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Be Well - February 2012


Feature: 8 Tips for Lowering Cholesterol With Diet & Exercise

Feature: 8 Tips for Lowering Your Cholesterol

We all want to be heart-healthy, and ensuring healthy levels of cholesterol — a fat, or lipid, carried through the bloodstream — is the first step.

Low-density lipoprotein or LDL (bad) cholesterol contributes to plaque buildup along with triglycerides, another lipid. High-density lipoprotein or HDL (good) cholesterol discourages plaque buildup. Plaque can threaten the blood supply to the heart, brain, legs or kidneys, leading to heart attack, stroke or even death.

The preventive cardiology team in Cleveland Clinic’s Heart & Vascular Institute is dedicated to making sure these medical emergencies never occur.

Registered dietitian Julia Zumpano, RD, LD, of the Weigh to a Healthier Heart Program, and exercise physiologist Michael Crawford, MS, Cardiac Rehabilitation Supervisor, share these tips:

4 ways to lower cholesterol through diet
  1. Cut back on animal fats. Forgo fatty meats, such as chicken or turkey with the skin; processed meats, such as bologna, salami and pepperoni; and fatty red meats, such as ribs and prime cuts of beef, pork, veal or lamb. Also avoid full-fat dairy products such as cheese, cream, sour cream, cream cheese and butter. These foods contain saturated fat as well as cholesterol — both associated with higher blood cholesterol and plaque buildup.
  2. Make friends with fiber. Specifically, get friendly with foods high in soluble fiber. In the gut, soluble fiber can bind to bile (which is made up of cholesterol) and remove it. Look for soluble fiber in oats, flaxseed, barley, dried beans and legumes, fruits and root vegetables, as well as some whole-grain cereals, cereal bars and pastas.
  3. Go veggie. Choose at least one meatless meal per week. Substitute beans, tofu or nuts for red meat or poultry in a bean burrito or a tofu stir-fry to decrease your saturated fat intake and increase your fiber intake. Shoot for one meatless meal —breakfast, lunch or dinner — per day!
  4. Be a loser. If you’re overweight or obese, shed the extra pounds. Weight loss helps lower bad (LDL) cholesterol. Even a small-to-moderate weight loss — just 10 to 20 pounds — can make an impact.
4 ways to lower cholesterol through exercise
  1. Move more. Work up to 90 minutes of cardiovascular exercise per day for optimum heart health and weight loss. Cardiovascular exercise means any activity that uses large muscles repetitively and increases the heart rate. Think walking, cycling, rowing, using the elliptical and swimming. If you find 90 minutes daunting, start with 30 minutes and work your way up a little at a time. For some people, 45 to 60 minutes of cardiovascular exercise is enough.
  2. Pick the right tempo. Aim for a moderate level of exercise. You’ll know you’ve reached it when you are able to carry on a conversation when you exercise, but can’t sing. Higher-intensity (more difficult) exercise is better at raising good (HDL) cholesterol. However, it also increases your risk of injuries, making it harder to continue exercising. Moderate intensity is preferable.
  3. Make a habit of it. Consistency is the key. Work out regularly and you’ll watch your triglyceride levels drop. Triglycerides are the only lipid in the cholesterol profile used for energy. They decrease an average of 24 percent with regular cardiovascular exercise.
  4. Change it up. Variety is the spice of life, so try different exercises to stay motivated, to challenge other muscle groups, to reduce the risk of overuse injuries and to enjoy your physical activity.

Note: If you have heart disease, check with your doctor before beginning an exercise program. If you experience chest pain, pressure, tightness, excessive shortness of breath, lightheadedness or palpitations, stop exercising and consult a doctor.

10-Week Heart-Healthy Weight Loss Program

Achieve your ideal weight and maximize your cardiovascular health in 10 weeks with our Weigh to a Healthier Heart Program, with private nutrition sessions, exercise prescriptions, exercise classes and group support. Let our team of physicians, dietitians, psychologists, counselors and exercise physiologists help you. Check with your insurer about fee coverage.

