revitalize your heart

The following outline is copied from my PowerPoint presentation. You are welcome to read and use, but any commercial use is strictly copyrighted to Steven Masley, M.D.: This information is not intended for medical decision making. Always consult your own physician who knows your personal medical history before making medical decisions.

Beyond Interventional Cardiology

REVITALIZE YOUR HEART with EFFECTIVE LIFESTYLE CHANGES

My goal is to help you prevent devastating events (heart attacks, strokes, & sudden cardiac deaths)
AND FEEL GREAT DOING IT !

Steven Masley, M.D.

“STATE OF THE ART” REVIEW OF CORONARY ARTERY THERAPIES
• LIFESTYLE CHANGES ARE MORE EFFECTIVE AT PREVENTING EVENTS (Heart attacks, strokes, and cardiac deaths) THAN MEDICATIONS OR SUPPLEMENTS
• ASPIRIN AND CHOLESTEROL LOWERING MEDS ARE MORE EFFECTIVE AT PREVENTING EVENTS (Heart attacks, strokes, and cardiac deaths) THAN CARDIAC PROCEDURES

DISCOVER THAT HEALTHY FOODS CAN BE DELICIOUS AND EASY-TO-PREPARE

MAGNTUDE OF CORONARY ARTERY DISEASE (CAD)
• Nearly 50% of deaths in the United States and Canada are from coronary-vascular disease (CVD)
• 500,000 new cases of coronary artery disease (CAD) are diagnosed yearly in the United States
• Care for this 4% of the population consumes 15% of our U.S.A. healthcare budget
• In 2000, we spent ~ $200 billion on CAD therapy, but only 6% of that on medical treatment and prevention *Am J Cardiol 998:82:10T-13T
• 27% of men and 44% of women will die within 1 year after having a heart attack
• The need for a paradigm shift is due to a misunderstanding regarding the benefits of interventional cardiology.

This perspective is both public and medical.

WE NEED A PARADIGM SHIFT IN HOW WE TREAT CAD
• Interventional cardiology doesn’t arrest the disease process; rather, for only a few does it actually prevent clinical events*
– Angioplasty has a 40% failure at 6 months, and prevents death in only 1 out of 30-40
– Stents have improved outcomes (preventing death & heart attacks) but only for 1 out of 30-40
– By-pass surgery only improves survival in a small subset of people with coronary heart disease* (those with bad pump function)
– Angioplasty, stents, and by-pass surgery are effective at treating angina (chest pain)
*Am J Cardiol 1998:82:10T-13T

Cholesterol (Lipid) Vocabulary
• Total cholesterol (TC) is the total floating fat in the blood (TC = LDL + HDL + Triglycerides / 5)
• LDL (low density lipoprotein) is the “bad” (not “Lethal”) cholesterol that is oxidized into plaque (Total garbage in your arteries)
• HDL is good, “Healthy” cholesterol that acts like a garbage truck cleaning arteries
• Triglycerides are smaller fats contributing in a smaller way to plaque formation
• TC / HDL ratio reflects how clean your arteries really are. For example a person with a TC =300 & HDL=100; TC/HDL=3) has a lower CAD risk than a person with a TC 180 & HDL = 30; TC/HDL = 6)

Cholesterol and Lipid Testing
• To obtain information on LDL and/or triglycerides, you need a fasting lipid level drawn (Which might include a fasting blood sugar level too.)
• You can check a Total cholesterol and HDL levels with a TC/HDL ratio either fasting or non-fasting

LDL Cholesterol
• LDL Cholesterol can be oxidized into plaque
• LDL plays an important health role -- carrying vitamins and antioxidants to your cells
• Antioxidants block the conversion of LDL cholesterol into plaque

The focus of attention has shifted in recent years from highly stenotic yet stable coronary lesions to small unstable culprit lesions that cause events

Antioxidants Impact Artery Function (Masley, AFP 1998)
Inadequate Diets Cause Events
Large stable plaques don’t cause events, they are the fire alarm that causes angina
Most Events Occur as a Consequence of Plaque Rupture
• Plaques that rupture (leading to clot formation and vasoconstriction) usually come from small arterial occlusions, likely considered to be normal during angiography
• Thus plaques at greatest risk of causing heart attacks and strokes aren’t identified by cath and thus can’t be treated by
– angioplasty
– Stent placement
– CABG

WHAT ARE THE RISKS OF CARDIAC INTERVENTIONS?
• Death and strokes are rare, but possible
– Caused by plaque showering
• 42% of patients may have a 20% loss in cognitive function with CABG (NEnglJMed2001;344:395)
– 261 subjects with elective CABG were found to have 53% cognitive decline at discharge, and 24% decline at 6 months
– Cerebral plaque showers have been noted during cardiovascular procedures for some time. This loss is greater than expected.
If cardiac interventions are great at treating angina (especially angina with pump failure) and heart attacks, but are not a highly effective way to prevent events--

What Should We Be Doing?

