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S. M. A. R. T. Heart 2013: Nutrition Strategies S. M. A. R. T. Heart 2013: Nutrition Strategies

Nutrition…It’s a Science “To protect yourself against nutrition cultism and quackery, you should realize Nutrition…It’s a Science “To protect yourself against nutrition cultism and quackery, you should realize that what is true about nutrition is not sensational and what is sensational isn’t true. Nutrition is a science and not black magic. ” Victor Herbert, MD, JD

Objectives 1. Review your numbers, what they mean and learn what changes you can Objectives 1. Review your numbers, what they mean and learn what changes you can make to care for your future self 2. Explore the basics of better nutrition and how to put out the “inflammatory fire” 3. Create a better/S. M. A. R. T. strategy based on the latest information re: diet, exercise recommendations and adequate sleep

Know Your Numbers NIH recs: Men - < 40 inches Women - < 35 Know Your Numbers NIH recs: Men - < 40 inches Women - < 35 inches WHO recs: Men - < 37 inches Women - < 31. 5 inches

Know Your Numbers Know Your Numbers

What is Blood Cholesterol? • Cholesterol is a waxy fat-like substance produced by the What is Blood Cholesterol? • Cholesterol is a waxy fat-like substance produced by the liver and supplied by the diet through animal foods • Cholesterol moves through your bloodstream to your body’s cells in special carriers called lipoproteins • Your body needs cholesterol to insulate nerves, form cell membranes and make certain hormones. It makes all it needs

Why Cholesterol Matters? • Too much blood cholesterol contributes to fatty build-up in the Why Cholesterol Matters? • Too much blood cholesterol contributes to fatty build-up in the arteries – a major risk factor for heart disease and stroke • Too much cholesterol in the blood can be trapped in artery walls • Over time, this builds up and is called plaque • Plaque can narrow vessels and make them less flexible, a condition called atherosclerosis or “hardening of the arteries”

What is LDL? • Low-density lipoproteins (LDLs) or “bad” cholesterol work like delivery vehicles What is LDL? • Low-density lipoproteins (LDLs) or “bad” cholesterol work like delivery vehicles • LDLs keep blood cholesterol circulating in your bloodstream allowing plaque to attach to artery walls • The higher the level of LDL cholesterol in the blood, the greater your risk for heart disease

What is HDL? • High-density lipoproteins (HDLs) or “good” cholesterol can help protect your What is HDL? • High-density lipoproteins (HDLs) or “good” cholesterol can help protect your heart • HDL acts like waste removal vehicles taking cholesterol from blood and artery walls to the liver where it is removed • A low level of HDL cholesterol increases your risk for heart disease

What Are Triglycerides? • Fats also carried through the bloodstream • If you eat What Are Triglycerides? • Fats also carried through the bloodstream • If you eat excess calories from carbs, protein or fat your body produces triglycerides and stores the extra as body fat • Measurements are affected by medication, hormones, excess sugar and fat menstrual cycle, time of day and recent exercise • Elevated blood triglycerides can put you at risk for CAD

Manage Your Cholesterol With Three Key Lifestyle Steps • Get moving • Aim for Manage Your Cholesterol With Three Key Lifestyle Steps • Get moving • Aim for a healthy weight • Choose a heart smart eating program

Lower Your LDL Through Diet • Eat less saturated fat – Women < 11 Lower Your LDL Through Diet • Eat less saturated fat – Women < 11 -13 grams – Men < 16 -18 grams

Saturated Fat Violators Item Premium ice cream (1 c) Cheesecake (5 oz) Sausage (3 Saturated Fat Violators Item Premium ice cream (1 c) Cheesecake (5 oz) Sausage (3 oz) Saturated fat 20 g 14 g 10 g Ribeye (3 oz) Hot dogs (1) Butter (1 Tbsp) Cheese (1 oz) Whole milk (1 c) 8 g 7 g 7 g 6 g 5 g Budget 11 -18 grams of saturated fat per day

Ban Trans Fat • raises LDL cholesterol similarly to saturated fat • lowers HDL Ban Trans Fat • raises LDL cholesterol similarly to saturated fat • lowers HDL cholesterol • Trans fat is found mainly in foods made with hydrogenated vegetable oils: § Shortenings § Snack foods § Processed foods § Bakery goods § Hard margarines

