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Blog author, Solai Buchanan is an experienced Registered Dietitian and Certified Diabetes Educator with an MS from Columbia Teachers College. She specializes in treating heart disease, diabetes, hypertension, high cholesterol, polycystic ovarian syndrome,and other chronic diseases. She is a provider at a full-service cardiology practice accepting most insurance and staffed with a primary care MD, pediatrician, and cardiologist. Call: 718.894.7907. NYCC is lead by Interventional Cardiologist Sanjeev Palta, MD, FSCAI, FACC. He trained at Cornell-Columbia Presbyterian Hospital and the State University Hospital of Brooklyn. He currently is an Attending Cardiologist at New York Methodist Hospital and Maimonides Medical Center. He is also an Assistant Clinical Professor in the Department of Medicine at Mount Sinai Medical Center. Having performed over 2000 invasive cardiac procedures Dr. Palta’s patients know they are in trusted hands.

Thursday, May 10, 2018

BRAIN HEALTH: HOW TO REDUCE YOUR RISK OF DEVELOPING DEMENTIA


One in every seven Americans older than 71 years of age has some form of dementia, most commonly Alzheimer’s disease.  Currently five million people in the U.S. currently suffer from Alzheimer’s and by 2050 the cases of Alzheimer's are projected to reach 16 million.   However, new research has proven that you can do some things to reduce your risk of developing dementia.

Nutrition Tips for Keeping Your Brain Healthy
In addition managing your weight, following a heart healthy antioxidant rich diet can help to reduce the risk of dementia.  Multiple studies have found that the 'MIND' diet, significantly reduces the risk of developing Alzheimer's disease and other forms of dementia.  Researchers developed the MIND diet by reviewing the body of evidence on how different dietary factors influence brain health. The MIND eating plan combines aspects of the heart healthy Mediterranean diet with certain features of the DASH (Dietary Approaches to Stop Hypertension) diet, both of which emphasize taking in plenty of fruits and vegetables and regularly eating beans, nuts, and whole grains while limiting meat, sugar, dairy fat, and deep fried items. The MIND diet specifically calls to:


Eat More of these
Recommended Intake
Whole grains
3+ servings daily
(serving = ½ cooked grains/1 slice of bread)
Nuts
Eat daily
(serving = 1.5 oz or 1/3 cup)                                                                 
Beans
4+ servings per week
(serving = ½ cooked beans)                                           
Fruits
Berries, especially blueberries and strawberries at least 3 times per week (serving = ½ cup)
Vegetables
Include dark leafy greens (e.g. kale, spinach, collard) plus at least one other vegetable serving each day.
(serving = 1 cup leafy green or ½ cup for others)
Poultry
2+ times per week
(serving = 3 oz. cooked/size of deck of cards)     
Fish
2+ times per week, especially fatty fish
(serving size = 3 oz. cooked/size of deck of cards)     

Eat less of these
Recommended Limit
Cheese
 1 serving per week or less
(serving size = 1 oz. / size of 2 dice)       
Butter & stick margarine  
Less than 1 Tablespoon daily.  Use olive oil instead.
Sweets and sugary beverages
5 times or less per week   (serving size 100-200 calories)        
Red meat
12 oz. or less per week.
Deep fried and fast food
Once per week or less

Additional Brain Healthy Lifestyle Factors
Besides eating a brain healthy diet, here are some additional tips to promote long term brain health:


Exercise, Exercise, Exercise:  Studies have shown that it does not matter what form of exercise you choose. Anything from water aerobics to hiking will work, but the frequency and intensity does matter. In fact, in one study of nearly 1500 people who were tested at midlife before displaying any symptoms of dementia and then tested again between 65-79 years of age, those who exercised at least two times each week during middle age had a significantly decreased risk of dementia development, even after all other variables were ruled out.

Doing challenging physical activity increases blood flow and oxygen to the brain, and helps to form new cells. In fact, physically active people actually have a larger hippocampus, the area of the brain that helps with learning and memory. Physical activity also produces endorphins and other “feel good” chemicals that lead to calming and improved focus. It appears that the more energy expended during physical activity, the greater the reduction of risk. Even after dementia has begun to develop, exercise can improve concentration and brain plasticity.  

