)
Documented Reports of Possible Decrease in Coumadin’s effects:
(Decrease in Coumadin Efficacy):
How much:
How does it affect Coumadin?
Coenzyme Q10
(30 mg daily)
(vitamin K like structure)
Ginseng
(amount not specified)
(Unknown mechanism)
Green tea
(large amounts, >0.5 gallon/day)
(contains Vitamin K)
This list is not complete. Always talk to your health care
provider before taking alternative therapies.
Information for Patients with Diabetes
Herbs that may interfere with blood sugar levels
The following herbs may make your blood sugar lower:
bitter melon
ginger
ginko
chromium
ginseng
gymnema
fenugreek
garlic
nettle
sage
The following herbs may make your blood sugar higher:
devil’s claw
glucosamine
ginseng
licorice
ma huang
Do not eat raw ackeefruit, it can cause your blood sugar to become very low
High dose of Vitamin B6 may cause nerve problems, do not use
If you choose to take an alternative medication with your diabetes medication,
after discussion with your doctor, test your blood sugar more often. That way if
you notice a benefit or a worsening of your blood sugars you will be able to
make a necessary change.
This list is not complete.
Never change the way that you take your medication without talking to your health care provider.
Medication
55
Information about Diabetes
and Non-Prescription Drugs *
Some products can affect blood sugar, whereas others have no effect
Table 6
PRODUCTS THAT DO NOT AFFECT BLOOD SUGAR
Aspirin (ASA)
Antihistamines (Reactine, Allegra)
Acetaminophen (Tylenol)
PRODUCTS THAT MAY AFFECT BLOOD SUGAR OR LABORATORY TESTS
Product
Effect on blood sugar
Comment
Oral Decongestants
Can increase your blood sugar
i.e. pseudoephedrine (Sudafed) and possibly your blood pressure.
Use single ingredient products.
A nasal spray decongestant
is a better choice. Do not use
longer than 3 days as the
blood vessels in your nose
can become dependant on
the spray.
Throat lozenges, cough syrups
May increase your blood sugar.
Sucrose, sorbitol, mannitol
and xylitol are different types
of sugar that may be in these
products.
Vitamin C
(more than 500 mg per day)
Can affect urine or blood sugar tests.
Antacids (Tums)
Avoid use with some
Antacids can affect the
anti-diabetic medication (glyburide). rate of absorption of your
medication, making your
blood sugar lower. Use with
caution.
*It is important to know how or if these medications may affect your diabetes.
Read the label and ask your health care provider if you have any questions.
56
Medication
Potential Food-Drug and Vitamin-Drug Interactions
Table 7
SOME OF THE MORE COMMON DRUGS THAT
CAN BE AFFECTED BY VITAMINS OR FOOD
Plus
Result
Comment
Grapefruit
juice
Nifedipine (Adalat, Procardia)
amlodipine (Norvasc)
felodipine (Plendil)
lovastatin (Mevacor)
simvastatin (Zocor)
atorvastatin (Lipitor)
Warfarin (Coumadin)
amiodarone (Cordorone)
Grapefruit juice may
cause an increase in
the amount of these
medications in your
system.
If you drink grapefruit
juice regularly and
are not experiencing
adverse effects, you
may continue. If you
have any questions,
ask you doctor.
Vitamin C
(high dose)
Coumadin
May shorten the INR*
(can make Coumadin
less effective) when
taken in doses more
than 1-16 grams.
Tell your doctor if you
take more than the
RDA** (60 mg daily
for men and women)
Vitamin E
Coumadin
May increase the risk
Avoid doses greater
of bleeding with
than 400 I.U. if you
Coumadin. Vit E may
takie Coumadin
prolong the INR *in
doses exceeding 400 I.U.
daily (inhibits Vit K
clotting factors
Vitamin K
Coumadin
containing foods
May reduce the
effectiveness of
coumadin
Eat the same
amount of green
leafy vegetables
from week to week
during treatment
with Coumadin***
Minerals (Iron,
magnesium
or zinc)
May bind to Coumadin,
which may decrease
their absorption
Take Coumadin and
Iron/Magnesium/Zinc
containing products at
least two hours apart
Coumadin
* INR= International Normalized Ratio ** RDA (Recommended Daily Amount)
*** A complete list of foods that contain Vitamin K will be given to you at your visit with the pharmacist.
This list is not complete. Always talk with your health care provider before taking vitamins.
