D.A.S.H. Diet (Dietary Approaches to Stop Hypertension)

Hypertension (high blood pressure) affects about 1 out of every 3 American adults (an estimated 67 million Americans).  Blood pressure is the force of blood against artery walls.  It is measured in millimeters of mercury (mmHg) and recorded as two numbers--systolic pressure (when the heart beats) over diastolic pressure (when the heart relaxes between beats).  Both numbers are important.  Normal blood pressure is lower than 120/80 mmHg.  High blood pressure (hypertension) is when your blood pressure is 140/90 mmHg or above.  Blood pressure between 120/80 and 140/90 is called prehypertension.  If you have prehypertension, you are more likely to develop high blood pressure.  Almost 30 percent of American adults ages 18 and older, or about 59 million people, have prehypertension.  

High blood pressure is dangerous because it makes the heart work too hard, and the high force of the blood flow can harm arteries and organs such as the heart, kidneys, brain, and eyes.  If uncontrolled, it can lead to heart and kidney disease, stroke, blindness and early death.  If you have heart or kidney problems, or if you had a stroke, your doctor may want your blood pressure to be even lower than that of people who do not have these conditions.  You are more likely to be told your blood pressure is too high as you get older because your blood vessels become stiffer as you age.

There are many things you can do to help control your blood pressure:

• Eat a heart-healthy diet, including potassium and fiber, and drink plenty of water.

• Limit the amount of sodium (and salt) you eat--aim for less than 1,500 mg per day.

• Reduce stress--try to avoid things that cause you to stress.

• Stay at a healthy body weight.

• Limit how much alcohol you drink--one drink a day for women, two a day for men.

• If you smoke, quit!

• Exercise regularly--at least 30 minutes of aerobic exercise a day (all at once or "piecemeal" in 10-minute bouts).  If your blood pressure is moderately elevated, 30 minutes of brisk walking on most days of the week may be enough to keep you off medication.  If you don’t have high blood pressure, being physically active can help prevent it.  If you have normal blood pressure but are not active, your chances of developing high blood pressure increase, especially as you get older.  If you have been sedentary, gradually build up the amount of exercise and do something you enjoy.  If you have a chronic health problem or a family history of heart disease, talk with your doctor before beginning a new physical activity program.

The DASH Diet (Dietary Approaches to Stop Hypertension) issued by the U.S. Dept. of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute (NHLBI) is proven to lower blood pressure.  The DASH Diet emphasizes fruits (4-6/day, depending on body weight), vegetables (3-6 servings/day), nuts (approximately a handful of nuts most days of the week) and fat-reduced milk products, and includes whole grain products, fish and poultry.  The diet is low in saturated fat (6%), cholesterol (150 mg), and total fat (27%) and is lower in lean meat, sweets, added sugars, and sugar-containing beverages than the typical American diet.  The eating plan is rich in potassium, magnesium, calcium, protein and fiber.  Studies conducted by scientists supported by the National Heart, Lung, and Blood Institute (NHLBI) and performed at 4 major medical centers found that the DASH Diet significantly reduces blood pressure.  The results were dramatic and fast, achieving reduced blood pressure within 2 weeks.  Even a modified plan that just added more fruits and vegetables to a typical American diet reduced blood pressure.  Another benefit of eating the DASH eating plan is that it reduces (bad) LDL cholesterol, further reducing your risk for cardiovascular disease.  You should be aware that since the DASH eating plan has more daily servings of fruits, vegetables, and whole grain foods than you may be used to eating and is high in fiber, it can cause bloating and diarrhea in some persons.  To avoid these problems, gradually increase your intake of fruit, vegetables, and whole grain foods.

While the studies show that eating the DASH Diet lowers blood pressure, the combination of the eating plan and a reduced sodium intake gives the biggest benefit and may help prevent the development of high blood pressure.  The highest level of sodium intake considered acceptable by the National High Blood Pressure Education Program and U.S. Dietary Guidelines for Americans is 2300 milligrams (the equivalent of 1 tsp. of table salt, or sodium chloride).  The 2010 Dietary Guidelines for Americans recommends that sodium intake be reduced to 1,500 mg (2/3 tsp. of table salt) among persons who are 51 and older and those of any age who are African American or have hypertension, diabetes, or chronic kidney disease.  The 1,500 recommendation applies to about half of the U.S. population overall and the majority of adults and is the amount recommended by the Institute of Medicine as an adequate intake level and one that most people should try to achieve.  Adult men in the U.S. currently eat about 3,100 - 4,200 mg/day (that's 2-3x the recommendation!).  Adult women in the U.S. eat about 2,500- 3,000 mg/day.  Furthermore, the average daily sodium intake for Americans age 2 years and older is 3,436 mg.  Only a small amount of salt that we consume comes from the salt added at the table, and only small amounts of sodium occur naturally in food.  Processed foods account for most of the sodium Americans consume so read food labels--you may be surprised to find which foods have sodium.  For example, which McDonald’s product has more sodium—the french fries, vanilla shake or apple pie?  The 16-oz. vanilla McCafe shake (200 mg) and the apple pie (170 mg) both have more sodium than the small french fries (160 mg)!  It tastes like there is more sodium in the french fries because the salt is on the surface.

