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doi: 10.1097/01.HEARTI.0000422222.50310.fa
Departments: Life's Simple 7(R)

Modest Lifestyle and Behavioral Changes That Can Improve Your Health

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The truth about chocolate: Is it really good for you?

Our devotion to chocolate dates back nearly 4,000 years. The average American eats about 11.2 pounds of the luscious treat annually, positive proof that we love it—but does it love us back?

Not when we indulge in too much of the good stuff, but if it's eaten in moderation, our relationship with chocolate may actually be healthy.

Chocolate is changing its “image,” just the way eggs and nuts have. Both were given a bad rap as unhealthy foods until science proved that they weren't so bad for us after all—again, in moderation.

The first research hinting at chocolate's benefits was published in the 1960s. Since then, evidence continues to mount indicating that people who eat chocolate are actually at reduced risk for heart disease, diabetes and high blood pressure. They may have improved blood flow and lipid levels—lipids are fats in the blood, including cholesterol and triglycerides.

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In the 1994 film, Tom Hanks' character Forrest Gump uttered these now-famous lines: “My momma always said life was like a box of chocolates. You never know what you're gonna get.” Unfortunately, we do know that we're going to get fat and sugar and ultimately, calories, when we eat chocolate. But you can choose wisely to get the health benefits of chocolate without adding to your waistline.

What you want to get is plain, dark chocolate—hands off truffles and other filled chocolate candies. Chocolate comes from the cacao or cocoa plant, which contains flavanols, compounds that are both antioxidant—protecting the body's cells—and anti-inflammatory. The more bitter the chocolate, the higher the flavanol level, and although levels vary, they show up more in dark chocolate than milk or white chocolate.

So how much “should” you eat? “It depends on several factors including current health, body mass index [an indirect measure of body weight] and your level of physical activity,” says Luc Djoussé, M.D., M.P.H., Sc.D., associate professor at Harvard Medical School and director of research in the Division of Aging at Brigham and Women's Hospital in Boston.

There's no “one size fits all,” says Djoussé, who frequently studies chocolate's potential. Talk to your healthcare provider about your overall diet and physical activity level, he advises.

“If tolerated, chocolate should be consumed in small quantities as a substitute for other macronutrients in the diet [that provide calories or energy],” he says. “If calories are not ‘spent,’ they will lead to weight gain and more health problems—total calories consumed in conjunction with regular exercise should be kept in mind when considering the amount and frequency of dark chocolate consumption.”

Europe consumes more than half of the chocolate eaten in the world. On July 17 the world's largest chocolate manufacturer, Barry Callebaut AG, received permission from the European Food Safety Authority to claim that flavanols in dark chocolate can help blood circulation.

Score another one for chocolate, but not so fast. “Long-term trials are still needed to have a definitive answer on whether dark chocolate can lower the risk of major chronic diseases and mortality,” Djoussé says.

So you don't have to say no to a little chocolate treat now and then—just make sure to choose dark chocolate and eat it in small amounts.

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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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What is prediabetes–and are you at risk?

Before many of the nearly 26 million people with diabetes in the United States develop that condition, they get prediabetes—which affects nearly 80 million Americans.

Prediabetes occurs when blood glucose, or blood sugar levels, are higher than normal but aren't high enough to be diagnosed as “diabetes.” Even so, prediabetes can cause long-term damage to the body and can increase risks of high blood pressure, high cholesterol and cardiovascular disease.

Studies show that 50 percent of people who have prediabetes are likely to develop type 2 diabetes. Without intervention, prediabetes can evolve into diabetes in 10 years or less.

Taking charge of prediabetes and stopping it from developing into diabetes isn't really complicated, says Om P. Ganda, M.D., a specialist in internal medicine, endocrinology and metabolism, and clinical nutrition, a senior physician in the adult diabetes section at Joslin Diabetes Center, and an associate clinical professor of medicine at Harvard Medical School. It doesn't even need to involve medications.

“Most people need to lose some weight and start exercising,” he says.

Ganda cites a study in which he was a co-investigator that showed losing 5 to 7 percent of body weight by dieting and exercising resulted in a 58 percent reduction in progression from prediabetes to diabetes.

