- Solai Buchanan, MS, RD, CDE & Sanjeev Palta, MD, FACC
- 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.
Tuesday, February 6, 2018
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.
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:
Posted by Solai Buchanan, MS, RD, CDE & Sanjeev Palta, MD, FACC at 1:01 PM
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:
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
Posted by Solai Buchanan, MS, RD, CDE & Sanjeev Palta, MD, FACC at 9:20 AM
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:
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
The American Institute for Cancer Research (AICR) and the World Cancer Research Fund (WCRF) recently updated information on diet, lifestyle and colon and rectal cancer risk. Their extensive research review of over 100 studies found there is strong evidence of links between lifestyle and colorectal cancer risk. An estimated 47% of American’s colorectal cancers, 63,700 cases, could be prevented each year with lifestyle changes. The 2017 report is the first by the AICR/WCRF to conclude there are substantial benefits to eating more whole grains (such as brown rice and 100% whole-grain bread) for reducing colon cancer risk. Consistent with earlier reviews they found regular physical activity, healthy weight, and not smoking also lower one’s odds of bowel cancers. Alcohol, meat, and particularly processed meats were found to increase risk of colon and rectal cancer.
The AICR/WCRF found that three servings (a serving equals 1 slice of bread or ½ cup of cooked grains) a day of whole grains can lower colorectal cancer by 17%. Other sources of dietary fiber including fruits, vegetables, beans, and nuts, as well as dairy products and calcium supplementation were also deemed beneficial for lowering colon cancer risk. Besides their fiber, plant foods contain a wide variety of substances that have been linked to lower risk for cancer, including carotenoids, selenium, lycopene and many more. Fruits and vegetables rich in vitamin C such as strawberries, oranges, and spinach appear to be especially beneficial. Interestingly, regular intake of garlic was also linked to reduced risk. Exactly how garlic contributes to lower risk is not known but in many laboratory studies, garlic and its components such as allyl sulphur compounds, has shown the ability to slow and stop the formation of colon tumors. The panel also recommended at least 30 minutes of daily physical activity.
As for foods to decrease, AICR/WCRF experts advised limiting intake of all red meat, such as beef or pork, to no more than about 17 ounces (i.e. just over 1 pound) per week. The report also stated it is best to eat little or no processed meats such as ham, hot dogs and bacon because frequent intake of these significantly increases the risk of bowel cancer. Nitrates are added to many processed meats; they contribute to the production of N-nitroso compounds that can damage the lining of the gut.
What to do: Colorectal cancer is one of the most common cancers, yet this report demonstrates healthy diet and lifestyle substantially lowers risk. Maintain a healthy weight with a diet rich in whole grains, fruits, and vegetables. Control portions of meat, opting for fish, chicken, or beans more often. Stay away from processed meats, alcohol, and smoking. Also get screened. The USPSTF recommends screening for colorectal cancer using fecal occult blood testing, sigmoidoscopy, or colonoscopy beginning at age 50 and continuing until age 75 years.
Adapted from articles available at:
American Institute for Cancer Research and the World Cancer Research Fund International. Continuous Update Project Report: Diet, Nutrition, Physical Activity and Colorectal Cancer. September 7, 2017. Available at: https://www.wcrf.org/colorectal-cancer-2017.
Tuesday, June 6, 2017
A recent review of existing experimental studies found that daily supplementation with riboflavin can significantly reduce migraine frequency. Migraine headaches are a common but debilitating neurological disorder. Approximately 12% of Americans suffer from migraines and it is estimated the condition costs our healthcare system over 78 billion dollars annually. Migraine symptoms are typically characterized by intense pulsing or throbbing pain in one area of the head and are often accompanied by visual disturbances, nausea, vomiting, dizziness, sensitivity to light and sound, and/or tingling in the extremities and face.
The pathophysiology of migraine headaches is complex and involves many diverse dysfunctional areas in the brain. One of the major genetic disorders that has been linked to migraine headaches is dysfunctional mitochondria (the powerhouses of our cells). Riboflavin, also known as B2, catalyzes the activity of flavoenzymes in mitochondria and it is via this mechanism that riboflavin is believed to aid in better functioning of neural cell metabolism and migraine relief. Previous research suggests a high percentage of migraine sufferers have at least mild deficiencies in riboflavin.
What to do: Riboflavin supplementation will not help all sufferers of this diverse condition but it does appear remarkably effective for some and, unlike most migraine medications, it has the benefits of being very safe and inexpensive. So, if you suffer from migraines consider supplementing with 300-400mg of riboflavin daily for 2-3 months. Foods that are especially rich in riboflavin include eggs, meat, and dairy. In the U.S. flour is also fortified with riboflavin.
Adapted from article available at:
Thompson DF, Saluja HS. Prophylaxis of migraine headaches with riboflavin: A systematic review. Journal of Clinical Pharmacy & Theraputics 2017;00:1–10. Published online ahead of print May 8, 2017. https://doi.org/10.1111/jcpt.12548
Posted by Solai Buchanan, MS, RD, CDE & Sanjeev Palta, MD, FACC at 3:06 PM
Thursday, April 13, 2017
A recent analysis of a prospective cohort study including over 600 older adults found that a diet rich in calcium was only associated with better bone health outcomes when participants were also supplementing with vitamin D. Dietary intake of calcium rich foods did not appear to support bone health among individuals who did not supplement with vitamin D. Study participants were drawn from those enrolled in the long-running Framingham Study, which began in 1948 and has followed the health and habits of a cohort Framingham, Massachusetts residents over time.
