Dietary Fat
The basic facts about fat:
· The American diet is high in fat.
· Fat is high in calories – higher than the same amount of protein or carbohydrate per gram.
· Most of us need to cut down on the total amount of fat we eat in our diet.
· Only 20 – 35% of the total calories consumed in a day should come from fat.
· A diet high in fat can contribute to high cholesterol, clogged arteries and being overweight (which may lead to type 2 diabetes and its associated health problems).
· Not all fats are created equal. Some types of fat are more damaging to our health than others.
Excess fat is stored in the liver. When more fat is consumed than can be stored, fats are left floating in the blood stream and are available to be laid down in arteries and around the organs. Fats laid down in arteries narrow the width of the artery opening. As arteries narrow, they are subject to blockage from blood clots and cholesterol. When an artery is completely blocked, the tissue that depends on it for blood supply dies from a lack of oxygen. This is what happens in the average heart attack.
The bottom line on fat: seek to limit fat intake from oils, spreads, sauces, desserts and greasy snack foods. Avoid anything containing trans-fat, partially hydrogenated oils or hydrogenated oils. Choose leaner cuts of meat, fish and lower fat dairy products. Processed foods that have a long shelf life often contain the “bad fats”, including many crackers, cookies and chips. Fat cannot and should not be totally eliminated from the diet, but try to choose the better kinds of fat when selecting foods to eat. For example, olive and canola oil are better choices than butter. The fat in an avocado is better for you than the fat from a piece of bacon.
The best way to manage fat in the diet is to learn which foods contain high levels of fat so that you can avoid or minimize them. One way to obtain this information is by reading food labels. In general, look for these kinds of words when reading a label:
Bad fats:
animal fats
palm oils
saturated fats
hydrogenated oils
trans-fats
partially hydrogenated oils
cholesterol
Better fats:
mono-saturated fats
poly-unsaturated fats
fish oils rich in omega-3
Cholesterol and Triglycerides
As we age, almost all of us will encounter the subject of cholesterol and triglycerides. Most of us have been tested at one time or another to measure the amount of these substances floating in our blood. These tests are one way doctors monitor our metabolic health and tendencies toward arterial disease.
Triglycerides are fatty materials that are measured in the blood along with cholesterol. Much like LDL cholesterol, triglycerides can increase the risk of heart attack, stroke and artery hardening. Triglycerides are usually very sensitive to dietary changes – heavy fat, starch or sugar can lead to high triglycerides in the blood. Diabetes that is not well controlled causes the liver to turn excess sugars into triglycerides. Triglycerides can also be genetically high, can increase if certain thyroid conditions are present, and may be elevated in women taking estrogens. If triglyceride levels are near 1000 or more on blood tests, it may indicate a relatively rare pancreatic inflammation that can cause painful pancreatitis. For people with existing artery narrowing due to cholesterol buildup or in people with diabetes over age 35, doctors recommend values under 150 for triglycerides on fasting blood tests. Individuals with no risk factors will want to keep triglyceride scores under 200. In some cases, just cutting back on sugar or starch portions, decreasing waist size slightly, and/or doing gentle daily exercises can help significantly lower triglycerides on blood tests. Using natural fish oils and/or niacin vitamins can also significantly lower triglyceride blood levels in some cases (niacin is best taken under a physician’s supervision).
Cholesterol is a substance produced by the liver and used in cell membrane construction. Although it is naturally produced by the body, it’s also present in foods we eat – most commonly in meat, poultry, fish and dairy products. Cholesterol is found primarily in foods of animal origin, not in foods that come from plants. Chemically speaking, cholesterol is a combination of lipid (fat) and steroid. The liver not only produces cholesterol, but also regulates how much cholesterol is stored or released into the blood from the foods we eat. The “total cholesterol” number measured on blood tests is broken into two kinds:
HDL = high density lipoprotein, considered “good” cholesterol (remember it by “H = happy”)
LDL = low density lipoprotein, considered “bad” cholesterol (remember it by “L = lousy”)
Target numbers for a healthy cholesterol level depend on other risk factors a person may have for disease. A healthy 35 year old without risk factors for coronary artery disease should aim for an LDL under 150 and HDL in the range of 65-75. If an individual has other risk factors for arterial disease, the LDL target number will be even lower. People with some cholesterol artery narrowing or diabetics who are above age 35 should have an LDL under 70.
