IN THIS CHAPTER
Shopping, cooking, and eating your way to a healthy heart
Gaining information on lowering blood pressure
Developing other healthy habits for your heart
It’s undebatable: Heart disease is the leading cause of death in the United States. Age, genetics, and gender play into the risk, but the majority of the risk factors are modifiable. You can control the following risk factors: smoking, abnormal cholesterol levels, high blood pressure, obesity, physical inactivity, uncontrolled diabetes, and stress. Four of those risk factors (including uncontrolled diabetes) are influenced by food choices.
This chapter addresses how dietary intakes affect heart-health outcomes. The good news is you can make a difference, and there are lots of great foods to enjoy while staying healthy and managing your diabetes.
Eating Smart for Your Heart
We are what we eat, as the old cliché goes. We can build heathy bodies and avoid preventable diseases with healthy lifestyle behaviors and the right foods. It takes some conviction to dodge the ever-abundant fast foods, convenience foods, junk-food snacks, sugary beverages, and processed foods. But healthy foods are there too, and with the right information, we have the power to make the right choices.
Food labels assure nutrition information is provided on packaged foods. Chain restaurants must make nutrition details available to consumers. This section provides sound guidance on selecting foods that support heart health. The diet strategies that are good for your cardiovascular system come with an added benefit: Most modifications also help with weight control (which I discuss later in this chapter).
The American Diabetes Association suggests lifestyle modifications to improve heart health. It suggests weight loss (if indicated) and increased physical activity as well as the reduction of saturated fat, trans fat, and cholesterol intake (although an upper limit of cholesterol is not specified). An additional recommendation is to increase dietary omega-3 fatty acids, soluble fiber, and plant stanols and sterols. Stanols and sterols help block the absorption of cholesterol in the intestinal tract. Plant foods naturally contain trace amounts. Some margarines are fortified with stanols and sterols and marketed for lowering cholesterol.
Getting the facts on cholesterol and fats
When cholesterol is mentioned, it’s usually in relation to heart disease risk factors. Cholesterol is a waxy, fat-like substance made by the liver. Cholesterol serves a purpose in human health and has specific functions to fulfill in the body. That’s right — cholesterol is actually a good thing, but only if you don’t have too much of it. Unfortunately, some people have livers that pump out too much. Genetics plays a role in cholesterol production, but dietary choices have influence. Some foods can raise your cholesterol levels.
Every cell in the body has tiny amounts of cholesterol because cell membranes require it to function normally. Additionally, cholesterol serves as a building block to make other substances. For example, some hormones are made from cholesterol. Cholesterol is required for your skin to synthesize vitamin D and to make a digestive juice called bile. Bile is used to help process and absorb dietary fats. (Soluble fiber and its effects on bile are discussed later in this chapter.)
Because cholesterol is made by the liver, it follows that only animal products have cholesterol. Meats, eggs, and dairy products contain cholesterol. Some are relatively low in cholesterol, while others have concentrated amounts. Plant foods contain no cholesterol whatsoever. Fruits, vegetables, grains, nuts, legumes, and vegetable oils are all naturally cholesterol-free.
For many years, consumers were told to limit their consumption of egg yolks and organ meats due to the fact that they are high in cholesterol. Shrimp was in the same brandished boat. If you’ve been staying up to date on the cholesterol debate, you may be aware that eggs have been pardoned. That’s right, and eggs across the country are out celebrating the news.
Every five years the Dietary Guidelines for Americans are reviewed and revised based on scientific principles. The 572-page scientific report most recently presented by the Dietary Guidelines Advisory Committee said that “based on available evidence there is no appreciable relationship between the cholesterol obtained in foods and blood cholesterol levels.” Therefore “cholesterol is not a nutrient of concern for overconsumption.” However, bacon and sausage are not off the hook. Dietary fats are still a concern, especially the fats in meats and dairy products; see the later section “Choosing fats wisely ” for more information.
Scientific opinion has shifted in terms of dietary cholesterol. The focus remains on the detrimental effects of saturated, trans, and hydrogenated fats as detailed in the next section. The cause for concern is the manner in which these specific fats are processed in the body. For one thing, they stimulate cholesterol production in your liver. The fats themselves do not contain cholesterol, but the net effect is that your internal cholesterol production ramps up in response to eating them. These fats are typically solid at room temperature and are more likely to contribute to the build-up of plaque on the interior walls of blood vessels. Envision this — what do you want flowing through your blood vessels: bacon fat or olive oil?
