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The Mind, Body, Spirit Approach to Weight Loss and Better Heart Health

Physical fitness and maintaining a proper weight are key elements in the prevention of diabetes and cardiovascular disease - which are closely linked - and are equally important in stemming the advance of both conditions in people who already suffer from these diseases.

But getting started with managing one’s weight plus staying on track once a regimen is developed can prove to be difficult for a great many people.

The trick is often to place individuals in a comprehensive program that is not only aimed at the body itself but also treats both the mind and the spirit.
The Mind, Body, Spirit Approach to Weight Loss and Better Heart Health
Dinesh Singal, MD
Dinesh Singal, M.D., a cardiologist and director of the Cardio Metabolic Institute at Saint Peter’s Healthcare System, in Somerset, N.J.

For more information about Saint Peter’s Healthcare System

Bill Klaproth (Host): Physical fitness and maintaining a proper weight are key elements in the prevention of diabetes and cardiovascular disease. But getting started with managing one’s weight plus staying on track once a regimen is developed can prove to be difficult for a great many people. With us is Dr. Dinesh Singal, a cardiologist and director of the Cardio Metabolic Institute at Saint Peter’s Healthcare System.
Dr. Singal, thank you so much for being on with us today. First off, how are diabetes and cardiovascular disease linked?

Dr. Dinesh Singal (Guest): There are many reasons by which people get cardiovascular disease. We call them, traditionally, risk factors. Diabetes is one of the major risk factors for cardiovascular disease. In fact, it’s such a potent risk factor that in our current guidelines, we assume that all diabetics already have heart disease and when we go to treat these folks, we treat them as if they’ve already had heart disease. It’s a really potent risk factor for this disease.

Bill: Okay. Let’s talk about diabetes then for a quick second. How would somebody know if they have it? Are there warning signs or symptoms that people should be watching out for?

Dr. Singal: Yes. From a symptoms standpoint, if someone starts losing weight, they have excessive urination which is unexplained, or they start feeling very thirsty, those are some of the clues by which they may realize and find out that they’re diabetic. But that’s usually when it’s fairly extreme. Most of the times, we pick up folks a lot earlier by doing routine blood tests. If in a fasting blood test, someone’s sugar is greater than 126 – or there’s another test called Hemoglobin A1c and if that’s more than 6.5, then that is diagnosed as diabetes.

Bill: What is the percentage of the population who is at risk for these conditions?

Dr. Singal: There’s an organization which puts out a report in a national level and they just came out last month for data from 2012. What they found was that in 2012, about 29.1 million Americans, almost 9.3% of the population had diabetes. In addition, there’s a condition called pre-diabetes when the numbers are somewhere between normal and toward the number that I just quoted. That population is almost a third of the US population. In the older population over 65, it’s almost close to 50% people are pre-diabetic.

Bill: Wow. And you said diabetes is kind of a precursor to cardiovascular disease or they’re at a higher risk for cardiovascular disease. Is that right?

Dr. Singal: It’s actually one of the most important and major risk factor. In the recent guidelines for cholesterol management, we very aggressively managed people who have underlying cardiovascular disease. What we found out was, like I said earlier, in diabetics, the incidence is just so high that we are as aggressive in lowering the cholesterol because the risk is just as significant. We treat diabetics almost as if they have underlying disease.

Bill: Okay. Let’s talk about lifestyle now. How does lifestyle a factor in the development of diabetes and cardiovascular disease?

Dr. Singal: The reason diabetes has become an epidemic all over the world is, in large part, because of lifestyle. Our exercise amount have decreased. People live in the suburbs where they are used to driving from one point to another, walking has reduced, so with that, folks wind up gaining weight. Eating habits for a lot of people are not very good. They wind up eating high glycemic index foods which aren’t metabolized as fast. Between all of that, folks tend to gain weight and obesity is a major precursor for diabetes and along with that come a whole host of medical issues which add to the burden of cardiovascular disease.

Bill: Right. Our current hectic, modern lifestyle certainly doesn’t put us on a good position for this. You mentioned exercise. It’s obviously very important. But why is it that exercise safeguards against the development of these conditions?

