- 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.
Saturday, December 19, 2015
A new small study suggests starting an exercise program helps protect older adults' brains from deterioration and can even help to reverse some early mental decline. In the study, researchers placed 34 inactive persons, aged 61-88, on an exercise program that consisted of moderate-intensity treadmill walking four times a week for 12 weeks.
By the end of the study period, cardiorespiratory fitness improved on average by 8%. MRI scans of the brain revealed an increase in the thickness of participants' cerebral cortex, the outer layer of the brain critical in cognitive function. Shrinkage of the brain's cortical layer is a marker of Alzheimer's disease progression and decline in cortex volume correlates closely with cognitive impairment. Notably, researchers found those with the greatest improvements in physical fitness exhibited the most cerebral cortex growth. While both the healthy and cognitively impaired participants showed increases in cortex thickness, the impaired individuals had greater improvements in two specific regions of the cortex known to be especially effected by Alzheimer's disease. Brain growth was also positively correlated with improvements in memory recall. Previous research by the same team has also shown moderate intensity physical activity, helps to stave off shrinkage of the hippocampus which is located near the center of the brain and is associated with long-term memory and spatial navigation.
What to do: It's never too late to get moving! Improved fitness pays off at all stages of life and for nearly all aspects of our physiology. And, it looks like we do not have to become a gym rat to realize these benefits. Getting a half-hour of moderate activity such as brisk walking four times per week demands a relatively modest time commitment and is realistic for individuals over a range of fitness levels. So, start moving more. Your body, mind, and mood will thank you.
Adapted from articles available at:
Reiter K, Nielson KA, Smith TJ et al. Improved cardiorespiratory fitness is associated with increased cortical thickness in mild cognitive impairment. Journal of the International Neuropsychological Society. 2015; 21 (10): 757. DOI: 10.1017/S135561771500079X
Posted by Solai Buchanan, MS, RD, CDE & Sanjeev Palta, MD, FACC at 1:11 PM
New research indicates normal weight people with excess fat around the waistline appear to be at higher risk of early death than overweight or obese people. Previous research has definitively found that overweight and obese persons with central obesity (defined as a waist greater than 40 inches in men and a waist over 35 inches in women) are at increased risk of heart disease, stroke, and diabetes but it has not been well understood the extent to which an apple shape body type in a normal weight individual increases chronic disease risk.
The study was based on data from a national survey of 15,000 adults ages 18 to 90. Participants’ weight, hip and waist measurements were measured periodically over 14 years. At every BMI level, people with thicker middles had a higher risk of death than those with trimmer waists. Notably, normal weight adults with central obesity had the worst long-term survival. Normal weight women with abdominal obesity were 32% more likely to die over the study period than overweight/obese women with a pear-shaped body type and for men those with normal weight but central obesity were 87% more likely to die.
Why is central obesity, even at normal weight so deadly? Centrally located fat often accumulates inside the abdomen around organs such as the liver, pancreas and intestines. This internal fat (known as visceral fat) interferes with the proper functioning of these organs, impacting blood cholesterol and the sensitivity of the body to insulin. Visceral fat also leads to an increase in leptin, the hormone that normally functions to signal our brains that we are full. Unfortunately, because elevated visceral fat releases an excess of leptin, the brain stops responding to leptin so that individuals do not feel full and are likely to overeat, precipitating greater weight gain around the middle.
What to do: Measure your waist to assess your risk. Check out our website (www.nycheartcenter.com) for detailed directions on how to measure waist size. If yours is greater than 40 inches for men or 35 inches for women, work on losing weight. Contrary to common perception, doing abdominal exercises will build muscle in the abdominal region but will not reduce fat around the middle. The best way to lose abdominal fat is to avoid smoking and excessive alcohol consumption, to consume a healthy calorie-controlled Mediterranean-style diet (i.e. a diet rich in plant foods and plant-based fats and low in refined carbohydrates) and to do regular, preferably vigorous, cardiovascular activity. Fortunately, cardiovascular activity appears to preferentially mobilize visceral abdominal fat.
Poirier P. The many paradoxes of our modern world: Is there really an obesity paradox or is it only a matter of adiposity assessment?. Annals of Internal Medicine. 2015;163:880-881. DOI:10.7326/M15-2435
Sahakyan KR, Somers VK, Rodriguez-Escudero JP, et al. Normal-weight central obesity: Implications for total and cardiovascular mortality. Annals of Internal Medicine. 2015;163:827-835. DOI:10.7326/M14-2525
Adapted from articles available at:
Posted by Solai Buchanan, MS, RD, CDE & Sanjeev Palta, MD, FACC at 11:10 AM
Tuesday, November 24, 2015
From Thanksgiving to the New Year’s Eve toast, the opportunities to overindulge are nearly endless. There is a common misconception that holidays are so infrequent that eating done only on special occasions doesn't matter. But, the celebrations can add up with parties, work events and family gatherings. And several high calorie days can significantly derail your weight management goals. For example, on Thanksgiving, the average American consumes 4,500 calories and 229 grams of fat. That's at least 2-3 times what one needs to eat in one day. The average holiday weight gain is 1-2 lbs. A pound is not so much, but people tend to not lose the weight when the holidays are over so it adds up over time. Also, while the average for the general population is just 1 pound gain, for those who are obese, average weight gain is 4-6 lbs.
