HealthDay reported, “Teens who consume large amounts of the food and beverage sweetener fructose show evidence of cardiovascular disease and diabetes risk in their blood,” according to a study published in the Journal of Nutrition. Continue reading
The Los Angeles Times “Booster Shots” blog reports, “They’re called ‘risk factors’ for a reason – people with high blood pressure, diabetes, high cholesterol and/or a smoking habit are much more likely to have heart attacks, strokes and other manifestations of cardiovascular disease, including death,” according to a study published in the New England Journal of Medicine. Continue reading
When it comes to the consumption of alcohol, the message has been decidedly mixed. Some studies show that moderate consumption might offer some health benefits, especially for the heart; other studies show an increased risk for certain cancers, especially breast cancer, with even the consumption of a very small amount of alcohol. What’s a woman to do? Continue reading
The Wall Street Journal reports that medications used for the treatment of attention-deficit/hyperactivity disorder (AD/HD) appear NOT to raise the risk of serious cardiovascular disease (CVD) in adults, according to a study published in the Journal of the American Medical Association. Continue reading
The Detroit Free Press discussed the advantages of healthy eating and exercise. “The American Heart Association says cardiovascular disease is the No. 1 cause of death in the US. Changing what you eat can help get you off medications and improve your cholesterol and blood pressure numbers.” Continue reading
The Los Angeles Times “Booster Shots” blog reports, “Fat kids often turn into fat adults with a host of related health problems: diabetes, high blood pressure, clogged arteries.” However, a study published in the New England Journal of Medicine “finds that if those heavy kids lose weight, they may be on a par with people who were never overweight.” Continue reading
In my book, SuperSized Kids: How to protect your child from the obesity threat, I stunned many readers when I wrote, “In obese children, their vascular age generally is three decades older than their chronological age.” Because of this, childhood obesity lowers life expectancy from eight to twenty years! Continue reading
So, for adding small amounts of salt to your food, should you use salt from the earth or salt of the sea (sea salt)? Recently a reader wrote to ask after seeing TV ads from fast-food restaurants that seem to indicate that french fries seasoned with sea salt are somehow safer and healthier. What’s the truth? Continue reading
CocoaVia and Cirku are new supplements used for high blood pressure and cardiovascular health according to the Natural Medicines Comprehensive Database (NMCD). These products are flavored powders that can be added to a beverage. Each packet contains a cocoa extract providing 350 mg of cocoa flavanols. Those selling the supplements say they may reduce heart disease, but do they? Continue reading
More research is showing that even small amounts of aerobic exercise help lower coronary heart disease risk. The newest review was published in the journal Circulation, the journal of the American Heart Association, and should encourage even the most sedentary of us to being moving physically. Continue reading
Being satisfied with your life can be good for your heart. That’s the finding of a new study that included almost 8,000 British civil servants, average age 49, who were asked about their satisfaction in seven areas of their lives: romantic relationships, leisure activities, job, family, sex, standard of living and one’s self. Continue reading
In the past I’ve told you that children younger than two years of age should have NO screen time, while children over two should have less than two hours per day. Now we may have to extend this advice to adults. Continue reading
In a number of previous blogs, I’ve warned you of the risks of too much TV for your kids. Now we have a new and far scarier risk to consider — the development of premature cardiovascular disease . Continue reading
While writing this blog, I was listening to Simon and Garfunkel singing, “Slow down, you move too fast. You need to make the morning last.” At the same time, I found a Bloomberg News report claiming that “working overtime may be a killer, according to research that finds long hours on the job is a heart risk along with smoking, bad cholesterol and high blood pressure.” Continue reading
Last week my blog, Diet soda consumption may be linked to increased heart attacks and strokes, was one of my most read postings in some time. Some commented that perhaps they would switch from diet to regular soda. NOT a good idea at all, and here’s another reason why:
Readers of this blog over the last year, have seen many of my posts on the plethora of studies and recommendations about vitamin D. Now there’s some new data I think you’ll be interested in. Continue reading
An easy-to-remember formula for good health (0, 5, 10, 30, 150) is proposed in a wonderful editorial in American Family Physician titled “Preventive Health: Time for Change.” The author suggests this formula to physicians to “help patients achieve healthy lifestyle goals”:
- 0 = no cigarettes or tobacco products
- 5 = five servings of fruits and vegetables per day
- 10 = ten minutes of silence, relaxation, prayer, or meditation per day
- 30 = keep your BMI (body mass index) below 30
- 150 = number of minutes of exercise per week (e.g., brisk walking or equivalent)
The editorial is penned y Colin Kopes-Kerr, MD, from the Santa Rosa Family Medicine Residency in Santa Rosa, California:
It is time to make a decision. Which will be our health promotion strategy—primary prevention or secondary prevention?
