Heart Healthy Overview Meghan Dawes Pharm D Meghan

Heart Healthy Overview Meghan Dawes, Pharm. D Meghan Donovan, MS, RD, LDN Rachel Thomas, Pharm. D Mandi Boykin, Pharm. D Jenelle Hall, Pharm. D

Overview • Gain a better understanding of pre-diabetes • Why should you care? • Identify risk factors for heart disease • Blood Pressure • • Goal blood pressure per ADA Treatment • Dietary changes • Medications • High Cholesterol • • Goal per ADA Treatment • Dietary changes • Medications • Discuss ways to lower risk for heart disease • Review of the ABC’s

WHAT IS PRE-DIABETES?

Pre-Diabetes • “Intermediate group of individuals whose glucose levels, although not meeting criteria for diabetes, are nevertheless too high to be considered normal. ” ADA. Standards of Medical Care in Diabetes. 2013.

What is Pre-Diabetes? • American Diabetes Association (ADA) ADA. Standards of Medical Care in Diabetes. 2013. healthy-ojas. com

Pre-Diabetes Statistics • 1 in 3 Americans has pre-diabetes – 79 million Americans ADA. Diabetes Statistics. 2013.

Why You Should Care About Pre-Diabetes? Adapted from UKPDS grp, Diabetes 1995; 44: 1249 -1258.

Why You Should Care About Pre-Diabetes? Diabetes Pre-diabetes Caution: Take steps to prevent type 2 diabetes. Normal Majority of people with pre-diabetes develop diabetes in 10 years U. S. Department of Health and Human Services. ADA. National Diabetes Clearinghouse. 2013.

What is going on? • Cells are unable to use the insulin being produced by the pancreas because of resistance • Pancreatic cells that produce insulin become tired and overworked, and begin to make less insulin ADA. Standards of Medical Care in Diabetes. 2013.

WHAT IS THE LINK BETWEEN HEART DISEASE AND DIABETES?

Heart Disease and Diabetes increased risk for heart disease of coronary stents implanted in 2011 heart attacks annually higher heart disease morbidity and mortality rates chance of dying from heart disease rehabilitateyourheart. wordpress. com

Helpful Hint…. The Good News is…. . Diabetes is 1 of the 7 major We can CONTROL this!!!! controllable risk factors for cardiovascular disease

Risk Factors for Heart Disease Factors that we can NOT change: • Gender male • Age 65 and older • Family history of heart disease • Females that are post-menopausal • Race • African Americans, American Indians, and Mexican Americans American Heart Association. www. heart. org

Risk Factors for Heart Disease Factors that we can CHANGE: • • Blood pressure Cholesterol levels Amount of exercise Weight Uncontrolled Diabetes Uncontrolled stress and anger Smoking American Heart Association. www. heart. org

Risk Factors For Heart Disease High Blood Pressure (hypertension) American Heart Association. www. heart. org londonderrynh. net

High Blood Pressure • Blood Pressure measures the force on the artery walls • 2 Forces: – Pumping of the heart = Systolic (top number) – Resting of the heart = Diastolic (bottom number) – Per ADA, goal blood pressure is < 140/90 mm. Hg American Heart Association. www. heart. org www. accuratebloodpressure. com

High Blood Pressure American Heart Association. www. heart. org www. accuratebloodpressure. com

High Blood Pressure Why do you need to keep your blood pressure controlled? • Arteries are made of muscle and flexible tissue • Increase in force of the heart beat = more stretching by the arteries • Increased stretching over time leads to arteries stretched beyond its healthy limit AHA. www. heart. org; www. hcahamilton. com

Shaking the Salt • ↑ sodium leads to ↑ fluids in the body thus leading to higher blood pressure AHA/ADA recommendations for persons with diabetes: Total Amount of Salt a Day Less than 1500 mg

Shaking the Salt • What is 1, 500 mg of Salt? 1/4 teaspoon salt = 600 mg sodium 1/2 teaspoon salt = 1, 200 mg sodium 3/4 teaspoon salt = 1, 800 mg sodium 1 teaspoon salt = 2, 400 mg sodium One Big Mac has 1010 milligrams of sodium!

