Cardiovascular Disease

Cardiovascular disease is the leading cause of death in Canada. It includes diseases and injuries to the cardiovascular system –the heart, blood vessels of the heart and the system of blood vessels (arteries and veins) throughout the body and brain. When blood flow is interrupted to the heart, it can cause a heart attack. A stroke is caused by a blockage of blood flow to the brain. Heart attacks may damage the heart muscle; strokes cause brain damage. It is estimated that 8 million Canadians have some sort of cardiovascular disease. In 2001, Stats Canada reported 74,824 deaths in Canada, due to cardiovascular disease. They also reported 33% of all male deaths and 35% of all female deaths in Canada, in 2001, were due to cardiovascular diseases. According to reports by the World Health Organization, heart attacks and strokes kill about 12 million people worldwide, each year. Another 3.9 million die from hypertension and other heart conditions. There is strong scientific evidence indicating that the major portion of these deaths is preventable with changes in dietary habits and lifestyle. In 2002, the World Health Assembly began developing a worldwide plan to improve the population’s diet, physical activity and health.

To understand how the heart works, visit the Heart and Stroke Foundation website at www.heartandstroke.ca

As with other chronic conditions, cardiovascular diseases develop over a long period of time. Some of the trouble begins in childhood with poor dietary habits and lack of physical activity. Coronary heart disease is the most common of the cardiovascular diseases and causes the most deaths. It includes atherosclerosis and hypertension. Atherosclerosis is caused by a build up of plaque along the walls of the arteries. This is normally the result of a diet high in saturated fats and cholesterol. As more plaque attaches to the artery walls, the blood flow becomes restricted and eventually a complete blockage may form. When blood supply to areas of the body is restricted, that part of the body is robbed of nutrients and oxygen. When this happens to the heart, the heart muscle can become damaged (coronary heart disease) and pain may be experienced around the heart area (angina). When the heart muscle does not receive blood part of the heart dies, causing a heart attack. If the blood supply is blocked to the brain, a stroke occurs.

When blood flow is restricted, the heart muscle must work harder and increase the pressure to pump the blood through the body. As blood pressure increases to pump the blood through the restricted arteries, it causes more damage to the artery walls. Fatty deposits and clots have a tendency to form where the damage occurs. Constant elevated blood pressure may cause an artery to balloon and eventually burst (aneurysm). The higher blood pressure is above normal, the greater the risk of atherosclerosis. High blood pressure (hypertension) and atherosclerosis, together, are a life-threatening combination. Strain on the heart can enlarge or weaken it, causing heart failure. An undetected aneurysm can result in massive bleeding and death.

Hypertension is an increase in blood pressure due to stress on the heart. It contributes to over a million heart attacks and over one half million strokes each year. Your heart beats, on average, 70 times per minute with a half second rest between beats. This action pumps blood into the arteries at a rate of about 70 ml per beat with a pressure of 120 mm. This flow may increase up to six times this amount with exercise. The resting heart has a normal range of 50 to 100 beats/minute, with the average resting rate of 70 beats/minute for males and 75 beats/minute for females. Your resting heart rate may vary due to heredity, gender, fitness level, stress, or other medical conditions. (Have your blood pressure checked regularly; high blood pressure often has no symptoms or warning signs.) Recent studies have indicated that a resting heart rate of 80 or more increases your risk of dying within ten years due to cardiovascular disease. The majority of people who experience a high resting heart rate are those who smoke, drink coffee, are overweight and out of shape, and are exposed to constant stress situations.Recently, a study called the DASH (Dietary Approaches to Stop Hypertension) study was carried out to evaluate the effects of diet and salt on blood pressure. This study confirmed what the Heart and Stroke Foundation and Health Canada have been saying regarding the relationship between what you eat and your heart health. From the study, emerged the DASH diet. It is very similar to Canada’s Food Guide to Healthy Eating, putting more emphasis on fruits and vegetables and low-fat dairy and meat products. According to an article, written by Gloria Tsang, RD, “High Blood Pressure Diet – the DASH Diet”, the “study showed that the DASH diet lowered both systolic and diastolic blood pressure, usually within two weeks.”1

The following DASH diet2 is based on 2000 kcal a day.

Summary of the High Blood Pressure Diet - DASHGrainsVegetablesFruitsLowfat or Fat-free DairyMeats, poultry & fishNuts, seeds & dry beansFats & oilsSweets

7-8 servings4-5 servings4-5 servings2-3 servings2 or less servings4-5 per week2-35 per week

Factors Affecting Your Heart Rate1. Age- although our maximum heart rate decreases as we age, the rate of the heart

at rest normally remains fairly stable.2. Gender- males usually have a lower heart rate than females.3. Fitness level- the better your physical condition, the lower your resting heart rate.

A person in top physical condition may have a resting heart beat of 50 beats/minute.

1 http://www.healthcastle.com/high-blood-pressure-diet.shtml , Gloria Tsang, RD, “High Blood Pressure Diet – the DASH Diet2 http://www.healthcastle.com/high-blood-pressure-diet.shtml , Gloria Tsang, RD, “High Blood Pressure Diet – the DASH Diet

4. Body temperature- the heart rate increases an average of 20 beats/minute for every 1°C above the normal body temperature of 37°C.

5. Sleep- heart rate lowers while you sleep.6. Smoking- increases heart rate due to the carbon monoxide in the smoke.7. Caffeine- stimulates the heart rate to beat faster.8. Environment temperature- Heat and humidity will increase a normal or resting

heart rate. Cold temperatures will lower heart rates.9. Obesity- added adipose tissue means extra blood vessels and capillaries to supply

blood to, causing an increase in blood pressure.10. Reduced blood flow to kidneys- kidneys respond by increasing blood pressure by

expanding blood volume and constricting the surrounding blood vessels.11. Diabetes- high blood pressure is 2-3 times more common in people who have type

II diabetes. High blood insulin triggers the kidneys to retain sodium this in turn, increases blood pressure.

For more information of your heart rate visit the Heart and Stroke Foundation of Canada website at www.heartandstroke.ca . Learn how to get physically fit to decrease your resting heart rate. Have your blood pressure checked regularly and know what is normal for you.

