Meditation

February 20, 2014 at 11:15 am | Posted in Blood Pressure, Health, Heart Health | Leave a comment
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It may be easiest to understand what meditation is by first explaining what it is not.  Meditation is not thinking.  It’s seeing, smelling, feeling and experiencing without applying thought.  It is a quieting of the mind where the thinking part of the brain is turned off.  If you’re thinking, you’re not meditating.  Meditation is often viewed as an exotic or foreign activity, but it’s really just using a different part of the brain.

Two of the defining qualities of meditation are focused awareness and a receptive state of mind.  The body was not meant to live in the stress response, yet in this modern world we often find ourselves living in a constant state of low-level stress.  Stress aggravates everything.  It causes inflammation in the body, tightening of the muscles, and interferes with getting good quality sleep (in fact fatigue is the number one symptom of stress).  Turning off the stress response helps encourage broader awareness and adaptability.  There is an expansive feeling in this adaptive state as all the muscles stretch and relax; a feeling of “oneness” or connection to everything and everybody (contrast this with the stress response which is very disconnecting).

A good place to start when beginning a meditation practice is with the breath.  Focusing on the inhale and the exhale develops a moment to moment focus of simply being.  You may also find it helpful to focus on an image, or choose a word or words (or phrase/phrases) to link with the rhythm of your breath.  Observe the sensations you experience mindfully, try not to be too “thinky,” and avoid judgments.  It may be difficult to keep your mind from wandering at first, but a wandering mind is not a sign you can’t meditate – it’s a sign that you need to meditate!  Catching yourself drifting and bringing your attention back to the present moment helps build your meditation practice.

It’s recommended to spend 10-20 minutes in quiet meditation 1-2 times a day.  Maintaining focus for 20 minutes at a time can be challenging in the beginning, but you can slowly work your way up to it.  The more often you practice, the more the brain changes (in a positive way).  Meditating daily for just 20 minutes has been shown to remodel your brain away from stress to more pleasant and steadying states of mind – so you can see, it’s well worth the effort!

(Post written in collaboration with the Benson-Henry Institute for Mind Body Medicine)

Spotlight on the Mediterranean Diet

May 23, 2013 at 1:26 pm | Posted in Guest Post, Heart Health, Nutrition | 2 Comments
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By Emma Louise Toolson
Dietetic Intern

Med Diet Pyramid 2

Earlier this year, the New England Journal of Medicine (NEJM) published a study linking the Mediterranean diet with a reduced risk of cardiovascular disease.  Quite simply, the Mediterranean diet is a way of eating that is based on the traditional foods and cooking styles of countries along the Mediterranean Sea. The general eating pattern while following a Mediterranean diet includes:

  • Several servings of fruits and vegetables daily
  • Focus on healthy fats like olive oil and canola oil
  • Consuming fish and poultry at least two times per week
  • Limiting dairy products, red meat, processed meats and sweets
  • Use of herbs and spices to flavor foods in place of salt
  • Red wine, in moderation (if appropriate)

While the Mediterranean diet is abundant in fruits, vegetables, whole grains and healthy fats, a typical Western diet, in contrast, contains more processed foods, refined carbohydrates and saturated fat. Another key feature of the Mediterranean diet is the inclusion of regular physical activity — the Western diet, meanwhile, tends to be more sedentary.

The NEJM study followed 7447 participants over 6 years. Two groups of participants were randomly assigned to a Mediterranean diet pattern, while a third followed a low-fat diet which acted as a control. The two groups following the Mediterranean eating plan were given either olive oil or mixed nuts to provide the monounsaturated (healthy) fats. Restricting calories was not advised for either group.  The study observed a Mediterranean diet, in which extra-virgin olive oil or nuts were the main source of fat, resulted in a significant reduction in the risk of major cardiovascular events in high-risk individuals. This led researchers to conclude that following a Mediterranean diet may prevent cardiovascular disease, particularly in those that are already at risk.

