Beating high blood pressure with food

10 tips for using diet to control blood pressure.

Fiddling with diet to control cholesterol makes perfect sense. After all, some of the cholesterol that ends up in arteries starts out in food. Changing your diet to control blood pressure doesn't seem quite so straightforward. Yet food can have a direct and sometimes dramatic effect on blood pressure.

Salt certainly plays a role. But there is far more to a blood pressure–friendly diet than minimizing salt intake. Fruits, vegetables, low-fat dairy foods, beans, nuts, whole-grain carbohydrates, and unsaturated fats also have healthful effects on blood pressure.

There isn't a single "magic" food in this list. Instead, it's the foundation for an all-around healthful eating strategy that is good for blood pressure and so much more. Rigorous trials show that eating strategies such as the Dietary Approaches to Stop Hypertension (DASH) diet, DASH variants like the OmniHeart diet, and Mediterranean-type diets lower blood pressure in people with hypertension (high blood pressure) and those headed in that direction. They also help prevent some of the feared consequences of high blood pressure.

Why bother?

Hypertension is the ultimate stealth condition. You'd never know you have it without having your blood pressure measured — or until high blood pressure begins to damage vital organs.

Half of the 65 million American adults with high blood pressure don't have it under control. That's worrisome given the insidious consequences of high blood pressure. It is the leading cause of stroke in the United States. It contributes to thousands of heart attacks. It overworks heart muscle, leading to heart failure. It damages the kidneys, erodes sight, interferes with memory, puts a damper on sexual activity, and steals years of life.

Blood pressure categories
	Systolic		Diastolic
Normal (optimal)	<120	and	<80
Prehypertension	120–139	or	80–89
Hypertension	≥140	or	≥90

10 tips

Drugs that lower blood pressure tend to work well. But they don't necessarily attack the cause of the problem. And no matter how safe they are, all drugs have some unwanted or unintended side effects.

A healthful diet is an effective first-line defense for preventing high blood pressure. It is an excellent initial treatment when blood pressure creeps into the unhealthy zone, and a perfect partner for medications. Unfortunately, translating the dietary strategies tested in clinical trials into diets for daily life hasn't been easy.

Drs. Frank M. Sacks and Hanna Campos, of the Department of Nutrition at Harvard School of Public Health, have done just that. In the June 3, 2010, New England Journal of Medicine, they offer evidence-based advice about diet and blood pressure, complete with a weekly shopping list (see below):

• Eat more poultry, fish, nuts, and legumes (beans) and less red meat.

• Choose low-fat or nonfat milk and other dairy products instead of full-fat versions.

• Turn to vegetables and fruits instead of sugary or salty snacks and desserts.

• Select breads, pasta, and other carbohydrate-rich foods that are made from whole grains instead of highly refined white flour.

• Eat fruit instead of drinking fruit juice.

• Use unsaturated fats like olive, canola, soybean, peanut, corn, or safflower oils instead of butter, coconut oil, or palm-kernel oil.

• Rely on fresh or frozen foods instead of canned and processed foods.

• Choose low-sodium foods whenever possible; use herbs, spices, vinegar, and other low-sodium flavorings instead of salt.

• Don't skip meals; try to eat one-third of your calories at breakfast.

• If you need help, record everything that you eat day by day for a week. Have this information reviewed by a dietitian.

Weekly shopping list As an aid for healthier eating, Drs. Frank M. Sacks and Hanna Campos recommend this weekly shopping list.
Type of food	Servings per week	Amount to buy for a week
Leafy salad greens (lettuce, spinach, etc.)	4	1–2 heads or bags
Other greens (kale, chard, etc.)	4	1–2 bunches
Broccoli, cabbage, cauliflower	3	1–2 heads
Tomatoes, carrots, peppers, avocados, eggplant, and other colorful vegetables	15	8–12 items
Celery, green beans, peas	3	½ pound
Fresh fruit (apples, pears, grapes, bananas, peaches, oranges, etc.)	20	15–20 items
Dried fruit (raisins, prunes, dates, etc.)	8	½ pound
Tomato sauce, paste, juice	4	2 jars or cans
Fruit juice	4	1 quart
Fish, shellfish	2	1 pound
Chicken, turkey	2	1 pound
Red meat (limit cold cuts, sausage, other processed meats)	1	¼ pound
Eggs	3	3 large
Dried beans	3	1 pound
Breakfast cereal (preferably whole grain)	2	1½–2 cups
Pasta, rice, grains	3	½ to 1 cup (dry)
Low-fat or skim milk	10	½ gallon
Yogurt	3	3 cups
Cheese	4	¼ pound
Nuts	10	½ pound
Olives	2	¼ to ½ pound
Baked goods (whole-grain bread, rolls, waffles, etc.)	20	1½ pounds
Popcorn, pretzels, chips	3	4 ½ ounces
Chocolate	1	7 ounces
Cooking oils	12	¾ cup
Table fat (olive oil, oil-based spread)	16	cup
Salad dressings and mayonnaise	21	½ cup
Sugars	24	½ cup
Desserts	1	½ cup
Salt	7	2tsp

