Functional Foods for Health: 6 Top Nutrients

Which functional food nutrients are worth your money? The experts weigh in.

We all want to improve heart health by lowering our cholesterol and blood pressure, boosting our immunity, and regulating digestion. That’s why so many of us are jumping on the functional food bandwagon.

Generally defined as any food that provides health benefits beyond basic nutrition, functional foods are “just foods that promote healthy body functions, helping the body repair itself and work optimally,” says Christine Gerbstadt, MD, RD, a physician and spokesperson for the American Dietetic Association. “They’re enhancing what food already does.”

Which is why so many of us are filling shopping carts with foods and drinks enriched with everything from omega-3 fatty acids and fiber, to plant sterols and probiotics. Not every functional food ingredient has been scientifically proven to be beneficial, however. That’s why WebMD asked the experts which nutrients they would single out as worthy, who benefits from them, and where in the functional food world each can be found.

6 Top Functional Food Ingredients

Before the health professionals named names, each echoed the sentiment of Susan Moores, a registered dietitian and American Dietetic Association spokesperson. “The most important message is: first lay the foundation of a healthy diet with whole foods, then weave in functional foods.”

Ingredients to look for include:

Calcium in Functional Foods

Instrumental in lowering high blood pressure, helping with regular heart beat, and building strong bones, calcium is also a nutrient most of us aren’t getting enough of, according to the 2005 Dietary Guidelines for Americans. And it’s not just women who need more calcium. Men, too, are also at risk for osteoporosis.

While one of the best ways to get calcium is through foods like milk, cheese, and yogurt, not everyone likes or can tolerate dairy. Here’s where functional foods can play a part, say the pros. Along with eating calcium-rich whole foods like dark, leafy greens, look for fortified orange juice, breads, waffles, and soy milk. And don’t forget to get enough vitamin D, which is vital to calcium’s absorption.

Calcium: how much? Adults and pregnant women between age 19 and 50 should aim for 1,000 mg of calcium daily. Adults over 51 should consume about 1,200 mg. Pregnant women under age 19 need 1,300 mg. Vitamin D is vital for the absorption of calcium, ideas on how to get more vitamin D in your diet follow.

Fiber in Functional Foods

Most of us know fiber aids in digestion, but keeping us regular is just the beginning. This powerhouse nutrient also helps fight disease, and may lower risk for high cholesterol, heart disease, diabetes, and cancer.

With all that going for it, it’s a shame that American men and women aren’t getting enough. Most of us are scraping by on half of the fiber we actually need, says the American Heart Association. How can you get more? Produce and whole grains are prime sources for heart-healthy fiber, while functional foods such as breads, cereals, soymilk, and yogurts can fill in gaps.

Fiber: how much? Most of us get about 15 grams daily, but to fight disease and keep digestion humming, aim for at least 30 grams. But take it slow, adding too much fiber too fast can lead to bloating, gas, and diarrhea.

Omega-3 Fatty Acids in Functional Foods

“I think pretty much everyone could benefit from more omega-3s,” says Elaine Magee, a registered dietitian, and author of Food Synergy. “They’re a smart, polyunsaturated fat, and one of the most powerful nutrients we know of.”

Omega-3 fatty acids not only raise good, HDL cholesterol and lower bad LDL cholesterol, they may also lower your risk of heart attack and strokes. Foods with omega-3s are “the functional foods I think are worth the extra pennies,” says Gerbstadt. At the supermarket, look for whole foods rich in omega-3s like salmon, walnuts and flax, as well as functional foods such as omega-3-rich eggs, breads, milk, soy milk, and cereal.

Omega-3s: how much? Of the three major types of omega-3 fatty acids -- alpha-linolenic (ALA), eicosapentaenoic (EPA) and docosahexaenoic (DHA), the body uses EPA and DHA more readily. The American Heart Association suggests that people with coronary heart disease consume about 1 gram of EPA+DHA omega-3 fatty acids daily. They do not recommend supplements for healthy people; instead, they recommend eating fish twice a week.

Plant Sterols and Stanols in Functional Foods

“Plant sterol spreads have good science behind them,” says David Grotto, RD, author of 101 Foods That Could Save Your Life, “if you have high cholesterol, they can be a really good thing.” Because they reduce cholesterol in the blood, plant sterols may also reduce your risk of coronary artery disease, a leading cause of death for American men and women.

Plant sterols and stanols are found in small amounts naturally in grains, vegetables, fruits, legumes, nuts, and seeds. It’s difficult to get enough sterols and stanols in whole foods, says Kerry Neville, MS, RD, a registered dietitian. That’s where functional foods may help. If you have high cholesterol, look for plant sterols in margarine, fortified juices, granola bars, among other foods.

Plant sterols: how much? The National Cholesterol Education Program recommends 2 grams of plant sterols and stanols a day for people with high cholesterol. To get that, look for functional foods containing at least 0.65 grams of plant sterols per serving, suggests the FDA. Note: The American Heart Association does not recommend plant sterols for people with normal or low cholesterol until further research on long-term health effects is done.

Probiotics in Functional Foods

Probiotics are live microorganisms very similar to the beneficial ones you’ve already got living inside your gut. Though still in the early stages of study, encouraging evidence suggests that probiotics may benefit those on antibiotics, with some bowel disorders, diarrhea, or certain infections.

While yogurt is a well-known functional food with probiotics, you can also find them in juices and soy drinks though some foods have far more than others and “each probiotic offers different things,” Magee tells WebMD. “What they do and how they help depends on the probiotic and the person using it. We’re still learning.”

Probiotics: how much? Because their effectiveness is still being studied, few recommendations exist. If you think probiotics may fit into your diet talk to your doctor -- and then read labels carefully.

Vitamin D in Functional Foods

“Vitamin D…is one of those nutrients we just don’t get enough of,” Neville says, “it’s very difficult to get, depending on where you live and the season.

