Expert Guest Chat Log
Topic: PH and Your Diet

Date: April 11, 2001
Guest: Christy Hummell, a clinical dietitian from Cleveland Clinic Foundation

<Moderator> ***ATTENTION*** 
<Moderator> ***Welcome to the PHCentral Guest Expert Chat
<Moderator> ***Our Guest Expert today is Christy Hummell, a clinical dietitian from Cleveland Clinic Foundation
<Moderator> ***Our topic is - PH and Your Diet
<Moderator> ***The moderator today is Michael Szczepkowski - that's me!
<Moderator> ***Here are the guidelines for today's chat: 
<Moderator> ***If you have a question, please send a "?" 
<Moderator> ***I will keep track of who is next in order and then....
<Moderator> ***call on you to ask your question. 
<Moderator> ***Ms. Hummell will answer your question and then I will ask if you to ask a followup question if you have one.
<Moderator> ***When you see some text followed by "..." that means the person...
<Moderator> ***still has not finished typing.
<Moderator> ***It would also help if you had your question typed and ready to submit when I call on you.
<Moderator> ***There will be a log for today's chat posted on PHCentral.
<Moderator> ***OK, we are ready to begin!!***OK, we are ready to begin!!***
<Moderator> ***If you have a question...
<Moderator> ***please type and send a "?"
<Margaret> ?
<Cheryl> ?
<Moderator> Go ahead Margaret
<Margaret> How does the consumption of alcohol affect people with ph?
<Christy Hummell> I don't know; we tell patients to ask their doctors about alcohol consumption.
<Moderator> Margaret, follow-up?
<Margaret> no
<Moderator> Hold On
<Moderator> Ms. Hummell is adding to the answer
<Christy Hummell> If the doctor does not know, your clinical pharmacist should be able to find out.....
<Joyce> I lost the room, can I ask what the question about alcohol was
<Christy Hummell> they have to have a listing of all drug-nutrient interactions...
<Christy Hummell> and this is one of them.
<Moderator> I will repeat the question
<Moderator> How does the consumption of alcohol affect people with ph?
<Joyce> thank you
<Moderator> Margaret, follow-up?
<Margaret> yes
<Margaret> Does alcohol cause oxygen sat level to lower?
<Christy Hummell> Again, I don't know the answer; the pulmonary doctor should know this answer.
<Moderator> Cheryl, you are next
<Cheryl> I am going to weight watchers and I follow all the point systems and I am struggling to loose what else can I do since we can't exercise?
<Joyce> besides sodium .should we be careful of any other foods?
<Moderator> Joyce, please wait
<Joyce> sorry ok
<Moderator> If anyone has a question, please send me a "?"
<Christy Hummell> We suggest keeping a diet diary; that may help pinpoint some foods that are not allowed.
<Cheryl> I keep a journal
<Christy Hummell> Also, perhaps using the lower level of the Weight Watchers diet may help....
<Cheryl> Thank You
<Christy Hummell> this is a difficult situation but weight loss will help with breathing. Keep trying!
<Moderator> Cheryls do you have a follow-up?
<Cheryl> No
<Moderator> Joyce, go ahead
<Moderator> HI Michele
<michele> hi everyone
<Moderator> If you have a question, please send me a "?"
<Christy Hummell> All we ask (and it's quite a bit) is to watch sodium, lose weight if overweight, gain weight...
<Christy Hummell> if underweight, and sometimes people will need a fluid restriction.
<Moderator> Joyce do you have a follow-up questions?
<Moderator> Any other questions??
<Moderator> Michele, go ahead
<michele> are any of the drugs we are on for ph specifically preventitive to losing weight
<Moderator> HI Maryde
<michele> ie: furosemide, procardia, 
<maryde> Oh good Hi. thought I was not here yet
<Moderator> If you have a question, send me a "?"
<Christy Hummell> I wish! The steroids seem to be guaranteed weight gainers! The upside is that if diurectics are used, then 
there will be weight loss from water.
<Moderator> Michele, do you have a follow-up?
<michele> yes 
<michele> i have been exercising and dieting for 2 months now
<michele> any suggestions, only lost 8 lbs
<Christy Hummell> You're doing GREAT!! A weight loss of 1/2 - 1 pound a week is recommended, and it's been shown that 
people are more likely to keep weight off if they lose it slowly.
<michele> thank you
<Moderator> Any other questions?? No one on the list.
<Pat K> ?
<Moderator> Go ahead Pat!