Risk Factors for Cardiovascular Disease1. Gender- males normally have higher blood cholesterol than females who are

under the age of 45-50. Menopause increases the risk for women.2. Age- cardiovascular disease develops over time therefore risk increases with age.3. Family history- family history of heart disease increases your risk.4. Smoking- carbon monoxide increases heart rate; effects of smoking cause damage

to the arteries or heart, itself. Smoking decreases the HDL level in the blood.5. Physical inactivity- increases risk of high blood pressure and obesity.6. Dietary habits

a) High fat diet causing abnormal blood lipids- high LDL and low HDL.b) Hypertension- high sodium dietc) Elevated blood insulin levels- trigger the kidneys to retain sodium; this in

turn, increases blood pressure.d) Obesity- BMI of 18.5-24.0 is desirable. Obesity is a risk factor of many

chronic conditions.

To reduce your risk of cardiovascular disease:- Do not smoke.- Become physically active.- Monitor and control your blood cholesterol. - Maintain a healthy BMI.- Reduce fat, especially saturated fat in your diet.

- Replace saturated fats with omega 3 fatty acids (from fish) to improve the HDL-LDL blood cholesterol ratio.

- Consume a variety of fruit, vegetables and whole grains to trap and excrete fatty acids.

- Monitor and control your blood pressure.- Reduce your intake of salt.- Moderate alcohol consumption for people over the age of 50 has heart health

benefits (raises HDL and helps prevent the formation of blood clots). Alcohol consumption may have other negative health effects that should be considered.

- Nutrients such as folacin, vitamin B6, vitamin B12, and vitamin E have shown to help protect people from cardiovascular disease.

- Soy (protein and isoflavones) help improve HDL-LDL ratio of blood cholesterol

Warning Signs of Heart Attacks- Heaviness, pressure, squeezing, fullness, burning, discomfort, or pain in the center

of the chest which may spread to the neck, jaw, shoulders, arms and back. Symptoms may be mild to severe and may come and go.

- Shortness of breath, paleness, sweating, or weakness- Nausea, vomiting, and/or indigestion- Fear, anxiety, denial

Warning Signs of a Stroke- A sudden temporary weakness or numbness in the face, leg or arm- Temporary loss of speech or trouble speaking or understanding speech- Episodes of double vision- Unexplained dizziness, headaches, etc., in conjunction with other symptoms

What to Do If Someone is Having a Heart Attack or Stroke- Act immediately; call 911. Time is important.- Have the person stop all activities and sit or lie down to rest.- Expect denial; take charge. Do not rely on the person’s opinion of whether or not

they need medical help.- Check to see if they have nitroglycerine (medication used by those who

experience angina attacks) and if so, help them administer it in the prescribed amount.

- Use CPR if needed and you have the training to use it.

1. Identify your risk factors for cardiovascular disease. 2. Identify ways you can improve your diet and lifestyle to help protect you against

cardiovascular diseases.3. What risk factors do you have no control over?

Cancer

The word “cancer” often causes fear in people, even though the prognosis is much better today for some types of cancer than it was in the past. Although education, identification of risk factors, early diagnosis, and advancement in treatments has helped reduce the death rate from cancer, the number of cases continues to rise.In 2003, cancer was the leading cause of premature death in Canada and it is believed that it will become the leading cause of all deaths in the next decade. The number of cancer cases is increasing at a rate of 2-3% per year with an increase of 8-10% of individuals on active treatment. New Brunswick has the 2nd highest cancer rate in Canada. Nova Scotia has the highest. According to the Canadian Cancer Society, in 2002, 3800 New Brunswick residents were diagnosed with cancer and 1850 residents died of the disease. Everyday, an average of 11 people in New Brunswick are diagnosed with cancer. Breast, lung, prostate and colorectal cancer, make up the majority of new cases. The survival rate for lung and colorectal cancer in New Brunswick is 10% below the national average. Medical experts believe this to be due to a poor system of managing cancer cases and the high risk behaviors of people living in New Brunswick. They believe that in many cases, cancer is a preventable disease. Scientist’s estimate 80% of cancers in the world are due to environmental and lifestyle factors. The Canadian Cancer Society reports that up to 35% of cancers in the world are due to dietary habits alone.

Risk factors of New Brunswicker’s- Smoking rates are comparable to the national average, but there is an increased

Incidence of second hand smoke- Poor dietary practices- Reduced leisure time physical activity- Frequency of heavy drinking

The economic burden of cancer is high. It by far exceeds that of any other disease including cardiovascular disease. Everyone pays:

- The government and the individual pay health care expenses.- The employer pays with lost work time and productivity of the worker.- The individual and possibly family members, lose time from work to help care for

the cancer patient.- The patient has a lowered quality of life and a reduced life span.

How Does Cancer Develop?Cancer develops from abnormal cell growth. The abnormal mass of cells grows into a tumor, which may be either benign (non-cancerous) or malignant (cancerous). Tumors continue to increase in size with blood vessels supplying them with the necessary nutrients. Eventually, the tumor will invade healthy tissue and may metastasize (spread to other body parts). Normally, a healthy immune system will recognize foreign cells and destroy them. For some reason, this is not the case with tumor cells. They are not destroyed and are seen as new tissues. The blood supply provides them with the necessary nutrients to sustain their growth. A weakened immune system may increase

your risk of developing tumors. Malignant tumors are dangerous and it is important to find and treat them before they spread. There is no single known cause of cancer. Types of cancer are named by the part of the body in which the tumor forms. For example a tumor may form in the breast and metastasize in the lungs. This type of cancer is called breast cancer.

Some Factors Affecting Specific Types of Cancer

Type of Cancer Risk Factors Preventive measuresBladder cancer Smoking, possibly artificial Fruit and vegetables

sweeteners, coffee, and alcohol and adequate fluid intake

Breast cancer Obesity, early puberty, alcohol, Fruit and vegetables,possibly meat and dietary fat especially bright

green and yellow ones possibly carotenes, fiber, and physical fitness

Cervical cancer Folate deficiency, smoking Possibly fruit, vegetables, carotenes,and vitamin C

Colorectal cancer Fat, meat, alcohol, possibly eggs, Vegetables, physicalgrilling, and sugar activity, possibly

carotenes and fiber

Endometrial cancer Obesity, estrogen therapy, dietary Possibly fruit fat vegetables

Esophageal cancer Alcohol, tobacco, and especially Fruit and vegetables,combined use possible carotenes and

vitamin CLiver cancer Infection with hepatitis B or Possibly vegetables

aflatoxins, alcoholLung cancer Smoking, possibly alcohol, fat, Fruit and vegetables,

And cholesterol especially green and yellow ones, possibly carotenes, vitamin C, and selenium;physical activity