Traditionally, the only one available to us was secondary prevention. Medicine consisted of a one-on-one physician-patient relationship, and taking care of patients meant minimizing the impact of any diseases the patient had. We did not have the time or tools to do anything else. More recently, we have been able to reduce a patient’s mortality by 20 to 30 percent by treating heart disease with a statin or beta blocker. These two medications have had the most dramatic effects in secondary prevention.
But now, the way we practice medicine has changed. We have a real choice to make. According to recent literature, primary prevention appears to work better than any other strategy in medicine. So why do some physicians not implement primary prevention? Despite the literature, maybe physicians are not getting the news. We need to keep repeating the message to physicians and patients that primary prevention is simple and effective. Next, we need to take a look at our own behavior as physicians and determine if it makes sense in the context of primary prevention.
There are 10 major studies on the effects of primary prevention.(1–15) These studies demonstrate very large correlations between specific healthy lifestyle behaviors and decreases in major chronic diseases (e.g., diabetes mellitus, heart disease, stroke, cancer) and all-cause mortality.
Although these studies offer a complex array of data to sift through, the elements of a healthy lifestyle are clear: not smoking, regular exercise, healthy diet, healthy body weight, and reduced stress.
Although exercise guidelines vary, I ascribe to the U.S. Department of Health and Human Services’ Physical Activity Guidelines for Americans, which recommends at least 150 minutes of brisk walking or the equivalent per week.(16) For the diet criterion, the Atherosclerosis Risk in Communities study illustrates that merely consuming five servings of fruits and vegetables per day is associated with the same benefits as consumption of a Mediterranean-style diet.(11) A standard of five servings of fruits and vegetables is much easier to remember and adhere to.
There is strong support for at least one weight-related variable in a healthy lifestyle. This may include body weight, body mass index (BMI), waist circumference, or waist:hip ratio. The INTERHEART study showed waist:hip ratio to be the most predictive of cardiovascular disease.(6) However, unlike BMI calculation, measurement of weight:hip ratio has not yet become standard in U.S. practices. I use BMI as the metric, and a value less than 30 kg per m2 as the cutoff between a healthy and unhealthy lifestyle. The goal is to move away from this outer limit toward a more ideal parameter, such as less than 25 kg per m2.
The final variable of a healthy lifestyle, which has strong support from the INTERHEART study, is stress reduction.(7) The INTERHEART study offers useful suggestions for measuring stress—perception of severe stress at home or at work, financial stress, or major life events.(7)
The minimal lifestyle intervention that would be beneficial is not defined. However, 15 to 20 minutes of silence, relaxation, or meditation appears to be a common interval.(17) To be more inclusive of patients, I set the criterion to an even less restrictive amount, about 10 minutes per day.(17) This is enough time to produce a change in biorhythms and is achievable for most patients.
Information alone does not lead to behavior change, however. Motivational interviewing or brief negotiation is a new framework that can close the gap between knowledge of available lifestyle interventions and changing behaviors. The framework has already been proven markedly effective for tobacco, drug, and alcohol addiction.(18) Few physicians have received the training necessary to implement motivational interviewing or brief negotiation. Resources for learning about these skills include the Kaiser Permanente Medical Group Web site and the book Motivational Interviewing in Health Care: Helping Patients Change Behavior.(18)
In terms of health, we can have it all. We have the requisite tools to convert knowledge into healthy behaviors. This newfound power to reduce diabetes, heart disease, stroke, cancer, and all-cause mortality with primary prevention strategies should impel us to change how we counsel patients. Research is needed to explore why some physicians are not making this change.
