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Three Ways You Can Reduce the Impact of Cardiovascular Disease this American Heart Month

Most of the readers of this blog know that cardiovascular disease (CVD) is the number one killer of men and women in this country. According to the Centers For Disease Control and Prevention, CVD is a leading cause of disability, preventing Americans from working and enjoying family activities. Out-of-hospital cardiac arrests cause the deaths of an estimated 250,000 Americans each year. CVD costs the United States over $300 billion each year.

Joel Zive

Joel Zive

There are many small but significant actions we can take. Here is what you can do to make a difference: empower or continue to empower patients to take care of themselves.

1. Address the cost of heart medication

If the cost of your medicine is an issue, talk to your doctor or contact a patient assistance program that may be able to help with prescription co-pays.

2. Encourage healthy behaviors

Want people to eat better? Give them coupons for healthy food. Exercise? Give them coupons for short-term memberships to health clubs.

The stakes are higher in our country’s current health care landscape. With more people on health insurance than ever before, we need to do everything we can to empower people to seek help before an emergency and talk to their doctor about what they can do to take better care of themselves. This will have a direct effect on deaths from heart disease.

3. Ask your employer about Automatic External Defibrillators

There are instances in which individuals are dealt devastating genetic hands of cards. Recently, the Philadelphia Inquirer highlighted the plight of a Philadelphia family that had a genetic link to hypertrophic cardiomyopathy, a disease of the heart muscle.

For those who do experience heart issues, or even have a major event such as cardiac arrest, Automatic External Defibrillator (AED) devices can significantly increase the likelihood of survival. AEDs have been available for over 20 years, but in recent years, device makers have reduced the size and cost and increased usability of defibrillators, making public access defibrillation viable. “We believe ease of use is one of the most important qualities in an AED because the potential user may not be well-trained in resuscitating a victim of sudden cardiac arrest,” said Bob Peterhans, General Manager for Emergency Care and Resuscitation at Philips Healthcare. “This is consistent with the American Heart Association’s criteria for choosing an AED.”

While risk factors for CVD are often genetic, the majority of CVD is triggered by factors that are controllable: smoking, diet, and exercise. And this is where individual efforts need to be focused.

For more information on preventing CVD, check out the American Heart Association’s guidelines for taking care of your heart, which are broken down by age. The Centers for Disease Control and Prevention also offer an American Heart Month guide to controlling risk factors for cardiovascular disease. You may also want to check out The Heart Truth, a campaign from the National Institutes of Health to make women more aware of the danger of heart disease.

Read more Real World Health Care heart health-related posts:

Are you taking steps to prevent cardiovascular disease? If you, a family member, or a friend has CVD, what is working for treatment? Share your experiences and insights in the comments section.

The Hospital Fast Food Debate: How a Simple, Low-cost Idea can Improve What People in Hospitals Eat

Back in April 2012, nearly two dozen hospitals that host fast food restaurant chains received a letter from an advocacy group asking them to evict their fast food tenants and to “stop fostering a food environment that promotes harm, not health.” But as it turns out, many of these outlets offer options that are nutritious in addition to unhealthy options, and the same can be said about many hospital-owned cafeterias.  In fact, a review by the Physicians Committee for Responsible Medicine (PCRM) found that some hospitals with fast food vendors also had their own cafeterias with equally unhealthy options.

David Sheon

David Sheon

Meanwhile, some fast food companies, such as McDonalds, have worked hard to improve nutritious options. Others, such as Burger King, should be acknowledged for adding veggie burgers.

Perhaps the debate over having these chains located in hospitals is misplaced. Perhaps the more important factor in helping customers make healthy decisions is labeling nutritious food in an easy to understand manner.

Hospitals appear to be able to convince cafeteria customers to buy healthier food by adjusting item displays to have traffic light-style green, yellow and red labels based on their level of nutrition.

According to a recent report by HealthDay News:

“Our current results show that the significant changes in the purchase patterns … did not fade away as cafeteria patrons became used to them,” study lead author Dr. Anne Thorndike, of the division of general medicine at Massachusetts General Hospital in Boston, said in a hospital news release. “This is good evidence that these changes in healthy choices persist over time.”

As part of the study, labels — green, yellow or red — appeared on all foods in the main hospital cafeteria. Fruits, vegetables and lean sources of protein got green labels, while red ones appeared on junk food.