Participants averaged 75 years age. Their patterns of food intake were assessed with detailed food frequency questionnaires and their bone density assessed with bone scans. The analysis found that absolute spinal bone mineral density levels as well as the change in hip bone mineral density over four years was significantly better among those who both consumed diets rich in calcium and who supplemented with vitamin D. In contrast, higher dietary calcium intake was not protective among those who were not supplementing in vitamin D. These results are consistent with the fact that vitamin D stimulates calcium absorption, which aids in bone building and prevention of bone loss.
Bone health problems are a widespread health concern. An estimated 44 million Americans have low bone density and 10 million Americans have more severe osteoporosis, a disease marked by low bone mass and progressive deterioration of bone tissue. Osteoporosis increases the risk of fractures, loss of physical function, decreased quality of life, and even death.
What to do: These findings underscore that the benefits of calcium rich diet to older person’s bones may be dependent on vitamin D intake. As we age, all individuals lose bone mass but those who lose mass more quickly as well as those who did not accumulate adequate bone mass in adolescence are at risk for osteoporosis. While the efficacy of calcium supplements remains debated there is generally consensus that individuals' bone health benefits from diets rich in calcium. An estimated 80% of Americans’ diets are insufficient in calcium. Some of the foods richest in calcium include dairy such as milk, yogurt, and cheese, fish with bones such canned salmon and sardines, and dark leafy vegetable such as Chinese cabbage, kale, and broccoli. Our bodies make vitamin D when our skin is exposed to the sun but persons who are older, obese, have darker skin, and/or get little sun exposure are at high risk for low vitamin D levels. If your bloodwork indicates you are low in vitamin D, supplementation as well as a calcium rich diet may be integral to maintaining bone health into old age.
Sahni S, Mangano KM, et al. Dairy intake is protective against bone loss in older vitamin D supplement users: The Framingham Study. Journal of Nutrition. First published online March 1, 2017. DOI:10.3945/jn.116.240390
Adapted from articles available at:
Posted by Solai Buchanan, MS, RD, CDE & Sanjeev Palta, MD, FACC at 11:33 AM
Tuesday, March 28, 2017
EATING HOME-COOKED MEALS and Keeping the TV off during meals both LINKED TO HEALTHIER WEIGHT
A recent study of more than 12,000 low-income Ohio residents found eating food cooked at home, rather than out, and without the television on, was tied to lower rates of obesity.
To determine how meal practices affect obesity risk, the study team analyzed data from the 2012 Ohio Medicaid Assessment Survey on for 12,842 adults. The participants answered questions about how often they ate meals at home and how often they watched TV while eating and how many of their meals were home-cooked. The researchers used self-reported height and weight data to calculate each participant’s body mass index (BMI), a ratio of weight to height. Approximately one-third of participants were obese.
They found that overall about a third of adults watched TV during most or all meals, while another 36% did not watch any TV or videos during meals. For 62% of adults, all of the meals they ate were cooked at home. Adults who cooked all of their meals at home were 26% less likely to be obese, compared with those who ate some or no home-cooked meals. And, individuals who never watched TV during meals had 37% lower odds of being obese than those who always or usually watched TV or videos during meals.
These findings are consistent with previous research that has found adults and children tend to eat more food, eat more quickly, and feel less satiated when they eat while watching TV. Trials have found focusing on the food and the experience of eating can help to slow down the rate of consumption, reduce the total calories consumed, and increase perceived fullness and satisfaction with the meal. There is also strong evidence that meals purchased outside the home are on average higher in total calories, sodium, and unhealthy fat than the average home cooked meal. One recent study that included many cities across the U.S. found that average restaurant/takeout entrée was over 1200 calories and that there was little difference in the nutritional breakdown of meals from chains and non-chains.
What to do: Prepare food at home when possible. Menu planning, weekend prepping, batch cooking, utilizing devices such as rice cookers and slow cookers and drawing on healthy convenience items such as frozen vegetables, pre-washed greens, and unsalted canned beans and fish can help to minimize the time needed to prepare meals. And, regardless of whether you are eating a meal prepared at a restaurant or at home, turning off the TV and avoiding other device screens while eating can help with portion control and meal satiety. If it feels empty without visual media at the meal, try playing music, or using the meal time as an opportunity to catch up with family members.
Tumin R & Anderson SE. Television, Home-Cooked Meals, and Family Meal Frequency: Associations with Adult Obesity. Journal of the Academy of Nutrition and Dietetics. Published online February 24, 2017. Available at DOI: http://dx.doi.org/10.1016/j.jand.2017.01.009
Adapted from article available at:
Posted by Solai Buchanan, MS, RD, CDE & Sanjeev Palta, MD, FACC at 12:13 PM