THERAPY GOALS
1) In known CAD, reduce LDL levels by at least 35%
2) Add special, beneficial foods
3) Change Type of Fat Intake
4) Reduce Total Cholesterol/HDL ratios and raise HDL levels
5) Decrease LDL oxidation
6) Decrease clotting
7) Improve artery function
8) Decrease homocysteine levels
9) Succeed in making lifestyle changes

LDL TARGETS
• We should not treat people with known CAD and those at risk the same.
– LDL remains the best indicator of lipid therapy in people with CAD
– Total Cholesterol (TC) / HDL ratios remain the best predictor of preventing CAD (fasting lipid profiles are not indicated for screening healthy patients)

LDL TARGETS FOR KNOWN CAD
• LDL reductions decrease event rates and lower health care expenses
• Evidence from outcome trials haven’t identified an ideal target
• Evidence has shown that the most benefit comes from lowering LDL levels 30-35% (Identify a baseline and a target!)
• Without a baseline, a rationale (but not evidence-based) target is a LDL <130 and a ratio < 4.0, OR, a LDL < 100.

THERAPY GOAL #1:

LOWER LDL LEVELS
LDL REDUCTIONS
• Medications (They work and they decrease events for 1 out of 20 taking them)
• Increase soy and bean intake
• Encourage garlic intake
• Lower fat intake, especially saturated fat. Foster a switch from trans fats and saturated fats to monounsaturated fats
• Plant sources of n-3 fatty acids (omega-3 fats) decrease LDL levels
• Encourage monounsaturated nut intake

LOWERING LDL LEVELS ALONE IS NOT ENOUGH
• In patients with known CAD, statin medications lower death rates by 30%; yet, 70% of deaths persist in patients treated with “statin” medications
• Eliminating tobacco use, changing diet patterns, and promoting activity will further reduce CAD death rates.
• Lifestyle choices account for 70% of the total illnesses seen in the USA
Lifestyles Determine Cardiac Risk, More than Does Cholesterol Levels
DIETARY INTERVENTIONS

LOWER LDL, CHOLESTEROL AND MUCH MORE !

NCEP STEP I-II (The AHA Diet)
• Sets limits (Many free handouts available)
– cholesterol (300mg/200mg qd),
– total fat intake (30% fat cal)
– saturated fat intake (8-10% fat cal/<7% fat cal)
– encourages the moderate use of polyunsaturated and monounsaturated fats
• Is an improvement over the typical American diet; however,

FOLLOWING THE NCEP STEP II-III RESULTS IN PROGRESSION OF CVD
– Hence, it is NOT the optimal diet for CVD treatment or prevention
A Pritikin-Like Program (The Ornish Program)
(Diet, Exercise, Meditation)
• A group educational program with <10% calories from fat, 1 hour of exercise daily, and 45 min meditation daily
• After 24 days, patients noted a 91% reduction in frequency of angina, LDL decreased 37%
• At one year, the plaque reduction was limited-1.75%, but dietary adherence was excellent
• At 5 years, the 20% lifestyle induced LDL reduction decreased cardiac events 50% more than the 20% lipid medication induced LDL reduction (28 events in the exp. group vs 45 events in control
Mediterranean Diet For CVD

• The most effective treatment studied to date for preventing CVD events when compared with the AHA diet
• Works without reduction in fat intake or cholesterol levels
• Relies on selecting type of fat intake
What has been our traditional medical message for lifestyle changes?

BALANCED DIET
BALANCED HEALTH
• “ADDING” healthful foods is the centerpiece of my program
• Limiting fat intake is only a small part of a healthy diet
• Choosing the best types of fat and carbohydrate are more important than cutting fat
My approach is to give you easy-to-make, delicious, recipes that make you feel great!