Ideally, the goal is to keep good cholesterol levels high and bad cholesterol levels low. Research has shown that keeping LDL (bad) cholesterol low reduces the risk of heart attack, stroke and hardening of the arteries.
HDL cholesterol is considered “good” because it actually can work as a mini vacuum cleaner, removing plaque from artery walls and disposing of it through the liver. Those lucky individuals with high HDL cholesterol can most often attribute it to heredity. Unfortunately a person’s HDL number is often hard to manipulate into a positive range simply by a change of eating habits or activity. Increasing exercise and eating foods like oatmeal, soy, and fish high in omega-3 oils (or fish oil supplements) can have a mild positive effect on HDL levels for some people when combined with reducing animal fat in their diet. Quitting smoking and vitamin niacin have also been shown to increase HDL. Regardless of your HDL number, slow daily exercise can help the HDL do its job of trying to clean out arteries naturally. When bad cholesterol is high, the body lays some of it down in the arteries in the form of plaque. Over time, the outside layer of this plaque develops a fibrous cap that acts like a protective shield. After about 20 minutes of exercise, the artery wall relaxes and this hardened area is more able to be removed by the “vacuum cleaners” of HDL cholesterol. Exercise makes the best conditions for what HDL you have to get in there and clean!
The easier blood cholesterol number to change is LDL (bad cholesterol). High LDL blood cholesterol is associated with increased risk of coronary heart disease and is therefore to be avoided. Many individuals can bring their LDL and triglyceride numbers down by changing their diet and reducing their waist size. The factors that affect blood cholesterol levels include what we eat, body weight, exercise, gender, age, diabetes, and heredity. Some individuals have high LDL because of their diet and physical condition. This group can impact and change their LDL cholesterol level simply by eating better, losing weight and/or exercising. Other individuals have inherited a tendency toward high LDL cholesterol. This group may have only a limited ability to change LDL levels by diet and exercise. Medications are available to effectively reduce LDL cholesterol for most individuals.
Your doctor monitors cholesterol levels carefully because they are an easy indicator of how much plaque your body may be laying down in the arteries. Risk factors for hardening of the arteries (arterial sclerosis) include smoking, family history of cardio-vascular disease at 55 or younger, being sedentary, diabetes, high blood pressure, being overweight, and/or being a Type A personality (anxious, angry, driven, stressed).
In some cases, individuals may have high cholesterol without accumulating plaque in the arteries. If your cholesterol is high but you have no other risk factors for heart disease, it may be a good idea to investigate how much plaque is accumulating in your arteries by another means. Other ways to check for hardening of the arteries include having a neck ultrasound or a CT scan called a “calcium score” that is now becoming affordable and commonly available. For around $125 (most insurances aren’t paying for this yet) your doctor can order a quick CAT scan test that will see how much calcification has occurred in the arteries around your heart. This is becoming a way to screen patients for hardening of the arteries earlier on in their life, before a heart event has ever occurred.
In general, lowering bad cholesterol and triglycerides is managed through a healthy diet, controlling weight, exercising and working with your doctor if medication is needed.
Blood Sugar
If you have someone in your life who is diabetic, or if you are yourself, you are well familiar with the subject of blood sugar. Even those who are not diabetic experience its effects when they become sleepy after eating a big meal high in carbohydrates: “I need a siesta!” Blood sugar interests me because I have someone very dear to me whose life has been devastated by adult onset diabetes (Type 2 diabetes). Factoring in my family history and body type, I too am at significant risk for developing the disease. The subject of adult onset diabetes and how we manage our blood sugars through diet and exercise is fairly complex. From a nutritional standpoint, it’s an important idea to wrap our brains around because diabetes will impact so many of us. If you are a person in your 50’s who just had a normal fasting glucose test at your last check up, you still have a 1 in 8 chance of developing diabetes in the next decade.
