Now Your Lifestyle

_ Do you get at least 30 minutes of moderate to vigorous physical activity most, if not all days, of the week?

_Are some of your physical activities weight-bearing (e.g., walking, dancing, tennis, basketball)?

_ If you drink alcoholic beverages, do you do so in moderation (no more than one drink daily for women, or two for men)?

Now count up all your "yes" answers:

For each checkmark, give yourself five points. What's your total score? _

Of course, these twenty eating and active living factors aren't the only ways to promote your good health. But the more often you said "yes," the better your chances are for a long, healthy life.

What does your score suggest? It only indicates how many different ways you already may be protecting yourself from health problems. And it suggests where you might improve.

Having a score of 50 compared with a perfect 100 doesn't mean you're twice as likely to develop heart disease, cancer, diabetes, or some other health problem. And this quick checkup is not meant for diagnosis, either. That's the role of your doctor in your regular physical checkups. However, your responses might point to risk factors that may contribute to health problems later. Read on to explore the role of nutrition in common health conditions.

  • Taking birth control pills (if you smoke or have other risk factors).
  • Stress, as it often leads to overeating, smoking, and other factors that aren't heart healthy. Having a high risk doesn't mean you're sure to have a heart attack or a stroke. That's good news! However, the more risks for heart disease you have, the greater your statistical chances. Using data from the long-term Framingham Heart Study, an interactive tool has been created to measure your ten-year statistical risk for a heart attack. Check out the Web site htp://hp2010nhlbihin/atpiii/ calculator.asp for your risk score. Changes in your food choices and lifestyle, and perhaps weight reduction and medication, can lower your risk score.

Insulin Resistance Syndrome, or Metabolic Syndrome

Insulin resistance syndrome, often called "syndrome X" or metabolic syndrome, is a trio of health conditions: abnormal lipid levels, high blood pressure, and obesity. When all these problems exist together, the risks for heart disease, a heart attack, and a stroke are many times higher. Several factors are among those that play a key role in the development of insulin resistance syndrome: inactivity, overeating, and insulin resistance itself.

With insulin resistance, body cells don't respond normally to insulin. The pancreas produces more insulin to overcome this insensitivity; however, insulin instead builds up in blood, contributing to high blood pressure, glucose intolerance, and abnormal levels of cholesterol and triglycerides. Upper body obesity (abdominal) adds to the problem.

The treatment? Address all conditions at the same time; the recommendations for dealing with them are consistent. This includes increased physical activity, achieving a healthy weight, and a diet that's low in saturated fat (less than 10 percent of total calories), more moderate in total fat content (20 to 35 percent of total calories), and moderate in carbohydrates. To the contrary, a high-carbohydrate, low-fat diet may aggravate the effects of this syndrome. Along with diet therapy, medications also may be prescribed to help control blood sugar, hypertension, and high blood lipids (cholesterol and triglycerides). Stop smoking if you smoke. See "Diabetes: A Growing Health Concern" in this chapter.

See "Heart Disease: A Woman's Issue, Too!" in chapter 17.

Heart Disease: The Blood Lipid Connection

High total and LDL cholesterol levels are major risk factors for heart disease. Conversely, lowering these cholesterol numbers and raising HDL cholesterol levels reduce the risk. What's the link?

Cholesterol, a fatlike substance produced in your liver, is found in everyone's bloodstream. As part of every body cell, it's essential to human health and cell-building. There's no Recommended Dietary Allowance for consuming enough cholesterol because your body makes it, too. The Dietary Guidelines advise eating less than 300 milligrams of cholesterol a day for adults if their LDL cholesterol is less than 130 mg/dL. As part of a therapeutic diet for adults with elevated LDL blood cholesterol (> 130 mg/dL), less than 200 mg cholesterol per day—and less than 7 percent calories from saturated fat—are advised.

Blood cholesterol is a problem only if your total or LDL blood cholesterol gets too high and your HDL too low. When total and LDL blood cholesterol levels are elevated, deposits of cholesterol, called plaque, collect on arterial and other blood vessel walls. This condition is called atherosclerosis, or hardening of the arteries. As fatty plaques build up, arteries gradually become more narrow and may slow or block the flow of oxygen-rich blood. Chest pain may result without enough oxygen to the heart.

Plaque buildup happens silently, usually without symptoms. Warnings in the form of chest pains may not occur until vessels are about 75 percent blocked. Often a heart attack or a stroke strikes with no

Arteries

Early Injury Atherosclerosis

Plaque

KFat Deposits (Cholesterol)

warning at all. A clot in a narrowed artery blocks blood flow to the heart, causing a heart attack. With a stroke, blood can't flow to the brain. The higher the blood cholesterol level, the greater the risk. When abnormally high total and LDL blood cholesterol levels go down, so does the risk for heart attack and stroke.

