“Adults should limit their sodium intake to no more than 2000mg per day,” Steinberg says. This seems like a number that is easy enough to work with, until you realize how much sodium is in some common food products:

• 1 Bick’s garlic dill pickle= 480mg
• 1 thick slice of cheddar cheese= 462mg
• 2 tbsp of smooth peanut butter= 149mg
• 75g of smoked salmon (lox)= 1500mg
• 2 slices of cooked Maple Leaf ham= 770mg
• 1 tbsp VH regular soy sauce= 1160mg

And let’s not forget salt itself. Just one teensy-tiny teaspoon has 2373mg of sodium. That alone puts you nearly 400 mg over the recommended daily intake!

“Hypertension means there is too much pressure in the blood vessels, and this can cause serious health problems like strokes, heart attacks, heart failure and kidney failure,” says Steinberg. Anyone can develop hypertension, although it is more common in diabetics and those who are older. Once you develop hypertension, there is no turning back- you will likely be managing it for life.

Steinberg has a few simple tips to help reduce sodium intake:

• Take the salt shaker off the table. It doesn’t matter if it’s sea salt, kosher salt, Himalayan salt or fleur de sel
• When cooking, replace garlic, onion and celery salt with the fresh product or powder
• Rinse any canned products, like beans
• Limit foods that have been pickled, processed, cured, smoked or salted
• Limit your consumption of canned soups, sauces, gravies and dressings
• Avoid MSG and brine, as well as salt substitutes (No Salt, Nu Salt, Half Salt), unless approved by your physician or dietitian
• Avoid foods that have visible salt, like salted nuts, potato chips, salted pretzels and crackers.
• If any of the following terms appear in the top 5 of the list of ingredients, avoid the product: sodium, brine, baking soda/powder, kelp or soy sauce.

Look for products that have reduced sodium options, like ketchup. Here’s a look at a few products you could swap to make a big difference in your sodium intake:

• 1 tbsp of Heinz low sodium ketchup has 60mg of sodium (vs. 140mg in the original version)
• 2 tbsp of natural peanut butter has just 2mg of sodium (vs. 149mg in smooth peanut butter)
• ½ cup of fresh mushrooms have only 3mg of sodium (vs. 350mg in canned mushrooms)
• ¼ cup of unsalted almonds have no sodium (vs. 119mg in salted almonds)

In honour of World Salt Awareness Week this week, see if you can make a few small changes in your diet- your body will thank you for it.

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View the post Are you eating too much salt? on Sunnybrook's Your Health Matters blog.

I’ll admit, sodium isn’t the most dynamic topic. But considering we all consume it (and sometimes a lot of it) everyday, why not dig a little deeper with a little game?

True or False?

1. Too much sodium in your diet can increase your blood pressure.
2. Half of Canadians have a condition known as sodium sensitivity.
3. If your socks leave indentations in your leg, you might have a problem with sodium.
4. Different types of sodium (table salt, kosher salt, sea salt) contain different amounts of sodium.
5. Salt substitutes can be risky if you have kidney disease.

Hopefully I’ve piqued your interest, as all of the answers can be found in my video. (Before I did my interview with Nephrologist Dr. Sheldon Tobe, I would have only gotten two answers right.) The whole thing has me paying much more attention to all the sources of sodium I’m consuming everyday… and my socks.

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View the post What you need to know about sodium on Sunnybrook's Your Health Matters blog.

Two questions often pop into people’s mind when they think of heart attacks.

One: How do I avoid having one, and

Two: How do I know if I’m having one?

Dr. Harindra Wijeysundera, an interventional cardiologist at Sunnybrook, says it’s never too late to take steps to prevent a heart attack.

Lifestyle factors that can really help to keep your ticker healthy include:

• Maintaining a healthy weight with a heart-healthy diet
• Quitting smoking
• Exercising regularly
• Managing stress and control conditions that can lead to heart attack, such as high blood pressure, high cholesterol and diabetes

What if you’ve already had a heart attack?  Taking your medications can reduce your risk of a subsequent heart attack and help your damaged heart function better.  Listen to your doctor, make sure you take prescribed medications and also be sure to check in with your doctor about how often you need to be monitored.

Dr. Wijeysundera cautions that the symptoms of a heart attack can vary.  Not all people who have heart attacks have the same symptoms or have the same severity of symptoms.  Some patients have mild pain, while others have more severe pain.

Common signs and symptoms include:

• Pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back
• Shortness of breath
• Nausea, indigestion, heartburn or abdominal pain
• Lightheadedness or sudden dizziness
• Cold sweat
• Fatigue

All right, so you or a loved one is having those symptoms.  What next?  Dr. Wijeysundera says to act immediately. Some patients wait too long because they don’t recognize the important signs and symptoms.

Here’s what to do if a loved one exhibits the above symptoms:

• Call 911 for emergency help: If you suspect you’re having a heart attack, don’t hesitate.  In Toronto, there is a coordinated system between Toronto Paramedics Services and several hospitals to ensure that if you’re having the most serious kind of heart attack, called a STEMI, you’ll get the care you need very quickly
• If you have a prescription for nitroglycerin, take it while awaiting emergency help
• Take aspirin, if your doctor or the paramedics recommend it

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View the post Heart attack 101 on Sunnybrook's Your Health Matters blog.