The best way for most of us to get the vitamin D we need is through 10 to 15 minutes of sunshine several times a week. But dark skin, season, and geography can limit how much vitamin D your body is able to make. That’s one reason you can find vitamin D in functional foods like milk, yogurt, and fruit juices.

Vitamin D: how much? Current recommendations for vitamin D are 200 international units (IU) for those under 50, and double that for those age 51 to 70. Vitamin D requirements increase to 600 IU for people over than 70, as older skin is less efficient at making the vitamin.

Functional Foods: Only Part of the Picture

It’s important to remember that functional foods and the nutrients in them won’t win the day if your diet is poor. "The underlying fact in all this is you really need to have a healthy diet,” says Neville.

That means following the basics of a heart-healthy living, including eating lots of good-for-you foods like fruits, veggies, and whole grains, getting plenty of exercise, and maintaining your weight.

“If you don’t have a healthy diet to begin with, adding functional foods isn’t going to make your diet healthy,” Neville sums up. The healthy diet part -- that’s up to you.

Teens Trim Up With Incisionless Surgery

“Sewing Machine” Used to Create Smaller Stomach Pouch, Limiting Food Intake

May 20, 2008 -- Using a tiny sewing machine that is advanced down through the mouth and into the stomach, doctors are successfully reducing the size of obese teens' tummies -- and helping them to shed unhealthy pounds.

So far, 12 adolescents aged 14 to 17 have undergone the procedure. Their average weight dropped from 236 pounds before the procedure to 187 pounds six months afterward.

On average, the teens lost 60% of their excess weight in six months, says Roberto Fogel, MD, of the Hospital de Clinicas Caracas in Venezuela. Fogel invented the procedure.

There were no serious complications, and the patients left the hospital a few hours after the 40-minute procedure. One played softball that night, Fogel says.

The findings were presented at Digestive Disease Week 2008 in San Diego.

How It Works

The incisionless technique involves sewing the front and the back of the stomach together. This creates a smaller stomach pouch, thus limiting how much food you can eat.

Also, food moves more slowly from the top of the stomach to the bottom because only a small opening is left between the two.

"Imagine taking a plastic bag and going two-thirds of the way up or one-third of the way down. Then you sew the front to the back wall, but you leave a little opening between the two," says Mark DeLegge, MD.

DeLegge, a professor of medicine at the Digestive Disease Center of the Medical University of South Carolina in Charleston, moderated a news briefing to discuss the findings.

Doctors introduce the surgical instruments through the mouth, down the esophagus, and into the stomach via a guidewire that is placed alongside a long flexible tube called an endoscope.

The procedure is performed while the patient is under general anesthesia.

Small Portions Key

Fogel stresses that patients have to agree to stick to a diet and exercise program after the procedure. Small portions are key.

"If you start eating too much, you can rip the sutures," he says. "But this [procedure] leaves you less hungry and with less space for food, so it's easier to eat less."

The study in teens was conducted in Venezuela. Fogel has also performed the technique on several hundred adult patients in Venezuela and Miami, with equally good results.

Because it doesn't involve surgery, the procedure may be particularly appropriate for teens, DeLegge tells WebMD.

Many doctors are reluctant to operate on "13-, 14-, or 15-year-olds whose digestive systems may not be fully developed. This [procedure] offers a nonsurgical approach, and one that can be reversed if necessary," DeLegge says.

With nearly one in five teens now obese, "it's obvious we have to do something to fight the epidemic," he says. Obesity in childhood and adolescence has been linked to obesity and an increased risk of cardiovascular disease in adulthood.

While further study is needed to confirm the procedure's safety and long-term effectiveness, "this is not pie in the sky stuff. This is real," DeLegge says.

Fogel says that in addition to the health benefits of shedding excess pounds, "these kids have a very nice change in quality of life. They lose 40 or 45 pounds, they feel different. They start going out more. It's a total life change," he says.

Healthy Oils, Healthy Fats

Good fats are emerging as one of the hottest new functional foods.

When Americans started to pack on pounds a few decades ago, fat was fingered as public enemy number one. “Low-fat” became the rallying cry for healthy eating. And so began one of the most misguided public health campaigns in history.

Most of us know by now that the main villains are saturated fats, found chiefly in meat and high-fat dairy products, and trans fats, found in fried foods, cakes, crackers, and some margarines. They raise total cholesterol levels and gum up arteries. Unsaturated fats, which mostly come from plants and fish, are essential to good health.

But even the good fat/bad fat message is turning out to be more complicated than nutritionists once thought, as researchers explore the health effects of the many different kinds of fatty acids. With evidence emerging that healthy fats not only improve cholesterol and triglyceride levels but also reduce inflammation, fats are emerging as one of the hottest new functional foods.

Polyunsaturated vs. Monounsaturated: Choosing the Healthiest Oil

“We can now say unequivocally that unsaturated fats protect against heart disease,” says John Brunzell, MD, professor emeritus in the division of metabolism at the University of Washington, Seattle.

• In an analysis of data from 60 trials, researchers at Maastricht University in the Netherlands found that cutting back on carbohydrates and consuming more polyunsaturated and monounsaturated fats decreases the level of harmful LDL cholesterol and increases protective HDL cholesterol.
• The more recent Optimal Macronutrient Intake Trial for Heart Health (OmniHeart) study showed that a diet rich in unsaturated fats also lowers blood pressure and reduces overall heart disease risk.

Debates have long raged about whether monounsaturates or polyunsaturates have the edge. The Maastricht University study found a slight advantage to polyunsaturated fats for improving the ratio of HDL (good cholesterol) to total cholesterol. But studies of people with diabetes, who have a high risk of heart disease, conducted at Trinity College in Dublin suggest that monounsaturated fats may offer more protection.