The DASH eating plan also emphasizes potassium from fruits and vegetables.  A potassium-rich diet helps reduce elevated blood pressure, but be sure to get your potassium from food sources not from supplements. Many fruits and vegetables, some milk products, and fish are rich sources of potassium.  While salt substitutes containing potassium are sometimes needed by persons on drug therapy for high blood pressure, these supplements can be harmful to people with certain medical conditions.  People who have kidney problems or who take certain medicines must be careful about how much potassium they consume.  If this is you, before you increase the potassium in your diet or use salt substitutes which contain potassium, check with your doctor.

Mediterranean Diet

It turns out that the healthiest diet is one of the most enjoyable diets.  Lucky for us, one of the most enjoyable ways to eat a more plant-based, animal-reduced diet is to eat as the traditional Greeks--the dietary pattern affectionately known as the "Mediterranean diet".

In the 1960’s Professor Ancel Keys first reported on the health benefits of people who ate the traditional diet in the Greek island of Crete and Southern Italy in the 7 Countries Study.  Professor Keys documented the diets of 13,000 middle-aged men (ages 40-59) living in Southern Italy, Crete, Yugoslavia, Finland, Netherlands, Japan and the US.  Interestingly, the Cretan diet was one of the highest fat diets in the study (40% fat), but it was low in saturated fat and high in monounsaturated fat, and the Cretan Greeks eating it came out with some of the lowest rates of coronary heart disease and all-cause mortality and had the longest life expectancy in the world at that time. The population of Finland ate the most saturated fat (mostly from cow’s milk products) and had the highest levels of blood cholesterol and the most heart disease.  Even though the population from Finland had a similar intake of fat to that of the Cretans, the population of Finland had 30 times higher the rate of heart disease!  

The Cretan diet was also relatively low in carbohydrates (45% energy) with most of the carbohydrates consumed being of low glycemic index.  However, this is not a “low carbohydrate diet” as has been popularized to Americans in the recent high-protein diet craze (those diets are usually based on a dangerously low carbohydrate intake of about 30-40%).  Unlike the popular “low-carbohydrate diets” of America, the Cretan diet was based on a large volume of plant foods and consisted of a high intake of vegetables (2-3 cups/day, especially green leafy types including purslane), high intakes of legumes (30g/day), nuts (30g/day, especially walnuts), fruit (2-3 fruits/day) and wholegrain cereals (equivalent to 8 slices of bread/day).  They also had moderate intakes of fish (40g/day), alcohol (20g/day with meals, i.e. 2 standard drinks/day) and low intakes of red/white meat (35g/day) and fermented sheep/goats milk products (cheese/yogurt consumed weekly). This is the equivalent of a 5 oz. serving of fish 2x/week, a 4-5 ounce serving of chicken/pork once a week, a 4-5 ounce serving of lamb once a week or less, and bean/lentil soups or casseroles about 2-3 times a week.

The Cretan diet was also low in animal and saturated fat (8% energy), but high in total fat (40% energy) and monounsaturated fat (25% energy).  The major source of fat was olive oil (about 4 tablespoons/day), which was nearly always consumed as 'extra virgin' or the first pressing of the olive and nearly always consumed with plant food.  The combination of vegetables with olive oil in the Mediterranean cuisine may be an important component responsible for its protective effect.  For example, the antioxidant lycopene in tomatoes is better absorbed in the intestine if the tomatoes are cooked, and absorption is even better if cooked with oil, which makes sense since these pigments are fat soluble.  

Countless studies have consistently verified the health benefits of the Mediterranean diet. The Mediterranean Diet pyramid was developed by Professor Walter Willet and colleagues at Harvard University. 

An Optimal Diet

There are numerous ways to discuss (and eat) an optimal diet—the overall health-supporting Mediterranean Diet, the metabolic syndrome-preventing Syndrome X Diet, the hypertension-reducing D.A.S.H. (Dietary Approaches to Stop Hypertension) Diet.  These are just a few of the more well-known (the topic of previous and upcoming blogs), but they are all based on the same idea--more plant, less animal food.  While they approach the healthy diet from different perspectives (a healthy culture, resolving metabolic syndrome, reducing hypertension), they really are all quite similar in composition.  The good news is there is not one diet for heart disease, one diet for cancer, one diet for diabetes, etc.  A healthy diet has significant impact on our overall health, and all of the public health organizations reflect that truth in their dietary recommendations.  The American Heart Association, National Cancer Institute, American Diabetes Association, Dietary Guidelines for Americans and others have always had variable but similar recommendations, but in recent years they have all become the same: eat a plant-based monounsaturated fat-rich diet based on whole grains, beans, nuts and seeds, fruits and vegetables with small portions of lean meat, poultry and dairy, generous amounts of fish (3-4x/week) and olive oil to prevent cardiovascular disease, cancer, diabetes, intestinal disease and more.  Also, what always has been, still is, and always will be an optimal diet.  It is not going to change—it is only our rather limited understanding that has been changing over the years. 

