Diet
We believe it is important that everyone remembers the key characteristics of the DASH diet, along with aspects of the 2015-2020 dietary guidelines in order to prevent the development of chronic disease states. The DASH diet has been proven to prevent and minimize the impact of HTN, diabetes, obesity, high cholesterol, kidney disease, heart failure, and many other conditions.
The key features of a healthy diet are:
A high intake of whole grains: (brown rice, oatmeal, whole grain bread, pasta, oats, granola): 6-7 servings/day
A high intake of fruits and vegetables: 4-5 servings/day
A moderate intake of low and non fat dairy products (low fat yogurt, low fat milk, cheese): 2-3 servings/day
A moderate-high intake of Lean meats, fish and poultry(try to limit/avoid processed and red meats)
Include Oils
A low intake of fats and sweets: 1 or less servings/day
Low sodium intake: Less than 2300mg/day, less than 1500/day for patients with hypertension
Limit saturated fat intake to less than 10% of daily calories.
Limit added sugar intake to less than 10% of daily calories.
Limit consumption of artificial sweeteners.
Some key things to look for on food labels are a low sodium, low sugar, low saturated fat (no more than 10% of calories), low trans fat, and high fiber.
Soluble Fiber:
Soluble fiber is beneficial by helping to decrease cholesterol and sugar levels. It binds to the materials that your body uses to create cholesterol(bile acid resins) in the intestines, and flushes them out of your body. To effectively decrease cholesterol an adequate intake(10-25Grams per day) of soluble fiber is required.
Insoluble Fiber:
Insoluble fiber is beneficial to those who would like to regulate digestion such as people with constipation, diverticulitis, IBS or other intestinal conditions. A healthy intake of insoluble fiber also can prevent intestinal conditions, diabetes, high blood pressure, and obesity from occurring in the future. It is an important part of a healthy diet.
An adequate fiber intake is known as 38 grams/day for men 50 or younger, 30 grams/day for men 51 or older, 25 grams/day for women 50 or younger, and 21 grams/day for women 51 or older.
Sodium:
High sodium intake causes the body to absorb water into the bloodstream, increasing blood pressure. Constantly having high blood pressure can result in changes in the blood vessels, which can lead to heart disease and other vascular conditions(if left untreated). An adequate potassium intake is important in order to balance the sodium levels in the body, and to counteract the effects of sodium.
It is recommended to consume less than 2300mg/day of sodium, or less than 1500/day for patients with hyptertension.(22).
Saturated fats:
It is recommended to consume less than 10%(around 5-6%) of your daily calories from saturated fat. Saturated fats have been shown to increase LDL cholesterol levels. Avoiding them can lower your "bad" cholesterol levels.(22).
Trans Fats:
Trans fats have also been shown to increase LDL cholesterol levels. Avoiding them can lower your "bad" cholesterol levels and decrease your chances of developing heart disease.
Unsaturated fat:
Unsaturated fats, are known as the "good" fats because they can help to lower LDL cholesterol, and therefore reduce the risk of cardiovascular disease. It is recommended to consume a higher content of unsaturated fats, and a low content of trans and saturated fats.
Sugar:
It is recommended to limit consumption of added sugars to less than 10% of calories per day. (22). A high intake of added sugar has been associated with obesity, diabetes, liver effects, and a variety of other hormonal effects.
Antioxidants:
Antioxidants work by neutralizing free radicals. Free radicals are molecules that can cause oxidative damage to the cells of the eyes, heart, skin, brain, immune system and other cells. Consuming foods high in antioxidants can be protective of the cells of the body. Antioxidants include flavanoids, beta carotene, alpha carotene and Vitamins A, C, and E.
Omega 3 fish oils:
Omega 3 fatty acids decrease the amount of free radicals and inflammation within the body, protecting your cells from damage and helping them to communicate. They have shown some benefit in heart and brain health. A diet high in fish provides adequate amounts of omeg-3's.
Exercise
Physical exercise while sticking to the DASH diet principles can dramatically improve your health and prevent disease development.
Engaging in high intensity aerobic exercise for 25 minutes 3 days a week, or moderate intensity aerobic exercise for at least 30 minutes for 5 days a week can increase your cardiovascular health and decrease your chances of developing diseases that are the leading causes of death in the U.S.A. (22).
Resistance training also offers many benefits in the prevention of osteoporosis and in overall health. Muscle training 2 days per week will have added health benefits. (22).
Stress Reduction
Cortisol:
During stressful situations, the brain signals the pituitary gland to release ATCH (adrenocorticotropic hormone), which travels through the blood stream to the adrenal glands which are located on top of the kidneys. This causes the adrenal glands to release cortisol. Cortisol then travels through the blood stream and contributes to a variety of processes that help an individual to deal with a stressor. These processes include gluconeogenesis (the production of glucose from fats, carbohydrates and proteins and release of glucose into the blood stream), blood pressure, immune system, nervous system, and inflammation regulation.