Ovarian cancer No dietary risk factors; inversely Possibly fruit andCorrelated to oral contraceptives vegetables, especially

green and yellow Prostate cancer High fat intake, especially saturated Possibly fruit and

fats from meats and milk products vegetablesStomach cancer Salt-preserved foods, possibly grilling Fresh fruit and

and barbecuing vegetables

Some risk factors initiate the development of cancers. These are known as initiators or carcinogens. There are found in heavily smoked, pickled or cured foods. Pesticides may also be carcinogenic. Wash fresh produce before cooking or consuming it.Smoking, exposure to sun, radiation and pollution have also been linked to an increased risk of cancer. Promoters help tumors grow once they have started; they may increase their rate of growth. Linoleic acid, (Omega 6 fatty acid) may promote cancer growth. It is found in vegetable oils and is an essential fatty acid.Some things protect against the development of cancer. These are known as antipromoters. Omega 3 fatty acid is known to have this effect. It is found in fish oils and is also an essential fatty acid. Fruit and vegetables are the best known antipromoters. In “5 to 10 a day. Are you Getting Enough?” the Canadian Cancer Society and the Heart and Stroke Foundation state that “fifteen of the world’s leading researchers in diet and cancer recently reviewed more than 4500 studies from around the world. Vegetables and fruit came out on top as the foods most likely to reduce the risk of cancer. Researchers recommend that everyone should eat 5 or more servings a day, all year round.”3 Fruits and vegetables contain fiber, nutrients, antioxidants and phytochemicals that help protect against cancer. Antioxidants protect you against free radicals. Phytochemicals help activate enzymes to destroy carcinogens.

The Canadian Cancer Society makes the following recommendations to reduce your risk of cancer:

- Increase physical activity. Current research has shown physical activity can reduce the incidence of colorectal cancer and may help reduce cancers of the breast and prostate. It also helps maintain a healthy body weight, which is important in reducing the risk for many cancers.

- Reduce your total daily fat intake to no more than 30% of total energy. Research studies indicate that both saturated and unsaturated fats seem to be associated with cancer.

- Eat more fiber-containing foods. Researchers believe that fiber dilutes concentration of cancer-causing substances and also speeds removal form the body.

- Have at least 5 or more servings of fruit and vegetables every day, all year long.- Keep your body mass close to ideal. People who are 40% or more above ideal

mass have a 50% higher risk of cancer.- Limit alcohol consumption. Alcohol has been associated with an unusual high

risk of cancer of the mouth, esophagus and throat, for heavy drinkers. The risk increases dramatically if the person smokes as well. Liver damage, due to excessive drinking, may also cause liver cancer.

- Minimize your consumption of smoked, nitrate cured and salted foods. These foods have been linked to cancer and hypertension.

- Reduce your exposure to UV (ultraviolet) rays from the sun or tanning beds.- Be familiar with your body and report any changes to your doctor or dentist.- Handle hazardous materials safety and according to instructions.

3 5 to 10 A Day; Canadian Cancer Society; www.5to10aday.com

Diabetes

Diabetes is a disorder that prevents the body from producing insulin or from using the insulin it does produce. Your body converts carbohydrates to glucose for energy. In order to metabolize glucose, insulin, a hormone produced by the pancreas is required. It moves glucose from your bloodstream to body cells where it is needed for energy. Sometimes the pancreas does not produce insulin or the body does not use it effectively. Without insulin, blood glucose levels increase dramatically in the blood and urine. This condition is called diabetes. If untreated, it can cause a variety of serious complications, such as heart disease, stroke, blindness, kidney disease, gangrene, or impotence.In Canada, it is estimated that 2.25 million are affected by diabetes and it is possible that 1 in every 3 persons with the disease are unaware of it. It costs the health care system an estimated $11 billion annually. The majority of the cases are type II diabetes, or “adult onset” diabetes. Diabetes is the seventh leading cause of death in Canada. It accounts for at least 5500 deaths per year and may be a contributing factor in as many as 25,000 deaths. People who have a history of diabetes in their families have an increased risk of inheriting the tendency to get diabetes. There are three types of diabetes:

- Type I ,also called juvenile diabetes or insulin dependent diabetes - Type II, also called adult onset or maturity onset diabetes - Gestational diabetes

Type I occurs when the insulin-producing cells of the pancreas have been damaged or destroyed. The body produces little or no insulin. It is more likely to occur in children or young adults. The onset is sudden and symptoms are often severe. Symptoms include- frequent urination in large quantities, constant extreme hunger, sudden weight loss for no apparent reason, weakness, drowsiness or exhaustion, sudden vision changes or blurred vision, and nausea and vomiting. If you experience any of these symptoms, see a doctor to determine if you have diabetes. A person with this type of diabetes must have insulin injections. Before insulin injections were discovered by Dr. Frederick Banting in 1921, people would go into a diabetic coma and die, often within a few weeks of developing the condition. Insulin is not a cure, but a means of managing diabetes; there is no cure.Risk factors associated with Type I diabetes are:

1. Heredity- father or mother have Type 1 diabetes.2. Race or ethnic background- more prevalent in people of Caucasian descent.

Type II diabetes often referred to as “maturity onset” or “adult onset” diabetes usually occurs in people over age 45. According to Health Canada, this type of diabetes accounts for 90% of all diabetes cases. The body produces insulin but is unable to use it effectively. This type may take months or even years to develop and symptoms are often mild or do not show. Often a person with Type II diabetes experiences recurring gum or bladder infections, cuts and bruises that are slow to heal, drowsiness and tingling or numbness in the hands or feet. Any of the symptoms of Type I diabetes may occur as well. If symptoms are mild, dietary changes may help. More severe cases may require

medication or injections to control insulin production or use. Approximately 20% of diabetics who have Type II need insulin injections to control the condition.Risk factors associated with Type II diabetes are:

1. Age- over age 452. Obesity- diabetes cases are double in people of unhealthy weights compared to

those who have a healthy BMI There is also a higher risk for those who have a tendency to gain the excess weight around the middle section of the body.

3. Family history of diabetes4. Physical inactivity5. Ethnic heritage- Aboriginal, African, Hispanic or Asian decent are at increased

risk.6. Give birth to babies over 4.0 Kg (9 lbs)7. Been previously diagnosed with impaired glucose tolerance8. Have difficulty dealing with stress9. Have a history of hypertension, high cholesterol, or other cardiovascular problems

Gestational Diabetes is a temporary condition that affects 2-4% of women during pregnancy. The stress of the pregnancy on the mother’s system may cause the pancreas to produce insufficient insulin or ineffectively use it, resulting in high blood glucose. Treatment may involve adjustment in the diet, exercise and sometimes insulin injections. Once the baby is born blood glucose levels return to normal, although 30-40% of women who experience gestational diabetes develop Type II diabetes later in life (within 5-10 years).

