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National Change in Diet and Lifestyle Reduces Death from Heart Disease and Diabetes
by Barbara J. Moore, PhD
In contrast to many developing countries,
Cuba has a national health care system and a
well developed system for tracking vital
events. It is known, for example, that life
expectancy in Cuba is 77 years and
cardiovascular disease is the leading cause
Since the 1960s, Cuba has been subjected to
an economic embargo by the United States. In
1989, with the fall of the Soviet
Union — Cuba's primary trading partner
entered a prolonged economic crisis, referred
to as the "Special Period." The crisis
deepened over the next six years with
economic output in 1995 reaching only half
the level in 1990. Foreign trade contracted
by 80% with reduced imports, limited fuel
availability, and a scarcity of many food
items. Food was rationed and reductions in
per capita daily energy intake were
documented along with significant increases
in walking and cycling as public
transportation became unavailable. Since
complete economic recovery did not occur
until 2000, the Special Period lasted an
In 1993, nutritional studies documented that
27% of Cubans lost 10% or more of their body
weight over the previous 12 months and 43%
experienced severe caloric restriction.
The prevalence of obesity
decreased from 11.9% to a low of 5.4% during
the height of the Special Period. Physical
activity — walking and cycling —
30% before the crisis to a high of 70% in
1995. This change was apparently sustained at
67%, as documented by national surveys in
Substantial declines in mortality, or death,
from type 2 diabetes (-51%), coronary heart
disease (-35%), and all-cause mortality
(-18%) were documented between the years 1995
and 2002, while rates of cancer mortality,
which are not sensitive to obesity, remained
relatively constant throughout the Special
The Special Period in Cuba is the first
demonstration of how decreased food intake
and weight loss, coupled with increased
levels of physical activity — circumstances
that lasted for 4 to 8 years — produced
significant reductions in diabetes and heart
disease mortality throughout an entire
It is interesting to note that diet
composition shifted during the Special
Period. Carbohydrate intake increased from
65% to 77% of calories, as sugar cane and
rice became the primary sources of energy.
Fat consumption decreased from 20% to 13% of
calories, as the availability of animal
products declined throughout the country, and
protein fell from 15% to 10% of
Some authorities would consider such a high
carbohydrate, low protein/low fat diet to
favor the development or exacerbation of
diabetes; yet, it was accompanied by marked
decreases in diabetes mortality.
There were many negative consequences of the
Special Period. More elderly persons died,
primarily of infections; the decline in
infant mortality was interrupted for three
years; and the incidence of low birth weight
increased from 7.3% to 9.0%. An epidemic of
neuropathy, or nerve damage, was documented.
This was attributed to vitamin and protein
deficiencies affecting at least 50,000 people
examined between 1992 and 1993.1
With the end of the Special Period, the Cuban
economy started to grow, productivity
increased, and energy and food availability
increased. Public transportation improved, so
levels of physical activity declined again.
Mortality from type 2 diabetes and heart
disease reached its lowest point in 2001, but
increased every year for the next four years.
Like most countries around the globe,
including the US, Cuba now faces the
challenge of crafting public health
initiatives to stem these increases.
The Special Period in Cuba suggests the
potential public health impact that could be
achieved with a carefully designed population
intervention that maintains nutritional
sufficiency while encouraging weight loss in
overweight individuals. This natural
experiment points to the importance of
boosting physical activity and reducing
calories while maintaining a high-quality
diet with adequate sources of lean protein
and other nutrient-rich foods such as
vegetables, fruits and whole grains.
Barbara J. Moore, PhD, is President and
CEO of Shape Up America!
Upper Arms Training: Part 1
by Shape Up America!