Enjoying the food is a big part of enjoying the holidays, but it doesn’t have to add inches to your waistline. It is possible to eat foods traditionally associated with holiday celebrations and to stick with a weight-loss plan. Try to maintain a clear idea about your weight goals during the holiday season and don't let small setbacks completely derail progress. The following tips can also help to prevent holiday weight gain.
Minimize mindless munching - Nibbling before and after a big holiday meal is a sure way to add significant calories. Between the eggnog, cheese ball, homemade cookies and candy, it’s easy to top 1,000 calories before sitting down to dinner. What to do? Survey the culinary landscape and decide what you really want. Keep the portion reasonable and then leave the food table. Also, beware the baskets, tins and trays of treats that frequently appear in the workplace around this time of year. Try to see these foods as not yours and avoid them altogether. Or, save one treat from the selections for the end of the day. Be mindful of your choices and honest with yourself about your decisions.
Enjoy the turkey, but don’t gobble - Life is so full of rushing, we forget that we can slow down and enjoy our food. Truly savor the rich pleasure of the foods you don’t get every day. Let the food linger on your tongue. You may discover a sense of satisfaction with half your typical portions when you take time to slow down and enjoy the food you’re eating.
Portion control, portion control, portion control - Make those special, holiday-only foods manageable by savoring them slowly in limited portion sizes. Skip the items that you do not really care about. It can also be helpful to plan ahead for a dinnertime celebration by having a lighter breakfast and lunch that day, but do not skip meals as that often leads to overeating later. To control daily calories in the face of frequent celebrations, some people find it helpful to substitute a calorie-controlled meal replacement for 1-2 meals per day during the holiday season.
Plan ahead & make wise choices - Plan ahead before heading to a holiday gathering or party. Know what will be served and figure out what it is you really want and if it’s worth the calories. If you can live without your mother’s pumpkin pie but not her sausage stuffing, then have some stuffing. The same goes for a holiday buffet: scan the table first before filling your plate and decide which foods you can live without. Choose small portions of the foods you want to enjoy, filling your plate once. If you’re asked to bring something to a gathering, try bringing something healthy, like veggies and low-fat dip, instead of cookies. That way, if there are leftovers, you will go home with a healthy option rather than problem treat.
Use high-protein and high-fiber foods to your advantage - Lean meats, poultry, fish and green vegetables can help you feel full when you’re hungry without adding a burdensome load of calories. To avoid going to a holiday party too hungry — eat something high in fiber and/or protein before heading out. Have ready-to-eat veggies with hummus, a cheese stick with fruit, a Greek yogurt cup, or a small portion of fiber rich cereal to help curb your hunger.
Beware of liquid calories - Being aware of the calories you’re drinking during the holiday season is also important to maintain a healthy weight. A cup of regular eggnog can have up to 500 calories and that Starbucks white hot chocolate with whipped cream will cost you even more. Factor in alcohol, sugar-loaded punch drinks, hot cider and more and see how liquid calories add up. What to do? Choose “light” or “diet” drinks and drink lots of water. Choose hot tea or coffee in place of hot chocolate or cider. Alcohol not only provides empty calories but it decreases one's resolve to stick to an eating plan, so use moderation when it comes to drinking. Diluting wine with club soda can make a tasty wine spritzer that has less alcohol and less calories.
Channel your inner-Santa in non-food ways - It can also be helpful to channel your holiday spirit in ways that are not focused on food. For example, to add activity, consider celebrating the season by going skating or going for a holiday lights walk. Decorating, crafts, and gift giving can also satisfy the homemaker in you without running the risk of exposing you to more homemade treats. And, if you are determined to bake consider giving friends with dogs homemade pet biscuits rather than items you might be tempted to sample.
Keep moving - Don't slow down or stop physical activity during the busy holiday months. Instead, try to maintain or even increase activity and exercise levels to compensate for additional caloric intake. On holidays with big meals, try to get active in the morning. Go outside with the kids to toss the football around, grab your music and take a brisk walk, or prepare for your mall shopping by doing some determined walking laps around the space first. Simply moving more can help burn off extra calories, moderate some of the negative metabolic effects of overeating, tone your muscles, and work off some of the holiday stress.
Posted by Solai Buchanan, MS, RD, CDE & Sanjeev Palta, MD, FACC at 2:06 PM
In a new small experimental trial, researchers found that the diabetes drug pioglitazone (Actos), which makes the body more sensitive to insulin, helped relieve symptoms of chronic depression in people with insulin resistance. These results add to growing evidence of a connection between insulin resistance — the body’s inability to efficiently process glucose, even with adequate insulin production in the pancreas — and mood disorders. Insulin’s important role in brain function is well-documented. Brain cells, unlike many other cells, can only use glucose for fuel and the brain accounts for one-fifth of all glucose use in an active human being. So, it makes sense that impaired glucose uptake due to insulin resistance would affect many pivotal processes in the brain.
