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

May
01
2004

Sugar And Starchy Foods Cause Colorectal Cancer

A study from the Harvard University involving 38,000 women and having been started in 1993 has surprised the researchers. They wanted to find out whether there were certain foods that may cause colon and rectal cancer. So they administered a “food-frequency” questionnaire with 131 questions to women 45 years or older who entered into the study. Such factors as low-dose aspirin, vitamin E and beta-carotene were included in the questionnaire as was the exact food composition for the year prior to enrolment into the study.

A sugar load (glycemic load) was calculated. This way the impact of various sugar and starch containing foods could be assessed and compared among different subgroups regarding the later development of cancer in the colon and rectum.
When Dr. Susan Higginbotham and Dr. Simin Liu analyzed the diets of the 174 patients who did develop cancer (26 rectal cancers, 148 colon cancers) they found that the women with the highest sugar and starch load were 3 times more likely to develop cancer than the controls with a low glycemic load. High glycemic load foods are candy, cakes, cookies; any other refined flour products including white bread, pasta, French fries and baked potatoes. Together with other literature in this field the authors of this study concluded that the high glycemic food load leads to increased insulin levels in the blood as well as insulin-like growth factors. This in turn leads to cell division in normal and cancerous cells including the lining of the colon and rectum. In addition it is known that the C-reactive protein promotes an inflammatory response that will lead to heart attacks and to cancer.

Sugar And Starchy Foods Cause Colorectal Cancer

Sugar And Starchy Foods Cause Colorectal Cancer

Dr. Bob Bruce from the University of Toronto has shown in his research on colon cancer that insulin and related factors are important in the promotion of this cancer. He commented regarding the Harvard study reviewed here that more research is required before the exact cause of cancer of the colon and rectum would be understood. This knowledge is required before more effective preventative measures can be found other than a simple reduction of sugar and starch in the foods we eat.

Based on the Feb.4 edition of the Journal of the National Cancer Institute (U.S.) and the National Review of Medicine (Canada) March 15, 2004.

More info about Colorectal cancer can be found through this link.

Last edited October 26, 2014

May
01
2004

Age-Related Macular Degeneration Can Be Postponed

In a well-controlled study that was published earlier in 2004 Dr. Johanna M. Seddon

has shown that age-related blindness (AMD) is caused from an inflammation in the blood vessels, which is associated with an elevated blood marker, called C-reactive protein (CRP). The authors of this study also showed that the dry form of AMD would tend to deteriorate with age and/or from smoking cigarettes into the more serious wet form, a common cause of blindness.

The inflammatory component of cardiovascular disease is known to be controlled by the use of aspirin (ASA) or the statins, medication that is known to lower the bad LDL cholesterol. It is with this background that the author of the study that I am reviewing here, Dr. Jacque L. Duncan from the University of California at San Francisco, has examined the effects of ASA and of statins on AMD. 326 patients with AMD (204 with dry AMD, 104 with wet AMD from blood vessels forming underneath the retina and 18 with geographic atrophy) were followed between January 1990 and March 2003. Patients were at least 60 years old or older and followed at the San Francisco VA Hospital Eye Clinic.
Dr. Duncan found that patients with blindness due to wet AMD used ASA or statins significantly less than patients with stable AMD. Moreover, he found that patients who had AMD and took statins were 49% less likely to develop wet AMD and if they took ASA the were 37% less likely to develop wet AMD.

Age-Related Macular Degeneration Can Be Postponed

Age-Related Macular Degeneration Can Be Postponed

The study also suggests that there is a link between the inflammatory process that leads to heart attacks and strokes on the one hand and the further deterioration to blindness when dry AMD is not treated on the other hand. The notion that inflammation is the missing link in both of these processes is a relatively new finding.

More information about Macular Degeneration here.

Based on article by Dr. Jacque L. Duncan in the American Journal of Ophthalmology 2004;137: 615-624.

Last edited October 26, 2014

Sep
01
2003

Poor Lungs And Heart Attacks Related To Leptin Levels

It is known from the medical literature that poor lung function can often lead to heart attacks making it one of the important causes of premature death for patients with poor lungs (due to emphysema, chronic bronchitis, COPD etc.).

A research team led by Dr. Don Sin from the University of Alberta, Edmonton, Canada, asked the question recently whether there may be a circulating factor that would be responsible for this association of poor lung function and increased cardiovascular disease.

They studied serum leptin and a variety of other inflammatory markers such as C reactive protein, leukocytes, and fibrinogen in 2808 participants in the Third National Health, Nutrition, and Examination Survey. Apart from blood tests they also measured lung function by spirometry (forced expiratory volume in 1 second, called FEV1). The leptin levels found in these patients were then divided into 5 groups from low to high levels. They also carefully adjusted the data for body mass index, sex, age and other factors. They compared the group with the lowest leptin concentration (lowest quintile) with the highest group of leptin concentration (highest quintile) and looked for any significant differences in any of the markers.

Results: The highest quintile group (high leptin in blood samples) had also the highest other inflammatory markers in their blood (C-reactive protein, leukocytes and fibrinogen). This group was the one that was associated with advanced lung diseases as well as heart disease. The authors of this study, which was recently published in a medical journal (Thorax 2003;58:695-698), concluded that leptin plays an important role, if not the major role, in the development of both chronic lung disease and cardiovascular complications.

Poor Lungs And Heart Attacks Related To Leptin Levels

Poor Lungs And Heart Attacks Related To Leptin Levels

Links to lung disease: http://www.nethealthbook.com/articles/chronicobstructivepulmonarydisease.php
Links to heart attacks:

http://www.nethealthbook.com/articles/cardiovasculardisease_heartdisease.php

Last edited December 9, 2012

Feb
01
2003

CRP Test Better Than Cholesterol Test

At the 75th Annual Scientific sessions of the American Heart Association in Chicago several presentations centered around the use of the C-reactive protein test to evaluate risks for heart attacks, strokes and the risk of restenosing after doing a cardiac procedure to reopen stenosed coronary arteries.