The amount of plant food in an optimal diet is significantly higher than the standard American diet (S.A.D.).  Healthy cultures around the world eat a strikingly similar 90% plant:10% animal food diet (in a variety of ways) whereas the typical American diet is based on 70% animal food and only 30% plant.  An optimal plant-based diet is low in animal protein and animal fat, low in processed foods, and high in health-supporting, disease-preventing plant foods with their 900+ discovered (so far) phytochemicals and fiber. 

This may sound extreme to our American meat-loving ears, but around the world people do not think it is normal to die of such long-term degenerative diseases which are the norm in America.  

Trans Fats

In the last several blogs I have mentioned the danger of processed “trans fats” in our diet.  Let's explore them a little more.

“Trans fatty acids”, otherwise labeled as “partially hydrogenated fatty acids” (or hydrogenated vegetable oils) are now widely used in many products to lengthen shelf life and improve the texture of foods.  Fatty acids are based on carbon chains that have hydrogens attached.  Saturated fatty acids have hydrogens attached at every available bond (they are saturated with hydrogens), whereas unsaturated fatty acids have one (monounsaturated fat) or more (polyunsaturated fat) places on the carbon chain that do not have a hydrogen attached (an "empty bond").  Normally, when oxygen attaches to the site on the carbon chain of the fatty acid where there is an empty (available) bond the product goes rancid faster.  Partially hydrogenated oils undergo a chemical process which adds hydrogens to unsaturated fat to make it more saturated, making less available bonds for oxygen to attach so the product stays fresher longer.  The purpose of “partially hydrogenating” a fat is to increase the product’s shelf life, not your life. 

In addition to making a perfectly healthy unsaturated fat more “saturated” (with hydrogens), hydrogenation causes the structure of the fatty acid to be altered.  During the process the structure of a natural unsaturated fat (where the "cis" configuration of the fatty acid hydrogens are attached on the same side of the carbon chain) may be changed to a "trans" configuration (where the hydrogen atoms occur on both sides).  Thus the name “trans” fatty acids.

Trans fatty acids are harmful!

Trans fatty acids have been implicated in a host of degenerative diseases including cardiovascular disease (which does not just happen because there is too much cholesterol—there is an initial insult to the inside of the arteries), cancer, arthritis, and even premature aging!  Trans fatty acids are at least as bad as, if not worse than, saturated fats as they have an equally negative effect on increasing the LDL (“bad”) cholesterol.  An increasing number of researchers and nutrition experts agree that trans fats are actually worse (and some say much worse) than saturated fats because they not only increase LDL cholesterol like saturated fats do but also significantly reduce HDL (“good”) cholesterol, delivering a “double whammy”.  Additionally, trans fatty acids increase Lp(a) lipoprotein levels (a particularly harmful type of LDL cholesterol associated with an increased risk of coronary heart disease) and triglycerides.  Many studies have confirmed the adverse effects of trans fatty acids, prompting the FDA to require labeling of trans fatty acid content of foods on product labels starting January 2006.

In June 2006 the American Heart Association issued updated dietary recommendations which set a goal for trans fatty acids of less than 1% of total calories.  The typical American diet contributes 10 grams of trans fatty acids for every 3,000 calories (equivalent to 3%).  The largest single source of trans fatty acids is margarine.  Watch out for peanut butter too!  Steer clear of the big brand name peanut butters which advertise “low cholesterol”, “low sugar” and/or “low fat” on the front of the label and check the label for “partially hydrogenated” oil.  Choose the brand that lists only “peanuts and salt” on the ingredients label.  While there are a lot of “natural” brands of peanut butter without partially hydrogenated fat, there is usually an inexpensive store brand with just “peanuts and salt” too.   

Dieting is Harmful to Your Health

In the last blog I presented overwhelming evidence that our obsessive focus on weight is misguided when it comes to actual mortality data.  In a previous blog I discussed the futility (failure) of dieting.  Whether your goal is prevention of lifestyle disease or weight-loss, I encourage you to take the obsessive focus off of weight and focus on the real problems instead--lack of activity and plant foods, and a high animal (saturated) and processed (trans) fat diet.  Today I hope to strengthen that focus by sharing about the downright danger of dieting.  Again, from the book Big Fat Lies by Glenn Gaesser, a large amount of research (and thus a longer-than-usual blog to make you aware of the danger) shows just how harmful dieting can be:

·   Fifteen studies published between 1983-1993 show that weight loss increases risk of premature death by up to 260%.

·    Dieters, especially yo-yo dieters (who make up about 90% of the dieters in this country), have a risk for Type II diabetes and cardiovascular disease that is up to twice that of “overweight” people who remain fat.

·    Weight loss was associated with 40-260% higher death rate when researchers devised 36 different ways of comparing causes of death and amount of body weight lost in a follow-up of the NHANES I study (1971-74) in 2,453 men and 2,739 women.

Focus on Fitness, Not Fatness

The following information is from the book Big Fat Lies by Glenn Gaesser, Ph.D. which I highly recommend.  I present this information in an effort to help you take the focus  off of body weight, and focus instead on physical activity and a healthy diet.  The evidence is overwhelming (and the blog is longer than usual to make you aware of the amount of evidence, though this is only a small overview) that body weight does not deserve the blame we have assigned to it.  And the evidence keeps coming in--you may have heard the "new" evidence consistently reported in the news over the past 2-3 years that "surprises" the experts (and reporters), concluding that body weight is not to blame.  The bottom line--fitness matters more than fatness.  The caveat is that abdominal fat is strongly associated with cardiovascular disease and diabetes.  Note how large and long these studies are, and how well-respected the sources are.

