Jan
01
2005

Doctor Recommended Diet Against Obesity

After overindulging over the holidays, new years resolutions often have diets and life style choices high on the list.
These concerns are not something new. Doctors have had concerns about heart disease, diabetes, bulging waistlines and elevated cholesterol. For over three decades there have been concerns that elevated insulin levels may be associated with heart disease, and the constellation of symptoms was called “syndrome X” and later the “insulin resistance syndrome”.

Most recently the evils that are associated with body fat have been called the “metabolic syndrome”.The problem has assumed epidemic proportions: by 2001, 30% of US adults were considered obese with a body mass index of over 30, and 50% were overweight with a body mass index over 25. The form of type 2 diabetes (the adult onset of the disease) is predicted to double in the next 20 years. Physicians are reporting that they are seeing increasing numbers of children who are obese and suffer of type 2 diabetes. The major concern with an accumulation of body fat is the area of the abdomen (think of the “apple shape” with fat around the abdomen). This visceral fat tissue is not just innocently sitting there stopping you from closing buttons and zippers. It is very metabolically active and the substances it releases are a threat to your health. These fat cells secret pro-inflammatory substances called “cytokines.”

They also form substances that influence blood-clotting, factors that increase insulin resistance, substances like angiotensin, which are signing responsible for high blood pressure as well. Among the host of damaging substances is also the C-reactive protein, which is recognized as a risk factor for heart disease.

Doctor Recommended Diet Against Obesity

Doctor Recommended Diet Against Obesity

There is only one solution: to reduce the risk, excessive weight has to be shed. A sensible diet to achieve that goal has to contain less saturated fat, more fiber, and low glycemic index carbohydrates. Proper dietary habits are only one part. The other as important measure is life style intervention, which includes 2.5 to 3 hours of moderate exercise per week.
Many of the current diets promise weight loss without compromising health. All of them promote weight loss, provided they are strictly adhered to.
The high protein diets (Atkins, Protein Power Plan) are useful for rapid initial weight loss, however due to the overload of protein long term use is highly questionable. Kidney dysfunction as a consequence is a threat to health and no benefit at all!
Moderate carbohydrate diets, moderate fat, as well as moderate protein will remain the answer for long-term life style changes. It is also of significance that the glycemic index of carbohydrates plays a major role. Food intake, which favors carbohydrates with a low glycemic index, is associated with less heart disease. It has also been documented that insulin levels are more stable. Low glycemic carbohydrates include most vegetables, beans, lentils, as well as fruit like apples, pears and oranges. In contrast, high glycemic carbohydrates result in a fast insulin release, which ultimately leads to insulin resistance. Among these items are potatoes, crackers and other flour products, rice, puffed or flaked breakfast cereals, and tropical fruit (papayas, pineapple, melons).

For short-term dieters, it is an option to embark on any of the current diets without deleterious effects, no matter whether they are high-carb or low-carb. But at this point only the diets with moderate carbohydrates have shown to have some benefits on heart health.
Ultimately the wiser choice is to consume foods with a low to moderate glycemic index, by increasing the intake of vegetable proteins and oils and by choosing increased servings of vegetables and fruit instead of highly processed items. So, when you next walk through your supermarket, remember that most of the good stuff is in the periphery, namely the area where all the fresh, unprocessed or minimally processed foods are found.

More info about Mediterranean diet: http://nethealthbook.com/news/mediterranean-diet-benefits-us-workers/

Reference: Metabolic Syndrome Rounds, Oct. 2004, Vol. 2, Issues 8, St. Michael’s Hospital, University of Toronto/On/Canada

Last edited October 27, 2014

Nov
01
2004

Flax Seed A Source Of Omega 3

Prevention has been gaining more momentum for public health as well as for the health conscious individual. Instead of looking at salvation from a slew of diseases like arteriosclerosis, high blood pressure, osteoporosis, Alzheimer’s, and the complications from diabetes in the form of super pills, prevention looks a lot more promising.
Flax seed has been around for several thousand years, but it has been making a name for itself as part of healthy eating.

