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HEART Insight:
doi: 10.1097/01.HEARTI.0000390848.47312.27
Departments: Life's Simple Seven

Modest Lifestyle And Behavioral Changes That Can Improve Your Health

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Diabetes Management Is A Family Affair

Diabetes is a family issue, not just an individual issue. When a parent, spouse or child has type 2 diabetes and is not following the doctor's diet, exercise and treatment recommendations, it causes emotional turmoil for the rest of the family. They worry about debilitating or life-threatening complications, and may be angry with their loved one for risking their health needlessly.

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But patients dealing with chronic health problems often experience the Three D's (denial, depression and defiance), which makes it hard to come to grips with their diagnosis and its implications — and type 2 diabetes is no exception.

Different ages also present different challenges for families. A teenager, for instance, wants to become his or her own person, and if parents continually nag, “Do this, do that,” he or she may reject well-meaning advice as a way of asserting self-control.

An elderly parent may also react with defiance, insisting “I intend to live the way I want to live.” No matter how bossy they were when you were growing up, many older parents resent being bossed around by their kids — even when it's for their own good.

Here's why it matters: adults with diabetes have a heart disease rate between two to four times higher than adults without diabetes, and 65 percent of deaths in type 2 diabetics are due to heart disease and stroke. In addition, persistently elevated blood glucose levels is the leading cause of diabetic complications such as blindness, limb amputation and kidney failure.

Achieving and maintaining recommended blood glucose levels is a lifelong endeavor, and patients are more likely to get there if their caregivers act less like police and more like partners. Instead of being on opposite ends of a tug-of-war over control of every choice a type 2 diabetic makes — for instance, obsessively counting carbs for them — agree on ways you can be pulling together towards the same goal.

When patients, their families and healthcare providers all work toward tight control of blood sugar levels, type 2 diabetics can have healthier, happier and more productive lives, with reduced risk of complications.

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Stress Can Ratchet Up Your Pressure

If high blood pressure runs in your family, is there anything you can do to avoid “the family curse” and the related risk of heart attack, heart failure and stroke?

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High blood pressure is inherited, and if your parents or close blood relatives have had HBP, you and your children are more likely to develop it, too — especially as you get older, because blood vessels become more rigid with age, which can contribute to increasing blood pressure.

Emerging research also suggests that stress may directly or indirectly contribute to high blood pressure. For instance, the loss of a job, the death of a loved one or marital issues are all highly stressful situations that can temporarily increase blood pressure. Some studies have noted a relationship between coronary heart disease risk and stress-related behaviors that undermine heart health:

▪ A 2005 study found that middle-aged Americans who lost their jobs were more likely to smoke more heavily or to fall off the wagon if they had quit the habit. The nicotine in cigarettes raises your blood pressure while it's in your system, and smoking intensifies age-related stiffening of the arteries. Secondhand smoke — breathing in other people's tobacco smoke — also increases the risk of heart disease for nonsmokers, so for the sake of your health and your family's, talk to your doctor about therapies that can help you quit.

▪ Stress can also drive people to drink. Heavy and habitual use of alcohol can cause blood pressure to zoom, as well as lead to irregular heart rhythm, heart failure and stroke. Heavy drinking can also raise triglyceride levels and contribute to obesity — both of which can lead to type 2 diabetes. If you drink, limit daily alcohol consumption to no more than two drinks for men and one drink for women. One drink equals a 12-ounce beer, a five-ounce glass of wine, 1.5 ounces of 80-proof liquor, or one ounce of hard liquor (100-proof). If you regularly drink more than this, your doctor can recommend treatment and counseling programs.

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▪ Stress is often accompanied by depression and listlessness, which can compel you to overeat (they don't call mashed potatoes “comfort food” for nothing) while also losing interest in activities you used to enjoy, such as working out or playing a round of golf with friends. More calories in and fewer calories out quickly shows up on the scale as extra pounds. Obesity can not only push blood pressure up, but also raises cholesterol and triglyceride levels and increase risk of type 2 diabetes. Losing 10 to 20 pounds can help lower blood pressure and your heart disease risk. To successfully and healthfully lose about a pound a week cut about 500 calories a day from your diet — for instance, limit intake of sugared beverages and high-sodium junk food snacks — and start or resume regular physical activity.

If several members of your family developed high blood pressure, chances are that you may be “salt sensitive” — meaning that a high-salt (sodium) diet raises your blood pressure. To reduce your risk for hypertension, and to successfully manage your condition if you have already been diagnosed, it's a good idea to limit your sodium intake to less than 1,500mg per day.

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How Trans Fats Hurt Your Heart

Research suggests that removing trans fats from processed foods could prevent 72,000 to 228,000 heart attacks, strokes and other cardiovascular complications each year. Just 2 to 7g of trans fats a day — that's one doughnut, one serving of french fries or one serving of microwave popcorn — can raise your cardiovascular risk. Every day, the average American eats about 6g of trans fats.

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Trans fats not only raise levels of LDL (bad cholesterol) and triglycerides (a type of fat found in the blood), they also lower HDL (good cholesterol). This combination sets people up for hardening of the arteries (atherosclerosis).

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HOW DO TRANS FATS GET INTO FOOD?

In the early 1900s, foods were typically fried in saturated fat-packed animal fats, such as lard or butter. As scientists began to link saturated fats with cardiovascular disease, food manufacturers and restaurants gradually switched to a type of fat thought to be healthier: partially hydrogenated oils.