Heart failure is the most rapidly rising cardiovascular disease, and the most common reason for hospitalization. At Sunnybrook’s latest Speaker Series, Take Heart: Latest Updates in Cardiac Care, a leading panel of experts discussed heart failure, innovations in cardiac imaging and treatment, as well as the connection between kidney and heart health.

Heart failure is a gradual decline in the heart’s ability to pump and circulate blood. This happens when the heart is damaged in some way, such as following a heart attack or as a result of chronic high blood pressure. Cardiologist Dr. Stephanie Poon says medications play an important role, and some patients will also need more advanced therapies like assist devices. She says that daily lifestyle modifications can also help patients living with heart failure, including:

1. Limiting your fluid intake to less than 2 litres per day.
2. Reducing the salt in your diet to less than 2 grams per day.
3. Exercising to reduce heart failure symptoms. Be sure to check with your doctor to see what is safe for you.
4. Avoiding heavy lifting, snow shoveling and high impact sports.

Over half a million Canadians are currently living with heart failure, and 50,000 new patients are diagnosed every year. Symptoms of heart failure include congested lungs, shortness of breath, cough, fluid retention, fatigue, weakness and/or irregular heartbeat. If you are concerned, consult with your doctor.

To view the complete Speaker Series webcast, click here.

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View the post Living with heart failure on Sunnybrook's Your Health Matters blog.

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View the post Tips for dining out – the heart-healthy way on Sunnybrook's Your Health Matters blog.

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View the post Try these heart-healthy menu swaps when dining out on Sunnybrook's Your Health Matters blog.

March is Nutrition Month. Let’s keep working toward our healthy eating goals all year long!

Dietitian Daphna Steinberg has some month-by-month tips to keep us on track. Check out a printable version below (I put one on my fridge for a good and healthy reminder!)

January – Keep a food diary to help you stay honest about what you are eating.

February – Sweet tooth? Enjoy a square or two of chocolate as a treat. Dark chocolate is best. (Share a bar with a friend).

March – Plan your meals and eat with your children to set good habits early in life.

April – What’s your salt intake? Aim for less than 2000mg a day

May – Add one extra fresh vegetable to each dinner! Check Foodland Ontario’s Availability Guide for what’s in season. Be sure to wash produce thoroughly before eating.

June – Practice mindful eating habits to prevent overeating. Make the dinner table a no-phone zone and try to eat slower.

July – Stay hydrated in warm weather, especially if you are being active outside. Choose calorie-free drinks, like water!

August – Hitting a patio for dinner? Don’t starve yourself all day. Eat a healthy snack to avoid overeating when you get to the restaurant.

September – Check out local fall markets and try harvest veggies that have been grown close to home.

October –Don’t overbuy Hallowe’en candy (and reduce your risk of eating all the leftovers!)

November – Give your breakfast a boost this month. Include protein in your morning meal. Did you know a boiled egg has about 6 grams of protein? Other good sources include cottage cheese and peanut butter.

December – Holiday party time! Be sure to have a healthy snack before you hit the party. This will help prevent you from stopping by the food table and staying there all night!

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View the post Monthly tips for healthy eating on Sunnybrook's Your Health Matters blog.

Did you know: Medical nutrition therapy may lower cholesterol by up to 20-30%, depending on individual response. A heart healthy diet is much more than just about watching your fat intake. In fact, it is a portfolio of some key foods that is needed to really lower cholesterol. This includes soluble fibres, nuts, soy protein, and plant sterols. Dietitians not only provide nutrition education, but also the counselling to help people make the behaviours changes that lead to improved cardiovascular health.

Soy protein has been shown to help lower LDL (lousy) cholesterol, yet a lot of people are not sure how to incorporate it into their diets. To lower cholesterol, aim for 25g of soy protein each day. Even if you are not looking to lower cholesterol, soy is high in protein and isoflavones, and is recommended as a part of a healthy diet.

Here are examples of food sources of soy protein:

Give this recipe a try to start incorporating some soy into your diet!

Tofu Stirfry

Serves 3

Ingredients:

• 3 tsp olive oil
• 1 package extra firm tofu (397g), rinsed and patted dry with paper towel, and cubed
• 1 onion, chopped
• 1 clove garlic, minced
• 1 bell pepper, chopped
• ½ package mushrooms (75g), chopped
• ¼ cup water
• 1 tbsp low sodium soy sauce
• 1 tsp sesame oil
• 1 scallion, chopped
• ¼ cup cashews
• Black pepper, to taste

Directions:

1. In a non-stick pan, sauté tofu in 2 tsp oil over medium-high heat until golden brown, and set aside.
2. Over medium heat, sauté the onion, garlic, and vegetables (except scallion) in the remaining olive oil.  Add water and cook until vegetables have softened.
3. Return the tofu to the pan, and stir in soy sauce and sesame oil.
4. Add scallion, cashews, and black pepper.  Cook for 2 more minutes.

