DASH diet – what is it?

The DASH (Dietary Approaches to Stop Hypertension) eating plan is a diet rich in fruits, vegetables, low fat or nonfat dairy. It also includes whole grains; lean meats, fish and poultry; nuts and beans. It is high fiber and low to moderate in fat. It is a plan that follows US guidelines for sodium content, along with vitamins and minerals. In addition to lowering blood pressure, the DASH eating plan lowers cholesterol and makes it easy to lose weight. It is a healthy way of eating, designed to be flexible enough to meet the lifestyle and food preferences of most people. It can be considered to be an Americanized version of the Mediterranean diet.  Endorsed by the federal government’s Department of Health and Human Services, the diet is packed with produce and light on saturated fat and salt.

The DASH diet rules to follow are:

  • Eat more fruits, vegetables, and low-fat dairy foods
  • Cut back on foods that are high in saturated fat, cholesterol, and trans fats
  • Eat more whole-grain foods, fish, poultry, and nuts
  • Limit sodium, sweets, sugary drinks, and red meats

In research studies, people who were on the DASH diet lowered their blood pressure within 2 weeks.  Over time, systolic blood pressure could drop by eight to 14 points, which can make a significant difference in health risks.

Because the DASH diet is a healthy way of eating, it offers health benefits besides just lowering blood pressure. The DASH diet is also in line with dietary recommendations to prevent osteoporosis, cancer, heart disease, stroke and diabetes.

Here’s a look at the recommended servings from each food group for the 2,000-calorie-a-day DASH diet.

Grains: 6 to 8 servings a day

  • Grains include bread, cereal, rice and pasta. Examples of one serving of grains include 1 slice whole-wheat bread, 1 ounce dry cereal, or 1/2 cup cooked cereal, rice or pasta.
  • Focus on whole grains because they have more fiber and nutrients than do refined grains. For instance, use brown rice instead of white rice, whole-wheat pasta instead of regular pasta and whole-grain bread instead of white bread.
  • Look for products labeled “100 percent whole grain” or “100 percent whole wheat.”
  • Grains are naturally low in fat. Keep them this way by avoiding butter, cream and cheese sauces.

Vegetables: 4 to 5 servings a day

  • Tomatoes, carrots, broccoli, sweet potatoes, greens and other vegetables are full of fiber, vitamins, and such minerals as potassium and magnesium. Examples of one serving include 1 cup raw leafy green vegetables or 1/2 cup cut-up raw or cooked vegetables.
  • Don’t think of vegetables only as side dishes — a hearty blend of vegetables served over brown rice or whole-wheat noodles can serve as the main dish for a meal.
  • Fresh and frozen vegetables are both good choices. When buying frozen and canned vegetables, choose those labeled as low sodium or without added salt.
  • To increase the number of servings you fit in daily, be creative. In a stir-fry, for instance, cut the amount of meat in half and double up on the vegetables.

Fruits: 4 to 5 servings a day

  • Many fruits need little preparation to become a healthy part of a meal or snack. Like vegetables, they’re packed with fiber, potassium and magnesium and are typically low in fat — coconuts are an exception. Examples of one serving include one medium fruit, 1/2 cup fresh, frozen or canned fruit, or 4 ounces of juice.
  • Have a piece of fruit with meals and one as a snack, then round out your day with a dessert of fresh fruits topped with a dollop of low-fat yogurt.
  • Leave on edible peels whenever possible. The peels of apples, pears and most fruits with pits add interesting texture to recipes and contain healthy nutrients and fiber.
  • Remember that citrus fruits and juices, such as grapefruit, can interact with certain medications, so check with your doctor or pharmacist to see if they’re OK for you.
  • If you choose canned fruit or juice, make sure no sugar is added.

Dairy: 2 to 3 servings a day

  • Milk, yogurt, cheese and other dairy products are major sources of calcium, vitamin D and protein. But the key is to make sure that you choose dairy products that are low fat or fat-free because otherwise they can be a major source of fat — and most of it is saturated. Examples of one serving include 1 cup skim or 1 percent milk, 1 cup low fat yogurt, or 1 1/2 ounces part-skim cheese.
  • Low-fat or fat-free frozen yogurt can help you boost the amount of dairy products you eat while offering a sweet treat. Add fruit for a healthy twist.
  • If you have trouble digesting dairy products, choose lactose-free products or consider taking an over-the-counter product that contains the enzyme lactase, which can reduce or prevent the symptoms of lactose intolerance.
  • Go easy on regular and even fat-free cheeses because they are typically high in sodium.

