October 2013 issue
Inside this issue This quarter’s topics !
A brief overview of hypertension, fibromyalgia, and Seasonal Affective Disorder (SAD)
Make Control Your Goal!
Fall Fitness Tips A Pep Talk with Coach Moon, the “Wellness Dude” By Eric Moon, MA, NASM, The Holmes Organisation
Learn about hypertension and what steps you can take to get it under control
Two heart healthy recipes featuring spinach from Amanda and Betsy
Seasonal Affective Disorder 6
Let’s face it—with the days growing shorter and the weather turning colder, it’s getting harder and harder to keep up good exercise habits. Read on for some tips to help keep you active and feeling fit during fall. 1. Plan family events Take advantage of the time the kids aren’t in school by planning outdoor family events. Simply walking through a park with the family will get you out of the house. 2. Enjoy the scenery Biking, hiking and jogging outdoors are great during the fall and will allow you to enjoy the weather before winter hits. Just remember to dress in layers and wear reflective clothing, as it gets cold and dark earlier in the fall.
3. Hit the gym To supplement your outdoor activity, consider going to the gym. Alternating between outdoor and indoor exercise will keep your workout fresh and, if you live in a colder climate, prepare you for a winter of indoor exercise.
Read up on Seasonal Aﬀective Disorder, and some foods you can eat to lift your mood this winter
Learn the eﬀects of fibromyalgia and what steps you can take to manage your symptoms
Food For Thought! & Additional Resources
4. Make exercise social The best way to stick to your workout is to find a buddy with similar workout goals. You can motivate each other, whether indoors or out.
! Read about some “happy foods” on page 6
Hypertension (High Blood Pressure)
67 million (1 in 3) adults in the United States have high blood pressure.
36 million adults in the United States with high blood pressure do not have their condition under control.
$47.5 billion $47.5 billion is spent each year on the treatment of high blood pressure in the United States.
Information from www.cdc.gov
The ratio of women to men diagnosed with fibromyalgia is 7:1
The average cost per person with fibromyalgia in the United States is $5,945 each year.
1/3 People with fibromyalgia have approximately 1 hospitalization every 3 years.
Information from www.cdc.gov
December Seasonal Affective Disorder (SAD) Information from www.nami.org
Seasonal affective disorder is also known as the â€œwinter blues.â€?
The most common treatment for SAD is to sit in artificial sunlight for 30 minutes per day -- usually in the morning.
October to May The period of time most symptoms of SAD usually occur is October to May.
fatigue and often psychological distress. People with fibromyalgia may also have other symptoms; such as: • Morning stiffness • Tingling or numbness in hands and feet • Cognitive problems with thinking and memory (sometimes called "fibro fog")
In October, we will focus on hypertension (high blood pressure). Blood pressure is the force of blood against your artery walls as it circulates through your body. Blood pressure normally rises and falls throughout the day, but it can cause health problems if it stays high for a long time. Having high blood pressure raises your risk for heart disease and stroke, leading causes of death in the United States. High blood pressure is called the "silent killer" because many people don't realize they have it. High blood pressure often has no warning signs or symptoms. The only way to detect whether or not you have high blood pressure is to have your blood pressure measured by a doctor or health professional—it is quick and painless. High blood pressure increases your risk for heart disease. People at any age can take the following steps each day to keep blood pressure levels normal: • Eat a healthy diet
• Don’t use tobacco
• Maintain a healthy weight
• Limit alcohol consumption
• Be physically active
In November, we will focus on fibromyalgia. Fibromyalgia is a disorder characterized by widespread pain, abnormal pain processing, sleep disturbance,
• Headaches, including migraines • Irritable bowel syndrome • Sleep disturbances
• Painful menstrual periods and other pain syndromes
In December, we will focus on Seasonal Affective Disorder (SAD). Seasonal affective disorder (SAD) is a form of depression that appears at the same time each year. With SAD, a person typically has symptoms of depression and unexplained fatigue as winter approaches and daylight hours become shorter. When spring returns and days become longer again, people with SAD experience relief from their symptoms, returning to their usual mood and energy level. What are the symptoms of SAD? • Changes in mood
• Changes in eating
• Lack of enjoyment
• Difficulty concentrating
• Low energy
• Less time socializing
• Changes in sleep Ways to deal with SAD: • Learn all you can about SAD and explain the condition to others so they can work with you
• Spend time with friends and loved ones who understand what you're going through
• Get plenty of exercise, especially outdoors
• Develop a sleep routine
• Be patient
• Follow your doctor's recommendations
• Eat healthy
Frequently Asked Questions (adapted from www.cdc.gov) What is high blood pressure? Blood pressure is the force of blood against your artery walls as it circulates through your body. Blood pressure normally rises and falls throughout the day, but it can cause health problems if it stays high for a long time. High blood pressure can lead to heart disease and stroke—the leading causes of death in the United States. Are you at risk? Several factors that are beyond your control can increase your risk for high blood pressure. These include your age, sex, and race or ethnicity. What are the signs and symptoms? High blood pressure usually has no warning signs or symptoms, so many people don’t realize they have it. That’s why it’s important to visit your doctor and have your blood pressure checked on a regular basis. How is it diagnosed? Your blood pressure is measured by wrapping an inflatable cuff with a pressure gauge around your arm to squeeze the blood vessels. Your pulse is measured with a stethoscope while releasing air from the cuff. The gauge measures the pressure in the blood vessels when the heart beats (systolic) and when it rests (diastolic). How is it treated? If you have high blood pressure, your doctor may prescribe medication to treat it. Lifestyle changes can be just as important as taking medicines. Talk with your doctor about the best ways to reduce your risk for high blood pressure.