Major Food Sources of Trans Fats in the American Diet Average daily intake of Major Food Sources of Trans Fats in the American Diet Average daily intake of trans fats is 5. 8 grams

Replace “bad” fats with “good” fats • Choose fats high in “monos” and “polys’ Replace “bad” fats with “good” fats • Choose fats high in “monos” and “polys’ which can lower LDL and may increase HDL: § § § § Olive oil Nuts/nut butters Avocado Fatty fish Flax Corn oil Safflower oil Sunflower oil

Add Omega-3 Fatty Acids • Found mostly in seafood, especially higher fat fish: Salmon Add Omega-3 Fatty Acids • Found mostly in seafood, especially higher fat fish: Salmon Albacore tuna Halibut Rainbow trout Sardines

Omega-3 Benefits Studies have shown beneficial trends with Omega-3 in: • • Blood pressure Omega-3 Benefits Studies have shown beneficial trends with Omega-3 in: • • Blood pressure Depression Resting heart rate ADD/ADHD Risk of arrhythmia Vision Sudden death • • Dry eyes Triglycerides Autoimmune diseases LDL/HDL cholesterol All-cause mortality Metabolic syndrome Fetal growth/development

Physicians’ Health Study Relative Risk of Sudden Cardiac Death and Blood Omega-3 Levels Physicians’ Health Study Relative Risk of Sudden Cardiac Death and Blood Omega-3 Levels

Continue On The Road To A Healthy Heart • • Plant stanols/sterols Soluble fiber Continue On The Road To A Healthy Heart • • Plant stanols/sterols Soluble fiber Weight loss Manage your blood pressure

Incorporate Plant Stanols and Sterols • Plant compounds that block the absorption of cholesterol Incorporate Plant Stanols and Sterols • Plant compounds that block the absorption of cholesterol form the intestines • National Cholesterol Education Program guidelines: 2 g/day can lower LDL cholesterol by 5 -15% within weeks • Fortified products available

Soluble Fiber • Oats: 3 grams per day* 1. 5 cups cooked oatmeal/day or Soluble Fiber • Oats: 3 grams per day* 1. 5 cups cooked oatmeal/day or 3 plain packets instant ¼ cup dry oat bran • Psyllium: 7 grams per day* Metamucil (1 Tbsp. Sugar-free/day) Konsyl (2 heaping tsp. /day) • Beans, fruits, vegetables * Supported by research to lower LDL 3 -7%.

Soluble Fiber Sources 3 packets plain instant oatmeal 3 gms fiber 300 calories ¾ Soluble Fiber Sources 3 packets plain instant oatmeal 3 gms fiber 300 calories ¾ cup dry oatmeal 3 gms 225 ¼ cup dry oat bran 3 gms 120 3 cups Cheerios 3 gms 330 2¼ cups Kashi Heart to Heart 3 gms 330 5 Metamucil psyllium wafers 7 gms 300 ½ cup beans 2 -3 gms 120 1 cup cooked vegetables 2 -3 gms 50 -100 2 medium fruits 2 -3 gms 200 -300

High Blood Pressure • Cutting sodium by 2, 000 mg a day could lead High Blood Pressure • Cutting sodium by 2, 000 mg a day could lead to 23% fewer strokes and 17% less heart disease. • The average American consumes 4, 000 mg/day. BMJ 339: B 4567, 2009

Salt Shockers! • Average 1 cup canned soup = 1, 000 – 1, 200 Salt Shockers! • Average 1 cup canned soup = 1, 000 – 1, 200 mg Try lower sodium options like: Tabatchnick Low Sodium (frozen), Health Valley No Salt, Campbell’s Ready to Serve Low Sodium Campbell’s Healthy Request, Healthy Choice

Salt Shockers! • Pretzels and other salty snacks average • 2 oz bag = Salt Shockers! • Pretzels and other salty snacks average • 2 oz bag = 1280 mg Try unsalted pretzels, baked chips, original Sun. Chips