Maintain a Healthy Weight:  Research indicates a strong relationship between maintaining a healthy weight and decreased risk of dementia.   Individuals who are obese, especially those with central obesity (weight in the abdominal area) appear to have higher risk for developing dementia. In one study of 6500 individuals within the Kaiser Permanente Northern California system, those with the largest abdominal measurement had three times the risk of developing dementia, compared to those with the smallest waist measurement.

Think Positively & Be Friendly: Depression is positively linked to a person’s chance of developing cardiovascular disease, which in turn is linked to development of vascular dementia.  Similarly, persons who maintain positive social relationships (spouses, family, friends, etc.) appear to have better brain health outcomes.

Control & Treat Chronic Diseases: Diabetes is linked to development of dementia. Control of preexisting diabetes and prevention of diabetes is critical to maintaining brain health.  Similarly, uncontrolled high blood pressure is also linked to the development of both Alzheimer’s disease and vascular dementia.

Get Enough Sleep: Sleep deprivation temporarily decreases levels of brain-derived neurotrophic factor, which is crucial for storing information.  Many studies have also found a correlation between chronic sleep deprivation and increased rates of heart disease, which in turn puts one at risk for decreased brain health.

Quit Smoking, If You Smoke: Smoking increases your risk of developing cerebrovascular disease, a condition that causes your brain to not receive all of the blood necessary to operate properly.

Tuesday, April 10, 2018

WEIGHT LOSS INCREASES HUNGER


Keeping lost weight off is notoriously difficult.  A recent two-year experimental study helps to shed light on just why it's so hard: cutting calories and losing weight causes long-term increases in the hormone ghrelin that increases hunger.  To truly keep the pounds away, people have to deal with feelings of increased hunger for the rest of their lives.  
This study provided a structured highly supportive weight loss program for 35 Norwegians who were morbidly obese. At the outset, all participants underwent a three-week inpatient program in which all meals and snacks were provided.  The inpatient program also provided intensive instruction in how to achieve and maintain healthy behavioral change with nutrition education and psychological counseling.  Participants also participated in daily exercise routines. Over the course of the next two years, four more three-week inpatient sessions were completed.  Throughout the study, all participants were placed on a moderately calorie restricted diet, consuming about 500 calories per day less than otherwise needed to maintain one’s weight. The macronutrient breakdown of the diet was 50% carbohydrates, 30% fat and 20% protein.  Between inpatient stays, participants were advised to continue exercise and maintain a healthy diet similar to that provided at the center.  On average, the participants lost about 11 lbs. (~4% of bodyweight) within the first three weeks of the program, and an average of 24 lbs. (~9% of bodyweight) at the end of the two-year study.
At both the one- and two-year marks all the patients reported feeling increasing hunger following their weight loss.  Why did hunger levels increase? Results indicated that as weight went down, levels of the hormone that drives hunger, ghrelin went up.  Ghrelin levels went up with initial weight loss and these levels stayed up even as patients maintained weight.  
On top of the increase in hunger, people's bodies become more efficient in using energy after weight loss.  For example, on average, a person who has weighed 176 lbs. their whole adult life can maintain their weight consuming about 400 more calories daily than a person who has come down to 176 lbs. after previously weighing more.
What to do:  The take home message here is that weight loss maintenance requires deliberate lifelong dietary and lifestyle changes.  To minimize ghrelin increases during weight loss, it helps to lose weight gradually over time without drastic decreases in calories consumed.  To cope with increased hunger it helps to increase intake of low calorie fluids and non-starchy vegetables.  It also helps to adopt a healthy balanced diet that does not profoundly differ from one’s usual intake.  For example, diets that radically switch up your intake such as very low carbohydrate diets are unlikely to be maintained and are especially associated with weight regain. It is also recommended that in order to keep weight off, individuals need to engage in 60 minutes or more of physical activity most days.  Odds of maintaining activity are best when exercise is social and when one does activities one enjoys.  Recording intake and portions also is positively associated with weight loss maintenance.  The likelihood of morbidly obese individuals keeping weight off over the long term is much better with bariatric surgery, partially because the surgery significantly reduces hunger.  Even though it is hard to keep lost weight off, remember maintaining even modest weight loss of 5-10% of bodyweight can meaningfully improve your health.  And, regular activity and better food choices have many health benefits even if they do not result in weight loss.