No matter what type you have, diet and exercise are extremely important. Blood sugar levels must be continually monitored. Weight control and lifestyle adjustments may be necessary. Once you reach age 45, you should be tested for diabetes every three years. If you exhibit any risk factors other than age, you should be checked yearly and at any earlier age.

Prevention of DiabetesObesity plays a major role in the development and progression of Type II diabetes. Achieving and maintaining a healthy weight and engaging in regular physical activities can help reduce the risk of developing Type II diabetes by as much as 50%. You should accumulate one hour of physical activity each day to stay healthy or improve your health. If you engage in moderate exercise, you can reduce the amount to 30 minutes/day, 4 days/week. Find an activity you enjoy and will continue to be involved in; walking is an excellent start. You do not need to go to expensive health and fitness clubs to benefit from physical activity. Healthy eating habits for diabetics are much the same as those of anyone who wishes to remain healthy. The most important thing is to eat regular meals, three times a day, to distribute energy intake over the day. Pay attention to the quantity and quality of the food you eat. Remember that carbohydrate, with the exception of fiber, is broken down into glucose in the body; therefore, it is important to watch how much carbohydrate you eat in order to control the amount of glucose in your blood. High fiber foods may help lower blood glucose levels by slowing down digestion. It is important to spread your

daily requirement of carbohydrate over the day (not eat too much in one meal), in order to help maintain a constant blood glucose level, instead of extreme highs and lows. Limit foods high in concentrated sugar and fat, since they have little nutritional value and cause blood glucose levels to rise. Choose variety from all four food groups. Include snacks between meals, especially if energy expenditure is greater than usual, or if you are taking medication or injections for diabetes. A healthy balanced diet, spread evenly over the day, may help reduce the medication you need.

Living with DiabetesOnce you develop Type I or Type II diabetes, it is with you for the rest of your life. Although currently there is no cure, scientists are making great progress in their research. At the University of Alberta, eight Type I diabetic patients were injected with pancreatic islets from healthy donors, as part of a research project. The islet cells were taken from the pancreases of healthy donors and injected into the liver of the Type I diabetics through the portal vein. The cells took root in the liver and produced sufficient insulin to almost perfectly control the blood sugar of the type I diabetic patients. This was so successful that it is now being tested on other patients and may someday be used to reverse the insulin dependency of diabetic patients.

Osteoporosis

Osteoporosis means porous bones. It is characterized by low bone mass and deterioration of bone tissue, leading to an increase in fragile bones and risk of fracture, particularly of the hip, spine and wrist. Health Canada and the Osteoporosis Society of Canada report 1.4 million Canadians suffer from osteoporosis. Approximately one in four women and one in eight men over age 50 are affected. There are no warning signs until bones being to fracture easily. One day you may be trying to open a jar and you fracture your wrist, or cough and fracture a rib. Seventy percent of hip fractures in seniors are believed to be due to osteoporosis. Severe cases of this disease result in disfigurement, reduced height, reduced mobility and loss of independence. Besides the human cost, there are economic costs as well. In Canada, it is estimated that $1.3 million/year is spent on treating osteoporosis and its effects. Due to our aging population, the Osteoporosis Society of Canada estimates that, by the year 2018, $32.5 billion will be spent on this disease, its prevention and treatment.

Development of OsteoporosisThe majority of cases of osteoporosis are due to reduced bone mass caused by low levels of calcium, phosphorus and other minerals in the bones. It may also be a result of endocrine disorders or excessive use of corticosteroids or some other medications. The disease sets in during the later years of life, but develops much earlier.Throughout your life, your bones are constantly replacing old bone tissue with new bone tissue. In the early years of your life, up to age 25-35, your bone mass increases, reaching its peak sometime during this stage of your life. As you age past these years, bone tissue is not renewed as quickly as it once was and you begin to lose bone mass. It is important to retain as much of this bone mass as possible through a healthy diet and an

active lifestyle. If not, you begin to lose bone mass and your bones begin to weaken. Early stages of the disease often do not cause any pain or symptoms. You can lose bone mass steadily over many years without noticing any changes in your health. As the disease progresses you may experience back pain, reduced height (due to stooping caused by a weaken spinal column), and fractures of the vertebrae, wrists, hips or other bones. Once these symptoms appear, the disease is fairly well advance. Diagnosis is made by assessing your risk and measuring bone density. Early detection of bone loss is critical to preventing fractures. There is no cure for this disease; prevention is the key.

Risk Factors Development of osteoporosis seems to depend partly on genetics and partly on other factors, including nutrition. Age and gender are the strongest indicators of risk, with one in four women over 50 developing osteoporosis and one in two women over age 70 being affected. The risk is double for women compared to men, until age seventy-five, when the risk is fairly even for both genders. Other risk factors include:

- Family history- you are at increased risk if a parent or sibling has had the disease or there is a family history of fractures.

- Spinal fractures or fractures from minor impact after age 40.- Long term low calcium intake or conditions that cause poor calcium absorption-

lack of vitamin D can reduce calcium absorption. - Ovaries removed or early menopause (before age 45)- when ovaries do not

produce estrogen, the rate of bone loss increases- Low levels of testosterone in men- Excessive use of some medications, such as corticosteroids (cortisone and

prednisone), thyroid medications, heparin, cancer fighting medications and anti-convulsion medications.

- Ethnic background- greatest risk for whites and South Asia descendents. (Black and Hispanic men and women have a lower risk.)

- Body frame size- small slender bones are at higher risk, due to low bone mass to begin with.

- Osteopenia –low bone mass shown on X-rays- Smoking or too much caffeine (more than four cups/day of beverages containing

caffeine)- Chronic alcoholism (highest risk factor in men) - having more than two drinks per

day on a regular basis reduces bone formation and interferes with calcium absorption.

- Some diuretics cause your kidneys to excrete more calcium- Eating disorders may result in low bone density- Physical inactivity- Physically active young people have the greatest bone density

(weight bearing exercises, such as walking, jogging, hopping and skipping are beneficial to keeping bones strong)

- Depression may increase the rate of bone loss in some people.

Prevention of Osteoporosis

The best way to prevent osteoporosis is to get your daily requirement of calcium and vitamin D and stay physically active. This can also help slow the progression of the disease.Calcium and Vitamin DYour calcium requirement and your body’s ability to absorb it changes as you age. The average adequate intake (AI) for young adults is 1000 mg/day and 1200 mg/day for older adults. This increase in intake with age is a result of bone density lost with normal aging.

