Healthy Living Spring 2014 by Tri-City Herald

Tri-City Herald’s Guide To

Spring 2014

Fearless Fitness Tips for getting back to regular exercise after a heart attack

The Numbers Don’t Lie Find out which health indicators are the most important when it comes to your heart

Simple Ways to Reduce Daily Stress

Keeping the Statins Quo FAST & Smart: Stroke Awareness Ask the Expert: Love Thy Fruits & Veggies

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PROGRESS 2013 tricityherald.com/progress

Look For PROGRESS 2014 Publishing Sunday, March 30, 2014

• AGRICULTURE & COMMERCE & ECONOMY • SCIENCE & TECHNOLOGY COMMUNITIES & LIFESTYLE • BUSINESS

Progress is our community’s annual look at the projects, goals and challenges facing Mid-Columbia business and industry. It is especially valuable because it is written and illustrated by local business and industrial leaders, giving our readers the best insight into our community’s progress.

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Voting starts January 27th February 14th

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H e a lt hy Living Spring 2014

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MIN. OF EXERCISE

SMOKING

WAISTLINE

By Bev Bennett nowing your cholesterol numbers says you’re in charge; you’re the master of your heart

health. What more do you need to track? Plenty. Your age, race, gender, weight, diet and exercise habits and whether you have diabetes could determine your potential for a heart attack or stroke, according to new guidelines to assess and reduce atherosclerotic cardiovascular risk from the American College of Cardiology and the American Heart Association. With these guidelines comes a different approach than in the past, according to Dr. Reena L. Pande, a cardiologist at Brigham and Women’s Hospital in Boston and an instructor at Harvard Medical School. You’ll find there’s more emphasis on your collective risk factors, according to Pande.

AGE

BLOOD PRESSURE

WEIGHT

BLOOD SUGAR

The Numbers Never Lie

CHOLESTEROL

It’s more important to know your personal health history, not just your cholesterol numbers. You’ll want to discuss your risks with your physician so you can determine whether you need to make lifestyle changes and whether you’d benefit from medications. Don’t ignore your cholesterol readings, however. You still need those. But you should also be aware of the other numbers linked to your health, according to Dr. Joel K. Kahn, clinical professor of medicine, Wayne State University School of Medicine, Detroit. These include: • Your blood pressure. • Your waistline circumference. You’re at greater risk for heart disease if you’re a man with a waistline that’s more than 40 inches or a woman measuring more than 35 inches around the waist (measure around your bare abdomen, just above your hipbone).

Tracking vital health statistics is vital to a maintaining a healthy heart. Here’s what you need to know about your own body • Your fasting blood sugar. “You can have elevated blood sugar for years before you have a diabetes diagnosis,” says Kahn, also director of cardiac wellness at Michigan Healthcare Professionals. Having diabetes increases your risk of heart disease, according to Kahn. • The number of first-degree relatives with heart disease before age 50. • The number of minutes a week you exercise. • The amount you’re smoking. Along with a profile of your health numbers, talk to your physician about any irregularities in your well-being. “Do you get short of breath on exertion? Has your physical fitness deteriorated so you can’t do regular things?” asks Kahn. Learn how your race could affect your heart health. African-Americans have a greater risk for developing heart disease and stroke.

H e a lt hy Living Spring 2014

“I see a zillion people who want to be checked out. People come in without symptoms, see the [heart] guidelines and want to be checked out.” — Dr. Joel K. Kahn

If you have concerns based on your personal history, ask about further tests to diagnose your heart health. “I see a zillion people who want to be checked out. People come in without symptoms, see the heart guidelines and want to be checked out,” Kahn says. Advanced tests include lipoprotein testing, which shows whether you have a specific type of lipoprotein, and a coronary calcium scan, which looks for specks of calcium on the walls of the coronary arteries. Positive results on

