Which State is the Healthiest? Where Does Jersey Stand?

All this talk about Disney's lack of healthy food options made me curious about which states are actually the healthiest overall.

It turns out that there is extensive data cultivated by the United Health Foundation on how states fare in a variety of outcome measures including smoking, obesity, cardiovascular deaths, etc etc

Well, we love a good rank list so we picked the most interesting points to share with you and then you're on your own to peruse the entire report on their website at America's Health Ranking.

First, let's look at the 2010 national numbers and then we'll go local.

Besides bucolic scenery, bed and breakfasts, old liberal arts colleges, and Yankee-hating, the New England states also excel at many of the important health measures. All six New England states, with Vermont leading the way, were in the Top 10 in overall health outcomes, in part because of their low rates of smoking and obesity, as well as a large number of doctors per capita, and strong emphasis on public health.

The southern states, while also excelling at Yankee-hating (of a different sort) unfortunately did not fare so well as they comprised 8 of the bottom 10. And Mississippi has the dubious honor of finishing at rock bottom for the 9th consecutive year because of its disproportionately high rates of cardiovascular deaths, obesity, prevalence of smoking and lack of insurance coverage - add to that a relatively low density of physicians per capita, plus child poverty and it's a perfect storm for bad health. To be fair, most of the poorly performing states did show significant improvement from 2009.

So how does the Garden State compare in all these measures? In 2010, we were ranked 17th overall, up 1 place from 2009. North Dakota is a little better and Wisconsin is a little worse. According to America's Health Rankings, our strengths are lower rates of obesity and impoverished children as well as higher rates of high school graduation and  ready availability of primary care MDs.

When you look a little deeper though it's scary that our percentage of obesity (23.9%), almost one-quarter of the population, is comparatively low - Mississippi's rate is 35.3%. Other Jersey high notes include improvements in our air quality and decreasing rates of children in poverty and violent crime.

While we write about things with a sense of humor,  healthy eating and obesity is an enormous problem in this country (pun intended) - and it's not getting any smaller. Look at the graphic above depicting percentage of obese US citizens over the past 20 years. Scary. Along with obesity comes increasing rates of diabetes, heart disease, and a host of other health issues is that's not enough. Education and proper eating habits are the groundwork for a healthier generation of children.

Stay tuned for our next post about peripheral artery disease and if you have suggestions for other topics please feel free to post them in the comments section. Stay healthy!


America's Health Rankings® employs a unique methodology, developed and periodically reviewed by a panel of leading public health scholars, which balances the contributions of various factors, such as smoking, obesity, binge drinking, high school graduation rates, children in poverty, access to care and incidence of preventable disease, to a state's health. The report is based on data from the U.S. Departments of Health and Human Services, Commerce, Education and Labor; U.S. Environmental Protection Agency;the American Medical Association;the Dartmouth Atlas Project; the Trust for America's Health;the World Health Organization; and the Organisation for Economic Co-operation and Development (OECD).

Cholesterol-Lowering Foods: They Do Exist

So, we've talked about the No-brainer bad foods, and the High-cholesterol surprises,  but there are rumors out there that all foods are not created equal and that you can actually improve your LDL by eating more of certain food items. It's true! Some of them decrease your LDL (should be <100 mg/dL), some increase your HDL (should be >35 mg/dL), and some do both.

"These foods may not be magic, but they're close to it," says Ruth Frechman, RD, a spokeswoman for the American Dietetic Association.

1. Nuts - Let's not get crazy here, only some nuts and in their healthiest form are good for you. Summarily discount anything that is honey-roasted, salted, or candied. The raw versions, and to a lesser extent, the dry roasted are your best bets. Believe it or not, the esteemed cardiac journal Circulation published a study
demonstrating that people who had two handfuls of almonds, lowered their LDL by more than 9%!
Along with almonds and walnuts, the FDA gave its qualified health claim to peanuts, hazelnuts, pecans, some pine nuts, and pistachios. Another study, published in the Journal of Nutrition, examined a standard low fat/low cholesterol diet with a diet that replaced one-fifth of the calories with pecans. When compared to the standard diet, the pecan diet lowered bad LDL cholesterol by 10.4% and decreased triglycerides by 11.1%. It also raised the levels of good HDL cholesterol by 5.6%.

2. Oatmeal - Yes, those annoying breakfast commercials are partially true. Oatmeal actually decreases the bad cholesterol (LDL) without affecting HDL. It is also a recipient of the illustrious FDA's "health claim" status, granted in 1997. Most adults should get at least 25 grams of fiber a day.There are 3 grams of soluble fiber in 1.5 cups of oatmeal -- enough to lower your cholesterol, according to the American Dietetic Association. It may be a bit much for breakfast, so just add in oatmeal or bran to dishes at other times of the day.

3. Plant sterols - "Eating sterol and stanol-containing foods is an easy way to lower your LDL cholesterol, which helps reduce the risk of heart disease," says Ruth Frechman, RD, a spokeswoman for the American Dietetic Association (ADA). A more recent study from the University of California Davis Medical Center looked at the effects of sterol-fortified orange juice. Of 72 adults, half received regular orange juice and half the fortified OJ. After just two weeks, the people who drank the stanol-fortified juice had a 12.4% drop in their LDL levels. The results were published in the journal Arteriosclerosis, Thrombosis, and Vascular Biology. Ok, that's easy enough, but what are they? And where do I find them? Many of the butter, or better even, margarines that you smear on bread have sterols added - check the labels! Sterols and stanols are also found in some cooking oils, salad dressings, milk, yogurt, and juices.

