Cleveland_Clinic_Host: Cleveland Clinic’s Wellness Institute is pleased to announce the creation of our Lifestyle 180 Program. This program is designed for individuals who want to
make positive changes in lifestyle and is the focus of our chat today with Dr. Elizabeth Ricanati.
Ask yourself, do you want to feel better? Look better? Actually be healthier? If you are among the 25 million Americans with a chronic disease, your risks for death and disability are significantly higher than normal. In addition, you are most likely coping with ongoing pain, fatigue, difficulty moving, sleep deprivation or other obstacles to a vibrant healthy life. The good news is that if you suffer from cardiovascular disease (including high blood pressure, high cholesterol, or diabetes), breast or prostate cancers, fatty liver disease (NASH),or multiple sclerosis, and are committed to making positive changes in your lifestyle, Cleveland Clinic's Lifestyle 180 program can teach you how to reclaim your health and vitality.
What makes Lifestyle 180 stand out is its blend of evidence-based medicine and a group wellness experience? Our medical wellness experts guide participants on setting specific, achievable goals to improve personal health and well-being.
Elizabeth Ricanati, MD, is a distinguished graduate of the Case Western Reserve University School of Medicine, is a staff physician for the Department of Disease Reversal at the Cleveland Clinic's Wellness Institute, and the Medical Director for the Lifestyle 180 Program.
Dr. Ricanati was the Associate Professor in Clinical Medicine and Co-Associate Director of the Center for Women's Health at Columbia prior to joining the Cleveland Clinic. In addition, she is board-certified in Internal Medicine, and a member of the American College of Physicians. She is a credentialed NAMS Menopause Clinician.
She has been the recipient of several prestigious awards, the co-author of several peer-reviewed journal articles, and a frequent invited guest contributor for both television and print media. Dr. Ricanati has given countless lectures and presentation of behalf of women's health initiatives, wellness and disease reversal.
Cleveland_Clinic_Host: Today, join us as Dr. Elizabeth Ricanati discusses a variety of questions healthy lifestyle and disease modification. To learn more about Lifestyle 180, or to enroll in the program, call 877.331.WELL (9355). Or, you can visit us online at www.clevelandclinic.org/lifestyle180
Welcome to our Online Health Chat with Elizabeth Ricanati, MD. We are excited to have Dr. Ricanati here today for this chat. She is considered an expert in the field of wellness and disease reversal and is the Medical Director for the Lifestyle 180 Program. Let’s begin with some questions.
Speaker_Dr__Elizabeth_Ricanati: I am happy to be here and have an opportunity to discuss lifestyle and your health with you.
Lifestyle 180: The Program
planningahead: How would I benefit from a program like Lifestyle 180? I currently have high blood pressure, cholesterol, and type 2 diabetes.
Speaker_-_Dr__Elizabeth_Ricanati: Lifestyle 180 is a program designed to treat chronic diseases through lifestyle modification. The program accomplishes this using three modalities: exercise, nutrition and stress management.
Currently, we are working with patients who have at least one of the following eight chronic disease states: diabetes, hypertension, obesity, high cholesterol, multiple sclerosis, active surveillance prostate cancer or recently diagnosed breast cancer. You would benefit from our program specifically because you in fact have three of the disease states that we are working with at this time.
ziahsgmom: What are the requirements for entering the program?
Speaker_-_Dr__Elizabeth_Ricanati: To participate in Lifestyle 180, one needs to have at least one of eight chronic diseases that we are currently looking at as described in the previous answer. We continue to add disease states, so keep watching for that.
In addition, you must be a non-smoker; for those interested in Lifestyle 180 who currently smoke, it is very easy for us to first enroll you in our Tobacco Cessation program here at the Clinic, and then have you start Lifestyle 180. The program is currently only offered for adults, as well.
studious: What results have patients already enrolled in this program experienced?
