1. Nutrition and Physical Activity

A Healthy Diet

Why should I try to have a healthy diet?
How can I start planning a healthy diet for me and my family?
What are the most important steps to a healthy diet?
I know a healthy diet means I should control my fat intake, but I'm confused by all the different kinds of fats in foods! How do I know which ones are ok and which ones to avoid?
I'm concerned about heart disease. Is there a special diet to help prevent or control it?
Many diets say to limit my sodium to an amount measured in milligrams per day, but exactly how much salt is that?
It's hard to know if my portions are too big or too small for a healthy diet. Do I have to measure everything I'm eating?
I'm confused by all of the labels I see on foods, like "fat free" and "low calorie." What do these terms mean?
How can I follow a healthy diet if I eat out a lot?

Why should I try to have a healthy diet?

Having a healthy diet is one of the most important things you can do to help your overall health. Along with physical activity, your diet is the key factor that affects your weight. Having a healthy weight for your height is important. Being overweight or obese increases your risk of heart disease, type 2 diabetes, high blood pressure, stroke, breathing problems, arthritis, gallbladder disease, sleep apnea (breathing problems while sleeping), osteoarthritis, and some cancers. You can find out if you're overweight or obese by figuring out your body mass index (BMI). Women with a BMI of 25 to 29.9 are considered overweight, whereas women with a BMI of 30 or more are considered obese. All adults (aged 18 years or older) who have a BMI of 25 or more are considered at risk for premature death and disability from being overweight or obese. These health risks increase as the BMI rises. Your health care provider can help you figure out your body mass, or you can go to www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm..

Having a healthy diet is sometimes easier said than done. It is tempting to eat less healthy foods because they might be easier to get or prepare, or they satisfy a craving. Between family and work or school, you are probably balancing a hundred things at once. Taking time to buy the ingredients for and cooking a healthy meal sometimes falls last on your list. But you should know that it isn't hard to make simple changes to improve your diet. And you can make sense of the mounds of nutrition information out there. A little learning and planning can help you find a diet to fit your lifestyle, and maybe you can have some fun in the process!

How can I start planning a healthy diet for me and my family?

You can start planning a healthy diet by looking at the Dietary Guidelines for Americans (http://www.health.gov/dietaryguidelines) by the U.S. Department of Agriculture (USDA) and the Department of Health and Human Services (HHS). These guidelines contain the Food Guide Pyramid, which shows how different food groups can come together to form your total diet. Eating is one of life's greatest pleasures. Because there are many foods and many ways to build a healthy diet, there is lots of room for smart, healthy choices. But you can use the pyramid as a starting point. Choose the recommended number of daily servings from each of the five major food groups.

Food Guide Pyramid
A Guide to Daily Food Choices

You might have seen some of the other food pyramids by other groups of health care providers, or pyramids for different ethnic groups, like the Puerto Rican, "Soul Food," Vegetarian style, or Latin American style pyramids. You could use any one of them for healthy eating, depending on the foods available to you and your culture's traditions. No matter which diet you choose, be sure to talk with your health care provider first, before starting any type of eating plan. You might want to ask your provider for a referral to a registered dietician (RD) who can help you or go to www.eatright.org for a listing of providers. You might also want to enlist the help of a family member or friend to give you support and help you stay on track. Try to have some fun learning new recipes and different ways to cook!

What are the most important steps to a healthy diet?

Although there are different food pyramids for you to choose from, the challenge is to pick one, then create an eating plan that embraces healthy food. No matter which specific diet or pyramid you choose, the basic steps to good nutrition come from a diet that:

helps you either lose weight or keeps your BMI in the "healthy" range
is balanced overall, with foods from all groups, with lots of delicious fruits, vegetables, and grains
is low in saturated fat and cholesterol and moderate in total fat intake (less than 10 percent of your daily calories should come from saturated fat, and less than 30 percent of your daily calories should come from total fat)
includes a variety of grains daily, especially whole grains, a good source of fiber
includes enough fruits and vegetables (a variety of each, five to nine servings each day)
has a small number of calories from added sugars (like in candy, cookies, and cakes)
has foods prepared with less sodium or salt (aim for no more than 2,400 milligrams of sodium per day, or about one teaspoon of salt per day for a healthy heart)
does not include more than one drink per day (two drinks per day for men) if you drink alcoholic beverages

I know a healthy diet means I should control my fat intake, but I'm confused by all the different kinds of fats in foods! How do I know which ones are ok and which ones to avoid?

There are different kinds of fats in our foods. Some can hurt our health, while others aren't so bad some are even good for you! Here's what you need to know:

Monounsaturated fats (canola, olive and peanut oils, and avocados) and polyunsaturated fats (saf flower, sesame, sunflower seeds, and many other nuts and seeds) don't raise your LDL ("bad") cholesterol levels but can raise your HDL ("good") cholesterol levels. To keep healthy, it is best to choose foods with these fats.
Saturated fat, trans fatty acids, and dietary cholesterol raise your LDL ("bad") blood cholesterol levels, which can lead to heart disease. Saturated fat is found mostly in food from animals, like beef, veal, lamb, pork, lard, poultry fat, butter, cream, whole milk dairy products, cheeses, and from some plants, such as tropical oils. Tropical oils include coconut, palm kernel, and palm oils that are found in commercial cakes, cookies, and salty snack foods. Unlike other plant oils, these oils have a lot of saturated fatty acids. Some processed foods (such as frozen dinners and canned foods) can be quite high in saturated fat it' s best to check package labels before purchasing these types of foods.
Trans fatty acids (TFAs) are formed during the process of making cooking oils, margarine, and shortening and are in commercially fried foods, baked goods, cookies, and crackers. Some are naturally found in small amounts in some animal products, such as beef, pork, lamb, and the butterfat in butter and milk. In studies, TFAs tend to raise our total blood cholesterol. TFAs also tend to raise LDL ("bad") cholesterol and lower HDL ("good") cholesterol. One study found that the four main sources of trans fatty acids in women's diets come from margarine, meat (beef, pork, or lamb), cookies, and white bread. At this time, TFAs are not listed on nutrition labels, but that will soon change. Although it might take a couple of years to begin seeing it, the Food and Drug Administration (FDA) is now asking food manufacturers to begin labeling TFA content. And some food manufacturers are announcing they are taking TFAs out of their food.

I'm concerned about heart disease. Is there a special diet to help prevent or control it?

Heart disease is the #1 killer of both women and men. Eating a heart-healthy diet is key to help reduce your risk factors for heart disease, like high blood pressure, high blood cholesterol, overweight, and obesity. It also will help you control these conditions if you already have them.

Here are some general guidelines for heart-healthy eating:

Choose foods low in saturated and trans fats. Foods low in saturated fat include fruits, vegetables, whole grain foods, and low-fat or nonfat dairy products. Try to avoid commercially fried and baked goods such as crackers and cookies.
Choose a diet moderate in total fat. The good news is that you don't have to eliminate all fat from your diet! A diet moderate in fat will give you enough calories to satisfy your hunger, which can help you to eat fewer calories, stay at a healthy weight, and lower your blood cholesterol level. To keep your total fat intake moderate, try to substitute unsaturated fat for saturated fat.
Choose foods low in cholesterol. Try to eat fruit, vegetables, whole grains, low-fat or nonfat dairy products, and moderate amounts of lean meats, skinless poultry, and fish. Eat plenty of soluble fiber, which may help lower your LDL ("bad") blood cholesterol. Good sources are oat bran, oatmeal, beans, peas, rice bran, barley, citrus fruits, and strawberries. Insoluble fiber will not help your blood cholesterol level but is still good for healthy bowel function. Good sources of insoluble fiber are whole wheat breads, kidney beans, almonds, beets, carrots, brussel sprouts, broccoli, cauliflower, green beans, and apple skin.
The American Heart Association also recommends that you try to eat at least two servings of fish per week (especially fatty fish like salmon and lake trout) because they are high in omega-3 fatty acids, which may help lower blood cholesterol. Some types of fish, such as swordfish, shark, or king mackerel, may contain high levels of mercury and other environmental contaminants that can damage the brain and nervous system, especially in developing fetuses. Children, pregnant, and breastfeeding women should limit how much fish they eat to no more than 12 ounces per week.
You also can eat omega-3 fatty acids from plant sources, such as from tofu, soybeans, canola, walnuts, and flaxseed (these contain alpha-linolenic acid, a less potent form of omega-3 fatty acid).
Cut down on sodium. If you have high blood pressure as well as high blood cholesterol and many people do your health care provider may tell you to cut down on sodium or salt. Even if you don't have high blood pressure or cholesterol, try to have no more than 2,400 milligrams of sodium each day. The DASH Diet also recommends a lower level of 1,500 mg of sodium a day. You can choose low-sodium foods, which will also help lower your cholesterol, such as fruits, vegetables, whole grains, low-fat or nonfat dairy products, and moderate amounts of lean meat. To flavor your food, reach for herbs and spices rather than high-sodium table salt. Be sure to read the labels of seasoning mixes because some contain salt.
Watch your body weight. It is not uncommon for overweight people to have higher blood cholesterol than people who are not overweight. When you reduce the fat in your diet, you cut down not only on cholesterol and saturated fat but on calories as well. This will help you to lose weight and improve your blood cholesterol, both of which will reduce your risk for heart disease.