·      Dr. Steven Blair and associates at the Cooper Institute of Aerobics Research in Dallas, Texas studied 10,244 men and 3,124 women between 1970-1981 and found that being heavy did NOT increase the risk of dying prematurely.  Furthermore, when considered in combination with fitness, being overweight seemed to be better than being underweight!

Demotivating Diets

After spending the last 6 blog entries helping to build motivation, I thought it would be fitting to pause and talk about what is demotivating, in order to defend against it.  In short, diets!   
                                                                                                                              

If you want to stay motivated, avoid the “diet trap”.  Here are some of the ways people find themselves caught in the diet trap:

·  Restrictive dieting causes loss of muscle tissue which results in a lower metabolic rate and subsequent weight-regain as fat and, of course, another diet to take care of that.  How depressing.

·    Restrictive dieting causes physical and emotional feelings of deprivation which result in rebound overeating leading to weight regain, often with more besides and, of course, another diet to take care of that.  Back to deprivation, round 2 (and 3, and 4 . . . )

·    Individuals whose eating is driven by underlying emotional issues are given a diet as the "solution" to their “problem” but cannot seem to stop overeating and, of course, try “harder” to diet.  What a “failure”.

Any one of these common scenarios, or a combination of any or all of them

¯

Weight regain

(often with a little more besides!)

¯

Lower self-esteem

¯

More weight gain or more dieting with increased intensity to do better

¯

More diet “failure”

¯

INCREASINGLY LOWER SELF-ESTEEM

In short, dieting wreaks physical and psychological havoc.    

                                                                                                                       

And if those typical cycles aren’t demotivating enough, weight-loss does not necessarily translate into better health.  That’s really depressing!  In fact, diets are often harmful to your health.  Accumulating evidence shows that dieting does more harm than good.  Glenn Gaesser, Ph.D., author of Big Fat Lies, presents a convincing review of the overwhelming evidence that in the effort to produce weight-loss, individuals actually increase their risk for earlier mortality.  Talk about demotivating. 

So if you struggle with motivation, stop dieting.  Diets sabotage motivation and are harmful to health.  In the next blogs I will discuss the futility and harm of dieting. 

If you need to lose weight realize the ironic truth is you need to eat to lose weight.

Living free of diets,
Diane Preves, M.S., R.D.

Thank you for sharing this post with others who might benefit from the information shared herein.
Please contact me if you are interested in hosting a 10-week N.E.W. LIFE program on Long Island.

N.E.W. LIFE copyright 2012

What is Your Motivation Based On?

This is the 6th of 7 blog posts meant to help with motivation: 1) physical activity prevents disease, 2) big benefits of just 10-minute bouts of exercise, 3) the many benefits of physical activity, 4) internal vs. external motivators, 5) changing desires, 6) basing motivation on truth vs. myths/lies, and the next blog 7) demotivation of diets.  If you struggle with motivation to make dietary changes or exercise, check in with yourself to see what your motivation is based on.  If your motivation is based on any myths or lies (which are like shifting sand--when the sand shifts, motivation crumbles) consider the truth upon which to build a more firm foundation for motivation which lasts:

The Myths and Lies:

1) Your worth is based on your body image.

2) You must be perfect to succeed (have a perfect body image, eat perfectly to lose weight).

3) There is good food and bad food, and furthermore, you are “good” if you eat good food or do good on your diet, and “bad” if you eat bad food or do poorly on your diet.

4) You do not have enough “willpower” if you are not able to change your habits.

5) Once you become thin your life will be better.

6) Overweight is the problem.

7) Healthy eating is rigid.


The Truth:

1) You are worthy regardless of your body weight!

2) Not only do you not need to be perfect to succeed, you won’t be!

3) You should not extend labels or make moral judgments about yourself based on how well or how poorly you eat!

4) In the case of compulsive eating/food addiction you must release control in order to have more control in your life!

5)  Life does NOT necessarily get better just because we get thin!  Basing motivation on such MYTHS about the joy and worth of life is like building a house on shifting sand.  The sand will shift and the motivation will crumble!  Furthermore, the goal is to be able to grieve the pain of the hard times without using food to numb the pain.

6) Overweight is the symptom.  Overeating is the problem!

7) Healthy eating is flexible!

Build motivation which lasts on the solid ground of the truth!

Diane Preves, M.S., R.D.

N.E.W. LIFE copyright 2012

Thank you for sharing this post with others who might benefit from the information shared herein.

Changing Desire

Continuing from the previous blog, perhaps the strongest internal motivator that participants develop with N.E.W. LIFE is feeling better. 