Insulin resistance is often a precursor to type 2 diabetes. Normally, when food is consumed, blood sugar levels in the body increase, and, in response, insulin is released by the pancreas, signaling the cells to take up the glucose and use it for food. However, the cells of people with insulin resistance fail to take up glucose adequately, causing blood sugar to stay elevated longer than normal. This increases inflammation in the body and, if unchecked, leads to type 2 diabetes.
The 12-week study involved both insulin sensitive and insulin resistant patients whose symptoms of depression had failed to improve substantially, despite treatment. Half the participants were randomly selected to receive treatment with pioglitazone while the other half received a placebo. Throughout the study, patients’ levels of depression and insulin resistance were monitored. Researchers found the insulin resistant patients on pioglitazone showed significantly improved depressive symptoms while those on the placebo did not. Also, the more insulin resistant a participant was at the beginning of the study, the better the drug’s antidepressant effect.
What to do: Excess weight and inactivity are potent risk factors for insulin resistance. Even though your fasting glucose may be normal you may still have insulin resistance. Discuss being screened for insulin resistance with your healthcare provider. Checking hemoglobin A1C in bloodwork is one way to screen for the presence of insulin resistance. Whether drugs for insulin resistance are a safe, effective way to treat depression in insulin resistant individuals remains to be seen but, in the meantime, weight loss and regular cardiovascular activity are two sure fire means of reducing insulin resistance. And, there is also plenty of evidence that healthier weight and activity are both supportive of mood.
Lin KW, Wroolie TE, Robakis T, & Rasgon NL. Adjuvant pioglitazone for unremitted depression: Clinical correlates of treatment response. Psychiatry Research. Published online ahead of print October 12, 2015. DOI: http://dx.doi.org/10.1016/j.psychres.2015.10.013
Adapted from articles available at:
Posted by Solai Buchanan, MS, RD, CDE & Sanjeev Palta, MD, FACC at 12:48 PM
Tuesday, October 13, 2015
A recent analysis tracking more than 100,000 individuals for over 20 years has found that persons who consume a diet rich in orange and dark green vegetables have lower rates of severe age-related macular degeneration (AMD). AMD, in which the center part of the retina fails, is one of the most common causes of vision loss. In previous studies, carotenoids, the pigments responsible for the bright orange and dark green colors of vegetables and fruits have been linked to fewer age-related vision problems.
In this recent analysis researchers tracked the dietary patterns and health outcomes of adults age 50 and older. They found people who consumed vegetables rich in phyto-pigments lutein and zeaxanthin most frequently, had a 40% lower risk of advanced AMD compared to those who consumed these foods least frequently. Those consuming a diet highest in pigments cryptoxanthin, alpha carotene, and beta carotene had a 35% decreased risk of advanced AMD. The researchers noted that carotenoids such as lutein, zeaxanthin, and others concentrate in the macula, where they are thought to help protect it from the harmful effects of oxygen and sunlight.
What to do: Consume a diet rich in a variety of fruits and vegetables. The foods highest in lutein and zeaxanthin include winter and summer squash, peas, corn, beet greens, pumpkin, Brussels sprouts, broccoli, spinach, romaine, kale, asparagus, goji berries, and carrots. Rich food sources of cryptoxanthin and alpha- and beta-carotene are generally orange including carrots, orange & red peppers, sweet potatoes, pumpkins, winter squash, papayas, and tangerines.
Adapted from article available at:
Wu J, Cho E, Willett WC, Sastry SM, & Schaumberg DA. Intakes of lutein, zeaxanthin, and other carotenoids and age-related macular degeneration during 2 decades of prospective follow-up. Published online ahead of print October 08, 2015. DOI:10.1001/jamaophthalmol.2015.3590.
Posted by Solai Buchanan, MS, RD, CDE & Sanjeev Palta, MD, FACC at 3:15 PM
Tuesday, October 6, 2015
Numerous studies have found the Mediterranean diet and other plant-rich dietary patterns are beneficial to heart health. The Mediterranean diet is plentiful in fruits, vegetables, legumes, nuts and whole grains; moderately high in olive oil and fish; and low in red meat, sweets, and dairy products. An interesting recent study reveals one way that Mediterranean-style diet is beneficial is that it boosts gut bacteria production of short-chain fatty acids (SCFA’s). These are the preferred fuel of our intestinal cells and higher levels have been found to decrease systemic inflammation and improve immune function. SCFA’s are associated with better cardiovascular and metabolic health, lower rates of insulin resistance and diabetes, decreases in the risk for autoimmune diseases, and decreases in the risk of colon cancer.
