A Cleveland Clinic Publication
How to Overcome
Mindless
Eating
Being Thin = Healthy Heart
True or False?
Knowledge for Better Living
9
Tips for
shedding
years – and
pounds!
Eating
Disorders
Equal opportunity conditions
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Weight Loss
Knowledge for Better Living
Cleveland Clinic
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table of
Contents
from the cover
p.04
p.08
p.10
p.12
Overcome
Mindless Eating
Eating Disorders: Equal
Opportunity Conditions
Weight Loss: When Your
Health Depends on It
Can Being Thin Protect
You From Heart Disease?
Combine the powers of
It’s not just teenage girls
Obesity affects more than
Maintaining an ideal weight
mind, body, feelings and
anymore. Experts are seeing
your pant size; it affects
is an important step toward
thought to overcome those
a surge in younger people
every organ system in the
heart health, but “Thin isn’t
with eating disorders,
body. But one weight-loss
necessarily synonymous with
boys included.
method can not only help
healthy,” says Cleveland Clin-
you shed pounds – and
ic cardiologist Arman Askari,
keep them off – but also
MD. What else can you do to
help you recover from the
maintain heart health?
“I can’t believe I ate the
whole thing” moments.
many “ills” of obesity.
heart health
Tips for Eating Heart Smart – p.14
It’s All in the Numbers – p.15
Grab your grocery list and add these hearthealthy foods. They’ll help you reduce your
risk of high blood pressure, high blood
cholesterol, diabetes and obesity. Your
heart – and taste buds – will thank you!
Discover how healthy your heart is
just by looking at the numbers.
also in this issue
Rethink Your Drink? – p.05
It’s common knowledge: Calorie-free diet soda
helps people stay in shape. Recent research,
however, suggests otherwise.
Turn Back the Clock (without surgery!) – p.16
If “mature” skin has you feeling down, learn how
the latest twist on microdermabrasion can leave
you with smoother, fresher-looking skin.
9 Tips for Shedding Years – and Pounds! – p.18
These simple, tried-and-true tips can help you
shed pounds and feel healthier, younger and
more vibrant.
Diet Pills: Our Expert Weighs In – p.06
Medical marvels abound, so how about
a pharmaceutical or herbal agent to help
overweight people slim down?
Targeting Pediatric Obesity – p.17
Seriously overweight children may face lifelong
health problems and a shorter life expectancy
than their parents. Cleveland Clinic Children’s
Hospital has launched several programs to
address this national health crisis.
Bringing Civility to the Cancer Experience – p.18
Once a week, patients at Cleveland Clinic Taussig
Cancer Institute enjoy high tea, a welcome departure
from their typical visits.
Food for Life – p.07
Fighting a life-threatening illness takes
strength. Learn what to eat – and how – to
boost energy and get healthy again.
Recipe: Mac and Cheese Please! – p.17
Try this heart-healthy version that’s sure
to please even the finickiest of eaters.
A Healing Link – p.20
Cleveland Clinic employees make a difference every
day in the community. Read about the professionals
who bring medical care to homeless women.
“
”
I Can’t Believe
Whole Thing
I ate the
When it comes to losing weight, what happens in your head may be as important as what goes
into your stomach. While nutrition and exercise will always be critical, the next most important
thing may be simply…paying…attention.
“Okay, let’s do what I call the ‘chocolate meditation,’” says
“Denying yourself a favorite
treat just leads to trouble.”
Susan Albers-Bowling, PsyD, author of Eating Mindfully: How to End
Mindless Eating and Enjoy a Balanced Relationship with Food. “Imagine you’re eating a chocolate kiss. As you peel off the wrapper, listen
to the crinkle of the foil. Study the chocolate. Appreciate its color,
texture and shape. Bring it up to your nose, and inhale the buttery,
cocoa aroma. Put it into your mouth slowly, and roll it around on
your tongue. Listen to your thoughts and feelings.”
This exercise is a good example of what Dr. Albers-Bowling calls
“eating mindfully,” or “being diligently attentive to your body, mind,
thoughts and feelings as you eat.”
“Too often, we make eating a routine matter,” says Dr. Albers-Bowling.
“Eating becomes part of our multi-tasking lifestyle. We eat while we’re
watching TV, surfing the Web, or reading a magazine. We get to the
bottom of the bag of chips, and realize we didn’t taste a single bite.
That’s when we get up for more.”
Eating mindfully calls for us to pay attention to what we put in our
mouths, but not to be harsh or judgmental about what we eat. Trendy
diets that cut out whole food groups tend to be short-term solutions,
says Dr. Albers-Bowling. “Denying yourself a favorite treat just leads
to trouble,” she warns. “You start to crave it all that much more.”
Dr. Albers-Bowling counsels people individually or in groups on
weight loss issues. She believes that eating mindfully combines the
powers of mind, body, feelings and thoughts. “Before you take a bite,”
she says, “rate your hunger on a scale of one to 10. Tune into your
body, and listen to what it’s telling you. Sometimes the clues are
subtle. For instance, you may think you’re feeling tired and irritable,
but you may just be hungry.”
With the “chocolate meditation” approach, no food is off limits.
“I don’t tell people to get rid of chocolate,” says Dr. Albers-Bowling.
“It’s not realistic, and what fun would life be if you got rid of chocolate? You just need to eat it, or whatever your food of choice may be,
in a mindful way.” ❖
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RethinkYourDrink
?
Many of us live life with a diet soda in hand, confident we can have our cola and stay in shape.
What could be bad about zero calories? But recent research casts doubt on that notion.
A n analysis of 10 years of data from the Framingham Heart Study, a project
of the National Heart, Lung and Blood Institute and Boston University, reveals that
middle-aged participants who drank one or more sodas daily — regular or diet — were
twice as likely as non-soda drinkers to develop a set of risk factors for heart disease and
type 2 diabetes. Known as metabolic syndrome, the risk factors include abdominal
obesity and high levels of blood sugar and LDL, or “bad,” cholesterol.
So should diet soda fans can their beverage of choice?
