Tags: arteries, coronary arteries, coronary heart disease, Diabetes, Diabetes management, healthy lifestyle, heart disease, heart health, heart month
By Aparna Mani, MD, PhD
MGH Medical Walk-In Unit
The heart is an amazing organ. From the time we’re embryos until the day we die our hearts are constantly beating, ticking away at sixty to one hundred beats per minute. The heart is the organ in the human body we most commonly associate with emotions and passions. We can actually feel it beating fast with excitement and slowing down as we rest, sleep and dream. How do we take care of such an important organ? We can best answer this question by taking a close look at what can go wrong with the heart.
The American Heart Association estimates that approximately 600,000 people die of heart disease in the United States each year. What we most often mean when we talk about heart disease is actually coronary heart disease. The heart is a muscular organ and just like any muscle its shape and form directly affect its ability to do its job: pumping blood carrying oxygen and nutrients to every inch of the body. And just like every other organ, the heart muscle needs the right nutrition and care to work properly. It gets its vital nutrients and oxygen not from the blood it holds and pumps out, but from blood that travels in vessels lying along its outer walls (these vessels are called the coronary arteries). If you were to look straight on at the heart, you would see these vessels wrapping like ivy on the heart’s surface.
The coronary arteries need to remain clean so that blood can flow freely through them to nourish the heart muscle. Atherosclerotic plaque, a mixture of cholesterol and other debris which can stick to the walls of the coronary arteries, can interfere with the delivery of nutrients to the heart. In certain spots the lump of sticky plaque can build up to such a degree that it limits or even blocks blood flow through a particular artery. When this happens, the portion of heart muscle that depends on the blood supply from this artery becomes unhealthy, weak, and can even die. But the heart depends on every single muscle fiber to be healthy and strong in order to pump well, so bad blood flow through even a single coronary artery can potentially affect the heart’s important squeezing ability and cause heart disease.
A lot of research has gone into figuring out how to prevent and even get rid of plaque build up in the coronary arteries. Since a major component of plaque is cholesterol, it’s thought that a low cholesterol diet is a key factor for preventing coronary plaque formation. In addition to diet, smoking and high blood pressure can increase the chances of plaque formation. For unclear reasons, people with diabetes seem to be more prone to developing coronary plaque as well.
Health care providers may recommend aspirin, blood pressure, or cholesterol lowering medications for good heart health. Maintaining a healthy diet low in sodium and cholesterol, exercising regularly, maintaining a healthy weight, keeping your blood sugar in good control and quitting smoking can also help prevent plaque buildup and resulting heart disease. So take this moment to listen to your heart and talk with your health care provider about taking steps toward beating heart disease.
Tags: balance, cholesterol levels, hdl and ldl, healthy lifestyle, heart health, what is cholesterol
By Aparna Mani, MD, PhD
MGH Medical Walk-In Unit
We hear about cholesterol almost as often as we hear about the weather on the news these days – but what is it really and why is it such a hot topic? Cholesterol is actually a type of fat particle that travels around in the bloodstream. It’s true that we get cholesterol from food, but our body also makes its own cholesterol in the liver. In fact, the liver can produce all the cholesterol our body needs even if we do not take in any cholesterol from our diet. Foods that are high in cholesterol include mostly animal sources like meats, eggs, fish, poultry, and dairy products like whole milk and butter. Plant-based foods like fruits, vegetables, tofu and grains contain little to no cholesterol.
So what do we need cholesterol for? Well, cholesterol is used for a couple of different things. It’s a component of the outer layer of all of the cells in our body, it helps to make vitamin D and hormones like estrogen and testosterone, and it helps in the digestion of fats in the intestine.
What’s the story about the good versus bad cholesterol? To understand this a bit better, we need to take a closer look at how cholesterol gets around the body. Because cholesterol does not mix easily with blood, it’s carried around in the bloodstream by a particle that acts as a kind of vehicle called a lipoprotein. There are several types of lipoproteins, but the ones you have probably heard of are HDL and LDL. The LDL particles carry cholesterol around and deliver it wherever it’s needed in our body. However, if we have too much LDL, the excess cholesterol can be deposited on the walls of our blood vessels.
Why is this a bad thing? The deposits of cholesterol in the coronary arteries, the blood vessels that supply our heart, can form plaque. It’s exactly this plaque that can eventually rupture and cause a blockage in a coronary artery, leading to a heart attack. This is why LDL is often referred to as ’bad’ cholesterol. But let’s look at another particle: HDL cholesterol. What makes HDL different is that instead of depositing cholesterol in various parts of our body (including blood vessels), it picks up any extra cholesterol that is lying around and brings it back to the liver. The liver can take this extra cholesterol and either make it into something useful or recycle it. This is why HDL is referred to as ‘good’ cholesterol.