If you are healthy, but would like to keep your cholesterol low, you can follow this diet:
Heart Healthy Diet http://nhlbisupport.com/cgi-bin/chd1/step1intro.cgi

If you currently have high cholesterol, here is a diet you can follow to help lower your LDL cholesterol:
Therapeutic Lifestyles Changes (TLC) Diet http://nhlbisupport.com/chd1/tlc_lifestyles.htm

If you need to lower high blood pressure, you can follow:
The Dietary Approaches to Stop Hypertension (DASH) Diet http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/

Many diets say to limit my sodium to an amount measured in milligrams per day, but exactly how much salt is that?

Salt is also labeled as sodium chloride. Soda, sodium bicarbonate, and the symbol "Na" on food labels mean the product contains sodium. Here are some general guidelines:

1/4 teaspoon salt = 600 milligrams (mg) sodium

1/2 teaspoon salt = 1,200 mg sodium

3/4 teaspoon salt = 1,800 mg sodium

1 teaspoon salt = 2,400 mg sodium

1 teaspoon baking soda = 1,000 mg sodium

It's hard to know if my portions are too big or too small for a healthy diet. Do I have to measure everything I'm eating?

It can be hard to learn if your portions of food are putting you over amounts of things you're trying to control. It doesn't help that sizes for everything from bananas to soft drinks have gotten larger in the past 20 years. It's not enough to eat the right kinds of food to maintain a healthy weight or to lose weight. Eating the right amount of food at each meal is just as important. If you are a healthy eater, it is possible to sabotage your efforts by eating more than the recommended amount of food. A serving is a specific amount of food, and it might be smaller than you realize. Here are some examples:

A serving of meat (boneless, cooked weight) is two to three ounces, or roughly the size of the palm of your hand, a deck of cards, or an audiocassette tape.
A serving of chopped vegetables or fruit is 1/2 cup, or approximately half a baseball or a rounded handful.
A serving of fresh fruit is one medium piece, or the size of a baseball.
A serving of cooked pasta, rice, or cereal is 1/2 cup, or half a baseball or a rounded handful.
A serving of cooked beans is 1/2 cup, or half a baseball or a rounded handful.
A serving of nuts is 1/3 cup, or a level handful for an average adult.
A serving of peanut butter is two tablespoons, about the size of a golf ball.

I'm confused by all of the labels I see on foods, like "fat free" and "low calorie." What do these terms mean?

Terms like these are on many food packages. Here are some definitions based on one serving of a food. If you eat more than one serving, you will go over these levels of calories, fat, cholesterol, and sodium.

Calorie-free: fewer than 5 calories
Low calorie: 40 calories or fewer
Reduced calorie: at least 25% fewer calories than the regular food item has
Fat free: less than ½ gram of fat
Low fat: 3 grams of fat or fewer
Reduced fat: at least 25% less fat than the regular food item has
Cholesterol free: fewer than 2 milligrams cholesterol and no more than 2 grams of saturated fat
Low cholesterol: 20 milligrams or fewer cholesterol and 2 grams or less saturated fat
Sodium free: fewer than 5 milligrams sodium
Very low sodium: fewer than 35 milligrams sodium
Low sodium: fewer than 140 milligrams sodium
High fiber: 5 grams or more fiber

How can I follow a healthy diet if I eat out a lot?

The American Heart Association gives these tips for a healthy diet, even when you aren't cooking at home:

Ask the server to make substitutions, like having steamed vegetables instead of fries.
Pick lean meat, fish, or skinless chicken.
Make sure your entrée is broiled, baked, grilled, steamed, or poached instead of fried.
Ask for baked, boiled, or roasted potatoes instead of fried.
Order lots of vegetable side dishes and ask that any sauces or butter be left off.
Ask for low-calorie salad dressing or a lemon to squeeze on your salad instead of dressing.
Order fresh fruit or fruit sorbet in place of cake, pie, or ice cream desserts.

Heart Healthy Eating

Why do I need to be concerned about heart healthy eating?
How do I get started with planning a heart healthy diet?
What is cholesterol and what diets can help me lower or maintain healthy levels of cholesterol?
How do the Heart Healthy and TLC Diets work?
What diets can help me maintain a healthy blood pressure level?
How does the DASH Diet work?
What else can I do, besides diet, to keep my heart healthy?

Why do I need to be concerned about heart healthy eating?

Diet is one of the things that can affect your heart health, and your risk for getting heart disease. And, every woman needs to be concerned about heart disease. It is the #1 killer of American women (and men). The good news is that diet is one of the things you can control to improve your heart health and lower your risk for heart disease. Making relatively simple changes in your daily eating habits will pay off quickly - not only will you feel better, your overall health will improve as well!

How do I get started with planning a heart healthy diet?

We all know that too much fat and salt are not good for us. But, it can be hard to change your diet, particularly when you are busy and often don't have time for three healthy, home-cooked meals a day. While the thought of changing your diet might be daunting, there are diets out there to help you! It can be very confusing knowing what to eat, how much to eat, what type of fat to eat, what type of fat to avoid, and how much salt to use. We will describe three easy-to-follow diets in this FAQ, to help you reduce your risk for getting heart disease.

What is cholesterol and what diets can help me lower or maintain healthy levels of cholesterol?

Our bodies need cholesterol to function normally. But, if you have too much cholesterol in your blood, it can build up (called plaque) in your arteries (blood vessels that carry oxygen- and nutrient-rich blood from the heart and lungs to all parts of the body). High cholesterol adds to the narrowing and blockages in arteries, which cause heart disease. We all have "good" cholesterol, called HDL, which helps remove cholesterol from the blood. We also all have "bad" cholesterol, or LDL, which causes cholesterol to build up in the blood.

There are two diets that focus on lowering or maintaining levels of cholesterol - a natural, waxy substance found in all parts of the body, including the blood - to reduce risk for heart disease.

The Heart Healthy Diet (http://nhlbisupport.com/cgi-bin/chd1/step1intro.cgi) helps you keep your blood cholesterol low, decreasing your chances of getting heart disease.
Similar to the Heart Healthy Diet, the Therapeutic Lifestyles Changes (TLC) Diet (http://nhlbisupport.com/chd1/tlc_lifestyles.htm) focuses on helping people lower their blood cholesterol. Sometimes a person may also need medicine prescribed by a health care provider to help lower their blood cholesterol.

It's important to note that diet isn't the only thing that can affect cholesterol levels. Your genes affect how fast cholesterol is made and removed from the blood, being overweight tends to increase your LDL ("bad" cholesterol), and physical activity (for 30 minutes most days of the week) helps lower your LDL. Before menopause (when your periods stop), women usually have cholesterol levels that are lower than those of men the same age. As women and men age, their cholesterol levels rise up until about age 60 to 65. But, after the age of about 50 (when menopause begins), women often have higher cholesterol levels than men of the same age.

How do the Heart Healthy and TLC Diets work?

Both of these diets help you to develop a personal eating plan. Be sure to talk with your health care provider first, before starting any type of eating plan. You might want to ask your provider for a referral to a registered dietician (RD) who can help you choose foods and plan menus, monitor your progress, and encourage you to stay on the diet. You might also want to enlist the help of a family member or friend, to give you support and help you stay on track. Finding a "buddy" to go on one of these diets with you can also provide support. Try to stay focused on your ultimate goal - to prevent heart disease and protect your health - and have some fun learning new recipes and different ways to cook!

Here are some general guidelines to follow, for both the Heart Healthy and TLC diets. Check the chart that follows to determine, for each diet, the daily amounts of saturated fat, total fat, cholesterol, and sodium that you should have.

Choose foods low in saturated fat. Saturated fat raises your LDL - "bad" cholesterol level more than anything else you eat. It's found the most in animal foods like fatty cuts of meat, poultry with the skin, whole-milk dairy products, and in tropical oils like coconut, palm kernel, and palm oils. Most other vegetable oils are low in saturated fats. Foods low in saturated fat include fruits, vegetables, whole grain foods, and low fat or nonfat dairy products. Some processed foods (such as frozen dinners and canned foods) can be quite high in saturated fat - it' s best to check package labels before purchasing these types of foods.
Choose a diet moderate in total fat. The good news is that you don't have to eliminate all fat from your diet! A diet moderate in fat will give you enough calories to satisfy your hunger, which can help you to eat fewer calories, stay at a healthy weight, and lower your blood cholesterol level. Keep in mind, though, that it's important to keep your total fat level within the levels on the chart below, depending on which diet you follow. You should substitute unsaturated fat for saturated fat, in order not to go over these levels.
Choose foods low in cholesterol. Dietary cholesterol found in animal foods can also raise your blood cholesterol level; many of these foods also are high in saturated fat. To reduce dietary cholesterol, eat fruit, vegetables, whole grains, low fat or nonfat dairy products, and moderate amounts of lean meats, skinless poultry, and fish.
Cut down on sodium. If you have high blood pressure (see next question) as well as high blood cholesterol - and many people do - your health care provider may tell you to cut down on sodium or salt. Even if you don't have high blood pressure or cholesterol, try to have no more than 2,400 milligrams of sodium a day. You can choose low sodium foods, which will also help lower your cholesterol, such as fruits, vegetables, whole grains, low fat or nonfat dairy products, and moderate amounts of lean meat. To flavor your food, reach for herbs and spices rather than high sodium table salt. There are many types of seasoning mixes in salt shaker-like containers you can find in grocery stores, but some do contain salt. Be sure to read the labels of these products before purchasing.
Watch your body weight. It is not uncommon for overweight people to have higher blood cholesterol than people who are not overweight. When you reduce the fat in your diet, you cut down not only on cholesterol and saturated fat, but on calories as well. This will help you to lose weight and improve your blood cholesterol, both of which will reduce your risk for heart disease. If you are overweight, talk with your health care provider about the best ways to lose weight, including having a regular exercise program. Regular exercise is important, even if you are not overweight. It will help lower your blood cholesterol and blood pressure and improve your overall health.