When we eat food, it is broken down into smaller packets by the digestive system. The energy that your body needs to run properly is sent out into the blood stream in the form of sugar (glucose). Your blood sugar level (blood glucose) is the amount of sugar in your blood at any given time. The muscles, the brain and all the organs of the body depend on receiving the right amount of glucose to function. After you eat a meal, blood sugar levels rise. Your body responds by sending out insulin to move some of the sugars into the muscles and other organs (like sending out the police force to move the thugs off the street). There is a very narrow range of blood sugar level that the body aims to achieve when it is working properly – not too much and not too little. For example, normal levels might mean fasting blood sugars in the 70s to mid-80s, a mild spike up to around 120 mg/dl after eating a significant amount of carbohydrates, and then a return to under 100 mg/dl by two hours after the meal. By comparison, diabetics are advised to keep their blood sugars under 140mg/dl two hours after eating.
The beta-cells in the pancreas are responsible for producing insulin at the right time and in the right amounts. The problem that occurs in diabetes is that the body’s sugar regulation mechanism fails and the blood sugar levels remain too high for too long. When there are perpetually too many sugars circulating in the blood, they harm the body. They can damage the retina of the eye and scratch the inner lining of the arteries. The body patches these arterial scratches with LDL cholesterol. The cholesterol hardens like cement, ultimately narrowing the artery wall (called hardening of the arteries). This of course can lead to heart attacks and strokes. It’s a big part of why we visit the cardiologist.
Two different malfunctions can cause the body to fail at regulating your blood sugar: your body’s muscle and liver cells may have become resistant to insulin (the normal amount of policemen aren’t able to make the thugs get off the street), or the beta-cells in the pancreas are failing – perhaps dying – and there are not enough of them to do the job of producing adequate insulin (there aren’t enough policemen to get the thugs off the street). The first condition is insulin resistance. The pancreas must respond to this situation by producing even more insulin than normal to keep blood sugars down. People with insulin resistance often have no symptoms and do not have abnormal scores on the traditional fasting blood glucose test that is given to detect diabetes. The average screening done in an annual physical will not identify a problem. If you have concerns because of your family history, you will have to press your physician for other tests that may give soft indicators that this is a problem for you.
The second scenario is characterized by the pancreas not being able to produce enough insulin to keep blood sugars down. This is what occurs in juvenile diabetes (Type 1), but there are some indicators that adults may also have genetic predispositions that lead the beta-cells to die off or fail at their insulin production duties later in life.
Both of these malfunctions in the body's ability to regulate blood sugar can lead to impaired glucose intolerance (pre-diabetes). There is no test to determine which one of these processes may be happening inside of you, and as you continue down the road to diabetes, you may actually have BOTH occuring. If either malfunction progresses to a serious enough level, you will eventually register as "diabetic": in both scenarios more insulin is needed to clear the blood of excess sugars. If you don’t respond to medications that encourages the pancreas to release more insulin, you likely have lost a lot of your insulin producing beta-cells. Another process that leads to the death of beta-cells in some people is when the body's own immune system, for reasons not well understood, begins to attack and kill the beta-cells. Both genetic and environmenatal causes may be to blame.
Insulin resistance sometimes leads to the death of beta-cells. The pancreas has to work so hard to make so much extra insulin for so long, the beta-cells eventually wear down and can’t keep up. Also playing into this dynamic is the fact that high levels of glucose in the blood stream are toxic to the beta-cells in the pancreas (called “glucose toxicity”). Having chronically high glucose in the blood damages and kills the beta-cells, contributing to the development of impaired glucose tolerance.
Another term frequently used in talking about the diabetes pathway is “metabolic syndrome”. You are labeled as having metabolic syndrome if you have excess weight around your middle, are insulin resistant, have low levels of good cholesterol (HDL), high blood pressure, and/or have high triglycerides (which indicate excess sugars are being stored in the liver, making it fatty).
The road to diabetes looks something like this:
Insulin resistance (your body doesn’t drop glucose levels as quickly as it should after eating; you have intermittent high blood sugars, but this doesn’t show up on a fasting glucose test)
↓
Metabolic syndrome (not all individuals will be identified with this profile on their path to diabetes)
↓
Impaired fasting glucose (you score high on a fasting glucose test)
(pre-diabetes)
and
Impaired glucose tolerance (not enough insulin is being produced and/or being used)
(pre-diabetes)
↓
Early diabetes, non-insulin dependent
↓
Late diabetes, insulin dependent
The best place to work on prevention of diabetes is at the stages of insulin resistance and impaired glucose tolerance, when there are still healthy beta-cells available to do at least some of the job. Unfortunately, since many people are not even aware that they may be insulin resistant, they don't perceive that diabetes is an issue for them.