Acquainting yourself with types of fats
There are three main macronutrients: carbohydrates, proteins, and fats. Gram for gram, fat has more than twice the number of calories than either protein or carbohydrate. Carbs have four calories per gram, proteins have four calories per gram, and fat has nine calories per gram. Liquid oils and solid fats have the same caloric density. When it comes to your body weight, all fats are the same.
Not so when it comes to heart health. Liquid oils are better for blood vessels. Unsaturated fats are healthier than saturated fats. To clarify terms, fats are referred to as saturated or unsaturated. The reference is to the chemical structure of the fat. Saturation relates to how hydrogen atoms are bound to the carbon atoms in the fat molecule. The degree of saturation determines whether a fat is solid, semi-solid, or liquid at room temperature. The more solid (saturated) a fat is, the more likely it is to clog arteries.
Fats are made out of carbon atoms linked together in a chain. Each carbon atom can bind to other atoms in four places. Hydrogen atoms can bind to the carbon atoms in fats:
· A saturated fat holds the maximum number of hydrogen atoms. Saturated fats tend to be solid at room temperature, such as butter and lard.
· A monounsaturated fat has one location in the chain where two carbon atoms have formed a double bond between themselves, which leaves less room for hydrogen atoms to attach.
· A polyunsaturated fat has two or more locations in the chain where double bonds have formed between carbon atoms, so even fewer hydrogen atoms can bind.
|
Type of Fat |
Carbon Chain |
Number of Double Bonds |
|
Saturated |
-C-C-C-C-C-C-C-C- |
0 |
|
Monounsaturated |
-C-C=C-C-C-C-C-C- |
1 |
|
Polyunsaturated |
-C-C=C-C-C-C=C-C- |
2 or more |
The term “hydrogenated” refers to the process of starting with a polyunsaturated fat (which is liquid at room temperature) and forcing the double bonds between the carbons to break apart so more hydrogen atoms can be added at those locations. Hydrogenation causes liquid oils to thicken or solidify. Margarine and vegetable shortening are examples of hydrogenated fats. The process of hydrogenation can cause trans fats to form. The term trans refers to where the hydrogen atoms bind to the carbon chain, specifically, on which side of the chain the bond forms. Don’t worry; you won’t be tested on the chemistry.
The take-home message is easy: Trans fats are the worst. Saturated fats are a close second. The goal is to limit those two types of fat, as you find out in the next section.
Choosing fats wisely
Dietary choices influence health. When it comes to your heart, it pays to choose heart-healthy fats, as shown in the right column of Table 16-1 . Minimize the fats in the left column and your heart will thank you.
TABLE 16-1 Picking Dietary Fats to Support Heart Health
|
Fats to Limit: Saturated, Hydrogenated, and Trans |
Heart-Healthy Fats to Choose: Monounsaturated, Polyunsaturated, and Omega-3 |
|
Dairy fats: Butter, cheese, cream cheese, cream, sour cream, whole milk, half-and-half |
Plant oils: Liquid at room temperature; olive, canola, safflower, sunflower, flax, grape seed, walnut, peanut, sesame, soybean, vegetable blends |
|
Meat fats: Fatty marbled meats, bacon, ribs, sausages, salami, hot dogs, bratwurst, chicken skin |
Nuts and nut butters: Almonds, cashews, hazelnuts, peanuts, pecans, pistachio, walnuts |
|
Tropical fats: Coconut and palm |
Seeds: Sesame, sunflower, pine, pumpkin, flax |
|
Hydrogenated oils, partially hydrogenated oils, trans fats |
Avocado |
|
Lard, manteca |
Fish oils (omega-3 fats) |
The following sections go into more detail on researching and understanding heart-healthy fats.
Do your heart a favor. Choose liquid oils rather than solid fats. Oils that are liquid at room temperature do not contribute to blocked arteries and do not raise your cholesterol.
