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HEART Insight:
doi: 10.1097/01.HEARTI.0000403782.48738.5b
Departments: Life's Simple 7(TM)

Modest Lifestyle And Behavioral Changes That Can Improve Your Health

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Weight Control = Diabetes Control

Type 2 diabetes and weight gain often go hand-in-hand. The more fat you carry, the less able your body is to use insulin properly.

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Insulin is a hormone made by the pancreas that helps your cells absorb glucose from the bloodstream and convert it into energy to fuel the body. When cells become resistant to the effects of insulin, sugar levels in the blood increase. In response, the pancreas pumps out more insulin. As insulin resistance increases, the pancreas can't keep up and the condition progresses to prediabetes (also known as impaired fasting glucose or impaired glucose tolerance) and type 2 diabetes.

According to a study that correlated Body Mass Index (BMI) with adult-onset diabetes risk, underweight men had a 7.6 percent lifetime risk compared to a more than 70 percent risk for obese men. Among women, the risk skyrocketed from 12.2 percent for those who were underweight to 74.4 percent for those who were obese.

So it shouldn't be surprising that weight loss can help prevent insulin resistance, and thus diabetes. One study found that in obese women (BMI 36.4), weight loss of just 15 percent had a major impact on lowering insulin levels.

Just as you gained weight one pound at a time, with each pound bringing you closer to developing diabetes and related cardiovascular conditions, you'll lose the extra weight one pound at a time, with each pound bringing you closer to good health. The trick is to set realistic goals like these:

▪ If you “have no time” to incorporate a 30-minute chunk of your day to physical activity, break the chunk up into three 10-minute “bites” of moderate-to-vigorous physical activity.

▪ Gradually cut back on sweets, instead of depriving yourself all at once, and substitute healthier snacks like unsalted, dry roasted or raw nuts, apples or small portions of dried fruits, such as raisins. High-fiber foods help fight insulin resistance, whereas high-sugar foods make the problem worse.

▪ When you go out to dinner, leave half of the meal on your plate; if you like, carry it home for the next day's lunch. Portion control is a surefire way to reduce the number of calories you take in.

Remember, whether the dial on your scale is going to the right or going to the left, every little bit counts.

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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 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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Building a Heart-Healthy Physical Activity Program

Most people are aware that regular physical activity can help prevent or manage a host of ailments, from arthritis to diabetes to heart disease. But they may believe that a physical activity regimen will be too time-consuming, too expensive and too unpleasant unless they are already in good shape. Even when the doctor is urging a more physically active lifestyle, too often what people believe about the obstacles cancels out their smarts.

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The best approach is to build a physical activity regimen around your obstacles. If you don't have the money to go to a gym, do some of your errands on foot. If finding time is a challenge, do sets of arm curls and leg lifts while watching the news or stretch while dusting or washing the car.

Every minute you spend moving counts toward the 30 or more minutes of moderate-to-vigorous aerobic activity you need to get at least five days of the week. A gradual approach to working physical activity into your day will increase your fitness level enough to make a difference and maybe you won't feel winded while walking, lethargic while lifting or stiff while stretching—and, believe it or not, eventually you will feel more invigorated and your mood will improve.

For most heart patients, physical activity is not only safe, it's part of the treatment. Be sure to talk with your doctor before you start your physical activity program if you're managing a serious condition. As a rule, activities that are good for your heart will also help you control your weight and increase your muscle tone. A heart-healthy physical activity regimen incorporates three elements:

Aerobic: Improving heart and lung function will help you feel better and will burn calories to help you lose weight and keep it off. Walking—especially in a hilly area—climbing steps, biking and playing a game of pick-up b-ball at the park are all aerobic activities that don't require a club or a gym.

Resistance: Weight training helps strengthen your muscles and bones, and improves your balance. In addition, weight training can manage various heart disease risk factors. You don't need to go to a gym or build one in your home to start a weight training program. Grab an 8-ounce can of tomato sauce and do arm curls while waiting for the kettle to come to a boil; work your way up to a 16-ounce can of beans. Later on, if you can't find anything heavier in the pantry to heft, start doing pushups against a wall, and invest in a set of hand weights or resistance bands.

Flexibility: Stretching, yoga and even chair exercises you can do while sitting in front of the TV will help keep you limber.

If you decide you're ready to join a gym, first take a tour to see whether the equipment and classes they offer will enable you to include aerobic, weight training and flexibility into your program. Also make sure there are enough well-trained staffers on hand to explain how to use the equipment and to supervise your progress.

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Getting Kids to Focus on Nutrition

New federal regulations expected to take effect in mid-2012 will require chain restaurants, bakeries, convenience and grocery stores, coffee shops and vending machines to post nutrition information. In 2008 New York City led the way in the effort to give consumers the facts they needed to make more healthful choices.

Did it work? Not so much. A study by the NYU School of Medicine found that 57 percent of kids in the city noticed the nutritional information, but only 9 percent of them said they made different food choices as a result.