Shaking the Salt • Where can you find Salt? • • Restaurant and fast food meals Convenience and packaged foods Condiments Canned foods • Frozen vegetable vs canned vegetables • Processed foods • Deli meats • Cheeses • Sodas eatright. org

Ways to Lower Your Blood Pressure • • • Healthy diet Decreasing sodium intake Regular physical activity Maintain healthy weight Manage stress Quit smoking Decrease caffeine Medications Limit alcohol

Limiting Alcohol • Limit the amount of alcohol you drink • In small amounts alcohol can lower your blood pressure by 2 to 4 mm. Hg – 1 drink a day for women & men over age 65 – 2 drinks per day for men age 65 and younger Key Point: If you don't normally drink alcohol, you shouldn't start drinking as a way to lower your blood pressure!

MEDICATIONS HELP LOWER BLOOD PRESSURE

Circulatory System

Treatment for Blood Pressure Overview • Medications that work on the kidney Drug Class Examples of Medications ACE-Inhibitors Zestril (Lisinopril), Vasotec (Enalapril) Monopril (Fosinopril) ARB’s Cozaar (Losartan), Micardis (Telmisartan) Benicar (Olmesartan) Diuretics Hydrocholorthiazide Chlorthalidone Lasix (Furosemide)

Treatment for Blood Pressure Overview • Blood pressure medications that work on the heart Class of Medications Examples of Medications Beta Blockers Toprol XL (Metoprolol) Lopressor (Metoprolol) Coreg (Carvedilol) Tenormin (Atenolol) Calcium Chanel Blockers Calan (Verapamil) Cardizem (Diltiziam) Norvasc (Amlodipine) • Lowers blood pressure AND heart rate

Blood Pressure Medications (covered by DHP) • Some medications help protect the Kidney from damage caused from diabetes: • ACE-Inhibitors: • Zestoril (Lisinopril), Lotensin (Benazepril), Vastotec (Enalapril) • ARB’s: • Cozaar (Losartan), Benicar (Olmesartan), Micardis (Telmisartan) • Side Effects: • • Cough (ACE-I) Edema (swelling)

Risk Factors For Heart Disease High Cholesterol (hyperlipidemia) American Heart Association. www. heart. org

Cholesterol • What is cholesterol? – Waxy substance found in all cells in the body that travel in the blood as small particles • Where does it come from? – 75 % made by the liver – Food: Animal Products • • Egg yolks Fatty meat Whole milk Whole cheese

Cholesterol • Why do we need cholesterol? – Hormones – Vitamin D – Substances that help breakdown food • Your body makes all the cholesterol it needs!! Total Amount of Cholesterol a day Less than 200 mg

Cholesterol • LDL • “BAD” cholesterol • Can cause build up in the arteries • HDL • “GOOD” or “Healthy” cholesterol • Carries cholesterol back to the liver • Liver then removes from the body

Cholesterol • Triglycerides – Found in the blood – Unused calories that are stored in your fat cells – For an accurate reading you must fast for 9 to 12 hours prior to lab work • Total Cholesterol – Total cholesterol = GOOD + BAD + TG • Formula: – LDL=TC-HDL-TG/5 (mg/d. L)

Targets of Nutrition Therapy for Lowering Cholesterol • • Total Fat Saturated Fat Trans Fat Cholesterol www. nature. com

Limit Total Fat • Keep total fat to less than 35% of daily calories • In general aim for: » 40 -75 grams of fat daily • Make most of your fats heart healthy fats like olive oil, peanut butter, nuts, avocado • Increase vegetables and whole foods • Eat more omega 3 heart healthy fats from flaxseed, canola, soybean oils, cold water fish

Limit Saturated Fat Foods high in Saturated Fatty meat Poultry skin Bacon Sausage Whole milk Cream Butter Foods low in Saturated Fat Lean meats Remove the skin from chicken Turkey bacon Turkey sausage 1% milk or skim milk Reduced fat creams I Can’t Believe it is Not Butter Goal Saturated Fat: Less than 12 -15 grams/ per day