In the end, few of us keep count of grams of monounsaturated or polyunsaturated fat, of course. All edible oils are a blend of these two types of fat. Edible oils also contain at least some saturated fat. The amount of saturated fat in oil may be a more important consideration than the ratio of monos to polys.

• Olive oil, for instance, contains 73% monounsaturated fat, 11% polyunsaturated fat, and 14% saturated fat.
• Soybean oil, by contrast, is 24% mono, 61% poly, and 15% saturated fat.
• Canola oil wins high marks. It’s 62% monounaturated, 32% polyunsaturated, and only 6% saturated fat -- by far the lowest among edible oils.

A 2007 study by researchers at the Department of Food Science and Human Nutrition at the University of Illinois, Urbana-Champaign found that substituting canola oil for other vegetable oils and canola oil-based margarine for other spreads could significantly lower saturated fat levels in the American diet. What’s more, canola oil is also a good source of omega-3 polyunsaturated fats, which may be especially crucial to good health.

Of course, studies of the Mediterranean diet suggest that olive oil, which has a very different fatty acid profile, also offers potent protection against heart disease.

“In fact, there are many healthy unsaturated oils,” says Brunzell. “The issue isn’t choosing the healthiest, but encouraging people to use the ones they like.”

Polyunsaturated fats can be subdivided into omega-6, found in most plants, and omega-3 fatty acids, found predominantly in fish oils. Many researchers think the balance of these two fats may be the most critical measure of a healthy diet.

Currently, the modern diet is tipped heavily toward omega-6s, says Floyd Chilton, PhD, director of the Bontanical Lipids Center at Wake Forest University. “In the average western diet, the ratio is about 9:1 omega-6s to omega-3s. In some individuals we’ve studied, the ratio is as high as 40:1.”

No one knows what the optimum balance should be. According to Chilton, there’s good evidence that the diet of hunter-gatherers -- and thus the diet our bodies evolved to eat -- had a ratio of 2:1 omega-6s to omega-3s.

Restoring something close to that balance could help fight many of the chronic diseases that plague us, Chilton believes. “Omega-6s fatty acids regulate genes that spark inflammation. And inflammation is increasingly being seen as the central process in heart disease, diabetes, arthritis, and other chronic health problems.”

Omega-3s, in contrast, tamp down inflammation and have been linked to many health benefits, including lowering triglyceride levels, guarding against dangerous irregular heart rhythms, and preventing plaque from breaking away from the lining of arteries. A 2006 review in The American Journal of Cardiology found that consuming omega-3s from fish, nuts, or soybean oil can lower cardiovascular risk by as much as 60%.

Contains Omega-3s: Can You Believe the Latest Health Claim?

The good news about omega-3s hasn’t been lost on food manufacturers. “Contains omega-3s” is the hottest new health claim on packages.

In 2000, omega-3 supplementation was a $100 million business, according to Chilton. By 2007, it had ballooned into a $3 billion business, which is expected to more than double by 2011.

Unfortunately, the omega-3s touted on the packages today are usually in the form of flaxseed oil, which is not as biologically available as omega-3s from fish oil. More and more manufacturers are beginning to switch to fish oil, according to Chilton, using a double encapsulation technology that prevents the flavor and smell from affecting food. The functional food industry is also working overtime to develop plant sources of omega-3s that are biologically active.

But not everyone’s sold on the idea that a healthy diet should be built on fortified foods and supplements. “There’s a long history of nutrients being taken out of food and put into pills, from vitamin E to beta carotene, and the results have not been encouraging,” says Brunzell. He thinks people should be encouraged to get their nutrients from foods that are known to be healthy -- fish, nuts, fruits and vegetables, and whole grains.

One of the first fat-based functional foods to hit the market were spreads and margarines made with substances from plants called sterols and stanols, which have been shown to lower LDL. These substances are similar in size to the cholesterol molecule but they work by blocking the absorption of cholesterol in the intestines. Plant stanols or sterols occur naturally in foods such as fruits and vegetables, but not in high enough concentration to have an impact on cholesterol. So they are concentrated and added back to select foods.

The National Cholesterol Education Program recommends eating 2 grams of plant sterols or stanols a day if you have high cholesterol. But for people who do not have high cholesterol, both the NCEP and the American Heart Association do not recommend foods enriched with plant sterols. Instead, those people should get the plant sterols found naturally in vegetables and fruits.

“Most people can get the same benefits from using unsaturated oils and eating plenty of vegetables, which are the natural source of sterols and stanols,” says Brunzell.

How Functional Foods May Help Your Heart

For a healthy heart, can foods fortified with calcium, omega-3s, plant sterols, and other nutrients help?

Most of us want to keep our hearts healthy. Increasingly in that quest, some of us are turning to functional foods, in addition to eating right, exercising, and maintaining our weight.

According to most definitions, functional foods are foods or drinks that provide a health benefit beyond basic nutrition. Think milk with added vitamin D and orange juice boosted with calcium.

They’re foods fortified “with natural substances to make them work better than they would,” says Christine Gerbstadt, MD, RD, a physician and spokesperson for the American Dietetic Association. Heart-healthy added nutrients include substances like omega-3 fatty acids, plant sterols, and calcium.

It’s because of these beneficial nutrients, and the fact that many of us are troubled with high blood pressure and cholesterol, that we’re turning to fortified foods in growing numbers. The question is, can functional foods help?

Functional Foods: Focusing In

The pocketbook vote is already in on functional foods, with their popularity expected to more than double by 2009, when sales are predicted to reach $60 billion, say market researchers Information Resources, Inc.

While studies are still unravelling the secrets of how nutrients like omega-3 fatty acids and plant sterols and stanols help lower cholesterol, food manufacturers are rushing to add these and other nutrients to everything from tea to whole grain bread.