Dr. Singal: Exercise plays many roles in a variety of ways. One, it allows us to burn more calories so the food we are eating actually has the chance to get burned and so weight is better controlled in someone who exercises regularly. It also improves the resistance to disease. We’ve seen over and over again, people who exercise regularly tend to have lower blood pressure than folks who don’t. Their lipid numbers are better, so the cardiovascular disease burden has reduced.
People’s moods are better when they exercise more, and those people have been, again, shown to have better outcomes in the long run. It also boosts energy by improving the metabolism, so a person who is more active actually feels more energetic than someone who is less active. People sleep better when they exercise and that also has a direct correlation with blood pressures when we are awake. Overall, exercise is fun and, with all these other factors, lead to a healthier lifestyle and a longer life.
Bill: Right. It’s just good for you, darn it, right?

Dr. Singal: That’s right.

Bill: We just all need to jump in there and do it. Diet and exercise are always linked. How does diet factor for the development and containment of these diseases?

Dr. Singal: Diet plays a major role because what we eat and how much we eat translates into all these things I just said earlier. There are foods which have so-called higher glycemic index, the starchy foods – potatoes, rice, bread, desserts, sweets. All these items tend to get converted to glucose and sugar much quickly, and the body only has a certain capacity to handle all that. When there is excess, then it all builds up in higher glucose and more predisposition to diabetes, higher lipid values.
And also the amount we eat, when you go to a restaurant, you have to make choices. This same item with some extra cheese can add a lot more calories than we need. Both the choice and the kind of food and the amount of food adds up and that then results in, again, what I said earlier, obesity, diabetes, hypertension, high lipids. Choice of food and how much we eat is extremely important in our wellbeing.

Bill: Okay. Let’s break this down a little bit farther for our listener. Give me, if you just briefly, the best exercises to do.

Dr. Singal: Well, the best exercise, at least, from a cardiovascular standpoint is aerobic exercise. The goal is to move our limbs, move our body. It could be whatever one is in a position to do based on their age and their overall condition. It could be a brisk walk, if a person can jog and run, bicycling, joining a Zumba class, Pilates. It needs to be fun and it needs to burn calories. Having said that, in addition to the aerobic piece, one needs to exercise most of the group muscles, so lifting some weights and some resistance activities are also useful. And it needs to be at least three to four times a week. Studies show at least a half hour, so the heart rate can go up and be sustained for at least that period of time.

Bill: Okay. Got you. That’s excellent. Pay attention to aerobic exercise – walking, jogging, biking, take a Zumba class. Pay attention to group muscles at least three to four times a week. All right, let’s do the same now with diet. What would be the best type of foods to eat then?

Dr. Singal: From a food standpoint, fruits and vegetables are the best bet. They give us fiber, they are less in calories, they are natural. Any kind of processed food has to be limited. Foods which have high glycemic index, like I said before, potatoes, rice, bread, pasta, desserts, they need to be in a lesser quantity, and a balance between protein. We obviously need some fat and some carbohydrates. Some of these fad diets where one is doing one extreme over the other, when studies have looked at it, they find that it really don’t do any better than just a reasonable calorie, well-distributed diet with a higher amount of vegetables and fruits and some nuts. That should be the focus, with a reasonable composition of proteins, white meat rather than red meat, less egg yolk (the yellow of the egg). So fruits and vegetables, again, need to be the bulk of one’s diet.

Bill: Excellent. In our last minute here, what is your best advice then for somebody to maintain the diet and exercise regimen? We know what exercise to do, we know what to eat, how do we stick with it?

Dr. Singal: One needs to find an activity which they enjoy doing. What we’ve discovered at the Cardio Metabolic Institute is that when we do activities in groups, people tend to sustain those more than when they’re trying to do it by themselves. The goal has to be to get to a certain point, but it can’t be achieved in one day. If somebody isn’t used to doing it, they start slow and work their way up. If they can maintain something for about a month or two months, they’ll find it isn’t that difficult. The first month or two months to change habits, to change lifestyle, is the toughest piece. Once you get past that, you can maintain it for a long time to come.

Bill: Sounds great. Dr. Singal, thank you so much for your time today. We really appreciate it. For more information on Saint Peter’s, please visit That’s This is Saint Peter’s Better Health Update. I’m Bill Klaproth. Thanks for listening.