Speaker_-_Dr__Elizabeth_Ricanati: Patients have experienced results in four areas:
- biometric measurements, laboratory measurements, medication use and quality of life measurements
- patients have seen their waist circumferences decrease, their weight go down, their blood pressure go down
- patients have seen improvements in their lipid profiles, i.e. reductions in total cholesterol, LDL (“lousy”) cholesterol and triglycerides; they have seen their glucose levels go down
- patients have been able to either decrease their medications, avoid starting a medication, or have been lower a dose of their medication
- and finally, patients report an improvement in their overall quality of life: they are sleeping better, their moods are better, their pain is better.
stilton: Is this program only for those with a chronic illness, or is it for anybody who is interested in either getting healthy or staying healthy and preventing chronic illnesses?
Speaker_-_Dr__Elizabeth_Ricanati: Great question. Currently, Lifestyle 180 has been developed to treat chronic diseases. We have slowly been adding disease states, and are currently up to eight and we plan to continue to add more. With that said, I am thrilled that you are interested in maintaining your health so as not to develop a chronic disease in the first place, and it is our intention to develop a version of Lifestyle 180 for prevention.
In the meantime, my recommendations are the same regardless of your disease state: we all need to eat more healthily, we all need to remember to breathe, and we all need to exercise more!
happyg: I have a friend that went through the program and raves about “how it changed her life”. I’m interested in pursuing but worry about the time commitment involved as I have young children. What are the time options/requirements?
Speaker_-_Dr__Elizabeth_Ricanati: Lifestyle 180 is a commitment to changing your lifestyle, and improving your health. The program is divided into two parts, an initial 6 week course that occurs two times per week, and then a follow-up component with five sessions over the course of the remaining year. The classes are four hours, and always include a meal. They are offered in the mornings and the evenings to accommodate a variety of working and personal obligations.
outfishing: I read the recent “Time” article that featured Lifestyle 180; it mentioned it being at the Lyndhurst campus. Where is that?
Speaker_-_Dr__Elizabeth_Ricanati: The Lyndhurst campus of the Cleveland Clinic is located approximately 20 minutes from the Main Campus of the Cleveland Clinic, on Richmond Road in Lyndhurst, OH, very close to I-271 and Cedar Road.
allegirlsc: I would like suggestions on a low fat, high fiber and protein diet. Also, I am wondering what types of exercises that I can do with a movement disorder. I suffer from a wide array of symptoms and was in the ER yesterday for a sudden severe onset of lightheadedness as well as other distress. I would love to do anything to feel even just a little bit better. Thank you for reading this!
Speaker_-_Dr__Elizabeth_Ricanati: I am sorry to hear you were in the ER yesterday. Please be sure to follow up with your primary care physician about this visit. Developing an exercise program and nutritional plan especially in light of your movement disorder should wait until this acute issue is resolved.
missourman: What kind of diet is the best for a heart patient?
Speaker_-_Dr__Elizabeth_Ricanati: We recommend that all of our patients, and this certainly applies to our heart patients, follow a diet low in saturated fat, that has no trans fats, no added syrups or sugars and that is high in fiber and omega-3s.
powersoff: Should protein, fat and carbohydrates be in all meals?
Speaker_-_Dr__Elizabeth_Ricanati: It is important to get protein, fat and carbohydrates in our diets. The type of protein, fat and carbohydrate help to determine how healthy it is. For example, plant-based proteins are healthier than animal-based proteins, and monounsaturated fats are better than saturated fats.
123456: Where does soy milk fit in? Is this better for me than cow’s milk?
Speaker_-_Dr__Elizabeth_Ricanati: Soy is a great example of a plant-based protein, or legume. There has been much research looking at soy and its health benefits. In particular, Asians do not appear to have as high rates of the diseases that we associated with a typical western lifestyle, such as diabetes, high blood pressure and obesity, and this has long been thought to be in part related to their diets.
For individuals who are interested in consuming less saturated fat, or who can not tolerate cows’ milk (and many of us are in fact lactose-intolerant), then soy milk may be an option.
get2it: I understand there is a cooking component to the program. What will I learn that I don’t already know? I’ve been the primary cook in my house for over 20 years.