Source: http://www.health.harvard.edu/newsletters/Harvard_Heart_Letter/2010/October/beating-high-blood-pressure-with-food

Information about the OmniHeart diets

The Optimal Macronutrient Intake Trial for Heart Health (OmniHeart) study compared the effects of three heart-healthy diets, all based on the Dietary Approaches to Stop Hypertension (DASH) diet — one emphasized carbohydrates, another emphasized protein, and the third emphasized unsaturated fat. Although all three lowered blood pressure and improved cholesterol and triglyceride levels, the higher-protein and higher-unsaturated-fat diets worked best.

The general plan for all three diets looked like this:

• Eat 1-2 servings of fruit at every meal and have an extra fruit at breakfast.

• Have 2-3 servings of vegetables at lunch and dinner.

• Create a fruit and nut trail mix for snacks: ¼ cup dried fruit with 1 oz. unsalted nuts.

• Each day have a serving of fat-free or low-fat milk and milk product (milk, yogurt, cheese) at two meals and occasionally at a third meal or snack.

• Use whole grains rather than refined grains as often as possible.

• Select lean versions of meats and remove skin from poultry.

The breakdown of calories and nutrients in the three OmniHeart diets are listed in the table below. You can also download a 7-day menu for the higher-protein diet or for the higher-unsaturated-fat diet.

Food group	Servings per day
	Higher carbohydrate diet	Higher protein diet	Higher unsaturated fat diet
Fruit and juices (½ cup)	6.6	3.8	4.8
Vegetables (½ cup)	4.4	5.4	6.3
Grains, mostly whole grains (1 oz or ½ cup)	5.3	5.0	4.3
Milk and milk products (1 cup)	2.1	2.5	1.9
Legumes, nuts, seeds, other vegetable protein (1 oz meat-equivalents)	1.3	3.0	1.2
Beef, pork, ham (1 oz)	0.9	1.1	1.0
Poultry (1 oz)	1.6	2.6	1.8
Fish (1 oz)	1.1	1.3	1.0
Egg product substitutes (1 oz meat-equivalents)	0.2	1.1	0.1
Desserts and sweets (tsp sugar)	4.6	2.5	1.7
Fats and oils (tsp)	6	3.5	12
Nutrient targets	Percent of daily calories
	Higher carbohydrate diet	Higher protein diet	Higher unsaturated fat diet
Carbohydrates	58	48	48
Total fat	27	27	37
Monounsaturated fat	13	13	21
Protein	15	25	15

Source: http://www.health.harvard.edu/newsletters/Harvard_Heart_Letter/2010/October/information-about-the-omniheart-diets

Sleep and mental health

Once viewed only as symptoms, sleep problems may actually contribute to psychiatric disorders.

Americans are notoriously sleep deprived, but those with psychiatric conditions are even more likely to be yawning or groggy during the day. Chronic sleep problems affect 50% to 80% of patients in a typical psychiatric practice, compared with 10% to 18% of adults in the general U.S. population. Sleep problems are particularly common in patients with anxiety, depression, bipolar disorder, and attention deficit hyperactivity disorder (ADHD).

Traditionally, clinicians treating patients with psychiatric disorders have viewed insomnia and other sleep disorders as symptoms. But studies in both adults and children suggest that sleep problems may raise risk for, and even directly contribute to, the development of some psychiatric disorders. This research has clinical application, because treating a sleep disorder may also help alleviate symptoms of a co-occurring mental health problem.

The brain basis of a mutual relationship between sleep and mental health is not yet completely understood. But neuroimaging and neurochemistry studies suggest that a good night's sleep helps foster both mental and emotional resilience, while chronic sleep disruptions set the stage for negative thinking and emotional vulnerability.

