The Heart Foundation Blog

Sleep Apnea and the Heart

June 9th, 2017

Sleep apnea is a serious sleep disorder that occurs when a person’s breathing is interrupted during sleep.  In sleep apnea your breathing passages becomes blocked, or the muscles that control your breathing stop moving. Either way, breathing stops, and then resumes with a gasp. In the worst cases, this can happen hundreds of times every night. This means the brain and the rest of the body may not get enough oxygen. And if left untreated, sleep apnea can result in a growing number of health problems, including:

  • Cardiovascular problems. The more severe the sleep apnea, the greater the risk of coronary artery disease, heart failure, irregular heartbeats, heart attack, and stroke. Men with sleep apnea are especially at risk of heart failure.
  • High blood pressure. Sudden drops in blood oxygen levels can increase blood pressure and strain the cardiovascular system.
  • Diabetes
  • Depression
  • In children, sleep apnea can cause hyperactivity, poor school performance, angry or hostile behavior and a worsening of ADHA.
  • Headaches
  • Fatigue. Sleep apnea usually is a chronic condition that disrupts your sleep. When your breathing pauses or becomes shallow, you’ll often move out of deep sleep and into light sleep. As a result, the quality of your sleep is poor, which makes you tired during the day. Sleep apnea is a leading cause of excessive daytime sleepiness and can increase the risk of having work-related or driving accidents

Symptoms of Sleep Apnea: Sleep apnea often goes undiagnosed, as doctors usually can’t detect the condition during routine office visits and there isn’t a blood test that can diagnose the condition. Most people who have sleep apnea don’t know they have it, because it only occurs during sleep. A family member or bed partner might be the first to notice signs of sleep apnea. Signs and symptoms of sleep apnea include:

  • Loud or frequent snoring
  • Daytime fatigue
  • Morning headaches
  • Memory or learning problems and not being able to concentrate
  • Feeling irritable, depressed, or having mood swings or personality changes
  • Waking up frequently to urinate
  • Dry mouth or sore throat when you wake up

There are two types of sleep apnea:

Obstructive Sleep Apnea (OSA). The most common type of sleep apnea is Obstructive Sleep Apnea (OSA). In this condition, the soft tissue in the back of the throat collapses or becomes blocked during sleep, causing shallow breathing or breathing pauses. Oxygen levels drop when  breathing slows and the body responds by releasing epinephrine (also called adrenaline), a stress hormone. When this happens over and over, adrenaline levels remain high, leading to high blood pressure. “Over time, OSA exposes the heart and circulation to harmful stimuli that may cause or contribute to the progression of most cardiovascular diseases,” explains Dr. Atul Malhotra, associate professor at Harvard Medical School and sleep specialist at Brigham and Women’s Hospital. OSA affects an estimated 15 million adult Americans and is present in a large proportion of people who have hypertension and other cardiovascular disorders, including coronary artery disease, stroke, and atrial fibrillation (irregular heartbeat).  

Central Sleep Apnea (CSA): Central sleep apnea (CSA) is a less common type of sleep apnea. This disorder occurs when the area of your brain that controls your breathing doesn’t send the correct signals to your breathing muscles. CSA can be caused by a number of conditions that affect the ability of your brain-stem, the area that links your brain to your spinal cord and controls many functions such as heart rate and breathing, to control your breathing. 

Who is at Risk for Sleep Apnea?

  • Men are more likely than women to develop sleep apnea
  • About half of the people who have sleep apnea are overweight
  • The risk for sleep apnea increases after age 40
  • A large neck (17 inches or greater in men and 16 inches or greater in women) has more soft tissue that can block your airway during sleep
  • Large tonsils, a large tongue, or a small jaw bone can restrict airways
  • Opioid users
  • A family history of sleep apnea
  • Gastro-esophageal reflux, or GERD
  • Nasal obstruction due to a deviated septum, allergies, or sinus problems
  • Heart disorders. People with irregular heartbeat (arrhythmia) or congestive heart failure are at greater risk of sleep apnea.  
  • Stroke, brain tumor or a structural brain-stem lesion.These brain conditions can impair the brain’s ability to regulate breathing.
  • High altitude.Sleeping at an altitude higher than you’re accustomed to may increase your risk of sleep apnea. High-altitude sleep apnea is no longer a problem when you return to a lower altitude.                                                                                      

Treatment: Sleep apnea is a chronic condition that requires long-term management. Lifestyle changes, mouthpieces, breathing devices, and surgery can successfully treat sleep apnea in many people.