Source
Coutinho SR, Rehfeld JF, Holst JJ et al.  Impact of weight loss achieved through a multidisciplinary intervention on appetite in patients with severe obesity. American Journal of Physiology Endocrinology and Metabolism, 2018; DOI: 10.1152/ajpendo.00322.2017

Information adapted from articles available at:
www.sciencedaily.com/releases/2018/02/180201123318.htm

Thursday, March 15, 2018

HIGH FIBER INTAKE HELPS YOUR GUT BACTERIA FIGHT DIABETES


A new experimental study found that eating a diet high in fiber helps to support a healthy mix of bacteria in the gut. Previous studies have shown that people who consume more fiber have a lower risk of developing type 2 diabetes.  Fibers are beneficial because they slow down how quickly foods are digested thus blunting blood sugar spikes.  The current study reveals high fiber diets are also beneficial because they favor the proliferation of helpful gut bacteria. 

The human gut contains diverse populations of billions of bacteria that are essential to the proper functioning of the digestive system.  Many gut bacteria types break down carbohydrates into short-chain fatty acids.  These fatty acids help to nourish the cells that line the gut, reduce inflammation, and regulate hunger.  A shortage of these fatty acids has been associated with type 2 diabetes and other diseases.

In the current study, half the participants followed a standard low-fat, low-carb diet, while the other half ate a lot of high fiber foods, including whole grains, fruits and vegetables.  The experimental diet also included pre-biotic supplements, which encourage the growth of gut bacteria that make short-chain fatty acids. Both groups also took a drug called acarbose, which helps to control blood sugar by slowing the digestion of starches. This allows greater amounts of starch to reach the large intestine, where microbes feed upon it.

 After 12 weeks, participants on the high-fiber diet demonstrated a larger reduction in their 3-month average blood glucose levels. Also, their fasting blood glucose levels dropped quicker, and they lost significantly more weight than the control group.  15 strains of short-chain fatty acid-producing gut bacteria were identified in patients who consumed a high-fiber diet.  A fiber-rich diet ensured that those 15 strains became the dominant strains in the gut and produced high levels of the short-chain fatty acids butyrate and acetate.

What to do: The best way to feed the good bacteria in your gut is to eat plenty of foods high in fermentable fibers including inulin, fructooligosaccharides (FOS), resistant starches, pectins, and arabinoxylan. High-fiber foods, such as fruits, veggies, legumes and whole grains, encourage the production of short-chain fatty acids. Some specific standout choices include artichokes, leeks, onions, garlic, asparagus, wheat bran, whole wheat, barley, bananas, garlic, green bananas, beans, apples, pears, plums, carrots, and citrus. 

Source:
Liping Zhao, Feng Zhang, et al. Gut bacteria selectively promoted by dietary fibers alleviate type 2 diabetes. Science, 2018; 359 (6380): 1151. DOI: 10.1126/science.aao5774

Information adapted from articles available at:
https://www.medindia.net/news/healthinfocus/high-fiber-diet-may-help-treat-type-2-diabetes-177703-1.htm
https://www.sciencedaily.com/releases/2018/03/180308143047.htm
https://www.medicalnewstoday.com/articles/321150.php


Thursday, March 8, 2018

DRINKING FRUIT JUICE LEADS TO WEIGHT GAIN


A new study concludes that drinking 100 percent fruit juice leads to long-term weight gain, while consumption of fresh whole fruits results in weight loss.  This new report relied on data from more than 49,000 post-menopausal American women who were part of the Women's Health Initiative, a 5-year national health study.  During three years of follow-up, on average, participants gained a little more than 3 pounds.  After controlling for other factors known to impact weight including exercise, total daily calories consumed, education and income, the researchers found that women who frequently drank fruit juice were more likely to gain weight.  A single 6-ounce daily serving of 100-percent fruit juice every day prompted an average weight gain of about half a pound over three years.  This is comparable to the weight gain of individuals who regularly consume 6 oz. of sugary drinks such as lemonade and soda.  In contrast, they found that increasing consumption of whole fruits by one serving a day was associated with losing about a pound over three years.

