A review of the numbers

Cholesterol is a waxy substance made in the liver that is found almost everywhere in the body.  It makes up cell membranes, bile to break down fat, hormones and as transporters.  Some cholesterol is needed for good health but too much can mean disaster.  Of primary importance for the heart patient is LDL cholesterol.  This is what is known as bad cholesterol and is by far the most important number to change for heart health. LDL carries the majority of the cholesterol in the blood.  LDL is designed to take cholesterol to cells that have run out.  In the ideal situation this cholesterol is used to repair membranes or make hormones, but if it is not needed LDL builds up in the bloodstream causing plaque buildup.  For every 1% reduction in LDL cholesterol you reduce your risk for developing heart disease by 2%.  For most individuals LDL cholesterol values should e less than 100 mg/dL but for those at the highest risk of heart disease the recommendation is less than 70 mg/dL. To learn more about your risk score visit:  http://www.heart.org/HEARTORG/Conditions/HeartAttack/HeartAttackToolsResources/Heart-Attack-Risk-Assessment_UCM_303944_Article.jsp

Statin drugs such as Lipitor or Crestor, block the creation of cholesterol in the liver itself. However,  statins alone while continuing an unhealthy lifestyle may not be enough to protect you. In fact research has shown that diet itself may be able to induce similar actions to statin drugs without side effects.   While this doesn’t mean you should stop taking your statin it does mean you should consider making some diet changes. Try the following diet strategies to decrease your LDL cholesterol:

Increase your intake of beans, oatmeal, apples, barley and prunes to increase your soluble fiber intake.  These foods can help reduce the absorption of cholesterol into your bloodstream as well as help flush them out of your body.  Shoot for 5-10g or more soluble fiber per day.  1.5 cups of cooked oatmeal provides about 6 g fiber.  For best results try steel cut oats or oat bran.

Try a handful (1.5 oz) of almonds, hazel nuts, peanuts, pecans, pine nuts, pistachios and walnuts every day.  Be sure the nuts aren’t salted or sweetened and watch the portion size as these guys carry a lot of calories.

Decrease animal products (including butter) and replace with olive oil.  Shoot for 2 tbsp per day.  Instead of spreading butter on your bread, dip into olive oil and vinegar, use olive oil for salad dressings or to prepare fish and vegetables. 

Look for foods fortified with sterols and stanols which will block the absorption of cholesterol.  These can reduce bad cholesterol by 5-15%.  Some foods such as wheat bran, wheat germ, peanuts, olive oil, beans, corn, Brussel Sprouts and almonds naturally have plant sterols and stanols.  Because it is hard to get enough from foods alone, some food companies have started fortifying foods such as orange juice and margarine with them as well.  Some brands to look for include Benecol, Take Control, and Minute Maid. 

Eliminate trans fats from your diet.  These sneaky fats raise your bad cholesterol and lower your good cholesterol.  Because food companies don’t need to list them on food labels if they contain less than half a gram you will need to check the ingredients list under the food label for “partially hydrogenated oils” to completely eliminate these from your diet.

Hand trick

Over the last few weeks I've been using a calorie tracking app to see how much I've been eating. The results have been enlightening to say the least. As we age our metabolism slows and what you've always eaten can suddenly be too much. I noticed the first dip around 25 and here at 32 I'm noticing it again. Calorie tracker apps are a great way to check in with what your current intake is and can make you think twice about that second handful of nuts (or two scoop sundae at Baskin Robbins). But while having a conversation with a friend I found out that tracking portions can be difficult if you're not used to measuring portions. As a general rule of hand:

3 oz of meat or chicken is about the size of the palm of your hand ( and yes that's what you should be eating per serving)

A cup is the size of your fist

An oz is about the size of the meaty part under your thumb

A tablespoon in the size of your thumb

And 1-2 oz of nuts or dried fruit should fit into your cupped hand.

We're all somebody

Nepal

I never expected to go to Nepal. It wasn't on a life list. In fact 8 months ago I probably couldn't have found it on a map and then, 5 months ago I found myself on a plane there to do humanitarian work. There are not enough words to tell you about the experience, but it filled my heart and it changed my life. When I was preparing to go the two predominate things I was told were: you're going to get sick/worms/parasites/die there and the people are the most amazing, generous and kind souls you'll meet. Only one of those things happened. Anyone that has been to Nepal will tell you that the place is magic. But the people there are what makes it truly special. And now those kind souls have been through a terrible tragedy and I feel so heart broken and far away. Most of all I want to know what I can do. More than anything I want to get over there and do something but I know the best thing I can do is donate. Please consider giving what you can https://campaigns.choicehumanitarian.org/events/nepal-earthquake-support/e49165

I went to Nepal with CHOICE, they're an amazing organization doing what they can and have people on the ground. In the meantime, Nepal you're in my heart.

Namaste

Cardiac Rehab Corner #2: Spring into Good Health

Every New Year about 45% of Americans make New Years’ resolutions, but only 8% of people actually keep them.  Now is a good time to check in with those resolutions.  Did you make any? Have you kept them?  What is standing in your way?

Take this as a moment to evaluate your progress.  Big changes take patience and little steps add up. March is National Nutrition Month so it is a perfect time to focus on your health-related goals.  Some goals to consider:

Move more- build up to 30-60minutes per day as long as your doctor is okay with you exercising.  Carve out some time every day.  Change your mind set.  It’s not wasted time, it’s time to take care of you and build up a healthy heart and body.  This doesn’t have to be a big chunk of time either.  Think about parking a little further, taking the stairs instead of the elevator, if you live near town walk to the store or the post office. Build exercise into your daily routine.

