WELLNESS GUIDELINES



WELLNESS GUIDELINES

Use as an adjunct not a substitute for specific recommendations

by your Health Care Providers

It is well known that both genetics and luck play a significant role in whether or not we will remain well or suffer from a host of diseases. It is also well known that the choices we make regarding diet, exercise, environmental exposures and preventive health can significantly impact our wellness as well.

Here is a summary of some of the simple things one can do to increase the chances of avoiding or at least postponing many of the common ailments of our time.

Obesity

In the last twenty years Americans have gone from 14.5% of us being Obese (>30 kg/M2) to 23%. Obesity increases the risk of High Blood Pressure, Diabetes, Arthritis as well as various common Cancers, including Breast Cancer.

Reducing caloric intake and increasing structured exercise as well as daily physical activity is the advised approach to prevent and correct Obesity. Options to assist you in achieving this goal include joining a local health club, Weight Reduction Support Groups and working with your Health Care Providers.

Diet and Nutrition

There are many different theories regarding just what is the ideal diet and what, if any, nutritional supplements are advisable. Let’s break these down for you.

The ideal diet consists of mostly “complex” carbohydrate, i.e.; rice, pasta and breads along with proteins and healthier fats. Examples of proteins are fish, poultry, beef, dairy foods and certain vegetables such as beans and chic-peas. Beef and dairy generally have high amounts of saturated (bad) fat so these foods should be reasonably limited. 1% (fat) yogurt remains a good source of protein.

It is wise to try to maximize fishes, poultry (without skin) or certain vegetables for your protein sources (yogurt and cottage cheese is also good) and minimize animal meat. This will result in reducing the unhealthy saturated fats from beef, poultry skin (which is often included in ground turkey and turkey lunch meats) and dairy fats.

The American Heart Association recommends up to 25% of your total calories as fat. We think this is a little high. Primarily “unsaturated” fats are advised. These are generally vegetable oils as opposed to the “saturated” fats in beef and dairy.

Coffee and decaffeinated coffee may mildly increase your LDL if you drink more than four cups daily. Foods that include “partially hydrogenated vegetables oils” should also be limited. These are vegetable oils that have been hardened into meat like fats. Butter is probably healthier than margarine, but limit it when possible. None of these are good for you. Sweet foods (simple sugars), fried foods and alcohol all increase triglycerides. These fats are probably less dangerous that cholesterol. They are a separate risk factor for heart and vascular disease, and many cancers, however.

Salt intake should as a general rule be limited to “minimal added” salt. Moderate or severe restriction is only necessary in certain hypertension and heart failure patients.

We also suggest that you try to avoid unnecessary chemicals, preservatives and food additives. Get in the habit of reading ingredients. Bottled or filtered water may be desirable; kids do require the fluoride in city water, however. A complete discussion is beyond the scope of this article. BHA, BHT and EDTA are probably fine. There are many books that discuss these issues. Additive/preservative free products are obviously best.

TIP: Vegetables aren’t as good if they’re dripping in oil. Fat free mayonnaise/salad dressing is available but will rarely be in a restaurant prepared foods i.e.; tuna salad. Also, Caesar salad dressing generally has both cheese and whole eggs, so not all salads are equally “healthy”.

Always avoid over-eating.

Supplements and Vitamins

Supplements are controversial with some studies suggesting benefits and yet other refuting any advantages. Certain vitamins may be protective and actually reduce the risk of certain forms of cancer such as breast and colon cancer. They also may slow the aging process by interfering with “free radicals” that are believed to destroy the cellular DNA. There is evidence that they may also decrease the incidence of heart disease. This is not absolutely proven at this time. Vitamin E (200 units/day or less) and vitamin C (500mgs/day) in addition to a multi-vitamin-mineral supplement (GNC brand Ultra-Mega, mens or woman’s), Folic Acid (400-400 mcg), and Coenzyme-Q (30 mg), and Selenium (200 mcg) is reasonable and relatively low in dose if you are so inclined. Calcium, at least 1,000 mg’s daily such as 5 Tums per day or Os-Cal tablets are advised for men and woman unless you have had kidney stones or other calcium endocrinopathies. For further discussion, speak to your Doctor.

Tip- Often, extra vitamin C and E with a good multi-vitamin is the easiest way to get much of the above, except calcium which is needed separately.

Physical Inactivity

Currently, in America, 25% of us are inactive during our leisure time. Another 60% are only occasionally physically active. The American Heart Association recommends at least 30 minutes of moderately intense exercise on a daily basis, although three times weekly may suffice. Moderate exercise (aerobic) is defined as the equivalent of walking at 40-60% of ones maximal capacity. Put another way, a brisk walk; less than a jog but more than a casual stroll.