<Pat K> How much sodium and fluid are we supposed to restrict ourselves to?
<Christy Hummell> Every doctor/hospital is different. I suggest restricting sodium to 3000 - 4000 mg. a day. If someone is on 
diuretics, then a fluid restriction of 1800cc (about 7 8-ounce glasses) is recommended.
<Moderator> Pat, do you have a follow-up?
<Pat K> What types of food should we avoid?
<Christy Hummell> The more processed the food is, the more sodium it will likely to have. Avoid salt and seasonings  containing salt....meats that are cured, smoked, canned.....canned vegetables (unless labeled low-sodium), including canned tomato products....cheese...pickles, mustard, catsup, steak sauce....the list goes on. Does this help?
<Moderator> Other questions, please send a "?"
<Pat K> Yes, Christy. Thank you
<Moderator> No other questions?
<maryde> ?
<Moderator> Go ahead Mary.
<maryde> I read not to use licorice , why
<Christy Hummell> What cardiac medication are you taking?
<maryde> meant eating licorice
<Moderator> Hold on, Ms. Hummel is looking up a reference
<Christy Hummell> There's a nasty drug-nutrient interaction between certain cardiac meds and large amounts of licorice....
<maryde> oooh, norvasc
<Christy Hummell> I don't remember the reaction, but if you could give me the name of the medication....I may have a reference for it.
<Armond> ?
<Moderator> Ms. Hummell thought she had another reference
<Christy Hummell> Norvasc is one of the newer drugs...and I don't a reference for it at hand. Your pharmacist can tell you.
<maryde> thank you
<Moderator> Maryde, do you have a follow-up?
<maryde> no
<Moderator> Armond, go ahead
<Armond> Other than salt, are there foods that all by themselves have a direct effect upon blood pressure or respiration?
<Christy Hummell> This is a "roundabout" answer. Losing weight can help lower blood pressure....
<KarenW> ?
<Christy Hummell> A weight loss as little as 10 pounds can significantly lower blood pressure....as for respiratory issues, 
weight loss may help....if you're someone who has problems breathing after eating large meals....then eating small meals and 
eating more often may help....for persons who are "CO2" retainers, try to
<Christy Hummell> get some fat in the diet (avoid low fat diets).
<Moderator> Armond, do you have a follow-up?
<Armond> I was thinking that maybe licorice extract all by itself is vaso-active, and the sulfites on some foods may affect b.p. or resp.
<Christy Hummell> I think that you're right about licorice causing hypertension, but I
<Christy Hummell> am not certain.
<Moderator> KarenW, go ahead.
<KarenW> How do you know if you are a CO2 retainer?
<Christy Hummell> Do you know what a CO2 retainer is?
<KarenW> no
<Christy Hummell> Oops! I used medical terminology....sorry!
<Christy Hummell> We breathe in oxygen and exhale carbon dioxide...
<Christy Hummell> Some persons with respiratory disorders may not be able to breathe off the carbon dioxide well...
<Christy Hummell> and so we call them "CO2" retainers, the CO2 referring to the chemical name.
<Moderator> KarenW, do you have a follow-up?
<KarenW> Aren't all PH patients CO2 retainers to some extent?
<Christy Hummell> Your pulmonary doctor can tell you if you are one...and not everyone with PH is a "CO2" retainer.
<Moderator> Other questions?
<maryde> ?
<Moderator> Go ahead Maryde
<maryde> What does the fat in your diet have to do with Co2 retention and probems or help?
<Christy Hummell> Food and liquids contain carbohydrates, protein, fat, vitamins, minerals, and water...
<Christy Hummell> Carbohydrates, protein, and fat provide calories; the other nutrients don't...
<Christy Hummell> When we eat, store, and burn up those 3 nutrients, the end products are energy, water, and carbon  dioxide...
<Christy Hummell> When carbohydrates are utilized, they give off  the most carbon dioxide....
<Christy Hummell> fat gives off the least....
<Christy Hummell> That's why "CO2 retainers" should avoid low fat diets so they don't get into respiratory distress.
<maryde> thats interesting, thank you
<Moderator> Maryde, do you have a follow-up question?
<maryde> not yet
<Moderator> Anyone else?
<Armond> ?
<Moderator> Go ahead Armond
<Armond> Vegetarians claim that they can get all their required preotein thru vegs. But do you think that such diets are good 
for cardiac patients?
<Moderator> Wb roz
<Christy Hummell> Yes. A vegetarian diet can be nutritionally adequate....strict vegetarians should combine legumes with 
grains to get high-quality proteins....
