The Low-salt, Low-fat Diet. Part 2

What kind of exercise is permissible? Among muscular activities that are suitable to patients who have recovered from heart attacks are swimming, walking, square dancing, fishing, gardening, bowling, and horseback riding. They may also resume normal sexual relations and otherwise live normally. More violent forms of exercise, such as tennis or squash, however, are definitely dangerous. Moderate physical activity is recommended for coronary patients because during mild exercise, there occurs a nutrient withdrawal from the blood to meet increased metabolic needs. This withdrawal, in turn, results in a lower serum concentration of fats and consequently of cholesterol.

Should you smoke? One of the first questions a smoker will ask his physician following a heart attack is, "Doctor, do I have to give up smoking?" In most instances, the doctor will have to say "yes." In general, smoking is not good for the circulation. In fact, it is often quite injurious to circulation in the legs, if the patient is sensitive to nicotine, as many are. In some persons, smoking produces a tightening or further narrowing of the blood vessels, an action that physicians call vaso-constriction. In cases of coronary artery disease, the added squeezing down of the arteries as a result of smoking can be quite dangerous. Available evidence from research is not sufficient to show that smoking causes heart attack, but physicians know that some patients with angina pectoris (a form of coronary artery disease) may easily aggravate their condition by heavy smoking. Many of my patients have found it extremely difficult to give up the tobacco habit. For them, I usually recommend filtered pipes instead of cigarettes or cigars. For others, denicotinized tobacco, or a substantial reduction in smoking is effective. A discussion of the role of smoking and its effects on your health may be found in Chapter 8.

Should you avoid alcohol? The use of alcohol in moderation is permitted and is, in fact, often beneficial. Refer to Chapter 9 for the full story on alcohol and health. Just a few reminders will be touched on here. Temperate use of distilled liquors and wines is usually healthful, for they tend to dilate or open up the arteries, and thus to improve circulation. As a rule, I do not recommend the use of beer, because it is a gas-former. When beer is taken with a heavy meal, the resulting gas in the stomach may embarrass the heart or restrict its free function. My experiments, as reported in Chapter 9, showed that severe gas-pressure could damage the heart or even arrest its action and thus affect the coronary arteries adversely. Many deaths that have been attributed to "acute indigestion" occurred in this way - gaseous ballooning of the stomach that actually squeezed life out of the heart. An additional disadvantage of beer, other than its gas-forming properties, is its salt content, which may be harmful to certain patients. For most coronary patients, moderate amounts of Scotch, brandy and wines, however, are recommended.

What about coffee and tea? Coffee and tea are also stimulants which, if used in moderation, may be helpful, since they too tend to dilate the blood vessels, permitting an increased flow of blood. But, as in the case of other stimulants, they can be harmful if they are used to excess.

Care of the bowels. Proper care of the bowels is essential. Constipation, which often results in straining at the stool, is harmful and may even be dangerous. Not infrequently I have known patients to precipitate heart attacks by straining to force a bowel movement. Because the importance of easy elimination in treatment of coronary patients is not generally known to the lay public, there was a good deal of surprise and amusement throughout the country when Dr. Paul Dudley White, the President's cardiologist, issued his now famous medical bulletin on the second day after the Chief Executive's coronary attack. At that time he stated that the President's condition was encouraging and that he had had a good bowel movement! This celebrated event is said to have been reported around the world. And the rejoicing was reflected in an upward swing in the stock market! On the matter of regulating the bowels your doctor is, of course, the best advisor. Most individuals require a well-balanced diet, containing fruits and vegetables, together with an adequate intake of water. They also need to take sufficient time for a relaxed bowel habit. Many of my patients have found that a glass of prune juice on arising in the morning, or one or two glasses of hot water with lemon juice or tea, are beneficial. Others have found that strained vegetable juices (cabbage juice, for example) or fruit juices taken upon arising stimulate natural bowel function. Still others have to resort to the natural, bulk-producing mild vegetable laxatives such as plantago (called Metamucil), psyllum seeds, "Saraka," "Serutan" and so on.