The study of 153 adults tracked dietary intake and levels of gut bacteria and their metabolites in stool and urine. Researchers found a clear pattern of higher SCFA levels in those who consumed more fiber-rich foods, especially those consuming plenty of beans. Participants whose diet most closely resembled the Mediterranean diet, whether vegan, vegetarian, or omnivore, had the highest levels of SCFA production. Interestingly, vegan diets were the diet that most frequently resembled the Mediterranean diet.
The study also showed that vegans or vegetarians had the lowest levels of a gut bacterial metabolite called trimethylamine oxide (TMAO). Eggs, beef, pork and fish are the primary sources of carnitine and choline--compounds that are converted by gut microbes into trimethylamine, which is then processed by the liver and released into the circulation as TMAO. TMAO levels appear to increase heart disease risk. Among non-vegetarians, people who adhered to the Mediterranean diet also had relatively low TMAO levels.
What to do: Eat more fiber rich foods. Fruits, vegetables, whole grains, nuts, and beans are all fantastic sources of dietary fiber. Typically, our first consideration when planning a meal is the protein option (usually fish, chicken, or meat). Instead, try meal planning by first considering the vegetable component. Aim to make half your plate vegetables. Also, beans and nuts are easily added to a variety of dishes, so mix things up a bit and add them in your favorite dishes to give your fiber intake a healthy boost.
Filippis F, Pellegrini N, Vannini L, et al. High-level adherence to a Mediterranean diet beneficially impacts the gut microbiota and associated metabolome. Gut. 2015, published online ahead of print September 28, 2015. DOI: 10.1136/gutjnl-2015-309957
Den Besten G, Van Eunen K, Groen AK, et al. The role of short-chain fatty acids in the interplay between diet, gut microbiota, and host energy metabolism. Journal of Lipid Research. 2013;54(9):2325-2340. DOI:10.1194/jlr.R036012.
Adapted from articles available at:
Posted by Solai Buchanan, MS, RD, CDE & Sanjeev Palta, MD, FACC at 8:44 AM
Tuesday, September 22, 2015
The links between smoking and increased risk for cancer and respiratory and cardiovascular disease are well-known, but the association between smoking and diabetes has received less attention. A new analysis of 88 existing studies that included almost six million people has found that current smokers and people exposed to secondhand smoke have a significantly increased risk of developing type 2 diabetes. The good news is that after quitting, over time the risk for diabetes decreases.
The study found a dose-response relationship between smoking and diabetes risk. Compared with those who have never smoked, light smokers have a 21% increased risk of type 2 diabetes, moderate smokers have a 34% increased risk, and heavy smokers have a 57% increased risk. Those who do not smoke but are regularly exposed to second hand smoke have a 22% increased risk of type 2 diabetes. Diabetes risk among quitters does substantially decline over time. Among those who quit within the past 5 to 9 years their increased risk falls to 18% and among those who have quit a decade ago or more saw their smoking related diabetes risk fall to 11%.
What to do: If you smoke, try to quit. Previous unsuccessful efforts to quit do not mean that you cannot succeed. Keep trying. Discuss smoking cessation treatment options with your healthcare provider. Check out www.nyc.gov/nycquits or call x311 to learn about the many free resources available including local tobacco cessation programs & support groups, and free nicotine patches.
Adapted from articles available at:
Pan A, Wang Y, Talaei M. Relation of active, passive, and quitting smoking with incident type 2 diabetes: a systematic review and meta-analysis. The Lancet: Diabetes & Endocrinology. Published online ahead of print Sept. 17, 2015. DOI: http://dx.doi.org/10.1016/S2213-8587(15)00316-2.
Posted by Solai Buchanan, MS, RD, CDE & Sanjeev Palta, MD, FACC at 10:57 AM
Two recent studies highlight the importance of adequate vitamin D levels to healthy aging. Vitamin D, the sunshine vitamin, is made by the skin when exposed to sunlight. As we age, the body becomes much less effective at making vitamin D, so many seniors have insufficient levels of vitamin D.
One recent study found that mental function may decline faster in older adults with low levels of vitamin D. For the study, researchers tracked the vitamin D levels and cognitive function of 380 seniors over 5 years. The researchers found that, like the general population, the majority of study participants had levels of vitamin D that were too low; 26% were vitamin D-deficient (below 12 nanograms per milliliter) and 35% were vitamin D-insufficient (12-19ng/mL). The study revealed that at baseline individuals with low vitamin D were more likely to have dementia as well as poorer thinking and memory skills, and during follow-up, the rates of decline in memory, thinking and problem-solving among those who were vitamin D-deficient and vitamin D-insufficient were significantly greater than among those with adequate levels of vitamin D. The study authors hypothesize that vitamin D may help protect the brain from developing the plaques and tangles associated with Alzheimer's disease.
In a second recent study, on homebound seniors, researchers found that vitamin D supplementation greatly reduced falls. Over five months, 68 homebound seniors received either a monthly vitamin D supplement of 100,000 international units (equivalent to taking approximately 3000 IU daily) or a placebo. At the start of the study, over three-fourths of participants were either deficient or insufficient in vitamin D. The supplemented group experienced less than half the falls of the placebo group. Every year, about one-third of seniors who live at home suffer falls, and about one in 10 falls results in serious injury.
