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Supporting the Heart through Nutrition,
Exercise and Lifestyle

Dear MC,

Your doctor is certainly right; some lifestyle changes are an important part of your ability to reduce risk of heart disease. I hope an alarm went off in your head because what your doctor really gave you is a wake up call, and the bell is ringing!

Heart disease is the major killer in this country. Physicians, and in particular cardiologists, understand that there is a great deal more to the problem than drugs can fix.

Diet, exercise, and smoking cessation are crucial factors in fighting heart disease of all kinds. They are considered the primary protocol for doctors before drugs are administered.

There are countless books dealing with the subject of heart smart dieting and lifestyle. Many patients are overwhelmed with the information and are unsure of which information to take. But since you ask, I will throw my two cents in as well. I am also happy to provide you with a complete cardiovascular plan, which includes dietary tips, patient information sheets and the research into a sound nutritional program. I can also provide you with a way to manage your stress. Contact me and I will be happy to provide you with an appointment to discuss your heart in detail. It is so important!

Nutrition plays a key role in the process of cardiovascular health. It is also the crucial aspect of circulation and cholesterol metabolism. Exercise is the other valuable component. To reduce problems of the heart and circulatory system, eat plenty of foods that are high in vitamins and minerals. I suggest 6-9 servings of fruits and vegetables AS A MINIMUM. These foods are high in antioxidants and studies clearly show these are important in reducing risks of heart disease.

Limit your intake of red meat, and change your protein source to cold-water fish, such as salmon, trout, or halibut. These fishes are high in fatty acids that help protect the heart. I also suggest eating soy products, which are now found in the local grocery. Studies suggest that soy can cut heart and cancer risks and is now endorsed by the American Heart Association as a "heart-healthy food.

Drink more water and don't count other beverages as part of a 64 oz. minimum quantity to consume. Water will help you circulate your nutrients and maintain a better balance of your body's fluids. If you are taking medications, please check with your physician or pharmacist about your water needs.

MC, I also suggest to all my patients that they get on a good supplement program, including a good multivitamin, a good multi-mineral formula, an added antioxidant formula, and a capsule of essential fatty acids. These four products are a great supplement to your diet and I have seen the results of these products in improvement of my patients' quality of life. You may choose to take my Optimal Nutrition Formula rather than these four separate formulas and I am happy to explain why it is perhaps the best multivitamin approach available for those with heart and energy needs. See my general nutrition products for all these essential nutrients.

I will also mention that there are great vitamin formulas that are targeted to help support the heart. Perhaps the most important nutrients to consider for the heart are the antioxidants, including vitamin C, vitamin E and CoQ10. Vitamin C is one of the most heart-protective vitamins we consume. It helps to maintain our circulatory system as well as support our process of blood pressure. This free-radical scavenger also supports the heart by strengthening collagen structures of the arteries and lowering total cholesterol levels and blood pressure.

Vitamin E is a natural heart protector. It aids in many of the processes that support the heart and circulatory system. It is an antioxidant that nutritionally promotes healthy nervous, cardiovascular, and circulatory systems by ensuring that they obtain enough oxygen from the red blood cells. Vitamin E helps support the integrity of red blood cells that carry oxygen to the tissues and organs throughout the body. Maintaining an adequate oxygen supply in your bloodstream is especially important for vigorous activities such as athletics and manual labor.

Scientific evidence suggests, although it isn't conclusive, that folic acid, vitamin B6, and vitamin B12 may also help maintain cardiovascular health. Studies in the general population have found that these vitamins help maintain already healthy levels of homocysteine, an amino acid found in the blood. Many studies have found those who enjoy good coronary artery function have healthy overall homocysteine blood levels.

These nutrients work synergistically to help break down homocysteine, a building block of arterial plaque. Scientific studies have shown that supplementing with these vitamins helps the body maintain safe homocysteine levels. Vitamin B6 also aids in the synthesis of coenzyme Q10, a heart-protecting compound. These B vitamins also play an important role within our nervous system, helping to keep us calm. Ask any person with high blood pressure how important it is to stay calm!

CoQ10 is a vitamin-like compound that is found in virtually all cells of the body. It is a fat-soluble antioxidant and is produced in all the tissues of the body, but dietary deficiencies of certain vitamins, special co-factors and amino acids may impair CoQ10 synthesis within the body. This is reason for concern for all people, but especially those with potential for heart problems, as CoQ10 is an important component of the process of energy production within the mitochondria of every cell in the body. Levels of CoQ10 are especially important to the heart, where it is highly concentrated due to the heart's high-energy requirements.

A truly important nutrient for people experiencing problems with blood pressure is magnesium. This mineral plays an important role in heart function and studies show that people are deficient in the mineral as we age. One study showed that up to 74% of all people over 50 are deficient in serum magnesium and the number jumps to 86% in those with heart problems! Magnesium is important for the balancing of calcium and potassium, other "heart-friendly" minerals. It is often the imbalance of these minerals that is at the root of problems with hypertension. Magnesium also plays the important role of protecting arteries as they expand and contract. For these two reasons alone, magnesium should be a part of your diet and your supplement program.

Herbal therapy has also been suggested for these problems. Two herbs that quickly come to mind are Hawthorne Berries and Garlic. European physicians use Hawthorne Berries as a first stage diuretic approach to hypertension. Studies show that hawthorn can strengthen and stabilize the heart muscle, promoting regular heart rhythms. Hawthorn also creates a positive isotropic effect on the heart muscle – increasing the force of the heart's contractions. Additionally, studies show that hawthorn supports healthy blood pressure by facilitating the opening of the coronary arteries. An added benefit of the herb is its ability to add HDL cholesterol to the system.

While there has been a great deal of press (forgive the pun) about Garlic, not enough can be said for its ability to help the heart and cholesterol metabolism. Supplementing with garlic is appropriate, but also try to eat as many cloves as possible, as the raw herb in food form seems to be more effective. Numerous scientific studies have been conducted with garlic. The studies show that garlic helps promote normal triglyceride levels by decreasing fat absorption. Some researchers also theorize that garlic may inhibit enzymes involved in the synthesis of cholesterol in the liver. And two of garlic's major compounds – allicin and ajoene – have been found to possess powerful actions that help the body boost its immune power.

Taking nutritional supplements can indeed help with the process of circulation and heart function, by providing protection to the process of blood pressure regulation, water balance and aiding the nervous system in its efforts to combat stress. There are several targeted formulations available that produce great results for my patients. Click here for more information and to purchase products targeted toward the heart.

Lifestyle Changes are Important

MC, two other bits of advice I can share are related to your overall Wellness program and will help in your quality of life challenge. The first is an obvious one, which I hope does not apply to your situation. It is about smoking.