Stroll down almost any supermarket aisle and you’ll find dozens of foods that fall under the broad label “functional,” including:

• Bread & waffles
• Cereal
• Pasta
• Margarine
• Milk, yogurt, & cheese
• Eggs
• Soy
• Juice
• Tea
• Even pet food

Are extra nutrients boosting the nutrient profile of these foods in turn boosting our health? All of the health professionals WebMD spoke with answered with a very qualified yes.

“Functional foods, including whole foods and fortified, enriched, or enhanced foods, have a potentially beneficial effect on health when consumed as part of a varied diet on a regular basis, at effective levels,” says Gerbstadt. “There are many heart benefits to eating foods high in polyunsaturated fats, plant sterols, omega-3 fatty acids, and potassium.”

Others echo these sentiments, adding that there’s strong evidence for the health claims of some nutrients -- such as plant sterols and omega-3 fatty acids -- but weak, or non-existent evidence for others.

“Remember, manufacturers are trying to sell a product, and some of it makes more sense than others,” says Elaine Magee, MPH, RD, WebMD’s ‘Recipe Doctor,’ and author of Food Synergy.

For example, Whole-grain bread with added fiber will always be more diet-sensible than fizzy drinks laced with antioxidants, or chocolates pumped with omega-3s.

“You still need to look at the label and ask yourself, “Is this my best choice?” says

Heart-Healthy Nutrients Found in Functional Foods

The best choices, of course, differ from person to person. Which is why, along with a diet rich in whole foods, registered dietitian Susan Moores recommends treating functional foods like supplements, there to fill in gaps in your regular diet.

Typically, American adults are short on calcium, fiber, magnesium, potassium, and vitamins A (as carotenoids), C, and E, according to the 2005 Dietary Guidelines for Americans, issued every five years by the Department of Health and Human Services. Add to that our love affair with saturated fats, sugars, and salt, and many of us are on our way to -- or are already coping with -- high blood pressure, high cholesterol, diabetes, and obesity.

Though you can likely find functional foods enriched with just about any nutrient you choose, here are some of the key nutrients experts say boost heart health. You can find these ingredients in almost everything from eggs to margarine spreads.

Omega-3 Fatty Acids

Your heart loves omega-3 fatty acids for a host of reasons. Studies show that these healthy fats reduce incidents of cardiovascular disease and protect against heart attacks, sudden coronary death, and blood clots.

A diet rich in omega-3 fatty acids also helps lower blood pressure, triglycerides, and LDL (bad) cholesterol. And omega-3s increase HDL (good) cholesterol, and may boost the immune system, and reduce inflammation (a component of heart disease and strokes).

Among other things, “think of omega-3 fats as a bucket of water on the fire of inflammation,” suggests nutrition advisor David Grotto, RD, LDN, author of 101 Foods That Could Save Your Life.

Foods rich in Omega-3 fatty acids

You can find omega-3 fatty acids in foods such as salmon, walnuts, and flaxseed. A superstar in the functional food world, you can also find heart healthy omega-3s in dozens of items on your supermarket shelf, including eggs, breads, cereal, margarine, soy beverages, milk, and yogurt.

Plant Sterols and Stanols

While chemically similar to cholesterol, it turns out that plant sterols and stanols can reduce bad cholesterol in the blood by preventing its absorption. That may mean a reduced risk of coronary heart disease, the leading cause of death for American men and women. The American Heart Association recommends plant sterols and stanols for people with high cholesterol -- or those who’ve had a heart attack -- but not for the general well population until further study.

Foods rich in plant sterols and stanols

Most people can get adequate sterols and stanols naturally in nuts, seeds, many fruits, vegetables, and other plants. But if you have high cholesterol “you almost can’t get enough plant sterols in your diet by eating regular foods,” says Kerry Neville, MS, RD, a registered dietitian in Washington. “Functional foods in this regard can really help.” Look for plant sterols in functional foods like margarine spreads, fortified juices, and granola bars.

Calcium

Important in lowering blood pressure, calcium plays many roles in a heart-healthy diet. Calcium helps with regular heart beat, muscle contractions, and of course, bone strength.

"Women, and men too, don’t get enough calcium,” Neville tells WebMD. While most dairy is calcium-rich, there are many people who can’t, or don’t, enjoy it. That’s where supplements and fortified foods and drinks can help, Neville says.

Foods rich in calcium: Look for calcium in foods such as cheese, yogurt and milk, as well as dark leafy greens and sardines. When searching for calcium-boosted functional foods, look for 100% fruit juices, soy milk, waffles, and some breakfast cereals. Important in lowering blood pressure, calcium plays many roles in a heart-healthy diet. Calcium helps with regular heart beat, muscle contractions, and of course, bone strength.

Vitamin D

Vitamin D is a powerhouse nutrient, known to build strong bones, and thought to protect against some cancers, inflammation, diabetes, and perhaps even multiple sclerosis. Now research also suggests that too-low levels of calcium can play havoc with heart health, doubling risks of stroke, heart failure, and heart attack.

Foods rich in Vitamin D

You’ll find vitamin D in whole foods like catfish, sardines, salmon, tuna and egg yolks, while functional foods enriched with vitamin D include milk, yogurt, margarines, cereals and some fruit juices.

It’s worth noting that one of the best ways to get vitamin D isn’t through food or drink, but via sunshine. The human body is adept at making all or almost all the vitamin D it needs with as little as 10 to 15 minutes of sunscreen-free sun exposure on arms and face a few times a week. However, if you have dark skin, or live in places where sunshine is limited you may need far more sun than that. To find out if you’re getting enough vitamin D, talk with your doctor about getting tested.