Individuals often share in Weeks 3, 4, 5, and 6 of the N.E.W. LIFE program that they feel better, and that they don’t feel good eating the same high-fat, meat, and/or junk foods that they used to eat regularly.  This is the motivation that is more certain to last for life.  N.E.W. LIFE participants are often amazed when their desires change (I am not surprised at the changes, but I am surprised at how quickly people report feeling better and experience changed desires).  No “all-or-nothing” diets necessary, just small, realistic and achievable changes.  Simply pick something that is missing in your diet.  For example, do you eat 3 fruits/day?  Choose something you actually like but are just not in the habit of doing.  If you like apples and your diet is regularly short on fruit, get a bag of apples from the store and just add one apple a day for the next week.  Little changes truly do go a long way! 

The N.E.W. LIFE philosophy is not to eliminate food, deny cravings, or unnecessarily restrict.  Deprivation usually serves to exacerbate cravings and increase preoccupation or obsession with food.  Your focus should be on putting in missing exchanges (i.e., eating more whole grains, fruits and vegetables) then the fluff foods begin to get crowded out, not to eliminate the foods you desire and then expect to eat more vegetables!  It is a lot harder (if possible at all for most people) to effect any change from that perspective.  The most effective change comes with adding healthy foods that may be chronically missing in your diet, then your body, tastes, and desires can change.  So focus on what to eat and the other foods will be modified over time.  Eat enough healthy food and it will soon “crowd out” the less healthy choices, simultaneously lead to a healthier body, and eventually (and surprisingly soon for most people) lead to a change of desire.  Your motivation need not be “should-shouldn’t” or “good food-bad food”.  Support your body with the healthy foods it was created to thrive on and let your healthy body reject junk and unhealthy food--or at least the excess of it--then you won't feel deprived. . . 

Motivation for a Healthy Lifestyle

This blog begins a 3 part series on motivation—internal vs. external motivators, changing desires, and basing motivation on truth vs. myths and lies. There's no doubt that the most motivated people in the N.E.W. LIFE programs are individuals motivated by fear after they have had a heart attack or other health scare.  But how much better is it to become motivated to exercise and eat a healthy diet before we have a problem?  I do realize motivation to exercise can be a challenge, especially for individuals who have been sedentary for awhile, and eating habits can be hard to change.  Often people start with very good intentions and begin  making changes, but soon they begin to struggle with motivation.  A key to becoming and staying motivated to exercise and eat right is to switch from external motivators to internal motivators. . .

Benefits of Physical Activity

This is the 3^rd of three blog entries on physical activity—importance, amount, and benefits.  In the first of the series I recommended that while weight-loss or maintenance is a wonderful by-product of an active lifestyle, I do not recommend weight-loss be your primary reason for exercising because people who exercise in order to lose weight often struggle with maintaining the motivation to exercise once they achieve their goal weight.  Furthermore, weight-loss exercisers who base their motivation on the myth that their worth is based on their body image are basing their motivation on shifting sand.  Since it is not true that you are worthy because of your body image, and since life doesn’t always get better once you lose the weight, if you have built your motivation on that shaky foundation, when the sand shifts the motivation will crumble.  Even if you can stay motivated, exercising for weight-loss can keep you in bondage to body image rather than experiencing the pure energizing joy of physical activity and the many other benefits it offers. 

I realize that many people who exercise for weight-loss are doing so because they have been told that weight-loss results in better health.  Unfortunately, weight-loss in and of itself does not necessarily result in better health (this complicated, sometimes controversial, often surprising topic will be discussed in a future blog)  and an increasing amount of research is bringing that to light.  Of course the physical activity does result in improved health, and in a multitude of ways.  So instead of exercising for weight-loss which often comes with motivation struggles, bondage to body image, and a misplaced value on weight in health, I highly recommend that you focus on the many other benefits of physical activity:

• Develops and maintains cardiorespiratory fitness

• Increases HDL’s (“good cholesterol”)

• Decreases LDL’s (“bad cholesterol”)

• Decreases triglycerides

• Decreases blood pressure

• Reduces stress 

• Anti-inflammatory properties

• Reduces body fat and maintains healthy body weight

• Helps to prevent heart disease, stroke, colon & breast cancer, diabetes, osteoporosis,   diverticular disease, and gallstones

• Helps manage arthritis

• Stabilizes blood sugars

•  Increases energy

•  Improves muscle tone, strength and flexibility 

• Increases metabolic rate for at least 12-14 hours after exercise.  In addition, lean tissue is more metabolically active 24 hours a day, even while sedentary

• Modifies or eliminates anxiety, depression

• Decreases symptoms of PMS

• Increases self-esteem and sense of well-being and improves mental outlook

• Improves blood flow to skin, hair and other organs contributing to a healthier skin, hair and body

• Immediate appetite suppressant

• Improves sleep

• Improves bodily processes from digestion to elimination

It feels good and it’s FUN!!!

It is important to make physical activity a consistent and enjoyable part of your life.  It does not have to involve long, sweaty workouts—

Just get moving!

Diane Preves, M.S., R.D.

Thank you for sharing this post with others who might benefit from the information shared herein.

 

How Much Exercise Should I Do?