The muscles in the upper arms can be a
challenge to maintain. With age, the strength
and tone of these muscles can decline and in
particular, the muscle at the back of the
upper arm tends to droop. Some call it flabby
arms — technically, the muscle is
triceps brachii. There are a variety of
exercises that you can do at home to
strengthen the muscles in your upper arms and
Here is one exercise to get you started:
Stand tall with your back straight and your
feet planted firmly on the ground. It's
important to maintain good form throughout
the exercise. Your feet should be slightly
apart so that you are well-balanced and
stable. Now raise your arms to shoulder
height and extend them out horizontally. Make
a loose fist and move your thumbs to a
"thumbs up" position toward the ceiling.
If you are a beginner, make small circles 10
times in the air. Each circle should be about
12 inches in diameter. Keep your arms
straight (and your thumbs pointing up) as you
make your circles; don't let your arms drop.
If you need to, rest for a few seconds with
your arms at your sides, before continuing.
Next, rotate your thumbs forward a quarter
turn. Your arms will now be straight out to
each side, but your hands will in a "thumbs
forward" position. Repeat your 10 circles.
Rest again if you need to.
With your arms straight out, rotate your
thumbs another quarter turn so your thumbs
are in a "thumbs down" position. This is the
most difficult position because it is hard to
keep your arms up as you do your 10 circles
in this position. You have now completed one
set. Bring your arms down to your sides and
rest for about 10 or 15 seconds.
Repeat the set. Beginners should do 2 sets
twice a week for several weeks before
advancing to a more challenging variation of
When you are able to complete 2 sets
without stopping, you may advance to the
intermediate level. Do 2 sets with the
circles in one direction and then add 2
more sets with the circles in the opposite
direction. After several weeks of working at
this level, if you no longer have to rest
between sets, you can increase the number of
circles in each thumb position from 10 to 20.
At the advanced level, add a ONE POUND weight
to each hand. This will make the exercise
significantly harder, especially if you
maintain good form by keeping your arms up as
you make your circles. To make a one pound
weight for each hand, fill two plastic water
bottles with two 8-ounce cups of water and
screw the lids on tight (16 ounces = 1
pound). If it feels too heavy, fill each
bottle with one (8-ounce) cup of water to
equal a half pound weight per bottle.
Grip the water bottles with each hand. Start
with 10 circles for each position (cap
pointing up, forward, then downward). Work
your way up SLOWLY — over several weeks
you are comfortable doing the exercise in
each position without resting between sets
and in each direction (circles forward and
backward). At that point, you can start to
increase from 10 to 20 circles per position.
||2 sets/30 reps per set, divided into 10
circles for each of 3 thumb positions
- Extend arms out, make a fist. One
set = 10 circles with thumbs up, 10 with
thumbs forward, 10 with thumbs down.
- Rest between each thumb
|2 sets twice a week
||4 sets/30 total reps per set
- Do 2 sets as above, circling arms
forward. Add 2 sets, circling arms backward.
- Increase from 10 to 20 circles in each
|4 sets twice a week
||4 sets/30 total reps per set
- Add 1-pound water bottle to each
hand. Do 10 circles in each of 3 cap
positions. Complete 2 sets, circling arms
forward and 2 sets circling arms backward.
- Slowly increase from 10 to 20 circles in
each cap position.
|4 sets twice a week
NIH Debuts First Annual Yoga Week
From May 19-23, the National Institutes of
Health (NIH) will premier the first annual
Yoga Week, in Bethesda, MD. Highlighting the
science and practice of yoga, this five-day
event will serve NIH employees and the
public. Participants will not only learn
about the benefits of yoga but also
experience them first-hand through stretching
and practice. Novice and experienced yoga
students are encouraged to attend.
NIH Yoga Week events include lectures by
current NIH grantees conducting research on
yoga and presentations by leading yoga
instructors. The kick-off event on Monday,
May 19 from 11 A.M.-1
P.M. at the Natcher
Auditorium (45 Center Drive, Bethesda, MD) is
free and open to the public. Also
incorporated into Yoga Week is "Karma Yoga,"
which is a theme of giving back to the
community and those in need. Two charity
outreach events will take place during Yoga
Week for the NIH Safra Family Lodge and Manna
Food Center in Rockville.