Speaker_-_Dr__Elizabeth_Ricanati: The Lifestyle 180 program believes that to understand how to eat and enjoy eating healthy foods, it is essential to learn how to prepare them correctly. Therefore, the nutrition component of the program does involve a cooking class, where the participants make part of the meal that they will enjoy that day. This class is a great opportunity to learn how to work with foods that may be new to you, such a whole wheat bread crumbs, vegenaise (instead of mayonnaise), and vegetables that you may not normally have eaten in the past.
tweetweet: Low fat yogurt; is it okay to buy the ones that are fruit flavored? Or just plain? The ones that are fruit flavored seem to have a lot of sugar.
Speaker_-_Dr__Elizabeth_Ricanati: Low fat yogurt is certainly better than fuller fat yogurts given the amount of saturated fat. In addition, you are right that added fruit usually means added sugar. A great way to get flavor is to start with plain yogurt and add your own fresh fruit, or even a little bit of agave nectar.
studio57: Eggs - I've read both that they are good and that they are bad. What is your opinion?
Speaker_-_Dr__Elizabeth_Ricanati: There has been a lot written about eggs, you are correct! Eggs have two parts, the yolk and the white. The yolk is known for its cholesterol content; the white for its protein content. At Lifestyle 180, we do use eggs, though primarily we use egg whites instead of the whole egg.
URLOVED: Regarding beef & chicken which of there are healthier?
Speaker_-_Dr__Elizabeth_Ricanati: Quite simply, the more feet the protein has, the more unhealthy it is! In other words, beef and other meats that come from four-legged animals have more saturated fats than their poultry (two-legged) counterparts.
KARENRICKE: Is there a good diet for MS patients?
Speaker_-_Dr__Elizabeth_Ricanati: There has been some mention in the literature about an 'anti-inflammatory' diet for chronic diseases such as MS. We know that insulin resistance leads to inflammation, and inflammation leads to disease. Therefore, in the Lifestyle 180 program, we have developed the nutritional component to decrease inflammation in order to decrease insulin resistance and ultimately to decrease disease. A way to do this is as follows: lower your saturated fats, eliminate all trans fats, eliminate added sugars and syrups (i.e. high fructose corn syrup, and in fact anything ending with -ose), substitute brown for white (i.e. whole wheat pasta, brown rice, quinoa) and increase your fiber and omega-3s.
punintended: Nuts, are they good? How and why?
Speaker_-_Dr__Elizabeth_Ricanati: Nuts are a terrific source of omega-3 fatty acids, which are so important for our cardiovascular and neurologic health, i.e. our hearts and our brains. We need omega-3 and omega-6 fatty acids in our diet, though the current western diet often has the wrong ratio of omega-3 to omega-6, and a quick and easy way to correct this is to eat nuts, i.e. a handful of walnuts, or almonds, or pistachios. Don’t forget, though, that although they are so beneficial for us, and have the good kind of fat (monounsaturated), they are high in calories so it is important not to eat too many!
centerin: What advice can you give the business traveler who is forced to eat at restaurants all week?
Speaker_-_Dr__Elizabeth_Ricanati: Restaurants are used to picky eaters – you can be one, too! Instead of having bread and butter, ask for olive oil…or better yet, ask for some raw vegetables cut up. It is easy to ask for fish, poultry or meat to be grilled rather than fried, for example. Instead of an appetizer and an entrée, try two appetizers. You can ask the waiter for a to-go box when your meal is served – it’s an easy way to monitor your portions as most of us like to finish what’s on our plates, and this way, you can. Fill up on water, too.
soolong: Found while on omega 3 for lowering cholesterol – did not help inflammation and raised cholesterol considerably (near 300). So, would flaxseed be helpful or could it make matters worse? Or what would you recommend?