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either test could indicate that you’re at risk for a heart attack. If you do have heart disease, you need to act, says Dr. William A. Zoghbi, immediate past president of the American College of Cardiology. You need to make lifestyle changes and you need to start a drug regimen (see sidebar on statins), he says. “It’s very important to have medication. It’s not controversial. We know it saves lives; we know it improves the quality of life,” says Zoghbi, also director

of the Cardiovascular Imaging Institute at the Methodist Hospital in Houston. If you don’t have heart disease, you’ll want to take the necessary steps to reduce your risk. This means making a serious commitment to change your lifestyle, says Zoghbi. Get more exercise, lose weight and eat healthier foods. If you smoke, stop. The good news is that only 25 percent of the risk of heart See Numbers | Page 7 disease comes from

GOAL SETTING

TO REDUCE YOUR CANCER RISK By: Sheila Rege, MD. WSMA Member As the New Year begins, some of us make resolutions to change our lifestyles to become healthier. Making any change in lifestyle can be very challenging. We often set high goals, and then become discouraged if those goals are not met. Our stress level then goes up; self-esteem sinks and we feel “bad” for not meeting what is often an “all or nothing” goal. One goal is to make changes in our life to reduce our cancer risk. Here’s a list of 5 things to do and how to do that within the Tri-Cities: (1) Kick the Nicotine Habit (2) Maintain an Ideal Body Weight (3) Exercise every day (4) Eat More Vegetables (5) Laugh More Regardless of which goal you pick, there are some suggestions to make the task easier. Let’s start with goal number one (Kick the Nicotine Habit) as a possible goal, and here’s what to do: 1. Break the Goal into small steps, and make them behavior specific. For example, instead of saying “I am going to stop smoking,” consider an intermediate goal like “I am going to increase the time between cigarettes by 10 minutes each day.” 2. Build on Past Successes. Use an example of something you’ve done successfully in the past; and think of how you did that. For example, most of us have to learn new computer software or programs. This is something that takes practice, and finally we are able to do it. 3. Focus on Improvement, not Perfection. After all, if you just “can’t stop smoking” like one of your friends did, you are a failure, right? WRONG. Focus on improvement. Maybe just delay your first cigarette by half-hour each week. 4. Keep a written record of your goals and progress. 5. Reward Yourself. Even an accomplishment seems small, rewarding yourself for your success reinforces the fact that you are successful. 6

Some of our local hospitals have programs mostly for those over 50: Kadlec Regional Medical Center has a “Kadlec Heatlhy Ages Over 50” at 509-942-2700; Lourdes Medical Center has a Thrive for Life with Wellness workshops for those over age 50 (509-546-2301), and Trios Healthcare has a website with useful information at http:// www.trioshealth.org/for-patients-visitors/health-resources/12635/content.aspx;.

Resources Within the Tri-Cities to quit smoking can be found at: Location

Telephone

American Cancer Society

509-783-5108

Northwest Cancer Clinic-Friday Chats at Noon

509-987-1800

Tri-Cities Cancer Center-Wellness Center

509-737-3420

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ESTEBAN AMBRAD -CHALELA, MD H e a lt hy Living Spring 2014

Numbers From page 5 genetic factors that can’t be changed. The remainder — 75 percent — comes from risk factors you can reduce, says Dr. Pande. “People with a genetic risk for heart disease can change their risk as well,” she says. “Take care of yourself and your outlook will be better,” says Zoghbi.