The balance between LDL and HDL in our body is important. We want to keep the levels of LDL low and the levels of HDL high so our body can function well without creating too much cholesterol or plaque build-up in our blood vessels. Some of us might have a genetic predisposition that determines our LDL and HDL levels, but we also have a role in striking this balance through diet and lifestyle. By eating a diet rich in fruits, vegetables and grains we can keep our LDL low. Healthy activities such as exercise and refraining from smoking also help to strike the right balance between HDL and LDL cholesterol. Some of us may need medications to modify our cholesterol levels in addition to following healthy habits. According to the American Heart Association, adults should get their cholesterol levels checked periodically so their health care provider can make recommendations for keeping their cholesterol levels in good balance.
Tags: blood clot, Diabetes management, heart health, lifestyle, prevention, stroke, TIA, warning signs
By Aparna Mani, MD, PhD
MGH Medical Walk-In Unit
It’s thought that the medical term stroke comes from ancient Greek for ‘struck down’. This meaning makes sense when you think of what happens when someone suffers the symptoms of a stroke. They may experience sudden weakness, numbness or paralysis of the face, arms or legs, a sudden loss of vision, difficulty speaking or an inability to understand speech. Our brains are responsible for all of these specialized, unique functions. Blood vessels carry oxygen-rich blood and glucose to the brain cells, powering them to do this work. With a stroke, there is a sudden block in the flow of blood through the arteries that supply blood to the brain.
This sudden ‘block’ in flow most commonly happens due to a clot getting stuck in an artery, or bleeding of the artery itself. When this happens, the blood flow is interrupted, and the cells in the affected area of the brain don’t get the oxygen and glucose that they need to function. If the blockage clears and blood flow resumes within a very short period of time, the patient may have had a transient ischemic attack (TIA) or ‘mini-stroke. If, however, blood flow does not resume for a longer period of time, the brain cells will start to die. A person suffering a stroke will show symptoms based on the specific portion of the brain that has bad blood flow. Emergency care is required for both strokes and TIAs. Doctors may use a CT scan or MRI to get an image of the brain to assess someone who has symptoms of a stroke. Depending on the time that has elapsed since symptoms began, doctors may be able to intervene and restore good blood flow to the brain.
Risk factors for stroke include high blood pressure, smoking, high cholesterol, family history of stroke, age, obesity and diabetes. Stroke prevention begins with a discussion of your personal risk factors with your doctor. By recognizing these personal risk factors you and your doctor can come up with strategies for lifestyle changes and medications to reduce your risk for stroke.
Strokes can have serious consequences and can lead to permanent brain damage, long-term disability and death. In fact, Strokes are one of the leading causes of death in the United States today. Know the signs: watch out for sudden weakness, numbness, paralysis, and difficulty with speech or vision. If you or someone you know has any symptoms of a stroke, Call 9-1-1 immediately. With fast treatment, it may be possible to avoid the long-term consequences of a stroke. Remember, time is of the essence and every minute counts.
Aparna recently finished an internal medicine residency at Mass General and sees patients at the hospital’s Medical Walk-In Unit.
Tags: alcohol, heart disease, lifestyle, lifestyle change, moderation, red wine
Lifestyle plays such an important role in managing chronic disease like hypertension. Making healthy diet choices—eating more fruits and vegetables, reducing sodium—and exercising regularly are both key components of a healthy lifestyle, as is quitting smoking. But many may wonder if (and where) alcohol fits in to this.
Here’s the good news: moderate drinking can be part of a healthy lifestyle. In small amounts, alcohol may actually lower blood pressure slightly. And, some types of alcohol are recognized for potential health benefits. Red wine, for example, has developed a bit of a reputation for promoting heart health. Antioxidants in the wine can help raise HDL or “good” cholesterol which can, in turn, lower the risk of developing heart disease.
Now for the bad news: while a little bit of alcohol may lower blood pressure, drinking too much can raise blood pressure. Not only that, but alcohol can interfere with many medications, making them less effective. And finally, all alcohol contains calories which can contribute to weight gain.
The key thing to remember is drinking is fine in moderation. Moderate drinking is defined at no more than 2 drinks a day for men and 1 drink a day for women (a “drink” is 12 oz of beer, 5 oz of wine or 1.5 oz of liquor). If you choose to drink, be mindful of how much alcohol you’re consuming. If you don’t drink, the best advice is: don’t start—you can get the health benefits of alcohol in other ways (like diet and exercise). Talk to your healthcare provider if you have any questions about alcohol or your alcohol use.