Lifestyle Changes: If you have mild sleep apnea, some changes in daily activities or habits might be all the treatment you need.

  • Avoid alcohol and medicines that make you sleepy. They make it harder for your throat to stay open while you sleep.
  • Lose weight if you’re overweight or obese. Even a little weight loss can improve your symptoms.
  • Sleep on your side instead of your back to help keep your throat open. 
  • Talk with your doctor about whether nasal sprays or allergy medicines might help keep your nasal passages open at night.
  • If you smoke, quit. 

Mouthpieces:  A mouthpiece, sometimes called an oral appliance, may help some people who have mild sleep apnea. A dentist or orthodontist can make a custom-fit plastic mouthpiece for treating sleep apnea. The mouthpiece will help keep your airways open while you sleep.

Breathing Devices: A  CPAP (continuous positive airway pressure) is the most common treatment for moderate to severe sleep apnea in adults. A CPAP machine uses a mask that fits over your mouth and nose, or just over your nose. The machine gently blows air into your throat. The pressure from the air helps keep your airway open while you sleep.

Surgery: Some people who have sleep apnea might benefit from surgery. Surgery is done to widen breathing passages by shrinking, stiffening, or removing excess tissue in the mouth and throat or resetting the lower jaw.

If you, or a loved one, is having trouble breathing at night, see a doctor. Life style changes can help a person with mild sleep apnea, and in more severe cases, there are treatments that can keep the breathing passages open and normalize oxygen levels.

 

 

 

Sources:
The American Heart Assoc. Sep. 16, 2016: http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Sleep-Apnea-and-Heart-Disease-Stroke_UCM_441857_Article.jsp#.WIkikVMrJ9M
Journal of the American Heart Assoc., Aug. 19, 2016:                                                        http://jaha.ahajournals.org/content/5/8/e004195.full
The Mayo Clinic, Jun 15, 2016:                                                                                                                                   http://www.mayoclinic.org/diseases-conditions/obstructive-sleep-apnea/symptoms-causes/dxc-20205871
Harvard Health Publications/Harvard Medical School , Feb 13, 2013:                                       http://www.health.harvard.edu/heart-health/how-sleep-apnea-affects-the-heart

 

 

 

 


Gum Disease and the Heart

May 26th, 2017

Does a healthy mouth equal a healthy heart? The indications appear to be yes! Doctors and researchers have been talking about and studying the relationship between periodontal disease and cardiovascular disease for nearly two decades. While the exact details of the cause and effect relationship are still under investigation, many researchers (including Dr. P.K. Shah) and government agencies have come to the conclusion there is a link between periodontal disease and an increased risk of heart attack and stroke. For this reason, maintaining optimal oral hygiene is an important component of not only heart health, but your overall health and well being.

What is gum or periodontal disease? Gum disease is an inflammation of the gums that affects the bone that surrounds and supports the teeth. Gum disease begins when a sticky, bacteria-laden film known as plaque builds up around your teeth. Plaque forms when starches and sugars in food interact with the bacteria normally found in your mouth. Plaque that is not removed by regular brushing and flossing can harden and form tartar. The bacteria in the plaque and tartar can cause a mild gum disease called gingivitis: an inflammation where the gums become red, swollen and can bleed easily. If not treated, gingivitis can advance to periodontal disease (periodontitis). In periodontitis the gums pull away from the root of the tooth, creating a tiny pocket of bacteria filled pus that gradually widens. Eventually, infection and inflammation will attack the tissue that holds the tooth to the jawbone, which can cause the tooth to loosen and possibly fall out. 

Nearly half the adult population in the US is affected by gum disease. Gum disease can often be painless, so it is important to see your dentist right away if you have any of the following symptoms:

  • Swollen, red, or tender gums
  • Gums that bleed easily while brushing, flossing, or eating hard food
  • Pus between the teeth and gums and sores in your mouth
  •  Persistent bad breath
  • Buildup of hard brown deposits along the gum line
  • Loose teeth or teeth that are moving apart
  • Receding gums or longer appearing teeth
  • Changes in the way dental appliances fit

Your gums are very vascular, meaning they’re full of blood vessels. When you have gum disease, the infected pockets of germy pus allow bacteria and other toxins to spread below the gum line and move into the bloodstream. Some studies indicate that when the bacteria from gum disease enter the bloodstream, they help to form the fatty deposits called plaque in the heart blood vessels. Over time, the plaque builds up and narrows and hardens your arteries. This results in atherosclerosis, a heart disease. Atherosclerosis limits the blood flow to your heart, putting you at greater risk for heart attack and stroke.