Add It Up

You can figure out your 10-year risk for cardiovascular disease using an online calculator from the American Heart Association and the American College of Cardiology. However, the calculator isn’t without controversy. Some suggest that the data used to determine risk is too old to be useful. Dr. William A. Zoghbi argues the merits of the calculator. “It’s like a weather forecast: rain in four days. There’s no certainty, but a warning, a higher chance that rain will happen, ” says Zoghbi, immediate past president of the American College of Cardiology. The calculator has a similar function to alert you to a higher risk for heart disease. “If you see risk you have to do something to reduce it,” Zoghbi says. For more information, visit the website of the American Heart Association at: http://www.heart.org/ HEARTORG/Conditions/ HeartAttack/ HeartAttackToolsResources/HeartAttack-Risk-Assessment_ UCM_303944_Article.jsp

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Statins Quo? If you have certain risk factors for atherosclerotic cardiovascular disease, your physician will most likely discuss statins, a family of medications recommended for heart disease or stroke prevention. In writing the new guidelines, experts from the American Heart Association and the American College of Cardiology identified four groups of individuals who could benefit from using statins. These include adults who have some clinical history of heart disease or stroke, such as unstable angina or peripheral artery disease. The second category includes adults those who have very high LDL (bad) cholesterol levels. Statins are also recommended for adults, ages 40 to 75, with diabetes. Adults ages 40 to 75 who don’t have cardiovascular disease but who have a 7.5 percent or greater risk for heart attack or stroke in the next 10 years should also consider statins.

Risk is based on race, gender, age, total cholesterol, HDL (good) cholesterol, blood pressure, use of blood pressure medication, having diabetes and/or smoking. Before accepting a prescription talk to your physician about potential side effects. Memory loss, confusion, increased blood sugar levels and muscle damage have all been reported, according to the U.S. Food and Drug Administration. “I’m not a statin basher. There are side effects patients should know,” says Dr. Joel K. Kahn, author of the upcoming book, “The Holistic Heart Book: A Preventive Cardiologist’s Guide to Halt Heart Disease Now” (Reader’s Digest, 2014). Kahn recommends taking the lowest statin dose possible for you to achieve good results.

State Your Age, Weight, Heart Health.... By Jeff Schnaufer

any think it’s just natural to put on weight as one ages, but some health experts say it may be the worst time in a person’s life to put on weight and get out of shape. Yet unfortunately, more and more seniors are becoming obese. According to Dr. Catherine Loria, nutritional epidemiologist in the National Heart Lung and Blood Institute’s Division of Cardiovascular Sciences in Bethesda, Md., the obesity rate among men greater than 60 years old is 37 percent and women greater than 60 is 42 percent. And data from the 2009-2010 National Health and Nutrition Examination Survey reveals that adults age 60 and over were more likely to be obese than younger adults. Myriad health risks accompany obesity, health experts say. These include hypertension or high blood pressure, high cholesterol and heart disease, 8

cancer, osteoarthritis and diabetes. For the 50-plus crowd, health experts say obesity can increase these risks even further. “Probably one of the main considerations there for the 50-plus population is that the conditions have had longer to do damage to the body,” says Dr. Vance Blackburn, a physician in Birmingham, Ala., who has conducted research for the American Academy of Family Physicians. “Another factor is that people who are overweight tend to have multiple problems, like high blood pressure or hypertension and diabetes. As you start adding all of those things together then the health risks significantly increase. Probably one of the main factors is that the body’s metabolism slows down as we age. I often have people say they are eating the same things they were eating before but they are gaining weight. And for those who are obese over 50, they are less likely because of fatigue or joint pain to be active. They’re more sedentary.

That definitely intensifies problems.” Among the trouble areas: High Triglycerides and Cholesterol “Obesity definitely increases the rates of high triglycerides in the blood and that’s a component of the cholesterol levels. It also tends to lower the good cholesterol,” Blackburn says. “Those things are part of the risk factors that can increase heart disease.” Heart Disease In addition to the risks of high triglycerides and dangerous cholesterol levels, Dr. Robert H. Eckel, former president of the American Heart Association, encourages people who may be obese to be tested for obstructive sleep apnea. “This can lead to a greater risk of heart disease,” Eckel says. “This can be treated. This is an important area that is underestimated.”

