Category: Prior Clinic Blog
STUDY: Inflammation is the key
JOURNAL: American Journal of Cardiology 08 2003
AUTHORS: Dr. Hecht
ABSTRACT: The rate at which plaque builds up in the coronary arteries seems to be unaffected by how much LDL ("bad") cholesterol is lowered using so-called statin drugs such as Zocor or Lipitor.
COMMENTARY: As Dr. Harvey S. Hecht of Beth Israel Medical Center, New York, said, "the question of whether or not 'lower is better' for LDL cholesterol is unresolved."
His research suggests that "lower is not necessarily better," at least in patients who have hardening of the coronary arteries but who do not yet have symptoms.
Dr. Hecht, along with Dr. S. Mitchell Harman of Kronos Longevity Research Center, Phoenix, Arizona, came to this conclusion after studying 182 patients with "subclinical atherosclerosis."
The duo measured the amount of calcified plaque in the participants' coronary arteries, using a technique called electron beam tomography, before and after a year of lipid-lowering treatment with statins alone or in combination with niacin.
As the researchers explain in the American Journal of Cardiology, treatments that aimed to lower LDL cholesterol to 80 milligrams per deciliter (mg/dL) or less were deemed more aggressive, those with a target of greater than 80 mg/dL were deemed less aggressive.
Despite a greater improvement in LDL levels in the more aggressively treated group, the researchers found that annual rate at which plaque increased (9.3%) was no different from that in the less aggressively treated group (9.1%).
STUDY: Watch your teeth
JOURNAL: Stroke, August 1, 2003
AUTHORS: Dr. Moise Desvarieux
ABSTRACT: Previous studies have linked tooth loss with cardiovascular disease, but now, new findings indicate that it also occurs more often in people who have a build-up of cholesterol plaque in their arteries (atherosclerosis), but who don't have symptoms.
COMMENTARY: In the Oral Infections and Vascular Disease Epidemiology Study (INVEST), Dr. Moise Desvarieux, from the University of Minnesota in Minneapolis, and colleagues evaluated periodontal disease, tooth loss, and plaque in the arteries of the neck in 711 subjects.
The subjects were 66 years of age, on average, and none had a history of stroke or heart attack. The severity of periodontitis was directly related to tooth loss.
In addition, the presence of plaque in the neck arteries was significantly associated with the extent of tooth loss. For example, 46% of subjects missing 9 or fewer teeth had such plaques, compared with about 60% of subjects missing 10 or more teeth.
However, plaques were actually less common among people missing 20 or more teeth than among those missing 10 to 19 teeth.
AUTHORS: William McCrea
ABSTRACT: Cardiac patients at a British hospital are being prescribed two glasses of red wine a day in the hope that this may prevent further heart complications.
COMMENTARY: William McCrea, a heart surgeon at the Great Western Hospital in Swindon, west England, told the media the idea came from looking at the health statistics of France.
"As a nation they consume twice the amount of fat we do, they smoke more and don't do any more exercise than us, but their rate of deaths from heart attacks is half ours. What's the difference? They drink red wine like we drink tea."
Unfortunately for any of his wine-loving patients, McCrea also believes that cheaper red wines are best, as they will contain more antioxidants than top-quality wines that have been kept for years in the barrel.
His favourites are said to include Pinot Noir, Cabernet Sauvignon and Shiraz.
The experiment is being paid for by the hospital's own charity rather than the National Health Service.
STUDY: TV and Obesity
JOURNAL: Pediatrics 2002;109:1028-1035
AUTHORS: Dr. Barbara A. Dennison
ABSTRACT: As America's kids continue to pack on the pounds, a team of doctors recommends a simple step that parents can take to lower their preschooler's risk of obesity: removing the TV from the child's bedroom.
COMMENTARY: Their study of low-income youngsters aged 1 to 5 years found that kids with TV sets in their bedrooms watched nearly 5 hours more TV and videos a week and were more likely to be overweight than their peers without bedroom TV sets regardless of the parents' education. Black and Hispanic children tended to watch more television than their white peers did, according to the report in Pediatrics.
The findings support other research showing that body mass index (BMI), a measure of weight in relation to height, tends to increase in tandem with the number of hours spent in front of the TV set among older children. However, few studies have examined whether TV-watching was associated with excess weight among younger kids.
Parents should not put TVs in their child's bedroom and (should) limit their child's TV viewing to 1 to 2 hours a day.
In the United States, nearly one quarter of low-income children younger than 5 years are overweight. Excess weight in childhood raises the risk for adult obesity and increases the chances of developing heart disease, type 2 diabetes and other chronic diseases.
Therefore, future studies should investigate whether watching fewer hours of television or removing TV sets from kids' bedrooms can help lower the rate of childhood obesity, the researchers suggest. In an interview, Dennison added that future studies should also investigate the relationship between overweight and having a TV in the bedroom among children from wealthier families.