Aerobic exercise, including jogging, cycling, swimming, rowing and aerobics classes all increase the desirable HDL cholesterol. “Aerobic” is defined as a pulse rate 220 minus your age X .70 minimally. If your triglycerides are not elevated, 1-2 drinks of alcohol/day may also raise HDL. It is not clear whether this HDL is cardio-protective or not, present data suggests that it is. For example, if your age is 40: 220 - 40 =180 X .70 =126 beats per minute. If you measure your pulse in your wrist or neck for 10 seconds, you multiply this X6 to determine your pulse rate.

The National health Institute (NIH) advises a medical evaluation for all individuals 40 years of age and older prior to beginning an exercise program. For some, an exercise stress test will be advised. For all, beginning slow and easy is a dictum that should always be followed.

Tobacco Use.

This is easy. If you do; STOP and if don’t; DO NOT START.

There are many other exposures that further increase ones risk of cancer and heart disease if you smoke. These include Radon gas exposure, Asbestos, Coal and other inhalant irritants and even alcoholic beverages. A good web site to review various methodologies for quitting is tobacco/consquits.htm.

We strongly suggest that you seek our help in your attempt to quit cigarettes as your chances for success will be significantly improved.

CANCER [Colorectal, Cervical, Prostate, Breast, Skin]

Colorectal Cancer

There are 148,000 new colon cancer cases in America annually. The risk is much greater in African-Americans. Colon Cancer screening saves lives and everyone should be screened according to these general guidelines;

At age 50 (earlier if significant risk factors are present including strong family history) begin screening with a colonoscopy. Annual rectal examinations and stool testing for hidden blood thereafter are recommended Repeat colonoscopy every five to ten years unless directed to be more frequent by your health care provider.

Cervical Cancer

14,000 new cases of cervical cancer would be avoided if all Americans underwent proper screening. The most significant risk factor for cervical cancer is exposure to the human Papilloma Virus (HPV), usually sexually. Other risk factors include various sexual activities and cigarette smoking. African-Americans are again at greater risk. The American Cancer Society (ACS) recommends annual Pap smears / Pelvic Exams beginning at the time of sexual activity or 18 years of age. Thereafter, either annual exams or if three consecutive annual Paps are negative, repeat tests every three years are advised. We typically recommend annual Pap smears / Pelvic Exams for all women. In most Elders, Pap smears can be discontinued at age 75-80 years.

Breast Cancer

Approximately 250,000 new cases of breast cancer occur annually with some 40,000 deaths. One percent occurs in males. Family history plays a major role here despite the fact that most women who contract breast cancer do not have family history of this disease. Currently, one in eight-½ woman develops breast cancer in their lifetime! As many of you are aware there are many current controversies surrounding breast cancer.

One such controversy is the relative risk of Hormone (Estrogen) Replacement Therapy (HRT) in post-menopausal women. Most believe that there is a 5-6% increased risk of breast cancer in women treated for many years with HRT. However, in most newly post-menopausal women, HRT is still appropriate and it is advised that each patient discuss this with their Health Care Provider to individualize therapy.

Another controversy is whether monthly Self-breast Exams are beneficial. To date, it has not been proven that these exams save lives, yet we typically believe that it is a wise endeavor.

Finally, mammography has come under fire as well. Currently subscribe to a mixture of the US Preventive Services task Force, the National Cancer Institute (NCI) and the American Cancer Society (ACS) and advise screening Mammography at age 35 and then annually at age 40.

Prostate Cancer

There are 190,000 new cases of Prostate Cancer annually with 30,000 deaths. There are at least as many controversies surrounding this disease as Breast Cancer screening. Once again, African-Americans are at greater risk. Family history plays a strong role here as well. High dietary fat intake probably increases the incidence of Prostate cancer. Increased ingestion of tomatoes, selenium, and Vitamin E and possibly lycopene, likely reduces the risk.

Screening is typically limited to Digital rectal Exams along with a blood test called a PSA. Neither have been proven to save lives, nevertheless, beginning at age 50 most doctors believe that annual screening is appropriate.

Honorable Mentions

Blood Pressure (Hypertension) screening is important in all adults, perhaps every three years in patients under 40 and then annually. Aggressive treatment of all Hypertension is imperative.

Skin Cancer is so common that there are more than one million cases annually with 10,000 deaths, mostly from Melanoma. Avoidance of sun exposure is the most important preventive action advised but skin screening by your Health Care Provider on a regular basis is advised.

Chest X-Rays, EKG’s, Lung Function Tests and other diagnostic tests should be performed according to a schedule determined by your Health Care Professional.

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