Lown Forum

No matter the lifestyle, men can benet from a routine that refocuses our attention to health.

T HE

2012

NUMBER

LOWN CARDIOVASCULAR RESEARCH FOUNDATION

In this special issue, Dr. Barbara Roberts and Dr. Brian Bilchik explore how cardiovascular disease aects men and women dierently as well as what we can do to prevent it.

Mens heart health

Brian Bilchik, MD

Womens heart health

Barbara Roberts, MD, FACC Knowing how women dier from men when it comes to cardiovascular disease is the key to eective prevention.
A better understanding of heart disease in women has been hampered by two factors. The rst is that until the last few decades, the medical profession took a bikini approach to womens health. The only diseases that fell under the rubric of womens health were those aecting the breasts and the reproductive tract. For other diseases, it was assumed women had the same risk factors, symptoms, and responses to medicine and interventions that men did. This turned out to be a rather egregious error. The second factor was that in medicine, what happened to men was considered the norm. To give an example, women, at equivalent levels of risk, tend to develop signs and symptoms of heart disease about 10 to 15 years later than men do. After noticing this, medical scientists embarked on a fruitless search for those factors that protected women. In an early study that attempted to lower the risk of subsequent cardiac events in male heart attack survivors, researchers treated men with high dose estrogen, which led to more deaths in those men compared to men on a placebo. It also suggested to physicians that giving post-menopausal women estrogen (based on the assumption that womens risk of heart disease increased because estrogen levels declined after menopause) would lower their risk. In fact, it did not.

Heart disease is the leading cause of death for men of all racial and ethnic groups, and although about half of all heart disease deaths occur among men and half among women, more than 70% of heart disease deaths among men occur before the age of 65. Data from 44 years of follow-up in the original Framingham Study and 20 years of surveillance of their children has given us important insight. For people who are 40 years old, the lifetime risk of developing heart disease - particularly from arterial narrowing - is 49% in men and 32% in women. For those who reach 70 years old, the lifetime risk is 35% in men and 24% in women. This is largely preventable!

I think I know what to do about my heart health I just cannot get it done.
What are the barriers to implementing preventive strategies on a personal basis? First, let us dispel the no pain - no gain myth as well as the old joke that everything pleasurable turns out to be illegal, immoral, or fattening. Healthy behaviors should not be mysterious or complicated, and the rewards can be immense. But gratication is not instantaneous, and some barriers for men to reach a healthy state can include procrastination, disorganization, denial, self-destructive tendencies, and diculty receiving constructive advice (nagging) from your spouse.

Heart disease is the number one cause of death for women worldwide
If what happened to women was considered the norm, scientists might instead have tried to identify what factors in men were making them susceptible to heart disease at a younger age than women.
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Get organized
One of the best things you can do to get healthy is to get organized. You might nd yourself falling into one of two extremes, either your life is so scheduled there is not time to take care of yourself or your life is so unstructured that
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INSIDE

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Presidents message Big changes coming to the Lown Forum Development in action Save the date Mens heart health (cont.)

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Womens heart health (cont.) How should I take my coee regular or decaf? Patient prole: Living longer and feeling better

