HEALTH MATTERS: How to manage your diet
Q. I try to follow a healthy lifestyle. I exercise regularly and try to eat smart. But what exactly should -- and shouldn't -- I eat? A. One of the most obvious suggestions is to watch your caloric intake. I've discussed the problem of obesity be...
Q. I try to follow a healthy lifestyle. I exercise regularly and try to eat smart. But what exactly should - and shouldn't - I eat? A. One of the most obvious suggestions is to watch your caloric intake. I've discussed the problem of obesity before, and part of the problem relates to consuming more calories than we need - those extra calories are quickly deposited around our bodies, usually in undesirable locations. It's important to understand most people can't exercise off those extra calories, so simply exercising more is not the answer - eating less is. But beyond watching your calories, here are some other suggestions that are contained in the latest edition of the "Dietary Guidelines for Americans:"
• Limit calories from added sugars in your diet to less than 10 percent of your total calories per day.
• Limit saturated fats to less than 10 percent of daily calories and replace them with polyunsaturated fats.
• Limit consumption of dietary cholesterol and sodium.
• If you are of legal age and consume alcohol, do it in moderation - no more than one drink per day for women and two for men.
• Include a variety of various vegetables, fruits, grains (especially whole grains), protein foods and oils in your diet.
Q. I think I'm healthy but I have a bad family history for heart problems. Should I have one of those X-ray tests to see if I have any blockages in my heart arteries? A. Perhaps the most common test that is used for screening for coronary disease without symptoms is known as the coronary artery calcium score. The coronary arteries are the blood vessels that not only feed the heart but also are the ones that cause heart attacks when they become clogged with cholesterol deposits. The CACS is a measurement of how much calcium is detected in the walls of each of the three major coronary arteries using a computed tomographic X-ray scan. If no calcium is detected, it's unlikely that the person has significant blockages, especially an older patient. But if calcium is detected, it is more likely that the person has some disease in one or more of their coronary arteries, especially if a lot of calcium (that is, a high CACS) is detected. The biggest problem is even if we identify someone with an abnormal CACS, there is no good evidence that treating the person, especially with stents or bypass surgery, lowers the subsequent risk of a heart attack or death. So when might a CACS be useful?
• When the doctor and patient are uncertain if a cholesterol-lowering medicine (a statin medication like Lipitor or Zocor) should be used.
• When a patient has a worrisome family history of coronary disease.
• When a patient has chest pain or other symptoms suggestive of coronary disease but otherwise is at low risk of having any blockages.
And who in general should not have a CACS test done?
• A patient who has known coronary disease.
• A patient already taking a statin.
• A person with no symptoms who is curious if coronary disease is present.
Wynne is vice president for health affairs at UND, dean of the School of Medicine and Health Sciences and a professor of medicine. He is a cardiologist by training.
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