For more information on NIH Yoga Week,
contact Dr. Rachel Permuth-Levine at
Menus for Weight Loss and Healthy Eating
Shape Up America! offers these simple,
calorie and 2000
calorie menus to help
you eat healthfully while controlling your
calories. If you have any suggestions or
comments, feel free to e-mail us at
Suzannah honored her
father's life by creating a better one for
herself. She lost weight, got fit, changed
careers and transformed herself into a
healthier, happier person with a new zest for
In June of 2006 my father died in the
hospital after dealing with complications
from a stroke. The stroke, on his 77th
birthday, was only a small part of his
problems, though. He had led a sedentary
lifestyle, had heart disease, type 2
diabetes, and was depressed for most of his
life. My father spent the last month of his
life in a new state-of-the-art cardiac-ICU.
It was the jewel of a hospital already
renowned for its expertise in cardiology.
Nevertheless, spending almost a month in a
hospital is sufficient time to make anyone
decide that they never want to be a patient
in one. Fancy schmancy or not.
Similar to being a middle school teacher, I
am quite sure that I'd never want to go back
to middle school. Of course losing a parent
necessitates change, but two messages from
that hospital experience stood out that moved
me to do a complete overhaul on my own life.
First, I read in some waiting room pamphlet
a quote that struck me in the right way at
just the right moment. It said, "If I'd known
I was going to live so long, I'd have taken
better care of myself" (by Leon Eldred). The
second thing that struck me in a serious way
was finding out that many of the ailments
that had plagued my dad could be prevented or
slowed through diet and exercise.
So, I had been dieting for 25 years, smoking
for six years, talking about getting fit
since high school. I weighed 192 lbs, was
seriously depressed, single for the first
time since I was 14, and had just lost my
father after watching him struggle with his
health for years. At 40, I decided that I'd
had enough and I decided to create a body
that would make me comfortable. I would
tackle all areas at once with diet and
exercise. I would get healthy and free myself
from pain and body image issues. I would
focus on myself for a change. I would change
my lifestyle, use movement to work through
grief, and best of all honor my father's life
by creating a better one for myself. Read
If you would like to share your personal
success story and be an inspiration to others
who desire to lose weight, simply use our story
submission system on the SUA Web site.
Recipe of the Month
Makes 6 servings
- 1 Tbsp. olive oil
- 1 medium onion, peeled and finely
- 1 carrot, peeled and grated
- 1/2 cup celery, finely chopped
- 2 garlic cloves, finely chopped
- 1 tsp. fresh or a pinch dried thyme
- 2 Tbsp. parsley, finely chopped
- 2/3 cup canned tomatoes, finely chopped
- 1 Tbsp. balsamic vinegar
- 1 Tbsp. dark brown sugar
- 3 drops Tabasco sauce
- 1 egg white, lightly beaten
- 1/2 cup bread crumbs
- 1 1/2 lbs. ground turkey *
- Dash salt and pepper
- 2 Tbsp. Dijon-style mustard
- Heat olive oil in a large non-stick
skillet over medium high heat. Add onion and
sauté until it begins to soften.
- Add carrot, celery, and garlic, sauté
until soft, about 5 minutes. Add thyme and
parsley and place in a bowl to let cool.
- Heat oven to 375 degrees.
- Place tomatoes, vinegar, brown sugar and
Tabasco in a mixing bowl. Add egg white,
bread crumbs, turkey, cooled vegetables, salt
and pepper. Mix until well combined.
- Transfer to a non-stick loaf pan (8" x
4"). Smooth top of loaf and brush with
mustard. Bake about 1 hour, or until slightly
golden on top. Pour off any fat and let stand
10 minutes before slicing and serving.
* Use lean ground turkey to cut down on
calories, fat and saturated fat.
Nutritional analysis per serving: 325
calories, 20 grams total fat, 6 grams
saturated fat, 77 milligrams cholesterol, 16
grams carbohydrate, 21 grams protein, 2 grams
dietary fiber, 390 milligrams sodium
Source: Shape Up