The ABCs of Eating Right & Exercising

Depsite the advancements in medical therapy for diseases like hypertension (high blood pressure), high cholesterol, and diabetes, very few treatments are as effective, or as longlasting, as weight loss, exercise and proper nutrition - and of course, smoking cessation in those that smoke. However, I also realize that exercising every day and eating "right" can be challenging on many levels, not the least of which is understanding how to eat right and what type of exercise is best. These type of lifestyle changes also require us to change our habits, our schedules, and most frustratingly, the comfort-giving routines that we have been entrenched in for weeks, months and sometimes years.

The DASH diet. DASH actually stands for Dietary Approach to Stop Hypertension. The basics: eat lots of fruits, vegetables, whole grain, low-fat dairy foods, as well as poultry, fish, meat, nuts and beans. The amounts of added fats, red meat, and sugary drinks and foods are limited - as is salt.
So how good is this diet? the NIH studied patients on the DASH diet as if they were studying a new medicine and found that:

• Patients with pre-hypertension who followed the DASH eating plan experienced an average drop of 6 mm Hg in systolic blood pressure and 3 mm Hg in diastolic blood pressure.
• Patients with hypertension experienced reductions of 11 mm Hg in systolic blood pressure and 6 mm Hg in diastolic blood pressure.

Not too shabby for changing the food that you eat. Most pharmaceutical companies would brag about this type of data if they could reliably produce it.

Furthermore, a recent study published in Circulation: Cardiovascular Quality and Outcomes pointed out that the DASH diet decreases the 10-year risk of heart attack..

You need more reasons you say? How about the fact that U.S. News & World Report just ranked the DASH diet as Best Overall Diet. A panel of experts in diet, nutrition, obesity, heart disease, diabetes and food psychology reviewed 29 diets and ranked them according to safety, short-term and long-term weight loss, how easy they were to follow, nutritional completeness, diabetes prevention and management, and heart disease prevention.

The diets were ranked according to a star system, with five stars being the best score. Below are the diets which ranked best:

• DASH diet - 4.1 stars. Nutritionally complete, safe, can prevent and control diabetes, also promotes heart health.
  
• TLC diet - 4 stars. TLC stands for Therapeutic Lifestyle Changes. This diet was created by the National Institutes of Health (NIH) to reduce levels of cholesterol. The panel said it is a healthy, well rounded diet. However, the dieter is left very much on his/her own.
  
• Mayo Clinic diet - 3.9 stars. Experts say it is safe and nutritious, and moderately effective for those aiming to lose weight. How can you go wrong with the Mayo?
  
• Mediterranean diet - 3.9 stars. The diet is rich in vegetables, fruits, olive oil, and other healthy nutrients. It was criticized for being too different to what Americans are used to and may consequently be hard to keep up.
  
• Weight Watchers - 3.9 stars. This diet was praised for the emotional support dieters receive, as well as being an easy one to stick to.

Above you will find links to where you can find and download the DASH Diet (YOU DO NOT HAVE TO BUY THE BOOK BECAUSE ALL THE INFO IS PUBLISHED FREE HERE) and all the other Top 5 diets. The best of them are free but others come with a fee and for some, that is a motivating factor, i.e. 'I payed for it, I better do it' phenomenon.  Each of the above diets are good for you and often times the one that seems most appealing and realistic for you will be the best one. At the very least, if you are not a structured diet person, here's a few simple tips on how to lose weight:

1. Limit your portion size. A good rule of thumb is that each portion should be no bigger than your fist.
2. Limit your intake of rice, pasta, potatoes and bread. These complex carbohydrates are heavy in calories, low in protein, and all eventually are converted to sugars. Replace the starchy sides with vegetables, e.g. curry roasted or pureed cauliflower (tastes like mashed potatoes), quinoa, string beans, etc
3. Eliminate all sugary drinks from your diet - particularly sodas. Empty calories with no nutritional benefit.
4. Exercise 4-6 days per week. Even 30 mins of walking on the treadmill with a modest incline would be greatly beneficial to you in the longterm. '

Here's to a healthier, thinner, you in 2013!

Another Health App I Love

I have a feeling you're going to start to get sick of me posting about new health-related apps, but if you have an iPhone, iPod touch or iPad, this is just a wonderfully simple and effective device - and one that can be easily brought to the doc's office!

