Archive for health
If you have not read the salt piece:
or the follow up info:
here’s your opportunity to catch up on all the discussion.
Also, do not forget the clock is ticking to get your free Dr. Mike Live at The Florida Blueberry Festival Cook book. Just head to the Facebook Fan Page and download from there!
Water is so essential for proper health! It is a key to maintaing ing a healthful diet and proper weight. Make sure you are drinking enough. Please view this heart month PSA and share!
February is National Heart Awareness Month, with a particular emphasis on Women’s Heart Health issues through the Go Red Campaign. Join me and the folks at the Health and Wellness Channel as we provide you series of short public service announcements with heart smart tips, important information and timely advice on a variety of health and heart related topics!
Read part 1 of a 2 part sereis from the Tampa Tribune here:
A recent study last month by the Centers for Disease Control (CDC)[i] highlighted the ongoing epidemic rise in the incidence and prevalence of diabetes. In 1995, age-adjusted prevalence was ≥6% in only three states, DC and Puerto Rico. However, just fifteen years later in 2010 it was ≥6% in every state, DC and Puerto Rico. In six states and Puerto Rico more than 1 in 10 persons is diabetic. In 2010 there were estimated to be over 25 million people in the United States with diabetes; almost 19 million diagnosed and an additional 7 million undiagnosed. The increase was across every age group, every ethnicity and racial group and both sexes. It increased in every region across the United States. The largest increase was in the South followed by the West, the Midwest and the Northeast.
Although some of the increase is due to increased survival and decreasing mortality in those persons with diabetes, the major driver is the fact that there are simply more people with the disease. There are many factors which contribute to the development of diabetes. However, there is no denying that the increase in diabetes parallels the increasing American waistline. Just as exercise confers a diverse set of benefits, physical inactivity confers a number of risks including extra poundage. Combine physical inactivity with the typical Western diet and you have the recipe for diabetes.
As a cardiologist I am often asked for advice and recommendations regarding exercise and diet. A reasonable and regular exercise program has innumerable benefits, no major downsides and is clearly something most of us don’t get enough of. However, when it comes to food it seems the majority of the advice from so-called ‘health experts’ involves deprivation, elimination or just plain denunciation. And the easiest guy in the room to pick on is the fat guy. Literally.
As a chef and a food person, that just makes me furious. Since an aggressive campaign was started in the 1970s to reduce the percentage of fat in the typical American diet, Americans have in fact continued to reduce not only the percentage of fats, but saturated fats in particular. This trending decrease in fat consumption clearly does not correlate with the increase in obesity and diabetes. Dr. Walter Willett, chairman of the department of nutrition at the Harvard School of Public Health, notes simply that “(f)at is not the problem.”[ii]
Fat is essential for good health providing the substrate for a number of important compounds and hormones. In fact, there are specific essential fatty acids that are called essential because they are necessary for life. Across all forms of media we are barraged with the message to consume heart healthy omega-3s for their purported cardiovascular and general health benefits. Omega-3s are fats. Fats also act as important transport vehicles for compounds like the fat dependent vitamins A, D, E, and K. In addition, fats transport an innumerable number of flavor molecules. They provide foods with that certain mouth feel, umami, often described as the fifth taste. The current recommendations for a heart healthy diet include 25% – 35% of total calories from fat[iii]. That’s more than one third of our daily calories from fat.
The common and misguided method to direct people to healthful eating is often to simply remove the fat in an attempt to reduce the overall caloric intake. This thoughtless and flavorless approach to ‘healthy eating’ becomes neither. Simply removing the natural fats found in wholesome and delicious foods and replacing them with highly processed, adulterated and shadowy substitutions is not a thoughtful solution. Sacrificing flavor on the altar of caloric reduction by removing the fats robs us of important balance in our diet, flavor in our food and joy in our lives.
Better to spend our daily allotment of caloric currency on items of value. Fresh, balanced and foods as nature intended them prepared with craft and care are the choices for healthful living. These items provide nutrition for our bodies and food for our soul. These are always the better choice, the better value; no matter how many weapons of mass consumption they cram into a sack for a dollar or how many calories have been reduced by transforming a delectable bastion of yumminess into a zombified shadow of its former self.
[i] (Geiss, Li, Kirtland, Barker, Burrows, & Gregg, 2012)
[ii] (Marni, 2010)
[iii] (Hoogwerf & Huang, 2012)
Geiss, L. S., Li, Y., Kirtland, K., Barker, L., Burrows, N. R., & Gregg, E. W. (2012, November 16). Increasing Prevalence of Diagnosed Diabetes — United States and Puerto Rico, 1995–2010. CDC Morbidity and Mortality Weekly Report (MMWR), pp. 61(45);918-921.