It is very important to have calcium-rich foods in your diet. Food sources of calcium include the dairy products, broccoli, canned salmon and foods fortified with calcium.It is also important to get your requirement of vitamin D to help your body absorb the calcium. Vitamin D is obtained from some foods but sunshine is an excellent source. Often seniors are not exposed to enough sunshine to get their requirement and therefore supplements may be needed. Supplements of calcium with vitamin D added are available and most effective if taken in divided doses with food. If you are taking medications that may interfere with absorption of calcium, supplements may also be necessary. Only take a supplement if your calcium intake is not sufficient, otherwise there may be other risks to your health.

Physical ActivityRegular physical activity, especially weight-bearing exercise such as walking, jogging, dancing, etc. can improve bone strength. Other types of exercise can improve balance and coordination to reduce bumps and falls. You’ll gain the most benefit from exercise if you start young and continue throughout your lifetime.

Other Prevention StrategiesAvoid smoking, excessive caffeine (more than three cups/day) and alcohol intake (more than two drinks/day)Consider hormone replacement therapy to reduce the risk after menopause. There are other side effects to these treatments and the benefit may not be worth the risks.

Oral Health

Regular dental check-ups are part of your overall health. It is important to visit your dentist every 6-9 months for dental examinations and cleanings. If you notice any changes in your oral health, visit immediately. Smoking, poor eating habits and poor oral hygiene can affect your oral health. Smoking and chewing tobacco increase your risk of oral cancers. Poor eating habits and improper oral hygiene increase your risk of cavities and gum disease.

Dental plaque is an invisible, sticky film full of bacteria that forms on teeth, especially along the gum line. It develops as food is digested and bacteria in the mouth produce acid; bacteria produce acid for 20-30 minutes after you eat. Depending on the type of

food you eat and how often you eat it, brushing using fluoride toothpaste at least twice each day will help remove this plaque from accessible areas. Foods that are sweet and sticky and stay on the teeth longer, produce more plaque than foods that are not chewy and do not remain in the mouth for a long time. If you are going to eat chewy candy, it is better to eat it all at once, instead of eating it slowly over a period of time. For example, eating a handful of candy within five minutes exposes your teeth for approximately 35 minutes. Eating one at a time over a couple of hours, exposes your teeth continually for more than 2.5 hours. More plaque has a chance of forming along the gum line.Flossing between teeth helps remove plaque and food particles that may become lodged between the teeth. Flossing is important to keep gums healthy.Sometimes food gets stuck in crevices, and if not removed, the plaque that it forms becomes hardened. This is called calculus and is not easily removed by brushing. It is removed by special instruments during your regular visit and cleaning at the dentist. Plaque and calculus on teeth that is not removed can cause cavities. If cavities are not treated (filled), they may cause infection within the tooth and gum.Gingivitis is a gum disease characterized by red, swollen and tender gums. The gums have a tendency to bleed easily when infected. If left untreated, periodontal disease results. The gums and supporting tissue becomes infected and teeth become loose and may fall out easily. This is usually the result of poor diet and improper dental care and often begins in the teen years. In a report by Health Canada, “The Effect of Oral Health on Overall Health”, they report that “cavities and gum disease may contribute to many serious conditions, including heart disease, diabetes, respiratory diseases, and premature and low birth weight babies. Untreated cavities can also be painful and lead to serious infections. Poor oral health can also affect your ability to chew and digest food properly.”4

It is important to include calcium in your diet to build strong teeth. Fluoride is also important to strengthen tooth enamel. Vitamin A and C are needed for healthy gums. Refer back to your lessons on Vitamins and Minerals to determine what foods give you strong healthy teeth and gums.

What would you suggest to a mother who is giving her child raisins, a few every 15 minutes or so? You have observed this at the park where the child is playing with your little sister. The mother says to you “she would eat the entire package at once if I let her”.Consider how your eating habits and oral hygiene affect your health. Are you at risk of periodontal disease?

Obesity

More than one billion adults worldwide are overweight, and at least 300 million of these are clinically obese (WHO). The WHO now considers obesity to be a global epidemic. According to a recent Canadian Heart Health survey (1997), obesity is reaching epidemic

4 www.hc-sc.gc.ca/english/ish/lifestyles.dental.html

proportions in Canada, with 44% of adult males and 25% of adult females being overweight. In 1997, obesity claimed 2.4 % of the health care budget, a total of $1.8 billion. Obesity can cause serious health problems and contributes to several other chronic conditions. The Canadian Cancer Society suggests that 35% of North Americans are obese, and if we were to reduce our body weight by 5-10% we would see significant health benefits. This reduction may eliminate 40-70% of high blood pressure cases, 50% high cholesterol cases and 85% adult diabetes cases. Obesity is also a major problem with children, with statistics showing 37% of Canadian children either overweight or obese. The Canadian Medical Association Journal (2000) reported the rate of obesity among Canadian boys aged 7-13 tripled between 1981 and 1996; the rate for girls of the same age group doubled. According to the National Institute of Nutrition, children are 80% more likely to be obese if both parents are obese. This statistic leads us to believe that obesity begins at home and is due to a combination of genetic and lifestyle factors.

Obesity means excessive body fat. It is the result of the body consuming more energy than it uses. The term is used to identify males who are 20% above their standard weight and females who are 30% above their standard weight. A BMI above 30 is also considered obese. The term overweight defines people who are within 10% and the above percentages of their standard weights, or a BMI or 25-29.9. Determining who is overweight and who is obese is complex, since both body weight and fatness are involved. Obesity is not determined by weight alone, but more importantly on the amount of body fat a person is carrying. Individuals who are obese by definition of weight standards usually also have excess amounts of body fat, although there are exceptions, such as the well-muscled athlete or body builder. Even when a person is within normal weight range or is underweight, he/she may carry excess body fat. Various measurements and factors are used to determine how much body fat a person accumulated and the health risks it may present.

1. BMI (body mass index) - a measurement of body fat. This is currently the most widely used measurement tool of healthy weights. It is based on a ratio between height and weight and is a quick way for most adults to determine their body fat. The calculations are not accurate for children, muscular athletes, or pregnant women. People deemed overweight are those with a BMI or 25-29.9. Those with a BMI over 30 are considered obese. Healthy weights fall between 18.5 and 24.9. You are considered underweight if your BMI is less than 18.5. High BMI’s have been associated with an increase risk of diabetes, cardiovascular disease and certain cancers.