The cafeteria also underwent a redesign to display healthier food products in locations — such as at eye level — that were more likely to draw the attention of customers.

The study showed that the changes appeared to produce more purchases of healthy items and fewer of unhealthy items — especially beverages. Green-labeled items sold at a 12 percent higher rate compared to before the program, and sales of red-labeled items dropped by 20 percent during the two-year study. Sales of the unhealthiest beverages fell by 39 percent.

“These findings are the most important of our research thus far because they show a food-labeling and product-placement intervention can promote healthy choices that persist over the long term, with no evidence of ‘label fatigue,'” said Thorndike, an assistant professor of medicine at Harvard Medical School.

Perhaps we should worry less about whether food vendors in hospitals are fast food chains, and more about labelling nutritious choices and positioning them to encourage healthy eating. What do you think? Would clear labelling of healthy choices affect the way you eat at hospitals? Would this translate outside of the hospital setting?

Categories: General

World Heart Day Underscores Why Exercise and Diet Count

This year’s World Heart Day on Sunday, September 29 will focus on raising awareness around changes that individuals – especially women and children – can incorporate into their daily habits to reduce the risk of developing cardiovascular disease (CVD).

Paul DeMiglio

Paul DeMiglio

Created in 2000 by the World Heart Federation (WHF) to highlight heart disease and stroke as the world’s leading causes of death claiming 17.3 million lives each year, advocates will educate the public about prevention strategies through talks and screenings, walks and runs, concerts and sporting events.

It is expected that by 2030, 23 million people will die of CVD, more than the entire population of Australia. Together with its members, WHF reports that 80 percent of premature deaths from CVD could be reduced if individuals take the following actions:

  • Reduce or discontinue use of tobacco
  • Eat healthfully
  • Engage in physical activity

CVD can affect people of all ages and population groups, including women and children, as illustrated in WHF’s infographic that also shares practical tips on how to eat more healthfully and exercise more frequently. To teach children about healthy heart living, WHF also created a leaflet along with a character, “Superheart,” that encourages:

  • Playing outdoor games
  • Cycling
  • Eating a diet rich in fruits and vegetables

The American Heart Association (AHA) recommends increasing daily servings of mostly plant-based foods to help improve cardio health, acknowledging that “many studies have shown that vegetarians seem to have a lower risk of obesity, coronary heart disease (which causes heart attack), high blood pressure, diabetes mellitus and some forms of cancer.”

To support better coronary health outcomes, AHA created five goals for healthy eating that encourage individuals to:

  • Eat more fruits and vegetables.
  • Consume more whole grain foods.
  • Use liquid vegetable oils such olive, canola, corn or safflower as your main kitchen fat.
  • Eat more chicken, fish and beans than other meats.
  • Read food labels to help you choose the healthiest option.

AHA also published an info sheet about the warning signs of a heart attack, which often starts slowly and usually goes unnoticed. This is especially true among women, whose symptoms can often mimic those of the flu. Additionally, it is common among women to put others first, especially their children, and so they usually do not recognize symptoms until it is too late. To address this public health challenge, AHA initiated the Go Red for Women campaign to empower women to know their risk, live more healthfully and share their stories.

The primary warning signs of a heart attack remain the same regardless of gender, however:

  • Chest discomfort
  • Discomfort in other areas of the upper body
  • Shortness of breath
  • Breaking out in a cold sweat, nausea or light headedness

Now tell us your story. Do you know anyone who experienced a heart attack or other heart condition? Are you aware of your own risk level? What could you, your friends or loved ones do differently to live more healthfully?

Patient Advocacy Group Shares Solutions to Fuel Greater Participation in Workplace Wellness Programs

Workplace wellness is not a new concept, but it is definitely one that is recently gaining more importance.

With non-communicable diseases on the rise, many people are becoming more concerned about what lifestyle choices can be made to avoid them and stay healthy. Furthermore, businesses recognize the cost of stressed, out of shape, non-productive employees: increased health insurance costs,absenteeism, retention problems, and loss in productivity. Trying to take a more active role in the health of their employees, employers are creating and implementing wellness programs that encourage healthy behavior. Through incentives and rewards, companies are encouraging their employees to make healthy lifestyle choices like eating well and exercising regularly.