Make Control Your Goal (adapted from www.cdc.gov) One in three American adults has high blood pressure, also called hypertension. That's 67 million people who have to work to keep their blood pressure in check each day. Unfortunately, more than half of people with high blood pressure do not have their condition under control. Keep it down You may not have any symptoms of high blood pressure, but it can damage your health in many ways. For instance, it can harden the arteries, decreasing the flow of blood and oxygen to the heart and brain. This reduced flow can cause— • Heart attack, which occurs when the blood supply to your heart is blocked and heart muscle cells die from a lack of oxygen • Stroke, which can occur when arteries that supply blood and oxygen to the brain become blocked or burst • Chest pain, also called angina • Heart failure, which occurs when the heart can't pump enough blood and oxygen to other organs
Make control your goal Of the 67 million American adults who have high blood pressure, 16 million know that they have the condition and are getting treatment, but their blood pressure still remains high. Awareness and treatment are not enough—that's why CDC is asking patients and health care professionals to "make control the goal." If you have high blood pressure, there are steps you can take to get it under control, including: • Ask your doctor what your blood pressure should be. Set a goal to lower your pressure with your doctor and then discuss how you can reach your goal. Work with your doctor to make sure you meet that goal. • Take your blood pressure medication as directed. • Quit smoking—and if you don't smoke, don't start. • Reduce sodium. Most Americans consume too much sodium, and it raises their risk for high blood pressure.
Spinach Casserole from the kitchen of Elizabeth Letcher, CareATC
Ingredients 1 package frozen leaf spinach 3 eggs 3 tablespoons flour 1 lb. (2 cups) reduced fat cottage cheese 1 cup sharp cheddar cheese (approximate)
Preparation 1. Thaw and squeeze dry your package of spinach. Make sure the spinach is damp or dry—not wet! 2. Mix the spinach, eggs, and flour until well blended. 3. Add cottage cheese and mix until just blended. 4. Spread the mixture in a greased 8"x8" or 9"x9" pan 5. Bake uncovered at 350º F for 35 minutes, then top with shredded cheddar cheese and bake another 20 minutes.
Popeye’s Superfood Popeye knew what he was talking about: Spinach is indeed a superfood, especially when it comes to heart health. Spinach is one of the most nutritionally dense foods in the kitchen and deserves its reputation as a lean, green, heart-disease fighting machine. Here are some ways spinach benefits heart health: 1. Spinach reduces inflammation. Among other nutrients, spinach is rich in folate, a water-soluble B vitamin (known as folic acid in supplement form), which is vital for healthy arteries. 2. Spinach lowers high blood pressure. In addition to inflammation, folate fights hypertension, or high blood pressure, by keeping arteries healthy and strong. 3. Spinach reduces the risk of stroke. According to the American Heart Association, low blood levels of folate or folic acid have been linked with a higher risk of fatal coronary heart disease and stroke. 4. Spinach prevents heart attacks. As little as 400 micrograms of folate a day can prevent heart attacks.