Lean meat, poultry and fish: 6 servings or fewer a day

  • Meat can be a rich source of protein, B vitamins, iron and zinc. Choose lean varieties and aim for no more than 6 ounces a day.
  • Cutting back on your meat portion will allow room for more vegetables.
  • Trim away skin and fat from poultry and meat and then bake, broil, grill or roast instead of frying in fat.
  • Eat heart-healthy fish, such as salmon, herring and tuna. These types of fish are high in omega-3 fatty acids, which can help lower your total cholesterol.

Nuts, seeds and legumes: 4 to 5 servings a week

  • Almonds, sunflower seeds, kidney beans, peas, lentils and other foods in this family are good sources of magnesium, potassium and protein. They’re also full of fiber and phytochemicals, which are plant compounds that may protect against some cancers and cardiovascular disease.
  • Serving sizes are small and are intended to be consumed only a few times a week because these foods are high in calories. Examples of one serving include 1/3 cup nuts, 2 tablespoons seeds, or 1/2 cup cooked beans or peas.
  • Nuts sometimes get a bad rap because of their fat content, but they contain healthy types of fat — monounsaturated fat and omega-3 fatty acids. They’re high in calories, however, so eat them in moderation. Try adding them to stir-fries, salads or cereals.
  • Soybean-based products, such as tofu and tempeh, can be a good alternative to meat because they contain all of the amino acids your body needs to make a complete protein, just like meat.

Fats and oils: 2 to 3 servings a day

  • Fat helps your body absorb essential vitamins and helps your body’s immune system. But too much fat increases your risk of heart disease, diabetes and obesity. The DASH diet strives for a healthy balance by limiting total fat to less than 30 percent of daily calories from fat, with a focus on the healthier monounsaturated fats.
  • Examples of one serving include 1 teaspoon soft margarine, 1 tablespoon mayonnaise or 2 tablespoons salad dressing.
  • Saturated fat and trans fat are the main dietary culprits in increasing your risk of coronary artery disease. DASH helps keep your daily saturated fat to less than 6 percent of your total calories by limiting use of meat, butter, cheese, whole milk, cream and eggs in your diet, along with foods made from lard, solid shortenings, and palm and coconut oils.
  • Avoid trans fat, commonly found in such processed foods as crackers, baked goods and fried items.
  • Read food labels on margarine and salad dressing so that you can choose those that are lowest in saturated fat and free of trans fat.

Sweets: 5 servings or fewer a week

  • You don’t have to banish sweets entirely while following the DASH diet — just go easy on them. Examples of one serving include 1 tablespoon sugar, jelly or jam, 1/2 cup sorbet, or 1 cup lemonade.
  • When you eat sweets, choose those that are fat-free or low-fat, such as sorbets, fruit ices, jelly beans, hard candy, graham crackers or low-fat cookies.
  • Artificial sweeteners such as aspartame (NutraSweet, Equal) and sucralose (Splenda) may help satisfy your sweet tooth while sparing the sugar. But remember that you still must use them sensibly. It’s OK to swap a diet cola for a regular cola, but not in place of a more nutritious beverage such as low-fat milk or even plain water.
  • Cut back on added sugar, which has no nutritional value but can pack on calories.

Remember, healthy eating isn’t an all-or-nothing proposition. What’s most important is that, on average, you eat healthier foods with plenty of variety  – both to keep your diet nutritious and to avoid boredom or extremes. And with the DASH diet, you can have both.

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Know Your ABCDE’s of Skin Cancer

Skin Cancer is the most common form of cancer in the U.S. Each year there are more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung and colon.

Your risk of getting skin cancer is real. One in five Americans will develop skin cancer in the course of a lifetime.

You can prevent and detect skin cancer. Skin cancer is very treatable when caught early.

These are the signs to look for if you are concerned about skin cancer.  Click on image for larger view.