The Blame Game
The study’s senior author, Ramachandran Vasan, MD, cautions against overreaction. The
findings don’t suggest soda directly causes metabolic syndrome. The study of close to 3,500
people, published in the journal Circulation in July 2007, indicates an association between
the two, a link that may say more about people who drink soda than the soda itself.
In the study, people who drank more diet and regular soda had a greater intake of fat and
sugar, and less intake of fiber in their diets, says Dr. Vasan. This finding squares with
other studies. “Soda drinkers may also have a more sedentary lifestyle,” Dr. Vasan adds.
Soda drinkers also may have a sweeter tooth than their non-soda-drinking brethren, says
Cindy Moore, MS, RD, Director of Nutrition Therapy at Cleveland Clinic. She draws an
analogy to people who consume a lot of salt.
“People can get so accustomed to food with high salt content that they think anything less
salty tastes bland. The same can happen with sweets, where you need higher and higher
sweetness levels.” And while your soda may be artificially sweetened, the cake and candy
you eat isn’t, helping to explain the higher rates of metabolic syndrome among soda
drinkers, she offers.
Then there’s the rationalization that diet soda drinking “allows” you to eat higher-calorie
foods — an approach bound to backfire, says Ms. Moore.
Other theories pin more blame on diet soda itself. One intriguing possibility is that
the caramel content in colas could promote insulin resistance, potentially leading to
the dangerously high blood sugar levels of type 2 diabetes and metabolic syndrome.
Research indicates an association between insulin resistance and caramel additives,
but the link has yet to be confirmed in people.
The Choice is Yours
Regardless of this latest study, a sure weight-gain culprit is sugary soda. “If you need
to control your blood sugar levels or weight, choosing diet soda over regular soda is
definitely the way to go,” says Mario Skugor, MD, a Cleveland Clinic endocrinologist.
However, everyone can benefit from drinking healthier alternatives, says Ms. Moore.
She suggests reaching for nutrient-packed skim milk, or tea and coffee (without the
cream and sugar), both low in calories and high in antioxidants.
Better yet, she says, “Why not pick water? It has no artificial sweeteners or additives,
no calories, and costs next to nothing.” ❖
Adapted from Cleveland Clinic Magazine, Winter 2008
A Cleveland Clinic Publication
Summer 2008
5
Diet Pills:
ur Expert Weighs In
Alice, in the book Alice’s Adventures in Wonderland, took a pill that shrank her to the size of a
keyhole. So what about the rest of us? Does the wonderland of pharmaceutical and herbal agents
have any poppable alternatives to calorie counting, exercise or stomach stapling?
“ There are no magic pills,” says Mandy Leonard, PharmD,
Assistant Director of the Drug Information Center at Cleveland Clinic.
“Everything we know tells us that the only safe and effective way to lose
weight is through nutrition and exercise.”
The FDA has approved certain medications for weight loss. But they
are not for the casual dieter, or those who would simply like to lose a
waist size or two. These drugs are usually reserved for people who are
seriously obese. These individuals – who have a body mass index
greater than 30 – are thought to benefit from the slight jump start
they may get from a prescription agent.
Dr. Leonard notes that while approved weight-loss drugs are associated with a modest reduction in poundage, all the data on them come
from studies where drugs were used along with dietary modification
and behavioral therapy. “And there are no data on how effective they
are in the long term,” she says.
Recently, the FDA approved Alli™, an over-the-counter version of a
prescription weight-loss compound called orlistat (Xenical®). Alli
works by blocking fat from being absorbed and digested.
“Alli can aid weight loss, but it has side effects and still needs to be used
in the context of a low-fat, reduced calorie diet,” says Dr. Leonard. “It’s
not a miracle drug for weight loss or, for that matter, a benign medication. People taking warfarin, cyclosporine, or drugs for diabetes or
thyroid disease should talk to their doctor before using this drug.”
What about herbal or other over-the-counter weight-loss remedies?
“You need to be very careful before using any over-the-counter
weight-loss product,” says Dr. Leonard. “Herbal weight-loss treatments may contain ephedrine, a compound that can have serious
side effects and is prohibited by the FDA. I strongly advise anyone to
talk with his or her doctor before using an over-the-counter weightloss pill. Anything that interferes with your metabolism has the
potential to cause serious damage.”
Other ephedrine-free, non-prescription weight-loss pills claim to help
weight loss by boosting energy levels and stimulating metabolism.
“These supplements usually have a lot of caffeine,” says Dr. Leonard.
Drug companies have tested countless agents over the years, hoping
to come upon the real-world equivalent of Alice’s little pill. But so far,
the results have not been promising.
“No drug is as powerful as switching to a healthier lifestyle,” says
Dr. Leonard. “That’s still the best ‘pill’ we have for losing weight.” ❖
6
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Food Life
for
Fighting a life-threatening illness, such as cancer, takes strength. Before, during and
even after treatment, it is crucial to get good nutrition. By keeping up your intake of calories
and protein, you can better maintain your lean muscle mass and boost your energy level.
But some treatments may cause side effects that leave you
feeling tired and without much appetite. Although eating well during
treatment can be challenging, here are some tips to help you cope.
Before treatment
“It’s extremely important to boost nutrition before treatment because
it’s safe to assume that your nutrition will be affected in some way,”
says Marianne Fischer, RD, LD, oncology dietitian at the Cleveland
Clinic Taussig Cancer Institute. Because treatment may leave you
exhausted, consider preparing and freezing meals before treatment
begins, so you will have nutritious food during your recovery.
During treatment
Poor appetite is the biggest challenge during treatment, according to
Ms. Fischer. “If you don’t take in enough calories, your body will break
down its own muscle tissue to get what it needs,” she says. “That’s
why protein is critical. Unfortunately, when you’re sick, it’s much
easier to eat carbohydrates like crackers or bread than to eat proteins
like meat, cheese or nuts.”
Her advice: Keep your favorite foods nearby, at the bedside if possible.
If you experience nausea or vomiting, drink extra fluids and try to eat
small snacks throughout the day rather than large meals. Be sure to
try to include some form of protein every time you eat, too.