For a healthy and balanced meal, enjoy with leafy greens and brown rice!

Nutrition Information (per serving):

268 kcal, 18g fat, 19g protein, 19g carbohydrate, 5g fibre, 195mg sodium, 335mg calcium, 9mg iron

Click here if you are interested in attending our next Healthy Heart, Healthy You group education session with a registered dietitian.

To connect with a registered dietitian, patients of the Sunnybrook Academic Family Health Team should ask their family doctor for a referral. If you have prediabetes or diabetes, you may call SUNDEC at 416-480-4805.

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View the post Add soy protein to your diet to help lower cholesterol on Sunnybrook's Your Health Matters blog.

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View the post Are your legs safe? More about Peripheral Artery Disease on Sunnybrook's Your Health Matters blog.

Dale Robarts was tired. Even the simplest tasks were draining him of breath and energy. He would go about his life in two-minute chunks and then have to sit down to catch his breath again. Something was seriously wrong.

Dale was diagnosed with two separate heart problems: one of his heart valves wasn’t opening properly, and another was leaking. He came to Sunnybrook, which specializes in minimally invasive surgeries to fix both problems. Little did he know he was about to make history.

Dale is the first Canadian patient to receive two specific heart procedures at the same time: TAVI and Mitral Clip. TAVI, or transcatheter aortic valve implantation, replaces a faulty heart valve with a new one, allowing blood to flow from the heart to the body properly. The Mitral Clip is another tiny but mighty device. It’s fished up to the problem of the heart to plug the leak.

Both procedures can be done by feeding catheters through a small incision in the leg or arm leading up to the heart, sparing patient riskier open heart surgery. And for some patients who aren’t candidates for open heart surgery – estimated to be about one third of patients who need an aortic valve replacement — this approach offers them a welcome and potentially lifesaving option.

Dr. Gideon Cohen, Chief of Cardiac Surgery at Sunnybrook, has done many TAVI procedures. “Some patients are simply too high risk for whatever reason. Either they are too elderly or have too many co-morbidities or other illnesses which preclude them from undergoing conventional aortic valve replacement.”

Dale knew he needed to have both procedures done, but it wasn’t at first clear if they could do them together. “They said they would do one, and then a month later, they would come back and do the other one,” says Dale. “So I asked Dr. Cohen if they could do both of them at once. He said we usually don’t do that but we’ll see when we have a look. So after the operation he told me they had done that both. I thought that was just great!”

“This patient, it was a perfect storm where it was the right thing to do for him,” says Dr. Sam Radhakrishnan, Director of the Catheterization Lab at Sunnybrook and one of Dale’s doctors. “It does have to be individualized but I suspect there are patients, more patients than we’ve treated thus far, that could potentially have the procedures at the same time.” For suitable candidates, this brings with it a host of benefits, including less exposure to sedation, reduced time in hospital and a faster recovery.

Dale was thrilled to be part of this pioneering move. And equally happy to feel well when finally returning to his day-to-day activities. “I’m getting stronger, able to do more without feeling tired. The breathing is much easier and I’m not short of breath. It worked out real well.”

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View the post One heart surgery, two procedures: a Canadian first on Sunnybrook's Your Health Matters blog.

QUESTION: A friend recently had a heart attack. His main symptoms were vomiting and being extremely sweaty.  I thought a heart attack produced really severe chest pain. How are you supposed to know if you’re having a heart attack?

ANSWER: The most common sign of a heart attack is, indeed, chest pain. But not everyone feels the same thing. Like your friend, some people have other symptoms.  And unfortunately, they may not realize they are having a heart attack and delay seeking potentially life-saving medical treatment.

The challenge of recognizing a real heart attack arises from the fact that the heart doesn’t have the same level of pain sensors found in some other parts of the body such as the surface of skin, says Dr. Harindra Wijeysundera, an interventional cardiologist at Sunnybrook Health Sciences Centre.

“A lot of patients think of pain as being sharp – a stabbing-like discomfort they get when they cut themselves,” he explains.

Heart attack pain can be different. It may feel like a pressure or tightness and general discomfort. It’s sometimes described as an “elephant standing on your chest.”  The discomfort can radiate up to the neck and jaw or down the left arm. These are the typical symptoms of a heart attack and they usually include shortness of breath.

Others may experience non-typical symptoms such as stomach upset or a feeling resembling heartburn. They may actually vomit and be extremely sweaty even though they are not hot.   They can also feel lightheaded.

And, in some cases, the person notices only one symptom, while others feel an array of them.

To further muddy the waters, the pain or discomfort may not seem extremely bad. Many people think a heart attack will produce “severe, overwhelming, stop-you-in-your-tracks chest pain,” notes Dr. Wijeysundera. That isn’t always the case.

Not so long ago, it was thought that women were less likely than men to experience the crushing chest pain associated with a heart attack. That assumption was used to explain why women tended to be treated less aggressively than men when they showed up at a hospital emergency department with a heart attack.