Address correspondence to Colin Kopes-Kerr, MD, at firstname.lastname@example.org. Reprints are not available from the author.
Author disclosure: Nothing to disclose.
- Stampfer MJ, Hu FB, Manson JE, et al. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 2000;343(1):16–22. View here
- Hu FB, Manson JE, Stampfer MJ, et al. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. N Engl J Med. 2001;345(11):790–797. View here
- Forman JP, Stampfer MJ, Curhan GC. Diet and lifestyle risk factors associated with incident hypertension in women. JAMA. 2009;302(4):401–411. View here
- Knowler WC, Barrett-Connor E, Fowler SE, et al.; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346(6):393–403. View here
- Knoops KT, de Groot LC, Kromhout D, et al. Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA. 2004;292(12):1433–1439. View here
- Yusuf S, Hawken S, Ounpuu S, et al.; INTERHEART Study Investigators. Effect of potentially modifiable risk factors associated with myocardial infraction in 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):937–952. View here
- Rosengren A, Hawken S, Ounpuu S, et al.; INTERHEART Investigators. Association of psychosocial risk factors with risk of acute myocardial infarction in 11119 cases and 13648 controls from 52 countries (the INTERHEART study): case-control study. Lancet. 2004;364(9438):953–962. View here
- Chiuve SE, McCullough ML, Sacks FM, et al. Healthy lifestyle factors in the primary prevention of coronary heart disease among men: benefits among users and nonusers of lipid-lowering and antihypertensive medications. Circulation. 2006;114(2):160–167. View here
- Chiuve SE, Rexrode KM, Spiegelman D, et al. Primary prevention of stroke by healthy lifestyle. Circulation. 2008;118(9):947–954. View here
- Kurth T, Moore SC, Gaziano JM, et al. Healthy lifestyle and the risk of stroke in women. Arch Intern Med. 2006;166(13):1403–1409. View here
- King DE, Mainous AG III, Geesey ME. Turning back the clock: adopting a healthy lifestyle in middle age. Am J Med. 2007;120(7):598–603. View here
- Khaw KT, Wareham N, Bingham S, et al. Combined impact of health behaviours and mortality in men and women: the EPIC-Norfolk prospective population study [published correction appears in PLoS Med. 2008;5(3):e70]. PLoS Med. 2008;5(1):e12. View here
- Ford ES, Bergmann MM, Kröger J, et al. Healthy living is the best revenge: findings from the European Prospective Investigation into Cancer and nutrition–Potsdam study. Arch Intern Med. 2009;169(15):1355–1362. View here
- Lee CD, Sui X, Blair SN. Combined effects of cardiorespiratory fitness, not smoking, and normal waist girth on morbidity and mortality in men. Arch Intern Med. 2009;169(22):2096–2101. View here
- Djoussé L, Driver JA, Gaziano JM. Relation between modifiable lifestyle factors and lifetime risk of heart failure. JAMA. 2009;302(4):394–400. View here
- U.S. Department of Health and Human Services. 2008 physical activity guidelines for Americans. View here.
- Dialogue Partner. View here
- Rollnick S, Miller WR, Butler CC. Motivational Interviewing in Health Care: Helping Patients Change Behavior. New York, NY: Guilford Press; 2008. View here
For the last couple of years, I’ve been offering my adolescent patients the option of checking their lipid panels, especially if they are overweight or obese. Now, new research is showing the wisdom of this approach. The Wall Street Journal reports that research published in the Annals of Family Medicine suggests that even younger people should pay attention to their cholesterol levels, being that they may have an impact on health later in life.
The Los Angeles Times “Booster Shots” blog reported that researchers “analyzed data from 3,258 men and women who have been tracked by the CARDIA , or Coronary Artery Risk Development in Young Adults, study for the last 20 years and were ages 18 to 30 at the start of the study.”
The investigators “found that participants with histories of high levels of the ‘bad’ LDL cholesterol were five and a half times as likely to have a buildup of calcium in their coronary arteries … than those who had optimal LDL cholesterol levels.”