Skin Cancer Detection Chart

ASSYMETRIC
One half unlike the other half.
BORDER
Irregular, scalloped or poorly defined border.
COLOR
Varied from one area to another; shades of tan and brown, black; sometimes white, red or blue.
DIAMETER
While melanomas are usually greater than 6mm (the size of a pencil eraser) when diagnosed, they can be smaller. See ruler below for a guide.
EVOLVING
A mole or skin lesion that looks different from the rest or is changing in size, shape or color.
Checking your skin means taking note of all the spots on your body, from moles to freckles to age spots. Remember, some moles are black, red, or even blue. If you see any kind of change on one of your spots, you should have a dermatologist check it out.  Individuals with a history of melanoma should have a full-body exam at least annually and perform monthly self-exams for new and changing moles.
For more information – http://lsofoundation.org/spot-check/
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Insomnia and Anxiety

Sleeping pills are not always the best solution.

More information on Insomnia

Nearly one third of older people in the U.S. take sleeping pills. These drugs are called “sedative- hypnotics” or “tranquilizers.” They affect the brain and spinal cord.

Doctors prescribe the drugs for sleep problems. The drugs are also used to treat other conditions, such as anxiety or alcohol withdrawal.

Usually older adults should try non-drug treatments first. According to the American Geriatrics Society, there are safer and better ways to improve sleep or reduce anxiety. Here’s why:

Sleeping pills may not help much.

Many ads say that sleeping pills help people get a full, restful night’s sleep. But studies show that this is not exactly true in real life. On average, people who take one of these drugs sleep only a little longer and better than those who don’t take a drug.

Sleeping pills can have serious, or even deadly side effects.

All sedative-hypnotic drugs have special risks for older adults. Seniors are likely to be more sensitive to the drugs’ effects than younger adults.

And these drugs may stay in their bodies longer.

The drugs can cause confusion and memory problems that:

  • More than double the risk of falls and hip fractures. These are common causes of hospitalization and death in older people.
  • Increase the risk of car accidents.

Try non-drug treatments first.

Get a thorough medical exam. Sleep problems can be caused by depression or anxiety, pain, restless leg syndrome, and many other conditions. Even if an exam does not turn up an underlying cause, you should try other solutions before you try drugs.

Sleep Tips for Better Rest

  • Exercise. Physical activity helps people sleep better. But avoid vigorous activity for several hours before bedtime.
  • Keep a routine. Try to go to bed and wake up at about the same time every day, even on weekends.
  • Try not to eat right before bedtime. Eat three hours or more before going to bed.
  • Avoid caffeine after 3 p.m. Some people need to avoid caffeine even earlier.
  • Limit alcohol. Alcohol causes sleepiness at first, followed by wakefulness.
  • Create the right environment. Keep the bedroom peaceful. And avoid mental excitement before bedtime.
  • Avoid bright lights. Watching a bright screen can make you stay awake.
  • Control pets. Pets disrupt sleep if they are on and off the bed, taking up space, or wanting to be let out.
  • If you don’t fall asleep soon, get out of bed and do something that will make you sleepy, such as reading. Return to bed after you start to feel drowsy.

For additional information, visit healthinaging.org.

When to try sedative-hypnotic drugs.

Consider these drugs if the sleep problems are affecting your quality of life and nothing else has helped. But your health-care provider should watch you carefully to make sure that the drug is helping and not causing bad side effects.

More information >

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Nine moves for strength training

Here are the best recommended body weight strength training moves that combine for a complete body workout.  Do each exercise for desired time until you complete the set, take a one minute break and then move on to the next set.

Beginner – 1 minute for each exercise nine minutes
Intermediate – 2 minute for each exercise, eighteen minutes
Advanced – 3 minute for each exercise, twenty seven minutes

SET ONE

  • Body Weight Squat
  • Pushups
  • Mountain Climbers

SET TWO

  • Forearm Plank
  • Bodyweight Split Squat
  • Single Leg Hip Raise

SET THREE

  • Burpee with Pushup
  • Single Leg Toe Touches
  • Leg Raises

See this web page for more information and how-to videos.