“But, to be honest, I think there is so much individual variability that I am not sure the gender differences stand up,” says Dr. Stephanie Poon, a staff cardiologist at Sunnybrook.  “Women can certainly feel heart attacks the same way as men.” It’s just impossible to predict how any particular person is going to feel when a heart attack happens.

A heart attack results from a blockage in the coronary arteries that supply blood and oxygen to the heart muscle. These obstructions usually develop over a period of time as plaque and fatty deposits build up inside the walls of the arteries. If left unchecked, an artery may become completely blocked. In some cases, the plaque ruptures or tears, causing the formation of a clot that immediately stops or hinders blood flowing to a part of the heart, thereby damaging the vital organ.

“For a lot of people, it is very much a progression and there are a lot of warning signs before they actually have a heart attack,” says Dr. Poon.

“As the blockages get bigger and bigger, the supply of blood and oxygen to the heart muscle is decreasing as well,” she explains.  That means the individual may no longer be able to do daily activities – such as walking up a flight of stairs – without feeling winded or having some chest tightness.

“If you feel you’re slowing down because you’re always out of breath or getting chest tightness, you should go see your family physician,” advises Dr. Poon. “Hopefully, the doctor can begin preventive measures that nip the problem in the bud.”

But sometime people ignore the warning signs, or the preventive measures are not enough to stop the inevitable and a heart attack still happens.

“If you are feeling really unwell, having chest tightness, shortness of breath, feel sweaty or very nauseated and it goes on for 15 or 20 minutes, or gets worse, then you should call 911 for EMS (Emergency Medical Services) to take you to the hospital,” says Dr. Poon.

Don’t try to drive yourself. “You can pass out at the wheel and have an accident,” she warns.

Furthermore, EMS can speed your way to rapid treatment. When the paramedics arrive, they will put electrodes on your chest to do an electrocardiogram, which measures the heart’s electrical activity. This test can often determine if a patient is having a heart attack. In some cases, patients are rushed into a hospital’s cardiac cath-lab, bypassing the emergency department “and saving valuable time,” says Dr. Wijeysundera, who is also an Assistant Professor at the University of Toronto.

The cardiac cath-lab is where doctors do angioplasty – a procedure that can open up blocked coronary arteries.

A catheter, or thin plastic tube, is inserted in an arm or leg artery and pushed along to the heart blockage. A balloon-like device at the end of the catheter is inflated to press the obstruction aside.  A stent, or tiny wire mesh, is then put in place to keep the artery propped open.

By rapidly restoring blood flow, damage to the heart can be limited.

“I often tell my patients to seek medical attention even if they are unsure they are having a heart attack,” says Dr. Wijeysundera.  “It’s better to err on the side of caution because a heart attack is such a serious condition and unfortunately our warning symptoms are not always that great.”

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View the post Why some people don’t know they’re having a heart attack on Sunnybrook's Your Health Matters blog.

Here are 6 changes you can make to your lifestyle to help out your heart (and other parts of you too!) Try even just one to give your heart a little love this year.

1. Quit smoking.

If you smoke, make a plan to quit. (And if you don’t smoke, don’t start. Within months, quitting smoking reduces your risk of a heart attack, improves breathing and helps circulation. After a year of quitting, your risk of heart disease and smoking-related heart attack is cut in half. Start by making a quit plan. Need help? Check out sunnybrook.ca/quitsmoking or talk to your health-care provider.

2. Cut down on sugar.

The World Health Organization (WHO) suggests we try to keep our sugar intake to less than 6 teaspoons a day (not including naturally occurring sugars, like in fruits). Eating too much sugar has been linked to cardiovascular disease and other health issues. Do you put two sugars in your tea? Try cutting back to one. (Even better, none!) Keep an eye out for hidden sugars. Cereals, yogurts, salad dressings and sauces can often have a wild amount of added sugar. Choose these items with less sugar (or use less dressing when tossing your greens!)

3. Add an extra veggie to each lunch.

Cut up some celery sticks to eat with your sandwich, or add broccoli to your pizza. Sneaking an extra vegetable in at lunchtime can help you reach Canada’s Food Guide recommended servings of vegetables/fruits (7-8 for adult women, 8-10 for men). Eating the recommended amount of vegetables can help reduce your risk of many chronic diseases.

4. Try a meatless Monday (or at least one meatless meal per week)

Have one vegetarian meal each week that includes legumes like beans, chickpeas or lentils. Legumes are packed with protein and fibre, and are lower in saturated fats than most meats. Eating more legumes can help manage diabetes and improve cholesterol levels. Need inspiration? Try this three-bean chili. 

5. Add three 10-minute chunks of activity to each day.

We know you’ve heard this one: adding daily activity to your lifestyle has many health benefits. But remember, daily activity doesn’t mean you have to spend hours at the gym. Try to add three 10-minute chunks of medium activity. Park farther away from the doors and briskly walk, get off the bus a stop early, have a walking meeting or take the stairs). Check out Canada’s Physical Activity Guidelines for more ideas.