What to do: While much remains unknown about how vitamin D impacts health, emerging research suggests nearly all cells in the body have receptors for vitamin D and it may play an important role in maintaining not only musculoskeletal health but also neurological, endocrine, cardiovascular, and immune health. It is difficult to get adequate vitamin D from diet. It is found in many fortified products including milk and it occurs naturally in fatty fish, fish liver oils, and the edible bones in foods such as canned salmon & sardines. The recommended daily intake of vitamin D for older adults is 600 to 800 IU. However many persons supplementing at this level still have inadequate levels. When getting bloodwork, request that your doctor check vitamin D levels. Persons with some conditions should not supplement with Vitamin D so check with your provider before starting supplementation. Vitamin D is widely available in over-the counter supplements. To maximize uptake of vitamin D, choose a supplement with D3 that includes calcium.
Houston DK, Tooze JA, Demons JL et al. Delivery of a vitamin D intervention in homebound older adults using a Meals-on-Wheels program: A pilot study. Journal of the American Geriatrics Society. September 2015 Sept; 63 (9): 1861-1867. DOI: 10.1111/jgs.13610
Miller JW, Harvey DJ, Beckett LA et al. Vitamin D status and rates of cognitive decline in a multiethnic cohort of older adults. JAMA Neurology. Published online ahead of print September 14, 2015 DOI: 10.1001/jamaneurol.2015.2115
Adapted from articles available at:
Posted by Solai Buchanan, MS, RD, CDE & Sanjeev Palta, MD, FACC at 8:33 AM
Wednesday, August 26, 2015
A large new observational study has linked frequent consumption of spicy foods to greater longevity and reduced rates of heart disease and cancer. For the 7-year study, researchers tracked the dietary intake and health outcomes of more than 485,000 people ages 30-79, living in China. The researchers collected information on participants' dietary habits including how often they ate spicy food, red meat, alcohol, and vegetables and then tracked participants disease and mortality. The study found that, compared to people who had spicy food less than once per week, people who ate spicy foods 1-2 days per week had a 10% reduced risk of overall mortality and those who had spicy food 3 or more times per week had a 14% reduced risk of all cause mortality. Spice eaters' better longevity appeared to stem specifically from lower rates of cancer, heart disease, diabetes, and respiratory diseases.
Though cause-and-effect cannot be proven in an observational study, there is significant evidence that many spices have potent anti-inflammatory and anti-oxidant effects that can help to reduce chronic disease risk. In the region where this study took place, the primary source of spice is chili peppers (cayenne). Those who consumed fresh chili peppers appeared to have a slightly lower rate of mortality than those who consumed chili's from dried sources. Capsaicin is believed to be the primary compound responsible for both the medicinal properties of cayenne and its spicy taste. The hotter the pepper, the more capsaicin it contains.
What to do: Herbs and spices contain a wide variety of antioxidants, minerals and vitamins, and help maximize the nutrient density of your meals. Every time you flavor your meals with herbs or spices you are literally "upgrading" your food without adding a single calorie, so go for plenty plenty of herbs and spices in your foods. Besides cayenne, some of the spices and herbs with the highest concentrations of beneficial phytonutrients include ginger, rosemary, turmeric, cinnamon, cloves, and sage. You can add these not only to your cooking but also tea, coffee, yogurt, cereal, oatmeal, salad dressings, sauces and condiments. Extra spices and herbs are also a great way to liven up prepared foods such as frozen meals, canned soups, and other ready-to-eat items.
Lv J, Qi L, Yu C et al. Consumption of spicy foods and total and cause specific mortality: population based cohort study. BMJ. 2015; 351:h3942. DOI:10.1136/bmj.h3942
Adapted from articles available at:
Posted by Solai Buchanan, MS, RD, CDE & Sanjeev Palta, MD, FACC at 8:48 AM
Saturday, August 22, 2015
Most of us are eating way too much sugar. The sweet stuff -- which also goes by names like fruit juice concentrate, fructose, honey and syrup -- is found in 74% of packaged foods in our supermarkets. Besides all the drinks and treats that are loaded with sugar, "savory" foods like sauces, pickles, condiments, peanut butter, salad dressing, frozen meals, bread, crackers, and chips often contain significant amounts of added sweeteners. The average American now consumes 22-28 teaspoons of added sugars a day -- mostly high-fructose corn syrup and ordinary table sugar. That adds up to 350-440 empty calories.
Research is increasingly finding that our high sugar consumption not only fuels weight gain, but also directly contributes to our risk of chronic diseases like heart disease and diabetes. Here's the lowdown on some of the consequences of a high sugar diet.
Weight Gain & Obesity
Intake of excessive sugar consistently results in weight gain. Sugary drinks, loaded with calories and devoid of nutrients, are quickly digested so that they do little to satiate hunger. A 2014 review of 68 different studies found the more sugar intake increases, the more weight increases. Fortunately, the converse is also true. Want to lose weight? Cutting sugar intake is a very effective place to start.