Manage Your Sugars • We now consume 22 -30 tsp sugar/day = 350 -475 Manage Your Sugars • We now consume 22 -30 tsp sugar/day = 350 -475 extra, empty calories • Recommendations (AHA, 2010): – Women – 100 calories/day/added sugar – Men – 150 calories/day/added sugar

Beverages = Liquid Candy Big Gulp Cal: 364 Sugar: 23. 5 tsp Super Big Beverages = Liquid Candy Big Gulp Cal: 364 Sugar: 23. 5 tsp Super Big Gulp Cal: 512 Sugar: 32 tsp Lemonade (8 oz) Cal: 140 Sugar: 7 tsp Lemonade (20 oz) Cal: 260 Sugar: 16. 5 tsp

The 10 -Percent Solution • Studies show that a weight loss of just 5 The 10 -Percent Solution • Studies show that a weight loss of just 5 to 10 percent of body weight can significantly lower your blood pressure, improve blood cholesterol and improve ability to control diabetes

Prescription: Exercise • Exercise: – Improves blood lipid levels – Increases energy – Helps Prescription: Exercise • Exercise: – Improves blood lipid levels – Increases energy – Helps lose weight and keep it off – Improves blood pressure – Increases confidence and decreases stress – Lessens sadness and depression

Get Moving • If inactive, ease into an exercise program 30 minutes of daily Get Moving • If inactive, ease into an exercise program 30 minutes of daily activity • Exercise aerobically (briskly) 30 -60 minutes 56 days per week

Stand Up! • The latest research suggests that in addition to exercise, limiting the Stand Up! • The latest research suggests that in addition to exercise, limiting the amount of time we are inactive i. e. sitting improves heart health, reduces insulin resistance and likely lowers cancer risk • Interspersing light bouts of movement through out the day helps with fat metabolism and waist size Am J Epidemiol. 2000; 152(12): 1171 -1178. Diabetes Care. 2012; 35(5): 976 -983.

S. M. A. R. T. Goals Specific, Measurable, Actionable, Realistic, Time Bound • Behavior S. M. A. R. T. Goals Specific, Measurable, Actionable, Realistic, Time Bound • Behavior modification – Positive, matter-of-fact attitude • Become aware of behaviors – Keep record • Change behaviors – Practice – Set small, specific goals

Unrealistic vs. Realistic Goals • I will walk 3 miles everyday I will walk Unrealistic vs. Realistic Goals • I will walk 3 miles everyday I will walk 30 minutes 3 x /week • I will never eat dessert again I will limit my desserts to 150 calories 3 x/week • I will lose 60 pounds in 5 months I will lose ½ -2 pounds /week

Possibilities! • Decrease negative cues: – Replace the candy dish on your desk with Possibilities! • Decrease negative cues: – Replace the candy dish on your desk with sugar free candies or a fruit bowl • Increase positive cues: – Keep extra workout clothes handy at home, work, and in the car

Mindless Eating Why we eat more than we think: Brian Wansink, Ph. D. Cornell Mindless Eating Why we eat more than we think: Brian Wansink, Ph. D. Cornell University Mindless. Eating. org

Lessons From Mindless Eating • • Water within arms reach, no soda in the Lessons From Mindless Eating • • Water within arms reach, no soda in the house Healthy options at eye level “Challenge” foods out of sight Pre-portioned items/bags for better accountability • Intentional monotony • Planned 150 -200 calorie snack (carb + protein)

Snacks • • • Greek yogurt ½ turkey sandwich Broth-based soup Dry roasted edamame Snacks • • • Greek yogurt ½ turkey sandwich Broth-based soup Dry roasted edamame Higher protein cereal + skim milk Trail mix Hummus and whole grain pita crisps/carrots Turkey jerky (try Krave – lower sodium/no nitrate) Babybel cheese and Special K cracker chips

Snacks, Snacks • • • Peanut butter crackers Apple slices and 1 T almond Snacks, Snacks • • • Peanut butter crackers Apple slices and 1 T almond butter Popcorn and pumpkin seeds Vitatop Flavored rice cake or mini bagel with low fat cream cheese • Sommersault crackers (sunflower seed base) • Healthy nachos (baked tortilla chips, fat-free refried beans, low fat cheese sprinkle, salsa)