 6. Take electronics out of the bedroom.

To improve your sleep quality, make your bedroom a no-phone zone. Leave phones, TVs, tablets or other things with bright screens out in the living room. Actually, studies show that avoiding these devices one hour before bedtime can improve your sleep quality, leaving you better able to make healthy choices the next day.

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View the post 6 nice things you can do for your heart this year on Sunnybrook's Your Health Matters blog.

If you are reading this, chances are you are thinking about quitting smoking, or you’d like to find ways to help a loved one quit. And if so, congratulations on taking this first step!

Quitting smoking is a journey, not an event. It can take time and require lots of support from family, friends or your healthcare provider.

Smoking is known to have negative effects on your health. But, rather than scare us with the dim facts, here’s a little positive motivation from the Heart and Stroke Foundation:

• Within one year of quitting smoking, your added risk of coronary heart disease is cut in half than that of a smoker.
• Within five years, your risk of having a stroke will be nearly the same as a non-smoker.
• Within 10 years, the risk of dying from lung cancer is cut in half.
• Within 15 years, your risk of coronary heart disease will be similar to that of a non-smoker.

Almost immediately after quitting, your body sees positive changes.

So, again with help from the Heart and Stroke Foundation, here are some tips to help you become smoke-free:

What’s your trigger?

Now that you are thinking about quitting, try to notice when in your day you smoke. Is it after your turn on the coffee pot? When you are waiting for the bus? When you are stuck in traffic? Or after that daily meeting with your boss? Figuring out what your triggers are is an important step on this journey.

The 4Ds of quitting

Delay.
Distract.
Drink Water.
Deep breathe.

It’s your morning break and you feel the need to smoke. What can you do?

Delay: Stop and ask yourself if you really need this cigarette, or if you can wait and do something else.

Distract yourself: Keep your hands and mouth busy. The Heart and Stroke Foundation recommends having a drink of water, brushing your teeth, reaching for some carrot or celery sticks, taking a walk, calling a friend.

Deep breathe: Take a few deep cleansing breaths. You can do this.

Drink water: As mentioned above, drinking water is a distraction and a delay tactic (plus, drinking water is good for us)

Set a quit date

Are you ready to start your quitting journey? Set a date. Write it down, and tell a family member or friend so that you feel accountable.

Set up smoke-free zones

Cutting down on the times you can smoke will make it more difficult to do so, and reduce the number of cigarettes you have in a day. Make your home and your car smoke-free zones.

It takes a village

Becoming smoke-free can be difficult, so please ask for help and support from family, friends, your healthcare provider or online community. As a family member, be supportive of your loved one’s quit-date and timing for this journey. If you smoke, respect their smoke-free zones.

More tips

Visit sunnybrook.ca/quitsmoking or Heart and Stroke Foundation for more tips, information and support.

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View the post Tips to help you quit smoking on Sunnybrook's Your Health Matters blog.

Great news for busy folks who want to be more active: you can reach the recommended 30 minutes a day of physical activity by breaking it into three, 10-minute chunks.

That sounds reasonable, don’t you think? Carving out a dedicated half hour might be tricky, but 10 minutes a few times a day seems way more doable! So, if you aren’t a gym person (like me!) then this type of physical activity might be right for you.

Physical activity has lots of known benefits, like reducing the risk of numerous chronic conditions, including coronary artery disease, stroke and Type 2 diabetes. The physical activity should be moderate intensity (so, you won’t be panting like a bulldog at the park in July, but your heart rate should be elevated. If 10 is the hardest you can move, moderate is about a 6 out of 10)

So, got 10 minutes? Here are some ideas for getting active:

(If you have health concerns or have been inactive, please consult your healthcare provider before starting any new activity.)

Get off the bus a stop or two early (or park farther away):

This one doesn’t sound too enticing during the great Canadian winter, but, keep up a good pace and you’ll be warm enough. I’ve been doing this lately, and I’ve come to enjoy arriving at my desk with my heart pumping and my cheeks rosy from the fresh air! Snowy where you are? Be sure to wear proper footwear and keep your hands out of your pockets for balance if you are doing this one! And, keep your head up – don’t text and walk.

Have an active walking meeting:

Instead of meeting a coworker for a coffee or in an office, ask for a walking meeting instead. Some studies suggest exercise boosts creativity, so your ideas will flow along with your blood!

Living room dance party:

Before hitting “play” on your latest Netflix binge of choice, pick three songs and have a 10-minute living room dance party. Clear a safe dancing space (watch out for the coffee table!) and shake your body! Dancing has also been found to improve mood, so this is a fun one! Get the whole family dancing!

Set up an in-house 5-station circuit:

This idea comes from Mark G. Anunciacion, physiotherapist at the Holland Centre. Set up a five-station circuit in your home and spend two minutes at each station. No gym and little to no equipment required! If you aren’t sure what’s right for you, consult a local health care professional. They can give you further details about correct body mechanics and what exercises might be best for you.

Here’s some ideas for circuit stations you can do inside your home.