2. Body Shape (Waist Circumference and Waist-Hip Ratio)- Abdominal fat is associated with an increased risk of disease as well. Women whose waist circumference is over 80 cm (31.5 inches) and men whose waist circumference is over 94 cm (37 inches) may have health concerns associated with weight. Women whose waist is greater than 89 cm (35 inches) and men whose waist is greater than 101.5 cm (40 inches) have shown increased risk of heart disease and diabetes. Evidence also suggests that the

“apple shape” figure (excessive weight around the middle compared to other areas of the body) is a stronger predictor of health problems than the BMI or waist circumference measurements alone.Fat distribution can also be measured in a ratio between the waist and hip measurements; the lower, the ratio, the better. There is a sharp increase in the risk of heart disease in women whose ratio is greater than 0.8 and men whose ratio is greater than 1.0. Excess fat around the hip, thigh and buttock area is often referred to as the “pear shape” figure. To determine your ratio take your waist and hip measurements. Divide your waist measurement by your hip measurement. This is your waist-hip ratio.

Example: waist = 28 inches Hips= 34 inches28 ÷ 34 = 0.82 ratio

This is slightly over the risk level for women and under for men.

Activity: Calculate your waist – hip ratio. Determine your risk.

3. Anthropometry (fat fold measure)- a measurement of the skin fold thickness in various areas of the body, including the triceps, shoulder blades and hips. The triceps skin fold measurement is often referred to as the TSF (triceps skin fold). This measurement is useful to determine how much weight is due to muscle verses fat. Pinch these areas on your body an determine the size of the skin fold. A large skin fold is excess body fat. If the skin fold is small, tissue is more muscular than fatty.

4. Hydrodensitometry- body density is measured by taking your weight twice- once on land and secondly while submerged in water. The difference between the two weights gives the body’s volume. Percentage of body fat can be determined using a mathematical equation using the body’s volume and actual weight. 5. Bioelectrical impedance- resistance to a low-density electrical current is low in persons who have lean tissue. The measure of resistance is used in a mathematical equation to determine the amount of body fat.

Causes of Obesity – Genetic, Environmental or Medical GeneticsScience is beginning to study the possibility of an inherited tendency toward obesity. They have recently identified a gene called the “obesity gene” or “ob”. This gene is expressed in the fat cells and codes for the protein leptin. Leptin is released by fat cells and acts as a hormone, mainly in the hypothalamus. Early research into this gene and its role suggests that leptin promotes a negative energy balance by suppressing appetite and increasing energy expenditure. Changes in energy expenditure are mainly reflected in changes in basal metabolism, but may also include changes in physical activity patterns.Leptin maintains energy balance. When the body gains fat, the increase in leptin shifts energy balance toward the negative, telling your body to eat less and use more energy. Such a scenario would ensure that all fat you gained would be followed by losses, maintaining a balance, but this is not the case with obesity. Most obese people have high levels of leptin, but their energy balance does not automatically shift to the negative, suggesting a resistance to leptin’s balance in obesity.

Negative Energy Balance

When the body loses fat, the decrease in leptin shifts energy balance toward the positive: eat more and spend less energy.

Positive Energy Balance

Increase in Body Fat

Increase in blood leptin

Hypothalamus responds by suppressing the appetite

Food intake decreases and energy output increases.

Decrease in size of fat cells

Weight loss

Decrease in Body Fat

Decrease in blood leptin

Someday, injections of leptin may be used to control obesity in genetically obese people, just as insulin is used to control diabetes in insulin-dependent diabetics.

Proteins and HormonesInsulin is the hormone that regulates the conversion of blood sugar into energy. Once glucose enters the body’s cells, insulin decides if it will be used for energy or stored for later use. Excess glucose storage is converted into fat storage.Resistin is a newly discovered hormone produced by fat cells. It may affect the activity of insulin in the body and may have something to do with the relationship of obesity to type II diabetes.Recent research has discovered proteins that are controlled by leptin and regulate food consumption; other proteins regulate genes that control fat cell formation. Other chemicals produced in the brain, digestive juices, and intestines are being investigated as possible pieces to this puzzle. Obesity and its causes are major concerns to health professionals and researchers and research continues to investigate the genetic relationship to obesity. They believe that genetics may account for 70-80% of obesity cases.

Environmental Factors1. Overeating- For every 3500 kcal you consume above your daily energy requirement, you will gain 1 pound (454 g) of body weight. For example, if you consume an extra 500 kcal per day, you will gain approximately 1 pound per week.

500 kcal x 7 day = 3500 kcal

Hypothalamus responds by stimulating the appetite

Food intake increases and energy output decreases.

Increase in size of fat cells

Weight gain

It is reported that enough food is produced in the US to supply every human with an average of 3800 kcal/day; this is far more than is required. Foods high in fat and sugar are also abundant in our diets. These are high calorie foods.Our busy or sometime sedentary lifestyles often provide us with a tendency to increase our use of fast foods (prepackaged processed foods ready to eat at home or foods from restaurants and fast food franchises). Often we use the excuse we are to busy or to lazy to prepare healthy meals for ourselves. Sometimes we eat to comfort ourselves or because we are bored. The choices we make are often the high calorie choices. Binge eating may cause a person to consume thousands of calories in one feast. About 30% of obese people are binge eaters.

2. Slow metabolism- There are several conditions that may slow your metabolic rate:1. Physical inactivity- Body metabolism is slow without physical activity. Regular exercise improves metabolism, the rate at which food is turned into energy2. Thyroid gland does not produce sufficient thyroxin, the hormone that controls metabolism. 3. Aging- As we age our basal metabolic rate (metabolism at rest) slows; therefore even an adult who maintains normal eating habits and activity will most likely gain weight. Adults gain an average of ½ lb/year between ages 25-55.4. Ex-smoker- Nicotine increases metabolism and if you quit smoking your metabolic rate may slow; this often leads to weight gain even without an increase in food. Ex-smokers often snack instead of smoking which will increase the kcaloric intake as well.