Melissa Kostinas

Melissa Kostinas

Despite the benefits of these programs, their success and sustainability can only be achieved through employee participation – which has been a challenging feat for many employers.  Without high participation, programs will result in limited return on investments for employers and might discourage them from implementing other programs in the future.  Because of this risk and the tug of war between cost and benefits, some companies find it too difficult and futile to implement workplace wellness programs.

Fortunately, there are solutions that help employers increase participation. First and foremost, companies should be focusing on the employees themselves – their needs, schedules, and interests – and design programs tailored to these considerations.

Employers should ask their employees: What gets you healthy? What motivates you to do what everyone knows is healthy behavior? We all have reasons for not doing what we know we should – time, access, knowledge, and cost. All these factors contribute to our denial.

Employees are busy, so the more a company can incorporate healthy eating and activity into existing schedules the more likely they are to embrace them. Easy access to workplace wellness programs makes a big difference. Onsite, or nearby programs offered during breaks or outside work hours also are great ways to tackle the time and access excuses.

Information and knowledge, while seemingly obvious, helps to motivate employees too. Of course we know we should exercise, but do your employees know that physical activity helps to prevent back pain?  It increases muscle strength and endurance, and improves flexibility and posture. With this knowledge, maybe the next time they get that twinge in their lower back they might think about exercise instead of painkillers. Providing reduced or no-cost programs will also boost participation rates. Coupled with incentives, like bonuses or rewards (e.g. allowing employees to trade in some of their unused sick days at the end of a year for an extra vacation day), rates of participation are likely to increase.

There are also management steps that can be taken to increase and maintain participation.

Unless employers are committed to employee wellness, the workplace wellness program becomes another ineffective plan that sounded good on paper but never achieved the anticipated results. The executives at Valley Health System understood the importance of managerial commitment. When they created Valley Health Workplace Connection the program managers worked closely with the health system’s managers to make sure all higher-level staff understood the importance of their involvement. Today, Valley Health Workplace Connection is a very successful workplace wellness program with high participation and employee satisfaction.

To ensure such success, workers from all levels should be actively engaged in programs. Planning should include processes to maintain communication with staff and the creation of program committees to guide intervention, observe participation, and adjust programs accordingly.

Additionally, program designers should consider all the major health risks in their targeted population as well as their business’ needs. Different programs should be offered at different levels, depending on characteristics of the recipients. The key is integrating health into the business. Policies governing the workplace wellness program should align with the organization’s mission, vision and values. They must affirm and communicate the value of good health and show commitment to engage workers in health enhancement. Again, a program is only effective if it reaches the intended audience and motivates them.

Pfizer recognized this and found that using programs like Keas got their employees more involved because it was engaging but less invasive. By making wellness a challenge and incorporating games and goals into the plan, Pfizer overcame the primary challenge in any wellness program — participation.

The bottom line is that wellness programs are gaining steam, but there are challenges. Having the support of management and creating a program that meets your employees’ needs will allow your program to overcome those challenges.  Be creative and remember: Wellness can be fun.

Turning DASH Strategy into Reality for Improved Cardio Wellness Outcomes: Part II

As part of their health & wellness program, the largest health insurer sent me a refrigerator magnet highlighting the National Institutes of Health’s (NIH) Dietary Approach to Stop Hypertension Diet (DASH).  In their accompanying letter, the company stated that the refrigerator magnet is a “tool to help you manage your blood pressure.”

Shawn J. Green

Shawn J. Green

The DASH Eating Plan refrigerator magnet was a nice gesture to remind clients to consume less sodium and incorporate more vegetables and fruits into their diet to lower blood pressure.  However, is this the most effective wellness tool to engage and motivate individuals to change their eating habits?

As we learned in last week’s post, plant-based diets – especially those rich in leafy greens, such as spinach and arugula – elevate cardio-protective nitric oxide.  For many pre-hypertensive individuals, staying with a plant-based diet is a critical driver to prevent elevated blood pressure and the diseases associated with hypertension.

Yet many Americans continue to fall far short of eating recommended daily servings of vegetables that elevate natural nitric oxide levels in our body.

A new model is needed to drive behavioral change. So how do we consistently integrate cardio-protective plant-based diets into our daily dietary lifestyle?

Berkeley Test may be a start.