After treatment
Eat plenty of protein to rebuild muscle mass you may have lost during
treatment. A diet rich in antioxidant foods — colorful fruits and
vegetables such as blueberries, red/yellow bell peppers and dark leafy
greens — is your first line of defense against further illness. Other
disease-fighting foods include:
• Skim milk, fatty fish and fortified OJ (packed with vitamin D)
• Spinach, tomatoes, OJ (rich in folate)
• Tomato sauce (the cancer-fighting magic of tomatoes is more readily
available when they are cooked and consumed with a bit of fat)
• Cruciferous vegetables such as Brussels sprouts, broccoli,
cabbage and cauliflower
The best advice: Consult with a registered dietitian who specializes in
nutrition for people with serious illnesses, and make him or her part
of your treatment team. ❖
A Cleveland Clinic Publication
Don’t just read it!
See and hear the latest health
news from Cleveland Clinic. Visit
clevelandclinic.org/BeWellPodcasts
for audio and video podcasts.
Hear it! Living...with Cancer
Feeling alone and scared is normal,
but life doesn’t have to lose meaning.
See it! New Hope for Brain Cancer
Cleveland Clinic is one of two medical centers in the country offering an
innovative way to get powerful radiation
beams to all areas of the brain, even
the hardest to reach tumors.
Summer 2008
7
EatingDisord
A first grader with a bottomless appetite wolfs down food in a suburban kitchen.
A young man in a nearby office park starves himself all day but “grazes” all night.
A career woman with walking pneumonia heads for the gym, afraid to miss a workout.
O
ver the last decade,
“eating disorders have become
an equal-opportunity disease,”
says Cleveland Clinic Children’s
Hospital Adolescent Medicine
specialist Ellen Rome, MD,
MPH. They affect every ethnic
group, all socioeconomic
classes, males as well as females,
the very young and the elderly.
“Identifying eating disorders
in 13- to 18-year-olds is not
uncommon, but we are seeing a
surge in younger kids, especially
8- to 12-year-olds. They are more
likely to suffer anxiety, depression, obsessive-compulsive
disorder and related challenges,
and 14 percent are male, versus
5 percent in older groups,”
says Dr. Rome.
Misguided coping strategies
Eating disorders consist of more
than anorexia nervosa (distorted
body image, marked weight loss,
failure to grow and, in girls, loss
of periods) and bulimia nervosa
(binges followed by vomiting,
hyper-exercising, and diet pills
or laxatives to purge calories).
Other examples are binge eating
disorder (binging without
purging) and night-eating
syndrome (not eating all day
and grazing all night).
“Eating disorders can be seen as
a maladaptive coping strategy in
times of change or stress, when
life seems a little out of control,”
explains Dr. Rome. Puberty,
entering junior high, starting
8
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your first “real” job and having
a baby can serve as triggers.
Early recognition
equals better outcomes
Early diagnosis prevents
serious health problems. “In
all eating disorders, abnormal
heart rhythms from malnutrition or electrolyte imbalance
are the most deadly,” says Dr.
Rome. “But we also worry about
brain health and bone health,
especially in young people. If
children’s diets are too low in
fat, their brains can shrink, and
we don’t know how reversible
that is.”
Our brains need fat to develop
normally. “From age 0 to 15, the
neural pathways in your brain
grow like a tree,” explains Dr.
Rome. “From 15 through 25,
you’re pruning and shaping that
tree. By the time you’re 30, those
pathways are hard-wired.”
Without adequate dietary
protein, children won’t achieve
their expected height or muscle
mass, delaying puberty and
compromising bone health.
Getting well –
and staying that way
Recovery is about restoring
balance, avoiding extremes and
pursuing wellness, notes Dr.
Rome. In Cleveland Clinic’s
Eating Disorders Program,
pediatricians team up with
dietitians, therapists, and
family therapists to coach
parents and significant others.
“We try to give each player the
right set of tools,” she stresses.
“Treatment is usually at least a
year-long proposition for patients
with full-blown abnormal eating
behaviors and attitudes toward
food,” says Dr. Rome.
Cleveland Clinic Children’s
Hospital offers intensive
outpatient treatment three days
a week, three hours per day. “But
many children and adults need
to completely relearn how to
eat,” says Dr. Rome. “In these
cases, we partner with the
independent Cleveland Center
for Eating Disorders, which
offers partial hospitalization
and intensive outpatient
coaching.”
All patients must be followed to
make sure medical complications do not arise. People with
anorexia have a 1-in-4 chance
of falling into binge-eating or
bulimic behaviors. Overweight
people trying to shed pounds
can fall into new abnormal
eating patterns.
Take-home messages
To the parents of the overeating first grader, Dr. Rome
would say: Establish a “medical home” with a pediatrician
who is knowledgeable about
eating disorders and obesity.
Yearly checkups will reveal
any worrisome changes in
growth patterns.
clevelandclinic.org
ders
Equal Opportunity Conditions
To the young man with night
eating syndrome and the
hyper-exercising career woman
she would say: Call for an
evaluation. Engage a team of
caregivers to help you make
manageable changes in your life.
Watch for medical complications through your doctor, and
follow up, follow up, follow up.
Cleveland Clinic Resources
Pediatric and
Adolescent Medicine
Ellen Rome, MD, MPH
216.444.3566
Eating disorders and obesity
Laura Gillespie, MD
216.444.3566
Eating disorders
Allison Brindle, MD
216.444.2733
Obesity
Awareness of Eating
Disorders is Key
Not all thin or obese
individuals have health
problems. “But if weight
extremes are associated
with abnormal eating or
exercise behaviors, it is
easy to cross the line
over to ill health,” says
Dr. Rome.
Raise the Red Flag:
When children
• e at too much or too
little in out-of-control
patterns
• fail to grow normally
• p
ut endless restrictions on what they’ll
eat, and have a
distorted body image
or fear growth
• exercise compulsively
Wellness Institute
Elizabeth Ricanati, MD
216.444.4645
Eating disorders
Eating Disorders Intensive
Outpatient Program for
Adolescents & Adults
Sandra Jay, RN, BSN, LPCC
216.444.4640
Clinical Coordinator
A Cleveland Clinic Publication
When teens or adults
• e at secretively,
refusing meals with
family and friends
• a
void social situations
involving food
• e xercise compulsively
and seem stressed
when they miss a
workout
• d
o without food
during the day but
snack all night
Summer 2008
9
Weight Loss
Depend On It?