NewsBeat
Healthy dining out

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PRESIDENTS MESSAGE

A fraught new year

Vikas Saini, MD
I want to extend my heartfelt thanks to all who have supported us this year as we seek to extend the message of the Lown Foundation to a national audience. The coming year promises to be tumultuous. By the time you read this, there may have been a drastic cut in Medicare payments, as happened in the spring of 2010. At that time there were stories of physicians using credit cards to keep their practices going until Congress acted. Now we are starting to receive notices of impending cuts while legislation remains tied up in the politics of payroll tax cuts and unemployment benets. Meanwhile, the Supercommittee conceded defeat in their eorts to agree on future cuts in 2013. Forgive us, but we are not optimistic! Regardless of the outcome, there is no question that we are all going to have to grapple with runaway costs in the health care system. A crisis of health care nancing is taking center stage nationally while in Massachusetts it is cresting. We will no doubt continue to see major changes roiling the system, which these days sometimes seems to be on the edge of a nervous breakdown. One common example: Finding a primary care physician is virtually impossible for many new patients. Even I had trouble nding one. Good luck if you are not in a network of friends and colleagues who can get you in! Despite the clear shortage, training slots for primary care physician residencies are not the most sought after. Part of this has to do with the lower compensation for primary care physicians in the face of astronomical medical school debt. The system is not changing fast enough for the needs of the people. The more general crisis in our society is obviously aecting medicine and how it is practiced. The old era of a broad, prosperous middle class is under an indenite siege in this great nancial crisis. In the setting of limited resources, the style of care and intensity of services of recent decades looks to be unsustainable. We cannot go on spending a much larger share of our national income on health than our international industrial competitors with no better outcomes. The situation is not good for us, nor good for our economy. And given the amount of unproven and unnecessary care, it is not good for our patients. A key question for health care today is whether the bifurcation of society due to income inequality will be mirrored within the health care system. We urgently need to nd ways of reorganizing health care delivery to serve the needs of all of society.

The Lown Forum is moving from print to digital

Please read this important message if you wish to continue receiving the Lown Forum
Starting with our next issue, the Lown Forum will transition to an online format. The new format not only cuts the high production costs of mailing the newsletter to 10,000+ subscribers, but it also gives us an opportunity to provide you with a deeper, more interactive reading experience. The primary method for distributing the Forum will be through email and the Lown Foundations website. If you wish to receive the new digital version of the newsletter, you will need to provide us with an email address. We will continue to produce limited print copies of the Forum and will provide a print copy for people who wish to receive one, however you will need to let us know if you wish to continue receiving a print copy. As always, print copies of the Forum will be available in the Lown Center waiting room.

What you need to do

If you would like to receive the Forum (either as a print copy or emailed to you) you need to contact us. There are two ways to let us know. You can email us at info@lownfoundation.org or you can ll out the appropriate information on the enclosed envelope and mail it back to us. Please note, you do not need to make a donation to continue receiving the Forum. Current and past issues of the Forum will remain available at www.lownfoundation.org. Thank you and we look forward to taking this exciting new step with you. - The Lown Forum Editorial Team

MEET THE LOWN CENTER STAFF

Welcome Melissa Sharkey

The Lown Center is pleased to welcome Melissa Sharkey as their newest exercise physiologist. Originally from Lain, Pennsylvania, Melissa received her MS in Clinical Exercise Physiology from Northeastern University and her BS in Exercise Science from University of Scranton. As one might guess, she enjoys exercise - as well as traveling, baking (she is known for her chocolate cranberry granola bars), and watching Disney movies. On a sadder note, we recently bid farewell to Samantha Esnaola, one of the stress and nuclear testing sta. Sam will be enrolling in nursing school this spring.

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DEVELOPMENT Straight From the Heart Celebration

The Lown Foundations rst Bernard Lown Humanitarian Award will be presented to John Bogle, Founder and Chair, Vanguard Investments, at our inaugural Straight from the Heart Celebration. Mr. Bogle was named one of the investment industrys four Giants of the 20th Century by Fortune Magazine and one of the worlds 100 most inuential people by Time Magazine. He is being honored for his leadership in advancing a strong ethical approach to business and investing. A festive event to raise funds for the Lown Foundations research and education activities, the dinner will feature spectacular live and silent auctions, and is co-chaired by Board Member Pat Aslanis and James Joslin, Chairman, CEO, and CCO of TFC Financial Management. For more information, including sponsorships, or to get involved with planning the dinner, contact Andi Brown (andrea.brown@lownfoundation.org or 617-732-1318, ext. 3350)