Medical Conditions that May Cause ObesityGenetic disorders- Froehlich’s syndrome in boys, Laurence-Moon-Biedl, and Prader-Willi SyndromeHypothalamic obesity- caused by an injury to the HypothalamusCushing’s Disease- due to a high level of steroid hormonePolycystic ovarian syndrome- a common hormonal disorder in women

Medications Some medications may cause a gain in weight due to retention of body fluid or increased appetite. These may include:

- Corticosteriods- Some oral contraceptives (usually temporary)- Cancer treating drugs (progestins)- Insulin or insulin-stimulating drugs may lead to weight gain- Anti-seizure agents used to treat epilepsy and bipolar disorders- Some antipsychotics

How Body Fat DevelopsWhen you consume more food (kcal) than your body requires, the excess energy is stored in the fat cells of adipose tissue. The amount of fat a person accumulates is reflected in

the number of fat cells and the size of these cells. Some people are born with more fat cells than others. In late childhood and early puberty, the number of fat cells increase more rapidly in obese children than in children of normal body size. A thirteen year old obese child may have as many fat cells accumulated as an adult of normal weight. When you consume more kcal than your body needs the fats cells fill. Once the cell fills, it divides in two and each new fat cell fills. This process continues as long as you consume more food than the body needs. When the body calls on the fat storage for extra kcalories, such as when your food supply decreases, or you diet, the fat cells shrink in size, but do not decrease in number. This may be the reason why it is so easy to regain weight after dieting. Another reason may be the “set point” theory. Our body is biologically programmed to maintain constants in internal temperature, blood Ph, blood glucose, heart rate, and so on. Researchers have confirmed that after weight gains or losses, the body adjusts its metabolic rate so as to restore the original weight of the person. Energy expenditure increases after weight gain and decreases after weight loss. These changes differ from the body’s natural “set point”. This may be why it is difficult for an underweight person to maintain weight gains and an overweight weight person to maintain weight losses.

This diagram illustrates the increase in size and number of fat cells as a person continues to take in more food energy than the body uses. The cells increase in size, divide, fill, and divide again. If the person continues to consume more food, the cells continue to fill and divide. If the person decreases food consumption, the cells shrink in size but do not decrease in number.Anyone who over indulges in food, needs to examine the reasons why. Some people overeat to deal with stress or boredom. Once you have determined the reasons, then you will be able to come up with a solution. Remember the excess weight was accumulated over a long period of time, and it is not expected to be lost in a short time. Most weight loss programs do not work, and people with extra fat cells tend to regain lost weight rapidly; the fat cells refill.

Fat Cell Development

Health Risks of ObesityObesity can cause serious health problems. One report warns that almost one-third of adult Canadians risk disability and premature death because of unhealthy weights. Obesity is related to several chronic health conditions and is threatening the health of a growing number of adults and children. Excessive body fat puts strain on body organs.

1. The bones must support more weight than they should. This may lead to problems with bones and joints such as osteoarthritis, eventually leading to joint replacement surgery.

2. The heart must beat more often to supply the excess fat cells with oxygen. This causes an increase in blood pressure and often damage to blood vessels. Studies have shown a significant increase in the risk of cardiovascular disease in a person with a BMI above 27. The risk increased slightly in persons with BMI’s between 25 and 27. Heart disease is the number one cause of death in obese people. Obese persons have almost three times the risk of heart disease as persons of normal weigh.

3. The pancreas must produce more insulin to regulate blood glucose levels. This may cause Type II diabetes.

4. High fat diets increase the risk of high cholesterol and some types of cancer.5. There is an increased risk of developing gallstones.6. Increase incidence of sleep apnea.

In May, 2004, the WHO endorsed a diet plan to fight obesity in the world. The main focus is on healthy eating and physical activity.

Prevention- Hints for Controlling Weight1. Eat a balanced diet including foods from all four food groups to avoid monotony.

Try new foods.2. Don’t skip meals, especially breakfast. You often want to snack on unhealthy

choices when you skip meals. Breakfast helps boost your metabolism.3. Choose low calorie foods more often, especially for snacks.4. Drink water with your meals and often during the day. You won’t feel as hungry

as often.5. Choose smaller portions of food during meal times.6. Eat slowly so food has a chance to reach the stomach and signal your brain (about

20 minutes) so you will know when you are full. 7. Learn to use herbs and spices instead of salt and sugar for flavor.8. Do not constantly weight yourself. You may become discouraged and go back to

old habits. Record what you eat and once a week check your progress. If you are not being successful, review what you have eaten during the week and make some necessary changes.

9. Choose low fat foods when you eat out. More and more restaurants and fast food franchises are offering healthy choices on their menus.

10. Get moving- that is the most effective way to lose or maintain weight. Do something you enjoy.

Eating Disorders

For some people, dieting to lose weight progresses to a dangerous and obsessive point. When low body weight becomes an important goal, people begin to view normal, healthy body weight as being too fat, and they take unhealthy actions to lose weight. The causes of this dangerous obsession are multifactorial: sociocultural, psychological and maybe, neurochemical. As weight loss and maintenance become a major focus in the life of a person, psychological problems worsen and the likelihood of developing eating disorders intensifies. Athletes are particularly likely to develop eating disorders.

Anorexia NervosaAnorexia nervosa is often considered to be a type of eating disorder in an entire spectrum of eating disorders. It is also a psychological disorder and a condition that goes beyond out-of-control dieting. The person initially begins dieting to lose weight, and over time, the weight loss becomes a sign of mastery and control. The individual continues the endless cycle of restrictive eating, often to a point close to starvation, in order to feel a sense of control over the body. Anorexia nervosa is a serious, often chronic and life-threatening eating disorder defined by a refusal to maintain minimal body weight within 15% of an individual’s normal weight. Other features of this disorder include an intense fear of gaining weight, a distorted body image, and amenorrhea (absence of at least three consecutive menstrual cycles when they are otherwise expected to occur). In addition to the classic pattern of restrictive eating, some people will engage in recurrent binge eating and purging episodes. Starvation, weight loss and related medical complications are quite serious and can result in death.The term Anorexia, literally means “loss of appetite”, but this is a misnomer, as in fact, people with anorexia nervosa ignore hunger and thus control their desire to eat. This desire may be controlled by cooking for others or hiding food that they will not eat in their personal space. Obsessive exercising may accompany the starving behavior and cause others to assume the person must be healthy.Like all eating disorders, anorexia nervosa tends to occur in pre-or post-puberty, but can develop at any major life change. It predominately affects adolescent girls and young adult women, although it also occurs in men and older women. One reason younger women are particularly vulnerable to eating disorders is their tendency to go on strict diets to achieve an “ideal” figure. This obsessive dieting behavior may reflect today’s societal pressure to be thin, which is seen in advertising and the media. Others especially at risk for eating disorders include athletes, actors, dancers, models and TV personalities for whom thinness has become a professional requirement. For the person with anorexia nervosa, the satisfaction of control achieved over weight and food becomes very important if the rest of their life is chaotic and emotionally painful.People with anorexia usually lose weight by reducing their total food intake and exercising excessively. They may restrict their intake to fewer than 1000 calories per day (often 750 – 1000 per day). Most avoid fattening, high-calorie foods and eliminate meats.