Opting for heart-friendly fats, not cholesterol-raising culprits
Fats that are liquid at room temperature fall into the heart-healthy category. Liquid oils can’t block arteries and don’t raise blood-cholesterol levels. Plant-based oils, fish oils (omega-3 fats; see the nearby sidebar for more information), monounsaturated fats, and polyunsaturated fats are the heart-healthier options. Foods that are rich in the heart-healthy fats include nuts, seeds, and avocado.
Solid fats, animal fats, trans fats, hydrogenated fats, and saturated fats should be limited. Overconsumption can increase blood-cholesterol levels and increase your risk of heart disease. Meats and dairy products contain saturated fat, so choose lean and lower-fat or nonfat versions (see Chapter 13 and Appendix A for guidance).
SPOTLIGHTING OMEGA-3 FATS
For optimal health, our bodies require omega-3 fats. These specific fats are considered essential because they must be obtained through foods and can’t be manufactured within the body. Omega-3 fatty acids are especially heart healthy because they help reduce triglyceride levels, inflammation, blood clotting, and the risk of chronic illnesses including heart disease. Omega-3 fats also reduce the incidence of irregular heartbeats and help lower blood pressure somewhat.
DHA and EPA are the two notable omega-3 fats that are found in fatty fish, including salmon, mackerel, herring, halibut, and lake trout. ALA is a non-fish omega-3 option that is found in flaxseeds, walnuts, soybeans, soy oil, and canola oil. The health benefits are more pronounced when using the DHA and EPA versions found in fish. Occasionally, fish oil capsules are prescribed to treat medical issues. For more information on supplementation and appropriate dosing, talk to your healthcare provider.
Figuring fats: Reading Nutrition Facts food labels
Nutrition Facts food labels are used for carb counting as discussed in Chapter 7 . Labels also make it easier to choose heart-healthy packaged items. Regulations mandate that labels identify the total amount of fat per serving in both grams and percent daily value. Total fat intake impacts calorie intake, which in turn affects your weight, but only certain fats are detrimental to heart health. Labels must display the details on the unhealthy types of fats. The grams of saturated and trans fats are already included in the total fat, but detailed separately. Labels aren’t required to list the amounts of heart-healthy monounsaturated and polyunsaturated fats, although some do so voluntarily. Cholesterol and sodium amounts are also listed.
The American Heart Association recommends limiting intakes of saturated fat, trans fat, and sodium. When based on a 2,000-calorie diet, that equates to no more than 11–13 grams of saturated fat and up to 1,500 milligrams of sodium per day. See Figure 16-1 , which identifies these sections in the shaded areas. There is no %Daily Value listed for trans fat because the goal is to avoid it entirely.
© John Wiley & Sons, Inc.
FIGURE 16-1: Identifying Nutrition Facts that affect heart health.
There are several ways to interpret the information on the label. You can look at the grams (g) and milligrams (mg), or you can look at the percent daily value (%Daily Value or %DV). Just keep in mind that the percentages are based on a 2,000-calorie diet, which may not coincide with your calorie targets. A Percent Daily Value of 5 percent or less is considered low in that particular nutrient or substance, and 20 percent or more is considered high. Aim low for saturated fat, trans fat, and sodium. Aim high for fiber.
High-fat meats and dairy products are discouraged because animal fats can raise cholesterol and clog arteries. You can do a quick label check to see whether a packaged meat or dairy product is low-fat, medium-fat, or high-fat. Check the Nutrition Facts food label for the Total Fat grams. The following key holds true “per ounce” of meat or cheese, and “per serving” of other dairy products:
· Low fat: 0–3 grams of fat per ounce
· Medium fat: 4–7 grams of fat per ounce
· High fat: 8 or more grams of fat per ounce
If you are looking for lean meats and trying to limit high-fat meats, keep this slogan in mind. It relates to the grams of total fat per ounce of meat or cheese: “3 or less is best, 8 or more stays at the store.”
Adding soluble fiber to your healthy heart regimen
Fiber is found only in plant foods. That means fruits, vegetables, beans, nuts, and whole grains contain fiber; meat, eggs, cheese, and fats do not contain fiber. Dietary fiber is the nondigestible portion of the plant. For this reason, as Chapter 7 points out, the grams of dietary fiber can be subtracted from the total carbohydrate count when calculating insulin doses to cover the carbs in a meal.