Spinach & Feta Stuffed Chicken from the kitchen of Amanda Mick, CareATC
Ingredients 4 - 4 to 6 oz boneless skinless chicken breasts 1 large bag of fresh spinach 1 - 8 oz container of feta cheese crumbles 1/2 lb. bacon Minced garlic to taste (optional) Sea salt Ground black pepper
Preparation 1. Pre-heat your oven to 425º. 2. Butterfly your chicken breasts on one side by cutting into the breasts sideways from close to the bottom up to the top. Make sure that you create a pocket for the stuffing, and be very careful not to cut through the chicken. Place your chicken in a glass pan or a deep baking dish with no lid.
3. Spoon some garlic into the chicken breasts so that it coats the inside of the pocket. (If you are not a garlic fan this step can be left out.) 4. Pre-heat a skillet on medium-high heat. 5. Chop bacon into chunks and place in skillet to fry. Leave about a tablespoon of bacon grease in the skillet and add your spinach. 6. Once your spinach is coated, take the filling off the heat and transfer to a dish to cool for 2 minutes. 7. Add feta cheese to your filling and begin stuffing the chicken breasts. Make sure that you get the filling as far into the pocket as possible (it is okay if there is filling coming out of the chicken). 8. Salt and pepper the tops of the chicken breasts and place them into the oven to bake for 30 minutes or until internal temp is 165º on a meat thermometer.
What is seasonal affective disorder? by Malinda Silva, CareATC (adapted from www.kidshealth.org)
Winter brings short days and chilly temperatures, and you might find your mood mirroring these bleak winter days. Seasonal affective disorder (SAD) is a form of depression that appears at the same time each year. With SAD, a person typically has symptoms of depression and unexplained fatigue as winter approaches and daylight hours become shorter. When spring returns and days become longer again, people with SAD experience relief from their symptoms, returning to their usual mood and energy level.
What Causes SAD? Experts think two specific chemicals in the brain, melatonin and serotonin, may be involved in SAD. These two chemicals help regulate a person's sleep-wake cycles, energy, and mood. Melatonin is linked to sleep. The body produces it in greater quantities when it's dark or when days are shorter. This increased production of melatonin can cause a person to feel sleepy and lethargic. With serotonin, it's the reverse — serotonin production goes up when a person is exposed to sunlight, so it's likely that a person will have lower levels of serotonin during the winter when the days are shorter. Low levels of serotonin are associated with depression, whereas increasing the availability of serotonin helps to combat depression.
Eat Happy Foods by Jenny Avera, CareATC (adapted from www.eatingwell.com)
While light therapy appears to be one of the most effective treatments for SAD, what you eat can also play a role in alleviating its symptoms. Can Vitamin D help? Studies of vitamin D’s ability to curb SAD have been mixed—some show a benefit, while others don’t. Researchers from the University of Toronto noticed that people who were suffering from depression, particularly those with SAD, tended to improve as their levels of vitamin D in the body increased over the course of a year. Researchers, though, are unsure how much vitamin D is ideal. Still, it doesn’t hurt to make sure you’re getting what you can from your diet. Some studies suggest that as many as 7 out of 10 Americans don’t get enough Vitamin D—particularly during winter. The Institute of Medicine’s daily-recommended amount (for ages 1 to 70) is 600 International Units (IUs). Check with your doctor to see if you might need a supplement. Food Sources of Vitamin D: Certain fatty fish (salmon, tuna, sardines, rainbow trout), fish oils (like cod liver oil), fortified milk and egg yolks are some of the richest sources of vitamin D.
Careful Carb Snacking Part of the reason people with SAD crave carbohydrates may be due to decreased serotonin activity. Carbohydrates promote the production of serotonin, a feel-good brain chemical. Snacking on the right kinds of carbohydrates can relieve some of the symptoms of SAD, according to Judith Wurtman, Ph.D., co-author of The Serotonin Power Diet. A recent study she led looking at the SAD-carb connection indicated that about 30 grams of carbs—or about 120 calories—per day were enough to make the serotonin you need. Wurtman recommends eating carbohydrates that have little fat and low protein to ensure serotonin is made (protein can dampen the effects of serotonin production in the body). Food Sources of SAD-Friendly Carbohydrates: Good snacking choices include popcorn, pretzels, shredded wheat squares or low-fat biscotti. When it comes to meals, Wurtman recommends making dinner your main carbohydrate-containing meal. That’s because evening is the time when the symptoms of SAD are strongest.