Why is fruit juice associated with weight gain while fruits are associated with weight loss?  A 6-ounce serving of pure fruit juice contains between 15 -30 grams of sugar and 60-120 calories.  It takes multiple fruits to make even a small glass of juice so when we drink juice we are drinking the sugar of several fruits versus when we eat a fruit we are likely to consume the sugar in just one.  Also, juiced fruit does not contain the fiber in whole fruit.  The semi-solid fiber matrix of the whole fruit slows down how quickly the sugars from the fruit are digested.  In contrast, fruit juice is a liquid without significant fiber so it is digested quickly, spiking blood sugar and inducing extra insulin release.  Higher insulin production favors storage of nutrients as fat.  Juice also is not as satiating as whole fruits, leading juice drinkers to take in more total calories than fruit eaters.   

What to do:  Even though juice contains natural sugars, it is still high in sugar - just as high as many sodas.  So, when you are thirsty, drink water!  When you want something sweet, eat fruit.  If you are not a fan of water, try seltzer, unsweetened herbal tea (hot or iced), or squeezing a little lemon or orange into your water. 

Source:
Auerbach BJ, Littman AL, Krieger J et al.  Association of 100% fruit juice consumption and 3-year weight change among postmenopausal women in the in the Women's Health Initiative.  Preventive Medicine, 2018; 109: 8-10.  Available at: https://doi.org/10.1016/j.ypmed.2018.01.004

Adapted from articles available at: 
https://consumer.healthday.com/vitamins-and-nutrition-information-27/food-and-nutrition-news-316/one-hidden-culprit-behind-weight-gain-fruit-juice-731105.html

Tuesday, February 6, 2018

MEDITERRANEAN DIET IMPROVES DEPRESSION


Diet matters when it comes to mental health.  Two recent trials have found that when people with severe depression follow the Mediterranean diet, they experience significant improvement in mental health.  The effects were shown to last up to 6 months.  
In the most recent randomized controlled trial to examine the effect of the Mediterranean diet on individuals with severe depression, researchers recruited 152 adults aged 18-65.  Participants were randomly assigned to the Mediterranean diet or control group. The Mediterranean diet intervention included an initial nutritional consultation, biweekly group cooking workshops, easy, inexpensive recipes, and take-home food hampers for making the recipes.  Some of the intervention group was also given fish oil but that was found not to significantly improve outcomes.  The control group attended biweekly meetings that included social activities such as board games, book clubs, and photo sharing.  Participants’ dietary intake as well as their levels of depression, anxiety, and stress were assessed at the beginning of the study and then at 3 and 6 months.
Both the intervention and control groups experienced mental health improvements, but the Mediterranean diet brought improvement to 45% of participants while 27% of the control experienced mood improvement.  The investigators also found that the Mediterranean diet was significantly associated with lower anxiety and negative affect, and better coping and overall quality of life. Earlier in the year a smaller trial found similar results.  33% of depressive individuals in the Mediterranean diet intervention were able to put their depression in remission while only 8% of the controls achieved remission.
The Mediterranean diet is based on the dietary traditions of the island of Crete in Greece circa 1950.   It is rich in fruits, vegetables, nuts, beans, whole grains, fish, and olive oil while minimizing meat, sugar, and refined flour.  In these two studies those on the Mediterranean diet consumed per day 6 servings of vegetables (serving = ½ cup cooked, 1 cup raw), 5 servings of whole grains (serving = 1/3 cup or 1 oz), 3 servings of fruit (serving = ½ cup cooked, 1 cup raw), 2 servings of unsweetened dairy (serving = 1 cup milk/ yogurt or  1 oz cheese), 1 serving of raw nuts (serving = 1 oz or ~1/3 cup), and 3 tablespoons of olive oil.  Each week they consumed 2 or more servings of fish (serving = 2oz) while limiting themselves to no more than 3 servings of lean red meat (serving = 2oz), 2 servings of chicken (serving = 2oz), and 6 eggs (serving = 1 egg).  They also were permitted no more than 3 servings per week of sweets or refined flour products. 
What to do:  The role of diet in mental health has been underappreciated in the past but it is increasingly an area interest.  Emerging research continues to elucidate how the health of the gut and its microbiome are intricately linked to our mental well being.  Besides benefiting mood, incorporating a Mediterranean eating pattern has also been found to improve cardiovascular and immune health, and lower rates of cancer, diabetes, dementia and many other chronic diseases.   Even if you are not ready to commit to all aspects of the Mediterranean diet, try more modest changes such as limiting sugary foods to a few times a week or eating 2+ cups of veggies daily.

