By Debra Gibbons, R.D.
As I write this, Valentine’s Day is just around the corner and chocolate sales are soaring. When trying to decide what type of chocolates to get your special Valentine, remember they are not all the same. In this case I’m talking about the candy.
Here are some of the basics we know about chocolate:
Chocolate is made from the whole cacao bean with additional cocoa butter. Most people do not realize that the cacao bean comes from a plant source. It’s actually the seed of the Theobroma cacao tree, which is rich in the antioxidant flavanol. Antioxidants offer protection from “free radicals,” which are harmful molecules that can damage our cells and cause disease.
Dark chocolate contains a lot more cocoa than white or milk chocolate, which means it contains more healthful flavonoids. The processing, handling and storage of the beans and the chocolate in the factory can affect the amount of flavonols in cocoa and chocolate products. In general, the less processing the better. And the higher the nonfat cocoa solids in the chocolate product, the higher the antioxidant content.
The largest amounts of flavonoids are found in natural, unsweetened cocoa powder, which is non-alkalized cocoa.
Cocoa powder is the lowest in fat and calories and can be used in baking and to make hot chocolate. It contains only 60 calories in three tablespoons. So, when buying chocolate, be aware that natural cocoa powder, dark chocolate, unsweetened baking chocolate and semisweet chocolate chips contain the highest amounts of flavonoids. Milk chocolate and chocolate syrup trail far behind.
Now, about the type of fat found in the cacao bean, it is a combination of saturated and unsaturated and studies have suggested it does not increase cholesterol levels. But when buying chocolates you need to check the food label to see if the manufacturer added partially hydrogenated oils, milk fat, or coconut or palm oil. These are harmful and can adversely affect cholesterol levels.
Some potential health benefits from cocoa and chocolate include the possibility they may lower cardiovascular risk. In most studies, the subjects were given a small portion of dark chocolate daily while they made other changes to limit their calories and avoid weight gain. Some feel chocolate helped regulate their moods, but more studies are needed to confirm that benefit.
If you’re worried about your caffeine intake, take note: one ounce of dark chocolate contains about 20 mg caffeine while milk chocolate contains only 5 mg per ounce. A cup of brewed regular coffee ranges from 65 to 150 or more and a cup of decaffeinated coffee contains about 5 mg.
Chocolate has a delicious flavor that most enjoy and could be part of a healthy diet that should be rich in other foods that are high in antioxidants such as brightly colored fruits and vegetables, nuts, whole grains, and beans.
(Ms. Gibbons, a Registered Dietician and Certified Diabetes Educator, provides outpatient nutrition medical therapy at Cape Cod Hospital.)
By Albert Barrows, M.D.
Imagine you’re running a marathon. Lungs bursting. Gasping for air. But at least you know there’s a finish line. For those with chronic obstructive pulmonary disease (COPD), however, the race is never over.
Indeed, for these people, success is measured not in winning a race or even completing a simple 100-yard dash…but in the ability to climb a few steps without losing their breath.
COPD is an obstruction of airflow in and out of the lungs. The most common cause is cigarette smoking and the two main diseases associated with this condition are emphysema and chronic bronchitis. Both cause shortness of breath that restricts the ability to exercise and perform any physical activities.
According to a recent survey by the American Lung Association, 51 percent of all COPD patients said the condition restricts their ability to hold a job. It also limits their ability to do household chores, social activities, sleeping and family activities.
COPD actually creates a vicious cycle. People with COPD grow short of breath when they start physical activities. They stop because they can’t breathe. And then they become more short of breath as time goes on because they don’t exercise.
Our challenge is to break that cycle and 17 years ago we started the Pulmonary Rehabilitation Program at Cape Cod Hospital.
The program is designed to teach participants:
We may not be able to “cure” COPD, but patients can improve their ability to exercise and develop a feeling of well-being.
Although the majority of the patients who participate in the program have COPD, anyone with a debilitating lung disease is welcome. They normally are referred by their primary care physician or pulmonologist and interviewed initially by a pulmonary rehabilitation nurse. Each participant is required to complete diagnostic tests at the start.
One benchmark test consists of a six-minute walk within the clinic to measure the patient’s level of physical performance. The test is then repeated at the end of the eight-week program and the distances covered are usually significantly greater.
Each group of 8-to-10 participants meets with the pulmonary rehabilitation team of three nurses, an occupational therapist, a dietician, pharmacist, respiratory therapist, psychologist, and pulmonologist twice-weekly in three-hour sessions.
The first part of each session is an educational time and covers topics such as anatomy and physiology, breathing techniques, medications, coping strategies, energy conservation, nutrition, travel, oxygen therapy, health care decisions and techniques to cope with activities of daily living. There is also an “Ask the Doctor” period.
The second part is exercise, such as riding a stationary bike, walking on a treadmill and a stretching routine.
One of the fun aspects is the socialization, which includes some field trips that also have a treatment purpose.