Hoogwerf, B. J., & Huang, J. C. (2012). Cardiovascular Disease Prevention Lipid-Lowering Strategies and Reduction of Coronary Heart Disease Risk. Cleveland, Ohio (page 12): The Cleveland Clinic.
Marni, J. (2010, December 20). A reversal on carbs. The Los Angeles Times, pp. http://articles.latimes.com/2010/dec/20/health/la-he-carbs-20101220.
Is there something fishy in the claims intimated by those hawking fish and omega-3 oil supplements? You betcha! If you have not already read it, get the detailed scoop in my article published in Outside Magazine:
Recent studies continue to confirm what I wrote several months ago. The latest was a review of several previous studies looking at fish consumption versus just supplementation with fish and omega-3 oils. The study was published in the British Medical Journal and found that consuming “fish, particularly oily fish, a couple of times a week may help protect you against stroke, but fish oil supplements don’t have the same effect.” The amount of fish consumed was modest, only two (or more) servings per week; yet this resulted in a 6-12% stroke reduction.The study looked at 38 previous trials encompassing over 794,000 people.The authors conclusion resonates with what I have said, and what is highlighted in The Grassroots Gourmet approach featured in Eating Well, Living Better -available at Amazon.com here:
“These findings therefore suggest that single nutrients may have limited effects on chronic disease outside of their original food sources.”
Chowdhury, R. et al. “Association between fish consumption, long-chain omega 3 fatty acids, and risk of cerebrovascular disease: Systemic review and meta-analysis.” BMJ 2012; doi:10.1136/bmj.e6698
During a recent radio interview, I was asked to comment on the benefits of exercise. Now mind you, the segment only had another 5 minutes or so, sans commercial interruption, so I decided to concentrate on some lesser known and more recently revealed exercise benefits.
Most everyone is aware of the positive effects exercise can have on the cardiovascular system. People are quite aware that regular exercise is a critical adjunct to any successful long term weight loss plan. However, the benefits of exercise are now extending beyond the conventional wisdom.
Increasingly exercise is being recognized as a potent therapy for treating depressive symptoms and disorders. In these increasingly stressful times we seem to be more and more inundated with quick fix pills and programs for everything and anything that might trouble us. There seems to be a rapid rise in the type and number of psychotropic medications available to treat those times you feel trapped with Debbie Downer-not to mention little Debbie can lead you astray with her cakes and cookies. All these recourses come with an important and potent list of side effects and disclaimers.
Previous research had shown that for middle aged women, regular exercise was as potent as a single anti-depressive medication in decreasing the signs and symptoms of depression; without the side effect profile. Now that list is expanding.
A recent study published in the Journal of the American College of Cardiology reported that ninety minutes of aerobic exercise per week reduced depressive symptoms in patients with stable coronary heart disease (CHD) to the same extent as did sertraline (an anti-depressive medication)[i]. The study examined over 100 patients. In particular, they researchers looked at a group of coronary heart disease patients who met the criteria for major depressive disorder. They found that exercise was more likely to alleviate their depressive symptoms than sertraline therapy; 40% in the exercise group compared to 10% in the sertraline group. All this benefit with a better side effect profile; 20% of the sertraline group reported worsening fatigue compared to only 2.4% of the exercise group. Only 2.4% of the exercise group experienced increased sexual problems, but 26% of the sertraline group reported issues.
Another study recently published in the Journal of the American Medical Association found similar results among patients suffering from heart failure[ii]. This study confirmed that modest exercise, 90-120 minutes per week reduced depressive symptoms in heart failure patients. This is important as we are increasingly becoming aware of how our mental and emotional well-being is inextricably linked to our physical state of health. The study’s author, Dr. Blumenthal from Duke University, noted that this is particularly meaningful “in light of the growing evidence that depression is associated with increased risk for fatal and nonfatal events in a wide range of CHD populations.”
In fact, the reduction in depressive symptoms in heart failure patients translated into a modest but real reduction in the incidence of death and need for hospitalization in this group. The mind is a powerful organ and implicit in an understanding of the mind is an acknowledgement that there is a powerful emotional aspect. This is an inescapable aspect of who we are and affects our health as forcefully as drugs and disease. Exercise does a body good. That’s a fact we are all well aware of; now you know it does your mind good as well.
[i] (James A. Blumenthal, et al., 2012)
[ii] (James A. Blumenthal, et al., 2012)
James A. Blumenthal, P., Andrew Sherwood, P., Michael A. Babyak, P., Lana L. Watkins, P., Patrick J. Smith, P., Benson M. Hoffman, P., et al. (2012). Exercise and Pharmacological Treatment of Depressive Symptoms in Patients With Coronary Heart DiseaseResults From the UPBEAT (Understanding the Prognostic Benefits of Exercise and Antidepressant Therapy) Study. Journal of the American College of Cardiology, doi:10.1016/j.jacc.2012.04.040.