Factors that put you in a higher risk group for pre-diabetes and diabetes:
- being overweight
- carryies any excess weight around the middle (an "apple" body type)
- being over age 45
- being physically inactive
- giving birth to a baby over 9 lbs. or having gestational diabetes
- having polycystic ovarian syndrome (PCOS)
- having a history of cardiovascular disease
- having a family background of African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, or Pacific Islander
- having a parent or sibling with diabetes
- having high blood pressure
- having low HDL (good) cholesterol and/or high LDL (bad) cholesterol
- having high fasting triglycerides
- insulin resistance which can go undetected for years -- more severe cases may have presence of dark patches on the skin called acanthosis nigricans
We cannot control the genetics we inherit, but we CAN control our diet and level of exercise. There ARE steps you can take to lessen the odds that you will head further down the road to diabetes.
Steps you can take to avoid diabetes:
· Eat a diet that is not always challenging the system to produce high levels of insulin to clear sugars out of the blood. Sorry, that does mean that sugary snacks and desserts should not be a commonplace event in your diet, but "special." Reduce carbohydrates to levels where blood sugars aren’t constantly spiking. Strive for a high protein/low-fat diet, with non-starchy vegetables and complex carbohydrates (as found in whole grains), rather than foods high in the simple carbohydrates found in refined sugar, starchy vegetables and white rice.
· Try eating 5-6 times a day (3 smaller meals and 2-3 snacks) instead of depending on two large meals – much like what is recommended for diabetics.
· Exercise, of course, causes the body to burn sugars and maintains the health of all body systems. Research indicates exercise can help make the insulin more effective. It kick starts the metabolism to help in weight management.
· Maintain a healthy weight and body mass index. Individuals who carry their excess weight around their middle are particularly vulnerable to developing diabetes.
There is some current debate whether being overweight causes diabetes OR whether the impaired ability of the body to regulate insulin and blood sugar causes people to be overweight. It’s probably a little of both. Even individuals with no weight problem can develop adult onset diabetes. The best approach is to not be defeated by guilt that you may have brought this condition upon yourself. Kick into gear with a commitment to do all you can to improve your health. Many people headed down the pathway to diabetes are able to reverse course when they eat better, exercise, and get down to a healthy weight.
I know some of you reading this have already walked this road and now are living with diabetes. I encourage you: continue to be diligent with your diet and exercise regimen to keep those blood sugars well managed. All the organs of your body receive the benefits of "keeping the thugs off the street". You can meet the challenges that diabetes has brought to your life by fighting back with all the weapons in your arsenal: good diet, consistent exercise, and close monitoring by your health professional. Let diabetes be the adversity that motivates and pushes you into a more healthy lifestyle. You can do it!
For more information go to: http://diabetes.niddk.nih.gov/index.aspx
Sodium
Even if your cardiologist has not yet put you on a low sodium diet, you mostly likely are guilty of consuming far too much salt (sodium) in your diet. The FDA recommends that you consume only 2300mg of sodium daily. The average person who is not actively trying to cut down on salt can easily consume 5000-7000mg daily. One teaspoon of salt contains about 2300mg. Most of us can get away with excess salt consumption early in life, but even if you have no symptoms of water retention or congestive heart failure, you are putting an extra load on your heart and kidneys by eating large amounts of salt in your diet. Salt causes the body to retain water and raises blood pressure. The heart must work harder to push this extra fluid around the body. The kidneys also must ramp up their work by secreting hormones that manage and rid the body of the excess sodium. As we age, the organs are less able to continue this pace and eventually lose their race to keep up with the work load salt creates. Fluid backs up in the lungs and collects in the legs and feet. Problems controlling blood pressure develop. High blood pressure can lead to heart disease, stroke, and kidney disease. For those individuals with congestive heart failure, overdoing it with salt even for a short time can send you to the ER.
If you are overweight, sedentary, over 50 or have a family predisposition to high blood pressure, you may be particularly vulnerable to the havoc created by a high sodium diet. The good news is that with exercise, weight loss and a managed low-sodium menu, patients can often improve their condition enough to get off of prescribed blood pressure medications. Patients who continue to eat lots of salty foods are actually defeating and counter-acting what their blood pressure medicines are trying to accomplish.