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Diabetes “The risk of diabetes almost exponentially increases with weight gain as we become older,” says Dr. Jack Dersarkissian, regional lead for Adult Weight Management for the Southern California Permanente Group. “As we all get older, we lose our lean muscle mass, so we may stay the same weight, but it is fat. And it’s fat in the visceral area, which is inside the belly. That’s the most dangerous type of fat. Diabetes in and by itself really cascades into a lot of other diseases, like heart attacks and kidney failure and increase of stroke.” High Blood Pressure or Hypertension “With hypertension, as we gain weight, our blood pressure can go up by 10 to 20 points,” Dersarkissian says. “If you are 200 pounds and you lose 20 pounds, that can improve diabetes and blood pressure risks and reduce the amount of blood pressure medication your are on.” Fortunately, there is a remedy for obesity for many people, including the 50-plus crowd. While it may not reverse an existing medical condition, the remedy may help prevent the onset of certain conditions. The treatment: lose weight and keep the weight off.

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Exercise After an Attack

After a heart attack or stroke, getting the heart in better shape is important for long-term survival. But how do you overcome the fear of elevating your heart rate? And what is safe to do and what isn’t? By Lindsey Romain

xercise is always an intimidating endeavor, but exercise after the trauma of a heart attack heightens that intimidation tenfold. Heart attacks are, after all, synonymous with increased heart rate, the exact goal one works towards when they work out. It’s hard to shake the fear of triggering another attack and undoing the hard work of rehabilitation. Luckily, the risk can be minimalized with the help of doctors. “The key is to start very slowly, with gentle and easy activity as tolerated and with caution,” says Dr. Mark Urman, clinical professor of medicine at the David Geffen School of Medicine at UCLA. Post-trauma exercise is case dependent – the severity of the attack and the 10

amount of exercise the patient performed beforehand are determining factors for how to jump back into a routine. Urman suggests starting with “walking on a flat surface for a few minutes at a time, doing light housework and gardening” in the first few days. “If tolerated, then we generally want our patients to gradually do more aerobic activity and increase it every few days,” he continues. That might mean walking on a treadmill and cycling on a stationary bike, ultimately building toward the level of strenuous activity the patient is comfortable with or used to perform regularly. Laura Zeller, clinical psychologist with the University of Wisconsin-Madison Health Preventive Cardiology Program, says that instead of using heart rate as a guide for intensity, heart patients should

instead focus on breathing or perceived exertion since heart medications can decrease heart rates. “Most heart patients will be recommended to work up to a minimum of 150 minutes per week of a moderate intensity aerobic exercise – or more, especially if weight loss is desired,” Zeller says. If the patient was active before the heart attack, they may require higher intensity workouts. “Some patients are told not to exercise vigorously at all, while others are advised to include it as part of their programs,” Zeller says. “Also, some patients are recommended to begin strength training while others are restricted.” Generally, patients are to avoid heavy lifting, pulling or straining in the first six weeks after a heart attack, Urman says. He also says no jogging or running until the patient gradually works into it, usually with the help of a cardiac rehabilitation team. A cardiac rehabilitation program is the best way to safely increase exercise while being monitored, Urman says. “Cardiac rehab is a customized program of exercise and education that has been shown to save lives and improve outcomes after heart attacks,” Urman says. Some other tips to consider when exercising after an attack, according to Zeller: • Warm up at an easy pace and cool down before stopping completely. • Avoid exercise in temperature extremes – like heat indexes above 85 degrees F or wind chill less than zero. • If prescribed nitroglycerin, carry if with you when you exercise. • Do not exercise to the point of chest pain – if you develop it, stop exercising and take nitroglycerin as prescribed, or call 911. • Stop exercise and let your health care providers know if you experience unusual shortness of breath, dizziness, nausea or irregular heartbeats. It’s also helpful to keep in mind that exercise has countless health benefits – and that easing back into a routine can be a matter of life or death. “Research shows the long-term benefits of exercise in heart patients outweigh the short-term risks,” Zeller says.

