A National Newsletter for Veterans and their Health Care Providers WRIISC AdvantageSPRING 2016 Learn more about the roles of DIET/NUTRITION and HEALTHThe benets of eatingen WHOLE FOODS EXERCISE foren CHRONIC CONDITIONS maintaining and sustaining GOOD HEALTH
1 3 4 2 With your health care provider, discuss which foods might be contributing to symptoms. Keep a food diary of what you eat and the symptoms you experience. Avoiding Once you have determined the food that you suspect may be a trigger for your symptoms, avoid that food for two weeks. Read food labels carefully during this step. If you feel worse or your symptoms increase while avoiding that food, consult with your health care provider. Challenging If your symptoms have improved in the two-week avoidance period, reintroduce the eliminated food to your diet. If you have eliminated multiple foods in the avoidance step, introduce each food back into your diet in three-day intervals. Creating The creation of a new nutrition plan based on the results of your elimination diet is the last step. 2 | SPRING 2016 WRIISC Advantage | 3 There are many factors that can impact our health. Lifestyle choices, such as what types of food we eat, how much we exercise, maintaining healthy relationships, trying to reduce stress, and sleep habits are all important in determining good health. This edition of WRIISC Advantage provides useful information for Veterans on the roles of diet/nutrition, exercise, and weight management in maintaining and sustaining good health. You Are What You Eat... DIET/NUTRITION is an important component of health and wellness for all Americans and an important part of post-deployment health. Your daily food choices can help promote and maintain good health and prevent many chronic diseases (like heart disease and diabetes) and treat others. Many Veterans seen at the War Related Illness and Injury Study Center (WRIISC) often leave with a recommendation for dietary changes to better address specic symptoms and improve overall health. ere are also some basic nutrition guidelines to follow for good health that hold true for everyone regardless of individual health status, lifestyle, and food likes and dislikes. e U.S. Oce of Disease and Health Promotions 2015 2020 Dietary Guidelines for Americans can be found at www.health.gov/dietaryguidelines/2015/ guidelines/. ese guidelines include:Choose a healthy eating pattern at an appropriate calorie level to help achieve and maintain a healthy body weight, support nutrient adequacy, and reduce the risk of chronic disease. Include a variety of foods from the major food groups: fruits, vegetables, whole grains, low-fat dairy products, and lean protein including beans and other legumes, nuts and seeds, and healthy fats. Limit calories from added sugars and saturated fats and reduce sodium intake. Remember, what you eat is just as important as the amount you eat! By adjusting input and output levels, you can control whether you gain, lose, or maintain your weight and are at a healthy weight for your height and age. rough portion control and eating less, your body will get used to becoming full after consuming a smaller quantity of food. In order to eat healthier and therefore live healthier, focus on making small changes, one at a time. MyPlate from the U.S. Department of Agriculture (www.choosemyplate.gov/dietary-guidelines) replaces the food pyramid concept. e MyPlate tool will help you to choose your portions of each food group in the most healthful way. ink of each change made as a step on your path to living a healthier life! HealthPOWER! is an award-winning, quarterly publication from the VHA National Center for Health Promotion and Disease Prevention, highlighting health promotion and disease prevention activities in VA. The Winter 2016 issue is now available: www.prevention.va.gov/ Publications/Newsletters/2016/HealthPOWER_Prevention_News_Winter_2016.asp. Personalized Dietary PlansA PERSONALIZED DIETARY PLAN made by a dietitian or health care provider will help take into account any individual conditions and recommend the type of diet that would work best under special individual circumstances. For example: Certain medical conditions including heart disease, type 2 diabetes, and rheumatoid arthritis are linked to inammation in the body. e ANTI-INFLAMMATORY DIET* aims to decrease the amount of inammation by increasing intake of foods that reduce inammation and by taking out foods that can trigger inammation. ree key points include: Decrease unhealthy fats. Eat more fruits and vegetables. Increase ber intake. *University of Wisconsin School of Medicine and Public Health. Patient Handout: Anti-Inammatory Diet. Sometimes certain foods can actually make health issues or symptoms worse! An ELIMINATION DIET* can be useful in determining if specic foods or trigger foods might be the cause. THERE ARE FOUR STEPS IN DETERMINING TRIGGER FOODS: Planning Always make sure you are getting adequate nutrition when trying this diet. University of Wisconsin School of Medicine and Public Health. Patient Handout: Elimination Diet. e CARDIOMETABOLIC FOOD PLAN*, developed by the Institute of Functional Medicine, is suggested to treat both cardiovascular and metabolic diseases. is plan is designed for: ose with or who have risk factors for cardiovascular disease. ose with or who have risk factors for metabolic syndrome or type 2 diabetes. rough dietary changes the plan allows for the body to more eectively regulate inammation, insulin, and metabolism. It works best when personalized for the patient by a health care provider. Richmond Integrative and Functional Medicine (RIFM). (2015). Cardiometabolic Food Plan: Comprehensive Guide. Before trying a diet for a specic health condition or symptom, talk with your health care provider to be sure that it is safe/appropriate for you or obtain a referral for an appointment with a VA dietitian/nutritionist.
