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					                                           February is National Heart Month

                                                      Heart Smart
San Mateo County Employee Health & Fitness Program                         _       February 2007
Hot Off the Diabetes Press!                               First, if you are between 130-140/80-90,
     The January 2007 issue of Diabetes Care               your health care provider should give
includes the annual “Standards of Medical Care             you three months to make lifestyle
in Diabetes”, an in-depth guide to providing the           changes to lower it to within goal levels.
best medical care to people with diabetes. Since           If readings below 130/90 are not
February is Heart Month, we thought we‟d                   achieved, then medications should begin.
highlight the key heart-related messages from
this publication.                                         Second, if your BP is >140/90, then you
     Since cardiovascular disease (CVD) is the             should be checked again within one
major cause of death in people with diabetes,              month and if it‟s still at this level,
it‟s wise to take steps to reduce those risk               medications should be started even if
factors as well ~ high blood pressure,                     you want to continue working on
dyslipidemia (high cholesterol and/or                      lifestyle changes.
triglycerides), obesity and smoking. If you
                                                          Third, if your BP is >160/100, then
haven‟t talked with your doctor about your heart
                                                           medications should be started
risk factors and/or diabetes treatment plan
                                                           immediately and there should be no one-
lately, we hope this newsletter encourages you
                                                           month wait to “confirm” a hypertension
to do so!
Hypertension - Blood Pressure Control                     Do not be discouraged if you end up being
     High blood pressure (hypertension) is a          put on two or more medications to control your
common in people with diabetes. In fact, the          BP. This is called “multiple drug therapy” and
literature states that a majority of diabetics have   is usually necessary to achieve BP goals.
it. It should be standard practice to have your           If this protocol seems strict to you,
blood pressure (BP) taken at the beginning of         remember that the main goal of diabetes
every doctor‟s visit but is your doctor or nurse      treatment is to prevent major complications. If
discussing the results with you and helping you       BP is not controlled, what typically happens is a
determine a course of action to keep it under         worsening of vision (“retinopathy”) and kidney
control?                                              function (“nephropathy”) that could ultimately
As a diabetic, your BP should be <130/80 and if       lead to dialysis.
it‟s not, one of three things should happen.                Does all this talk of medication have you
                                                      feeling a bit more motivated to work on lifestyle
                                                      habits that help to lower BP? If so, the tips
                                                      below will help you on your way!
     Lower Your Sodium Intake.                         Your blood cholesterol levels should be
Although the studies didn‟t include diabetics,      checked at least yearly but more often if
using data from the landmark DASH (Dietary          recommended goals are not being achieved.
Approaches to Stop Hypertension) research
suggests that you should lower your sodium              LDL-cholesterol should be <100mg/dl.
intake to 2,300-2,400 mg/day. This level has            HDL-cholesterol should be >40mg/dl if
been shown to drop BP by as much as 2-8                  you are male and >50mg/dl if you are
points.                                                  female
     Increase Your Produce Consumption.
The DASH diet recommends 8-10 servings of               Triglycerides should be <150mg/dl.
fruits and vegetables per day, yes, per day! This
provides the body with a fiber-rich diet that is        LDL-cholesterol. Unfortunately, lab tests
low in sodium and high in potassium (another        don‟t always flag an LDL-cholesterol unless it‟s
mineral that is beneficial for BP control).         over 130mg/dl. As a diabetic trying to reduce
     Enjoy 2-3 Servings of Dairy per Day.           complications, your LDL-cholesterol goal is
The DASH studies also promote a consistent          really <100 mg/dl. If recommended lifestyle
intake of calcium-rich dairy products. Calcium,     changes don‟t help, medication therapy should
like potassium, has been shown to help keep BP      begin. The main type of drug used to lower
levels under control. Just remember that it‟s the   LDL-cholesterol is a statin such as Lipitor,
low fat or non-fat dairy choices that are           Mevacor, Zocor, Pravachol and Crestor.
recommended – milk, yogurt and reduced fat              Recent research shows that people with
cheese.                                             heart disease benefit by even more aggressive
     Exercise, Exercise, Exercise. Research         medication management to achieve a LDL-
shows that just 30 minutes of physical activity     cholesterol goal of <70mg/dl.