“It is difficult for some people to lose weight, but engaging in regular exercise, 150 minutes a week, can have a major impact,” he says.

As always, making good food choices is a smart way to help prevent or manage prediabetes, by eating heart-healthy foods that are low in fat, cholesterol, sodium and added sugars. Additionally, limiting simple carbohydrates such as table sugar, cake, soda, candy and jellies can help prevent increases in blood glucose.

How do you know if you're at risk for prediabetes or diabetes? Talk to your healthcare professional if you:

* are overweight, with a body mass index over 25

* have high blood pressure, low high-density lipoprotein (HDL) levels (also known as “good” cholesterol) or high triglyceride levels

* are not active or engaged in regular physical activity

* are age 45 or older

* have a family history of type 2 diabetes

* are African-American, Hispanic, American Indian, Asian-American or a Pacific Islander

* developed gestational diabetes when you were pregnant or gave birth to a baby weighing more than nine pounds

* are female, with polycystic ovary syndrome (irregular menstrual periods, excess hair growth and obesity)

* sleep fewer than six hours or more than nine hours a night.

Learn more at

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Finding affordable, healthy food at warehouse food stores

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You show your membership card at the front door of your favorite super-center store and “you're in!” That is, you're in for countless temptations in a big place with big carts and big packages that invite you to buy big—more than you normally would.

You can buy affordable, healthy food for the whole family, even as you're confronted with items in bulk. Before you head to the store, strategize and plan your meals ahead for the next week or two. Decide how you'll break up large packages into smaller portion sizes and what you can store or freeze. Connect with friends and neighbors and share grocery lists and expenses so all of you can take advantage of fresh, quality food and better pricing. It takes time, but it sure beats throwing food—and money—away.

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Processed or pre-packaged foods—those usually changed from their “natural” state—are often sampled on the food aisles, and can contain unhealthy levels of fat, salt and sugar. Steer clear by becoming an educated consumer, says Judy Caplan, M.S., R.D., spokesperson for the Academy of Nutrition and Dietetics.

“It's really easy for you take the first step to being a smart, savvy shopper in warehouse stores,” says Caplan. Look for products with the American Heart Association's Heart-Check Mark. When you see a Heart-Check Mark, it means the product has been certified to meet the American Heart Association's guidelines for heart-healthy food. You'll find it on more than 900 food items, representing more than 100 food companies.

“The mark tells you the food has a limited amount of saturated and trans fats, sugar and sodium, plus it encourages a significant amount of whole grains and fiber in your diet. That's all good,” Caplan says.

You might think that it's hard to get fresh produce at a warehouse store, but you'd be wrong. Most of these stores have produce departments full of healthy choices—these are the products you should be buying large quantities of.

“Fruits and vegetables are loaded with antioxidant phytochemicals—compounds produced by plants that may reduce the risk of certain diseases,” Caplan says. While fresh produce is always preferable, you can look for acceptable alternatives like bags of frozen fruits and vegetables without added sodium or sugar. Dried blueberries or other dried fruits are good healthy snacks, but look for ones without sulfites, which are preservatives that many people are allergic to, and remember that dried fruits contain sugar—2 tablespoons of raisins is considered a fruit serving, the same as one small apple.

Some other tips for getting the most out of warehouse stores:

* Choose high fiber, whole grain bread, crackers and pancakes, brown rice, quinoa and lentils.

* Buy lots of fish, with its healthy omega-3 fats, and try to eat it twice a week. Most experts agree that fresh, wild-caught vs. farm-raised is best, without added color. Cut whole fish into recommended 4 to 6 ounce portions.

* For snack time, try hummus, little packages of low-fat cheese, roasted peppers packed in oil or water, oven-roasted turkey breast with no nitrites and low in sodium, frozen fruit juice pops, edamame (cooked soy beans), or dry-roasted nuts like almonds, pecans, pistachios and dry-roasted peanuts. Servings of nuts are small, so a handful goes a long way.

Shopping at warehouse food superstores doesn't mean you have to buy super quantities. Plan your shopping trip before you go and make the right choices for good nutrition and health.