PROVIDE HEALTHY, TASTY MENUS FOR PEOPLE TO EAT
BORSCHT
Passover Feast

THERAPY GOAL #2;

ADD SPECIFIC FOODS
• Garlic
• Beans
• Low-glycemic carbohydrates
• Antioxidant-rich foods
– Fruits and Vegetables
– Cocoa, red wine, and nuts--but all in moderation

GARLIC:
Herb or Wonder Spice?
• Decreases LDL levels, 9% with a clove/day (not seen with steam distilled extract)
• Slightly increases HDL levels
• Decreases clotting (platelet aggregation)
• Lowers systolic BP, 5-6 mm Hg
• Improves immune function
• Decreases oxidation
• Kills cancer cells in the lab

GARLIC USE
• Garlic should be crushed
• Allowing alliinase (an enzyme in garlic) to convert alliin to allicin, which is the active agent
• Allicin is then converted to polysulfides which provides the aroma and plausible therapeutic benefits
• Don’t overcook or deodorize
• Commercial products quantitate alliin content (which is not the active agent)

LEGUMES (Beans):
A wonder food!
• Lower LDL levels *
• Raise HDL levels
• Control blood sugar and insulin levels
• Suppress appetite
• Associated with decreased cancer risk (especially soy products)

ADD BEANS TO
• Pasta dishes
• Soups
• Salads
• Or use as side dishes
Adding legumes can be as simple as enjoying Chili with Cornbread Or savoring Bell Pepper, Black Bean, and Cilantro Paté

SOY PRODUCTS
• Soy protein
– lowers total cholesterol and LDL cholesterol with a small increase in HDL cholesterol
• Soy isoflavones (genistein, etc.)
– improve endothelial function
– decrease clot formation
– are associated with reduced cancer risk, especially breast and prostate cancer
WE ARE NO LONGER LIMITED BY PLAIN-OLD-TOFU
SOY PRODUCTS ARE EASY TO ADD TO YOUR DIET

CHOCOLATE AND COCOA
CHOCOLATE
• Hi source of calories
• Make sure it has cocoa butter, not palm oil, milk, or butter
• Rich source of magnesium, stress-relieving compounds
• Biochemically cocoa butter acts more like olive oil than butter
COCOA
• Usually non-fat
• Rich source of magnesium, and stress relieving compounds
• Decreases clotting (Am J Clin Nutr 2000;72:30-5)
• Potent anti-oxidant (anti-aging) agent
• Suppress LDL oxidation, lowering plaque formation
THERAPY GOAL #3;

CHANGE TYPE OF FAT INTAKE
FATS
Rule #1:

“The type of fat we choose is more important than how much fat we eat”

Steven Masley, M.D.

Rule #2:

“Limit even healthy fats if you need to control your weight”

Steven Masley, M.D.

FAT CALORIES:
• Nuts (cashews, hazelnuts, almonds)
– 2 tsp has ~30 calories and 0.2 grams of saturated fat
– 1/3 cup (1 hand-full) has 280 calories and 2.4 grams of saturated fat
• Virgin olive oil
– 1/6 tsp (1 second spray) has 5 calories with 0.1 grams of saturated fat
– ½ tsp has 19 calories with 0.3 grams of saturated fat
– 2 Tbsp has 228 calories with 3.6 grams of saturated fat

CLINICAL STUDIES SUPPORT HEALTHY FAT INTAKE:

• Olive and Canola Oil in Moderation: (20-30% calories)
– Decrease LDL oxidation
– Improve Total Cholesterol / HDL lipid levels
– Improve cardiac outcomes compared to the AHA diet
• Nut Intake:
– Associated with decreased cardio-vascular mortality and morbidity
– Improves Total Cholesterol / HDL lipid levels

CANOLA OIL
• Use of canola oil is NOT without controversies, and it may not be equal to olive oil in the long run
– But face it, it is hard to bake a cake or make cookies with olive oil
• Choose organic canola oil
• Choose pressed/expressed products
• Observational studies that look at how canola oil is used in the restaurant industry could show it to be harmful
• Randomized studies show lower mortality and heart attack rates with canola use

FATS WORTH LIMITING
Polyunsaturated Fats: (corn oil, grain oils, many spreads)
• Lack a long-term safety record
• Increase net fat oxidation
• Increase inflammation (in joints and intestine)
• Increase blood clot formation