The American Academy of Pediatrics recommends that parents limit children's total media time to 1 to 2 hours of quality programming per day, remove television sets from children's bedrooms and discourage television viewing for children younger than 2 years. Parents are also encouraged to view television programs with children and discuss the content.
The study findings are based on a survey of more than 2,700 low-income parents with preschool-aged children. Nearly 40% of kids had a TV set in their bedroom, raising their risk of overweight by nearly one third.
Black children watched nearly 18 hours of TV a week, Hispanic youngsters watched about 15 hours and white children watched nearly 13 hours of television each week. About 43% of Hispanic children were overweight, compared with 35% of black children and 33% of white children.
Because most children watch TV by age 2, educational efforts about limiting child TV/video viewing and keeping the TV out of the child's bedroom need to begin before then.
STUDY: New research suggests not all calories equal
JOURNAL: American Dietetic Association
AUTHORS: Donald Layman
ABSTRACT: For years diet doctors have criticized Americans for yo-yo dieting. But looking at the protein advice given by nutrition specialists over the past year or two, it seems instead that it’s the experts who’ve been bouncing back and forth with no clear advice for confused consumers.
COMMENTARY: At one time or another, protein, carbohydrates and fats have all been vilified. These days, when you sit down to a meal it seems as if you’re facing a traitor in every bite.
A prime example of recommendation flip-flopping is the experts’ advice on protein. Back in the 1960s, Americans were told they would be healthy if they ate lots of meat. But over the next two decades, health experts began to promote high-carbohydrate diets and to warn Americans against eating too much protein.
When the low-carbohydrate, high-protein Atkins’ diet first came out 30 years ago, and again after its recent resurgence in popularity, mainstream experts came out strongly against it: protein — along with fat — is what is killing Americans, they intoned.
In fact, in 2000, the American Heart Association published several statements critiquing the regimen. The association insisted that there was no evidence showing that high-protein meals could lead to weight loss and they might even hurt the dieter’s kidneys and rob strength from the bones.
A year later, the heart association backed off these statements a bit and simply argued that weight loss seen by those following the protein gurus was simply “fluid loss.” And still they warned against deviations from the USDA’s Food Pyramid.
NEW PROTEIN RANGES
But the tide seems to be turning yet again.
The latest nutrition guidelines seem to reflect confusion even among the experts. No longer are there hard and fast numbers for the percentages of major food groups. Now protein can range from 10 percent to 35 percent of daily intake. At the annual meeting of the American Dietetic Association, nutritionists basically admitted that they really don’t know how much protein Americans need.
And several new studies have shown that diets that have moderately high levels of protein can lead to weight loss that targets fat and spares muscle, said Donald Layman, a professor in the department of food science and human nutrition at the University of Illinois, Urbana-Champaign.
While all low-calorie diets lead to weight loss, recent research has shown that not all calories are created equal, Layman said at the meeting. For example, one new study looked at two groups of dieters: one with a high-protein regimen —125 grams of protein and 171 grams of carbs — and one with a high-carbohydrate regimen — 68 grams of protein and 246 grams of carbs. Both groups were also required to exercise.
At the end of four months, people who ate more protein lost more weight — 22 pounds versus 15 pounds. Further, people on the high-protein diet had lost more fat and less muscle than the group on the high-carb diet.
Another important finding: higher levels of protein may also help dieters stick with their plans.
Studies have shown that protein, more than carbohydrates or fat, leads to feelings of fullness and satiety, said Richard Mattes, a professor of foods and nutrition at Purdue University.
People given a high-protein breakfast feel full longer than those who eat a carbohydrate-rich breakfast, Mattes said.
Mattes also cautioned that the form of protein consumed makes a difference. Solid protein is satisfying. Protein in liquid form is not.
Ultimately, the percentage of protein you need will depend on whether you are dieting or not, said Cathy Nonas, of the New York Obesity Research Center in New York City. “If you’re on a 1,200 calorie a day diet and want to lose weight and you’re only eating 10 percent protein, you’re not getting enough protein to support lean tissue. Even 20 percent isn’t enough to support lean tissue. Studies have shown that you need to get at least 76 grams of protein, so that means you have to go to the upper ranges of the protein recommendations for a 1,200 calorie diet.”
But Nonas and the other experts stopped short of recommending the very high levels of protein suggested by eating plans like the Atkins’ diet because these plans so drastically cut carbohydrates — the initial phase of the Atkins’ diet limits carbohydrates to 20 grams a day. T
That’s because carbohydrates are the major source of fiber in the diet. Just cutting carbohydrates back to 50 percent of your diet would be enough, Nonas said, and that would still allow for enough carbs to be within the range recommended by the ADA.
You can increase lean protein and decrease carbohydrates and still have a really healthy mix.
Remember to start your day with protein and have some form of protein at every meal.