Does Your Health
America is facing a weight crisis.
More than half of us are overweight
and roughly 12 million Americans
have severe obesity (defined as
being 100 pounds or more overweight). Obesity is a major cause of
premature death — more than 30
medical conditions are associated
with severe obesity.
“Obesity is a complex disease that affects
every organ system in the body,” says Stacy
Brethauer, MD, a bariatric surgeon at Cleveland
Clinic. Some of the conditions associated with
obesity are related to the presence of the excess
weight, others are caused by the increased
intra-abdominal pressure due to the extra fat
carried in the abdomen, and some are related to
the pro-inflammatory state caused by obesity.
“Fat cells are metabolically active, releasing
Lipid & cholesterol disorders
Hypertension (high blood pressure)
Heart disease
The risk of cardiac disease goes down with weight loss and
improvement of hypertension, diabetes and high cholesterol —
all of which are addressed with bariatric surgery.
Non-alcoholic fatty liver disease
“This is one of those conditions that is not obvious to the
patient, but it can be a serious problem,” says Dr. Brethauer.
Fatty deposits in the liver can progress to non-alcoholic fatty
liver disease and, if left untreated, ultimately liver failure.
Metabolic syndrome
This condition is a group of metabolic disorders —
including insulin resistance, diabetes, hyperlipidemia
(the elevation of lipids in the bloodstream) and high blood
pressure — that puts patients at greater risk for heart
disease. “It’s more common in patients who carry their
weight more centrally in their abdominal cavity,” says
Dr. Brethauer. “You can take medicine for all the different
parts of metabolic syndrome — pills for blood pressure,
diabetes, lipids — but bariatric surgery simultaneously
addresses all of these, so it’s a very powerful tool.”
hormones, cytokines (proteins that help the
body generate an immune-system response)
and other inflammatory molecules that put the
individual at risk for further metabolic disease,”
explains Karen Cooper, DO, a bariatrician with
Cleveland Clinic.
Bariatric surgery is an effective tool not only
for shedding significant pounds, but also for
Polycystic ovary syndrome
Also linked to insulin resistance, polycystic ovary
syndrome is an important illness that can cause
women to have difficulty getting pregnant, experience abnormal menstrual periods and suffer from
hirsutism (excessive body hair). Studies have
shown that almost all women who have been
struggling with infertility find that conception is
possible after bariatric surgery.
resolving the plethora of conditions associated
with it. The surgery is more effective than weight
loss through diet and exercise because it results
in more dramatic weight loss that can be kept
Who should consider bariatric surgery?
off over time.
Any individual who has a body mass index (BMI) of 40, or a BMI of
The illustration at right shows some of the more
35 or more with one or more of these obesity-associated conditions, is
common conditions related to obesity — conditions that improve or resolve after dramatic
weight loss, whether through traditional dieting
or bariatric surgery. To schedule an appointment
eligible for bariatric surgery. “This is particularly recommended if there
is a strong family history of obesity and the individual has tried many
times, unsuccessfully, to lose weight by non-surgical methods,” says
Dr. Cooper. Visit clevelandclinic.org/BeWellBariatric to find out more.
for medical weight management or bariatric
surgery, call 800.890.2467. ❖
10
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Depression
Migraines
Pseudotumor cerebri
In this condition, too much cerebrospinal
fluid is trapped in the head, which puts
pressure on the brain.
Adding the Finishing Touch
Body Contouring
Losing 100 pounds or more is a major
achievement. But once you’ve reached your
goal, you might find that your new healthier
Obstructive sleep apnea
and thinner body needs some additional
Obstructive sleep apnea (OSA) is a breathing disorder in which individuals
stop breathing or have shallow breathing recurrently during sleep. “OSA is
one of those conditions that is probably under-diagnosed in obese patients,”
says Dr. Brethauer. Left untreated, OSA can lead to pulmonary hypertension
(high blood pressure in the arteries leading to the lungs) and heart failure.
fine-tuning. That’s because large amounts of
excess skin that have been stretched around
the abdomen, arms, legs, breasts and face
may have lost its elasticity.
Cleveland Clinic plastic surgeons offer body
Asthma
contouring surgery designed specifically for
patients who have achieved significant weight
loss. Procedures such as skin-trimming, lifts
Type 2 Diabetes
and liposuction can help your clothes fit better
Obesity is one of the most important factors for the
development of type 2 diabetes. “If I had to pick the most
important condition that we basically cure with bariatric surgery, No. 1 on the list would be diabetes,” says
Dr. Brethauer. More than 85 percent of patients who
were diabetic before bariatric surgery have remission
of their diabetes within two years after surgery.
and allow you to participate more comfortably
GERD
risk of complications. Skilled and experienced
Gastroesophageal Reflux Disease (GERD) occurs when the
contents of the stomach travel back up into the esophagus.
“GERD is virtually eliminated by gastric bypass [one type
of bariatric surgery],” says Dr. Brethauer.
plastic surgeons will discuss your goals and
in your favorite activities.
You can begin body contouring as soon as you
have achieved your target weight. Depending
on how much weight you’ve lost, the procedures may be done in stages to minimize the
map out a customized program to help you
achieve them.
For an appointment with one of our plastic
Stress urinary incontinence
surgeons, call 800.890.2467.
The most common type of incontinence, stress
urinary incontinence, results in an involuntary
loss of urine during physical activity, such as
coughing, sneezing or exercise.
Osteoarthritis
With bariatric surgery, patients typically lose between 50
and 80 percent of their excess body weight during the 18 to 24
months following surgery. Since osteoarthritis is a result of
excessive mechanical forces on the joints, almost all obese
individuals suffer from this condition — and experience
significant relief as they lose the excess weight.