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Tip: A Heart-Healthy Diet Can Include Limited Amounts of Red Meat

Tip: A Heart-Healthy Diet Can Include Limited Red Meat

There's no need for most of us to ban red meat from our diets if we eat the right kind in moderation. High intake of meats rich in saturated fat is linked to increased LDL (bad) cholesterol, a key risk factor for heart disease. Smoked, cured, salted and preserved meats are among the most important offenders. Filled with sodium, nitrates and nitrites, these processed meats are linked to high blood pressure and heart disease. An occasional lean steak is fine, but avoid fatty cuts, limit portions, and don’t indulge every day.


Be Well – February 2012 Issue

Feature: How to Talk to a Doctor — and Safeguard Your Health

Feature: How to Talk to Your Doctor and Safeguard Your Care

Miscommunication about healthcare is epidemic. Nine out of 10 people don’t fully understand or remember what to do after a doctor visit. More than 40 percent of people don’t fully understand or remember how to take medication or care for themselves after they leave the hospital.

The consequences can be devastating. Thousands of Americans are injured or die each year because written or verbal communication about healthcare isn’t clear or because they don’t understand the information or its importance.

Getting clarity

“Clear communication is one of the most powerful tools you can use to stay healthy,” says Julie N. Baker, of Cleveland Clinic’s Office of Patient Experience. In fact, how well you and your providers communicate about your care — called “health literacy”— is the greatest predictor of how well your care will go.

Health literacy is called the silent crisis because healthcare providers can’t always tell whether or not patients understand.

Lost in translation

Health literacy has nothing to do with your level of education, income, job or race. Medical terminology is a foreign language to most of us, but even those in the medical field may not process what they hear during a health crisis.

Anyone can become confused about what to do after discharge or an appointment — especially when we’re expected to manage increasingly complex care at home.

Stress hinders our ability to listen, to process what we hear and to recall it. “Stress can reduce our thinking ability by about three to four grade levels,” says Ms. Baker.

Pain, surgery and the side effects of certain medications can further confuse communication.

Listen to your gut

The solutions are basic: Trust your instincts, and take an active role in your care.

“Don’t be embarrassed to ask questions if you feel confused or to voice concerns if something just doesn’t feel right,” says Ms. Baker. Remember that nine out of 10 people have been in your shoes.

Here are 6 tips for ensuring safer care for you and your loved ones:

1. Speak up — and be heard. If you have new information, even a minor change in symptoms, tell your doctor. “Doctors aren’t mind-readers. They need your input,” says Ms. Baker. Don’t say you understand if you don’t; you may be taken at your word. If your doctor seems busy, say: “I want to understand, but I feel rushed.” Most doctors will stop and take time to explain things. If not, ask to speak to the physician assistant or nurse.

2. Don’t trust your memory; write it down. Before a doctor’s appointment, write down your questions and concerns, leaving space for the answers. At the office, write down your doctor’s answers; ask your provider to draw a diagram if that will help.

3. Bring a second set of ears. Ask a trusted relative or friend to go with you to an appointment to make sure you remember and understand everything. This is critical when you are being discharged from the hospital, when an appointment is especially important and when you are under stress.

4. Follow directions. Many people don’t understand how important it is to take medication exactly as prescribed and to follow all directions for care. If you have questions or if something you’re supposed to do doesn’t seem right, call your doctor’s office or pharmacy. “Don’t guess — you’re playing with your life,” says Ms. Baker.

5. Master your medications.

  • Get smart — Know which medications you need and why. Bringing your medications to doctor's appointments is often helpful.
  • Look at labels — Make sure it’s your name on prescriptions, and that drug names and dosages are correct, before you leave the pharmacy. Human and computer errors do happen; some medications sound or look alike.
  • Take it well — Know how to take your medicine. For example, a plastic dropper (syringe) is safer than a teaspoon for precisely measuring liquid medicine.
  • Make a list — Give your doctor and pharmacist a list of all your prescription and over-the-counter medicine and supplements.
  • Never double up Never finish old medication if your new medication replaces it.
  • Don’t let cost stop you — If you can’t afford medication, tell your provider. You may be able to get a full or partial discount. “Your doctor prescribed it because you need it,” says Ms. Baker.