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How to identify ticks and avoid tick bites

Tick season in Maine becomes more of a concern each year as tick borne illnesses are on the rise.  Here are some tips on prevention and tick removal.

Prevention

  • Wear light colored clothing to find ticks easily
  • Wear EPA-approved insect repellent on skin or clothing
  • Treat dogs & cats as recommended by your vet
  • Check for ticks daily during the season (April – August), under arms, in and around ears, inside belly button, behind knees, between legs, around waist and on hairline and scalp.
  • Shower soon after being outdoors

Tick Removal

Remove ticks immediately.  Ticks need to attach for 24 hours to transmit Lyme disease.  Consult your family practitioner if you remove an engorged deer tick.

  • Use a tick spoon, apply slight pressure downward on the skin and “frame” the tick in the spoon notch, then continue to slide the spoon to detach the tick.
  • Use tweezers to grasp the tick as close to the skin as possible and gently pull until the tick lets go.

In general, it is not recommended to take antibiotics following a tick bite, instead a person who has experienced a tick bite should be alert for symptoms suggestive of tick borne illness and consult your family practitioner if fever, rash or other symptoms develop.

Deer Tick Identification

Deer Tick Identification

For more information see Tick ID information from Maine Public Health.

 

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Should I take antibiotics before a dental procedure if I’ve had a hip, knee or other joint replacement?

Short Answer:  No.

Long Answer:  There has been a fair amount of recent recommendations to take antibiotics before a dental procedure if you’ve had a joint replacement to prevent a hardware infection.  There have been very few reported cases of joint infection after dental procedures or an association between dental procedures and bacteria causing infections in joints because of  those procedures.  There was a case study done from 1997 – 2006 resulting in no significant association between dental procedures and prosthetic joint infection.  So don’t just take it from us, the American Academy of Oral Medicine, the American Dental Association (ADA) in conjunction with the American Academy of Orthopedic Surgeons (AAOS), and the British Society for Antimicrobial Chemotherapy all advise against universal use of antibiotics prior to dental procedures for prevention of PJI or prosthetic joint infection.

Read more from Up To Date website>>

According to the CDC, overusing antibiotics is the leading cause of antibiotic resistance.  Up to one-third to one-half of antibiotic use in humans is either unnecessary or inappropriate.

Read more from the CDC website >>

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Practitioners at Hope Health Family Practice Encourage ALL Parents to Immunize Their Children

  • Imagine you are the parent of a newborn who is too young for a Pertussis (whooping cough) vaccination.  A group in your community has decided not to immunize and an outbreak of Pertussis occurs and spreads rapidly throughout this group.  Your infant is exposed (the library, grocery store, playground, etc…) and contracts this disease which could potentially be fatal.  This has happened, and does happen, and infants as well as other immunocompromised individuals have died from this disease when it could have been prevented.
  • In 1952 38,000 people contracted polio in America alone, according to the Centers for Disease Control. In 2012 there were fewer than 300 reported cases of polio in the entire world.  With more and more parents choosing not to immunize, this number could begin to rise again.
  • If you do not immunize and have never come face to face with a serious disease that is preventable by vaccine, you can thank the rest of your community for being immunized.  The people who choose to immunize are the people who have kept these diseases from making a comeback in our communities.  Again, with more and more people choosing not to immunize, the risk is becoming greater and greater.
  • Vaccines can eradicate disease and prevent serious illness and death. Mandatory vaccination has eradicated diseases that once killed thousands of children, such as polio and smallpox. According to researchers at the Pediatric Academic Society, childhood vaccinations in the US prevent about 10.5 million cases of infectious illness and 33,000 deaths per year.
  • The study that linked autism to childhood vaccines (specifically the MMR vaccine) was retracted and the study’s author, Dr. Andrew Wakefield, stripped of his medical license due to fraud.  Wakefield has been unable to reproduce his results in the face of criticism, and other researchers have been unable to match them.
  • 75% – 94% of the population (depending on the disease) must be vaccinated to achieve “herd immunity” or “community immunity”.   When herd immunity is achieved the number of immunized individuals is high enough to prevent the spread of disease through the population.  This is important!   In order to continue preventing the spread of serious disease that once killed thousands of people, everyone must participate as a community.