Smoking is implicated in both heart disease and cholesterol problems. Smoking will cause plaque to build up in the arteries, and also will decrease your ability to eat properly and exercise properly. Smoking is indicated in blood pressure changes, and is dangerous for many other reasons.

For all of you still smoking, you have some form of heart-related problem coming. You may not see the damage now, but you will. Between cancer and heart disease, smoking is deadly, so STOP IT!

Finally, MC, I would also suggest you look at ways to counter stress in your life. Hypertension is a physical symptom of stress, and in order to lead a quality life, we all must find the means to remain free of stress. Studies suggest that 80% of the visits to physicians are related in some manner to stress. Exercise will help relieve some of the problem, but dealing with mental stress also requires a conscious effort not to allow it to control us.

There are stress management courses and counselors. There are books and tapes that will help. Prayer and meditation have both been proven to ease stress. Balancing your life, your work, and your free time also will help.

MC, Wellness is a pretty comprehensive approach to fighting heart disease. It does take a commitment and it is not especially easy. However, adopting the resolve to fight illness every day requires this approach. It is not simply about being well. It is about being well and being productive…and happy!

Good luck with your treatment plan and keep seeking advice. I have never seen an example of too little advice being better than too much. For a complete counseling program, contact me or stop by the Wellness Store.

Questions about Health?
Ask "Mike"
For Consultation with Jerry "Michael" Casso R.Ph.
Phone: (504) 888-3077

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Supporting the Function of Blood Pressure
Through a Targeted Wellness Approach:
Patient's Primer on Hypertension

Frequently Asked Questions (FAQ) regarding Nutritional Approaches to Heart Health

Part One: Vitamins, Minerals and Other Nutrients Important to Heart Health

Part Two - Dietary and Lifestyle Influences on Blood Pressure

Part Three - The DASH Diet in Detail

Frequently Asked Questions (FAQ) regarding Nutritional Approaches to Heart Health

What is essential hypertension?

In the vast majority of people with hypertension, the cause is referred to as essential hypertension, which basically means that there is no single identifiable cause that can be corrected. Treatment is therefore usually life long, and usually involves taking medications to keep the blood pressure down, though there are many instances where diet and lifestyle changes have caused patients to stop taking medications.

What is secondary hypertension?

In a small proportion of cases (less than 5%), however, the condition is referred to as secondary hypertension, which means that the hypertension is secondary to a single specific problem, such as a tumor of the adrenal gland, or a narrowing of the artery to one kidney. In the majority of such cases, when the problem is taken care of, typically by surgery, the hypertension is cured.

How is Hypertension defined?

Two numbers monitor blood pressure; each represents a opposite action in the heart. Systolic blood pressure, the first number in the ratio, is the measurement of the heart as it contracts to pump blood. The second measurement, or diastolic measurement, gauges pressure as the heart relaxes and blood flows into the organ.

What could be considered a "normal" blood pressure reading?

While there is continuous study to determine an optimal range of blood pressure, a ratio of 130 systolic to 85 diastolic can be considered normal blood pressure. Most experts in the field believe an optimal ratio for a healthy individual is 120 over 80.

How serious a disorder is hypertension?

Hypertension is responsible directly for the deaths of over 51000 Americans in 2000. It may have contributed to the deaths of over 200,000 Americans. The mortality rate rose 6.8% over the previous ten years and the actual number of deaths increased by 34%. It is particularly deadly for African-Americans.

Hypertension can damage other organs over time and patients that do not control hypertension face a reduced life span. Compared with others, hypertensive patients can have as high as ten times the risk of stroke and five times the risk of heart attacks, depending on severity. High blood pressure accounts for 30% of all cases of kidney failure. Hypertension also increases the elimination of calcium in urine that may lead to loss of bone density, a significant risk factor in osteoporosis.

How is salt intake measured?

This can be confusing because different units are used to express salt intake. Salt is usually expressed in grams, one teaspoon of salt being about 5 grams. The salt content of foods, however, is given as milligrams (mg) of sodium. Finally, if that isn't confusing enough, salt excretion in the urine is expressed as milliequivalents (mEq). The conversions are shown below:

Salt (grams) Sodium (milligrams) Sodium (mEq)

2.5 1,000 44

5 2,000 88

7.5 3,000 132

10 4,000 176

20 8,000 352

In practical terms, we consume most sodium as sodium chloride, so the conversion table holds up quite well. A typical American diet would be 10 grams of salt per day, or 4,000 mg of sodium, giving a 24 hour urine sodium content of 176 mEq. The amount of sodium recommended in food labels is 2,400 mg, but the optimal intake is considered less than 2000 mg.

Should I restrict my salt intake?

Most American organizations, such as the American Heart Association, have recommended salt be moderately restricted with high blood pressure. The latest report [Joint National Committee on the Detection and Treatment of High Blood Pressure] has proposed less than 6 grams of salt (or 2,400 mg of sodium), a reduction of about one third for most of us.

Elsewhere, the situation is different. The British Hypertension Society has the lowest priority on salt restriction, simply to avoid excessively salty foods. The World Health Organization prescribes: weight reduction, restriction of alcohol, exercise and salt restriction, which was judged to be effective in some patients.

How do I know if I'm salt sensitive?

One evolving concept is that high blood pressure has different mechanisms in different people. A particular type of medication, or treatment, may work very well in one patient but not at all in another. Salt restriction is no exception.

There is a very wide variation in sensitivity between changes in dietary salt intake and blood pressure in hypertensive patients. Some ("salt insensitive") people can eat as much, or as little salt, as they like, without effecting their blood pressure. "Salt sensitives" may change their pressure by as much as 5 or 10 mm Hg. Their kidneys cannot remove the extra salt from a high salt diet, so their blood pressure goes up. There's no standard of salt sensitivity but a 10 mm Hg change (from a high to a low salt diet) is accepted. About 40 percent of people with high blood pressure are salt sensitive.

It would be very helpful if there were a simple test, which could tell your doctor whether or not you are salt sensitive. The only way to find out is through trial and error However, the chances of your being salt sensitive are increased if you are:

* Older rather than younger
* Black rather than white
* Fat rather than thin
* Diabetic

Part One: Vitamins, Minerals and Other Nutrients Important to Heart Health

Do minerals play an important role in supporting the heart?

The process of blood pressure depends on the proper balance of essential minerals and some experts believe that sufficient intake of minerals, particularly potassium, magnesium, and calcium, may be beneficial to your overall health in general and your heart in particular. Recent studies indicate that a calcium, potassium and magnesium rich diet may reduce hypertension. A number of studies have also shown that daily potassium supplements can modestly reduce blood pressure. However, since potassium supplements may interact with your prescription medications, consult your physician or pharmacist before adding this supplement to your diet.

