A nutrient-rich diet is crucial for everyone, but it’s especially beneficial for individuals managing pulmonary arterial hypertension (PAH). A heart-healthy eating plan can significantly aid in managing this condition. PAH is a specific type of pulmonary hypertension (PH) characterized by increased blood pressure in the pulmonary arteries, the large blood vessels in the lungs. Alongside prescribed medication, dietary and lifestyle adjustments can help manage PAH symptoms and lower the risk of complications, including sleep apnea and comorbidities like obesity.
Foods to Incorporate into Your PAH Diet
Fueling your body with nutritious foods is an excellent strategy for managing PAH. Consuming fruits, vegetables, and whole grains ensures you meet your body’s nutritional needs while minimizing complications associated with PAH.
Fruits and Vegetables
Fruits and vegetables are vital sources of vitamins and minerals essential for bodily functions. Research indicates that individuals with PAH may experience impaired nutrient absorption compared to those without the condition. This can lead to deficiencies in key vitamins and minerals, such as iron, selenium, and vitamins B12, D, and K1. While vegetables and fruits are not strong sources of vitamin D, this nutrient can be found in fortified cereals, milk, and juices, as well as fatty fish like salmon and sardines.
Incorporating more fruits and vegetables into your diet promotes healthy gut bacteria and is linked to an improved quality of life for people with PAH. Some evidence suggests a link between low vitamin C levels and PAH. Consuming plenty of vitamin C through fruits and vegetables provides beneficial antioxidants, supporting better health when managing a chronic disease.
When choosing canned or frozen options, carefully check nutrition labels for low added sugar and reduced sodium. Opt for canned vegetables labeled “low sodium” or “no salt added,” and rinse them with water before cooking to remove any extra salt. For fruit, choose options packed in water rather than syrup or juice.
Read also: The Hoxsey Diet
Whole Grains
Instead of refined grains like white bread and white pasta, incorporate more whole-grain options into your diet. Whole grains utilize the entire grain kernel, providing more fiber, protein, and essential nutrients, including B vitamins and iron.
Foods that typically come in whole-grain options include:
- Brown rice
- Whole-grain crackers
- Whole-wheat bread
- Hulled barley
- Oatmeal
- Quinoa
- Whole-wheat pasta
- Popcorn
Adding whole grains to your diet can also help you feel fuller for longer. The Dietary Guidelines for Americans recommend that at least half of your grain intake should be whole grains.
Leafy Greens and Other High-Iron Foods
Leafy greens are excellent sources of fiber and essential nutrients, including iron. Many individuals with PAH have low iron levels, potentially leading to more severe disease symptoms. Insufficient iron can lead to anemia (low red blood cell levels), causing shortness of breath or extreme fatigue, especially with PAH. Iron is a crucial component of hemoglobin, the protein in red blood cells responsible for carrying oxygen throughout the body.
Increase your iron intake by consuming leafy green vegetables like kale, spinach, or collard greens. The National Institutes of Health recommends a daily iron intake of 8 milligrams for adult males and 18 milligrams for adult females who are not pregnant. For adults aged 51 years or older, the recommended amount is 8 milligrams. If necessary, consider taking an iron supplement to boost your levels.
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Consult your healthcare provider before starting any supplements. They can determine if a supplement is appropriate for you, check for potential risks like interactions with your current medications, and guide you toward safe, trustworthy options.
Foods to Limit or Avoid with Pulmonary Arterial Hypertension
Limiting salt and fluid intake can help prevent unwanted PAH symptoms and maintain heart health.
Salt and Processed Foods
In PAH, the heart and lungs are already working harder. Consuming salt causes the body to retain more fluid, leading to fluid retention. This puts extra stress on the right side of the heart, increasing blood pressure in the lungs, causing shortness of breath, and leading to edema (swelling caused by fluid buildup) in the legs or abdomen. The American Heart Association recommends that individuals with high blood pressure limit their salt and sodium intake to less than 1,500 milligrams per day.
Pay close attention to nutrition labels for added salt, as many foods contain surprisingly high amounts of sodium. These include:
- Cheese
- Deli meats
- Canned vegetables with added salt
- Frozen dinners
- Pickled foods (such as sauerkraut or pickles)
- Canned soups
- Dressings, condiments, and sauces
- Cereals
Before eating at restaurants, check the nutritional information for meals to identify low-sodium options. Processed or fast foods should be avoided with pulmonary hypertension.
Read also: Weight Loss with Low-FODMAP
When cooking at home, use other spices and herbs instead of salt to add flavor to your dishes. Salt-free seasonings are available in most grocery stores.
Excessive Fluids
Staying hydrated is important, but excessive fluid intake can cause an uncomfortable and potentially harmful buildup in the body. For individuals with PAH, this can lead to edema, making breathing difficult.
Health experts often recommend a limit of 2 liters of fluid (approximately 8.5 cups) per day. It’s important to follow your provider’s individualized guidance, as everyone with PAH is different.
Fluid intake includes more than just what you drink. It also comes from foods like:
- Fruit
- Popsicles
- Soups
- Gelatin desserts like Jell-O
If your doctor advises you to limit fluids, tracking your daily intake-both food and drink-can help you stay on target and feel your best.