Many of the negative effects associated with stress come from chronically elevated stress hormones such as cortisol. Normal adults tend to have highest cortisol levels in the morning upon awakening, and the levels decrease throughout the day and are lowest in the evening before sleeping. If cortisol remains constantly elevated for an extended period of time, it can lead to negative effects such as: weight gain, suppressed immune system, high blood pressure, impaired brain function, changes in thyroid function, high blood sugar, and decreased bone mass. Chronically elevated cortisol has been linked to Alzheimer's disease, depression, anxiety, heart disease, and digestive conditions.
Cortisol levels which are constantly too low are also associated with negative effects such impaired brain functioning, low blood sugar, low blood pressure, inflammation, low immune system function, thyroid function changes, and tiredness.
Ways to decrease stress and keep cortisol balanced:
1) Exercise (see above)
2) Meditation/breathing/relaxation techniques
3) Healthy Diet, limiting sugar consumption and trans fats(see above)
4)Avoiding chronic, severe stress. It is a good idea to make your primary care physician, aware of how much stress you are experiencing regularly, and what the causes are.
5)Decrease consumption of alcohol and caffeine.
6)Getting 7-9 hours of sleep per night for adults.
7)Laughter, and spending time with people who you enjoy being around.
8)Herbs and supplements: supplements such as B complex, magnesium, omega 3 fatty acids, turmeric, DHEA and other adaptogen herbs have been shown to decrease cortisol levels. Not all of these substances have proven to be safe for use in the long term.
9) massages/acupuncture
10) some research has shown that chewing gum, and listening to music can decrease cortisol levels.
11)Verbally expressing your experiences, frustrations and angers to a therapist or friend.
12) Setting goals that are realistic and not feeling the need to be perfect.
13) Spending time doing activities or hobbies that you enjoy.
14) Spending time outdoors, in nature.
Meditation
Mindful Meditation has many benefits. Meditation can alter your brain in a way that makes it better able to deal with stress and anxiety, it can improve concentration, lower blood pressure, and has been shown to boost your immune system. Stress reduction has been shown to lead to weight loss due to a decrease in "stress hormones" within the bloodstream. These mindful breathing exercises use rhythmic, slow, abdominal breathing along a clearing of the analytical thoughts in your mind, to achieve changes within the nervous system which can achieve the previously described benefits. For many people it can takes months to master these techniques.
Meditation Technique
Wear lose clothing, remove any constricting clothing items.
Lie flat on your back or sit in a comfortable position with your back straight.
Concentrate on relaxing your body. Try to relax and release the tension in your neck, chest, abdomen and shoulders. You should not be using upper body muscles to breath.
Some find it beneficial to place a book or light object over their navel, under their rib cage to encourage abdominal movement through resistance.
Keep your body relaxed and inhale through your nose. Breath effortlessly and rhythmically, allowing your lower stomach/abdomen to expand like a balloon, causing the balloon to rise and fall. Try to clear your mind of all thoughts, having nothing in your mind other than focusing of your breathing. At the end of each exhalation, count from 1 to 10, 10 being the 10nth breath, and repeat(this is only if you have trouble clearing the thoughts in your mind, many people find this helpful if they are new to meditation). Keep the airways open with smooth transitions from inhaling to exhaling.
Practice this technique, after you get used to it you may not need the book or the counting.
Some forms of meditation are geared towards a focus on one object, word, situation, or setting to imagine that you are in, which can help to evoke positive feelings.
Routine Physical Exams
We encourage all people to develop a great relationship with their primary care physician. It is important in order to minimize the risk of disease development, and to maximize therapy outcomes.
Ages 19-21: Annually
Ages 22-26: Once every 1-3 years according to risk factors.
Over 50 years old: Annually
Cancer Screening
Testicular Cancer
Breast Cancer
Skin Cancer
Oral Cancer
Prostate Cancer
Colorectal Cancer
Lung Cancer
Cervical Cancer
Testicular Cancer Screening and Prevention:
Correct undescended testicle at an early age.
Be sure to get a testicular exams at every physical exam.
Self Exams:
It is best to talk to your doctor about the best way to do a self exam.
It is best to conduct the self examination after a shower or bathing.
1) Hold the penis out of the way. Hold one testicle between the thumb and fingers and roll it very gently, you are feeling for lumps or bumps. You are also feeling for any chances in size, texture or shape.
2) Repeat with the other testicle.
3) Notify your doctor if you notice a change.
Symptoms:
Enlargement of either testicle or a lump on the testicle
Heaviness of the scrotum
Aches or pain in the back, groin or lower abdomen region
Pain in the testicles
Fluid collection or swelling in the scrotum
Breast Cancer
Screening:
Breast exam every 3 years or less for women ages 20-40
Mammogram and breast exam once per year for women over age 40
High risk patients should discuss more frequent screening with their doctor
Discuss genetic tests with your doctor if you have a family history of breast cancer. These tests can show mutations in genes that can tell us the likelihood of cancer development, and guide treatments.
Discuss hormone replacement therapy with your doctor after menopause
Self Exams:
Become familiar with the normal structure of your breasts, if you ever notice a change, notify your doctor.