Heart Healthy Diet - Every Day You Should Have:	TLC Diet - Every Day You Should Have:
8 to 10 percent of total calories from saturated fat	less than 7 percent of total calories from saturated fat
30 percent or less of total calories from fat	25-35 percent or less of total calories from fat
less than 300 milligrams (mg) of dietary cholesterol	less than 300 milligrams (mg) of dietary cholesterol
no more than 2400 milligrams (mg) of sodium	no more than 2400 milligrams (mg) of sodium
just enough calories to achieve or maintain a healthy weight and reduce your blood cholesterol level*	just enough calories to achieve or maintain a healthy weight and reduce your blood cholesterol level*
*Ask your health care provider or RD what is a reasonable daily calorie level for you.

What diets can help me maintain a healthy blood pressure level?

Research has shown that diet affects the development of high blood pressure (hypertension). As blood is pumped from your heart through your body, the blood puts force or pressure against the blood vessel (or artery) walls. Your blood pressure is a reading, or measure, of this pressure. When that pressure

goes above a certain point, it is called high blood pressure, another name for hypertension. High blood pressure is called the "silent killer" because it most often has no signs or symptoms. It makes the heart work too hard and if not controlled over time, it can lead to heart and kidney disease, and stroke.

Studies have shown that following the Dietary Approaches to Stop Hypertension or DASH Diet http://www.nhlbi.nih.gov/health/public/heart/hbp/dash/index.htm and reducing sodium, lowers blood pressure. If you do not have high blood pressure, following the DASH diet and reducing your sodium intake may help prevent the development of high blood pressure.

How does the DASH Diet work?

The DASH diet is similar to the Heart Healthy and TLC diets. Like these diets, the DASH diet recommends no more that 2,400 mg of sodium a day. But, the DASH diet also recommends a lower level of 1,500 mg sodium a day. Talk with your health care provider before making any type of change in your diet. And, if you choose the DASH diet, ask your provider what amount of sodium (2,400 or 1,500 mg) you should not exceed on a daily basis. You can ask your provider for a referral to a registered dietician (RD), who can help you choose foods and plan menus, monitor your progress, and encourage you to stay on the diet. You might also want to enlist the help of a family member or friend, to give you support and help you stay on track. Finding a "buddy" to go on one of these diets with you can also provide support. Try to stay focused on your ultimate goal - to prevent heart disease and protect your health - and have some fun learning new recipes and different ways to cook!

The DASH diet is made up of foods that are low in saturated fat, cholesterol, and total fat, such as fruits, vegetables, and low fat dairy products. It also includes whole grain products, fish, poultry and nuts, and reduced amounts of red meat, sweets, and sugar-containing beverages. It is rich in magnesium, potassium, and calcium, as well as protein and fiber. Eating foods rich in potassium is especially important, since potassium seems to prevent high blood pressure. Try to have more than 3,500 mg of potassium per day. There are different amounts, or servings, of specific food groups for different daily calorie levels, described in the charts that follow. DASH Eating Plan for a 2000 Calories/day (Average) Diet

Food Group Daily Servings Serving Sizes Examples and Notes

Grains and products 7 to 8 1 slice bread 1 oz dry cereal ½ cup cooked rice, pasta, or cereal whole wheat bread, English muffin, pita bread, bagel, cereal, grits, oatmeal, crackers, unsalted pretzels and popcorn - these are major sources of energy and fiber

Vegetables 4 to 5 1 cup raw leafy vegetable, ½ cup cooked vegetable, 6 oz vegetable juice tomatoes, potatoes, carrots, green peas, squash, broccoli, turnip, greens, collards, kale, spinach, artichokes, green beans, lima beans, sweet potatoes - these are rich sources of potassium, magnesium, and fiber

Fruits 4 to 5 6 oz fruit juice1 medium fruit ¼ cup dried fruit, ½ cup fresh frozen, or canned fruit apricots, bananas, dates, grapes, oranges, orange juice, mangoes, melons, peaches, pineapples, prunes, raisins, strawberries, tangerines - these are important sources of potassium, magnesium and fiber

Low-fat or non-fat dairy foods 2 to 3 8 oz milk, 1 cup yogurt, 1.5 oz cheese fat free or low-fat milk, fat free or low-fat buttermilk, fat free or low-fat regular or frozen yogurt, low-fat and fat free cheeses - these are major sources of calcium and protein

Meats, poultry, and fish 2 or less 3 oz cooked meats, poultry, or fish select only lean; trim away visible fats; broil, roast, or boil instead of frying; remove skin from poultry - these are rich sources of protein and magnesium

Nuts, seeds, and dry beans 4 to 5 per week 1/3 cup or 1.5 oz nuts 2 Tbsp or ½ oz seeds ½ cup cooked dry beans almonds filberts, mixed nuts, peanuts, walnuts, sunflower seeds, kidney beans, lentils, peas - these are rich sources of energy, magnesium, potassium, protein and fiber

Fats and oils 2 to 3 1 tsp soft margarine 1 Tbsp low-fat mayonnaise 2 Tbsp light salad dressing 1 tsp vegetable oil soft margarine, low-fat mayonnaise, light salad dressing, vegetable oil (such as olive, corn, canola or sunflower) - DASH has 27 percent of calories as fat, including that in or added to foods

Sweets 5 per week 1 Tbsp sugar 1 Tbsp jelly or jam ½ oz jelly beans, 8 oz lemonade maple syrup, sugar, jelly, jam, fruit-flavored gelatin, jelly beans, hard candy, fruit punch, sorbet, ices - these are sweets, should be low in fat

*Ask your health care provider or RD what is a reasonable daily calorie level for you.

DASH Eating Plan Number of Servings for Other Calorie Levels*

Food Group 1,600 calories/day 3,100 calories/day

Grains and grain products 6 servings/day 12 to 13 servings/day

Vegetables 3 to 4 servings/day 6 servings/day

Fruits 4 servings/day 6 servings/day

Low fat of nonfat dairy foods 2 to 3 servings/day 3 to 4 servings/day

Meats, poultry, and fish 1 to 2 servings/day 2 to 3 servings/day

Nuts, seeds, and dry beans 3 servings/week 1 serving/day

Fats and oils 2 servings/day 4 servings/day

Sweets 0 2 servings


Grains and products	7 to 8	1 slice bread 1 oz dry cereal ½ cup cooked rice, pasta, or cereal	whole wheat bread, English muffin, pita bread, bagel, cereal, grits, oatmeal, crackers, unsalted pretzels and popcorn - these are major sources of energy and fiber
Vegetables	4 to 5	1 cup raw leafy vegetable, ½ cup cooked vegetable, 6 oz vegetable juice	tomatoes, potatoes, carrots, green peas, squash, broccoli, turnip, greens, collards, kale, spinach, artichokes, green beans, lima beans, sweet potatoes - these are rich sources of potassium, magnesium, and fiber
Fruits	4 to 5	6 oz fruit juice1 medium fruit ¼ cup dried fruit, ½ cup fresh frozen, or canned fruit	apricots, bananas, dates, grapes, oranges, orange juice, mangoes, melons, peaches, pineapples, prunes, raisins, strawberries, tangerines - these are important sources of potassium, magnesium and fiber
Low-fat or non-fat dairy foods	2 to 3	8 oz milk, 1 cup yogurt, 1.5 oz cheese	fat free or low-fat milk, fat free or low-fat buttermilk, fat free or low-fat regular or frozen yogurt, low-fat and fat free cheeses - these are major sources of calcium and protein
Meats, poultry, and fish	2 or less	3 oz cooked meats, poultry, or fish	select only lean; trim away visible fats; broil, roast, or boil instead of frying; remove skin from poultry - these are rich sources of protein and magnesium
Nuts, seeds, and dry beans	4 to 5 per week	1/3 cup or 1.5 oz nuts 2 Tbsp or ½ oz seeds ½ cup cooked dry beans	almonds filberts, mixed nuts, peanuts, walnuts, sunflower seeds, kidney beans, lentils, peas - these are rich sources of energy, magnesium, potassium, protein and fiber
Fats and oils	2 to 3	1 tsp soft margarine 1 Tbsp low-fat mayonnaise 2 Tbsp light salad dressing 1 tsp vegetable oil	soft margarine, low-fat mayonnaise, light salad dressing, vegetable oil (such as olive, corn, canola or sunflower) - DASH has 27 percent of calories as fat, including that in or added to foods
Sweets	5 per week	1 Tbsp sugar 1 Tbsp jelly or jam ½ oz jelly beans, 8 oz lemonade	maple syrup, sugar, jelly, jam, fruit-flavored gelatin, jelly beans, hard candy, fruit punch, sorbet, ices - these are sweets, should be low in fat
*Ask your health care provider or RD what is a reasonable daily calorie level for you.