How does Potassium play a role in heart health and hypertension?

Potassium regulates blood pressure and can, in some cases, lower blood pressure in persons afflicted with essential hypertension. Increasing dietary potassium can offset the tendency of excess dietary salt to raise blood pressure. A low to normal potassium intake encourages this sodium-induced hypertensive state. Potassium intake in the typical American diet is considered deficient and most diets are inversely high in sodium. 2.25 times more Potassium should ideally be consumed than Sodium. Vitamin B6 controls sodium/potassium balance and should be considered in supplement form for hypertensive patients.

Although vegetarians have comparable amounts of sodium in the diet, potassium stores are considerably higher and there is a marked difference in the occurrence of hypertension. The average western diet supplies a total of 1,900 - 5,800 mg of Potassium per day. The average vegetarian diet supplies a total of 8,000 - 11,000 mg of Potassium per day.

African Americans, a subject group with a large risk for hypertension, respond more positively to a change in the potassium-sodium ratio through supplementation than white subject groups.

Food sources of potassium include avocados, bananas, melons and citrus fruits, broccoli, cabbage, potatoes, nonfat milk products, red beans, oranges, prunes, green peas and squash. The recommended daily allowance of Potassium is 2,000 - 2,500 mg per day (including dietary sources). 95% of all dietary potassium is typically absorbed. Most supplemental delivery systems insure 99 mg of elemental potassium and 15 grams of total potassium is considered toxic.

Some patients, such as those taking certain diuretics that do not spare potassium, may require supplements. Excess potassium level, however, can cause abdominal distress, muscle weakness, and, in rare cases, dangerous heart events. Some people should be particularly cautious about potassium supplements, including those with conditions such as diabetes or kidney disease, that increase potassium levels or those taking medications, such as ACE inhibitors or potassium-sparing diuretics, that limit the kidney's ability to excrete potassium.

How does Magnesium play a role in hypertension?

Hypertension can occur as a result of Magnesium deficiency. 300-600 mg of Magnesium per day lowers both systolic and diastolic blood pressure in hypertension patients deficient in Magnesium. Deficiencies are reported in direct proportion to various heart ailments, and some estimates suggest that 80% of all heart patients are deficient in the mineral and over 70% of all Americans are deficient.

Magnesium plays several vital roles in the body contributing to heart health. It is both a potassium and a calcium antagonist. It strengthens arterial walls and relaxes smooth muscles in the heart. Several studies indicate that, as cellular magnesium levels increase in subjects, overall blood pressure levels drop and potassium stores increase.

Magnesium is considered a volatile mineral and competes with many elements for absorption. Calcium and vitamin D3 are both antagonistic and magnesium is therefore considered the body's natural calcium channel blocker. Diuretic, contraceptive, and beta blocker medications deplete magnesium, as does dairy, caffeine and alcohol.

Food sources for the mineral include almonds, cashews, rice, bananas, potatoes, most beans, and dark vegetables. Magnesium is a major component in plant photosynthesis and is found primarily through vegetable sources.

Magnesium is absorbed in the small intestines. Persons consuming the RDA of Magnesium, 300-380 mg., usually absorb about 50% and the strongest absorption strategy is divided doses of 200-300 mg three time daily. Many commercially available forms of delivery are excellent, including aspartate and glycinate chelates. While calcium/magnesium supplements are considered excellent supplements for bone health, magnesium taken separately will provide added cardiovascular benefit.

Studies have shown that most patients with cardiovascular disease are deficient in magnesium and that supplementation with magnesium has provided benefit to patients with mild to moderate hypertension. Magnesium plays a role in the proper blood pressure by supporting the arterial walls and protecting the heart from sudden changes in blood pressure. Magnesium is also shown to aid in the brain's calming state to help reduce stress, which may be an important factor in heart problems.

What about the role of Calcium?

Abnormalities in calcium balance appear to be a primary factor in the creation of hypertension, but studies are mixed regarding its therapeutic role in blood pressure regulation. While some studies have shown a modest reduction of blood pressure with supplemental calcium, other studies suggest its magnesium-antagonist action may actually increase blood pressure. It is important to remember that, when taking a calcium supplement, you should also be supplementing with magnesium. The generally-accepted ratio is 2:1, but heart patients may wish to consider a reverse ratio, as studies indicate that patients with hypertension are more deficient in magnesium.

Many food sources contribute to calcium intake. These include most dairy products, nuts, some fruits, and beans. Calcium is also provided in fortified food sources, such as citrus juices and cereals. Digestive problems are noted in the inability of the body to absorb calcium.

Calcium relies on other nutrients for its absorption, including vitamin D3 and boron. Levels of calcium in the body diminish with age. RDAs and absorption rates vary with age and digestive ability, as well as other conditions. Most professionals prefer citrate or aspartate forms of calcium, although there is much debate over absorption standards and systems of delivery.

Calcium regulates the tone of the smooth muscles lining blood vessels, and population studies have found that people who have sufficient dietary calcium have lower blood pressure than those who do not. Hypertension itself increases calcium loss from the body. Some studies have found modest beneficial effects on blood pressure from calcium supplements.

One study found protection against stroke in men whose diets were rich in magnesium and potassium but no similar effects from diets high in calcium. Sufficient calcium is important, in any case, for strong bone, muscle, and nerve health.

How does vitamin C play a role in Hypertension?

Vitamin C reduces systolic Blood Pressure in persons afflicted with Hypertension and there is an inverse correlation between vitamin C levels and incidence of hypertension. Vitamin C can reduce plaque suspected in the development of atherosclerosis, by facilitating the removal of calcium from atherosclerotic plaque and by preventing cholesterol deposits into plaque. Further, Vitamin C is an important component of collagen, which is a crucial constituent in cellular health. Most researchers agree that the RDA (Recommended Daily Allowance) for vitamin C is markedly low. There is no consensus on proper levels, but most studies indicate that 2-3 grams daily are safe and provide nutritional benefit for the heart.

Vitamin C strengthens blood vessels through collagen synthesis and aids in reduction of hypertension-related stroke and eschemic heart disease. Vitamin C facilitates the normal transport of calcium through the body's membranes. It also enhances the absorption of Magnesium and the function of Phosphorus. Vitamin C also aids in the function of conversion of LDL cholesterol to HDL.