For good health, aim to fit your blood cholesterol level within a desirable range. Check "Strive for Desirable Blood Lipid Levels " in this chapter. High total blood cholesterol isn't the only risk factor for heart disease. Even a total of200 or less won't automatically keep you safe.

Why Do Blood Cholesterol Levels Rise and Fall?

Usually there's no single reason. For some people, high or low blood cholesterol is an inherited tendency; in part, genetics affects how much cholesterol your body makes. Families with heart disease share more than their genetic makeup. People also grow up with similar lifestyle habits that may raise cholesterol levels—perhaps high-fat eating, excessive calories, inactivity, excessive alcohol intake, or smoking (or exposure to tobacco products).

From a nutrition standpoint, a diet high in fat, especially saturated fats and trans fats, is a risk factor for high blood cholesterol levels—in fact, compared to other dietary components, "sat fats" and trans fats have the most significant cholesterol-raising effect for most of us. Obesity, which tends to increase cholesterol levels, is a key factor. Some people are cholesterol-sensitive—that is, a high-cholesterol diet significantly boosts their total blood cholesterol level and LDL blood cholesterol level. For more on dietary fat and cholesterol, see chapter 3.

HDLs and LDLs: The Ups and the Downs. Lipopro-teins—both HDLs and LDLs—transport "packages" of cholesterol through your blood. Here's how:

  • High-density lipoproteins (HDLs), or good blood cholesterol, act like waste removal vehicles. They take cholesterol from blood and artery walls to your liver for removal from the body. According to the National Heart, Lung, and Blood Institute, an HDL level of 60 mg/dL or more protects against heart disease. Tip: Remember "H" stands for HDLs and "healthy."
  • Low-density lipoproteins (LDLs), or bad blood cholesterol, work like delivery vehicles. They keep blood cholesterol circulating in your bloodstream, depositing plaque on artery walls along the way. As plaque builds up, atherosclerosis risk goes up. For optimal health, keep LDLs at less than 100 mg/dL. Tip: Remember "L" stands for LDLs and "lousy."

With these in mind, the heart-smart goal is obvious: high levels of HDLs and low levels of LDLs (both within normal guidelines). The next questions: How do you boost your HDLs? How do you lower your LDLs?

  • To increase HDL blood cholesterol: Stay physically active and trim any extra pounds of body fat if you're not at your healthy weight. Reduce fat intake to no more than 20 to 35 percent calories from fat in your overall diet. Replace some saturated fats with monounsaturates. Keep trans fats as low as you can. If you smoke, quit.
  • To decrease LDL blood cholesterol: Substitute unsaturated fats for saturated fats, while keeping total fat and dietary cholesterol low; cut back on trans fatty acids (found in partly hydrogenated vegetable oils). Soluble fiber and soy protein may help lower LDL cholesterol. Keeping excess body weight off may help.

"Strive for Desirable Blood Lipid Levels" in this chapter shows target levels for HDLs and LDLs. For more about them, see "The 'Good'and the 'Bad'" in chapter 3.

Prevention: Cholesterol Countdown. A heart-healthy eating pattern—a diet low in saturated fat, trans fat, and dietary cholesterol—helps reduce or maintain blood cholesterol levels. For more about fat and cholesterol in food and health, see chapter 3, "Fat Facts."

  • Be moderate in the total fat you consume—no more than 20 to 35 percent of your total calories a day advises the Dietary Guidelines for Americans, 2005 (see chapter 3)—rather than attempt to cut fat out of your diet entirely. You need fat to keep you healthy. And many foods with fat also contain other nutrients your body needs. Tip: In the Nutrition Facts on food labels, 100% Daily Value (for 2,000 calories daily) is 65 fat grams, which is 30 percent of total calories.
  • Follow an eating pattern that's low in saturated fat—less than 10 percent of your total daily calories (see chapter 3), or not more than a third of your total fat intake advises the Dietary Guidelines. "Sat fats"

boost blood cholesterol levels more than anything else you consume. You probably won't need to track "sat fats." By keeping your total fat intake moderate, you'll likely consume less saturated fat, too. Substitute foods with unsaturated fats for those higher in saturated fats and trans fat, without increasing your total fat intake.