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FIVE By Lindsey Romain

tress is more than just frustration at work or exasperation from a packed schedule – in some instances, it’s a precursor to deadly debilitations. Stress is a general term given to the body’s responses to stressors, which “induce activation of the sympathetic nervous system responsible for flight-orfight response,” says Krishna Tummalapalli, cardiologist at the University of Pittsburgh Medical Center. The sympathetic nervous system releases hormones like adrenaline, cortisol and serotonin, which lead to accelerated heart and lung action, inhibition of digestion and a number of other physiological responses. The human body, while complex and adaptable, isn’t equipped to handle constant sympathetic nervous system activation, Tummalapalli says. It’s not just moments of intense stress – like Tako Tsubo syndrome, which refers to the sudden onset of heart attack or heart failure symptoms due to the sudden deterioration of heart function after a person hears unexpected tragic news –

Simple Ways to Reduce Daily Stress

that are detrimental to heart health, but prolonged minor stressors, too. Stress is a leading factor in chest pain, strokes, elevated blood pressure and heart attacks. If left unattended, warns Tummalapalli, it can lead to unhealthy coping mechanisms like smoking, poor food choices and a sedentary lifestyle. “Stress also impairs our ability to fight infection, impairs our cognitive abilities – like thinking clearly and remembering accurately – and increases inflammatory markers in the body,” says Catherine M. Stoney, program director for the Division of Prevention and Population Sciences at the National Heart, Lung and Blood Institute in Bethesda, Md. And though, according to Stoney, eliminating stress isn’t always a realistic goal, learning to live and cope with it is the best possible outlook. It’s all about finding what works for you. Here are some suggestions for ways to reduce stress in everyday life: 1) Exercise. It almost goes without saying in this day and age – exercise is a great way to both relax and stay in shape. “This might be the single most important thing you can do to improve your health,” Tummalapalli says.

2) Meditation and Yoga. Tummalapalli and Stoney both recommend these soothing activities as a way to center oneself and learn proper deep-breathing techniques, which are helpful in times of panic. 3) Find a hobby. “Tennis, dance, photography – whatever you like!” Tummalapalli says. 4) Take a time out. Similar to a hobby, this involves taking some time out of every day to spend quality time with yourself. “Read, watch a movie, take a relaxing bath or choose another enjoyable activity that provides a quiet time apart from your daily activities,” says Stoney, who also advises turning off electronic devices to truly “commit to the notion that time for yourself is as important as time for work.” 5) Socialize and volunteer. “Humans are social animals,” says Tummalapalli, who notes the importance of being selective about who you choose to interact with: “Socialize with people you genuinely enjoy spending time with.” Keep yourself surrounded by people who love and support you, and “ask for help when you need it,” Stoney says. H e a lt hy Living Spring 2014

From the mouths of survivors

Butt Out! Quitting smoking is one of the best ways to prevent heart disease, but it’s also one of the hardest.Think it can’t be done? Get inspired by these true stories of heart patients who successfully quit smoking and learn how it’s impacted their overall health and lives for the better

By Dawn Klingensmith

s most heart patients are well aware, quitting smoking can bring about drastic improvements in cardiovascular health. “Improvement is seen almost immediately, and in as little as three years, the risk of heart attack or stroke returns down 14

to the level of a nonsmoker,” says Dr. Richard Krasuski, a cardiologist at the Cleveland Clinic in Ohio. What patients may not know is that many smoking cessation programs “stress comfort” instead of dire warnings, says Patricia Folan, director of the Center for Tobacco Control at North Shore University Hospital in Long Island, N.Y. “We don’t ask people to quit. We pre-

pare them to quit. We talk about medications and products than can help keep them comfortable.” Some prefer to quit cold turkey, without the use of nicotine replacement therapies. Here, heart patients who have successfully quit smoking share their experiences – their methods, their challenges and the outcomes that make it all worthwhile. H e a lt hy Living Spring 2014