Grains and grain products	6 servings/day	12 to 13 servings/day
Vegetables	3 to 4 servings/day	6 servings/day
Fruits	4 servings/day	6 servings/day
Low fat of nonfat dairy foods	2 to 3 servings/day	3 to 4 servings/day
Meats, poultry, and fish	1 to 2 servings/day	2 to 3 servings/day
Nuts, seeds, and dry beans	3 servings/week	1 serving/day
Fats and oils	2 servings/day	4 servings/day
Sweets	0	2 servings

Know that the DASH diet has more daily servings of fruits, vegetables, and whole grain foods than you may be used to eating. This increases the fiber in your diet, which can cause bloating and diarrhea in some persons. To avoid these problems, gradually increase your intake of fruit, vegetables, and whole grain foods. Also know that only a small amount of sodium occurs naturally in foods. Because most of the sodium we consume is in processed foods, be sure to carefully check the label of these types of foods before purchasing. While some processed foods do have low or reduced sodium levels, some are loaded with it!

Here are some other helpful tips to reduce sodium and salt in your diet:

Aim for no more than 2,400 milligrams of sodium per day.
Use reduced sodium or no-salt-added products.
Buy fresh, frozen, or canned with no-salt-added vegetables.
Use fresh poultry, fish, and lean meat, rather than canned, smoked, or processed types.
Choose ready-to-eat breakfast cereals that are low in sodium.
Limit cured foods (like bacon and ham), foods packed in brine (like pickles, olives and sauerkraut), and condiments (like MSG, mustard, horseradish, catsup and barbeque sauce). Limit even lower sodium versions of soy and teriyaki sauce.
Be spicy instead of salty! Flavor foods with herbs, spices, lemon, lime, vinegar, or salt-free seasoning blends. Start by cutting salt in half.
Cook rice, pasta, and hot cereals without salt. Cut back on instant or flavored rice, pasta, and cereal mixes, which often contain added salt.
Choose convenience foods that are lower in sodium. Cut back on frozen dinners, pizza, packaged mixes, canned soups or broths, and salad dressings - these often have a lot of sodium.
Rinse canned foods like tuna to remove some sodium.

What else can I do, besides diet, to keep my heart healthy?

Regular physical activity can help you reduce your risk of heart disease. Being active helps you take off extra pounds, helps to control blood pressure, and boosts your level of "good" cholesterol. Some studies show that being inactive increases the risk of a heart attack. To reduce your risk for heart disease:

Quit smoking - talk with your health care provider if you need help quitting.
Exercise at least 30 minutes a day on most (if not all) days of the week.
Lose weight if you are overweight and keep at a healthy weight.
Check blood pressure, cholesterol, and blood sugar levels and keep them under control.

What Parents Need to Know About Children's Bone Health

I thought osteoporosis affects older women. Why should girls and teenage girls be concerned about bone health?
What is "weight bearing" physical activity?
How do calcium and physical activity make bones stronger?
How much calcium do adolescents need?
It seems pretty hard to get 1300 milligrams of calcium from food alone. Should girls take a calcium supplement to make sure they get enough calcium? And, is it possible to get too much calcium?
Can you get enough calcium if you are lactose intolerant?
I've heard that milk and other dairy products can be fattening, or aren't good for you in other ways.
Why are dairy products recommended for adolescents who want to build strong bones?
How does caffeine affect bone health?
What else can adolescents do to improve and promote their bone health?
My neighborhood is not very safe. How can girls take part in weight bearing physical activity while staying indoors?
What kinds of weight bearing exercises can girls with physical disabilities do to keep their bones strong?

What is osteoporosis?

Osteoporosis is a disease that thins and weakens bones to the point where they break easily - especially bones in the hip, spine (backbone) and wrist. It is called a "silent disease" because bone loss occurs without symptoms. Having a bone break easily or losing height is often the first sign of this disease. While osteoporosis can strike at any age, over half of all women over age 65 have it. Women are four times more likely than men to develop the disease because women have lower bone mineral density to begin with. Estrogen loss at menopause (when a woman's periods stop for good) may add to this.

There are certain things that are linked to whether or not a woman will develop osteoporosis. These things are called risk factors. Some risk factors cannot be changed, while others can be changed.

Risk factors that cannot be changed include:

Sex - women are more likely to develop the disease than men are. This is because women have lighter, thinner bones and lose bone strength and density rapidly after menopause.
Age - the longer you live, the greater your chances are of getting the disease. Know that rates of bone loss vary among women and that not all women get osteoporosis.
Family history - this disease runs in families, which increases your risk if it is in your family.
Body size - women who are small-boned and thin have a higher risk than women who are larger-boned and weigh more. But, being heavy does not mean that you will get this disease.
Ethnicity - White and Asian women are more at risk for this disease than are Black women. Black and Hispanic women, though, do get osteoporosis.

Risk factors that Can be changed include:

Diet - getting enough calcium and vitamin D in your diet will help you to build and keep strong, healthy bones.
Physical activity - helps keep bones strong and healthy over your lifetime.
Smoking - lowers estrogen levels in your body and can cause you to go through menopause earlier, increasing your chances for getting osteoporosis.
Alcohol - having 1 or 2 drinks a day can damage bone density and strength, even in young women.

I thought osteoporosis affects older women. Why should girls and teenage girls be concerned about bone health?

It is never too early to start being concerned about bone health. Childhood - the peak bone producing years - is the time to start teaching your children about bone health. You can work with them to develop good diet and exercise habits, which will help them to have strong, healthy bones throughout their lives. And, a poor diet and not enough physical activity during the adolescent years (age 9 to 18) can result in weaker bones in adulthood. This increases the risk for osteoporosis, and can affect the body's ability to heal properly after an injury. By making sure they get enough calcium, as well as weight bearing physical activity, girls can develop strong bones and reduce their risk for osteoporosis later in life.

What is "weight bearing" physical activity?

Weight bearing physical activity is any activity in which your body works against gravity, so your feet and legs are supporting or carrying your weight. Examples of weight bearing physical activities that young girls like include walking, running, tennis, dancing, tae kwon do, hiking, hopscotch, and basketball.

Activities that are not weight bearing include riding a bike or a scooter, swimming, and skateboarding. But, these activities do benefit overall health and can be mixed with weight bearing activities.

How do calcium and physical activity make bones stronger?

To make bones strong and to keep them strong, the body needs both calcium and weight bearing physical activity. It's not enough to do one or the other to make bones strong, it takes two!

Calcium - helps bones to develop properly. When the body makes new bone tissue, it first lays down a framework of a protein called collagen. Then, calcium from the blood spreads throughout the collagen framework. The hard crystals of calcium fill in all the nooks and crannies of the framework. Calcium and collagen work together to make bones strong and flexible.
Calcium is also needed for many other activities within the body such as neural communication (the way your nerves and brain send signals to each other) and heart and lung functions. If the body doesn't get enough calcium from foods and drinks, it can take it from bones, which can make bones weaker.
Physical activity - just as a muscle gets stronger and bigger the more you use it, a bone becomes stronger and denser when you exercise. Bones are living tissue. Weight bearing physical activity causes new bone tissue to form, making bones even stronger. It also makes muscles stronger, and muscles push and tug against bones, making bones even stronger. And, it improves coordination, which makes falls less likely, keeping bones safer from breaks.

How much calcium do adolescents need?

The recommended intake for girls aged 9-18 is 1300 milligrams of calcium per day. But, many girls in this age group do not get enough calcium. Some studies have shown that a typical girl gets only about 800 mg of calcium a day.

For recommended calcium intake for adults, go to http://www.4woman.gov/osteopor.htm. The chart below lists the calcium content of foods and drinks that many young girls like.

Food Portion Size Calcium (Milligrams)*

Plain, fat-free yogurt 1 cup 450

Grilled cheese sandwich** 1 sandwich 371

American cheese 2 ounces 348

Ricotta cheese, part skim ½ cup 337

Fruit yogurt 1 cup 315

Cheddar cheese 1-½ ounces 305

Milk (fat-free or low-fat) 1 cup 300

Orange juice with added calcium 1 cup 300

Soy beverage with added calcium 1 cup 250-300

Tofu (made with calcium) ½ cup (about five 1-inch cubes) 204

Macaroni and cheese ½ cup 204

Cheese pizza 1 slice 111-147

Frozen yogurt (fat-free or low-fat) ½ cup 105

Broccoli, cooked or fresh 1 cup 90

Ice cream ½ cup 84

Bok choy, cooked or fresh ½ cup 80

Almonds, dry roasted 1 ounce (About 20-25 almonds) 71

White bread 2 slices 70

* Calcium content varies depending on the ingredients of many foods.

**Using 2 slices of white bread, 1-½ ounces of cheese, and nonstick cooking spray.

Food	Portion Size	Calcium (Milligrams)*
Plain, fat-free yogurt	1 cup	450
Grilled cheese sandwich**	1 sandwich	371
American cheese	2 ounces	348
Ricotta cheese, part skim	½ cup	337
Fruit yogurt	1 cup	315
Cheddar cheese	1-½ ounces	305
Milk (fat-free or low-fat)	1 cup	300
Orange juice with added calcium	1 cup	300
Soy beverage with added calcium	1 cup	250-300
Tofu (made with calcium)	½ cup (about five 1-inch cubes)	204
Macaroni and cheese	½ cup	204
Cheese pizza	1 slice	111-147
Frozen yogurt (fat-free or low-fat)	½ cup	105
Broccoli, cooked or fresh	1 cup	90
Ice cream	½ cup	84
Bok choy, cooked or fresh	½ cup	80
Almonds, dry roasted	1 ounce (About 20-25 almonds)	71
White bread	2 slices	70
* Calcium content varies depending on the ingredients of many foods.
**Using 2 slices of white bread, 1-½ ounces of cheese, and nonstick cooking spray.

