Promoting Health and Wellness

  • At the NAMI 2008 convention, I attended the Promoting Health and Wellness: Strategies and Action workshop, featuring Marilyn Ricci, R.D., a registered dietician from Collinsville, CT.  Ricci spoke on eating for both mental and physical health.  After her talk, attendees could line up at the microphone to ask questions of her and the other panelists.


    Here now I will give an overview of the talk.  She focused on our daily needs: whole grains, Omega 3 essential fatty acids, low fat dairy, vegetables, fruits, nuts and seeds, beans and protein.  I'll give you the scoop:

    • Whole grains. When you look at the ingredient list, the first ingredient should say for example, "whole wheat." On any bread product, the nutrition panel should list 3 grams of dietary fiber, minimum. One kind of bread I like is Arnold's Double Fiber, which has 5 grams of fiber per slice. Along with the benefits of a high fiber diet (most notably that you feel fuller and aren't hungry all the time), grains provide B vitamins, folic acid, iron and magnesium. According to research at Penn State, dieters who at lots of whole grains lost more belly fat and improved their levels of an inflammatory marker that is linked to diabetes, hypertension and cardiovascular disease. The recommended serving of fiber based on a 2000 calorie diet is 6 servings per day.
    • Omega 3 essential fatty acids. Omega 3 fatty acid is found throughout the body, especially in the brain and eyes. Omega 3 and Omega 6 fatty acids are "good fats." Fish, especially fatty fish like salmon and tuna, are excellent sources of omega 3 fatty acids. Benefits of Omega 3 are improved lipid profile reducing cardiovascular risk, improved diabetes outcome, improved neurotransmission stimulation improving depression, reducing suicide and hostility and improved memory function. The recommended intake of Omega 3 is 1.6 grams/day for men and 1.1 grams per day for women. The recommended intake of Omega 6 is 14-17 grams per day for men and 11-12 grams for women. (The American Heart Association recommends that all adults eat fish at least two times per week.) I do eat fish twice a week, and I take two soft gels of fish oil concentrate with Omega 3 per day, 1000 mg each, taken with dinner. The best kind of fish to eat is smaller fish that isn't predatory. Tilapia and flounder are delicious.
    • Low fat dairy. Dairy products are our main source of calcium and vitamin D, essential for healthy bones and teeth. Dairy is also a good source of potassium, protein and magnesium. Research from Brigham and Women's Hospital of 30,000 women in the Women's Health Study found that an increased intake of low fat dairy products reduced women's risk of developing hypertension. Some research points to a weight reduction benefit of dairy calcium showing it to trigger the body to burn more fat, particularly around the waistline. The recommended intake is 1200 mg dairy calcium per day. This is the equivalent of 4 cups of low fat milk. I prefer Stonyfield Farms fat-free yogurt because it doesn't have added sugars or chemicals. You can squeeze in a glass of calcium-fortified orange juice as one of your servings. The U.S. Department of Agriculture MyPyramid recommends 3 cups per day based on a 2000 calorie diet.
    • Vegetables. These nutrition workhorses are low in calories, high in fiber, potassium, vitamins A, C, and E and phytonutrients. The ones that are dark in color have the most nutrients. Examples are broccoli, spinach, sweet potatoes, and carrots. Benefits of eating vegetables include reduced cancer risk, reduced risk of heart disease, lower blood pressure, diabetes prevention, and help with weight control. The recommended intake is 5 (1/2 cup) servings of vegetables every day. (Again based on a 2000 calorie diet.)
    • Fruits. These most colorful foods provide fiber, vitamin C, folic acid and phytonutrients and are relatively low in calories. Benefits of fruits are similar to those of vegetables. The recommended intake is 4 (1/2 cup) servings of fruits every day for a 2000 calorie diet.
    • Nuts and seeds. Walnuts are the most nutrient packed of the nuts and seeds, and contain plant Omega 3 fatty acids, vitamins E and B6, magnesium, protein, fiber, potassium and polyphenols. Nuts and seeds, though, are high in calories and expensive, so it is very important to eat them in small amounts. The recommendation is ¼ cup per day and no more. 1 oz of almonds=12 nuts; 1 tablespoon of peanut butter= 1 oz. Nuts and seeds are a portion of your protein requirement for the day. I used to eat natural peanut butter more often, slathering it on apple slices since I wasn't a big fan of apples [though apples are high in fiber]. Every so often, I will indulge. You can have an "open face" sandwich and spread peanut butter on a slice of high fiber bread, when you're feeling hungry.
    • Beans. They contain low fat protein, fiber, B vitamins, iron, folate, potassium, magnesium, and phytonutrients. Beans can help lower cholesterol, combat heart disease, stabilize blood sugar, help with constipation and diverticulitis, reduce blood sugar and control weight. The recommendation is to substitute meat with beans-often. I have a bowl of Progresso Lentil soup once a week, with a side of a couple of slices of mozzarella (or string cheese) and a slice of high fiber bread dunked in the soup instead of crackers.
    • Protein. This food group comes from multiple sources (meat, beans, seeds, nuts and fish) and provides protein, B vitamins, iron, magnesium, zinc and vitamin E. Protein is the primary material of our bodies. The building blocks of protein are amino acids some of which are essential as they cannot be made in the body and must be consumed in food. Some of the roles of protein are: supporting growth and maintenance such as building new tissues and replacing worn out cells; building enzymes and hormones; building antibodies which improve the immune system; maintaining fluid and electrolyte balance; maintaining acid-base balance; and providing energy. The recommendation is 5 ½ ounces per day, again based on a 2000 calorie diet.