Speaker_-_Dr__Elizabeth_Ricanati: There are a variety of foods that have high amounts of omega-3’s, such as fish (especially fatty fishes), walnuts, flax seeds, chia and other nuts. In addition, one can take supplemental omega 3 fatty acids, such as fish oil.
ziahsgmom: I was recently diagnosed with pulmonary hypertension, sleep apnea and had severe back pain. How can I reclaim my health and consequently my life? Also I am over weight and I am a carb addict. How can I wean off carbs?
Speaker_-_Dr__Elizabeth_Ricanati: Today is the first day of the rest of your life. Since you have so many chronic diseases, it will take some time to address them. However, I admire your desire to 'reclaim your health' and I believe that you can be successful in this effort: modifying your nutrition with a goal of losing weight will help with all of your diagnoses, as will increasing your exercise and managing your stress levels.
Simple stretching, such as restorative yoga, can help with your chronic back pain. Finally, I believe in moderation, not in elimination: not all fats are bad (think monounsaturated fats=good; trans fat=bad), and not all carbs are bad (think healthy whole wheat pasta vs. processed white pasta).
myOmy: Please comment of the effects of a vegetarian diet and good health.
Speaker_-_Dr__Elizabeth_Ricanati: The health benefits of vegetarian diets are related to the amount of saturated fat. Animal products are high in saturated fats, whereas fruits and vegetables and legumes are not. Fruits and vegetables are high in fiber and the majority of us in America are woefully deficient in our fiber intake. Did you know that men need 35g per day of fiber and women need 25g per day (most of us come nowhere near that!) Don't forget, though, that a calorie is a calorie and substituting a portion of meat for a calorie-laden piece of cheese lasagna is not necessarily healthier.
nystrom: I still want to put brown sugar in my oatmeal; what can I do?
Speaker_-_Dr__Elizabeth_Ricanati: Although we do not recommend sugars in general (brown or white), there is a natural sugar that we use in moderation in our program (our participants really like it!). Agave nectar, from a cactus plant, is a very sweet natural sugar that is lower on the glycemic index than other sugars. The benefit, therefore, is that you can use less of it and not experience the sugar high that normally follows sugar consumption. The consistency is like honey, so if you're cooking with it, be mindful of that. And finally, don't forget that it is a sugar and has calories, so don't go overboard!
raine: How important are multivitamins when it comes to your health and a chronic disease?
Speaker_-_Dr__Elizabeth_Ricanati: Although we all wish we had the perfect diet to obtain these nutrients entirely through diet, most of us do not! Therefore, we encourage multivitamins, Vitamin D, Calcium and Omega 3's.
pranker: Comments on supplements?
Speaker_-_Dr__Elizabeth_Ricanati: If at all possible, I prefer that one get their nutrients through food, and not supplements. That is not always possible, though, and so it is perfectly reasonable to take a multivitamin, for example. In addition, no matter how well we eat, most of us come nowhere close to the current government recommendations for calcium and vitamin D. Recent literature on omega-3s for both heart and brain health have documented the importance of this; and again, most of us do not eat enough of the foods high in omega-3s (salmon, flaxseed, chia, walnuts, for example), therefore it is reasonable to take this as a supplement too.
tweetweet: Is calcium and exercise enough to help bone density?
Speaker_-_Dr__Elizabeth_Ricanati: Calcium, vitamin D and weight-bearing exercise are all important for helping to maintain bone density. This is especially important as we age: we achieve peak bone mass in our late twenties – early thirties.
Calcium requirements vary by where you are in your life cycle:
- Premenopausal women: 1200 mg daily
- Postmenopausal women: 1500 mg daily
- Children: 800 mg daily
- Men: 1200 mg daily
Vitamin D requirements are also changing. We used to think that 400 iu daily was enough, but have recently realized that this may be too low and currently, recommendations are increasing and many of us take at least Vitamin D3 1000 iu daily.
kplank: How often do I need to exercise to be of benefit? How about stretching? Weights?
Speaker_-_Dr__Elizabeth_Ricanati: We all should strive to get at least 150 minutes of exercise per week, or on average thirty minutes five days per week. If you are interested in weight loss, then this number should be closer to two hundred minutes per week.