FATS WORTH ELIMINATING
Saturated Fats: (animal meats, fatty dairy products, and some oils)
• Increase blood clot formation
• Increase bad LDL cholesterol levels
• Promote weight gain
• Increase insulin levels (more so than carbohydrates)
Trans Fats:

TRANS FATS or Hydrogenated Fats (Margarines and processed foods)
• Make your intracellular fats stiff
• Act like saturated fats
– Raise LDL levels
– Lower HDL levels
• Their intake is associated with increased cancer rates, especially breast cancer
• They are hidden in the food supply, and their intake in Americans is rising rapidly
THERAPY GOAL #4:

INCREASE HDL LEVELS
• Prolonged, regular aerobic exercise helps to raise HDL levels in many patients
– Over 30-45 minutes, 6 days per week
– Not shown with 20 minutes, 3 days per week
• Moderate Alcohol Intake Raises HDL levels (1-2 drinks per day maximum)
• Garlic and Onion Intake Raises HDL levels slightly (3-5%)
• Soy intake increases HDL levels 2-3%
• Choose carbohydrates that don’t raise blood sugar levels
Type of Carbohydrate Intake Lowers Insulin levels and TC/HDL Ratios Frost., The Lancet 1999;353:1045
• Choose dense grain and vegetable sources of carbohydrates
– Veggies, beans, whole-grain pastas, bulgur wheat, quinoa, wild rice
• Picking “whole grains” isn’t enough
– Fluffy breads and white potatoes raise blood sugar levels and lower TC / HDL ratios just like table sugar

THERAPY GOAL #5:

REDUCE LDL OXIDATION
OXIDATION IMPACTS CAD IN SEVERAL WAYS
• LDL is oxidized into plaque
• Oxidation fosters vasoconstriction and poor artery function
• Clot formation increases during oxidative stress

REDUCE LDL OXIDATION
• Add fruits and vegetables
– Five-a-day is the minimum
– 5 cups daily is better
• Add garlic and spices daily
• Limit total fat intake
• Choose healthy fats when you eat fat
• Dietary Vitamin E intake reduces LDL oxidation
• If you drink alcohol, choose red wine, 1-2 servings/day (The type of alcohol intake has not been shown to decrease event rates)
Plant Pigments Have Greater Antioxidant Activity than Vitamin E
BUTTERNUT SQUASH SOUP WITH GINGER AND FENNEL

THERAPY GOAL #6;

DECREASE CLOTTING AND EVENTS
DECREASE CLOT FORMATION
• Avoid saturated and polyunsaturated fats; simply substituting PUFA’s for saturated fats may increase clotting
• Garlic and mild alcohol intake decreases clot formation (High alcohol intake increases your risk of a hemorrhagic stoke)
• Vitamin E decreases clot formation
• Omega-3 fats decrease clot formation

IF YOU ARE AT ELEVATED RISK FOR CAD OR STROKE, TAKE AN ASPIRIN DAILY ! (Unless you take coumadin)

OMEGA-3 FATS (N-3 FATTY ACIDS)
• Sources include many nuts, seafood, flax oil (Ornish now recommends 1 Tbsp flax oil daily), canola oil, green leafy veggies
• Used in Europe to treat rheumatoid arthritis and inflammatory bowel disease

SOURCES OF OMEGA-3 FATS
• Flax (Ground flax seed better than oil)
• Seafood
• Soy products
• Nuts
• Green leafy veggies
• Canola oil (organic)
Increase Omega-3 fat Intake
• Increasing omega-3 fat intake is more important than cutting saturated fat intake Ascherio, BMJ 1996;313:84
• The Mediterranean Diet Study and DART showed lower death rates with greater omega-3 fat intake
• The Italian, GISSI-Prevenzione Trial showed that with known CAD, omega-3 fat intake appears more important than Vitamin E intake Lancet 1999;354:471

SEAFOOD
• Seafood includes fish, shellfish, and seaweed products
• Provides a rich source of omega-3 fats which decrease inflammation, clot formation, and are associated with decreased rates of sudden death

PEOPLE WITH KNOWN CAD BENEFIT BY EATING “SEAFOOD” 1-2 TIMES/WK
Eating more than 2 seafood servings weekly is associated with no benefit or adverse outcomes--unless you live in Italy (live like an Italian?)
– Seafood intake:
• is associated with decreased sudden death, arrhythmic events, and MI’s.
• decreases platelet aggregation
• raises LDL levels (garlic can offset LDL rise)
• increases LDL oxidation (Vitamin E can offset this)
– Seaweed “might” be the best type of seafood
Sushi