There is also evidence that high sugar intake alters hunger-related hormones, increasing appetite. Leptin is a hormone released in response to food intake. It is instrumental in the system that signals your brain you have had enough to eat. High sugar directly stimulate higher than normal levels of leptin, which actually reduces the body's sensitivity to the hormone, leading to chronic over consumption. Although excess weight itself also contributes to leptin resistance, experimental studies find that when excess sugar is removed from the diet, leptin resistance improves.
High Blood Pressure
Hypertension is usually associated with salty foods, not desserts — but eating lots of added sugar has also been linked to high blood pressure. In one study following 4,528 adults without a history of hypertension, consuming 74 or more grams of sugar each day (about 20oz. of soda) was strongly associated with an elevated risk of high blood pressure, independent of weight status. It is widely know that blood pressure increases after a salty meal but it also responds to sugar intake. For example, a recent experimental study found that drinking 60 grams of fructose elicited a spike in blood pressure two hours later.
A mounting body of evidence indicates the odds of dying from heart disease appear to rise in tandem with the percentage of sugar in the diet—and that holds true regardless of a person’s age, sex, physical activity level, and weight status. For example, a large 15-year long observational study recently found participants who took in 20-25% of their daily calories as sugar were more than twice as likely to die from heart disease as those whose diets included less than 10% added sugar, and participants
Insulin Resistance & Diabetes
Intake of excess sugar increases the body's demand for insulin, a hormone that signals the cells to use digested sugars for fuel. Chronically elevated insulin levels produce insulin resistance in the body's cells -- the cells fail to take up sugar in the blood, leaving blood sugar levels elevated. Insulin resistance necessitates excessive insulin production and high levels of insulin predisposes nutrients to be stored as fat, especially in the abdominal region. If unchecked, insulin resistance progresses into pre-diabetes and then diabetes. A recent review of previous research involving a total of 310,819 participants found that consistent intake of sugar throughout the day (i.e. the duration of sugar exposure) and average amount of sugar ingested (the dose) correspond closely with diabetes rates.
Fatty Liver & Liver Failure
Most sweeteners are made up of two kinds of molecular sugars, fructose and glucose. Fructose must be metabolized first by the liver. Large intakes of fructose increases deposition of detrimental fat in the liver (and other organs) that can result in nonalcoholic fatty liver disease. The incidence of fatty liver is strongly linked to rates of sugary drink consumption. Fatty liver can progress to full-on liver failure in some individuals, especially in those with additional risk factors for liver failure.
Gout is a type of arthritis that is triggered by high levels of uric acid in the blood. Classic dietary sources of uric acid include high purine foods such as meat, shellfish, and beer but fructose metabolism also increases uric acid production. A recent study tracking thousands of men for over a decade found a strong relationship between sugar consumption and rates of gout.
Trust your dentist on this one: sugar is the "arch criminal" behind cavities. Tooth decay occurs when the bacteria that line the teeth feed on simple sugars, creating acid that destroys enamel. The consequences of dental health go beyond the mouth. Chronic dental inflammation adversely effects heart health.
How Much Added Sugar Is Too Much?
As the evidence of sugar's ill health effects has mounted, the dietary recommendations on sugar consumption have become more stringent. The American Heart Association and the World Health Organization currently recommend that no more than 5% of daily calories come from added sweeteners. This means cutting back intake to 100-150 calories (i.e. 6½ to 9½ teaspoons --the amount of sugar in 8-12 oz. of soda ). The average American gets 18% of their calories from added sweeteners, well in excess of the 5% limit. But, a few diet tweaks can help you quickly reduce your sugar intake, knock down your disease risk, and improve your weight status. Here's what to do:
Nix sweetened beverages: More than one-third of the added sugar in Americans’ diets come from sugary beverages like soda, energy drinks, sports drinks, sweet tea, lemonade, and fruit punch. Just one 12-ounce can of regular soda contains about 10 teaspoons of sugar which means that a single soda exceeds the recommended limit. Replace sweetened drinks and juice which is concentrated with natural sugars with water or seltzer. Liven up good, old-fashioned H2O with healthy, flavorful add-ins like lemon, lime, fresh mint, strawberries, cucumber, herbal tea sachets, or a splash of juice. When you need something sweet opt for diet drinks or diet flavoring packets (such as Crystal Light). While artificial sweeteners do have some negative health effects -- they appear to increase our cravings for sweets and slightly stimulate insulin production -- recent research reviews have found they have no clear links to chronic disease risk.