Important in the process of maintaining blood pressure is the interaction of vitamin C with bioflavonoids. Bioflavonoids inhibit the oxidation of Vitamin C. Recent studies indicate that certain bioflavonoids, including quercetin, increase the oral bioavailability of vitamin C. These micronutrients play an important role in controlling blood pressure and making blood cells less prone to clotting, which can cause heart attacks. Food sources containing vitamin C are abundant, mainly in the fruit and vegetable groups.

Supplemental Vitamin C should ideally be taken at 4-hour intervals. The body's Vitamin C is not stored - most ingested Vitamin C is excreted within 4 hours after ingestion: 75% of the body's Vitamin C store is excreted within 24 hours of consumption. Only 5% of the Ester form of Vitamin C is excreted at 24 hours after consumption. 80- 90% of Vitamin C ingested is readily absorbed from the Intestines.

Is CoQ10 an important nutrient for the heart?

Coenzyme Q10 is one of the most-studied nutrients related to heart function and indeed improves many aspects of heart health. Over 60% of all cardiovascular patients are deficient in CoQ10. Using supplemental CoQ10 to correct the deficiency has served as treatment plan for many patients, with good results. CoQ10 lowers blood pressure in hypertensive patients through its influence in the potassium/sodium ratio, but the same studies showed that it does not lower blood pressure in persons with normal or low blood pressure readings. Additional studies suggest that 39% of persons afflicted with hypertension are found to be deficient in CoQ10.

HMG-CoA Reductase is an essential catalyst for the production of Coenzyme Q10 and levels may be depleted by statin class medications (used to combat high cholesterol), which are designed to inhibit the action. It may also be negatively affected by beta-blocker medications which prevent its development. It is enhanced in the body through synergy with the trace mineral selenium. Both nutrients are considered heart-specific antioxidants.

CoQ10 stabilizes heartbeat in arrhythmia patients and helps prevent oxidation of LDL cholesterol in the arteries. Coenzyme Q10 improves blood circulation and assists the heart to function normally in the presence of clotting and platelet aggregation. COQ10 is found in every cell and plays a role in energy function through its use in mitochondrial ATP production.

Supplemental Coenzyme Q10 is poorly absorbed from the intestines when it is consumed on an empty stomach and should be consumed with meals.

The average human requirement for Coenzyme Q10 to prevent deficiency is 5 mg per day. The usual therapeutic dosage for otherwise healthy people is 50 - 150 mg of Coenzyme Q10 per day, or more precisely, 2 mg of CoQ10 per kg of body weight. Clinical studies have concluded that daily doses of at least 30 mg per day are required to significantly raise blood CoQ10 levels and dosages of 30 mg per day or greater are normally administered in 2 or 3 divided doses. Therapeutic doses for treatment of hypertension are 100-200mg daily .

What about amino acids; do they help?

Three amino acids are instrumental in the process of blood pressure regulation. These are arginine, carnitine, and taurine. Arginine is a nonessential amino acid that serves as a precursor of nitric acid. Nitric acid is an arterial wall muscle relaxant, which helps to open up the arteries. As a consequence of its action, arginine is suggested supplementation for patients with hypertension. Arginine can work synergistically with ACE inhibitors and may be an important supplement for chronic hypertensives that fail to respond to either allopathic or alternative therapies. With some people, arginine actually can raise blood pressure, so it is a good idea to discuss its use with your physician.

Carnitine aids in the metabolism of fat cells. It is essential for the transference of fat across the mitochondrial membrane, where it may be burned as energy. As a consequence, carnitine enhances fat burning, lowers triglycerides in the blood, and in some studies has lowered blood pressure in individuals with high fat diets.

Taurine may be the most important amino acid in the process of blood pressure regulation. Taurine, a sulfur containing amino acid, is touted as a major carrier of antioxidants and is known to stabilize cell membranes. Taurine has a role of balancing sodium and potassium in the heart muscle and increases the strength of heartbeat during congestive heart failure.

Taurine in less than optimal levels prevents proper uptake of potassium into the heart. Taurine also directly plays a role in hypertension, possibly related to effects in the renin-angiotensin system of the kidneys. Patients low in taurine may be deficient in vitamin B6. As a result, the diuretic process becomes imbalanced. Adults can process taurine from vitamin B6 and cysteine, another amino acid.

Are there any other heart-healthy nutrients?

While the above mentioned nutrients are considered primary protocol for supplementation, other products may also be of benefit and worth mentioning. It is the opinion of most nutritional professionals that, regardless of dietary compliance to fat intake, supplementing with essential fatty acids is an imperative part of a heart support protocol. Essential fatty acid products, found in either liquid or capsule form, are comprised mainly of fish oils or vegetable oils. Omega-3 and –6 are the main constituents of the formulas, which include both fish and vegetable blends (flax, borage, evening primrose, and black currant oil are examples).

Consideration to the stress-related aspects of hypertension may allow for supplementation with B-Complex vitamins. Vitamin B-6 is noted to be deficient in people with hypertension and should be considered as a major nutrient for supplementation. Studies show that homeocysteine levels that are elevated can contribute to heart disease, most notably heart attacks. In these studies, it was determined that these dangerous levels can be countered by the use of vitamins B-6 and B-12.

Energy concerns and nervous system support in relation to the heart are important considerations and B vitamins have been effective in supporting both functions. B vitamins are water-soluble and should be taken several times daily, preferably with meals. It has been determined that B vitamins are best taken in a complex formula, which includes most of the vitamins, as the "synergy" of these nutrients helps their absorption and utilization.

One of the most important elements of nurtitional support for the heart is fiber. Both soluble and non-soluble fiber in the diet is beneficial in removing fat, cholesterol and preventing various forms of cancer. The best source of fiber is from fruits, vegetables, grains and beans. It can also be found in supplemental form.

Fiber, reduction of fat, and attention to wise vegetable food choices will insure the patient is supporting the body. Supplements will provide added insurance and are especially suggested for those unwilling to be compliant to changes in their diet.

Are there herbal products being used for the heart?

There are dozens of herbs that have been traditionally used to support cardiovascular health. Please consider the following as herbs most commonly used in prescriptive and cultural medicine. These herbs include the Ayurvedic herbs coleus and guggul, the universal herbs garlic, onions, and leeks, and the native herb hawthorn. Other herbs that have use with blood pressure include valerian, corn silk, cat's claw and devil's claw, and the pepper cayenne.

How does Garlic help?

Garlic, known traditionally as the stinking rose, has been used extensively as a cardiotonic and is perhaps the most-researched herb in cardiovascular treatment. While purists in herbology prefer the food form of the herb, supplements are gaining acceptance by both practitioners and patients.Garlic has an abundance of uses in cardiovascular health. It has been used to help prevent future angina attacks. Garlic has been shown to reduce the incidence of atherosclerotic lesions by 15-50%. Garlic prevents abnormal blood clotting.