As Rose O’Sullivan, LPN, one of the rehabilitation nurses, explains, “It shows them that they can do these activities on their own, while at the same time they have the security of knowing there is staff on hand in case something happens.”
We also have an optional follow-up maintenance program and patients are encouraged to participate because any improvements they’ve made won’t last unless they continue to work at it.
Pulmonary rehabilitation is covered by most insurance companies including Medicare, but we recommend checking with private carriers to make sure. For more information call 508-862-5709.
(Dr. Barrows is founder and Medical Director of the Pulmonary Rehabilitation Program at Cape Cod Hospital. He practices with Pulmonary Internists & Consultants in Hyannis, 508-775-2295.)
By Denise M. Dever
If you once enjoyed walking, but no longer hit the trail or running track on a regular basis, it may be time to get back to that form of exercise. You’ll find it will help improve not only your quality of life but your length of life as well.
According to the latest research, picking up your walking pace may be one way for you or a loved one to improve your health. A study of speed walking from the Division of Geriatric Medicine, School of Medicine, University of Pittsburgh, found that picking up speed will produce a predictable and substantial reduction in mortality. (The study, which looked at seniors aged 65 or older, appeared in the November issue of the Journal of the American Geriatrics Society.)
The study on walking speed followed 439 senior citizens to produce estimated relationships between one-year improvement in measures of health and physical function, and eight-year survival. The authors concluded that, “Because gait speed is easily measured, clinically interpretable, and potentially modifiable, it may be a useful 'vital sign' for older adults.” But, they added, “Further research is needed to determine whether interventions to improve gait speed affect survival.”
Of course, you should always ask your doctor for recommendations about the best ways to stay fit as you age. Many communities have walking clubs that could be a great motivation to resume this hobby.
And don’t underestimate the value of companionship, especially if you live alone. Walking with a friend is a great way to catch up and stay in touch with what is going on around you so exercising does not become a chore.
Also, think about making this part of your daily activities.
(Ms. Dever is President and Co-Owner of Home Instead Senior Care in Centerville, 508-778-8613 or www.homeinstead.com.)
By Diana Di Gioia
Your health insurance probably doesn't cover acupuncture. That's just a fact in most of the country, including Massachusetts. And it's an economic reality that has kept acupuncture unavailable for most people, except for the well-to-do.
But things are finally changing, including here on the Cape, thanks to a national movement called Community Acupuncture. Community Acupuncture clinics bring the cost of treatment down to little more than the equivalent of a co-pay, whether clients have insurance or not.
Clinics that practice Community Acupuncture commit to three main principles.
The Community Acupuncture movement started in Portland, Oregon about five years ago, with a clinic called Working Class Acupuncture. Besides providing treatments, the founders wanted to spread their ideas about how to make acupuncture accessible across income and class lines to others around the country.
The nonprofit Community Acupuncture Network was formed last year to help acupuncturists who wanted to adopt these practice concepts. At last count there were 44 member clinics around the country, plus as many as 200 others that offer the community treatments part-time.
(Ms. Di Gioia, a licensed acupuncturist, converted her West Dennis clinic to Community Acupuncture two years ago. She was joined in November by licensed acupuncturist Antonio Da Silva, a Brazilian native who is fluent in English, Portuguese and Spanish. For information: www.acuforall.com, or 508-398-7770.)
By Carol Penfield M.S., NP
Although walking is the most common form of exercise, many find this regimen difficult or impossible due to pain or medical limitations. Since 30 minutes of exercise most days of the week is recommended for heart disease prevention, it is important for those unable to walk to try alternative ways to exercise the heart.
Following are a few ideas:
For people with arthritis of the knees: Stationary biking will take the weight bearing pressure off the joints and help nourish the cartilage and absorb excess knee fluid. Water walking also is an excellent choice since the buoyancy of walking in waist high water-walking takes 50 percent of a person’s weight off the joints.
For women with osteoporosis: The elliptical trainer, usually found in health clubs, offers a weight-bearing alternative without increased impact on the joints while promoting bone strength.
For scoliosis or leg length/pelvic asymmetry: Seated exercises such as recumbent cycling, or the Nu-Step, will allow a range of motion of the lower extremities without asymmetric irritation. Swimming also is a good choice and will improve back strength.
For individuals with back or hip arthritis: An upright bike is an option since it provides a comfortable range of motion to the hip and allows those with back problems to lean forward for support.
It is important to find a form of exercise that is enjoyable and can be practiced regularly. It is not uncommon for some individuals to feel discomfort when trying a new fitness routine until the body has a chance to warm up. When starting a new type of exercise, begin with half of the resistance and initially start with 3-5 minutes of activity. Try to add one minute every one to two weeks until you reach your goal of either 30 minutes or three sessions of 10 minutes of sustained exercise throughout the day.
Consulting with a physical therapist or personal trainer is encouraged for supplementing a cardio-fitness routine with strengthening and stretching exercises.
(Ms. Penfield, owner of Chatham Health and Swim Club, is available for fitness consultations and classes; 508-945-7761