I have previously reported about the use of the C-reactive protein (CRP) test in a review regarding Dr. Paul Ridker’s study in the New England Journal of Medicine.

This study is ongoing and is known under the name “Women’s Health Study”. He followed a large group of women and found that an increase of the CRP was closely associated with heart attacks. Other investigators found now that an increase of CRP is closely linked with obesity, with the metabolic syndrome (also known under “insulin resistance”) and hormone replacement therapy.

CRP Test Better Than Cholesterol Test

CRP Test Better Than Cholesterol Test

There appears to be a pivotal shift among cardiologists in that it is now clear that inflammation seems to be at the center of the process of hardening of the arteries, not just in a few cases, but in everybody who has heart disease.  Below I  summarized some of the features of CRP in a table.

C-reactive protein (CRP) and risk for heart disease
Facts: Comments:
CRP is produced by the endothelial cells that line the arteries CRP is intimately involved with arteriosclerosis. It has been identified as the culprit, which produces hardening of the arteries together with LDL cholesterol
CRP interferes with nitric oxide release from the endothelial cells, which is required for normal function this leads to a dysfunction of the lining of the arteries, atheromatous plaque formation and it stimulates scavenger cells, called macrophages, to take up LDL. CRP also causes plaque destabilization and clotting
these factors elevate CRP: obesity, the metabolic syndrome, hormone replacement in menopause with artificial hormones, but NOT with bio-identical hormones
these factors lower CRP: low carbohydrate diet, exercise, statins, rosiglitazone (Avandia), lowering of insulin

There will be a lot of information coming out in the next few years. Two major trials have been started where patients with a normal cholesterol, but an abnormally high CRP, will be followed along.

The JUPITER trial will look at the effect of treating these patients with rosuvastatin (brand name: Crestor). About 15,000 patients will be enrolled in this trial and followed for about 4 years. The Canadian 4R trial (Risk Reduction with Ramipril in patients with high CRP) uses ramipril (brand name: Altace) for 12 weeks to see whether it reduces CRP levels. Much more research is needed, but the doctors already know enough about CRP to state that it is a major player when it comes to hardening of arteries. They also know that LDL cholesterol is not outdated, as both LDL cholesterol and CRP play important roles in this process.

Based on a cardiology update in the Medical Post, Dec. 31, 2002, page 17 to 19.

Comments on Dec. 10, 2012: The 4 R Canadian study showed a tendency towards a lowering of CRP with Ramipril, but it was statistically not significant due to numbers that were too low and the observation period was not long enough. The Jupiter trial had to be abandoned after two years as there was concern of diabetes being caused by Crestor and because the effect of prevention of heart attacks was not seen early enough (the number of treatments required before a beneficial effect could be seen was too high). Here is a review why  rosuvastatin (brand name: Crestor) should be approached with caution.

Here are other links to related topics that won’t have serious side-effects:

Heart disease: http://www.nethealthbook.com/articles/cardiovasculardisease_heartdisease.php

Two things will lead to a normal weight (as you likely have heard before):

Proper nutrition…http://www.nethealthbook.com/articles/nutrition.php

…and proper exercise (fitness): http://www.nethealthbook.com/articles/fitness.php

Last edited December 10, 2012

Nov
01
2002

Heart Attack And Stroke Risk Measured With C-Reactive Protein

An old blood test that has been popular in assessing how aggressive rheumatic illnesses such as rheumatoid arthritis or lupus are, is now considered as the newest test to assess the risk of heart attacks. Up to now subfractions of cholesterol, in particular the LDL cholesterol level, has been used to assess the risk for a heart attack, but this according to a new study in the New England Journal of Medicine (Nov. 14, 2002) by Dr. Paul Ridker should be supplemented by a blood test checking for the C-reactive protein. What is interesting about the C-reactive protein is that it originates from certain lining cells in blood vessels of liver tissue when inflammatory substances circulate in the body. Other research has shown in the past that arteriosclerosis is in part due to an inflammatory process in the lining of the blood vessels that leads to the production of the C-reactive protein. Unfortunately other chronic illnesses and infections also lead to an elevation of the C-reactive protein as does the common cold or the flu. However, when 28,000 women of the Brigham and Women’s Hospital study were followed for 8 years it turned out that the C-reactive protein was a more reliable predictor for who would eventually suffer from a stroke or a heart attack than the traditional LDL cholesterol. The investigators felt that the LDL cholesterol is predictive for who is more likely to develop fatty deposits (atheromatous plaques). On the other hand the C-reactive protein appears to be more predictive for who is at a high risk for rupture of these atheromatous plaques. The bottom line is prevention by eating a diet with less fatty meats, by eating more fruit and vegetables and by engaging in an exercise program.

Heart Attack And Stroke Risk Measured With C-Reactive Protein

Heart Attack And Stroke Risk Measured With C-Reactive Protein

Some patients need their cholesterol reduced with medication such as the statins. You may want to browse through these useful related links to chapters of my free Internet based Nethealthbook: For more details regarding the use of the C-reative protein test in rheumatoid arthritis see this link: http://www.nethealthbook.com/articles/rheumatologicaldisease_rheumatoidarthritis.php Regarding arteriosclerosis, heart attacks and strokes follow this link: http://www.nethealthbook.com/articles/cardiovasculardisease_heartdisease.php

Last edited December 10, 2012