Garlic improves blood circulation and lowers elevated blood pressure levels in persons afflicted with hypertension. Garlic strengthens blood vessels and has been shown to cause a reduction of fibrinogen levels within 6 hours of their consumption. This reduction in Fibrinogen levels is sustained during long-term consumption of Garlic.

Garlic reduces the risk of heart attack and reduces the risk of second heart attack in persons who have already suffered a heart attack. Studies also indicate that garlic reduces the risk of a second attack by 30% in second year and 60% in the third year. With the added benefit of garlic in cholesterol metabolism, it should always be considered as nutritional support for the heart. Onions and leeks are two other plants that will provide similar properties. Check with your pharmacist to make sure garlic does not interfere with your medications.

What are Hawthorne berries and how do they help?

Perhaps the best known herb for the heart in Western medicine is the Hawthorn , known as "the gentle herb." Native to North America, Europe and areas of northern Asia, the hawthorn fruits, flowers and leaves are all processed in tinctures, capsules, teas, and baths. Early use of the herb for heart-related maladies dates to the 17th century, where its uses were documented in both French and British journals of dispensary. Its use continued in both homeopathic and allopathic medicine through the 20th century and is listed in pharmacopoeias in Brazil, China, France, Germany, Hungary, Russia, and Switzerland and the United States.

Hawthorn has many uses within the cardiovascular system. It is well known for its diuretic ability and is prescribed in Europe for this purpose. Hawthorn prevents angina and reduces the frequency of pectoris form of angina attacks. Hawthorn prevents irregular heartbeats, known as arrhythmia, which can lead to heart attacks. The herb has been used traditionally to prevent and treat atheroschlerosis, through the herb's ability to reduce plaque formations in the arteries. Hawthorn has been clinically shown to improve vasocirculation through its ability to dilate coronary blood vessels, which aids in delivery of oxygen to the organ. Talk to your physician or pharmacist about supplementing your diet with this herb.

Should I incorporate nutritional supplements into my dietary plan? Why should I?

Incorporating nutritional supplements into your dietary plan is considered a good idea, particularly if you are not compliant to your diet in general. Nutritional supplements, including multi-vitamins and heart-specific supplements, can provide you with added insurance of getting the necessary micro-nutrients your heart requires. Nutrition supplements can also support your heart function by providing specific nutrients that may be in less than optimal amounts in your body.

Nutritional supplementation has become a quite complicated and often controversial intrusion into our current medical understanding. Nutritional technology has become a part of mainstream medicine and is increasingly taught in both medical and pharmacy schools. As more is learned about nutrition, companies seeking to capitalize on the knowledge are selling potent products, either through traditional channels or through the various self-help channels, including info-mercials and the Internet. As a result, more and more people are "self-medicating" with these products.

Please understand that there is no substitute for a proper diet. Also recognize that, in some cases, taking nutritional and herbal supplements without the benefit of professional guidance can pose a danger. Many herbs and high levels of nutrients can interact with your medications and may actually encourage a heart event, rather than prevent one.

It is important to seek the advice of your physician or pharmacist regarding the use of nutritional supplements. Specially-trained pharmacists can help you understand the interactions between these products and your medications, as well as offer you advice on the proper supplements to encourage your optimal health and safety. Please do not be afraid to talk to your physician or pharmacist about nutritional supplements and their role in your health program.

How can I incorporate nutritional supplements into my dietary plan?

First, recognize that nutritional supplements are only that - a supplement to your diet. Nutritional supplements can not be taken as meal replacements. Rather, they offer supplemental nutrition to your diet plan. For example, most daily supplements provide 99 mg. of Potassium. Did you know that one banana offers more than 225 mgs.?

Also, recognize that most supplements are only as good as your ability to digest and utilize the nutrients. Many people take expensive vitamin products that are neither absorbed nor used by the body. It is important to take these products with your foods (for the most part) and to purchase products that have been professionally manufactured with these considerations in mind.

Governmental regulations addressing nutritional supplements do not monitor the manufacturing process. Therefore, it is important to choose a product that has been produced in a facility that has stringent practices for safety, potency and efficacy of ingredients. Unfortunately, many products on the market choose not to share their practices with you.

For this reason, it is wise to show your supplements to your pharmacist. They are usually aware of the best practices of manufacturing and can help you decide if the products you are taking meet the standards of acceptance. Since vitamin products are paid with cash, it is important to get the very best for your money.

This information provided you by your pharmacist is out of concern for your health. While most pharmacies also carry nutritional products, it is important to remember that pharmacists are first and foremost your healthcare provider. Using nutritional supplements , as part of a pharmacy disease management program, is secondary to helping you understand your health needs and how you can benefit from your diet, your supplements and your medications.

Questions about Health?
Ask "Mike"
For Consultation with Jerry "Michael" Casso R.Ph.
Phone: (504) 888-3077

line

Part Two - Dietary and Lifestyle influences on Blood Pressure

How can I modify my diet and lifestyle to control or prevent high blood pressure and heart disease?

Dietary Considerations and Weight Management

DASH DIET. Strictly controlled diets generally do not work. They are often too difficult and most patients stray from the diet plan. One diet that considers this factor is the DASH diet. This diet is designed to be flexible on which foods are eaten, as long as a general adherence to the diet is followed.

The DASH Diet (DASH stands for Dietary Approaches to Stop Hypertension) is now the leading recommendation for dietary control of blood pressure and heart function. It is a diet low in saturated fats and rich in whole grains, vegetables and fruits. This diet includes daily choices for nuts, seeds, and legumes and contains modest amounts of proteins, preferably fish, poultry and soy proteins. This diet has had extensive clinical study and patients adhering to the diet experienced significant reductions in both blood pressure and cholesterol levels.

This diet is not only rich in important nutrients and fiber but also includes foods containing two and half times the amounts of potassium, calcium, and magnesium--as are found in the average American diet. Important foods include most fruits, many vegetables (especially, carrots, spinach, celery, alfalfa, mushrooms, lima beans, potatoes, avocados, broccoli), chicken, liver, and no-fat or low-fat milk. Many of these foods are also high in fiber, which is protective against many diseases. It should be noted that grapefruit (but not other citrus fruits) boosts the effects of calcium channel blocking drugs used for hypertension. Get to know the DASH Diet in detail in Part Three below.