James A. Blumenthal, P., Michael A. Babyak, P., Christopher O’Connor, M., Steven Keteyian, P., Joel Landzberg, M., Jonathan Howlett, M., et al. (2012). Effects of Exercise Training on Depressive Symptoms in Patients With Chronic Heart FailureThe HF-ACTION Randomized Trial. The Journal of the American Medical Association, 308(5):465-474.
Much like the French Paradox of the late 1990′s, the current obesity paradox remains an enduring mystery; a Bermuda Triangle of medicine. For several years now, many a well done study has demonstrated a reduction in the incidence of cardiovascular and other morbidity and mortality in those over the ideal body mass index (BMI) of 18-25. The groups having the best outcomes are often in the overweight, and in some cases in the slightly obese category, according to BMI measures. To some extent that was attributable to the overall poor job that BMI does as a measure of obesity, something covered many times here in the blog (search the archives for BMI to catch up!). However, this new wrinkle to obesity paradox might even have Stephen Hawking scratching his head. It is remarkable because a better correlate to obesity, waist circumference was also used as a measure. In men, a waist circumference of 40 inches or more indicates a high risk group. For women, it is 37 inches or more that is considered high risk. Even more intriguing was the improved survival of the heavier group with heart failure; a condition for which previous studies have shown obesity to be a risk factor for developing. Heart failure has many causes, but the end result is a condition in which the heart muscle is weakened and unable to pump efficiently enough to meet the demands of the body. A condition, by which all conventional wisdom would agree should be exacerbated by increased weight.That’s not what the data showed.A study done at The University of California found that adults with heart failure who were overweight or obese had lower risk of death. Their survival was superior to both underweight (a known higher risk group) and those with a “normal” BMI (between 18-25). Not only was the risk of death lower, but the higher weight groups were less likely to require a heart transplant or suffer other related morbidities. The study examined approximately 2,700 heart failure patients. The participants were followed for two years. The study found men with a high waist circumference and a high BMI were more likely to survive and were less likely to need a heart transplant. Overweight and obese women also fared better than normal-weight women. The cardioprotective effect was significant: men with a normal BMI and smaller waist circumference had a 34 percent higher risk for adverse outcomes and normal-weight women had a 38 percent higher risk for adverse outcomes.An interesting hypothesis suggested by the study authors involves increased serum lipoproteins (molecules in the body which transport fats), which they suggest may have anti-inflammatory properties. Fascinating food for thought-for those attending the American Culinary Federation national Convention in Orlando, Florida next week, Dr. Mike will be lecturing on this and related topics.
Horwich, T. et al.American Journal of Cardiology, July 1 2012
For those that missed it, here is the recap of the radio interview about The Affordable Healthcare Act and its implications; a detailed and apolitical commentary. If you enjoy this, please pass it along and share. It is important people know the information so we can all make up our own minds, based on the data. Thanks again to Josh Tolley for allowing us to discuss on the program!
Aspirin is an inexpensive, highly effective and arguably underutilized therapy in treating atherosclerotic disease; especially in those patients already with some form of cardiovascular pathology. In looking at all groups (young/old, male/female, diabetic/non-diabetic, etc.) aspirin demonstrates a benefit in reducing mortality and future cardiovascular non-fatal events (cardiovascular morbidity). There is roughly a 25% reduction in all combined endpoints including all-cause mortality (16% reduction), vascular death (17% reduction), non-fatal stroke (25% reduction) and non-fatal myocardial infarction or a heart attack that doesn’t kill you (34% reduction). These data are derived from combining a number of studies examining over 100,000 patients world-wide. For every thousand patients with cardiovascular disease, it is estimated that 40 patients avoid a major vascular event every year simply by taking an aspirin a day. The cost (remember that all medicine is about balancing risk and reward) is that 1-2 people will suffer a major bleed and about 8% will experience gastrointestinal and minor bleeding. A risk/benefit analysis in favor of taking a daily aspirin for those at risk. The economics are a no-brainer. Moderate alcohol consumption has also been associated with a decrease in cardiovascular morbidity and mortality. Over sixty prospective studies have been done and there is a preponderance of evidence that moderate alcohol consumption, for example 1-2 glasses of wine per day, is associated with a significant cardiovascular risk reduction. A recent study published in the European Heart Journal specifically examined the risk of those who had a first heart attack. The study findings were in agreement with what has been seen before; those that consume a moderate amount of alcohol have a lower risk of death from heart disease than those that do not drink alcohol at all. Those that consume excess have increased morbidity and mortality. The study examined over 1,800 men who survived a first heart attack between 1986 and 2006. The follow-up period extended as long as 20 years for some study participants. For those that consumed roughly two alcoholic drinks per day there was a 14% lower risk of all-cause mortality death from any cause, and a 42% lower risk of cardiovascular death. These reductions were achieved in addition to the benefits of aspirin therapy. This is better living through ancient pharmacology.