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Parkinson Research Foundation Invites You to See Sarasota! . . . . . . . . . . . . . . . . . . . . . . . . . Page 1

Female Hormones and Parkinson’s Disease . . . . . . . . . . Page 2

Winning Ways to Be Your Best with Parkinson’s Disease . . . . . . . . . . . . . . . . . . . . . . . . . Page 3

Parkinson Research Foundation Educational Cruise 2015 . . . . . . . . . . . . . . . . . . . . . Pages 4 & 5

Fetal Midbrain Transplants for PD: A Re-Assessment of Results . . . . . . . . . . . . . . . . . . . . . . Page 6WHO CARES! “Success Strategies for Parkinson Caregivers” . . . . . . . . . . . . . . . . . . . . . . . . Page 7Healthy Fats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 8Help Us Help Others . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Page 8Where There’s a Will . . . . . . . . . . . . . . . . . . . . . . . . . Page 8

PARKINSON RESEARCH FOUNDATION INVITES YOU TO SEE SARASOTA!

T here will never be a better time to look to Sarasota for the finest Parkinson services and resources and the finest arts, leisure and “must

see” spots that the world has to offer, all nestled on the beautiful, breathtaking gulf coast of Florida.

Along with our mission to fund research, promote Parkinson awareness and sponsor ongoing educational conferences with renowned physicians and experts in the field, Parkinson Research Foundation (PRF) is committed to promoting a better life today for patients and caregivers by means of the programs and services provided at PARKINSON PLACE, a Multidisciplinary Care Center in Sarasota, FL.

Parkinson Place, an 11,000 square foot site funded by generous donations to the Parkinson Research Foundation, houses the Sarasota USF Parkinson Clinic directed by Juan Sanchez-Ramos, MD, PhD a noted Fellowship Trained Movement Disorders Specialist, who sees patients locally and those visiting from near and far. Additional clinical services, conveniently located under the same roof, include a general neurology clinic, a psychology clinic, a speech and swallowing clinic, a nutrition clinic and an onsite physical therapy clinic. PARKINSON PLACE offers everything necessary for an initial comprehensive assessment or all inclusive second opinion when need be.

In addition to the finest clinical services, PARKINSON PLACE offers over 80 free morning and afternoon classes a week from 9am to 4:30pm providing a daily opportunity for back to back classes geared to improve physical performance

and cognitive function. Yoga, Tai Chi, Dance, Fun Fitness and Ageless Grace for Parkinson’s, all with published proven benefits, get your body, mind and spirit up and moving in a hurry! Monthly “Ask-The-Doctor” and weekly “Parkinson Power” educational programs offer fun ways to learn over complimentary lunch and social time. PARKINSON PLACE, a first of its kind care center, offers everything you need for a better life today with Parkinson’s disease.

And if that is not enough, Sarasota, where award winning beaches and golf meet culture, art and beautiful weather, welcomes thousands of visitors annually to the Ringling Art Museum, Asolo Repertory Theatre, Sarasota Opera, Van Wezel Performing Arts Hall, Sarasota Ballet and many other cultural and family oriented attractions.

PRF invites you to join us for the perfect year round vacation! Customized destination packages are available just for you filled with the unlimited benefits of PARKINSON PLACE in addition to endless opportunities to enjoy the arts, attractions, leisure and luxury that only Sarasota has to offer people of all ages and interests.

For personal assistance or further details, please contact our Service Coordinator, Toni Goin, at (941) 893-4188 or TGoin@ParkinsonHope.org. I would love to personally introduce you to PARKINSON PLACE and a city like none other.

Kind Regards,

Lawrence HoffheimerChairman, PRF

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The frequency of PD in men is higher than in women by nearly a two to one margin. Many investigations support

this estimate. In particular, the “incidence” of PD (number of new cases of PD in a population diagnosed each year) has been reported to be 91% greater in men than in women. This observation has raised

questions as to why and how being a woman is relatively “protective” against developing the disease. Not only do fewer women develop PD, but they tend to have the onset of the illness an average of two years later than men. In addition, tremors are usually the dominant symptoms when women are first diagnosed but the initial symptom in men tends to be slowness of movement (bradykinesia) and muscle rigidity. Interestingly, tremor-dominant PD tends to progress slower than the rigid-bradykinetic form more common in men. Women with PD tend to have more levodopa-induced dyskinesias and less levodopa requirements even when adjusted for body weight.