It seems pretty hard to get 1300 milligrams of calcium from food alone. Should girls take a calcium supplement to make sure they get enough calcium? And, is it possible to get too much calcium?

Girls can get plenty of calcium from food. It's found in a variety of good tasting foods like milk, yogurt, broccoli, and low-fat cheese. Many foods also have (extra) calcium added to them like orange juice, milk, breakfast cereals, cereal and other bars, and soy drinks. Be sure to check food package labels to see if they have added calcium. While not common, some girls might have allergies or other dietary restrictions, and can ask their health care provider about supplements. But, most girls can get enough calcium by eating the right types of foods.

While it is possible to get too much calcium, it is not likely for most girls. Even with all the products that have added calcium, girls consume far less calcium each day than the recommended 1300 mg.

Can you get enough calcium if you are lactose intolerant?

Yes. Lactose intolerance means some girls don't feel well (stomachache, gas) after they have milk or other dairy products. The good news is that there is milk and other dairy products that are specially made for people with lactose intolerance. Look for milks, cheeses, cottage cheese and other products that have the enzyme lactase, which helps a person to digest dairy. You can also buy Lactaid pills to chew or swallow with the first bite of dairy, which contain lactase. There are also other foods that have calcium like broccoli, almonds, and foods fortified with calcium like orange juice and cereals. Remember to look for "calcium" on food labels.

I've heard that milk and other dairy products can be fattening, or aren't good for you in other ways. Why are dairy products recommended for adolescents who want to build strong bones?

Milk and other dairy products do not have to be fattening. It is easy to get low-fat or non-fat milk. Dairy products are a very important part of an adolescent's diet. They provide calcium, vitamin D and other nutrients that help prevent osteoporosis.

There are good non-dairy sources of calcium. But, dairy products offer the greatest amounts of calcium per serving. For instance, one cup of fat-free or low-fat milk contains about 300 milligrams of calcium. One cup of broccoli (cooked or fresh) contains about 90 milligrams of calcium.

How does caffeine affect bone health?

Caffeine itself does not appear to have harmful effects on bone health. But, young girls often choose soft drinks with caffeine over milk drinks.

What else can adolescents do to improve and promote their bone health?

It is important for girls to not drink alcohol or smoke, and to have a healthy overall diet. Smoking, drinking alcohol, and having eating disorders such as anorexia nervosa or bulimia can increase a girl's risk for developing weaker bones.

My neighborhood is not very safe. How can girls take part in weight bearing physical activity while staying indoors?

There are plenty of indoor weight bearing exercises that girls can do to help them develop strong, healthy bones. Dancing, lifting hand-held weights (or soup cans), jogging in-place, and push-ups can be done indoors, as well as outdoors.

What kinds of weight bearing exercises can girls with physical disabilities do to keep their bones strong?

There are a number of weight bearing exercises available to girls with physical disabilities:

Wheelchair aerobics - combines upper body movements and stretches to increase flexibility. They are done in a seated position, often to music.
Arm cycling (ergometry) - this is like bicycling, only it is done with the arms instead of the legs. A girl can use a stationary (non-moving) bike or arm-driven cycles designed for outdoor use. Be sure your girl always wears a helmet when cycling outdoors.
Wheeling - this involves moving a wheelchair forward, using the arms or legs, over an extended distance. This can be done inside or outside, using a regular wheelchair or a specialized sport wheelchair.
Resistance training - wide elastic bands used for resistance training and stretching. One end is attached to a non-moving object, such as a doorknob or the leg of a bed or a heavy table, while the other end is held and stretched to exercise one part of the body at a time. Hand weights can also be used for this type of training.
Some sports can be adapted for girls with physical disabilities, like wheelchair tennis and wheelchair basketball.

Obesity

What is obesity?
What causes being overweight and obesity?
How many women are obese?
What are some of the serious health problems linked to obesity?
What are metabolic syndrome and abdominal obesity?
How can I improve my health if I am obese?

What is obesity?

Obesity means that you have an unhealthy amount of body fat. Everyone needs some body fat, but too much fat can cause health problems.

Overweight and obesity are defined using a tool called Body Mass Index (BMI). BMI is a way of estimating total body fat for most people. The easiest way to find out your BMI is to use a BMI table for adults (see below). There is also a handy BMI calculator at the National Heart, Lung and Blood Institute's web site (see resources at the end of this FAQ). To find your BMI, you need to know your height and your weight. You can also take your weight in pounds, divide that number by your height in inches squared, and multiply the result by 703 to get your BMI.

Note: This chart is for adults (age 20 years and older)
Source: Surgeon General's Healthy Weight Advice for Consumers, 2001
If your BMI is 25-29.9, you are in the "overweight" category. If your BMI is 30 or above, you are in the "obese" category. There are three classes of obesity:

Class I obesity BMI of 30-34.9
Class II obesity of 35-39.9
Class III obesity of 40 and higher

In general, the higher your BMI is above 25, the greater your weight-related health risks.

What causes being overweight and obesity?

The main causes of being overweight or obese are eating too much and/or not being active enough. If you eat more calories than your body burns up, the extra calories are stored as fat. Everyone has some stored fat. Too much fat results in being overweight or obese. Other factors that may affect your weight include your genes (obesity tends to run in families), your metabolism (how your body processes food), your racial/ethnic group, and your age. Sometimes an illness or medicine can contribute to weight gain. Researchers are studying the causes of obesity to learn more about how to prevent and reverse it.

How many women are obese?

According to the Surgeon General of the United States, overweight and obesity are increasing in both men and women. The latest estimates are that 34 percent of U.S. adults aged 20 to 74 years are overweight, and an additional 27 percent are obese. About half of all women aged 20 to 74 are overweight or obese. The percentages of obese women among African American, Native American and Mexican American women are even higher.

What are some of the serious health problems linked to obesity?

If you are overweight or obese, you are more likely to develop health problems such as heart disease, diabetes, and some types of cancer. The good news is that losing weight can improve how your heart works, lower your blood pressure, improve your cholesterol levels, and lower your chances of getting other health problems.

Overweight and obesity are linked to:

Heart disease. Heart disease is the leading cause of death for both men and women in the United States. Heart disease includes heart attack, heart failure, and angina (chest pain caused by reduced blood flow to the heart).
Stroke. A stroke is sometimes called a "brain attack." Most strokes are caused by a blood clot blocking an artery that takes blood to the brain.
Diabetes. Overweight people are twice as likely to develop type 2 diabetes as people who are not overweight. Type 2 diabetes reduces your body's ability to control your blood sugar. It is a major cause of early death, heart disease, kidney disease, stroke, and blindness. If you have type 2 diabetes, losing weight and being more physically active can help control your blood sugar levels. You may also be able to reduce the amount of medicine that you need.
Cancer of the gallbladder, breast, uterus, cervix, and ovaries (for women). Overweight men are at greater risk for developing cancer of the colon, rectum, and prostate.
Gallstones or gallbladder disease. Gallbladder disease and gallstones are more common if you are overweight. Your risk of disease increases as your weight increases. But weight loss itself, particularly rapid weight loss or loss of a large amount of weight, can actually increase your chances of getting gallstones. Modest, slow weight loss of about 1 pound a week is less likely to cause gallstones.
Osteoarthritis (wearing away of the joints). Osteoarthritis is a common joint disorder that most often affects the joints in your knees, hips, and lower back. Extra weight puts extra pressure on these joints and wears away the cartilage (tissue that cushions the joints) that normally protects them. Weight loss may improve the symptoms of osteoarthritis.
Gout (joint pain caused by excess uric acid). Gout is a joint disease caused by high levels of uric acid in the blood. Uric acid sometimes forms crystals that are deposited in the joints. Gout is more common in overweight people. If you have a history of gout, check with your doctor before trying to lose weight. Some diets may lead to an attack of gout in people who have high levels of uric acid or who have had gout before.
Breathing problems, including sleep apnea (interrupted breathing during sleep). Sleep apnea is a serious condition that can cause a person to stop breathing for short periods during sleep and to snore heavily. Sleep apnea may cause daytime sleepiness and even heart failure. The risk for sleep apnea increases with higher body weights. Weight loss usually improves sleep apnea.
High blood cholesterol. High levels of total cholesterol, LDL cholesterol ("bad cholesterol") and triglycerides (another type of fat in the blood) can lead to heart disease. Obesity is also linked to low levels of HDL cholesterol ("good cholesterol"). Weight loss can improve your cholesterol levels.
High blood pressure. High blood pressure is a major risk factor for heart disease and stroke. Obese adults are twice as likely to have high blood pressure as those who are at a healthy weight. Weight loss can lower your blood pressure.
Complications of pregnancy. Obesity increases the risks of high blood pressure and a type of diabetes that develops during pregnancy. Obese women are more likely to have problems with labor and delivery.
Irregular menstrual cycles and infertility. Abdominal obesity is linked to polycystic ovary syndrome, a cause of infertility in women.