Limit Trans Fat Foods high in Trans Fat Stick margarine Shortening Cake mixes Fried foods Packaged foods (like microwave popcorn) • Commercially prepared muffins, pastries, etc • • • Foods low in Trans Fat Fruits and vegetables Lean meats Nonfat dairy products Vegetarian proteins like tofu, beans, soy, peanut butter, etc • Whole wheat and whole grain products • • Goal Trans Fats: 0 -2 grams per day

Keep Total Cholesterol as Low as Possible • In general aim for : » Less than 200 mg daily – Plan to eat more plant based meals – Check the food labels for cholesterol – Increase vegetables and whole foods Example: 3 oz chicken and lean meat has 75 -85 mg cholesterol

Cholesterol by the Numbers American Heart Association

MEDICATIONS THAT LOWER CHOLESTEROL

Treatment for Cholesterol Overview Fibric Acid Fenofibrate Bile Acid Sequestrant Welchol, Cholestyramine, Colestipol HMG-COa reductase Inhibitors (Statins) Simvastatin, Lovastatin, Atorvastatin, Rosuvastatin, Fluvastatin, Pravastatin Niacor Miscellaneous All of these medications are covered at $0 co-pay under the DHP

Treatment for High Cholesterol • “Statin” Medications • • • Simvastatin (Zocor) Lovastatin (Mevacor) Atorvastatin (Lipitor) Rosuvastatin (Crestor) Fluvastatin (Lescol) Pravastatin (Pravachol)

Treatment for High Cholesterol • How do statins work? • Improve your cholesterol panel by: • Stabilizing plaque • ↓ LDL (“bad” cholesterol) • ↑ HDL (“good” cholesterol) • ↓ Triglycerides

Treatment for High Cholesterol • Possible side effects: • Muscle pain/weakness • Increase in liver enzymes • When do I take this medication? • It depends on the medication! Anytime of the Day Before Bed Atorvastatin (Lipitor) Rosuvastatin (Crestor) Pravastatin (Pravachol) Lovastatin (Mevacor) Simvastatin (Zocor) fluvastatin (Lescol)

WHAT CAN I DO TO HELP LOWER MY RISK FOR HEART DISEASE?

Ways to Prevent Heart Disease • • Decrease weight Watch your diet Exercise Avoid smoking Better control your diabetes Better control your blood pressure Take your medications Follow up with your doctor

Exercise • 150 minutes of moderate intensity physical activity every week and do not skip more than 2 days a week • • • Overall risk of heart disease by 14% Weight A 1 c Blood pressure Stress

Know your ABC’s Target: Less than 7% Target: Less than 140/90 mm. Hg Target: Decrease LDL “bad cholesterol”

Healthy Lifestyles Meghan Dawes, Pharm. D Meghan Donovan, MS, RD, LDN Rachel Thomas, Pharm. D

Overview • • • Stress Reduction Wheel of Health Activity Setting SMART goals Foods to Fuel a Healthy Life Exercise Ways to Move More

Stress Reduction

Why Does Stress Matter? – Stress can prevent the body from properly releasing insulin among those with Type 2 diabetes – Individuals with Type 2 diabetes may be more sensitive to stress hormones – Individuals with diabetes are 2 x more likely to suffer from chronic depression

Wheel of Health Please complete the wheel of health activity on the DHP website. Think about each of these areas of your life. Draw a dot where you feel you are in that area. Connect the dots and use the wheel to make a plan. Think about your optimal health vision, choose the area that you would like to work on. Nutrition Spirituality & Personal Growth Movement, Exercise & Rest Career & Professional Development Physical Environment Mind-Body Connection Fun & Recreation Relationships & Communication

Making Lifestyle Changes • Factors that Enable Change – Establish the right mind-set, positive attitude and commitment. – Recognize that gradual changes are lasting changes. – Eat mindfully: enjoy each bite. – Plan ahead and have a daily game plan. – Plan purposeful physical activity each day. – Set S. M. A. R. T. goals • specific, measurable, action oriented, relevant, timed

Making Lifestyle Changes • Initiating Change – Identify your trouble spots (habits, sweets, snacks, restaurants, etc. ). Establish solutions. – List your barriers to change. Create solutions. – Take one step at a time, including one change at a time if necessary. – Look for support. Be accountable to yourself and others. – Hang in there and persevere!