Key points Sleep problems are more likely to affect patients with psychiatric disorders than people in the general population. Sleep problems may increase risk for developing particular mental illnesses, as well as result from such disorders. Treating the sleep disorder may help alleviate symptoms of the mental health problem.

The benefits of sleep

Every 90 minutes, a normal sleeper cycles between two major categories of sleep — although the length of time spent in one or the other changes as sleep progresses.

During "quiet" sleep, a person progresses through four stages of increasingly deep sleep. Body temperature drops, muscles relax, and heart rate and breathing slow. The deepest stage of quiet sleep produces physiological changes that help boost immune system functioning.

The other sleep category, REM (rapid eye movement) sleep, is the period when people dream. Body temperature, blood pressure, heart rate, and breathing increase to levels measured when people are awake. Studies report that REM sleep enhances learning and memory, and contributes to emotional health — in complex ways.

Although scientists are still trying to tease apart all the mechanisms, they've discovered that sleep disruption — which affects levels of neurotransmitters and stress hormones, among other things — wreaks havoc in the brain, impairing thinking and emotional regulation. In this way, insomnia may amplify the effects of psychiatric disorders, and vice versa.

Sleep disorders in psychiatric patients

More than 70 types of sleep disorders exist. The most common problems are insomnia (difficulty falling or staying asleep), obstructive sleep apnea (disordered breathing that causes multiple awakenings), various movement syndromes (unpleasant sensations that prompt night fidgeting), and narcolepsy (extreme sleepiness or falling asleep suddenly during the day).

Type of sleep disorder, prevalence, and impact vary by psychiatric diagnosis. But the overlap between sleep disorders and various psychiatric problems is so great that researchers have long suspected both types of problems may have common biological roots.

Depression. Studies using different methods and populations estimate that 65% to 90% of adult patients with major depression, and about 90% of children with this disorder, experience some kind of sleep problem. Most patients with depression have insomnia, but about one in five suffer from obstructive sleep apnea.

Sleep problems also increase the risk of developing depression. A longitudinal study of about 1,000 adults ages 21 to 30 enrolled in a Michigan health maintenance organization found that, compared with normal sleepers, those who reported a history of insomnia during an interview in 1989 were four times as likely to develop major depression by the time of a second interview three years later. And two longitudinal studies in young people — one involving 300 pairs of young twins, and another including 1,014 teenagers — found that sleep problems developed before major depression did.

Sleep problems affect outcomes for patients with depression. Studies report that depressed patients who continue to experience insomnia are less likely to respond to treatment than those without sleep problems. Even patients whose mood improves with antidepressant therapy are more at risk for a relapse of depression later on. Depressed patients who experience sleep disturbances are more likely to think about suicide and die by suicide than depressed patients who are able to sleep normally.

Bipolar disorder. Studies in different populations report that 69% to 99% of patients experience insomnia or report less need for sleep during a manic episode of bipolar disorder. In bipolar depression, however, studies report that 23% to 78% of patients sleep excessively (hypersomnia), while others may experience insomnia or restless sleep.

Longitudinal studies suggest that insomnia and other sleep problems worsen before an episode of mania or bipolar depression, and lack of sleep can trigger mania. Sleep problems also adversely affect mood and contribute to relapse.

Anxiety disorders. Sleep problems affect more than 50% of adult patients with generalized anxiety disorder, are common in those with post-traumatic stress disorder (PTSD), and may occur in panic disorder, obsessive-compulsive disorder, and phobias. They are also common in children and adolescents. One sleep laboratory study found that youngsters with an anxiety disorder took longer to fall asleep, and slept less deeply, when compared with a control group of healthy children.

Insomnia may also be a risk factor for developing an anxiety disorder, but not as much as it is for major depression. In the longitudinal study of teenagers mentioned earlier, for example, sleep problems preceded anxiety disorders 27% of the time, while they preceded depression 69% of the time.

But insomnia can worsen the symptoms of anxiety disorders or prevent recovery. Sleep disruptions in PTSD, for example, may contribute to a retention of negative emotional memories and prevent patients from benefiting from fear-extinguishing therapies.

ADHD. Various sleep problems affect 25% to 50% of children with ADHD. Typical problems include difficulty falling asleep, shorter sleep duration, and restless slumber. The symptoms of ADHD and sleeping difficulties overlap so much it may be difficult to tease them apart. Sleep-disordered breathing affects up to 25% of children with ADHD, and restless legs syndrome or periodic limb movement disorder, which also disrupt sleep, combined affect up to 36%. And children with these sleeping disorders may become hyperactive, inattentive, and emotionally unstable — even when they do not meet the diagnostic criteria for ADHD.

