Heart Health Month

When it comes to preventive health, cardiovascular disease is on the top of my list. My passion for spreading the word about heart health came a young age and grew over time as every single person I knew was touched in some way or another by cardiovascular disease (CVD). That should come as no surprise – CVD is the leading cause of death for both men and women in the United States. According to the Centers for Disease Control and Prevention, every 25 seconds an American will have a coronary event. The most common one – heart attack.

What is CVD? This umbrella term refers to diseases of the heart and blood vessels such as heart disease, aneurysm, stroke, congestive heart failure, hypertension, peripheral arterial disease, and congenital heart disease.

Luckily, it is never to late to start working on preventing CVD by incorporating a good diet and fitness routine into your daily life.
Some of the diet recommendations from the CDC include:
– choose lean meats and poultry without the skin and don’t fry them!
– select fat free or 1% fat dairy products
– cut back on foods high in saturated fat, trans fats and partially hydrogenated oils (actually I say cut out partially hydrogenated oils completely)
– choose foods with little or no salt (unless directed otherwise by a sports dietitian or physician)
– if you drink, do so in moderation

Tomorrow I’ll get into fats, especially partially hydrogenated oils, a bit more.

Is the range for Healthy LDL levels too high?

A January 2009 American Heart Journal study is garnering quite a bit of attention lately.  This study examined lipid levels in over 136,000 patients who were hospitalized with coronary artery disease from 2000-2006 in 541 participating hospitals.  Now, according to the American Heart Association, our LDL (bad cholesterol) levels should be less than 100 mg/dL.  However, in this particular study almost 1/2 of the patients admitted had LDL levels within the “healthy” range.

For years, total cholesterol and LDL levels have been recognized as prominent, modifiable risk factors for cardiovascular disease.  Keep both low and your risk for cardiovascular disease is low. But, there are many additional pieces to the cardiovascular disease puzzle.  In this particular study, upon further examination of the data, it is evident that a greater number of these patients with LDL within the normal range also had low HDL (<40 mg/dL)

And, there is another, newer piece to the puzzle that is absolutely fascinating though not examined in this particular study:  inflammation.   LDL, as it makes it’s way through our body, can be deposited on arterial walls.  However, scientists now believe that inflammation signals the cascade that makes arterial plaque burst leading to blood clots and cardiovascular events (heart attack, stroke).

What causes inflammation?  Many things including high blood pressure, smoking, high blood sugar levels, atherosclerotic plaque and certain viruses and bacteria.  How do you lower your levels of inflammation?  That’s something that I’ll expand on more tomorrow (diet-wise) but cholesterol-lowering statin drugs play a role in decreasing inflammation.

How do you measure systemic inflammation? Ask your physician for a highly sensitive C-reactive protein assay (hs-CRP).

Cardiovascular disease is the number one cause of death among men and women in the U.S.  It is never too early to start looking at ways to prevent cardiovascular disease and over the next several days, I’ll examine many of the diet and exercise factors that will help you lower your risk of CVD.

Super Bowl XLIII

Today I am frantically editing references and finalizing a textbook that I am co-authoring (all in time to watch the Super Bowl).  As I look ahead at the party I am going to in a few hours I realize that Super Bowl parties could be a train wreck for people who are consciously trying to watch their weight and pull through 2009 carrying around less weight and healthier than they started this year off.

And, it isn’t really about the food and blowing it for one day.  Instead it’s about the change in one’s perception or attitude after they feel like they “failed” for a day.  Unless you are a bodybuilder or fitness competitor, blowing it out one day probably won’t hurt you (though a good amount of food in a short period of time can bring on an attack of acute pancreatitis or even a heart attack if you are at risk).  However, when this one day becomes two then three and soon a week and so on, that’s when you know you’ve carried out the “one day won’t hurt” attitude too far.  On the flip side, some people view their food intake or exercise regimen as all or nothing.  Just one slip and they throw in the towel.  Let me remind you though that making changes in your physique and your health take some time and should be viewed like a marathon and not a sprint.  Those who have the endurance will indeed persevere.  
That being said, here are a few tips to keep you feeling good about yourself today:
 – Eat beforehand.  Never “diet” all day before a party.  Even cardboard will look appetizing at that point.
– Fill up first on the healthy stuff – deli turkey, cut up veggies and fruit
– Watch the game.  Seriously, who cares about the food when the Super Bowl is on the line (right?)
– Alternate water with your alcoholic beverages (not just a sip, a good 8 oz).  If you hate water, try something that is lower in calories (then beer) and tastes good, selzer, Crystal Lite, vitaminwater etc.
– Eat slowly and savor every bite
– Concentrate on portion control when it comes to the heavy foods
– Wait for quite a while before going up for second helpings.  The longer you wait the more likely others will have devoured them before you get a chance to dig in.
Lastly, enjoy!  

Nuts for Good Health

I’ve mainly been talking about goals and weight (a common January theme) for the past month. And I also threw in a few of my favorite Superbowl Sunday appetizers a few days back.  Among the chips, dips and spread of food this Sunday, there will be a common snack food: nuts.  People seem to fall into one of two camps when it comes to nuts.  They either eat them or avoid them because they are high in fat and calories (yet snack on nutritionally-empty chips instead).