The average person is unaware of the many foods which contain significant salt. These include:
Milk
Cheese, cottage cheese
Cereal
Bread
Soda pop
Frozen foods
Canned vegetables
Processed meats like bacon, sausage, pepperoni and bologna
Pizza
Creamy salad dressings
Ketchup
Soy sauce
Barbecue sauce
Crackers
Chips, pretzels, popcorn
French Fries
Canned soups
Gravy
Noodles cooked in salted water
Sea salt and Lite Salt contain a little less sodium, but are still big offenders
If you have just found new resolve to cut your sodium intake or have recently been put on a low-sodium diet by your doctor, it’s a good idea to begin with a self-assessment. Take a day when you have nothing to do except be compulsive about reading every label of every food item you eat during the day. Keep a running tally of milligrams (mg) of sodium consumed for one day. Be careful to see if the amount you ate of any given food was “one serving” according to the label. If it was twice the serving size, then double the amount of milligrams of sodium that are added to the tally. Once you see how much sodium you’ve consumed during an average day, you’ll have a lot better idea of how much adjustment needs to be made in your diet. Work with your doctor if you are already on medications (they need to monitor your dose if you suddenly start eating differently). Then start making changes in some of the bigger offending items containing the most amount of salt. Find creative recipes that are low in sodium. Shop more carefully and buy “no salt added” or “reduced sodium” food items. A good website for low-sodium recipes is www.lowsodiumcooking.com (the link is on the home page of my blog). You will be surprised how much salt you can cut out of your diet without undue suffering. Good luck!
Caffeine and Acid Reflux
Although caffeine is not particularly harmful in and of itself, individuals vary greatly in their sensitivities to it. How much caffeine you can consume without suffering for it will be unique to you. Most health professionals recommend no more than 15 oz. of caffeinated coffee a day or 30 oz. of tea. Caffeine stimulates the heart muscle and can cause the heart to race or beat irregularly in people sensitive to it. Caffeine also works as a diuretic, stimulating the kidneys to remove more water from the body. Drinking large amounts of coffee can lead to mild dehydration. However, caffeine doesn’t seem to cause the kidneys to secrete their hormones in excess like sodium, so is not considered harmful in that regard. Since it is a stimulant, caffeine leads to wakefulness and difficulty sleeping if consumed too close to bedtime. The effects of caffeine can last 7-10 hours, so caffeinated drinks should be avoided later in the day. Disrupted sleep is a major health issue in America, and caffeine is a player in the problem. The jitters that come along with drinking too much caffeine can also cause an uncomfortable sense of anxiousness in some people.
Acid reflux caused or exacerbated by caffeine can lead to a more serious condition called “esophagitis”. Caffeine relaxes the closure that keeps acidic stomach contents from coming back up into the esophagus (the tube leading down to the stomach). When this opening to the stomach does not do its job in closing tightly, the acid washing back into the esophagus burns its lining. People can be unaware or only mildly aware that they have this condition, and therefore often ignore it. If acid reflux continues long enough, the esophagus will become so irritated and inflamed that it will go into spasm. The pain caused by the esophagitis can exactly mimic the pain of a heart attack and land you in the ER. The esophageal nerves run throughout the chest, so pain from esophageal spasm can radiate into the left shoulder, arm and back just like a heart attack. Esophageal spasms are the number one non-cardiac reason for chest pain. This alone is good reason to limit consumption of caffeine to 2-3 cups per day.
Food labels are not required to list amounts of caffeine present in foods. Coffee, tea, chocolate, sodas and energy drinks are the most common caffeine sources. Note that “decaf” really means “less caf “, not “no caf”. Decaf drinks contain much less caffeine than regular, but cannot be consumed in limitless amounts as a “freebie” if you have been told to eliminate caffeine consumption for health reasons.
To give you an idea of caffeine content:
1 oz. dark chocolate 18 mg
8 oz. tea 47 mg
8 oz. decaf tea 2 mg
8 oz. coffee 95 mg
8 oz. decaf coffee 2 mg
8 oz. Red Bull Energy Drink 80 mg
12 oz. cola 30-50 mg
If you are trying to cut back on caffeine, do so gradually so as to avoid a massive headache and sluggishness. Decrease your intake by 1 cup of coffee (or 1 can of cola) every 2-3 days until you get it down to the recommended levels.