Lifestyle and behavioral interventions

In some respects, the treatment recommended for the most common sleep problem, insomnia, is the same for all patients, regardless of whether they also suffer from psychiatric disorders. The fundamentals are a combination of lifestyle changes, behavioral strategies, psychotherapy, and drugs if necessary.

Lifestyle changes. Most people know that caffeine contributes to sleeplessness, but so can alcohol and nicotine. Alcohol initially depresses the nervous system, which helps some people fall asleep, but the effects wear off in a few hours and people wake up. Nicotine is a stimulant, which speeds heart rate and thinking. Giving up these substances is best, but avoiding them before bedtime is another option.

Physical activity. Regular aerobic activity helps people fall asleep faster, spend more time in deep sleep, and awaken less often during the night.

Sleep hygiene. Many experts believe that people learn insomnia, and can learn how to sleep better. Good "sleep hygiene" is the term often used to include tips like maintaining a regular sleep-and-wake schedule, using the bedroom only for sleeping or sex, and keeping the bedroom dark and free of distractions like the computer or television. Some experts also recommend sleep retraining: staying awake longer in order to ensure sleep is more restful.

Relaxation techniques. Meditation, guided imagery, deep breathing exercises, and progressive muscle relaxation (alternately tensing and releasing muscles) can counter anxiety and racing thoughts.

Cognitive behavioral therapy. Because people with insomnia tend to become preoccupied with not falling asleep, cognitive behavioral techniques help them to change negative expectations and try to build more confidence that they can have a good night's sleep. These techniques can also help to change the "blame game" of attributing every personal problem during the day on lack of sleep.

Medication options

If such nondrug interventions are not enough, an additional option is medication. A variety of medications are available to treat sleep problems. In some cases, both a sleep disorder and a psychiatric problem can be treated with one drug.

Depression. Although selective serotonin reuptake inhibitors (SSRIs) are a mainstay of treatment for depression, some may cause or worsen insomnia. Alternatives without this side effect include serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, and mirtazapine (Remeron).

Something else to be aware of: an insomnia drug that works at melatonin receptors, ramelteon (Rozerem), may exacerbate depression.

It may be possible to combine antidepressant therapy with a sleeping medication. One placebo-controlled study of 545 patients with depression found that combining eszopiclone (Lunesta) and fluoxetine (Prozac) improved both mood and sleep. Another study found that treating insomnia with zolpidem (Ambien), after successful SSRI treatment, improved sleep and daytime functioning.

Bipolar disorder. Researchers have not done much testing of sleep aids in patients with bipolar disorder. The agents most often prescribed for insomnia in bipolar patients are the newer benzodiazepine-like drugs, such as eszopiclone, zaleplon (Sonata), and zolpidem. Two anticonvulsants, gabapentin (Neurontin) and tiagabine (Gabitril), might also treat insomnia in patients with bipolar disorder. Tricyclic antidepressants, though often prescribed to alleviate sleep problems because they are sedating, can trigger mania in patients with bipolar disorder. Likewise, antipsychotics may worsen sleep-related movement disorders in this population.

Anxiety disorders. Benzodiazepines such as alprazolam (Xanax) and temazepam (Restoril) not only help treat insomnia but also are used to treat anxiety, so these are options to consider when a patient suffers from both disorders. Case reports indicate that pregabalin (Lyrica), a fibromyalgia drug, and the anticonvulsant tiagabine might also help treat insomnia in generalized anxiety disorder.

ADHD. Stimulants such as methylphenidate (Ritalin) are often prescribed to treat children with ADHD, but can cause insomnia. Taking stimulants only early in the day or using a time-release formulation may help.

Cho HJ, et al. "Sleep Disturbance and Depression Recurrence in Community-Dwelling Older Adults: A Prospective Study," American Journal of Psychiatry (Dec. 2008): Vol. 165, No. 12, pp. 1543–50.

Germain A, et al. "Sleep-Specific Mechanisms Underlying Post-traumatic Stress Disorder: Integrative Review and Neurobiological Hypotheses," Sleep Medicine Reviews (June 2008): Vol. 12, No. 3, pp. 185–95.