Sources
Jacka FN, O’Neil A, Opie R et al.  A randomised controlled trial of dietary improvement for adults with major depression (the ‘SMILES’ trial).  BMC Medicine 2017 15:23. Available online at:  https://doi.org/10.1186/s12916-017-0791-y
Sarris J, Logan AC,  Akbaraly TN et al.  Nutritional medicine as mainstream in psychiatry. The Lancet Psychiatry, 2015; 2 (3): 271. Available online at: http://dx.doi.org/ 10.1016/S2215-0366(14)00051-0
Parletta N, Zarnowiecki D, Cho J, et al.  A Mediterranean dietary intervention supplemented with fish oil improves diet quality and mental health in people with depression: A randomized controlled trial (HELFIMED).  Nutritional Neuroscience 2017; 0:0. Available online at:  https://doi.org/10.1080/1028415X.2017.1411320
Adapted from articles available at:
https://www.sbs.com.au/news/mediterranean-diet-can-beat-depression-research-suggests
https://www.medscape.com/viewarticle/890506

UNTREATED OBSTRUCTIVE SLEEP APNEA HAS IMMEDIATE & LONG-TERM HEALTH CONSEQUENCES

A recent study underscores the importance of consistently treating obstructive sleep apnea (OSA).  The research trial revealed that when individuals with sleep apnea do not use their continuous positive airway pressure (CPAP) devices, even for just a couple of days, they experience marked increases in blood sugar, stress hormones, and blood pressure.  Another recent study concluded that over time untreated sleep apnea increases the build-up of amyloid beta, the plaque-building peptides associated with Alzheimer's disease. 
An estimated 25% of adults and 45% of obese adults have obstructive sleep apnea in which one's airway momentarily closes multiple times per hour during sleep. Treatment typically entails wearing a mask that provides air pressure into the throat to keep the airway open during sleep but there are also other less intrusive treatment options that can work in some cases.
"This is one of the first studies to show real-time effects of sleep apnea on metabolism during the night," said study senior author Dr. Jonathan Jun.  In the study, researchers monitored 31 obese individuals as they slept. All the subjects had moderate to severe obstructive sleep apnea and were monitored either while using a CPAP device or after not using it for two nights.  During the night, researchers measured levels blood fatty acids, insulin, glucose and the stress hormone cortisol. They found that having not worn the CPAP for two previous nights resulted in elevated heart rate and reduced blood oxygen. CPAP withdrawal also increased levels of free fatty acids, glucose, cortisol and blood pressure during sleep. The more severe the OSA, the more these parameters increased.
Another recent report finds that OSA puts elderly at greater risk of developing Alzheimer's disease.  Researchers from this study report that biomarkers for amyloid beta, the plaque-building peptides associated with Alzheimer's disease, increase over time in elderly adults with OSA in proportion to OSA severity. Thus, individuals with more apneas per hour had greater accumulation of brain amyloid over time.
What to do:  These studies emphasize the importance of treating OSA to prevent its metabolic, cardiovascular, and neurological consequences.  Indications one is at increased risk for OSA include obesity, particularly in the upper body and neck, daytime sleepiness, snoring, and waking at night feeling like one cannot breath.  Maintain a healthy weight or work on weight loss to minimize your risk for OSA.  Screening with a sleep study can reliably diagnose OSA but  many diagnosed individuals find it difficult to tolerate wearing their CPAP device. In this case work with a sleep specialist with whom you can explore the various CPAP mask options and potential alternative OSA therapies including implanted devices, dental appliances, and positional therapy. 