It was win-win for consumers and the food industry, because these oils were cheaper; they had a long shelf life; they could be reused to deep fry potatoes and other foods; and they added crispiness and texture to cookies, cakes, pastries, crackers and some breads.

It wasn't until the 1990s that researchers discovered that trans fats — which form when liquid oils are transformed into solid fats by adding hydrogen (hydrogenation) — are even worse for cardiovascular health than saturated fats. Small amounts of trans fats occur naturally in some meat and dairy products, and it is unclear whether they have the same effect on heart health.

According to American Heart Association guidelines, trans fat intake should be “less than 1 percent of your total daily calories or” as low as possible. To help people keep track of how much trans fat they are eating — and the foods and products they buy that have the most of it — the Food and Drug Administration has required manufacturers to list trans fat content on food labels since January 2006 (it's right underneath the saturated fat listing).

The FDA's new food labeling requirement — as well as trans fat bans that went into effect in New York City in July 2008, the state of California in January of this year and several other cities and counties nationwide — pushed many manufacturers to reduce or eliminate trans fats voluntarily. But sometimes reading food labels isn't enough. The only way to really know whether a food contains trans fats is to look at the ingredient list for “partially hydrogenated oils.”

There's a quick way to find heart-healthy foods while shopping. Look for the American Heart Association's heart-check mark on food packaging in the grocery store. It looks like this:

This means the product complies with the AHA's standards for total fat (3g or less), saturated fat (1g or less), trans fat (less than 0.5g), sodium (480mg or less) and cholesterol (20mg or less).

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Visit http://www.heartcheckmark.org for a list of certified foods.

The AHA also helps you create a shopping list of heart-healthy foods with an interactive tool at: www.heartcheckmark.org. You can choose your favorite foods by manufacturer or category (bread, snacks, deli meat, for instance), then type the quantity you need, and add it to your list with a click of the mouse.

A really neat feature of the shopping tool is that you can add non-food items to the list, such as laundry detergent and plastic wrap, so everything you want to buy is on a single piece of paper when you head out the door.

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Life's Simple 7™ In A Nutshell

Cardiovascular health encompasses two basic components: ideal health behaviors, and ideal health factors.

The behaviors include not smoking, maintaining a healthy weight, meeting or exceeding AHA recommendations for physical activity and eating a healthy diet.

The health factors include blood pressure, fasting blood glucose and total cholesterol levels that are within the AHA's recommended range — preferably without needing medication to keep them there.

Modest lifestyle or behavioral changes can improve your health and move you in the right direction. And those who make behavioral changes before developing any serious health risks can look forward to a better quality of life and moving toward excellent heart health.

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Yoga: Bent Into Shape

Millions of people have discovered the feel-good benefits of yoga, but studies suggest that practicing this ancient discipline can also promote and maintain cardiovascular health. Physical activity that helps reduce stress or allows blood to flow through vessels more efficiently may be good for the heart. The good news is, yoga does both.

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There are several yoga styles that range from low-exertion (emphasizing meditation and breath control; these include Integral, Kripalu, gentle Hatha and Viniyoga) to moderate exertion (more demanding poses, such as standing on one leg; these include Iyengar, Anusara and Kundalini) to high exertion (vigorous aerobic activity; these include Ashtanga, Power Yoga and Bikram).

Although there is no research that directly matches a particular yoga style to a specific health benefit, even the gentlest disciplines may contribute to heart health through stress-reduction.

Your first step is to talk to your doctor — but bring along a book that illustrates the poses you will be doing, because he or she may not know the difference between a soothing style, and one that involves a demanding aerobic routine. Written descriptions of yoga poses, and terms like “basic,” “intermediate” and “advanced” won't give your doctor enough information.

Just to be on the safe side, you should also call the instructor or studio to discuss your health issues and ask about alternative yoga styles if a particular class is not appropriate.

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Neck Circumference A Good Measure Of Obesity In Kids: Study

Measuring neck circumference in addition to body mass index (a ratio of weight to height) may be a better way to determine whether children six-years-old and older are overweight or obese. Much like measuring an adult around the waist, neck circumference can give doctors a better idea of how much body fat a child has.

A new study published in the journal Pediatrics finds that neck circumference correlates well with both BMI and waist size in boys and girls ages 6 to 18. The research suggests that a child with a neck circumference greater than 11.2 inches is more likely to be overweight or obese, but additional research is needed to determine a cut-off point below which a child is considered at low risk for obesity and related health problems, such as diabetes, elevated cholesterol, high blood pressure and sleep apnea.

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Resources

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Life's Simple 7™ Assessment

To receive your personal health assessment based on Life's Simple 7™ and learn the steps you may need to take to improve heart health and quality of life, visit www.heart.org/MyLifeCheck.

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Diabetes Management

Learn about diabetes & share your experiences at www.heart.org/diabetes

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Smoking Cessation

For tips and tools check out www.americanheart.org/quitsmoking

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Substance Abuse & Mental Health Services Administration

Find alcohol abuse treatment programs in your state at http://dasis3.samhsa.gov/

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National Center for Complimentary and Alternative Medicine

Yoga-related information and research http://nccam.nih.gov/health/yoga/

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Alliance for a Healthier Generation

http://www.HealthierGeneration.org

© 2010 American Heart Association, Inc.

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