Dark Chocolate: Cardiovascular Prevention

A study from Australia predicts that if 10,000 men with big bellies and the “metabolic syndrome” (abdominal obesity, diabetes, hyperlipidemia , hypertension)  ate 100 grams of  dark chocolate daily, it would prevent 70 non-fatal and 15 fatal heart attacks per year.  The total yearly cost of the chocolate is less than $50 per patient.   Recent studies have shown that dark chocolate can reduce high blood pressure and lower lipids.  This study was based on a model that predicted the effects of dark chocolate lasting for 10 years when, in fact, true research studies have not lasted that long.

This is a promising avenue of research involving a food substance that most of us enjoy.  For my patients, almost any food in moderation produces success.

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Soda – Does it Cause Asthma and COPD?

With the USA dealing with a youth epidemic of obesity we have been educated as to the large amount of sugar and calories we get from drinking a can of  carbonated soda pop or pouring a glass of soda.   Vending machines for soda as well as fountain service have been removed from schools and school cafeterias in an effort to stop the youth intake of cheap inefficient calories.  Nobody criticizes the occasional use of soda pop in moderation but the continued use at 250-500 calories per 8 ounce serving will cause anyone to gain weight easily.

We now have another disease entity to think about. Australian researchers, in a pulmonary journal named  Respirology, have published the results of a “cross sectional study” that seems to link drinking at least a half liter of soda per day with the development of asthma and chronic obstructive lung disease.   By design, cross sectional studies will not show that drinking a half liter of soda a day is a cause of asthma or COPD, but it certainly can establish a relationship.

US researchers looking at the preliminary data seem to feel that individuals who consume that much soda a day probably have a poor overall diet and pay poor attention to their overall health putting themselves at risk for many types of diseases.  Additional research is needed on the subject but the message is clear, keep your soda intake to occasional use at moderate levels until more is known.

Bariatric Surgery Reverses Diabetes – But What About Seniors?

A recent well written article in the Fort Lauderdale Sun Sentinel discussed how bariatric surgery to treat extreme obesity was also now a formidable weapon against Type II Diabetes Mellitus.   Type II Diabetes Mellitus or adult onset diabetes occurs in older individuals and is closely related to weight gain, high blood pressure, elevated cholesterol, triglycerides and accelerated narrowing of arteries. The accelerated artery-narrowing results in premature and advanced coronary artery disease and peripheral arterial vascular disease.  A study published in the American Journal of Medicine in 2009 looked at 3,188 obese Type 2 diabetics who had bariatric surgery and lost weight.  Amazingly, 78% of them no longer met the criteria to be called diabetics.

Bariatric surgery includes minimally invasive surgery such as laparoscopic adjusted gastric banding to the more invasive re-routing of the intestines and reduction of stomach volume in the classic Roux-en-Y gastric bypass. Other procedures include open duodenal switch and vertical banded gastroplasty.  These types of procedures are only performed in the morbidly obese defined as those with a Body Mass Index (BMI) of 40 or greater.  The results in reversing Type II diabetes have been so impressive that experts are now considering reducing the BMI to 35 for consideration of candidacy to have these procedures.

Why these procedure reverse diabetes is a matter of debate. Weight loss is a traditional successful treatment for Type II diabetes. Some believe that the actual surgery on the gut stimulates hormones that help control the blood sugar. The positive result has led insurance companies to now start approving payment for these procedures because the $18,000- $30,000 cost is cheap compared to the $300,000 lifetime cost of treating a Type II diabetic.

With so many elderly obese patients with Type II Diabetes, and other metabolic and cardiovascular complications of obesity in the health system, is the procedure safe for the elderly?  A recent study by Robert B. Dorman M.D., at the University of Minnesota seemed to indicate that the surgery is safe.  He looked at 48,378 patients with a BMI above 35 who had bariatric surgery between 2005 and 2009.  He found that the mortality rate for seniors over 65 was higher than for younger patients but was still extremely low and rare for a death to occur. Longer hospital stays were noted for the elderly and were related to how heavy the patient was prior to surgery.  This study gives bariatric surgeons excellent figures on the risk of complications when performing bariatric surgery in the elderly.

As a primary care physician working with elderly Type II Diabetics, I will continue to stress lifestyle improvement with dietary improvement, weight reduction, increased exercise and activity as first line therapy.  Medication when necessary will be next. Bariatric surgery, now proven to be safe is a new weapon available to the proper patient.  Finding an experienced surgeon in performing the procedures (more than 200 of that procedure) will be paramount in reducing complications and mortality.

Dutch Diet Drink Reduces Hunger

Obesity is an epidemic negatively impacting our health in America and around the world.  According to the National Center for Health Statistics, over 68% of American adults are overweight or obese.  As we move away from a hard working agrarian society to a society which consumes fast food while getting less activity due, in part, to our technological advances, we are always looking for aids to keep our weight down.