Its most important components are its fiber content, the alpha-linoleic acid, and the lignans. Eating flax seed helps to mop up cholesterol in the bowel, and studies have shown a drop in the “bad” LDL cholesterol levels. Duke University is publishing results that show flax seed to be helpful in blocking prostate cancer. A publication going back to August 2001 in the Archives of Ophthalmology point out the fact, that the omega-3 fatty acids, which are contained in flax seed, reduce the risk of macular degeneration. The same omega-3 fatty acids also have a favorable influence in the glucose response after a meal, a fact that is important for the prevention of diabetes.

It has to be mentioned at this point, that flax seed oil does not have all the benefits, as the fiber has been removed, and some of the benefits get lost as a result of the temperature used with processing. Also, just eating a spoon full of flax seeds will not be the answer, as flax seed is not fully used during digestion (the seeds are simply excreted in a bowel movement). To unlock the benefits it is best, to grind the seed.

Flax Seed A Source Of Omega 3

Flax Seed A Source Of Omega 3

A coffee mill does the job well enough, and freshly ground seeds are better than the pre-ground variety that has been sitting around in the bin of a store for some time. Two teaspoons of ground flax seed mixed with some yogurt and fruit makes for a good starter in the morning or an easy evening snack. A slice of flax seed bread does not give you the benefits; remember that heat during cooking or baking destroys the key components.
The nice part about flax seed is the fact, that it is inexpensive, plentiful, has no adverse side effects*, and it is the ounce of prevention which is readily available to you.

More info on Omega-3: http://nethealthbook.com/news/inflammation-extinguished-omega-3/

Reference: The Medical Post, October 12, 2004, page 13

* Comments (added Aug.28, 2005): Despite the Duke University study cited above there are disturbing news from a 14 year follow-up prospective study that has been confirmed by other studies showing that there are side-effects. This study showed that in males there is a 2-fold risk of developing invasive prostate cancer when flax seed was the supplement used. As flax seed contains alpha-linolenic acid (=ALA) and fish oil contains eicosapentaenoic acid (=EPA), there are striking differences of action that have not yet been defined in more detail. The same study showed that over 14 years EPA (when mixed with DHA) lowered the risk of getting invasive prostate cancer by 26%. Until it is known more how flax seed works, it likely is wiser to to take a molecularly distilled EPA/DHA supplement daily as this also reduces the cardiovascular risk, but at the same time prevents cancer.

Last edited October 27, 2014

Nov
01
2004

Weight Gain After Quitting Smoking A Myth

The fear of gaining weight after quitting to smoke tends to be a fear among a number of smokers, but a study presented at the annual congress of the European Respiratory Society in Glasgow in 2004 may very well put these fears to rest.
Dr. Audrey Lynas, a respiratory specialist at Sunderland Royal Hospital reported a study on 622 patients with chronic obstructive pulmonary disease (a late effect of smoking). The body mass index was not different from those who continued to smoke than those who were ex-smokers. Both groups had a BMI of 26, and five years down the line, they still haven’t put on any weight, reported Dr. Lynas.

According to a 2002 survey in Britain, 30% of female smokers and 14% of male smokers said, that they would not try to quit, as they were afraid of gaining weight. Even patients with COPD (the previously mentioned chronic obstructive lung disease) may be influenced by this fear, even though it is crucial for them to quit in order to stop the progression of their lung disease.

It seems logical, that quitting the cigarette habit is not associated with weight gain. However, if nibbling becomes a substitute for smoking, frequent snacks lead to an overload of calories.

Weight Gain After Quitting Smoking A Myth

Weight Gain After Quitting Smoking A Myth

Weight gain will be the consequence of the additional munching. Stop smoking is not the culprit for weight gain.

