When cancer and heart disease are combined, managing both conditions can be challenging. Because of age, many cancer patients have pre-existing heart disease when they’re diagnosed, while some may develop heart problems because of the drugs they're taking for treatment.
Chemotherapy drugs such as doxorubicin, epirubicin, idrarubicin and daunorubicin are called "cardiotoxic" because they weaken the heart muscle. Chronic cardiotoxicity can occur within a couple of weeks to as long as 10 years after treatment. Since many cardiotoxic drugs are used to treat childhood leukemias, heart health can become an issue for long-term cancer survivors.
Symptoms of Congestive Heart Failure (CHF)
Since the symptoms of CHF are very similar to cancer and other diseases like diabetes, obesity and cirrhosis, they often go unrecognized. The FACES system makes it easy to remember CHF symptoms:
- Fatigue: Have you been feeling more tired lately?
- Activity: Has your activity level changed?
- Congestion: Are you feeling a tightness or congestion in the chest?
- Edema: Do you have swelling in your ankles or lower extremities?
- Shortness of Breath: Are you having trouble breathing?
People with any or all of these symptoms should have an echocardiogram to confirm congestive heart failure.
Treating Cancer-Related Heart Problems
Any pre-existing heart disease must be addressed before chemotherapy treatment can begin. A healthy heart can handle aggressive cancer therapies better than a diseased heart.
Chemotherapy-induced heart failure requires careful monitoring during and long after treatment. A blood test that measures the levels of Brain Natriuretic Peptide (BNP) can help detect heart failure and determine the effectiveness of treatment.
ACE inhibitors and beta-blockers, two medications used to treat high blood pressure, are extremely effective in treating weak heart muscle. Pacemakers may be an option if your body does not respond to or cannot tolerate these medications.
We diagnose and manage cancer and treatment- related heart conditions.
If you’re newly diagnosed with cancer and preparing to start treatment, heart health might be the last thing on your mind. But it shouldn’t be, says clinical dietitian Cindy Hwang.
“Some cancer treatments can damage the heart and blood vessels,” says Hwang. “Adopting a heart-healthy diet before you start treatment strengthens your heart for what lies ahead.”
She breaks down the basics of the cardiac diet, also called a heart-healthy diet, to help you get started and stick to the plan.
What is a cardiac diet?
“Cardiac diet” is an unofficial term for a heart-healthy diet. It’s an eating plan that emphasizes foods that promote heart health, such as vegetables and fruits, whole grains, lean poultry and oily fish like salmon and tuna that are high in omega-3 fatty acids. The diet also limits processed foods that are high in sugar, salt and unhealthy fats, because these increase the risk of heart disease.
What are some recommended cardiac diets?
Several heart-healthy diets are highly recommended for cancer patients and for anyone wanting to improve their heart health. These include the DASH (Dietary Approaches to Stop Hypertension) diet, the Mediterranean diet, and many vegetarian diets.
“These heart-healthy diets are very similar to the American Institute for Cancer Research’s dietary recommendations for cancer prevention,” Hwang says. “They not only help your heart, but they can also help prevent cancer from recurring.”
How strict is a cardiac diet?
“Cardiac diets are very flexible,” Hwang says, “and offer a wide array of food choices.”
She points to fruits and vegetables as an example.
“You can eat any fruit or vegetable you desire – whether fresh, frozen, canned or dried – but watch out for added salt or sugar in the packaged varieties.”
Frozen vegetables and fruits can be just as nutritious, or sometimes even more nutritious, than fresh fruits and vegetables, according to the U.S. Department of Agriculture (USDA). That’s because produce is frozen at its nutritional peak. Fresh produce, on the other hand, may lose vitamins and minerals during the time it takes to get from the field to the plate.
What can I eat on a cardiac diet?
To build a heart-healthy plate, choose foods from the following categories:
- Whole grain bread, bagels, English muffins, and tortillas
- Whole grain hot or cold breakfast cereals with no added sugar, like oatmeal or shredded wheat
- Whole grain brown or wild rice, or quinoa
- Whole wheat or whole grain pasta and couscous
Choose products with the word “whole” in the first ingredient – for example, “whole wheat,” “whole grain” or “whole oats.”
Meats and other proteins
- Seafood – fish (especially varieties rich in omega-3 fatty acids) like salmon, mackerel, herring and lake trout
- Poultry – chicken or turkey breast without skin, or lean ground chicken or turkey (at least 93% lean)
- Lean meats – pork shoulder, beef sirloin, or lean ground beef (at least 93% lean)
- Beans, peas, and lentils
- Egg whites or egg substitute
- Unsalted seeds and nuts
Vegetables and fruits
- All fresh vegetables and leafy greens
- All canned vegetables (rinse to remove salt, or choose “no salt added”)
- Frozen vegetables without added butter or sauces
- All fresh fruits
- Canned, frozen, or dried fruit without added sugars
Look for fat-free or low-fat options.
- Skim or low-fat (1%) milk
- Fat-free or low-fat plain yogurt
- Fat-free or low-fat cheeses or cottage cheese
Healthy fats and oils
- Unsaturated vegetable oils (olive, canola, safflower, peanut, soybean, sunflower or avocado)
- Low-fat or light mayonnaise
- Oil-based, non-creamy salad dressings like balsamic vinaigrette or Italian
- Soft margarines in tubs, not sticks
- Water (plain or flavored with fruit slices)
- Sparkling water
Which foods should I limit while on a cardiac diet?
- Baked goods like cakes, cookies, muffins, scones, biscuits, croissants, cobblers, doughnuts, pastries and pies
- White rice, bread and pasta
- Snacks containing partially hydrogenated oils. This includes some potato chips, crackers, snack mixes, cheese puffs and microwave popcorn.
Meats and other protein
- High-fat cuts of beef (regular ground meat, ribs, T-bone and ribeye steaks)
- Processed meats like hot dogs, sausage, salami, lunch meat, bacon
- Organ meats (liver, brains and sweetbreads)
- Fried chicken or fish
- Poultry with skin
- Whole eggs
Vegetable and fruits
- Fried vegetables and fruits
- Vegetables prepared with butter, cheese or creamy sauces
- Canned or frozen fruits in heavy syrup
- Full-fat cheese
- Cream cheese
- Whole or 2% milk
- Whole milk yogurt
- Ice cream
- Cream or half-and-half
Fats and oils
- Stick margarine
- Tropical oils like coconut, palm and palm kernel oil
- Drinks with added sugars
Heart-healthy diets also limit sodium, which bumps up your blood pressure and makes your heart work harder.
"Limit your sodium intake to no more than 2,000 milligrams per day," Hwang says. "For reference, a teaspoon of table salt is about 2,300 milligrams. Make sure to check nutrition labels for the sodium content in processed and packaged foods."
Make one change at a time
Starting and sticking to the cardiac diet is a process, Hwang says.
She advises starting with one change. For example, start by replacing butter with olive oil when cooking. Once that’s become second nature, add another change, like eating more fruits and vegetables.
“It might be challenging at first if a heart-healthy diet is different from your usual diet,” Hwang says. “But even with small changes over time, you can gain the benefits of a heart-healthy diet.”
Make a heart-healthy diet a long-term lifestyle
Not every cancer survivor will experience heart problems after cancer treatment. But those who do may live 15 years or longer before heart-damage symptoms emerge.
“That’s why we advise cancer survivors to continue following a heart-healthy diet throughout their lifetimes,” says Hwang. “It truly can change your health for the better – during and beyond cancer. In fact, this is the way we should all be eating.”
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