WEIGHT MANAGEMENT. Weight management is an important consideration in prevention of hypertension. It is as important as salt reduction, proper fat intake, and stress control. Loss of weight, particularly in the abdominal area, immediately reduces blood pressure and helps reduce heart size. Patients that have successfully lost or controlled their weight and salt intake have been able to reduce and, in some cases, eliminate their medication regimen, so it is important to realize that weight management is crucial. Reduced portions of the right foods can bring about healthy body fat percentages, but consult with a professional before beginning a strict weight program.

SALT INTAKE. If you are consuming excessive salt, you must stop this. There are herbs and seasonings that may help foods taste good, without resorting to table salt. Salt intake is more likely to increase blood pressure and salt restriction to lower it. People who are most likely to be very salt-sensitive are overweight, older, African American, and those who have low levels of renin--a hormone that prevents reduction of blood pressure.

Restricting salt enhances benefits of standard antihypertensive drugs by reducing potassium loss, and may help protect against kidney disease in patients taking calcium-blocker drugs. Simply eliminating table and cooking salt can be beneficial. It should be noted that about 75% of the salt in the typical American diet comes from processed or commercial foods, so try to eat as many fresh foods as possible and stay away from canned foods.

From a lifestyle consideration, what should I avoid?

If you are smoking, you must quit. Ask your physician or pharmacist about programs to help you stop smoking. If you drink alcohol, do so in moderation. Studies are conflicting regarding the amount of alcohol that may have benefit, but is you are serious about lifestyle modification, studies indicate that only wine has cardiovascular benefit. While coffee consumption among healthy people is not likely to do harm, caffeine drinkers would do better to choose tea, which may provide beneficial nutrients. People with existing hypertension should avoid caffeine altogether.

What about exercise…will it help?

Studies indicate that regular exercise helps keep arteries elastic, keeps blood flowing and blood pressure low. Sedentary people have a 35% greater risk of developing hypertension than athletes do. No person with high blood pressure should start an exercise program without consulting a physician.

Studies have shown that high-intensity exercise may not lower blood pressure as effectively as moderate intensity exercise. In one study, for example, moderate exercise (jogging two miles a day) controlled hypertension so well that more than half the patients who had been taking drugs for high blood pressure were able to discontinue the medication. Studies have indicated that Tai Chi, an ancient Chinese exercise involving slow, relaxing movements may lower blood pressure almost as well as moderate-intensity aerobic exercises. People with physical limitations may consider yoga.

An estimated 1.5 million heart attacks occur every year; of these, 75,000, or about 5%, occur after heavy exertion, leading to 25,000 deaths. Isometric workouts, such as snow shoveling, tend to stress the heart and raise blood pressure for a brief period; it can also cause spasms in the arteries leading to the heart. Some studies indicate that competitive sports, which couple intense activity with aggressive emotions, are more likely to trigger a heart attack than other forms of exercise.

One major study found that sedentary people who throw themselves into a grueling workout increase the risk of heart attack by 107 times over that which would occur with low or no exertion. More recent studies, conducted among people in age groups over 50, suggest that walking over 30 minutes daily will lower your blood pressure and reduce the likelihood of cardiovascular illness by 59%.

If you have not included exercise as a part of your daily routine, you should begin by walking 30-45 minutes daily, at a speed that will increase your heart rate, but not increase your level of breathing beyond that in which you can still carry on a conversation. If possible, include strength training 2-3 times a week. Invest in weights, such as dumbbells, and use these during your walk or after you have walked.

A personal trainer will help you to learn exercises you can perform in your home or at a local gym. Ultimately, exercising can increase your heart's strength, provide your body with endorphins, which are the brain's "feel good" chemicals and potentially change your lifestyle to a more healthful and happier one.

If you are overweight, seek the services of a nutritional guide and an exercise coach in your efforts to reduce weight. A simple suggestion is to expend, or burn, more calories daily than you ingest, or eat. Your particular weight dilemma may be more complicated than this and a nutritionist can help you decide which foods are optimal for your body and health condition. However, without exercise, your chance of maintaining a healthful weight is less likely.

Certain antihypertensive medications, including diuretics and beta-blockers, can interfere with exercise capacity. ACE inhibitors or calcium channel blockers are the best drugs for active individuals. However, patients who must take drugs that interfere somewhat with exercise capability should still adhere to an exercise program and consult a physician on how best to balance medications with exercise.

Stress Reduction and Psychological Therapy.

Emotional factors or psychological stress are possible precursors to hypertension. One study found that 73% of patients with mild to moderate hypertension who underwent cognitive-behavioral therapy were able to reduce their medication after 6 weeks; after 12 months, 55% required no medication. Studies also reported that religious faith and activity was associated with healthy blood pressure levels, possibly indicating the benefits of a strong social network and reduced stress from spiritual activities. In another study, a simple relaxation technique called transcendental meditation (TM), which involves silent repetition of a single sound, was shown to be effective in reducing blood pressure.

Simple meditation programs can be used effectively, as well, simply by quietly sitting with eyes closed or focused on a stationary object, breathing deeply (inhaling through the nose, exhaling through the mouth), and trying to listen to the sound of the breath for five minutes. Detach from thoughts and emotions and concentrate on the sound of breathing may bring about a meditative state. Another form of meditation and soft exercise is yoga. There are numerous books and tapes available on these subjects.

Stress is the most debilitating occurrence to health on a daily basis. Stress is responsible for over 80% of all visits to the doctor. Seek out the elements that are causing stress in your life and find methods to effectively reduce them or allow you to combat them. While breathing and meditative actions will help you on a temporary basis, it may be important to seek guidance for long term solutions to your stress. Ask your physician or pharmacist for healthcare practitioners that are skilled in methods of coaching stress reduction.

This information is intended to educate you on this important healthcare subject. It should not be used for purposes of diagnosing, treating, or curing any disease. It is intended to offer general guidelines on methods of managing this disease, with the cooperation and guidance of your healthcare professional. It is available to you, courtesy of your healthcare professional.

Questions about Health?
Ask "Mike"
For Consultation with Jerry "Michael" Casso R.Ph.
Phone: (504) 888-3077

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Part Three - The DASH Diet

Dietary Approaches to Stop Hypertension (DASH) is a major research study of diet and high blood pressure. Its findings led to the development of the DASH diet, which offers a set of dietary guidelines for patients with high blood pressure. In general, it encourages patients to take the following steps in order to lower their blood pressure:

o Reduce the overall amount of fat, particularly saturated fat.
o Increase the number of fruits, vegetables and low-fat dairy foods.
o Moderately restrict salt to around 3,000 milligrams per day.
o Moderately restrict calories to around 2,000 per day.