The researchers also found that “rates of coronary calcium buildup were also higher in those who had suboptimal levels of the so-called ‘good’ cholesterol, high density lipoprotein, or HDL cholesterol, although this association was weaker.”
The New York Times reports in Vital Signs that “young adults tend to be notoriously lax about preventive health care, and cholesterol screening is no exception,” according to the new study.
Barely “half of all young men and women are screened for high LDL, the so-called bad cholesterol,” according to the study by the CDC’s Elena Kuklina and others.
The research was based on “analysis of data on 2,587 young adults — including men aged 20 to 35 and women aged 20 to 45.”
Kuklina said “young adults should be screened, because heart disease is a chronic condition that can begin damaging blood vessels at an early age.”
In our practice we’ve certainly found scores of kids with surprisingly abnormal lipid panels. I, my patients, and their parents are certainly glad we did.
Readers of this blog are well aware than many (if not most) Americans have insufficient to deficient levels of vitamin D. Other than prescribing oral vitamin D or vitamin D-containing foods, we doctors were left with prescribing a little sunshine. But, we know that exposing your skin to unprotected UVA or UVB light can increase your risk of skin cancer. And, there has been controversy about exactly how much sunlight one might need to avoid vitamin D supplements. Now, I may have an answer for you.
But, first a few basics. Vitamin D is essential for bone mineralization and may have a wide variety of other health benefits. Here are just a few I’ve blogged about:
- Vitamin D Supplementation and Cancer Prevention
- Vitamin D helps fend off flu and asthma attacks
- Increasing vitamin D levels may cut heart disease risk
- Vitamin D Supplementation Helps Prevent Falls in Older Adults
- Vitamin D Linked to Lower Heart Risk
- Can Vitamin D Ease Fibromyalgia Pain?
- In Lab Tests Vitamin D Shrinks Breast Cancer Cells
- Vitamin D May Lower Colon Cancer Risk
- Daily Calcium Plus Vitamin D Supplements May Reduce Fracture Risk
- Low levels of vitamin D may be linked to greater asthma severity
- Heart patients lacking vitamin D more likely to be depressed
- More reasons to consider having your vitamin D level checked – you may think better and have less arthritis
- Vitamin D tests soar as deficiency, diseases linked
Experts disagree on the serum vitamin D level necessary to maintain health. Some recommend concentrations above 30 ng/mL and consider the range between 20 and 30 ng/mL insufficient and concentrations lower than 20 ng/mL deficient. In our area, most experts are recommending level of 50 ng/mL (and, indeed, we are supplementing to this level).
By this reckoning, many, perhaps most, Americans are vitamin D insufficient or deficient.
Because it is difficult to obtain enough vitamin D from food intake, oral supplements and sunlight have been recommended for individuals with low serum D levels.
The suggested dose for supplements is 400 to 1000 IU/day.
It has also been suggested that a few minutes of sunlight each day to the face, neck, hands, and arms are all that is necessary to restore vitamin D sufficiency, but the amount of sunlight required for photoconversion of 7-dehydrocholesterol to pre–vitamin D varies considerably depending on a person’s age, Fitzpatrick sun-reactive skin type, geographic location, and season.
The six Fitzpatrick skin types classify sensitivity to ultraviolet light; skin type I is fair skin that always burns, never tans; type III is darker white skin that burns and tans; type V is brown skin that rarely burns, tans easily.
Investigators in a new study employed the FastRT computational tool to predict the length of daily exposure required to obtain the sunlight equivalent of 400 and 1000 IU oral vitamin D supplementation.
At noon in Miami, someone with Fitzpatrick skin type III would require 6 minutes to synthesize 1000 IU of vitamin D in the summer and 15 minutes in the winter.
Someone with skin type V would need 15 and 29 minutes, respectively.
At noon in the summer in Boston, necessary exposure times approximate those in Miami, but in winter, it would take about 1 hour for type III skin and 2 hours for type V skin to synthesize 1000 IU of D.
