Wednesday, November 21, 2012

How Healthy is Your Holiday Meal?

With the holidays being upon us in no time this is  a good time to remind heart patients of being acutely aware of the sodium content in foods. The holiday meal contributes to many heart patients having increased symptoms of  high blood pressure, congestive heart failure, fluid retention, shortness of breath. The holiday meals  can be the culprit. Traditional foods like the turkey are often injected with  approximately 8% solution sodium to enhance moistness and flavor. If you read the ingredients you will often note: turkey broth, salt, sodium phosphates, sugar & flavoring. Then many a cook will soak the already salt injected turkey in a brine solution or salt it well, prior to cooking. The turkey alone gets many into trouble, then you add pre-packaged stuffing, broth, or use canned mushroom soups in casseroles. Did I mention the relish tray with pickled foods?                                                           

A little extra salt in or on your holiday foods makes a difference.

1 teaspoon salt = 2131 mg sodium                                          1/2 teaspoon salt = 1066 mg sodium
1/4 teaspoon salt = 533 mg sodium                                        1/8 teaspoon salt = 266 mg sodium
75 mg—the average sodium content of 3 ounces fresh, unsalted beef, turkey, chicken, pork
240 mg sodium in 3 ounces self-basting frozen turkey, cooked (that’s without the gravy!)
580 mg sodium in 3 ounces frozen fully cooked baked turkey
820 mg sodium in 3 ounces honey baked ham
Bread is a major sodium contributor if you eat more than a couple of pieces a day unless you buy special low sodium bread. A slice (1 ounce) of loaf bread has 150 to 200 mg sodium—not including salted butter or other spreads or toppings. Consider using a bread maker to make a low sodium recipe.
Skip the gravy! But if you must go for low or reduced sodium gravy instead of regular salted gravy which has more than 300 mg sodium for 1/4 cup.                                                                                                                                                              

Measurements and labels of sodium

  •  1/4 teaspoon salt= 600 mg sodium
  • 1/2 teaspoon salt= 1,200 mg sodium
  • 3/4 teaspoon salt=1,800 mg sodium
  • 1 teaspoon salt= 2,300 mg sodium
  • 1 teaspoon baking soda =1,000 mg sodium
  • Sodium-free: Less than 5 milligrams of sodium per serving
  • Very low-sodium: 35 milligrams or less per serving
  • Low-sodium: Less than 140 milligrams per serving
  • Reduced sodium: Sodium level reduced by 25%
  • Unsalted, no salt added, or without added salt: Made without the salt that's normally used, but still contains the sodium that's a natural part of the food itself.

Names for salt

  • sodium alginate
  • sodium ascorbate
  • sodium bicarbonate (baking soda)
  • sodium benzoate
  • sodium caseinate
  • sodium chloride
  • sodium citrate
  • sodium hydroxide
  • sodium saccharin
  • sodium stearoyl lactylate
  • sodium sulfite
  • disodium phosphate
  • monosodium glutamate (MSG)
  • trisodium phosphate
  • Na
Some drugs contain high amounts of sodium.
Need an antacid after that holiday meal?  Watch out there is excess sodium there too. Carefully read the labels on all over-the-counter drugs. Look at the ingredient list and warning statement to see if the product has sodium. A statement of sodium content must be on labels of antacids that have 5 mg or more per dosage unit (tablet, teaspoon, etc.). Some companies are now producing low-sodium over-the-counter products. If in doubt, ask your healthcare practitioner or pharmacist if the drug is OK for you.

How Sodium causes fluid retention

The job of the kidneys is to filter the excess sodium into the urine so that the body can get rid of it. Many with heart disease and diabetes kidneys cannot handle all the extra work. The kidneys become less efficient at filtering the blood stream. This causes excess sodium to enter the bloodstream. Sodium attracts water to it and effect known as being osmotic. Water follows the sodium  and is drawn into the bloodstream. Excessive salt keeps the circulatory volume higher than it should be, creating and increased pressure in the blood stream and pressing on the blood vessel walls. The stress of the pressure on the walls creates thickening and narrowing of the vessel, leaving less space for the fluid in the blood vessels and raising resistance.  The body then requires higher pressure to move blood to the organs. The heart has to pump against this high pressure system.
I equate it to trying to blow up one of those kids balloons that is turned into animal shapes. They are really tough to blow air into, your cheeks get really sore - this is the resistance of air, similar to the resistance pressure of blood in the arteries. If you stretch the balloon (relax the arteries) then there is less resistance in blowing up the balloon (filling the artery with blood). Twenty percent  of the blood pumped from the heart goes  first to the kidneys.  High blood pressure within the kidneys cause  damage to the heart and to the vascular system in the kidneys. Salt makes you thirsty so limit salty foods, especially if on a fluid restriction.