Heart Month: The Health of Your Heart

February 28, 2013 at 3:36 pm | Posted in Health, Heart Health | Leave a comment
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By Aparna Mani, MD, PhD
MGH Medical Walk-In Unit

Aparna Mani, MD, PhD

The heart is an amazing organ. From the time we’re embryos until the day we die our hearts are constantly beating, ticking away at sixty to one hundred beats per minute.  The heart is the organ in the human body  we most commonly associate with emotions and passions. We can actually feel it beating fast with excitement and slowing down as we rest, sleep and dream. How do we take care of such an important organ? We can best answer this question by taking a close look at what can go wrong with the heart.

The American Heart Association estimates that approximately 600,000 people die of heart disease in the United States each year.  What we most often mean when we talk about heart disease is actually coronary heart disease. The heart is a muscular organ and just like any muscle its shape and form directly affect its ability to do its job: pumping blood carrying oxygen and nutrients to every inch of the body. And just like every other organ, the heart muscle needs the right nutrition and care to work properly. It gets its vital nutrients and oxygen not from the blood it holds and pumps out,  but from blood that travels in vessels lying along its outer walls (these vessels are called the coronary arteries). If you were to look straight on at the heart, you would see these vessels wrapping like ivy on the heart’s surface.

The coronary arteries need to remain clean so that blood can flow freely through them to nourish the heart muscle.  Atherosclerotic plaque, a mixture of cholesterol and other debris which can stick to the walls of the coronary arteries, can interfere with the delivery of nutrients to the heart.  In certain spots the lump of sticky plaque can build up to such a degree that it limits or even blocks blood flow through a particular artery. When this happens, the portion of heart muscle that depends on the blood supply from this artery becomes unhealthy, weak, and can even die. But the heart depends on every single muscle fiber to be healthy and strong in order to pump well, so bad blood flow through even a single coronary artery can potentially affect the heart’s important squeezing ability and cause heart disease.

A lot of research has gone into figuring out how to prevent and even get rid of plaque build up in the coronary arteries. Since a major component of plaque is cholesterol, it’s thought that a low cholesterol diet is a key factor for  preventing coronary plaque formation. In addition to diet, smoking and high blood pressure can increase the chances of plaque formation. For unclear reasons, people with diabetes seem to be more prone to developing coronary plaque as well.

Health care providers may recommend aspirin, blood pressure, or cholesterol lowering medications for good heart health.  Maintaining a healthy diet low in sodium and cholesterol, exercising regularly, maintaining a healthy weight, keeping your blood sugar in good control and quitting smoking can also help prevent plaque buildup and resulting heart disease. So take this moment to listen to your heart and talk with your health care provider about taking steps toward beating heart disease.

A Cholesterol Q & A

September 28, 2012 at 10:56 am | Posted in Guest Post, Health, Heart Health | 1 Comment
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By Aparna Mani, MD, PhD
MGH Medical Walk-In Unit

Aparna Mani, MD, PhD

We hear about cholesterol almost as often as we hear about the weather on the news these days – but what is it really and why is it such a hot topic?  Cholesterol is actually a type of fat particle that travels around in the bloodstream. It’s true that we get cholesterol from food, but our body also makes its own cholesterol in the liver. In fact, the liver can produce all the cholesterol our body needs even if we do not take in any cholesterol from our diet.  Foods that are high in cholesterol include mostly animal sources like meats, eggs, fish, poultry, and dairy products like whole milk and butter. Plant-based foods like fruits, vegetables, tofu and grains contain little to no cholesterol.

So what do we need cholesterol for?  Well, cholesterol is used for a couple of different things.  It’s a component of the outer layer of all of the cells in our body, it helps to make vitamin D and hormones like estrogen and testosterone, and it helps in the digestion of fats in the intestine. 

What’s the story about the good versus bad cholesterol?  To understand this a bit better, we need to take a closer look at how cholesterol gets around the body.  Because cholesterol does not mix easily with blood, it’s carried around in the bloodstream by a particle that acts as a kind of vehicle called a lipoprotein. There are several types of lipoproteins, but the ones you have probably heard of are HDL and LDL.  The LDL particles carry cholesterol around and deliver it wherever it’s needed in our body.  However, if we have too much LDL, the excess cholesterol can be deposited on the walls of our blood vessels.