After 2 PM in the winter in Boston, it is impossible for even someone with Fitzpatrick type I skin to receive enough sun to equal even 400 IU of vitamin D.
About this study, Craig A. Elmets, MD, writes, “These findings raise serious questions about the recommendation that a ‘little bit’ of outdoor sun exposure is sufficient to maintain adequate vitamin D levels.
“Moreover, predictions of the time required to achieve adequate vitamin D photosynthesis are probably underestimates, because it is unlikely that people would walk around Boston for an hour or two in the winter with face, neck, and arms exposed.
“These findings corroborate another study that casts doubt on sun exposure as a way to prevent vitamin D deficiency.”
The bottom line is that it looks like oral vitamin D supplements are going to end up being shown to be the safest and most effective to gain adequate vitamin D levels.
Today, I have three blogs to encourage all of you who, when you wake up at the crack of dawn each day need your coffee. Some of you think it’s healthy. Some of you worry it may not be. So, I hope these blogs will bring you the latest “medical news that you can use” on the health benefits and risks of a beverage that’s chock full of antioxidants … coffee. This first blog report is an excellent review of the published data published in USA Today:
“I’m up every morning by 5 o’clock. Coffee gets the energy going,” says the owner of Natalia’s Elegant Creations in Falls Church, Va.
Kost-Lupichuk is among 56% of American adults who drink coffee regularly, the National Coffee Association says.
Though many refer to their java habit as an unhealthy indulgence, experts say that in moderation, a cup or two of joe a day actually has numerous health perks.
“People always talk about it as if it’s a little bad for you. That’s not necessarily true,” says Donald Hensrud, associate professor of Preventive Medicine and Nutrition at the Mayo Clinic. “Coffee contains over 2,000 different chemical components, including cancer-fighting anti-oxidants.”
Some studies suggest coffee can boost vision and heart health, says registered dietitian Elisa Zied, author of Nutrition at Your Fingertips. Research also has suggested coffee helps people with liver disease, but it has had mixed results when it comes to diabetes.
But be aware of how much caffeine you’re consuming, because it varies among coffee drinks, says Mary Rosser, assistant professor of obstetrics and gynecology at Montefiore Medical Center in the Bronx, N.Y.
Loading up on cream and sugar is a bad idea, Hensrud says. A Starbucks venti 24-ounce double chocolate chip frappucino has 520 calories, 14 grams of saturated fat and 75 grams of carbohydrates. Pregnant women and people with anxiety and sleep problems should especially watch their intake, he says.
Also, people metabolize caffeine differently — the result of genetic differences, Hensrud says.
Caffeine’s influence can last for 10 hours or more, says researcher Jim Lane, a professor of medical psychology at Duke. He recommends pacing yourself throughout the day: “It’s nice to have places to meet friends that aren’t alcohol-related, but it does sort of encourage people to ignore the drug effects of caffeine.”
More on coffee’s perks and pitfalls:
Recent research suggests caffeine could help protect against cognitive decline, including Alzheimer’s disease and other dementia, says Mayo’s Hensrud. Large clinical trials are still needed, though, says Duke aging expert Murali Doraiswamy. “We still don’t know the right dose for seniors,” Doraiswamy says. “Bottom line: I would not recommend caffeine solely as a preventive strategy for dementia.”
Convinced you need a morning cup to wake up? Research online this month in Neuropsychopharmacology suggests frequent coffee drinkers develop a tolerance to the anxiety-producing and stimulatory effects of caffeine. A study last month suggests those who consume caffeine perform better on the job.
Coffee exacerbates bad breath, Zied says. It also can give teeth a yellow tinge.
Although research suggests drinking five or six cups a day might reduce the risk of developing type 2 diabetes, other studies show caffeine can exaggerate blood sugar problems in people who already have it, says Duke’s Lane.
High levels of caffeine can exert a laxative effect in some people but constipate others, Zied says. Heartburn and peptic ulcer patients should steer clear, too.
Too much coffee at once can increase blood pressure, but a cup or two a day generally does no harm to heart health, says Carl Lavie, medical director of Cardiac Rehabilitation and Prevention at John Ochsner Heart and Vascular Institute in New Orleans. Rarely, overindulgence can increase heart rate and cause heart rhythm disturbances, he says.