It has been suggested that these differ-ences between men and women is related to the role of female hormones, especially estrogens. Women who experience later menopause or have more children are more like-ly to have delayed onset of PD symptoms. These two indicators provide estimates of estrogen exposure over the woman’s lifetime. Women who have oophorectomy (surgical removal of ovaries) before menopause have an increased risk of PD. Postmenopausal hormone therapy has been associated with reduced PD risk in sever-al studies but not all investigations support this conclusion. Perhaps some of the divergent results have to do with when the hormones are administered relative to a woman’s age, type of menopause (natural or surgical) and stage of menopause. For example, women with early menopause administered hormone therapy at a young age are more likely to demonstrate neuroprotective effects whereas late postmenopausal hormone therapy may be deleterious.

Women with PD who are approaching or who are already experiencing menopause often want to know if they should take female hormones as disease modifying or symptom improving therapy. Moreover, as more at-risk groups are identified (for example carriers of LRRK2 mutations which increases risk of PD) many more women will be seeking advice as to whether and when to take female hormones.

A recent article (Lui et al. 2014) has examined the role of female hormones in PD and the report appeared along with a thoughtful editorial article (Marras et al., 2014) in the same issue of the Movement Disorders Journal. The authors examined associations between PD and a number of factors related to reproductive history and hormone use including age at menarche (age at first menstruation), live births, menopause,

oral contraceptive use, postmenopausal hormone therapy type, duration and frequency. They evaluated data from the National Institute of Health’s American Association of Retired Persons (NIH-AARP) Diet and Health study which ascertained these exposures between 1995 and 1997 and diagnosis of PD between 2004 and 2006—both by self-report. Over 100,000 women participated in both exposure and outcome surveys. The investigators found a significantly reduced PD risk with long-term oral contraceptive use (or more than 10 years of use) compared with those who never took oral contraceptives. Assessing postmenopausal factors they reported an increased PD risk with current hormone therapy of less than 5 years’ duration compared with no hormone therapy. Increased risk with bilateral oophorectomy, presumably associated

with earlier menopause and falling estrogen levels, was consistent with findings of others. The finding of reduced risk with long-term oral contraceptive use was novel since previous studies have either not shown an association between oral contraceptive use or have suggested an increased risk. This observation, however, is consistent with a prevailing theory of estrogen’s neuroprotective effects.

Some of the findings reported are puzzling or not consistent with other reports. For example, the finding of an association between PD risk and early hysterectomy without oophorectomy doesn’t make sense because hysterectomy alone is not known to cause a drop in endogenous hormone levels. The investigators did not find an association with other markers of estrogen exposure that has been demonstrated in prior reports (age at menarche, age at natural or surgical menopause or duration of estrogen-containing hormone therapy). The absence of these associations led Liu et al to conclude that little support exists for an important role of estrogen as an agent that decreases risk of PD or mitigates symptoms of PD. Perhaps the beneficial effects of oral contraceptive use could be attributed to the progesterone content rather than estrogen.

What advice should be given to those women who consider themselves at higher risk of PD because of a family history, or those who harbor a mutation in a PD causing gene, or have PD and are in transition to menopause? At the present moment no definitive answers can be given regarding potential disease modifying effects of hormonal therapy or hysterectomy and oophorectomy. Continued research, especially prospective long term studies, will eventually permit rational guidance on the use of female hormones.

REFERENCES: Liu et al. “Female Reproductive factors, menopause hormone use

and Parkinson’s disease” Movement Disorders 2014; 29:889-896.

Marras et al. “Complexities of Hormonal Influences and Risk of Parkinson’s Disease” Movement Disorders 2014 29: 845-848

Female Hormones and Parkinson’s DiseaseJuan Sanchez-Ramos, MD, PhD

Medical Director, PRF

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Parkinson’s disease, for many, can create the chal-lenge of a lifetime with its devastating, non-stop progressive life altering effects on one’s body,

mind and spirit. Life with Parkinson’s is far from pretty so what is the key to remaining optimistic and hopeful about today and tomorrow?

The two most important things necessary for the strength to face each day are a positive attitude and a sense of control. The emotions associated with Parkin-son’s are anything but positive and the physical symp-toms are many times impossible to control but you can

do it if you hold hands with those who love you and do everything possible to help yourself. Make the following check list part of your daily routine.