4 | SPRING 2016 WRIISC Advantage | 5WHOLE FOODS DIET: What is it? What are the benets? Where can I start?EATING A WHOLE FOODS DIET* relies primarily on foods that are in their natural state with minimal processing. A whole foods diet can be beneficial for all Americans so it is appropriate for Veterans, too! Many vitamins and minerals work together to make the systems in the body function properly. A whole foods diet provides micronutrients that are well absorbed and utilized, and are in the proper proportion to one another. It also provides other benets such as phytonutrients, which are compounds that are unique to plants and have demonstrated many anti-disease benets. A whole foods approach also provides ber which is essential for optimal health but is often decient in the Standard American Diet. In addition, this natural diet does not include harmful chemical preservatives that are used to extend the shelf life of processed foods. Try moving toward a whole foods diet by taking one step at a time. You can use each month to focus on a dierent food group. Perhaps you can begin by focusing on increasing vegetable intake and replacing processed food items with fresh fruits and vegetables. Another approach might be to start by focusing on individual meals. ere are many ways that you can make a slow but steady transition from processed foods to foods closer to their natural state. Make 2016 the year to transition to whole foods! *Texas Tech University Health Science. (2012). Whole Foods Diet. *Live Strong. (2015). e Whole Foods Diet Weight Loss Eating Plan. What about Chocolate? Studies sho But scienti anti-infla our brains w that our mothers are right: we should eat our vegetables. sts have also found that the pleasure of chocolate supplies mmatory compounds which are good for our hearts and Cocoa is rich in polyphenols, an antioxidant found in many fruits and vegetables as well as wine and tea. Chocolates labeled with a higher percentage of cocoa will generally provide a higher dose of these good components; look for products with chocolate listed as the first ingr edient, not sugar. A typical Hershey bar is only 11% cocoa, so its mostly sugar, milk products, emulsifiers, and flavorings. Recent studies suggest that specific compounds found in chocolate may offer several heart-healthy benefits by lowering blood pressure, reducing risk of blood clots, and decreasing bad cholesterol. The brain also benefits from chocolate by reducing the risk of stroke, improving memory, elevating mood, and lowering stress hormone levels. Some studies have shown that people who eat good quality dark chocolate may be more likely to maintain a healthy weight, as chocolate seems to reduce cravings for sweet, salty, and fatty foods. Darker chocolate tends to be more satisfying than milk chocolate because of its higher fiber and intensity. While chocolate can be a healthy treat, its calories still add up, so it should be consumed in moderation. Enjoying an ounce or two of good dark chocolate a few times a week can be a treat even your mother would approve. Veterans, Aerobic Exercise, and Chronic PainA COMMON RECOMMENDATION made to Veterans who are evaluated at the WRIISC is to include a regimen of exercise along with a healthy diet. Depending on a Veterans health status and concerns, this recommendation focuses on the Veterans beginning a program of low-impact exercisestarting