Berkeley Test’s Saliva Nitric Oxide Test Strips and its iPhone Cardio Diet Tracker are designed to break bad habits and empower folks from various walks of life to incorporate plant-based foods into their daily diets.  These engaging tools provide a model to influence dietary change on a personal level that supports lasting compliance with measurable outcomes.

Designed to detect nitric oxide status in the body throughout the day, Berkeley Test developed the next generation proprietary nitric oxide test strip; for less than 70-cents, an easy-to-use, 1-minute saliva test strip enables consumers to make immediate and real-time dietary lifestyle adjustments.

Once users finish the strip test, they can use Berkeley Test’s Cardio Diet Tracker App to compare their results to a color-coded indicator showing whether nitric oxide levels are on target. After 2-3 hours, the user is alerted to check their nitric oxide status.  Users can leverage the Cardio Diet Tracker App to more effectively adhere to plant-based diets by tracking nitric oxide status in conjunction with the type, frequency, and amount of nitric oxide-potent foods eaten to sustain their levels.

Michael Greger, M.D., of NutritionFacts.org, suggests that Berkeley Test may offer hope by bringing plant-based foods into our dietary lifestyle in an engaging fashion. At the very least, it will remind us to eat our greens on a more frequent basis, he says.

Berkeley’s strip-app bundled technologies demonstrate that self-assessing, analyzing, and fine-tuning wellness outcomes with a shared, open, interactive community can be a catalyst to sustain plant-based cardio-protective diets in our daily lifestyle. The value of Berkeley Test’s model is not only demonstrated in how it equips consumers to make healthier dietary choices, but also in its ability to connect users by allowing them to share dietary successes with their Facebook friends.  In today’s society, wellness outcomes and fitness is highly social and valued.

Individuals – who range from Olympians seeking to boost their physical endurance to baby boomers looking for an easier way to eat healthfully and prevent high blood pressure – are embracing these innovations.  As more people turn to Berkeley’s strip and mobile App to improve adherence to plant-based diets, such as DASH and Ornish, natural communities of mutual support are growing.  These networks offer a unique venue to share experiences, provide strategies for success and a forum to discuss common challenges, refine approaches and achieve desired outcomes.

A dynamically open community to share new knowledge about wellness and create a model for achieving and maintaining healthy living and eating is what we hope Berkeley’s ‘health biomarker’ test strips (such as nitric oxide and mobile App combo) provides.

So, what is your nitric oxide level, today?

More Patients DASH to New Solution to Reduce High Blood Pressure: Part I

Shawn_J_Green

Shawn J. Green

What’s the solution to reversing the tide of hypertension, the most commonly diagnosed condition in the United States?  More evidence indicates that the answer begins with the food choices we make every day.

An underlying cause of heart attacks, strokes and kidney disease, one in three American adults now experiences high blood pressure – the single-largest contributor to death worldwide. It is also becoming more resistant to the pharmaceutical drugs used to lower it. In fact, blood pressure remains elevated in nearly one-third of all treated hypertensive patients on pharmaceutical drugs.

Instead of relying on prescriptions, more patients are turning to a healthier eating approach: Keeping sodium intake low and making consumption of nitric oxide-rich vegetables and leafy greens high. This cardio-protective daily diet, known as the DASH (Dietary Approach to Stop Hypertension) Eating Plan, is emerging as an effective way to delay or prevent high blood pressure altogether.

The value of nitric oxide was spotlighted when the Nobel Prize was awarded in 1998 for discovery of this naturally produced cardio-protective factor. A string of clinical studies underscored that vegetables (like red beet roots) and leafy greens (such as spinach and arugula) are replete with nitric oxide.

Diets known for promoting heart health and lowering rates of diabetes and obesity – like Japanese diets, Mediterranean diets and plant-based diets, such as DASH, among others including TLC, Ornish, and Pritikin – incorporate these natural whole foods. The need to consume more nitric oxide-potent vegetables and leafy greens becomes even more critical as we age because our bodies are less able to synthesize this natural hypertensive-fighting factor.

Reducing hypertension would not only improve health outcomes for individual patients, but would also benefit the health system as a whole. Although the percentage of resistance to antihypertensive drugs is relatively lower in the U.S., elevated blood pressure among a rapidly growing number of baby boomers will mean more challenges for health care in the long run unless we identify tools that work and make them as accessible and user-friendly to the public as possible.