Foundations invest in the Lown Foundation

A number of major national foundations have recognized the Lown Foundations innovative approach to changing the delivery of health care with signicant nancial investments in our work. The Mattina Proctor, Robert Wood Johnson, Fannie E Ripple, and Kaiser Permanente Foundations have all made major donations to support our upcoming Conference on Avoiding Avoidable Care. Avoidable care includes inappropriate care, overutilization of routine services, and defensive medicine. The conference - slated for April 25-26 in Cambridge, MA - will address important questions regarding avoidable care throughout the medical sphere. How much care is avoidable? Can we quantify its consequences, in terms of nancial impact and harm to patients? What factors drive the overutilization of inappropriate medical services, how can we curb it, and do physicians have an ethical and professional duty to do so? This conference, organized by the Lown Foundation in concert with the New America Foundation and co-hosted by the Institute of Medicine, represents an opportunity to bring together physicians, opinion leaders, and medical students from a broad range of specialties to discuss the problem and develop a research agenda that will continue the dialogue at their own institutions. Our ultimate goal is to transform the culture of health care in the United States from one that focuses on volume and quantity to one centered on value and quality.

Thank you for your support!

The Lown Foundations activities are funded entirely through charitable dollars, some from foundations, but most from people like you who care about the more humane, patient-centric style of care we advocate. Projects like the Conference on Avoiding Avoidable Care, ProCor, our research on outcomes achieved through our approach, and the Louise Lown Heart Hero Award are possible through your generosity. If you have not already sent in your donation, you can use the envelope provided in this issue.

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(continued from page 1)

Mens heart health

Brian Bilchik, MD
you have no routine. No matter what end of the spectrum you fall on, getting yourself organized means prioritizing your health. My patients often hear me tell them, You cannot take care of anyone else unless you take care of yourself. This should be an opportunity to take time out from your stressors, take a break, listen to music, etc. Our brains need a rest - we become more creative, productive, and ecient - and our quality of life improves - when we give ourselves a break.

Nutrition
Certain foods make us hungrier - yes really! Rened carbohydrates (the whites), sweet things, even articial sweeteners, can make us hungry. Pay attention to your waist size. Fat cells (adipocytes) are very metabolically active, the fatter we are the hungrier we get. Fat cells cause inammation, create insulin resistance, and glucose metabolism issues, and this feeds the hunger cycle. As with most addictions - the habituation to overeating, especially energy dense food, takes at least three months to diminish the craving. Alcohol can also make us hungry, but it also contains calories and it decreases our inhibitions - a triple whammy when it comes to nutrition. Watch the salt, especially if you have high blood pressure. Salt will elevate blood pressure and make you more resistant to medications. My patients generally want less medication, and decreasing salt intake can be quite eective. Remember that 80% of the salt we eat is embedded in our food - the more we eat, the higher our salt ingestion and the more resistant our blood pressure. There is good information that controlling obesity would eliminate up to 48% of hypertension. On average, blood pressure falls 0.5 to 2.0 mmHg for every 1.0 kg of weight that is lost. Furthermore, a sustained 4 to 5 mmHg decrease in blood pressure among those with systolic blood pressure >140 or diastolic blood pressure >90 can reduce the incidence of stroke up to 42% and heart attack up to 14%. American adults have access to quick, energy dense, salty food and as a result we have become addicts. These fast foods are cheap, they are subsidized, and they accelerate the path to death and disease. The so called Happy Meals that are underpriced and have a prize are the trap to future addiction. Your best bet is to avoid fast food altogether.