There are two types of fiber: soluble and insoluble. Insoluble fiber is good for intestinal health and bowel regularity. Soluble fiber benefits your heart health by lowering your blood-cholesterol levels. It has been shown that including adequate amounts of soluble fiber, in conjunction with a diet low in saturated fat and cholesterol, may reduce your risk of heart disease. To understand how soluble fiber impacts cholesterol levels, a little background information is required first.
Foods are digested in the intestine. Digestive juices include enzymes and a substance called bile. Bile, also known as bile acids or bile salts, helps process and transport dietary fats. After the bile has completed its job, it is reabsorbed to be reused when the next meal moves through the digestive system. Bile is recycled and used over and over again. Soluble fiber absorbs water, swells, and forms a gooey gel that traps the bile and prevents it from being reabsorbed. Dietary cholesterol can also get stuck in the soluble fiber. Because fiber is not digested or absorbed, it carries the bile and some of the dietary cholesterol out with the stool. Consequently, the liver has to make new bile. The liver uses cholesterol to produce bile, which in turn lowers blood-cholesterol levels.
Oats are especially high in this beneficial type of fiber. The less-processed slow-cooking oats are higher in soluble fiber than instant processed oatmeal. Additional sources include oat bran, barley, the dried bean family (legumes), soybeans, potatoes, sweet potatoes, carrots, broccoli, apples, pears, citrus fruits, berries, bananas, almonds, and flaxseeds. Whole foods offer soluble fiber along with other nutrients. Some people boost intakes with soluble fiber supplements. Psyllium or psyllium husk is the ingredient to look for.
Creating a heart-healthy grocery list
The first step toward heart-healthy home cooking is to stock your kitchen with the right foods. Use the following tips for grocery shopping:
· Opt for liquid vegetable oils such as olive oil, canola oil, and soy oil.
· Buy nonhydrogenated peanut butter.
· Try nonfat or reduced-fat sour cream and cream cheese.
· For beef and pork, choose cuts labeled “loin” or “round,” such as sirloin, tenderloin, and top round.
· Choose “select” or “choice” cuts of meat rather than “prime.” Avoid marbled meats.
· Find margarines that are labeled “no trans fats.” They are usually in tubs.
· Choose Canadian bacon rather than strips of bacon.
· Try tofu, soy burgers, vegetarian hot dogs, and vegetarian sausages.
· Pick nonfat and low-fat milk and yogurts.
· Select skinless chicken breast or remove poultry skin before eating.
· Plan on having fish twice a week.
· Give 2 percent reduced-fat cheeses a chance.
· Choose unsweetened oatmeal.
· Opt for brown rice, quinoa, millet, wild rice, barley, bulgur, farro, and any other whole grain. Limit intake of refined grains and white rice.
· Buy breads that list “whole grain” as the first ingredient on the list.
· Skip the breakfast pastries and muffins. Instead, enjoy a slice of raisin toast or whole-grain toast and fruit spreads with no added sugars.
· Stock up on dried beans; if you’re buying canned beans, choose a low-sodium version.
· Select unsalted nuts and seeds. Eat in moderation due to high calories.
· Skip the sugary soft drinks; if desired, choose diet drinks (see Chapter 11 for more on beverages).
· Leave the fruit juices at the store and purchase fruits instead.
· Look for low-sodium and low-fat varieties of crackers and chips.
· Purchase cooking oil spray to use with a nonstick pan.
· Read ingredient lists and avoid foods made with hydrogenated oils.
· Stay away from palm oil, palm kernel oil, coconut oil, and cocoa butter.
· Load up on fruits and vegetables of all kinds. Choose fresh, frozen, or canned varieties without added sugars, sodium, or fats.
The Exchange Lists in Appendix A separate the meats and proteins into three categories according to fat content. Refer to the lean meats list when planning your protein purchases. Choose fats and oils from the heart-healthy monounsaturated and polyunsaturated sections, and limit the fats identified on the saturated fats list.
Cooking your foods the heart-healthy way
So what do you do when you get your healthy groceries home? Some cooking methods are better than others when it comes to your weight and heart. Lower-fat cooking methods include baking, broiling, roasting, braising, steaming, stewing, and boiling. You can also cook in a crockpot or microwave, or use a barbeque grill. Try a nonstick skillet sprayed with cooking oil. Sauté using controlled amounts of vegetable oil.