DASH holds great promise to fuel compliance – a critical driver to prevent elevated blood pressure – among those living with hypertension. But a healthful eating strategy alone will not mean better outcomes for patients without a model to help them break bad habits and support dietary changes on a personal level, one day at a time.

So how do we get there?

Join us here next Thursday for the second post in our two-part series. Discover what innovative tools can empower patients to make the DASH Diet a part of their arsenal in the fight against hypertension.

Good for Your Body and Your Budget

Does stocking your shelves with nutritious foods always mean breaking your budget at the grocery store or local market? You probably think the answer is yes, but what we found might shock you.

Paul DeMiglio

Paul DeMiglio

Dawn Undurraga, a consulting nutritionist for the Environmental Working Group (EWG) and registered dietitian, tells a different story: Purchasing healthy foods and saving money can go hand in hand.

“Maintaining a delicious diet that’s good for you and the planet doesn’t have to be expensive,” she says. “You can eat 5-9 servings of fruits and vegetables for less than the cost of a bus ride, for example. But people need the tools to help make this happen.”

And that’s exactly what the EWG “Good Food on a Tight Budget” free shopping guide provides, to help people eat cheap, clean, green and healthy.

“We focused on the things that you can do and the changes you can make to save money,” Undurraga says, based on recent data from the U.S. Department of Agriculture (USDA) as well as feedback from groups that have on-the-ground expertise empowering consumers to navigate through the issues surrounding tight budgets, like Feeding America and Share Our Strength.

This guide includes lists that open the door to purchasing foods with the most nutritional value for the lowest price, including 15 practical recipes that on average cost less than $1.

Tips enable shoppers to spend their dollars smartly, specifying which items are best to purchase frozen (like corn) or fresh (like lima beans), as well as how to prepare dishes at home and how to make your foods last longer.

One key recommendation for saving money on a nutritious eating regimen is to plan meals ahead, budget your time while shopping and to know what you want at the store beforehand.

“When you do, you’ll find you waste less food. Not wasting food by having a good plan can save you money too. When you shop with a meal list and a timeline, you can get in and out of a store quickly,” without going outside your budget by getting distracted and purchasing less healthy foods you don’t want or need, Undurraga explains.

The EWG created “Good Food on a Tight Budget” based on specific measures to establish the amount of pesticides that the foods contain, also comparing and rating the foods to organize the guide on a balance of five factors.

  • Beneficial nutrients
  • Nutrients to minimize (i.e. sodium)
  • Price
  • Extent of processing
  • Harmful contaminants from environmental pollution and food packaging

The USDA also underscores that planning your meals for the week and doing an inventory of foods you already have before making a list are essential. They also encourage buying non-perishables in bulk during sales and to purchase foods in season to get the lowest prices while optimizing freshness.

Similar strategies for making healthy shopping choices on a budget can also be found herehere and here.

All the research, planning and preparation involved in being a selective shopper might seem daunting at first, but the payoff to your health and budget is worth the investment.

“There’s so many ways to put together a diet. The shoppers who often make the most of their budget are those already on a tight budget. It’s tough but possible,” when you incorporate approaches that work best for you, Undurraga says.

Have you used any of these tips when grocery shopping? Did they help make it easier to purchase healthy foods and stay within your financial means? Tell us why or why not.

Categories: Cost-Savings

Take a Vacation from Guilt with Practical Tips for Healthful Eating

Worried that your upcoming summer getaway will mean overindulgence and more hours on the treadmill? Well you might be relieved to find out that coming home from your next trip doesn’t have to mean running away from the scale.

Paul DeMiglio

Paul DeMiglio

Following a few simple, evidence-based eating strategies will equip you with the tools you need to make healthy choices, burn calories and still have a great time while you’re away.

And guess what? Keeping off the unwanted pounds doesn’t mean having to disrupt your vacation time by spending long hours at the gym. In fact, maintaining good eating habits can even open new doors to trying exciting foods with friends and family.

The Academy of Nutrition and Dietetics, the world’s largest organization of food and nutrition professionals, recommends integrating the following steps when taking trips near and far:

  • Enjoy high-calorie foods by sampling them in small amounts. 
  • Share large-portioned meals – which abound in places like restaurants – with your travel companions.
  • Break up your meals throughout the day.
  • Make physical activity part of your plans in simple ways, even if it just means walking to some of your favorite destinations instead of taking the car or using the stairs instead of the elevator at your hotel.