Physical activity
Once you nd time for yourself, you should make sure it also includes physical activity. Optimally you should participate in sustained activity 30 minutes every other day. This will keep your vessels healthier, lower blood pressure, and improve energy, and you may even see an increase in your HDL cholesterol, the good cholesterol. If you feel like you have no time, even exercising for a quick 10 minutes every day will make a dierence. You can be creative with exercise too, it should not be a burden. Socialize around physical activity instead of around food (the Meet to Eat syndrome). Music is a great motivator. I tell all my patients to dance, and this usually brings a smile to their face - hopefully they act on this as well. Some data that proves the benet of consistent gentle exercise: Physical activity habits were analyzed in 10,269 Harvard alumni (their average age was 58) in a retrospective study over 12 years. Those men who engaged in moderately vigorous sports activity (dened as brisk walking, recreational cycling or swimming, home repair, and yard work for 30 min/day on most days) had a 23% lower risk of death than those who were less active. Another study published in a report of the Honolulu Heart Program also showed the benet of regular walking. More than 700 retired nonsmoking men (their average age was 69) who were capable of participating in a lowintensity activity on a daily basis were enrolled. The distance walked was measured at baseline and data then collected over a 12-year period. After adjustment for age, men who walked more than two miles per day had a signicantly lower chance of dying than those who walked less than one mile.

Starting the routine

It might seem unmanageable to start a heart healthy routine, but if you break it down into smaller achievable goals, you could be quite successful. First, start exercising. Get into that heart health habit, and after two to three weeks of consistent exercise, start a healthy eating program. The tter you are, the healthier choices you will make and the less you will eat creating a healthier feedback loop. Brian Z. Bilchik, MD is Co-Director of the Lown Cardiovascular Center. Dr. Bilchik graduated from the University of Witwatersrand in Johannesburg, South Africa in 1989. He completed his residency training at St. Marys Health Center in St. Louis and a fellowship in cardiovascular disease at Brigham and Womens Hospital. Dr. Bilchik is also the Director of ProCor.

Organize your home health environment

Unclutter! Being organized increases medication compliance, decreases error, and thereby improves outcome. Review your meds, discard expired or discontinued medications, even over-the-counter stu. Check with your doctor to see if you really need supplements, there are very few supplements that have shown to be benecial. Have an up-to-date list of your medications. Use weekly pill boxes. Look at other places

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(continued from page 1)

Womens heart health

Barbara Roberts, MD, FACC
Having said this, what do we know today about cardiovascular disease in women? The most common form of heart disease in the developed world is atherosclerotic cardiovascular disease, which is also becoming epidemic in the developing world. In this type of heart disease, a complex material called plaque builds up inside arteries. If plaque build-up is severe, blood ow through the artery is compromised. If a coronary artery (the name of the arteries that supply the heart) is so aected, people may experience the discomfort we call angina pectoris. The hallmark of this symptom is that it is precipitated by exercise or emotional stress, and resolves within a few minutes with rest, relaxation, or taking a medicine called nitroglycerin. Sometimes plaque can rupture, exposing the plaque contents to the blood stream. This is analogous to an abscess bursting. When a plaque ruptures (and this tends to occur in arteries that are not very narrowed by the plaque), a clot usually forms in an attempt to seal o the area of rupture. A large enough clot may totally block the artery, and if blood ow is not restored within a few hours, the heart muscle downstream of the clot dies commonly called a heart attack.

women, more risk accrues due to high levels of another blood fat, called triglycerides, and to low levels of good HDL-cholesterol. Therapeutic lifestyle interventions such as smoking cessation, maintenance of normal body weight, regular exercise, and a heart-healthy, plant-based diet benet both women and men and should be the rst steps taken in any preventive approach. Women are more likely than men to die after bypass surgery, even though they often appear to have less severe degrees of artery narrowing, and have better heart function, on average, than men do. This is partly due to the fact that women are more apt than men to have high blood pressure, heart failure, and diabetes. They are also on average older than men when they undergo bypass surgery. But it is younger women who have higher mortality rates post-operatively compared to men of the same age. Women are also more apt than men to have complications when they undergo procedures to open narrowed arteries, that is, angioplasties and stenting. In studies that looked at the results of automatic implantable debrillators (AICDs), devices which are used to abort potentially fatal abnormal heart rhythms in people with heart failure, men who had these devices had better survival than those treated with medications, but this same benet of AICDs was not found in women. However, there is one cardiac treatment from which women derive more benet than men. Certain people with weakened heart muscle (cardiomyopathy) and a specic nding on the EKG called left bundle branch block (LBBB) may benet from a new form of pacemaker called a bi-ventricular pacemaker. In a study of more than 1200 people with cardiomyopathy and LBBB, women had signicantly greater reductions in risk of death or heart failure, heart failure alone, or death from any cause, than men did. Signicant dierences exist between men and women when it comes to heart disease. Women have dierent risk factor weighting, and may derive less benet from certain medicines/interventions. More research needs to be done to understand these gender dierences so that both women and men can receive optimal advice on prevention strategies and treatment options. Barbara H. Roberts, MD, FACC, is Director of The Womens Cardiac Center at the Miriam Hospital in Providence, Rhode Island and is an Associate Clinical Professor of Medicine at Brown Universitys Alpert Medical School. One of the top cardiologists in the United States, she serves on the Lown Foundation Board of Directors and the Heart Health Advisory Committee for Womans Day Magazine. Dr. Robert's next book, The Truth About Statins: Risks and Alternatives to Cholesterol-Lowering Drugs will be published by Simon & Schuster in April 2012.