6. Don't rush transitions. You may be eager to leave the hospital, but vital information can get lost in the shuffle. "Discharge is a dangerous time," says Ms. Baker. So is being moved to another unit within the hospital.

In either case, ask for a copy of your discharge summary. If you're going to a new unit, double-check that they have the correct treatment plan and medication list. If you meet resistance, politely explain, “I want to be able to understand my care.” Take any problems to the Nurse Manager — your feedback will be confidential.

If you're being discharged to your home, make sure you know when to start on medication and why, and whether your pharmacy carries it.

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Be Well – February 2012 Issue

Free Guide: Arthritis and Joint Pain

Free Guide: Arthritis and Joint Pain

When you hit your funny bone, you know why your elbow hurts. But when your joints ache constantly, how do you know if it’s arthritis or something else? Learn about three common forms of arthritis — osteoarthritis, rheumatoid arthritis and gout — and how our experts manage them.


Recipe: Tofu, Broccoli, Shiitake Mushroom and Walnut Stir-Fry

Recipe: Tofu, Broccoli, Shiitake Mushroom & Walnut Stir-Fry

Try this delicious vegetarian entrée the next time you make dinner. You’ll benefit from its heart-healthy monounsaturated and polyunsaturated fats — especially the omega-3 fat from walnuts.

Ingredients

3 dried shiitake mushrooms, rehydrated*
2 teaspoons extra virgin olive oil
1 large white onion, cut in half and then quartered
4 garlic cloves, sliced
2 carrots, thinly sliced
2 cups broccoli florets
1 cup sliced shiitake mushrooms
1 pound water-packed firm tofu, prepared for cooking** and cut into ½-inch cubes
12 walnut halves, roughly chopped
2 tablespoons brown rice miso
Freshly ground pepper
2 cups hot cooked brown basmati rice
Fresh mint leaves, optional
Reduced-sodium soy sauce

Preparation
  1. Drain the soaked mushrooms, discarding the liquid, and chop roughly. Place a wok or large nonstick skillet over medium heat. When the wok is hot, swirl in the oil and add the onion and garlic. Stir-fry until onion wilts, about 4 minutes. Add the carrots, broccoli, and fresh and rehydrated shiitake. Stir-fry for 2 minutes.
  2. Add the tofu, walnuts, miso and ¼ cup water. Continue to stir-fry for another 1–2 minutes, until the tofu is hot and the vegetables are crisp-tender. Grind pepper to taste over all.
  3. Press the hot rice into ½-cup molds. Invert onto heated dinner plates, top with the stir-fry, and serve. If using mint, place the leaves on a small plate and pass them along with a bottle of soy sauce to sprinkle over each serving.

*To rehydrate dried mushrooms, soak the mushrooms in just enough boiling water to cover for about 15 minutes, or until softened. Remove the mushrooms with a slotted spoon. Strain the soaking liquid through a coffee filter to remove sediment.

** There are two ways to prepare tofu for cooking. The first is to wrap the tofu in paper towels and press it to remove all of the water. Place a weight on top of a plate placed on the wrapped tofu, changing the paper towels as they become saturated with water. The second is to freeze the tofu in its container. When ready to use, thaw the tofu and squeeze out all the liquid.

Makes 4 servings

Nutrition

Calories: 410
Fat: 15 g
Saturated fat: 1.5 g
Sodium: 420 mg
Protein: 20 g
Carbohydrate: 57 g
Dietary fiber: 7 g

Recipe from The Cleveland Clinic Healthy Heart Lifestyle Guide and Cookbook

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Be Well – February 2012 Issue

Let's Move It! Free Mobile App

Let Cleveland Clinic and your mobile phone keep you motivated. More than just a pedometer, our free mobile app offers walking challenges, a calorie tracker and videos to encourage and inspire.