Psychological and social effects, such as depression and discrimination. One of the most painful aspects of obesity may be the emotional suffering it causes. American society places great emphasis on physical appearance, often equating attractiveness with slimness, especially in women. The messages, intended or not, make overweight people feel unattractive. Obese people often face prejudice or discrimination at work, at school, while looking for a job, and in social situations. Feelings of rejection, shame, or depression are common.

What are metabolic syndrome and abdominal obesity?

The latest national guidelines for preventing and managing high blood cholesterol describe a group of risk factors called metabolic syndrome. Abdominal obesity, defined as a large waist size (more than 35 inches in women and more than 40 inches in men), is part of the syndrome. Metabolic syndrome is linked to insulin resistance (which can lead to diabetes) and a high risk of getting heart disease. You have metabolic syndrome if you have at least three of these risk factors:

a large waist measurement (abdominal obesity) of over 35 inches for women
high triglycerides (150 or above)
a low HDL or "good" cholesterol level (for women, under 50)
blood pressure of 130/85 or higher
fasting glucose (blood sugar) of 110 or higher.
Improved diet, weight loss, and increased physical activity are very important if you have metabolic syndrome.

How can I improve my health if I am obese?

The key to reaching and staying at a healthy (or healthier) body weight is to balance healthful eating with regular physical activity. The Surgeon General suggests the following steps to better health.

Aim for a healthy weight. If you are overweight or obese, losing just 10 percent of your body weight can improve your health. Lose weight gradually 1/2 to 2 pounds per week. Do not go on fad diets. These can often hurt your health. Ask your doctor about the best weight loss plan for you.
Be active. Be physically active for at least 30 minutes on most days of the week. Regular exercise is very important in weight control and has many other health benefits.

Some examples of good ways to exercise include walking, yard work, housework, and dancing. More vigorous exercise can raise your HDL ("good cholesterol") level and make your heart stronger. This kind of activity is called "aerobic" and includes jogging, swimming, jumping rope, or brisk walking or bicycling. Be sure to build up your activity level gradually over a period of several weeks. Check with your doctor before starting a vigorous exercise program.

Eat well. Eat smaller portions, eat more foods that are lower in fat and calories, and follow the Dietary Guidelines for Americans. These guidelines call for eating plenty of fruits, vegetables, and whole grains. Try to eat five servings of fruits and vegetables every day. Choose foods that are low in saturated fat and eat fewer foods that are high in sugar or salt.

If you are overweight or obese, talk with your doctor or health care provider about ways to improve your health. If you already have health problems related to obesity, such as high blood pressure or diabetes, follow the treatment plan prescribed by your doctor.

Weight Loss

What is the best way to lose weight?
What are high protein/low carbohydrate diets? Are they a healthy way to lose weight?
Is it safe to use diet pills or herbal supplements when trying to lose weight?
Are there any weight loss programs that work?
If I quit smoking, will I gain weight?

What is the best way to lose weight?

There is no "best" way to lose weight. Don't forget to talk with your doctor about setting up a weight loss plan.

The federal government has set dietary guidelines to aim for a healthy weight that you can check out at: http://www.health.gov/dietaryguidelines/dga2000/document/aim.htm Also, see the federal government guidelines for healthy eating, using the food pyramid at: http://www.health.gov/dietaryguidelines/dga2000/document/build.htm

Some general guidelines for losing weight safely are:

Eat fewer calories. The best formula for losing weight is to decrease the number of calories you get while increasing your physical activity every day. Depending on how active you are, you may need between 1,500 2,500 calories a day. A safe plan is to eat 300 to 500 fewer calories a day to lose 1 to 2 pounds a week.
Lose weight slowly. It is best to aim for losing 1/2 to 2 pounds a week. By improving eating and exercise habits, you will develop a healthier lifestyle. And, this will help you to control your weight over time. You will also lower your chances of getting heart disease, high blood pressure and diabetes. "Crash" diets may take off pounds faster, but can cause you to gain back even more pounds than you lost after you stop the diet.
Exercise. Get active for at least 30 minutes every day. You don't have to train for a marathon to be active! Brisk walking, gardening, riding a bicycle, tennis and dancing all count as exercise. You can also break up the 30 minutes into three 10-minute periods. To get even more active every day, you can do things like park farther away from the mall in the parking lot and take the stairs instead of the elevator. The idea is to use up more calories than you eat each day. This will keep the calories from being stored as fat in your body.
Eat less fat and sugar. This will help lower the number of calories you eat each day. Select foods whose labels say low, light or reduced to describe calories or fat, including milk products and cheese. Eat lean types of meat, poultry, and fish. Eat less sugar and fewer sweets (don't forget that soda and juice can have lots of sugar). Drink less or no alcohol.
Eat a wide variety of foods, including starches and dairy products. This helps your body to get the nutrients and vitamins it needs to be healthy. Include plenty of vegetables, fruits, grain products and whole grains each day. Don't skip dairy products there are many good tasting low, no, and reduced fat milks, yogurts, cheeses, ice creams, and other products to choose from. Proper calcium intake is needed for all women to prevent bone loss.
Starch is an important source of energy that all bodies need, even when a person is trying to lose weight. It is found in foods like potatoes, rice, pasta, bread, beans, and some vegetables. Foods high in starch can become high in fat and calories when you eat them in large amounts, or when they are made with rich sauces, oils, or other high-fat toppings like butter, sour cream, or mayonnaise. Stick to starchy foods that are high in fiber, like whole grains, beans, and peas.
Practice portion control. Eat smaller amounts of food at each meal. Let go of belonging to the "clean plate club." Don't feel like you have to eat everything on your plate, even when eating out. You can also try eating more small meals throughout the day, rather than three large meals.
Get support. It can be hard to start a weight loss program, particularly if you are out of shape and not used to exercising. Ask your family and friends for support. Try to find an exercise buddy. Make your activity fun and social go on a walk or hike with a friend or learn a new sport like tennis or ice-skating.
Treat yourself (once in a while). When trying to lose weight, we all feel tempted to "cheat" by eating a favorite, rich food like cake or cookies. But, sometimes it can be helpful to eat a small amount of a favorite food. This may keep you from craving it and overeating if you do "cheat."

What are high protein/low carbohydrate diets? Are they a healthy way to lose weight?

Most of a person's calories come from protein foods, like meat, eggs, and cheese when on a high-protein/low carbohydrate diet. This diet has fewer calories that come from carbohydrate foods, like breads, pasta, potatoes, fruits, and vegetables. Two problems with this type of diet are it: 1) can lack key nutrients found only in carbohydrates that a person needs to be healthy; 2) allows foods high in fat, which can raise blood cholesterol levels, increasing a person's risk for heart disease and some cancers.

These diets have become popular because people often loss weight quickly. But, most of the weight a person looses is water weight and lean muscle mass, not fat. Water is lost because the kidneys try to get rid of the excess waste products of protein and fat, called ketones, that the body makes. These diets are not a healthy way to lose weight. They overwork your kidneys, can cause dehydration, headaches, and bad breath. You can also feel nauseous, tired, weak, and dizzy. Health problems, like kidney stones and gout (a painful swelling of the joints) can develop as a result of these diets. A reduced-calorie diet that has a good balance of carbohydrates, proteins, and fats is the safest and best way to lose weight. You will also be more likely to keep the weight off over time.

Is it safe to use diet pills or herbal supplements when trying to lose weight?

There are many types of diet pills and herbal, or natural, supplements that you can buy over-the-counter at a drug or discount store, or on-line. You can't assume that a product that is called "natural" or "herbal" is safe. It may also hurt you if you are on other medications. It is best to always check with your doctor before using any herbal or natural weight-loss product.

Diet pills you can buy over-the-counter don't make much of a difference in how much weight you lose, how fast you lose it, or how long you keep the weight off. Some diet pills can raise your blood pressure. Also, cough or cold medicines often have the same drug used in diet pills. If you take both products together, you may get too much of the same drug and have harmful side effects. For some people, diet pills prescribed by a doctor can be helpful. If you do use these, be sure to follow your doctor's directions.

In 1997, The Food and Drug Administration (FDA) removed the weight-loss drug called Fen-Phen (fenfluramine and dexfenfluramine) from the market because this drug was found to cause heart valve disease. Today, there are weight loss products containing herbal fen-phen, which do not contain fenfluramine or dexfenfluramine, on the market. These products, not regulated by the FDA, often contain ephedra and have caused side effects in people using them. Always talk with your health care provider before taking any over-the-counter weight loss product, even it if is herbal or "natural."

Are there any weight loss programs that work?

There are many commercial weight loss programs that can help you to lose weight. While some people lose weight on their own, others find it very helpful and like the support of a structured program. If you think you might want to try a weight loss program, be sure to check it out before you sign up. It also may be helpful to talk it over with your health care provider.

Here are some questions you can ask to help you decide if a weight loss program will be right for you.

Does the program:

Offer counseling, or teach you how to change your eating and exercise habits?
Have qualified counselors and health professionals, such as nutritionists, registered dieticians, doctors, nurses, psychologists, and exercise physiologists?
Help you to deal with stress and how to avoid slipping back into old habits?
Talk about how to keep weight off once you lose it?
Have food choices that are flexible and suit you?
Have you set weight goals with the help of a health professional?

There are other questions you can ask to figure out how well a program works. Not all programs collect this type of information, but it is still important to ask:

How many people who begin the program actually finish it?
About how much weight do most people lose who finish the program?

Do people have problems or side effects and what are they?