Venous stasis disease
In this condition, veins in the legs
that carry blood back to the heart
function improperly.
Gout
Gout is a form of arthritis that causes sudden,
severe attacks of pain, tenderness, redness,
warmth and swelling in some joints.
A Cleveland Clinic Publication
Summer 2008
11
hearthealth hearthealth hearthealth hearthealth hearthealth hearthealth hearthealth
Thin people can have
heart disease, too
You’re not overweight. So, hear t disease isn’t a threat. Right?
“W r o n g , ” s ay s C l e v e l a n d C l i n i c c a r d i o l o g i s t
Arman Askari, MD. “Thin isn’t necessarily synonymous with healthy.”
Carrying too many pounds does put a stress on your heart, causing
it to work harder to carry and nourish that excess weight.
“While it’s true that being overweight is a risk factor for heart disease,
weight is only a small part of the picture,” Dr. Askari explains.
Sometimes, being thin carries a false sense of security. “While it’s true
that thin people may be more prone to lead active, healthy lifestyles, I’ve
also seen all types of people — from a 39-year-old smoker or a buff, pro
beach volleyball player — who suffer heart attacks,” he says. “Coronary
artery disease doesn’t discriminate fat or thin, male or female.”
T h e b i gg e r p i ct u r e
When trying to live a heart-healthy lifestyle, it’s important to begin
with a more comprehensive look at all of the risk factors for heart
disease — or conditions that increase a person’s risk of developing
heart disease.
“It’s important to know that some risk factors cannot be changed while
others can be modified or treated,” Dr. Askari says. “The more risk
factors you have, the more likely you are to develop heart disease.”
Know the basics
These factors for heart disease are ones beyond your control.
They include:
• I ncreasing age – Heart disease becomes more likely as you get older.
About 85 percent of people who die of heart disease are age 65 or older.
• Male gender – Men have a greater risk of heart attack than women.
• M
enopause – After menopause, a woman’s risk of heart disease
increases and approaches the level of a man’s.
• F
amily history – Your risk of heart disease increases if your parents,
brothers, sisters or children have the disease.
• R
ace – The risk of cardiovascular disease is higher in Blacks,
Mexican Americans, American Indians, native Hawaiians and some
Asian Americans. This increased risk is partly due to higher rates of
high blood pressure, obesity and diabetes in these populations.
12
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hearthealth hearthealth hearthealth hearthealth hearthealth hearthealth hearthealth
What you can do
Last but not least
Not all risk factors, however, are set in stone. “Focus on those factors
that you can change,” advises Dr. Askari:
While not traditional risk factors, the following are thought to
contribute to overall risk for heart disease:
Stop smoking – Smoking is the most preventable risk factor for heart
disease. Eliminate the use of all tobacco products — and stay away
from other’s smoke.
Individual response to stress – Some researchers have noted a
relationship between cardiovascular disease risk and stress. This is
because stress can raise blood pressure, which is a risk factor for
heart disease, Dr. Askari explains. Try managing stress by practicing
relaxation techniques, guided imagery, massage, Tai Chi, yoga,
learning time management, and setting realistic goals.
Lower your total cholesterol, LDL (bad) cholesterol & triglyceride
levels – It is recommended to have your cholesterol level checked as
early as age 20 or earlier if you have a family history of high cholesterol. The cholesterol profile includes an evaluation of total cholesterol, HDL, LDL and triglyceride levels. Your healthcare provider can
tell you how often to have your cholesterol tested.
Raise your HDL (good cholesterol) – HDL cholesterol takes the LDL
(bad) cholesterol away from the arteries and back to the liver where
it can be passed out of the body. High levels of HDL seem to protect
against cardiovascular disease.
Lower high blood pressure – High blood pressure increases the
workload of the heart and kidneys, increasing the risk of heart attack,
heart failure, stroke and kidney disease.
“It’s balancing a whole host of factors
that make up the big picture.”
Control diabetes – People with diabetes, especially women, have a
higher risk of heart disease because diabetes increases other risk
factors, such as high cholesterol, LDL and triglycerides; lower HDL;
and high blood pressure. Keeping diabetes under control is critical
to reducing your risk.
Drinking too much alcohol – Too much alcohol can lead to
increased blood pressure, heart failure and stroke. It is also linked
to high triglycerides, irregular heart beats, obesity and cancer.
Research also has shown that those who drink one to two drink per
day (4 oz. of wine, 12 oz. of beer, or 1-1/2 oz. of 80-proof spirits)
may have less risk. However, also know that too much alcohol is
detrimental to your heart because it damages the myocardium,
Dr. Askari cautions.
Maintain a healthy body weight – While being thin isn’t a panacea,
research has shown that being overweight contributes to the onset of
cardiovascular disease. That makes it important that you achieve and
maintain a desirable weight.
“Just remember, it’s not one thing – whether it’s weight, how much
you exercise, or what you had for dinner last night – that determines
your heart health,” Dr. Askari concludes. “It’s balancing a whole host
of factors that make up the big picture.”
Exercise – The heart is like any other muscle — it needs a workout to
stay strong and healthy. Exercising helps improve how well the heart
pumps blood through your body. Aim for moderate exercise 30
minutes a day, on most days.
For an evaluation of risk factors and current prevention strategies
for heart disease, call 800.890.2467. ❖
Follow a heart-healthy diet – Whether you’re aiming to prevent heart
disease or trying to prevent further heart damage, following a “traditional Mediterranean diet” has been shown to have a heart-protective effect.
Aim for a diet rich in fruits, vegetables, legumes and whole grains and
that includes fish, nuts and low-fat dairy. Also choose vegetables oils rich
in monounsaturated fats and low in saturated fats and avoid products
that contain hydrogenated and partially hydrogenated vegetable oils.
A Cleveland Clinic Publication
To get answers to your questions about heart and vascular
disease, please call 216.445.9288 or toll-free 866.289.6911.
A trained nurse specialist will help you.
Summer 2008
13
hearthealth hearthealth hearthealth hearthealth hearthealth hearthealth hearthealth
Tips Eating Heart Smart
for
The old saying, “You are what you eat,” may be truer than
ever – especially when it comes to cardiovascular disease.