Clearly, the availability of nutritional information alone won't fight childhood obesity. So how can you help your kids make healthier food choices?

Get them more involved in grocery shopping. Try to navigate nutritional landmines by comparing food labels and discussing the pros and cons of different versions of a product—for instance, a snack-sized pudding cup. One brand of fat-free chocolate pudding has 101 calories, 22.7 g of carbohydrates and 17.3 g of sugar; its sugar-free counterpart has 10 calories and no fat, carbs or sugar. Remember, though, if the taste and texture of the sugar-free product isn't appealing, the fat-free alternative may be your best bet.

Not all product lines include reduced-fat, fat-free and sugar-free alternatives to choose from. So when your only choice is less fat or less sugar, which should you opt for? Sugar is 4 calories per gram, while fat is 9 calories per gram. So a lower-fat food will also have fewer calories than a sugar-free food. Unless you or your kids need to control glucose intake, the lower-calorie choice is usually the better choice.

Here are some more tips to help kids take charge of their eating habits, even when you aren't around to steer them in the right direction:

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▪ Teach them common-sense rules to follow when eating out. They don't need a point-of-purchase nutrition chart to understand that supersizing, bacon and extra cheese are less healthy choices.

▪ Show them ways to add healthy ingredients to their favorite foods—for instance, throwing a cup of fresh blueberries into pancake batter.

▪ Make a special effort to focus on healthy snack options. For example, keep grapes in the house instead of gummies, or offer frozen bananas on a stick instead of popsicles. Also, bake brownies using applesauce instead of butter and make your own trail mix without the candy.

▪ Help them work treats into their diets from time to time by teaching them how to make trade-offs. For instance, to be able to eat a small scoop of ice cream, let them choose another food they could eat less of or skip that day to compensate for the added carbs, fat and calories. Better yet, show them how much additional physical activity it would take to burn it off.

Reading nutrition information at restaurants and food labels in supermarkets isn't enough unless you encourage your kids to put the information to use.

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Sloth and Sodium

Salt sensitivity is a factor in high blood pressure, which is why the AHA recommends keeping sodium intake below 1,500 mg a day (one teaspoon of salt has 2,300 mg of sodium). A Chinese study involving 1,900 people (average age 38) suggests it's even more important for those who are inactive to cut back on their sodium intake because they are more likely to be salt sensitive.

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Researchers determined which study participants were salt sensitive by comparing their blood pressure readings on a diet of 3,000 mg of salt a day for a week, and then after feeding them an eye-popping 18,000 mg a day for a week to see which ones would experience an increase in the top number of their blood pressure reading (the systolic pressure) as a result. Those whose systolic reading went up 5 percent were deemed “salt sensitive.”

The researchers then asked the study participants to rate their level of physical activity from “quite sedentary” to “very active.” Those who reported being “very active” had a 38 percent lower risk of being salt sensitive than those who were the least active.

This study needs to be duplicated to see if the results hold up, and researchers don't yet know how exercise may moderate the impact of sodium on blood pressure. Perhaps those who are more active are losing excess sodium in their sweat, or physical activity helps discourage atherosclerosis and helps keep blood vessels from becoming stiff and narrow. Until more data is available, your best bet is to decrease sodium intake and be regularly physically active.

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How Long Can You Stay on Nicotine Replacement?

Many smokers who are ready to quit reach for nicotine replacement therapy (NRT) to help ease their transition to being ex-smokers. NRT helps smokers get their “fix” of nicotine—the substance in cigarettes that causes addiction—so they can concentrate on dealing with smoking-related behaviors, such as lighting up when they sit down to have a cup of coffee, as they gradually taper their cigarette use. Nicotine gum, for example, helps increase a smoker's chance of quitting as much as 50 percent.

Since the introduction of NRT gum in 1984—and now, lozenges and patches—doctors routinely weaned patients off these products within eight to 12 weeks. But a University of Pennsylvania study found that smokers who used a nicotine patch for 24 months were less likely to relapse than those who used the other quit-aids for just eight weeks.

But is long-term NRT use dangerous? Britain's Royal College of Physicians studied over-the-counter NRT products in 2007 and found “medicinal nicotine” very safe, without significant long-term harmful effects.

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If you've tried NRT in the past and continue to smoke more than 25 cigarettes a day, talk to your doctor about giving it another go, this time for a longer period.

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Resources

Life's Simple 7™ Assessment

To understand the steps you may need to take to improve heart health and quality of life, visit heart.org/mylifecheck

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Diabetes Management

Learn about diabetes and share your experiences at iknowdiabetes.org To figure out what foods you can—and should—eat to manage prediabetes and type 2 diabetes, visit tracker.diabetes.org

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Smoking Cessation

For tips and tools, check out heart.org/quitsmoking

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Start! Walking for a Healthier Lifestyle

Motivate yourself to Start! Walking, and connect with “Sole-Mates”—friends, colleagues and walkers nationwide who share your goals at startwalkingnow.org

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Body Mass Index Calculator

heart.org/BMI

© 2011 American Heart Association, Inc.

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