More on weight loss here: http://nethealthbook.com/health-nutrition-and-fitness/weight-loss-and-diet/

Reference: The Medical Post October 5, 2004, page 7

Last edited Oct. 27, 2014

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Oct
01
2004

Studies Show Ginseng Works

As early as 25 A.D. a medical journal praised ginseng “the imperial herb” because of its nontoxic and rejuvenating properties. In the meantime 16-31% of Americans have consumed ginseng in the hope to increase their health and wellness. It is mostly the root of ginseng, which is used for medical purposes, and it is sold either whole, as a powder, or as a water- or alcohol based extract.
Among the many medically active ingredients, the ginsenosides are the most intensely studied substances.
There are well designed clinical studies which have tested ginseng’s ability to modulate diabetes, heart disease, mental function and physical performance. In the meantime there is enough evidence, which shows that Panax quinquefolius (its botanical name) can reduce blood glucose in individuals with and without type 2 diabetes.
Another study examined ginseng and its influence on blood pressure readings. Patients with type 2 diabetes (adult onset diabetes) who received a dosage of 3 grams daily over a period of 8 weeks achieved a reduction in their blood pressure readings, making it safe to take and also as an adjunct in the management of blood pressure.

Cognitive performance may be influenced positively by ginseng, however it is dependent on the dose, which is used. A lower dose of 200 mg reduced the mental performance, whereas a dose of 400 mg significantly improved accuracy in a demanding test.
Ginseng has not found to be effective to improve physical performance or be a weapon against fatigue.
In a 12- week trial patients received ginseng as a general supplement together with multivitamins or multivitamins alone. Ginseng significantly improved the quality of life, which could not be achieved with multivitamins alone.

Studies Show Ginseng Works

Studies Show Ginseng Works

Taking all the findings together, it is evident, that ginseng has beneficial properties for patients with diabetes, and it is also useful to improve cognitive function. Ginseng may reduce blood pressure readings, but more studies are needed. The blood pressure reducing effect seems marginal and ginseng, if taken for this purpose, should be used only as an adjunctive treatment along with the regular medication. As far as physical performance is concerned, it seems to be of little use. It does not show any interaction with prescription drugs, and for this reason it can be considered safe for general use.

More info on:

Diabetes: http://nethealthbook.com/hormones/diabetes/type-2-diabetes/

Heart disease: http://nethealthbook.com/cardiovascular-disease/heart-disease/

Alzheimer’s disease: http://nethealthbook.com/neurology-neurological-disease/alzheimers-dementia-and-delirium/

Reference: The Whitehall-Robins Report, September 2004, Vol.13,No.3

Last edited Oct. 27, 2014

Oct
01
2004

What Went Wrong With VIOXX

Merck &. Co., Inc. announced on Sept. 30, 2004 that VIOXX® (rofecoxib), an arthritis and acute pain medication, would be withdrawn voluntarily worldwide. VIOXX was FDA approved as a new anti-inflammatory drug for osteoarthritis in 1999. Later it was also cleared for rheumatoid arthritis. As a Cox-2 inhibitor it was different from aspirin and the conventional anti-inflammatory drugs such as Naproxen, Motrin or Voltaren.

In a study called VIGOR , which is detailed more under this link, VIOXX was compared to Naproxen in terms of gastrointestinal side-effects. It was found that the risks of bleeding ulcers, perforation and bowel obstruction were 50% reduced (frequency of cases with naproxen 1.22% versus VIOXX with a frequency of 0.52%). Surprisingly, in this study of 4000 patients over 1 year the cardiovascular risks such as heart attacks, strokes, blood clots for VIOXX was 1.8%, 3-fold higher than Naproxen, which had only 0.6% such complications. In addition it was noted that high blood pressure was more common in rheumatoid patients. The FDA made Merck add a warning on the drug label regarding these added risks, but this went more or less unnoticed by the public.

It has been known for some time that aspirin (ASA) has polyp preventative action on the colon and thus reduces the risk of colon cancer. A specific study, called APPROVe (Adenomatous Polyp Prevention on VIOXX) trial, was designed to show that VIOXX could do the same as aspirin, but with less toxic side effects. In 2000 Merck started enrolling patients into this 3 year long trial.

What Went Wrong With VIOXX

What Went Wrong With VIOXX

After 18 months into the trial cardiovascular side-effects started to show up that were statistically significant when compared to controls. This is what prompted the recent press release that VIOXX would be taken off the market altogether.

More info on treatment of osteoarthritis: http://nethealthbook.com/arthritis/osteoarthritis/treatment-osteoarthritis/

Comments: One of the potential problems with receptor specific medications is that they can be so specific that the metabolism in the human body is changed. What’s good for the gut may not be good for the circulation, blood pressure and the heart. Merck did the right thing to withraw the medication altogether. It is not known at this time whether other similar medications such as Celebrex, which has a different molecular configuration, will stand up in the future to post-marketing testing.