per day on most days of the week can lower              HDL-cholesterol. The main way to raise
your BP by 4 to 9 points. Walking is just as        HDL-cholesterol is daily heart-pumping
effective as other types you might consider!        physical activity for 30-60 minutes at a pace
     Moderate Your Alcohol Intake. If you are       that‟s comfortable yet challenging. If this does
a man and consume more than two drinks per          not increase your HDLs above the goal level,
day or a woman having more than one, reducing       then the next recommended strategy is to
your intake to these levels can lower your BP by    increase your niacin intake to between 750-
2 to 4 points. It may seem like a small change      2,000mg/day. Your doctor will prescribe this
but if it‟s paired with some of the other changes   vitamin to assure its proper potency and quality.
listed above, you have a good chance of                 Triglycerides. “Triglyceride” is simply the
lowering your BP without the use of                 name for fat and a level above 150mg/dl
medications.                                        increases your risk of heart attacks or stroke. It
                                                    is common to see triglyceride (TG) levels rise
Dyslipidemia – Cholesterol Mgmt                     when a person‟s blood glucose levels are high,
    People with diabetes have an increased          so improved diabetes control is often the first
prevalence of cholesterol (lipid) abnormalities,    approach to improving this cholesterol level. If
which contributes to higher rates of CVD.           other lifestyle changes do not work, medication
Cholesterol management aimed at lowering            use is recommended next.
LDL-cholesterol (the “bad one”), raising HDL-
cholesterol (the “good one”) and lowering           Tips for Lowering LDLs and TGs
triglycerides (the fancy name for fat) has been         Our hope is that this newsletter has
shown to reduce long-term complications and         motivated you to dig out your most recent lab
death in people with diabetes.                      results and cross check it with the guidelines
                                                    and goals listed above. If you‟ve done that and
                                                    are discouraged to see that your values fall
outside the ideal levels, don‟t let that stop you   will have a clinically significant impact on
from doing what you can to improve your             cholesterol levels, blood glucose and blood
values. Yes, your doctor might eventually           pressure.
recommend medications, but the following
health actions are something you can start          “Heart Smart” Take Away Messages
today!                                                  These are our bottom line messages for you
     Lower Saturated Fat. Saturated fat is the      during February‟s Heart Month:
type that comes in animal foods (meat, cheese,          Review Your Lab Tests. Ask your doctor
dairy, eggs, etc.) and tropical fats (coconut and   to review your most recent blood pressure and
palm). The daily goal is to consume <20 grams       cholesterol lab results with you. Ask questions
per day. This is easier to achieve if you include   about treatment options if the results are outside
some vegetarian meals in your diet.                 the recommended levels.
     Eliminate Trans Fats. Trans fats occur in          Choose One Food Goal. Review the list of
food when manufacturers hydrogenate oil to          dietary modifications that can improve your
improve product shelf life and texture.             blood pressure and cholesterol values. Select
Research now shows these fats are as bad for        one change as the starting point to your lifestyle
your health as saturated fat is and may even be     improvements. Right now, it may be easier for
worse. Packaged foods now have trans fats           you to consider adding more fiber in your diet
listed on their nutrition labels. Your daily goal   than eating fewer animal foods ~ FINE, that‟s a
is to consume as few as possible.                   great place to start!
     Increase Your Fiber. If you are working            Move, Move, Move. Make a commitment
to include the 8-10 fruits and vegetables           to getting more physical activity in your day.
recommended by the DASH diet to lower your          Physical activity is a key component to both
blood pressure, then your fiber intake will be      heart disease risk reduction and weight loss.
ideal for LDL lowering too! If that amount of
produce daily is too much to consider right now,
you must make other fiber-rich choices instead      Web Resources: Great Places to Get
– such as high fiber grains, breads, pastas,        Diabetes Information, Recipes & Tips
cereals and beans. Don‟t forget you can also
choose some of the new fiber products on the        -- American Dietetic Association -
market (e.g. Benefiber) to increase your intake.           www.eatright.org
     Quit Smoking. Just as a reduction in           -- American Diabetes Association -
smoking results in a lowering of blood pressure,           www.diabetes.org
it lowers LDL-cholesterol too. Another reason       -- Diabetes Care journal (Jan ‟07 issue
to quit!                                            summarized in this newsletter)
     Minimize Concentrated Sweets. One of                  www.care.diabetesjournals.org
the best dietary ways to reduce triglyceride
levels is to reduce your intake of concentrated
sweets. These are foods and beverages that                        For more information:
simply taste sweet. It does not matter whether             Employee Health & Fitness Program
your concentrated sweets come naturally (fruit,            http://www.co.sanmateo.ca.us/hr/hf
dried fruits, fruit juice) or are manmade (soda,
hard candies, sorbet, sweets, coffee drinks). Any
of these can be easily converted to triglycerides
and cause a high reading.