The one cooking method to limit or avoid is deep-frying. Deep-fried foods absorb a lot of the cooking oil, which bumps up the calories and can lead to weight gain. If you aren’t willing to give up a favorite food that’s fried, then cut back on quantity and frequency of consumption. If you normally have fried chicken once a week, limit it to once a month. If you usually have a large order of fries, switch to a small order. Also keep in mind the quality of the oil used for frying. Some restaurants use hydrogenated oils in their deep fryers, which is not a heart-healthy type of oil. You have more control over the type of oil used if you fry at home. At least you can fry your fish in a liquid vegetable oil that won’t clog arteries.
All fats and oils are equally high in calories. If weight control is a concern, reserve fried foods for special occasions.
Handling the (Blood) Pressure
High blood pressure, which is also called hypertension, is known as the silent killer because symptoms are not always obvious. Elevated blood pressure is tough on the blood vessels. Uncontrolled diabetes can also jeopardize the integrity of the blood vessels. When hypertension damages the large blood vessels in the body, the risk of heart disease and stroke goes up significantly. Hypertension can also accelerate the risk of diabetic complications affecting the small vessels in the eyes and kidneys.
About one-third of American adults have high blood pressure. The sobering warning is that 90 percent of adults are expected to eventually develop hypertension within their lifetimes. You can improve your blood pressure and reduce your risks by controlling your weight, managing stress, exercising, avoiding tobacco, and limiting alcohol intake. I cover many of these strategies later in this chapter, but here, I focus on the well-known dietary culprit: salt.
The link between dietary salt intake and high blood pressure is well known. Salt is made from two minerals: It’s 40 percent sodium and 60 percent chloride. Sodium has important roles in the body, such as regulating fluid balance and assisting in nerve and muscle function. Only minute amounts of sodium are needed, though. Small amounts of sodium occur naturally in many foods. The big problem is the amount of sodium being consumed in processed and packaged foods. The kidneys have to work at removing excess sodium from the bloodstream to dispose of it in the urine.
Excess salt intake raises blood-sodium levels, which in turn draws more fluid into the blood vessels. The extra fluid exerts more force on the blood vessels, causing them to stretch. Injured blood vessels are more likely to accumulate gunky plaque that could lead to blood-vessel blockages. When fluids accumulate due to excess dietary sodium, the heart muscle has to work harder. Excess fluid in the blood vessels isn’t something you can see or necessarily feel. Some people, but not all, have additional side effects caused by fluid retention, such as puffiness, swelling, or weight gain. If you make a deliberate effort, you can reduce the sodium (salt) intake in your diet. The next sections walk you through how to do that.
Taking a look at the DASH diet
The DASH diet, which stands for Dietary Approaches to Stop Hypertension, has been shown to improve blood pressure. The diet is rich in fruits, vegetables, low-fat dairy products, fish, poultry, lean meats, beans, nuts, seeds, whole grains, and heart-healthy fats. The diet plan was developed by the National Heart, Lung, and Blood Institute, which is part of the National Institutes of Health. More information may be found online at the following site: www.nhlbi.nih.gov/health/health-topics/topics/dash .
The DASH diet encourages eating foods rich in potassium, a mineral that is necessary for health. Adequate potassium intake is important because it counteracts the effects of sodium by relaxing blood-vessel walls. Most people do not reach the recommended intake targets for potassium. Foods rich in this mineral include potatoes, sweet potatoes, greens, spinach, kale, tomatoes, mushrooms, okra, winter squash, legumes, avocados, cantaloupe, oranges, apricots, bananas, milk, yogurt, fish, poultry, and beef.
Certain medical conditions, such as kidney disease, require potassium restriction. Damaged kidneys can cause potassium to accumulate in the bloodstream, which is dangerous. If you have kidney disease or take medications that cause your body to retain potassium, speak to a dietitian about planning a low-potassium diet. Some salt substitutes are made from potassium chloride rather than sodium chloride, and those products should be avoided by anyone restricting potassium.