The iHealth Blood Pressure Dock is about as simple and straightforward as it gets. And at $99.95, it's not too pricey (only about $50 more than a typical digital cuff that you can buy at the pharmacy). There are 2 cuff sizes (standard and large) and they also have a scale available to record your daily weights.

Check it out here: http://www.ihealth99.com/

Home Blood Pressure Monitoring: Who, Why and How

More and more, our patients are becoming proactive about their health and increased access to affordable, reliable and portable home health tools like glucometers and blood pressure monitors only makes the doctors' job easier. Sort of. If done correctly, these tools can be an invaluable asset to your physician and your health. However, when they are done at inappropriate times or done incorrectly they can adversely affect the way you are treated and cause more harm than good.

Why is home monitoring important?

Going to your scheduled doctors' appointments and having your BP checked is indeed a necessary and important feature of your healthcare but it is only one snapshot of your blood pressure. Our circulatory systems are not a static object - they are constantly changing and accommodating external forces like what we eat and drink, our anxiety and stress levels, the ambient temperature, medications etc etc. A well-kept log of your readings taken regularly, at similar times every day, can provide us doctors with a much clearer picture of your blood pressure. It also eliminates those falsely high BP readings.

Who should home monitor?

• Patients starting meds for high blood pressure to determine its effectiveness
• Patients that need closer monitoring than occasional office visits provide, especially individuals with coronary heart disease, diabetes and/or kidney disease
• Pregnant women since preeclampsia or pregnancy-induced hypertension can develop rapidly
• People who have some high readings at the doctor's office, to rule out white-coat hypertension and confirm true HBP
• Elderly patients, because the white-coat effect increases progressively with age
• People suspected of having masked hypertension

Who should NOT home monitor?

People with atrial fibrillation or other arrhythmias may not be good candidates for home monitoring. Why? Oscillometric-method monitoring devices recommended for use at home may not be able to give accurate measurements for people with these conditions. If your doctor recommends home monitoring, have your monitor's readings compared to readings taken by your office using the manual approach.


What type of monitor should I get and where?

The American Heart Association recommends an automatic, cuff-style, bicep (upper-arm) monitor. Wrist and finger monitors are not recommended because they yield less reliable readings.

A quick look on Amazon.com yielded a variety of automatic cuffs ranging from about $30 - $60.

 Search Amazon.com for bp monitor automatic

Your local pharmacy would also be a good resource but you should not have to pay more than $60 for a reliable cuff. Make sure it is automatic and not aneroid. If you have extra large arms, make sure the cuff fits before you purchase it.


What is the best way to measure my BP?

• Measure around your upper arm and choose a monitor that comes with the correct size cuff.
• Be still.
• Don't smoke, drink caffeinated beverages or exercise within the 30 minutes before measuring your blood pressure.
• Sit correctly.
• Sit with your back straight and supported (on a dining chair, for example, rather than a sofa). Your feet should be flat on the floor; don't cross your legs. Your arm should be supported on a flat surface (such as a table) with the upper arm at heart level. Make sure the middle of the cuff is placed directly over your brachial artery. Check your monitor's instructions for an illustration or have your healthcare provider show you how.
• Measure at the same time daily.
• It's important to take the readings at the same time each day, such as morning and evening, or as your healthcare professional recommends.
• Accurately record all your results.
• Record all of your readings, including the date and time taken. Share your blood pressure records with your healthcare team. Some monitors have built-in memory to store your readings; if yours does, take it with you to your appointments. Some monitors may also allow you to upload your readings to a secure Web site after you register your profile.
• Take advantage of the American Heart Association's BP tracking tools. Heart360 allows you to track your blood pressure and the steps you're taking to manage it online. You can print your readings to take or fax to your doctor.
• Understand the readings. Optimal blood pressure is less than 120/80 mm Hg (systolic pressure is 120 AND diastolic pressure is less than 80). Read Understanding Blood Pressure Readings to learn more about what the numbers mean. Consult your healthcare professional if you get several high readings.
• A single high reading of blood pressure is not an immediate cause for alarm. However, if you get a high reading, take your blood pressure several more times and consult your healthcare professional to make sure you (or your monitor) don't have a problem. When blood pressure reaches a systolic (top number) of 180 or higher OR diastolic (bottom number) of 110 or higher, emergency medical treatment is required for hypertensive crisis.

OK! You got all that? If not, it is always here on our blog for your reference. Beyond all that is said above it is also critical to keep your doctors involved and aware.

Stay healthy!

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.