Lifestyle

Nutritional Guidelines

Making the best nutritional choices can be difficult, especially when we are bombarded with information regarding the latest fad diets and programs. We find that, in general, Americans are overeating, decreasing their exercise, and restaurants are typically serving 3 times the recommended portion size of food. This is leading to an epidemic of obesity, diabetes, and hypertension in our communities and families. Good nutrition should be simple and easy to follow. The guidelines outlined below are for everyone age 2 and older, even people with diabetes. It is important you study and understand the recommendations and apply it to your daily routine. Sometimes changing can be overwhelming, start with one aspect such as decreasing portion sizes. Each portion of food at each meal should be no greater than the size of your fist. Once you are eating less, then focus on what you are eating. Continue to modify and make adjustments to fit your lifestyle; you and your body will appreciate the benefits. 

Water: 

Drink plenty of water. If you are not urinating every hour throughout the day then you are not drinking enough water. This may be more than the traditional 8 or 9 glasses that are traditionally recommended. 

Breakfast:

This is the most important meal of the day. Enjoy it! Use this time to eat a well-balanced meal that consists of your favorite health and low sugar breakfast foods. Your body uses the food you eat for breakfast to jumpstart your day. 

Lunch: 

Lunch is considered by many to be the main meal of the day. A well-balanced and healthy lunch keeps your body going throughout the day and well into the night. Eat your protein at this meal.

Dinner: 

Dinner should be your smallest meal of the day. When we eat a heavy meal late in the day, our bodies become stressed because we spend time digesting instead of sleeping. Options may be small amounts of carbohydrates like half a potato, a small cup of soup or a half a sandwich for quick digestion. No protein should be eaten in the late afternoon or early evening, at least four hours before retiring. 

Alcohol:

Drinking a glass of wine or other beverage, one in the evening, 4 to 5 times a week is acceptable. 

Vitamins: 

There are many products available, all claiming to be the best. We don’t promote any particular brand only that it contains at least our recommended dosages and doesn’t contain iron. Vitamin C-500mg/day, Vitamin D-800 IU’s/day, Folic Acid 0.8mg/day, Fish oil (Omega 3) 1000mg MWF, B12 injection once a month. Niacin (E.R. not non-flushing) start 100mg and increase to 500mg/night as tolerated (take 72 hour after aspirin if having problems with flushing), Aspirin 81mg/night, Cinnamon (table spice) 1:-1 tsp/day. 

Dairy: 

Avoid milk and cheese. Milk contains hormones, fat and can cause intestinal irritation. Replace with soy or rice milk, yogurt (non-fat), occasionally. No use of butter or margarine. Use olive oil as a replacement as much as possible. 

Meats: 

2(2-4 oz, fist size) servings/week. Meats include chicken, beef, turkey, lamb & pork. 

Fish:

3(2-4 oz, fist size) servings/week. See Fish/Mercury sheet for recommended fish. 

Beverages:

For better digestion, a minimal amount of beverage should be taken with meals. In addition, beverages should be taken 30 minutes before, or two hours after your meal. 

Eat breakfast like a king, lunch like a prince, and dinner like a pauper! 

Use the following meal and portions guide to plan your daily intakes. 

Meal and Portions Guide 

Breakfast: 

Main Item: (choose one per meal) 

• Multigrain Cereal, oatmeal, cream of wheat, etc.
• Egg whites or egg substitute

Others (one each):

• Fresh Fruit
• Corn or wheat tortilla (low or non-fat)
• Whole grain toast 
• Coffee or Tea (green tea)
• Milk Substitute

Lunch: 

This may be your largest meal of the day!

Main Item: (Choose one per meal) 

• Meats- chicken, turkey, beef, pork, or lamb
• Fish- trout, tuna, salmon, or sardines
• Soup (broth based, not creamed), stew

Carbohydrate: (Choose one)

• Pasta or Bread (whole grain)
• Rice (brown or wild), or beans
• Sweet or baked potato

Other: (One each)

• Vegetables
• Salad- Lettuce varieties
• Fresh Fruit

DINNER: 

This should be your smallest meal of the day! 