Shaking the salt habit and opting for alternate seasonings
The Dietary Guidelines for Americans recommend limiting daily sodium intake to 2,300 milligrams (mg). The American Heart Association says the ideal limit is 1,500 mg per day. One single teaspoon of salt is 2,300 mg. Clearly, salting your food racks up the sodium.
Don’t be fooled. Sea salt and regular table salt have the same amount of sodium. Ditto for rock salt, kosher salt, pink salt, or any other variety. Salt is salt.
Take the salt shaker off the table. Don’t add salt during cooking. There are many ways to add flavor without compromising your health. Here are some ideas:
· Choose any herb or spice provided it isn’t a salt blend. If you aren’t sure where to start with individual seasonings, try a pre-mixed blend or a salt-free seasoning shaker.
· Incorporate fresh garlic or garlic powder, not garlic salt.
· Add onions, cilantro, ginger, lemon, limes, and peppers (white, black, and red).
· Flavored vinegars add zip.
· Wine used in cooking adds flavor, and the alcohol cooks off.
· Soy sauce is high in sodium, so use it sparingly. One teaspoon of soy sauce has nearly 300 milligrams of sodium. Low-sodium soy sauce has less. Brands vary, so compare the Nutrition Facts food labels.
There’s no need to add salt to the cooking water for pasta, rice, or grains. In restaurants, ask for your dishes to be prepared without salt.
Identifying hidden sodium suspects
It’s estimated that Americans eat well over 3,000 milligrams of sodium per day. About 12 percent is naturally occurring in foods. You may be surprised to hear that roughly 75 percent of the sodium consumed comes from eating processed foods, not from the salt shaker. Here are some common hiding places for sodium:
· Salt is a preservative. The reason beef jerky can sit in your cupboard for weeks without spoiling is because it is so high in sodium that bacteria don’t find it palatable and they move on. Processed meats are salted too. Bacon, sausage, hot dogs, bologna, salami, and many other processed lunch meats are loaded with sodium. Choose fresh lean meats, fish, and poultry instead.
· Soups are notoriously high in sodium. Read the food labels and check the sodium counts as discussed earlier in this chapter. Look for lower-sodium versions of soups and broths. By the way, bouillon cubes are salt cubes.
· Convenience foods such as frozen appetizers and entrees rack up the sodium quickly. Look for those that boast being heart healthy or reduced in sodium.
Keep in mind the daily total budget. If you are allotting yourself 1,500 mg of sodium per day, you can afford to spend 500 mg on one meal. If your daily target is 2,300 mg of sodium, adjust mealtime budgets accordingly. If you choose a processed entrée for one meal, make sure your other meals and snacks are low in sodium.
· Canned goods often come in a no-salt-added version. If you have a pantry full of canned vegetables and legumes that do have salt, at least drain and rinse the product before eating.
· Choose low-sodium versions of tomato juice and low-sodium V8. Add a dash of tabasco and lime to boost flavor.
· Snack foods can pack a double punch with excess fat and salt. Choose lower-fat and reduced-sodium crunchy munchies.
· Fast foods are notoriously high in sodium (and fat). Most chain restaurants post their nutrition information online. Compare menu options and choose wisely. Limit the frequency of fast-food forays.
· Any meal that allows you to peel back the lid, add hot water, and wait a few minutes before it is ready for consumption is likely high in sodium. Read labels so you know what you are in for.
· Rice pilaf, cups of noodles, instant ramen, and other side dishes with flavor packets are likely high in sodium. Look for versions that cut the salt. Another option for those items already in your cupboard is to use just half of the flavor packet instead of the whole packet of seasoning.
· Curb the condiments. Use smaller portions of the higher-sodium items.
Deciphering label claims related to sodium
Label claims on food packages are regulated. When you’re looking to limit sodium, you’ll encounter numerous claims. Here’s what they mean:
· Sodium free: Less than 5 mg of sodium
· Very low sodium: 35 mg or less of sodium
· Low sodium: 140 mg or less of sodium
· Reduced or less sodium: At least 25 percent less sodium than the regular product
· Light or lite sodium: At least 50 percent less sodium than the regular product
Embracing Heart-Healthy Habits
Eating right pays off. It’s also important to incorporate physical activity, manage stress, work toward weight control, and kick the habit if you’re a smoker. This section focuses on other important variables affecting heart health.