Tips for Developing Healthy Eating Habits with PAH
Making dietary changes can be challenging, but even small changes can significantly impact your health. Building new habits takes time, so start by making one or two small adjustments at a time.
As you become more comfortable, incorporate additional changes. Keeping a food and drink journal for a few days can help you identify patterns and track your sodium intake. Consult your healthcare provider or a registered dietitian for meal and snack ideas and discuss your food journal with them. You can also search online for low-sodium recipes to try at home with family or friends. Bringing in your support system can provide accountability and support as you make these changes.
Dietary Changes and Amino Acids: Recent Research
Recent research suggests that dietary changes limiting certain amino acids may help slow disease progression in pulmonary hypertension. About 1% of the world’s population lives with pulmonary hypertension, which currently has no cure. Treatment options - medication, surgery, and lifestyle changes - can help manage symptoms and prolong a person’s life.
A recent mouse study published in Cell Metabolism indicates that dietary changes limiting the amino acids glutamine and serine may help slow disease progression in pulmonary hypertension and improve the effectiveness of current medications.
Stephen Y. Chan, MD, PhD, co-senior author of the study and Vitalant Chair in vascular medicine and professor of medicine in the Division of Cardiology at the University of Pittsburgh School of Medicine, told Medical News Today:
“Contrary to a popular misconception, pulmonary hypertension is a prevalent condition with often limited therapeutic options. As such, there is still a 50% mortality rate within 5 to 8 years of diagnosis. While there are new exciting therapies recently approved for the treatment of pulmonary hypertension, we are far from a cure, and our patients are desperate for better therapies to improve mortality rates and quality of life.”
Chan said they decided to look for a link between diet and pulmonary hypertension when they observed that diseased cells called fibroblasts of the lung blood vessels in pulmonary hypertension are surprisingly “hungry” for the amino acids glutamine and serine.
“Our data later showed that this hunger comes from the need (for) fibroblasts to increase collagen production and deposition in and around the blood vessels to stiffen them in disease,” he continued. “When we cut off that amino acid supply or prevented the use of these amino acids for collagen production, we could reduce collagen production, vessel stiffening, and worsening of pulmonary hypertension.”
Chan and his team used a mouse model to test their theory. When the mice were administered drugs that lowered their cellular uptake of glutamine and serine, the pulmonary hypertensive blood vessels were relieved of their craving. Additionally, researchers found the lack of glutamine and serine stopped the production of excess collagen, which would lead to lung blood vessel stiffening and impaired function.
Through the research team’s findings regarding serine and glutamine, they were also able to develop a new diagnostic test for pulmonary hypertension. The test uses positron emission tomography (PET) scan technology and a glutamine imaging tracer to track where glutamine goes in the body. Cells “hungry” for glutamine distinguish themselves on the PET scan, helping doctors with making a diagnosis.
“One of the crucial obstacles in managing pulmonary hypertension is that the diagnosis requires an invasive test called cardiac catheterization, where a long hollow tube is inserted into the blood vessels of the neck,” Chan detailed. “That catheter is then threaded all the way down into the heart and lungs to measure pressure directly. Not every medical center has this capability, particularly those in more rural or isolated settings, and this limits the ability to appropriately identify and treat patients with this disease.”
“While we use some noninvasive imaging studies like MRI and ultrasound in managing the disease, they are not sufficient to make the diagnosis,” he continued. “Thus, accurate and early diagnosis of pulmonary hypertension is crucial, and there is a clear unmet need for developing better noninvasive diagnostic technology.”
“Our data was only performed in animals with experimental pulmonary hypertension,” Chan added. “We are actively recruiting for a clinical trial at our institution that is testing this new PET technology in patients with pulmonary hypertension.”
Chan said that for the first time, researchers have proof that specific dietary adjustments - reducing glutamine and serine consumption, in particular - may serve as an effective way of treating pulmonary hypertension. “It opens up a new way that we could manage this disease, because now - instead of just relying on medications and transplantation - there are possibly effective lifestyle interventions,” he continued. “For patients with pulmonary hypertension, avoiding foods rich in serine and glutamine, or eating foods with these amino acids depleted, might improve symptoms, reduce disease progression, or bolster the effectiveness of current medications,” Chan explained.
However, Chan did urge caution in over-interpreting their findings at this stage. “Our work fully restricted all glutamine and serine from the rodent diets which led to improvement of pulmonary hypertension,” he said.
“We view this finding as (an) important proof-of-concept that dietary maneuvers can be effective as therapies in this deadly disease. However, this level of absolute restriction would not be feasible in a normal human diet, and we certainly do not recommend that our patients attempt to do so at this time.”
“More work is needed to determine if lower levels of amino acid restriction have the same therapeutic effect and/or if more feasible and safe dietary maneuvers could bolster current treatments to promote even better improvement of (the) disease,” Chan added.
After reviewing this study, Cheng-Han Chen, MD, a board certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA, told MNT that a dietary approach to improving pulmonary hypertension is a novel approach that could be more accessible to people with pulmonary hypertension as a form of treatment.