Sharing high-calorie foods is a tip that WebMD’s Expert Columnist Elaine Magee, MPH, RD also recommends when it comes to having dessert:

“Part of being on vacation is enjoying life, and part of enjoying life is ordering dessert when you really want to. If your meal has left you satisfied, you can take your dessert with you and enjoy it later when you are hungry again. You can also share your dessert with one or more dining partners, either at the table or later on.”

The American Diabetes Association (ADA) also agrees that spacing out your meals to several each day boosts weight management, often helping to decrease hunger and reduce the number of calories consumed each day.

If you’re going on a road trip, the Academy says to pack 100-percent fruit juice or bottled water along with easy snacks you can store in your cooler that include fresh fruits and vegetables, deli sandwiches, bean salad or pasta salad.

“When traveling, the key is to plan ahead,” said Angela Lemond, Registered Dietitian Nutritionist, Speaker, Wellness Coach and Spokesperson for the Academy of Nutrition and Dietetics. “Look at the day or week ahead of you, and see what the situation allows for you when it comes to eating right.  Plan for unexpected delays or changes in your schedule by packing plenty of snacks.  If you can keep your hunger level controlled, it is much easier to make the right food choices.”

Last week when I went to Rehoboth for a fun getaway with friends, I found that putting some of these tips into practice was easy to do while on the run.

Instead of driving to the beach, for example, we walked there and back as a group. When trying out area restaurants, we sampled desserts and ordered large dishes to share – which actually turned out to be more interesting because we could enjoy a wider selection of food with much less guilt.

So relax, enjoy yourself, and remember that cutting down on calories doesn’t have to mean cutting out the fun during your next excursion.

Say Goodnight to Unhealthy Diet Habits for Better Sleep

Are you having trouble getting enough zzz’s? If so, it might be time for a quick inventory of your bed-time diet to avoid another round of tossing, turning and sleep deprivation come the next day.

Paul DeMiglio

Paul DeMiglio

Although a variety of health factors play a role in the duration and quality of your sleep, watching what you eat and drink is a good place to start.

Avoid going to bed hungry, but don’t eat a heavy meal either.
Having a light snack a few hours before bed helps your body achieve the hormonal balance it needs to fall asleep, especially for many of those with insomnia. Antonio Culebras, MD, neurology professor at the State University of New York Upstate Medical University in Syracuse, says the following snacks are healthy choices before you hit the sheets:

  • Small bowl of cereal and milk
  • A few cookies
  • Toast
  • A small muffin

Be careful, though. Heaping on the portions will put your digestive system to work and risk keeping you up later as a result. Diabetes patients should discuss any diet regimen with a doctor first.

Stay away from alcohol or caffeine.
This doesn’t just mean the usual suspects like coffee and soda, but also extends to less-obvious options including chocolate, non-herbal teas, diet drugs and even some pain relievers.

Drinking matters.
One too many cups of your favorite beverage might mean more disruptive late-night trips to the bathroom.

Good diet choices are a step in the right direction to sleeping better, feeling better, and even saving health care costs. With 60 million Americans experiencing sleep disorders or sleep problems, the National Institutes of Health (NIH) estimates associated medical expenses to be  $16 billion annually.

Have you tried to change your bedtime eating habits? Did it help you sleep? Share your story.

Not So Fast! Chews Your Bites Carefully.

Paul DeMiglio

Paul DeMiglio

You might ask what gulping down your meal has to do with health. Well, the reason could lie somewhere in your middle.

Proper diet and exercise are critical ingredients to successful weight management, but there’s even more to the story. When you have your next meal, remember that fewer bites might mean more calories consumed and a snugger fit into your swimsuit this summer.

The New York Times did our homework for us in a May 6 story by C. Claiborne Ray:

“Long-term effects of fast eating on weight gain were examined in a 2006 Japanese study using questionnaires filled out by 3,737 men and 1,005 women. The faster they reported eating, the higher their reported body mass index and the greater the increase since the age of 20.”

Do you agree? Does fast eating have something to do with putting on more pounds? Share your story below.

This post is the first in a series of tips we will share for watching what and how you eat.