Can you continue to have sex relations? Mr. L., 43, had just recovered from his first coronary attack and was about to leave the hospital. His attractive young wife, who was his constant bedside companion, stepped out of the room to pay the hospital bill, leaving us alone for the first time without either his wife or his nurse in the room. The first question he asked: "Doctor, when will it be safe for me to have sexual relations with my wife?" This is one of the most pressing questions in the mind of most male patients under 60 (and even in some who are older!). This spoken or unspoken fear is so intimately linked with the patient's fear that he has "lost his manhood" or his virility, or that he is to be an invalid or semi-invalid from then on, that it is a deep psychological concern to men. It is a fear profoundly linked to the male personality, so shaken by a threat to existence as brought on by a coronary attack. Some men are like my patient, Mr. A., aged 63, who, whenever he attempted the sex act following his coronary attack, developed severe anginal pains. Even administration of nitroglycerine for pain prevention was to no avail. Mr. A. finally had to resign himself to the inevitable and seek gratification from other things in his life. This he did with resourcefulness. He developed the hobby of water-color painting and derived keenest pleasure and pride from this art. To most men and women who have made a good recovery from their "coronary," however, the sex act is an expression of love and devotion and is generally a relaxing, healthful experience. However, this is always so when carried out in moderation, never to the point of strain, or when fatigued or during unfavorable circumstances, since the heart actually does significantly increase its action during the sex act, as shown by recent published medical research. One businessman, a 44-year old European patient of mine, Mr. H., is an example of a well-recovered "coronary" case with a relaxed, philosophical attitude toward life. A devoted husband, deeply in love with his attractive, loving wife, he finds great satisfaction from frequent sexual relations. Mr. H. assures me this is the best "sedative" he knows, and that it banishes the daily tensions of his work. Love-making both refreshes and soothes him and is as necessary to "nourish" his love-life, as his daily food is necessary to nourish his body.

What is the best "coronary climate"? The ideal climate, as far as the coronary patient is concerned, is a temperate one. Extremes of heat and cold should be avoided. High altitudes, especially those above 5000 feet, are also a strain on the heart. Newspaper readers are well aware that during heat waves or hot spells, hospitals and emergency treatment rooms are kept busy treating patients who have collapsed from both heat strokes and heart strain. Similarly, patients who suffer from angina - a heart or coronary disease - experience their worst pains when they walk about in cold or freezing weather. Sections of the United States that are favorable to the coronary patient are the central and southern areas of California, the southern portions of New Mexico, Arizona, and Florida. There are other temperate localities in the country where the coronary patient will experience no discomfort from the weather. Your physician can advise you which locality would be best for you. To demonstrate how some men with initiative lick a climatic problem, there is a 59-year old former patient of mine who came to see me 10 years ago from a northern part of the state of Washington. Mr. 0. had had a coronary but, on exertion, suffered from anginal chest pains only during cold weather, in the winter season.

I persuaded him to leave his wheat farm after harvest time to the care of his son-in-law, who farmed with him, and to drive down and live in a trailer during the winter months in a charming spot between Los Angeles and San Diego, by the ocean and the desert. He now spends practically half the year working on his Washington farm and half the year living with his wife in their trailer in Southern California. For 10 years now he has had no anginal pain, but here is the "pay-off": After his first winter spent in Southern California, he returned to Washington so tanned, healthy, and happy that his friends (and even people he did not know but who had heard of him) formed a "Coronary" Club, and established a trailer settlement in this Southern California spot. Here a sizeable settlement from North Washington was formed, and the amount of fishing, bathing, card playing, and general fun and relaxation for members of this "Coronary" Club are a delight not only to those who have had a coronary attack, but to those men and women who are desirous of avoiding one and who wish to enjoy life and good health in their older years.