Gregory AM, et al. "The Direction of Longitudinal Associations Between Sleep Problems and Depression Symptoms: A Study of Twins Aged 8 and 10 Years," Sleep (Feb. 1, 2009): Vol. 32, No. 2, pp. 189–99.

Krystal AD. "Sleep and Psychiatric Disorders: Future Directions," Psychiatric Clinics of North America (Dec. 2006): Vol. 29, No. 4, pp. 1115–30.

Walker MP. "Sleep-Dependent Memory Processing," Harvard Review of Psychiatry (Sept.–Oct. 2008): Vol. 16, No. 5, pp. 287–98.

Source: https://www.health.harvard.edu/newsletters/Harvard_Mental_Health_Letter/2009/July/Sleep-and-mental-health

Getting your vitamins and minerals through diet

The benefits of multivitamins are looking doubtful. Can we do without them?

We all know that vitamin supplements are no substitute for a healthy diet, but nobody's perfect when it comes to healthful eating. It can be particularly challenging to get the nutrients you need if you're dieting or if you avoid animal or dairy products. So, many of us take a daily multivitamin as nutritional insurance. But research suggests that multivitamins may not be all they're cracked up to be. Moreover, many multivitamins contain some micronutrients in amounts in excess of those recommended in the government's Dietary Guidelines for Americans (www.health.gov/dietaryguidelines). In some cases, these levels may result in unsafe intakes.

In February 2009, a study involving 161,808 postmenopausal women in the Women's Health Initiative (WHI) concluded that those who took multivitamins did not have a lower death rate than others and were just as likely to develop cardiovascular disease or cancers of the lung, colon/rectum, breast, and endometrium — the kinds that are most common in women. Granted, WHI participants were healthy to begin with, but these results are consistent with findings from other studies. There's been little or no evidence of protection against cardiovascular disease or cancers from a number of vitamin supplements, including vitamin E, vitamin C, beta carotene, and the B-vitamin trio — B₆, B₁₂, and folic acid. And in 2006, the National Institutes of Health (NIH) said there wasn't enough evidence for a recommendation about taking multivitamins.

Now research suggesting potential harm has been added to the mix. In 2008, a Cochrane Collaboration review found that people in trials who were given supplements of vitamin A, vitamin E, and beta carotene had a higher death rate. And there's some evidence that excess folic acid (the synthetic version of folate, a vitamin found abundantly in vegetables, fruits, and grains) may be contributing to an uptick in colorectal cancer. Multi vitamins contain the recommended daily amount — 400 micrograms (mcg) — but folic acid is also added to breakfast cereals and enriched grain and cereal products, including breads, rice, and pasta. A person taking a multivitamin can easily exceed the recommended total intake, and maybe even the safe upper limit of 1,000 mcg. (Excess isn't a problem with folate found naturally in foods.)

These findings raise questions about the use of multivitamins as a safety net. Experts agree that the best way to get the nutrients we need is through food. A balanced diet — one containing plenty of fruits, vegetables, and whole grains — offers a mix of vitamins, minerals, and other nutrients (some yet to be identified) that collectively meet the body's needs. Maybe what counts is the synergistic interactions of these nutrients — which might also help explain why trials of single nutrients often don't pan out.

But many of us doubt whether we can get all the nutrients we need from food alone. For one thing, the "percent daily values" featured on food labels are based on a 2,000-calories-a-day diet. Many of us can't eat that much without gaining weight. What if your energy needs are closer to 1,500 calories a day? What if you're dieting? Can you eat enough to take in the recommended micronutrients without falling back on a multivitamin? To find out, we consulted two nutrition experts, clinical dietitian Ellen di Bonaventura, R.D., at Massachusetts General Hospital in Boston, and Helen Delichatsios, M.D., nutrition educator at Harvard Medical School and Massachusetts General Hospital. Dr. Delichatsios is also on the editorial board of the Harvard Women's Health Watch.

Some nutrient-dense foods*

• Avocados

• Chard, collard greens, kale, mustard greens, spinach

• Bell peppers

• Brussels sprouts

• Mushrooms (crimini and shiitake)

• Baked potatoes

• Sweet potatoes

• Cantaloupe, papaya, raspberries, strawberries

• Low-fat yogurt

• Eggs

• Seeds (flax, pumpkin, sesame, and sunflower)

• Dried beans (garbanzo, kidney, navy, pinto)

• Lentils, peas

• Almonds, cashews, peanuts

• Barley, oats, quinoa, brown rice

• Salmon, halibut, cod, scallops, shrimp, tuna

• Lean beef, lamb, venison

• Chicken, turkey

*Foods that have a lot of nutrients relative to the number of calories.