Main Item: (Choose one)

• Pasta (whole grain)
• Rice (brown or wild), or beans
• Sweet or baked potato
• Soup or stew

Others: (One each)

• Vegetables
• Salad (greens only)
• Fruit 

SNACKS: 

Snacks should be eaten 3 times a day between breakfast and lunch, lunch and dinner, and occasionally after dinner. Portion size should be approximately one handful. Healthy snacks are important in preventing extreme hunger at meals. Feeling hungry can lead to overeating. 

• Raw vegetables- carrots, celery, broccoli, cucumbers, green beans, or cauliflower.
•  Fresh fruit-cut in slices or halves, such as apples, oranges, bananas, peaches, grapes, melons (avoid grapefruit because of multiple medication interactions).
•  Low fat, whole wheat muffins, pumpkin, banana, or zucchini bread. 
• Non-sugared whole grain cereals, snack mixes with low salt, pretzels, popcorn. 
• Non-fat yogurt with fresh frozen fruit and walnuts. 
• Shakes made with fresh or frozen fruit and nonfat soy, rice or organic milk. 
• Nuts-soy, walnuts or almonds (unsalted preferred). 
• Whole wheat crackers-triscuits, wheat thins. 
• Un-buttered, low salt popcorn microwave. Can make yourself, on stove, using a small amount of olive oil. 
• Rice cakes-plain 
• Granola- low sugar (dried fruit but no candy) 
• Sorbet- occasionally 1/2 cup 

Fish, Levels of Mercury and Omega-3 Fatty Acids 

Fish is a good source of protein and, unlike fatty meat products, it’s not high in saturated fat. It’s also a good source of omega-3 which benefits heart health. 

The American Heart Association recommends eating fish at least twice a week. However, some types of fish may contain high levels of mercury, PCBs (polychlorinated biphenyls), dioxins and other environmental contaminants. Levels of these substances are generally highest in older, larger, predatory fish and marine mammals. Levels of mercury and omega-3 fatty acids for various fish and shellfish are : 

The benefits and risks of eating fish vary depending on a person’s stage of life. 

• Children, pregnant and nursing women usually have low CVD risk but may be at higher risk of exposure to excessive mercury. Avoiding potentially contaminated fish is a higher priority for these groups.

• For middle-aged and older men, and women after menopause, the benefits of eating fish far outweigh the risks within the guidelines of the FDA and Environmental Protection Agency.

• Eating a variety of fish will help minimize any potentially adverse effects due to environmental pollutants. 

Top 10 fish and shellfish consumed in the United States 

Other common seafoods 

Fish with the highest levels of mercury (about 1 ppm Hg) 

Advice from the FDA

Women who are pregnant, planning to become pregnant or nursing to — and young children — should not eat these fish. Everyone should limit themselves to 7 ounces of high-mercury fish per week. 

Fish with about 0.5 ppm Hg 

Advice from the FDA 

Minimizing exposure to methylmercury is particularly important for pregnant women, women who are planning to become pregnant, nursing women and young children. These people should limit their consumption of all fish with much lower mercury levels than 1 ppm. The guideline for them is 12 ounces per week (about 3 to 4 servings). Other people can eat 14 ounces a week of fish with mercury levels of an average of 0.5 ppm. 

Related AHA publications: 

• An Eating Plan for Healthy Americans… Our American Heart Association Diet 
• Easy Food Tips for Heart Healthy Eating (also in Spanish)

Detailed Research 

AHA Scientific Statement Fish Consumption, Fish Oil, Omega-3 Fatty Acids and Cardiovascular Disease, #71–0241 Circulator 2757 

AHA Scienunc Statement AHA Dietary Guidelines: Revision 2000, 71-0193 Circulation. 2000.102:2284-2299, Stroke. 2000;3 

Environmental Protection Agency’s National Listing of Fish and Wildlife Advisories, www.epa.govhaterscienceliah 

U.S. Food and Drug Administration’s list of mercury content of selected fish, www.ctsan.fda.govt-fifisee–mehg.html 

USDA Nutrient Laboratory, hatto:/www.nal.usda.gov/fnic/foodcomp http://www.americanheart.org/presenter.jhtml?identifier=3013797 

5/27/2004 

IRON RICH FOODS 

Exactly What Other Foods Rich in Iron Will Help Me the Most?

