Cardiologist in Subotica

Individual nutrition and dietary plan

Nutrition and physical activity are today regarded as part of the treatment, on an equal footing with medication, and not as general advice that applies equally to everyone. In raised blood pressure, raised blood lipids, heart failure, diabetes or reduced kidney function, the same advice helps one patient and may harm another: the intake of salt, fluid and protein and the type of exertion have to match the diagnosis and the current condition.

At Poliklinika Sente, dr med Nataša Gocić, internist and cardiologist, draws up an individual nutrition and dietary plan. The plan is based on the diagnosis and the current test results, the therapy the patient is already receiving, body weight and daily routine, and on how well the patient tolerates exertion. Prescribed physical activity is an integral part of the plan: the type of load, its intensity, its duration and the number of sessions per week, with clearly set limits that are not to be crossed.

The patient receives a written regimen: the timing and composition of meals, the foods that are recommended and those that are limited, target intake of salt, fluid and fat, and practical substitutes for favourite dishes. At follow-up examinations the plan is reviewed and adjusted according to the results achieved, new test results and changes in therapy. A regimen that is not followed up over time stops being treatment.

The plan is drawn up after an internal medicine and cardiology examination with dr med Nataša Gocić. Please bring your most recent laboratory results and a list of the medication you are taking.

High blood pressure does not hurt, and that is the biggest problem

Raised blood pressure can go for years without producing a single symptom. It is most often found by chance, at a routine check-up, or only after an event that has already done damage.

Arterial hypertension is in a great many cases discovered by chance. The reason is simple and all the more dangerous for it: raised blood pressure in itself usually does not hurt. Headache, dizziness or flushing of the face occur in some patients, but the absence of these complaints does not mean that blood pressure is in order. A great many people whose readings call for treatment feel perfectly well.

What happens during that period is not without consequences. Raised blood pressure places a permanent burden on the walls of the blood vessels, the heart muscle, the kidneys and the retina. The changes develop gradually and silently, over years, and as a rule are not felt until they pass a certain threshold. That is why hypertension is often described as a condition that first announces itself as an event: a heart attack, a stroke, a disturbance of heart rhythm or a deterioration in kidney function.

The practical consequence is that blood pressure is not detected by how you feel, but by measurement. An adult with no known risk factors should know their readings at least once a year. If hypertension runs in your family, if you are overweight, if you smoke, if you have raised blood lipids or blood sugar, or if you are going through a period of increased stress and too little sleep, measurement should be more frequent and accompanied by a fuller examination.

A cardiology examination does not come down to a single reading in the consulting room. A value obtained at one moment may be higher than usual, which is why blood pressure is assessed through several measurements, at home or by 24-hour monitoring, alongside an electrocardiogram, laboratory results and, where needed, an ultrasound scan of the heart. Only that whole picture shows whether there is a problem, how long it has been present and whether it has already left a mark.

The message we repeat to patients is that the absence of complaints is not proof of health. A regular examination is the only way for hypertension to be found before it announces itself in an unwelcome way.

Why diet and physical activity are prescribed, not merely recommended

In heart conditions it matters a great deal what you eat, and how much and how you exercise. The type and amount of exertion are part of the treatment and differ from one diagnosis to another.

The advice to eat healthily and keep moving is accurate and at the same time useless for a patient who already has a diagnosis. In heart failure, hypertension, the period after a heart attack, rhythm disorders or valve disease, diet and physical activity behave like treatment: they have a type, a dose and a limit, and if they are set wrongly they can do harm.

With diet the differences are very concrete. Salt intake is not the same for a patient with hypertension as for a patient with heart failure who retains fluid. Fluid intake is restricted in some conditions and increased in others. Patients on therapy that affects blood clotting have to pay attention to foods rich in vitamin K, not in order to cut them out but to keep their intake even. The same plate, therefore, is not equally good for two people with different diagnoses.

With physical activity the difference is even more pronounced. Aerobic exertion such as brisk walking or cycling is not the same as exercise against heavy resistance. In some conditions working with heavy loads and holding the breath are undesirable, while moderate and regular aerobic activity is distinctly beneficial. What matters is the intensity, the duration, the frequency and, above all, the upper limit that is not to be crossed. That limit is not judged by feel, but from the test results and, where needed, from an exercise stress test.

This is why an individual nutrition and dietary plan always starts from the diagnosis, the current test results and the therapy the patient is receiving, rather than from a general table. The plan sets out what is eaten and in what quantity, and with equal precision which type of activity, how many times a week, for how long and up to what level of exertion.

A plan that is not followed up does not work. At the follow-up examination we check what has been achieved, how well the patient tolerates exertion and whether the test results or the therapy have changed, and the regimen is adjusted accordingly.