Conduct a self breast examination once per month and notify your doctor of any changes, click here for breast exam instructions.
Symptoms:
A hard lump in the breast or under the arm
Changes in size, shape, weight or color of breast including redness or inflammation, purplish color, scales, or an itching rash on the breast
Pain of the nipple, bleeding or discharge from the nipple
Nipple becoming inverted
Swelling or warmth of the breast
Skin Cancer
Screening:
A skin exam(from doctor) once per year starting at age 50.
Self Exams:
Know the ABCDE rule for abnormal mole identification:
Asymmetry, Border irregularity, Color is uneven, Diameter greater than 6mm
Evolving size, color or shape.
You can examine your own skin once per month. notify your doctor if you notice anything unusual.Click here for skin exam instructions.
Symptoms:
Sore on skin that dose not heal
A new mole that was not there before
Changes in the border or color of a spot on the skin, redness or inflammation around the area
A lump on the skin that can bleed. The lump is small and pale
Oozing or crusting areas of skin that are large in size
A lump or a red spot on the skin that is crusting or has a scaly appearance
A mole or area of skin that is inflamed, red, itchy or painful
A spot on the skin that is dark brown or black
Oral Cancer
Screening:
Oral cancer screening at each dentist visit.
Self Exams:
Examine your mouth regularly once per month, notify your doctor if you notice any changes. Click here for further instructions on how to conduct a self exam for oral cancer.
Click here for further instructions on how to conduct a self exam for oral cancer.
Symptoms:
Patches in the mouth on the gums, tongue, inner cheek or lips that are white or red
Lump in the mouth or on neck
Difficulty or pain when trying to speak, swallow or chew
Hoarseness that is persistent for more than 1-2 weeks
Pain or numb feeling in the mouth that is persistent
Loosened teeth
Jaw swelling
Bleeding from the mouth
Persistent ear ache
Liver Cancer
Screening and Prevention:
Get vaccinated for Hepatitis B.
Get tested for and treat Hepatitis B and Hepatitis C. Many patients who have Hepatitis C are asymptomatic until they beginning having symptoms of liver disease. If it is diagnosed early the likelihood of it progressing to anything serious is much lower.
Symptoms:
Weight loss
Nausea/vomiting
Increased size of liver (large mass underneath right rib cage)
Increased size of spleen (large mass underneath left rib cage)
Pain of the right shoulder or abdomen
Fluid collection in the abdomen
Itching
Yellowish skin or eyes
Fever
Increased size of veins of the abdomen which are visible
Unusual bleeding or bruises
Fainting or tiredness(low blood sugar)
Muscle changes, weakness, confusion, nausea(high calcium)
Breast enlargement
Decreased testicle size
Being flush or redness in the face(high red blood cells)
High cholesterol
Prostate Cancer
Screening:
Discuss screening with your doctor when you reach the age of 50. If you have an immediate family member who has ever had prostate cancer, or if you are african american, begin discussing screening options at age 45. If two or more immediate family members have ever had prostate cancer, begin talking to your doctor regarding screening at age 40.
A Prostate Specific Antigen(PSA) test every 1-2 years is an option.
Symptoms:
Changes in urination such as difficulty urinating or pain when urinating
Trouble initiating urination
Erections that are painful or difficulty getting an erection
Lower back, thigh or pelvic pain
Blood in the urine
Colorectal Cancer
Screening:
Screening should begin at age 50, options include:
Flexible sigmoidoscopy every 5 years
Virtual colonoscopy every 5 years
Colonoscopy every 10 years
Double contrast barium enema every 5 years
Stool occult blood test every year
Stool immunochemical test every year
Stool DNA test
Symptoms:
Blood in the stool or bleeding from the rectum
Narrow stools
Bowel movement changes
Cramps or bloating of the abdomen
Feeling of incomplete bowel movement, diarrhea or constipation
Weight loss
Constantly feeling tired
Vomiting
Lung Cancer
Screening:
Consult with your doctor about CT screening for lung cancer.
Symptoms:
Persistent cough for more than 2 weeks
Coughing up blood
Persistant pain in chest
Reoccurring bronchitis or pneumonia
Loss of appetite and weight loss
Trouble breathing, hoarseness, or wheezing
Constantly feeling tired
Cervical Cancer
Screening Information:
Pap tests ever three years between ages 21-29
Pap and HPV test every 5 years from ages 30-65 OR Pap test every three years
High risk patients should talk to their doctor about screening and possibly should be screened more frequently
Women over 65 who have had negative results for all cervical cancer do not need to continue screening
Women over 65 with history of cervical cancer should be tested for 20 years after their cancer diagnosis
Symptoms:
Discharge from the vagina that is unusual
Pain or bleeding during or after sexual intercourse
Post-menopausal bleeding
Bleeding or blood spots at a time other than period
Menstrual bleeding that is heavier or lasts longer than usual
Click here for more cancer screening and prevention information including the anti cancer diet.