Small steps in the right direction add up. Prioritize what to focus on first. Making progress in one area often helps you find success in another. For example, exercise helps manage stress, and it also benefits weight-control efforts. Managing stress makes it easier to make the right food choices.
Managing stress
Chronic stress can take a toll on your physical and mental health. Finding healthy ways to manage your stress is important. Exercise is one way to release tension (as you find out later in this chapter). Exercise increases endorphin levels. Endorphins are natural chemicals that improve mood. Other mechanisms shown to reduce stress include meditation, yoga, recreational activities, creative expression through arts and crafts, and other techniques you can learn in stress-management classes.
Working with a mental-health specialist or a good counselor can be invaluable. If left unchecked, stress can sabotage your diabetes self-management efforts and increase your risk of heart disease.
Avoiding tobacco and secondhand smoke
Smoking is the most preventable cause of premature death in the United States. Besides causing cancer and raising blood pressure, smoking increases the risk of blood vessel disease, coronary heart disease, and stroke.
If you smoke, seek advice from your doctor on how to quit. Find a smoking cessation program. Nonsmokers should avoid secondhand smoke. Exposure to other people’s smoke can increase your risk of having a stroke by 20–30 percent.
Staying active
The American Heart Association (AHA) encourages at least 150 minutes of physical activity per week. The suggestion is to get 30 minutes per day, five days per week. Moderate activity is fine. If you exercise more vigorously, you can aim for 75 minutes per week — for example, 25-minute sessions three days per week.
There are many options for adding physical activity, such as joining a gym, taking an exercise class, getting exercise equipment for the home, swimming, cycling, using an exercise DVD to guide your workout, or simply walking more. Walking is an excellent way to improve fitness. It’s free and can be done outdoors when the weather permits or indoors if space permits. Halls, corridors, and malls offer sufficient space in a protected atmosphere.
Break up periods of sedentary time by getting up to stretch and move around every 30 minutes.
Chapter 14 provides more details on exercise.
Controlling weight
Obesity is contributing to the health crisis we face as a nation. Close to 80 million Americans are classified as obese, which is defined by a body mass index (BMI) of 30 or higher. (Use the chart in Chapter 5 to assess your BMI.)
Losing weight lowers your risk of heart attack and stroke. Weight loss does more than reduce cardiovascular risks; it’s also a foundation strategy for treating type 2 diabetes. Weight loss improves insulin sensitivity and blood-glucose control for people with prediabetes and type 2 diabetes. Studies show that combining weight loss with exercise is an effective intervention that decreases the chance of prediabetes progressing to type 2 diabetes. Losing weight if you’re overweight can also reduce blood pressure, improve sleep apnea, and lower triglyceride levels.
You don’t have to achieve a normal body weight to reap health benefits. Any amount of weight loss helps. A reasonable goal is to lose about 5–10 percent of your starting weight at a rate of one pound per week. To achieve weight loss, you need to eat fewer calories than you burn. Here are some guidelines to help you do just that:
· Reduce calories. The heart-healthy shopping tips earlier in this chapter also help cut calories and make weight loss easier to achieve.
· Control portions. At mealtimes keep your protein portion about the size of your own palm and your starch serving the size of your own clenched fist. Increase your intake of nonstarchy vegetables and salads. Cut excess calories from alcohol, junk foods, and desserts. Use smaller bowls and plates to cut portion sizes. Cook using lower-fat methods. See Chapter 8 for more details.
· Be active. Make exercise (discussed in the preceding section) a priority. Find something you enjoy doing or you probably won’t stick with it. Aim for 30 minutes of physical activity per day at a moderate rate of exertion. Do it all at once or split the sessions into 10- to 15-minute blocks of activity. Start with whatever works for you, and you will gradually gain stamina. In time, you will be able to increase the duration or intensity of your activity. See Chapter 14 for more on exercise.
· Change unhealthy behaviors. If you reach for food, cigarettes, or alcohol as methods for coping with stress, you’re headed down a slippery slope. Identify what triggers your stress and come up with a plan for handling the situation without sabotaging your health. Consider discussing issues with a counselor or therapist who can help you come up with behavior modification strategies that work for you.