“Pulmonary hypertension is a complex disease that could have many different causes,” Chen explained. “Many of the causes are not easily treatable with our current therapies. This type of research has the potential to provide new targets for medications that could improve the prospects for our patients with pulmonary hypertension.”
However, Chen said we are not yet at the point where people should adjust their diets specifically for glutamine and serine based on the results of this study. “I advise all patients to eat a well-balanced, heart-healthy diet. The next step should be to see if these findings apply in humans, not just in mice. They probably will be looking at clinical studies to evaluate the effects of diet, specifically glutamine and serine intake, on pulmonary hypertension in those individuals.”
Monique Richard, a registered dietitian nutritionist and owner of Nutrition-In-Sight, explained that amino acids are the building blocks of protein. Foods rich in amino acids include animal and plant proteins, grains, and legumes with the richest sources, most bioavailable - meaning the body can use efficiently. “In practice, we often observe an excess intake of animal proteins from those who have hypertension, cardiovascular disease risk, chronic obstructive pulmonary disease (COPD), and other related conditions, as well as contributory factors related to lifestyle choices such as minimal activity, smoking, alcohol intake, poor sleep hygiene, (and) hydration status,” she said. For those worried about their glutamine and serine intake, Richard advised meeting with a registered dietitian nutritionist (RDN) to fully assess diet composition and intake appropriate for an individual’s needs. “An RDN will also assess (the) overall balance of dietary and lifestyle factors that influence health in conjunction with the person’s genetics and current physical state allowing for specific and personalized recommendations to be given,” she continued.
Additional Dietary Considerations
Maintaining a Healthy Weight
Maintaining a healthy weight and setting consistent fitness goals can help reduce strain on the heart and lungs and aid in an improved quality of life.
Aim for a healthy BMI (Body Mass Index). Body Mass Index is a guideline for healthy weight. While the BMI is not perfect, aiming for a number in the healthy range is considered a sensible target. A healthy BMI should rest between 18.5 and 24.9 unless advised differently by your health care team.
With PH, being overweight can increase the strain on your heart and lungs, and being underweight can lead to muscle loss or other nutritional deficiencies.
Knowing your daily caloric intake can help you identify struggles and reach your weight goals. To lose one pound, you need to be in a deficit of 3,500 calories. To lose one to two pounds a week, aim for 500-1,000 fewer calories each day through eating changes and activity. Choose balanced, lower sodium meals rather than skipping meals.
Staying Active Safely
Movement helps keep your muscles strong and supports heart and lung health. But with PH, exercise must be done carefully. Consider cardiopulmonary rehabilitation - this monitored exercise program is designed for people with activity limitations. Walking is safe for most - go at your own pace and rest when needed. Stop and rest if you notice worsening symptoms. Ask your doctor before trying more intense exercise.
Dietary Tips and Strategies
- Embrace Fresh Ingredients: Because salt hides in many packaged, pickled, and canned foods, choosing fresh ingredients can help limit the amount of sodium you consume.
- Experiment with Spices: If you’re worried about losing flavor, try experimenting with spices like cumin and herbs like garlic.
- Monitor Fluid Consumption: Many people with PAH are placed on a two-liter fluid restriction, but talk to your doctor about the appropriate amount for you. Keep track of your weight to help you assess your proper fluid consumption. If you experience weight gain over the course of a day, you may be getting more fluids than you need. Avoid drinking too many fluids to prevent fluid buildup.
- Avoid Stimulants: Avoiding caffeine and other stimulants, such as alcohol, is necessary for regulating your blood pressure.
- Eat Smaller Meals: Many people with PAH report that new treatments make them nauseous. To help ease this side effect try eating smaller meals and cutting back on food with high fat. Dry toast and plain, unsalted crackers can help you feel better when you’re queasy. Avoid sodas and ginger in your diet too.
- Incorporate Iron-Rich Foods: PAH is aggravated when your body lacks iron. Try incorporating more red meat, beans, and dark, leafy greens into your diet. Your body will better absorb iron if you include foods rich in vitamin C such as tomatoes, bell peppers, and broccoli. Fresh citrus juices or a few slices of mango or papaya are good sources of vitamin C too, and a great addition to a healthy breakfast.
- Consider Garlic: A study found that a compound in garlic called allicin helps widen blood vessels and keeps blood pressure down. Add raw or cooked garlic to your dishes for this benefit. Make sure to eat garlic within an hour of chopping it or you won’t receive the benefits that allicin provides.
- Be Mindful of Vitamin K: Though dark, leafy greens are a good source of iron, they also contain a considerable amount of vitamin K. Inconsistent intake of too much of this vitamin can affect how well blood-thinning medications work. Ask your doctor how much vitamin K is safe for your diet. According to the NIH, the key is to keep your intake of vitamin K consistent from day to day, whether higher or lower.
- Keep a Daily Journal: Track what you eat and drink. Monitor sodium and fluid intake. Record weight changes. Spot patterns in your food or exercise that can affect your symptoms.
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