Careful planning and extra D

Both di Bonaventura and Dr. Delichatsios say that a woman can meet her nutrient needs through food alone even if she eats 1,500 calories (or less) per day. "It's not an issue of food quantity but rather food quality. Even a low-calorie diet can have the needed vitamins and minerals," says Dr. Delichatsios. The only exception is vitamin D. Most experts now recommend a daily intake of 1,000 international units (IU), an amount that's difficult to get through foods or sun exposure (unless you live in the lower half of the United States and spend time outdoors). So plan to take a vitamin D supplement.

Getting the rest of your micronutrients through diet requires planning, patience, and knowledge about the foods that will help you meet your daily requirements. Such nutrient-dense foods, as they're called, are packed with vitamins and minerals and have relatively few calories. (See examples above.)

Nutrient-dense foods are the foundation of the sample menu (see box below) that di Bonaventura devised at our request to meet the daily vitamin and mineral needs of a healthy postmenopausal woman consuming 1,500 calories or less a day. "You'd probably eat more salmon on this diet than most people. You'd have an occasional egg, because that's the easiest way to get a lot of vitamins for a low number of calories," says di Bonaventura. Our menu covers all the bases at about 1,200 calories. This leaves some discretionary calories for additional nutrient-dense foods and a treat — say, a piece of chocolate, a dish of sorbet, or a glass of wine. Notice that the menu provides more than 1,200 mg of calcium, the amount recommended for women over age 50 — thanks to the calcium in nutrient-dense foods such as nonfat dairy products and bok choy (Chinese cabbage).

1,200-calorie sample menu that meets the daily DRIs* for a woman 51 to 70 years of age

Breakfast 8 oz nonfat yogurt ½ cup sliced papaya ½ cup sliced kiwi 1 oz (14 halves) walnuts 4 oz skim milk

Lunch 1 small whole-wheat pita Green salad: 1 cup dark green lettuce 1 red or orange pepper 1 cup grape tomatoes ½ cup edamame beans 1 tbsp. unsalted sunflower seeds. Salad dressing made with 1 tbsp. olive oil, balsamic vinegar, and pepper

Dinner 4 oz broiled wild salmon and yogurt sauce (1 tbsp. Greek-style nonfat yogurt, 1 tsp. lemon juice, 1 clove chopped garlic) ¼ cup cooked barley and ¼ cup cooked lentils with spices to taste 1 cup steamed baby bok choy * Dietary reference intakes.

Menu provides 1,155 calories: 33% of calories from fat, 40% from carbohydrate, and 27% from protein

Vitamins and minerals and their amounts in the sample menu, above (DRIs are listed in parentheses) Vitamin A, 1,031 mcg (700 mcg) Vitamin C, 383 mg (75 mg) Vitamin D, 12 mcg (10 mcg) Vitamin E, 11 mg (15 mg) Vitamin K, 156 mcg (90 mcg) Thiamin, 1.3 mg (1.1 mg) Riboflavin, 1.8 mg (1.1 mg) Niacin, 14 mg (14 mg) Vitamin B6, 2.23 mg (1.5 mg) Folate, 556 mcg (400 mcg) Vitamin B12, 10.6 mcg (2.4 mcg) Pantothenic acid, 5.5 mg (5 mg) Calcium, 1,222 mg (1,200 mg) Copper, 900 mcg (1,156 mcg) Iron, 11 mg (8 mg) Magnesium, 355 mg (320 mg) Manganese, 2.8 mg (1.8 mg) Phosphorus, 1,530 mg (700 mg) Selenium, 90 mcg (55 mcg) Zinc, 8.6 mg (8 mg) Potassium, 4.7 g (4.7 g)

Note: Biotin, choline, and chromium are not precisely measured in foods and thus not included in our analysis. Source: Ellen di Bonaventura, R.D., clinical dietician, Massachusetts General Hospital, Boston, MA.