THERAPY GOAL #7;

ENHANCE ARTERIAL FUNCTION
IMPROVE ARTERY FUNCTION
• Exercise tunes your endothelium
• Ace-inhibitors (and maybe Angiotension Receptor Blockers) improve arterial function
– Ace-inhibitores include lisinopril, acupril, monopril, -pril etc.
– The benefits are worth tolerating a mild cough
• Dietary and vitamin sources of antioxidants improve arterial function
– garlic, fruits and veggies, soy products, Vitamin E
• Avoid unhealthy fats and passive tobacco use

ENJOY A FITNESS PROGRAM
• You have the time--Who doesn’t have the time to be more productive?
• Monitor your pulse rate; don’t exceed 80% of your maximum heart rate
– (220 - your age = Your maximum heart rate; Aim for 60-70% of our maximum rate, although higher heart rates burn more calories)
• Combine aerobic and strength training sessions for the best results

EXERCISE--THE FAST TRACK TO SUCCESS
• Aerobic exercise
– 30-45 minutes of moderate activity, and 5-6 times per week (Burning at least 1500 calories per week)
– Increases energy
– Increases efficiency and time
– Prevents pains and slow arthritis

STRENGTH TRAINING
(Resistance Exercise)
• Increases bone strength
• Protects joints from aging and arthritis
• Increases your capacity to burn calories during exercise; hence, increases baseline metabolism and improves weight control
• Produces Glutamine, an essential amino acid building block, which regenerates your antioxidant system

IT IS NEVER TO LATE TO BE MORE FIT
• Inactive people can reverse the aging process
• Seniors over age 63 can increase aerobic power and conditioning with regular exercise
– 30-45 minutes of regular moderate to vigorous activity is the most helpful
– 20-30 minutes of mild activity is still beneficial

ENCOURAGE REGULAR ACTIVITY
• A regular walking program is associated with 40% fewer cardiac events
• Benefits extend to regular walkers and to regular vigorous exercise for prevention
– Vigorous activity may increase risk in known CAD
• The greatest benefit is shifting from sedentary to regular moderate activity (20 minutes 3 times per week)
• Next benefit appears to be with moderate activity of 30-45 minutes, 5-6 days per week
Can’t I just take a pill?

ESTROGEN REPLACEMENT IMPROVES LIPID PROFILES, BUT HASN’T BEEN SHOWN TO DECREASE CARDIAC EVENTS
• POSITIVES:
– Estrogen improves lipid profiles
– Estrogen enhances bone strength
• NEGATIVES:
– Estrogen increases clotting (? thru C-reactive protein)
– Estrogen increases breast cancer risk

PROGESTERONE IMPACTS ENDOTHELIAL FUNCTION and HDL LEVELS
• Micronized progesterone (natural) enhances endothelial function
– Has the most favorable influence on HDL levels (JAMA 1995;273:199-208)
– It also protects the uterus lining from hyperplasia (pre-cancer changes) (JAMA 1995;273:199-208)
• Medroxyprogesterone acetate (Provera) appears to inhibit endothelial vasodilation (Nature Medicine 1997;3:324-327)

NUTRIENT SUPPLEMENTS
• Supplements are SUPPLEMENTAL to a healthy diet!
• Study after study shows that nutrient rich foods are superior to supplements
• Vitamin E appears beneficial to specific groups (those with CAD and Anglo diets, & those with diabetes)
• Folic acid and mineral intake is critical; most Americans need to take One-A-Day supplements with folic acid, selenium, calcium/magnesium & minerals!

DO PEOPLE FOLLOWING AN ANTIOXIDANT-RICH DIET NEED TO TAKE SUPPLEMENTS?
• People following a Mediterranean Diet with known CAD (living in Italy) benefit little, if at all, by taking Vitamin E Lancet 1999;354:471
– This could be related to diet or genetic biochemistry
– No benefit to Vitamin E with HOPE either, They did benefit by adding an omega-3 fat source daily, fish oil, in a dosage equivalent to adding a serving of seafood daily (It is unknown if seaweed or flax oil would provide the same benefit--yet Ornish adds flax oil 1 Tablespoon daily to his dietary program)
• They still need folic acid, minerals, calcium, zinc, magnesium, selenium, and plant pigments

VITAMIN E DOSAGES
• For known CAD on an Anglo diet, alpha-tocopherol 2200 IU daily might be helpful, but
– No Vitamin E benefit in the >9,000 person HOPE trial (N ENGL J Med 2000;342:154), nor the Italian Trial
• For healthy adults, natural blends of Vitamin E 200 IU daily “might” be the best choice. For sure, focus on eating many plant pigments (such as flavonoids found in blueberries) that are more potent antioxidants than Vitamin E.