with as little as ve minutes per day, three times a week, and gradually increasing the time and frequency to 30 minutes per day, ve times a week as tolerated over a period of about six months. For Veterans with chronic pain, we provide an easyto-follow chart in our WRIISC fact sheet Exercise to Manage Pain which is located on our website (www.WarRelatedIllness.va.gov/education/factsheets. asp). WRIISC exercise recommendations often include a program of low-impact aerobic exercise, strength training, and stretching. If you are a Veteran with a knee or back injury, swimming can provide an excellent opportunity for aerobic exercise with low impact. Some VA facilities provide opportunities for therapeutic swimming, and the U.S. Masters Swimming program (www.usms.org), a non-profit national program, provides opportunities to improve tness in a positive social environment and friendly competitive fashion. Local YMCA programs can also provide opportunities for exercise at reduced cost for Veterans as a result of a VA-YMCA partnership. Finding the right exercise programcan provide an enjoyable way to"live healthier. Research Supports Exercise for Chronic Conditions INCREASING EVIDENCE SHOWS that exercise can be benecial when prescribed as treatment for more conditions than just chronic pain. In a 2015 review article*, Pedersen and Saltin reported on using exercise as treatment for over 20 chronic conditions as gathered from published research papers. They found strong evidence for exercise as treatment in psychiatric, neurological, cardiovascular, and metabolic diseases to name a few. From the evidence, they provided examples of recommended "prescriptions" for each condition and dened recommended intensity using the Borg Rating of Perceived Exertion (Borg RPE, see chart to the right). Most of the recommended exercise prescriptions incorporate both aerobic exercise and strength (resistance) training guidelines. For example, a prescription for exercise as treatment for type 2 diabetes provides guidelines for taking medications and blood glucose monitoring, as well as dietary adjustments to complement the exercise program. The evidence-based exercise program includes a combination of aerobic and resistance training and suggests that high-intensity exercise improves glycemic control more than low-intensity exercise. In this context, incorporating interval training is benecial. For example, an exercise plan that includes 30 minutes of moderate-intensity exercise (Borg 12-13) a day should incorporate short bursts of high-intensity exercise (Borg 15-16) within it. The strength training program should include exercises that target all the major muscle groups with a warm-up and cool down period. As always, check with your health care provider before beginning any exercise program. *Pedersen. BK, Saltin, B. (2015). Exercise as medicineevidence for prescribing exercise as therapy in 26 dierent chronic diseases. Scand J Med Sci Sports. 2015: (Suppl. 3) 25: 1-72.Rating of Perceived Exertion Borg RPE Scale6 How you feel when lying in bed or sitting in a chair relaxed. Little or no effort. 7 Very, very light 8 9 Very light 10 11 Fairly light 12 Target range: How you should feel with exercise or activity. 13 Somewhat hard 14 15 Hard 16 17 Very hard How you felt with the hardest work you have ever done. 18 19 Very, very hard 20 Maximum exertion Don't work this hard!