What you can do

One way to set up a plan that precisely meets your nutritional needs is to work with a registered dietitian, who can take into account your food preferences and allergies or other health issues (such as lactose intolerance). Many dietitians have access to computer programs and databases that ease the most difficult calculations, such as nutrient analyses of menus. You can ask your clinician for a referral (check to see if your insurance covers the cost of nutritional counseling), or ask at a local hospital or medical center. But if you have the time and the inclination to do the work yourself, there are free tools and calculators on the Web that can help. Here are some questions you'll need to ask and some of the Web sites where you can find the answers:

How much of what vitamins and minerals do I need? Most healthy postmenopausal women ages 51 to 70 require the same amounts of vitamins and minerals. The government's nutrient recommendations are called dietary reference intakes (DRIs); these replace the old RDAs, or Recommended Dietary Allowances. The quantities listed on the label of a multivitamin bottle may be more than you need, so don't use them for guidance. Instead, consult the DRI tables found at www.iom.edu/Object.File/Master/21/372/0.pdf. Or use the "daily nutrition calculator" at www.ahealthyme.com/topic/rdacalc.

How many calories do I need? It depends on your age, height, weight, and activity level. You can calculate the number of calories you need per day at several Web sites, including these: www.caloriecontrol.org/healthy_calculators.html, www.calorieking.com/tools, and www.bmi-calculator.net/bmr-calculator. (The last of these Web sites takes a two-step approach, first calculating your basal metabolic rate — the number of calories you'd need if you did nothing but rest — then linking you to a second page that takes your activity level into account.)

What do I eat? For a list of nutrient-dense foods you can incorporate into your meal plan, go to www.whfoods.com/foodstoc.php. To look up the nutrient and calorie content of specific foods — or to find out which foods contain specific nutrients — go to the U.S. Department of Agriculture (USDA) National Nutrient Database for Standard Reference, www.nal.usda.gov/fnic/foodcomp/search. Another good source of information on specific foods (including brand-name and fast-food items) is Calorie King, www.calorieking.com. To get an idea of how much you'll need daily from each of the basic food groups, see the chart below.

Daily amounts of basic food groups meeting recommended nutrient intakes at four different calorie levels
Calorie level	1,200	1,400	1,600	1,800
Fruits+	1 cup	1.5 cups	1.5 cups	1.5 cups
Vegetables+	1.5 cups	1.5 cups	2 cups	2.5 cups
Grains	4 ounce equivalents*	5 ounce equivalents	5 ounce equivalents	6 ounce equivalents
Lean meat and beans	3 ounce equivalents**	4 ounce equivalents	5 ounce equivalents	5 ounce equivalents
Dairy (choose fat-free or low-fat)	2 cups***	2 cups	3 cups	3 cups
Oils	17 g	17 g	22 g	24 g
Discretionary calories	171	171	132	195
+Choose a wide variety of colorful fruits and vegetables. *1 ounce equivalent = ½ cup cooked rice, pasta, or cooked cereal; 1 ounce dry pasta or rice; 1 slice bread; 1 small muffin; 1 cup ready-to-eat cereal flakes. **1 ounce equivalent = 1 ounce of lean meat, poultry, or fish; 1 egg; ¼ cup cooked dry beans or tofu; 1 tablespoon peanut butter; ½ ounce nuts or seeds. ***1 cup = 1 cup milk or yogurt; 1.5 ounces natural cheese or 2 ounces processed cheese. Source: USDA Food Guide, Appendix A-2, Dietary Guidelines for Americans, 2005, www.health.gov/dietaryguidelines.

How do I know if my diet provides what I need? You can track your daily intake and have it analyzed at the USDA's My Pyramid Tracker, www.mypyramidtracker.gov. (This program is free, but you'll need to register first.) Entering everything you eat can be cumbersome, but if you try it for just a few days, you'll learn a lot about food quality and how to get the best nutritional return on the calories you consume. All in all, if you avoid saturated and trans fat, take a daily 1,000 IU vitamin D supplement, and eat a balanced diet — one that contains a variety of colorful fruits and vegetables, whole grains, legumes, and nonfat diary products — you probably don't need a multivitamin on your plate.

Source: https://www.health.harvard.edu/newsletters/Harvard_Womens_Health_Watch/2009/July/Getting-your-vitamins-and-minerals-through-diet

Coffee Health Benefits : Coffee may protect against disease

It’s surprising when something that was once considered questionable for your health turns out to have health benefits, usually with the proviso to use it “in moderation.” That happened with chocolate and alcohol, and now it is coffee’s turn, reports the February issue of the Harvard Health Letter. Here’s some of the mostly good news about coffee:

Blood pressure. Results from long-term studies are showing that coffee may not increase the risk for high blood pressure over time, as previously thought. Study findings for other cardiovascular effects are a mixed bag.