• Quarter wall squats (Stand with your back against a wall and then push down into a squat position. Knees must not pass ahead of toes) with forward reach of arms as you squat.
• Marching with arm swing.
• Countertop push-ups (wear your running shoes to avoid slipping)
• Chair rise (sit-to-stand motion. knees must not pass ahead of toes)
• Seated rowing with a theraband (resistance band)

How do you get your 30 minutes a day of physical activity? If you have any ideas to share, post in the comments below!

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View the post Got 10 minutes? You can get active! on Sunnybrook's Your Health Matters blog.

I’m sure by now you’ve noticed that vegetable prices at Canadian supermarkets are climbing. And, word on the street is that climb is going to continue.

So, how can we keep up our vegetable intake – or add more! – when prices are skyrocketing? (I’ve been tempted to throw in the towel on vegetables all together after some trips to the near-vacant / pricey produce aisle at my local supermarket! My grocery list went out the window!)

Daphna Steinberg, registered dietitian, shares these tips to help you fill up on veggies but not empty your wallet:

Talk to the produce manager at the grocery store

The manager can help guide you to what’s freshest and tastiest, and can even give you ideas on how to cook them best.

What’s on sale?

Check flyers and coupons for what’s on sale and plan your menu accordingly. I’ve never been so excited to see a cauliflower until I saw a fine-looking bunch on sale for $3.99 this week! Sweet potatoes on sale? Add baked sweet potato fries to a dinner this week. And if something is on sale…

…Buy lots and freeze it!

It’s best for nutritional value for you to freeze while it’s fresh. So, buy double, and chop and freeze half right away. Be sure to store in airtight containers.

Frozen and canned vegetables count

Choose low sodium canned goods. And choose plain frozen vegetables (not with sauces already added) or freeze your own.

Shop local

Try to buy produce that’s grown locally (think greenhouse tomatoes and cucumbers, winter squashes). Keep track of what’s in season.

Think outside the {fill in your go-to vegetable here}

We all have favourites we reach for in the produce aisle – whether for taste, habit or convenience. Try to shake it up a little and give some other vegetables that you usually skip over a try. Hate boiled brussel sprouts? (need I even ask?) Try tossing brussel sprouts in olive oil, garlic and salt and pepper and roasting them (about 20-25 minutes at 375 C). Daphna says her four-year-old son gobbles these up. Or, try roasting beets (cheap and delicious).

Skip the organic

If you are looking to save on vegetables, don’t purchase organic, which are more expensive and typically travel longer distances so don’t last as long once in your fridge.

Make the most of  ’em

Make the most out of the vegetables you purchase by using them all up! Leave the skin on those cucumbers, carrots and potatoes, just give them a good wash. That’ll help avoid peeling the bulk of them away – and leaves on good fibre. Finely chop up the broccoli stalks and use them for coleslaw. Or, include the stalks in a soup.

Soup’s on

Instead of tossing out that wilted cauliflower that cost you $7.99, or those carrots that have lost their crispness, throw them all into a stock pot with some low sodium broth and make a nice warm soup!

How are you managing with soaring produce prices? Share your ideas below (but just don’t say boil brussel sprouts!)

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View the post Tips for eating veggies on a budget on Sunnybrook's Your Health Matters blog.

Watch out for sneaky sugar if you want to reduce your risk of heart disease, obesity and diabetes.

The World Health Organization (WHO) recommends we aim to keep our sugar consumption to below 6 teaspoons (25 g) a day for health benefits. “This refers to monosaccharides (such as glucose, fructose) and disaccharides (such as sucrose or table sugar) added to foods and drinks by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates,” according to WHO.

There’s a few obvious ways we can reduce our sugar intake (Cut out sugary things, like pop, for example).

But, sometimes it’s a little more sneaky. Here’s a list of 5 of the top offenders in the hidden sugar department. My patients (and family and friends) are often shocked that these are on the list.

Juice:

Watch out! Even freshly squeezed juice contains sugar. These naturally occurring sugars from fruit juice or fruit juice concentrate still count towards your daily sugar intake! There’s been some talk in the past year about removing juice from the fruits and vegetable category of Canada’s Food Guide because of its high sugar content. Be smart. Switch to water. If you need some flavour, try cutting up a lemon or other fruit to infuse the water that way.

Flavoured Yogurt:

That low fat yogurt that still tastes delicious – be careful! It might have loads of sugar. A spot-check my colleague’s 100 g yogurt this morning revealed it had 12 g of sugar. Food labels don’t distinguish between added sugars and naturally occurring sugars.

Yogurt has other health benefits, but just limit your intake and try to choose low sugar options.

Cereal:

Yes, we know that the “sugary cereal” brands should be avoided – but watch out for health-branded cereals too. Granolas often contain lots of sugar (think upwards of 30 grams per 100 gram serving).

“Healthy” sweeteners:

There seems to be a move toward “healthy” sweeteners like honey, agave and maple syrup. These taste delicious. But they are still sugar.

Ketchup:

Yup, this kid favourite is packed with sugar. So, limit Junior’s ketchup intake or make your own at home!