Why is this a bad thing?  The deposits of cholesterol in the coronary arteries, the blood vessels that supply our heart, can form plaque. It’s exactly this plaque that can eventually rupture and cause a blockage in a coronary artery, leading to a heart attack. This is why LDL is often referred to as ’bad’ cholesterol.  But let’s look at another particle:  HDL cholesterol. What makes HDL different is that instead of depositing cholesterol in various parts of our body (including blood vessels), it picks up any extra cholesterol that is lying around and brings it back to the liver. The liver can take this extra cholesterol and either make it into something useful or recycle it.  This is why HDL is referred to as ‘good’ cholesterol.

The balance between LDL and HDL in our body is important.  We want to keep the levels of LDL low and the levels of HDL high so  our body can function well without creating too much cholesterol or plaque build-up in our blood vessels. Some of us might have a genetic predisposition that determines our LDL and HDL levels, but we also have a role in striking this balance through diet and lifestyle.  By eating a diet rich in fruits, vegetables and grains we can keep our LDL low.  Healthy activities such as exercise and refraining from smoking also help to strike the right balance between HDL and LDL cholesterol. Some of us may need medications to modify our cholesterol levels in addition to following healthy habits.  According to the American Heart Association, adults should get their cholesterol levels checked periodically so  their health care provider can make recommendations for keeping their cholesterol levels in good balance.

About Stroke

September 6, 2012 at 11:42 am | Posted in Guest Post, Health, Heart Health | Leave a comment
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By Aparna Mani, MD, PhD
MGH Medical Walk-In Unit

Aparna Mani, MD, PhD

It’s thought that the medical term stroke comes from ancient Greek for ‘struck down’. This meaning makes sense when you think of what happens when someone suffers the symptoms of a stroke. They may experience sudden weakness, numbness or paralysis of the face, arms or legs, a sudden loss of vision, difficulty speaking or an inability to understand speech.  Our brains are responsible for all of these specialized, unique functions. Blood vessels carry oxygen-rich blood and glucose to the brain cells, powering them to do this work. With a stroke, there is a sudden block in the flow of blood through the arteries that supply blood to the brain. 

This sudden ‘block’ in flow most commonly happens due to a clot getting stuck in an artery, or bleeding of the artery itself. When this happens, the blood flow is interrupted, and the cells in the affected area of the brain don’t get the oxygen and glucose that they need to function. If the blockage clears and blood flow resumes within a very short period of time, the patient may have had a transient ischemic attack (TIA) or ‘mini-stroke. If, however, blood flow does not resume for a longer period of time, the brain cells will start to die. A person suffering a stroke will show symptoms based on the specific portion of the brain that has bad blood flow.  Emergency care is required for both strokes and TIAs.  Doctors may use a CT scan or MRI to get an image of the brain to assess someone who has symptoms of a stroke. Depending on the time that has elapsed since symptoms began, doctors may be able to intervene and restore good blood flow to the brain. 

Risk factors for stroke include high blood pressure, smoking, high cholesterol, family history of stroke, age, obesity and diabetes.  Stroke prevention begins with a discussion of your personal risk factors with your doctor. By recognizing these personal risk factors you and your doctor can come up with strategies for lifestyle changes and medications to reduce your risk for stroke. 

Strokes can have serious consequences and can lead to permanent brain damage, long-term disability and death. In fact, Strokes are one of the leading causes of death in the United States today.  Know the signs:  watch out for sudden weakness, numbness, paralysis, and difficulty with speech or vision.   If you or someone you know has any symptoms of a stroke, Call 9-1-1 immediately.  With fast treatment, it may be possible to avoid the long-term consequences of a stroke.  Remember, time is of the essence and every minute counts.

Aparna recently finished an internal medicine residency at Mass General and sees patients at the hospital’s Medical Walk-In Unit.