See more information about how coffee may prevent heart disease in my other blogs on the topic.
“Coffee intake is associated with a reduced risk of cirrhosis and liver cancer,” Hensrud says.
Hensrud says coffee can ease migraines in some people. Coffee lovers who drink at work each day should keep up the habit on weekends, because skipping coffee can lead to withdrawal headaches, he says.
Too much coffee can increase anxiety, Zied says, especially in people who are prone to panic attacks. Lane has done studies showing that caffeine ups adrenaline and stress, especially if the body is already under stress.
The March of Dimes and the Food and Drug Administration recommend no more than 200 milligrams of caffeine a day for pregnant women and nursing mothers, says Montefiore obstetrician Rosser. More can affect babies in utero — increasing the heart rate and possibly slowing fetal growth. Trying to get pregnant? Same recommendation. But if infertility is a concern, avoid coffee.
The caffeine in coffee is a stimulant. It can make you jittery and contribute to insomnia, says sleep expert Craig Schwimmer, medical director of The Snoring Center in Dallas.
“It’s all in how you use it,” he says, explaining that caffeine has a half-life of about six hours. A couple of cups in the morning is fine, but for those with sleep troubles, cut coffee at least six hours before bedtime.
Drinking up to six cups of coffee a day may lower the overall odds of dying prematurely, mainly because it cuts the risk of dying from heart disease, a recent study suggests. But the study found that heavy coffee drinking doesn’t cut your chance of dying from cancer.
“Our results suggest that long-term, regular coffee consumption has several beneficial health effects,” says Esther Lopez-Garcia, lead author of the Harvard School of Public Health report.
Here are more details contained in a report from USA Today: The study, published in the Annals of Internal Medicine, examines the relationship between coffee and mortality. It is based on the coffee drinking habits of 41,736 men and 86,216 women with no history of cardiovascular disease (CVD) or cancer. The men were followed for 18 years, the women for 24 years.
The results show that as coffee consumption increases, the overall risk of death decreases. The association is explained mostly by a decrease in CVD deaths, Lopez-Garcia says. Women who drank two to three cups of coffee a day, for instance, had a 25% lower risk of dying from heart disease than non-drinkers.
“Coffee has some beneficial effects on inflammation and endothelial function, which are the first stages of CVD development,” Lopez-Garcia says.
No connection was found between coffee consumption and cancer deaths, however. “More studies are necessary to confirm this lack of effect,” she says.
Researchers warn that the study does not prove a cup of joe is linked with long life. A factor other than coffee could be protecting participants, Lopez-Garcia says. A measurement error also could be possible, because consumption levels were self-reported.
“More research is necessary to be able to recommend consuming coffee on a health basis,” she says. “Our study is not enough to make such a statement.”
The findings suggest that a component other than caffeine explains the relationship between coffee and a lower risk of death, Lopez-Garcia says. Participants who drank both decaf and caffeinated coffee had lower death rates than non-drinkers.
Some experts still warn, however, that caffeine can lead to detrimental short-term health effects, such as anxiety and sleep problems.
“If you want the best of both worlds, drink decaf — avoid the caffeine and get the good stuff,” says longtime coffee researcher Terry Graham of the University of Guelph in Canada.
Past research has produced mixed results on the health effects of coffee, but most experts agree coffee is safe and even healthful.
In 2000, a study from researchers at the Mayo Clinic found that coffee intake was linked with decreased rates of Parkinson’s disease. In 2004, Harvard researchers reported that it significantly reduced the risk of developing type 2 diabetes. And a 2005 study found that coffee could help prevent the most common type of liver cancer, according to the Journal of the National Cancer Institute.
Karen Collins, a nutrition adviser with the American Institute for Cancer Research, says the key to coffee’s health benefits is its antioxidants.
“Coffee drinkers who were scared off years ago by reports that it poses a health threat have no reason to be afraid,” she says. “But people also shouldn’t be saying, ‘I’ll just have some coffee today instead of my fruits and vegetables.’ “