Be under the medical care of a Board Certified Neurologist experienced in treating Parkinson’s disease

Develop and maintain a loving dignified partnership with your caregiver

Do everything you can to remain independent because the more you do for yourself the more dignified and under control you will feel (dressing, grooming, eating, etc.)

Take your medications on time and ask for help if need be to avoid dosing mistakes

Rely on a walker or wheelchair if need be to stay safe and mobile

Eat 3-6 small meals each day focused on your favorite healthy foods and snacks

Drink 6-8 glasses of water every day but not too close to bedtime

Get daily exercise and benefit from physical therapy programs when recommended

Promote sleep health by going to bed and waking up at the same time every day

Stay empowered by learning everything you can about your disease. Knowledge is power!

Stay engaged in life. Keep doing the things you love to do with those you love the most

Surround yourself with positive supportive people

Lighten up, laugh and love yourself

Accept and believe the “You have Parkinson’s. Parkinson’s does not have you!”

* Marilyn Tait, Parkinson Place Director, is a noted Parkinson educator, motivator and advocate with forty five years of experience in healthcare management and program development. For the past 18 years, she has dedicated a full time effort to identify and meet the physical, mental, emotional and social needs of Parkinson’s patients, caregivers and families. The Parkinson Research Founda-tion, under the direction of Larry Hoffheimer, Chairman and Marilyn Tait, Director, has designed and developed Parkinson Place with the intent of creating a paradigm for Parkinson care in the twenty first century.

“Winning Ways to Be Your Best with Parkinson’s Disease”

By Marilyn Tait*Parkinson Educator, Motivator & Advocate

Director, Parkinson Place Multidisciplinary Care Center, Sarasota, FL

Marilyn Tait

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T ransplantation of midbrain fetal cells for the repair of the Parkinson’s disease (PD) brain was a source of great hope several decades ago. Not only were fetal midbrain cells

effective in treating PD but embryonic stem cells could also be used for this procedure. Unlike fetal cells that required access to aborted fetus material the embryonic stem cells provided a potentially unlimited source of cells for transplantation. In the beginning, ethical, religious and political issues regarding supply of fetal cells from therapeutic abortions or the use of embryonic stem cells derived from surplus fertilized eggs appeared to be the main obstacles to moving ahead. More recently, use of non-embryonic stem cells derived from a patient’s own skin fibroblasts (induced pluripotent stem cells) overcame ethical and religious objections. Unfortunately, biological issues turned out to be major obstacles to greater application of the cell transplantation approach to treat PD.

The transplantation of dopamine progenitor cells in PD suffered two major setbacks that sent neuroscientists back to the drawing board. The first setback was the development of “runaway dyskinesias” in about half the transplanted patients. These severe involuntary movements (twisting, turning or dance-like movements) were similar to those that are triggered by levodopa in many patients. Unfortunately, the post-transplant dyskinesias persisted even when all dopamine replacement medication was stopped. The dyskinesias were severe enough in some patients to warrant neurosurgical intervention (pallidotomy or deep brain stimulation (DBS) in the same way that levodopa-induced dsykinesia often requires DBS. The second setback was the report that the transplanted neurons developed Lewy bodies, the neuropathological hallmark of the disease. Apparently, there was a spread of the disease process from the host brain to the newly grafted fetal dopamine neurons. The concept of disease spread from neuron to neuron, in particular the spread of the abnormal form of an important synaptic protein, (alpha-synuclein a component of Lewy bodies), is now considered to be a real problem for the transplant field. In fact, it is well known from studies of post-mortem brains of PD cases at various stages of the illness that the progression of the disease is associated with the gradual spread of Lewy bodies from olfactory bulb and brain stem to the midbrain and cerebral cortex. In addition to the post-mortem evidence of progressive Lewy body dissemination throughout brain, recent research has demonstrated direct injection of mutated forms of alpha-synuclein fragments can spread throughout the brain, mimicking the neuropathological progression of disease in humans. With this new information, there has been a re-examination of post-mortem cases of PD that had in life received fetal midbrain cell transplants.

A recently published report* reviewed the data available from cases of transplanted patients and provides new information regarding the survival and functional integrity of transplanted neurons. In particular, the authors claim that review of the literature reveals that only a very small fraction of transplanted fetal midbrain neurons actually developed the pathology (i.e. Lewy bodies). In the new study, DAT immunostaining was assessed in 4 to 14 year-old grafts in five patients from their previously published

series in order to further understand the long-term characteristics of the transplanted dopamine neurons and potential effects of the aging of transplants. DAT refers to the dopamine transporter, an

important protein marker expressed in healthy dopamine neurons and their nerve fibers. DAT immunostaining provides a morphological assessment of intactness of the transplanted dopamine neurons. The investigators also examined a marker of mitochondria (the energy producing organelles within neurons) within the dopamine neurons thus providing another measure of neuronal integrity over many years after transplantation.