Four risk factors are related to diet: high blood pressure,
high blood cholesterol, diabetes and obesity.
T
Fish, particularly oily fish, can help reduce your risk of heart disease
in several ways. While not particularly powerful for cholesterol
management, the heart-healthy omega-3 fats in fish can help control
your blood pressure and triglycerides, help keep your arteries more
elastic (that’s a good thing) and act as a natural anti-inflammatory.
Nuts have even more added benefits: They are naturally cholesterol
free, a good source of dietary fiber and protein, and contain a variety
of heart disease-fighting vitamins and minerals. Nuts also contain
the nonessential amino acid arginine. Arginine is touted for its role
in protecting the inner lining of the arterial walls, making them
more pliable and less susceptible to plaque build up. Lastly, nuts are
a good source of healthful phytochemicals, biologically active plant
chemicals with high antioxidant properties linked to prevention of
coronary heart disease.
Easy way to do it: When choosing fish, look for those with the highest
omega-3 fatty acid content: salmon, rainbow trout, herring, mackerel
and sardines. Eating two 3.5 oz servings of these oily fish per week will
meet the American Heart Association’s guidelines for heart disease
prevention.
Easy way to do it: Be creative. Spread peanut butter on your morning
toast, grab a handful of almonds for a mid-morning snack, sprinkle
some walnuts on your lunch salad or have a slice of date-nut bread
for dessert. The only caveat? Because nuts are so calorically dense,
it is important to incorporate them into the diet sensibly.
Go nuts
Use your bean
Whether walnuts, almonds or peanuts – go ahead. Once shunned for
their high fat content, emerging evidence links the consumption of
nuts to a reduced risk of coronary heart disease.
Add more beans and legumes to your diet. Often excluded from
the typical North American diet, foods from the bean and legume
family, including lentils, soybeans, kidney beans, chick peas and
black beans, are high in soluble fiber. Also known as viscous fiber,
soluble fiber is particularly helpful for cholesterol management,
not to mention bowel health. They are also rich in protein, and
many legumes (especially the darker-colored beans) are high in
polyphenols, compounds that have received a great deal of
attention in recent years for their potential as disease-fighters.
o keep your heart healthy, keep these top choices in mind
for your next grocery trip:
Focus on fish
The fat in nuts is primarily in the monounsaturated form. Monounsaturated fats, when substituted for saturated fat in the diet, can help
reduce total and LDL, or “bad,” cholesterol levels while maintaining
the “good” cholesterol, HDL.
Easy way to do it: If you are relatively new to using beans and legumes
in your diet, you might want to start with more common bean-based
dishes, such as hummus (made from chick peas), chili (usually made
with kidney beans), lentil soup or by adding a few beans to a salad.
Over time, you might start to choose a mixed bean salad as a side dish
with your lunch or even as an afternoon snack. Beans also make great
additions to soups and can make great dips. Low-fat refried beans are
available at most grocery stores and can make a great burrito or
quesadilla with some cheese, salsa and chili powder.
Jennifer Sygo is a dietitian in private practice at Cleveland Clinic
Canada (clevelandcliniccanada.com), which offers executive physicals,
prevention and wellness counseling and personal healthcare management in Toronto. Adapted from a column originally appearing in
Canada’s National Post.
Next issue: Why veggies and healthy oils are heart-healthy picks.
14
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hearthealth hearthealth hearthealth hearthealth hearthealth hearthealth hearthealth
It’s
all in the
Numbers
You can learn a lot about your heart health by the numbers. The numbers you need to know include
your cholesterol levels, blood pressure, ejection fraction, your fasting glucose levels, and your weight.
Blood Pressure
Cholesterol
Low density lipoprotein (LDL cholesterol) goal values:
Blood Pressure Classifications
Range (mm/hg)
Therapy
Normal blood pressure*
less than 120/80
Encourage healthy lifestyle
Pre-hypertension
120-139/80-89
Modify lifestyle
• L
ess than 70 mg/dL for those with heart or blood
vessel disease and for other patients at very high risk
of heart disease (those with metabolic syndrome)
• L
ess than 100 mg/dL for high risk patients
(for example, some patients who have diabetes
or multiple heart disease risk factors)
Hypertension
Stage 1
140-159/90-99
• Modify lifestyle
• Medications
• Less than 130 mg/dL otherwise
Stage 2
greater or equal to 160/ greater
to or equal to 100
• Modify lifestyle
• Medications
Total cholesterol (TC) goal values:
Patients with chronic renal disease or diabetes should be treated to less than 130/80*
While 120/80 is optimal blood pressure, if you have been diagnosed with high blood pressure,
the goal is to lower your blood pressure to less than 140/80.
• 75-169 mg/dL for those age 20 and younger
• 100-199 mg/dL for those over age 21
JNC VII, National Heart, Lung, and Blood Institute - nhlbi.nih.gov, 2003.
3
45 goal value:
High
lipoprotein3(HDL)
12density
<35%
Patient may be at risk of life-threatening
irregular heartbeats
18.5 - 24.9
Overweight
25.0 - 29.9
Obesity
30.0 and above
56
7
Summer 2008
3
4
56
78
A Cleveland Clinic Publication
01
Normal
78
90
1
23
4
Below 18.5
56
78
9
01
2
Underweight
23
4
56
BMI
78
9
The BMI is a mathematical formula that factors a person’s height and
weight in determining obesity. It may be less accurate for athletes or
older persons who have lost muscle mass. Those who are overweight
or obese and have two or more risk factors should lose weight to
decrease their risk for heart disease. Use the body mass indicator at
clevelandclinic.org/BeWellBMI to calculate your BMI.
01
23
4
May confirm diagnosis of systolic heart failure
0
89
7
6
45
3
12
35 - 40%
0
89
7
6
45
3
12
Below normal
78
6
5
34
2
1
36 - 49%
67
Normal
5
34
2
1
90
50 - 70%
• Less than 150 mg/dL
789012345
89
What it Means
6
345
2
01
89
7
56
Ejection Fraction Measurement
Triglyceride (TG) goal value:
4
23
01
An ejection fraction is a test that determines how well your heart
pumps with each beat.