Adapted from articles available at:
https://www.medlineplus.gov/news/fullstory_168254.html
https://www.sciencedaily.com/releases/2017/08/170831101454.htm
https://www.sciencedaily.com/releases/2017/11/171110084325.htm

Sources
Chopra S, Rathore A, Younas H et al. Obstructive sleep apnea dynamically increases nocturnal plasma free fatty acids, glucose, and cortisol during sleep. The Journal of Clinical Endocrinology & Metabolism, 2017; DOI: 10.1210/jc.2017-00619

Sharma RA, Varga AW, Bubu OM et al. Obstructive sleep apnea severity affects amyloid burden in cognitively normal elderly: A longitudinal study.  American Journal of Respiratory and Critical Care Medicine, 2017; DOI: 10.1164/rccm.201704-0704OC

GUM DISEASE MAY INCREASE STROKE RISK

A new study further strengthens the scientific evidence that cardiovascular health is deeply connected to oral health.  It found that the more severe an individual’s gum disease, the greater their stroke risk.  The study also found a strong association between regular dental care and reduced stroke risk.

Periodontal disease is a chronic inflammatory disease caused by bacterial colonization that affects the soft and hard structures that support the teeth. Gum disease is widespread. In the U.S. more than half of adults age 30 and older have have periodontitis, the more advanced form of periodontal disease.

Previously, observational studies have found that poor gum health is associated with an increase in stroke risk. However, long-term, population-based research on this topic is lacking.  For this study, researchers used data from dental exams performed on more than 6,730 participants in the Atherosclerosis Risk in Communities study. The study enrolled more than 10,000 middle-aged adults in 1987 and 1989, and then studied their long-term health outcomes through 2012.

Researchers found participants with any form of periodontal disease, including mild periodontal disease, were significantly more likely to experience an ischemic stroke than those with healthy gums. And, the more severe the gum disease, the greater the stroke risk.  This was true even after adjusting for potential confounding variables including race, education level, smoking status, age, education, diabetes incidence, hypertension, high cholesterol, and body mass index.  Interestingly, further detailed analysis found that inflammation of the gums rather than the level of bacterial infiltration of the gums appeared to be the real driver between periodontal disease and stroke incidence.

The study also examined links between better oral care and reduced stroke rates.  The findings showed that compared with those who only had dental care when experiencing problems, regular dental care users had a significantly lower risk for ischemic stroke.  Even after the analysis controlled for known stroke risk factors, regular dental care use continued to be associated with lower rates of ischemic stroke. 

What to do:  Observational studies suggest gum disease may increase risk for a host of chronic diseases including mouth and upper GI cancers, infertility, and diabetes.  This study shows a graded association between gum disease severity and stroke risk but it does not demonstrate that gum disease causes increased stroke risk. For the definitive answer, stay tuned.  A current trial is now investigating whether increased periodontal care can reduce stroke risk. In this trial patients with gum disease who have already had a stroke are being assigned to either standard or intensive periodontal treatment.  In the meantime, you can’t go wrong by practicing good oral hygiene including having a thorough home cleaning routine with brushing and flossing and regular dentist and hygienist visits.  Not smoking, managing your weight, reducing stress, controlling chronic conditions such as diabetes, and consuming a healthy fiber rich diet also support better gum health as well as better cardiovascular health.

Information adapted from:

Source:


Sen S, Giamberardino LD, Moss K et al.  Periodontal disease, regular dental care use, and incident ischemic stroke.  Stroke. 2018, originally published January 15, 2018.  Available at: https://doi.org/10.1161/STROKEAHA.117.018990