The researchers demonstrated long-term graft survival in their PD cases. A general assessment of the integrity of the grafted DA cell (TH-immunoreactive neurons) in all patients revealed cells with a healthy appearance, including a robust cell body and absence of signs of atrophy. They also found that DAT was maintained for as long at 9 and 14 years post-transplantation along the dopamine fibers in the re-innervated striatum but absent in the non-transplanted parts of the striatum. The authors also reported there were no mitochondrial abnormalities in the transplanted cells. The data is consistent with other authors’ reports of long term cell survival and function for as long as 18 years after surgery. Regarding the presence of Lewy bodies in these grafted cells, only one Lewy body was found in single neuron in one of these five cases. Review of other transplant series has however reported more frequent Lewy body and alpha-synuclein pathology. It has been estimated that less than 5% of the grafted cells did develop the pathology. The authors of the present study do not support the hypothesis that the alpha-synuclein spreads from the host brain to the transplanted cells to cause dysfunction. They take the counterpoint that healthy transplanted cells provide a clearance mechanism for the abnormal proteins (misfolded alpha-synuclein). They assert that their review of these five cases provides data that is not consistent with the suggestion that these grafts degenerate over time.

It is clear that the authors of this report, who have spent their entire careers in cell transplant and brain repair research, have been greatly troubled by the setbacks to their field. Unfortunately, they do not discuss the practical issues of graft-induced dyskinesias and the biological problem posed by unregulated release of dopamine by the healthy appearing grafted cells. Indeed, the reconstruction of the injured nigro-striatal system is going to require more than insertion of dopamine progenitor cells. It is now clear that PD is not just a dopamine problem. It involves many other brain regions over time that result in non-motor symptoms (depression, sleep disorders, autonomic nervous system problems). It will require more than cell transplantation to cure PD.

Stem cells for brain repair have been big buzz words in the media and perhaps too much hype has created exaggerated expectations among patients. Nonetheless, many great accomplishments in the sciences have been attained despite multiple setbacks and this requires perseverance and hard work.

*Hallet et al., “Long-term health of dopaminergic neuron transplants in Parkinson’s disease patients”. Cell Reports 7, 1755–1761, June 26, 2014. To view the open access article go to: http://dx.doi.org/10.1016/j.celrep.2014.05.027

Fetal Midbrain Transplants for PD: A Re-Assessment of ResultsJuan Sanchez-Ramos, MD, PhD

Medical Director, PRF

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WHO CARES!“Success Strategies for Parkinson Caregivers”

By Marilyn Tait, Director, Parkinson Place, Sarasota

STRESS LESS – “Manage Stress or It Will Manage You!”

For Parkinson caregivers, stress is a normal part of daily life but to be a happy caregiver, you must make every effort to keep stress at a healthy level. A daily overdose of stress can kill you!

• THINK IT – What is stress? Can you hold it in your hand? Can you stomp it like a bug? Stress is a state of mind that’s caused by difficulty, pressure and strain. Like a vapor, it’s intangible and non-descript. Stress exists inside of you and only you can control it. A healthy amount of stress is good because it motivates you to move. The stress of catching a plane or getting to work on time keeps you going. You would be a blob without it!

• WATCH IT – An unhealthy amount of stress can make you sick. How can you stay well if you’re dragged down all day and kept up all night? The mega dose of stress that comes with caregiving can overwhelm and consume you. Don’t let it! Take immediate action and defend yourself! Deal with stress early, when it’s small, before it gets too big for you to handle. To manage stress before it manages you, you must identify it, confront it and contain it. Here is your simple solution.

• IDENTIFY IT – When you are stressed you’re in a frenzy going non-stop with no direction. You feel frantic and vulnerable because you’re frightened and confused. More horrifying, you can’t pinpoint or know the face of what’s threatening you. The first thing to do is stop! Sit down, alone in a quiet place, and go inside your mind. Clearly identify what’s causing your anguish and pain.