Are there any extra costs for the program, like dietary supplements or special brand foods?
Do they have proof that their program works, not just praise given by other people?

Keep in mind that quick weight loss methods that rely on diet aids (like drinks, prepackaged foods, or diet pills) will not keep weight off in the long run. The best way to lose weight is slowly, with a healthy diet and exercise. The good eating and exercise habits you develop by losing weight this way will last a lifetime, helping you to control your weight and be healthy.

If I quit smoking, will I gain weight?

Not everyone gains weight when they quit smoking. Most people who do gain weight gain about 5 to10 pounds when they stop smoking. You are more likely to gain weight if you have smoked for 10 to 20 years or smoked one or more packs of cigarettes a day. It helps to remember that you can lose this weight with healthy eating and exercise. And, the health effects of smoking are far worse than being a few pounds overweight. If you smoke, talk with your health care provider about quitting.

Physical Activity

How can physical activity improve my health?
How can I prevent injuries when I exercise?
I am a larger woman. Can I be physically active?
Can I stay active if I have a disability?
What are some tips to help me get moving?
Do I need to talk to my health care provider before I start?

How can physical activity improve my health?

An active lifestyle can help every woman. Being physically active can provide these benefits:

reduces your risk of dying from heart disease or stroke
lowers your risk of getting heart disease, stroke, high blood pressure, colon cancer, and diabetes
lowers high blood pressure
helps keep your bones, muscles, and joints healthy
reduces anxiety and depression and improves your mood
helps you handle stress
helps control your weight
protects against falling and bone fractures in older adults
may help protect against breast cancer
helps control joint swelling and pain from arthritis
gives you more energy
helps you sleep better
helps you look better

Physical activity also is an important part of weight loss treatment. If you are overweight or obese, losing weight can lower your risk for many diseases. A growing number of women are overweight or obese. Being overweight or obese increases your risk of heart disease, type 2 diabetes, high blood pressure, stroke, breathing problems, arthritis, gallbladder disease, sleep apnea (breathing problems while sleeping), osteoarthritis, and some cancers. Obesity is measured with a body mass index (BMI). BMI shows the relationship of weight to height. Women with a BMI of 25 to 29.9 are considered overweight, whereas women with a BMI of 30 or more are considered obese. All adults (aged 18 years or older) who have a BMI of 25 or more are considered at risk for premature death and disability from being overweight or obese. These health risks increase as the BMI rises. Your health care provider can help you figure out your body mass, or you can go to http://www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm.

Not only are health care providers concerned about how much fat a person has, but also where the fat is located on the body. Women with a "pear" shape tend to store fat in their hips and buttocks. Women with an "apple" shape store fat around their waists. For most women, carrying extra weight around their waists or middle (with a waist larger than 35 inches) raises health risks (like heart disease, diabetes, or cancer) more than carrying extra weight around their hips or thighs

How can I prevent injuries when I exercise?

If you're not active at all or have a medical problem, start your program with short sessions (5 to 10 minutes) of physical activity and build up to your goal. Before you start your activity, be sure to warm up for 5 to 10 minutes. Use the right equipment - whether it's walking shoes, running shoes, or knee pads - make sure it's in good condition and right for your skill level. Drink water before, during, and after exercise. At the end of your physical activity, cool down by decreasing the intensity of your activity so your heartbeat is normal. Be sure to stretch. If your chest feels tight or painful, or you feel faint or have trouble breathing at any time, stop the activity right away and talk to your health care provider.

I am a larger woman. Can I be physically active?

Very large people face special challenges trying to be active. You may not be able to bend or move in the same way that other people can. It may be hard to find clothes and equipment for exercising. You may feel self-conscious being active around other people. Facing these challenges is hard, but it can be done! The Weight Control Information Network says that non-weight-bearing activities, like swimming or water workouts, put less stress on your joints because you don't have to lift or push your own weight. If your feet or joints hurt when you stand, non-weight-bearing activities may be best for you. If you can't do an activity, don't be hard on yourself. Be proud of pushing yourself up out of a chair or walking a short distance. Pat yourself on the back for trying even if you can't do it the first time. It may be easier the next time - so try again! Remember to appreciate what you can do, even if you think it's a small amount. Just moving any part of your body - even for a short time - can make you healthier.

Can I stay active if I have a disability?

One of the best things you can do for your health is to find an activity that gets your body moving and stick with it. You may be limited by a disability. This disability may make it harder, but it doesn't need to stop you from staying active. In most cases, people with disabilities can improve their heart, lungs, muscles, and bones - in addition to flexibility, mobility, and coordination - by becoming physically active. Talk to your health care provider about your personal needs.

What are some tips to help me get moving?

Choose an activity that's fun.
Change your activities, so you don't get bored.
Doing housework may not be fun, but it does get you moving! So does gardening, yard work, and walking the dog.
If you can't set aside one block of time, do short activities during the day, such as three, 10-minute walks.
Create opportunities for activity, such as parking your car farther away, taking the stairs instead of the elevator, or walking down the hall to talk to a coworker instead of using e-mail.
Don't let the cold weather keep you on the couch! You can still find activities to do in the winter like exercising to a workout video or joining a sports league. Or get a head start on your spring cleaning by choosing active indoor chores like window washing or reorganizing closets.
Use different jogging, walking, or biking paths to vary your routine.
Exercise with a friend or family member.
If you have children, make time to play with them outside. Set a positive example!
Make activities into social occasions - have dinner after you and a friend work out.
Read books or magazines to inspire you.
Set specific, short-term goals, and reward yourself when you achieve them.
Don't feel badly if you don't notice body changes right away.
Make your activity a regular part of your day, so it becomes a habit.
Build a community group to form walking clubs, build walking trails, start exercise classes, and organize special events to promote physical activity.

Do I need to talk to my health care provider before I start?

Talk to your health care provider before you start any physical activity if you:

have heart disease or had a stroke or are at high risk for them
have diabetes or are at high risk for it
are obese (body mass index of 30 or greater)
have an injury (like a knee injury)
are older than age 50
are pregnant

Carpal Tunnel Syndrome

What is carpal tunnel syndrome (CTS)?
What are the symptoms of CTS?
What causes CTS?
How is CTS treated?
Is there a cure for CTS?
How can I prevent CTS?

What is carpal tunnel syndrome (CTS)?

Carpal tunnel syndrome occurs when tendons in the wrist become inflamed after being aggravated. Tendons can become aggravated when the carpals (a tunnel of bones) and the ligaments in the wrist narrow, pinching nerves that reach the fingers and the muscle at the base of the thumb. Repetitive flexing and extension of the wrist may cause a thickening of the protective sheaths that surround each of the tendons, which narrows the tunnel. Women are three times more likely to develop CTS than men, and the risk increases with age. People between the ages of 40 and 60 are more commonly affected.

What are the symptoms of CTS?

The first symptoms usually appear at night. Symptoms range from a burning, tingling numbness in the fingers (especially the thumb and the index and middle fingers) to difficulty in gripping or making a fist. Many patients with CTS are unable to differentiate hot from cold by touch, and they experience an apparent loss of strength in their fingers. They might appear clumsy because they have trouble performing simple tasks such as tying their shoes or picking up small objects. In advanced cases, the thenar muscle at the base of the thumb atrophies, and strength is lost.

What causes CTS?

Although there are many reasons for developing this swelling of the tendon, it can result from repetitive and forceful movements of the wrist during work and leisure activities. Research by the National Institute for Occupational Safety and Health (NIOSH) indicates that job tasks involving highly repetitive manual acts, or necessitating wrist bending or other stressful wrist postures, are connected with incidents of CTS or related problems. Moreover, it is apparent that this hazard is not confined to a single industry or job but occurs in many occupations, especially those in the manufacturing sector. Jobs involving cutting, small parts assembly, finishing, sewing, and cleaning seem predominantly associated with the syndrome. The factor common in these jobs is the repetitive use of small hand tools. CTS can also be due to trauma from repetitive work such as that of supermarket checkers, checkers in other types of stores, assembly line workers, meat packers, typists, word-processors, accountants, and writers.

How is CTS treated?

CTS is treated by immobilizing the wrist in a splint. Then, either anti-inflammatory drugs or injections of cortisone are used to reduce swelling in the wrist. There is also a surgical procedure in which doctors can open the wrist and cut the ligament at the bottom of the wrist to relieve the pressure. However, only a small percentage of patients require surgery.

Is there a cure for CTS?

Most people with CTS recover completely and can avoid re-injury by changing the way they do repetitive movements, the frequency with which they do the movements, and the amount of time they rest between periods when they perform the movements. Approximately 1 percent of individuals with CTS develop permanent injury.

How can I prevent CTS?

You can help prevent CTS by taking the following precautions:

Reduce your force and relax your grip. Studies show that most people use four to five times more force than necessary to perform most tasks involving the hands. If your work involves hitting keys, hit them softly. If you frequently write by hand, use a big pen with an oversized, soft grip adapter and free-flowing ink. This way, you will not have to grip the pen tightly or press hard on the paper.