Eat more slowly-  pay attention to your body cues so you know if you’re really hungry and when you’re really full. Take the time to put your food on a plate and really experience the flavors and textures of what you’re eating.  Remember that it takes 20 minutes or so for your body to realize that you are full, so try to eat until you’re satisfied but not stuffed.

Try smaller portions-  start with less if you’re really hungry, you can always go back for more.  Keep in mind that half of your plate should be fruits or vegetables (you’re trying for 5-9 servings per day). A meat portion is about the size of the palm of your hand and a quarter of your plate should be fiber rich whole grains or other carbohydrates.  Drink more water.  Decrease your intake of high sugar/low nutrition beverages by cutting your portion in half, diluting your juice or eliminating them all together. 

Food is magic

Shortly after I went to work for WIC I gave up jam and juice. I prided myself on it.  “It’s wasted calories and sugar”  I’d boast.  “I only drink juice when I’m sick”.  And yet on days I hated my job, I’d stop and buy a piece of cake for two and eat the whole thing by myself, on the couch and call it dinner.  So in an attempt to reacquaint with food is magic I had a friend teach me to make jam.  We cut up apples and blood oranges and Meyer lemons and then threw them in a pot with sugar to brew.  We went for a walk, we caught up, we added some rosemary to the pot,  we talked about how hard it is to get together and talk and catch up and that once upon a time women gathered to do just this.  5 hours later we boiled some glass jars, funneled the marmalade in and reboiled the jars to get them to seal.  We tasted our creation and it was amazing.  It tasted like Christmas and friendship and work.  I think we often lose out when we forget the effort that goes into food. 

Reluctantly yours

Several years ago when I started blogging, I wasn’t quite sure why I was the reluctant dietitian but I was.  I felt it.  I love food.  I love helping people.  Health is important to me, so this path just felt like it fit when I was in school.  And, to be honest, I got an A in my first nutrition class.  But the more I learned the more I riled against it.  Nutrition takes the magic out of food.  Out of bodies.  You mean certain nutrients get absorbed in certain places? We’re going to spend the whole day baking cookies just so we can learn the effects of cook time, temperature, sugar, eggs, certain types of flour on the outcome? So I came out of school and took the first job I was offered.  Selling lettuce, nothing remotely related to nutrition.  And then I started talking to people about nutrition because that’s what happens when you have a nutrition degree.  So I came back to it.  Slowly, reluctantly.  It took me almost 5 years post bachelor’s degree to get into an internship then sit the exam to become a Registered Dietitian. Being a dietitian is hard.  Everyone knows something about food.  Your years of specialized training are often thrown aside for the quick and easy blurb by a certain tv doctor or anyone that has ever read a nutrition book or eaten.  And I am the first to say I don’t know it all.  I work as an acute care dietitian and in cardiac rehab this is what I know.  I don’t do sports nutrition (there’s a book on my nightstand I mean to read every time I run a half marathon). Or anything involving guts, gluten free or allergies. I'm moderately helpful when it comes to Diabetes. But as I stood in Target last night searching for a tortilla that didn’t have hydrogenated oils, it occurred to me that very few people in my age range are doing the same.  Being a dietitian makes grocery shopping take forever, on some subconscious level you’re almost always surveying what you’re eating, what others are eating, or what the food choices are.  I recently came across a book called Intuitive Eating By Evelyn Tribole MS, RD and Elyse Resch MS, RD and it resonated with me.  We are often called the food police as dietitians but I have to disagree. We are food lovers, food supports, promoters of GOOD food.  And not just food that is good for you but food that nourishes you.  That will make you feel better and be better.  If you are unfamiliar with the idea of intuitive eating it is the idea of reconnecting with what I’d like to call your inner toddler or your inner teenager. Do away with the voices that tell you you’re good or bad for eating one way or another.  These are moral judgments, you are not bad if you like to eat bacon, particularly maple bacon on Sunday at brunch with your girlfriends.  Eat what you want in the anounts you want. Think of food as part of your life experience.  Nourish your body and really listen to it.  How does it feel after you eat fast food or a bowl of fruit?  What are your energy levels like when you eat certain foods?  How does your skin feel? Your hair grow? Do you feel hungry?  Really hungry like the only things that will fix this is food hungry or are you bored, depressed, angry, or feeling social?  And on the other side of that how do you know that you are done eating?  What are your cues that you are full?  Take some time to get back in touch with you.  All too often I feel like our culture treats food as a burden. What I was initially afraid of becoming a dietitian was that I’d enjoy food less.  Growing up in an apple orchard filled with blackberry bushes and pear trees and friends in trees, I celebrated the seasons by coveting the newly budding apples, crawling all over the blackberry bushes for squishy finger staining berries. I knew where my food came from. It came from the top of that tree there the one we called the carousel or the tree by the road. Apple season was my favorite we'd wait all year for it to come. Store apples pale in comparison. So I work hard to eat locally and in season so good tastes like food. For a long time knowing what to eat and how felt like a burden, there was too much pressure to eat right all the time, to be the leading shining example, but food is just food and all I really want to do is help people feel better. So this year I’m trying to reconnect myself and my patients (and you) with the magic of food.