How’s your sugar intake? Are you doing anything to cut down?

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View the post 5 foods where sugar hides on Sunnybrook's Your Health Matters blog.

I’ve been hearing and reading a lot lately about “pulses” – another name for legumes: dried beans, peas, lentils and chickpeas. Some foodies are calling this group the latest “superfood”. The United Nations has even declared 2016 the Year of the Pulse.

Curious if legumes really are all the rage when it comes to healthy eating, I spoke to Daphna Steinberg, registered dietitian, and as it turns out, a legume fan!

“Legumes make a great, low-fat meat alternative,” Daphna said. “We know that consumption of red meat has been found to be a risk factor for cancer and heart disease, and so we shouldn’t eat too much of it.”

A few more legume pros:

Legumes are high in fibre. Meat is not.

Fibre helps lower cholesterol, which is helpful in the prevention of heart disease. Fibre also helps us have regular bowel movements, and helps control blood sugar levels and blood pressure, and keeps you feeling full for longer.

They also contain protein, B vitamins and iron.

According to Eat Right Ontario,

• Protein is an essential nutrient to keep your body functioning well. Proteins are needed to build and repair muscle, tissue, skin, nails and hair.
• B vitamins are vitamins that help our body use fat, carbohydrates, and protein for fuel.
• Iron, a mineral, is needed to make blood in your body. Iron comes in two forms, called heme and non-heme iron. Non-heme iron, which is found in plant foods like beans and lentils, is absorbed best when consumed with vitamin C rich foods like bell peppers, tomatoes, strawberries and citrus fruits.

Legumes also have a lower glycemic index than many other carbohydrates so they won’t spike blood sugars.

And so, how can we add these little power-packed beans and peas into our routine? They can take the place of meat at a meal, or be added to other dishes to give them a boost.

Need inspiration?

Daphna suggests adding beans, peas, chickpeas or lentils to soups, stews, chili (for example, this chipotle three-bean chili), pasta or salad.

Try chickpea curry, with lots of veggies, sweet potatoes, coconut milk, and curry paste and spices.

How about a light orzo pasta dressed with sautéed chickpeas, garlic, veggies and herbs in olive oil?

Need a new side dish? How about a mixed bean salad?

Tip: Soak dried legumes overnight (according to package directions). If using canned goods, choose low sodium options. Always rinse legumes, whether canned or dried.

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View the post What’s a legume and why should I eat it? on Sunnybrook's Your Health Matters blog.

Everyone knows humans need sleep.

Adults need on average just under 8 hours of sleep per night for good brain function (although this varies from person to person, with some needing as little as 6.5 hours and some needing as many as 10).

To find out why sleep is so important, I talked to Dr. Andrew Lim, neurologist.

“Sleep plays a key role in maintaining brain health — clearing toxins, regulating the connections between neurons, maintaining healthy brain blood flow, consolidating memories — but clearly sleep also plays a role in cardiovascular health, immune health, and other organ systems.  Sleep touches pretty much every major organ system, from brain on down.”

That includes the heart, says Dr. Anu Tandon, respirologist and sleep specialist.

“Reduced sleep may put excess strain on the heart by releasing certain hormones in the body that cause your blood pressure and heart rate to increase. Over time, this can lead to development on hypertension – one of the well-known risk factors for developing heart disease.”

Sleep fragmentation can also be a problem, she says. That’s when waking up or entering into a lighter sleep phase interrupts deep REM sleep. It can be related to obstructive sleep apnea (pauses or shallow breaths for a few seconds to a minute).

“A severe degree of apnea has been linked to increase risk of heart attacks, development of hypertension and worsening heart failure if your heart is already damaged,” Dr. Tandon says.

Talk to your doctor if you still don’t feel rested after a long night’s sleep.

So, how can we be sure to get a good rest for our brains and hearts?

• Avoid caffeine in the afternoon and evening.
• Get regular exercise.
• Keep to a sleep schedule, even on weekends.
• Avoid alcohol (it disrupts REM sleep)
• Keep the bedroom dark and cool.
• Keep electronics out of the bedroom – Oh no. My phone is practically attached to me! Let’s dig into this one a little further…

Say no to electronics in the bedroom

A TV, tablet or phone (or all three) in the bedroom can affect your sleep.

“Very similar to how one stretches before exercises, the brain needs ‘down time’ before settling,” Dr. Tandon says. “These devices engage the brain preventing it from realizing it is time to rest.”

Dr. Lim says the light from electronic devices can potentially disrupt one’s internal biological clock, making it more difficult to fall asleep. As well, the activities that you do on these devices (surfing the web, playing games, checking e-mail, doing work) are often quite activating, making it even harder to fall asleep.

For people who have trouble falling asleep (sleep initiation insomnia), it’s very important to allow the brain to decompress before sleep so it’s not over-stimulated.

Some experts suggest avoid your electronics for two hours before bedtime. If that’s not possible for you, at least try to keep them out of your bedroom or on dim.

What’s your key to a good night’s sleep? For me, it’s no caffeine after noon and a few pages of a good book to wind down before bedtime.