Mariano Zermeno, 56, Chicago The doctor said, ‘You have a big problem. Your blood pressure is very high.’ He told me, ‘You have to stop – the problem you have is from smoking.’ I smoked for 35 years and had never tried to quit. But after open-heart surgery, God gave me a second chance and I had to take it. I just said, ‘No more cigarettes’ and that was all. I should have quit smoking years ago and probably could have avoided all these problems. I still pay the price – medicine and needles and

all that stuff for the rest of my life. But it leaves me no time to think about cigarettes. I have more energy and can ride a bike for two or three hours. Before, I could not do these things. I can also taste all the different flavors in all the foods. When I see someone who smokes, I show them my scar. Maybe they won’t need to go through what I did. Not everyone is lucky like me and gets a second chance. Mariano Zermeno is featured in CDC’s “Tips From Former Smokers” campaign

Tommy Piver, 61, Naples, Fla. I’d already lost a kidney to cancer, but my initial motivation to quit was financial. My insurance rates as a smoker were sky-high. I didn’t quit in time for my heart. In 2012 I had a quadruple bypass. The surgeon said my lungs were still pretty black. But I believe quitting did save my life. Now, at 61, I’m much healthier physically than I was at 51. My quit day was January first, 2010. I’m one of those rare New Year’s resolution quitters who made it. The first 30 days you can really run on motivation – you can rah-rah yourself through. The next one hundred days are the no-man’s land where most ‘quits’ are lost. You need support from people who’ve been there. People who have never smoked – they want you to be successful, but their support wanes after the first month and they expect you to be over it. On the eighth day of my quit, I saw a commercial for the website (BecomeAnEx.org), and I was skeptical. I actually went on the site to fight with them. Through the site, I have lifelong friends that I’ve never laid eyes on. And I’ve learned ‘collateral kindness’ – helping myself by helping others.

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Get Smarter, Think Fast

for Stroke Awareness By Lisa Iannucci

ccording to American Heart Association statistics, every 45 seconds, someone in the U.S. has a stroke, and 1 out of 18 people will die from it. It’s a startling fact, but the good news is that the National Stroke Association says that 80 percent of strokes can be prevented.

A stroke occurs when a blood clot blocks an artery or a blood vessel breaks (called an aneurysm), interrupting blood flow to an area of your brain. When either of these things happens, brain cells begin to die and brain damage occurs. “Most common strokes are from a hemorrhage or aneurysm,” says Dr. Elliott M. Badder, vascular surgeon at Mercy Medical Center in Baltimore.

To prevent a stroke, it’s vital to get your risk factors under control and, if you’re over 55, consider being screened for Carotid Artery Disease.

“Then there are poor circulation strokes, which are more of a limited area of loss and mini strokes, or transient ischemic attacks (TIAs).” Anyone can have a stroke but a person’s risk increases with certain risk factors such as hypertension, high cholesterol and diabetes, all which worsen with age. Risk also increases if you are a smoker, are overweight and aren’t physically active. “Risk factors like high blood pressure, cholesterol and diabetes don’t hurt and my stroke patients in the ER thought they were healthy and wonder why it’s happening to them, but they aren’t healthy,” says Dr. Randall Wright, medical director of the Stroke Recovery Care Unit, Health South Rehabilitation Hospital in The Woodlands, Texas. Stroke symptoms can be confused for other conditions, such as multiple sclerosis, other neurological problems and even a tumor, which can delay someone from going to the hospital quickly. To prevent a stroke, it’s vital to get your risk factors under control and, if you’re over 55, consider being screened for hardening of the arteries, or Carotid Artery Disease (CAD), especially if you H e a lt hy Living Spring 2014