A Heart to Heart about Alcohol (and your Heart)

February 24, 2012 at 2:33 pm | Posted in Blood Pressure, Heart Health | Leave a comment
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Glass of red wine, glass of white wineLifestyle plays such an important role in managing chronic disease like hypertension.  Making healthy diet choices—eating more fruits and vegetables, reducing sodium—and exercising regularly are both key components of a healthy lifestyle, as is quitting smoking.  But many may wonder if (and where) alcohol fits in to this. 

Here’s the good news:  moderate drinking can be part of a healthy lifestyle.  In small amounts, alcohol may actually lower blood pressure slightly.  And, some types of alcohol are recognized for potential health benefits.  Red wine, for example, has developed a bit of a reputation for promoting heart health.  Antioxidants in the wine can help raise HDL or “good” cholesterol which can, in turn, lower the risk of developing heart disease.  

Now for the bad news:  while a little bit of alcohol may lower blood pressure, drinking too much can raise blood pressure.  Not only that, but alcohol can interfere with many medications, making them less effective.  And finally, all alcohol contains calories which can contribute to weight gain.    

The key thing to remember is drinking is fine in moderation.  Moderate drinking is defined at no more than 2 drinks a day for men and 1 drink a day for women (a “drink” is 12 oz of beer, 5 oz of wine or 1.5 oz of liquor).  If you choose to drink, be mindful of how much alcohol you’re consuming.  If you don’t drink, the best advice is:  don’t start—you can get the health benefits of alcohol in other ways (like diet and exercise).  Talk to your healthcare provider if you have any questions about alcohol or your alcohol use. 

(Post content reviewed by Mass General Cardiologist. Photo credit: Trish Hughes)

Just the Facts (on Fats)

February 10, 2012 at 10:20 am | Posted in Heart Health, Nutrition, Uncategorized | Leave a comment
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Originally posted on MGH Hypertension Blog:

Olive Oil. Photo credit: Thomas Lobker

Remember the big “low-fat craze” of the 1990’s?  It seemed like every magazine was proclaiming the dangers of fat in the diet, no-fat diet books filled the bookstores, and supermarkets began carrying a variety of fat-free chips and cookies.  All of this was based around the idea that fat is bad for you, and eating healthy meant avoiding it whenever possible.  When you consider that high fat diets are linked to an increased risk of developing high blood pressure and heart disease, it’s understandable how this craze could catch on.  But the truth is we need some fat in our diet.

 Fat is used to build and maintain cell membranes and is crucial for the body to absorb certain vitamins (such as Vitamins A and D).  And, like carbohydrate and protein, fat is used as a source of energy.  However, not all fats are the same.  While some types…

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FYI: BMI

November 18, 2011 at 3:56 pm | Posted in Health, Heart Health | Leave a comment
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Scale. Photo Credit: Victor Maltby

We use a lot of acronyms and abbreviations in our modern world.  LOL—laugh out loud; ASAP—as soon as possible; TTFN—ta ta for now.  Here’s another one you may be familiar with:  BMI. 

Body Mass Index (BMI) is a simple calculation used to determine if a person’s weight is appropriate for their height and is a fairly reliable estimate of body fat for most adults. You can easily find your BMI using a calculator like this one from CDC.  A BMI between 18.5 and 24.9 is considered normal; anything below 18.5 is classified as underweight.  Along the same lines, a BMI between 25 and 29.9 is considered overweight and, taking it one step beyond, anything above 30 is considered obese.  Because there is a connection between weight and some chronic diseases, BMI is often used as a screening tool to identify potential risk for developing conditions such as hypertension, Type 2 Diabetes and stroke.  

However, BMI does have some limitations.  For starters, BMI is calculated using the total weight—meaning it doesn’t distinguish between body fat and other elements that contribute to a person’s weight (bones, organs, muscle, etc).  Since muscle weighs more than fat, it’s possible for someone with a muscular build and little body fat to fall in the “overweight” category.  Many professional athletes, for instance, have BMI in the overweight range because of the muscle they develop during training.  Secondly, BMI is a generalization.  Everyone is different and body composition varies by age and gender. 