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Why smoking makes high cholesterol more dangerous

More than 45 million Americans smoke cigarettes, even though cigarette smoking is the leading preventable cause of death in the United States, accounting for more than one in every five deaths.

If you already have high cholesterol—too much of that waxy, fatty substance in your body's cells—smoking is especially risky. Low-density lipoproteins (LDL) and high-density lipoproteins (HDL) carry cholesterol throughout your body and ideally, you need healthy levels of both. LDL is usually known as “bad” cholesterol and can build up in your arteries, putting you at risk for coronary heart disease.

Smoking affects cholesterol in both a direct and indirect way, says David Frid, M.D., of the Cleveland Clinic's Department of Cardiovascular Medicine.

Research shows that smoking can lower levels of “good,” heart-protecting HDL cholesterol, just the opposite of what's desirable.

“HDL's primary role is ‘reverse cholesterol transport,’ to transport LDL out of the system—out of places it shouldn't be,” Frid says. “A lower HDL number means its benefits will be less and that LDL will hang around and won't get removed as easily.”

Nicotine and tar from smoking also irritate blood vessels. Troublesome LDL actually “latches on” to those areas of irritation and inflammation, says Frid.

“It gets into the blood vessel walls and starts developing plaque—a fat- or lipid-filled bump in the blood vessel—and then blockages,” he says.

As plaque becomes more prominent, the vessel becomes more unstable and more likely to rupture or have a clot attached, possibly causing a heart attack.

With LDL as a catalyst for plaque development, and high blood pressure and diabetes—also irritants to blood vessel walls—“you've set yourself up for a process that is just out of control,” says Frid.

So if you have high cholesterol levels, it's more important than ever that you stop smoking—and soon. Don't go it alone and you'll have a better chance of success. For help quitting smoking, contact the American Heart Association at 800-242-8721 or visit to request a Stop Smoking packet.

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Does physical activity make you hungrier?

After a 30-minute swim, Jane dries off and feels famished. John comes back from an hour workout at the gym and the hunger pangs he felt before he got to the gym have gone away. So, which is it—does physical activity make you hungrier or suppress your appetite?

Unfortunately, the answer isn't black and white because many factors make predicting the effects of exercise on hunger and food intake “very tricky,” says Barry Braun, Ph.D., associate professor and director of the Energy Metabolism Lab at the University of Massachusetts Amherst.

Here's why. Exercise generally suppresses appetite by lowering circulating concentrations of appetite-stimulating hormones or raising the concentration of hormones that cause lack of appetite, making you feel less hungry. But the number of hours after exercise is a factor in whether or not you'll be hungry, as is the type of physical activity you're doing. The body's core temperature is also a factor because exercising in heat suppresses appetite more than in cold.

“Anecdotally, people always say that swimming does not suppress appetite as effectively as running or cycling or lifting,” Braun explains. “That may be true and may be related to a lower rise in [the body's] core temperature during swimming, but this has never been systematically evaluated.”

Braun says that during physical activity and for several hours after, you're probably not going to feel hungrier. But physiological, genetic and behavioral factors also cause differences in the way each of our bodies responds to exercise.

“Some people compensate minimally for the energy they expend during exercise and they lose considerable weight,” Braun says. “Others compensate more fully and lose a little weight, while an unhappy minority overcompensate and actually gain weight. Even those who lose little weight usually lose some body fat, thus, lowering risks for obesity-related disease.”

It's important to understand the relationship between calories burned during exercise and the calories contained in common foods. “It is so easy to overestimate the first and underestimate the second,” Braun says.

“Remember that exercise has a host of health benefits and helps prevent almost every major disease, even when people are not losing weight.” Pay attention to how your body feels after physical activity, and if you do feel hungry, don't dive into a bag of potato chips—step back and think about a healthy snack that can satisfy your hunger without adding a lot of excess calories.

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Life's Simple 7® Assessment

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

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Quit smoking

Get tips on ways to break the habit at

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Get physically active

For ideas on how to incorporate physical activity into your life, visit

© 2012 American Heart Association, Inc.