Addendum on Nov. 6, 2012: In 2005 Bextra was also taken off the market by the FDA, but Celebrex was allowed to stay, but required to label their product with warnings about potentially serious side-effects.

Last edited October 27, 2014

Sep
01
2004

Second Hand Cigarette Smoke Kills

A recent publication in the British Medical Journal was reviewed in the Aug.10 issue of The Medical Post. The study was concerning detailed census data from New Zealand where two cohorts of the population were compared in 1981 and 1996.

The 1981 study involved 286,796 people, the 1996 study involved 382,462 people. Both cohorts were further classified into exposure to second hand smoke and non-exposure meaning that they lived in a smoke-free home (controls). I have elected to show the results in a graph below for ease of reference. The authors Dr. Tony Blakely and others from the University of Otago had followed each cohort for 3 years and recorded death rates (mortality rates) for each of the subgroups.

They pointed out that there was a 15% increase in premature death for those exposed to second hand smoke when compared to the controls who were not exposed.

Comments: 1. The mortality in the 1996 study (in blue bars in the graph below) for males is what the authors quoted (15.1%). However, for females, the death rate was even higher with regard to exposure to second hand smoke: mortality was 26.7% higher when the exposed group is compared to the controls.

Second Hand Cigarette Smoke Kills

Second Hand Cigarette Smoke Kills

2. The 1981 study (green bars in the graph below) had a much higher overall mortality than the overall mortality in the 1996 study (blue bars). This likely is due to the 15 year interval between the two study groups and the fact that during that time in New Zealand as in many other industrialized countries the death rate from cigarette smoke exposure has declined significantly.

One such study indicates a reduction between 1981 and 1997 of 38% in all preventable deaths, which includes death as a result of exposure to cigarette smoke. The average death rate reduction in the New Zealand study over the 15 years was 31.7% for men and 29.35% for women when the exposed groups and control groups were pooled.

3. The controls and the relationship of the subgroups within the 1996 study (the blue bars in the graph below) were very consistent , but were not consistent within the 1981 study (green bars).

For instance, the controls of death rates should always be smaller in both males and females when compared to the groups that were exposed to second hand cigarette smoke. In the 1996 study this was the case, but in the 1981 study this was not the case. This may indicate that there were other negative factors included in the 1981 study leading to premature death or that the controls were simply also exposed to cigarette smoke in the past.

Mortalitiy Rates (%) Resulting From Exposure to Second Hand Smoke in New Zealand Study
 Second Hand Cigarette Smoke Kills1

Conclusion: This is an important study as it is based on large numbers and it shows that even relatively small concentrations of cigarette smoke in the environment make a measurable difference in terms of death rates among the population. It also confirms the fact that the death toll has been reduced by about 30% in the population within 15 years (between 1981 and 1996), because many people have quit smoking during that time period and this is measurable as indicated above (green bars higher on average than blue bars).

More info on:

Heart attacks: http://nethealthbook.com/cardiovascular-disease/heart-disease/heart-attack-myocardial-infarction-or-mi/

Lung cancer: http://nethealthbook.com/cancer-overview/lung-cancer/

Reference: The Medical Post, Aug. 10, 2004, page 48

Last edited October 27, 2014

Sep
01
2004

Stop That Heart Attack

There is a window of opportunity for the patient who is rushed to hospital with a heart attack.

To be precise: if the patient is brought to hospital without delay, and there are changes in the ECG, which traces the heartbeat, and there are changes that point to the possibility of a heart attack, there is a chance to administer medication that prevents blood clots. If these “clot busters” are administered within one hour, as many as 25 % of heart attacks in the making can be aborted. This procedure is called “fibrinolysis”.