Eat more food containing Vitamin C. Vitamin C enhances the absorption of iron into your body. This is very helpful if you are a vegetarian. Vegetarians consume less iron because they obtain it from plant sources. Some plants contain chemicals that bind the iron rendering it more easily absorbed. You can also counteract this by eating foods high in calcium. Calcium binds the chemicals that make iron more easily absorbed. You can still obtain iron from vegetables. Foods such as beans, whole grains, spinach, and dried fruits have a significant amount of iron. 

Eat a lot of iron rich cereal. Many cereals are fortified with iron. Check the food label on the box and look for iron under the daily values. 

You should also avoid drinking tea with your meals that are high in iron. Tea contains tannin that could inhibit the absorption of iron. 

A good policy is to monitor what you eat. You must know exactly what your diet is, having a brief written food intake list, if you wish to enhance or improve it. 

Some Good Sources Foods Rich in Iron* (Dietary Iron) are: 

Iron(mg.)

A Sample List of Foods Rich in Iron:

*Varies with the brand. Check the iron content on the label

**Pregnant women should not eat liver because of its very high Vitamin A content. Large Amount of Vitamin A can be harmful to the baby. 

What Else Can I Do to increase Iron in My Blood?

Again, if all else fails, take an iron supplement or a multivitamin with iron. Though vitamins could cause side effects such as constipation and nausea, the proper balance of iron is easily achieved, and the rewards for your efforts are great. You can alleviate most of the problems by consuming the iron supplement on a full stomach. In addition, make sure drink plenty of fluids and eat plenty of fiber rich vegetables. 

Why Shouldn’t I Smoke? 

List of Diseases and Other Adverse Health Effects 

for Which Smoking Is Identified as a Cause in the Current Surgeon General’s Report 

Cancer

• Bladder Cancer 
• Cervical Cancer 
• Esophageal Cancer 
• Kidney Cancer 
• Laryngeal Cancer
• Leukemia 
• Lung Cancer 
• Oral Cancer
• Pancreatic Cancer 
• Stomach Cancer
  

Cardiovascular Diseases 

• Abdominal Aortic Aneurysm 
• Atherosclerosis
• Cerebrovascular Disease 
• Coronary Heart Disease
  

Respiratory Diseases 

Chronic Obstructive Pulmonary Disease 

Pneumonia 

Respiratory Effects in Utero 

Respiratory Effects in Childhood and Adolescence such as impaired lung growth, early onset decline in lung function, coughing, phlegm, wheezing, dyspnea, and asthma symptoms 

Respiratory Effects in Adulthood: decline in lung function 

Other Respiratory Effects: coughing, phlegm, wheezing, dyspnea, poor asthma control 

Reproductive Effects 

• Sudden Infant Death Syndrome 

• Reduced Fertility

• Low Birth Weight

• Pregnancy Complications: Preterm delivery, shortened gestation 

Other Effects 

Cataract 

Hip Fractures 

Low Bone Density 

Peptic Ulcer Disease

Diminished Health Status/Morbidity: increased absenteeism from work; increase use of medical services; adverse surgical outcomes related to poor wound health and respiratory complications 

Why Should I Quit Smoking? 

Summary of the Benefits of Smoking Cessation Over Time 

Time Since Quitting Smoking- Benefits 

2 Weeks to 3 Months-Improvements in pulmonary function, circulation, and ambulation

1 to 9 Months-Restoration of ciliary’s function of the lung epithelial cells; may result in temporary increase in coughing as lungs clear excess mucus and tobacco smoke particles 

Over Time-Measurable improvements in lung function: decreased coughing, 

sinus congestion, fatigue, shortness of breath, and risk of pulmonary infection

1 Year- Excess risk of coronary heart disease is reduced by half that of continuing smokers

5 to 15 Years- Risk of stroke is reduced to a rate similar to lifetime nonsmokers

10 years- Chance of dying from lung cancer is half that of continuing smokers. Also, risk of developing mouth, throat, esophagus, bladder, kidney, or pancreatic cancer is decreased

15 Years- Risk of coronary heart disease is reduced to a rate that is similar to nonsmokers

How Do I Quit Smoking? 