B o dy M a s s I n d e x ( B MI )
67
90
89
8
the better)
67 • Greater than 45 mg/dL (the higher
34567890
9012
12
8
7
34
56
4
3
5
2
1
0
89
Ej e ct i o n f r a ct i o n
456789012
15
Turn Back
the Clock
(without Surgery)
Fine lines, wrinkles and blotchy skin can make you look older than you feel.
And while there’s nothing wrong with trying the home remedies at salons and
drug stores, Cleveland Clinic experts say they can’t hold a candle to diamond
dermabrasion performed at a dermatologist’s office.
Diamond dermabrasion is the latest twist on microdermabrasion techniques,
which revitalize and smooth the skin through controlled “polishing” and exfoliation of damaged skin,
allowing smoother, younger looking skin to develop.
“Microdermabrasion and diamond dermabrasion work well on age spots, fine lines,
small scars and uneven pigmentation,” says Cleveland Clinic dermatologist
Rebecca Tung, MD. “The techniques also can thicken collagen, which is
important in maintaining a youthful-looking complexion.”
Home microdermabrasion remedies, on the other hand, only slough away
dead skin cells, producing a short-term effect of adding polish and shine to
the face.
During traditional microdermabrasion, the physician uses a small, handheld device to stream tiny crystals across the skin. The instrument’s vacuum
component simultaneously suctions the crystals back into the machine,
along with the dead, loosened, outer layer of skin. Diamond dermabrasion
works in much the same way, except the physician uses a diamond tipped
wand to gently exfoliate the skin.
“Patients find the diamond wand more comfortable. The results are
more dramatic with no residual redness,” says Dr. Tung. “There is no
recovery or down time with either procedure, and patients can return
immediately to their normal routines.”
Dermatologists usually recommend a series of four to six treatments,
approximately two to four weeks apart.
Diamond dermabrasion is effective on all skin types and colors. In addition to
subtle surface rejuvenation, the technique is a course of therapy for people suffering
from mild acne, fine acne scarring, slight sun damage or hyperpigmentation — such as
brown patches on the skin due to sun exposure or hormones. For severe wrinkles,
extensive sun damage and acne scars, a dermatologist may recommend chemical peels,
laser treatments or other minimally invasive procedures.
Diamond dermabrasion is available at Cleveland Clinic’s main campus and the
Beachwood Family Health and Surgery Center. To schedule an appointment
with a Cleveland Clinic dermatologist, call 800.890.2467. ❖
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Targeting Pediatric Obesity
Seriously overweight children face potentially lifelong health problems and, for the first time in decades,
a shorter life expectancy than their parents. Cleveland Clinic Children’s Hospital has launched a Pediatric
Obesity Initiative to address this health crisis, including:
• Fit Youth programs offered in the community and at Main
Campus to help 7- to 12- and 13- to 18-year-olds overcome
weight challenges. The 10-week peer and family sessions team
nutritionists, psychologists and exercise physiologists.
• T
he Food is Knowledge program, aimed at curbing type 2 diabetes
and the obesity epidemic in preschool and the primary grades at public
schools in the region. Students learn about science, language arts,
math, culture and hospitality using food and nutrition as the medium.
• One-on-one office evaluations for obesity from pediatric and
adolescent medicine specialists.
• Multi-site research to measure the long-term impact of the programs.
• A medically monitored protein-sparing modified fast program
for highly motivated teens and young adults.
To sign up for Fit Youth programs at Main Campus, call 216.445.0299;
in Independence, call 216.986.4128; and in Willoughby Hills, call
440.516.8690.
For more information on the Pediatric Obesity Initiative, visit clevelandclinic.org/BeWellKids
Mac and Cheese Please!
Looking for a quick, healthy meal that’s sure to please the entire family?
Try this recipe, one of 150 delicious and easy-to-follow recipes featured in the
Cleveland Clinic Healthy Heart Lifestyle Guide and Cookbook, which was recently
nominated as a finalist in the 2008 IACP Cookbook Awards. The cookbook is
available at Random House, Inc. or wherever books are sold.
Refrigerated butter-flavored cooking spray
6 ounces whole wheat medium shells,
elbow macaroni, or other small pasta
6 ounces low-fat sharp Cheddar cheese,
grated (about 1 ¼ cups)
2 to 3 teaspoons Dijon mustard
½ teaspoon cornstarch
Freshly ground white pepper
¾ cup evaporated skim milk
2 medium tomatoes, seeded and diced
1. Coat an 8 x 8 baking dish with cooking
spray and set aside. Cook the pasta
according to package directions, drain,
and set aside.
melted. Stir in the cooked pasta and spoon
into the prepared baking dish. Sprinkle with
the diced tomatoes and place under the
broiler for 2 to 3 minutes, until the top
browns. Remove from the oven and allow
to cool for 5 minutes before serving.
2. Preheat the broiler.
3. In a saucepan, stir the cornstarch into
1 tablespoon of the evaporated milk, then
whisk in the remaining milk. Add the
cheese, mustard to taste, and pepper.
Bring to a simmer and stir until the sauce
thickens a bit and the cheese is completely
DIETITIAN’S NOTE: Our mac and cheese,
packed with dietary fiber and anti-oxidantrich carotenoids, is a sure winner over
traditional macaroni and cheese, which has
25 percent more calories and double the fat!
Nutrition Information (Per Serving) Recipe Makes 4 Servings
Total calories...................................... 290
Total fat................................................7g
Saturated fat.........................................4g
A Cleveland Clinic Publication
Protein................................................20g
Total carbohydrate................................42g
Dietary fiber..........................................6g
Cholesterol.......................................20mg
Sodium..........................................330mg
Potassium......................................387mg
Summer 2008
17
9
Tips for
shedding
years – and
pounds!
Need help incorporating new dietary
choices into your daily routine? Here are
some tried-and-true tips that patients have
found help them shed pounds and feel
healthier, younger and more vibrant:
1. M
ake every calorie you eat delicious
and nutrient rich.