Patients in the DASH study who used the diet were able to lower their blood pressure to the same extent as other patients prescribed anti-hypertensive medications. Patients are encouraged to speak with their physician about whether the DASH diet might be used as a replacement for medications. However, no one should abruptly stop taking their medications or begin this diet without first consulting their physician.

The DASH plan is based on a 2,000-calorie diet but can be adjusted according to individual needs. The DASH diet guidelines are presented below for information and educational purposes only. Patients should not make any diet or medication changes before consulting with their physician.

The general guidelines are as follows:

* Seven to eight servings each day of grains or grain products. These include breads, cereals and pastas. Grains are important sources of fiber, vitamins and minerals. Each serving should be prepared with as little added fat or sugar as possible.
* Four to five servings of vegetables each day. Vegetables are a good source of potassium, magnesium and fiber. This category of the DASH diet includes beans, potatoes, squash and others as well as the more common vegetables such as spinach, broccoli and corn.
* Four to five servings of fruit each day. This category of the DASH diet includes all fruits, even exotic selections like kiwi, mangos, currants and figs. The fruits may be eaten fresh, canned, frozen, dried, blended in 100 percent fruit juices or in any other pure form.
* Two to three servings each day of low-fat or non-fat dairy products. These are a major source of protein and calcium. This category includes skim milk, low-fat cottage cheese, Parmesan cheese and low-fat yogurt.
* No more than two servings each day of meats, poultry and fish. High in protein and magnesium, this category includes red meat and white meat, as well as meat alternatives, such as eggs or tofu. It also includes shrimp, fish and other types of seafood.
* Four to five servings each week of nuts, seeds and legumes. While rich in magnesium, potassium, protein and fiber, recommended portions are small because the items in this category are high in fat. It includes all types of nuts, peanut butter, beans and lentils.
* No more than three servings each day of fats. These fats include butter, margarine, salad dressing and mayonnaise.
* No more than five servings each week of sweets. These include sugar, maple syrup, jelly, hard candies, fruit punches, and more.

It is important to note that the serving sizes for the DASH diet may vary from heart-healthy diets, such as the Dietary Guidelines for Americans. If you are considering beginning the DASH diet, consult your physician.

What is the history of the DASH diet?

Funded by the National Heart, Lung and Blood Institute, Dietary Approaches to Stop Hypertension (DASH) is a major research study of high blood pressure. High blood pressure is a major risk factor for coronary artery disease (which can lead to heart attack) and carotid artery disease (which can lead to stroke).

The goal of the DASH study was to determine whether a particular diet could lower blood pressure, reducing the risk of potentially fatal events. Ideally, the researchers could identify a diet to lower blood pressure, as a vegetarian diet often does, but that would also include some meat to appeal to a broader group of people.

The DASH study examined the impact of three different diets on a group of 459 subjects. The average age of the group was 44.6 years old, and 49 percent of the participants were women. In addition, 59 percent of the participants were African-American. After the participants had eaten an average American diet for three weeks, their blood pressure was measured. They were then asked to do one of the following:

* Continue eating the average American diet without adding or limiting any specific types of foods.
* Eat more fruits and vegetables than one normally would.
* Eat more fruits, vegetables and dairy products than one normally would, and restrict one's intake of fat and sweets. This later became known as the DASH diet.

After eight weeks, all participants on the DASH diet exhibited lower blood pressure. In fact, the blood pressure of participants on the DASH diet was about as low as that of patients who took medications to lower blood pressure. It is estimated that widespread use of the DASH diet could reduce the overall incidence of coronary artery disease by 15 percent and stroke by 27 percent.

Follow-up research suggested that the DASH diet is even more effective for African-Americans than it is for Caucasians. Identifying an effective treatment for African-Americans is particularly important because they are at particularly high risk of developing high blood pressure.

Results of the study were published in the February 8 publication of the Archives of Internal Medicine.

General Information about the DASH Diet

The DASH diet is a good example of what Hippocrates, the Ancient Greek scholar known as the "Father of Medicine" meant when he remarked, "Let foods be thy medicine and medicine be thy foods." Many heart problems are the result of the foods eaten over time. Poor food choices can lead to a number of chronic illnesses. The DASH diet has been scientifically designed to help those with heart problems, by largely eliminating the foods that are potentially dangerous and suggesting foods that will help to provide the nutrients that can help the heart and its function.

The DASH diet provides more servings of foods that support the body's needs. It increases the amount of servings of fresh vegetables and fruits, both of which are higher in fiber and nutrients that are heart-friendly. It decreases, compared to the average American diet, the amount of servings of meat, high in fat, and makes suggestions for alternative choices of protein, including fresh fish and legumes.

While many nutritionists suggest following the DASH diet literally, others insist that a strict vegetarian diet will provide a more healthful dietary approach to the heart. The danger in a vegetarian diet providing the body with enough healthful fats and protein sources. Ask your Wellness Store pharmacist or nutritionist how to offset this danger if you have selected a vegetarian diet for your "medicine."

What foods are used in the DASH diet?

The DASH eating plan is based on 2,000 calories a day and your number of daily servings may vary from those given in parentheses depending on your calorie requirements.

Grains & grain products (7-8)

* Whole grain sliced bread (1 slice)
* ½ cup whole grain cereal
* ½ cup brown rice or whole grain pasta
* *whole wheat bread, cereals, grains contain more fiber than refined grains
* *oatmeal is particularly helpful in reducing cholesterol

Vegetables (4-5)

* cup raw vegetables (vegetables with colors are preferred)
* ½ cup cooked vegetables (steamed cooking preferred, to provide nutrients)
* vegetable juices, (low sodium)
* tomatoes, carrots, broccoli, kale, beans, sweet potatoes are excellent foods

Fruits (4-5) *Fruits low on glycemic index are preferred.

* oz fruit juice (fresh squeezed is preferred)
* medium fruit (apples, pears, citrus, grapes are preferred)
* ¼ cup dried fruit
* ½ cup fresh, frozen, or canned fruit apricots, bananas, grapes, oranges, peaches, prunes, strawberries

Low fat or nonfat dairy foods or dairy substitutes (2-3)

* 8 oz milk or dairy substitute, such as soy milk
* 1 cup yogurt or 1/2 cup cottage cheese
* 1.5 oz cheese
* skim or 1% milk, non fat or low fat yogurt, nonfat cheese
* Soy milk, cheese, and sour cream are now readily available and heart-healthy (preferred)

Meat, poultry, or fish (2 or less)

* 3 oz cooked meats, poultry and fish choose lean; trim fat; broil, roast, or boil; remove skin from poultry.
* Cold-water fishes, such as salmon, halibut, albacore tuna, or trout are preferred, as they are all considered heart-healthy.