Snacks, Snacks and More Snacks • • Orgain or Mix 1 shake Kind bar, Snacks, Snacks and More Snacks • • Orgain or Mix 1 shake Kind bar, Clif Builder bar, Nu. Go bar, Luna bar Drinkable yogurt/kefir Shirataki noodles and Laughing Cow cheese PB 2 crackers Meridan’s protein muffin Hard boiled egg and piece of fruit

Eggcellent Choice? • Harvard/China metaanalysis of 8 studies (263, 000 cases CVD and 210, Eggcellent Choice? • Harvard/China metaanalysis of 8 studies (263, 000 cases CVD and 210, 000 stroke) • Found NO evidence of an association between egg consumption and heart health risk – BMJ, December 2012

Reducing the Risk • The research is clear – Reduction of body fat is Reducing the Risk • The research is clear – Reduction of body fat is a primary target for reducing CVD, prediabetes, diabetes and cancer – Even modest composition change is linked to significant improvements in health metrics (blood sugar, BP, TG, HDL chol. , inflammation) • Today’s Dietitian, March 2013

Why Should We Learn More About Inflammation? • Some researchers believe that low-grade inflammation Why Should We Learn More About Inflammation? • Some researchers believe that low-grade inflammation is associated with everything from heart disease and diabetes to Alzheimer’s and arthritis, and may even be the cause of most chronic diseases • Test for inflammation = C-reactive protein (CRP). Elevated levels of CRP often signal an increased risk of heart attack and stroke

Put Out the Fire • The same steps that help prevent heart disease may Put Out the Fire • The same steps that help prevent heart disease may reduce chronic inflammation: – Talk to MD about low-dose aspirin to help prevent heart attack and stroke – Control your blood pressure with diet, exercise, and medication (if needed) – If you are overweight, lose some weight (even 5 -7%). Obese people tend to have high CRP – Eat a healthy diet with a moderate amount of fish (high in omega-3 DHA and EPA fats)

The Anti-inflammatory Lifestyle • • Varied high quality foods; Few low nutrient foods Total The Anti-inflammatory Lifestyle • • Varied high quality foods; Few low nutrient foods Total calories awareness to promote optimal weight Emphasizes healthful, high fiber carbohydrates Focuses on plant proteins with less animal protein Healthful fats and omega 3 fatty acids Generous use of spices: garlic, ginger, tumeric, etc. Increased tea consumption

Green Tea • Green tea is rich in catechins • Claims: anti-inflammatory; metabolism-boosting action Green Tea • Green tea is rich in catechins • Claims: anti-inflammatory; metabolism-boosting action • Science: preliminary evidence suggests green tea can boost metabolism (Dose: 270 mg EGCG per day) • Advice: Drink green tea and experience a reduction of 50100 calories

Anti-inflammatory Diet = Mediterranean Diet • The Mediterranean diet, supplemented with extra-virgin olive oil Anti-inflammatory Diet = Mediterranean Diet • The Mediterranean diet, supplemented with extra-virgin olive oil or tree nuts reduced the risk of suffering a cardiovascular death, a myocardial infarction or a stroke by 30%! • The research is part of the project PREDIMED, a multicenter trial carried out between 2003 and 2011 to study the effects of the Mediterranean diet on the primary prevention of cardiovascular diseases. – “Primary Prevention of Cardiovascular Disease with a Meditteranean Diet. ” New England Journal of Medicine, 25 th February 2013.

How Much Is Going In? • Write it down to identify your problem areas/opportunities How Much Is Going In? • Write it down to identify your problem areas/opportunities for change Try these “apps”: • Lose It (i. Phone app) • My. Fitness. Pal. com • Sparkpeople • Slim Down Shopping List (i. Phone app) • Calorie. Tracker. com • The. Carrot. com • Calorie. King. com

Recharge your battery • Get a good night’s sleep (7 -8 hours)! – Less Recharge your battery • Get a good night’s sleep (7 -8 hours)! – Less than seven hours increases the risk of obesity approximately 30% and – Appetite increases by 22% – Inadequate sleep increases the stress hormone cortisol