Knowing the dierences

One way women dier from men is that they are more apt to have what is called atypical angina. Women are more likely than men to have angina at rest, or awakening them from sleep, or with emotional stress. Before the age of 65, women with angina have a more benign prognosis, or outlook, than men, but after age 65 men and women with angina have equal risks of developing further heart complications. Women are also more likely than men to have silent heart attacks, that is, heart attacks without chest pain. Women having heart attacks are also more likely than men to have pain in unusual locations, like shoulders, the neck, arms, and the back, and are more likely than men to die from a heart attack. They are also less likely than men to be treated with aspirin, medicines called betablockers, or interventions to dissolve or remove coronary artery clots. There are also dierences between women and men when it comes to risk factors for developing plaque. Two risk factors, smoking and diabetes, increase risk more for women than men, while elevation of the bad or LDLcholesterol is a stronger risk factor in men than in women. This may be why treatment with statin medicines (which mainly lower LDL-cholesterol) is less eective in reducing risk in women than in men. Women also have more side eects to statins than men do. In

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QUESTION FROM A PATIENT

How should I take my coee - regular or decaf?

Charles Blatt, MD
It is common to see questions about coee on medical history forms. How many cups do you drink? Do you drink regular or decaf? I noticed that most new patients drink only decaf because a doctor told them to switch from drinking caeinated coee years ago. But does this recommendation make sense? Although the eect of caeine varies from one individual to the next, the potential benets of caeine are often overlooked and come with little risk. Caeine is a naturally occurring substance in coee, chocolate, tea and is a common additive in many soft drinks and energy snacks and beverages. The eect of caeine varies from one individual to the next - some will be sleepless all night if caeine is ingested in the evening while others routinely have coee at bedtime with no harm to sleep. A study published not long ago found that 43% of people did not have the receptor that helps produce caeines sleep depriving eects - some people might not feel any eect from caeinated beverages.

PATIENT PROFILE

Will I live longer? Will I feel better?

While in India celebrating his 25th wedding anniversary, Kanwaljit Singh Khangura (Ken) felt heaviness and small pain in his chest one night. A few tests at a reputed hospital revealed that his right artery was 100% blocked and he had two small blockages in his LAD (a major artery that feeds the heart). The cardiologist urged Ken to get stents before ying home. But the blockages had been there for a few months at least and Ken did not see the need to rush to surgery. I was not in severe pain, so what would another week do, he said. If I needed surgery, I wanted to have it at home. Although the cardiologist insisted, a second opinion by a leading cardiologist in India agreed that Ken should go home for the procedures. Back home, Ken saw two cardiologists and they both urged Ken to have the procedures to remove the three blockages - at around $60,000 per procedure. Although hesitant, Ken heeded their advice and had a stent put in his right artery, but not the two minor blockages. Ken felt healthy, even with the blockages, and he questioned the necessity of an invasive procedure from which he could