Though not conclusive, some studies also suggest that the bacteria from gum disease in your bloodstream can trigger inflammation throughout the body (systemic inflammation). Inflammation is the body’s natural response to an infection or injury. When these bacteria reach the heart, they can attach themselves to any damaged area and cause inflammation. According to the Mayo Clinic, this can result in endocarditis, an infection of the inner lining of the heart. The American Heart Association has also stated that there is a causal association between inflammation caused by oral bacteria and cardiovascular conditions such as atherosclerosis (clogged arteries) and stroke. Controlling periodontal disease may decrease systemic inflammation and reduce the risk factor for cardiovascular disease.

The health of your mouth can affect the health of your entire body. In addition to possible connections with heart disease and stroke, gum disease has also been closely linked to premature birth, diabetes, and other chronic health problems. In the mouth, gum disease can lead to pain, bone loss, and ultimately tooth loss. Our teeth are essential to healthy eating; when we lose the ability to chew well, it affects our overall nutrition and our body. Our teeth are integral to our smile and the structure of our face; tooth loss or discomfort with the way our mouth looks can lead to a loss of self-esteem and confidence. Follow these guidelines to maintain proper oral health and reduce your risk for gum disease:

• Quit smoking. Smokers are seven times more likely to get gingivitis, periodontitis and oral cancers than nonsmokers.
• Manage diabetes; high blood sugar can lead to infections. Diabetes can also lead to dry mouth, poorly healing gums and thrush (a yeast infection in the mouth and throat). Those who have diabetes and also smoke are 20 times more likely to have thrush or periodontal disease.
• Get regular preventive care checkups with your dentist. Proper plaque control consists of professional cleanings every six months.
• Brush your teeth a minimum of twice daily
• Floss your teeth regularly
• Make sure your dentures fit properly
• Eat a balanced diet, and reduce sugary and processed foods and drinks
• Manage your weight
• Control your blood pressure
• Reduce stress
• Get more exercise

Your body is the sum of many parts and it is important for your overall health to maintain each of those parts. Gum disease can be a sign of the general health of your body. By taking care of your oral health, you are also taking care of your heart. Be aware of the symptoms of gum disease, brush and floss daily, and get regular dental check-ups. Your smile and your heart will thank you!


Cardiovascular System

May 19th, 2017

 

The cardiovascular system consists of the heart, blood vessels (arteries, veins, and capillaries), and the approximately 5 liters of blood that the blood vessels transport. This system transports oxygen, nutrients, hormones, and cellular waste products throughout the body. The cardiovascular system is powered by the heart, which is only about the size of a closed fist. Even at rest, the average heart easily pumps over 5 liters of blood throughout the body every minute.

To learn more about how the circulatory system works, please refer to an article from Pacific Medical Training, using the following link:

https://scribeschool.net/circulatory-system-info-for-scribes.html  

 


Fitness and Exercising Myths

May 12th, 2017

Your heart is a muscle, and it gets stronger and healthier if you lead an active life. It’s never too late to start exercising. Regular exercise can help burn calories, lower your blood pressure, reduce your LDL “bad” cholesterol and increase your HDL “good” cholesterol. People who don’t exercise are almost twice as likely to get heart disease as people who are active However, in the world of fitness and exercise, myths and fallacies flourish, and some of them may be keeping you and your family from getting the best and safest workout. Some myths are just harmless half-truths, but many others can actually be harmful and can even lead to injury.

Myth: Crunches are the key to flat abs.
Can doing ab crunches help you to lose that belly fat? Experts say no. They may be the most iconic abdominal exercise around, but doing crunches is not actually the best way to slim your midsection. While crunches do tone a small portion of your abs, help to strengthen the muscles around your core, and improve your posture, they don’t burn off a lot of calories and don’t help with fat loss. You cannot pick and choose areas where you’d like to burn fat. In order to burn that belly fat your workout should include both cardiovascular and strength-training elements. The cardio and strength-training will help to decrease your overall body fat content.

Myth: Doing lots of cardio is the best way to lose weight.
Weight loss is about calories in – calories out. In addition to a smart nutrition plan, a combination of both high-intensity cardio and strength-training is a good idea since having more lean muscle mass helps your body burn more calories at rest.