Fiber

Fiber is another powerhouse nutrient for heart health. Along with a low-fat diet, soluble fiber -- the type that is absorbed by the body -- is associated with reducing LDL cholesterol and cardiovascular risk. Insoluble fiber -- the type that passes through the digestive system without getting absorbed by the body -- helps prevent or slow the progression of cardiovascular disease and aids digestion. Most fruits, vegetables, and whole grains contain both types of fiber.

Foods rich in fiber

You’ll find dozens of whole foods packed with fiber, including oats, oatmeal and barley, beans, peas, carrots, cabbage, and apples. Functional foods to look for include low-fat waffles, breads and yogurt, as well as soy milk and cereal.

A Healthy Heart and Functional Foods

So what’s the take-home message on a heart-healthy diet and functional foods? Many experts echo dietitian Susan Moores, who advises people to “lay the foundation…with whole foods, then weave in functional foods,” to help close nutrient gaps.

When added to a diet rich in produce and whole grains, and a lifestyle of weight maintenance and exercise, functional foods may be an easy way to help many of us get the nutrients we need to keep us going strong.

6 Simple Steps to Keep Your Heart Healthy

Keeping your heart healthy is so simple it can be put into catchy, two-word phrases: Eat right. Get exercise. Don’t smoke.

Putting those heart-healthy catch phrases into action, of course, isn’t so simple. Which matter most? How can you put them into daily practice?

Here are practical heart health hints you can use every day.

Get Exercise: Time to Play

Adults need at least 30 minutes of exercise five or more days a week for heart health. But improving cardiovascular and overall health isn’t only about sweating on a treadmill or climbing stairs, say the pros. Getting out to play is exercise too, and improving heart health is just as easily about kickball with your kids, walking the dog, or shooting hoops with colleagues during your lunch break.

Heart-Healthy Keys to Exercise

Get a total of at least 30 minutes of exercise daily -- and you don’t have to do it all at once. Aim for a 10-minute morning walk perhaps, a short workout with hand weights at lunch, and some digging in the garden before dinner, and you’ve met your goals.

To get the full benefits of aerobic exercise “folks should get their heart rate up so they’re somewhat breathless, but can still carry on a conversation,” says Susan Moores, RD, MS, a registered dietitian and American Dietetic Association spokeswoman. She adds that all kinds of exercises are important, from strength training and aerobics, to flexibility and stretching exercises.

Routine Exams: Get Checked

“Nobody’s going to keep an eye on your medical health other than you," says Elaine Magee, MPH, RD, author of Food Synergy, and WebMD’s "Recipe Doctor." "You are in charge."

That’s an easy thing to forget, especially when talking about the ho-hum pragmatism of routine health exams. Yet getting regular blood pressure, blood sugar, and cholesterol checks, as well as physical exams are important steps in maintaining heart health.

“Anything you can find out about what’s going on inside your body the better,” says Magee. Especially true when you consider that heart-threatening conditions like high blood pressure and high cholesterol are “silent” -- meaning there’s almost no way to know you have them unless you get tested.

Heart-Healthy Keys to Routine Exams

Which regular exams you need depends on you age, health risks, and gender, so talk with your physician about what’s right for you. However there are some exams just about everyone needs:

For everyone: We all benefit from regular blood pressure, blood sugar, and blood cholesterol checks, as well as immunizations, eye exams, and mole checks. As we enter our 50s and 60s, colon cancer screenings, rectal exams, and bone density tests become important, too.

For women: Stay on top of regular breast exams and mammograms, pap tests, and pelvic exams, and in your 50s you’ll want to add a thyroid hormone test. How often you need these routine exams depends on your age and risks, so talk with your physician.

For men: Men need regular testicular exams at least through their 40s, and PSA-prostate exams as they approach middle age. Some men may require other exams depending on their family history and risks; be sure to check with your doctor to find out what tests make sense for you.

And if you experience anything out of the ordinary it’s always “better to be safe than sorry -- go seek medical attention,” stresses Magee. After all, you know your body.

Weight Maintenance: Keeping a Healthy Weight

Obesity in the United States is at an all-time high, says the Centers for Disease Control and Prevention, putting a growing number of people are at risk for heart disease, stroke, and high blood pressure.

Maintaining a healthy weight not only reduces your risks for these and other conditions, it can improve sleep, boost energy, and rev up self-esteem.

Heart-Healthy Keys to Weight Maintenance

Go for calorie density: Choose nutritionally-dense foods to get as much nutrition as you can from the calories you eat. A can of cola has over 120 calories and no nutrients. A palmful of mixed nuts has about 165 calories and is packed with body-building protein and heart-healthy fats.

Get physical: Get moving at least 30 minutes daily, most days of the week. Children and teens need at least 60 minutes of activity most days.

Balance calories: Be aware of the balance between the calories you consume and the calories your body needs. To lose weight, consume fewer calories than you burn.

Eat Healthy: Quick Tips

You know the drill: Eat more produce (aim for at least two and a half cups-worth a day) and whole grains, and consume less salt and fat. Here are the reasons why.

Heart-Healthy Reasons to Eat Right

Pump Up Produce: A diet rich in produce may help lower your risk of heart disease, stroke, and cancer. A bonus: “For all the nutrients fruits and vegetables provide you’re also getting few calories,” says Kerry Neville MS, RD, a registered dietitian, “And they fill you up.”

Heart-Healthy Reasons to Eat Right continued...

Go Grains: Whole grains help lower cholesterol and blood pressure, and reduce the risk of type 2 diabetes. “Why would anyone not be eating whole grains,” Magee asks.

Forgo Bad Fat: Lower the saturated fat in your diet and you can “reduce your risk of heart issues by half,” says Christine Gerbstadt, MD, RD, a registered dietician and spokeswoman for the American Dietetic Association. You can start by switching to low-fat meat and dairy, and change to healthier fats like olive and safflower oils.

Cut the Salt: You can get your diet down to the recommended 2,400 mg daily of sodium (or about 1 teaspoon) by cooking without salt, limiting processed foods, and going easy on the salt shaker.