Dr. Paul Armstrong, professor of medicine at the University of Alberta, explains, that the aborted heart attack (or “aborted MI”) is a new term in cardiology. If treatment is received early, the patient will avoid heart muscle damage. Even if the treatment with the anti-clotting medication is given after only two hours, the patients still have a more favorable outcome. Patients with aborted heart attacks also have smaller infarcts than those who go on to have a full-blown MI (or heart attack). Dr. Armstrong points out that it is important to not only watch out for known high-risk factors (previous coronary artery bypass surgery, hypertension and diabetes), but also to pay close attention to treating the patient early.

Stop That Heart Attack

Stop That Heart Attack

More info on heart attacks: http://nethealthbook.com/cardiovascular-disease/heart-disease/heart-attack-myocardial-infarction-or-mi/

Reference: The Medical Post, July 27,2004, Vol.40, No. 29,pg.8

Last edited October 26, 2014

Aug
01
2004

Uric Acid Blood Test Predicts Future Health Problems

A 12 year prospective, well controlled follow-up study from Finland determined that uric acid blood tests are not only useful in following patients with gout or kidney stones, but are also predictive for future health problems including death. Dr. Leo K. Niskanen from Kuopio University in Finland and colleagues followed 1,423 middle-aged Finnish men who at the beginning of the study were free from cancer, heart disease, strokes and diabetes. After about 12 years the researchers found that 157 men had died, 55 from heart disease or strokes. When men with elevated uric acid levels were classified into low, medium and high levels, an interesting observation was made when subclasses were compared with each other. Those men in the upper range of uric acid levels had a risk of more than 2.5-fold to die from a heart attack or stroke when compared to men with uric acid levels in the lower range. Also, men in the higher range were 1.7-fold more at risk to die from any cause than men in the lower range of uric acid levels.

Dr. Niskanen said that uric acid simply seems to be another good marker for spotting troubles in health. The mechanism of this connection is not known at this point in time, but the test is easy to do and is very useful in screening a middle aged population.

Risk of Developing a Heart Attack or Stroke with Elevated Uric Acid Blood Test

Uric Acid Blood Test Predicts Future Health Problems1

Uric Acid Blood Test Predicts Future Health Problems

 

 

 

 

 

 

 

 

 

Other investigators in the past have also observed a similar association, but this seems to be the first longterm and prospective study.

More info on:

1.heart attacks: http://nethealthbook.com/cardiovascular-disease/heart-disease/heart-attack-myocardial-infarction-or-mi/

2. strokes: http://nethealthbook.com/cardiovascular-disease/stroke-and-brain-aneurysm/

3. Gout: http://nethealthbook.com/arthritis/gout/

Reference: Arch Intern Med 2004;164:1546-1551

Last edited October 26, 2014

Aug
01
2004

Birth Control Pill Increases Strokes And Heart Attacks

At the recent 86th Annual Meeting of the Endocrine Society in New Orleans/Louisiana a Canadian delegation presented data from a meta-analysis of 14 trials regarding side effects of the birth control pill (BCP) when taken on a prolonged basis. The researchers were interested to know the risk of heart attacks or strokes that would be associated with the prolonged use of the low dose estrogen BCP. All of the studies between 1980 and October of 2002 were examined and 14 independent studies qualified for the meta-analysis. The strength of such a meta-analysis lies in the pooling of data and the fact that the data is derived from a much larger patient population, which generally makes the results more reliable. Dr. J. Baillargeon from the Centre Hospitalier Universitaire in Sherbrooke, Quebec/Canada, stated that they found a 1.85-fold risk for developing heart attacks with longterm use of the BCP and at the same time there was a risk of 2.54-fold of hemorrhagic strokes with longterm use of the low-dose BCP.

I have depicted these findings below in graph form where the risk is readily seen when compared to women who did not use any birth control pills. In discussions following this presentation the authors explained that with short-term use of the BCP using the modern low dose formulations heart attacks and strokes would likely not be noticeable.

Birth Control Pill Increases Strokes And Heart Attacks

Birth Control Pill Increases Strokes And Heart Attacks

But women should know that long-term use does have this risk. These decisions of whether to take the BCP and for how long needs to be discussed with the treating physician also in the view that other risks such as high blood pressure, diabetes or the metabolic syndrome would be added risks where heart attacks and strokes can occur more frequently. In these conditions the BCP likely should be avoided.