already have heart disease. Otherwise known as the silent disease, because it shows no warning signs and the first symptom may be a stroke, CAD is a narrowing of the neck arteries that blocks blood flow to the brain. “Plaque formation forms in the blood vessels that lead to the brain,” explains Dr. Michael H. Yen, who practices cardiology at Vassar Brothers Medical Center in Poughkeepsie, N.Y. To determine if your arteries are narrowing, doctors will place a stethoscope over your neck’s carotid artery and listen for a lack of blood flow, or a bruit. If they find one, further tests are performed and, depending on the severity of the blockage, you’ll either be monitored or undergo surgery. According to the Society of Vascular Surgery, only 1 percent of adults age 50 to 59 have significantly narrowed carotid arteries, but it increases with age, with men having a higher risk of CAD before age 75 and women having a higher risk after age 75. If you think you’re suffering from a stroke think FAST, which stands for Face, Arm, Slurred Speech and Time. “If you ignore your symptoms you’ve already lost valuable time for us to get a clot-busting drug in your system,” Wright says.

Stroke Warning Signs (via National Stroke Association)

• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body. • Sudden confusion, trouble speaking or understanding. • Sudden trouble seeing in one or both eyes. • Sudden trouble walking, dizziness, loss of balance or coordination. • Sudden, severe headache with no known cause. For more information visit: • National Stroke Association: www.stroke.org • American Stroke Association: www.strokeassociation.org • Dr. Wright: www.thewrightchoicerx.com

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Out From page 17 Roosevelt Smith, 53, Norfolk, Va. My heart attack played a big part but it wasn’t the deciding factor. What did it was my family and their response to me after having surgery. I slowly, slowly, slowly got back to smoking even after a total of seven heart attacks and bypass surgery at age 45. I remember almost forcing myself to do it even though it was painful, and even though the surgeon told me he felt like he was wasting his time on me because I’d last less than two years if I continued to smoke. It was like something was missing and I needed to get that something back, no matter the cost. What has smoking cost me? My livelihood as a commercial plumber – I can no longer do it. I wound up losing my home, which put a strain on the marriage and cost me that, too. I don’t want to put it all on cigarettes because there were other factors. When I quit for good, I went cold turkey. But by that point, I had reduced the amount I was smoking to two to three cigarettes a day. By degrees, I have started to feel better. And I’m happy to say I outlived that doctor’s prediction. – Roosevelt Smithis featured in the CDC’s “Tips From Former Smokers” campaign

Marc Lawrence, 51, Long Island, N.Y. That morning, I got up and had a cup of coffee, and I couldn’t get through my second cup. I had a dull pain in my chest. As the day wore on, I continued to smoke throughout the whole episode – through the shoulder pain and the numbness in my left arm. However, I did not take cigarettes when I packed my bag to go to the hospital – I knew by then I was having a heart attack. I had a blockage in my right coronary artery and needed a stent. A nurse told me in a very nonthreatening, nonjudgmental manner about the hospital’s smoking cessation program (North Shore-LIJ Health System’s Center for Tobacco Control). It’s free, and they give you free products. I used the patch mainly, but it was the support group that helped the most. I continue to go now almost as kind of a ‘pay it forward’ to help others along. What I learned from my group and my experience is you have to want to quit – for yourself. Three months before my heart attack, my mother died of lung cancer and still I smoked. When I decided to quit, I had 25 cartons of cigarettes in my apartment and I gave them all to my siblings. But I kept one pack of cigarettes on the coffee table. If I wanted to smoke, I could – they were right there. But I chose not to. It reinforced that it was my decision to quit and stay quit. One year later, I brought them to the center and we had a little ceremony out front and destroyed that last pack of cigarettes.

Ask the Expert: Rip Esselstyn

Love Thy Fruits & Veggies By Rachel Graf The definition of “healthy eating” is constantly evolving. The paleo diet advocates eating meat but no carbohydrates, a vegetarian diet includes carbohydrates but no meat and a Mediterranean diet is a mixture of the two. However, author Rip Esselstyn says the only way to live a truly healthful life is to eat a strictly plant-based diet. Esselstyn, a former firefighter, explains the benefits of a plant-based diet in his most recent book “My Beef with Meat.”