Medication
57
Drug /Alcohol Interactions
Alcohol can affect the blood levels of many medications. The effects of alcohol or of the medication that
you take may be increased. This could result in many health-related problems.
Table 8
Medication
(must be used with caution with alcohol)
Interaction with alcohol
acetaminophen (Tylenol, APAP)
There is a chance of liver problems when you take
Tylenol and drink alcohol on a regular basis. Be aware
of Tylenol in OTC products.
aspirin (ASA)
When taken with alcohol, it can increase your risk of
bleeding due to stomach irritation. Separate alcohol and
ASA by 12 hours after taking ASA to avoid problems.
warfarin (Coumadin)
At least three drinks per day (>50 g) may make
coumadin less effective. Less than two drinks daily
should not have an effect on Coumadin. Binge drinking
(> 250 g) can increase your risk of bleeding. Avoid
rapid changes in the amount of alcohol that you drink.
buproprion (Wellbutrin)
Do not combine with alcohol, this may increase your
risk of having a seizure
anithistamines (Benadryl),
anxiety pills (Ativan, Xanax, Serax)
sleeping pills (Restoril, Halcion)
These medications may make you feel drowsy
and the effect may be increased with alcohol.
beta- blockers (Atenolol,
Corgard, Metoprolol)
The combination of certain beta-blockers can increase
the impact alcohol has on reflexes, use with extreme
caution if you are driving.
diabetes medication
[ Glyburide (DiaBeta, Micronase),
Glipizide (Glucotrol)], Insulin
Blood sugars may stay low longer after a drink or two.
Eating food when you drink alcohol may help reduce
the chance of having low blood sugar.
ibuprofen (Advil, Motrin IB, Nuprin, others),
Indomethacin
Regular use of both ibuprofen and alcohol
may increase your chance of developing heartburn or
ulcers. Ibuprofen may prolong the effects of alcohol
(drowsiness, dizziness, in-coordination).
narcotics (painpills) (Codeine, Darvocet,
Percocet, Vicodin, others)
These medications on their own can interfere
with alertness and coordination. Avoid use with alcohol.
nitroglycerin (Nitro-Dur, Nitrostat,
Transderm-Nitro)
Avoid use with alcohol. The combination may lower
your blood pressure and make you dizzy which could
cause you to fall.
Ranitidine (Zantac)
Use caution if driving or operating machinery
Vitamins B6 and B12
Absorption may be decreased with regular use of alcohol.
Verapamil (Calan, Isoptin, Verelan)
Three drinks can cause a decrease in your level of
alertness when taken with verapamil.
58
Medication
THINGS TO REMEMBER
Take your medication exactly as ordered by your doctor. See Table 1 for more information. You can do it!!
If you miss a dose, take it as soon as you remember. If it’s near your next dose, skip the missed dose.
DO NOT TAKE DOUBLE DOSES.
Do you store medications in a cool, dry place? Store medication away from direct heat, light or moisture.
When should you refill your medication? For refills, call your pharmacy 24 hours in advance. If there
are no refills, contact your doctor or pharmacist.
Inform your doctor(s) of which medications you are currently taking
Before buying medications that do not require a prescription, talk to your pharmacist. Some medications
require special safety measures. SeeTable 3 for more information.
Who will you talk to if you have any concerns about your medication? You can always talk to your
doctor or pharmacist to get the answers you need.
Do not share your medications with other people
All medications have an expiry date. Always check the expiry date on medications that you take.
Please remember to bring all of your pill bottles with you to all of your doctor visits
Please make sure that you have enough refills of your medication before you leave a S.P.A.C.E. clinic
visit or any doctor visit.
Medication
59
60
Medication