• WRITE IT – Take time for serious thought and a long hard look. Clarify each culprit and write it down. Family issues, failed relationships, unhappy home life, hurtful friends, conflicts at work and financial worries are usually high on the list. Health problems most often take first place. Look closely at each issue and say to yourself, “Is there anything I can do about it?” If the answer is no, throw it over the fence and forget it! If the answer is yes, begin to plot a plan to deal with it. You have now faced your stressor. By taking control with an action plan, you contain it.

• STRESS FOR SURE – With the role of caregiver, comes stress. It’s part of the package. You face a difficult time, pressured by daily demands. The ongoing strain on your life makes stress inevitable. If not kept in check, stress will grow in strength and harm you. To be a happy, effective caregiver, you must deal with stress on an ongoing basis. Do your best to avoid it. Stay awake and watch for the warning signs so you see it coming way in advance.

• WARNING SIGNS – Stress affects you physically and emotionally. Emotional signs usually come first and may include apathy, anxiety, frustration, forgetfulness, irritability, distraction, quick temper, insomnia, eating disorders and depression among others.

If stress goes untreated it will worsen leading the way for physical

symptoms to include fatigue; recurring headaches; noticeable weight loss or gain; intermittent chest pain; shortness of breath; nausea and vomiting; dizzy spells; frequent stomach aches; back, neck and shoulder pain; and bowel problems to name a few.• AVOID DEPRESSION – Stress opens the door for depression

which is a low, blue mood that lasts for more than a few weeks. The “red flag” warning signs include: Isolation: You stop going out Disinterest: You stop doing the things you love to do Sleeping Too Much: You prefer to be in bed in a ball Eating Disorders: You eat too much or not enough Unruly Appearance: You don’t care how you look

Poor Personal Hygiene: You don’t bathe and groom daily

Apathy: You sit and do nothing Uncontrollable Tears: You cry for no reason Unhappy Face: You look sad and dismal Hopeless Comments: You say things like “I

hate my life” or “I can’t face another day” or “I don’t care if I live or die.”

Serious depression can lead to thoughts of suicide. It’s frightening and tormenting. If some or all of these symptoms describe you, tell someone and get to your physician immediately as depression is treatable. Don’t suffer in silence when you can get help.• STRESS BUSTERS THAT COULD SAVE YOUR LIFE

Say No … Limit Change … Rest Up … Eat Well … Take Time Off … Ask for Help … Get a Massage … Laugh A Lot … Have a Hobby … Take Tai Chi … Listen to Music … Stay Organized … Have Faith … Get Exercise … Practice Yoga … Do Fun Things … Seek Sunshine … Meditate Daily … Sit & Just Be … Try Aroma Therapy … Take Walks … Deep Breath … Work Out … Lighten Up … Lunch with Friends … Play Golf … Beach It … Take a Bubble Bath … See a Movie … Relax & Read … Dine Out … Soak in a Jacuzzi … Try Acupuncture … Have Fun with Family … Go Shopping … Enjoy a Spa Day … Think Positive … Pray … and on & on …

Reward yourself with “My Time” as often as possible. Do whatever you enjoy that takes you away and works for you.

Message from Marilyn…You cannot be a happy caregiver if you’re stressed, depressed and out of control. It doesn’t matter how you are, only how you feel. If you’re overloaded with stress and distracted by scattered thinking, you won’t be up and able to face the daily demands of caregiving. Always stay alert for stressors and keep your stress level well in check. Be prepared to step up to the plate. When stress comes at you take aim and whack it out of the ballpark. Remember you’re a Super Star! If you would like to share your caregiving success strategies, email them to Marilyn at MTait@ParkinsonHope.org

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Parkinson’s Disease Update is published quarterly by the Parkinson Research Foundation, a nonprofit organization located at 5969 Cattleridge Blvd ., Ste . 100, Sarasota, FL 34232 . The material in this newsletter may be reproduced, but credit must be given to the Parkinson Research Foundation . © Parkinson Research Foundation, 2014

… there is increased hope for victory over Parkinson’s disease!

Many individuals have asked the Parkinson Research Foundation for advice on ways to include the Foundation as a beneficiary in their wills. It goes without saying that such bequests are of great value to the Foundation and play a key role in its ongoing efforts to improve the quality of life for those affected by Parkinson’s and their families.

The following language has been reviewed and is deemed a legally acceptable form for including such a bequest in a will:

“I give and bequeath to the Parkinson Research Foundation, 5969 Cattleridge Blvd., Ste. 100, Sarasota, FL 34232 for discretionary use in carrying out its aims and purposes, (the sum of $____) OR (a sum equal to ____% of the value of my gross estate at the time of my death under this will or any codicil hereto).”