Myth: Lifting weights will bulk a woman up.
Women typically have less muscle tissue and produce lower levels of testosterone than men, meaning they are physiologically less prone to becoming brawny. If weight loss is your goal, strength-training can actually help, but you have to also watch your diet

Myth: The more you sweat, the more calories you burn.
Not necessarily. Sweat is a biological response that cools your skin and regulates your internal body temperature. You sweat when your core temperature increases. Sweating could be the result of a grueling workout, an overheated studio, the humidity in the air, or your personal physiology. Unfortunately, sweating doesn’t mean you necessarily burned any more calories than usual (sorry!). It is possible to burn a significant number of calories without breaking a sweat: Try taking a walk or doing some light weight training.

Myth: You need to work out for 45 minutes or more to get a health benefit.
If you’ve got just half an hour to spare a day—or even a mere 10 minutes—you have enough time to bolster your cardiovascular health. More and more studies are indicating that shorter workout sessions could be better for you. In research the Arizona State University published last year, people had consistently lower blood pressure readings on the average when they split their daily walk into three 10-minute segments rather than tackling one 30-minute stroll. But while this may be enough to keep up your general health, you’ll still need to get more active most days of the week if you’re trying to lose weight. For weight loss, it is recommended that you get at least 250 minutes of moderate to vigorous exercise a week.

Myth: Not feeling sore means you didn’t get a good workout.
While soreness and workout intensity are sometimes connected, how tired your muscles feel after is not always a good indicator of a good workout. Soreness indicates that a significant amount of stress was applied to the muscle tissue. You don’t have to feel soreness to gain muscle strength. A degree of soreness a day or two after working out is very different from feeling pain while you are working out. Of all the fitness rumors ever to have surfaced, experts agree that the “no pain – no gain” holds the most potential for harm. A fitness activity should not hurt while you are doing it, and if it does, then you are either doing it wrong, or you already have an injury. If you are experiencing pain while working out, stop, rest, and see if the pain goes away. If it doesn’t go away, or if it begins again or increases after you start to work out, see a doctor.

Myth: You should work out every day.
Definitely not true! When you work out, you’re breaking down muscle fibers so they can rebuild stronger. However, to do this, you need to give your body time to recover from working out. Scheduling in rest days is crucial. If you work out every single day, you could injure yourself or over-train, which keeps your muscles from rebounding and your body from improving. Aim for one to two days per week of active recovery rest days – that means doing something that doesn’t put stress on your body, like gentle stretching or a walk. And keep your workout varied – repeating the same training pattern over and over can lead to injuries.

Myth: You need to stretch before a workout.
Stretching is something many people just do because they feel they should or someone told them to. The conventional wisdom is that stretching elongates the muscle and helps prevent injury. However, it has been found that stretching before a workout will weaken your tendons and make your muscles feel weak and less steady, which may increase the risk of injury. Warm up by walking before cardio or doing light weights before intense training, and do stretch after a workout.

Myth: Stretching helps your body recover faster after a workout.
A recent University of Milan study on the effects of post-workout recovery methods found no significant changes in blood lactate levels (a measure of how fatigued your muscles are) for people who stretch after exercise. While stretching may not completely reduce muscle soreness or speed muscle tissue repair, stretching still has certain benefits. Stretching right after a workout, when the body is still warm, is the best way to increase joint flexibility.

Myth: Yoga isn’t a “real” workout.
While there are some blissfully relaxing yoga classes out there, tougher types (like Bikram and power Vinyasa yoga) can definitely improve your flexibility and strength.


Smoking & Heart Disease

April 28th, 2017

Most people associate cigarette smoking with breathing problems and lung cancer. But smoking harms nearly every organ in the body, including the heart, blood vessels, lungs, eyes, mouth, reproductive organs, bones, bladder, and digestive organs. Smoking is the main preventable cause of death and illness in the United States.

About 20% of deaths from heart disease in the U.S. are directly related to tobacco use. The nicotine from chewing tobacco or any amount of smoking, even light smoking or occasional smoking, can damage your heart and blood vessels, temporarily raise blood pressure and lower your exercise tolerance.  This damage increases your risk of atherosclerosis.  Atherosclerosis a disease in which a waxy substance called plaque builds up in the arteries. Over time, plaque hardens and narrows your arteries. Smoking also decreases the amount of oxygen that the blood can carry and increases the tendency for blood to clot. Blood clots can form in arteries causing a range of heart diseases that could ultimately result in a stroke or sudden death.