Soothe Stress: Be Good to Yourself

Nothing at all can be a big part of maintaining a healthy heart. So be sure to “relax and unplug daily,” advises Moores. “Stress is a significant villain of heart health and really any health issue. It can wreak havoc.”

Heart-Healthy Keys to Soothing Stress

Moores suggestion, echoed by everyone from the American Heart Association to the CDC: Carve out time for yourself regularly. Walk away from the computer, the phone, and other distractions. Make time to recharge your batteries, to find both energy and calm.

Quit Smoking: You Can Do It

Cancer, lung disease, a higher chance of heart disease: The damages smoking can do are well-known. Did you also know that smoking is associated with early menopause, infertility, and pregnancy complications?

Heart-Healthy Keys to Going Smoke-Free

There’s no one way to successfully give up smoking. Medications, support groups, counseling, or a combination of all three -- and more -- may be what it takes to help you quit. Reach out, get help. For you, for your heart.

Simple Steps to Keep Your Heart Healthy

Eating right, staying on top of checkups, managing stress: When it comes to living a heart-healthy life what it all comes down to can be summed up by Grotto: “You just have to have you time.”

How simple is that?

Ideal Weight or Happy Weight?

How much weight do you really need to lose?

Maybe you've been struggling -- without success -- to get down to the size you were in high school or on your wedding day. But do you really need to go that low? The truth, experts say, is that you can weigh more than your ideal weight and still be healthy (not to mention happy).

If you're overweight, losing just 10% of your body weight is associated with a myriad of health benefits, including lowering blood pressure, blood cholesterol, and blood sugar, and reducing your risk for heart disease. Not only that, experts say, but this kind of weight loss is easier to attain and maintain, setting you up for success in the long run.

Your Weight "Set Point"

Just as your body temperature is programmed to stay around 98.6 degrees, your body weight is naturally regulated to stay within a range of 10%-20%, says Thomas Wadden, PhD, director of the Center for Weight and Eating Disorders at University of Pennsylvania Medical School. This weight range is known as the "set point."

A complex set of hormones, chemicals, and hunger signals help your body naturally maintain your weight within this range, says American Dietetic Association spokeswoman Dawn Jackson Blatner, RD.

It is not just a matter of genetics, though. Your eating and exercise habits can also help to determine your set point.

"Overeating swamps the internal regulatory system, and, as a result, the set point increases -- which is much easier to do than it is to lower it," says Wadden. The body adjusts to the higher weight and "resets" the set point to defend the new weight.

It is difficult, but not impossible, to set your range lower. "With changes in healthy eating and exercise behavior, you can lower your set point," says Blatner.

The 10% Solution to Weight Loss

A recent book, Break Through Your Set Point: How to Finally Lose the Weight You Want and Keep It Off, by George Blackburn, MD, suggests that maintaining a 10% loss for six months to a year helps your body adjust to the lower weight and thus reset the set point.

Wadden explains that when you lose large amounts of weight at once, you set up an internal struggle and hormones like ghrelin spike to make you hungrier as your body tries to defend its comfortable range.

Instead, experts recommend that you try losing 10% the old-fashioned way -- by slowly changing eating and exercise behaviors -- then maintain this new weight for a few months before trying to lose more. Not only will your body get the signal to lower its "set point," but you'll give yourself a chance to get used to new food choices, smaller portions, and regular exercise.

“When patients lose 10% it may not be the pant size they want, but they start to realize how a little weight loss impacts their health in very positive ways," says Blatner. "They feel better, sleep better, have more energy or less joint pain, and some people are able to reduce medications."

How Much Should I Weigh?

Most people overestimate how much weight they can realistically lose, which leads to frustration, says Blatner. To find your happy or healthy weight, Blatner suggests looking back on your weight history as an adult and identify a weight you were able to maintain naturally and fairly easily.

And if you've gained more than a few pounds since your wedding day, forget trying to fit into that bridal gown. "As you gain weight, you experience an increase in fat cell size and number, which will probably prevent you from getting back to your married weight," says Wadden.

Instead of focusing on the numbers on the scale, Blatner suggests setting behavioral goals: "Eat breakfast every day, go for daily walks, eat more fruits and vegetables -- when you set behavior goals, they are easier to accomplish and they make you feel good." Stick with these behaviors for 3-6 months and they will become part of your life.

Based on your current weight, eat about 10 calories per pound of nutritious food (low in fat, rich in lean protein, high in fiber), get regular exercise, and assess your weight after a month or so.

"Your weight will settle out and typically you will lose 10%, then hit a plateau, which is a good time to maintain the weight loss," says Wadden.

As you get to a healthy weight, you can go up to 12 calories per pound.

Tips for Weight Loss Success

Here are some tips from Blatner for weight loss success:

1. Eat regular meals. People who eat regular meals consume fewer calories than those who eat irregular meals.
2. Use a plate, sit down, and enjoy your meals. Folks who do this eat 43% smaller portions than those who eat out of containers or on the run, according to Blatner.
3. Get at least 30 minutes of moderate activity each day.
4. How much and what you eat makes a big difference. Enjoy normal portions of foods that are high in fiber (fruits, veggies, whole grains) and rich in lean or low fat protein is the secret to feeling full.
5. Think positive: Focus on the benefits of a healthier lifestyle rather than the scale.

The Nutrition Source

Introduction

We've come a long way from the days when one of the knee-jerk answers to the question "What should I eat?" was "You can't go wrong with carbohydrates." We now know that carbohydrates, the staple of most diets, aren't all good or all bad. Some kinds promote health while others, when eaten often and in large quantities, actually increase the risk for diabetes and coronary heart disease.