Identify hidden sources of sugar: Added sugar hides in dozens of foods you might not suspect. You can look at the Nutrition Facts label to see how many grams of sugar are in the specified serving size, though the label does not distinguish between natural sugars and added sugars. Still, if it is not a product with an obvious source of natural sugars such as fruits, milk, or plain yogurt, you can assume the grams of sugar are from added sources. Divide the grams of sugar by four to learn how many teaspoons of sugar is in a serving. Also, you can scope out added sugar by reading the ingredient lists. Brown sugar, corn syrup, maltose, fructose, dextrose, molasses, agave, brown rice syrup, cane syrup, evaporated cane juice, fruit juice concentrate, date crystals, coconut crystals, and maple syrup are all forms of added sugars. Ingredients are listed in descending order by weight, so if sugar is near the top that is a red flag the product is high in sugar.
For the most part, sweeteners are similar in their calorie content and their effect on blood sugar, so the most important thing is to limit them, regardless of type. Still sweeteners with more glucose such as dextrose and corn syrup (not high-fructose corn syrup which is a little over 1/2 fructose) have less of an effect on insulin resistance, fatty liver, and high tryglycerides than those high in fructose such as agave, apple juice concentrate, and fructose.
Eat outside the box: Most of our sugar intake comes from packaged and restaurant foods, so, to avoid added sugars, cook from scratch or buy plain foods and, if desired, sweeten them just enough for your needs. Adding in fiber rich fruit is a great way to sweeten your food choices while still avoiding sugar isolates. Sometimes foods do not need more sugar but just more flavor. Utilize vanilla and other extracts, orange zest, unsweetened cocao powder, cinnamon, ginger, cardamom and other spices to enhance the flavor of your foods.
Trade sweetened foods for naturally sweet fruit: Instead of concentrated sweeteners, sweeten up your foods with fruits and root vegetables. Unlike concentrated sugars, fruits and vegetables are packed with heart healthy fiber, vitamins, minerals, and anti-inflammatory phytonutrients. For example, in place of strawberry jam on PB&J's, try sliced bananas, pureed sweet potato, unsweetened apple sauce, or warmed up frozen fruit. Just one level tablespoon of jam packs 50 calories and is typically made with three sweeteners: high fructose corn syrup, corn syrup, and sugar while a half cup of frozen strawberries, warmed up on the stovetop and seasoned with a little cinnamon, contains less than 25 calories plus many beneficial nutrients. Fruit—whether it’s fresh, baked, grilled, or pureed—makes a great replacement for sugar in lots of dishes, from cookies to coleslaw. Do not worry about overdosing on fructose, and sugar generally, from whole fruits. However fruit juices and juice concentrates, are significant sources of sugar that should be avoided as much as possible. Unsweetened dried and canned fruits are also reasonable options but go with fresh or frozen most of the time.
Think protein and fat: Moderating carbohydrates in the diet, especially quickly digested carbohydrates such as white flour, white rice, potatoes, and high sugar products can help to curb sugar cravings. Refined carbohydrates and sugar cause the blood sugar to rise rapidly, stimulating a large insulin release that then causes blood sugar to plummet. To minimize this rapid rise and fall, control your carbohydrate portions, and pair carbohydrates with protein, healthy fats, and fiber. These can slow down the release of blood sugar in your body and keep you full for longer. This is especially important at breakfast, so, for example, add minced raisins and nuts to your unsweetened oatmeal or pair your toast with an egg or unsweetened peanut butter rather than jam. Including healthy fats (fats do not raise blood sugar) such as nuts, seeds, avocado, and plant oils is especially helpful in curbing sugar cravings.
Decrease gradually: Humans are hard-wired to love sugar. Sugar intake stimulates the release of hormones in the brain that help us feel pleasure and serenity. When you cut sugar out of your diet, you may find yourself in sugar withdrawal. Try cutting back slowly. For instance, if you normally put two sugars in your coffee, try one for a time. For your cereal and yogurt, mix half a serving of sweetened versions with unsweetened ones, and eventually move on to just using fresh fruits in plain yogurt or unsweetened cereals. When you get sugar cravings, fight back. Opt for a naturally sweet fruit or vegetable. Sometimes we craves sweets when we are actually hungry, thirsty, or tired. Try satisfying these needs in healthy ways and the sweets craving may go away. Or, if it is a pick-me-up you are after, try doing something else you enjoy such as listening to music, going for a walk, or playing a game on your phone.
Limit sugary treats to 1-2 times per week: Pick a day or two a week to have the sugary treat you love most. This will help you be deliberate about your choices and bypass many of those incidental treats we encounter - on the street, in the workplace, or in front of the TV. Just knowing that you have a pre-planned treat to look forward to can help you avoid a good deal of sugar intake. When you do have a treat, slowly savor each bite to maximize your satisfaction.
Posted by Solai Buchanan, MS, RD, CDE & Sanjeev Palta, MD, FACC at 11:40 AM
Tuesday, July 28, 2015
A new study confirms that eating out, no matter what type of restaurant you choose, is less healthy than eating at home. Using dietary intake data gathered from 24-hour food recalls of more than 18,000 U.S. adults, the analysis revealed that eating at full-service sit-down restaurants is nutritionally similar to eating at fast-food outlets and that eating at home is significantly healthier.