(Post content reviewed by Mass General Cardiologist. Photo credit: Trish Hughes)
Tags: good fats, heart health month, olive oil, saturated, unsaturated
Remember the big “low-fat craze” of the 1990’s? It seemed like every magazine was proclaiming the dangers of fat in the diet, no-fat diet books filled the bookstores, and supermarkets began carrying a variety of fat-free chips and cookies. All of this was based around the idea that fat is bad for you, and eating healthy meant avoiding it whenever possible.
Tags: BMI, heart health, weight management
We use a lot of acronyms and abbreviations in our modern world. LOL—laugh out loud; ASAP—as soon as possible; TTFN—ta ta for now. Here’s another one you may be familiar with: BMI.
Body Mass Index (BMI) is a simple calculation used to determine if a person’s weight is appropriate for their height and is a fairly reliable estimate of body fat for most adults. You can easily find your BMI using a calculator like this one from CDC. A BMI between 18.5 and 24.9 is considered normal; anything below 18.5 is classified as underweight. Along the same lines, a BMI between 25 and 29.9 is considered overweight and, taking it one step beyond, anything above 30 is considered obese. Because there is a connection between weight and some chronic diseases, BMI is often used as a screening tool to identify potential risk for developing conditions such as hypertension, Type 2 Diabetes and stroke.
However, BMI does have some limitations. For starters, BMI is calculated using the total weight—meaning it doesn’t distinguish between body fat and other elements that contribute to a person’s weight (bones, organs, muscle, etc). Since muscle weighs more than fat, it’s possible for someone with a muscular build and little body fat to fall in the “overweight” category. Many professional athletes, for instance, have BMI in the overweight range because of the muscle they develop during training. Secondly, BMI is a generalization. Everyone is different and body composition varies by age and gender.
The important thing to remember is BMI is a guideline and isn’t meant to be used to diagnose health risks. However, regular exercise and a healthy diet can help you reach or maintain a healthy weight. If you have questions about weight loss or BMI, you may want to talk to your health care provider or a registered dietitian.
(Post content reviewed by MGH Primary Care Physician. Photo credit: Victor Maltby)
Tags: DASH Diet, fruits and vegetables, healthy diet, research, whole grains
It seems every day we’re hearing about some new product that promises to do amazing things like save you time and/or money on household chores or eliminate fat from certain parts of the body. Sometimes these gadgets and gizmos work, and sometimes they . . . well . . . don’t.
The same is true for a number of popular (some may say “fad”) diet programs on the market: some are more successful at helping people develop healthy eating habits and maintain a healthy weight than others. Earlier this year, U. S. News & World Report investigated and ranked 20 popular diet plans based on their effectiveness at promoting weight loss (both short and long term), ease of use, nutritional content and other criteria. The DASH diet, an eating plan recognized for its effectiveness at lowering high blood pressure, was ranked number one in two categories.
DASH (which stands for Dietary Approaches to Stop Hypertension) was developed through research by the National Heart, Lung and Blood Institute on the effect of diet on blood pressure. Study participants following the DASH eating plan—which emphasizes fruits and vegetables, whole grains and low fat dairy, as well lean protein and nuts (which are all naturally low in sodium and saturated fat)—saw a significant decrease in blood pressure and cholesterol. Not only that, following the DASH diet can help avoid heart attack and stroke and can prevent the development of hypertension among people with normal blood pressure. Thanks to its proven cardiovascular benefits, the DASH diet has been endorsed by the American Heart Association
DASH is lower in fat and sodium and higher in several key nutrients believed to help lower blood pressure (including magnesium, calcium and potassium) than a typical American diet. And, because of its focus on nutrient-rich whole foods (especially fruits, vegetables and whole grains), DASH may also help prevent the development of osteoporosis and some cancers.
(Post content reviewed by MGH Nutrition Department. Photo Credit Zsuzsanna Kilian)
Tags: banana, DASH Diet, potassium, potato
Many discussions about hypertension lately seem to revolve around sodium, most notably the recommendation for limiting the amount of sodium in the diet. One of the findings of the National Heart, Lung and Blood Institute’s DASH study was a diet low in sodium is effective at lowering high blood pressure (DASH stands for Dietary Approaches to Stop Hypertension). But there’s another nutrient that also needs to be included in the hypertension conversation: potassium.