4. Fish - Because of the high levels of the oft praised Omega-3 fatty acids, which have been shown to reduce the risk of heart disease and stroke while helping to reduce symptoms of hypertension, the American Heart Association recommends eating a variety of types of fatty fish (such as salmon, tuna, and mackerel) at least twice a week. You should be grilling or baking that fish though and not eating out of a can, covered in oil, or frying it!

5. Olive Oil - The cholesterol-lowering effects of this Mediterranean Diet staple is most effective when it is the extra virgin variety, meaning the oil is less processed, thereby leaving many of the beneficial nutrients. Careful though, the caloric content is high so only use the recommended amount.

High Cholsterol Surprises

Not all of the high cholesterol foods are as obvious as milk, ice cream and egg yolks. Staying heart healthy is all about being aware of the not-so-obvious things that put you at elevated risk for coronary artery disease. So here's a few more clandestine cholesterol-containing food items:

1. Lobster - If you listen to most of my patients, they will tell you that anything that tastes good, is probably not good for you. And sure enough, this most prized crustacean packs a walloping 61 mg of cholesterol in every 3 oz bite! Add the melted butter and you might as well schedule your stress test for the following week. If you're going to splurge, avoid the butter (or most any "dipping" sauce for that matter), steam that sucker and watch your portions! By the way, processed shrimp, crab cakes and anything fried also have super high levels of cholesterol as well.

2. Chicken - But you were told it's so healthy, right? Well, it all depends on how it's prepared. With the skin on, a drumstick has more cholesterol than a cup of ice cream or a burger. Also, the dark meat, which tends to contain more fat, is higher on cholesterol. When the chicken is breaded, egg-dipped, fried, sauteed in butter/oil it becomes no more healthy than any of the other offenders above. Bake or broil it, stick to the white, skinless meat and surround it with vegetables - not batter.

3. Liver - While most of the younger readers will cringe at the thought of eating liver there are still many out there who gladly smother it in onions, spread it on a cracker or choose it in a fine dining establishment where it gains the much prettier title of foie gras. But no matter what name it is give, this organ meat is like the motherload of cholesterol, amassing more than a single day's daily allowance in one 3 oz chunk. Yikes! If you need further discouragement, just picture it when it's raw and that should do the trick.

4. Mashed potatoes - Surprise! They're not really much healthier than fries. The majority of recipes for this classic American side dish involve whole milk, lots of butter, and sour cream - the perfect storm. Throw some liver on top and you might break some kind of record.

5. Movie theatre popcorn - There seems to be a popular myth that popcorn is a healthy snack. This is very untrue unless you're popping those kernels in a pan by yourself, without oil. WebMD reports that Regal Cinema's medium-sized popcorn has a whopping 60 grams of saturated fat and 1,200 calories. Not healthy! Definitely do not add any of the liquid coronary-clogging butter and go for the small - we want you to have some enjoyment!

Stay tuned for the next installment where we discuss foods that may actually improve your cholesterol profile.

Red and Blue Berries Good for your Blood Pressure?

A recently published study has suggested that fruits and vegetables that are rich in anthocyanins--such as blueberries, strawberries, and blood oranges--may help prevent the development of high blood pressure, new research suggests.

It seems like every week we hear about a new food that is good, or bad, for your health and even the same foods have sometimes been linked with both good and bad data. What is most important is to see HOW the scientists performed the study and what their actual conclusions were. In other words, you must take these news snippets with a grain of salt (pun totally intended).

The media is very fond of stories like this because they are widely applicable to the general public and everyone can relate to eating berries, etc. However, just because a newspaper or Yahoo! publishes a study, it does not mean that it was well done or even clinically relevant. Sometimes, it's just interesting.

In this most recent food-for-therapy study, the subjects, who did not have high blood pressure at baseline, were asked to complete health questionnaires every two years, and their dietary intake was assessed every four years through a food frequency questionnaire. But this does not account for so many factors that also may have contributed to their blood pressure or health changes, e.g. drinking, smoking, social factors, other illnesses etc. In scientific lingo, these are known as confounding variables, ie factors that may impact the results of a study that cannot be controlled. There are ways, in a questionnaire-based study to try and make up for these variables but inevitably the study becomes less accurate because of it.

The most accurate studies are those that analyze 2 groups of patients, one which uses the treatment and one that does not - and neither group, nor the scientists are aware who is getting what. This is known as a randomized, double-blinded, control trial.

This is not to say that the results culled from thousands of questionnaires and analyzed by very smart people should be completely discounted but what we do with the results and how we interpret them and integrate them into recommendations for patients is very important. Here's what the author of the trial, Dr. Aedin Cassidy, stated - which often gets buried under a bold, sexy headline:

"Our findings are exciting and suggest that an achievable dietary intake of anthocyanins may contribute to the prevention of hypertension."

OK. That's a fair statement. Weekly intake of these blueberries, strawberries and foods high in anthocyanins MAY prevent development of high blood pressure.

"In terms of guidance to patients, I think this can help us give a little bit more targeted advice. Rather than just telling them to eat more fruit and vegetables--which they are tired of hearing--we can try to refine messages about which dietary components are beneficial in terms of cardioprotective effects," she says.

She cautions, however, that these findings come from an observational study and so will require confirmation in interventional trials.

Dr. Cassidy concludes by nothing that the next stage of the research will be to conduct randomized controlled trials with different dietary sources of anthocyanins to define the optimal dose and sources for hypertension prevention, enabling the development of targeted public-health recommendations on how to reduce blood pressure.

So are the red and blue berries good for high blood pressure? The take home message is that they might be, but more refined studies would need to be performed to say this with any certainty.