see no benet. I asked every doctor two questions, Ken said. What were risks of the procedure? And what were the benets? It was clear there were a lot of risks, but no one could tell me why I should get stents for the two minor blockages. Looking for answers, Ken heard about the Lown Center from a friend. Dr. Bilchik spent 45 minutes with me just talking during my rst visit. He asked me so many questions about what happened that it really blew me away. He gave me a chance to tell my entire story. He told me I did not need the procedures. My heart, he explained, was healthy and getting good circulation without the stents. After our talk, it seemed like such a simple decision. I chose to not have the procedures. Three years on and Ken feels as healthy as ever. Listening to a patient is crucial. Dr. Bilchik was the only one who answered my questions he took the time to have a risk/benet discussion with me. I had two concerns that determined my choice: Will I live longer and will I feel better? For me, if the answer is no to those two questions, there is no benet to the procedures. Dr. Bilchik was the rst to give me those answers with simple and clear rationale.

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LOWN CARDIOVASCULAR CENTER

Thank you for your support

The Lown Cardiovascular Research Foundation promotes cardiac care that advocates prevention over costly, invasive treatments and restores the relationship between doctor and patient. Your financial support allows us to continue our work and carry our heart health message to local, national, and global audiences. We greatly appreciate any donation you are able to make. You can donate online at our website (www.lownfoundation.org) or mail your donation to 21 Longwood Avenue, Brookline, MA 02446. Please make checks payable to the Lown Cardiovascular Research Foundation. For more information about supporting the Foundation, please contact Andi Brown, Director of Development at andrea.brown@lownfoundation.org or 617-732-1318 (x3350).

NewsBeat
Dr. Vikas Saini attended the National Summit on NonCommunicable Diseases in New Delhi, India on August 23-24, 2011. The theme of the meeting was Universal coverage and NCDs and Dr. Saini was a speaker for the panel discussion on Service needs to tackle NCDs: Prevention and Control. On September 14, 2011 Dr. Vikas Saini spoke at Mercy Hospitals annual leadership event held in Portland, ME. His talk, Navigating the channel: Avoiding avoidable care in a cost-conscious era was part of an event that brought together providers, friends, and leadership of Mercy Health Systems of Maine. Benn Grover represented ProCor and the Lown Foundation at the United Nations High-level Meeting on Non-communicable Diseases in New York City on September 1920, 2011. Advocating for action on non-communicable diseases: Leveraging technology and social media, a report he coauthored, was presented during a side event hosted by the Healthy Caribbean Coalition, Global Health Council, Young Professionals Chronic Disease Network, and PAHO. Benn Grover also facilitated a concurrent session, titled The world mobilizes for non-communicable disease prevention: The NCD Alliance and the UN Summit, during the 9th National Forum for Heart Disease and Stroke Prevention in Maryland on September 22-23, 2011. Dr. Tom Graboys book - Life in the Balance: A Physicians Memoir of Life, Love, and Loss with Parkinsons Disease and Dementia - is now available for purchase through the Barnes & Noble NOOK. For more information please visit: www.tomgraboys.com. Dr. Charles Blatt was a guest speaker at Temple Emanuel in Newton, MA on November 8, 2011. The topic of his talk was heart health prevention. Shannon Brownlee, author of Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer, Acting Director of the New America Health Policy Program, and Co-Director of the 2012 Avoidable Care Conference, spoke at the Lown Foundation on November 11, 2011. The title of her talk was: From stents to PSA tests: Involving patients in decisions that matter most to them. On November 17, 2011 Benn Grover was a guest speaker on an Emerson talk radio program that focused on the health and development burden of non-communicable diseases in developing countries.

Educational opportunities
Interested in hosting a lecture on a heart health topic by one of our physicians at your worksite or community organization? Please contact us at info@lownfoundation.org or 617-732-1318 (x3355).