Risk of Developing Heart Attack or Stroke after Longterm Use of The Birth Control Pill
 Birth Control Pill Increases Strokes And Heart Attacks1

 

 

 

 

 

 

 

 

 

Dr. Ricardo Azziz, chairman of obstetrics and gynecology at the Cedars-Sinai Medical Centre in Los Angeles, California, stated that these findings from this meta-analysis would be very important because it was based on such a large data base and was measuring the effect of the BCP over a long period of time. He stressed that the benefits of any medication must always be weighed against the risks by the treating physician. In diabetic patients on the BCP, for instance, the benefits likely outweigh the risks as the metabolism is stabilized through an improved insulin sensitivity, improved managability of the diabetes and avoidance of the high risk pregnancies in diabetics.

More info on:

Heart attacks: http://nethealthbook.com/cardiovascular-disease/heart-disease/heart-attack-myocardial-infarction-or-mi/

Strokes: http://nethealthbook.com/cardiovascular-disease/stroke-and-brain-aneurysm/

Reference: The Medical Post, Vol.40, July 20, 2004, page 20

Comments on Nov. 6, 2012: What was not discussed by these experts is the fact that the BCP contains a mix of two artificial hormones (estrogen and progesterone equivalents) that the body’s estrogen and progesterone hormone receptors cannot recognize. Bio-identical estrogen and progesterone creams on the other hand would be recognized by these receptors, but nobody has researched their use for BCP purposes, only for post-menopausal hormone replacement.

Last edited Oct. 26, 2014

Aug
01
2004

Too Much Fat Fuels Metabolic Syndrome

In a review article for physicians from the St. Michael’s Hospital of the University of Toronto (see reference below) Dr. Monge outlined some of the newer human research where links were found between the lining of the blood vessels and the hormones produced by fat cells that lead to the complications of the metabolic syndrome. In obese people there is a cluster of conditions such as high blood pressure, high blood sugar, high cholesterol, lipid abnormalities and high insulin levels, which is known as “metabolic syndrome”. Another name that was used for this condition in the 1990’s was “syndrome of insulin resistance”.

Dr. Monge pointed out that blood vessel health depends on the fine balance between two opposing forces. On the one hand there is a system that leads to blood vessel spasm, blood clotting, growth promoting, inflammation causing and oxidizing. On the other hand there is a system that is responsible for blood vessel relaxation, growth inhibition, blood clot dissolving, inhibiting inflammation and antioxidant activity. Complex changes occur in our metabolism when we put on pounds and accumulate too much fat. It is important to realize that fat is not just sitting there, but is composed of highly active fat cells that respond to insulin and growth factors and in turn produce a number of hormones and factors that affect the cells that are lining the blood vessels. Inflammatory cytokines are produced by fat cells that attack the blood vessels by producing atheromatous plaques, causing them to accumulate fat again and help in the processes that lead to rupture of the plaques.

Too Much Fat Fuels Metabolic Syndrome

Too Much Fat Fuels Metabolic Syndrome

The end result is that the deadly interplay between the fat cells and the endothelial cells lining the blood vessels tips the balance between the two systems mentioned above to the point where heart attacks and strokes suddenly occur.

There are two complex pathways that are involved in this process and that are linked to what was stated above. One crucial aspect of this involves nitric oxide, a small molecule that is normally produced by the endothelial lining cells and that is needed for normal circulation of the heart muscle, skeletal muscles and internal organs. This protective system is where much of the derangement of normal metabolism occurs with regard to the metabolic syndrome.

Dr. Monge pointed out that with these newer insights into the complex metabolic changes associated with the metabolic syndrome in obese people, there will be very practical results in the near future. Anti-inflammatory medications are already being utilized and some of the anti-diabetic medications have been shown to reduce the risk of heart attacks. It is hoped that sensitive tests will be developed to measure the hidden endothelial dysfunction at a time when preventative steps are still effective or early intervention can be done.

More info on the metabolic syndrome: http://nethealthbook.com/hormones/metabolic-syndrome/

Reference: Metabolic Syndrome Rounds (April 2004): J.C. Monge “Endothelial Dysfunction and the metabolic syndrome”

Last edited Oct. 26, 2014