Often when people do decide to exercise, the very next question is 
how much?  Let me start off by saying that any physical activity is good, so no matter how few moments you can dedicate to it will make a difference.  You may believe “no pain, no gain” from messages of a time gone by that have convinced you that unless you are involved in intense sweaty workouts there is no benefit.  Not true.  Any physical activity is good--any time, any amount.  The goal is to incorporate physical activity as part of your lifestyle—that means ongoing and consistent.  If the only way to consistently add exercise to your life is to start small, then start small--very small if need be.  Just get moving!  As you realize how achievable small steps are (no pun intended), and you quickly begin to feel the benefits, it will become a self-motivating endeavor.  So just start where you are at.  It may take a few weeks (or even months) to budge the schedule enough to incorporate consistent physical activity into your lifestyle, so don’t be discouraged if your reality (and schedule) is a little slower to change than you would hope.  Just keep looking for opportunities in the schedule and determine to become more physically active, remember that any activity matters, and just get moving.

The very good, somewhat surprising news from accumulating research:

·      Studies have shown that disease and death rates go down as the total daily amount of exercise goes up.  Furthermore clinical trials have shown that several 10-minute bursts of exercise yield essentially the same benefits in blood pressure, weight, body fat, cholesterol levels, and cardiovascular fitness as the same total amount of exercise done in a single session.  Therefore, exercise done “piecemeal” throughout the day seems as beneficial as the same total amount of exercise done in a single session. . .

The Elixir of Exercise

The next 3 blog entries will be about exercise--importance, amount, benefits--all in an effort to convince and motivate you to make physical activity a consistent part of your lifestyle.  It would be impossible to overstate the importance of exercise.

First of all, you cannot experience optimal health without activity/exercise in your life.  Physical activity increases physical and emotional well-being, prevents a long list of diseases, and seems to slow down the very process of aging itself.  Do you know someone who seems to stay perennially “young” looking?  Inevitably they exercise, regularly.   There’s a lot of talk about the anti-aging properties of foods, but hardly a mention about exercise.

Ironically, you will have more energy if you exercise.  I know, it doesn’t make sense.  We have more energy when we spend more energy?  Yup.  I do realize the huge time obstacle most people face—we are maxed out to the limit with a weakening economy and ever-increasing demands on our time, but the truth is you don’t have the time (or money, considering the cost of healthcare) to not exercise.  Improvement in energy translates into feeling better and being more productive with the time you have, not to mention preventing illness, a huge component of our economic well-being, both individual and collective.  Few of us really “have time” to exercise, but I wish my uncles, who all died in their 40’s and 50’s of heart disease, would have taken the time to exercise then--we would have more time with them now.

Then there is prevention of lifestyle disease.  You name the disease, exercise makes it better.  Most people are aware that exercise reduces the major risk factors for heart disease, but let’s strengthen the case and look at each of the individual risk factors for cardiovascular disease.  Exercise reduces “bad” LDL cholesterol, increases “good” HDL cholesterol, reduces triglycerides, reduces high blood pressure, reduces stress, reduces overweight/obesity, and even has anti-inflammatory properties (C-reactive protein, a measure of inflammation in the body, is reduced).  Why do we spend so much more of our resources in the continual search and development of drugs to “help” reduce cardiovascular disease when we rarely tap into the much more effective no-cost exercise?  Many physicians are much quicker to put patients on a drug treatment program than on an exercise program, and we should be asking why.

But the positive effect of exercise does not stop with heart disease.  Exercise has an extremely positive impact on diabetes, obesity, cancer, intestinal disorders (including constipation, diverticulosis, irritable bowel syndrome and Crohn’s disease), alzheimer’s, depression, PMS, osteoporosis, and (perhaps counterintuitively) arthritis.  Exercise even improves sleep!  In fact exercise is SO important to your health that you would very likely be healthier to be a junk food addict who exercises than if you become a “health food nut” in a health food store who does no exercise—and that’s from a dietitian!  That’s how important exercise is.  (Note: I do not condone junk food addict exercisers—that is the addictive cycle of bondage to an eating/body image disorder that ate up 15-20 years of my life).

 

And there simply is no successful weight-management or weight-loss without exercise. . .  

HDL Cholesterol

Recall from the blog entry “Is a Low-Fat Diet Healthiest?” that a low-fat diet is not necessarily the best diet to prevent heart disease because

·        triglycerides increase

·        HDL’s decrease, and

·        insulin-resistance gets worse! 

In previous blogs I discussed insulin-resistance and triglycerides, but what exactly are HDL’s? 

HDL ("high-density lipoprotein") is affectionately known as the "good cholesterol".  Cholesterol is a waxy steroid of fat, and HDL is one of 5 forms of lipoprotein which carry cholesterol in the blood

Triglycerides

In the last blog entry I shared a counterintuitive finding—a relatively "high" (40%) fat diet lowers triglycerides (fat in the blood)!  The key: eat predominately plant and fish fat.

Triglycerides consist of three fatty acids (“tri”) attached to a glycerol molecule (“glycerides”).  Triglycerides are one of the components of the atherosclerotic plaque which leads to cardiovascular disease. Triglycerides may be just as important as cholesterol, if not more important, in the progression of cardiovascular disease.   

Know your triglycerides! 

A serum triglyceride level of 150 milligrams/deciliter or higher is cause for concern and dietary (and exercise) modification.  The American Heart Association recently published a statement recommending that a new “optimal” fasting triglyceride level be defined as 100 mg/dL (Triglycerides and Cardiovascular Disease : A Scientific Statement From the American Heart Association, April 18, 2011 in Circulation).