In recent years the pharmacological approach has fallen on hard times due to the many significant side effects associated with diet medications.  Expensive surgery to reduce the stomach size and re-route the intestines has met with mixed success, high costs and adverse effects as well.

Last month, Harry Peters, a research manager of Unilever Research and Development in the Netherlands announced preliminary successful results of a prototype diet beverage. He and his staff concocted a chocolate flavored brew that stayed liquid and palatable when you drank it but firmed up into a thick gel when exposed to the acidic and digestive juices in the stomach.  The gel distended the stomach and produced a sense of satiety and fullness with a resultant decrease in appetite in the vast majority of the study participants. The research is quite preliminary but again presents hope to those of us fighting the battle of the bulge.

“Although the self-reported decreases in hunger are robustly reported in this study, further studies are needed to establish its implications for food intake, compliance to weight loss programs and long-term effects on weight loss or weight maintenance,” Peters and colleagues concluded.

Reducing Triglyceride Levels

The American Heart Association along with Michael Miller, M.D., director for the Center for Preventive Cardiology at the University of Maryland – School of Medicine in Baltimore, just released data and recommendations that diet and lifestyle changes alone should be sufficient to reduce elevated triglyceride levels.

The researchers analyzed more than 500 international studies conducted over the last 30 years for the purpose of updating doctors on the role of triglycerides in the evaluation and management of cardiovascular disease risks. The study confirmed that triglycerides are not directly atherogenic but are instead a marker of cardiovascular disease risk.  High triglycerides are commonly seen in diabetes mellitus, chronic kidney disease and certain disorders associated with HIV disease. Alcohol and obesity plus inactivity all contribute to elevated levels with TG levels rising markedly in this country since the mid 1970’s in concert with the obesity epidemic we are now seeing.

Triglycerides are checked on a fasting blood test of optimally 12 hours with the upper limit of normal set at 150mg/dl. Newer recommendations will reduce the level to 100 mg/dl.  If your triglycerides are elevated the study made the following suggestions to lower them to appropriate levels:

  1. Limit your sugar intake to less than 5% of calories consumed with no more than 100 calories per day from sugar for women and no more than 150 calories per day from sugar for men.
  2. Limit Fructose from naturally occurring foods and processed foods to less than 50 -100 grams per day
  3. Limit saturated fats to less than 7% of total calories
  4. Limit trans-fat to less than 1% of total calories.

Elevated triglycerides, especially above 500 mg/dl, are associated with an increased risk of pancreatitis. For individuals with TG levels this high we recommend complete abstinence from alcohol.

Exercise is necessary to lose weight and lower triglyceride levels as well. Physical activity of a moderate level such as brisk walking for at least 150 minutes per week (2.5 hours) can lower your triglycerides another 20-30%.

If lifestyle changes including diet modifications and aggressive exercise do not bring you to target levels we suggest the addition of marine based omega 3 products. Also, eat fleshy cold water fish!

A combination of dietary changes, moderate regular exercise and weight reduction is all that is needed to control most problems with triglycerides.  Referrals to registered dietitians can be very helpful in assisting you with the dietary changes required to be successful.

It’s Proven – High Activity Levels Keep Us Healthy and Slim

A recent article in the Journal of the American Medical Association clearly pointed out that those individuals who maintain a high activity level over a twenty year period gain less weight than individuals with a low activity level.  The Association followed 3,554 men and women in Chicago Illinois, Birmingham Alabama, Minneapolis Minnesota and Oakland California over twenty years.  They found that men with a high activity level gained about 12 pounds less than inactive men. The weight difference in women was more profound at 25 pounds.

This study clearly pointed out that the reduction in weight gained was extremely significant as adults entered middle age. The duration of daily exercise required to obtain this benefit was only about thirty minutes. Walking twenty minute miles provided the benefit.

If staying thin and trim isn’t a strong enough incentive to stay active, then avoiding colds and flu is an additional incentive. A recent study cited that individuals who exercised regularly for thirty minutes a day five days a week had fewer colds than sedentary individuals. When they were unlucky enough to catch a cold, the illness was shorter and less intense. The researchers hypothesized that exercise moved the blood and cells responsible for immunity through the system more frequently and this contributed to the protective effect.

There is currently an epidemic of obesity in the United States.  According to the National Health and Nutrition Examination Survey, as published on the Centers for Disease Control and Prevention web site, 73.7% of American adults are either overweight or obese.

  • 34.2% are overweight
  • 33.8% are obese
  • 5.7% are extremely obese

Staying active, making good choices concerning portion size and food groups is all part of the strategy to keep Americans healthier. It is all part of a formula to stay healthy that you should talk to your doctor about annually.