New patient appointments available

The highest compliment we can receive is the referral of your family and friends. New patient appointments are currently available. If you would like to make an appointment with one of the Lown Group cardiologists, please call 617-732-1318 (x3315).
Board of Directors
Nassib Chamoun Chairman of the Board Vikas Saini, MD President Bernard Lown, MD Chairman Emeritus Thomas B. Graboys, MD President Emeritus Patricia Aslanis Charles M. Blatt, MD Joseph Brain, SD Janet Johnson Bullard J. Breckenridge Eagle Carole Anne McLeod C. Bruce Metzler Barbara H. Roberts, MD Ronald Shaich Robert F. Weis

CONTACT US
Lown Cardiovascular Research Foundation
21 Longwood Avenue Brookline, MA 02446 USA (617) 732-1318 info@lownfoundation.org www.lownfoundation.org www.lowncenter.org www.procor.org

Lown Cardiovascular Group

Brian Z. Bilchik, MD Charles M. Blatt, MD Wilfred Mamuya, MD, PhD Shmuel Ravid, MD, MPH Vikas Saini, MD

Lown Forum Editorial Sta

Andi Brown Jessica Gottsegen Benn Grover Claudia Kenney

Advisory Board
Martha Crowninshield Herbert Engelhardt Edward Finkelstein William E. Ford Renee Gelman, MD Barbara Greenberg Milton Lown John R. Monsky Jerey I. Sussman David L. Weltman

2011 Lown Foundation Printed on recycled paper with soybased ink.

Lown Cardiovascular Research Foundation 21 Longwood Avenue Brookline, Massachusetts 02446-5239

Nonprofit Org. US Postage PAID Boston, MA Permit No. 53936

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here for a chart on healthy portions). Ask for a smaller portion or take part of the meal home. Avoid all you can eat buets or specials as well as pre-meal appetizers and bread. Ask your companions to share an entre. Do not go out to eat while starving. Decide in advance what to eat to avoid temptations.

Healthy dining out: An achievable goal or an oxymoron?

Shmuel Ravid, MD, MPH
A healthy diet is a cornerstone in preventing heart disease. However, because many of us often eat out, we have limited control over the content of the meals we order. Super-sized portions, loaded with saturated and trans fats, carbohydrates, and sodium can make healthy dining out a challenge. While we may not have full control over how food is prepared, we can make healthier choices when we order. Below are a few tips for making healthier choices when dining out.

Minimize the harm of fast food

When a fast food restaurant is the only option, better choices can make a dierence. Order only regular, small, or junior sized burgers value or super-sized meals may look like a deal, but inevitably contain more fat, sodium, and sugar. Avoid bacon or cheese on sandwiches; instead order pickles or vegetables. Use ketchup or mustard instead of mayonnaise. Drink water instead of sugarloaded soda. Order whole grain buns if they are available. Steer clear from fried dishes. When it comes to your health, dining out may not always be the best option, but if you order smart and limit your portions, you can make it a healthier experience.

Order healthy alternatives

Avoid foods containing saturated fats, a lot of sodium, or excessive calories. Grilled, steamed, baked, roasted, or broiled foods are healthier than fried, stued, buttered, or creamed foods. Ask for dressing, butter, sauce, or gravy on the side. Substitute French fries, coleslaw, and onion rings with vegetables or a baked potato. Try olive oil or vinegar instead of traditional salad dressings. Choose fruit and vegetables for side dishes, but avoid marinated salads or canned processed fruit salads, which are high in sugar and sodium. Poultry and sh are healthier options than red meat. Avoid processed or smoked meats, sh, and cheese. If you must have a dessert, try fresh fruit, sherbet, or gelatin instead of rich pastries or ice cream.

Tips on healthy dining out

It is not only what, but how much, you eat. Eating large portions of healthier food can be unhealthy. Vegetables and fresh fruits are preferable side dishes and desserts. Avoid breads, particularly rened white breads. Share your meal with your dining companions. Ask for dressing, sauce, and gravy on the side. Order food that is grilled, baked, or broiled rather than fried or stued.

Control portion size!

Curbing our tendency to overeat will go a long way. Learn what the healthy portions of your favorite foods are (click