     Lose Weight. Weight loss improves just
about every lab value you can list and LDL-
cholesterol and triglycerides are no exception.
The weight loss goal of 10% of current weight
                                                              Tours are limited to 10 people each and pre-
Heart Healthy Boot Camp ~ April „07                       registration is required; call (408) 808-1333 or email
    This 4-hour boot camp includes everything you         toni@tonibloom.com. Class is conducted on
need to know about blood pressure, cholesterol,           County time with your supervisor‟s approval.
triglycerides, omega-3‟s, lab testing and special
heart healthy diets. It‟s taught by Susan Vana,           HEAR2TCheck Clinics ~ Sept “07
HEAR2T Program Nurse Coordinator, and Toni                Get tested for blood pressure, cholesterol, glucose
Bloom, Registered Dietitian.                              and triglycerides, then complete an online heart
                                                          healthy questionnaire to learn more about what you
     San Mateo                    Redwood City            can do to stay heart healthy!
     Monday, April 9th            Wed, April 18th
     222. W 39th Ave              455 County Ctr          Weight Watchers at Work ~ 2007
     Edn Conf Rm 1                Room 501                    Weekly “Weight Watchers at Work” classes are
     8:30am -12:30pm              8:30am-12:30pm          currently offered in Belmont (Harbor Blvd),
                                                          Redwood City (County Gov‟t Center), and South
Class is limited to 20 people and pre-registration is     San Francisco (Mission Road).
required; call (408) 808-1333 or email                        For class schedules and tuition reimbursement
toni@tonibloom.com. Class is conducted on                 information, go to www.co.sanmateo.ca.us/hr/hf
County time with your supervisor‟s approval.
                                                          Individual Nutrition Counseling
Diabetes Boot Camp ~ Dec „07                              Email our registered dietitian Toni Bloom at
    This class consists of two information-packed         toni@tonibloom.com for information about her
sessions, each 4-½ hours long, taught by Registered       nutrition counseling services at County discounted
Dietitian, Toni Bloom, MS, RD. The first class            rates. Whether you need help setting up a weight
covers the types of diabetes, complications,              loss plan or better understand carbohydrates and
medications and lab tests. The second class is            blood sugars, she‟s a great coach! Counseling
devoted to nutrition management, meal planning and        services are also available to family members.
carbohydrate counting.
    San Mateo                     Redwood City
                                                          HEAR2T Program
    Nov. 29th & Dec. 6th          Dec. 3rd & 10th         There is a strong link between heart disease and
    222 W. 39th Ave               455 County Ctr          Diabetes. Employees with Diabetes are
    Edn Conf Rm 1                 Room 501                automatically eligible to receive confidential health
    8am – 12:30pm                 8am – 12:30pm           & nutrition counseling services FREE of charge.
                                                          Go to https://www.stanfordheart.net/online/smc
    Maintenance Group – Lunch „n Learns                   and complete the questionnaire. You‟ll be
    Dec. 6th                 Dec. 10th                    contacted by the Nurse Coordinator to determine
    11:30am -12:30pm         11:30am-12:30pm              your interest.

     Class is limited to 20 people and pre-registration   Health in Motion
is required; call (408) 808-1333 or email                 Log your physical activity and get $5 rewards!
toni@tonibloom.com. Class is conducted on                 Health in Motion returns February 14th. Watch for
County time with your supervisor‟s approval.              County emails or visit our website.

Supermarket Tours                                         Stop Smoking Information
     Our Registered Dietitian shares label reading        Call the County‟s Tobacco Prevention Program for
tips, recipe ideas and focuses on nutrition must-         information on local stop smoking programs,
knows for diabetes, heart disease and weight loss.        including FREE classes and FREE patches offered
                                                          by the Health Department. 573-3989
    Heart & Diabetes              Weight Loss
    Tues, Feb 13th, 2007          Tues, Feb. 20th
    10am – 11:30am                10am – 11:30am
                                                                       For more information:
    Sequoia Station Safeway       Sequoia Safeway                 Employee Health & Fitness Program
    meet @ floral dept            meet @ floral dept

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