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HEART Insight:
doi: 10.1097/01.HEARTI.0000437026.25304.ac
Departments: Life's Simple 7

Modest Lifestyle and Behavioral Changes That Can Improve Your Health

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Making the most of fall and winter produce

Fresh fruits and vegetables are an important part of a healthy eating plan, but how do you know you're getting the best produce for your dollar? Whether you shop at a large supermarket or your local farmer's market, choosing produce when it's in season is your best bet. Seasonal fruits and vegetables not only have the best flavor, but they're often cheaper during their growing peak. The fall and winter seasons bring an abundance of orange, deep green, red and purple produce to entice your taste buds and provide you with the nutrients you need to stay healthy.

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During the fall in most areas of the United States, apples, dates, pears, pumpkins, broccoli, Brussels sprouts, sweet potatoes and squashes such as acorn, butternut and spaghetti squash are all in season. Choose a rainbow of colors with your fall produce—those with deep, rich colors contain vitamins, minerals, fiber and phytochemicals that have disease-fighting elements.

Winter brings a variety of fruits and vegetables that are in season, including citrus fruits, dark greens and root vegetables. Fill your fruit basket with oranges, tangerines, clementines and grapefruit. Add color and essential vitamins to your meals with beets, turnips, bok choy, spinach, cauliflower, collards, endive and mustard greens.

When picking seasonal produce, make sure you choose wisely to get the best-tasting and safest fruits and vegetables available. Here are some tips to follow when you're shopping:

* Look for produce that's not bruised or damaged.

* When selecting pre-cut produce, such as bagged salad greens or cut-up fruit, choose only those that are refrigerated or surrounded by ice to ensure freshness.

* When bagging groceries at the market, keep fresh fruits and vegetables separate from meat, poultry and seafood by bagging them separately.

And when you get home:

* Store perishable fruits and vegetables in a refrigerator at a temperature of 40 degrees or below. Always refrigerate pre-cut produce. If you're unsure whether an item needs refrigeration, ask your grocer.

* Before eating or preparing produce, wash your hands for at least 20 seconds with soap and warm water, both before and after preparation. Cut off any bruised or damaged areas. If it looks rotten, throw it away.

* Wash all fruits and vegetables thoroughly under running water. Using soap isn't recommended. Even if you are going to peel the produce before eating, it's important to wash it first—bacteria can be transferred from the knife to the produce when it's peeled. Use a clean produce brush on firm produce like oranges and grapefruit.

* Dry off all produce with a clean cloth towel or paper towel.

The American Heart Association recommends at least four to five cups of fruits and vegetables per day, so take advantage of the fall and winter's colorful choices and stock up!

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What are the risk factors for high blood pressure?

High blood pressure, or hypertension, can increase your risk of stroke and can also damage your kidneys and eyes. In most cases, the cause of high blood pressure is unknown. But there are some factors that can increase your chances of developing high blood pressure. These are called risk factors.

If you have any of these risk factors for high blood pressure, it's important to manage your lifestyle with heart-healthier habits. Risk factors are put into two categories: those you can control and those you can't control.

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First, let's look at the ones you can't control. These include your race, family history and age. African-Americans develop high blood pressure more often and at an earlier age than Caucasians. If your parents or close blood relatives have had high blood pressure, you're more likely to develop it, too. And you can pass that risk on to your children. As we age, all of us increase our chances for developing high blood pressure and cardiovascular disease because our blood vessels lose flexibility over time.

While you can't change your race, family history or age, there are several risk factors that you can control to help lower your risk. These include:

* Being overweight. Being overweight increases your chances of developing high blood pressure. Excess weight puts strain on your heart, raises cholesterol and triglycerides in your blood and lowers levels of “good,” or HDL, cholesterol. Losing as little as 10 to 20 pounds can help lower your blood pressure and heart disease risk.

* Eating too much salt. Salt keeps excess fluid in the body, which can put an undue burden on your heart to keep pumping. Aim for limiting your salt intake to 1,500 milligrams or less per day, which is a little more than ½ a teaspoon of salt. Avoid foods that are high in sodium such as tomato sauce or sliced ham.

* Drinking too much alcohol. Heavy and regular use of alcohol can lead to high blood pressure and cause heart failure, stroke and irregular heartbeats. If you drink, limit your intake to no more than two drinks a day for men and one for women. One drink equals a 12-ounce beer, 4-ounce glass of wine, 1.5 ounces of 80-proof liquor or 1 ounce of 100-proof liquor. If you can't get down to this level, seek help from your healthcare provider.

* Not getting enough physical activity. An inactive lifestyle makes it easier to become overweight and increases your chances of high blood pressure, heart disease and stroke. Getting active can help reduce these risks. You need a total of at least 150 minutes per week of moderate-intensity physical activity, such as brisk walking. See “Five easy ways to get more physical activity in your day” on page 19 for some ideas on how to get moving.

High blood pressure can be dangerous to your health, but there are things you can do to keep it at bay. By taking a close look at the risk factors you may have, you can take steps to decrease your chances of developing high blood pressure.

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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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When diet and exercise aren't enough: All about cholesterol medicines

The best way to prevent or treat unhealthy cholesterol levels is to make lifestyle changes in what you eat and how you exercise. But for some people, diet and physical activity aren't enough, and they may need to take a prescribed medicine to get those levels down. Cholesterol medicines can decrease low-density lipoprotein (LDL) cholesterol (also known as “bad” cholesterol) and triglycerides, or blood fats, both of which increase the risk of heart disease. They can also increase high-density lipoprotein (HDL) cholesterol, or “good” cholesterol, which provides protection against heart disease.