    Click on to determine the suggested calories you need each day.  My daily requirement was 1746 calories per day.  So the 2000 calories is just a guide that isn't useful for everyone, and thus the recommended portions above can be adjusted to suit how much you ideally will be eating.

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    I'll wrap up with a talk on Metabolic Syndrome, which a lot of us are at risk for because the second generation atypical (SGAs) tend to cause weight gain, leading to diabetes and other medical problems.  Metabolic syndrome (MS) is the name given to the cluster of risk factors leading to cardiovascular disease.  The criteria proposed by the National Cholesterol Education Program Adult Treatment Panel (ATPIII) are widely used as a reference.  According to the ATP III guidelines, a patient with any 3 of the risk factors is considered to have MS.


    The ATP III criteria for clinical identification of Metabolic Syndrome are as follows:

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    Risk Factor:                         Defining Level:


    Abdominal Obesity                 Waist Circumference

    • Men                           >102 cm (>40 inches)
    • Women                       >88 cm (>35 inches)

    Triglycerides                        >150/dl


    HDL Cholesterol

    • Men                           <40 mg/dl
    • Women                       <50 mg/dl

    Blood pressure                      > 130/ > 85 mmHg

    Fasting glucose                     > 110 mg/dl


    (Per recommendations from the Mount Sinai Conference: measurement of fasting plasma glucose level is preferred, but measurement of Hemoglobin A1C is acceptable if a fasting plasma glucose test is not feasible.)


    According to the Stable Resource Toolkit handout given at this workshop:


    All five criteria for Metabolic Syndrome need to be tested as soon as you're put on a second generation atypical, even if you're taking Geodon or Abilify, which are less likely to cause weight gain.  Your personal family history, weight (BMI), waist circumference, blood pressure, fasting Plasma glucose and fasting Lipid profile should be taken at baseline.  Weight (BMI) should be followed-up at 4 weeks, 8 weeks, 12 weeks, and then quarterly.  Personal family history should then be measured annually.  Waist circumference should be measured annually after baseline.  Blood pressure should be taken again at 12 weeks, and then annually.  Fasting Plasma glucose should be measured also at 12 weeks and annually.  Fasting Lipid profile should be taken 12 weeks after baseline, and then every five years.


    These are guidelines in the handout given at the Promoting Health and Wellness: Strategies and Action workshop.  Remember, they are guidelines and your primary care doctor may decide to test you more frequently.  You will need to schedule an appointment at baseline for this testing; it is your right to have your doctor monitor these things and tell you in detail what the numbers are and some ways to counteract Metabolic Syndrome if you are on a weight-gaining atypical.


    This is your life and your health.  I know it's easier said than done, however, you have to expect that your doctor will take your concerns seriously, and if he or she doesn't, you need to find the doctor who will, and not give up until you find a medical doctor who's on the ball.


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    Interestingly, I'm lucky that I'm on an atypical that doesn't cause weight gain, but my c-reactive protein is wacky.  Dr. Ken Duckworth, NAMI's medical director, told me to visit a preventive cardiologist to allay my fears that I'm at an elevated risk for heart disease.  I spoke up at the microphone after the panel, telling him that I was at risk for cardiovascular disease because I have inflammation and my c-reactive protein is out of line.  He knew that testing c-reactive protein is a sophisticated tool that's now in vogue with some doctors.  I will take him up on his suggestion to see a preventive cardiologist ("the ones who drive the ordinary cars," he joked) if my blood work this month comes back abnormal again.


    So take heart: do all within your power to control your risk factors, and know you've done your best.  It may not have occurred to you to get tested, so do it and put your mind at ease.


Published On: July 08, 2008