2. E
at breakfast, preferably one containing
whole grains and a little healthy fat.
The order of eating these foods matters –
choose fat first (about 70 calories worth)
with each meal. This will slow emptying
of the stomach.
3. Read the labels for serving size.
4. Healthy food can taste great – if you develop
a passion for cooking. Learn new, healthy
cooking techniques. Try sautéing, pan
roasting, grilling, microwaving, roasting,
baking, steaming or using a blender.
5. K
eep your portions energy-giving,
not energy-sapping.
6. Drink lots of water.
7. Don’t eat absentmindedly.
8. T
reat yourself to 9-inch plates. Eating from
right size plates is key to portion control.
9. Make eating, and the place you eat, special.
Adapted from The RealAge Makeover by
Michael F. Roizen, MD, Chairman of
Cleveland Clinic’s Wellness Institute. His
bestselling RealAge and You series of books
is available wherever books are sold.
Bringing Civility
to the Cancer Experience
Instead of focusing on the treatment options and doctor’s
appointments that accompany a cancer diagnosis, there is a time
once each week when patients at Cleveland Clinic Taussig Cancer
Institute gather to drink tea, eat pastries, listen to music and relax.
This special time is high tea, held at 2:30 p.m. every Wednesday at
Taussig Cancer Institute in The Bistro. Patients, family, friends and
caregivers spend an hour socializing and feeling at ease.
“It is intended to create a civilized
pause in an atmosphere of comfort
in the middle of a hectic day.”
The weekly tea was created by Cleveland Clinic’s Volunteer Service
and Nursing World Class Service a year ago and is meant to be “an
elegant activity and healing ritual designed to enhance the patient
experience,” says Elizabeth Stein, Director of Volunteer Services. “It
is intended to create a civilized pause in an atmosphere of comfort
in the middle of a hectic day.”
As it grows more popular, patients have begun to schedule their
appointments to coincide with the tea, and physicians are encouraging patients to attend after their clinic visits.
“I recently met a couple at high tea who commutes six hours to
Cleveland Clinic each week for the wife’s treatment because, they
said, ‘There’s no place else like it,’” says Ms. Stein. “They told me,
‘High tea is a perfect example of the class and service that we’ve
come to know at Cleveland Clinic.’”
Cancer Answer Line
If you have a question or concern about cancer for you or a loved one,
want to learn more about our services, or would like to schedule an
appointment for a second opinion or any other matter, call the
Cleveland Clinic Cancer Answer Line. A clinical nurse specialist is
available from 8:30 a.m. to 4:30 p.m., Monday through Friday, to
assist you. Call toll-free 866.223.8100. ❖
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Editorial Director and Managing Editor
Laura R. Greenwald
Art Director
Barbara Ludwig Coleman
Graphic Designer
Michael Viars
Assistant Managing Editor
Ann Bungo
Contributing Writers
Ann Bungo
Christine Coolick
Marjie Heines
Bridget Murray Law
Liz Lear
Cora Liderbach
Steve Szilagyi
Contributing Photographers
Don Gerda
Russell Lee
Advisory Board
Carl Aquila
Susan Bowling, PsyD
Ann Bungo
Cynthia Galbincea
Cindy Moore, RD, LD
Tod Podl, MD
Lori Weinstein
Editorial Office/Address Changes
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a positive manner: environmentally, socially and economically.
Be Well is a publication of Cleveland Clinic. Copyright © 2008
Cleveland Clinic. All rights reserved. Reproduction or use without
written permission of written or pictorial content in any manner is
prohibited. Printed in the United States. The magazine accepts no
unsolicited manuscripts, photography or artwork.
Cleveland Clinic
Marketing Division/AC311
9500 Euclid Avenue
Cleveland, OH 44195
Contact us at [email protected],
or visit us online at clevelandclinic.org
This publication is for informational purposes only and should not
be relied upon as medical advice. It has not been designed to replace
a physician’s medical assessment and medical judgment. Always
consult first with your physician about anything related to your
personal health.
Cleveland Clinic Ranked Among Top Hospitals in Nation
Cleveland Clinic is ranked among the top hospitals in the country, according to the latest U.S.News &
World Report’s annual survey of “America’s Best Hospitals.” For the 13th consecutive year, Cleveland
Clinic’s heart program is ranked No. 1. For details, visit clevelandclinic.org.
A Cleveland Clinic Publication
Summer 2008
19
A
Healing
Link
Partnership with shelter brings
care to homeless women
For Hilda, home is not a place, but a collection of
memories she carries with her: hand-beaded reminders
of family around her wrist, the joy of singing in church
and a nurse’s kind smile. She spent several months at
the Community Women’s Shelter in Cleveland before
moving to another temporary residence.
Many women at the shelter struggle with substance addiction
or mental illness, or both. The shelter aims to provide the basic
necessities of survival — a hot meal and safe place to sleep —
and to connect residents with community services to help
their other needs.
Through a partnership with Cleveland Clinic, women at the
shelter can get professional medical care. Kristin Englund,
MD, and her team of nurses and medical residents provide
care from two recently renovated exam rooms.
“We’re like an urgent care facility,” says Dr. Englund, an
infectious disease specialist. The goals are to keep women out
of the emergency room and help them get on a healthy path.
With support from Cleveland Clinic Pharmacy and Laboratory
Medicine, the team diagnoses and treats conditions ranging
from bronchitis and skin infections to sexually transmitted
diseases. The on-site lab helps the team diagnose urinary tract
infections and perform pregnancy tests and rapid HIV testing.
Instant results are vital for these women. Some, like Hilda,
stay for months. But others are on the move, looking for a
place to call home.
Cleveland Clinic hospitals are dedicated to the health and
well-being of our neighbors. In 2006, we contributed $390
million in community benefits. Read more in Community
Connections, our annual report to the community, by
visiting clevelandclinic.org/BeWellCommunity. ❖
9500 Euclid Avenue /AC311
Cleveland, OH 44195
clevelandclinic.org