Your doctor may prescribe one or a combination of cholesterol-lowering medicines, depending on your cholesterol and triglyceride levels. They may include:

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Statins, which work in the liver to prevent the formation of cholesterol. They're most effective at lowering LDL cholesterol and triglyceride levels. Common side effects include constipation, upset stomach, diarrhea, cramps, muscle soreness, pain and weakness, most of which are mild and generally go away as your body adjusts. People who are pregnant or who have liver disease should not take statins.

Selective cholesterol absorption inhibitors, which work by preventing the absorption of cholesterol from the intestine. They are most effective at lowering LDL cholesterol, but may also have modest effects on lowering triglycerides and raising HDL cholesterol. Common side effects include stomach pain, tiredness and muscle soreness, which usually lessen as your body adjusts to the medicine.

Resins, which are used to lower LDL cholesterol levels, work in the intestines by promoting increased disposal of cholesterol. Common side effects, which usually decrease once your body adjusts to the medicine, include constipation, bloating, upset stomach and gas.

Lipid-lowering therapies, which include fibrates, niacin and omega-3 fatty acids. Fibrates are best at lowering triglycerides and in some cases increasing HDL cholesterol levels. They're not very effective in lowering LDL cholesterol, however, so they're usually prescribed for people whose triglycerides are high or whose HDL is low, after reaching their LDL goal. Fibrates may be used in combination therapy with statins. Common side effects include upset stomach, stomach pain and gallstones.

Niacin, in prescription strength (not the over-the-counter version), works in the liver by affecting the production of blood fats. It's prescribed to lower triglycerides and LDL cholesterol and raise HDL cholesterol. Common side effects include flushing, itching and upset stomach. Your liver function may be closely monitored because niacin can be harmful to the liver. It's used cautiously in people with diabetes because it can raise blood sugar levels.

Omega-3 fatty acids are made of fish oils that are chemically changed and purified. They're used in addition to a sensible eating plan to lower triglycerides in individuals with very high triglyceride levels. People with allergies or sensitivities to fish and/or shellfish may have a severe adverse reaction to use of these medicines. Common side effects include belching, a fishy aftertaste and an increased risk of infection.

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Five easy ways to get more physical activity in your day

Trying to get at least 30 minutes of physical activity most days of the week may seem like an impossible task, with work and kids and family taking up all your time. But those 30 minutes don't have to be done all at once—adding little bits of activity here and there throughout your day can help you increase your physical activity. To get started, try these five easy ways to get more activity into your day:

1. Walk instead of drive. Walk to the corner store instead of taking the car. Park farther away at the shopping mall and walk the extra distance. Get off the bus a stop early and walk the rest of the way.

2. Make the most of walking. When you're walking, pick up the pace—turn a leisurely walk into a brisk one. Climb hills instead of avoiding them. Listen to upbeat music to get you moving faster.

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3. Take the stairs. Avoid elevators and escalators and take the stairs instead. Or get off the elevator a few floors early and take the stairs the rest of the way.

4. Get out of your chair at work. Walk down the hall to speak with someone instead of calling or using email. Walk during business calls if you don't need to reference important documents. Stand while talking on the telephone. Walk around the building at lunch time.

5. Add exercise to TV time. You don't have to miss your favorite shows to get in some activity. When watching TV, sit up instead of lying on the couch. If you have a stationary bike, pedal while watching TV. Hide the remote and get up to change the channel. Lift weights while watching your favorite sitcom. Instead of asking someone to bring you a drink, get up and get it yourself.

Make it a point to add some of these extra activities into your day to help you increase your physical activity. You'll be surprised at how much they add up!

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Type 1 and type 2 diabetes: What's the difference?

Diabetes is a condition that causes blood sugar to rise to dangerous levels. This occurs when your body doesn't make enough insulin, which is a hormone that's produced by the pancreas. Without insulin, the body is unable to take the blood sugar it gets from food into the cells to fuel the body. When there's too much sugar in the blood, organs in the body can suffer long-term damage. There are two main types of diabetes: Type 1 and type 2. What's the difference?

Type 1 diabetes, also called insulin-dependent diabetes, occurs when the pancreas makes little or no insulin. People with type 1 diabetes can't survive without daily insulin injections. It used to be known as juvenile diabetes because it's usually diagnosed in children and young adults, but it can strike at any age. Family history increases the risk of developing this type.

Type 2 diabetes, which is more common, occurs when the body can't make use of the insulin it creates, and the pancreas gradually loses its ability to produce insulin. It can develop at any age and is managed with diet and exercise. Being overweight increases the risk of developing this type of diabetes. Sometimes, people with type 2 diabetes will need to take medicines or insulin.

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There's also another form of diabetes, gestational diabetes, which affects some women during the late stages of pregnancy. It's caused by pregnancy hormones or an insulin shortage. Gestational diabetes usually goes away after the baby is born, but it increases the woman's risk of developing type 2 diabetes later in life.

Whatever type of diabetes you may have been diagnosed with, following your doctor's orders when it comes to taking insulin and making lifestyle changes in diet and exercise are important to keep the condition under control and avoid complications.

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Resources

Life's Simple 7® Assessments

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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Track your heart health

To track your blood pressure, blood glucose, weight, cholesterol and more online, visit heart360.org

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Control diabetes

To learn more about diabetes and how to control it, visit heart.org/diabetes

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Get physically active

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

© 2013 by the American Heart Association

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