Summary of Cognitive and Behavioral Tobacco Cessation Counseling Strategies 

Strategy: Cognitive Approaches 

Commitment to Quit- Verbalize out loud that you want to be a nonsmoker and that you will overcome temporary temptations

Distract Thought Pattern- Think about something else when the urge to smoke occurs 

Think Positive- Smokers should give themselves “pep talks” to keep on track despite obstacles they may face

Relaxation Through Imagery- Focus thinking on positive, relaxing images

Rehearse Responses to Possible Scenarios- Practice how to react when temptations arise, such as if at a social gathering where there are other smokers, or if someone offers a cigarette 

Strategy: Behavioral Approaches 

Coping With Stress- Rehearse coping strategies to deal with work, school, or with family stresses, e.g, taking a walk, deep breathing, call a friend for support, of massage

Alcohol –  Alcohol use can lead to relapse so patients should be advised to limit or abstain from drinking, especially in the early stages of trying to quit 

Other Tobacco Users – Try to limit exposure to fellow family members, co-workers, and friends who are smoking. Encourage them not to smoke in your presence

Satisfying Oral Gratification Urges – Keep non-tobacco oral substitutes on hand, including gum, sugarless candy, straws, bottled water, or a nicotine therapy replacement

Break Automatic Smoking Routines- Identify situations when smoking is often part of everyday activity and try to displace the smoking behavior from the routine. For example, smoking while drinking morning coffee-take a walk after breakfast; driving-have car detailed and aired out to remove all signs of cigarettes in the vehicle such as ashtrays, etc. and have some gum handy when you drive; telephone-keep hands busy, walk and talk, limit length of call; after meals- don’t linger at the table, call a friend

Post-cessation Weight Gain-Can be a barrier to quitting so address the issue, encouraging healthful eating with increased fruits and vegetables, adequate water intake and a modest exercise program; moderation is the key

Tobacco Cravings- Usually temporary, 5-10 minutes in duration; encourage distractive behavior and thinking 

Long Walks

We commonly recommend long walks or other forms of aerobic exercise. This is because after walking for an hour, a natural production of nitric oxide occurs. Walking for an hour a day, especially outdoors if possible, can show large increases in vascular health and moods.

Its Importance to our Practice

Your vascular health is a large concern in our practice. Our practice is familiar with reversing cardiovascular diseases such as diabetes. We accomplish this with your help in maintaining your daily aerobic exercises and nutritional diet.

Vascular Diseases

Cardiovascular diseases include stroke, heart attacks, cardiac arrest, and coronary artery disease which combined account for over a million yearly deaths in the US. There are even more cardiovascular diseases and risks for even more diseases. Recent research shows a link between vascular health and the risk for Alzheimer’s.

Potential cardiovascular diseases include:

• Stroke
• Heart attack
• Diabetes
• Arrhythmia
• High blood pressure

Funciton

Nitric oxide is released from the inner lining of the blood vessels. Once released it communicates with other cells to open the blood vessels, lowering blood pressure. It behaves as a messenger, the more it is present in the body the more the blood vessels open. This function is referred to as a vasodilator.

Nitroglycerin

When people have a heart attack, typically a dosage of nitroglycerin is prescribed to them. The body turns nitroglycerin into nitric oxide for the chemical to be functional. Nitric oxide is given because it functions to open the blood vessels, reducing blood pressure and allowing blood to flow with minimal resistance throughout the body.

Research

Recent research has shown the use of a Viagra-like drug to treat systolic heart failure. The drug, tadalafil, increases the effects of nitric acid by stopping an enzyme that destroys nitric acid products. The treatment used the same dosages to treat erectile dysfunction.

Stress

Exercise has been known to treat symptoms of stress. This is because of nitric acid countering the effects of cortisol. Cortisol, the hormone released when stressed, causes a rise in blood pressure and other potential cardiovascular disease risks. Nitric oxide lowers blood pressure.

Depression

Research is being done on nitric oxide based antidepressants. The reasoning is that nitric oxide has been found to inhibit serotonin reuptake enzymes. This means serotonin, a happy chemical, stays in the body longer. However, nitric oxide can be naturally produced.