Cancer. Coffee might have anti-cancer properties. Last year, researchers found that coffee drinkers were 50% less likely to get liver cancer than nondrinkers. A few studies have found ties to lower rates of colon, breast, and rectal cancers.

Cholesterol. Two substances in coffee — kahweol and cafestol — raise cholesterol levels. Paper filters capture these substances, but that doesn’t help the many people who now drink non-filtered coffee drinks, such as lattes. Researchers have also found a link between cholesterol increases and decaffeinated coffee, possibly because of the type of bean used to make certain decaffeinated coffees.

Diabetes. Heavy coffee drinkers may be half as likely to get diabetes as light drinkers or nondrinkers. Coffee may contain chemicals that lower blood sugar. A coffee habit may also increase your resting metabolism rate, which could help keep diabetes at bay.

Parkinson’s disease. Coffee seems to protect men, but not women, against Parkinson’s disease. One possible explanation for the sex difference may be that estrogen and caffeine need the same enzymes to be metabolized, and estrogen captures those enzymes.

Source: https://www.health.harvard.edu/press_releases/coffee_health_benefits

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5 tips to increase HDL cholesterol

Thanks to powerful cholesterol-lowering statin drugs, driving down low-density lipoprotein (LDL), or “bad” cholesterol, has been the primary approach to improving cholesterol levels. But there’s more to the story of cholesterol and cardiovascular risk than LDL alone. Another key player is high-density lipoprotein (HDL), the “good” cholesterol. Higher levels of HDL are associated with lower cardiovascular risk. The good news about this good cholesterol is that simple lifestyle changes can help boost HDL, reports the June 2008 issue of Harvard Women’s Health Watch.

HDL removes LDL from artery walls and ferries it to the liver for processing or removal. HDL also fights potentially dangerous inflammation and clot formation. According to a recent review of research on HDL, there’s some evidence that increasing HDL can reduce the risk of heart attack and stroke—even without changes in LDL.

Harvard Women’s Health Watch suggests several things people can do to nudge up HDL levels. Most of these strategies also improve health in other ways.

1. Get aerobic exercise. Moderate to vigorous aerobic exercise can boost HDL by 5% to 10%. Aim for five 30-minute sessions per week.
2. Lose weight if you need to. If you’re overweight or obese, you can boost your HDL level by about 1 mg/dL for every seven pounds lost, although any amount of weight loss will help.
3. If you smoke, quit. HDL levels rise by as much as 15% to 20% after you quit.
4. Eat a healthy diet. Avoid trans fats, which increase bad cholesterol and decrease good cholesterol. Avoid highly refined carbohydrates, such as white-flour products.
5. Consider medications. Niacin, available over the counter, is the most effective HDL-raising medication available. Niacin can be strong medicine — work with your clinician if you want to try it.

Source: https://www.health.harvard.edu/press_releases/5-tips-to-increase-HDL-cholesterol

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High calcium intake may not help prevent fractures

For years, getting a lot of calcium has been portrayed as one of the best things you could do to prevent osteoporosis and related bone fractures. Small study results supported this view. But when researchers started to crunch the data from large, prospective studies that followed people for many years, the benefits weren’t so clear-cut, reports the March 2008 issue of the Harvard Health Letter.

The ambiguity led to trials to test what effect calcium might have on fracture rates. Two studies showed that calcium didn’t prevent fractures—even when taken in combination with vitamin D. Another study showed that postmenopausal women who took a calcium-vitamin D combination were no less likely to break their hip than women who took a placebo pill. And other researchers reported the results from a meta-analysis of studies on calcium that found no connection between high calcium intake and lower hip fracture risk.

While a certain level of calcium intake is undoubtedly important to keeping bones strong, amounts above that level might not do much good, notes the Harvard Health Letter. One reason some of these studies on supplements may not have shown a benefit is because the study participants were already getting over 1,000 milligrams (mg) of calcium daily through diet.

The bottom line: According to current recommendations, Americans over 50 are supposed to get 1,200 mg of calcium daily, but 600 mg is probably enough for most people to keep their fracture risk low. Still, because extra calcium might be protective against colon cancer, a daily intake of 600 to 1,000 mg is a reasonable goal.

Source: https://www.health.harvard.edu/press_releases/calcium-intake-and-fractures

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