Compared to eating at home, eating out at either sit-down or fast food outlets, led to an average increased intake of nearly 200 calories per day. As for sodium and total fat, both fast-food and restaurant diners increase their intake but full-service restaurant meals contained an additional 412 mg of sodium compared to home while fast food offered 297 mg of additional sodium.
Still, fast-food meals got poorer marks with respect to excess saturated fat content. Fast-food meals also contained significantly more sugar and significantly less fiber, potassium, magnesium, omega-3 fatty acids, and vitamins A and C than home-cooked meals, while full-service restaurant meals did not. Interestingly, when participants ordered out from sit-down restaurants, they consumed less than when they ate out. This was not the case at fast-food restaurants. The authors hypothesize that eating in the home setting rather than at a restaurant, prevents impulse orders of desserts or extra drinks and may facilitate adding some healthy foods from home to the take-out.
What to do: Prepare food at home as a much as possible. Menu planning is one of the most effective ways to increase meals prepared at home. Convenience foods, (e.g. frozen meals, canned soups, ready-to-eat grilled chicken, etc.), though often high in sodium, can also be a reasonable calorie-controlled home option. Combining these with frozen veggies steamed in the microwave or fresh raw vegetables can result in very quick, healthy meals. There's also always eggs or canned tuna for a lightning fast healthy dinner.
When you do eat out, look for entrees that include lean proteins and plenty of vegetables. Avoid options high in carbohydrate (i.e. pasta entrees) or cream (i.e. Alfredo sauce) and meat fats (i.e. prime rib). Also focus on keeping the portions controlled. When available, choose the small option, half-portion, or kid's sized meals. And, extras such as bread, drinks that contain calories, and dessert.
Adapted from articles available at:
An R. Fast-food and full-service restaurant consumption and daily energy and nutrient intakes in US adults. European Journal of Clinical Nutrition. Available online ahead of publication 1 July 2015. DOI: 10.1038/ejcn.2015.104
Posted by Solai Buchanan, MS, RD, CDE & Sanjeev Palta, MD, FACC at 4:43 PM
Tuesday, July 14, 2015
Diets rich in antioxidant phytonutrients called polyphenols are associated with lower systemic inflammation and improved health. Resveratrol, abundant in dark chocolate, red wine, berries, and nuts is one of the most studied phenolic compounds. A growing number of small studies have linked supplementation with resveratrol to improvements in blood cholesterol, body fat percentage, weight, exercise performance and recovery, and biomarkers of inflammation. A new experimental study in mice has revealed that polyphenols may help protect against obesity and related metabolic diseases by promoting the "browning" of white fat tissue. Unlike most fat stores, brown fats are very metabolically active and promote the breakdown of fat stores.
In the study, female mice fed a high-fat diet supplemented with resveratrol were found to be 40% less likely to develop diet-induced obesity than control mice whose diets were not supplemented with the polyphenol compound. Resveratrol appeared to induce brown-like fat formation in white fat by increasing the expression of genes specific to brown fat cells and stimulating fatty acid breakdown.
While it is not known whether resveratrol stimulates the browning of white fats in humans, some studies in humans suggest resveratrol has similar metabolic effects. For example, in a 2014 randomized cross-over experimental study, researchers found 30 days of 150mg resveratrol supplementation significantly decreased fat cell size compared to placebo. The study also revealed that resveratrol supplementation resulted in increased expression of genes involved in fat breakdown.
What to do: While preliminary evidence is encouraging, larger studies need to be conducted to truly determine whether it is useful and safe to supplement with resveratrol. In the meantime, there is plenty of evidence that consuming a diet high in polyphenols helps to reduce inflammation and improve chronic disease risk. Foods richest in polyphenols include cocao powder and dark chocolate (look for at least 70% cocoa), flax seeds, blueberries, red grapes, red wine, pecans, hazelnuts, plums, and artichokes. Most herbs and spices also contain high levels of polyphenols. Foods especially high in resveratrol specifically, include purple grape juice, red wine, red grapes, peanuts, cocoa, blueberries, and cranberries.
Adapted from article available at:
Wang S, X Liang, Q Yang. Resveratrol induces brown-like adipocyte formation in white fat through activation of AMP-activated protein kinase. International Journal of Obesity. 2015 39: 967–976. DOI:10.1038/ijo.2015.23. Published online ahead of print March 12, 2015.
Konings E, Timmers S, Boekschoten MV et al. The effects of 30 days resveratrol supplementation on adipose tissue morphology and gene expression patterns in obese men. International Journal of Obesity. 2014 Mar;38(3):470-3. DOI:10.1038/ijo.2013.155. Published online ahead of print Aug 20, 2013.
Timmers S, Konings E, Bilet L et al. Calorie restriction-like effects of 30 days of resveratrol supplementation on energy metabolism and metabolic profile in obese humans. Cell Metabolism. 2011 Nov 2;14(5):612-22. DOI: 10.1016/j.cmet.2011.10.002.
Posted by Solai Buchanan, MS, RD, CDE & Sanjeev Palta, MD, FACC at 5:26 PM