Holiday Health

FJ Vol 20, No 24
Dec 15-31/06

One of my friends is new to Canada and is unable to make it home to the Philippines to visit her family. She seems sad all the time, and I think she is depressed. What should I do?

Christmastime is a very difficult time for many people, and problems related to depression and anxiety/stress are more common during this time. Some key features of depression include sad mood, decrease/loss in interest/pleasure, feelings of excessive guilt/worthlessness, decrease in energy/fatigue, indecisiveness or poor concentration, decrease/changes in appetite/weight, sleep disorders, and recurrent thoughts of death or suicide. If your friend has any of these symptoms, you should urge her to see a doctor or health care professional to get help. Her doctor may prescribe medications such as anti-depressants that can help her cope with this difficult time and/or refer her to therapy/counseling. You can remain supportive to her by encouraging her to become active in the community and share her feelings with you as a friend. If she has expressed thoughts of harming herself or others, it is really important that you give her the Mobile Crisis phone number: 946-9109 and consider calling the number if she won’t phone herself. The website www.canmat.org and self-help books such as Mind Over Mood and Feeling Good are useful references you can pass on to her for learning about this type of problems.

Relatively mild anxiety states in reaction to life circumstances are often time-limited, and many people respond to anxiety management strategies without medication. Support, problem-solving and relaxation techniques often help as the environmental crisis resolves. However, specific anxiety or mood disorders may develop from the original reaction. One should control caffeine or other stimulant use, minimize alcohol use (often used to control anxiety), reduce the use of short-acting tranquilizers (eg Valium and Ativan), and take steps to reduce stress including relaxation training and time management. More specific therapy/counselling and referral to a psychiatrist may be necessary if there is little improvement after several months of adequate medication therapy. Clicking on the title "Holiday Health" should link you to the information resource "Coping with Stress" [http://www.cmha.ca/data/1/rec_docs/403_CMHA_coping_with_stress_EN.pdf] by the Canadian Mental Health Association (www.cmha.ca).

I have high cholesterol, and my doctor warned me to stay away from fat. What can I do, especially during the Christmastime?

Having high cholesterol levels in your blood (dyslipidemia) is important, not because you can feel it directly, but because it is associated with a higher risk of cardiovascular disease (CVD; heart attacks and stroke). This is because excess fat deposits in the blood vessels throughout your body (atherosclerosis, AS), which can make it difficult for the heart to pump the blood (with the oxygen it carries) to the tissues that need it. Eventually, the arteries can block up completely, which can cause the tissues that are not getting the blood/oxygen to die (a “heart attack” results from a blockage of the arteries that feed the heart muscle; a stroke from a blockage of the arteries that feed the different areas of the brain). Dyslipidemia, diabetes, overweight, abdominal obesity (overweight in the tummy area), high blood pressure, and low cardio-respiratory fitness are primary risk factors for CVD. You are also at a higher risk if you have a strong family history of heart attacks/stroke or smoke. There are different types of cholesterols and different types of high cholesterol problems; some are genetic (run in the family), and others due to conditions such as hypothyroidism, pregnancy, excess weight, alcohol excess, certain liver and kidney diseases, and medications such as corticosteroids, hormone replacement therapy/oral contraceptives, and some blood pressure and heart medications.

Triglycerides are a type of fat that can be high from certain fats in the diet, but also extra sugars in the blood (excess starches like white breads, alcohol, sugared beverages) that your body turns into triglycerides. Niacin and fibrates help decrease mainly this type of fat.

LDL's (low-density lipoproteins) are the "bad cholesterols--you want them to be low. The “statin” drugs commonly target these fats by helping to lower the amount in your blood, but if you are on one, make sure to check in with your doctor regularly to monitor your liver and muscle enzyme level in your blood, which can go up with this class of drugs. “Resins” are another type of drug that lower LDL and can increase HDLs.

HDL's (high-density lipoproteins) are the good cholesterols that you want high, as they have a protective effect against heart disease + stroke. Regular exercise has been shown to boost this good cholesterol in the blood. Niacin and fibrates can increase this type.