Nuts, seeds, and legumes (4-5 per week)

* 1 / 3 cup raw unsalted nuts, preferably almonds
* ½ cup cooked legumes, such as black beans, green beans, kidney or white beans.
* 2 Tbsp seeds almonds, peanuts, sunflower seeds, lentils, kidney beans.

Sample menu:

Breakfast

* Orange juice 6 oz 1(fruit)
* 1 cup 1% low-fat milk (1 dairy) or dairy-alternative, such as soy milk
* Corn flakes with fruit - 1 cup (2 grains)
* Banana 1 medium (1 fruit)
* Whole wheat bread with 1 tbsp jelly or honey 1 slice (1 grain)
* 1 tbsp non-TFA form of margarine (canola margarine) (1 fat)

Lunch

* ¾ cup tuna salad (1 protein)
* Pita bread ½ large (1 grain)
* Raw vegetable medley: (1 vegetable)
* Carrot & celery sticks 3-4 each
* Radishes 2
* Lettuce 2 leaves
* Part skim mozzarella or soy cheese 1.5 slice (1 dairy)
* 1% low fat milk 1 cup or soy milk (8 oz) (1 dairy)
* Fruit cocktail ½ cup (1 fruit)

Dinner

* Herbed baked cod 3 oz (1 fish)
* 1 cup Brown rice (2 grains)
* 1 cup Steamed broccoli (2 vegetable)
* Spinach salad: (1 vegetable)
* ½ cup Raw spinach
* Cherry tomatoes 2
* Cucumber 2 slices
* 1 tbsp Light Italian dressing (½ fat)
* 1 small Whole wheat roll (1 grain)
* 1 tbsp Butter or Canola Margarine (new forms of margarine providing Omega-3 oils) (1 fat)
* ½ cup Stewed pears (1 fruit)

Snacks

* Dried apricots ¼ cup 1 fruit
* 3 almonds (or 1/2 teaspoon almond nut better with fruit)
* Mixed nuts 1 / 3 cup 1 nuts
* 1/2 apple, pear, or small bunch grapes

Please note:

Your local grocer now carries products derived from soy, which has been shown to positively affect heart function. Many soy-based foods are now available and considered delicious. Experiment with vegetable-based foods that are low in sodium. While many companies attempt to produce healthful foods, they include large amounts of salt for taste. It is important to read the "Nutrition Facts" located on labels to determine if your foods are too salty.

A new type of margarine is now available, which boasts a "heart healthy approach" by offering content of Omega-3 fats and reducing hydrogenated oils. These forms of margarine are now well accepted as healthful, provided they do not contain Trans-Fatty Acids (TFA). For more information about essential Fats, click here.

Ask your grocer for these types of margarine. For cooking purposes, olive oil is the preferred form of oil, as it also contains these important healthful fats. Fried foods and high-fat foods are not a part of the DASH diet, but your body does need good fats.

We want you to understand that supporting the heart can be the most important health consideration you can actively pursue. We are happy to work with anyone, to answer questions not found here and make recommendations for the proper diet and nutritional supplements. You can contact me here or stop by the Wellness Store for more information or to set an appointment for counseling. Be Smart - Take Care of your Heart!

What are some tips for staying on the DASH diet?

Staying true to any diet is a challenge, but keep in mind that any change you are able to make today is a step toward a healthier tomorrow. Here are some tips to help you stay on track:

* Do start small. Make gradual changes to your eating habits.

* Do center meals on complex carbohydrates (vegetables, brown rice, beans, etc.)

* Do treat meat as only a part of the meal, instead of the focus of the meal.

* Do use fruits or low fat, low calorie foods for desserts and snacks. Sugar and other refined carbohydrates can turn to fat in the body.

* Do add a serving of vegetables at lunch.

* Do use only half the butter, mayonnaise, salad dressing or other high-fat items that you normally use. Trying low-fat or non-fat alternatives will also help.

* Do eat fruit as a snack. An apple, pear or banana is perfect for those hungry times between meals. Try berries or a couple of almonds. While almonds are high in fat, it is a "good fat!" (Just don't eat too many! Three at a time are quite filling!)

* Do watch what you drink. Replace soda, sugary teas or punches and alcoholic beverages with water or herb teas. These will not only help you cut back on your sweets, but will also help you meet the DASH diet's requirements.

* Do learn serving sizes. Serving-sizes are a guideline to help you change not only what you are eating, but also how much of each type of food you are eating. While all the numbers and charts are initially cumbersome, they will become second nature once a daily routine has been set

* Do experiment with vegetarian dishes or dishes with little meat and more vegetables and grains. These include stir-fry meals, pasta dishes and casseroles. These healthy and tasty alternatives will add spice and variety to your diet. Try the soy foods now in supermarkets. They are considered "heart-healthy."

* Do change your shopping list. That way, you won't be eating the same things in the same proportions. Increase the amount of fruits and vegetables on your weekly shopping list. Don't buy as much meat. If it's not there, you can't eat it.

* Do try to eat fresh as much as possible. Here is a simple tip; try to shop only the perimeter of the supermarket, where only the fresh foods exist. Shop the produce department first and load up; you will not spend as much time at the meat counter.

* Do keep it simple. Remember that you are not trying to stay on a short-term diet. You are changing your lifestyle. The simpler you keep your meals, your goals and your tasks, the easier they will be to maintain.

* Do keep a record. Keeping a diary or a logbook can help you keep track of the number of servings you are eating in each category. Plus, seeing what you are eating in black and white is a great way to check your progress. It can also help you to identify patterns and triggering events that put you off track.

* Do celebrate success! Reward yourself for every accomplishment (but not with food!)

* Don't make meat the center of your meal. Although meat contains nutrients that are good for the body, it is also high in saturated fat and cholesterol, not to mention calories. You can continue to enjoy meat as part of a balanced meal rather than the whole meal. Remember to make this change gradually. If you typically eat more than the suggested amount of meat, reduce your portions by a third for one week. After a week, cut back another third until your serving sizes of meat are equal to the DASH serving size of 3 ounces.

* Don't try to do it all at once. You will be more successful if you make gradual changes in your eating habits.

* Don't be discouraged by occasional lapses. They happen. It is important, however, to determine why the lapse occurred so you can avoid that same trigger in the future. Perhaps it was a holiday party that got you off track? Stress due to a problem at work? Learn from the mistake and move on; don't beat yourself up. It's all part of the process of change.

Mike Casso, R.Ph.

Questions about Health?
Ask "Mike"
For Consultation with Jerry "Michael" Casso R.Ph.
Phone: (504) 888-3077