The wild popularity of the Atkins, South Beach, and other low-carbohydrate diets led many Americans to believe that carbohydrates are "bad," the source of unflattering flab, and a cause of the obesity epidemic. That's a dangerous oversimplification, on a par with "fat is bad." Easily digested carbohydrates from white bread, white rice, pastries, sugared sodas, and other highly processed foods may, indeed, contribute to weight gain and interfere with weight loss. Whole grains, beans, fruits, vegetables, and other sources of intact carbohydrates do just the opposite—they promote good health. Don't be misled by the blanket pronouncements on the dangers of carbohydrates. They are an important part of a healthy diet. Carbohydrates provide the body with the fuel it needs for physical activity and for proper organ function. The best sources of carbohydrates—fruits, vegetables, and whole grains—deliver essential vitamins and minerals, fiber, and a host of important phytonutrients.

What Are Carbohydrates?

Carbohydrates are found in a wide array of foods—bread, beans, milk, popcorn, potatoes, cookies, spaghetti, soft drinks, corn, and cherry pie. They also come in a variety of forms. The most common and abundant forms are sugars, fibers, and starches.

The basic building block of every carbohydrate is a sugar molecule, a simple union of carbon, hydrogen, and oxygen. Starches and fibers are essentially chains of sugar molecules. Some contain hundreds of sugars. Some chains are straight, others branch wildly.

Carbohydrates were once grouped into two main categories. Simple carbohydrates included sugars such as fruit sugar (fructose), corn or grape sugar (dextrose or glucose), and table sugar (sucrose). Complex carbohydrates included everything made of three or more linked sugars. Complex carbohydrates were thought to be the healthiest to eat, while simple carbohydrates weren't so great. It turns out that the picture is more complicated than that.

The digestive system handles all carbohydrates in much the same way—it breaks them down (or tries to break them down) into single sugar molecules, since only these are small enough to cross into the bloodstream. It also converts most digestible carbohydrates into glucose (also known as blood sugar), because cells are designed to use this as a universal energy source.

Fiber is an exception. It is put together in such a way that it can't be broken down into sugar molecules, and so it passes through the body undigested. Fiber comes in two varieties: soluble fiber dissolves in water, while insoluble fiber does not. Although neither type nourishes the body, they promote health in many ways. Soluble fiber binds to fatty substances in the intestines and carries them out as a waste, thus lowering low-density lipoprotein (LDL, or bad cholesterol). It also helps regulate the body's use of sugars, helping to keep hunger and blood sugar in check. Insoluble fiber helps push food through the intestinal tract, promoting regularity and helping prevent constipation.

When Sugar Management Goes Awry: Insulin and Diabetes

When you eat a food containing carbohydrates, the digestive system breaks down the digestible ones into sugar, which then enters the blood. As blood sugar levels rise, special cells in the pancreas churn out more and more insulin, a hormone that signals cells to absorb blood sugar for energy or storage. As cells sponge up blood sugar, its levels in the bloodstream begin to fall. That's when other cells in the pancreas start making glucagon, a hormone that tells the liver to start releasing stored sugar. This interplay of insulin and glucagon ensure that cells throughout the body, and especially in the brain, have a steady supply of blood sugar.

In some people, this cycle doesn't work properly. People with type 1 diabetes (once called insulin-dependent or juvenile diabetes) don't make enough insulin, so their cells can't absorb sugar. People with type 2 diabetes (once called non-insulin-dependent, or adult-onset diabetes) generally start out with a different problem—their cells don't respond well to insulin's "open up for sugar" signal. This condition, known as insulin resistance, causes blood sugar and insulin levels to stay high long after eating. Over time, the heavy demands made on the insulin-making cells wears them out, and insulin production slows, then stops.

Insulin resistance isn't just a blood sugar problem. It has also been linked with a variety of other problems, including high blood pressure, high levels of triglycerides, low HDL (good) cholesterol, and excess weight. In fact, it travels with these problems so often that the combination has been given the name metabolic syndrome. (1) Alone and as part of the metabolic syndrome, insulin resistance can lead to type 2 diabetes, heart disease, and possibly some cancers.

Genes, a sedentary lifestyle, being overweight, and a diet rich in processed carbohydrates can each promote insulin resistance. (The combination is far worse.) Data from the Insulin Resistance Atherosclerosis Study suggests that cutting back on refined grains and eating more whole grains in their place can improve insulin sensitivity. (2) As described in "Health Gains from Whole Grains", the benefit of eating whole grains extends far beyond insulin to helping prevent type 2 diabetes, atherosclerosis (the build-up of cholesterol-filled patches that clog and narrow artery walls), heart disease, colorectal cancer, and premature death from noncardiac, noncancer causes.

Carbohydrates and the Glycemic Index

Dividing carbohydrates into simple and complex makes sense on a chemical level. But it doesn't do much to explain what happens to different kinds of carbohydrates inside the body. For example, the starch in white bread and French-fried potatoes clearly qualifies as a complex carbohydrate. Yet the body converts this starch to blood sugar nearly as fast as it processes pure glucose. Fructose (fruit sugar) is a simple carbohydrate, but it has a minimal effect on blood sugar.

A new system, called the glycemic index, aims to classify carbohydrates based on how quickly and how high they boost blood sugar compared to pure glucose.(3) Foods with a high glycemic index, like white bread, cause rapid spikes in blood sugar. Foods with a low glycemic index, like whole oats, are digested more slowly, causing a lower and gentler change in blood sugar. Foods with a score of 70 or higher are defined as having a high glycemic index; those with a score of 55 or below have a low glycemic index.

The most comprehensive list of the glycemic index of foods was published in the July 2002, issue of the American Journal of Clinical Nutrition. (4) It included almost 750 foods, ranging from angel food cake to yams. The University of Sydney in Australia maintains an updated searchable database at www.glycemicindex.com that now has almost 1,600 entries.