6 | SPRING 2016 WRIISC Advantage | 7 Around the WRIISC NewsCA WRIISCYoga Program and VA Palo Alto Recreation Facilities Help Local VeteranTHE CA WRIISC YOGA PROGRAM has been in place since the beginning of 2010. Louise Mahoney, Deputy Director of Education and Risk Communication at the CA WRIISC has been at the forefront of this eort to help Veterans seeking treatment for chronic symptoms and better health outcomes. Dennis Kim, the programs very rst Yoga program participant, served as a combat rieman with the Marines in Vietnam and as a Marine Reservist until he was medically retired in 2003. Dennis severely injured his left arm and shoulder in a parachute accident while serving in the Reserves and has limited range of motion in that arm. Although he is retired from the military he is still active as an American Red Cross certied CPR instructor and certied EMT, and teaches CPR classes regularly. During a recent hospital visit, Dennis provided Louise with an update. He reported that his current exercise routine, which includes yoga, swimming, and biking, keeps him looking young and feeling healthy. After he started the regular exercise program, he found that he was much more enthusiastic about a lot more things and not as lazy. He can do more and as a result, things have changed for him. Dennis Veteran Dennis Kim strikes a tree pose which establishes strength and balance in the legs and helps him feel centered, steady, and grounded. re ported that yoga has helped him in many ways, particularly with symptoms from Post-Traumatic Stress Disorder (PTSD). He also says that the yoga has helped with anger management it calms me down, stretches me out, and is benecial for balance. Yoga also helps with his lower back pain, particularly the Warrior series involving standing poses and twists.In a Warrior II pose, Veteran Dennis Kim strengthens his legs and arms while increasing his stamina.I n June, Dennis will be competing in swimming in the Valor Games. Regardless of the outcome of those games, Dennis is certainly a winner and a shining example of the healing powers of yoga and exercise. DC WRIISCWelcome, Dr. Rachel Stewart!DR. RACHEL STEWART recently joined the DC WRIISC team as a clinical social worker. Dr. Stewart has been with VA for over six years, during which she has served Veterans in several programs and areas of the DC VA Medical Center. For over ve years she worked independently as the mental health professional covering the Emergency Room and the hospital during o-hour tours. She was instrumental in the development and implementation of the Fast Track program in the Emergency Department which helped streamline patient ow and increase customer satisfaction while providing excellent care to our Veterans. Prior to coming to the VA, Dr. Stewart already had over a decade of clinical experience focusing on serious mental illness in a variety of settings, both inpatient and outpatient, and both civilian and government. With over 12 years of experience and two state independent clinical licenses, Dr. Stewart is excited to bring her expertise to the DC WRIISC team. NJ WRIISCClinical Program: Making a DifferenceWRIISC CLINICIANS CONTINUE to put the Veteran at the center of our clinical program while evaluating the most complex patient cases. A Veteran who recently visited the NJ WRIISC wrote a personal thank you. Everyone here has treated us with respect and listened to every word. Now, I have hope. I have reason to believe I may get some help and some answers (in addressing my health problems). We are extremely proud that Veterans continue to report their high satisfaction with our unique program and services and are honored to assist our Nations heroes on the road to living a better, healthier life. WRIISC AdvantageSPRING 2016Produced by the War Related Illness and Injury Study CenterEditor:en Susan L. Santos, PhD, MSAssistant Editor:en Christina Rumage, MSPHGraphic Artists:en Florence B. Chua, MS Jose B. Chua, BSContributors:Wes Ashford, MD, PhD Alyssa Adams, PsyD, CNS Sharon DeMocker, MD Amanda Hull, PhD Louise Mahoney, MS, RYT Danielle Mooney, MPH, CHESChristina Rumage, MSPHSusan L. Santos, PhD, MS Rachel Stewart, PhD, LICSW1-800-722-8340 War Related Illness and Injur y Study Center Department of Veterans Affairsen Washington, DC VA Medical Center Room 3B 203, Mail Stop 127 50 Irving St., NW Washington, DC 20422-0002 1-888-482-4376 War Related Illness and Injury Study Center Department of Veterans Affairsen Palo Alto Health Care Systemen 3801 Miranda Ave. Mail Code 151Y Palo Alto, CA 94304-1290 1-800-248-8005 War Related Illness and Injury Study Centeren Department of Veterans Affairs New Jersey Health Care System 385 Tremont Ave. Mail Stop 129, 11th oor East Orange, NJ 07018-1023 For comments or concerns regarding this newsletter, please contact us at: 1-800-248-8005 or email@example.com.
Department of Veterans Affairs (VA) New Jersey Health Care System 385 Tremont Ave., Mail Stop 129 East Orange, NJ 07018 1-800-248-8005 www.WarRelatedIllness.va.gov This newsletter contains a minimum of 30% post-consumer waste.ATTENTION READER: Do you prefer to receive the WRIISC Advantage newsletter electronically? Email us at firstname.lastname@example.org with your full name and preferred email address. See more by visiting:www.move.va.gov VA's MOVE! Weight Management Program promotes health with tools designed to improve the lives of Veterans through healthy eating and increased physical activity.