I once had a patient who lost 45 lbs simply from adhering to low sodium diet. He had a very weak heart with only 10% ejection fraction meaning very limited pumping ability. So a weak heart and sodium in the diet made him retain fluid more than most. He began to measure and count sodium with every meal for a few months and was shocked by how much sodium he consumed even though he thought he ate pretty healthy. By reading labels, doing the math every day and making changes such as eating out less, ordering special, reviewing his medication he lost the fluid and added years to his life, not to mention the improved quality of life with less shortness of breath and fatigue by easing the workload of the heart.                                                   
According to the American Heart Association, eating more than the recommended 1500 milligrams a day puts you at direct risk of high blood pressure. Yet in America we consume an average of 3400 milligrams a day; more than twice what we should. While people with hypertension, heart and kidney disease are always advised by doctors to eat less salt, the AHA wants all of us to do this, whether or not our blood pressure is currently in the normal range. So if you are cooking or know the cook for pass this info on! 

Tuesday, November 13, 2012

Can we be children again?

When can we be children again and giggle and laugh at silly things?
When can we be children again and play hide and seek in the dark?
When can we be children again and play on the slide and the tire swings?
When can we be children again and skip a huge rope in the park?
When can we be children again and hop in and out of a puddle?
When can we be children again to run and laugh when we play?
When can we be children again and just want a friend to cuddle?
When can we be children again and race all our friends in a relay?
So when can we do these things without being stared at or pointed to?
Whenever we want is my answer, there’s no need to analyse or think it through
To bring out that fun and enthusiasm like a child that is hidden in our heart
We can be the child if we choose once again and that’s the amazing part
If you hear good music that fills you with joy then do a little dance – doesn’t matter where you are.
Laugh out loud if you want to. Swing and slide down that slide without a care. Skip rope and jump in puddles. Giggle and play hide and seek. Do what brings you joy and not what you think you have to do, for there’s no fun in that.
And if people stare and point and think you’re a little crazy, well maybe it’s just because the child that is hidden in them can’t return

Reposted from November 7, 2012

Tuesday, November 6, 2012

Fitness for Aging

Fitness as we age

It is important to work on physical fitness life long.

Physical fitness benefits include reduction of heart disease, reduction in Alzheimer’s and most importantly independence.  A recent study showed Finnish men who lost more than 15% of their cardiorespiratory fitness over a 10-year period faced a near doubling of their risk of acute MI over the subsequent decade and more than twice the risk of dying of any cause, a new study shows. But as we age fitness programs change. It isn’t realistic to ask the very elderly to jog, participate in spinning classes, hit the elliptical or rowing machine like those who are younger. The issues with mobility and frailty prevent such activities for most. So what does one do for fitness as they age?
Walking, stationary biking, water aerobics, swimming laps with a kick board, recumbent bike or  recumbent steppers are some of my favorite means of obtaining aerobic exercise. Also programs such as Sit and Be Fit.   Any is exercise is better than no exercise. If exercise is done in a group or a class you also get the additional benefits of socialization. As we age socialization is vital. The more socially isolated a person becomes the worse the predictors for health. I found over the years many adhered to light continuous aerobic exercise because of the socialization of the classes more than the physical benefits of the exercise. New interns would come aboard and roll their eyes when they noted the workloads of many of the elderly, then I would point out the ages of many of my clients being in upper 80′s to mid 90′s and regularly attending classes 2-3 times per week, aerobically exercising, resistance training, stretching and socializing.
Resistance training is very important as we age as well as I am frequently promoting the following:

Your Strength is your Independence

This is what allows you to live in your own home, to care for yourself, to get up off the floor if you fall, to carry in the groceries.  It is your ability to cope with emergencies, to interact with the grandkids by walking up the bleachers, or across the soccer field, to lift up the two-year old, to get to their musicals across a long parking lot, to walk the hills at the nature center etc.

Here are a few simple strengthening exercise that most can perform. Wall squat

Wall Squats

With feet 8-12 inches apart and approximately 6 inches from the wall, slide down the wall a few inches. Hold this position as long as able. Push back up to standing. Repeat as many times as possible. Don’t go down to far, and if you fear not being able to stand all the way back up, keep a chair next to you for assistance. Breath out as you push back  up.

calf raises

Toe Raises

This exercise is surprisingly hard for many of the elderly to perform. Go up on tip toes and back down as many times as possible. To make harder try on a stair step or try doing on only one leg.

Wall push ups

Just like the old-fashioned push up but do against a wall. Breath out as you are pushing yourself back from the wall. Exhale on Exertion! I say this because many hold their breath which is hard on the heart and blood pressure.

Lateral leg exercises

These are really important for maintaining a good gait when we walk as we get older. Lying on side – do in bed – as easier than getting up from the floor. Lift leg out and back down. Do as many as possible.

Be a mentor, assist to make it happen
As most blog readers tend to be younger, pass this advice on to your elders, work out with them, purchase and arrange for transportation to fitness classes, make a big deal out of wanting them to stay fit and healthy to participate in life with you. We all need encouragement at times. Don’t assume being old means sitting in the recliner all day. Keep those in your live vital through physical activity. And have a great day!