However, nuts are a fantastic snack (skip the honey roasted, sugar-coated ones though).  You only need a shot glass full (or think of a golf ball size quantity) and they all have a variety of different vitamins and minerals + healthy fats.  My personal favorites are peanuts, pistachios and walnuts. And here’s another interesting tidbit about nuts – a recent study showed that people who ate in the shell nuts (pistachios for instance) ate significantly fewer calories than those who just ate the unshelled nuts.  Why?  For one thing, it takes some time to crack open a nut and that little bit of effort slows you down.  And, the shells themselves provide a visual reminder of how much you have eaten.  
So take a look this Sunday at the spread.  If it comes down to chips, nuts and a bunch of fried appetizers or baked goods, opt for the nuts.  A little goes a long way.

Whey Less Weight

This week I’ve had the pleasure of editing textbook chapters.  Aside from re-formatting references, the rest has truly been fun and rewarding.  I have a fantastic detail-oriented co-editor and top notch authors who wrote each chapter.  

While reading through the protein chapter today, Dr. Richard Kreider (Texas A&M) included a great section the various types of protein, including whey.  Men and women alike who pump iron and make frequent appearances at their gym may be familiar with whey protein.  However, this isn’t just a bodybuilding supplement.  And, Dr. Kreider noted that whey protein may help augment weight loss efforts and boost the immune system.
A 2004 review article by Layman (J Am College Nutr) reviewed some of the research behind higher protein diets and weight loss.  He postulated that whey protein, due to it’s leucine content (leucine is an essential amino acid that stimulates fatty acid oxidation), may boost weight loss efforts.  Since his review, two additional studies have come out in support of whey’s weight loss benefits.
In addition to it’s potential to augment weight loss, whey is full of immune-boosting compounds (though some whey processing techniques can destroy these healthy compounds). For more information on whey see www.wheyoflife.org).
If you are aiming for weight loss, preventing muscle loss associated with aging (and lack of use!), want to boost your immune system functioning or build muscle, consider adding whey to your diet. 

Intuitive Eating vs. Counting Calories?

I’ve seen many dietitians decide between using intuitive eating and counting calories with their clients.  Intuitive eating, coined by dietitian Evelyn Tribole, means separating the emotional and physical aspects of food and learning to eat entirely on physiological hunger and satiety cues (read this article for more information:  www.figureathlete.com/readArticle.do?id=2392335). Counting calories means, well, counting calories (food logs etc. – see previous post from a few days ago).  However, I view the two as not mutually exclusive.  When it comes to nutrition there isn’t a one-size-fits-all approach that works nearly as well as individual customization.  

How do you know which one to use or whether you should use both?  First, it comes down to your goals.  Granted, many people are solely motivated by weight loss for physical appearance purposes.  Others realize that losing weight is the ticket to help them break free from hypertension medication, Type 2 diabetes medications, osteoarthritis knee pain etc. (the list goes on and on).  And there are also those who realize they better start engaging in resistance exercise and good eating to build muscle mass so they can lift their grandchild out of their crib safely.  
After writing down your specific goals, it is important to realize what works for you.  Does counting calories help hold you accountable or aggravate those nagging and deep rooting emotional eating issues that you cling on to during times of stress?  Is intuitive eating enough to help you gain the weight and muscle mass you need to get stronger after a round of chemo and radiation?  If your answers to these questions are not immediately evident, read more on intuitive eating and consider working with a dietitian who can help design an individual approach specifically for you.  Though there are many great group programs out there (I’ll cover these tomorrow), nothing beats a one-on-one setting to help you meet your goals.

Super Bowl Sunday

I am pumped up about Sunday’s game. And no, I’m not the die-hard football fan that my brother-in-law is. But, I am excited about watching the game in good company and cheering on an athlete I worked with when he was a college standout (a stellar Steeler and all around phenomenal person).

As a dietitian I realize many people also get pumped up because football is an excuse to drink beer and eat fried food, chips and more fried food. I often wonder how anyone gets excited about that (isn’t fried food plentiful in our country? It isn’t unique to football, the fall or anything else for that matter). There are however tons of healthy and much more flavorful foods that you can incorporate into your big game day.

I have two favorite dips I’m going to share with you. The first one is simple:

Smoked Salmon Dip
Fat free cream cheese
skinless, boneless canned salmon
smoke flavoring (a dash will do, more to taste)

Directions: Just mix it together in a bowl and you are done! Seriously, that easy.

By the way, smoke flavoring is found near the soy sauce in your grocery store. Fat free + healthy salmon and delicious!