Looking at Your Barriers to Change Strategies, Solutions, & Goals Time • Plan ahead and be prepared to have portable, healthy food with you! • Select healthier fast food alternatives Convenience • Know 4 -5 quick fix meals for daily last minute cooking Knowledge • Read labels and apply knowledge gained for DHP classes Attitude • Don’t deprive yourself • Remember that small changes add up to big ones in the long run Habit • Know your challenges. Replace old habits with new ones. Portions • Eat off smaller plates and bowls.

Healthy Living

Nutrition Overview • Recap : Carbohydrate Counting • Plate Method • Eating Healthy at NHRMC • Recipe Modification • Making Better Choices • Easy Food Prep at Home • Eating on the Run

Menu Planning: Carbohydrate Counting Women Men 30 -45 grams per meal 45 -60 grams per meal 15 -30 grams per snack

Menu Planning: Plate Method With a packed lunch In the main cafeteria ½ Plate Non-starchy vegetables ¼ Plate Lean Protein ¼ Plate Starchy Vegetables, Grains, Fruit or Dairy At the deli station

Healthy Eating at NHRMC • Look for the 5 under 5 options at all NHRMC cafeterias • Use the salad bar to increase vegetables consumed at lunch or dinner • Choose mindful items at Lighthouse and NHRMC cafeteria • Grilled chicken sandwich • Veggie burger • Deli sandwich on wheat thins

Healthy Eating at Au Bon Pain • Breakfast Sandwich Choice – Egg whites & Cheddar – Eggs with cheddar and avocado on a skinny whole wheat bagel, hold the lemon aioli • Sandwiches – Classic Chicken salad sandwich (half) – Caprese sandwich (half) – Black angus roast beef and herb cheese signature sandwich (half) • Soups(8 oz serving) – Southwest vegetable – Tomato basil bisque • Specialty Salads (without dressing) – Garden salad – Thai peanut chicken salad

Foods to Fuel a Healthy Life • Choose minimally processed foods are from the 5 basic food groups – Eat each color of the rainbow daily – Try almonds to reduce LDL cholesterol – Avocados offer more potassium than bananas – Broccoli has more vitamin C and calcium than milk or oranges

How Do I Keep My Favorite Foods Around? “You can have them all…. but not all at once. ” - Bethenny Frankel

Recipe Modification Visit DHP website for stovetop and baking swaps Save CALORIES, CARBOHYDRATES, AND FAT!

Did you know? 2 slices Pepperoni Pizza = 596 calories, 24 g fat, 74 g CHO • To burn off these calories you’d have to spend • 78 minutes on the elliptical • 91 minutes walking Cheeseburger plus fries = 1270 calories, 74 g fat, 101 g CHO • To burn off these calories you’d have to spend • 2 hours and 20 minutes on the elliptical • 4 hours of walking

Re-do Recipes • Visit the DHP website (www. nhrmc. org/dhp) for the following recipe re-dos that will save you calories, fat, and carbohydrates! • Homemade Veggie Pizza • Cheeseburger • Sweet Potato French Fries

Tips To Save Calories While Dining Out • Ask for a to go box at the start of your meal; save half for a later meal. • Hold the cheese, mayo and sauce or order on the side. • Choose a baked potato, non-starchy vegetables or a salad as your side. • Chew slowly and savor your food • Share with a friend!