Fibromyalgia (adapted from www.mayoclinic.com)
Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals. The pain associated with fibromyalgia is often described as a constant dull ache, typically arising from muscles. To be considered widespread, the pain must occur on both sides of your body and above and below your waist. Fibromyalgia is characterized by additional pain when firm pressure is applied to specific areas of your body, called tender points. Tender point locations include: • Back of the head
• Outer elbows
• Between shoulder blades
• Upper hips
• Top of shoulders
• Sides of hips
• Front sides of neck
• Inner knees
• Upper chest
Tips to Manage Your Symptoms Reduce Stress Develop a plan to avoid or limit overexertion and emotional stress. But try not to change your routine completely. People who quit work or drop all activity tend to do worse than those who remain active. Try stress management techniques, such as deepbreathing exercises or meditation.
Get Enough Sleep Getting sufficient sleep is essential. In addition to allotting enough time for sleep, practice good sleep habits, such as going to bed and getting up at the same time each day and limiting daytime napping.
Fatigue and sleep disturbances People with fibromyalgia often awaken tired, even though they report sleeping for long periods of time. Sleep is frequently disrupted by pain, and many patients with fibromyalgia have other sleep disorders, such as restless legs syndrome and sleep apnea, that further worsen symptoms.
At first, exercise may increase your pain. But doing it gradually and regularly can decrease symptoms. Appropriate exercises may include walking, swimming, biking and water aerobics.
Coexisting conditions Many people who have fibromyalgia also may have: • Fatigue
• Irritable bowel syndrome
Managing your symptoms Self-care is critical in the management of fibromyalgia. Check out some ways to help manage your symptoms to the right.
Keep your activity on an even level. If you do too much on your good days, you may have more bad days. Moderation means not "overdoing it" on your good days, but likewise it means not self-limiting or doing "too little" on the days when symptoms flare.
Maintain a Healthy Lifestyle Eat healthy foods. Limit your caffeine intake. Do something that you find enjoyable and fulfilling every day.
food for thought
Simple Substitutions by Janessa Eades, CareATC
www.heart.org You may find it difficult to cook healthy meals that your family (especially children) will eat, but making some small changes to your favorite recipes is a great way to “healthify” them. Here are some simple substitutions for commonly used ingredients: INGREDIENT Butter or Oil
AMOUNT 1 cup
SUBSTITUTION • • • •
2/3 cup applesauce 1 cup pureed beans, pumpkin, or fruit 1 cup polyunsaturated margarine Substitute canola oil for up to half of butter in baked goods to reduce saturated fat
• 1 tablespoon lemon juice or vinegar with enough low fat or non-fat milk to make 1 cup • 1 cup plain yogurt
• 1 cup dried fruit or chopped nuts
• 1 cup honey, maple syrup, rice syrup, or agave nectar
• 1 cup pureed cottage cheese or plain yogurt
• 1 tablespoon ground flaxseed + 3 tablespoons water • 2 egg whites • 1/4 cup egg substitute
Flour, all purpose
• 1/2 cup cake flour + 1/2 cup whole wheat flour
Half & Half
• 1 cup evaporated skim milk
• 1 cup light cream, half & half, or evaporated skim milk • 1/2 cup low fat yogurt + 1/2 cup cottage cheese
• 1 cup plain yogurt
• 1 cup soy milk or other milk substitute • 1/4 cup nuts or seeds blended with 1 cup water
• 1 cup low fat or non-fat evaporated milk
Milk, sweetened condensed
14 oz can
• 14 oz can low or non-fat sweetened condensed milk
• 1 cup skim milk • 1 cup pureed silken tofu
• 1 cup dry cottage cheese • 1 cup pureed silken tofu
• 1 cup plain yogurt or low fat Greek yogurt
Sugar, white granulated
• 2/3 cup agave nectar, then reduce liquid in recipe by 1/4 cup
The American Heart Association is a national voluntary health agency to help reduce disability and death from cardiovascular diseases and stroke.
www.fmaware.org Founded in 1997 in Orange, California, the National Fibromyalgia Association (NFA) is an organization working to support people with fibromyalgia and other chronic pain illnesses.
www.nami.org NAMI is the National Alliance on Mental Illness, the nation’s largest grassroots mental health organization dedicated to building better lives for the millions of Americans affected by mental illness.
CareATC wellness newsletter featuring high blood pressure, fibromyalgia, and Seasonal Affective Disorder (SAD).