  • Go easy on trans fatty acids, too—the kind in partially hydrogenated margarines and some snack foods. They, too, are cholesterol-raising. See chapter 3 for more on trans fatty acids.
  • Follow an eating plan that's low in cholesterol— less than 300 milligrams a day. Although not as significant as cutting back on saturated fat, reducing your dietary cholesterol may help lower your blood cholesterol level. You don't need to eliminate foods with cholesterol—just be prudent. Milk, cheese, eggs, poultry, fish, and meat supply nutrients your body needs.
  • If you're already at your healthy weight, enjoy nutrient-rich foods with more starches and fiber as you cut back on fat. Otherwise you'll lose weight. Grain products, beans, and vegetables all contain starches (complex carbohydrates). See "From Complex to Simple . . ." in chapter 5, and "Too Much of a Good Thing?" in chapter 3 for more guidance on fat, cholesterol, and whole-grain foods.
  • Eat more fiber. Fiber-rich foods may help lower blood cholesterol levels, especially for those with high levels, offering some protection from heart disease. Fiber also may improve the ratio between LDL and HDL cholesterol. In the intestine, fiber binds to cholesterol-rich bile acids, passing them out of the body as waste rather than reabsorbing them. Among the sources of fiber: oatmeal, oat bran, rice, wheat bran, barley, canned or cooked dried beans (such as kidney and pinto beans), and many fruits and vegetables. For more on fiber, see "Fiber: Heart Healthy, Too!" in chapter 6.

For the record, no long-term studies show heart-healthy benefits from fiber supplements. At least for now, they're not recommended as an approach for reducing heart disease risk.

• Eat plenty of fruits and vegetables; eat a variety daily. Besides their fiber content, emerging research also suggests a link to high intakes of antioxidant vita mins: beta carotene and vitamin C, which may be heart-protective. Prepare them with a little added saturated or trans fat, salt, and sugar.

On the Emerging Edge of Science. Other substances in food also may be cholesterol-lowering; hence, the interest in functional foods. See "Functional Foods for Heart Health!" in this chapter. For some, research evidence is strong; for others, it's preliminary but promising. Here are some new areas of scientific investigation.

• Soybean products. Soybeans and soy products such as soy beverage, tofu, tempeh, and soyburgers (but not soybean oil) may contain several phytonutrients that promote heart health; soy protein and isoflavones get the most consumer attention. In fact, the U.S. Food and Drug Administration has approved a health claim for labeling: 25 grams of soy protein per day, as part of a diet low in saturated fat and cholesterol, can reduce the risk of heart disease. Although research can't confirm a direct benefit between soy intake and blood cholesterol levels, there may be an indirect benefit if soy replaces foods high in saturated fats.

Soy Protein: How Much?

Foods with Soy Amount of Soy

Protein (examples) Protein (grams)

V2 cup tempeh 19.5

V4 cup roasted soy nuts 19

4 oz. firm tofu 13

1 soy protein bar 14

1 soyburger patty 10 to 12

8 oz. plain soy beverage 10

1 soy sausage link 6

Source: FDA Consumer (May-June 2000).

• Plant stanols and sterols. Plant stanols and sterols, found naturally in fruits, vegetables, and plant oils, have an LDL-cholesterol-lowering effect. They work by inhibiting the absorption of cholesterol (from food and bile acids) in the intestine; instead, cholesterol passes out of the body through waste.

Some spreads, juices, yogurts, and soft gel capsules are formulated to be high in plant sterol esters or plant stanol esters. These can be effective for lowering cholesterol for those with elevated LDL cholesterol levels. To be effective, you need to consume enough: two label servings of a spread that contains plant stanol (Benecol) or sterol (Take Control) esters daily—with meals—as part of an eating plan that's low in saturated fat and cholesterol. See "Functional Nutrition: Fatty Acids, Stanol- and Sterol-Based Ingredients " in chapter 3.

  • Omega-3 fatty acids. "Omega-3s" from fatty fish, such as tuna or salmon, may help reduce the risk of heart disease, although the data aren't conclusive. That's why the American Heart Association recommends eating two weekly servings (about 8 ounces total) of fatty (oily) fish. Omega-3 fatty acids from other sources—for example canola, soy, and flaxseed oil—may have a similar effect. See "Eat Your Omega-3s and-6s" in chapter 3.
  • Folic acid. The fact that today's grain products are fortified with folic acid (a form of folate) to prevent neural tube defects also may benefit heart health (another reason to enjoy grain products). Here's why: A high level of homocysteine, an amino acid (a protein) in the blood, may indicate heart disease. Although the reasons aren't clear, homocysteine may promote buildup of plaque in the arteries. An area of scientific study and controversy: the role of folic acid (a B vitamin), and perhaps vitamins B6 and B12, in lowering an elevated level of homocysteine in blood, and so helping to protect against heart disease. (A doctor can order a lab test to check your homocysteine level.)

Folate comes from fortified grain products, vegetables, and fruits. Folate and B vitamin supplementation studied to reduce heart disease have not shown a benefit.

  • Antioxidant nutrients. Antioxidant nutrients in food may benefit the heart. For example, vitamin E may offer protection from blood clots and atherosclerosis, and vitamin C may help keep blood vessels flexible. The evidence is too weak to recommend vitamin supplements; instead, enjoy a variety of nutrient-rich, plant-based foods that supply antioxidant nutrients.
  • Arginine. The amino acid arginine may protect against atherosclerosis. However, studies haven't yet determined how much is either safe or effective. Not enough is known yet to advise any benefits from extra arginine.
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