Quick Dinner Competition To-go from Chick-Fil-A (2) Chargrilled Chicken Sandwich Combos - $12. 98 + (1) 8 pc. Chicken Nugget Combo $5. 95 + (1) 6 pc. Chicken Nugget Kid’s Meal - $3. 99 = TOTAL - $22. 82 Harris Teeter (1) Harris Teeter Whole Roasted Rotisserie Chicken - $7. 49 + (1) 16 oz. Harris Teeter California Blend Frozen Vegetables - $1. 55 + (2) Uncle Bens Whole-Grain Brown Ready Rice - $3. 34 = TOTAL - $12. 38

Eating on the Go Always plan ahead: • Use smart phone apps and websites to look up calorie counts. www. calorieking. com “Undress” your food: • Ask for dressing and sauces on the side. Downsize portions: • Ask for less, • Order child-size items, • Save half for later • Did you know? Starbucks has a short size - they just don’t advertise it.

Exercise

Why Exercise? • 150 minutes of moderate intensity physical activity every week and do not skip more than 2 days a week o Overall risk of heart disease by 14% o Weight o A 1 C o Type 2 Diabetes risk lowered by 58%! o Blood pressure o Stress

Why Exercise? • 150 minutes equals: 30 to 45 min on 3 -5 days/week For a 200 lb. individual, a weight loss of 14 pounds (over a period of 3 -6 months) Sources: NIH, New England Journal of Medicine

Why Exercise? • Exercise improves insulin action • Improved insulin action = better blood glucose control • Exercise lowers blood glucose by: – Increasing insulin sensitivity – Allowing glucose to be used more efficiently – Over time, this may help lower Hb. A 1 c! Sources: ECU, AACE

Being Proactive for Prevention • Regular exercise can: – Improve blood glucose control – Prevent or delay Type 2 diabetes – Positively influence lipids – Improve blood pressure – Reduce risk for cardiovascular events – Improve quality of life Sources: Mayo. Clinic, ADA

How Does Exercise Relieve Stress? • Release of endorphins – “feel good” chemicals that help reduce pain and improve mood • Relaxes the body • Improves self-esteem • Enhances overall well-being • Improves sleep • Reduces risk for chronic depression • Improves physiological function Sources: Mayo. Clinic, ADA

Types of Exercise Aerobic Anaerobic Exercise • Running • Walking • Biking Resistance bands Flexibility • Yoga • Stretching Bodyweight Exercises Water Bottle Workout

EFC Programs • • 12 to. Life: 12 weeks to a new lifestyle Weight Loss Challenge Stay Fit Challenge FITastic Kids Program Other programs to consider: • Group exercise classes • Personal training • Massage therapy • No Excuses Workout (N. E. W. ) found on EFC website

EFC Group Fitness • In Gear • Yoga • Barre • Pilates • Boxing Bootcamp • Spin Combo • Club Spin • Century Strength • Zumba • ABS • Circuit Strength • Kids Camp (5 -8 yr olds & 9 -12 yr olds) • Bands & Balance Training • Bootcamp • Zumba Toning • Boxing Express • Track Conditioning • Olympic Weightlifting • Spin • Abs • Kick - Boxing Bootcamp • Hydra Tone • Strength & Endurance • Kettle Bell Strength • SPIN The full schedule is available on the EFC website or at the EFC front desk!

Consequences of Sitting How often do you sit? The average person sits 8 -10 hours per day!

Flexibility • Stretch at work and during breaks • Maintain a neutral spine • Stretch your calves and feet when wearing certain types of shoes (i. e. , high heels) • Use a foam roller or assisted stretching equipment if needed

Fit Exercise Into Your Day! • Walk at work! - Walking paths at NHRMC, Cape Fear and Business Center locations – Check the NHRMC website! • Short breaks throughout the work day – 10 minute increments • Group exercise class or activity with coworkers during breaks • Find resources in your community – Independence Mall walking program

Let’s Get Moving! • Short walks (2 -3 minutes every hour) • Physical activity after every meal • Stand while working • Park in the back of the lot • Take the stairs • Walk your grocery cart back into the store • Go inside for fast food or drinks • Become more aware of how often you sit

Contact Information For appointments with a Dietitian or Pharmacist: • Contact Dee Freeman at 667 -5183 or • Diabetes. Pharmacy@nhrmc. org DHP Questions or Concerns: • Contact DHP Administrator at 667 -5959 DHP Hotline 667 -7777

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