Our Federal ID number is 20-0205035.

Some additional bequest options would include the bequest of a specific object of value or of the remainder of an estate after provisions for debts, general and specific bequests, and administrative expenses, including taxes.

Also, there are Charitable Remainder Trusts, which make annual payments to a beneficiary for a specific period of time (including a lifetime), after which the trust remainder is transferred to another designated organization, and Charitable Lead Trusts, which work in the exact reverse order.

The most important aspect considering or making any changes to a will is that the well-being of your own family occupies the top most position in your planning. And, for their and your protection, you should always consult an attorney about any changes you plan to make to your will.

Where There’s a Will …

Help Us Help OthersWAYS TO DONATE

The Parkinson Research Foundation relies on contributions from our generous donors to fund research and provided onsite and online services for the millions of people affected by Parkinson’s disease around the world.

Phone, Mail or OnlinePhone: To speak to our Donor Services Representative, simply call

941-870-4438.Mail: Send your check or money order payable to:

Parkinson Research Foundation, 5969 Cattleridge Blvd. Suite 100, Sarasota,FL 34232.

Online: www.parkinsonhope.org click on the donate link. Or you can navigate directly to our Network for Good page: https://donatenow.networkforgood.org/1416005.

Stocks, Securities, Mutual Funds and IRAsDonating stock and mutual fund shares are wonderful ways to help. Making a gift of securities is simple and offers a number of valuable financial benefits.

Stock Transfer Information:Investment brokerage: Fidelity Investments (Phone: 800-544-6666)DTC#: 0226Account Name: Parkinson Research Foundation, Inc.Account #: Z50054607

Wills, Bequests and Planned GiftsFor more details on Wills, Charitable Trusts, Life Insurance, Appreciated Securities, Real Estate and any other giving opportunities, please call Lynne Henry at the Parkinson Research Foundation 941-870-4438. She will be pleased to assist you.

Workplace Giving: Launch a Giving CampaignWant to get your employees fired up about donating to the Parkinson Research Foundation? Launch a workplace giving campaign!

Ask about Matching GiftsYour company might match your gift! Many employers double, even triple charitable donations. Some companies also match gifts made by retirees and/or spouses. Contact your employer for matching gift eligibility.

Healthy FatsWhat Does Fat Do?Fat is one of the three main building blocks of food, along with carbohydrate and protein. You need some fat in your diet – but not too much. Fat from food helps your body make new cells and tissues. Your body also needs fat to absorb certain vitamins.

Fat has more calories than carbohydrates or protein(1 gram fat = 9 calories; 1 gram protein or carbohydrate = 4 calories).

What Types of Fats Are in Food?Unsaturated fats are healthy fats. Types include monounsaturated fats, poly-unsaturated fats, and omega-3 fats. These fats do not increase cholesterol or triglyceride levels in the blood. Some types, such as omega-3 fats, may actually lower your triglycerides. Omega-3 fats may prevent heart disease and provide other health benefits. Choose unsaturated fats instead of the unhealthy types. Saturated fats and trans fats are unhealthy fats. These fats increase cholesterol and triglyceride levels. This puts you at greater risk of a heart attack or stroke. Limit these unhealthy fats.

Which Foods Have Healthy (Unsaturated) Fats?Monounsaturated Fats:• Some vegetable oils, including

olive oil, canola oil, peanut oil, sunflower oil and sesame oil.

• Avocados• Olives• Nut butters, such as peanut butter• Many nuts and seeds, such as

macadamia nuts, pecans, and almonds

• Polyunsaturated Fats:

• Some vegetable oils, including soybean oil, corn oil, and saf-flower oil

• Fatty fish, such as salmon, mackerel, herring and trout

• Some nuts and seeds, such as walnuts and sunflower seeds

• Omega-3 Fats:• Oily fish• Flax seeds and flaxseed oil• Walnuts and walnut oil• Canola oil

Tips for Choosing Healthy (Unsaturated) Fats• Snack on a handful of nuts or sunflower seeds.• Use olives and avocado in salads and sandwiches.• Try different nut butters (such as cashew or almond butter) in sandwiches.• To get more omega-3 fats:• Eat fish at least twice a week.• Try flax-fortified cereals and breads.• Add ground flaxseed to baked goods, cereals, soups and salads.

American Dietetic Association