Our body fat is composed largely of triglycerides.  When excess fat is present in our bodies, the serum triglyceride (blood fat) level may increase.  In fact waist circumference (belly storage fat) is a better predictor of cardiovascular disease and diabetes risk than body weight.  A waist circumference of 35” in women, or 40” in men, will put you at significantly higher risk for cardiovascular disease and diabetes. 

Recommendations for Lowering Triglycerides:

The dietary/lifestyle recommendations for lowering triglycerides are similar to those for lowering cholesterol, with the additional focus on reducing simple carbohydrates and alcohol:

·        ¯ Animal/Saturated Fat

               

·    ¯ Simple Carbohydrates. In “insulin resistant” individuals, eating refined carbohydrates can lead to hyperinsulinemia and high triglycerides.  It is the simple carbohydrates which Americans consume in excess that are known to affect insulin--there is no evidence that complex carbohydrates are to blame.  Research on healthy cultures around the world indicate that an optimal diet (consumed in a variety of ways) is based on 90% plant and 10% animal food based on 50% whole grains, beans, nuts and seeds, 30% vegetables, and 10% fruit, a large carbohydrate intake to be sure, but very different from the largely refined carbohydrates upon which Americans base their Standard American Diet.

·        ¯ Alcohol.  Alcohol contributes 7 calories/gram and virtually no nutrition.  When we consume alcohol it is not immediately burned for calories, but first converted to fatty acids in the liver (cirrhosis of the liver in alcoholics = fatty livers which scar and burst), then the fatty acids are burned for energy secondary to available carbohydrates.  The beer-belly softball player doesn’t burn the beer for energy first, but the hot dog bun instead!  More often the fatty acids are stored.

·        Exercise.  Consistent exercise is very helpful in controlling serum triglyceride levels.

So to lower your triglycerides reduce animal protein, simple (refined) carbohydrates and alcohol, and eat whole grains, beans, nuts and seeds, vegetables, fruit, fish and plant oils with moderate amounts of lean meat and dairy (think Mediterranean).  Remember, counterintuitively, a seemingly "high" 40% fat diet based predominately on plant (especially monounsaturated fat, olive oil) and fish fat lowers triglycerides, likely due to an indirect affect of eating less simple carbohydrates and animal protein.  Finally, consistent exercise can have a major positive effect on your triglycerides, and on your risk for cardiovascular disease and diabetes.

Know your triglycerides.

Eat right, exercise, enjoy!

Diane Preves, M.S., R.D.

Note:  it is not uncommon to see a transient rise in triglycerides during weight-loss (it usually resolves within 6-12 months).

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Is a Low-Fat Diet Healthiest?

In the last two blogs I tried to correct the (dangerous) misunderstanding many Americans have regarding high-protein diets.  Today I focus on the confusion many people have about low-fat diets.

Americans have focused ad nauseam on low-fat diets.  Now overwhelming evidence indicates that it is the type of fat that matters, not the amount.  Traditional Greeks, arguably the healthiest people on the planet measured by low rates of premature mortality, ate a 40% fat diet based predominantly on olive oil.  Americans are shocked to hear that such a “high” fat diet actually lowers triglycerides.  In recent years the American Heart Association has “tweaked” its recommendation upwards from 20 to 30% fat.  The National Cholesterol Education Program’s cholesterol-lowering diet (p. V-2) has been revised to 25-35% fat with an emphasis on plant fat.

Yet due to decades of low-fat recommendations based on nutrition research which at first glance seemed to indicate that a low-fat diet would prevent cardiovascular disease, and due to the plethora of low-fat products which subsequently flooded the market with their “nutrition education” influence on the American public, many Americans still think that eating a low-fat diet is the “healthiest” way to live.  However, overwhelming evidence indicates that a moderate fat diet is much healthier.  Actually, a diet that would be considered high-fat (40%) in comparison to previous recommendations (20%) actually reduces the incidence of cardiovascular disease.  The 7 Countries Study performed way back in the 1960’s by T. Ancel Keys found that the diet eaten by the Greeks on the island of Crete was one of the highest fat diets at 40% fat, low in saturated (or animal) fat and high in monounsaturated fat (from plants), but the Greeks eating it came out with some of the lowest rates of cardiovascular disease and all-cause mortality and had the longest life expectancies in the world at that time.  The diet, now fondly called the “Mediterranean Diet” is high in vegetables (about 2-3 cups/day), especially green leafy types, high in fruits (2-3 /day), high in wholegrain carbohydrates (equivalent to 8 servings/day), high in legumes and nuts, moderate in fish and alcohol, low in meat and fermented milk products.  The diet is also low in animal and saturated fat but high in total fat (40%) with 4 Tbsp. olive oil/day. 

So how was it that American nutrition experts originally came to the low-fat conclusion? 