<Christy Hummell> lacto-ova vegetarians consume dairy products and eggs, and those are great protein sources.....
<roz> Just got back
<Christy Hummell> Very strict cardiac diets are vegetarian-based and nearly fat-free...
<Christy Hummell> and there has been some success with them...
<Christy Hummell> but it's difficult to keep fat intake below 10% of total calories.
<Margaret> ?
<Moderator> Armond, follow-up?
<Armond> When I was growing up, about a huindred years ago, I was taught that red meat had special nutrients unmatched by other foods
<Moderator> ... looking up a reference.
<Christy Hummell> Red meat is an excellent source of iron and it's tricky to get iron from a vegetarian diet, but not impossible....
<Christy Hummell> Also, animal products (meat, milk, cheese) contain Vitamin B12...
<Christy Hummell> strict vegetarians (no animal products whatsoever) may be deficient in this vitamin.
<Moderator> Margaret, go ahead
<Margaret> I get chest pains when I consume caffeine. How does the consumption of caffeine affect people with ph?
<KarenW> ?
<maryde> ?
<Christy Hummell> I'm not sure that it does...we don't restrict caffeine for our patients....
<Christy Hummell> sometimes there's correlations between caffeine and cardiac arrhthymias but...
<Christy Hummell> our doctors tend to adjust the medications based on usual caffeine intake....
<Christy Hummell> we just don't recommend drinking quarts of coffee.
<Moderator> Margaret, do you have a follow-up?
<Margaret> No
<Margaret> Thank you
<Moderator> Go ahead, KarenW.
<KarenW> Patients with PH seem to have a lot of problems sleeping well. Are there any foods that would help solve that 
problem?
<Christy Hummell> Sleeping problems tend to be related to the time flolan is taken...
<Christy Hummell> taking it as early as possible in the evening may help....
<Christy Hummell> as for food, eat meals at least 2 hours before bedtime...
<Christy Hummell> this will help prevent reflux/indigestion....
<roz> Is there a diet or diet restrictions specific to ph patients?
<Moderator> Roz, please wait. 
<Christy Hummell> sometimes, a glass of warm milk or wine could be helpful. Avoid caffeine.
<Moderator> Karen, do you have a follow-up?
<KarenW> No, thank you
<Moderator> Maryde, your next
<maryde> with ph being a respiratory and heart problem would you base your diet on which is more affected? fat vs low fat?
<Moderator> Then roz and that will be all
<Christy Hummell> If you are a "CO2 retainer" (and ask your doctor about it) then you need some fat...
<Christy Hummell> actually a heart-healthy diet can fit....
<Christy Hummell> just don't restrict fat to less than 30% of total calories...
<Christy Hummell> extreme cardiac diets limit fat to 20% or less of total calories...
<Christy Hummell> and this could cause some respiratory problems.
<Moderator> Maryde, do you have a follow-up?
<maryde> no, Thank You
<Moderator> Roz, go ahead
<roz> Are there diets or diet restrictions specific to ph?
<Christy Hummell> Salt restriction is the number one restriction because of the problems with heart failure...
<Christy Hummell> which is often the first symptom of ph. If overweight, then losing weight will help with breathing...
<Christy Hummell> if underweight, try to gain weight to improve well-being...
<Christy Hummell> If on diuretics, limit fluids to 1800 cc a day (about 7 8-ounce glasses).
<Moderator> Roz, do you have a follow-up?
<alex> how do you try to gain weight?
<roz> Are there any foods or food catagories that are healthful for us?
<Christy Hummell> To gain weight, eat the "calorically dense" foods; these are foods that contain fat like...
<Christy Hummell> whole milk, adding butter to vegetables, using cream sauces and gravy, if eating canned fruit,
<Christy Hummell> then use the fruits canned in heavy syrup, cheese, ice cream, anything with the word "cream" in it....
<Christy Hummell> try out the nutritional supplements that are available and add ice cream and nonfat dry milk powder to 
them...
<Christy Hummell> As for food categories that are healthful, the Food Pyramid is recommended: starches/grains/cereals...
<Christy Hummell> fruits and vegetables, meats, dairy products...
<Moderator> That's ALL folks, Thanks!!! Thank you Ms. Hummell!
<Armond> Christy, Many Thanks! You have a wealth of knowledge, and have shared it very generously with us.
<Moderator> The room is now open for free form chat
<maryde> Another Big Thank You
<alex> thank you !
<Margaret> Thank you