In general, it is important to follow your doctor’s advice about your cholesterol problem, but diet, aimed at reducing blood cholesterol levels and weight (if needed) should always be the first approach. CVD can be reduced by eating less saturated and trans fats, less salt and sufficient amounts of fruit, vegetables and omega-3 and omega-6 polyunsaturated fats. Risk is also reduced with weight control and physical activity. A dietician is usually recommended to reach these goals:
- decrease dietary cholesterol intake to < 300 mg/day (<200 mg/d if AS already a problem): raises blood cholesterol levels but no significant association found yet between CVD and egg consumption (egg yolks—leche flan, dairy products, meat and shellfish)
- restrict fat intake to 30% of calories (20% if AS);
- fat distribution goals as a % of total energy:
o < 10%: Saturated fats tend to raise total & LDL cholesterol levels & are associated with increased risk of CVD: processed foods, coconut oil, lard, hydrogenated hard margarines, butter, full-fat dairy products and fatty meats—so avoid/cut down! Lechon is a big culprit because it is animal fat deep fried in fat—often animal. Yikes!
o < 1%: Trans fats elevate LDL and decrease HDL: partially hydrogenated margarines & shortenings, deep fried foods, processed foods made with partially hydrogenated fats and baked goods—AVOID
o 5-8%: Omega-6 polyunsaturated fats are the most effective replacement for saturated fats to improve heart disease outcomes: soybean, sunflower, safflower, corn and cottonseed oils
o 1-2%: Omega-3 polyunsaturated fats have good effects and decrease fatal CVD: fatty fish (tuna, salmon, mackerel, sea bass, fish oils), plant sources (canola, soybean, flaxseed oils, soft non-hydrogenated margarines, nuts, tofu, ground flaxseed)
o By difference to achieve a total fat intake of 15-30%: Monounsaturated fatty acids lower total & LDL cholesterol levels when substituted for saturated fats but not as well as polyunsaturated fats: canola, olive oils, nuts
- favour high-fibre intake
- limit simple sugars to 8% of total calories
- limit alcohol consumption to 5% of total calories

Plant sterols: the cholesterol-lowering effects have been well documented: vegetable oils, nuts, sesame & sunflower seeds, soy & other legumes.

Other nutrients: fruit and vegetables contribute to heart health through fibre, vitamins, minerals and phytonutrients (esp green leafy & cruciferous veggies, legumes & berries).
Also, if you can increase your fiber intake (10-15 g/d of soluble fiber—eg psyllium, oat bran, kidney beans, artichokes, dried prunes) not only will this help combat constipation which is common with fattening foods and lack of exercise common during Christmastime, but it also may lower cholesterol levels by an additional 10-15%. Pretty good deal! Although some studies suggest a protective role of antioxidants (vitamin E in nuts, seeds, some soft, non-hydrogenated margarines; vitamin C in citrus fruit, berries, tomatoes, potatoes, broccoli, cauliflower, kale, cabbage, sweet peppers; carotenoids/beta-carotene in carrots & tomatoes), controlled studies have not shown much proof. Sodium intake is directly associated with blood pressure, so limit it (salt added to foods, sodium in processed foods & additives like MSG)! Potassium (fruit and vegetables) helps lower blood pressure.

So in summary:
- Avoid hydrogenated oils and fats--Opt for low fat options on the labels of foods you buy.
- Limit the intake of fat from dairy and meat sources; Hidden fats you can cut down on: Whole or 2% milk—go for skim instead.
- Use appropriate vegetable oils in small amounts.
- Ensure a regular intake of fish (1-2 times per week) or plant sources of omega-3 fatty acids.
- Choose foods prepared without frying.
- Eat 400-500 g (6-8 servings) of fruit and vegetables daily.
- Restrict daily salt intake to less than 5 g.
- Choose fibre-rich whole grain cereals, as well as fruits and vegetables.

Increased physical activity may help decrease cholesterol and triglyceride levels while increasing HDL. Try to get regular physical activity/aerobic activity, decrease/stop smoking, watch extra sugars and salts in your foods, and try not to get too stressed during Christmastime! If you overdo it during the holidays, it might be a good idea to discuss this with your doctor to check where your cholesterol levels are at so you can modify your plan to better suit your lifestyle.

Have a healthy and relaxing Christmas! Maligayang Pasko at Masaganang Bagong Taon!