Stretching is important for many reasons. For example, it helps to prevent injuries and it helps to increase flexibility.
Weights are an important part of strength training and for building muscle mass.
Yme_: What exactly are the true benefits of walking?
Speaker_-_Dr__Elizabeth_Ricanati: Walking is a great way to increase your overall cardiovascular health. Walking does this two ways: first, it builds your endurance and second, it increases your strength (as you build your leg muscles). The American Heart Association recommends that we all strive for 10,000 steps a day. As part of our program here, we provide our participants with pedometers so that they can monitor their progress.
Walking can be done anywhere, at any pace, and at any time: indoors, outdoors, even around your dining room table at night as you sort mail and try and get in those last 250 steps. Simple ways to increase your steps include: parking your car at the far end of the parking lot, taking the steps instead of the elevator/escalator, or walking your dog instead of just letting the dog out.
twiddleDD: Is there a spirituality component available, or built into, this program?
Speaker_-_Dr__Elizabeth_Ricanati: In the behavioral health component there is some discussion about spirituality and how it may be relevant on an individual basis. It can complement the program for some individuals.
gondaf111: I am always tired; why is this and what can I do to change that?
Speaker_-_Dr__Elizabeth_Ricanati: Getting enough sleep is not to be underestimated. Unfortunately, given our busy lives with work and family and other obligations, many of us do not get enough sleep. Fortunately, there are behavior modifications that you can do, starting tonight, that will improve your ability to get a good night’s sleep and feel less tired. We call this “Sleep Hygiene” and it includes the following behaviors:
- trying to go to bed and wake up at the same time every night, regardless of whether it’s a weekday or weekend day
- avoiding caffeine at least after 6pm, if not earlier
- limiting alcohol intake
- trying not to exercise at night just before sleep
- lying in bed awake: if you are in bed trying to sleep and awake for more than 20”, then get up and out of bed; beds are for sleeping – not reading, eating, watching television, etc.
angesviper_2: How does one that is a type 1 diabetic that also has Multiple Sclerosis deal with fatigue and staying as well as possible?
Speaker_-_Dr__Elizabeth_Ricanati: Both of these, as with many chronic diseases, can cause fatigue. Unfortunately, it can be a bit of a chicken and egg situation, and sometimes is very hard to tease out what is causing what. To help combat the fatigue, it is imperative that you maximize both your treatment of your diabetes and your MS.
Ways to do this, in addition to the treatment plan that you have with your current physicians, include maximizing your lifestyle: specifically, it is especially important for you to eat well (think of food as medicine), to exercise as much as you are able to (if you have limitations related to the MS, our MS program here at Cleveland Clinic can work with you on this), and to manage your stress as much as possible (i.e. don't forget to breathe!).
We have noticed at Lifestyle 180 that in our participants overall, including our participants with MS, their fatigue has improved with the integration of these three components.
Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Elizabeth Ricanati is now over. Thank you again for taking the time to answer our questions about healthy lifestyle.
Speaker_-_Dr__Elizabeth_Ricanati: Thank you for the opportunity to chat with you today about lifestyle and chronic diseases. I hope that you found this helpful; I certainly enjoyed reading and answering your questions. We look forward to seeing you here at our program, Lifestyle 180, in the future!
- To learn more about Lifestyle 180, or to enroll in the program, call 877.331.WELL (9355). Or, you can visit us online at www.clevelandclinic.org/lifestyle180
- A remote second opinion may also be requested from Cleveland Clinic through the secure eCleveland Clinic MyConsult website. To request a remote second opinion, visit eclevelandclinic.org/myConsult.
- If you need more information, contact us, chat online or call the Center for Consumer Health Information at 216.444.3771 or toll-free at 800.223.2272 ext. 43771 to speak with a Health Educator. We would be happy to help you. Let us know if you want us to let you know about future web chat events!
- Some participants have asked about upcoming web chat topics. If you would like to suggest topics for 2009, please use our contact link clevelandclinic.org/webcontact.
This chat occurred on July 21, 2009.
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