A person’s chance of heart disease increases with the number of cigarettes they smoke and how long they have smoked. If you smoke a pack of cigarettes a day, you are twice as likely to have a heart attack as someone who doesn’t smoke. For women who take birth control pills and people who have diabetes, smoking poses an even greater risk to the heart and blood vessels. Chewing tobacco and the smoke from cigars and pipes contains the same harmful chemicals as the smoke from cigarettes and can result in heart disease.

 The impact of tobacco smoke is not confined solely to smokers. When you smoke, the people around you, especially children,  are also at risk for having health problems.  Secondhand smoke is the smoke that comes from the burning end of a cigarette, cigar, or pipe or the smoke that’s breathed out by a person who is smoking. Secondhand smoke contains many of the same harmful chemicals that people inhale when they smoke. Secondhand smoke can damage the hearts and blood vessels, and can increase the risk of heart attack and death, in people who don’t smoke in the same way that active smoking harms people who do smoke. About 35,000 nonsmokers die from heart disease each year as a result of exposure to secondhand smoke. 

The good news is that quitting smoking and avoiding secondhand smoke can help reverse heart and blood vessel damage and reduce heart disease risk. The impact of quitting is almost immediate

  • Within 20 minutes of quitting smoking, blood pressure and pulse return to normal, and circulation improves.
  • Within eight hours, blood oxygen levels increase and the chances of a heart attack start to fall.
  • Within 24 hours, carbon monoxide is eliminated from the body and the lungs start to clear out mucus and debris.
  • Within 72 hours, the lungs can hold more air and breathing becomes easier.
  • Within five years, the risk of a heart attack falls to about half that of a smoker.
  • Within 10 years, the risk of lung cancer falls to around half that of a smoker.
  • Within 15 years, the risk of heart disease becomes nearly the same as someone who has never smoked.
  • Quitting when older is still worthwhile: among smokers who quit at age 66 years, men gained up to two years of life, and women gained up to 3.7 years.  

Quitting smoking is possible, but it can be hard. Millions of people have quit smoking successfully and remained nonsmokers. A variety of strategies, programs, and medicines are available to help you quit smoking. Above all, you must also want to quit smoking for yourself, and not try to quit to please your friends or family. 

  • First, pick a date to stop smoking and then stick to it.
  • Write down your reasons for quitting. Read over the list every day, before and after you quit.
  • Write down when you smoke, why you smoke, and what you are doing when you smoke. You’ll learn what causes you to smoke.
  • Stop smoking in certain situations (such as during your work break or after dinner) before actually quitting.
  • Make a list of activities you can do instead of smoking — and do them when the urge hits.
  • Ask your doctor about nicotine gum or patches, or  drugs that can help you quit.
  • Join a stop-smoking support group or program. 

If you relapse, don’t lose hope. Seventy-five percent of those who quit smoke again. Most folks quit three times before they succeed. Plan ahead and think about what you’ll do the next time you get the urge to smoke.


SUGAR

April 21st, 2017

We are surrounded by sugar. 80% of the foods in your supermarket contain sugar. Whole wheat bread can have a teaspoon of sugar per slice, ketchup contains 22.8% sugar. Even if you are not overweight, over consumption of sodas, candy, cookies and processed foods can significantly increase your risk of dying from cardiovascular disease. 

According to a study published in JAMA: Internal Medicine, in April, 2014, those who got 17 to 21 percent of calories from added sugar had a 38 percent higher risk of dying from cardiovascular disease compared to those who consumed 8 percent of their calories from added sugar. The study factored in socio-demographic, behavioral, and clinical characteristics such as age, ethnicity, level of schooling, smoking, medication use, and others. The relative risk was more than double for those who consumed 21 percent or more of their calories from added sugar. In summary, the study found the odds of dying from heart disease rose in tandem with the percentage of sugar in the diet—and that was true regardless of a person’s age, sex, physical activity level, and body-mass index (a measure of weight).

Natural sugars are found in fruit as fructose and in dairy products, such as milk and cheese, as lactose. Foods with natural sugar have an important role in your diet they provide essential nutrients that keep the body healthy and help prevent disease. Fruit and unsweetened milk have vitamins and minerals. Milk also has protein and fruit has fiber. Refined sugar comes from sugar cane or sugar beets, which are processed to extract the sugar. It is typically found as sucrose, which is the combination of glucose and fructose. White and brown sugars are used to sweeten cakes and cookies, coffee, cereal and even fruit. Food manufacturers add chemically produced sugar, typically high-fructose corn syrup, to beverages and processed foods, including crackers, flavored yogurt, tomato sauce and salad dressing. Low-fat foods are the worst offenders, as manufacturers use sugar to add flavor. Most of the processed foods we eat add calories and sugar with little nutritional value. 