Like sodium, potassium is an essential nutrient for living—in fact it works along with sodium to keep the body’s fluids in balance and send messages along the nervous system. Potassium also plays a role in muscle contraction and is crucial for keeping the heart beating properly. But while sodium is abundant in the typical American diet, many people don’t get enough potassium.
Adding more potassium to your diet can be as easy as eating a variety of fruits and vegetables—in fact the DASH eating plan, which emphasizes fresh fruits and vegetables, is higher in potassium than the typical American diet. Bananas are probably one of the best known sources of potassium (there’s about 450mg in one medium banana), but sweet potatoes, white potatoes (with skin), tomatoes, oranges, avocados and apricots are good sources as well. And another plus: fresh fruits and vegetables are naturally low in sodium.
Some other non-vegetable sources of potassium include white beans; fish such as tuna, halibut and salmon; and dairy products like low fat milk and yogurt. Check out the USDA’s Nutrient Database for more information on nutrient content— including sodium and potassium— of many common foods.
(Post content reviewed by MGH Cardiologist and Nutritionist. Photo from http://www.pachd.com/)
Tags: blood pressure, causes of hypertension, controlling high blood pressure, health care, heart, heart health, high blood pressure, hypertension, lifestyle, lifestyle modification, vlog
In this overview, Mass General Cardiologist Dr. Randy Zusman discusses some of the causes of hypertension, the benefit controlling high blood pressure has on other aspects of your health, and some of the treatments available for controlling high blood pressure.
Tags: complete proteins, healthy whole grains, quinoa, recipes quinoa
Whole grains have gained a lot of attention lately. They have been shown to promote heart health and are good sources of fiber, vitamins and minerals. One of the key recommendations of the Dietary Guidelines for Americans updated earlier this year was replacing at least half of our refined grains with whole grains. Oatmeal, barley, buckwheat and corn are all pretty common; examples of less common whole grains include amaranth and bulgur. Another whole grain that has been steadily increasing in popularity is quinoa.
Although considered a grain product, quinoa (pronounced keen-wah) is actually a seed native to South America. While it has been appearing more and more in steadily in American supermarkets recently, quinoa has been grown and harvested for thousands of years—it was once was a staple food for the Incas. Quinoa is high in protein, with 9 grams in each cup (cooked). It’s also a complete protein, meaning it has all the essential amino acids the body needs to function but can’t produce on its own (meat, dairy products and soy are also complete proteins). And, because it doesn’t contain gluten, a protein found in many grain products, quinoa is ideal for someone on a gluten free diet.
In addition to being high in protein, quinoa is also a good source of iron and folate, and vitamin B2 (riboflavin) which the body uses when converting food into energy. Quinoa is also a good source of magnesium, a mineral necessary for many of the body’s day to day functions from repairing cells to maintaining a regular heart beat.
Quinoa is easy to prepare, usually simmered in hot water like rice, and cooks quickly—ready to serve in 12-15 minutes (compare this to 30+ minute cook time for brown rice). Just remember to rinse your quinoa well before cooking to remove the seeds’ bitter coating.
Looking to try a new side dish? Try this quinoa salad recipe recommended by one of our nutritionists:
Orange Quinoa Salad
(Recipe adapted from Cooking Light)
1-1/3 cup quinoa, uncooked
2-3/4 cup water
¼ cup orange juice
2 tbsp olive oil
1-1/2 tbsp reduced fat (2%) buttermilk
2 tsp honey
½ tsp salt
1/8 tsp black pepper
1 cup scallions, sliced
1 cup dried cranberries
1/3 cup fresh parsley, chopped
3 tbsp pumpkin seeds (or pepitas)
Place uncooked quinoa in a large skillet and cook 4 minutes on medium heat, stirring frequently. Next, place quinoa in a sieve and rinse under cold water. Repeat rinsing procedure a second time (this removes quinoa’s natural bitter coating). Combine quinoa and 2-3/4 cups of water together in a large saucepan and bring to a boil. Once the quinoa boils, cover and reduce heat; cook for about 20 minutes or until all liquid is absorbed. Meanwhile, whisk orange juice, olive oil, buttermilk, honey, salt and pepper together in a bowl and set aside. When quinoa is cooked through, remove from heat and let cool. Toss quinoa with orange juice mixture, scallions, cranberries, parsley and pumpkin seeds and serve room temperature.
Yield: (10 servings; 1/2 cup each)
NUTRITION INFORMATION PER SERVING:
CALORIES: 185 calories
PROTEIN: 5 g
SODIUM: 155 g
Iron: 2 g
CARBOHYDRATE: 30 g
FIBER: 3 g
FAT: 6 g Sat Fat: 1.0 g