The information below is taken from http://www.vaccines.gov/basics/protection:

Community Immunity (“Herd Immunity”)

Vaccines can prevent outbreaks of disease and save lives.

When a critical portion of a community is immunized against a contagious disease, most members of the community are protected against that disease because there is little opportunity for an outbreak. Even those who are not eligible for certain vaccines—such as infants, pregnant women, or immunocompromised individuals—get some protection because the spread of contagious disease is contained. This is known as “community immunity.”

In the illustration below, the top box depicts a community in which no one is immunized and an outbreak occurs. In the middle box, some of the population is immunized but not enough to confer community immunity. In the bottom box, a critical portion of the population is immunized, protecting most community members.

The principle of community immunity applies to control of a variety of contagious diseases, including influenza, measles, mumps, rotavirus, and pneumococcal disease.

Illustration of Community Immunity (also known as “herd” immunity)

Like any medication, vaccines can cause side effects.  The side effects are almost always mild (such as redness and swelling where the shot was given) and go away within a few days. If your child experiences a reaction at the injection site, you can use a cool, wet cloth to reduce redness, soreness, and swelling.

Serious side effects following vaccination, such as severe allergic reaction, are very rare and doctors and clinic staff are trained to deal with them. Pay extra attention to your child for a few days after vaccination. If you see something that concerns you, call us.

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What Does “Gluten-Free” Really Mean? The New FDA Labeling Standard

Earlier this month the Food and Drug Administration (FDA) announced that food claiming to be “gluten-free” must meet a new stringent standard:  Gluten is a protein found mostly in wheat but also is some other grains.  To comply with the FDA’s new rules, products labeled “gluten-free” must contain less than 20 parts per million of the protein—or about an eighth of a teaspoon of flour in 18 slices of gluten-free bread. That’s low enough for most people who have mild to severe gluten allergies to safely consume the product.  This new labeling standard is the same as the European and Canadian requirements.  Manufactures have until August 5, 2014 to comply with the new standard.

There are a few details of this new labeling requirement that are important to know.

·         This standard applies to dietary supplements claiming to be “gluten-free” as well. 

·         Manufactures using the “gluten-free” claim may not have had their product tested for compliance.  The onus is on the FDA to test products making the “gluten-free” claim.  Some manufactures making the claim may go untested or slip through the cracks.

·         Manufactures can use other wording such as “No Gluten Ingredients” or “No Gluten Added” that would exempt them from the “gluten-free” labeling standard.

·         Alcoholic beverages are not regulated by the FDA.  Therefore they are not part of this labeling requirement.

·         Foods that naturally have no gluten can use this labeling as a way of looking more health conscious.

So, while the new labeling is an improvement, consumers must be knowledgeable about the finer points of this new standard.  If you have celiac disease, or some other reaction to gluten, continue to be careful about your food choices and don’t completely rely on the new labeling requirements.

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Nurse Practitioners: Understanding and accepting all that we do

One of the biggest challenges our practice has is overcoming the perception that Nurse Practitioners can’t provide comprehensive primary care.   The health care culture in this country assumes that only MDs are qualified to provide this kind of care.   However, Nurse Practitioners are qualified and have been providing this kind care for years.   Now, as our health care system is struggling to meet the needs of our communities, Nurse Practitioners are finally being recognized and accepted as providers who are providing excellent comprehensive primary care services to people throughout this nation.

Attached is a great article from the NY Times about MD acceptance of the Nurse Practitioner role.

http://www.newstimes.com/opinion/article/A-greater-role-for-nurse-practitioners-4660232.php

 

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On-line drug interaction websites: Make sure your medicines/remedies are safe to take together.

Attached is a quick article with links to on-line drug interaction sites.  These sites are designed to help you make sure that your prescription medications, over-the-counter remedies and herbs or supplements are safe to take together.  When you read this remember to contact your prescriber or pharmacist if you have any concerns.  Many medications will say there is a risk for interaction but the interactions are dose dependent.  Additionally, many medications should not be stopped abruptly without the guidance of the prescriber.

http://news.consumerreports.org/health/2013/06/where-can-i-look-up-drug-interactions.html?EXTKEY=NB36S00H

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