The important thing to remember is BMI is a guideline and isn’t meant to be used to diagnose health risks.  However, regular exercise and a healthy diet can help you reach or maintain a healthy weight.  If you have questions about weight loss or BMI, you may want to talk to your health care provider or a registered dietitian.

(Post content reviewed by MGH Primary Care Physician.  Photo credit: Victor Maltby)

Ready . . . Set . . . DASH!

September 23, 2011 at 4:13 pm | Posted in Blood Pressure, Heart Health, Nutrition | Leave a comment
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Apples and pears. Photo Credit Zsuzsanna Kilian

It seems every day we’re hearing about some new product that promises to do  amazing things like save you time and/or money on household chores or eliminate fat from certain parts of the body.  Sometimes these gadgets and gizmos work, and sometimes they . . . well . . . don’t. 

 The same is true for a number of popular (some may say “fad”) diet programs on the market:  some are more successful at helping people develop healthy eating habits and maintain a healthy weight than others.  Earlier this year, U. S. News & World Report investigated and ranked 20 popular diet plans based on their effectiveness at promoting weight loss (both short and long term), ease of use, nutritional content and other criteria.  The DASH diet, an eating plan recognized for its effectiveness at lowering high blood pressure, was ranked number one in two categories.

 DASH (which stands for Dietary Approaches to Stop Hypertension) was developed through research by the National Heart, Lung and Blood Institute on the effect of diet on blood pressure.  Study participants following the DASH eating plan—which emphasizes fruits and vegetables, whole grains and low fat dairy, as well lean protein and nuts (which are all naturally low in sodium and saturated fat)—saw a significant decrease in blood pressure and cholesterol.  Not only that, following the DASH diet can help avoid heart attack and stroke and can prevent the development of hypertension among people with normal blood pressure.  Thanks to its proven cardiovascular benefits, the DASH diet has been endorsed by the American Heart Association  

DASH is lower in fat and sodium and higher in several key nutrients believed to help lower blood pressure (including magnesium, calcium and potassium) than a typical American diet.  And, because of its focus on nutrient-rich whole foods (especially fruits, vegetables and whole grains), DASH may also help prevent the development of osteoporosis and some cancers

(Post content reviewed by MGH Nutrition Department. Photo Credit Zsuzsanna Kilian)

Pass the Potassium, Please

September 9, 2011 at 4:08 pm | Posted in Blood Pressure, Heart Health, Nutrition | Leave a comment
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yellow bananas

Many discussions about hypertension lately seem to revolve around sodium, most notably the recommendation for limiting the amount of sodium in the diet.  One of the findings of the National Heart, Lung and Blood Institute’s DASH study was a diet low in sodium is effective at lowering high blood pressure (DASH stands for Dietary Approaches to Stop Hypertension).  But there’s another nutrient that also needs to be included in the hypertension conversation:  potassium. 

Like sodium, potassium is an essential nutrient for living—in fact it works along with sodium to keep the body’s fluids in balance and send messages along the nervous system.  Potassium also plays a role in muscle contraction and is crucial for keeping the heart beating properly.  But while sodium is abundant in the typical American diet, many people don’t get enough potassium. 

 Adding more potassium to your diet can be as easy as eating a variety of fruits and vegetables—in fact the DASH eating plan, which emphasizes fresh fruits and vegetables, is higher in potassium than the typical American diet.  Bananas are probably one of the best known sources of potassium (there’s about 450mg in one medium banana), but sweet potatoes, white potatoes (with skin), tomatoes, oranges, avocados and apricots are good sources as well.  And another plus:  fresh fruits and vegetables are naturally low in sodium.  

Some other non-vegetable sources of potassium include white beans; fish such as tuna, halibut and salmon; and dairy products like low fat milk and yogurt.  Check out the USDA’s Nutrient Database for more information on nutrient content— including sodium and potassium— of many common foods.

(Post content reviewed by MGH Cardiologist and Nutritionist. Photo from http://www.pachd.com/)

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