IF YOU ARE TAKING A STATIN (CHOLESTEROL-LOWERING) MEDICATION OR NIACIN, TAKING VITAMIN E AND OFFSET THE BENEFIT OF RAISING YOUR HDL AND BLOCK THE EFFECTIVENESS OF IMPROVING YOUR CHOLESTEROL PROFILE. ALWAYS CHECK WITH YOUR PHYSICIAN BEFORE STARTING VITAMIN E FOR HEALTH REASONS
SINCE VITAMIN E LOWERS HDL2 LEVELS, TAKING VITAMIN E HAS BECOME VERY CONTROVERSIAL

THERAPY GOAL #8;

LOWER HOMOCYSTEINE LEVELS
GET YOUR FOLIC ACID!
• Folic acid is a B vitamin
• Folic acid lowers homocysteine
• Homocysteine is toxic to your arteries
• High doses of folic acid are safe
• Glutathione, the product of homocysteine metabolism, actively regenerates your antioxidant balance

FOLIC ACID DOSING
• The general public needs 400 mcg (.4 mg) daily
• You can get 800 mcg folate (=400 mcg folic acid) with: 1 glass O.J., 2 servings beans, grain servings, and 2-3 servings green leafy veggies daily-- but most people don’t eat this way! Most people need to take a supplement
• People with unexplained CAD should check a homocysteine level (<10 umol normal, >14 high)

JUICE PLUS (17 servings of fruits and vegetables juiced into capsule form without sugar and without salt)
• Made from pesticide-free, vine ripened, freshly picked fruits and vegetables
• Increases human blood antioxidant levels (American Medical Review, 1999. Vol2)
• Increases immune function in the elderly
• (Integrative Medicine 1999, Vol. 2)
• Decreases oxidation of LDL cholesterol
• Costs $40 per month for 4 capsules daily

RESULTS FROM D.I.E.T.
The Dietary Intervention and Exercise Trial in Patients with Known CAD (Masley 1998)
• Increased vegetable and fruit intake, (30% increase, p=.001)
• Increased bean intake, (54% increase, p=.03)
• Changed type of fat intake (p= .004)
• Reduced health care expenses
• Is associated with lower LDL levels and a 13% triglyceride reduction
– (In contrast to 10% fat intake interventions with complex carbohydrate intake that increase triglyceride levels)
• Associated with a 30% reduction in event rates
THERAPY GOAL #9;

SUCCEED IN MAKING LIFESTYLE CHANGES
ENHANCE YOUR SUCCESS AT CHANGING LIFESTYLES
• Involve partners and family members
• Monitor food choices. Monitoring food records decreases fat intake by 10%.
• Providing menu plans to “motivated” people is as effective as providing food
• ADD FOODS to your menu plans!
• ADD ACTIVITY to your life
– walk, bicycle, dance, swim
Gazpacho
Veggie Stir Fry
Thanksgiving Feast

TAKE-HOME MESSAGES
• Choose evidence-based interventions to treat and prevent coronary artery disease
– (Diet + Activity + Aspirin + cholesterol reductions)
• Target & reach LDL & TC/HDL ratio goals
– Develop a plan to follow cholesterol levels over time
• Other important goals
– Keep your blood pressure < 140/90
– Ensure blood sugar control, take a One-A-Day Vitamin, and avoid passive tobacco smoke
• Choose a cardio-protective lifestyle--it is more effective than cardiac procedures
– Cardiac procedures do treat angina
Choosing a cardio-protective lifestyle means
– ADDING more antioxidant-rich foods, especially colorful fruits and veggies, legumes (soy), garlic, and spices daily
– LIMITING FAT INTAKE
– CHOOSING healthy fats!
– ENSURING adequate folic acid and omega-3 fat intake
– ADDING a regular exercise (activity) program
– ADDING IS THE MY THEME TO SUCCESS

CHOOSING A HEALTHY LIFESTYLE MAKES YOU FEEL GREAT!