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View the post Get some sleep for your heart and brain on Sunnybrook's Your Health Matters blog.

As a family doctor, I have the privilege of caring for women and their families through many life stages.  Time and time again, I’m struck by the profound link between a woman’s health pre-pregnancy, during pregnancy, and her future heart health.  Quite simply: pregnancy can provide a window into your future heart health

Here are my tips for pregnant women:

1. Stay active: Physical activity in pregnancy has minimal risks and has been shown to benefit most women.  Of course, your body is changing with a little one on board, so you may need to modify your exercise routine.  I recommend my pregnant patients with uncomplicated pregnancies do aerobic and strength-conditioning exercises before, during, and after pregnancy.  The impact of exercise on reducing your risk of gestational diabetes, and on maintaining a healthy weight, have positive implications for both you and your baby. Exercising for two helps both of you to be heart healthy for life!
2. Keep an eye on the scale: There are guidelines for recommended weight gain during pregnancy, and for good reason: women who gain more than the recommended weight are at risk of complications for both themselves and their unborn children even if their pre-pregnancy weight is in the normal range. When eating for two you are not eating as if you are two! Pop culture, including TV and movies, can play into the idea that pregnant women can or should eat whatever they like (tub of Ben and Jerry’s anyone)! The reality is that currently almost half of Canadian women of childbearing age are overweight or obese, which is associated with an increased risk of gestational diabetes, hypertensive disorders in pregnancy, thromboembolic disease (blood clots formed in blood vessels) and operative deliveries.  A healthy diet and staying within the guidelines of recommended weight gain goes a long way in setting you and your baby up for good health both now and in the future!
3. Share your pregnancy history with your family doctor: After your baby is born, be sure to fill in your family doctor about your pregnancy.  You may have seen an obstetrician, midwife, or family physician for your pregnancy but your family doctor may not be aware of your pregnancy history or complications. What happens in pregnancy is important for your future health as well as for planning for next time. If you developed gestational diabetes, you have a 10 to 20 per cent risk of developing type 2 diabetes over the next 10 years.  Knowing this can help you and your primary care doctor develop a plan together to reduce that risk. Women with a hypertensive disorder in pregnancy are at higher risk of developing earlier high blood pressure, heart disease and stroke but knowing this history helps you and your family physician make the changes together to change that future. Take advantage of the opportunity provided by pregnancy to change the future.

Pregnancy is a wonderful opportunity to embrace lifestyle changes with support that benefit both you and your family, “when it matters most”

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View the post Pregnant? Good health now leads to a happy healthy future on Sunnybrook's Your Health Matters blog.

If you have a surgery coming up, your health care team or loved ones may be encouraging you to quit smoking. Smoking and surgery, they say, don’t make a great pair.

They are right. But why? To answer that question, Dr. Chris Idestrup, Anesthesia Site Chief at Sunnybrook’s Holland Orthopaedic and Arthritic Centre, directed me to StopSmokingforSaferSurgery.ca, a site maintained by Ontario’s Anesthesiologists. This site has some great info and five reasons about why it might be a good idea to quit smoking before going in for surgery.

Your lungs.

Smoking damages your lungs and that can put you at a higher risk of breathing issues from the anesthetic you need for surgery.

Being smoke-free for even just a few weeks before your surgery can help your lungs heal.

Your heart.

According to StopSmokingforSaferSurgery.ca, the carbon monoxide in cigarette smoke reduces the amount of oxygen that your blood can carry to your heart. Nicotine makes your heart beat faster. Together, that puts you at a higher risk of a heart attack.

Your recovery.

If you smoke after surgery, this can slow down your healing and increase your chance of getting an infection. This is because of the reduced oxygen getting to your surgery site, slowing the normal healing process. Staying smoke-free after surgery can help your healing.

Your success at quitting for the long-term.

Changing your routine can help you quit smoking – so preparing for and undergoing surgery is a good time to switch things up. Plus, hospitals are smoke-free zones, so even a short stay in the hospital will limit your actual ability to light up. And, hospitals are full of people who can give you the necessary resources and support for quitting. Tell your doctor or another health-care provider that you have recently quit smoking or if you are in the process of quitting; they can help.

The rest of your life.

If you stay smoke-free, it’ll reduce your risk of returning to the hospital, both due to infection from this surgery and for further health issues.

From the Heart and Stroke Foundation:

• Within one year of quitting smoking, your added risk of coronary heart disease is cut in half than that of a smoker.
• Within five years, your risk of having a stroke will be nearly the same as a non-smoker.
• Within 10 years, the risk of dying from lung cancer is cut in half.
• Within 15 years, your risk of coronary heart disease will be similar to that of a non-smoker.

Check out StopSmokingforSaferSurgery.ca and Ontario Anesthesiologist’s site for more information.

The Smoker’s Helpline has quitting support and info.

Or check out quick tips on quitting from a Sunnybrook social worker.

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View the post Got surgery coming up? Quit smoking now. on Sunnybrook's Your Health Matters blog.