Take frequent breaks. Every 15 to 20 minutes, give your hands and wrists a break by gently stretching and bending them. Also alternate tasks when possible. For example, type for 15 minutes then do some phone work for 5 minutes. If you use equipment that vibrates or on which you exert a great amount of force, taking breaks is even more important.
Watch your form. Avoid bending your wrist all the way up or down. A relaxed middle position is best. If you use a keyboard, keep it at elbow height or slightly lower.
Improve your posture. The tendency to roll the shoulders forward shortens the neck and shoulder muscles, compressing nerves in the neck. This, in turn, can affect the wrist, fingers and hand.
Keep your hands warm. You're more likely to develop carpal tunnel syndrome if you work in a cold environment. If you can't control the temperature at work, put on fingerless gloves that keep your hands and wrists warm.
Use ergonomically designed equipment. If you use a computer, try using a track ball instead of a mouse if you're on a computer all day, or position your keyboard at elbow height or lower so that it reduces stress and increases efficiency. Also try to use proper seating. The height of your seat and position of your backrest should be adjustable. The chair should be on wheels so you can move easily, and arm rests are also helpful.

On a large scale, the Centers for Disease Control and Prevention (CDC) recommends the redesign of tools or tool handles to enable the user's wrist to maintain a more natural position during work. Other recommendations have involved modifying the layouts of workstations. Other approaches include altering the existing method for performing the job task, providing more frequent rest breaks, and rotating workers across jobs.

For more information

U.S. Federal Government Nutrition.gov
Internet: www.nutrition.gov

American Diabetes Association
Phone: 800-DIABETES (800-342-2383)
Internet: www.diabetes.org

American Dietetic Association
Phone: 800-366-1655
Internet: http://www.eatright.org

American Heart Association
Phone: 800-242-8721
Internet: www.americanheart.org

National Heart, Lung, and Blood Institute
Phone Number (s): (301) 592-8573
Internet Address: http://www.nhlbi.nih.gov/index.htm

National Cholesterol Education Program
National Heart, Lung, and Blood Institute
Internet Address: http://www.nhlbi.nih.gov/chd/

The Heart Truth
National Awareness Campaign for Women about Heart Disease
National Heart, Lung, and Blood Institute
Phone Number(s): (800) 793-2665
Internet Address: http://www.nhlbi.nih.gov/health/hearttruth/index.htm

National High Blood Pressure Education Program
National Heart, Lung, and Blood Institute
Internet Address: http://www.nhlbi.nih.gov/about/nhbpep/

The National Bone Health Campaign: Powerful Bones. Powerful Girls.
Centers for Disease Control and Prevention
Phone Number(s): (770) 488-5820
Internet Address: http://www.cdc.gov/powerfulbones

National Institutes of Health
Osteoporosis and Related Bone Disease National Resource Center
Phone Number(s): (800) 624-2663
Internet Address: http://www.osteo.org

Office of the Surgeon General, OS, HHS
Phone Number(s): (301) 443-6496
Web Site: http://www.surgeongeneral.gov/Default.htm

The Surgeon General's Call to Action to Prevent and Decrease Overweight and Obesity
http://www.surgeongeneral.gov/topics/obesity/

National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK)
Phone Number(s): (301) 654-4415
Weight Loss and Control Topics: http://www.niddk.nih.gov/health/nutrit/nutrit.htm
Web Site: http://www.niddk.nih.gov/

National Heart, Lung, and Blood Institute Information Center (NHLBI)
Phone Number(s): (301) 592-8573 (Publications) or (800) 575-9355 (Blood Pressure & Cholesterol Information)
Web Site: http://www.nhlbi.nih.gov/health/infoctr/index.htm

NHLBI Aim for a Healthy Weight (Obesity Education Initiative):
http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/index.htm
NHLBI's BMI Calculator
http://www.nhlbisupport.com/bmi/bmicalc.htm
NHLBI's BMI Tables
http://www.nhlbi.nih.gov/guidelines/obesity/bmi - tbl.htm

National Library of Medicine
Phone Number(s): (888) 346-3656
MEDLINE plus links to obesity information: http://www.nlm.nih.gov/medlineplus/obesity.html
Web Site: http://www.nlm.nih.gov/

Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Phone Number(s): (888) 232-4674
Nutrition and Physical Activity: http://www.cdc.gov/nccdphp/dnpa/index.htm
Web Site: http://www.cdc.gov/nccdphp/dnpa/

President's Council on Physical Fitness and Sports
Phone Number(s): (800) 258-8146
Web Site: http://www.fitness.gov

Weight Control Information Network
National Institute of Diabetes and Digestive and Kidney Diseases
(NIDDK)
Phone Number(s): (877) 946-4627
Web Site: http://www.niddk.nih.gov/health/nutrit/win.htm

Food and Nutrition Information Center
U.S. Department of Agriculture
Phone Number(s): (301) 504-5414
Web Site: http://www.nal.usda.gov/fnic/

Food and Drug Administration
Phone Number(s): (888) 463-6332 (Consumer Information)
Web Site: http://www.fda.gov

Federal Trade Commission
Phone Number(s):(202) 326-2222
Web Site: http://www.ftc.gov/

American Heart Association
Phone Number(s): (800) 793-2665
Web Site: http://www.americanheart.org/

International Food Information Council
Phone Number(s): (202) 296-6540
Web Site: http://ificinfo.health.org/

Center for Nutrition Policy and Promotion, FCS, FNCS, USDA
Phone: (703) 605-4266
Internet Address: http://www.usda.gov/cnpp/

Division of Nutrition and Physical Activity, NCCDPHP, CDC
Phone: (770) 488-5820
Internet Address: http://www.cdc.gov/nccdphp/dnpa/

Food and Nutrition Information Center, NAL, USDA
Phone: (301) 504-5414
Internet Address: http://www.nal.usda.gov/fnic/

Weight Control Information Network, NIDDK, NIH, HHS
Phone: (877) 946-4627
Internet Address: http://www.niddk.nih.gov/health/nutrit/win.htm

American Council on Exercise
Phone: (800) 825-3636
Internet Address: http://www.acefitness.org/

American Obesity Association
Phone: (800) 98-OBESE
Internet Address: http://www.obesity.org/

American Chronic Pain Association
Phone: (916) 632-0922
Internet Address: http://www.theacpa.org

Clearinghouse for Occupational Safety and Health Information, National Institute for Occupational Safety and Health (NIOSH)
Phone: (800) 35-NIOSH
Internet Address: http://www.cdc.gov/niosh/homepage.html

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMSD)
Phone: (301) 496-8190
Internet Address: http://www.niams.nih.gov

Food Group	Daily Servings	Serving Sizes	Examples and Notes
Grains and products	7 to 8	1 slice bread 1 oz dry cereal ½ cup cooked rice, pasta, or cereal	whole wheat bread, English muffin, pita bread, bagel, cereal, grits, oatmeal, crackers, unsalted pretzels and popcorn - these are major sources of energy and fiber
Vegetables	4 to 5	1 cup raw leafy vegetable, ½ cup cooked vegetable, 6 oz vegetable juice	tomatoes, potatoes, carrots, green peas, squash, broccoli, turnip, greens, collards, kale, spinach, artichokes, green beans, lima beans, sweet potatoes - these are rich sources of potassium, magnesium, and fiber
Fruits	4 to 5	6 oz fruit juice1 medium fruit ¼ cup dried fruit, ½ cup fresh frozen, or canned fruit	apricots, bananas, dates, grapes, oranges, orange juice, mangoes, melons, peaches, pineapples, prunes, raisins, strawberries, tangerines - these are important sources of potassium, magnesium and fiber
Low-fat or non-fat dairy foods	2 to 3	8 oz milk, 1 cup yogurt, 1.5 oz cheese	fat free or low-fat milk, fat free or low-fat buttermilk, fat free or low-fat regular or frozen yogurt, low-fat and fat free cheeses - these are major sources of calcium and protein
Meats, poultry, and fish	2 or less	3 oz cooked meats, poultry, or fish	select only lean; trim away visible fats; broil, roast, or boil instead of frying; remove skin from poultry - these are rich sources of protein and magnesium
Nuts, seeds, and dry beans	4 to 5 per week	1/3 cup or 1.5 oz nuts 2 Tbsp or ½ oz seeds ½ cup cooked dry beans	almonds filberts, mixed nuts, peanuts, walnuts, sunflower seeds, kidney beans, lentils, peas - these are rich sources of energy, magnesium, potassium, protein and fiber
Fats and oils	2 to 3	1 tsp soft margarine 1 Tbsp low-fat mayonnaise 2 Tbsp light salad dressing 1 tsp vegetable oil	soft margarine, low-fat mayonnaise, light salad dressing, vegetable oil (such as olive, corn, canola or sunflower) - DASH has 27 percent of calories as fat, including that in or added to foods
Sweets	5 per week	1 Tbsp sugar 1 Tbsp jelly or jam ½ oz jelly beans, 8 oz lemonade	maple syrup, sugar, jelly, jam, fruit-flavored gelatin, jelly beans, hard candy, fruit punch, sorbet, ices - these are sweets, should be low in fat
*Ask your health care provider or RD what is a reasonable daily calorie level for you.

Food Group	1,600 calories/day	3,100 calories/day
Grains and grain products	6 servings/day	12 to 13 servings/day
Vegetables	3 to 4 servings/day	6 servings/day
Fruits	4 servings/day	6 servings/day
Low fat of nonfat dairy foods	2 to 3 servings/day	3 to 4 servings/day
Meats, poultry, and fish	1 to 2 servings/day	2 to 3 servings/day
Nuts, seeds, and dry beans	3 servings/week	1 serving/day
Fats and oils	2 servings/day	4 servings/day
Sweets	0	2 servings