How can eating a plant-based diet benefit heart health specifically? We’re in a bit of a quagmire right now when it comes to the health of this country, and the number one killer of Americans is heart disease. A lot of people think it’s hereditary when the reality is something completely different. Animal products and animal byproducts, as well as processed and refined foods, are the building blocks for plaque in our bodies. Animal products contain an abundance of saturated fat, dietary cholesterol and problematic animal protein; these are

sources that promote inflammation and increase plaque formations in the arteries. What if someone has been eating red meat and dairy products for 50 years? At what point is it too late to switch to a plant-based diet? The good news is it’s never too late to start eating this way. Something like 65 percent of the people who have a heart attack are over the age of 55. Plant-based foods can not only stop but also reverse heart disease by metabolizing away plaque formations. The human body wants to be healthy, and if you take care of it and feed it plants exclusively, the sky is the limit in terms of reversing the disease. By eliminating meat from their diet, do people run the risk of deficiencies in protein and other essential nutrients? They can get everything they need from plants. People need to put the protein myth to rest. You only need somewhere between 5 and 10 percent of your total calories from protein, and it’s impossible not to get that much eating a plant-based diet. As for other nutrients, 11 of the earth’s 13 vitamins come from plants. The two

that don’t are B12 and Vitamin D, which come from soil and the sun respectively. So, B12 is the only supplement that anyone on a plant-based diet should ever need to take. Is there a healthy middle ground for people who are intimidated by the idea of completely eliminating meat and dairy products from their diet? A lot of people don’t know that chicken has the same amount of cholesterol as red meat. Similarly, most fish have more cholesterol than red meat or chicken. Egg yolk has the same amount of cholesterol as two Burger King “Whopper” sandwiches. Taking baby steps is not gonna do it. That’s why I tell people you gotta lose the moderation mentality. Heart disease and obesity laugh and snicker and ridicule moderation. Often, friends or neighbors will invite people to dinner parties. Could you share advice on how to refuse food that is not part of a plant-based diet without seeming rude? It’s so funny that, somehow, by declining animal products and animal byproducts we come across as rude when the reality is we’re being compassionH e a lt hy Living Spring 2014

heart healthy recipe: kale ceviche salad Excerpted from “My Beef With Meat” by Rip Esselstyn (Grand Central Life & Style, 2013) Ingredients: 1 bunch Kale, stripped and chopped 1 large (or 2 small) avocados OR 1/4 cup oil free hummus ½ lemon, juiced ¼ – ½ teaspoon salt ½ teaspoon, red chili flakes ½ red bell pepper, finely chopped 1 small carrot, grated ½ purple onion, diced 11 oz. mandarin oranges (about 3 oranges) Instructions: 1) Throw stripped and chopped Kale leaves in a large bowl with avocado, lemon juice, salt, and red chili flakes 2) Mash and massage the avocado (or hummus) into the Kale with your hands until the avocado is spread evenly -like a dressing- throughout the kale 3) Stir in red bell pepper, carrot, purple onion, and mandarin oranges 4) If you can, let the salad sit for 30 minutes before serving, if not, dive in!

ate toward animals, protecting our own health and doing the number one thing to protect the environment and the climate. So, you should let your friends or family know that this is an experiment and you’d really appreciate their support. It’s also always nice to bring a couple dishes - whether it’s root veggies or salads or tofu. It’s a spread that anyone would love.

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You mentioned that eating a plantbased diet has environmental benefits, in addition to health benefits. Would you explain what these are? Meat production is the number one driver of climate change. It exploits 90 percent more water than plants do. We have a population of over 7 billion people. We have to connect the dots and realize if we want to save the health of the planet, and ourselves, we need to start moving toward an exclusively plant-based diet and we need to do it fast.

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