The diet of persons with anorexia may consist almost completely of low-calorie vegetables like lettuce and carrots, or popcorn.

The most common signs of anorexia nervosa include: A preoccupation with food and a refusal to maintain minimally normal body weight Continually thinking they look fat even when they are bone-thin Nails and hair become brittle and skin becomes dry and yellow Depression Complaints of feeling cold (hypothermia) because their body temperature drops Formation of lanugo (fine hair found on newborns) on their body

Persons with anorexia nervosa develop strange eating habits, such as cutting their food into tiny pieces, refusing to eat in front of others, or fixing elaborate meals for others that they themselves don’t eat. Food and weight become obsessions as they constantly think about their next encounter with food. Anorexia can have dangerous effects on all aspects of an individual’s life; it can affect other family members as well. Being seriously underweight can lead to depression and social withdrawal. The individual can become irritable and easily upset, and have difficulty interacting with others. Sleep can become disrupted and lead to fatigue during the day. Attention and concentration can decrease. All of these features can negatively affect one’s daily activities.Most of the medical complications of anorexia nervosa result from starvation. Few organs are spared the deterioration brought about by anorexia. Although not life-threatening, abnormally slow heart action (bradycardia) and unusually low blood pressure (hypotension) are frequently seen. There may also be disturbances in the heart rate and a reduction in the work capacity of the heart.Gastrointestinal complications are also associated with anorexia. Constipation and abdominal pain are the most common symptoms. The rate at which food is absorbed into the body is slowed down. Starvation and overuse of laxatives can seriously disrupt the body’s normal functions involved in the elimination process.Disturbances in the menstrual cycle are frequent and can affect not only child-bearing but also bone density growth, which is very important to a woman’s health as she ages. Hormonal imbalances are found in men with anorexia as well. Continual restrictive eating can trick the thyroid into thinking that the body is starving, causing it to slow down in an attempt to preserve calories.Anorexics who use a large quantity of laxatives or who frequently vomit are at great risk for electrolyte imbalance, which can have life-threatening consequences.Physical symptoms, other than the obvious loss of weight, can be seen. Anorexia can cause dry, flaky skin that takes on a yellow tinge. Fine, downy hair grows on the face, back, arms and legs. Despite this new hair growth, loss of hair on the head is not uncommon. Nails can become brittle. Frequent vomiting can erode dental enamel and eventually lead to tooth loss.

Bulimia NervosaBulimia is characterized by episodes of secretive excessive eating (bingeing) followed by inappropriate methods of weight control, such as self-induced vomiting (purging), abuse

of laxatives and diuretics, or excessive exercise. Like Anorexia, bulimia is a psychological disorder. It is another condition that goes beyond “out-of-control” dieting.

Bulimia is not as obvious as anorexia, but is actually more common. Unlike anorexics, bulimics experience significant weight fluctuations, but their weight loss is usually not as severe or as obvious and the recovery rate is felt to be higher; however, many bulimics continue to retain slightly abnormal eating and dieting behaviors even after the recovery period.The secrecy of bulimia stems from the shame that bulimics often attach to the disorder. Binge eating is not triggered by intense hunger, but is often a response to depression, stress or other feelings related to body weight, shape or food. At first, binge eating often brings on a feeling of calm or happiness, but self-loathing soon replaces the short-lived euphoria because of the overeating.Often, the individual will feel an impairment or loss of control during the binge eating and the purging becomes a way of regaining control. Not all bulimics engage in self-induced vomiting or the misuse of laxatives, diuretics or enemas during an episode. Some may fast for days following a binge episode, while others resort to excessive exercise as a method to regain their control and rid their body of the possible weight gained during the binge.As with anorexia, there is currently no definite known cause of bulimia, but it is generally felt to begin with a dissatisfaction of one’s body. The individual may actually be underweight, but when they look in the mirror they see a distorted image and feel heavier than they really are. At first, this distorted body image leads to dieting, and this dieting escalates and can lead to bulimic practices.

There are five basic criteria in the diagnosis of bulimia: Recurrent episodes of binge eating. This is characterized by eating within a two- hour

period an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.

A sense of lack of control over the eating, during the episode, or a feeling that one cannot stop eating.

In addition to the binge eating, there is an inappropriate behavior in order to prevent weight gain. These behaviors can include self-induced vomiting, misuse of laxatives, diuretics, enemas or other medications, fasting or excessive exercise.

Both the binge eating and the compensatory behaviors must occur at least two times per week for three months and must not occur exclusively during episodes of anorexia.

Finally, the behavior above is unduly influenced by body image.

The medical complications that result from bulimia are generally due to continual bingeing and purging. The type of purging behavior used can have varied effects on different body systems.Self-induced vomiting can result in oral complications. Repeated exposure to acidic gastric contents can erode tooth enamel, increase dental cavities and create a sensitivity to hot or cold foods. Swelling and soreness in the salivary glands from repeated vomiting can also be a concern.

The esophagus and the colon are the areas most affected by bulimic behaviors. Repeated vomiting can result in ulcers, ruptures or strictures of the esophagus. Acid that backs up from the stomach (reflux) can also become a problem.

The misuse of diuretics and laxatives combined can place the bulimic at great risk for electrolyte imbalance, which can have life-threatening consequences.

Treatment for Anorexia and Bulimic Behaviors

Patients with Anorexia and/or Bulimia present a variety of medical and psychological complications, which are usually considered to be reversible through a multidisciplinary treatment approach. Treatment can be managed by a physician, psychiatrist, a clinical psychologist, hospitalization for a period of time or a combination of these. The extent of the medical complications generally dictates the primary treatment manager.An appropriate treatment approach addresses underlying issues of control, self-perception, and family dynamics. Nutritional education and behavior management provides the patient with healthy alternatives to weight management. Group counseling or support groups can assist the patient in the recovery process as well. The ultimate goal should be for the patient to accept herself/himself and lead a physically and emotionally healthy life. Restoration of physical and mental health will take time, and the results will be gradual. Patience is a very important part of the recovery process.

For more information on chronic diseases visit the following websites:Dietitians of Canada- www.dietitians.caHealth Canada- www.hc-sc.gc.caCanadian Cancer Society- www.cancer.caHeart and Stroke Foundation- www.heartandstroke.caDiabetes Association- www.diabetes.caWorld Health Organization- www.who.int