How the body metabolizes the sugar in fruit and milk differs from how it metabolizes refined sugar and high-fructose corn syrup. When a person consumes too much processed sugar, the liver becomes overwhelmed and begins to convert the sugars into fats. A accumulation of fat in the liver can cause  insulin resistance , which disrupts the body’s ability to maintain stable levels of blood sugar and fat. Insulin resistance is a stepping stone towards Metabolic Syndrome and Diabetes. Symptoms of  Metabolic Syndrome include weight gain, abdominal obesity, decreased HDL and increased LDL, elevated blood sugar, elevated triglycerides, high blood pressure and increased uric acid levels. 

The average American adult consumes 22 teaspoons per day, the average child in the US consumes 32 teaspoons! The American Heart Association recommends no more than 6 teaspoons (100 calories, or 25 grams) a day of sugar for most women and no more than 9 teaspoons  (150 calories, 37.5 grams) a day for most men. And children, ages 2 to 18 should eat or drink no more than 6 teaspoons of added sugars daily.  One teaspoon of granulated sugar equals 4 grams of sugar. To put it another way, 16 grams of sugar in a product is equal to about 4 teaspoons of granulated sugar. Sugar-sweetened beverages such as sodas, energy drinks, and sports drinks are by far the biggest sources of added sugar in the average American’s diet. They account for more than one-third of the added sugar we consume as a nation. Other sugar filled foods include cookies, cakes, pastries, fruit drinks, ice cream and frozen yogurt, candy, ready-to-eat cereals, and many processed foods.

 But an even bigger problem may be the sneaky sugar lurking where you least expect it. It’s in everything—even seemingly healthy foods like salad dressing, whole-wheat breads, and tomato sauces. What’s more, it’s impossible to find out how much added sugar a food contains by looking at the nutrition facts panel, since labels don’t distinguish between added sugars and naturally occurring ones. 

How do you reduce the sugar in you diet? Eliminating certain foods, such as processed foods, sodas, sugary cereals, cookies and ice cream, is an easy and obvious way to start. Following are 6 more ways to  cut back on sugar:                                                                                                                     1. READ LABELS: There are more than 70 different names for sugar. Look closely at ingredients list on any packaged food you buy for words like sucrose, barley malt, beet sugar, brown rice syrup, agave, and cane juice.

2. BUY PLAIN: Flavored foods are often code for “sugar added”.  If a strawberry flavored yogurt has 15 grams of sugars, there’s no way to tell how much is from added sugars and how much is from the naturally occurring lactose. Stick with the plain version, and it will be easy to see that all 4 grams of the sugars are natural and supposed to be there. Add flavor with whole fruit.  This way, you get to be in control of how much sweetness is added to your food.                                        

3.  DROP DRINKABLE SUGAR:  Almost half of Americans’ added sugars intake comes from drinks. Limit beverages like soda, iced teas, flavored coffee drinks, lemonade, and fruit punch. Even healthy-sounding drinks like kombucha and vitamin waters have added sugar.                      

4. SKIP JUICES & SMOOTHIES:  Without fiber to buffer the sugar load, the natural fructose in, say, an orange, is a very different animal. A cup of juice can be equivalent to about four oranges—an amount you’d be pretty unlikely to eat in whole-fruit form. As for smoothies, they’re a step in the right direction since they contain the whole fruit—but research from Purdue University found that liquid calories aren’t as filling as chewable ones. And by blending fruit into a pulp, it’s easy to get more fructose than you’re bargaining for.                                                

5. CUT THE CONDIMENTS: Ketchup, barbecue sauce, flavored vinegars, and some mustards (like honey mustard) can be loaded with sugar. Read labels to be certain there are no surprises—Dijon mustard, apple cider vinegar, and hot sauce are usually good options.  

6. ADD HERBS, SPICES, AND EXTRACTS: They’re flavorful and low-calorie additions to any meal. Cinnamon, vanilla, ginger, and nutmeg are some of “sweet” spices, and can be added to oatmeal or yogurt instead of sugar.