Diets rich in high-glycemic-index foods, which cause quick and strong increases in blood sugar levels, have been linked to an increased risk for diabetes, (5) heart disease, (6, 7) and overweight, (8, 9,10) and there is preliminary work linking high-glycemic diets to age-related macular degeneration, (11) ovulatory infertility, (12) and colorectal cancer. (13) Foods with a low glycemic index have been shown to help control type 2 diabetes and improve weight loss. Other studies, though, have found that the glycemic index has little effect on weight or health. This sort of flip-flop is part of the normal process of science, and it means that the true value of the glycemic index remains to be determined. In the meantime, eating whole grains, beans, fruits, and vegetables—all foods with a low glycemic index—is indisputably good for many aspects of health.

One of the most important factors that determine a food's glycemic index is how much it has been processed. Milling and grinding removes the fiber-rich outer bran and the vitamin- and mineral-rich inner germ, leaving mostly the starchy endosperm. (See the sidebar, Nutrition In-Depth, for more information on what affects a food's glycemic index.)

One thing that a food's glycemic index does not tell us is how much digestible carbohydrate it delivers. Take watermelon as an example. The sweet-tasting fruit has a very high glycemic index. But a slice of watermelon has only a small amount of carbohydrate per serving (as the name suggests, watermelon is made up mostly of water). That's why researchers developed a related way to classify foods that takes into account both the amount of carbohydrate in the food and the impact of that carbohydrate on blood sugar levels. This measure is called the glycemic load. (14, 15) A food's glycemic load is determined by multiplying its glycemic index by the amount of carbohydrate it contains. In general, a glycemic load of 20 or more is high, 11 to 19 is medium, and 10 or under is low.

You can't use the glycemic index to rule your dietary choices. For example, a Snickers bar has a glycemic index of 41, marking it as a low glycemic index food. But it is far from a health food. Instead, use it as a general guide. Whenever possible, replace highly processed grains, cereals, and sugars with minimally processed whole grain products. And only eat potatoes—once on the list of preferred complex carbohydrates—occasionally because of their high glycemic index and glycemic load.

Good Carbs, not No Carbs

Some popular diets treat carbohydrates as if they are evil, the root of all body fat and excess weight. That was certainly true for the original Atkins diet, which popularized the no-carb approach to dieting. And there is some evidence that a low-carbohydrate diet may help people lose weight more quickly than a low-fat diet, although so far, that evidence is short term.

In two short, head-to-head trials, (16, 17) low-carb approaches worked better than low-fat diets. A later year-long study, published in 2007 in the Journal of the American Medical Association, showed the same thing. In this study, overweight, premenopausal women went on one of four diets: Atkins, Zone, Ornish, or LEARN, a standard low-fat, moderately high-carbohydrate diet. The women in all four groups steadily lost weight for the first six months, with the most rapid weight loss occurring among the Atkins dieters. After that, most of the women started to regain weight. At the end of a year, it looked as though the women in the Atkins group had lost the most weight, about 10 pounds, compared with a loss of almost 6 pounds for the LEARN group, 5 for the Ornish group, and 3.5 for the Zone group. (18) Levels of harmful LDL, protective HDL, and other blood lipids were at least as good among women on the Atkins diet as among those on the low-fat diet.

If you read the fine print of the study, though, it turns out that few of the women actually stuck with their assigned diets. Those on the Atkins diet were supposed to limit their carbohydrate intake to 50 grams a day, but they took in almost triple that amount. The Ornish dieters were supposed to limit their fat intake to under 10 percent of their daily calories, but they got about 30 percent from fat. There were similar deviations for the Zone and LEARN groups. What this and other diet comparisons tell us is that sticking with a diet is more important than the diet itself.

No one knows the long-term effects of eating little or no carbohydrates. Equally worrisome is the inclusion of unhealthy fats in some of these diets.

If you want to go the lower carb route, try to include some fruits, vegetables, and whole grain carbohydrates every day. They contain a host of vitamins, minerals, and phytonutrients that are essential for good health and that you can't get out of a supplement bottle. And do your heart a favor by choosing healthy fats and proteins to go along with those healthy carbohydrates: A 20-year prospective study of 82,802 women looked at the relationship between lower carbohydrate diets and heart disease; a subsequent study looked at lower carbohydrate diets and risk of diabetes. Women who ate low-carbohydrate diets that were high in vegetable sources of fat or protein had a 30 percent lower risk of heart disease (7) and a modestly lower risk of type 2 diabetes, (19) compared to women who ate high-carbohydrate, low-fat diets. But women who ate low-carbohydrate diets that were high in animal fats or proteins did not have a reduced risk of heart disease or diabetes.(7, 19)

Adding Good Carbohydrates

For optimal health, get your grains intact from foods such as whole wheat bread, brown rice, whole grain pasta, and other possibly unfamiliar grains like quinoa, whole oats, and bulgur. Not only will these foods help protect you against a range of chronic diseases, they can also please your palate and your eyes.

Until recently, you could only get whole-grain products in organic or non-traditional stores. Today they are popping up in more and more mainstream grocery stores. Here are some suggestions for adding more good carbohydrates to your diet:

• Start the day with whole grains. If you're partial to hot cereals, try old-fashioned or steel-cut oats. If you're a cold cereal person, look for one that lists whole wheat, whole oats, or other whole grain first on the ingredient list.
• Use whole grain breads for lunch or snacks. Check the label to make sure that whole wheat or another whole grain is the first ingredient listed.
• Bag the potatoes. Instead, try brown rice or even "newer" grains like bulgur, wheat berries, millet, or hulled barley with your dinner.
• Pick up some whole wheat pasta. If the whole grain products are too chewy for you, look for those that are made with half whole-wheat flour and half white flour.
• Bring on the beans. Beans are an excellent source of slowly digested carbohydrates as well as a great source of protein.