My other favorite is:
Roasted Red Pepper Pistachio Dip
Makes 12 servings

1/4 cup pistachios, shelled and toasted (3 oz)
3/4 cup roasted red peppers (almost the entire 7 oz jar minus the liquid)
2 Tbsp bread crumbs
1 ounce lemon or lime juice
1 Tbsp honey
1/2 tsp cumin
1/2 tsp sea salt or regular salt

Directions: Toast pistachios in 350 degree oven for 4-5 minutes. Cool to room temperature. Pulse pistachios in food processor (or a clean coffee grinder) for 30 seconds to chop nuts (reserve 1 Tbsp for garnish). Add all other ingredients to food processor bowl (changing blades on the food processor). Blend in food processor for 1 minute until smooth. Refrigerate for a few hours. Garnish with remaining pistachios and serve with vegetables or chips.

Nutrition Analysis (per 1/12 of recipe):
Calories: 53
Fat: 3 grams
Protein: 1.7 grams
Carbohydrate: 5 grams
Fiber: < 1 gram
Sodium: 183 mg

In addition to my favorite dips (paired with veggies of course), take a peek at Whole Foods all time favorites:

Spicy Cheddar-Jack Cauliflower Dip (Vegetarian, Gluten-Free)http://www.wholefoodsmarket.com/recipes/recipe.php?recipeId=2428

Tofu Curry Dip with Chives (Vegetarian, Dairy Free)http://www.wholefoodsmarket.com/recipes/recipe.php?recipeId=29

Spinach-Mushroom Quesadillas with Feta (Vegetarian)http://www.wholefoodsmarket.com/recipes/recipe.php?recipeId=2426

Eight-Layer Mediterranean Dip (Vegetarian)http://www.wholefoodsmarket.com/recipes/recipe.php?recipeId=2439

Vegetarian Chipotle Chili (Vegetarian, Gluten-Free)http://www.wholefoodsmarket.com/recipes/recipe.php?recipeId=1851

Turkey Chili (Gluten Free, Dairy Free)http://www.wholefoodsmarket.com/recipes/recipe.php?recipeId=387

Herb-Roasted Sweet Potato Skins (Vegan, Gluten-Free)http://www.wholefoodsmarket.com/recipes/recipe.php?recipeId=1397

Eating out and Your Weight

Now that I’ve sold you (or at the very least you are in the precontemplation stage) on keeping a food diary/log, you are probably going to tell me that you eat out all of the time right?  Sure, you can keep a food log when traveling  but you may have no clue what is in that delicious creamy dish you are devouring.  Wonder no longer.  Dr. Jo, a dietitian who specializes in dining healthy when dining out, created an entire series of books and printable cards that give you the strategies you need and provide meal suggestions for dining healthy when dining out!  She includes tips and strategies for breakfast, lunch and dinner and every dining situation you can think of.

You can lose weight or maintain your weight when you eat out if you make it a priority.  Sure, not every restaurant has the best selection of healthy entrees but most will alter their cooking method if you just ask (grilled vs. fried for instance).  Many people have told me that they can’t lose weight because they travel, don’t have time to exercise and they eat out all of the time. However, it comes down to priorities.  Jarred made it a priority (Subway Jarred that is) and became a huge success. (By the way, if you haven’t read his amazing story, I encourage you to do so.  Pure inspiration!)  All you need are the tools to navigate you along the way.

Keeping Track of your Food Intake

Yesterday I discussed how important it is to keep track of your food intake if you want to lose weight.  The money experts tell you that it is wise to figure out where your money is going if you want to make sure that it isn’t going to steep credit card interest payments.  Well, I am telling you the same thing with food.  If you have trouble losing weight or maintaining your weight loss, you need to take a better look at what you are eating and how you are exercising.  Here are some of the internet-based tools (many are free) that you can use to do this:

www.dieticianmobile.com (just $9.99 from itunes for your iphone and ipod)
Most of these (if not all) analyze your intake as well, so they’ll tally your calorie intake, macronutrient intake and sometimes even your vitamin and mineral intake.  Sometimes it takes an easy tool to bring you lasting results.

Is losing weight one of your New Year’s Resolutions?

 If weight loss was one of the resolutions you committed to on January 1, 2009, by now you should have made some progress.  That progress could be weight loss, behavior change or a combination of the two.  If you don’t feel like you are making progress though, it is time to take a step back and ask yourself why you haven’t.  As a dietitian I’ve heard literally every excuse in the book but it really comes down to priorities.  If you didn’t exercise all week, what did you do with that time instead?  Watch TV?  Run errands?  Talk on the phone?  Take a nap?  As with any goal, you have to make weight loss and your overall health a priority.  A top priority in fact if you want to trim down your future health care costs while increasing your productivity in all areas of your life.  

A great, cheap tool to help you lose weight is a weight loss diary.  If you have access to the computer you can enter your food intake into one of the many programs (some free) on the internet that help you track your total calorie, fat, protein and carbohydrate intake.  If you are on the go try using a spiral notebook. For just $2 you have a handy weight loss tool that you can take with you anywhere and log your food intake.  Why do diet diaries work?  They hold you accountable. If you are eating a brownie you have to write it down.  When you reach for brownie #2, you’ll think twice about eating it since you will have to log that too. A multi-center trial published this past summer with a total of 1685 participants found that the mere act of keeping a daily food intake record led to twice as much weight loss as not keeping a record at all.  So if you are serious about weight loss (or weight gain for young athletes), keep track of your intake and watch the weight fall off.