The Harms of a High (Animal) Protein Diet: Part 2

The Problems with High Animal Protein Diets

Continuing from the previous blog, recall that a three-pronged approach to prevent the metabolic syndrome seems prudent—weight-loss, exercise, and incorporating anti-inflammatory foods in a plant and fish based diet.  Recall also that there is more harm than good in trying to follow the weight-loss recommendation with a high-protein diet.  To continue the list of harms:

·   In the American diet, animal protein (but not plant) is usually linked with saturated fat and cholesterol, which increases LDL-cholesterol (an effect that is compounded when high-carbohydrate, high-fiber plant foods are limited).  It is generally recommended that 10% or less of your total daily calorie intake come from saturated fat, whereas a high-protein diet can have as much as 25% saturated fat.

·   Increased homocysteine levels in blood (a by-product of animal protein breakdown) have been associated with increased risk for cardiovascular disease.  Hospitals now routinely test for homocysteine.

·   Excess animal protein (but not plant) can crowd out a sufficient intake of protective fruits, vegetables, whole grains, beans, nuts and seeds.  High-protein diets are carbo-phobic.  Many high-protein diets intentionally restrict fruit, vegees, beans and whole grains, further reducing your intake of health-supporting, disease-preventing phytochemicals.  Most high-protein diets are based on 30-40% calories from carbohydrates whereas a healthy diet is based on 45-65% calories from nutrient-rich, fiber-rich carbohydrate foods. 

· High-animal-protein diets are low in fiber which can cause constipation and diverticulitis.

·  A high animal protein intake usually means a lower carbohydrate intake.  Since carbohydrates are the “high energy nutrient”, the first source of energy the body uses for fuel, high-protein (low carb) diets often result in fatigue, and sometimes headaches (due to low blood sugar and/or dehydration).

·   Dietary animal protein sources are usually expensive.

·   A high-carbohydrate diet including fruit, vegees, whole grains, and nonfat dairy products has been shown to decrease blood pressure.  Limiting these foods may increase blood pressure as potassium, calcium, and magnesium are decreased and sodium is increased. 

·   Strong evidence has accumulated indicating harmful “meat factors” promote cancer.  Restricting fruit, vegees, beans and whole grains reduces your intake of health-supporting, disease-preventing phytochemicals which further increases your risk of cancer.

·   High animal protein diets (but not plant) increase urinary calcium losses, contributing to osteoporosis and kidney stones.

·   High-protein foods such as meat, poultry, seafood, eggs, seeds and nuts are high in purines.  An excess of purines may cause gout in susceptible individuals.

·   People with liver or kidney disease are at increased risk on high-protein diets.  High-protein diets can increase your chances of developing kidney disease, especially in diabetics, because of the high level of protein which puts a strain on the kidneys.  A very high-protein diet, even for short lengths of time, can speed progression of diabetic renal disease.

·   High-protein diets can result in a dangerous metabolic condition called ketosis.  The body normally   burns carbohydrates first for energy.  High-protein diets that are low in carbohydrates force the body to burn fat for energy instead.  The by-product of fat breakdown are substances called ketones.  The very low-carbohydrate intake required in the first “phase” or weeks of many high-protein diets leads to a state of ketosis in which a large amount ketones accumulate in the body.  Ketosis occurs in uncontrolled diabetes (as when a diabetic does not have the necessary insulin), which can lead to coma and death, and in eating disorders (as a result of starvation).  High-protein diets put individuals in a similarly "sickened" state.

·   A high-protein diet can lead to or exacerbate dehydration.  Protein has nitrogen, which breaks down to ammonia, and must be diluted by the body.  Additional water is necessary to remove nitrogen from the body via urine. 

Is it any wonder high-protein diets cause health problems?  Yet even given all of these facts, and the physiological problems and recidivism rate of these popular diets, the high-protein diets continue to be popular because they “tickle the ears” of an American public wanting a quick fix to their problems without making real change.  Americans typically eat 2 1/2 times the amount of protein physiologically necessary.  The message of the high-protein diet authors to Americans—you can have your steak and eat it too.  Sorry, but some things really are too good to be true. 

The fact is despite the reported physical harm and weight-regain experienced by high-protein dieters, because of the insane popularization of the high-protein diets in the media (and I include food product advertising in that) many people now think that a high-protein (carbo-phobic) diet is the best way, even a healthy way, to lose weight.  The recommendation to lose weight to resolve the metabolic syndrome which 1 out of 3 Americans now suffer will likely result in masses of well-intentioned people going on high-protein diets, which will make their metabolic problems (and America’s already epidemic health crisis) worse.  Many Americans will unknowingly be led to slaughter even more willingly because many of the diet books give mention to the metabolic syndrome (often with interesting but not completely correct discussions about insulin and blood sugar) to support their dietary claims. 

The combination of the power of the media to promote high-protein diets and the “success” of quick visible weight-loss on high-protein diets has convinced many Americans that they are healthy.  A big part of the problem is the incessant value we put on weight-loss in America so that we have fallen for yet another false solution.  The bottom line is the public needs to be aware that there are two ways to lose weight—healthy and unhealthy—and wellness professionals need to be careful to not indiscriminately promote treatment for the metabolic syndrome with “weight-loss and exercise” without explaining that vital distinction clearly to patients. 

Let’s do this right,

Diane Preves, M.S., R.D.

N.E.W. LIFE I/ copyright 2013

Thank you for sharing this post with others who might benefit from the information shared herein.